Acetate Dialysis Research Articles

Ion-imprinted silica adsorbent modified diffusive gradients in thin films technique: Tool for speciation analysis of free lead species

A new diffusive gradients in thin films (DGT) device, using Pb(II) ion-imprinted silica (IIS) as the binding agents and commercial cellulose acetate dialysis (CAD) membrane as the diffusion layer (CAD/IIS-DGT), has been developed and evaluated for sampling and measurement of free Pb(II) species. The CAD/IIS-DGT devices were successfully applied to the measurement of free Pb(II) species in synthetic solutions, in natural freshwaters and in industrial wastewaters. The CAD/IIS-DGT provides reliable results over pH range of 4.5–6.5 and a wide range of ionic strength from 1.0×10−3 to 0.7molL−1. The concentrations of the free Pb(II) species in synthetic solution containing different concentrations of ligands measured by CAD/IIS-DGT showed a good agreement with the value measured by Pb-ion selective electrode. Field deployments of the CAD/IIS-DGT devices allowed accurate measurements of the concentrations of free Pb(II) species.

The effect of citrate dialysate on intradialytic heparin dose in haemodialysis patients: study design of a randomised controlled trial.

BackgroundUnfractionated heparin is the most common anticoagulant used in haemodialysis (HD), although it has many potential adverse effects. Citrate dialysate (CD) has an anticoagulant effect which may allow reduction in cumulative heparin dose (CHD) compared to standard acetate dialysate (AD).MethodsThis double-blinded, randomised, cross-over trial of chronic haemodialysis patients determines if CD allows reduction in CHD during HD compared with AD. After enrolment, intradialytic heparin is minimised during a two-week run-in period using a standardised protocol based on a visual clotting score. Patients still requiring intradialytic heparin after the run-in period are randomised to two weeks of HD with AD followed by two weeks of CD (Sequence 1) or two weeks of HD with CD followed by two weeks of AD (Sequence 2). The primary outcome is the change in CHD with CD compared with AD. Secondary outcomes include metabolic and haemodynamic parameters, and dialysis adequacy.DiscussionThis randomised controlled trial will determine the impact of CD compared with AD on CHD during HD.Trial registrationClinicalTrials.gov NCT01466959

A Randomized Controlled Study on the Effects of Acetate‐Free Biofiltration on Organic Anions and Acid‐Base Balance in Hemodialysis Patients

Metabolic acidosis correction is achieved by the transfer of bicarbonate and other buffer anions in dialysis. The aim of this study was to evaluate changes in the main anions of intermediary metabolism on standard hemodiafiltration (HDF) and on acetate-free biofiltration (AFB). A prospective, in-center, crossover study was carried out with 22 patients on maintenance dialysis. Patients were randomly assigned to start with 12 successive sessions of standard HDF with bicarbonate (34 mmol/L) and acetate dialysate (3 mmol/L) or 12 successive sessions of AFB without base in the dialysate. Acetate increased significantly during the standard HDF session from 0.078 ± 0.062 mmol/L to 0.156 ± 0.128 mmol/L (P < 0.05) and remained unchanged at 0.044 ± 0.034 mmol and 0.055 ± 0.028 mmol/L in AFB modality. Differences in the acetate levels were observed at two hours (P < 0.005), at the end (P < 0.005) and thirty minutes after the session between HDF and AFB (P < 0.05). There were significantly more patients above the normal range in HDF group than AFB group (68.1% vs 4.5% P < 0.005) postdialysis and 30 minutes later. Serum lactate and pyruvate concentrations decreased during the sessions without differences between modalities. Citrate decreased only in the AFB group (P < 0.05). Acetoacetate and betahydroxybutyrate increased in both modalities, but the highest betahydroxybutyrate values were detected in HDF (P < 0.05). The sum of postdialysis unusual measured organic anions (OA) were higher in HDF compared to AFB (P < 0.05). AFB achieves an optimal control of acid-base equilibrium through a bicarbonate substitution fluid. It also prevents hyperacetatemia and restores internal homeostasis with less production of intermediary metabolites.

A case of anaphylactoid reaction to acetate in acetate-containing bicarbonate dialysate.

A 35-year-old man with end-stage kidney disease due to chronic glomerulonephritis was admitted to our hospital to start maintenance hemodialysis (HD). One hour after starting the first session of HD, he experienced general pruritus, urticaria, and dyspnea. Signs and symptoms were resolved by discontinuing HD and administrating an antihistamine drug; HD-associated anaphylactoid reactions were therefore suspected. Over the next few HD sessions, we changed the dialysis membrane, anticoagulant, HD circuit and needle, in that order, but general pruritus and urticaria again appeared within 3h after starting each session of HD. Finally, when we changed the dialysate from acetate-containing bicarbonate dialysate to acetate-free bicarbonate dialysate, urticaria was clearly less than that seen in previous HD sessions, and subsided after discontinuation of HD. Subsequently, 20mg of oral prednisolone (PSL) was administered 1h before starting HD, and the patient did not experience general pruritus, urticaria, or dyspnea after starting the session. When administered acetate-containing bicarbonate dialysate after oral PSL pretreatment, the patient again experienced general pruritus, urticaria and dyspnea. Few reports have been published on the occurrence of anaphylactoid reactions during HD using acetate dialysate. We report a rare case of anaphylactoid reactions with acetate in acetate-containing bicarbonate dialysate that were reduced with the use of acetate-free bicarbonate dialysate and oral PSL pretreatment.

Comparison between Acetate versus Bicarbonate dialysate during Hemodialysis among Acute Renal Failure Patients, Assuit University hospital

Critically ill patients with acute renal failure who are receiving dialysis therapy may suffer from many complications that can be decreased by using bicarbonate dialysate during dialysis sessions. Aim: this study was carried out to compare between the hemodialized acute renal failure patientsusing bicarbonate versus acetate dialysate ondeveloping complications. Design: descriptive comparative designutilized in this study. Setting: This study was carried out at the kidney dialysisunit, Assiut University Hospital. Subjects Sixty adult male and female critically ill patients with acute renal failure who are admitted to the kidney dialysis unit (how many using bicarbonate and how many using acetate and how you selected them).Tool:“hemodialysis patient observational and monitoring tool” was used to monitor and record the personal and medical data needed for this study by the researcher.Methods: Interview, observation and reviewing patient`s records were utilized to collect data pertinent to the study. Each patient was monitored closely ten minutes before connection to the dialysis machine, during the dialysis session and ten minutes after disconnection, three times per week for two successive weeks. Results: The patients on the acetate group had experienced many problems (tachycardia, hypotension and dyspnea). There was a significant statistical difference between both groups with (p value=0.001). Conclusion: the group of patients on bicarbonate dialysate during dialysis sessions was found to experience lesser problems than acetate dialysis group.

Detection of Trace Glucose on the Surface of a Semipermeable Membrane Using a Fluorescently Labeled Glucose-Binding Protein: A Promising Approach to Noninvasive Glucose Monitoring

Our motivation for this study was to develop a noninvasive glucose sensor for low birth weight neonates. We hypothesized that the underdeveloped skin of neonates will allow for the diffusion of glucose to the surface where it can be sampled noninvasively. On further study, we found that measurable amounts of glucose can also be collected on the skin of adults. Cellulose acetate dialysis membrane was used as surrogate for preterm neonatal skin. Glucose on the surface was collected by saline-moistened swabs and analyzed with glucose-binding protein (GBP). The saline-moistened swab was also tested in the neonatal intensive care unit. Saline was directly applied on adult skin and collected for analysis with two methods: GBP and high-performance anion-exchange chromatography (HPAEC). The amount of glucose on the membrane surface was found (1) to accumulate with time but gradually level off, (2) to be proportional to the swab dwell time, and (3) the concentration of the glucose solution on the opposite side of the membrane. The swab, however, failed to absorb glucose on neonatal skin. On direct application of saline onto adult skin, we were able to measure by HPAEC and GBP the amount of glucose collected on the surface. Blood glucose appears to track transdermal glucose levels. We were able to measure trace amounts of glucose on the skin surface that appear to follow blood glucose levels. The present results show modest correlation with blood glucose. Nonetheless, this method may present a noninvasive alternative to tracking glucose trends.

The Prevalence of Peyronie's Disease in Japan: A Study in Men Undergoing Maintenance Hemodialysis and Routine Health Checks

The incidence of Peyronie's disease (PD) in the general population is believed to be as high as 20%. However, most of the data concerning the prevalence of PD have been obtained from Caucasian populations. The aim of this study was to examine the prevalence of PD in Asia and among men undergoing hemodialysis and discuss the pathophysiology of PD. A total of 1,090 men who received a routine health check at our hospital (control group) as well as 130 male patients undergoing maintenance hemodialysis were enrolled. The diagnosis of PD was based on a palpable penile plaque. Hemodialysis patients were asked about their sexual activity and completed the International Index of Erectile Function-5 questionnaires. The differences between patients' and hemodialysis-associated factors, comorbidities, and medications were statistically assessed for patients with and without PD. The prevalence of PD was significantly increased among hemodialysis patients (12 patients: 9.2%) relative the control group (six men: 0.6%) (P<0.0001, odds ratio: 18.4). In both groups, the plaques were primarily allocated dorsally. In the hemodialysis patients with PD, the frequency of masturbation (P<0.05) and the incidence of moderate or severe erectile dysfunction (P<0.01) were significantly higher than those among hemodialysis patients without PD. In comparison with patients without PD, the number of acetate dialysate users was significantly higher among patients with PD (P<0.05), and none of the PD patients used angiotensin-related antihypertensive drugs (P<0.05). The prevalence of PD in healthy Japanese men is low (0.6%), which suggests the existence of racial differences in the prevalence of PD. Moreover, these results indicate that hemodialysis increases the incidence of PD. The differences in the characteristics between male hemodialysis patients with and without PD provide new insights into the pathophysiology and therapeutic window of PD.

Preparation Of Cellulose Acetate Dialysis Membrane Using D–Glucose Monohydrate As Additive

Dialisis membran yang mengandungi sellulosa asetat (CA) sebagai polimer, asid formik (FA) sebagai pelarut dan glukosa-D monohidrat sebagai bahan tambah telah disediakan melalui proses fasa balikan. Objektif utama bagi penyelidikan ini adalah untuk menyelidik pengaruh bahan tambah glukosa–D terhadap prestasi membran dialisis dari segi pemisahan urea dan kreatinina. Kepekatan glukosa–D diubah daripada 2 hingga 10 wt%. Pemanasan menggunakan ketuhar mikrogelombang yang dapat memendekkan masa pelarutan digunakan untuk melarutkan CA polimer dalam pelarut asid formik. Keputusan menunjukkan bahawa membran yang dihasilkan daripada 20 wt% selulosa asetat, 70 wt% asid formik dan 10 wt% glukosa–D monohidrat memberi prestasi yang terbaik bagi penyingkiran urea and kreatinina sebanyak masing–masimg 49.77% dan 19.54%. Apabila membran yang sama dikaji bagi penahanan BSA, ia memberikan peratus penyingkiran larutan BSA sebanyak 96.78%. Berbanding dengan membran dialisis selulosa asetat komersial, didapati bahawa keputusan adalah memuaskan. Gambar SEM menunjukkan bahawa penambahan glukosa–D monohidrat dalam larutan memberi pembentukan struktur jejari. Kata kunci: Membran dialisis; selulosa asetat; penyingkiran urea; penyingkiran kreatinina; peratus penahanan BSA Dialysis membrane containing cellulose acetate (CA) as polymer, formic acid (FA) as solvent and D–glucose monohydrate as additive was prepared by phase inversion method. The main objective of this study is to investigate the influence of D–glucose monohydrate as an additive on the performance of dialysis membrane in terms of urea and creatinine clearance. The concentration of D–glucose is varied from 2 to 10 wt%. Microwave heating which is capable of reducing dissolution time was used to dissolve the CA polymer in the formic acid solvent. Results revealed that the membrane produced from the 20 wt% cellulose acetate, 70 wt% formic acid and 10 wt% D–glucose monohydrate gives the best performance with urea and creatinine clearance of 49.77% and 19.54% respectively. When testing the same membranes with BSA solutions, it gives a BSA rejection rate as high as 96.78%, which seems to be comparable with the commercial cellulose acetate dialysis membranes. Membrane morphology was observed by using a scanning electron microscopy (SEM). The SEM images illustrated that the increment of D–glucose monohydrate in casting solution tends to promote macrovoid formation. Key words: Dialysis membrane; cellulose acetate; SEM images; urea clearance; creatine clearance; BSA rejection rate

Comparison of Acetate‐Free Citrate Hemodialysis and Bicarbonate Hemodialysis Regarding the Effect of Intra‐Dialysis Hypotension and Post‐Dialysis Malaise

Compared with acetate dialysate, bicarbonate dialysate has shown beneficial effects in reducing the morbidity associated with dialysis, but a small amount of acetate in bicarbonate dialysate may evoke hypotension or malaise. Acetate-free citrate hemodialysis (AFHD) may avoid these problems. In 44 hemodialysis patients bicarbonate hemodialysis (BHD) was conducted for three months, followed by a switch to AFHD for three months, and a further switch to bicarbonate hemodialysis (ReBHD). In BHD, AFHD and ReBHD, intra-dialysis hypotension and post-dialysis malaise were determined (hypotension: intra-dialysis systolic blood pressure (SBP) was expressed as a percentage of SBP at the start of hemodialysis, malaise was assessed by a self-reported 0 to 3 scale, 0: absence of malaise, 3: unbearable malaise). Compared with BHD, AFHD patients complained of less malaise but the intra-dialysis blood pressure change did not differ significantly (malaise: BHD 0.73 ± 0.76 vs. AFHD 0.32 ± 0.47, P < 0.0001, end hemodialysis SBP: BHD 93.6 ± 8.9 vs. AFHD 93.8 ± 10.1, P = NS). After switching to ReBHD from AFHD, the malaise score increased (AFHD 0.32 ± 0.47 vs. ReBHD 0.77 ± 0.89, P < 0.0001) and the intra-dialysis blood pressure dropped markedly (end hemodialysis SBP: AFHD 93.8 ± 10.1 vs. ReBHD 87.3 ± 10.5, P < 0.0001). Malaise was very severe in five patients who could not continue ReBHD. After ten days under ReBHD, ReBHD was changed to AFHD again in all patients. Although the exact mechanisms are not known, AFHD may be preferable to BHD to prevent hemodialysis-induced hypotension and malaise.

Preparation and characterization of a novel smart polymeric hydrogel for drug delivery of insulin.

Over the past years, temperature and pH-sensitive hydrogels was developed as suitable carriers for drug delivery. In this study temperature and pH-sensitive hydrogels was designed for an oral insulin delivery modeling. NIPAAm-MAA -HEM copolymers were synthesized by radical chain reaction with 86:4:10 (5% w/v) ratios respectively. Reaction was carried out in 1,4-Dioxane under Nitrogen gas-flow. The copolymers were characterized with FT-IR, 1H-NMR and DSC. Copolymers were loaded with regular insulin by modified double emulsion method with ratio of 1:10. Release study carried out in two different pH (pH=2 and 7.4 for stomach and intestine simulation respectively) at 37ºC. For each pH, a 5 mL suspension of the insulin containing hydrogel was taken in to a cellulose acetate dialysis membrane, and the dialysis membrane was allowed to float in a beaker containing 15 mL of buffer solution. The beakers were placed in a shaker incubator maintained at 37ºC. Phosphate buffer (0.1 M, pH 3)/ acetonitrile (60/40) was used as the mobile phase in HPLC assay. Yield of reaction was 86% with an optimum Lower Critical Solution Temperature point (30ºC). In-vitro studies showed a control release behavior via pH changes which the amount of insulin releases was 80% and 20% at pH=2 and 7.4 respectively. Results showed that by optimizing polymerization and loading method we could achieve a suitable nano system for oral delivery of insulin.

Effective concentration difference model to study the effect of various factors on the effective diffusion coefficient in the dialysis membrane

Cellulose acetate dialysis membrane (CDM) has been used in the diffusive gradients in thin films (DGT) technique, where accurate diffusion coefficients are essential for the assessment of the concentrations of labile metal in solution. Effective concentration difference model (ECDM), based on the assumption that the effective diffusion coefficient of metal ion in the dialysis membrane is determined by the effective concentration difference (Δ C e) across the dialysis membrane, is proposed and applied to study the effect of ionic strength, binding agent, ligands and Donnan potential on the effective diffusion coefficient. The effective diffusion coefficients of Cd 2+ through the dialysis membrane immersed in receptor solutions with binding agent were almost the same as those in receptor solutions without binding agent at higher ionic strengths (0.01–1 M) but much higher than those at lower ionic strengths (0.001–0.0001 M). The effective diffusion coefficients of Cd 2+ through the dialysis membrane immersed in deionized water receptor solutions with binding agent were not significantly different from those in synthetic receptor solutions (receptor solutions with various ionic strengths) with binding agent. The DGT-labile fractions were measured in synthetic solutions and natural waters, which indicated that the effective diffusion coefficients, through the dialysis membrane immersed in the deionized water solution with binding agent as receptor solution and in the spiked natural water as source solution, were more suitable for DGT application.

Analysis of inorganic cations in biological samples by the combination of micro‐electrodialysis and capillary electrophoresis with capacitively coupled contactless conductivity detection

Micro-electrodialysis (μED) and CE were combined for rapid pretreatment and subsequent determination of inorganic cations in biological samples. Combination of μED with CE greatly improved the analytical performance of the latter as the adsorption of high molecular weight compounds present in real samples on the inner capillary wall was eliminated. Fifty microliter of 80-fold diluted human body fluids such as plasma, serum and whole blood was used in the donor compartment of the μED system requiring less than 1 μL of the original body fluid per analysis. Inorganic cations that migrated through a cellulose acetate dialysis membrane with molecular weight cut-off value of 500 Da were collected in the acceptor solution and were then analyzed using CE-C⁴D. Baseline separation of inorganic cations was achieved in a BGE solution consisting of 12.5 mM maleic acid, 15 mM L-arginine and 3 mM 18-crown-6 at pH 5.5. Repeatability of the CE-C⁴D method was better than 0.5% and 2.5% for migration times and peak areas, respectively; limits of detection of all inorganic cations in the presence of 2 mM excess of Na(+) were around 1 μM and calibration curves were linear with correlation coefficients better than 0.998. Repeatability of the sample pretreatment procedure was calculated for six independent electrodialysis runs of artificial and real samples and was better than 11.8%. Recovery values between 96.3 and 110% were achieved for optimized electrodialysis conditions of standard solutions and real samples; lifetime of the dialysis membranes for pretreatment of real samples was estimated to 100 runs.

Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: the effect of dialyzer composition

Pulmonary hypertension (PHT) increases mortality rate in hemodialysis (HD) patients. Numerous clinical, hemodynamic, and metabolic abnormalities have been suggested to be associated with the development of PHT in HD patients. We aimed to investigate the acute effects of two different dialyzer membranes on pulmonary arterial pressure (PAP) throughout a HD session in maintenance HD patients. Seventy-four HD patients dialyzed through permanent tunneled jugular central venous catheter were enrolled. A first-use cellulose acetate and high-flux polysulfone dialysis membrane were tested using a crossover design. For each membrane, pre- and post-dialysis pulmonary artery pressures were measured echocardiographically. Elevated pulmonary artery pressure was observed in 68.8% of patients (n = 51), whereas mild PHT was observed in 28.3% of patients (n = 21) and moderate PHT in 40.5% (n = 30). Decrease in pulmonary artery pressure following HD procedure performed using high-flux polysulfone membrane was significantly higher than the decrease observed following HD procedure performed using cellulose acetate membrane (p < 0.05). Significant decrease in pulmonary artery pressures was observed only after HD procedures performed using high-flux polysulfone membrane (p < 0.05). Ultrafiltered volume was only significantly correlated with the decrease in pulmonary artery pressure observed after HD procedure performed through high-flux polysulfone membrane (β = 0.411, p < 0.05). PHT seems to be prevalent among HD patients even in the absence of AV fistula and abnormal cardiac functions. Membrane composition seems to be important, which may overwhelm the improving effects of ultrafiltration.

Vitamin E-coated cellulose acetate dialysis membrane: long-term effect on inflammation and oxidative stress

Background: Chronic inflammation and oxidative stress are prevalent in hemodialysis (HD) patients. We evaluated the long-term effect of a vitamin E-coated cellulose acetate (CAE) membrane on oxidative stress and inflammation. Methods: Nine patients were switched to CAE membrane for 3 months and then changed back to polysulfone (PS) membrane again for 6 months. Reactive oxygen metabolites and derivatives (d-ROMs), total antioxidant capacity (TAC) and superoxide dismutase (SOD) (oxidative stress biomarkers), high-sensitivity C-reactive protein (Hs-CRP), and interleukin-6 (IL-6) (inflammation biomarkers) were measured. Results: d-ROMs decreased and TAC rose significantly at the end of the study, whereas SOD increased rapidly and immediately after the end of CAE treatment. Hs-CRP and IL-6 levels were significantly lowered at the end of the study. Conclusions: Vitamin E supplementation by vitamin E-coated CAE dialysis membrane suppresses oxidative stress and inflammation.

Asymmetric cellulose acetate dialysis membranes: Synthesis, characterization, and performance

AbstractCellulose acetate (CA) is highly comparable to other synthetic polymer materials and is effective in the hemodialysis process. In this work, asymmetric CA membranes were synthesized with the phase‐inversion method. CA with a molecular weight of 52,000, poly(ethylene glycol) (PEG) with a molecular weight of 400, and 1‐methyl‐2‐pyrrolidone (NMP) were used as the polymer, additive, and solvent, respectively. The effects of the CA and PEG concentrations and coagulation bath temperature (CBT) on the morphology, pure water permeability (PWP), insulin/human serum albumin (HSA) transmission, and finally thermal and chemical stability of the prepared membranes were determined and investigated. In general, increasing the PEG concentration and CBT and reducing the CA concentration resulted in increased PWP and insulin/HSA transmission. Also, these variations facilitated the formation of macrovoids in the membrane sublayer. On the other hand, increasing the PEG and CA concentrations and reducing CBT resulted in increased thermal and chemical stability of the prepared membranes. Also, ratios of 15.5/10/74.5 and 17.5/10/72.5 (w/w) for the CA/PEG/NMP casting solutions and their immersion into coagulation baths with CBTs of 0 and 25°C, respectively, resulted in the preparation of membranes that had not only optimum sieving properties and higher PWP but also thermal and chemical stability better than that of conventional CA hemodialysis membranes. © 2010 Wiley Periodicals, Inc. J Appl Polym Sci, 2010

Prevalence of Hyperkalemia among Hemodialysis Patients in Egypt

Introduction. Hyperkalemia is a frequent problem in patients with end stage renal disease (ESRD) on maintenance hemodialysis and is often attributed as a cause of deaths in these patients. The aim of this study was to estimate the prevalence of hyperkalemia among Egyptian hemodialysis patients. Patients and methods. 400 ESRD patients on maintenance hemodialysis were enrolled in the study. They were allowed their usual diets and medications during the study periods. For all patients, history and clinical examinations and serum potassium level was measured three times—pre- and post-1st session and pre-next session—at two successive sessions of hemodialysis. Results. The results of this study showed that the prevalence of hyperkalemia was 41.2%, 6.5%, and 66.9% of pre- and post-dialysis and before the next session of dialysis, respectively. Hyperkalemia significantly correlates with potassium-rich diets, non-compliant patients, two sessions of hemodialysis per week, and constipation in ESRD patients during the study periods. Serum potassium level was significantly higher in anuric ESRD patients than those who had residual renal function, patients using acetate dialysate than those using bicarbonate dialysate, and patients with low blood flow rate than those with higher blood flow rates. There was a non-significant correlation between serum potassium and ACEls, B-blockers, or diabetes. Conclusion. Hyperkalemia is a frequent problem in patients with end stage renal disease in Egypt. Hyperkalemia significantly correlates with a potassium-rich diet and inadequate dialysis either by prescription or non-compliance. Thrice weekly bicarbonate dialysis with higher blood pump flow rate had better elimination of potassium.

Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes

BackgroundA concentrate for bicarbonate haemodialysis acidified with citrate instead of acetate has been marketed in recent years. The small amount of citrate used (one-fifth of the concentration adopted in regional anticoagulation) protects against intradialyser clotting while minimally affecting the calcium concentration. The aim of this study was to compare the impact of citrate- and acetate-based dialysates on systemic haemodynamics, coagulation, acid-base status, calcium balance and dialysis efficiency.MethodsIn 25 patients who underwent a total of 375 dialysis sessions, an acetate dialysate (A) was compared with a citrate dialysate with (C+) or without (C) calcium supplementation (0.25 mmol/L) in a randomised single-blind cross-over study. Systemic haemodynamics were evaluated using pulse-wave analysis. Coagulation, acid-base status, calcium balance and dialysis efficiency were assessed using standard biochemical markers.ResultsPatients receiving the citrate dialysate had significantly lower systolic blood pressure (BP) (-4.3 mmHg, p < 0.01) and peripheral resistances (PR) (-51 dyne.sec.cm-5, p < 0.001) while stroke volume was not increased. In hypertensive patients there was a substantial reduction in BP (-7.8 mmHg, p < 0.01). With the C+ dialysate the BP gap was less pronounced but the reduction in PR was even greater (-226 dyne.sec.cm-5, p < 0.001). Analyses of the fluctuations in PR and of subjective tolerance suggested improved haemodynamic stability with the citrate dialysate. Furthermore, an increase in pre-dialysis bicarbonate and a decrease in pre-dialysis BUN, post-dialysis phosphate and ionised calcium were noted. Systemic coagulation activation was not influenced by citrate.ConclusionThe positive impact on dialysis efficiency, acid-base status and haemodynamics, as well as the subjective tolerance, together indicate that citrate dialysate can significantly contribute to improving haemodialysis in selected patients.Trial registrationClinicalTrials.gov NCT00718289

Hemodialysis Modality, Percentage of Body Fat, and Patient Survival

A number of studies have reported lower mortality of overweight hemodialysis patients. This post hoc analysis of an observational prospective single-center study was aimed at elucidating whether both being overweight and surviving longer could result from changes in the hemodialysis modality. The study included a cohort of 242 patients who were gradually switched from cuprophane membrane and acetate dialysis to polysulfone (including high-flux) membranes and bicarbonate dialysis. The analysis involved 12 months of baseline data obtained during the first calendar year after the patients entered the study (1994-2001) and repeated measurements for up to 132 months of follow-up (until 2004). Anthropometric measurements were made during the winter season and the percentage of body fat (%fat) was calculated from triceps, biceps, subscapular, and suprailiac skinfolds (K/DOQI guidelines).Kt/V, normalized protein catabolic rate, and cardiovascular comorbidity were also determined and laboratory analyses undertaken. Significant correlations were found between %fat and bicarbonate dialysate as well as polysulfone membrane and high-flux membrane. The linear mixed model showed dependence of %fat on polysulfone and high-flux membrane (p<0.01) Multivariate Cox regression (time-dependent covariates) found %fat to be an independent factor for longer survival, in addition to polysulfone and high-flux membranes. Changes in hemodialysis modality were followed by both higher body fat percentage and patient survival. The reverse epidemiology of overweight patients might be at least partially the result of the influence of nonnutritional factors, such as a change in hemodialysis modality (introducing biocompatible high-flux and low-flux membranes and bicarbonate dialysis).

Efektifitas Pemakaian Ulang Ginjal Buatan

Hemodialysis is a therapy for patient with end state renal diseases, but it is very expensive specially dialyzer. Now we could use a reuse of dialyzer to reduce the cost. The aim of this study was to examine the effectiveness of dialyzer reuse and its frequent possible reuse. A prospective study with the comparative experimental approach was carried out. The population was all patient with end state renal diseases underwent twice hemodialysis in a week at fifth hours in each period at least within three months using acetate dialysate and reuse dialyzer in the Dialysis Unit. Sample size was 20 subjects determined based on time continuum It was concluded that the reuse dialyzer could be used 6,06 + 2,01 times without negative influence on dialysis adecuacy.

The impact of haemodialysis-associated variables on lipid profile in Egyptian haemodialysis population

Haemodialysis (HD) patients appear to have particular susceptibility for cardiovascular (CV) diseases with lipid abnormalities among its significant contributors. However, there is controversy concerning the combined effect on lipid constituents during HD of the three commonly used variables; the type of heparin, dialysis membrane and the constituent of dialysate buffer bases. Consequently, this controlled prospective study was thought of. Randomly 63 patients were assigned from Urology and Nephrology haemodialysis (HD) unit, Mansoura, Egypt for the planned study. Their mean age was 45.79 +/- 13.11 years. Fourteen patients with end-stage renal disease (ESRD) served as control group for the remaining 49 HD patients. They were subdivided according to the HD duration (< and > 1 year), anticoagulant used (unfractionated [UFH] and low-molecular weight heparin [LMWH, Enoxaparin), membrane type (Hemophane [HP] and polysulfone [PS] membrane) and dialysate buffer bases (bicarbonate versus acetate based). Determining the fasting lipid value of total cholesterol (TC) and triglycerides (TG) as well as lipoproteins including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and lipoprotein (a) [Lp (a)] was completed. Bicarbonate dialysate was associated with significantly lower TG (134.7 +/- 11 mg/dl vs. 153 +/- 14 mg/dl, p = 0.004), higher HDL-C (33.1 +/- 3 vs. 28.3 +/- 2, p = 0.0002) and subsequently better atherosclerosis risk ratio [TC/HDL-C (ARR)] (6.02 +/- 0.09 vs. 5.3 +/- 0.9, p = 0.001) despite its insignificant effect on TC and LDL-C. However, logarithm (log) Lp (a) level was significantly higher (1.92 +/- 0.05 vs. 1.82 +/- 0.04 p = 0.001) in comparison with acetate dialysate. Membrane type was not influential in those dialyzed for < 1 year before intervention while after a year of HD, PS (n = 11) compared to HP filters (n = 11) significantly lowered TC (151.7 +/- 16 vs. 172.6 +/- 12, p = 0.003), TG (127.8 +/- 15 vs. 155.7 +/- 15, p = 0.004), LDL-C (122.1 +/- 5 vs. 130.6 +/- 7, p = 0.006) levels as well as ARR (5.9 +/- 0.5 vs. 5.4 +/- 0.3, p = 0.02). Likewise was the reduction in log Lp (a) (1.9 +/- 0.03 vs. 1.8 +/- 0.04, p = 0.002) with insignificant effect on HDL-C. After 6 months, Enoxaparin caused significant improvement of TC (0.0004), TG (p = 0.018), LDL-C (p = 0.006), HDL-C (0.041) and Lp (a) (0.047) compared to UFH. Patients who continued on Enoxaparin for 3 more months displayed an even better attenuation in most of lipid parameters whilst continuation of UFH was insignificant. Switching few patients (n = 4) from UFH to LMWH for 3 months resulted in significant lowering of TC (153 +/- 7 vs. 177.7 +/- 3, p = 0.01), TG (127.5 +/- 5 vs. 137.3 +/- 4, p = 0.03) and LDL-C (124.7 +/- 5 vs. 127.5 +/- 5, p = 0.005). However, switching equal number of patients from LMWH to UFH caused no significant change. Dyslipidaemia in Egyptian haemodialysis patients was improved when bicarbonate-based haemodialysis, the use of polysulfone membrane, and more so when the low-molecular weight heparin Enoxaparin were used.