Dialysis Filter Research Articles

23. EFFICIENCY OF ABDOMINAL FLUID DRAINAGE COMBINED WITH CONTINUOUS HEMOFILTRATION FOR TREATMENT OF SEVERE ACUTE PANCREATITIS AT NGHE AN FRIENDSHIP GENERAL HOSPITAL

Objective: Evaluate the effectiveness of abdominal fluid drainage combined with continuous hemofiltration to treat severe acute pancreatitis with increased abdominal pressure at Nghe An General Friendship Hospital. Subjects: 14 patients diagnosed with severe acute pancreatitis according to Atlanta 2012 criteria, with increased abdominal pressure and were treated with abdominal drainage combined with continuous dialysis at the Intensive Care Department - Friendship Hospital Nghe An General Hospital from January 2023 to September 2023. Methods: Case series study. Results: Grade I increased abdominal pressure: 14.3%; Grade II: 50%; grade II: 21.4%; Grade IV: 14.3%. Continuous dialysis time: Grade I intra-abdominal hypertension: 16.3 ± 2.83 hours; Grade II: 44.5 ± 16.5 hours; Grade III: 46.6 ± 18.7 hours; Grade IV: 82.5 ± 18.3 hours. Average amount of abdominal drainage fluid in the first 3 days: Grade I increased intra-abdominal pressure: 1221.5 ± 451.5 ml; grade II: 1912.12 ± 612.4 ml; grade III: 2978.21 ± 725.7 ml; Grade IV: 3571.21 ± 767.5 ml. The recovered group accounted for 64.3%, abdominal pressure decreased and returned to normal from day 4, average blood pressure tended to gradually increase and remained stable, creatinine decreased rapidly to near normal values after 1 day. week of treatment. Continuous dialysis time ranges from 1-7 days and the number of dialysis filters ranges from 1–8. Conclusion: The cure rate of abdominal fluid drainage combined with continuous hemofiltration to treat severe acute pancreatitis with increased abdominal pressure is 64.3%; Abdominal pressure decreased rapidly, blood creatinine decreased and returned to normal, hemodynamics were stable in the recovery group.

Linezolid Adsorption on Filters during Continuous Renal Replacement Therapy: An In Vitro Study.

Background: Renal replacement therapy (RRT), widely used in the treatment of renal injury during sepsis, aims to eliminate the toxins and proinflammatory cytokines involved in the pathomechanism underlying septic shock. Dialysis filters are characterized by a high adsorption potential for cytokines in RRT in the case of septic renal injury. For the treatment of sepsis with antibiotics, it is of key importance to achieve the desired values of PK/PD indices. Continuous renal replacement therapy (CRRT) may affect antimicrobial clearance, increasing their elimination in some cases. Methods: The aim of this study was to determine the degree of adsorption for linezolid on three different types of filters used in CRRT. In our in vitro study, a continuous veno-venous hemofiltration (CVVH) was conducted using three types of filters: polysulfone (PS), polyethyleneimine-treated polyacrylonitrile (PAN PEI), and non-PEI-treated polyacrylonitrile (PAN). Each type of filter was used in three CVVH cycles, involving the use of 600 mg of linezolid dissolved in 700 mL of bovine blood or in 700 mL of 0.9% NaCl. In each case, the total volume of the obtained solution was 1000 mL. Blood samples were collected at particular time points to measure their drug concentration. The differences in mean drug/NaCl adsorption and drug/blood adsorption were determined using a one-way ANOVA with multiple comparisons via Tukey's post hoc test; a p-value of <0.05 was considered significant. Results: A significant adsorption of linezolid was found for PAN PEI filters, both in samples obtained from bovine blood and 0.9% NaCl solutions, at the endpoint. In PAN PEI samples, the concentration of linezolid in 0.9% NaCl solutions decreased from 594.74 μg/mL to 310.66 μg/mL after 120 min (the difference was established at 52%). In blood samples, the initial concentration was 495.18 μg/mL, which then decreased to 359.84 μg/mL (73% of the beginning value). No significant adsorption was demonstrated on PAN or PS filters. Conclusion: There is a need for in vivo research to confirm the effect of filter type on linezolid concentration in patients undergoing CRRT.

Creating a Data Cleaning and Pre-Processing Module for Generalisable Data Linkage

ObjectiveAcute renal replacement therapy (RRT) is an important life saving technology used in critical care. However, variation in clinical practice for initiation and maintenance of RRT can increase healthcare costs and worsen patient outcomes. In Alberta, Canada, a province-wide electronic health record provides a unique opportunity to measure and evaluate clinical practice. The present study aims to improve the quality of RRT delivery in Alberta critical care units by providing feedback on key performance indicators (KPIs) for RRT based on current evidence. ApproachKPIs for RRT included an initiation pathway based on threshold lab values, and measures of RRT quality such as the time from order to treatment initiation, the average life of dialysis filters, and the actual vs. prescribed fluid removal. Clinical KPI definitions were mapped to data available in the electronic health record to evaluate current practice and track changes in KPIs over time. ResultsMapping the clinical guidelines to the electronic health record took significant time and effort in a large team with expertise on both the data and clinical sides. Each KPI data definition went through several cycles of development, validation and refinement before being included in the dashboards and reports given to participating sites. ConclusionsProviding accurate data on RRT ordering and delivery practices is an important step in aligning acute RRT delivery with current best practice, ultimately improving the quality of care and reducing unnecessary costs. ImplicationsElectronic health records provide a powerful tool for evaluating clinical decisions and implementing best practice guidelines.

Deciphering simplified regional anticoagulation with citrate in intermittent hemodialysis: a clinical and computational study

Regional citrate anticoagulation use in intermittent hemodialysis is limited by the increased risk of metabolic complications due to faster solute exchanges than with continuous renal replacement therapies. Several simplifications have been proposed. The objective of this study was to validate a mathematical model of hemodialysis anticoagulated with citrate that was then used to evaluate different prescription scenarios on anticoagulant effectiveness (free calcium concentration in dialysis filter) and calcium balance. A study was conducted in hemodialyzed patients with a citrate infusion into the arterial line and a 1.25 mmol/L calcium dialysate. Calcium and citrate concentrations were measured upstream and downstream of the citrate infusion site and in the venous line. The values measured in the venous lines were compared with those predicted by the model using Bland and Altman diagrams. The model was then used with 22 patients to make simulations. The model can predict the concentration of free calcium, bound to citrate or albumin, accurately. Irrespective of the prescription scenario a decrease in free calcium below 0.4 mmol/L was obtained only in a fraction of the dialysis filter. A zero or slightly negative calcium balance was observed, and should be taken into account in case of prolonged use.

A randomized crossover trial of regional anticoagulation modalities for intermittent hemodialysis.

The optimal regional anticoagulation (RA) of dialysis filters in patients at risk of bleeding remains elusive. Inducing hypocalcemia within the filter by using a calcium-free dialysate has emerged as an easy-to-use heparin-free RA, including in critically ill patients, but comparative studies are lacking. We conducted a multicentre, randomized, crossover trial to compare the efficacy and tolerance of two RAs (heparin-coated membrane (HCM) or calcium free dialysate with calcium reinjection according to ionic dialysance (CFD)) in patients requiring hemodialysis and at risk of bleeding. During the study period, each patient received two dialysis sessions (one with each RA in a randomly assigned order). The primary endpoint was the proportion of dialysis sessions completed (≥ 240min). 94 patients were included in the intention-to-treat analysis, including 16 critically ill patients (17.0%). Coagulation and inflammation parameters, as well as hemodynamic status at baseline, were balanced between groups. Premature coagulation of the filter occurred in 19 HCM (20.9%) compared to 3 (3.2%) CFD sessions. In half of the sessions with premature termination, coagulation occurred before 180 minutes. The proportion of patients who completed the CFD session while failing to complete the HCM session (n=17) was significantly higher than the proportion of patients who completed the HCM session while failing to complete the CFD session (n=1; p<0.001). Hemodynamic and metabolic tolerance were not different between groups. In individuals at risk of bleeding, RA with calcium-free dialysate significantly reduces the incidence of premature dialysis termination compared to heparin-coated membrane without safety concerns. Trial registration and statistical analysis plan: ClinicalTrials.gov identifier: NCT03842657.

Same therapy, same calcium mobilization? Exploring calcium exchange across body compartments using a patient-specific predictive model.

Comprehensive, patient-specific models are essential to study calcium deposition and mobilization during dialysis. We aim to develop tools to support clinical prescriptions with a more accurate approach for the prediction of calcium mobilization while also considering major electrolytes and catabolites. We modified a multi-solute model predicting patient-specific dialysis response by incorporating a calcium buffer to represent bone exchanges. Data from four centers, involving 127 patients with six sessions each, were utilized. For each patient, three sessions were allocated for model training (ID123), while the remaining sessions were for validation (PRED456). The normalized root mean square error (nRMSE%) was used to evaluate both descriptive and predictive accuracy. Correlations between initial data and calcium exchanges were also assessed. The overall nRMSE% for ID123 was 3.92%. For PRED456, it was 3.46% (ranging from a minimum of 1.17% for [Na+] to a maximum of 6.62% for [urea]). The median nRMSE% for plasma calcium varied between 1.13 and 8.32 for SHD sessions, depending on whether Ca_dialysis fluid (Cad) was ≥ or <1.50 mmol/L, respectively. For HDF sessions, the range was between 2.90 and 5.89. A significant and moderate correlation was found between overall calcium removal and the buffer balance. The most robust correlation observed was between the amount of calcium administered via post-dilution fluid and the overall calcium removal in the dialysis filter. Identical therapy settings do not uniformly affect calcium mobilization, and our approach offers insight into calcium distribution across body compartments. This understanding will enhance clinical prescription practices.

Incorporating a hemodialysis filter into a commercial normothermic perfusion system to facilitate long-term preservation of human split-livers.

Normothermic machine perfusion (NMP) allows for the assessment and resuscitation of ex-vivo human livers prior to transplantation. Commercially available NMP systems are closed circuits that accumulate metabolic waste and cytokines over time, potentially limiting organ preservation times. Dialysis has been proposed as a method to remove waste and excess fluid from such systems. This study aimed to demonstrate the utility of integrating dialysis into a commercially available system by quantifying solute removal. A dialysis filter was attached in parallel to a commercially available liver perfusion system. Three livers declined for transplantation were split before undergoing long-term NMP with blood using the modified system. During perfusion, dialysate flow rates were set in the range of 100-600 mL/h for short periods of time. At each flow rate, perfusate and spent dialysate samples were collected and analyzed for solute clearance. The addition of dialysis to a commercial NMP system removed water-soluble waste and helped regulate electrolyte concentrations. Interleukin-6 was successfully removed from the perfusate. Solute clearance was proportional to dialysate flow rate. A guide for our perfusion setup was created for the appropriate selection of dialysis flow rates and duration based on real-time perfusate composition. Dialysis circuits can efficiently remove waste and regulate perfusate composition, and can be easily incorporated to improve the performance of commercially available systems. Quantification of the effect of dialysis on perfusate composition enables refined dialysis control to optimize electrolyte profiles and avoid the over- or under-correction of key solutes.

Continuous Renal Replacement Therapy During Long-term Normothermic Machine Perfusion of Human Donor Livers for up to 7 D.

Normothermic machine perfusion (NMP) is used to preserve and test donor livers before transplantation. During NMP, the liver is metabolically active and produces waste products, which are released into the perfusate. In this study, we describe our simplified and inexpensive setup that integrates continuous renal replacement therapy (CRRT) with NMP for up to 7 d. We also investigated if the ultrafiltrate could be used for monitoring perfusate concentrations of small molecules such as glucose and lactate. Perfusate composition (urea, osmolarity, sodium, potassium, chloride, calcium, magnesium, phosphate, glucose, and lactate) was analyzed from 56 human NMP procedures without CRRT. Next, in 6 discarded human donor livers, CRRT was performed during NMP by integrating a small dialysis filter (0.2 m2) into the circuit to achieve continuous ultrafiltration combined with continuous fluid substitution for up to 7 d. Within a few hours of NMP without CRRT, a linear increase in osmolarity and concentrations of urea and phosphate to supraphysiological levels was observed. After integration of CRRT into the NMP circuit, the composition of the perfusate was corrected to physiological values within 12 h, and this homeostasis was maintained during NMP for up to 7 d. Glucose and lactate levels, as measured in the CRRT ultrafiltrate, were strongly correlated with perfusate levels (r = 0.997, P < 0.001 and r = 0.999, P < 0.001, respectively). The integration of CRRT into the NMP system corrected the composition of the perfusate to near-physiological values, which could be maintained for up to 7 d. The ultrafiltrate can serve as an alternative to the perfusate to monitor concentrations of small molecules without potentially compromising sterility.

Microbial Contamination During Long-term Ex Vivo Normothermic Machine Perfusion of Human Livers.

Normothermic machine perfusion permits the ex vivo preservation of human livers before transplantation. Long-term perfusion for days-to-weeks provides the opportunity for enhanced pretransplant assessment and potential regeneration of organs. However, this risks microbial contamination and infection of the recipient if the organ is transplanted. An understanding of perfusate microbial contamination is required to inform infection control procedures and antimicrobial prophylaxis for this technology. We modified a liver perfusion machine for long-term use by adding long-term oxygenators and a dialysis filter. Human livers that were not suitable for transplantation were perfused using a red-cell-based perfusate under aseptic and normothermic conditions (36 °C) with a goal of 14 d. Cephazolin was added to the perfusate for antimicrobial prophylaxis. Perfusate and bile were sampled every 72 h for microbial culture. Eighteen partial human livers (9 left lateral segment grafts and 9 extended right grafts) were perfused using our perfusion system. The median survival was 7.2 d. All organs surviving longer than 7 d (9/18) had negative perfusate cultures at 24 and 48 h. Half of the grafts (9/18) became culture-positive by the end of perfusion. Microbial contaminants included Gram-negative (Pseudomonas species, Proteus mirabilis, Stenotrophomonas maltophilia) and Gram-positive bacteria (Staphylococcus epidermidis, Enterococcus faecalis, and Bacillus species) as well as yeast (Candida albicans). Microbial contamination of perfusate is common during long-term perfusion of human livers with both exogenous and endogenous sources. Enhanced infection control practices and review of targeted antimicrobial prophylaxis are likely to be necessary for translation into the clinical arena.

Dialysis resource allocation in critical care: the impact of the COVID-19 pandemic and the promise of big data analytics.

The COVID-19 pandemic resulted in an unprecedented burden on intensive care units (ICUs). With increased demands and limited supply, critical care resources, including dialysis machines, became scarce, leading to the undertaking of value-based cost-effectiveness analyses and the rationing of resources to deliver patient care of the highest quality. A high proportion of COVID-19 patients admitted to the ICU required dialysis, resulting in a major burden on resources such as dialysis machines, nursing staff, technicians, and consumables such as dialysis filters and solutions and anticoagulation medications. Artificial intelligence (AI)-based big data analytics are now being utilized in multiple data-driven healthcare services, including the optimization of healthcare system utilization. Numerous factors can impact dialysis resource allocation to critically ill patients, especially during public health emergencies, but currently, resource allocation is determined using a small number of traditional factors. Smart analytics that take into account all the relevant healthcare information in the hospital system and patient outcomes can lead to improved resource allocation, cost-effectiveness, and quality of care. In this review, we discuss dialysis resource utilization in critical care, the impact of the COVID-19 pandemic, and how AI can improve resource utilization in future public health emergencies. Research in this area should be an important priority.

Impact of Single Hemodialysis Treatment on immune Cell Subpopulations.

Hemodialysis (HD) is known to trigger a chronic inflammatory status, affecting the innate and acquired immune response. This study was aimed at a comparative analysis of immune cell subsets, proliferation, and apoptosis in subjects receiving chronic HD treatment with respect to a healthy control. Regardless of the dialysis filter used, we observed a reshaping of the acquired immune component both with respect to healthy patients and between the various sessions of dialysis treatment, with an impairment of CD3 cells, along with an increase in CD4 and CD8 cell populations producing pro-inflammatory factors such as IL-17 and IFN-gamma. The population of B cells, monocytes and NK cells were not impaired by the dialysis procedure. These results confirmed the high impact of the HD treatment on the patient's immune system, underlying the imbalance of T cell counterparts.

Manual Single-Lumen Alternating Micro-Batch Device as Renal Replacement Therapy in Austere Environments

Introduction: Electrolyte derangements, acidosis, and volume overload remain life-threatening emergencies in people with acute kidney injury in austere environments. A single-lumen alternating micro-batch (SLAMB) dialysis technique was designed to perform renal replacement therapy using a single-lumen access, low-cost disposable bags and tubing, widely available premade fluids, and a dialysis filter. A manual variation (mSLAMB) works without electricity, battery, or a pump. We modeled mSLAMB dialysis and predicted it could achieve adequate small solute clearance, blood flow rates, and ultrafiltration accuracy. Methods: A 25- to 30-kg pediatric patient’s blood volume was simulated by a 2-L bag of expired blood and spiked with 5 g of urea initially, then with 1–2 g between experiments. Experiments had 8 cycles totaling prescription volumes of 800–2,400 mL and were conducted with different ratios of hemofiltration fluid to blood volume. Concentrations of urea and potassium, final effluent volumes, and cycle duration were measured at the end of each cycle to determine clearance, ultrafiltration accuracy, and blood flow rates. Results: Each cycle lasted 70–145 s. Experiments achieved a mean urea reduction ratio of 27.4 ± 7.1% and a mean potassium reduction of 23.4 ± 9.3%. The largest urea and potassium reduction percentage occurred with the first cycle. Increased hemofiltration fluid to blood volume ratio did not increase clearance. Mean (+/− standard deviation) blood flow ranged from 79.7 +/− 4.4 mL/min to 90.8 +/− 6.5 mL/min and increased with larger batch volume and height difference between reservoirs. Ultrafiltration accuracy ranged from 0 to 2.4% per cycle. Discussion: mSLAMB dialysis is a simple, manual, cost-effective mode of dialysis capable of providing clearance and accurate ultrafiltration. With further refinement of technique, we believe this can be a potentially lifesaving treatment in austere conditions and low-resource settings.

The Effect of Bacterial DNA and Hemodialysis Therapy Conditions on Interleukin 6 Levels Variation in End-stage Renal Disease Patients

Hemodialysis (HD) is the most common therapy to treat end-stage renal disease (ESRD) patients. That is used to clear blood from metabolism end products and maintain water and electrolyte balance in patients’ body when failed kidneys unable to do that. Patient’s blood contact via dialysis filter (dialyzer) about 400 L of dialysis fluid that is mainly form of water and some electrolyte, this quantity of fluid contact can stimulate the production of pre-inflammatory markers due to carrying pathogens such as bacterial DNA fragments even in small quantity that can pass all filters to bloodstream stimulating production of IL-6. A total of 90 blood samples were collected from 45 patients under hemodialysis therapy in Baghdad Teaching Hospital, Gazy Alhariry general hospital, Al-khayal private hospital and Al-Muayad private hospital before and after 3 hours of HD therapy to detect IL-6 by ELISA technique. And from the same centers dialysis fluid and water samples were collected to detect bacterial DNA fragments. PCR technique using 16s universal bacterial primer showed presence of bacterial DNA fragments in dialysis fluid and water used to prepare it.The ELISA readings showed a variety in IL-6 levels higher in patients with low ultrafiltration UF rate than its level in patients with high UF and generally, the level of IL-6 in patients treated in centers with DF preparation direct water distribution system were lower than its level in patients treated in centers with indirect water distribution systems.

RHABDOMYOLYSIS: HOW MUCH DO WE KNOW ABOUT IT? MODERN CLINICAL CONSENSUS (Literature review)

The article presents a review of the world data on modern approaches to the treatment of patients with rhabdomyolysis according to the principles of evidence-based medicine. Rhabdomyolysis is a condition occurring in critically ill and injured patients. But only 20 % of all cases of rhabdomyolysis are usually related to direct trauma. Diagnosis is made based on a combination of clinical and laboratory findings, determining the need for surgical intervention to stop any processes causing muscle damage and to prevent or treat known complications of the disease. Careful examination of patients and identification of potential risk factors associated with myocyte damage and release of breakdown products (myoglobin, creatinine, potassium, phosphorus) into the systemic bloodstream, which can lead both to asymptomatic elevations of muscle enzymes in the blood and to life-threatening acute renal damage and severe electrolyte disturbances. Although early volume resuscitation for rhabdomyolysis is a well-established principle for improving renal tubular function, diluting nephrotoxins such as myoglobin, and providing adequate renal perfusion to prevent acute kidney injury (AKI), choosing the best type of crystalloid for this purpose. Existing protocols and benefits of infusion therapy, rate of administration, target recommendations, and diuresis rate to prevent ARF in rhabdomyolysis are analyzed. The appropriateness of diuretics and/or bicarbonate administration for the prevention of AKI is considered. Whether extracorporeal removal of myoglobin can be an effective preventive strategy and taking into account the molecular weight of myoglobin or effective use of different dialysis regimens, filters and flow types to treat and prevent AKI.

Review of Anticoagulation in Continuous Renal Replacement Therapy.

Continuous renal replacement therapy is an important, yet challenging, treatment of critically ill patients with kidney dysfunction. Clotting within the dialysis filter or circuit leads to time off therapy and impaired delivery of prescribed treatment. Anticoagulation can be used to prevent this complication; however, doing so introduces risk for unintended complications such as bleeding or metabolic derangements in patients who are already critically ill. A thorough understanding of indications, therapeutic options, and monitoring principles is necessary for safe and effective use of this strategy. This review provides clinicians important information regarding when to anticoagulate, differences in pharmacologic agents, recommended doses, routes of drug delivery, and appropriate laboratory monitoring for patients receiving anticoagulation to support continuous renal replacement therapy.

IN VITRO ANTIOXIDANT ACTIVITY OF C-PHYCOCYANIN PURIFIED FROM Spirulina platensis DRY BIOMASS

C-phycocyanin (C-PC) was a phycobiliprotein found exclusively in cyanobacteria as Spirulina and exhibited a variety of pharmacological properties, which were not yet studied for any purpose in commercial applications in the pharmaceutical and cosmetic industry in Vietnam. At present, there are no other sources of natural phycocyanin than Spirulina, it is the sole efficient source of natural phycocyanin production under photoautotrophic conditions. The present research was conducted to determine an efficient extraction method from C-PC from Spirulina platensis dry biomass. Antioxidant activity of purified C-PC was investigated. Extractions were carried out using distilled water and Na-phosphate buffer pH 7.0 as solvents and freeze\thaw and ultrasonication techniques were applied to optimize the extraction process. Extraction using the freeze\thaw method proved to be the most efficient method. Phycocyanin purification from crude extracts was carried out by a combination of methods such as ammonium sulfate (NH4)2SO4 65% precipitation, dialysis filter, and Sephadex G-100 gel filtration chromatography, to give 121.63 ± 0.03 mg\g C-PC content and 3.52 ± 0.04 purity. Antioxidant activity in vitro was determined by nitric oxide (NO) scavenging activity, percentage inhibition of NO by the C-PC in concentration 10 μg\mL to 100 μg\mL which significantly scavenged 55.89% to 91.54% of NO radicals, respectively. They exhibited strong NO radical scavenging capacity, the C-PC and vitamin C were able to reduce the stable NO radical to 50% reduction with EC50 of 4.53 and 3.66 µg\mL. Research results showed that S. platenis dry biomass provided by Dalitra was potential for obtaining C-phycocyanin (12.16% of dry biomass) and it was evaluated as an antioxidant in vitro able to scavenge nitric oxide. C-PC (12.16% of dry biomass) and was evaluated as an antioxidant in vitro able to scavenge nitric oxide.

Strategies to Protect Dialysis Patients against Bisphenol A.

Bisphenol A (BPA), also known as 2,2,-bis(4-hydroxyphenyl) propane, is a common component of plastics worldwide. However, it has been shown to act as an endocrine disruptor with some hormonal functions. Furthermore, high levels of BPA have been related to the development of cardiovascular events and the activation of carcinogenesis pathways. Patients with chronic kidney disease (CKD) have higher serum concentrations of BPA due to their impaired renal function. This situation is aggravated in CKD patients requiring dialysis, because the BPA content of dialysis devices (such as, for example, the filters) is added to the lack of excretion. In addition to the development of BPA-free dialysis filters, some techniques can contribute to the reduction of BPA levels in these patients. The aim of this review is to illustrate the impact of BPA on dialysis patients and suggest some strategies to reduce its inherent risks.

Challenging the Ex Vivo Lung Perfusion Procedure With Continuous Dialysis in a Pig Model.

Normothermic ex vivo lung perfusion (EVLP) increases the pool of donor lungs by requalifying marginal lungs refused for transplantation through the recovery of macroscopic and functional properties. However, the cell response and metabolism occurring during EVLP generate a nonphysiological accumulation of electrolytes, metabolites, cytokines, and other cellular byproducts which may have deleterious effects both at the organ and cell levels, with impact on transplantation outcomes. We analyzed the physiological, metabolic, and genome-wide response of lungs undergoing a 6-h EVLP procedure in a pig model in 4 experimental conditions: without perfusate modification, with partial replacement of fluid, and with adult or pediatric dialysis filters. Adult and pediatric dialysis stabilized the electrolytic and metabolic profiles while maintaining acid-base and gas exchanges. Pediatric dialysis increased the level of IL-10 and IL-6 in the perfusate. Despite leading to modification of the perfusate composition, the 4 EVLP conditions did not affect the gene expression profiles, which were associated in all cases with increased cell survival, cell proliferation, inflammatory response and cell movement, and with inhibition of bleeding. Management of EVLP perfusate by periodic replacement and continuous dialysis has no significant effect on the lung function nor on the gene expression profiles ex vivo. These results suggest that the accumulation of dialyzable cell products does not significantly alter the lung cell response during EVLP, a finding that may have impact on EVLP management in the clinic.

COVID-19 and Dialysis Patients: Unsolved Problems in Early 2021.

COVID-19 and Dialysis Patients: Unsolved Problems in Early 2021.

Toxin Removal and Inflammatory State Modulation during Online Hemodiafiltration Using Two Different Dialyzers (TRIAD2 Study).

Uremic toxins play a pathological role in atherosclerosis and represent an important risk factor in dialysis patients. Online hemodiafiltration (HDF) has been introduced to improve the clearance of middle- and large-molecular-weight solutes (>500 Da) and has been associated with reduced cardiovascular mortality compared to standard hemodialysis. This non-randomized, open-label observational study will explore the efficacy of two dialyzers currently used for online HDF, a polysulfone-based high-flux membrane, and a cellulose triacetate membrane, in hemodialysis patients with signs of middle-molecule intoxication or intradialytic hypotension. In particular, the two filters will be evaluated for their ability in uremic toxin removal and modulation of inflammatory status. Sixteen subjects in standard chronic bicarbonate hemodialysis requiring a switch to online HDF in view of their clinical status will be enrolled and divided into two treatment arms, according to the previous history of hypersensitivity to polysulfone/polyethersulfone dialysis filters and hypersensitivity to drugs or other allergens. Group A will consist of 16 patients without a previous history of hypersensitivity and will be treated with a polysulfone filter (Helixone FX100), and group B, also consisting of 16 patients, with a previous history of hypersensitivity and will be treated with asymmetric triacetate (ATA; SOLACEA 21-H) dialyzer. Each patient will be followed for a period of 24 months, with monthly assessments of circulating middle-weight toxins and protein-bound toxins, markers of inflammation and oxidative stress, lymphocyte subsets, activated lymphocytes, and monocytes, cell apoptosis, the accumulation of advanced glycation end-products (AGEs), variations in arterial stiffens measured by pulse wave velocity (PWV), and mortality rate. The in vitro effect on endothelial cells of uremic serum collected from patients treated with the two different dialyzers will also be investigated to examine the changes in angiogenesis, cell migration, differentiation, apoptosis and proliferative potential, and gene and protein expression profile. The expected results will be a better awareness of the different effects of polysulfone gold-standard membrane for online HDF and the new ATA membrane on the removal of uremic toxins removal and inflammation due to blood–membrane interaction.