Normal Dialysate Research Articles

The effect of lowering the dialysate temperature on the stabilization of hemodynamic indices of diabetic patients admitted to Ali ibn Abi Talib Hospital, Zahedan: A clinical trial

Introduction: One of the basic pillars of hemodialysis is its adequacy, which is achieved by stabilizing hemodynamic parameters. This is especially important in the hemodialysis adequacy of diabetic patients. The current study aims to determine the effect of lowering the dialysate temperature on hemodynamic indices and dialysis adequacy of diabetic patients. Materials and methods: This is a clinical trial that was performed on 32 diabetic patients admitted to the Dialysis Ward of Ali ibn Abi Talib Hospital affiliated with Zahedan University of Medical Sciences in 2017. The research subjects were selected using the convenience sampling method from eligible patients. Each patient underwent hemodialysis twice; i.e. routine dialysate temperature (37° C) and cold dialysate temperature (36 °C). Except for lowering the dialysate temperature to (36 °C), all other conditions were the same during the study. Blood pressure (BP) and pulse rate of patients were monitored before and after dialysis and during the first, second, and third hours after dialysis; however, the body temperature and weight of patients were monitored before and after each dialysis session. Patients' blood samples were collected at each stage before and after dialysis to evaluate urea and calculate dialysis adequacy. Data analysis was carried out using descriptive statistics, paired t-test, and one-way repeated measures ANOVA in SPSS Ver. 21. P-value <0.05 was considered as the significant level. Results: Systolic, diastolic, and mean arterial blood pressure among patients who underwent hemodialysis with normal dialysate temperature were significantly lower than those who underwent hemodialysis with cold dialysate temperature (p<0.05). There were no significant differences between cold and routine dialysis in terms of changes in body temperature before and after dialysis. The dialysis adequacy at 36 °C showed a significant increase as compared to 37° C. Conclusion: The results of the present study showed that hemodialysis with cold solution (36 °C) stabilized hemodynamic variables and improved dialysis adequacy among diabetic patients, therefore, this treatment is recommended in hemodialysis wards.

Development of a Cold Dialysate Regeneration System for Home Hemodialysis

Background/Aims: Because longer and/or more frequent dialysis has potential clinical benefits, home hemodialysis (HHD) systems should provide flexible renal replacement therapies. We propose a new cold dialysate regeneration system that requires 10 l per treatment for HHD. Methods: We designed a dialysate regeneration system using cold dialysate and 2 activated carbon columns alternatively switched between adsorption and desorption. Urea adsorption ratios were compared in three different conditions; cold dialysate (5.7°C), normal dialysate (36.8°C), and cold dialysate with washing. In vivo tests (n = 8) were conducted to validate this system. Results: The urea removal ratios were 20.0 ± 1.7% in cold dialysate, 36.0 ± 1.7% in normal dialysate, and 82.5 ± 1.2% in cold dialysate with washing. In animal experiments, the urea reduction ratio was 60.9 ± 6.3%, Kt/V was 1.0 ± 0.2, and serum electrolytes remained stable. Conclusion: The proposed cold dialysate regeneration system using a small volume of dialysate will be useful for HHD.

Pharmacokinetics of once daily intra-peritoneal aztreonam and vancomycin in the treatment of CAPD peritonitis

The pharmacokinetics of aztreonam and vancomycin were studied in six adult patients who developed peritonitis during Continuous Ambulatory Peritoneal Dialysis. Aztreonam 3 g was added to the first exchange in each 24 h period with vancomycin 500 mg on the first day and 250 mg on each subsequent day (provided the pre-dose serum vancomycin concentration was less than 10 mg/l) for a total of ten days. Aztreonam and vancomycin concentrations were measured in the serum and dialysate at 1, 2, 6, 12, 18 and 24 h after the initial dose and pre-dose on days 5 and 10. By the end of the ten day study all patients had recovered clinically and had a normal dialysate. For aztreonam, the mean peak serum concentration was 84.3 mg/l (range 59.6-102.8), the mean 24 h pre-dose serum concentration was 23.0 mg/l (range 8.6-39.2) and the mean 24 h pre-dose dialysate concentration was 15.5 mg/l (range 5.0-32.0). For vancomycin, the mean peak serum concentration was 10.2 mg/l (range 8.1-12.6), the mean 24 h pre-dose concentration was 5.5 mg/l (range 3.6-6.4), and the mean 24 h pre-dose dialysate concentration was 3.4 mg/l (range 2.4-4.6). In the treatment of CAPD peritonitis, once daily intra-peritoneal administration of aztreonam 3 g with vancomycin 500 mg initially and 250 mg on subsequent days (serum concentrations permitting) provides concentrations of antibiotic in both the serum and dialysate throughout the 24 h period in excess of the inhibitory concentrations of those organisms most frequently encountered in this condition.