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urea dialysate

Magdalena Madero, Karla B Cano, Israel Campos, Xia Tao, Vaibhav Maheshwari, Jillian Brown, Beatriz Cornejo, Garry Handelman, Stephan Thijssen, Peter Kotanko
BACKGROUND AND OBJECTIVES: Current hemodialysis techniques fail to efficiently remove the protein-bound uremic toxins p-cresyl sulfate and indoxyl sulfate due to their high degree of albumin binding. Ibuprofen, which shares the same primary albumin binding site with p-cresyl sulfate and indoxyl sulfate, can be infused during hemodialysis to displace these toxins, thereby augmenting their removal. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We infused 800 mg ibuprofen into the arterial bloodline between minutes 21 and 40 of a conventional 4-hour high-flux hemodialysis treatment...
February 12, 2019: Clinical Journal of the American Society of Nephrology: CJASN
Eun Ji Park, Su Woong Jung, Da Rae Kim, Jin Sug Kim, Tae Won Lee, Chun Gyoo Ihm, Kyung Hwan Jeong
Background: The objective of this study was to compare the impact of citrate dialysate (CD) and standard acetate dialysate (AD) in hemodialysis by central delivery system (CDS) on heparin demand, and clinical parameters. Methods: We retrospectively evaluated 75 patients on maintenance hemodialysis with CDS. Patients underwent hemodialysis with AD over a six-month period (AD period), followed by another six-month period using CD (CD period). Various parameters including mean heparin dosage, high sensitivity C-reactive protein (hsCRP), calcium-phosphate product (CaxP), intact parathyroid hormone (iPTH), and urea reduction ratio (URR) were collated at the end of each period...
February 12, 2019: Kidney Research and Clinical Practice
Rafael Bueno Orcy, Maria Fernanda Antunes, Jean Pierre Oses, Maristela Böhlke
The measure of hemodialysis (HD) adequacy recommended nowadays by most guidelines, Kt/V-urea, presents significant drawbacks. Direct dialysis quantification (DDQ) through total dialysate collection (TDC), considered the gold standard measure of HD adequacy, is cumbersome, which precludes its widespread use in clinical practice. The present study aims to validate a low-volume continuous sampling of spent dialysate (CSSD). Cross-sectional study carried out at a university hospital. Throughout 4-h hemodialysis sessions, urea removal was measured by three DDQ methods: TDC, CSSD, and fractional sampling of dialysate (FSD)...
February 8, 2019: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
John K Leypoldt, Sarah Prichard, Glenn M Chertow, Luis Alvarez
BACKGROUND: High dialysate flow rates (QD) of 500-800 mL/min are used to maximize urea removal during conventional hemodialysis. There are few data describing hemodialysis with use of mid-rate QD (300 mL/min). METHODS: We constructed uremic solute (urea, beta2-microglobulin and phosphate) kinetic models at varying volumes of distribution and blood flow rates to predict solute clearances at QD of 300 and 500 mL/min. RESULTS: Across a range of volumes of distribution a QD of 300 mL/min generally yields a predicted urea spKt/V greater than 1...
January 30, 2019: Blood Purification
Verena Gotta, Olivera Marsenic, Marc Pfister
Urea dialyzer clearance (KD) has been suggested to be underpredicted from blood flow (QB), dialysate flow (QD), and in vitro mass transfer-area coefficient of urea (KoA) in pediatric hemodialysis (HD) patients using a widely accepted mechanistic equation. We characterize factors that could explain this, assuming that it results from a bias between reported in vitro and actual in vivo KoA. An adult urea kinetic model was scaled to 923 patients aged 1-29 years based on pediatric physiologic knowledge (intercompartmental clearance, volumes of distribution)...
January 14, 2019: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Md Tipu Sultan, Bo Mi Moon, Jae Won Yang, Ok Joo Lee, Soon Hee Kim, Ji Seung Lee, Young Jin Lee, Ye Been Seo, Do Yeon Kim, Olatunji Ajiteru, Gun Yong Sung, Chan Hum Park
The chronic kidney disease (CKD) patients are undergoing continuous ambulatory peritoneal dialysis (CAPD). However, there are some constraints, the frequent exchange of the dialysate and limitation of outside activity, associated with CAPD remain to be solved. In this study, we designed the wearable artificial kidney (WAK) system for peritoneal dialysis (PD) using urease-immobilized silk fibroin (SF) membrane and polymer-based spherical carbonaceous adsorbent (PSCA). We evaluated this kit's removal abilities of uremic toxins such as urea, creatinine, uric acid, phosphorus, and β2-microglobulin from the dialysate of end-stage renal disease (ESRD) patients in vitro...
April 2019: Materials Science & Engineering. C, Materials for Biological Applications
Joanna Stachowska-Pietka, Jan Poleszczuk, Josep Teixido-Planas, Josep Bonet-Sol, Maria I Troya-Saborido, Jacek Waniewski
BACKGROUND: It is typically assumed that within short timeframes, patient-specific peritoneal membrane characteristics are constant and do not depend on the initial fluid tonicity and dwell duration. The aim of this study was to check whether this assumption holds when membrane properties are estimated using the 3-pore model (3PM). METHODS: Thirty-two stable peritoneal dialysis (PD) patients underwent 3 8-hour peritoneal equilibration tests (PETs) with different glucose-based solutions (1...
January 18, 2019: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Javier A Neyra, Victor M Ortiz-Soriano, Dina Ali, Peter E Morris, Clayton M Johnston
Introduction: Hyponatremia is a common electrolyte disorder in critically ill patients. Rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. Management of severe hyponatremia in patients with acute or chronic kidney disease who require continuous renal replacement therapy (CRRT) is limited by the lack of commercially available hypotonic dialysate or replacement fluid solutions. Methods: This was a single-center quality improvement project that consisted of the development and implementation of a multidisciplinary protocol for gradual correction of severe hyponatremia in patients who were admitted to the intensive care unit (ICU) and required CRRT...
January 2019: KI Reports
James Tattersall
Incremental haemodialysis has the potential to allow better preservation of renal function, is less invasive to the patient and has lower cost. Despite these advantages, it is not commonly applied. This may be due to uncertainty about how to account for renal function in the prescription of dialysis and measurement of dose. In this issue, Vartia describes the practical basis for including the effect of renal function in the prescription and quantification of dialysis. He uses a well-known and validated urea kinetic model to calculate time average urea concentrations and the equivalent renal clearance (EKR) from dialysis...
December 2018: Clinical Kidney Journal
Susie Q Lew
Urea kinetics (weekly Kt/V) greater than 1.7 generally define adequate peritoneal dialysis (PD). Adequacy of PD depends on residual renal function and PD clearance. Preserving residual renal function and peritoneal membrane characteristics helps to maintain PD adequacy.The dose of PD can be augmented by increasing the total dialysate volume. Greater volume can be achieved by increasing either the fill volume per exchange or the number of exchanges. Increased time on dialysis can be achieved by keeping PD fluid in the peritoneal cavity at all times...
November 2018: Advances in Peritoneal Dialysis
Hilal Seval Abanoz, Buket Kunduhoglu
In this study, the antimicrobial activity of a bacteriocin produced by Enterococcus faecalis KT11, isolated from traditional Kargı Tulum cheese, was determined, and bacteriocin KT11 was partially characterized. The results showed that bacteriocin KT11 was antagonistically effective against various Gram-positive and Gram-negative test bacteria, including vancomycin- and/or methicillin-resistant bacteria. The activity of bacteriocin KT11 was completely abolished after treatment with proteolytic enzymes (proteinase K, α-chymotrypsin, protease and trypsin), which demonstrates the proteinaceous nature of this bacteriocin...
October 2018: Korean Journal for Food Science of Animal Resources
Joanna Stachowska-Pietka, Jan Poleszczuk, Michael F Flessner, Bengt Lindholm, Jacek Waniewski
Background: Ultrafiltration failure (UFF) in peritoneal dialysis (PD) patients is due to altered peritoneal transport properties leading to reduced capacity to remove excess water. Here, with the aim to establish the role of local alterations of the two major transport barriers, peritoneal tissue and capillary wall, we investigate changes in overall peritoneal transport characteristics in UFF patients in relation to corresponding local alterations of peritoneal tissue and capillary wall transport properties...
November 6, 2018: Nephrology, Dialysis, Transplantation
Yuanyuan Shi, Yifeng Wang, Shuai Ma, Tingyan Liu, Huajun Tian, Qiuyu Zhu, Wenji Wang, Yulin Li, Feng Ding
Protein-bound uremic toxins (PBUTs) accumulate at high plasma levels and cause various deleterious effects in end-stage renal disease patients because their removal by conventional hemodialysis is severely limited by their low free-fraction levels in plasma. Here, we assessed the extent to which solute removal can be increased by adding liposomes to the dialysate. The uptake of liposomes by direct incubation in vitro showed an obvious dose-response relationship for p-cresyl sulfate (PCS) and indoxyl sulfate (IS) but not for hippuric acid (HA)...
October 30, 2018: Artificial Organs
Raja Mohammed Kaja Kamal, Ken Farrington, Amanda D Busby, David Wellsted, Humza Chandna, Laura J Mawer, Sivakumar Sridharan, Enric Vilar
Background: Initiating twice-weekly haemodialysis (2×HD) in patients who retain significant residual kidney function (RKF) may have benefits. We aimed to determine differences between patients initiated on twice- and thrice-weekly regimes, with respect to loss of kidney function, survival and other safety parameters. Methods: We conducted a single-centre retrospective study of patients initiating dialysis with a residual urea clearance (KRU) of ≥3 mL/min, over a 20-year period...
October 23, 2018: Nephrology, Dialysis, Transplantation
Surachet Vongsanim, Clara Salame, Simon Eaton, George Grimble, Andrew Davenport
OBJECTIVE: Patients treated by peritoneal dialysis (PD) are at increased risk of muscle wasting, and clinical guidelines recommend assessing dietary intake, by calculating protein equivalent of nitrogen appearance (PNA) to assure protein sufficiency. The PNA equations were developed many years ago, and we wished to re-evaluate them by comparing estimated and measured peritoneal nitrogen losses. DESIGN AND METHODS: This is a cross-sectional observational cohort study...
October 19, 2018: Journal of Renal Nutrition
Shashidhar Cherukuri, Maria Bajo, Giacomo Colussi, Roberto Corciulo, Hafedh Fessi, Maxence Ficheux, Maria Slon, Eric Weinhandl, Natalie Borman
BACKGROUND: Utilization of home hemodialysis (HHD) is low in Europe. The Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) is a multi-center study of HHD patients who have used a transportable hemodialysis machine that employs a low volume of lactate-buffered, ultrapure dialysate per session. In this retrospective cohort analysis, we describe patient factors, HHD prescription factors, and biochemistry and medication use during the first 6 months of HHD and rates of clinical outcomes thereafter...
October 11, 2018: BMC Nephrology
Wihib Gebregeorgis, Zeenat Yousuf Bhat, Nishigandha Pradhan, Stephen D Migdal, Lakshminarayanan Nandagopal, Reddy Singasani, Tehmina Mushtaq, Ronald Thomas, Yahya M Osman Malik
Background: The Dt/V obtained by using ionic dialysance (D) as a surrogate for urea clearance (K) is a well-validated adjunct measure of hemodialysis adequacy, with a variable level of correlation with urea-based Kt/V. However, this correlation has not been examined based on patients' body size and ultrafiltration (UF) volume during the dialysis session. Methods: Simultaneous evaluations of online Dt/V and single-pool variable-volume urea Kt/V were made. Patients were categorized into three subgroups based on their weight (<60, 60-80 and ≥80 kg), body mass index (<25, 25-30 and >30 kg/m2 ) and UF volume (<1...
October 2018: Clinical Kidney Journal
Satoshi Hibino, Osamu Uemura, Hiroshi Uchida, Hisakazu Majima, Reiko Yamaguchi, Kazuki Tanaka, Azusa Kawaguchi, Satoshi Yamakawa, Naoya Fujita
Large-dose cyclic tidal peritoneal dialysis (TPD) is an original prescription of TPD involving frequent infusion and drainage of the dialysate to increase weekly urea clearance normalized to total body water (Kt/Vurea ) and fluid removal. This study aimed to evaluate the efficiency of solute clearance and fluid removal achieved with large-dose cyclic TPD compared to that achieved with nightly peritoneal dialysis (NPD). Seventeen patients with end-stage renal disease, for whom maintenance PD was changed from NPD to large-dose cyclic TPD, were enrolled...
September 27, 2018: Therapeutic Apheresis and Dialysis
Fayan Meng, Mykola Seredych, Chi Chen, Victor Gura, Sergey Mikhalovsky, Susan Sandeman, Ganesh Ingavle, Tochukwu Ozulumba, Ling Miao, Babak Anasori, Yury Gogotsi
The wearable artificial kidney can deliver continuous ambulatory dialysis for more than 3 million patients with end-stage renal disease. However, the efficient removal of urea is a key challenge in miniaturizing the device and making it light and small enough for practical use. Here, we show that two-dimensional titanium carbide (MXene) with the composition of Ti3 C2 T x , where T x represents surface termination groups such as -OH, -O-, and -F, can adsorb urea, reaching 99% removal efficiency from aqueous solution and 94% from dialysate at the initial urea concentration of 30 mg/dL, with the maximum urea adsorption capacity of 10...
October 23, 2018: ACS Nano
John K Leypoldt, Eric D Weinhandl, Allan J Collins
With dialysis delivery systems that operate at low dialysate flow rates, prescriptions for more frequent hemodialysis (HD) employ dialysate volume as the primary parameter for small solute removal rather than blood-side urea dialyzer clearance (K). Such delivery systems, however, yield dialysate concentrations that almost completely saturate with blood (water), suggesting that the volume of urea cleared (the product of K and treatment time or Kt) can be readily estimated from the prescribed dialysate volume to target small solute removal...
September 25, 2018: Hemodialysis International
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