Expanded hemodialysis is a method of treatment to replace kidney function, which effectively removes uremic toxins of middle molecular weight from the blood of the patients with the end stage of chronic kidney disease. Two basic principles of removing uremic toxins during an expanded hemodialysis session are diffusion and convection. The basis of diffusion is the concentration gradient, and the basis of convection is internal filtration (covective transport). Increased MCO membrane sieving capacity and high internal filtration provide high clearance of middle molecular weight uremic toxins. Expanded hemodialysis prevents the development of microinflammation, malnutrition, resistance to the action of erythropoietin, amyloidosis, accelerated atherosclerosis and atherosclerotic cardiovascular diseases in the population of patients treated with regular dialysis. The task of the nephrologist is to evaluate different dialysis modalities that are available and to select the optimal dialysis modality for the treatment of each patient individually, i.e., the individualization of dialysis treatment.
Objective. The aim of this study was to examine the effect of expanded hemodialysis on the degree of b2-microglobulin removal. Methods. Sixteen patients treated with extended MCO hemodialysis were examined. The main parameter for assessing the efficiency of removal of uremic toxins of middle molecular weight is the concentration of b2-microglobulin in the serum before and after a single session of extended MCO hemodialysis. The following were used for statistical analysis: Kolmogorov-Smirnov test, Student's T test for bound samples and Wilcoxon test. Results. Extended MCO hemodialysis effectively removes uremic toxins of middle molecular weight. The reduction index of b2-microglobulin during a single session of extended MCO hemodialysis is 70.60 ± 5.88%. The average loss of albumin during a single session of extended MCO hemodialysis is 1.88 ± 1.02 g/4h, and the index of albumin reduction is 4.94 ± 2.49%. Conclusion. Extended MCO hemodialysis effectively removes b2-microglobulin. The b2-microglobulin reduction index is ~ 71% and the albumin loss is less than 4.0 g/4h. This dialysis modality prevents the development of amyloidosis, atherosclerosis and atherosclerotic cardiovascular diseases in the population of patients treated with regular hemodialysis.
Introduction. Conventional high-flux hemodialysis effectively removes uremic toxins of medium molecular weight of 0.5-15 (20) kDa, while postdilution online hemodiafiltration effectively removes uremic toxins of medium molecular weight in the range of 0.5-60 kDa. AIM. The aim of the study was to compare the efficacy of b2-microglobulin removal from the patient serum during a single session of conventional high-flux hemodialysis and postdilution online hemodiafiltration. METHOD. Eighty-five patients treated with conventional high-flux hemodialysis and thirty patients treated with postdilution online hemodiafiltration were examined. The main parameter for assessing the removal efficiency of medium molecular weight uremic toxins was serum b2microglobulin concentration before and after a single session of conventional high-flux hemodialysis and postdilution online hemodiafiltration. The following were used for statistical analysis: Kolmogorov-Smirnov test, Student's T test and Mann-Whitney U test. RESULTS. In patients treated with postdilution online hemodiafiltration, the average total convective volume was 21.38 ± 2.97 liters per session. The b2-microglobulin reduction index for the FX CorDiax 600 dialysis membrane was 61.76 ± 7.32%, while for the FX CorDiax 800 dialysis membrane it was 74.69 ± 6.51%. The albumin reduction index for the FX CorDiax 600 membrane was 3.48 ± 1.28%, and for the FX CorDiax 800 dialysis membrane it was 6.01 ± 2.97%. There is a highly statistically significant difference between the reduction index of b2-microglobulin and albumin, for two different dialysis modalities and two different dialysis membranes (p < 0.01). CONCLUSION. Postdilution online hemodiafiltration is more efficient in removing b2-microglobulin from patient serum, compared to conventional high-flux hemodialysis. Albumin loss during a single session of high-flux hemodialysis is lower compared to a single session of postdilution online hemodiafiltration. With both dialysis modalities, albumin loss is less than 4.0 g/4h. High-flux hemodialysis effectively prevents the development of dialysis-related amyloidosis, while postdilution online hemodiafiltration effectively prevents not only the development of dialysis-related amyloidosis, but also the development of resistance to erythropoietin and atherosclerotic cardiovascular diseases in the population treated with regular dialysis.
Gastrointestinal complications are common among patients on peritoneal dialysis. Risk factors for the development of gastrointestinal complications in this patient population include: toxic effects of uremic toxins, frequent use of nonsteroidal anti-inflammatory drugs, Helicobacter pylori infection, angiodysplasia, increased intra-abdominal pressure, use of bioincompatible solution for peritoneal dialysis, increased glucose in solutions for peritoneal dialysis, secondary hyperparathyroidism (hypercalcemia), a disorder of lipid metabolism (hypertriglyceridemia), and the duration of peritoneal dialysis treatment. The most important non-infectious gastrointestinal complications in patients on peritoneal dialysis are: gastrointestinal bleeding, herniation and leaking of the dialysate from the abdomen (increased intra-abdominal pressure), impaired lung function (intra-abdominal hypertension), acute pancreatitis, and encapsulating sclerosis of the peritoneum. Intra-abdominal hypertension is defined as IAP ≥ 12 mmHg. Pouring the peritoneal dialysis solution leads to increased intra-abdominal pressure, which results in the development of hernias, pleuro-peritoneal dialysate leakage (hydrothorax), and restrictive pulmonary dysfunction. Risk factors for the development of acute pancreatitis in this patient population include: uraemia, secondary hyperparathyroidism with hypercalcemia, hypertriglyceridemia, features of the peritoneal dialysis solution (osmolarity, acidity, glucose, chemical irritation, and calcium in the solution for peritoneal dialysis lead to “local hypercalcemia”), toxic substances from the dialysate, the bags and tubing, and peritonitis and treatment of peritonitis with antibiotics and anticoagulants. Encapsulating sclerosis of the peritoneum is rare and is the most serious complication of long-term peritoneal dialysis. It is characterized by thickening of the peritoneum, including cancer, and signs and symptoms of obstructive ileus. Diagnosis is based on clinical, laboratory and radiological parameters. Encapsulating sclerosis of the peritoneum can be indicated by an AR-CA-125 concentration of less than 33 U/min and a concentration of AR-IL-6 greater than 350 pg/min in the effluent of patients with ultrafiltration weakness. Treatment consists of stopping peritoneal dialysis, using anti-inflammatory (corticosteroids) and anticicatricial drugs (tamoxifen), while surgical treatment includes enterolysis and adhesiolysis.
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