Biocompatibility issues in hemodialysis

Vanholder, Raymond

doi:10.1016/0267-6605(92)90090-g

Cited by 44 publications

(20 citation statements)

References 317 publications

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“…Extremely high (43 Pa) and low (o0.5 Pa) WSS values have been correlated to intimal hyperplasia development leading to stenosis (Vanholder, 1992;Ene-Iordache et al, 2001;Meyerson et al, 2001). The wall shear stress gradient expresses the spatial variation of the wall shear stress.…”

Section: Geometry Governing Equations and Hemodynamic Parametersmentioning

confidence: 99%

Comparison of the hemodynamics in 6 mm and 4–7 mm hemodialysis grafts by means of CFD

Tricht

Wachter

Tordoir

et al. 2006

Journal of Biomechanics

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Section: Geometry Governing Equations and Hemodynamic Parametersmentioning

confidence: 99%

Comparison of the hemodynamics in 6 mm and 4–7 mm hemodialysis grafts by means of CFD

Tricht

Wachter

Tordoir

et al. 2006

Journal of Biomechanics

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“…Extremely high and low WSS values coupled with oscillatory flows are strongly correlated with the IH development and subsequent stenosis (Kleinstreuer et al 1991;Vanholder 1992;He & Ku 1996;Ene-Iordache et al 2001;Meyerson et al 2001). Also, large spatial WSSG contributes to the elevated wall permeability and atherosclerotic lesions (DePaola et al 1992).…”

Section: Hemodynamic Parametersmentioning

confidence: 95%

Sequential venous anastomosis design to enhance patency of arterio-venous grafts for hemodialysis

Kabinejadian

Ghista³

et al. 2016

Computer Methods in Biomechanics and Biomedical Engineering

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Arterio-venous grafts (AVGs), the second best option as long-term vascular access for hemodialysis, face major issues of stenosis mainly due to development of intimal hyperplasia at the venous anastomosis which is linked to unfavorable hemodynamic conditions. We have investigated computationally the utility of a coupled sequential venous anastomotic design to replace conventional end-to-side (ETS) venous anastomosis, in order to improve the hemodynamic environment and consequently enhance the patency of AVGs. Two complete vascular access models with the conventional and the proposed venous anastomosis configurations were constructed. Three-dimensional, pulsatile blood flow through the models was simulated, and wall shear stress (WSS)-based hemodynamic parameters were calculated and compared between the two models. Simulation results demonstrated that the proposed anastomotic design provides: (i) a more uniform and smooth flow at the ETS anastomosis, without flow impingement and stagnation point on the artery bed and vortex formation in the heel region of the ETS anastomosis; (ii) more uniform distribution of WSS and substantially lower WSS gradients on the venous wall; and (iii) a spare route for the blood flow to the vein, to avoid re-operation in case of stenosis. The distinctive hemodynamic advantages observed in the proposed anastomotic design can enhance the patency of AVGs.

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“…Furthermore, a human plasma solution was circulated in the blood compartment before the start of the infusion of the contaminated dialysis fluid, to create a protein coating to the tested membranes, a phenomenon also present in real clinical conditions [38] . This coating is important with respect to biocompatibility in vivo [39] , but of note, it also decreases transport through the membrane and in this way also backfiltration of contaminants [38] .…”

Section: Why Do We Need Studies On Cross-contamination Of Bacterial Pmentioning

confidence: 99%

The Place of Large Pore Membranes in the Treatment Portfolio of Patients on Hemodialysis

Biesen

Vanholder

Schepers

et al. 2017

Expanded Hemodialysis: Innovative Clinical Approach in Dialysis

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Cardiovascular disease is a major concern in patients with end-stage kidney disease (ESKD). Inflammation induced by retention of uremic toxins, of which a substantial fraction has a molecular weight in the middle molecular range, has been associated with increased cardiovascular risk. In an attempt to reduce inflammation and thus cardiovascular toxicity in patients with ESKD, hemodiafiltration (HDF) has been promoted to enhance the clearance of middle molecular weight substances during dialysis. However, HDF increases the technical complexity and costs, and requires ultrapure dialysis fluid. Also, HDF becomes less beneficial when it is not possible to achieve sufficient convective volume in all patients. Over the last years, membranes with larger pore sizes, such as medium cut-off and high cut-off, have been introduced. These membranes, applied in hemodialysis mode, appear to have removal rates of middle molecular weight molecules that are comparable to those achieved with HDF, and could thus obviate the need for HDF. However, ultrapure dialysis fluid might still be required if there is a risk of transmigration of contaminants from the dialysate side into the blood because of the increased pore size. This transmigration of pyrogens might upregulate the expression of cytokines and other pro-inflammatory factors, and thus completely neutralize the beneficial effects of higher clearance of middle molecules. This chapter will explore the existing evidence on permeability of membranes with large pores for bacterial degradation products, and based on this information we will try to define the position of these novel membranes among the spectrum of existing membranes.

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Biocompatibility issues in hemodialysis

Cited by 44 publications

References 317 publications

Comparison of the hemodynamics in 6 mm and 4–7 mm hemodialysis grafts by means of CFD

Comparison of the hemodynamics in 6 mm and 4–7 mm hemodialysis grafts by means of CFD

Sequential venous anastomosis design to enhance patency of arterio-venous grafts for hemodialysis

The Place of Large Pore Membranes in the Treatment Portfolio of Patients on Hemodialysis

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