Biomarkers for Evaluation of Clinical Outcomes of Hemodiafiltration

Sakurai, Katsunobu

doi:10.1159/000346364

Cited by 44 publications

(35 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The aim of HDF, however, is to remove much larger solutes than hemodialysis, and the largest target substance to remove may be α 1 -microglobulin (α 1 -MG) [4], the molecular weight of which is 33 kDa. The reduction rate of α 1 -MG corresponds to improvement of clinical symptoms such as bone pain and restless legs syndrome [5]. Since direct toxicity of α 1 -MG has not yet been reported, it may be one of surrogate markers for evaluation of clinical outcomes of treatment.…”

Section: Resultsmentioning

confidence: 99%

Diafilters for Predilution and Postdilution On-Line Hemodiafiltration

Yamashita

2013

Blood Purif

View full text Add to dashboard Cite

When hemodiafiltration (HDF) is performed, we can choose the point on the blood circuit where the substitution fluid goes in, i.e. before the diafilter (predilution) or after the diafilter (postdilution). We must avoid unexpected loss of albumin; however, we should remove a certain amount of albumin in order to remove much larger solutes than β₂-microglobulin and obtain better clinical outcomes. Previously, ultrafiltration experiments were performed in vitro using aqueous albumin solution and commercial diafilters. The results showed a high sieving coefficient for albumin right after starting the experiment that is identical to several clinical reports. Based on these results, a novel design of the diafilter was attempted for predilution and postdilution HDF. Diafilters for predilution HDF do not require much change in design specifications, employing hollow fibers with a slightly larger diameter in order to reduce high blood pressure caused by the high blood flow rate. Diafilters for postdilution HDF may require much change, including shortening the length in order to reduce the amount of internal filtration. Diafilters specifically designed for predilution or postdilution may be necessary to assure future success of clinical HDF treatment.

show abstract

Section: Resultsmentioning

confidence: 99%

Diafilters for Predilution and Postdilution On-Line Hemodiafiltration

Yamashita

2013

Blood Purif

View full text Add to dashboard Cite

show abstract

“…The advantages of OHDF over HD (the more conventional blood purification method) are as follows: (i) OHDF stabilizes the circulation dynamics and there is no need to remove low molecular weight proteins proactively, and (ii) OHDF is beneficial in treating dialysisrelated amyloidosis, pruritus, and restless leg syndrome; however, proactive removal of low molecular weight proteins (β2-MG and α1-MG) is required in this case. Albumin is also largely removed when treating dialysisrelated amyloidosis, pruritus, and restless leg syndrome using OHDF [7]. Furthermore, there was no significant correlation between pre-dialysis blood glucose levels and HbA1c or GA levels in each group as shown in the regular blood test results, which had been performed under non-fasting conditions.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, based on a target value for low molecular weight protein removal in relation to complications as proposed by Sakurai [7], we classified the 41 patients from whom we had collected effluent dialysate fluid samples into 3 groups. According to Sakurai's study, the α1-microglobulin (α1-MG) removal rate corresponds to a reduction in uremic symptoms and albumin loss.…”

Section: Measurementsmentioning

confidence: 99%

Glycated hemoglobin and glycated albumin in patients with diabetes undergoing hemodiafiltration

et al. 2020

View full text Add to dashboard Cite

Background: Online hemodiafiltration (OHDF), which results in high albumin leakage, is now widely used in Japan for dialysis, since the national insurance system began reimbursing its costs in 2012. Glycated albumin (GA) levels are affected by albumin leakage into effluent dialysate fluid. Therefore, GA levels in patients requiring diabetesrelated dialysis undergoing OHDF require monitoring. However, there have been no previous reports on glycemic control indicators of patients with diabetes undergoing OHDF. We aimed to develop a glycemic control index for patients requiring diabetes-related dialysis undergoing OHDF. Methods: This study comprised 133 diabetic patients undergoing OHDF. We examined the correlation between GA and glycated hemoglobin (HbA1c) levels. We analyzed effluent dialysate fluid samples from 41 patients classified into 3 groups, namely, group A, non-protein-leaking OHDF (n = 20); group B, protein-leaking OHDF (n = 14); and group C, highly efficient protein-leaking OHDF (n = 7). We examined the association between GA and HbA1c levels in each group and among patients. Results: A significant positive correlation was observed between GA and HbA1c levels (r = 0.562, p < 0.0001). There was no significant correlation between pre-dialysis blood glucose levels and HbA1c or GA levels as observed on regular blood tests performed under non-fasting conditions. Patients were classified into 2 groups based on their mean albumin levels (3.4 g/dL cutoff). The correlation between HbA1c and GA levels was found to be weaker in the 51 patients with mean albumin levels < 3.4 g/dL (r = 0.399, p = 0.0037) than in the 82 patients with mean albumin levels ≥ 3.4 g/dL (r = 0.674, p < 0.0001). When the hemodiafilter performance was assessed, no correlation was observed between HbA1c and GA levels in group C patients. Conclusions: GA levels may be underestimated in patients undergoing OHDF because of the effect of albumin leakage into the effluent dialysate fluid. If a stable hemoglobin value can be maintained during OHDF therapy, then GA and HbA1c levels should be used as a glycemic control index for patients requiring diabetes-related dialysis, considering the dialysis treatment method and protein permeability of the dialyzers and hemodiafilters.

show abstract

“…This is particularly relevant for β-lactam antibiotics or azoles 16 17. This high variability of concentrations is largely due to changes in the patient with renal failure (including weight, plasma proteins and non-renal clearance of drugs)18 19 and the equipment used (haemofiltration system, flow or membrane used by the system) 5 20 21…”

Section: Discussionmentioning

confidence: 99%

Individualised antimicrobial dosing in critically ill patients undergoing continuous renal replacement therapy: focus on total drug clearance

et al. 2017

View full text Add to dashboard Cite

BackgroundContinuous renal replacement therapy (CRRT) is common practice in critical care patients with acute renal failure.ObjectivesTo evaluate the adequacy of antimicrobial doses calculated based on the total drug clearance and dose recommended by different guides in critically ill patients undergoing CRRT.MethodsRetrospective observational study. Patients admitted to a critical care unit during May 2014 to May 2016 and subjected to CRRT were included. The recommended dose was established as the product of the usual dose of the drug by total drug clearance.Results177 antimicrobial agents, used in 64 patients were analysed; 45 (25.4%) antimicrobials were given in an insufficient dose (<20%) according to the theoretical calculation. Following the recommendations in the revised guidelines, between 10% and 20% of antimicrobials were given in insufficient doses. A higher success rate of treatment in those patients not receiving a low drug dosage was seen (35.2% vs 24.0%).ConclusionsThere is a great disparity between the antimicrobial dose prescribed, recommended and calculated based on drug clearance in critically ill patients undergoing CRRT.

show abstract

Biomarkers for Evaluation of Clinical Outcomes of Hemodiafiltration

Cited by 44 publications

References 39 publications

Diafilters for Predilution and Postdilution On-Line Hemodiafiltration

Diafilters for Predilution and Postdilution On-Line Hemodiafiltration

Glycated hemoglobin and glycated albumin in patients with diabetes undergoing hemodiafiltration

Individualised antimicrobial dosing in critically ill patients undergoing continuous renal replacement therapy: focus on total drug clearance

Contact Info

Product

Resources

About