Pros and Cons of Short, High Efficiency, and High Flux Dialysis

Barth, Robert H.

doi:10.1007/978-0-585-36947-1_17

Cited by 4 publications

(8 citation statements)

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“…The simulated blood pressure waves in the left ventricle, right ventricle, aorta, pulmonary artery, and pulmonary vein (Fig. 7) matched the hemodynamic values for a normal person 12…”

Section: Resultssupporting

confidence: 52%

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Numerical Simulation of the Effect of Sodium Profile on Cardiovascular Response to Hemodialysis

et al. 2008

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PurposeWe developed a numerical model that predicts cardiovascular system response to hemodialysis, focusing on the effect of sodium profile during treatment.Materials and MethodsThe model consists of a 2-compartment solute kinetics model, 3-compartment body fluid model, and 12-lumped-parameter representation of the cardiovascular circulation model connected to set-point models of the arterial baroreflexes. The solute kinetics model includes the dynamics of solutes in the intracellular and extracellular pools and a fluid balance model for the intracellular, interstitial, and plasma volumes. Perturbation due to hemodialysis treatment induces a pressure change in the blood vessels and the arterial baroreceptors then trigger control mechanisms (autoregulation system). These in turn alter heart rate, systemic arterial resistance, and cardiac contractility. The model parameters are based largely on the reported values.ResultsWe present the results obtained by numerical simulations of cardiovascular response during hemodialysis with 3 different dialysate sodium concentration profiles. In each case, dialysate sodium concentration profile was first calculated using an inverse algorithm according to plasma sodium concentration profiles, and then the percentage changes in each compartment pressure, heart rate, and systolic ventricular compliance and systemic arterial resistance during hemodialysis were determined. A plasma concentration with an upward convex curve profile produced a cardiovascular response more stable than linear or downward convex curves.ConclusionBy conducting numerical tests of dialysis/cardivascular models for various treatment profiles and creating a database from the results, it should be possible to estimate an optimal sodium profile for each patient.

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“…The simulated blood pressure waves in the left ventricle, right ventricle, aorta, pulmonary artery, and pulmonary vein (Fig. 7) matched the hemodynamic values for a normal person 12…”

Section: Resultssupporting

confidence: 52%

“…To facilitate the comparison, we used a urea clearance rate identical to that used by Barth et al,12 As shown in Fig. 6, the 2 models give essentially identical urea concentration profiles and both show the concentration rebound phenomenon for extracellular fluid.…”

Section: Resultsmentioning

confidence: 99%

Numerical Simulation of the Effect of Sodium Profile on Cardiovascular Response to Hemodialysis

et al. 2008

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“…The absence of decrease in urea clearance in the initial (chronic) phase of the occlusion process, in spite of the increase in ¢P, might be due to: (1) an incomplete occlusion of the fibers involved in the clotting phenomena (causing an increase in the resistance without loss of effective surface area and the likely occurrence of accentuated Starling's flow transport with increase of both proximal filtration and distal reabsorption thereby enhancing urea loss [13,14]) and/or (2) a complete occlusion of a minority of the fibers producing an increase in the blood flow in the remaining fibers and consequently an improvement in the urea clearance per fiber (with the polysulfone dialyzer used in the study, an increase in the Q B from 300 to 400 ml/min generates a 14% improvement in the urea clearance [9][10][11]). In the majority of the cases a clot in the venous or arterial drip chamber was detected simultaneously to a clot in the dialyzer; its role in the ¢P variability ( fig.…”

Section: Discussionmentioning

confidence: 99%

“…The blood flow rate was set at 300 ml/min and the dialysis fluid flow rate at 500 ml/min. As dialyzer we used a hollow-fiber (wall thickness 40 Ìm, lumen diameter 200 Ìm) high-flux polysulfone membrane with an effective surface area of 1.3 m 2 and a urea clearance of 242 and 276 ml/min for a Q B of 300 and 400 ml/min respectively (F60S; Fresenius Medical Care) [8][9][10][11]. The monitoring of ¢P was performed with a digital manometer (NEO-1 Dialysate-meter; Automata Medical Instrumentation) inserted into both the arterial and venous drip chamber; a sterile security valve being placed between the manometer and the chamber.…”

Section: Methods and Patientsmentioning

confidence: 99%

Does Monitoring of Pre-/Post-Dialyzer Pressure Difference Improve Efficiency in Intermittent Hemodialysis?

Gabutti

Colucci²,

Martella³

et al. 2003

Blood Purif

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Background: Continuous monitoring of pre-/post-dialyzer pressure difference (ΔP) is widely used in continuous renal replacement therapies to monitor extracorporeal circuit function. The aim of this study was to verify whether ΔP may help to identify chronic subclinical worsening of dialysis quality due to incomplete dialyzer clotting in intermittent hemodialysis. Methods: Nine chronic hemodialysis patients were enrolled in the study and dialyzed twice (high-flux polysulfone dialyzer) with ΔP and urea-clearance monitoring: the first session with a standard anticoagulation and the second without. To verify whether a visible clotting of the dialyzer precedes or follows a significant ΔP increase, we checked the dialyzers for the presence of red clots after a saline flush performed when a 50% increase in ΔP was registered. Results: In the second dialysis session after a 50% increase in ΔP (documented in 7/9 patients), all dialyzers, after saline flush, showed a visible fiber clotting but not a significant reduction (>15%) in urea clearance. In the majority of the patients (6/7), until a few minutes before complete occlusion of the extracorporeal circuit, the urea clearance did not change significantly (–8.9 ± 12.7%). Conclusions: The usual check of the presence or absence of red clots in the dialyzer at the end of the dialysis session is enough, in the absence of red clots, to ensure that dialyzer efficiency is maintained during the whole treatment. Contrary to what is applied in CRRT, a continuous monitoring of ΔP during intermittent hemodialysis would not significantly help to unmask unnoticed inefficient hemodialysis sessions.

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“…Inulin (MW 5200) is cleared 12 times better by high-flux membranes, and 0-2 microglobulin (MW 11 800) is not cleared at all by low-flux cellulosic membranes. 12 On the other hand, clearance of albumin is usually negligible across high-flux membranes, although albumin losses can occur under conditions of reuse with b1ea~h.l~ It remains unclear as to whether there are definite advantages resulting from the clearance of larger-molecular-weight solutes. P-2 Microglobulin (p-2m) has been extensively examined owing to its implication in dialysis-related amyloidosis (DRA).…”

Section: What Are the Advantages Of Highsflux Dialysis?mentioning

confidence: 99%

High‐flux dialysers*

Kerr¹

2002

Nephrology

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SUMMARY: This brief review attempts to define high‐flux dialysis and differentiate it from low‐flux and high‐efficiency dialysis. High‐flux dialysis membranes offer improved clearance of larger‐molecular‐weight solutes, particularly β‐2 microglobulin. Patients exhibit improved cardiovascular stability and long‐term use of these membranes may delay the onset of dialysis‐related amyloidosis. Although high‐flux membranes have improved biocompatibility compared with most low‐flux membranes, this has not been demonstrated to provide morbidity or mortality benefits. Backfiltration of solutes and toxins from the dialysate to the blood is a potential but probably overstated complication of high‐flux dialysis. Most high‐flux membranes are actually efficient barriers to the passage of endotoxins. Cost is the major barrier to more widespread use of high‐flux dialysis.

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Pros and Cons of Short, High Efficiency, and High Flux Dialysis

Cited by 4 publications

References 322 publications

Numerical Simulation of the Effect of Sodium Profile on Cardiovascular Response to Hemodialysis

Numerical Simulation of the Effect of Sodium Profile on Cardiovascular Response to Hemodialysis

Does Monitoring of Pre-/Post-Dialyzer Pressure Difference Improve Efficiency in Intermittent Hemodialysis?

High‐flux dialysers*

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