Re‐evaluation of Pre‐pump Arterial Pressure to Avoid Inadequate Dialysis and Hemolysis: Importance of Prepump Arterial Pressure Monitoring in Hemodialysis Patients

Shibata, Eriko; Nagai, Kojiro; Takeuchi, Risa; Noda, Yoichi; Makino, Tomomi; Chikata, Yusuke; Hann, Michael; Yoshimoto, Sakiya; Ono, Hiroyuki; Ueda, Sayo; Tamaki, Masanori; Murakami, Taichi; Matsuura, Motokazu; Abe, Hideharu; Doi, Toshio

doi:10.1111/aor.12448

Cited by 12 publications

(17 citation statements)

References 17 publications

(28 reference statements)

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“…Such pressures can decrease the delivery of blood flow, result in inadequate dialysis and lead to haemolysis. Even pressure values below −150 mmHg have been shown to induce haemolysis …”

Section: Causesmentioning

confidence: 99%

Haemolysis in haemodialysis

Tharmaraj

Kerr

2017

Nephrology

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ABSTRACT:Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk. Haemolysis can manifest with non-specific signs and symptoms including but not restricted to hypertension, nausea, pain (abdominal, chest, back) and dyspnoea. It may present acutely during the dialysis session or may take a protracted course. Potential life threating consequences include; hyperkalaemia induced cardiac arrhythmias, profound anaemia and associated acute coronary events and respiratory distress, and severe necrotizing pancreatitis. Chronic haemolysis results in impaired endothelial function thus contributing to the long-term cardiovascular risk profile in haemodialysis patients. Stringent national and international standards, technological advancements in membrane and dialysis equipment design, dialyser purification methods and water treatment systems have greatly reduced the incidence of haemolysis. Despite these improvements recognition of haemolysis risk and ongoing clinical vigilance is important.

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“…Such pressures can decrease the delivery of blood flow, result in inadequate dialysis and lead to haemolysis. Even pressure values below −150 mmHg have been shown to induce haemolysis …”

Section: Causesmentioning

confidence: 99%

Haemolysis in haemodialysis

Tharmaraj

Kerr

2017

Nephrology

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“…Over time the standard blood pump for dialysis circuits changed from a small three headed peristaltic rotatory positive displacement pump to the current two headed rotary pump. Clinical studies using blood flows < 350 ml/min were unable to demonstrate red cell fragmentation, but laboratory studies reported increased haemolysis with blood flows increasing above 300 ml/min with increasing pre-pump pressures of -150 mmHg [4,5]. This mechanical trauma to cells is reduced by using lower pump speeds, but also by redesigning the blood pump.…”

Section: Improving the Design Of The Extracorporeal Circuitmentioning

confidence: 99%

New Dialysis Technology and Biocompatible Materials

Davenport

2016

Contributions to Nephrology

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Although haemodialysis is an established treatment for patients with end-stage kidney disease, sustaining life for more than 2 million patients world-wide, the mortality of dialysis patients remains high and is greater than that for some of the more common solid organ cancers. As such, the question arises as to whether more efficient clearance of the waste products of metabolism which accumulate would improve outcomes. Recent reports of an association between improved patient survivals with higher-volume on-line haemodiafiltration exchanges would support this hypothesis. This has led to both the development of newer dialyser designs based on microfluidics using convective clearances to increase middle-molecule clearances and also a generation of superflux dialysers designed to remove larger-molecular-weight azotaemic toxins which have yet to be studied in large randomised prospective clinical trials. However, haemodiafiltration and superflux dialysers do not affectively clear protein-bound azotaemic toxins, and there is accumulating evidence that some of these toxins increase cardiovascular morbidity and mortality. This has led to resurgence in the interest of developing adsorption devices, using activated carbon technology, and the development of composite dialyser membranes by either adding carbons or other biomaterials to increase adsorption capacity to the standard dialyser. While anaphylactoid reactions used to be a recognised complication of haemodialysis, improvements in dialyser membrane bioincompatibility and changing sterilisation techniques have markedly reduced these reactions. Organic chemicals can leach out from the plastics in the blood lines and dialyser, and attention is required to adequately rinse the extracorporeal circuit to reduce patient exposure.

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“…Eriko Shibata et al of the University of Tokushima, Tokushima, Japan evaluated the importance of prepump arterial pressure (PreAP) and delivered flow or PreAP and hemolysis in the prediction of inadequate dialysis and hemolysis. By using different diameter needles, human blood samples from healthy volunteers were circulated in a closed dialysis circuit.…”

Section: Renal Supportmentioning

confidence: 99%

Artificial Organs 2015: A Year in Review

Malchesky¹

2016

Artificial Organs

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In this Editor's Review, articles published in 2015 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for providing their work to this journal. We offer our very special thanks to our reviewers who give so generously of their time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers, the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

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Re‐evaluation of Pre‐pump Arterial Pressure to Avoid Inadequate Dialysis and Hemolysis: Importance of Prepump Arterial Pressure Monitoring in Hemodialysis Patients

Cited by 12 publications

References 17 publications

Haemolysis in haemodialysis

Haemolysis in haemodialysis

New Dialysis Technology and Biocompatible Materials

Artificial Organs 2015: A Year in Review

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