The central dialysis fluid delivery system (CDDS): is it specialty in Japan?

Kawanishi, Hideki; Moriishi, Misaki; Takahashi, Naoko; Tsuchiya, Shinichiro

doi:10.1186/s41100-016-0016-4

Cited by 20 publications

(17 citation statements)

References 11 publications

(23 reference statements)

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“…The apparatus used at the five institutions included 7 RO equipment, 7 CDDS, and 23 dialysis machines, and the data shown represent the measurements performed four times for each site. Clinical trials were conducted after the confirmation that water/dialysate met the specified water quality standards [6,7].…”

Section: Water Removal Errormentioning

confidence: 99%

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Clinical evaluation of a newly developed automated hemodialysis system as a clinical trial

Sügimura

Murata²,

Funakoshi³

et al. 2018

Ren Replace Ther

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Background: To cope with the increasing number of patients on long-term hemodialysis (HD), especially those with diabetic nephropathy, we designed a fully automated HD system to decrease staff workload and hence human errors related to HD treatment. In this study, we evaluated this new system as a clinical trial. Methods: Based on a dialysis machine combined with a central dialysate delivery system (CDDS), the new system is characterized by the use of back ultrafiltrated dialysate (BUD) as a substitute fluid for priming, bonus shot and blood return, and the attachment of double endotoxin retentive filters (ETRFs). Results: The subjects comprised 61 patients from five HD facilities enrolled in a randomized, open-labeled crossover study after giving written informed consent. A total of 348 HD treatments for 58 of the 61 patients were studied under a protocol designed in accordance with good clinical practice (GCP) guidelines and approved by the respective institutional review boards. No severe adverse effects were observed with either the test or control systems. The incidence of clinical events, including blood pressure decline, residual blood, and error in fluid removal, was not statistically significant in either group. Neither endotoxins nor bacteria were detected in the dialysate passing through the double filters. Conclusions: This study confirmed the safety and effectiveness of an automated HD system based on CDDS.

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Section: Water Removal Errormentioning

confidence: 99%

“…5 Division of Nephrology and Dialysis, Department of Medicine, Social Insurance Chuo General Hospital, Tokyo, Japan. 6 Department of Blood Purification, Heisei Hidaka Clinic, Takasaki, Japan. 7 Toray Medical Co., Ltd., Tokyo, Japan.…”

Section: Fundingmentioning

confidence: 99%

Clinical evaluation of a newly developed automated hemodialysis system as a clinical trial

Sügimura

Murata²,

Funakoshi³

et al. 2018

Ren Replace Ther

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“…20 Unlike in other countries, where singlepatient dialysis fluid delivery systems have been used based on each patient's condition, a central dialysis fluid delivery system has been adopted for the past 45 years in Japan with the dialysate calcium concentration determined based on the policy of the medical facility. 21 Because evocalcet and cinacalcet both lower the serum calcium concentration, their efficacy and safety may be affected by the concentration of dialysate calcium.…”

Section: Introductionmentioning

confidence: 99%

<p>Efficacy and Safety of Evocalcet Evaluated by Dialysate Calcium Concentration in Patients with Secondary Hyperparathyroidism Undergoing Hemodialysis</p>

Sügimura

Asada

Endo

et al. 2020

IJNRD

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Purpose: Evocalcet is a novel oral calcimimetic drug that has demonstrated similar efficacy to cinacalcet in regulating serum parathyroid hormone (PTH), calcium, and phosphate levels, with fewer upper gastrointestinal tract-related adverse drug reactions (ADRs) in patients with secondary hyperparathyroidism undergoing hemodialysis in Japan. We investigated the efficacy and safety of once-daily oral evocalcet under different dialysate calcium concentrations. Patients and Methods: A post hoc analysis by dialysate calcium concentration (2.5, 2.75, and 3.0 mEq/L) was performed using data from a previous Phase 3 study that included cinacalcet as an active control. Efficacy endpoints were the proportion of patients who achieved the target intact PTH levels of ≥60 and ≤240 pg/mL between Week 28 and Week 30; time-course changes in serum intact PTH; calcium and phosphorus levels, bone turnover markers, and fibroblast growth factor 23 (FGF23) over the 30-week study period. Safety endpoints were overall ADRs and hypocalcemiaand upper gastrointestinal tract-related ADRs. Results: A total of 634 patients were included in the analysis. Levels of intact PTH, calcium, phosphate, bone turnover markers, and FGF23 showed improvement in all subgroups , irrespective of dialysate calcium concentration. The incidence of upper gastrointestinal tractrelated ADRs was significantly lower in the evocalcet group than the cinacalcet group with dialysate calcium concentrations of 2.75 and 3.0 mEq/L (p<0.05 for both concentrations). Conclusion: Evocalcet was effective and safe in regulating the levels of serum intact PTH, calcium, and phosphate in patients with secondary hyperparathyroidism undergoing hemodialysis, irrespective of dialysate calcium concentration.

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“…Standard reverse osmosis discharges more water than it actually produces for dialysis; the recovery ratio, i.e. the percentage of depurated water used for dialysis, can be over 80%, if the newer systems are employed; these are more expensive and the lifespan of the reverse osmosis membranes is often considerably shorter, especially when reverse osmosis is not coupled with a water softener system [9,19,27,31,[52][53][54][55][56][57].…”

mentioning

confidence: 99%

“…Centralised water preparation systems, available since the late 1970s, and particularly diffused in Japan, are The circular "cradle to cradle" model: technical waste should nourish the technical cycle, similar to organic waste, nourishing plants and being continously recycled in the biosphere increasingly being used: they combine water treatment with dialysis fluid preparation, both for haemodialysis and for haemodiafiltration [53][54][55][56][57]. This partly compensates for the higher costs of HDF and the avoidance of plastic bags for reinfusion is of obvious interest not only for reducing waste, but also as for water consumption.…”

mentioning

confidence: 99%

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

et al. 2020

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High-technology medicine saves lives and produces waste; this is the case of dialysis. The increasing amounts of waste products can be biologically dangerous in different ways: some represent a direct infectious or toxic danger for other living creatures (potentially contaminated or hazardous waste), while others are harmful for the planet (plastic and non-recycled waste). With the aim of increasing awareness, proposing joint actions and coordinating industrial and social interactions, the Italian Society of Nephrology is presenting this position statement on ways in which the environmental impact of caring for patients with kidney diseases can be reduced. Due to the particular relevance in waste management of dialysis, which produces up to 2 kg of potentially contaminated waste per session and about the same weight of potentially recyclable materials, together with technological waste (dialysis machines), and involves high water and electricity consumption, the position statement mainly focuses on dialysis management, identifying ten first affordable actions: (1) reducing the burden of dialysis (whenever possible adopting an intent to delay strategy, with wide use of incremental schedules); (2) limiting drugs and favouring "natural" medicine focussing on lifestyle and diet; (3) encouraging the reuse of "household" hospital material; (4) recycling paper and glass; (5) recycling non-contaminated plastic; (6) reducing water consumption; (7) reducing energy consumption; (8) introducing environmental-impact criteria in checklists for evaluating dialysis machines and supplies; (9) encouraging well-planned triage of contaminated and non-contaminated materials; (10) demanding planet-friendly approaches in the building of new facilities.

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The central dialysis fluid delivery system (CDDS): is it specialty in Japan?

Cited by 20 publications

References 11 publications

Clinical evaluation of a newly developed automated hemodialysis system as a clinical trial

Clinical evaluation of a newly developed automated hemodialysis system as a clinical trial

<p>Efficacy and Safety of Evocalcet Evaluated by Dialysate Calcium Concentration in Patients with Secondary Hyperparathyroidism Undergoing Hemodialysis</p>

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

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