Haemofiltration and haemodiafiltration

2018 ◽  
Author(s):  
Francesco Locatelli ◽  
Celestina Manzoni ◽  
Giuseppe Pontoriero ◽  
Vincenzo La Milia ◽  
Salvatore Di Filippo
Keyword(s):  
Chronic Kidney Disease Stage ◽  
Cost Effective ◽  
Convective Transport ◽  
Disease Stage ◽  
High Flux ◽  
Beneficial Effects ◽  
Positive Effects ◽  
Randomized Controlled ◽  
On Line ◽  
The Impact

Many observational studies have consistently shown that high-flux haemodialysis (hf-HD) has positive effects on the survival and morbidity of uraemic patients when compared with low-flux haemodialysis, and mainly considering the results of Membrane Permeability Outcome (MPO) studies there is evidence favouring high-flux treatments. A further improvement in convective treatments is represented by the on-line modality. On-line preparation from fresh dialysate by a cold-sterilizing filtration process is a cost-effective method of providing large volumes of infusion solution. Randomized, controlled, large-sized trials with long follow-up in haemofiltration (HF) are unfortunately lacking, possibly suggesting the difficulties in performing these trials, mainly in providing the same urea Kt/V considered adequate in HD. On-line haemodiafiltration (HDF) is considered the most efficient technique of using high-flux membranes, and clearances of small solutes like urea are higher in HDF than in HF and of middle solutes like β‎‎‎2-microglobulin are higher than in hf-HD. Thus HDF, as a strategy based on simultaneous diffusive and convective transport, may combine the beneficial effects of diffusive standard HD with the possible advantages of convective HF. Five large, randomized controlled trials just concluded are inconclusive in definitively clarifying the impact of on-line HDF on chronic kidney disease stage 5 patient outcomes.

Randomized Controlled Trial of a Cognitive Narrative Crisis Intervention for Bereavement in Primary Healthcare

2016 ◽  
Vol 45 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Ana Sofia Andrade ◽  
Margarida Moreira ◽  
Mónica Sá ◽  
Duarte Pacheco ◽  
Vera Almeida ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Traumatic Stress ◽  
Controlled Trial ◽  
Cost Effective ◽  
Structured Interview ◽  
Control Group ◽  
Randomized Controlled ◽  
Demographic Questionnaire ◽  
The Impact ◽  
Experimental Group

Background and Aims: As there are known risks of retraumatization through bereavement crisis interventions, we tailored a new intervention lowering the degree of direct emotional activation. However, we need some evidence on the effects of depression and psychotraumatic symptoms between 1 and 6 months after a loss. Method: We conducted a randomized controlled trial with two groups: control group (n = 18) and experimental group (n = 11) in two assessments (1 and 6 months after loss); both included a semi-structured interview (Socio-Demographic Questionnaire, Beck Depression Inventory and the Impact of Events Scale-Revised–IES-R). The experimental group had a cognitive-narrative program with four sessions: recalling; cognitive and emotional subjectivization; metaphorization; and projecting sessions. Results: Participants in the experimental and control groups have lower levels of depression and traumatic stress 6 months after a loss. Statistically significant results in emotional numbing IES-R sub-scale are observed. Conclusions: A brief narrative-based cost-effective intervention has a positive effect on depression, controlling the traumatic stress and time after a loss.

scholarly journals Impact of television on children and adolescents: A research review

2016 ◽  
pp. 917-929
Author(s):  
Ana Pesikan
Keyword(s):  
Children And Adolescents ◽  
Dietary Habits ◽  
Violent Behavior ◽  
Research Review ◽  
Negative Effects ◽  
Beneficial Effects ◽  
Positive Effects ◽  
Increased Risk ◽  
Elevated Cholesterol ◽  
The Impact

Media has one of the most important and under-recognized influence on health, development and behavior of children and adolescents. Television is still the most popular form of media among children and adolescents. In the last 50 years, more than a thousand researches have been carried out in the world showing the great impact of television on children and adolescents. Television shapes the attitudes, beliefs and behaviors of children and adolescents and strongly influences their perception of reality. The high impact of television is neither recognized by children nor adults; they estimate that the media affect all others except themselves. Television can positively influence a child?s prosocial behavior and acquisition of certain types of knowledge. However, the positive effects have been much less common and usually obtained at a younger age (3-5 years). Most of the studies provide a persistent and robust findings indicating the correlation between exposure to television and a variety of health problems (such as obesity, low physical activity, elevated cholesterol, diabetes, high blood pressure, etc.) and an increased risk of certain types of behavior (like poor dietary habits, less sleep, smoking, violent behavior, alcoholism, drug addiction, etc.). The research results show that the potentials of television with beneficial effects on children have not been realized; the list of negative effects is much longer and much more diverse; and strategies to reduce the negative effects of television do not apply. The documented findings on the impact of television should elicit serious concern, not just from parents and educators but from many others such as physicians, public health advocates, entertainment industry, politicians, and government.

scholarly journals Mindfulness Enhances Cognitive Functioning: A Meta-Analysis of 95 Randomized Controlled Trials

2020 ◽  
Author(s):  
Nur Hani Hani Zainal ◽  
Michelle G. Newman
Keyword(s):  
Randomized Controlled Trials ◽  
Sustained Attention ◽  
Treatment Effects ◽  
Control Group ◽  
Controlled Trials ◽  
Cognitive Domains ◽  
Positive Effects ◽  
Mindfulness Skills ◽  
Randomized Controlled ◽  
The Impact

Background: The past 30 years have witnessed growing scientific interest regarding the impact of mindfulness-based interventions (MBIs) on cognitive functions. Several theories propose that habitually exercising mindfulness skills can improve cognitive abilities, but no comprehensive quantitative reviews of the effect of MBIs on global and unique cognitive domains exist to date. Method: This systematic review thus examined the effects of MBI on global cognitive ability (GCA) and 16 specific cognitive domains. MBI randomized controlled trials (RCTs) that administered cognitive tests pre- and post-treatment were included. Open-trials, non-randomized MBIs, and case-control studies were excluded. Keywords included “mindful*,” AND “executive attention (EA),” OR “working memory (WM).” Robust variance estimation and moderator analyses were conducted. Results: Ninety-five RCTs (n = 7,408) met eligibility criteria. MBI (vs. waitlist or no-treatment) had small-to-moderate significant effects on GCA, WM accuracy, inhibition accuracy and latency, EA, sustained attention accuracy, processing speed, and subjective attentional control (SAC) (g = 0.24 – 0.52). Likewise, MBI (vs. active control) had small-to-moderate positive effects on GCA, orienting, EA, WM accuracy, sustained attention (indexed by intra-individual coefficient of variation), and SAC (average g = 0.17 – 0.41). Age, gender, study quality, treatment duration, publication year, retention, statistical analysis, and country, moderated some treatment effects. Publication bias analyses showed that reliable treatment effects were restricted to EA, WM accuracy, inhibition accuracy, sustained attention, and SAC, depending on the control group. Conclusion: MBIs confer notable neuropsychological benefits and dose-response effects on some specific (vs. global) cognitive domains. Limitations, theoretical, and applied implications are discussed. (NOTE: This paper has not been peer reviewed. Please do not copy or cite without author's permission.)

scholarly journals P1082COMPARISON OF THE REMOVAL OF PROTEIN-BOUND TOXINS AND LARGE MIDDLE MOLECULES WITH HIGH-FLUX PMMA AND MEDIUM CUT-OFF DIALYZERS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Pablo Molina ◽  
Julio Peiró ◽  
María Amparo Martínez-Gómez ◽  
Belén Vizcaíno ◽  
Mercedes Gonzã¡lez Moya ◽  
...  
Keyword(s):  
Membrane Surface ◽  
Convective Transport ◽  
Reduction Ratio ◽  
Prospective Clinical Study ◽  
Dialysis Session ◽  
High Flux ◽  
Dialysate Flow ◽  
Middle Molecules ◽  
On Line ◽  
New Generation

Abstract Background and Aims Dialytic clearance of protein-bound toxins and large middle molecules is poor by diffusive treatment and limited by high-flux hemodialysis (HD) and on-line hemodiafiltration (OL-HDF), and only a few studies have examined how to improve their removal by other extracorporeal strategies. Since 2017, there is a new generation of polymethyl methacrylate (PMMA) membranes that suppress platelet adhesion on the membrane surface improving hemocompatibility and permeability, while also maintaining adsorption properties related to conventional PMMA membranes. Expanded HD (HDx) with medium cut-off (MCO) membranes has also recently been incorporated into clinical practice and may improve the removal of uremic toxins in HD treatments. The aim of this pilot study was to compare the efficacy of a new high-flux PMMA dialyzer (Filtryzer® NF-2.1H) in a post-dilution OL-HDF session with a new MCO membrane (Theranova® 400) in a HDx session. Method In an open, cross-over, single-center, controlled, prospective clinical study, 40 adult stable HD patients were assigned to be treated by post-dilution OL-HDF with the NF-2.1H dialyzer or by HDx with the Theranova 400 dialyzer. All other dialysis parameters, including blood and dialysate flow rates, length of dialysis session, and ultrafiltration rate remained unchanged during both sessions. P-cresyl sulfate (PCS), indoxyl sulfate (IS), and kappa (κ) and lambda( λ) free light chains (FLC) reduction rates were intraindividually compared for the two dialyzer types (primary outcomes). Secondary outcomes included the kt and the reduction ratio of blood urea nitrogen, phosphate and β2 -microglobulin (β 2-m). Results The reduction ratio of protein-bound toxins ranges from 60% to 67%, with no differences between membranes (Figure). PMMA membrane achieved greater FLC reduction ratios than MCO membrane, reaching significance for λFLC (56.6% vs. 77.4%; p < 0.001). Conversely, β2M reduction ratio was slightly but significantly higher with MCO membrane (68.5 vs. 72.1%; p = 0.002). Small molecules removal including urea and phosphate were similar in both groups, achieving an optimal Kt with no differences between groups (61.3±9.2 Vs. 59.7±9.3; p=0.16). Albumin reduction ratio tended to be higher with PMMA membrane without reaching significance (10.1±5.9% Vs. 7.8±12.3%; p=0.17). The mean convective volume achieved with PMMA was 23.5±4.4 L. Conclusion This study suggested that new high-flux PMMA dialyzer in post-dilution OL-HDF mode might achieve better FLC reduction ratios than MCO dyalizer in HDx mode, whereas both techniques may equally remove protein-bound toxins. OL-HDF with new PMMA membranes could be a good dialysis strategy for adding convective transport to the well-known mechanisms of diffusion and absorption previously described with conventional PMMA membranes, enabling an adequate substitution volume.

Single Session and Weekly Beta 2-Microglobulin Removal with Different Dialytic Procedures: Comparison between High-Flux Standard Bicarbonate Hemodialysis, Post-Dilution Hemodiafiltration, Short Frequent Hemodialysis with NxStage Technology and Automated Peritoneal Dialysis

2019 ◽  
Vol 48 (1) ◽  
pp. 86-96 ◽  
Author(s):  
Chiara Carla Maria Brunati ◽  
Francesca Gervasi ◽  
Mara Cabibbe ◽  
Federica Ravera ◽  
Alberto Menegotto ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Removal Rate ◽  
High Flux ◽  
Automated Peritoneal Dialysis ◽  
Single Session ◽  
Daily Dialysis ◽  
On Line ◽  
Beta 2 Microglobulin ◽  
Few Data ◽  
The Impact

Background: NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this “low dialysate volumes system” on the removal rate of poorly diffusible, time-dependent solutes like β2-microglobulin (β2M). Methods: Single-session and weekly balances of β2M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD). Results: Intradialytic fall of plasma water β2M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD. Conclusions: Weekly β2M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.

On-Line Hemodiafiltration with Pre- and Postdilution: A Comparison of Efficacy

1997 ◽  
Vol 20 (2) ◽  
pp. 81-90 ◽  
Author(s):  
P. Ahrenholz ◽  
R.E. Winkler ◽  
W. Ramlow ◽  
M. Tiess ◽  
W. Müller
Keyword(s):  
Molecular Weight ◽  
Theoretical Description ◽  
Convective Transport ◽  
Small Molecular Weight ◽  
Dialysate Flow ◽  
Significant Difference ◽  
On Line ◽  
The Impact

Since the introduction of on-line substituate preparation, high substituate rates (Qs) in pre- and postdilution for hemodiafiltration (HDF) procedures can be realized. During postdilution HDF (POD-HDF) and additional convective removal is possible, but in vivo Qs is limited to approx. 1/3Qb (bloodflow). With predilution HDF (PRD-HDF) higher Qs and therefore high convective transport rates by ultrafiltration can be reached. On the other hand the blood concentration is diminished by predilution. Further decrease of the diffusive transport is caused by reduced dialysate flow Qd due to separation of the substituate from the dialysate (Fresenius 4008 On-Line HDF, Gambro AK100 Ultra). The theoretical description of the combined diffusive-convective transport is limited to 1-dimensional models and small UF-rates. Therefore for practical and theoretical purposes the assessment of the efficacy of on-line PRD-HDF and POD-HDF in different molecular weight ranges is desirable. By means of in vitro experiments the effective clearances Keff of hemodialysis (HD, dialyzer: Fresenius F60) for urea, creatinine, vitamin B12 and inulin were compared with measured and theoretical Keff of POD- and PRD-HDF. The theoretical expectation is confirmed that Keff for small molecular weight substances decreases slightly with PRD-HDF and increases for larger molecules. In the case of POD-HDF Keff for small molecular weight substances increases slightly and strongly for larger molecules. In vivo experiments were performed to measure the real substance removal from patient's blood and to figure out the impact of dialysate flow (collection of the used dialysate during the 1. treatment hour and concentration measurements for urea, creatinine, phosphate, ß2-MG). The results show that the substraction of Qs from Qd reduces Keff for urea, creatinine and phosphate but not for ß2-MG. PRD-HDF with Qd = 500 ml/min is significantly less effective for small molecules than HD. There is no significant difference of Keff for urea, creatinine, phosphate during HD and PRD-HDF with Qd = 800 ml/min, but a significant increase of 10-15% for POD-HDF Keff for ß2-MG increases by 75% for PRD-HDF and 95% for POD-HDF compared with HD (Qd = 500 ml/min).

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