P1051ASINGLE SESSION AND WEEKLY BETA 2 MICROGLOBULIN REMOVAL DURING SHORT FREQUENT HEMODIALYSIS USING PHYSIDIA TECHNOLOGY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Michel Thomas ◽  
Eric Vincent ◽  
Veliana Todorova
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Removal Rate ◽  
Blood Flow Rate ◽  
Single Session ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Beta 2 ◽  
Beta 2 Microglobulin ◽  
Conventional Hemodialysis

Abstract Background and Aims S3 Physidia monitor is a dedicated system for short frequent hemodialysis at home based on push pull dialysis mode. Clinical data is provided to show the Beta 2 microglobulin elimination, used as a model for middle molecule removal. The aim of the study is to compare Beta 2 microglobulin removal between hemodialysis systems with low dialysate flow rate and conventional hemodialysis or hemodiafiltration. Method Analyzed data is collected during multicentric clinical study performed to evaluate the safety and performances level with S3 Physidia system. This clinical investigation has been conducted in accordance with the Good Clinical Practices (Helsinki Declaration), every patient was informed by the investigator and has signed the consent form prior to the completion of the study. The project has been approved by the local Committee and authorities. Anonymized data of 10 patients (age: 55.3 +/- 12.3 years, weight: 72.8 +/- 17.2 kg) is collected during 126 dialysis sessions (blood flow rate: 293 +/- 24 ml/min, dialysate flow rate: 190 +/- 14 ml/min). The convection volume (Ultrafiltration and back filtration generated by the push pull technique) is between 1 to 8 l per session (dialyzer used: Smartflux HFP190). For each session, Beta 2 microglobulin (β2M) removal rate is calculated by using pre and post dialysis β2M blood concentrations. Post concentration is corrected by using Bergström formula to take into account the hemoconcentration and rebound. Both single session (2hours) and weekly (12 hours/week) β2m removal rates were calculated. Single session and weekly β2m removal levels are compared to published data with conventional hemodialysis or post dilution hemodiafiltration. Weekly dialysis performance is evaluated according to the standardized Kt / V (sdt) according to the Gotch calculation method. Results Using S3 daily hemodialysis, weekly dialysis diffusive performance for urea (standardized Kt / V is 2.56 +/- 0.39, higher than KDIGO recommendations for frequent dialysis (min 2.1). β2M removal rate per session is 52.9 +/- 6.6 % with pre dialytic concentration average value of 25 mg/l corresponding to 73 mg of β2M removed per session. Calculated weekly β2M removal is 438 mg. These results are compared to β2M removal obtained by standard treatment procedures (ref1) and by short frequent hemodialysis using diffusive low dialysate flow (Nx Stage system One, ref 2). During conventional hemodialysis (4h, 3 sessions per week), the β2M removal rate is between 60 to 80 % corresponding to a removal of 300 to 380 mg/week (ref 1) During high volume post dilution hemofiltration (4h, 3 sessions per week, convection > 20 l per session), the average β2M removal rate is 80% corresponding to a removal of 380 mg/week (ref 1) With Nx Stage device, without convective component, single session β2M removal rate is between 40 and 50 % depending on blood flow rate (maximum obtained with blood flow rate 400 ml/min) (ref 2) Ref 1: J. Potier et al, Int J Artif Organs. 2016 Nov 11;39(9):460-470 Ref 2 : M. Leclerc et al, Blood Purif 2018;46:279–285 Conclusion β2M reduction rate obtained with the S3 Physidia system is greater than 50%, removing any dowry concerning the performance of a low dialysate flow rate system. The convective component, provided by the push pull technique, must be confirmed, but these initial results are encouraging (reduction rate > 50% despite a relatively low blood flow rate). Due to the frequency, the quantity of β2M weekly removed is higher than that obtained with conventional treatment methods.

scholarly journals Manual Individualization of the Dialysate flow according to blood flow: Effects on the Hemodialysis dose delivered and on Dialysate consumption

2020 ◽  
Author(s):  
FAYE Moustapha ◽  
Niakhaleen KEITA ◽  
Maria Faye ◽  
Yousseph BERDAI ◽  
Ahmed Tall LEMRABOTT ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Dialysis Dose ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Flow Effects ◽  
The Impact

Abstract Background: The objective of this work was to assess the impact of the decrease in dialysate flow rate on the dialysis dose delivered (spKt /V) to chronic hemodialysis patients and to estimate the resulting water saving. Methods: It was a prospective 4-week-period study that included chronic hemodialysis patients with clinical and hemodynamic stability. The patients successively underwent hemodialysis with a dialysate flow rate of 500 ml / min, at 1, 1.2 and 1.5 times the blood flow rate. Each dialysate flow rate was applied for one week. During these 4 weeks, the following parameters were kept constant: duration of dialysis, blood flow rate, anticoagulation, membrane nature and surface. Results: Forty-five chronic hemodialysis patients were included with a mean age of 48.4 ± 12.07 years. The weekly average spKt/V was statistically higher with a dialysate flow rate at 1.5 times the blood flow rate compared to the dialysate flow at 500 mL / min (p = 0.001). The proportion of patients achieving a standardized dialysis dose ≥ 1.4 was statistically higher with dialysate flow at 500 mL / min (64.4%) compared to dialysate flow at 1 or 1.2 times the blood flow rate which were 57.8% and 55.6%, respectively. It was statistically higher with a dialysate flow at 1.5 times the blood flow (93.3%) compared to the dialysate flow at 500 mL / min (p = 0.036). The dialysate volume used with a dialysate flow rate of 500 mL / min was higher compared to the other dialysate flow rates (p = 0.0001). Conclusions: An adequate dialysis dose could be achieved with a dialysate flow rate of 1.5 times the blood flow rate, thereby saving significant amount of water.

Cost Optimization of a Multilayer Microchannel Dialyzer

2013 ◽  
Author(s):  
Mahshid Mohammadi ◽  
Kendra V. Sharp
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Cost Optimization ◽  
Life Quality ◽  
Single Layer ◽  
Blood Flow Rate ◽  
Porous Membrane ◽  
Dialysate Flow ◽  
Novel Approach ◽  
Dialysate Flow Rate

A microchannel-based hemodialyzer offers a novel approach to hemodialysis practice and holds many promises to improve kidney patients’ life quality and dialysis treatment efficiency. The hallow fiber hemodialyzer, a conventional dialysis device, has certain limitations including non-uniformity of the dialysate flow path which necessitates the use of a high dialysate flow rate. The microchannel-based hemodialyzer with flat membranes remarkably improves the mass transfer characteristics and enables the design of a smaller and less expensive unit with lower dialysate-to-blood flow rate ratios [1, 2]. In the microchannel-based design, successive stacked layers alternate between blood flow and dialysate flow. A porous membrane between these layers allows for the transport of toxins from blood side to dialysis fluid side. A schematic view of a single layer is shown in Fig. 1.

scholarly journals INADEQUACY OF DIALYSIS

2018 ◽  
Vol 25 (03) ◽  
pp. 434-439
Author(s):  
Aurangzeb Afzal ◽  
Adnan Shabbir ◽  
Maira Iqbal Malik
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Reduction Ratio ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Second Phase ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Urea Reduction Ratio

Background: Objectives: In patients with end stage renal disease, inadequatedialysis can lead to increased morbidity and mortality. We conducted a study to analyze effectsof increasing dialysate flow rate (DFR) and blood flow rate (BFR) on adequacy of dialysis.URR was used as an indicator of dialysis adequacy. Study Design: Prospective comparativestudy. Period: 02 months (February 2017 to March 2017). Setting: Department of Nephrology,Lahore General Hospital. Method: 40 patients on maintenance hemodialysis were included.We divided study in three phases. First phase with blood flow 300mL/min dialysate flow 500mL/min. Second phase blood flow 350mL/min dialysate flow 500mL/min. Third phase blood flow300mL/min dialysate flow rate 800mL/min. Blood samples were collected before and after eachdialysis session. Urea reduction ratio (URR) was used to measure delivered dose of dialysis andwas assessed at the two levels of dialysate flow rate and two blood flow rates. Statistical analysiswas done by using SPSS 23.0 software package. P values <0.05 was taken as statisticallysignificant. Result: After statistical analysis we reached the conclusion that enhancing bloodflow rate from 300 to 350 is associated with an increase of URR of 6.9 % as compared toincreasing dialysate flow rate from 500 to 800 of 4.6%. In both settings increase in URR wasclinically significant. We can also deduce that increase in dialysate flow will allow us to achievea substantial increase in dialysis dose as assessed by urea reduction ratio for a given amountof dialysis time when we are unable to achieve a high blood flow rate. Difference in increasein URR for two groups one with increased blood flow and other with increased dialysate flowwas statistically insignificant (p value >0.05). Conclusion: Our study shows that if we increaseblood flow rate to 350 mL/min from 300 mL/min and dialysate flow rate to 800 mL/min from usual500 mL/min there is significant increase in URR and adequacy of dialysis. We can decreasemortality and morbidity by increasing adequacy to optimal level using both methods accordingto patient feasibility and clinical status.

scholarly journals Dialysis Efficiency of AN69, a Semisynthetic Membrane Not Well Suited for Diffusion

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
M. E. Herrera-Gutiérrez ◽  
G. Seller-Pérez ◽  
D. Arias Verdu ◽  
C. Jironda-Gallegos ◽  
M. Martín-Velázquez ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Continuous Hemodiafiltration ◽  
Standard Dosage ◽  
Dialysate Flow ◽  
Good Marker ◽  
Large Dispersion ◽  
Dialysate Flow Rate ◽  
Continuous Hemodialysis

AN69 membrane is not suited for diffusion, with an suggested limit at 25 mL/min dialysate flow rate. When prescribing continuous hemodialysis this threshold must be surpassed to achieve. We designed a study aimed to check if a higher dose of dialysis could be delivered efficiently with this membrane. Ten ICU patients under continuous hemodiafiltration with 1.4 m2 AN69 membrane were included and once a day we set the monitor to exclusively 50 mL/min dialysate flow rate and 250 mL/min blood flow rate and after 15 minutes measured dialysate saturation for urea, creatinine, and -microglobulin. We detected that urea saturation of dialysate was nearly complete () for at least 40 hours, while creatinine saturation showed a large dispersion () and did not detect any relation for these variables with time, blood flow, or anticoagulation regime. Saturation of -microglobulin was low () and decreased discretely with time (, ) and significantly with TMP increases (, ). In our experience AN69 membrane shows a better diffusive capability than previously acknowledged, covering efficiently the range of standard dosage for continuous therapies. Creatinine is not a good marker of the membrane diffusive capability.

scholarly journals Effect of increased blood flow rate on renal anemia and hepcidin concentration in hemodialysis patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masateru Yamamoto ◽  
Tomio Matsumoto ◽  
Hiromitsu Ohmori ◽  
Masahiko Takemoto ◽  
Masanobu Ikeda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Interleukin 6 ◽  
Iron Homeostasis ◽  
Blood Flow Rate ◽  
High Sensitivity ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Dialysate Flow ◽  
Dialysate Flow Rate

Abstract Background Increasing the blood flow rate (BFR) is a useful method for increasing Kt/V and the clearance for low molecular solutes. Hemodialysis patients are often anemic due to hypoerythropoiesis and their chronic inflammatory state. Hepcidin, a hormone that regulates iron homeostasis, is considered as an indicator of iron deficiency in patients with end-stage renal disease. This study aimed to investigate the effects of an increased BFR during hemodialysis on serum hepcidin levels and anemia. Methods Between April 2014 and March 2016, 22 chronic dialysis patients (11 men [50.0 %]; mean [± standard deviation] age, 72 ± 12 years) undergoing maintenance hemodialysis treatment, thrice weekly, were enrolled and followed prospectively for 24 months. In April 2014, the BFR was 200 mL/min; in April 2015 this was increased to 400 mL/min, which was within acceptable limits. The dialysate flow rate remained stable at; 500mlL/min. Blood samples were collected in March 2015 and 2016. The primary endpoint was the comparison of the amounts of erythropoiesis-stimulating agent (ESA) required. Results The increased BFR increased the Kt/V and contributed to significantly decreased urea nitrogen (UN) (p = 0.015) and creatinine (Cr) (p = 0.005) levels. The dialysis efficiency was improved by increasing the BFR. Ferritin (p = 0.038), hepcidin (p = 0.041) and high-sensitivity interleukin-6 (p = 0.038) levels were also significantly reduced. The ESA administered was significantly reduced (p = 0.004) and the Erythropoietin Resistant Index (ERI) significantly improved (p = 0.031). The reduction rates in UN (p < 0.001), Cr (p < 0.001), and beta-2 microglobulin (p = 0.017) levels were significantly greater post the BFR increase compared to those prior to the BFR increase. However, hepcidin was not affected by the BFR change. Conclusions Increasing BFR was associated with hemodialysis efficiency, and led to reduce inflammatory cytokine interleukin-6, but did not contribute to reduce C-reactive protein. This reduced hepcidin levels, ESA dosage and ERI. Hepcidin levels were significantly correlated with ferritin levels, and it remains to be seen whether reducing hepcidin leads to improve ESA and iron availability during anemia management.

scholarly journals In vivo / in vitro Correlation of Pharmacokinetics of Gentamicin, Vancomycin, Teicoplanin and Doripenem in a Bovine Blood Hemodialysis Model

2021 ◽  
Vol 12 ◽  
Author(s):  
M G Vossen ◽  
S Pferschy ◽  
C Milacek ◽  
M Haidinger ◽  
Mario Karolyi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Replacement Therapy ◽  
Protein Binding ◽  
Replacement Therapy ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Bovine Blood ◽  
Flow Rates ◽  
Dialysate Flow Rate

Background: Elimination of a drug during renal replacement therapy is not only dependent on flow rates, molecular size and protein binding, but is often influenced by difficult to predict drug membrane interactions. In vitro models allow for extensive profiling of drug clearance using a wide array of hemofilters and flow rates. We present a bovine blood based in vitro pharmacokinetic model for intermittent renal replacement therapy.Methods: Four different drugs were analyzed: gentamicin, doripenem, vancomicin and teicoplanin. The investigated drug was added to a bovine blood reservoir connected to a hemodialysis circuit. In total seven hemofilter models were analyzed using commonly employed flow rates. Pre-filter, post-filter and dialysate samples were drawn, plasmaseparated and analyzed using turbidimetric assays or HPLC. Protein binding of doripenem and vancomycin was measured in bovine plasma and compared to previously published values for human plasma.Results: Clearance values were heavily impacted by choice of membrane material and surface as well as by dialysis parameters such as blood flow rate. Gentamicin clearance ranged from a minimum of 90.12 ml/min in a Baxter CAHP-170 diacetate hemofilter up to a maximum of 187.90 ml/min in a Fresenius medical company Fx80 polysulfone model (blood flow rate 400 ml/min, dialysate flow rate 800 ml/min). Clearance of Gentamicin vs Vancomicin over the F80s hemofilter model using the same flow rates was 137.62 mL vs 103.25 ml/min. Doripenem clearance with the Fx80 was 141.25 ml/min.Conclusion: Clearance values corresponded very well to previously published data from clinical pharmacokinetic trials. In conjunction with in silico pharmacometric models. This model will allow precise dosing recommendations without the need of large scale clinical trials.

Changing Emphasis in Modern Hemodialysis Therapies: Cost-Effectiveness of Delivering Higher Doses of Dialysis

2007 ◽  
Vol 30 (7) ◽  
pp. 577-582 ◽  
Author(s):  
J. Kult ◽  
E. Stapf
Keyword(s):  
Medical Care ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Treatment Modalities ◽  
The Novel ◽  
Widespread Application ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
The Individual ◽  
Higher Doses

This paper describes the clinical experience of a therapy concept involving advanced functions of a new dialysis machine system (5008 Therapy System, Fresenius Medical Care, Bad Homburg Germany) that is able to provide adequate Kt/V for patients, while consuming lower amounts of dialysate, water and energy during the treatment. The novel “AutoFlow” function of this therapy system adjusts automatically the dialysate flow rate according to the effective blood flow rate of the individual patient without compromising the dose of dialysis the patient receives. The new therapy system of Fresenius Medical Care enables a more widespread application of advanced convective treatment modalities in a more affordable manner. (Int J Artif Organs 2007; 30: 577–82)

P1055REMARKABLE REMOVALS OF BETA-2-MICROGLOBULIN AND PHOSPHATE WITH SHORT-DAILY HOME HEMODIALYSIS USING LOW DIALYSATE FLOW RATE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mercedes Gonzã¡lez Moya ◽  
Pablo Molina ◽  
Belén Vizcaíno ◽  
María Rodrigo ◽  
Pilar Pascual ◽  
...  
Keyword(s):  
Flow Rate ◽  
Uremic Toxins ◽  
Volume Control ◽  
Dialysis Session ◽  
Single Session ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
The Mean ◽  
The Impact ◽  
Dialysate Volume

Abstract Background and Aims Short-daily hemodialysis (HD) with low-dialysate volume is an appealing portable dialysis approach for home use. Although this type of HD has proved being effective for the volume control and the clearance of low molecular-weight uremic toxins, limited data are available on the impact on the removal rates of other uremic toxins like β2-microglobulin (β2M) or phosphate (P), whose clearance is limited by sequestration into compartments, poor diffusion, high time-dependency, or protein binding. We evaluated the impact of short-daily HD with slow dialysate flow rate on the removal of solutes of different molecular weights and distribution volumes. Method Single-session and weekly balances of β2M, P, urea, and creatinine were prospectively assessed with total dialysate collection and serum measurements before and after 341 dialysis sessions (mean dialysate volume: 30963 ± 862 mL; mean length of dialysis session: 153 ± 8 min) in 31 stable patients (female; 9, 29 %; mean age: 55.6 ± 13.6 y; dry weight: 74.9 ± 13.3 kg) undergoing short-daily home HD with NxStage cycler, between July 2014 and October 2019. The mean blood flow rate was 365 ± 17 mL/min, whereas the mean dialysate flow rate was 194 ± 12 mL/min. Results Single-session β2M, P, urea, and creatinine removals were 0.138 ± 0.050 g, 0.610 ± 0.161 g, 18.89 ± 6.07 g and 1.07 ± 0.31 g, respectively, whereas the reduction rates (%) were 38.0 ± 13.0, 46.8 ± 8.6, 48.2 ± 7.0 and 46.6 ± 6.6, for β2M, P, urea and creatinine, respectively. The estimated weekly β2M, P, urea and creatinine removals in HDD patients dialyzing 5-6 days per week were comparable with 4-h in-center thrice-weekly on-line hemodiafiltration according to previous studies (Table 1). Conclusion Treating patients with short-daily HD with low-dialysate volume at a 5-6 days per week prescription may achieve an efficient weekly β2M and P removal.

scholarly journals Clinical Expectation of Online Hemodiafiltration: A Japanese Perspective

2015 ◽  
Vol 40 (Suppl. 1) ◽  
pp. 12-16 ◽  
Author(s):  
Tadao Akizawa ◽  
Fumihiko Koiwa
Keyword(s):  
Clinical Trial ◽  
Blood Flow ◽  
Flow Rate ◽  
Membrane Fouling ◽  
Clinical Evidence ◽  
Treatment Time ◽  
Blood Flow Rate ◽  
Clinical Advantage ◽  
Japanese Perspective ◽  
Conventional Hemodialysis

Many pieces of evidence of online hemodiafiltration (HDF) have been reported, and the clinical advantage of postdilution online HDF with sufficient substitution is now established. After the approval of online HDF in 2012, the number of online HDF patients has been dramatically increasing in Japan and reached 10% of the total dialysis population at the end of 2013. One of the marked characteristics of Japanese online HDF is a widespread use of predilution treatment and, in 2013, 90.8% of online HDFs were carried out with the predilution mode. The main reason for the wide use of predilution online HDF results from the low blood flow rate in Japan, by which it is difficult to substitute a sufficient volume during the limited treatment time. Other reasons to choose the predilution mode include the reduction of albumin loss and the suppression of membrane fouling during treatment. Contrary to postdilution treatment, adequate clinical evidence has not been reported for predilution online HDF to provide a better outcome of the patients. A further clinical trial is expected to elucidate the clinical advantages over conventional hemodialysis for predilution online HDF.

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