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.

Does the Blood Pump Flow Rate have an Impact on the Dialysis Dose During Low Dialysate Flow Rate Hemodialysis?

2018 ◽  
Vol 46 (4) ◽  
pp. 279-285 ◽  
Author(s):  
Maxime Leclerc ◽  
Clémence Bechade ◽  
Patrick Henri ◽  
Elie Zagdoun ◽  
Erick Cardineau ◽  
...  
Keyword(s):  
Flow Rate ◽  
Blood Pump ◽  
Bivariate Analysis ◽  
Dialysis Dose ◽  
Dialysate Flow ◽  
Pump Flow ◽  
Dialysate Flow Rate ◽  
Pump Flow Rate ◽  
A Prospective Study ◽  
The Impact

We conducted a prospective study to assess the impact of the blood pump flow rate (BFR) on the dialysis dose with a low dialysate flow rate. Seventeen patients were observed for 3 short hemodialysis sessions in which only the BFR was altered (300,350 and 450 mL/min). Kt/V urea increased from 0.54 ± 0.10 to 0.58 ± 0.08 and 0.61 ± 0.09 for BFR of 300, 400 and 450 mL/min. For the same BFR variations, the reduction ratio (RR) of β2microglobulin increased from 0.40 ± 0.07 to 0.45 ± 0.06 and 0.48 ± 0.06 and the RR phosphorus increased from 0.46 ± 0.1 to 0.48 ± 0.08 and 0.49 ± 0.07. In bivariate analysis accounting for repeated observations, an increasing BFR resulted in an increase in spKt/V (0.048 per 100 mL/min increment in BPR [p < 0.05, 95% CI (0.03–0.06)]) and an increase in the RR β2m (5% per 100 mL/min increment in BPR [p < 0.05, 95% CI (0.03–0.07)]). An increasing BFR with low dialysate improves the removal of urea and β2m but with a potentially limited clinical impact.

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 &gt; 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 &gt; 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.

A Comparison of Clearances on Tidal Peritoneal Dialysis and Intermittent Peritoneal Dialysisa

1994 ◽  
Vol 14 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Beth Piraino ◽  
Filitsa Bender ◽  
Judith Bernardini
Keyword(s):  
Peritoneal Dialysis ◽  
Small Molecule ◽  
Flow Rate ◽  
Peritoneal Equilibration Test ◽  
Urea Nitrogen ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Fill Volume ◽  
The Mean ◽  
Tidal Peritoneal Dialysis

Objectives To compare the small molecule clearances on tidal peritoneal dialysis (TPD) and intermittent peritoneal dialysis (IPD), controlling for dialysate flow rate. Design Alternating 8-hour treatments on IPD and TPD (2 of each in 6 patients), each treatment separated by 3 or more days [patients returning to continuous ambulatory peritoneal dialysis (CAPD) in the interim] were performed. IPD treatments consisted of 15 exchanges with 2 Llexchange for a total of 30 Lltreatment. TPD treatments consisted of 29 exchanges, with an initial fill volume of 2 L, followed by 1 L tidal volume for the subsequent exchanges (reserve volume of 1 L) for a total of 30 Lltreatment. Patients Six patients, with a mean dialysatelplasma (DIP) creatinine as determined by the peritoneal equilibration test (PET) of 0.64±0.1 0, were studied. Four had a low -average DIP creatinine, while 2 had a high-average DIP creatinine. Measurements Urea nitrogen, creatinine, phosphate, and potassium clearances on TPD and IPD were compared using the paired t-test. Results The dialysate flow rates were 3.7±0.1 Llhour for IPD and 3.8±0.2 Llhour for TPD. The mean dialysate dextrose was 1.9±0.5 gldL for both. The creatinine clearances were 9±2 versus 10±3 mLlminute, the urea nitrogen clearances 19±3 versus 20±3 mLlminute, and phosphate clearances 10±3 versus 11±3 mLlminute for IPD and TPD, respectively (all not different). The ultrafiltration rates were 2.9±0.9 mLlminute on IPD and 3.3±1.6 mLI minute on TPD (not different). On both IPD and TPD the clearances of urea nitrogen, creatinine, and phosphate for the 2 patients with high-average DIP creatinine were higher than for the 4 patients with low -average DIP creatinine. Conclusions When the dialysate flow rate is controlled and a TPD prescription of 1 L reserve and tidal volumes is used, the small molecule clearances on IPD are similar to those on TPD.

MO1052GREEN DIALYSIS: FROM MITH TO FUTURE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Bianca Covella ◽  
Luigi Rossi ◽  
Simone Corciulo ◽  
Antioco Fois ◽  
Carlo Lomonte ◽  
...  
Keyword(s):  
Waste Water ◽  
Reverse Osmosis ◽  
Flow Rate ◽  
Water Consumption ◽  
World Population ◽  
Dialysis Session ◽  
Dialysate Flow ◽  
Starting Point ◽  
Dialysate Flow Rate ◽  
Significant Difference

Abstract Background and Aims Over 2 million persons of the 7.8 billion world population undergo hemodialysis (HD). The need is underestimated because dialysis is not available free of charge for more of half of the word population. HD is costly process and produces a large quantity of medical waste. Reducing the environmental burden should be addressed as part of implementation dialysis programs. While collaboration between physicians and several different professionals is needed to design and develop projects in this direction, these are lingering and the literature is still scant. We overviewed literature to frame what is in progress and find clues for development. Method We conducted a systematic review of the literature from 2000 searching in PubMed, Scopus, Web of Science, and Google Scholar using search keywords including dialysis, green, recycling, ecology. We retrieved 41 publications in medical and technological fields. The results were summarized in a narrative review. Results Facilities: the points on which attention is focused are the design of new buildings, whose project should encompass green solutions, including solar power and water conservation, to reduce long-term expenses and ensure an eco-friendly development. Water: water consumption remains high, and the essential targets to improve efficiency are the optimization of the reverse osmosis system, and of the dialysate flow rate, and the waste-water management. The current idea is to substitute standard reverse osmosis, which have a high percent of waste-water, with recirculating systems. Likewise, lowering of dialysate flow rate could spare water consumption with no significant difference in term of efficiency. Moreover, different solutions have been proposed to reuse reject water: local sanitation, laundry departments, sterilization units within health facilities using redirected water, landscaping and irrigation. Power: electricity needed per dialysis session is twice the average daily consumption of a family of four people. Use of renewable energies, as solar or wind power, has been proposed, and are occasionally applied to home HD. To date just one attempt has been made to recycling energy by using hydroturbine. Disposable materials: most of dialysis disposables is made of plastic, over half of which is labeled as “potentially hazardous”. Only a minimal part of the plastic used in dialysis disposables is recyclable, both because of its composition and its assembly which makes in fact impossible the segregation of the different components. Present research regards bioplastics, new assembling techniques, alternative technologies of incineration, microwave treatment, alkaline hydrolysis, biological treatment and the new steam sterilize-then-shred system. Dialysis machines: at the best of our knowledge there are no studies available about dialysis machine recycling. Personnel education: the role of dialysis staff is essential in recycling and reusing materials as well as in correctly dividing contaminated and non-contaminated waste. Conclusion The development of sustainable buildings, devices and procedures requires a multidisciplinary approach: medical, chemical, biological, engineering; in addition producers contribution and government regulation are needed. Talking about these issues, involving specialists, spreading the concepts of planet friendly treatments, gives the opportunity to share ideas, experiences and turn them into relevant innovations. A good starting point could be data collection to identify critical issues and outline pragmatic operational possibilities to reduce consumption, increase reuse and recycle, involve and instruct health care personnel, integrate dialysis facilities in the environment they are built in.

Influence of Peritoneal Dialysate Flow Rate on the Pharmacokinetics of Cefazolin

2003 ◽  
Vol 23 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Harold J. Manley ◽  
Darcie L. Bridwell ◽  
Rowland J. Elwell ◽  
George R. Bailie
Keyword(s):  
Flow Rate ◽  
Continuous Flow ◽  
Elimination Rate ◽  
Coefficient Of Determination ◽  
P Value ◽  
Data Set ◽  
Dialysate Flow ◽  
Medline Search ◽  
Dialysate Flow Rate ◽  
The Impact

Objective To determine the impact of dialysate flow rate (DFR) on cefazolin pharmacokinetics (PK) in peritoneal dialysis (PD) patients. Methods A meta-analysis of published reports, identified by MEDLINE search (1966-2002) and other sources, containing information on cefazolin PK data in PD patients was conducted. Data were analyzed based upon low DFR (≤ 5.50 mL/minute) or high DFR (> 5.50 mL/minute). Data available were from North American (NA) ( n = 45) and Singaporean ( n = 10) patients. Complete data sets were available for 33 patients (CDS patients). Data were analyzed with respect to data origin and data set completeness: all patients (ALL), NA, and CDS. Analysis of log-transformed cefazolin PK data was performed to determine coefficient of determination ( r2) between DFR and cefazolin elimination rate constant (kel), clearance total (ClT), and clearance peritoneal (ClPD). Clearance total data were extrapolated to DFR observed in continuous flow PD. Results Published literature provided data on 55 PD patients (12 high DFR, 43 low DFR). Regardless of data origin (ALL, NA, or CDS), a prominent coefficient of determination ( p < 0.0001) existed between DFR and all cefazolin PK data except ClPD. The p value for DFR correlation to ClPD was 0.953, 0.011, and 0.036 for ALL, NA, and CDS patients, respectively. Cefazolin ClT and ClPD increased at higher DFRs. Conclusion These findings demonstrate that an increased DFR leads to an increased rate of cefazolin clearance in NA PD patients. The impact of Asian descent on cefazolin ClPD warrants further investigation. Clinicians dosing cefazolin in PD patients using a higher DFR than that used to determine cefazolin PK should use increased doses or prescribe lower/comparable DFRs. Data are not yet available for patients prescribed very high DFRs ( e.g., continuous flow PD); extrapolation of our results demonstrates significant influences on clearance and risk for underdosing.

scholarly journals A Study of Executive Function in Patients with Chronic Kidney Disease before and after a Single Session of Hemodialysis

2020 ◽  
Vol 11 (02) ◽  
pp. 250-255
Author(s):  
Vasantmeghna S. Murthy ◽  
Vedant S. Shukla
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Statistical Tests ◽  
T Test ◽  
Emotional States ◽  
Single Session ◽  
Dialysis Unit ◽  
Before And After ◽  
The Mean ◽  
The Impact

Abstract Background Executive functions (EFs) are critical to daily life and sensitive to our physiological functioning and emotional states. The number of people living with chronic kidney disease (CKD) on hemodialysis (HD) globally is increasing steadily. We aimed to determine the impact of a single session of HD on EFs in patients with CKD receiving maintenance HD (MHD). Methods This was a quasi-experimental study conducted at the department of psychiatry and dialysis unit of a tertiary hospital. Patients undergoing MHD underwent screening to rule out delirium, using the Confusion Assessment Method prior to EF testing. The tests of EF used were the Trail-Making Test—Part B (TMT-B) and Frontal Assessment Battery (FAB), both of which were administered before and after a session of HD. Statistical tests used were Wilcoxon matched pairs signed ranks test, paired t-test, single sample t-test, and correlation analyses. Results The mean time taken on TMT-B before HD was 195.36 seconds and after HD, 171.1 seconds; difference is significant (p = 0.0001). The mean FAB score was 13.19 before HD and 14.83 after HD; the difference is significant (p < 0.0001). Significant differences were observed on similarities (p = 0.003), lexical fluency (p = 0.02), and go–no go (p = 0.003) subtests of FAB. Mean TMT-B scores before and after HD differed significantly from that of a reference study (reference TMT-B 150.69 seconds), p = 0.0002 and 0.04, respectively. Conclusion We conclude that patients with CKD on MHD, in general, have worse executive cognitive functioning compared with healthy populations. A session of HD results in significant improvement in these functions.

Myoglobin Clearance during Continuous Veno-Venous Hemofiltration with or without Dialysis

1998 ◽  
Vol 21 (4) ◽  
pp. 205-209 ◽  
Author(s):  
D. Nicolau ◽  
Y.S. Feng ◽  
A.H.B. Wu ◽  
S.P. Bernstein ◽  
C.H. Nightingale
Keyword(s):  
Renal Failure ◽  
Animal Model ◽  
Flow Rate ◽  
Major Complication ◽  
Viable Option ◽  
Effective Technique ◽  
Dialysate Flow ◽  
Continuous Arteriovenous Hemofiltration ◽  
Pump Rate ◽  
Dialysate Flow Rate

The management of acute myoglobinuric renal failure, the major complication of rhab-domyolysis, continues to be a treatment dilemma for the clinician as limited therapeutic options are available. Previously, we have demonstrated that continuous arteriovenous hemofiltration (CAVH) is an effective technique for removing myoglobin in an animal model. In the present study, swine were administered four grams of equine myoglobin intravenously and underwent the continuous veno-venous hemofiltration (CVVH) procedure for six hours each. Animals were studied in each of the following groups: CVVH at a pump rate 100 ml/minute, CVVH at a pump rate 200 ml/minute and CVVH at a pump rate 100 ml/minute plus dialysis at a dialysate flow rate of one Liter/h. Once the filtering process was initiated there was a rapid and sustained production of ultrafiltrate in all groups. The amount of myoglobin excreted in the ultrafiltrate over the six-hour filtering period was 688, 948 and 570 mg which corresponded to 17, 24 and 14 percent of the administered dose, respectively, for the three treatments. In comparison to previous CAVH experiments, CVVH removed more circulating myoglobin and the addition of the dialysis component did not appear to improve removal. Based on these findings, it appears that the CVVH hemofiltration system is a viable option for the removal of systemic myoglobin.

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