Predicting the Hermeticity of Compression Seals in Microchannel Hemodialysers

2014 ◽  
Author(s):  
Brian K. Paul ◽  
Dustin K. Ward
Keyword(s):  
Mass Transfer ◽  
Patient Outcomes ◽  
End Stage Renal Disease ◽  
Limiting Factor ◽  
Home Hemodialysis ◽  
Kidney Dialysis ◽  
Medical Facilities ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

Most end stage renal disease patients receive kidney hemodialysis three to four times per week at central medical facilities. At-home kidney dialysis increases the convenience and frequency of hemodialysis treatments which has been shown to produce better patient outcomes. One limiting factor in realizing home hemodialysis treatments is the cost of the hemodialyser. Microchannel hemodialysers produced using compression sealing techniques show promise for reducing the size and cost of hemodialysers. Challenges include the use of a 25 μm thick elastoviscoplastic mass transfer membrane for gasketing. This paper provides a framework for predicting the hermeticity of these compression seals. The mechanical properties of a Gambro AN69ST membrane are determined and used to establish limits on the dimensional tolerances of the polycarbonate laminae containing sealing boss used to seal the hemodialyser. The resulting methods are applied to the fabrication of a hemodialysis device showing constraints on the scaling of this method to larger device sizes. The resulting hemodialysis device is used to perform urea mass transfer experiments without leakage.

scholarly journals The Hermeticity of Compression Seals in Microchannel Hemodialyzers

2014 ◽  
Vol 2 (3) ◽  
Author(s):  
Brian K. Paul ◽  
Dustin K. Ward
Keyword(s):  
Mass Transfer ◽  
Patient Outcomes ◽  
End Stage Renal Disease ◽  
Limiting Factor ◽  
Home Hemodialysis ◽  
Kidney Dialysis ◽  
Medical Facilities ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

Most end stage renal disease patients receive kidney hemodialysis three to four times per week at central medical facilities. At-home kidney dialysis increases the convenience and frequency of hemodialysis treatments which has been shown to produce better patient outcomes. One limiting factor in realizing home hemodialysis treatments is the cost of the hemodialyzer. Microchannel hemodialyzers produced using compression sealing techniques show promise for reducing the size and cost of hemodialyzers. Challenges include the use of a 25 μm thick elastoviscoplastic (EVP) mass transfer membrane for gasketing. This paper provides a framework for understanding the hermeticity of these compression seals. The mechanical properties of a Gambro AN69ST membrane are determined and used to establish limits on the dimensional tolerances of the polycarbonate (PC) laminae containing sealing bosses used to seal the hemodialyzer. The resulting methods are applied to the fabrication of a hemodialysis device showing constraints on the scaling of this method to larger device sizes. The resulting hemodialysis device is used to perform urea mass transfer experiments without leakage.

Economic Evaluation of Kidney Transplantation versus Hemodialysis in Patients with End-Stage Renal Disease in Hungary

2001 ◽  
Vol 11 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Zoltán Kaló ◽  
Jeno Járay ◽  
Júlia Nagy
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cost Effective ◽  
Effective Option ◽  
Hungarian Population ◽  
Cadaveric Kidney ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

Background— Kidney transplantation is generally acknowledged as the more clinically effective and more cost-effective option in managing patients with end-stage renal disease, compared with dialysis. This study looked for confirmatory evidence in a Hungarian population. Methods— Patients (n = 242) with end-stage renal disease who received cadaveric kidney transplantation during 1994 were followed up for 3 years. They were compared with patients (n = 840) receiving hemodialysis who were on a waiting list for transplantation. Data were collected retrospectively. Treatments were compared for clinical efficacy and for cost-effectiveness. Results— At month 36, the standard mortality hazard function was 3.5 times higher in the group receiving hemodialysis ( P<.0001) than in the transplant recipients. Average treatment costs per patient over the 3 years were also significantly higher ( P<.0001) in the hemodialysis group than in the group that received transplants. The cost of 1 year gained by transplantation was significantly less ( P<.0001) than the cost associated with hemodialysis. Conclusions— Compared with hemodialysis, kidney transplantation provides greater survival benefits to patients with end-stage renal disease, at less cost.

Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Developing Country

1985 ◽  
Vol 5 (1) ◽  
pp. 56-58 ◽  
Author(s):  
Jorge Dominguez ◽  
Gladys Gonzalez ◽  
Lenin Figueroa ◽  
Jose Mendez
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
Admission Rate ◽  
Home Hemodialysis ◽  
Hospital Admission Rate ◽  
Economic Problems ◽  
Stage Renal Disease ◽  
End Stage ◽  
Chronic Ambulatory Peritoneal Dialysis

This paper describes our experience during the first 39 months of the CAPD program at the Miguel Perez Carreno Hospital in Caracas, Venezuela. Forty-eight patients were started on CAPD and treated for a total of 767 patient/months. Mean age was 45.8 years. Average time in the program was 15.9 months. At 39 months 87% of patients were alive and 78% were still on CAPD. The peritonitis rate was one episode per 6.39 pt/month with a probability of peritonitis of 0.70 at 25 months. Incidence of sterile peritonitis was high (41 %). Our patients had a low hospital admission rate (0.5 days per patient month) and a high percentage were rehabilitated (81%). Chronic ambulatory peritoneal dialysis (CAPD) is a widely accepted therapy for end-stage renal disease (ESRD): in Venezuela, approximately 160 patients (37%) of all those under treatment for ESRD receive this form of therapy. The Nephrology Section of the Miguel Perez Carreno Hospital in Caracas manages the largest CAPD program in the country. Here 149 patients are receiving treatment for ESRD by different techniques -hospital hemodialysis, home hemodialysis, intermittent peritoneal dialysis, CAPD and renal transplantation, under the care of five nephrologists, four nephrology residents and 30 nurses. Our CAPD program started in January 1980. This paper, which describes our three years of experience, indicates that CAPD is feasible in a country such as ours which, because of economic problems, is limited in its ability to provide other forms of treatment for ESRD.

The patient with vasculitis

2018 ◽  
Author(s):  
Alan D. Salama
Keyword(s):  
Patient Outcomes ◽  
End Stage Renal Disease ◽  
Impaired Renal Function ◽  
Systemic Vasculitis ◽  
Renal Involvement ◽  
Small Vessel Vasculitis ◽  
Organ Systems ◽  
Primary Systemic Vasculitis ◽  
Stage Renal Disease ◽  
End Stage

Primary systemic vasculitis frequently leads to renal involvement and is responsible for significant numbers of patients progressing to end-stage renal disease. Frequently this is due to small vessel vasculitis, in association with antineutrophil cytoplasm antibody, which requires prompt recognition and timely therapeutic intervention to optimize renal and patient outcomes. Other organ systems are often affected. Relapses occur in about 50%.Less commonly medium or larger vessel vasculitis may involve the kidneys and through ischaemia lead to impaired renal function and renovascular hypertension, as in Takayasu’s or Kawasaki disease, and polyarteritis nodosa (PAN).

DIALYSIS FOR END-STAGE RENAL DISEASE

2001 ◽  
Vol 17 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Liz Kirby ◽  
Luke Vale
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cost Effective ◽  
Considerable Variability ◽  
The United Kingdom ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost ◽  
Initial Method

Objective: Renal replacement therapy (RRT) is essential for maintenance of life for those with end-stage renal disease. However, there remain many areas of uncertainty about which method of RRT should be chosen. This paper reports an economic model based on a systematic review that attempts to determine which method of dialysis, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis, a patient should have as the initial method of RRT.Methods: A systematic review and a costing exercise carried out in a Scottish hospital were used to populate a Markov model. Scenario analysis was used to model plausible variations in variables included in the model.Results: In 8 of the 16 scenarios developed hemodialysis dominated CAPD. In a further eight scenarios, the cost per life-year displayed considerable variability, ranging from between £5,000 to £51,000. The higher costs per life-year were associated with minimum estimates of additional survival for a patient starting RRT on hospital hemodialysis.Conclusion: It may be more cost-effective to manage patients starting on RRT with hospital hemodialysis than CAPD. This has particular implications for the United Kingdom, given that up to 50% of new patients receive CAPD.

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