Double Pass Dialysis: A New Method of Renal Replacement in Patients with Malfunctioning Vascular Access

1994 ◽  
Vol 17 (7) ◽  
pp. 379-384 ◽  
Author(s):  
A. Brendolan ◽  
C. Ronco ◽  
C. Crepaldi ◽  
L. Bragantini ◽  
M. Milan ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Blood Flow ◽  
Vascular Access ◽  
Positive Impact ◽  
Clinical Results ◽  
Dialysis Session ◽  
High Flux ◽  
Double Pass ◽  
Dialysis Treatment ◽  
Blood Flows

Several patients undergoing chronic renal replacement therapy present problems related to their vascular access. Low blood flows and high rates of recirculation are common in such patients in which, for this reason, it becomes difficult to apply highly efficient techniques or techniques where diffusion and convection are combined as in hemodiafiltration. In these patients we studied the possibility of partially recirculating the blood in the extracorporeal circuit in order to increase the flow rate per single hollow fiber; we defined our system “double pass dialysis”. We evaluated the system's efficiency in 12 patients during 24 dialysis sessions: 12 high flux dialysis sessions (without reinfusion) and 12 hemodiafiltration sessions (9 liters reinfusion). Different surfaces of polyacrylonitrile dialyzers were utilized (1.3-1.7-2.1 sqm) at 250 and 350 ml/min of blood flow with or without 100 ml/min of recirculation. During each dialysis session blood and dialysate samples were taken in order to calculate BUN, Creatinine, Phosphate and Inuline clearances from both the blood and dialysate side. The clearances of low molecular weight solutes were not really influenced by the artificial increase of the blood flow, but on the other hand, the clearances of higher molecular weight solutes increased from 10 to 30% during both high flux dialysis and hemodiafiltration with recirculation. This increase was evident mostly in hemodiafiltration suggesting that the cleaning effect on the membrane has a positive impact on the permeability. The good clinical results obtained with the double pass dialysis show that the system is safe and reliable and may become a valid support in critical situations in order to reach adequate dialysis treatment.

Thermodilution versus saline dilution method for vascular access blood flow measurement in high-flux and on-line hemodiafiltration

2012 ◽  
pp. 0-0
Author(s):  
Néstor Fontseré ◽  
Francisco Maduell ◽  
Miquel Blasco ◽  
Manel Vera ◽  
Marta Arias ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Flow Measurement ◽  
Dilution Method ◽  
High Flux ◽  
Blood Flow Measurement ◽  
On Line

The Complications of Vascular Access in Hemodialysis

2017 ◽  
Vol 44 (01) ◽  
pp. 057-059 ◽  
Author(s):  
Avais Masud ◽  
Eric Costanzo ◽  
Roman Zuckerman ◽  
Arif Asif
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Great Majority ◽  
Dialysis Access ◽  
Luminal Diameter ◽  
Dialysis Treatment ◽  
Hemodialysis Vascular Access ◽  
Arteriovenous Access ◽  
Risk For Thrombosis

AbstractComplications related to hemodialysis vascular access continue to have a major impact on morbidity and mortality. Vascular access dysfunction is the single most important factor that determines the quality of dialysis treatment. Vascular access stenosis is a common complication that develops in a great majority of patients with an arteriovenous access and leads to access dysfunction. By restricting luminal diameter, this complication leads to a reduction in blood flow and places the access at risk for thrombosis. Similarly, the development of catheter-related fibroepithelial sheath also causes catheter dysfunction with its detrimental effects on blood flow. In this article, we discuss the most common complications associated with dialysis access and provide therapeutic options to manage these problems.

Comparison of Four Different Short Dialysis Techniques

1988 ◽  
Vol 11 (3) ◽  
pp. 169-174 ◽  
Author(s):  
C. Ronco ◽  
A. Fabris ◽  
S. Chiaramonte ◽  
E. De Dominicis ◽  
M. Feriani ◽  
...  
Keyword(s):  
Hollow Fiber ◽  
Hydraulic Properties ◽  
Treatment Time ◽  
Hollow Fiber Membrane ◽  
High Flux ◽  
Clinical Routine ◽  
Standard Equipment ◽  
Dialysis Treatment ◽  
Blood Flows ◽  
Catabolic Rate

The goal of shortening dialysis treatment time has stimulated the development of new, highly efficient dialytic strategies. In this study the Authors compared four different short dialysis treatments in terms of efficiency, clinical tolerance, technological investment and costs: 1) Rapid bicarbonate dialysis with 1.5 sq.m. cuprophane membrane; 2) High flux biofiltration with 1.2 sq.m. AN69S hollow fiber membrane; 3) Hemodiafiltration with 1.2-1.9. sq.m. polysulphonic hollow fiber hemodiafilters, and 4) High flux hemodiafiltration with two serial hemodiafilters with AN69s membrane (total 2.4 sq.m.). Hydraulic properties and solute clearances at different blood flows (300-500 ml/min) were tested for each technique. Once the optimal operative level was established three patients were treated with each technique for at least six months. Since BUN clearance averaged 310 ml/min, the treatment duration varied from 120 to 180 min/session with KT/V always higher than 1. The average protein catabolic rate was 0.9 g/kg/24h. Clinical tolerance was generally good, slightly better in treatments with a high convective component. Despite the greater efficiency of treatment No. 4, the technological requirements and costs are such that the others are currently more feasible and acceptable in clinical routine. The study demonstrates that reduction of dialysis treatment time is possible in all centres in a selected population with adequate blood access. Treatment No. 1 can even be performed with standard equipment and cuprophan membranes, while bicarbonate in the dialysate is mandatory. The real limit to shortening treatment time seems to be related to the maximal rate of ultrafiltration achievable in the patient during dialysis.

Thermodilution versus Saline Dilution Method for Vascular Access Blood Flow Measurement in High-Flux and On-Line Hemodiafiltration

2012 ◽  
Vol 13 (4) ◽  
pp. 482-489 ◽  
Author(s):  
Néstor Fontseré ◽  
Francisco Maduell ◽  
Miquel Blasco ◽  
Manel Vera ◽  
Marta Arias ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Flow Measurement ◽  
Dilution Method ◽  
High Flux ◽  
Blood Flow Measurement ◽  
On Line

P1059REMOVAL OF LOW MOLECULAR WEIGHT AND PROTEIN-BOUND UREMIC RETENTION SOLUTES WITH ALLO-HEMODIALYSIS: RESULTS FROM EX VIVO STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vaibhav Maheshwari ◽  
Nadja Grobe ◽  
Joshua Chao ◽  
Xia Tao ◽  
Stephan Thijssen ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Blood Flow ◽  
Ex Vivo ◽  
Equilibrium Concentration ◽  
Blood Flow Rate ◽  
Chronic Kidney Failure ◽  
Low Molecular Weight ◽  
Blood Flows ◽  
Uremic Solutes ◽  
Patient Side

Abstract Background and Aims It is projected that in 2030, 14.5 million people will have end stage kidney disease and need kidney replacement therapy, yet only 5.4 million will receive it due to economic, social, and political factors. We have proposed allo-hemodialysis (alloHD) as a simple and low-cost HD alternative (https://www.kidneynews.org/kidney-news/features/buddy-dialysis-probed-hemodialysis-alternative). In alloHD, the patient’s blood is dialyzed against the blood of a healthy subject (‘buddy’), who receives the excess fluid and uremic solutes and excretes them via his/her healthy kidneys. Method We conducted ex vivo experiment with bovine whole blood, 4L in a patient and buddy bucket, respectively. In this setup, buddy blood flows through the dialyzer fiber lumen, while patient blood flows in the dialysate space (Nipro Cellentia 17H dialyzer). The patient blood was spiked with urea, creatinine, potassium chloride, indoxyl sulfate (IS), and p-cresyl sulfate (pCS); solute levels on the buddy side were not altered. The alloHD session lasted for 3 hours, the ultrafiltration (UF) volume was 750 mL. The blood flow rates were kept constant at 150 and 200 mL/min on the patient and buddy side, respectively. Heparin (5000 IU/L) was added to either bucket. The alloHD machine prototype comprises 2 pumps on the buddy side and one on patient side (Figure 1A). UF is controlled by the blood flow rate differential between the buddy-sided arterial and venous pumps, respectively. Results The levels of small unbound solutes (urea, creatinine, potassium) equilibrate quickly between patient and buddy buckets (Fig. 1B, top panel). Of note, the buddy-sided potassium equilibrium concentration is lower, because ongoing UF dilutes albumin in the buddy bucket and concentrates it in the patient bucket, resulting in a Gibbs-Donnan potential. The protein-bound uremic solutes IS and pCS equilibrate towards lower total concentrations on the buddy side due to the earlier mentioned UF-induced albumin dilution. Of note, the levels of free IS and pCS, respectively, converge on both sides of the dialyzer membrane (Fig 1B, bottom panel). Conclusion Our ex vivo data suggest that alloHD can be used to treat hyperkalemia, a major cause of death in acute and chronic kidney failure. Both unbound and protein-bound low molecular weight uremic solutes are also removed. With elimination of “classical” dialysate, we simplify the HD procedure and reduce machine size and costs significantly, making it an affordable HD alternative. Feasibility and efficacy studies in animal models are the next step.

Dialysis Needle Hemodynamics in Arterio-Venous Fistulae: A Technical Report

2009 ◽  
Vol 10 (3) ◽  
pp. 157-159 ◽  
Author(s):  
Vladimir Tuka ◽  
Edwin Wijnen ◽  
Frank M. van der Sande ◽  
Jan Hm Tordoir
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Doppler Ultrasonography ◽  
Direct Visualization ◽  
Pulsed Doppler ◽  
Dialysis Treatment ◽  
Technical Report ◽  
Stage Renal Disease ◽  
End Stage ◽  
Ultrasound Investigation

Background Vascular access is the lifeline for end-stage renal disease patients needing hemodialysis treatment. For dialysis treatment two needles are placed into the vascular access. Few studies on needle hemodynamics have been published. Methods We investigated needle hemodynamics by means of Doppler ultrasonography, both in B-mode and in pulsed Doppler mode. Results Direct visualization of the needles, turbulence around the arterial needle and blood flow jet from the venous needle are presented. Conclusions Ultrasound investigation of the hemodynamics of the dialysis needles is feasible. The extreme blood flow jet through the arterial needle was directed in all patients to the anterior vessel wall.

COMPARISON OF ANTIHYPERTENSIVE EFFECT OF MOXONIDINE VERSUS CLONIDINE IN RENAL FAILURE PATIENTS.

2018 ◽  
Vol 6 (9) ◽  
Author(s):  
DR.MATHEW GEORGE ◽  
DR.LINCY JOSEPH ◽  
MRS.DEEPTHI MATHEW ◽  
ALISHA MARIA SHAJI ◽  
BIJI JOSEPH ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Blood Flow ◽  
Blood Vessel ◽  
Blood Vessels ◽  
High Blood Pressure ◽  
Antihypertensive Effect ◽  
The Body ◽  
Ability To Work ◽  
Blood Flows

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged(1). High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys.

The Learning Curve in Arthroscopic ACL Reconstruction. The impact on the Surgical Time and Postoperative Clinical Results

2018 ◽  
Vol 69 (10) ◽  
pp. 2874-2876
Author(s):  
Teodor Negru ◽  
Stefan Mogos ◽  
Ioan Cristian Stoica
Keyword(s):  
Anterior Cruciate Ligament ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Single Bundle ◽  
Surgical Time ◽  
Anterior Cruciate ◽  
The Impact

Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up.

Myocardial blood flow determined with krypton 85 in unanesthetized dogs

1962 ◽  
Vol 203 (1) ◽  
pp. 122-124 ◽  
Author(s):  
J. A. Herd ◽  
M. Hollenberg ◽  
G. D. Thorburn ◽  
H. H. Kopald ◽  
A. C. Barger
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Myocardial Blood Flow ◽  
Exponential Function ◽  
Scintillation Detector ◽  
Left Ventricular ◽  
Blood Flows ◽  
Single Exponential Function ◽  
Single Exponential ◽  
Rapid Measurements

Serial, rapid measurements of left ventricular myocardial blood flow in trained, unanesthetized dogs have been made by injecting krypton 85 through chronically implanted coronary artery catheters and counting with an external scintillation detector. Precordial radioactivity declined as a single exponential function during the first 2 min after injection, suggesting a single rate of myocardial blood flow. Simultaneous estimations with Kr85 and blood flowmeters in acute experiments established the accuracy and reproducibility of the technique. Myocardial blood flows between 40 and 55 ml/100 g/min were observed repeatedly in three well-trained, unanesthetized dogs in the basal state.

scholarly journals Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 594
Author(s):  
Amy L. Lesneski ◽  
Payam Vali ◽  
Morgan E. Hardie ◽  
Satyan Lakshminrusimha ◽  
Deepika Sankaran
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Oxygen Saturation ◽  
Ductus Arteriosus ◽  
Neonatal Resuscitation ◽  
Meconium Aspiration Syndrome ◽  
Ovine Model ◽  
Neurodevelopmental Outcomes ◽  
Meconium Aspiration ◽  
Blood Flows

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.

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