Abstract:
:The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they consume. Death is the thermodynamically favored state: it represents a large increase in entropy as molecular structure yields to chaos. The kidney is an organ dissipating large amounts of energy to maintain the level of entropy of the organism as low as possible. Diseases, and in particular uremia, represent conditions of rapid increase in entropy. Therapeutic strategies are oriented towards a reduction in entropy or at least a decrease in the speed of entropy increase. Uremia is a process accelerating the trend towards randomness and disorder (increase in entropy). Dialysis is a factor external to the patient that tends to reduce the level of entropy caused by kidney disease. Since entropy can only increase in closed systems, energy and work must be spent to limit the entropy of uremia. This energy should be adapted to the system (patient) and be specifically oriented and personalized. This includes a multidimensional effort to achieve an adequate dialysis that goes beyond small molecular weight solute clearance. It includes a biological plan for recovery of homeostasis and a strategy towards long-term rehabilitation of the patient. Such objectives can be achieved with a combination of technology and innovation to answer specific questions that are still present after 60 years of dialysis history. This change in the individual bioentropy may represent a local exception to natural trends as the patient could be considered an isolated universe responding to the classic laws of thermodynamics.
journal_name
Blood Purifjournal_title
Blood purificationauthors
Ronco Cdoi
10.1159/000345755subject
Has Abstractpub_date
2013-01-01 00:00:00pages
8-15issue
1-3eissn
0253-5068issn
1421-9735pii
000345755journal_volume
35pub_type
杂志文章abstract:BACKGROUND:We estimated the flow of endotoxins (ET) from dialysates into the blood of patients on hemodialysis (HD) using limulus amebocyte lysate (LAL) assays and endotoxin activity (EA) determined by neutrophil respiratory burst activity. METHODS:A cross-sectional study compared groups given ultrapure bicarbonate (n...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000322622
更新日期:2011-01-01 00:00:00
abstract::Many organic solutes accumulate in end-stage renal disease (ESRD) and some are poorly removed with urea-based prescriptions for hemodialysis. However, their toxicities have been difficult to assess. We have employed an animal model, the zebrafish embryo, to test the toxicity of uremic serum compared to control. Serum ...
journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000348456
更新日期:2013-01-01 00:00:00
abstract::Numerous experimental and clinical studies suggest that uric acid might have pathobiologic implications in the development and progression of hypertension, kidney disease, and coronary heart disease, among others, resulting in renewed interest in uric acid as a potential pathogenic mediator in these clinical condition...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000360520
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND/AIMS:To determine adsorption and transmembrane clearances (CLTM) of rezafungin, a novel long-acting echinocandin, in continuous venovenous hemofiltration (CVVH). METHODS:A validated ex vivo bovine blood CVVH model using polysulfone and AN69 hemodiafilters was used to evaluate urea and rezafungin CLTM at 3 d...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000489212
更新日期:2018-01-01 00:00:00
abstract::During hemodialysis, amino acids (AA) are lost in the ultrafiltrate with consequent modification of their plasma profile. The aim of this cross-sectional study was to evaluate intradialytic changes of plasma AA levels during a single session of hemodiafiltration with endogenous reinfusion (HFR) versus acetate-free bio...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000320133
更新日期:2010-01-01 00:00:00
abstract::Effective dialysis therapy is now understood to encompass both small and large solute removal, using approaches that minimize intradialytic symptoms and maximize patient safety. Achieving the goal of providing effective dialysis for an expanding population of patients with increasingly complex medical problems at a ti...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000167001
更新日期:2009-01-01 00:00:00
abstract::The administration of intravenous fluids is perhaps the most common treatment given in the intensive care unit. According to biologic rationale, ongoing fluid losses should be replaced to maintain fluid homeostasis and relative or absolute deficiencies in circulating blood volume should be prevented or rapidly correct...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000047015
更新日期:2002-01-01 00:00:00
abstract::At present the treatment of hepatitis C virus infection (HCV) has improved because of combined treatment with interferon (IFN) and ribavirin. The association of these two drugs has obtained a positive response in 40-50% of naive patients treated. Patients with relapse after monotherapy with IFN also show positive resp...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000046996
更新日期:2002-01-01 00:00:00
abstract::Evidence that protein restriction retards the progression of chronic renal failure in man is mostly derived from anecdotic data and retrospective studies with inappropriate controls and inferior methodology for evaluating renal function. Data from a prospective randomized study in Stockholm demonstrate that more frequ...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000169562
更新日期:1988-01-01 00:00:00
abstract::In hemodialysis patients, C-reactive protein (CRP), an acute-phase reactant, is a sensitive and independent marker of malnutrition, anemia, and amyloidosis. The aim of the present studies was to evaluate CRP and interleukin 6 levels in plasma samples from long-term hemodialysis patients on different extracorporeal mod...
journal_title:Blood purification
pub_type: 杂志文章,多中心研究
doi:10.1159/000014405
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND/AIMS:There is a clear association between one allele of the interleukin-1 receptor-antagonist gene (IL-1RN) and inflammatory diseases in which IL-1 is implicated. We evaluated patient survival and technique survival of peritoneal dialysis (PD) patients, while analyzing independent risk factors, in a PD progr...
journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000088988
更新日期:2005-01-01 00:00:00
abstract::A strict control of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) is indicated to avoid serious complications linked to osteitis fibrosa and other parathyroid-hormone (PTH)-related bodily disturbances. However, such a control is often achieved only at the price of unacceptably high plasma...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000074922
更新日期:2004-01-01 00:00:00
abstract::While the optimal vascular conduit for hemodialysis is undeniably an arterialized autogenous subcutaneous vein, only a minority of end-stage renal disease patients can count on such access: the remainder require implantation of a biomaterial conduit. This paper will briefly survey current biografts used for hemodialys...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000170148
更新日期:1994-01-01 00:00:00
abstract::Heart failure results in significant morbidity and mortality in the United States. Chronic heart failure is often complicated by renal insufficiency. Further, acute decompensated heart failure is often complicated by worsening renal function or the development of diuretic resistance. Heart failure complicated by renal...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000207198
更新日期:2009-01-01 00:00:00
abstract::Optimal iron level in hemodialysis patients remains a subject of debate. The reticulocyte hemoglobin content (CHr) is believed to reflect the concentration of iron required in the most recent hematopoiesis in the bone marrow. CHr is not influenced by any factors that measure direct hemoglobin (Hb) of reticulocytes and...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000496641
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Of 5 clinical trials testing dose response of continuous renal replacement therapy (CRRT) in acute kidney injury, 2 showed a benefit, 2 showed none, and 1 appeared equivocal. However, blood-membrane interactions may dominate macromolecule transport in continuous venovenous hemodiafiltration, reducing the imp...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000266483
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND/AIMS:Sudden K removal is thought to be implicated in ECG alterations observed during hemodialysis (HD). The effects of the K removal rate on ECG-derived parameters have been investigated. METHODS:Two different hemodiafiltration (HDF) schedules were used for 10 HD patients: the dialysate K concentration was ...
journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000073440
更新日期:2003-01-01 00:00:00
abstract:UNLABELLED:Hyperhomocysteinemia (HH), a known risk factor for vascular diseases, is a frequent condition in hemodialysis (HD) patients. HH induces an oxidant stress to the vascular endothelium, causing a failure of vasodilation and an impairment of the antithrombotic properties. Vitamins B(6), B(12) and folic acid are ...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000014416
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND AND AIM:Acute kidney injury (AKI) is a common complication in intensive care units (ICUs). However, its incidence and outcome vary in several studies depending on definitions used or even the geographic origin of the study. We aimed to evaluate the epidemiology of AKI in ICUs in Greece. METHOD:Prospective m...
journal_title:Blood purification
pub_type: 杂志文章,多中心研究
doi:10.1159/000231986
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Intradialytic hypotension (IDH) is a major challenge to safely performing haemodialysis. Blood volume depletion due to fluid removal is a major cause of hypotension, so more emphasis should be placed on finding alternative modalities to traditional constant rate ultrafiltration. SUMMARY:Intermittent back-fi...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000503878
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Hemodiafiltration (HDF) is effective in delaying the surgical need for carpal tunnel syndrome in chronic hemodialysis patients, however, predialysis beta(2)-microglobulin levels were not reduced in most short-term studies. The aim of this study was to assess the effect of long-term and differing frequencies ...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000046958
更新日期:2001-01-01 00:00:00
abstract::Hypertension is present in most patients with end-stage renal disease and likely contributes to the premature cardiovascular disease in dialysis patients. Previous practice guidelines have recommended that, in patients on chronic dialysis, blood pressure (BP) should be reduced below 130/80 mm Hg. This is based on opin...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000245631
更新日期:2010-01-01 00:00:00
abstract::In patients with chronic kidney disease (CKD), peptides and proteins circulate at altered concentrations versus in healthy individuals. We have characterized proteome samples from 7 pooled CKD stage 5 patients not yet on dialysis and with no known co-morbidities. We also analyzed pooled plasma samples from 7 healthy a...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000178773
更新日期:2008-01-01 00:00:00
abstract::Malnutrition, which is common in maintenance hemodialysis (HD) patients, is strongly associated with increased morbidity and mortality. Protein requirements in HD patients are increased twice or more compared to those of healthy subjects. Underdialysis leads to anorexia with low protein and energy intake in relation t...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000170072
更新日期:1992-01-01 00:00:00
abstract::Clinical trials using very low protein supply supplemented with amino acid or keto acid preparations have shown the possibility of slowing the rate of decline of renal function in patients with advanced chronic renal failure together with preservation of nutritional status. The possible mechanisms by which this effect...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,评审
doi:10.1159/000169557
更新日期:1988-01-01 00:00:00
abstract::Severe hypertriglyceridemia (HTG) is associated with acute pancreatitis (AP). Treatment options include total plasma exchange (TPE). We report a case of AP due to severe HTG treated with TPE. ...
journal_title:Blood purification
pub_type:
doi:10.1159/000510647
更新日期:2020-11-24 00:00:00
abstract::Dialysis fluid produced by state-of-the-art water preparation and distribution is contaminated with gram-negative bacteria and cytokine-inducing substances (CIS) derived from these microorganisms. The presence of a biofilm increases the risk of continuous contamination of dialysis fluid. Depending on the type of dialy...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000074932
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:The relationship between heart rate variability (HRV) and residual renal function (RRF) has not been elucidated previously. METHODS:In this cross-sectional study, HRV was evaluated in 71 peritoneal dialysis patients. Patients were divided into RRF decline group, RRF stable group and anuric group. RESULTS:R...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000338184
更新日期:2012-01-01 00:00:00
abstract:PURPOSE:This study was aimed at evaluating the efficacy and safety of regional citrate anticoagulation (RCA) versus no-anticoagulation continuous venovenous hemofiltration (CVVH) in acute severe hypernatremia patients with increased bleeding risk. MATERIALS AND METHODS:Acute severe hypernatremia patients with high ble...
journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000502937
更新日期:2020-01-01 00:00:00
abstract::Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ampl...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000321840
更新日期:2011-01-01 00:00:00