Abstract:
BACKGROUND:Dialysate fluid connection to the membrane in continuous dialysis may affect solute clearance. Although circuit connections are routinely made counter-current to blood flow in intermittent dialysis, no study has assessed the effect of this dialysate fluid flow direction on removal of small solutes creatinine and urea during treatment using continuous veno-venous haemodialysis (CVVHD). AIMS:To assess if dialysate flow direction during CVVHD affects small solute removal. METHODS:This ethics-approved study recruited a convenience sample of 26 adult ICU patients requiring continuous dialysis to assess urea and creatinine removal for con-current vs. counter-current dialysate flow direction. The circuit was adjusted from continuous veno-venous haemodiafiltration to CVVHD 20 min prior to sampling with no fluid removal. Blood (b) and spent dialysate fluid (f) were taken in both concurrent and counter-current fluid flow at 1 (T1) and 4 (T4) hours with a new treatment. Blood flow was 200 ml/min. Dialysate flow 33 ml/min. Removal of urea and creatinine was expressed as the diafiltrate/plasma concentration ratio: Uf/b and Cf/b respectively. Data lacking normal distribution are presented as median with 25th and 75th interquartile ranges (IQR), otherwise as mean with SD and assessed with the independent t test for paired data. p < 0.5 was considered significant. RESULTS:Fifteen male patients were included with a median (IQR) age of 67 years (52-75), and APACHE x0399;x0399; score 17 (14-19) with all patients meeting RIFLE criteria 'F'. At both times, the counter-current dialysate flow was associated with higher mean (SD) diafiltrate/plasma concentration ratios: T1 0.87 (0.16) vs. 0.77 (0.10), p = 0.006; T2 0.96 (0.16) vs. 0.76 (0.09), p < 0.001 for creatinine and T1 0.98 (0.09) vs. 0.81 (0.09), p < 0.001; T2 0.99 (0.07) vs. 0.82 (0.08), p < 0.001 for urea. CONCLUSION:Counter-current dialysate flow during CVVHD for ICU patients is associated with an approximately 20% increase in removal of small solutes creatinine and urea. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=441270.
journal_name
Blood Purifjournal_title
Blood purificationauthors
Baldwin I,Baldwin M,Fealy N,Neri M,Garzotto F,Kim JC,Giuliani A,Basso F,Nalesso F,Brendolan A,Ronco Cdoi
10.1159/000441270subject
Has Abstractpub_date
2016-01-01 00:00:00pages
171-6issue
1-3eissn
0253-5068issn
1421-9735pii
000441270journal_volume
41pub_type
杂志文章,多中心研究abstract:BACKGROUND:To study calcium homeostasis during citrate-based compared to nadroparin-based CVVH in critically-ill patients with acute renal failure. METHODS:11 patients were observed during citrate anticoagulation, 9 with nadroparin and 10 controls. Citrate was chosen for patients with active or at risk for bleeding. ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000101853
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Dialysis patients have higher cardiovascular events rate than patients with normal renal function. Hyperhomocysteinemia, a risk factor for cardiovascular disease, is frequently detected in dialysis patients. Vitamin B supplementation lowers hyperhomocysteinemia, but it is unknown whether it reduces cardiovas...
journal_title:Blood purification
pub_type: 杂志文章,随机对照试验
doi:10.1159/000093680
更新日期:2006-01-01 00:00:00
abstract::We have investigated the effect of the direction of the dialysate flow during continuous arteriovenous haemodialysis. Under similar conditions countercurrent flow was more efficient than concurrent flow in terms of both urea clearance (mean +/- SEM), 23.5 +/- 0.5 compared to 18.4 +/- 0.4 ml/min (p less than 0.001) and...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169987
更新日期:1990-01-01 00:00:00
abstract::Contradictory data are reported in the literature concerning the diffusion kinetics of inorganic phosphates (iPh) between red blood cells and plasma during haemodialysis. Accordingly, we performed mass balance and equilibration studies to analyze the diffusion kinetics of iPh in vivo and in vitro. Mass balance analysi...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000014470
更新日期:2001-01-01 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:BACKGROUND/AIMS:We derived a novel equation for calculating weekly urea standard Kt/V (stdKt/V) during hemodialysis (HD) based on urea mass removed, comparable to the approach during peritoneal dialysis. METHODS:Theoretical consideration of urea mass balance during HD led to the following equation for stdKt/V, namely,...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000493178
更新日期:2019-01-01 00:00:00
abstract:INTRODUCTION:Plastic cannulas have been used to cannulate arteriovenous fistulas (AVFs) for hemodialysis (HD) in Japan for many years. However, the effect of early cannulation with plastic cannulas on AVF patency is not known. OBJECTIVE:We analyzed the relationship between first cannulation time (FCT) and patency rate...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000503678
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND/AIMS:Carpal tunnel syndrome (CTS) is a common clinical presentation of dialysis-related amyloidosis. It was determined whether β(2)-microglobulin (β2M) and advanced glycation end products in serum are predictors of CTS in dialysis patients. METHODS:A total of 385 hemodialysis patients were screened for CTS....
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000338923
更新日期:2012-01-01 00:00:00
abstract:AIMS:This study was aimed at comparing the incidence of arterial hypertension and blood pressure (BP) variance in hospital and out-of-hospital hemodialysis (HD) patients during HD sessions. METHODS:A cross-sectional study was conducted for 1 week at all the HD centers in Dalmatia, Croatia. The pre-, intra-, and post-d...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000474931
更新日期:2017-01-01 00:00:00
abstract::Cuprophane hemodialysis is associated with an early fall of leukocyte counts and an intradialytic rise in serum beta 2-microglobulin (beta 2M), in contrast to dialysis with more compatible dialyzers. It has been suggested that these two phenomena may be related. This study sets out to verify this hypothesis by compari...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169922
更新日期:1990-01-01 00:00:00
abstract::In the last years, publications have questioned the classical dose of 35 ml/kg, but are those studies strong enough in terms of scientific power in order to change our practice? We will try to settle some recommendations for clinicians. Manipulation of dose, porosity, and combinations have yielded promising findings. ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000227282
更新日期:2009-01-01 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:BACKGROUND/AIMS:Increasing evidence suggests that clinical signs of periodontal disease are independently associated with renal impairment. However, no studies have examined the possible linkage of kidney disease with serum antibody to oral pathogens. METHODS:The periodontal disease status was assessed in an older com...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000096411
更新日期:2007-01-01 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:BACKGROUND AND AIM:Elevated low-density lipoprotein cholesterol and/or lipoprotein(a) are established risk factors for cardiovascular disease (CVD). Management of hypercholesterolemia consists of drug therapies, including statins and proprotein convertase subtilisin/kexin type 9 inhibitors. In patients with familial hy...
journal_title:Blood purification
pub_type: 杂志文章,meta分析,评审
doi:10.1159/000497447
更新日期:2019-01-01 00:00:00
abstract::Continuous arteriovenous hemofiltration requires continuous anticoagulation to prevent early hemofilter clotting. We used heparin given continuously in the arterial line of the extracorporeal circuit as anticoagulant in children with initially normal coagulation status, and heparin and/or prostacyclin in high-risk ble...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169489
更新日期:1988-01-01 00:00:00
abstract::Heart failure (HF) is a chronic disease process associated with significant morbidity and mortality. Hospitalizations for acute decompensation may be frequent and herald a downward trajectory for the underlying disease state and overall poor prognosis for the patient. While significant advances have been made in the r...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000110558
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Asymmetric dimethylarginine (ADMA) levels are increased in hemodialysis (HD) patients. Reports on the effect of various dialysis strategies on ADMA, symmetric dimethylarginine (SDMA) and L-arginine levels are inconclusive. PATIENTS/METHODS:In this randomized crossover study, 15 patients were dialyzed for 4 ...
journal_title:Blood purification
pub_type: 杂志文章,随机对照试验
doi:10.1159/000104868
更新日期:2007-01-01 00:00:00
abstract::The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molec...
journal_title:Blood purification
pub_type: 社论
doi:10.1159/000476012
更新日期:2017-01-01 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::One of the main problems in low protein diet is patient's noncompliance and the risk of both depression and reduced quality of life. A pilot study investigated the life-style and the state of mood before and during low protein diet. The results show a deterioration in the life-style and the state of mood. Conclusions ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169572
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Frequent hemodialysis (HD) may be associated with an increased risk of vascular access complications. Studies addressing vascular access outcomes in frequent HD show conflicting results. METHODS:We searched Medline for trials looking at vascular access outcomes in frequent HD. RESULTS:Nineteen studies met ...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000362106
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Omni® (B. Braun, Germany) is a new-generation, continuous renal replacement therapy (CRRT) machine designed to improve user interface, minimize downtime and optimize renal dose delivery. It was never tested in humans. METHODS:We used Omni® to provide CRRT in 10 critically ill patients. We collected therapy ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000451053
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Anemia is a major complication of end-stage renal disease. Hemodialysis itself is regarded as a stimulus activating inflammation. Pro-inflammatory cytokines are able to suppress erythropoiesis. In this pilot study, we analyzed the changes in methylation status of promoters of immune response genes in cell-fr...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000356094
更新日期:2013-01-01 00:00:00
abstract::The study was made in vitro of reactions elicited by contact of granulocytes suspended in autologous plasma with three polymers: polyacrylonitrile (AN); polyetherpoly-carbonate (PC), and regenerated cellulose (Cu). Alterations in basal metabolism and biological function of the human blood granulocytes induced by inter...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000170015
更新日期:1991-01-01 00:00:00
abstract::The biological processes governing vascular endothelial cell health are complex and highly redundant. The mechanisms involved in cell injury and repair remain an area of intense study. This paper attempts to review current knowledge regarding hormones such as vitamin D, erythropoietin and aldosterone within the contex...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000089436
更新日期:2006-01-01 00:00:00
abstract::A significant and increasing number of chronic kidney disease (CKD) patients are treated with online hemodiafiltration (OL-HDF), even in the absence of more conclusive survival data. OL-HDF affords several clinical benefits including control of anemia of CKD, a common affliction in dialysis patients. In efforts to und...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000329573
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:It was recently reported that the severity of coronary and carotid atherosclerosis in patients with end-stage kidney disease (ESKD) has improved over the last two decades. However, the frequency of coronary artery events observed at the initiation of dialysis remains high. SUMMARY:Recently, 5 different clin...
journal_title:Blood purification
pub_type: 评论,杂志文章
doi:10.1159/000441582
更新日期:2015-01-01 00:00:00
abstract::Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (L...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000094574
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Satisfactory and noninvasive diagnostic tools for coronary artery disease (CAD) are not available in hemodialysis patients. We aimed to elucidate a reliable tool to diagnose CAD in these patients. METHODS:102 hemodialysis patients received 2D speckle-tracking echocardiography with left ventricular (LV) stra...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000323536
更新日期:2011-01-01 00:00:00