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Said N, Lau WJ, Ho YC, Lim SK, Zainol Abidin MN, Ismail AF. A Review of Commercial Developments and Recent Laboratory Research of Dialyzers and Membranes for Hemodialysis Application. MEMBRANES 2021; 11:767. [PMID: 34677533 PMCID: PMC8540739 DOI: 10.3390/membranes11100767] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
Dialyzers have been commercially used for hemodialysis application since the 1950s, but progress in improving their efficiencies has never stopped over the decades. This article aims to provide an up-to-date review on the commercial developments and recent laboratory research of dialyzers for hemodialysis application and to discuss the technical aspects of dialyzer development, including hollow fiber membrane materials, dialyzer design, sterilization processes and flow simulation. The technical challenges of dialyzers are also highlighted in this review, which discusses the research areas that need to be prioritized to further improve the properties of dialyzers, such as flux, biocompatibility, flow distribution and urea clearance rate. We hope this review article can provide insights to researchers in developing/designing an ideal dialyzer that can bring the best hemodialysis treatment outcomes to kidney disease patients.
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Affiliation(s)
- Noresah Said
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
| | - Woei Jye Lau
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
| | - Yeek-Chia Ho
- Centre of Urban Resource Sustainability, Department of Civil and Environmental Engineering, Institute of Self-Sustainable Building, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia;
| | - Soo Kun Lim
- University Malaya Primary Care Research Group (UMPCRG), Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Muhammad Nidzhom Zainol Abidin
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
| | - Ahmad Fauzi Ismail
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
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Sánchez-Álvarez E, Rodríguez-García M, Locatelli F, Zoccali C, Martín-Malo A, Floege J, Ketteler M, London G, Górriz JL, Rutkowski B, Ferreira A, Pavlovic D, Cannata-Andía JB, Fernández-Martín JL. Survival with low- and high-flux dialysis. Clin Kidney J 2020; 14:1915-1923. [PMID: 34345415 PMCID: PMC8323142 DOI: 10.1093/ckj/sfaa233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/02/2020] [Indexed: 11/14/2022] Open
Abstract
Background Besides advances in haemodialysis (HD), mortality rates are still high. The effect of the different types of HD membranes on survival is still a controversial issue. The aim of this COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis was to survey, in HD patients, the relationship between the use of conventional low- or high-flux membranes and all-cause and cardiovascular mortality. Methods COSMOS is a multicentre, open-cohort, 3-year prospective study, designed to evaluate mineral and bone disorders in the European HD population. The present analysis included 5138 HD patients from 20 European countries, 3502 randomly selected at baseline (68.2%), plus 1636 new patients with <1 year on HD (31.8%) recruited to replace patients who died, were transplanted, switched to peritoneal dialysis or lost to follow-up by other reasons. Cox-regression analysis with time-dependent variables, propensity score matching and the use of an instrumental variable (facility-level analysis) were used. Results After adjustments using three different multivariate models, patients treated with high-flux membranes showed a lower all-cause and cardiovascular mortality risks {hazard ratio (HR) = 0.76 [95% confidence interval (CI) 0.61-0.96] and HR = 0.61 (95% CI 0.42-0.87), respectively}, that remained significant after matching by propensity score for all-cause mortality (HR = 0.69, 95% CI 0.52-0.93). However, a facility-level analysis showed no association between the case-mix-adjusted facility percentage of patients dialysed with high-flux membranes and all-cause and cardiovascular mortality. Conclusions High-flux dialysis was associated with a lower relative risk of all-cause and cardiovascular mortality. However, dialysis facilities using these dialysis membranes to a greater extent did not show better survival.
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Affiliation(s)
- Emilio Sánchez-Álvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, REDinREN del ISCIII, Gijón, Spain
| | - Minerva Rodríguez-García
- Department of Nephrology, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy
| | - Carmine Zoccali
- CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Ancona, Italy
| | - Alejandro Martín-Malo
- Nephrology Service, University Hospital Reina Sofia, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, REDinREN del ISCIII, Córdoba, Spain
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology Stuttgart, Robert-Bosch-Krankenhaus GmbH, Baden-Württemberg, Germany
| | - Gerard London
- Centre Hospitalier FH Manhes, Fleury-Mérogis, France
| | - José L Górriz
- Department of Nephrology, Hospital Clinico Universitario, Valencia, Spain.,Department of Medicine, Health Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Boleslaw Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
| | - Anibal Ferreira
- Nephrology Department, Hospital Curry Cabral and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Drasko Pavlovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - José L Fernández-Martín
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
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Chen X, Shen B, Cao X, Xiang F, Zou J, Ding X. Acute effect of one session of hemodiafiltration with endogenous reinfusion on uremic toxins and inflammatory mediators. Int J Artif Organs 2020; 43:437-443. [PMID: 31942823 DOI: 10.1177/0391398819899102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aims: To investigate the acute effects of hemodiafiltration with endogenous infusion on the elimination of uremic toxins and inflammatory mediators in patients with end-stage renal disease. Materials and methods: A total of 37 end-stage renal disease patients undergoing chronic hemodialysis received a single hemodiafiltration with endogenous infusion dialysis treatment. The acute effects of one hemodiafiltration with endogenous infusion session on uremic toxins and inflammatory mediators were assessed by comparing the pre- and post-hemodiafiltration with endogenous infusion concentrations. Results: Hemoglobin and albumin were stable during hemodiafiltration with endogenous infusion therapy. The mean reduction ratios of β2-microglobulin, p-cresyl sulfate, and indoxyl sulfate were 43.60%, 40.91%, and 43.64%, respectively. Tumor necrosis factor-α also decreased significantly at a mean rate of 28.10%, while the concentrations of interleukin-6 and high-sensitivity C-reactive protein remained unchanged after one session of hemodiafiltration with endogenous infusion. Conclusion: The hemodiafiltration with endogenous infusion system is a new dialysis technique that combines diffusion, convection, and adsorption processes. It allows for extensive solute removal, including protein-bound uremic toxins and some pro-inflammatory cytokines, but does not cause nutrient loss and inflammatory response during the treatment. Although the effect after a single hemodiafiltration with endogenous infusion session is limited, it may be improved by repeated and long-term treatment.
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Affiliation(s)
- Xiaohong Chen
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Bo Shen
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Xuesen Cao
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Fangfang Xiang
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Jianzhou Zou
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
| | - Xiaoqiang Ding
- Shanghai Institute of Kidney and Dialysis, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Shanghai, China
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Shen Y, Wang Y, Shi Y, Bi X, Xu J, Zhu Q, Ding F. Improving the clearance of protein-bound uremic toxins using cationic liposomes as an adsorbent in dialysate. Colloids Surf B Biointerfaces 2019; 186:110725. [PMID: 31862563 DOI: 10.1016/j.colsurfb.2019.110725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/26/2019] [Accepted: 12/12/2019] [Indexed: 12/19/2022]
Abstract
Anionic and protein-bound uremic toxins, represented by indoxyl sulfate (IS), may be associated with cardiovascular outcomes and the progression of chronic kidney disease in cases of injured kidney function and are not easily cleared by traditional dialysis therapy. We fabricated cationic liposomes that were modified with polyethyleneimine (PEI), octadecylamine (Oct), and hexadecyl trimethyl ammonium bromide (CTAB), and evaluated the effects on the clearance of the representative protein-bound uremic toxins (PBUTs). The binding rate was obtained by ultrafiltration and in vitro dialysis was performed in a Rapid Equilibrium Dialysis (RED) device to assay the clearing efficiency of the dialysate supported by three types of cationic liposomes. The cationic liposomes showed a higher binding rate with IS (1.24-1.38 fold higher) and p-cresol (1.07-1.09 fold higher) than in the unmodified plain liposomes. The dialysate supported by cationic liposomes also exhibited better clearing efficiency for IS (PEI-20: 57.65 ± 1.74 %; Oct-5: 62.80 ± 0.69 %; CTAB-10: 66.54 ± 0.91 %; p < 0.05) and p-cresol (PEI-20: 67.05 ± 3.09 %; Oct-5: 79.26 ± 0.43 %; CTAB-5: 68.45 ± 1.72 %; p < 0.05) than for phosphate buffer saline (IS: 29.70 ± 2.38 %; p-cresol: 33.59 ± 3.44 %) or dialysate supported by bovine serum albumin (IS: 50.00 ± 4.01 %; p-cresol: 53.06 ± 0.97 %). In conclusion, cationic liposomes are efficient in the clearance of anionic PBUTs, and these modified liposomes suggest a potential application in blood purification.
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Affiliation(s)
- Yue Shen
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yifeng Wang
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yuanyuan Shi
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiao Bi
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Jingyi Xu
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Qiuyu Zhu
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Feng Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.
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Abdel-Magied N, Elkady AA. Possible curative role of curcumin and silymarin against nephrotoxicity induced by gamma-rays in rats. Exp Mol Pathol 2019; 111:104299. [PMID: 31442446 DOI: 10.1016/j.yexmp.2019.104299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Curcumin (CUR) and silymarin (SLM) are powerful antioxidant and anti-inflammatory compounds with beneficial protective effects against renal diseases. The purpose of this study was to evaluate the efficacy of CUR and SLM alone or in combination on radiation (IR) induced kidney injury. The results showed that CUR and SLM alone or in combination attenuated the oxidative stress denoted by a reduction in the level of malondialdehyde (MDA), hydrogen peroxide (H2O2) and advanced oxidation protein products (AOPP) along with a marked increase of glutathione GSH content and total antioxidant capacity (TAC). Additionally, a significant decrease in the level of blood urea nitrogen (BUN), creatinine, Cystatin-C (CYT-C), neutrophil gelatinase-associated lipocalin (N-GAL) and Kidney Injury Molecule-1 (Kim-1) was recorded. Moreover, the treatment resulted in a remarkable decline in the serum levels of interleukin-18(IL-18), tumor necrosis factor- alpha (TNF-α), C reactive protein (CRP), BCL2 associated X protein (Bax), Factor-related Apoptosis (FAS) and the activity of Caspase-3 associated by an increase of B-cell CLL/lymphoma 2 (Bcl2) level. The results were confirmed with the histopathological examination. Kidney of irradiated showed glomerular atrophy, massive necrotic changes of expanded tubules with hyaline cast inside some tubules and apoptotic changes were recorded in some renal tubules. While irradiated rats treated with CUR and SLM exhibited marked preservation of the cellular structure of their kidney tissue. In conclusion, the combination of CUR and SLM could be more potent than a single agent on the biochemical and histological changes of the irradiated rat renal tissue.
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Affiliation(s)
- Nadia Abdel-Magied
- Radiation Biology Research Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), P.O. Box 29, Nasr City, Cairo, Egypt.
| | - Ahmed A Elkady
- Health Radiation Research Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), P.O. Box 29, Nasr City, Cairo, Egypt.
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Legallais C, Kim D, Mihaila SM, Mihajlovic M, Figliuzzi M, Bonandrini B, Salerno S, Yousef Yengej FA, Rookmaaker MB, Sanchez Romero N, Sainz-Arnal P, Pereira U, Pasqua M, Gerritsen KGF, Verhaar MC, Remuzzi A, Baptista PM, De Bartolo L, Masereeuw R, Stamatialis D. Bioengineering Organs for Blood Detoxification. Adv Healthc Mater 2018; 7:e1800430. [PMID: 30230709 DOI: 10.1002/adhm.201800430] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/23/2018] [Indexed: 12/11/2022]
Abstract
For patients with severe kidney or liver failure the best solution is currently organ transplantation. However, not all patients are eligible for transplantation and due to limited organ availability, most patients are currently treated with therapies using artificial kidney and artificial liver devices. These therapies, despite their relative success in preserving the patients' life, have important limitations since they can only replace part of the natural kidney or liver functions. As blood detoxification (and other functions) in these highly perfused organs is achieved by specialized cells, it seems relevant to review the approaches leading to bioengineered organs fulfilling most of the native organ functions. There, the culture of cells of specific phenotypes on adapted scaffolds that can be perfused takes place. In this review paper, first the functions of kidney and liver organs are briefly described. Then artificial kidney/liver devices, bioartificial kidney devices, and bioartificial liver devices are focused on, as well as biohybrid constructs obtained by decellularization and recellularization of animal organs. For all organs, a thorough overview of the literature is given and the perspectives for their application in the clinic are discussed.
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Affiliation(s)
- Cécile Legallais
- UMR CNRS 7338 Biomechanics & Bioengineering; Université de technologie de Compiègne; Sorbonne Universités; 60203 Compiègne France
| | - Dooli Kim
- (Bio)artificial organs; Department of Biomaterials Science and Technology; Faculty of Science and Technology; TechMed Institute; University of Twente; P.O. Box 217 7500 AE Enschede The Netherlands
| | - Sylvia M. Mihaila
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Universiteitsweg 99 3584 CG Utrecht The Netherlands
- Department of Nephrology and Hypertension; University Medical Center Utrecht and Regenerative Medicine Utrecht; Utrecht University; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Milos Mihajlovic
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Universiteitsweg 99 3584 CG Utrecht The Netherlands
| | - Marina Figliuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; via Stezzano 87 24126 Bergamo Italy
| | - Barbara Bonandrini
- Department of Chemistry; Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Piazza Leonardo da Vinci 32 20133 Milan Italy
| | - Simona Salerno
- Institute on Membrane Technology; National Research Council of Italy; ITM-CNR; Via Pietro BUCCI, Cubo 17C - 87036 Rende Italy
| | - Fjodor A. Yousef Yengej
- Department of Nephrology and Hypertension; University Medical Center Utrecht and Regenerative Medicine Utrecht; Utrecht University; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Maarten B. Rookmaaker
- Department of Nephrology and Hypertension; University Medical Center Utrecht and Regenerative Medicine Utrecht; Utrecht University; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | | | - Pilar Sainz-Arnal
- Instituto de Investigación Sanitaria de Aragón (IIS Aragon); 50009 Zaragoza Spain
- Instituto Aragonés de Ciencias de la Salud (IACS); 50009 Zaragoza Spain
| | - Ulysse Pereira
- UMR CNRS 7338 Biomechanics & Bioengineering; Université de technologie de Compiègne; Sorbonne Universités; 60203 Compiègne France
| | - Mattia Pasqua
- UMR CNRS 7338 Biomechanics & Bioengineering; Université de technologie de Compiègne; Sorbonne Universités; 60203 Compiègne France
| | - Karin G. F. Gerritsen
- Department of Nephrology and Hypertension; University Medical Center Utrecht and Regenerative Medicine Utrecht; Utrecht University; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension; University Medical Center Utrecht and Regenerative Medicine Utrecht; Utrecht University; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Andrea Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; via Stezzano 87 24126 Bergamo Italy
- Department of Management; Information and Production Engineering; University of Bergamo; viale Marconi 5 24044 Dalmine Italy
| | - Pedro M. Baptista
- Instituto de Investigación Sanitaria de Aragón (IIS Aragon); 50009 Zaragoza Spain
- Department of Management; Information and Production Engineering; University of Bergamo; viale Marconi 5 24044 Dalmine Italy
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas (CIBERehd); 28029 Barcelona Spain
- Fundación ARAID; 50009 Zaragoza Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz; 28040 Madrid Spain. Department of Biomedical and Aerospace Engineering; Universidad Carlos III de Madrid; 28911 Madrid Spain
| | - Loredana De Bartolo
- Institute on Membrane Technology; National Research Council of Italy; ITM-CNR; Via Pietro BUCCI, Cubo 17C - 87036 Rende Italy
| | - Rosalinde Masereeuw
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Universiteitsweg 99 3584 CG Utrecht The Netherlands
| | - Dimitrios Stamatialis
- (Bio)artificial organs; Department of Biomaterials Science and Technology; Faculty of Science and Technology; TechMed Institute; University of Twente; P.O. Box 217 7500 AE Enschede The Netherlands
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Chevtchik NV, Mihajlovic M, Fedecostante M, Bolhuis-Versteeg L, Sastre Toraño J, Masereeuw R, Stamatialis D. A bioartificial kidney device with polarized secretion of immune modulators. J Tissue Eng Regen Med 2018; 12:1670-1678. [DOI: 10.1002/term.2694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/04/2018] [Accepted: 05/03/2018] [Indexed: 12/24/2022]
Affiliation(s)
- N. V. Chevtchik
- Bioartificial Organs, Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; Enschede the Netherlands
| | - M. Mihajlovic
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht the Netherlands
| | - M. Fedecostante
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht the Netherlands
| | - L. Bolhuis-Versteeg
- Bioartificial Organs, Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; Enschede the Netherlands
| | - J. Sastre Toraño
- Division of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht the Netherlands
| | - R. Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht the Netherlands
| | - D. Stamatialis
- Bioartificial Organs, Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; Enschede the Netherlands
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Lauri K, Tanner R, Jerotskaja J, Luman M, Fridolin I. HPLC Study of Uremic Fluids Related to Optical Dialysis Adequacy Monitoring. Int J Artif Organs 2018. [DOI: 10.1177/039139881003300205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The aim of this study was to investigate uremia-related high-performance liquid chromatography (HPLC) ultraviolet (UV) absorbance profiles of serum and spent dialysate and to study the removal of uremic retention solutes in connection with optical dialysis adequacy monitoring. Methods 10 uremic patients were investigated using online spectrophotometry at a wavelength of 280 nm over the course of 30 hemodialysis treatments. The dialysate and blood samples were taken and analyzed simultaneously using standard biochemical methods and reversed-phase HPLC. Filters with cutoff at 3 kDa and 70 kDa were used for the pre-treatment of the serum. The chromatographic peaks were detected by a UV detector at wavelengths of 254 and 280 nm. Results This study indicated that the main solute responsible for UV absorbance in the spent dialysate is a low-molecular-weight, water-soluble, non-protein-bound compound uric acid (UA). Three additional uremic retention solutes – creatinine (CR), indoxyl sulphate (IS) and hippuric acid (HA) – were identified from the HPLC profiles. The number of detected HPLC peaks was not significantly different for a serum filtered through the 3 kDa or 70 kDa cutoff filters, and was lower for the spent dialysate, indicating that the molecular weight (MW) of the main UV chromophores in the uremic fluids did not exceed 3 kDa. The reduction ratio (RR) estimated by the total area of HPLC peaks at 254 nm and 280 nm in the serum and by the online UV absorbance at 280 nm was best related to the removal of small water-soluble non-protein bound solutes like urea (UR), CR and UA. Conclusions The present study contributes new information on the removal of uremic retention solutes during hemodialysis and on the origin of the optical dialysis adequacy monitoring signal.
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Affiliation(s)
- Kai Lauri
- Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Tallinn
| | - Risto Tanner
- Laboratory of Chemical Physics, National Institute of Chemical Physics and Biophysics, Tallinn
| | - Jana Jerotskaja
- Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Tallinn
| | - Merike Luman
- Department of Dialysis and Nephrology, North Estonia Medical Centre, Tallinn - Estonia
| | - Ivo Fridolin
- Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Tallinn
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Hemodialysis is associated with higher serum FGF23 level when compared with peritoneal dialysis. Int Urol Nephrol 2017; 49:1653-1659. [PMID: 28455658 DOI: 10.1007/s11255-017-1605-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Considering the growing relevance of fibroblast growth factor-23 (FGF23) and increased cardiovascular mortality in dialysis population, an analysis was performed to assess the influence of dialysis modality (peritoneal dialysis and hemodialysis) on level of FGF23. METHODS A cross-sectional study was performed in 80 continuous ambulatory peritoneal dialysis (CAPD) and 65 hemodialysis (HD) patients without residual renal function. Levels of calcium, phosphate, parathyroid hormone and FGF23 were measured, and their correlations were analyzed. Data on demographics, dialysis modality and FGF23 level were also analyzed. RESULTS A significant correlation was found between FGF23 and serum calcium, serum phosphate and dialysis vintage in dialysis patients. Level of FGF23 was significantly higher in hemodialysis patients than that in peritoneal dialysis population. Multivariable regression revealed that, compared to CAPD, hemodialysis was found to be a predictor for higher FGF23 level, which was independent of serum calcium and phosphate level (P < 0.05). CONCLUSIONS These findings demonstrate that FGF23 levels are significantly higher in hemodialysis patients than that in peritoneal dialysis patients. We demonstrate an important association between dialysis modality (HD vs CAPD) and higher FGF23, independent of classical determinants (serum calcium and phosphate level).
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10
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Chevtchik NV, Fedecostante M, Jansen J, Mihajlovic M, Wilmer M, Rüth M, Masereeuw R, Stamatialis D. Upscaling of a living membrane for bioartificial kidney device. Eur J Pharmacol 2016; 790:28-35. [PMID: 27395800 DOI: 10.1016/j.ejphar.2016.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/24/2016] [Accepted: 07/06/2016] [Indexed: 12/01/2022]
Abstract
The limited removal of metabolic waste products in dialyzed kidney patients leads to high morbidity and mortality. One powerful solution for a more complete removal of those metabolites might be offered by a bioartificial kidney device (BAK), which contains a hybrid "living membrane" with functional proximal tubule epithelial cells (PTEC). These cells are supported by an artificial functionalized hollow fiber membrane (HFM) and are able to actively remove the waste products. In our earlier studies, conditionally immortalized human PTEC (ciPTEC) showed to express functional organic cationic transporter 2 (OCT2) when seeded on small size flat or hollow fiber polyethersulfone (PES) membranes. Here, an upscaled "living membrane" is presented. We developed and assessed the functionality of modules containing three commercially available MicroPES HFM supporting ciPTEC. The HFM were optimally coated with L-Dopa and collagen IV to support a uniform and tight monolayer formation of matured ciPTEC under static culturing conditions. Both abundant expression of zonula occludens-1 (ZO-1) protein and limited diffusion of FITC-inulin confirm a clear barrier function of the monolayer. Furthermore, the uptake of 4-(4-(dimethylamino)styryl)-N-methylpyridinium iodide (ASP+), a fluorescent OCT2 substrate, was studied in absence and presence of known OCT inhibitors, such as cimetidine and a cationic uremic solutes mixture. The ASP+ uptake by the living upscaled membrane was decreased by 60% in the presence of either inhibitor, proving the active function of OCT2. In conclusion, this study presents a successful upscaling of a living membrane with active organic cation transport as a support for BAK device.
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Affiliation(s)
- Natalia Vladimirovna Chevtchik
- Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Michele Fedecostante
- Department of Pharmaceutical Sciences, UIPS Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jitske Jansen
- Department of Pharmaceutical Sciences, UIPS Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Milos Mihajlovic
- Department of Pharmaceutical Sciences, UIPS Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Martijn Wilmer
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Marieke Rüth
- eXcorLab GmbH, Industrie Center Obernburg, Obernburg, Germany
| | - Rosalinde Masereeuw
- Department of Pharmaceutical Sciences, UIPS Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Dimitrios Stamatialis
- Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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11
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Kirkman DL, Roberts LD, Kelm M, Wagner J, Jibani MM, Macdonald JH. Interaction between intradialytic exercise and hemodialysis adequacy. Am J Nephrol 2013; 38:475-82. [PMID: 24296748 DOI: 10.1159/000356340] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS According to mathematical modeling, intradialytic exercise of sufficient intensity and duration implemented in the second half of dialysis should be as efficacious as increasing dialysis time for dialysis adequacy. This assumption has not been tested in vivo. METHODS In this controlled trial, 11 hemodialysis (HD) patients (mean (SD) age 56 (13) years) were recruited. Each patient completed three trial arms in a randomized order: routine care (CONT), increased HD time of 30 min (TIME), and intradialytic exercise (EXER), 60 min of cycling at 90% of the lactate threshold in the last 90 min of HD. The primary outcome was eKt/Vurea. Secondary outcomes included reduction and rebound ratios of urea, creatinine, phosphate and β2-microglobulin. Outcomes were calculated from blood sampling collected pre-, post- and 30 min post-HD and confirmed with dialysate sampling. RESULTS Exercise was not as efficacious as increased HD time for eKt/Vurea (EXER vs. CONT, mean change (95% CI): 0.03 (-0.05 to 0.12); TIME vs. CONT: 0.15 (0.05-0.26)). Exercise was less efficacious at improving reduction ratios of urea and creatinine. However, exercise was more efficacious than increased dialysis time for phosphate reduction ratio (EXER vs. CONT: 8.6% (0.5-16.7); TIME vs. CONT: 5.0% (-1.0 to 11.1)). CONCLUSION This study utilized a rigorously controlled in vivo design to test mathematical models and assumptions regarding dialysis adequacy. Intradialytic exercise towards the end of HD cannot replace the prescription of increased HD time for dialysis adequacy, but may be an adjunctive therapy for serum phosphate control.
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Affiliation(s)
- Danielle L Kirkman
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
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12
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Muralidhar K, Bhagyashri K, Guptha R, Hegde N, Ahmed I, Vincent L. Determinants of renal replacement therapy after adult cardiac surgery. Asian Cardiovasc Thorac Ann 2013; 21:533-8. [PMID: 24570554 DOI: 10.1177/0218492312461638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute renal injury requiring renal replacement therapy after cardiac surgery develops in 1%-5% of patients, and is strongly associated with perioperative morbidity and mortality. The prognostic risk factors for development acute renal injury requiring renal replacement therapy are identified in this study. METHODS 2585 adult patients who underwent cardiac surgery during a 1-year period (November 2010 to October 2011) were studied. The patients who developed acute renal injury requiring renal replacement therapy were compared with matched controls. Logistic regression analysis was applied to determine the predictors of acute renal injury requiring renal replacement therapy. RESULTS 44 patients developed acute renal injury requiring renal replacement therapy following cardiac surgery. On multivariate logistic analysis, the following factors independently predicted acute renal injury requiring renal replacement therapy (p < 0.05): preoperative critical state, pre-existing renal dysfunction, preoperative diastolic dysfunction, and combined cardiac surgery. CONCLUSION The risk of acute renal injury requiring renal replacement therapy can be fairly accurately predicted and quantified on the basis of available preoperative and intraoperative data. These predictors may be used by physicians to estimate the risk and target high-risk groups for interventions that prevent, reduce, or ameliorate the occurrence of renal failure needing acute renal replacement therapy.
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Affiliation(s)
- Kanchi Muralidhar
- Department of Anesthesia and Intensive Care, Narayana Hrudayalaya Hospitals, Bangalore, Karnataka, India
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13
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Fissell R, Schulman G, Pfister M, Zhang L, Hung AM. Novel dialysis modalities: do we need new metrics to optimize treatment? J Clin Pharmacol 2012; 52:72S-8S. [PMID: 22232756 DOI: 10.1177/0091270011414576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Delivered dose of hemodialysis has long been an important predictor of mortality. The limitations of conventional hemodialysis treatments have led to a renewed interest in more frequent and longer hemodialysis treatments. As alternative hemodialysis schedules have become more prevalent, a need for modified metrics to measure adequacy has emerged. In addition, there is an interest in finding measures of hemodialysis adequacy that are more reliable in certain subgroups of patients, such as women, ethnic minority groups, or people with small body size. Finally, extended hemodialysis schedules suggest a need for metrics that can measure the clearance of solutes other than urea, such as middle-size molecules, and solutes for which clearance depends on intercompartmental transport across membranes. New metrics to quantify clearance in extended and alternate hemodialysis schedules are needed. As new metrics are developed, it is anticipated that they will also contribute to more accurate assessments of associations between clinical outcomes and delivered dose of dialysis in more intensive, nontraditional hemodialysis schedules. This review provides a historical prospective of dialysis dose and adequacy and describes the need for new metrics from both solute type and dialysis dose prospective as alternative hemodialysis schedules have emerged and become more prevalent.
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Affiliation(s)
- Rachel Fissell
- Glickman Urological/Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Klammt S, Wojak HJ, Mitzner A, Koball S, Rychly J, Reisinger EC, Mitzner S. Albumin-binding capacity (ABiC) is reduced in patients with chronic kidney disease along with an accumulation of protein-bound uraemic toxins. Nephrol Dial Transplant 2011; 27:2377-83. [PMID: 22086973 DOI: 10.1093/ndt/gfr616] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Albumin is an important transport protein for non-water-soluble protein-bound drugs and uraemic toxins. Its transport capacity is reduced in patients with advanced chronic kidney disease (CKD) and unbound fractions of uraemic toxins are related to complications of CKD. We investigated whether this reduction could be quantified and how it correlated with the stages of CKD. Albumin-binding capacity (ABiC) is a dye-based method that quantifies the remaining binding capacity of one major binding site (site II) of the albumin molecule. METHODS Blood samples from 104 CKD patients were incubated with a binding site-specific fluorescent marker and the amount of unbound marker was determined by means of fluorescence detection after filtration. Measurements in a pooled human plasma were used for reference. Glomerular filtration rate and serum indoxyl sulphate (IS) levels were also determined. RESULTS Impairment of renal function was associated with a reduction in ABiC (mean ± SD: 118 ± 12; 111 ± 11; 99 ± 8 and 79 ± 9% for Stages 1/2, 3, 4 and 5, respectively; P < 0.001) and an increase in IS (3.9 ± 1.1; 6.2 ± 3.2; 16.3 ± 14.9 and 56.1 ± 28.6 μmol/L for Stages 1/2, 3, 4 and 5, respectively; P < 0.001). In dialysis patients, ABiC was lower in those with urine outputs <500 mL/day than in those with preserved urine output (73.7 ± 6.0 versus 83.8 ± 8.5%; P < 0.001). CONCLUSION Impaired albumin function in CKD patients can be quantified, is related to severity of kidney disease and is associated with an accumulation of uraemic albumin-bound retention solutes.
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Affiliation(s)
- Sebastian Klammt
- Division of Nephrology, Department of Medicine II, Medical Faculty of the University of Rostock, Rostock, Germany.
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15
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Varshney A, Rehan M, Subbarao N, Rabbani G, Khan RH. Elimination of endogenous toxin, creatinine from blood plasma depends on albumin conformation: site specific uremic toxicity & impaired drug binding. PLoS One 2011; 6:e17230. [PMID: 21386972 PMCID: PMC3046181 DOI: 10.1371/journal.pone.0017230] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/26/2011] [Indexed: 11/18/2022] Open
Abstract
Uremic syndrome results from malfunctioning of various organ systems due to the retention of uremic toxins which, under normal conditions, would be excreted into the urine and/or metabolized by the kidneys. The aim of this study was to elucidate the mechanisms underlying the renal elimination of uremic toxin creatinine that accumulate in chronic renal failure. Quantitative investigation of the plausible correlations was performed by spectroscopy, calorimetry, molecular docking and accessibility of surface area. Alkalinization of normal plasma from pH 7.0 to 9.0 modifies the distribution of toxin in the body and therefore may affect both the accumulation and the rate of toxin elimination. The ligand loading of HSA with uremic toxin predicts several key side chain interactions of site I that presumably have the potential to impact the specificity and impaired drug binding. These findings provide useful information for elucidating the complicated mechanism of toxin disposition in renal disease state.
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Affiliation(s)
- Ankita Varshney
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Mohd Rehan
- School of Information Technology, Centre for Computational Biology and Bioinformatics, Jawaharlal Nehru University, New Delhi, India
| | - Naidu Subbarao
- School of Information Technology, Centre for Computational Biology and Bioinformatics, Jawaharlal Nehru University, New Delhi, India
| | - Gulam Rabbani
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Rizwan Hasan Khan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
- * E-mail:
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16
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The impact of beta2-microglobulin clearance on the risk factors of cardiovascular disease in hemodialysis patients. ASAIO J 2010; 56:326-32. [PMID: 20431482 DOI: 10.1097/mat.0b013e3181de0842] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
beta2-Microglobulin (beta2M) is an independent predictor of outcome for hemodialysis (HD) patients and a representative substance of middle molecules. We tested the relationship among serum beta2M levels and cardiovascular disease (CVD) risk factors in HD patients. A total of 132 HD patients were divided according to the dialysis membrane used [property; cellulose and synthetic or beta2M clearance; low filtration (LF), middle filtration (MF), and high filtration (HF)]. There was no significant difference in CVD risk factors between cellulose and synthetic groups. On the other hand, serum beta2M, highly-sensitive C-reactive protein (hCRP), troponin-T (TnT), and myeloperoxidase (MPO) levels of LF were significantly higher and those of prealbumin (PA) were lower than the MF and HF. Serum beta2M level was positively correlated with hCRP, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), MPO, TnT, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and inversely correlated with PA and ankle-brachial index (ABI). There was a significant correlation between serum beta2M levels and various CVD risk factors in HD. Cardiovascular disease risk factors in HD patients were dependent on the beta2M clearance but not membrane property.
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17
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Kreusser W, Reiermann S, Vogelbusch G, Bartual J, Schulze-Lohoff E. Effect of different synthetic membranes on laboratory parameters and survival in chronic haemodialysis patients. NDT Plus 2010; 3:i12-i19. [PMID: 27046088 PMCID: PMC4813822 DOI: 10.1093/ndtplus/sfq032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background. A number of studies suggested that the type of dialysis membrane is associated with differences in long-term outcome of patients undergoing haemodialysis, both in terms of morbidity and mortality. In the majority of dialysis units, synthetic membranes are being used. However, no studies are available so far for comparison between different biocompatible membranes. Therefore, we studied the influence of high- and low-flux polysulphone membranes (PS) in comparison with polymethylmethacrylate (PMMA) membranes on mortality and morbidity on the basis of various laboratory parameters. Methods. In a cohort study, data of 260 consecutive haemodialysis patients entering our dialysis unit in the years 2003-07 were collected, comparing 435 PS patient-years and 85 PMMA patient-years. PMMA membranes (n = 33) were used for those patients who did not tolerate (e.g. for pruritus) PS membranes (n = 227). Low-flux dialysers (n = 233) were compared with high-flux (n = 37). Laboratory values were evaluated by unpaired t-test, and mortality was evaluated by log-rank test and Cox regression analysis adjusted for age, diabetes and laboratory parameters. Results. Patients in our dialysis unit had a high cardiovascular risk as demonstrated by a proportion of 63% of peripheral arterial disease. Despite this, cumulative survival was almost 60% after 5 years on dialysis. It was slightly but not significantly higher in patients on PMMA (68%) compared with PS dialysers (54%) and on high-flux (61%) versus low-flux membranes (54%). After accounting for the confounding effect of age and diabetes in the multivariate Cox regression analysis, there was no impact of the membranes used (high- or low-flux, PMMA or PS) on survival. Only age at the onset of dialysis showed a significant influence on survival (P ≤ 0.001). Independent predictors of mortality in all patients in the multivariate Cox regression analysis were age, haemoglobin, leucocytes, C-reactive protein (CRP) and creatinine. Laboratory parameters between the high- and low- flux groups were not different. PS-treated patients showed significantly (P ≤ 0.05) higher values for leucocytes, thrombocytes, ferritin, and CRP and lower values for haemoglobin, transferrin, creatinine, uric acid, creatine kinase (CK), and sodium than PMMA-treated patients. Irrespective of the membrane used, in deceased patients, the following laboratory values were higher than for patients alive: leucocytes, thrombocytes, ferritin and CRP; the following were lower: haemoglobin, iron, total protein, urea, creatinine, uric acid and CK. Conclusions. The data of 260 severely ill haemodialysis patients showed a slightly, but not significantly, reduced mortality in patients treated with PMMA membranes in comparison with PS and with high-flux membranes compared with low-flux. High- or low-flux membranes exhibited no difference in laboratory values. However, in PMMA patients, laboratory data with respect to inflammation, anaemia and nutrition were significantly improved compared with the PS group. A similarly positive laboratory pattern was seen in patients alive compared with patients deceased with both membrane types. The favourable effect of PMMA membranes may be explained by the reduced activation of catabolic components and inflammation, which, in turn, would result in an improved nutrition and better response to recombinant human erythropoietin.
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Affiliation(s)
| | - Stefanie Reiermann
- Department of Internal Medicine D , University of Muenster, Muenster , Germany
| | - Gert Vogelbusch
- Department of Nephrology , Marien-Hospital , Duisburg Germany
| | - Josè Bartual
- Department of Nephrology , Marien-Hospital , Duisburg Germany
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18
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Stosovic M, Stanojevic M, Simic-Ogrizovic S, Jovanovic D, Djukanovic L. Relation between Serum Urea and Mortality of Hemodialysis Patients. Ren Fail 2009; 31:335-40. [DOI: 10.1080/08860220902835848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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The clearance of unidentified uremic solutes (with molecular weight under 5 kDa) plays an important role in hemodialyzer selection. Int Urol Nephrol 2009; 42:465-70. [DOI: 10.1007/s11255-009-9613-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
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20
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Stamopoulos D, Bouziotis P, Benaki D, Zirogiannis PN, Kotsovassilis K, Belessi V, Dalamagas V, Papadopoulos K. Nanobiotechnology for the Prevention of Dialysis-related Amyloidosis. Ther Apher Dial 2009; 13:34-41. [DOI: 10.1111/j.1744-9987.2009.00603.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Stamopoulos D, Manios E, Gogola V, Benaki D, Bouziotis P, Niarchos D, Pissas M. Bare and protein-conjugated Fe(3)O(4) ferromagnetic nanoparticles for utilization in magnetically assisted hemodialysis: biocompatibility with human blood cells. NANOTECHNOLOGY 2008; 19:505101. [PMID: 19942758 DOI: 10.1088/0957-4484/19/50/505101] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Magnetically assisted hemodialysis is a development of conventional hemodialysis and is based on the circulation of ferromagnetic nanoparticle-targeted binding substance conjugates (FN-TBS Cs) in the bloodstream of the patient and their eventual removal by means of a 'magnetic dialyzer'. Presented here is an in vitro investigation on the biocompatibility of bare Fe(3)O(4) FNs and Fe(3)O(4)-bovine serum albumin Cs with blood cells, namely red blood cells (RBCs), white blood cells (WBCs) and platelets (Plts). Atomic force microscopy (AFM) and optical microscopy (OM) enabled the examination of blood cells at the nanometer and micrometer level, respectively. The observations made on FN- and C-maturated blood samples are contrasted to those obtained on FN- and C-free reference blood samples subjected to exactly the same maturation procedure. Qualitatively, both AFM and OM revealed no changes in the overall shape of RBCs, WBCs and Plts. Incidents where bare FNs or Cs were bound onto the surface of RBCs or internalized by WBCs were very rare. Detailed examination by means of OM proved that impaired coagulation of Plts is not initiated/promoted either by FNs or Cs. Quantitatively, the statistical analysis of the obtained AFM images from RBC surfaces clearly revealed that the mean surface roughness of RBCs maturated with bare FNs or Cs was identical to the one of reference RBCs.
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Affiliation(s)
- D Stamopoulos
- Institute of Materials Science, NCSR 'Demokritos', GR-15310 Aghia Paraskevi, Athens, Greece
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22
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Kwon O, Wang WW, Miller S. Renal organic anion transporter 1 is maldistributed and diminishes in proximal tubule cells but increases in vasculature after ischemia and reperfusion. Am J Physiol Renal Physiol 2008; 295:F1807-16. [DOI: 10.1152/ajprenal.90409.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal solute clearances are reduced in ischemic acute kidney injury. However, the mechanisms explaining how solute clearance is impaired have not been clarified. Recently, we reported that cadaveric renal allografts exhibit maldistribution of organic anion transporter 1 (OAT1) in proximal tubule cells after ischemia and reperfusion, resulting in impairment of PAH clearance. In the present study, we characterized renal OAT1 in detail after ischemia-reperfusion using a rat model. We analyzed renal OAT1 using confocal microscopy with a three-dimensional reconstruction of serial optical images, Western blot, and quantitative real-time RT-PCR. OAT1 was distributed to basolateral membranes of proximal tubule cells in controls. With ischemia, OAT1 decreased in basolateral membrane, especially in the lateral membrane domain, and appeared diffusely in cytoplasm. After reperfusion following 60-min ischemia, OAT1 often formed cytoplasmic aggregates. The staining for OAT1 started reappearing in lateral membrane domain 1 h after reperfusion. The basolateral membrane staining was relatively well discernable at 240 h of reperfusion. Of note, a distinct increase in OAT1 expression was noted in vasculature early after ischemia and after reperfusion. The total amount of OAT1 protein expression in the kidney diminished after ischemia-reperfusion in a duration-dependent manner until 72 h, when they began to recover. However, even at 240 h, the amount of OAT1 did not reach control levels. The kidney tissues tended to show a remarkable but transient increase in mRNA expression for OAT1 at 5 min of ischemia. Our findings may provide insights of renal OAT1 in its cellular localization and response during ischemic acute kidney injury and recovery from it.
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23
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Stamopoulos D, Bouziotis P, Benaki D, Kotsovassilis C, Zirogiannis PN. Utilization of nanobiotechnology in haemodialysis: mock-dialysis experiments on homocysteine. Nephrol Dial Transplant 2008; 23:3234-9. [DOI: 10.1093/ndt/gfn189] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Jerotskaja J, Lauri K, Tanner R, Luman M, Fridolin I. Optical dialysis adequacy sensor: wavelength dependence of the ultra violet absorbance in the spent dialysate to the removed solutes. ACTA ACUST UNITED AC 2008; 2007:2960-3. [PMID: 18002616 DOI: 10.1109/iembs.2007.4352950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A need for dialysate-based, on-line, continuous monitoring systems for the control of dialysis efficiency and the prevention of dialysis-associated complications is arisen due to increasing number of dialysis patients and related treatment quality requirements. The aim of this study was to investigate the wavelength dependence between the the ultra-violet (UV) absorbance in the spent dialysate and the retained solutes removed during the hemodialysis in order to explain possibilities to estimate removal of the solutes by the optical dialysis adequacy sensor. Ten uremic patients, during 30 hemodialysis treatments, were followed at the Department of Dialysis and Nephrology, North-Estonian Regional Hospital. The dialysate samples were taken and analyzed with spectrophotometer to get absorbance spectra. The results confirm previous studies considering similarity for the UV-spectrum on the spent dialysate samples during a single dialysis session indicating presence of the same type of chromophores in the spent dialysate removed from the patient's blood for different patients groups. At the same time the highest correlation in the spent dialysate for urea, creatinine, potassium, and phosphate was obtained at the wavelength 237 nm that is a new finding compared to earlier results. The highest correlation between the UV-absorbance and uric acid in the spent dialysate was obtained at the wavelength 294 nm. Presence of at least two different wavelength ranges may add selectivity for monitoring several compounds. Our study indicates that the technique has a potential to estimate the removal of retained substances.
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Affiliation(s)
- Jana Jerotskaja
- Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, 19086 Tallinn, Estonia.
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25
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Stamopoulos D, Benaki D, Bouziotis P, Zirogiannis PN. In vitro utilization of ferromagnetic nanoparticles in hemodialysis therapy. NANOTECHNOLOGY 2007; 18:495102. [PMID: 20442466 DOI: 10.1088/0957-4484/18/49/495102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The in vitro utilization of biocompatible ferromagnetic nanoparticles (BFNs) in hemodialysis (HD), routinely used today for the treatment of end stage renal disease (ESRD), is introduced in this work. The proposed strategy is termed magnetically assisted hemodialysis (MAHD) and it aims to become a more efficient development of conventional HD. The method is based on the production of biocompatible ferromagnetic nanoparticles-targeted binding substances conjugates (BFNs-TBSs Cs) constructed of BFNs and specifically designed TBSs that should have high affinity and binding capacity for target toxic substances (TTSs) which must be removed from the ESRD patient subjected to HD. Antibodies or even specific proteins could serve as the TBS of the desired BFNs-TBSs Cs. The BFNs-TBSs Cs should be administered to the patient timely prior to the MAHD session so as to bind with the desired TTSs during their free circulation in the vascular network. Eventually, the complete BFNs-TBSs-TTSs structure can be selectively removed during the MAHD session by means of an external inhomogeneous magnetic field that is applied either at the dialyzer or at other collection point(s) along the blood circulation line of the dialysis machine. The advantages of MAHD over conventional HD regarding the patient's comfort and overall health status are discussed in detail among practical issues. To examine this proposition we employed Fe(3)O(4) and bovine serum albumin (BSA) as the BFN and the TBS constituents respectively, since they are both highly biocompatible. By means of x-ray diffraction, atomic force microscopy, circular dichroism spectropolarimetry, UV-vis spectrophotometry, SQUID magnetometry, and nuclear magnetic resonance we evaluated (i) the structural/morphological characteristics, (ii) the magnetic retraction efficiency, and most importantly (iii) the toxin binding affinity and capacity of both bare Fe(3)O(4) BFNs and Fe(3)O(4)-BSA Cs by performing in vitro experiments on specific TTSs. Homocysteine and p-cresol were chosen as representative TTSs and were investigated in great detail. The results obtained prove the in vitro applicability of the proposed MAHD method. Corrections were made to this article on 6 November 2007 (see figure 10 caption and lines 10 and 11 of page 11). The corrected electronic version is identical to the print version.
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Affiliation(s)
- D Stamopoulos
- Institute of Materials Science, NCSR Demokritos, 153-10, Aghia Paraskevi, Athens, Greece.
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Kwon O, Hong SM, Blouch K. Alteration in Renal Organic Anion Transporter 1 After Ischemia/Reperfusion in Cadaveric Renal Allografts. J Histochem Cytochem 2007; 55:575-84. [PMID: 17312013 DOI: 10.1369/jhc.6a7130.2007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have previously shown that postischemic injury to renal allografts results in profound impairment of p-aminohippuric acid (PAH) extraction. To elucidate the cellular integrity of the human organic anion transporter 1 (hOAT1) in postischemic acute renal failure (ARF), immunohistochemical analysis of hOAT1 was performed in cadaveric renal allografts using confocal microscopy for three-dimensional reconstruction of serial optical images. Biopsy samples were obtained from 10 cadaveric renal allografts 1 hr after reperfusion during transplant operation. Control tissues were obtained from four living donors of healthy kidneys immediately before an arterial clamp was applied to the renal artery. Control tissues demonstrated hOAT1 distributed to basolateral membrane of proximal tubule cells. In contrast, maldistribution of hOAT1 to cytoplasm and/or diminution of the protein was noted in cadaveric allografts. Characteristics of maldistribution were variable: disappearance of lateral distribution, diffuse cytoplasmic aggregates, apical cytoplasmic aggregates, and disappearance of the staining. In addition, iothalamate and PAH clearances were performed on posttransplant days 3–7 in 18 recipients of a cadaveric renal allograft. PAH clearance was depressed <250 ml/min in all but three subjects. We conclude that reperfused, transplanted kidneys exhibit maldistribution of hOAT1 in proximal tubule cells, resulting in impairment of PAH clearance. This manuscript contains online supplemental material at http://www.jhc.org . Please visit this article online to view these materials.
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Affiliation(s)
- Osun Kwon
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
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Ishikawa I, Hayama T, Yoshida S, Asaka M, Tomosugi N, Watanabe M, Yamato H, Sugano M. Proteomic Analysis of Rat Plasma by SELDI-TOF-MS under the Condition of Prevention of Progressive Adriamycin Nephropathy Using Oral Adsorbent AST-120. ACTA ACUST UNITED AC 2006; 103:p125-30. [PMID: 16557031 DOI: 10.1159/000092246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 11/08/2005] [Indexed: 11/19/2022]
Abstract
AIMS To determine changes in relative peak intensities of mass-to-charge ratio (m/z) between 2,000 and 15,000, which are difficult to evaluate by 2-dimensional gel electrophoresis, SELDI-TOF-MS (surface-enhanced laser desorption/ionization time of flight-mass spectrometry) proteomic changes in rat models of adriamycin nephropathy with or without AST-120 were investigated. METHODS A normal group (n = 5), an adriamycin nephropathy group (n = 9), and an adriamycin nephropathy + AST-120 group (4 g/head/day) (n = 9) were established in SD rats. Anion exchange chips, Q10, washed by 50 mM Tris-HCl pH 8 as a ProteinChip and sinapinic acid were used. The mass range between 2,000 and 15,000 Da was measured. Twenty to 34 weeks after adriamycin 3 mg/kg injection, the adriamycin nephropathy + AST-120 group (plasma creatinine value: 2.1 +/- 0.8 mg/dl) clearly demonstrated slight renal dysfunction compared with that in the adriamycin nephropathy group (5.4 +/- 2.0 mg/dl). RESULTS The relative intensities in the adriamycin nephropathy group were significantly higher in 7 peaks (such as 8,640, and 8,822 Da) and lower in 8 peaks (such as 4,188, and 8,358 Da) than those in the normal group. The relationship between the relative intensity of peaks and the plasma creatinine value demonstrated a positive correlation in 11 peaks (such as 8,640, and 8,822 Da), and a negative correlation in 6 peaks (such as 4,188 and 8,358 Da). Although the relative intensities of peaks in the adriamycin nephropathy + AST-120 group were between that of the adriamycin nephropathy group and that of the normal group, the relative intensities of 4 peaks (such as 3,664 and 5,179 Da) in the adriamycin nephropathy + AST-120 group demonstrated higher values than in the two other groups. The m/z 3,664 peak was purified and identified as a C-terminal fragment of apolipoprotein C-III. CONCLUSION Low-molecular proteins and peptides in plasma in this chronic renal failure model showed not only increases but also decreases in some peaks. The relative intensities in some peaks increased in the adriamycin nephropathy + AST-120 group more than in the two other groups. One of these peaks was identified as the apolipoprotein C-III fragment. The relationship between these changes and the prevention of progression of chronic renal failure by AST-120 remains to be established.
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Affiliation(s)
- Isao Ishikawa
- Division of Nephrology, Department of Internal Medicine, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan.
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Testa A, Gentilhomme H, Le Carrer D, Orsonneau JL. In vivo removal of high- and low-molecular-weight compounds in hemodiafiltration with on-line regeneration of ultrafiltrate. Nephron Clin Pract 2006; 104:c55-60. [PMID: 16741371 DOI: 10.1159/000093671] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 01/30/2006] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Current methods of renal replacement therapy, combining convection and diffusion, are largely unsatisfactory in removing uremic toxins. Adsorption is a third mechanism that has been applied in extracorporeal therapy. This study evaluates the impact of hemodiafiltration with on-line regeneration of ultrafiltrate, a new two-step integrated sorbent system, on in vivo removal of a wide spectrum of solutes with different molecular weights. METHODS Pre- and post-dialysis concentrations of small, medium-size, and large molecules were determined in ten patients undergoing regular hemodiafiltration treatments with on-line regeneration of the ultrafiltrate. We also analyzed, at different times of the same dialysis session, the inlet and outlet ultrafiltrate; the latter had been regenerated by the sorbent cartridge and was used as reinfusion liquid. The mean dialysis time was 260 +/- 21.2 min with a blood flow of 361 +/- 33.3 ml/min and a reinjection volume of 3.6 +/- 0.2 l/h. RESULTS Urea, creatinine and phosphate reduction ratio were respectively 69.8 +/- 8.2, 61.9 +/- 5.5, and 40.2 +/- 17.3%. Removal of medium-size markers such as calcitonin, osteocalcin, beta2-microglobulin, cystatin C, myoglobin and prolactin varied between 24 and 60%. The percentage of reduction for retinol binding protein and alpha1-microglobulin was negligible and we were unable to demonstrate any removal of alpha1-acid glycoprotein, pre-albumin, and albumin in the regenerated ultrafiltrate. CONCLUSION The hemodiafiltration with on-line regeneration of ultrafiltrate is a new hemodialysis system, which allows uremic toxin removal over a wide molecular-weight spectrum.
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Affiliation(s)
- Angelo Testa
- E.C.H.O., Expansion Centres de Hémodialyse de l'Ouest, Nantes, France.
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Ranganathan N, Patel BG, Ranganathan P, Marczely J, Dheer R, Pechenyak B, Dunn SR, Verstraete W, Decroos K, Mehta R, Friedman EA. In Vitro and In Vivo Assessment of Intraintestinal Bacteriotherapy in Chronic Kidney Disease. ASAIO J 2006; 52:70-9. [PMID: 16436893 DOI: 10.1097/01.mat.0000191345.45735.00] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic kidney disease may progress to end-stage renal disease, which requires dialysis or kidney transplantation. No generally applicable therapies to slow progression of renal disease are available. Bacteriotherapy affords a promising approach to mitigate uremic intoxication by ingestion of live microbes able to catabolize uremic solutes in the gut. The present study evaluates the nonpathogenic soil-borne alkalophilic urease-positive bacterium Sporosarcina pasteurii (Sp) as a potential urea-targeted component for such "enteric dialysis" formulation. Data presented herein suggest that Sp survives through exposure to gastric juice retaining the ability to hydrolyze urea. In vitro, 10 cfu (colony forming units) of Sp removed from 21 +/- 4.7 mg to 228 +/- 6.7 mg urea per hour, depending on pH, urea concentration, and nutrient availability. Beneficial effects of Sp on fermentation parameters in the intestine were demonstrated in vitro in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME) inoculated with fecal microbiota. Enumeration of marker organisms suggested that presence of Sp does not disturb microbial community of the SHIME. Additionally, a pilot study in 5/6th nephrectomized rats fed 10 cfu of live Sp daily throughout the study demonstrated that the tested regimen reduced blood urea-nitrogen levels and significantly prolonged the lifespan of uremic animals.
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Diepeveen SHA, Verhoeven GHWE, van der Palen J, Dikkeschei BLD, van Tits BLJ, Kolsters G, Offerman JJG, Bilo HJG, Stalenhoef AFH. The effect of the initiation of renal replacement therapy on lipid profile and oxidative stress during the first 6 months of treatment. Clin Chim Acta 2005; 361:112-8. [PMID: 16122722 DOI: 10.1016/j.cccn.2005.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2004] [Revised: 05/04/2005] [Accepted: 05/04/2005] [Indexed: 12/17/2022]
Abstract
BACKGROUND Disturbed lipoproteins and increased oxidative stress are two of the "non-traditional" cardiovascular risk factors in chronic renal failure. There are very few prospective data of the influence of dialysis on these two factors. In the present study we investigated the effects of the initiation of both hemo- and peritoneal dialysis therapy on lipoproteins and parameters of LDL oxidation. METHODS In this prospective cohort study, we assessed lipoproteins, plasma lipid peroxides and in vitro copper-induced LDL oxidation in 46 patients with end-stage renal disease prior to the start of dialysis and after 6 months of treatment with either hemodialysis (n=33) or peritoneal dialysis (n=13). RESULTS After 6 months of treatment with hemodialysis there was an increase in total cholesterol (4.6+/-1.1 vs. 5.0+/-1.3 mmol/l; p<0.05) and triglycerides (2.0+/-0.9 vs. 2.8+/-1.6 mmol/l; p<0.03). In the peritoneal dialysis group the lipoproteins did not change. Regarding lipid peroxides and in vitro copper-induced LDL oxidation, also no changes were observed after 6 months of treatment in both groups. CONCLUSION Dyslipidemia aggravates after 6 months of hemodialysis but not after 6 months of peritoneal dialysis. During this period, no net effects on oxidative stress were demonstrated.
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Affiliation(s)
- Sabine H A Diepeveen
- Department of Internal Medicine, Isala Clinics, location Weezenlanden, Zwolle, The Netherlands.
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Abstract
The concept of an immunoadsorption wall, which combines the principles of immunoisolation and immunoadsorption, was proposed in 1999 to remove certain toxins accumulated in patients' blood. However, realization of this concept is obviously handicapped by the inefficient use of immunoadsorbent. This study is intended to improve the use of immunoadsorbent and optimize the formation of a stationary phase in an immunoadsorption wall. Polyacrylamide gel, which has the advantages of being chemically inert, having minimal diffusion effect and reasonable cost, could be considered as the medium of choice for a stationary phase. In this study, new approaches aimed at effective allocation of immunoadsorbent utilizing polyacrylamide gel are attempted. The advantages and disadvantages of these new approaches are discussed according to the preparation, formation, and outcome of a stationary phase. It is hoped that these new approaches could serve as a first step toward building an immunoadsorption wall.
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Affiliation(s)
- Tsung-Hua Yang
- Department of Chemical Engineering, Cheng Shiu University, Kaohsiung, Taiwan, Republic of China.
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Grooteman MPC, Nubé MJ. Impact of the type of dialyser on the clinical outcome in chronic haemodialysis patients: does it really matter? Nephrol Dial Transplant 2004; 19:2965-70. [PMID: 15507481 DOI: 10.1093/ndt/gfh502] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Muriel P C Grooteman
- Department of Nephrology, Free University Medical Centre, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Boggi U, Ferrari M, Vistoli F, Sgambelluri F, Vignali C, Cioni R, Petruzzi P, Del Chiaro M, Berchiolli R, Signori S, Coletti L, Gremmo F, Rizzo G, Mosca F. Rescue of kidney and pancreas grafts with complex vascular lesions. Transplant Proc 2004; 36:505-8. [PMID: 15110573 DOI: 10.1016/j.transproceed.2004.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The organ shortage mandates that grafts with complex vascular lesions be considered for graft rescue. METHODS Surgical graft rescue was attempted in 8 patients bearing 8 kidneys and 2 pancreata that showed complex vascular lesions deemed not suitable for interventional radiology procedures. RESULTS All procedures but 1 were performed under elective conditions. Seven grafts were repaired in situ, while cooling the organ through retrograde venous perfusion, and 3 kidneys were explanted, repaired extracorporeally, and retransplanted. All vascular reconstructions remain patent after a mean follow-up period of 3.3 years (+/-2.1 years). CONCLUSIONS Careful patient selection, multidisciplinary evaluation, and personalized surgical technique may allow the rescue of kidney and pancreas grafts with complex vascular lesions that, otherwise, would be lost.
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Affiliation(s)
- U Boggi
- Divisione di Chirurgia Generale e Trapianti Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Vlatković V, Mitrović Đ, Arežina A, Vuković L, Bogićević K, Radivojević S. Epidemiology of renal disease patients treated by continuous dialyses in Republika Srpska. SCRIPTA MEDICA 2004. [DOI: 10.5937/scrimed0401023v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Vlatković V. Improvement of hemodialysis quality by application of various models for adequacy aseessment. SCRIPTA MEDICA 2004. [DOI: 10.5937/scrimed0402099x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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