1
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Trandafir MF, Savu OI, Gheorghiu M. The Complex Immunological Alterations in Patients with Type 2 Diabetes Mellitus on Hemodialysis. J Clin Med 2024; 13:3687. [PMID: 38999253 PMCID: PMC11242658 DOI: 10.3390/jcm13133687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/14/2024] [Accepted: 06/23/2024] [Indexed: 07/14/2024] Open
Abstract
It is widely known that diabetes mellitus negatively impacts both the innate immunity (the inflammatory response) and the acquired immunity (the humoral and cellular immune responses). Many patients with diabetes go on to develop chronic kidney disease, which will necessitate hemodialysis. In turn, long-term chronic hemodialysis generates an additional chronic inflammatory response and impairs acquired immunity. The purpose of this paper is to outline and compare the mechanisms that are the basis of the constant aggression towards self-components that affects patients with diabetes on hemodialysis, in order to find possible new therapeutic ways to improve the functionality of the immune system. Our study will take a detailed look at the mechanisms of endothelial alteration in diabetes and hemodialysis, at the mechanisms of inflammatory generation and signaling at different levels and also at the mechanisms of inflammation-induced insulin resistance. It will also discuss the alterations in leukocyte chemotaxis, antigen recognition and the dysfunctionalities in neutrophils and macrophages. Regarding acquired immunity, we will outline the behavioral alterations of T and B lymphocytes induced by diabetes mellitus and chronic hemodialysis.
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Affiliation(s)
- Maria-Florina Trandafir
- Pathophysiology and Immunology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Octavian Ionel Savu
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “N. C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 020475 Bucharest, Romania
| | - Mihaela Gheorghiu
- Pathophysiology and Immunology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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2
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Yamamoto S, Umeno H, Sano Y, Koremoto M, Goda Y, Kaneko Y, Torisu S, Tsuruda T, Fujimoto S. A chronic intermittent haemodialysis pig model for functional evaluation of dialysis membranes. Int J Artif Organs 2024; 47:321-328. [PMID: 38738648 DOI: 10.1177/03913988241253152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Performance evaluation of new dialysis membranes is primarily performed in vitro, which can lead to differences in clinical results. Currently, data on dialysis membrane performance and safety are available only for haemodialysis patients. Herein, we aimed to establish an in vivo animal model of dialysis that could be extrapolated to humans. We created a bilateral nephrectomy pig model of renal failure, which placed a double-lumen catheter with the hub exposed dorsally. Haemodialysis was performed in the same manner as in humans, during which clinically relevant physiologic data were evaluated. Next, to evaluate the utility of this model, the biocompatibility of two kinds of membranes coated with or without vitamin E used in haemodiafiltration therapy were compared. Haemodialysis treatment was successfully performed in nephrectomized pigs under the same dialysis conditions (4 h per session, every other day, for 2 weeks). In accordance with human clinical data, regular dialysis alleviated renal failure in pigs. The vitamin E-coated membrane showed a significant reduction rate of advanced oxidation protein products during dialysis than non-coated membrane. In conclusion, this model mimics the pathophysiology and dialysis condition of patients undergoing haemodialysis. This dialysis treatment model of renal failure will be useful for evaluating the performance and safety of dialysis membranes.
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Affiliation(s)
- Shushi Yamamoto
- Division of Companion Animal Surgery, Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido Prefecture, Japan
- Department of Hemo-Vascular Advanced Medicine, Cardiorenal Reseach Laboratory, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Umeno
- Medical Technology and Material Laboratory, Asahi Kasei Medical Co. Ltd., Fuji, Shizuoka, Japan
| | - Yusuke Sano
- Medical Technology and Material Laboratory, Asahi Kasei Medical Co. Ltd., Fuji, Shizuoka, Japan
| | - Masahide Koremoto
- Product Development Strategy Department, Asahi Kasei Medical Co. Ltd., Chiyoda-ku, Tokyo, Japan
| | - Yoshimichi Goda
- Department of Hemo-Vascular Advanced Medicine, Cardiorenal Reseach Laboratory, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasuyuki Kaneko
- Veterinary Teaching Hospital, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Shidow Torisu
- Division of Companion Animal Surgery, Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido Prefecture, Japan
| | - Toshihiro Tsuruda
- Department of Hemo-Vascular Advanced Medicine, Cardiorenal Reseach Laboratory, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shouichi Fujimoto
- M&M Collaboration Research Laboratory, Department of Medical Environment Innovation, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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3
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Ichikawa J, Iba T, Okazaki R, Fukuda T, Kodaka M, Komori M, Levy JH. Hemostatic capability of ultrafiltrated fresh frozen plasma compared to cryoprecipitate. Sci Rep 2023; 13:21579. [PMID: 38062086 PMCID: PMC10703847 DOI: 10.1038/s41598-023-48759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
This in vitro study evaluated the potential hemostatic effect of fresh frozen plasma (FFP) ultrafiltration on clotting factors, coagulation parameters, and plasma properties. ABO-specific units of FFP (n = 40) were prepared for the concentrated FFP and cryoprecipitate. Plasma water was removed from FFP by ultrafiltration using a dialyzer with a pump running at a 300 mL/min. The aliquot of each concentrated FFP after 50, 100, 200, and 250 mL of fluid removal were measured the standard coagulation assay, clotting activity, and plasma properties to compare those parameters of cryoprecipitate. Concentrated FFP contained 36.5% of fibrinogen in FFP with a mean concentration of 7.2 g/L, lower than the cryoprecipitate level. The levels of factor VIII (FVIII), von Willebrand factor (VWF):antigen (Ag), and VWF:ristocetin cofactor (RCo) were also lower in concentrated FFP, whereas the levels of factor V, factor IX, factor XIII, antithrombin and albumin was higher in concentrated FFP. Maximum clot firmness (MCF) in thromboelastometry was approximately one-half of that in cryoprecipitate. Although the levels of VWF:Ag, VWF:RCo, and FVIII differed depending on the ABO blood types, fibrinogen levels, and MCF were not significantly different among the ABO blood groups in FFP and concentrated FFP.
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Affiliation(s)
- Junko Ichikawa
- Department of Anesthesiology, Tokyo Women's Medical University, Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8858, Japan.
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryouta Okazaki
- Department of Anesthesiology, Tokyo Women's Medical University, Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8858, Japan
| | - Tomoki Fukuda
- Department of Anesthesiology, Tokyo Women's Medical University, Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8858, Japan
| | - Mitsuharu Kodaka
- Department of Anesthesiology, Tokyo Women's Medical University, Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8858, Japan
| | - Makiko Komori
- Department of Anesthesiology, Tokyo Women's Medical University, Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8858, Japan
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
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4
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Vanommeslaeghe F, Van Biesen W, François K. Detection and Scoring of Extracorporeal Circuit Clotting During Hemodialysis. Semin Nephrol 2023; 43:151474. [PMID: 38267348 DOI: 10.1016/j.semnephrol.2023.151474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Maintaining patency of the extracorporeal hemodialysis (HD) circuit is a prerequisite to perform HD. Unfractionated heparin and low-molecular-weight heparins are the most used anticoagulants in maintenance HD, but their administration comes with a major trade-off of bleeding complications. This narrative review article discusses technical factors impacting on HD circuit patency, such as tubings, dialyzer membranes, priming practices, and treatment settings. Strategies for monitoring extracorporeal circuit clotting during and after treatment are also reviewed, as these are essential tools for optimizing anticoagulation.
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Affiliation(s)
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Gent, Belgium
| | - Karlien François
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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5
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Syed Mohamed SMD, Welsh GI, Roy I. Renal tissue engineering for regenerative medicine using polymers and hydrogels. Biomater Sci 2023; 11:5706-5726. [PMID: 37401545 DOI: 10.1039/d3bm00255a] [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: 07/05/2023]
Abstract
Chronic Kidney Disease (CKD) is a growing worldwide problem, leading to end-stage renal disease (ESRD). Current treatments for ESRD include haemodialysis and kidney transplantation, but both are deemed inadequate since haemodialysis does not address all other kidney functions, and there is a shortage of suitable donor organs for transplantation. Research in kidney tissue engineering has been initiated to take a regenerative medicine approach as a potential treatment alternative, either to develop effective cell therapy for reconstruction or engineer a functioning bioartificial kidney. Currently, renal tissue engineering encompasses various materials, mainly polymers and hydrogels, which have been chosen to recreate the sophisticated kidney architecture. It is essential to address the chemical and mechanical aspects of the materials to ensure they can support cell development to restore functionality and feasibility. This paper reviews the types of polymers and hydrogels that have been used in kidney tissue engineering applications, both natural and synthetic, focusing on the processing and formulation used in creating bioactive substrates and how these biomaterials affect the cell biology of the kidney cells used.
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Affiliation(s)
| | - Gavin I Welsh
- Renal Bristol, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS1 3NY, UK
| | - Ipsita Roy
- Department of Materials Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield S37HQ, UK.
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Gaina C, Gaina V, Ursache O, Vasiliu L. TEOS loading effect on the properties of PVA-modified polysulfone membranes. POLYM-PLAST TECH MAT 2023. [DOI: 10.1080/25740881.2022.2133614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Constantin Gaina
- Polyaddition and Photochemistry Laboratory, “Petru Poni” Institute of Macromolecular Chemistry, 41 Gr.Ghica Voda Alley, Iasi RO-700487, Romania
| | - Viorica Gaina
- Polyaddition and Photochemistry Laboratory, “Petru Poni” Institute of Macromolecular Chemistry, 41 Gr.Ghica Voda Alley, Iasi RO-700487, Romania
| | - Oana Ursache
- Polyaddition and Photochemistry Laboratory, “Petru Poni” Institute of Macromolecular Chemistry, 41 Gr.Ghica Voda Alley, Iasi RO-700487, Romania
| | - Lavinia Vasiliu
- Polyaddition and Photochemistry Laboratory, “Petru Poni” Institute of Macromolecular Chemistry, 41 Gr.Ghica Voda Alley, Iasi RO-700487, Romania
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7
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ElSayed H, Sayed KS, Gharib MS. Effect of dialyzer geometry on coagulation activation in the extracorporeal circuit in maintenance hemodialysis patients: Prospective randomized trial. Ther Apher Dial 2023. [PMID: 36762467 DOI: 10.1111/1744-9987.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/26/2022] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The coagulation cascade is activated during hemodialysis (HD) due to interaction of blood with the dialysis circuit. There is a paucity of data on the effect of the physical structure of the dialyzers on coagulation activation during HD. We conducted this study to compare the effect of Helixone FX80 versus Platinum H4 dialyzers on coagulation activation during HD. METHODS Twenty patients on maintenance HD were enrolled in this randomized prospective crossover study. Each patient was dialyzed using Helixone FX80 and Platinum H4 dialyzers. Serum thrombin-antithrombin complex (TAT) was measured before (T0h) and at the end (T4H) of HD. RESULTS The absolute changes of serum TAT were comparable with the two dialyzers (median [IQR]: 1.15 [0.65, 1.75] for Helixone FX80 vs. 1.15 [0.67, 2.05] for Platinum H4, p = 0.371). CONCLUSION Helixone FX80 and Platinum H4 dialyzers have similar effects on coagulation activation during HD.
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Affiliation(s)
- Hesham ElSayed
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khalid Samir Sayed
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Sary Gharib
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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8
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Zawada AM, Lang T, Ottillinger B, Kircelli F, Stauss-Grabo M, Kennedy JP. Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance. MEMBRANES 2022; 12:932. [PMID: 36295691 PMCID: PMC9610916 DOI: 10.3390/membranes12100932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
The dialyzer is the core element in the hemodialysis treatment of patients with end-stage kidney disease (ESKD). During hemodialysis treatment, the dialyzer replaces the function of the kidney by removing small and middle-molecular weight uremic toxins, while retaining essential proteins. Meanwhile, a dialyzer should have the best possible hemocompatibility profile as the perpetuated contact of blood with artificial surfaces triggers complement activation, coagulation and immune cell activation, and even low-level activation repeated chronically over years may lead to undesired effects. During hemodialysis, the adsorption of plasma proteins to the dialyzer membrane leads to a formation of a secondary membrane, which can compromise both the uremic toxin removal and hemocompatibility of the dialyzer. Hydrophilic modifications of novel dialysis membranes have been shown to reduce protein adsorption, leading to better hemocompatibility profile and performance stability during dialysis treatments. This review article focuses on the importance of performance and hemocompatibility of dialysis membranes for the treatment of dialysis patients and summarizes recent studies on the impact of protein adsorption and hydrophilic modifications of membranes on these two core elements of a dialyzer.
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Affiliation(s)
- Adam M. Zawada
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany
| | - Thomas Lang
- Global Biomedical Evidence Generation, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany
| | | | - Fatih Kircelli
- Medical Information and Education (EMEA), Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany
| | - Manuela Stauss-Grabo
- Global Biomedical Evidence Generation, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany
| | - James P. Kennedy
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany
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9
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Kobayashi K, Kurihara Y, Ueki S, Kokubo K, Kubota M, Kobayashi H. Effects of hydrophilic polymer-embedded membrane on permeability and cell adhesion during continuous hemofiltration. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and Aims
Clotting within the membrane and/or venous ‘air trap’ chamber is common problems during continuous blood purification therapy. Frequent clotting during continuous blood purification therapy leads to inadequate solute removal, an increased circuit and filter cost, and an increased burden for the medical staff. Improvements in filter membrane materials may reduce the extent of clotting and prolong the filter life. The purpose of the present study was to clarify the characteristics of an NV polymer-embedded membrane (NV-PS) after long-term use, especially the adhesiveness of blood cells and changes in the solute removal performance.
Methods
Continuous hemofiltration (CHF) experiments using a permeate recycle mode were performed for 24 h using the same porcine whole blood divided into two portions to compare the NV-PS with a conventional polysulfone membrane (PS). The activated clotting time was adjusted to within a range of 300–400 s. The change in the dextran sieving coefficient (SC) of the membrane and the residual blood clots in the filters were evaluated after the completion of the CHF experiment.
Results
The increase in the transmembrane pressure and the pressure drop of the hemofilter were significantly smaller using the NV-PS than with the PS. For larger molecules (SC $$ \leqq $$
≦
0.4), the reduction in SC after blood contact was significantly smaller for the NV-PS. Fewer blood cells remained in the residual blood clots when the NV-PS was used.
Conclusion
NV-PS has the advantages of showing a lower degree of reduction of the solute removal performance and also a lower degree of clogging of the hollow fibers during prolonged circulation. These characteristics may be expected to be advantageous when this membrane is used for continuous blood purification therapy in acute-phase patients.
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10
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Impact of Dialysis Clinical Operating Conditions on Human Serum Protein-Mediated Inflammatory Biomarkers Released in Patients Using Polyarylethersulfone Membranes. JOURNAL OF COMPOSITES SCIENCE 2022. [DOI: 10.3390/jcs6080226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hemodialysis (HD) is a life-sustaining treatment of crucial importance in managing end-stage renal disease (ESRD). However, this membrane-based therapy is associated with acute side-effects due to bioincompatibility issues and limitations on the removal of uremic toxins. The present study assessed the influence of hydrodynamic conditions applied during HD treatment on protein-mediated inflammatory and thrombotic responses. The membrane modules considered are commonly used in Canadian hospitals and are comprised of a polymer blend of polyarylether sulfone-polyvinylpyrrolidone (PAES). The membranes morphology and hydrophilicity were assessed using SEM, AFM, BET, and zeta potential. An in vitro study evaluated the adsorptive behavior of fibrinogen (FB) to the membrane under different flow conditions. Lower rates of 200 mL/min promoted slower and significant FB adsorption, leading to more severe inflammatory and thrombotic responses. Hydrodynamic conditions also affected the concentration of all inflammatory biomarkers. Lower flow rates triggered more complement activation as well as coagulation, clotting, and inflammatory responses compared to higher flow rates. At the end of the dialysis session, patients treated with a Qb of 200 mL/min presented a significant increase in the concentration of C5a (232%), properdin (114%), serpin (545%), IL-1α (50%), IL-6 (450%), and vWF (212%). IL-1β and TNF-α concentrations declined by 12.5 and 35.5%, respectively. Male patients experienced more severe inflammatory responses than female patients at the operating conditions considered. Comparing the pre- and post-dialysis levels of female and male patients, female patients experienced significantly higher levels of IL-6 and properdin, while male patients presented higher levels of C5a, IL-1α, and IL-6. The results of this study will help clinical doctors evaluate the impact of HD operating conditions on blood activations before prescribing treatment and inform expectations for outcomes in female and male patients.
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11
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Maggay IV, Yu ML, Wang DM, Chiang CH, Chang Y, Venault A. Strategy to prepare skin-free and macrovoid-free polysulfone membranes via the NIPS process. J Memb Sci 2022. [DOI: 10.1016/j.memsci.2022.120597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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12
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Abdelrasoul A, Shoker A. Influence of Hydration Shell of Hemodialysis Clinical Membranes on Surrogate Biomarkers Activation in Uremic Serum of Dialysis Patients. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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13
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Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin. J Clin Med 2022; 11:jcm11133759. [PMID: 35807042 PMCID: PMC9267256 DOI: 10.3390/jcm11133759] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
Biocompatibility in hemodialysis (HD) has considerably improved in recent decades, but remains an open issue to be solved, appearing essential to reduce systemic inflammation and enhance patients’ clinical outcomes. Clotting prevention, reduction in complement and leukocyte activation, and improvement of antioxidant effect represent the main goals. This review aims to analyze the different pathways involved in HD patients, leading to immune system dysfunction and inflammation. In particular, we mostly review the evidence about thrombogenicity, which probably represents the most important characteristic of bio-incompatibility. Platelet activation is one of the first steps occurring in HD patients, determining several events causing chronic sub-clinical inflammation and immune dysfunction involvement. Moreover, oxidative stress processes, resulting from a loss of balance between pro-oxidant factors and antioxidant mechanisms, have been described, highlighting the link with inflammation. We updated both innate and acquired immune system dysfunctions and their close link with uremic toxins occurring in HD patients, with several consequences leading to increased mortality. The elucidation of the role of immune dysfunction and inflammation in HD patients would enhance not only the understanding of disease physiopathology, but also has the potential to provide new insights into the development of therapeutic strategies.
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14
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Mollahosseini A, Abdelrasoul A. Zwitterionization of common hemodialysis membranes: assessment of different immobilized structure impact on hydrophilicity and biocompatibility of poly aryl ether sulfone (PAES) and cellulose triacetate (CTA) hemodialysis membranes. Struct Chem 2022. [DOI: 10.1007/s11224-022-01940-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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15
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Nica SL, Zaltariov MF, Pamfil D, Bargan A, Rusu D, Raţă DM, Găină C, Atanase LI. MWCNTs Composites-Based on New Chemically Modified Polysulfone Matrix for Biomedical Applications. NANOMATERIALS 2022; 12:nano12091502. [PMID: 35564211 PMCID: PMC9101761 DOI: 10.3390/nano12091502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023]
Abstract
Polyvinyl alcohol (PVA) is a non-toxic biosynthetic polymer. Due to the hydrophilic properties of the PVA, its utilization is an easy tool to modify the properties of materials inducing increased hydrophilicity, which can be noticed in the surface properties of the materials, such as wettability. Based on this motivation, we proposed to obtain high-performance composite materials by a facile synthetic method that involves the cross-linking process of polyvinyl alcohol (PVA) with and aldehyde-functionalized polysulfone(mPSF) precursor, prior to incorporation of modified MWCNTs with hydrophilic groups, thus ensuring a high compatibility between the polymeric and the filler components. Materials prepared in this way have been compared with those based on polyvinyl alcohol and same fillers (mMWCNTs) in order to establish the influence of the polymeric matrix on the composites properties. The amount of mMWCNTs varied in both polymeric matrices between 0.5 and 5 wt%. Fourier transformed infrared with attenuated total reflectance spectroscopy (FTIR-ATR) was employed to confirm the changes noted in the PVA, mPSF and their composites. Hemolysis degree was investigated in correlation with the material structural features. Homogenous distribution of mMWCNTs in all the composite materials has been confirmed by scanning electron microscopy. The hydrophilicity of both composite systems, estimated by the contact angle method, was influenced by the presence of the filler amount mMWCNTs in both matrices (PVA and mPSF). Our work demonstrates that mPSF/mMWCNTs and PVA/mMWCNTs composite could be used as water purification or blood-filtration materials.
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Affiliation(s)
- Simona Luminita Nica
- Petru Poni Institute of Macromolecular Chemistry, 41A Grigore GhicaVoda Alley, 700487 Iasi, Romania; (M.-F.Z.); (D.P.); (A.B.); (D.R.); (C.G.)
- Correspondence: (S.L.N.); (L.I.A.)
| | - Mirela-Fernanda Zaltariov
- Petru Poni Institute of Macromolecular Chemistry, 41A Grigore GhicaVoda Alley, 700487 Iasi, Romania; (M.-F.Z.); (D.P.); (A.B.); (D.R.); (C.G.)
| | - Daniela Pamfil
- Petru Poni Institute of Macromolecular Chemistry, 41A Grigore GhicaVoda Alley, 700487 Iasi, Romania; (M.-F.Z.); (D.P.); (A.B.); (D.R.); (C.G.)
| | - Alexandra Bargan
- Petru Poni Institute of Macromolecular Chemistry, 41A Grigore GhicaVoda Alley, 700487 Iasi, Romania; (M.-F.Z.); (D.P.); (A.B.); (D.R.); (C.G.)
| | - Daniela Rusu
- Petru Poni Institute of Macromolecular Chemistry, 41A Grigore GhicaVoda Alley, 700487 Iasi, Romania; (M.-F.Z.); (D.P.); (A.B.); (D.R.); (C.G.)
| | - Delia Mihaela Raţă
- Faculty of Medical Dentistry, Apollonia University of Iasi, Pacurari Street, No. 11, 700511 Iasi, Romania;
| | - Constantin Găină
- Petru Poni Institute of Macromolecular Chemistry, 41A Grigore GhicaVoda Alley, 700487 Iasi, Romania; (M.-F.Z.); (D.P.); (A.B.); (D.R.); (C.G.)
| | - Leonard Ionut Atanase
- Faculty of Medical Dentistry, Apollonia University of Iasi, Pacurari Street, No. 11, 700511 Iasi, Romania;
- Correspondence: (S.L.N.); (L.I.A.)
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16
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Chida T, Igarashi H, Masakane I. New polymethylmethacrylate membrane, NF-U, improves nutritional status and reduces patient-reported symptoms in older dialysis patients. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
We previously reported the nutritional advantage of polymethylmethacrylate (PMMA) membranes to prevent the progression of malnutrition in dialysis patients. In this study, we examined whether a new PMMA dialyzer, NF-U, has advantages to improve the nutritional condition, patient-reported symptoms, and other clinical parameters in older dialysis patients.
Methods
We selected ten older chronic dialysis patients who were treated with NF-U for improving their worsening nutritional parameters and retrospectively evaluated nutrition and patient-reported symptoms. Patient-reported symptoms were surveyed by our original questionnaire including 20 items of symptom.
Results
Serum albumin concentration, geriatric nutritional risk index, and percent creatinine generation rate increased from 3.01 ± 0.16 to 3.25 ± 0.17 g/dL, 87.7 ± 5.8 to 91.4 ± 6.2, 100.2 ± 21.6 to 111.9 ± 20.9% at 1 and 4 months after switching to NF-U, respectively. For patient-reported outcomes, fatigue and the total score of patient-reported outcomes were improved after switching to NF-U.
Conclusion
Our results suggest that NF-U is a good choice for older dialysis patients to ameliorate their nutritional status and patient-reported outcomes.
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Bonomini M, Piscitani L, Di Liberato L, Sirolli V. Biocompatibility of Surface-Modified Membranes for Chronic Hemodialysis Therapy. Biomedicines 2022; 10:biomedicines10040844. [PMID: 35453594 PMCID: PMC9025662 DOI: 10.3390/biomedicines10040844] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 02/06/2023] Open
Abstract
Hemodialysis is a life-sustaining therapy for millions of people worldwide. However, despite considerable technical and scientific improvements, results are still not fully satisfactory in terms of morbidity and mortality. The membrane contained in the hemodialyzer is undoubtedly the main determinant of the success and quality of hemodialysis therapy. Membrane properties influence solute removal and the interactions with blood components that define the membrane’s biocompatibility. Bioincompatibility is considered a potential contributor to several uremic complications. Thus, the development of more biocompatible polymers used as hemodialyzer membrane is of utmost importance for improving results and clinical patient outcomes. Many different surface-modified membranes for hemodialysis have been manufactured over recent years by varying approaches in the attempt to minimize blood incompatibility. Their main characteristics and clinical results in hemodialysis patients were reviewed in the present article.
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Affiliation(s)
- Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University, Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy; (L.D.L.); (V.S.)
- Correspondence:
| | - Luca Piscitani
- Nephrology and Dialysis Unit, Department of Medicine, San Salvatore Hospital, Via Vetoio, 67100 L’Aquila, Italy;
| | - Lorenzo Di Liberato
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University, Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy; (L.D.L.); (V.S.)
| | - Vittorio Sirolli
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University, Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy; (L.D.L.); (V.S.)
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Platelet thrombus formation in patients with end-stage renal disease before and after hemodialysis as measured by the total thrombus-formation analysis system. Int Urol Nephrol 2022; 54:2695-2702. [PMID: 35366741 PMCID: PMC9463292 DOI: 10.1007/s11255-022-03184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Abstract
Background Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) often experience bleeding. However, mechanisms behind this bleeding tendency are incompletely understood but may involve platelet dysfunction. We, therefore, studied platelet-dependent thrombus formation in flowing whole blood inside a microchip coated with collagen, and its association with circulating von Willebrand factor (VWF). Methods Blood samples were obtained in 22 patients before and after HD. The area under the 10 min flow pressure curve in a microchip (AUC10) reflecting total platelet thrombogenicity was measured, using the Total Thrombus-formation Analysis System (T-TAS01). AUC10 < 260 indicates platelet dysfunction. VWF activity and antigen in plasma were also assayed. Results VWF levels were moderately elevated and increased further after HD (P < 0.01 or lower). In contrast, AUC10 before and after HD was < 260 in 17/22 patients and < 130 in 15/22 patients, with no statistically significant difference in pre- vs post-HD measurements, indicating reduced platelet thrombogenicity, but with some variability as 5/22 patients showed normal platelet responsiveness. AUC10 and VWF activity or antigen levels in plasma were not correlated, either before or after HD. Conclusions Most ESRD patients display moderate-to-severe platelet dysfunction as assessed by shear-induced platelet-dependent thrombus formation with T-TAS01. HD does not influence platelet function despite HD-induced elevations in VWF. T-TAS01 should be further evaluated as a tool in the assessment of bleeding risk in patients on HD. Graphical abstract ![]()
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Canaud B, Kooman JP, Selby NM, Taal M, Maierhofer A, Kopperschmidt P, Francis S, Collins A, Kotanko P. Hidden risks associated with conventional short intermittent hemodialysis: A call for action to mitigate cardiovascular risk and morbidity. World J Nephrol 2022; 11:39-57. [PMID: 35433339 PMCID: PMC8968472 DOI: 10.5527/wjn.v11.i2.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/30/2021] [Accepted: 03/23/2022] [Indexed: 02/06/2023] Open
Abstract
The development of maintenance hemodialysis (HD) for end stage kidney disease patients is a success story that continues to save many lives. Nevertheless, intermittent renal replacement therapy is also a source of recurrent stress for patients. Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities, increases cardiovascular risk, and exacerbates disease burden. Altering cycles of fluid loading associated with cardiac stretching (interdialytic phase) and then fluid unloading (intradialytic phase) likely contribute to cardiac and vascular damage. This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burden of treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory, inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed the dialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidity associated with conventional intermittent HD appears to be a priority for improving patient experience and reducing disease burden. In this in-depth review, we summarize the hidden effects of intermittent HD therapy, and call for action to improve delivered HD and develop treatment schedules that are better tolerated and associated with fewer adverse effects.
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Affiliation(s)
- Bernard Canaud
- Global Medical Office, Fresenius Medical Care, Bad Homburg 61352, Germany
- Department of Nephrology, Montpellier University, Montpellier 34000, France
| | - Jeroen P Kooman
- Department of Internal Medicine, Maastricht University, Maastricht 6229 HX, Netherlands
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Derby DE22 3DT, United Kingdom
| | - Maarten Taal
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Derby DE22 3DT, United Kingdom
| | - Andreas Maierhofer
- Global Research Development, Fresenius Medical Care, Schweinfurt 97424, Germany
| | | | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - Allan Collins
- Global Medical Office, Fresenius Medical Care, Bad Homburg 61352, Germany
| | - Peter Kotanko
- Renal Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10065, United States
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20
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Zawada AM, Melchior P, Schall C, Erlenkötter A, Lang T, Keller T, Stauss-Grabo M, Kennedy JP. Time-resolving characterization of molecular weight retention changes among three synthetic high-flux dialyzers. Artif Organs 2022; 46:1318-1327. [PMID: 35192209 DOI: 10.1111/aor.14216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Toxin removal capacity (i.e. performance) of a dialyzer is not constant but diminishes during treatment, as the adsorption of proteins to the membrane provides an additional barrier to uremic solutes. We investigated time-resolving molecular weight retention changes among synthetic high-flux dialyzers and compare the results with recent data from a randomized controlled trial. METHODS In plasma recirculation experiments over 240min, sieving coefficients (SC) for β2-microglobulin, myoglobin and albumin were determined for the FX CorAL (Fresenius Medical Care), ELISIO (Nipro) and xevonta (B. Braun). Molecular weight retention (MWR) curves were generated and the shifts over 120min were characterized. Effective pore radius was determined, and the predicted albumin loss was compared with clinical data. RESULTS SC decreased over time for all dialyzers (mean relative decrease across all dialyzers: β2-microglobulin: 8.0% (120min); myoglobin: 56.6% (240min); albumin: 94.1% (240min)). FX CorAL (7.3%, 52.6% and 91.1%) and ELISIO (7.7%, 51.0% and 93.8%) showed a lower decrease than xevonta (9.0%, 66.2% and 97.4%). For all dialyzers, MWR curves shifted towards lower molecular weight, with the lowest shift for FX CorAL (by 0.23nm at SC50%, 120 min) and highest for xevonta (0.50nm). FX CorAL had the highest slope over time and the smallest decrease in the effective pore radius (2min: 2.31nm, 120min: 2.08nm). Predicted albumin loss over 4h was highest for xevonta (609.3mg) and comparable between ELISIO (283.6mg) and FX CorAL (313.3mg). CONCLUSIONS Substantial differences in the temporal performance profile of dialyzers exist. The present approach allows characterization of dialyzer permeability changes over time using standard, clinically relevant protein markers.
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Affiliation(s)
- Adam M Zawada
- Fresenius Medical Care Deutschland GmbH, Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Sankt Wendel, Germany
| | - Pascal Melchior
- Fresenius Medical Care Deutschland GmbH, Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Sankt Wendel, Germany
| | - Christian Schall
- Fresenius Medical Care Deutschland GmbH, Process Technology, Filter Production, Sankt Wendel, Germany
| | - Ansgar Erlenkötter
- Fresenius Medical Care Deutschland GmbH, Global Research and Development, Product Engineering Center Dialyzers & Membranes, Biosciences - Biotechnology, Sankt Wendel, Germany
| | - Thomas Lang
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Clinical Research EMEA, AP, Germany
| | - Torsten Keller
- Fresenius Medical Care Deutschland GmbH, Global Research and Development, Product Engineering Center Dialyzers & Membranes, Membrane Development, Sankt Wendel, Germany
| | - Manuela Stauss-Grabo
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Clinical Research EMEA, AP, Germany
| | - James P Kennedy
- Fresenius Medical Care Deutschland GmbH, Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Sankt Wendel, Germany
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Artificial Kidney Engineering: The Development of Dialysis Membranes for Blood Purification. MEMBRANES 2022; 12:membranes12020177. [PMID: 35207097 PMCID: PMC8876607 DOI: 10.3390/membranes12020177] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/17/2022]
Abstract
The artificial kidney, one of the greatest medical inventions in the 20th century, has saved innumerable lives with end stage renal disease. Designs of artificial kidney evolved dramatically in decades of development. A hollow-fibered membrane with well controlled blood and dialysate flow became the major design of the modern artificial kidney. Although they have been well established to prolong patients’ lives, the modern blood purification system is still imperfect. Patient’s quality of life, complications, and lack of metabolic functions are shortcomings of current blood purification treatment. The direction of future artificial kidneys is toward miniaturization, better biocompatibility, and providing metabolic functions. Studies and trials of silicon nanopore membranes, tissue engineering for renal cell bioreactors, and dialysate regeneration are all under development to overcome the shortcomings of current artificial kidneys. With all these advancements, wearable or implantable artificial kidneys will be achievable.
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Bowry SK, Kircelli F, Himmele R, Nigwekar SU. Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation. Clin Kidney J 2022; 14:i59-i71. [PMID: 34987786 PMCID: PMC8711760 DOI: 10.1093/ckj/sfab185] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 12/14/2022] Open
Abstract
Blood-incompatibility is an inevitability of all blood-contacting device applications and therapies, including haemodialysis (HD). Blood leaving the environment of blood vessels and the protection of the endothelium is confronted with several stimuli of the extracorporeal circuit (ECC), triggering the activation of blood cells and various biochemical pathways of plasma. Prevention of blood coagulation, a major obstacle that needed to be overcome to make HD possible, remains an issue to contend with. While anticoagulation (mainly with heparin) successfully prevents clotting within the ECC to allow removal of uraemic toxins across the dialysis membrane wall, it is far from ideal, triggering heparin-induced thrombocytopenia in some instances. Soluble fibrin can form even in the presence of heparin and depending on the constitution of the patient and activation of platelets, could result in physical clots within the ECC (e.g. bubble trap chamber) and, together with other plasma and coagulation proteins, result in increased adsorption of proteins on the membrane surface. The buildup of this secondary membrane layer impairs the transport properties of the membrane to reduce the clearance of uraemic toxins. Activation of complement system-dependent immune response pathways leads to leukopenia, formation of platelet–neutrophil complexes and expression of tissue factor contributing to thrombotic processes and a procoagulant state, respectively. Complement activation also promotes recruitment and activation of leukocytes resulting in oxidative burst and release of pro-inflammatory cytokines and chemokines, thereby worsening the elevated underlying inflammation and oxidative stress condition of chronic kidney disease patients. Restricting all forms of blood-incompatibility, including potential contamination of dialysis fluid with endotoxins leading to inflammation, during HD therapies is thus still a major target towards more blood-compatible and safer dialysis to improve patient outcomes. We describe the mechanisms of various activation pathways during the interaction between blood and components of the ECC and describe approaches to mitigate the effects of these adverse interactions. The opportunities to develop improved dialysis membranes as well as implementation strategies with less potential for undesired biological reactions are discussed.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Rainer Himmele
- Global Medical Information and Education, Fresenius Medical Care, Charlotte, NC, USA
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Maggay IVB, Aini HN, Lagman MMG, Tang SH, Aquino RR, Chang Y, Venault A. A Biofouling Resistant Zwitterionic Polysulfone Membrane Prepared by a Dual-Bath Procedure. MEMBRANES 2022; 12:69. [PMID: 35054595 PMCID: PMC8780878 DOI: 10.3390/membranes12010069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 01/06/2023]
Abstract
This study introduces a zwitterionic material to modify polysulfone (PSf) membranes formed by a dual bath procedure, in view of reducing their fouling propensity. The zwitterionic copolymer, derived from a random polymer of styrene and 4-vinylpyrridine and referred to as zP(S-r-4VP), was incorporated to the PSf solution without any supplementary pore-forming additive to study the effect of the sole copolymer on membrane-structuring, chemical, and arising properties. XPS and mapping FT-IR provided evidence of the modification. Macrovoids appeared and then disappeared as the copolymer content increased in the range 1-4 wt%. The copolymer has hydrophilic units and its addition increases the casting solution viscosity. Both effects play an opposite role on transfers, and so on the growth of macrovoids. Biofouling tests demonstrated the efficiency of the copolymer to mitigate biofouling with a reduction in bacterial and blood cell attachment by more than 85%. Filtration tests revealed that the permeability increased by a twofold factor, the flux recovery ratio was augmented from 40% to 63% after water/BSA cycles, and irreversible fouling was reduced by 1/3. Although improvements are needed, these zwitterionic PSf membranes could be used in biomedical applications where resistance to biofouling by cells is a requirement.
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Affiliation(s)
- Irish Valerie B. Maggay
- R&D Center for Membrane Technology and Department of Chemical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan; (I.V.B.M.); (H.N.A.); (S.-H.T.)
| | - Hana Nur Aini
- R&D Center for Membrane Technology and Department of Chemical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan; (I.V.B.M.); (H.N.A.); (S.-H.T.)
| | - Mary Madelaine G. Lagman
- School of Chemical, Biological, and Materials Engineering and Science, Mapúa University, 658 Muralla St., Intramuros, Manila 1002, Philippines; (M.M.G.L.); (R.R.A.)
| | - Shuo-Hsi Tang
- R&D Center for Membrane Technology and Department of Chemical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan; (I.V.B.M.); (H.N.A.); (S.-H.T.)
| | - Ruth R. Aquino
- School of Chemical, Biological, and Materials Engineering and Science, Mapúa University, 658 Muralla St., Intramuros, Manila 1002, Philippines; (M.M.G.L.); (R.R.A.)
| | - Yung Chang
- R&D Center for Membrane Technology and Department of Chemical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan; (I.V.B.M.); (H.N.A.); (S.-H.T.)
| | - Antoine Venault
- R&D Center for Membrane Technology and Department of Chemical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan; (I.V.B.M.); (H.N.A.); (S.-H.T.)
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24
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Liu Y, Li G, Han Q, Lin H, Li Q, Deng G, Liu F. Construction of electro-neutral surface on dialysis membrane for improved toxin clearance and anti-coagulation/inflammation through saltwater fish inspired trimethylamine N-oxide (TMAO). J Memb Sci 2022. [DOI: 10.1016/j.memsci.2021.119900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Chen Y, Lin B, Qiu Y. Modification of polysulfone and the biomedical application of modified polysulfone. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.2006653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yuxin Chen
- College of Chemistry and Chemical Engineering, Central South University, Changsha, China
| | - Bingxian Lin
- College of Chemistry and Chemical Engineering, Central South University, Changsha, China
| | - Yunren Qiu
- College of Chemistry and Chemical Engineering, Central South University, Changsha, China
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26
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Westphalen H, Kalugin D, Abdelrasoul A. Structure, function, and adsorption of highly abundant blood proteins and its critical influence on hemodialysis patients: A critical review. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abdelrasoul A, Westphalen H, Saadati S, Shoker A. Hemodialysis biocompatibility mathematical models to predict the inflammatory biomarkers released in dialysis patients based on hemodialysis membrane characteristics and clinical practices. Sci Rep 2021; 11:23080. [PMID: 34845257 PMCID: PMC8630185 DOI: 10.1038/s41598-021-01660-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease affects millions of people around the globe and many patients rely on hemodialysis (HD) to survive. HD is associated with undesired life-threatening side effects that are linked to membrane biocompatibility and clinical operating conditions. The present study develops a mathematical model to predict the inflammatory biomarkers released in HD patients based on membrane morphology, chemistry, and interaction affinity. Based on the morphological characteristics of two clinical-grade HD membrane modules (CTA and PAES-PVP) commonly used in Canadian hospitals, a molecular docking study, and the release of inflammatory cytokines during HD and in vitro incubation experiments, we develop five sets of equations that describe the concentration of eight biomarkers (serpin/antithrombin-III, properdin, C5a, 1L-1α, 1L-1β, C5b-9, IL6, vWF). The equations developed are functions of membrane properties (pore size, roughness, chemical composition, affinity to fibrinogen, and surface charge) and HD operating conditions (blood flow rate, Qb, and treatment time, t). We expand our model based on available clinical data and increase its range of applicability in terms of flow rate and treatment time. We also modify the original equations to expand their range of applicability in terms of membrane materials, allowing the prediction and validation of the inflammatory response of several clinical and synthesized membrane materials. Our affinity-based model solely relies on theoretical values of molecular docking, which can significantly reduce the experimental load related to the development of more biocompatible materials. Our model predictions agree with experimental clinical data and can guide the development of novel materials and support evidence-based membrane synthesis of HD membranes, reducing the need for trial-and-error approaches.
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Affiliation(s)
- Amira Abdelrasoul
- Department of Chemical and Biological Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
| | - Heloisa Westphalen
- Department of Chemical and Biological Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Shaghayegh Saadati
- Department of Chemical and Biological Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Ahmed Shoker
- Nephrology Division, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
- Saskatchewan Transplant Program, St. Paul's Hospital, 1702 20th Street West, Saskatoon, SK, S7M 0Z9, Canada
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Fortier C, Obeid H, Paré M, Garneau CA, Sidibé A, Boutouyrie P, Agharazii M. Changes in arterial stiffness indices during a single haemodialysis session in end-stage renal disease population: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e045912. [PMID: 34475148 PMCID: PMC8413866 DOI: 10.1136/bmjopen-2020-045912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Patients with end-stage renal disease are at higher risk of cardiovascular morbidity and mortality, a risk mediated in part by increased aortic stiffness. Arterial stiffness is assessed at different anatomical locations (central elastic or peripheral muscular arteries) using a variety of mechanical biomarkers. However, little is known on the robustness of each of these mechanical biomarkers following a haemodynamic stress caused by a single haemodialysis (HD) session. METHODS AND ANALYSIS A systematic review has been designed and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A targeted search strategy applicable in key databases (PubMed, Embase, the Cochrane Library, Web of Science and grey literature) is constructed to search articles and reviews from inception to 16 October 2020. Only articles of studies conducted with adults under chronic HD for kidney failure, with repeated measures of arterial stiffness metrics (pulse wave velocity, Augmentation Index, arterial distensibility or stiffness) following a before-and-after design surrounding a HD session will be selected. The screening process, data extraction and assessment of risk bias will be done by two independent pairs of reviewers. Meta-analysis will enable adjustments for potential confounders and subgroup analyses will be performed to discriminate changes in arterial stiffness metrics from elastic, muscular or global arterial territories. ETHICS AND DISSEMINATION This study does not require ethical approval. Findings will be submitted for publication to relevant peer-reviewed journals and will be presented at profession-specific conferences. PROSPERO REGISTRATION NUMBER CRD42020213946.
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Affiliation(s)
- Catherine Fortier
- Paris Cardiovascular Research Center (PARCC), Team 7, INSERM-U970, Paris, France
- Endocrinology and Nephrology research axis, CHU de Québec-Université Laval Research Center, Québec City, Quebec, Canada
| | - Hasan Obeid
- Endocrinology and Nephrology research axis, CHU de Québec-Université Laval Research Center, Québec City, Quebec, Canada
| | - Mathilde Paré
- Endocrinology and Nephrology research axis, CHU de Québec-Université Laval Research Center, Québec City, Quebec, Canada
| | - Charles-Antoine Garneau
- Endocrinology and Nephrology research axis, CHU de Québec-Université Laval Research Center, Québec City, Quebec, Canada
| | - Aboubacar Sidibé
- Endocrinology and Nephrology research axis, CHU de Québec-Université Laval Research Center, Québec City, Quebec, Canada
| | - Pierre Boutouyrie
- Paris Cardiovascular Research Center (PARCC), Team 7, INSERM-U970, Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Université de Paris, APHP, Paris, Île-de-France, France
| | - Mohsen Agharazii
- Endocrinology and Nephrology research axis, CHU de Québec-Université Laval Research Center, Québec City, Quebec, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Université Laval, City of Québec, Quebec, Canada
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Skinner SC, Derebail VK, Poulton CJ, Bunch DC, Roy-Chaudhury P, Key NS. Hemodialysis-Related Complement and Contact Pathway Activation and Cardiovascular Risk: A Narrative Review. Kidney Med 2021; 3:607-618. [PMID: 34401728 PMCID: PMC8350825 DOI: 10.1016/j.xkme.2021.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Individuals receiving long-term hemodialysis are at increased risk of developing cardiovascular disease (CVD). Traditional cardiovascular risk factors do not fully explain the high CVD risk in this population. During hemodialysis, blood interacts with the biomaterials of the hemodialysis circuit. This interaction can activate the complement system and the factor XII-driven contact system. FXII activation triggers both the intrinsic pathway of coagulation and the kallikrein-kinin pathway, resulting in thrombin and bradykinin production, respectively. The complement system plays a key role in the innate immune response, but also contributes to the pathogenesis of numerous disease states. Components of the complement pathway, including mannose binding lectin and C3, are associated with CVD risk in people with end-stage kidney disease (ESKD). Both the complement system and the factor XII-driven contact coagulation system mediate proinflammatory and procoagulant responses that could contribute to or accelerate CVD in hemodialysis recipents. This review summarizes what is already known about hemodialysis-mediated activation of the complement system and in particular the coagulation contact system, emphasizing the potential role these systems play in the identification of new biomarkers for CVD risk stratification and the development of potential therapeutic targets or innovative therapies that decrease CVD risk in ESKD patients.
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Affiliation(s)
- Sarah C. Skinner
- Division of Hematology and UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Vimal K. Derebail
- Division of Nephrology and UNC Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Caroline J. Poulton
- Division of Nephrology and UNC Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Donna C. Bunch
- Division of Nephrology and UNC Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Prabir Roy-Chaudhury
- Division of Nephrology and UNC Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
- WG (Bill) Hefner VA Medical Center, Salisbury, NC
| | - Nigel S. Key
- Division of Hematology and UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
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Zawada AM, Melchior P, Erlenkötter A, Delinski D, Stauss-Grabo M, Kennedy JP. Polyvinylpyrrolidone in hemodialysis membranes: Impact on platelet loss during hemodialysis. Hemodial Int 2021; 25:498-506. [PMID: 34085391 DOI: 10.1111/hdi.12939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/29/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hydrophilic modification with polyvinylpyrrolidone (PVP) increases the biocompatibility profile of synthetic dialysis membranes. However, PVP may be eluted into the patient's blood, which has been discussed as a possible cause for adverse reactions rarely occurring with synthetic membranes. We investigated the content of PVP and its elution from the blood-side surface from commercially available dialyzers, including the novel FX CorAL, with PVP-enriched and α-tocopherol-stabilized membrane, and link the results to the level of platelet loss during dialysis as a maker of biocompatibility. METHODS Six synthetic, PVP containing, dialyzers (FX CorAL, FX CorDiax [Fresenius Medical Care]; Polyflux, THERANOVA [Baxter]; ELISIO [Nipro]; xevonta [B. Braun]) were investigated in the present study. The content of PVP on blood-side surface was determined with X-ray photoelectron spectroscopy (XPS). The amount of elutable PVP was measured photometrically after 5 h recirculation. The level of platelet loss was evaluated in an ex vivo recirculation model with human blood. FINDINGS Highest PVP content on the blood-side surface was found for the polysulfone-based FX CorAL (26.3%), while the polyethersulfone-based THERANOVA (15.6%) had the lowest PVP content. Elution of PVP was highest for the autoclave steam-sterilized THERANOVA (9.1 mg/1.6 m2 dialyzer) and Polyflux (9.0 mg/1.6 m2 dialyzer), while the lowest PVP elution was found for the INLINE steam sterilized FX CorAL and FX CorDiax (<0.5 mg/1.6 m2 dialyzer, for both). Highest platelet loss was found for xevonta (+164.4% compared to the reference) and the lowest for the FX CorAL (-225.2%) among the polysulfone-based dialyzers; among the polyethersulfone-based dialyzers, THERANOVA (+95.5%) had the highest and ELISIO (-52.1%) the lowest platelet loss. DISCUSSION Polyvinylpyrrolidone content and elution differ between commercially available dialyzers and were found to be linked to the membrane material and sterilization method. The amount of non-eluted PVP on the blood-side surface may be an important determinant for the biocompatibility of dialyzers.
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Affiliation(s)
- Adam M Zawada
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Pascal Melchior
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Ansgar Erlenkötter
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Biosciences-Biotechnology, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Dirk Delinski
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Manuela Stauss-Grabo
- Global Medical Office, Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - James P Kennedy
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
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Westphalen H, Abdelrasoul A, Shoker A, Zhu N. Assessment of hemodialysis clinical practices using polyaryl ether sulfone-polyvinylpyrrolidone (PAES: PVP) clinical membrane: Modeling of in vitro fibrinogen adsorption, in situ synchrotron-based imaging, and clinical inflammatory biomarkers investigations. Sep Purif Technol 2021. [DOI: 10.1016/j.seppur.2020.118136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Melchior P, Erlenkötter A, Zawada AM, Delinski D, Schall C, Stauss-Grabo M, Kennedy JP. Complement activation by dialysis membranes and its association with secondary membrane formation and surface charge. Artif Organs 2021; 45:770-778. [PMID: 33326619 DOI: 10.1111/aor.13887] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/06/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
Activation of the complement system may occur during blood-membrane interactions in hemodialysis and contribute to chronic inflammation of patients with end-stage renal disease. Hydrophilic modification with polyvinylpyrrolidone (PVP) has been suggested to increase the biocompatibility profile of dialysis membranes. In the present study we compared the complement activation of synthetic and cellulose-based membranes, including the polysulfone membrane with α-tocopherol-stabilized PVP-enriched inner surface of the novel FX CorAL dialyzer, and linked the results to their physical characteristics. Eight synthetic and cellulose-based dialyzers (FX CorAL, FX CorDiax [Fresenius Medical Care]; Polyflux, THERANOVA [Baxter]; ELISIO, SUREFLUX [Nipro]; xevonta [B. Braun]; FDX [Nikkisio Medical]) were investigated in the present study. Complement activation (C3a, C5a, and sC5b-9) was evaluated in a 3 hours ex vivo recirculation model with human blood. Albumin sieving coefficients were determined over a 4 hours ex vivo recirculation model with human plasma as a surrogate of secondary membrane formation. Zeta potential was measured as an indicator for the surface charge of the membranes. The FX CorAL dialyzer induced the lowest activation of the three complement factors (C3a: -39.4%; C5a: -57.5%; and sC5b-9: -58.9% compared to the reference). Highest complement activation was found for the cellulose-based SUREFLUX (C3a: +154.0%) and the FDX (C5a: +335.0% and sC5b-9: +287.9%) dialyzers. Moreover, the FX CorAL dialyzer had the nearest-to-neutral zeta potential (-2.38 mV) and the lowest albumin sieving coefficient decrease over time. Albumin sieving coefficient decrease was associated with complement activation by the investigated dialyzers. Our present results indicate that the surface modification implemented in the FX CorAL dialyzer reduces the secondary membrane formation and improves the biocompatibility profile. Further clinical studies are needed to investigate whether these observations will result in a lower inflammatory burden of hemodialysis patients.
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Affiliation(s)
- Pascal Melchior
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Ansgar Erlenkötter
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Biosciences - Biotechnology, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Adam M Zawada
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Dirk Delinski
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Christian Schall
- Process Technology, Filter Production, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
| | - Manuela Stauss-Grabo
- Global Medical Office, Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - James P Kennedy
- Global Research and Development, Product Engineering Center Dialyzers & Membranes, Product Development, Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
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Kubo M, Nakazawa R, Akiyama K, Tsunoda Y, Kimura K, Koide K, Matsushima Y, Hasegawa S, Ikeda K, Azuma N. Estimated influence of a novel biocompatible dialysis membrane on vascular events in dialysis patients with diabetic nephropathy: a prospective randomized controlled pilot study. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Polysulfone (PS) dialyzers are most frequently used worldwide for chronic renal failure patients and they are produced by several manufacturers. Despite using the same materials, differences in biocompatibility among PS dialyzers have been reported. TORAYLIGHT NV (NV) is a PS dialyzer that was reported to have superior biocompatibility compared with other PS membranes (conventional PS membranes). Therefore, we examined whether biocompatibility of PS membranes would affect the occurrence of cardiovascular events in hemodialysis patients with diabetic nephropathy (DN).
Methods
Fifty hemodialysis patients with DN were enrolled. They were randomly divided into NV and PS groups and then followed up for 3 years. The number of patients who developed cardiovascular events and clinical data including laboratory tests and blood pressure was recorded.
Results
There were 13 and 14 patients who developed cardiovascular events during the 3-year follow-up of the NV and PS groups, respectively. There was no significant difference between the groups. There were no significant differences in most of the clinical data between the two groups. However, serum pentosidine concentrations in the PS group significantly increased throughout this study, while those in the NV group did not change. Additionally, the width of the systolic blood pressure drop, which was shown to be the difference between before and after dialysis session, in the PS group showed no change, while that in the NV group tended to decrease.
Conclusions
The superiority of using NV membrane compared with conventional PS membranes in reducing cardiovascular events in hemodialysis patients with DN remains unclear. However, our results suggested that PS membranes with superior biocompatibility would slow the progression of atherosclerosis and reduce the occurrence of intradialytic hypotension.
Trial registration
This study was retrospectively registered with the Clinical Trials Registry at the University Hospital Medical Information Network (UMIN-CTR) on March 17, 2017 (registration ID, UMIN 000026339). https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000030259&type=summary&language=J
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Saadati S, Westphalen H, Eduok U, Abdelrasoul A, Shoker A, Choi P, Doan H, Ein-Mozaffari F, Zhu N. Biocompatibility enhancement of hemodialysis membranes using a novel zwitterionic copolymer: Experimental, in situ synchrotron imaging, molecular docking, and clinical inflammatory biomarkers investigations. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 117:111301. [DOI: 10.1016/j.msec.2020.111301] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
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Kamata K, Hatanaka Y, Tanaka H, Inoue S, Tokimizu Y, Tanba S, Kishikawa Y, Koizumi T. In vitro blood compatibility evaluation method: incubating while rotating hemodialyzers filled with fresh human blood. J Artif Organs 2020; 24:412-416. [PMID: 33200301 PMCID: PMC8380571 DOI: 10.1007/s10047-020-01224-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/25/2020] [Indexed: 11/24/2022]
Abstract
One of the often-used methods for in vitro evaluation of the blood compatibility of hemodialysis membranes is the circulation of human blood through a miniaturized hemodialyzer. The use of a rather small amount of human blood in its evaluation is one advantage of this method. However, because it is manufactured by a different process than actual ones, a miniaturized hemodialyzer membrane cannot always preserve the properties of actual hemodialyzers. To address this problem, we established a new experimental method that uses a relatively small amount of human blood and actual dialyzers. In this method, a test hemodialyzer and a control hemodialyzer filled with human blood obtained from the same donor is slowly rotated to prevent spontaneous blood cell sedimentation for 4 h at 37 °C. By use of this method, we were able to compare blood compatibility between a polysulfone (PS) membrane and a vitamin E (VE)-bonded PS membrane in terms of their relative antithrombotic, antioxidative, and anti-inflammatory properties. Consistent with many previous reports, the results clearly showed that compared with the PS membrane, VE-bonded PS membrane is more blood compatible. These findings suggest that our method is applicable, at least to in vitro blood compatibility evaluation of PS type dialysis membranes.
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Affiliation(s)
- Kinue Kamata
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan.
| | - Yoshihiro Hatanaka
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan.
| | - Hiromi Tanaka
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan
| | - Satoru Inoue
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan
| | - Yusuke Tokimizu
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan
| | - Sayuri Tanba
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan
| | - Yuki Kishikawa
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan
| | - Toshinori Koizumi
- Medical Technology and Material Laboratory, Research and Business Development Division, Asahi Kasei Medical Co., LTD., 2-1, Samejima, Fuji-City, Shizuoka, 416-8501, Japan
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Canaud B, Kooman JP, Selby NM, Taal MW, Francis S, Maierhofer A, Kopperschmidt P, Collins A, Kotanko P. Dialysis-Induced Cardiovascular and Multiorgan Morbidity. Kidney Int Rep 2020; 5:1856-1869. [PMID: 33163709 PMCID: PMC7609914 DOI: 10.1016/j.ekir.2020.08.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
Hemodialysis has saved many lives, albeit with significant residual mortality. Although poor outcomes may reflect advanced age and comorbid conditions, hemodialysis per se may harm patients, contributing to morbidity and perhaps mortality. Systemic circulatory "stress" resulting from hemodialysis treatment schedule may act as a disease modifier, resulting in a multiorgan injury superimposed on preexistent comorbidities. New functional intradialytic imaging (i.e., echocardiography, cardiac magnetic resonance imaging [MRI]) and kinetic of specific cardiac biomarkers (i.e., Troponin I) have clearly documented this additional source of end-organ damage. In this context, several factors resulting from patient-hemodialysis interaction and/or patient management have been identified. Intradialytic hypovolemia, hypotensive episodes, hypoxemia, solutes, and electrolyte fluxes as well as cardiac arrhythmias are among the contributing factors to systemic circulatory stress that are induced by hemodialysis. Additionally, these factors contribute to patients' symptom burden, impair cognitive function, and finally have a negative impact on patients' perception and quality of life. In this review, we summarize the adverse systemic effects of current intermittent hemodialysis therapy, their pathophysiologic consequences, review the evidence for interventions that are cardioprotective, and explore new approaches that may further reduce the systemic burden of hemodialysis. These include improved biocompatible materials, smart dialysis machines that automatically may control the fluxes of solutes and electrolytes, volume and hemodynamic control, health trackers, and potentially disruptive technologies facilitating a more personalized medicine approach.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, Montpellier, France
- GMO, FMC, Bad Homburg, Germany
| | - Jeroen P. Kooman
- Maastricht University Medical Centre, Department of Internal Medicine, Maastricht, Netherlands
| | - Nicholas M. Selby
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, UK
| | - Maarten W. Taal
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, UK
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, UK
| | | | | | | | - Peter Kotanko
- Renal Research Institute, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Validity of Three-Dimensional Tortuous Pore Structure and Fouling of Hemoconcentration Capillary Membrane Using the Tortuous Pore Diffusion Model and Scanning Probe Microscopy. MEMBRANES 2020; 10:membranes10110315. [PMID: 33138163 PMCID: PMC7692505 DOI: 10.3390/membranes10110315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
Hemoconcentration membranes used in cardiopulmonary bypass require a pore structure design with high pure water permeability, which does not allow excessive protein adsorption and useful protein loss. However, studies on hemoconcentration membranes have not been conducted yet. The purpose of this study was to analyze three-dimensional pore structures and protein fouling before and after blood contact with capillary membranes using the tortuous pore diffusion model and a scanning probe microscope system. We examined two commercially available capillary membranes of similar polymer composition that are successfully used in hemoconcentration clinically. Assuming the conditions of actual use in cardiopulmonary bypass, bovine blood was perfused inside the lumens of these membranes. Pure water permeability before and after bovine blood perfusion was measured using dead-end filtration. The scanning probe microscopy system was used for analysis. High-resolution three-dimensional pore structures on the inner surface of the membranes were observed before blood contact. On the other hand, many pore structures after blood contact could not be observed due to protein fouling. The pore diameters calculated by the tortuous pore diffusion model and scanning probe microscopy were mostly similar and could be validated reciprocally. Achievable pure water permeabilities showed no difference, despite protein fouling on the pore inlets (membrane surface). In addition, low values of albumin sieving coefficient are attributable to protein fouling that occurs on the membrane surface. Therefore, it is essential to design the membrane structure that provides the appropriate control of fouling. The characteristics of the hemoconcentration membranes examined in this study are suitable for clinical use.
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Wang Y, Cheng L, Wen S, Zhou S, Wang Z, Deng L, Mao HQ, Cui W, Zhang H. Ice-Inspired Superlubricated Electrospun Nanofibrous Membrane for Preventing Tissue Adhesion. NANO LETTERS 2020; 20:6420-6428. [PMID: 32813534 DOI: 10.1021/acs.nanolett.0c01990] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Inspired by the superlubricated surface (SLS) of ice, which consists of an ultrathin and contiguous layer of surface-bound water, we built a SLS on the polycaprolactone (PCL)/poly(2-methacryloxyethylphosphorylcholine) (PMPC) composite nanofibrous membrane via electrospinning under controlled relative humidity (RH). The zwitterionic PMPC on the nanofiber provided a surface layer of bound water, thus generating a hydration lubrication surface. Prepared under 20% RH, electrospun PCL/PMPC nanofibers reached a minimum coefficient of friction (COF) of about 0.12 when the weight ratio of PMPC to PCL was 0.1. At a higher RH, a SLS with an ultralow COF of less than 0.05 was formed on the composite nanofibers. The high stability of the SLS hydration layer on the engineered nanofibrous membrane effectively inhibited fibroblast adhesion and markedly reduced tissue adhesion during tendon repair in vivo. This work demonstrates the great potential of this ice-inspired SLS approach in tissue adhesion-prevention applications.
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Affiliation(s)
- Yi Wang
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, P.R. China
| | - Liang Cheng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Shizhu Wen
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, P.R. China
| | - Shaobing Zhou
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, P.R. China
| | - Zhen Wang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Hai-Quan Mao
- Institute for NanoBioTechnology, Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, United States
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Hongyu Zhang
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, P.R. China
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Case studies of clinical hemodialysis membranes: influences of membrane morphology and biocompatibility on uremic blood-membrane interactions and inflammatory biomarkers. Sci Rep 2020; 10:14808. [PMID: 32908160 PMCID: PMC7481195 DOI: 10.1038/s41598-020-71755-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
End stage renal disease (ESRD) patients depend on hemodialysis (HD) as a life-sustaining treatment, but HD membrane properties play a critical role in blood activation during HD and can lead to severe patient outcomes. This study reports on a series of investigations on the common clinical HD membranes available in Canadian hospitals to explore the key reasons behind their susceptibility to blood activation and unstable cytokine. Clinical HD membranes composed of cellulose triacetate (CTA) and polyvinylpyrrolidone: polyarylethersulfone (PAES: PVP) were thoroughly characterized in terms of morphology and chemical composition. Membrane-surface interactions with uremic blood samples after HD treatment were probed using Fourier Transform Infra-Red (FTIR) and Raman spectroscopic techniques in order to understand changes in chemistry on membrane fibers. In addition, as part of this innovative study, we utilized Molecular Modeling Docking to examine the interactions of human blood proteins and membrane models to gain an in-depth understanding of functional group types responsible for perceived interactions. In-vitro adsorption of fibrinogen on different clinical HD membranes was compared at similar clinical operating conditions. Samples were collected from dialysis patients to ascertain the extent of inflammatory biomarkers released, before, during (30 and 90 min) and after dialysis (4 h). Collected blood samples were analyzed using Luminex assays for the inflammatory biomarkers of Serpin/Antithrombin-III, Properdin, C5a, 1L-1α, 1L-1β, TNF-α, IL6, and vWF. We have likewise incubated uremic blood in vitro with the two membrane materials to determine the impact that membrane materials pose in favor of activation away from the hydrodynamics influences. The results of our morphological, chemical, spectroscopic, and in vitro incubation analyses indicate that CTA membranes have a smoother surface and higher biocompatibility than PAES: PVP membranes, however, it has smaller pore size distribution, which results in poor clearance of a broad spectrum of uremic toxins. However, the rougher surface and greater hydrophilicity of PAES: PVP membranes increases red blood cell rupture at the membrane surface, which promotes protein adsorption and biochemical cascade reactions. Molecular docking studies indicate sulfone functional groups play an important role in the adsorption of proteins and receptors. PAES: PVP membranes result in slower but greater adsorption of fibrinogen, but are more likely to experience reversible and irreversible fouling as well as backfiltration. Our major finding is that a single dialysis session, even with a more biocompatible membrane such as CTA, increases the levels of complement and inflammation factors, but to a milder extent than dialysis with a PAES membrane.
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Geremia I, Pavlenko D, Maksymow K, Rüth M, Lemke HD, Stamatialis D. Ex vivo evaluation of the blood compatibility of mixed matrix haemodialysis membranes. Acta Biomater 2020; 111:118-128. [PMID: 32447066 DOI: 10.1016/j.actbio.2020.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
The patients with end stage kidney disease need haemodialysis therapies, using an artificial kidney. Nevertheless, the current therapies cannot remove a broad range of uremic toxins compared to the natural kidney. Adsorption therapies, using sorbent-based columns, can improve the clearance of uremic toxins, but the sorbent particles often require polymeric coatings to improve their haemocompatibility leading to mass transfer limitations and to lowering of their performance. Earlier, we have developed a dual layer Mixed Matrix fiber Membrane (MMM) based on polyethersulfone/polyvinylpyrrolidone (PES/PVP) polymer blends. There, the sorbent activated carbon particles are embedded in the outer membrane layer for achieving higher removal whereas the inner blood contacting selective membrane layer should achieve optimal blood compatibility. In this work, we evaluate in detail the haemocompatibility of the MMM following the norm ISO 10993-4. We study two generations of MMM having different dimensions and transport characteristics; one with low flux and no albumin leakage and another with high flux but some albumin leakage. The results are compared to those of home-made PES/PVP single layer hollow fiber and to various control fibers already applied in the clinic. Our results show that the low flux MMM successfully avoids contact of blood with the activated carbon and has good haemocompatibility, comparable to membranes currently used in the clinic. STATEMENT OF SIGNIFICANCE: Haemodialysis is a life-sustaining extracorporeal treatment for renal disease, however a broad range of uremic toxins cannot still be removed. In our previous works we showed that a double layer Mixed Matrix Membrane (MMM) composed of polyethersulfone/polyvinylpyrrolidone and activated carbon can achieve higher removal of uremic toxics compared to commercial haemodialysers. In this work we evaluate the haemocompatibility profile of the MMM in order to facilitate its clinical implementation. The lumen particle-free layer of the MMM successfully avoids the contact of blood with the poorly blood-compatible activated carbon. Moreover, thanks to the high amount of polyvinylpyrrolidone and to the smoothness of the lumen layer, the MMM has very good haemocompatibility, comparable to membranes currently used in the clinic.
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Affiliation(s)
- I Geremia
- (Bio)artificial organs, Department of Biomaterials Science and Technology, TechMed Centre, Faculty of Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - D Pavlenko
- (Bio)artificial organs, Department of Biomaterials Science and Technology, TechMed Centre, Faculty of Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - K Maksymow
- eXcorLab GmbH, Industrie Center Obernburg, Obernburg, Germany
| | - M Rüth
- eXcorLab GmbH, Industrie Center Obernburg, Obernburg, Germany
| | - H D Lemke
- eXcorLab GmbH, Industrie Center Obernburg, Obernburg, Germany
| | - D Stamatialis
- (Bio)artificial organs, Department of Biomaterials Science and Technology, TechMed Centre, Faculty of Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands.
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Kohlová M, Rocha S, Gomes Amorim C, de Nova Araújo A, Santos-Silva A, Solich P, Branco da Silva Montenegro MC. Doping Polysulfone Membrane with Alpha-Tocopherol and Alpha-Lipoic Acid for Suppressing Oxidative Stress Induced by Hemodialysis Treatment. Macromol Biosci 2020; 20:e2000046. [PMID: 32543121 DOI: 10.1002/mabi.202000046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/14/2020] [Indexed: 11/07/2022]
Abstract
The reduction of free radicals by bioactive membranes used for hemodialysis treatment is an important topic due to the constant rise of oxidative stress-associated cardiovascular mortality by hemodialysis patients. Therefore, it is urgent to find an effective solution that helps to solve this problem. Polysulfone membranes enriched with α-lipoic acid, α-tocopherol, and with both components are fabricated by spin coating. The antioxidant properties of these membranes are evaluated in vitro by determining the lipid-peroxidation level and the total antioxidant status of the blood plasma. The biocompatibility is assessed by quantifying the protein adsorption, platelet adhesion, complement activation, and hemolytic effect. All types of membranes show in vitro antioxidant activity and a trend to reduce oxidative stress in vivo; the best results show membranes prepared with a combination of both compounds and prove to be nonhemolytic and hemocompatible. Moreover, the membrane specific separation ability for the main waste products is not affected by antioxidants incorporation.
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Affiliation(s)
- Michaela Kohlová
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal.,Department of Analytical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
| | - Susana Rocha
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Célia Gomes Amorim
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Alberto de Nova Araújo
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Alice Santos-Silva
- UCIBIO-REQUIMTE, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Petr Solich
- Department of Analytical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
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Hollow fiber membranes for long-term hemodialysis based on polyethersulfone-SlipSkin™ polymer blends. J Memb Sci 2020. [DOI: 10.1016/j.memsci.2020.118068] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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43
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Stegmayr B, Willems C, Groth T, Martins A, Neves NM, Mottaghy K, Remuzzi A, Walpoth B. Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions. Int J Artif Organs 2020; 44:3-16. [PMID: 32438852 PMCID: PMC7780365 DOI: 10.1177/0391398820922231] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In hemodialysis, vascular access is a key issue. The preferred access is an arteriovenous fistula on the non-dominant lower arm. If the natural vessels are insufficient for such access, the insertion of a synthetic vascular graft between artery and vein is an option to construct an arteriovenous shunt for punctures. In emergency situations and especially in elderly with narrow and atherosclerotic vessels, a cuffed double-lumen catheter is placed in a larger vein for chronic use. The latter option constitutes a greater risk for infections while arteriovenous fistula and arteriovenous shunt can fail due to stenosis, thrombosis, or infections. This review will recapitulate the vast and interdisciplinary scenario that characterizes hemodialysis vascular access creation and function, since adequate access management must be based on knowledge of the state of the art and on future perspectives. We also discuss recent developments to improve arteriovenous fistula creation and patency, the blood compatibility of arteriovenous shunt, needs to avoid infections, and potential development of tissue engineering applications in hemodialysis vascular access. The ultimate goal is to spread more knowledge in a critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients’ quality of life.
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Affiliation(s)
- Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christian Willems
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Thomas Groth
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany.,Interdisciplinary Center of Material Research, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Albino Martins
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal
| | - Nuno M Neves
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal
| | - Khosrow Mottaghy
- Department of Physiology, RWTH Aachen University, Aachen, Germany
| | | | - Beat Walpoth
- Department of Cardiovascular Surgery (Emeritus), University of Geneva, Geneva, Switzerland
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François K, Orlando C, Jochmans K, Cools W, De Meyer V, Tielemans C, Wissing KM. Hemodialysis Does Not Induce Detectable Activation of the Contact System of Coagulation. Kidney Int Rep 2020; 5:831-838. [PMID: 32518865 PMCID: PMC7270976 DOI: 10.1016/j.ekir.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Systemic anticoagulation is administered during hemodialysis to prevent clotting of the extracorporeal circuit. The role of contact system activation in thrombin generation during hemodialysis using current era dialyzer membranes is unknown. Methods We performed a single-center randomized crossover study. Ten patients treated with hemodialysis underwent 3 standardized hemodialysis sessions. For every patient, each session was performed with a different type of dialyzer membrane (polyphenylene [PP], polymethylmetacrylate [PMMA], polyethylenimine-coated polyacrylonitrile [AN69ST]). Blood samples were collected before and 5, 15, 30, 90, and 240 minutes after blood pump start to evaluate coagulation activation (thrombin–antithrombin complex [TAT], prothrombin fragment 1+2 [PF1+2], activated factor XII [FXIIa], kallikrein, activated factor XI [FXIa]). Plasma of healthy volunteers (n = 20) was used as a reference. Results Baseline TAT and PF1+2 levels were higher in hemodialysis patients compared to healthy controls (median [interquartile range] for TAT: 3.3 [2.9–4.2] vs. 2.4 [2.3–2.5] μg/l [P = 0.0002] and for PF1+2: 647 [478–737] vs. 138 [125–254] pmol/l [P < 0.0002]). Despite the use of systemic anticoagulation, TAT further increased during treatment, with the increase starting after 30 minutes (median TAT at t240: 9.0 μg/l (PP), 5.5 μg/l (PMMA), and 7.2 μg/l (AN69ST), all P < 0.05 vs. baseline). Contact system markers FXIIa and kallikrein did not differ significantly between dialysis patients and healthy controls, whereas baseline FXIa levels were significantly lower in dialysis patients compared to healthy controls (P = 0.001). Levels of all contact system markers remained unchanged during hemodialysis with all types of dialyzer membranes. Conclusion Routine hemodialysis using systemic heparin anticoagulation induces coagulation activation without measurable contact system activation.
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Affiliation(s)
- Karlien François
- Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Christelle Orlando
- Department of Hematology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kristin Jochmans
- Department of Hematology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Center for Data Processing & Statistics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Vicky De Meyer
- Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Christian Tielemans
- Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karl Martin Wissing
- Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Tagaya M, Okano S, Murataka T, Handa H, Ichikawa S, Takahashi S. Biocompatibility of a polymer-coated membrane possessing a hydrophilic blood-contacting layer: Adsorption-related assessment. Int J Artif Organs 2019; 43:405-410. [PMID: 31875413 DOI: 10.1177/0391398819895525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Currently, the foreign surfaces of extracorporeal circulation devices are coated with an acrylate-based copolymer that creates a hydrophilic blood-contacting layer to enhance biocompatibility. Several reports of acrylate-based copolymer with respect to biocompatibility have been published; however, the adsorption of peptide compounds on acrylate-based copolymer-coated membranes still requires clarity. In this study, we aimed to understand the adsorption of several peptide compounds of various molecular weights, including albumin, lysozyme, and vancomycin, on acrylate-based copolymer-coated membranes using in vitro studies. METHODS Six experimental circuits consisting of acrylate-based copolymer-coated tubes and membranes, and six comprising acrylate-based copolymer-coated tubes and non-coated membranes were prepared for comparison. An experimental solution, composed of albumin, lysozyme, vancomycin, and saline, was continuously stirred in a reservoir, recirculated in each experimental circuit, and then filtered. Concentrations of albumin, lysozyme, and vancomycin were measured after 0, 15, 30, 45, 60, 90, and 120 min of recirculation. Similar experiments were performed in all the prepared circuits. RESULTS The ratio of measured values at each time point to those at 0 min was not significantly different between acrylate-based copolymer-coated and non-coated membranes for albumin and lysozyme, but differed significantly for vancomycin; the ratios were higher in acrylate-based copolymer-coated than in non-coated membranes. CONCLUSION This study suggests that albumin is not adsorbed on either acrylate-based copolymer-coated or non-coated membranes, that lysozyme is not adsorbed on either membrane or is adsorbed at a similar rate on both membranes, and that vancomycin is less adsorbed on acrylate-based copolymer-coated membranes. Thus, acrylate-based copolymer coating could inhibit the adsorption of various peptide compounds.
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Affiliation(s)
- Masashi Tagaya
- Department of Medical Engineering, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Shinya Okano
- Department of Medical Engineering, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Takuo Murataka
- Department of Medical Engineering, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hiroki Handa
- Department of Medical Engineering, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Shunsuke Ichikawa
- Department of Medical Engineering, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Shunsuke Takahashi
- Department of Nephrology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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Sepe V, Gregorini M, Rampino T, Esposito P, Coppo R, Galli F, Libetta C. Vitamin e-loaded membrane dialyzers reduce hemodialysis inflammaging. BMC Nephrol 2019; 20:412. [PMID: 31729973 PMCID: PMC6858730 DOI: 10.1186/s12882-019-1585-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inflammaging is a persistent, low-grade, sterile, nonresolving inflammatory state, associated with the senescence of the immune system. Such condition downregulates both innate and adaptive immune responses during chronic disorders as type II diabetes, cancer and hemodialysis, accounting for their susceptibility to infections, malignancy and resistance to vaccination. Aim of this study was to investigate hemodialysis inflammaging, by evaluating changes of several hemodialysis treatments on indoleamine 2,3-dioxygenase-1 activity and nitric oxide formation. METHODS We conducted a randomized controlled observational crossover trial. Eighteen hemodialysis patients were treated with 3 different hemodialysis procedures respectively: 1) Low-flux bicarbonate hemodialysis, 2) Low-flux bicarbonate hemodialysis with vitamin E - loaded dialyzers, and 3) Hemodialfitration. The control group consisted of 14 hospital staff healthy volunteers. Blood samples were collected from all 18 hemodialysis patients just after the long interdialytic interval, at the end of each hemodialysis treatment period. RESULTS Hemodialysis kynurenine and kynurenine/L - tryptophan blood ratio levels were significantly higher, when compared to the control group, indicating an increased indoleamine 2,3-dioxygenase-1 activity in hemodialysis patients. At the end of the low-flux bicarbonate hemodialysis with vitamin E - loaded dialyzers period, L - tryptophan serum levels remained unchanged vs both low-flux bicarbonate hemodialysis and hemodialfitration. Kynurenine levels instead decreased, resulting in a significant reduction of kynurenine/L - tryptophan blood ratio and indoleamine 2,3-dioxygenase-1 activity, when matched to both low-flux bicarbonate hemodialysis and HDF respectively. Serum nitric oxide control group levels, were significantly lower when compared to all hemodialysis patient groups. Interestingly, low-flux bicarbonate hemodialysis with vitamin E - loaded dialyzers nitric oxide serum levels from venous line blood samples taken 60 min after starting the hemodialysis session were significantly lower vs serum taken simultaneously from the arterial blood line. CONCLUSIONS The treatment with more biocompatible hemodialysis procedure as low-flux bicarbonate hemodialysis with vitamin E - loaded dialyzers, reduced indoleamine 2,3-dioxygenase-1 activity and nitric oxide formation when compared to both low-flux bicarbonate hemodialysis and hemodialfitration. These data suggest that low-flux bicarbonate hemodialysis with vitamin E - loaded dialyzers lowering hemodialysis inflammaging, could be associated to changes of proinflammatory signalling a regulated molecular level. TRIAL REGISTRATION NCT Number: NCT02981992; Other Study ID Numbers: 20100014090. First submitted: November 26, 2016. First posted: December 5, 2016. Last Update Posted: December 5, 2016.
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Affiliation(s)
- Vincenzo Sepe
- 0000 0004 1760 3027grid.419425.fUnit of Nephrology and Dialysis, Transplantation; Fondazione IRCCS Policlinico «San Matteo», Viale Camillo Golgi 19, 27100 Pavia, Italy
- 0000 0004 1760 3027grid.419425.fUOC di Nefrologia e Dialisi, Trapianto, Fondazione IRCCS Policlinico «San Matteo», Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Marilena Gregorini
- 0000 0004 1760 3027grid.419425.fUnit of Nephrology and Dialysis, Transplantation; Fondazione IRCCS Policlinico «San Matteo», Viale Camillo Golgi 19, 27100 Pavia, Italy
- 0000 0004 1762 5736grid.8982.bChair of Nephrology, University of Pavia, Corso Strada Nuova 65, 27100 Pavia, Italy
| | - Teresa Rampino
- 0000 0004 1760 3027grid.419425.fUnit of Nephrology and Dialysis, Transplantation; Fondazione IRCCS Policlinico «San Matteo», Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Pasquale Esposito
- 0000 0004 1760 3027grid.419425.fUnit of Nephrology and Dialysis, Transplantation; Fondazione IRCCS Policlinico «San Matteo», Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Rosanna Coppo
- 0000 0004 5907 3255grid.478931.0Fondazione Ricerca Molinette, Regina Margherita Hospital 94, Piazza Polonia, 10126 Torino, Italy
| | - Francesco Galli
- 0000 0004 1757 3630grid.9027.cUniversità degli Studi di Perugia, Pharmaceutical Sciences, Branch of Via del Giochetto, building B, 2nd floor, 06123 Perugia, Italy
| | - Carmelo Libetta
- 0000 0004 1760 3027grid.419425.fUnit of Nephrology and Dialysis, Transplantation; Fondazione IRCCS Policlinico «San Matteo», Viale Camillo Golgi 19, 27100 Pavia, Italy
- 0000 0004 1762 5736grid.8982.bChair of Nephrology, University of Pavia, Corso Strada Nuova 65, 27100 Pavia, Italy
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ter Beek O, Pavlenko D, Suck M, Helfrich S, Bolhuis-Versteeg L, Snisarenko D, Causserand C, Bacchin P, Aimar P, van Oerle R, Wetzels R, Verhezen P, Henskens Y, Stamatialis D. New membranes based on polyethersulfone – SlipSkin™ polymer blends with low fouling and high blood compatibility. Sep Purif Technol 2019. [DOI: 10.1016/j.seppur.2019.05.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lucas TC, Carvalho MDG, Duarte RCF, Haniel J, Trindade SA, Ottoni MHF, Dos Santos LI, Brito Alvim de Melo GE, Huebner R. Effect of the expression of CD62P and thrombin generation on patients using central venous catheters for hemodialysis. Artif Organs 2019; 44:296-304. [PMID: 31520401 DOI: 10.1111/aor.13568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022]
Abstract
The formation of thrombi in medical devices that come into contact with blood is a common cause of increased morbidity and mortality. Prolonged use of central venous catheters (CVCs) may cause high infection rates or compromise CVC patency due to thrombus development. In this study, we sought insights into possible changes in the hemostatic system during prolonged use of inserted CVCs for hemodialysis by assessing platelets by CD62P and CD41a expression and the potential for thrombin generation (TG). This study included patients with chronic renal failure who were undergoing hemodialysis three times a week using a CVC, and healthy subjects as controls. The participants were distributed into three groups: Group 1: clinically and laboratorially healthy individuals matched by sex and age to the patients (controls); Group II: patients who had completed 1 month of CVC insertion; and Group III: the same patients after they had completed 4 months of CVC insertion. Platelet activation analysis and TG evaluation were performed using blood samples obtained through two different accesses, that is, through a peripheral vein and directly from the CVC lumen. The data showed platelet activation and an increase in the generation of thrombin, particularly after 4 months of CVC use. The results also indicated that insertion of the catheter into the blood stream stimulated the intrinsic rather than the extrinsic pathway. Taken together, the data showed a direct relationship between the use of CVCs in hemodialysis patients and a state of hypercoagulability, most likely associated with endothelial damage and the contact of the medical device with blood components such as platelets and coagulation factors.
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Affiliation(s)
- Thabata Coaglio Lucas
- Department of Nursing, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil.,Laboratory of Bioengineering, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria das Graças Carvalho
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Laboratory of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rita Carolina Figueiredo Duarte
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Laboratory of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jonathas Haniel
- Department of Mechanical Engineering, Laboratory of Bioengineering, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sissy Araújo Trindade
- Department of Nursing, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil
| | | | - Luara Isabela Dos Santos
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Laboratory of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Rudolf Huebner
- Department of Mechanical Engineering, Laboratory of Bioengineering, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Malchesky PS. Artificial Organs 2018: A Year in Review. Artif Organs 2019; 43:288-317. [PMID: 30680758 DOI: 10.1111/aor.13428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/24/2022]
Abstract
In this Editor's Review, articles published in 2018 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer-reviewed special issues this year included contributions from the 13th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, and the 25th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Marvin Slepian. Additionally, many editorials highlighted the worldwide survival differences in hemodialysis and perspectives on mechanical circulatory support and stem cell therapies for cardiac support. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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Koga Y, Meguro H, Fujieda H, Ueno Y, Miwa K, Kainoh M. A new hydrophilic polysulfone hemodialysis membrane can prevent platelet-neutrophil interactions and successive neutrophil activation. Int J Artif Organs 2019; 42:175-181. [PMID: 30638104 PMCID: PMC6421590 DOI: 10.1177/0391398818823767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: Microaggregates have often been observed during hemodialysis and are clearly associated with complications of hemodialysis therapy. In this study, we aimed to clarify the effects of two polysulfone membranes, with different abilities to activate blood cells, on the formation of these microaggregates; we also investigated their molecular mechanisms. METHODS: Human whole blood was circulated through a mini-module dialyzer using the membranes in vitro; platelet-neutrophil complexes in blood were determined by flow cytometry. Isolated human neutrophils were incubated with the membranes in plasma, in the presence or absence of platelets, followed by flow cytometric analysis of intracellular reactive oxygen species and cell-surface activated CD11b on neutrophils. RESULTS: CX-U, a conventional polysulfone membrane with remarkable cell activation, induced the formation of platelet-neutrophil complexes; however, NV-U, a new hydrophilic polysulfone membrane with slight or no cell activation, did not cause complex formation. Moreover, CX-U-induced reactive oxygen species production and the increase in activated CD11b expression on neutrophils were enhanced by platelets. On the other hand, NV-U hardly affected neutrophil activation, regardless of whether platelets were present or not. The enhancement of CX-U-induced neutrophil activations by platelets was greatly inhibited by anti-CD62P antibody. CONCLUSION: The ability of polysulfone membranes to activate blood cells is closely related to platelet-neutrophil interaction. Therefore, a biocompatible membrane, like NV-U, can be expected to prevent microaggregate formation during hemodialysis and avoid subsequent cell activation.
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Affiliation(s)
- Yoko Koga
- 1 Pharmaceutical Research Laboratories, Toray Industries, Inc., Kamakura, Japan
| | - Hiroyuki Meguro
- 1 Pharmaceutical Research Laboratories, Toray Industries, Inc., Kamakura, Japan
| | - Hiroaki Fujieda
- 2 Advanced Material Research Laboratories, Toray Industries, Inc., Otsu, Japan
| | - Yoshiyuki Ueno
- 2 Advanced Material Research Laboratories, Toray Industries, Inc., Otsu, Japan
| | - Keishi Miwa
- 2 Advanced Material Research Laboratories, Toray Industries, Inc., Otsu, Japan
| | - Mie Kainoh
- 1 Pharmaceutical Research Laboratories, Toray Industries, Inc., Kamakura, Japan
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