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Goldman M, Lagmiche M, Dhaene M, Amraoui Z, Thayse C, Vanherweghem JL. Adsorption of ß2-Microglobulin on Dialysis Membranes: Comparison of Different Dialyzers and Effects of Reuse Procedures. Int J Artif Organs 2018. [DOI: 10.1177/039139888901200605] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In order to measure ß2-microglobulin adsorption on dialysis membranes, uremic plasma was passed through different dialyzers in a simulated hemodialysis circuit in which both plasma and dialysate compartments were organized as closed loops, the ultrafiltration pressure being adjusted to minimize water shifts. Under these conditions, comparison of the amounts of ß2-m in the plasma and dialysate compartments allowed us to calculate the binding of ß2-m to the membrane at different times of the procedure. Whereas cuprophane membrane (Gambro gf 180m, 1.8m2) did not bind ß2-m, AN69 (Filtral, 1.1 m2), high flux polysulfone (F60, 1.2m2) and modified polyamide (Polyflux 130, Gambro, 1.3m2) were found to adsorb 49 ± 8 mg (mean ± SEM), 17 ± 5 mg and 38 ± 4 mg of 82-m, respectively. These data were confirmed in trace labeling experiments with 125I-ß2-m. Adsorption was a saturable phenomenon occurring during the first 90 min of in vitro dialysis. After reuse with peracetic acid, the adsorption capacity of AN69 membrane was lowered to 20 ± 4 mg of ß2-m, contrasting with the unchanged adsorption after reuse with sodium hypochlorite. These data indicate that adsorption significantly contributes to ß2-m removal during hemodialysis with certain dialyzers and that reuse procedures may affect the propensity of dialysis membranes to bind 82-m.
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Affiliation(s)
- M. Goldman
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme and Laboratoire Pluridisciplinaire de Recherche Expérimentale Biomédicale, Université Libre de Bruxelles - Belgium
| | - M. Lagmiche
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme and Laboratoire Pluridisciplinaire de Recherche Expérimentale Biomédicale, Université Libre de Bruxelles - Belgium
| | - M. Dhaene
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme and Laboratoire Pluridisciplinaire de Recherche Expérimentale Biomédicale, Université Libre de Bruxelles - Belgium
| | - Z. Amraoui
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme and Laboratoire Pluridisciplinaire de Recherche Expérimentale Biomédicale, Université Libre de Bruxelles - Belgium
| | - C. Thayse
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme and Laboratoire Pluridisciplinaire de Recherche Expérimentale Biomédicale, Université Libre de Bruxelles - Belgium
| | - J.-L. Vanherweghem
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme and Laboratoire Pluridisciplinaire de Recherche Expérimentale Biomédicale, Université Libre de Bruxelles - Belgium
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Vanherweghem J, Drukker W, Schwarz A. Clinical Significance of Blood-Device Interaction in Hemodialysis. A Review. Int J Artif Organs 2018. [DOI: 10.1177/039139888701000404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J.L. Vanherweghem
- Dept. of Nephrology, Erasme Hospital, University of Brussels, Brussels, Belgium
| | - W. Drukker
- Dept. of Nephrology, St. Lucas Hospital, Amsterdam, The Netherlands
| | - A. Schwarz
- Universitäts Kliniken Steglitz, Freie Universität Berlin, Berlin, FRG
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Contou D, d'Ythurbide G, Messika J, Ridel C, Parrot A, Djibré M, Hertig A, Rondeau E, Fartoukh M. Description and predictive factors of infection in patients with chronic kidney disease admitted to the critical care unit. J Infect 2013; 68:105-15. [PMID: 24140065 DOI: 10.1016/j.jinf.2013.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the spectrum of infection and multidrug-resistant bacterial colonization, and to identify early predictors of infection in patients with chronic kidney disease (CKD) admitted to the critical care unit (CCU). METHODS A 7-month observational prospective single-centre study in a French university hospital. RESULTS 791 patients were admitted to the CCU, 135 of whom (17%) had severe CKD. Among these, 41 (30%) were infected on admission. Infection was microbiologically documented in 32 patients (78%), of which 7 (22%) were related to Pseudomonas aeruginosa. There was no infection related to extended-spectrum β-lactamase-producing enterobacteriaceae despite a 12% carriage rate on admission. A temperature ≥37.6 °C and a leukocyte count >12.000/mm³ were specific but poorly sensitive of infection (91% and 80%, and 45% and 39%, respectively). Using the threshold of 0.85 ng/ml, procalcitonin was a strong independent predictor of infection on admission (OR 12.8, 95% CI 4.4-37.3). Age (≥60 years) and the cause of CKD were two other predictors. CONCLUSIONS Infection accounts for one-third of CCU admissions in CKD patients, with a high prevalence of P. aeruginosa. The usual diagnostic criteria are inaccurate for diagnosing infection in this population. A procalcitonin ≥0.85 ng/ml might be helpful for early identifying CKD patients with infection.
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Affiliation(s)
- Damien Contou
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France
| | - Géraldine d'Ythurbide
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, France
| | - Jonathan Messika
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France
| | - Christophe Ridel
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, France
| | - Antoine Parrot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France
| | - Michel Djibré
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France
| | - Alexandre Hertig
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, France
| | - Eric Rondeau
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, France
| | - Muriel Fartoukh
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France.
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Lorton F, Veinberg F, Ielsch D, Deschênes G, Bensman A, Ulinski T. Procalcitonin serum levels in children undergoing chronic haemodialysis. Pediatr Nephrol 2007; 22:430-5. [PMID: 17043886 DOI: 10.1007/s00467-006-0304-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Revised: 08/09/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
Infections account for considerable morbidity and mortality in patients requiring haemodialysis (HD). Procalcitonin (PCT)-a low molecular weight protein of 13 kDa-helps one to distinguish viral from bacterial infections and to evaluate the severity of bacterial infections. We investigated (1) PCT baseline levels in eight children undergoing chronic HD with high-flux membranes and (2) changes in the serum levels of PCT, C-reactive protein (CRP) and beta-2-microglobulin (beta2-MG)-a peptide with biochemical characteristics similar to those of PCT-before and after haemodialysis sessions. Blood sampling was performed three times in the mid-week session. Serum PCT of the seven uninfected children before HD sessions was increased (0.75+/-0.07 ng/ml), whereas CRP levels were normal. PCT after dialysis decreased significantly by 40% (P<0.0001) compared with initial values, whereas CRP levels before and after HD were not different. beta2-MG decreased by 70%, probably due to different biochemical properties of both proteins. PCT serum levels 15 min and 60 min after the HD session remained unchanged in comparison with those at the end of the HD session, suggesting accumulation of PCT between HD sessions rather than HD-induced production to be responsible for the increased baseline PCT serum levels. We concluded that CRP serum levels were not affected by HD in our group. Moderately elevated baseline PCT serum levels that are presumably due to reduced renal clearance and uraemia and dialysis-ability of PCT should be taken into consideration. However, increase of serum PCT in patients with severe bacterial infections is generally massive (10-fold to 1,000-fold), suggesting a low risk for false negative results in such cases.
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Affiliation(s)
- Fleur Lorton
- Department of Pediatric Nephrology, Hôpital Trousseau, 26 Avenue du Docteur Netter, 75012, Paris, France
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Herget-Rosenthal S, Marggraf G, Pietruck F, Hüsing J, Strupat M, Philipp T, Kribben A. Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant 2001; 16:975-9. [PMID: 11328903 DOI: 10.1093/ndt/16.5.975] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infection results in considerable morbidity and mortality in haemodialysis patients. Diagnosis of infection can be difficult because currently applied laboratory parameters may be non-specifically altered due to uraemia or haemodialysis (HD). This study investigated the diagnostic value and kinetics of serum procalcitonin (PCT), a low-molecular-weight protein, in patients receiving intermittent HD. METHODS Sixty-eight patients receiving intermittent HD for end-stage renal disease (n=48) or acute renal failure (n=20) were prospectively studied, 47 treated with high-flux and 21 with low-flux membranes. Of 36 patients with severe infections or sepsis, 27 were treated with high-flux and nine with low-flux membranes. WBC, serum PCT and C-reactive protein (CRP) concentrations were measured immediately before HD, and PCT repeatedly during the following 48 h. RESULTS When determined immediately before HD, PCT demonstrated a sensitivity of 89%, a specificity of 81%, and positive and negative predictive values of 84 and 87%, indicating severe infection or sepsis. These levels were higher than the respective values for CRP (89, 48, 68 and 78%) and WBC (58, 75, 71 and 59%). After 4 h of HD with high-flux membranes, PCT decreased significantly to 83+/-25% and did not return to predialysis concentrations before 48 h. This decrease in serum PCT resulted in markedly reduced sensitivity (65%) and negative predictive value (54%). In contrast, no marked change in PCT concentration occurred during or after HD with low-flux membranes. CONCLUSION Serum PCT is an accurate indicator of severe infection and sepsis in patients receiving intermittent HD. High-flux membranes substantially decrease PCT. When utilizing high flux membranes, serum PCT concentrations should be determined prior to the start of HD.
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Affiliation(s)
- S Herget-Rosenthal
- Division of Nephrology, University Hospital, University of Essen, D-45122 Essen, Germany
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