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Karabelas AJ, Moschona A, Merenidis K. On the Temporal Evolution of Key Hemofilter Parameters-In Vitro Study under Co-Current Flow. MEMBRANES 2024; 14:200. [PMID: 39330541 PMCID: PMC11434192 DOI: 10.3390/membranes14090200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/11/2024] [Accepted: 09/18/2024] [Indexed: 09/28/2024]
Abstract
Effective permeability KP, the ultrafiltration coefficient (KUF), the sieving coefficient (SC), and the loss/permeation of proteins (primarily albumin) are key parameters/specifications characterizing hemofilter (HF) performance. However, there are uncertainties regarding their determination. This work aims (a) to demonstrate that the co-current flow (of blood and dialysate) can lead to beneficial unidirectional filtration (from blood/plasma to dialysate) under a fairly uniform local trans-membrane pressure (TMP), unlike the presently employed counter-current flow; (b) to study the temporal evolution of key HF performance parameters under co-current flow, particularly during the important early stage of hemocatharsis (HC). Experiments with human plasma and BSA solutions in co-current flow mode (for which a fluid mechanical model is developed) show a fairly uniform local/axial TMP, which also improves the local/axial uniformity of protein membrane fouling, particularly under (currently favored) high convective flux operation. Due to incipient membrane fouling, a significant temporal variability/decline in the effective KP is observed, and, in turn, of other parameters (i.e., the Kuf, SC, and permeation/mass flux Mm for albumin and total proteins). A satisfactory correlation of the albumin/protein mass flux Mm with permeability KP is obtained, indicating strong inter-dependence. In conclusion, co-current flow, allowing for a fair local TMP axial uniformity, enables the acquisition of accurate/representative data on the evolution of HF parameters, facilitating their interpretation and correlation. The new results provide a basis for exploring the clinical application of the co-current flow.
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Affiliation(s)
- Anastasios J. Karabelas
- Chemical Process and Energy Resources Institute, Centre for Research and Technology—Hellas, Thermi, 57001 Thessaloniki, Greece; (A.M.); (K.M.)
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2
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Silvinato A, Floriano I, Bernardo WM. Online hemodiafiltration vs. high-flux hemodialysis in end-stage renal disease: a meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024D709. [PMID: 39292097 PMCID: PMC11404996 DOI: 10.1590/1806-9282.2024d709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Antonio Silvinato
- Brazilian Medical Association, Evidence-Based Medicine - São Paulo (SP), Brazil
| | - Idevaldo Floriano
- Brazilian Medical Association, Evidence-Based Medicine - São Paulo (SP), Brazil
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3
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Karabelas AJ. On the total albumin losses during haemocatharsis. J Artif Organs 2024; 27:91-99. [PMID: 38238597 PMCID: PMC11126488 DOI: 10.1007/s10047-023-01430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/16/2023] [Indexed: 05/26/2024]
Abstract
Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin losses considers albumin "leaking" into the dialysate and losses due to protein/membrane interactions (i.e. adsorption, "secondary membrane formation" and denaturation). The former are fairly easy to determine, usually varying at the level of ~ 2 g to ~ 7 g albumin loss per session. Such values, commonly accepted as representative of the total albumin losses, are often quoted as limits/standards of permissible albumin loss per session. On albumin mass lost due to adsorption/deposition, which is the result of complicated interactions and rather difficult to determine, scant in vivo data exist and there is great uncertainty and confusion regarding their magnitude; this is possibly responsible for neglecting their contribution to the total losses at present. Yet, many relevant in vitro studies suggest that losses of albumin due to protein/membrane interactions are likely comparable to (or even greater than) those due to leaking, particularly in the currently favoured high-convection HDF (haemodiafiltration) treatment. Therefore, it is emphasised that top research priority should be given to resolve these issues, primarily by developing appropriate/facile in vivo test-methods and related analytical techniques.
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Affiliation(s)
- Anastasios J Karabelas
- Chemical Process and Energy Resources Institute, Centre for Research and Technology-Hellas, 6th Km Charilaou - Thermi Road, Thermi - Thessaloniki, GR 57001, Greece.
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4
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Zawada AM, Emal K, Förster E, Saremi S, Delinski D, Theis L, Küng F, Xie W, Werner J, Stauss-Grabo M, Faust M, Boyington S, Kennedy JP. Hydrophilic Modification of Dialysis Membranes Sustains Middle Molecule Removal and Filtration Characteristics. MEMBRANES 2024; 14:83. [PMID: 38668111 PMCID: PMC11052066 DOI: 10.3390/membranes14040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
While efficient removal of uremic toxins and accumulated water is pivotal for the well-being of dialysis patients, protein adsorption to the dialyzer membrane reduces the performance of a dialyzer. Hydrophilic membrane modification with polyvinylpyrrolidone (PVP) has been shown to reduce protein adsorption and to stabilize membrane permeability. In this study we compared middle molecule clearance and filtration performance of nine polysulfone-, polyethersulfone-, and cellulose-based dialyzers over time. Protein adsorption was simulated in recirculation experiments, while β2-microglobulin clearance as well as transmembrane pressure (TMP) and filtrate flow were determined over time. The results of this study showed that β2-microglobulin clearance (-7.2 mL/min/m2) and filtrate flow (-54.4 mL/min) decreased strongly during the first 30 min and slowly afterwards (-0.7 mL/min/m2 and -6.8 mL/min, respectively, for the next 30 min); the TMP increase (+37.2 mmHg and +8.6 mmHg, respectively) showed comparable kinetics. Across all tested dialyzers, the dialyzer with a hydrophilic modified membrane (FX CorAL) had the highest β2-microglobulin clearance after protein fouling and the most stable filtration characteristics. In conclusion, hydrophilic membrane modification with PVP stabilizes the removal capacity of middle molecules and filtration performance over time. Such dialyzers may have benefits during hemodiafiltration treatments which aim to achieve high exchange volumes.
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Affiliation(s)
- Adam M. Zawada
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany; (E.F.); (S.S.); (D.D.); (L.T.); (F.K.)
| | - Karlee Emal
- Applications Laboratory, Fresenius Medical Care, Ogden, UT 84404, USA; (K.E.); (S.B.)
| | - Eva Förster
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany; (E.F.); (S.S.); (D.D.); (L.T.); (F.K.)
| | - Saeedeh Saremi
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany; (E.F.); (S.S.); (D.D.); (L.T.); (F.K.)
- Institute for Physical Process Technology, Saarland University of Applied Sciences, 66117 Saarbrücken, Germany;
| | - Dirk Delinski
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany; (E.F.); (S.S.); (D.D.); (L.T.); (F.K.)
| | - Lukas Theis
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany; (E.F.); (S.S.); (D.D.); (L.T.); (F.K.)
| | - Florian Küng
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany; (E.F.); (S.S.); (D.D.); (L.T.); (F.K.)
| | - Wenhao Xie
- Product Development, Fresenius Medical Care, Shanghai 200233, China;
| | - Joanie Werner
- Clinical Marketing & Innovations, Fresenius Medical Care, Waltham, MA 02451, USA;
| | - Manuela Stauss-Grabo
- Global Biomedical Evidence Generation, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany;
| | - Matthias Faust
- Institute for Physical Process Technology, Saarland University of Applied Sciences, 66117 Saarbrücken, Germany;
| | - Skyler Boyington
- Applications Laboratory, Fresenius Medical Care, Ogden, UT 84404, USA; (K.E.); (S.B.)
| | - James P. Kennedy
- Product Development, Fresenius Medical Care, Ogden, UT 84404, USA;
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5
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Hemodiafiltration: Technical and Medical Insights. Bioengineering (Basel) 2023; 10:bioengineering10020145. [PMID: 36829639 PMCID: PMC9952158 DOI: 10.3390/bioengineering10020145] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Despite the significant medical and technical improvements in the field of dialytic renal replacement modalities, morbidity and mortality are excessively high among patients with end-stage kidney disease, and most interventional studies yielded disappointing results. Hemodiafiltration, a dialysis method that was implemented in clinics many years ago and that combines the two main principles of hemodialysis and hemofiltration-diffusion and convection-has had a positive impact on mortality rates, especially when delivered in a high-volume mode as a surrogate for a high convective dose. The achievement of high substitution volumes during dialysis treatments does not only depend on patient characteristics but also on the dialyzer (membrane) and the adequately equipped hemodiafiltration machine. The present review article summarizes the technical aspects of online hemodiafiltration and discusses present and ongoing clinical studies with regards to hard clinical and patient-reported outcomes.
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Mohajerani F, Clark WR, Ronco C, Narsimhan V. Mass Transport in High-Flux Hemodialysis: Application of Engineering Principles to Clinical Prescription. Clin J Am Soc Nephrol 2022; 17:749-756. [PMID: 35277434 PMCID: PMC9269577 DOI: 10.2215/cjn.09410721] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An understanding of the processes underlying mass transfer is paramount for the attainment of adequate solute removal in the dialytic treatment of patients with kidney failure. In this review, engineering principles are applied to characterize the physical mechanisms behind the two major modes of mass transfer during hemodialysis, namely diffusion and convection. The manner in which flow rate, dialyzer geometry, and membrane microstructure affect these processes is discussed, with concepts such as boundary layers, effective membrane diffusivity, and sieving coefficients highlighted as critical considerations. The objective is to improve clinicians' understanding of these concepts as important factors influencing the prescription and delivery of hemodialysis therapy.
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Affiliation(s)
- Farzad Mohajerani
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana
| | - William R Clark
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.,Nephrology Department, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Vivek Narsimhan
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana
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Marczak L, Idkowiak J, Tracz J, Stobiecki M, Perek B, Kostka-Jeziorny K, Tykarski A, Wanic-Kossowska M, Borowski M, Osuch M, Formanowicz D, Luczak M. Mass Spectrometry-Based Lipidomics Reveals Differential Changes in the Accumulated Lipid Classes in Chronic Kidney Disease. Metabolites 2021; 11:275. [PMID: 33925471 PMCID: PMC8146808 DOI: 10.3390/metabo11050275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is characterized by the progressive loss of functional nephrons. Although cardiovascular disease (CVD) complications and atherosclerosis are the leading causes of morbidity and mortality in CKD, the mechanism by which the progression of CVD accelerates remains unclear. To reveal the molecular mechanisms associated with atherosclerosis linked to CKD, we applied a shotgun lipidomics approach fortified with standard laboratory analytical methods and gas chromatography-mass spectrometry technique on selected lipid components and precursors to analyze the plasma lipidome in CKD and classical CVD patients. The MS-based lipidome profiling revealed the upregulation of triacylglycerols in CKD and downregulation of cholesterol/cholesteryl esters, sphingomyelins, phosphatidylcholines, phosphatidylethanolamines and ceramides as compared to CVD group and controls. We have further observed a decreased abundance of seven fatty acids in CKD with strong inter-correlation. In contrast, the level of glycerol was elevated in CKD in comparison to all analyzed groups. Our results revealed the putative existence of a functional causative link-the low cholesterol level correlated with lower estimated glomerular filtration rate and kidney dysfunction that supports the postulated "reverse epidemiology" theory and suggest that the lipidomic background of atherosclerosis-related to CKD is unique and might be associated with other cellular factors, i.e., inflammation.
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Affiliation(s)
- Lukasz Marczak
- Department of Natural Products Biochemistry, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland; (J.I.); (M.S.)
| | - Jakub Idkowiak
- Department of Natural Products Biochemistry, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland; (J.I.); (M.S.)
- Department of Analytical Chemistry, Faculty of Chemical Technology, University of Pardubice, 532 10 Pardubice, Czech Republic
| | - Joanna Tracz
- Department of Biomedical Proteomics, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland;
| | - Maciej Stobiecki
- Department of Natural Products Biochemistry, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland; (J.I.); (M.S.)
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-001 Poznan, Poland;
| | - Katarzyna Kostka-Jeziorny
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-001 Poznan, Poland; (K.K.-J.); (A.T.)
| | - Andrzej Tykarski
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-001 Poznan, Poland; (K.K.-J.); (A.T.)
| | - Maria Wanic-Kossowska
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Marcin Borowski
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznan, Poland;
| | - Marcin Osuch
- Department of Molecular and Systems Biology, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland;
| | - Dorota Formanowicz
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Magdalena Luczak
- Department of Biomedical Proteomics, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland;
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8
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Maduell F, Broseta JJ, Rodas L, Montagud‐Marrahi E, Rodriguez‐Espinosa D, Hermida E, Arias‐Guillén M, Fontseré N, Vera M, Gómez M, González B, Rico N. Comparison of Solute Removal Properties Between High‐Efficient Dialysis Modalities in Low Blood Flow Rate. Ther Apher Dial 2019; 24:387-392. [DOI: 10.1111/1744-9987.13440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Lida Rodas
- Department of NephrologyHospital Clínic Barcelona Barcelona Spain
| | | | | | - Evelyn Hermida
- Department of NephrologyHospital Clínic Barcelona Barcelona Spain
| | | | - Néstor Fontseré
- Department of NephrologyHospital Clínic Barcelona Barcelona Spain
| | - Manel Vera
- Department of NephrologyHospital Clínic Barcelona Barcelona Spain
| | - Miquel Gómez
- Department of NephrologyHospital Clínic Barcelona Barcelona Spain
| | | | - Nayra Rico
- Department of BiochemistryHospital Clínic Barcelona Barcelona Spain
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9
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Ficheux A, Gayrard N, Szwarc I, Duranton F, Vetromile F, Brunet P, Servel MF, Jankowski J, Argilés À. Measuring intradialyser transmembrane and hydrostatic pressures: pitfalls and relevance in haemodialysis and haemodiafiltration. Clin Kidney J 2019; 13:580-586. [PMID: 32905251 PMCID: PMC7467581 DOI: 10.1093/ckj/sfz033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background Post-dilutional haemodiafiltration (HDF) with high convection volumes (HCVs) could improve survival. HCV-HDF requires a significant pressure to be applied to the dialyser membrane. The aim of this study was to assess the pressure applied to the dialysers in HCV-HDF, evaluate the influence of transmembrane pressure (TMP) calculation methods on TMP values and check how they relate to the safety limits proposed by guidelines. Methods Nine stable dialysis patients were treated with post-dilutional HCV-HDF with three different convection volumes [including haemodialysis (HD)]. The pressures at blood inlet (Bi), blood outlet (Bo) and dialysate outlet (Do) were continuously recorded. TMP was calculated using two pressures (TMP2: Bo, Do) or three pressures (TMP3: Bo, Do, Bi). Dialysis parameters were analysed at the start of the session and at the end of treatment or at the first occurrence of a manual intervention to decrease convection due to TMP alarms. Results During HD sessions, TMP2 and TMP3 remained stable. During HCV-HDF, TMP2 remained stable while TMP3 clearly increased. For the same condition, TMP3 could be 3-fold greater than TMP2. This shows that the TMP limit of 300 mmHg as recommended by guidelines could have different effects according to the TMP calculation method. In HCV-HDF, the pressure at the Bi increased over time and exceeded the safety limits of 600 mmHg provided by the manufacturer, even when respecting TMP safety limits. Conclusions This study draws our attention to the dangers of using a two-pressure points TMP calculation, particularly when performing HCV-HDF.
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Affiliation(s)
- Alain Ficheux
- RD - Néphrologie, Montpellier, France.,BC2M, Univ Montpellier, Montpellier, France
| | - Nathalie Gayrard
- RD - Néphrologie, Montpellier, France.,BC2M, Univ Montpellier, Montpellier, France
| | - Ilan Szwarc
- Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, Sète, France
| | - Flore Duranton
- RD - Néphrologie, Montpellier, France.,BC2M, Univ Montpellier, Montpellier, France
| | | | - Philippe Brunet
- Hôpital de La Conception, Université Aix-Marseille, Service de Néphrologie, Marseille, France
| | | | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research, RWTH Aachen University, Aachen, Germany
| | - Àngel Argilés
- RD - Néphrologie, Montpellier, France.,BC2M, Univ Montpellier, Montpellier, France.,Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, Sète, France
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10
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Locatelli F, Carfagna F, Del Vecchio L, La Milia V. Haemodialysis or haemodiafiltration: that is the question. Nephrol Dial Transplant 2018; 33:1896-1904. [DOI: 10.1093/ndt/gfy035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Francesco Locatelli
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital ASST Lecco, Lecco, Italy
| | - Fabio Carfagna
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital ASST Lecco, Lecco, Italy
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital ASST Lecco, Lecco, Italy
| | - Vincenzo La Milia
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital ASST Lecco, Lecco, Italy
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11
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Hulko M, Haug U, Gauss J, Boschetti-de-Fierro A, Beck W, Krause B. Requirements and Pitfalls of Dialyzer Sieving Coefficients Comparisons. Artif Organs 2018; 42:1164-1173. [PMID: 30281162 PMCID: PMC6585607 DOI: 10.1111/aor.13278] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/12/2022]
Abstract
Sieving coefficients reported in dialyzer data sheets and instructions for use (IFUs) indicate the potential of different solutes to pass across a particular membrane. Despite being measured in vitro, sieving coefficient data are often used as a predictor of the clinical performance of dialyzers. Although standards for the measurement of sieving coefficients exist, the stated methodologies do not offer sufficient guidance to ensure comparability of test results between different dialyzers. The aim of this work was to investigate the relationship between sieving coefficients and published clinical performance indicators for two solutes, albumin loss and beta‐2 microglobulin (β2M) reduction ratio (RR), and to assess the impact of different in vitro test parameters on sieving coefficient values for albumin, β2M, and myoglobin. Clinical albumin loss and β2M RR for commercially available dialyzers used in hemodialysis (HD) and post‐dilution hemodiafiltration (HDF) were extracted from the literature and plotted against sieving coefficients reported in data sheets and IFUs. Albumin, β2M, and myoglobin sieving coefficients of a selection of dialyzers were measured per the ISO 8637 standard. The impact of in vitro testing conditions was assessed by changing blood flow rate, ultrafiltration (UF) rate, sampling time, and origin of test plasma. Results showed variation in albumin loss and β2M RR for the same sieving coefficient across different dialyzers in HD and HDF. Changes in blood flow rates, UF rates, sampling time, and test plasma (bovine vs. human) caused marked differences in sieving coefficient values for all investigated solutes. When identical testing conditions were used, sieving coefficient values for the same dialyzer were reproducible. Testing conditions have a marked impact on the measurement of sieving coefficients, and values should not be compared unless identical conditions are used. Further, variability in observed clinical data in part reflects the lack of definition of test conditions.
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Affiliation(s)
| | - Ulrike Haug
- Research & Development, Baxter International Inc
| | - Julia Gauss
- Research & Development, Baxter International Inc
| | | | - Werner Beck
- Global Medical Affairs, Baxter International Inc., Hechingen, Germany
| | - Bernd Krause
- Research & Development, Baxter International Inc
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12
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The CKD plasma lipidome varies with disease severity and outcome. J Clin Lipidol 2018; 13:176-185.e8. [PMID: 30177483 DOI: 10.1016/j.jacl.2018.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/29/2018] [Accepted: 07/24/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Various alterations in lipid metabolism have been observed in patients with chronic kidney disease (CKD). OBJECTIVES To determine the levels of lipid species in plasma from CKD and hemodialysis (HD) patients and test their association with CKD severity and patient outcome. METHODS Seventy-seven patients with CKD stage 2 to HD were grouped into classes of CKD severity at baseline and followed-up for 3.5 years for the occurrence of transition to HD or death (combined outcome). Plasma levels of phosphatidylcholines (PCs), lysophosphatidylcholines (LPCs), sphingomyelins (SMs), and fatty acids were analyzed by flow-injection analysis coupled to tandem mass spectrometry or gas chromatography coupled with mass spectrometry. Kruskal Wallis rank tests and Cox regressions were used to analyze the association of lipids with CKD severity and the risk of combined outcome, respectively. RESULTS The plasma level of PCs, LPCs, and SMs was decreased in HD patients compared with nondialyzed CKD patients (all P < .05), whereas esterified and/or nonesterified fatty acids level did not change. Thirty-four lipids displayed significantly lower abundance in plasma of HD patients, whereas elaidic acid (C18:1ω9t) level was increased (P < .001). The total amount of LPCs and individual LPCs were associated with better outcome (P < .05). In particular, LPC 18:2 and LPC 20:3 were statistically associated with outcome in adjusted models (P < .05). DISCUSSION In HD patients, a reduction in plasma lipids is observed. Some of the alterations, namely reduced LPCs, were associated with the risk of adverse outcome. These changes could be related to metabolic dysfunctions.
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13
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14
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Gayrard N, Ficheux A, Duranton F, Guzman C, Szwarc I, Vetromile F, Cazevieille C, Brunet P, Servel MF, Argilés À, Le Quintrec M. Correction: Consequences of increasing convection onto patient care and protein removal in hemodialysis. PLoS One 2018; 13:e0190761. [PMID: 29293688 PMCID: PMC5749870 DOI: 10.1371/journal.pone.0190761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0171179.].
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15
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Roumelioti ME, Trietley G, Nolin TD, Ng YH, Xu Z, Alaini A, Figueroa R, Unruh ML, Argyropoulos CP. Beta-2 microglobulin clearance in high-flux dialysis and convective dialysis modalities: a meta-analysis of published studies. Nephrol Dial Transplant 2017; 33:1025-1039. [DOI: 10.1093/ndt/gfx311] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/04/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Maria-Eleni Roumelioti
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Gregory Trietley
- Department of Pharmacy and Therapeutics, Renal-Electrolyte Division, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
| | - Thomas D Nolin
- Department of Pharmacy and Therapeutics, Renal-Electrolyte Division, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
| | - Yue-Harn Ng
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Zhi Xu
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Ahmed Alaini
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rocio Figueroa
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Mark L Unruh
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
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Donadio C, Kanaki A, Sami N, Tognotti D. High-Flux Dialysis: Clinical, Biochemical, and Proteomic Comparison with Low-Flux Dialysis and On-Line Hemodiafiltration. Blood Purif 2017; 44:129-139. [PMID: 28571019 DOI: 10.1159/000476053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/24/2017] [Indexed: 11/19/2022]
Abstract
Hemodiafiltration on-line (on-line HDF) is a more efficient treatment than low-flux hemodialysis (HD). Unfortunately, it cannot be proposed to all patients. The aim of this study was to evaluate the safety, efficiency, and mechanisms of removal of toxins with high-flux HD vs. low-flux HD and on-line HDF. Randomized cross-over study designed to evaluate efficiency and tolerability of high-flux HD vs. low-flux HD in aged patients; to compare by means of biochemical and proteomic analyses the efficiency and mechanisms of removal of toxins with high-flux HD vs. on-line HDF. The removal of small toxins was similar with high-flux and low-flux HD. β2-microglobulin was removed only with high-flux HD, which had an excellent tolerability. The efficiency of high-flux HD was similar to on-line HDF. Proteomic analysis demonstrated that only high-flux membranes remove and adsorb small proteins. High-flux HD may be an efficient alternative to on-line HDF.
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Affiliation(s)
- Carlo Donadio
- Department of Clinical and Experimental Medicine, Division of Nephrology, University of Pisa, Istituto di Biofisica, CNR, Pisa, Italy
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