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Dialysis System (dialysis + system)

Distribution by Scientific Domains

Medical Sciences	88%

Selected Abstracts

Overproduction of reactive oxygen species in end-stage renal disease patients: A potential component of hemodialysis-associated inflammation

HEMODIALYSIS INTERNATIONAL, Issue 1 2005
Marion Morena
Abstract During the past decade, hemodialysis (HD)-induced inflammation has been linked to the development of long-term morbidity in end-stage renal disease (ESRD) patients on regular renal replacement therapy. Because interleukins and anaphylatoxins produced during HD sessions are potent activators for nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, an example of an enzyme that is responsible for overproduction of reactive oxygen species (ROS), this may constitute a link between leukocyte activation and cell or organ toxicity. Oxidative stress, which results from an imbalance between oxidant production and antioxidant defense mechanisms, has been documented in ESRD patients using lipid and/or protein oxidative markers. Characterization of HD-induced oxidative stress has included identification of potential activators for NADPH oxidase. Uremia per se could prime phagocyte oxidative burst. HD, far from improving the oxidative status, results in an enhancement of ROS owing to hemoincompatibility of the dialysis system, hemoreactivity of the membrane, and trace amounts of endotoxins in the dialysate. In addition, the HD process is associated with an impairment in antioxidant mechanisms. The resulting oxidative stress has been implicated in long-term complications including anemia, amyloidosis, accelerated atherosclerosis, and malnutrition. Prevention of oxidative stress in HD might focus on improving the hemocompatibility of the dialysis system, supplementation of deficient patients with antioxidants, and modulation of NADPH oxidase by pharmacologic approaches. [source]

Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience

LIVER INTERNATIONAL, Issue 6 2006
Alexander Chiu
Abstract: Background: The molecular adsorbent recirculating system (MARS) is an extracorporeal liver dialysis system that allows selective removal of bilirubin and other albumin-bound toxins. We reported here our experience with the use of this technique for management of liver failure at Queen Mary Hospital, Hong Kong. Methods: From December 2002 to 2004, a total of 74 MARS sessions were performed on 22 patients. The cause of liver failure included acute liver failure (n=2), acute on chronic liver failure (n=12), posthepatectomy liver failure (n=4), and posttransplantation allograft failure (n=4). Results: MARS treatment showed significant reduction in total bilirubin level, serum ammonia level and blood urea, and nitrogen (P<0.001 for all three parameters). Five patients (22.7%) were able to bridge to transplantation and one patient (4.5%) made a spontaneous recovery. The 30-day mortality rate was 72.7%. Conclusions: Our results indicated that MARS can effectively improve serum biochemistry and is suitable for temporarily supporting patients with liver failure where transplantation is not immediately available. There is, however, no clear evidence showing that MARS can increase survival, improve the chance of transplantation or assist liver regeneration. Future studies in the form of randomized-controlled trials are crucial to characterize the true potential of this treatment. [source]

Application of Molecular Adsorbent Recirculating System® in patients with severe liver failure after hepatic resection or transplantation: initial single-centre experiences

LIVER INTERNATIONAL, Issue 2002
R Kellersmann
Abstract: Acute liver failure after hepatic surgery is still plaqued with high mortality rate. Recently, a liver dialysis system (MARS®) that allows detoxification of albumin-bound substances and may hereby support liver regeneration and patient's recovery has been developed. In the present study, we report our experiences with MARS® dialysis in patients with liver failure after hepatic resection or transplantation. Between September 1999 and January 2001, five patients were treated with MARS® (2,5 courses). Though beneficial effects such as improvement of encephalopathy and renal function as well as reduced bilirubin levels were recorded during MARS® therapy, only one patient survived. Neither significant technical problems nor adverse effects occurred by using MARS® dialysis. We conclude that in surgical patients, acute liver failure is usually part of a complicated clinical course affecting multipleorgan systems. Thus, it is difficult to determine the specific influence of MARS® on patient's outcome. However, beneficial effects observed in our patients justify its continuous use and may stimulate further evaluation in controlled studies with surgical patients. [source]

Review article: albumin in the treatment of liver diseases,new features of a classical treatment

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2002
V Arroyo
Summary Albumin was introduced initially in the treatment of patients with cirrhosis and ascites to increase serum albumin concentration due to its oncotic effect. Although its administration declined some years later, at present it constitutes an essential treatment in clinical hepatology. Several studies have clearly demonstrated its efficacy in the prevention and treatment of circulatory dysfunction and hepatorenal syndrome in patients with cirrhosis. These effects can be due not only to its properties as a plasma expander but also to its capacity to bind numerous substances such as bile acids, nitric oxide and cytokines. Based on this capacity an albumin dialysis system (MARS) has recently been developed. The usefulness of this system in the management of patients with acute and chronic liver failure is, at present, under evaluation. [source]

Reduction-Sensitive Self-Aggregates as a Novel Delivery System

MACROMOLECULAR CHEMISTRY AND PHYSICS, Issue 8 2010
Ju Eun Kim
Abstract Methoxy PEG amine with molecular weight of 5k and , -caprolactone with molecular weight of 1,960 were conjugated to a peptide comprising three cysteine residues. The shift of peak molecular weight and narrow molecular weight distribution in GPC trace without any noticeable shoulder as well as 1H NMR analysis confirmed the successful synthesis of the copolymer. A modified O/W dialysis system was employed to prepare self-aggregates having the size around 210,nm. During the dialysis, stabilized aggregates were obtained by intermolecular disulfide bonds via oxidation. Critical aggregate concentration (CAC) of the copolymer was determined as 0.07,mg,·,mL,1 and disulfide-stabilized self-aggregates remained stable regardless of the concentration without displaying CAC. Doxorubicin-loading amount and efficiency was 8.7 and 26.0%, respectively. Release profile of doxorubicin below CAC at 37,°C showed a sustained release and the addition of D,L -dithiothreitol (DTT) after 24,h triggered a burst release of doxorubicin. Intermolecular disulfide bonds via oxidation stabilized the polymeric aggregates even in the diluted condition similar to that in the bloodstream and addition of DTT destabilized the aggregates to burst encapsulated doxorubicin in the reductive condition. [source]

Forward Osmosis Process for Dialysis Fluid Regeneration

ARTIFICIAL ORGANS, Issue 12 2009
Khaled Mohamed Talaat
Abstract In a preliminary experiment, 38% of the spent dialysis fluid water was reclaimed by a forward osmosis process through a cellulose triacetate membrane. The simplicity of forward osmosis and its minimal external energy requirements may allow the construction of a small bulk device that can reclaim a considerable portion of the water used in the patient's dialysis process. For developing an acceptable ambulatory dialysis system, decreasing the bulk of the fluid and equipment carried on the patient is essential. Forward osmosis may feasibly be used for dialysis fluid regeneration in ambulatory dialysis systems. [source]

Thermodynamic Considerations in Solid Adsorption of Bound Solutes for Patient Support in Liver Failure

ARTIFICIAL ORGANS, Issue 7 2008
John F. Patzer II
Abstract:, New detoxification modes of treatment for liver failure that use solid adsorbents to remove toxins bound to albumin in the patient bloodstream are entering clinical evaluations, frequently in head-to-head competition. While generally effective in reducing toxin concentration beyond that obtainable by conventional dialysis procedures, the solid adsorbent processes are largely the result of heuristic development. Understanding the principles and limitations inherent in competitive toxin binding, albumin versus solid adsorbent, will enhance the design process and, possibly, improve detoxification performance. An equilibrium thermodynamic analysis is presented for both the molecular adsorbent recirculating system (MARS) and fractionated plasma separation, adsorption, and dialysis system (Prometheus), two advanced systems with distinctly different operating modes but with similar equilibrium limitations. The Prometheus analysis also applies to two newer approaches: sorbent suspension reactor and microsphere-based detoxification system. Primary results from the thermodynamic analysis are that: (i) the solute,albumin binding constant is of minor importance to equilibrium once it exceeds about 105 L/mol; (ii) the Prometheus approach requires larger solid adsorbent columns than calculated by adsorbent solute capacity alone; and (iii) the albumin-containing recycle stream in the MARS approach is a major reservoir of removed toxin. A survey of published results indicates that MARS is operating under mass transfer control dictated by solute,albumin equilibrium in the recycle stream, and Prometheus is approaching equilibrium limits under current clinical protocols. [source]

1. The influence of peritoneal dialysis systems and solutions on the incidence of peritonitis and catheter-related infections

NEPHROLOGY, Issue S3 2004
Article first published online: 6 OCT 200
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