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Dialysis Fluid (dialysis + fluid)
Kinds of Dialysis Fluid Selected AbstractsSHORTNESS OF BREATH DURING DIALYSIS,A ROLE OF BICARBONATE IN DIALYSIS FLUID?JOURNAL OF RENAL CARE, Issue 1 2008Karen Latchford BSN SUMMARY Occasionally dialysis patients show symptoms that indicate intolerance in the way dialysis is delivered. This paper describes two cases of transient shortness of breath during the initial treatments after starting online haemodiafiltration (HDF). Our actions to deal with these symptoms focused on reducing the bicarbonate gain during the first phase of the dialysis treatment. As the symptoms gradually disappeared we hypothesise that the bicarbonate concentration in the dialysis fluid may play an important role for the development of shortness of breath and hypoxemia during HDF treatments. [source] Similarity of permeabilities for Ficoll, pullulan, charge-modified albumin and native albumin across the rat peritoneal membraneACTA PHYSIOLOGICA, Issue 4 2009D. Asgeirsson Abstract Aim:, Compared to neutral globular proteins, neutral polysaccharides, such as dextran, pullulan and Ficoll, appear hyperpermeable across the glomerular filtration barrier. This has been attributed to an increased flexibility and/or asymmetry of polysaccharides. The present study investigates whether polysaccharides are hyperpermeable also across the continuous capillaries in the rat peritoneum. Methods:, In anaesthetized Wistar rats, FITC,Ficoll or FITC,pullulan together with 125I-human serum albumin (RISA) or neutralized 125I-bovine serum albumin (nBSA) were given intravenously, after which peritoneal dialysis (PD) using conventional PD fluid (Gambrosol 1.5%) was performed for 120 min. Concentrations of FITC-polysaccharides and radioactive albumin species in plasma and dialysis fluid were analysed with high-performance size exclusion chromatography and a gamma counter respectively. Transperitoneal clearance values were calculated for polysaccharides in the molecular radius range 36,150 Å, and for RISA and nBSA. Results:, Ficoll and pullulan showed more or less identical permeabilities, compared to RISA and nBSA, across the peritoneal membrane. Although RISA-clearance, 5.50 ± 0.28 (,L min,1; ±SEM), tended to be lower than the clearances of Ficoll36Å (6.55 ± 0.25), pullulan36Å (6.08 ± 0.22) and nBSA (6.56 ± 0.23), the difference was not statistically significant. This is in contrast to the hyperpermeability exhibited by polysaccharides across the glomerular filtration barrier and also contrasts with the charge selectivity of the latter. Conclusion:, The phenomenon of molecular flexibility is more important for a macromolecule's permeability through the glomerular filter than across the continuous peritoneal capillary endothelium. Furthermore, it seems that charge plays a subordinate role in the steady-state transport across the combined peritoneal capillary,interstitial barrier. [source] Biofilm formation and changes in bacterial cell surface hydrophobicity during growth in a CAPD model systemJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 7 2004G. W. Hanlon Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD), with patients suffering recurrent attacks. The microorganisms most frequently implicated in the infection are the skin microflora, in particular, the coagulase-negative staphylococci such as Staphylococcus epidermidis. These microorganisms gain access to the peritoneal cavity via the in-dwelling silicone rubber catheter in the abdominal wall and often persist as biofilms on the surface of the catheter. The surface characteristics of S. epidermidis were monitored during growth in a CAPD in-vitro model together with their ability to adhere to silicone rubber substrata. Fresh dialysis fluid exerted an injurious effect on the cells leading to a decrease in cell numbers but during the simulated dialysis period the cells adapted to the applied stresses. Over a 96-h period in the model both a clinical isolate and a skin isolate of S. epidermidis adopted a more hydrophobic phenotype. The data presented here show that the bacteria grown in this in-vivo reflective CAPD model continually adapt to their environment and become more tolerant to the stresses imposed. The adapted cells were seen to colonise silicone rubber substrata. [source] SHORTNESS OF BREATH DURING DIALYSIS,A ROLE OF BICARBONATE IN DIALYSIS FLUID?JOURNAL OF RENAL CARE, Issue 1 2008Karen Latchford BSN SUMMARY Occasionally dialysis patients show symptoms that indicate intolerance in the way dialysis is delivered. This paper describes two cases of transient shortness of breath during the initial treatments after starting online haemodiafiltration (HDF). Our actions to deal with these symptoms focused on reducing the bicarbonate gain during the first phase of the dialysis treatment. As the symptoms gradually disappeared we hypothesise that the bicarbonate concentration in the dialysis fluid may play an important role for the development of shortness of breath and hypoxemia during HDF treatments. [source] Peritoneal mesothelial cells and the extracellular matrixNEPHROLOGY, Issue 6 2001Susan Yung SUMMARY: Continuous ambulatory peritoneal dialysis (CAPD) is an important treatment for patients with end-stage renal failure. Long-term success is dependent on the functional and structural integrity of the peritoneal membrane. Conventional peritoneal dialysis fluids are non-physiological. They contain glucose at high concentrations to provide the osmotic drive for ultrafiltration, lactate to correct the metabolic acidosis of renal failure, and a low pH to prevent caramelization of glucose during heat sterilization. These components, in isolation or acting together, exert adverse influences on both the resident cellular and extracellular elements of the peritoneal membrane, as well as phagocytic cells which infiltrate the peritoneum during inflammation, culminating in detrimental structural and functional effects, compromising the viability of the peritoneum during dialysis. Peritoneal biopsy studies of patients on long-term CAPD have demonstrated an intercellular space between adjacent mesothelial cells which allows the penetration of peritoneal dialysis fluid into the underlying submesothelium. This, together with episodes of peritonitis, can initiate a chronic inflammatory reaction within the peritoneum characterized by increased synthesis of matrix proteins. Perturbation of the regulatory mechanisms which govern the balance of synthesis and degradation of extracellular matrix can lead to progressive fibrosis. Human peritoneal mesothelial cells (HPMC) have been shown to synthesize fibronectin, laminin, collagens, proteoglycans and hyaluronan in vitro, and thus play a role in the pathogenesis of peritoneal fibrosis. This review will give an overview of extracellular matrix (ECM) synthesis by HPMC, how changes in the synthesis are affected by CAPD and postulate how these changes can compromise the dialytic properties of the peritoneum. [source] Computational Evaluation of Dialysis Fluid Flow in Dialyzers With Variously Designed JacketsARTIFICIAL ORGANS, Issue 6 2009Ken-ichiro Yamamoto Abstract Dialyzer performance strongly depends on the flow of blood and dialysis fluid as well as membrane performance. It is necessary, particularly to optimize dialysis fluid flow, to develop a highly efficient dialyzer. The objective of the present study is to evaluate by computational analysis the effects of dialyzer jacket baffle structure, taper angle, and taper length on dialysis fluid flow. We modeled 10 dialyzers of varying baffle angles (0, 30, 120, 240, and 360°) with and without tapers. We also modeled 30 dialyzers of varying taper lengths (0, 12.5, 25.0, and 50.0 mm) and angles (0, 2, 4, and 6°) based on technical data of APS-SA dialyzers having varying surface areas of 0.8, 1.5, and 2.5 m2 (Rexeed). Dialysis fluid flow velocity was calculated by the finite element method. The taper part was divided into 10 sections of varying fluid resistances. A pressure of 0 Pa was set at the dialysis fluid outlet, and a dialysis fluid flow rate of 500 mL/min at the dialysis fluid inlet. Water was used as the dialysis fluid in the computational analysis. Results for dialysis fluid flow velocity of the modeled dialyzers indicate that taper design and a fully surrounded baffle are important in making the dialysis fluid flow into a hollow-fiber bundle easily and uniformly. However, dialysis fluid flow channeling occurred particularly at the outflowing part with dialyzers having larger taper lengths and angles. Optimum design of dialysis jacket structure is essential to optimizing dialysis fluid flow and to increasing dialyzer performance. [source] Cytokine Induction in Patients Undergoing Regular Online Hemodiafiltration TreatmentARTIFICIAL ORGANS, Issue 7 2000Lajos Vaslaki Abstract: End-stage renal disease (ESRD) patients are known to suffer from chronic inflammation as the result of an ongoing subacute cytokine induction, which may contribute considerably to dialysis-related, long-term morbidity and mortality. Preparation of infusate from cytokine-inducing dialysis fluid and its administration in large quantities as well as the use of high-flux membranes bear the risk of aggravating the chronic inflammatory response among online hemodiafiltration (online HDF) patients. In order to assess the inflammatory risk associated with online HDF, we compared the cytokine induction profile of ESRD patients receiving either online HDF or low-flux hemodialysis (low-flux HD). Specifically, we measured spontaneous and lipopolysaccharide (LPS)-stimulated tumor necrosis factor , (TNF,) and interleukin-1 receptor antagonist (IL-1Ra) release during ex vivo incubation of whole blood. Ultrapure dialysis fluid and polysulfone membranes were used for both treatment modalities. LPS-stimulated release of TNF, and IL-1Ra was elevated for both online HDF and low-flux HD patients compared to healthy individuals (TNF,: 2,336 ± 346 and 2,192 ± 398 versus 1,218 ± 224 pg/106 white blood cells [WBC]; IL-1Ra: 2,410 ± 284 and 2,326 ± 186 versus 1,678 ± 219 pg/106 WBC). Likewise, spontaneous production of TNF,, but not IL-1Ra, was higher in online HDF and low-flux HD patients than in normal controls (37 ± 32 and 22 ± 19 versus 0.8 ± 0.3 pg TNF,/106 WBC). There was no difference in spontaneous and LPS-stimulated cytokine release between both dialysis groups. In addition, intradialytic cytokine induction was not significant for either treatment modality as spontaneous and LPS-stimulated cytokine release were not increased postdialysis. These findings indicate that online HDF does not contribute to chronic leukocyte activation and, consequently, does not place ESRD patients at greater risk with respect to inflammatory morbidity and mortality. [source] Microbubble-enriched lavage fluid for treatment of experimental peritonitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2008P. K. Sharma Background: Relaparotomies and closed postoperative peritoneal lavage (CPPL) are performed to treat persistent peritonitis. This experimental animal study compared open abdominal lavage with CPPL, and evaluated the potential of microbubble-enriched lavage fluids to improve the efficiency of CPPL and reduce clinical morbidity, mortality and cost. Methods: Fluorescent polystyrene spheres were injected intraperitoneally into 22 male Wistar rats to simulate localized peritonitis. After 18 h the rats received open abdominal lavage and CPPL, with and without microbubbles. Microbubbles were obtained by adding ultrasound contrast agents to continuous ambulatory peritoneal dialysis fluid. Results: Open abdominal lavage was 3·5 times more effective in particle removal than CPPL, owing to better fluid dynamics. The introduction of air,liquid interfaces in the form of microbubbles made CPPL up to 2·4 times more effective than lavage without bubbles. Best detachment results were obtained when microbubbles with a flexible surfactant shell and longer blood elimination half-life were used. Conclusion: Open abdominal and CPPL lavage techniques are not efficient beyond a certain duration and volume as they do not cause bacterial detachment from the peritoneal membrane. Using surface tension forces from microbubbles significantly enhanced polystyrene particle detachment. These findings may have great consequences for the treatment of patients with peritonitis. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Is it time to revisit residual renal function in haemodialysis? (Review Article)NEPHROLOGY, Issue 3 2007TSUN G NG SUMMARY: Residual renal function (RRF) is not currently emphasized for patients undergoing haemodialysis (HD). The role of RRF is well recognized in the peritoneal dialysis population as studies have clearly demonstrated a survival benefit with preservation of RRF. There is however, data to suggest that RRF is important in HD patients as well. Contemporary HD therapies using high flux biocompatible synthetic dialysers, bicarbonate buffered ultrapure dialysis fluids with ultrafiltration control appear to allow better preservation of RRF. The long held belief that peritoneal dialysis is better at preserving RRF than HD may no longer be true. More robust studies are required to determine the relative importance of RRF in HD and strategies to best preserve this vital asset. [source] Peritoneal mesothelial cells and the extracellular matrixNEPHROLOGY, Issue 6 2001Susan Yung SUMMARY: Continuous ambulatory peritoneal dialysis (CAPD) is an important treatment for patients with end-stage renal failure. Long-term success is dependent on the functional and structural integrity of the peritoneal membrane. Conventional peritoneal dialysis fluids are non-physiological. They contain glucose at high concentrations to provide the osmotic drive for ultrafiltration, lactate to correct the metabolic acidosis of renal failure, and a low pH to prevent caramelization of glucose during heat sterilization. These components, in isolation or acting together, exert adverse influences on both the resident cellular and extracellular elements of the peritoneal membrane, as well as phagocytic cells which infiltrate the peritoneum during inflammation, culminating in detrimental structural and functional effects, compromising the viability of the peritoneum during dialysis. Peritoneal biopsy studies of patients on long-term CAPD have demonstrated an intercellular space between adjacent mesothelial cells which allows the penetration of peritoneal dialysis fluid into the underlying submesothelium. This, together with episodes of peritonitis, can initiate a chronic inflammatory reaction within the peritoneum characterized by increased synthesis of matrix proteins. Perturbation of the regulatory mechanisms which govern the balance of synthesis and degradation of extracellular matrix can lead to progressive fibrosis. Human peritoneal mesothelial cells (HPMC) have been shown to synthesize fibronectin, laminin, collagens, proteoglycans and hyaluronan in vitro, and thus play a role in the pathogenesis of peritoneal fibrosis. This review will give an overview of extracellular matrix (ECM) synthesis by HPMC, how changes in the synthesis are affected by CAPD and postulate how these changes can compromise the dialytic properties of the peritoneum. [source] Induction of Metallothionein in Mesothelial Cells by ZincARTIFICIAL ORGANS, Issue 6 2007Dominik M. Alscher Abstract:, Patients on peritoneal dialysis (PD) are exposed to peritoneal dialysis fluids with unphysiological properties. Local defense systems are of importance. In this respect, metallothionein (MT) might play an important role. Because nothing is known about the achievability of MT induction in peritoneum by zinc, we performed the following study. We investigated human peritoneal mesothelial cells (HPMC) from omentum and a mesothelioma cell (MTC) line after addition of zinc in concentrations from 35 to 350 µM. Measurements of MT-mRNA and protein (by immuncytochemistry [IHC], Western blots, and dot blots) were performed. Zinc caused a clear and highly significant fourfold increase of RNA in MTC and to a lower extent in HPMC (1.6-fold, P < 0.001). IHC demonstrated a clear induction in HPMC and MTC. Western and dot blots confirmed this and showed an increase of MT from 112-mg/g total protein (TP) to 410-mg/g TP. Zinc was able to upregulate MT significantly in HPMC and MTC on the RNA and protein level. Fourfold increases of MT were achievable. [source] Stimulated IFN, and IL-10 Secretion of Blood Mononuclear Cells in Patients on Renal Replacement Therapies Show Different Secretion PatternsARTIFICIAL ORGANS, Issue 10 2000Dominik Mark Alscher Abstract: Infection is still a leading cause of morbidity and mortality in patients on renal replacement therapy (RRT). Although the role of the immune system is of great importance, little is known about the influence of the mode of RRT to the preferential excretions of regulator cytokines of mononuclear cells. Therefore, we investigated the stimulated IFN, (Th1) and IL-10 (Th2) secretions of mononuclear cells from patients on RRT. Blood was drawn from 10 controls, 15 patients on hemodialysis (HD), 15 on peritoneal dialysis (PD), and 10 after kidney transplantation (Tx). The cells were separated, and phytohemagglutinine (PHA) was added for stimulation. After 0, 6, and 24 h, IFN, and IL-10 (pg/ml) were measured by enzyme-linked immunosorbent assay. IFN, secretion was significantly enhanced 6 (p < 0.001) and 24 h (p = 0.002) after stimulation in all groups (in mean ± SEM). The analysis of the subgroups 6 h after adding PHA showed significant differences (p = 0.0239) with the lowest IFN, in Tx (16 ± 5) and the highest in PD (79 ± 30). For IL-10, secretion was enhanced in all groups 6 h after stimulation (p < 0.0116). The lowest secretions were seen in HD (18 ± 8) and controls (27 ± 9); the highest secretions were in Tx (98 ± 20) and PD (57 ± 12). The differences between HD and Tx (p < 0.01) and HD versus PD (p = 0.05) were significant. The stimulated cytokine secretion of blood mononuclear cells is preserved with RRT. The modes of RRT could influence the pattern of cytokine secretion. Surprisingly, the cells from patients on PD showed enhanced IL-10 secretion compared to HD. Presumably, this is due to the chronic contact of peritoneal dialysis fluids with monocytes and the lymphatic system in PD. [source] | ||||||||||