Biocompatibility of Dialysis Fluid for Online HDF

Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.

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The Effect of a Nitric Oxide Inhibitor (L-Name) on Peritoneal Transport during Dialysis in Rats

Peritoneal Dialysis International ◽

10.1177/089686089801800208 ◽

1998 ◽

Vol 18 (2) ◽

pp. 188-192 ◽

Cited By ~ 11

Author(s):

Andrzej Breborowicz ◽

Katarzyna Wieczorowska Tobis ◽

Katarzyna Korybalska ◽

Alicja Polubinska ◽

Maciej Radkowski ◽

...

Keyword(s):

Nitric Oxide ◽

Peritoneal Dialysis ◽

Significant Decline ◽

Nitric Oxide Synthesis ◽

Dialysis Fluid ◽

Large Molecules ◽

Acute Peritonitis ◽

Important Mediator ◽

Peritoneal Transport ◽

Nitric Oxide Inhibitor

Objective To assess the effect of an inhibitor of nitric oxide synthesis [NG-nitro-L-arginine methyl ester (L-NAME)] on peritoneal transport during peritoneal dialysis (PD) and peritonitis in rats. Methods The authors studied peritoneal transport of small and large solutes, and net ultrafiltration (UF) in rats during PD with Dianeal 3.86 (Baxter, McGaw Park, IL, U.S.A.). They evaluated the effect of L-NAME used as an additive to dialysis fluid in concentrations 0.5 -5 mg/m L on peritoneal transport of small and large molecules and on transperitoneal UF. In addition, they studied the effect of L-NAME (5 mg/mL) during acute peritonitis induced by lipopolysaccharides (5 μg/mL) given intraperitoneally. Results The addition of L-NAME to dialysis fluid increased the selectivity of the peritoneum and net UF during dialysis. Lipopolysaccharides used as an additive to the dialysis fluid, together with L-NAME, did not induce changes in transperitoneal transport of small and large solutes and did not cause a significant decline in net UF. L-NAME given intraperitoneally reduced both local and systemic production of nitric oxide, which might explain its effects on peritoneal transport. Conclusions Nitric oxide is an important mediator of changes in peritoneal transport and its effect is especially significant during peritonitis.

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Safety Management of Dialysis Fluid in Japan: Important Duties and Responsibilities of Clinical Engineers

Blood Purification ◽

10.1159/000512349 ◽

2021 ◽

pp. 1-6

Author(s):

Masanori Shibata

Keyword(s):

Renal Failure ◽

Safety Management ◽

Standard Procedure ◽

Medical Personnel ◽

Maintenance Hemodialysis ◽

Dialysis Fluid ◽

Fluid Delivery ◽

Technical Ability ◽

Number Of Patients ◽

Clinical Engineers

Dialysis therapy is the predominant choice for renal failure in Japan, and almost 30% of the patients with renal failure have been treated for 10 years or more. Dialysis became the standard procedure to treat renal failure nationwide in the 1980s. However, at that time, managing the increased number of patients on maintenance hemodialysis as well as operating and maintaining the newly developed advanced medical technologies at extensive numbers of clinical sites proved problematic. To help address this, the clinical engineer system was established in 1987 and certain aspects of the clinical engineers’ role remain unique to Japan today. For the last 30 years, clinical engineers have worked as frontline medical personnel not only operating dialysis-related devices but also placing their hands directly on patients when providing care, routinely performing puncture, and administering drugs through the blood circuit under physicians’ instructions. As part of their work, they crucially maintain the use of central dialysis fluid delivery systems (CDDSs) – also unique to Japan – which prepare and deliver a large quantity of dialysis fluid through a central circuit to individual dialysis consoles. CDDSs are widely used because they effectively alleviated the early confusion at clinical sites caused by the rapidly increasing hemodialysis population and the serious shortage in medical personnel. Moreover, clinical engineers alone have the technical ability to provide safe dialysis fluids adjusted to strict standards at clinical sites. In this review article, we focus on the crucial roles that clinical engineers have in maintaining the safety of dialysis-related medical devices and the preparation and delivery of dialysis fluid at many dialysis facilities across the country.

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Replacement of acetate with citrate in dialysis fluid: a randomized clinical trial of short term safety and fluid biocompatibility

BMC Nephrology ◽

10.1186/1471-2369-14-216 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 31

Author(s):

Gunilla Grundström ◽

Anders Christensson ◽

Maria Alquist ◽

Lars-Göran Nilsson ◽

Mårten Segelmark

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Dialysis Fluid ◽

Short Term

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Guidance of Technical Management of Dialysis Water and Dialysis Fluid for the Japan Association for Clinical Engineering Technologists

Blood Purification ◽

10.1159/000213497 ◽

2009 ◽

Vol 27 (1) ◽

pp. 41-49 ◽

Cited By ~ 2

Author(s):

Tadayuki Kawasaki ◽

Junji Uchino ◽

Toshio Shinoda ◽

Hideki Kawanishi

Keyword(s):

Clinical Engineering ◽

Dialysis Fluid ◽

Technical Management ◽

Dialysis Water

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Newly Developed Neutralized pH Icodextrin Dialysis Fluid: Nonclinical Evaluation

Artificial Organs ◽

10.1111/aor.12783 ◽

2016 ◽

Vol 40 (8) ◽

pp. E158-E166 ◽

Cited By ~ 4

Author(s):

Naoya Yamaguchi ◽

Keiichi Miyamoto ◽

Tomohiro Murata ◽

Eiji Ishikawa ◽

Takashi Horiuchi

Keyword(s):

Dialysis Fluid

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Leakage of Endotoxins through the Endotoxin Retentive Filter: An in vitro Study

Blood Purification ◽

10.1159/000520792 ◽

2022 ◽

pp. 1-9

Author(s):

Hiroshi Nozaki ◽

Yoshihiro Tange ◽

Yoji Inada ◽

Takashi Uchino ◽

Nakanobu Azuma

Keyword(s):

Sodium Hypochlorite ◽

Peracetic Acid ◽

In Vitro Study ◽

Dialysis Fluid ◽

High Concentration ◽

Membrane Pores ◽

Polyether Sulfone ◽

Repeated Use ◽

High Concentrations

Introduction: Ultrapurification of dialysis fluid has enabled highly efficient dialysis treatments. Online hemodiafiltration is one such treatment that uses a purified dialysis fluid as a supplemental fluid. In this method, an endotoxin retentive filter (ETRF) is used in the final step of dialysis fluid purification, with the aim of preventing leakage of endotoxins. Sodium hypochlorite and peracetic acid are used as disinfecting agents for the dialysis fluid pipes containing the ETRF; however, the effects of these agents on ETRF membrane pores have not been fully clarified. Methods: Water permeability (flux) and endotoxin permeability were assessed in 3 types of ETRFs made with different membrane materials: polyester polymer alloy (PEPA), polyether sulfone (PES), and polysulfone (PS). High-concentration sodium hypochlorite and 2 types of peracetic acid were used as disinfecting agents, and the changes in flux and the endotoxin sieving coefficient (SC) were measured. Results: After repeated use of high concentrations of sodium hypochlorite and peracetic acid, the PEPA and PES ETRFs did not permit passage of endotoxins, regardless of their flux. However, in the PS ETRF, the flux and endotoxin SC increased with the number of cleaning cycles. No differences were observed according to the concentration of peracetic acid disinfecting agents. Conclusion: PEPA and PES ETRFs completely prevent endotoxin leakage and can be disinfected at concentrations higher than the conventionally recommended concentration without affecting pore expansion. Even new PS ETRFs have low levels of endotoxin leakage, which increase after disinfection cycles using sodium hypochlorite and peracetic acid.

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Peritoneal Dialysis

10.2310/nephro.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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