Development of Intermittent Infusion Hemodiafiltration Using Ultrapure Dialysis Fluid with an Automated Dialysis Machine

2013 ◽  
Vol 35 (s1) ◽  
pp. 55-58 ◽  
Author(s):  
Michio Mineshima ◽  
Kei Eguchi
Keyword(s):  
Intermittent Infusion ◽  
Dialysis Fluid

scholarly journals Clinical assessment of intermittent infusion hemodialysis (I-HD) using backfiltration of ultrapure dialysis fluid by an automated dialysis machine

2009 ◽  
Vol 42 (9) ◽  
pp. 695-703 ◽  
Author(s):  
Kei Eguchi ◽  
Masaki Miyao ◽  
Yushi Yamada ◽  
Yoshie Konno ◽  
Iwakazu Kaneko ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Intermittent Infusion ◽  
Dialysis Fluid

A Clinical Significance of Intermittent Infusion Hemodiafiltration Using Backfiltration of Ultrapure Dialysis Fluid Compared to Hemodialysis: A Multicenter Randomized Controlled Crossover Trial

2019 ◽  
Vol 48 (4) ◽  
pp. 368-381
Author(s):  
Michio Mineshima ◽  
Susumu Takahashi ◽  
Tadashi Tomo ◽  
Hideki Kawanishi ◽  
Hiroshi Kawaguchi ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Treatment Period ◽  
Clinical Significance ◽  
Intermittent Infusion ◽  
Dialysis Fluid ◽  
Removal Rates ◽  
Polysulfone Membrane ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Intermittent infusion hemodiafiltration ­(I-HDF) using repeated infusion of ultrapure dialysis fluid through a dialysis membrane or sterile nonpyrogenic substitution fluid was developed to prevent a rapid decrease in blood pressure by increasing the patient’s circulating blood volume, to enhance the plasma refilling rate by improving peripheral circulation, and to enhance solute transfer from the extravascular space to the intravascular space by enhancing the plasma refilling rate. Furthermore, the effect of fouling caused by attachment of proteins to the membrane as a result of ultrafiltration can be reduced by backflushing of the membrane with the purified dialysate in I-HDF. Although there have been several clinical trials of I-HDF, there have been no comparisons of the clinical significance of and indications for ­I-HDF with those of conventional hemodialysis (HD). Objective: The aim of this multicenter randomized controlled crossover trial was to compare the clinical significance of ­I-HDF with that of HD in Japan. Method: Patients were randomized to receive HD, I-HDF, and HD (group A) or I-HDF, HD, and I-HDF (group B) in that order for 14 weeks each. The sample size of 70 was determined based on the operability and patient availability. Treatment outcomes were evaluated 5 and 14 weeks after the start of each treatment period. The patients received 4-h treatment sessions with no changes in session duration or anticoagulant therapy during the study. I-HDF was performed using a GC-110N dialysis machine. Two hundred milliliters of ultrapure dialysis fluid were infused at a rate of 150 mL/min by backfiltration every 30 min during treatment. The first and last infusions were performed 30 min after the start and 30 min before the end of treatment, respectively. The total estimated infusion volume per session was 1.4 L (i.e., 200 mL × 7 infusions). I-HDF is a type of online HDF with a small fluid replacement volume. An ABH-P polysulfone membrane hemodiafilter was used for ­I-HDF and a class 1 or 2 hemodialyzer with a polysulfone membrane not coated with vitamin E and approved by the Japanese reimbursement system was used for HD. The primary outcomes were the Short Form-36 version 2 summary scores for quality of life and the visual analog scale scores for clinical symptoms. Secondary outcomes were vital signs, number of interventions, and pre-treatment blood test results. These variables were evaluated 1 week before at the start of the study, and at 5 and 14 weeks after the start of each treatment period. The removal characteristics of the various solutes were evaluated when possible on the first day of each treatment period. All patients provided written informed consent to participate. Results: Thirty-two patients in group A and 32 patients in group B completed the trial. There were no differences in the primary or secondary outcomes between I-HDF and HD. Serum α1-microglobulin (MG) levels at 14 weeks were significantly lower for I-HDF than for HD. During treatment, the removal rates for urea and creatinine, which are low molecular weight substances, were significantly lower during I-HDF than during HD. In contrast, the β2-MG and α1-MG removal rates were significantly higher during I-HDF than during HD. Furthermore, there was significantly less albumin leak during I-HDF than during HD. The solute removal results reflect the difference in pore size between the hemodiafilter used for I-HDF and the hemodialyzer used for HD and the difference in convective transport attributable to filtration between the 2 methods. Conclusions: These findings show that the removal rates of low molecular weight substances are significantly lower and those of medium to high molecular weight substances are significantly higher with I-HDF than with HD. They also indicate that there is significantly less albumin leak during I-HDF than during HD, meaning that I-HDF may be a particularly suitable dialysis modality for patients with malnutrition and the elderly in Japan.

Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 145-148 ◽  
Author(s):  
Paulo Cezar Fortes ◽  
Thyago Proença de Moraes ◽  
Jamille Godoy Mendes ◽  
Andrea E. Stinghen ◽  
Silvia Carreira Ribeiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Peritoneal Dialysis ◽  
Metabolic Disorders ◽  
Patient Survival ◽  
Metabolic Abnormalities ◽  
Dialysis Fluid ◽  
Altered Glucose ◽  
Insulin Homeostasis ◽  
Therapeutic Measures

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.

scholarly journals 1306. Comparison of the Use of Extended and Intermittent Infusion Cefepime and Piperacillin/tazobactam in Non-critically Ill, Obese Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S667
Author(s):  
Carolyn Marg ◽  
Zach DeLanoit ◽  
Kimberly D Boeser
Keyword(s):  
Clinical Success ◽  
Small Sample Size ◽  
Clinical Success Rate ◽  
Intermittent Infusion ◽  
Volume Of Distribution ◽  
Small Sample ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
Target Time ◽  
All Cause Mortality

Abstract Background Obesity rates have dramatically increased over the last several decades, however, there is limited data to guide how antibiotics should be adjusted in obese patients. Physiologic differences including an increased volume of distribution and increased renal clearance may alter their pharmacokinetics and pharmacodynamics and subsequently, their efficacy. For beta-lactams like piperacillin/tazobactam (pip/tazo) and cefepime, extended infusion (EI) maximizes the time above the minimum inhibitory concentration (MIC) for optimal bactericidal activity. This dosing strategy may help decrease variability in achieving the target time above MIC in this patient population and lead to more favorable outcomes. Methods This single-center, retrospective, pre-/post- analysis included patients with a body mass index (BMI) > 30 that received EI (infused over 4 hours) or intermittent infusion (II) (infused over 30 minutes) pip/tazo or cefepime between 2/1/2020-4/30/2020 and 2/1/2019-4/30/2019, respectively. The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included clinical success rate and hospital length of stay (LOS). Results During the evaluation periods, 98 patients met inclusion criteria (EI, N=53; II, N=45). Mean BMI was not statistically different between groups (EI, 36.0 kg/m2 [30.1-46.3]; II, 36.5 kg/m2 [30-48]). There were no cases of mortality in either group. The mean LOS in the II group was 13 days compared to 11.5 days in the EI group [95% CI -4.14-7.04; p=0.606]. After excluding one outlier of 104 days in the EI group, the average LOS was 9.5 days [95% CI: -0.87-7.33; p=0.121]. Markers of clinical success including time to resolution of fever (II: 47 hours; EI: 34 hours; p=0.216) and time to resolution of leukocytosis (II: 2 days; EI: 3.8 days; p=0.089) were not significantly different between groups. Conclusion The use of EI pip/tazo and cefepime was not associated with any differences in in-hospital, all-cause mortality, hospital LOS, or clinical success when compared to the use of II pip/tazo and cefepime. The lack of significant differences between groups may be attributable to the small sample size limiting the ability to detect a difference, especially regarding hospital LOS. Disclosures All Authors: No reported disclosures

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