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Endotoxin filter in hemodialysis

Bernard Canaud, Jörg Vienken, Stephen Ash, Richard A Ward
Hemodiafiltration combines diffusive and convective solute removal in a single therapy by ultrafiltering 20% or more of the blood volume processed using a high-flux hemodialyzer and maintaining fluid balance by infusing sterile nonpyrogenic replacement fluid directly into the patient's blood. In online hemodiafiltration, the large volumes of replacement fluid required are obtained by online filtration of standard dialysate through a series of bacteria- and endotoxin-retaining filters. Currently available systems for online hemodiafiltration are on the basis of conventional dialysis machines with added features to safely prepare and infuse replacement fluid and closely control fluid balance...
March 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Anthony Valeri, Bobby Lee, John Duffy, Robin Ferrer, Ronald Vilotta
Installation of the Nephros Dual Stage Ultrafilter (DSU) added to a conventional hemodialysis unit to achieve ultrapure dialysate was tested in a group of 23 stable outpatients on chronic hemodialysis. Comparing the 6-month period prior to the installation of the filters (as baseline) to the 6-month period after the installation of the filters, we found a significant 40% reduction in the darbepoetin dose needed to maintain a stable hemoglobin level (p < 0.001). In addition, surrogate inflammatory markers, WBC count and serum albumin level, showed small but statistically significant improvements (p = 0...
January 2016: Case Reports in Nephrology and Dialysis
Tohid F Didar, Mark J Cartwright, Martin Rottman, Amanda R Graveline, Nazita Gamini, Alexander L Watters, Daniel C Leslie, Tadanori Mammoto, Melissa J Rodas, Joo H Kang, Anna Waterhouse, Benjamin T Seiler, Patrick Lombardo, Elisabet I Qendro, Michael Super, Donald E Ingber
Here we describe development of an extracorporeal hemoadsorption device for sepsis therapy that employs commercially available polysulfone or polyethersulfone hollow fiber filters similar to those used clinically for hemodialysis, covalently coated with a genetically engineered form of the human opsonin Mannose Binding Lectin linked to an Fc domain (FcMBL) that can cleanse a broad range of pathogens and endotoxin from flowing blood without having to first determine their identity. When tested with human whole blood in vitro, the FcMBL hemoadsorption filter (FcMBL-HF) produced efficient (90-99%) removal of Gram negative (Escherichia coli) and positive (Staphylococcus aureus) bacteria, fungi (Candida albicans) and lipopolysaccharide (LPS)-endotoxin...
October 2015: Biomaterials
Tomotaka Naramura, Toru Hyodo, Kenichi Kokubo, Hirokazu Matsubara, Haruki Wakai, Fumitaka Nakajima, Nobuhisa Shibahara, Kazunari Yoshida, Yoshinori Komaru, Hideki Kawanishi, Akio Kawamura, Hideo Hidai, Shingo Takesawa
BACKGROUND: The number of dialysis patients has been increasing in Southeast Asia, but statistical data about these patients and on the quality of dialysates in Southeast Asian dialysis facilities are still imprecise. For this study, dialysis-related statistical data were collected in Southeast Asia. METHODS: A survey of the quality of dialysates was carried out at 4 dialysis facilities in Vietnam and Cambodia. The dialysis patient survey included the numbers of dialysis facilities and patients receiving dialysis, a ranking of underlying diseases causing the initiation of dialysis, the number of patients receiving hemodialysis (HD)/on-line hemodiafiltration/continuous ambulatory peritoneal dialysis, the number of HD monitoring devices installed, the cost of each session of dialysis (in USD), the percentage of out-of-pocket payments, and the 1-year survival rates of the dialysis patients (in percent)...
January 2014: Nephron Extra
V Corradi, D Cruz, A Vázquez-Rangel, F Furlan, R Grillone, A Bonaccorsi, S Cazzavillan, M de Cal, P Frisone, A Morea, A Brendolan, M Rassu, C Ronco
BACKGROUND/AIMS: Previous studies have suggested that online hemodiafiltration (OL-HDF) fluid can be used as dialysate for continuous renal replacement therapies, and thus HDF costs can be reduced. The aims of this study were to determine the purity of OL-HDF fluid and to verify the stability of the electrolyte composition and acid-base balance during its storage. METHODS: OL-HDF fluid was collected in 70 individual bags and stored for up to 7 days. The following tests were performed daily in 10 bags: natural visible precipitation (macrocrystallization), sample collection for chemical analysis and fluid culture, limulus amebocyte lysate endotoxin test, standard culture of NALGENE® filters after passing of the fluid, and molecular analysis of bacterial DNA...
2013: Blood Purification
Tetsuya Kashiwagi, Kazuto Sato, Seiko Kawakami, Masayoshi Kiyomoto, Hiroyuki Takei, Tatsuya Suzuki, Hirokazu Genei, Hiroaki Nakata, Yasuhiko Iino, Yasuo Katayama
BACKGROUND: Hemodialysis is a method for removing uremic toxins and water directly from the blood into a dialysis fluid through an artificial semipermeable membrane called a dialyzer. The ability of the dialyzer to remove uremic toxins has steadily improved, but the likelihood has also increased that bioactive substances, such as bacterial endotoxin (ET) fragments, can be transferred from the dialysis fluid into the patient's blood through the phenomena of back-diffusion and back-filtration in the dialyzer...
2011: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
I Akhmouch, M Asserraji, A Bahadi, E Bouaiti, M Alayoude, T Aatif, M A Hamzi, H Kawtar, M Allam, Z Oualim
The quality of the water used for dialysis has been suggested as a factor causing inflammation in patients on hemodialysis (HD). We therefore conducted this study to identify the effect of quality of the water on nutritional state, inflammation and need for human recombinant erythropoietin (EPO) in patients undergoing HD at Agadir, Morocco. This prospective study included patients on HD for at least one year. The water treatment was done according to the standard protocol, which was followed by additional enhancement of ultrafiltration using an additional polysulfone filter (diasafe, Fresenius, Bad Homburg, Germany) before the dialyser...
May 2011: Saudi Journal of Kidney Diseases and Transplantation
Helmut Schiffl
Currently, high-flux hemodialysis is the most common mode of dialysis therapy worldwide. Its steadily increasing use is largely based on the desire to reduce the excessively high morbidity and mortality of end-stage renal disease patients maintained on conventional dialysis (low-flux, mostly cellulosic membranes) by offering better biocompatibility and enhanced removal of uremic toxins. Two large randomized trials suggest a survival benefit for selected subgroups of high-flux dialysis patients such as diabetics, patients with hypoalbuminemia, or patients who have been on dialysis for a long period (>3...
January 2011: Seminars in Dialysis
M Takatori, M Yamaoka, S Nogami, K Ojima, T Masuda, S Takeuchi, K Tada
We developed an online continuous hemodiafiltration (CHDF) system with a central reverse osmosis (RO) fluid delivery system in 1996. This was improved to a system composed of a single-patient dialysis machine and RO module in 2003. This comprises a water treatment system, an RO module, a dialysis machine with 3 endotoxin retentive filters, 2 additional roller pump units, and a disposable special circuit. Dialysate is produced online by a dialysis machine using RO water and dialysate concentrate, which passes through endotoxin retentive filters and is supplied via the machine in the usual manner...
2010: Contributions to Nephrology
Silvia Gramaticopolo, Alexandra Chronopoulos, Pasquale Piccinni, Federico Nalesso, Alessandra Brendolan, Monica Zanella, Dinna N Cruz, Claudio Ronco
Extracorporeal therapies are able to sustain life through different mechanisms. This approach, called multiple organ support therapy, can in fact obtain blood purification by hemodialysis/hemofiltration to replace kidney function, temperature control, electrolyte and acid-base control to mimic homeostatic regulation of the kidney and circulation, fluid balance control to support the right hydration and cardiac performance, cardiac support removing cardiodepressant substances and equilibrating potassium levels, blood detoxification and liver support by coupled plasma filtration and adsorption or direct adsorption on blood (hemoperfusion), immunomodulation and endothelial support in the presence of sepsis by cutting the peaks of pro- and anti-inflammatory mediators, and immunoadsorption or adsorption of specific substances such as endotoxin...
2010: Contributions to Nephrology
Sang-Woong Han, Joo-Hark Yi, Ho-Jung Kim
So far, less than 10% of hemodialysis (HD) facilities in Korea have adopted a kind of central delivery system (CDS) for dialysates, the so-called Korean central concentrate delivery system (CCDS). In our CCDS, all concentrate solutions of the acid and bicarbonate dry powder mixed with the treated reverse osmosis (RO) water in the mixing tank and stored in the holding tank are centrally delivered to individual HD machines via two streams along with a one further stream for dilution RO water. This mode of Korean CCDS is different from the central dialysate delivery system (CDDS), which uses already fully proportioned acid and bicarbonate concentrates with dilution RO water delivering it via a single stream...
2009: Blood Purification
Tadashi Tomo, Tosiho Shinoda
The central dialysis fluid delivery system (CDDS) has been mainly used for hemodialysis therapy in Japan. Validation and a parametric method are necessary for the quality control of dialysis fluid in CDDS. Validation is a concept for the assurance of system compatibility and product quality, and is defined as follows: the manufacturing and quality control methods including the system design and equipment of the manufacturing facility, manufacturing procedure and processes. Confirmed results must be kept within acceptable limits and they must be documented in a record...
2009: Blood Purification
Yutaka Koda, Michio Mineshima
The central dialysis fluid delivery system (CDDS) has been working exclusively in Japan since 1970, a fact which proves that CDDS is useful in the multi-patient treatment with in-center regular hemodialysis. It is a cost-effective, labor-saving and time-tested system with 40 years of experience. Microbial safety is improved by a refined system design, multiple endotoxin retentive filters (ETRF) and daily overnight disinfection of the entire system. Consequently, the usage of backfiltered dialysate is now accepted by regulatory authorities in some bedside consoles and even more the creation of dialysate is possible for infusion to meet its requirements...
2009: Blood Purification
Ingrid Ledebo
When dialysis became a chronic therapy, certain clinical symptoms could be connected to the fluid quality and some form of water treatment had to be introduced. The required equipment was empirically developed and consisted of sedimentation filters, carbon filters and softeners. In the mid-1970s the toxic effect of aluminum accumulation was discovered and led to the introduction of reverse osmosis modules. When these components - prefilters, softeners and RO modules - are properly maintained, they produce water of a quality that should meet modern standards...
2009: Blood Purification
Ikuto Masakane, Yoshiaki Takemoto, Shigeru Nakai, Yoshiharu Tsubakihara, Takashi Akiba, Yuzo Watanabe, Kunitoshi Iseki
The Japanese Society for Dialysis Therapy (JSDT) surveyed all dialysis facilities for bacteriological quality of dialysis fluid and quality controls for dialysis fluid in 2006 and 2007. The JSDT collected the data for endotoxin (ET) levels, bacterial count and usage of ET retentive filters (ETRF). The JSDT standard for ET level in dialysis fluid (<0.050 EU/ml) was achieved in 89.0% in 2006 and in 93.6% in 2007. The JSDT standard for bacterial cell counts in dialysis fluid (<100 cfu/ml) was achieved in 96...
2009: Blood Purification
Hirokazu Honda, Hiroki Suzuki, Nozomu Hosaka, Yuki Hirai, Daisuke Sanada, Mari Nakamura, Hisako Nagai, Eijin Ashikaga, Kei Matsumoto, Masanori Mukai, Makoto Watanabe, Tadao Akizawa
BACKGROUND: Ultrapure dialysate (UD) might contribute to improvements in the morbidity and mortality of hemodialysis (HD) patients. However, it is unclear whether increasing dialysate purity affects chronic inflammation, oxidative stress, and lipid abnormalities. METHODS: In a prospective cohort study, 126 patients undergoing maintenance HD using conventional dialysate (CD) with one endotoxin cut filter were assigned to either continuation of the same HD or HD using UD (more purified dialysate)...
2009: Blood Purification
Rosemary Ouseph, Richard A Ward
Use of ultrapure dialysate (bacteria < 0.1 CFU/mL and endotoxin < 0.03 EU/mL) is associated with a reduction in inflammation and morbidity in patients treated with conventional thrice-weekly dialysis. The improved outcomes obtained with more frequent dialysis schedules have reawakened interest in home hemodialysis. More frequent dialysis also appears to reduce inflammation, and whether combining more frequent dialysis with use of ultrapure dialysate will have an additive effect on inflammation and its consequences remains unclear...
July 2007: Advances in Chronic Kidney Disease
A Stragier
The quality of dialysis fluids has become increasingly important in the treatment of HD patients. Purified water represents over 95% of its volume. Bacterial and endotoxin content of Reverse Osmosis (RO) water is usually kept under control by bacterial filters, inserted in the distribution departure loop, and by monthly disinfection of the distribution circuit; the simpler the circuit, the better. This paper reports 12 years experience during which Ultraviolet Irradiation (UV) has replaced bacterial filters...
October 2005: EDTNA/ERCA Journal
G Pontoriero, P Pozzoni, F Tentori, P Scaravilli, F Locatelli
Water treatment systems must be submitted to maintenance, disinfections and monitoring periodically. The aim of this review is to analyze how these processes must complement each other in order to preserve the efficiency of the system and optimize the dialysis fluid quality. The correct working of the preparatory process (pre-treatment) and the final phase of depuration (reverse osmosis) of the system need a periodic preventive maintenance and the regular substitution of worn or exhausted components (i.e. the salt of softeners' brine tank, cartridge filters, activated carbon of carbon tanks) by a competent and trained staff...
November 2005: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
A Stragier, M Jadoul
AIMS: The use of ultrapure dialysate decreases hemodialysis patients' morbidity. Bacterial and endotoxin content of reverse osmosis (RO) water is usually lowered or eliminated by a combination of bacterial filtration and regular disinfection of the distribution. Whether bacterial filtration may be replaced by UV irradiation is unknown. MATERIALS AND METHODS: One, and subsequently two UV lamps were inserted in a complex RO water distribution circuit, devoid of bacterial filters...
January 2005: Clinical Nephrology
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