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Per Jonsson, Lorentz Lindmark, Jan Axelsson, Lars Karlsson, Lennart Lundberg, Bernd Stegmayr
We were encouraged to investigate the reasons for large amounts of foam observed in bloodlines during hemodialysis (HD). Foam was visible in the venous air trap within the Artis Gambro dialysis device. Estimates of the extent of foam were graded (0-no foam, 10-extensive foam) by two persons that were blind to the type of dialyzer used. Thirty-seven patients were involved in the dialysis procedures. Consecutive dialyses were graded using dialyzers from Fresenius Medical Care (CorDiax dialyzers that were used for high flux HD-FX80 and FX100, and for hemodiafiltration-FX1000)...
March 15, 2018: Artificial Organs
Randall Hoover, Harry Alcorn, Laura Lawrence, Susan K Paulson, Megan Quintas, Sue K Cammarata
This was an open-label, parallel-group, crossover study that examined the pharmacokinetics and safety of delafloxacin, an anionic fluoroquinolone, after a single intravenous infusion in subjects with end-stage renal disease (ESRD; creatinine clearance <15 mL/min) undergoing hemodialysis compared with healthy subjects. Subjects received 300 mg delafloxacin containing sulfobutylether-β-cyclodextrin in 2 periods separated by ≥14-day washouts. Blood and urine samples were collected, and pharmacokinetic parameters were calculated using noncompartmental methods...
March 14, 2018: Journal of Clinical Pharmacology
Benjamin Wu, Murad Melhem, Raju Subramanian, Ping Chen, Bethlyn Jaramilla Sloey, Bruno Fouqueray, M Benjamin Hock, Gary L Skiles, Andrew T Chow, Edward Lee
Etelcalcetide, a d-amino acid peptide, is an intravenous calcimimetic approved for the treatment of secondary hyperparathyroidism. Etelcalcetide binds the calcium-sensing receptor and increases its sensitivity to extracellular calcium, thereby decreasing secretion of parathyroid hormone (PTH) by chief cells. Etelcalcetide and its low-molecular-weight transformation products are rapidly cleared by renal excretion in healthy subjects, but clearance is substantially reduced and dependent on hemodialysis in end-stage renal disease...
March 13, 2018: Journal of Clinical Pharmacology
Shuyu Zhan, Baoyue Ding, Yu-Er Ruan, Xuan Huang, Guoqiang Liu, Xiaoqing Lv, Xiong Huang, Mingjuan Li, Ninghua Jiang, Qing Shao
Microdialysis is a powerful in vivo sampling technique for pharmacokinetic-pharmacodynamic (PK-PD) modeling of drugs in pre-clinical and clinical studies. However, the noticeable limitations of previous studies using microdialysis were that animals anesthesia in the whole experiment and the combination of microdialysis and blood sampling for drug and (or) effect detection, which can obviously influence PK and PD behavior of drugs. In this study, a simple blood microdialysis sampling system in freely-moving rats was established for simultaneous study of PK and PD of Shengmai injection (SMI) effect on inducing real-time nitric oxide (NO) release on isoproterenol (ISO) induced myocardial ischemia rats...
March 9, 2018: Journal of Pharmaceutical and Biomedical Analysis
Daniel Elbaum, Maria G Beconi, Edith Monteagudo, Annalise Di Marco, Maria S Quinton, Kathryn A Lyons, Andrew Vaino, Steven Harper
In cells, phosphorylation of pantothenic acid to generate phosphopantothenic acid by the pantothenate kinase enzymes is the first step in coenzyme A synthesis. Pantothenate kinase 2, the isoform localized in neuronal cell mitochondria, is dysfunctional in patients with pantothenate kinase-associated neurodegeneration. Fosmetpantotenate is a phosphopantothenic acid prodrug in clinical development for treatment of pantothenate kinase-associated neurodegeneration, which aims to replenish phosphopantothenic acid in patients...
2018: PloS One
Alvin Tieu, Thomas J Velenosi, Andrew S Kucey, Matthew A Weir, Bradley L Urquhart
BACKGROUND AND OBJECTIVES: There is a paucity of data available to describe drug dialyzability. Of the available information, most was obtained before implementation of modern hemodialysis membranes. Our study characterized dialyzability of the most commonly prescribed β -blockers in patients undergoing high-flux hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients on hemodialysis ( n =8) were recruited to an open label, pharmacokinetic, four-way crossover trial...
March 8, 2018: Clinical Journal of the American Society of Nephrology: CJASN
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
Pan Fang, Jia Lu, Ying-Hong Liu, Hong-Mei Deng, Lei Zhang, Hong-Qing Zhang
BACKGROUND: Peritonitis, which is one of the leading complications of peritoneal dialysis (PD) worldwide, severely affected morbidity and mortality of the PD patients. Although many efforts have been made to prevent PD-related peritonitis, it seems impossible to prevent it completely. Many causes have been reported to lead to peritonitis, and contamination during bag exchange is one of the important risk factors for peritonitis. METHODS: Here, we introduce an operating vehicle, which we invented to provide a sterile and safe space for bag exchange...
March 5, 2018: International Urology and Nephrology
Bing-Xin Xiao, Jie Dong, Mingzhu Yan, Yun Liu, Yanli Li, Guangsheng Yang, Zengxian Sun
Pueraria lobata is a medicinal plant widely used in traditional Chinese medicine. The total pueraria isoflavones have been demonstrated positive effect against neurological disorders. In present study, we firstly develop an ultra high performance liquid chromatography and tandem mass spectrometry method to quantify the multiple active pueraria isoflavonoids and neuro-chemical markers in brain dialysate to provide tools for further exploring the functional mechanism of pueraria isoflavones for neuro-activities...
February 27, 2018: Journal of Separation Science
Kamonwan Tangvoraphonkchai, Andrew Davenport
The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration...
February 26, 2018: Hemodialysis International
Raphael Henn, Christian G Kirchler, Zora L Schirmeister, Andreas Roth, Werner Mäntele, Christian W Huck
Blood constituents such as urea, glucose, lactate, phosphate and creatinine are of high relevance in monitoring the process of detoxification in ambulant dialysis treatment. In the present work two different vibrational spectroscopic techniques are used to determine those molecules quantitatively in artificial dialysate solutions. The goal of the study is to compare the performance of near- and mid-infrared spectroscopy in hyphenation with Partial Least Squares Regression directly by using the same sample set...
February 26, 2018: Journal of Biophotonics
Esther R van de Wal-Visscher, Jeroen P Kooman, Frank M van der Sande
BACKGROUND: Magnesium (Mg) is an essential cation for multiple processes in the body. The kidney plays a major role in regulating the Mg balance. In a healthy individual, total-body Mg content is kept constant by interactions among intestine, bones and the kidneys. SUMMARY: In case of chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal Mg absorption. Usually Mg remains normal; however, when glomerular filtration rate declines, changes in serum Mg are observed...
January 26, 2018: Blood Purification
Frank M van der Sande, Marijke J Dekker, Karel M L Leunissen, Jeroen P Kooman
BACKGROUND: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. SUMMARY: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia...
January 26, 2018: Blood Purification
Joanne M Bargman, Michael Girsberger
BACKGROUND: Peritoneal dialysis (PD) is one of the corner stones of renal replacement therapy and should be strongly considered if preemptive kidney transplantation is not available. SUMMARY: There are several initiatives that may help the growth in the use of PD around the world. First, PD is an underused and valuable option in patients with heart failure and the chronic cardiorenal syndrome, especially in those with frequent hospitalizations despite optimal medical therapy...
January 26, 2018: Blood Purification
Aleksey Etinger, Kumar, William Ackley, Leland Soiefer, Jonathan Chun, Prabjhot Singh, Eric Grossman, Albert Matalon, Robert S Holzman, Bjorn Meijers, Jerome Lowenstein
BACKGROUND: There is growing evidence that the accumulation of protein- bound uremic retention solutes, such as indoxyl sulfate, p-cresyl sulfate and kynurenic acid, play a role in the accelerated cardiovascular disease seen in patients undergoing chronic hemodialysis. Protein-binding, presumably to albumin, renders these solutes poor-dialyzable. We previously observed that the free fraction of indoxyl sulfate was markedly reduced at the end of hemodialysis. We hypothesized that solute binding might be pH-dependent and attributed the changes in free solute concentration to the higher serum pH observed at the end of standard hemodialysis with dialysis buffer bicarbonate concentration greater than 35 mmol/L...
2018: PloS One
Adrianna Douvris, Gurpreet Malhi, Swapnil Hiremath, Lauralyn McIntyre, Samuel A Silver, Sean M Bagshaw, Ron Wald, Claudio Ronco, Lindsey Sikora, Catherine Weber, Edward G Clark
BACKGROUND: Hemodynamic instability related to renal replacement therapy (HIRRT) may increase the risk of death and limit renal recovery. Studies in end-stage renal disease populations on maintenance hemodialysis suggest that some renal replacement therapy (RRT)-related interventions (e.g., cool dialysate) may reduce the occurrence of HIRRT, but less is known about interventions to prevent HIRRT in critically ill patients receiving RRT for acute kidney injury (AKI). We sought to evaluate the effectiveness of RRT-related interventions for reducing HIRRT in such patients across RRT modalities...
February 22, 2018: Critical Care: the Official Journal of the Critical Care Forum
Dahai Yu, Yamei Cai, Rui Qin, Xing Tian, Jing Xiao, Zhanzheng Zhao
BACKGROUND/AIMS: During peritoneal equilibrium test (PET), intermediate measures of Dt/P (dialysate/plasma creatinine ratio), D0/P, D2/P and D4/P ratios might provide additional information regarding a patient's cardiovascular mortality. We aimed to characterise heterogeneity of dialysate creatinine response patterns based on three ratios and compare cardiovascular mortality risks by response patterns. METHODS: 3,477 patients initialising peritoneal dialysis (PD) between 2007-2015 were measured D0/P, D2/P and D4/P at baseline and 2-year cardiovascular mortality was defined as the primary outcome...
February 16, 2018: Kidney & Blood Pressure Research
Beatrise Berzina, Robbyn K Anand
To improve the health of patients with end-stage renal disease, there is a clear need for slow, continuous hemodialysis, and the pri-mary barrier to a wearable device is the requirement of a large reservoir of dialysate. We describe an electrokinetic means of produc-ing dialysate from the excess fluid extent in the peripheral blood of patients undergoing therapy. A critical feature of this process is the retention of essential components of blood - especially serum albumin. In progress towards this goal, we demonstrate the sepa-ration of charged from neutral species in blood plasma at a branched microchannel junction by ion concentration polarization (ICP)...
February 21, 2018: Analytical Chemistry
Chiara Carla Maria Brunati, Francesca Gervasi, Costanza Casati, Maria Luisa Querques, Alberto Montoli, Giacomo Colussi
BACKGROUND: Short frequent dialysis with NxStage System One cycler (NSO) has become increasingly popular as home hemodialysis prescription. Short dialysis sessions with NSO might not allow adequate phosphate (P) removal. METHODS: Single-session and weekly balances of P and calcium (Ca) were compared in 14 patients treated with NSO (6 sessions/week) and in 14 patients on standard bicarbonate dialysis (BHD). RESULTS: NSO and BHD showed similar plasma P fall, with end-dialysis plasma P slightly lower in BHD (2...
February 16, 2018: Blood Purification
Marta Albalate Ramón, Patricia Martínez Miguel, Lourdes Bohorquez, Patricia de Sequera, Hanane Bouarich, Rafael Pérez-García, Diego Rodríguez Puyol, Guillermina Barril, Jose Antonio Sánchez Tomero, Martin Giorgi, Manuel Rafael Ramirez Chamond
BACKGROUND: In post-dilution haemodiafiltration only synthetic membranes have been used to date. Asymmetric cellulose triacetate (ATA™) is now available, whose characteristics are suitable for this technique. OBJECTIVES: To describe the in vivo performance and behaviour of this membrane, to identify its depurative effectiveness, use in clinical practice and its biocompatibility, both acute and after one month of treatment. METHODS: Observational prospective study of 23 patients who were dialysed for 4 weeks using an ATA™ membrane and who maintained their prior regimen...
February 14, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
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