PubMed Health⌕ Search

Biomedical subjects

K Opatrný

Publications and source records attributed to K Opatrný.

At least 19 recordsLinked to original sources
PubMed2003

[Acute adverse effects of dialysis].

Adverse reactions to dialyzers are a not very frequent, but because of the serious, sometimes fatal course, a dreaded complication of haemodialysis treatment. Most important among these reactions are hypersensitive reactions (anaphylactoid, reaction type A to dialyzer), which develop as a rule within the 10th minute of the procedure, and the reaction caused by the action of perfluorohydrocarbon which develop hours after onset or even completion of haemodialysis. Explanation of the development of hypersensitive reactions (HSR) by complement activation and formation of anaphylatoxins C3a and C5a during contact of blood with the bioincompatible dialysis membrane has been abandoned. Evidence of the etiological role of ethylene oxide (ETO) in the development of HSR influenced the selection of materials for the production of dialyzers and sterilization during manufacture, it emphasized the importance of rinsing of the dialyzer in the dialysis centre and led to the wide application of alternative methods of sterilization by gamma radiation and steam. HSR may be also caused by overproduction of bradykinin and inhibition of its degradation or degradation of its metabolites. Excessive bradykinin production caused by dialysis membranes with a negative charge is potentiated e.g. by a lower pH and increased plasma dilution in the initial stage of haemodialysis. Inhibition of bradykinin degradation develops during treatment with angiotensin converting enzyme inhibitors (ACEI). In prevention of HSR associated with bradykinin in addition to elimination of a combination of a negatively charged dialysis membrane and ACEI treatment a part is played also by rinsing of the dialyzer before haemodialysis with a bicarbonate solution and the modification of the membrane surface (implemented by the manufacturer) which reduces its negative charge. The first reaction to the dialyzer in conjunction with perfluorohydrocarbon (PF-5070), used in production of some dialyzers for testing the integrity of their capillaries were first described in 2001 and have caused since then at least 50 deaths. Reactions associated with PF-5070 are still the subject of research and forensic investigations. Despite this they draw already now attention to the failure in manufacture of dialyzers, to the inadequacy of hitherto accepted testing procedures of dialyzers and the constant necessity of careful clinical, laboratory and post-mortem examination of dialyzed patients.

Complement Activation↗
PubMed2003

[Hemodialysis in the treatment of chronic kidney failure. Present status].

In advanced countries haemodialysis treatment is available to all patients with chronic renal failure who need it. At present nephrologists must resolve the problem when it is possible to with-hold long-term haemodialysis treatment, or withdraw it because it no longer leads to prolongation of a good quality life. The results of long-term dialysis treatment depend on the correct timing of its initiation and the quality of nephrological care provided already a long time before the development of renal failure. The morbidity, mortality and quality of life of the patients are influenced in a fundamental way by the quality of provided haemodialysis. An important factor is the dose of dialysis treatment evaluated according to index Kt/Vurea reflecting the urea elimination and obviously also the elimination of other low molecular weight substances. Although prospective controlled trials did not prove so far a favourable effect of haemodialysis membranes permeable for larger molecules ("high-flux" membranes) on the patients' fate, the possible toxic effect of so-called middle molecule substances and peptides with a low molecular weight is assumed. Data suggesting improvement of the quality of life of patients having daily haemodialyses call for further investigations. A still unresolved problem of contemporary haemodialysis systems remains inadequate biocompatibility which leads to reactions associated with possible acute and long-term damage of dialyzed patients.

Humans↗
PubMed2002

[Transitional elements and free radicals].

Iron and copper are essential trace elements, which in certain conditions, namely in the ionised form or in low-molecular complexes, can participate in single electron reactions and catalyse formation of free radicals, including the dangerous hydroxyl radical. Similar behavior have also some other transitive metals. Our overview is aimed on the role of transitive elements in the formation of free radicals and on the mechanisms that organisms have to prevent it. The highest attendance is given to the metabolism of iron and cooper. Consistent protection against free transitive metals (by binding with proteins, by oxidation or sequestration in a special compartment) enables organism to use their beneficial and required features without impairment of cell. Knowledge of these mechanisms provides the means to predict and effectively prevent the brake down of such defend systems in situations of the intravascular hemolysis, hemodialysis, administration of iron, impairments of the iron and copper metabolism, intoxication by oxidising substances etc.

Copper↗
PubMed2002

[Effect of a dialysis solution with icodextrin on ultrafiltration and selected metabolic parameters in patients treated with peritoneal dialysis].

BACKGROUND: To date, peritoneal dialysis has been performed almost exclusively using dialysis solutions containing glucose as the osmotic agent. Use of these solutions is fraught with problems regarding adequate fluid removal from the body and is also associated with undesirable metabolic effects; hence the search for alternative osmotic agents. A dialysis solution with the glucose polymer icodextrin generates ultrafiltration on the principle of colloidal osmosis. The aim of the study was to establish the effect of icodextrin-base dialysis solution on the magnitude of ultrafiltration and evaluate selected metabolic parameters of patients treated by ambulatory peritoneal dialysis. METHODS AND RESULTS: A total of 9 patients whose glucose-based solution was replaced by an icodextrin-based solution during the night-time exchange were evaluated. A control group of 9 patients used glucose-solution during all exchanges. Night-time bag ultrafiltration, blood pressure, and the serum levels of lipids, insulin, leptin, maltose, and amylase were determined before icodextrin administration (time 0), at one-month intervals (time 1, 2, 3), and one month after study completion (time 4). In icodextrin-treated patients, ultrafiltration rose from 246.5 +/- 60.5 ml (mean +/- SEM) at time 0 to 593.1 +/- 87.4 ml; p < 0.01, at time 1, to 547 +/- 67 ml; p < 0.05, at time 2, and to 586.7 +/- 58.8 ml; p < 0.01, at time 3, the icodextrin administration led to a rise in maltose from 0.02 +/- 0.01 g/l at time 0 to 0.1 +/- 0.1 g/l; p < 0.01, at time 1, to 1.0 +/- 0.09 g/l; p < 0.01, at time 2, and to 1.1 +/- 0.09 g/l; p < 0.01, at time 3, with a fall to zero values at time 4 (NS). Icodextrin administration was followed by a decrease in leptinemia from 34.6 +/- 17.2 ng/ml at time 0 to 21.7 +/- 8.9 ng/ml; p < 0.05, at time 1, to 21.4 +/- 9.5 ng/ml; p < 0.05, at time 2, and to 15.9 +/- 24.1 ng/ml; p < 0.05 at time 4. Insulin and lipid levels were not affected. There was no change in the above parameters in the control group. Icodextrin-treated patients reduced their antihypertensive medication, but not statistically significantly. CONCLUSION: Icodextrin administration significantly increase ultrafiltration thus providing for effective control of hydration status without the need for high-level glucose-based dialysis solutions. The use of a glucose polymer-based dialysis solution is associated with a significant yet reversible rise in serum maltose. The decrease in leptin may signal a reduction in body weight after replacing glucose in dialysis solutions with icodextrin, or enhanced rates of leptin elimination as a result of ultrafiltration-induced convective transport.

Adult↗
PubMed2002

The effect of heparin rinse on the biocompatibility of continuous veno-venous hemodiafiltration.

UNLABELLED: The aims of our cross-over randomized study were (1) to assess hemostasis in patients with acute renal failure (ARF) and (2) to determine whether or not the generally recommended heparin rinse of the extracorporeal circuit (ECC) prior to the procedure affects thrombogenicity, complement activation, and leukocyte count in blood during continuous venovenous hemodiafiltration (CVVHDF). Eleven critically ill ARF patients were treated, in random order, using CVVHDF in postdilution setup following ECC rinse with saline (A) with heparin at a concentration of 2,000 IU/L (10 procedures), (B) with heparin at a concentration of 10,000 IU/L (7 procedures), and (C) without heparin (9 procedures). Except for the rinse, anticoagulation therapy did not differ in individual patients during the procedures. Blood was withdrawn before, and at minutes 15, 60, and 360 invariably at diafilter inlet and outlet. Compared with healthy individuals, patients showed lower blood thrombocyte counts (153 vs 233*10(9)/L, p<0.01, arithmetic means, Student's t test), longer aPTT (44 vs 36 s, p<0.05), higher plasma levels of heparin (0.1 vs 0.0 U/mL, p<0.05), D-dimer (1129 vs 36 ng/mL, p<0.001) and beta-thromboglobulin (BTG) (159 vs 37 U/mL, p<0.001) prior to CVVHDF. The comparison of procedures with different rinsing technique did not reveal any significant difference in their effects on blood thrombocyte and leukocyte counts, aPTT, plasma levels of heparin, BTG, thrombin-antithrombin III complexes, D-dimer, or the C5a complement component. CONCLUSIONS: (1) Patients indicated for CVVHDF show impaired hemostasis involving thrombocytes, coagulation, and fibrinolysis, (2) no beneficial effect of heparin rinse on CVVHDF ECC thrombogenicity, complement activation or blood leukocyte counts was demonstrated.

Acute Kidney Injury↗
PubMed2002

Fibrinolysis in chronic renal failure, dialysis and renal transplantation.

The best known function of the fibrinolytic system is its ability to dissolve blood clots. The key enzyme of fibrinolysis, plasmin, is formed by conversion from plasminogen through the action of activators, the most important of which is tissue type plasminogen activator (tPA). Low levels of tPA or excessive levels of plasminogen activator inhibitor-I (PAI-I) cause hypofibrinolysis, causally related to the development of atherosclerosis and associated thrombotic complications, as well as with the development of venous and arterial thrombosis. A chronic decrease in renal function leads to hypofibrinolysis due primarily to low levels of tPA. Hypofibrinolysis is present both in patients treated by long-term hemodialysis and by peritoneal dialysis. The hemodialysis procedure acutely raises the plasma levels of tPA, primarily as a result of the bioincompatibility of materials in the extracorporeal circuit. In peritoneal dialysis, dialysis solution dwell time is associated with an increase in PAI-I levels in the abdominal cavity. Fibrinolysis defects occur also in renal transplant recipients. In transplant patients, the main abnormality is also hypofibrinolysis which, however, unlike the situation with the other methods of renal replacement therapy, is secondary to a rise in PAI-I. A role in the increase of the plasma levels of PAI-I in transplant patients is played by steroid- and cyclosporine-based immunosuppression, most likely by metabolic disorders such as insulin resistance or dyslipoproteinemia, and by genetic factors. Animal experiments with chronic rejection have shown abnormalities in local fibrinolysis in the graft, particularly increased PAI-I expression. Fibrinolysis defects may contribute to an early and frequent development of atherosclerosis in patients with chronic renal failure, to chronic dysfunction of the renal transplant, or to peritoneal fibrosis and peritoneal catheter obstruction in patients on peritoneal dialysis. The exact role of hypofibrinolysis in the development of these complications, and the potential for modulating it, warrant further research.

Fibrinolysis↗
PubMed2001

[Paired filtration dialysis and free radicals].

BACKGROUND: Extracorporeal dialysis compensating kidney function represents a risk of elevated production of free radicals (FR). Paired filtration dialysis (PFD) is a hemodialysing method used to compensate kidney function. The aim of our work was to study effects of PFD with two types of hemodiafilters on the activity of free radicals. METHOD AND RESULTS: Group of nine regularly dialysed patients was treated with PFD 1) with demodiafilter SG3, composed of polysulphone high-flux hemodiafilter and hemophane low-flux dialysator, 2) with hemodiafilter SG30, composed of identical hemodiafilter as the above on and of a polysulphone low-flux dialysator. Parameters related to FR were examined before, at 30th minute and at the end of procedure. Plasma concentration of substances reacting with thiobarbiturate acid (TBARS) increased at 30th minute when PFD with SG3 was used (3.24 +/- 0.36 versus 3.48 +/- 0.31, p < 0.01) and at the end of the procedure (3.24 +/- 0.36 versus 3.58 +/- 0.48, p < 0.05). Glutathione values in erythrocytes (GSH) decreased at 30th minute of PFD with SG3 (1.85 +/- 0.27 versus 1.68 +/- 0.20, p < 0.05). Plasma antioxidative capacity decreased at 30th minute and at the end of PFD with equal significance when either type of treatment was used (p < 0.001). Glutathione peroxidase (GSHPx) decreased at 30th minute of PFD with SG30 (35.6 +/- 3.8 versus 32.2 +/- 3.1, p < 0.05). Selenium (Se) in blood decreased at 30th minute (44.9 +/- 5.4 versus 40.4 +/- 5.9, p < 0.05) and at the end of PFD with the same membrane (44.9 +/- 5.4 versus 39.4 +/- 5.2, p < 0.05). CONCLUSIONS: Elevation of TBARS and decrease of GSH show the presence of oxidative stress during the PFD treatment with hemodiafilter SG3. Changes probably result from the contact of blood with the hemophane membrane. The decrease of GSHPx during PFD with hemodiafilter SG30 is probably caused by the loss of Se. From the point of FR production, hemodiafilter SG30 can be considered as more advantageous, from the point of Se loss and decreased activity of GSHPx, hemodiafilter SG3 has better effects.

Adult↗
PubMed2001

Effects of a vitamin E-modified dialysis membrane and vitamin C infusion on oxidative stress in hemodialysis patients.

Hemodialysis deteriorates oxidative stress. Vitamin E is an antioxidant whose regeneration is provided for by vitamin C. The authors tested the effects of a vitamin E-modified membrane (E), nonmodified cellulose membrane (O), and vitamin C infusion (500 mg, C) into the arterial blood line during dialysis on parameters of oxidative stress. In a short-term study, 24 patients were subjected to a single dialysis session with E, O, E with C, and O with C protocols. In a long-term study (12 weeks), 20 patients were randomized into groups with C and without C on each dialysis, and both groups had dialysis using O, E, and again O membrane for 4 weeks each. In the short-term study, thiobarbituric acid reacting substances (TBARS) in plasma rose after dialysis (p < 0.02) with O, and no changes were observed in the other 3 protocols. In the long-term study, predialysis TBARS declined when using E both in the groups with C (p < 0.02) and without C (p < 0.05). A switch over to O resulted in TBARS returning to baseline levels. The E membrane prevented an increase in lipid peroxidation during single dialysis, and long-term use of the E membrane also resulted in a decrease in the predialysis lipid peroxidation level. The antioxidant capacity of the E membrane was not enhanced by vitamin C infusion. High doses of vitamin C administered during dialysis using a nonmodified cellulose membrane prevented an increase in lipid peroxidation, most probably due to the enhanced rate of endogenous vitamin E regeneration.

Adult↗
PubMed2000

Oxidative stress: the effect of erythropoietin and the dialysis membrane.

Dialysis patients run the risk of impaired antioxidative defense and increased free radicals (FR) production. The study was made in order to compare FR-related parameters in ten patients treated with erythropoietin (EPO+) and ten patients not subject to this treatment (EPO-). All patients showed stable hemoglobin levels at > 95 g/L. FR-related parameters were monitored during hemodialysis (HD) using a polysulfon (PS) or a hemophan (H) membrane for 12 of them (6 EPO+ a 6 EPO-). The EPO- group was found to have a higher activity of superoxide dismutase (SOD, 1160 + 218 vs; 882 + 125 IU/gHb, p<0.01) and a higher SOD/glutathione peroxidase (GSHPx) ratio compared with EPO+ (30.5 +/- 7.1 vs; 21.2 + 4.8, p<0.01). A total of 35 healthy volunteers were also examined. When compared with controls EPO- showed higher SOD (p<0.001), lower GSHPx (p<0.05) and a higher SOD/GSHPx ratio (p<0.001). Thiobarbituric acid reacting substances in EPO+ and EPO- were comparable with the levels found in controls. HD using H as well as PS membranes was associated with a decrease in erythrocyte glutathione levels (GSH after 30 minutes; also for H after HD). HD using H and PS membranes resulted in a decrease in the plasma antioxidant capacity (AOC). We can conclude that the intraerythrocyte antioxidant conditions of EPO+ patients are similar to those found in the general population and differ from those in EPO- exhibiting increased SOD and the SOD/GSHPx ratio. HD using the H as well as the PS membrane is accompanied by oxidative stress.

Adult↗
PubMed1999

[Renal anemia and the effect of long-term dialysis].

Renal anaemia causes in patients with chronic renal failure numerous serious problems which can be favourably influenced by improvement of the anaemia. There is a number of known factors which cause deterioration of anaemia and make its treatment more difficult. For a long time it was not clear that these negatively acting factors included also insufficiently effective dialysis treatment. The authors of the submitted paper evaluate the relationship between anaemia and the effectiveness of dialysis based on new data reported in the literature and their own results. From this evaluation ensues that inadequate haemodialysis, assessed from the percentage reduction of urea in blood, is associated with a reduced response to recombinant human erythropoietin which is the basic remedy of renal anaemia. If the inadequate intensity of haemodialysis is increased, anaemia improves substantially. In patients on continuous ambulatory peritoneal dialysis (CAPD) there is a direct relationship between the effectiveness of blood purification expressed by the index KT/Vurea, i.e. the indicator of urea elimination, and the severity of anaemia. In patients treated by CAPD there is a significant association between the haematocrit and KT/Vurea supplied by the peritoneum as well as the kidneys. KT/Vurea supplied by the patient's own kidneys is from the aspect of anaemia more significant. Some facts regarding the relationship between anaemia and the effectiveness of dialysis treatment remain obscure so far. This however does not influence the fact that based on data available at present, effective dialysis must be included among basic prerequisites of effective treatment of renal anaemia in dialyzed patients.

Anemia↗
PubMed1999

The anemia in continuous ambulatory peritoneal dialysis patients is related to Kt/V index.

Anemia in chronic renal failure causes a number of serious problems to the patient. As a result, it is imperative to make use of all rational options to alleviate it. The present study addresses the question, the answer to which is not yet known, whether or not the degree of anemia depends on the efficacy of continuous ambulatory peritoneal dialysis (CAPD) and, if so, what the importance of peritoneal clearance and residual renal function is. A significant correlation between the hematocrit (Hct) and the total weekly Kt/V index (tKt/V) (r = 0.61, p<0.01), total weekly creatinine clearance (tCLCR) (r = 0.50, p<0.05), and residual glomerular filtration rate (r = 0.43, p<0.05) was demonstrated in a group of 22 CAPD patients. Stepwise regression analysis showed that of all the variables monitored, Hct depends exclusively on tKt/V (p<0.01, r2 = 0.37). The value of Hct in a group of patients with a tKt/V <2.3 (n = 15) was 28.9+/-1.2% (arithmetic mean +/- SEM) while in a group with a tKt/V > or =2.3 (n = 7), it was 35.1+/-1.9% (p<0.01). On dividing tKt/V and tCLCR into their peritoneal and renal components, a significant correlation between Hct and renal Kt/V (r = 0.47, p<0.05) was found; stepwise regression analysis identified renal Kt/V (p<0.01) and peritoneal Kt/V (p<0.05), with R2 = 0.38 as major variables with an effect on Hct. The authors conclude the efficacy of blood purification is another factor affecting renal anemia in CAPD patients. The relationship between anemia and blood purification is best expressed using the Kt/V index. The Kt/V provided by one's own kidneys seems to be of greater importance for anemia than the Kt/V provided by peritoneal dialysis. The results provide the basis for prospective interventional studies.

Adult↗
PubMed1998

The effects of a polyacrylonitrile membrane and a membrane made of regenerated cellulose on the plasma concentrations of erythropoietin during hemodialysis.

In vitro studies have shown that some dialysis membranes significantly adsorb erythropoietin (EPO), a fact that might have an effect on anemia in long-term hemodialysis (HD) patients and on anemia treatment with recombinant human EPO. The purpose of the study was to determine whether the ability of adsorption demonstrated in vitro also has an effect on EPO concentrations in vivo. In a crossover study, the plasma concentrations of EPO were examined in 11 patients on chronic HD during HD using a polyacrylonitrile (AN69) membrane (high in vitro adsorption) plus EPO administered subcutaneously after the HD session, HD using a Cuprophan membrane (low in vitro adsorption) plus EPO administered subcutaneously after the HD session, HD using an AN69 membrane plus EPO administered subcutaneously after the HD session plus EPO administered intravenously immediately before HD, or HD using a Cuprophan membrane plus EPO administered subcutaneously after the HD session plus EPO intravenously immediately before HD. The intradialysis plasma concentrations of EPO (not detectable in the dialysate) determined at the dialyzer inlet and outlet at Minutes 5 and 240 of the procedure did not differ significantly after its subcutaneous administration from its predialysis concentrations with either the Cuprophan or AN69 membrane. A comparison of EPO concentrations between AN69 and Cuprophan did not reveal marked differences either. The course of concentrations after additional EPO intravenous administration was similar with no statistically demonstrable difference between the 2 membranes. In conclusion, under clinical conditions, AN69 and Cuprophan membranes do not differ in their effects on plasma EPO concentrations. The differences in EPO adsorption between AN69 and Cuprophan, demonstrated in vitro, do not seem to be of clinical importance.

Acrylic Resins↗
PubMed1998

Tissue-type plasminogen activator (tPA) and its inhibitor (PAI-1) in patients treated with continuous ambulatory peritoneal dialysis.

AIM: To establish whether the values of two key enzymes of fibrinolysis, tissue-type plasminogen activator (tPA) and its inhibitor (PAI-1), differ between patients treated with continuous ambulatory peritoneal dialysis (CAPD) and healthy volunteers and whether plasma and dialysate tPA and PAI-1 values vary during one exchange of dialysis solution. METHODS: A total of 11 patients with chronic renal failure, treated with CAPD during the peritoneal equilibration test (in addition with blood sampling at time 0), and a control group of 11 healthy volunteers were examined. To identify the factors involved in the changes in tPA and PAI-1, 9 CAPD patients were subsequently monitored, in a crossover manner, during dialysis with solutions of 1.36 and 3.86% dextrose and off dialysis. RESULTS: Compared with healthy individuals, CAPD-treated patients showed a significantly lower tPA activity (0.39 vs. 0.81 IU/ml, p < 0.05). Changes in plasma fibrinolysis during one exchange of dialysis solution were characterized mainly by a decrease in PAI-1 concentrations and activities caused by the circadian rhythm of fibrinolysis. To explain, in the crossover part of the study, the values of plasma PAI-1 antigen at time 0 (07.00 h) and at time 2 (09.00 h) were 9.4 versus 6.5 ng/ml with the 1.36% solution (p < 0.05), 8.2 versus 4.9 with the 3.86% solution (p < 0.05), and 14.1 versus 9.1 ng/ml off dialysis (p < 0.01). Compared to baseline (0 ng/ml with 1.36 as well as 3.86% solutions), the levels of PAI-1 antigen in dialysis solution rose, apparently due to local production in the peritoneal cavity, to 0.5 ng/ml (p < 0.05) with the 1.36% solution, to 0.7 (p < 0.05) with the 3.86% solution after a 2-hour dwell time, and to 1.6 (p < 0.05) and 1.3 ng/ml (p < 0.05) after a 4-hour dwell time, respectively. Hence, the different dextrose levels in the dialysis solutions had no effect on the monitored parameters of fibrinolysis. CONCLUSION: The lower activity of plasma tPA, and the increase in PAI-1 levels in dialysis solutions may contribute to the development of thromboses in CAPD patients and to fibrin formation on the peritoneal surface with consequences such as peritoneal fibrosis.

Adult↗
PubMed1998

[Paired filtration dialysis--evaluation of effectiveness of the method].

Paired filtration dialysis (PFD) is a haemodiafiltration method which uses in a major way the convection as well as the diffusion principle of blood clearance. It is the only method replacing renal function where blood filtration is separated from diffusion. The objective of the study is to make the medical community familiar with this method and to assess the effectiveness of PFD when two types of haemodiafilters are used. The effectiveness of PFD is also compared with haemodialysis where a highly permeable haemofilter is used (high-flux haemodialysis, HFHD) with a medium-size area. A group of 8 dialyzed patients was treated after weekly intervals by PFD in two set-ups: 1. PFD with a haemodiafilter SG3 (high-flux polysulphon haemofilter and a low-flux haemophan dialyzer, area 0.55 m2 and 1.36 m2). 2. PFD with haemodiafilter SG30 (high-flux polysulphon haemofilter and low-flux polysulphon dialyzer, area 0.55 m2 and 1.36 m2). The author used also HFHD with a polyacrylonitrile membrane AN 69 (Filtral 12, area 1.3 m2). The index of the dialyzation dose Kt/V was higher in PFD, similarly as the clearance of creatinine, urea, phosphates and uric acid. Beta-2-microglobulin was investigated as a representative of medium-sized molecular substances. Beta-2-microglobulin was eliminated in HFHD and PFD, HFHD being most effective. The selected variants of PFD replace effectively the excretory renal function. The effectiveness of PFD is in particular due to the large total area of the haemodiafilter. According to the authors the standard length of the procedure for a patient with a mean height at a rate of 300 ml/min. is 4 hours. PFD eliminates also beta-2-microglobulin similarly (SG3) or less (SG30) than HFHD with membrane AN 69 with a medium-sized area.

Adult↗
PubMed1997

[The effect of dialysis solutions containing amino acids on the nutritional status of patients treated with continuous ambulatory peritoneal dialysis].

BACKGROUND: In the patient population which is subjected to haemodialysis or peritoneal dialysis is a high prevalence of protein-energy malnutrition which independently on the causal factor causes a deterioration of their prognosis. To influence protein nutrition in patients on peritoneal dialysis Nutrineal was developed, i.e., a dialysis solution using as an osmotic agent a 1.1% amino acid mixture instead of glucose used as a rule. The objective of the present study was to evaluate the effect of its administration on some nutritional indicators in patients treated by continuous ambulatory peritoneal dialysis (CAPD) and to assess its tolerance. METHODS AND RESULTS: The authors investigated eight patients aged 45.5 years (29-78 years, median, minimal and maximal value), treated for 19.9 (5-42) months by CAPD. For a period of four weeks Nutrineal was administered once a day instead of glucose based solution to patients without diseases complicating nutrition, with a serum albumin concentration (ALB) below 35 (20-34) g/l. Before treatment and after its termination an anthropometric examination was made, the rate of protein catabolism was examined (PCR), plasma concentrations of total proteins were assessed, as well as ALB, transferrin (TRF) and 14 free amino acids substituted by the dialysis solution. For statistical comparison the paired Wilcoxon test was used. As compared with the baseline value of 0.83 g/kg/24 h after treatment a significant increase of PCR was recorded--to 0.96 g/kg/24 h (p < 0.05) as well as a significant increase of the urea concentration from 18.4 (10.9-34.8) mmol/l to 26.7 (19.6-33) mmol/l (p < 0.05). The value of phosphorus declined significantly from 2.25 (1.6-2.6) to 1.9 (0.9-2.5) mmol/l (p < 0.05). No significant difference was recorded in the anthropometric findings and in concentrations of total proteins, ALB, TRF and amino acids. CONCLUSIONS: Four weeks administration of a solution with amino acids raised significantly the PCR which may be indirect evidence of an anabolic effect and it reduced plasma phosphates which participate in uraemic toxicity. The solution was well tolerated by the patients. Final evaluation of the values of the solution containing amino acids calls for long-term and controlled studies.

Adult↗
PubMed1997

Glutamine and other amino acid losses during continuous venovenous hemodiafiltration.

Serum amino grams and daily losses of glutamine (Gln) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 +/- 0.1 gN) and reached 4.5% of the daily AA substitution. Gln represented 32.7 +/- 5.9% of the total AA losses (0.19 +/- 0.04 gN). Serum levels of Gln (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gln in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gln losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gln metabolism and distribution that are reflected by a decrease of serum Gln levels at the institution of this treatment. Therefore, the need for Gln supplementation in ICU patients is even greater in the first days of CVVHDF.

Acute Kidney Injury↗
PubMed1997

A clinical study to assess the effect of heparin in dialyzer rinsing solutions.

The solution usually recommended for rinsing the blood side, which is an indispensable step in preparing a dialyzer for hemodialysis (HD), contains saline and heparin. The heparin used for rinsing is said to reduce the thrombogenic properties of the dialysis membrane and, hence, also the need for systemic heparinization during the whole procedure. The aim of our study was to establish whether this postulate also applies to polysulphone steam-sterilized dialyzers. To do so, 16 patients on long-term dialysis were randomized into two groups of eight. One group was subsequently treated with polysulphone low-flux dialyzers (F6HPS), the other with polysulphone high-flux dialyzers (F6OS). Both groups were examined, in a crossover manner during HD using a dialyzer previously rinsed with 1000 ml of saline plus 2,000 IU of heparin, and during HD using a dialyzer previously rinsed with 500 ml of saline without heparin. Except for the rinsing, HD conditions were completely identical. Blood obtained before HD, and at 15, 60 and 240 min of HD at the dialyzer inlet, was used to determine the activated partial thromboplastin time (to test heparinization control), the thrombin-antithrombin III complex (ELISA, to evaluate coagulation system activation), platelet factor 4 (ELISA, a substance with antiheparin activity), and platelet count. None of the above parameters showed, at any of the collecting intervals, a statistically significant difference between HD with and without heparin with a reduced volume of rinsing solution, or between HD using low- and high-flux dialyzers. It is concluded that heparin used to rinse polysulphone dialyzers before HD has no effect on blood coagulation or on the need for heparin during the procedure.

Adult↗