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PubMed1982

Selection of filters and evaluation in vitro of the selective dual filtration artificial kidney, SEDUFARK.

Transport properties of different artificial kidney membranes have been studied employing substances with molecular weights ranging from 60 daltons (urea) to 62,000 daltons (dextran). The results from these studies were used to select filters for the SElective DUal Filtration ARtificial Kidney, SEDUFARK. Selection criteria for filters to be used in long-term clinical trials with SEDUFARK were based on biological tests showing toxicity of large molecular weight substances in uremic blood plasma and clinical advantages of returning middle molecular weight substances to the patient. The filters selected were used for evaluation in vitro of the complete SEDUFARK system. The results confirmed a theoretical analysis of this system, demonstrating that selective removal of substances within given molecular weight ranges from uremic blood plasma is feasible with a combination of commercial filters. The efficiency of the system, however, is limited due to the "cut-off" characteristics and hydraulic permeabilities of membrane types currently available.

Biological Transport↗
PubMed1979

Present status of the hemofiltration/molecular separation artificial kidney.

The hemofiltration/molecular separation (HFMS) artificial kidney concept, first proposed over a decade ago, involves continuous ultrafiltration from the blood stream followed by cleansing of the filtrate, with subsequent return to the body. Thus, the system is completely self-contained and portable. During recent preclinical trials on nephrectomized canines, HFMS was better than hemodialysis (HD) in several important ways. First, the removal or clearance of middle molecules was better with 0.34 m(2) HFMS than with 1 m(2) HD. Significant phosphate clearance was achieved, and the removal rate for creatinine was the same as that for urea. This uniform clearance extends to even higher molecular weight solutes and could potentially result in improved patient response. It mimics the real kidney, whereas membrane-limited dialysis undergoes a logarithmic decrease of clearance with molecular weight. This is due to the fact that solute transport through the membrane involves solution into its matrix followed by diffusion, and solute diffusivity decreases with molecular volume. In order to achieve this potential for hemofiltration-based systems, however, there are stringent requirements on both the membrane and the plasma proteins allowed to accumulate on the membrane surface.

Animals↗
PubMed1985

The current status and future of the artificial kidney.

The use of the artificial kidney can presently be extended to almost all patients with end-stage renal failure. To reduce the cost of treatment, technological choices have to be made. These are always a compromise between cost and adequacy. The liberty obtained by technical improvements to perform a dialysis "à la carte," depending on patient and doctor wishes, is one of the main characteristics of the present status of hemodialysis.

Adolescent↗
PubMed1976

Effects of ultrafiltration on solute clearances in hollow fiber artificial kidneys.

Although solute clearances in artificial kidney coils increase with ultrafiltration (UF), we have previously shown that increases are usually less than UF rate (most likely because of decreases in diffusive transport with UF coils and, for larger solutes, molecular sieving). The present studies demonstrate the effects of UF on clearances of Na and bromsulphalein (BSP) (mol. wt. 838) in hollow fiber dialyzers. Clearances were measured at increasing transmembrane hydrostatic pressures at perfusion rates of 200 and 500 ml. per minute. Fractions of total clearance attributable to diffusion as compared to solvent drag forces were calculated. Sieving coefficients were determined in studies where diffusion was minimized and clearance was primarily by solvent drag. Clearance increases were less than UF rate only for BSP; molecular sieving most likely accounts for the difference at high perfusion rates. Only at 200 ml. per minute was slight decrease of diffusion with UF suggested. Thus, in contrast to coils, there is minimal or no decrease in diffusion with UF in hollow fiber dialyzers.

Kidneys, Artificial↗
PubMed1976

[The use of an artificial kidney in edema therapy].

An artificial kidney (HFAK 5) was evaluated as an ultrafiltration device and was found to efficiently remove water from fluid-overloaded patients. The fluid removal rate was quantitated on a chronically hemodialyzed patient and an example of clinical application on a patient without renal insufficiency, is reported. It is suggested that ultrafiltration is a helpful method for treating refractory edematous states.

Adult↗