The International journal of artificial organs
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Extracorporeal cytokine removal may be desirable. We sought to assess extracorporeal blood purification (EBP) techniques for cytokine removal in experimental animal studies. ⋯ Experimental animal studies indicate that HVHF (especially with HCO filters) and plasmafiltration have the potential to achieve appreciable IL-6 and IL-10 clearances. However, only PF can remove TNF-alpha reliably.
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During continuous renal replacement therapy (CRRT), anticoagulation of the extracorporeal circuit is required. The aim of this study was to assess the efficacy and safety of nafamostat mesilate, a serine protease inhibitor, compared with heparin. ⋯ Nafamostat mesilate anticoagulation was associated with prolonged filter survival compared with heparin. These data suggest that nafamostat mesilate is a good choice for anticoagulant with prolonged filter survival during CRRT in critically ill patients.
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Hemodialysis patients are at risk of chronic volume overload, with consequent increased cardiovascular morbidity and mortality. Multifrequency bioimpedance allows assessment of body fluid volumes. Devices vary from two paired electrodes which measure bioimpedance down one side of the body to four paired electrodes which measure both sides of the body. As arteriovenous fistulae may cause arm swelling, we investigated whether the presence of a fistula affected bioimpedance limb measurements. ⋯ Although absolute and also relative extracellular fluid volumes are increased in the fistula arm of hemodialysis patients, particularly right-sided and with brachial fistulae, the amount of fluid is unlikely to be of clinical significance when making bioimpedance measurements in the non-fistula side of the body to determine volume status.
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Randomized Controlled Trial
A significant proportion of patients treated with citrate containing dialysate need additional anticoagulation.
The blood membrane interaction induced during hemodialysis (HD) activates the coagulation system. To prevent clotting and to maintain dialyzer patency, an anticoagulant such as tinzaparin is used. To increase patency of the dialyzers and to reduce the risk of bleeding related to anticoagulation, citrate-containing dialysate has been introduced in Europe. ⋯ A significant proportion of patients treated with citrate-containing dialysate need additional anticoagulation.
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Comparative Study
Evaluation of alternatives for dysfunctional double lumen central venous catheters using a two-compartmental mathematical model for different solutes.
Double lumen (DL) central venous catheters (CVC) often suffer from thrombosis, fibrin sheet formation, and/or suction towards the vessel wall, resulting in insufficient blood flow during hemodialysis. Reversing the catheter connection often restores blood flows, but will lead to higher recirculation. Single lumen (SL) CVCs have often fewer flow problems, but they inherently have some degree of recirculation. ⋯ The same trend was found for MG and P. However, β2M RR decreased only 1.5% with SL CVC although TSR decrease was 17.2%, while RR decreased 21.1% with DL-low flow although TSR decrease was only 4.9%. In the case of dysfunctional DL CVCs, reversing the catheter connection and restoring the blood flow did not impair TSR, with 10% recirculation. The SL CVC showed suboptimal TSR results that were similar to those of the dysfunctional DL CVC.