Treatment of dialysis membranes for simultaneous dialysis and concentration

Dialysis membranes used for simultaneous dialysis-concentration required pretreatment to remove uv-absorbing compounds leached from the membranes and to reduce the absorption of protein to the membranes. This was accomplished with sodium carbonate and ethanol or with "sulfur-removal solutions." Protein determinations were made with a micro-Bradford protein reaction and with uv absorbance at 280 nm. Soluble membrane components contributed to aberrant uv spectra and altered the ratio of 280/260-nm absorbance. Simultaneous dialysis and concentration in the micro protein dialyzer-concentrator apparatus, combining aspects of thin-layer dialysis and ultrafiltration, resulted in rapid removal of salts from the protein solutions. Prior treatment of membranes reduced uncertainties in retentate recoveries, eliminated uv-absorbing components of membranes, and improved recoveries of protein.     

Peritoneal dialysis solutions

Certain preventable complications in the treatment of renal failure, in part related to the composition of commercially prepared peritoneal dialysis solutions, continue to occur.Solutions are advocated which would contain sodium 132, calcium 3.5, magnesium 1.5, chloride 102 and lactate or acetate 35 mEq./1., and dextrose 1.5% or about 4.25%. Elimination of 7% dextrose solutions and a reduction of the sodium and lactate concentrations should reduce complications due to hypovolemia, hyperglycemia, hypernatremia and alkalosis. Reduction in the number of solutions should simplify the procedure and perhaps reduce costs. It is anticipated that some of the changes discussed will soon be introduced by industry.     

Osteomalacic dialysis osteodystrophy: a trial of phosphate-enriched dialysis fluid.

To assess whether phosphate depletion is an aetiological factor in osteomalacic dialysis osteodystrophy we undertook a prospective trial of phosphate-enriched dialysis fluid, in association with oral 1alpha-hydroxycholecalciferol, for this condition. Thirty patients started the trial; of the 27 who completed more than 6 months'' treatment, 14 had iliac crest bone biopsies at the beginning and end of the treatment period. Side effects included pruritus, stiffness, and increase in corneal and vascular calcification. Only one patient showed histological improvement of osteomalacia, and eight deteriorated; in seven the osteitis fibrosa worsened. Myopathy showed some improvement in four patients, but became worse in four. This treatment does not seem to have a place in the routine management of non-hypophosphataemic patients on dialysis.     

Diet and dialysis.

Personal experience shows that subjective and objective improvements can be achieved in chronic renal failure treated with dialysis. These aims were achieved by limiting energy intake to 8 MJ a day and by substituting cassava for bread and potatoes, thereby reducing the intake of protein, sodium, potassium, and phosphorus. Water soluble vitamins were added to the diet. With this regimen blood urea concentrations vary between 2.5 and 12 mmol/l for most of the week and the packed cell volume between 0.30 and 0.37.