Comparison of Coil and Kiil Dialysers

To assess the comparative efficiency, safety, and cost of maintenance dialysis, the treatment of 13 patients with a Kiil dialyser (representing 1,477 hospital and 735 home dialyses) was compared with that of 11 patients using a coil dialyser (898 hospital and 396 home dialyses). Kiil and coil dialysers proved equally satisfactory from a medical standpoint and equally acceptable to the patients. The capital costs of home dialysis were considerably reduced without any threat to safety or efficiency. The running costs of coil dialysers approximate to those of Kiil dialysers.     

A Study of Membrane Permeability in Haemodialysis

The efficiency of haemodialysis has been determined when a Watson-Marlow (Kiil) dialyser was used repetitively without changing the membranes. Dialysis efficiency was assessed from the clearance of creatinine and of urea from the patient''s blood. No significant deterioration in dialysis could be detected in six dialyses through the same membrane. Leaving the dialyser unit for up to eight hours before washing it out after the completion of each dialysis did not appear to have any effect on dialysis efficiency.It was concluded that repetitive haemodialysis through the same membranes is possible, but careful monitoring of the patient to assess suitability for such treatment, and subsequently at each dialysis, is essential.     

Clinical Evaluation of a Disposable Artificial Kidney

The in-vivo performance of a new disposable parallel flow countercurrent type of artificial kidney has been compared with that of the modified four-layered Kiil dialyser. The dialysance of urea and endogenous creatinine in the former was significantly better than in the latter for similar blood flow rates, and, moreover, unlike the dialysance with the Kiil dialyser it continued to improve over 12 hours. Among 100 disposable artificial kidneys tested no failure occurred from blood leaks despite the use of high negative pressures in the dialysate compartment. No pyrogen reactions were observed.These new artificial kidneys were ready for use in less than one-seventh of the time taken to prepare the conventional Kiil dialyser. Other advantages are their low priming volumes, the lack of a pump in the blood line, and the reduced risk of infection.     

Acute Zinc Toxicity in Haemodialysis

A country patient on home haemodialysis suffered acute nausea, vomiting, and fever during dialyses when she used water stored in a galvanized tank. She subsequently was found to have severe anaemia with raised plasma and erythrocyte zinc concentrations. Intercurrent hospital haemodialyses and subsequent home dialyses with deionized water were symptom-free.Experimental haemodialyses of dogs against small concentrations of zinc showed a disproportionate rise in plasma zinc and possible uptake of zinc by the liver.     

Arteriovenous hemofiltration as an adjuvant therapy in peritoneal dialysis and hemodialysis in a patient with terminal renal failure]

In the uraemic patient regularly treated with peritoneal dialyses occurring peritonitis caused a decrease of ultrafiltration and transfer abilities of the peritoneum. Other symptoms dangerous for life also appeared: uraemic pericarditis and significant overhydration. Peritoneal dialyses lost its effectiveness. Therefore they were supplemented by arterio-venous haemofiltration. Haemofiltration was also conducted at the beginning of haemodialysis treatment, which was initially unregular. Application of haemofiltration enabled the patient to survive during the time of waiting for regular haemodialyses. It may be useful to consider such a treatment, when the adequacy of proper renal substitutive management of uraemia by other methods is impossible to obtain.     

Observations on neutropenia associated with haemodialysis

In the first 30 minutes of haemodialysis, in patients with chronic renal failure, there is a dramatic fall in total neutrophil count in the peripheral blood. An hour after the start of dialysis this has returned to normal.We have carried out a series of experiments in an attempt to elucidate the cause of this neutropenia. Both the patient and the membranes of the dialyser appeared to be a necessary combination to produce these changes, which could not be induced by the infusion of blood or saline that had previously been in contact with the dialyser. The composition of the dialysing fluid was not related to the fall of white count, and this fall was repeated when the patient was connected to a second dialyser after recovering from the neutropenia caused by the first. It was only when reusing a kidney, by rinsing it out and resterilizing it, that the neutropenia could be modified, but this was not a constant finding.     

Role of Venous Needle Hub in Extracorporeal Pressure Changes during Haemodialysis

Certain types of stainless steel needles with metal hubs, and also a fistula set with projecting internal edges, were used at the venous end of the haemodialysis circuit and found to be associated with undesirable rises in extracorporeal pressure in 56 to 64% of dialyses. These increases in pressure are likely to be the result of platelet thrombus formation at the hub of the needle brought about by turbulent flow. The use of a plastic cannula and a stainless steel needle with a plastic hub, both of which have smooth internal surfaces, resulted in increases in pressure in only 4 to 12% of dialyses.     

A comparison of prostacyclin and heparin on hemodialyses in dogs

A comparison of the efficacy of prostacyclin and herapin as anticoagulants during hemodialysis in uremic dogs was evaluated. Prostacyclin was infused continuously into the arterial limb of the dialyzer (100 ng/kg/min) while heparin was administered as a 5000 unit bolus at the beginning of dialysis. Prostacyclin and heparin were alternated and a total of 4 dialyses/dog were performed. Parameters followed to assess the efficiency of dialyses included: dialysance (ml/min) of urea, creatinine, ultrafiltration rate (ml/hr), residual volume and platelet count (% of baseline). A lesser degree of hemodialysis associated thrombocytopenia, and a higher ultrafiltration rate were observed with prostacylcin. These studies demonstrate that prostacyclin can be used alone as an anticoagulant in a uremic dog model, and in contrast to heparin it maintains the platelet count and improves the ultrafiltration rate during hemodialysis.     

Effect of intraperitoneal furosemide administration on levels of +proteins+ in plasma and signs of their ability to be dialyzed during intermittent peritoneal dialysis]

The study aimed at evaluating an effect of intraperitoneal furosemide on plasma proteins such as albumins, globulins, IgG and IgA and their loss during dialysis. An experiment involved 18 patients with critical renal failure treated with intermittent peritoneal dialyses. Furosemide was administered intraperitoneally with dialysing fluid (40 mg/1) in a total dose of 240 mg. Each patient underwent 2 dialyses of 14 exchanges each. The first dialysis without furosemide served as a control of plasma protein loss during conventional dialysis with a fluid of 369 mOsm/kg at flow rate 2.4 l/hour. Furosemide was given during the second dialysis during three consecutive exchanges. An effect of furosemide on plasma proteins was compared with the results obtained before and after its administration. It was found that furosemide did not change plasma proteins levels and does not increase their loss during exchanges of dialysing fluid containing this drug; during dialysing fluid exchanges without furosemide some indices of IgG and IgA dialysis are significantly decreased due to an increase in ultrafiltration following furosemide cessation. It is important for the increase in intermittent peritoneal dialyses efficiency with the aid of furosemide that its short-term administration does not increase proteins loss during dialysis, if their molecular weight is not exceeding 69,000.     

Bacteriological Studies of the Modified Kiil Dialyser

Bacterial proliferation in dialysis fluid during haemodialysis may be associated with rigors, hypotension, and bacteraemia. Investigations carried out in a period in which rigors were particularly common showed the source of bacteria to be parts of the gasket system of the Kiil dialyser, areas that are inaccessible to disinfectants.     

Dialysance of Molecules of Different Size in Reused Kiil,Ab-Gambro,and Rh?ne-Poulenc Dialysers

Dialysances of urea, creatinine, ethylenediamine tetraacetic acid, and ouabain were determined in three different flat-bed dialysers during three successive uses on 15 patients. There were no untoward reactions. A significant decrease in dialysing efficiency was observed only with the Ab-Gambro dialyser, in which the dialysance of the small molecules decreased more than that of the large. This is thought to result from blood deposits on the membrane surface inhibiting exchange.     

Home peritoneal dialysis: 3 years' experience in Toronto.

From November 1972 to November 1975, 52 males and 39 females aged 11 to 71 years were trained for home peritoneal dialysis. Dialysis was performed through a permanent catheter 4 nights a week. The first 11 patients used the manual system, exchanging 2 / of dialysate solution every 50 to 60 minutes. Subsequently 73 patients used the automatic cycler and commercially available dialysate and 7 patients used Tenckhoff''s reverse osmosis peritoneal dialysis machine. The average duration of training was 15, 11.6 and 15 dialysis days, respectively, for the three methods. For the 83 patients followed up, the average duration of home dialysis was 8.3 months (range, 0.5 to 33 months); the total number of dialyses at home was 10 571. Ten received a transplant, 20 were transferred to hospital peritoneal dialysis or hemodialysis, 8 died and 48 continued with home dialysis. Twenty-three patients had a total of 33 episodes of peritonitis, an incidence of 27.7% among the patients in the program for up to 3 years or 0.3% among all the dialyses. By November 1975, 46 patients had returned to their predialysis lifestyle, 18 were working part-time, 10 were able to work but were not doing so, and 9 were unable to work or care for themselves.     

Direct method for osmotic pressure measurement (author's transl)]

A new dynamic method to measure osmotic pressure was presented. The method is easy and with only a 1.8% degree of error. All determinations were done with an osmometer, equipped with three small chambers of methyl metacrilate and dialyser membranes. The central area had two capillaries: one for measuring and the other for changing dynamic pressure. The data from different albumin concentrations were satisfactory, and they agreed with published results from others. The present results indicate that osmotic pressure is an exponential function of albumin concentration.     

An improved automated method for the estimation of sialic acid released in the neuraminidase assay

An improved automated method for the estimation of sialic acid released from macromolecular substrates in the neuraminidase assay is described. The problems of introducing a dialyser into the system are outlined, and the possible causes of an apparently bimodal distribution of results are discussed.     

Optimisation of solute transport in dialysers using a three-dimensional finite volume model

Dialyser manufacturers only provide limited information about mass removal under well-defined flow and solute conditions in commercially available dialysers for hemodialysis. This computational study aimed at assessing the solute transport efficiency in a dialyser for different geometries (fiber lengths and diameters). A three-dimensional finite volume model of a single fiber in a high flux polysulphone dialyser (Fresenius F60) was developed. Different equations describe blood and dialysate flow (Navier-Stokes), radial filtration flow (Darcy) and solute transport (convection-diffusion). Fluid and membrane properties were derived from in vitro and in vivo tests as well as from literature data. Urea (MW60) was used as marker to simulate small molecule removal, while middle molecule transport was modelled using vitamin B12 (MW1355) and inulin (MW5200). Keeping the fluid velocity in a single fiber constant, fiber diameter and length were changed in a wide range for evaluation of solute removal efficiency. Clearances were found enhanced by 13% (urea), 50% (vitamin B12) and 89% (inulin) for a fiber twice as long as a standard one and by 5.5% (vitamin B12) and 21% (inulin) for a fiber diameter of 150 mum instead of 200 mum. The impact of fiber dimensions was more pronounced for the middle molecules compared to urea.     

Haemodialysis Cost Reduction by Artificial Kidney Storage: A Simple Effective Technique for Re-use of Coil Kidneys

A simple method of storing and re-using coil dialysers was used in over 700 dialysers without serious complications but mantaining the efficiency of the dialyser. The method can reduce the expense of coil and tubing by as much as 70%, while the total cost of home or hospital dialysis can be reduced by as much as 15 to 25% even when the coil is re-used only once. Coils were re-used as many as 14 times, making the potential reduction in cost much larger. This technique deserves further evaluation in both hospital and home dialysis programmes.     

Development of a potentially wearable glucose sensor for patients with diabetes mellitus: design and in-vitro evaluation

A potentially wearable glucose sensor was developed, consisting of an oxygen electrode as detector and a dynamic enzyme perfusion system as selector. The selector is a hollow fibre, which can be placed subcutaneously and dialyses glucose from tissue fluid. In this design the problems of enzyme instability and oxygen limitation might be circumvented. The sensor measures glucose reliably for over two weeks, provided a new 10 ml syringe containing a glucose oxidase solution is connected to the system each day.     

Disposable Membrane Insert for the Kiil Dialyser

The use of a presterilized, disposable, mesh-supported membrane envelope in the Watson Marlow Kiil dialyser results in a 12% improvement in urea and creatinine clearance. Priming volume, uptake volume, and ultrafiltration rate are unchanged. Residual blood volume remains small. Blood flow resistance is increased. The envelope therefore offers considerable advantages over conventional assembly for dialysis with a blood pump.     

Evaluation of the effect of d,l-carnitine on lipid metabolism of patients after prolonged dialysis]

An effect of carnitine (Bicarnesine) on lipid metabolism in 14 patients treated with prolonged dialyses has been analysed. Carnitine has been administered orally in the dose of 30 mg/kg b.w. three times per week for 8 weeks and every day for the next 8 weeks. Carnitine, total triglycerides, total and HDL cholesterol, and glucose have been determined in serum. Blood lipoproteins have been assayed with electrophoresis in agarose gel. Total and free carnitine concentrations increased by 3.5 times within 16 weeks. Triglycerides level did not change significantly in all examined patients except a group of 6 patients with baseline hypertriglyceridemia, in which a significant but transient decrease in triglycerides level has been noted after 4 weeks of treatment. At the same time, normalization of blood lipoproteins has been observed. In the eighth week, a transient decrease in HDL-cholesterol has been noted. Result suggest, that carnitine despite an increase in total and free carnitine blood levels did not regulate lipid metabolism disorders. Moreover, its administration to patients treated with prolonged dialyses seems to be unfavourable due to several adverse reactions.     

High Dose Frusemide in Established Acute Renal Failure

The results of treatment with frusemide in 105 patients with established acute renal failure admitted during the past six years were reviewed and compared with control groups. Daily doses of 2,000 mg of frusemide administered from the day of admission onwards produced a significant increase in the number of patients who attained a diuresis and decreased the duration of oliguria.The reduction in the time spent in hospital and in the number of dialyses required suggests that the use of frusemide in these large doses is indicated in patients with severe established acute renal failure.