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.     

Haemostatic Changes during Dialysis Associated with Thrombus Formation on Dialysis Membranes

Platelet counts, coagulation factors, and the fibrinolytic system were studied in seven regular dialysis patients during the course of haemodialysis by parallel flow (Gambro-Alwall) and coil (Travenol Ultra-Flo 100) dialysers. Significant falls in the patients'' platelet counts and rises in their factor V levels were found with both dialysis systems. The changes were more pronounced over the course of a Gambro-Alwall dialysis, when significant falls in the partial thromboplastin clotting time and in the plasminogen levels were also noted. These haemostatic changes were associated with the retention of platelets on the dialysis membranes and, in the case of the Gambro-Alwall dialyser, with the formation of platelet-fibrin thrombus. This thrombus formation may take place in spite of efficient heparin anticoagulation and may cause excessive blood loss to the regular dialysis patient.     

Reuse of haemodialysis equipment: convenience and cost effectiveness.

The shortage of resources for providing renal replacement makes it essential to reduce revenue costs wherever possible. Assuming that haemodialysis is likely to remain a mainstay of renal replacement, a policy of reusing the expensive disposable dialysers and blood lines could offer substantial cost savings. Such reuse has been shown to be safe and to maintain efficiency, but it must also take account of convenience to the patient, especially those dialysing at home. A survey of patients treated with home dialysis shows that the rate of reuse of the complete extracorporeal circuit was highest for those patients who had automated reuse systems.     

Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association.

The practice of reusing dialysers in renal units in the UK was surveyed by examining the patient questionnaires returned to the EDTA registration committee for 1976 and by a special questionnaire sent to all UK renal units. Altogether 65.6% of the 1785 patients treated with non-disposable dialysers and 49.6% of the 1109 treated with disposable dialysers reused their equipment. Reuse of dialysers caused some morbidity but no mortality. Most centres where disposable dialysers were used accepted that their reuse was necessary because of financial constraints and was ethically defensible.     

Dialyser reuse: a study in applied medical ethics.

A dialysis unit''s introduction of automated recycling of dialysers is described. The responses of the staff and the patients are outlined, along with the pertinent ethical issues. Suggestions regarding the educational processes necessary with any innovation in long-term medical care are discussed.     

Active Uptake of Copper and Zinc during Haemodialysis

The uptake of copper and zinc by patients undergoing regular haemodialysis has been assessed by measuring the dialysis fluid for copper and zinc concentration, and the blood entering and leaving the dialysis coil for red cell copper, plasma free copper, and plasma zinc levels during priming of the coil and subsequent haemodialysis, and by in-vitro studies.Red cells avidly removed copper from dialysis fluid when mixed with saline during priming, but did not take up copper during the haemodialysis. At both these stages plasma actively took up both copper and zinc from dialysis fluid, even against a concentration gradient, so that loss of these metals from plasma to dialysis fluid did not occur.In the dialysis systems investigated the sources of the copper in the dialysis fluid were the copper plumbing of the tap-water and the dialysis coil, and the major source of zinc was the zinc oxide of the adhesive plaster around the dialysis coil.     

Some Administrative Problems in Adaptation of Houses for Home Dialysis

A study of the rate of adaptation, cost, and method of payment for converting the house for home dialysis in 35 patients from Fulham Hospital has shown considerable differences among local authorities in assessing and demanding contributions from patients in various areas. It is shown that delay in adapting houses has resulted in the dialysis unit being unable to take on at least 19 new patients during the years 1967-70. A more uniform approach, together with some central financial arrangements, might avoid undue hardship and delay.     

Harvesting of microalgae by bio-flocculation

The high-energy input for harvesting biomass makes current commercial microalgal biodiesel production economically unfeasible. A novel harvesting method is presented as a cost and energy efficient alternative: the bio-flocculation by using one flocculating microalga to concentrate the non-flocculating microalga of interest. Three flocculating microalgae, tested for harvesting of microalgae from different habitats, improved the sedimentation rate of the accompanying microalga and increased the recovery of biomass. The advantages of this method are that no addition of chemical flocculants is required and that similar cultivation conditions can be used for the flocculating microalgae as for the microalgae of interest that accumulate lipids. This method is as easy and effective as chemical flocculation which is applied at industrial scale, however in contrast it is sustainable and cost-effective as no costs are involved for pre-treatment of the biomass for oil extraction and for pre-treatment of the medium before it can be re-used.     

一次性氧气湿化瓶与重复使用湿化瓶应用的对比观察

目的：检测一次性氧气湿化瓶与重复使用湿化瓶用后细菌污染的程度和患者对噪音感受的舒适程度,对比两者的成本效益。方法：随机选出心内科病房内持续吸氧时间超过10天的患者100名,以随机分组的方法分出A组50名、B组50名。A组使用一次性氧气湿化瓶,B组使用重复使用的氧气湿化瓶。按照《医疗卫生机构消毒技术规范》进行采样后送微生物检验室进行病原学检验;同时对两组患者进行噪音感受舒适度的调查;根据使用的氧气湿化瓶成本费用、氧气湿化用灭菌注射用水的价格、含氯消毒剂健之素的费用计算成本。结果：50只一次性氧气湿化瓶使用时间120小时（5天）,微生物学检测未发现致病菌,成本费用9-3元／日,患者噪音感受舒适度满意度调查结果为100％;重复使用氧气湿化瓶使用24小时染茵率28％,成本费用9．6元／日,患者噪音感受舒适度满意度调查结果为60％。结论：使用合格的一次性氧气湿化瓶,在患者费用不会增加的前提下,减少了医院感染机会,增加了患者的舒适度,值得推广使用。     

Pyrexial Reactions during Haemodialysis

The characteristics, circumstances, and treatment of 450 pyrexial reactions occurring in 468 patient-months over a period of two and a half years, using a warm single-pass Kiil system, were studied. There is a wide variation in severity of symptoms and morbidity. The incidence of pyrexial reactions has an epidemic pattern within the hospital unit. Patients on dialysis at home have reactions much less often than patients in hospital.Blood cultures taken from patients during each of the 450 reactions showed a growth on 38 occasions, but this was not significantly different from the incidence of positive cultures taken simultaneously from control patients during haemodialysis. Reactions were not correlated with bacterial growth from the blood compartment of the kidney before dialysis. There was no difference in incidence of reactions when using different types of equipment which were either a central tank distribution system with bedside monitors or chemically- or heat-sterilized individual proportioning pump systems. Reactions were also noted with the disposable coil kidney and recirculating single-pass (R.S.P.) system, but presented different features from those of the Kiil kidney.The incidence of reactions was not related to the albuminoid nitrogen content of the water supply. Reactions were not abolished by deionization of the tap-water.     

Iron Metabolism in the Anaemia of Chronic Renal Failure. Effects of Dialysis and of Pareuteral Iron

Serial studies of iron transport in patients on maintenance dialysis showed normal or raised values in almost all subjects and a transient increase soon after the start of dialysis in three. These patients, who were seldom or never transfused, had low serum iron levels and normal iron-binding capacity with low saturation. Iron transport was substantially increased by parenteral iron-dextran treatment. Tracer studies showed good iron utilization, with transport to the marrow rather than to the liver. In these circumstances iron therapy is safe and beneficial, and a useful rise in red cell mass was shown to result from it. The packed cell volume was found to be a valid index of red cell mass in these patients. Red cell loss in the dialysers was insufficient to account for the observed reduction in red cell survival.     

Renal Dialysis Center Operational Plans

The Southern California region has available a Renal-Dialysis Center at the University of Southern California School of Medicine and the Los Angeles County General Hospital. The center is prepared to carry out dialysis, transplantation, research and education in nephrology.Patient selection for dialysis will be randomized among optimum candidates.The high cost of dialysis per patient might be reduced through home dialysis and by successful homotransplantation. The center plans to arrange transplantation of cadaver kidneys matched by tissue typing to a recipient undergoing hemodialysis. Such an approach will keep a constant turnover of patients and will help in research efforts toward better understanding of problems in nephrology.     

金属螫合亲和层析纯化和复性重组人铜锌超氧化物歧化酶

将重组人铜锌超氧化物歧化酶（rhCu,Zn-SOD）包含体（经纯化后纯度达80％以上）以稀释法或透析法初步复性后,分别再经金属螯合亲和层析（MCAC）纯化。结果透析复性样品和稀释复性样品经MCAC纯化后的rhSOD比活是各自上柱前样品比活的2．2倍和5．3倍,蛋白回收率分别为64％和25％,同时两者活性回收率皆大于130％。表明目标蛋白rhSOD在经过MCAC纯化的同时又获得进一步复性。SDS-PAGE显示rhSOD为19kD的单一条带,纯度大于95％,比活达到5000u／mg左右,同时NBT生物活性染色鉴定显示出很强的超氧化物歧化酶活性。表明MCAC对于复性不完全的rhCu,Zn-SOD而言是一种纯化和使其进一步复性的简便省时且有效的方法。该方法为以包含体形式表达的基因重组蛋白的纯化和复性提供了新思路。     

Survival on Home Dialysis in New Zealand

Background

New Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities.

Methods

We analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression.

Results

We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (<3 years) that is offset by a 33% greater mortality risk in the late period (>3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era.

Conclusion

Our study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.     

Meltec Multipoint Haemodialyser

The 0·61 m² Meltec Multipoint dialyser has a performance 25% better than the standard Kiil at clinically important blood flows despite its smaller surface area. With low priming and uptake volumes, adequate ultrafiltration, and a negligible residual blood volume, it is compact and can be assembled by one person. It should replace the Kiil as the standard against which new dialysers are measured.     

Results of 12 years' treatment of chronic renal failure by dialysis and transplantation.

The survival of 305 patients with chronic renal failure treated at the Vancouver General Hospital by centre and home peritoneal dialysis, centre and home hemodialysis and cadaver renal transplantation over a 12-year period was analysed. There was decreasing survival with age except in patients undergoing home dialysis. Hypertension and analgesic nephropathy as primary causes of renal disease were associated with a poor prognosis. Hence age and diagnosis appear to be two of the main determinants of survival. Cardiovascular disease was the commonest cause of death but seven deaths were due to dialysis dementia. The results compare favourably with other published statistics.     

Rotary dialysis: its application to the preparation of large liposomes and large proteoliposomes (protein-lipid vesicles) with high encapsulation efficiency and efficient reconstitution of membrane proteins

An apparatus for rotary dialysis is introduced and described in detail. The component parts are inexpensive, widely available, and relatively easy to modify and assemble. The apparatus achieves increased mixing of the contents of dialysis bags by constant end-over-end rotation. This technique is particularly useful in systems where maximum contact is desired between substances which would tend to partition under standard dialysis conditions. We have applied rotary dialysis to two liposome production methods. These are (i) the calcium-EDTA-chelation method of Papahadjopoulos et al. (1), which produces large unilamellar liposomes from negatively charged phospholipids, and (ii) a procedure for the reconstitution of membrane proteins into liposomes with a large internal aqueous space, which we have developed using the calcium-EDTA-chelation technique as a point of departure. In both techniques, vesicle formation occurs when a calcium-phospholipid precipitate is dissolved by the addition of EDTA. Instead of adding a 150 mM EDTA solution directly, as described in the original method, we have used overnight rotary dialysis against buffer containing 10 mM EDTA at the vesicle formation stage. Materials are encapsulated within the aqueous interior of the vesicles at much higher efficiencies when rotary dialysis is used in either method, compared to efficiencies obtained with direct addition of EDTA (up to 37% of added material vs a maximum published efficiency of 10% for direct addition). Rotary dialysis also promotes the reconstitution of a higher proportion of the membrane proteins present in the dialysis mixture into the bilayer of large liposomes (79 vs 41.6%). It also affects the content of liposomes qualitatively, allowing better reconstitution of the Sendai virus F glycoprotein than does direct addition of EDTA. These effects may be due to the slow time course, the extensive mixing of components, and the low volume-to-phospholipid ratios maintained during vesicle formation.     

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.     

Costs and benefits of a community special care baby service

Between January 1981 and December 1986 3829 low birthweight (<2500 g) infants and 1980 other high risk infants were cared for at home after they were discharged from hospital by a specialist neonatal nursing service. Of the infants who were referred to this service, 720 (12%) weighed under 2000 g and 1919 (33%) under 2250 g at the time of discharge home. The infants were visited by the community neonatal sisters on an average of 11 occasions, but the number of visits varied from six to over 100 depending on the needs of the child and parents. There was close liaison with other community and hospital staff. Two hundred and thirty (4%) referred infants were readmitted to hospital while under the care of the specialist nursing service. In 1985 the cost of the service was £127 000, or £123 for each infant referred. Providing this specialist support at home allowed much earlier discharge of low birthweight infants from hospital. When compared with the cost of providing continuing inpatient neonatal care earlier discharge was estimated to have saved roughly £250 000 in 1985.Low birthweight infants have an increased risk of serious illness or death that extends beyond the neonatal period. Many are born to young and socially disadvantaged parents who can benefit from expert guidance and support at home. A community neonatal nursing service has advantages for high risk infants and their parents, is cost effective, and allows more efficient use of limited hospital resources.