Sample records for rotating dialysis cell

  1. Assessment of drug salt release from solutions, suspensions and in situ suspensions using a rotating dialysis cell

    Parshad, Henrik; Frydenvang, Karla; Liljefors, Tommy


    A rotating dialysis cell consisting of a small (10 ml) and a large compartment (1000 ml) was used to study the release of drug salt (bupivacaine 9-anthracene carboxylate) from (i). solutions, (ii). suspensions and (iii). in situ formed suspensions. Initial release experiments from suspensions...

  2. Studies on dissolution tests for soft gelatin capsules by the rotating dialysis cell (RDC) method. VI. Preparation and evaluation of ibuprofen soft gelatin capsule.

    Takahashi, M; Yuasa, H; Kanaya, Y; Uchiyama, M


    We prepared soft gelatin capsules (SC) containing ibuprofen (IB), a widely used phenylpropionic acid-derived antiphlogistic-analgesic drug. To evaluate the SC, in vitro dissolution tests were performed both by the paddle (PD) method described in the Japanese Pharmacopoeia (JPXII) and by the rotating dialysis cell (RDC) method which we previously developed and evaluated for application. In vivo, the blood IB concentration was determined after administration to beagles. Higher bioavailability was observed after administration of the SC containing IB than after administration of the bulk IB powder. A higher correlation was observed between the in vitro dissolution behavior and in vivo results by the RDC method than by the PD method, suggesting the usefulness of the RDC method in the dissolution test of SC.

  3. Bupivacaine salts of diflunisal and other aromatic hydroxycarboxylic acids: aqueous solubility and release characteristics from solutions and suspensions using a rotating dialysis cell model.

    Østergaard, Jesper; Larsen, Susan W; Parshad, Henrik; Larsen, Claus


    In the search for poorly soluble bupivacaine salts potentially enabling prolonged postoperative pain relief after local joint administration in the form of suspensions the solubility of bupivacaine salts of diflunisal and other aromatic hydroxycarboxylic acids were investigated together with the release characteristics of selected 1:1 salts from solutions and suspensions using a rotating dialysis cell model. The poorest soluble bupivacaine salts were obtained from the aromatic ortho-hydroxycarboxylic acids diflunisal, 5-iodosalicylic acid, and salicylic acid (aqueous solubilities: 0.6-1.9 mM at 37 degrees C). Diffusant appearance rates in the acceptor phase upon instillation of solutions of various salts in the donor cell applied to first-order kinetics. Calculated permeability coefficients for bupivacaine and the counterions diflunisal, 5-iodosalicylic acid, and mandelic acid were found to be correlated with the molecular size of the diffusants. Release experiments at physiological pH involving suspensions of the bupivacaine-diflunisal salt revealed that at each sampling point the diflunisal concentration exceeded that of bupivacaine in the acceptor phase. However, after an initial lag period, a steady state situation was attained resulting in equal and constant fluxes of the two diffusants controlled by the permeability coefficients in combination with the solubility product of the salt. Due to the fact that the saturation solubility of the bupivacaine-salicylic acid salt in water exceeded that of bupivacaine at pH 7.4, suspensions of the latter salt were unable to provide simultaneous release of the cationic and anionic species at pH 7.4. The release profiles were characterised by a rapid release of salicylate accompanied by a much slower appearance of bupivacaine in the acceptor phase caused by precipitation of bupivacaine base from the solution upon dissolution of the salt in the donor cell.

  4. Bidirectional optical rotation of cells

    Jiyi Wu


    Full Text Available Precise and controlled rotation manipulation of cells is extremely important in biological applications and biomedical studies. Particularly, bidirectional rotation manipulation of a single or multiple cells is a challenge for cell tomography and analysis. In this paper, we report an optical method that is capable of bidirectional rotation manipulation of a single or multiple cells. By launching a laser beam at 980 nm into dual-beam tapered fibers, a single or multiple cells in solutions can be trapped and rotated bidirectionally under the action of optical forces. Moreover, the rotational behavior can be controlled by altering the relative distance between the two fibers and the input optical power. Experimental results were interpreted by numerical simulations.

  5. Bidirectional optical rotation of cells

    Wu, Jiyi; Zhang, Weina; Li, Juan


    Precise and controlled rotation manipulation of cells is extremely important in biological applications and biomedical studies. Particularly, bidirectional rotation manipulation of a single or multiple cells is a challenge for cell tomography and analysis. In this paper, we report an optical method that is capable of bidirectional rotation manipulation of a single or multiple cells. By launching a laser beam at 980 nm into dual-beam tapered fibers, a single or multiple cells in solutions can be trapped and rotated bidirectionally under the action of optical forces. Moreover, the rotational behavior can be controlled by altering the relative distance between the two fibers and the input optical power. Experimental results were interpreted by numerical simulations.

  6. Dialysis cultures.

    Pörtner, R; Märkl, H


    Dialysis techniques are discussed as a means for effective removal of low-molecular-mass components from fermentation broth to reach high cell density. Reactor systems and process strategies, the relevant properties of membranes and examples for high-density fermentation with dialysis, and problems related to scale-up are addressed. The dialysis technique has turned out to be very efficient and reliable for obtaining high cell densities. As in dialysis processes the membranes are not perfused, membrane clogging is not a problem as it is for micro- and ultrafiltration. By applying a "nutrient-split" feeding strategy, the loss of nutrients can be avoided and the medium is used very efficiently. The potential of dialysis cultures is demonstrated on the laboratory scale in a membrane dialysis reactor with an integrated membrane and in reactor systems with an external dialysis loop. In dialysis cultures with different microorganisms (Staphylococci, Escherichia coli, extremophilic microorganisms, Lactobacilli) the cell densities achieved were up to 30 times higher than those of other fermentation methods. The technique enables high cell densities to be attained without time-consuming medium optimization. For animal cell cultures the concept of a fixed bed coupled with dialysis proved to be very effective.

  7. Dialysis cultures with immobilized hybridoma cells for effective production of monoclonal antibodies

    Pörtner, Ralf; Lüdemann, Ines; Märkl, Herbert


    An industrial scale reactor concept for continuous cultivation of immobilized animal cells (e.g. hybridoma cells) in a radial-flow fixed bed is presented, where low molecular weight metabolites are removed via dialysis membrane and high molecular products (e.g. monoclonal antibodies) are enriched. In a new “nutrient-split” feeding strategy concentrated medium is fed directly to the fixed bed unit, whereas a buffer solution is used as dialysis fluid. This feeding strategy was investigated in a...

  8. Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation.

    Peces, Ramón; Martínez-Ara, Jorge; Miguel, José Luis; Arrieta, Javier; Costero, Olga; Górriz, José Luis; Picazo, Mari-Luz; Fresno, Manuel


    Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation. We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups. Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive. ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.

  9. Sensorineural Hearing Affection In Sickle Cell Disease Patients With Chronic Renal Failure Under Dialysis

    Saeed Abdelwhab Saeed MD*, Magdy M El Sharkawy


    Full Text Available Objective: to study the problem of hearing loss in patients of chronic renal failure on regular haemodialysis and The factors which affect it. And to study the effect of sickle cell disease on hearing loss. we studied hearing loss in dialysis patients, sickle cell disease patients and patients of sickle cell disease with chronic renal failure under dialysis compared to normal control subjects. Design: !"",include sickle cell disease patients with chronic renal fa"# $%& ' ", i ,nclude ( # #"# $%&'", , ,( #&'", i 9nclude the normal *+&*+' All groups are subjected to full history, thorough clinical examination including neurological and ENT examination, investigations includes Hb, s. creatinine, s.albumen, s.calcium and calculation of kt/v for dialysis patients. Full audiological assessment, using #,-GSI audiometer was done for all groups with special concentration at frequency of - .Results: hearing loss was found in patients with chronic renal failure more than normal control. Patient with sickle cell disease have hearing disorders significantly higher than $/%- .% 0( # #cell disease have significantly. Marked degree of SNHL than those with SCD only. Hearing loss in patients with 12( # * 3 &4 !4! '#"#"patients with chronic renal failure with or without SCD correlate with duration of dialysis , presence of peripheral neuropathy, s. calcium level, efficiency of dialysis marked by kt/v. Conclusion and recommendation: hearing disorder is common in patients with chronic renal failure under regular haemodialysis and it increase with duration of dialysis it should be suspected if there is Peripheral neuropathy. It can be reduced with efficient dialysis, correction of anemia, adjustment of calcium level. Patients with SCD suffer also some degree of hearing loss especially at higher frequency and this degree of hearing loss

  10. Dialysis cultures with immobilized hybridoma cells for effective production of monoclonal antibodies.

    Pörtner, R; Lüdemann, I; Märkl, H


    An industrial scale reactor concept for continuous cultivation of immobilized animal cells (e.g. hybridoma cells) in a radial-flow fixed bed is presented, where low molecular weight metabolites are removed via dialysis membrane and high molecular products (e.g. monoclonal antibodies) are enriched. In a new "nutrient-split" feeding strategy concentrated medium is fed directly to the fixed bed unit, whereas a buffer solution is used as dialysis fluid. This feeding strategy was investigated in a laboratory scale reactor with hybridoma cells for production of monoclonal antibodies. A steady state monoclonal antibody concentration of 478 mg l(-1) was reached, appr. 15 times more compared to the concentration reached in chemostat cultures with suspended cells. Glucose and glutamine were used up to 98%. The experiments were described successfully with a kinetic model for immobilized growing cells. Conclusions were drawn for scale-up and design of the large scale system. c(Glc) - glucose concentration, mmol l(-1); c(Gln) - glutamine concentration, mmol l(-1); c(Amm) - ammonia concentration, mmol l(-1); c(Lac) - lactate concentration, mmol l(-1); c(MAb) - MAb concentration, mg l(-1); D - dilution rate, d(-1); D(i) - dilution rate in the inner chamber of the membrane dialysis reactor, d(-1); D(0) - dilution rate in the outer chamber of the membrane dialysis reactor, d(-1); q*(FB,Glc) - volume specific glucose uptake rate related to the fixed bed volume, mmol l(FB) (-1) h(-1); q*(FB,Gln) - volume specific glutamine uptake rate related to the fixed bed volume, mmol l(FB) (-1) h(-1).

  11. PI3K / Akt signaling regulates epithelialmesenchymal transition of peritoneal mesothelial cells in peritoneal dialysis



    Objective To investigate the role of PI3K/Akt signaling in the regulation of epithelial-mesenchymal transition(EMT)of peritoneal mesothelial cells(PMCs)in peritoneal dialysis in vitro and in vivo.Methods The level of phosphorylated serine/threonine kinase Akt and the expression of EMT associated gene and protein,including ZO-1,Vimentin and FN,were measured in mice EMT model.In vitro study,phosphorylation level and

  12. Alterations of intercellular junctions in peritoneal mesothelial cells from patients undergoing dialysis: effect of retinoic Acid.

    Retana, Carmen; Sanchez, Elsa; Perez-Lopez, Alejandro; Cruz, Armando; Lagunas, Jesus; Cruz, Carmen; Vital, Socorro; Reyes, Jose L


    Dialysis patients are classified according to their peritoneal permeability as low transporter (LT, low solute permeability) or high transporter (HT, high solute permeability). Tight junction (TJ) proteins are critical to maintain ions, molecules and water paracellular transport through peritoneum. Exposure to peritoneal dialysis solutions causes damage to TJ in human peritoneal mesothelial cells (HPMCs). We analyzed the quantity, distribution and function of TJ proteins: claudin-1, -2 and -8, ZO-1 and occludin, in HPMC cultures from LT and HT patients. Since all-trans retinoic acid (ATRA) might modify the expression of TJ proteins, we studied its effect on HPMCs. Control HPMCs were isolated from human omentum, while HT or LT cells were obtained from dialysis effluents. Cells were cultured in presence of ATRA 0, 50 or 100 nM. Transepithelial electrical resistance (TER) measurement, immunostaining and Western blot analyses were performed. HT exhibited lower TER than control and LT monolayers. Immunofluorescence for TJ was weak and discontinuous along the cell contour, in LT and HT. Furthermore, claudin-1, occludin and ZO-1 expressions were decreased. In all groups, claudin-2 was localized at nuclei. We observed that ATRA improved TJ distribution and increased TJ expression in HT. This retinoid did not modify claudin-2 and -8 expressions. All-trans retinoic acid decreased TER in HT, but had no effect in LT. Tight junctions were altered in HPMCs from dialyzed patients. The HT monolayer has lower TER than LT, which might be associated with the peritoneal permeability in these patients. ATRA might be a therapeutic alternative to maintain mesothelial integrity, since it improved TJ localization and expression. Copyright © 2015 International Society for Peritoneal Dialysis.

  13. Outpatient red blood cell transfusion payments among patients on chronic dialysis

    Gitlin Matthew


    Full Text Available Abstract Background Payments for red blood cell (RBC transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Methods Using Truven Health MarketScan® data (1/1/02-10/31/10 in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days, blood acquisition/administration (within 2 days, and associated complications (within 3 days for acute events; up to 45 days for chronic events. Results A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD] age was 60.9 (15.0 years, and mean Charlson comorbidity index was 4.3 (2.5. During a mean (SD follow-up of 495 (474 days, patients had a mean of 2.2 (3.8 outpatient RBC transfusion episodes. Mean/median (SD total payment per RBC transfusion episode was $854/$427 ($2,060 with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD $213 ($168 for delayed hemolytic transfusion reaction to $19,466 ($15,424 for congestive heart failure. Conclusions Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

  14. Rotating pigment cells exhibit an intrinsic chirality.

    Yamanaka, Hiroaki; Kondo, Shigeru


    In multicellular organisms, cell properties, such as shape, size and function are important in morphogenesis and physiological functions. Recently, 'cellular chirality' has attracted attention as a cellular property because it can cause asymmetry in the bodies of animals. In recent in vitro studies, the left-right bias of cellular migration and of autonomous arrangement of cells under some specific culture conditions were discovered. However, it is difficult to identify the molecular mechanism underlying their intrinsic chirality because the left-right bias observed to date is subtle or is manifested in the stable orientation of cells. Here, we report that zebrafish (Danio rerio) melanophores exhibit clear cellular chirality by unidirectional counterclockwise rotational movement under isolated conditions without any special settings. The chirality is intrinsic to melanophores because the direction of the cellular rotation was not affected by the type of extracellular matrix. We further found that the cellular rotation was generated as a counter action of the clockwise movement of actin cytoskeleton. It suggested that the mechanism that directs actin cytoskeleton in the clockwise direction is pivotal for determining cellular chirality.

  15. Retinoic acid improves morphology of cultured peritoneal mesothelial cells from patients undergoing dialysis.

    Carmen Retana

    Full Text Available Patients undergoing continuous ambulatory peritoneal dialysis are classified according to their peritoneal permeability as low transporter (low solute permeability or High transporter (high solute permeability. Factors that determine the differences in permeability between them have not been fully disclosed. We investigated morphological features of cultured human peritoneal mesothelial cells from low or high transporter patients and its response to All trans retinoic Acid (ATRA, vitamin A active metabolite, as compared to non-uremic human peritoneal mesothelial cells. Control cells were isolated from human omentum. High or low transporter cells were obtained from dialysis effluents. Cells were cultured in media containing ATRA (0, 50, 100 or 200 nM. We studied length and distribution of microvilli and cilia (scanning electron microscopy, epithelial (cytokeratin, claudin-1, ZO-1 and occludin and mesenchymal (vimentin and α-smooth muscle actin transition markers by immunofluorescence and Western blot, and transforming growth factor β1 expression by Western blot. Low and high transporter exhibited hypertrophic cells, reduction in claudin-1, occludin and ZO-1 expression, cytokeratin and vimentin disorganization and positive α-smooth muscle actin label. Vimentin, α-smooth muscle actin and transforming growth factor-β1 were overexpressed in low transporter. Ciliated cells were diminished in low and high transporters. Microvilli number and length were severely reduced in high transporter. ATRA reduced hypertrophic cells number in low transporter. It also improved cytokeratin and vimentin organization, decreased vimentin and α-smooth muscle actin expression, and increased claudin 1, occludin and ZO-1 expression, in low and high transporter. In low transporter, ATRA reduced transforming growth factor-β1 expression. ATRA augmented percentage of ciliated cells in low and high transporter. It also augmented cilia length in high transporter

  16. Cell Cycle Progression of Human Cells Cultured in Rotating Bioreactor

    Parks, Kelsey


    Space flight has been shown to alter the astronauts immune systems. Because immune performance is complex and reflects the influence of multiple organ systems within the host, scientists sought to understand the potential impact of microgravity alone on the cellular mechanisms critical to immunity. Lymphocytes and their differentiated immature form, lymphoblasts, play an important and integral role in the body's defense system. T cells, one of the three major types of lymphocytes, play a central role in cell-mediated immunity. They can be distinguished from other lymphocyte types, such as B cells and natural killer cells by the presence of a special receptor on their cell surface called T cell receptors. Reported studies have shown that spaceflight can affect the expression of cell surface markers. Cell surface markers play an important role in the ability of cells to interact and to pass signals between different cells of the same phenotype and cells of different phenotypes. Recent evidence suggests that cell-cycle regulators are essential for T-cell function. To trigger an effective immune response, lymphocytes must proliferate. The objective of this project is to investigate the changes in growth of human cells cultured in rotating bioreactors and to measure the growth rate and the cell cycle distribution for different human cell types. Human lymphocytes and lymphoblasts will be cultured in a bioreactor to simulate aspects of microgravity. The bioreactor is a cylindrical culture vessel that incorporates the aspects of clinostatic rotation of a solid fluid body around a horizontal axis at a constant speed, and compensates gravity by rotation and places cells within the fluid body into a sustained free-fall. Cell cycle progression and cell proliferation of the lymphocytes will be measured for a number of days. In addition, RNA from the cells will be isolated for expression of genes related in cell cycle regulations.

  17. Cell Cycle Progression of Human Cells Cultured in Rotating Bioreactor

    Parks, Kelsey


    Space flight has been shown to alter the astronauts immune systems. Because immune performance is complex and reflects the influence of multiple organ systems within the host, scientists sought to understand the potential impact of microgravity alone on the cellular mechanisms critical to immunity. Lymphocytes and their differentiated immature form, lymphoblasts, play an important and integral role in the body's defense system. T cells, one of the three major types of lymphocytes, play a central role in cell-mediated immunity. They can be distinguished from other lymphocyte types, such as B cells and natural killer cells by the presence of a special receptor on their cell surface called T cell receptors. Reported studies have shown that spaceflight can affect the expression of cell surface markers. Cell surface markers play an important role in the ability of cells to interact and to pass signals between different cells of the same phenotype and cells of different phenotypes. Recent evidence suggests that cell-cycle regulators are essential for T-cell function. To trigger an effective immune response, lymphocytes must proliferate. The objective of this project is to investigate the changes in growth of human cells cultured in rotating bioreactors and to measure the growth rate and the cell cycle distribution for different human cell types. Human lymphocytes and lymphoblasts will be cultured in a bioreactor to simulate aspects of microgravity. The bioreactor is a cylindrical culture vessel that incorporates the aspects of clinostatic rotation of a solid fluid body around a horizontal axis at a constant speed, and compensates gravity by rotation and places cells within the fluid body into a sustained free-fall. Cell cycle progression and cell proliferation of the lymphocytes will be measured for a number of days. In addition, RNA from the cells will be isolated for expression of genes related in cell cycle regulations.

  18. Orbital rotation of biological cells using two fibre probes

    Huang, J.; Liu, X.; Zhang, Y.; Li, B.


    We report the orbital rotation of biological cells using two tapered fibre probes. We launched laser beams into the probes at a wavelength of 980 nm and rotated 5 µm-diameter yeast cells and 13.5 µm-diameter human leukemic K562 by optical force. The rotation period varied from 1.59 to 2.41 s for the yeast cells and was 4.83 s for the human leukemic K562. The rotation direction of the cells can be controlled by adjusting the position of the two probes. The experimental results were interpreted by theoretical analysis and numerical simulations.

  19. Peroxiredoxins, thioredoxin, and Y-box-binding protein-1 are involved in the pathogenesis and progression of dialysis-associated renal cell carcinoma.

    Fushimi, Fumiyoshi; Taguchi, Kenichi; Izumi, Hiroto; Kohno, Kimitoshi; Kuwano, Michihiko; Ono, Mayumi; Nakashima, Yutaka; Takesue, Tetsuro; Naito, Seiji; Oda, Yoshinao


    Patients with end-stage renal disease are exposed to increased oxidative stress and impairment of antioxidant mechanisms. We focused on dialysis renal cell carcinoma (RCC), including epithelial hyperplasia in acquired cystic disease of the kidney (ACDK). We attempted to obtain insight into the carcinogenesis and tumor progression in terms of cellular defense mechanisms associated with oxidative stress by investigating the expression of antioxidant proteins by immunohistochemistry. We evaluated retrospectively 43 cases of dialysis RCC and, as a control group, 49 cases of sporadic RCC. Peroxiredoxin (Prx) 1, 3, 4, 5, and 6 expression in dialysis RCC was positively correlated with the duration of dialysis. In epithelial hyperplasia, in 17 cases of acquired cystic disease of the kidney, Prxs and thioredoxin were highly expressed. Moreover, in dialysis RCC, Prx 3, 4, and 5 immunoreactivity and nuclear expression of Y-box-binding protein-1 were higher than in sporadic RCC. In dialysis RCC, Prx 3, 4, and 5 immunoreactivity positively correlated with the Fuhrman nuclear grade. These data suggest that oxidative stress during dialysis enhances antioxidant activity, with an inhibiting effect on carcinogenesis. Once cancer has developed, antioxidant activity might have a stimulating effect on the progression of dialysis RCC.

  20. Peritoneal Dialysis

    Peritoneal dialysis Overview By Mayo Clinic Staff Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste ...

  1. Increased SOCS expression in peripheral blood mononuclear cells of end stage renal disease patients is related to inflammation and dialysis modality.

    Rastmanesh, M Mehdi; Braam, Branko; Joles, Jaap A; Boer, Peter; Bluyssen, Hans A R


    Inflammation is a characteristic of cardiovascular disease and is increased in end-stage renal disease. Suppressors of cytokine signaling (SOCS) inhibit and reflect activation of intracellular inflammatory pathways. We hypothesized that SOCS expression in peripheral blood mononuclear cells of end stage renal disease patients is increased. Whether SOCS expression in peripheral blood mononuclear cells is related to inflammation, dialysis, and dialysis modality was investigated. Monocytes and lymphocytes were isolated from peripheral blood mononuclear cells of patients not on dialysis (n=8), on peritoneal dialysis (n=8), on hemodialysis (n=14) and of healthy control (n=15) subjects. SOCS expression was assessed by real-time quantitative PCR and plasma cytokines by ELISA. In end stage renal disease patients monocyte SOCS1, and lymphocyte SOCS1 and cytokine-inducible SH2 containing protein-1 (CIS-1) gene expression were increased along with increased plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF)alpha ,and C-reactive protein (CRP). Monocyte SOCS1 correlated with IL-6. Lymphocyte CIS-1 was increased in non-dialysis and peritoneal dialysis but not in hemodialysis patients. Lymphocyte CIS-1 in peritoneal dialysis patients correlated with plasma TNFalpha. Despite the relatively low number of patients studied we observed increased expression of SOCS1 in both monocytes and lymphocytes, and of CIS-1 solely in lymphocytes of the patients. SOCS expression was related to increased systemic inflammation, illustrated by a significant correlation between monocyte SOCS1 and plasma IL-6. SOCS expression in peripheral blood mononuclear cells was also affected by hemodialysis, indicated by increased lymphocyte CIS-1 in non-dialysis and peritoneal dialysis but not in hemodialysis patients. We suggest that increased SOCS expression in peripheral blood mononuclear cells of end stage renal disease patients reflects whether and to which extent systemic inflammation

  2. Glycated adducts induce mesothelial cell transdifferentiation: role of glucose and icodextrin dialysis solutions.

    Conti, Giovanni; Amore, Alessandro; Cirina, Paola; Peruzzi, Licia; Balegno, Sabrina; Coppo, Rosanna


    In peritoneal dialysis (PD), the peritoneum is exposed to intermediate Amadori adducts (AmAs) and advanced (AGE) glycated products of proteins. The aim of this study was to test the capacity of AmAs created in different PD solutions (PDSs) to elicit a fibroblast-like transdifferentiation of human peritoneal mesothelial cells (HPMCs) in culture. HPMCs were incubated for 12 hours with AmA obtained by human serum albumin (HSA) incubated for 6 days with commercial 3.86% glucose (Glu), 1.36% Glu and 7.5% icodextrin (Ico) PDS. Mesenchymal (vimentin), epithelial (cadherin) and myofibroblastic (Type I collagen and alpha smooth muscle cell actin [ASMA]) markers were evaluated (RT-PCR, immunostaining and Western blot), as well as TGF-b3 synthesis (ELISA and Western blot). Ico-PDS was less active than 3.86% and 1.36% Glu-PDS in glycating albumin (pIco (pIco (pIco (pIco (pIco-PDS, can turn on the fibroblastic-like transdifferentiation in HPMCs, and this mechanism may result in peritoneal sclerosis.

  3. T Helper 17/Regulatory T Cell Balance and Experimental Models of Peritoneal Dialysis-Induced Damage

    Georgios Liappas


    Full Text Available Fibrosis is a general complication in many diseases. It is the main complication during peritoneal dialysis (PD treatment, a therapy for renal failure disease. Local inflammation and mesothelial to mesenchymal transition (MMT are well known key phenomena in peritoneal damage during PD. New data suggest that, in the peritoneal cavity, inflammatory changes may be regulated at least in part by a delicate balance between T helper 17 and regulatory T cells. This paper briefly reviews the implication of the Th17/Treg-axis in fibrotic diseases. Moreover, it compares current evidences described in PD animal experimental models, indicating a loss of Th17/Treg balance (Th17 predominance leading to peritoneal damage during PD. In addition, considering the new clinical and animal experimental data, new therapeutic strategies to reduce the Th17 response and increase the regulatory T response are proposed. Thus, future goals should be to develop new clinical biomarkers to reverse this immune misbalance and reduce peritoneal fibrosis in PD.

  4. T Helper 17/Regulatory T Cell Balance and Experimental Models of Peritoneal Dialysis-Induced Damage

    Liappas, Georgios; Gónzalez-Mateo, Guadalupe Tirma; Majano, Pedro; Sánchez- Tomero, José Antonio; Ruiz-Ortega, Marta; Martín, Pilar; Sanchez-Díaz, Raquel; Selgas, Rafael; López-Cabrera, Manuel; Aguilera Peralta, Abelardo


    Fibrosis is a general complication in many diseases. It is the main complication during peritoneal dialysis (PD) treatment, a therapy for renal failure disease. Local inflammation and mesothelial to mesenchymal transition (MMT) are well known key phenomena in peritoneal damage during PD. New data suggest that, in the peritoneal cavity, inflammatory changes may be regulated at least in part by a delicate balance between T helper 17 and regulatory T cells. This paper briefly reviews the implication of the Th17/Treg-axis in fibrotic diseases. Moreover, it compares current evidences described in PD animal experimental models, indicating a loss of Th17/Treg balance (Th17 predominance) leading to peritoneal damage during PD. In addition, considering the new clinical and animal experimental data, new therapeutic strategies to reduce the Th17 response and increase the regulatory T response are proposed. Thus, future goals should be to develop new clinical biomarkers to reverse this immune misbalance and reduce peritoneal fibrosis in PD. PMID:26064907

  5. Rotator cuff repair using cell sheets derived from human rotator cuff in a rat model.

    Harada, Yoshifumi; Mifune, Yutaka; Inui, Atsuyuki; Sakata, Ryosuke; Muto, Tomoyuki; Takase, Fumiaki; Ueda, Yasuhiro; Kataoka, Takeshi; Kokubu, Takeshi; Kuroda, Ryosuke; Kurosaka, Masahiro


    To achieve biological regeneration of tendon-bone junctions, cell sheets of human rotator-cuff derived cells were used in a rat rotator cuff injury model. Human rotator-cuff derived cells were isolated, and cell sheets were made using temperature-responsive culture plates. Infraspinatus tendons in immunodeficient rats were resected bilaterally at the enthesis. In right shoulders, infraspinatus tendons were repaired by the transosseous method and covered with the cell sheet (sheet group), whereas the left infraspinatus tendons were repaired in the same way without the cell sheet (control group). Histological examinations (safranin-O and fast green staining, isolectin B4, type II collagen, and human-specific CD31) and mRNA expression (vascular endothelial growth factor; VEGF, type II collagen; Col2, and tenomodulin; TeM) were analyzed 4 weeks after surgery. Biomechanical tests were performed at 8 weeks. In the sheet group, proteoglycan at the enthesis with more type II collagen and isolectin B4 positive cells were seen compared with in the control group. Human specific CD31-positive cells were detected only in the sheet group. VEGF and Col2 gene expressions were higher and TeM gene expression was lower in the sheet group than in the control group. In mechanical testing, the sheet group showed a significantly higher ultimate failure load than the control group at 8 weeks. Our results indicated that the rotator-cuff derived cell sheet could promote cartilage regeneration and angiogenesis at the enthesis, with superior mechanical strength compared with the control. Treatment for rotator cuff injury using cell sheets could be a promising strategy for enthesis of tendon tissue engineering. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:289-296, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. Effect of peritoneal dialysis fluid containing osmo-metabolic agents on human endothelial cells

    Bonomini, Mario; Di Silvestre, Sara; Di Tomo, Pamela; Di Pietro, Natalia; Mandatori, Domitilla; Di Liberato, Lorenzo; Sirolli, Vittorio; Chiarelli, Francesco; Indiveri, Cesare; Pandolfi, Assunta; Arduini, Arduino


    Background The use of glucose as the only osmotic agent in peritoneal dialysis (PD) solutions (PDSs) is believed to exert local (peritoneal) and systemic detrimental actions, particularly in diabetic PD patients. To improve peritoneal biocompatibility, we have developed more biocompatible PDSs containing xylitol and carnitine along with significantly less amounts of glucose and have tested them in cultured Human Vein Endothelial Cells (HUVECs) obtained from the umbilical cords of healthy (C) and gestational diabetic (GD) mothers. Methods Primary C- and GD-HUVECs were treated for 72 hours with our PDSs (xylitol 0.7% and 1.5%, whereas carnitine and glucose were fixed at 0.02% and 0.5%, respectively) and two glucose-based PDSs (glucose 1.36% or 2.27%). We examined their effects on endothelial cell proliferation (cell count), viability (3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide assay), intracellular nitro-oxidative stress (peroxynitrite levels), Vascular Cell Adhesion Molecule-1 and Intercellular Adhesion Molecule-1 membrane exposure (flow cytometry), and HUVEC-monocyte interactions (U937 adhesion assay). Results Compared to glucose-based PDSs, our in vitro studies demonstrated that the tested PDSs did not change the proliferative potential both in C- and GD-HUVECs. Moreover, our PDSs significantly improved endothelial cell viability, compared to glucose-based PDSs and basal condition. Notably, glucose-based PDSs significantly increased the intracellular peroxynitrite levels, Vascular Cell Adhesion Molecule-1 and Intercellular Adhesion Molecule-1 membrane exposure, and endothelial cell–monocyte interactions in both C- and GD-HUVECs, as compared with our experimental PDSs. Conclusion Present results show that in control and diabetic human endothelial cell models, xylitol–carnitine-based PDSs do not cause cytotoxicity, nitro-oxidative stress, and inflammation as caused by hypertonic glucose-based PDSs. Since xylitol and carnitine are also known to

  7. Inhibiting effect of short hairpin RNA on expression of transforming growth factor-β1 in human peritoneal mesothelial cells induced by peritoneal dialysis solution

    LIU Fu-you; LING Guang-hui; LIU Hong; PENG You-ming; LIU Ying-hong; DUAN Shao-bin


    @@ The peritoneum response to peritoneal dialysis can lead to fibrosis. The transforming growth factor-β1 (TGF-β1) plays an important role in regulating tissue repair and remodeling after injury. Excessive synthesis and deposition of matrix proteins by peritoneal mesothelial cells can lead to structural and functional changes in the peritoneal membrane, jeopardizing the long-term efficacy of peritoneal dialysis (PD).

  8. Natures of Rotating Stall Cell in a Diagonal Flow Fan



    In order to clarify the natures of a rotating stall cell, the experimental investigation was carried out in a high specific-speed diagonal flow fan. The pressure field on the casing wall and the velocity fields at the rotor inlet and outlet were measured under rotating stall condition with a fast response pressure transducer and a single slant hot-wire probe, respectively. The data were processed using the "Double Phase-Locked Averaging (DPLA)"technique, which enabled to obtain the unsteady flow field with a rotating stall cell in the relative co-ordinate system fixed to the rotor. As a result, the structure and behavior of the rotating stall cell in a high specific-speed diagonal flow fan were shown.

  9. Editor’s Pick: Targeted Agents in Patients with Metastatic Renal Cell Carcinoma on Dialysis: Myths and Reality

    Annalisa Guida


    Full Text Available Agents targeting the vascular endothelial growth factor (VEGF/VEGF receptor (VEGFR pathway, as well as mammalian target of rapamycin (mTOR inhibitors have revolutionised the therapeutic landscape of metastatic renal cell carcinoma (mRCC in the past decade, greatly improving the survival rates of these patients. However, translating results of registrative Phase III trials into everyday clinical practice is often troublesome, since real-world patients are completely different from those enrolled in randomised controlled Phase III trials. Prospective data on active oncological treatments in mRCC patients on dialysis are dramatically lacking. This literature review summarises and critically comments on available data relative to mRCC patients on dialysis receiving either VEGF/VEGFR-targeting agents, or mTOR inhibitors. Although prospective studies would definitely be warranted in these specific patient populations, all the available data suggest that mRCC patients on dialysis have the same outcome, both in terms of efficacy and safety, as mRCC patients with normal or marginally impaired kidney function, when treated with VEGF/VEGFR-targeting agents and/or mTOR inhibitors.

  10. Preliminary evaluation of a microbial fuel cell treating artificial dialysis wastewater using graphene oxide

    Goto, Yuko; Yoshida, Naoko


    Artificial dialysis wastewater (ADWW) generally contains 800-2,200 mg L-1 of organic matter. Prior to its discharge to the sewage system, ADWW must be treated in order to reduce organic matter to less than 600 mg L-1. This study assesses the applicability of a microbial fuel cell (MFC) to the reduction of organic matter in ADWW as an alternative pre-treatment system to aeration. In the MFC, conductive floccular aggregates microbially produced from graphene oxide (GO-flocs) were applied as an anode material in the MFC. The GO-flocs were obtained by anaerobic incubation of graphene oxide (GO) with microorganisms in ADWW at 28 °C for a minimum of 10 days. During incubation, GO in the mixture was transformed into black conductive floccular aggregates having 0.12 mS cm-1, suggesting the microbial reduction of GO to the reduced form. The produced GO-flocs were then used as the anode material in a cylindrical MFC, which was filled with ADWW and covered with a floating, platinum (Pt)-coated carbon cathode. The MFC was polarized via an external resistance of 10 Ω and applied for 120 days by replacing half of the supernatant of the MFC with fresh ADWW, every 6-9 days. As a result, the MFC achieved a 128 mg L-1 d-1 chemical oxygen demand (CODCr) removal rate. For example, the MFC contained 1,500 mg-CODCr L-1 just after replacement, with this concentration being reduced to 1,000 mg-CODCr L-1 after 6-9 days of incubation. At the same time, the MFC showed an average power density of 28 mW m-2 and a maximum power density of 291 mW m-2. These results suggest that a MFC packed with GO-flocs can be used as an alternative biotreatment system, replacing the energy-intensive aeration process.

  11. Horizontally rotated cell culture system with a coaxial tubular oxygenator

    Wolf, David A. (Inventor); Schwarz, Ray P. (Inventor); Trinh, Tinh T. (Inventor)


    The present invention relates to a horizontally rotating bioreactor useful for carrying out cell and tissue culture. For processing of mammalian cells, the system is sterilized and fresh fluid medium, microcarrier beads, and cells are admitted to completely fill the cell culture vessel. An oxygen containing gas is admitted to the interior of the permeable membrane which prevents air bubbles from being introduced into the medium. The cylinder is rotated at a low speed within an incubator so that the circular motion of the fluid medium uniformly suspends the microbeads throughout the cylinder during the cell growth period. The unique design of this cell and tissue culture device was initially driven by two requirements imposed by its intended use for feasibility studies for three dimensional culture of living cells and tissues in space by JSC. They were compatible with microgravity and simulation of microgravity in one G. The vessels are designed to approximate the extremely quiescent low shear environment obtainable in space.

  12. Culture medium refinement by dialysis for the expansion of human induced pluripotent stem cells in suspension culture.

    Nath, Suman Chandra; Nagamori, Eiji; Horie, Masanobu; Kino-Oka, Masahiro


    Human induced pluripotent stem cells (hiPSCs) secrete essential autocrine factors that are removed along with toxic metabolites when the growth medium is exchanged daily. In this study, after determining the minimum inhibitory level of lactic acid for hiPSCs, a medium refining system was constructed by which toxic metabolites were removed from used culture medium and autocrine factors as well as other growth factors were recycled. Specifically, about 87 % of the basic fibroblast growth factor and 80 % of transforming growth factor beta 1 were retained in the refined medium after dialysis. The refined medium efficiently potentiated the proliferation of hiPS cells in adherent culture. When the refining system was used to refresh medium in suspension culture, a final cell density of (1.1 ± 0.1) × 10(6) cells mL(-1) was obtained, with 99.5 ± 0.2 % OCT 3/4 and 78.3 ± 1.1 % TRA-1-60 expression, on day 4 of culture. These levels of expression were similar to those observed in the conventional suspension culture. With this method, culture medium refinement by dialysis was established to remove toxic metabolites, recycle autocrine factors as well as other growth factors, and reduce the use of macromolecules for the expansion of hiPSCs in suspension culture.

  13. Local viscoelasticity of living cells measured by rotational magnetic spectroscopy.

    Berret, J-F


    When submitted to a magnetic field, micron-size wires with superparamagnetic properties behave as embedded rheometers and represent interesting sensors for microrheology. Here we use rotational magnetic spectroscopy to measure the shear viscosity of the cytoplasm of living cells. We address the question of whether the cytoplasm is a viscoelastic liquid or an elastic gel. The main result of the study is the observation of a rotational instability between a synchronous and an asynchronous regime of rotation, found for murine fibroblasts and human cancer cells. For wires of susceptibility 3.6, the transition occurs in the range 0.01-1 rad s(-1). The determination of the shear viscosity (10-100 Pa s) and elastic modulus (5-20 Pa) confirms the viscoelastic character of the cytoplasm. In contrast to earlier studies, it is concluded that the interior of living cells can be described as a viscoelastic liquid, and not as an elastic gel.

  14. Particle Trajectories in Rotating Wall Cell Culture Devices

    Ramachandran N.; Downey, J. P.


    Cell cultures are extremely important to the medical community since such cultures provide an opportunity to perform research on human tissue without the concerns inherent in experiments on individual humans. Development of cells in cultures has been found to be greatly influenced by the conditions of the culture. Much work has focused on the effect of the motions of cells in the culture relative to the solution. Recently rotating wall vessels have been used with success in achieving improved cellular cultures. Speculation and limited research have focused on the low shear environment and the ability of rotating vessels to keep cells suspended in solution rather than floating or sedimenting as the primary reasons for the improved cellular cultures using these devices. It is widely believed that the cultures obtained using a rotating wall vessel simulates to some degree the effect of microgravity on cultures. It has also been speculated that the microgravity environment may provide the ideal acceleration environment for culturing of cellular tissues due to the nearly negligible levels of sedimentation and shear possible. This work predicts particle trajectories of cells in rotating wall vessels of cylindrical and annular design consistent with the estimated properties of typical cellular cultures. Estimates of the shear encountered by cells in solution and the interactions with walls are studied. Comparisons of potential experiments in ground and microgravity environments are performed.

  15. Hematopoietic Stem Cells Expansionin Rotating Wall Vessel


    1 IntroductionClinical trials have demonstrated that ex vivo expanded hematopoietic stem cells (HSCs) and progenitors offer great promise in reconstituting in vivo hematopoiesis in patients who have undergone intensive chemotherapy. It is therefore necessary to develop a clinical-scale culture system to provide the expanded HSCs and progenitors. Static culture systems such as T-flasks and gas-permeable blood bags are the most widely used culture devices for expanding hematopoietic cells. But they reveal sev...

  16. Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

    Pichaya Tantiyavarong


    Full Text Available Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7% of early response, 122 (18.9% of delayed response, and 144 (22.3% of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value < 0.001 for all comparisons. Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

  17. Dialysis vintage, body composition, and survival in peritoneal dialysis patients.

    Avram, Morrell M; Mittman, Neal; Fein, Paul A; Agahiu, Samuel; Hartman, William; Chattopadhyay, Neil; Matza, Betty


    The relationship between dialysis vintage (length of time on dialysis), body composition, and survival has been reported in hemodialysis patients. In the present study, we examined the association ofdialysis vintage with body composition and survival in peritoneal dialysis (PD) patients. At enrollment, body composition in 65 PD patients was determined by bioelectrical impedance analysis. Patients (mean age at enrollment: 54 years) were followed for up to 11 years maximum. At enrollment, the mean, median, and maximum dialysis vintages were 51, 34, and 261 months respectively. After adjusting for age, race, sex, and diabetes status, dialysis vintage was indirectly correlated (partial correlation coefficients) with body weight (r = -0.40, p = 0.001), body mass index (r = -0.40, p = 0.002), body surface area (r = -0.39, p = 0.002), body cell mass (r = -0.39, p = 0.002), total body fat weight (r = -0.30, p = 0.02), and fat percentage of body weight (r = -0.31, p = 0.018), and directly correlated with extracellular mass to body cell mass ratio (r = 0.27, p = 0.039). The observed cumulative survival was significantly higher (p = 0.007) in patients with a dialysis vintage at enrollment of 35 months or less, than in patients with dialysis vintage at enrollment of more than 35 months. In the multivariate Cox regression analysis, adjusting for age, race, sex, and diabetes, dialysis vintage at enrollment remained an independent predictor of mortality (relative risk: 1.010; p = 0.002). Increase in relative risk of death with increasing dialysis vintage may be partly explained by the association of vintage with unfavorable changes in body composition and the nutrition status of patients over time.

  18. Characterization of tendon cell cultures of the human rotator cuff.

    Pauly, S; Klatte, F; Strobel, C; Schmidmaier, G; Greiner, S; Scheibel, M; Wildemann, B


    Rotator cuff tears are common soft tissue injuries of the musculoskeletal system that heal by formation of repair tissue and may lead to high retear rates and joint dysfunction. In particular, tissue from chronic, large tendon tears is of such degenerative nature that it may be prone to retear after surgical repair. Besides several biomechanical approaches, biologically based strategies such as application of growth factors may be promising for increasing cell activity and production of extracellular tendon matrix at the tendon-to-bone unit. As a precondition for subsequent experimental growth factor application, the aim of the present study was to establish and characterize a human rotator cuff tendon cell culture. Long head biceps (LHB)- and supraspinatus muscle (SSP)- tendon samples from donor patients undergoing shoulder surgery were cultivated and examined at the RNA level for expression of collagen type-I, -II and -III, biglycan, decorin, tenascin-C, aggrecan, osteocalcin, tenomodulin and scleraxis (by Real-time PCR). Finally, results were compared to chondrocytes and osteoblasts as control cells. An expression pattern was found which may reflect a human rotator cuff tenocyte-like cell culture. Both SSP and LHB tenocyte-like cells differed from chondrocyte cell cultures in terms of reduced expression of collagen type-II (ptendon matrix and osteofibroblastic integration at the tendon-bone unit following tendon repair.

  19. Mapping cell surface adhesion by rotation tracking and adhesion footprinting

    Li, Isaac T. S.; Ha, Taekjip; Chemla, Yann R.


    Rolling adhesion, in which cells passively roll along surfaces under shear flow, is a critical process involved in inflammatory responses and cancer metastasis. Surface adhesion properties regulated by adhesion receptors and membrane tethers are critical in understanding cell rolling behavior. Locally, adhesion molecules are distributed at the tips of membrane tethers. However, how functional adhesion properties are globally distributed on the individual cell’s surface is unknown. Here, we developed a label-free technique to determine the spatial distribution of adhesive properties on rolling cell surfaces. Using dark-field imaging and particle tracking, we extract the rotational motion of individual rolling cells. The rotational information allows us to construct an adhesion map along the contact circumference of a single cell. To complement this approach, we also developed a fluorescent adhesion footprint assay to record the molecular adhesion events from cell rolling. Applying the combination of the two methods on human promyelocytic leukemia cells, our results surprisingly reveal that adhesion is non-uniformly distributed in patches on the cell surfaces. Our label-free adhesion mapping methods are applicable to the variety of cell types that undergo rolling adhesion and provide a quantitative picture of cell surface adhesion at the functional and molecular level.

  20. Characterization of tendon cell cultures of the human rotator cuff

    S Pauly


    Full Text Available tator cuff tears are common soft tissue injuries of the musculoskeletal system that heal by formation of repair tissue and may lead to high retear rates and joint dysfunction. In particular, tissue from chronic, large tendon tears is of such degenerative nature that it may be prone to retear after surgical repair. Besides several biomechanical approaches, biologically based strategies such as application of growth factors may be promising for increasing cell activity and production of extracellular tendon matrix at the tendon-to-bone unit. As a precondition for subsequent experimental growth factor application, the aim of the present study was to establish and characterize a human rotator cuff tendon cell culture.Long head biceps (LHB- and supraspinatus muscle (SSP- tendon samples from donor patients undergoing shoulder surgery were cultivated and examined at the RNA level for expression of collagen type-I, -II and -III, biglycan, decorin, tenascin-C, aggrecan, osteocalcin, tenomodulin and scleraxis (by Real-time PCR. Finally, results were compared to chondrocytes and osteoblasts as control cells.An expression pattern was found which may reflect a human rotator cuff tenocyte-like cell culture. Both SSP and LHB tenocyte-like cells differed from chondrocyte cell cultures in terms of reduced expression of collagen type-II (p≤0.05 and decorin while higher levels of collagen type-I were seen (p≤0.05. With respect to osteoblasts, tenocyte-like cells expressed lower levels of osteocalcin (p≤0.05 as well as tenascin C, biglycan and collagen type-III. Expression of scleraxis, tenomodulin and aggrecan was similar between all cell types.This study represents a characterization of tenocyte-like cells from the human rotator cuff as close as possible. It helps analyzing their biological properties and allows further studies to improve production of tendon matrix and osteofibroblastic integration at the tendon-bone unit following tendon repair.

  1. Effects of rotational culture on morphology, nitric oxide production and cell cycle of endothelial cells.

    Tang, Chaojun; Wu, Xue; Ye, Linqi; Xie, Xiang; Wang, Guixue


    Devices for the rotational culture of cells and the study of biological reactions have been widely applied in tissue engineering. However, there are few reports exploring the effects of rotational culture on cell morphology, nitric oxide (NO) production, and cell cycle of the endothelial cells from human umbilical vein on the stent surface. This study focuses on these parameters after the cells are seeded on the stents. Results showed that covering of stents by endothelial cells was improved by rotational culture. NO production decreased within 24 h in both rotational and static culture groups. In addition, rotational culture significantly increased NO production by 37.9% at 36 h and 28.9% at 48 h compared with static culture. Flow cytometry showed that the cell cycle was not obviously influenced by rotational culture. Results indicate that rotational culture may be helpful for preparation of cell-seeded vascular grafts and intravascular stents, which are expected to be the most frequently implanted materials in the future.

  2. Effects of Icodextrin and Glucose Bicarbonate/Lactate-Buffered Peritoneal Dialysis Fluids on Effluent Cell Population and Biocompatibility Markers IL-6 and CA125 in Incident Peritoneal Dialysis Patients.

    Opatrná, Sylvie; Pöpperlová, Anna; Lysák, Daniel; Fuchsová, Radka; Trefil, Ladislav; Racek, Jaroslav; Topolčan, Ondrej


    Icodextrin peritoneal dialysis (PD) solution has been shown to increase interleukin-6 (IL-6) levels in PD effluent as well as leukocyte and mesothelial cell count. Mesothelial cells release cancer antigen 125 (CA125), which is used as a marker of mesothelial cell mass. This 1-year prospective study was designed to compare peritoneal effluent cell population, its inflammatory phenotype and biocompatibility biomarkers IL-6 and CA125 between icodextrin (E) and glucose bicarbonate/lactate (P) based PD solutions. Using baseline peritoneal ultrafiltration capacity, 19 stable incident PD patients were allocated either to P only (N = 8) or to P plus E for the overnight dwell (N = 11). Flow cytometry was used to measure white blood cell count and differential and the expression of inflammatory molecules on peritoneal cells isolated from timed overnight peritoneal effluents. Compared to P, E effluent showed higher leukocyte (10.9 vs. 7.9), macrophages (6.1 vs. 2.5) and mesothelial cells (0.3 vs. 0.1)×10(6) /L count, as well as expression of HLA DR on mesothelial cells and IL-6 (320.5 vs. 141.2 pg/min) on mesothelial cells and CA125 appearance rate (159.6 vs. 84.3 IU/min), all P Icodextrin PD solution activates local inflammation without systemic consequences so the clinical relevance of this observation remains obscure. Correlation between effluent IL-6 and CA125 suggests that CA125 might be upregulated due to inflammation and thus is not a reliable marker of mesothelial cell mass and/or biocompatibility. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  3. Electromechanical effects on multilayered cells in nonuniform rotating fields.

    Sebastián, José Luis; Muñoz, Sagrario; Sancho, Miguel; Martínez, Genoveva; Alvarez, Gabriel


    We use the Maxwell stress tensor to calculate the dielectrophoretic force and electrorotational torque acting on a realistic four-shelled model of the yeast Saccharomyces cerevisiae in a nonuniform rotating electric field generated by four coplanar square electrodes. The comparison of these results with numerical calculations of the dipolar and quadrupolar contributions obtained from an integral equation for the polarization charge density shows the effect of the quadrupole contribution in the proximity of the electrode plane. We also show that under typical experimental conditions the substitution of the multilayered cell by an equivalent cell with homogeneous permittivity underestimates the quadrupole contribution to the force and torque by 1 order of magnitude.

  4. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Lok, Charmaine E


    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  5. Optical high-resolution analysis of rotational movement: testing circular spatial filter velocimetry (CSFV) with rotating biological cells

    Schaeper, M.; Schmidt, R.; Kostbade, R.; Damaschke, N.; Gimsa, J.


    Circular spatial filtering velocimetry (CSFV) was tested during the microscopic registration of the individual rotations of baker’s yeast cells. Their frequency-dependent rotation (electrorotation; ER) was induced in rotating electric fields, which were generated in a glass chip chamber with four electrodes (600 μm tip-to-tip distance). The electrodes were driven with sinusoidal quadrature signals of 5 or 8 V PP with frequencies up to 3 MHz. The observed cell rotation was of the order of 1-100 s per revolution. At each measuring frequency, the independent rotations of up to 20 cells were simultaneously recorded with a high-speed camera. CSFV was software-implemented using circular spatial filters with harmonic gratings. ER was proportional to the phase shift between the values of the spatial filtering signal of consecutive frames. ER spectra obtained by CSFV from the rotation velocities at different ER-field frequencies agreed well with manual measurements and theoretical spectra. Oscillations in the rotation velocity of a single cell in the elliptically polarized field near an electrode, which were resolved by CSFV, could not be visually discerned. ER step responses after field-on were recorded at 2500 frames per second. Analysis proved the high temporal resolution of CSFV and revealed a largely linear torque-friction relation during the acceleration phase of ER. Future applications of CSFV will allow for the simple and cheap automated high-resolution analysis of rotational movements where mechanical detection has too low a resolution or is not possible, e.g. in polluted environments or for gas and fluid vortices, microscopic objects, etc.

  6. Performance of a membrane-dialysis bioreactor with a radial-flow fixed bed for the cultivation of a hybridoma cell line.

    Bohmann, A; Pörtner, R; Märkl, H


    A bioreactor system for the continuous cultivation of animal cells with a high potential for scale-up is presented. This reactor system consists of radial-flow fixed-bed units coupled with a dialysis module The dialysis membrane enables the supply of low-molecular-weight nutrients and removal of toxic metabolites, while high-molecular-weight nutrients and products (e.g., monoclonal antibodies) are retained and accumulated. This concept was investigated on the laboratory scale in a bioreactor with an integrated dialysis membrane. The efficiency of the reactor system and the reproducibility of the cell activity (hybridoma cells) under certain process conditions could be demonstrated in fermentations up to 77 days. Based on model calculations, an optimized fermentation strategy was formulated and experimentally confirmed. Compared to chemostat cultures with suspended cells, a ten-times higher mAb concentration (383 mg1(-1)) could be obtained. The highest volumetric specific mAb production rate determined was 6.1 mg mAb (1 fixed bed)-1h-1.

  7. Killer cell immunoglobulin receptor profile on CD4(+)  CD28(-) T cells and their pathogenic role in non-dialysis-dependent and dialysis-dependent chronic kidney disease patients.

    Zal, Behnam; Chitalia, Nihil; Ng, Yin Sing; Trieu, Verna; Javed, Sana; Warrington, Rachelle; Kaski, Juan Carlos; Banerjee, Debasish; Baboonian, Christina


    There is a progressive increase in cardiovascular disease with declining renal function, unexplained by traditional risk factors. A CD4(+) T-cell subpopulation (CD4(+)  CD28(-) ), activated by human heat-shock protein 60 (hHSP 60), expands in patients with acute coronary syndrome and is associated with vascular damage. These cells exhibit cytotoxicity via expression of activating killer cell-immunoglobulin-like receptor KIR2DS2, mainly in the absence of inhibitory KIR2DL3. We investigated expansion of these cells and the pathogenic role of the KIR in non-dialysis-dependent chronic kidney disease (NDD-CKD) and end-stage haemodialysis-dependent renal disease (HD-ESRD) patients. CD4(+)  CD28(-) cells were present in 27% of the NDD-CKD and HD-ESRD patients (8-11% and 10-11% of CD4(+) compartment, respectively). CD4(+)  CD28(-) cells were phenotyped for KIR and DAP12 expression. Cytotoxicity was assessed by perforin and pro-inflammatory function by interferon-γ expression on CD4(+)  CD28(-) clones (NDD-CKD n = 97, HD-ESRD n = 262). Thirty-four per cent of the CD4(+)  CD28(-) cells from NDD-CKD expressed KIR2DS2 compared with 56% in HD-ESRD patients (P = 0·03). However, 20% of clones expressed KIR2DL3 in NDD-CKD compared with 7% in HD-ESRD patients (P = 0·004). DAP12 expression in CD28(-)  2DS2(+) clones was more prevalent in HD-ESRD than NDD-CKD (92% versus 60%; P < 0·001). Only 2DS2(+)  2DL3(-)  DAP12(+) clones were cytotoxic in response to hHSP 60. CD4(+)  CD28(-) cells exhibited increased KIR2DS2, reduced KIR2DL3 and increased DAP12 expression in HD-ESRD compared with NDD-CKD patients. These findings suggest a gradual loss of expression, functionality and protective role of inhibitory KIR2DL3 as well as increased cytotoxic potential of CD4(+)  C28(-) cells with progressive renal impairment. Clonal expansion of these T cells may contribute to heightened cardiovascular events in HD-ESRD.

  8. Muscle Progenitor Cell Regenerative Capacity in the Torn Rotator Cuff

    Meyer, Gretchen A.; Farris, Ashley L.; Sato, Eugene; Gibbons, Michael; Lane, John G.; Ward, Samuel R.; Engler, Adam J.


    Chronic rotator cuff (RC) tears affect a large portion of the population and result in substantial upper extremity impairment, shoulder weakness, pain and limited range of motion. Regardless of surgical or conservative treatment, persistent atrophic muscle changes limit functional restoration and may contribute to surgical failure. We hypothesized that deficits in the skeletal muscle progenitor (SMP) cell pool could contribute to poor muscle recovery following tendon repair. Biopsies were obtained from patients undergoing arthroscopic RC surgery. The SMP population was quantified, isolated and assayed in culture for its ability to proliferate and fuse in-vitro and in-vivo. The SMP population was larger in muscles from cuffs with partial tears compared with no tears or full thickness tears. However, SMPs from muscles in the partial tear group also exhibited reduced proliferative ability. Cells from all cuff states were able to fuse robustly in culture and engraft when injected into injured mouse muscle, suggesting that when given the correct signals, SMPs are capable of contributing to muscle hypertrophy and regeneration regardless of tear severity. The fact that this does not appear to happen in-vivo helps focus future therapeutic targets for promoting muscle recovery following rotator cuff repairs and may help improve clinical outcomes. PMID:25410765

  9. Muscle progenitor cell regenerative capacity in the torn rotator cuff.

    Meyer, Gretchen A; Farris, Ashley L; Sato, Eugene; Gibbons, Michael; Lane, John G; Ward, Samuel R; Engler, Adam J


    Chronic rotator cuff (RC) tears affect a large portion of the population and result in substantial upper extremity impairment, shoulder weakness, pain, and limited range of motion. Regardless of surgical or conservative treatment, persistent atrophic muscle changes limit functional restoration and may contribute to surgical failure. We hypothesized that deficits in the skeletal muscle progenitor (SMP) cell pool could contribute to poor muscle recovery following tendon repair. Biopsies were obtained from patients undergoing arthroscopic RC surgery. The SMP population was quantified, isolated, and assayed in culture for its ability to proliferate and fuse in vitro and in vivo. The SMP population was larger in muscles from cuffs with partial tears compared with no tears or full thickness tears. However, SMPs from muscles in the partial tear group also exhibited reduced proliferative ability. Cells from all cuff states were able to fuse robustly in culture and engraft when injected into injured mouse muscle, suggesting that when given the correct signals, SMPs are capable of contributing to muscle hypertrophy and regeneration regardless of tear severity. The fact that this does not appear to happen in vivo helps focus future therapeutic targets for promoting muscle recovery following rotator cuff repairs and may help improve clinical outcomes.

  10. Hematopoietic Stem Cells Expansion in Rotating Wall Vessel

    Yang LIU; Tian-Qing LIU; Xiu-Bo FAN; Dan GE; Zhan-Feng CUI; Xue-Hu MA


    @@ 1 Introduction Clinical trials have demonstrated that ex vivo expanded hematopoietic stem cells (HSCs) and progenitors offer great promise in reconstituting in vivo hematopoiesis in patients who have undergone intensive chemotherapy.It is therefore necessary to develop a clinical-scale culture system to provide the expanded HSCs and progenitors.Static culture systems such as T-flasks and gas-permeable blood bags are the most widely used culture devices for expanding hematopoietic cells. But they reveal several inherent limitations: ineffective mixing, lack of control options for dissolved oxygen and pH and difficulty in continuous feeding, which restricts the usefulness of static systems. Several advanced bioreactors have been used in the field of HSCs expansion. But hematopoietic cells are extremely sensitive to shear, so cells in bioreactors such as stirred and perfusion culture systems may suffer physical damage. This problem will be improved by applying the rotating wall vessel (RWV) bioreactor in clinic because of its low shear and unique structure. In this research, cord blood (CB) HSCs were expanded by means of a cell-dilution feeding protocol in RWV.

  11. Dialysis Facility Compare

    U.S. Department of Health & Human Services — Dialysis Facility Compare helps you find detailed information about Medicare-certified dialysis facilities. You can compare the services and the quality of care that...

  12. Study of a Microfluidic Chip Integrating Single Cell Trap and 3D Stable Rotation Manipulation

    Liang Huang


    Full Text Available Single cell manipulation technology has been widely applied in biological fields, such as cell injection/enucleation, cell physiological measurement, and cell imaging. Recently, a biochip platform with a novel configuration of electrodes for cell 3D rotation has been successfully developed by generating rotating electric fields. However, the rotation platform still has two major shortcomings that need to be improved. The primary problem is that there is no on-chip module to facilitate the placement of a single cell into the rotation chamber, which causes very low efficiency in experiment to manually pipette single 10-micron-scale cells into rotation position. Secondly, the cell in the chamber may suffer from unstable rotation, which includes gravity-induced sinking down to the chamber bottom or electric-force-induced on-plane movement. To solve the two problems, in this paper we propose a new microfluidic chip with manipulation capabilities of single cell trap and single cell 3D stable rotation, both on one chip. The new microfluidic chip consists of two parts. The top capture part is based on the least flow resistance principle and is used to capture a single cell and to transport it to the rotation chamber. The bottom rotation part is based on dielectrophoresis (DEP and is used to 3D rotate the single cell in the rotation chamber with enhanced stability. The two parts are aligned and bonded together to form closed channels for microfluidic handling. Using COMSOL simulation and preliminary experiments, we have verified, in principle, the concept of on-chip single cell traps and 3D stable rotation, and identified key parameters for chip structures, microfluidic handling, and electrode configurations. The work has laid a solid foundation for on-going chip fabrication and experiment validation.

  13. Critical Care Dialysis System


    Organon Teknika Corporation's REDY 2000 dialysis machine employs technology originally developed under NASA contract by Marquardt Corporation. The chemical process developed during the project could be applied to removing toxic waste from used dialysis fluid. This discovery led to the development of a kidney dialysis machine using "sorbent" dialysis, a method of removing urea from human blood by treating a dialysate solution. The process saves electricity and, because the need for a continuous water supply is eliminated, the patient has greater freedom.

  14. A New Rotation Phenomena of Cells Induced by Homegeneous Electric Field

    Hatakeyama, Toyomasa; Yagi, Hiroshi


    When at least two plant protoplasts are located close to each other under homogeneous electric field, almost all of the cells rotate in the vicinity of its frequency of 10 kHz and specific cells in the vicinity of 10 MHz. The first rotation occurs in the plane constituted by the connecting line between two cells and the applied electric field line. This angular velocity increases with the square of the field strength. On the other hand, the second rotation or new rotation occurs in any plane and its angular velocity complicatedly depends on the field strength. Furthermore, when two cells are arranged in such a way that their connecting line is parallel to the applied field, the second rotation occurs but the first does not. The distinctive feature of the second rotation can be explained by the anisotropic dielectric in the cell due to the shape of its vacuole.

  15. Influence of acetic acid on the growth of Escherichia coli K12 during high-cell-density cultivation in a dialysis reactor.

    Nakano, K; Rischke, M; Sato, S; Märkl, H


    High-cell-density cultivations of Escherichia coli K12 in a dialysis reactor with controlled levels of dissolved oxygen were carried out with different carbon sources: glucose and glycerol. Extremely high cell concentrations of 190 g/l and 180 g/l dry cell weight were obtained in glucose medium and in glycerol medium respectively. Different behaviour was observed in the formation of acetic acid in these cultivations. In glucose medium, acetic acid was formed during the earlier phase of cultivation. However, in glycerol medium, acetic acid formation started later and was particularly rapid at the end of the cultivation. In order to estimate the influence of acetic acid during these high-cell-density cultivations, the inhibitory effect of acetic acid on cell growth was investigated under different culture conditions. It was found that the inhibition of cell growth by acetic acid in the fermentor was much less than that in a shaker culture. On the basis of the results obtained in these investigations of the inhibitory effect of acetic acid, and the mathematical predictions of cell growth in a dialysis reactor, the influence of acetic acid on high-cell-density cultivation is discussed.

  16. AC electric field induced dipole-based on-chip 3D cell rotation.

    Benhal, Prateek; Chase, J Geoffrey; Gaynor, Paul; Oback, Björn; Wang, Wenhui


    The precise rotation of suspended cells is one of the many fundamental manipulations used in a wide range of biotechnological applications such as cell injection and enucleation in nuclear transfer (NT) cloning. Noticeably scarce among the existing rotation techniques is the three-dimensional (3D) rotation of cells on a single chip. Here we present an alternating current (ac) induced electric field-based biochip platform, which has an open-top sub-mm square chamber enclosed by four sidewall electrodes and two bottom electrodes, to achieve rotation about the two axes, thus 3D cell rotation. By applying an ac potential to the four sidewall electrodes, an in-plane (yaw) rotating electric field is generated and in-plane rotation is achieved. Similarly, by applying an ac potential to two opposite sidewall electrodes and the two bottom electrodes, an out-of-plane (pitch) rotating electric field is generated and rolling rotation is achieved. As a prompt proof-of-concept, bottom electrodes were constructed with transparent indium tin oxide (ITO) using the standard lift-off process and the sidewall electrodes were constructed using a low-cost micro-milling process and then assembled to form the chip. Through experiments, we demonstrate rotation of bovine oocytes of ~120 μm diameter about two axes, with the capability of controlling the rotation direction and the rate for each axis through control of the ac potential amplitude, frequency, and phase shift, and cell medium conductivity. The maximum observed rotation rate reached nearly 140° s⁻¹, while a consistent rotation rate reached up to 40° s⁻¹. Rotation rate spectra for zona pellucida-intact and zona pellucida-free oocytes were further compared and found to have no effective difference. This simple, transparent, cheap-to-manufacture, and open-top platform allows additional functional modules to be integrated to become a more powerful cell manipulation system.

  17. [The DIALYSIS AMICA project].

    Marchionni, B


    The denominated Plan "DIALYSIS FRIEND" organized in the region March in the 1998, has seen involved almost all the centers of Dialysis of the region. He has the purpose of furnish the sanitary operators the tools for face the varied strife-torn situations in first person and emotional that they present themselves in an U.O. to "high tension" like result be the Dialysis and the "particularity" personality of whom affection from chronic uraemia comes subjected to dialysis. Besides through the identification of a "profile of fitness" furnishes data on the compliance of the person dialyzed or in pre-dialysis to the different techniques of dialysis. The share of the doctor, of a chief ward, and of any nurses of the U.O. of Nefro/Dialysis of Fano to such plan has resulted to be a very significance experience. The participants to the course tell their experience.

  18. Rotation of single live mammalian cells using dynamic holographic optical tweezers

    Bin Cao; Kelbauskas, Laimonas; Chan, Samantha; Shetty, Rishabh M.; Smith, Dean; Meldrum, Deirdre R.


    We report on a method for rotating single mammalian cells about an axis perpendicular to the optical system axis through the imaging plane using dynamic holographic optical tweezers (HOTs). Two optical traps are created on the opposite edges of a mammalian cell and are continuously transitioned through the imaging plane along the circumference of the cell in opposite directions, thus providing the torque to rotate the cell in a controlled fashion. The method enables a complete 360° rotation of live single mammalian cells with spherical or near-to spherical shape in 3D space, and represents a useful tool suitable for the single cell analysis field, including tomographic imaging.

  19. [Continuous ambulatory peritoneal dialysis: the perfect dialysis?].

    Marichal, J F


    Among the dialysis method, Continuous Ambulatory Peritoneal Dialysis (CAPD) is considered as simple, efficient, economical and giving autonomy to the patient. After more than ten year using Continuous Ambulatory Peritoneal Dialysis, results are evaluated. The method remains simple, but the obvious simplicity demands a strict medical control. It is efficient, but the hope in anemia and osteodystrophy correction is not confirmed. It offers more freedom but with a lot of restraints: the dietary restriction must be followed and there is only relative moving autonomia. It is economical, but the costs with the use of disconnectable systems which reduce morbidity, bring it near to the home hemodialysis.

  20. Rotating cell culture systems for human cell culture: human trophoblast cells as a model.

    Zwezdaryk, Kevin J; Warner, Jessica A; Machado, Heather L; Morris, Cindy A; Höner zu Bentrup, Kerstin


    The field of human trophoblast research aids in understanding the complex environment established during placentation. Due to the nature of these studies, human in vivo experimentation is impossible. A combination of primary cultures, explant cultures and trophoblast cell lines support our understanding of invasion of the uterine wall and remodeling of uterine spiral arteries by extravillous trophoblast cells (EVTs), which is required for successful establishment of pregnancy. Despite the wealth of knowledge gleaned from such models, it is accepted that in vitro cell culture models using EVT-like cell lines display altered cellular properties when compared to their in vivo counterparts. Cells cultured in the rotating cell culture system (RCCS) display morphological, phenotypic, and functional properties of EVT-like cell lines that more closely mimic differentiating in utero EVTs, with increased expression of genes mediating invasion (e.g. matrix metalloproteinases (MMPs)) and trophoblast differentiation. The Saint Georges Hospital Placental cell Line-4 (SGHPL-4) (kindly donated by Dr. Guy Whitley and Dr. Judith Cartwright) is an EVT-like cell line that was used for testing in the RCCS. The design of the RCCS culture vessel is based on the principle that organs and tissues function in a three-dimensional (3-D) environment. Due to the dynamic culture conditions in the vessel, including conditions of physiologically relevant shear, cells grown in three dimensions form aggregates based on natural cellular affinities and differentiate into organotypic tissue-like assemblies. The maintenance of a fluid orbit provides a low-shear, low-turbulence environment similar to conditions found in vivo. Sedimentation of the cultured cells is countered by adjusting the rotation speed of the RCCS to ensure a constant free-fall of cells. Gas exchange occurs through a permeable hydrophobic membrane located on the back of the bioreactor. Like their parental tissue in vivo, RCCS

  1. Very large optical rotation generated by Rb vapor in a multi-pass cell

    Li, S; Sheng, D; Dural, N; Romalis, M V


    Paramagnetic Faraday rotation is a powerful technique for atom sensing widely used in quantum non-demolition measurements, fundamental symmetry tests, and other precision measurements. We demonstrate the use of a multi-pass optical cell for Faraday rotation spectroscopy and observe polarization rotation in excess of 100 radians from spin-polarized Rb vapor. Unlike optical cavities, multi-pass cells have a deterministic number of light passes and can be used to measure large optical rotations. We also observe a 10-fold suppression of transverse spin relaxation when Rb atoms are placed in a coherent superposition state immune to spin-exchange collisions.

  2. Perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease.

    Yamashita, Kaori; Ito, Fumio; Nakazawa, Hayakazu


    The aims of this study were: (i) to analyze the perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease and (ii) to reveal perioperative management problems that are unique to these patients. Between June 2004 and June 2011, laparoscopic radical nephrectomy was performed in 39 patients who had renal cell carcinoma and dialysis-dependent end-stage renal disease. The operative outcomes of these patients were compared with the operative outcomes of 104 non-end-stage renal disease patients with sporadic renal cell carcinoma who underwent laparoscopic radical nephrectomy during the same period. Laparoscopic surgery was completed in thirty-eight end-stage renal disease patients. One patient was converted to open surgery because of an intraoperative injury to the inferior vena cava. This patient was excluded from the analysis. The mean operative time was 240 min; blood loss, 157 mL; and postoperative hospital stay, 9.6 days. Postoperative complications were observed in six patients, as follows: retroperitoneal hematoma and abscess in one patient, thrombosis of the arteriovenous fistula in three patients, pneumonia in one patient, and gastrointestinal bleeding in one patient. Eleven patients required blood transfusions. There was no significant difference between the end-stage renal disease patients and the non-end-stage renal disease patients in the mean operative time or the amount of blood loss. In conclusion, laparoscopic radical nephrectomy is feasible for dialysis-dependent end-stage renal disease patients, as well as for non-end-stage renal disease patients; however, end-stage renal disease patients may have a higher probability of experiencing non-life-threatening complications.

  3. Effectiveness of peritonaeal dialysis

    Jovanović Nataša


    Full Text Available Introduction. In the last few years, an increasing number of patients suffering from terminal renal disease of various leading causes was treated with renal replacement therapy. Peritonaeal dialysis involves an exchange of water and solutes between blood in the peritonaeal capillaries and dialysate in the peritonaeal cavum throughout the peritonaeum. Effective dialysis treatment should provide good quality of life, decrease the number of physical complaints, and bring the incidence of morbidity and mortality closer to the incidence of morbidity and mortality in the healthy population. Aim. The aim of this study was the evaluation of peritonaeal transport characteristics and dialysis effectiveness in 58 patients affected by terminal renal disease who underwent peritonaeal dialysis treatment during August 2003 at the Clinic of Nephrology of the Clinical Centre of Serbia. Method. We examined 30 male and 28 female patients, with an average age of 52 years (range 26 to 78 years. The average duration of peritoneal dialysis treatment was 20 months (ranging from 2 to 66 months, and the end-stage renal failure was caused by different leading disease in our patients. We applied different dialysis modalities: continuous ambulatory peritonaeal dialysis (CAPD with three to five 2- or 3-litre exchanges daily, cyclic peritonaeal dialysis (CCPD, intermittent peritonaeal dialysis (IPD, or automatic peritonaeal dialysis (APD, according to the transport characteristics of the peritonaeal membrane, the residual renal function (RRF, and the clinical status of the patients, in order to perform adequate depuration as suggested by the new international criteria. A peritonaeal equilibrium test (PET was performed according to the new international advice; urea and creatinine clearances (Kt/V and Ccr as well as RRF were calculated using the internationally suggested formulas. Results. Most of our patients received effective dialysis treatment, thanks to the modulation of

  4. Cell dialysis by sharp electrodes can cause nonphysiological changes in neuron properties.

    Hooper, Scott L; Thuma, Jeffrey B; Guschlbauer, Christoph; Schmidt, Joachim; Büschges, Ansgar


    We recorded from lobster and leech neurons with two sharp electrodes filled with solutions often used with these preparations (lobster: 0.6 M K2SO4 or 2.5 M KAc; leech: 4 M KAc), with solutions approximately matching neuron cytoplasm ion concentrations, and with 6.5 M KAc (lobster, leech) and 0.6 M KAc (lobster). We measured membrane potential, input resistance, and transient and sustained depolarization-activated outward current amplitudes in leech and these neuron properties and hyperpolarization-activated current time constant in lobster, every 10 min for 60 min after electrode penetration. Neuron properties varied with electrode fill. For fills with molarities ≥2.5 M, neuron properties also varied strongly with time after electrode penetration. Depending on the property being examined, these variations could be large. In leech, cell size also increased with noncytoplasmic fills. The changes in neuron properties could be due to the ions being injected from the electrodes during current injection. We tested this possibility in lobster with the 2.5 M KAc electrode fill by making measurements only 10 and 60 min after penetration. Neuron properties still changed, although the changes were less extreme. Making measurements every 2 min showed that the time-dependent variations in neuron properties occurred in concert with each other. Neuron property changes with high molarity electrode-fill solutions were great enough to decrease neuron firing strongly. An experiment with (14)C-glucose electrode fill confirmed earlier work showing substantial leak from sharp electrodes. Sharp electrode work should thus be performed with cytoplasm-matched electrode fills.

  5. Nanoparticle induced cell magneto-rotation: monitoring morphology, stress and drug sensitivity of a suspended single cancer cell.

    Remy Elbez

    Full Text Available Single cell analysis has allowed critical discoveries in drug testing, immunobiology and stem cell research. In addition, a change from two to three dimensional growth conditions radically affects cell behavior. This already resulted in new observations on gene expression and communication networks and in better predictions of cell responses to their environment. However, it is still difficult to study the size and shape of single cells that are freely suspended, where morphological changes are highly significant. Described here is a new method for quantitative real time monitoring of cell size and morphology, on single live suspended cancer cells, unconfined in three dimensions. The precision is comparable to that of the best optical microscopes, but, in contrast, there is no need for confining the cell to the imaging plane. The here first introduced cell magnetorotation (CM method is made possible by nanoparticle induced cell magnetization. By using a rotating magnetic field, the magnetically labeled cell is actively rotated, and the rotational period is measured in real-time. A change in morphology induces a change in the rotational period of the suspended cell (e.g. when the cell gets bigger it rotates slower. The ability to monitor, in real time, cell swelling or death, at the single cell level, is demonstrated. This method could thus be used for multiplexed real time single cell morphology analysis, with implications for drug testing, drug discovery, genomics and three-dimensional culturing.

  6. The Therapeutic Potential of Human Umbilical Mesenchymal Stem Cells From Wharton's Jelly in the Treatment of Rat Peritoneal Dialysis-Induced Fibrosis.

    Fan, Yu-Pei; Hsia, Ching-Chih; Tseng, Kuang-Wen; Liao, Chih-Kai; Fu, Tz-Win; Ko, Tsui-Ling; Chiu, Mei-Miao; Shih, Yang-Hsin; Huang, Pei-Yu; Chiang, Yi-Chia; Yang, Chih-Ching; Fu, Yu-Show


    A major complication in continuous, ambulatory peritoneal dialysis in patients with end-stage renal disease who are undergoing long-term peritoneal dialysis (PD) is peritoneal fibrosis, which can result in peritoneal structural changes and functional ultrafiltration failure. Human umbilical mesenchymal stem cells (HUMSCs) in Wharton's jelly possess stem cell properties and are easily obtained and processed. This study focuses on the effects of HUMSCs on peritoneal fibrosis in in vitro and in vivo experiments. After 24-hour treatment with mixture of Dulbecco's modified Eagle's medium and PD solution at a 1:3 ratio, primary human peritoneal mesothelial cells became susceptible to PD-induced cell death. Such cytotoxic effects were prevented by coculturing with primary HUMSCs. In a rat model, intraperitoneal injections of 20 mM methylglyoxal (MGO) in PD solution for 3 weeks (the PD/MGO 3W group) markedly induced abdominal cocoon formation, peritoneal thickening, and collagen accumulation. Immunohistochemical analyses indicated neoangiogenesis and significant increase in the numbers of ED-1- and α-smooth muscle actin (α-SMA)-positive cells in the thickened peritoneum in the PD/MGO 3W group, suggesting that PD/MGO induced an inflammatory response. Furthermore, PD/MGO treatment for 3 weeks caused functional impairments in the peritoneal membrane. However, in comparison with the PD/MGO group, intraperitoneal administration of HUMSCs into the rats significantly ameliorated the PD/MGO-induced abdominal cocoon formation, peritoneal fibrosis, inflammation, neoangiogenesis, and ultrafiltration failure. After 3 weeks of transplantation, surviving HUMSCs were found in the peritoneum in the HUMSC-grafted rats. Thus, xenografts of HUMSCs might provide a potential therapeutic strategy in the prevention of peritoneal fibrosis. Significance: This study demonstrated that direct intraperitoneal transplantation of human umbilical mesenchymal stem cells into the rat effectively

  7. Pharmacokinetics of Gefitinib in a Patient with Non-Small Cell Lung Cancer Undergoing Continuous Ambulatory Peritoneal Dialysis

    Teppei Yamaguchi


    Full Text Available A 72-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD for chronic renal failure and who had undergone right upper lobectomy for lung adenocarcinoma (pT2aN0M0 2 years ago was admitted for recurrence of lung cancer presenting as multiple brain metastases. An epidermal growth factor receptor mutation analysis of his lung cancer revealed a deletion of 15 nucleotides (E746-A750 in exon 19. After whole-brain radiotherapy, we started daily administration of 250 mg gefitinib under the continuation of CAPD and performed a pharmacokinetic analysis. We speculated that the plasma concentration of gefitinib reached the steady state at least by day 16 after the start of gefitinib (626.6 ng/ml at trough level. On day 46, the plasma concentration was 538.4 ng/ml at trough level and the concentration in the peritoneal dialysis fluid was 34.6 ng/ml, suggesting that CAPD appeared to have little effect on the pharmacokinetics of gefitinib. During gefitinib therapy, there were no significant adverse events except for grade 2 diarrhea. Gefitinib could be safely administered to a patient undergoing CAPD.

  8. Adipose tissue-derived mesenchymal stem cells in long-term dialysis patients display downregulation of PCAF expression and poor angiogenesis activation.

    Shuichiro Yamanaka

    Full Text Available We previously demonstrated that mesenchymal stem cells (MSCs differentiate into functional kidney cells capable of urine and erythropoietin production, indicating that they may be used for kidney regeneration. However, the viability of MSCs from dialysis patients may be affected under uremic conditions. In this study, we isolated MSCs from the adipose tissues of end-stage kidney disease (ESKD patients undergoing long-term dialysis (KD-MSCs; mean: 72.3 months and from healthy controls (HC-MSCs to compare their viability. KD-MSCs and HC-MSCs were assessed for their proliferation potential, senescence, and differentiation capacities into adipocytes, osteoblasts, and chondrocytes. Gene expression of stem cell-specific transcription factors was analyzed by PCR array and confirmed by western blot analysis at the protein level. No significant differences of proliferation potential, senescence, or differentiation capacity were observed between KD-MSCs and HC-MSCs. However, gene and protein expression of p300/CBP-associated factor (PCAF was significantly suppressed in KD-MSCs. Because PCAF is a histone acetyltransferase that mediates regulation of hypoxia-inducible factor-1α (HIF-1α, we examined the hypoxic response in MSCs. HC-MSCs but not KD-MSCs showed upregulation of PCAF protein expression under hypoxia. Similarly, HIF-1α and vascular endothelial growth factor (VEGF expression did not increase under hypoxia in KD-MSCs but did so in HC-MSCs. Additionally, a directed in vivo angiogenesis assay revealed a decrease in angiogenesis activation of KD-MSCs. In conclusion, long-term uremia leads to persistent and systematic downregulation of PCAF gene and protein expression and poor angiogenesis activation of MSCs from patients with ESKD. Furthermore, PCAF, HIF-1α, and VEGF expression were not upregulated by hypoxic stimulation of KD-MSCs. These results suggest that the hypoxic response may be blunted in MSCs from ESKD patients.

  9. Training echo state networks for rotation-invariant bone marrow cell classification.

    Kainz, Philipp; Burgsteiner, Harald; Asslaber, Martin; Ahammer, Helmut


    The main principle of diagnostic pathology is the reliable interpretation of individual cells in context of the tissue architecture. Especially a confident examination of bone marrow specimen is dependent on a valid classification of myeloid cells. In this work, we propose a novel rotation-invariant learning scheme for multi-class echo state networks (ESNs), which achieves very high performance in automated bone marrow cell classification. Based on representing static images as temporal sequence of rotations, we show how ESNs robustly recognize cells of arbitrary rotations by taking advantage of their short-term memory capacity. The performance of our approach is compared to a classification random forest that learns rotation-invariance in a conventional way by exhaustively training on multiple rotations of individual samples. The methods were evaluated on a human bone marrow image database consisting of granulopoietic and erythropoietic cells in different maturation stages. Our ESN approach to cell classification does not rely on segmentation of cells or manual feature extraction and can therefore directly be applied to image data.

  10. Dialysis Facility Compare Data

    U.S. Department of Health & Human Services — These are the official datasets used on the Dialysis Facility Compare Website provided by the Centers for Medicare and Medicaid Services. These data...

  11. Phosphate control in dialysis

    Cupisti A; Gallieni M; Rizzo MA; Caria S; Meola M; Bolasco P


    Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal ...

  12. Dialysis provision in Malaysia.

    Lim, T O; Lee, D G; Zaki, M


    We determined the provision for dialysis treatment in Malaysia. There were 181 dialysis centres as at 1st June 1999 (161 Haemodialysis (HD) and 20 Continuous Ambulatory Peritoneal Dialysis (CAPD) centres), providing treatment for 5614 patients. This is equivalent to an estimated prevalence rate of 253 patients per million population (pmp) and new dialysis acceptance rate of 49 patients pmp. Dialysis facilities were widely distributed throughout the country though rather unevenly among states. Penang, Selangor/KL, Malacca led with number of dialysis patients pmp ranging from 417 to 480. Kelantan and Sabah had the lowest provision with 51 and 64 patients pmp respectively. There were more centres and HD capacity in the private sector while the Non-Government Organisation and public sectors had about the same capacity. However the public sector had more patients on account of availability of CAPD and home HD services, as well as low HD capacity to patient ratio. The number ofcentres, HD capacity and patients have increased rapidly especially since 1991; the estimated growth rates were 16.5 centres/year, 658 capacity/year, and 392 patients/year respectively. There was also a trend toward increasing over-capacity in the private and NGO sectors. In conclusion, the level of dialysis provision is increasing, indicating increasing accessibility of dialysis treatment in Malaysia. Over-capacity is a concern in the private and NGO sectors. Thus funding agencies should be encouraged to source provision from those sectors. The public sector still has the crucial role of providing for under-served areas in the country.

  13. Initiation of dialysis.

    Hakim, R M; Lazarus, J M


    The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. There is an increasing need to identify objective criteria for such a decision. Recent evidence suggests that malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, the role of prescribed protein restriction as well as the influence of the progression of renal disease on spontaneous dietary protein intake is examined. It is proposed that the indices of malnutrition such as progressive weight loss, serum albumin levels below 4.0 g/dL, serum transferrin levels below 200 mg/dL, and spontaneous dietary protein intake (using 24-hr urinary nitrogen measurement) below 0.8 to 0.7 g/kg per day be considered as objective criteria for the initiation of dialysis. Studies that have examined the role of "early" versus "late" dialysis have consistently shown a better outcome in the patients starting dialysis early. Other studies also suggest that early referral to nephrologists results in improved morbidity and mortality as well as hospitalization costs. An adequate vascular access, as well as social and psychological preparation of the patient, is an important early step in the process.

  14. Dialysis access, infections, and hospitalisations in unplanned dialysis start patients

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy


    Introduction: Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient ou...

  15. Phosphate control in dialysis

    Cupisti A


    Full Text Available Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease–mineral and bone disorder (CKD–MBD management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive–convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200–300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source

  16. Effect of Shear Stress in Flow on Cultured Cell: Using Rotating Disk at Microscope

    Haruka Hino


    Full Text Available An experimental system of the Couette type flow with a rotating disk has been designed to apply wall shear stress quantitatively on the cell culture at the microscopic observation in vitro. The shear stress on the wall is calculated with an estimated Couette type of the velocity profile between the rotating disk and the culture plate. The constant rotational speed (lower than 400 rpm produces the wall shear stress lower than 2 Pa. The rotating disk system is mounted on the stage of an inverted phase contrast microscope to observe the behavior of cells adhered on the plate under the shear flow. Two kinds of cells were used in the test: C2C12 (mouse myoblast cell line, and MC3T3-E1 (mouse osteoblast precursor cell line. The experiments show that C2C12 tends to make orientation diagonal to the stream line, and that MC3T3-E1 tends to make orientation parallel to the stream line. Deformation and exfoliation of cells can be observed under controlled wall shear stress by the experimental system.

  17. Dialysis centers -- what to expect

    ... F (38.0°C) The arm where your catheter is placed swells and the hand on that side feels cold Your hand gets ... kidneys - dialysis centers; Dialysis - what to expect; Renal replacement therapy - ...

  18. Wearable impedance monitoring system for dialysis patients.

    Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P


    This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

  19. Peritoneal dialysis and inflammation.

    Velloso, Marina Souza Silva; Otoni, Alba; de Paula Sabino, Adriano; de Castro, Whocely Victor; Pinto, Sérgio Wyton Lima; Marinho, Maria Aparecida Silva; Rios, Danyelle Romana Alves


    Peritoneal dialysis (PD) is a kidney replacement therapy for end stage renal disease (ESRD) patients. Despite being a lifesaving treatment, the rate of mortality in patients under PD is elevated, mainly due to the chronic peritoneal dysfunction which is characterized by inflammation, peritoneal fibrosis and neoangiogenesis. The inflammatory process is trigged and modulated by the type of the peritoneal dialysis solutions (PDSs) used during PD. Currently, different PDSs are commercially available: (i) the conventional solutions; (ii) solutions of neutral pH containing low concentration of glucose degradation products (GDPs); (iii) solutions with icodextrin; and (iv) solutions containing taurine. Therefore, the aim of this review is to describe the different types of peritoneal dialysis solutions used during PD and their relationship with systemic and intraperitoneal inflammation. Some studies suggested that solutions of neutral pH containing low concentration of GDPs, icodextrin and taurine have better biocompatibility and lower influence on the inflammatory process compared to the conventional one. On the other hand, the studies, in general, were performed with a small population and for a short period of time. Therefore, further well-designed and -controlled clinical trials with larger number of individuals are required in order to better understand the role of different peritoneal dialysis solution types in the development of inflammation in patients with chronic peritoneal dialysis. Accordingly, studies that are more well-designed, well-controlled and with a larger number of patients are needed to explain and define the role of different types of PDS in the inflammation development in patients with chronic peritoneal dialysis.

  20. Phosphate control in dialysis.

    Cupisti, Adamasco; Gallieni, Maurizio; Rizzo, Maria Antonietta; Caria, Stefania; Meola, Mario; Bolasco, Piergiorgio


    Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

  1. Rotation and deformation of human red blood cells with light from tapered fiber probes

    Liu, Xiaoshuai; Huang, Jianbin; Li, Yuchao; Zhang, Yao; Li, Baojun


    Dynamic rotation and deformation of human red blood cells (RBCs) are extremely important to investigate the survival and mechanical features of cells, which will be of great physiological and pathological significance. Here, we report an optical approach that is capable of both rotating and deforming RBCs with light from two tapered fiber probes (TFPs). With laser beams at the wavelength of 980 nm injected into the TFPs, a single RBC was rotated around different axes while single or multiple RBCs were stretched by adjusting the points of action and magnitude of the optical forces from the TFPs. The biological safety of the approach was also discussed by taking the laser power required into account.

  2. The cell adhesion molecules Echinoid and Friend of Echinoid coordinate cell adhesion and cell signaling to regulate the fidelity of ommatidial rotation in the Drosophila eye.

    Fetting, Jennifer L; Spencer, Susan A; Wolff, Tanya


    Directed cellular movements are a universal feature of morphogenesis in multicellular organisms. Differential adhesion between the stationary and motile cells promotes these cellular movements to effect spatial patterning of cells. A prominent feature of Drosophila eye development is the 90 degrees rotational movement of the multicellular ommatidial precursors within a matrix of stationary cells. We demonstrate that the cell adhesion molecules Echinoid (Ed) and Friend of Echinoid (Fred) act throughout ommatidial rotation to modulate the degree of ommatidial precursor movement. We propose that differential levels of Ed and Fred between stationary and rotating cells at the initiation of rotation create a permissive environment for cell movement, and that uniform levels in these two populations later contribute to stopping the movement. Based on genetic data, we propose that ed and fred impart a second, independent, ;brake-like' contribution to this process via Egfr signaling. Ed and Fred are localized in largely distinct and dynamic patterns throughout rotation. However, ed and fred are required in only a subset of cells - photoreceptors R1, R7 and R6 - for normal rotation, cells that have only recently been linked to a role in planar cell polarity (PCP). This work also provides the first demonstration of a requirement for cone cells in the ommatidial rotation aspect of PCP. ed and fred also genetically interact with the PCP genes, but affect only the degree-of-rotation aspect of the PCP phenotype. Significantly, we demonstrate that at least one PCP protein, Stbm, is required in R7 to control the degree of ommatidial rotation.

  3. Two-Phase Flow in Rotating Hele-Shaw Cells with Coriolis Effects

    Escher, Joachim; Walker, Christoph


    The free boundary problem of a two phase flow in a rotating Hele-Shaw cell with Coriolis effects is studied. Existence and uniqueness of solutions near spheres is established, and the asymptotic stability and instability of the trivial solution is characterized in dependence on the fluid densities.

  4. Benchmarking Pt-based electrocatalysts for low temperature fuel cell reactions with the rotating disk electrode

    Pedersen, Christoffer Mølleskov; Escribano, Maria Escudero; Velazquez-Palenzuela, Amado Andres


    We present up-to-date benchmarking methods for testing electrocatalysts for polymer exchange membrane fuel cells (PEMFC), using the rotating disk electrode (RDE) method. We focus on the oxygen reduction reaction (ORR) and the hydrogen oxidation reaction (HOR) in the presence of CO. We have chosen...

  5. Feasibility of mesothelial transplantation during experimental peritoneal dialysis and peritonitis

    Hekking, L. H. P.; van den Born, J.


    The mesothelial cell layer lining the peritoneum orchestrates peritoneal homeostasis. Continuous exposure to peritoneal dialysis fluids and episodes of peritonitis may damage the monolayer irreversibly, eventually leading to adhesion formation and fibrosis/sclerosis of the peritoneum. Autologous mes

  6. [Incremental peritoneal dialysis - yes].

    Neri, Loris


    The incremental modality at the start of peritoneal dialysis (Incr-DP) is implicit in the definition of adequacy, which is expressed as the sum of dialysis clearance and renal clearance.Theoretically, it is possible to demonstrate that with a glomerular filtration rate at the start of dialysis of 6 mL/min, the minimum Kt/V target of 1.70 indicated by the current guidelines is easily exceeded with both 2-exchange of CAPD (incremental CAPD) and APD of 3 or 4 weekly sessions (Incr-APD), with a daytime icodextrin dwell. The GSDP (Peritoneal Dialysis Study Group) census data suggest that Incr-DP favors the choice of peritoneal dialysis. Although limited to a few studies with a relatively small number of patients, data show that Incr- CAPD is associated with a better quality of life, the achievement of Kt/V targets, and satisfactory ultrafiltration. The clearance of medium molecules is equivalent in Incr-DP and full-dose PD as it depends on the duration of the dwell and not on the number of exchanges. The maintenance of body weight, protein intake and peritoneal permeability may be explained by the lower glucose load with Incr-DP. The preservation of residual renal function is similar to that recorded with full-dose PD, while the peritonitis rate seems to be lower. The favorable results reported in the literature and the indications of the most recent guidelines about the importance of reducing the exposure to glucose to a minimum and safeguarding the patient's quality of life in our opinion further justify the use of Incr-DP.

  7. An improved rotating disc cathode cell for electrodeposition of actinides. The case of plutonium

    Becerril, V.A.; Tejera, R.A. (Inst. Nacional de Investigaciones Nucleares, Mexico City (Mexico)); Meas, V.Y. (Univ. Autonoma Metropolitana Iztapalapa, Area de Electroquimica, Mexico City (Mexico) CIDETEQ, Queretaro (Mexico)); Ozil, P. (CREMGP, ENSEEG, 38 - Saint Martin d' Heres (France))


    An electrolytic rotating disc electrode cell for electrodeposition of very thin and uniform plutonium (Pu) films with consistently high recoveries, was designed. It was made emphasizing the hydrodynamic conditions to be fulfilled by the device in agreement with the rotating disc electrode (RDE) model. The system was characterized by hydrodynamical parameters. The electrodeposition technique will be discussed elsewhere. The deposition yield was 97.5[+-]2.5%. The high quality of the very thin and uniform Pu deposits allowed one to obtain very suitable Pu sources (FWHM=10.8 keV, LM=100 and uniformity =10%) for alpha spectroscopy and for alpha emission probabilities and isotopic ratios studies. (orig.).

  8. Comparative release studies on suppositories using the basket, paddle, dialysis tubing and flow-through cell methods I. Acetaminophen in a lipophilic base suppository.

    Hori, Seiichi; Kawada, Tsubasa; Kogure, Sanae; Yabu, Shinako; Mori, Kenji; Akimoto, Masayuki


    The release characteristics of lipophilic suppositories containing acetaminophen (AAP) were examined using four types of dissolution methods: the basket, paddle, dialysis tubing (DT) and flow-through cell (FTC) methods. The suitability of each apparatus for quality control in AAP compounded suppositories was evaluated using statistical procedures. More than 80% of the drug was released over 60 min in all the release methods studied, with the exception of the basket method. Reproducible and faster release was achieved using the paddle method at 100 and 200 rpm, whereas poor release occurred with the basket method. The mean dissolution time (MDT), maximum dissolved quantity of AAP at the end of the sampling time (Q) and dissolution efficiency (DE) were calculated by model-independent methods. The FTC method with a single chamber used in this study was also appreciable for AAP suppositories (Q of 100%, MDT of 71-91 min and DE of 75-80%). The DT apparatus is considered similar to the FTC apparatus from a quality control perspective for judging the release properties of lipophilic base suppositories containing AAP. However, even the single chamber FTC used in this study has potential as an in vitro drug release test for suppositories. The comparative dissolution method is expected to become one of the valuable tools for selecting an adequate dissolution test.

  9. Expression of membrane complement regulators, CD46, CD55 and CD59, in mesothelial cells of patients on peritoneal dialysis therapy.

    Sei, Yumi; Mizuno, Masashi; Suzuki, Yasuhiro; Imai, Masaki; Higashide, Keiko; Harris, Claire L; Sakata, Fumiko; Iguchi, Daiki; Fujiwara, Michitaka; Kodera, Yasuhiro; Maruyama, Shoichi; Matsuo, Seiichi; Ito, Yasuhiko


    We investigated the expression of membrane complement regulators (CRegs), CD46, CD55 and CD59 in human mesothelial cells, and correlated with clinical background and level of complement (C) activation products in peritoneal dialysis (PD) fluids (PDF) to clarify influence of the C activation system in PD patients. Expression of CRegs was assessed on primary cultures of mesothelial cells (HPMC) harvested from PD fluid of 31 PD patients. Because expression of CD55 but not CD46 and CD59 in mesothelial cells was significantly correlated to value of dialysate-to-plasma creatinine concentration ratio (D/P Cre) (p<0.005) as an indicator of peritoneal function, we focused on analysis of CD55 expression of HPMCs in comparison with levels of C activation products in the PDF of the PD patients, and their background factors. When comparing expression of the CRegs between systemic neutrophils and HPMC, no correlation was observed, supporting that change of CRegs' expression in HPMC was independently occurring in the peritoneum. Expression of CD55 protein in HPMC was closely correlated with expression at the mRNA level (p<0.0001) and was inversely correlated with levels of sC5b-9 (p<0.05), but not C3, C4, IL6 and CA125 in the PDF. Complications of diabetes, usage of icodextrin and residual renal function were not correlated with change of CD55 expression in HPMCs. Our data show that the process of PD therapy modifies expression of CD55 on peritoneal mesothelium and triggers local C activation. These findings support efforts to modify PD therapy to limit effects on activation and regulation of the C system.

  10. [Assisted peritoneal dialysis].

    Klarić, Dragan; Prkačin, Ingrid


    According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.

  11. Perivascular Stem Cells Diminish Muscle Atrophy Following Massive Rotator Cuff Tears in a Small Animal Model.

    Eliasberg, Claire D; Dar, Ayelet; Jensen, Andrew R; Murray, Iain R; Hardy, Winters R; Kowalski, Tomasz J; Garagozlo, Cameron A; Natsuhara, Kyle M; Khan, Adam Z; McBride, Owen J; Cha, Peter I; Kelley, Benjamin V; Evseenko, Denis; Feeley, Brian T; McAllister, David R; Péault, Bruno; Petrigliano, Frank A


    Rotator cuff tears are a common cause of shoulder pain and often necessitate operative repair. Muscle atrophy, fibrosis, and fatty infiltration can develop after rotator cuff tears, which may compromise surgical outcomes. This study investigated the regenerative potential of 2 human adipose-derived progenitor cell lineages in a murine model of massive rotator cuff tears. Ninety immunodeficient mice were used (15 groups of 6 mice). Mice were assigned to 1 of 3 surgical procedures: sham, supraspinatus and infraspinatus tendon transection (TT), or TT and denervation via suprascapular nerve transection (TT + DN). Perivascular stem cells (PSCs) were harvested from human lipoaspirate and sorted using fluorescence-activated cell sorting into pericytes (CD146 CD34 CD45 CD31) and adventitial cells (CD146 CD34 CD45 CD31). Mice received no injection, injection with saline solution, or injection with pericytes or adventitial cells either at the time of the index procedure ("prophylactic") or at 2 weeks following the index surgery ("therapeutic"). Muscles were harvested 6 weeks following the index procedure. Wet muscle weight, muscle fiber cross-sectional area, fibrosis, and fatty infiltration were analyzed. PSC treatment after TT (prophylactic or therapeutic injections) and after TT + DN (therapeutic injections) resulted in less muscle weight loss and greater muscle fiber cross-sectional area than was demonstrated for controls (p muscle atrophy in the groups treated with PSCs compared with controls. This suggests that the use of PSCs may have a role in the prevention of muscle atrophy without leading to increased fibrosis or fatty infiltration. Improved muscle quality in the setting of rotator cuff tears may increase the success rates of surgical repair and lead to superior clinical outcomes.

  12. Trace elements in dialysis.

    Filler, Guido; Felder, Sarah


    In end-stage chronic kidney disease (CKD), pediatric nephrologists must consider the homeostasis of the multiple water-soluble ions that are influenced by renal replacement therapy (RRT). While certain ions such as potassium and calcium are closely monitored, little is known about the handling of trace elements in pediatric dialysis. RRT may lead to accumulation of toxic trace elements, either due to insufficient elimination or due to contamination, or to excessive removal of essential trace elements. However, trace elements are not routinely monitored in dialysis patients and no mechanism for these deficits or toxicities has been established. This review summarizes the handling of trace elements, with particular attention to pediatric data. The best data describe lead and indicate that there is a higher prevalence of elevated lead (Pb, atomic number 82) levels in children on RRT when compared to adults. Lead is particularly toxic in neurodevelopment and lead levels should therefore be monitored. Monitoring of zinc (Zn, atomic number 30) and selenium (Se, atomic number 34) may be indicated in the monitoring of all pediatric dialysis patients to reduce morbidity from deficiency. Prospective studies evaluating the impact of abnormal trace elements and the possible therapeutic value of intervention are required.

  13. Renal Dialysis and its Financing.

    Borelli, Marisa; Paul, David P; Skiba, Michaeline


    The incidence of end-stage renal disease (ESRD) and its associated comorbidities such as diabetes and hypertension continue to increase as the population ages. As most ESRD patients qualify for Medicare coverage, the U.S. government initiated reforms of the payment system for dialysis facilities in an effort to decrease expenditures associated with ESRD reimbursement. The effects of reduced reimbursement rates, bundled payment options, and quality incentives on the current dialysis system, including kidney dialysis units, physicians, and patients, are examined.

  14. Peritoneal Dialysis Dose and Adequacy

    ... salt, and other minerals dissolved in water, called dialysis solution, is placed in a person's abdominal cavity through a catheter. The body's peritoneal membrane enclosing the digestive organs ...

  15. Treatment Methods for Kidney Failure: Peritoneal Dialysis

    ... During an exchange, you can read, talk, watch television, or sleep. Usually, you change the dialysis solution at least ... During an exchange, you can read, talk, watch television, or sleep. Dialysis Solution Dialysis solution comes in 1.5-, ...

  16. Effect of glucose and pyruvate in acidic and non-acidic peritoneal dialysis fluids on leukocytes cell functions.

    Mahiout, A; Matata, B M; Brunkhorst, R


    A new peritoneal dialysate containing pyruvate anions has been tested for its effects on cell functions and compared with conventional lactate and bicarbonate based solutions. The dialysate has a final pH of 5.4 to 5.6 and is composed of 1.36 to 3.86% glucose-monohydrate, 132 mmol/liter sodium, 1.75 mmol/liter calcium, 0.75 mmol/liter magnesium, 102 mmol/liter chloride and 35 mmol/liter pyruvate. For cytotoxicity testing peritoneal macrophages and peripheral blood mononuclear cells (PBMC) were exposed to conventional lactate dialysate, pyruvate dialysate, bicarbonate dialysate and a control medium RPMI 1640 (Biochrom KG, Berlin, Germany), followed by activation with different bacterial stimuli. In addition, the study further investigated the effect of varying glucose concentration in the different dialysates ranging from 0 to 3.86% and pH changes between 5.2 and 7.4 on the cytotoxicity effect on the selected cells. Mononuclear cells exposed to pyruvate-based dialysate before stimulation with endotoxin exhibited a tumor necrosis factor (TNF)-mRNA signal comparable to those of cells exposed to RPMI. In contrast, exposure to lactate-based dialysate completely inhibited TNF-mRNA synthesis. In addition, cytokine synthesis in macrophages and PBMCs after exposure to pyruvate was less inhibited when compared to the corresponding levels measured after exposure to lactate. The chemotactic response of polymorphonuclear cells and O-2 generation in all tested cell types after exposure to pyruvate was found not to be inhibited, whereas a complete inhibition was observed after exposure to lactate. The results demonstrate that cytotoxicity effects of peritoneal dialysate on cell lines can be minimized by using a new dialysate formulation containing pyruvate anions instead of lactate.

  17. [Icodextrine peritoneal dialysis solution in clinical practice].

    Opatrná, S


    Icodextrin, a glucose polymer, is an alternative osmotic agent to glucose in peritoneal dialysis solutions. Icodextrin generates ultrafiltration through colloid osmosis and is thus effective even during long-term (e.g., nighttime) dwells and in cases of high peritoneal permeability, where it prevents dialysate reabsorption into the systemic circulation. Ultrafiltration is maintained even in the presence of peritonitis. The incidence of bacterial peritonitis is not different when using icodextrin- or glucose-based solutions. Some time ago, icodextrin use was implicated in an increased incidence of sterile peritonitis. This was due to contamination of some batches of the solution by peptidoglycan present in the cell wall of G+ bacteria. Using exact isotope methods, treatment with icodextrin-based solution has been shown to improve the hydration status of peritoneal dialysis patients, suggesting a potential for improved blood pressure control. Icodextrin-based dialysis is associated with a reduction of left ventricular mass. Given the methodological flaws of trials conducted to date, the acute hemodynamic effects of icodextrin cannot be conclusively interpreted. Inclusion of icodextrin-based solution instead of the glucose-based one into the prescription of peritoneal dialysis decreases the metabolic load with glucose potentially having a beneficial effect on hyperlipidemia, hyperinsulinemia and hyperleptinemia, with improved glycemic control in patients with diabetes as an additional benefit. Function of the peritoneum as a dialysis membrane is stable during icodextrin-based treatment, possibly longer compared with glucose-based solutions. Data derived from a large-scale registry have shown lower mortality oficodextrin-treated patients; this, however, needs to be confirmed by prospective randomized controlled trials.

  18. Optical path length and trajectory stability in rotationally asymmetric multipass cells.

    Harden, Galen H; Cortes-Herrera, Luis E; Hoffman, Anthony J


    We describe the behavior of optical trajectories in multipass rotationally asymmetric cavities (RACs) using a phase-space motivated approach. Emphasis is placed on generating long optical paths. A trajectory with an optical path length of 18 m is generated within a 68 cm3 volume. This path length to volume ratio (26.6 cm-2) is large compared to current state of the art multipass cells such as the cylindrical multipass cell (6.6 cm-2) and astigmatic Herriott cell (9 cm-2). Additionally, the effect of small changes to the input conditions on the path length is studied and compared to the astigmatic Herriott cell. This work simplifies the process of designing RACs with long optical path lengths and could lead to broader implementation of these multipass cells.

  19. Cell culture for three-dimensional modeling in rotating-wall vessels: an application of simulated microgravity

    Schwarz, R. P.; Goodwin, T. J.; Wolf, D. A.


    High-density, three-dimensional cell cultures are difficult to grow in vitro. The rotating-wall vessel (RWV) described here has cultured BHK-21 cells to a density of 1.1 X 10(7) cells/ml. Cells on microcarriers were observed to grow with enhanced bridging in this batch culture system. The RWV is a horizontally rotated tissue culture vessel with silicon membrane oxygenation. This design results in a low-turbulence, low-shear cell culture environment with abundant oxygenation. The RWV has the potential to culture a wide variety of normal and neoplastic cells.

  20. Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients.

    Mitsuhiro Tawada

    Full Text Available Encapsulating peritoneal sclerosis (EPS is a rare but serious and life-threatening complication of peritoneal dialysis (PD. However, the precise pathogenesis remains unclear; in addition, predictors and early diagnostic biomarkers for EPS have not yet to be established.Eighty-three peritoneal membrane samples taken at catheter removal were examined to identify pathological characteristics of chronic peritoneal deterioration, which promotes EPS in patients undergoing long-term PD treatment with low occurrence of peritonitis.According to univariable logistic regression analysis of the pathological findings, thickness of the peritoneal membrane (P = 0.045, new membrane formation score (P = 0.006, ratio of luminal diameter to vessel diameter (L/V ratio, P<0.001, presence of CD31-negative vessels (P = 0.021, fibrin deposition (P<0.001, and collagen volume fraction (P = 0.018 were associated with EPS development. In analyses of samples with and without EPS matched for PD treatment period, non-diabetes, and PD solution, univariable analysis identified L/V ratio (per 0.1 increase: odds ratio (OR 0.44, P = 0.003 and fibrin deposition (OR 6.35, P = 0.027 as the factors associated with EPS. L/V ratio was lower in patients with fibrin exudation than in patients without fibrin exudation.These findings suggest that damage to vascular endothelial cells, as represented by low L/V ratio, could be a predictive finding for the development of EPS, particularly in long-term PD patients unaffected by peritonitis.

  1. Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

    Luciola de Barros Pontes


    Full Text Available Purpose of the Study: Diffuse large B-cell lymphoma (DLBCL is the most common lymphoid malignancy worldwide. Its incidence increases with age and about 40% of cases occur in patients over 70 years. Herein, we describe a case of a frail elderly patient with renal insufficiency and DLBCL treated with R-mini-CHOP. Case Report: A 77-year-old man on maintenance hemodialysis started experiencing persistent fatigue. He was diagnosed with a large mass on the left lobe of the lung. Biopsy demonstrated a DLBCL, CD20 positive. The patient was assigned clinical stage IIBX, with a high age-adjusted international prognosis index. A proper geriatric assessment revealed a frail patient. Thus, an adapted chemotherapy regimen was proposed which consisted of R-mini-CHOP every 21 days, with a reduction of 10% in the doses of doxorubicin and cyclophosphamide. During the treatment, the patient went through regular dialysis sessions, 3 times per week, with an extra session performed 12 h after each chemotherapy administration. The patient experienced no adverse events or grade 3/4 toxicities. After 6 cycles of R-mini-CHOP, the patient achieved unconfirmed complete remission, and consolidation radiotherapy was performed. At the last follow-up, he was still in unconfirmed complete remission, with a progression-free survival of 11.3 months. Conclusions: R-mini-CHOP represented a reasonable treatment option for this patient with renal failure. The oncogeriatric approach led to a successful management of this frail patient, highlighting that an adapted plan of care is a key issue to improve the outcomes of elderly cancer patients.

  2. Comparison of icodextrin- and glucose-based peritoneal dialysis fluids in their acute and chronic effects on human peritoneal mesothelial cells.

    Bender, T O; Witowski, J; Ksiazek, K; Jörres, A


    Icodextrin-based peritoneal dialysis fluids (PDFs) display several features that may potentially improve their biocompatibility compared to conventional glucose-containing solutions. So far, however, the studies assessing the biocompatibility profile of icodextrin toward human peritoneal mesothelial cells (HPMC) has produced mixed results. The present study was performed to examine the acute and chronic impact of icodextrin on HPMC in vitro in comparison with standard glucose-based PDF. Omentum-derived HPMC were either acutely pre-exposed to or incubated chronically (for up to 10 days) in the presence of icodextrin-PDF. Parallel cultures were treated with conventional PDFs containing either 1.5% or 4.25% glucose. All fluids were tested at neutral pH. HPMC were assessed for viability, proliferation, IL-6 secretion and generation of reactive oxygen species (ROS). Incubation in the presence of icodextrin-PDF significantly reduced HPMC proliferation in a manner similar to that of 1.5% glucose-PDF. In addition, exposure to icodextrin-PDF impaired viability and IL-6 release from HPMC. This effect occurred both after the short pre-treatment with neat icodextrin-PDF for 1-4 hours and after prolonged incubation (up to 10 days) in media supplemented with icodextrin-PDF (1:1). The dysfunction of icodextrin-treated HPMC was of the magnitude that was between the effects exerted by 1.5%- and 4.25%-glucose PDF. Furthermore, exposure of HPMC to icodextrin-PDF induced a dose-dependent increase in ROS generation which was comparable to that produced by 1.5%-glucose PDF. Exposure to icodextrin-PDF may impair viability and function of HPMC. The detrimental effects of icodextrin-PDF are at least as serious as those produced by conventional heat-sterilized low glucose-based PDF.

  3. Improved Imaging of Magnetically Labeled Cells Using Rotational Magnetomotive Optical Coherence Tomography

    Peter Cimalla


    Full Text Available In this paper, we present a reliable and robust method for magnetomotive optical coherence tomography (MM-OCT imaging of single cells labeled with iron oxide particles. This method employs modulated longitudinal and transverse magnetic fields to evoke alignment and rotation of anisotropic magnetic structures in the sample volume. Experimental evidence suggests that magnetic particles assemble themselves in elongated chains when exposed to a permanent magnetic field. Magnetomotion in the intracellular space was detected and visualized by means of 3D OCT as well as laser speckle reflectometry as a 2D reference imaging method. Our experiments on mesenchymal stem cells embedded in agar scaffolds show that the magnetomotive signal in rotational MM-OCT is significantly increased by a factor of ~3 compared to previous pulsed MM-OCT, although the solenoid’s power consumption was 16 times lower. Finally, we use our novel method to image ARPE-19 cells, a human retinal pigment epithelium cell line. Our results permit magnetomotive imaging with higher sensitivity and the use of low power magnetic fields or larger working distances for future three-dimensional cell tracking in target tissues and organs.

  4. Stromal vascular stem cell treatment decreases muscle fibrosis following chronic rotator cuff tear.

    Gumucio, Jonathan P; Flood, Michael D; Roche, Stuart M; Sugg, Kristoffer B; Momoh, Adeyiza O; Kosnik, Paul E; Bedi, Asheesh; Mendias, Christopher L


    Rotator cuff injuries are associated with atrophy and fat infiltration into the muscle, commonly referred to as "fatty degeneration." As the poor function of chronically torn muscles may limit recovery after surgical repair, there is considerable interest in finding therapies to enhance muscle regeneration. Stromal vascular fraction stem cells (SVFCs) can improve muscle regeneration in other chronic injury states, and our objective was to evaluate the ability of SVFCs to reduce fibrosis and fat accumulation, and enhance muscle fibre specific force production after chronic rotator cuff tear. Chronic supraspinatus tears were induced in adult immunodeficient rats, and repaired one month following tear. Rats received vehicle control, or injections of 3 × 10(5) or 3 × 10(6) human SVFCs into supraspinatus muscles. Two weeks following repair, we detected donor human DNA and protein in SVFC treated muscles. There was a 40 % reduction in fibrosis in the treated groups compared to controls (p = 0.03 for 3 × 10(5), p = 0.04 for 3 × 10(6)), and no differences between groups for lipid content or force production were observed. As there has been much interest in the use of stem cell-based therapies in musculoskeletal regenerative medicine, the reduction in fibrosis and trend towards an improvement in single fiber contractility suggest that SVFCs may be beneficial to enhance the treatment and recovery of patients with chronic rotator cuff tears.

  5. Metabolic alterations in dialysis patients

    Drechsler, Christiane


    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney d

  6. Metabolic alterations in dialysis patients

    Drechsler, Christiane


    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney

  7. Stem cell therapy in the management of shoulder rotator cuff disorders

    Mora, Maria Valencia; Ibán, Miguel A Ruiz; Heredia, Jorge Díaz; Laakso, Raul Barco; Cuéllar, Ricardo; Arranz, Mariano García


    Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy. PMID:26029341

  8. Testosterone deficiency in dialysis patients: Difference between dialysis techniques.

    Cigarrán, Secundino; Coronel, Francisco; Florit, Enrique; Calviño, Jesús; Villa, Juan; Gonzalez Tabares, Lourdes; Herrero, José Antonio; Carrero, Juan Jesús

    Testosterone deficiency is a prevalent condition in male patients with chronic kidney disease. However, it is not known whether the type of renal replacement therapy has an impact on testosterone deficiency that accompanies loss of renal function. The cross-sectional study enrolled 79 prevalent male patients on dialysis; 43 on haemodialysis (HD) and 36 on peritoneal dialysis (PD). The median age was 69 years and 31.6% were diabetics. Endogenous testosterone levels were measured by immunoluminescence assay (normal range 3-10.5ng/ml), while nutritional/inflammatory markers, bone and mineral metabolism markers, anaemia, type of dialysis technique and time on dialysis were also assessed. Body composition was evaluated by bioimpedance vector analysis and bioimpedance spectroscopy. Testosterone deficiency was defined as levels below 3ng/ml. Mean testosterone levels were 8.81±6.61ng/ml. Testosterone deficiency affected 39.5% of HD patients and only 5.6% of PD patients. In the univariate analysis, testosterone levels were directly correlated with type of dialysis technique (HD) (Rho Spearman 0.366; P<.001) and time on dialysis (Rho -0.412; P=.036) and only with the HD technique in the multivariate analysis. No other significant correlations were found. Circulating testosterone levels in men on dialysis were independently associated with HD technique. It can be concluded that a new factor -namely the dialysis technique- may be associated with falling testosterone levels and the associated loss of muscle mass and inflammation. Further studies are needed to establish whether the dialysis technique itself triggers testosterone elimination. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

    Stamopoulos D


    Full Text Available Dimosthenis Stamopoulos,1 Nerantzoula Bakirtzi,2,3 Efthymios Manios,1 Eirini Grapsa41Institute of Advanced Materials, Physicochemical Processes, Nanotechnology and Microsystems, National Center for Scientific Research 'Demokritos,' Athens, Greece; 2Department of Nephrology, Hospital 'G. Gennimatas,' Athens, Greece; 3Renal Unit, Hospital 'Alexandra,' Athens, Greece; 4Renal Unit, Hospital 'Aretaieion,' Athens, GreeceBackground: In hemodialysis (HD patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs. The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level.Methods: Atomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones.Results: The iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100–1,000 nm and crevice-like (low incidence; typical size within 500–4,000 nm defects that exhibited a statistically significant (P < 0.05 relative increase (+55% and +350%, respectively in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface between pre- and post-HD was not statistically significant (−3.3% and +4.5%, respectively. The orifice index correlates with the concentrations of urea, calcium, and

  10. Anodic concentration loss and impedance characteristics in rotating disk electrode microbial fuel cells.

    Shen, Liye; Ma, Jingxing; Song, Pengfei; Lu, Zhihao; Yin, Yao; Liu, Yongdi; Cai, Lankun; Zhang, Lehua


    A rotating disk electrode (RDE) was used to investigate the concentration loss and impedance characteristics of anodic biofilms in microbial fuel cells (MFCs). Amperometric time-current analysis revealed that at the rotation rate of 480 rpm, a maximum current density of 168 µA cm(-2) can be achieved, which was 22.2 % higher than when there was no rotation. Linear sweep voltammetry and electrochemical impedance spectroscopy tests showed that when the anodic potential was set to -300 mV vs. Ag/AgCl reference, the power densities could increase by 59.0  %, reaching 1385 mW m(-2), the anodic resistance could reduce by 19  %, and the anodic capacitance could increase by 36 %. These results concur with a more than 85 % decrease of the diffusion layer thickness. Data indicated that concentration loss, diffusion layer thickness, and the mixing velocity play important roles in anodic resistance reduction and power output of MFCs. These findings could be helpful to the design of future industrial-scale MFCs with mixed bacteria biofilms.

  11. Selected indices of peritoneal fibrosis in patients undergoing peritoneal dialysis

    Józef Penar


    Full Text Available Peritoneal dialysis is an alternative to hemodialysis in the treatment of patients with end-stage renal disease. Long-term use of peritoneal dialysis is limited by progressive alterations in the peritoneal membrane. The pathological changes in the peritoneum are due to the exposure to traditional nonphysiological peritoneal dialysis fluids that have low pH, high glucose and glucose degradation product content, and high molarity. Repeated episodes of bacterial peritonitis are another cause of peritoneal membrane damage. The characteristic features of peritoneal alterations include peritoneal fibrosis and morphologic changes in the peritoneal microvasculature with the accumulation of extracellular matrix in the submesothelial area and loss of mesothelial cells. These changes in the peritoneal membrane cause ultrafiltration failure and loss of dialysis efficacy. The pathogenesis of the peritoneal membrane damage is very complicated and understanding the processes involved in these alterations will be crucial in improving treatment with peritoneal dialysis. Some points of view on fibrosis of peritoneal membrane in patients undergoing peritoneal dialysis are presented here.

  12. Peritoneal dialysis in Asia.

    Cheng, I K


    The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last

  13. A minimal model for spontaneous cell polarization and edge activity in oscillating, rotating and migrating cells

    Raynaud, Franck; Gabella, Chiara; Bornert, Alicia; Sbalzarini, Ivo F; Meister, Jean-Jacques; Verkhovsky, Alexander B


    How the cells break symmetry and organize their edge activity to move directionally is a fun- damental question in cell biology. Physical models of cell motility commonly rely on gradients of regulatory factors and/or feedback from the motion itself to describe polarization of edge activity. Theses approaches, however, fail to explain cell behavior prior to the onset of polarization. Our analysis using the model system of polarizing and moving fish epidermal keratocytes suggests a novel and simple principle of self-organization of cell activity in which local cell-edge dynamics depends on the distance from the cell center, but not on the orientation with respect to the front-back axis. We validate this principle with a stochastic model that faithfully reproduces a range of cell-migration behaviors. Our findings indicate that spontaneous polarization, persistent motion, and cell shape are emergent properties of the local cell-edge dynamics controlled by the distance from the cell center.

  14. Dialysis and transplantation in Sudan.

    Suliman, S M; Beliela, M H; Hamza, H


    In this report we present the current status of the renal replacement therapy in Sudan. Sudan is a large country with 30 million inhabitants. Peritoneal Dialysis was started in 1968, while hemodialysis was started in 1973. At present, there are only 16 hemodialysis machines serving 56 patients in two centers in Sudan. There are also 15 peritoneal dialysis beds for 70 intermittent peritoneal dialysis patients in three centers. Continuous ambulatory peritoneal dialysis is not being practiced in Sudan. The first renal transplant was in 1974, and till now more than 30 transplants have been performed in two transplant centers. All the transplants have been from living donors. The scholars of Islam in Sudan oppose to donation from cadavers. There are 200 renal transplant patients being followed up in Sudan and the majority had their renal transplants abroad. We conclude that there is a tremendous shortage of renal services in Sudan. There are more efforts being made to improve these services.

  15. [Peritoneal dialysis today and tomorrow].

    Grangier, Jean-Pierre


    Peritoneal dialysis was first used in the 1980s. Less well-known than haemodialysis, it represents an important treatment option for elderly patients at home. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Culturing and applications of rotating wall vessel bioreactor derived 3D epithelial cell models.

    Radtke, Andrea L; Herbst-Kralovetz, Melissa M


    Cells and tissues in the body experience environmental conditions that influence their architecture, intercellular communications, and overall functions. For in vitro cell culture models to accurately mimic the tissue of interest, the growth environment of the culture is a critical aspect to consider. Commonly used conventional cell culture systems propagate epithelial cells on flat two-dimensional (2-D) impermeable surfaces. Although much has been learned from conventional cell culture systems, many findings are not reproducible in human clinical trials or tissue explants, potentially as a result of the lack of a physiologically relevant microenvironment. Here, we describe a culture system that overcomes many of the culture condition boundaries of 2-D cell cultures, by using the innovative rotating wall vessel (RWV) bioreactor technology. We and others have shown that organotypic RWV-derived models can recapitulate structure, function, and authentic human responses to external stimuli similarly to human explant tissues (1-6). The RWV bioreactor is a suspension culture system that allows for the growth of epithelial cells under low physiological fluid shear conditions. The bioreactors come in two different formats, a high-aspect rotating vessel (HARV) or a slow-turning lateral vessel (STLV), in which they differ by their aeration source. Epithelial cells are added to the bioreactor of choice in combination with porous, collagen-coated microcarrier beads (Figure 1A). The cells utilize the beads as a growth scaffold during the constant free fall in the bioreactor (Figure 1B). The microenvironment provided by the bioreactor allows the cells to form three-dimensional (3-D) aggregates displaying in vivo-like characteristics often not observed under standard 2-D culture conditions (Figure 1D). These characteristics include tight junctions, mucus production, apical/basal orientation, in vivo protein localization, and additional epithelial cell-type specific properties

  17. Water channels in peritoneal dialysis.

    Devuyst, Olivier


    Peritoneal dialysis involves diffusive and convective transports and osmosis through the highly vascularized peritoneal membrane. Several lines of evidence have demonstrated that the water channel aquaporin-1 (AQP1) corresponds to the ultrasmall pore predicted by the modelization of peritoneal transport. Proof-of-principle studies have shown that up-regulation of the expression of AQP1 in peritoneal capillaries is reflected by increased water permeability and ultrafiltration, without affecting the osmotic gradient and the permeability for small solutes. Inversely, studies in Aqp1 mice have shown that haploinsufficiency in AQP1 is reflected by significant attenuation of water transport. Recent studies have identified lead compounds that could act as agonists of aquaporins, as well as putative binding sites and potential mechanisms of gating the water channel. By modulating water transport, these pharmacological agents could have clinically relevant effects in targeting specific tissues or disease states. These studies on the peritoneal membrane also provide an experimental framework to investigate the role of water channels in the endothelium and various cell types.

  18. Tidal peritoneal dialysis: preliminary experience.

    Flanigan, M J; Doyle, C; Lim, V S; Ullrich, G


    To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). An open enrollment pilot study. The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 +/- 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).

  19. Determinants of survival among HIV-infected chronic dialysis patients.

    Rodriguez, Rudolph A; Mendelson, Michael; O'Hare, Ann M; Hsu, Ling Chin; Schoenfeld, Patricia


    Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.

  20. Effect of atomic noise on optical squeezing via polarization self-rotation in a thermal vapor cell

    Hsu, M.T.L.; Hetet, G.; Peng, A.


    show results of the characterization of PSR in isotopically enhanced rubidium-87 cells, performed in two independent laboratories. We observed that, contrary to earlier work, the presence of atomic noise in the thermal vapor overwhelms the observation of squeezing. We present a theory that contains......The traversal of an elliptically polarized optical field through a thermal vapor cell can give rise to a rotation of its polarization axis. This process, known as polarization self-rotation (PSR), has been suggested as a mechanism for producing squeezed light at atomic transition wavelengths. We...... atomic noise terms and show that a null result in squeezing is consistent with this theory....

  1. The dialysis catheter and infectious peritonitis in intermittent peritoneal dialysis

    Kolmos, Hans Jørn; Hemmeløff Andersen, Karl Erik; Hansen, Lise


    118 episodes of infectious peritonitis registered among 156 patients treated with intermittent peritoneal dialysis over a 5-yr period were analysed with special reference to potential routes of infection associated with the dialysis catheter. Peritonitis was randomly distributed among the patients......, and the change of keeping free of peritonitis declined exponentially with time. The main factor determining the individual number of episodes was the total space of time, in which a patient had been wearing a dialysis catheter, whereas the number of catheter disconnections played no significant role. A relative...... preponderance of cases due to Enterobacteriaceae was noted within the first week after catheter implantation. In contrast with this, peritonitis with skin microorganisms was not associated with the implantation of catheters....

  2. Anemia in peritoneal dialysis patients

    Laušević Mirjana


    Full Text Available A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13% patients were treated with rHuEPO, 14 (28% underwent continuous ambulatory peritoneal dialysis (CAPD, 2 (100% - automated peritoneal dialysis (APD and 2 (33.3% - intermittent peritoneal dialysis (IPD. Mean hemoglobin level was 98.6±17.82 g/l in patients treated with rHuEPO versus 98.81±15.14 g/I in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85±1211.77 IU/week. AII patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 ±360 μg/l. Transferrin saturation (TSAT was 0.35±0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and

  3. Particle image velocimetry (PIV) study of rotating cylindrical filters for animal cell perfusion processes.

    Figueredo-Cardero, Alvio; Chico, Ernesto; Castilho, Leda; de Andrade Medronho, Ricardo


    In the present work, the main fluid flow features inside a rotating cylindrical filtration (RCF) system used as external cell retention device for animal cell perfusion processes were investigated using particle image velocimetry (PIV). The motivation behind this work was to provide experimental fluid dynamic data for such turbulent flow using a high-permeability filter, given the lack of information about this system in the literature. The results shown herein gave evidence that, at the boundary between the filter mesh and the fluid, a slip velocity condition in the tangential direction does exist, which had not been reported in the literature so far. In the RCF system tested, this accounted for a fluid velocity 10% lower than that of the filter tip, which could be important for the cake formation kinetics during filtration. Evidence confirming the existence of Taylor vortices under conditions of turbulent flow and high permeability, typical of animal cell perfusion RCF systems, was obtained. Second-order turbulence statistics were successfully calculated. The radial behavior of the second-order turbulent moments revealed that turbulence in this system is highly anisotropic, which is relevant for performing numerical simulations of this system.

  4. Far off-resonance laser frequency stabilization using multipass cells in Faraday rotation spectroscopy.

    Quan, Wei; Li, Yang; Li, Rujie; Shang, Huining; Fang, Zishan; Qin, Jie; Wan, Shuangai


    We propose a far off-resonance laser frequency stabilization method by using multipass cells in Rb Faraday rotation spectroscopy. Based on the detuning equation, if multipass cells with several meters optical path length are used in the conventional Faraday spectroscopy, the detuning of the lock point can be extended much further from the alkali metal resonance. A plate beam splitter was used to generate two different Faraday signals at the same time. The transmitted optical path length was L=50  mm and the reflected optical path length was 2L=100  mm. When the optical path length doubled, the detuning of the lock points moved further away from the atomic resonance. The temperature dependence of the detuning of the lock point was also analyzed. A temperature-insensitive lock point was found near resonance when the cell temperature was between 110°C and 130°C. We achieved an rms fluctuation of 0.9 MHz/23 h at a detuning of 0.5 GHz. A frequency drift of 16 MHz/h at a detuning of -5.6  GHz and 4 MHz/h at a detuning of -5.2  GHz were also obtained for the transmitted and reflected light Faraday signal.

  5. Aliskiren prevents the toxic effects of peritoneal dialysis fluids during chronic dialysis in rats.

    Juan Pérez-Martínez

    Full Text Available The benefits of long-term peritoneal dialysis (PD in patients with end-stage renal failure are short-lived due to structural and functional changes in the peritoneal membrane. In this report, we provide evidence for the in vitro and in vivo participation of the renin-angiotensin-aldosterone system (RAAS in the signaling pathway leading to peritoneal fibrosis during PD. Exposure to high-glucose PD fluids (PDFs increases damage and fibrosis markers in both isolated rat peritoneal mesothelial cells and in the peritoneum of rats after chronic dialysis. In both cases, the addition of the RAAS inhibitor aliskiren markedly improved damage and fibrosis markers, and prevented functional modifications in the peritoneal transport, as measured by the peritoneal equilibrium test. These data suggest that inhibition of the RAAS may be a novel way to improve the efficacy of PD by preventing inflammation and fibrosis following peritoneal exposure to high-glucose PDFs.

  6. Features of Rotating Stall Cell in a Diagonal Flow Fan(in Case of Mid-loading Rotor)



    The structure and behavior of rotating stall cell were experimentally clarified in a diagonal flow fan. The specific-speed of the fan was 1140 (r/min, m3/min, m), and the total pressure-rise coefficient at design flow-rate was 0.345. The static pressure on outer casing wall and the total pressure at rotor inlet and outlet were measured using a high response pressure transducer. The measured data were processed by the use of DPLA technique, and the structure and behavior of rotating stall cell were obtained. As a result, the stall cell extent for circumferential and spanwise direction and the pressure distributions inside stall cell were clarified. The details of stall cell propagation were also shown.

  7. Depression Often Untreated in Dialysis Patients

    ... page: Depression Often Untreated in Dialysis Patients Sometimes it's the ... 26, 2017 THURSDAY, Jan. 26, 2017 (HealthDay News) -- Depression is common among kidney failure patients undergoing dialysis. ...

  8. Dialysis: MedlinePlus Health Topic

    ... Filtering Dialysis Myths from Facts (National Kidney Foundation) Hemodialysis Catheters: How to Keep Yours Working Well (National Kidney ... Thrombotic complications and tip position of transjugular chronic dialysis catheter... Article: Clinical emergency treatment of 68 critical patients ...

  9. Effects of disinfectants in renal dialysis patients

    Klein, E.


    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has let to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe/sup 2 +/ in hemoglobin to Fe/sup 3 +/ forms methemoglobin, which is incapable of carrying either O/sub 2/ or CO/sub 2/. Chloramine can form not only methemoglobin, but can also denature proteins within the red cell, thus forming aggregates (Heinz bodies). Chloramines also inhibit hexose monophosphate shunt activity, a mechanism that makes the red cell even more susceptible to oxidant damage.

  10. Alternative dialysis strategies with icodextrin.

    Panzer, Sarah E; Teitelbaum, Isaac


    Proper volume management continues to be a major challenge in patients requiring renal replacement therapy. In patients performing peritoneal dialysis the introduction of icodextrin represented a major advance in this effort. Recent studies have demonstrated a potential role for the use of novel dialysis strategies employing icodextrin to further enhance ultrafiltration and to improve cardiac indices in patients with ultrafiltration failure. These alternative strategies include the use of icodextrin in non-traditional patient populations (low transporters), the simultaneous use of glucose-based and icodextrin solutions in combination, and the use of icodextrin twice daily rather than for just a single dwell. This paper will briefly review the current status of these alternative dialysis strategies with icodextrin. In addition, the potential role for icodextrin to decrease postoperative adhesions will be discussed as well. Copyright © 2012 S. Karger AG, Basel.

  11. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.


    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program...

  12. Lymphocyte apoptosis: role of uremia and permeability of dialysis membrane.

    Soriano, Sagrario; Martín-Malo, Alejandro; Carracedo, Julia; Ramírez, Rafael; Rodríguez, Mariano; Aljama, Pedro


    Uremia is associated to host defense mechanism disorders. Lymphocyte apoptosis, which may cause alteration of the immune system, is increased in uremic patients. The aim of the present study was to determine if, in addition to uremia, dialysis membranes with different biocompatibility and permeability have an effect on lymphocyte apoptosis. Cell apoptosis and Fas expression were assessed using flow cytometry in four groups of patients: (1) uremic non-dialyzed (Non-D) patients; (2) hemodialysis (HD) patients on hemophan; (3) low-flux polysulfone, and (4) high-flux polysulfone membrane. Ten healthy volunteers were used as controls. At baseline, lymphocytes from patients on hemophan showed an increase in apoptosis (18.4 +/- 6.9%) as compared with Non-D (7.2 +/- 2.8%; p dialysis patients lymphocyte apoptosis is influenced not only by the biocompatibility but also by the permeability of the dialysis membrane.

  13. [Use of adipose-derived stem cells in an experimental rotator cuff fracture animal model].

    Barco, R; Encinas, C; Valencia, M; Carrascal, M T; García-Arranz, M; Antuña, S


    Rotator cuff repairs have shown a high level of re-ruptures. We hypothesized that the use of adipose-derived stem cells (ASC) could improve the biomechanical and histological properties of the repair. Controlled experimental study conducted on 44 BDIX rats with section and repair of the supraspinatus tendon and randomization to one of three groups: group A, no intervention (control); group B, local applications of a fibrin sealant; and group C, application of the fibrin sealant with 2 x 10(6) ASC. At 4 and 8 weeks a biomechanical and histological analysis was performed. There were no differences in load-to-failure at 4 and 8 weeks between groups. The load-to-failure did increase between week 4 and week 8. Histologically the tendon-to bone union showed a disorganized fibrovascular tissue. Group C showed a different inflammatory pattern, with less presence of neutrophils and more presence of plasma cells. The use of ASC does not improve the biomechanical or histological properties of the repair site. More studies are needed to improve techniques that enhance the healing site of the repair. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Autologous tendon-derived cell-seeded nanofibrous scaffolds improve rotator cuff repair in an age-dependent fashion.

    Huegel, Julianne; Kim, Dong Hwa; Cirone, James M; Pardes, Adam M; Morris, Tyler R; Nuss, Courtney A; Mauck, Robert L; Soslowsky, Louis J; Kuntz, Andrew F


    Rotator cuff tendon tears are one of the most common shoulder pathologies, especially in the aging population. Due to a poor healing response and degenerative changes associated with aging, rotator cuff repair failure remains common. Although cell-based therapies to augment rotator cuff repair appear promising, it is unknown whether the success of such a therapy is age-dependent. We hypothesized that autologous cell therapy would improve tendon-to-bone healing across age groups, with autologous juvenile cells realizing the greatest benefit. In this study, juvenile, adult, and aged rats underwent bilateral supraspinatus tendon repair with augmentation of one shoulder with autologous tendon-derived cell-seeded polycaprolactone scaffolds. At 8 weeks, shoulders treated with cells in both juvenile and aged animals exhibited increased cellularity, increased collagen organization, and improved mechanical properties. No changes between treated and control limbs were seen in adult rats. These findings suggest that cell delivery during supraspinatus repair initiates earlier matrix remodeling in juvenile and aged animals. This may be due to the relative "equilibrium" of adult tendon tissue with regards to catabolic and anabolic processes, contrasted with actively growing juvenile tendons and degenerative aged tendons. This study demonstrates the potential for autologous cell-seeded scaffolds to improve repairs in both the juvenile and aged population. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1250-1257, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  15. Impact of scaffold micro and macro architecture on Schwann cell proliferation under dynamic conditions in a rotating wall vessel bioreactor

    Valmikinathan, Chandra M.; Hoffman, John [Department of Chemistry, Chemical Biology and Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, 07030 (United States); Yu, Xiaojun, E-mail: [Department of Chemistry, Chemical Biology and Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, 07030 (United States)


    Over the last decade tissue engineering has emerged as a powerful alternative to regenerate lost tissues owing to trauma or tumor. Evidence shows that Schwann cell containing scaffolds have improved performance in vivo as compared to scaffolds that depend on cellularization post implantation. However, owing to limited supply of cells from the patients themselves, several approaches have been taken to enhance cell proliferation rates to produce complete and uniform cellularization of scaffolds. The most common approach is the application of a bioreactor to enhance cell proliferation rate and therefore reduce the time needed to obtain sufficiently significant number of glial cells, prior to implantation. In this study, we show the application of a rotating wall bioreactor system for studying Schwann cell proliferation on nanofibrous spiral shaped scaffolds, prepared by solvent casting and salt leaching techniques. The scaffolds were fabricated from polycaprolactone (PCL), which has ideal mechanical properties and upon degradation does not produce acidic byproducts. The spiral scaffolds were coated with aligned or random nanofibers, produced by electrospinning, to provide a substrate that mimics the native extracellular matrix and the essential contact guidance cues. At the 4 day time point, an enhanced rate of cell proliferation was observed on the open structured nanofibrous spiral scaffolds in a rotating wall bioreactor, as compared to static culture conditions. However, the cell proliferation rate on the other contemporary scaffolds architectures such as the tubular and cylindrical scaffolds show reduced cell proliferation in the bioreactor as compared to static conditions, at the same time point. Moreover, the rotating wall bioreactor does not alter the orientation or the phenotype of the Schwann cells on the aligned nanofiber containing scaffolds, wherein, the cells remain aligned along the length of the scaffolds. Therefore, these open structured spiral

  16. Forward osmosis process for dialysis fluid regeneration.

    Talaat, Khaled Mohamed


    In a preliminary experiment, 38% of the spent dialysis fluid water was reclaimed by a forward osmosis process through a cellulose triacetate membrane. The simplicity of forward osmosis and its minimal external energy requirements may allow the construction of a small bulk device that can reclaim a considerable portion of the water used in the patient's dialysis process. For developing an acceptable ambulatory dialysis system, decreasing the bulk of the fluid and equipment carried on the patient is essential. Forward osmosis may feasibly be used for dialysis fluid regeneration in ambulatory dialysis systems.

  17. Phosphorus balance with daily dialysis.

    Kooienga, Laura


    Hyperphosphatemia is an almost universal finding in patients with end-stage renal disease and is associated with increased all-cause mortality, cardiovascular mortality, and vascular calcification. These associations have raised the question of whether reducing phosphorus levels could result in improved survival. In light of the recent findings that increased per-session dialysis dose, as assessed by urea kinetics, did not result in improved survival, the definition of adequacy of dialysis should be re-evaluated and consideration given to alternative markers. Two alternatives to conventional thrice weekly dialysis (CHD) are nocturnal hemodialysis (NHD) and short daily hemodialysis (SDHD). The elimination kinetics of phosphorus as they relate to these alternative daily dialysis schedules and the clinical implications of overall phosphorus balance are discussed here. The total weekly phosphorus removal with NHD is more than twice that removed by CHD (4985 mg/week +/- 1827 mg vs. 2347 mg/week +/- 697 mg) and this is associated with a significantly lower average serum phosphorous (4.0 mg/dl vs. 6.5 mg/dl). In spite of the observed increase in protein and phosphorus intake seen in patients on SDHD, phosphate binder requirements and serum phosphorus levels are generally stable to decrease although this effect is strongly dependent on the frequency and overall treatment time.

  18. Pulmonary hypertension in dialysis patients.

    Kosmadakis, George; Aguilera, Didier; Carceles, Odette; Da Costa Correia, Enrique; Boletis, Ioannis


    Pulmonary hypertension in end-stage renal disease patients is associated with significantly increased morbidity and mortality. The prevalence of pulmonary hypertension in dialysis patients is relatively high and varies in different studies from 17% to 49.53% depending on the mode of dialysis and other selection factors, such as the presence of other cardiovascular comorbidities. The etiopathogenic mechanisms that have been studied in relatively small studies mainly include arteriovenous fistula-induced increased cardiac output, which cannot be accomodated by, the spacious under normal conditions pulmonary circulation. Additionally, pulmonary vessels show signs of endothelial dysfunction, dysregulation of vascular tone due to an imbalance in vasoactive substances, and local as well as systemic inflammation. It is also believed that microbubbles escaping from the dialysis circuit can trigger vasoconstriction and vascular sclerosis. The non-specific therapeutic options that proved to be beneficial in pulmonary artery pressure reduction are endothelin inhibitors, phosphodiesterase inhibitor sildenafil, and vasodilatory prostaglandins in various forms. The specific modes of treatment are renal transplantation, size reduction or closure of high-flow arteriovenous fistulas, and transfer from hemodialysis to peritoneal dialysis-a modality that is associated with a lesser prevalence of pulmonary hypertension.

  19. Dynamics of viscous fingers in rotating Hele-Shaw cells with Coriolis effects.

    Gadêlha, Hermes; Brito, Nielison; Miranda, José A


    A growing number of experimental and theoretical works have been addressing various aspects of the viscous fingering formation in rotating Hele-Shaw cells. However, only a few of them consider the influence of Coriolis forces. The studies including Coriolis effects are mostly restricted to the high-viscosity-contrast limit and rely on either purely linear stability analyses or intensive numerical simulations. We approach the problem analytically and use a modified Darcy's law including the exact form of the Coriolis effects to execute a mode-coupling analysis of the system. By imposing no restrictions on the viscosity contrast A (dimensionless viscosity difference) we go beyond linear stages and examine the onset of nonlinearities. Our results indicate that when Coriolis effects are taken into account, an interesting interplay between the Reynolds number Re and A arises. This leads to important changes in the stability and morphological features of the emerging interfacial patterns. We contrast our mode-coupling approach with previous theoretical models proposed in the literature.

  20. Steep dispersion and coherent control of Faraday rotation in a potassium vapor cell

    Lampis, Andreas; Megyeri, Balázs; Goldwin, Jon


    Electromagnetically induced transparency (EIT) was studied in a heated vapor cell of potassium without buffer gas or anti-relaxation coating. Transparency windows 60 times narrower than the natural line width and group indices exceeding 6000 were generated using a simple optical setup with a single free-running laser and an acousto-optic modulator. A longitudinal magnetic field was used to split the EIT feature into three components for either lin-perp-lin or lin-par-lin polarizations of probe and coupling beams. Measurements of polarization rotation revealed that only the lin-par-lin configuration leads to circular birefringence, an effect which we attribute to quantum interference between the multiple \\Lambda-type subsystems contributing to the signal. The Verdet constant of the EIT medium was measured to be (2.33+/-0.10)x10^5 rad/T/m, and a novel measurement of group index based on birefringence was demonstrated. For larger fields, where the individual peaks were well resolved, resonant polarization rotati...

  1. Morphological Differentiation of Colon Carcinoma Cell Lines in Rotating Wall Vessels

    Jessup, J. M.


    The objectives of this project were to determine whether (1) microgravity permits unique, three-dimensional cultures of neoplastic human colon tissues and (2) this culture interaction produces novel intestinal growth and differentiation factors. The initial phase of this project tested the efficacy of simulated microgravity for the cultivation and differentiation of human colon carcinoma in rotating wall vessels (RWV's) on microcarrier beads. The RWV's simulate microgravity by randomizing the gravity vector in an aqueous medium under a low shear stress environment in unit gravity. This simulation achieves approximately a one-fifth g environment that allows cells to 'float' and form three-dimensional relationships with less shear stress than in other stirred aqueous medium bioreactors. In the second phase of this project we assessed the ability of human colon carcinoma lines to adhere to various substrates because adhesion is the first event that must occur to create three-dimensional masses. Finally, we tested growth factor production in the last phase of this project.

  2. Severe venous neointimal hyperplasia prior to dialysis access surgery

    Lee, Timmy; Chauhan, Vibha; Krishnamoorthy, Mahesh; Wang, Yang; Arend, Lois; Mistry, Meenakshi J.; El-Khatib, Mahmoud; Banerjee, Rupak; Munda, Rino; Roy-Chaudhury, Prabir


    Background. Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement. Methods. Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples. Results. Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present. Conclusion. Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created. PMID:21220751

  3. Biocompatible Peritoneal Dialysis Fluids: Clinical Outcomes

    Yeoungjee Cho


    Full Text Available Peritoneal dialysis (PD is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes.

  4. Dissolved organic nitrogen measurement using dialysis pretreatment.

    Lee, Wontae; Westerhoff, Paul


    Dissolved organic nitrogen (DON) is important for ecological and engineering researches. Quantification of low DON concentrations in waters with elevated dissolved inorganic nitrogen (DIN) using existing methods is inaccurate. In this study, a dialysis-based pretreatment technique was optimized and adopted to reduce the interference from DIN to the quantification of DON in natural water. A cellulose ester dialysis tube (nominal molecular weight cutoff = 100 Da) was used in batch and continuous-flow dialysis steps with model compounds, natural organic matter isolates, and bulk waters to develop a dialysis pretreatment approach that selectively reduces DIN from solutions containing DON. By reducing DIN concentrations, propagation of analytical variance in total dissolved nitrogen (TDN) and DIN species concentrations allows more accurate determination of DON (DON = TDN - NO3 - NO2- - NH3/NH4+). Dialysis for 24 h against continuously flowing distilled water reduced DIN species by 70%. With dialysis pretreatment, DON recoveries of more than 95% were obtained for surface water and finished drinking water, but wastewater experienced a slight loss (approximately 10%) of DON possibly due to the adsorption of organics onto the dialysis membrane, permeation of low molecular weight fractions, or biodegradation. Dialysis experiments using surface water spiked with different DIN/TDN ratios concluded that dialysis pretreatment leads to more accurate DON determination than no dialysis when DIN/TDN ratios exceed 0.6 mg of N/mg of N.

  5. The spatial rotator

    Rasmusson, Allan; Hahn, Ute; Larsen, Jytte Overgaard


    to identify the specific tissue region under study. In order to use the spatial rotator in practice, however, it is necessary to be able to identify intersection points between cell boundaries and test rays in a series of parallel focal planes, also at the peripheral parts of the cell boundaries. In cases......This paper presents a new local volume estimator, the spatial rotator, which is based on measurements on a virtual 3D probe, using computer assisted microscopy. The basic design of the probe builds upon the rotator principle which requires only a few manual intersection markings, thus making...... the spatial rotator fast to use. Since a 3D probe is involved, it is expected that the spatial rotator will be more efficient than the the nucleator and the planar rotator, which are based on measurements in a single plane. An extensive simulation study shows that the spatial rotator may be more efficient...

  6. Maintenance of employment on dialysis.

    Rasgon, S; James-Rogers, A; Chemleski, B; Ledezma, M; Mercado, L; Besario, M; Trivedi, J; Miller, M; Dee, L; Pryor, L; Yeoh, H


    This article describes the components of a multidisciplinary effort focused on promoting, among other goals, continued employment during end-stage renal disease (ESRD) treatment. The education and guidance of the patient begin during the pre-ESRD period, intensify through dialysis treatment, and continue even through posttransplantation follow-up. Such focused programs support patients in retaining their usual lifestyle, staying in their current jobs where possible, and maximizing self-esteem and quality of life.

  7. Intraperitoneal pressure in peritoneal dialysis.

    Pérez Díaz, Vicente; Sanz Ballesteros, Sandra; Hernández García, Esther; Descalzo Casado, Elena; Herguedas Callejo, Irene; Ferrer Perales, Cristina


    The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with "Y" system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10-16 cmH2O, intraperitoneal pressure should never exceed 18 cmH2O. With basal values that depend on body mass index, it increases 1-3 cmH2O/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  8. Prophylactic dialysis in non-dialysis-dependent patients with renal failure after CABG

    Roghayyeh Borji


    Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

  9. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    Burton, James O; Hamali, Hassan A; Singh, Ruchir; Abbasian, Nima; Parsons, Ruth; Patel, Amit K; Goodall, Alison H; Brunskill, Nigel J


    Cardiovascular (CV) death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs) are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs) are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD), 17 peritoneal dialysis (PD) patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve)) and PMVs (CD42b(+ ve)) were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p0.3). Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients.

  10. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    James O Burton

    Full Text Available Cardiovascular (CV death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD, 17 peritoneal dialysis (PD patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve and PMVs (CD42b(+ ve were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p0.3. Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients.

  11. Immune suppression of human lymphoid tissues and cells in rotating suspension culture and onboard the International Space Station.

    Fitzgerald, Wendy; Chen, Silvia; Walz, Carl; Zimmerberg, Joshua; Margolis, Leonid; Grivel, Jean-Charles


    The immune responses of human lymphoid tissue explants or cells isolated from this tissue were studied quantitatively under normal gravity and microgravity. Microgravity was either modeled by solid body suspension in a rotating, oxygenated culture vessel or was actually achieved on the International Space Station (ISS). Our experiments demonstrate that tissues or cells challenged by recall antigen or by polyclonal activator in modeled microgravity lose all their ability to produce antibodies and cytokines and to increase their metabolic activity. In contrast, if the cells were challenged before being exposed to modeled microgravity suspension culture, they maintained their responses. Similarly, in microgravity in the ISS, lymphoid cells did not respond to antigenic or polyclonal challenge, whereas cells challenged prior to the space flight maintained their antibody and cytokine responses in space. Thus, immune activation of cells of lymphoid tissue is severely blunted both in modeled and true microgravity. This suggests that suspension culture via solid body rotation is sufficient to induce the changes in cellular physiology seen in true microgravity. This phenomenon may reflect immune dysfunction observed in astronauts during space flights. If so, the ex vivo system described above can be used to understand cellular and molecular mechanisms of this dysfunction.

  12. [Natural history of HBV in dialysis population].

    Fabrizi, F; Martin, P; Lunghi, G; Ponticelli, C


    Dialysis patients remain at risk of acquiring hepatitis B virus (HBV) infection. The issue of the natural history of HBV among patients undergoing long-term dialysis remains unclear. Assessing the natural history of hepatitis B in patients on maintenance dialysis is problematic because of the unique characteristics of this population: serum aminotransferase activity is lower in dialysis patients compared with patients without renal disease; also, chronic hepatitis B has an insidious and prolonged natural history, and the competing mortality from complications of end-stage renal disease may obscure the long-term consequences of hepatitis B. HBV-related liver disease frequently runs an asymptomatic course in dialysis patients and the liver-related mortality in this population is very low; thus, the prognosis for chronic HBV infection in dialysis patients has been reported as benign. However, the frequency of liver cancer in dialysis patients appears higher than that observed in the general population, this has been related to a greater exposure to HBV/HCV. Cirrhosis is not a frequent comorbid condition in the dialysis population of industrialised countries, but the death rate for dialysis patients with cirrhosis is 35% higher than for those without it. In addition, it has been observed that liver disease remains a significant cause of mortality among HbsAg-positive carriers on dialysis in developing countries. The low viral load measured in dialysis patients with persistent HBsAg carriage could be accounted for by the relatively benign course of HBV-related liver disease in this population. Prospective clinical trials are under way to better define the virological features of HBV in the dialysis population.

  13. Protein binding studies with radiolabeled compounds containing radiochemical impurities. Equilibrium dialysis versus dialysis rate determination

    Honoré, B


    The influence of radiochemical impurities in dialysis experiments with high-affinity ligands is investigated. Albumin binding of labeled decanoate (97% pure) is studied by two dialysis techniques. It is shown that equilibrium dialysis is very sensitive to the presence of impurities resulting...

  14. Recovery of renal function in dialysis patients

    Patlovany Matthew


    Full Text Available Abstract Background Although recovery of renal functions in dialysis dependent patients is estimated to be greater than 1%, there are no indicators that actually suggest such revival of renal function. Residual renal function in dialysis patients is unreliable and seldom followed. Therefore renal recovery (RR in dialysis dependent patients may remain unnoticed. We present a group of dialysis dependent patients who regained their renal functions. The aim of this project is to determine any indicators that may identify the recovery of renal functions in dialysis dependent patients. Methods All the discharges from the chronic dialysis facilities were identified. Among these discharges deaths, transplants, voluntary withdrawals and transfers either to another modality or another dialysis facility were excluded in order to isolate the patients with RR. The dialysis flow sheets and medical records of these patients were subsequently reviewed. Results Eight patients with a mean age of 53.8 ± 6.7 years (± SEM were found to have RR. Dialysis was initiated due to uremic symptoms in 6 patients and fluid overload in the remaining two. The patients remained dialysis dependent for 11.1 ± 4.2 months. All these patients had good urine output and 7 had symptoms related to dialysis. Their mean pre-initiation creatinine and BUN levels were 5.21 ± 0.6 mg/dl and 72.12 ± 11.12 mg/dl, respectively. Upon discontinuation, they remained dialysis free for 19.75 ± 5.97 months. The mean creatinine and BUN levels after cessation of dialysis were 2.85 ± 0.57 mg/dl and 29.62 ± 5.26 mg/dl, respectively, while the mean creatinine clearance calculated by 24-hour urine collection was 29.75 ± 4.78 ml/min. One patient died due to HIV complications. One patient resumed dialysis after nine months. Remaining continue to enjoy a dialysis free life. Conclusion RR must be considered in patients with good urine output and unresolved acute renal failure. Dialysis intolerance may be

  15. The use of peritoneal dialysis in newborns

    Stojanović Vesna


    Full Text Available Introduction. Acute renal failure is a common complication in critically ill newborn infants. The therapy of acute renal failure is conservative and etiological. Patients not responding to this kind of therapy require peritoneal dialysis. Material and methods. This retrospective study included 6 newborn infants undergoing peritoneal dialysis during the period from January 2004 to June 2006, at the Nephrology Department of the Institute of Child and Youth Health Care in Novi Sad. All patients presented with complications of acute renal failure including hypercalemia and uremic encephalopathy. Results. Complete restoration of kidney function was evident in four patients on peritoneal dialysis. Three patients are still alive, but in one patient acute renal failure progressed to chronic renal failure. One patient died in the third month of life due to multiple organ dysfunction, after just two days of dialysis. Several complications were reported: intra-abdominal hemorrhage, dialysate leakage, peritonitis and dialysis catheter obstruction. Discussion. Periotoneal dialysis catheter placement is a great problem due to the size of the newborn. If it is estimated that it will be a long-lasting dialysis, Tenckhoff catheter is recommended. In very low birth weight newborn infants, in poor overall condition, general anesthesia is too risky, and acute peritoneal dialysis catheter should be placed (i.v. cannula, venous catheter. Conclusion. Peritoneal dialysis is the method of choice in newborns with acute renal failure, and it is used in the treatment of neonatal asphyxia till the restoration of kidney function is achieved. .

  16. [The specific nutritionnal care in peritoneal dialysis].

    Castrale, Cindy; Azar, Raymond; Piquet, Marie-Astrid; Lobbedez, Thierry


    Protein energy wasting is a major complication in peritoneal dialysis. It is leading to a poor quality of life and increasing mortality. Diagnosis must be early, according to criteria defined by the International society of renal nutrition and metabolism. It is necessary to appropriate the diagnostic tools with dialysis method. The nutritional care is difficult in peritoneal dialysis. Indeed, studies are limited and practical nutrition is complex. In this point of view, we propose to treat guidelines for protein energy wasting, in peritoneal dialysis patients. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  17. Fully automated dialysis system based on the central dialysis fluid delivery system.

    Kawanishi, Hideki; Moriishi, Misaki; Sato, Takashi; Taoka, Masahiro


    The fully automated dialysis system (FADS) was developed as an improvement over previous patient monitors used in the treatment of hemodialysis, with the aim of standardizing and promoting labor-saving in such treatment. This system uses backfiltration dialysis fluid to perform priming, blood rinse back and rapid fluid replenishment, and causes guiding of blood into the dialyzer by the drainage pump for ultrafiltration. This requires that the dialysis fluid used be purified to a high level. The central dialysis fluid delivery system (CDDS) combines the process of the creation and supply of dialysis water and dialysis fluid to achieve a level of purity equivalent with ultrapure dialysis fluid. FADS has the further advantages of greater efficiency and streamlined operation, reducing human error and the risk of infection without requiring the storage or disposal of normal saline solution. The simplification of hemodialysis allows for greater frequency of dialysis or extended dialysis, enabling treatment to be provided in line with the patient's particular situation. FADS thus markedly improves the reliability, safety and standardization of dialysis procedures while ensuring labor-saving in these procedures, making it of particular utility for institutions dealing with dialysis on a large scale.

  18. Assessing of Dialysis Adequacy in Patients under Hemodialysis in Dialysis Department of Ekbatan Hospital in Hamadan

    E. Nadi


    Full Text Available Determining reduction proportion of blood urea in patients under hemodialysis in dialysis department of Ekbatan hospital and comparison between obtained results and standard scales. This study was descriptive, cross - Sectional. In this study the number of 100 patient under dialysis in were evaluated and their blood samples were accumitated before and after dialysis and were transferred to the laboratory. Results were calculated by BUN formula, meanwhile the other parameters as, the time of dialysis, speed of blood circulation, percentage of filter clearance, patient weight before and after dialysis, blood pressure before and after dialysis, also evaluated and registered. To consider the obtained results from BUN calculations we found out that 10% of individuals have URR 65%. In that the results are in accord with standard scales, and revealed adequate dialysis. About 34% were near accepted range (55%-64%. The rest of individuals about 56% were lower than accepted URR.

  19. [Immigrants and dialysis: a survey in Piedmont].

    Forneris, Giacomo; Boero, Roberto; Massara, Carlo; Quarello, Francesco


    The number of immigrants has been rapidly increasing in Italy in the last decade, with potentially profound effects on the national health care system. Yet, few data are available on the clinical and demographic features of these subjects, or on their need for nephrological care and dialysis treatment. A survey was conducted in 19 dialysis facilities of Piedmont (a northwestern Italian region) about immigrants on chronic dialysis treatment. Data on native country, administrative position, clinical and dialysis aspects were anonymously collected. Overall, 93 immigrant dialysis patients coming from 24 foreign countries were registered. Most of them were young (mean age 46∓14 years) and on extracorporeal treatment (87%); late referral (38%) or starting dialysis in emergency (17%) were common modalities of presentation. Glomerular (33%) or unknown (31%) nephropathies were the most representative causes of end stage renal disease. No difference in incidence of HCV, HBV and HIV compared with native Italian patients was observed. Notably, more than 50% of the immigrant patients had low-level knowledge of Italian. As regards administrative position, 69% were regular foreign citizens, 19% were temporary foreign workers, and 9% had a residence permit. Our survey confirms the existence of a young immigrant population on dialysis in Piedmont, whose social and relational problems are more challenging than clinical aspects and call for new organizational models to manage this growing population on dialysis.

  20. Effects of disinfectants in renal dialysis patients.

    Klein, E


    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. More recently, reuse of dialyzers has introduced the use of additional sterilants, such as hydrogen peroxide and peracetic acid. The use of these sterilants is recognized by the center staffs and the home patient as a potential risk, and residue tests are carried out for the presence of these sterilants at the ppm level. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. Such reactions probably do not occur with hypochlorite or chloramines. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has led to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe2+ in hemoglobin to Fe3+ forms methemoglobin, which is incapable of carrying either O2 or CO2.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3816735

  1. Neural stem cells transplanted in a mouse model of Parkinson's disease differentiate to neuronal phenotypes and reduce rotational deficit.

    Ziavra, Despina; Makri, Georgia; Giompres, Panagiotis; Taraviras, Stavros; Thomaidou, Dimitra; Matsas, Rebecca; Mitsacos, Ada; Kouvelas, Elias D


    The most prominent pathological feature in Parkinson's disease (PD) is the progressive and selective loss of mesencephalic dopaminergic neurons of the nigrostriatal tract. The present study was conducted in order to investigate whether naive and or genetically modified neural stem/precursor cells (NPCs) can survive, differentiate and functionally integrate in the lesioned striatum. To this end, stereotaxic injections of 6-OHDA in the right ascending nigrostriatal dopaminergic pathway of mice and subsequent NPC transplantations were performed, followed by apomorphine-induced rotations and double-immunofluorescence experiments. Our results demonstrate that transplanted embryonic NPCs derived from the cortical ventricular zone of E14.5 transgenic mouse embryos expressing the green fluorescent protein (GFP) under control of the beta-actin promoter and cultured as neurospheres can survive in the host striatum for at least three weeks after transplantation. The percentage of surviving GFP-positive cells in the host striatum ranges from 0.2% to 0.6% of the total transplanted NPCs. Grafted cells functionally integrate in the striatum, as indicated by the statistically significant decrease of contralateral rotations after apomorphine treatment. Furthermore, we show that within the striatal environment GFP-positive cells differentiate into beta-III tubulin-expressing neurons, but not glial cells. Most importantly, GFP-positive cells further differentiate to dopaminergic (TH-positive) and medium size spiny (DARPP-32- positive) neuronal phenotypes. Over-expression of the cell cycle exit and neuronal differentiation protein Cend1 in NPCs enhances the generation of GABAergic, but not dopaminergic, neuronal phenotypes after grafting in the lesioned striatum. Our results encourage the development of strategies involving NPC transplantation for the treatment of neurodegenerative diseases.

  2. The new Medicare PPS and home dialysis.

    Curtis, Jim; Schatell, Dori


    Overall, we believe that bundling of payments to dialysis facilities is positive for home dialysis. The incentive for higher utilization of home therapies comes down to the fact that, with treatments for all modalities being paid at the same rate, providers will see that home modalities cost less than facility-based treatments. The adjustment for home training treatments is certainly helpful, but it is not incentive enough on its own. From our perspective, one of the biggest financial incentives for home dialysis and more frequent dialysis therapies is that these patients are statistically known to spend less time in the hospital, over time costing taxpayers and the ESRD Program less money. We will continue to encourage CMS to consider the overall cost implications of more frequent dialysis. We are hopeful that when hospitalization costs are accounted for, CMS will do even more to encourage the use of these modalities.

  3. Update on dialysis economics in the UK.

    Sharif, Adnan; Baboolal, Keshwar


    The burgeoning population of patients requiring renal replacement therapy contributes a disproportionate strain on National Health Service resources. Although renal transplantation is the preferred treatment modality for patients with established renal failure, achieving both clinical and financial advantages, limitations to organ donation and clinical comorbidities will leave a significant proportion of patients with established renal failure requiring expensive dialysis therapy in the form of either hemodialysis or peritoneal dialysis. An understanding of dialysis economics is essential for both healthcare providers and clinical leaders to establish clinically efficient and cost-effective treatment modalities that maximize service provision. In light of changes to the provision of healthcare funds in the form of "Payment by Results," it is imperative for UK renal units to adopt clinically effective and financially accountable dialysis programs. This article explores the role of dialysis economics and implications for UK renal replacement therapy programs.

  4. Facile electrochemical polymerization of polypyrrole film applied as cathode material in dual rotating disk photo fuel cell

    Li, Kan; Zhang, Hongbo; Tang, Tiantian; Tang, Yanping; Wang, Yalin; Jia, Jinping


    Polypyrrole (PPy) film is synthesized on Ti substrate through electrochemical polymerization method and is applied as cathode material in a TiO2 NTs-PPy dual rotating disk photo fuel cell (PFC). The optimized PPy electrochemical polymerization is carried out using linear sweep voltammetry from 0 V to 1.2 V (vs. SCE) with scan rate of 0.1 V s-1, 100 circles. Sixty milliliter real textile wastewater with the initial COD and conductivity of 408 ± 6 mgO2 L-1 and 20180 μS cm-1 is treated in this PFC under UV irradiation. About 0.46 V open-circuit voltage (VOC) and 1.8-2.2 mA short-circuit current (JSC) are obtained. Due to the effective electron-hole separation effect, the COD removal rate is as high as 0.0055 min-1. Stable current and COD removal can be obtained at different output voltage. Two influence factors including rotating speed and pH are investigated. Better electricity generation performance and COD removal activity are achieved at high rotating speed and in acidic condition. In comparison with platinized cathode, though VOC is lower, similar JSC is measured. Considering the high cost of Pt, PPy is a promising alternative cathode material in PFC that can also generate electricity efficiently and stably.

  5. Effects of circular rigid boundaries and Coriolis forces on the interfacial instability in a rotating annular Hele-Shaw cell.

    Abidate, Asmaa; Aniss, Said; Caballina, Ophélie; Souhar, Mohamed


    We report analytical results for the development of instability of an interface between two immiscible, Newtonian fluid layers confined in a rotating annular Hele-Shaw cell. We perform a linear stability analysis and focus our study on the influence of both Coriolis force and curvature parameters on the interface instability growth rate. The results show that the Coriolis force does not alter the stability of a disturbance with a particular wave number but reduces the maximum growth rate. The results related to the role played by the confinement of the liquid layers are also shown to provide a modification of the fastest-growing mode and its corresponding linear growth rate.

  6. Regulation of Synthesis and Roles of Hyaluronan in Peritoneal Dialysis

    Timothy Bowen


    Full Text Available Hyaluronan (HA is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis.

  7. Dialysis

    ... chap 132. Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 133. Review Date 12/30/2014 Updated by: Deepak Sudheendra, ...

  8. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneal dialysis system and accessories. 876... Peritoneal dialysis system and accessories. (a) Identification. (1) A peritoneal dialysis system and... peritoneal dialysis, a source of dialysate, and, in some cases, a water purification mechanism. After...

  9. Confocal microscopy of colloidal dispersions in shear flow using a counter-rotating cone-plate shear cell

    Derks, Didi; Wisman, Hans; Blaaderen, Alfons van; Imhof, Arnout [Soft Condensed Matter, Debye Institute, Utrecht University, Princetonplein 5, 3584 CC Utrecht, The (Netherlands)


    We report on novel possibilities for studying colloidal suspensions in a steady shear field in real space. Fluorescence confocal microscopy is combined with the use of a counter-rotating cone-plate shear cell. This allows imaging of individual particles in the bulk of a sheared suspension in a stationary plane. Moreover, this plane of zero velocity can be moved in the velocity gradient direction while keeping the shear rate constant. The colloidal system under study consists of rhodamine labelled PMMA spheres in a nearly density and refractive index matched mixture of cyclohexylbromide and cis-decalin. We show measured flow profiles in both the fluid and the crystalline phase and find indications for shear banding in the case of a sheared crystal. Furthermore, we show that, thanks to the counter-rotating principle of the cone-plate shear cell, a layer of particles in the bulk of a sheared crystalline suspension can be imaged for a prolonged time, with the result that their positions can be tracked.

  10. The atrial fibrillation conundrum in dialysis patients.

    De Vriese, An S; Caluwé, Rogier; Raggi, Paolo


    The burden of atrial fibrillation (AF) and the risk of stroke are high in dialysis patients. The decision to use anticoagulation rests heavily on effective risk stratification. Because both the pathophysiology of the disease and the response to therapy differ in dialysis, data from the general population cannot be extrapolated. The effect of vitamin K antagonists (VKAs) on the risk of stroke in dialysis patients with AF has not been studied in randomized trials. The available observational data provide contradictory results, reflecting differences in the degree of residual confounding, quality of international normalized ratio control, and stroke characterization. Dialysis patients have a high baseline bleeding risk. It remains unclear to what extent VKAs affect the overall bleeding propensity, but they may significantly increase the risk of intracerebral hemorrhage. Vascular calcifications are extremely prevalent in dialysis patients and independently associated with an adverse outcome. Vitamin K antagonists inhibit the activity of key anticalcifying proteins and may thus compound the risk of vascular calcification progression in dialysis. In the absence of evidence-based guidelines for anticoagulation in dialysis patients with AF, we provide recommendations to assist clinicians in individualized risk stratification. We further propose that new oral anticoagulants may have a better benefit-risk profile in dialysis patients than VKA, provided appropriate dose reductions are made. New oral anticoagulant may yield more on-target anticoagulation, reduce the risk of intracerebral bleeding, and not interfere with vascular calcification biology. Clinical trials with new oral anticoagulant in dialysis patients are eagerly awaited, to reveal whether these assumptions can be confirmed.

  11. Being-in-dialysis: The experience of the machine-body for home dialysis users.

    Shaw, Rhonda


    New Zealand leads the world in rates of home dialysis use, yet little is known about the experience of home dialysis from the patient's perspective. This article contributes to the literature on the self-care of dialysis patients by examining the relevance of the concept of the machine-body and cyborg embodiment for the lived experience of people with end-stage renal failure. The article, which presents a discussion of 24 in-depth interviews undertaken between 2009 and 2012, shows that although dialysis therapy is disruptive of being and time, study participants experience home dialysis in terms of flexibility, control and independence. While they do not use the term machine-body as a descriptor, the concept resonates with felt experience. Data also indicate that positive experience of home dialysis is relative to socio-economic positioning and the lived relation of patients to others, necessitating further research to examine these factors. © The Author(s) 2014.

  12. Collagen markers in peritoneal dialysis patients

    Graff, J; Joffe, P; Fugleberg, S


    (PICP), aminoterminal propeptide of type III procollagen (PIIINP), and carboxyterminal telopeptide of type I collagen (ICTP)] were studied in 19 nondiabetic peritoneal dialysis patients. The absence of correlation between the mass appearance rates of the markers and the duration of dialysis treatment...... as well as the number of peritonitis episodes supports the concept that peritoneal dialysis does not cause persistent changes in the deposition and degradation rates of collagen. A correlation between the D/Pcreatinine 4 hr and the PICP mass appearance rates was found. Since it is unlikely...

  13. Dialysis technicians' perception of certification.

    Williams, Helen F; Garbin, Margery


    The Nephrology Nursing Certification Commission initiated this research project to study the viewpoint of dialysis technicians regarding the value of certification. A national convenience sample was obtained using both paper-and-pencil and online forms of the survey instrument. Demographic characteristics were obtained concerning age, race, ethnicity, education, and future employment planning. Technicians' primary work settings, the roles they fill, and the types of certification they hold are described. Incentives offered by employers are considered to explore how they contribute to job satisfaction. Understanding the perceptions of technicians regarding the benefits of certification and the limitations of workplace incentives should enable employers to improve their recruitment and retention programs. Information obtained may offer a baseline for future observations of the characteristics of these significant and essential contributors to the nephrology workforce.

  14. Anxiety disorders in dialysis patients

    Novaković Milan


    Full Text Available Introduction. Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. Material and Methods. This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN, and the control group included 405 patients with other diagnoses causing renal insufficiency (N18. The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. Results. Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural (c2 = 23.970 p<0.01; in the incidence of renal comorbidity (c2 = 23.970 p<0.01; familial renal comorbidity (c2 = 23.970 p<0.01; and migrations (c2 = 4.874 p<0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p<0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p<0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examination pointing to generalmental weakness. Conclusion. Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk. .

  15. Ultrastructural changes of the peritoneum in a rabbit model of peritoneal dialysis

    Jovanović Nataša


    Full Text Available Background/Aim. The number of patients with end-stage renal diseases treated with chronic dialysis is increasing over the last years. Long-term peritoneal dialysis is associated with progressive development of structural and functional alterations of peritoneal membrane. The aim of the study was to analyze ultrastructural alterations of mesothelial monolayer and submesothelial tissue in a modified nonuremic experimental model of peritoneal dialysis in rabbits. Methods. The study was performed on 5 healthy Chinchilla rabbits. Surgical procedures of implantation and removal of peritoneal catheter, prevention of catheter clothing, prevention of infection and dialysate instillation were performed according to previously described protocols. Peritoneal tissue samples were collected upon catheter placement and removal after a 5-week follow-up and processed for transmission electron microscopy (TEM examination. Results. The rabbits tolerated anesthesia, surgical procedure and the applied regimen of dialysate instillations well. The animals recovered completely and no adverse effects were noted. In the animals treated with peritoneal dialysis instillations, TEM revealed alterations of the mesothelial monolayer and submesothelial tissue. The mesothelial cells in direct contact with dialysis fluid were prone to shrinking. They lost the typical cobblestone morphology and assumed a flattened shape. The mesothelial cells were often detached from the basement membrane. These cells showed euchromatic nuclei, higher number of microvilli in their apical part and very numerous vesicles. A higher quantity of collagen fibers was noticed in the peritoneal lamina propria in close relation to the basement membrane of mesothelium. The nuclei of the fibroblasts were also euchromatic. Numerous mitochondria, granules and vesicles were present in their cytoplasm. Conclusion. The used rabbit model of peritoneal dialysis is simple, practical to perform, reproducible, not

  16. Evaluation of Efficacy of Performed Dialysis According to Changes in Bone Metabolism Related Parameters in Hamadan City

    N. Sheikh


    Full Text Available Introduction & Objective : Most of the CRF patients undergo dialysis to correct the CRF complications. Alterations in biochemical parameters of blood depends on the quality of dialysis. Several factors such as membrane , concentration of dialysis solutions , and dilution are involved in this process. Since the efficacy of the dialysis performed in Hamadan have not been studied previously and there was not information about the efficiency of Iranian made membrane (HD , R4 , R3 , S3 , this study was designed and performed.Materials & Methods: In this study some biochemical parameters including Hb , Hct , alkaline phosphatase , Ca , P , total protein , urea , creatinine before and after dialysis were measured in all patients referring to dialysis center of Hamadan. After collecting the blood samples before and after the dialysis, Hb and Htc were measured using the ABX cell counter. The other parameters were measured using Technicon RA1000 autoanalyser. The mean of these parameters before and after dialysis were compared using paired t-test. The results of different membranes were compared using ANOVA.Results: Results showed the serum level of total Ca increased 33% after dialysis (P<0.0001 while the P showed 36% decrease (P<0.0001. Alkaline phosphatase activity did not show any significant differences. Comparing the efficacy of different membrane in correction of urea and creatinine , HD membrane showed the most efficiency and R4 had the least (P<0.03. Other parameters did not show significant differences.Conclusion: The data obtained from this study showed a significant change in Ca , P, and ALP level after dialysis . Also it was concluded that different membrane had different effect on correction of studied parameters.

  17. Best Practices and Testing Protocols for Benchmarking ORR Activities of Fuel Cell Electrocatalysts Using Rotating Disk Electrode

    Kocha, Shyam S; Shinozaki, Kazuma; Zack, Jason W; Myers, Deborah J.; Kariuki, Nancy N.; Nowicki, Tammi L.; Stamenkovic, Vojislav; Kang, Yijin; Li, Dongguo; Papageorgopoulos, Dimitrios


    Abstract Thin-film-rotating disk electrodes (TF-RDEs) are the half-cell electrochemical system of choice for rapid screening of oxygen reduction reaction (ORR) activity of novel Pt supported on carbon black supports (Pt/C) electrocatalysts. It has been shown that the magnitude of the measured ORR activity and reproducibility are highly dependent on the system cleanliness, evaluation protocols, and operating conditions as well as ink formulation, composition, film drying, and the resultant film thickness and uniformity. Accurate benchmarks of baseline Pt/C catalysts evaluated using standardized protocols and best practices are necessary to expedite ultra-low-platinum group metal (PGM) catalyst development that is crucial for the imminent commercialization of fuel cell vehicles. We report results of evaluation in three independent laboratories of Pt/C electrocatalysts provided by commercial fuel cell catalyst manufacturers (Johnson Matthey, Umicore, Tanaka Kikinzoku Kogyo—TKK). The studies were conducted using identical evaluation protocols/ink formulation/film fabrication albeit employing unique electrochemical cell designs specific to each laboratory. The ORR activities reported in this work provide a baseline and criteria for selection and scale-up of novel high activity ORR electrocatalysts for implementation in proton exchange membrane fuel cells (PEMFCs).

  18. Rotating three-dimensional dynamic culture of adult human bone marrow-derived cells for tissue engineering of hyaline cartilage.

    Sakai, Shinsuke; Mishima, Hajime; Ishii, Tomoo; Akaogi, Hiroshi; Yoshioka, Tomokazu; Ohyabu, Yoshimi; Chang, Fei; Ochiai, Naoyuki; Uemura, Toshimasa


    The method of constructing cartilage tissue from bone marrow-derived cells in vitro is considered a valuable technique for hyaline cartilage regenerative medicine. Using a rotating wall vessel (RWV) bioreactor developed in a NASA space experiment, we attempted to efficiently construct hyaline cartilage tissue from human bone marrow-derived cells without using a scaffold. Bone marrow aspirates were obtained from the iliac crest of nine patients during orthopedic operation. After their proliferation in monolayer culture, the adherent cells were cultured in the RWV bioreactor with chondrogenic medium for 2 weeks. Cells from the same source were cultured in pellet culture as controls. Histological and immunohistological evaluations (collagen type I and II) and quantification of glycosaminoglycan were performed on formed tissues and compared. The engineered constructs obtained using the RWV bioreactor showed strong features of hyaline cartilage in terms of their morphology as determined by histological and immunohistological evaluations. The glycosaminoglycan contents per microg DNA of the tissues were 10.01 +/- 3.49 microg/microg DNA in the case of the RWV bioreactor and 6.27 +/- 3.41 microg/microg DNA in the case of the pellet culture, and their difference was significant. The RWV bioreactor could provide an excellent environment for three-dimensional cartilage tissue architecture that can promote the chondrogenic differentiation of adult human bone marrow-derived cells.

  19. Impact of advanced dialysis technology on the prevalence of dialysis-related amyloidosis in long-term maintenance dialysis patients.

    Schiffl, Helmut


    Dialysis-related amyloidosis (DRA) is a unique type of amyloidosis (beta-2 microglobulin) predominantly in end-stage renal disease. Its clinical manifestations add to increased morbidity and reduced quality of life. There seems to be a relative risk reduction in DRA manifestations when hemodialysis (HD) patients are treated with advanced HD technology, but changes of the course of DRA are uncertain. The aim of our investigation was to evaluate the prevalence and severity of carpal tunnel syndrome (CTS) in long-term dialysis patients receiving either conventional or high-flux, online-produced ultrapure dialysis fluid. The cross-sectional study included 147 HD patients (at least 10 years). The definitive diagnosis of CTS was made histologically or by the coexistence of CTS with other radiological DRA manifestations (bone cysts, arthropathies). The two HD patient groups did not differ significantly in age at start of HD, gender, major co-morbid diseases, anuria, and dialysis vintage. The conventional HD group had significantly higher circulating beta-2 microglobulin and C-reactive protein (CRP) levels. The prevalence of DRA was 68% for the conventional HD group and 28% for the advanced HD group. Duration of dialysis treatment was the only significant risk factor for the development of clinical DRA manifestations in both study groups, but CTS, bone cysts, or arthropathies occurred significantly earlier in conventional HD patients. The prevalence and severity of DRA have decreased with advances in dialysis technology during the last two decades, although its occurrence is simply delayed.

  20. Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution

    Hamasaki, Yoshifumi; Doi, Kent; Tanaka, Mototsugu; Kume, Haruki; Ishibashi, Yoshitaka; Enomoto, Yutaka; Fujita, Toshiro; Homma, Yukio; Nangaku, Masaomi; Noiri, Eisei


    Background Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical f...

  1. Laughter and humor therapy in dialysis.

    Bennett, Paul N; Parsons, Trisha; Ben-Moshe, Ros; Weinberg, Melissa; Neal, Merv; Gilbert, Karen; Rawson, Helen; Ockerby, Cherene; Finlay, Paul; Hutchinson, Alison


    Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.

  2. Are Diuretics Underutilized in Dialysis Patients?

    Trinh, Emilie; Bargman, Joanne M


    While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential benefits and few side effects. Moreover, when diuretics are used, optimal doses are not always prescribed. In peritoneal dialysis, the use of diuretics can improve volume status and minimize the need for higher glucose-containing solutions. In patients on haemodialysis, diuretics can help lessen interdialytic weight gain, resulting in decreased ultrafiltration rates and fewer episodes of intradialytic hypotension. This paper will review the mechanism of action of diuretics in patients with renal insufficiency, quantify the risk of side effects and elaborate on the potential advantages of diuretic use in peritoneal dialysis and hemodialysis patients with residual kidney function.

  3. Artificial design of three-dimensional retina-like tissue from dissociated cells of the mammalian retina by rotation-mediated cell aggregation.

    Rothermel, Andrée; Biedermann, Thomas; Weigel, Winnie; Kurz, Randy; Rüffer, Markus; Layer, Paul G; Robitzki, Andrea Anneliese


    The goal of this study was to establish a reliable three-dimensional culture system for the mammalian retina that allows the analysis of retinal function and dysfunction. To produce three-dimensional retinal tissues in vitro, dissociated retinal cells of neonatal rats were maintained in culture dishes on a self-made orbital shaker. On the basis of well-defined rotation conditions, dissociated free-floating cells reaggregate in the center of the culture dish to form a multicellular cluster. Subsequently, cells begin to proliferate, whereby they form spherelike retinal tissues that grow to a size of 180-210 microm. Immunohistochemical characterization of mature retinal spheres revealed the presence of ganglion cells, amacrine cells, Müller cells, and rod photoreceptors, which are arranged in different retina-like layers. Although a small number of cells undergo programmed cell death, retinal spheres remain viable for at least 35 days in culture as revealed by fluorescein diacetate and TUNEL staining. Because most biological processes involved in tissue organization such as proliferation, differentiation, apoptosis, and survival are also observable in retinal spheres, the presented novel mammalian three-dimensional culture system is not only an outstanding model for basic research but may also be of great benefit for stem cell tissue engineering and the pharmaceutical industry.

  4. A case of misplaced permacath dialysis catheter

    Mohammed Arshad Ali


    Full Text Available Central venous placement using ultrasound has significantly reduced the complications associated with blind puncture. The central venous catheter can still get misplaced if it follows an anomalous route after appropriate puncture of desired vessel. We report a case of misplaced dialysis catheter into the accessory hemiazygos vein which resulted in a large hemothorax, and we recommend the routine use of a fluoroscope for placement of dialysis catheters so as to avoid serious complications.

  5. Transmission of HIV in dialysis centre.

    Velandia, M; Fridkin, S K; Cárdenas, V; Boshell, J; Ramirez, G; Bland, L; Iglesias, A; Jarvis, W


    In August, 1993, 13 dialysis patients at one dialysis centre in Colombia, South America, were found to be HIV positive, and this prompted an epidemiological investigation. We carried out a cohort study of all dialysis centre patients during January, 1992 to December, 1993 (epidemic period) to determine risk factors for HIV seroconversion. Haemodialysis and medical records were reviewed, dialysis centre staff and surviving patients were interviewed, and dialysis practices were observed. Stored sera from all dialysis centre patients were tested for HIV antibody. 12 (52%) of 23 patients tested positive for HIV antibody by enzyme immunoassay and western blot during the epidemic period. Of the 23 tested, 9 (39%) converted from HIV antibody negative to positive (seroconverters) and 10 (44%) remained HIV negative (seronegatives). The HIV seroconversion rate was higher among patients dialysed at the centre while a new patient, who was HIV seropositive, was dialysed there (90% vs 0%; p dialysis centre reprocessed access needles, dialysers, and bloodlines (60% vs 0%). While 2 of 9 HIV seroconverters had had sex with prostitutes, none had received unscreened blood products or had other HIV risk factors. No surgical or dental procedures were associated with HIV seroconversion. Dialysers were reprocessed separately with 5% formaldehyde and were labelled for use on the same patient. Access needles were reprocessed by soaking them in a common container with a low-level disinfectant, benzalkonium chloride; 4 pairs of needles were placed in one pan creating the potential for cross-contamination or use of one patient's needles on another patient. HIV transmission at the dialysis centre was confirmed. Improperly reprocessed patient-care equipment, most probably access needles, is the likely mechanism of transmission. This outbreak was discovered by accident and similar transmission may be occurring in many other countries where low-level disinfectants are used to sterilise critical

  6. Peritoneal Dialysis Registry With 2012 Survey Report.

    Hasegawa, Takeshi; Nakai, Shigeru; Moriishi, Misaki; Ito, Yasuhiko; Itami, Noritomo; Masakane, Ikuto; Hanafusa, Norio; Taniguchi, Masatomo; Hamano, Takayuki; Shoji, Tetsuo; Yamagata, Kunihiro; Shinoda, Toshio; Kazama, Junichiro; Watanabe, Yuzo; Shigematsu, Takashi; Marubayashi, Seiji; Morita, Osamu; Wada, Atsushi; Hashimoto, Seiji; Suzuki, Kazuyuki; Kimata, Naoki; Wakai, Kenji; Fujii, Naohiko; Ogata, Satoshi; Tsuchida, Kenji; Nishi, Hiroshi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu; Nakamoto, Hidetomo


    Since 2009, the peritoneal dialysis (PD) registry survey has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this report, the current status of PD patients is presented on the basis of the results of the survey conducted at the end of 2012. The subjects were PD patients who lived in Japan and participated in the 2012 survey. Descriptive analysis of various items was performed, which included the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the rates of peritonitis and catheter exit-site infection. From the results of the facility survey in 2012, the number of PD patients was 9514, a decrease of 128 from 2011. Among the entire dialysis patient population, 3.1% were PD patients, a decrease of 0.1%. Among the studied patients, 347 had a peritoneal catheter and underwent peritoneal lavage, 175 were started on PD in 2012 but introduced to other blood purification methods in the same year, and 1932 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with PD vintage: vintage of ≥2 years. The mean rate of peritonitis was 0.22 per patient per year. The mean rate of catheter exit-site infections was 0.36 per patient per year.

  7. Morphologic differentiation of colon carcinoma cell lines HT-29 and HT-29KM in rotating-wall vessels

    Goodwin, T. J.; Jessup, J. M.; Wolf, D. A.


    A new low shear stress microcarrier culture system has been developed at NASA's Johnson Space Center that permits three-dimensional tissue culture. Two established human colon adenocarcinoma cell lines, HT-29, an undifferentiated, and HT-29KM, a stable, moderately differentiated subline of HT-29, were grown in new tissue culture bioreactors called Rotating-Wall Vessels (RWVs). RWVs are used in conjunction with multicellular cocultivation to develop a unique in vitro tissue modeling system. Cells were cultivated on Cytodex-3 microcarrier beads, with and without mixed normal human colonic fibroblasts, which served as the mesenchymal layer. Culture of the tumor lines in the absence of fibroblasts produced spheroidlike growth and minimal differentiation. In contrast, when tumor lines were co-cultivated with normal colonic fibroblasts, initial growth was confined to the fibroblast population until the microcarriers were covered. The tumor cells then commenced proliferation at an accelerated rate, organizing themselves into three-dimensional tissue masses that achieved 1.0- to 1.5-cm diameters. The masses displayed glandular structures, apical and internal glandular microvilli, tight intercellular junctions, desmosomes, cellular polarity, sinusoid development, internalized mucin, and structural organization akin to normal colon crypt development. Differentiated samples were subjected to transmission and scanning electron microscopy and histologic analysis, revealing embryoniclike mesenchymal cells lining the areas around the growth matrices. Necrosis was minimal throughout the tissue masses. These data suggest that the RWV affords a new model for investigation and isolation of growth, regulatory, and structural processes within neoplastic and normal tissue.

  8. Erythroid cell growth and differentiation in vitro in the simulated microgravity environment of the NASA rotating wall vessel bioreactor

    Sytkowski, A. J.; Davis, K. L.


    Prolonged exposure of humans and experimental animals to the altered gravitational conditions of space flight has adverse effects on the lymphoid and erythroid hematopoietic systems. Although some information is available regarding the cellular and molecular changes in lymphocytes exposed to microgravity, little is known about the erythroid cellular changes that may underlie the reduction in erythropoiesis and resultant anemia. We now report a reduction in erythroid growth and a profound inhibition of erythropoietin (Epo)-induced differentiation in a ground-based simulated microgravity model system. Rauscher murine erythroleukemia cells were grown either in tissue culture vessels at 1 x g or in the simulated microgravity environment of the NASA-designed rotating wall vessel (RWV) bioreactor. Logarithmic growth was observed under both conditions; however, the doubling time in simulated microgravity was only one-half of that seen at 1 x g. No difference in apoptosis was detected. Induction with Epo at the initiation of the culture resulted in differentiation of approximately 25% of the cells at 1 x g, consistent with our previous observations. In contrast, induction with Epo at the initiation of simulated microgravity resulted in only one-half of this degree of differentiation. Significantly, the growth of cells in simulated microgravity for 24 h prior to Epo induction inhibited the differentiation almost completely. The results suggest that the NASA RWV bioreactor may serve as a suitable ground-based microgravity simulator to model the cellular and molecular changes in erythroid cells observed in true microgravity.

  9. Three-Dimensional Rotating Wall Vessel-Derived Cell Culture Models for Studying Virus-Host Interactions

    Jameson K. Gardner


    Full Text Available The key to better understanding complex virus-host interactions is the utilization of robust three-dimensional (3D human cell cultures that effectively recapitulate native tissue architecture and model the microenvironment. A lack of physiologically-relevant animal models for many viruses has limited the elucidation of factors that influence viral pathogenesis and of complex host immune mechanisms. Conventional monolayer cell cultures may support viral infection, but are unable to form the tissue structures and complex microenvironments that mimic host physiology and, therefore, limiting their translational utility. The rotating wall vessel (RWV bioreactor was designed by the National Aeronautics and Space Administration (NASA to model microgravity and was later found to more accurately reproduce features of human tissue in vivo. Cells grown in RWV bioreactors develop in a low fluid-shear environment, which enables cells to form complex 3D tissue-like aggregates. A wide variety of human tissues (from neuronal to vaginal tissue have been grown in RWV bioreactors and have been shown to support productive viral infection and physiological meaningful host responses. The in vivo-like characteristics and cellular features of the human 3D RWV-derived aggregates make them ideal model systems to effectively recapitulate pathophysiology and host responses necessary to conduct rigorous basic science, preclinical and translational studies.

  10. [Dialysis adequacy and Kt/V].

    Formica, Marco; Bosticardo, Gianmario


    Fractional clearance of urea to quantify the adequacy of dialysis was introduced in the late 1980s to allow nephrologists to personalize hemodialysis treatment, assess its effectiveness (dose), and create an index that would represent the concept of adequate dialysis. Since then, the number of nephrologists really involved in this novelty has been rather small, while the majority have been using the new instrument more or less uncritically. At the same time, the dialysis technology has evolved: the extracorporeal techniques have become more diversified, dialyzers have been transformed in terms of materials, hydraulic permeability and purification efficiency, and treatment schedules have been modified in terms of duration and frequency. The purpose of this paper is to evaluate, at a distance of about 30 years, the validity of the control parameter of dialysis - Kt/V - in 2010. In essence, the authors claim that Kt/V is of marginal utility in the quantification of traditional dialysis, while it is wholly inappropriate for frequent or long-term treatment schemes. We maintain that the calculation of Kt/V is still a tool to be used - also recommended by international guidelines - at least until the validation of new and more efficacious solutions, in order to avoid ineffective dialysis sessions (in terms of dose for small molecules), although it does not provide any certainty of a fully adequate performance in terms of reduced morbidity and mortality.

  11. Restless legs syndrome in patients on dialysis

    Al-Jahdali Hamdan


    Full Text Available Restless legs syndrome (RLS is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG. This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH, Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC, Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG′s RLS Questionnaire (RLSQ. Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM, coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively. Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS (P= < 0.001 and 0.001, respectively. Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis

  12. Restless legs syndrome in patients on dialysis.

    Al-Jahdali, Hamdan H; Al-Qadhi, Waleed A; Khogeer, Haithm A; Al-Hejaili, Fayez F; Al-Ghamdi, Saeed M; Al Sayyari, Abdullah A


    Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG's RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 +/- 17.2 years and mean duration on dialysis 40.4 +/- 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and

  13. Is dialysis modality a factor in the survival of patients initiating dialysis after kidney transplant failure?

    Perl, Jeffrey; Dong, James; Rose, Caren; Jassal, Sarbjit Vanita; Gill, John S


    Kidney transplant failure (TF) is among the leading causes of dialysis initiation. Whether survival is similar for patients treated with peritoneal dialysis (PD) and with hemodialysis (HD) after TF is unclear and may inform decisions concerning dialysis modality selection. Between 1995 and 2007, 16 113 adult dialysis patients identified from the US Renal Data System initiated dialysis after TF. A multivariable Cox proportional hazards model was used to evaluate the impact of initial dialysis modality (1 865 PD, 14 248 HD) on early (1-year) and overall mortality in an intention-to-treat approach. Compared with HD patients, PD patients were younger (46.1 years vs 49.4 years, p data suggest that increased initial use of PD among patients returning to dialysis after TF may be associated with improved outcomes, except among patients with a higher BMI and those who initiate dialysis at lower levels of eGFR. The reasons behind the inferior late survival seen in PD patients are unclear and require further study.

  14. Death or dialysis? The risk of dialysis-dependent chronic renal failure after trauma nephrectomy.

    Dozier, Kristopher C; Yeung, Louise Y; Miranda, Marvin A; Miraflor, Emily J; Strumwasser, Aaron M; Victorino, Gregory P


    Although renal trauma is increasingly managed nonoperatively, severe renovascular injuries occasionally require nephrectomy. Long-term outcomes after trauma nephrectomy are unknown. We hypothesized that the risk of end-stage renal disease (ESRD) is minimal after trauma nephrectomy. We conducted a retrospective review of the following: 1) our university-based, urban trauma center database; 2) the National Trauma Data Bank (NTDB); 3) the National Inpatient Sample (NIS); and 4) the U.S. Renal Data System (USRDS). Data were compiled to estimate the risk of ESRD after trauma nephrectomy in the United States. Of the 232 patients who sustained traumatic renal injuries at our institution from 1998 to 2007, 36 (16%) underwent a nephrectomy an average of approximately four nephrectomies per year. The NTDB reported 1780 trauma nephrectomies from 2002 to 2006, an average of 356 per year. The 2005 NIS data estimated that in the United States, over 20,000 nephrectomies are performed annually for renal cell carcinoma. The USRDS annual incidence of ESRD requiring hemodialysis is over 90,000, of which 0.1 per cent (100 per year) of renal failure is the result of traumatic or surgical loss of a kidney. Considering the large number of nephrectomies performed for cancer, we estimated the risk of trauma nephrectomy causing renal failure that requires dialysis to be 0.5 per cent. National data regarding the etiology of renal failure among patients with ESRD reveal a very low incidence of trauma nephrectomy (0.5%) as a cause; therefore, nephrectomy for trauma can be performed with little concern for long-term dialysis dependence.

  15. Dialysis and Renal Transplantation in HIV-Infected Patients: a European Survey

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;


    OBJECTIVES:: To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. METHODS:: Cross-sectional multicenter survey of EuroSIDA clinics during 2008. RESULTS:: Prevalence of ESRD was 0.5%. Of 122...... patients with ESRD 96 were on dialysis and 26 had received a RT. Median age was 47 years, 73% were males and 43% were black. Median duration of HIV infection was 11 years. Thirty-three percent had prior AIDS; 91% were receiving antiretrovirals; and 88% had undetectable viral load. Median CD4T-cell count...... was 341 cells per cubic millimetre; 20.5% had hepatitis C coinfection. Most frequent causes of ESRD were HIV-associated nephropathy (46%) and other glomerulonephritis (28%). Hemodialysis (93%) was the most common dialysis modality; 34% of patients were on the RT waiting list. A poor HIV control...

  16. The optical rotator

    Tandrup, T; Gundersen, Hans Jørgen Gottlieb; Jensen, Eva B. Vedel


    The optical rotator is an unbiased, local stereological principle for estimation of cell volume and cell surface area in thick, transparent slabs, The underlying principle was first described in 1993 by Kieu Jensen (T. Microsc. 170, 45-51) who also derived an estimator of length, In this study we...... further discuss the methods derived from this principle and present two new local volume estimators. The optical rotator benefits from information obtained in all three dimensions in thick sections but avoids over-/ underprojection problems at the extremes of the cell. Using computer-assisted microscopes...... the extra measurements demand minimal extra effort and make this estimator even more efficient when it comes to estimation of individual cell size than many of the previous local estimators, We demonstrate the principle of the optical rotator in an example (the cells in the dorsal root ganglion of the rat...

  17. Achieving more frequent and longer dialysis for the majority: wearable dialysis and implantable artificial kidney devices.

    Fissell, William H; Roy, Shuvo; Davenport, Andrew


    The long-term survival for many chronic kidney failure patients who remain treated by dialysis in economically advanced countries remains similar to that of those with solid-organ malignancy, despite a disproportionate amount of health-care expenditure. As such, the current paradigm of three times weekly in-center hemodialysis for 4 h or shorter sessions needs to change to improve patient outcomes. Although more frequent and longer dialysis sessions have been reported to improve cardiovascular risk surrogates and short-term outcomes, these options are only practically available to a very small fraction of the total dialysis population. As such, radically new approaches are required to improve patient outcomes and quality of life for the majority of dialysis patients. Currently, two different approaches are being developed, wearable devices based on current dialysis techniques and more futuristic implantable devices modeled on the natural nephron.

  18. Rotating flow

    Childs, Peter R N


    Rotating flow is critically important across a wide range of scientific, engineering and product applications, providing design and modeling capability for diverse products such as jet engines, pumps and vacuum cleaners, as well as geophysical flows. Developed over the course of 20 years' research into rotating fluids and associated heat transfer at the University of Sussex Thermo-Fluid Mechanics Research Centre (TFMRC), Rotating Flow is an indispensable reference and resource for all those working within the gas turbine and rotating machinery industries. Traditional fluid and flow dynamics

  19. Optimization of dialysis catheter function.

    Gallieni, Maurizio; Giordano, Antonino; Rossi, Umberto; Cariati, Maurizio


    Central venous catheters (CVCs) are essential in the management of hemodialysis patients, but they also carry unintended negative consequences and in particular thrombosis and infection, adversely affecting patient morbidity and mortality. This review will focus on the etiology, prevention, and management of CVC-related dysfunction, which is mainly associated with inadequate blood flow. CVC dysfunction is a major cause of inadequate depuration. Thrombus, intraluminal and extrinsic, as well as fibrous connective tissue sheath (traditionally indicated as fibrin sheath) formation play a central role in establishing CVC dysfunction. Thrombolysis with urokinase or recombinant tissue plasminogen activator (rTPA) can be undertaken in the dialysis unit, restoring adequate blood flow in most patients, preserving the existing catheter, and avoiding an interventional procedure. If thrombolytics fail, mainly because of the presence of fibrous connective tissue sheath, catheter exchange with fibrin sheath disruption may be successful and preserve the venous access site. Prevention of CVC dysfunction is important for containing costly pharmacologic and interventional treatments, which also affect patients' quality of life. Prevention is based on the use of anticoagulant and/or thrombolytic CVC locks, which are only partially effective. Chronic oral anticoagulation with warfarin has also been proposed, but its use for this indication is controversial and its overall risk-benefit profile has not been clearly established.

  20. [Focusing on peritoneal dialysis adequacy].

    Issad, Belkacem; Durand, Pierre-Yves; Siohan, Pascale; Goffin, Eric; Cridlig, Joëlle; Jean, Guillaume; Ryckelynck, Jean-Philippe; Arkouche, W; Bourdenx, J-P; Cridlig, J; Dallaporta, B; Fessy, H; Fischbach, M; Giaime, P; Goffin, E; Issad, B; Jean, G; Joly, D; Mercadal, L; Poux, J-M; Ryckelynck, J-P; Siohan, P; Souid, M; Toledano, D; Verger, C; Vigeral, P; Uzan, M


    The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane. Copyright © 2013. Published by Elsevier SAS.

  1. [Cost of dialysis in France].

    Zambrowski, Jean-Jacques


    According to latest data published by the French health authority (HAS), nearly 74,000 French patients in end-stage chronic renal disease are following a replacement therapy. They were 61,000 in 2007, amounting to a cost of 4 billions euros for public health insurance. The cost varies depending on the age and comorbidities. Continuous ambulatory peritoneal dialysis is the cheapest mode of treatment, while the heavy haemodialysis centres costs are close to twice as expensive. But these two different treatments are - a priori - not applied for the same patients in terms of level of severity of disease. Moreover, associated costs, medical treatment, transportation, etc. are to be taken into account, as well as losses of income for patients facing major job difficulties. As recommended by HAS experts, it will be important to regularly conduct surveys allowing a regular economic assessment of the various modes of financial healthcare for end-stage chronic renal disease. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  2. Patency and Complications of Translumbar Dialysis Catheters.

    Liu, Fanna; Bennett, Stacy; Arrigain, Susana; Schold, Jesse; Heyka, Robert; McLennan, Gordon; Navaneethan, Sankar D


    Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short- and long-term patency and safety of TLDC. We conducted a retrospective analysis of adult patients who received TLDC for hemodialysis access from June 2006 to June 2013. Patient demographics, comorbid conditions, dialysis details, catheter insertion procedures and associated complications, catheter patency, and patient survival data were collected. Catheter patency was studied using Kaplan-Meier curve; catheter functionality was assessed with catheter intervals and catheter-related complications were used to estimate catheter safety. There were 84 TLDCs inserted in 28 patients with 28 primary insertions and 56 exchanges. All TLDC insertions were technically successful with good blood flow during dialysis (>300 ml/minute) and no immediate complications (major bleeding or clotting) were noted. The median number of days in place for initial catheter, secondary catheter, and total catheter were 65, 84, and 244 respectively. The catheter patency rate at 3, 6, and 12 months were 43%, 25%, and 7% respectively. The main complications were poor blood flow (40%) and catheter-related infection (36%), which led to 30.8% and 35.9% catheter removal, respectively. After translumbar catheter, 42.8% of the patients were successfully converted to another vascular access or peritoneal dialysis. This study data suggest that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access. © 2015 Wiley Periodicals, Inc.

  3. Rotation-Driven Microfluidic Disc for White Blood Cell Enumeration Using Magnetic Bead Aggregation.

    Ouyang, Yiwen; Li, Jingyi; Haverstick, Doris M; Landers, James P


    We recently defined a magnetic bead-based assay that exploited an agglutination-like response for DNA and applied it to DNA-containing cell enumeration using inexpensive benchtop hardware [ J. Am. Chem. Soc. 2012 , 134 ( 12 ), 5689 - 96 ]. Although cost-efficient, the open-well format assay required numerous manual steps, and the magnetic field actuation scheme was not readily adaptable for integration. Here, we demonstrate a low-cost (valves. The RDM accepts four samples that undergo on-chip dilution to five different concentrations that cover the effective concentration range needed for downstream cell counting by pinwheel assay. We show that a bi-RMF is effective for the simultaneous actuation of pinwheel assays in 20 detection chambers. The optimization of the bi-RMF frequencies allows the RDM-based pinwheel assay detect human genomic DNA down to a mass of human genomic DNA (5.5 picograms) that is roughly equal to the mass in a single cell. For proof of principle, enumeration of the white blood cells in human blood samples on the RDM provided data correlating well (C.V. of 10%) with those obtained in a clinical lab. Fusing the cost-effective RDM with a simple bi-RMF provides a promising strategy for automation and multiplexing of magnetic particle-based agglutination assays.

  4. Determination of free concentration of piroxicam and naproxen in plasma. The influence of experimental conditions in equilibrium dialysis.

    Hundal, O; Rugstad, H E


    An equilibrium dialysis method was established in order to investigate possible relationships between free drug concentrations of piroxicam and naproxen and clinical events. Therefore the influence of variations in pH, phosphate concentration and sodium azide concentration of the dialysis buffer on the free concentrations of piroxicam and naproxen was investigated. Piroxicam was found to have a pH-dependent protein binding. Therefore a good control of pH during the dialysis process is necessary. This has been achieved by increasing the buffer capacity of the dialysis buffer, by adding an antibacterial agent to the dialysis buffer and by cleansing the dialysis cells with 70% ethanol before use to prevent bacterial growth. Addition of 0.03% sodium azide as an antibacterial agent and the use of a 0.09 mol/l phosphate buffer gave good pH control. A method to correct for deviations of pH in measurements of free concentrations of piroxicam by a simple mathematical correction has been found. As naproxen was found to have a protein binding independent of pH, a pH-correction is not necessary for this drug. Standardized conditions in determination of protein binding of drugs by equilibrium dialysis are important, as composition of the dialysis buffer and pH of plasma compartment at equilibrium may influence the free concentration measurements. Comparisons of data from experiments using different methods are therefore difficult; the importance of pH-control is stressed. With the methods used in the present investigation, equilibrium dialysis in connection with HPLC, the coefficients of variation for piroxicam and naproxen free concentrations are 5.5% and 7.4%, respectively.

  5. Effects of platelet-rich plasma and triamcinolone acetonide on interleukin-1ß-stimulated human rotator cuff-derived cells.

    Muto, T; Kokubu, T; Mifune, Y; Inui, A; Sakata, R; Harada, Y; Takase, F; Kurosaka, M


    Triamcinolone acetonide (TA) is widely used for the treatment of rotator cuff injury because of its anti-inflammatory properties. However, TA can also produce deleterious effects such as tendon degeneration or rupture. These harmful effects could be prevented by the addition of platelet-rich plasma (PRP), however, the anti-inflammatory and anti-degenerative effects of the combined use of TA and PRP have not yet been made clear. The objective of this study was to determine how the combination of TA and PRP might influence the inflammation and degeneration of the rotator cuff by examining rotator cuff-derived cells induced by interleukin (IL)-1ß. Rotator cuff-derived cells were seeded under inflammatory stimulation conditions (with serum-free medium with 1 ng/ml IL-1ß for three hours), and then cultured in different media: serum-free (control group), serum-free + TA (0.1mg/ml) (TA group), serum-free + 10% PRP (PRP group), and serum-free + TA (0.1mg/ml) + 10% PRP (TA+PRP group). Cell morphology, cell viability, and expression of inflammatory and degenerative mediators were assessed. Exposure to TA significantly decreased cell viability and changed the cell morphology; these effects were prevented by the simultaneous administration of PRP. Compared with the control group, expression levels of inflammatory genes and reactive oxygen species production were reduced in the TA, PRP, and TA+PRP groups. PRP significantly decreased the expression levels of degenerative marker genes. The combination of TA plus PRP exerts anti-inflammatory and anti-degenerative effects on rotator cuff-derived cells stimulated by IL-1ß. This combination has the potential to relieve the symptoms of rotator cuff injury.Cite this article: T. Muto, T. Kokubu, Y. Mifune, A. Inui, R. Sakata, Y. Harada, F. Takase, M. Kurosaka. Effects of platelet-rich plasma and triamcinolone acetonide on interleukin-1ß-stimulated human rotator cuff-derived cells. Bone Joint Res 2016;5:602-609. DOI: 10

  6. Mesenchymal Stem Cell Secretome: A Potential Tool for the Prevention of Muscle Degenerative Changes Associated With Chronic Rotator Cuff Tears.

    Sevivas, Nuno; Teixeira, Fábio Gabriel; Portugal, Raquel; Araújo, Luís; Carriço, Luís Filipe; Ferreira, Nuno; Vieira da Silva, Manuel; Espregueira-Mendes, João; Anjo, Sandra; Manadas, Bruno; Sousa, Nuno; Salgado, António J


    Massive rotator cuff tears (MRCTs) are usually chronic lesions with pronounced degenerative changes, where advanced fatty degeneration and atrophy can make the tear irreparable. Human mesenchymal stem cells (hMSCs) secrete a range of growth factors and vesicular systems, known as secretome, that mediates regenerative processes in tissues undergoing degeneration. To study the effect of hMSC secretome on muscular degenerative changes and shoulder function on a rat MRCT model. Controlled laboratory study. A bilateral 2-tendon (supraspinatus and infraspinatus) section was performed to create an MRCT in a rat model. Forty-four Wistar-Han rats were randomly assigned to 6 groups: control group (sham surgery), lesion control group (MRCT), and 4 treated-lesion groups according to the site and periodicity of hMSC secretome injection: single local injection, multiple local injections, single systemic injection, and multiple systemic injections. Forelimb function was analyzed with the staircase test. Atrophy and fatty degeneration of the muscle were evaluated at 8 and 16 weeks after injury. A proteomic analysis was conducted to identify the molecules present in the hMSC secretome that can be associated with muscular degeneration prevention. When untreated for 8 weeks, the MRCT rats exhibited a significantly higher fat content (0.73% ± 0.19%) compared with rats treated with a single local injection (0.21% ± 0.04%; P muscle atrophy, 8 weeks after injury, only the single local injection group (0.0993% ± 0.0036%) presented a significantly higher muscle mass than that of the untreated MRCT group (0.0794% ± 0.0047%; P muscle regeneration, namely, pigment epithelium-derived factor and follistatin. The study data suggest that hMSC secretome effectively decreases the fatty degeneration and atrophy of the rotator cuff muscles. We describe a new approach for decreasing the characteristic muscle degeneration associated with chronic rotator cuff tears. This strategy is particularly

  7. Rotating Wavepackets

    Lekner, John


    Any free-particle wavepacket solution of Schrodinger's equation can be converted by differentiations to wavepackets rotating about the original direction of motion. The angular momentum component along the motion associated with this rotation is an integral multiple of [h-bar]. It is an "intrinsic" angular momentum: independent of origin and…

  8. Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

    Heumann, Thatcher R. [Emory University School of Medicine, Emory University, Atlanta, Georgia (United States); Esiashvili, Natia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States); Parker, Sareeta [Department of Dermatology, Emory University, Atlanta, Georgia (United States); Switchenko, Jeffrey M. [Biostatistics Shared Core Resource at WCI, Emory University, Atlanta, Georgia (United States); Dhabbaan, Anees [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States); Goodman, Michael [Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Lechowicz, Mary Jo; Flowers, Christopher R. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Department of Hematology and Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia (United States)


    Purpose: To report our experience with rotational total skin electron irradiation (RTSEI) in cutaneous T-cell lymphoma (CTCL), and to examine response by disease stage and race. Methods and Materials: We reviewed our outcomes for 68 CTCL patients who received RTSEI (≥30 Gy) from 2000 to 2013. Primary outcomes were complete clinical response (CCR), recurrence-free survival (RFS), and overall survival (OS). Using log–rank tests and Cox proportional hazards, OS and RFS were compared across tumor stages at time of RTSEI with further racial subgroup analysis. Results: Median age at diagnosis and at time of radiation was 52 and 56 years, respectively. Median follow-up was 5.1 years, 49% were African American, and 49% were female. At time of treatment, 18, 37, and 13 patients were T stage 2, 3, and 4, respectively. At 6 weeks after RTSEI, overall CCR was 82% (88%, 83%, and 69% for T2, T3, and T4, respectively). Median RFS was 11 months for all patients and 14, 10, and 12 months for stage T2, T3, and T4, respectively. Tumor stage was not associated with RFS or CCR. Maintenance therapy after RTSEI was associated with improved RFS in both crude and multivariable analysis, controlling for T stage. Median OS was 76 months (91 and 59 months for T3 and T4, respectively). With the exception of improved OS in African Americans compared with whites at stage T2, race was not associated with CCR, RFS, or OS. Conclusions: These results represent the largest RTSEI clinical outcomes study in the modern era using a dual-field rotational technique. Our observed response rates match or improve upon the standard set by previous outcome studies using conventional TSEI techniques, despite a large percentage of advanced CTCL lesions in our cohort. We found that clinical response after RTSEI did not seem to be affected by T stage or race.

  9. Characteristics and stimulation potential with BMP-2 and BMP-7 of tenocyte-like cells isolated from the rotator cuff of female donors.

    Franka Klatte-Schulz

    Full Text Available Tendon bone healing of the rotator cuff is often associated with non-healing or recurrent defects, which seems to be influenced by the patient's age and sex. The present study aims to examine cellular biological characteristics of tenocyte-like cells that may contribute to this impaired rotator cuff healing. Moreover, a therapeutic approach using growth factors could possibly stimulate tendon bone healing. Therefore, our second aim was to identify patient groups who would particularly benefit from growth factor stimulation. Tenocyte-like cells isolated from supraspinatus tendons of female donors younger and older than 65 years of age were characterized with respect to different cellular biological parameters, such as cell density, cell count, marker expression, collagen-I protein synthesis, and stem cell potential. Furthermore, cells of the donor groups were stimulated with BMP-2 and BMP-7 (200 and 1000 ng/ml in 3D-culture and analyzed for cell count, marker expression and collagen-I protein synthesis. Female donors older than 65 years of age showed significantly decreased cell count and collagen-I protein synthesis compared to cells from donors younger than 65 years. Cellular biological parameters including cell count, collagen-I and -III expression, and collagen-I protein synthesis of cells from both donor groups were stimulated with BMP-2 and BMP-7. The cells from donors older than 65 years revealed a decreased stimulation potential for cell count compared to the younger group. Cells from female donors older than 65 years of age showed inferior cellular biological characteristics. This may be one reason for a weaker healing potential observed in older female patients and should be taken into consideration for tendon bone healing of the rotator cuff.

  10. Sexual function in women receiving maintenance dialysis.

    Seethala, Srikanth; Hess, Rachel; Bossola, Maurizio; Unruh, Mark L; Weisbord, Steven D


    While substantial attention has been paid to the issue of sexual dysfunction in men on chronic dialysis, less is known about this problem in women with end-stage renal disease. We sought to assess sexual dysfunction in women on chronic dialysis and determine whether patients discuss this problem with their providers and receive treatment. We prospectively enrolled women receiving chronic hemodialysis or peritoneal dialysis in Pittsburgh, PA. We asked patients to complete the 19-item Female Sexual Function Index (FSFI) to assess sexual function and a 5-item survey that assessed whether patients had discussed sexual dysfunction with their providers and/or received treatment for this problem in the past. We enrolled 66 patients; 59 (89%) on hemodialysis and 7 (11%) on peritoneal dialysis. All patients completed the FSFI, of whom 53 (80%) had FSFI scores <26.55, consistent with the presence of sexual dysfunction. Of 37 patients who were married or residing with a significant other, 27 (73%) had sexual dysfunction. Among 24 participants who reported having been sexually active over the previous 4 weeks, 11 (46%) had sexual dysfunction. Only 21% of patients with sexual dysfunction had discussed this problem with their gynecologist, renal or primary provider, and 3 (6%) reported having received treatment. Sexual dysfunction is common in women on dialysis, even among patients who are married or residing with a significant other and those who are sexually active. However, few women discuss this issue with their providers or receive treatment.

  11. Interfacial instability in a time-periodic rotating Hele-Shaw Cell

    Bouchgl J.


    Full Text Available The effect of time-periodic angular velocity on the interfacial instability of two immiscible, viscous fluids of different densities and confined in an annular Hele-Shaw cell is investigated. An inviscid linear stability analysis of the viscous and time dependent basic flow leads to a periodic Mathieu oscillator describing the evolution of the interfacial amplitude. We show that the relevant parameters that control the interface are the Bond number, viscosity ratio, Atwood number and the frequency number.

  12. Fuel Cells Using the Protic Ionic Liquid and Rotator Phase Solid Electrolyte Principles


    these newer, mechanically sound , membranes in the coming year if this extension proposal is funded. Comparisons with previous work These... biomolecules discussed in the next section. FIGURE 10. IR-corrected polarization curves for hydrogen/oxygen fuel cells utilizing inorganic and organic cation...role for ionic liquids may lie in the storage and manipulation of sensitive biomolecules . Fujita et al.30 have recently reported that the protein

  13. Rotational elasticity

    Vassiliev, Dmitri


    We consider an infinite three-dimensional elastic continuum whose material points experience no displacements, only rotations. This framework is a special case of the Cosserat theory of elasticity. Rotations of material points are described mathematically by attaching to each geometric point an orthonormal basis that gives a field of orthonormal bases called the coframe. As the dynamical variables (unknowns) of our theory, we choose the coframe and a density. We write down the general dynamic variational functional for our rotational theory of elasticity, assuming our material to be physically linear but the kinematic model geometrically nonlinear. Allowing geometric nonlinearity is natural when dealing with rotations because rotations in dimension three are inherently nonlinear (rotations about different axes do not commute) and because there is no reason to exclude from our study large rotations such as full turns. The main result of the talk is an explicit construction of a class of time-dependent solutions that we call plane wave solutions; these are travelling waves of rotations. The existence of such explicit closed-form solutions is a non-trivial fact given that our system of Euler-Lagrange equations is highly nonlinear. We also consider a special case of our rotational theory of elasticity which in the stationary setting (harmonic time dependence and arbitrary dependence on spatial coordinates) turns out to be equivalent to a pair of massless Dirac equations. The talk is based on the paper [1]. [1] C.G.Boehmer, R.J.Downes and D.Vassiliev, Rotational elasticity, Quarterly Journal of Mechanics and Applied Mathematics, 2011, vol. 64, p. 415-439. The paper is a heavily revised version of preprint

  14. Peritoneal dialysis in developing countries.

    Nayak, K S; Prabhu, M V; Sinoj, K A; Subhramanyam, S V; Sridhar, G


    Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 billion and the two fastest growing economies worldwide. A holistic approach to tackle the issues in the developing countries, which may vary from region to region, is critical in popularizing PD and establishing PD as the first-choice RRT for ESRD. At our center, we have been pursuing a 'PD first' policy and promoting PD as the therapy of choice for various situations in the management of renal failure. We use certain novel strategies, which we hope can help PD centers in other developing countries working under similar constraints. The success of a PD program depends on a multitude of factors that are interlinked and inseparable. Each program needs to identify its strengths, special circumstances, and deficiencies, and then to strategize accordingly. Ultimately, teamwork is the 'mantra' for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program.

  15. Dialysis Patients May Walk Their Way to Better Health

    ... page: Dialysis Patients May Walk Their Way to Better Health ... just be steps away for people on kidney dialysis, a new study suggests. A simple program that ...

  16. Thyroid Problems May Make Things Worse for Dialysis Patients

    ... page: Thyroid Problems May Make Things Worse for Dialysis Patients ... 2017 THURSDAY, July 13, 2017 (HealthDay News) -- Poor thyroid function may diminish kidney dialysis patients' health and ...

  17. Administration of calcimimetics after dialysis: Same effectiveness, better gastrointestinal tolerability

    Vicent Esteve Simo


    Conclusions: Post-dialysis use of calcimimetic was effective in secondary hyperparathyroidism control, improved gastrointestinal tolerability and ameliorated patients’ satisfaction. Based on our findings, post-dialysis use of calcimimetics should be considered in selected patients with low therapeutic compliance.

  18. Inflammation and the Peritoneal Membrane: Causes and Impact on Structure and Function during Peritoneal Dialysis

    Gilberto Baroni


    Full Text Available Peritoneal dialysis therapy has increased in popularity since the end of the 1970s. This method provides a patient survival rate equivalent to hemodialysis and better preservation of residual renal function. However, technique failure by peritonitis, and ultrafiltration failure, which is a multifactorial complication that can affect up to 40% of patients after 3 years of therapy. Encapsulant peritoneal sclerosis is an extreme and potentially fatal manifestation. Causes of inflammation in peritoneal dialysis range from traditional factors to those related to chronic kidney disease per se, as well as from the peritoneal dialysis treatment, including the peritoneal dialysis catheter, dialysis solution, and infectious peritonitis. Peritoneal inflammation generated causes significant structural alterations including: thickening and cubic transformation of mesothelial cells, fibrin deposition, fibrous capsule formation, perivascular bleeding, and interstitial fibrosis. Structural alterations of the peritoneal membrane described above result in clinical and functional changes. One of these clinical manifestations is ultrafiltration failure and can occur in up to 30% of patients on PD after five years of treatment. An understanding of the mechanisms involved in peritoneal inflammation is fundamental to improve patient survival and provide a better quality of life.

  19. Dialysate as food as an option for automated peritoneal dialysis

    Tjiong, Hoey Lan; Swart, Roel; Berg, Willem; Fieren, Marien


    textabstractProtein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could serve as a source of food. The authors of this article found that such a dialysis solution when administered to fasting patients who were on nightly automated peritoneal dialysis (APD), as part of ...

  20. Sodium Balance During Extra Corporeal Dialysis

    Locatelli Francesco


    Full Text Available In order to reduce intradialytic and interdialytic morbidity, it is important to obtain a zero sodium balance at the end of each dialysis session. This can be achieved by matching exactly the interdialytic sodium and water intake with the intradialytic sodium and water removal. A positive sodium balance can be obtained by using hypernatric dialysis or "sodium ramping" or convective techniques. While reducing the intradialytic side effects (hypotension, cramps, nausea, vomiting, these methods may increase the interdialytic side effects (thirst, weight gain, hypertension and pulmonary edema. Given the highly variable amounts of sodium introduced during the interdialytic periods, the use of sodium-conductivity kinetic models allows removing exactly the amount of sodium accumulated in the interdialytic period. This strategy may be advantageous towards cardiovascular stability in patients prone to dialysis hypotension.

  1. Optimizing home dialysis: role of hemodiafiltration.

    Vilar, Enric; Farrington, Ken; Bates, Chris; Mumford, Carol; Greenwood, Roger


    Over the last 40 years the technical obstacles which prevented a convective contribution to diffusive dialysis have been overcome. Hemodiafiltration represents a natural evolution of intermittent extracorporeal blood purification and the technology is now available to offer this as standard treatment in-center. The first randomized control trial of dialysis dose (National Cooperative Dialysis Study) showed that for three times weekly dialysis a critical level of urea clearance was necessary to ensure complication-free survival, the effect being noticeable by 3 months. Following this, observational studies suggested that higher doses improved longer term outcome. In a second large randomized controlled study (HEMO), higher small molecule clearance did not further improve outcome, but high-flux membranes, which permitted enhanced clearance of middle molecules, appeared to confer survival benefit in patients who had already been on dialysis > 3.7 years. Recently, outcomes from the Membrane Permeability Outcome study confirmed a survival benefit of high-flux membranes in high-risk patients. These studies indicate that in the medium term survival is critically dependent on achieving a minimum level of small solute removal. However, longer term survival (measured in years or decades) not only requires better small solute clearance but also enhanced clearance of middle molecules, the toxicity of which manifest over longer time scales. The rationale for convective treatment is strongest, therefore in those patients who have the greatest potential for long-term survival. Patients who opt for self-care at home to allow frequent dialysis generally are constituents of this group. Hemodiafiltration is likely to become standard therapy in-center and in the home. Copyright © 2011 S. Karger AG, Basel.

  2. 42 CFR 415.176 - Renal dialysis services.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Renal dialysis services. 415.176 Section 415.176 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Renal dialysis services. In the case of renal dialysis services, physicians who are not paid under...

  3. [Should dialysis be for all? Yes indeed!].

    Panzetta, G; Grignetti, M; Toigo, G


    Clinically compromised patients who must undergo chronic dialysis are, in general, at risk because the procedure can be difficult to perform and give poor results in terms of survival and of rehabilitation. However, it is dialysis of the very elderly which is routinely characterized by misgivings about the indication for and limits of the technique. Patients older than 75 years of age currently represent more than 35% of the population that begin dialysis in most European registries. In our center at least 30 very old patients begin dialysis every year, which represents 45% of the total incident patients. About 30% of these patients, because of severe physical and/or mental disability, often associated with a situation of social deprivation, rarely achieve true clinical stability and depend upon outside caregivers in order to survive. The treatment of these patients strains the resources of the health and social structure, as well as the Nephrology Division, whose organization can be disrupted by their urgent needs, such as hospitalization, transportation, convalescent care, etc. Despite these difficulties and a mean survival of only 28 months, the global clinical conditions of patients older than 75 years of age are not much different than patients in the age bracket of 65 to 75 years. In fact, excluding patients older than 85 years of age (a category which geriatricians consider separately), the survival and rehabilitation of the very elderly appear similar to those of patients 65 to 75 years of age. Many of the clinical problems of the dialyzed elderly, such as sensory, mental and functional impairment, are the result of advanced age per se rather than of uremia or of dialysis. Therefore, ethical considerations of dialysis and of health maintenance in the very elderly are similar to those presented by patients who are afflicted by other serious diseases such as cancer, heart failure, or extensive stroke. As a result of modern technology and the advancement of

  4. [Diabetic patients survival rates in dialysis].

    Cano, Noël


    Since the beginning of the eighties, the prevalence and incidence of diabetes have been increasing in dialysis units. In France, type 2 diabetes accounts for approximately 90% of diabetic hemodialysis patients. Among the etiologies of renal failure, diabetes is characterized by increased hospitalization rates and reduced quality of life, transplantation rates and survival. In dialysis patients, diabetes mellitus enhances the main factors leading to an increase in cardiovascular and non-cardiovascular deaths: inflammation, dyslipidemia, hypertension, increased energy expenditure, oxidative stress and plasma assymetrical dimethylarginine. The prevention of these complications includes the control of blood glucose, plasma lipids, hypertension, and anemia. The role of antioxidant therapies remains to be evaluated.

  5. Increasing sodium removal on peritoneal dialysis: applying dialysis mechanics to the peritoneal dialysis prescription.

    Fischbach, Michel; Schmitt, Claus Peter; Shroff, Rukshana; Zaloszyc, Ariane; Warady, Bradley A


    Optimal fluid removal on peritoneal dialysis (PD) requires removal of water coupled with sodium, which is predominantly achieved via the small pores in the peritoneal membrane. On the other hand, free-water transport takes place through aquaporin-1 channels, but leads to sodium retention and over hydration. PD prescription can be adapted to promote small pore transport to achieve improved sodium and fluid management. Both adequate dwell volume and dwell time are required for small pore transport. The dwell volume determines the amount of "wetted" peritoneal membrane being increased in the supine position and optimized at dwell volumes of approximately 1400 ml/m(2). Diffusion across the recruited small pores is time-dependent, favored by a long dwell time, and driven by the transmembrane solute gradient. According to the 3-pore model of conventional PD, sodium removal primarily occurs via convection. The clinical application of these principles is essential for optimal performance of PD and has resulted in a new approach to the automated PD prescription: adapted automated PD. In adapted automated PD, sequential short- and longer-dwell exchanges, with small and large dwell volumes, respectively, are used. A crossover trial in adults and a pilot study in children suggests that sodium and fluid removal are increased by adapted automated PD, leading to improved blood pressure control when compared with conventional PD. These findings are not explained by the current 3-pore model of peritoneal permeability and require further prospective crossover studies in adults and children for validation. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.


    Zakaria, El Rasheid; Patel, Anuj A.; Li, Na; Matheson, Paul J.; Garrison, Richard N.


    Background Conventional peritoneal dialysis (PD) solutions elicit vasodilation, which is implicated in the variable rate of solute transport during the dwell. The components causing such vasoactivity are still controversial. This study was conducted to define the vasoactive components of conventional and new PD solutions. Methods Three visceral peritoneal microvascular levels were visualized by intravital video microscopy of the terminal ileum of anesthetized rats. Anesthesia-free decerebrate conscious rats served as control. Microvascular diameter and blood flow by Doppler measurements were conducted after topical peritoneal exposure to 4 clinical PD solutions and 6 prepared solutions designed to isolate potential vasoactive components of the PD solution. Results All clinically available PD solutions produced a rapid and generalized vasodilation at all intestinal microvascular levels, regardless of the osmotic solute. The pattern and magnitude of this dilation was not affected by anesthesia but was determined by arteriolar size, the osmotic solute, and the solution’s buffer anion system. The greatest dilation occurred in the small precapillary arterioles and was elicited by conventional PD solution and heat re-sterilized solution containing low glucose degradation products (GDPs). Hypertonic mannitol solutions produced a dilation that was approximately 50% less than the dilation obtained with glucose solutions with identical osmolarity and buffer. Increasing a solution’s osmolarity did not produce a parallel increase in the magnitude of dilation, suggesting a nonlinear relationship between the two variables. Lactate dissolved in an isotonic solution was completely non-vasoactive unless the solution’s H+ concentration was increased. At low pH, isotonic lactate produced a rapid but transient vasodilation. This vascular reactivity was similar in magnitude and pattern to that obtained with the isotonic 7.5% icodextrin solution (Extraneal; Baxter Healthcare

  7. Guidance of technical management of dialysis water and dialysis fluid for the Japan Association for Clinical Engineering Technologists.

    Kawasaki, Tadayuki; Uchino, Junji; Shinoda, Toshio; Kawanishi, Hideki


    There has been remarkable medical and technological progress in Japanese dialysis therapy where more than 270 thousand patients had been treated with dialysis by the end of 2007. Clinical engineering technologists have played an important role not only in the safety treatment but also in the technological development of dialysis therapy. It is very important to supply pure dialysis fluid for both the efficacy and the safety of hemodialysis in which high permeable dialysis membranes are used. The Japanese Society for Dialysis Therapy recently issued the standard for bacterial management of fluids for hemodialysis and related therapies according to the International Organization for Standardization (ISO)/DIS 23500. In order to achieve the standard, the management of dialysis water treatment is important as well as the role of clinical engineering technologists in daily dialysis practice. Purification is defined as no contamination by chemical substances and/or microorganisms and its components. The purification consists of the design and the system structure of the water treatment equipment and dialysis fluid-supplying equipment, and the operation and management of the equipment. The guideline aims to show the minimum standard and the management method of the water treatment system and dialysis fluid-supplying equipment in order to perform hemodialysis safely. They should outline safer dialysis by the management of purification of dialysis fluid.

  8. Rotator cuff tear state modulates self-renewal and differentiation capacity of human skeletal muscle progenitor cells.

    Thomas, Kelsey A; Gibbons, Michael C; Lane, John G; Singh, Anshuman; Ward, Samuel R; Engler, Adam J


    Full thickness rotator cuff tendon (RCT) tears have long-term effects on RC muscle atrophy and fatty infiltration, with lasting damage even after surgical tendon repair. Skeletal muscle progenitor cells (SMPs) are critical for muscle repair in response to injury, but the inability of RC muscles to recover from chronic RCT tear indicates possible deficits in repair mechanisms. Here we investigated if muscle injury state was a crucial factor during human SMP expansion and differentiation ex vivo. SMPs were isolated from muscles in patients with no, partial-thickness (PT), or full-thickness (FT) RCT tears. Despite using growth factors, physiological niche stiffness, and muscle-mimetic extracellular matrix (ECM) proteins, we found that SMPs isolated from human RC muscle with RCT tears proliferated slower but fused into myosin heavy chain (MHC)-positive myotubes at higher rates than SMPs from untorn RCTs. Proteomic analysis of RC muscle tissue revealed shifts in muscle composition with pathology, as muscle from massive RCT tears had increased ECM deposition compared with no tear RC muscle. Together these data imply that the remodeled niche in a torn RCT primes SMPs not for expansion but for differentiation, thus limiting longer-term self-renewal necessary for regeneration after surgical repair. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1816-1823, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Proteomics in extracorporeal blood purification and peritoneal dialysis.

    Thongboonkerd, Visith


    Extracorporeal blood purification and peritoneal dialysis are widely used in renal replacement therapy for patients with end-stage renal disease (ESRD) and acute kidney injury (AKI). Additionally, extracorporeal blood purification can be used also for treatment of non-renal disorders to remove endogenous or exogenous toxins from the blood circulation. Efforts have been made to characterize these toxins removed by diffusion (dialysis), convection (ultrafiltration), and/or adsorption (toxins are adsorbed onto the dialysis membrane and are thus removed) using different types of dialysis membrane. This review summarizes important findings obtained from recent proteomic studies applied to extracorporeal blood purification and peritoneal dialysis in settings of ESRD, AKI and hepatic failure.

  10. [Dialysis and ecology: can we do better in the future?].

    Vuignier, Y; Pruijm, M; Jarrayah, F; Burnier, M


    Development of dialysis has saved the lives of many patients. However, haemodialysis and peritoneal dialysis are very demanding in resources such as water and electricity, and generate a large amount of waste. In this article, we will review the environmental aspects of dialysis. Different solutions will be discussed, such as recycling of water discharged during reverse osmosis, the integration of solar energy, recycling of waste plastics, and the use of other techniques such as sorbent dialysis. In a world where natural resources are precious and where global warming is a major problem, it is important that not only dialysis, but all branches of medicine become more attentive to ecology.

  11. Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation.

    James G Heaf

    Full Text Available Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1 whether, and if so, how, PD and HD prognosis had changed in recent years, (2 whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3 whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation.12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI, and mode of dialysis initiation.Overall adjusted prognosis improved by 34% (HD 30%, PD 42%. PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation.Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.

  12. Fungal peritonitis in children on peritoneal dialysis.

    Raaijmakers, R.; Schroder, C.; Monnens, L.A.H.; Cornelissen, E.A.M.; Warris, A.


    Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 month

  13. Nutritional status of maintenance dialysis patients

    Koefoed, Mette Juul; Kromann, Charles Boy; Juliussen, Sophie Ryberg


    in maintenance dialysis patients, and compared different methods of nutritional assessment. Methods In a cross-sectional study conducted in 2014 at Roskilde Hospital, Denmark, we performed anthropometry (body weight, skinfolds, mid-arm, waist, and hip circumferences), and determined plasma albumin and normalized...

  14. Peritoneal dialysis peritonitis: risk factors and effects

    Alikari V.


    Full Text Available Introduction: Peritonitis is the most frequent complication of peritoneal dialysis. It is the main cause of failure of the method and inclusion of patients in hemodialysis Purpose: The purpose of this study is to explore the risk factors of peritoneal dialysis peritonitis as well as the acute and long-term effects of peritonitis on peritoneal membrane function and success of the method. Methods: Literature review of relevant articles in the database Pubmed as well as the official website of the International Society of Peritoneal Dialysis (ISPD was carried out. The search included articles published during the period 1986 -2012.Results: Lack of patient compliance with the peritoneal changes protocol, lack of social support, systemic diseases and connection systems are risk factors of peritonitis. Peritonitis causes transient increase of peritoneum permeability, loss of the ability of the peritoneum for ultrafiltration and, consequently, overhydration. Long-term, recurrent episodes of peritonitis resulting in permanent loss of peritoneum capacity for ultrafiltration even fibrosis that leads to failure of the method. Finally, its effect on the reduction of the residual renal function seems to be remarkable. Conclusions: Peritonitis is the most common infectious complication of peritoneal dialysis and the main cause of morbidity associated with the method. Moreover, it is the major cause of failure of the method and patients accession in hemodialysis. Any attempt to prevent peritonitis passes through the careful patient selection and effective patient education on compliance with the rules of asepsis during peritoneal changes.

  15. Laboratory dialysis--past, present and future.

    Bansal, Parikshit; Ajay, Dara


    Laboratory dialysis, one of the most widely used techniques in biological research is truly a ' gateway technology' . The analogy is to that of a ' gate' of a building through which everybody has to pass, even though they may wish to go to different departments. Similarly, researchers may be working in altogether different areas but all may need to use laboratory dialysis at one stage or the other during the course of their research. Biochemists may use it to purify enzymes, an immunologist may use it to purify monoclonal antibodies from culture supernatants, a chemist may use it as a step in the crystallography process or for purification of ionic liquids, a biotechnologist may use it to study the effectiveness of enzyme immobilization and a drug discovery scientist may use it for determining drug-protein interaction. The present article reviews patents in the field of laboratory dialysis from inception till date, focusing on the various developmental and innovation related milestones during evolution of the technique. It captures the full panorama of a very interesting technique which continues to be as relevant today as it was in 1866 when the term ' dialysis' was first coined.

  16. Fungal peritonitis in children on peritoneal dialysis.

    Raaijmakers, R.; Schroder, C.; Monnens, L.A.H.; Cornelissen, E.A.M.; Warris, A.


    Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 month

  17. Continuous ambulatory peritoneal dialysis: Indian scenario.

    Abraham, Georgi; Mathew, Milli; Hinduja, Anish; Padma, G


    Chronic peritoneal dialysis (CPD) has been initiated as a treatment modality for chronic renal failure patients in the Indian subcontinent since 1990. Over a period of 9 years both continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) have emerged as accepted forms of renal replacement therapy in our country. Although there were government restrictions on import of dialysis fluid until 1993, the availability of locally manufactured fluid in collapsible bags had facilitated the expansion of the programme to the far corners of the country and in neighbouring countries. Initially majority (78%) of the patients who were started on this programme were diabetics with other comorbid conditions who were drop-outs from haemodialysis and unfit for transplantation. Both CAPD and CCPD have been used for all age groups and for men and women. Majority of the patients do 3 x 2 l exchanges a day on CAPD; 8-10 l using a cycler at night those who are onCCPD. Peritonitis rate was 1 episode every 18 patient months. With the introduction of new connection and disposable sets the incidence of peritonitis is dropping down. The major cause of drop-out is cardiovascular death followed by peritonitis. Malnutrition is a major problem in both CAPD and haemodialysis patients. The programme has been expanded and there are over one thousand patients on this treatment in the country. The introduction of CPD had a major impact on the treatment of renal failure in India.

  18. Blood pressure management in children on dialysis.

    Paglialonga, F; Consolo, S; Edefonti, A; Montini, G


    Hypertension is a leading cause of cardiovascular complications in children on dialysis. Volume overload and activation of the renin-angiotensin-aldosterone system play a major role in the pathophysiology of hypertension. The first step in managing blood pressure (BP) is the careful assessment of ambulatory BP monitoring. Volume control is essential and should start with the accurate identification of dry weight, based on a comprehensive assessment, including bioimpedance analysis and intradialytic blood volume monitoring (BVM). Reduction of interdialytic weight gain (IDWG) is critical, as higher IDWG is associated with a worse left ventricular mass index and poorer BP control: it can be obtained by means of salt restriction, reduced fluid intake, and optimized sodium removal in dialysis. Optimization of peritoneal dialysis and intensified hemodialysis or hemodiafiltration have been shown to improve both fluid and sodium management, leading to better BP levels. Studies comparing different antihypertensive agents in children are lacking. The pharmacokinetic properties of each drug should be considered. At present, BP control remains suboptimal in many patients and efforts are needed to improve the long-term outcomes of children on dialysis.

  19. Morphological changes of the peritoneum in peritoneal dialysis patients

    方炜; 钱家麒; 余志远; 陈诗书


    Background Long-term peritoneal dialysis (PD) requires that the peritoneal membrane remain effective for dialysis. Research directed toward human peritoneal morphology and structure is limited. The present study was performed to investigate morphological changes of the human peritoneal membrane during PD and to elucidate the possible mechanisms of its functional deterioration. Methods A total of 32 peritoneal biopsies were performed in normal subjects (n=10), uremic nondialysis patients (n=12) at the time of catheter insertion, and PD patients (n=10) at the time of catheter removal or reinsertion or at the time of renal transplantation. Peritoneal morphology was examined by light microscopy, scanning electron microscopy, and transmission electron microscopy. Results The peritoneal membrane in normal subjects consisted of a monolayer of mesothelial cells on a basement membrane and a layer of connective tissue containing cells, blood vessels, and lymphatic vessels. Mesothelial cells were polygonal, often elongated, and had numerous microvilli on their luminal surface. There were lots of oval or roundish pinocytotic vesicles in the cytoplasm of the mesothelial cells. The peritoneal morphology of uremic nondialysis patients was similar to that of normal subjects. However, significant abnormalities of the peritoneal membrane were observed in PD patients, and the changes were found to be progressive. Microvilli were the first site of damage which involved microvilli shortening, a gradual reduction in their number, and, eventually, the total disappearance of microvilli. Mesothelial cells then detached from the basement membrane, disappearing completely in some cases. In the end, the peritoneal membrane consisted only of submesothelial connective tissue without any cells.Conclusions PD can modify peritoneal morphology and structure. The morphological change is progressive and may be one of the important causes of peritoneal failure. Peritoneal biopsies can provide lots of

  20. Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution.

    Hamasaki, Yoshifumi; Doi, Kent; Tanaka, Mototsugu; Kume, Haruki; Ishibashi, Yoshitaka; Enomoto, Yutaka; Fujita, Toshiro; Homma, Yukio; Nangaku, Masaomi; Noiri, Eisei


    Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical factors at peritoneal dialysis initiation, including peritoneal transport status, are associated with cardiovascular event in patients using biocompatible peritoneal dialysis solution. This retrospective cohort study of peritoneal dialysis patients using biocompatible solutions with neutral pH assessed relations of clinical parameters at peritoneal dialysis initiation to cardiovascular event during the subsequent five years. Of 102 patients who started peritoneal dialysis, cardiovascular event occurred in 18. Age, history of cardiovascular disease before peritoneal dialysis initiation, hemoglobin, serum albumin, C-reactive protein, peritoneal permeability defined by the ratio of dialysate to plasma creatinine concentration at 4 hr (D/Pcre) in peritoneal equilibration test (PET), number of patients in each PET category defined by D/Pcre, and peritoneal protein clearance significantly differed between patients with and without cardiovascular event. For patients divided according to PET category using Kaplan-Meier method, the group of high average to high peritoneal transporters exhibited significantly high incidence of cardiovascular event and mortality compared with the groups of low and low-average peritoneal transporters (Log rank; p=0.0003 and 0.005, respectively). A Cox proportional hazards model showed independent association of PET category classification with cardiovascular event. Peritoneal permeability expressed as PET category at peritoneal dialysis initiation is an independent

  1. Dose adjustment of carboplatin in patients on peritoneal dialysis.

    Guddati, Achuta K; Joy, Parijat S; Marak, Creticus P


    The Calvert equation has been extensively used to determine the dosage of carboplatin. However, in patients on dialysis, it predicts the same dosage regardless of the frequency of dialysis. Clearance of carboplatin during hemodialysis has been studied to a lesser extent, but there have been very few studies which have investigated the clearance of carboplatin in patients on peritoneal dialysis. A mathematical formula is proposed here to predict the dose of carboplatin for a given AUC in patients on peritoneal dialysis. This formula takes into account the frequency of dialysis sessions and the time delay between carboplatin infusion and the initiation of dialysis. The formula predicts an approximately similar dosage of carboplatin as that of the Calvert formula in patients undergoing peritoneal dialysis four times per day if dialysis is initiated 12 h after infusion. The formula may help in guiding the adjustment of carboplatin dose in patients who receive a lesser number of dialysis sessions per day and in those patients whose dialysis is initiated at different times (0-24 h) after carboplatin infusion. It is suggested that usage of this formula will result in a better dosage of carboplatin to suit specific dialysis frequencies in specific patients and eventually may result in a better efficacy and toxicity profile.

  2. [Report on chronic dialysis in France in 2016].

    Société Francophone de Néphrologie Dialyse Et Transplantation


    The report on dialysis in France in 2016 from the French Speaking Society of Nephrology Dialysis and Transplantation (SFNDT) provides an exhaustive and documented inventory on dialysis in France. It underlines the organizations that are important in 2016 to maintain a high quality dialysis. Several measures are proposed to maintain and improve the care of dialysis in France: (1) The regulation of dialysis treatment in France must be maintained; (2) a burden of care indicator is proposed to ensure that patients requiring the most care are treated in the centers. Proposals are also made to stimulate peritoneal dialysis offers, (3) to improve the calculation of the cost of dialysis and warn against lower reimbursement rates of dialysis, (4) to reduce transport costs by minimizing transport by ambulance (5). The SFNDT recalls recent recommendations concerning access to the renal transplant waiting list, are recalled; (6) as well as recommendations that require waiting until clinical signs are present to start dialysis (7). The SFNDT makes the proposal to set up advanced renal failure units. These units are expected to develop care that is not supported today: consultation with a nurse, a dietician, a social worker or psychologist, palliative care, and coordination (8). Finally, the financial and human resources for pediatric dialysis should be maintained. Copyright © 2017. Published by Elsevier Masson SAS.

  3. Survival on home dialysis in New Zealand.

    Mark R Marshall

    Full Text Available 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, 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.

  4. Pharmacotherapy of Hypertension in Chronic Dialysis Patients.

    Georgianos, Panagiotis I; Agarwal, Rajiv


    Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third-line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

  5. Use of hospice in the United States dialysis population.

    Murray, Anne M; Arko, Cheryl; Chen, Shu-Cheng; Gilbertson, David T; Moss, Alvin H


    Hospice is recognized for providing excellent end-of-life care but may be underused by dialysis patients. Hospice use and related outcomes were measured among dialysis patients, and factors that were associated with hospice use were identified. The 2-yr US Renal Data System dialysis patients who died between January 1, 2001, and December 31, 2002, and hospice claims from the Centers for Medicare & Medicaid Services were examined to measure prevalence, factors, and costs that were associated with dialysis withdrawal and hospice use. Of the 115,239 deceased patients, 21.8% withdrew from dialysis and 13.5% used hospice. Of those who withdrew, 41.9% used hospice. Failure to thrive was the most common reason for dialysis withdrawal (42.9%). On multivariable logistic regression analysis, factors that were significantly associated with hospice referral among patients who withdrew from dialysis were age, race, reason for withdrawal, ability to walk or transfer at dialysis initiation, and state of residence. Among patients who withdrew from dialysis and used hospice, median cost of per-patient care during the last week of life was $1858, compared with $4878 for nonhospice patients (P < 0.001); hospitalization costs accounted for most of that difference. Only 22.9% of dialysis hospice patients died in the hospital, compared with 69.0% of nonhospice patients (P < 0.001). A minority of dialysis patients use hospice, even among patients who withdrew from dialysis, whose death usually is certain. Increased hospice use may enable more dialysis patients to die at home, with substantial cost savings. Research regarding additional benefits of hospice care for dialysis patients is needed.

  6. Low-GDP peritoneal dialysis fluid ('balance') has less impact in vitro and ex vivo on epithelial-to-mesenchymal transition (EMT) of mesothelial cells than a standard fluid.

    Bajo, María Auxiliadora; Pérez-Lozano, María Luisa; Albar-Vizcaino, Patricia; del Peso, Gloria; Castro, María-José; Gonzalez-Mateo, Guadalupe; Fernández-Perpén, Antonio; Aguilera, Abelardo; Sánchez-Villanueva, Rafael; Sánchez-Tomero, J Antonio; López-Cabrera, Manuel; Peter, Mirjam E; Passlick-Deetjen, Jutta; Selgas, Rafael


    Peritoneal membrane deterioration during peritoneal dialysis (PD) is associated with epithelial-to-mesenchymal transition (EMT) of mesothelial cells (MC), which is believed to be mainly due to glucose degradation products (GDPs) present in PD solutions. Here we investigate the impact of GDPs in PD solutions on the EMT of MC in vitro and ex vivo. For in vitro studies, omentum-derived MC were incubated with standard PD fluid or low-GDP solution diluted 1:1 with culture medium. For ex vivo studies, 33 patients, who were distributed at random to either the 'standard' or the 'low GDP' groups, were followed over 24 months. Effluents were collected every 6 months to determine EMT markers in effluent MC. Exposure of MC to standard fluid in vitro resulted in morphological change into a non-epitheloid shape, down-regulation of E-cadherin, indicative of EMT, and in a strong induction of vascular endothelial growth factor (VEGF) expression. In contrast, in vitro exposure of MC to low-GDP solution did not lead to these phenotype changes. This could be confirmed ex vivo, as the prevalence of non-epitheloid phenotype of MC in the standard group was significantly higher with increasing PD duration and MC isolated from this group showed significantly higher levels of EMT-associated molecules including fibronectin, collagen I, VEGF, IL-8 and TGF-β levels when compared with the low-GDP group. Over time, the expression of E-cadherin also decreased in the standard but increased in the low-GDP group. In addition, the levels of EMT-associated molecules (fibronectin, VEGF and IL-8) increased in the standard but decreased in the low-GDP group. A similar trend was also observed for collagen I and for TGF-β (for the first year), but did not reach global statistical significance. Accordingly, effluent MC with non-epitheloid morphology showed significantly lower levels of E-cadherin and greater levels of fibronectin, collagen I, VEGF and IL 8 when compared with MC with epitheloid phenotype

  7. Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: report on three cases.

    Piccoli, Giorgina Barbara; Guzzo, Gabriella; Vigotti, Federica Neve; Capizzi, Irene; Clari, Roberta; Scognamiglio, Stefania; Consiglio, Valentina; Aroasio, Emiliano; Gonella, Silvana; Veltri, Andrea; Avagnina, Paolo


    Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is reported in about 1% of chronic dialysis patients. The role of personalized, intensive dialysis schedules and of resuming low-protein diets has not been studied to date. This report describes three patients with RFR who were recently treated at a new dialysis unit set up to offer intensive hemodialysis. All three patients were females, aged 73, 75, and 78 years. Kidney disease included vascular-cholesterol emboli, diabetic nephropathy and vascular and dysmetabolic disease. At time of RFR, the patients had been dialysis-dependent from 3 months to 1 year. Dialysis was started with different schedules and was progressively discontinued with a "decremental" policy, progressively decreasing number and duration of the sessions. A moderately restricted low-protein diet (proteins 0.6 g/kg/day) was started immediately after dialysis discontinuation. The most recent update showed that two patients are well off dialysis for 5 and 6 months; the diabetic patient died (sudden death) 3 months after dialysis discontinuation. Within the limits of small numbers, our case series may suggest a role for personalized dialysis treatments and for including low-protein diets in the therapy, in enhancing long-term RFR in elderly dialysis patients.

  8. Optimal choice of dialysis access for chronic kidney disease patients: developing a life plan for dialysis access.

    Lok, Charmaine E; Davidson, Ingemar


    Patient-focused dialysis modality and access selection requires a coordinated teamwork approach that emphasizes chronic kidney disease care to be a continuum of care. Individualized and detailed patient history and examination are the mainstays of dialysis modality and access selection. Preoperative vessel mapping by duplex Doppler ultrasonography can be a useful supplementary investigation to the history and physical examination to determine the optimal dialysis access type and site. Dialysis access modality and choice considers many patient factors that can be aided by a clinical risk score, asking key clinical questions, surgical expert opinion, and a multidisciplinary approach to individualized patient care. In many situations, a lifelong access utilization strategy prioritizes peritoneal dialysis as the first dialysis modality followed by appropriately planned hemodialysis. The goal of an integrated patient-focused approach is to achieve complication-free access to help patients achieve their life goals on and off dialysis. Copyright © 2012. Published by Elsevier Inc.

  9. Distribution and Viability of Fetal and Adult Human Bone Marrow Stromal Cells in a Biaxial Rotating Vessel Bioreactor after Seeding on Polymeric 3D Additive Manufactured Scaffolds.

    Leferink, Anne M; Chng, Yhee-Cheng; van Blitterswijk, Clemens A; Moroni, Lorenzo


    One of the conventional approaches in tissue engineering is the use of scaffolds in combination with cells to obtain mechanically stable tissue constructs in vitro prior to implantation. Additive manufacturing by fused deposition modeling is a widely used technique to produce porous scaffolds with defined pore network, geometry, and therewith defined mechanical properties. Bone marrow-derived mesenchymal stromal cells (MSCs) are promising candidates for tissue engineering-based cell therapies due to their multipotent character. One of the hurdles to overcome when combining additive manufactured scaffolds with MSCs is the resulting heterogeneous cell distribution and limited cell proliferation capacity. In this study, we show that the use of a biaxial rotating bioreactor, after static culture of human fetal MSCs (hfMSCs) seeded on synthetic polymeric scaffolds, improved the homogeneity of cell and extracellular matrix distribution and increased the total cell number. Furthermore, we show that the relative mRNA expression levels of indicators for stemness and differentiation are not significantly changed upon this bioreactor culture, whereas static culture shows variations of several indicators for stemness and differentiation. The biaxial rotating bioreactor presented here offers a homogeneous distribution of hfMSCs, enabling studies on MSCs fate in additive manufactured scaffolds without inducing undesired differentiation.

  10. Distribution and viability of fetal and adult human bone marrow stromal cells in a biaxial rotating vessel bioreactor after seeding on polymeric 3D additive manufactured scaffolds

    Anne eLeferink


    Full Text Available One of the conventional approaches in tissue engineering is the use of scaffolds in combination with cells to obtain mechanically stable tissue constructs in vitro prior to implantation. Additive manufacturing by fused deposition modeling is a widely used technique to produce porous scaffolds with defined pore network, geometry, and therewith defined mechanical properties. Bone marrow derived mesenchymal stromal cells (MSCs are promising candidates for tissue engineering based cell therapies due to their multipotent character. One of the hurdles to overcome when combining additive manufactured scaffolds with MSCs is the resulting heterogeneous cell distribution and limited cell proliferation capacity. In this study, we show that the use of a biaxial rotating bioreactor, after static culture of human fetal MSCs (hfMSCs seeded on synthetic polymeric scaffolds, improved the homogeneity of cell and extracellular matrix (ECM distribution and increased the total cell number. Furthermore, we show that the relative mRNA expression levels of indicators for stemness and differentiation are not significantly changed upon this bioreactor culture, whereas static culture shows variations of several indicators for stemness and differentiation. The biaxial rotating bioreactor presented here offers a homogeneous distribution of hfMSCs, enabling studies on MSCs fate in additive manufactured scaffolds without inducing undesired differentiation.

  11. Clinical experience with a single field rotational total skin electron irradiation technique for cutaneous T-cell lymphoma

    Freeman, C.R.; Shenouda, G.; Vuong, T.; Souhami, L.; Pla, M.; Podgorsak, E.B.; Pla, C. (McGill University, Montreal (Canada). Division of Radiation Oncology, Department of Oncology); Suissa, S. (McGill University, Montreal (Canada). Department of Epidemiology and Biostatics)


    Between October 1981 and December 1989, 44 patients with CTCL (cutaneous T-cell lymphoma) were treated with a single-field RTSEI (rotational total skin electron irradiation) technique developed in McGill University Radiation Oncology Department. Only 11/44 patients received no prior treatment (25%). Advanced (T[sub 3] or T[sub 4]) disease had 75% (33/44). Complete response was seen in 32/44 (73%) of patients (91% T[sub 2], 71% T[sub 3] and 58% T[sub 4]), only 27% (3/11) of patients with T[sub 2] and 14% (3/21) with T[sub 3] disease remain in continuous complete remission in the skin, after median intervals of 58 and 35 moths, resp. Median cause-specific survival for whole group is 43 months and survival at 5 years is 38%. Survival was much better for patients with T[sub 2] disease than for patients with T[sub 3] disease (relative risk 4.3; 95% CI 1.4-13.2) and patients with T[sub 4] disease (relative risk 3.1; 95% CI 0.8-12.1). The RTSEI technique used at McGill has depth-dose characteristics and photon contamination similar to other commonly used TSEI techniques. It is relatively simple and provides a homogenous dose distribution over entire skin surface in short treatment time. Results of treatment are similar to those obtained with other techniques. For T[sub 2] disease, TSEI is an effective treatment modality with a possibility of long-term tumor control. For more advanced disease, more aggressive treatment, which may include TSI, is necessary. (author). 27 refs.; 7 figs.; 3 tab.

  12. A Shape Memory Polymer Dialysis Needle Adapter for the Reduction of Hemodynamic Stress within Arteriovenous Grafts

    Ortega, J M; Small, W; Wilson, T S; Benett, W; Loge, J; Maitland, D J


    A deployable, shape memory polymer adapter is investigated for reducing the hemodynamic stress caused by a dialysis needle flow within an arteriovenous graft. Computational fluid dynamics simulations of dialysis sessions with and without the adapter demonstrate that the adapter provides a significant decrease in the wall shear stress. In vitro flow visualization measurements are made within a graft model following delivery and actuation of a prototype shape memory polymer adapter. Vascular access complications resulting from arteriovenous (AV) graft failures account for over $1 billion per year in the health care costs of dialysis patients in the U.S.[1] The primary mode of failure of arteriovenous fistulas (AVF's) and polytetrafluoroethylene (PTFE) grafts is the development of intimal hyperplasia (IH) and the subsequent formation of stenotic lesions, resulting in a graft flow decline. The hemodynamic stresses arising within AVF's and PTFE grafts play an important role in the pathogenesis of IH. Studies have shown that vascular damage can occur in regions where there is flow separation, oscillation, or extreme values of wall shear stress (WSS).[2] Nevaril et al.[3] show that exposure of red blood cells to WSS's on the order of 1500 dynes/cm2 can result in hemolysis. Hemodynamic stress from dialysis needle flow has recently been investigated for the role it plays in graft failure. Using laser Doppler velocimetry measurements, Unnikrishnan et al.[4] show that turbulence intensities are 5-6 times greater in the AV flow when the needle flow is present and that increased levels of turbulence exist for approximately 7-8cm downstream of the needle. Since the AVF or PTFE graft is exposed to these high levels of hemodynamic stress several hours each week during dialysis sessions, it is quite possible that needle flow is an important contributor to vascular access occlusion.[4] We present a method for reducing the hemodynamic stress in an AV graft by tailoring

  13. Leptin and beta2-microglobulin kinetics with three different dialysis modalities.

    Mandolfo, S; Borlandelli, S; Imbasciati, E


    Leptin is a protein produced by fat cells and involved in body weight regulation. In patients with normal kidney function, leptin has been considered an independent predictor of cardiovascular events. In uremic patients, leptin in plasma serum was assumed to be associated with malnutrition, inflammation and atherosclerosis. Because of its molecular weight and characteristics, leptin can be considered as a protein-bound uremic retention solute. Some authors have reported the possibility of decreasing the serum leptin concentration with high flux membranes, but limited data are available on the elimination with medium-flux membranes or alternative dialysis strategies such as hemodiafiltration. We evaluated the kinetics of leptin and beta2m in a study of 18 chronic hemodialysis patients using low-flux, medium-flux and high-flux biocompatible membranes, the last one used in hemodiafiltration (HDF). Blood samples for leptin and beta2m were collected pre- and post-treatment and 30 minutes after the end of treatment, over a 1-week period that included 3 dialysis sessions. Clearances of leptin and beta2m across the dialyzer were also determined directly from the arterial and venous blood concentrations 60 and 210 minutes after starting dialysis. At baseline, all groups showed similar leptin (18.8+/-4.4 ng/mL) and beta2m concentrations (29.2+/-7.1 ng/mL). After a single dialysis session, a reduction of both solutes was observed with HDF (39.8+/-1.9%, 78.1+/-4.9) and medium flux membranes (18.2+/-0.9%, 52.2+/-1.7%), whereas the concentrations remained unchanged with the low-flux membranes. After one-week period, a trend of reduction of plasma pre dialysis leptin and beta2m were observed with HDF and medium flux membranes. At 60 minutes, HDF showed the best instantaneous clearance across the filter for leptin (56.2+/-10.1 ml/min) and beta2m (75.3+/-4.4 ml/min). The magnitude of post dialysis rebound of leptin at 30 min was variable and strongly correlated with the

  14. Does an Injection of Adipose-Derived Mesenchymal Stem Cells Loaded in Fibrin Glue Influence Rotator Cuff Repair Outcomes? A Clinical and Magnetic Resonance Imaging Study.

    Kim, Yong Sang; Sung, Chang Hun; Chung, Sung Hoon; Kwak, Sang Joon; Koh, Yong Gon


    The mesenchymal stem cell (MSC)-based tissue engineering approach has been developed to improve the treatment of rotator cuff tears. Hypothesis/Purpose: The purpose was to determine the effect of an injection of adipose-derived MSCs loaded in fibrin glue during arthroscopic rotator cuff repair on clinical outcomes and to evaluate its effect on structural integrity using magnetic resonance imaging (MRI). The hypothesis was that the application of adipose-derived MSCs would improve outcomes after the surgical repair of a rotator cuff tear. Cohort study; Level of evidence, 3. Among 182 patients treated with arthroscopic surgery for a rotator cuff tear, 35 patients treated with arthroscopic rotator cuff repair alone (conventional group) were matched with 35 patients who underwent arthroscopic rotator cuff repair with an injection of adipose-derived MSCs loaded in fibrin glue (injection group) based on sex, age, and lesion size. Outcomes were assessed with respect to the visual analog scale (VAS) for pain, range of motion (ROM) (including forward flexion, external rotation at the side, and internal rotation at the back), and functional measures of the Constant score and University of California, Los Angeles (UCLA) shoulder rating scale. Repaired tendon structural integrity was assessed by using MRI at a minimum of 12 months after surgery, and the mean clinical follow-up was 28.8 ± 4.2 months in the conventional group and 28.3 ± 3.8 months in the injection group. The mean VAS score at rest and during motion improved significantly in both groups after surgery. However, there were no significant differences between the groups at the final follow-up ( P = .256 and .776, respectively). Compared with preoperative measurements, forward flexion and external rotation at the side significantly improved at the final follow-up in both groups (all P rotation at the back were observed in either group ( P = .625 and .834 for the conventional and injection groups, respectively

  15. Biofeedback-driven dialysis: where are we?

    Santoro, Antonio; Ferramosca, Emiliana; Mancini, Elena


    The progressive increase in the mean age and the growing conditions of co-morbidity, especially of cardiovascular pathologies and diabetes, have significantly worsened the patients' clinical status and tolerance to the hemodialysis (HD) treatment. On the other hand, the demand for short treatment times enhances the risk for hemodynamic instability as well as for inadequate depuration. The traditional management of the dialysis session, setting of predefined treatment parameters, with active therapeutic interventions only in the event of complications, is definitely unsuitable for short-lasting treatments, often complicated by hemodynamic instability, especially in critical patients. The first step to improve the management of the dialysis session is the utilization of continuous and uninvasive monitoring systems for hemodynamic or biochemical parameters involved in the dialysis quality. Special sensors for the continuous measurement of blood volume, blood temperature, blood pressure, heart rate, electrolytes, have been realized throughout the last 10 years. As a second step, some of these devices have been implemented in the dialysis instrumentation, mainly with a view to preventing cardiocirculatory instability but also to control the dialysis efficiency (biofeedback control systems). The basic components of a biofeedback system are: the plant, the sensors, the actuators and the controller. The plant is the biological process that we need to control, while the sensors are the devices used for measuring the output variables. The actuators are the working arms of the controller. The controller is the mathematical model that continuously sets the measured output variable against the reference input and modifies the actuators in order to reduce any discrepancies. Yet, in practice there are a number of conceptual, physical and technological difficulties to be overcome. In particular, the behavior of what is to be controlled may be non-linear and time-varying, with

  16. Dialysis and Quality of Dialysate in Southeast Asian Developing Countries

    Tomotaka Naramura


    Full Text Available Background: The number of dialysis patients has been increasing in Southeast Asia, but statistical data about these patients and on the quality of dialysates in Southeast Asian dialysis facilities are still imprecise. For this study, dialysis-related statistical data were collected in Southeast Asia. Methods: A survey of the quality of dialysates was carried out at 4 dialysis facilities in Vietnam and Cambodia. The dialysis patient survey included the numbers of dialysis facilities and patients receiving dialysis, a ranking of underlying diseases causing the initiation of dialysis, the number of patients receiving hemodialysis (HD/on-line hemodiafiltration/continuous ambulatory peritoneal dialysis, the number of HD monitoring devices installed, the cost of each session of dialysis (in USD, the percentage of out-of-pocket payments, and the 1-year survival rates of the dialysis patients (in percent. The dialysate survey covered the endotoxin (ET level and bacterial count in tap water, in water filtered through a reverse osmosis system and in dialysate. Results: In each of the countries, the most frequent reason for the initiation of dialysis is diabetes mellitus. HD is usually carried out according to the ‘reuse' principle. The 1-year survival rates are 70% in Myanmar and about 90% in the Philippines and Malaysia. The ET levels in standard dialysates were satisfactory at 2 facilities. The bacterial counts in dialysates were not acceptable at any of the facilities investigated. Conclusion: There is an urgent need to teach medical workers involved in dialysis how to prepare sterile and ET-free dialysates.

  17. The possible impact of dialysis modality on cognitive function in chronic dialysis patients.

    Radić, J; Ljutić, D; Radić, M; Kovaĉić, V; Sain, M; Curković, K Dodig


    Chronic kidney disease (CKD) is a growing public health problem. Individuals in all stages of CKD are at higher risk for development of cognitive impairment and this may be a major determinant in their quality of life (QOL). The prevalence of cognitive deficits is particularly high in subjects with end-stage renal disease (ESRD). While it is sufficiently well documented that ESRD is linked with a change in cognitive function, little is known about the influence of different dialysis modalities on cognitive function. The effect of dialysis modality on risk of cognitive impairment is unclear. Some data suggest that patients with ESRD treated with chronic ambulatory peritoneal dialysis (CAPD) had consistently better cognitive function than patients treated with haemodialysis (HD). We concluded that the previously observed apparent difference between two modalities of dialysis treatments resulted either from very low dialysis delivery or comparison with poorly matched controls. Regarding these data from previous studies we hypothesised that well-dialysed, well-nourished and medically stable HD patients had no cognitive dysfunction in comparison with well-dialysed, well-nourished, medically stable and demographically matched CAPD patients. Also, future studies are needed to differentiate between modality as a risk factor from the factors contributing to selection bias among patients choosing CAPD over HD.

  18. A prime determinant in selecting dialysis modality: peritoneal dialysis patient survival

    Hyunwook Kim


    Full Text Available The number of patients with end-stage renal disease (ESRD has rapidly increased, as has the cost of dialysis. Peritoneal dialysis (PD is an established treatment for ESRD patients worldwide; it has a variety of advantages, including autonomy and flexibility, as well as economic benefits in many countries compared to hemodialysis (HD. However, the long-term survival rate of PD remains poor. Although direct comparison of survival rate between the dialysis modalities by randomized controlled trials is difficult due to the ethical issues, it has always been a crucial point when deciding which dialysis modality should be recommended to patients. Recently, in many countries, including the United States, Brazil, Spain, Australia, and New Zealand, the survival rate in PD patients has significantly improved. PD patient survival in Korea has also improved, but Korean PD patients are known to have higher risk of mortality and major adverse cardiovascular, cerebrovascular events than HD patients. Herein, we further evaluate why Korean PD patients had worse outcomes; we suggest that special attention should be paid to patients with diabetes, coronary artery disease, or congestive heart failure when they choose PD as the first dialysis modality in order to reduce mortality risk.

  19. Sodium removal in peritoneal dialysis: the role of icodextrin and peritoneal dialysis modalities.

    Fourtounas, Costas; Hardalias, Andreas; Dousdampanis, Periklis; Papachristopoulos, Basil; Savidaki, Eirini; Vlachojannis, Jannis G


    One of the main goals of dialysis is the control of extracellular volume, because inadequate sodium and fluid removal result in fluid overload and increased mortality. In the present study, we evaluated the roles of continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and the use of icodextrin on sodium removal in 29 patients (n = 18 on CAPD, n = 11 on CCPD). Daily removal of sodium by each modality and dialysis adequacy by Kt/V and creatinine clearance were evaluated. A significantly higher amount of sodium was removed in CAPD patients than in CCPD patients, although peritoneal dialysis clearances were lower in CAPD, and no difference in daily ultrafiltration was observed between the modalities. In the CAPD group, patients using icodextrin for the long dwell showed significantly increased 24-hour sodium removal (218 +/- 65 mmol/L) as compared with patients not using icodextrin (96.3 +/- 58 mmol/L, p icodextrin for the long dwell, and they showed significantly increased sodium removal only for the day exchange (43 +/- 49 mmol/L) as compared with patients not using icodextrin (-60 +/- 6, p Icodextrin is an effective tool not only for increasing adequacy, but also for removing more sodium in both modalities.

  20. Bioreactor rotating wall vessel


    The NASA Bioreactor provides a low turbulence culture environment which promotes the formation of large, three-dimensional cell clusters. Due to their high level of cellular organization and specialization, samples constructed in the bioreactor more closely resemble the original tumor or tissue found in the body. The work is sponsored by NASA's Office of Biological and Physical Research. The bioreactor is managed by the Biotechnology Cell Science Program at NASA's Johnson Space Center (JSC). NASA-sponsored bioreactor research has been instrumental in helping scientists to better understand normal and cancerous tissue development. In cooperation with the medical community, the bioreactor design is being used to prepare better models of human colon, prostate, breast and ovarian tumors. Cartilage, bone marrow, heart muscle, skeletal muscle, pancreatic islet cells, liver and kidney are just a few of the normal tissues being cultured in rotating bioreactors by investigators. Cell constructs grown in a rotating bioreactor on Earth (left) eventually become too large to stay suspended in the nutrient media. In the microgravity of orbit, the cells stay suspended. Rotation then is needed for gentle stirring to replenish the media around the cells.

  1. Bioreactor rotating wall vessel


    The NASA Bioreactor provides a low turbulence culture environment which promotes the formation of large, three-dimensional cell clusters. Due to their high level of cellular organization and specialization, samples constructed in the bioreactor more closely resemble the original tumor or tissue found in the body. The work is sponsored by NASA's Office of Biological and Physical Research. The bioreactor is managed by the Biotechnology Cell Science Program at NASA's Johnson Space Center (JSC). NASA-sponsored bioreactor research has been instrumental in helping scientists to better understand normal and cancerous tissue development. In cooperation with the medical community, the bioreactor design is being used to prepare better models of human colon, prostate, breast and ovarian tumors. Cartilage, bone marrow, heart muscle, skeletal muscle, pancreatic islet cells, liver and kidney are just a few of the normal tissues being cultured in rotating bioreactors by investigators. Cell constructs grown in a rotating bioreactor on Earth (left) eventually become too large to stay suspended in the nutrient media. In the microgravity of orbit, the cells stay suspended. Rotation then is needed for gentle stirring to replenish the media around the cells.

  2. Berardinelli-Seip syndrome in peritoneal dialysis.

    Bande-Fernández, José Joaquín; García-Castro, Raúl; Sánchez-Alvarez, José Emilio; Rodríguez-Suárez, Carmen; Coronel-Aguilar, Diego; Hidalgo, Carlos; Istanbuli, Beatriz; Merino-Bueno, Carmen; Del Rio-García, Laura


    A case of Berardinelli-Seip syndrome, a congenital generalised lipodystrophy, is reported. Symptoms first appeared when the patient was 20 years old. She showed severe insulin resistance as well as micro- and macro-angiopathic complications, including chronic kidney disease, which required renal replacement therapy with peritoneal dialysis. The patient's clinical course was reviewed since paediatric age (when initial signs of the disease being already evident) to present time. Berardinelli-Seip syndrome is very uncommon, and the present case is particularly rare because it is the only case (at least as reported in the literature) in a patient receiving dialysis. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  3. [Exploration of ultrafiltration failure in peritoneal dialysis].

    Bellavia, Salvatore; Coche, Emmanuel; Goffin, Eric


    Ultrafiltration failure (UFF) is a common complication of peritoneal dialysis (PD). It may be due to a technical problem (PD catheter obstruction or migration, peritoneal leaks or intraperitoneal adhesions) or because of a peritoneal membrane alteration (hyperpermeability, aquaporin dysfunction, peritoneal sclerosis or enhanced lymphatic reabsorption). We, here, present the case of a patient who developed several consecutive PD complications that eventually led to UFF. We also present an algorithm, which may help clinicians to establish a precise etiological diagnosis of UFF.

  4. Green dialysis: the environmental challenges ahead.

    Agar, John W M


    The US Environmental Protection Agency Resource Conservation website begins: "Natural resource and energy conservation is achieved by managing materials more efficiently--reduce, reuse, recycle," yet healthcare agencies have been slow to heed and practice this simple message. In dialysis practice, notable for a recurrent, per capita resource consumption and waste generation profile second to none in healthcare, efforts to: (1) minimize water use and wastage; (2) consider strategies to reduce power consumption and/or use alternative power options; (3) develop optimal waste management and reusable material recycling programs; (4) design smart buildings that work with and for their environment; (5) establish research programs that explore environmental practice; all have been largely ignored by mainstream nephrology. Some countries are doing far better than others. In the United Kingdom and some European jurisdictions, exceptional recent progress has been made to develop, adopt, and coordinate eco-practice within dialysis programs. These programs set an example for others to follow. Elsewhere, progress has been piecemeal, at best. This review explores the current extent of "green" or eco-dialysis practices. While noting where progress has been made, it also suggests potential new research avenues to develop and follow. One thing seems certain: as global efforts to combat climate change and carbon generation accelerate, the environmental impact of dialysis practice will come under increasing regulatory focus. It is far preferable for the sector to take proactive steps, rather than to await the heavy hand of government or administration to force reluctant and costly compliance on the un-prepared.

  5. Macrognathia of renal osteodystrophy in dialysis patients.

    Damm, D D; Neville, B W; McKenna, S; Jones, A C; Freedman, P D; Anderson, W R; Allen, C M


    A multiinstitutional study of macrognathia secondary to renal osteodystrophy in dialysis patients is presented. The nine cases reviewed reveal a variety of radiographic and histopathologic features, some of which resemble fibrous dysplasia and others suggestive of Paget's disease of bone. This article contains diagnostic criteria for differentiating renal osteodystrophy from similar fibro-osseous proliferations along with a discussion of the underlying cause and appropriate therapeutic interventions.

  6. External Approach Microsurgery of Retinal Dialysis

    Ying Zhang; Piqing Hu; Lixin Shun; Xuechun Zhu; Yingwu Yi; Wen Liu


    Purpose: To explore the effect of external approach microsurgery in retinal dialysis.Methods: Consecutive 30 eyes of 28 patients with retinal dialysis were enrolled for this study. The progresses of the external approach microsurgery were following. Under the surgical microscopy, the preplacement of mattress sutures for buckling and/or encircling following retrobulbar anesthesia and scleral exposure, draining subretinal fluid, the cryotherapy of retinal breaks, checking the position of breaks on scleral buckle and gases injection were performed in turn.Results: After drainage of subretinal fluid, with scleral depression cryotherapy reaction around breaks could be observed clearly under the microscopy. All breaks were located on anterior slope of the buckle. Intraoperative complications were mild subretinal hemorrhage at drainage site and corneal epithelium exfoliation in 3 eyes, respectively.Postoperative complications were mainly secondary glaucoma and retinal redetachment.The one-operation reattachmentl rate was 96.7% (29 eyes), and the final reattachment rate was 100% after one eye had a second external approach microsurgery. The postoperative vision acuity (VA) was significantly better than the preoperative VA (X2=9.529, P< 0.01).Conclusion: External approach microsurgery has favourable effect on the surgery of retinal dialysis.

  7. Lower Extremity Permanent Dialysis Vascular Access.

    Parekh, Vishal B; Niyyar, Vandana D; Vachharajani, Tushar J


    Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access.

  8. Satisfaction with care in peritoneal dialysis patients.

    Kirchgessner, J; Perera-Chang, M; Klinkner, G; Soley, I; Marcelli, D; Arkossy, O; Stopper, A; Kimmel, P L


    Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL.

  9. Nephrologists' professional ethics in dialysis practices.

    Ozar, David T; Kristensen, Cynthia; Fadem, Stephen Z; Blaser, Robert; Singer, Dale; Moss, Alvin H


    Although the number of incidents is unknown, professional quality-oriented renal organizations have become aware of an increased number of complaints regarding nephrologists who approach patients with the purpose of influencing patients to change nephrologists or dialysis facilities (hereinafter referred to as patient solicitation). This development prompted the Forum of ESRD Networks and the Renal Physicians Association to publish a policy statement on professionalism and ethics in medical practice as these concepts relate to patient solicitation. Also common but not new is the practice of nephrologists trying to recruit their own patients to a new dialysis unit in which they have a financial interest. This paper presents two illustrative cases and provides an ethical framework for analyzing patient solicitation and physician conflict of interest. This work concludes that, in the absence of objective data that medical treatment is better elsewhere, nephrologists who attempt to influence patients to change nephrologists or dialysis facilities fall short of accepted ethical standards pertaining to professional conduct, particularly with regard to the physician-patient relationship, informed consent, continuity of care, and conflict of interest.

  10. Dialysis Modalities and HDL Composition and Function.

    Holzer, Michael; Schilcher, Gernot; Curcic, Sanja; Trieb, Markus; Ljubojevic, Senka; Stojakovic, Tatjana; Scharnagl, Hubert; Kopecky, Chantal M; Rosenkranz, Alexander R; Heinemann, Akos; Marsche, Gunther


    Lipid abnormalities may have an effect on clinical outcomes of patients on dialysis. Recent studies have indicated that HDL dysfunction is a hallmark of ESRD. In this study, we compared HDL composition and metrics of HDL functionality in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) with those in healthy controls. We detected a marked suppression of several metrics of HDL functionality in patients on HD or PD. Compositional analysis revealed that HDL from both dialysis groups shifted toward a more proinflammatory phenotype with profound alterations in the lipid moiety and protein composition. With regard to function, cholesterol efflux and anti-inflammatory and antiapoptotic functions seemed to be more severely suppressed in patients on HD, whereas HDL-associated paraoxonase activity was lowest in patients on PD. Quantification of enzyme activities involved in HDL metabolism suggested that HDL particle maturation and remodeling are altered in patients on HD or PD. In summary, our study provides mechanistic insights into the formation of dysfunctional HDL in patients with ESRD who are on HD or PD.

  11. Can convective therapies improve dialysis outcomes?

    Locatelli, Francesco; Manzoni, Celestina; Cavalli, Andrea; Di Filippo, Salvatore


    Convective treatments are characterized by enhanced removal of middle and large molecular weight solutes, important in the genesis of many complications of hemodialysis, compared with conventional low-flux hemodialysis. The availability of these techniques represented an intriguing innovation and a possible means to improve the still poor prognosis of hemodialysis patients. In this study we will critically review the most important published studies evaluating the impact of convective treatments on dialysis outcomes. The Hemodialysis (HEMO) study showed that greater urea removal nonsignificantly reduces the relative risk of mortality and that also high-flux hemodialysis was associated with a nonsignificant reduction, although a secondary analysis pointed to an advantage for high-flux membranes in subgroups of patients. More recently, the Membrane Permeability Outcome (MPO) study found that survival could be improved by use of high-flux membranes compared with low-flux dialysis in high-risk patients as identified by serum albumin Dialysis Outcomes and Practice Patterns (DOPPS) studies are supporting rationales for the use of convective treatments to improve survival and delay long-term complications of hemodialysis patients.

  12. Dialysis Modalities and HDL Composition and Function

    Holzer, Michael; Schilcher, Gernot; Curcic, Sanja; Trieb, Markus; Ljubojevic, Senka; Stojakovic, Tatjana; Scharnagl, Hubert; Kopecky, Chantal M.; Rosenkranz, Alexander R.; Heinemann, Akos


    Lipid abnormalities may have an effect on clinical outcomes of patients on dialysis. Recent studies have indicated that HDL dysfunction is a hallmark of ESRD. In this study, we compared HDL composition and metrics of HDL functionality in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) with those in healthy controls. We detected a marked suppression of several metrics of HDL functionality in patients on HD or PD. Compositional analysis revealed that HDL from both dialysis groups shifted toward a more proinflammatory phenotype with profound alterations in the lipid moiety and protein composition. With regard to function, cholesterol efflux and anti-inflammatory and antiapoptotic functions seemed to be more severely suppressed in patients on HD, whereas HDL-associated paraoxonase activity was lowest in patients on PD. Quantification of enzyme activities involved in HDL metabolism suggested that HDL particle maturation and remodeling are altered in patients on HD or PD. In summary, our study provides mechanistic insights into the formation of dysfunctional HDL in patients with ESRD who are on HD or PD. PMID:25745027

  13. Periodontal treatment reduces chronic systemic inflammation in peritoneal dialysis patients.

    Siribamrungwong, Monchai; Yothasamutr, Kasemsuk; Puangpanngam, Kutchaporn


    Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis-related data as well as highly sensitive C-reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C-reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients.

  14. Peritoneal dialysis in acute renal failure in canines: A review

    R. H. Bhatt

    Full Text Available Peritoneal dialysis is a technique whereby infusion of dialysis solution into the peritoneal cavity is followed by a variable dwell time and subsequent drainage. During peritoneal dialysis, solutes and fluids are exchanged between the capillary blood and the intraperitoneal fluid through a biologic membrane, the peritoneum. Inadequate renal function leads to disturbance in the removal of the extra fluid and waste products. It removes the waste product and extra fluid from the body in renal failure in small animal practice. Peritoneal dialysis is more accessible, more affordable and easier to administer to the small animal patient. The most common indication for peritoneal dialysis in dogs is acute renal failure (ARF. Peritoneal dialysis is an important therapeutic tool for mitigating clinical signs of uremia and giving the kidneys time to recover in cats with acute kidney injury when conventional therapy is no longer effective. [Vet. World 2011; 4(11.000: 517-521

  15. The influence of the slowing of Earth's rotation: A hypothesis to explain cell division synchrony under different day duration in earlier and later evolved unicellular algae

    Costas, E.; González-Gil, S.; López-Rodas, V.; Aguilera, A.


    Every year the Earth's rotation period is reduced, mainly due to the tidal drag of the moon. The length of day increases continuously by about 1 h every 200 million years. The period of rotation around the Sun remains constant; hence, the length of the year remains constant, so years acquire progressively fewer days. Many unicellular algae show rhythmicity in their cell division cycle. If primitive algae evolved under a shorter day duration, then it is possible that the early-evolved algae had to synchronize their cell division cycle to shorter lengths of day than did later-evolved algae. We tested this hypothesis by growing Cyanobacteria, Dinophyceae, Prasinophyceae, Bacillariophyceae and Conjugatophyceae (evolutionary appearance probably in this order) at 8∶8 h light-dark cycles (LD), 10∶10 LD, and 12∶12 LD, at 20 or 27°C. Cyanobacteria synchronized their cell division cycles optimally at 8∶8 h LD, Dinophyceae and Prasinophyceae at 10∶10 h LD, and Conjugatophyceae and Bacillariophyceae at 12∶12 h LD. The synchrony of cell division was scarcely affected by temperature. Results suggested that the early evolved unicellular autotrophic organisms such as the Cyanobacteria synchronized their cell division cycle under a shorter day duration than later-evolved unicellular algae, and these traits may have been conserved by quiescent genes up to the present day.

  16. Acute hydrothorax complicating peritoneal dialysis: a case report


    Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with ac...

  17. [The diet of the elderly person undergoing dialysis].

    Gourc, Christophe; Ramade, Nathalie


    The elderly patient undergoing dialysis is often at risk of undernutrition. The condition may already be present at the pre-dialysis stage and can worsen once dialysis starts. Aside from the impact on the patient's quality of life and general health status, undernutrition exposes them to serious risk of complications and can be life-threatening. It is therefore essential that it is diagnosed early. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    M. Al Eissa


    Full Text Available Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients. The mean age was 51.7 years (±15.4; 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2, and Kt/V was 1.3 (±0.44. The mean satisfaction score was (7.41 ± 2.75 and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given.

  19. [Dialysis after graft failure: How to improve survival?].

    Mourad, Georges; Szwarc, Ilan; Buzançais, Aurèle


    Ten to 15 % of transplant recipients will return to dialysis, or require another transplantation within 5years, rising to 23 % by 10years, and failed transplantation is now one of the major indications for starting dialysis, accounting for almost 5 % of incident dialysis patients in the US and 10 % in France. Patients who resume dialysis post-transplantation have usually experienced an extended period of uraemia and long-term immunosuppressive therapy, and exhibit high rates of anaemia and erythropoietin resistance, hypoalbuminaemia and persistent chronic inflammation from the failed graft. These factors may increase mortality risk during the first year of dialysis, as observed in the US, but not in Canada or France. When compared to a control group of transplant-naive patients followed in the same institution in France, patients with transplant failure have a higher rate of usable arteriovenous fistula or graft, a similar rate of non-planned dialysis, and initiate dialysis with a higher glomerular filtration rate. We suggest that patient survival in dialysis after graft loss is influenced by both patient characteristics and quality of care, and this may explain the favourable outcome of this specific dialysis population in France. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  20. QtUCP-A program for determining unit-cell parameters in electron diffraction experiments using double-tilt and rotation-tilt holders

    Zhao Hongsheng [Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011 (China); Institute of Semiconductors, Chinese Academy of Sciences, P.O. Box 912, Beijing 100083 (China); Graduate School of Chinese Academy of Sciences, Beijing 100049 (China)], E-mail:; Wu Deqi [Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011 (China); Institute of Semiconductors, Chinese Academy of Sciences, P.O. Box 912, Beijing 100083 (China); Graduate School of Chinese Academy of Sciences, Beijing 100049 (China); Yao Jincheng; Chang Aimin [Institute of Semiconductors, Chinese Academy of Sciences, P.O. Box 912, Beijing 100083 (China)


    A computer program, QtUCP, has been developed based on several well-established algorithms using GCC 4.0 and Qt 4.0 (Open Source Edition) under Debian GNU/Linux 4.0r0. It can determine the unit-cell parameters from an electron diffraction tilt series obtained from both double-tilt and rotation-tilt holders. In this approach, two or more primitive cells of the reciprocal lattice are determined from experimental data, in the meantime, the measurement errors of the tilt angles are checked and minimized. Subsequently, the derived primitive cells are converted into the reduced form and then transformed into the reduced direct primitive cell. Finally all the patterns are indexed and the least-squares refinement is employed to obtain the optimized results of the lattice parameters. Finally, two examples are given to show the application of the program, one is based on the experiment, the other is from the simulation.

  1. QtUCP-a program for determining unit-cell parameters in electron diffraction experiments using double-tilt and rotation-tilt holders.

    Zhao, Hongsheng; Wu, Deqi; Yao, Jincheng; Chang, Aimin


    A computer program, QtUCP, has been developed based on several well-established algorithms using GCC 4.0 and Qt 4.0 (Open Source Edition) under Debian GNU/Linux 4.0r0. It can determine the unit-cell parameters from an electron diffraction tilt series obtained from both double-tilt and rotation-tilt holders. In this approach, two or more primitive cells of the reciprocal lattice are determined from experimental data, in the meantime, the measurement errors of the tilt angles are checked and minimized. Subsequently, the derived primitive cells are converted into the reduced form and then transformed into the reduced direct primitive cell. Finally all the patterns are indexed and the least-squares refinement is employed to obtain the optimized results of the lattice parameters. Finally, two examples are given to show the application of the program, one is based on the experiment, the other is from the simulation.

  2. Purification of dialysis water in the central dialysis fluid delivery system in Japan: a prospective observation study.

    Uchino, Junji; Kawasaki, Tadayuki


    Whereas the main measure of dialysis fluid purity is endotoxin (ET) activity in Japan, it is the viability count in Western countries. Because of this difference, little information is available concerning dialysis fluid purity determined in terms of viability count in Japan. Under these circumstances a fact-finding investigation was planned and conducted concerning dialysis fluid purity to demonstrate the effectiveness of dialysis fluid purification measures. 93 medical institutions are equipped with the central dialysis fluid delivery system (CDDS) unique to Japan. Almost all medical institutions surveyed have achieved the purification level of ultrapure dialysis fluid after ETRF, but the methods of ETRF use and management widely vary with each institution so that early validation of the methods of evaluation of ET inhibition and system management is in urgent need. It is also important that simple universal microbial monitoring and purification procedures be diffused far and wide as suggested by the Purification Guidelines proposed by us.

  3. China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis

    Hou Fanfan


    Full Text Available Abstract Background Cardiovascular disease (CVD is the main cause of death in patients on chronic dialysis. The question whether dialysis modality impacts cardiovascular risk remains to be addressed. China Collaborative Study on Dialysis, a multi-centers cohort study, was performed to evaluate cardiovascular morbidity during maintenance hemodialysis (HD and peritoneal dialysis (PD. Method The cohort consisted of chronic dialysis patients from the database of 9 of the largest dialysis facilities around China. The inclusion period was between January 1, 2005, and December 1, 2010. Cardiovascular morbidity was defined as the presence of clinically diagnosed ischemic heart disease, heart failure, peripheral vascular disease, and/or stroke. The patients who had cardiovascular morbidity before initiation of dialysis were excluded. Data collection was based on review of medical record. Result A total of 2,388 adult patients (1,775 on HD and 613 on PD were enrolled. Cardiovascular morbidity affected 57% patients and was comparable between HD and PD patients. However, clinically diagnosed ischemic heart disease and stroke was more prevalent in PD than HD patients. When the patients were stratified by age or dialysis vintage, the cardiovascular morbidity was significantly higher in PD than HD among those aged 50 years or older, or those receiving dialysis over 36 months. Multivariate analysis revealed that the risk factors for cardiovascular morbidity had different pattern in PD and HD patients. Hyperglycemia was the strongest risk factor for cardiovascular morbidity in PD, but not in HD patients. Hypertriglyceridemia and hypoalbuminemia were independently associated with CVD only in PD patients. Conclusions Cardiovascular morbidity during chronic dialysis was more prevalent in PD than HD patients among those with old age and long-term dialysis. Metabolic disturbance-related risk factors were independently associated with CVD only in PD patients

  4. Appendix to dialysis centre guidelines: recommendations for the relationship between outpatient haemodialysis centres and reference hospitals. Opinions from the Outpatient Dialysis Group. Grupo de Trabajo de Hemodiálisis Extrahospitalaria.

    Berdud, I; Arenas, M D; Bernat, A; Ramos, R; Blanco, A


    other procedure. As such, the nephrologists from each centre should be familiar with the existing protocols and new developments in this context, and should participate in meetings with nephrology and urology departments in each hospital. The transplant protocol at each town/region should be followed for all patients, whether dialysis is undergone in a hospital or private centre. Characteristics of the work at dialysis centres. The doctor attending patients at each dialysis centre must be a specialist in nephrology. This complicated issue must be a requirement for agreements within the regional health system in order to guarantee a proper and equitable treatment of patients that receive dialysis in private centres. Only in the case of an absence of a nephrologist should a general practitioner be used, and this doctor must have adequate training in haemodialysis. This training should also be standardised. Over 75% of nephrologists that work at these centres are alone during the workday, and 40% never see another colleague during the whole shift. The administrators of these centres should seek out protocols that provide professional contact, both with the hospital staff and nephrologists from other centres, which would facilitate an exchange of ideas. Training. The nephrologists at each centre have the right and the obligation to perform research and to continuously expand their training, so as to develop and improve health care provision. Since the majority of patients in haemodialysis programmes are treated in outpatient centres that depend on reference hospitals, we might suggest a minimal rotation of nephrology residents in private outpatient dialysis centres, once accreditation has been given for providing this training.

  5. Association of dialysis with the risks of cancers.

    Ming Yen Lin

    Full Text Available To increase the survival span after dialysis in patients with end-stage renal disease (ESRD, identifying specific cancer risks is crucial in the cancer screening of these patients. The aim of this study was to investigate the risks of various cancers in an incident dialysis group in comparison with a non-dialysis group.We conducted a nationwide cohort study by using data from the Taiwan National Health Insurance Research Database. Patients who initially received long-term dialysis between January 1997 and December 2004, were selected and defined as the dialysis group and were matched with the non-dialysis patients (control group according to age, sex, and index year. Competing risk analysis was used to estimate cumulative incidence and subdistribution hazard ratios (SHRs of the first cancer occurrence.After consideration for the competing risk of mortality, the dialysis group showed a significantly higher 7-year cancer incidence rate than did the control group (6.4%; 95% confidence interval [CI], 6.0%-6.7% vs 1.7%; 95% CI, 1.4%-2.1%; P <0.001.The modified Cox proportional hazard model revealed that the dialysis group had significantly association with increased risks for all cancers (SHR, 3.43; 95% CI, 3.02-3.88. The risk of cancers was dominated in younger and female patients. Specific cancer risks were significantly higher in the dialysis group particularly in the development of oral, colorectal, liver, blood, breast, renal, upper urinary tract, and bladder cancer than in the control group. Multivariable stratified analyses confirmed the association between long-term dialysis and cancer in all subgroups of patients.Dialysis is associated with a higher risk of cancer in patients with ESRD. However, cancer screening in ESRD population should be a selective approach, based on individual patient health condition and life expectancy.

  6. Older peoples' satisfaction with home-based dialysis.

    Derrett, Sarah; Darmody, Maryann; Williams, Sheila; Rutherford, Merrin; Schollum, John; Walker, Rob


    The proportion of older people receiving dialysis is rapidly increasing. The typical choice for older patients is between home-based peritoneal dialysis (PD) and clinic-based haemodialysis (HD). Some centres have been successful in encouraging all patients - including older patients - to have home-based self-administered PD or HD. To (i) describe the overall satisfaction with renal services among older patients dialysing, or in training, with HD or PD at home; and (ii) examine the relationship between residential distance from the nephrology unit and satisfaction with home-based dialysis. Participants were aged 60 years or more; and were either dialysing at home or training for dialysis at home. Two methods of cross-sectional data collection were used: (i) structured quantitative interviews with all participants; and (ii) qualitative interviews with a selected subgroup. Participants comprised 45 patients on dialysis (94% of 48 eligible). Their average age was 68 years. Duration of dialysis averaged 28 months (range 3-150 months). Ratings of 'very good or excellent' were reported for dialysis treatment by 40 (89%) patients. Patients on dialysis, despite experiencing frustration with dialysis itself, expressed satisfaction across four categories: staff, information provision, involvement in decision-making and confidence in managing dialysis. Dissatisfaction was infrequent. This pilot study suggests that older patients trained to dialyse at home using PD or HD are highly satisfied with the nephrology service - even when living remote from the nephrology unit. Home-based dialysis is possible in older patients with levels of comorbidity and disease severity as serious as elsewhere.

  7. Effects of exercise therapy during dialysis for elderly patients undergoing maintenance dialysis

    Chigira, Yusuke; Oda, Takahiro; Izumi, Masataka; Yoshimura, Tukasa


    [Purpose] Exercise therapy during dialysis is currently being recommended since it is easy for patients to follow and results in high participation rates. In this study, this therapy was performed for elderly patients undergoing maintenance dialysis, and its effects were examined. [Subjects and Methods] Seven elderly patients (age: 70.6 ± 4.4) with chronic renal failure, who were able to perform exercises during maintenance dialysis, received the exercise therapy 2 or 3 times weekly for 3 months. Lower-limb muscle strength as well as the standardized dialysis dose (Kt/V) was measured before and after intervention. The patients were also evaluated using the 30-sec chair stand test (CS-30), the World Health Organization QOL Assessment 26 (WHO-QOL26), and a questionnaire. [Results] The lower-limb muscle strength and circumference, CS-30 score, and Kt/V values improved after intervention, but the difference was not significant. Significant differences were observed only in the WHO-QOL26 score. [Conclusion] The outcome was particularly favorable in terms of the quality of life (QOL). Based on the results from the questionnaire, the higher QOL may be due to the patients’ development of a positive attitude toward these activities. Although there were no significant differences, the values for the other criteria also improved, thereby supporting the effectiveness of exercise therapy to maintain or improve the patients’ motor functions and activity daily living (ADL) ability. PMID:28210031

  8. Cost analysis of hemodialysis and peritoneal dialysis access in incident dialysis patients.

    Coentrão, Luis A; Araújo, Carla S; Ribeiro, Carlos A; Dias, Claúdia C; Pestana, Manuel J


    Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD. We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros. Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04). Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.

  9. Entropy of uremia and dialysis technology.

    Ronco, Claudio


    The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they consume. Death is the thermodynamically favored state: it represents a large increase in entropy as molecular structure yields to chaos. The kidney is an organ dissipating large amounts of energy to maintain the level of entropy of the organism as low as possible. Diseases, and in particular uremia, represent conditions of rapid increase in entropy. Therapeutic strategies are oriented towards a reduction in entropy or at least a decrease in the speed of entropy increase. Uremia is a process accelerating the trend towards randomness and disorder (increase in entropy). Dialysis is a factor external to the patient that tends to reduce the level of entropy caused by kidney disease. Since entropy can only increase in closed systems, energy and work must be spent to limit the entropy of uremia. This energy should be adapted to the system (patient) and be specifically oriented and personalized. This includes a multidimensional effort to achieve an adequate dialysis that goes beyond small molecular weight solute clearance. It includes a biological plan for recovery of homeostasis and a strategy towards long-term rehabilitation of the patient. Such objectives can be achieved with a combination of technology and innovation to answer specific questions that are still present after 60 years of dialysis history. This change in the individual bioentropy may represent a local exception to natural trends as the patient could be considered an isolated universe responding to the classic laws of thermodynamics.

  10. Automated peritoneal dialysis in Brunei Darussalam.

    Ishrat KAMAL


    Full Text Available Introduction: Chronic kidney disease in Brunei Darussalam is a growing problem. The number of patients reaching end stage kidney failure has increased dramatically in the last ten years. Currently, most are managed with haemodialysis while a smaller proportion is managed with continuous ambulatory peritoneal dialysis (CAPD. Automated peritoneal dialysis (APD is a form of peritoneal dialysis and has been used in Brunei Darussalam since May 2008. Materials and Methods: Eight patients participated in this prospective clinical trial. As all APD patients were previously on CAPD, comparisons are made between the outcomes of APD against CAPD. Results: The median and mean age of APD patients were 42 and 45.5 ± 12.73 years respectively. After switching to APD, the serum haemoglobin and albumin improved from 10.56 ± 1.95 gm/L and 27.88 ± 7.71 gm/dL to 12.26 ± 1.82 gm/L and 33.63 ± 6.89 gm/dL respectively (p values <0.05. This corresponded to improvements in seven (87.5% and six (75% patients respectively in both parameters. Erythropoietin requirement was reduced in six (75% patients, including three (37.5% patients who were able to stop erythropoietin completely. There was no peritonitis encountered. All patients reported improved quality of life with better sleep, appetite and general well-being. Conclusions: Our study showed that APD was as good as CAPD with improvement seen in both laboratory and quality of life parameters. There was also reduction in erythropoietin requirement. Based on these findings, we will actively encourage and promote APD usage as oppose to CAPD usage in our population.

  11. [Peritonitis in pediatric patients receiving peritoneal dialysis].

    Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar


    Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  12. Optimizing of Culture Conditionin Horizontal Rotating Bioreactor


    1 IntroductionBioreactor is the most important equipment in tissue engineering. It can mimic the micro-environment of cell growth in vitro. At present, horizontal rotating bioreactor is the most advanced equipment for cell culture in the world. 2 Rotating bioreactors2.1 Working principleThere are two kinds of horizontal rotating bioreactor: HARV(high aspect ratio vessel) and RCCS (rotary cell culture system). It is drived by step motor with horizontal rotation, the culture medium and cell is filled between ...

  13. Formation of three-dimensional cell/polymer constructs for bone tissue engineering in a spinner flask and a rotating wall vessel bioreactor

    Sikavitsas, Vassilios I.; Bancroft, Gregory N.; Mikos, Antonios G.; McIntire, L. V. (Principal Investigator)


    The aim of this study is to investigate the effect of the cell culture conditions of three-dimensional polymer scaffolds seeded with rat marrow stromal cells (MSCs) cultured in different bioreactors concerning the ability of these cells to proliferate, differentiate towards the osteoblastic lineage, and generate mineralized extracellular matrix. MSCs harvested from male Sprague-Dawley rats were culture expanded, seeded on three-dimensional porous 75:25 poly(D,L-lactic-co-glycolic acid) biodegradable scaffolds, and cultured for 21 days under static conditions or in two model bioreactors (a spinner flask and a rotating wall vessel) that enhance mixing of the media and provide better nutrient transport to the seeded cells. The spinner flask culture demonstrated a 60% enhanced proliferation at the end of the first week when compared to static culture. On day 14, all cell/polymer constructs exhibited their maximum alkaline phosphatase activity (AP). Cell/polymer constructs cultured in the spinner flask had 2.4 times higher AP activity than constructs cultured under static conditions on day 14. The total osteocalcin (OC) secretion in the spinner flask culture was 3.5 times higher than the static culture, with a peak OC secretion occurring on day 18. No considerable AP activity and OC secretion were detected in the rotating wall vessel culture throughout the 21-day culture period. The spinner flask culture had the highest calcium content at day 14. On day 21, the calcium deposition in the spinner flask culture was 6.6 times higher than the static cultured constructs and over 30 times higher than the rotating wall vessel culture. Histological sections showed concentration of cells and mineralization at the exterior of the foams at day 21. This phenomenon may arise from the potential existence of nutrient concentration gradients at the interior of the scaffolds. The better mixing provided in the spinner flask, external to the outer surface of the scaffolds, may explain the

  14. Formation of three-dimensional cell/polymer constructs for bone tissue engineering in a spinner flask and a rotating wall vessel bioreactor

    Sikavitsas, Vassilios I.; Bancroft, Gregory N.; Mikos, Antonios G.; McIntire, L. V. (Principal Investigator)


    The aim of this study is to investigate the effect of the cell culture conditions of three-dimensional polymer scaffolds seeded with rat marrow stromal cells (MSCs) cultured in different bioreactors concerning the ability of these cells to proliferate, differentiate towards the osteoblastic lineage, and generate mineralized extracellular matrix. MSCs harvested from male Sprague-Dawley rats were culture expanded, seeded on three-dimensional porous 75:25 poly(D,L-lactic-co-glycolic acid) biodegradable scaffolds, and cultured for 21 days under static conditions or in two model bioreactors (a spinner flask and a rotating wall vessel) that enhance mixing of the media and provide better nutrient transport to the seeded cells. The spinner flask culture demonstrated a 60% enhanced proliferation at the end of the first week when compared to static culture. On day 14, all cell/polymer constructs exhibited their maximum alkaline phosphatase activity (AP). Cell/polymer constructs cultured in the spinner flask had 2.4 times higher AP activity than constructs cultured under static conditions on day 14. The total osteocalcin (OC) secretion in the spinner flask culture was 3.5 times higher than the static culture, with a peak OC secretion occurring on day 18. No considerable AP activity and OC secretion were detected in the rotating wall vessel culture throughout the 21-day culture period. The spinner flask culture had the highest calcium content at day 14. On day 21, the calcium deposition in the spinner flask culture was 6.6 times higher than the static cultured constructs and over 30 times higher than the rotating wall vessel culture. Histological sections showed concentration of cells and mineralization at the exterior of the foams at day 21. This phenomenon may arise from the potential existence of nutrient concentration gradients at the interior of the scaffolds. The better mixing provided in the spinner flask, external to the outer surface of the scaffolds, may explain the

  15. Continuous ambulatory peritoneal dialysis: no longer experimental.

    WU, G.; Khanna, R.; Vas, S I; Digenis, G.; Oreopoulos, D G


    Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months ...

  16. Evaluation of dialyzer jacket structure and hollow-fiber dialysis membranes to achieve high dialysis performance.

    Hirano, Ayaka; Yamamoto, Ken-ichiro; Matsuda, Masato; Ogawa, Takehito; Yakushiji, Taiji; Miyasaka, Takehiro; Sakai, Kiyotaka


    The objective of this study was to determine the optimum dialyzer jacket structure and hollow-fiber dialysis membrane, both of which are indispensable factors for achieving high dialysis performance, by clarifying the relationship between the dialysis performance and the flow of dialysate and blood in a hollow-fiber dialyzer. We evaluated the clearance, dialysate, and blood flow for four commercially available hollow-fiber dialyzers, namely, the APS-15S, APS-15SA, TS-1.6UL, and CX-1.6U. To evaluate dialysate and blood flow, we measured the residence-time distribution of dialysate and blood flow of these dialyzers by the pulse-response method. We also determined the clearances of urea, creatinine, vitamin B(12), and lysozyme to evaluate the dialysis performance of these dialyzers. While the baffle and taper structures allow effective supply of dialysate into the dialyzer jacket, the hollow-fiber shape, inner diameter, and packing density significantly influence the dialysate flow. In dialyzers with long taper-holding slits, the slit area is a key design parameter for achieving optimum dialysate flow. Similarly, the blood flow is significantly influenced by the structure of the inflowing and outflowing blood ports at the header of a dialyzer, and the shape and inner diameter of the hollow fibers. Hollow fibers with smaller inner diameters cause an increase in blood pressure, which causes blood to enter the hollow fibers more easily. The hollow-fiber shape hardly affects the blood flow. While improved dialysate and blood flow cause higher clearance of low molecular-weight substances, higher membrane area and pure-water permeability accelerate internal filtration, thereby causing an increase in the clearance of large molecular-weight substances. © 2010 The Authors. Therapeutic Apheresis and Dialysis © 2010 International Society for Apheresis.

  17. Water-Permeable Dialysis Membranes for Multi-Layered Micro Dialysis System

    Naoya eTo


    Full Text Available This paper presents the development of water-permeable dialysis membranes that are suitable for an implantable microdialysis system that does not use dialysis fluid. We developed a microdialysis system integrating microfluidic channels and nanoporous filtering membranes made of polyethersulfone (PES, aiming at a fully implantable system that drastically improves the quality of life of patients. Simplicity of the total system is crucial for the implantable dialysis system, where the pumps and storage tanks for the dialysis fluid pose problems. Hence, we focus on hemofiltration, which does not require the dialysis fluid but water-permeable membranes. We investigated the water-permeability of the PES membrane with respect to the concentrations of the PES, the additives, and the solvents in the casting solution. Sufficiently water-permeable membranes were found through in vitro experiments using whole bovine blood. The filtrate was verified to have the concentrations of low-molecular-weight molecules, such as sodium, potassium, urea, and creatinine, while proteins, such as albumin, were successfully blocked by the membrane. We conducted in vivo experiments using rats, where the system was connected to the femoral artery and jugular vein. The filtrate was successfully collected without any leakage of blood inside the system and it did not contain albumin but low-molecular-weight molecules whose concentrations were identical to those of the blood. The rat model with renal failure showed 100% increase of creatinine in 5 h, while rats connected to the system showed only a 7.4% increase, which verified the effectiveness of the proposed microdialysis system.

  18. Cardiovascular and noncardiovascular mortality among men and women starting dialysis

    Carrero, Juan J; de Jager, Dinanda J; Verduijn, Marion;


    Although women have a survival advantage in the general population, women on dialysis have similar mortality to men. We hypothesized that this paired mortality risk during dialysis may be explained by a relative excess of cardiovascular-related mortality in women....

  19. Multicystic transformation of the kidneys in dialysis patients

    Frifelt, J J; Larsen, C; Elle, Birgitte;


    In a dialysis population patients who had been treated merely with haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) were examined with ultrasound. The occurrence of multicystic transformation of the kidney was 4/15 in HD patients and 8/25 in CAPD patients with no significant...

  20. Acute hydrothorax complicating peritoneal dialysis: a case report

    Ranganathan Dwarkanathan


    Full Text Available Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis. Conclusion Although our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.

  1. Dialysis modalities as risk factors in the development of atherosclerosis

    Damjanović Tatjana


    Full Text Available Introduction Atherosclerosis is a major risk factor for increased cardiovascular morbidity and mortality in dialysis patients. First clinical symptoms are usually associated with initial atherosclerotic changes of blood vessels. The aim of this study was ultrasound evaluation of intimae media thickness (IMT of carotid arteries in dialysis patients and its correlation with certain risk factors. Patients and methods IMT was measured in 45 dialysis patients with no signs of cardiovascular diseases:15 continuous ambulatory peritoneal dialysis (CAPD patients, 30 haemodialysis (HD patients and in 20 healthy controls. IMT was correlated with certain risk factors for atherosclerosis (general parameters - age, gender, duration of dialysis cause of renal diseases, parameters of nutrition, parameters of calcium and phosphorus metabolism, lipid parameters, blood pressure and smoking. Results The mean carotid artery IMT was significantly higher in dialysis patients than in the control group (p<0.05. In addition, the mean IMT was statistically significantly higher in PD than in HD patients (p<0.05. In CAPD patients there was a significant correlation between IMT and total and LDL cholesterol. In the second group (HD patients IMT was significantly correlated with diastolic blood pressure, BMI and smoking. Conclusion Although atherosclerotic cardiovascular disease may not manifest in dialysis patients, IMT of carotid arteries significantly increases. Major risk factors affecting IMT are lipid disturbances in patients on peritoneal dialysis and hypertension, obesity and smoking in HD patients.

  2. Kidney Dialysis Patients Discover New Hope through ABE Program.

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  3. Age-related and prognostic risk factors in dialysis patients

    G.L. Tripepi (Giovanni)


    textabstractThe replacement of renal function by dialysis is one of the major achievements of modern medicine. However, given the fact that renal failure shares common causes with cardiovascular diseases, dialysis patients are a population with a risk profile of almost unique severity. In fact, it w

  4. Measures of blood pressure and cognition in dialysis patients

    There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...

  5. Dialysate as food as an option for automated peritoneal dialysis

    H.L. Tjiong (Hoey Lan); R. Swart (Roel); J.W.O. van den Berg (Willem); M.W.J.A. Fieren (Marien)


    textabstractProtein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could

  6. Nutritional status over time in hemodialysis and peritoneal dialysis

    Jager, KJ; Merkus, MP; Huisman, RM; Boeschoten, EW; Dekker, FW; Korevaar, JC; Tijssen, JGP; Krediet, RT


    Malnutrition is a risk factor for mortality in the dialysis population. So far, prospective studies comparing the time course of nutritional status in new hemodialysis (HD) and peritoneal dialysis (PD) patients have not been published. The aims of this study were to compare the time course of nutrit

  7. Current topics of purification and constitutions of dialysis fluid.

    Tomo, Tadashi


    Dialysis fluid is a fundamental component of hemodialysis treatment, and its roles include the correction of electrolyte levels, pH, and osmolality, as well as the removal of uremic solutes from the blood of patients with renal failure. In recent years, purification of dialysis fluid has become essential due to the use of high-flux membrane dialyzers. Therefore, rigorous standards have been established for the purification of dialysis fluid, which is becoming widely practiced in Japan. The effects of dialysis fluid purification include the prevention of micro-inflammation, preservation of residual renal function, improvement of nutritional status, and resolution of resistance to erythropoiesis-stimulating agents. When purifying the dialysis fluid used in the central dialysis fluid delivery system, validation of the system is also important. Dialysis fluid that does not contain acetate has become available, and there have been reports of decreased micro-inflammation, etc., with this innovation. In addition, dialysis fluid containing a higher concentration of bicarbonate than is conventionally employed has become available. Although correction of acidosis remains important, excess alkalosis may reportedly worsen the survival prognosis of hemodialysis patients. Sufficient attention should be paid to these issues.

  8. Dialysis and renal transplantation in HIV-infected patients

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;


    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  9. Microcystin exposure and biochemical outcomes among dialysis patients

    Background and aims Dialysis patients appear to be at special risk for exposure to cyanobacteria toxins; episodes of microcystin (MCYST) exposure via dialysate during 1996 and 2001 have been previously reported. During 2001, as many as 44 dialysis patients were exposed to contam...

  10. Shewanella algae Peritonitis in Patients on Peritoneal Dialysis.

    Shanmuganathan, Malini; Goh, Bak Leong; Lim, Christopher; NorFadhlina, Zakaria; Fairol, Ibrahim

    Patients with peritonitis present with abdominal pain, diarrhea, fever, and turbid peritoneal dialysis (PD) fluid. Shewanella algae peritonitis has not yet been reported in PD patients in the literature. We present the first 2 cases of Shewanella algae peritonitis in PD patients. Mupirocin cream is applied on the exit site as prophylactic antibiotic therapy. Copyright © 2016 International Society for Peritoneal Dialysis.

  11. Reducing staff turnover: a case study of dialysis facilities.

    Tai, T W; Robinson, C D


    A multivariate logistic analysis of 42 Texas dialysis facilities indicated that younger, white, short tenure, an LVN/LPN, with less support from family and friends for emotional concerns, and less supervisor support significantly increased the likelihood of turnover (p staff turnover of these dialysis facilities increases costs and impedes the delivery of quality patient care. Managerial strategies to increase staff retention are suggested.

  12. A peritoneal dialysis patient with osmotic demyelination syndrome

    Hing Ming Cheng


    Full Text Available A peritoneal dialysis patient with cirrhosis presented with drowsiness, vomiting, and mild hyponatremia. Despite no active correction of hyponatremia, she developed convulsion and quadriplegia. Magnetic resonance imaging of the brain showed changes of osmotic demyelination syndrome. This case illustrates that osmotic demyelination syndrome may occur in peritoneal dialysis without rapid correction of hyponatremia.

  13. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis.

    Koch, Michael; Kohnle, Matthias; Trapp, Rudolf; Haastert, Burkhard; Rump, Lars Christian; Aker, Sendogan


    The impact of dialysis modality on outcome, especially on infection early in the course of dialysis, in unplanned acute dialysis initiation has not been well evaluated. The aim of the study was to compare the rates and causes of mortality and morbidity in incident dialysis patients started unplanned acute peritoneal dialysis (PD) or haemodialysis (HD). In this observational cohort study, incident dialysis patients with initiation of unplanned and acute PD (n = 66) or HD (n = 57) at a single centre from March 2005 to June 2010 were included and followed up for 6 months (0-183 days, mean follow-up time 4.72 months). For PD, surgically placed Tenckhoff catheters were used. All HD patients were dialysed with a central venous catheter (non-tunnelled or tunnelled). There were no significant differences in terms of gender, age and prevalence of diabetes mellitus in either group. The prevalence of heart failure [New York Heart Association (NYHA) Stage III-IV] was significantly higher in the PD group (73 versus 46% in HD group, P dialysis, n = 44 (35.8%) died during the follow-up period of 0-183 days. There were no significant difference in half-year mortality in n = 20 PD patients (30.3%) versus n = 24 HD patients (42.1%) (P = 0.19). The cardiovascular mortality in PD and HD patients were 9.1 and 10.5%, respectively (P = 1.00). Overall mortality due to infection was higher in the HD (17.5%) versus in the PD group (9.1%), however, not significant (P = 0.19). HD patients had significantly higher probability of bacteraemia in the first 183 days compared to PD patients (21.1 versus 3.0%, P dialysis, male sex, heart failure (NYHA III-IV), diabetes, malignancy and peripheral arterial occlusive disease Stage IV. There were high proportions of hospitalization after the initiation of dialysis in both groups (PD 75.0% and HD 67.3%, P = 0.40). Univariate and multiple regression analyses revealed only age at initiation of dialysis to be significantly associated with overall mortality

  14. Peritoneal Dialysis in Diabetics: There Is Room for More

    P. Cotovio


    Full Text Available End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.

  15. [News on single needle dialysis: technique, indications, precautions and limits].

    Ervo, Roberto


    The technique of single needle dialysis (SN) was invented in the 1960s and enjoyed great success during the 1970s and '80s in northern Europe, particularly in Belgium. In recent years, the double needle mode has awakened new interest in this technique, as it may represent a good alternative to the use of a central venous catheter at the beginning of dialysis, while waiting for the growth of the arteriovenous fistula. For today's dialysis patients, mostly elderly with ever greater numbers of co-morbid conditions, in particular vascular disease, treatments have become ever more flexible and individually tailored. A single needle approach can be also used in the case of native fistula dislocation. The single needle technique requires careful control of dialysis dose, keeping recirculation into account. If the technique is used for long periods of time, there is the risk of inadequate dialysis dose and it is necessary to pay particular attention to the sampling of post dialysis urea for the KT/V calculation (always 20 minutes after the end of dialysis). Modern dialysis machines have greatly reduced the risk of hemolysis (which can be evaluated with the control of LDH pre and post dialysis) and of back-filtration which no longer represents a problem thanks to ultrapure dialysate. The probability of of blood circuit coagulation has also been greatly reduced thanks to citrate dialysis baths and membranes treated with heparin or vitamin E, and systems often do not require an increase of anticoagulants. The technique is, therefore, particularly reliable and easy to use thanks to its simplicity.

  16. Modeled transport of As (V) in the Nernst layer of an electro dialysis cell; Modelado del transporte de As (V) en la capa de Nernst de una celda electro dialitica

    Ibanez, J. P.; Aracena, A.; Cifuentes, L.


    The transport of As (V) oxianions was modeled through the boundary layer generated between the bulk of an acidic As (V) electrolyte and the surface of an anionic exchange membrane during a batch electro dialysis process without agitation. The model was adapted from one developed for the transport of Cu (II) ions in the Nernst layer under the same hydrodynamic and electric conditions. The model shows the flux of oxianions in terms of the difference between the transport number of As (V) in the boundary layer and in the membrane as a function of the current density. The model approaches to the experimental data when the transport number in the boundary layer is 1.5 × 10-4 and 1.5 × 10{sup -}5 for As (V)-H{sub 2}SO{sub 4} and As (V)-Cu (II)-H{sub 2}SO{sub 4} electrolytes, respectively. The validation of the model was made with published data of As (V) transport. (Author)

  17. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy


    Objectives: Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for pat...

  18. Appraising and monitoring a life on dialysis.

    Brunier, G


    I feel that the adaptation theories proposed by Nerenz and Leventhal (1983) and by Taylor (1983), although offering insights into how chronically sick individuals may interpret and manage their illness, do not capture completely the complexities of how D.R. has successfully learned over the years to live with renal disease and dialysis. I find it interesting that Lazarus and Folkman's theory of stress, adaptation and coping, which is based more on the belief that everyone experiences stress every day and, thereby, does not single out chronically ill people as being different, has more to offer in interpreting D.R.'s own perceptions on how he monitors his health than the illness-based models of Nerenz/Leventhal and Taylor. After eight years of continuous appraisal and reappraisal, D.R. has taught himself, through his own perceptions and interactions with those close to him, how he can live successfully with renal failure. The recording of his insights has helped me appreciate more deeply what an endless challenge a life lived on dialysis is.

  19. [Guidelines for quality management of dialysis solutions].

    Pérez García, R; González Parra, E; Ceballos, F; Escallada Cotero, R; Gómez-Reino, Ma I; Martín-Rabadán, P; Pérez García, A; Ramírez Chamond, R; Sobrino, P E; Solozábal, C


    A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to

  20. Peritoneal Dialysis Tailored to Pediatric Needs

    C. P. Schmitt


    Full Text Available Consideration of specific pediatric aspects is essential to achieve adequate peritoneal dialysis (PD treatment in children. These are first of all the rapid growth, in particular during infancy and puberty, which must be accompanied by a positive calcium balance, and the age dependent changes in body composition. The high total body water content and the high ultrafiltration rates required in anuric infants for adequate nutrition predispose to overshooting convective sodium losses and severe hypotension. Tissue fragility and rapid increases in intraabdominal fat mass predispose to hernia and dialysate leaks. Peritoneal equilibration tests should repeatedly been performed to optimize individual dwell time. Intraperitoneal pressure measurements give an objective measure of intraperitoneal filling, which allow for an optimized dwell volume, that is, increased dialysis efficiency without increasing the risk of hernias, leaks, and retrofiltration. We present the concept of adapted PD, that is, the combination of short dwells with low fill volume to promote ultrafiltration and long dwells with a high fill volume to improve purification within one PD session. The use of PD solutions with low glucose degradation product content is recommended in children, but unfortunately still not feasible in many countries.

  1. Modeling and control of dialysis systems


    This book is the first text of its kind that presents both the traditional and the modern aspects of dialysis modeling and control in a clear, insightful and highly comprehensive writing style. It provides an in-depth analysis of the mathematical models and algorithms, and demonstrates their applications in real world problems of significant complexity. It explains concepts in a clear, matter-of-fact style. The material of this book will be useful to advanced undergraduate and graduate biomedical engineering students. Also, researchers and practitioners in the field of dialysis, control systems, soft computing will benefit from it. In order to make the reader aware of the applied side of the subject, the book includes:       Chapter openers with a chapter outline, chapter objectives, key terms list, and abstract.       Solved numerical examples to illustrate the application of a particular concept, and also to encourage good problem-solving skills.       More than 1000 questions to give the rea...

  2. Survival by Dialysis Modality-Who Cares?

    Lee, Martin B; Bargman, Joanne M


    In light of the recent emphasis on patient-centered outcomes and quality of life for patients with kidney disease, we contend that the nephrology community should no longer fund, perform, or publish studies that compare survival by dialysis modality. These studies have become redundant; they are methodologically limited, unhelpful in practice, and therefore a waste of resources. More than two decades of these publications show similar survival between patients undergoing peritoneal dialysis and those receiving thrice-weekly conventional hemodialysis, with differences only for specific subgroups. In clinical practice, modality choice should be individualized with the aim of maximizing quality of life, patient-reported outcomes, and achieving patient-centered goals. Expected survival is often irrelevant to modality choice. Even for the younger and fitter home hemodialysis population, quality of life, not just duration of survival, is a major priority. On the other hand, increasing evidence suggests that patients with ESRD continue to experience poor quality of life because of high symptom burden, unsolved clinical problems, and unmet needs. Patients care more about how they will live instead of how long. It is our responsibility to align our research with their needs. Only by doing so can we meet the challenges of ESRD patient care in the coming decades.

  3. Arterial Stiffness and Dialysis Calcium Concentration

    Fabrice Mac-Way


    Full Text Available Arterial stiffness is the major determinant of isolated systolic hypertension and increased pulse pressure. Aortic stiffness is also associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease, hypertension, and general population. Hemodynamically, arterial stiffness results in earlier aortic pulse wave reflection leading to increased cardiac workload and decreased myocardial perfusion. Although the clinical consequence of aortic stiffness has been clearly established, its pathophysiology in various clinical conditions still remains poorly understood. The aim of the present paper is to review the studies that have looked at the impact of dialysis calcium concentration on arterial stiffness. Overall, the results of small short-term studies suggest that higher dialysis calcium is associated with a transient but significant increase in arterial stiffness. This calcium dependant increase in arterial stiffness is potentially explained by increased vascular smooth muscle tone of the conduit arteries and is not solely explained by changes in mean blood pressure. However, the optimal DCa remains to be determined, and long term studies are required to evaluate its impact on the progression of arterial stiffness.

  4. Evolution of technology for automated peritoneal dialysis.

    Ronco, Claudio; Amerling, Richard; Dell'aquila, Roberto; Rodighiero, Maria Pia; Di Loreto, Pierluigi


    Automated peritoneal dialysis (APD) is important for the further penetration of PD in the dialysis marketplace. Long dwell, equilibration PD (CAPD) has limited applicability in many patients due to inadequate solute clearance or fast membrane transport characteristics. Providing large volumes of dialysate over circumscribed hours is highly labor intensive without an automated system. Early attempts at APD were crude but effective in reducing labor, which was generally provided by nursing staff. Later evolution of PD technology has been greatly accelerated by the microchip, and by miniaturization of components. Current generation machines allow individualized fill volumes, variable tidal volumes and additional daytime automated exchanges, teledialysis, memorized delivery control, and full portability. The ideal machine should not only be able to perform all treatment schedules, but it should also optimize the performance of a selected treatment strategy. Biocompatible solutions, improved osmotic agents, and sorbent technology are all adaptable to APD. The eventual evolution toward continuous flow PD will resolve many of the current problems with both CAPD and APD.


    Ronald C. Timpe


    This project will determine whether electrolytic dialysis has promise in the separation of charged particles in an aqueous solution. The ability to selectively move ions from one aqueous solution to another through a semipermeable membrane will be studied as a function of emf, amperage, and particle electrical charge. The ions selected for the study are Cl{sup -} and SO{sub 4}{sup 2-}. These ions are of particular interest because of their electrical conduction properties in aqueous solution resulting with their association with the corrosive action of metals. The studies will be performed with commercial membranes on solutions prepared in the laboratory from reagent salts. pH adjustments will be made with dilute reagent acid and base. Specific objectives of the project include testing a selected membrane currently available for electrolytic dialysis, membrane resistance to extreme pH conditions, the effectiveness of separating a mixture of two ions selected on the basis of size, the efficiency of the membranes in separating chloride (Cl{sup 1-}) from sulfate (SO{sub 4}{sup 2-}), and separation efficiency as a function of electromotive force (emf).

  6. A Reuse Evaluation for Solar-Cell Silicon Wafers via Shift Revolution and Tool Rotation Using Magnetic Assistance in Ultrasonic Electrochemical Micromachining

    P. S. Pa


    Full Text Available A new reuse fabrication using a tool module with rotation and revolution through a process of magnetic assistance in ultrasonic electrochemical micromachining (UEMM for removal of the surface layers from silicon wafers of solar cells is demonstrated. The target of the proposed reuse fabrication method is to replace the current approach, which uses strong acid and grinding and may damage the physical structure of silicon wafers and pollute to the environment. A precisely engineered clean production approach to removal of surface microstructure layers from silicon wafers is to develop a mass production system for recycling defective or discarded silicon wafers of solar cells that can reduce pollution and cost. The high revolution speed of the shift with the high rotation speed of the designed tool increases the discharge mobility and improves the removal effect associated with the high feed rate of the workpiece. High frequency and high power of ultrasonic with large electrolyte flow rate and high magnetic strengths with a small distance between the two magnets provide a large discharge effect and good removal; only a short period of time is required to remove the epoxy film and Si3N4 layer easily and cleanly.

  7. Quality of Life and Self-Efficacy in Three Dialysis Modalities: Incenter Hemodialysis, Home Hemodialysis, and Home Peritoneal Dialysis.

    Wright, Linda S; Wilson, Linda


    Previous research has demonstrated improved outcomes for patients on dialysis who have better quality of life and self-efficacy, but has focused almost exclusively on those receiving hemodialysis. The goal of this study was to describe the quality of life and self-efficacy of patients receiving incenter hemodialysis versus those receiving a home dialysis modality (hemodialysis or peritoneal dialysis). The study utilized a correlational cross-sectional design and quota sampling methods. Participants were recruited from outpatient dialysis facilities and included 77 community dwelling adult patients who had been on dialysis for at least six months. Quality of life was measured using the Kidney Disease Quality of Life instrument, and self-efficacy was measured using the Strategies Used by People to Promote Health instrument. Findings suggest equal outcomes between treatment groups, with no contraindication to the use of home therapies.

  8. Peritoneal Dialysis Fluid and Some of Its Components Potentiate Fibrocyte Differentiation.

    Herlihy, Sarah E; Starke, Hannah E; Lopez-Anton, Melisa; Cox, Nehemiah; Keyhanian, Katayoon; Fraser, Donald J; Gomer, Richard H


    Long-term peritoneal dialysis (PD) often results in the development of peritoneal fibrosis. In many other fibrosing diseases, monocytes enter the fibrotic lesion and differentiate into fibroblast-like cells called fibrocytes. We find that peritoneal tissue from short-term PD patients contains few fibrocytes, while fibrocytes are readily observed in the peritoneal membrane of long-term PD patients. The PD fluid Dianeal (Baxter Healthcare Corporation, Deerfield, IL, USA) contains dextrose, a number of electrolytes including sodium chloride, and sodium lactate. We find that PD fluid potentiates human fibrocyte differentiation in vitro and implicates sodium lactate in this potentiation. The plasma protein serum amyloid P (SAP) inhibits fibrocyte differentiation. Peritoneal dialysis fluid and sodium chloride decrease the ability of human SAP to inhibit human fibrocyte differentiation in vitro Together, these results suggest that PD fluid contributes to the development of peritoneal fibrosis by potentiating fibrocyte differentiation.

  9. Peritoneal macrophage infiltration is correlated with baseline peritoneal solute transport rate in peritoneal dialysis patients.

    Sawai, Akiho; Ito, Yasuhiko; Mizuno, Masashi; Suzuki, Yasuhiro; Toda, Susumu; Ito, Isao; Hattori, Ryohei; Matsukawa, Yoshihisa; Gotoh, Momokazu; Takei, Yoshifumi; Yuzawa, Yukio; Matsuo, Seiichi


    High baseline peritoneal solute transport rate is reportedly associated with reduced patient and technique survival in continuous peritoneal dialysis (PD) patients. However, the determinants of baseline peritoneal solute transport rate remain uncertain. The aim of this study was to investigate the relationship between peritoneal local inflammation, angiogenesis and systemic inflammation and baseline peritoneal permeability. Peritoneal biopsy specimens from 42 pre-dialysis uraemic patients and 11 control individuals were investigated. Immunohistochemistry for CD68-positive macrophages, chymase- and tryptase-positive mast cells, interleukin-6 (IL-6)-positive cells, CD3-positive T cells, CD20-positive B cells, neutrophils and CD31- and pathologische anatomie Leiden-endothelium (PAL-E)-positive blood vessels in the peritoneum was performed. Baseline dialysate-to-plasma ratio for creatinine (D/P Cr) was determined within 6 months of PD induction. Clinical and laboratory parameters were measured at the time of peritoneal biopsy. Factors associated with peritoneal permeability were assessed by multiple linear regression analysis. Pre-dialysis uraemic peritoneum showed infiltration by CD68-positive macrophages, and mast cells, as compared with controls. Baseline D/P Cr was correlated with density of CD68-positive macrophages (P permeability was not correlated with infiltration by mast cells, B cells, T cells, neutrophils, serum C-reactive protein or other clinical factors. On multiple linear regression analysis, the number of CD68-positive macrophages in peritoneum was an independent predictor for baseline peritoneal permeability (P = 0.009). Peritoneal macrophage infiltration is predominant in uraemic patients and is an important factor in predicting baseline peritoneal permeability.

  10. 42 CFR 494.120 - Condition: Special purpose renal dialysis facilities.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Special purpose renal dialysis... RENAL DISEASE FACILITIES Patient Care § 494.120 Condition: Special purpose renal dialysis facilities. A special purpose renal dialysis facility is approved to furnish dialysis on a short-term basis at...

  11. Specific opsonic activity for staphylococci in peritoneal dialysis effluent during continuous ambulatory peritoneal dialysis

    Nielsen, H; Espersen, F; Kharazmi, A


    In a prospective study of intraperitoneal opsonins in 30 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), the IgG concentration, the fibronectin concentration, the specific antistaphylococcal antibody level, and the opsonic activity against Staphylococcus epidermidis were...... measured in peritoneal dialysis effluent from the initiation of CAPD and monthly for 6 months. Significant correlation was found between the four assays, but the interindividual and intraindividual variations were considerable. No statistically significant correlation was observed between susceptibility...... of the patients to CAPD-related infectious peritonitis and any of the above-mentioned parameters of humoral defense. We conclude that at the present time it is not feasible to use these assays for the establishment of prognosis with regard to peritonitis in CAPD....

  12. Water diffusion-exchange effect on the paramagnetic relaxation enhancement in off-resonance rotating frame

    Zhang, Huiming; Xie, Yang; Ji, Tongyu


    The off-resonance rotating frame technique based on the spin relaxation properties of off-resonance T1 ρ can significantly increase the sensitivity of detecting paramagnetic labeling at high magnetic fields by MRI. However, the in vivo detectable dimension for labeled cell clusters/tissues in T1 ρ-weighted images is limited by the water diffusion-exchange between mesoscopic scale compartments. An experimental investigation of the effect of water diffusion-exchange between compartments on the paramagnetic relaxation enhancement of paramagnetic agent compartment is presented for in vitro/ in vivo models. In these models, the size of paramagnetic agent compartment is comparable to the mean diffusion displacement of water molecules during the long RF pulses that are used to generate the off-resonance rotating frame. The three main objectives of this study were: (1) to qualitatively correlate the effect of water diffusion-exchange with the RF parameters of the long pulse and the rates of water diffusion, (2) to explore the effect of water diffusion-exchange on the paramagnetic relaxation enhancement in vitro, and (3) to demonstrate the paramagnetic relaxation enhancement in vivo. The in vitro models include the water permeable dialysis tubes or water permeable hollow fibers embedded in cross-linked proteins gels. The MWCO of the dialysis tubes was chosen from 0.1 to 15 kDa to control the water diffusion rate. Thin hollow fibers were chosen to provide sub-millimeter scale compartments for the paramagnetic agents. The in vivo model utilized the rat cerebral vasculatures as a paramagnetic agent compartment, and intravascular agents (Gd-DTPA) 30-BSA were administrated into the compartment via bolus injections. Both in vitro and in vivo results demonstrate that the paramagnetic relaxation enhancement is predominant in the T1 ρ-weighted image in the presence of water diffusion-exchange. The T1 ρ contrast has substantially higher sensitivity than the conventional T1

  13. Pharmacokinetics of icodextrin in peritoneal dialysis patients.

    Moberly, James B; Mujais, Salim; Gehr, Todd; Hamburger, Richard; Sprague, Stuart; Kucharski, Andrew; Reynolds, Robin; Ogrinc, Francis; Martis, Leo; Wolfson, Marsha


    Pharmacokinetics of icodextrin in peritoneal dialysis patients. Icodextrin is a glucose polymer osmotic agent used to provide sustained ultrafiltration during long peritoneal dialysis (PD) dwells. A number of studies have evaluated the steady-state blood concentrations of icodextrin during repeated use; however, to date the pharmacokinetics of icodextrin have not been well studied. The current study was conducted to determine the absorption, plasma kinetics and elimination of icodextrin and metabolites following a single icodextrin exchange. Thirteen PD patients were administered 2.0 L of solution containing 7.5% icodextrin for a 12-hour dwell. Icodextrin (total of all glucose polymers) and specific polymers with degrees of polymerization ranging from two to seven (DP2 to DP7) were measured in blood, urine and dialysate during the dwell and after draining the solution from the peritoneal cavity. A median of 40.1% (60.24 g) of the total administered dose (150 g) was absorbed during the 12-hour dwell. Plasma levels of icodextrin and metabolites rose during the dwell and declined after drain, closely corresponding to the one-compartment pharmacokinetic model assuming zero-order absorption and first-order elimination. Peak plasma concentrations (median C peak = 2.23 g/L) were observed at the end of the dwell (median Tmax = 12.7 h) and were significantly correlated with patients' body weight (R2 = 0.805, P insulin or glucose levels during icodextrin administration, indicating that icodextrin does not result in hyperglycemia or hyperinsulinemia as occurs during dextrose-based dialysis. Serum sodium and chloride declined in parallel with the rise in plasma levels of icodextrin, supporting the hypothesis that these electrolyte changes are the result of the increased plasma osmolality due to the presence of icodextrin metabolites. The pharmacokinetics of icodextrin in blood following intraperitoneal administration conforms to a simple, single-compartment model that can be

  14. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure.

    Klouche, Kada; Amigues, Laurent; Deleuze, Sebastien; Beraud, Jean-Jacques; Canaud, Bernard


    Availability of a functional vascular access is a mandatory prerequisite for extracorporeal renal replacement therapy in patients with acute renal failure. The femoral site of insertion commonly is chosen because it is an easy and convenient access. However, an array of complications may substantially alter the quality of treatment, and it appears that catheter-related morbidity and dysfunction are more frequent with the femoral than internal jugular site. This study is designed to evaluate the potential benefits of using soft silicone tunneled catheters ((ST)Caths) at the femoral site. Thirty patients with acute renal failure treated by intermittent hemodialysis (IHD) and/or continuous venovenous hemodiafiltration (CVVHDF) were assigned to either twin (ST)Caths or twin polyurethane nontunneled femoral catheters. Time necessary for catheter insertion, catheter-related complications, and catheter lifespan were monitored. Catheter performance during IHD and the effect of catheter type on dialysis dose were evaluated. The time necessary for (ST)Cath insertion was significantly longer. The incidence of vein thrombosis and catheter-related infection was lower, and the ratio of venous return pressure to catheter blood flow was better with an (ST)Cath. Recirculation rates were similar for both types of catheters. Whether treated by using IHD or CVVHDF, patients with an (ST)Cath benefited from a greater delivered dialysis dose. Multivariate analysis confirmed that (ST)Cath use was a determinant factor to optimize dialysis dose delivery. (ST)Cath patency was significantly longer. In patients with acute renal failure, use of an (ST)Cath minimizes catheter-related morbidity and improves dialysis efficiency compared with conventional femoral catheters.

  15. Determinants of survival in patients receiving dialysis in Libya.

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W


    Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice.

  16. Prescription and practice of dialysis in Australia, 1988.

    Disney, A P


    Facilities for provision of treatment of end-stage renal failure with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) are available in many centers, most of which are government-funded. Medicare provides free treatment for all patients. There are no specific criteria for determining a patient's acceptance for dialysis treatment: age, quality of life, and capacity for independent living are important factors. The usual HD prescription is three dialysis periods weekly, hollow-fiber dialyzer, 1.0-1.2 m2 surface area, for 4 to 5 hours, with blood flow rate 250 mL/min and acetate-based dialysate flow rate 500 mL/min. Reuse of the dialyzer is common, but many units practice single use to reduce the expense and time necessary for processing the dialyzer and the risks of formalin exposure. There is only limited use of hemofiltration, or highly efficient dialyzers for shortened hours at higher blood flow rates. The choice of dialysis prescription is influenced by the physician's preference for the patient to be treated at home or in a self-care center with limited assistance. CAPD is preferred for home dialysis, especially for elderly or diabetic patients. There is no personal financial incentive to the physician to favor any particular form of dialysis. The costs of dialysis do influence the provision and prescription of treatment, causing the reuse of dialyzers and the limited use of bicarbonate-based HD and highly permeable dialyzers. Nevertheless, adequate dialysis should be available to all patients, and noncompliance with prescribed dialysis is infrequent. Quality-assurance programs have been developed both for nursing and medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Amyloidosis associated with dialysis. Dialyseassoziierte Amyloidosteopathie - radiologische Aspekte

    Schadmand, S.; Klose, K.J. (Mainz Univ. (Germany, F.R.). Inst. fuer Klinische Strahlenkunde); Wandel, E. (Mainz Univ. (Germany, F.R.). 1. Medizinische Klinik und Poliklinik)


    Amongst the complications of dialysis, amyloid osteopathy is getting increasingly significant. It is due to deposition of {beta}2-microglobulin. To determine the incidence and time of development of this complication, the skeletal radiographs of 185 patients undergoing dialysis, some for up to ten years, were analysed retrospectively. In about 10% of patients, the presence of {beta}2-microglobulin osteopathy may be expected. The radiological features, sites of predilection and differential diagnosis of amyloid osteopathy and of other skeletal changes due to dialysis are discussed. (orig.).

  18. An evidence-based approach to earlier initiation of dialysis.

    Churchill, D N


    The objective was to review evidence addressing the optimal time to initiate dialysis treatment. The database was derived from an evidence-based review of the medical literature and from the Canada-United States peritoneal dialysis study. The publications were divided into (1) those addressing the clinical impact of early versus late referral to a dialysis program; (2) those evaluating the association between residual renal function at initiation of dialysis and the concurrent nutritional status; (3) those evaluating the association between residual renal function at initiation of dialysis and subsequent clinical outcomes, including patient survival. There were five studies evaluating early versus late referral, three cohort design and two case-control design. Late referrals had worse outcomes than early referrals. The former had more serious comorbidity and many had been noncompliant with follow-up. The latter were more likely to have hereditary renal disease. Renal function was slightly worse at initiation among those referred late. Three studies addressed the association between renal function at initiation of dialysis and concurrent nutritional status. Two showed decreased protein intake with diminished glomerular filtration rate (GFR). Poor nutritional status is associated with decreased patient survival among both incident and prevalent dialysis patients. The third study reported excellent patient survival among patients with late initiation of dialysis. These patients had received a supplemented low-protein diet and were not malnourished at initiation of dialysis. Three groups have studied the association between GFR at initiation of dialysis and clinical outcomes. Decreased GFR at initiation of dialysis is associated with a increased probability of hospitalization and death. None of these studies has used the rigorous randomized clinical trial design, and they are therefore subject to bias. Referral time bias, comorbidity, patient compliance, and starting

  19. Clinical outcomes and mortality in elderly peritoneal dialysis patients

    Tamer Sakacı


    Full Text Available OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50% and cardiovascular events (30%. The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of

  20. Meralgia paraesthetica: an unusual complication in peritoneal dialysis.

    Talwar, Ambika; Baharani, Jyoti


    A 53-year-old woman with a history of end-stage renal disease on peritoneal dialysis (PD) presented with a 3-month history of intermittent numbness and paraesthesia over the anterior aspect of the right thigh. The patient noticed the pain was worse on walking and related to dialysis sessions. An examination revealed no neurovascular abnormalities or abdominal masses. However, there was subjective paraesthesia in the distribution of the right lateral cutaneous nerve. Subsequent nerve conduction studies revealed the cause of the patient's symptoms. She was diagnosed with meralgia paraesthetica. Her symptoms resolved when the dialysis regime was modified.

  1. Strategies for preserving residual renal function in peritoneal dialysis patients.

    Nongnuch, Arkom; Assanatham, Montira; Panorchan, Kwanpeemai; Davenport, Andrew


    Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis

  2. Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation

    Chau, Elaine M. T.; Manns, Braden J.; Garg, Amit X.; Sood, Manish M.; Kim, S. Joseph; Naimark, David; Nesrallah, Gihad E.; Soroka, Steven D.; Beaulieu, Monica; Dixon, Stephanie; Alam, Ahsan; Tangri, Navdeep


    Background: Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published. Objective: The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice. Design: This study is a multicenter, 2-arm parallel, cluster randomized trial. Setting: The study involves 55 advanced chronic kidney disease clinics across Canada. Patients: Patients older than 18 years who are managed by nephrologists for more than 3 months, and initiate dialysis in the follow-up period are included in the study. Measurements: Outcomes will be measured at the patient-level and enumerated within a cluster. Data on characteristics of each dialysis start will be determined by linkages with the Canadian Organ Replacement Register. Primary outcomes include the proportion of patients who start dialysis early with an estimated glomerular filtration rate greater than 10.5 mL/min/1.73 m2 and start dialysis in hospital as inpatients or in an emergency room setting. Secondary outcomes include the rate of change in early dialysis starts; rates of hospitalizations, deaths, and cost of predialysis care (wherever available); quarterly proportion of new starts; and acceptability of the knowledge translation materials. Methods: We randomized 55 multidisciplinary chronic disease clinics (clusters) in Canada to receive either an active knowledge translation intervention or no intervention for the uptake of the guideline on the timing of dialysis initiation. The active knowledge translation intervention consists of audit and feedback as well as patient- and provider-directed educational tools delivered at a comprehensive in

  3. Blazed vector grating liquid crystal cells with photocrosslinkable polymeric alignment films fabricated by one-step polarizer rotation method

    Kawai, Kotaro; Kuzuwata, Mitsuru; Sasaki, Tomoyuki; Noda, Kohei; Kawatsuki, Nobuhiro; Ono, Hiroshi


    Blazed vector grating liquid crystal (LC) cells, in which the directors of low-molar-mass LCs are antisymmetrically distributed, were fabricated by one-step exposure of an empty glass cell inner-coated with a photocrosslinkable polymer LC (PCLC) to UV light. By adopting a LC cell structure, twisted nematic (TN) and homogeneous (HOMO) alignments were obtained in the blazed vector grating LC cells. Moreover, the diffraction efficiency of the blazed vector grating LC cells was greatly improved by increasing the thickness of the device in comparison with that of a blazed vector grating with a thin film structure obtained in our previous study. In addition, the diffraction efficiency and polarization states of ±1st-order diffracted beams from the resultant blazed vector grating LC cells were controlled by designing a blazed pattern in the alignment films, and these diffraction properties were well explained on the basis of Jones calculus and the elastic continuum theory of nematic LCs.

  4. Surveillance and Monitoring of Dialysis Access

    Lalathaksha Kumbar


    Full Text Available Vascular access is the lifeline of a hemodialysis patient. Currently arteriovenous fistula and graft are considered the permanent options for vascular access. Monitoring and surveillance of vascular access are an integral part of the care of hemodialysis patient. Although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have been performed evaluating different surveillance techniques. We performed a study of the recent literature published in the PUBMED, to review the scientific evidence on different methodologies currently being used for surveillance and monitoring and their impact on the care of the dialysis access. The limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistula and graft.

  5. Percutaneous mechanical declotting of thrombosed dialysis graft

    Yang, Seung Boo; Goo, Dong Erk; Kim, Dae Ho; Lee, Hae Kyung; Choi, Deuk Lin; Kwon, Kee Hyang; Hong, Hyun Sook; Moon, Chul [College of Medicine, Soonchunhyang University, Seoul (Korea, Republic of)


    To evaluate the effectiveness of percutaneous mechanical declotting. Using a 7-F Desilets-Hoffman sheath and the crossed-catheter technique, we aspirated the intragraft clot and pushed the residual clot into the central circulation with balloon catheters. The success rate, procedure time, complications and patency rates were evaluated. Technical success was achieved in 24 of 32 cases, with a procedure time of 30-240 (average, 111) minutes. In five of eight cases in which technical failure occurred, the guide wire failed to reach the stenotic site and in the other three, there was insufficient luminal dilatation. Complications included vein ruptures (n=2), arterial emboli (n=1) and arterial dissection (1), but there was no evidence of clinical symptoms of pulmonary embolism. The six-month patency rate was 67.8%. Mechanical declotting of thrombosed dialysis graft using a balloon catheter is relatively inexpensive, safe and fast, and is well tolerated. (author)

  6. [Quality guide in nephrology and dialysis].

    Manno, C; Palmieri, V; Virgilio, M; Palasciano, G; Schena, F P


    The Quality Guide, a strategic tool for any nephrologist wishing to initiate a quality policy in his own renal unit, describes to the organisation of total quality management. This article gives a short description of a Quality Guide in Nephrology and Dialysis. According to ISO 9004:2000 Norms, the Quality Guide can be subdivided into four sections: Managerial Accountability, Resource Management; Implementation of Services; Analysis, Evaluation and Continuous Quality Improvement. The quality cycle begins by identifying the customers, who added to the resources constitute the input that will be transformed by the service into output (results). By measuring customer satisfaction the results will be evaluated and analyzed to allow continuous improvement of the service. In conclusion, the drafting of the Guide by all staff members involved has a twofold value: it organizes the quality management within the renal unit and certifies the quality level guaranteed to the customer.

  7. Dialysis membrane for separation on microchips

    Singh, Anup K.; Kirby, Brian J.; Shepodd, Timothy J.


    Laser-induced phase-separation polymerization of a porous acrylate polymer is used for in-situ fabrication of dialysis membranes inside glass microchannels. A shaped 355 nm laser beam is used to produce a porous polymer membrane with a thickness of about 15 .mu.m, which bonds to the glass microchannel and forms a semi-permeable membrane. Differential permeation through a membrane formed with pentaerythritol triacrylate was observed and quantified by comparing the response of the membrane to fluorescein and fluorescently tagging 200 nm latex microspheres. Differential permeation was observed and quantified by comparing the response to rhodamine 560 and lactalbumin protein in a membrane formed with SPE-methylene bisacrylamide. The porous membranes illustrate the capability for the present technique to integrate sample cleanup into chip-based analysis systems.

  8. [Withdrawal of dialysis--decision-making criterion].

    Oehmichen, Frank


    Improvement in prolongation and quality of life has been made possible by medical progress, but life for the patient can become ever more dependent on artificial support and death may be prolonged in unwanted ways. The choice between prolongation of life, quality of life and the abatement of suffering is of great importance in decisions on the continuation or cessation of dialysis and is naturally a process of weighing different positions. This process requires not only medical decision-making but also a structure for the organization of communication between all involved parties. Only thus is it possible to reach a satisfactory resolution to such a situation, a resolution that shows medical responsibility on the part of the physician and one that can be borne by all those involved.

  9. Clinical effects of icodextrin in peritoneal dialysis.

    Cnossen, Trijntje T; Konings, Constantijn J; van der Sande, Frank M; Leunissen, Karel M; Kooman, Jeroen P


    Objective. This study reviews the relevant publications on the clinical effects of icodextrin in peritoneal dialysis (PD). Design. The study provides a systematic review of the literature (MEDLINE search with icodextrin as the keyword). Results. Icodextrin induces sustained transcapillary ultrafiltration during long dwell periods. It also stimulates increased removal of sodium by the peritoneal membrane, reduction of extracellular water (ECW) and total body water (TBW). Effects of icodextrin on blood pressure control and residual renal function are discrepant. Icodextrin induces a reduction in the formation of advanced glycation end-products, while the longitudinal changes in the peritoneal membrane transport are less prominent. Conclusions. Use of icodextrin in PD improves the sodium and fluid balance. Icodextrin is potentially more biocompatible, when compared with the conventional glucose solutions. The side effects are rare.

  10. Sodium management in dialysis by conductivity.

    Bosetto, A; Bene, B; Petitclerc, T


    The determination of dialysate sodium concentration is one of the challenges of dialysis prescription, because no accurate information on the predialytic sodium overload is available. Too low dialysate sodium is responsible for intradialytic intolerance symptoms, whereas too high sodium may lead to long-term water sodium overload with cardiovascular hazards (hypertension, left heart failure). We propose here a biofeedback system based on noninvasive repeated measures of ionic dialysance and plasma water conductivity used here as a surrogate of plasma water sodium. This system achieves a stable postdialytic sodium pool and subsequently a dialysate sodium concentration adapted to the inter dialytic sodium load. This new tool in dialysate sodium prescription aims at reducing the morbidity related to patient sodium balance impairment.

  11. The kinetics of water transperitoneal transport during long-term peritoneal dialysis performed using icodextrin dialysis fluid.

    Olszowska, Anna; Zelichowski, Grzegorz; Waniewski, Jacek; Stachowska-Pietka, Joanna; Weryński, Andrzej; Wańkowicz, Zofia


    Dialysis fluid containing icodextrin is used in patients on peritoneal dialysis (PD) because of its significant ultrafiltration properties. The use of the fluid in treating patients with congestive heart failure resistant to diuretics has also been reported. The aim of the study was to evaluate water peritoneal transport during a 16-hour dialysis exchange performed using icodextrin-containing dialysis fluid. Eleven clinically stable patients were enrolled in the study (5 women and 6 men; mean age, 50.4 +/- 18.3 years), treated with PD for 26.9 +/- 22.4 months. Water transperitoneal transport was evaluated using a modified version of Babb-Randerson-Farrell thermodynamic model of membrane transport with human albumin marked with iodine as the marker of intraperitoneal volume. Based on blood and dialysate samples collected during the 16-hour dialysis exchange, the intraperitoneal volume of dialysate and dialysate reverse absorption were calculated. There were no clinical complications associated with the use of icodextrin fluid during the study. A significant increase in intraperitoneal volume of dialysate (950 ml on average) compared to the initial value was observed in the whole group at the 16th hour of the exchange. The study demonstrated that dialysis fluid with icodextrin ensured effective ultrafiltration during a 16-hour dialysis exchange. This indicates its potential usefulness in the treatment of patients with severe congestive heart failure with or without coexisting end-stage renal disease.

  12. Rotator cuff exercises

    ... this page: // Rotator cuff exercises To use the sharing features on this ... gov/pubmed/25560729 . Read More Frozen shoulder Rotator cuff problems Rotator cuff repair Shoulder arthroscopy Shoulder CT scan Shoulder ...

  13. Bladder perforation in a peritoneal dialysis patient

    M Ounissi


    Full Text Available The dysfunction of the catheter in peritoneal dialysis (PD is a frequent compli-cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re-quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.

  14. Aquaporin-1: new developments and perspectives for peritoneal dialysis.

    Devuyst, Olivier; Yool, Andrea J


    Peritoneal dialysis involves diffusive and convective transport and osmosis through the highly vascularized peritoneal membrane. Several lines of evidence have demonstrated that the water channel aquaporin-1 (AQP1) corresponds to the ultrasmall pore predicted by the model of peritoneal transport. Proof-of-principle studies have shown that upregulation of the expression of AQP1 in peritoneal capillaries results in increased water permeability and ultrafiltration, without affecting the osmotic gradient or small solute permeability. Conversely, studies in Aqp1 mice have shown that haplo-insufficiency for AQP1 results in significant attenuation of water transport. Recent studies have demonstrated that AQP1 is involved in the migration of different cell types, including endothelial cells. In parallel, chemical screening has identified lead compounds that could act as antagonists or agonists of AQPs, with description of putative binding sites and potential mechanisms of gating the water channel. By modulating water transport, these pharmacological agents could have clinically relevant effects in targeting specific tissues or disease states.

  15. Leukotriene release from peripheral and peritoneal leukocytes following exposure to peritoneal dialysis solutions.

    Jörres, A; Jörres, D; Topley, N; Gahl, G M; Mahiout, A


    During continuous ambulatory peritoneal dialysis (CAPD), peritoneal host defence mechanisms are repeatedly exposed to dialysis solutions (with unphysiological composition) which may compromise peritoneal immune cell functions. In this context, the current study focused on the capacity of peripheral and peritoneal PMN to release leukotrienes following exposure to conventional CAPD dialysates. PMN were obtained from peripheral blood of healthy volunteers and from the peritoneal effluent of CAPD patients with acute peritonitis. Following isolation, cells were incubated in fresh CAPD dialysates or control buffer, and calcium ionophore A23187-stimulated leukotriene synthesis was measured. Additional experiments included RP-HPLC analysis and radioactivity monitoring of lipoxygenase products in PMN labelled with 14C-arachidonic acid. Leukotriene B4 and leukotrienes C4/D4/E4 were determined by radioimmunoassay. Ionophore-triggered leukotriene release from cells exposed to control buffer was pronounced in inflammatory peritoneal PMN (70.4 +/- 31.3 ng/5 x 10(6) cells LTB4 and 13.4 +/- 19.8 ng/5 x 10(6) cells LTC4/D4/E4, mean +/- SD, n = 14) when compared to healthy peripheral PMN (26.6 +/- 16.9 ng/ml LTB4 and 6.3 +/- 6.6 ng/ml LTC4/D4/E4, n = 12). Incubation in fresh solutions for peritoneal dialysis severely depressed leukotriene release from both cell populations. These results indicate a severe inhibition of cellular responsiveness as a consequence of dialysate exposure which could contribute to the impairment of host defence early in the CAPD cycle.

  16. 2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients.

    Gejyo, Fumitake; Saito, Akira; Akizawa, Tadao; Akiba, Takashi; Sakai, Tatsuya; Suzuki, Masashi; Nishi, Shinichi; Tsubakihara, Yoshiharu; Hirakata, Hideki; Bessho, Masami


    The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Professor F. Gejyo of Niigata University, now publishes an original Japanese guideline entitled 'Guidelines for Renal Anemia in Chronic Hemodialysis Patients'. It includes the re-evaluation of the usage of recombinant human erythropoietin (rHuEPO) with the medical and economical arguments regarding the prognosis and the quality of life of Japanese hemodialysis patients. This guideline consists of 7 sections. The first section comprises the general definition and the differential diagnosis of anemia. The hemoglobin (Hb) level of the Japanese population seemed to be low when compared with that of the European and American populations. The second section describes the target Hb level in hemodialysis patients. Multivariate analysis of the data that were collected from dialysis institutions throughout the country showed that an Hb level of 10-11 g/dL (Ht level 30-33%) at the first dialysis session in a week is the ideal range for chronic hemodialysis patients in terms of the 3-5 year survival rate. The supine position at blood sampling and the sampling timing at the first dialysis session in a week might affect the lower setting of target Hb hematocrit (Ht), compared to that of European and American guidelines. However, we particularly recommended that an Hb level of 11-12 g/dL (Ht level from 33 to 36%) at the first dialysis session in a week is desirable in relatively young patients. In the third section, the markers of iron deficiency are discussed. The Transferin saturation test (TSAT) and serum ferritin were emphasized as the standard markers. The routes of administration of rHuEPO and its dosages are written in the fourth section. The subcutaneous route was associated with the occurrence of secondary red cell aplasia due to anti-rHuEPO antibodies; however, secondary red cell aplasia was seldom observed in the venous injection. From this fact we recommend venous injection for chronic

  17. Rotating Cavitation Supression Project

    National Aeronautics and Space Administration — FTT proposes development of a rotating cavitation (RC) suppressor for liquid rocket engine turbopump inducers. Cavitation instabilities, such as rotating...

  18. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD).

    Gorrin, Maite Rivera; Teruel-Briones, José Luis; Vion, Victor Burguera; Rexach, Lourdes; Quereda, Carlos


    Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a shortterm life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis. Copyright © 2015. Published by Elsevier España, S.L.U.

  19. Spontaneous Rotational Inversion in Phycomyces

    Goriely, Alain


    The filamentary fungus Phycomyces blakesleeanus undergoes a series of remarkable transitions during aerial growth. During what is known as the stagea IV growth phase, the fungus extends while rotating in a counterclockwise manner when viewed from above (stagea IVa) and then, while continuing to grow, spontaneously reverses to a clockwise rotation (stagea IVb). This phase lasts for 24-48Ah and is sometimes followed by yet another reversal (stageAIVc) before the overall growth ends. Here, we propose a continuum mechanical model of this entire process using nonlinear, anisotropic, elasticity and show how helical anisotropy associated with the cell wall structure can induce spontaneous rotation and, under appropriate circumstances, the observed reversal of rotational handedness. © 2011 American Physical Society.

  20. Aseptic peritonitis due to peptidoglycan contamination of pharmacopoeia standard dialysis solution.

    Martis, Leo; Patel, Mehul; Giertych, Joe; Mongoven, Jim; Taminne, Michel; Perrier, Michele A; Mendoza, Omar; Goud, Niranjan; Costigan, Aidan; Denjoy, Nicole; Verger, Christian; Owen, William F

    Manufacturers of parenteral solutions adhere to European and US Pharmacopoeia standards to define safety and sterility. In response to excess cases of aseptic peritonitis in peritoneal dialysis patients using icodextrin-containing dialysate that met all pharmacopoeia standards, a global recall was issued in May, 2002. We aimed to establish the cause of aseptic peritonitis. We analysed 186 reports of aseptic peritonitis between September, 2001, and January, 2003. Extensive physical, chemical, and microbiological investigations of recalled dialysate were done. We calculated dose-response curves for peptidoglycan-induced interleukin 6 elaboration in peripheral blood mononuclear cells (PBMCs) from healthy donors and for sterile peritonitis in rats. Although its chemical constituents and concentrations of endotoxin were within pharmacopoeia specifications, the dialysis solution elicited an interlukin 6 response in vivo and in vitro. We identified peptidoglycan from thermophilic acidophilic bacteria (Alicyclobacillus acidocaldarius) as the contaminating proinflammatory substance. In the PBMC assay, strong dose-response relations were noted between peptidoglycan concentrations and interleukin 6. In rats injected with peptidoglycan, dose-dependent increases of intraperitoneal neutrophils and pyrogenic cytokines were recorded. We measured a positive relation between peptidoglycan concentrations in recalled dialysate and reports of aseptic peritonitis. After implementation of corrective actions, the rate of peritonitis returned to baseline. Excess cases of aseptic peritonitis in peritoneal dialysis patients were due to peptidoglycan contamination of dialysate by Alicyclobacillus. This outbreak serves as an example of how contemporary parenteral products with microbial contaminants can be considered safe under current pharmacopoeia tests, but provoke adverse clinical effects.

  1. Thyroid Cells Exposed to Simulated Microgravity Conditions - Comparison of the Fast Rotating Clinostat and the Random Positioning Machine

    Warnke, Elisabeth; Kopp, Sascha; Wehland, Markus; Hemmersbach, Ruth; Bauer, Johann; Pietsch, Jessica; Infanger, Manfred; Grimm, Daniela


    The ground-based facilities 2D clinostat (CN) and Random Positioning Machine (RPM) were designed to simulate microgravity conditions on Earth. With support of the CORA-ESA-GBF program we could use both facilities to investigate the impact of simulated microgravity on normal and malignant thyroid cells. In this review we report about the current knowledge of thyroid cancer cells and normal thyrocytes grown under altered gravity conditions with a special focus on growth behaviour, changes in the gene expression pattern and protein content, as well as on altered secretion behaviour of the cells. We reviewed data obtained from normal thyrocytes and cell lines (two poorly differentiated follicular thyroid cancer cell lines FTC-133 and ML-1, as well as the normal thyroid cell lines Nthy-ori 3-1 and HTU-5). Thyroid cells cultured under conditions of simulated microgravity (RPM and CN) and in Space showed similar changes with respect to spheroid formation. In static 1 g control cultures no spheroids were detectable. Changes in the regulation of cytokines are discussed to be involved in MCS (multicellular spheroids) formation. The ESA-GBF program helps the scientists to prepare future spaceflight experiments and furthermore, it might help to identify targets for drug therapy against thyroid cancer.

  2. Peritonitis in peritoneal dialysis patients after renal transplantation

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG


    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  3. H1N1 in dialysis units: Prevention and management

    Karkar Ayman


    Full Text Available Dialysis patients are at increased risk of contracting influenza A H1N1 and deve-loping serious illness. Increasing the awareness of dialysis patients and continuous education and training of medical staff on early recognition and management of influenza A H1N1 can help in saving the life of patients. Antiviral drugs and influenza vaccines are effective in providing ade-quate immunity in dialysis patients with strict implementation of infection control policies and procedures can help in preventing and controlling the dissemination of influenza A H1N1 in dia-lysis units. We report a case of a patient who presented with HINI influenza and developed acute kidney injury during his hospitalization and his course with disease.

  4. Catheters Often to Blame for Blood Infections After Dialysis

    ... as an arteriovenous fistula. This is created by connecting a patient's own vein and artery to form ... Dialysis Infection Control About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  5. [Oxidative stress in patients on regular hemodialysis and peritoneal dialysis].

    Vostálová, J; Galandáková, A; Strebl, P; Zadražil, J


    Hemodialysis and peritoneal dialysis are methods of blood purification, which partially replaced excretory renal function in patients with chronic renal failure, which was depleted regime, dietary and pharmaco-therapeutic remedy, and who are not eligible for kidney transplantation. Both two methods are accompanied by increased oxidative stress. In peritoneal dialysis particularly the composition of dialysis solution contributes to oxidative stress. In extracorporeal hemodialysis the oxidative stress is associated with the character of hemodialysis membranes, non-specific loss of low molecular weight antioxidants, activation of leukocytes (oxidative burst), feroteraphy, supplementation with low molecular weight antioxidants and other factors. To improve and maintain the quality of life of dialysis patients, the continuous monitoring of oxidative stress-related parameters as non-traditional risk factors for cardiovascular complications development is suitable.

  6. Increasing fill volume reduces cardiac performance in peritoneal dialysis

    Ivarsen, Per; Povlsen, Johan V; Jensen, Jens Dam


    BACKGROUND: It is generally accepted that peritoneal dialysis (PD) affects systemic haemodynamics less than haemodialysis, but little is known about changes in haemodynamics during PD. It is unknown if increasing PD volume causes changes in cardiovascular haemodynamics possibly increasing...

  7. Peritonitis in peritoneal dialysis patients after renal transplantation

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG


    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  8. [Maintaining residual renal function in patients on dialysis].

    Ryckelynck, Jean-Philippe; Goffin, Éric; Verger, Christian


    There are evidences supporting a positive impact of renal residual function (RRF) on survival and quality of life of dialysis patients. Many strategies are available in clinical practices to maintain RRF. Hemodiafiltration seems to be better that conventional hemodialysis and similar to peritoneal dialysis. Arterial hypotension in hemodialysis or dehydration in peritoneal dialysis are deleterious in terms of preservation of RRF. Loop diuretics increase urine volume and natriuresis, not RRF. Radiocontrast and aminoglycosides may be used safely. The benefits of ACE inhibitors and angiotensin II receptor blockers are debated but have positive effect on blood pressure control and cardiac function. Neither biocompatible solutions nor the modality of peritoneal dialysis have demonstrated benefits on RRF. Copyright © 2013 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  9. Diabetic patients treated with dialysis: complications and quality of life

    Sørensen, V R; Mathiesen, E R; Watt, T


    AIMS/HYPOTHESIS: The aim of this study was to describe the prevalence of complications, health-related quality of life (HRQOL) and the influence of beliefs about control over health in diabetic dialysis patients. METHODS: Of 53 eligible diabetic patients on chronic dialysis during January 2004...... in our clinic, 38 (76%) completed a kidney-specific (Kidney Disease Quality of Life) and a generic (SF-36) questionnaire and were characterised in terms of cardiovascular diseases and diabetic complications. Matched groups of non-diabetic dialysis patients (n = 40) and diabetic patients with a long...... population (47 +/- 19). The diabetic dialysis patients had similar levels of kidney-specific quality of life and mental health compared with the control groups. Reduced physical health was predicted by the presence of end-stage renal disease, diabetes and short time spent in education. Among the diabetic...

  10. Risk factors for peritoneal dialysis catheter failure in children ...

    Risk factors for peritoneal dialysis catheter failure in children. ... tertiary Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia, from January ... improvement of patients' nutritional status, use of a swan-neck double-cuffed catheter, ...

  11. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C


    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established.

  12. Transperitoneal transport of sodium during hypertonic peritoneal dialysis

    Graff, J; Fugleberg, S; Brahm, J


    The mechanisms of transperitoneal sodium transport during hypertonic peritoneal dialysis were evaluated by kinetic modelling. A total of six nested mathematical models were designed to elucidate the presence or absence of diffusive, non-lymphatic convective and lymphatic convective solute transport....... Experimental results were obtained from 26 non-diabetic patients undergoing peritoneal dialysis. The model validation procedure demonstrated that only diffusive and non-lymphatic convective transport mechanisms were identifiable in the transperitoneal transport of sodium. Non-lymphatic convective sodium...

  13. Efficacy of peritoneal dialysis in severe thiazide-induced hyponatraemia


    A patient with severe thiazide-induced hyponatraemia (plasma sodium 99 mmol/l) is described, who had signs suggestive of cerebral oedema. Co-existent problems of cardiac and respiratory insufficiency were thought to make treatment with hypertonic saline hazardous. A 40-hr peritoneal dialysis successfully reversed both hyponatraemia and the associated cerebral signs, plasma sodium increasing at a rate of 0·83 mmol/hr. Peritoneal dialysis appears to be a safe and efficacious method of treating ...

  14. High-quality dialysis: a lesson from the Japanese experience

    Masakane, Ikuto


    High-quality dialysis does not always mean high efficiency; dialysis should maintain nutritional balance and full biocompatibility. In undergoing treatment with polymethylmethacrylate (PMMA) and/or ethylene vinyl alcohol copolymer (EVAL) membrane dialysers, the body weight decrease caused by polysulfone membrane has been dramatically improved for those receiving predilution online haemodiafiltration (HDF) as well. These membranes are assumed to somewhat suppress the clearance of small molecul...

  15. Clinical reports for peritoneal dialysis-related peritonitis



    Objective To investigate causes and risk factors of peritoneal dialysis-related peritonitis,explore the pathogenic bacteria and drug sensitivity.Methods CAPD patients suffered peritoneal dialysis-related peritonitis were recruited in the First Affiliated Hospital of Nanjing Medical University in 2012.Gender,age and possible risk factors were analyzed by unvaried and multivariate logistic regression analysis.The causes,pathogenic bacteria,

  16. Clostridium difficile-associated diarrhea in dialysis patients ☆

    Sook Eui Oh; Seung Min Lee; Young-Ki Lee; Sun Ryoung Choi; Myung-Jin Choi; Jwa-Kyung Kim; Young Rim Song; Soo Jin Kim; Tae Jin Park; Sung Gyun Kim; Jieun Oh; Jang Won Suh; Jong-Woo Yoon; Ja-Ryong Koo; Hyung Jik Kim


    Background: Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD). Methods: During the 4-year study period (2004–2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were consi...

  17. Hydration Status of Patients Dialyzed with Biocompatible Peritoneal Dialysis Fluids.

    Lichodziejewska-Niemierko, Monika; Chmielewski, Michał; Dudziak, Maria; Ryta, Alicja; Rutkowski, Bolesław


    ♦ Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve dialysis and patient outcome in end-stage renal disease. However, their impact on hydration status (HS), residual renal function (RRF), and dialysis adequacy has been a matter of debate. The aim of the study was to evaluate the influence of a biocompatible dialysis fluid on the HS of prevalent PD patients. ♦ The study population consisted of 18 prevalent PD subjects, treated with standard dialysis fluids. At baseline, 9 patients were switched to a biocompatible solution, low in glucose degradation products (GDPs) (Balance; Fresenius Medical Care, Bad Homburg, Germany). Hydration status was assessed through clinical evaluation, laboratory parameters, echocardiography, and bioimpedance spectroscopy over a 24-month observation period. ♦ During the study period, urine volume decreased similarly in both groups. At the end of the evaluation, there were also no differences in clinical (body weight, edema, blood pressure), laboratory (N-terminal pro-brain natriuretic peptide, NTproBNP), or echocardiography determinants of HS. However, dialysis ultrafiltration decreased in the low-GDP group and, at the end of the study, equaled 929 ± 404 mL, compared with 1,317 ± 363 mL in the standard-fluid subjects (p = 0.06). Hydration status assessed by bioimpedance spectroscopy was +3.64 ± 2.08 L in the low-GDP patients and +1.47 ± 1.61 L in the controls (p = 0.03). ♦ The use of a low-GDP biocompatible dialysis fluid was associated with a tendency to overhydration, probably due to diminished ultrafiltration in prevalent PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.

  18. The management of anemia in pediatric peritoneal dialysis patients

    Schröder, Cornelis H.; ,


    Anemia is common in chronic renal failure. Guidelines for the diagnosis and treatment of anemia in adult patients are available. With respect to the diagnosis and treatment in children on peritoneal dialysis, the European Pediatric Peritoneal Dialysis Working Group (EPPWG) has produced guidelines. After a thorough diagnostic work-up, treatment should aim for a target hemoglobin concentration of at least 11 g/l. This can be accomplished by the administration of erythropoietin and iron preparat...

  19. Prevalence and clinical characteristics of HIV type 1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006: GESIDA 48/05 study.

    Trullàs, J-C; Barril, G; Cofan, F; Moreno, A; Cases, A; Fernandez-Lucas, M; Martinez-Ara, J; Ceballos, M; Garcia-de-Diego, J; Muñiz, M-L; Molina, J; Martínez-Castelao, A; González-Garcia, J; Miró, J-M


    End-stage renal diseases (ESRD) are becoming more frequent in HIV-infected patients. In Europe there is little information about HIV-infected patients on dialysis. A cross-sectional multicenter survey in 328 Spanish dialysis units was conducted in 2006. Information from 14,876 patients in dialysis was obtained (81.6% of the Spanish dialysis population). Eighty-one were HIV infected (0.54%; 95% CI, 0.43-0.67), 60 were on hemodialysis, and 21 were on peritoneal dialysis. The mean (range) age was 45 (28-73) years. Seventy-two percent were men and 33% were former drug users. The mean (range) time of HIV infection was 11 (1-27) years and time on dialysis was 4.6 (0.4-25) years. ESRD was due to glomerulonephritis (36%) and diabetes (15%). HIV-associated nephropathy was not reported. Eighty-five percent were on HAART, 76.5% had a CD4 T cell count above 200 cells, and 73% had undetectable viral load. Thirty-nine percent of patients met criteria for inclusion on the renal transplant (RT) waiting list but only 12% were included. Sixty-one percent had HCV coinfection. HCV-coinfected patients had a longer history of HIV, more previous AIDS events, parenteral transmission as the most common risk factor for acquiring HIV infection, and less access to the RT waiting list (p HIV infection in Spanish dialysis units in 2006 was 0.54% HCV coinfection was very frequent (61%) and the percentage of patients included on the Spanish RT waiting list was low (12%).

  20. Dialysis for undocumented immigrants in the United States.

    Rodriguez, Rudolph A


    The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane. Published by Elsevier Inc.

  1. [Interests of advanced systematic evaluation of dialysis session].

    Galland, Roula; Hallonet, Patrick; Pachot, Monique; Combe, Corinne; Schoenfelder, Isabelle; Caillette Beaudoin, Agnès


    In order to rationalize the cost of care for dialysis patients in Centre, regulatory authorities urge establishments to favor the orientation of the patients in Medical Dialysis Unit where the medical presence is not permanent. This involves clinical skills for nurses in the conduct of the dialysis session. Faced with this changing work patterns, we present two security tools of the dialysis session. The first is a "check-list", simple, quick and easy to use, it enables secure connection phase of the patient. It was quickly integrated practice of all professionals. The second tool developed is a combination of indicators "DEAUP" for Pain, Purification, Blood access, Ultrafiltration and other Problems for assessing the quality of the course of the dialysis session. The aim is to reduce the occurrence of adverse events, the DEAUP rating certain criteria depending on the occurrence of incidents, from 0 to 2, 2 corresponding to the appearance of an incident having required the call of the doctor and constitute a precious tool of evaluation of the session for all the professionals. All nurses have joined the practice of evaluation, 98% of the realized sessions are informed and quoted; 8.4% of sessions required call nephrologists before or at the connection. The evaluation at the end of dialysis session found 15% of the sessions listed 2. Calls have resulted in an adjustment to the prescription of the sessions.


    罗新锦; 许建屏; 沈向东; 陈霞


    Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in childrenwho receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwentheart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 pa-tients was (2.9±2.0) years (range, 5 months~7 years) and the mean body weight was (12±3) kg (range,7.4~18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2±11.4)hours (4.4~42 hours). The duration of peritoneal dialysis was (6.3±4.8) days (0.47~15 days). Mortality inthese 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7±17.8) ml@kg1@day-1@ Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easilymanaged. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe method totreat acute renal failure after cardiac operation in children.

  3. Natural disasters and dialysis care in the Asia-Pacific.

    Gray, Nicholas A; Wolley, Martin; Liew, Adrian; Nakayama, Masaaki


    The impact of natural disasters on the provision of dialysis services has received increased attention in the last decade following Hurricane Katrina devastating New Orleans in 2005. The Asia-Pacific is particularly vulnerable to earthquakes, tsunami, typhoons (also known as cyclones and hurricanes) or storms and flooding. These events can seriously interrupt provision of haemodialysis with adverse effects for patients including missed dialysis, increased hospitalization and post-traumatic stress disorder. Furthermore, haemodialysis patients may need to relocate and experience prolonged periods of displacement from family and social supports. In contrast to haemodialysis, most literature suggests peritoneal dialysis in a disaster situation is more easily managed and supported. It has become apparent that dialysis units and patients should be prepared for a disaster event and that appropriate planning will result in reduced confusion and adverse outcomes should a disaster occur. Numerous resources are now available to guide dialysis units, patients and staff in preparation for a possible disaster. This article will examine the disaster experiences of dialysis units in the Asia-Pacific, the impact on patients and staff, methods employed to manage during the disaster and suggested plans for reducing the impact of future disasters.

  4. Testing protein permeability of dialysis membranes using SDS-PAGE.

    Mann, H; Melzer, H; Al-Bashir, A; Xu, X Q; Stiller, S


    Permeability of dialysis membranes for high molecular weight compounds should be similar to that of the glomerular membrane in order to remove uremic toxins like the human kidney does. In order to evaluate permeability of high-flux dialysis membranes SDS-PAGE is applied for examination of filtrate of dialysers during routine dialysis with different membranes. SDS-PAGE analysis is performed with silver staining method according to the modification of Melzer (5) and consecutive laser densitometry. The protein pattern of filtrate from dialysis membranes is similar to that of the glomerular membrane containing IgG, transferrin, albumin, alpha-1-microglobulin, retinol binding protein and beta-2-microglobulin. Comparing different membranes there are considerable differences depending on cut-off, charge and adsorption capacity of the particular membrane. In all membranes tested permeability of proteins decreases during one treatment session. Protein permeability of high-flux dialysis membranes is similar to the gloemerular membrane but modified according to pore-size, surface charge, adsorption and time on dialysis. In contrast to the glomerular membrane in each of the investigated membranes protein permeability decreases during function.

  5. Comparing the incomparable: hemodialysis versus peritoneal dialysis in observational studies.

    Foley, Robert N


    A randomized trial comparing survival in hemodialysis and peritoneal dialysis remains a utopian aspiration. Dialysis is still relatively rare on a population basis, and a natural tension exists between desirability and feasibility in terms of quality of evidence. In practice, it is very difficult to perform prospective comparisons with large groups of contemporary representative subjects, and much of the literature comes from retrospective national registries. This article considers several questions to address when trying to compare the outcomes of peritoneal dialysis and hemodialysis. Prognostic similarity at baseline is a fundamental issue. Traditionally, adjustment for known prognostic factors has been used in an attempt to minimize the bias caused by nonrandom treatment assignment. Propensity scores have been suggested to be superior, and matched-case analysis may also be a useful method for comparison. Other questions include, when, in relation to starting dialysis, to start the observation clock; the definition and handling of switches of dialysis therapy; and the decision to censor at transplantation. Finally, comparisons are complicated by hazards ratios that vary over time, and time-segmented analysis is obligatory. Many types of analytical approaches are needed to begin to appreciate outcome disparities between dialysis therapies.

  6. Hospitalization rates among dialysis patients during Hurricane Katrina.

    Howard, David; Zhang, Rebecca; Huang, Yijian; Kutner, Nancy


    Dialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear. The impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated. Data from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations. The rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics. Hospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.

  7. Practical approach to data collection in a European dialysis network


    @@ Collection of Dialysis Treatment Data and Patient-Related Information in a Single Dialysis Unit State-of-the-art dialysis machines are capable of automatically collecting huge volumes of dialysis treatment data (blood and dialysate flow rates, venous and arterial pressures, ultrafiltration rate, ultrafiltration volume, transmembrane pressure, conductivity, etc.) and displaying the information on the monitor screen. Commercially available software allows this information to be exported to a clinical database on a server through a local network in the clinic, enabling healthcare professionals to further process, display, and evaluate the data. Moreover, on-line sensors can be used to monitor patient-related information, e.g.effective ionic dialysance as a marker of urea clearance[1-3], urea removal and additional parameters(e.g. whole-body Kt/V) based on dialysate urea measurements[4,5], and blood volume changes[6]. Although many of these sensors are available in dialysis machines, their clinical value in routine dialysis is still subject to debate[7].

  8. 3D rotating wall vessel and 2D cell culture of four veterinary virus pathogens: A comparison of virus yields, portions of infectious particles and virus growth curves.

    Malenovská, Hana


    Only very few comparative studies have been performed that evaluate general trends of virus growth under 3D in comparison with 2D cell culture conditions. The aim of this study was to investigate differences when four animal viruses are cultured in 2D and 3D. Suid herpesvirus 1 (SuHV-1), Vesicular stomatitis virus (VSIV), Bovine adenovirus (BAdV) and Bovine parainfluenza 3 virus (BPIV-3) were cultivated in 3D rotating wall vessels (RWVs) and conventional 2D cultures. The production of virus particles, the portion of infectious particles, and the infectious growth curves were compared. For all viruses, the production of virus particles (related to cell density), including the non-infectious ones, was lower in 3D than in 2D culture. The production of only infectious particles was significantly lower in BAdV and BPIV-3 in 3D cultures in relation to cell density. The two cultivation approaches resulted in significantly different virus particle-to-TCID50 ratios in three of the four viruses: lower in SuHV-1 and BPIV-3 and higher in BAdV in 3D culture. The infectious virus growth rates were not significantly different in all viruses. Although 3D RWV culture resulted in lower production of virus particles compared to 2D systems, the portion of infectious particles was higher for some viruses.

  9. A double chamber rotating bioreactor for enhanced tubular tissue generation from human mesenchymal stem cells: a promising tool for vascular tissue regeneration.

    Stefani, I; Asnaghi, M A; Cooper-White, J J; Mantero, S


    Cardiovascular diseases represent a major global health burden, with high rates of mortality and morbidity. Autologous grafts are commonly used to replace damaged or failing blood vessels; however, such approaches are hampered by the scarcity of suitable graft tissue, donor site morbidity and poor long-term stability. Tissue engineering has been investigated as a means by which exogenous vessel grafts can be produced, with varying levels of success to date, a result of mismatched mechanical properties of these vessel substitutes and inadequate ex vivo vessel tissue genesis. In this work, we describe the development of a novel multifunctional dual-phase (air/aqueous) bioreactor, designed to both rotate and perfuse small-diameter tubular scaffolds and encourage enhanced tissue genesis throughout such scaffolds. Within this novel dynamic culture system, an elastomeric nanofibrous, microporous composite tubular scaffold, composed of poly(caprolactone) and acrylated poly(lactide-co-trimethylene-carbonate) and with mechanical properties approaching those of native vessels, was seeded with human mesenchymal stem cells (hMSCs) and cultured for up to 14 days in inductive (smooth muscle) media. This scaffold/bioreactor combination provided a dynamic culture environment that enhanced (compared with static controls) scaffold colonization, cell growth, extracellular matrix deposition and in situ differentiation of the hMSCs into mature smooth muscle cells, representing a concrete step towards our goal of creating a mature ex vivo vascular tissue for implantation. Copyright © 2016 John Wiley & Sons, Ltd.

  10. Randomized controlled study of icodextrin on the treatment of peritoneal dialysis patients during acute peritonitis.

    Chow, Kai Ming; Szeto, Cheuk Chun; Kwan, Bonnie Ching Ha; Pang, Wing Fai; Ma, Terry; Leung, Chi Bon; Law, Man Ching; Li, Philip Kam-Tao


    The clinical benefits of using icodextrin during acute peritonitis in peritoneal dialysis are uncertain. On the premise that high glucose concentration might jeopardize the peritoneal defense during peritonitis, icodextrin administration during acute peritonitis could have the potential to improve the peritonitis outcome whilst improving ultrafiltration. We conducted a single-center, open-label, randomized controlled trial in which 53 adult continuous ambulatory peritoneal dialysis patients underwent randomization to receive either icodextrin or original glucose-based dialysis solution. The primary outcome measure was the peritoneal dialyzate white cell count on Day 3. Secondary outcome measures comprised the need of additional hypertonic exchanges, fluid control as denoted by changes in body weight, and the clinical outcome of peritonitis including 30-day and 120-day all-cause mortality. Between icodextrin and control treatment groups, there were no statistically significant differences in the peritoneal dialyzate white cell count on day (1829 versus 987/mm(3), P = 0.13). There was neither improvement in primary cure rate (31.8 versus 32.3%, P = 1.00), nor was there any change in 120-day mortality after icodextrin use (13.6 versus 12.9%, P = 1.00). However, requirement of hypertonic dialysis exchange was much more frequent in the control group than in those randomized to icodextrin (35.5 versus 0%, P = 0.001). Body weight did not change significantly in the icodextrin group, but body weight in the control group increased from 63.3 ± 14.5 kg at baseline to 64.2 ± 14.2 kg at Day 5 (P = 0.0002) and 65.2 ± 14.1 kg at Day 10 (P icodextrin achieved better ultrafiltration and fluid control during acute peritonitis complicating continuous ambulatory peritoneal dialysis, although we found no evidence of a worthwhile clinical benefit on peritonitis resolution. ( number, NCT0104446 [].). © The Author 2014. Published by Oxford University

  11. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

    Nadeau-Fredette, Annie-Claire; Hawley, Carmel M.; Pascoe, Elaine M.; Chan, Christopher T.; Clayton, Philip A.; Polkinghorne, Kevan R.; Boudville, Neil; Leblanc, Martine


    Background and objectives Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. Design, setting, participants, & measurements This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile–stratified model, and propensity score–matched model. Results The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the

  12. [Effect of a dialysis solution with icodextrin on ultrafiltration and selected metabolic parameters in patients treated with peritoneal dialysis].

    Opatrná, S; Racek, J; Stehlík, P; Senft, V; Sefrna, F; Topolcan, O; Opatrný, K


    To date, peritoneal dialysis has been performed almost exclusively using dialysis solutions containing glucose as the osmotic agent. Use of these solutions is fraught with problems regarding adequate fluid removal from the body and is also associated with undesirable metabolic effects; hence the search for alternative osmotic agents. A dialysis solution with the glucose polymer icodextrin generates ultrafiltration on the principle of colloidal osmosis. The aim of the study was to establish the effect of icodextrin-base dialysis solution on the magnitude of ultrafiltration and evaluate selected metabolic parameters of patients treated by ambulatory peritoneal dialysis. A total of 9 patients whose glucose-based solution was replaced by an icodextrin-based solution during the night-time exchange were evaluated. A control group of 9 patients used glucose-solution during all exchanges. Night-time bag ultrafiltration, blood pressure, and the serum levels of lipids, insulin, leptin, maltose, and amylase were determined before icodextrin administration (time 0), at one-month intervals (time 1, 2, 3), and one month after study completion (time 4). In icodextrin-treated patients, ultrafiltration rose from 246.5 +/- 60.5 ml (mean +/- SEM) at time 0 to 593.1 +/- 87.4 ml; p Insulin and lipid levels were not affected. There was no change in the above parameters in the control group. Icodextrin-treated patients reduced their antihypertensive medication, but not statistically significantly. Icodextrin administration significantly increase ultrafiltration thus providing for effective control of hydration status without the need for high-level glucose-based dialysis solutions. The use of a glucose polymer-based dialysis solution is associated with a significant yet reversible rise in serum maltose. The decrease in leptin may signal a reduction in body weight after replacing glucose in dialysis solutions with icodextrin, or enhanced rates of leptin elimination as a result of

  13. Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous ambulatory peritoneal dialysis

    Stanković-Popović Verica


    Full Text Available Background/Aim. Peritoneal dialysis (PD patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions. Methods. After 3±2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1, average age 47.43±12.87 years, and 21 PD patients on the treatment with biocompatible dialysis solutions (neutral solutions with lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH: PDP-2, average age 68.62±13.98 years, participated in the longitudinal study. The average number of episodes of peritonitis was similare in both groups: 1 episode per 36 months of the treatment. The control group included 21 patients with preterminal phase of chronic renal failure (Glomerular Filtration Rate: 22.19±10.73 ml/min, average age 65.29± 13.74 years. All the patients underwent transthoracal echocardiography (in order to detect: eject fraction (EF, left ventricular hypertrophy (LVH, and valvular calcification (VC and B-mode ultrasonography of common carotid artery (CCA: IMT, lumen narrowing, and plaque detection. Results. The values of EF were: in PDP-1 group 62.05±5.65%, in PDP-2 group 53.43±7.47%, and in the control group 56.71±8.12% (Bonferroni test, p = 0.001. The recorded LVH was: in PDP-1 group in 47.6% of the patients; in PDP-2 group in 61.9% of the patients; and in control the group in 52.4% (χ2 test; p = 0.639. The detected VC was: in PDP-1 in 52.4% of the patients, in PDP-2 group in 42.9% of the patients, and in the control group in 23.8% of the patients (χ2 test; p = 0.776. The IMT was: in PDP-1 group 1.26±0.54 mm, in PDP-2 group 1.23±0.32, and in the control group 1.25±0.27 mm (Bonferroni test; p = 0.981. An average lumen narrowing was: in PDP-1 group 13

  14. Solute clearance measurement in the assessment of dialysis adequacy among African continuous ambulatory peritoneal dialysis patients

    Aliyu Abdu


    Full Text Available Solute clearance measurement is an objective means of quantifying the dose of peritoneal dialysis (PD. Despite continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients, guidelines based on solute clearance values are common in clinical practice. There is limited information on the solute clearance indices and PD adequacy parameters among this predominantly low socioeconomic status PD population. We investigated the solute clearance among continuous ambulatory peritoneal dialysis (CAPD patients at the Charlotte Maxeke Johannesburg Academic Hospital and its relationship with other parameters of PD adequacy. Seventy patients on CAPD were studied in this cross-sectional study. Solute clearance was assessed using urea clearance (Kt/V. Linear regression analysis was used to determine factors associated with solute clearance, while analysis of variance was used to test the influence of weekly Kt/V on blood pressure (BP, hemoglobin (Hb and other biochemical parameters. The mean age of the study population was 37.9 ± 12.4 years, 43% were females and 86% were black Africans. The mean duration on CAPD was 19.7 ± 20.8 months. Mean systolic and diastolic BP were 144 ± 28 and 92 ± 17 mm Hg, respectively. The mean Hb was 11.1 ± 2.2 g/dL and the mean weekly Kt/V was 1.7 ± 0.3. Factors like systolic BP, Hb level, serum levels of cholesterol, calcium, phosphate, parathyroid hormone and albumin were not significantly associated with the weekly Kt/V. We conclude that the dose of PD received by the majority of our patients in terms of the weekly Kt/V is within the recommended values and that this finding is significant considering the low socioeconomic background of our patients. There is no significant association between Kt/V and other indices of dialysis adequacy.

  15. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

    Jacek Waniewski


    Full Text Available During peritoneal dialysis (PD, the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87 years; median time on PD 19 (3–100 months underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS, fraction of ultrasmall pores (αu, osmotic conductance for glucose (OCG, and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters. Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  16. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia


    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  17. [Electro-encephalographic study of the disequilibrium syndrome during bicarbonate dialysis and acetate dialysis].

    Hampl, H; Klopp, H W; Michels, N; Mahiout, A; Schilling, H; Wolfgruber, M; Schiller, R; Hanefeld, F; Kessel, M


    Continuous long-time electroencephalographic (EEG) monitoring was performed during AHD and BHD in 20 patients. Persisting normal basic activity of the EEG without neurological symptoms could be found only during the course of BHD. However, in AHD, during the decrease of arterial CO2 tension (PaCO2) we registered EEG disturbances with moderate to severe slowing down, dysrythmic activity and high voltage discharges. The decrease in PaCO2 and the deterioration in EEG activity in the patients during AHD was concomitant with severe neurological alterations, e.g. the typical symptoms of so-called "disequilibrium" causing a cessation of dialysis in 3 patients.

  18. [Early kidney transplant failure and return to peritoneal dialysis: preliminary study of permeability and dialysis efficacy].

    Coronel, Francisco; Florit, Enrique; Cigarrán-Guldrís, Secundino; Herrero-Calvo, José A; Delgado-Córdova, Margarita; Rodríguez-Cubillo, Beatriz


    The return to dialysis after kidney transplant (TX) failure is increasingly common. On returning to dialysis after TX failure, there is usually a similar or worse clinical situation than in patients who are on haemodialysis or peritoneal dialysis (PD) for the first time. Although there are several studies on the clinical situation of patients who return to PD after long periods with a functioning TX, there is hardly any information on the progression of a patient subgroup returning to PD after TX failure a few days or weeks after transplantation. Assess whether a short period of time on suboptimal TX and aggressive treatment/measures may influence membrane permeability, the clinical situation and dialysis efficacy on returning to PD. In 9 patients (53.5 ± 15.4 years of age, 5 males and 4 females) who had previously been on PD before early TX failure and had returned to PD (25 ± 23 days, range 10-64) over the last five years, we studied laboratory data including inflammation, nutrition, kidney function, permeability and PD efficacy, at four points during progression: before TX, immediately after returning to PD and after one month and three months on PD. We did not detect significant differences in the progression of nutrition and inflammation parameters. Diuresis decreased significantly from pre-TX volume to diuresis on return to PD and after one month on PD (p=.032), remaining at low levels after three months on PD. UF decreased from 1407 to 951 ml/day (p=.022) and from 314 to 260 ml/4h (p=.018) in the peritoneal equilibration test after three months on PD, without changes being observed in the creatinine dialysate/plasma ratio. Kt/V and weekly creatinine clearance decreased slightly and remained at adequate efficacy levels. In this small sample of patients, who returned to PD after early TX failure, it does not appear that the measures involved in managing a graft at risk over a short period of time have a major effect on clinical parameters and permeability or

  19. Why does three times per week hemodialysis provide inadequate dialysis for children?

    Fischbach, Michel; Zaloszyc, Ariane; Laetitia, Higel; Menouer, Soraya; Terzic, Joelle


    The duration of chronic conventional dialysis is a risk factor in children, both in terms of growth retardation and cardiovascular morbidity and mortality. Therefore, we need to develop alternative strategies, such as preemptive kidney transplantation and/or more intensive dialysis prescription. Indeed, conventional hemodialysis could be improved in all children by the use of high permeable membrane and ultrapure dialysis fluids (having very low endotoxin levels); by the addition of a convective dialysis dose to the urea diffusion dialysis dose (Kt/Vurea), i.e., hemodiafiltration; moreover, by the preservation of cardiovascular morphology and function (optimized blood pressure control); and also by the prescription of more frequent/longer dialysis sessions.

  20. John Dique: dialysis pioneer and political advocate.

    George, Charles R P


    John Dique (1915-1995) epitomized the internationalism of medicine, the intellectual and manual dexterity of many pioneers of dialysis, and the social concern evinced by many nephrologists. Born in Burma of French, German, British and Indian ancestry; educated in India; an Anglo-Indian who described himself as British without ever having visited Britain; he moved to Australia in 1948 to escape the murderous inter-ethnic conflict that befell multicultural India as it and Pakistan became independent. Settling in Brisbane, he pioneered several novel medical techniques. After inventing some simple equipment to facilitate intravenous therapy, he established a neonatal exchange blood transfusion programme. Then, between 1954 and 1963, he personally constructed and operated two haemodialysis machines with which to treat patients suffering from acute renal failure, the first such treatment performed in Australasia. His patients survival results were, for the era, remarkable. He subsequently helped found the Royal Australasian College of Pathologists and went on to establish a successful private pathology practice. The latter years of his life, however, saw him become a social and political advocate. He fiercely opposed the emerging ideologies of multiculturalism and social liberalism that, he predicted, would seriously damage the national fabric of Western society. Public vilification ensued, his medical achievements disregarded. It does seem likely, however, that in none of the areas that he touched - whether medical, social, or political - has the last word yet been said.

  1. Laparoscopic interventions in children on peritoneal dialysis

    Maria Szczepańska


    Full Text Available Introduction: The benefits of peritoneal dialysis (PD are multiple. However, it is connected with the risk of numerouscomplications, both infectious and non-infectious. Laparoscopic interventions in children on PD have seldom been presented.Aim: To analyse laparoscopic interventions in 23 children (mean age 10.2 ±5.2 years treated with PD.Performed procedures (30 included: diagnostic (explorative laparoscopy, laparoscopic replacement of thecatheter and laparoscopic recanalisation of occluded catheter.Results: In 29 cases laparoscopy with reduced invasive procedures was completed. During surgery 5 catheters wereremoved. In 16 cases of catheter malfunction, omental wrap releasing, recanalization and/or reposition was done,including omentectomy in 9 cases. In 6 cases of acute abdomen symptoms, 3 adhesiolysis procedures in bowelobstruction, 2 appendectomies and in 1 case laparoscopic reduction of intussusception were done. There were nointraoperative complications. After surgery PD was continued in 19 children. Catheter survival rate was 261 ±297 days.Conclusion: Laparoscopic surgery had no influence on peritoneal permeability or adequacy of PD treatment.Laparoscopic technique is highly effective in children on PD especially related to catheter malfunction. Itis an excellent option that enables restarting of PD shortly after the surgery.

  2. Application of layered poly (L-lactic acid cell free scaffold in a rabbit rotator cuff defect model

    Inui Atsuyuki


    Full Text Available Abstract Background This study evaluated the application of a layered cell free poly (L-lactic acid (PLLA scaffold to regenerate an infraspinatus tendon defect in a rabbit model. We hypothesized that PLLA scaffold without cultivated cells would lead to regeneration of tissue with mechanical properties similar to reattached infraspinatus without tendon defects. Methods Layered PLLA fabric with a smooth surface on one side and a pile-finished surface on the other side was used. Novel form of layered PLLA scaffold was created by superimposing 2 PLLA fabrics. Defects of the infraspinatus tendon were created in 32 rabbits and the PLLA scaffolds were transplanted, four rabbits were used as normal control. Contralateral infraspinatus tendons were reattached to humeral head without scaffold implantation. Histological and mechanical evaluations were performed at 4, 8, and 16 weeks after operation. Results At 4 weeks postoperatively, cell migration was observed in the interstice of the PLLA fibers. Regenerated tissue was directly connected to the bone composed mainly of type III collagen, at 16 weeks postoperatively. The ultimate failure load increased in a time-dependent manner and no statistical difference was seen between normal infraspinatus tendon and scaffold group at 8 and 16 weeks postoperatively. There were no differences between scaffold group and reattach group at each time of point. The stiffness did not improve significantly in both groups. Conclusions A novel form of layered PLLA scaffold has the potential to induce cell migration into the scaffold and to bridge the tendon defect with mechanical properties similar to reattached infraspinatus tendon model.

  3. Biomechanics of hair cell kinocilia: experimental measurement of kinocilium shaft stiffness and base rotational stiffness with Euler-Bernoulli and Timoshenko beam analysis.

    Spoon, Corrie; Grant, Wally


    Vestibular hair cell bundles in the inner ear contain a single kinocilium composed of a 9+2 microtubule structure. Kinocilia play a crucial role in transmitting movement of the overlying mass, otoconial membrane or cupula to the mechanotransducing portion of the hair cell bundle. Little is known regarding the mechanical deformation properties of the kinocilium. Using a force-deflection technique, we measured two important mechanical properties of kinocilia in the utricle of a turtle, Trachemys (Pseudemys) scripta elegans. First, we measured the stiffness of kinocilia with different heights. These kinocilia were assumed to be homogenous cylindrical rods and were modeled as both isotropic Euler-Bernoulli beams and transversely isotropic Timoshenko beams. Two mechanical properties of the kinocilia were derived from the beam analysis: flexural rigidity (EI) and shear rigidity (kGA). The Timoshenko model produced a better fit to the experimental data, predicting EI=10,400 pN μm(2) and kGA=247 pN. Assuming a homogenous rod, the shear modulus (G=1.9 kPa) was four orders of magnitude less than Young's modulus (E=14.1 MPa), indicating that significant shear deformation occurs within deflected kinocilia. When analyzed as an Euler-Bernoulli beam, which neglects translational shear, EI increased linearly with kinocilium height, giving underestimates of EI for shorter kinocilia. Second, we measured the rotational stiffness of the kinocilium insertion (κ) into the hair cell's apical surface. Following BAPTA treatment to break the kinocilial links, the kinocilia remained upright, and κ was measured as 177±47 pN μm rad(-1). The mechanical parameters we quantified are important for understanding how forces arising from head movement are transduced and encoded by hair cells.

  4. A new method based on Adaptive Discrete Wavelet Entropy Energy and Neural Network Classifier (ADWEENN) for recognition of urine cells from microscopic images independent of rotation and scaling.

    Avci, Derya; Leblebicioglu, Mehmet Kemal; Poyraz, Mustafa; Dogantekin, Esin


    So far, analysis and classification of urine cells number has become an important topic for medical diagnosis of some diseases. Therefore, in this study, we suggest a new technique based on Adaptive Discrete Wavelet Entropy Energy and Neural Network Classifier (ADWEENN) for Recognition of Urine Cells from Microscopic Images Independent of Rotation and Scaling. Some digital image processing methods such as noise reduction, contrast enhancement, segmentation, and morphological process are used for feature extraction stage of this ADWEENN in this study. Nowadays, the image processing and pattern recognition topics have come into prominence. The image processing concludes operation and design of systems that recognize patterns in data sets. In the past years, very difficulty in classification of microscopic images was the deficiency of enough methods to characterize. Lately, it is seen that, multi-resolution image analysis methods such as Gabor filters, discrete wavelet decompositions are superior to other classic methods for analysis of these microscopic images. In this study, the structure of the ADWEENN method composes of four stages. These are preprocessing stage, feature extraction stage, classification stage and testing stage. The Discrete Wavelet Transform (DWT) and adaptive wavelet entropy and energy is used for adaptive feature extraction in feature extraction stage to strengthen the premium features of the Artificial Neural Network (ANN) classifier in this study. Efficiency of the developed ADWEENN method was tested showing that an avarage of 97.58% recognition succes was obtained.

  5. Diαgnostic approaches of peritoneal dialysis in peritonitis

    Alikari V.


    Full Text Available Introduction: Peritonitis is the most important and frequent infectious complication of peritoneal dialysis. It is the most common cause of failure of the method and inclusion of patients in hemodialysis. Purpose: Τhe purpose of this study is to explore the diagnostic approaches of peritoneal dialysis peritonitis. Methods: Literature review of relevant articles in the database Pubmed as well as the official website of the International Society of Peritoneal Dialysis (ISPD was carried out. The search included articles published during 1996-2013. Results: According to the International Society of Peritoneal Dialysis, peritonitis requires the presence of two of the following criteria: (a cloudy peritoneal fluid, (b symptoms of inflammation of the peritoneum and (c the presence of microorganisms in the peritoneal fluid (> 100 leukocytes / μL of the solution of which most (> 50 % are polymorphnuclear. Some rules of sampling peritoneal fluid for culture and Gram staining are important for the right and immediate treatment of peritonitis: a the first cloudy peritoneal bag is the best sample b sending of the first bag for cultures should be done as early as possible in order to begin the appropriate antibiotic therapy. Gram stain, although in most cases is negative, it is particularly useful for the diagnosis of fungal peritonitis. Conclusions: Patient education, mainly of new Peritoneal Dialysis patients, about the early recognizing of cloudy fluids and exit-site infection, must be the primary concern of a Peritoneal Dialysis Unit. Careful use of antibiotics will reduce the frequency of negative cultures in order not to exceed the limit of 20% of the tests, as recommended by the International Society of Peritoneal Dialysis.

  6. Endovascular dialysis interventions in the era of DOQI.

    Greenberg, Joshua I; Suliman, Ahmed; Angle, Niren


    The National Kidney Foundation Dialysis Outcomes and Quality Initiative (DOQI) recommends autogenous fistulae as the preferred access for new dialysis procedures. Unfortunately, despite superior patency rates compared to prosthetic grafts, even autogenous access durability is often undermined by venous stenosis due to intimal hyperplasia at the outflow vein or by central venous stenosis due to long-standing central venous catheters. Salvage interventions, in the form of endovascular treatments such as percutaneous transluminal angioplasty (PTA) and/or stenting, are increasingly utilized for access salvage and maintenance. The objective of this study was to evaluate the efficacy of endovascular dialysis interventions in the era of DOQI. A retrospective review of a database of endovascular interventions for dialysis access during 36 months at an academic medical center was performed. Both central venous and access outflow lesions were included in the analysis. Kaplan-Meier curves and log-rank analysis were used to assess and compare time-dependent variables. Forty-five patients with dialysis access underwent 72 endovascular interventions for access maintenance. There were 27 central venous and 32 outflow endovascular interventions with 98% follow-up. Primary and assisted primary patency rates for outflow balloon PTA were 50% and 72% at 12 months, respectively. There were 1.1 reinterventions required per index outflow PTA procedure. Postintervention primary patency rates for central venous PTA were 30% and 9% at 6 and 12 months, respectively. Postintervention assisted patency for central venous PTA was 100% at 12 months, requiring 1.8 reinterventions per index PTA. Central venous and venous outflow interventions extended overall access patency by 38.5 and 33 months, respectively (p dialysis access. Despite the need for multiple reinterventions and close surveillance, catheter-based interventions positively contribute to dialysis access durability in accordance with

  7. Pathophysiology of the Peritoneal Membrane during Peritoneal Dialysis: The Role of Hyaluronan

    Susan Yung


    Full Text Available During peritoneal dialysis (PD, constant exposure of mesothelial cells to bioincompatible PD solutions results in the denudation of the mesothelial monolayer and impairment of mesothelial cell function. Hyaluronan, a major component of extracellular matrices, is synthesized by mesothelial cells and contributes to remesothelialization, maintenance of cell phenotype, and tissue remodeling and provides structural support to the peritoneal membrane. Chronic peritoneal inflammation is observed in long-term PD patients and is associated with increased hyaluronan synthesis. During inflammation, depolymerization of hyaluronan may occur with the generation of hyaluronan fragments. In contrast to native hyaluronan which offers a protective role to the peritoneum, hyaluronan fragments exacerbate inflammatory and fibrotic processes and therefore assist in the destruction of the tissue. This paper will discuss the contribution of mesothelial cells to peritoneal membrane alterations that are induced by PD and the putative role of hyaluronan in these processes.

  8. Minimal requirements for rotation of bacterial flagella.

    Ravid, S; Eisenbach, M


    An in vitro system of cell envelopes from Salmonella typhimurium with functional flagella was used to determine the minimal requirements for flagellar rotation. Rotation in the absence of cytoplasmic constituents could be driven either by respiration or by an artificially imposed chemical gradient of protons. No specific ionic requirements other than protons (or hydroxyls) were found for the motor function.

  9. Polyclonal gammopathy related to renal bleeding in a peritoneal dialysis patient

    Eun-Mi Cho


    Full Text Available Polyclonal gammopathy represents the diffuse activation of B cells and is usually related to inflammation or immune-related diseases. However, the mechanisms leading to polyclonal gammopathy are essentially speculative. Generally, infectious, inflammatory, or various other reactive processes may be indicated by the presence of a broad-based peak or band in the gamma region on serum protein electrophoresis results. A 15-year-old girl, who had been receiving peritoneal dialysis, presented with polyclonal gammopathy and massive gross hematuria. Renal artery embolization was performed, after which the continuous bleeding subsided and albumin-globulin dissociation resolved. This is a rare case of polyclonal gammopathy related to renal bleeding.

  10. Fast, label-free super-resolution live-cell imaging using rotating coherent scattering (ROCS) microscopy

    Jünger, Felix; Olshausen, Philipp V.; Rohrbach, Alexander


    Living cells are highly dynamic systems with cellular structures being often below the optical resolution limit. Super-resolution microscopes, usually based on fluorescence cell labelling, are usually too slow to resolve small, dynamic structures. We present a label-free microscopy technique, which can generate thousands of super-resolved, high contrast images at a frame rate of 100 Hertz and without any post-processing. The technique is based on oblique sample illumination with coherent light, an approach believed to be not applicable in life sciences because of too many interference artefacts. However, by circulating an incident laser beam by 360° during one image acquisition, relevant image information is amplified. By combining total internal reflection illumination with dark-field detection, structures as small as 150 nm become separable through local destructive interferences. The technique images local changes in refractive index through scattered laser light and is applied to living mouse macrophages and helical bacteria revealing unexpected dynamic processes.

  11. Medium Cut-Off (MCO) Membranes Reduce Inflammation in Chronic Dialysis Patients—A Randomized Controlled Clinical Trial

    Zickler, Daniel; Schindler, Ralf; Willy, Kevin; Martus, Peter; Pawlak, Michael; Storr, Markus; Hulko, Michael; Boehler, Torsten; Glomb, Marcus A.; Liehr, Kristin; Henning, Christian; Templin, Markus; Trojanowicz, Bogusz; Ulrich, Christof; Werner, Kristin; Fiedler, Roman; Girndt, Matthias


    Background To increase the removal of middle-sized uremic toxins a new membrane with enhanced permeability and selectivity, called Medium Cut-Off membrane (MCO-Ci) has been developed that at the same time ensures the retention of albumin. Because many middle-sized substances may contribute to micro-inflammation we hypothesized that the use of MCO-Ci influences the inflammatory state in hemodialysis patients. Methods The randomized crossover trial in 48 patients compared MCO-Ci dialysis to High-flux dialysis of 4 weeks duration each plus 8 weeks extension phase. Primary endpoint was the gene expression of TNF-α and IL-6 in peripheral blood mononuclear cells (PBMCs), secondary endpoints were plasma levels of specified inflammatory mediators and cytokines. Results After four weeks of MCO-Ci the expression of TNF-α mRNA (Relative quantification (RQ) from 0.92 ± 0.34 to 0.75 ± 0.31, -18.5%, pkappa and lambda free light chains, urea and an increase for Lp-PLA2 (PLA2G7) compared to High-flux. Albumin levels dropped significantly after 4 weeks of MCO dialysis but increased after additional 8 weeks of MCO dialysis. Twelve weeks treatment with MCO-Ci was well tolerated regarding the number of (S)AEs. In the extension period levels of CRP, TNF-α-mRNA and IL-6 mRNA remained stable in High-flux as well as in MCO-Ci. Conclusions MCO-Ci dialyzers modulate inflammation in chronic HD patients to a greater extent compared to High-flux dialyzers. Transcription of pro-inflammatory cytokines in peripheral leukocytes is markedly reduced and removal of soluble mediators is enhanced with MCO dialysis. Serum albumin concentrations stabilize after an initial drop. These results encourage further trials with longer treatment periods and clinical endpoints. PMID:28085888

  12. Pediatric Chronic Dialysis in Brazil: Epidemiology and Regional Inequalities.

    Tulio Konstantyner

    Full Text Available There are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and great need for continuous attention of specialized services with high demand for complex and costly procedures.The aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey.A cross-sectional study was performed in a representative sample of dialysis centers (nc = 239 that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708. We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers' leaders.We estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp (95% CI: 14.8-25.3 and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8-8.4. The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3-48.1 and 11.0 (95% CI: 2.8-19.3 cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2-21.4, and in the Northeast region, 3.8 (95% CI: 1.4-6.3 cases pmarp, respectively.Brazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint

  13. Reduction in slow intercompartmental clearance of urea during dialysis

    Bowsher, D.J.; Krejcie, T.C.; Avram, M.J.; Chow, M.J.; Del Greco, F.; Atkinson, A.J. Jr.


    The kinetics of urea and inulin were analyzed in five anesthetized dogs during sequential 2-hour periods before, during, and after hemodialysis. The distribution of both compounds after simultaneous intravenous injection was characterized by three-compartment models, and the total volumes of urea (0.66 +/- 0.05 L/kg) and inulin (0.19 +/- 0.01 L/kg) distribution were similar to expected values for total body water and extravascular space, respectively. Intercompartmental clearances calculated before dialysis were used to estimate blood flows to the fast and slow equilibrating compartments. In agreement with previous results, the sum of these flows was similar to cardiac output, averaging 101% of cardiac output measured before dialysis (range 72% to 135%). Dialysis was accompanied by reductions in the slow intercompartmental clearances of urea (81%) and inulin (47%), which reflected a 90% attenuation in blood flow supplying the slow equilibrating compartments. This was estimated to result in a 10% average reduction in the efficiency with which urea was removed by dialysis (range 2.0% to 16.4%). Mean arterial pressure fell by less than 5% during dialysis, but total peripheral resistance increased by 47% and cardiac output fell by 35%. In the postdialysis period, total peripheral resistance and cardiac output returned toward predialysis values, but blood flow to the slow equilibrating peripheral compartment was still reduced by 80%. These changes parallel activation of the renin-angiotensin system, but further studies are required to establish causality.

  14. Severe defect in clearing postprandial chylomicron remnants in dialysis patients.

    Weintraub, M; Burstein, A; Rassin, T; Liron, M; Ringel, Y; Cabili, S; Blum, M; Peer, G; Iaina, A


    Lipid abnormalities have been suggested as a major cause of the accelerated atherosclerosis and the high incidence of coronary heart disease in chronic renal failure patients. In the present work the postprandial lipoprotein metabolism was studied in chronic dialysis patients with or without fasting hypertriglyceridemia using the vitamin A loading test. This method investigates specifically postprandial lipoprotein metabolism. The determination of vitamin A ester level retinyl palmitate (RP) differentiates the circulating plasma chylomicron and chylomicron remnant fractions from the endogenous VLDL and IDL. Subjects with normal renal function with or without fasting hypertriglyceridemia served as control groups. Dialysis patients have significantly higher level of chylomicron remnants for a more prolonged period of time than controls, irrespective of their fasting triglyceride levels. The area below retinyl palmitate chylomicron remnants curve was 26308 +/- 12422 micrograms/ in the normolipidemic dialysis patients, significantly higher than (6393 +/- 2098 micrograms/; P 21021 +/- 4560 micrograms/, which was higher than 12969 +/- 2215 micrograms/ (P < 0.0001) in the hypertriglyceridemic controls. Moreover, the hypertriglyceridemic dialysis patients had an additional defect in the lipolysis metabolic step, that is, accumulation of chylomicrons in circulation. These findings show a severe defect in postprandial lipoprotein metabolism in chronic renal failure patients. The prolonged exposure of the vascular wall to high chylomicron remnant concentrations might be an important pathogenetic factor in the accelerated atherosclerosis seen in chronic dialysis patients.

  15. TOF-SIMS imaging of protein adsorption on dialysis membrane

    Aoyagi, Satoka; Hayama, Msayo; Hasegawa, Urara; Sakai, Kiyotaka; Hoshi, Takahiro; Kudo, Masahiro


    Time-of-flight secondary ion mass spectrometry (TOF-SIMS) is capable of chemical imaging of proteins on insulated samples such as hollow-fiber dialysis membranes. Albumin loss and a lowering of diffusive permeability caused by protein adsorption on dialysis membranes should be reduced in order to enhance dialysis adequacy of the patients. Bovine serum albumin (BSA)-adsorbed hollow-fiber dialysis membranes were tested in the present study. TOF-SIMS images and spectra of both native membranes and BSA-adsorbed membranes were compared in order to identify secondary ions related to BSA and membranes. Peaks of secondary ions related to BSA and each membrane were selected by means of information theory, and they are characterized by principal component analysis (PCA). Chemical images of BSA adsorption on both native and treated membranes were obtained to find that BSA permeability and interaction between the membranes and BSA definitely depend on the properties of a membrane. TOF-SIMS imaging obtained with information theory is a powerful tool to estimate protein adsorption on the dialysis membranes.

  16. Vitamins in dialysis: who, when and how much?

    Kosmadakis, George; Da Costa Correia, Enrique; Carceles, Odette; Somda, Frederic; Aguilera, Didier


    Despite the significant technical evolution of the blood purification methods, cardiovascular morbidity and mortality in dialysis patients is still several times higher than that observed in the general population. Vitamins are playing a crucial role in multiple key metabolic pathways. Due to multiple factors, dialysis patients present very often hypo- or hypervitaminosis for a broad range of vitamins. Dialysis in the context of renal replacement therapy is associated with a non-physiological potassium-sparing dietetic regime. Additionally, there is a non-selective intradialytic loss of micro- and macronutrients, deranged intracellular kinetics and gastrointestinal malabsorption due to uratemia. Frequent treatment with antibiotics due to infections associated with the acquired uremia-related immunosuppression may derange the vitamin-producing intestinal microflora. Certain agents prescribed in the context of renal failure or other conditions may reduce the absorption of vitamins from the gastrointestinal tract. These factors may deplete a dialysis patient from vitamins, especially the ones with antioxidant activity that may be associated with cardioprotective properties. In other cases, vitamins metabolized and excreted by the kidneys may be accumulated and exert toxic effects. The scope of this paper is to describe the main issues on vitamin therapy in dialysis patients in view of the ever contradictory opinions and practices.

  17. Intermittent Oral Versus Intravenous Alfacalcidol in Dialysis Patients

    Mitwalli Ahmed


    Full Text Available Patients with end-stage renal failure (ESRF on maintenance dialysis, commonly develop secondary hyperparathyroidism and renal osteodystrophy (ROD. Alfacalcidol, taken orally or administered intravenously, is known to reverse these complications. In this study, 19 ESRF patients, who were on dialysis (13 on hemodialysis and six on peritoneal dialysis for longer than six months and having serum parathormone levels at least four times normal and serum calcium less than 2.1 mmol/L, were randomly allocated to treatment with oral or intravenous (i.v. alfacalcidol for a period of 12 months. There were six patients on hemodialysis (HD and three on peritoneal dialysis (PD in the oral treatment group while in the i.v. group there were seven patients on HD and three on PD. Clinical and serial biochemical assessments showed no statistically significant difference between the orally- and i.v.-treated patients in terms of suppressing secondary hyperparathyroidism and osteodystrophy. However, patients with features of mild ROD on bone histology, had more satisfactory changes in biochemistry when compared to others. Our results further support the use of intermittent oral alfacalcidol in ESRF patients because of its cost effectiveness, ease of administration and convenience, especially for peritoneal dialysis patients.

  18. Cooperation and successful outcomes in home dialysis.

    MacElveen, P M; Alexander, R A; Hoover, P M


    Cooperation among those involved in the triad of patient-partner-health professional is associated with desirable patient outcomes and has been demonstrated in 2 studies with consistent results. In the dyad analysis, cooperation between the patient and partner was associated with work and leisure activity. Spouses often encourage and facilitate the patients ability to engage in work and leisure activities and probably can impede activity equally well. The correlations of cooperation in the patient-doctor dyad with physical status and adherence is also of note. Many of the patients who have been on dialysis for several years and are doing well see their doctor for checkups only a few times a year, which might suggest patients' independence of their physicians or at least some distancing due primarily to the infrequency of contacts with each other. On the contrary, the data suggest some that the patient-doctor relationship remains important. Cooperation in the partner-doctor dyad did not relate to any of the patient outcomes; many of the partners and doctors hardly knew each other personally. Whether this is reflected by the data cannot be determined. How accurately triad members perceived each other (mutual perception) was related to adherence and total activity while trust was related to physical status and adherence. Empirical evidence has been presented to support the long held assumption that cooperation among those caring for a patient is associated with selected patient outcomes. The study also provides an alternative to the traditional model for interactions between health care providers and patients, which includes a family member. While the traditional model fits the needs of emergency and acute care situations effectively, the cooperation model is one alternative that may fit the different needs in the long term, self-care, chronic illness situation, which is the greatest health care delivery challenge of today and tommorrow. Patient and family

  19. Effect of sertraline hydrochloride on dialysis hypotension.

    Dheenan, S; Venkatesan, J; Grubb, B P; Henrich, W L


    Hemodialysis hypotension (HH) is a very common disorder and has a multifactorial etiology. Autonomic dysfunction occurs in up to 50% of patients with end-stage renal disease (ESRD) and plays a key role in HH in some patients. Sertraline hydrochloride, a central nervous system serotonin reuptake inhibitor, has been shown to be an effective treatment of hypotension caused by autonomic dysfunction in disorders such as neurocardiogenic syncope and idiopathic orthostatic hypotension. This study sought to determine whether sertraline was effective in ameliorating HH. A retrospective chart analysis was performed that included nine consecutive patients (aged > or = 54 years, time on hemodialysis > or = 2.2 years) placed on sertraline (50 to 100 mg/d) for depression who also had HH (defined as prehemodialysis systolic blood pressure [SBP] or = 40 mm Hg decrease in SBP during hemodialysis, SBP sertraline. The data from a 6-week pre-sertraline period were compared with the data from a 6-week sertraline period (defined as 6 weeks after drug begun). Blood pressure medications were unchanged during the trial period of sertraline. However, nadir mean arterial pressure recorded during a given dialysis session in the pre-sertraline period (55+/-4 mm Hg) was significantly lower than that recorded in the sertraline period (68+/-5 mm Hg; P sertraline period was significantly lower than that during the pre-sertraline period (mean, 0.6+/-0.2 episodes per session v 1.4+/-0.3 episodes per session; P sertraline period was also significantly less than that during the pre-sertraline period (mean, 1.7+/-0.8 interventions v 11.0+/-3.0 interventions; P sertraline hydrochloride reduces HH in some patients with ESRD. A possible mechanism for this effect is sertraline-induced attenuation of the paradoxical sympathetic withdrawal that may underlie HH in some patients with ESRD.


    Mishalov, V G; Zavodovskiy, E S; Markulan, L Yu; Goyda, S M


    The risk factors of the dialysis peritonitis occurrence were determined in patients with chronic renal disease, to whom a substitute renal therapy, using peritoneal dialysis, was conducted. The results of a three-year prospective investigation and treatment of 73 patients in Kyiv City Oleksandrivska Clinical Hospital on the base of the general surgery and nephrology departments in 2007 - 2010 yrs were studied. The dialysis peritonitis (first episode) have occurred in 42 (57.5%) patients. Cumulative rate of a dialysis peritonitis in accordance to a censored data (the dialysis peritonitis suspension or other causes) have constituted 67.7%. Due to the dialysis peritonitis occurrence the peritoneal dialysis was stopped in 14 (19.2%) patients. The obesity, raising of a serum albumin level, constipation, preliminary injection into the site of the catheter exit site we consider a risk factors for the dialysis peritonitis occurrence.

  1. Intraperitoneal heparin reduces peritoneal permeability and increases ultrafiltration in peritoneal dialysis patients

    Sjøland, Jonas Angel; Smith Pedersen, Robert; Jespersen, Jørgen; Gram, Jørgen


    Patients on long-term treatment with peritoneal dialysis (PD) suffer from increasing peritoneal permeability and loss of ultrafiltration as a result of persistent inflammation, which may be triggered by bioincompatible dialysis fluids...

  2. Rotator cuff repair - slideshow

    ... this page: // Rotator cuff repair - series—Normal anatomy To use the sharing ... to slide 4 out of 4 Overview The rotator cuff is a group of muscles and tendons that ...

  3. Predictors of mortality in dialysis patients: Association between malnutrition, inflammation and atherosclerosis (Mia syndrome)


    Introduction Numerous recent studies have shown increased comorbidity and mortality in dialysis patients with malnutrition. Protein-energy malnutrition with muscle wasting occurs in a large proportion of patients with chronic renal failure and is, in addition to atherosclerosis, a strong risk factor for mortality in patients undergoing dialysis. Malnutrition is also associated with increased cardiovascular mortality in dialysis patients. Pathogenic factors of malnutrition in dialysis patients...

  4. Mortality during first hospital admission in a population that begins chronic dialysis in a general hospital

    Herrera Añazco, Percy; Médico Asistente, Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú; Docente de la Facultad de Medicina, Universidad Científica del Sur, Lima, Perú; Docente de la Facultad de Medicina, Universidad Nacional de Piura, Piura, Perú.; Palacios Guillén, Melissa; Médico Asistente, Servicio de Nefrología, Hospital Daniel Alcides Carrión, Lima, Perú; Docente, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Chipayo Gonzales, David; Médico Residente, Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú.; Silveira Chau, Manuela; Médico Asistente, Unidad Médica Empresarial, Clínica Internacional, Lima, Perú.


    The Health Ministry attends Peruvian population without social security and without a national dialysis program. Attention is limited to a few hospitals with dialysis centers. objectives: To determine mortality in the first hospitalization for dialysis in a population without social security. design: Descriptive study. Setting: Hospital Nacional Dos de Mayo, Lima, Peru. Patients: Patients with chronic renal disease. Interventions: We studied patients who started dialysis from January to Decem...

  5. Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

    Jack Kit-Chung Ng


    Full Text Available Background/Aims: Previous studies showed that frailty is prevalent in both pre-dialysis and dialysis patients. However, the prevalence and prognostic implication of frailty in Chinese peritoneal dialysis (PD patients remain unknown. Methods: We used a validated questionnaire to determine the Frailty Score of 193 unselected prevalent PD patients. All patients were then followed for 2 years for their need of hospitalization and mortality. Results: Amongst the 193 patients, 134 (69.4% met the criteria of being frail. Frailty Score significantly correlated with Charlson's comorbidity score (r = 0.40, p Conclusions: Frailty is prevalent among Chinese PD patients. Frail PD patients have a high risk of requiring hospitalization and their hospital stay tends to be prolonged. Early identification may allow timely intervention to prevent adverse health outcomes in this group of patients.

  6. Purification of dialysis fluid: historical background and perspective.

    Ledebo, Ingrid


    When dialysis became a chronic therapy, certain clinical symptoms could be connected to the fluid quality and some form of water treatment had to be introduced. The required equipment was empirically developed and consisted of sedimentation filters, carbon filters and softeners. In the mid-1970s the toxic effect of aluminum accumulation was discovered and led to the introduction of reverse osmosis modules. When these components - prefilters, softeners and RO modules - are properly maintained, they produce water of a quality that should meet modern standards. However, the water quality could be ruined by bacterial contamination from the distribution pipes, unless the entire flow path is hygienically designed and frequently disinfected. The quality of the concentrate is also important, especially the bicarbonate component which is prone to bacterial growth. The extent of the microbiological burden in water and dialysis fluid has been brought to the attention of the dialysis community through new and sensitive detection and quantification methods for bacteria and endotoxin.

  7. Transitions in turbulent rotating convection

    Rajaei, Hadi; Alards, Kim; Kunnen, Rudie; Toschi, Federico; Clercx, Herman; Fluid Dynamics Lab Team


    This study aims to explore the flow transition from one state to the other in rotating Rayleigh-Bènard convection using Lagrangian acceleration statistics. 3D particle tracking velocimetry (3D-PTV) is employed in a water-filled cylindrical tank of equal height and diameter. The measurements are performed at the center and close to the top plate at a Rayleigh number Ra = 1.28e9 and Prandtl number Pr = 6.7 for different rotation rates. In parallel, direct numerical simulation (DNS) has been performed to provide detailed information on the boundary layers. We report the acceleration pdfs for different rotation rates and show how the transition from weakly to strongly rotating Rayleigh-Bènard affects the acceleration pdfs in the bulk and boundary layers. We observe that the shapes of the acceleration PDFs as well as the isotropy in the cell center are largely unaffected while crossing the transition point. However, acceleration pdfs at the top show a clear change at the transition point. Using acceleration pdfs and DNS data, we show that the transition between turbulent states is actually a boundary layer transition between Prandtl-Blasius type (typical of non-rotating convection) and Ekman type.

  8. Morganella morganii Peritonitis Associated with Continuous Ambulatory Peritoneal Dialysis (CAPD) after Colonoscopy.

    Kimura, Yukihiro; Ito, Ayano; Miyamoto, Kanyu; Suga, Norihiro; Miura, Naoto; Kasagi, Tomomichi; Yamagishi, Yuka; Mikamo, Hiroshige; Imai, Hirokazu


    A 79-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and cloudy peritoneal fluid two days after colonoscopy that revealed multiple diverticula. The white blood cell count was 9,000 cells/μL, C-reactive protein level was 6.86 mg/dL, and the white blood cell count of the peritoneal fluid was 7,800 cells/μL, suggesting acute peritonitis. Empiric therapy consisting of cefazolin and ceftazidime slowly improved the patient's symptoms. The initial microbiological examination of the peritoneal fluid demonstrated Morganella morganii. He was changed from CAPD to hemodialysis. It is important to consider M. morganii peritonitis in patients with colonic diverticula.

  9. On Averaging Rotations

    Gramkow, Claus


    In this article two common approaches to averaging rotations are compared to a more advanced approach based on a Riemannian metric. Very offten the barycenter of the quaternions or matrices that represent the rotations are used as an estimate of the mean. These methods neglect that rotations belong...... approximations to the Riemannian metric, and that the subsequent corrections are inherient in the least squares estimation. Keywords: averaging rotations, Riemannian metric, matrix, quaternion...

  10. Identical location transmission electron microscopy in combination with rotating disc electrode measurements. The activity of fuel cell catalysts and their degradation

    Schloegl, Katrin G.


    As an alternative to conventional combustion engines, the Proton Exchange Membrane Fuel Cell (PEMFC) using hydrogen as a fuel is a promising concept owing to its potential independence from fossil fuels, high efficiency and zero emissions. Concerning its commercial viability, the fundamental problem of high system cost per power output and lifetime is closely related to finding more active and stable catalysts for the oxygen reduction reaction. In the presented work, several methods are combined to examine the parameters and processes responsible for both activity and degradation of platinum-based catalysts. Degradation mechanisms are scrutinized by means of electrochemical measurements with the rotating disc electrode in combination with a recently developed TEM technique, which allows for the comparison of identical locations before and after accelerated stress tests. (orig.) [German] Die mit Wasserstoff betriebene Proton Exchange Membrane Brennstoffzelle (PEMFC) stellt aufgrund ihrer potentiellen Unabhaengigkeit von fossilen Energietraegern, ihrem hohen Wirkungsgrad und fehlendem Schadstoffausstoss eine vielversprechende Alternative zum konventionellen Verbrennungsmotor dar. Das grundlegende Problem der zu hohen Systemkosten und zu geringen Lebensdauer fuer kommerzielle Anwendungen ist eng mit der Entwicklung aktiverer und stabiler Elektrokatalysatoren fuer die Sauerstoffreduktion verknuepft. In der vorliegenden Arbeit werden verschiedene Methoden kombiniert, um die Parameter und Prozesse zu untersuchen, welche fuer die Aktivitaet und Degradation platinbasierter Katalysatoren verantwortlich sind. Zur Aufklaerung vorliegender Degradationsmechanismen werden elektrochemische Messungen mit der rotierenden Scheibenelektrode in Kombination mit einer neu entwickelten TEM Methode eingesetzt, welche es ermoeglicht, identische Stellen vor und nach beschleunigten Degradationstests zu untersuchen.

  11. Development and evaluation of a retroperitoneal dialysis porcine model.

    Okhunov, Zhamshid; Yoon, Renai; Perez Lanzac, Alberto; Sgroi, Michael; Lau, Wei Ling; Del Junco, Michael; Ordon, Michael; Drysch, Austin; Hwang, Christina; Vernez, Simone L; Fujitani, Roy; Kabutey, Nii-Kabu; Kalantar-Zadeh, Kamyar; Landman, Jaime


    We attempted to create a surgical model to evaluate the retroperitoneal space for the ability to transfer solutes through the retroperitoneal membrane. Our dual objectives were to develop a technique to assess the feasibility of retroperitoneal dialysis (RPD) in a porcine model. We incorporated two 35-kg Yorkshire pigs for this pilot study. In the first animal, we clamped renal vessels laparoscopically. In the second animal, we embolized renal arteries. In both animals, we dilated the retroperitoneal space bilaterally and deployed dialysis catheters. We measured serum creatinine (Cr), urea, and electrolytes at baseline 6 hours before the dialysis and every 4 hours after. We successfully created retroperitoneal spaces bilaterally and deployed dialysis catheters in both animals. In the first animal, dialysate and plasma Cr ratio (D/P) on the left and right side were 0.43 and 0.3, respectively. Cr clearance by 40 minutes of dialysis treatment was 6.3 mL/min. The ratio of dialysate glucose at 4 hours dwell time to dialysate glucose at 0 dwell time (D/D0) for left/rights sides were 0.02 and 0.02, respectively. kt/Vurea was 0.43. In the second animal, D/P Cr for left/right sides were 0.34 and 0.33, respectively. kt/Vurea was 0.17. We euthanized the pigs due to fluid collection in the peritoneal space and rapid increase of serum Cr, urea, and electrolytes. We demonstrated the feasibility of creation of a functionally anephric porcine model with successful development of retroperitoneal spaces using balloon inflation. Notwithstanding minimal clearance and limited diffusion capacity in this experiment, additional studies are needed to examine potential use of retroperitoneal space for peritoneal dialysis.

  12. Phosphate binding therapy in dialysis patients: focus on lanthanum carbonate

    Ismail A Mohammed


    Full Text Available Ismail A Mohammed, Alastair J HutchisonManchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, UKAbstract: Hyperphosphatemia is an inevitable consequence of end stage chronic kidney disease and is present in the majority of dialysis patients. Recent observational data has associated hyperphosphatemia with increased cardiovascular mortality among dialysis patients. Dietary restriction of phosphate and current dialysis prescription practices are not enough to maintain serum phosphate levels within the recommended range so that the majority of dialysis patients require oral phosphate binders. Unfortunately, conventional phosphate binders are not reliably effective and are associated with a range of limitations and side effects. Aluminium-containing agents are highly efficient but no longer widely used because of well established and proven toxicity. Calcium based salts are inexpensive, effective and most widely used but there is now concern about their association with hypercalcemia and vascular calcification. Sevelamer hydrochloride is associated with fewer adverse effects, but a large pill burden and high cost are limiting factors to its wider use. In addition, the efficacy of sevelamer as a monotherapy in lowering phosphate to target levels in severe hyperphosphatemia remains debatable. Lanthanum carbonate is a promising new non-aluminium, calcium-free phosphate binder. Preclinical and clinical studies have demonstrated a good safety profile, and it appears well tolerated and effective in reducing phosphate levels in dialysis patients. Its identified adverse events are apparently mild to moderate in severity and mostly GI related. It appears to be effective as a monotherapy, with a reduced pill burden, but like sevelamer, it is significantly more expensive than calcium-based binders. Data on its safety profile over 6 years of treatment are now available.Keywords: hyperphosphatemia, lanthanum

  13. Biological Augmentation of Rotator Cuff Tendon Repair

    Kovacevic, David; Rodeo, Scott A


    A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site...

  14. Rotations with Rodrigues' Vector

    Pina, E.


    The rotational dynamics was studied from the point of view of Rodrigues' vector. This vector is defined here by its connection with other forms of parametrization of the rotation matrix. The rotation matrix was expressed in terms of this vector. The angular velocity was computed using the components of Rodrigues' vector as coordinates. It appears…

  15. On Averaging Rotations

    Gramkow, Claus


    In this paper two common approaches to averaging rotations are compared to a more advanced approach based on a Riemannian metric. Very often the barycenter of the quaternions or matrices that represent the rotations are used as an estimate of the mean. These methods neglect that rotations belong...

  16. Timing of dialysis initiation in transplant-naive and failed transplant patients

    Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar


    Over the past two decades, most guidelines have advocated early dialysis initiation on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m2, from 20% in 1996 to 52% in 2008. During this period, patients starting dialysis with an eGFR ≥15 ml/min/1.73 m2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes in patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Dialysis reinitiation in patients with a failing renal allograft encounters similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients. In this Review, we will discuss studies of dialysis initiation and compare risks and benefits of early versus late dialysis therapy. PMID:22371250

  17. 42 CFR 414.330 - Payment for home dialysis equipment, supplies, and support services.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for home dialysis equipment, supplies, and... dialysis equipment, supplies, and support services. Link to an amendment published at 75 FR 49202, Aug. 12..., Medicare pays for home dialysis equipment and supplies only under the prospective payment rates...

  18. 42 CFR 413.186 - Payment exception: Self-dialysis training costs in pediatric facilities.


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment exception: Self-dialysis training costs in....186 Payment exception: Self-dialysis training costs in pediatric facilities. (a) Qualification. To qualify for an exception to the prospective payment rate based on self-dialysis training costs,...

  19. 42 CFR 413.198 - Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.


    ... outpatient maintenance dialysis. 413.198 Section 413.198 Public Health CENTERS FOR MEDICARE & MEDICAID... § 413.198 Recordkeeping and cost reporting requirements for outpatient maintenance dialysis. (a) Purpose... will enable CMS to determine the costs incurred in furnishing outpatient maintenance dialysis...

  20. 42 CFR 410.50 - Institutional dialysis services and supplies: Scope and conditions.


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Institutional dialysis services and supplies: Scope... Medical and Other Health Services § 410.50 Institutional dialysis services and supplies: Scope and... following institutional dialysis services and supplies if they are furnished in approved ESRD facilities:...

  1. Changes of serum leptin levels and the influential factors in peritoneal dialysis patients



    Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients.Methods Seventy-six peritoneal dialysis patients were chosen at the time before,and 3months,6 months,12 months,18 months and 24months after they began the peritoneal dialysis therapy,to examine body mass index(BMI),

  2. Fibrin glue used successfully in peritoneal dialysis catheter leakage in children.

    Rusthoven, E.; Kar, N.C.A.J. van de; Monnens, L.A.H.; Schröder, C.H.


    BACKGROUND: Acute renal failure in infants and small children is generally treated with peritoneal dialysis (PD). Dialysis has to be started immediately after catheter implantation. Early dialysate leakage can complicate the effectiveness of dialysis. Fibrin glue applied to the external part of the

  3. A new paradigm: home therapy for patients who start dialysis in an unplanned way.

    Lecouf, Angelique; Ryckelynck, Jean-Philippe; Ficheux, Maxence; Henri, Patrick; Lobbedez, Thierry


    Starting dialysis in a non-planned manner or in a 'suboptimal' manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow-up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in-centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD). This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home-based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long-term). This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre-dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  4. Fibrin glue used successfully in peritoneal dialysis catheter leakage in children.

    Rusthoven, E.; Kar, N.C.A.J. van de; Monnens, L.A.H.; Schröder, C.H.


    BACKGROUND: Acute renal failure in infants and small children is generally treated with peritoneal dialysis (PD). Dialysis has to be started immediately after catheter implantation. Early dialysate leakage can complicate the effectiveness of dialysis. Fibrin glue applied to the external part of the

  5. Differences in survival on chronic dialysis treatment between ethnic groups in Denmark

    van den Beukel, Tessa O.; Hommel, Kristine; Kamper, Anne-Lise


    Background In Western countries, black and Asian dialysis patients experience better survival compared with white patients. The aim of this study is to compare the survival of native Danish dialysis patients with that of dialysis patients originating from other countries and to explore the associ...

  6. Peritoneal transport mechanisms and their application during peritoneal dialysis in children

    Rusthoven, Esther


    Introduction - Peritoneal dialysis takes an important place as a treatment modality for children with chronic renal failure. This dialysis modality has important advantages compared to hemodialysis: it allows children of all ages to receive dialysis at home with the subsequent experience of a more n

  7. Clinical research: making it work in the outpatient dialysis facility.

    Doss, Sheila; Schiller, Brigitte; Fox, Rosemary; Moran, John


    Performing clinical research in the outpatient dialysis facility can be very challenging. Research protocols define time-specific and detailed procedures to be performed. In dialysis units where staff members are responsible for the delivery of life-sustaining therapy to an aging end stage renal disease patient population with multiple co-morbidities, these requirements can easily be considered too burdensome to be implemented successfully. In the authors'facility, clinical research has been successfully implemented with a close team approach supported by a dedicated research group and unit staff

  8. Salmon calcitonin in prevention of osteoporosis in maintenance dialysis patients

    WANG Shi-xiang; LI Han


    Background Renal osteodystrophy is one of the commonest complications of chronic renal failure. It may have a severe impact on the quality of life of patients on maintenance dialysis therapy. Besides post-menopausal women and elderly people, the dialysis patients are another high risk group. But at present, there is no research on how to prevent osteoporosis in maintenance dialysis patients. This study was conducted to observe the bone density of maintenance dialysis patients and to evaluate the clinical outcomes and safety of different administration dosage of salmon calcitonin to prevent osteoporosis in maintenance dialysis patients.Methods One hundred and forty-eight patients on maintenance dialysis were involved in the 12-month, randomized, controlled trial. Fifty patients (experiment Ⅰ group) received subcutaneous injection of salmon calcitonin (50 U) three times a week for 12 months. Fifty patients (experiment Ⅱ group) received subcutaneous injection of salmon calcitonin (100 U) three times a week for 12 months. At the same time, both of them received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The control group only received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The levels of bone mass density (BMD) of the lumbar spine and femoral neck, serum intact parathyroid hormone (iPTH), osteocatcin (OC), calcium, phosphorus, alkaline phosphatase (ALP) were assessed at baseline and then again after 3, 6 and 12 months of treatment.Results The values of BMD at the lumbar spine and femoral neck before the treatment were not significantly different from those 3, 6, and 12 months after the treatment in trial groups I and II (all P >0.05) and there were no significant differences in the BMD values at different time points between trial groups I and I1. In the control group, the BMD values at the lumbar spine and femoral neck 3, 6, and 12 months after the beginning of trial were significantly lower than

  9. Fate of patients during the first year of dialysis

    Selma Siham El Khayat


    Full Text Available Care in dialysis is often associated with significant morbidity and mortality during the first year. Knowledge of its magnitude and causes could improve the prognosis of these patients. The aim of this study was to evaluate the survival and morbidity during the first year of dialysis for patients who initiated their dialysis between January 1, 2009 and December 31, 2009 and to study their possible correlation with baseline status at the beginning of treatment. A multi-center retrospective study was conducted in 11 dialysis centers. Clinical data at the beginning of dialysis and during the following year were collected. Mortality and morbidity risk factors were assessed by comparing different groups. Statistical analysis was performed with SPSS version 11. This study involved 134 patients, 79 men and 55 women, of whom 132 were on hemodialysis and two patients were on peritoneal dialysis. The mean age at initiation of treatment was 54.37 ± 18.09 years. Initial causes of nephropathy were dominated by diabetes (44.02% and hypertension (11.19%. Among these patients, 39.55% had never received prior nephrological follow-up and 64.92% had started renal replacement therapy on an emergency basis. The initial clinical state was dominated by the presence of hypertension (50.74%, diabetes (44.02%, coronary insufficiency (13.43% and heart failure (7.46%. Only 26.86% of the incident patients showed no comorbidity. During the first year of follow-up, 37.31% of the patients experienced at least one episode of comorbidity. Hospitalization was necessary in about half of these cases (17.91% of all patients. The overall mortality rate was 14.17%. One patient received a kidney transplant. The mortality rate in the first year of dialysis was lower in our study than in other series. Regular nephrological follow-up of these patients before they reach end-stage could have a significant influence on survival in dialysis.

  10. Patients in assisted automated peritoneal dialysis develop strategies for selfcare

    Holch, Kirsten

    Henderson's areas of need and Dorothea Orem's self - care theory combined with problems and symptoms in End Stage Renal Disease (ESRD) patients. Results The results showed that patients in their own home improve their self-care capacity in the period between three and six months after starting AAPD......  Patients in Assisted Automated Peritoneal Dialysis develop strategies for self-care Background: Since 2000 a model for Assisted Automated Peritoneal Dialysis (AAPD) in the patients own home has been developed at Aarhus University Hospital, Skejby. The patient group consists of physically...

  11. Tsukamurella peritonitis associated with continuous ambulatory peritoneal dialysis.

    Shaer, A J; Gadegbeku, C A


    A case of Tsukamurella peritonitis associated with peritoneal dialysis in a 23-year-old woman is described. The organism was difficult to identify and was mistaken for Corynebacterium and atypical mycobacteria. Despite prolonged, multidrug, antimicrobial therapy with conventional antibiotics including vancomycin, ciprofloxacin, rifampin, gentamicin and ceftazidime, catheter removal was required to successfully treat peritonitis. Human infection due to this organism is rare and has been previously reported in only 13 cases, 1 of which was peritonitis. We describe here the second case of Tsukamurella peritonitis associated with peritoneal dialysis.

  12. Assessment and Management of Hypertension in Patients on Dialysis

    Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.


    Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

  13. A Patient on Peritoneal Dialysis with Refractory Volume Overload


    The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status. It requires sequential evaluation of volume status and adjustment of the peritoneal dialysis prescription on the basis of assessments of membrane function and alterations in urine volume. Steps should be taken to preserve residual renal function for as long as possible. Ultimately, in patients who have become anuric and have developed ultrafiltration failure, timely transfer to hemodialysis may be necessary, requiring discussion and planning with the patient. PMID:26185264

  14. Effects of gasket on coupled plastic flow and strain-induced phase transformations under high pressure and large torsion in a rotational diamond anvil cell

    Feng, Biao; Levitas, Valery I.


    Combined plastic flow and strain-induced phase transformations (PTs) under high pressure in a sample within a gasket subjected to three dimensional compression and torsion in a rotational diamond anvil cell (RDAC) are studied using a finite element approach. The results are obtained for the weaker, equal-strength, and stronger high-pressure phases in comparison with low-pressure phases. It is found that, due to the strong gasket, the pressure in the sample is relatively homogenous and the geometry of the transformed zones is mostly determined by heterogeneity in plastic flow. For the equal-strength phases, the PT rate is higher than for the weaker and stronger high-pressure phases. For the weaker high-pressure phase, transformation softening induces material instability and leads to strain and PT localization. For the stronger high-pressure phase, the PT is suppressed by strain hardening during PT. The effect of the kinetic parameter k that scales the PT rate in the strain-controlled kinetic equation is also examined. In comparison with a traditional diamond anvil cell without torsion, the PT progress is much faster in RDAC under the same maximum pressure in the sample. Finally, the gasket size and strength effects are discussed. For a shorter and weaker gasket, faster plastic flow in radial and thickness directions leads to faster PT kinetics in comparison with a longer and stronger gasket. The rates of PT and plastic flows are not very sensitive to the modest change in a gasket thickness. Multiple experimental results are reproduced and interpreted. Obtained results allow one to design the desired pressure-plastic strain loading program in the experiments for searching new phases, reducing PT pressure by plastic shear, extracting kinetic properties from experiments with heterogeneous fields, and controlling homogeneity of all fields and kinetics of PTs.

  15. The Different Association between Serum Ferritin and Mortality in Hemodialysis and Peritoneal Dialysis Patients Using Japanese Nationwide Dialysis Registry.

    Maruyama, Yukio; Yokoyama, Keitaro; Yokoo, Takashi; Shigematsu, Takashi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu


    Monitoring of serum ferritin levels is widely recommended in the management of anemia among patients on dialysis. However, associations between serum ferritin and mortality are unclear and there have been no investigations among patients undergoing peritoneal dialysis (PD). Baseline data of 191,902 patients on dialysis (age, 65 ± 13 years; male, 61.1%; median dialysis duration, 62 months) were extracted from a nationwide dialysis registry in Japan at the end of 2007. Outcomes, such as one-year mortality, were then evaluated using the registry at the end of 2008. Within one year, a total of 15,284 (8.0%) patients had died, including 6,210 (3.2%) cardiovascular and 2,707 (1.4%) infection-related causes. Higher baseline serum ferritin levels were associated with higher mortality rates among patients undergoing hemodialysis (HD). In contrast, there were no clear associations between serum ferritin levels and mortality among PD patients. Multivariate Cox regression analysis of HD patients showed that those in the highest serum ferritin decile group had higher rates of all-cause and cardiovascular mortality than those in the lowest decile group (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.31-1.81 and HR, 1.44; 95% CI, 1.13-1.84, respectively), whereas associations with infection-related mortality became non-significant (HR, 1.14; 95% CI, 0.79-1.65). Using Japanese nationwide dialysis registry, higher serum ferritin values were associated with mortality not in PD patients but in HD patients.

  16. Predictors of human rotation.

    Stochl, Jan; Croudace, Tim


    Why some humans prefer to rotate clockwise rather than anticlockwise is not well understood. This study aims to identify the predictors of the preferred rotation direction in humans. The variables hypothesised to influence rotation preference include handedness, footedness, sex, brain hemisphere lateralisation, and the Coriolis effect (which results from geospatial location on the Earth). An online questionnaire allowed us to analyse data from 1526 respondents in 97 countries. Factor analysis showed that the direction of rotation should be studied separately for local and global movements. Handedness, footedness, and the item hypothesised to measure brain hemisphere lateralisation are predictors of rotation direction for both global and local movements. Sex is a predictor of the direction of global rotation movements but not local ones, and both sexes tend to rotate clockwise. Geospatial location does not predict the preferred direction of rotation. Our study confirms previous findings concerning the influence of handedness, footedness, and sex on human rotation; our study also provides new insight into the underlying structure of human rotation movements and excludes the Coriolis effect as a predictor of rotation.

  17. The impact of patient preference on dialysis modality and hemodialysis vascular access.

    Keating, Patrick T; Walsh, Michael; Ribic, Christine M; Brimble, Kenneth Scott


    Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), is associated with improved health related quality of life and reduced health resource costs. It is uncertain to what extent initial preferences for dialysis modality influence the first dialysis therapy actually utilized. We examined the relationship between initial dialysis modality choice and first dialysis therapy used. Patients with chronic kidney disease (CKD) from a single centre who started dialysis after receiving modality education were included in this study. Multivariable logistic regression models were constructed to assess the independent association of patient characteristics and initial dialysis modality choice with actual dialysis therapy used and starting hemodialysis (HD) with a central venous catheter (CVC). Of 299 eligible patients, 175 (58.5%) initially chose a home-based therapy and 102 (58.3%) of these patients' first actual dialysis was a home-based therapy. Of the 89 patients that initially chose facility-based HD, 84 (94.4%) first actual dialysis was facility-based HD. The adjusted odds ratio (OR) for first actual dialysis as a home-based therapy was 29.0 for patients intending to perform PD (95% confidence interval [CI] 10.7-78.8; p dialysis was HD, an initial choice of PD or not choosing a modality was associated with an increased risk of starting dialysis with a CVC (adjusted OR 3.73, 95% CI 1.51-9.21; p = 0.004 and 4.58, 95% CI 1.53-13.7; p = 0.007, respectively). Although initially choosing a home-based therapy substantially increases the probability of the first actual dialysis being home-based, many patients who initially prefer a home-based therapy start with facility-based HD. Programs that continually re-evaluate patient preferences and reinforce the values of home based therapies that led to the initial preference may improve home-based therapy uptake and improve preparedness for starting HD.

  18. Deciphering the Contribution of Biofilm to the Pathogenesis of Peritoneal Dialysis Infections: Characterization and Microbial Behaviour on Dialysis Fluids

    Sampaio, Joana; Machado, Diana; Gomes, Ana Marta; Machado, Idalina; Santos, Cledir; Lima, Nelson; Carvalho, Maria João; Cabrita, António


    Infections are major complications in peritoneal dialysis (PD) with a multifactorial etiology that comprises patient, microbial and dialytic factors. This study aimed at investigating the contribution of microbial biofilms on PD catheters to recalcitrant infections and their interplay with PD related-factors. A prospective observational study was performed on 47 patients attending Centro Hospitalar of Porto and Vila Nova de Gaia/Espinho to whom the catheter was removed due to infectious (n = 16) and non-infectious causes (n = 31). Microbial density on the catheter was assessed by culture methods and the isolated microorganisms identified by matrix-assisted laser desorption/ionization time-of-flight intact cell mass spectrometry. The effect of conventional and three biocompatible PD solutions on 16 Coagulase Negative Staphylococci (CNS) and 10 Pseudomonas aeruginosa strains planktonic growth and biofilm formation was evaluated. Cultures were positive in 87.5% of the catheters removed due infectious and 90.3% removed due to non-infectious causes. However, microbial yields were higher on the cuffs of catheters removed due to infection vs. non-infection. Staphylococci (CNS and Staphylococcus aureus) and P. aeruginosa were the predominant species: 32% and 20% in the infection and 43.3% and 22.7% in the non-infection group, respectively. In general, PD solutions had a detrimental effect on planktonic CNS and P. aeruginosa strains growth. All strains formed biofilms in the presence of PD solutions. The solutions had a more detrimental effect on P. aeruginosa than CNS strains. No major differences were observed between conventional and biocompatible solutions, although in icodextrin solution biofilm biomass was lower than in bicarbonate/lactate solution. Overall, we show that microbial biofilm is universal in PD catheters with the subclinical menace of Staphylococci and P. aeruginosa. Cuffs colonization may significantly contribute to infection. PD solutions differentially

  19. Deciphering the Contribution of Biofilm to the Pathogenesis of Peritoneal Dialysis Infections: Characterization and Microbial Behaviour on Dialysis Fluids.

    Joana Sampaio

    Full Text Available Infections are major complications in peritoneal dialysis (PD with a multifactorial etiology that comprises patient, microbial and dialytic factors. This study aimed at investigating the contribution of microbial biofilms on PD catheters to recalcitrant infections and their interplay with PD related-factors. A prospective observational study was performed on 47 patients attending Centro Hospitalar of Porto and Vila Nova de Gaia/Espinho to whom the catheter was removed due to infectious (n = 16 and non-infectious causes (n = 31. Microbial density on the catheter was assessed by culture methods and the isolated microorganisms identified by matrix-assisted laser desorption/ionization time-of-flight intact cell mass spectrometry. The effect of conventional and three biocompatible PD solutions on 16 Coagulase Negative Staphylococci (CNS and 10 Pseudomonas aeruginosa strains planktonic growth and biofilm formation was evaluated. Cultures were positive in 87.5% of the catheters removed due infectious and 90.3% removed due to non-infectious causes. However, microbial yields were higher on the cuffs of catheters removed due to infection vs. non-infection. Staphylococci (CNS and Staphylococcus aureus and P. aeruginosa were the predominant species: 32% and 20% in the infection and 43.3% and 22.7% in the non-infection group, respectively. In general, PD solutions had a detrimental effect on planktonic CNS and P. aeruginosa strains growth. All strains formed biofilms in the presence of PD solutions. The solutions had a more detrimental effect on P. aeruginosa than CNS strains. No major differences were observed between conventional and biocompatible solutions, although in icodextrin solution biofilm biomass was lower than in bicarbonate/lactate solution. Overall, we show that microbial biofilm is universal in PD catheters with the subclinical menace of Staphylococci and P. aeruginosa. Cuffs colonization may significantly contribute to infection. PD solutions

  20. Structural Analysis of N- and O-glycans Using ZIC-HILIC/Dialysis Coupled to NMR Detection

    Qu, Yi; Feng, Ju; Deng, Shuang; Cao, Li; Zhang, Qibin; Zhao, Rui; Zhang, Zhaorui; Jiang, Yuxuan; Zink, Erika M.; Baker, Scott E.; Lipton, Mary S.; Pasa-Tolic, Ljiljana; Hu, Jian Z.; Wu, Si


    Protein glycosylation, an important and complex post-translational modification (PTM), is involved in various biological processes including the receptor-ligand and cell-cell interaction, and plays a crucial role in many biological functions. However, little is known about the glycan structures of important biological complex samples, and the conventional glycan enrichment strategy (i.e., size-exclusion column [SEC] separation,) prior to nuclear magnetic resonance (NMR) detection is time-consuming and tedious. In this study, we employed SEC, Zwitterionic hydrophilic interaction liquid chromatography (ZIC-HILIC), and ZIC-HILIC coupled with dialysis strategies to enrich the glycopeptides from the pronase E digests of RNase B, followed by NMR analysis of the glycoconjugate. Our results suggest that the ZIC-HILIC enrichment coupled with dialysis is the most efficient, which was thus applied to the analysis of biological complex sample, the pronase E digest of the secreted proteins from the fungi Aspergillus niger. The NMR spectra revealed that the secreted proteins from A. niger contain both N-linked glycans with a high-mannose core and O-linked glycans bearing mannose and glucose with 1->3 and 1->6 linkages. In all, our study provides compelling evidence that ZIC-HILIC separation coupled to dialysis is superior to the commonly used SEC separation to prepare glycopeptides for the downstream NMR analysis, which could greatly facilitate the future NMR-based glycoproteomics research.

  1. Preventive effect of continuous quality improvement on the malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly peritoneal dialysis patients



    Objective To investigate the preventive effect of continuous quality improvement (CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving

  2. Electroencephalogram investigations of the disequilibrium syndrome during bicarbonate and acetate dialysis.

    Hampl, H; Klopp, H W; Michels, N; Mahiout, A; Schilling, H; Wolfgruber, M; Schiller, R; Hanefeld, F; Kessel, M


    Continuous long-time electroencephalographic (EEG) monitoring was performed during acetate and bicarbonate dialysis in 20 patients. Persisting normal basic activity of the EEG without neurological symptoms was found only during the course of bicarbonate dialysis. However, in acetate dialysis, during the decrease of arterial CO2 tension (PaCO2), we registered EEG disturbances with moderate to severe slowing, dysrhythmic activity and high voltage discharges. The decrease in PaCO2 and the deterioration in EEG activity in the patients during acetate dialysis was concomitant with severe neurological alterations, e.g. the typical symptoms of so-called 'disequilibrium' causing a cessation of dialysis in three patients.

  3. Peritoneal dialysis in an ageing population: a 10-year experience.

    Smyth, Andrew


    Chronic kidney disease (CKD) is becoming increasingly prevalent and there are increasing numbers of older patients with advanced CKD. Peritoneal dialysis (PD) is a potential treatment. This study aims to compare PD outcomes in age-defined populations in the largest PD centre in the Republic of Ireland over 10 years.

  4. The Dialysis Exercise: A Clinical Simulation for Preclinical Medical Students.

    And Others; Bernstein, Richard A.


    A clinical decision-making simulation that helps students understand the relationship between psychosocial factors and medical problem-solving is described. A group of medical students and one faculty member comprise a selection committee to agree on the order in which four patients will be selected for renal dialysis. (MLW)

  5. Causes for Withdrawal in an Urban Peritoneal Dialysis Program

    Biruh Workeneh


    Full Text Available Background. Peritoneal dialysis (PD is an underutilized dialysis modality in the United States, especially in urban areas with diverse patient populations. Technique retention is a major concern of dialysis providers and might influence their approach to patients ready to begin dialysis therapy. Methods. Records from January 2009 to March 2014 were abstracted for demographic information, technique duration, and the reasons for withdrawal. Results. The median technique survival of the 128 incident patients during the study window was 781 days (2.1 years. The principle reasons for PD withdrawal were repeated peritonitis (30%; catheter dysfunction (18%; ultrafiltration failure (16%; patient choice or lack of support (16%; or hernia, leak, or other surgical complications (6%; and a total of 6 patients died during this period. Of the patients who did not expire and were not transplanted, most transferred to in-center hemodialysis and 8% transitioned to home-hemodialysis. Conclusions. Our findings suggest measures to ensure proper catheter placement and limiting infectious complications should be primary areas of focus in order to promote technique retention. Lastly, more focused education about home-hemodialysis as an option may allow those on PD who are beginning to demonstrate signs of technique failure to stay on home therapy.

  6. Relative survival of peritoneal dialysis and haemodialysis patients

    Heaf, James G; Wehberg, Sonja


    INTRODUCTION: Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was perfor...


    Baillie, Jessica; Lankshear, Annette


    Internationally, increasing numbers of patients are requiring treatment for end-stage kidney disease and greater use of peritoneal dialysis is thus being promoted. However, peritonitis can be a significant problem in this population. It is the leading cause of technique failure in patients using peritoneal dialysis and results in considerable morbidity and mortality. There is a dearth of research exploring patients' and their families' experiences of peritonitis. The aim of this paper is to explore patients' and their families' perspectives and experiences of peritonitis. An ethnographic study was conducted in 2011 in the United Kingdom. Sixteen patients and nine of their relatives were recruited through purposive and convenience sampling. In-depth interviews were undertaken with patients and their families, who were also observed using peritoneal dialysis in their homes. The data were analysed thematically using Wolcott's (1994) three-stage approach. This article describes four themes: learning about the risk of peritonitis; measures taken to prevent the infection; how participants monitored continuously for signs and symptoms of the infection; how they then identified and intervened once peritonitis was suspected. Overall, peritonitis was associated with fear and uncertainty, pain and learning from episodes of the infection. Overall, peritonitis was a distressing experience that participants sought to prevent. However, there was some confusion amongst participants about the signs and symptoms of the infection and further education for patients and their families is thus crucial. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  8. [Technological advances and micro-inflammation in dialysis patients].

    Ferro, Giuseppe; Ravaglia, Fiammetta; Ferrari, Elisa; Romoli, Elena; Michelassi, Stefano; Caiani, David; Pizzarelli, Francesco


    As currently performed, on line hemodiafiltration reduces, but does not normalize, the micro-inflammation of uremic patients. Recent technological advances make it possible to further reduce the inflammation connected to the dialysis treatment. 
Short bacterial DNA fragments are pro-inflammatory and can be detected in the dialysis fluids. However, their determination is not currently within normal controls of the quality of the dialysate. The scenario may change once the analysis of these fragments yields reliable, inexpensive, quick and easy to evaluate the results. At variance with standard bicarbonate dialysate, Citrate dialysate induces far less inflammation both for the well-known anti-inflammatory effect of such buffer and also because it is completely acetate free, e.g. a definitely pro-inflammatory buffer. However, the extensive use of citrate dialysate in chronic dialysis is prevented because of concerns about its potential calcium lowering effect. In our view, high convective exchange on line hemodiafiltration performed with dialysate, whose sterility and a-pirogenicity is guaranteed by increasingly sophisticated controls and with citrate buffer whose safety is certified, can serve as the gold standard of dialysis treatments in future.

  9. Continuous ambulatory peritoneal dialysis: Nurses′ experiences of teaching patients

    Amnah Shubayra


    In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.


    Investigation of Serum Microcystin Concentrations Among Dialysis Patients, Brazil, 1996Elizabeth D. Hilborn 1, Wayne W. Carmichael 2, Sandra M.F.O. Azevedo 31- USEPA/ORD/NHEERL, Research Triangle Park, NC2- Wright State University, Dayton, OH3- Federal Univers...

  11. Prevention of access-related infection in dialysis.

    Barraclough, Katherine A; Hawley, Carmel M; Playford, E Geoffrey; Johnson, David W


    Access-related infections (ARIs), such as exit-site infections, tunnel infections, bacteremia, fungemia and peritonitis, are the Achilles' heel of dialysis, and contribute significantly to morbidity, mortality and excess healthcare costs in hemodialysis and peritoneal dialysis patient populations. Despite international guidelines recommending the avoidance of catheters for hemodialysis access, hospital admissions for vascular ARIs have doubled in the last decade. Moreover, repeated use of antibiotics to treat ARIs has been associated with the selection of multiresistant organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. ARIs result from direct inoculation of skin organisms during access cannulation/connection, migration of skin organisms along dialysis catheters into the bloodstream or peritoneal cavity, or contamination and colonization of catheter lumens with subsequent biofilm formation. This paper will review the epidemiology, pathogenesis and prevention of ARIs. It will focus specifically on randomized, controlled trial evidence in relation to the safety and efficacy of aseptic techniques, nasal eradication of S. aureus, oral antimicrobial prophylaxis, topical antimicrobial prophylaxis (including disinfectants, antibiotics and antibacterial honey), antimicrobial catheter lock solutions (including gentamicin, citrate and ethanol), antimicrobial-impregnated catheters, catheter design (straight vs coiled, single vs double cuff), peritoneal dialysis catheter connectology, catheter insertion technique, germicidal devices, vaccines and preinsertion antibiotic prophylaxis.

  12. Capnocytophaga cynodegmi peritonitis in a peritoneal dialysis patient

    Pers, Charlotte; Tvedegaard, Erling; Christensen, Jens Jørgen


    The first reported case of peritonitis caused by Capnocytophaga cynodegmi is presented. The patient was treated with peritoneal dialysis and had contact with a cat. C. cynodegmi is part of the normal oral flora of dogs and cats but is very rarely isolated in clinical specimens from humans....

  13. Sonographic detection of a radiolucent object in dialysis vascular access.

    Tanemoto, Masayuki; Higaki, Masato; Amano, Keiko; Toyoki, Daigo; Arai, Shigeyuki; Tomioka, Satoru; Uchida, Shunya


    Percutaneous endovascular angioplasty is a valuable tool to salvage dialysis vascular access failure, but is accident-prone if performed by unskilled operators. We report a case of vascular access failure caused by the plastic protective tube of a balloon catheter, which had been mistakenly left in the vasculature and was undetectable on radiography but was detected by ultrasonography. © 2014 Wiley Periodicals, Inc.

  14. Estimating residual kidney function in dialysis patients without urine collection.

    Shafi, Tariq; Michels, Wieneke M; Levey, Andrew S; Inker, Lesley A; Dekker, Friedo W; Krediet, Raymond T; Hoekstra, Tiny; Schwartz, George J; Eckfeldt, John H; Coresh, Josef


    Residual kidney function contributes substantially to solute clearance in dialysis patients but cannot be assessed without urine collection. We used serum filtration markers to develop dialysis-specific equations to estimate urinary urea clearance without the need for urine collection. In our development cohort, we measured 24-hour urine clearances under close supervision in 44 patients and validated these equations in 826 patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. For the development and validation cohorts, median urinary urea clearance was 2.6 and 2.4 ml/min, respectively. During the 24-hour visit in the development cohort, serum β-trace protein concentrations remained in steady state but concentrations of all other markers increased. In the validation cohort, bias (median measured minus estimated clearance) was low for all equations. Precision was significantly better for β-trace protein and β2-microglobulin equations and the accuracy was significantly greater for β-trace protein, β2-microglobulin, and cystatin C equations, compared with the urea plus creatinine equation. Area under the receiver operator characteristic curve for detecting measured urinary urea clearance by equation-estimated urinary urea clearance (both 2 ml/min or more) were 0.821, 0.850, and 0.796 for β-trace protein, β2-microglobulin, and cystatin C equations, respectively; significantly greater than the 0.663 for the urea plus creatinine equation. Thus, residual renal function can be estimated in dialysis patients without urine collections.

  15. Flow-through microsensor array based on semipermeable dialysis tubing

    Bohm, Sebastian; Olthuis, Wouter; Bergveld, Piet


    In this contribution, a flow-through potentiometric micro sensor is described which is based on semi-permeable tubing. Basically the proposed ion selective electrodes are of the liquid membrane type having an internal electrolyte. Sensors were constructed by guiding 0.3 mm diameter dialysis tube from an artificial kidney through a cavity, precision machined in PerspexTM.

  16. Bone alkaline phosphatase and mortality in dialysis patients

    C. Drechsler; M. Verduijn; S. Pilz; R.T. Krediet; F.W. Dekker; C. Wanner; M. Ketteler; E.W. Boeschoten; V. Brandenburg


    Serum alkaline phosphatase (AP) is associated with vascular calcification and mortality in hemodialysis patients, but AP derives from various tissues of origin. The aim of this study was to assess the effect of bone-specific AP (BAP) on morbidity and mortality in dialysis patients. From a prospectiv

  17. Dialysis facility joint ventures--current structures and issues.

    Riley, James B; Pristave, Robert


    With the ongoing consolidation of the health care industry, including renal care, providers and physicians alike are using joint ventures as a means to partner on business transactions. This article discusses the expanding use of joint ventures in health care, including the dialysis industry, and looks at the types of structures being utilized and key legal concerns relating to such structures and issues.

  18. Intraperitoneal treatment with darbepoetin for children on peritoneal dialysis.

    Rijk, Y.; Raaijmakers, R.; Kar, N.C.A.J. van de; Schroder, C.


    To determine the efficacy and safety of intraperitoneal administration of darbepoetin in children with renal anemia on peritoneal dialysis, we conducted a single-arm, retrospective, two-centre study in which children were treated with intraperitoneal darbepoetin at the end of nightly intermittent

  19. Non Infectious Complications of Continuous Ambulatory Peritoneal Dialysis

    K. Flayou


    Full Text Available Introduction: Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study is to evaluate the prevalence and outcome of complications in patients treated with peritoneal dialysis at our center. Material and methods: A retrospective study between January 2007 and February 2015 at the nephrology, dialysis and renal transplantation department of Ibn Sina university. Predisposing factors and long-term outcomes were analyzed. Results: Fifty two mechanical complications were noted among thirty eight patients between June 2007 and February 2015. Migration was the most common (23 cases followed by obstruction, hernia and dialysate leakes in respectively 9, 7 and 6 cases. We have also noted 2 cases of hemoperitoneum, 3 catheter perforation and 2 cases of externalization. Onset time of complications was 25,4 ± 12,7 months. Conclusion: this study proves the interest of the prevention of mechanical complications in peritoneal dialysis. This requires a periodic retraining of patients and caregivers.

  20. [Clinical characteristics and indicators of care of dialysis patients].

    Kolko, A; Hannedouche, T; Couchoud, C


    This chapter provides a set of indicators on patients treated by dialysis at December the 31th 2011. Even if ESRD is found in all classes of age, elders account for the great majority of the patients undergoing dialysis (median age: 70.4 years). These patients present a high rate of comorbidity especially diabetes (37% of patients) and cardiovascular comorbidities (59% of patients) that increases with the patient's age. Considering indicators of care, the main dialysis technique was hemodialysis (93.3% of patients). Even if an important inter-region variability remains considering the choices of treatment, more than 50% of the patients are undergoing hemodialysis in a hospital-based in-center unit, and we noticed an increase in hemodialysis in a medical satellite unit with time whereas the rate of self-care hemodialysis decreases. The rate of peritoneal dialysis remains stable. When comparing guidelines to real-life treatments, 77.5% of patients receive adequate dose of treatment (12H/week, KT/V>1.2), the rate of patients with a hemoglobin blood-level lower than 10 g/dl and without erythropoietin treatment is 1.3%, which confirmed a good management of anemia. On the contrary, 34% of patients have a BMI lower than 23 kg/m(2) and only 23% have an albumin blood-level over 40 g/l, which underlines that nutritional management of ESRD patients can be improved. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis

    Regeur, L; Colding, H; Jensen, H


    renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between...

  2. Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis

    Maryam Masoumi


    Conclusions: Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients.

  3. Recurrent peritoneal dialysis-related peritonitis caused by Microbacterium resistens.

    Gallois, Emmanuelle; Lamy, Thomas; Fines-Guyon, Marguerite; Lobbedez, Thierry; Cattoir, Vincent


    We report a case of a recurrent peritonitis due to Microbacterium resistens in a 71-year-old male patient undergoing peritoneal dialysis (PD). Importantly, this Gram-positive rod was intrinsically resistant to cephalosporins and vancomycin, classically used in PD-related peritonitis treatment. His infection resolved after several weeks of appropriate therapy (amoxicillin plus gentamicin) and PD catheter removal.

  4. High fall incidence and fracture rate in elderly dialysis patients

    Polinder-Bos, H. A.; Emmelot-Vonk, M. H.; Gansevoort, R. T.; Diepenbroek, A.; Gaillard, C. A. J. M.


    Background: Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors f

  5. Newly Developed Neutralized pH Icodextrin Dialysis Fluid: Nonclinical Evaluation.

    Yamaguchi, Naoya; Miyamoto, Keiichi; Murata, Tomohiro; Ishikawa, Eiji; Horiuchi, Takashi


    A two-compartment system (NICOPELIQ; NICO, Terumo Co., Tokyo, Japan) has recently been developed to neutralize icodextrin peritoneal dialysis fluid (PDF). In this study, a nonclinical evaluation of NICO was carried out to evaluate biocompatibility as well as water transport ability. Glucose degradation products (GDPs) in the icodextrin PDFs were analyzed via high-performance liquid chromatography (HPLC). The cell viability of human peritoneal mesothelial cells derived from peritoneal dialysis effluent (PDE-HPMCs) was evaluated as well as the amount of lactate dehydrogenase (LDH) released after exposure to different PDFs (NICO and EXTRANEAL [EX, Baxter Healthcare Corp., Chicago, IL, USA]) and neutralized pH glucose PDF MIDPELIQ 250 (M250, Terumo). The water transport ability of NICO, EX, and M250 was tested using dialysis tube membranes with various pore sizes: 1, 2, 6-8, and 12-16 kDa. Although cell viability decreased by 30% after 30 min exposure to NICO, it was maintained for 6 h while a significant decrease was observed after 6 h exposure to EX. However, following adjustment of the pH to the same pre-exposure pH value, there was no significant difference in cell viability within the same pH group despite a doubling of the difference in the total amount of GDPs (44.6 ± 8.6 µM in NICO and 91.9 ± 9.5 µM in EX, respectively). In contrast, a significant decrease in cell viability was observed when the pH decreased to less than pH 6. Levels of released LDH, a cytotoxic marker, were within 5% after a 6-h exposure of NICO to PDE-HPMCs. There was no significant difference in water transport ability represented as overall osmotic gradients between NICO and EX. In conclusion, neutralization of icodextrin PDF is beneficial for maintaining cell viability and minimizing LDH release while water transport ability is comparable to the conventional icodextrin PDF. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  6. Galaxy cluster's rotation

    Manolopoulou, Maria


    We study the possible rotation of cluster galaxies, developing, testing and applying a novel algorithm which identifies rotation, if such does exits, as well as its rotational centre, its axis orientation, rotational velocity amplitude and, finally, the clockwise or counterclockwise direction of rotation on the plane of the sky. To validate our algorithms we construct realistic Monte-Carlo mock rotating clusters and confirm that our method provides robust indications of rotation. We then apply our methodology on a sample of Abell clusters with z<~0.1 with member galaxies selected from the SDSS DR10 spectroscopic database. We find that ~35% of our clusters are rotating when using a set of strict criteria, while loosening the criteria we find this fraction increasing to ~48%. We correlate our rotation indicators with the cluster dynamical state, provided either by their Bautz-Morgan type or by their X-ray isophotal shape and find for those clusters showing rotation that the significance and strength of their...

  7. The medical director and quality requirements in the dialysis facility.

    Schiller, Brigitte


    Four decades after the successful implementation of the ESRD program currently providing life-saving dialysis therapy to >430,000 patients, the definitions of and demands for a high-quality program have evolved and increased at the same time. Through substantial technological advances ESRD care improved, with a predominant focus on the technical aspects of care and the introduction of medications such as erythropoiesis-stimulating agents and active vitamin D for anemia and bone disease management. Despite many advances, the size of the program and the increasingly older and multimorbid patient population have contributed to continuing challenges for providing consistently high-quality care. Medicare's Final Rule of the Conditions for Coverage (April 2008) define the medical director of the dialysis center as the leader of the interdisciplinary team and the person ultimately accountable for quality, safety, and care provided in the center. Knowledge and active leadership with a hands-on approach in the quality assessment and performance improvement process (QAPI) is essential for the achievement of high-quality outcomes in dialysis centers. A collaborative approach between the dialysis provider and medical director is required to optimize outcomes and deliver evidence-based quality care. In 2011 the Centers for Medicare & Medicaid Services introduced a pay-for-performance program-the ESRD quality incentive program (QIP)- with yearly varying quality metrics that result in payment reductions in subsequent years when targets are not achieved during the performance period. Success with the QIP requires a clear understanding of the structure, metrics, and scoring methods. Information on achievement and nonachievement is publicly available, both in facilities (through the facility performance score card) and on public websites (including Medicare's Dialysis Facility Compare). By assuming the leadership role in the quality program of dialysis facilities, the medical

  8. [The contribution of dialysis and laboratoristic methods for the control of phosphates].

    Bolasco, Piergiorgio


    Prevention and correction of hyperphosphatemia is the first main goal of CKD-MBD management. Therefore, special attention is required to prevent a positive phosphate balance. In addition to a careful use of phosphate binders and dietary, phosphate control is needed to optimize the control of phosphate balance. In well-nourished patients is necessary to provide an optimal dialysis removal schedule. A solution could be the increase of the number of dialysis sessions per week and to carry out longer dialysis session strategies. Nevertheless, many patients have a high phosphate (P) intake linked to the high dietary protein requirement of dialysis patients, hence the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately the phosphate molecule must be considered as a medium molecular toxin. Nowadays it remains difficult to remove with modern dialysis strategies and ones clearance is still dependent on dialysis time. The best solutions are: hemodiafiltration with high-volume reinfusion, daily dialysis, long dialysis and modern peritoneal dialysis. Today, this scheduled strategies are difficult because of logistic and cost problems. However the milestone will be an adequate nutrition surveillance, especially with nursing collaboration toward dialysis treatments. This strategy should start in outpatient pre-dialysis ambulatory.

  9. Hemodialysis versus peritoneal dialysis: epidemiologic and demographic characteristics

    Hekmat R


    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The preferred modality of dialysis is a controversial issue in nephrology. In this study we compare some demographic and epidemiological characteristics of hemodialysis and peritoneal dialysis patients in an attempt to analyze this issue."n"n Methods: The results of the research protocol "A survey of the epidemiological characteristics of chronic dialyzed patients in Khorassan province", was used to compare some demographic and epidemiological aspects of chronic hemodialysis and peritoneal dialysis patients in search of any statistically significant difference."n"n Results: A total of 836 chronic dialysis patients entered this study, 802 (95.9% of which were under chronic hemodialysis, and 34 (4.1% patients were undergoing peritoneal dialysis, with 339 (42.3% and 12 (35.3% being female, respectively. The mean age for each group was 47.57 and 46.75 years, respectively. The causes of end-stage renal disease in hemodialzed patients were most commonly hypertension (32.2%, followed by diabetes mellitus (22.3%, unknown causes (19.6% and chronic glomeru-lonephritis (10.2%. In the peritoneal dialysis group, chronic glomerulonephritis (32.4% was the most common reason for dialysis, followed by diabetes mellitus (26

  10. Historical Study (1986-2014): Improvements in nutritional status of dialysis patients

    Koefoed, Mette; Kromann, Charles Boy; Hvidtfeldt, Danni


    OBJECTIVE: Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct...... historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in 2014. DESIGN: Historical study...... comparing results of two cross-sectional studies performed in 1986 and 2014. SETTING: We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated...

  11. Profile of peginesatide and its potential for the treatment of anemia in adults with chronic kidney disease who are on dialysis

    Mikhail A


    Full Text Available Ashraf MikhailRenal Unit, Morriston Hospital, Swansea University, Wales, UKAbstract: Peginesatide is a synthetic, dimeric peptide that is covalently linked to polyethylene glycol (PEG. The amino acid sequence of peginesatide is unrelated to that of erythropoietin (EPO and is not immunologically cross-reactive with EPO. Peginesatide binds to and activates the human EPO receptor, stimulating the proliferation and differentiation of human red cell precursors in vitro in a manner similar to other EPO-stimulating agents (ESAs. In Phase II and III studies in dialysis and predialysis patients, peginesatide administered once monthly was as effective as epoetin alfa given thrice weekly (dialysis patients or darbepoetin given once weekly (nondialysis patients, in correcting anemia of chronic kidney disease as well as maintaining hemoglobin within the desired target range. In the dialysis population, the reported side-effect profile of peginesatide was comparable to that known with other marketed ESAs. In the nondialysis studies, compared with those treated with darbepoetin, patients treated with peginesatide experienced a higher adverse-effect profile. Peginesatide is likely to be licensed for treatment of renal anemia in dialysis patients and not in nondialysis patients. Despite this limitation, peginesatide is likely to prove valuable in treating dialysis patients because of its infrequent mode of administration, thereby allowing for a reduced number of injections, with associated better compliance, reduced cold storage requirement, and improved stock accountability. PEGylated therapeutic proteins can elicit immunological response to the PEG moiety of the therapeutic complex. Only long-term experience and post-marketing surveillance will address whether this immunological response will have any impact on the clinical efficacy or safety of peginesatide in clinical practice.Keywords: peginesatide, dialysis, chronic kidney disease

  12. Burnout Syndrome Among Hemodialysis and Peritoneal Dialysis Nurses.

    Karakoc, Ayten; Yilmaz, Murvet; Alcalar, Nilufer; Esen, Bennur; Kayabasi, Hasan; Sit, Dede


    Burnout, a syndrome with 3 dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment, is very common among hemodialysis nurses, while data are scarce regarding the prevalence of burnout syndrome (BS) among peritoneal dialysis (PD) nurses. This study aimed to assess and compare demographic and professional characteristics and burnout levels in hemodialysis and PD nurses, and to investigate factors that increase the level of burnout in dialysis nurses. A total of 171 nurses from 44 dialysis centers in Turkey were included in a cross-sectional survey study. Data were collected using a questionnaire defining the social and demographic characteristics and working conditions of the nurses as well as the Maslach Burnout Inventory for assessment of burnout level. There was no significant difference in the level of burnout between the hemodialysis and PD nurses groups. Emotional exhaustion and depersonalization scores were higher among the shift workers, nurses who had problems in interactions with the other team members, and those who wanted to leave the unit, as well as the nurses who would not attend training programs. In addition, male sex, younger age, limited working experience, more than 50 hours of working per week, and working in dialysis not by choice were associated with higher depersonalization scores. Personal accomplishment score was lower among the younger nurses who had problems in their interactions with the doctors, who would not regularly attend training programs, and who felt being medically inadequate. Improving working conditions and relations among colleagues, and also providing further dialysis education are necessary for minimizing burnout syndrome. Burnout reduction programs should mainly focus on younger professionals.

  13. Vasoactive Peptide Levels after Change of Dialysis Mode

    Fredrik Uhlin


    Full Text Available Background/Aims: Plasma concentrations of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP are increased in end-stage renal disease. Improvement in hemodynamic stability has been reported when switching from hemodialysis (HD to on-line hemodiafiltration (ol-HDF. The aim of this study was to investigate plasma concentrations of NT-proBNP, BNP and neuropeptide Y (NPY during a 1-year follow-up, after a change from high-flux HD to postdilution ol-HDF. Additional variables were also studied, e.g. pulse wave velocity and ordinary clinical parameters. Method: We conducted a prospective, single-center study including 35 patients who were switched from HD to HDF. Plasma concentrations of NT-proBNP, BNP and NPY before and after dialysis were measured at baseline (i.e. HD and at 1, 2, 4, 6 and 12 months on HDF. Results: All three peptide levels decreased significantly during HD and HDF when comparing concentrations before and after dialysis. Mean absolute value (before/after and relative decrease (% before versus after dialysis was 13.697/9.497 ng/l (31% for NT-proBNP, 62/40 ng/ml (35% for BNP and 664/364 pg/l (45% for NPY. No significant differences were observed when comparing predialysis values over time. However, postdialysis NT-proBNP concentration showed a significant decrease of 48% over time after the switch to HDF. Conclusion: The postdialysis plasma levels of NT-proBNP, BNP and NPY decreased significantly during both dialysis modes when compared to before dialysis. The postdialysis lowering of NT-proBNP increased further over time after the switch to ol-HDF; the predialysis levels were unchanged, suggesting no effect on its production in the ventricles of the heart.

  14. Predicting mortality in patients with diabetes starting dialysis.

    Merel van Diepen

    Full Text Available BACKGROUND: While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. METHODS: Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD, a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. RESULTS: A total of 394 patients were available for statistical analysis; 82 (21% patients died within one year after baseline (3 months after starting dialysis therapy. The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. CONCLUSIONS: A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary.

  15. Surgical thrombectomy for thrombosed dialysis grafts: comparison of adjunctive treatments.

    Liu, Yun-Hen; Hung, Yen-Ni; Hsieh, Hung-Chang; Ko, Po-Jen


    Vascular surgeons often encounter dialysis graft failure in hemodialysis patients during their daily practice. Despite advances in percutaneous treatment, there remains a role for surgical thrombectomy of thrombosed dialysis grafts. This study was designed to investigate the long-term outcome of dialysis graft thrombectomy and to examine the indications for and effectiveness of therapies adjuvant to Fogarty thrombectomy. Surgical outcomes of 590 consecutive dialysis graft thrombectomies performed between 2001 and 2003 were retrospectively reviewed. The 590 cases were classified into four groups based on the procedure performed adjuvant to Fogarty thrombectomy: group A, surgical thrombectomy by Fogarty thrombectomy catheter alone; group B, thrombectomy plus intraoperative angioplasty of graft outlet; group C, thrombectomy plus sequential balloon angioplasty in subsequent intervention; group D, thrombectomy plus graft outlet surgical revision. Age, gender, co-morbidity, and primary patency of grafts were reviewed and analyzed. The four groups exhibited similar demographic features and comorbidities (p>0.05). Mean primary patency in the four groups was 1.99+/-4.02, 7.21+/-7.61, 8.35+/-9.53, and 7.26+/-6.99 (months), respectively. Survival curves for each group were determined by Kaplan-Meier methods. Primary patency in group A was statistically inferior to all of the other three groups, whereas groups B, C, and D did not significantly differ with regard to graft patency. Surgical thrombectomy alone is inadequate for treating a thrombosed dialysis graft. The underlying graft outlet stricture requires direct surgical revision or balloon angioplasty during surgery or intervention in the angiography suite to ensure long-term patency of the graft.

  16. [Educational scheme for patients on home peritoneal dialysis in Spain].

    Cirera Segura, F; Martín Espejo, J L; Reina Neyra, M


    The objective of the present study is to obtain information about the training programme for patients undergoing Domiciliary Peritoneal Dialysis (DPD) in Spain. For the purposes of the study we designed a questionnaire comprising 50 closed-ended items and one open response item. The questionnaire was sent to 104 hospitals and was completed by 78.84% of them (n > or = 82). The average of patients undergoing peritoneal dialysis (PD) in the hospitals under study was 27.6: 15.8 of them receiving Chronic Ambulatory Peritoneal Dialysis (CAPD) and 11.8 Automatic Peritoneal Dialysis (APD). The questionnaire also served to investigate into the training methodology used in the different units, the involvement of the family in the programme, the basic knowledge patients received about Chronic Renal Insufficiency, the procedures associated with the therapy and the preparation they obtained to solve small-scale contingencies and emergency situations as well as the improvement of their quality of life. We also evaluated the training programme of autonomous patients on DPD and at the end of the questionnaire a blank space was left for facilities to add any comments or suggestions they considered relevant. From the results obtained we may conclude that most Spanish hospitals have devised a training planning for patients undergoing PD which helps them or caregivers to perform domiciliary treatment safely, provides them with basic knowledge about the disease and the routine procedures associated with the treatment, enables them to cope with contingencies and emergency situations and improves their quality of life during the dialysis period.

  17. Depression in hemodialysis patients: the role of dialysis shift

    Flavio Teles


    Full Text Available OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years. Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001, although patients in rural areas did not have a higher prevalence of depression (p= 0.30. Patients with depression were more likely to be dialyzed during the morning shift (p= 0.008. Independent risk factors for depression were age (p<0.03, lower levels of hemoglobin (p<0.01 and phosphorus (p<0.01, and dialysis during the morning shift (p= 0.0009. The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008. CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

  18. Quality of life in dialysis: A Malaysian perspective.

    Liu, Wen J; Musa, Ramli; Chew, Thian F; Lim, Christopher T S; Morad, Zaki; Bujang, Adam


    There is a growing interest to use quality of life as one of the dialysis outcome measurement. Based on the Malaysian National Renal Registry data on 15 participating sites, 1569 adult subjects who were alive at December 31, 2012, aged 18 years old and above were screened. Demographic and medical data of 1332 eligible subjects were collected during the administration of the short form of World Health Organization Quality of Life questionnaire (WHOQOL-BREF) in Malay, English, and Chinese language, respectively. The primary objective is to evaluate the quality of life among dialysis patients using WHOQOL-BREF. The secondary objective is to examine significant factors that affect quality of life score. Mean (SD) transformed quality of life scores were 56.2 (15.8), 59.8 (16.8), 58.2 (18.5), 59.5 (14.6), 61.0 (18.5) for (1) physical, (2) psychological, (3) social relations, (4) environment domains, and (5) combined overall quality of life and general health, respectively. Peritoneal dialysis group scored significantly higher than hemodialysis group in the mean combined overall quality of life and general health score (63.0 vs. 60.0, P income, mode of dialysis, hemoglobin, diabetes mellitus, coronary heart disease, cerebral vascular accident and leg amputation. Subjects on peritoneal dialysis modality achieved higher combined overall quality of life and general health score than those on hemodialysis. Religion and cerebral vascular accident were significantly associated with all domains and combined overall quality of life and general health.

  19. Impact on peritoneal membrane of use of icodextrin-based dialysis solution in peritoneal dialysis patients.

    Moriishi, Misaki; Kawanishi, Hideki; Tsuchiya, Shinichiro


    The usefulness of icodextrin-containing peritoneal dialysis (PD) solution for the management of body fluid and blood pressure has been reported. However, icodextrin PD solution is a foreign solution in the body, and the possible induction of intraperitoneal inflammation has been reported. In this study, we investigated at 6-month intervals the influence of icodextrin solution on peritoneal permeability and inflammatory reactions in patients in whom glucose solution had been changed to icodextrin solution for the overnight dwell. We enrolled 9 anuric PD patients (5 men, 4 women) of mean age 58 +/- 5.9 years (range: 45.6-64.8 years) into the study. The patients' mean duration of PD was 61.9 +/- 42 months (range: 6.7-142.5 months). The cause of end-stage renal disease was chronic glomerulonephritis in all patients. For evaluation ofperitoneal permeability, we performed peritoneal equilibration tests (PETs) immediately after an overnight dwell and determined the dialysate-to-plasma ratios of creatinine (D/P Cr), beta2-microglobulin (D/P beta2m), albumin (D/P Alb), immunoglobulin G (D/P IgG), and alpha2-macroglobulin (D/P alpha2m). We also measured interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) in overnight effluent as indices of inflammation and of the fibrinolysis-coagulation system. The evaluation was performed every 6 months for 24 months. The FDPs in effluent increased significantly at 6 months after the change to icodextrin solution, and IL-6 tended to increase. The D/P beta2m, D/P Alb, D/P IgG, and D/P alpha2m all significantly increased in the course of follow-up. In the PETs, the D/P Cr increased slightly, but the change was nonsignificant. At 30 months after the change to icodextrin solution, 1 patient was diagnosed as having a risk of encapsulating peritoneal sclerosis (pre-EPS). In this patient, rapid increases in IL-6, D/P Cr and macromolecular and small molecular D/P by PET were noted after the change to icodextrin solution. Steroids were

  20. A report of the Malaysian dialysis registry of the National Renal Registry, Malaysia.

    Lim, Y N; Lim, T O; Lee, D G; Wong, H S; Ong, L M; Shaariah, W; Rozina, G; Morad, Z


    The Malaysian National Renal Registry was set up in 1992 to collect data for patients on renal replacement therapy (RRT). We present here the report of the Malaysian dialysis registry. The objectives of this papar are: (1) To examine the overall provision of dialysis treatment in Malaysia and its trend from 1980 to 2006. (2) To assess the treatment rate according to the states in the country. (3) To describe the method, location and funding of dialysis. (4) To characterise the patients accepted for dialysis treatment. (5) To analyze the outcomes of the dialysis treatment. Data on patients receiving dialysis treatment were collected at initiation of dialysis, at the time of any significant outcome, as well as yearly. The number of dialysis patients increased from 59 in 1980 to almost 15,000 in 2006. The dialysis acceptance rate increased from 3 per million population in 1980 to 116 per million population in 2006, and the prevalence rate from 4 to 550 per million population over the same period. The economically advantaged states of Malaysia had much higher dialysis treatment rates compared to the less economically advanced states. Eighty to 90% of new dialysis patients were accepted into centre haemodialysis (HD), and the rest into the chronic ambulatory peritoneal dialysis (CAPD) programme. The government provided about half of the funding for dialysis treatment. Patients older than 55 years accounted for the largest proportion of new patients on dialysis since the 1990s. Diabetes mellitus has been the main cause of ESRD and accounted for more than 50% of new ESRD since 2002. Annual death rate averaged about 10% on HD and 15% on CAPD. The unadjusted 5-year patient survival on both HD and CAPD was about 80%. Fifty percent of dialysis patients reported very good median QoL index score. About 70% of dialysis patients were about to work full or part time. There has been a very rapid growth of dialysis provision in Malaysia particularly in the older age groups. ESRD