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Biomedical subjects

P Keshaviah

Publications and source records attributed to P Keshaviah.

At least 37 records · Page 2Linked to original sources
PubMed1986

Technical requirements for rapid high-efficiency therapies.

Significant reductions in treatment time are possible with rapid high-efficiency hemodialysis and hemodiafiltration, provided the therapies are implemented so as to maintain adequacy of solute and fluid removal without compromising patient comfort. The key technical elements necessary for such implementation include high blood flow rates, higher efficiency dialyzers/diafilters, ultrafiltration control systems, and bicarbonate as the buffer source. In addition, hemodiafiltration requires schemes to ensure sterility and nonpyrogenicity of the infusion fluid and appropriate balancing of the rates of ultrafiltration and reinfusion. In general, rapid high-efficiency therapies are technically more complex than standard therapy, and rapid hemodiafiltration appears to be more complex than rapid hemodialysis. The technology required for rapid hemodialysis currently exists, but it needs to be fine-tuned and integrated for routine application.

Acetates↗
PubMed1984

Effect of dialyzer reuse on complement activation and neutropenia in hemodialysis.

A prospective study of 10 patients undergoing hemodialysis showed that less neutropenia and complement activation occurred with dialyzer reuse. Neutrophil counts fell 95% +/- 5% (SEM) with first use and 66% +/- 8% and 48% +/- 10% with second and third uses, respectively (p less than 0.05). The production of complement component C5a-desarg, as measured by the bioassay granulocyte aggregation, was decreased by 96% +/- 1% and 93% +/- 2% with second and third uses, respectively (p less than 0.05). We investigated the role of the dialyzer disinfectant formaldehyde in decreased neutropenia. In vitro, formaldehyde inhibited granulocyte aggregation and chemotaxis and the dialyzer membrane's ability to generate granulocyte aggregating activity; however, this occurred only at concentrations higher than those likely to obtain in patients. The ability of dialysis membranes to generate granulocyte aggregating activity in plasma was decreased 55% +/- 5% by their prior sequential preincubation in plasma and then formalin (p less than 0.05) and extensive rinsing, which is similar to the circumstances obtaining with dialyzer reuse. Preincubation of membranes in plasma or formalin alone resulted in no change in the membrane's ability to generate granulocyte aggregating activity. We conclude that the exposure of membranes to both plasma and formalin during dialysis and storage is responsible for the decreased C5a-desarg production with reuse, probably because plasma proteins are fixed to the membrane in such a way that interrupts free interaction between the membrane and plasma complement components.

Agranulocytosis↗
PubMed1984

Peracetic acid for reuse of hemodialyzers clinical studies.

When Renalin was used for reprocessing, the incidences of headache and hypotension were reduced and no changes in serum chemistries were noted. Dialyzer appearance was superior to that achieved with formaldehyde but accompanied by decreases in clearance of urea, creatinine, vitamin B-12 and a fall in KUF. While long-term patient toxicity studies are not yet available, laboratory studies suggest potential problems with carcinogenicity similar to those erroneously attributed to formaldehyde. These data suggest that Renalin may be a suitable alternative to formaldehyde for reprocessing hemodialyzers.

Acetates↗
PubMed1978

The metabolic effects of hemodialysis with and without glucose in the dialysate.

The present study compares some of the metabolic effects of hemodialysis of fasting patients with and without glucose in the dialysate bath. Unlike glucose dialysis, glucose-free dialysis caused marked decreases in blood levels of glucose, insulin, lactate, and pyruvate along with profound increases in acetoacetate and beta-hydroxybutyrate. It is concluded that oxidation of fatty acids increases to meet energy demands and that the combined processes of glycogenolysis and gluconeogenesis serve to prevent critical hypoglycemia during glucose-free dialysis.

Adult↗
PubMed1978

Unsolved technical problems of maintenance dialysis.

The present paper describes some of the technical inadequacies in the clinical practice of dialysis. Problem areas of hemodialysis, i.e., those related to blood access, dialyzer and delivery system, are treated in depth. Corollaries with peritoneal dialysis are obvious. Research priorities, in particular development of a more sophisticated delivery system, are suggested. The intent of this discussion is to outline a rational progression in improvement of care of the end-stage renal disease patient.

Kidneys, Artificial↗