The bicarbonate, calcium, and magnesium values of a single pass, batch system, bicarbonate based hemodialysate were found to be stable during a period of 5 hours, whether the solution was extensively covered by a floating polystyrene lid or not. The pH and PCO2 of the dialysate that had been covered with a floating lid remained stable during the 5 hours, whereas the corresponding values of the dialysate that had not been so covered did show changes that were secondary to the loss of carbon dioxide. The changes were not marked enough to preclude the clinical use of the latter uncovered dialysate.

Bicarbonates↗

PubMedDate not supplied

Erythropoietin ameliorates anemia of cisplatin induced acute renal failure.

Daily intraperitoneal injections of recombinant human erythropoietin (EPO) were administered for 9 days to Sprague-Dawley rats with cisplatin induced acute renal failure (ARF/ EPO group). A group of placebo treated rats with cisplatin induced acute renal failure (ARF group) was used as the control group. As expected, administration of cisplatin to rats caused ARF that was marked by a significant rise in serum creatinine and a significant reduction in creatinine clearance in both groups. The placebo treated ARF animals showed a significant fall in hematocrit, erythrocyte count, reticulocyte count, and hemoglobin concentration. These abnormalities were averted by EPO therapy in the ARF/EPO group. Therefore, when compared to the ARF group, the ARF/EPO group had higher hematocrits (45.8+/-0.6% vs 36.1+/-0.7%, SEM), reticulocyte counts (7.7+/-0.3% vs 3.4+/-0.6%, SEM), erythrocyte counts (7.7+/-0.2 x 10(12)/L vs 6.3+/-0.2 x 10(12)/L, SEM), and hemoglobin levels (16.6+/-0.3 g/dl vs 13.3+/-0.3 g/dl, SEM). The differences were all statistically significant (p < 0.05). Plasma EPO was found to be higher in the ARF/EPO group (reflecting exogenously administered hormone) than in the ARF group, which showed undetectable values. The results suggest that anemia in rats with cisplatin induced ARF can be corrected by EPO therapy.

Acute Kidney Injury↗

PubMedDate not supplied

New access device for hemodialysis.

A new subcutaneous device (Dialock; Biolink Corp., Middleboro, MA) provides vascular access to patients who currently require hemodialysis (HD). The device consists of a port-like valve, implanted subcutaneously below the clavicle, which provides a linear flow passage to two catheters placed in the right atrium via the jugular vein. The valve is accessed percutaneously with needle-cannulas that functionally convert the device to twin catheters for connecting the patient to the HD lines. Interdialytic patency is maintained using a standard heparin lock. The device has been implanted in 10 outpatients under local anesthesia, with almost immediate use for HD (median, 3 days) and has functioned successfully for more than 6 months (mean +/- SD, 4.0 +/- 1.7; > 400 dialysis sessions). Blood flows over 300 ml/min were consistently achieved (average, 320 +/- 50) with venous and arterial pressures of 197 +/- 42 mmHg and -241 +/- 31 mmHg, respectively. After 40 patient-months, condition of the needle puncture sites remains satisfactory. Four systemic infections have occurred in three patients; all have resolved without the need for device removal. There have been no infections at the puncture sites. One patient whose heparin lock was not changed for 23 days (for reasons unrelated to the device) required fibrin sheath stripping of his catheters. Patient and nurse acceptance has been excellent. The device may offer substantial improvement over conventional devices for HD access.

Adult↗

PubMedDate not supplied

Adjunctive antibiotic/anticoagulant lock therapy in the treatment of bacteremia associated with the use of a subcutaneously implanted hemodialysis access device.

To improve vascular access for hemodialysis, a new device (Dialock Hemodialysis Access System, Biolink Corporation, Middleboro, MA) has been developed. Implanted subcutaneously, the device is accessed by percutaneous puncture. Attached to the device are two catheters that are implanted into the superior vena cava or right atrium. Clinical results thus far have been promising. However, use of this device is not free from infectious complications. In the present pilot study, 25 maintenance hemodialysis patients were implanted with 26 Dialock devices. The incidence of bacteremia was 2.9/1,000 catheter days. In 14 episodes of bacteremia in 8 patients the infection was successfully treated with a combination of systemic antibiotic treatment and adjunctive antibiotic/anticoagulant lock therapy. The lock therapy entailed the instillation of both an antibiotic and an anticoagulant into the device. We believe that the antibiotic/anticoagulant lock technique is an effective, adjunctive therapeutic modality in the treatment of infections related to the use of indwelling vascular access devices.

Anti-Bacterial Agents↗

PubMedDate not supplied

Post to predialysis plasma urea nitrogen ratio, ultrafiltration and weight to estimate K.t/V. Use in auditing the amount of dialysis being administered.

The formula -In (R - 0.03 - UF/W), where R is the ratio of the postdialysis to predialysis plasma urea nitrogen level, UF the ultrafiltrate volume per session, and W the postdialysis weight, has been shown by us to estimate K.t/V accurately. We audited the amount of dialysis being administered in a moderate size outpatient unit in which urea kinetic modeling was not being done and in which 4 hr dialysis at a 250 or 300 ml/min blood flow rate was routinely prescribed. R was determined once per month on each of six successive months, and standard three point urea kinetic modeling was done on all patients once. R was quite reproducible in each patient, with a coefficient of variation of 6.6% +/- 3.2 standard deviation (SD). The R:UF:W-derived K.t/V averaged 0.91 +/- 0.19; the R:UF:W-derived K.t/V correlated with the modeled K.t/V (r = 0.98), with a mean percent error of only 0.12% +/- 3.6. A negative correlation (r = -0.56) was present between the R:UF:W-derived K.t/V and postdialysis weight; 9 of 40 patients had K.t/V values below 0.8 and 7 of these 9 weighed more than 85 kg. In 13 other patients, K.t/V was between 0.8 and 0.9. After inclusion of residual renal function (Kru) to calculate KT, KT was still below 0.9 in 19 patients. The main cause of underdialysis was inadequate prescription. The results suggest that monthly monitoring of R, with inclusion of UF and W to estimate K.t/V, is one useful quality assurance tool to assess the amount of dialysis being administered.

Blood Urea Nitrogen↗

PubMedDate not supplied

Extractable ethylene oxide from cuprammonium cellulose plate dialyzers: importance of potting compound.

Our results suggest that ethylene oxide retention after sterilization is increased in cuprammonium cellulose plate dialyzers containing potting compound. In contrast, cuprammonium cellulose plate dialyzers without potting compound were characterized by a rapid disappearance of retained ethylene oxide after sterilization. Whether these findings explain the low incidence of SARD with cuprammonium cellulose plate dialyzers that do not contain potting material is a matter for continued study and experimentation.

Anaphylaxis↗