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Extractive ultrafiltration.

Extractive ultrafiltration is a separation process by which liquid extraction in series with ultrafiltration removes contaminants from water. The toxin is extracted into an organic-in-water emulsion which is then separated by an ultrafilter. The ultrafilter thus replaces the settler in a conventional mixer-settler process; the extraction and emulsification allow ultrafiltration to remove much smaller molecules than is indicated by the nominal molecular weight cut-off of the membrane. In the present study, the toxins, toluene and monochlorobenzene, were individually extracted from water into heptane and hexane, respectively, reducing their concentration in the permeate water five to ten fold, at fluxes in excess of 60% of the pure water flux for the membrane. The operating temperature, organic to water ratio, and amount of surfactant used to stabilize the emulsion, were independently varied to determine the optimum values of each quantity, consistent with highest possible permeate flux through the membrane and maximum removal of the contaminant. General conclusions drawn were that the optimum permeate was obtained 1. at ambient temperature 2. when surfactant concentration was a minimum 3. when a minimum amount of extraction solvent was used.

Chemical Phenomena↗

[A case report of infective endocarditis with acute pulmonary edema and renal dysfunction treated by emergent mitral valve replacement and postoperative extracorporeal ultrafiltration].

A 40-year-old woman with staphylococcus aureus endocarditis of the mitral valve associated with acute pulmonary edema and renal dysfunction is presented. The patient was admitted to Hiroshima University Hospital with infective endocarditis. On the 14th day after admission, she suffered from severe cardiac failure and oligouria, then she was transferred ICU. Chest X-ray film showed pulmonary congestion and echocardiogram revealed 4th grade of mitral valve regurgitation. Emergent mitral valve replacement was performed and rupture of anterior mitral chorda was found as the cause of acute pulmonary edema. Postoperative care was difficult because of advanced renal failure and cardiac failure not responded to diuretics. Extracorporeal ultrafiltration method was effectively used on the 1st and the 2nd postoperative days and 3000 ml of water was filtered without hemodynamic change. Symptoms of renal and cardiac failure recovered promptly after ultrafiltration. Emergent operative and postoperative use of ultrafiltration method is effective in some cases of infective endocarditis complicated with cardiac and renal failure.

Acute Disease↗

[Application of the ultrafiltration method to the isolation of cholesterol oxidase of microbial origin].

Ultrafiltration of solutions of intracellular cholesterol oxidase of Actinomyces lavendulae through semi-permeable membranes (N-vinyl pyrrolidone and methacrylate copolymers) of varying porosity and acetyl cellulase ultrafilter UAM-200 M was investigated. The ultrafiltration through membranes of both types involved both concentration and purification of cholesterol oxidase from low molecular weight protein admixtures. When copolymer membranes were used, their performance and degree of purification were higher and losses were lower than in case of UAM-200 M filter. The optimum hydrolytic mode of ultrafiltration of intracellular cholesterol oxidase through both filters was determined.

3-Hydroxysteroid Dehydrogenases↗

Bile acids in serum, ultrafiltrate of serum and saliva from patients with cholestatic jaundice.

Individual bile acid conjugates in serum, the ultrafiltrate of serum and in saliva from patients with cholestatic jaundice were determined by gas-liquid chromatography. The bile acid concentration in the ultrafiltrate was 4-20% of that in serum and had also a different composition, with higher ratio of cholic to chenodeoxycholic acid. In saliva, the bile acid concentration was 1-8% of that in serum and the composition was different due to a higher proportion of unconjugated cholic acid. The results indicate that neither the bile acid concentration in the ultrafiltrate, nor that in saliva corresponds to the non-protein-bound bile acids in serum.

Adult↗

Dialytic ultrafiltration by hemofilter in treatment of patients with refractory ascites and renal insufficiency.

Six cirrhotic patients with intractable ascites had coexisting renal insufficiency. Dialytic ultrafiltration of ascitic fluid by hemofilter was attempted in these patients for symptomatic relief. The hemofilter removes fluid and substances with a molecular weight less than 50,000 daltons and the concentrated ascitic fluid was reinfused into the peritoneal cavity after ultrafiltration. A transient increase in urine output (p less than 0.01), urinary sodium excretion (p less than 0.01), and endogenous creatinine clearance (p less than 0.02) was noted and the plasma creatinine levels had remained stable for more than 4 months after the procedure. Our study suggests that dialytic ultrafiltration of ascites by hemofilter is a safe method in the management of patients with refractory ascites and renal insufficiency.

Adult↗

Sorbent recycling of ultrafiltrate in man--a 45-week crossover study.

Chronic hemofiltration as a treatment for end stage renal disease has been shown to have several advantages over standard hemodialysis including: improvement in well being, increased strength, decrease in hypotensive episodes during treatment and decrease in the degree of hypertension between treatments. The major drawback of hemofiltration as practiced today is the need to replace the large quantities of ultrafiltrate formed with sterile, pyrogen-free replacement solution. We have solved this problem by passing the ultrafiltrate through a sterile REDY Sorbent Cartridge to remove urea, creatinine and "uremic toxins" prior to returning it to the patient via a closed system. We have called this system SRUF for Sorbent Recycling of Ultrafiltrate and have carried out an A-B-A, B-A-B cross-over study (15 week periods) comparing SRUF with standard hemodialysis in 8 ESRD patients previously treated with hemodialysis. Clinical and laboratory parameters measured included: hemoglobin, hematocrit, blood transfusion requirement, electrolytes, aluminum levels, liver function tests, enzymes, lipids, glucose, cardiac function studies, weight, blood pressure, urea generation, urea space, incidence of hypotension and muscle cramps, and questionnaires on well being. The results of these studies can be summarized as follows: SRUF can be performed by the hemodialysis staff as a routine, outpatient procedure for ESRD patients utilizing the machinery and tubing developed as part of this protocol. SRUF, when used as a chronic treatment for ESRD patients, has no deleterious effects and is associated with many of the same benefits ascribed to routine hemofiltration, including improvement in well being, decrease in cramping and decrease in symptomatic hypotension during treatment as compared to hemodialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adsorption↗

The relationship between peritoneal glucose absorption and body fluid loss by ultrafiltration during continuous ambulatory peritoneal dialysis.

Eight continuous ambulatory peritoneal dialysis (CAPD) patients were studied during six consecutive days using dialysate with a different glucose concentration on each day. For all dialysate glucose concentrations ranging from 70 to 198 mmol/l, an inverse linear relationship was found between the percentage of absorbed glucose and the ultrafiltration rate. In each patient a linear correlation was demonstrated between the dialysate glucose concentration and the quantity of body fluid removed by ultrafiltration. Therefore the dialysate glucose concentration without net removal of fluid could be calculated for each patient: DGCUF = 0. This DGCUF = 0 is a parameter of the relationship between the transport of water and glucose over the peritoneal membrane and can thus be considered a marker of the individual ultrafiltration. The calculated DGCUF = 0 was compared with DGCUF = 0 predicted from the glucose absorption using the equation as derived from our data: DGCUF = 0 (mmol/l) = 2.1 X glucose absorption (%) -67 (mmol/l). As marked day to day variations were found, the results of these predicted DGCUF = 0 should be interpreted cautiously when used for long-term follow-up of peritoneal permeability in CAPD patients.

Adult↗

The effect of dialysate volume on ultrafiltration in young patients treated with CAPD.

The effect of dialysate volume on ultrafiltration in young patients on continuous ambulatory peritoneal dialysis (CAPD) was studied. Twelve patients were evaluated. Each patient was studied with five different dialysate volumes (30, 40, 50 cc/kg and 2, 3 liters/1.73 m2) and two different dialysate glucose concentrations (1.5% and 4.25%). Dialysate osmolalities were measured at 30 minutes, one hour, two hours, and four hours. Dialysate volume was measured after four hours. Increased dialysate volume was associated with an increase in ultrafiltration rate and a slower fall in dialysate osmolality. It is concluded that since infants have a greater peritoneal surface area per kg than adults, they absorb dialysate glucose at a greater rate when related to body weight. This will lower dialysate osmolality at a faster rate and reduce ultrafiltration. Dialysate volume prescribed for children should not be extrapolated from the adult experience on the basis of 2 liters/70 kg, but rather by surface area (2 liters/1.73 m2).

Acute Kidney Injury↗

[Systolic time intervals during sequential ultrafiltration and hemodialysis].

The effects of a forced withdrawal of fluid by ultrafiltration and the influences of a connected haemodialysis on the period of isometric contraction of the heart were recorded by periodical registration during the treatment. A statistically certain decrease of the LVET (-19.2%) and an increase of the PEP (+ 11.1%) were found. Since at least in the period of the isolated ultrafiltration several essential parameters of the interior milieu do not change decisively, as cause for the changes observed of the systolic intervals of the heart period the decrease of the preload is discussed. During the period of ultrafiltration on an average 15.3 +/- 3.3 ml of plasma water were taken per minute.

Blood Pressure↗

Dialysance of acetate and bicarbonate: effect of ultrafiltration.

The dialysance of acetate and bicarbonate measured using a 1.8 M2 hollow fiber artificial kidney was quantitated both in vivo and in vitro. The diffusional transfers of acetate and bicarbonate were similar as would be expected from their almost identical ionic weights. However, ultrafiltration increased bicarbonate loss and decreased acetate uptake and at a TMP of 300 mm Hg the dialysance of bicarbonate was significantly greater than the dialysance of acetate. Therefore, ultrafiltration reduces the transfer of net base to the patient which impairs the correction of acidosis, and may contribute to clinical problems associated with ultrafiltration during hemodialysis.

Acetates↗

[Concentration and purification of alkaline proteinase by ultrafiltration].

The mode of ultrafiltration of the culture fluid of Bacillus subtilis, producer of alkaline proteinase, through semipermeable acetate cellulose membranes was examined. The ultrafiltration of the enzyme-containing solutions involved both concentration of the solution and enzyme purification from low molecular weight admixtures. The optimum mode of ultrafiltration of alkaline proteinase on UAM membranes "Vladipore" was developed.

Bacillus subtilis↗

Dialytic ascitic ultrafiltration in refractory ascites.

Nine patients with hepatic cirrhosis and refractory ascites underwent dialytic ascitic ultrafiltration with intraperitoneal reinfusion of the concentrated ascites. Ascites was removed via a peritoneal catheter and ultrafiltered using a hemodialyzer. The concentrate was continuously returned to the peritoneal space. A mean of 4.8 l of protein-free ascitic ultrafiltrate was removed without adverse effects over the course of the 3- to 5-h procedure. Preliminary evidence indicates a potential role for dialytic ascitic ultrafiltration in the management of refractory ascites.

Ascites↗

High efficiency haemofiltration (ultrafiltration of more than 250ml/min for two hours) in eight uraemic patients.

In eight uraemic patients a haemofiltration of very high efficiency was carried out from a double extracorporeal circuit set up via an arteriovenous fistula. The weight of the patients was kept constant throughout the session. The average ultrafiltration flow rate was 274ml/min; the total ultrafiltration volume was 32.9L/min. The clinical tolerance was very good. The loss of efficiency associated with the magnitude of the ultrafiltration volume and with the diffusion delay of the removed molecules was evaluated at 9 per cent for urea and 17 per cent for creatinine. In spite of a considerable phosphorus depletion no severe hypophosphoraemia was observed; the stable value of the phosphoraemia between the 90th and the 120th minute of the session suggests the existence of a physico-chemical balance around the value of 0.74mmol/L.

Adult↗

Ultrafiltration and high sodium concentration dialysis: pathophysiological correlation.

Five stabilised uraemic patients underwent two different procedures using the Gambro Ultradiffuser: ultrafiltration alone for one hour (mean body weight loss 2.97 +/- 0.24 kg) and ultrafiltration with simultaneous dialysis for one hour (mean body weight loss 2.92 +/- 0.22 kg) using a given dialysate sodium concentration which reproduced the changes in osmolality which occur during ultrafiltration alone. This mean sodium concentration was 154.75 +/- 2.02 mEq/L. The results did not show significant differences for the two procedures as regards tolerance to dehydration. These results underline the key role of osmolar stability in making dehydration tolerable.

Blood Pressure↗

Improved ultrafiltration method for determining unbound cortisol in plasma.

We describe a modified ultrafiltration method for measuring unbound cortisol in diluted or undiluted plasma or serum. After equilibration at 37 degrees C with purified [3H]cortisol, plasma or serum with or without buffer was placed in the ultrafiltration cell and two successive 0.2-mL fractions of protein-free ultrafiltrate were obtained. Under our conditions, free ligand concentration was independent of flow rate. The second fraction (the first is discarded) was used for determining the proportion of unbound cortisol. The assay is rapid (less than 2 h), practical (no more than 1.5 mL of plasma or serum is necessary), and reproducible (CV: 4.5% within assay and 5.2% in different assays). Samples from normal men and women (blood taken at 0800 and 1600 hours), from pregnant women, and from patients with Cushing's disease and adrenal insufficiency gave results that agreed with those obtained by equilibrium dialysis.

Adult↗

The "ultra-free" ultrafiltration technique compared with equilibrium dialysis for determination of unbound thiopental concentrations in serum.

We compare a new ultrafiltration technique, involving a unique Millipore membrane, with the classical method of equilibrium dialysis for determining the fraction of thiopental not bound to serum proteins. This fraction, as determined by equilibrium dialysis at 37 degrees C, ranged between 12 and 16% for total concentrations at 50 microgram/L to 10 mg/L of serum. In contrast, ultrafiltration at 37 degrees C yielded a 49% higher value for unbound thiopental: 26.3 (SD 2.6)%. Determined at room temperature (24 degrees C), there was no statistically significant difference for results by the two methods: 14.2 and 15.9%, respectively. The discrepancy between results at 37 degrees C may partly be explained by serum proteins penetrating the Ultra-Free filter. For the routine clinical measurement of unbound drug concentrations, the ultrafiltration membrane at room temperature appears to be sufficiently accurate and less time-consuming than equilibrium dialysis.

Blood Chemical Analysis↗

[Technic and indication for controlled ultrafiltration].

The isolated ultrafiltration with commercial dialysators gives a possibility of the massive dehydration in a short time without disturbing the well-being of the patient. If in patients undergoing a dialysis a following haemodialysis (sequential ultrafiltration haemodialysis) is necessary, particularly in patients with acute complications hypotonic circulatory conditions may develop. An infusion of a fourfold concentrated human dry plasma during the ultrafiltration may prevent these hypotensions, since reduction of osmolality and losses of circulation-effective substances are prevented during haemodialysis. With the help of this kind of treatment conditions of hyperhydration of different genesis may be removed also in patients with inclination to hypotension.

Acute Kidney Injury↗