No abstract available.
Hemodiafiltration ; Hyperpigmentation ; Skin

Valproic acid intoxication is a fairly common clinical problem that can result in serious complications. Traditionally the treatment of valproic acid overdose has been limited to supportive measures, but high blood levels may require extracorporeal removal, and publications on this experience are scarce. This case demonstrated continuous veno-venous hemodiafiltration successfully used in patient with severe valproic acid overdose who was hemodynamically unstable.
Hemodiafiltration ; Humans ; Valproic Acid

Lithium is commonly used for the treatment of bipolar affective disorders. Lithium therapy has a narrow therapeutic window, which can lead to various neurologic, cardiovascular, and renal side effects. Dialysis is recommended for the treatment of severe lithium toxicity, but conventional hemodialysis can cause post-dialysis rebound of serum lithium level. We report a case of lithium intoxication in which continuous venovenous hemodiafiltration (CVVHDF) was successfully used in reducing toxicity. CVVHDF provides excellent lithium clearance, and prevents post-therapy lithium rebound by allowing a progressive removal of intracellular lithium. It could become a modality of choice for lithium intoxication.
Dialysis ; Hemodiafiltration* ; Lithium* ; Mood Disorders ; Renal Dialysis

Extracorporeal elimination techniques have been frequently used in paraquat poisoning. But the effect of these techniques is controversial. Plasma paraquat concentration falls rapidly during first few hours after ingestion as the compound is taken by the tissues and excreted by the kidney. Tissue binding is very strong, resulting in slow release of substance from the tissues into the plasma. Thus, once the substance has reached its body stores, it is very difficult to eliminate. For these reasons, any effective extracorporeal elimination therapy should be initiated as early as possible, while paraquat concentrations are high and thereafter, continuous elimination therapy should be maintained to keep plasma paraquat levels as low as possible and remove the toxin as it enters the circulation from tissue stores. We present a case of paraquat poisoning treated by hemoperfusion and hemodiafiltration on this theoretical basis.
Eating ; Hemodiafiltration* ; Hemoperfusion* ; Humans ; Kidney ; Paraquat* ; Plasma ; Poisoning

PURPOSE: Quantification of the dialysis dose is an essential element in the management of hemodialysis. The author investigates the reliability of hemodialysis adequacy measured by ionic dialysance (Online clearance monitoring(R), OCM). Because OCM is a non-invasive and instantly accessible method, it could be replaced Kt/V derived from single-pool variable volume urea kinetic model (UKM). METHODS: Kt/V using UKM and OCM were measured simultaneously in 51 patients who have received hemodialysis therapy via arteriovenous fistula. The analysis of the data collected from 186 hemodialysis sessions were performed. RESULTS: Kt/V of conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration measured by UKM were 1.39+/-0.24, 1.41+/-0.23 and 1.53+/-0.17, and by OCM were 1.24+/-0.17, 1.26+/-0.19 and 1.39+/-0.19, respectively. The data of UKM were significantly higher than those of OCM (p=0.00). Also, there were strong positive correlations between UKM and OCM in hemodialysis (r=0.80, p=0.00), high efficiency hemodialysis (r=0.65, p=0.00) and hemodiafiltration (r=0.67, p=0.00). CONCLUSION: The Kt/V using OCM measured by ionic dialysance provided slightly lower data than that of UKM derived from single-pool variable volume urea kinetic model, but it may be a reliable test to evaluate dialysis adequacy in conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration.
Arteriovenous Fistula ; Dialysis ; Hemodiafiltration ; Humans ; Renal Dialysis ; Urea

PURPOSE:The purpose of this study was to assess the effect of long-term and differing frequency of on-line hemodiafiltration (OL-HDF) on changes in degree of hemoglobin, albumin level, serum small and middle molecules concentration in stable patients with undergoing high-flux hemodialysis (HF-HD). METHODS:Twenty five patients with more than 3 months of HF-HD were divided into two groups and followed for more than 36 months. Group 1 was treated once with OL-HDF and twice with HF-HD per week. Group 2 was treated three times with OL-HDF per week. Analysis was performed to compare hemoglobin, biochemical parameters, serum beta-microglobulin, leptin, alpha-microglobulin levels in both groups. RESULTS:There were significant improvements in hemoglobin and albumin level in group 2 compared to group 1. After receiving OL-HDF for a mean of 24 months, patients on both groups had the significantly reduced predialysis level of beta-microglobulin compared to baseline level. However, there is no significant difference in beta-microglobulin level between both groups. The predialysis level of leptin and alpha-microglobulin with relatively large molecular weight was not significantly reduced during observational period and was not significantly different between both groups. CONCLUSION:There were improvements in hemoglobin and albumin level according to the frequency of OL-HDF. The predialysis level of beta-microglobulin was significantly reduced after receiving even once with OL-HDF per week for long-term. Therefore, our study can suggest that there is no correlation between the frequency of OL-HDF and the predialysis level of beta-microglobulin.
Hemodiafiltration ; Hemoglobins ; Humans ; Leptin ; Molecular Weight ; Renal Dialysis

A prospective study was done to evaluate the on- line hemodiafiltration(HDF) as a safe and efficient way to increase beta2-microglobulin(beta2-M) removal. We have compared treatment with hemodialysis(HD) and HDF in 10 stable patients over a period of three months. All HDF sessions were well tolerated. No pyrogenic reactions were observed during the study. Cardiovascular parameters were remarkably similar in both of treatment periods. However, the incidence of hypotension was significantly less frequent during HDF peroid(9.43% vs. 2.41%, P=0.04). The reduction rates of urea and creatinine were similar in both of treatment periods, ranging 60-70%. The beta2-M reduction rate was significantly improved by HDF compared to HD(43.2% vs. 6.8%, P=0.006). The serum beta2-M levels fell progressively from the HD value of 32.2mg/L to 21.0mg/L at the end of 3 months' HDF. In conclusion, HDF with on-line production of substitution fluid in has been confirmed by us to be a safe and more efficient way to increase beta2-M removal. Long-term clinical studies are necessary to determine whether improved removal of beta2-M will reduce or prevent the dialysis amyloidosis.
Amyloidosis ; Creatinine ; Dialysis ; Hemodiafiltration* ; Humans ; Hypotension ; Incidence ; Prospective Studies ; Urea

BACKGROUND: Because hemodiafiltration (HDF) involves large amounts of ultra-filtration and substitution fluid infusion, its effects on serum electrolytes may be different from those of hemodialysis (HD). Serum sodium and blood pressures were compared between patients undergoing online HDF and high-flux HD (HFHD). METHODS: Thirty-two of 101 patients on HFHD switched voluntarily to online HDF. Their pre- and postdialysis serum measurements were compared with those of the remaining 69 HFHD patients. RESULTS: Online HDF patients had lower pre- and postdialysis systolic blood pressures (SBPs) than HFHD patients (predialysis, 136+/-21 vs. 145+/-19 mmHg, P<0.05; postdialysis, 129+/-22 vs. 142+/-25 mmHg, P<0.05). Pre- and postdialysis serum sodium concentrations were not significantly different between online HDF and HFHD (predialysis, 138+/-2 vs. 137+/-3 mEq/L; postdialysis, 134+/-2 vs. 134+/-2mEq/L). However, the change in serum sodium concentration after dialysis was greater in online HDF than HFHD patients (-3.7+/-2.2 vs. -2.5+/-2.8 mEq/L, P<0.05). The change in serum sodium concentrationwas correlated with postdialysis SBP (r=0.304, P<0.005) and pulse pressure (r=0.299, P<0.005). Predialysis SBP (r=0.317, P<0.005) and pulse pressure (r=0.324, P=0.001) were also correlated with the postdialysis serum sodium change. CONCLUSION: Compared with HFHD, online HDF has a greater serum sodium lowering effect. This might contribute to the ability of online HDF to stabilize both pre- and postdialysis SBP.
Blood Pressure ; Dialysis ; Electrolytes ; Hemodiafiltration ; Humans ; Renal Dialysis ; Sodium

Adsorption ; Hemodiafiltration ; methods ; Humans ; Liver, Artificial ; Plasmapheresis ; methods

PURPOSE: The purpose of this study was to develop nursing practice guidelines for water treatment system used in hemodialysis and to evaluate the guidelines by applying them in practice. METHOD: The first draft for the guidelines was developed based on advice and recommendations obtained from procedure review of critical literature. The draft was modified through evaluation by an expert group and pilot application to practice. The final draft was evaluated by the expert group using the AGREE instrument (Appraisal of Guidelines for Research and Evaluation). RESULTS: For the pilot test using the draft guidelines, 144 samples were collected from the water treatment system and hemodialysis machines. Results showed no bacteria. Endotoxin tests and chemical tests passed the criteria. After revision of the draft guidelines and additions to the draft guidelines, the final draft was confirmed. The quality of the final draft was evaluated by 4 experts using the AGREE instrument. The mean standard score was 76.9% for the 19 items. CONCLUSION: The clinical guidelines developed in this research can be utilized as systematic and scientific guidelines for water treatment systems used in hemodialysis. In addition, the results of the research can contribute to improving care services.
Bacteria ; Hemodiafiltration ; Renal Dialysis ; Water ; Water Purification ; Water Supply