A prospective study on a group of 129 patient was echocardiographical compared with a group of 109 normal subjects: based on Framingham criteria, the prevalence of LV hypertrophy were 88.4%, LV dilatation - 58.9% and systolic dysfunction - 21.7%. To determine the influence of haemodyalysis on echo-Doppler indices of the heart, 58 patients were studied by Doppler-echocardiography immediately before and after haemodialysis. This procedure resulted in immediate alterations of the heart: decrease in blood pressure, increase in heart rate. Left ventricular diameters and volumes decreased significantly whereas, the systolic function, cardiac output and index increased. Haemodialysis elicited marked changes in the left ventricular filling pattern: mitral peak E, peak A, ratio E/A decreased and pulmonary vein flow S/D ratio increased. The results provide evidence for the pronounced preload-dependence of morphologic, functional and hemodinamic indices of the heart.
Hemodialysis Solutions ; Ultrasonics ; Renal Dialysis

PURPOSE: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. METHODS: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. RESULTS: The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. CONCLUSION: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.
Dialysis* ; Fatigue* ; Hemodialysis Solutions ; Humans ; Prospective Studies ; Renal Dialysis* ; Treatment Outcome ; Urea

OBJECTIVETo determine bacterial endotoxin in the replacement solution of on-line hemodiafiltration (on-line HDF) using kinetic turbidimetric limulus test.

METHODS AND RESULTSValidation test was performed with the replacement solution of on-line HDF in which quantified standard endotoxin was added. The recovery rates of endotoxin from the replacement solution and its dilutions at 1/5, 1/10, and 1/20 were 58.17%, 106.7%, 99.00% and 98.79%, respectively, suggesting that the optimal dilution was at 1/10. Standard endotoxin was added into the replacement solution of on-line HDF of 3 batches (040408, 040511,040527), and the recovery rates in their dilution at 1/10 were 76.32%, 99.00% and 96.24%, respectively. The standard endotoxin in the working curve was 1.00, 0.125, and 0.0156 Eu/ml (endotoxin unit/ml), and the dilution at 1/10 of the replacement solution is effective to eliminate the interference in limulus test.

CONCLUSIONKinetic turbidimetric limulus test provide a means to detect endotoxin in the replacement solution of on-line HDF.

Endotoxins ; analysis ; Hemodiafiltration ; methods ; Hemodialysis Solutions ; analysis ; Humans ; Kinetics ; Limulus Test ; Nephelometry and Turbidimetry ; methods

PURPOSE: There are methods to prevent intradialytic hypotension such as cool dialysate and sodium profiling but hemodynamic effects of these methods are not proved yet. We studied hemodynamic effects of cool dialysate and sodium profiling through brachial pulse monitoring which is simple and not invasive. METHODS: Ten patients selected by single, blind, randomized study are enforced control phase, cool dialysate phase, and sodium profiling phase and checked brachial pulse for 10 minutes after dialysis and 10 minutes before finishing. Hemodynamics is checked by DynaPulse 5200A (Pulse metric, Inc. San Diego, CA, USA). RESULTS: In control, central artery systolic blood pressure is decreased after dialysis. Brachial and central artery compliance is increased but brachial artery resistance is decreased. The central artery systolic pressure, brachial mean artery pressure, and brachial artery resistance is increased, but compliance is decreased in cool dialysate as compared with control dialysis. The comparison of intradialytic changes of hemodynamic parameters between control dialysis and sodium profiling shows that intradialytic changes of hemodynamic parameters are similar, but pre-hemodialytic weight is increased in sodium profiling. Number of episodes of symptomatic hypotension per dialysis treatment in cool dialysate and sodium profiling is decreased more than in control dialysis. CONCLUSION: Our study suggests changes of compliance and resistance are most important in hemodynamic parameters of intradialytic hypotension, especially changes of compliance and resistance of vessel in cool dialysate are useful in preventing intradialytic hypotension.
Arteries ; Blood Pressure ; Brachial Artery ; Compliance ; Dialysis ; Hemodialysis Solutions ; Hemodynamics* ; Humans ; Hypotension* ; Renal Dialysis ; Sodium*

BACKGROUND/AIMS: Although high-flux (HF) dialyzers with enhanced membrane permeability are widely used in current hemodialysis (HD) practice, urea kinetic modeling is still being applied to indicate the adequacy of both low-flux (LF) and HF HD. In comparison with urea (molecular weight, 60 Da) and beta2-microglobulin (beta2MG, 12 kDa), cystatin C (CyC, 13 kDa) is a larger molecule that has attractive features as a marker for assessing solute clearance. We postulated that CyC might be an alternative for indicating the clearance of middle molecules (MMs), especially with HF HD. METHODS: Eighty-nine patients were divided into LF and HF groups. Using single pool urea kinetic modeling, the urea reduction ratio (URR) and equilibrated Kt/Vurea (eKt/Vurea) were calculated. The serum CyC concentrations were measured using particle-enhanced immunonephelometry. As indices of the middle molecular clearance, the reduction ratios of beta2MG and CyC were calculated. RESULTS: The beta2MG reduction ratio (beta2MGRR) and CyC reduction ratio (CyCRR) were higher in the HF group compared to the LF group. However, the URR and eKt/Vurea did not differ between the two groups. The CyCRR was significantly correlated with the eKt/Vurea and beta2MGRR (r = 0.47 and 0.69, respectively, both p < 0.0001). CONCLUSIONS: Compared to the LF dialyzer, the HF dialyzer removed CyC and beta2MG more efficiently. Unlike the beta2MGRR, the CyCRR was correlated with the eKt/Vurea and beta2MGRR. This study suggests a role for the CyCRR as an alternative indicator of the removal of MMs.
Adult ; Aged ; Biological Markers/blood ; Case-Control Studies ; Cystatin C/*blood ; Female ; Hemodialysis Solutions ; Humans ; Kidney Failure, Chronic/*blood/*therapy ; Male ; Middle Aged ; Models, Biological ; Nephelometry and Turbidimetry/*methods ; Renal Dialysis/*methods ; Urea/blood ; Uremia/blood/therapy ; beta 2-Microglobulin/blood

OBJECTIVE: To investigate the effect of different concentrations of glucose peritoneal dialysates (PDS) on monolayer transmesothelial electrical resistance (TER) and migration ability of cultured human peritoneal mesothelial cells (HPMCs) to clarify the cause of peritoneal hyperpermeability state and ultrafiltration failure during prolonged peritoneal dialysis. METHODS: HPMCs were cultured in a 1:1 mixture of DMEM and PDS containing 1.5%, 2.5%, and 4.25% glucose. Methyl thiazolyl tetrazolium (MTT) assay and TER were measured to determine the effect of glucose PDS on the proliferation and permeability of human peritoneal mesothelial monolayers, respectively. Wound-healing assay was used to confirm whether glucose could do harm to the migration of cells. RESULTS: Proliferation of HPMCs was significantly suppressed by different glucose concentrations at 24 hours. TER decreased in a time- and concentration-dependent manner after culture with different concentrations of glucose PDS. Cells lost migration in the presence of high glucose after 24 hours, and most cells lost their normal morphology and became detached from plates after 48 hours of wounding. CONCLUSION High glucose in PDS can cause peritoneal damage by suppressing cell proliferation, inducing increase in paracellular permeability of HPMCs and inhibiting cell migration after damage, which may be responsible for peritoneal hyperpermeability and the development of ultrafiltration failure.
Cell Line ; Cell Membrane Permeability ; drug effects ; Cell Movement ; Electric Impedance ; Epithelium ; metabolism ; Glucose ; adverse effects ; metabolism ; Hemodialysis Solutions ; adverse effects ; Humans ; Peritoneal Dialysis ; Peritoneum ; cytology ; drug effects ; metabolism

BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis. METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A. RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 +/- 1.0 to 9.0 +/- 0.7, p = 0.002 vs. 1.3 +/- 0.1 to 1.1 +/- 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 +/- 45.8 pmol/mL at baseline to 124.9 +/- 82.2 pmol/mL at 6 months, p = 0.043). CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
Aged ; Analysis of Variance ; Ankle Brachial Index ; Arteries/*drug effects/physiopathology ; Biological Markers/blood ; Blood Pressure/drug effects ; Calcium/*administration & dosage/adverse effects ; Compliance ; Female ; Hemodialysis Solutions/*administration & dosage/adverse effects/chemistry ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulsatile Flow/*drug effects ; *Renal Dialysis ; Republic of Korea ; Time Factors ; Treatment Outcome ; alpha-2-HS-Glycoprotein/metabolism