With the rapid development of my country's hemodialysis industry, the application of hemodialysis machines has become more and more extensive, but at the same time, the quality control technology of hemodialysis machines is not perfect. Especially for a wide range of leachable substances in dialyzers, there are few studies and detection methods. This study first briefly describes the development of hemodialyzers, and then expounds the common types of leachables, extraction methods, and chromatography and mass spectrometry conditions. It is summarized that the research plan of leachable substances is to determine the type first, then formulate the extraction plan, and then establish the detection method. Finally, we look forward to the research prospects of hemodialyzer leachables, and point out that with the deepening and extensive development of research, it can further promote the healthy development of the hemodialyzer industry.
Humans ; Kidney Failure, Chronic/therapy* ; Kidneys, Artificial ; Renal Dialysis

Kidney diseases including acute kidney injury and chronic kidney disease are among the largest health issues worldwide. Dialysis and kidney transplantation can replace a significant portion of renal function, however these treatments still have limitations. To overcome these shortcomings, a variety of innovative efforts have been introduced, including cell-based therapies. During the past decades, advances have been made in the stem cell and developmental biology, and tissue engineering. As part of such efforts, studies on renal cell therapy and artificial kidney developments have been conducted, and multiple therapeutic interventions have shown promise in the pre-clinical and clinical settings. More recently, therapeutic cell-secreting secretomes have emerged as a potential alternative to cell-based approaches. This approach involves the use of renotropic factors, such as growth factors and cytokines, that are produced by cells and these factors have shown effectiveness in facilitating kidney function recovery. This review focuses on the renotropic functions of bioactive compounds that provide protective and regenerative effects for kidney tissue repair, based on the available data in the literature.
Acute Kidney Injury ; Cell- and Tissue-Based Therapy ; Cytokines ; Developmental Biology ; Dialysis ; Intercellular Signaling Peptides and Proteins ; Kidney ; Kidney Diseases ; Kidney Transplantation ; Kidneys, Artificial ; Recovery of Function ; Regenerative Medicine ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Stem Cells ; Tissue Engineering

The number of patients is increasing and their mean age is also increasing. Proper dietary adjustments are necessary to prevent protein-calorie malnutrition or complications but it is difficult for dialysis patients to adapt to diet therapy due to stress or anorexia. Education does not consider the individual characteristics, knowledge, dietary inhabit education demands, and initial education. The purpose of this study was to identify dialysis patient's nutrition knowledge and, dietary practice and compare those with nutrition education or counseling demands for providing basic data of desirable nutrition management. The data were collected by a survey consisting of the general characteristics, disease related characteristics, nutrition education and counsel characteristics, level of nutrition knowledge, diet therapy, and nutrition education and counsel demands from the 28th March to 22th July 2017. The total number of subjects were 33 patients among dialysis patients at two tertiary medical institutions and an artificial kidney room at a private hospital in Incheon·Gyeonggi. The data collected were analyzed statistically using the SPSS program 23.0, followed by further analyses using frequency analysis, one-way ANOVA, cross analysis, and correlation analysis. The results of the dialysis patients showed that younger (P < 0.05), female (P < 0.05), abnormal high school diploma (P < 0.001) groups had high nutrition scores. In addition, dietary practice and nutrition education and counsel demands showed a positive correlation (P < 0.05, P < 0.01). In particular, females were higher than males in nutrition knowledge, dietary practice, nutrition education, and counseling demand scores.
Anorexia ; Counseling ; Dialysis ; Diet Therapy ; Diet ; Education ; Female ; Hospitals, Private ; Humans ; Kidney Failure, Chronic ; Kidneys, Artificial ; Male ; Protein-Energy Malnutrition

Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 +/- 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 +/- 6.7 kcal/kg/day) and protein (0.9 +/- 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 +/- 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ > or = 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy.
Calcium ; Cross-Sectional Studies ; Diet Records ; Diet* ; Energy Intake* ; Female ; Folic Acid ; Humans ; Kidneys, Artificial ; Korea ; Male ; Mortality ; Nutritive Value ; Recommended Dietary Allowances ; Renal Dialysis* ; Seoul

The purpose of this study was to evaluate diet-related Quality of Life (QOL) and to analyze the relationship among diet-related QOL, dietary regimen practice, health-related QOL, and gastrointestinal symptoms in hemodialysis patients. Subjects were recruited from an artificial kidney center in Seoul. The self-report questionnaire consisted of socio-demographic characteristics, diet-related QOL, compliance with dietary regimen practice, health-related QOL, and gastrointestinal symptoms was distributed. Diet-related QOL includes a 'Quality of Life and Related to Dietary Change Questionnaire', 'Satisfaction Survey', and 'Dietary Impact Survey'. According to their responses, participants had experienced the greatest difficulty with 'Dietary Impact'. In particular, the mean score for general health was low. Association of dietary regimen practice showed a positive association with 'Cost' and 'Self-care' score. In addition, diet-related QOL showed positive correlation with health-related QOL, particularly in 'taste'. Scores for 'Taste', 'Convenience', and 'Dietary Impact' were lower for subjects with constipation compared to those of subjects without constipation. Scores for 'Taste' and 'Dietary Impact' were lower in subjects with irritable bowel syndrome compared to those of subjects without the syndrome (p < 0.05). Diet-related QOL showed a positive association with health-related QOL (p < 0.05), whereas it showed a negative association with constipation (p < 0.01). In conclusion, hemodialysis patients in Korea suffer from burden of dietary regimen practice and most scores for diet-related QOL and health-related QOL from patients with gastrointestinal symptoms were low. Therefore, appropriate nutrition education considering gastrointestinal symptoms is necessary for improvement of patients' QOL during dietary regimen practice.
Compliance ; Constipation ; Humans ; Irritable Bowel Syndrome ; Kidney Failure, Chronic ; Kidneys, Artificial ; Korea ; Quality of Life ; Surveys and Questionnaires ; Renal Dialysis

Maintenance hemodialysis is a mainstay of the renal replacement therapy for patients with end stage renal disease. The development of modern hemodialysis is principally owing to the invention of artificial kidney machine and the establishment of a stable and practical dialysis access. The developmental history of vascular access surgery will be discussed with the heroic works of the pioneers.
Dialysis ; Humans ; Inventions ; Kidney Failure, Chronic ; Kidneys, Artificial ; Renal Dialysis ; Renal Replacement Therapy

BACKGOUND: Bisphenol-A (2,2-bis (4-hydroxyphenyl)propane, BPA) is suspected to be an endocrine disruptor. BPA is a component of polycarbonate (PC), polysulfone (PS), and epoxy resins. PC is used as a material in the case header. Evaluation of BPA release from hemodialyzers may be very important, because BPA released from hemodialyzers is directly introduced into blood circulation. We examined the plasma levels of BPA before and after a hemodialysis session to evaluate the degree of BPA in patients with regular hemodialysis. METHODS: Ten patients undergoing regular hemodialysis were enrolled. We used cellulosynthetic dialyzer (Hemophan(R)-Alwall GFS Plus 2) and Bisphenol A concentration in plasma that had been taken before and after a hemodialysis session determined by gas chromatography-mass spectrometry (GC/MS) analysis. RESULTS: Plasma BPA levels before and after a hemodialysis session were 0.02+/-0.05 ng/mL and 0.16+/-0.15 ng/mL respectively. Plasma BPA levels after a hemodialysis session were significantly higher than those before hemodialysis. There were no significant correlations between plasma BPA level and several clinical parameters such as Kt/V, duration of hemodialysis, ultrafiltraion, blood flow, and age. CONCLUSION: Very small amounts of BPA were released from the cellulosynthetic hemodialyzer during a hemodialysis session. BPA doesn't seem to accumulate in the body of patients undergoing regular hemodialysis using cellulosynthetic hemodialyzer.
Blood Circulation ; Epoxy Resins ; Gas Chromatography-Mass Spectrometry ; Humans ; Kidneys, Artificial ; Plasma ; Renal Dialysis*

PURPOSE: This study was designed to explore the effects of providing individualized education for hemodialysis patients on their knowledge of hemodialysis, compliance of patient role behavior, and physiologic parameters. METHOD: A quasi experimental design with a non-equivalent control group and a non-synchronized design was used. The experiment was conducted with a total of 40 hemodialysis patients (20 in the experimental group and 20 in the control group) at the artificial kidney center, C University Hospital. The experimental group was provided with individualized education, 30 minutes per session, three times per week, for two weeks. RESULTS: The experimental group had significantly higher knowledge of hemodialysis than the control group after the education. The compliance of patient role behavior was more enhanced in the experimental group than the control group. The experimental group showed significantly higher values of blood urea nitrogen, but not the values of blood creatinine, albumin, kalium, and phosphorus. CONCLUSION: The individualized education was found to be an effective intervention for improving patients' knowledge of hemodialysis and compliance of patient role behavior.
Blood Urea Nitrogen ; Compliance* ; Creatinine ; Education* ; Humans ; Kidneys, Artificial ; Phosphorus ; Renal Dialysis* ; Research Design

BACKGROUND: Continuous veno-venous hemofiltration (CVVH) is one of the continuous renal replacement therapies for managing patients with refractory edema or oliguric renal failure with unstable vital signs. High-flux hemofilters are usually used for CVVH, but low-flux hemodialyzers are not used for CVVH. We tried temporary veno-venous hemofiltration (TVVH) procedures using low-flux hemodialyzers for 9 patients with acute or chronic renal failure who were on mechanical ventilation with positive end-expiratory pressure (PEEP) in the ICU. METHODS: All of the nine patients with acute or chronic oligo-anuric renal failure could not receive hemodialysis treatment in the hemodialysis room, because they were on mechanical ventilation with PEEP in the ICU due to severe fluid overload with elevated CVP and acute pulmonary edema. Low-flux hemodialyzers with effective membrane area of 1.0- 1.1 m2 and blood pumps on the discarded hemodialysis machines were used for TVVH procedures. RESULTS: Mean duration of TVVH was 17.0+/-16.7 hours and mean ultrafiltration rate was 440+/-203 mL/hour. After finishing the TVVH procedures, CVP decreased from 22.9+/-8.5 cmH2O to 6.4+/-2.4 cmH2O. Of nine patients, 6 patients (67%) were able to be off the mechanical ventilation with clinical improvement. CONCLUSION: Even if CVVH is usually done with expensive high-flux hemofilters and CVVH machines, simplified and cheaper TVVH procedures using low- flux hemodialyzers and discarded hemodialysis machines with functioning blood pumps can be done with good results and cost effectiveness, especially in institutions not equipped with facilities such as CVVH machines or portable water purification systems for hemodialysis in the ICU.
Cost-Benefit Analysis ; Edema ; Hemofiltration* ; Humans ; Kidney Failure, Chronic ; Kidneys, Artificial* ; Membranes ; Positive-Pressure Respiration ; Pulmonary Edema ; Renal Dialysis ; Renal Insufficiency ; Renal Replacement Therapy ; Respiration, Artificial ; Ultrafiltration ; Vital Signs ; Water Purification

The present study was designed to compare the nutritional status of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Subjects were 58 HD patients (male/female = 29/29) and 33 CAPD patients (male/female=23/10) undergoing dialysis treatment in Artificial Kidney Unit of Chonbuk National University Hospital. For nutritional assessment, %IBW (ideal body weight), %TSF (tricep skin fold), %MAC (mid arm circumference), %MAMC (mid arm muscle circumference), serum albumin, serum transferrin, TLC (total lymphocyte count), SGA (subjective global assessment) and estimated energy and protein intakes by 1-month food frequency method were used. Between HD and CAPD group, mean age (50+/-12 vs. 52+/-12 yr), dialysis durations (37+/-36 vs. 30+/-26 mon), dietary energy intakes (28.3+/-9.0 vs. 28.8+/-8.6 kcal/kg/day), dietary protein intakes (1.1+/-0.4 vs. 1.2+/-0.3 g/kg/day) and incidence of co-morbid conditions (69.0% vs. 69.7%) were not significantly different. Data by using SGA showed a higher incidence of malnutrition in CAPD patients (45.6%) than in HD patients (36.2%). %IBW (p<0.001), %TSF (p<0.001) and %MAC (p<0.001) were higher in CAPD patients than were in HD patients. But serum albumin (p<0.001) and transferrin (p<0.001) were significantly lower in CAPD patients than were in HD patients. A higher incidence of malnutrition was shown in CAPD Patients than in HD Patients due to different dialysis type. A significant finding was that CAPD showed protein deficient malnutrition and HD did calorie deficient malnutrition. It suggests that an adequate dietary intake considering dialysis type prevents a prevalence of malnutrition.
Arm ; Dialysis ; Dietary Proteins ; Humans ; Incidence ; Jeollabuk-do* ; Kidneys, Artificial ; Lymphocytes ; Malnutrition ; Nutrition Assessment ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory ; Prevalence ; Renal Dialysis* ; Serum Albumin ; Skin ; Transferrin