cellulose-triacetate and Kidney-Failure--Chronic

The aim of the present study was to evaluate the alteration in plasma immunoreactive insulin (IRI) concentrations due to hemodialysis (HD) treatment by using three types of membranes in diabetic HD patients.. We recruited 20 outpatients on maintenance HD with diabetes for this crossover study. HD was performed using membranes made of cellulose triacetate (CTA), polyester-polymer alloy (PEPA), and polysulphone (PS). These membranes were used for 2 weeks (6 HD sessions) in each patient in a randomized order decided by drawing lots. Blood samples were obtained at the beginning and end of the HD session from the blood tubing at the arterial (A) site. At 60 min after the initiation of dialysis, blood samples were obtained from the blood tubing at both the A and venous (V) sites of the dialyzer.. The plasma IRI levels decreased significantly at the sites an hour after initiating HD in all membranes. The clearance of IRI was significantly higher in the case of the PS membrane when compared with the CTA and PEPA membranes.. It was concluded that plasma insulin is cleared by HD, and the rate differs for each membrane. Plasma insulin clearance with the PS membrane is higher than that with the PEPA and CTA membranes.

Topics: Biocompatible Materials; Blood Glucose; Cellulose; Cross-Over Studies; Diabetic Nephropathies; Female; Humans; Insulin; Kidney Failure, Chronic; Male; Membranes, Artificial; Middle Aged; Polyesters; Polymers; Renal Dialysis; Sulfones

Neutrophil oxygen radical production is increased in end-stage renal disease (ESRD) patients and it is further enhanced during dialysis with low-flux cellulosic membranes. This increased oxygen radical production may contribute to the protein and lipid oxidation observed in ESRD patients. We tested the hypothesis that high-flux hemodialysis does not increase oxygen radical production and that it is not associated with protein oxidation.. Neutrophil oxygen radical production was measured during dialysis with high-flux dialyzers containing polysulfone and cellulose triacetate membranes. Free sulfhydryl and carbonyl groups and advanced oxidation protein products were measured to assess plasma protein oxidation.. Pre-dialysis, neutrophil oxygen radical production was significantly greater than normal and increased significantly as blood passed through the dialyzer in the first 30 minutes of dialysis. Post-dialysis, however, neutrophil oxygen radical production had decreased and was not different from normal. Pre-dialysis, significant plasma protein oxidation was evident from reduced free sulfhydryl groups, increased carbonyl groups, and increased advanced oxidation protein products. Post-dialysis, plasma protein free sulfhydryl groups had increased to normal levels, while plasma protein carbonyl groups increased slightly, and advanced oxidation protein products remained unchanged.. The results of this study show that neutrophil oxygen radical production normalizes during high-flux dialysis, despite a transient increase early in dialysis. This decrease in oxygen radical production is associated with an improvement in some, but not all, measures of protein oxidation.

Topics: Blood Proteins; Cellulose; Female; Humans; Kidney Failure, Chronic; Leukocyte Count; Male; Membranes, Artificial; Middle Aged; Neutrophils; Oxidation-Reduction; Oxidative Stress; Polymers; Renal Dialysis; Respiratory Burst; Sulfones

Degranulation of polymorphonuclear leukocytes (PMNL) occurs during extracorporeal circulation. A degranulation-inhibiting protein identical to angiogenin was recently isolated from high-flux dialyzer ultrafiltrate. This protein inhibits the release of lactoferrin and metalloproteinases from PMNL in vitro. In the present study, we investigated end-stage renal disease patients undergoing regular hemodialysis treatment with either high-flux dialyzers (n = 51) or low-flux dialyzers (n = 44), and chronically uremic patients undergoing hemodiafiltration (n = 30). Hemodialysis therapy with low-flux polysulfone or cellulose triacetate membranes caused no or only minimal reduction (

Topics: Adult; Aged; Aged, 80 and over; Azo Compounds; Cell Degranulation; Cellulose; Extracorporeal Circulation; Female; Humans; Kidney Failure, Chronic; Lactoferrin; Leukocyte Elastase; Male; Membranes, Artificial; Middle Aged; Neutrophils; Polymers; Renal Dialysis; Ribonuclease, Pancreatic; Sulfones

Traditionally, vancomycin is administered following dialysis to minimize drug loss when high-flux membranes are employed. Unfortunately, this approach is extremely inconvenient for patients and staff, requiring the patients to remain in the unit for at least 1 hour following dialysis. This study was designed to evaluate the feasibility of administering vancomycin during hemodialysis. Specifically, this study was designed to compare the pharmacokinetics of vancomycin when administered during the last 1-2 hours of dialysis (i.e. intra-dialytic administration) to that administered after completion of dialysis.. In a randomized, 3-way crossover trial, the pharmacokinetics of vancomycin were evaluated in 9 hemodialysis patients, comparing vancomycin 15 mg/kg following dialysis (Phase I), vancomycin 15 mg/kg during the last hour of hemodialysis (Phase II) or vancomycin 30 mg/kg during the last 2 hours of hemodialysis (Phase III). Vancomycin plasma concentrations were obtained over an 8-day period and subsequent comparisons between the treatment approaches were made with paired t-tests or ANOVA, as appropriate. Dialysate vancomycin concentrations determined on Day 1 and Day 3 of Phases II and III were used to calculate the fraction of vancomycin dose removed, and were compared to plasma data using paired t-tests.. Vancomycin was significantly removed (33.4 to 39.5%) during a 3- to 4-hour high-flux dialysis session occurring on Day 3 after vancomycin administration. Mean serum concentrations immediately following intradialytic vancomycin administration of 15 mg/kg over the last hour of dialysis or 30 mg/kg over the last 2 hours of dialysis were initially high (77.7 and 95.5 mcg/ml respectively), but fell to 25.9 and 40.5 mcg/ml, respectively, by 4 hours post-dialysis. Predialysis concentrations on Days 3, 5 and 8 were similar for vancomycin 30 mg/kg administered over the last 2 hours of dialysis as compared with a 15 mg/kg dose given after dialysis. Vancomycin 15 mg/kg over the last hour of dialysis resulted in significantly lower subsequent predialysis concentrations than the other dosing schemes.. Vancomycin administration of 30 mg/kg over the last 2 hours of dialysis achieves serum concentrations similar to conventional dosing of 15 mg/kg after dialysis and would allow dosing on a weekly basis.

Topics: Adult; Anti-Bacterial Agents; Cellulose; Cross-Over Studies; Drug Administration Schedule; Drug Monitoring; Feasibility Studies; Female; Humans; Kidney Failure, Chronic; Male; Membranes, Artificial; Renal Dialysis; Time Factors; Vancomycin

Membrane biocompatibility has long been thought to be relevant to hemodialysis outcomes and, possibly, renal anemia.. We performed a randomized, controlled, single-center study comparing the consequences on renal anemia of 2 dialyzers of equivalent performance, but different composition, during 7 months. Two hundred eleven patients of an unselected dialysis population of 235 patients gave informed consent to undergo random assignment to either group A (SF170E; modified cellulose triacetate/midflux membrane; Nipro, Osaka, Japan) or group B (HF80LS; polysulfone/high-flux membrane; Fresenius, Bad Homburg, Germany). Anemia management was identical in both treatment groups and followed strict clinical protocols managed by computer algorithms. Dialysis adequacy, hemoglobin (Hb) level, ferritin level, percentage of red blood cell hypochromicity, C-reactive protein (CRP) level, and intravenous iron and epoetin doses were monitored monthly.. One hundred seventy-seven patients completed the 7-month study. Equilibrated Kt/V increased in both groups. Hb outcome improved overall, but did not differ between the 2 study groups. Epoetin dose was not significantly different after 7 months compared with baseline in either group. Hb level, epoetin dose, iron status, CRP level, dialysis Kt/V, and residual renal function did not differ between the 2 groups. A slight but significant negative correlation was identified between dialysis Kt/V and Hb level in the population as a whole (Spearman's correlation, -0.16; P = 0.04).. No significant epoetin-sparing effect was identified through the use of the high-flux polysulfone HF80LS membrane over the modified cellulose triacetate SF170E membrane. Although not a primary outcome for this study, there was a suggestion of benefit of improved Hb level, without increased need for epoetin, through increasing delivered dialysis dose.

Topics: Adult; Aged; Anemia; C-Reactive Protein; Cellulose; Epoetin Alfa; Erythrocytes; Erythropoietin; Female; Ferritins; Hemoglobins; Humans; Iron; Kidney Failure, Chronic; Male; Membranes, Artificial; Middle Aged; Parathyroid Hormone; Phosphorus; Polymers; Potassium; Recombinant Proteins; Renal Dialysis; Sulfones

Secretion of cytokines by monocytes has been implicated in the pathogenesis of dialysis-related morbidity. Cytokine generation is presumed to take place in two steps: induction of mRNA transcription for cytokines by C5a and direct membrane contact, followed by lipopolysaccharide (LPS)-induced translation of mRNA (priming/second signal theory, Kidney Int 37: 85-93, 1990). However, the in vitro conditions on which this theory was based differed markedly from clinical dialysis. To test this postulate for routine hemodialysis, 13 patients were studied cross-over with high-flux cuprammonium (CU), cellulose triacetate (CTA), and polysulfon dialyzers, using standard bicarbonate dialysate, as well as CTA with filtered dialysate (fCTA). Besides leukocytes, C3a, C5a, and limulus amebocyte lysate reactivity, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-6, IL-1RA, soluble TNF receptors, and IL-1 beta mRNA were assessed. Only during dialysis with CU did C5a increase significantly (561 to 8185 ng/ml, P < 0.001). Endotoxin content of standard bicarbonate was higher than filtered dialysate (median, 24.3 and < 5 pg/ml respectively, P = 0.002), whereas limulus amebocyte lysate reactivity was not detected in the blood, except in the case of CU. TNF-alpha levels were elevated before, and remained stable during, dialysis, independent of the modality used. IL-1 beta, IL-6, and mRNA coding for IL-1 beta could not be demonstrated. IL-1RA and soluble TNF receptors (p55/p75) were markedly elevated compared with normal control subjects, but showed no differences between fCTA and CTA. To summarize, no evidence was found for production and release of cytokines by monocytes during clinical high-flux bicarbonate hemodialysis, neither with complement-activating membranes nor with unfiltered dialysate. Therefore, this study sheds some doubt on the relevance of the "priming/second signal" theory for clinical practice. The data presented suggest that reluctance to prescribe the use of high-flux dialyzers, as advocated in many reports, may not be warranted.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Cellulose; Cross-Over Studies; Cytokines; Dialysis Solutions; Female; Humans; Indicators and Reagents; Kidney Failure, Chronic; Leukocyte Count; Male; Membranes, Artificial; Middle Aged; Monocytes; Radioimmunoassay; Receptors, Interleukin-1; Receptors, Tumor Necrosis Factor; Renal Dialysis; Tumor Necrosis Factor-alpha

To assess the capability of three different membranes to remove porphyrins, plasma and dialysate porphyrin levels were fluorometrically measured in 10 patients with end-stage renal failure who were on hemodialysis. Three different hemodialysis membranes were used: cuprophan, polyacrylonitrile, and cellulose triacetate. Total plasma porphyrin concentrations decreased after dialysis, but to a lesser extent when using the cuprophan membrane (19%) than with the polyacrylonitrile (26%) or cellulose triacetate (30%) membranes (P < 0.01). However, since the free plasma porphyrin fraction remained unchanged, it can be assumed that the equilibrium between protein-bound and non-protein-bound (free) porphyrins is displaced toward the latter fraction. Dialysate porphyrin levels were lower (P < 0.01) when using the cuprophan membrane (10.1 micrograms/session) than when using polyacrylonitrile (17.8 micrograms/session) and cellulose triacetate (21.9 micrograms/session). Although most of the plasma porphyrins are protein bound, our results show that hemodialysis can remove significant amounts of non-protein-bound (free) porphyrins. The polyacrylonitrile and cellulose triacetate membranes had a greater capacity for porphyrin removal than cuprophan. Thus, two high-permeability membranes (polyacrylonitrile and cellulose triacetate) should be used whenever a reduction of plasma porphyrin levels is desired.

Topics: Acrylic Resins; Adult; Aged; Analysis of Variance; Biocompatible Materials; Cellulose; Female; Humans; Kidney Failure, Chronic; Male; Membranes, Artificial; Middle Aged; Porphyrins; Renal Dialysis

This study was designed to evaluate the pharmacokinetics of vancomycin during hemodialysis with cellulose triacetate (CT) high-flux dialyzers and to assess the influence of membrane surface area on intradialytic clearance. In a randomized crossover fashion, the pharmacokinetics of vancomycin were evaluated during dialysis with the CT 110 and CT 190 membranes. Six hemodialysis patients received 1 g of vancomycin immediately after the completion of a dialysis session, and subsequently, blood samples were obtained over a 5-day study period. On Day 3 subjects were dialyzed with CT 110 or CT 190 membranes. The mean intradialytic clearance of vancomycin was 56.7 +/- 7.5 and 100.70 +/- 10.7 mL/min with the CT 110 and CT 190 membranes, respectively (P < 0.05). Significant rebound in vancomycin serum concentrations occurred after dialysis; this rebound appeared to be complete 3 h postdialysis. On the basis of postrebound concentrations, the apparent percent removal of vancomycin was 23.6 +/- 1.2 and 25.2 +/- 8.6% for CT 110 and CT 190 membranes, respectively (not significant). Vancomycin is significantly cleared during dialysis with cellulose triacetate membranes, and its clearance is dependent on membrane surface area. Although a small supplemental dose of vancomycin could be administered after dialysis to replace drug lost during dialysis, it may be more efficient to give a larger dose of vancomycin after several dialysis periods. The determination of vancomycin removal can be used to estimate vancomycin serum concentrations as well as dosage requirements. This in conjunction with serum concentration monitoring can be used to optimize vancomycin dosing.

Topics: Adult; Aged; Anti-Bacterial Agents; Cellulose; Cross-Over Studies; Female; Humans; Kidney Failure, Chronic; Male; Membranes, Artificial; Middle Aged; Osmolar Concentration; Renal Dialysis; Time Factors; Vancomycin

An in vivo cross-over study has investigated plasma and cellular levels of IL-1 (IL-1 alpha IL-1 beta and IL-1Ra) when using Cuprophan (C) and cellulose triacetate (CTA) membranes to assess the roles of complement activation and dialysate endotoxin content in the induction of cytokines during the dialysis procedure. The mean C5a level during Cuprophan dialysis was 29.9 +/- 0.63 ng/ml (Mean +/- SEM), while for the cellulose triacetate dialysis was 3.09 +/- 0.7 ng/ml. The endotoxin content of the dialysate was 0.31 +/- 0.34 EU/ml and 0.68 +/- 1.39 EU/ml. These two factors failed to produce measurable changes in plasma or cellular IL-1 alpha and IL-1 beta levels during treatment. The plasma IL-1Ra levels predialysis were similar to those for normal controls (CTA 769 +/- 156 ng/ml, C739 +/- 93, normal controls 635 +/- 33) with a considerable day to day variation. A membrane independent fall in plasma IL-1Ra at 15 minutes was noted (CTA 420 +/- 92 ng/ml, C 503 +/- 139) with a return to pre-dialysis levels by the end of treatment. Cellular IL-1Ra levels pre-dialysis were similar to the normal group--(CTA 1904 +/- 291 ng/ml, C 1564 +/- 292 and normal control 1971 +/- 368). However, on average, the values when using cellulose triacetate were 655 +/- 623 pg/ml higher than for Cuprophan (p = 0.03). These findings indicate that the measurement of plasma cytokine levels is of limited use in the study of cytokine induction by the haemodialysis procedure and that IL-1Ra may be a better indicator of the host response to cytokine stimuli during treatment. However, a considerable inter-patient and intra-treatment variation is present and further studies are required to elucidate the factors involved.

Topics: Aged; Biocompatible Materials; Cellulose; Complement Activation; Complement C5a; Cross-Over Studies; Endotoxins; Enzyme-Linked Immunosorbent Assay; Female; Humans; Interleukin 1 Receptor Antagonist Protein; Interleukin-1; Kidney Failure, Chronic; Longitudinal Studies; Male; Membranes, Artificial; Middle Aged; Recombinant Proteins; Renal Dialysis; Sialoglycoproteins

The mechanisms behind reported decreases in plasma insulin and glucagon during hemodialysis (HD) are not clear. Here, we investigated these mechanisms during HD treatment and the characteristics of insulin and glucagon removal when using two super high-flux membranes. In an experimental study, clearance, adsorption rates, and reduction rates of insulin and glucagon were investigated when using cellulose triacetate (CTA) and polysulfone (PS) membranes in a closed circuit using bovine blood. In a clinical study, 20 diabetes patients with end-stage kidney disease who were stable on HD were randomly selected for two HD sessions with two different membranes. At 1 h after the initiation of HD, insulin and glucagon clearance were measured, and the reduction rates were also investigated. In the experimental study, the PS membrane showed significantly higher clearance, adsorption rates, and reduction rates of insulin and glucagon compared with the CTA membrane. Although glucagon was detected in the ultrafiltration fluids in both membranes, insulin was absent in the PS membrane. In the clinical study, both membranes showed significant reductions in plasma insulin and glucagon at each time point. The PS membrane showed significantly higher insulin clearance and reduction rates compared with the CTA membrane. The two membranes showed no significant difference in glucagon clearance, but the glucagon reduction rate was significantly higher with the PS membrane. Our findings show that HD with the two super high-flux membranes used removes significant amounts of glucoregulatory peptide hormones from plasma in patients with diabetes and end-stage kidney disease, potentially affecting their glucose metabolism.

Topics: Animals; Cattle; Diabetes Mellitus; Glucagon; Humans; Insulin; Insulin, Regular, Human; Kidney Failure, Chronic; Kinetics; Membranes, Artificial; Renal Dialysis

Topics: C-Reactive Protein; Cellulose; Glomerulonephritis, Membranous; Humans; Hyperlipidemias; Kidney Failure, Chronic; Lymphoma; Male; Membranes, Artificial; Middle Aged; Pneumonia, Pneumocystis; Renal Dialysis; Triglycerides

Serum β-trace protein (βTP, MW 23-29 kDa) is a marker of GFR impairment in renal patients. Recent papers propose to predict residual renal function (RRF) in maintenance haemodialysis (MHD) patients from serum concentrations of βTP and other small proteins, avoiding the collection of urine. Few data are available on the removal of βTP in patients treated with dialysis membranes with different flux characteristics. The aim of this study was to evaluate the effects of haemodialysis with low-flux, high-flux and super high-flux membranes on serum concentrations of ßTP in MHD patients with null RRF.. Serum ßTP concentrations were measured before and after the first dialysis of the week in 51 MDH patients treated by low-flux (n = 24), high-flux (n = 17), or super high-flux (n = 10) membranes. The removal of β2-microglobulin (β2M, MW 11.8), cystatin C (Cys, MW 13.3), urea and creatinine was also analyzed.. Low-flux membranes did not remove βTP, β2M and Cys whose concentration increased at the end of dialysis. High-flux membrane removed more efficiently β2M and Cys than ßTP. Super high-flux membrane had the highest efficiency to remove ßTP: mean reduction ratio (RR) 53.4%, similar to β2M (59.5%), and Cys (62.0%).. In conclusion, the plasma clearance of small proteins and particularly of βTP is dependent from the permeability of the dialysis membranes Therefore, the reliability of the formulas proposed to predict RRF from serum βTP and other LMWP may be affected by the different permeability of the dialysis membranes.

Topics: Acrylonitrile; Aged; Aged, 80 and over; Alkanesulfonates; beta 2-Microglobulin; Cellulose; Creatinine; Cross-Sectional Studies; Cystatin C; Female; Glomerular Filtration Rate; Humans; Intramolecular Oxidoreductases; Kidney Failure, Chronic; Lipocalins; Male; Membranes, Artificial; Middle Aged; Polymers; Renal Dialysis; Sulfones; Urea

During hemodialysis session, several adverse reactions can occur on platelets, which are attributable to bioincompatibility of the dialysis membrane. Glycoprotein IIb/IIIa (GPIIb/IIIa) is the receptor for fibrinogen, which mediates platelet aggregation and adhesion. Accordingly, we compared the influence of a cellulose triacetate (CTA) and polysulfone (PS) membrane on GPIIb/IIIa and platelet activation.. Blood samples from 5 patients on hemodialysis were taken at 0 time, 15 min, 30 min, 60 min and 240 min, during a single hemodialysis session, by a crossover design using CTA or PS. Platelet count and plasma concentration of GPIIb/IIIa, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF-4) were measured. GPIIb/IIIa was measured by flow cytometry. beta-TG and PF-4 were measured by ELISA.. There was no significant change in the total amount of GPIIb/IIIa during dialysis session between the CTA and PS. However, the level of bound GPIIb/IIIa was significantly (p < 0.0002) increased from 1,426 +/- 435 to 40,446 +/- 2,777 mol/PLT with PS. In contrast, there was no significant change with CTA (3,258 +/- 1,469 to 4,301 +/- 1,422 mol/PLT). The platelet counts and beta-TG and PF-4 behavior during the dialysis session did not show significant change between the PS and CTA.. The characterization of changes in platelet membrane receptor (GPIIb/IIIa) may be a useful marker for studying the biocompatibility of dialysis membranes. On platelet aggregation, CTA might be more biocompatible membrane than PS.

Topics: Adult; beta-Thromboglobulin; Biocompatible Materials; Cellulose; Cross-Over Studies; Female; Humans; Kidney Failure, Chronic; Male; Materials Testing; Membranes, Artificial; Middle Aged; Platelet Activation; Platelet Count; Platelet Factor 4; Platelet Glycoprotein GPIIb-IIIa Complex; Polymers; Renal Dialysis; Sulfones; Thrombosis

Topics: Anticonvulsants; Cellulose; Humans; Kidney Failure, Chronic; Phenytoin; Renal Dialysis