No abstract

High clearance continuous renal replacement therapy with a SLOW CONTINUOUS DIALYSIS modified dialysis machine. Recent studies suggest that the dial-We used a modified dialysis machine, the 2008H (Freysis dose significantly affects survival in acute renal failure senius Medical Care, Lexington, MA, USA), for SCD. (ARF) patients and that bicarbonate dialysate improves acidbase balance during continuous renal replacement therapy Special software was developed to permit dialysate flow (CRRT). These data inspired us to use slow continuous dialysis rates down to 100 ml/min (range 100 to 800 ml/min) (SCD) in the treatment of ARF. SCD is defined by the followwhile maintaining temperature control. ing parameters: (a) blood flow (Q B ) ϭ 100 to 200 ml/min, (b) Patients were treated continuously with a blood flow dialysate flow (Q D ) ϭ 100 to 300 ml/min, (c) the use of a (Q B ) of 100 to 200 ml/min and a dialysate flow (Q D ) modified hemodialysis machine with controlled ultrafiltration and online production of bicarbonate-based dialysate, and (d) of 100 ml/min. F40 or AV400S polysulfone hemofilters continuous or extended daily treatment for 8 to 24 hours. SCD (Fresenius Medical Care), each with surface areas of 0.7 provides a urea clearance in the 70 to 80 ml/min range. Prelimim 2 and standard dialysis tubing, were used. The hemonary data from an ongoing clinical trial demonstrate the safety,filter and blood lines were changed every 24 to 36 hours efficiency, and simplicity of the treatment.

The Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state-of-the-art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step-by-step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long-term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service.

Systems for monitoring hemodialysis patients at home have evolved during the past 30 years. They consist of hardware and software to record dialysis events from the home hemodialysis machine and transmit them to a server, which in turn sends the data to a remote central monitoring center. Most of the parameters monitored are related to machine function and events. At present, the only commonly monitored patient vital functions are pulse and blood pressure. The early systems used direct telephone lines and modem for telecommunication. The use of Internet links reduces the cost of the service and provides fast and safe transmission of the data. The actual value of these monitoring systems, the need for additional monitoring options, indications for specific groups of patients dialyzing at home, and acceptance by patients, physicians, and regulators will require further evaluation.

The changing patterns of utilization of home hemodialysis (HHD) are reviewed with special reference to the factors responsible for its decline and recent revival. Equipment and monitoring systems dedicated to HHD have been recently introduced in response to the demand for more frequent therapies at home. The advantages and disadvantages of novel technology versus time-tested, reliable and versatile platforms are discussed. Despite the significant technological progress achieved, much remains to be done in our quest to make HHD a simple, cost-effective and very safe renal replacement therapy.