Sorbent Augmented Dialysis: Minor Addition or Major Advance in Therapy?

Winchester, James F.; Ronco, Claudio; Brady, James A.; Golds, Ellen; Clemmer, J; Cowgill, Larry D; Muller, Thomas E.; Levin, Nathan W.

doi:10.1159/000046951

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…In the hemodialysis modalities, adsorption is the third mechanism of uremic toxin removal [12,13,14]. Sorbents can be of two major types: (a) those that have hydrophobic properties such as charcoal and non-ionic macroporous resin; (b) those that eliminate substances by chemical affinity (ion exchange resin and chemiosorbents) [14].…”

Section: Discussionmentioning

confidence: 99%

“…Sorbents can be of two major types: (a) those that have hydrophobic properties such as charcoal and non-ionic macroporous resin; (b) those that eliminate substances by chemical affinity (ion exchange resin and chemiosorbents) [14]. Charcoal-derived adsorbents remove high amounts of creatinine and ‘small uremic peaks’ but not urea, or inorganic ions (Ca ++ , K + , and HCO 3 – ); in contrast, adsorbents of the resin type remove large toxins such as β 2 -microglobulin [12,13,14, 21]. In a previous study, both the charcoal and the resin of Selecta cartridge were tested for heavy metal contamination and other toxic substances [21].…”

Section: Discussionmentioning

confidence: 99%

“…These treatments are becoming more and more popular and considered to be superior to diffusive hemodialysis [6,7,8,9,10,11]. Adsorption is a now-established third mechanism applied in extracorporeal therapies to increase the removal of uremic toxins [12,13,14]. Adsorption may be obtained by various methods, and was initially applied to the regeneration of the dialysate using charcoal-based sorbents in the search for a wearable or at least miniaturized artificial kidney system [12, 13].…”

Section: Introductionmentioning

confidence: 99%

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In vivo Removal of High- and Low-Molecular-Weight Compounds in Hemodiafiltration with On-Line Regeneration of Ultrafiltrate

Testa

Gentilhomme²,

Carrer³

et al. 2006

Nephron Clin Pract

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Background: Current methods of renal replacement therapy, combining convection and diffusion, are largely unsatisfactory in removing uremic toxins. Adsorption is a third mechanism that has been applied in extracorporeal therapy. This study evaluates the impact of hemodiafiltration with on-line regeneration of ultrafiltrate, a new two-step integrated sorbent system, on in vivo removal of a wide spectrum of solutes with different molecular weights. Methods: Pre- and post-dialysis concentrations of small, medium-size, and large molecules were determined in ten patients undergoing regular hemodiafiltration treatments with on-line regeneration of the ultrafiltrate. We also analyzed, at different times of the same dialysis session, the inlet and outlet ultrafiltrate; the latter had been regenerated by the sorbent cartridge and was used as reinfusion liquid. The mean dialysis time was 260 ± 21.2 min with a blood flow of 361 ± 33.3 ml/min and a reinjection volume of 3.6 ± 0.2 l/h. Results: Urea, creatinine and phosphate reduction ratio were respectively 69.8 ± 8.2, 61.9 ± 5.5, and 40.2 ± 17.3%. Removal of medium-size markers such as calcitonin, osteocalcin, β₂-microglobulin, cystatin C, myoglobin and prolactin varied between 24 and 60%. The percentage of reduction for retinol binding protein and α₁-microglobulin was negligible and we were unable to demonstrate any removal of α₁-acid glycoprotein, pre-albumin, and albumin in the regenerated ultrafiltrate. Conclusion: The hemodiafiltration with on-line regeneration of ultrafiltrate is a new hemodialysis system, which allows uremic toxin removal over a wide molecular-weight spectrum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vivo Removal of High- and Low-Molecular-Weight Compounds in Hemodiafiltration with On-Line Regeneration of Ultrafiltrate

Testa

Gentilhomme²,

Carrer³

et al. 2006

Nephron Clin Pract

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“…In extracorporeal blood purification, these could be the application of 1) adsorptive systems [24]; 2) alternative dialytic schedules [25]; 3) protein-leaking membranes [26]; 4) dialysis against albumin containing dialysate [27]; and 5) modification of solute protein binding during the dialysis session, allowing more removal of free solute. In extracorporeal blood purification, these could be the application of 1) adsorptive systems [24]; 2) alternative dialytic schedules [25]; 3) protein-leaking membranes [26]; 4) dialysis against albumin containing dialysate [27]; and 5) modification of solute protein binding during the dialysis session, allowing more removal of free solute.…”

Section: Protein-bound Compoundsmentioning

confidence: 99%

“…To obtain an acceptable decrease in the concentration of most protein-bound solutes, it may be necessary to introduce conceptual changes regarding removal strategies. In extracorporeal blood purification, these could be the application of 1) adsorptive systems [24]; 2) alternative dialytic schedules [25]; 3) protein-leaking membranes [26]; 4) dialysis against albumin containing dialysate [27]; and 5) modification of solute protein binding during the dialysis session, allowing more removal of free solute.…”

Section: Protein-bound Compoundsmentioning

confidence: 99%

Uremic Toxins: Removal with Different Therapies

Vanholder

Glorieux

Smet

2003

Hemodialysis International

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A convenient way to classify uremic solutes is to subdivide them according to the physicochemical characteristics influencing their dialytic removal into small water-soluble compounds (<500 Da), protein-bound compounds, and middle molecules (>500 Da). The prototype of small water-soluble solutes remains urea although the proof of its toxicity is scanty. Only a few other water-soluble compounds exert toxicity (e.g., the guanidines, the purines), but most of these are characterized by an intra-dialytic behavior, which is different from that of urea. In addition, the protein-bound compounds and the middle molecules behave in a different way from urea, due to their protein binding and their molecular weights, respectively. Because of these specific removal patterns, it is suggested that new approaches of influencing uremic solute concentration should be explored, such as specific adsorptive systems, alternative dialytic timeframes, removal by intestinal adsorption, modification of toxin, or general metabolism by drug administration. Middle molecule removal has been improved by the introduction of large pore, high-flux membranes, but this approach seems to have come close to its maximal removal capacity, whereas multicompartmental behavior might become an additional factor hampering attempts to decrease toxin concentration. Hence, further enhancement of uremic toxin removal should be pursued by the introduction of alternative concepts of elimination.

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