Uremic toxicity

Vanholder, Raymond; Smet, Rita De; Lameire, Norbert

doi:10.1007/978-1-4020-2275-3_2

Cited by 8 publications

(8 citation statements)

References 423 publications

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“…This divergence may be due to the following reasons: (a) several solutes are measured with UV absorbance and compared with only one solute, respectively, (b) a dilution effect in the TDC tank that is more prominent at the end of session, and (c) different characteristics of dialyzers affecting the solute elimination rates differently. It is surprising that the studied solutes all have such a good correlation to AUCa n despite the kinetic behavior of different solutes during dialysis being different 10 . It is a fact that only one of the studied solutes is UV active at the wavelength of 297 nm, namely urate; 3 on the other hand, urea removal strongly exceeds the other solutes.…”

Section: Discussionmentioning

confidence: 94%

Complementary parameter for dialysis monitoring based on UV absorbance

Uhlin

Pettersson

Fernström

et al. 2009

Hemodialysis International

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An optical on-line monitoring system aimed at the estimation of dialysis dose has been tested clinically. The natural logarithmic slope is used to calculate Kt/V(urea) from ultraviolet (UV)-absorbance measurements. Errors in the calculation of Kt/V(urea) may appear due to changes in blood and dialysate flow or due to disturbances when the slope is used to estimate dialysis dose. This study introduces a new parameter for dialysis monitoring that may be used as a complementary parameter, the area under UV-absorbance curve (AUCa), to reflect a total solute removal during dialysis. The aim was to investigate the relationship between this new dialysis on-line monitoring parameter, AUCa, and the total removal of a few solutes. Fifteen patients were monitored during hemodialysis using UV absorbance at the wavelength of 297 nm. All spent dialysate passed through a flow cuvette in a spectrophotometer and then further to a collection tank where solute concentrations in the entire spent dialysate were determined. The AUCa at 297 nm was compared with the total amount of removed solute in the tank (reference method). The result shows strong correlations between AUCa and the total removal of urea, urate, creatinine, and phosphate during a given treatment and less strong correlation in all 15 patients together. A first indication of a new, possible, complementary parameter in hemodialysis treatment is presented, the AUCa, prospected to estimate solute removal.

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Section: Discussionmentioning

confidence: 94%

Complementary parameter for dialysis monitoring based on UV absorbance

Uhlin

Pettersson

Fernström

et al. 2009

Hemodialysis International

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“…Dialysate effluent is predominantly water, as well as by‐products of the human metabolism (organic and mineral compounds) plus possible bacteria, viruses, and medications …”

Section: Resultsmentioning

confidence: 99%

Toward green dialysis: Focus on water savings

Ponson

Arkouche

Laville

2013

Hemodialysis International

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Hemodialysis is one of the most water and energy-hungry medical procedures, and thus represents a clear opportunity where improvements should be made concerning the consumption and wastage of water. Three levels were investigated on which there are potential savings: the precise adjustment of water production according to specific needs, the reuse of reverse osmosis rejected water, and finally the huge volumes of post-patient dialysate effluent. The "AURAL" (Association pour l'Utilisation du Rein Artificiel à Lyon), main unit in Lyon, was the site of investigation for this study, which cares for 173 chronic hemodialysis patients. Evaluation of the 3 levels described earlier was undertaken on this particular building, and on the water treatment currently used. Volumes of produced water can be improved by different hydraulic systems or by adjusting the pure water conductivity used for dialysis. Concerning the reject water, reuse for building sanitation became the focus of further attention. The technical feasibility, volume of saved water, and applicable work costs were considered. The results suggest that out of a possible 2834 m(3)/year of reject water, 1200 m(3)/year may be reused and return on investment recovered within 5.8 years. Finally, the reprocessing and feasibility of reuse of dialysate effluent were investigated. Initial calculations show that although technical solutions are available, such processing of the wastewater production is not profitable in the short term. Regarding the significant prior authorization and risk management analysis necessary for such a project, this avenue was pursued no further. From the perspective of a "green dialysis," the reuse of reject water into sanitation is both viable and profitable in our unit, and must be the next step of our project. More widely, improvements can be made by defining a more precise range of pure water conductivity for dialysis and by applying reuse water project to new or to be renovated units.

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“…Uremia decreases immune function, and indwelling catheters (vascular or urinary) and feeding tubes are potential portals of entry for bacteria. 33,34 Other open sites, such as surgical incisions or pressure sores, are possible entry sites for bacteria as well. Finally, the dialysis catheter and the extracorporeal circuit are potentially large sources of bacteria.…”

Section: Infectionmentioning

confidence: 99%