Intensive dialysis and pregnancy

Pregnancy in women with end stage renal disease on renal replacement therapy is uncommon due to the physiologic changes associated with renal failure as well as the complexities and risk involved in managing these patients. As most of these women had long periods of illness with chronic kidney disease, the effects of their chronic illness together with the current societal trends to delay child bearing to a more advanced maternal age can hamper fertility. For those able to conceive, intensified hemodialysis (HD), through longer and/or more frequent dialysis sessions, offers improved maternal and neonatal outcomes. Intensified HD is most conveniently offered in the patient's home, where possible. This review expands the scope of the Implementing Hemodialysis in the Home website and associated supplement published previously in Hemodialysis International and includes information tailored to women of reproductive age. We describe the necessary counseling that women should receive before conception and before intensification of HD, and provide a detailed management strategy that includes nephrologic and obstetric care, should pregnancy occur.     

Modifications to bicarbonate conductivity: A way to increase phosphate removal during hemodialysis? Proof of concept

Introduction Hyperphosphatemia and cardiovascular mortality are associated particularly with end‐stage renal disease. Available therapeutic strategies (i.e., diet restriction, calcium [or not]‐based phosphate binders, calcimimetics) are associated with extrarenal blood purification. Compartmentalization of phosphate limits its depuration during hemodialysis. Several studies suggest that plasmatic pH is involved in the mobilization of phosphate from intracellular to extracellular compartments. Consequently, the efficiency of modified bicarbonate conductivity to purify blood phosphate was tested. Methods Ten hemodialysis patients with chronic hyperphosphatemia (>2.1 mmol/L) were included in the two three–sessions‐per week periods. Bicarbonate concentration was fixed at 40 mmol/L and 30 mmol/L in the first and second periods, respectively. Phosphate depuration was evaluated by phosphate mobilization clearance (K_M). Findings Although bicarbonatemia was lower during the second period (21.0 ± 2.7 vs. 24.4 ± 3.1 mmol/L, P < 0.01), no difference was observed in phosphatemia (2.4 ± 0.5 vs. 2.3 ± 0.4 mmol/L, P = NS). The in‐session variation of phosphate was lower (?1.45 ± 0.42 vs. ?1.58 ± 0.44 mmol/L, P < 0.05) and K_M was higher during the second period (82.94 ± 38.00 vs. 69.74 ± 24.48 mL/min, P < 0.05). Discussion The decrease of in‐session phosphate and the increase in K_M reflect phosphate refilling during hemodialysis. Thus, modulation of serum bicarbonate may play a role in controlling the phosphate pool. Even though correcting metabolic acidosis during hemodialysis remains important, alkaline excess can impair phosphate mobilization clearance. Clinical trials are needed to test the efficiency and relevance of a strategy where bicarbonatemia is corrected less at the beginning of sessions.     

Antibiotic lock: In vitro stability of gentamicin and sodium citrate stored in dialysis catheters at 37 °C

Catheter‐related bacteremia (CRB) is a major cause of morbidity and mortality especially among patients receiving hemodialysis. Antibiotic lock therapy represents a promising technique in the treatment of CRB. Several studies have evaluated antibiotics in combination with heparin as an interdialytic locking solution for prophylaxis of CRB. The objective of this study was to evaluate the stability of gentamicin and sodium citrate in hemodialysis catheters as an interdialytic lock. Solutions containing gentamicin 2.5 mg/mL and sodium citrate 40 mg/mL (4%) were prepared individually and in combination. The solutions were instilled into dialysis catheters and stored at 37 °C for 96 h. Samples were withdrawn randomly from catheter lumens at 24‐hour intervals for 4 days and stored at ?20 °C until analysis. The samples were analyzed with validated, stability‐indicating HPLC assays. The luminal concentration of gentamicin 2.5 mg/mL, sodium citrate 40 mg/mL (4%), and the combination was determined on study days 0, 1, 2, 3, and 4. When gentamicin was combined with sodium citrate and stored at 37 °C in dialysis catheters, the solution showed no decrease in either the gentamicin or the sodium citrate concentrations over the 96‐hour study period. The percent of the original concentration at 96 h was 102.4±1.03 for gentamicin and 102.9±1.25 for citrate (P=0.5556). The combination of gentamicin 2.5 mg/mL and sodium citrate 40 mg/mL (4%) can be retained in hemodialysis catheters for at least 96 h at 37 °C with no evidence of degradation.     

腹膜透析治疗心脏手术后急性肾功能衰竭

目的探讨腹膜透析（PD）对心脏手术后急性肾功能衰竭（ARF）的治疗效果。方法选择心脏手术后ARF患者26例,采用2．5％葡萄糖透析液行PD。观察透析前和透析后24、48、72、96h时尿量、超滤量、电解质、血尿素氮（BUN）、血肌酐（Cr）的变化。结果PD时间3～16d,26例患者中23例患者肾功能恢复至术前水平,1例死于多脏器功能衰竭,2例自动放弃治疗。23例患者经PD治疗后,尿量逐渐增加,BUN、Cr明显低于PD前（P〈0．05）。未发生严重并发症。结论PD安全、经济、有效,是心脏手术后治疗ARF的首要选择。     

Asymmetric cellulose acetate dialysis membranes: Synthesis,characterization, and performance

Cellulose acetate (CA) is highly comparable to other synthetic polymer materials and is effective in the hemodialysis process. In this work, asymmetric CA membranes were synthesized with the phase‐inversion method. CA with a molecular weight of 52,000, poly(ethylene glycol) (PEG) with a molecular weight of 400, and 1‐methyl‐2‐pyrrolidone (NMP) were used as the polymer, additive, and solvent, respectively. The effects of the CA and PEG concentrations and coagulation bath temperature (CBT) on the morphology, pure water permeability (PWP), insulin/human serum albumin (HSA) transmission, and finally thermal and chemical stability of the prepared membranes were determined and investigated. In general, increasing the PEG concentration and CBT and reducing the CA concentration resulted in increased PWP and insulin/HSA transmission. Also, these variations facilitated the formation of macrovoids in the membrane sublayer. On the other hand, increasing the PEG and CA concentrations and reducing CBT resulted in increased thermal and chemical stability of the prepared membranes. Also, ratios of 15.5/10/74.5 and 17.5/10/72.5 (w/w) for the CA/PEG/NMP casting solutions and their immersion into coagulation baths with CBTs of 0 and 25°C, respectively, resulted in the preparation of membranes that had not only optimum sieving properties and higher PWP but also thermal and chemical stability better than that of conventional CA hemodialysis membranes. © 2010 Wiley Periodicals, Inc. J Appl Polym Sci, 2010     

以工业钛液为原料低成本制备锐钛矿型纳米二氧化钛(英文)

釆用扩散渗析法降低了钛白粉生产过程中工业钛液里硫酸的浓度。通过扩散渗析处理的工业钛液在低温常压下制备了纳米二氧化钛粉体。用Furrier变换红外透射光谱、X射线衍射、激光散射粒度分析仪、X射线光电子能谱(X-ray photoe lectron spectroscopy,XPS)、N2吸附-脱附等温线测量比表面积和扫描电镜对样品进行了表征,研究了反应温度和反应时间对晶形的影响。结果表明:球形的二氧化钛粒子尺寸小于10nm,并有较窄的粒径分布和良好的结晶度,比表面积为258.1m2/g,样品中的聚集体为近似球形,其尺寸大约为70nm。随煅烧温度的升高,粒径增大,比表面积变小。XPS结果表明:在纳米二氧化钛颗粒表面不仅包括钛、氧和碳元素,而且还包括少量的氮元素和硫元素。     

以不同体外模拟系统评价大豆蛋白的胃消化特性

采用静态消化模型和半动态消化模型,评价经透析处理和未经透析处理的大豆蛋白的胃消化特性。结果表明：在静态消化模型中,透析对大豆蛋白的胃消化过程没有影响;但在半动态消化模型中,未经透析的大豆蛋白pH值、排空内容物的干物质质量和游离氨基的含量与经透析处理的大豆蛋白存在一定差异,表明未经透析处理的大豆蛋白保留较多大豆中的成分,使其缓冲能力更强,胃排空滞后,蛋白质消化速率减慢。此外,静态消化模型和半动态消化模型有不同的优势,所以可以根据不同的研究目的采用不同的消化模型。这项工作将为大豆蛋白产品的开发和健康效应提供新的见解。     

Fate of the glucose degradation products 3-deoxyglucosone and glyoxal during peritoneal dialysis

Conventional fluids for peritoneal dialysis (PD) contain reactive glucose degradation products (GDPs) as a result of glucose breakdown during heat-sterilization. GDPs in PD fluids (PDFs) have been associated with the progressive alteration of the peritoneal membrane during long-term PD by cytotoxic effects and formation of advanced glycation endproducts (AGEs). In this study, we investigated the possible fate of two characteristic GDPs, 3-deoxyglucosone (3-DG) and glyoxal, during PD. In vivo, 3-DG and glyoxal concentrations, which were analyzed by high-performance liquid chromatography (HPLC), decreased in PDFs by 78% and 88% during 4 h of dwell time. The PDFs were then incubated in vitro in the presence of the most important reaction partners of GDPs in the peritoneal cavity. Neither human peritoneal mesothelial cells, human peritoneal fibroblasts, soluble protein, an insoluble collagen surface, nor components of spent dialysate led to a significant reduction of 3-DG or glyoxal after 6 h. Only after long-term incubation, a noticeable decrease of 3-DG was observed (-37% after three weeks), more likely due to spontaneous degradation reaction than formation of advanced glycation endproducts. These results suggest that in the course of PD, 3-DG, and glyoxal are absorbed into the organism and thus might contribute to the systemic pool of reactive carbonyl compounds.