Inappropriately elevated endothelin‐1 plays a role in the pathogenesis of intradialytic hypertension

The aim of this study is to investigate the effects of endogenous vasoactive substances on the occurrence of intradialytic hypertension (IDH) in patients during maintenance hemodialysis. Thirty‐four maintenance hemodialysis patients were enrolled in this trial, and 17 of them were diagnosed with IDH (defined as an increase in blood pressure of at least 10 mmHg during or immediately after a hemodialysis session), while 17 age‐matched and sex‐matched controls without IDH were selected for a retrospective comparison. We collected patients' blood samples before and after a dialysis session and measured the plasma levels of N‐terminal fragment brain natriuretic peptide, renin, angiotensin‐II, aldosterone (ALD), angiotensin‐converting enzyme (ACE), endothelin‐1 (ET‐1), nitric oxide (NO), norepinephrine (NOR), and adrenomedullin. The post‐dialysis serum ET‐1 concentrations were significantly higher (4.09 ± 2.06 vs. 2.75 ± 1.34 pg/mL, P < 0.05), while the post‐dialysis ratio of NO to ET‐1 was lower (17.79 ± 5.65 vs. 24.78 ± 12.04, P < 0.05) in IDH patients compared with the control group. Post‐dialysis ALD and NOR values were significantly lower (P < 0.01) and ACE levels were significantly higher (P < 0.01) than the pre‐dialysis concentrations only in the control and not in the IDH group. All other measured factors did not differ significantly between the groups and between pre‐dialysis and post‐dialysis determinations. Compared with blood angiotensin‐II, ALD, ACE, NOR, adrenomedullin, N‐terminal fragment brain natriuretic peptide, and NO status, inappropriately elevated ET‐1 plasma concentrations may play a predominant role in the pathogenesis of IDH.     

扩散渗析回收含铜退镀液中的硝酸

采用扩散渗析法回收含铜退镀液中的HNO3,考察流量、流量比、温度等因素对硝酸的回收率、回收液中硝酸浓度以及铜和镍离子截留率的影响.将单级扩散渗析仪改装成新的三级扩散渗析仪,考察了三级逆流扩散渗析对实验结果的影响.单级扩散渗析的结果表明,最佳条件:水/料的流比为1∶1、流量90 mL/h、温度19℃,其硝酸回收率为86.95％、回收浓度6.04 mol/L、Cu2+和Ni2+的截留率分别为90.19％、92.71％.相对于单级扩散渗析,自行改装的三级扩散渗析过程能达到更高回收酸浓度和单位时间内处理更多的料液.在含铜退镀液体系下,利用国产扩散膜实现了扩散渗析对于H+和金属离子具有良好的分离,同时达到了回收硝酸浓度高于原退镀液的效果.     

Knowledge of Home Dialysis Among Inner‐City Satellite Hemodialysis Patients

There is limited use of home renal replacement therapies in the U.S.A. One percent of dialysis patients are on home hemodialysis (HHD) and only 9% undergo peritoneal dialysis (PD). In an effort to better understand this, 161 satellite hemodialysis patients in 6 units in Brooklyn were surveyed. Forty‐eight percent of patients were women, 86% were black, 5% white, 8% Hispanic, and 1% other. Mean age was 49.4 years (range 22 – 69 years). Etiology of renal disease was hypertension (41%), diabetes mellitus (31%), polycystic kidney disease (3%), systemic lupus erythematosus (4%), and other or unknown (21%). Patients were queried about knowledge of and attitudes toward home therapies. Seventy‐nine percent of patients knew of home dialysis. The source of this information was the nephrologist (59%), the social worker (14%), a nurse (8%), other patients (4%), and other sources (15%). Only 10% of patients had ever considered HHD. Fifty‐four percent were afraid to do self‐care at home and 35% were not interested. Surprisingly, only 3% felt they had no reliable helper and 8% felt that their housing was not suitable. Similarly, 78% of patients had been spoken to about PD, but only 11% had considered it. Forty‐one percent were afraid of doing self‐care on PD, and 45% were not interested. We conclude that, although the majority of patients in six inner‐city dialysis units had heard of home dialysis, only a small number ever considered it. As many patients were afraid of doing home therapy, better education about the risks and benefits needs to be disseminated.     

Extracorporeal Support for Patients with Hepatic Failure

Extracorporeal support has been advocated for patients with acute and chronic liver failure. Patients with acute liver failure and those with decompensated cirrhosis can be broadly divided into two groups. The first group comprises those with acute liver failure and ongoing hepatic necrosis, and the second, those with long-standing chronic decompensation admitted with one or more complications of liver failure, such as encephalopathy without any evidence of a precipitating factor or accompanying acute deterioration of liver function. This second group includes patients with acute liver failure, where the insult causing hepatic necrosis has been resolved, and those patients with chronic decompensation who suffer another insult to the liver, such as acute infection or variceal hemorrhage that causes further liver injury in the setting of multiorgan failure. These two groups are likely to have different outcomes and may need to be managed differently. In the first group, liver transplantation is the only possible long-term therapeutic option, whereas in the second group, other possibilities such as extracorporeal liver support systems and/or medical therapy may allow these patients to return to their previous state before the acute insult. Over time extracorporeal support has expanded from simple peritoneal dialysis and hemodialysis, to the development of circuits designed primarily to remove both water and lipid-soluble toxins and, in addition, bioartificial devices to provide replacement synthetic hepatic function.
Because many of the patients with an acute liver insult have ongoing chronic liver disease and develop hepatorenal syndrome, this group of patients has been targeted by several groups to study the role of liver support systems.     

A COMPARISON OF PROTEIN ASSAYS FOR THE DETERMINATION OF THE PROTEIN CONCENTRATION OF BEER

Seven protein assays have been compared for determination of the protein content of beer. Dialysis and ultrafiltration have been used to investigate possible interference and the protein content of the samples has been simultaneously monitored by sodium dodecyl sulphate-polyacrylamide gel electro-phoresis. The Fisons NA2000 Nitrogen/Protein Analyzer gave identical results to the standard Kjeldahl method but both measure nitrogen-containing compounds rather than protein. Colorimetric methods based upon the biuret reaction (including the Lowry and bicinchoninic acid protein assays) are particularly prone to interference from reducing substances and gave protein concentration values dependent upon the sample volume. The protein dye-binding assays (Coomassie Brilliant Blue and pyrogallol red-molybdate methods) were optimal for beer protein analysis displaying minimal inter ference and giving reproducible protein concentration values consistent with the protein content of the beers as indicated by electrophoresis.     

Evaluation of advanced glycation end products and carbonyl compounds in patients with different conditions of oxidative stress

Advanced glycation end products (AGE) and dicarbonyl compounds accumulate in serum and tissues of patients with diabetes and chronic renal failure. Pentosidine, free pentosidine, glyoxal and methylglyoxal have been evaluated in plasma of diabetic patients with poor metabolic control at baseline and after the improvement of glycemic levels, and in plasma and peritoneal dialysate of patients with renal failure before and after 12 h of peritoneal dialysis. In diabetic patients, acceptable metabolic control was unable to normalize levels of pentosidine (after 2 and 10 months), glyoxal and methylglyoxal (after 2 months). In patients with end-stage renal disease, mean values of pentosidine, free pentosidine, glyoxal and methylglyoxal decreased in plasma after dialysis. No pentosidine or free pentosidine were present in the peritoneal dialysate at time 0, but were found after 12 h of peritoneal dialysis; glyoxal and methylglyoxal decreased after 12 h of dialysis. So, glyoxal and methylglyoxal, already present in the dialysis fluid, can react with the peritoneal matrix protein, giving a reason for the gradual loss of peritoneal membrane function often observed in patients undergoing long-term peritoneal dialysis.     

The morbidity and cost implications of hemodialysis clinical performance measures

Clinical performance measures, including dialysis dose, hemoglobin, albumin, and vascular access, are the focus of monitoring and quality improvement activities. However, little is known about the implications of clinical performance measures for hospital utilization and health care costs. We obtained clinical performance measures and hospitalization records for a national random sample of 10,650 hemodialysis patients and analyzed the relationship between changes in clinical performance measures and hospital utilization after adjustment for patient demographic and medical characteristics. Higher hemoglobin, higher albumin, and fistula or graft use were independently associated with fewer hospitalizations, fewer hospital days, and decreased Medicare inpatient reimbursement. For example, a 0.5 g/dL higher hemoglobin, a 0.25 g/dL higher albumin, fistula use, and graft use were associated with hospitalization rate ratios of 0.90 (95% confidence interval 0.85, 0.96), 0.64 (0.53, 0.77), 0.60 (0.52, 0.69), and 0.79 (0.71, 0.89), respectively. Moreover, there was a 2-3-fold variation in hospital utilization across end-stage renal disease networks that was still evident after adjustment for patient characteristics and clinical performance measures. Clinical performance measures, especially albumin and vascular access, are strongly associated with hospital utilization and health care costs. These results highlight the importance of targeting nutrition and vascular access in quality improvement efforts. The marked variation in hospital utilization across networks deserves further examination.     

Antibody response to Engerix-B and Recombivax-HB hepatitis B vaccination in end-stage renal disease

Recombivax-HB (REC) and Engerix-B (ENG) are FDA-approved vaccines for hepatitis B virus (HBV) in end-stage renal disease (ESRD). This study compares antibody response rates between them in routine clinical practice. Patients completing the recommended 40 mug dose of REC (3 doses) or ENG (4 doses) between January 1, 2000 to April 30, 2003 were eligible. Patients with prior positive HBV surface antigen (HBsAg) or antibody (HBsAb) test results were excluded. The conversion rate and persistence of protective titer (HBsAb titer>or=10 IU/mL) were tracked for 1 year. A supplemental analysis of a one-to-one matched patient sample was also performed. REC patients (N=885) were older, had longer dialysis vintage, and had a larger proportion of whites than ENG patients (N=13,661). Cumulative conversion response was greater in ENG (58%) than REC (40%) at 1 year (p<0.0001). The odds ratio for response to ENG compared with REC was 1.96 (95% limits: 1.56, 2.45; p<0.0001) adjusted for age, gender, race, diabetes, vintage, BSA, hemoglobin, and eKt/V. Persistent protective HBsAb after 1 year was 77% (ENG) vs. 53% (REC). HBsAg was positive in 208 ENG patients (1.5%) with all but 1 because of transient, vaccine-related antigenemia. The difference in conversion response favoring ENG persisted in a one-to-one sample matched for age, gender, race, modality, and dialysis vintage. The study found higher seroconversion response to ENG compared with REC at several time points up to 1 year. Protective HBsAb disappeared in 23-47% of patients 1 year later, validating CDC recommendations to re-test HBsAb yearly. The observed difference in response rates may be related to the extra ENG dose given at the second month (0, 1, 2, 6 regimen). The study raises a hypothesis that requires confirmation in a prospective clinical trial.     

Comparison of different separative techniques in the quantitative determination of active compound enclosed in liposomal systems

The suitability of three different separative techniques, dialysis, gel filtration and centrifugation, for determining the percentage of active compound included (PAI) in liposomal systems was assessed. Two model compounds, glucose and vitamin E acetate were encapsulated in dipalmitoylphosphatidylcholine (DPPC), soybean lecithin (SL) and hydrogenated soybean lecithin (HSL) multilamellar vesicles (MLV). Vitamin E acetate PAI values from DPPC MLV liposomes obtained by dialysis, gel filtration and centrifugation, were compared with those determined by differential scanning calorimetry. Glucose PAI values from DPPC MLV liposomes, obtained using the same separative techniques, were compared with that calculated by taking into account the glucose content of the liposome internal aqueous phase on the basis of liposome mean size determined by light scattering.
Vitamin E acetate and glucose PAI values from SL and HSL liposomes were compared with those obtained for DPPC liposomes. Dialysis proved suitable for PAI determination for both lipophilic and hydrophilic compounds, centrifugation was found to be suitable only for the determination of lipophilic compound PAI values while gel filtration using Sephadex G-25M proved inadequate for the determination of PAI values for both lipophilic and hydrophilic compounds in the experimental conditions used in this study.     

Inorganic ligand-modified, colloid-enhanced ultrafiltration: A novel method for removing uranium from aqueous solution

Inorganic ligand-modified, colloid-enhanced ultrafiltration (ILM-CEUF) is as a novel membrane-based separation method for selectively removing target ions from aqueous solution. Traditional colloid-enhanced ultrafiltration (CEUF) is a well-established membrane-based separation technique that can be used to separate metal ions from other aqueous solution components. Ligand-modified, colloid-enhanced ultrafiltration (LM-CEUF) uses organic ligands that selectively complex target ions and also associate with a water-soluble colloid, such as a surfactant micelle or polyelectrolyte. The colloid, associated -ligand, and target ion are then concentrated using an ultrafilter, producing a filtrate with a low concentration of the target ion. While traditional LM-CEUF techniques are able to provide quantitative separations of a variety of ionic pollutants, the high costs of the chelating agents make such techniques nonviable in most remediation schemes. This study investigated the replacement of organic ligands with carbonate for the selective removal of U(VI) from aqueous solution.In slightly to moderately basic solutions containing carbonate, UO₂(CO₃)₃⁴⁻ can be made to dominate the U(VI) speciation. Using poly(diallyldimethylammonium) chloride, the effectiveness and efficiency of ILM-CEUF for removing U(VI) from other aqueous solution components was investigated as a function of carbonate concentration, pH, and ionic strength. Uranium separations of greater than 99.6% were achieved; even in the presence of large excesses of competing ions. The specific separation of U(VI) from Sr²⁺ was also examined.