==================================HSR43================================== 43. Hemofiltration. 1 UI - 87121238 AU - Tomoda H TI - Experimental study on the effects of the extracorporeal ultrafiltration method in advanced congestive heart failure. AB - The effects of the extracorporeal ultrafiltration method were studied in an experimental canine model of advanced congestive heart failure with mitral regurgitation, coronary artery occlusion and overhydration. With the application of this technique, cardiac output, stroke work, systemic vascular resistance and left ventricular dp/dt increased significantly associated with reduction in the right atrial and left ventricular filling pressures. Serum electrolytes were stable throughout the procedure, and there were significant elevations in serum protein and hematocrit levels. The composition of the ultrafiltrate indicated that excessive extracellular fluid was removed. Five out of seven cardiogenic shock subjects also benefited. The clinical application of this approach using recently developed dialyzers to treat intractable heart failure with overhydration under close hemodynamic monitoring is warranted. MH - Animal ; *Blood ; Cardiac Output ; Dogs ; Heart Failure, Congestive/ PHYSIOPATHOLOGY/*THERAPY ; Support, Non-U.S. Gov't ; *Ultrafiltration SO - Tokai J Exp Clin Med 1986 Mar;11(1):5-11 2 UI - 87099422 AU - Maeda K ; Shinzato T ; Yoshida F ; Tsuruta Y ; Usuda M ; Yamada K ; Ishihara T ; Inagaki F ; Igarashi I ; Kitano T TI - Newly developed circulating blood volume-monitoring system and its clinical application for measuring changes in blood volume during hemofiltration. AB - Blood and ultrafiltrate electrical resistivities were continuously monitored during hemofiltration. By substituting these values into a previously developed equation that was modified by the authors, the hematocrit value was determined; and blood volume change was obtained from the change in this value. The following facts were discovered as the result of monitoring the blood volume change during treatment: When the body position was changed from the reclining to the sitting position, the blood volume decreased by 4.2 +/- 0.3%. With the body water removal rate kept constant, the body position recumbent, and the subject fasted, the blood volume gradually decreased. However, when the position was changed from reclining to sitting for food intake and once more returned to the supine position after the meal, the blood volume was greatly affected by the change in position and the food intake. MH - Blood Volume Determination/*INSTRUMENTATION ; *Blood Volume ; *Blood ; Eating ; Electric Conductivity ; Hematocrit ; Human ; Monitoring, Physiologic/INSTRUMENTATION ; Posture ; *Ultrafiltration SO - Artif Organs 1986 Dec;10(6):452-9 3 UI - 87087979 AU - Eisenhauer T ; Talartschik J ; Scheler F TI - Detection of fluid overload by plasma concentration of human atrial natriuretic peptide (h-ANP) in patients with renal failure. AB - There are no reliable parameters for the detection of fluid overload in anuric patients. In 70 patients on regular haemodialysis (HD) or haemofiltration (HF) treatment, plasma ANP IR concentrations were determined by radioimmunoassay and compared to 43 controls with normal renal function. ANP IR levels were markedly elevated immediately before HD or HF (m 82 fmol/ml) compared to ANP IR plasma concentrations after HD or HF (m 42 fmol/ml) and to ANP IR levels of healthy controls (m 19 fmol/ml). ANP IR was detected in haemofiltrates and found to be eliminated by HF. During isovolemic HF, ANP IR levels remained constant suggesting that ANP synthesis is much higher than elimination by HF and that the decrease in circulating volume at the end of HF or HD is the main stimulus for a lower secretion rate of ANP. Elevated ANP IR levels at the end of HD/HF were found to be associated with fluid overload even without clinical or radiographic symptoms. Consistent weight reduction was followed by a decrease of ANP IR levels. MH - Adolescence ; Adult ; Aged ; Body Weight ; Female ; Hemodialysis ; Human ; Kidney Failure, Chronic/*BLOOD/COMPLICATIONS ; Male ; Middle Age ; Natriuretic Peptides, Atrial/*BLOOD ; Radioimmunoassay ; Ultrafiltration ; Water-Electrolyte Imbalance/*BLOOD/DIAGNOSIS/ETIOLOGY SO - Klin Wochenschr 1986;64 Suppl 6:68-72 4 UI - 87087965 AU - Hartter E ; Pacher R ; Frass M ; Woloszczuk W ; Leithner C TI - Plasma levels of atrial natriuretic peptide (ANP) in volume expanded patients: response to fluid removal by continuous pump driven hemofiltration. AB - Circulating amounts of human atrial natriuretic peptide (hANP) are elevated in congestive heart failure and renal failure. Stretching of cardiac atria, due to volume expansion associated with these diseases, is widely accepted to be the predominant stimulus for release of the hormone. Measurements of hemodynamic parameters as well as plasma concentrations of ANP in the right cardiac atrium, pulmonary artery, radial artery and vena cava superior, before and after continuous veno-venous hemofiltration (CVVH) of critically ill volume expanded patients, proved that ANP might be a useful indicator of fluid balance in these patients. MH - *Blood ; Heart Failure, Congestive/BLOOD ; Human ; Kidney Failure, Chronic/BLOOD ; Natriuretic Peptides, Atrial/*BLOOD ; *Ultrafiltration ; Water-Electrolyte Imbalance/*BLOOD/THERAPY SO - Klin Wochenschr 1986;64 Suppl 6:112-4 5 UI - 87084080 AU - Zarowitz BJ ; Anandan JV ; Dumler F ; Jayashankar J ; Levin N TI - Continuous arteriovenous hemofiltration of aminoglycoside antibiotics in critically ill patients. AB - The effect of continuous arteriovenous hemofiltration on the clearance of either tobramycin or gentamicin (mean dose, 1.65 +/- 0.36 mg/kg) was studied in eight critically ill patients. Mean aminoglycoside clearance by hemofiltration was 3.47 +/- 1.93 mL/min and total body clearance was 11.92 +/- 3.51 mL/min. Hemofiltration clearance (HFCL) was directly correlated with hemofiltration flow rate (HFQR): HFCL (mL/min) = 1.03 HFQR (mL/min)-0.88 (R = .89). Mean volume of distribution was 0.31 +/- 0.08 L/kg, and the elimination rate constant was 0.020 +/- 0.01 hr-1. Continuous arteriovenous hemofiltration was responsible for the removal of between 3% and 36% of each aminoglycoside dose in 24 hours. In critically ill patients with changing hemofiltration flow rates, measurement of multiple serum aminoglycoside concentrations is necessary to accurately assess dosing requirements and avoid ototoxicity and nephrotoxicity. MH - Adult ; Aged ; Aminoglycosides/BLOOD ; Antibiotics/*BLOOD ; *Blood ; Critical Care ; Female ; Gentamicins/BLOOD ; Human ; Kinetics ; Male ; Middle Age ; Tobramycin/BLOOD ; *Ultrafiltration SO - J Clin Pharmacol 1986 Nov-Dec;26(8):686-9 6 UI - 87075334 AU - Yoshiba M ; Yamada H ; Yoshikawa Y ; Fujiwara K ; Toda G ; Oka H ; Sanjo T ; Yamazaki Z ; Idezuki Y ; Inoue N ; et al TI - Hemodiafiltration treatment of deep hepatic coma by protein passing membrane: case report. AB - Based on the assumption that middle molecules that induce hepatic coma occur in the plasma of patients with fulminant hepatic failure (FHF), the authors have developed a hemodiafiltration (HDF) method using a large-pore poly(methylmethacrylate) (PMMA) membrane that allows proteins to pass through. PMMA HDF resulted in complete recovery of deep coma and long-term survival in a patient with severe FHF. Although a large-scale controlled trial is needed, PMMA HDF is believed to be promising as a future artificial liver support. MH - Adult ; Blood Proteins ; *Blood ; Female ; *Hemodialysis ; Hepatic Encephalopathy/*THERAPY ; Human ; *Membranes, Artificial ; Methylmethacrylates ; Plasma Exchange ; *Ultrafiltration SO - Artif Organs 1986 Oct;10(5):417-9 7 UI - 87062715 AU - Stairmand JW ; Bellhouse BJ ; Jamal Z ; Lewis RW ; Urban JP ; Entwistle CC TI - Separation of plasma from whole blood by membrane filtration in oscillatory flows. AB - This paper describes the performance of a microfiltration plasmapheresis unit operating with reversing oscillatory flows. The device consists of a flat channel duct between cellulose nitrate membranes and was used to extract plasma from anticoagulated fresh whole bovine blood. Measurements were made of plasma flux, haematocrit concentration, haemolysis and protein sieving coefficients. The effects on plasma flux are reported for alterations in the stroke and frequency of flow pulsations, transmembrane pressure, membrane properties and blood throughput. It was found that the imposition of oscillatory flows enhanced the plasma extraction rate by a factor of 3, producing about 0.9 litre/min/m2 membrane. MH - Animal ; Blood Proteins/ANALYSIS ; *Blood ; Cattle ; Cellulose ; Hemoglobins/ANALYSIS ; Hemolysis ; Mathematics ; *Membranes, Artificial ; Models, Biological ; Nitrates ; Oscillometry ; Plasmapheresis/ INSTRUMENTATION/*METHODS ; Support, Non-U.S. Gov't ; Ultrafiltration/ INSTRUMENTATION/*METHODS SO - Life Support Syst 1986 Jul-Sep;4(3):193-204 8 UI - 87062036 AU - R:ockel A ; Hertel J ; Fiegel P ; Abdelhamid S ; Panitz N ; Walb D TI - Permeability and secondary membrane formation of a high flux polysulfone hemofilter. AB - It has been assumed that the molecular weight (MW) cut-off of a newly fabricated polysulfone capillary dialyzer (F60, Fresenius, FRG) is similar to that of the human glomerulus. We recently tested the device in vivo and found this not to be so, based on the device's ability to eliminate substances of a MW of 10,000 to 60,000 daltons. One of the reasons for this discrepancy was found to be the influence of secondary membrane formation on solute permeability. Endogenous marker substances of a defined MW (beta 2-microglobulin, myoglobin, RBP, alpha 1-microglobulin, acid alpha 1-glycoprotein, alpha 1-antitrypsin, prealbumin, and albumin were measured by laser nephelometry or radioimmune assay; sieving coefficients (SC) and protein eliminations were calculated for each low MW protein. MH - *Blood ; Diabetic Nephropathies/THERAPY ; Evaluation Studies ; Female ; Glomerulonephritis/THERAPY ; Human ; Kidney, Polycystic/THERAPY ; Male ; Middle Age ; Molecular Weight ; Permeability ; Polymers ; Sulfones ; Support, Non-U.S. Gov't ; Ultrafiltration/*INSTRUMENTATION SO - Kidney Int 1986 Sep;30(3):429-32 9 UI - 87056168 AU - Agishi T TI - Selective removal of pathogenetic macromolecules directly from whole blood by double filtration technique. AB - Double filtration plasmapheresis (DFPP) is a technique devised in an attempt to selectively remove pathogenetic macromolecules such as antibodies, immune complexes or viscosity-increasing substances directly from blood. In order to realize the differential filtration principle, two filters, one for separation of plasma and another for fractionation of plasma components, are installed in an extracorporeal circulation line. Selective separation of the plasma components is dependent on the filtration property of the two filters. Clinical experiences evidence the usefulness of this technique in regard to conservation of human blood products for supplementation. MH - *Blood ; Human ; Lupus Erythematosus, Systemic/THERAPY ; Membranes, Artificial ; *Plasmapheresis ; *Ultrafiltration SO - Int J Artif Organs 1986 Sep;9(5):355-8 10 UI - 87056167 AU - Malchesky PS ; Horiuchi T ; Usami M ; Emura M ; Nose Y TI - Blood detoxification by membrane plasma filtration. AB - The recognition of macromolecule abnormalities in various metabolic or immunologic related disease states has led to the use of plasma exchange for therapeutics. Limitations of plasma exchange, however, exist. Membrane plasma filtration provides a practical alternative. Solute removal can be made selective by the choice of operating conditions as temperature and the selection of the membrane/module design. The optimal temperature range is a function of the plasma type, solute concentrations and membrane system. Operation at below physiologic temperature (cryofiltration) is particularly suited for the removal of cold aggregative solutes, while operation at near or above physiologic temperature is more suited for the separation of solutes having large size differences at normal physiologic temperature. Membrane filtration is simple and safe to perform, is more selective than plasma exchange, does not require plasma product infusion and is more versatile than selective sorption in its applications. MH - *Blood ; Cold ; Heat ; Human ; *Membranes, Artificial ; *Plasmapheresis ; Pressure ; Temperature ; *Ultrafiltration SO - Int J Artif Organs 1986 Sep;9(5):349-54 11 UI - 87056163 AU - Lotan N ; Grynspan E ; Grunfeld H ; Brunner G ; Sideman S TI - Enzyme-based hemoperfusion and blood treatment. AB - Enzyme-based artificial organs are being developed as metabolic assist devices. These are required when normal metabolism is impaired, or when the body is overloaded by undesired metabolites or toxins. The implementations of this approach for treating a genetic disease, and for metabolic support in liver failure are envisaged. The kinetic aspects and mass transfer characteristics of bioreactors for these systems are considered in detail. MH - Beta-Glucosidases ; *Blood ; *Enzymes ; Gaucher's Disease/THERAPY ; Glutathione Transferases ; *Hemoperfusion ; Human ; Liver Diseases/ THERAPY ; Support, Non-U.S. Gov't ; *Ultrafiltration SO - Int J Artif Organs 1986 Sep;9(5):331-4 12 UI - 87056151 AU - Trevi:no-Becerra A TI - Blood detoxification and other therapeutical alternatives in nephrology. AB - The author summarizes a number of blood detoxification procedures with emphasis on hemoperfusion, hemodialysis and chronic ambulatory peritoneal dialysis. MH - *Blood ; Hemodialysis ; Hemoperfusion ; Human ; Kidney Diseases/*THERAPY ; Membranes, Artificial ; Peritoneal Dialysis, Continuous Ambulatory ; Plasma Exchange ; Plasmapheresis ; *Ultrafiltration SO - Int J Artif Organs 1986 Sep;9(5):281-4 13 UI - 87056144 AU - Bianchi ML ; Bettinelli A ; Soldati L ; Saccaggi A ; Ortolani S ; Edefonti A TI - Mineral metabolism during a hemofiltration session in children. AB - We studied the effects of one session of hemofiltration on the mineral metabolism in a group of uremic children. We observed an increase of calcemia, accompanied by positive calcium balance, and a decrease of plasma phosphate and PTH-MM. No substantial loss of plasma 25-OH D was found. It is concluded that hemofiltration has a positive effect on calcemia and is very effective in removing phosphate, but it acts only temporarily on PTH removal. An adequate calcium concentration must be provided in the substitution fluid. MH - Adolescence ; *Blood ; Calcium/*BLOOD ; Child ; Dihydroxycholecalciferols/ BLOOD ; Female ; Human ; Kidney Failure, Chronic/BLOOD/*THERAPY ; Male ; Parathyroid Hormones/BLOOD ; Phosphates/*BLOOD ; *Ultrafiltration SO - Int J Artif Organs 1986 Jul;9(4):257-62 14 UI - 87056143 AU - Epstein M ; Perez GO ; Bedoya LA ; Molina R TI - Continuous arterio-venous ultrafiltration in cirrhotic patients with ascites or renal failure. AB - To assess whether continuous arteriovenous ultrafiltration (CAVU) might constitute a useful alternative to hemodialysis in the management of patients with advanced liver failure, we carried out CAVU in 3 patients with decompensated Laennec's cirrhosis. CAVU was utilized in two patients with acute renal failure and pulmonary edema to stabilize renal function and facilitate administration of large amounts of fluid. In the third case, CAVU was successfully utilized to mobilize fluid in a patient refractory to conventional diuretic regimens. We conclude that CAVU may constitute an appropriate alternative to traditional hemodialysis in patients with advanced liver disease and renal functional impairment. MH - Aged ; Ascites/ETIOLOGY/*THERAPY ; *Blood ; Case Report ; Human ; Kidney Failure, Chronic/ETIOLOGY/*THERAPY ; Liver Cirrhosis/*COMPLICATIONS ; Liver Cirrhosis, Alcoholic/ETIOLOGY/THERAPY ; Male ; Middle Age ; *Ultrafiltration SO - Int J Artif Organs 1986 Jul;9(4):253-6 15 UI - 87056141 AU - Schaefer K ; von Herrath D ; H:ufler M ; Pauls A TI - The occurrence of fever during hemodialysis and hemofiltration. A comparative study. AB - The occurrence of fever during various blood purification methods was evaluated in a retrospective study. It could be demonstrated, that patients treated chronically by conventional hemodialysis experience six times more febrile episodes than patients on chronic hemofiltration (4.84% versus 0.81%). Since many of the increased temperatures could not be explained by conventional means, it has to be assumed that the treatment itself caused the fever, possibly activating the monocyte hormone interleukin 1. It is of further note that there was no difference in the magnitude of the temperature due to septicaemia or to no obvious cause. This finding necessitates in our opinion an early antibiotic therapy in those cases where fever develops without clear explanation. MH - *Blood ; Comparative Study ; Fever/*ETIOLOGY/MICROBIOLOGY ; Hemodialysis/ *ADVERSE EFFECTS ; Human ; Kidney Failure, Acute/THERAPY ; Kidney Failure, Chronic/THERAPY ; Retrospective Studies ; Septicemia/ COMPLICATIONS ; Ultrafiltration/*ADVERSE EFFECTS SO - Int J Artif Organs 1986 Jul;9(4):247-50 16 UI - 87054200 AU - Loute G ; Adam A ; Ers P ; Heremans C ; Willems B TI - The influence of haemodialysis and haemofiltration on the clearance of torasemide in renal failure. AB - The concentration of Torasemide in plasma, dialysate and ultrafiltrate were determined during one haemofiltration and three dialyses. Results show that Torasemide is not significantly eliminated from the blood by these technics. MH - *Blood ; Case Report ; Diuretics, Sulfamyl/*METABOLISM ; *Hemodialysis ; Human ; Kidney Failure, Acute/*METABOLISM ; Kidney Failure, Chronic/ *METABOLISM ; Kinetics ; Male ; Sulfonamides/*METABOLISM ; *Ultrafiltration SO - Eur J Clin Pharmacol 1986;31 Suppl:53-5 17 UI - 87052846 AU - Leone MR ; Jenkins RD ; Golper TA ; Alexander SR TI - Early experience with continuous arteriovenous hemofiltration in critically ill pediatric patients. AB - The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient, CAVH was the sole renal replacement therapy employed; in this critically ill anuric infant, we were best able to evaluate the ability of CAVH to continuously control fluid, electrolyte, and acid-base balance, and allow the administration of adequate parenteral nutrition. The difficulties encountered were related to anticoagulation, establishment of adequate vascular access, and selection of an appropriate hemofilter for the performance of the technique. Despite the application of suction-assistance, we were unable to effectively employ a prototype pediatric hemofilter to attain a level of plasma ultrafiltration consistent with the objectives of therapy. However, we were able to effectively and safely employ an adult hemofilter for these purposes; modifications were made in the adult hemofilter system before its application in the smallest pediatric patients. Our experience suggests that, even in critically ill infants, CAVH can be successfully applied as an effective renal replacement therapy. However, further experience is required before its potential impact on patient survival can be assessed. MH - Anuria/THERAPY ; *Blood ; Case Report ; Child, Preschool ; *Critical Care ; Equipment Design ; Female ; *Hemodialysis ; Human ; Infant ; Infant, Newborn ; Kidney Failure, Acute/*THERAPY ; Male ; Peritoneal Dialysis ; *Ultrafiltration SO - Crit Care Med 1986 Dec;14(12):1058-63 18 UI - 87052835 AU - Pacher R ; Frass M ; Hartter E ; Woloszczuk W ; Leithner C TI - Continuous pump-driven hemofiltration associated with a decline in alpha-atrial natriuretic peptide. AB - The levels of alpha-atrial natriuretic peptide (ANP) in the right atrium, pulmonary artery, radial artery, and superior vena cava plasma were measured by radioimmunoassay in eight patients with volume-expansion due to different diseases. The alpha-ANP levels were significantly increased, but became decreased after fluid removal by continuous veno-venous hemofiltration. When all alpha-ANP concentrations of different anatomical locations and hemodynamic variables were grouped, pulmonary capillary wedge pressure correlated significantly with all alpha-ANP groups, whereas right atrial mean pressure correlated with alpha-ANP levels in pulmonary artery plasma only. Alpha-ANP concentrations were distinctly lower in superior vena cava plasma than in plasma from the right atrium, pulmonary artery, and radial artery. Since alpha-ANP plays an important role in the homeostasis of sodium and fluid balance, measurement of alpha-ANP concentrations, particularly in right atrium, pulmonary artery, or radial artery plasma, might provide valuable information on the status of the critically ill. MH - Adult ; Aged ; *Blood ; *Critical Care ; Female ; Hemodynamics ; Human ; Male ; Middle Age ; Natriuretic Peptides, Atrial/*BLOOD ; Radioimmunoassay ; *Ultrafiltration SO - Crit Care Med 1986 Dec;14(12):1010-4 19 UI - 87045679 AU - Wallace MJ ; Ogawa K ; Wright K ; Carrasco CH ; Richli W ; Charnsangavej C TI - Inferior vena caval stent filter. AB - New inferior vena caval filters for percutaneous placement were made by attaching filter wires similar to those in the bird's nest inferior vena caval filter onto expandable metallic stents. These stents formed a base on which to anchor the filter to the wall of the inferior vena cava. The stent filter can be introduced through a 12- to 13-French catheter sheath system. The system was successfully tested in 13 dogs. MH - Animal ; Autopsy ; *Blood ; Catheterization/INSTRUMENTATION ; Dogs ; Implants, Artificial ; Pulmonary Embolism/PREVENTION & CONTROL ; Support, Non-U.S. Gov't ; Ultrafiltration/*INSTRUMENTATION ; Vena Cava, Inferior/ PATHOLOGY/*RADIOGRAPHY SO - AJR 1986 Dec;147(6):1247-50 20 UI - 87034569 AU - Bion JF ; Logan BK ; Newman PM ; Brodie MJ ; Oliver JS ; Aitchison TC ; Ledingham IM TI - Sedation in intensive care: morphine and renal function. AB - Intravenous morphine infusions have been administered to 12 critically-ill patients during controlled ventilation. Acute oliguric renal failure was present in 4 patients, who were treated with a combination of haemofiltration and haemodialysis. Severity of physiological disturbance was assessed using a modified APACHE Score, level of sedation by a linear-analogue scale, and blood morphine levels by high-pressure liquid chromatography. Morphine clearance was impaired in renal failure, and was dependent on haemofiltration volumes; accumulation of morphine did not occur during this form of treatment. Conscious level was clearly more closely related to the degree of physiological disturbance than blood morphine levels; and for a given blood morphine level, depression of consciousness was more pronounced the greater the degree of physiological disturbance. Use of a physiological sickness score may help to clarify some of the factors influencing cerebral function during critical illness. Careful clinical monitoring of level of sedation is important in patients with oliguric renal failure receiving morphine, and haemofiltration appears to reduce the risk of morphine accumulation in these patients. MH - Blood ; Combined Modality Therapy ; Critical Care/*METHODS ; Half-Life ; Hemodialysis ; Human ; Kidney Failure, Acute/PHYSIOPATHOLOGY/THERAPY ; Kidney/*DRUG EFFECTS/PHYSIOPATHOLOGY ; Kinetics ; Liver/DRUG EFFECTS/ PHYSIOPATHOLOGY ; Morphine/*ADMINISTRATION & DOSAGE/METABOLISM ; Time Factors ; Ultrafiltration SO - Intensive Care Med 1986;12(5):359-65 21 UI - 87032740 AU - Solski J ; Ksia~zek A ; Spasiewicz D TI - High and low sodium acetate haemodialysis and ultrafiltration. I. Comparison of haemodynamic effects. AB - This study was undertaken to evaluate the effect of increasing the dialysate sodium concentration on haemodynamic effects, arterial blood gases and chemistries during haemodialysis and ultrafiltration. Significant changes in mean blood pressure (MBP) and heart rate (HR) were not noted; but significant differences in sodium, potassium, total protein concentration, haematocrit and plasma osmolality during dialysis and ultrafiltration were found with both dialysates. Significant differences were also noted in pCO2 during dialysis and ultrafiltration with both dialysates and increase of pH during dialysis with low sodium dialysate. Significant changes in kind and frequency of unpleasant symptoms were found with both dialysates. MH - Acetic Acids/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS/PHARMACODYNAMICS ; Adult ; Blood Pressure/DRUG EFFECTS ; Blood Proteins/METABOLISM ; *Blood ; Body Weight ; Carbon Dioxide/BLOOD ; Comparative Study ; Electrolytes/ BLOOD ; Female ; Heart Rate/DRUG EFFECTS ; Hematocrit ; *Hemodialysis ; Hemodynamics/*DRUG EFFECTS ; Human ; Hydrogen-Ion Concentration ; Male ; Middle Age ; Osmolar Concentration ; *Ultrafiltration SO - Int Urol Nephrol 1986;18(3):333-9 22 UI - 87003294 AU - Matzke GR ; O'Connell MB ; Collins AJ ; Keshaviah PR TI - Disposition of vancomycin during hemofiltration. AB - The disposition of vancomycin was assessed in five patients receiving hemofiltration after intravenous dosing with an 18 mg/kg dose after a hemofiltration procedure. The serum concentration-time profile was characterized before, during, and after the next hemofiltration procedure. The t 1/2 of vancomycin was 136.0 +/- 27.2 hours (mean +/- SD) before hemofiltration and 4.1 +/- 1.2 during hemofiltration. Approximately 400 mg of vancomycin was recovered in the filtrate and the hemofiltration clearance was 152.6 +/- 21.5 ml/min. A significant relationship was observed between vancomycin clearance and ultrafiltration flow rate (r = 0.9914). A marked rebound in vancomycin serum concentration (52.4% +/- 15.6%) was observed in all patients. Hemofiltration has a significant effect on the disposition of vancomycin. Because of the marked interpatient variability in elimination t 1/2 and the degree and time course of the rebound, an individualized approach to vancomycin therapy in this patient population is recommended. MH - Aged ; Female ; Human ; Kidney Diseases/*METABOLISM ; Kinetics ; Male ; Middle Age ; Support, Non-U.S. Gov't ; *Ultrafiltration ; Vancomycin/ *BLOOD/METABOLISM SO - Clin Pharmacol Ther 1986 Oct;40(4):425-30 23 UI - 86316590 AU - Henriksen L ; Hjelms E TI - Cerebral blood flow during cardiopulmonary bypass in man: effect of arterial filtration. AB - Cerebral blood flow was recorded in 39 patients undergoing cardiac surgery by intraarterial injection of xenon 133. There were three subgroups of patients: 10 patients had a 20 micron arterial filter (Johnson) and 11 a 40 micron filter (Pall), and 18 had no arterial filtration. All patients had a 40 micron (Pall) filter in the coronary suction line. Significant changes in cerebral blood flow occurred during extracorporeal circulation (p less than 0.0001). For all patients cerebral blood flow increased from a resting prebypass level of 30 to 46 and 57 ml/100 g a minute during initial and stable hypothermic extracorporeal circulation respectively. Both measurements were obtained at 26 degrees C and the recordings were made on average 12 and 55 minutes after the extracorporeal circulation was started. During rewarming cerebral blood flow increased to 64, 53, 41, and 36 ml/g a minute at 31 degrees, 33 degrees, 35 degrees, and 37 degrees C respectively, and when measured four and 16 minutes on average after bypass it was 44 and 41 ml/100 g a minute. This general brain hyperperfusion was noticed in all patients with a high enough mean blood pressure to produce hyperaemia. Interposing 20 and 40 micron arterial filters reduced cerebral blood flow but did not prevent this hyperaemia. The cerebral autoregulation, which maintains a constant cerebral blood flow within wide limits of perfusion pressures, was not affected by arterial filtration. The lower limit of blood pressure at which a further reduction in blood pressure was followed by a reduction in cerebral blood flow was around 60 mm Hg in all three groups. MH - Adult ; Aged ; *Blood ; Body Temperature ; Brain/*BLOOD SUPPLY ; Carbon Dioxide/BLOOD ; *Cardiopulmonary Bypass ; Female ; Human ; Male ; Middle Age ; Perfusion ; Support, Non-U.S. Gov't ; *Ultrafiltration SO - Thorax 1986 May;41(5):386-95 24 UI - 86302020 AU - Schrader J ; Kandt M ; Z:urcher C ; K:ostering H ; Scheler F TI - Comparison of unfractionated heparin and low molecular weight heparin during long-term use in chronic haemodialysis and haemofiltration patients. AB - Antithrombotic activity, necessary doses and effects on coagulation and lipid variables of the low molecular weight heparin derivative Fragmin were compared to unfractionated (UF) heparin in long-term multicentre trials. Results of more than 10,000 dialyses are reported. On the basis of preliminary studies, UF heparin and Fragmin doses were used that lead to anti-Xa activities of more than 0.5 U/ml. With this dose, sufficient antithrombotic activity was achieved with both heparins. Bleeding complications were not noticed. Partial thromboplastin time (PTT) and thrombin time were only marginally increased by Fragmin (5-8 s) in contrast to UF heparin (PTT 90-120 s, thrombin time 230-260 s). Surprisingly, the elevated levels of factor VIII strongly decreased during the 6-month treatment period with Fragmin and increased again during the following 6-month treatment period with UF heparin. Creatinine, urea, haemoglobin and transaminases did not change in both heparin groups: this excluded reduced dialysis efficiency or occult blood loss. Additionally, 15 patients with acute renal failure and high bleeding risk were dialysed with low doses of Fragmin (anti-FXa: 0.2-0.3 U/ml). No severe bleeding occurred. A continuous ambulant peritoneal dialysis patient with deep vein thrombosis was treated effectively with intraperitoneal application of Fragmin for 6 months without any problems. MH - *Blood ; Comparative Study ; Factor VIII/ANALYSIS ; Factor X/PHYSIOLOGY ; *Hemodialysis ; Heparin/ADMINISTRATION & DOSAGE/BLOOD/PHARMACODYNAMICS/ *THERAPEUTIC USE ; Human ; Injections, Intraperitoneal ; Injections, Subcutaneous ; Kidney Failure, Acute/DRUG THERAPY ; Kidney Failure, Chronic/DRUG THERAPY ; Partial Thromboplastin Time ; Thrombosis/ OCCURRENCE/PREVENTION & CONTROL ; *Ultrafiltration SO - Haemostasis 1986;16 Suppl 2:48-58 25 UI - 86294685 AU - Zobel G ; Trop M ; Ring E ; Suppan C ; Grubbauer HM TI - Arteriovenous haemofiltration in hypervolaemia. AB - Arteriovenous haemofiltration was used for removal of fluid overload in a 9 month old burned infant with diuretic resistant hypervolaemia. After 60 hours of arteriovenous haemofiltration hypervolaemia had disappeared. Arteriovenous haemofiltration proved to be a safe and simple extracorporal method of managing severe fluid overload. MH - *Blood ; Burns/THERAPY ; Case Report ; Human ; Infant ; Shock/*THERAPY ; *Ultrafiltration SO - Arch Dis Child 1986 Aug;61(8):803-4 26 UI - 86293969 AU - Sznajder JI ; Zucker AR ; Wood LD ; Long GR TI - The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema. AB - Aspiration of hydrochloric acid causes pulmonary capillary endothelial damage and edema. One approach to treatment is reduction of circulating volume and pulmonary wedge pressure (Ppw) to low values compatible with adequate cardiac output (QT) and oxygen delivery (QO2) to the tissues. We investigated this approach in 18 dogs after intratracheal instillation of HCl. One hour after injury, animals were randomized into 3 equal groups and studied for another 4 h. Control dogs (Group C) were maintained at a Ppw of 12 mmHg throughout the experiment. In a second group (Group H), Ppw was reduced over 30 min to 5 mmHg by hemofiltration and maintained at this amount throughout the experiment. In a third group (Group P) Ppw was reduced and maintained at 5 mmHg by plasmapheresis. In Group C, extravascular thermal volume (ETV), measured in vivo, increased to 520 ml by 5 h, and venous admixture (QVA/QT) increased to 30%. In contrast, plasmapheresis stopped ETV accumulation at the 1-h value of 250 ml, whereas QVA/QT decreased to 8% at 5 h. Hemofiltration did not significantly reduce either ETV or QVA/QT, which were 420 ml and 30%, respectively, at 5 h. The wet weights of lungs excised at 5 h and normalized to body weight (WW/BW) confirmed that plasmapheresis reduced edema (WW/BW, 19 ml/kg) compared (p less than 0.05 ANOVA) with that in the control group (WW/BW, 27), and that hemofiltration did not significantly reduce edema (WW/BW, 24).(ABSTRACT TRUNCATED AT 250 WORDS) MH - Animal ; *Blood ; Dogs ; *Gastric Acid ; Hemodynamics ; Leukocyte Count ; *Plasmapheresis ; Pneumonia, Aspiration/*COMPLICATIONS ; Pulmonary Edema/ ETIOLOGY/*THERAPY ; Pulmonary Gas Exchange ; Support, U.S. Gov't, P.H.S. ; *Ultrafiltration SO - Am Rev Respir Dis 1986 Aug;134(2):222-8 27 UI - 86290020 AU - Bartlett RH ; Mault JR ; Dechert RE ; Palmer J ; Swartz RD ; Port FK TI - Continuous arteriovenous hemofiltration: improved survival in surgical acute renal failure? AB - Continuous arteriovenous hemofiltration (CAVH) is an effective method for renal failure management that has the potential to decrease mortality rates. This hypothesis has not been comparatively studied. Fifty six patients with acute oliguric renal failure complicating multiple organ failure had measurements of resting energy expenditure by indirect calorimetry, caloric and protein intake, energy balance, and outcome. Two management protocols included hemodialysis, full calories, and low protein (phase I) or CAVH, full calories, and high protein (phase II). The survival rate in phase I was 12% and 28% in phase II (not a statistically significant difference); CAVH did facilitate parenteral feeding. Patients with positive energy balance had improved survival compared with those with significant energy deficit (37.5% versus 9.4%, p less than 0.025). We conclude that full nutritional support improves survival in acute renal failure. The method of renal replacement therapy is of secondary importance, but CAVH has distinct advantages in the nutritional management of surgical patients. MH - Adult ; Aged ; *Blood ; Caloric Intake ; Calorimetry, Indirect ; Energy Metabolism ; Hemodialysis ; Human ; Kidney Failure, Acute/MORTALITY/ *THERAPY ; Middle Age ; *Multiple Organ Failure ; *Parenteral Feeding ; Prognosis ; *Ultrafiltration SO - Surgery 1986 Aug;100(2):400-8 28 UI - 86277067 AU - Alonso IG ; Mari:no EL ; Dominguez-Gil A ; Tabernero JM TI - Pharmacokinetics of cefotiam during hemofiltration. AB - In a study in which i.v. bolus injections of cefotiam were administered at a dose of 1000 mg directly before the start of hemofiltration sessions, the purification capacity of the drug was seen to be similar to that of other cephalosporins. Hemofiltration did not completely restore normal renal function, though it was only slightly less efficient with mean values and standard deviations for the extraction coefficient (E.C.) and hemofiltration clearance (Clh) of 0.25 +/- 0.06 and 74.02 +/- 17.05 ml/min, respectively. MH - Adult ; *Blood ; Cefotaxime/*ANALOGS & DERIVATIVES/BLOOD ; Female ; Human ; Kidney Failure, Chronic/BLOOD/THERAPY ; Kinetics ; Male ; Middle Age ; *Ultrafiltration SO - Int J Clin Pharmacol Ther Toxicol 1986 Jul;24(7):359-61 29 UI - 86276986 AU - Barr:e PE ; Prichard S TI - Combined hemofiltration and desferrioxamine treatment for aluminum induced osteomalacia. AB - A 61-year-old male hemodialysis patient developed the syndrome of aluminum intoxication including bone pain, fractures, proximal myopathy, progressive anemia and expressive aphasia. Serum aluminum was 130 micrograms/l and rose to 445 micrograms/l after the administration of 2 grams of desferrioxamine. Bone biopsy of the iliac crest revealed severe osteomalacia, heavy staining for aluminum and a bone aluminum content of 229 mg/kg dry bone. Treatment with combined hemofiltration and desferrioxamine administration led to a marked clinical improvement and a repeat bone biopsy striking healing of the osteomalacia with a bone aluminum content of 11 mg/kg dry bone. MH - *Aluminum ; *Blood ; Case Report ; Deferoxamine/*THERAPEUTIC USE ; Hemodialysis/*ADVERSE EFFECTS ; Human ; Male ; Middle Age ; Osteomalacia/ *THERAPY ; *Ultrafiltration SO - Int J Artif Organs 1986 May;9(3):167-72 30 UI - 86276984 AU - Kimura G ; Satani M ; Kojima S ; Saito F ; Kawano Y ; Ito K ; Omae T TI - Total body fluid volume determination based on urea kinetics in hemofiltration as an index of basal body weight in uremic patients. AB - Assuming that urea is distributed uniformly within the total body water, urea-space or total body fluid volume was determined in six uremic patients based on urea kinetics in hemofiltration. The total body fluid volume before hemofiltration was 36.0 +/- 3.6 L (61.8 +/- 2.6% BW) and after hemofiltration 32.5 +/- 3.4 L (59.3 +/- 2.8% BW), suggesting that the total body fluid volume was nearly normalized by hemofiltration. It is concluded that urea-space, easily measurable based on urea kinetics during hemofiltration, is useful in evaluating the fluid balance in patients undergoing artificial kidney therapy. MH - *Blood ; Body Water/*ANALYSIS ; Body Weight ; Female ; Human ; Kinetics ; Male ; Support, Non-U.S. Gov't ; *Ultrafiltration ; Urea/*METABOLISM ; Uremia/*THERAPY SO - Int J Artif Organs 1986 May;9(3):159-62 31 UI - 86272778 AU - Panzetta G ; Tessitore N ; Valvo E ; Lupo A ; Loschiavo C ; Fabris A ; Oldrizzi L ; Gammaro L ; Rugiu C ; Bellotti Z ; et al TI - Biofiltration in the treatment of patients with acetate dialysis intolerance. AB - Nine patients with intolerance to acetate hemodialysis were treated with biofiltration. It consisted of a 4 hour acetate hemodialysis during which an additional 2 liters of ultrafiltrate was replaced by a bicarbonate solution (100 mEq/l). Hypotensive episodes disappeared and six out of nine patients were symptomless during the session. Compared to standard hemodialysis, arterial blood bicarbonate and pO2 did not drop during biofiltration. Serum acetate levels, which were abnormally high in patients during standard hemodialysis, were reduced during biofiltration to the levels of a control group of acetate tolerant patients. Our data show that positive clinical results are obtained with biofiltration and suggest that they can be due to a better cellular metabolism of acetate induced by the bicarbonate infusion. MH - Acetates/*ADVERSE EFFECTS/BLOOD ; Adult ; Aged ; Bicarbonates/ ADMINISTRATION & DOSAGE/BLOOD ; *Blood ; Female ; Hemodialysis/*ADVERSE EFFECTS ; Human ; Hydrogen-Ion Concentration ; Hypotension/ETIOLOGY/ PREVENTION & CONTROL ; Middle Age ; Oxygen/BLOOD ; Partial Pressure ; Ultrafiltration/*METHODS SO - Clin Nephrol 1986 Jul;26(1):33-6 32 UI - 86246437 AU - Coraim FJ ; Coraim HP ; Ebermann R ; Stellwag FM TI - Acute respiratory failure after cardiac surgery: clinical experience with the application of continuous arteriovenous hemofiltration. AB - Hemodynamic and oxygen measurements were obtained before and during 24 h of continuous arteriovenous hemofiltration (CAVH) in 36 postoperative cardiac surgery patients with severe acute pulmonary failure. During the first 6 h, the low mean arterial pressure averaged only 50 +/- 7 mm Hg; PaO2 was 90 torr on an inspired oxygen fraction of 0.86 +/- 0.03; and lactic acid was 10.5 +/- 6 mmol/L. Of the 34 patients recovering from shock within 12 h, only 24 (67%) were hospital survivors. Cardiac index, oxygen availability index, oxygen consumption, and PaO2 increased during CAVH. This treatment decreased serum levels of the myocardial depressant factor, thus allowing catecholamine support to be reduced. We conclude that CAVH eliminates cardiopulmonary toxic substances partly responsible for shock. Our patients' improved hemodynamic and respiratory function suggests that CAVH may be useful in postoperative cardiac surgery patients with respiratory and hemodynamic failure. MH - Adult ; Aged ; *Blood ; Critical Care ; Evaluation Studies ; Female ; Heart Surgery ; Hemodynamics ; Human ; Male ; Middle Age ; Oxygen Consumption ; Postoperative Complications/MORTALITY ; Respiratory Insufficiency/*THERAPY ; Ultrafiltration SO - Crit Care Med 1986 Aug;14(8):714-8 33 UI - 86246093 AU - Wilkins MR ; Wood JA ; Adu D ; Lote CJ ; Kendall MJ ; Michael J TI - Change in plasma immunoreactive atrial natriuretic peptide during sequential ultrafiltration and haemodialysis. AB - Plasma immunoreactive human atrial natriuretic peptide (Ir-ANP) levels were measured in eight patients with chronic renal failure who were volume-expanded and during treatment by sequential ultrafiltration and haemodialysis. One patient was studied at two separate treatment sessions. Plasma Ir-ANP levels were raised in all patients (mean +/- SE 184 +/- 44 pmol/l, n = 9) compared with healthy controls (11 +/- 1.4 pmol/l), but showed considerable inter-patient variability. Plasma Ir-ANP levels fell with fluid removal during ultrafiltration (123 +/- 30 pmol/l, n = 9, P less than 0.02) and again as fluid was removed during haemodialysis (76 +/- 20 pmol/l, n = 9, P less than 0.02). Seven patients studied 48 h later, before their next dialysis treatment, had regained weight and showed a coincident rise in circulating plasma Ir-ANP (130 +/- 33 pmol/l, n = 7). Our data would support the hypothesis that the secretion of ANP is determined by volume or by a stimulus related to volume. However, it does not exclude the possibility that a factor other than extracellular fluid volume expansion contributes to the raised plasma Ir-ANP levels in chronic renal failure. MH - Adult ; Argipressin/BLOOD ; *Blood ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Female ; *Hemodialysis ; Human ; Kidney Failure, Chronic/ *BLOOD/THERAPY ; Male ; Middle Age ; Natriuretic Peptides, Atrial/*BLOOD ; Osmolar Concentration ; Potassium/BLOOD ; Radioimmunoassay ; Sodium/ BLOOD ; *Ultrafiltration SO - Clin Sci 1986 Aug;71(2):157-60 34 UI - 86241187 AU - Lai KN ; Swaminathan R ; Pun CO ; Vallance-Owen J TI - Hemofiltration in digoxin overdose. AB - We used hemofiltration to treat a patient with digoxin overdose complicated by refractory hyperkalemia, congestive heart failure, chronic renal failure, and complete atrioventricular heart block. Hemofiltration was associated with a progressive fall in plasma digoxin level and potassium level. This was accompanied by resolution of the heart failure and complete heart block. Hemofiltration appears to provide a therapeutic alternative in digoxin overdose. MH - Alcoholism/COMPLICATIONS ; *Blood ; Case Report ; Combined Modality Therapy ; Digoxin/BLOOD/*POISONING ; Heart Failure, Congestive/ COMPLICATIONS/DRUG THERAPY ; Human ; Male ; Middle Age ; Time Factors ; *Ultrafiltration/METHODS SO - Arch Intern Med 1986 Jun;146(6):1219-20 35 UI - 86239220 AU - Basile C ; Di Maggio A ; Manente G ; Gugliotta F ; Scatizzi A TI - Solute kinetics in hypertonic hemodiafiltration and standard hemodialysis. AB - Hemodiafiltration (HDF) is a new dialysis treatment that combines convective and diffusive forces. In order to assess the efficiency of a peculiar model of hypertonic HDF (H HDF), we studied eight uremic patients when they were undergoing five sessions of H HDF of 180 minutes duration and two sessions of standard hemodialysis (HD) of 270 minutes duration with a comparable blood (approximately 400 mL/min) and dialysate flow rate (approximately 520 mL/min). The plasma water clearances (Kw) of small [urea (U), creatinine (C), uric acid (UA), and phosphorus (P)] and middle molecules [netilmicin (N) and inulin (I)] were exceedingly higher in H HDF than in HD; however, because of the different treatment times, U and C removal (R) in HD overcame and UA and P R in HD equalized that in H HDF. The factor time was not sufficient to HD to compensate for the large difference in Kw in the case of I. Additional studies were performed in seven out of the eight patients after two sessions of H HDF and one session of HD. Two significantly higher rebounds were observed when comparing both treatments: for U after HD and for parathyroid hormone (PTH) after H HDF; however, PTH Cx/Cs ratios (ratios of the plasma water concentration of PTH at any postdialysis time to the plasma water concentration of PTH at the start of the run) were not different in both treatments, meaning that there was an increased PTH secretion in the early post H HDF hours in order to compensate for the larger PTH R with H HDF.(ABSTRACT TRUNCATED AT 250 WORDS) MH - *Blood ; Chronic Disease ; Creatinine ; Female ; *Hemodialysis ; Human ; Inulin ; Kinetics ; Male ; Middle Age ; Models, Biological ; Netilmicin ; Parathyroid Hormones/BLOOD ; Phosphorus ; Toxins ; Ultrafiltration/ *METHODS ; Urea ; Uremia/BLOOD/THERAPY ; Uric Acid SO - Am J Kidney Dis 1986 Jun;7(6):483-9 36 UI - 86228671 AU - Ronco C ; Brendolan A ; Bragantini L ; Chiaramonte S ; Feriani M ; Fabris A ; Dell'Aquila R ; La Greca G TI - Treatment of acute renal failure in newborns by continuous arterio-venous hemofiltration. AB - The treatment of acute renal failure (ARF) in the newborn with hemo- or peritoneal dialysis is technically difficult and may even be contraindicated. As in the adult, continuous arterio-venous hemofiltration (CAVH) may be an alternative therapy. We used CAVH in the treatment of four newborns with ARF of different etiology. Two brachial, one femoral and one umbilical arteries were cannulated as arterial access, while three jugular and one umbilical veins were used as venous return. An Amicon 0.005 m2 Polysulphon Hollow Fiber hemofilter was connected to the patient with shortened pediatric hemodialysis lines. Total blood volume of the extracorporeal circuit was 15 to 22 ml. Before starting the procedure, an initial bolus of heparin was administered to the patient (100 i.u./kg body wt) and a successive continuous heparin administration was provided during the treatment at the rate of 5 to 7 i.u./kg/hr. Hyperalimentation and/or buffer solutions were used as replacement fluids and were administered according to the patient's fluid balance. mean data in the four patients are summarized as follows. The age of the patients ranged from two to 12 days, while the average body weight was about 3 kg. The ultrafiltration rate during the treatment averaged 0.9 ml/min with a plasma flow ranging from 9.8 to 19.6 ml/min. The treatment duration varied from 30 to 86 hrs. The treatment was well tolerated (patients 1 and 2 recovered, and patients 3 and 4 died due to complications unrelated to the treatment). Arterial pressure remained stable during the procedure. Metabolic acidosis, when present, was corrected by increasing the amount of buffer administered. BUN was maintained below 60 mg/dl in three patients.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Arteriovenous Shunt, Surgical/METHODS ; Bicarbonates/BLOOD ; *Blood ; Blood Pressure ; Blood Urea Nitrogen ; Female ; Heart Rate ; Human ; Infant, Newborn ; Kidney Failure, Acute/*THERAPY ; Male ; Rheology ; Ultrafiltration/*METHODS ; Water-Electrolyte Balance SO - Kidney Int 1986 Apr;29(4):908-15 37 UI - 86228670 AU - Henderson LW TI - Heterogeneity of the cardiovascular response to hemofiltration. AB - Twenty-one stable maintenance hemodialysis patients were studied in a crossover format with hemofiltration to determine whether the lower incidence of symptomatic hypotension noted with hemofiltration could be correlated with changes in baroreflex function as tested using the cold pressor test and amyl nitrite inhalation study. Baroreflex function remained abnormal and unchanged in all patients in the face of a reduced incidence of symptomatic hypotension. Subdivision of the patients into frequent (greater than 1 episode/treatment) and infrequent (less than 1 episode/treatment) reactors during the hemodialysis control period resulted in the infrequent reactors, showing a significant increase in episodes of symptomatic hypotension/hemofiltration treatment where a significant reduction was noted with the frequent reactors. No clear correlation could be made between the incidence of symptomatic hypotension and the pre- to post-treatment change in body temperature. The presence of pretreatment hypertension, another previously identified correlate of symptomatic hypotension with hemodialysis, also could not be corroborated. Further, changes from baseline predialysis values in mean arterial pressure noted with hemofiltration could not be correlated with a changed incidence of symptomatic hypotension. We conclude that previously identified correlates of symptomatic hypotension noted in the hemodialysis setting may be dissociated during treatment with hemofiltration and that there is a heterogeneous patient response to this treatment. These data suggest that there are additional, as yet undetermined, pathophysiologic events that underly the symptomatic hypotension of artificial kidney treatment. MH - Adult ; Aged ; *Blood ; Blood Pressure ; Body Temperature Regulation ; Body Weight ; Female ; Hemodialysis ; Human ; Hypotension/ *PHYSIOPATHOLOGY ; Kidney Failure, Chronic/*PHYSIOPATHOLOGY/THERAPY ; Male ; Middle Age ; Pressoreceptors/PHYSIOPATHOLOGY ; Reflex/PHYSIOLOGY ; Support, U.S. Gov't, Non-P.H.S. ; *Ultrafiltration SO - Kidney Int 1986 Apr;29(4):901-7 38 UI - 86217069 AU - Stevens PE ; Bloodworth LL ; Rainford DJ TI - High altitude haemofiltration. AB - Evacuating people in acute renal failure by air is difficult because the hazards of fluid overload and anaemia are potentiated by altitude. In two such patients continuous arteriovenous haemofiltration was used to control their fluid problems during aeromedical evacuation. In the first case, a patient with renal failure and blast lung, haemofiltration was performed at 500 ml/h over a four hour journey; in the second, a woman with severe pre-eclamptic toxaemia who developed acute renal failure after caesarean section, haemofiltration was performed at 200 ml/h over a 14 hour flight. Both patients recovered fully. In these two cases haemofiltration permitted control of the intravascular volume during aeromedical evacuation. The technique represents a major advance in the safe transfer of casualties. MH - Adult ; Aerospace Medicine ; Aircraft ; *Altitude ; *Blood ; Case Report ; Cesarean Section ; Female ; Human ; Kidney Failure, Acute/*THERAPY ; Male ; Postoperative Complications ; Pregnancy ; *Transportation of Patients ; *Ultrafiltration ; Water-Electrolyte Balance SO - Br Med J [Clin Res] 1986 May 24;292(6532):1354 39 UI - 86120047 AU - Bettinelli A ; Bianchi ML ; Aimini E ; Ortolani S ; Soldati L ; Edefonti A TI - Effects of 1,25-dihydroxyvitamin-D3 treatment on mineral balance in children with end stage renal disease undergoing chronic hemofiltration. AB - Ten children with end stage renal disease on chronic hemofiltration (HF) were studied for a 1-yr period to evaluate the efficacy of 1,25-dihydroxyvitamin-D3 (1,25(OH)2D3) therapy on biohumoral parameters of renal osteodystrophy and bone mineral content. In six of these children an acute study was done of the direct effect of the HF procedure on calcium and phosphate balance during 12 HF sessions. During the first 6 months of the study all children were treated with 1,25(OH)2D3 (0.25-0.50 microgram/day) to maintain plasma calcium at 9.5-11.0 mg/dl. There was a significant increase in plasma calcium (p less than 0.05) and a significant decrease in plasma phosphate (p less than 0.01) and alkaline phosphatase concentrations (p less than 0.05). The circulating levels of NH2 immunoreactive parathyroid hormone did not change, remaining at the upper limits of reference values. Immunoreactive parathyroid hormone-COOH terminal fragment levels decreased significantly (p less than 0.05). Bone mineral content rose significantly (p less than 0.01). During the last 6 months of the study, to evaluate the possibility that HF alone might control secondary hyperparathyroidism, 1,25(OH)2D3 treatment was discontinued in five children; plasma calcium and phosphate were well controlled whereas hyperparathyroidism worsened in all five, and one also developed intense pruritus and hypertension. The other five children remained on 1,25(OH)2D3 treatment; two of these were transplanted, and the other three continued to show an improvement of mineral balance. The results of the acute study showed that calcium balance was positive with a mean Ca++ gain of 140 mg/HF session. The mean total phosphate removed per HF run was 574 mg.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Adolescence ; Alkaline Phosphatase/BLOOD ; Aluminum Hydroxide/THERAPEUTIC USE ; Blood ; Bone and Bones/METABOLISM ; Calcitriol/*THERAPEUTIC USE ; Calcium/METABOLISM ; Child ; Child, Preschool ; Female ; Hemodialysis ; Human ; Hyperparathyroidism, Secondary/DRUG THERAPY/ETIOLOGY ; Hypertension/DRUG THERAPY/ETIOLOGY ; Kidney Failure, Chronic/ COMPLICATIONS/*METABOLISM ; Male ; Minerals/*METABOLISM ; Phosphates/ METABOLISM ; Prospective Studies ; Random Allocation ; Ultrafiltration SO - Pediatr Res 1986 Jan;20(1):5-8 40 UI - 86193514 AU - Rakela J ; Kurtz SB ; McCarthy JT ; Ludwig J ; Ascher NL ; Bloomer JR ; Claus PL TI - Fulminant Wilson's disease treated with postdilution hemofiltration and orthotopic liver transplantation. AB - A 22-yr-old woman presented with fulminant Wilson's disease. The diagnosis was suspected clinically and was later confirmed with chemical and pathologic studies. She presented with acute hepatic failure, hemolysis, and acute anuric renal failure. Postdilution hemofiltration and continuous arteriovenous hemofiltration with oral D-penicillamine allowed removal of a total of 95,700 micrograms of copper; 78,665 micrograms of the total were removed via postdilution hemofiltration alone. On the 57th day, the patient received successful liver and renal transplants. We found that the determination of serum copper was instrumental in the diagnosis of fulminant Wilson's disease, that postdilution hemofiltration allowed a rapid removal of copper in the presence of renal failure, and that, finally, orthotopic liver transplantation should be performed early in the clinical course of these patients. This patient is the longest survivor of this serious condition. MH - Acute Disease ; Adult ; Case Report ; Combined Modality Therapy ; Copper/ BLOOD ; Female ; Hemodialysis ; *Hemodilution/METHODS ; Hepatolenticular Degeneration/BLOOD/COMPLICATIONS/*THERAPY ; Human ; Kidney/ TRANSPLANTATION ; Kidney Failure, Acute/BLOOD/THERAPY ; Liver/ *TRANSPLANTATION SO - Gastroenterology 1986 Jun;90(6):2004-7 41 UI - 86178914 AU - Gotloib L ; Barzilay E ; Shustak A ; Wais Z ; Jaichenko J ; Lev A TI - Hemofiltration in septic ARDS. The artificial kidney as an artificial endocrine lung. AB - Twenty-four patients with high microvascular permeability pulmonary edema were initially treated by means of conventional supportive therapy for 1-12 days. Continued deterioration was treated by predilutional hemofiltration and induced a dramatic improvement in 22/24 patients. Survival was 92%. Sieving coefficients for autacoids and middle molecular weight vasoactive peptides involved in the development of high microvascular permeability pulmonary edema were higher than 0.88 indicating that clearing from blood of these peptides during one pass through the hemofilter is similar to that obtained during one pass through the pulmonary normal microvasculature. Hemofiltration seems to be a significant breakthrough in the treatment of ARDS secondary to severe sepsis. MH - Adolescence ; Adult ; Aged ; *Blood ; Creatinine/BLOOD ; Hemodialysis ; Hemodynamics ; Human ; Hydrogen-Ion Concentration ; Kidney Failure, Acute/ ETIOLOGY/THERAPY ; Middle Age ; Oxygen/BLOOD ; Positive Pressure Respiration ; Respiratory Distress Syndrome, Adult/BLOOD/MICROBIOLOGY/ *THERAPY ; *Ultrafiltration SO - Resuscitation 1986 Jan;13(2):123-32 42 UI - 86166951 AU - B:ottcher M ; Falkenhagen D ; Nebe B ; Holtz M ; Neumann J ; Ryan C ; W:ustenberg PW ; D:orp E ; Klinkmann H TI - Experiments with continuous hemofiltration and hemofiltrate regeneration in the rat. AB - Experimental studies were made with continuous hemofiltration treatment for bilaterally nephrectomized rats and initial observations regarding the effects of such treatment on leukocyte and thrombocyte counts are reported. Hemofiltration of unanesthetized rats able to move freely within their cage could be continued for up to 30 h using a pump-driven ECC system. Blood parameters recorded during this treatment indicate that the detoxification was effective. In another series of experiments the water and electrolyte reabsorption capacity of the colon ascendens of healthy rats was tested by continuously supplying NaCl solution into the colon via a fistula. A large proportion, if not all, of the hemofiltrate can be discharged into the colon without diarrhoea. A final series of experiments showed that the three-stage operation (implantation of permanent catheters, connection of a permanent intestinal fistula and bilateral nephrectomy) is possible with the rat. MH - Animal ; *Blood ; Catheters, Indwelling ; Colon ; Intestinal Absorption ; Leukocyte Count ; Nephrectomy ; Platelet Count ; Rats ; *Ultrafiltration/ INSTRUMENTATION ; Water-Electrolyte Balance SO - Int J Artif Organs 1986 Jan;9(1):11-6 43 UI - 86140852 AU - Chan R ; Munro R ; Tomlinson P TI - Evaluation of lysis filtration as an adjunct to conventional blood culture. AB - A lysis filtration system was used in conjunction with conventional broth culture for 1112 blood cultures. The system, which entailed collection of 5 ml of blood into bottles containing 50 ml isotonic phosphate buffer, Tween 20, and Rhozyme with subsequent filtration using a 0.45 micron Millipore field monitor, was simple and economical to use. Positive results were obtained earlier than those obtained with conventional broth cultures, and almost twice as many fungi and yeasts were isolated. Some fastidious organisms such as Haemophilus influenzae and Streptococcus pneumoniae however, were not recovered from the lysis system, and contaminants in lysis cultures were three times as common as in conventional culture. The number of positive cultures was also adversely influenced by incubation of the blood lysis mixture overnight before filtration. We conclude that this lysis filtration system is useful as an adjunct to conventional broth culture in selected patients in cases in which filtration can be carried out soon after collection. MH - Bacteria/ISOLATION & PURIFICATION ; Blood/*MICROBIOLOGY ; Fungi/ISOLATION & PURIFICATION ; Hemolysis ; Human ; Microbiological Technics ; Septicemia/*MICROBIOLOGY ; Time Factors ; *Ultrafiltration SO - J Clin Pathol 1986 Jan;39(1):89-92 44 UI - 86118923 AU - Tominaga H ; Tanaka S ; Tominaga N TI - Endotoxin level of sterile injection solutions and substitution fluid for hemofiltration in Japan and Australia. AB - The endotoxin contamination levels of sterile distilled water and saline solutions used for injection and hemofiltration in Japan and Australia were examined with a colorimetric limulus test using a chromogenic substrate. The endotoxin levels of injection solutions in most products from both countries measured against E. coli 0111:B4 endotoxin or USP reference standard endotoxin were less than 0.2 pg or 0.0006 endotoxin units (EU) X ml-1. Only 2 solutions in 30 from both countries showed higher levels: 7.7 and 10.8 pg for E. coli 0111:B4 endotoxin X ml-1 (0.02 and 0.03 EU X ml-1). Even these higher values were well below the level recommended by the draft guideline published by the United States Food and Drug Administration (FDA). The endotoxin contamination level of a Japanese hemofiltration substitution fluid ranged from 8.2 to 9.2 pg E. coli 0111:B4 endotoxin X ml-1 (0.024-0.027 EU X ml-1). MH - Australia ; Colorimetry/METHODS ; Endotoxins/*ANALYSIS ; Escherichia Coli ; *Hemodialysis ; Human ; Japan ; Limulus Test ; Quality Control ; Sodium Chloride ; Solutions ; Water SO - Nephron 1986;42(2):128-32 45 UI - 86092395 AU - Sebert JL ; Fournier A ; Leflon P ; Fohrer P ; de Fr:emont JF ; Morini:ere P ; Galy C ; Marie A ; Demontis R ; Boudailliez B ; et al TI - Comparative evaluation of bone aluminum content and bone histology in patients on chronic hemodialysis and hemofiltration. AB - In order to compare hemofiltration (HF) and hemodialysis (HD) in connection with the risk of aluminum overload and renal osteodystrophy, double bone biopsies after double tetracycline labeling and a desferrioxamine test were performed in 12 patients on HF and 15 patients on HD. The aluminum concentration was low (less than 0.6 mumol/l) both in the dialysate and the substitution fluid. The duration of treatment (about 2 years) and the cumulative doses of Al(OH)3 and CaCO3 were comparable in the two groups. None of the patients was taking 1 alpha-OH-D. The aluminum balance during an HF run ranged from -22 to +1.8 mumol/l, the balance being positive only when the plasma aluminum was less than 0.5 mumol/l. Basal plasma aluminum and its increase induced by desferrioxamine were comparable in the two groups. Bone aluminum content was also comparable, but was about 10 times higher than in 7 nonuremic controls. Bone aluminum content and plasma aluminum increase after desferrioxamine were correlated to the Al(OH)3 cumulative dose. None of the patients had florid osteomalacia with increased osteoid thickness, and only 1 in each group had traces of stainable aluminum. The mineralization front was decreased in 8 of 12 HF and in 9 of 14 HD patients, so that no difference was observed between the means of the two groups. The predominant histological bone picture of the patients was osteitis fibrosa which was present in 10 of 12 HF and in 13 of 15 HD patients. Mean osteoclast count and active resorption surface were comparable in the two groups, but was increased (5-10 times the mean of the controls).(ABSTRACT TRUNCATED AT 250 WORDS) MH - Adult ; Alkaline Phosphatase/BLOOD ; Aluminum/BLOOD/*METABOLISM ; Aluminum Hydroxide/ADVERSE EFFECTS ; *Blood ; Bone and Bones/*METABOLISM/ PATHOLOGY ; Comparative Study ; Dose-Response Relationship, Drug ; Electrolytes/BLOOD ; Female ; *Hemodialysis ; Human ; Kidney Failure, Chronic/METABOLISM/PATHOLOGY/*THERAPY ; Male ; Middle Age ; Osteogenesis/ DRUG EFFECTS ; Parathyroid Hormones/BLOOD ; Peptide Fragments/BLOOD ; Renal Osteodystrophy/METABOLISM ; *Ultrafiltration SO - Nephron 1986;42(1):34-40