An unsuspected cause for metabolic acidosis in chronic renal failure: sorbent system hemodialysis

A severe metabolic acidosis was produced in a patient with chronic renal failure by hemodialysis using a sorbent system to regenerate bicarbonate dialysate with an initial bicarbonate concentration of 60 mEq/L. The acidosis resolved with standard single-pass hemodialysis. In five additional patients, the bicarbonate concentration of the dialysate with the sorbent system was noted to be low and quite variable (mean +/- SD, 16.5 +/- 8.3 mEq/L, range 5 mEq/L to 39 mEq/L). The low dialysate bicarbonate failed to correct metabolic acidosis and, in fact, was capable of further lowering the serum bicarbonate. The capacity of the regenerating cartridge to release protons makes this form of dialysis a potential cause for metabolic acidosis. The safety of the sorbent system dialysis, at least in the bicarbonate mode, requires further evaluation.     

透析液配制用的浓缩液及反渗水

纯透析液的使用和推广,对现代化血液透析的质量是非常必要的。     

HD组方对血透患者内皮素与降钙素基因相关肽影响的临床研究

目的：观察中药HD组方在血液透析中对血透患内皮素(ET)、降钙素基因相关肽(CGRP)的影响，探讨如何进一步提高尿毒症终末期维持性血透患的透析效率和生活质量。方法：选择终末期肾衰竭(ESRD)患66例，已作维持性血液透析(HD)治疗1年以上，随机分为常规治疗组32例，中药治疗组34例；另设正常对照组20例。常规治疗组：继续进行常规血液透析；中药治疗组：在常规治疗组透析的基础上，将常规透析液中加入中药HD组方。并定期观察各组患的收缩压(SBP)、舒张压(DBP)、内皮素(ET)、降钙素基因相关肽(CGRP)，疗程均为6个月。结果：治疗6个月后，中药治疗组与治疗前及常规治疗组相比SBP、DBP、ET水平显降低(P＜0．01)，而CGRP水分显增高(P＜0．05)。结论：HD组方的应用可通过改善血循环状态，调节患ET、CGRP代谢失衡状况，从而调节血管舒、缩功能，有利于降低血压。     

Serum and dialysate concentrations of cephalexin following repeated dosing in CAPD patients

Oral cephalexin, 1 to 2 g daily for 3 days, was given to six stable, noninfected patients receiving maintenance continuous ambulatory peritoneal dialysis (CAPD). The peak serum concentration after a 2 g initial dose was between 73 and 123 mg/L. On the second and third day in five patients who received a 2 g daily oral dose, the serum concentrations were between 35 and 118 mg/L in serum obtained 1 to 1.5 hours after the dosing. Similar serum concentrations were seen in one patient who only received a 1 g oral dose on the second and third day. Cephalexin concentrations in the peritoneal dialysate reached a peak on the first day between 4 to 14 hours after the dose and were between 31 to 78 mg/L. During the second and third day, the highest cephalexin concentration was 118 mg/L and the lowest was 12 mg/L. The data are consistent with the feasibility of oral cephalexin for treatment of CAPD-associated peritonitis with microorganisms that are sensitive to these levels of cephalexin.     

Infusion-free hemodiafiltration: simultaneous hemofiltration and dialysis with no need for infusion fluid

A new simultaneous hemofiltration and dialysis system was developed which has no need of infusion fluid. The system employs two hemodiafilters in a direct series. An ultrafiltration rate and dialysate flow rate control system was employed to control the dialysate flow at the inlet and outlet, and the difference in volume was arranged to be the amount of water removed from the body. When the blood circuit was narrowed between the two hemodiafilters, the ultrafiltration was performed at the first hemodiafilter; at the second one, the dialysate moved to the blood side as a dilution fluid. To remove pyrogens and bacteria, tap water was subjected to activated charcoal, ion exchange and reverse osmosis treatment, followed by preparation of the dialysate. In clinical evaluation, this system showed marked improvement in clearance of middle and large molecules.     

Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis.

BACKGROUND: This study compares the effect of online-haemodiafiltration (o-HDF, post-dilution mode) with conventional haemodialysis (HD) and 'temperature-controlled' HD (Temp-HD) on the haemodynamic stability of hypotension-prone patients. METHODS: Seventeen patients with a history of frequent hypotensive episodes during dialysis sessions were studied, each patient serving as his or her own control. The first 25 HD treatments in comparison with 25 o-HDF sessions were evaluated using identical dialysate temperature. In the second part of the study, o-HDF (n = 25) was compared with Temp-HD (n = 25). In the latter method, the temperature of the dialysate was adjusted to result in identical energy transfer rates to those in the corresponding o-HDF. The number of hypotensive episodes, blood temperature and blood volume regulation were assessed. RESULTS: Symptomatic hypotension was much more frequent during HD (40%) than during o-HDF (4%) (P < 0.001). During o-HDF, an enhanced energy loss within the extracorporeal system occurred (o-HDF, 16.6 +/- 4.0 W; HD, 5.4 +/- 5.1 W; P < 0.0001), despite identical temperature settings for dialysate and substitution fluid. As a result, the blood returning to the patient was cooler during o-HDF than during HD (o-HDF 35 +/- 0.2 degrees C vs HD 36.5 +/- 0.3 degrees C; P < 0.0001). In o-HDF, even in the patients' circulation, the mean blood temperature was lower (o-HDF 36.7 +/- 0.2 degrees C vs HD 36.9 +/- 0.3 degrees C; P < 0.0001) and blood volume was significantly more reduced (o-HDF, 91.8 +/- 3.1%; HD, 94.0 +/- 3.2%; P < 0.05). Energy transfer rates and blood temperature did not differ significantly between o-HDF and Temp-HD. The rate of hypotensive episodes was low and not different between o-HDF (4%) and Temp-HD (4%). Neither was there any significant difference in blood volume reduction. CONCLUSIONS: O-HDF showed a significant reduction of hypotensive episodes compared with HD. Surprisingly, o-HDF resulted in cooling of the blood via enhanced thermal energy losses within the extracorporeal system, despite use of replacement fluid prepared from pre-warmed dialysate. The incidence of symptomatic hypotension was reduced to that of o-HDF by using cooler Temp-HD. Thus, unexpected blood cooling appears to be the main blood pressure-stabilizing factor in o-HDF.     

动态浊度法检测透析用水和透析液细菌内毒素含量

目的：建立韶关地区医院透析用水和透析液细菌内毒素动态浊度检查法,了解分析韶关地区透析用水和透析液质量状况。方法：按照《中国药典》2015年版第四部通则1143细菌内毒素检查法方法2光度测定法,对韶关地区医院透析用水和透析液进行动态浊度法的方法学研究,使用SPSS软件分析不同稀释倍数下细菌内毒素的回收率,确定检测方法,并按照建立方法检测细菌内毒素含量。结果：建立细菌内毒素标准曲线LgT=2.80493-0.27415 LgC（r＝-0.9983）,干扰试验中,稀释倍数越大,回收率越接近100%。不同稀释倍数对透析用水的回收率无显著影响（P=0.521）,对透析液的回收率有显著影响（P=0.000）,透析用水使用原液进行细菌内毒素检查无干扰作用,透析液使用8倍或16倍稀释液进行细菌内毒素检查无干扰作用。结论：医院透析用水和透析液细菌内毒素检测可用本研究建立的细菌内毒素检查法进行检测,韶关地区医院透析用水和透析液总体质量水平较好,均可达到标准要求。     

透析设备质量控制实践中的几个问题

本文通过分析透析用水、透析液及透析机质量控制实践中存在的问题,为避免透析并发症提出了有效的控制方案。同时阐述了透析工程技术人员的重要性,指明了透析工程技术人员存在的不足,并提出加强透析工程技术队伍建设,提高其综合素质的方案。     

维持性血液透析患者透析液钠模式的选择

维持性血液透析患者容量超负荷的现象非常普遍,调整透析液的钠离子浓度可清除体内多余水分。目前透析过程中常用的钠模式有低钠透析、标准钠透析、可调钠透析和个体化钠透析模式。前三种透析模式在透析结束时都可能会达到钠离子的负平衡或正平衡,引起透析失衡综合征或透析间期口渴、干体重增加等。个体化钠模式的目标是透析结束时实现钠离子的零平衡,既不引起钠潴留,也不过度丢失钠,更好地控制血压及干体重,减少不良事件的发生,是非常理想的透析液钠模式。