Long-term peritoneal dialysis is associated with the development of peritoneal membrane alterations, both in morphology and function. Impaired ultrafiltration (UF) is the most important functional change, and peritoneal fibrosis is the major morphological alteration. Both are caused by the continuous exposure to dialysis solutions that are different from plasma water with regard to the buffer substance and the extremely high-glucose concentrations. Glucose has been incriminated as the major cause of long-term peritoneal membrane changes, but the precise mechanism has not been identified. We argue that glucose causes the membrane alterations by peritoneal pseudohypoxia and by the formation of advanced glycosylation end products (AGEs). After a summary of UF kinetics including the role of glucose transporters (GLUT), and a discussion on morphologic alterations, relationships between function and morphology and a survey of the pathogenesis of UF failure (UFF), it will be argued that impaired UF is partly caused by a reduction in small pore fluid transport as a consequence of AGE-related vasculopathy and - more importantly - in diminished free water transport due to pseudohypoxia, caused by increased peritoneal cellular expression of GLUT-1. The metabolism of intracellular glucose will be reviewed. This occurs in the glycolysis and in the polyol/sorbitol pathway, the latter is activated in case of a large supply. In both pathways the ratio between the reduced and oxidised form of nicotinamide dinucleotide (NADH/NAD+ ratio) will increase, especially because normal compensatory mechanisms may be impaired, and activate expression of hypoxia-inducible factor-1 (HIF-1). The latter gene activates various profibrotic factors and GLUT-1. Besides replacement of glucose as an osmotic agent, medical treatment/prevention is currently limited to tamoxifen and possibly Renin/angiotensis/aldosteron (RAA) inhibitors.
- MeSH
- dialyzační roztoky škodlivé účinky metabolismus MeSH
- glukosa škodlivé účinky metabolismus MeSH
- glykosylace MeSH
- lidé MeSH
- peritoneální dialýza * škodlivé účinky MeSH
- peritoneum metabolismus MeSH
- ultrafiltrace MeSH
- voda metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
In this study, we investigated the clinical effects of blood ultrafiltration therapy in patients with acute decompensated chronic heart failure. We enrolled 78 patients with acute decompensated chronic heart failure who were admitted to a hospital from September 2017 to December 2021, and divided them into two groups based on the digital randomization method. The FQ-16 heart failure ultrafiltration dehydrating device blood ultrafiltration therapy was administered to the observation group (39 patients) for 8-16 hours, while the control group (39 patients) received the stepped drug therapy. Echocardiography was used to assess the changes in cardiac function of the patients in both groups before and after treatment. The changes in urine volume, N-terminal pro-B-type natriuretic peptide (NT-proBNP), plasma renin, and serum creatinine levels were measured before and after the treatment to compare the overall response rate of the patients in both groups. The differences in left ventricular end-systolic dimension and left ventricular end-diastolic dimension and the ejection fraction between the groups before treatment were not statistically significant (P > 0.05), however, the left ventricular end-diastolic dimension in the observation group was significantly lower and the ejection fraction was significantly higher (P < 0.05) compared with that before treatment; the urine volume, N-terminal pro-B-type natriuretic peptide (NT-proBNP), plasma renin, and serum creatinine were significantly improved in both groups after treatment compared with that before treatment. All indexes in the observation group were better than those in the control group (P < 0.05), 74.36%. The overall response rate of the observation group was 94.87%, x2 = 4.843 and the difference between groups was statistically significant (P < 0.05). Blood ultrafiltration therapy for patients with acute decompensated chronic heart failure can improve their cardiac and renal functions, reduce NT-proBNP, reduce volume load, and enhance efficacy while ensuring high safety.
- MeSH
- biologické markery MeSH
- diuretika terapeutické užití MeSH
- funkce levé komory srdeční fyziologie MeSH
- kreatinin MeSH
- lidé MeSH
- natriuretický peptid typu B * MeSH
- peptidové fragmenty MeSH
- renin MeSH
- srdeční selhání * MeSH
- tepový objem fyziologie MeSH
- ultrafiltrace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- chronická renální insuficience diagnóza terapie MeSH
- dialýza MeSH
- kardiorenální syndrom * etiologie klasifikace MeSH
- lidé MeSH
- renální insuficience MeSH
- senioři MeSH
- srdeční selhání MeSH
- ultrafiltrace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
Nedávné pokroky v léčbě snižují mortalitu a zvyšují kvalitu života pacientů s chronickým srdečním selháním. Chronické onemocně-ní ledvin (CKD) je u pacientů se srdečním selháním časté, doklady pro účinnost léčby srdečního selhání u pacientů s CKD 4–5 jsou ale nedostatečné, protože tito pacienti nebyli zařazováni do uskutečněných randomizovaných kontrolovaných studií. U pacientů se srdečním selháním a CKD 1–3 jsou léčebné intervence přinejmenším stejně účinné jako u pacientů s normální renální funkcí, v některých případech mohou mít i příznivý vliv na progresi chronické renální insuficience, problémem ale může být kontrola pře-vodnění a hyperkalemie.
- MeSH
- aminobutyráty farmakologie terapeutické užití MeSH
- antagonisté receptorů pro angiotenzin aplikace a dávkování farmakologie metabolismus MeSH
- blokátory receptorů AT1 pro angiotensin II aplikace a dávkování farmakologie metabolismus MeSH
- chronická renální insuficience * klasifikace komplikace MeSH
- enalapril aplikace a dávkování farmakologie MeSH
- glifloziny aplikace a dávkování farmakologie MeSH
- hodnoty glomerulární filtrace účinky léků MeSH
- hyperkalemie epidemiologie etiologie prevence a kontrola MeSH
- inhibitory fosfodiesterasy 5 farmakologie terapeutické užití MeSH
- interleukin-1beta antagonisté a inhibitory terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- neprilysin antagonisté a inhibitory farmakologie MeSH
- srdeční selhání farmakoterapie klasifikace MeSH
- tetrazoly farmakologie terapeutické užití MeSH
- ultrafiltrace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinická studie MeSH
- přehledy MeSH
To date, according to the latest literature inputs, membranes-based technologies (microfiltration, ultrafiltration and nanofiltration) have demonstrated to meet the recovery of biologically active compounds, mainly phenolic compounds and their derivatives, from agro-food products and by-products. The goal of this paper is to provide a critical overview of the on ongoing development works aimed at improving the separation, fractionation and concentration of phenolic compounds and their derivatives from their original sources. The literature data are analyzed and discussed in relation to separation processes, molecule properties, membrane characteristics and key factors affecting the performance of such technologies. Technological advances and improvements over conventional technologies, as well as critical aspects to be further investigated are highlighted and discussed. Finally, a critical outlook about the current status for a large-scale application and the role of these processes from an environmental viewpoint is provided.
V polovině 90. let byla vyvinuta první metoda měření průtoku krve cévním přístupem (QVA) pro dialýzu „u lůžka“, využívající měřenínucené recirkulace při invertovaném zapojení jehel ultrazvukovou dilucí. Profylaktické měření QVA se poté stalo metodou volby připravidelném sledování stavu cévních přístupů a od roku 2016 je v ČR pojišťovnami hrazeným výkonem. Následně byla vyvinutařada alternativních metod měření QVA, většinou dilučních, ale i metod na jiném principu. Článek je přehledem všech těchto metod.Uvádí jejich principy (ultrazvuková diluce, termodiluce, optodiluce, optokoncentrace, iontová dialysance, vodivost, klasické duplexnídopplerovské měření i pouze dopplerovské měření rychlosti toku), přednosti a omezení i potřebné technické vybavení.Klíčová slova: cévní přístup, recirkulace, průtok krve, měření „u lůžka“, diluční metody, vodivost, dopplerovské měření.
In the mid-nineties, the first vascular access blood flow (QVA) measurement at the bedside has been developed, based on measurement of forced recirculation at inverted needles by ultrasonic dilution. Prophylactic QVA measurement soon became the method of choice in regular vascular access status assessment. Since 2016, this procedure is also reimbursed by all insurance companies in the Czech Republic. Subsequently, number of alternative methods of QVA evaluation was developed, mostly but not exclusively based on dilutional techniques. The article describes all those methods, their principles (ultrasonic dilution, thermodilution, optodilution/optoconcentration, ionic dialysance, conductivity step-wise change, conventional duplex-doppler and sole doppler velocity measurement), technical and performance pros and cons as well as technical means needed for practical implementation.
- Klíčová slova
- ultrazvuková diluce, optodiluce,
- MeSH
- cévní přístupy MeSH
- dialýza ledvin * metody přístrojové vybavení MeSH
- duplexní dopplerovská ultrasonografie MeSH
- hemodynamika MeSH
- krevní oběh MeSH
- lidé MeSH
- rychlost toku krve * MeSH
- termodiluce MeSH
- ultrafiltrace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- MeSH
- dialýza ledvin * metody přístrojové vybavení škodlivé účinky MeSH
- dialyzační roztoky MeSH
- hypotenze prevence a kontrola MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- ultrafiltrace metody přístrojové vybavení MeSH
- zpětná vazba fyziologická MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- komentáře MeSH
- souhrny MeSH
Pressure-driven membrane-based technologies represent a valid approach to reduce the environmental pollution of several agro-food by-products. Recently, in relation to the major interest for natural compounds with biological activities, their use has been also addressed to the recovery, separation and fractionation of phenolic compounds from such by-products. In particular, tight ultrafiltration (UF) and nanolfiltration (NF) membranes have been recognized for their capability to recover phenolic compounds from several types of agro-food by-products. The separation capability of these membranes, as well as their productivity, depends on multiple factors such as membrane material, molecular weight cut-off (MWCO) and operating conditions (e.g., pressure, temperature, feed flow rate, volume reduction factor, etc.). This paper aims at providing a critical overview of the influence of these parameters on the recovery of phenolic compounds from agro-food by-products by using tight UF and NF membranes. The literature data are analyzed and discussed in relation to separation processes, molecule properties, membrane characteristics and other phenomena occurring in the process. Current extraction methodologies of phenolic compounds from raw materials are also introduced in order to drive the implementation of integrated systems for the production of actractive phenolic formulations of potential interest as food antioxidants.
