In standard care, hemodialysis patients are often treated with a center-specific fixed dialysate sodium concentration, potentially resulting in diffusive sodium changes for patients with plasma sodium concentrations below or above this level. While diffusive sodium load may be associated with thirst and higher interdialytic weight gain, excessive diffusive sodium removal may cause intradialytic symptoms. In contrast, the new hemodialysis machine option "Na control" provides automated individualization of dialysate sodium during treatment with the aim to reduce such intradialytic sodium changes without the need to determine the plasma sodium concentration. This proof-of-principle study on sodium control was designed as a monocentric randomized controlled crossover trial: 32 patients with residual diuresis of ≤1000 mL/day were enrolled to be treated by high-volume post-dilution hemodiafiltration (HDF) for 2 weeks each with "Na control" (individually and automatically adjusted dialysate sodium concentration) versus "standard fixed Na" (fixed dialysate sodium 138 mmol/L), in randomized order. Pre- and post-dialytic plasma sodium concentrations were determined at bedside by direct potentiometry. The study hypothesis consisted of 2 components: the mean plasma sodium change between the start and end of the treatment being within ±1.0 mmol/L for sodium-controlled treatments, and a lower variability of the plasma sodium changes for "Na control" than for "standard fixed Na" treatments. Three hundred seventy-two treatments of 31 adult chronic hemodialysis patients (intention-to-treat population) were analyzed. The estimate for the mean plasma sodium change was -0.53 mmol/L (95% confidence interval: [-1.04; -0.02] mmol/L) for "Na control" treatments and -0.95 mmol/L (95% CI: [-1.76; -0.15] mmol/L) for "standard fixed Na" treatments. The standard deviation of the plasma sodium changes was 1.39 mmol/L for "Na control" versus 2.19 mmol/L for "standard fixed Na" treatments (P = 0.0004). Whereas the 95% CI for the estimate for the mean plasma sodium change during "Na control" treatments marginally overlapped the lower border of the predefined margin ±1.0 mmol/L, the variability of intradialytic plasma sodium changes was lower during "Na control" versus "standard fixed Na" treatments. Thus, automated dialysate sodium individualization by "Na control" approaches isonatremic dialysis in the clinical setting.

• MeSH
• algoritmy MeSH
• chronické selhání ledvin terapie   MeSH
• dialýza ledvin metody   MeSH
• dialyzační roztoky chemie   terapeutické užití   MeSH
• individualizovaná medicína metody   MeSH
• klinické křížové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• sodík chemie   terapeutické užití   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

Electrodialysis (ED) is frequently used in the desalination of whey. However, the fouling onto the membrane surface decreases the electrodialysis efficiency. Pulsed Electrodialysis Reversal (PER), in which short pulses of reverse polarity are applied, is expected to decrease the fouling onto membrane surface during ED. Three (PER) regimes were applied in the desalination of acid whey (pH ≤ 5) to study their effects on the membrane fouling and the ED efficiency. The PER regimes were compared to the conventional ED as the control. For each regime, two consecutive runs were performed without any cleaning step in-between to intensify the fouling. After the second run, the membranes were subjected to the Scanning electron microscope (SEM) imaging and contact angle measurement to investigate the fouling on the membrane surface in different regimes. The ED parameters in the case of conventional ED were almost the same in the first and the second runs. However, the parameters related to the ED efficiency including ED capacity, ash transfer, and ED time, were deteriorated when the PER regimes were applied. The contact angle values indicated that the fouling on the diluate side of anion exchange membranes was more intensified in conventional ED compared to the PER regimes. The SEM images also showed that the fouling on the diluate side of both cation and anion exchange membranes under PER regimes was reduced in respect to the conventional ED. However, the back transfer to the diluate compartment when the reverse pulse was applied is dominant and lowers the ED efficiency slightly when the PER is applied.

• MeSH
• dialýza metody   MeSH
• dialyzační roztoky chemie   MeSH
• elektrochemie MeSH
• membrány umělé MeSH
• mikroskopie elektronová rastrovací MeSH
• povrchové vlastnosti MeSH
• soli chemie   MeSH
• syrovátka chemie   MeSH
• Publikační typ
• časopisecké články MeSH

Indoxyl sulfate has been identified as a major factor in the dysregulation of several genes. It is classified as a poorly dialyzable uremic toxin and thus a leading cause in the poor survival rate of dialysis patients. A monocentric, prospective, open cohort study was performed in 43 male patients undergoing chronic renal replacement therapy in a single hemodialysis center. The aim of the study was to determine the influence of acetate- versus citrate-buffered dialysis fluids in hemodialysis (HD) and postdilution hemodiafiltration (HDF) settings on the elimination of indoxyl sulfate. Also, additional factors potentially influencing the serum concentration of indoxyl sulfate were evaluated. For this purpose, the predialysis and postdialysis concentration ratio of indoxyl sulfate and total protein was determined. The difference was of 1.15 (0.61; 2.10), 0.89 (0.53; 1.66), 0.32 (0.07; 0.63), and 0.44 (0.27; 0.77) μmol/g in acetate HD and HDF and citrate HD and HDF, respectively. Acetate HD and HDF were superior when concerning IS elimination when compared to citrate HD and HDF. Moreover, residual diuresis was determined as the only predictor of lower indoxyl sulfate concentration, suggesting that it should be preserved as long as possible. This trial is registered with EU PAS Register of Studies EUPAS23714.

• MeSH
• acetáty farmakologie   MeSH
• dialýza ledvin metody   MeSH
• dialyzační roztoky chemie   farmakologie   MeSH
• hemodiafiltrace metody   MeSH
• hydrogenuhličitany MeSH
• indican krev   farmakokinetika   MeSH
• kyselina citronová krev   farmakologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci ledvin terapie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

The effect of peritoneal dialysates with low-glucose degradation products on peritoneal membrane morphology is largely unknown, with functional relevancy predominantly derived from experimental studies. To investigate this, we performed automated quantitative histomorphometry and molecular analyses on 256 standardized peritoneal and 172 omental specimens from 56 children with normal renal function, 90 children with end-stage kidney disease at time of catheter insertion, and 82 children undergoing peritoneal dialysis using dialysates with low-glucose degradation products. Follow-up biopsies were obtained from 24 children after a median peritoneal dialysis of 13 months. Prior to dialysis, mild parietal peritoneal inflammation, epithelial-mesenchymal transition and vasculopathy were present. After up to six and 12 months of peritoneal dialysis, blood microvessel density was 110 and 93% higher, endothelial surface area per peritoneal volume 137 and 95% greater, and submesothelial thickness 23 and 58% greater, respectively. Subsequent peritoneal changes were less pronounced. Mesothelial cell coverage was lower and vasculopathy advanced, whereas lymphatic vessel density was unchanged. Morphological changes were accompanied by early fibroblast activation, leukocyte and macrophage infiltration, diffuse podoplanin presence, epithelial mesenchymal transdifferentiation, and by increased proangiogenic and profibrotic cytokine abundance. These transformative changes were confirmed by intraindividual comparisons. Peritoneal microvascular density correlated with peritoneal small-molecular transport function by uni- and multivariate analysis. Thus, in children on peritoneal dialysis neutral pH dialysates containing low-glucose degradation products induce early peritoneal inflammation, fibroblast activation, epithelial-mesenchymal transition and marked angiogenesis, which determines the PD membrane transport function.

• MeSH
• biopsie MeSH
• chronické selhání ledvin terapie   MeSH
• dialyzační roztoky chemie   toxicita   MeSH
• dítě MeSH
• epitelo-mezenchymální tranzice účinky léků   MeSH
• fibróza MeSH
• glukosa metabolismus   MeSH
• kojenec MeSH
• koncentrace vodíkových iontů MeSH
• lidé MeSH
• mladiství MeSH
• peritoneální dialýza škodlivé účinky   MeSH
• peritoneum krevní zásobení   účinky léků   patologie   MeSH
• peritonitida chemicky indukované   patologie   MeSH
• předškolní dítě MeSH
• studie případů a kontrol MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

• MeSH
• biokompatibilní materiály terapeutické užití   MeSH
• dialyzační roztoky * chemie   farmakologie   škodlivé účinky   terapeutické užití   MeSH
• glukosa aplikace a dávkování   metabolismus   škodlivé účinky   MeSH
• lidé MeSH
• peritoneální dialýza metody   MeSH
• peritoneum metabolismus   účinky léků   MeSH
• produkty pokročilé glykace škodlivé účinky   MeSH
• Check Tag
• lidé MeSH

Dialysate conductivity is routinely used as a surrogate for dialysate sodium concentration. However, dialysis machine manufacturers apply different conductivity temperature correction coefficients. With the same conductivity in dialysis machines manufactured by different manufacturers, dialysate sodium may significantly differ. Also, electrolyte prescriptions are individualized (K, Ca, HCO3) and this is associated with another variation in dialysate sodium in the order of 1-5 mmol/L and both deviations are cumulative and chronic for each patient. Equivalence of the prescribed dialysate sodium and the concentration measured in it is not granted. Both variables differ and it is machine dependent! This paper analyses those variations from a technical point of view and suggests how to detect them and how to deal with or avoid them in clinical practice.

• MeSH
• dialýza ledvin MeSH
• dialyzační roztoky chemie   MeSH
• elektrická vodivost MeSH
• lidé MeSH
• nevhodné předepisování MeSH
• sodík analýza   normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Byť je složení dialyzačního roztoku vnímáno jako do značné míry neměnná záležitost, i ono prošlo, podobně jako další dvě součásti umělé ledviny – dialyzátor nebo vlastní dialyzační přístroj – řadou změn. V klíčových vývojových krocích změny v jedné z těchto součástí dokonce podmiňovaly nebo vyvolávaly změny v těch ostatních. Ve složení dialyzačního roztoku lze od zavedení dialyzační léčby terminálního selhání ledvin v 60. letech rozlišit zhruba 9 základních změn, které jsou v článku podrobněji rozvedeny: náhrada bikarbonátu acetátem, zvýšení koncentrace sodíku, návrat k bikarbonátu, zavedení suchého B-koncentrátu, zavedení standardu mikro- biologické „čistoty“ a následně „ultračistoty“, snížení obsahu glukózy, inovace acidifikátoru dialyzačního roztoku, přidání fosfátu a přidání rozpustného pyrofosfátu železa. Vývojem prošlo i monitorování správnosti složení dialyzačního roztoku – od prosté teplotně nekompenzované vodivosti k jejímu přepočtu na koncentraci sodíku a bikarbonátu, které však přineslo i některá úskalí. Ke změnám došlo i v regulatorní oblasti zavedením nové skupiny norem ISO ČSN EN.

Despite being perceived as a rather stable part of the artificial kidney, composition of dialysis solution – similarly to the other two component of artificial kidney, dialyzer and dialysis machine – went through a number of changes. In key developmental steps, changes in one of those components implicated or induced changes in the other ones. Since the initiation of terminal renal failure treatment by dialysis in the 60-ies, roughly nine principal changes can be identified in dialysate composition. Those changes are described and commented in the article: replacement of bicarbonate by acetate, increase in dialysate sodium, return to bicarbonate, introduction of dry bicarbonate concentrate, change-over from the “purity” to “ultrapurity” standard, decrease in glucose content, innovation of acidifying agent, addition of phosphates, inclusion of ferric salt. Also monitoring of dialysate composition developed from simple conductivity measurement over temperature compensation to current display of sodium and bicarbonate concentrations. Regulatory framework of fluids in dialysis has changed with recent adoption of the pentad of ČSN EN ISO standards, too.

• Klíčová slova
• mikrobiologická čistota,
• MeSH
• acetáty MeSH
• dialyzační roztoky * dějiny   chemie   normy   MeSH
• glukosa MeSH
• hydrogenuhličitany MeSH
• lidé MeSH
• sodík MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: The requirements for magnesium (Mg) supplementation increase under regional citrate anticoagulation (RCA) because citrate acts by chelation of bivalent cations within the blood circuit. The level of magnesium in commercially available fluids for continuous renal replacement therapy (CRRT) may not be sufficient to prevent hypomagnesemia. METHODS: Patients (n = 45) on CRRT (2,000 ml/h, blood flow (Qb) 100 ml/min) with RCA modality (4% trisodium citrate) using calcium free fluid with 0.75 mmol/l of Mg with additional magnesium substitution were observed after switch to the calcium-free fluid with magnesium concentration of 1.50 mmol/l (n = 42) and no extra magnesium replenishment. All patients had renal indications for CRRT, were treated with the same devices, filters and the same postfilter ionized calcium endpoint (<0.4 mmol/l) of prefilter citrate dosage. Under the high level Mg fluid the Qb, dosages of citrate and CRRT were consequently escalated in 9h steps to test various settings. RESULTS: Median balance of Mg was -0.91 (-1.18 to -0.53) mmol/h with Mg 0.75 mmol/l and 0.2 (0.06-0.35) mmol/h when fluid with Mg 1.50 mmol/l was used. It was close to zero (0.02 (-0.12-0.18) mmol/h) with higher blood flow and dosage of citrate, increased again to 0.15 (-0.11-0.25) mmol/h with 3,000 ml/h of high magnesium containing fluid (p<0.001). The arterial levels of Mg were mildly increased after the change for high level magnesium containing fluid (p<0.01). CONCLUSIONS: Compared to ordinary dialysis fluid the mildly hypermagnesemic fluid provided even balances and adequate levels within ordinary configurations of CRRT with RCA and without a need for extra magnesium replenishment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01361581.

• MeSH
• antikoagulancia chemie   MeSH
• citráty chemie   MeSH
• dialýza ledvin MeSH
• dialyzační roztoky chemie   MeSH
• dospělí MeSH
• hemofiltrace škodlivé účinky   MeSH
• homeostáza MeSH
• hořčík chemie   metabolismus   MeSH
• kritický stav MeSH
• kyselina citronová MeSH
• ledviny metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• prospektivní studie MeSH
• renální insuficience terapie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Icodextrin peritoneal dialysis (PD) solution has been shown to increase interleukin-6 (IL-6) levels in PD effluent as well as leukocyte and mesothelial cell count. Mesothelial cells release cancer antigen 125 (CA125), which is used as a marker of mesothelial cell mass. This 1-year prospective study was designed to compare peritoneal effluent cell population, its inflammatory phenotype and biocompatibility biomarkers IL-6 and CA125 between icodextrin (E) and glucose bicarbonate/lactate (P) based PD solutions. Using baseline peritoneal ultrafiltration capacity, 19 stable incident PD patients were allocated either to P only (N = 8) or to P plus E for the overnight dwell (N = 11). Flow cytometry was used to measure white blood cell count and differential and the expression of inflammatory molecules on peritoneal cells isolated from timed overnight peritoneal effluents. Compared to P, E effluent showed higher leukocyte (10.9 vs. 7.9), macrophages (6.1 vs. 2.5) and mesothelial cells (0.3 vs. 0.1)×10(6) /L count, as well as expression of HLA DR on mesothelial cells and IL-6 (320.5 vs. 141.2 pg/min) on mesothelial cells and CA125 appearance rate (159.6 vs. 84.3 IU/min), all P < 0.05. In the E group, correlation between IL-6 and CA125 effluent levels (r = 0.503, P < 0.05) as well as appearance rates (r = 0.774, P < 0.001) was demonstrated. No effect on systemic inflammatory markers or peritoneal permeability was found. Icodextrin PD solution activates local inflammation without systemic consequences so the clinical relevance of this observation remains obscure. Correlation between effluent IL-6 and CA125 suggests that CA125 might be upregulated due to inflammation and thus is not a reliable marker of mesothelial cell mass and/or biocompatibility.

• MeSH
• antigen CA-125 metabolismus   MeSH
• dialyzační roztoky chemie   MeSH
• dospělí MeSH
• glukany chemie   MeSH
• glukosa chemie   MeSH
• hydrogenuhličitany chemie   MeSH
• interleukin-6 metabolismus   MeSH
• laktáty chemie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• peritoneální dialýza metody   MeSH
• počet leukocytů MeSH
• prospektivní studie MeSH
• průtoková cytometrie MeSH
• senioři MeSH
• zánět MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• cefalosporiny terapeutické užití   MeSH
• cefazolin terapeutické užití   MeSH
• chronické selhání ledvin terapie   MeSH
• dialyzační roztoky chemie   MeSH
• lidé MeSH
• peritoneální dialýza * škodlivé účinky   MeSH
• peritonitida * etiologie   farmakoterapie   krev   terapie   MeSH
• počet leukocytů * MeSH
• prognóza MeSH
• zaváděcí katétry škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• komentáře MeSH