Dialyzer reprocessing for dialyzer reuse in the same patient has been developed since the early time in hemodialysis history to save cost and time related to reassembling the new dialyzer during that ...time. The procedure can reduce the first-use and allergic reactions from using incompatible cellulosic dialyzer membrane by altering some manufacturing chemicals.
All of established literatures regarding recent dialyzer reprocessing methods and considerations were extensively reviewed and summarized.
Dialyzer reprocessing can be performed by multiple protocols but involves common steps including bedside rinsing after use, cleaning, dialyzer testing to prevent excessive drop in dialyzer clearance and membrane integrity, high-level disinfection or sterilization either by chemicals or heat, storage, and preparation for subsequent dialysis session by adequate rinsing to reduce the residual reprocessing chemical to the safe level. Compared with the single-use strategy, evidence is conflicting for the mortality advantages or disadvantages of dialyzer reuse, with some showing increased mortality in patients receiving peracetic acid sterilization. Keys for the effective and safe dialyzer reuse involve strict adherence to specific manufacturer's protocol, adequate dialysis water quality complied with the Association for the Advancement of Medical Instrumentation standard, measurement of the total cell volume to prevent inadequate hemodialysis, and infectious control consideration. In the present era, single-use strategy is increasingly adopted due to the decreased cost for dialyzer manufacturing. Environmental concerns of higher solid waste from dialyzer disposal in single-use dialysis should be compared with the liquid waste from reprocessing chemicals along with plastic waste and cardboard in reuse dialysis.
Dialyzer reprocessing with adequate regulation is considered as an acceptable option for cost-effective hemodialysis, compared with the single-use strategy.
Abstract
Kidney transplantation recipients (KTR) with coronavirus disease 2019 (COVID-19) are at higher risk of death than general population. However, mortality risk factors in KTR are still not ...clearly identified. Our objective was to systematically analyze published evidence for risk factors associated with mortality in COVID-19 KTR. Electronic databases were searched for eligible studies on 1 August 2021. All prospective and retrospective studies of COVID-19 in KTR were considered eligible without language restriction. Since data in case reports and series could potentially be subsets of larger studies, only studies with ≥ 50 patients were included. Random-effects model meta-analysis was used to calculate weighted mean difference (WMD) and pooled odds ratio (OR) of factors associated with mortality. From a total 1,137 articles retrieved, 13 were included in the systematic review and meta-analysis comprising 4,440 KTR. Compared with survivors, non-survivors were significantly older (WMD 10.5 years, 95% CI 9.3–11.8). KTR of deceased donor were at higher risk of death (OR 1.73, 95% CI 1.10–2.74). Comorbidities including diabetes mellitus, cardiovascular disease, and active cancer significantly increased mortality risk. KTR with dyspnea (OR 5.68, 95% CI 2.11–15.33) and pneumonia (OR 10.64, 95% CI 3.37–33.55) at presentation were at higher mortality risk, while diarrhea decreased the risk (OR 0.61, 95% CI 0.47–0.78). Acute kidney injury was associated with mortality (OR 3.24, 95% CI 1.36–7.70). Inflammatory markers were significantly higher in the non-survivors, including C-reactive protein, procalcitonin, and interleukine-6. A number of COVID-19 mortality risk factors were identified from KTR patient characteristics, presenting symptoms, and laboratory investigations. KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.
Background
Hemodialysis (HD) using super high‐flux dialyzer (HD + SHF) comparably removed uremic toxins to high‐volume postdilution online hemodiafiltration (olHDF). Integration of hemoperfusion (HP) ...to HD + SHF (HD + SHF + HP) might provide superior uremic toxin removing capability to high‐volume postdilution olHDF.
Method
The present study was conducted in thrice‐a‐week HD patients to compare the efficacy in removing indoxyl sulfate (IS), beta‐2 microglobulin (β2M), and urea between high‐volume postdilution ol‐HDF and HD + SHF + HP, comprising HD + SHF as the main treatment plus HD + SHF + HP 1/week in the first 4 weeks and 1/2 weeks in the second 4 weeks.
Results
Ten prevalent HD patients with blood flow rate (BFR) above 400 ml/min were randomized into two sequences of 8‐week treatment periods of HD + SHF + HP and later high‐volume postdilution olHDF or vice versa. When compared with high‐volume postdilution olHDF (convective volume of 26.02 ± 1.8 L/session), HD + SHF + HP provided comparable values of percentage reduction ratio of IS (52.0 ± 11.7 vs. 56.3 ± 7.5%, p = 0.14) and β2M (83.7 ± 4.9 vs. 84.0 ± 4.3%, p = 0.37) and slightly lower urea reduction ratio. Despite greater dialysate albumin loss (p = 0.008), there was no significant change in serum albumin level in HD + SHF + HP group.
Conclusions
HD + SHF + HP could not provide superior efficacy in removing uremic toxins to high‐volume postdilution olHDF. The use of low BFR of 200 ml/min during the first 2 h of HD + SHF + HP session, according to the instruction of manufacturer, might impair the efficacy of the HD + SHF part in removing uremic toxins.
HD + SHF + HP provided comparable efficacy in removing uremic toxins when compared with high‐volume postdilution olHDF.
HD + SHF + HP could have important role in the community that HDF is not available or in HD patients with limited BFR that could not achieve high volume of convection in HDF.
Aim
miRNA‐122 (miR‐122) is a new, interesting liver injury biomarker but little is known about its effects when there is an indirect acute liver injury.
Methods
We investigated this by using indirect ...liver injury mice models with bilateral ureter obstruction (BUO), bilateral nephrectomy (BiNx) and cecal ligation and puncture (CLP). A direct liver injury model, liver ischemia/reperfusion injury (liver I/R), was performed in parallel. Liver injury (i.e. liver histology, alanine transaminase ALT), kidney damage (i.e. serum creatinine) and cytokines (i.e. tumor necrosis factor‐α, interleukin IL‐6, IL‐1β, IL‐10) were assessed.
Results
Six hours after BUO/BiNx/CLP, the ALT and serum cytokines were approximately 1.5‐fold higher than the baseline whereas miR‐122 did not change. After 6 h of BiNx, there were prominent hepatocyte vacuolization but no elevations of miR‐122. However, after 24 h of BUO/BiNx/CLP, ALT, hepatocyte vacuolization and miR‐122 increased. The cytokines at 6 h might have induced the production of miR‐122 at 24 h. The results from the in vitro study with HepG2 cells and each of the cytokines resulted in increased miR‐122. On the other hand, when the direct liver injury model was used, there was a fivefold and 22‐fold increase in the ALT at 0.5 and 1 h after surgery, respectively, and high serum miR‐122 which corroborated the results from the liver histopathology.
Conclusion
We demonstrated that prior serum cytokine accumulation increased serum miR‐122 in indirect liver injury induced by BUO/BiNx and less severe sepsis mouse models. Cytokine accumulation may be responsible for miR‐122 expression in these models. The clinical importance of liver injury demonstrated by the discordance between serum miR‐122 and ALT was an interesting issue.
Aim
The incidences of osteoporosis, fracture and vascular calcification increase concordantly with the progression of chronic kidney disease (CKD). CKD‐mineral bone disease (CKD‐MBD) induced by ...hyperphosphatemia is a major pathophysiologic mechanism. The effects of phosphate binders on bone turnover biomarkers and bone mineral density (BMD) in haemodialysis patients are still inconclusive. Our aim is to demonstrate the effects of these phosphate binders on different aspects of CKD‐MBD.
Methods
We conducted a prospective cohort of 65 haemodialysis patients to investigate the effect of 12‐month monotherapy of phosphate binders composing calcium‐based phosphate binders (CPB) or non‐calcium‐based phosphate binders (NCPB), including sevelamer and lanthanum, on bone turnover biomarkers and BMD changes. The performance of bone turnover biomarkers to predict low BMD was attentively determined.
Results
When compared with CPB, NCPB use was associated with higher levels of bone turnover biomarkers. NCPB was also associated with lower BMD at lumbar and distal radius. Total procollagen type 1N‐terminal propeptide (P1NP), bone‐specific alkaline phosphatase (BALP), and tartrate‐resistant acid phosphatase 5b (TRAP5b) provided the best performance for diagnosing low BMD in haemodialysis patients.
Conclusion
Switching from CPB to NCPB might increase bone biomarkers and prevent the development of adynamic bone disease. On the contrary, NCPB should be cautiously used in haemodialysis patients who already had low BMD. P1NP, BALP and TRAP5b could be used to guide the appropriate management, including anti‐resorptive and anabolic medications, and predict low BMD in haemodialysis patients treated with phosphate binders.
SUMMARY AT A GLANCE
The effect of phosphate binders on bone biomarkers and bone mineral density (BMD) in haemodialysis patients is unestablished. This prospective study revealed that non‐calcium‐based phosphate binders were associated with higher bone turnover biomarkers compared with calcium‐based phosphate binders. Diagnostic power of each bone biomarker for low BMD was demonstrated.
Aim
Colistimethate sodium (CMS) has been postulated as the principal cause of high incidence of clinical acute kidney injury (AKI) in multidrug‐resistance (MDR) septic patients with normal baseline ...serum creatinine (sCr) who were treated with CMS. This prospective observational study was conducted to examine the incidence and clinical outcomes of clinical and subclinical AKI in MDR septic patients receiving CMS.
Methods
Forty‐two MDR septic patients with normal sCr who required CMS were included. Clinical AKI was diagnosed by increased sCr levels according to the KDIGO2012 criteria while subclinical AKI was identified by elevated levels of urinary neutrophil gelatinase‐associated lipocalin (uNGAL > 150 ng/mL) or urinary liver‐type fatty‐acid‐binding protein (uL‐FABP > 10.5 ng/mL).
Results
Clinical AKI was noted in 47.6% of patients on day 5 and 38.1% on day 7 after initiating CMS. By using uL‐FABP, subclinical AKI was observed in 45.2% and 54.8% on day 5 and 7, respectively. At baseline prior to CMS treatment, subclinical AKI was already present in 90%. The baseline uL‐FABP was superior to the baseline uNGAL in early prediction of clinical AKI on day 5. The subclinical AKI patients had comparable worse outcomes as clinical AKI patients.
Conclusion
The incidence of subclinical AKI in MDR septic patients before CMS treatment was extremely high. The baseline uL‐FABP provided the best predictive capacity of clinical AKI. The causes of clinical AKI might include the persistence of sepsis process, subclinical AKI and CMS nephrotoxicity. Proper management of subclinical AKI patients before CMS initiation should be concerned to prevent further renal damage and improve patient and renal outcomes.
SUMMARY AT A GLANCE
The present study, conducted to determine the incidence and clinical outcomes of clinical and subclinical AKI in multi‐drug resistant septic patients who were treated with the nephrotoxic antibiotic colistimethate sodium, raised the potential benefit of identifying subclinical AKI by measuring urinary liver‐type fatty acid binding protein (uL‐FABP) before initiating colistimethate sodium to prevent further renal damage to improve renal outcomes.
Background
This study aims to investigate the influence of different kidney biopsy practices on the prevalence of glomerular pathologic patterns in the largest kidney biopsy registry in Thailand.
...Methods
We conducted a retrospective review of kidney biopsy records from the period between 2000 and 2014. The records were obtained from 2 major institutions: King Chulalongkorn Memorial Hospital, a large university‐based hospital, and the Kidney Center Bangkok Hospital, which provides pathology services to hospitals throughout Thailand. The study included native kidney biopsies from all provinces in Thailand, excluding paediatric patients, kidney transplant recipients, and cases of inadequate and repeated biopsies. Patient demographics, indications for biopsy, and final glomerular diagnoses were compared across different hospital practice settings: university (UVH), private (PVH) and public (PBH).
Results
A total of 5893 eligible native kidney biopsies were identified from a pool of 7005 biopsies conducted over a 15‐year period in 25 provinces throughout Thailand. The 3 most common indications for biopsy were suspected kidney involvement in systemic lupus erythematosus (SLE) (29%), nephrotic syndrome (NS) (29%), and acute glomerulonephritis (AGN)/rapidly progressive glomerulonephritis (RPGN) (13%). The leading indication for biopsy differed across practice types, with suspected kidney involvement in SLE being the primary indication in UVH, while NS took precedence in both PBH and PVH practices. Notably, UVH performed fewer kidney biopsies for asymptomatic urinary abnormalities and diabetes‐related indications compared with PVH and PBH. The leading glomerular diagnoses correlated with the biopsy indications, with lupus nephritis (LN) being the most common diagnosis in UVH and PBH practices, whiles immunoglobulin A nephropathy was the predominant diagnosis in PVH practice.
Conclusion
Hospital practice types significantly impact the prevalence of glomerular pathologic diagnosis patterns in kidney biopsy data, highlighting the importance of considering this influence in epidemiological comparisons.
The objective of this study was to determine the impact of calcium sensing receptor (CASR) A990G genetic polymorphism on parathyroid hormone (PTH) lowering response to cinacalcet treatment when ...controlling for significant influencing clinical factors. This retrospective study was conducted on 135 Thai hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT). CASR A990G genotypes were determined. The patients were identified as either G carriers (heterozygous or homozygous CASR 990G allele carriers) or noncarriers (homozygous CASR 990A carriers). Tested covariates were baseline PTH level (bPTH), baseline serum phosphate (bPhos), baseline serum calcium (bCa), baseline calcitriol equivalent dose (bCtriol), baseline ergocalciferol dose (bErgo), and age. The ANCOVA showed that intact PTH levels after 12 weeks of cinacalcet treatment (PTHw12) was significantly lower among G carriers compared with noncarriers after controlling for bPTH, bPhos, bCtriol, and bErgo (F(1, 127) = 15.472, p < 0.001), with the adjusted mean difference of 253.7 pg/mL. The logistic regression analysis revealed that the odds of a G carrier achieving 30% PTH reduction after 12-week cinacalcet treatment were 3.968 times greater than the odds for a noncarrier after adjusting for bPhos, bCtriol, and age. In conclusion, the CASR A990G polymorphism significantly influences cinacalcet response in HD patients with SHPT.
Background Non-vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non-valvular ...atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin particularly renal outcomes remain inconclusive. Methods and Results Electronic searches were conducted through Medline, Scopus, Cochrane Library databases, and ClinicalTrial.gov. Randomized controlled trials and observational cohort studies reporting incidence rates and hazard ratio (HR) of renal outcomes (including acute kidney injury, worsening renal function, doubling serum creatinine, and end-stage renal disease) were selected. The random-effects model was used to calculate pooled incidence and HR with 95% CI. Eighteen studies were included. A total of 285 201 patients were enrolled, 118 863 patients with warfarin and 166 338 patients with NOACs. The NOACs group yielded lower incidence rates of all renal outcomes when compared with the warfarin group. Patients treated with NOACs showed significantly lower HR of risk of acute kidney injury (HR, 0.70, 95% CI, 0.64-0.76;
<0.001), worsening renal function (HR, 0.83; 95% CI, 0.73-0.95;
=0.006), doubling serum creatinine (HR, 0.58; 95% CI, 0.41-0.82;
=0.002), and end-stage renal disease (HR, 0.82; 95% CI, 0.78-0.86;
<0.001). Conclusions In non-valvular atrial fibrillation, patients treated with NOACs have a lower risk of both acute kidney injury and end-stage renal disease when compared with warfarin.
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