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PROGRESS IN HEMODIALYSIS – FROM EMERGENT BIOTECHNOLOGY TO CLINICAL PRACTICE Edited by Angelo Carpi, Carlo Donadio and Gianfranco Tramonti Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice Edited by Angelo Carpi, Carlo Donadio and Gianfranco Tramonti Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Masa Vidovic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright argus, 2011. Used under license from Shutterstock.com First published September, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice, Edited by Angelo Carpi, Carlo Donadio and Gianfranco Tramonti p. cm. ISBN 978-953-307-377-4 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Modeling, Methods and Technique 1 Chapter 1 Kinetic Modeling and Adequacy of Dialysis 3 Malgorzata Debowska, Bengt Lindholm and Jacek Waniewski Chapter 2 Automated Blood Volume Regulation During Hemodialysis 27 Isabelle Chapdelaine, Clément Déziel and François Madore Chapter 3 Sodium and Hemodialysis 47 Matthew Gembala and Satish Kumar Chapter 4 Polyethersulfone Hollow Fiber Membranes for Hemodialysis 65 Baihai Su, Shudong Sun and Changsheng Zhao Chapter 5 The Evolution of Biocompatibility: From Microinflammation to Microvesiscles 93 Ciro Tetta, Stefano Maffei, Barbara Cisterna, Valentina Fonsato, Giorgio Triolo, Giuseppe Paolo Segoloni, Giovanni Camussi, Maria Chiara Deregibus and Emanuele Gatti Chapter 6 Pulse Push/Pull Hemodialysis: Convective Renal Replacement Therapy 113 Kyungsoo Lee Chapter 7 Optical Dialysis Adequacy Monitoring: Small Uremic Toxins and Contribution to UV-Absorbance Studied by HPLC 143 Kai Lauri, Jürgen Arund, Jana Holmar, Risto Tanner, Merike Luman and Ivo Fridolin Chapter 8 Influence of Online Hemodiafiltration on Hemoglobin Level, ESA-Dosage and Serum Albumin – A Retrospective, Multicenter Analysis 161 Roland E. Winkler, Peter Ahrenholz and Klaus Freivogel VI Contents Chapter 9 Leukocyte Function in High-Flux Hemodialysis 175 Jenny Olsson Chapter 10 Dialysis Membrane Manipulation for Endotoxin Removal 197 Michael Henrie, Cheryl Ford, Eric Stroup and Chih-Hu Ho Chapter 11 Citrate Anticoagulation in Hemodialysis 217 Stephan Thijssen Chapter 12 Hemodialysis Principles and Controversies 227 Parin Makadia, Payam Benson, Filberto Kelly and Joshua Kaplan Part 2 Prognosis 253 Chapter 13 Residual Renal Function in Hemodialysis Patients 255 Zachary Z. Brener, Stephan Thijssen, Peter Kotanko, James F. Winchester and Michael Bergman Chapter 14 Biomarkers in Chronic Kidney Disease - The Linkage Between Inflammation, Ventricular Dysfunction and Overhydration 265 Olimpia Ortega Chapter 15 Determinants of Cardiovascular Risk in Hemodialysis Patients Without Significant Comorbidities 281 Aysegul Zumrutdal Chapter 16 Malnutrition, Inflammation and Reverse Epidemiology in Hemodialysis Patients 297 Rodney G. Bowden, Neil A. Schwarz and Brian D. Shelmadine Part 3 Complications 313 Chapter 17 Complications and Managements of Hyperphosphatemia in Dialysis 315 Eiji Takeda, Hironori Yamamoto, Hisami Yamanaka-Okumura and Yutaka Taketani Chapter 18 Management of Secondary Hyperparathyroidism in Hemodialysis Patients 331 Emanuel Zitt and Ulrich Neyer Chapter 19 Lipid and Lipoprotein Abnormalities in Chronic Renal Insufficiency: Review 349 Oliver Rácz, Rudolf Gaško and Eleonóra Klímová Contents VII Chapter 20 Hemodialysis Vascular Access Dysfunction 365 Timmy Lee Chapter 21 Nontraditional Anti - Infectious Agents in Hemodialysis 389 Martin Sedlacek Chapter 22 Sleep in Patients with ESRD Undergoing Hemodialysis 407 Mukadder Mollaoğlu Chapter 23 The Importance of Exercise Programs in Haemodialysis Patients 429 Susanne Heiwe, Andrej Ekholm and Ingela Fehrman-Ekholm Preface Hemodialysis (HD) represents the first successful long term substitutive therapy with an artificial organ for severe failure of a vital organ. Because HD was started many decades ago, a book on HD may not appear up-to-date. Indeed, HD covers many basic and clinical aspects and this book reflects the rapid expansion of new and controversial aspects either in the biotechnological or in the clinical field. The related topics are multiple because HD includes either biotechnology or multi- organ involvement as well as different pathogenetic factors. Many efforts to reduce dialysis complications and their treatment are made. This book revises new technologies and therapeutic options to improve dialysis treatment of uremic patients. This book consists of three parts:  modeling, methods and technique  prognosis  complications The first part includes twelve chapters, five on modeling, water and electrolyte preparation or regulation, four face membranes and biocompatibility, the remaining three deal with procedures or controversies. Besides important progress in biotechnology, a common and principal aim crossing most of these chapters is the attempt to reduce morbidity by the use of more compatible devices. Prediction of morbidity or mortality by progress in the laboratory is a principal general topic or aim of the second group of four chapters. These chapters underline the relevance of the residual renal function and of the main laboratory biomarkers to predict cardiovascular complications. The third part includes seven chapters on clinical complications. The principal topic crossing two chapters is the importance of metabolic disorders for the origin and the development of the most important clinical complications (cardiovascular and bone). X Preface The remaining five chapters deal with lifestyle aspects (sleep or physical activity) and local (vascular access) or systemic (infections) complications. Therefore, this book reflects either emergent biotechnological or updated clinical aspects concerning HD. These two topics include suggestions to improve prognosis and therapy of the patients on HD. The book will help not only general physicians, nephrologists, internists, cardiologists, endocrinologists but also basic researchers, including bioengineers, to approach, understand and manage the principal problems related to HD. Finally, we consider that we were medical students in the same university hospital in the sixties and successively we worked in the same university hospital department. Our original department of internal medicine specialized in nephrology, under the leadership of the late Prof. Gabriele Monasterio, who first proposed and validated the low protein diet and included teachers who were pioneers in projecting and using the artificial kidney. Thanks to them, the authors of these book chapters and the publisher, we once more have the pleasure to work together in this project including colleagues from multiple continents. Prof. Angelo Carpi, M.D., Department of Reproduction and Aging, University of Pisa, Italy Prof. Carlo Donadio, M.D., Department of Internal Medicine, University of Pisa, Italy Prof. Gianfranco Tramonti, M.D., Department of Internal Medicine, University of Pisa, Italy [...]... derived from theoretical considerations of disequilibrium and rebound, but the coefficient was derived from fitting to clinical data 12 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice 3.2 Urea KT/V and creatinine clearance for the kidneys To assess the residual renal function (RRF) urine is usually collected for 24 hours and analyzed for urea as well as creatinine (Daugirdas... compartment (intracellular) according to the concentration gradient with an intercompartmental mass transport coefficient (Kc, mL/min) For a low value of Kc, the 10 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice discrepancy between one and two compartment modeling is larger because the immediate intercompartmental flow is precluded (Debowska et al., 2007b) Assuming one compartment... spKT /V N⋅T 10080 (34) 14 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice where N is number of treatments per week and eqKT/V is derived from spKT/V by using one of the equations (20), (22), (23) or (24) stdKT/V calculated using equation (34) differs slightly from stdKT/V using the exact method, equation (32), that takes into account among other things asymmetry of weekly... hemofiltration treatments, because fresh dialysis fluid without these solutes is continuously provided The rate of total solute mass removal from the body, dMR/dt, during hemodialysis is: dM R = K ( Ce − Cd ) + K rCe dt (9) 8 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice The total solute amount removed from the body ΔMR is the mass removed by dialyzer with clearance K and by the... 1: 16 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice ΔM R t ⋅ C ref ECC ref = (36) where index "ref" denotes a reference concentration, e.g ref = ta or ref = p, etc If the patient is in a steady metabolic state, i.e after a cycle time (Tc) the solute concentration and solute mass in the body return to their initial values, then the total amount of solute removed during Tc... day 5 6 7 Fig 5 Urea concentration, Ce, in the extracellular compartment during conventional hemodialysis provided three times a week (HD3x), daily hemodialysis carried out six times a week (HD6xd) and long, nocturnal hemodialysis (HD6xn) Average urea concentration was plotted with dashed line 20 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice HD3x 10 8 FSR 6 4 trta ta 2 pa... and continuous therapies, such as continuous ambulatory peritoneal dialysis (CAPD), is by definition equal to zero (Waniewski & Lindholm, 2004) Therefore, Keshaviah (Keshaviah, 1995) used for CAPD and automated peritoneal dialysis the definition of SRI as the ratio of solute removed during a dialysis session over its initial amount in the body, i.e., the definition of FSR 3.6 International guidelines... failure patients during either urea non-steady state or treatment with irregular or continuous schedules Nephrol Dial Transplant, Vol 19, No 6, pp (145466) 24 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice Charra, B., Terrat, J C., Vanel, T., Chazot, C., Jean, G., Hurot, J M & Lorriaux, C (2004) Long thrice weekly hemodialysis: the Tassin experience Int J Artif Organs,... other symbols have the same meaning as in equation (25) In clinical practice, the most popular methods used for evaluation RRF is creatinine clearance (ClCr), calculated as follows: weekly Cl Cr , RRF = 7 ⋅ ΔM R ,Cr 1.73 1week ⋅ C e ,Cr BSA (27) where ΔMR,Cr is creatinine total mass removed during one day due to therapy and by residual renal function, Ce,Cr is serum creatinine concentration, BSA is body... all definitions, in contrast to much different values of the indices themselves 5 Adequacy indices for steady and non-steady metabolic state The change of solute mass in the body during dialysis is due to the generation minus removal, but, in general, one can not assume that the solute removal is equal to the generation during the cycle time (i.e intra- plus inter-dialysis time), especially in acute . PROGRESS IN HEMODIALYSIS – FROM EMERGENT BIOTECHNOLOGY TO CLINICAL PRACTICE Edited by Angelo Carpi, Carlo Donadio and Gianfranco Tramonti Progress in Hemodialysis. M i , C i , V i M b , C b , V b Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice 8 The total solute amount removed from the body ΔM R is the mass removed. was introduced to clinical practice (Daugirdas et al., 2001). Equilibrated KT/V values can be also calculated using an alternative equation by Daugirdas and Progress in Hemodialysis – From Emergent