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Nephrology Dialysis Transplantation
Kallel Hend2, Krid Madiha2, Jbeli Hela2, Khedher Rania2, Ben Mami Ikram2,
Smaoui Wided2, Ben Fatma Lilia2, Ben Hmida Fethi1, Raies Lamia2, Beji
Soumaya2, Zouaghi Mohammed Karim2
Laboratory of renal disease LR00SP01 Charles Nicolles Hospital Tunis Tunisia and
Nephrology Rabta Hospital Tunis Tunisia
INTRODUCTION AND AIMS: The preservation of residual renal function (RRF)
has become of paramount importance to nephrologists in the clinical management of
patients on peritoneal dialyse PD. We studied the impact of RRF on clinical outcome
and quality of life in 90 patients on peritoneal dialysis (PD).
METHODS: All consecutive patients receiving PD between January 2007 and
December 2016 were included. The study was carried out at Rabta Hospital, Tunis,
Tunisia. A total number of 90 patients were enrolled after obtaining their consents.
They were assigned to two groups, at the time of initiation of PD, based on their
estimated RRF: RRF was estimated by calculating glomerular filtration rate (GFR)
expressed as a mean of creatinine and urea clearance (ml/min/1, 73 m): high RRF
group (with eGFR 5 mL/min/1.73 m2) and low RRF (with eGFR <5 mL/min/1.73
m2). Seventy tow patients were in the high RRF group and 18 patients in the low RRF.
A record of the following clinical and biochemical parameters was made: weight, BMI,
blood pressure BP, urine output, eGFR , ultra filtration, serum albumin, hemoglobin,
serum potassium , serum alkaline phosphatase (ALP), serum phosphorous.
Parathyroid hormone (PTH) and vitamin D, levels were measured. During the study,
number of peritonitis events were recorded. Sleep quality assessment was carried out
using the Pittsburgh Sleep Quality. Depression was assessed during the similar time
frame, using the Becks Depression Score BDS . We excluded from the study patients
who died within three months of initiation of PD .
RESULTS: Baselines characteristics including age, sex, BMI, and native kidney disease
were similar in both groups. The number of patients who discontinued CAPD were
thirty (41, 66%) in the high RRF group and 6 (33.33%) in low RRF group.Six (8.33%)
patients in high RRF group had at least one episode of peritonitis whereas 8 (44.44%)
of patients in the low RRF group had peritonitis. As assessed by PSQI, in high the RRF
group, 36 patients (50%) had normal sleep quality score, eighteen (25%) had mild sleep
disturbances and eight (25%) had moderate sleep disturbances, and none had severe
sleep disturbances. In low RRF group, 9 patients (50%) had normal score, tow (11,
11%) had mild sleep disturbances, and 6 (33.33%) had moderate sleep disturbances,
and one (5.55%) had severe sleep disturbances. Thirty six patients (50%) in the high
RRF group had normal depression score, 26 (33.3%) had mild depression and 10
(13.88%) had moderate depression, and none had severe depression. In low RRF group,
four patients (22.22%) had normal score, ten (55.55%) had mild depression, three
(16.66%) had moderate depression and one (5.55%) had severe depression. We
observed a better correlation between RRF and serum albumin concentration and a
tendency toward better nutritional status in patients with RRF .Serum ALP level was
low in high RRF group (Table 1)
CONCLUSIONS: We found that a high RRF at the time of initiation of PD,
significantly decreased the incidence of infections, depression, better nutrition, and
lower levels of alkaline phosphatase. We need to develop treatment plans that focus on
preserving RRF in dialysis patients
Jacek Waniewski2, Jan Poleszczuk1
Department of Mathematical Modelling of Physiological Processes Nalecz Institute of
Biocybernetics and Biomedical Engineering Warszawa Poland and 2Department of
Mathematical Modelling of Physiological Systems Nalecz Institute of Biocybernetics and
Biomedical Engineering Warszawa Poland
INTRODUCTION AND AIMS: During the flow of blood through hemodialyzer
small solutes are removed from plasma to dialysis fluid across the dialyzer membrane
and from erythrocytes to plasma across the cellular membrane. The rate of exchange of
solutes between cells and plasma influences the performance of hemodialyzer. A
mathematical model was applied to assess the impact of this exchange on the effective
hemodialyzer clearance.
METHODS: The model describes the flow of solutes in the countercurrent dialyzer
with one phase flow of dialysis fluid in the dialysate channel and two phase flow of
plasma water and water in cellular blood components (erythrocytes) in the blood
channel. The one dimensional approach to the distribution of solute concentration in
the channel cross-section is assumed. The channels are characterized by their volumes
and the solute transport characteristics by diffusive permeability of the dialyzer membrane KoA, the transmittance coefficients of the dialyzer, and the diffusive permeability
of cellular membrane, PAer. The rate of ultrafiltration is assumed to be constant.
Computer simulation of the model predicts the profile of the solute distribution along
the dialyzer channels, the change of the profiles with time, and three clearances: 1) dialyzer clearance KD calculated using the amount of solute removed with dialysate over
its concentration in inlet plasma, 2) plasma clearance KP calculated using the amount
of solute removed from plasma over its concentration in inlet plasma, 3) erythrocyte
clearance KE calculated using the amount of solute removed from erythrocytes to
plasma over the difference in its concentration in inlet cellular water. The typical values
of the volumetric flow rates in dialyzer and dialyzer membrane diffusive permeability
for urea and creatinine were assumed. The cellular membrane permeability for urea
and creatinine were taken as estimated by Schneditz et al, 2009.
RESULTS: For the constant solute concentrations in plasma water and cellular water at
the inlet to dialyzer the steady state of the transport in dialyzer is obtained after around
two minutes for both solutes. The results were however much different for urea and
creatinine. The urea concentrations profiles in plasma water and cellular water are
similar along the dialyzer and the system behaves as the removal was from the whole
water in the blood channel. In contrast, the creatinine concentration in cellular water
changes only slightly along the dialyzer and the system may be approximated as the
removal of creatinine from plasma water. For a standard dialysis (blood and dialysis
fluid inflow of 300 and 500 mL/min, respectively, zero ultrafiltration, hematocrit 35%),
permeability of dialyzer membrane KoA = 789 and 556 mL/min, and permeability of
cellular membrane PAer = 78400 and 4.4 mL/min for urea and creatinine, respectively,
the clearances for urea were KD = 219.5, KP = 162.0, KE = 64.3 mL/min and KD =
169.9, KP = 165.0, KE = 2.2 mL/min for creatinine.
CONCLUSIONS: The highly different diffusive permeability of cellular membrane for
urea and creatinine yields much different contribution of blood cellular compartment
to the removal of these solutes from blood in dialyzer: whereas urea is removed from
the whole blood water without any hindrance in cellular membrane, creatinine is
removed practically from plasma water only. Typically, the dialyzer clearance, KD, is
close to the sum of plasma clearance, KP, and cellular clearance, KE.
Alvita Gincaite1, Vaidas Vicka1, Diana Sukackiene2, Migle Gudynaite1, Agne
Laucyte-Cibulskiene2, Laurynas Rimsevicius2,1, Marius Miglinas2,1
Faculty of Medicine Vilnius University Vilnius Lithuania and 2Center of Nephrology
Vilnius University Hospital Santariskiu Klinikos Vilnius Lithuania
MP513 Figure
INTRODUCTION AND AIMS: The amount of elderly patients undergoing
hemodialysis (HD) is steadily increasing. Therefore age related problems are gaining
more relevance in hemodialysis patients care, one of them is chronic fluid overload.
Our aim was to compare fluid status between young and elderly patients using
bioelectrical impedance analysis (BIA) and to evaluate possible risk factors associated
with fluid overload in these patients.
METHODS: We conducted an observational study in a tertiary reference hospital.
Fluid state of 99 HD patients was examined post HD procedure using BIA data, such as
intracellular (ICW) and extracellular water, extracellular water (ECW)/total body water
doi:10.1093/ndt/gfx175 | iii617
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volume overload accompanied by retention of nitrogenous waste products and some
electrolytes. The aim of the present study was to evaluate the efficacy of Cross Linked
Polyelectrolyte (CLP) on adsorption of fluid, nitrogenous waste products and
METHODS: In an experimental study on 30 hemodialysis patients, the effect of CLP
on adsorption of fluid, urea, creatinine, uric acid, sodium and potassium of dialysate
effluent were evaluated. 500 ml of effluent fluid of each patient were collected at the
begining of dialysis. The concentrations of urea, creatinine, uric acid, sodium and
potassium of fluid were measured by standard methods. Then effluent samples were
treated with 6g CLP and incubated for 4h at 37 . The efficacy of CLP on adsorption of
water, and waste products was evaluated. Statistical analysis was performed using SPSS
software and result was presented as mean +/- SD and p-value was set at 0.05.
RESULTS: Up to 80% of effluent fluid water was adsorbed by CLP. There was
significant reduction of urea, creatinine, uric acid and sodium in the remaining effluent
fluid (p<0.001). In contrast, the amount of potassium has been increased in the
effluent fluid.
CONCLUSIONS: this study showed that CLP can adsorb significant amount of fluid
and nitrogenous waste products and in the future it may be used to reduction of
dialysis dose especially in volume overload patients.