Background The main objective of this study was to theoretically quantify the fluctuations of fluid volume excess for different modes of intermittent ultrafiltration schedules and to compare the prediction for the typical and asymmetric thrice-weekly schedule to clinical, physiological and biophysical markers of volume expansion in a group of stable haemodialysis patients. Methods Overall volume excess (V(OVE)) was described as the sum of a time-independent (V(0)) and a time-dependent component (V). An exact relationship was developed to relate V to variable treatment frequency, treatment spacing and net volume accumulation rate. In a single-centre haemodialysis population, body mass profiling was combined with volume state evaluation by bioimpedance analysis, N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels, clinical signs, a volume questionnaire and blood pressure levels. Results In 23 patients following the typical thrice-weekly schedule, the time-averaged volume excess (V) during the whole week (1.1 ± 0.5 L) was significantly larger than that during the midweek interval (0.9 ± 0.4 L) (P < 0.002) by a factor comparable to that of 1.21 obtained from the theoretical analysis. V(OVE) was 1.3 ± 1.7 L and significantly related to pre- (P < 0.001) and post-dialysis levels of NT-pro BNP (P < 0.001). Conclusion Asymmetric treatment spacing such as with the typical thrice-weekly treatment schedule leads to a significant increase in time-averaged volume excess. The theoretical analysis allows for comparison of time-averaged volume excess in treatments varying with regard to treatment frequency and regularity and could be helpful to prescribe post-treatment volume (target weight) for such variable treatment modes.
- ASAIO journal (American Society for Artificial Internal Organs : 1992)
- Published almost 6 years ago
This proof of concept pilot study was performed to determine whether vibration can increase solute clearance when applied to an in vitro dialysis model. Urea, creatinine, gentamicin, and vancomycin transmembrane clearances were calculated at a blood flow rate of 200 ml/min, dialysate flow rates of 2 and 8 L/hr, and no concurrent ultrafiltration at various vibration intensities. Dialyzer integrity was determined by measuring transmembrane pressure, filter drop pressure, and albumin clearance, and by visually inspecting the dialysate. Comparing the highest vibration modality with no vibration, the median percentage increase in urea, creatinine, gentamicin, and vancomycin clearance was 18% (all p < 0.005). The transmembrane clearance of albumin was negligible for all experiments. When measuring transmembrane pressure and filter drop pressure, no significant differences were found between nonvibration and vibration dialysis. The addition of vibration during dialysis increased transmembrane clearance for solutes with molecular weights of 60-1450 Daltons.
In this work, we describe multifunctional, crumpled graphene oxide (CGO) porous nanocomposites that are assembled as advanced, reactive water treatment membranes. Crumpled 3D graphene oxide based materials fundamentally differ from 2D flat graphene oxide analogues in that they are highly aggregation and compression-resistant (i.e. π - π stacking resistant) and allow for the incorporation (wrapping) of other, multifunctional particles inside the 3D, composite structure. Here, assemblies of nanoscale, monomeric CGO with encapsulated (as a quasi core-shell structure) TiO2 (GOTI) and Ag (GOAg) nanoparticles, not only allow high water flux via vertically tortuous nanochannels (achieving water flux of 246 ± 11 L/(m(2)∙h∙bar) with 5.4 µm thick assembly, 7.4 g/m(2)), outperforming comparable commercial ultrafiltration membranes, but also demonstrate excellent separation efficiencies for model organic and biological foulants. Further, multifunctionality is demonstrated through the in situ photocatalytic degradation of methyl orange (MO), as a model organic, under fast flow conditions (tres < 0.1 s); while superior antimicrobial properties, evaluated with GOAg, were observed for both biofilm (contact) and suspended growth scenarios (> 3 log effective removal, Escherichia coli). This is the first demonstration of 3D, crumpled graphene oxide based nanocomposite structures applied specifically as (re)active membrane assemblies and highlights the material’s platform potential for a truly tailored approach for next generation water treatment and separation technologies.
Peritonitis and ultrafiltration failure remain serious complications of chronic peritoneal dialysis (PD). Dysfunctional cellular stress responses aggravate peritoneal injury associated with PD fluid exposure, potentially due to peritoneal glutamine depletion. In this randomized cross-over phase I/II trial we investigated cytoprotective effects of alanyl-glutamine (AlaGln) addition to glucose-based PDF.
Dialysis is a ubiquitous separation process in biochemical processing and biological research. State-of-the-art dialysis membranes comprise a relatively thick polymer layer with tortuous pores, and suffer from low rates of diffusion leading to extremely long process times (often several days) and poor selectivity, especially in the 0-1000 Da molecular weight cut-off range. Here, the fabrication of large-area (cm(2) ) nanoporous atomically thin membranes (NATMs) is reported, by transferring graphene synthesized using scalable chemical vapor deposition (CVD) to polycarbonate track-etched supports. After sealing defects introduced during transfer/handling by interfacial polymerization, a facile oxygen-plasma etch is used to create size-selective pores (≤1 nm) in the CVD graphene. Size-selective separation and desalting of small model molecules (≈200-1355 Da) and proteins (≈14 000 Da) are demonstrated, with ≈1-2 orders of magnitude increase in permeance compared to state-of-the-art commercial membranes. Rapid diffusion and size-selectivity in NATMs offers transformative opportunities in purification of drugs, removal of residual reactants, biochemical analytics, medical diagnostics, therapeutics, and nano-bio separations.
- Clinical journal of the American Society of Nephrology : CJASN
- Published about 5 years ago
Intradialytic hypotension is the most common adverse event that occurs during the hemodialysis procedure. Despite advances in machine technology, it remains a difficult management issue. The pathophysiology of intradialytic hypotension and measures to reduce its frequency are discussed. An accurate assessment of dry weight is crucial in all patients on dialysis and especially those patients prone to intradialytic hypotension. The presence of edema and hypertension has recently been shown to be a poor predictor of volume overload. Noninvasive methods to assess volume status, such as whole body and segmental bioimpedance, hold promise to more accurately assess fluid status. Reducing salt intake is key to limiting interdialytic weight gain. A common problem is that patients are often told to restrict fluid but not salt intake. Lowering the dialysate temperature, prohibiting food ingestion during hemodialysis, and midodrine administration are beneficial. Sodium modeling in the absence of ultrafiltration modeling should be abandoned. There is not enough data on the efficacy of l-carnitine to warrant its routine use.
HD tissue hypoxia associates with organ dysfunctions. OER, the ratio between SaO2and central-venous-oxygen-saturation, could estimate oxygen requirements during sessions, but no data are available. We evaluated OER behavior in 20 HD patients with permanent central venous catheter (CVC) as vascular access. Pre-HD OER (33.6 ± 1.4%; M ± SE) was higher than normal (range 20-30%). HD sessions increased OER to 39.2 ± 1.5% (M ± SE; p < 0.05) by 30' and to 47.4 ± 1.5% (M ± SE; p < 0.001) by end of treatment (delta 40%). During HD sessions of the long and short interdialytic intervals, OER values overlapped, suggesting no influence of patient's hydration status shifts. OER increased (p < 0.05) after 30' of isolated HD (zero ultrafiltration), but not during isolated ultrafiltration (zero dialysate flow), suggesting a role for blood-membrane-dialysate interaction, independent of volume reduction. In ten patients, individual variability of pre-HD OER was low and repeatable (maximum calculated difference over time 6.6%), and negatively correlated with HD-induced OER increments (r = 0.860; p < 0.005), suggesting a decline in the adaptive response along with resting OER increments. In 30 prevalent patients, adjusted multivariate analysis showed that pre-HD OER (HR = 0.88, CI 0.79-0.99, p = 0.028) and percent HD-induced OER (HR = 1.04, CI 1.01-1.08, p = 0.015) were both associated with mortality, with threshold values respectively <32% and >40%. In HD patients with CVC as vascular access, OER is a cheap, easily measurable and repeatable parameter useful to assess intradialytic hypoxia, and a potential biomarker of HD related stress and morbidity, helpful to recognize patients at increased risk of mortality.
Hydrometallurgical processes for the treatment and recovery of metals from waste electrical and electronic equipment produce wastewaters containing heavy metals. These residual solutions cannot be discharged into the sewer without an appropriate treatment. Specific wastewater treatments integrated with the hydrometallurgical processes ensure a sustainable recycling loops of the electrical wastes to maximize the metals recovery and minimize the amount of wastes and wastewaters produced. In this research activity the efficiency of ultrafiltration combined with surfactant micelles (micellar-enhanced ultrafiltration) was tested to remove metals form leach liquors obtained after leaching of NiMH spent batteries. In the micellar-enhanced ultrafiltration, a surfactant is added into the aqueous stream containing contaminants or solute above its critical micelle concentration. When the surfactant concentration exceeding this critical value, the surfactant monomers will assemble and aggregate to form micelles having diameter larger than the pore diameter of ultrafiltration membrane. Micelles containing contaminants whose diameter is larger than membrane pore size will be rejected during ultrafiltration process, leaving only water, unsolubilized contaminants and surfactant monomers in permeate stream. The experiments are carried out in a lab-scale plant, where a tubular ceramic ultrafiltration membrane is used with adding a surfactant to concentrate heavy metals in the retentate stream, producing a permeate of purified water that can be reused inside the process, thus minimizing the fresh water consumption.
Propensity towards anti-organic fouling, anti-biofouling property and low rejection of multivalent cation (monovalent counter ion) restricts the application of the state-of-art poly(piperazineamide) [poly(PIP)] thin film composite (TFC) nanofiltration (NF) membrane for the treatment of water containing toxic heavy metal ions, organic fouling agents and microbes. Herein, we report the preparation of thin film nanocomposite (TFNC) NF membranes with improved heavy metal ions rejection efficacy, anti-biofouling property, and anti-organic fouling properties compared to that of poly(PIP) TFC NF membrane. The TFNC NF membranes were prepared by the interfacial polymerization (IP) between PIP and trimesoyl chloride followed by post-treatment with polyethyleneimine (PEI) or PEI-polyethylene glycol conjugate and then immobilization of Ag NP. The IP was conducted on a polyethersulfone/poly(methyl methacrylate)-co-poly(vinyl pyrollidone)/silver nanoparticle (Ag NP) blend ultrafiltration membrane support. The TFNC membranes exhibited >99% rejection of Pb2+, 91-97% rejection of Cd2+, 90-96% rejection of Co2+ and 95-99% rejection of Cu2+ with permeate flux ∼40Lm-2h-1 at applied pressure 0.5MPa. The improved heavy metal ions rejection efficacy of the modified NF membranes is attributed to the development of positive surface charge as well as lowering of surface pore size compared to that of unmodified poly(PIP) TFC NF membrane.
Pressure-driven and lower flux of superwetting ultrafiltration membranes in various emulsions separation are long-standing issues and major barriers for their large-scale utilization. Even though currently reported membranes have achieved great success in emulsions separeation, they still suffer from low flux and complex fabrication process resulting from their smaller nanoscale pore size. Herein, utilizition of coconut shell as a novel biomaterial for developing into a layer through the simple smashing, cleaning and stacking procedures, which not only could avoid the complexity of film making process, but also could realize efficient gravity-directed separation of both immiscible oil/water mixtures and water-in-oil emulsions with high flux. Specifically, the layer acted as “water-removing” type filtrate material with excellent underwater superoleophobicity, exhibiting high efficiency for various immiscible oil/water mixtures separation and larger oil intrusion pressure. More importantly, the layer could also serve as adsorbent material with underoil superhydrophilicity, achieving gravity-directed kinds of water-in-oil emulsions separation with high separation efficiency (above 99.99%) and higher flux (above 1620L/m2h), even when their pore sizes are larger than that of emulsified droplets. We deeply believe that this study would open up a new strategy for both immiscible oil/water mixtures and water-in-oil emulsions separation.