Abstract
The increase in the number of chronic kidney disease patients has encouraged the development of hemodialysis as a routine therapy. Basic improvements in the dialysis system, from the membrane and the tubing system to the dialysis monitor, have laid the basis for this development. The understanding of underlying control variables and their settings in terms of optimal therapy has also led to reduction of side effects that used to occur and therefore improved the quality of life and reduced mortality [31.1]. Innovative processes associated with the analysis of individual physiological patient parameters use feedback systems and control realized in the dialysis machine. These are currently state of the art. Using bioimpedance procedures, precise monitoring of the water balance of patients is possible. Even patients with liver failure currently use extracorporeal blood purification procedures. In contrast to hemodialysis, one uses protein-permeable membranes with which albumin-bound toxins are filtered. Their purification of the filtrate is then achieved by adsorber columns. Clinical studies have confirmed the efficacy of this procedure.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
J. Himmelfarb, T.A. Ikizler: Hemodialysis, N. Engl. J. Med. 363, 1833–1845 (2010)
A. Kramer, V. Stel, C. Zoccali, J. Heaf, D. Ansell, C. Grönhagen-Riska, T. Leivestad, K. Simpson, R. Palsson, M. Postorino, K. Jager: An update on renal replacement therapy in Europe: ERA-EDTA Registry data from 1997–2006, Nephrol. Dial. Transplant. 24, 3557–3566 (2009)
C. Goddemeier: Die Entdeckung des Blutkreislaufs, Deutsch. Ärztebl. 104, 1168–1170 (2007)
T. Graham: The Bakerian lecture: on osmotic forces, Philos. Trans. R. Soc. London144, 177–228 (1854)
A. Fick: Über Diffusion, Ann. Phys. Chem. 94, 59–86 (1855)
W. Schumacher: Über Membrandiffusion, Ann. Phys. Chem. 110, 337–370 (1860)
A. Eggerth: The preparation and standardisation of collodion membranes, J. Biol. Chem. 18, 203–221 (1921)
J.J. Abel, L. Rowntree, B. Turner: On the removal of diffusible substances from the circulating blood of living animals by means of dialysis, J. Pharmacol. Exp. Ther. 5, 275–283 (1913)
G. Haas: Dialysieren des strömenden Bluts am Lebenden, Klin. Wochenschr. 2, 1888 (1923)
G. Haas: Über Blutwaschung, Klin. Wochenschr. 7, 1356–1362 (1928)
W. Kolff, H. Berk, M. ter Welle, J. van der Leij, E. van Dijk, J. van Nordwijk: The artificial kidney: a dialyser with a great area, Acta. Med. Scand. 117, 121–134 (1944)
G. Lonnemann: The quality of dialysate: an integrated approach, Kidney Int. 76, S112–S119 (2000)
M. Henrie, C. Ford, M. Andersen, E. Stroup, J. Diaz-Buxo, B. Madsen, D. Britt, H. Chih-Hu: In vitro assessment of dialysis membrane as an endotoxin transfer barrier: geometry, morphology, permeability, Artif. Organs. 32, 701–710 (2008)
M. Kessler, B. Canaud, L. Pedrini, J. Tattersall, P. ter Wee, R. Vanholder, C. Wanner: European best practice guidelines for haemodialysis (Part 1). Biocompatibility, Nephrol. Dial. Transplant. 17(7), 32–44 (2002)
J. Vienken, C. Ronco: New developments in hemodialysers, Contr. Nephrol. 133, 105–118 (2001)
W. Ansorge, M. Pelger, W. Dietrich, U. Baurmeister: Ethylene oxide in dialyser rinsing fluid: effect of rinsing technique, dialyser storage time and potting compound, Artif. Organs. 11, 118–122 (1987)
H. Lemke: Mediation of hypersensitivity reactions during hemodialysis by IgE-antibodies against ethylene oxide, Artif. Organs. 11, 104–110 (1987)
F. Gotch, H. Peter, F. Panilio, T. Folden, M. Keen: Online measurement of delivered kt/V during dialysis, J. Am. Soc. Nephrol. 6,600 (1995)
National Kidney Dialysis Outcome Quality Initiative (DOQI): Clinical Practice guidelines: hemodialysis adequacy and peritoneal dialysis adequacy, J. Am. Kidney Dis. 30(2), 1–64 (1997)
U. Kuhlmann, R. Goldau, N. Samadi, T. Graf, M. Gross, G. Orlandini, H. Lange: Accuracy and safety of online clearance monitoring based on conductivity variation, Nephrol. Dial. Transplant. 16, 1053–1058 (2001)
F. Gotch, J. Sargent, M. Keen: Whither goest Kt/V?, Kidney Int. 58, 3–18 (2000)
R. Vanholder, Eutox Gruppe: Review on uremic toxins: classification, concentration and interindividual variability, Kidney Int. 63, 1934–1943 (2003)
M. Lysaght: Haemodialysis membranes in transition, Contrib. Nephrol. 61, 1–17 (1988)
C. Ronco, P. Ghezzi, N. Hoenich, P. Delfino: Computerized selection of membranes and hemodialysers, Contrib. Nephrol. 133, 119–130 (2001)
W. Clark, R. Hamburger, M. Lysaght: Effect of membrane composition and structure on solute removal and biocompatibility, Kidney Int. 56, 2005–2015 (1999)
J. Leypoldt, B. Schmidt, H.J. Gurland: Measurement of backfiltration rates during hemodialysis with highly permeable membranes, Blood Purif. 9, 74–84 (1991)
J. Leypoldt, B. Schmidt, H.J. Gurland: Net ultrafiltration may not eliminate backfiltration during hemodialysis with highly permeable membranes, Artif. Organs. 15, 164–170 (1991)
J. Sargent, F. Gotch: Principles and biophysics of dialysis. In: Replacement of Renal Function by Dialysis, 4th edn., ed. by C. Jacobs, C. Kjellstrand, K. Koch, J. Winchester (Kluwer Academic, Dordrecht 1996) pp. 188–230
R. Vanholder, N. Meert, E. Schepers, G. Glorieux: Uremic toxins: do we know enough to explain uremia?, Blood Purif. 26, 77–81 (2008)
H.W. Leber, V. Wizemann, G. Goubeaud, P. Rawer, G. Schütterle: Simultaneous hemofiltration/hemodialysis: an effective alternative to hemofiltration and conventional hemodialysis in the treatment of uremic patients, Clin. Nephrol. 9, 115–121 (1978)
L.W. Henderson, M.L. Sanfelippo, E. Beans: “On line” preparation of sterile pyrogen-free electrolyte solution, Trans. Am. Soc. Artif. Intern. Organs. 24, 465–467 (1978)
H. Polaschegg: Automatic, noninvasive intradialytic clearance measurement, J. Int. Artif. Organs. 16, 185–191 (1993)
H.D. Polaschegg, T. Roy: Technical aspects of online hemodiafiltration, Contrib. Nephrol. 158, 68–79 (2007)
B. Canaud, J. Bragg-Gresham, M. Marshall, S. Desmeules, B. Gillespie, T. Depner, P. Klassen, F. Port: Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS, Kidney Int. 69, 2087–2093 (2006)
M. Krämer: Physiological monitoring and control in hemodialysis: state of the art and outlook, Expert. Rev. Med. Devices. 3, 617–634 (2006)
Q. Maggiore, F. Pizzarelli, A. Santoro, G. Panzetta, G. Bonforte, T. Hannedouche, M.A. Alvarez de Lara, I. Tsouras, A. Loureiro, P. Ponce, S. Sulkovà, G. van Roost, H. Brink, J.T. Kwan: Study group of thermal balance and vascular stability. The effects of control of thermal balance on vascular stability in hemodialysis patients: results of the European randomized clinical trial, J. Am. Kidney Dis. 40, 280–290 (2002)
A. Santoro, E. Mancini, C. Basile, L. Amoroso, S. DiGiulio, M. Usberti, G. Colasanti, G. Verzetti, A. Rocco, E. Imbasciati, G. Panzetta, R. Bolzani, F. Grandi, M. Polacchini: Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial, Kidney Int. 62, 1034–1045 (2002)
M. Kraemer, C. Rode, V. Wizemann: Detection limit of methods to assess fluid status changes in dialysis patients, Kidney Int. 69, 1609–1620 (2006)
R.M. Fagugli, P. Pasini, F. Pasticci, G. Ciao, B. Cicconi, U. Buonchristiani: Effects of short daily hemodialysis and extended standard hemodialysis on blood pressure and cardiac hypertrophy: a comparative study, J. Nephrol. 19, 77–83 (2006)
P. Chamney, P. Wabel, U. Moissl, M. Müller, A. Bosy-Westphal, O. Korth, N. Fuller: A whole-body model to distinguish excess fluid from the hydration of major body tissues, J. Am. Clin. Nutr. 85, 80–89 (2007)
K.S. Cole, R.H. Cole: Dispersion and adsorption in dielectrics, J. Chem. Phys. 9, 341–351 (1941)
U.M. Moissl, P. Wabel, P. Chamney, I. Bosaeues, N. Levin, A. Bosy-Westphal, O. Korth, M. Müller, L. Ellegard, V. Malmros, C. Kaitwatcharachai, M. Kuhlmann, F. Zhu, N. Fuller: Body fluid volume determination via body composition spectroscopy in health and disease, Physiol. Meas. 27, 921–933 (2006)
P. Wabel, P. Chamney, U. Moissl, T. Jirka: Importance of whole-body bioimpedance spectroscopy for the management of fluid balance, Blood Purif. 27, 75–80 (2009)
P. Wabel, U. Moissl, P. Chamney, T. Jirka, P. Machek, P. Ponce, P. Taborski, C. Tetta, N. Velascon, J. Vlasak, W. Zaluska, V. Wizemann: Towards improved cardio-vascular management: the necessity of combining blood pressure and fluid overload, Nephrol. Dial. Transplant. 23, 2965–2971 (2008)
V. Wizemann, P. Wabel, P. Chamney, W. Zaluska, U. Moissl, C. Rode, T. Malecka-Masalska, D. Marcelli: The mortality risk of overhydration in haemodialysis patients, Nephrol. Dial. Transplant. 24, 1574–1579 (2009)
Newsweek Magazine: Hepatitis C, The insidious spread of a killer virus, from May 20, pp. 75–79 (2002)
J.P. Leigh, C.L. Bowlus, B.N. Leistikow, M. Schenker: Cost of hepatitis C, Arch. Intern. Med. 161, 2231–2233 (2001)
P. Konstantin, J. Chang, V. Otto, G. Brunner: Artificial Liver, Artif. Organs. 16, 235–242 (1992)
S. Mitzner, J. Stange, S. Klammt, P. Peszynski, R. Schmidt, G. Nölde- Schomburg: Extracorporeal detoxification usingthe molecular adsorbent recirculating system for critically ill patients with liver failure, J. Am. Soc. Nephrol. 12, 75–82 (2001)
J. Vienken, H. Christmann: How can liver toxins be removed? Filtration and adsorption with the Prometheus System, Ther. Aph. Dial. 10, 125–131 (2006)
J. Stange, S. Mitzner: A carrier-mediated transport of toxins in a hybrid membrane: safety barrier between a patient’s blood and a bioartificial liver, J. Int. Artif. Organs. 19, 677–691 (1996)
K. Rifai, T. Ernst, U. Kretschmer, C. Hafer, H. Haller, M.P. Manns, D. Fliser: The Prometheus device for extracorporeal support of combined liver and renal failure, Blood Purif. 23, 298–302 (2005)
K. Rifai, C. Hafer, J. Rosenau, C. Athmann, H. Haller, M.P. Manns, D. Fliser: Treatment of severe refractory pruritus with fractionated plasma separation and adsorption. (Prometheus), J. Scand. Gastroenterol. 41, 1212–1217 (2006)
J. Stange, S. Mitzner, T. Risler, C. Erley, W. Lauchart, H. Goehl, S. Klammt, P. Peszynski, J. Freytag, H. Hickstein, M. Löhr, S. Liebe, W. Scharek, U. Hopt, R. Schmidt: Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support, Artif. Organs. 23, 319–330 (1999)
U. Heemann, U. Treichel, J. Loock, T. Philipp, G. Gerken, M. Malago, S. Klammt, M. Loehr, S. Liebe, S. Mitzner, R Schmidt, J. Stange: Albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective controlled study, Hepatology 36, 949–958 (2002)
J. Hartmann, K. Strobl, D. Falkenhagen: Anticoagulation in combined membrane/adsorption systems Contributions, Sec. Biol. Med. Sci. MASA 2, 39–49 (2008)
S. Herget-Rosenthal, U. Treichel, F. Saner: Citrate anticoagulated modified fractionated plasma separation and adsorption: first clinical efficacy and safety data in liver failure,J. Am. Soc. Nephrol. 14, 729A (2003)
J. Kozik-Jaromin, V. Nier, U. Heemann, B. Kreymann, J. Boehler: Citrate pharmacokinetics and calcium levels during highflux dialysis with regional citrate anticoagulation, Nephrol. Dial. Transplant. 24, 2244–2251 (2009)
M. Janssen, J. Deegens, T. Kapinga, J. Beukhof, P. Huijgens, A. van Loenen, J van der Meulen: Citrate compared to low molecular weight heparin anticoagulation in chronic hemodialysis patients, Kidney Int. 49, 806–813 (1996)
D. Falkenhagen, Donau University Krems, Austria (personal communication)
L. Kjaergard, J. Liu, B. Als-Nielsen, C. Gluud: Artificial and bioartificial support systems for acute and acute-on-chronic liver failure, JAMA 289, 217–222 (2003)
European Commission: Regulation (EU) No 1394/2007 of the European Parliament and of the Council of November 13, 2007 on Advanced Therapy Medicinal Products. J. Official, European Union, L324/121 from 10.12.2007 (2007)
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Vienken, J. (2011). Extracorporeal Blood Purification Systems. In: Kramme, R., Hoffmann, KP., Pozos, R.S. (eds) Springer Handbook of Medical Technology. Springer Handbooks. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-74658-4_31
Download citation
DOI: https://doi.org/10.1007/978-3-540-74658-4_31
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-74657-7
Online ISBN: 978-3-540-74658-4
eBook Packages: EngineeringEngineering (R0)