New trends in blood purification.
Considering the different methods of blood purification, designed and developed during the last ten years, some common trends can be pointed out (Table 4). The uniformity of treatment during the first 30 years has been substituted by a variety of new methods, allowing a specific attribution to different underlying diseases. Whereas haemodialysis, haemofiltration and intermittent peritoneal dialysis exhibit a relatively broad spectrum of indications, CAPD, haemoperfusion and plasmapheresis are restricted to a reduced number of underlying diseases. Certain diseases, until a few years ago regarded as a contra-indication for blood purification treatment, are today considered to be specific indications for newly developed methods of treatment, for example diabetic nephropathy for CAPD and vascular instability for haemofiltration or its modifications. Apart from this individualization an important trend of modern artificial kidney design has been the attempt to miniaturize the devices in order to facilitate their application and to encourage self-treatment. This trend could result in a concentration of the patients on self-care and a substantial reduction of treatment costs. Moreover, a miniaturized artificial organ could reduce many immunological problems, which today result from transplantation of natural kidney. Imitation of the natural kidney has been an important goal of many investigators during the last years. Promising approaches have been attempted by the development of haemofiltration, imitating the process of glomerular filtration, or continuous ambulatory peritoneal dialysis, copying the continuously excreting natural kidney. In his assay 'De Urina', Homer Smith says, 'This liquid, which commonly inspires men only with contempt and disgust, which is generally ranked amongst vile and repulsive matters has become, in the hands of the chemists, a source of important discoveries'. Today the inspiration of the chemists has been replaced by the unceasing endeavours of technicians to create an artificial organ which produces a urine of similar qualities.
D001769:Blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D009638:Norepinephrine / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000639:trends; D010956:Plasmapheresis / Q000639:trends; D006435:Renal Dialysis / Q000639:trends*; D012083:Renin / Q000097:blood; D012964:Sodium / Q000097:blood; D014462:Ultrafiltration / Q000295:instrumentation
D012964:Sodium; D012083:Renin; D009638:Norepinephrine