Reduction of circulating microemboli in the subclavian vein of patients undergoing haemodialysis using pre-filled instead of dry dialysers.
BACKGROUND
Chronic microembolization that can be demonstrated by pulsed Doppler ultrasound may give rise to pulmonary side-effects during haemodialysis by direct vessel obstruction, increased complement activation or platelet aggregation. The objective of the present investigation was to study whether the use of pre-filled instead of dry dialysers would help to minimize the number of microemboli.


METHODS
The study cohort consisted of 23 patients undergoing maintenance haemodialysis. Using a 2 MHz pulsed ultrasound device, the subclavian vein downstream to the dialysis fistula was investigated for 10 min during the dialysis session. The ultrasound examination was performed twice during two successive dialysis sessions, using a pre-filled or a dry dialyser in randomized order.


RESULTS
In all patients investigated, numerous microembolic signals (MES) could be observed in the subclavian vein. Treatment with pre-filled dialysers was associated with significantly less MES (82 +/- 94) as compared with dry dialysers (268 +/- 296; P = 0.002).


CONCLUSIONS
In comparison to dry dialysers, the use of pre-filled dialysers leads to a significant reduction in microembolization, which may prevent repeated damage to the pulmonary vasculature and, thus, cause less pulmonary damage.
Droste
Dirk W
DW
Department of Neurology, University of Münster, Germany. droste2@uni-muenster.de
Beyna
Torsten
T
Frye
Bernhard
B
Schulte
Volker
V
Ringelstein
E Bernd
EB
Schaefer
Roland M
RM
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000502:physiology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography