title: Pulse push/pull hemodialysis: in vitro study on new dialysis modality with higher convective efficiency.
abstract: Midsize molecule retention is related with renal-failure-associated mortality. Here, the authors describe a new dialysis modality, pulse push/pull hemodialysis (PPPHD), which increases convective clearance. Blood and dialysate are circulated by a pulsatile pump, but with pulsatile flow patterns that are 180 degrees out of phase. This causes blood-to-dialysate pressure gradients that oscillate between positive and negative, and which cause consecutive periods of ultrafiltration and backfiltration. The devised PPPHD was compared with conventional high-flux hemodialysis (CHFHD) in terms of solute clearances, albumin loss, and total protein levels. Human plasma containing dissolved uremic marker molecules was used as a blood substitute, and clearances were investigated for blood urea nitrogen, creatinine, vitamin B12, and inulin. Observed clearances were found to be significantly higher for PPPHD by approximately 3-14% for low-molecular-weight solutes, by 47-48% for vitamin B12, and by 38-49% for inulin than for CHFHD. No albumin loss was observed in either of these two study groups. The authors conclude that PPPHD offers a simple straightforward means of enhancing uremic molecule removal by increasing total ultrafiltration volume without the need to infuse replacement fluid.
authors.affiliation: Interdisciplinary Program in Biomedical Engineering Major, Korea Artificial Organ Center, Seoul National University, Seoul, Korea.
authors.forename: Kyungsoo
authors.initials: K
authors.lastname: Lee
authors.forename: Sa Ram
authors.initials: SR
authors.lastname: Lee
authors.forename: Cho Hae
authors.initials: CH
authors.lastname: Mun
authors.forename: Byoung Goo
authors.initials: BG
authors.lastname: Min
mesh_terms: D001806:Blood Urea Nitrogen; D018481:Convection; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000627:therapeutic use; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007444:Inulin / Q000097:blood; D008567:Membranes, Artificial; D011673:Pulsatile Flow; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000628:therapy; D012709:Serum Albumin / Q000032:analysis*; D013242:Sterilization; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D015314:Dialysis Solutions; D008567:Membranes, Artificial; D012709:Serum Albumin; D007444:Inulin; D003404:Creatinine; D014805:Vitamin B 12