title: A high blood level in the venous chamber and a wet-stored dialyzer help to reduce exposure for microemboli during hemodialysis.
abstract: During hemodialysis (HD), microemboli develop in the blood circuit of the apparatus. These microemboli can pass through the venous chamber and enter into the patient's circulation. The aim of this study was to investigate whether it is possible to reduce the risk for exposure of microemboli by altering of the treatment mode. Twenty patients on chronic HD were randomized to a prospective cross-over study of three modes of HD: (a) a dry-stored dialyzer (F8HPS, Fresenius, steam sterilized) with a low blood level in the venous chamber (DL), (b) the same dialyzer as above, but with a high level in the venous chamber (DH), and (c) a wet-stored dialyzer (Rexeed, Asahi Kasei Medical, gamma sterilized) with a high blood level (WH). Microemboli measurements were obtained in a continuous fashion during 180 minutes of HD for all settings. A greater number of microemboli were detected during dialysis with the setting DL vs. WH (odds ratio [OR] 4.07, 95% confidence interval [CI] 4.03-4.11, P<0.0001) and DH vs. WH (OR 1.18, 95% CI 1.17-1.19, P<0.0001) and less for DH vs. DL (OR 0.290, 95% CI 0.288-0.293, P<0.0001). These data indicate that emboli exposure was least when using WH, greater with DH, and most with DL. This study shows that using a high blood level in the venous chamber and wet-stored dialyzers may reduce the number of microemboli.
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden; Department of Internal Medicine, Skellefteå County Hospital, Skellefteå, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Forsberg
authors.forename: Per
authors.initials: P
authors.lastname: Jonsson
authors.forename: Christofer
authors.initials: C
authors.lastname: Stegmayr
authors.forename: Fredrik
authors.initials: F
authors.lastname: Jonsson
authors.forename: Bo
authors.initials: B
authors.lastname: Nilsson
authors.forename: Kristina
authors.initials: K
authors.lastname: Nilsson Ekdahl
authors.forename: Bernd
authors.initials: B
authors.lastname: Stegmayr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004618:Embolism, Air / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*
keywords: Hemodialysis; dialyzer; in vivo; microbubbles; microemboli; venous chamber