Enhancement of solute clearance using pulsatile push-pull dialysate flow for the Quanta SC+: A novel clinic-to-home haemodialysis system

Autor: Detlef H. Krieter, Clive Buckberry, Marieke Rüth, Nicholas A. Hoenich, John Milad, Horst-Dieter Lemke
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Physiology
030232 urology & nephrology
Pulsatile flow
Glycobiology
Hemodialysis
Home
Plant Science
030204 cardiovascular system & hematology
Biochemistry
chemistry.chemical_compound
0302 clinical medicine
Dialysis Solutions
Medicine and Health Sciences
Membrane Technology
Glucans
Flow Rate
Fluids
Multidisciplinary
Physics
Classical Mechanics
Fluid transport
Volumetric flow rate
Body Fluids
Separation Processes
Membrane
Dextran
Blood
Nephrology
Pulsatile Flow
Plant Physiology
Physical Sciences
Engineering and Technology
Medicine
Female
Current (fluid)
Anatomy
Solute Transport
Dialysis (biochemistry)
Research Article
States of Matter
Science
Hemodiafiltration
Fluid Mechanics
Research and Analysis Methods
Continuum Mechanics
03 medical and health sciences
Polysaccharides
Medical Dialysis
Humans
Fluid Flow
Toxins
Biological
Molecular Dialysis
Albumin
Biology and Life Sciences
Fluid Dynamics
Membrane Dialysis
chemistry
Biomedical engineering
Zdroj: PLoS ONE, Vol 15, Iss 3, p e0229233 (2020)
PLoS ONE
ISSN: 1932-6203
Popis: Background and objective The SC+ haemodialysis system developed by Quanta Dialysis Technologies is a small, easy-to-use dialysis system designed to improve patient access to self-care and home haemodialysis. A prototype variant of the standard SC+ device with a modified fluidic management system generating a pulsatile push-pull dialysate flow through the dialyser during use has been developed for evaluation. It was hypothesized that, as a consequence of the pulsatile push-pull flow through the dialyser, the boundary layers at the membrane surface would be disrupted, thereby enhancing solute transport across the membrane, modifying protein fouling and maintaining the surface area available for mass and fluid transport throughout the whole treatment, leading to solute transport (clearance) enhancement compared to normal haemodialysis (HD) operation. Methods The pumping action of the SC+ system was modified by altering the sequence and timings of the valves and pumps associated with the flow balancing chambers that push and pull dialysis fluid to and from the dialyser. Using this unique prototype device, solute clearance performance was assessed across a range of molecular weights in two related series of laboratory bench studies. The first measured dialysis fluid moving across the dialyser membrane using ultrasonic flowmeters to establish the validity of the approach; solute clearance was subsequently measured using fluorescently tagged dextran molecules as surrogates for uraemic toxins. The second study used human blood doped with uraemic toxins collected from the spent dialysate of dialysis patients to quantify solute transport. In both, the performance of the SC+ prototype was assessed alongside reference devices operating in HD and pre-dilution haemodiafiltration (HDF) modes. Results Initial testing with fluorescein-tagged dextran molecules (0.3 kDa, 4 kDa, 10 kDa and 20 kDa) established the validity of the experimental pulsatile push-pull operation in the SC+ system to enhance clearance and demonstrated a 10 to 15% improvement above the current HD mode used in clinic today. The magnitude of the observed enhancement compared favourably with that achieved using pre-dilution HDF with a substitution fluid flow rate of 60 mL/min (equivalent to a substitution volume of 14.4 L in a 4-hour session) with the same dialyser and marker molecules. Additional testing using human blood indicated a comparable performance to pre-dilution HDF; however, in contrast with HDF, which demonstrated a gradual decrease in solute removal, the clearance values using the pulsatile push-pull method on the SC+ system were maintained over the entire duration of treatment. Overall albumin losses were not different. Conclusions Results obtained using an experimental pulsatile push-pull dialysis flow configuration with an aqueous blood analogue and human blood ex vivo demonstrate an enhancement of solute transport across the dialyser membrane. The level of enhancement makes this approach comparable with that achieved using pre-dilution HDF with a substitution fluid flow rate of 60 mL/min (equivalent to a substitution volume of 14.4 L in a 4-hour session). The observed enhancement of solute transport is attributed to the disruption of the boundary layers at the fluid-membrane interface which, when used with blood, minimizes protein fouling and maintains the surface area.
Databáze: OpenAIRE
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