Evidence for Internal Filtration in the Genius® System, Performing Slow Low Efficient Daily Dialysis in the Intensive Care Unit

Background: Since most intensive care units (ICUs) have no access to high-quality water, the Genius® system, using ultrapure water and high-flux dialyzers, might be used during slow low efficient daily dialysis (SLEDD). To get an idea about convective removal, internal filtration (IF) was calculated and compared to other modalities. Methods: Validated with in vivo measurements, IF was calculated for 8 h Genius® SLEDD and 4 h Genius® standard dialysis with high-flux dialyzers, and for 8 h SLEDD and 4 h both with standard dialysis machines and low-flux as well as high-flux dialyzers. Results: In Genius® SLEDD (FX80), IF was 2.36 l (hematocrit [Hct] 30%) and 3.37 l (Hct 40%). About the same amount of IF was found for the different dialysis modalities, except when using low-flux dialyzers, where no IF occurred. Conclusion: The Genius® system allows the implementation of high-flux dialysis with ultrapure dialysate, and can be run in a SLEDD mode in the ICU.

[1]  W. Fassbinder.  Experience with the GENIUS® Hemodialysis System , 2003, Kidney and Blood Pressure Research.

[2]  H. Emrich,et al.  High-flux hemodialysis--an effective alternative to hemoperfusion in the treatment of carbamazepine intoxication. , 2002, Clinical nephrology.

[3]  W. van Biesen,et al.  Clamping of the dialysate outlet line in the Genius dialysis system does not alter dialysate flow or clearances. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  A. Cheung,et al.  Quantification of Middle Molecular Weight Solute Removal in Dialysis , 2001, Seminars in dialysis.

[5]  C. Ronco,et al.  Solute removal by hollow-fiber dialyzers. , 2007, Contributions to nephrology.

[6]  D. Fliser,et al.  Efficiency of High‐Flux Hemodialysis in the Treatment of Valproic Acid Intoxication , 2003, Journal of toxicology. Clinical toxicology.

[7]  L. Mockros,et al.  Compact cross-flow tubular oxygenators. , 1985, Transactions - American Society for Artificial Internal Organs.

[8]  Pascal Verdonck,et al.  Modeling of transport phenomena in an artificial kidney , 2006 .

[9]  J. Floege,et al.  Extended daily veno-venous high-flux haemodialysis in patients with acute renal failure and multiple organ dysfunction syndrome using a single path batch dialysis system. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[10]  P. Verdonck,et al.  Computational flow modeling in hollow-fiber dialyzers. , 2002, Artificial organs.

[11]  R. Vanholder,et al.  New insights in uremic toxins. , 2003, Kidney international. Supplement.

[12]  W. Kleophas,et al.  Long-term experience with an ultrapure individual dialysis fluid with a batch type machine. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  R. Schindler,et al.  Short bacterial DNA fragments: detection in dialysate and induction of cytokines. , 2004, Journal of the American Society of Nephrology : JASN.

[14]  C. Ronco.  Evolution of hemodiafiltration. , 2007, Contributions to nephrology.

[15]  S Mandolfo,et al.  Impact of Blood and Dialysate Flow and Surface on Performance of New Polysulfone Hemodialysis Dialyzers , 2003, The International journal of artificial organs.

[16]  C. Ronco.  Fluid mechanics and crossfiltration in hollow-fiber hemodialyzers. , 2007, Contributions to nephrology.

[17]  C Ronco,et al.  Enhancement of convective transport by internal filtration in a modified experimental hemodialyzer: technical note. , 1998, Kidney international.

[18]  G. Lonnemann.  Chronic Inflammation in Hemodialysis: The Role of Contaminated Dialysate , 2000, Blood Purification.

[19]  C. Ronco,et al.  Dialysate Flow Distribution in Hollow Fiber Hemodialyzers with Different Dialysate Pathway Configurations , 2000, The International journal of artificial organs.

[20]  Gualtiero Guadagni,et al.  A New Semiempirical Mathematical Model for Prediction of Internal Filtration in Hollow Fiber Hemodialyzers , 2006, Blood Purification.

[21]  B. Tersteegen,et al.  Clearance of a dialyzer under varying operating conditions. , 1986, Artificial organs.

[22]  J. De Sutter,et al.  Cytokine removal during continuous hemofiltration in septic patients. , 1999, Journal of the American Society of Nephrology : JASN.

[23]  G. Lonnemann.  The quality of dialysate: an integrated approach. , 2000, Kidney international. Supplement.

[24]  A. Wuepper,et al.  Internal filtration--advantage in haemodialysis? , 1996, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[25]  W. Fassbinder.  Renaissance of the batch method? , 1998, Nephrology, Dialysis and Transplantation.

[26]  T. Akiba,et al.  Effect of Hollow Fiber Length on Solute Removal and Quantification of Internal Filtration Rate by Doppler Ultrasound , 2003, The International journal of artificial organs.

[27]  J. Leypoldt,et al.  Solute fluxes in different treatment modalities. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[28]  R. Vanholder,et al.  Studies on dialysate mixing in the Genius single-pass batch system for hemodialysis therapy. , 2003, Kidney international.

[29]  J T Daugirdas,et al.  Hemodialyzer mass transfer-area coefficients for urea increase at high dialysate flow rates. The Hemodialysis (HEMO) Study. , 1997, Kidney international.

[30]  P. Verdonck,et al.  Dialysate partitioning in the Genius batch hemodialysis system: effect of temperature and solute concentration. , 2005, Kidney international.

[31]  P. Verdonck,et al.  Impact of hemodialysis duration on the removal of uremic retention solutes. , 2008, Kidney international.

[32]  Gianfranco Beniamino Fiore,et al.  Principles and practice of internal hemodiafiltration. , 2007, Contributions to nephrology.

[33]  N. Hoenich,et al.  The influence of the dialysate flow rate on hollow fiber hemodialyzer performance. , 1995, Artificial organs.