A CONCEPT OF AUGMENTED ISOLATED GASTROINTESTINAL DIALYSIS WITH CHEMICAL ADSORBENTS

Gordon et al has reported that one to two liters of dialysate with chemical adsorbents has the capability of carrying out effective hemodialysis, and ever since isolated intestinal loop dialysis has been performed clinically by several investigators.These reports suggest that the isolated gastrointestinal tract can be used as a container for dialysate with chemical adsorbents to carry out dialysis for 24 hours a day without the necessity of frequent exchange of dialysate and the patient be free from any lines or attached equipment.It is also possible that this procedure could be supplemented with hemo dialysis either with conventional equipment or a compact hemodialyzer inserted into isolated gastrointestinal tract or stomach pouch, jejunal loop and colon loop. The capability of these three types of isolated gastrointestinal loop were studied and reported.It was found that isolated jejunal loop primed with dialysate containing chemical adsorbents such as activated charcoal for removal of creatinine and other organic metabolites and Kayexalate, a cation exchange resin for removal of potassium, can serve as a life saving method for uremic dogs. However, some methods to allow the circulation of dialysate throughout the loop and avoid the accumulation of charcoal and chemical resin at the end of the loop must be improved.Studies on insertion of compact hemodialyzers into the isolated gastro intestinal loop will be discussed elsewhere.