Customization of hemodialysis therapy: dialysis is not a washing machine

Abstract

In recent years, the population of chronic dialysis has grown in number but also in age and frequency of co-morbidies such as cardiac diseases, vascular pathologies, diabetes, etc. The majority of patients on chronic hemodialysis are over 70 years and, given the high number of comorbidities, they often exhibit poor tolerance to dialysis treatments.
A non-tolerated dialytic treatment can have side-effects that would require an intensification of the dialysis sessions and many hospitalizations. Consequently, the problematic dialysis treatments, as well as harmful for the patient, become economically more detrimental than other treatments apparently more expensive but more tolerated ones In the current days we have, thanks to the huge developments in dialysis technology, powerful weapons to ensure effective and scarcely symptomatic dialysis treatments to the majority of the HD patients. New, highly biocompatible membranes with defined and modular cut-off and / or absorption capacity may allow us to provide adequate purification. Moreover the monitoring and biofeedback systems such as blood volume tracking, body temperature monitoring (BTM) and blood pressure (BPM) can be very useful in reducing the risk of intra-dialytic hypotension and symptoms. Therefore, the dialytic therapy, as well as all the pharmacological therapies for the chronic patient, must consider the specificity of the patient, basing on his metabolic problems, cardiovascular tolerance, residual renal function and on his dietary and general compliance. The central aim of the nephrologist is to formulate the better prescription for the individual patient, considering the dialysis modalities, the membrane type, the dry weight (ideal post-dialysis body weight), the frequency and the duration of the weekly sessions and the technological tools that can optimize the treatment.

Keywords : dialysis adequacy, dialysis tolerance, biocompatibility, dialysis membrane, dialysis monitoring, biofeedback

Sorry, this entry is only available in Italian.

Update on proteomic use in hemodialysis

Abstract

Application of proteomics has become one of the leading experimental disciplines for increased understanding of the key role played by proteins and protein–protein interactions in all aspects of cell function. There is an increasing use of proteomic technologies for investigation into renal replacement therapy such as hemodialysis. In the last 10 years, the application of shotgun bottom-up liquid chromatography-mass spectrometry/mass spectrometry approaches has been successfully applied to research in uremic toxicity, with the discovery of novel uremic toxins and the potential to delineate a precise molecular approach to defining the biochemical nature of uremia.
Major investigations of proteomics in hemodialysis therapy include molecular definition of uremic toxicity, identification of prognostic biomarkers, blood purification efficiency testing, and biocompatibility assessment of the dialyzer membrane materials.
In this article, we review the results of recent proteomic investigations in the setting of chronic hemodialysis therapy.

KEY WORDS: Proteomic, hemodialysis, membrane, uremic toxins, biocompatibility, adsorption, proteins.

Sorry, this entry is only available in Italian.