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Research Papers

Development of a New Method for Pulse Push/Pull Hemodialysis

[+] Author and Article Information
Kyungsoo Lee1

 ANC Bio Inc., Seoul, Koreajake0902@snu.ac.krDepartment of Biomedical Engineering,  Seoul National University, Seoul, Koreajake0902@snu.ac.krSchool of Veterinary Medicine,  Jeju National University, Jeju, Koreajake0902@snu.ac.kr

Dong Wook Lee, Byoung Goo Min, Kyoung Kap Lee, Young Min Yun

 ANC Bio Inc., Seoul, KoreaDepartment of Biomedical Engineering,  Seoul National University, Seoul, KoreaSchool of Veterinary Medicine,  Jeju National University, Jeju, Korea

1

Corresponding author. Present address: ANC Bio Inc., 918 SUNTECH City Building, Sangdaewon, Seongnam, Gyunggi, 462-725, Korea.

J. Med. Devices 5(3), 031004 (Aug 08, 2011) (6 pages) doi:10.1115/1.4004316 History: Received May 05, 2011; Revised May 23, 2011; Published August 08, 2011; Online August 08, 2011

Although hemodiafiltration is presumed to be a gold standard for higher convective therapy for kidney failure patients, the repetition of forward and backward filtration during hemodialysis increases the total filtration volume and convective clearance. Hence, the authors describe a new method of enhancing forward filtration and backfiltration. The devised method, named pulse push/pull hemodialysis (PPPHD), is based on the utilization of dual pulsation in a dialysate stream; namely, pulsatile devices in the dialysate stream both upstream (a dialysate pump) and downstream (an effluent pump) of the dialyzer. Fluid management accuracy of the unit was assessed using fresh bovine blood, and its hemodialytic performance was investigated in a canine renal failure model. Forward filtration rates during PPPHD were maintained at the levels of dialysate flow rates. Fluid balancing error was less than ±0.84% of total dialysate volume, when 97.4 ± 1.66L of pure dialysate was circulated for 4 hs. The animal remained stable without any complication. Urea and creatinine reductions were 56.9 ± 1.6 and 52.8 ± 2.3%, respectively, and albumin levels remained uniform throughout treatment. The devised PPPHD unit offers a simple, but efficient strategy of combined simultaneous diffusive and convective solute transport for ESRD patients, without the need for external replacement infusion.

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Copyright © 2011 by American Society of Mechanical Engineers
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Figures

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Figure 1

Dual Pulse Pump for PPPHD system. The DPP was modified for the flow requirement of the present study and used as the dialysate and effluent pump. It comprises a cam and four actuators, and also contains two separate sacs. Pulsatile flow is generated by squeezing each dialysate and effluent tubing segments, as was described in the text. Its detailed dimensions are; length − 340 mm, width − 260 mm, height (including a driving motor) − 320 mm. (A1∼A4, actuators 1 to 4; p1∼p6, tubing segments at positions 1 to 6, respectively).

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Figure 2

Changes in Tube Openness at p1∼p3 for the Dialysate Pump (top), and at p4∼p6 for the Effluent Pump (bottom). As the cam rotates, the actuators compress silicone tubing at each position and produce pulsatile flow. Tube openness is defined as the ratio of compressed to original internal tubing diameter. Tube opennesses of p1 and p3 during cycles ranged between 77% and 0%, corresponding to fully opened and completely closed, respectively. The p2 had an openness that ranged from 88% to 11%. Likewise, the p4 and p6 tube opennesses of the effluent pump range between 77% and 0%, corresponding to fully opened and closed, respectively, and the openness of p5 from 11% to 88%. (p1∼p6, tubing segments at positions 1 to 6, respectively, as shown in Fig. 1).

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Figure 3

(a) Experimental Dialysis Setup for Fluid Management Accuracy and (b) Animal Experiments. The experimental dialysis circuit includes a blood pump, a hemodialyzer and a dialysate supply unit. The DPP was used as the flow equalizer. Pressure gauges were also inserted in blood and dialysate tubing to measure TMPs of the dialysis circuit. (BP, blood pump; P, pressure gauge).

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Figure 4

(a) Pressure profiles during PPPHD. TMP was defined as the difference of mean blood and dialysate pressures. Obvious cycles of the positive and negative TMPs were obtained during PPPHD. (b) Pressure profiles during conventional HD. (c) Pressure profiles during the original PPPHD. (MBP, mean blood pressure; MDP, mean dialysate pressure).

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