Skip to main content
SpringerLink
Log in

Clinical Application of Haemoperfusion in Uraemia

  • Chapter
Artificial Organs

Part of the book series: Strathclyde Bioengineering Seminars ((KESE))

  • 21 Accesses

Summary

Activated charcoal haemoperfusion offers potential clinical benefit for the treatment of end-stage chronic uraemia. Haemoperfusion has been shown to have plasma creatinine and plasma urate clearances superior to those obtained with conventional haemodialysis at comparable blood flow rates through the respective devices. Urea and phosphate removal, however, is inferior to conventional dialysis while water and electrolyte removal is negligible. Haemoperfusion therefore requires combination with dialysis or ultrafiltration apparatus in patients without high urine volumes in order to remove sufficient water and electrolytes. Molecules of 350 – 1500 daltons are removed more efficiently than by dialysis, and offer potential benefit to patients with specific complications of dialysis therapy such as peripheral neuropathy and pericarditis.

Haemostatic changes occurring with haemoperfusion are minor and present little clinical hazard to patients, although it would be desirable to reduce platelet loss to a minimum before repeated use of these devices is recommended.

Total solute removal of creatinine and urate, in a 2 h combined dialysis — ultrafiltration — haemoperfusion system is less than a longer period of conventional dialysis, but would appear to be sufficient for stable management of uraemic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Andrade, J. D., Kunitomo, K., Van Wagenen, R., Kastigir, B., Gough, D. and Kolff, W. J. (1971). Coated adsorbents for direct blood perfusion HEMA/ activated carbon. Trans. Amer. Soc. Artif Int. Organs, 17, 222–228.

    CAS  Google Scholar 

  • Babb, A. L., Popovich, R. P., Christopher, T. G. and Scribner, B. H. (1971). The genesis of the square metre-hour hypothesis. Trans. Amer. Soc. Artif Im. Organs, 17, 81–91.

    CAS  Google Scholar 

  • Babb, A. L., Farrell, P. C., Uvelli, D. A. and Scribner, B. H. (1972). Haemodialyser evaluation by examination of solute molecular spectra. Trans. Amer. Soc.Artif Int. Organs, 18, 98.

    Article  CAS  Google Scholar 

  • Babb, A. L., Strand, M. J., Uvelli, D. A., Milutinovic, J. and Scribner B. H. (1975). Quantitative description of dialysis treatment: a dialysis index. Kidney International, 7, S23–29.

    Google Scholar 

  • Bergstrom, J. and Furst, P. (1976). Uraemic middle molecules. Clin. Nephrol. 5, 143–152.

    PubMed  CAS  Google Scholar 

  • Bright, R. (1836). Cases and observations illustrative of renal disease accompanied by the secretion of albuminous urine. Guy’s Hospital Report, 1, 338–379.

    Google Scholar 

  • Brunner, F. P., Giesecke, B., Gurland, H. J., Jacobs, C., Parsons, F. M., Scharer, K., Seyffart, G., Spies, G. and Wing, A. J. (1975). Combined report on intermittent dialysis and transplantation in Europe. Proc. Eur. Dial. Transpl. Assoc., 12, 3–64.

    Google Scholar 

  • Bryan, F. A. (1974). Sixth Annual Progress Report 1973–1974: The National Dialysis Registry. National Institutes of Arthritis, Metabolism and Digestive Diseases, National Institutes of Health, Bethesda, Maryland 20014.

    Google Scholar 

  • Chang, T. M. S. (1966). Semipermeable aquaeous microcapsules (‘artificial cells’): with emphasis on experiments in an extracorporeal shunt system. Trans. Amer. Soc. Artif Int. Organs, 12, 13.

    CAS  Google Scholar 

  • Chang, T. M. S. (1969). Removal of endogenous and exogenous toxins by a microencapsulated adsorbent. Can. J. Physiol. Pharmacol., 47, 1043–1045.

    Article  Google Scholar 

  • Chang, T. M. S. (1974). A comparison of semipermeable microcapsules and standard dialysers for use in separation. Separation and Purification Methods, 3, (2), 245–262.

    Google Scholar 

  • Chang, T. M. S., Pont, A., Johnson, L. J. and Malave, N. (1968). Response to intermittent extracorporeal perfusion through shunts containing semipermeable microcapsules. Trans. Amer. Soc. Artif. Int. Organs, 14, 162–168.

    Google Scholar 

  • Chang, T. M. S., and Malave, N. (1970). The development and first clinical use of semipermeable microcapsules (artificial cells) as a compact artificial kidney. Trans. Amer. Soc. Artif Int. Organs, 16, 141–148.

    CAS  Google Scholar 

  • Chang, T. M. S., Gonda, A., Dirks, J. H. and Malave, N. (1971). Clinical evaluation of chronic intermittent and short-term haemoperfusion in patients with chronic renal failure using semipermeable microcapsules (artificial cells) formed from membrane coated activated charcoal. Trans. Amer. Soc. Artif Int. Organs, 17, 246–252.

    CAS  Google Scholar 

  • Chang. T. M. S., Gonda, A., Dirks, J. H., Coffey, J. F. and Burns, T. (1972). ACAC microcapsule artificial kidney for the long-term and short-term manage-ment of patients with chronic renal failure. Trans. Amer. Soc. Artif Int. Organs, 18, 465–472.

    Article  CAS  Google Scholar 

  • Chang, T. M. S. and Migchelsen, M. (1973). Characterisation of possible ‘toxic’ metabolites in uraemia and hepatic coma based on the clearance spectrum for larger molecules by the ACAC microcapsule artificial kidney. Trans. A ner. Soc. Artif Int. Organs, 19, 314–319.

    Article  CAS  Google Scholar 

  • Chang, T. M. S., Migchelsen, M., Coffey, J. F. and Stark, A. (1974). Serum middle molecule levels in uraemia during long-term intermittent haemoperfusions with the ACAC (coated charcoal) microcapsule artificial kidney. Trans. Amer. Soc. Artif Int. Organs, 20, 364–371.

    Google Scholar 

  • Chang, T. M. S., Chirito, E., Barre, B., Cole, C. and Hewish, M. (1975). Clinical performance-characteristics of a new combined system for simultaneous haemoperfusion-haemodialysis-ultrafiltration in series. Trans. Amer. Soc. Artif. Int. Organs, 21, 502–508.

    CAS  Google Scholar 

  • Chang, T. M. S., Chirito, E., Barre, P. and Resureccion, E. (1976). The use of ACAC microencapsulated charcoal haemoperfusion in series with Amicon ultrafiltration for patients with chronic renal failure. Abstracts, Amer. Soc. Artif Int. Organs, 5, 15.

    Google Scholar 

  • Dunea, G. and Koiff, W. J. (1965). Clinical experience with the Yatzidis charcoal artificial kidney. Trans. Amer. Soc. Artif Int. Organs, 11, 178–182.

    Article  CAS  Google Scholar 

  • Dunea, G., Rizvi, S. H., Mamdani, B. H., Anicama, H. J. and Mahurkar, S. D. (1976). Charcoal hemoperfusion and combination dialysis-haemoperfusion in chronic renal failure. Abstracts Amer. Soc. Artif Int. Organs, 5, 22.

    Google Scholar 

  • Flendrig, J. A., Kruis, H. and Das, H. A. (1976). Aluminium intoxication: the cause of dialysis dementia? Proc. Eur. Dial. Transpl. Assoc., 13, 355.

    Google Scholar 

  • Friedman, E. A. (1976). Oxidised starch and oral charcoal in uraemic patients. Kidney International (in press).

    Google Scholar 

  • Friedman, E. A., Laungani, G. B. and Beyer, M. M. (1975). Life prolongation in nephrectomized rats fed oxidized starch and charcoal. Kidney International, 7, 377–379.

    Google Scholar 

  • Funck-Brentano, J. L., Man, N. K., Sausse, A., Cueille, G., Zingraff, J., Drueke, T., Jungers, P. and Billon, J. P. (1975). Neuropathy and ‘middle’ molecule toxin. Kidney International, 7, 352–356.

    Google Scholar 

  • Funck-Brentano, J. L., Man, N. K., Sausse, A., Zingraff, J., Cloix, J. F., Becker, A. and Cueille, G. (1976). Characterisation of a 1100–1300 MW uraemic neurotoxin. Trans. Amer. Soc. Artif. Int. Organs, 22, 163.

    CAS  Google Scholar 

  • Gazzard, B. G., Portmann, B. A., Weston, M. J., Langley, P. G., Murray-Lyon, I. M., Dunlop, E. H., Flax, H., Mellon, P. J., Record, C. O., Ward, M. B. and Williams, R. (1974). Charcoal haemoperfusion in the treatment of fulminant hepatic failure. Lancet, 1, 1301–1307.

    Google Scholar 

  • Gordon, A., Gral, T., De Palma, J. R., Greenbaum, M. A., Marantz, L. B., MacArthur, M. J. and Maxwell, M. H. (1970). A sorbent-based low-volume dialysate system. Preliminary studies in human subjects. Proc. Eur. Dial. Transpl. Assoc. 7, 63–68.

    Google Scholar 

  • Gordon, A., Furst, P., Bergstrom, J., Lewin, A., Rosenfeld, M. D. J., Roberts, M. and Maxwell, M. H. (1976). Adsorption of uremic toxins. Proc. 6th Int. Cong. Nephroi. (in press).

    Google Scholar 

  • Graham, T. (1854). Bakerian lecture on osmotic force. Phil. Trans. Roy. Soc., London, p. 177.

    Google Scholar 

  • Hagstam, K. E., Larsson, L. E. and Thysell, H. (1966). Experimental studies on charcoal haemoperfusion in phenobarbital intoxication and uraemia, including histopathologic findings. Acta. Med. Scand., 180, 593–603.

    Article  PubMed  CAS  Google Scholar 

  • Johnson, W. J., Hagge, W. W., Wagoner, R. D., Dinapoli, R. P. and Rosevear,J. W. (1975). Toxicity arising from urea. Kidney International, 7, S288–293.

    Google Scholar 

  • Jones, J. D. and Burnett, P. C. (1975). Creatinine metabolism and toxicity. Kidney International, 7 S294–298.

    Google Scholar 

  • Kolff, W. J., and Berk, H. T. J. (1944). Artificial kidney: dialyser with great area. Acta Med. Scand., 117, 121–134.

    Google Scholar 

  • Leber, H. W., Neuhauser, M., Goubeaud, G. and Schutterle, W. (1976). Removal of toxic middle molecular solutes from uraemic serum by haemoperfusion. Abstracts, Eur. Dial. Transp. Assoc., p. 265.

    Google Scholar 

  • Malchesky, P. S., Nokoff, R., Varnes, W. and Nosé, Y. (1976) The charcoal capillary hemoperfusion system. Proc. 13th Eur. Dial. Transpl. Assoc., 13, 242.

    Google Scholar 

  • Muirhead, E. E. and Reid, A. F. (1948). A resin artificial kidney. J. Lab. Clin. Med., 33, 841–844.

    Google Scholar 

  • Ota, K., Ohta, T., Kobayashi, M., Yoshida, S., Kaneko, 1., Agishi, T. Sugihara, M. (1976). Petroleum based activated charcoal for direct haemoperfusion. Proc. Eur. Dial. Transp. Assoc., 13, 250.

    Google Scholar 

  • Sparks, R. E. (1975). Gastrosorbents in the therapy of uraemia; inferences from intestinal loop dialysis. Kidney International, 7, S373–376.

    Google Scholar 

  • Stephen, R. L., Jacobsen, S. C., Atkin-Thor, E. and Kilff, W. J. (1975). Portable/ wearable artificial kidney (WAK) -initial evaluation. Proc. Eur. Dial. Transpl. Assoc., 12, 26.

    Google Scholar 

  • Ward, M. K., Pierides, A. M., Fawcett, P., Shaw, D. A., Perry, R. H., Tomlinson, B. E. and Kerr, D. N. S. (1976). Dialysis encephalopathy syndrome. Proc. Europ. Dial. Transpl. Assoc., 13, 348.

    Google Scholar 

  • Winchester, J. F. (1976). Working luncheon on adsorbent haemoperfusion for uraemia, acute intoxication and liver failure. 22nd Amer. Soc. Artif. Int. Organs, San Francisco.

    Google Scholar 

  • Winchester, J. F., Tilstone, W. J., Edwards, R. O., Gilchrist, T. and Kennedy, A. C. (1974). Haemoperfusion for enhanced drug elimination - a kinetic analysis in paracetamol poisoning. Trans. Amer. Soc. Artif. Int. Organs, 20, 358–363.

    Google Scholar 

  • Winchester J. F., Edwards, R. O., Tilstone, W. J. and Woodcock, B. G. (1975a). Activated charcoal haemoperfusion and experimental acetaminophen poisoning. Toxicol. Appl. Pharmacol. 31, 120–127.

    Article  PubMed  CAS  Google Scholar 

  • Winchester, J. F.,Apiliga, M. T., Mackay, J. M. and Kennedy, A. C. (1975b). Haemodialysis with charcoal haemoperfusion. Proc. Eur. Dial. Transpl. Assoc., 12, 526–533.

    Google Scholar 

  • Winchester, J. F. Apiliga, M. T. and Kennedy, A. C. (1976). Short term evaluation of charcoal haemoperfusion combined with dialysis in uraemic patients. Kidney International (in press).

    Google Scholar 

  • Yatzidis, H. (1964). A convenient haemoperfusion micro-apparatus over charcoal for the treatment of endogenous and exogenous intoxications. Its use as an artificial kidney. Proc. Eur. Dial. Transpl. Assoc., 1, 83–87.

    Google Scholar 

Download references

Authors
  1. J. F. Winchester
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Bioengineering Unit Wolfson Centre, University of Strathclyde, UK

    Susan M. Gerard

Copyright information

© 1977 Bioengineering Unit, University of Strathclyde

About this chapter

Cite this chapter

Winchester, J.F. (1977). Clinical Application of Haemoperfusion in Uraemia. In: Kenedi, R.M., Courtney, J.M., Gaylor, J.D.S., Gilchrist, T., Gerard, S.M. (eds) Artificial Organs. Strathclyde Bioengineering Seminars. Palgrave, London. https://doi.org/10.1007/978-1-349-03458-1_23

Download citation

Publish with us

Policies and ethics

Search

Navigation