[Show abstract][Hide abstract]ABSTRACT: Research on pulsatile blood pumps for extracorporeal life support has been widely performed because of the proven advantageous effects of blood pulsation. However, studies on the use of pulsatile blood pumps for hemodialysis are limited, although available evidence demonstrates that pulsatile blood flow has a positive influence on dialysis outcome. Therefore, the authors designed a new pulsatile pump, which is characterized by minimal-occlusion of blood-containing tubing, no requirement for valves, and no blood flow regurgitation. In-vitro hemolysis tests were conducted using fresh bovine blood, and the normalized index of hemolysis was adopted to compare blood traumas induced by the devised pulsatile pump and a conventional roller pump. In addition, experimental hemodialyses with a canine renal failure model were performed using the devised pump. Normalized index of hemolysis levels obtained was much smaller for the devised pulse pump (45 +/- 21 mg/100 L) than for the roller pump (103 +/- 10 mg/100 L), and no technical problems were encountered during dialysis sessions. Blood and dialysate flow rates were maintained at predetermined values and molecular removal was satisfactory. Postdialysis urea and creatinine reduction ratios were 61.8% +/- 10.6% and 57.4% +/- 9.0%, respectively. Pulsatile flow has usually been generated using pulsatile devices containing valves, but the valves cause concern in terms of the clinical applications of these devices. However, the described pulsatile pump does not require valves, and yet no blood flow regurgitation was observed.
Full-text Article · Mar 2008 · ASAIO journal (American Society for Artificial Internal Organs: 1992)
[Show abstract][Hide abstract]ABSTRACT: Internal filtration contributes to convective clearance in high-flux hemodialysis but its contribution is limited by low pressure gradients. Therefore, a modification using a conventional dialyzer was conceived to enhance internal filtration and backfiltration (BF) rates. The modified dialyzer includes two longitudinal independent regions for blood flow, which were created by redesigning dialyzer caps. Blood pressures remained higher than dialysate pressures in one region and lower in the other region, allowing continuous internal filtration and BF in these respective regions. Modified and conventional dialyzers were compared in terms of pressure gradients and solute clearances. Thus, our experiments involved two groups: the modified dialyzer group and the conventional dialyzer group. A renal failure model was established using a dog weighing 25-30 kg by renal artery and vein ligation. With the exception of the dialyzers, experimental conditions were identical in the two groups. The pressure gradients between blood and dialysate were much higher for the modified dialyzer than for the conventional dialyzer. No significant differences were observed with respect to small solute clearances between the two groups, but mid-range solute clearances were significantly higher in the modified group. More optimization is required before the devised unit can be used clinically. However, the devised unit offers a straightforward means of regulating internal filtration and BF rates.