By L. Henderson (auth.), Emil P. Paganini M.D., F.A.C.P. (eds.)

The preliminary observations of dialytic help have been introduced from the laboratory and constrained to sufferers with reversible acute renal failure. the concept at the moment was once one in all brief time period upkeep. It was once theorized that elimination of waste items from the blood, albeit incomplete and inefficient, may perhaps permit those sufferers time to regenerate broken tubules and regain renal functionality. After a dis­ appointing prior adventure in survival, better sophisti­ cation and broader perform sophisticated the dialysis abilities and diminished mortality. It additionally grew to become obvious that lengthy classes of help have been attainable and profitable makes an attempt have been then made in using this know-how in sufferers with continual renal failure. those early younger sufferers have been a really choose staff who possessed merely renal disorder and no different systemic involvement. still, they proven a 12 months survival of in basic terms 55-64%. There are shortly over 80,000 sufferers on dialytic help within the usa and over 250,000 sufferers all over the world depending on synthetic change­ ment. Mortality data range yet regardless of a 20-30% systemic sickness involvement and a 5th decade typical age within the North American event, the single yr survival has risen to it sounds as if 90%.

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The properties of the membrane depend to a great the kinetics of the precipitation, extent on which can be controlled, albeit in a semiempirical fashion (2). 45 M. Lysaght and D. OF LENGTH ,m RADIUS microns " 06 2500 4800 13 20 100 100 11 17 +iJJJlLiJt ! L! J..! L 1 !.. os 4JOO 19 100 15 ~1 "14 "'" 9000 06 6200 • AREA MEMBRANE MATERIAL MANUFACTURER {©{~ AMICON CORPORATION LEXINGTON, MAUSA FIBERS PRIMING VOLUME ,m '83 10 06. " '77 " POLYSULfONE ULTRAFILTtRCS ASAHI MEOICAl CO, LTD TOoo,JAPAN POLYACAYLONI"TRILE FRESENIUSAG AV-

MEMBRANES Figure 1 is a scanning electron micrograph that shows the unique structure of the membranes employed in hemofiltration. Two distinct regions are visible: the consolidated layer surrounding the fiber lumen, strate, of and a a and the sub- broad microporous region comprising the remainder the fiber wall. contains retain skin, plasma The skin is less than one micron extremely small pores of a proteins size while passing urea and thick suitable other to low- molecular-weight solutes. This skin region determines the transport properties of the membrane; the substrate simply provides mechanical strength and support.

52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 41 Continuous arteriovenous Geronemus R, Schneider N: hemodialysis: A new modality for treatment of acute renal failure. Trans Am Soc Artif Intern Organs 30:610, 1984. Ronco C, Brendo1an A, Bragantini L, et al: Arteriovenous hemodiafiltration combined with continuous arteriovenous hemofiltration (Abstract) • ASAIO abstracts 14:36, 1985. Henderson LW, Beans E: Successful production of sterile pyrogen-free electrolyte solution by ultrafiltration. Kid lnt 14:522, 1978.

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