**5. References**


<sup>2</sup> Body Temperature Monitor, Body Volume Monitor, and Online Clearance Monitor

As these novel HDF strategies evolved, remarkable improvements have been achieved in dialysis technologies. Modern dialysis machines offer HDF and HD as default therapies, and are also equipped with outstanding monitoring facilities not only for patients (BTM, BVM, OCM2), but also for treatments (fail-safe design and high-precision balancing) (Polaschegg, 2010). In particular, advances in water treatment allow ultrapure replacement fluid to be prepared in real time. These technical advancements are certainly lowering the barriers to

Internal HDF 1 - + proximal part

Double HDF 2 flow restrictor ++ hemodialyzer

pump

filtrate pump <sup>+</sup>

§ Total filtration volume per session (4 hours, L); +, low (<20L); ++, moderate (20-40L); +++ high (>60L) Table 3. Infusion-free HDF modalities. (HFR, hemofiltrate reinfusion; TFV, total filtration

Therefore, in addition to convective clearances, we believe the PPPHD system should be equipped by features that simplify overall treatment and enable dialysis to be performed in outside clinics, because this unit allows simple and efficient operation. Future development targets designed to accomplish these features include; greater user friendliness (that is, intuitive control and operation, fail-safe operations and treatment automation), readily available sterile dialysate, accessible maintenance, and a miniaturized unit that is both light and portable (without compromising depurative efficiency). A dialysis unit equipped with these features may also provide treatment alternatives beyond the current thrice weekly 4-h

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components TFV § Filtration Reinfusion

+++

of dialyzer BF

(upstream) BF

(upstream) FR

membrane BF

membrane BF

hemofilter

whole

whole

higher convective HDF therapies.

**5. References** 

0301-0430

6040(e)

Modality Filter(s) Additional

HFR 2 adsorbent column,

PP HDF 1 double-chamber

Pulse PP HD 1 - +++

volume; PP, push/pull; FR, filtrate regeneration; BF, backfiltration)

practice, and perhaps allow even daily dialysis for ESRD patients.

2 Body Temperature Monitor, Body Volume Monitor, and Online Clearance Monitor


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**7** 

*Estonia* 

**Optical Dialysis Adequacy Monitoring:** 

**UV-Absorbance Studied by HPLC** 

Merike Luman3 and Ivo Fridolin1

Kai Lauri1, Jürgen Arund1, Jana Holmar1, Risto Tanner1,2,

*3Department of Dialysis and Nephrology, North Estonia Medical Centre,* 

**Small Uremic Toxins and Contribution to** 

*1Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, 2Laboratory of Chemical Physics, National Institute of Chemical Physics and Biophysics,* 

Uremic toxicity is described as a clinical picture resulting from impaired renal elimination and accumulation of uremic toxins in the body. Uremic toxins can be classified as small water-soluble compounds, middle molecules and protein-bound compounds. A long list of possible uremic toxins has been identified in recent decades. Under normal conditions these compounds are excreted by healthy kidneys. If kidney function fails, waste products accumulate in the blood and in the body. Dialysis treatment replaces some kidney functions through diffusion (waste removal) and ultrafiltration of fluid across a semi-permeable membrane, which is a thin layer of material with holes or pores of various sizes. A deeper understanding about the accumulation and removal mechanisms of the retained solutes during care of renal insufficiency is needed (Eloot, 2008; Eloot, 2007). This understanding would be especially informative with respect to predicting the mode of action of uremic toxins and their specific role in complications associated with dialysis or ureamia, but also with cardiovascular disease and inflammation (Vanholder, et al., 2008; Vanholder, 2003). The methods contributing to the identification, characterisation and evaluation of uremic retention solutes could be assessed in order to ensure dialysis adequacy and quality (Vanholder, 2005). The choice of the correct concentration of potential uremic toxins is still an unresolved issue (Vanholder, 2003). In everyday clinical practice, uremic components are not examined due to the measurement of most uremic components using the available laboratory methods being difficult and complex. A number of standard biochemical techniques are used in clinical laboratories, but there is no universal methodology. In addition, some chromatographic methods have been developed which explore uremic

Dialysis efficiency and quality has been an important issue accompanied by optimisation and the best outcome of the treatment of chronic end stage renal disease for many years. In connection to this, online monitoring of the dialysis dose has been suggested as an effective way of improving treatment quality. The concept of online monitoring is based on the realtime measurement of chemical signals coming from the patient. This enables the early

**1. Introduction** 

retention solutes.

