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In Vitro Comparative Assessment of Mechanical Blood Damage Induced by Different Hemodialysis Treatments
Author(s) -
Sakota Ranko,
Lodi Carlo Alberto,
Sconziano Sara Antonia,
Beck Werner,
Bosch Juan P.
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12499
Subject(s) - hemolysis , hemodialysis , dialysis , medicine , venous blood , hemoglobin , extracorporeal , in vitro , surgery , urology , anesthesia , chemistry , biochemistry
Gradual deterioration of red blood cells ( RBCs ) due to mechanical stress (chronic hemolysis) is unavoidable during treatments that involve extracorporeal blood circulation, such as hemodialysis ( HD ). This effect is generally undetectable and does not generate any acute symptoms, but it leads to an increase in plasma free hemoglobin ( fHb ). There are no absolute safety levels for fHb increase, indicating the need for an empirical evaluation using comparative testing. The increase in fHb levels was investigated in vitro by applying double‐needle double‐pump HD ( HD‐DNDP ), a new modality in which arterial and venous pumps both run continuously. fHb was measured during typical and worst‐case simulated dialysis treatments (double‐needle single‐pump HD [ HD‐DNSP ], hemodiafiltration [ HDF‐DN ], single‐needle double‐pump HD [ HD‐SNDP ], and HD‐DNDP ) performed in vitro using bovine blood for 4 h. Hemolysis‐related indices ( fHb% ; index of hemolysis, IH ; and normalized IH ) were calculated and used for comparison. The increase in fHb during either HDF‐DN or HD‐SNDP with A rtis and AK 200 dialysis machines was similar, while the fHb at the maximum real blood flow rate ( Qb real ) at the completion of the HD‐DNDP treatment on A rtis was higher than that for HD‐DNSP using a P hoenix dialysis machine ( fHb % = 1.24 ± 0.13 and 0.92 ± 0.12 for the A rtis machine with HD‐DNDP at Qb real = 450 mL/min and P hoenix with HD‐DNSP at Qb real = 500 mL/min, respectively). However, the fHb levels increased linearly, and no steep changes were observed. The increases observed during HD‐DNDP were the same order of magnitude as those for widely used bloodlines and treatment modes for delivering dialysis treatments. The observed results matched literature findings, and thus the measured fHb trends are not predicted to have clinical side effects. HD‐DNDP treatment with A rtis does not merit any additional concern regarding mechanical stress to RBCs compared with that observed for routinely used dialysis treatments, bloodlines and machines. Although the in vitro measurement of the fHb increase in bovine blood does not allow a prediction of the absolute level of blood mechanical damage or the possible effects in humans, such measurements are valuable for assessing hemolytic harm by performing tests comparing the proposed treatment with existing devices.