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Published in: Journal of Nephrology 1/2019

01-02-2019 | Technical Note

Overcoming glucose delivery by on-line hemodiafiltration: a feasible chimera for diabetics on dialysis

Authors: Marco Marano, Fabrizio Fanelli

Published in: Journal of Nephrology | Issue 1/2019

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Abstract

The increasing number of patients with diabetes undergoing renal replacement therapy has raised interest in the issue of glucose delivery with the substitution fluid—over 20 g per session. The ideal situation would be to have a glucose-containing bath to avoid glycemic disarrays and a glucose-free substitution fluid. But this seems a chimera because the substitution fluid is nothing else than an ultrapure dialysis bath. In this technical note, we present a cheap solution to realize the desired mix, using a commercially available glucose-free dialysate and adding glucose in the inlet dialysate compartment of the dialyzer by means of a common pump and a unique handmade T-tube. Our in vitro experiments showed glucose levels in the dialysate (mean ± SD, mg/dl): 99.7 ± 4.6 at baseline, 100.7 ± 7.3 at mid-session and 100.7 ± 2.1 at the end of dialysis, whereas measurements in the substitution fluid always gave a “low” output (p < 0.0001). Similar results were obtained in single 1- and 4-h in vivo experiments carried out in a non-diabetic overweight hemodialysis patient. Our simple, yet unequivocal, results lay the foundation for assembling a hemodialysis machine equipped with an infusion pump to modify the on-line substitution fluid without affecting the dialysate. This would overcome the ethical issue of delivering glucose intravenously in certain groups of patients.
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Metadata
Title
Overcoming glucose delivery by on-line hemodiafiltration: a feasible chimera for diabetics on dialysis
Authors
Marco Marano
Fabrizio Fanelli
Publication date
01-02-2019
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 1/2019
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-018-0503-5

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