ArtiJicial Organs 12(3);219, Raven Press, Ltd., New York 0 1988 International Society for Artificial Organs

Innovations in Blood Purification: Substantive or Cosmetic?

Paul E. Teschan

Departments of Medicine and Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, U.S.A.

This panel reported some of the active research work by industrial concerns that is focused on and responsive to contemporary issues that are impor- tant to nephrologists who treat patients with end- stage renal disease (ESRD), thus helping to trans- late theoretical possibilities into practical realities.

An overview of goals and some constraints was provided by Dr. Lebedo (Gambro) who defined “high-tech” or “advanced dialysis” as the “best treatment for the patient according to the latest findings” in terms of the combined effects of bio- compatible dialyzers, high blood flows, short treat- ment times, maintained KtIV = 1, erythropoietin- reversed anemia, high water quality, etc., recogniz- ing also the increasing incidence of cardiovascular and other diseases and long term dialysis complka- tions in the aging ESRD population.

Received December 1987. Address correspondence and reprint requests to Dr. P. E. Te-

schan at Department of Medicine, Vanderbilt University, Nash- ville, TN 37232, U S A .

This summary of trade panel 1 was presented at the VIth World Congress of the International Society for Artificial Organs and the XIVth Congress of the European Society for Artificial Organs.

Drs. von Sengbusch (Enka) and Krick (Frese- nius) addressed biocompatibility in terms of com- plement activation, increased release of tumor ne- crosis factor, interleukin 1, beta-2-microglobulin generation and concurrent removal by more perme- able membranes versus the spuriously elevated concentrations that are induced by concurrent ul- trafiltration. Relief of symptomatic carpal tunnel syndrome was linked by inference if not by clear evidence to enhanced beta-2-microglobulin remov- al. Sodium modeling, bicarbonate dialysate, and postdilution biofiltration relative to blood pressure fluctuations and the risks of increased thirst and fluid overloading were addressed variously by Re- inhardt (Fresenius) and Fritsch (Hospal). Finally, Gervasio (Sorin Biomedica) recommended a two- chamber unit, separate for filtration (volume con- trol) and for dialysis (maximal solute transport), noting that the convective solute removal is re- duced when solute concentrations fall as the result of diffusive transport in the same dialysis/filtration unit. The improved solute removal of the two- chamber unit promises shortened dialysis times, presumably at some increase in cost per treatment.

Thus, convergence of industry-based research and clinical problems was evident and encouraging.

219