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      One for All – A Multi-Use Dialysis System for Effective Treatment of Severe Thallium Intoxication

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          Abstract

          Guided by the idea of providing a stable electrolyte composition of the dialysate, the late Bernd Tersteegen designed a machine ingeniously combining the advantages of a closed tank hemodialysis system with the efficacy and bacteriological safety of a single-pass system. Several thousand dialysis sessions have been performed with this system in the chronic hemodialysis population. Recently, highly efficient (i.e. high volume) dialysis systems have been successfully introduced for the treatment of critically ill patients in the intensive care unit as extended dialysis. Furthermore, they can also be a safer, more effective and less costly alternative to traditional extracorporeal techniques in the treatment of severe intoxication. In a case-based approach, we review the increasing use of such a system.

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          Efficiency of high-flux hemodialysis in the treatment of valproic acid intoxication

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            Experience with the GENIUS ® Hemodialysis System

            The late B. Tersteegen devised a clever way to combine the advantages of a closed tank hemodialysis system with the efficacy and bacteriological safety of a single-pass system. The Teerstegen equipment is now marketed as the GENIUS ® hemodialysis system. For each treatment, fresh dialysis fluid is prepared according to the physician’s prescription by mixing sterile ingredients (electrolytes and glucose) with preheated ultrapure water. The total amount of dialysis fluid is put into a thermally insulated glass tank (volume 75 l) of the hemodialysis machine. The filling and emptying process is completely automated. An UV radiator is used for desinfection. Due to a consequent hygienic concept, the system operates with an almost sterile and usually pyrogen-free dialysis fluid. During treatment, fresh dialysis fluid is taken from the top of the system, and the used dialysate is returned to the bottom. There is a sharp interface between the fresh and used dialysis fluids because of a small difference in temperature (1°C). True volumetric ultrafiltration control is simply achieved; ultrafiltration rates between 100 and 1,000 ml/h can be selected as considered appropriate by the physician. Microbiological examination: We cultured more than 2,000 dialysate specimens to examine bacterial contamination, and found either no bacterial growth at all (in the vast majority of the cases) or less than 1 CFU/ml dialysate. Clinical experience: We have utilized the GENIUS ® system since 1994. Meanwhile, more than 40,000 treatments have been performed in our center. Biochemical results of the first 19 stable hemodialysis patients (mean age 66 years, range 45–82), who had been treated with conventional hemodialysis systems for at least 6 months (range 6–157) before changing to GENIUS ® , were evaluated. We observed an increase of mean serum albumin concentration from 4.1 (±0.4 SD) g/dl to 4.8 (±0.3) g/dl (p ® system in comparison to conventional hemodialysis machines. Conclusion: The GENIUS ® hemodialysis system permits an individualized therapy of high quality; most patients prefer this system to conventional hemodialysis machines. Serum albumin levels increased significantly from normal to high normal values after change from conventional hemodialysis machines to GENIUS ® , probably due to less catabolic stress during the hemodialysis sessions.
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              Author and article information

              Journal
              KBR
              Kidney Blood Press Res
              10.1159/issn.1420-4096
              Kidney and Blood Pressure Research
              S. Karger AG
              1420-4096
              1423-0143
              2004
              April 2004
              12 August 2004
              : 27
              : 3
              : 197-199
              Affiliations
              Division of Nephrology, Medical School Hanover, Hannover, Germany
              Article
              79811 Kidney Blood Press Res 2004;27:197–199
              10.1159/000079811
              15256818
              © 2004 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 1, References: 10, Pages: 3
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/79811
              Categories
              NephroPharmacology 7 Meeting

              Cardiovascular Medicine, Nephrology

              Intensive care unit, Extended hemodialysis, Intoxication

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