Journal of Biomedical Engineering Research (대한의용생체공학회:의공학회지)

The Korean Society of Medical and Biological Engineering (대한의용생체공학회)
권호 표지

The Effect of Pulsatile Flow on Ultrafiltration In-Vitro Study and Comparison with Roller Pump

  • Lee K. (Interdisciplinary Program in Medical and Biomedical Engineering Major, Seoul National University, Institute of Medical Engineering, Medical Research Center, Seoul National University, Cancer Research Center, Seoul National University Hospital, Korea Artificial Organ Center, Korea University) ;
  • Jeong J. H. (Interdisciplinary Program in Medical and Biomedical Engineering Major, Seoul National University, Institute of Medical Engineering, Medical Research Center, Seoul National University, Cancer Research Center, Seoul National University Hospital, Korea Artificial Organ Center, Korea University) ;
  • Mun C. H. (Interdisciplinary Program in Medical and Biomedical Engineering Major, Seoul National University, Institute of Medical Engineering, Medical Research Center, Seoul National University, Cancer Research Center, Seoul National University Hospital, Korea Artificial Organ Center, Korea University) ;
  • Lee J. C. (Interdisciplinary Program in Medical and Biomedical Engineering Major, Seoul National University, Institute of Medical Engineering, Medical Research Center, Seoul National University, Cancer Research Center, Seoul National University Hospital, Korea Artificial Organ Center, Korea University) ;
  • Min B. G. (Department of Biomedical Engineering, College of Medicine, Seoul National University, Institute of Medical Engineering, Medical Research Center, Seoul National University, Cancer Research Center, Seoul National University Hospital, Korea Artificial Organ Center, Korea University)
  • Published : 2005.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Blood pulsation has been reported to have an advantageous effect on extracorporeal blood circulation. However, the study of pulsatile blood flow in renal replacement therapy is very limited. The in-vitro experimental results of pulsatile blood flow on ultrafiltration, when compared with the conventional roller pump, are described in this paper. Methods: Blood flow rate (QB) and transmembrane pressure (TMP) were considered as regulating factors that have an influence on ultrafiltration. Experiments were performed under the condition of equal TMP and OB in both pulsatile and roller pump groups, Several kinds of hollow fiber dialyzers were tested using distilled water containing chemicals as a blood substitute. Mean TMP (mTMP) varied from 10 to 90mmHg while the QB was 200ml/min. Results: Ultrafiltration rate (QUF) was found to be linearly proportional to TMP, whereas QB had little influence on QUF. In addition, QUF was higher in the pulsatile group than the roller pump group at the identical TMP. Conclusion: In the controlled test, QUF increased solely as a consequence of blood pulsation, which implies that the pulse frequency represents an additional and important clinical variable during renal replacement therapy.

Keywords

References

  1. K. M. Taylor, G. S. Wright, J. M. Reid, W. H. Bain, P. K. Caves, M. S. Walker, et al., 'Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. II. The effects on adrenal secretion of cortisol', J Thorac Cardiovasc Surg, Vol.75, pp.574-8, 1978
  2. I. S. Chiu, S. H. Chu and C. R. Hung, 'Pulsatile flow during routine cardiopulmonary bypass', J Cardiovasc Surg, Vol.25, pp.530-6, 1984
  3. H. Matsuda, H. Hirose, S. Nakano, R. Shirakura, M. Ohtani, M. Kaneko, et al., 'Results of open heart surgery in patients with impaired renal function as creatinine clearance below 30 ml/min. The effects of pulsatile perfusion', J Cardiovasc Surg, Vol.27, pp.595-9, 1986
  4. F. Dapper, H. Neppl, G. Wozniak, I. Strube, B. Zickmann, F. W. Hehrlein, et al., 'Effects of pulsatile and nonpulsatile perfusion mode during extracorporeal circulation-${\alpha}$ comparative clinical study', Thorac Cardiovasc Surg, Vol.40, pp.345-51, 1992 https://doi.org/10.1055/s-2007-1020178
  5. A. Undar, N. Henderson, G. B. Thurston, T. Masai, E. A. Beyer, O. H. Frazier, et al., 'The effects of pulsatile versus non pulsatile perfusion on blood viscoelasticity before and after deep hypothermic circulatory arrest in a neonatal piglet model', Artif Organs, Vol.23, pp.717-21, 1999 https://doi.org/10.1046/j.1525-1594.1999.06408.x
  6. K. Nakata, M. Shiono, Y. Orime, M. Hata, A. Sezai, T. Saitoh, et al., 'Effect of pulsatile and nonpulsatile assist on heart and kidney microcirculation with cardioqenic shock', Artif Organs, Vol.20, pp.681-4, 1996 https://doi.org/10.1111/j.1525-1594.1996.tb04502.x
  7. A. Sezai, M. Shiono, Y. Orime, K. Nakata, M. Hata, H. Yamada, et al., 'Renal circulation and cellular metabolism during left ventricular assisted circulation: comparison study of pulsatile and non pulsatile assists', Artif Organs, Vol.21, pp.830-5, 1997 https://doi.org/10.1111/j.1525-1594.1997.tb03752.x
  8. A. Sezai, M. Shiono, Y. Orime, K. Nakata, M. Hata, M. Iida, et al., 'Microcirculation of kidney and skin during left ventricular assisted circulation--comparative studies of pulsatile and nonpulsatile assists', Jpn J Thorac Cardiovasc Surg, Vol.46, pp.1239-46, 1998 https://doi.org/10.1007/BF03217910
  9. Y. Orime, M. Shiono, H. Hata, S. Vagi, S. Tsukamoto, H. Okumura, et al., 'Cytokine and endothelial damage in pulsatile and nonpulsatile cardiopulmonary bypass', Artif Organs, Vol.23, pp.508-12, 1999 https://doi.org/10.1046/j.1525-1594.1999.06392.x
  10. J. T. Daugirdas and J. C. Van Stone, 'Physiologic principles and urea kinetic modeling. In: Daugirdas JT, Blake PG, Ing TS, eds. Handbook of dialysis', Lippincott Williams & Wilkins, pp.15-45, 2000
  11. L. W. Henderson, 'Biophysics of ultrafiltration and hemofiltration. In: Jacobs C, Kjellstrand CM, Koch KM, Winchester JF, eds. Replacement of Renal Function By Dialysis', Dordrecht; Boston Kluwer Academic Publishers, pp.113-145, 1996
  12. S. Troyanov, J. Cardinal, D. Geadah, D. Parent, S. Courteau, S. Caron, et al., 'Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters', Nephrol Dial Transplant, Vol.18, pp.961-6, 2003 https://doi.org/10.1093/ndt/gfg055
  13. L. A. Pedrini and V. De Cristofaro, 'On-line mixed hemodiafiltration with a feedback for ultrafiltration control: effect on middle-molecule removal', Kidney Int, Vol.64, pp.1505-13, 2003 https://doi.org/10.1046/j.1523-1755.2003.00240.x
  14. T. M. Runge, J. C. Briceno, M. E. Sheller, C. E. Moritz, L. Sloan, F. O. Bohls, et al., 'Hemodialysis: evidence of enhanced molecular clearance and ultrafiltration volume by using pulsatile flow', Int J Artif Organs, Vol.16, pp.645-52, 1993
  15. M. Ruperez, C. Sanchez, C. Garcia, E. Garcia, J. Lopez-Herce, F. J. Del Canizo, et al., 'Continuous venovenous renal replacement therapy using a pulsatile blood pump', Pediatr Nephrol, Vol.18, pp.29-32, 2003 https://doi.org/10.1007/s00467-002-0991-2
  16. Y. R. Rho, H. Choi, J. C. Lee, S. W. Choi, Y. M. Chung, H. S. Lee, et al., 'Applications of the pulsatile flow versatile ECLS; in vivo studies', Int J Artif Organs, Vol.26, pp.428-35, 2003
  17. A. Undar, O. H. Frazier and C. D. Fraser, Jr., 'Defining pulsatile perfusion: quantification in terms of energy equivalent pressure', Artif Organs, Vol.24, pp.712-6, 1999
  18. A. Undar, T. Masai, S. Q. Yang, H. C. Eichstaedt, M. C. McGarry, W. K. Vaughn, et al., 'Pulsatile perfusion improves regional myocardial blood flow during and after hypothermic cardiopulmonary bypass in a neonatal piglet model', Asaio J, Vol.48, pp.90-5, 2002 https://doi.org/10.1097/00002480-200201000-00017
  19. A. Undar, T. Masai, O. H. Frazier and C. D. Fraser, Jr., 'Pulsatile and non pulsatile flows can be quantified in terms of energy equivalent pressure during cardiopulmonary bypass for direct comparisons', Asaio J, Vol.45, pp.610-4, 1999 https://doi.org/10.1097/00002480-199911000-00017
  20. A. Undar and C. D. Fraser, Jr., 'Influence of pulsatile and non pulsatile left heart bypass on the hormonal circadian rhythm', Asaio J, Vol.47, pp.305-7, 2001 https://doi.org/10.1097/00002480-200105000-00029
  21. A. Undar and C. D. Fraser, Jr., 'The alphabet of research on pulsatile and nonpulsatile (continuous flow) perfusion during chronic support', Artif Organs, Vol.26, pp.812-3; author reply 813-5, 2002 https://doi.org/10.1046/j.1525-1594.2002.00919.x
  22. A. Undar, 'Fundamentals of pulsatile versus nonpulsatile flow during chronic support', Asaio J, Vol.49, pp.139-40, 2003 https://doi.org/10.1097/00002480-200301000-00024
  23. A. Undar, 'Energy equivalent pressure formula is for precise quantification of different perfusion modes', Ann Thorac Surg, Vol.76, pp.1777-8, 2003
  24. A. Undar, 'Controversy over the benefits of pulsatile perfusion', Int J Artif Organs, Vol.27, pp.509-10; author reply 511-2, 2004
  25. B. Krause, M. Storr, T. Ertl, R. Buck, H. Hildwein, R. Deppisch, et al., 'Polymetric Membranes for Medical applications', Chemie Ingenieur Technik, Vol. 75, pp.1725-1732, 2003 https://doi.org/10.1002/cite.200306149