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K @ Normal ]a c"A@"Default Paragraph Font,/!     &,/C5S&(*9-// !"# ,d)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd*C:\Biocompatible\bc-bic drugi asopisi.doc@OKIPAGE 4wLPT1:VHSD4W12OKIPAGE 4wOKIPAGE 4w Dl OKIPAGE 4wOKIPAGE 4w Dl OKIPAGE 4w  JTimes New Roman Symbol &ArialTimes New Roman CE"1h3[&Q8Jw$N!\FBiocompatible membranes in acute renal failure (ARF), hope or illusionddrge data source!Checks for errors in a mail merge4Collects the results of the mail merge in a document P$Q(\8= P+;S PA(H T@D uT PA(P$ WqT PA(:= P@p$# P= PQ(AhHf+fH$fL3Root EntryNOPRS]bw FV e0WordDocumentakFfh+N#CompObj$$$$B%C%%%%&&'((((j*SummaryInformationr r r r (r r r {r  8,1/2345679:;<=>?@ABCDEFGHIJKLMNO ܥhW e/8N,HpHppHpHpHpHpHHHHHHH HFH(MJBIBIBIBIBIBIBIBI2K4K4K4K%YK LLrMXMnLQpHBI BIBIBIBILdIpHpHBIBIDocumentSummaryInformation8 Root EntryNOPRS]bw FVn e0WordDocumentakFfhN#CompObj$$$$B%C%%%%&&'((((j*SummaryInformationr r r r (r r r {r   !"#$%&',/57Microsoft Word for Windows 95@>a.@В@.]U<@dx$՜.+,0HP\dl t| dlN GBiocompatible membranes in acute renal failure (ARF), hope or illusionࡱ>  FMicrosoft Word Document MSWordDocWord.Document.69qࡱOh+'0 0 LX    GBiocompatible membranes in acute renal failure (ARF), hope or illusiondNormalVladimir GaparovicdIdIdIBI"pHBIpHBI2K eH H6pHpHpHpHBI2KdIdIBIOCOMPATIBLE MEMBRANES IN ACUTE RENAL FAILURE (arf), HOPE OR ILLUSION? Vladimir Gaparovi1, Kristina Djakovi2, Hrvoje Gaparovi2, Marijan Merkler1, Dragutin Ivanovi1, Mate Majerovi3, Ivan Jeli3 1Department of Emergency and Intensive Care Medicine, Internal Clinic, Rebro, Zagreb, Croatia 2Medical School, Zagreb, Croatia 3Departmen of Surgery, Surgery Clinic, Rebro, Zagreb, Croatia key words: biocompatible membranes, acute renal failure, outcome Introduction: The technological progress in medicine, as in other categories of science, brings new discoveries, but sometimes disappointments, as well. There is a constant need for objective evaluation of new techniques. One is always faced with the question whether the new idea is truly beneficial, or simply more expensive. Acute renal failure remains associated with high mortality rates. Different attempts to increase survival have not been successful (1,2,3). The use of biocompatible polyacrylonitrile membrane gave promising, but controversial results (4,5,6,7). This paper compares the results of treatment of patients with ARF by hemodialysis using polysulfone (BC) and modified cellulose acetate membrane (BIC). Patients and methods: During a one year period we have divided all dialysed patients with ARF into two groups. Group 1 was dialysed on modified cellulose acetate membrane (BIC), Group 2 on polysulfone membrane (BC). The aim of our study was to evaluate the benefits of biocompatible membranes in the treatment of patients with ARF. Out of a group of 49 patients with ARF (surgical and medical group, 34 males and 15 females, average age 61.73+/-12.99 years) scheduled for haemodialysis, polysulfone membrane was used in 24 patients (group BC), and cellulose acetate membrane in 23 patients (group BIC). Two patients (Nr 4 and Nr 35) was excluded from the study because of missing data, and other used membrane. On inclusion in the study, there were no significant differences in the severity of the underlying disease between the observed groups. All patients were dialysed without heparin on the modified cellulose acetate (group BIC) membrane or the polysulfone membrane (group BC). APACHE II0,1,2,3,7,14,21 score were registered at the introduction into the study, and 1,2,3,7,14 and 21 days after onset of haemodialysis. Haemodialysis was performed on the modified cellulose acetate membrane (Group 1), or on the polysulphone membrane (Group 2). Our statistical analysis included the t-test for independent samples for the APACHE II Scores, as well as the (2 test and the Fisher exact test for the outcome with respect to the type of membrane used. Results: The results are presented in Table 1. APACHE II Scores upon inclusion into the study are shown in Table 2 and 3. The variances in the outcome with respect to different hemodialysis membranes are presented in Table 4 and 5. The mean number of haemodialysis required for recovery of renal function in surviving patients with ARF is shown in Table 6. Table 2. APACHE II SCORE AT INCLUSION INTO THE STUDY, AND 24, 48 AND 72 HOURS THERAFTER (MEAN VALUES +/- SD) 02448727 daysGROUP 134.65+/-11.22 (23)32.77+/-11.86 (22)30.55 +/-12.19 (20)29.83+/-12.13 (18)27.23 +/-10.70 (13)GROUP 231.04+/-9.50 (24)29.54+/-9.76 (22)29.25 +/-10.96 (20)28.65+/-12.67 (20)nation for this may be in the decreased activation of complement and its fractions, as well as in the lesser influence of the biocompatible membranes on the patient's granulocytes (13). One must stress that ARF is usually a component of multiple organ failure (14). Therefore, the management of ARF is only a part of the treatment and our observation required further confirmation as well as other also recommended(15).The control over the basic etiologic moment remains of paramount importance. The mortality rate of ARF remains high. Patients die in the clinical syndrome of MOF, despite the utilisation of artificial ventilation, vasoactive therapy and hemodialysis. The high mortality rates of patients dialyzed on both the biocompatible and the bioincompatible membrane is secondary to protracted sepsis caused by resistant micro-organisms (staphylococci, pseudomonas, acinetobacter) which usually progresses to death. In the domain of ARF management a number of issues remain unresolved; i.e. the role of intermittent procedures in comparison to continuous ones, hemodialysis versus peritoneal dialysis, etc. Our work points to the significance of biocompatible membranes in the treatment of ARF. The restitution of the kidney function does not guarantee patient recovery, as we have observed in some our patients. Today we find that a patient may die with ARF, but should not die from it. We believe that the institution of biocompatible membranes into the treatment of patients with ARF has improved their chances for a favourable outcome. The use of biocompatible polysulfone membrane in acute renal failure, along with other measures, represents an advancement in patient management. Literature: 1. H R Brady, G.G. Singe. Acute renal failure, The Lancet, 346;1533-1540, 1995. 2. Schiffl H, SM Lang, A. Koenig, T. Strasser, MC Haider, E. Held. Biocompatible membranes in acute renal failure: prospective case-controlled study. Lancet 344:570-2. 1994. 3. Bonomini V, L. Coli, M.P, Scolari, S. Stefoni. Structure of Dialysis Membranes and Long-Term Clinical Outcome. Am J Nephrol 15:455-462, 1995. 4. Schifl H. T. Sitter, S. Lang. Hemodialysis in acute Renal Failure: Which Type of Dialysis Membrane? Year book of Intensive Care Medicine, Brusseles, 758-763,l995. 5.Hakim R M Wingard R L, Parker R.A.: Effect of the dialysis membrane in the treatment of patients with acute renal failure. N Engl J Med, 17, 1338-1341, 1994. 6. Turney J H.Acute renal failure-some progress?, N Eng J Med, 331:1372-1374,1994 7.Kurtal H D von Herrath, Schaefer K: Is the Choice of Membrane Important for Patients with Acute Renal Failure Requiring Hemodialysis. Art Org, Boston, Vol 19, No.5 391-394, 1995. 8. Kaplan A, Paganini P, Bosch P. Effect of the dialysis membrane in acute renal failure. N Engl. J Med. 332:961-962,1995. 9. Corwin H.L, Bonventre J.V. Acute renal failure in the intensive care unit. Part 2. Intensive Care Med 14:86-96,1988. 10. Husedinovi I, . Sutli, B. Bioina, I. Rude. Inotropic Agents in the Treatment of Postoperative Low Cardiac Output Syndrome. Acta Med Croat 49:201-205, 1995. 11. V. Gaparovi, R. Radoni, M. Gjurain, D. Ivanovi, M. Kvarantan, J. Husar: Acute renal failure in the war in Croatia, Nephrol Dialys Transpl, 10:1261, 1995. Gaparovi V, R. Radoni, M. Gjurain, H. Gaparovi, D. Ivanovi, M. Merkler, I. Jeli. Aetiology and outcome of acute renal failure secondary to war related trauma and infectious disease in Croatia. Nephrology, 3:155-158, l997. 13. International Co-operative Biocompatibility Study(I.C.B.S.), Nephrol Dial Transplant 8(S2), 1-42, 1993 14. Gaparovi V, K. Ilekovi, M. Gjurain, D. Ivanovi, R. Radoni, M. Merkler, Z. Pil. Acute renal failure-a part of the syndrome of multiple organ failure or an independent event? Neurol. Croat. 45, (S) l:67-71,1996. 15. Jacobs C. Membrane biocompatibility in the treatment of acute renal failure:what is the evidence in 1996?, Nephrol Dialys Transpl, 12:38-42,1997 .AwereinsufficientarButtonMacro$ WW2_InsertAtEndOfDocJRS]^qr-.NO W ^ -/C-/016LMR`fhs&&////u]b]c[]c]c[]cU]bbJchUVUhU[G7IJ-N V W A./0258;BCr r r r r r r r r r r r r r r r r r r r r r r r r pppppp$YYYYII6: 48. !CK^q #&),-./8ppppppppppppppppppppppppr r r r r ppppp$YYYYII6:' 0DEM_r/012345pppppppppppppppppppppppppr r r r r 8L $YYYYII6:&567AFZ[cehkltwz}~LMNOPQRS 8L  8L  8L  8L  8L  8L  r r r 8L  $YYYYII v (S]bvw_`ak8L  8L  8L  8L  8L  8L  r r r r r  $YYYYII v %Ffh#&&&&&&           r r r r r k# r  r r r r r r  48. $YYYYII &!&''''B(C(((r r r r |r ^r ^r >r  48.  48.  48. ! 48. 3   48.  48. (())))***r r r r r gr r Fr    48 .  48.  48.  48.  48. r 48. *++++>,?,,,,9-r r r r r r r r r ]r ! W 48 .  48.   48 . r 48.   48. 9---<.=./////r r r r dr r Cr r Cr    48 .  48.  48 .   48.  48. < 48. ///r r  48.  48 . K @ Normal ]a c"A@"Default Paragraph Font,/!     &, ,r r {/C5S&(*9-// !"#TXZ],d)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd)C:\Biocompatible\Nephrology recenzija.docd*C:\Biocompatible\bc-bic drugi asopisi.docVladimir Gaparovic*C:\Biocompatible\bc-bic drugi asopisi.doc@OKIPAGE 4wLPT1:VHSD4W12OKIPAGE 4wOKIPAGE 4w Dl OKIPAGE 4wOKIPAGE 4w Dl OKIPAGE 4wL#GS,,@A/A" A/@M @/JTimes New Roman Symbol &ArialTimes New Roman CE"1hTfQ9Lx$N!nFBiocompatible membranes in acute renal failure (ARF), hope or illusiondVladimir Gaparovic!\FBiocompatible membranes in acute renal failure (ARF), hope or illusionddviestrukom zatajenju organa u petgodinjem razdoblju. Febrilne komplikacije u ranom postpartalnom razdoblju mahom su uvjetovane uroinfekcijama, no ponekad kao i febrilna stanja prije samog poroda posljedica su patologije trudnoe i babinja uslijed ega zbog razvoja sepse nerijetko dolazi do razvoja viestrukog zatajenja organa. Br. 17. Z. Durakovi