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\b\f4 \sbasedon0\snext0 heading 2;}{\*\cs10 \additive Default Paragraph Font;}}{\info{\title BIOCOMPATIBLE MEMBRANES - A CONTROVERSY WORTHY OF }{\author Unknown}{\operator Vladimir Ga\'9aparovic}{\creatim\yr1998\mo5\dy1\hr17\min29}
{\revtim\yr1998\mo5\dy4\hr16\min54}{\printim\yr1998\mo5\dy4\hr13\min57}{\version2}{\edmins2}{\nofpages6}{\nofwords1885}{\nofchars10745}{\*\company Doma}{\vern57431}}\widowctrl\ftnbj\aenddoc\hyphcaps0\formshade \fet0\sectd 
\linex0\headery709\footery709\colsx709\endnhere {\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl4
\pnlcltr\pnstart1\pnindent720\pnhang{\pntxta )}}{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}
{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain \s2\fi720\keepn\widctlpar \b\f4 BIOCOMPATIBLE MEMBRANES - A CONTROVERSY DESERVING 

\par \pard\plain \fi720\li2880\widctlpar \f4\fs20 {\b\fs24 ATTENTION
\par }\pard \widctlpar {\b\fs24 
\par 
\par 
\par 
\par }\pard \qj\widctlpar {\f17 Vladimir Ga\'9aparovi\'e6 MD}{\super 1}{\f17 , PhD, Kristina \'d0akovi\'e6 MD}{\super 2}{\f17 , Hrvoje Ga\'9aparovi\'e6 MD}{\super 2}, Marijan Merkler MD{\super 1}{\f17 , Radovan Radoni\'e6 MD}{\super 1}{\f17 ,  Dragutin Ivanovi
\'e6 MD}{\super 1}, Josip HusarMD{\super 3}{\f17 , Ivan Jeli\'e6 MD, PhD}{\super 3}{\b\fs24 
\par }\pard \qj\fi720\li2880\widctlpar {\b\fs24 
\par }\pard \qj\widctlpar {\super 1}Department of Emergency and Intensive Care Medicine, Department of Internal medicine, Rebro, Zagreb, Croatia
\par {\super 2}Medical School, University of Zagreb, Croatia
\par {\super 3}Department of Surgery, Rebro, Zagreb, Croatia
\par 
\par key words: biocompatible membranes, acute renal failure, outcome
\par 
\par 
\par {\b\caps\fs24 Abstract}{\fs24 
: The persistently high mortality rate of patients with acute renal failure (ARF) calls for intensive exploration of different modes of management. The institution of biocompatible membranes into the treatment of ARF resulted in controversial opinions reg
arding its benefit. Our study showed that the outcome of patients in whom ARF followed a surgical procedure was better in the group whi
ch underwent hemodialysis on the polysulfone membrane (BC group) when compared to the group in which the modified cellulose acetate membrane (BIC group) was used (p=0,0223 Chi square test). We have also found that the renal function in the BC group  recov
er sooner, requiring a fewer number of extracorporeal circulation sessions.  It is important to stress that the BC and BIC group included patients of comparable severity of the underlying disease as is documented by the mean APACHE II scores of each group
. 
\par 
\par }{\b\fs24 INTRODUCTION}{\fs24 
:  Various endeavors to improve the outcome of patients with ARF have not proven to be efficient (1,2,3). Few issues have brought on as much disagreement as did the introduction of biocompatible membranes into the management of the clinical syndrome of AR
F. The results were controversial and inconclusive (4,5,6,7,8). The mentioned procedure is more costly, therefore necessitating that its benefit be carefully assessed. The aim of our study was to evaluate the results of hemodialysis treatment 
of patients with ARF on the polysulfone membrane (BC) in comparison to the standard regimen in which the modified cellulose acetate membrane is used (BIC).
\par 
\par }{\b\fs24 PATIENTS AND METHODS}{\fs24 
: Our investigation of the role of the biocompatible membrane in comparison to the standard modified cellulose acetate membrane was founded upon our results in the last year. A group of 49 patients scheduled for hemodialysis which included both surgical a
nd medical patients, consisting of 34 males and 15 females,  mean age  61,73+/-1
2,99 years, was the basis of our analysis. The above mentioned group of patients was subdivided into two groups with respect to the membrane which was used in the hemodialysis protocol (group BC (24 patients): polysulfone membrane; group BIC (23 patients)
: modified cellulose acetate membrane).
\par Acute renal failure was defined by azotemia (serum creatinine >400 }{\fs24 {\field{\*\fldinst SYMBOL 109 \\f "Symbol" \\s 12}{\fldrslt\f1\fs24}}}{\fs24 
mol/L) with or without oliguria, and by serum potassium levels exceeding 5,5 mmol/L. The dialysis blood flow was 150-20
0 mL/min, and the dialysate flow was 500 mL/min. The duration of a single hemodialysis session was 3-3,5 hours. There was a minimum of 6 dialysis sessions a week. The levels of serum creatinine, urea, sodium and potassium were observed and documented prio
r to as well as following hemodialysis. Certain other biochemical parameters were also noted. Two of our patients (Number 4 and Number 35) were excluded from the study either because the data gathered was insufficient to meet the standards of this study o
r 
due to a different type of hemodialysis membrane. Patients on either membrane were dialyzed without heparin. The biocompatible polysulfone membrane used was the Fresenius F60 membrane, whereas our modified cellulose acetate membrane was the MCA 130 with a
n area of 1,3 m}{\fs24\super 2}{\fs24 . APACHE II Scores were noted at the introduction into the study and 1,2,3,7,14 and 21 days after the commencement of hemodialysis and thus labeled APACHE II}{\fs24\sub  0,1,2,3,7,14,21}{\fs24 
. We have separately analyzed the outcome of patients suffering from
 multiple organ failure (at least two organ systems insufficient, one of which is the renal system) with respect to the type of membrane used in their hemodialysis protocols. Our statistical analysis included the t-test for independent samples for the APA
CHE II Scores, the }{\fs24 {\field{\*\fldinst SYMBOL 99 \\f "Symbol" \\s 12}{\fldrslt\f1\fs24}}}{\fs24\super 2}{\fs24  test and the Fisher test for the patient outcome with regard to the two types of membranes. 
\par 
\par }{\b\fs24 RESULTS:}{\fs24  The difference in the outcome of patients with ARF with respect to different membranes used for hemodialysis may be seen in Table 1.
\par }
\par 
\par {\fs24 Table 1.
\par 
\par  }{\caps\fs24 The most frequently observed disorders leading to the development of ARF }{\fs24 
\par }{\b    
\par }\trowd \trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrdb\brdrw15\brdrcf1 
\clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx1212\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2652\clbrdrt
\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx4092\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx5532\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx6972\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr
\brdrdb\brdrw15\brdrcf1 \cellx8412 \pard \qj\widctlpar\intbl {\caps GROUP\cell DIAGNOSIS\cell APACHE II}{\caps\sub 0}{\caps \cell APACHE II}{\caps\sub 1}{\caps \cell APACHE II}{\caps\sub 7}{\caps \cell OUTCOME\cell }\pard \widctlpar\intbl {\caps \row 
}\trowd \trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrs\brdrw15\brdrcf1 
\clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx1212\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2652\clbrdrt
\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx4092\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx5532\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx6972\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr
\brdrdb\brdrw15\brdrcf1 \cellx8412 \pard \qj\widctlpar\intbl {\fs18 GROUP 1 BIC\cell }{\b 1}(14),{\b 2}(3),{\b 3}(3){\b 4(}2),{\b 7}(1)\cell 34.65+/-11.22\cell 32.77+/-11.86\cell 27.23+/-10.7\cell 5*/23\cell \pard \widctlpar\intbl \row \pard 
\qj\widctlpar\intbl {\fs18 GROUP 2 BC\cell }{\b 1}(16){\b 2}(4){\b 3}(1)
\par {\b 4}(1),{\b 5}(1),{\b 6}(1)\cell 31.04+/-9.5\cell 29.54+/-9.76\cell 29.12+/-11.92\cell 13*/24\cell \pard \widctlpar\intbl \row \trowd \trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 
\trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx1212\clbrdrt
\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2652\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx4092\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx5532\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr
\brdrs\brdrw15\brdrcf1 \cellx6972\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrdb\brdrw15\brdrcf1 \cellx8412 \pard \qj\widctlpar\intbl p\cell \cell {\caps ns\cell ns}\cell {\caps ns}\cell 
0.0223**
\par 0.0355***{\fs18 \cell }\pard \widctlpar\intbl \row \pard \qj\widctlpar \tab \tab \tab \tab \tab \tab \tab \tab *survivors\tab \tab 
\par \pard \qj\li5760\widctlpar **Chi squre test
\par \pard \qj\fi720\li5040\widctlpar ***Fisher exact two tailed test
\par \pard \qj\widctlpar DIAGNOSIS
\par \pard \widctlpar {\b 1}=sepsis following open heart surgery\tab 
\par {\b 2}=sepsis following abdominal surgery 
\par {\b 3}=vasculitis\tab \tab \tab 
\par {\b 4}=sepsis in the medical ICU
\par {\b 5}=leptospirosis
\par {\b 6}=rabdhomiolysis
\par {\b 7}=severe heart failure
\par 
\par \pard \qj\widctlpar {\fs24 
\par }
\par 
\par 
\par 
\par 
\par {\fs24 The mean number of haemodialysis required for recovery of renal function in surviving patients with ARF is presented in Table2.
\par 
\par }
\par {\b Table 2.
\par 
\par  AVERIGE  NUMBER OF HAEMODIALYSIS PROCEDURES REQUIRED FOR RENAL RECOVERY IN SURVIVORS WITH ARF
\par }
\par \trowd \trgaph30\trrh247\trleft-30\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt
\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx1026\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx2262\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrdb\brdrw15\brdrcf1 \cellx5670 \pard \qr\widctlpar\intbl {\caps\f5 \cell }\pard \widctlpar\intbl {\caps\f5 SURVIVORS \cell 
AVERIGE NUMBER OF HD+/- SD UNTIL RENAL RECOVERY \cell }\pard \widctlpar\intbl {\caps\f5 \row }\trowd \trgaph30\trrh247\trleft-30\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr
\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx1026\clbrdrt\brdrs\brdrw15\brdrcf1 
\clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2262\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrdb\brdrw15\brdrcf1 \cellx5670 \pard 
\widctlpar\intbl {\f5 GROUP 1\cell }\pard \qr\widctlpar\intbl {\f5 5\cell 21.2+/-10.42\cell }\pard \widctlpar\intbl {\f5 \row }\pard \widctlpar\intbl {\f5 GROUP 2\cell }\pard \qr\widctlpar\intbl {\f5 13\cell 9,85+/-8,92       \cell }\pard 
\widctlpar\intbl {\f5 \row }\pard \qr\widctlpar\intbl {\f5 \cell \cell \cell }\pard \widctlpar\intbl {\f5 \row }\pard \widctlpar\intbl {\f5 p\cell }\pard \qr\widctlpar\intbl {\f5 0.048316 Chi square\cell \cell }\pard \widctlpar\intbl {\f5 \row }\trowd 
\trgaph30\trrh247\trleft-30\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrs\brdrw15\brdrcf1 
\clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx1026\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2262\clbrdrt
\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrdb\brdrw15\brdrcf1 \cellx5670 \pard \widctlpar\intbl {\f5 \cell }\pard \qr\widctlpar\intbl {\f5 0.019788 Mann Whitney test.\cell \cell }\pard 
\widctlpar\intbl {\f5 \row }\pard \qj\widctlpar {\cf1 
\par 
\par 
\par }{\fs24 The difference in the outcome of patients with ARF and respiratory insufficiency requiring  artificial ventilation  with respect to different membranes used for hemodialysis may be seen in Table 3.
\par 
\par }{\cf1 
\par }{\b\cf1 Table 3.
\par }{\cf1 
\par 
\par }\pard\plain \s1\qj\keepn\widctlpar \f4\cf1 THE OUTCOME OF PATIENTS WITH MOF DEPENDANT  OF THE TYPE OF HEMODIALYSIS MEMBRANE USED
\par \pard\plain \qj\widctlpar \f4\fs20 {\cf1 
\par }\trowd \trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrdb\brdrw15\brdrcf1 
\clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx996\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2124\clbrdrt
\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx3505\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx4393\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx5774\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr
\brdrs\brdrw15\brdrcf1 \cellx7155\clbrdrt\brdrdb\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrdb\brdrw15\brdrcf1 \cellx8415 \pard \qj\widctlpar\intbl {\caps \cell }{\caps\fs16 SURVIVED}{\caps \cell }{
\caps\fs16 SURVIVED+RESPIRATOR**\cell }{\caps DIED\cell }{\caps\fs16 DIED+RESPIRATOR**}{\caps \cell }{\caps\fs16 TOTAL ALIVED}{\caps \cell }{\caps\fs16 TOTAL DIED}{\caps \cell }\pard \widctlpar\intbl {\caps \row }\trowd \trgaph108\trleft-108\trbrdrt
\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb
\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx996\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2124\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl
\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx3505\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx4393\clbrdrt
\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx5774\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx7155\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrs\brdrw15\brdrcf1 \clbrdrr\brdrdb\brdrw15\brdrcf1 \cellx8415 \pard \qj\widctlpar\intbl BIC\cell 3\cell 2\cell 3\cell 13\cell 5\cell 16\cell \pard \widctlpar\intbl \row 
\pard \qj\widctlpar\intbl BC\cell 7\cell 6\cell 1\cell 10\cell 13*\cell 11\cell \pard \widctlpar\intbl \row \trowd \trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15\brdrcf1 \trbrdrl\brdrdb\brdrw15\brdrcf1 \trbrdrb\brdrdb\brdrw15\brdrcf1 \trbrdrr
\brdrdb\brdrw15\brdrcf1 \trbrdrh\brdrs\brdrw15\brdrcf1 \trbrdrv\brdrs\brdrw15\brdrcf1 \clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrdb\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx996\clbrdrt\brdrs\brdrw15\brdrcf1 
\clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx2124\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx3505\clbrdrt
\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx4393\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 
\cellx5774\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr\brdrs\brdrw15\brdrcf1 \cellx7155\clbrdrt\brdrs\brdrw15\brdrcf1 \clbrdrl\brdrs\brdrw15\brdrcf1 \clbrdrb\brdrdb\brdrw15\brdrcf1 \clbrdrr
\brdrdb\brdrw15\brdrcf1 \cellx8415 \pard \qj\widctlpar\intbl TOTAL\cell 10\cell 8\cell 5\cell 23\cell 18\cell 27\cell \pard \widctlpar\intbl \row \pard \qj\widctlpar {\cf1 *McNemar Chi square p=0.0265
\par ** Patients with ARF & respiratory failure requiring artificial ventilation 
\par 
\par 
\par 
\par 
\par GROUP 1 = MODIFIED CELLULOSE ACETATE MEMBRANE
\par GROUP 2 = POLYSULPHONE MEMBRANE
\par }{\f5\cf1  
\par }{\fs24 
\par 
\par }{\b\fs24 DISCUSSION}{\fs24 : Certain studies have established the incidence of ARF in hospital patients at approximately 5%. The incidence of ARF development in ICU patients, however, is approximately 30%. Many procedure
s have been undertaken in improving the outcome of the affected patients (9,10). The high mortality rates can be explained by the occurrence of ARF in the clinical syndrome of multiple organ failure (MOF), where the underlying disorder determines the prog
nosis. The resistance to treatment of the basic process resulting in MOF cripples the efforts for organ function restitution. This should be an encouragement for the development of new techniques, which could reduce the mortality rates of patients with AR
F. Though biocompatible membranes have offered contradictory results, certain reports of their benefit should stimulate a prospective study of this problem. 
\par }{\caps\fs24 m}{\fs24 
ore aggressive types of treatment often recently employed result in an increase in ARF frequency. Inclusion of the elderly population into the more aggressive medical management, wars and trauma, as well as radical approaches in cardiac and abdominal surg
ery, maintain the mortality rates of patients with ARF between 60 and 70% (11,12). Our goal was to d
etermine the variance in the outcome of patients with ARF when different types of hemodialysis membranes were used. The severity of the underlying condition upon inclusion into the study was not different in the two groups we observed, accordin APACHE II 
score (13). Recognizing the fact that the APACHE II score was somewhat higher in a group 2 (the difference was not statistically significant) we have separately analyzed patients with ARF following sepsis, in an effort to evaluate the accuracy of the resu
lt
s. The severity of the disease was comparable in both groups. It is important to note that the survival rates of the patients with ARF were higher in the group of patients who were subjected to hemodialysis on the biocompatible polysulfone membranes, when
 compared to the patients dialyzed on the modified cellulose acetate membrane. Patients developing ARF secondary to sepsis following open heart and abdominal surgery, as well as those suffering from ARF caused by medical sepsis, were studied apart from th
e 
patients developing ARF as a result of a non-septic etiologic factor. The group of patients with ARF secondary to sepsis dialyzed on biocompatible membranes recovered sooner with a significantly lower number of hemodialysis sessions required for the renal
 function recovery (14). Furthermore, in the patients suffering from ARF in whom the condition was further aggravated by an acute respiratory insufficiency warranting the use of artificial ventilation we have demonstrated a better outcome when the biocomp
at
ible membrane was used in hemodialysis. We believe that these results deserve a detailed investigation. As we have already emphasized the severity of the basic disorder leading to MOF is of paramount importance. This may explain why the amount of produced
 urine did not present a prognostic factor in our patients. The occurrence of diuresis in a previously anuric patient did not affect the final outcome. If the septic process remained out of control the evolution of kidney function recovery could not preve
nt a lethal outcome. That is to say that the importance of control over the underlying condition could not be overemphasized (15).
\par 
\par 
\par 
\par 
\par }{\b\fs24 
\par }{\fs24 
The mortality rate of ARF remains high. Patients die in the clinical syndrome of MOF, despite the utilization of artificial ventilation, vasoactive therapy and hemodialysis. The high mortality rates of patients dialyzed on both the biocompatible and the b
ioincompatible membrane is secondary to protracted sepsis caused by resistant micro-organisms which usually progresses to death.
\par We also believe that the institution of biocompatible membranes into the treatment of patients with ARF has improved their chances for a favorable outcome (16). The use of biocompatible polysulfone membrane in acute renal failure, along with other measure
s, represents an advancement in patient management. Our data justifies a randomized study because we believe  that the results presented in this article are encouraging and that they offer new hope in the treatment of patients with ARF. 
\par }{\b\fs24 
\par }{\fs24 
\par 
\par }{\b\fs24 Literature: 
\par }\pard \qj\fi-284\widctlpar {\b 
\par 
\par {\pntext\pard\plain\fs20\lang1033 1. \tab}}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart1\pnindent283\pnhang{\pntxta . }}
Alkhunaizi AM, Schrier RW. Management of acute renal failure: New perspectives, Am j.Kidney Dis, 28:325-328, l996.
\par \pard \qj\widctlpar 
\par 2. Gubern JM,  Sancho JJ,  Simo J,  Sitges-Serra R.R. Randomized trial on the effect of mannitol on 
\par      postoperative renal function in patients with obstructive jaundice. Surgery, 103:39-44, 1988.
\par \pard \qj\fi-284\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 3. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart3\pnindent283\pnhang{\pntxta . }}
Bonomini V, Coli L, Maria Scolari, Stefoni S. Structure of Dialysis Membranes and Long-Term Clinical Outcome. Am J Nephrol 15:455-462, 1995.
\par \pard \qj\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 4. \tab}\pard \qj\fi-283\li283\widctlpar\tx1843{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart4\pnindent283\pnhang{\pntxta . }}Schiffl H,  Lang SM,  Koenig A
, Strasser T, Haider MC, Held E.. Biocompatible membranes in acute 
\par \pard \qj\widctlpar\tx1843       renal failure: prospective case-controlled study. Lancet 344:570-2. 1994.
\par \pard \qj\fi-284\widctlpar 
\par \pard \qj\widctlpar 5.   Hakim RM, Wingard RL, Parker RA: Effect of the dialysis membrane in the treatment of patients with
\par       acute renal failure. N Engl J Med, 17, 1338-1341, 1994. 
\par 
\par 6.  Shaldon S. Biocompatible membranes in acute renal failure. Lancet, 347:205, 1996.
\par 
\par {\pntext\pard\plain\fs20\lang1033 7. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart7\pnindent283\pnhang{\pntxta . }}Kurtal H D von Herrath, Schaefer K: Is the Choice of Membrane Important for P
atients with Acute Renal Failure Requiring Hemodialysis. Art Org, Boston, Vol 19, No.5 391-394, 1995.
\par \pard \qj\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 8. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart8\pnindent283\pnhang{\pntxta . }}Kaplan A, Paganini P, Bosch P. Effect of the dialysis membrane in acute renal failure. N Engl. J 

\par \pard \qj\widctlpar       Med. 332:961-962,1995.
\par \pard \qj\fi-284\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 9. \tab}\pard \qj\fi-283\li287\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart9\pnindent283\pnhang{\pntxta . }}
Corwin HL,  Bonventre JV. Acute renal failure in the intensive care unit. Part 2. Intensive Care Med 
\par \pard \qj\li4\widctlpar       14:86-96,1988.
\par 
\par {\pntext\pard\plain\fs20\lang1033 10. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart10\pnindent283\pnhang{\pntxta . }}Turney JH. Acute renal failure-some progress?, N Eng J Med, 331:1372-1374,1994
\par \pard \qj\widctlpar 
\par 
\par \pard \qj\fi142\li-142\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 11. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart11\pnindent283\pnhang{\pntxta . }}
Lameire N, Matthys E, Vanholder R, De Keyser K, Pauwels W, Nachtergaele H, Lambrecht L,  Ringoir S. Cause  and prognosis of acute renal failure in elderly patients. Nephrol Dial Transplant 2:316-322, 1987.
\par \pard \qj\widctlpar 
\par {\f17 12. Ga\'9aparovi\'e6 V, Radoni\'e6 R, Gjura\'9ain M,  Ga\'9aparovi\'e6 H, Ivanovi\'e6 D, Merkler M,  Jeli\'e6 I. Aetiology 
\par }\pard \qj\li60\widctlpar       and outcome of acute renal failure secondary to war related trauma and infectious disease in Croatia.
\par       Nephrology, 3:155-158, l997.
\par \pard \qj\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 13. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart13\pnindent283\pnhang{\pntxta . }}Knaus WA,  Draper EA, Wagner DP,  Zimmerman JE. APACHE II. a severity of disease 
\par \pard \qj\widctlpar classification system. Crit Care Med 13:818-829,1985.
\par 
\par {\pntext\pard\plain\f17\fs20\lang1033 14. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart14\pnindent283\pnhang{\pntxta . }}{\f17 Ga\'9aparovi\'e6 V, Djakovi\'e6 K, Ga\'9aparovi\'e6 H, Merkler M, Ivanovi\'e6 D, Pi\'9a
l Z, Majerovi\'e6 M, Jeli\'e6 I. Biocompatible membranes in acute renal failure (ARF), hope or illusion?, Nefrologia, 18:27-31, 1998.
\par }\pard \qj\widctlpar 
\par {\pntext\pard\plain\fs20\lang1033 15. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart15\pnindent283\pnhang{\pntxta . }}
Jacobs C. Membrane biocompatibility in the treatment of acute renal failure:what is the evidence in 
\par \pard \qj\widctlpar       1996 ?, Nephrol Dialys Transpl, 12:38-42,1997
\par 
\par {\pntext\pard\plain\fs20\lang1033 16. \tab}\pard \qj\fi-283\li283\widctlpar{\*\pn \pnlvlbody\pndec\pnb0\pni0\pnfs20\pnstart16\pnindent283\pnhang{\pntxta . }}Himmelfarb J. Tolkoff Rubin Nina, Chandran P,  Parker RA, Rebecca L Wingard, Hakim R. A 
\par \pard \qj\widctlpar        Multicenter Comparison of Dialysis Membranes in the Treatment of Acute Renal Failure Requiring 
\par        Dialysis. J Am Soc. Nephrol 9:257-266, 1998.
\par \pard \qj\fi-284\widctlpar 
\par \pard \qj\widctlpar 
\par 
\par {\fs24 
\par 
\par }{\b\fs24 
\par 
\par }}