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Gašparoviц, K. Djakoviц, H. Gašparoviц, M. Merkler, D. Ivanoviц and M. Gjurašin Department of Emergency and Intensive Care Medicine, Internal Clinic, Rebro, Zagreb, CroatiMicrosoft Word for Windows 95@(-к @8юЭ,NМ@ЦићL<М@"‹‹QNМK/аЯрЁБсўџеЭеœ.“—+,љЎ0фHP\dl t| „тdЫ}@ GBiocompatible membranes in acute renal failure (ARF), hope or illusionаЯрЁБс>ўџ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Word Document MSWordDocWord.Document.6є9ВqаЯрЁБсўџр…ŸђљOhЋ‘+'Гй0Р˜ №ќ 0 <H p | ˆ ” ЈАИтGBiocompatible membranes in acute renal failure (ARF), hope or illusiondNormald26a key words: biocompatible membranes, acute renal failure 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 cellulose acetate membrane (BIC). Patients and methods: During a one year period we have randomly divided patients with ARF into two groups. The aim of our study was to evaluate the benefits of biocompatible membranes in the treatment of patients with ARF. In a group of 31 patients with ARF (surgical and medical group, 22 males and 13 females, average age 58.7+/-8.3 years), polysulfone membrane was used in 14 patients (group BC), and cellulose acetate membrane in 17 patients (group BIC). Due to certain missing data patients number 4 (please see Table 1) was excluded from the study. On inclusion into the study, there were no significant differences in the severity of the underlying disease between the observed groups, as was objectively represented with the APACHE II Score. 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. The variances in the outcome with respect to different hemodialysis membranes are presented in Table 3. Discussion: The past attempts of ARF management with dopamine, dobutamine, diuretics of the ascending loop of Henle have proven disappointing. Many efforts have been made in the prevention of ARF, but few have proven to be useful. On the other hand, the more aggressive types of treatment often employed by modern medicine result in an increased frequency of ARF occurrence. The high mortality rates of patients with ARF in both the surgical and medical group of patients demand an evaluation of new approaches to the treatment. Inclusion of the elderly population into the more aggressive medical management, as well as the more progressive approaches in cardiac and abdominal surgery, war situation, maintain the mortality rates of patients with ARF between 60 % and 70%(9,10,11,12). According to certain studies the incidence of ARF in patients admitted to the hospital is approximately 5%. Our goal was to determine the variance in the outcome of patients with ARF when different type MEMBRANE USED SURVIVED DIEDTOTAL NUMBER OF PTSGROUP 151621GROUP 2121022TOTAL43p0,0394 X-2 TEST0,0394 Fisher exact GROUP 1 = MODIFIED CELLULOSE ACETATE MEMBRANE GROUP 2 = POLYSULPHONE MEMBRANE 41418771431p=0,07, NSNS, , x2 testNS, testcd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd+C:\Biocompatible\arf brijuni,97 revised.docџ@OKIPAGE 4wLPT1:VHSD4W12OKIPAGE 4wOKIPAGE 4w e/v/x/…/†/‡/ˆ/Є/Ј/000&0—0š0ш0ъ0ы0э0я0№0ё0ѓ0ѕ0џ0111 111ќќќќќќќњѕёёњяёёёёёёёёёёъёёё]chU]c[]cb]cФ.ж.щ.§./#/$/,/>/Q/e/x/Š/‹/Œ//Ž///‘/’/”/—/š// /Ѓ/Є/Ѕ/І/Ї/Ј/0000000§pЙ§pЙ§pЙ§pЙ§pЙцpЙ§Й§pЙ§pЙ§pЙ§pЙ§pЙцpЙтЙтpЙтpЙтpЙтpЙтpЙцpЙ§Й§pЙ§pЙ§pЙ§pЙ§pЙцpЙпr пr пr пr пr пr пr тффт8фтLфт„ фИНїЛYYYYIIОтџ6тŽ:ц’&000!0&0:0;0C0E0H0K0L0T0W0Z0]0^0d0e0f0i0j0l0|0}0~00€0”0•0–0—0˜0™0š0Ш0ш0щ0ъ0ы„ фчффф8ффLфф„ фы„ ффффч8фчLфч„ фы„ ффффч8фчLфч„ фы„ ффффч8фчLфч„ фы„ ффффф8фчLфч„ фы„ фчффф8фчLфч„ фы„ фсr сr сr сr сr сr сr ИНїЛYYYYIIО тџv ў О& Ћџџџџ!џџ џџ џџ џџе у БRSTUчшщ8JkЊЋЌэюНе ж п C D E G J M P X ` r … ™ Ќ Р Ш к э   ' ( ) * + , . 0 3 6 9 < @ A B C D Ћ Ќ ­ Ў Џ А В Г Н Т з п с ф ш № ђ є ј ў џ       3 4 6 7 8 9 g ‡ ˆ ‰   r Kr Kr r r r r r r r r r r r r r џr r r r r ЙpЙpЙpЙpЙpЙЙpЙpЙpЙpЙpЙЙpЙpЙpЙpЙpЙЙpЙpЙpЙpЙpЙЙpЙpЙpЙpЙpЙr r r r r r r ффcфCфb фффcфCфb фффcфCфb фффcфCфb фффcфCфb фффcфCфb фффcфCфb фr r r r r r r џr Шr e/1Œ!#ЉФ.0ъ055PэююмоъыЌЙЃ Џ е ‰ Щ г ™Ÿ••[\‚Ъа05 žd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd#C:\Biocompatible\arf brijuni,97.docd+C:\Biocompatible\arf brijuni,97 revised.docd+C:\Biocompatible\arf brijuni,97 revised.docd+C:\Biocompatible\arf brijuni,97 revised.docd+C:\Biocompatible\arf brijuni,97 revised.docџ@OKIPAGE 4wLPT1:VHSD4W12OKIPAGE 4wOKIPAGE 4w Dl ќџOKIPAGE 4wџџџџOKIPAGE 4w Dl ќџOKIPAGE 4wSЄ<IJ ф х ч C J " - ,:ЋТУХЦЧp,x,y,ƒ,„,—,˜,Ћ,Ќ,Н,О,б,в,т,у,ѓ,є,------e-f-†-‡-Ф-Х-.4.5.6.7.8.9.:.‘.’.І.Ј.М.Ф.д.ж.ш.щ.ѕ.ї.ћ.§.//!/,/:/;//O/Q/c/e/§њјјѕјђ№јјјюыыю§№№№№№№№№№№№№№јщхщрммммммммммммммммммммм]c[]cU]bbUcuhJcUVUUcU[W6RSЃЄ;<  B C t Й ! 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Gašparoviц, K. Djakoviц, H. Gašparoviц, M. Merkler, D. Ivanoviц and M. Gjurašin Department of Emergency and Intensive Care Medicine, Internal Clinic, Rebro, Zagreb, Croatia key words: biocompatible membranes, acute renal failure 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 cellulose acetate membrane (BIC). Patients and methods: During a one year period we have randomly divided patients with ARF into two groups. The aim of our study was to evaluate the benefits of biocompatible membranes in the treatment of patients with ARF. In a group of 31 patients with ARF (surgical and medical group, 22 males and 13 females, average age 58.7+/-8.3 years), polysulfone membrane was used in 14 patients (group BC), and cellulose acetate membrane in 17 patients (group BIC). Due to certain missing data patients number 4 (please see Table 1) was excluded from the study. On inclusion into the study, there were no significant differences in the severity of the underlying disease between the observed groups, as was objectively represented with the APACHE II Score. 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. The variances in the outcome with respect to different hemodialysis membranes are presented in Table 3. Discussion: The past attempts of ARF management with dopamine, dobutamine, diuretics of the ascending loop of Henle have proven disappointing. Many efforts have been made in the prevention of ARF, but few have proven to be useful. On the other hand, the more aggressive types of treatment often employed by modern medicine result in an increased frequency of ARF occurrence. The high mortality rates of patients with ARF in both the surgical and medical group of patients demand an evaluation of new approaches to the treatment. Inclusion of the elderly population into the more aggressive medical management, as well as the more progressive approaches in cardiac and abdominal surgery, war situation, maintain the mortality rates of patients with ARF between 60 % and 70%(9,10,11,12). According to certain studies the incidence of ARF in patients admitted to the hospital is approximately 5%. Our goal was to determine the variance in the outcome of patients with ARF when different type MEMBRANE USED SURVIVED DIEDTOTAL NUMBER OF PTSGROUP 151621GROUP 2121022TOTAL43p0,0394 X-2 TEST0,0394 Fisher exact GROUP 1 = MODIFIED CELLULOSE ACETATE MEMBRANE GROUP 2 = POLYSULPHONE MEMBRANE 41418771431p=0,07, NSNS, , x2 testNS, test Summary:()., . Sažetak: Akutno zatajenje bubrega povezano je još uvijek sa visokom smrtnošцu. Postoje razni pokušaji, od primjene vazoaktivnih tvari (dopomin, dobutamin), diuretici i sl. u smanjivanju visoke smrtnosti. e/v/x/…/†/‡/ˆ/Є/Ј/000&0—0š0ш0ъ0ы0э0я0№0ё0ѓ0ѕ0џ0111 1111111 1!1"1#1$1%101T1`1j1k1m1n1Ј1е1ж1з1є1868H8K8^8e8o899/9L9c9ќќќќќќќњѕёёњяёёёёёёёёёёъёёёчяяххuU[]chU]c[]cb]c@Ф.ж.щ.§./#/$/,/>/Q/e/x/Š/‹/Œ//Ž///‘/’/”/—/š// /Ѓ/Є/Ѕ/І/Ї/Ј/0000000§pЙ§pЙ§pЙ§pЙ§pЙцpЙ§Й§pЙ§pЙ§pЙ§pЙ§pЙцpЙтЙтpЙтpЙтpЙтpЙтpЙцpЙ§Й§pЙ§pЙ§pЙ§pЙ§pЙцpЙпr пr пr пr пr пr пr тффт8фтLфт„ фИНїЛYYYYIIОтџ6тŽ:ц’&000!0&0:0;0C0E0H0K0L0T0W0Z0]0^0d0e0f0i0j0l0|0}0~00€0”0•0–0—0˜0™0š0Ш0ш0щ0ъ011ы„ фчффф8ффLфф„ фы„ ффффч8фчLфч„ фы„ ффффч8фчLфч„ фы„ ффффч8фчLфч„ фы„ ффффф8фчLфч„ фы„ фчффф8фчLфч„ фы„ фсr сr сr сr сr сr сr пr пr ИНїЛYYYYIIО тџv ў О( Svi ovi pokušaji ostali su bez uvjerljivog odgovora. Danas se pokušava i kroz tehnološki napredak medicine utjecati na smrtnost u ovom kliniшkom sindromu. Uvo№enje biokompatibilnih membrana u zbrinajvanje akutnog zatajenje bubrega predstavlja novost, a prvi ohrabrujuцi ali proturijeшni rezultati nalažu daljnja istraživanja. Є‚.ЅЦAІЇЈ Љ Њ п с ф ш № ђ є ј ў џ       3 4 6 7 8 9 g ‡ ˆ ‰   r Kr Kr r r r s 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. Their condition was objectively represented by the APACHE II score. 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 purified cellulose acetate membrane, but statistically still insignificant. The explanation 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). Thus fore, the management of ARF is only a part of the treatment. The control over the basic etiologic moment remains of paramount importance. We believe it is necessary to continue the study, to have a bigger study groups and than to analysed the data. 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 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 could 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 Cute 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. Husedžinoviц I, Ž. Sutliц, B. Bioшina, I. Rudež. Inotropic Agents in the Treatment of Postoperative Low Cardiac Output Syndrome. Acta MEd Croat 49:201-205, 1995. 11. V. Gašparoviц, R. Radoniц, M. Gjurašin, D. Ivanoviц, M. Kvarantan, J. Husar: Acute renal failure in the war in Croatia, Nephrol Dialys Transpl, 10:1261, 1995. 12. Gašparoviц V, R. Radoniц, M. Gjurašin, H. Gašparoviц, D. Ivanoviц, M. Merkler, I. Jeliц. Aetiology and outcome of acute renal failure secondary to war related trauma and infectious disease in Croatia. Nephrology, in press, l997. 13. International Co-operative Biocompatibility Study(I.C.B.S.), Nephrol Dial Transplant 8(S2), 1-42, 1993 14. Gašparoviц V, K. Ilekoviц, M. Gjurašin, D. Ivanoviц, R. Radoniц, M. Merkler, Z. Pišl. Acute renal failure-a part of the syndrome of multiple organ failure or an independent event? Neurol. Croat. 45, (S) l:67-71,1996. 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K @ёџ Normal ]a c"A@ђџЁ"Default Paragraph FontVladimir Gašparoviц1, Kristina Djakoviц2, Hrvoje Gašparoviц2, Marijan Merkler1, Dragutin Ivanoviц1, Mirko Gjurašin1, Mate Majeroviц3, Ivan Jeliц3 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 (surgical and medical group, 19 males and 12()()t Table 2. APACHE II SCORE AT INCLUSION INTO THE STUDY, AND 24, 48 AND 72 HOURS THERAFTER (MEAN VALUES +/- SD) 02448727 daysGROUP 135,88+/-11,02(18)34,00+/-11,77 (17)32,68 +/-12,79 (16)30,00+/-12,59 (13)27,50 +/-13,07(10)GROUP 230,78+/-10,03(14)28,76+/-10,21 (13)28,08 +/-11,25 (12)24,41+/-11,24 (12)26,14+/-10,79 (7)pNSNSNSNSNS Table 3. 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