In Vitro and Clinical Studies of Fluid Removal With the Kiil Dialyzer and Subatmospheric-Pressure Dialysate Circuit

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WHEN blood passes through an artificial kidney, a pressure gradient is exerted across the dialyzing membrane. As a consequence, plasma water is removed by ultrafiltration. During the next circuit of the blood through the body, edema fluid replaces the loss of plasma water until it in turn is removed in the artificial kidney. Fluid removal through ultrafiltration by an artificial kidney may be lifesaving for a patient with acute pulmonary edema,1, 2 or with increased intracranial pressure.3 Patients desperately ill and cyanotic from pulmonary edema are almost miraculously improved by this fluid removal. An hour and a half of ultrafiltration with an artificial kidney may improve the clinical air hunger so much that a patient may be taken out of an oxygen tent. If the patient can survive for an hour and a half after the onset of dialysis, he probably will live. In the treatment of patients with chronic renal failure, fluid removal by ultrafiltration is necessary for the management of hypertension and the avoidance of otherwise refractory edema.1, 2 In many patients who are dependent for life on the artificial kidney, the blood pressure can be controlled at will by varying the total body water and sodium. These patients must be on a salt-restricted diet. When they have no urinary output, they depend for the removal of water and sodium on the artificial kidney. Because excessive removal of body fluid may result in complications such as hypotension or weakness, one should be able to predetermine the amount of . . .



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