Browsing by Subject "ultrafiltration"
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Item Open Access Decongestion strategies and renin-angiotensin-aldosterone system activation in acute heart failure.(JACC Heart Fail, 2015-02) Mentz, Robert J; Stevens, Susanna R; DeVore, Adam D; Lala, Anuradha; Vader, Justin M; AbouEzzeddine, Omar F; Khazanie, Prateeti; Redfield, Margaret M; Stevenson, Lynne W; O'Connor, Christopher M; Goldsmith, Steven R; Bart, Bradley A; Anstrom, Kevin J; Hernandez, Adrian F; Braunwald, Eugene; Felker, G MichaelOBJECTIVES: The purpose of this study was to assess the relationship between biomarkers of renin-angiotensin-aldosterone system (RAAS) activation and decongestion strategies, worsening renal function, and clinical outcomes. BACKGROUND: High-dose diuretic therapy in patients with acute heart failure (AHF) is thought to activate the RAAS; and alternative decongestion strategies, such as ultrafiltration (UF), have been proposed to mitigate this RAAS activation. METHODS: This study analyzed 427 AHF patients enrolled in the DOSE-AHF (Diuretic Optimization Strategies in Acute Heart Failure) and CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trials. We assessed the relationship between 2 markers of RAAS activation (plasma renin activity [PRA] and aldosterone) from baseline to 72 h and 96 h and decongestion strategy: high- versus low-dose and continuous infusion versus bolus furosemide for DOSE-AHF and UF versus stepped pharmacologic care for CARRESS-HF. We determined the relationships between RAAS biomarkers and 60-day outcomes. RESULTS: Patients with greater RAAS activation at baseline had lower blood pressures, lower serum sodium levels, and higher blood urea nitrogen (BUN) concentration. Continuous infusion furosemide and UF were associated with greater PRA increases (median: +1.66 vs. +0.66 ng/ml/h with continuous vs. bolus infusion, respectively, p = 0.021; +4.05 vs. +0.56 ng/ml/h with UF vs. stepped care, respectively, p = 0.014). There were no significant differences in RAAS biomarker changes with high- versus low-dose diuretic therapy (both: p > 0.5). Neither baseline log PRA nor log aldosterone was associated with increased death or HF hospitalization (hazard ratio [HR] for a doubling of 1.05; 95% confidence interval [CI]: 0.98 to 1.13; p = 0.18; and HR: 1.13; 95% CI: 0.99 to 1.28; p = 0.069, respectively). The change in RAAS biomarkers from baseline to 72 and 96 h was not associated with outcomes (both: p > 0.5). CONCLUSIONS: High-dose loop diuretic therapy did not result in RAAS activation greater than that with low-dose diuretic therapy. UF resulted in greater PRA increase than stepped pharmacologic care. Neither PRA nor aldosterone was significantly associated with short-term outcomes in this cohort. (Determining Optimal Dose and Duration of Diuretic Treatment in People With Acute Heart Failure [DOSE-AHF]; NCT00577135; Effectiveness of Ultrafiltration in Treating People With Acute Decompensated Heart Failure and Cardiorenal Syndrome [CARRESS]; NCT00608491).Item Open Access Implementing Electrochemical Impedance Spectroscopy for the In Situ Analysis Of Conducting-Membrane Fouling(2020) DuToit, Marielle McCallenAbstract
As natural resource scarcity and industrial productivity continue to rise, membrane filtration technologies provide a compelling solution for the production of clean water. Membranes are versatile, energy-efficient, and highly effective, yet they suffer from the indomitable problem of fouling. Abundant research has been conducted on this topic, but new methods for understanding and assessing fouling are still emerging, and are nevertheless needed. The present work endeavors to study membrane fouling from yet another perspective using a powerful electrochemical technique known as electrochemical impedance spectroscopy (EIS). EIS is a non-destructive electrical perturbative method, thus it can be performed during filtration. While some research groups have applied EIS for membrane characterization, none have yet incorporated conductive polymeric membranes into the electrochemical setup.
The primary objectives of this study were to (1) synthesize a robust and sufficiently conductive polymeric membrane for use as a working electrode; (2) develop a non-invasive non-Faradaic EIS method to characterize membrane fouling in real time; (3) separate contributions to total fouling from processes happening on the membrane surface and within the interior pore network. Membrane fouling was studied using three model foulants, bovine serum albumin (BSA), humic acid, and colloidal silica in a supporting electrolyte of phosphate buffered saline (PBS) and potassium nitrate (KNO3), respectively. To better understand the spatial position and magnitude of fouling, EIS spectra were interpreted by fitting equivalent circuits informed by the physical structures of the membrane surface and interior.
Data from the EIS fouling tests showed good agreement between changes in impedance, conductance, and capacitance and reduction in permeate flow, which is the conventional parameter used to monitor fouling severity. The conductive coating also allowed for fouling to be differentiated between the surface and interior layers of the membrane. Moreover, experiments with feed solutions containing separate foulants in different solution chemistries verified that EIS is sensitive enough to differentiate between various membrane fouling effects as well as irreversible fouling phenomena. These results suggest that conductive membranes can be used alongside EIS to spatially and temporally characterize membrane fouling as it happens in real time without the need to remove or damage the membrane for analysis.