Novel techniques for volume management and toxin removal in end-stage renal disease

This first part of this thesis, ’Removing substances’, describes a novel immunoadsorption technique that uses variable domains of heavy chain llama antibodies (VHH) to remove a toxic agent, Toxic Shock Syndrome Toxin-1 (TSST-1) from the circulation. This study was designed as a proof-of-principle that immunoadsorption of substances by VHH is a feasible, effective technique. We chose the removal of TSST-1 from a porcine sepsis model because in this system, there was a direct relation between the (one) substance (TSST-1) and the disease (sepsis). The second part of this thesis, ’Removing excess volume’, describes a novel method to measure absolute plasma refill rates during hemodialysis, using a feedback-regulated ultrafiltration system coupled to a dialysis machine. We designed this system because we wanted to be able to non-invasively measure absolute plasma refill rates continuously during dialysis. This system is the first to do so, and, using the method, we investigated the influence of blood-pressure stabilizing interventions on refill. Finally, the application of the method as a novel determinant of the patient’s dry weight was investigated