THERANOVA…… A breakthrough science in dialysis treatment

The loss of kidney function in patients with kidney failure causes accumulation of solutes termed as uremic toxins, which have immense negative effect on patient health. The uremic syndrome is attributed to the progressive retention of a large number of compounds, which are unable to be excreted by the less functional kidneys or non-functional kidneys.

These compounds are called uremic retention solutes or uremic toxins, which interact negatively with biological functions of the body. These toxins can be grouped into small water soluble molecules, middle molecules, and protein-bound solutes.

Although smaller molecules can be effectively removed by conventional dialysis, but it is quite difficult to clear the middle molecules by the conventional HD process.

Middle molecules can be further subdivided into two groups on the basis of their molecular mass: conventional middle molecules and larger middle molecules. Β2-microglobulin is considered the standard representative of a middle molecule whereas large middle molecules include free Ig light chains.

Larger middle molecules are associated with inflammation, cardiovascular events, and other dialysis-related comorbidities in patients with cardiovascular disease, mineral and bone disorders, and infectious diseases.

Highly porous membranes, as those featured in high-flux dialyzers, allow some middle molecules to pass through the membrane, but even these membranes do not readily clear larger solutes. Larger middle molecules need to be removed either by convection or through the use of highly permeable membranes.

A dialyzer can also be considered as an “artificial kidney.” Its function is to remove the excess wastes and fluid from the blood when an individual’s kidneys can no longer perform effectively. Dialyzers are made of thin, fibrous material with, a medium cut-off membrane, which combines high permeability and uremic toxin selectivity.

Factors that influence the choice of dialyzer:

1. The membrane material of the dialyzer.

2. Biocompatibility of dialyzer and dialysis membrane.

3. The clearance capability of the dialyzer.

4. The ultrafiltration potential of the dialyzer.

5. The dialyzer’s area and the blood chamber’s volume.

The accumulation of solutes in patients with chronic kidney disease may be associated with complications resulting in poorer outcomes, including higher morbidity and mortality. These uremic retention solutes, also known as uremic toxins, range widely in size from small molecules to middle molecules. Larger middle molecules, are associated with comorbid conditions that are common in dialysis patients such as inflammation and cardiovascular events.

What is HDx dialysis?

Expanded hemodialysis (HDx) therapy is a novel treatment concept for hemodialysis patients, which involves the usage of membrane technology that has a high retention onset for better solute (uremic toxins) clearance in the upper middle molecular range.

Theranova dialyser is designed for expanded hemodialysis (HDx) therapy.

What is Theranova dialyzer?

The Theranova Dialyzer is recommended for patients with kidney failure who are prescribed or dependent on hemodialysis. It provides an expanded solute removal option that increases the removal of various large middle molecules which cannot be removed through other form of dialysis.

WHY THERANOVA 400…… Reason and Utility

1. Theranova is a hollow-fiber, single-use dialyzer, with improved removal of large proteins, as well as selective maintenance of essential proteins such as albumin.

2. Theranova 400 dialyzer, through its innovative design, combines the functional features of enhanced permeability, increased selectivity, controlled retention, and improved internal filtration, into a single dialyzer.

3. This is a specialized dialysis treatment called “expanded Hemodialysis”, where diffusion & convection are integrated inside a hollow fiber dialyzer, equipped with a medium cut-off membrane.

4. Theranova 400 enables removal of small, conventional middle molecules as well as large middle molecule uremic toxins.

5. Expanded hemodialysis therapy through Theranova 400 helps superior of larger middle molecules that comprise putative uremic solutes, than conventional high-flux dialyzer. At the same time maintains good level of serum albumin.

6. Reduced loss of protein helps in maintaining health balance and thus promotes better immunity.

Eligibility for Theranova400

1. Patients who are clinically stable without acute medical events for 30 days prior.

2. Receiving HD with a high-flux dialyzer for at least 3 months prior.

3. Patient having stable functioning vascular access.

4.  Patients with chronic liver disease, paraprotein-associated disease, hepatitis, HIV, bleeding disorders, active cancer, and monoclonal plasma diseases are not suitable for expanded HD.8

Conclusion

Optimal removal of uremic solutes has been a goal of HD since its inception. New technologies, enhancing the clearance of middle molecules while limiting the loss of important proteins, such as albumin, have an important role in improving the health of patients on dialysis.

It is possible that expanded HD may potentially demonstrate improved mortality with long-term treatment because of better clearance of larger middle molecules. Theranova 400 membrane, will be a real paradigm shifts in the provision of kidney care as envisioned by the Nephrocare India Pvt Ltd. Hence, with a goal of good renal care for all, we have successfully introduced the expanded hemodialysis at Nephrocare through THERANOVA 400. And we are on continuous process of upgradation, so as to offer the best possible treatment for our patients.

What kind of patient would be eligible for Theranova? Let us know in the comment section

Published by Dr.Pratim Sengupta

Dr. Pratim Sengupta thinks of himself as conscious, living, soulful being with an inner urge to break the inertia of life. He feels that life is nothing but a material expression of the Supreme Almighty Consciousness. His conscious existence empowered him to see, to hear, to talk, to interact, to feel, to dream, to ask questions, and to seek solutions to every problem. In the flow of life, as he grew up, he understood that knowledge of life is the only way to understand the scientific basis of conscious existence. Hence Dr. Sengupta felt the urge to study the science of life – i.e. Medicine. After he completed his higher secondary education from the Ramakrishna Mission Vidyamandira in Belurmath, he joined the MBBS (Bachelor of Medicine, Bachelor of Surgery) course at RG Kar Medical College, Kolkata. The professional packaging of knowledge in terms of a time-bound, goal-oriented syllabus frustrated him a bit, but nevertheless ignited the urge within him to study further. He thus went on to his post-graduation (MD) in Medicine from IPGMER and SSKM Hospital, Kolkata. During his MD training, he got a glimpse of the vastness of knowledge, and the quest to learn precisely the facts of life narrowed down his area of interest to the functioning of the kidneys and the specialisation of Nephrology – a discipline that is complex, yet relatively new and still evolving in terms of complete understanding of renal physiology and pathology. So, Dr. Sengupta decided to study and train for the DM (Doctorate of Medicine) degree in Nephrology. Right from the start of his career, Dr. Sengupta was passionate about Research. During the MD programme he worked on Cirrhotic Cardiomyopathy, Autonomic Neuropathy of Lupus, and Insulin resistance in Diabetics. All these research studies were published in national journals. During his postdoctoral study in Nephrology, he worked on Hemodialysis efficiency, and suggested an angular placement of the Dialyser in order to increase efficiency. This innovative concept was accepted for presentation at the World Congress of Nephrology, Milan, in 2009, and also published in Hemodialysis International. Dr. Sengupta also worked on Plasmapheresis – a blood filtering technique by which toxic and pathogenic immunoglobulins can be removed from the body. He studied the role of Prethymectomy Plasmapheresis in Myasthenia Gravis patients, and his findings were published in the journal Interactive Cardiovascular and Thoracic Surgery. The patient-empowered nutritional model for nutritional care of kidney patients is another interesting and innovative area in which Dr. Sengupta has worked for quite a long time. Dr.Pratim Sengupta won the Bharat Jyoti award for his excellency in the field of medicine. He is also the president of our non-governmental organization, The Kidney Care Society. His tireless contribution to provide quality living for his patients is worth mentioning. He introduced Mukti, blending ancient Indian yoga with modern medicine for well being of every patient. He has also introduced an unique online course "Art of Living with diabetes" which is a complete solution to diabetes management. He has authored many books, blogs, for the patients. Searching and researching for solutions to problems in the field of Nephrology remains the passion and dream of Dr. Pratim Sengupta, and he intends to persist on this journey as long as he is conscious. Meanwhile, even as he pursues his dreams, Dr. Sengupta diligently puts into practice all he has learned about Nephrology over the years, at the Belle Vue Clinic in Kolkata and ILS hospital,Dumdum where he is available for his patient

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