TECHNOLOGY ASSESSMENT OFBLOOD PURIFICATION FOR THE ELDERLY

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As a final year of the project, we focused on three subjects, namely (1) continuousambulatory peritoneal dialysis, (2) apheresis as a preventive therapy and (3) handling cells and proteins by physical principle. A part of the survey was presented at 5th International Conference of World Apheresis (symposium : New separation and apheresis technologies, Houston, March, 1994)1. Technology assessment of CAPD for the elderlyAs mentioned generally, catheter exit infection, deterioration of the peritoneal membrane, under dialysis and malnutrition are main issues to be overcome for the elderly patients, too. Based on our interviews with Dr.Nissenson (UCLA, USA), Dr.Kharna (Univ. of Miss, USA), Dr.Shreiber (Clev. Clin. Found., USA), substitution of hypersonic agent from glucose to amino acid or polypeptide may improve malnutrition and maintain a function of the peritoneal membrane. To overcome under dialysis status in some patients, programmable machine, which can controlinjection and discard of dialysate automatically, could be effective if mass transport in the peritoneal cavity is well known in each patient. Infection seems to be not technologicalissue but more likely educational one.2. Blood purification as a preventive modalitySome blood purification procedures have possibility to prevent total loss of the organ function that may be promising to decrease the patient population. Removal of LDL has been proved to decrease risk factors of heart failure. Extracorporeal immuno-modulation may activate patient's own immune response. The key issue in this category is to handle or stimulate immune response cells selectively.