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Blood Purification

Peter Kotanko, Laura M Rosales, Claudio Ronco
No abstract text is available yet for this article.
January 9, 2019: Blood Purification
Piergiorgio Bolasco, Pierluigi Spiga, Marcella Arras, Stefano Murtas, Giorgio La Nasa
BACKGROUND: The main aim is to compare the pro-inflammatory CD14+CD16+ monocytes blood levels in patient in end-stage renal disease (ESRD) undergoing Mixed online Haemodiafiltration (Mixed OL-HDF) vs. post-dilution OL-HDF and online high-efficiency haemodialysis. METHODS: The study is a prospective double-blind randomized controlled cross-over trial. Dialysis monitor, membrane, duration and dialytic adequacy, volume ultrapure dialysate/infusion were the same in all treatments...
January 2, 2019: Blood Purification
Shuchita Sharma, Siddhartha Kattamanchi, Mary Grace Gonzales, James A Sloand, Jaime Uribarri
BACKGROUND: AMIA cycler is a new automated peritoneal dialysis (APD) system, which was approved by FDA in 2015, which is more patient centric due to its features of voice guidance and touch screen. We retrospectively studied if these patient-centric features translated into better patient outcomes. METHODS: We compared 18 patients on AMIA cycler to 18 patients on conventional APD system. Data regarding training duration, dialysis adequacy, laboratory data, and peritonitis incidence were obtained using chart review and compared between the 2 groups...
January 2, 2019: Blood Purification
Jing Yang, Xiang-Ming Qi, Yong-Gui Wu
BACKGROUND/AIMS: To estimate the clinical value of bacterial detection in peritoneal dialysis-associated peritonitis (PDAP) by multiplex real-time polymerase chain reaction (RT-PCR). This study was undertaken to evaluate multiplex RT-PCR for identifying clinically significant bacteria in PDAP. METHODS: Seventy peritoneal dialysate specimens were collected and traditional bacterial culture and universal primer RT-PCR detection of the bacterial were used. RESULTS: The positive rate of traditional culture method was 65...
January 2, 2019: Blood Purification
Laura M Rosales
No abstract text is available yet for this article.
December 20, 2018: Blood Purification
Yuanyuan Shi, Huajun Tian, Yifeng Wang, Yue Shen, Qiuyu Zhu, Feng Ding
BACKGROUND AND OBJECTIVES: While trying to optimize the dialysis clearances of protein-bound uremic toxins (PBUTs), their percentage protein binding (% PB) is an important parameter. We evaluated the effects of ionic strength, pH change and chemical displacers on the dissociation of PBUTs from albumin in vitro. METHODS: PBUTs, such as 3-Carboxy-4-methyl-5-propyl-2-furan-propanoic acid (CMPF), p-cresylsulfate (PCS), indoxyl sulfate (IS) and indole-3-acetic acid (IAA), were spiked with human serum albumin (HSA) solution prepared with different Nacl concentrations and pH values or in the presence of a series of chemical displacers...
December 18, 2018: Blood Purification
Thananda Trakarnvanich, Saowanee Thirathanakul, Nongnaphat Sriphueng, Pathitta Thumrongthongjaroon, Sathit Kurathong, Tanun Ngamvichchukorn
BACKGROUND: Citrate anticoagulation is increasingly favored for preventing extracorporeal circuit clotting during renal replacement therapy. This study tested the effect of citrate compared with acetate on heparin avoidance and other parameters. METHODS: Sixty-one chronic hemodialysis (HD) patients were switched from conventional dialysis fluid (acetate) to citrate dialysis fluid and were treated in 3 phases, each lasting 4 weeks: 50%, 25%, and no heparin. Visual clotting score, erythropoiesis stimulating agent (ESA) dose, and laboratory parameters were measured...
December 13, 2018: Blood Purification
Patrycja Sosinska-Zawierucha, Ewa Baum, Beata Mackowiak, Monika Misian, Andrzej Bręborowicz
BACKGROUND/AIMS: Hemodialysis causes the systemic inflammatory response, which may affect the function of endothelial cells. METHODS: We studied the effect of the serum obtained after a hemodialysis session, compared to serum collected before the start of the treatment, on the gene expression and secretory activity of arterial endothelial cells (AECs) and venous endothelial cells (VECs) in in vitro culture. RESULTS: Serum collected at the end of the hemodialysis session increased expression of the studied genes in VECs, and at the same time decreased their expression in AECs...
December 13, 2018: Blood Purification
Laura M Rosales, Hanjie Zhang, Marilou Mateo, Brenda Chan, Israel Campos, Nikolas Harbord, Stephan Thijssen, Peter Kotanko
BACKGROUND: The time between the creation of an arteriovenous fistula (AVF) and its successful use is significantly longer in hemodialysis (HD) patients in the United States compared to those in other countries, and there is an urgent need to reduce the residence time of central-venous catheters (CVC). METHODS: Successful AVF creation and maturation results in typical hemodynamic changes, such as an increase in cardiac output and upper body blood flow (UBBF). In patients with CVC as vascular access, we measured once per minute intradialytic central-venous oxygen saturation (ScvO2) and hemoglobin levels simultaneously using the Crit-Line Monitor...
December 6, 2018: Blood Purification
Masataka Banshodani, Hideki Kawanishi, Misaki Moriishi, Sadanori Shintaku, Shinichiro Tsuchiya
BACKGROUND: The impact of hybrid therapy comprising peritoneal dialysis (PD) and hemodialysis on cardiovascular events in PD patients remains unclear. OBJECTIVE: We aimed to evaluate the effect of hybrid therapy on cardiovascular events. METHODS: A total of 93 PD patients undergoing hybrid therapy for ≥3 years were divided into 2 groups according to left ventricular ejection fraction (LVEF): lower ejection fraction (LEF [n = 29], LVEF < 60%) and normal ejection fraction (NEF [n = 64], LVEF ≥60%)...
December 6, 2018: Blood Purification
Panagiota Zgoura, Daniel Hettich, Jonathan Natzel, Fedai Özcan, Boris Kantzow
BACKGROUND/AIM: Peritonitis rates in peritoneal dialysis (PD) vary considerably not only across countries but also between centers in the same country. Patient education has been shown to significantly reduce infection rates but up till now training lacks standardization with patients being trained using different methods and media (e.g., illustrations, videos). As a result, patients may be insufficiently experienced in performing PD, which might be one of the causes for high peritonitis rates...
December 6, 2018: Blood Purification
Danielle Janosevic, Aileen X Wang, Jay B Wish
Difficult behavior exhibited by dialysis patients is a spectrum that includes nonadherence, verbal or physical abuse, and threatening acts. Such behaviors may lead to harmful consequences to the patient, other patients, the facility, and staff and can culminate in involuntary discharge. It is important to recognize that these "difficult behaviors" may be due to underlying psychosocial or medical issues, which places an onus on care providers to explore further. According to the Conditions for Coverage (CfC) for dialysis facilities, it falls upon the medical director to coordinate and oversee policies for patient satisfaction, patient safety and rights, involuntary discharges, and adverse events and outcomes...
December 6, 2018: Blood Purification
Hanjie Zhang, Israel Campos, Lili Chan, Anna Meyring-Wösten, Leticia M Tapia Silva, Lemuel Rivera Fuentes, Priscila Preciado, Stephan Thijssen, Jeroen P Kooman, Frank M van der Sande, Peter Kotanko
BACKGROUND: Central venous oxygen saturation (ScvO2) is correlated with cardiac output. In most patients, ScvO2 declines during hemodialysis (HD) due to factors such as reduced preload, myocardial stunning, and intermittent arrhythmias. Previous research has shown that low ScvO2 is associated with higher mortality in chronic HD patients. In this research, we tested the hypothesis that ScvO2 variability is associated with all-cause mortality. METHODS: We conducted a retrospective study in 232 chronic HD patients with central venous catheter as vascular access...
December 6, 2018: Blood Purification
Grazia Maria Virzì, Chiara Borga, Chiara Pasqualin, Silvia Pastori, Alessandra Brocca, Massimo de Cal, Federico Nalesso, Monica Zanella, Alessandra Brendolan, Claudio Ronco
BACKGROUND: Sepsis is a life-threatening condition often associated with a high incidence of multiple organs injury. Several papers suggested the immune response by itself, with the production of humoral inflammatory mediators, is crucial in determining organ injury. However, little is known of how sepsis directly induces organ injury at the cellular levels. To assess this point, we set up an in vitro study to investigate the response of renal tubular cells (RTCs), monocytes (U937) and hepatocytes (HepG2) after 24 h-incubation with septic patients' plasma...
December 6, 2018: Blood Purification
Kabir O Olaniran, Nwamaka D Eneanya, Sagar U Nigwekar, Xavier F Vela-Parada, Maureen M Achebe, Amita Sharma, Ravi I Thadhani
BACKGROUND: Compared to the past, patients with sickle cell disease (SCD) currently live longer due to improvements in diagnosis and comprehensive care. Due to these advances, long-term chronic complications pose a greater challenge in the management of patients with SCD. In particular, sickle cell nephropathy (SCN) is associated with significant morbidity and mortality across all age groups. Furthermore, SCN is an understudied condition with relatively few symptoms and therefore requires close surveillance...
December 5, 2018: Blood Purification
Frank M van der Sande, Karlien J A Ter Meulen, Peter Kotanko, Jeroen P Kooman
BACKGROUND: Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume...
December 5, 2018: Blood Purification
Melvin Bonilla-Félix, Marta Suárez-Rivera
BACKGROUND: Puerto Rico suffered a major humanitarian -crisis after Hurricane Maria. We describe our experience with patients with renal disease in an academic medical center. SUMMARY: A comprehensive emergency response plan should be developed, shared and discussed with the team and the patients prior to the hurricane. The needs of the staff should not be ignored to ensure their ability to participate as responders. Physical damage to facilities, lack of basic services, shortage of disposable products, and the inability to get to treatment centers are the most common threats...
December 5, 2018: Blood Purification
Arif Asif, Mohamed M Bakr, Michael Levitt, Tushar Vachharajani
BACKGROUND: Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. SUMMARY: While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates...
December 5, 2018: Blood Purification
Jeroen P Kooman, Frank M van der Sande
BACKGROUND: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. SUMMARY: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis...
December 5, 2018: Blood Purification
Charles Chazot, Guillaume Jean
Recently the concept that prescription of chronic hemodialysis (HD) start should be tailored based on residual renal function (RRF) and urine output (UO) has been revived from the past and called infrequent or incremental dialysis. It mainly consists in prescribing 1 or 2 HD sessions per week instead of what has become the standard thrice-weekly HD. It is both surprising and fascinating that almost 60 years after the first end-stage kidney disease patient was treated by Scribner et al. [Trans Am Soc Artif Intern Organs 1960; 6: 114-122], the nephrology community still questions the best way to start HD therapy...
December 5, 2018: Blood Purification
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