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Seminars in Dialysis

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https://www.readbyqxmd.com/read/29750827/self-cannulation-of-the-vascular-access-in-home-hemodialysis-overcoming-patient-level-barriers
#1
Frank L Ward, Rose Faratro, Rory F McQuillan
Patients with end-stage kidney disease who are considering home hemodialysis (HHD) face the challenge of learning to self-cannulate their arteriovenous access. Current practice discourages the use of tunneled central venous catheters, with recent indications that self-cannulating patients have superior outcomes. Patient-level barriers do not appear to preclude a successful HHD program and should not be viewed as insurmountable by healthcare staff or patients. The healthcare team must address patient fears while instructing the patient to perform self-cannulation safely...
May 11, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29742283/vaccination-practices-in-dialysis-patients-a-narrative-review
#2
REVIEW
Georges Kosmadakis, Julie Albaret, Enrique Da Costa Correia, Frederic Somda, Didier Aguilera
In a period of turmoil concerning vaccination practices, there is a serious conflict between scientifically reasonable, evidence-based guidelines and the far-fetched rumors or misconceptions concerning the vaccination practices in the general population. When a significant portion of the medical and paramedical personnel may be deliberately unvaccinated against common biological agents, achieving effective vaccination rates in the dialysis population may be complicated. Vaccination rates are unacceptably low in dialysis patients and seroconversion rates are even lower; further, serological follow-up is generally poor...
May 9, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29738093/acute-kidney-injury-epidemiology-outcomes-complications-and-therapeutic-strategies
#3
REVIEW
Shigeo Negi, Daisuke Koreeda, Sou Kobayashi, Takuro Yano, Koichi Tatsuta, Toru Mima, Takashi Shigematsu, Masaki Ohya
Acute kidney injury (AKI) is one of the most common serious complications for all hospital admissions, with its incidence increasing among hospitalized patients, particularly those in the intensive care unit. Despite significant improvements in critical care and dialysis technology, AKI is associated with an increased risk of short- and long-term mortality, prolonged hospital stays, and dialysis dependence. These risks are particularly relevant for critically ill patients with AKI severe enough to require renal replacement therapy (RRT)...
May 8, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29736915/planning-and-evaluation-for-vascular-access-in-the-elderly
#4
Candice Halinski, Holly M Koncicki
Vascular access is of vital importance for patients requiring dialysis therapies. AV fistulas have been endorsed by many professional societies as the access of choice, however, subsequent creation does not go without consequences. As the population ages and patients become more medically complex, access failure has become a major cause of treatment complication. For the elderly, this is especially true and there are multiple decision points that require careful reflection before an AVF is placed. This article reviews access considerations for AVF placement in the elderly population and considers the possibility that the fistula first approach to vascular access should not be an absolute...
May 8, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29737013/incremental-dialysis-for-preserving-residual-kidney-function-does-one-size-fit-all-when-initiating-dialysis
#5
Anna T Mathew, Yoshitsugu Obi, Connie M Rhee, Jason A Chou, Kamyar Kalantar-Zadeh
While many patients have substantial residual kidney function (RKF) when initiating hemodialysis (HD), most patients with end stage renal disease in the United States are initiated on 3-times per week conventional HD regimen, with little regard to RKF or patient preference. RKF is associated with many benefits including survival, volume control, solute clearance, and reduced inflammation. Several strategies have been recommended to preserve RKF after HD initiation, including an incremental approach to HD initiation...
May 7, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29733462/current-and-potential-therapeutic-strategies-for-the-management-of-vascular-calcification-in-patients-with-chronic-kidney-disease-including-those-on-dialysis
#6
REVIEW
Irene Ruderman, Stephen G Holt, Tim D Hewitson, Edward R Smith, Nigel D Toussaint
Patients with CKD have accelerated vascular stiffening contributing significantly to excess cardiovascular morbidity and mortality. Much of the arterial stiffening is thought to involve vascular calcification (VC), but the pathogenesis of this phenomenon is complex, resulting from a disruption of the balance between promoters and inhibitors of calcification in a uremic milieu, along with derangements in calcium and phosphate metabolic pathways. Management of traditional cardiovascular risk factors to reduce VC may be influential but has not been shown to significantly improve mortality...
May 7, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29722062/patient-to-patient-peer-mentor-support-in-dialysis-improving-the-patient-experience
#7
REVIEW
Paul N Bennett, Jennifer St Clair Russell, Jug Atwal, Lashone Brown, Brigitte Schiller
Greater focus on patient-reported outcome measures for dialysis patients and an increased patient engagement focus has highlighted a lack of formal patient-generated strategies. Patient-to-patient peer mentoring is one approach that may improve the outcomes for people receiving dialysis. This review aims to synthesize quantitative and qualitative studies investigating dialysis-associated patient-to-patient peer mentor support among adults with chronic kidney disease and end stage kidney disease. Research studies describe the benefits of peer mentor programs in dialysis to include: improved goal setting, decision-making and increased self-management...
May 2, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29707830/esrd-induced-dyslipidemia-should-management-of-lipid-disorders-differ-in-dialysis-patients
#8
Hamid Moradi, Elani Streja, Nosratola D Vaziri
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Although numerous modifiable risk factors in the pathogenesis of CVD and its associated mortality have been identified, dyslipidemia remains to be a key focus for therapy. In this regard, significant progress has been made in reducing cardiovascular mortality via the use of lipid-lowering agents such as HMG CoA reductase inhibitors (statins). Yet, despite the disproportionate risk of CVD and mortality in patients with advanced chronic and end stage renal disease (ESRD), treatment of dyslipidemia in this patient population has not been associated with a notable improvement in outcomes...
April 29, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29676003/does-peritoneal-dialysis-have-a-role-in-urgent-start-end-stage-kidney-disease
#9
Rory F McQuillan, Charmaine E Lok
Despite its many positive attributes, peritoneal dialysis remains underutilized, particularly in the United States. Urgent-start peritoneal dialysis (PD) has been proposed as a method of increasing PD prevalence. Urgent-start PD has been shown to be safe, feasible, and effective. However, urgent-start PD is also accompanied by several multidimensional challenges. This article is intended to equip the reader with a practical sense of whether an urgent-start PD program would be appropriate in his or her own clinical context and if appropriate, what factors would be necessary for such a program to flourish...
April 19, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29675862/hemodialysis-a-model-for-extreme-physiology-in-a-vulnerable-patient-population
#10
REVIEW
Jeroen P Kooman, Krassimir Katzarski, Frank M van der Sande, Karel M Leunissen, Peter Kotanko
Hemodialysis (HD) is a lifesaving treatment for patients with end-stage renal disease, which is very efficient in the correction of abnormalities of the internal environment. However, this efficiency also induces significant hemodynamic, thermal, and respiratory stressors. These have parallels with the extreme physiologic demands which are normally mainly experienced by healthy subjects under adverse environmental conditions, with the difference that they must be endured by a vulnerable patient population. Hemodynamic stress induced by ultrafiltration leads to a decline in circulating blood volume, which may result in intradialytic hypotension (IDH) and changes in tissue perfusion, which may have long-term consequences for the function of vital organs such as the brain and the heart...
April 19, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29671909/should-phosphate-management-be-limited-to-the-kdigo-kdoqi-guidelines
#11
Sangeet Dhillon-Jhattu, Stuart M Sprague
Hyperphosphatemia is a common complication of CKD. Prior to development of overt hyperphosphatemia, there are several adaptive mechanisms that occur to maintain normal phosphorus equilibrium in patients with CKD. These include an early and progressive rise in fibroblast growth factor 23 (FGF 23), followed by an increase in parathyroid hormone (PTH) with a decrease in 1,25-dihydroxyvitamin D (1,25 Vit D). Over the last 20 years, a large number of studies have shown that hyperphosphatemia is a strong predictor of adverse clinical outcomes including increased incidence of vascular calcification, cardiovascular disease, and all-cause mortality in both individuals with CKD as well as those with normal kidney function...
April 19, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29664556/clinical-problems-in-hemodialysis-patients-with-autosomal-dominant-polycystic-kidney-disease
#12
REVIEW
Ismail Kocyigit, Eray Eroglu, Ozkan Gungor
Autosomal dominant polycystic kidney disease (ADPKD) is a common monogenic disease characterized by massive enlargement of fluid-filled cysts in the kidney. Due to its genetic pattern, the disease differs from other CKD. ADPKD is a multi-system, progressive disorder which is frequently complicated with hypertension, cardiovascular events and cerebrovascular disease. Thus, there are many clinical problems specific to ADPKD. In this article, we reviewed these clinical problems and their management in ADPKD with hemodialysis patients...
April 17, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29659052/is-the-management-of-diabetes-different-in-dialysis-patients
#13
Silvia Coelho
Diabetes is highly and increasingly prevalent in the dialysis population and negatively impacts both quality and quantity of life. Nevertheless, the best approach to these patients is still debatable. The question of whether the management of diabetes should be different in dialysis patients does not have a clear yes or no answer but is divided into too many sub-issues that should be carefully considered. In this review, lifestyle, cardiovascular risk, and hyperglycemia management are explored, emphasizing the possible pros and cons of a similar approach to diabetes in dialysis patients compared to the general population...
April 16, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29652109/an-aspirational-diet-for-dialysis-patients-evidence-and-theory
#14
REVIEW
Jaime Uribarri
Dialytic renal replacement therapy is now entering into its sixth decade in the United States. Despite major advances in dialysis technology, regimens and protocols, and pharmacological treatments, patients' restricted dietary intake remains the lynchpin to their well-being and success. Herein, we review current guidelines that limit dietary intake of nutrients and minerals in dialysis patients and explore potential ways to use them in designing a daily food intake that is not only healthy, but also easy to implement and therefore patient friendly...
April 13, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29642268/breaking-the-cycle-of-functional-decline-in-older-dialysis-patients
#15
EDITORIAL
Rasheeda K Hall, Mara A McAdams-DeMarco
Currently, older adults comprise nearly one-third of prevalent US dialysis patients, and this proportion will increase as the population ages. Older dialysis patients experience greater morbidity and mortality than nondialysis patients of the same age, and in part, it is related to progressive functional decline. Progressive functional decline, characterized by need for assistance with more than 2 activities of daily living, contributes to risk of hospitalization, further functional decline, and subsequent nursing home placement when a patient no longer functions independently at home...
April 11, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29635792/haste-makes-waste-should-current-guideline-recommendations-for-initiation-of-renal-replacement-therapy-for-acute-kidney-injury-be-changed
#16
EDITORIAL
Jill Vanmassenhove, Raymond Vanholder, Wim Van Biesen, Norbert Lameire
There is broad consensus among guideline organizations that renal replacement therapy (RRT) should not be delayed in case of life-threatening conditions. However, in case of severe acute kidney injury (AKI) without these conditions, it is unclear whether immediate RRT has an advantage over delayed RRT. Two recently published randomized controlled trials (AKIKI and ELAIN) with seemingly opposite results have reignited the discussion whether guideline recommendations on initiation strategies in severe AKI should be adapted...
April 10, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29624739/hemodialysis-induced-cardiovascular-disease
#17
REVIEW
Shadi Ahmadmehrabi, W H Wilson Tang
More than half of all deaths among end stage renal disease (ESRD) patients are due to cardiovascular disease (CVD). Cardiovascular changes secondary to renal dysfunction, including fluid overload, uremic cardiomyopathy, secondary hyperparathyroidism, anemia, altered lipid metabolism, and accumulation of gut microbiota-derived uremic toxins like trimethylamine N-oxidase, contribute to the high risk for CVD in the ESRD population. In addition, conventional hemodialysis (HD) itself poses myocardial stress and injury on the already compromised cardiovascular system in uremic patients...
April 6, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29573025/should-we-look-beyond-kt-v-urea-in-assessing-dialysis-adequacy
#18
Clare B Jones, Joanne M Bargman
Since the advent of maintenance dialysis therapy, our interpretation of what adequate dialysis really is has broadened and become more controversial. This is not only due to our changing and aging dialysis population but also to our evolving knowledge base. As nephrologists, we strive to achieve both quality and (often) quantity of life for our patients and we feel reassured when we have a quantifiable marker to show for our efforts. However, we suggest that adequate dialysis reaches far beyond the realms of attaining a particular biochemical result...
March 23, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29539161/dialysis-modality-and-survival-done-to-death
#19
Emilie Trinh, Christopher T Chan, Jeffrey Perl
The debate surrounding whether peritoneal dialysis or hemodialysis is associated with differential survival continues as the numerous comparative studies over the past 3 decades have yielded conflicting results. Findings have also evolved over time in the setting of changing patient characteristics, advances in dialytic technologies, and the use of more robust statistical and epidemiologic approaches. Here, we will critically review the body of evidence, both historical and contemporary, comparing survival across dialysis modalities...
March 14, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29528138/when-is-more-frequent-hemodialysis-beneficial
#20
Rita S Suri, Alan S Kliger
The use of frequent hemodialysis (HD) is growing, with the hope of improving outcomes in end-stage renal disease. We narratively review the three randomized trials, 15 comparative cohort studies, and several case series of frequent HD that empirically demonstrate the potential efficacy and adverse effects of these regimens. Taken together, the randomized studies suggest frequent HD may result in left ventricular mass regression. This effect is most pronounced when left ventricular mass is abnormal, but attenuated by significant residual urine output...
March 12, 2018: Seminars in Dialysis
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