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Seminars in Dialysis

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https://www.readbyqxmd.com/read/28707330/the-impact-of-dialysis-modality-and-membrane-characteristics-on-intradialytic-hypotension
#1
Samir Patel, Jochen G Raimann, Peter Kotanko
The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published in English that investigated the association between IDH and dialysis modality and membrane, respectively. This literature search revealed 669 publications on dialysis modality, 64 on dialysis membrane, and 24 on acetate/bicarbonate dialysate...
July 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28707302/dialysate-sodium-and-intradialytic-hypotension
#2
Wael F Hussein, Brigitte Schiller
Intradialytic hypotension (IDH) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain (IDWG), high ultrafiltration rates (UFR), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D-Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG, UFR, and hypertension...
July 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28699181/predicting-in-a-predicament-stroke-and-hemorrhage-risk-prediction-in-dialysis-patients-with-atrial-fibrillation
#3
REVIEW
Amber O Molnar, Manish M Sood
Whether to anticoagulate dialysis patients with atrial fibrillation is a common clinical dilemma with limited high-quality data to inform decision-making. While the efficacy and safety of anticoagulation for stroke prevention in dialysis patients with atrial fibrillation has long been debated and remains unclear, the more upstream issue of stroke risk assessment from atrial fibrillation has received relatively little attention. In the general population, a handful of risk scores to help predict stroke and hemorrhage risk in the setting of atrial fibrillation are widely validated and applied in clinical practice...
July 11, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28691402/osmolality-and-blood-pressure-stability-during-hemodialysis
#4
Anika T Singh, Finnian R Mc Causland
Homeostatic regulation of plasma osmolality (POsm) is critical for normal cellular function in humans. Arginine vasopressin (AVP) is the major hormone responsible for the maintenance of POsm and acts to promote renal water retention in conditions of increased POsm. However, AVP also exerts pressor effects, and its release can be stimulated by the development of effective arterial blood volume depletion. Patients with end-stage renal disease on hemodialysis, particularly those with minimal or no residual renal function, have impaired ability to regulate water retention in response to AVP...
July 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28691195/definitions-of-intradialytic-hypotension
#5
Magdalene M Assimon, Jennifer E Flythe
Intradialytic hypotension (IDH) is a common and often distressful complication of hemodialysis. However, despite its clinical significance, there is no consensus, evidence-based medical definition for the condition. Over the years, numerous definitions have been implemented in both the clinical and research settings. Definition inconsistencies have hindered data synthesis and the development of evidence-based guidelines for the prevention and treatment of IDH, as well as prevented accurate estimation of the population burden of IDH and patient risk assessment...
July 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28681510/impact-of-drugs-on-intradialytic-hypotension-antihypertensives-and-vasoconstrictors
#6
Tara I Chang
Intradialytic hypotension (IDH) is a common complication of hemodialysis and is associated with numerous adverse outcomes including cardiovascular events, inadequate dialysis, loss of vascular access, and death. It is estimated that approximately 20%-30% of all dialysis sessions are affected by IDH. In seeking ways to reduce the occurrence of IDH, dialysis providers often turn to pharmacological approaches: withholding antihypertensive medications prior to hemodialysis or administering vasoconstrictor medications...
July 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28677243/parathyroidectomy-a-last-resort-for-hyperparathyroidism-in-dialysis-patients
#7
EDITORIAL
Amr El-Husseini, Kevin Wang, Adeleye Annick Edon, B Peter Sawaya
Despite advancements in the medical management of secondary hyperparathyroidism, parathyroidectomy is still necessarily in some patients. However, patients' selection, optimal surgical intervention and long-term outcome are still not well-defined and very challenging for the practicing nephrologists. In this manuscript we will attempt to answer several questions related to parathyroidectomy in dialysis patients. We will discuss the indications, the appropriate parathyroidectomy surgical techniques and current guidelines for parathyroidectomy...
July 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666082/intradialytic-hypotension-in-acute-kidney-injury-requiring-renal-replacement-therapy
#8
Shilpa Sharma, Sushrut S Waikar
The treatment of severe acute kidney injury (AKI) with dialytic support for renal replacement therapy can be life sustaining and permit recovery from critical illness. Like any interventional therapy, however, renal replacement therapy with intermittent hemodialysis or continuous therapy can cause complications. Intradialytic hypotension is a common complication and can cause further ischemic injury to the recovering kidneys, thereby reducing the probability of renal recovery. The optimal dialytic technique-continuous or intermittent-has not been conclusively demonstrated in randomized controlled trials...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666075/the-effect-of-treatment-time-dialysis-frequency-and-ultrafiltration-rate-on-intradialytic-hypotension
#9
George R Aronoff
Dialysis treatment time, the frequency of dialysis treatments, and the rate of fluid ultrafiltration-each impacts the incidence of intradialytic hypotension. These factors influence blood pressure independently and together. The strongest evidence supports that rapid ultrafiltration increases the likelihood of intradialytic hypotension and that combined strategies leading to a reduction in ultrafiltration rate have the greatest impact on reducing intradialytic hypotension. A practical approach to avoiding the effects of ultrafiltration on systemic hemodynamics would be to set a maximum ultrafiltration rate needed to achieve the desired fluid removal and vary the duration of the treatment to achieve that target volume...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666073/to-cool-or-too-cool-is-reducing-dialysate-temperature-the-optimal-approach-to-preventing-intradialytic-hypotension
#10
John W Larkin, Marta M Reviriego-Mendoza, Len A Usvyat, Peter Kotanko, Franklin W Maddux
Abnormal decreases in blood pressure during hemodialysis are frequent in end stage renal disease (ESRD) patients treated with hemodialysis, and thought to be largely due to an inadequate cardiovascular response to the rapid blood volume decline. Intradialytic hypotension (IDH) and cardiac instability during dialysis can increase risks for negative health consequences and is possibly preventable though several types of interventions. One intervention that holds promise for prevention of IDH in hemodialysis patients is to reduce the temperature of the dialysate to or below the patient's core temperature...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666072/special-situations-intradialytic-hypertension-chronic-hypertension-and-intradialytic-hypotension
#11
Peter Noel Van Buren, Jula K Inrig
Hypertension is a comorbidity that is present in the majority of end-stage renal disease patients on maintenance hemodialysis. This population is particularly unique because of the dynamic nature of blood pressure (BP) during dialysis. Modest BP decreases are expected in most hemodialysis patients, but intradialytic hypotension and intradialytic hypertension are two special situations that deviate from this as either an exaggerated or paradoxical response to the dialysis procedure. Both of these phenomena are particularly important because they are associated with increased mortality risk compared to patients with modest decreases in BP during dialysis...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666069/setting-the-dry-weight-and-its-cardiovascular-implications
#12
Arjun D Sinha, Rajiv Agarwal
Volume overload is common and associated with adverse outcomes in the hemodialysis population including systemic hypertension, pulmonary hypertension, left ventricular hypertrophy, and mortality. Since the beginning of the era of maintenance dialysis, prescribing and maintaining a dry weight remains the standard of care for managing volume overload on hemodialysis. Reducing dry weight even by relatively small amounts has been shown to improve blood pressure and has been associated with reductions in left ventricular hypertrophy...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28661565/a-brief-review-of-intradialytic-hypotension-with-a-focus-on-survival
#13
Jason A Chou, Kamyar Kalantar-Zadeh, Anna T Mathew
Intradialytic hypotension (IDH), a common complication of ultrafiltration during hemodialysis therapy, is associated with high mortality and morbidity. IDH, defined as a nadir systolic blood pressure of less than 90 mm Hg on more than 30% of treatments, is a relevant definition and is correlated with mortality. Risk factors for IDH include patient demographics, anti-hypertensive medication use, larger interdialytic weight gain, and dialysis prescription features as dialysate sodium, high ultrafiltration rate, and dialysate temperature...
June 29, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28628255/still-a-reasonable-goal-targeting-cholesterol-in-dialysis-and-advanced-chronic-kidney-disease-patients
#14
EDITORIAL
Gunnar H Heine, Kyrill S Rogacev, Oliver Weingärtner, Gunther Marsche
Chronic kidney disease (CKD) patients have a high burden of cardiovascular disease. In the general population, lipid metabolism disorders, which cause the initiation and progression of atherosclerotic vascular changes, are major targets for preventive and therapeutic strategies in cardiovascular medicine. However, data from large cohort studies and from clinical trials suggest that the treatment guidelines on cardiovascular disease prevention and therapy cannot uncritically be transferred from individuals with intact renal function to CKD patients...
June 19, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28628236/blastomyces-dermatitidis-peritonitis-complicating-peritoneal-dialysis
#15
Yogesh Sanghvi, Douglas Somers
Fungal peritonitis is an uncommon complication in peritoneal dialysis patients. We report a case of blastomyces dermatitis peritonitis in a nonimmunocompromised peritoneal dialysis patient, who initially presented with symptoms of lower extremity weakness and altered mental status. Peritoneal blastomycosis is rare condition and not previously reported in end stage renal disease patients on peritoneal dialysis. Fungal peritonitis can present with subtle clinical findings so a high index of suspicion is needed as early detection and treatment may decrease mortality and morbidity...
June 19, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28609017/clinical-aspects-of-magnesium-physiology-in-patients-on-dialysis
#16
REVIEW
Paraish S Misra, Sharon J Nessim
Magnesium balance is infrequently discussed in the dialysis population, and the clinical consequences of derangements in magnesium homeostasis are incompletely understood. There is an association between hypomagnesemia and adverse outcomes including increases in cardiovascular disease and mortality, while elevated magnesium levels have also been linked with complications such as osteomalacia. In this review, we discuss the features of magnesium physiology relevant to dialysis patients and provide an updated summary of the literature linking magnesium derangements with bone disease, cardiovascular disease, sudden cardiac death, and mortality...
June 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28608994/hiv-in-the-dialysis-population-current-issues-and-future-directions
#17
REVIEW
Suzanne M Boyle, Dong H Lee, Christina M Wyatt
Antiretroviral therapy has significantly reduced mortality due to HIV infection, but the aging HIV-positive patient population now faces a growing burden of comorbidity. This review describes the changing epidemiology of chronic kidney disease and end-stage renal disease in this population, and highlights recent advances in antiretroviral therapy and kidney transplantation that directly impact the care of patients with HIV infection and end-stage renal disease.
June 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28608984/dialysis-in-the-undocumented-the-past-the-present-and-what-lies-ahead
#18
EDITORIAL
Shruti Gupta, Andrew Z Fenves
In many states undocumented immigrants with end stage renal disease (ESRD) do not have access to regular, thrice weekly dialysis. The term "compassionate dialysis" is used to describe dialysis that is provided on an emergent basis, when patients are in extremis from symptoms of volume overload or suffer from life-threatening electrolyte abnormalities. In this editorial, one particularly poignant anecdote is presented from the experience of one of the authors (AZF) as a nephrologist in Texas, a state where undocumented immigrants have faced difficulties in accessing regular dialysis...
June 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28608981/health-related-quality-of-life-of-patients-on-chronic-dialysis-the-need-for-a-focused-effort
#19
EDITORIAL
Maurizio Bossola, Gilda Pepe, Emanuele Marzetti
Health-related quality of life (HRQOL) in patients on chronic hemodialysis has not improved significantly in the last 20 years. This is largely due to their substantial symptom burden which is rarely assessed and treated in routine clinical practice. It also is a consequence of the lack of an appropriate armamentarium for the treatments of such symptoms. Adequate studies on the causes and pathogenesis of the symptoms of hemodialysis patients are needed followed by high quality studies on possible therapeutic pharmacological and nonpharmacological interventions...
June 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28608938/when-the-hero-becomes-the-villain
#20
Patrick Onkka, Roger Rodby
No abstract text is available yet for this article.
June 13, 2017: Seminars in Dialysis
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