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Seminars in Dialysis

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https://www.readbyqxmd.com/read/28335077/introduction-to-the-critical-balance-residual-kidney-function-and-incremental-transition-to-dialysis
#1
Yoshitsugu Obi, Jason Chou, Kamyar Kalantar-Zadeh
No abstract text is available yet for this article.
March 23, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28332217/imaging-for-vascular-calcification
#2
Paolo Raggi, W Charles O'Neill
Chronic decline in renal function is accompanied by deterioration of bone structure and function and progressive calcification of the vascular system. Both disease states have been linked with increased morbidity and mortality in chronic kidney disease. The severe alterations of mineral metabolism inherent with loss of renal function have an impact on vascular calcification development and progression, and several investigators have focused on ways to reduce their impact on vascular health. Imaging has contributed an important role in the assessment of vascular calcification, and the impact of various interventions aimed at curbing their progression...
March 22, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28326604/cardiac-imaging-in-chronic-kidney-disease-patients
#3
Paolo Raggi, Nikolaos Alexopoulos
Cardiovascular disease is highly prevalent and it is associated with high morbidity and mortality rates in patients with chronic kidney disease (CKD). The implementation of various imaging modalities may help to risk stratify these patients with a potential ease on the burden of complications and the rising costs of care. In this article we review some of the modern imaging techniques to diagnose cardiac disease in patients affected by CKD.
March 21, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28295607/incremental-hemodialysis-the-university-of-california-irvine-experience
#4
Mehrdad Ghahremani-Ghajar, Vanessa Rojas-Bautista, Wei-Ling Lau, Madeleine Pahl, Miguel Hernandez, Anna Jin, Uttam Reddy, Jason Chou, Yoshitsugu Obi, Kamyar Kalantar-Zadeh, Connie M Rhee
Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen...
March 14, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28281281/hemodialysis-disparities-in-african-americans-the-deeply-integrated-concept-of-race-in-the-social-fabric-of-our-society
#5
REVIEW
Keith C Norris, Sandra F Williams, Connie M Rhee, Susanne B Nicholas, Csaba P Kovesdy, Kamyar Kalantar-Zadeh, L Ebony Boulware
End-stage renal disease (ESRD) is one of the starkest examples of racial/ethnic disparities in health. Racial/ethnic minorities are 1.5 to nearly 4 times more likely than their non-Hispanic White counterparts to require renal replacement therapy (RRT), with African Americans suffering from the highest rates of ESRD. Despite improvements over the last 25 years, substantial racial differences are persistent in dialysis quality measures such as RRT modality options, dialysis adequacy, anemia, mineral and bone disease, vascular access, and pre-ESRD care...
March 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28264226/dialysis-related-amyloidosis-is-it-gone-or-should-it-be
#6
EDITORIAL
Laura Labriola, Michel Jadoul
The prevalence and severity of dialysis-related amyloidosis (DRA) appear to have decreased significantly over the last two decades, although recent, large-scale epidemiological studies show that DRA continues to occur. Recent experimental findings have documented a direct cellular toxicity of β2microglobulin (β2m) fibrils but the mechanisms of β2m fibrillogenesis remain incompletely understood. Although a high plasma concentration of β2m is still considered as a prerequisite for developing DRA, other factors have been clearly incriminated such as older age at dialysis onset and longer dialysis vintage, or suspected effects such as proinflammatory effects of bioincompatible dialysis techniques...
March 6, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28264150/blood-pressure-management-in-hemodialysis-patients-what-we-know-and-what-questions-remain
#7
REVIEW
Dana C Miskulin, Daniel E Weiner
Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in the dialysis unit. However, we do not know if using home vs. in-center measurements to guide treatment decisions improves BP control and/or clinical outcomes. Moreover, a recent US study suggests that typical hemodialysis patients are unlikely to adhere to home monitoring over the long term...
March 6, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28264139/residual-kidney-function-implications-in-the-era-of-personalized-medicine
#8
Tariq Shafi, Surekha Mullangi, Stephanie M Toth-Manikowski, Seungyoung Hwang, Wieneke M Michels
The association of residual kidney function (RKF) with improved outcomes in peritoneal dialysis and hemodialysis patients is now widely recognized. RKF provides substantial volume and solute clearance even after dialysis initiation. In particular, RKF provides clearance of nonurea solutes, many of which are potential uremic toxins and not effectively removed by conventional hemodialysis. The presence of RKF provides a distinct advantage to incident dialysis patients and is an opportunity for nephrologists to individualize dialysis treatments tailored to their patients' unique solute, volume, and quality of life needs...
March 6, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28240423/nutritional-issues-with-incremental-dialysis-the-role-of-low-protein-diets
#9
Francesco Locatelli, Lucia Del Vecchio, Valeria Aicardi
A gentle start of dialysis is a welcome possibility for both patients and physicians. Incident dialysis patients often maintain residual kidney function (RKF) for a considerable period of time; the start of dialysis is often driven mainly by uremic symptoms. Recently, the combination of a low-protein diet, along with a less-frequent dialysis schedule, has regained interest as an alternative option in selected and motivated patients. In addition, there is renewed interest in a low-protein diet in patients with moderate to advanced chronic kidney disease (CKD)...
February 27, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28239994/aortic-stenosis-in-dialysis-patients
#10
REVIEW
Yousif Ahmad, Michael F Bellamy, Christopher S R Baker
Aortic valve stenosis occurs 10-20 years earlier in patients on dialysis compared with the general population. This is likely related to the exposure of the valve to a milieu that predisposes to calcification as well as increased shear stress across the valve. Objective assessment of stenosis severity is largely made using echocardiography though accurate interpretation requires an understanding of the potential pitfalls of the technique and the influence of cardiac output upon the gradient measured across the valve...
February 26, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28239979/beyond-sodium-phosphate-and-potassium-potential-dietary-interventions-in-kidney-disease
#11
EDITORIAL
Jaimon T Kelly, Megan Rossi, David W Johnson, Katrina L Campbell
People with kidney disease are advised to restrict individual nutrients, such as sodium, potassium, and phosphate, in line with current best practice guidelines. However, there is limited evidence to support the efficacy of single nutrient strategies, and compliance remains a challenge for clinicians to overcome. Many factors contribute to poor compliance with dietary prescriptions, including conflicting priorities for single nutrient restriction, the arduous self-monitoring required, and the health-related knock-on effects resulting from targeting these nutrients in isolation...
February 26, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28229483/venous-hemodialysis-catheters-and-cardiac-implantable-electronic-devices-avoiding-a-high-risk-combination
#12
EDITORIAL
Theodore F Saad, Henry L Weiner
End-stage renal disease is frequently accompanied by cardiac comorbidity that warrants treatment with a cardiovascular implantable electronic device (permanent pacemaker or implantable cardioverter-defibrillator). In the United States, chronic hemodialysis (HD) population, cardiac implantable devices are present in up to 10.5% of patients; a venous HD catheter is utilized for blood access in 18% of prevalent patients. The concomitant presence of a venous HD catheter and cardiovascular implantable device creates a high-risk circumstance, with potential for causing symptomatic central venous stenosis, and for developing complicated endovascular infection...
February 23, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28194810/assessing-the-adequacy-of-small-solute-clearance-for-various-dialysis-modalities-with-inclusion-of-residual-native-kidney-function
#13
Andrew I Chin, Thomas A Depner, John T Daugirdas
Measurement of small molecule clearance remains important in the clinical care of patients requiring long-term dialysis. Many patients maintain a significant degree of residual native kidney function and may have nontraditional schedules with or without combined dialysis modalities. In this review, we examine and outline methods for comparing small molecule clearances among various dialysis prescriptions and modalities, with inclusion of residual kidney urea clearance.
February 14, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28185299/incremental-hemodialysis-a-european-perspective
#14
Kamonwan Tangvoraphonkchai, Andrew Davenport
Most patients initiating hemodialysis have residual renal function (RRF). Whereas RRF is monitored prior to commencing hemodialysis, once dialysis is started most centres simply rely on dialyzer urea clearance to determine adequate uremic toxin clearance and disregard the effect of RRF. However sustaining RRF is important for the dialysis patient, as RRF reduces inter-dialytic weight gains, increases middle molecule and protein bound toxin clearances and is associated with better quality of life assessments...
February 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28155246/introduction-to-30%C3%A2-years-lessons-learned-in-dialysis
#15
Allen R Nissenson, Rajnish Mehrotra
No abstract text is available yet for this article.
February 2, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28144977/changing-landscape-for-peritoneal-dialysis-optimizing-utilization
#16
Martin J Schreiber
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation...
February 1, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28083917/target-based-anemia-management-with-erythropoiesis-stimulating-agents-risks-and-benefits-relearned-and-iron-still-more-to-learn
#17
John C Stivelman
The FDA first licensed erythropoiesis stimulating agents (ESA) for use in patients with ESRD in 1989. Hemoglobin targets for treatment with ESAs were established at the outset on the basis of descriptive pre-ESA literature and Phase I-III data in patients with ESRD. Postrelease literature in ESA-treated patients accumulating over time initially supported improvement in indices of both cardiovascular and other organ function as well as quality of life with therapy. Recommended treatment targets for hemoglobin would evolve further in the United States from four iterations of evidence- and opinion-based practice guidelines appearing between 1997 and 2007...
January 12, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28074616/is-hemodialysis-patient-survival-dependent-upon-small-solute-clearance-kt-v-if-so-how-can-kt-v-be-adjusted-to-prevent-under-dialysis-in-vulnerable-groups
#18
Andrew Davenport
Small solute clearance achieved during a single hemodialysis session has been traditionally evaluated by urea clearance, normalized for total body water (Kt/Vurea) for more than 30 years. By consensus, the target sessional KtVurea for thrice weekly treatments has been increased from 0.9 to 1.2 over the years. Although this is supported by observational studies, there is a fundamental lack of prospective studies to support this threshold target. In clinical practice achieving sessional Kt/Vurea targets are most closely followed in the US...
January 11, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28066932/reuse-and-biocompatibility-of-hemodialysis-membranes-clinically-relevant
#19
Ashish Upadhyay, Bertrand L Jaber
The practice of reprocessing dialyzers for reuse, once predominant in the United States, has been steadily declining over the last 20 years. The professed roles of reuse in improving dialyzer membrane biocompatibility and lowering the risk of first-use syndrome have lost relevance with the advent of biocompatible dialyzer membranes and favorable sterilization techniques. The potential for cost-savings from reuse is also called into question by the easy availability of comparatively cheaper dialyzers and rising regulatory demands and operational cost of reprocessing systems...
January 8, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28066927/dialysate-composition-for-hemodialysis-changes-and-changing-risk
#20
Rita L McGill, Daniel E Weiner
Dialysate composition is a critical aspect of the hemodialysis prescription. Despite this, trial data are almost entirely lacking to help guide the optimal dialysate composition. Often, the concentrations of key components are chosen intuitively, and dialysate composition may be determined by default based on dialysate manufacturer specifications or hemodialysis facility practices. In this review, we examine the current epidemiological evidence guiding selection of dialysate bicarbonate, calcium, magnesium, and potassium, and identify unresolved issues for which pragmatic clinical trials are needed...
January 8, 2017: Seminars in Dialysis
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