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Intradialytic hypotension

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https://www.readbyqxmd.com/read/28501302/measuring-the-patient-response-to-dialysis-therapy-hemodiafiltration-and-clinical-trials
#1
Mark R Marshall
There is a strong biological plausibility for benefit from removal of larger uremic toxins and increasing positive clinical experience with hemodiafiltration. However, evidence supporting hemodiafiltration is not definitive with studies that are often limited by serious methodological shortcomings. Morena et al. show that hemodiafiltration may prevent intradialytic hypotension, albeit in a study that also has some shortcomings. Ongoing research for hemodiafiltration is still needed through high-quality clinical trials that adhere to standards for clinical trial conduct and reporting...
June 2017: Kidney International
https://www.readbyqxmd.com/read/28483384/-online-hemodiafiltration-practical-aspects-safety-and-efficacy
#2
Bernard Canaud, Leïla Chénine, Hélène Leray-Moraguès, Laure Patrier, Annie Rodriguez, A Gontier-Picard, Marion Moréna
Purification of high molecular uremic toxins by conventional hemodialysis is limited. It remains associated with a high morbidity and excessively high mortality. Online hemodiafiltration using a high permeability hemodiafilter, an ultrapure dialysate, and which tends to maximize substitution volumes, provides a high efficiency and low bio-incompatibility renal supplementation. Regular use of online hemodiafiltration is associated with reduced morbidity (reduction of intradialytic hypotension episodes, improved blood pressure control, reduced inflammatory profile, better anemia correction and prevention of β2-microglobulin-associated amyloidosis)...
May 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28469119/blood-pressure-variation-and-its-correlates-among-patients-undergoing-hemodialysis-for-renal-failure-in-benin-city-nigeria
#3
Enajite I Okaka, Chimezie G Okwuonu
BACKGROUND: Blood pressure (BP) variation is commonly encountered during hemodialysis (HD) procedure. Both intradialysis hypotension and hypertension have implications for outcome of treatment and overall morbidity and mortality of the patients. METHODOLOGY: A retrospective study was carried out in the dialysis unit of a tertiary health institution in Benin City among patients who had HD for acute kidney injury (AKI) or chronic kidney disease (CKD) over a 3-year period...
April 2017: Annals of African Medicine
https://www.readbyqxmd.com/read/28444336/intradialytic-hypotension-blood-pressure-changes-and-mortality-risk-in-incident-hemodialysis-patients
#4
Jason A Chou, Elani Streja, Danh V Nguyen, Connie M Rhee, Yoshitsugu Obi, Jula K Inrig, Alpesh Amin, Csaba P Kovesdy, John J Sim, Kamyar Kalantar-Zadeh
Background.: Intradialytic hypotension (IDH) occurs frequently in maintenance hemodialysis (HD) patients and may be associated with higher mortality. We hypothesize that nadir intradialytic systolic blood pressure (niSBP) is inversely related to death risk while iSBP change (Δ) and IDH frequency are incrementally associated with all-cause mortality. Methods.: In a US-based cohort of 112 013 incident HD patients over a 5-year period (2007-11), using niSBP, ΔiSBP (pre-HD SBP minus niSBP) and IDH frequency (proportion of HD treatments with niSBP <90 mmHg) within the first 91 days of HD, we examined mortality-predictability at 1, 2 and 5 years using Cox models and restricted cubic splines adjusted for case-mix, comorbidities and laboratory covariates...
April 21, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28413417/the-dialysis-sodium-gradient-a-modifiable-risk-factor-for-fluid-overload
#5
Emilie Trinh, Catherine Weber
BACKGROUND: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate the 6-month risk of hospitalization and mortality in relation to sodium gradient. METHODS: We performed a cross-sectional study of 110 prevalent conventional hemodialysis patients at a single center...
January 2017: Nephron Extra
https://www.readbyqxmd.com/read/28407637/pneumatic-compression-but-not-exercise-can-avoid-intradialytic-hypotension-a-randomized-trial
#6
Valeria R C Álvares, Camila D Ramos, Benedito J Pereira, Ana Lucia Pinto, Rosa M A Moysés, Bruno Gualano, Rosilene M Elias
BACKGROUND: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. METHODS: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min...
2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28399019/pathophysiology-and-implications-of-intradialytic-hypertension
#7
Peter Noel Van Buren
PURPOSE OF REVIEW: Intradialytic hypertension occurs regularly in 10--15% of hemodialysis patients. A large observational study recently showed that intradialytic hypertension of any magnitude increased mortality risk comparable to the most severe degrees of intradialytic hypotension. The present review review discusses the most recent evidence underlying the pathophysiology of intradialytic hypertension and implications for its management. RECENT FINDINGS: Patients with intradialytic hypertension typically have small interdialytic weight gains, but bioimpedance spectroscopy shows these patients have significant chronic extracellular volume excess...
April 8, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28359656/in-center-nocturnal-hemodialysis-versus-conventional-hemodialysis-a-systematic-review-of-the-evidence
#8
Ben Wong, David Collister, Maliha Muneer, Dale Storie, Mark Courtney, Anita Lloyd, Sandra Campbell, Robert P Pauly
BACKGROUND: Owing to its longer treatment duration-up to 8 hours per dialysis treatment-in-center thrice-weekly nocturnal hemodialysis (HD) is receiving greater attention. To better understand the evidence for in-center nocturnal HD, we sought to systematically review the literature to determine the effects of in-center nocturnal HD versus conventional HD on clinically relevant outcomes. STUDY DESIGN: We searched MEDLINE, Embase, Evidence-Based Medicine Reviews (EBMR), Web of Science, and Scopus from the earliest date in the database to November 2016...
March 27, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28352013/factors-influencing-patency-of-brescia-cimino-arteriovenous-fistulas-in-hemodialysis-patients
#9
Venu Manne, Surya Prakash Vaddi, Vijaya Bhaskar Reddy, Sridhar Dayapule
Autologous arteriovenous fistula is gold standard to maintain vascular access for hemodialysis patients. As per the Kidney Disease Outcomes Quality Initiative guidelines, distal veins are preferred as the first choice. In this study, a total of 134 patients and 138 fistulas were evaluated from April 2015 to March 2016. Demographic factors and clinical factors were taken into consideration. Our study showed that age, sex, diabetes, and type of construction (end-to-side vs. side-to-side) had no influence over fistula patency rates...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28337715/is-incremental-hemodialysis-ready-to-return-on-the-scene-from-empiricism-to-kinetic-modelling
#10
REVIEW
Carlo Basile, Francesco Gaetano Casino, Kamyar Kalantar-Zadeh
Most people who make the transition to maintenance dialysis therapy are treated with a fixed dose thrice-weekly hemodialysis regimen without considering their residual kidney function (RKF). The RKF provides effective and naturally continuous clearance of both small and middle molecules, plays a major role in metabolic homeostasis, nutritional status, and cardiovascular health, and aids in fluid management. The RKF is associated with better patient survival and greater health-related quality of life, although these effects may be confounded by patient comorbidities...
March 23, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28318624/treatment-tolerance-and-patient-reported-outcomes-favor-online-hemodiafiltration-compared-to%C3%A2-high-flux%C3%A2-hemodialysis-in-the-elderly
#11
Marion Morena, Audrey Jaussent, Lotfi Chalabi, Hélène Leray-Moragues, Leila Chenine, Alain Debure, Damien Thibaudin, Lynda Azzouz, Laure Patrier, Francois Maurice, Philippe Nicoud, Claude Durand, Bruno Seigneuric, Anne-Marie Dupuy, Marie-Christine Picot, Jean-Paul Cristol, Bernard Canaud
Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration...
June 2017: Kidney International
https://www.readbyqxmd.com/read/28296033/predictors-of-post-hospitalization-recovery-of-renal-function-among-patients-with-acute-kidney-injury-requiring-dialysis
#12
Russell Pajewski, Patrick Gipson, Michael Heung
INTRODUCTION: Acute kidney injury (AKI) requiring dialysis complicates 1% of all hospital admissions, and up to 30% of survivors will still require dialysis at hospital discharge. There is a paucity of data to describe the postdischarge outcomes or to guide evidence-based dialysis management of this vulnerable population. METHODS: Single-center, retrospective analysis of 100 consecutive patients with AKI who survived to hospital discharge and required outpatient dialysis...
March 13, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28270412/relationship-between-hypotension-and-cerebral-ischemia-during-hemodialysis
#13
Clare MacEwen, Sheera Sutherland, Jonathan Daly, Christopher Pugh, Lionel Tarassenko
The relationship between BP and downstream ischemia during hemodialysis has not been characterized. We studied the dynamic relationship between BP, real-time symptoms, and cerebral oxygenation during hemodialysis, using continuous BP and cerebral oxygenation measurements prospectively gathered from 635 real-world hemodialysis sessions in 58 prevalent patients. We examined the relationship between BP and cerebral ischemia (relative drop in cerebral saturation >15%) and explored the lower limit of cerebral autoregulation at patient and population levels...
March 7, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28264150/blood-pressure-management-in-hemodialysis-patients-what-we-know-and-what-questions-remain
#14
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...
May 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28185407/effects-of-sodium-concentration-and-dialysate-temperature-changes-on-blood-pressure-in-hemodialysis-patients-a-randomized-triple-blind-crossover-clinical-trial
#15
Hossein Ebrahimi, Mahboobeh Safavi, Marzieh Hossein Saeidi, Mohammad Hassan Emamian
The present study investigated the effects of different temperatures and sodium dialysate concentration on blood pressure in hemodialysis patients. Following Williams' design, hemodialysis patients were randomly assigned into four dialysis modes. Dialysate temperature was set at 37°C for modes A and C and, 35°C for modes B and D. Sodium concentration was set at 138 mmol/L in modes A and B, while it changed from 150 mmol/L to 138 mmol/L in modes C and D. Using analysis of variance for repeated measures, the mean values of systolic and diastolic blood pressure were investigated...
February 10, 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28134403/-hfr-aequilibrium-can-be-an-answer-to-malnutrition-and-hypotension-in-dialisys-case-report
#16
Isabella Corino, Paolo Ria, Nicoletta Pertica, Gianluigi Zaza, Antonio Lupo
The interdialytic hypotension is still the most frequent complication during the hemodialysis. A-HFR has dynamic profiles of ultrafiltration and conductivity of the dialysate that ensure a better refilling and reduce compliance during the dialysis treatment, furthermore reduce the amino acid loss and has a lower inflammatory effect. In our Center, we wanted to analyze the impact of this kind of dialysis on intradialytic tolerance and nutritional status in two malnourished patients with encouraging data on the use of AHFR in malnutrition and disequilibrium syndromes...
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28120381/use-of-ultrasound-by-registered-nurses-a-systematic-literature-review
#17
REVIEW
Ulrich Steinwandel, Nicholas P Gibson, James Charles Rippey, Amanda Towell, Johan Rosman
BACKGROUND: In Western Australia (WA), most stable patients undergoing haemodialysis receive treatment in a satellite setting where no doctors are on-site during treatment hours, so nurses must make critical decisions about fluid removal. Some patients regularly experience adverse events during dialysis (intradialytic), often due to excessive ultrafiltration goals, with intradialytic hypotension being particularly challenging. Ultrasound of the inferior vena cava has been previously demonstrated being a rapid and non-invasive method for volume assessment on haemodialysis patients, thus could hold valuable information for the treating nurse...
January 25, 2017: Journal of Renal Care
https://www.readbyqxmd.com/read/28098098/a-study-of-clinical-assessment-of-frailty-in-patients-on-maintenance-hemodialysis-supported-by-cashless-government-scheme
#18
Manjusha Yadla, Jyothi Priyadarshini John, Mahesh Mummadi
This is a prospective cohort study to assess the prevalence of frailty in patients undergoing maintenance hemodialysis (HD) under the government-funded scheme at our center and to assess the relationship between frailty and falls, hospitalizations, and mortality. This was done at our center which is completely supported by the government, which provides HD to all the patients under poverty line. Epidemiological data, anthropometric measurements, comorbidities assessment, frailty assessment using Fried criteria, subsequent hospitalizations, falls, and mortality were recorded in our prevalent dialysis population at our center between October 2014 and October 2015...
January 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28024931/a-randomized-single-blind-crossover-trial-of-recovery-time-in-high-flux-hemodialysis-and-hemodiafiltration
#19
James R Smith, Norica Zimmer, Elizabeth Bell, Bernard G Francq, Alex McConnachie, Robert Mactier
BACKGROUND: The choice between hemodiafiltration (HDF) or high-flux hemodialysis (HD) to treat end-stage kidney disease remains a matter of debate. The duration of recovery time after treatment has been associated with mortality, affects quality of life, and may therefore be important in informing patient choice. We aimed to establish whether recovery time is influenced by treatment with HDF or HD. STUDY DESIGN: Randomized patient-blinded crossover trial. SETTINGS & PARTICIPANTS: 100 patients with end-stage kidney disease were enrolled from 2 satellite dialysis units in Glasgow, United Kingdom...
December 23, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27951544/haemodiafiltration-at-higher-volumes-and-patient-survival
#20
Francesco Locatelli, Lucia Del Vecchio, Vincenzo La Milia
Patient morbidity and mortality rates are still very high in standard low-flux haemodialysis (lf-HD). On-line haemodiafiltration (OL-HDF) is considered the most efficient dialysis technique, as clearances of small solutes, like urea, may be even higher than in lf-HD and clearances of middle solutes, like β2-microglobulin, are much higher than in lf-HD. OL-HDF has been suggested to reduce mortality compared to HD, possibly due to more effective removal of larger uraemic retention solutes and/or better fluid removal...
2017: Contributions to Nephrology
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