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Himmele Rainer

Bolesław Rutkowski, Paul Tam, Frank M van der Sande, Andreas Vychytil, Vedat Schwenger, Rainer Himmele, Adelheid Gauly
BACKGROUND: Peritoneal dialysis (PD) solutions with reduced sodium content may have advantages for hypertensive patients; however, they have lower osmolarity and solvent drag, so the achieved Kt/Vurea may be lower. Furthermore, the increased transperitoneal membrane sodium gradient can influence sodium balance with consequences for blood pressure (BP) control. STUDY DESIGN: Prospective, randomized, double-blind clinical trial to prove the noninferiority of total weekly Kt/Vurea with low-sodium versus standard-sodium PD solution, with the lower confidence limit above the clinically accepted difference of -0...
May 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jose A Diaz-Buxo, Corinne E Zeller-Knuth, Kerry Anne Rambaran, Rainer Himmele
BACKGROUND: The aim in defining the dose of HHD is to provide sufficient dialysis required to possibly 'normalize' all abnormalities associated with renal failure in order improve patient survival and quality of life. Much progress has been made in defining the dose required to accomplish this goal, but the evidence is still far from robust. The main limitations are incomplete understanding of uremic toxins, their relative importance in causing uremic symptoms, and our inability to comprehensively assess dry weight...
2015: Blood Purification
Jose A Diaz-Buxo, Sarah A White, Rainer Himmele
Increased peritoneal clearance can compensate for reductions in renal solute removal in patients receiving peritoneal dialysis (PD); however there is abundant evidence to suggest that renal rather than peritoneal clearance contributes to clinical outcomes. We review the evidence investigating the impact of residual renal function (RRF) and peritoneal solute clearances on survival and quality of life in PD patients. We also provide a comparison of the relative contribution of RRF and peritoneal clearance to patient survival...
2013: Advances in Peritoneal Dialysis
Jose A Diaz-Buxo, Sarah A White, Rainer Himmele
Conventional, thrice-weekly hemodialysis (CHD) is the most commonly prescribed dialysis regimen. Despite widespread acceptance of CHD, long-term analyses of registry data have revealed an increased risk for mortality during the long 2-day interdialytic interval of thrice-weekly therapies. High mortality rates during this period suggest that there may be a role for more frequent HD in improving patient outcomes and survival through elimination of the long interdialytic period. Several regimens have been investigated including: short, daily HD, frequent nocturnal HD, and alternate-day HD...
September 2013: Seminars in Dialysis
Conor T Hanrahan, Rainer Himmele, Jose A Diaz-Buxo
Peritoneal dialysis (PD) solutions are currently sterilized in an autoclave using high-temperature saturated steam. Although thermal methods are an effective means of sterilization, the heating of PD solutions results in the formation of toxic glucose degradation products (GDPs). Here, we review basic concepts in the sterilization of PD solutions and discuss possible alternatives to steam sterilization, including filtration, ohmic heat, ionizing radiation, and pulsed ultraviolet light. Although the latter methods have several advantages, many also have prohibitive limitations or have not been adequately studied for use on PD solutions...
2012: Advances in Peritoneal Dialysis
Dixie-Ann Sawin, Rainer Himmele, Jose A Diaz-Buxo
Although dialytic removal of phosphate significantly contributes to the management of phosphate levels in end-stage renal disease, many patients on peritoneal dialysis (PD) still do not reach optimal phosphate control. The present review discusses the impact of PD modality--continuous ambulatory (CAPD) or automated (APD)--on phosphate removal. Relevant factors are the diffusive properties of the phosphate anion and the kinetics of phosphate distribution in various body compartments. Confounders that potentially affect comparisons of phosphate clearances in CAPD and APD are differences in residual renal function, membrane transport status, and prescribed dialysis dose...
2012: Advances in Peritoneal Dialysis
Rainer Himmele, Lynn Jensen, Dominik Fenn, Chih-Hu Ho, Dixie-Ann Sawin, Jose A Diaz-Buxo
BACKGROUND: Conventional peritoneal dialysis fluids (PDFs) consist of ready-to-use solutions with an acidic pH. Sterilization of these fluids is known to generate high levels of glucose degradation products (GDPs). Although several neutral-pH, low-GDP PD solutions have been developed, none are commercially available in the United States. We analyzed pH and GDPs in Delflex Neutral pH (Fresenius Medical Care North America, Waltham, MA, USA), the first neutral-pH PDF to be approved by the US Food and Drug Administration...
July 2012: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Rainer Himmele, Dixie-Ann Sawin, Jose A Diaz-Buxo
Glucose degradation products (GDPs) are highly reactive precursors of advanced glycation end-products (AGEs). High glucose concentrations, GDPs, and AGEs can activate specific pathways, including inflammatory and oxidative stress response pathways, which may adversely affect the cardiovascular system. This review discusses the impact and possible mechanisms of action of GDPs and AGEs with regard to cardiovascular toxicity in chronic kidney disease patients. The AGE-RAGE pathway appears to be particularly important in the pathogenesis of cardiovascular diseases in dialysis patients...
2011: Advances in Peritoneal Dialysis
Wim Van Biesen, John D Williams, Adrian C Covic, Stanley Fan, Kathleen Claes, Monika Lichodziejewska-Niemierko, Christian Verger, Jurg Steiger, Volker Schoder, Peter Wabel, Adelheid Gauly, Rainer Himmele
BACKGROUND: Euvolemia is an important adequacy parameter in peritoneal dialysis (PD) patients. However, accurate tools to evaluate volume status in clinical practice and data on volume status in PD patients as compared to healthy population, and the associated factors, have not been available so far. METHODS: We used a bio-impedance spectroscopy device, the Body Composition Monitor (BCM) to assess volume status in a cross-sectional cohort of prevalent PD patients in different European countries...
2011: PloS One
Jose A Diaz-Buxo, Rainer Himmele
Despite technology advances, prevention of peritonitis remains one of the major challenges in peritoneal dialysis (PD). Several innovative developments have shown an impact on peritonitis rates. Innovative antimicrobial-coated catheter modifications have been introduced, showing promising results in vitro. Topical application of antimicrobial agents such as mupirocin to prevent exit-site infections has been successfully used. New alternative agents for topical exit-site care with reduced potential for antimicrobial resistance are under development...
2010: Advances in Peritoneal Dialysis
Gerd R Hetzel, Michael Schmitz, Heimo Wissing, Wolfgang Ries, Gabriele Schott, Peter J Heering, Frank Isgro, Andreas Kribben, Rainer Himmele, Bernd Grabensee, Lars C Rump
BACKGROUND: Continuous venovenous haemofiltration (CVVH) in the intensive care setting requires anticoagulation to prevent clotting of the extracorporeal circuit. Several protocols avoiding heparin and using regional citrate anticoagulation have been developed to diminish bleeding risks. However, data from randomized trials comparing citrate anticoagulation with systemic heparinization are very limited. METHODS: One hundred and seventy-four patients on mechanical ventilation, requiring renal replacement therapy for acute renal failure, were included in this prospective randomized multicentre trial comparing regional citrate with systemic heparin...
January 2011: Nephrology, Dialysis, Transplantation
James R Gavin, Rolf Kubin, Shurjeel Choudhri, Dagmar Kubitza, Hebert Himmel, Rainer Gross, Jutta M Meyer
BACKGROUND: Recently, clinical data has emerged suggesting that the fluoroquinolone, gatifloxacin, can affect glucose homeostosis through an unknown mechanism. In order to explore the potential effects of moxifloxacin on glucose metabolism in humans, a pooled analysis of phase II/III clinical trials and postmarketing studies was performed and compared with results from an investigation in laboratory animals. METHODS: A pooled analysis of 30 (26 controlled, 4 uncontrolled) oral and two intravenous/oral prospective, controlled phase II/III moxifloxacin studies was performed to evaluate the frequency of hyper- and hypoglycaemic episodes and glucose-related adverse events and adverse reactions (i...
2004: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
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