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Zhuo Gao, Xiaomei Li, Jing Miao, Lide Lun
BACKGROUND: Secondary hyperparathyroidism (SHPT) and calcium and phosphorus metabolism disorder are important complications in haemodialysis patients. Parathyroidectomy (PTX) may prevent or delay the progress of vascular calcification in haemodialysis patients. OBJECTIVE: To investigate the impacts of PTX on calcium and phosphorus metabolism, arterial calcification and arterial stiffness in haemodialysis patients with SHPT. METHODS: Twenty-one SHPT-haemodialysis patients were selected for PTX...
June 13, 2018: Asian Journal of Surgery
Iain C Macdougall
PURPOSE OF REVIEW: Iron deficiency is a major contributory cause to the development of anaemia in chronic kidney disease (CKD), and thus, iron replacement therapy plays a critical role in the management of this condition. The two main routes for administering iron are oral and intravenous, and there have been a number of new publications relevant to both routes of administration. RECENT FINDINGS: Recent developments on the topic of iron management in CKD include the introduction of new oral iron preparations, as well as two recent meta-analyses on iron therapy in CKD (one on oral versus intravenous iron, and one on high- versus low-dose intravenous iron in haemodialysis patients)...
June 13, 2018: Current Opinion in Nephrology and Hypertension
Inés Aragoncillo Sauco, José Manuel Ligero Ramos, Almudena Vega Martínez, Ángel Luis Morales Muñoz, Soraya Abad Estébanez, Nicolás Macías Carmona, Diego Ruiz Chiriboga, Rosario García Pajares, Teresa Cervera Bravo, Juan Manuel López-Gómez, Soledad Manzano Grossi, Elena Menéndez Sánchez, Javier Río Gomez, Ana María García Prieto, Tania Linares Grávalos, Fernando Garcia Boyano, Luis Manuel Reparaz Asensio, Marta Albalate Ramón, Patricia de Sequera Ortiz, Beatriz Gil Casares, Jara Ampuero Mencía, Sandra Castellano, Belén Martín Pérez, José Luís Martín Conty, Alba Santos Garcia, José Luño Fernandez
BACKGROUND: A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU. MATERIAL AND METHODS: We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF...
June 11, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Laura Labriola, Benjamin Seront, Ralph Crott, Pauline Borceux, Frank Hammer, Michel Jadoul
Background: Although superior vena cava (SVC) stenosis may be a life-threatening complication of haemodialysis (HD) catheters, its prevalence and risk factors in HD patients are unknown. Our aim was to assess the prevalence and risk factors for SVC stenosis in HD patients with a tunnelled cuffed catheter (TCC) and to describe its clinical presentation. Methods: In this single-centre, retrospective cohort study, all in-centre chronic HD patients carrying a TCC (1 January 2008-31 December 2012) were included (n = 117 patients, 214 TCC, 80 911 catheter-days)...
June 8, 2018: Nephrology, Dialysis, Transplantation
María Laura Bucalo, Carlo Barbieri, Susana Roca, Jasmine Ion Titapiccolo, Maria Soledad Ros Romero, Rosa Ramos, Mercedes Albaladejo, Diana Manzano, Flavio Mari, Manuel Molina
INTRODUCTION: Anaemia is common in haemodialysis patients and treating it with erythropoiesis-stimulating agents (ESAs) is complex due to many factors. OBJECTIVES: To assess the usefulness of the Anaemia Control Model (ACM) in the treatment of anaemia in haemodialysis. METHODS: ACM is a software that predicts the optimal dose of darbepoetin and iron sucrose to achieve target haemoglobin (Hb) and ferritin levels, and makes prescription suggestions...
June 3, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Joana Gameiro, Sofia Jorge, José António Lopes
Heparin-induced thrombocytopenia (HIT) is a serious and life-threatening complication that occurs in five per cent of patients exposed to heparin. It should be considered in patients with a platelet count <100×109 cells/l or a >50% decrease from baseline count in association with heparin therapy. Thromboembolic complications develop in 50% of patients. Bleeding is rare as the platelet count nadir typically does not drop below 20×109 cells/l. Up to 12% of dialysis patients develop HIT, named haemodialysis-related-heparin-induced thrombocytopenia (HD-HIT), as they are a risk group with continuous exposure to heparin...
June 2, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Indranil Dasgupta, David Keane, Elizabeth Lindley, Ihab Shaheen, Kay Tyerman, Franz Schaefer, Elke Wühl, Manfred J Müller, Anja Bosy-Westphal, Hans Fors, Jovanna Dahlgren, Paul Chamney, Peter Wabel, Ulrich Moissl
BACKGROUND: Bioimpedance spectroscopy (BIS) with a whole-body model to distinguish excess fluid from major body tissue hydration can provide objective assessment of fluid status. BIS is integrated into the Body Composition Monitor (BCM) and is validated in adults, but not children. This study aimed to (1) assess agreement between BCM-measured total body water (TBW) and a gold standard technique in healthy children, (2) compare TBW_BCM with TBW from Urea Kinetic Modelling (UKM) in haemodialysis children and (3) investigate systematic deviation from zero in measured excess fluid in healthy children across paediatric age range...
June 4, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Huan-Tang Lin, Fu-Chao Liu, Jr-Rung Lin, See-Tong Pang, Huang-Ping Yu
OBJECTIVE: Most patients with uraemia must undergo chronic dialysis while awaiting kidney transplantation; however, the role of the pretransplant dialysis modality on the outcomes of kidney transplantation remains obscure. The objective of this study was to clarify the associations between the pretransplant dialysis modality, namely haemodialysis (HD) or peritoneal dialysis (PD), and the development of post-transplant de novo diseases, allograft failure and all-cause mortality for kidney-transplant recipients...
June 4, 2018: BMJ Open
Anna B Basok, Boris Rogachev, Yosef Shmuel Haviv, Marina Vorobiov
A patient with extremely high calcium level of 23.9 mg/dL (5.97 mmol/L) was admitted to our department unconscious with pathological ECG recording, demonstrating shortening of QT interval. The patient was treated by fluid resuscitation, bisphosphonates, salmon calcitonin and steroids. Haemodialysis with low calcium bath had been promptly provided with improvement of consciousness and calcium level. ECG changes disappeared. Subsequent investigations revealed hyperparathyroidism and a large parathyroid adenoma was then surgically removed...
June 4, 2018: BMJ Case Reports
Anna Gluba-Brzózka, Beata Franczyk, Aleksandra Ciałkowska-Rysz, Robert Olszewski, Jacek Rysz
In patients suffering from chronic kidney disease (CKD), the prevalence of cardiovascular disease is much more common than in the general population. The role of vitamin D deficiency had been underestimated until a significant association was found between vitamin D therapy and survival benefit in haemodialysis patients. Vitamin D deficiency is present even in the early stages of chronic kidney disease. The results of experimental studies have revealed the relationship between vitamin D deficiency and impairment of cardiac contractile function, higher cardiac mass and increased myocardial collagen content...
June 1, 2018: Nutrients
Arijana Turčin
We report a case of a 35-year old male patient that was in treatment for chronic kidney failure for 20 years, with a personal history of unsuccessful kidney transplantation and undergoing continuous haemodialysis. He had to be treated psychiatrically for the first time because of exacerbation of psychotic symptoms. He was hospitalized twice in succession, because of the severity of the psychotic symptoms that included imperative auditory hallucinations that also led to a serious suicidal attempt. The prescribed psychiatric therapy had to be adjusted in type, dosage and especially the time of administration as his psychiatric status fluctuated every two days in sync with the wash-out of medication due to haemodialysis...
June 2018: Psychiatria Danubina
Georg Lorenz, Christopher C Mayer, Quirin Bachmann, Sarah Stryeck, Matthias C Braunisch, Bernhard Haller, Javier Carbajo-Lozoya, Alina Schmidt, Simon Witthauer, Jasmin Abuzahu, Stephan Kemmner, Susanne Angermann, Naresh Koneru, Siegfried Wassertheurer, Richard Bieber, Uwe Heemann, Tobias Madl, Andreas Pasch, Christoph Schmaderer
Background: A novel in vitro test (T50 test) assesses ex vivo serum calcification propensity and predicts mortality in chronic kidney disease and haemodialysis (HD) patients. For the latter, a time-dependent decline of T50 was shown to relate to mortality. Here we assessed whether a 3-month switch to acetate-free, citrate-acidified, standard bicarbonate HD (CiaHD) sustainably improves calcification propensity. Methods: T50 values were assessed in paired midweek pre-dialysis sera collected before and 3 months after CiaHD in 78 prevalent European HD patients...
May 30, 2018: Nephrology, Dialysis, Transplantation
Juan G Ripoll, Mahrukh S Rizvi, Rebecca L King, Craig E Daniels
A previously healthy 67-year-old farmer presented to an outside hospital after a 2-week history of non-specific respiratory symptoms. A certain diagnosis was not initially apparent, and the patient was discharged home on a regimen for presumed chronic obstructive pulmonary disease exacerbation. He re-presented to the emergency department with shock and hypoxaemic respiratory failure requiring prompt intubation and fluid resuscitation. He was then transferred to our institution due to multiorgan failure. On arrival, the patient demonstrated refractory shock and worsening acute kidney injury, severe anaemia and thrombocytopaenia...
May 30, 2018: BMJ Case Reports
Sameer Saleem, Sabah Patel, Adnan Ahmed, Nasir Saleem
Denosumab is a fully human monoclonal antibody that is being increasingly used for the treatment of osteoporosis and prevention of skeletal-related events (SREs) in bone metastases from primary tumours. It has improved efficacy, better tolerability and convenient administration via subcutaneous route, in comparison with bisphosphonates; however, it has been reported to cause severe hypocalcaemia in certain high-risk individuals. We report the case of a 71-year-old man with a history of haemodialysis-dependent end-stage renal disease who developed severe hypocalcaemia with electrocardiographic changes after being started on denosumab for prevention of SREs from a recently diagnosed metastatic prostate cancer...
May 30, 2018: BMJ Case Reports
A A Bonenkamp, M K van Gelder, A C Abrahams, F T J Boereboom, T Cornelis, A J Luik, A Özyilmaz, F M van der Sande, A van Eck van der Sluijs, K G F Gerritsen, B C van Jaarsveld
Home haemodialysis (HHD) has gained popularity in recent years, due to improved clinical outcomes associated with frequent or prolonged haemodialysis sessions, best achievable at home. However, several barriers to HHD are perceived by the physician and patient, among which lack of experience and education, logistic difficulties and reimbursement issues seem to be the most important ones. HHD, in particular when performed with intensified frequency or duration, is associated with improved quality of life, blood pressure control and survival...
May 2018: Netherlands Journal of Medicine
Julien Al Shakarchi, Nicholas Inston
PURPOSE: Early cannulation grafts are specifically designed for dialysis, whereas standard expanded polytetrafluoroethylene grafts were not. There is developing collective experience and literature available to allow the assessment of outcomes of these early cannulation grafts. The aim of this review was to review the evidence for both short- and long-term outcomes of early cannulation grafts. METHODS: Using standardized searches of electronic databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the primary outcomes for this study were primary and secondary patency rates for early cannulation grafts for dialysis at 12 months and beyond...
May 1, 2018: Journal of Vascular Access
Lene Langhoff Clausen, Judith Nielsen
An upper extremity vascular access (VA) is preferred for haemodialysis, but when the central veins are occluded or all opportunities are exhausted, a lower extremity VA is necessary. Transposition of the superficial femoral vein is a durable arteriovenous fistula and should be the first choice in patients with long expected remaining lifetime. Peripheral arterial disease and heart failure are contraindications, and careful selection of the patients is mandatory. There is a risk of ischaemic steal and an even higher risk of wound complications...
June 4, 2018: Ugeskrift for Laeger
Maurizio Ronci, Lidia Leporini, Paolo Felaco, Vittorio Sirolli, Luisa Pieroni, Viviana Greco, Antonio Aceto, Andrea Urbani, Mario Bonomini
The artificial membrane packed inside the haemodialyzer is the main determinant of the quality and success of haemodialysis therapy. The performance of a haemodialysis membrane is highly influenced by its interaction with plasma proteins, which in turn is related to the physical and chemical characteristics of the membrane material. A novel membrane named ATA™ made of cellulose triacetate featuring improved filtration properties due to its asymmetric structure, has recently been introduced. The aim of the present study is to analyse the biocompatibility, the structural properties, and the haemodialysis performance of the newly developed ATA membrane in comparison to the conventional symmetric cellulose triacetate membrane, using a bottom-up shotgun proteomics approach...
May 28, 2018: Proteomics. Clinical Applications
Ozlem Bulantekin Duzalan, Sezgi Cinar Pakyuz
OBJECTIVE: To evaluate the effect of education provided by the nurse on the knowledge and behaviours of haemodialysis patients about dietary and fluid restrictions. METHODS: This quasi-experimental study was conducted at five publicly funded dialysis centres located in Istanbul Province, Turkey, in 2014, and comprised dialysis patients and controls. Data was collected using the Scale for Dietary Knowledge in Haemodialysis Patients and the Scale for Dietary Behaviours in Haemodialysis Patients...
April 2018: JPMA. the Journal of the Pakistan Medical Association
Haytham Allaham, Dania Hudhud, William Salzer
We present a 23-year-old female patient with a chief complaint of progressively worsening dyspnoea of 2 days duration. Her medical history was significant for end stage renal disease secondary to membranoproliferative glomerulonephritis. A peritoneal dialysis (PD) catheter was placed 8 weeks prior to admission. She did not miss any of the PD sessions prior to this admission. Vital signs were significant for hypoxemia. Physical examination was remarkable for right-sided basilar crackles with no other signs of fluid overload...
May 26, 2018: BMJ Case Reports
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