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Márcio Viegas, Cristina Cândido, Joana Felgueiras, José Clemente, Sara Barros, Rostislav Farbota, Filipa Vera, Antero Matos, Francisco Sousa
Introduction The dialysate bicarbonate (DB) influences the acid-base balance in dialysis patients. Very low and high serum bicarbonate (SB) have been related with a higher mortality. Acid-base balance also has been associated with hemodynamic effects in these patients. The trial aim was to compare the effect of DB concentration variation on SB levels in maintenance hemodiafiltration (HDF) patients and the effect on intradialytic hypotension and interdialytic weight gain. Methods  A prospective study, with 9 months of follow-up, involving 93 patients, divided in two groups: group 1 and group 2 with a DB of 34 mmol/L and 30 mmol/L, respectively, with monitoring of pre and post HDF SB, intradialytic hypotension, and interdialytic weight gain...
October 20, 2016: Hemodialysis International
Juergen Prattes, Daniel Schneditz, Florian Prueller, Eva Jaindl, Notburga Sauseng, Martin Hoenigl, Gernot Schilcher, Robert Krause
BACKGROUND: The aim of this combined in-vitro and in-vivo study was to investigate whether state of the art dialysis modalities produce false positive serum 1,3-ß-d-Glucan (BDG) levels. METHODS: Dialysis fluid for simulated dialysis treatments was spiked with BDG from different sources. Samples were taken from the dialysate and dialyzer blood compartments at various time points. In addition, serum samples were obtained in three groups of patients without invasive fungal disease: a...
October 4, 2016: Journal of Infection
Francesco Ramponi, Claudio Ronco, Giacomo Mason, Enrico Rettore, Daniele Marcelli, Francesca Martino, Mauro Neri, Alejandro Martin-Malo, Bernard Canaud, Francesco Locatelli
BACKGROUND: Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD. METHODS: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature...
2016: ClinicoEconomics and Outcomes Research: CEOR
Maoqin Li, Zhidong Wang, Yining Wang, Changhong Du, Songhai Li, Zaixiang Shi, Bo Lu
The present study is a retrospective analysis of 11 cases with severe acute liver failure combined with multiple organ dysfunction syndrome (MODS) performed during the period June, 2012 to December, 2014. After part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration treatment, good curative effects were obtained and the main clinical symptoms and biochemical index were significantly improved. Following treatment, 8 of the 11 patients survived at a survival rate of 72...
October 2016: Experimental and Therapeutic Medicine
Hyo Shik Kim, Kyung Eun Lee, Ji Hyun Oh, Chan Sung Jung, Dughyun Choi, Yunsuek Kim, Jin Seok Jeon, Dong Cheol Han, Hyunjin Noh
A 65-year-old man was transferred from the Department of Vascular Surgery to Nephrology because of cardiac arrest during hemodialysis. He underwent incision and drainage for treatment of a buttock abscess. Nafamostat mesilate was used as an anticoagulant for hemodialysis to address bleeding from the incision and drainage site. Sudden cardiac arrest occurred after 15 minutes of dialysis. The patient was treated in the intensive care unit for 5 days. Continuous veno-venous hemodiafiltration was started without any anticoagulant in the intensive care unit...
September 2016: Kidney Research and Clinical Practice
Zuray Corredor, Lara Rodríguez-Ribera, Irene Silva, Juan Manuel Díaz, José Ballarín, Ricard Marcos, Elisabet Coll, Susana Pastor
Chronic kidney disease (CKD) patients exhibit high levels of genetic damage. Part of this genetic damage is supposed to be caused by the hemodialysis (HD) therapy. Different and more efficient HD procedures could reduce the genetic damage and improve health status of CKD patients. In the present study, we analyzed if changing to online hemodiafiltration (OL-HDF) has a beneficial effect on the levels of genetic damage. The levels of genetic damage (DNA breaks and oxidatively damaged DNA) were analyzed in peripheral blood lymphocytes by using the comet assay...
September 15, 2016: Mutation Research. Genetic Toxicology and Environmental Mutagenesis
Sigrid Kalle, Risto Tanner, Jürgen Arund, Ruth Tomson, Merike Luman, Ivo Fridolin
AIM: In this work we estimated the contribution of the fluorescence of 4-pyridoxic acid (4-PA) to the total fluorescence of spent dialysate with the aim of evaluating the on-line monitoring of removal of this vitamin B-6 metabolite from the blood of patients with end-stage renal disease (ESRD). METHODS: Spectrofluorometric analysis of spent dialysate, collected from hemodialysis and hemodiafiltration sessions of 10 patients receiving regularly pyridoxine injections after dialysis treatment, was performed in the range of Ex/Em 220-500 nm...
2016: PloS One
Boaz Gedaliahu Samolsky Dekel, Gabriele Donati, Alessio Vasarri, Anna Laura Croci Chiocchini, Alberto Gori, Giuseppe Cavallari, Gianfranco Di Nino, Laura Mercolini, Michele Protti, Roberto Mandrioli, Rita Maria Melotti, Gaetano La Manna
OBJECTIVES: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. METHODS: We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone...
September 2, 2016: Pain Practice: the Official Journal of World Institute of Pain
Alexander H Kirsch, Raphael Lyko, Lars-Göran Nilsson, Werner Beck, Michael Amdahl, Petra Lechner, Andreas Schneider, Christoph Wanner, Alexander R Rosenkranz, Detlef H Krieter
BACKGROUND: Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules. METHODS: In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent hemodialysis (HD) patients were studied in four dialysis treatments as follows: study 1, three MCO prototype dialyzers (AA, BB and CC with increasing permeability) and one high-flux dialyzer in HD; and study 2, two MCO prototype dialyzers (AA and BB) in HD and high-flux dialyzers in HD and hemodiafiltration (HDF)...
September 1, 2016: Nephrology, Dialysis, Transplantation
Takayuki Nishimoto, Yukihiro Bonkohara, Takashi Azuma, Masaki Iijima, Masafumi Higashidate
A 60-year-old woman was transfer-red to the emergency department of our medical center with worsening chest and back pain. Computed tomography revealed Stanford type B aortic dissection. There was a false lumen from the distal arch to the abdominal aorta just above the celiac artery. Although she was at 1st treated conservatively, she abruptly developed acute renal failure and lower limb ischemia because of an enlarged false lumen, and emergency axillo-femoral bypass surgery was performed with an 8 mm tube graft...
September 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Carlo Basile, Andrew Davenport, Peter J Blankestijn
The mortality rate of patients on maintenance dialysis remains alarmingly high, at approximately 15-20 % per year. Increasing dialyzer urea clearance has not been shown to improve survival and hence interest has shifted towards convective therapies, such as hemodiafiltration (HDF) which can remove middle molecular weight uremic toxins, which have been suggested to increase mortality in patients with end-stage kidney disease. During the last few years, four large prospective randomized controlled trials (RCTs) have been conducted in different European countries to compare survival outcomes in prevalent patients receiving conventional hemodialysis with online post-dilution HDF (OL HDF)...
September 1, 2016: Journal of Nephrology
Simonetta Palleschi, Paolo M Ghezzi, Giuseppe Palladino, Barbara Rossi, Marino Ganadu, Domenica Casu, Maria Cossu, Giovanni Mattana, Antonio Maria Pinna, Bruno Contu, Tonina Ghisu, Alessandro Monni, Luana Gazzanelli, Maria Cristina Mereu, Franco Logias, Mario Passaghe, Alessandro Amore, Piergiorgio Bolasco
BACKGROUND: Hemodiafiltration with on-line endogenous reinfusion (HFR) is an extracorporeal dialytic method that combines diffusion, convection and adsorption. HFR-Supra (HFR-S) is a second-generation system with increased convective permeability and adsorption capability. Previous studies suggested that HFR reduces oxidative stress compared to standard haemodialysis. The principal aim of the present study was to compare antioxidant vitamins behavior and oxidative status of hemodialysis patients treated with HFR and HFR-S...
2016: BMC Nephrology
Devika Rao, Nikulkumar Kumar Chaudhari, Robert Michael Moore, Belinda Jim
The HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome is believed to be part of the spectrum of pre-eclampsia, which falls within the category of hypertensive disorders of pregnancy. Maternal and fetal complications are more severe in HELLP as opposed to pre-eclampsia alone. We describe a 26-year-old primigravida woman with no medical history who presents with signs of HELLP with marked transaminitis and mild disseminated intravascular coagulation at 35 weeks of gestation who required emergent delivery of the fetus; the patient also sustained acute kidney injury requiring continuous veno-venous hemodiafiltration and a prolonged intensive care unit admission...
2016: BMJ Case Reports
Michael F Papacostas, Margaret Hoge, Michel Baum, Samuel Z Davila
OBJECTIVE: To report a case of salicylate toxicity treated with continuous venovenous hemodiafiltration (CVVHDF) and review the literature regarding the use of continuous renal replacement therapy (CRRT) for salicylate toxicity. CASE: A 16-year-old male presented after ingesting 1901 mg/kg of enteric coated aspirin. Salicylate level was 92 mg/dl 4 h after ingestion. Sequele included seizure, acute kidney injury, pulmonary edema, and prolonged QTc. He received 5...
September 2016: Heart & Lung: the Journal of Critical Care
Maiko Esaki, Kazuyoshi Ishii, Yoshiko Azuma, Yukie Tsubokura, Hideaki Yoshimura, Masaaki Hotta, Takahisa Nakanishi, Shinya Fujita, Aya Nakaya, Atsushi Satake, Tomoki Ito, Shosaku Nomura
A 74-year-old man visited our hospital with complaints of anorexia, weight loss, and impaired activities of daily living. He presented mild consciousness disturbance at the first visit, but specific causes were identified. The IgD level was>2,000 mg/dl and bone marrow biopsy was performed after aspiration failed due to excessive density. He was diagnosed with IgD/λ multiple myeloma (MM). He lapsed into a coma with an extremely high ammonia level of 484 μg/dl on day 8 after admission. His diagnosis was established as hyperammonemic encephalopathy (HE)...
July 2016: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Tomonori Takazawa, Jou Ohta, Tatsuo Horiuchi, Hiroshi Hinohara, Fumio Kunimoto, Shigeru Saito
BACKGROUND: Gas gangrene is a necrotic infection of soft tissue associated with high mortality rates. We report a case of postoperative gas gangrene with very acute onset and rapid progression of symptoms. To our knowledge, this case is the most acute onset of postoperative gas gangrene ever reported. CASE PRESENTATION: A 65-year-old Japanese female patient developed a shock state 16 h after radical cystectomy with ileal conduit reconstruction. Two days after the operation, she was transferred to the intensive care unit because of deterioration in her respiratory and circulatory condition...
2016: BMC Research Notes
Sérgio Aparecido Cleto, Camila Eleutério Rodrigues, Ceila Maria Malaque, Jaques Sztajnbok, Antônio Carlos Seguro, Lúcia Andrade
BACKGROUND: Leptospirosis is a health problem worldwide. Its most severe form is a classic model of sepsis, provoking acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), with associated mortality that remains unacceptably high. We previously demonstrated that early initiation of sustained low-efficiency dialysis (SLED) followed by daily SLED significantly decreases mortality. However, the mode of clearance can also affect dialysis patient outcomes. Therefore, the objective of this study was to compare the effects of SLED with traditional (diffusive) clearance, via hemodialysis, and SLED with convective clearance, via hemodiafiltration (SLEDf), in patients with severe leptospirosis...
2016: PloS One
Bernard Canaud, Peter J Blankestijn, Andrew Davenport, Michiel L Bots
No abstract text is available yet for this article.
August 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Yang Wook Kim, Sihyung Park
Conventional hemodialysis, which is based on the diffusive transport of solutes, is the most widely used renal replacement therapy. It effectively removes small solutes such as urea and corrects fluid, electrolyte and acid-base imbalance. However, solute diffusion coefficients decreased rapidly as molecular size increased. Because of this, middle and large molecules are not removed effectively and clinical problem such as dialysis amyloidosis might occur. Online hemodiafiltration which is combined by diffusive and convective therapies can overcome such problems by removing effectively middle and large solutes...
June 2016: Electrolyte & Blood Pressure: E & BP
Finnian R Mc Causland, Josephine Asafu-Adjei, Rebecca A Betensky, Paul M Palevsky, Sushrut S Waikar
BACKGROUND AND OBJECTIVES: Intensive RRT may have adverse effects that account for the absence of benefit observed in randomized trials of more intensive versus less intensive RRT. We wished to determine the association of more intensive RRT with changes in urine output as a marker of worsening residual renal function in critically ill patients with severe AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Acute Renal Failure Trial Network Study (n=1124) was a multicenter trial that randomized critically ill patients requiring initiation of RRT to more intensive (hemodialysis or sustained low-efficiency dialysis six times per week or continuous venovenous hemodiafiltration at 35 ml/kg per hour) versus less intensive (hemodialysis or sustained low-efficiency dialysis three times per week or continuous venovenous hemodiafiltration at 20 ml/kg per hour) RRT...
August 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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