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Per Jonsson, Lorentz Lindmark, Jan Axelsson, Lars Karlsson, Lennart Lundberg, Bernd Stegmayr
We were encouraged to investigate the reasons for large amounts of foam observed in bloodlines during hemodialysis (HD). Foam was visible in the venous air trap within the Artis Gambro dialysis device. Estimates of the extent of foam were graded (0-no foam, 10-extensive foam) by two persons that were blind to the type of dialyzer used. Thirty-seven patients were involved in the dialysis procedures. Consecutive dialyses were graded using dialyzers from Fresenius Medical Care (CorDiax dialyzers that were used for high flux HD-FX80 and FX100, and for hemodiafiltration-FX1000)...
March 15, 2018: Artificial Organs
Sebastian Mas, Enrique Bosch-Panadero, Pedro Abaigar, Vanesa Camarero, Ignacio Mahillo, Esther Civantos, Didier Sanchez-Ospina, Alberto Ruiz-Priego, Jesus Egido, Alberto Ortiz, Emilio González-Parra
INTRODUCTION: Bisphenol A (BPA) is an ubiquitous environmental toxin that is also found in dialyzers. Online hemodiafiltration (OL-HDF) more efficiently clears high molecular weight molecules, and this may improve BPA clearance. However, the BPA contents of dialysis membranes may be a source of BPA loading during OL-HDF. METHODS: A prospective study assessed plasma BPA levels in OL-HDF patients using BPA-free (polynephron) or BPA-containing (polysulfone) dialyzers in a crossover design with two arms, after a run-in OL-HDF period of at least 6 months with the same membrane: 31 patients on polynephron at baseline were switched to polysulfone membranes for 3 months (polynephron-to-polysulfone) and 29 patients on polysulfone were switched to polynephron for 3 months (polysulfone-to-polynephron)...
2018: PloS One
R Niessen, T Sottiaux, J F Adam, A Schillaci, F Lejeune
Since many years a correlation between neuropsychiatric disorders and eating disorders resulting in obesity is well established. According to different studies, 1.2 - 4 % of patients scheduled for bariatric surgery are taking lithium as a mood stabilizer treatment for bipolar disorder. We are presenting a case of lithium toxicity after vertical sleeve gastrectomy surgery in a 40 years-old female. The patient developed severe neurological and renal signs needing an intensive care unit admission and continuous veno-venous hemodiafiltration...
February 2018: Revue Médicale de Liège
Khajohn Tiranathanagul, Paweena Susantitaphong, Nattachai Srisawat, Nanta Mahatanan, Kriang Tungsanga, Kearkiat Praditpornsilpa, Somchai Eiam-Ong
BACKGROUND: Recently, in the first hemodiafiltration (HDF) experience report from South East Asia (SEA), we reported a 3-year prospective study demonstrating the various short-term benefits of high-efficiency online HDF (OL-HDF) over high-flux hemodialysis (HD). Very few long-term survival reports of high-efficiency OL-HDF are available and the data are heterogeneous and incomplete. OBJECTIVES: The present historical cohort study was conducted to determine the long-term survival and outcome of high-efficiency OL-HDF-treated patients...
March 7, 2018: Nephron
Richard A Ward, Jörg Vienken, Douglas M Silverstein, Stephen Ash, Bernard Canaud
Online hemodiafiltration provides greater removal of higher molecular weight uremic retention solutes than conventional high-flux hemodialysis. However, online hemodiafiltration is used sparsely in the United States in part because of a paucity of delivery systems cleared for clinical use by the US Food and Drug Administration. Although a pathway for regulatory approval exists in the United States, concerns remain, particularly regarding online production of the large volumes of sterile, nonpyrogenic substitution fluid infused directly into the bloodstream to maintain fluid balance...
March 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Bernard Canaud, Jörg Vienken, Stephen Ash, Richard A Ward
Hemodiafiltration combines diffusive and convective solute removal in a single therapy by ultrafiltering 20% or more of the blood volume processed using a high-flux hemodialyzer and maintaining fluid balance by infusing sterile nonpyrogenic replacement fluid directly into the patient's blood. In online hemodiafiltration, the large volumes of replacement fluid required are obtained by online filtration of standard dialysate through a series of bacteria- and endotoxin-retaining filters. Currently available systems for online hemodiafiltration are on the basis of conventional dialysis machines with added features to safely prepare and infuse replacement fluid and closely control fluid balance...
March 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Mohamed Said Abdelsalam, Mohamed Rashwan, Mohamed Mahdi Althaf, Osman I Alfurayh, Lutfi Alkorbi, Ihab A Ibrahim
Conventional hemodialysis (HD) is the most common treatment modality used for renal replacement therapy. The concept of HD is based on the diffusion of solutes across a semipermeable membrane. Hemofiltration (HF) is based on convective transport of solutes; hemodiafiltration (HDF) is based on combined convective and diffusive therapies. Data about survival benefit of on-line HDF (OL-HDF) over high-flux HD (HF-HD) is conflicting. We conducted this study to investigate if there is a survival difference between the two treatment modalities...
January 2018: Saudi Journal of Kidney Diseases and Transplantation
Yutaka Ikeda, Kazuhiro Shoji, Chitho P Feliciano, Shinji Saito, Yukio Nagasaki
Acute inflammatory conditions such as sepsis lead to fatal conditions, including multiple organ failure. Several treatments such as steroidal anti-inflammatory drugs are currently being investigated in order to decrease the blood cytokine level, which increases remarkably. However, any of these therapeutic treatments are not always reliable and effective; none have drastically improved survival rates, and some have mostly ended with failure. Reactive oxygen species (ROS) are signaling molecules responsible for the production of cytokines and chemokines that can mediate hyperactivation of the immune response called cytokine storm...
February 20, 2018: Molecular Pharmaceutics
Haruhi Yamada, Yukiko Katsumori, Miki Kawano, Shumpei Mori, Ryo Takeshige, Jun Mukai, Hiroshi Imada, Hiroyuki Shimoura, Hachidai Takahashi, Tadasu Horai, Yutaka Okita, Ken-Ichi Hirata
A 73-year-old man, with congestive heart failure due to combined valvar disease, underwent curative surgery. Although the surgery was successful, his clinical course was eventful because of pulmonary complications, and he began to deteriorate mentally. Quetiapine was prescribed, which appeared to effectively settle his mental status. Following the administration of quetiapine, however, he developed acute kidney injury (AKI) that required continuous hemodiafiltration. Subsequent to discontinuation of quetiapine, his renal function gradually improved...
February 9, 2018: Internal Medicine
Pasquale Esposito, Edoardo La Porta, Maria Antonietta Grignano, Daniela Verzola, Samantha Milanesi, Francesca Ansaldo, Marilena Gregorini, Carmelo Libetta, Giacomo Garibotto, Teresa Rampino
OBJECTIVE: Toll-like receptor 4 (TLR4) promotes inflammation in hemodialysis patients (HD). A soluble form of extracellular TLR4 (sTLR4) has been recently characterized, which showed the ability to attenuate TLR4 signalling. In this study, we describe the sTLR4 profile in regular HD patients. SUBJECTS: In a cross-sectional study we enrolled forty prevalent HD patients (68.2 ± 16.3 years, twenty-five males) with a median dialysis vintage of 41 months. Nineteen patients were undergoing standard bicarbonate HD (BHD) and 21 patients on-line hemodiafiltration (HDF)...
February 8, 2018: Journal of Renal Nutrition
Akio Namikawa, Yuko Shibuya, Haruki Ouchi, Hiroko Takahashi, Yoshitaka Furuto
ABO-incompatible blood transfusion is potentially a life-threatening event. A 74-year-old type O Rh-positive male was accidentally transfused with 280 mL type B Rh-positive red blood cells during open right hemicolectomy, causing ABO-incompatible blood transfusion. Immediately after the transfusion, the patient experienced a hypotension episode followed by acute hemolytic reaction, disseminated intravascular coagulation and acute kidney injury. Plasma exchange therapy was performed to remove anti-B antibody and free hemoglobin because they caused acute hemolytic reaction, disseminated intravascular coagulation, and acute kidney injury...
January 31, 2018: CEN Case Reports
Joan Perelló, M Gómez, M D Ferrer, N Y Rodríguez, C Salcedo, J M Buades, M M Pérez, J V Torregrosa, E Martín, F Maduell
BACKGROUND: Cardiovascular calcification (CVC) is a major concern in hemodialysis (HD) and the loss of endogenous modulators of calcification seems involved in the process. Phytate is an endogenous crystallization inhibitor and its low molecular mass and high water solubility make it potentially dialyzable. SNF472 (the hexasodium salt of phytate) is being developed for the treatment of calciphylaxis and CVC in HD patients. We aimed to verify if phytate is lost during dialysis, and evaluate SNF472's behaviour during dialysis...
January 19, 2018: Journal of Nephrology
Sophie De Seigneux, Belen Ponte, Karine Hadaya, Yassine Bouatou, Patrick Saudan
New antidiabetic drugs which slow effectively the course of diabetic nephropathy are now available. There is no benefit of prophylactic hydratation to prevent contrast nephropathy in patients with moderate chronic kidney disease. In elderly hemodialysis patients, hemodiafiltration seems better tolerated than conventional hemodialysis, although there is a similar dialysis-induced myocardial stress with both methods. Role of de novo donor-specific antibodies is better characterized, which may subsequently lead to new treatments of graft rejection...
January 10, 2018: Revue Médicale Suisse
Chang Seong Kim, Sung Sun Kim, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim
RATIONALE: Povidone-iodine is a broad-spectrum antiseptic applied topically to treat wounds and prevent their infection. There have been several case reports of acute kidney injury (AKI) in burn patients after povidone-iodine irrigation and in patients receiving the substance as a sclerotherapy agent for management of lymphocele after renal transplantation. However, biopsy-confirmed AKI after ingestion of povidone-iodine has not previously been described. PATIENT CONCERNS: A 47-year-old man who had apparently ingested povidone-iodine solution and presented with nausea, vomiting, and reduced urine output...
December 2017: Medicine (Baltimore)
Kada Klouche, Laurent Amigues, Marion Morena, Vincent Brunot, Anne Marie Dupuy, Audrey Jaussent, Marie Christine Picot, Noémie Besnard, Delphine Daubin, Jean Paul Cristol
BACKGROUND: Though on-line intermittent hemodiafiltration (OL-IHDF) is a routine therapy for chronic dialysis patients, it is not yet widespread used in critically ill patients. This study was undergone to evaluate efficiency and tolerance of OL-IHDF and to appreciate inflammatory consequences of its use in intensive care unit (ICU)-acute kidney injury (AKI) patients. METHODS: In this prospective cohort study conducted in a medical academic ICU in France, 30 AKI patients who underwent OL-IHDF were included...
December 22, 2017: BMC Nephrology
Yoshihiro Hatanaka, Satoru Inoue, Koji Goto, Norihisa Yasuda, Seigo Hidaka, Takaaki Kitano
Background: Acute blood purification (ABP) therapy is used regularly in the clinical setting and reportedly alleviates organ failure associated with severe systemic inflammatory responses, leading to reduced mortality. The present study aimed to determine whether there is a difference in efficacy between polysulfone (PS) membranes, which are currently used regularly in the clinical setting, and vitamin E-coated polysulfone (VEPS) membranes, which are anticipated to exhibit the antioxidant and anti-inflammatory properties of vitamin E...
September 2017: Iranian Journal of Medical Sciences
Camiel L M de Roij van Zuijdewijn, Isabelle Chapdelaine, Menso J Nubé, Peter J Blankestijn, Michiel L Bots, Constantijn J A M Konings, Ton K Kremer Hovinga, Femke M Molenaar, Neelke C van der Weerd, Muriel P C Grooteman
Background. Available evidence suggests a reduced mortality risk for patients treated with high-volume postdilution hemodiafiltration (HDF) when compared with hemodialysis (HD) patients. As the magnitude of the convection volume depends on treatment-related factors rather than patient-related characteristics, we prospectively investigated whether a high convection volume (defined as ≥22 L/session) is feasible in the majority of patients (>75%). Methods. A multicenter study was performed in adult prevalent dialysis patients...
December 2017: Clinical Kidney Journal
Evgenija Homsak, Robert Ekart
BACKGROUND: Patients with end-stage renal disease (ESRD) are prone to severe heart failure (HF) and to several life-threatening events. Therefore, the ability to assess disease prognosis and the risk of short-term events or death is of great importance. The role of soluble ST2 (sST2) as a potential new prognostic marker in ESRD patients is not yet known. The aim of our study was to assess the prognostic value of sST2 in ESRD patients on hemodiafiltration (HDF) and compare it with NT-proBNP, an established prognostic marker for HF and renal disease...
February 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Maria-Eleni Roumelioti, Gregory Trietley, Thomas D Nolin, Yue-Harn Ng, Zhi Xu, Ahmed Alaini, Rocio Figueroa, Mark L Unruh, Christos P Argyropoulos
Background: Recent meta-analyses suggest that higher removal of beta-2 microglobulin (β2M) with either high-flux (HFD) dialysis or hemodiafiltration (HDF) may be associated with decreased total and cardiovascular mortality in dialysis patients. However, there are limited data about the performance of high flux dialyzers and/or convective therapies in removing β2M. Methods: This is a random effects meta-analysis and meta-regression of data extracted from randomized controlled trials and observational studies in hemodialysis, hemofiltration and HDF regarding the efficiency of high flux dialyzers to remove β2M...
November 27, 2017: Nephrology, Dialysis, Transplantation
Gabriele Donati, Mauro Ursino, Alessandra Spazzoli, Nicolò Natali, Roberto Schillaci, Diletta Conte, Andrea Angeletti, Anna Laura Croci Chiocchini, Irene Capelli, Olga Baraldi, Gaetano La Manna
BACKGROUND: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist, as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium levels. METHODS: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller. RESULTS: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis (HD) and discusses 2 strategies to remove excess sodium in patients prone to intradialytic hypotension, namely, Profiled HD and the hemodiafiltration Aequilibrium System...
November 23, 2017: Blood Purification
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