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Pre- dialysis

Fabrizio Fabrizi, Piergiorgio Messa
Liver disease in patients with chronic kidney disease (CKD) is most commonly due to hepatitis C virus (HCV) and contributes to increased rates of mortality. Among the pre-dialysis population, the estimated prevalence of anti-HCV positivity is based on few, limited-size studies. In hemodialysis patients however, HCV remains very prevalent despite large declines in seropositivity rates in dialysis facilities in developed countries after preventive measures were adopted in the 1990s. Recent surveys indicate that the HCV seropositivity prevalence ranges from 1...
December 9, 2018: Seminars in Dialysis
Ching-Wei Tsai, Han-Chun Huang, Ni Tien, Chih-Wei Chung, Hsien-Tsai Chiu, Hung-Chieh Yeh, Chin-Chi Kuo
BACKGROUND: The clinical importance of random urine creatinine concentration in CKD population remains undetermined. Earlier studies found that lower 24-h urine creatinine excretion was associated with the risk of ESRD and all-cause mortality among CKD patients. METHODS: We modeled the longitudinal trajectories of serial random urine creatinine among 4689 CKD patients enrolled in a national registry-based pre-ESRD program between 2003 and 2015 at a tertiary medical center...
December 7, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Ines Aragoncillo, Jose Manuel Ligero, Covadonga Hevia, Angel Luis Morales, Yésika Amézquita, Teresa Cervera, Almudena Vega, Soraya Abad, Nicolás Macías, Jose Luño
Background: A good vascular access (VA) is vital for haemodialysis (HD) patients. HD with an autologous arteriovenous fistula (AVF) is associated with higher survival, lower health care costs and fewer complications. Although a distal forearm AVF is the best option, not all patients are good candidates for this approach and the primary failure rate ranges from 20% to 50%. The optimal AVF depends mainly on the anatomical and haemodynamic characteristics of the artery and the vein chosen for the anastomosis...
December 2018: Clinical Kidney Journal
Ban-Hock Khor, Karuthan Chinna, Abdul Halim Abdul Gafor, Zaki Morad, Ghazali Ahmad, Sunita Bavanandam, Ravindran Visvanathan, Rosnawati Yahya, Bak-Leong Goh, Boon-Cheak Bee, Tilakavati Karupaiah
BACKGROUND: This study aimed to assess the situational capacity for nutrition care delivery in the outpatient hemodialysis (HD) setting in Malaysia by evaluating dietitian accessibility, nutrition practices and patients' outcomes. METHODS: A 17-item questionnaire was developed to assess nutrition practices and administered to dialysis managers of 150 HD centers, identified through the National Renal Registry. Nutritional outcomes of 4362 patients enabled crosscutting comparisons as per dietitian accessibility and center sector...
December 4, 2018: BMC Health Services Research
Robin Lohse, Michael Ibsen, Jørgen Wiis, Anders Perner, Theis Lange, Mette Brimnes Damholt
BACKGROUND: In ICU patients, we aimed to describe the outcomes of those with end-stage renal disease (ESRD) as compared to those requiring acute renal replacement therapy (RRT). METHODS: Retrospective analysis of all adult patients admitted to a general, university hospital ICU from 2005 to 2012. ESRD was defined as use of chronic RRT >90 days prior to admission. RESULTS: We included 5927 patients of whom 1004 (17%) received acute RRT and 161 (3%) had pre-existing ESRD requiring RRT...
December 3, 2018: Acta Anaesthesiologica Scandinavica
Chao Chai, Huiying Wang, Zhiqiang Chu, Jinping Li, Tianyi Qian, E Mark Haacke, Shuang Xia, Wen Shen
The purpose of this study was to noninvasively evaluate the changes of regional cerebral venous oxygen saturation (rSvO2 ) in hemodialysis patients using quantitative susceptibility mapping (QSM) and investigate the relationship with clinical risk factors and neuropsychological testing. Fifty four (54) hemodialysis patients and 54 age, gender and education matched healthy controls (HCs) were recruited in this prospective study. QSM data were reconstructed from the original phase data of susceptibility weighted imaging to measure the susceptibility of cerebral regional major veins in all subjects and calculate their rSvO2 ...
December 4, 2018: Brain Imaging and Behavior
Syed Rizwan A Bokhari, Faisal Inayat, Mah Jabeen, Zumar Sardar, Sara Saeed, Ayesha M Malik, Sabin Nasir, Amtul Zareen, Hafiz Ijaz Ahmad
Introduction Acute kidney injury (AKI) continues to be a cause of increased morbidity and mortality in pregnant women. While studies have been conducted on the incidence and etiology of this complication, the outcomes of obstetric AKI have not been extensively investigated. The primary focus of this prospective observational study was to analyze the risk factors, etiologies as well as maternal and fetal outcomes of AKI in pregnant females in Pakistan. Methods A total of 56 patients with obstetric AKI were recruited...
September 26, 2018: Curēus
Alireza Peyro-Shabani, Mehrdad Nabahati, Mohammad-Ali Saber-Sadeghdoust, Mohammad Jafar Soleymani, Farshid Oliaei
Background: There are some uncertainties among the risk factors of vascular calcification in the hemodialysis patients. This study was planned to examine the association between abdominal aortic calcification and concerned biochemical parameters in hemodialysis patients. Methods: In this cross- sectional study, 84 stable hemodialysis patients admitted on hemodialysis section of Shahid Beheshti Hospital in 2013 were enrolled after obtaining informed consent. Pre-dialysis venous blood samples were taken from patients to determine the amount of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk...
2018: Caspian Journal of Internal Medicine
Ralphe Bou Chebl, Gilbert Abou Dagher, Jeffrey Wuhantu, Rana Bachir, Jennifer Carnell
BACKGROUND: Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness. METHODS: This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled...
December 2, 2018: Critical Ultrasound Journal
Joel Sousa, Ana-Teresa Vilares, Armando Mansilha
INTRODUCTION: Only a minority of vascular surgeons have personal experience on thoracoabdominal aneurysm (TAA) repair, and even less have performed surgery on these formidable lesions for rupture. Unsurprisingly, when open surgery was the only treatment option available, these impressive pathologies were frequently deemed inoperable and managed conservatively. Endovascular techniques brought new hope in these scenarios, but despite current advances, morbidity and mortality remains high, even in experienced centres...
November 27, 2018: Annals of Vascular Surgery
Matt Hall
In 2018, it is unusual for women with chronic kidney disease (CKD) to be told that pregnancy is not an option. Maternal and foetal outcomes have steadily improved over the last 50 years and a successful pregnancy, resulting in a healthy infant without detrimental to maternal health, is commonplace. Nevertheless, the incidence of adverse outcomes including pre-eclampsia, preterm birth and small-for-gestational age infants is higher for women with CKD than the general population, requiring enhanced monitoring...
October 30, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Charlene M T Robertson, Karin T Bork, Gerda Tawfik, Gwen Y Bond, Leonora Hendson, Irina A Dinu, Elham Khodayari Moez, Ivan M Rebeyka, Gonzalo Garcia Guerra, Ari R Joffe
OBJECTIVE: To reduce bilateral delayed-onset progressive sensory permanent hearing loss using a systems-wide quality improvement project with adherence to best practice for the administration of furosemide. DESIGN: Prospective cohort study with regular audiologic follow-up assessment of survivors both before and after a 2007-2008 quality improvement practice change. SETTING: The referral center in Western Canada for complex cardiac surgery, with comprehensive multidisciplinary follow-up by the Complex Pediatric Therapies Follow-up Program...
November 26, 2018: Pediatric Critical Care Medicine
Lalathaksha Kumbar, Ed Peterson, Matthew Zaborowicz, Anatole Besarab, Jerry Yee, Gerard Zasuwa
BACKGROUND AND OBJECTIVES: The vascular access pressure ratio test identifies dialysis vascular access dysfunction when three consecutive vascular access pressure ratios are >0.55. We tested whether the magnitude of the decline in vascular access pressure ratio 1-week post-intervention could alert of subsequent access failure. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The retrospective study included all vascular access procedures at one institution from March 2014 to June 2016...
November 27, 2018: Journal of Vascular Access
Thierry Hannedouche, Denis Fouque, Dominique Joly
Metabolic complications of chronic kidney disease (CKD) are frequent; the aims of this review are to present a 2018 update for hyperkalemia, hyperphosphatemia and anemia. Hyperkalemia is defined by a plasma level above 5.0 mmol/L, after ruling out pre-analytical problems such as hemolysis. It is frequent in CKD, most often due to drugs and notably renin/ angiotensin blockers. Chronic hyperkalemia is deleterious, with an increased risk of mortality. Therapeutic strategies to decrease the incidence and severity of hyperkalemia are therefore crucial in nephrology: experts recommend to maintain the renin/angiotensin blockers as long as possible, whilst associating diuretics and potassium binders...
November 2018: Néphrologie & Thérapeutique
Fahad Saeed, Susana Arrigain, Jesse D Schold, Joseph V Nally, Sankar Dass Navaneethan
BACKGROUND: Prognostic factors after dialysis initiation among older chronic kidney disease (CKD) patients are not well studied. In this study, we examined the risk factors associated with 1-year mortality after dialysis initiation among older CKD patients. METHODS: In this retrospective study, we included 621 CKD patients from an electronic medical record based CKD registry that was linked to the United States Renal Data System data. In terms of age, they were all ≥65...
November 21, 2018: Nephron
Mara A McAdams-DeMarco, Hao Ying, Sarah Van Pilsum Rasmussen, Jennifer Schrack, Christine E Haugen, Nadia M Chu, Marlís González Fernández, Niraj Desai, Jeremy D Walston, Dorry L Segev
Prehabilitation is the process of enhancing pre-operative functional capacity to improve tolerance for the upcoming stressor; it was associated with improved post-operative outcomes in a handful of studies, but never evaluated in transplantation. Kidney transplant (KT) candidates may be uniquely suited for prehabilitation because they experience a profound loss of functional capacity while waiting years on dialysis. To better understand the feasibility and effectiveness of prehabilitation in KT, we conducted a pilot study of center-based prehabilitation for candidates; this intervention consisted of weekly physical therapy sessions at an outpatient center with at home exercises...
November 21, 2018: Clinical Transplantation
Abhijit Jagdale, David K C Cooper, Hayato Iwase, Robert S Gaston
Renal allotransplantation clearly offers better survival and quality of life for end-stage renal disease (ESRD) patients than chronic dialysis. The median waiting time for a deceased donor kidney in a suitable ESRD patient is 3.9 years. The initial candidates for pig kidney xenotransplantation will be those with ESRD unlikely to receive an allograft within a reasonable period of time. It is thus reasonable to ascertain whether clinical trials of xenotransplantation might likewise offer superior outcomes. Chronic dialysis in patients with ESRD is associated with poor quality of life, significant morbidity, and relatively high mortality, with only 56% surviving 3 years and 42% at 5 years...
November 20, 2018: Xenotransplantation
Shunsuke Yamada, Hokuto Arase, Toshifumi Morishita, Akihiro Tsuchimoto, Kumiko Torisu, Takehiro Torisu, Kazuhiko Tsuruya, Toshiaki Nakano, Takanari Kitazono
A 57-year-old woman with pre-dialysis chronic kidney disease (CKD) was hospitalized because of fever and fatigue. On admission, increased inflammatory response and pyuria with bacteriuria were observed. Pyelonephritis was successfully treated with antibiotics, whereas her fatigue continued and she developed progressive hypercalcemia and hyponatremia; serum sodium level, 116 mEq/L and corrected serum calcium level, 13.4 mg/dL. Plasma concentrations of adrenocorticotropic hormone and cortisol and serum luteinizing hormone were under the detection level...
November 19, 2018: CEN Case Reports
Virginia Wang, Cynthia J Coffman, Linda L Sanders, Shoou-Yih D Lee, Richard A Hirth, Matthew L Maciejewski
BACKGROUND AND OBJECTIVES: Peritoneal dialysis is a self-administered, home-based treatment for ESKD associated with equivalent mortality, higher quality of life, and lower costs compared with hemodialysis. In 2011, Medicare implemented a comprehensive prospective payment system that makes a single payment for all dialysis, medication, and ancillary services. We examined whether the prospective payment system increased dialysis facility provision of peritoneal dialysis services and whether changes in peritoneal dialysis provision were more common among dialysis facilities that are chain affiliated, located in nonurban areas, and in regions with high dialysis market competition...
November 19, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Eylem Topbaş, Banu Terzi, Öznur Görgen, Gülay Bingöl
BACKGROUND: Applying the proper technique for connections in Peritoneal Dialysis (PD) is crucial in preventing potential infectious complications. OBJECTIVES: The aim of this study is to investigate the effects of different education methods in peritoneal dialysis (PD) application training on the psychomotor skills and self-efficacy of nursing students. METHODS: The randomized controlled and experimental study was conducted with a total of 28 nursing student participants...
November 9, 2018: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
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