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Pre- dialysis

John T Daugirdas
BACKGROUND: Changes in plasma volume during hemodialysis are complex and have been shown to depend on the rate of fluid removal and the degree of fluid overload. We examined changes in total protein concentration during and shortly after a dialysis treatment in archived data from the HEMO study. METHODS: During follow-up months 4 and 36 of the HEMO study, additional blood samples were obtained during a typical dialysis session at 30 and 60 min after dialysis. In 315 studies from 282 patients where complete data were available, we calculated the concentration change in total protein and compared it to the modeled change in both total body water and extracellular fluid space as derived from 2-pool urea kinetic modeling...
August 15, 2018: American Journal of Nephrology
Fernando G Zampieri, Theodore J Iwashyna, Elizabeth M Viglianti, Leandro U Taniguchi, William N Viana, Roberto Costa, Thiago D Corrêa, Carlos Eduardo N Moreira, Marcelo O Maia, Giulliana M Moralez, Thiago Lisboa, Marcus A Ferez, Carlos Eduardo F Freitas, Clayton B de Carvalho, Bruno F Mazza, Mariza F A Lima, Grazielle V Ramos, Aline R Silva, Fernando A Bozza, Jorge I F Salluh, Marcio Soares
PURPOSE: Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients' physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. METHODS: Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI)...
August 13, 2018: Intensive Care Medicine
Ben-Chung Cheng, Po-Cheng Chen, Pei-Chin Chen, Cheng-Hsien Lu, Yu-Chi Huang, Kun-Hsien Chou, Shau-Hsuan Li, An-Ni Lin, Wei-Che Lin
OBJECTIVES: The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. METHODS: ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group...
August 13, 2018: European Radiology
Yoshitsugu Obi, Danh V Nguyen, Hui Zhou, Melissa Soohoo, Lishi Zhang, Yanjun Chen, Elani Streja, John J Sim, Miklos Z Molnar, Connie M Rhee, Kevin C Abbott, Steven J Jacobsen, Csaba P Kovesdy, Kamyar Kalantar-Zadeh
OBJECTIVE: To develop and validate a risk prediction model that would help individualize treatment and improve the shared decision-making process between clinicians and patients. PATIENTS AND METHODS: We developed a risk prediction tool for mortality during the first year of dialysis based on pre-end-stage renal disease characteristics in a cohort of 35,878 US veterans with incident end-stage renal disease who transitioned to dialysis treatment between October 1, 2007, and March 31, 2014 and then externally validated this tool among 4284 patients in the Kaiser Permanente Southern California (KPSC) health care system who transitioned to dialysis treatment between January 1, 2007, and September 30, 2015...
August 10, 2018: Mayo Clinic Proceedings
Gokcen Gozubatik-Celik, Derya Uluduz, Baki Goksan, Nazan Akkaya, Melis Sohtaoglu, Ugur Uygunoglu, Fatih Kircelli, Adem Sezen, Sabahattin Saip, Feray Karaali Savrun, Aksel Siva
BACKGROUND: Hemodialysis(HD) may have some adverse effects on the nervous system. Headache is the most commonly reported neurological symptom among HD-patients. AIM: To determine the frequency, clinical characteristics, triggering factors of HD-related headache(HRH); to evaluate preventive strategies for reducing the HRH. METHOD: 494 patients were included. Comparative controls(CC) were classified within the same patients without headache...
August 13, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Ruoxi Liao, Jiameng Li, Yuqin Xiong, Liping Lin, Liya Wang, Si Sun, Baihai Su
BACKGROUND/AIMS: Blood pressure variability (BPV) is a novel cardiovascular risk factor for the population undergoing hemodialysis (HD). METHODS: We conducted a retrospective cohort study of 526 HD patients. Four short-term peridialysis BPV metrics were analyzed: systolic blood pressure (SBP) change, SBP coefficient of variation (CV), SBP intradialytic average real variability (ARV), and absolute SBP residual. Multi variate analysis with Cox regression models were used to account for the potential confounders...
August 10, 2018: Kidney & Blood Pressure Research
Jessica A Vanderlinden, Amanda Ross-White, Rachel Holden, M Khaled Shamseddin, Andrew Day, J Gordon Boyd
IMPORTANCE: Cognitive dysfunction is reportedly highly prevalent among chronic kidney disease (CKD) patients. A variety of screening tools and neuropsychiatric batteries are utilized to quantify the magnitude and nature of this dysfunction in CKD patients. OBJECTIVE: To summarize the neurocognitive testing used and determine what degree cognitive dysfunction is reported in CKD patients. METHODS: Articles published in English containing consenting age of majority participants who were either: pre-dialysis patients, hemodialysis (HD) or peritoneal dialysis (PD) patients, or renal transplant recipients were considered...
August 10, 2018: Nephrology
Frederic Sacher, Laurence Jesel, Claire Borni-Duval, Valerie De Precigout, Frédéric Lavainne, Jean-Philippe Bourdenx, Atman Haddj-Elmrabet, Bruno Seigneuric, Adrien Keller, Julien Ott, Helene Savel, Yahsou Delmas, Dorothée Bazin-Kara, Nicolas Klotz, Sylvain Ploux, Sébastien Buffler, Philippe Ritter, Virginie Rondeau, Pierre Bordachar, Claire Martin, Antoine Deplagne, Sylvain Reuter, Michel Haissaguerre, Jean-Baptiste Gourraud, Cécile Vigneau, Philippe Mabo, Philippe Maury, Thierry Hannedouche, Antoine Benard, Christian Combe
OBJECTIVES: The aim of this study was to identify using implantable loop recorder (ILR) monitoring the mechanisms leading to sudden death (SD) in patients undergoing hemodialysis (HD). BACKGROUND: SD accounts for 11% to 25% of death in HD patients. METHODS: Continuous rhythm monitoring was performed using the remote monitoring capability of the ILR device in patients undergoing HD at 8 centers. Clinical, biological, and technical HD parameters were recorded and analyzed...
March 2018: JACC. Clinical Electrophysiology
Matthew J Kaptein, John S Kaptein, Zayar Oo, Elaine M Kaptein
Background: Ultrasound (US) assessment of intravascular volume may improve volume management of dialysis patients. We investigated the relationship of intravascular volume evaluated by inferior vena cava (IVC) US to net volume changes with intermittent hemodialysis (HD) in critically ill patients. Methods: A retrospective cohort of 113 intensive care unit patients in 244 encounters had clinical assessment of intravascular volume followed by US of respiratory/ventilatory variation of IVC diameter, and had HD within 24 h...
2018: International Journal of Nephrology and Renovascular Disease
Tatsuyoshi Ikenoue, Kiyomi Koike, Shingo Fukuma, Satoshi Ogata, Kunitoshi Iseki, Shunichi Fukuhara
BACKGROUND: Although some clinical practice guidelines regarding hemodialysis recommend salt restriction, few studies have examined the association between salt intake and clinical outcomes in hemodialysis patients. This study aimed to clarify the association between salt intake and mortality in hemodialysis patients. METHODS: This retrospective cohort study was based on the Japanese Society for Dialysis Therapy renal data registry database (2008) and included 88,115 adult patients who had received hemodialysis for at least 2 years...
August 7, 2018: American Journal of Nephrology
Giorgina Barbara Piccoli, Conrad Breuer, Gianfranca Cabiddu, Angelo Testa, Christelle Jadeau, Giuliano Brunori
Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties...
August 3, 2018: Journal of Clinical Medicine
Melissa Soohoo, Elani Streja, Yoshitsugu Obi, Connie M Rhee, Daniel L Gillen, Keiichi Sumida, Danh V Nguyen, Csaba P Kovesdy, Kamyar Kalantar-Zadeh
OBJECTIVE: To determine whether kidney function level and its rate of decline in the immediate predialysis period among veterans transitioning to end-stage renal disease (ESRD) predict postdialysis mortality and hospitalization. PATIENTS AND METHODS: In 19,985 veterans transitioning to ESRD during the period October 1, 2007, to March 30, 2014, we examined kidney function and its slope over the final year of the pre-ESRD(prelude) period. Two categories of low vs high estimated glomerular filtration rate (eGFR, dichotomized at 10 mL/min/1...
August 2018: Mayo Clinic Proceedings
April A Pottebaum, Jennifer C Hagopian, Daniel C Brennan, Ara Gharabagi, Timothy A Horwedel
Evaluation of potential kidney transplant recipients is important to identify and treat conditions that may influence graft or patient survival after transplantation. We performed a single-center, observational cohort study to determine whether pre-transplant midodrine use influences outcomes after kidney transplantation. We analyzed graft and patient outcomes for adult patients who underwent a kidney-only transplantation at Barnes-Jewish Hospital from January 1999 to December 2015. We quantified adjusted associations of pre-transplant midodrine use with post-transplant complications by multivariable Cox regression...
August 4, 2018: Clinical Transplantation
Armando Vázquez-Rangel
El acceso vascular es el primer eslabón para la terapia de apoyo extracorpórea renal. A diferencia de la terapia de reemplazo renal para pacientes con enfermedad renal crónica donde la fístula arteriovenosa es la primera opción, seguida del catéter tunelizado, en pacientes con lesión renal aguda el acceso vascular de elección es el catéter temporal. El presente estudio constituye una revisión narrativa de resumen de los estudios que analizan la elección, colocación y cuidados del acceso vascular temporal para apoyo renal agudo...
2018: Gaceta Médica de México
Eugene H Blackstone, Jeevanantham Rajeswaran, Vincent B Cruz, Eileen M Hsich, Marijan Koprivanac, Nicholas G Smedira, Katherine J Hoercher, Lucy Thuita, Randall C Starling
BACKGROUND: Heart transplant allocation in the United States is made on the basis of coarse tiers, defined by mechanical circulatory devices and therapy for advanced heart failure, updated infrequently as a patient's condition deteriorates. Thus, many patients die awaiting heart transplantation. What is needed is a tool that continuously updates risk of mortality as a patient's condition changes to inform clinical decision making. OBJECTIVES: This study sought to develop a decision aid that aggregates adverse events and measures of end-organ function into a continuously updated waitlist mortality estimate...
August 7, 2018: Journal of the American College of Cardiology
Patricia Taschner Goldenstein, Fabiana Giorgeti Graciolli, Gisele Lins Antunes, Wagner Vasques Dominguez, Luciene Machado Dos Reis, Sharon Moe, Rosilene Motta Elias, Vanda Jorgetti, Rosa Maria Affonso Moysés
BACKGROUND: Calcium gradient, the difference between serum calcium and dialysate calcium d[Ca], is the main contributor factor influencing calcium transfer during hemodialysis. The impact, however, of bone turnover, on calcium mass transfer during hemodialysis is still uncertain. METHODS: This prospective cross-sectional study included 10 patients on hemodialysis for a 57.6±16.8 months, with severe hyperparathyroidism. Patients were submitted to 3 hemodialysis sessions using d[Ca] of 1...
2018: PloS One
Brittany A Shelton, Deirdre Sawinski, Benjamin P Linas, Peter P Reese, Margaux Mustian, Mitch Hungerpiller, Rhiannon D Reed, Paul A MacLennan, Jayme E Locke
Direct acting antivirals approved for use in end-stage renal disease (ESRD) patients now exist. HCV-positive (HCV+) ESRD patients have the opportunity to decrease waiting times for transplantation by accepting HCV-infected kidneys. The optimal timing for HCV treatment (pre vs posttransplant) among kidney transplant candidates is unknown. Monte Carlo microsimulation of 100,000 candidates was used to examine the cost-effectiveness of HCV treatment pretransplant versus posttransplant by liver fibrosis stage and waiting time over a lifetime time horizon using two regimens approved for ESRD patients...
July 30, 2018: American Journal of Transplantation
Graziano Colombo, Francesco Reggiani, David Cucchiari, Emanuela Astori, Maria L Garavaglia, Nicola M Portinaro, Nicola Saino, Silvia Finazzi, Aldo Milzani, Salvatore Badalamenti, Isabella Dalle-Donne
Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) experience oxidative/carbonyl stress, which is postulated to increase after the HD session. The influence of diabetes mellitus and sex on oxidation of plasma proteins in ESRD has not yet been clarified despite that diabetic nephropathy is the most common cause of ESRD in developed and developing countries and despite the increasingly emerging differences between males and females in epidemiology, pathophysiology, clinical manifestations, and outcomes for several diseases...
2018: Oxidative Medicine and Cellular Longevity
Wei Lu, Geng-Ru Jiang
INTRODUCTION: Haemodialysis (HD) is the cornerstone treatment for patients with end-stage renal disease (ESRD). However, highly protein bound or large molecular weight uremic toxins such as phenolic and indolic compounds and homocysteine, which are associated with adverse outcomes such as cardiovascular disease of patients with ESRD, are difficult to remove via HD but can be effectively eliminates by haemoperfusion (HP). The proposed trial (referred to as HD/HP vs HD below) is a randomised, open-label, multicentre trial comparing HD plus HP versus HD alone in adult patients with ESRD...
July 28, 2018: BMJ Open
A K Kasper, A M Pallotta, C S Kovacs, M L Spinner
BACKGROUND: Vaccines prevent infections and avoid related complications. Low rates in immunocompromised patients are concerning due to increased morbidity. Vaccinations are less effective when administered post-transplant and should be administered prior. We describe pre-transplant vaccination rates among kidney or kidney-pancreas transplant recipients. METHODS: Retrospective review including adults receiving kidney or kidney-pancreas allografts at Cleveland Clinic from October 2013 to October 2016...
August 16, 2018: Vaccine
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