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https://www.readbyqxmd.com/read/30343516/dialysate-sodium-concentration-the-forgotten-salt-shaker
#1
Norio Hanafusa, Ken Tsuchiya, Kosaku Nitta
The concentration of sodium in dialysis fluid, a major determinant of extracellular fluid volume and blood pressure, plays a major role in the sodium balance in end-stage renal disease patients. A low dialysate sodium concentration (DNa) reduces interdialytic weight gain (IDWG) and blood pressure and might help ameliorate endothelial dysfunction and inflammation. However, low DNa can also increase the incidence of hypotensive episodes and muscle cramps. Sodium profiling, as typically prescribed in which the DNa is ramped up from above 140 mEq/L to nonphysiological levels, might reduce hypotension in patients with hemodynamic instability but at the cost of the consequences of hypernatremia...
October 21, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/30325241/forecast-post-dialysis-blood-pressure-in-hemodialysis-patients-with-intradialytic-hypertension
#2
Lu-Xi Zou, Ling Sun
BACKGROUND: Intradialytic hypertension (IDH) is emerging as an important issue in maintenance hemodialysis (MHD) patients. This study aimed to discuss potential factors related to IDH and build forecasting models for post-dialysis blood pressure (BP) in MHD patients with IDH. METHODS: A total of 266 MHD patients were enrolled, included 133 (50%) patients with IDH and 133 patients without IDH. The BP and pulse were determined and recorded over six consecutive dialysis treatments...
October 16, 2018: Clinical and Experimental Hypertension: CHE
https://www.readbyqxmd.com/read/30297763/coffee-consumption-in-hemodialysis-patients-how-many
#3
Cristina Caetano, Ana Valente, Telma Oliveira, Cristina Garagarza
BACKGROUND AND AIMS: Coffee is one of the most widely consumed beverages worldwide. However, fluid intake restriction is an important and difficult challenge for hemodialysis (HD) patients. The aim of this study was to analyze the effect of coffee intake on hydration and nutritional parameters of HD patients. METHODS: This was an observational, cross-sectional, multicenter study where 373 HD patients from 8 dialysis centers in Portugal were enrolled. A face-to-face questionnaire was applied and patient's clinical and body composition parameters were analyzed...
October 8, 2018: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/30178237/interdialytic-weight-gain-and-vasculopathy-in-children-on-hemodialysis-a-single-center-study
#4
Vasiliki Karava, Cherine Benzouid, Theresa Kwon, Marie-Alice Macher, Georges Deschênes, Julien Hogan
BACKGROUND: Increased interdialytic weight gain (IDWG) has been associated with poor outcomes in adults, but its impact on hemodialysis vasculopathy in children is unknown. METHODS: Nineteen patients (age 9 to 19 years old) with a median hemodialysis duration of 10.4 months were enrolled. Cardiovascular evaluation included left ventricular mass index (LVMI), pulse wave velocity (PWV), and carotid intima-media thickness (cIMT) measurements. PWV and cIMT were expressed as z-scores based on reference values in healthy children...
December 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/30124529/techniques-to-improve-intradialytic-haemodynamic-stability
#5
V R Latha Gullapudi, Isma Kazmi, Nicholas M Selby
PURPOSE OF REVIEW: Intra-dialytic hypotension (IDH) remains a significant problem for patients undergoing chronic haemodialysis. IDH causes symptoms that degrade patients' experience, compromises dialysis delivery and is strongly associated with adverse patient outcomes. Greater understanding of the link between IDH and dialysis-induced ischaemia in heart and brain has characterized mechanistic pathways, with repeated episodes of ischaemia resulting in organ dysfunction. This review provides updates from published evidence over the last 2 years across the range of potential interventions for IDH...
November 2018: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/29691160/the-frustrating-attempt-to-limit-the-interdialytic-weight-gain-in-patients-on-chronic-hemodialysis-new-insights-into-an-old-problem
#6
REVIEW
Maurizio Bossola, Gilda Pepe, Carlo Vulpio
A significant percentage of patients on chronic hemodialysis have an interdialytic weight gain (IDWG) above the recommended values. High IDWG has detrimental effects on survival, cardiovascular outcomes, and quality of life. High IDWG is secondary to poor adherence to fluid restriction and to excessive intake of fluids, due to thirst and xerostomia. Various strategies have been proposed to limit IDWG such as the reduction of dietary salt intake, behavioral interventions aimed at improving the adherence to fluid restriction, the improvement of xerostomia, and the use of lower dialysate sodium concentration...
September 2018: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/29688512/greater-fluid-overload-and-lower-interdialytic-weight-gain-are-independently-associated-with-mortality-in-a-large-international-hemodialysis-population
#7
Manfred Hecking, Ulrich Moissl, Bernd Genser, Hugh Rayner, Indranil Dasgupta, Stefano Stuard, Andrea Stopper, Charles Chazot, Franklin W Maddux, Bernard Canaud, Friedrich K Port, Carmine Zoccali, Peter Wabel
Background: Fluid overload and interdialytic weight gain (IDWG) are discrete components of the dynamic fluid balance in haemodialysis patients. We aimed to disentangle their relationship, and the prognostic importance of two clinically distinct, bioimpedance spectroscopy (BIS)-derived measures, pre-dialysis and post-dialysis fluid overload (FOpre and FOpost) versus IDWG. Methods: We conducted a retrospective cohort study on 38 614 incident patients with one or more BIS measurement within 90 days of haemodialysis initiation (1 October 2010 through 28 February 2015)...
October 1, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29624853/impact-of-salt-reduction-in-meals-consumed-during-hemodialysis-sessions-on-interdialytic-weight-gain-and-hemodynamic-stability
#8
Arthur Colson, Anita Brinkley, Philippe Braconnier, Nadia Ammor, Michel Burnier, Menno Pruijm
INTRODUCTION: Patients on hemodialysis (HD) are advised to limit daily water- and salt intake to reduce interdialytic weight gain (IDWG). To counterbalance protein-losses, protein-rich meals are sometimes provided during HD sessions, but their salt content is not always taken into account. The aim of this study was to assess the influence of a lower salt content of meals provided during HD sessions on IDWG, blood pressure (BP), and hemodynamic stability during dialysis. METHODS: This monocentric, interventional study was proposed to all the patients treated with three weekly HD sessions...
April 6, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29619872/association-of-short-term-blood-pressure-variability-with-cardiovascular-mortality-among-incident-hemodialysis-patients
#9
Yiduo Feng, Ziqian Li, Jing Liu, Fang Sun, Lijie Ma, Yang Shen, Yilun Zhou
OBJECTIVE: To investigate the association of short-term blood pressure variability (BPV) with cardiovascular mortality in hemodialysis (HD) patients, using a reliable index called average real variability (ARV), and to assess the factors associated with ARV in incident HD population. METHODS: A total of 103 HD patients were recruited, with 44-h ambulatory blood pressure monitoring performed after the midweek HD session. Systolic BPV was assessed by SD, coefficient of variation (CV), and ARV, respectively...
November 2018: Renal Failure
https://www.readbyqxmd.com/read/29609536/effects-of-dialysate-to-serum-sodium-na-alignment-in-chronic-hemodialysis-hd-patients-retrospective-cohort-study-from-a-quality-improvement-project
#10
Jochen G Raimann, Linda H Ficociello, Len A Usvyat, Hanjie Zhang, Lisa Pacelli, Sandi Moore, Penny Sheppard, Qingqing Xiao, Yuedong Wang, Claudy Mullon, Paul Balter, Terry Sullivan, Peter Kotanko
BACKGROUND: Evidence indicates favorable effects of dialysate (DNa+ ) to serum sodium concentration (SNa+ ) alignment, however, results from larger sample populations are needed. For this reason, we conducted a retrospective propensity score-matched cohort study from a quality improvement project to investigate the effects of alignment on population of maintenance hemodialysis patients. METHODS: At 4 participating hemodialysis (HD) clinics, patients with SNa+ lower than the standard DNa+ of 137 mEq/L who received HD with DNa+ aligned to the average of the last 4 SNa+ measurements were evaluated (clinicaltrials...
April 2, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29482263/why-does-the-choice-of-dialysate-sodium-concentration-remain-controversial
#11
REVIEW
Kamonwan Tangvoraphonkchai, Andrew Davenport
The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration...
October 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29409160/decreasing-hospitalizations-in-patients-on-hemodialysis-time-for-a-paradigm-shift
#12
REVIEW
Ladan Golestaneh
Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categories include: (1) fluid (interdialytic weight gain (IDWG) and chronic volume status), (2) infection (vascular access and malnutrition/inflammation resilience), and c) psychosocial (poor social support, poor self-efficacy, and mood disorders) risks...
May 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29325339/-risk-factors-and-impacts-on-prognosis-of-ultrasound-lung-comets-in-patients-undergoing-hemodialysis
#13
Z L Wang, J Y Liu, C J Zhou, M B Wang, H Y Wang, Y Xu
Objective: To investigate the risk factors of ultrasound lung comets and its impact on the survivals of patients undergoing hemodialysis. Methods: One hundred and forty-two patients on hemodialysis (Male 76, female 66) were divided into three groups according to the score of lung comets (mild: ≤14 comets; moderate: 15 to 30 comets; severe: >30 comets). Seventy-two healthy subjects examined by lung ultrasound serve as a control. Pulmonary artery systolic pressure and left ventricular ejection fraction (LVEF) were assessed by Doppler ultrasonography...
December 26, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29198641/hemodialysis-self-management-intervention-randomized-trial-hed-smart-a-practical-low-intensity-intervention-to-improve-adherence-and-clinical-markers-in-patients-receiving-hemodialysis
#14
Konstadina Griva, Mooppil Nandakumar, Jo-An H Ng, Kevin F Y Lam, Hayley McBain, Stanton P Newman
BACKGROUND: Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. STUDY DESIGN: Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. SETTING & PARTICIPANTS: Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers...
March 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29166378/blood-pressure-variability-is-independent-of-systolic-pressure-in-adolescent-and-young-adult-patients-undergoing-hemodialysis
#15
Jingjing Da, Zulong Zhang, Yan Shen, Qian Li, Ying Hu, Yan Zha
BackgroundPre-dialysis blood pressure variability (BPV) in adolescent and young-adult maintenance hemodialysis (MHD) patients remains unknown. This study aimed to show the degree of 44-h BPV and to explore its related risk factors in adolescent and young-adult MHD patients.MethodsOne hundred and fifty-three hemodialysis patients aged from 14 to 29 were selected from 11 medical facilities in Guizhou, China. Variability independent of the mean BP (VIM) obtained by 44-h ambulatory BP monitoring was used to calculate BPV...
March 2018: Pediatric Research
https://www.readbyqxmd.com/read/28707302/dialysate-sodium-and-intradialytic-hypotension
#16
REVIEW
Wael F Hussein, Brigitte Schiller
Intradialytic hypotension (IDH) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain (IDWG), high ultrafiltration rates (UFR), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D-Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG, UFR, and hypertension...
November 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28634051/revisiting-interdialytic-weight-gain-and-mortality-association-with-serum-albumin-interactions-the-japanese-dialysis-outcomes-and-practice-pattern-study
#17
Noriaki Kurita, Yasuaki Hayashino, Shin Yamazaki, Tadao Akizawa, Takashi Akiba, Akira Saito, Shunichi Fukuhara
BACKGROUND: The dialysis practice guideline in Japan sets a limit on the allowed interdialytic weight gain (IDWG) <6%. However, the effects of relative gain of fluid volume to body weight may differ in presence of morbid conditions. Here, we examined whether or not the associations between IDWG and mortality differ by serum albumin (sAlb), a nutritional and illness marker. DESIGN: The study type used was prospective cohort study. SUBJECTS: Patients who participated in the Japan Dialysis Outcomes and Practice Pattern Study (phase 1-4 [1999-2011]) and received thrice-weekly hemodialysis...
November 2017: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/28600736/blood-pressure-management-in-children-on-dialysis
#18
F Paglialonga, S Consolo, A Edefonti, G Montini
Hypertension is a leading cause of cardiovascular complications in children on dialysis. Volume overload and activation of the renin-angiotensin-aldosterone system play a major role in the pathophysiology of hypertension. The first step in managing blood pressure (BP) is the careful assessment of ambulatory BP monitoring. Volume control is essential and should start with the accurate identification of dry weight, based on a comprehensive assessment, including bioimpedance analysis and intradialytic blood volume monitoring (BVM)...
February 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28578687/target-weight-achievement-and-ultrafiltration-rate-thresholds-potential-patient-implications
#19
Jennifer E Flythe, Magdalene M Assimon, Robert A Overman
BACKGROUND: Higher ultrafiltration (UF) rates and extracellular hypo- and hypervolemia are associated with adverse outcomes among maintenance hemodialysis patients. The Centers for Medicare and Medicaid Services recently considered UF rate and target weight achievement measures for ESRD Quality Incentive Program inclusion. The dual measures were intended to promote balance between too aggressive and too conservative fluid removal. The National Quality Forum endorsed the UF rate measure but not the target weight measure...
June 2, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28456922/nutritional-status-after-conversion-from-conventional-to-in-centre-nocturnal-hemodialysis
#20
MULTICENTER STUDY
Nazanin Noori, Andrew T Yan, Mercedeh Kiaii, Andrea Rathe, Marc B Goldstein, Olugbenga Bello, Ron Wald
INTRODUCTION: Recipients of conventional hemodialysis (CHD; 3-4 h/session, 3 times/week) experience volume expansion and nutritional impairment which may contribute to high mortality. Prolongation of sessions with in-centre nocturnal hemodialysis (INHD; 7-8 h/session, 3 times/week) may improve clinical outcomes by enhancement of ultrafiltration and uremic toxin removal. MATERIALS AND METHODS: In this prospective cohort study, 56 adult patients who were receiving maintenance CHD for at least 90 days were assigned to CHD (patients who remained in CHD) and INHD (patients who switched to INHD) groups...
August 2017: International Urology and Nephrology
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