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Hemodialysis Prescription

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https://www.readbyqxmd.com/read/28619128/bioimpedance-based-rather-than-weight-based-ultrafiltration-prescription-for-children-on%C3%A2-maintenance-hemodialysis%C3%A2
#1
Gianluigi Ardissino, Mirco Belingheri, Michela Perrone, Francesca Tel, Dario Consonni, Sara Testa
The determination of dry weight (DW) in young children on hemodialysis (HD) remains challenging. Bioimpedance analysis (BIA) is a potentially helpful means of estimating the need for ultrafiltration and monitoring body fluids in patients on renal replacement therapy, but its role has not yet been clearly defined. The aim of this paper is to share our experience of prescribing ultrafiltration on the basis of BIA parameters alone. The body weight (BW), resistance (Rx), and reactance (Xc) of a 3-year-old girl on chronic HD were recorded pre- and post-HD over a period of 16 months...
June 16, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28574107/continuous-renal-replacement-therapy-forty-year-anniversary
#2
Claudio Ronco
In 1977 Peter Kramer performed the first CAVH (continuous arteriovenous hemofiltration) treatment in Gottingen, Germany. CAVH soon became a reliable alternative to hemo- or peritoneal dialysis in critically ill patients. The limitations of CAVH spurred new research and the discovery of new treatments such as CVVH and CVVHD (continuous veno-venous hemofiltration and continuous veno-venous hemodialysis). The alliance with industry led to development of new specialized equipment with improved accuracy and performance in delivering continuous renal replacement therapies (CRRTs)...
May 31, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28564644/erythropoietin-hyporesponsiveness-in-dialysis-patients-possible-role-of-statins
#3
Takeshi Hasegawa, Junhui Zhao, Douglas S Fuller, Brian Bieber, Jarcy Zee, Hal Morgenstern, Norio Hanafusa, Masaomi Nangaku
BACKGROUND: Hypothesizing that statins may be useful as adjuvant treatment for renal anemia, we examined the association between statin prescription (Rx) and erythropoiesis-stimulating agent (ESA) hyporesponsiveness in Japanese hemodialysis (HD) patients prescribed ESAs. METHODS: We examined 3,602 patients in 60 HD facilities dialyzed 3 times/week for ≥4 months from the Japan Dialysis Outcomes and Practice Patterns Study phases 3-5 (2005-2015). Statin Rx was reported at the end of a 4-month interval (baseline) for each patient...
June 1, 2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28537215/pharmacokinetic-pharmacodynamic-considerations-for-cancer-patients-undergoing-hemodialysis
#4
REVIEW
Nicolas Janus, Vincent Launay-Vacher
The increased incidence of cancer in hemodialysis patients has been discussed since the mid-70s. Today, physicians regularly encounter situations where they must manage the prescription of anticancer drugs in hemodialysis patients. Areas covered: Hemodialysis patients are at risk of dose-related toxicities due to pharmacokinetic modifications. Hemodialysis patients are at risk of therapeutic drug removal during their hemodialysis session, which may result in a loss of efficacy. In the advent of novel immunotherapies, particularly tumor vaccines, there is an increased theoretical risk of pharmacodynamic modification...
June 2017: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/28472927/renal-replacement-therapy-in-acute-kidney-injury-from-a-chinese-cross-sectional-study-patient-clinical-socioeconomic-and-health-service-predictors-of-treatment
#5
Fang Wang, Daqing Hong, Yafang Wang, Yunlin Feng, Li Wang, Li Yang
BACKGROUND: Renal replacement therapy (RRT) is important to support critically ill patients with acute kidney injury (AKI). This study, a part of a nation-wide survey for AKI conducted by the ISN AKF 0 by 25 China Consortium, aims to study the current RRT practical situation and problems in China. METHODS: The current study is a part of a nation-wide survey for AKI conducted by ISN AKF 0 by 25 China Consortium. The survey included 44 sites all over the country, including 22 academic hospitals in big cities and 22 local hospitals in smaller cities or rural areas...
May 4, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28438255/a-strategy-based-on-patient-preference-improves-the-adherence-and-outcomes-of-phosphate-binders-in-hemodialysis%C3%A2
#6
M Dolores Arenas Jiménez, Eduardo Parra Moncasi, Fernando Álvarez-Ude Cotera
PURPOSE: Phosphate binders (PB) have to be taken with food, their interference with an individual's lifestyle and social habits influences treatment adherence. Several PBs are available, and patient preferences should not be ignored when prescribing. The purpose was to know the extent of intentional and unintentional nonadherence to PB in hemodialysis (HD) patients, and to evaluate the long-term results (adherence, serum phosphate levels, and cost) of a strategy of prescription of PB that takes into account patient preferences...
April 25, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28425578/survival-comparisons-of-intensive-vs-conventional-hemodialysis-pitfalls-and-lessons
#7
REVIEW
Amanda J Miller, Jeff Perl, Karthik K Tennankore
The optimal dose of hemodialysis (HD) has not yet been established. As a means of better approximating the physiology of native kidney function, there has been a growing interest in intensive HD (an increase in dialysis frequency and/or duration). Although many studies have demonstrated a survival benefit with intensive dialysis, results have been conflicting. This controversy stems from the challenges of randomizing patients to conventional vs. intensive HD modalities and, therefore, the reliance on observational comparisons that have been limited by varying definitions for intensive dialysis, differences in dialysis location and prescription, unavoidable treatment selection bias, and a potential lack of generalizability...
April 20, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28418614/efficacy-and-safety-of-low-dose-heparin-in-hemodialysis
#8
Mariana Murea, Gregory B Russell, Pirouz Daeihagh, Anita M Saran, Karan Pandya, Mark Cabrera, John M Burkart, Barry I Freedman
INTRODUCTION: The dose of unfractionated heparin (UFH) administered during hemodialysis (HD) varies widely. This prospective study evaluated the safety and efficacy of UFH dose de-escalation. METHODS: Sixty-six prevalent patients on HD receiving UFH per standard-dose protocol (load dose [LD] 50-75 units/kg, maintenance dose [MD] 500-1000 units/hour) had heparin prescription converted to low-dose protocol (start LD 15 units/kg and MD 500 units/hour; dose adjusted in small increments based on assessments of extracorporeal blood circuit)...
April 18, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28413417/the-dialysis-sodium-gradient-a-modifiable-risk-factor-for-fluid-overload
#9
Emilie Trinh, Catherine Weber
BACKGROUND: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate the 6-month risk of hospitalization and mortality in relation to sodium gradient. METHODS: We performed a cross-sectional study of 110 prevalent conventional hemodialysis patients at a single center...
January 2017: Nephron Extra
https://www.readbyqxmd.com/read/28401120/estimating-patient-borne-water-and-electricity-costs-in-home-hemodialysis-a-simulation
#10
Matthew Nickel, Wes Rideout, Nikhil Shah, Frances Reintjes, Justin Z Chen, Robert Burrell, Robert P Pauly
BACKGROUND: Home hemodialysis is associated with lower costs to the health care system compared with conventional facility-based hemodialysis because of lower staffing and overhead costs, and by transferring the treatment cost of utilities (water and power) to the patient. The purpose of this study was to determine the utility costs of home hemodialysis and create a formula such that patients and renal programs can estimate the annual patient-borne costs involved with this type of treatment...
January 2017: CMAJ Open
https://www.readbyqxmd.com/read/28337715/is-incremental-hemodialysis-ready-to-return-on-the-scene-from-empiricism-to-kinetic-modelling
#11
REVIEW
Carlo Basile, Francesco Gaetano Casino, Kamyar Kalantar-Zadeh
Most people who make the transition to maintenance dialysis therapy are treated with a fixed dose thrice-weekly hemodialysis regimen without considering their residual kidney function (RKF). The RKF provides effective and naturally continuous clearance of both small and middle molecules, plays a major role in metabolic homeostasis, nutritional status, and cardiovascular health, and aids in fluid management. The RKF is associated with better patient survival and greater health-related quality of life, although these effects may be confounded by patient comorbidities...
March 23, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28240423/nutritional-issues-with-incremental-dialysis-the-role-of-low-protein-diets
#12
Francesco Locatelli, Lucia Del Vecchio, Valeria Aicardi
A gentle start of dialysis is a welcome possibility for both patients and physicians. Incident dialysis patients often maintain residual kidney function (RKF) for a considerable period of time; the start of dialysis is often driven mainly by uremic symptoms. Recently, the combination of a low-protein diet, along with a less-frequent dialysis schedule, has regained interest as an alternative option in selected and motivated patients. In addition, there is renewed interest in a low-protein diet in patients with moderate to advanced chronic kidney disease (CKD)...
May 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28223837/efficacy-of-low-dose-cinacalcet-on-alternate-days-for-the-treatment-of-secondary-hyperparathyroidism-in-hemodialysis-patients-a-single-center-study
#13
Pongsathorn Gojaseni, Dolnapa Pattarathitinan, Anutra Chittinandana
INTRODUCTION: Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (HPT). This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT. MATERIALS AND METHODS: A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group)...
2017: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/28214287/association-of-warfarin-with-congestive-heart-failure-and-peripheral-artery-occlusive-disease-in-hemodialysis-patients-with-atrial-fibrillation
#14
Kuo-Hua Lee, Szu-Yuan Li, Jin-Sin Liu, Chi-Ting Huang, Ying-Ying Chen, Yao-Ping Lin, Chih-Cheng Hsu, Der-Cherng Tarng
BACKGROUND: The effect of warfarin on the risk of cardiovascular (CV) disease is unknown among chronic hemodialysis patients with atrial fibrillation (HD-AF). METHODS: Population-based propensity score and prescription time-distribution matched cohort study including 6719 HD-AF patients with CHA2DS2-VASc score ≥ 2 were divided into warfarin users and nonusers and followed-up for CV events and death. RESULTS: Warfarin treatment in HD-AF patients with AF preceding HD was associated with higher risks of developing congestive heart failure [hazard ratio (HR)=1...
May 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28160765/the-use-of-complementary-and-alternative-medicine-among-dialysis-patients
#15
Ronit Koren, Hadas Zafrir Danieli, Keren Doenyas-Barak, Tomer Ziv-Baran, Ahuva Golik
Context • The use of complementary and alternative medicine (CAM) has been on the rise in the last decade. Subpopulations of patients with chronic diseases are at risk for adverse events and potential drug-herb interactions, among them dialysis patients. Objective • The study aimed to evaluate the prevalence of CAM consumption among dialysis patients and to search for potential interactions. Design • The study was cross-sectional, based on questionnaires. Setting • The study occurred in the hemodialysis unit at Assaf Harofeh Medical Center (Zeriffin, Israel)...
January 2017: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/28151871/antihypertensive-medications-and-risk-of-death-and-hospitalizations-in-us-hemodialysis-patients-evidence-from-a-cohort-study-to-inform-hypertension-treatment-practices
#16
Tariq Shafi, Stephen M Sozio, Jason Luly, Karen J Bandeen-Roche, Wendy L St Peter, Patti L Ephraim, Aidan McDermott, Charles A Herzog, Deidra C Crews, Julia J Scialla, Navdeep Tangri, Dana C Miskulin, Wieneke M Michels, Bernard G Jaar, Philip G Zager, Klemens B Meyer, Albert W Wu, L Ebony Boulware
Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity and mortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes in US hemodialysis patients.We used 2 datasets for our analysis. Our primary cohort (US Renal Data System [USRDS]) included adult patients initiating in-center hemodialysis from July 1, 2006 to June 30, 2008 (n = 33,005) with follow-up through December 31, 2009...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28124306/gastrointestinal-bleeding-in-patients-with-renal-failure-under-hemodialysis-treatment-a-single-center-experience
#17
Özgür Can, Gözde Koç, Sema Berk Ocak, Nursel Akbay, Emel Ahishali, Mustafa Canbakan, Gülizar Manga Şahin, Süheyla Apaydin
PURPOSE: Gastrointestinal bleeding remains the leading cause of morbidity and mortality for patients who need hemodialysis treatment. Our aim was to evaluate patients who needed hemodialysis and presented with bleeding during their hospital stay (uremic bleeding patients). Factors that increased the risk of bleeding and death were evaluated. Additionally, uremic bleeding patients were compared to non-uremic bleeding patients regarding gastrointestinal findings. PATIENTS AND METHODS: Fifty-one uremic bleeding patients were compared to two control groups which included uremic (hemodialysis dependent and non-bleeding) and non-uremic (no renal insufficiency and bleeding) patients...
January 25, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28066927/dialysate-composition-for-hemodialysis-changes-and-changing-risk
#18
Rita L McGill, Daniel E Weiner
Dialysate composition is a critical aspect of the hemodialysis prescription. Despite this, trial data are almost entirely lacking to help guide the optimal dialysate composition. Often, the concentrations of key components are chosen intuitively, and dialysate composition may be determined by default based on dialysate manufacturer specifications or hemodialysis facility practices. In this review, we examine the current epidemiological evidence guiding selection of dialysate bicarbonate, calcium, magnesium, and potassium, and identify unresolved issues for which pragmatic clinical trials are needed...
January 8, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28066913/dialysate-sodium-rationale-for-evolution-over-time
#19
Jennifer E Flythe, Finnian R Mc Causland
Oligo-anuric individuals receiving hemodialysis (HD) are dependent on the dialysis machine to regulate sodium and water balance. Interest in adjusting the dialysate sodium concentration to promote tolerance of the HD procedure dates back to the early years of dialysis therapy. Evolution of dialysis equipment technologies and clinical characteristics of the dialysis population have prompted clinicians to increase the dialysate sodium concentration over time. Higher dialysate sodium concentrations generally promote hemodynamic stabilization and reduce intradialytic symptoms but often do so at the expense of stimulating thirst and promoting volume expansion...
March 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/27991476/cardiovascular-and-cerebrovascular-comorbidities-in-hemodialysis-patients-from-the-gulf-cooperation-council-countries-enrolled-in-the-dialysis-outcome-and-practice-pattern-study-phase-5-2012-2015
#20
Faissal A M Shaheen, Jamal Al Wakeel, Saeed M G Al-Ghamdi, Bassam Alhelal, Sumaya AlGhareeb, Ali Abdulkarim Al Obaidli, Issa AlSalmi, Hani Ezzat Abdulaziz, Brian A Bieber, Ronald L Pisoni
To determine the prevalence of cardiovascular comorbidities and their active risk factors in the selected hemodialysis centers in the Gulf Cooperation Council (GCC) countries, the Dialysis Outcome and Practice Pattern Study (DOPPS) was performed on 40 dialysis centers in the six GCC countries from June 2012 to May 2015. There were 21 dialysis centers from Saudi Arabia, nine from the United Arab Emirates (UAE), four from Kuwait, four from Oman, two from Qatar, and one from Bahrain. There were 922 patients participating in the study; 419 patients from Saudi Arabia, 144 from the UAE, 164 from Kuwait, 89 from Oman, 58 from Qatar, and 25 from Bahrain...
November 2016: Saudi Journal of Kidney Diseases and Transplantation
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