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Hemodialysis Prescription

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https://www.readbyqxmd.com/read/28066927/dialysate-composition-for-hemodialysis-changes-and-changing-risk
#1
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
#2
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...
January 8, 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
#3
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
https://www.readbyqxmd.com/read/27951567/evidence-for-targeting-low-molecular-weight-proteins-in-hemodialysis-and-hemodiafiltration
#4
Kenji Tsuchida, Kojiro Nagai, Narushi Yokota, Satoru Yamada, Hiroyuki Michiwaki, Jun Minakuchi
BACKGROUND: With the identification of β2-microglobulin (β2MG) as an active participant in dialysis-related amyloid fibril formation, low-molecular-weight proteins (LMWPs) are now recognized as a distinct class of uremic toxins, and numerous compounds in this category have been identified. The class of LMWPs, although not precisely defined, has a molecular weight range of approximately 1,000-50,000 Da. With this in mind, dialysis prescriptions have been modified to increase the efficiency of uremic solute removal...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27951558/evolution-of-technology-for-continuous-renal-replacement-therapy-forty-years-of-improvements
#5
Claudio Ronco
Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27928454/the-role-of-oral-sodium-bicarbonate-supplementation-in-maintaining-acid-base-balance-and-its-influence-on-the-cardiovascular-system-in-chronic-hemodialysis-patients-results-of-a-prospective-study
#6
Voiculeț C, Zară O, Bogeanu C, Văcăroiu I, Aron G
Background: Major acid-base variations during dialysis and the imbalances in serum calcium levels intensified by them play a role in cardiovascular damage of hemodialysis patients. Early vascular walls modifications can be objectified by determining the pulse wave velocity (PWV) - a marker of vascular stiffness that is associated with increased risk of cardiovascular events. Material and methods: This was a prospective study conducted on 63 chronic hemodialysis patients with diuresis above 500 mL/ 24 hours and predialysis blood pressure below 160 mmHg (treatment controlled) randomized in two groups for 12 months - the study group receiving interdialitic oral sodium bicarbonate doses and control group, without oral sodium bicarbonate supplementation, but receiving higher bicarbonate prescriptions in dialysis...
October 2016: Journal of Medicine and Life
https://www.readbyqxmd.com/read/27895933/influence-of-proton-pump-inhibitors-and-histamine-h2-receptor-antagonists-on-serum-phosphorus-level-control-by-calcium-carbonate-in-patients-undergoing-hemodialysis-a-retrospective-medical-chart-review
#7
Masaomi Tatsuzawa, Ryuichi Ogawa, Atsushi Ohkubo, Kazuyo Shimojima, Kunimi Maeda, Hirotoshi Echizen, Akihisa Miyazaki
BACKGROUND: Hyperphosphatemia is one of the common complications in patients undergoing hemodialysis. Although calcium carbonate (CaC) is often used to control serum inorganic phosphorus level in dialysis patients, co-administration of gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC. We performed a retrospective medical chart review to study whether ARs attenuate the hypophosphatemic effect of CaC in patients undergoing hemodialysis. METHODS: One hundred and eight chronic hemodialysis patients receiving either CaC alone or CaC concomitant with one of the ARs (proton pump inhibitors and histamine H2-receptor antagonists) were retrieved from the medical charts in Juntendo University Nerima Hospital...
2016: Journal of Pharmaceutical Health Care and Sciences
https://www.readbyqxmd.com/read/27884309/would-prescribing-target-kt-dose-adjusted-for-body-surface-area-improve-hemodialysis-outcomes
#8
Ken Farrington, Andrew Davenport
The use of Kt/V to prescribe and monitor hemodialysis adequacy remains the current standard, although it is increasingly questioned. Alternative proposals for dose prescription and monitoring have been advocated. In a noninterventional, prospective study reported in this issue, Maduell et al., utilizing online ionic dialysance, explore the association between outcome measures (mortality and hospitalization rates) and the extent to which delivered Kt dose achieved minimal target Kt doses calculated from individual estimates of body surface area...
December 2016: Kidney International
https://www.readbyqxmd.com/read/27881607/bicarbonate-balance-and-prescription-in-esrd
#9
Matthew K Abramowitz
The optimal approach to managing acid-base balance is less well defined for patients receiving hemodialysis than for those receiving peritoneal dialysis. Interventional studies in hemodialysis have been limited and inconsistent in their findings, whereas more compelling data are available from interventional studies in peritoneal dialysis. Both high and low serum bicarbonate levels associate with an increased risk of mortality in patients receiving hemodialysis, but high values are a marker for poor nutrition and comorbidity and are often highly variable from month to month...
November 23, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27876356/-low-flux-dialysate-daily-home-hemodialysis-a-result-for-the-62%C3%A2-first-french-and-belgian-patients
#10
Anaïs Benabed, Patrick Henri, Thierry Lobbedez, Eric Goffin, Simona Baluta, Abdelkader Benziane, Ahmed Rachi, Johan W van der Pijl, Clémence Bechade, Maxence Ficheux
Since 2011, a new device is available for low flux dialysate quotidian home hemodialysis in France and Belgium. This study aims to evaluate the characteristics and dialysis prescriptions for Nx Stage System One™ users. We retrospectively included patients trained between 2011 and 2013 in France and Belgium. We collected data concerning their clinical features, their dialysis prescriptions, their laboratory parameters until 6 months of dialysis and, reason for dropping in case of cessation. Sixty-two patients from 31 centers, aged 48±18 years old, with a sex ratio 46/16 (M/F) are included with a median Charlson comorbidity index of 1 [0-3]...
November 18, 2016: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/27866964/dialysate-potassium-serum-potassium-mortality-and-arrhythmia-events-in-hemodialysis-results-from-the-dialysis-outcomes-and-practice-patterns-study-dopps
#11
Angelo Karaboyas, Jarcy Zee, Steven M Brunelli, Len A Usvyat, Daniel E Weiner, Franklin W Maddux, Allen R Nissenson, Michel Jadoul, Francesco Locatelli, Wolfgang C Winkelmayer, Friedrich K Port, Bruce M Robinson, Francesca Tentori
BACKGROUND: Sudden death is a leading cause of death in patients on maintenance hemodialysis therapy. During hemodialysis sessions, the gradient between serum and dialysate levels results in rapid electrolyte shifts, which may contribute to arrhythmias and sudden death. Controversies exist about the optimal electrolyte concentration in the dialysate; specifically, it is unclear whether patient outcomes differ among those treated with a dialysate potassium concentration of 3 mEq/L compared to 2 mEq/L...
November 17, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27814946/phosphate-containing-prescription-medications-contribute-to-the-daily-phosphate-intake-in-a-third-of-hemodialysis-patients
#12
Seana M L Nelson, Samantha R S Sarabia, Erin Christilaw, Emilie C Ward, Stephanie K Lynch, Michael A Adams, Rachel M Holden
OBJECTIVES: Hyperphosphatemia is associated with all-cause mortality in hemodialysis (HD) patients and is managed by restricting dietary phosphate. Many patients are unable to adhere to the recommended dietary phosphate limit. We sought to quantify the additional phosphate burden from prescription medication in a hemodialysis population. DESIGN: Cross-sectional study. SUBJECTS: Adult patients on hemodialysis at a single center. SETTING: The Health Canada Drug Product Database was used to identify formulations of medications prescribed in an HD program that contain phosphate salts...
November 1, 2016: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/27790813/hemodialysis-practice-patterns-in-the-russia-dialysis-outcomes-and-practice-patterns-study-dopps-with-international-comparisons
#13
Boris Bikbov, Brian Bieber, Anton Andrusev, Natalia Tomilina, Alexander Zemchenkov, Junhui Zhao, Friedrich Port, Bruce Robinson, Ronald Pisoni
Introduction There is little comparable information about hemodialysis (HD) practices in low- and middle income countries, including Russia. Evaluation of HD in Russia and its international comparisons could highlight factors providing opportunities for improvement. Methods We examined treatment patterns for 481 prevalent HD patients in 20 Russian facilities, and compared them to contemporary data for 8512 patients from 311 facilities in seven European countries, Japan, and North America. Data were collected according to the uniform methodology of the Dialysis Outcomes and Practice Patterns Study, phase 5...
October 27, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27789113/baclofen-toxicity-in-a-patient-with-hemodialysis-dependent-end-stage-renal-disease
#14
Lauren M Porter, Stephanie S Merrick, Kenneth D Katz
BACKGROUND: Oral baclofen toxicity is extremely rare, but can affect patients with renal disease due to the drug's predominant renal clearance of approximately 69-85%. Patients with severely impaired renal function typically develop symptoms soon after initiating baclofen therapy, even at relatively low doses. CASE REPORT: A 69-year-old woman with a history of hemodialysis-dependent end-stage renal disease presented to the Emergency Department with encephalopathy, ataxia, and dystonia after the addition of a recent baclofen prescription for back pain (10 mg twice daily)...
October 24, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27781388/the-dialysis-outcomes-and-practice-patterns-study-dopps-in-turkey
#15
Tevfik Ecder, Cengiz Utas, Kenan Ates, Brian Bieber, Bruce M Robinson, Ronald L Pisoni, Gültekin Süleymanlar
Introduction Turkey has one of the largest treated end-stage renal disease (ESRD) patient populations in Europe (N = 66,711). In 2013, the international Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective study of hemodialysis (HD) practices and outcomes, initiated data collection in Turkey. Here we provide comparisons of HD patients in DOPPS-Turkey with other international regions and with patients in the Registry of Turkish Nephrology, Dialysis and Transplantation. Methods DOPPS-Turkey study sites were randomly selected from all Turkish HD units treating ≥25 in-center chronic HD patients...
October 25, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27738228/a-two-pool-kinetic-model-predicts-phosphate-concentrations-during-and-shortly-following-a-conventional-three-times-weekly-hemodialysis-session
#16
John T Daugirdas
BACKGROUND: Previous studies have suggested that a conventional two-pool model cannot be used to predict intradialysis and early postdialysis phosphorus concentrations. METHODS: A conventional two-pool urea model was modified by increasing the distal compartment volume from two-thirds to three times the total body water and by the use of a dynamically variable intercompartmental phosphorus clearance during dialysis. The phosphate solver model parameters were derived from an examination of the results in the literature, and fine-tuned using a training set (F4) of 415 Hemodialysis (HEMO) Study patients studied during a dialysis session where phosphorus was measured at 4 months of follow-up...
October 13, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27721548/prescribing-patterns-of-medicines-in-chronic-kidney-disease-patients-on-maintenance-hemodialysis
#17
Sourav Chakraborty, Saugata Ghosh, Avishek Banerjea, Radha Raman De, Avijit Hazra, Swapan Kumar Mandal
OBJECTIVES: To study medicine prescribing pattern for chronic kidney disease (CKD) patients on maintenance hemodialysis. MATERIALS AND METHODS: This prospective observational study was conducted in hemodialysis unit of a teaching hospital with adult CKD patients on maintenance hemodialysis. Patients' clinical profile, drug-use pattern, and medication-related problem data were captured in a structured case report form and the data were analyzed descriptively. Adherence level was assessed by Morisky Medication-Taking Adherence Scale 4-item...
September 2016: Indian Journal of Pharmacology
https://www.readbyqxmd.com/read/27672007/a-comparative-study-of-renal-care-in-brazil-and-mexico-hemodialysis-treatment-from-the-perspective-of-esrd-sufferers
#18
Francisco J Mercado-Martinez, Denise Guerreiro V da Silva, Mauricio E Correa-Mauricio
Renal replacement therapy is the indicated treatment for individuals with chronic kidney disease (CKD) to survive. However, not all sick people have access to the same treatment. This study compares renal care in two developing countries with different health systems. Specifically, it explores hemodialysis treatment from the perspective of low-income individuals. A qualitative, comparative study was performed in Brazil and Mexico. Using purposive sampling, the research was based on open-ended interviews with nineteen participants with kidney failure undergoing hemodialysis treatment in public hospitals and ten relatives...
September 27, 2016: Nursing Inquiry
https://www.readbyqxmd.com/read/27663037/scaling-hemodialysis-target-dose-to-reflect-body-surface-area-metabolic-activity-and-protein-catabolic-rate-a-prospective-cross-sectional-study
#19
Sivakumar Sridharan, Enric Vilar, Andrew Davenport, Neil Ashman, Michael Almond, Anindya Banerjee, Justin Roberts, Ken Farrington
BACKGROUND: Women and small men treated by hemodialysis (HD) have reduced survival. This may be due to use of total-body water (V) as the normalizing factor for dialysis dosing. In this study, we explored the equivalent dialysis dose that would be delivered using alternative scaling parameters matching the current recommended minimum Kt/V target of 1.2. STUDY DESIGN: Prospective cross-sectional study. SETTING & PARTICIPANTS: 1,500 HD patients on a thrice-weekly schedule, recruited across 5 different centers...
September 20, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27660305/the-agreement-between-auscultation-and-lung-ultrasound-in-hemodialysis-patients-the-lust-study
#20
Claudia Torino, Luna Gargani, Rosa Sicari, Krzysztof Letachowicz, Robert Ekart, Danilo Fliser, Adrian Covic, Kostas Siamopoulos, Aristeidis Stavroulopoulos, Ziad A Massy, Enrico Fiaccadori, Alberto Caiazza, Thomas Bachelet, Itzchak Slotki, Alberto Martinez-Castelao, Marie-Jeanne Coudert-Krier, Patrick Rossignol, Faikah Gueler, Thierry Hannedouche, Vincenzo Panichi, Andrzej Wiecek, Giuseppe Pontoriero, Pantelis Sarafidis, Marian Klinger, Radovan Hojs, Sarah Seiler-Mussler, Fabio Lizzi, Dimitrie Siriopol, Olga Balafa, Linda Shavit, Rocco Tripepi, Francesca Mallamaci, Giovanni Tripepi, Eugenio Picano, Gérard Michel London, Carmine Zoccali
BACKGROUND AND OBJECTIVES: Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound-guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis...
November 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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