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Adequate dialysis

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https://www.readbyqxmd.com/read/29782261/-chronic-kidney-disease-as-basis-of-high-thrombotic-and-bleeding-risk-in-patients-with-atrial-fibrillation-place-of-oral-anticoagulants
#1
A G Obrezan, A Y Zemchenkov
Chronic kidney disease (CKD) aggravates course of practically all diseases by worsening outcomes and hindering adequate treatment. Specificities of renal excretion of various drugs, changes of parameters of their pharmacokinetics and pharmacodynamics, nephrotoxic effects of drugs, tactics of drug therapy in conditions of CKD, terminal stage of kidney failure and dialysis are in the focus of attention of internists. To a greatest degree difficulties of drug therapy in CKD and associated clinical states refer to the group of anticoagulants...
April 2018: Kardiologiia
https://www.readbyqxmd.com/read/29775967/bilateral-breast-calciphylaxis-in-a-patient-who-survived-earlier-extensive-tissue-necrosis-5-years-previously-a-case-report
#2
E M J Verstappen, A J G Maaskant-Braat, M R Scheltinga
INTRODUCTION: Calciphylaxis is a rare condition including patchy dermal necrosis that mostly affects chronic hemodialysis patients. The syndrome usually heralds impending death although patients may survive following a set of measures including an adapted dialysis regimen. The present case is a unique patient who recovered from an earlier episode of upper leg calciphylaxis 5 years previously but developed fatal bilateral breast necrosis. PRESENTATION OF CASE: A 69 year old Caucasian woman with a history of atrial fibrillation, hypertension, CVA, hyperparathyroidectomy for secondary hyperparathyroidism and end stage renal disease with hemodialysis recovered in 2012 from extensive symptomatic left upper leg necrosis due to calciphylaxis...
May 7, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29762046/effects-of-calcimimetics-on-long-term-outcomes-in-dialysis-patients-literature-review-and-bayesian-meta-analysis
#3
Greta Lozano-Ortega, Nathalie Waser, Mark E Bensink, Sarah Goring, Heather Bennett, Geoffrey A Block, Glenn M Chertow, Marie-Louise Trotman, Kerry Cooper, Adrian R Levy, Vasily Belozeroff
AIM: Randomized controlled trials (RCTs) with clinical outcomes are considered the gold standard for regulatory approval. However, by design they are only able to answer a small number of clinical questions. Other high-quality studies are required for clinical decision-making. The EVOLVE was the largest RCT, evaluating the effects of cinacalcet on clinical outcomes among adult patients receiving maintenance dialysis suffering from secondary hyperparathyroidism. While the EVOLVE trial did not reach its primary end point, imbalance in subjects' age at randomization and discontinuation rates are two of the reasons that the lack of mortality benefit is in question...
May 15, 2018: Journal of Comparative Effectiveness Research
https://www.readbyqxmd.com/read/29737013/incremental-dialysis-for-preserving-residual-kidney-function-does-one-size-fit-all-when-initiating-dialysis
#4
Anna T Mathew, Yoshitsugu Obi, Connie M Rhee, Jason A Chou, Kamyar Kalantar-Zadeh
While many patients have substantial residual kidney function (RKF) when initiating hemodialysis (HD), most patients with end stage renal disease in the United States are initiated on 3-times per week conventional HD regimen, with little regard to RKF or patient preference. RKF is associated with many benefits including survival, volume control, solute clearance, and reduced inflammation. Several strategies have been recommended to preserve RKF after HD initiation, including an incremental approach to HD initiation...
May 7, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29734155/role-of-frailty-on-outcomes-of-dialysis-patients
#5
Kosaku Nitta, Norio Hanafusa, Ken Tsuchiya
Frailty is a clinical state in which there is an increase in the individual's vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Since the mean age of dialysis patients is increasing worldwide, frailty has recently come to be considered one of the risk factors for mortality in the older dialysis population. The prevalence of frailty among dialysis patients has ranged from 3.0- to 10-fold higher than in community-dwelling elderly, depending on the method of assessing frailty and patient characteristics...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29730670/haemodialysis-membranes
#6
REVIEW
Claudio Ronco, William R Clark
Haemodialysis is an extracorporeal process in which the blood is cleansed via removal of uraemic retention products by a semipermeable membrane. Traditionally, dialysis membranes have been broadly classified on the basis of their composition (cellulosic or noncellulosic) and water permeability (low flux or high flux). However, advances in materials technology and polymer chemistry have led to the development of membranes with specific characteristics and refined properties that mandate a reconsideration of traditional membrane classification systems...
May 5, 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29724122/a-meta-analysis-of-the-association-between-diabetic-patients-and-avf-failure-in-dialysis
#7
Yan Yan, Dan Ye, Liu Yang, Wen Ye, Dandan Zhan, Li Zhang, Jun Xiao, Yan Zeng, Qinkai Chen
PURPOSE: The most preferable vascular access for patients with end-stage renal failure needing hemodialysis is native arteriovenous fistula (AVF) on account of its access longevity, patient morbidity, hospitalization costs, lower risks of infection and fewer incidence of thrombotic complications. Meanwhile, according to National Kidney Foundation (NKF)̸Dialysis Out-comes Quality Initiative (DOQI) guidelines, AVF is more used than before. However, a significant percentage of AVF fails to support dialysis therapy due to lack of adequate maturity...
November 2018: Renal Failure
https://www.readbyqxmd.com/read/29674410/a-large-intraperitoneal-residual-volume-hampers-adequate-volumetric-assessment-of-osmotic-onductance-to-glucose
#8
Anne-Lorraine Clause, Mehdi Keddar, Ralph Crott, Tom Darius, Catherine Fillée, Eric Goffin, Johann Morelle
BACKGROUND: In end-stage renal disease patients treated with peritoneal dialysis (PD), the osmotic conductance to glucose (OCG) represents the intrinsic ability of the membrane to transport water in response to a crystalloid osmotic gradient. A progressive loss of OCG in long-term PD patients indicates the development of fibrosis in the peritoneal interstitium, and helps identify patients at risk for encapsulating peritoneal sclerosis. The double mini-peritoneal equilibration test (PET) has been proposed as a simple method to assess OCG using the difference in initial ultrafiltration rates generated by 2 successive dwells using 1...
April 19, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/29671909/should-phosphate-management-be-limited-to-the-kdigo-kdoqi-guidelines
#9
Sangeet Dhillon-Jhattu, Stuart M Sprague
Hyperphosphatemia is a common complication of CKD. Prior to development of overt hyperphosphatemia, there are several adaptive mechanisms that occur to maintain normal phosphorus equilibrium in patients with CKD. These include an early and progressive rise in fibroblast growth factor 23 (FGF 23), followed by an increase in parathyroid hormone (PTH) with a decrease in 1,25-dihydroxyvitamin D (1,25 Vit D). Over the last 20 years, a large number of studies have shown that hyperphosphatemia is a strong predictor of adverse clinical outcomes including increased incidence of vascular calcification, cardiovascular disease, and all-cause mortality in both individuals with CKD as well as those with normal kidney function...
April 19, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29651510/-vomiting-and-collapse-of-a-28-year-old-male-long-distance-runner-in-middle-european-summer
#10
J Herold, A Mitrasch, E Lorenz, U Lodes, I Tanev, R Braun-Dullaeus, F Meyer
BACKGROUND: Hyperthermia often ends fatally and must therefore be promptly recognized and adequately treated. CASE: A 28-year-old man participated in a long-distance race (3 km) on a hot summer day (28 °C). The runner collapsed, had to vomit but continued the run and reached the finish. Neurologically, the patient presented with intermittent cerebral seizures. External cooling batteries were immediately applied and cold infusions were started. The patient was admitted to the intensive care unit of the university hospital (body temperature 40...
April 12, 2018: Der Internist
https://www.readbyqxmd.com/read/29649836/-flight-routes-to-germany-of-seriously-ill-children-and-adolescents-from-former-eastern-bloc-countries-for-treatment-of-renal-failure
#11
Dilbar Mammadova, Ines Marek, Matthias Galiano, Wolfgang Rascher
BACKGROUND: Increased patient mobility and restricted treatment of children with end-stage renal disease forced families from the former Eastern Bloc countries to flee with their children to Germany for adequate medical treatment. METHODS: In a case study, the patients' charts were analysed retrospectively. In structured interviews, parents and patients were asked about their flight routes to Germany, their medical treatment and their integration. RESULTS: From 2003 to 2013, eight children and adolescents with renal failure were treated with dialysis or renal transplantation in Erlangen...
April 12, 2018: Klinische Pädiatrie
https://www.readbyqxmd.com/read/29644065/frailty-and-chronic-kidney-disease-current-evidence-and-continuing-uncertainties
#12
Andrew C Nixon, Theodoros M Bampouras, Neil Pendleton, Alexander Woywodt, Sandip Mitra, Ajay Dhaygude
Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization...
April 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29600583/compositional-analysis-of-coronary-artery-calcification-in-dialysis-patients-in-vivo-by-dual-energy-computed-tomography-angiography
#13
Yoko Nishizawa, Chieko Higuchi, Takashi Nakaoka, Hisako Omori, Tetsuya Ogawa, Hiroshi Sakura, Kosaku Nitta
While vascular calcification is an important factor regulating prognosis in dialysis patients, its components have not been adequately studied. We analyzed in vivo components of calcification in the coronary arteries of dialysis patients using the effective atomic number from dual-energy computed tomography. In dialysis patients (hemodialysis, N = 10; peritoneal dialysis, N = 12), average of median effective atomic number was 13.8 in the hemodialysis group, and 13.7 in the peritoneal dialysis group...
March 30, 2018: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/29597223/discontinuation-of-continuous-renal-replacement-therapy-and-dialysis-dependence
#14
Gregorio Romero-González, Anna Lorenzin, Mauro Neri, Fiorenza Ferrari, Alejandra Molano-Triviño, Alessandra Brendolan, Claudio Ronco
Renal replacement therapy (RRT) is a form of extracorporeal support for critical patients, especially for those with acute kidney injury. This therapy enables to gain adequate control over the great metabolic and fluids demand when kidneys are not able to do so; this condition is habitually present in patients who are admitted to intensive care units. However, it is also clear that these patients present a higher mortality rate and, in some cases, complications associated with the therapy. Therefore, it is fundamental to optimize and customize different aspects of RRT that range from the ideal timing including the modality and the dose until its suspension or ending...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29582148/assessment-of-dialysis-adequacy-beyond-urea-kinetic-measurements
#15
Lesley Rees
Adequacy of dialysis is a term that has been used for many years based on measurement of small solute clearance using urea and creatinine. This has been shown in some but not all studies in adults to correlate with survival. However, small solute clearance is just one minor part of the effectiveness of dialysis and in fact 'optimum' dialysis, rather than 'adequate' dialysis is what most paediatric nephrologists would want for their patients. Additional ways to assess the success of dialysis in children would include dialysis access complications and longevity, preservation of residual kidney function, body composition, biochemical and haematological control, nutrition and growth, discomfort during the dialysis process and psychosocial adjustment including hospitalisation and school attendance...
March 26, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29578403/patient-reported-outcomes-pros-argue-against-the-limited-use-of-peritoneal-dialysis-in-end-stage-renal-disease
#16
Carola W H de Fijter, Anouk T N van Diepen, Fariba Amiri, Friedo W Dekker, Ray T Krediet
AIM: Approximately 40% of dialysis patients are durably treated with peritoneal dialysis (PD) in our teaching hospital. Patients' perspectives were studied by patient-reported outcome measurements (PROMs) to find possible explanations for why the generally-reported decline in the use of PD hardly occurred in our facility. MATERIALS AND METHODS: All 75 prevalent adult dialysis patients hemodialysis (HD) duration 27, PD 16 months) were included. All had received predialysis care and education for > 6 month...
March 26, 2018: Clinical Nephrology
https://www.readbyqxmd.com/read/29573025/should-we-look-beyond-kt-v-urea-in-assessing-dialysis-adequacy
#17
Clare B Jones, Joanne M Bargman
Since the advent of maintenance dialysis therapy, our interpretation of what adequate dialysis really is has broadened and become more controversial. This is not only due to our changing and aging dialysis population but also to our evolving knowledge base. As nephrologists, we strive to achieve both quality and (often) quantity of life for our patients and we feel reassured when we have a quantifiable marker to show for our efforts. However, we suggest that adequate dialysis reaches far beyond the realms of attaining a particular biochemical result...
March 23, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29564903/-palliative-care-in-nephrology
#18
Barbora Szonowská
Despite the advances in dialysis technology over the past decades, patients with advanced chronic kidney disease (CKD) have a high symptom burden, shortened survival and substantial physical, emotional and spiritual suffering. Number of frailty patients with advanced chronic kidney disease is growing and for many of them the beginning or continuation of dialysis is associated with a high risk of short-term mortality or worsening of functional status. Identifying these fragile patients and integrating palliative care into standard nephrological care improves patients quality of life and has the potential to prolong their lives without demanding dialysis treatment...
2018: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/29539161/dialysis-modality-and-survival-done-to-death
#19
Emilie Trinh, Christopher T Chan, Jeffrey Perl
The debate surrounding whether peritoneal dialysis or hemodialysis is associated with differential survival continues as the numerous comparative studies over the past 3 decades have yielded conflicting results. Findings have also evolved over time in the setting of changing patient characteristics, advances in dialytic technologies, and the use of more robust statistical and epidemiologic approaches. Here, we will critically review the body of evidence, both historical and contemporary, comparing survival across dialysis modalities...
March 14, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29532306/calcimimetics-versus-parathyroidectomy-what-is-preferable
#20
REVIEW
M Rroji, G Spasovski
Secondary hyperparathyroidism (SHPT) is common among patients with end-stage renal disease (ESRD). SHPT is associated with high-turnover bone disease, interstitial and vascular calcifications, cardiovascular morbidity and mortality. The pharmacological management of SHPT has progressed in recent years. The introduction of targeted therapies, such as selective vitamin D receptors activators and calcium-sensing receptor modulators, offers an increased opportunity to adequately control elevated parathyroid hormone (PTH), especially in patients with chronic kidney disease under dialysis treatment...
March 12, 2018: International Urology and Nephrology
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