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Dialysis Adequacy

James Tattersall
Current guidelines focus on conventional dialysis defined as 3-5 hours, three times per week, and suggest that longer or more frequent dialysis be considered. This paper presents the case for considering that shorter or less frequent dialysis should also be considered. More frequent and/or longer dialysis facilitates control of fluid overload, blood pressure, and phosphate levels. These benefits will require time to translate into probable hard outcome improvement. Patients are unlikely to participate in productive or pleasurable activities while undergoing dialysis in center or traveling to treatment...
October 20, 2016: Seminars in Dialysis
Parvin Soltani, Pardis Ketabi Moghaddam, Farshid Haghverdi, Ali Cheraghi
INTRODUCTION:  C-reactive protein (CRP) is increased among patients on maintenance hemodialysis. Such inflammatory markers can result in protein-energy deficit syndromes and low adequacy of dialysis in these patients. This study evaluated the effect of pentoxifylline on serum CRP level and KT/V in end-stage renal disease patients on maintenance hemodialysis. MATERIAL AND METHODS: This 1-month randomized, double-blind, placebo-controlled clinical trial involving 73 patients with end-stage renal disease on maintenance hemodialysis assessed the effectiveness of 400 mg/d of pentoxifylline on serum CRP level decrease and improvement of dialysis adequacy...
September 2016: Iranian Journal of Kidney Diseases
Carlo Basile, Luigi Vernaglione, Francesco Casucci, Pasquale Libutti, Piero Lisi, Luigi Rossi, Valentina Vigo, Carlo Lomonte
BACKGROUND: Satisfactory vascular access flow (Qa) of an arteriovenous fistula (AVF) is necessary for haemodialysis (HD) adequacy. The aim of the present study was to further our understanding of haemodynamic modifications of the cardiovascular system of HD patients associated with an AVF. The main objective was to calculate using real data in what way an AVF influences the load of the left ventricle (LLV). METHODS: All HD patients treated in our dialysis unit and bearing an AVF were enrolled into the present observational cross-sectional study...
October 2016: Clinical Kidney Journal
Kyung Hee Lee, Jang-Hee Cho, Owen Kwon, Sang-Un Kim, Ryang Hi Kim, Young Wook Cho, Hee-Yeon Jung, Ji-Young Choi, Chan-Duck Kim, Yong-Lim Kim, Sun-Hee Park
BACKGROUND: Prealbumin, a sensitive marker for protein-energy status, is also known as an independent risk factor for mortality in hemodialysis patients. We investigated the impact of prealbumin on survival in incident peritoneal dialysis (PD) patients. METHODS: In total, 136 incident PD patients (mean age, 53.0 ± 15.8 years) between 2002 and 2007 were enrolled in the study. Laboratory data, dialysis adequacy, and nutritional parameters were assessed 3 months after PD initiation...
September 2016: Kidney Research and Clinical Practice
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
Laura Rivoli, A D Bastiaan Vliegenthart, Carmelita M J de Potter, Job J M H van Bragt, Nikolaos Tzoumas, Peter Gallacher, Tariq E Farrah, Neeraj Dhaun, James W Dear
AIM: microRNA-122 (miR-122) is a hepatotoxicity biomarker with utility in the management of paracetamol overdose and in drug development. Renal dysfunction and haemodialysis have been associated with a reduction in circulating microRNA. The objective of this study was to determine their effect on miR-122. METHODS: Blood samples were collected from 17 patients with end-stage renal disease (ESRD) on haemodialysis, 22 healthy controls, 30 patients with chronic kidney disease (CKD) and 15 patients post-kidney transplantation...
September 21, 2016: British Journal of Clinical Pharmacology
Maria Roszkowska-Blaim, Piotr Skrzypczyk
♦ Background: The aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD). ♦ Methods: The study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m(2)/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m(2)]), etiology of ESRD, PD fluid volume (mL/m(2)/24 h), glucose load (g/m(2)/24 h), ultrafiltration (mL/m(2)/24 h), peritoneal permeability (D/P Crea 4h, D/D0 Glu 4h), dialysis adequacy (twKt/V, twCCr [L/week/1...
September 7, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Wen-Hung Huang, Ching-Wei Hsu, Ching-Chih Hu, Tzung-Hai Yen, Cheng-Hao Weng
INTRODUCTION: Predialysis hypotension has been noted to be a predictor of mortality in hemodialysis (HD) patients. Previous studies evaluating the impact of predialysis hypotension on the mortality of HD patients did not exclude patients with diabetes mellitus (DM) or cardiovascular disease. METHODS: Eight hundred and sixty-six patients on maintenance HD were recruited. Clinical parameters were recorded and subjected to the analysis of predictors of predialysis hypotension and mortality...
2016: Therapeutics and Clinical Risk Management
Shubha Ananthakrishnan, Thomas A Depner
Hemodialysis has come a long way since its early days and is a life sustaining therapy for millions of people with end-stage kidney disease throughout the world. Although thrice weekly hemodialysis remains the most common form of renal replacement therapy, other therapies such as more frequent, prolonged dialysis modalities have seen a rise recently. In this review, we compare and contrast methods for measuring the dialysis dose, with a focus on small molecule clearance (Kt/Vurea ) among various dialysis modalities...
September 4, 2016: Seminars in Dialysis
John T Daugirdas
BACKGROUND: The publicly available Solute Solver module allows calculation of a variety of two-pool urea kinetic measures of dialysis adequacy using pre- and postdialysis plasma urea and estimated dialyzer clearance or estimated urea distribution volumes as inputs. However, the existing program does not have a 'what if' module, which would estimate the plasma urea values as well as commonly used measures of hemodialysis adequacy for a patient with a given urea distribution volume and urea nitrogen generation rate dialyzed according to a particular dialysis schedule...
September 1, 2016: Nephrology, Dialysis, Transplantation
Massimo Sandrini, Valerio Vizzardi, Francesca Valerio, Sara Ravera, Luigi Manili, Roberto Zubani, Bernardo J A Lucca, Giovanni Cancarini
INTRODUCTION: Incremental dialysis consists in prescribing a dialysis dose aimed towards maintaining total solute clearance (renal + dialysis) near the targets set by guidelines. Incremental peritoneal dialysis (incrPD) is defined as one or two dwell-times per day on CAPD, whereas standard peritoneal dialysis (stPD) consists in three-four dwell-times per day. PATIENTS AND METHODS: Single-centre cohort study. Enrollement period: January 2002-December 2007; end of follow up (FU): December 2012...
August 31, 2016: Journal of Nephrology
John K Leypoldt, Björn K I Meijers
The kinetics of uremic solute clearances are discussed based on two categories of uremic solutes, namely those that are and those that are not derived directly from nutrient intake, particularly dietary protein intake. This review highlights dialysis treatments that are more frequent and longer (high-dose hemodialysis) than conventional thrice weekly therapy. It is proposed that the dialysis dose measures based on urea as a marker uremic solute, such as Kt/V and stdKt/V, be referred to as measures of dialysis inadequacy, not dialysis adequacy...
August 31, 2016: Seminars in Dialysis
Hengameh Barzegar, Mahmoud Moosazadeh, Hedayat Jafari, Ravanbakhsh Esmaeili
PURPOSE: Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran. MATERIALS AND METHODS: All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases...
2016: Urology Journal
Vicent Esteve, José Carneiro, Fátima Moreno, Miquel Fulquet, Salud Garriga, Mónica Pou, Verónica Duarte, Anna Saurina, Irati Tapia, Manel Ramírez de Arellano
INTRODUCTION: Haemodialysis (HD) patients are characterised by significant muscle loss. Recently, neuromuscular electrical stimulation (NMES) has emerged as a new therapeutic alternative to improve these patients' physical condition. To date, no studies on the effects of NMES on body composition in HD patients have been published. OBJECTIVE: To analyse the effect of NMES on muscle strength, functional capacity and body composition in our HD patients. MATERIAL AND METHODS: A 12-week, single-centre, prospective study...
August 26, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Jessica J Geer, Shweta Shah, Eric Williams, Ayse Akcan Arikan, Poyyapakkam Srivaths
BACKGROUND: Intradialytic hypotension and myocardial stunning are proposed as contributing to the pathogenesis of increased cardiovascular disease burden and death in patients receiving maintenance hemodialysis (HD). Noninvasive cardiac output measurements provide a dynamic, real-time assessment of hemodynamic parameters. We investigated intradialytic changes in hemodynamic parameters in pediatric outpatients receiving chronic HD and determined patient and treatment risk factors associated with such intradialytic changes...
August 23, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Dirk G Struijk
BACKGROUND: Peritoneal dialysis (PD) for the treatment of end-stage renal failure was introduced in the 1960s. Nowadays it has evolved to an established therapy that is complementary to hemodialysis (HD), representing 11% of all patients treated worldwide with dialysis. Despite good clinical outcomes and similar results in patient survival between PD and HD, the penetration of PD is decreasing in the Western world. SUMMARY: First the major events in the history of the development of PD are described...
December 2015: Kidney Diseases
Maria E Linnaus, Crystal S Langlais, Kevin N Johnson, David M Notrica
INTRODUCTION: Hypertrophic pyloric stenosis is a commonly encountered pediatric surgical issue. Initially treated with open surgical techniques, many pediatric surgeons have adopted the minimally invasive approach using laparoscopy. However, some concerns exist that the rate of incomplete pyloromyotomy is elevated in laparoscopy. We propose a new technique to assess the adequacy of laparoscopic pyloromyotomy. METHODS: Adequacy of laparoscopic pyloromyotomy was assessed by confirming that the top of the serosa on one side of the pylorus has adequate freedom to reach the bottom of the muscle on other side...
August 17, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Roberto Chimenz, Antonio Lacquaniti, Laura Colavita, Valeria Chirico, Claudia Fede, Michele Buemi, Carmelo Fede
BACKGROUND: Peritonitis, the most important limitation of peritoneal dialysis (PD), could be detected by biomarkers in dialysate effluent, representing a noninvasive method to indirectly assess the peritoneum status. The aim of our study was to test high mobility group box 1 (HMGB1) in PD patients, evaluating its role as precocious marker of peritoneum damage during peritonitis. Transforming growth factor (TGF)-β was correlated with peritoneal transport characteristics. METHODS: Six patients, treated by ambulatory PD, were enrolled...
August 8, 2016: Renal Failure
Ertugrul Erken, Ruya Ozelsancak, Safak Sahin, Emine Ece Yılmaz, Dilek Torun, Berrin Leblebici, Yunus Emre Kuyucu, Siren Sezer
BACKGROUND: Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis...
October 2016: International Urology and Nephrology
Anna Mudoni, Francesco Caccetta, Maurizio Caroppo, Fernando Musio, Antonella Accogli, Maria Dolores Zacheo, Maria Domenica Burzo, Maurizio Gallieni, Vitale Nuzzo
A functioning vascular access is a critical requirement to improve the quality of life in hemodialysis patients, so monitoring and surveillance of vascular access play key roles in identifying all dysfunctions and reducing the huge economic cost as well as adequacy of dialysis.In our five-year experience, a study protocol has been used and improved with the help of ultrasonography.Doppler ultrasound is an excellent and sensitive modality for hemodialysis access evaluation, one of techniques employed for arteriovenous fistulae (AVF) study, not only as a preoperative tool, but also in post-operative monitoring of AVF maturation...
July 27, 2016: Journal of Vascular Access
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