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https://www.readbyqxmd.com/read/28340192/prediction-equation-for-calculating-residual-kidney-urea-clearance-using-urine-collections-for-different-hemodialysis-treatment-frequencies-and-interdialytic-intervals
#1
Yoshitsugu Obi, Kamyar Kalantar-Zadeh, Elani Streja, John T Daugirdas
Background.: The purpose of the study was to explore the precision of an equation designed to estimate residual kidney urea clearance (K RU ) from interdialytic urine collection data and pre-hemodialysis (HD) serum urea nitrogen (SUN) in different hemodialysis treatment schedules. Methods.: The generalizability of the proposed equation was tested in 32 731 HD treatments where urine was collected prior to a dialysis session, mostly for 24 h but sometimes longer, in patients being dialyzed 1-4 times/week...
March 15, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28322642/impact-of-volume-management-on-volume-overload-and-rehospitalization-in-capd-patients
#2
Yi Xu, Shen-Min Yang, Xiao-Hua Wang, Hai-Fang Wang, Mei-E Niu, Yi-Qun Yang, Guo-Yuan Lu, Jian-Hong Pang, Fei Wang, Lin Li
Heart failure due to volume overload is a major reason for rehospitalization in continuous ambulatory peritoneal dialysis patients. Strict volume control provides better cardiac functions and blood pressure in this population. Volume management, which is a volume control strategy, may decrease volume overload and related complications. Using a quasi-experimental design, 66 continuous ambulatory peritoneal dialysis patients were randomly assigned to the intervention group ( n = 34) and control group ( n = 32)...
December 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28295607/incremental-hemodialysis-the-university-of-california-irvine-experience
#3
Mehrdad Ghahremani-Ghajar, Vanessa Rojas-Bautista, Wei-Ling Lau, Madeleine Pahl, Miguel Hernandez, Anna Jin, Uttam Reddy, Jason Chou, Yoshitsugu Obi, Kamyar Kalantar-Zadeh, Connie M Rhee
Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen...
March 14, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28260431/problems-associated-with-access-to-renal-replacement-therapy-experience-of-the-sindh-institute-of-urology-and-transplantation
#4
Farida Mazhar, Naveeda Nizam, Nazia Fatima, Sana Siraj, Syed Adibul Hasan Rizvi
OBJECTIVES: The prevalence of end-stage renal disease is increasing worldwide. It is also one of the main health problems in Pakistan. Currently, hemodialysis represents the main mode of treatment for patients with end-stage renal disease in this country. Despite 24-hour free dialysis at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan), a significant number of patients do not turn up for regular dialysis or miss regular sessions of dialysis. We conducted this study to identify and highlight the factors leading to poor compliance with regular hemodialysis treatment despite free dialysis treatment offered at our center...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28240423/nutritional-issues-with-incremental-dialysis-the-role-of-low-protein-diets
#5
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)...
February 27, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28194810/assessing-the-adequacy-of-small-solute-clearance-for-various-dialysis-modalities-with-inclusion-of-residual-native-kidney-function
#6
Andrew I Chin, Thomas A Depner, John T Daugirdas
Measurement of small molecule clearance remains important in the clinical care of patients requiring long-term dialysis. Many patients maintain a significant degree of residual native kidney function and may have nontraditional schedules with or without combined dialysis modalities. In this review, we examine and outline methods for comparing small molecule clearances among various dialysis prescriptions and modalities, with inclusion of residual kidney urea clearance.
February 14, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28166331/the-illness-experience-of-undocumented-immigrants-with-end-stage-renal-disease
#7
Lilia Cervantes, Stacy Fischer, Nancy Berlinger, Maria Zabalaga, Claudia Camacho, Stuart Linas, Debora Ortega
Importance: The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients. Objective: To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis. Design, Setting, and Participants: A qualitative, semistructured, interview study was conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis...
February 6, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28115820/emergent-dialysis-and-its-impact-on-quality-of-life-in-undocumented-patients-with-end-stage-renal-disease
#8
Andrew N Hogan, William R Fox, Lynn P Roppolo, Robert E Suter
OBJECTIVE: This study aimed to define the ethnographic composition and assess the health-related quality of life (HRQoL) of a large population of undocumented patients with end-stage renal disease (ESRD) seeking emergent dialysis in the emergency department (ED) of a large public hospital in the United States. DESIGN: All ESRD patients presenting to the hospital's main ED were identified during a 4-week consecutive enrollment period. Consenting patients completed two surveys-an ethnographic questionnaire and the validated kidney disease quality of life-36 (KDQOL-36) instrument...
January 19, 2017: Ethnicity & Disease
https://www.readbyqxmd.com/read/28094031/patients-receiving-frequent-hemodialysis-have-better-health-related-quality-of-life-compared-to-patients-receiving-conventional-hemodialysis
#9
Amit X Garg, Rita S Suri, Paul Eggers, Fredric O Finkelstein, Tom Greene, Paul L Kimmel, Alan S Kliger, Brett Larive, Robert M Lindsay, Andreas Pierratos, Mark Unruh, Glenn M Chertow
Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis...
March 2017: Kidney International
https://www.readbyqxmd.com/read/28090764/incremental-and-infrequent-hemodialysis-a-new-paradigm-for-both-dialysis-initiation-and-conservative-management
#10
Connie M Rhee, Mehrdad Ghahremani-Ghajar, Yoshitsugu Obi, Kamyar Kalantar-Zadeh
Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function...
June 2017: Panminerva Medica
https://www.readbyqxmd.com/read/28073619/cytomegalovirus-serostatus-as-predictor-for-adverse-events-after-cardiac-surgery-a-prospective-observational-study
#11
Malte Ziemann, Matthias Heringlake, Philipp Lenor, David Juhl, Thorsten Hanke, Michael Petersen, Julika Schön, Hermann Heinze, Heinrich V Groesdonk, Hauke Paarmann, Holger Hennig
OBJECTIVE: To clarify whether reactivated cytomegalovirus (CMV) infections in critically ill patients lead to worse outcome or just identify more severely ill patients. If CMV has a pathogenic role, latently infected (CMV-seropositive) patients should have worse outcome than seronegative patients because only seropositive patients can experience a CMV reactivation. DESIGN: Post-hoc analysis of a prospective observational study. SETTING: Single university hospital...
October 20, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28052451/a-clinical-study-on-low-molecular-weight-heparin-infusion-as-anticoagulation-for-nocturnal-home-haemodialysis
#12
Steve Siu-Man Wong, Wai-Yan Lau, Man-Luen Ng, Shuk-Yin Chan, So-Fan Chan, Ping-Kwan Chan, Ching-Kit Wan, Yuk-Lun Cheng
AIM: This study was conducted to evaluate low-molecular weight heparin (LMWH) as anticoagulation for nocturnal home haemodialysis (NHHD). Whilst its longer half-life may cause drug accumulation in frequent dialysis, the essential need of a supplementary intra-dialytic bolus for the sleeping patients also renders LMWH's use impractical. METHODS: The recruited patients, who were on alternate-day 8-hour haemodialysis, were randomized to receive either nadroparin or unfractionated heparin (UFH) for a week...
January 4, 2017: Nephrology
https://www.readbyqxmd.com/read/27966247/can-twice-weekly-hemodialysis-expand-patient-access-under-resource-constraints
#13
REVIEW
Dipal Savla, Glenn M Chertow, Timothy Meyer, Shuchi Anand
The convention of prescribing hemodialysis on a thrice weekly schedule began empirically when it seemed that this frequency was convenient and likely to treat symptoms for a majority of patients. Later, when urea was identified as the main target and marker of clearance, studies supported the prevailing notion that thrice weekly dialysis provided appropriate clearance of urea. Today, national guidelines on hemodialysis from most countries recommend patients receive at least thrice weekly therapy. However, resource constraints in low- and middle-income countries (LMIC) have resulted in a substantial proportion of patients using less frequent hemodialysis in these settings...
December 14, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27905888/medicare-program-end-stage-renal-disease-prospective-payment-system-coverage-and-payment-for-renal-dialysis-services-furnished-to-individuals-with-acute-kidney-injury-end-stage-renal-disease-quality-incentive-program-durable-medical-equipment-prosthetics-orthotics
#14
(no author information available yet)
This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP...
November 4, 2016: Federal Register
https://www.readbyqxmd.com/read/27772644/intensive-hemodialysis-and-potential-risks-with-increasing%C3%A2-treatment
#15
Michael A Kraus, Sheru Kansal, Michael Copland, Paul Komenda, Eric D Weinhandl, George L Bakris, Christopher T Chan, Richard J Fluck, John M Burkart
Although intensive hemodialysis (HD) can address important clinical problems, increasing treatment also introduces risks. In this review, we assess risks pertaining to 6 domains: vascular access complications, infection, mortality, loss of residual kidney function, solute balance, and patient and care partner burden. In the Frequent Hemodialysis Network (FHN) trials, short daily and nocturnal schedules increased the incidence of access complications, although the incidence of access loss was not statistically higher...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772643/intensive-hemodialysis-left-ventricular-hypertrophy-and-cardiovascular-disease
#16
Peter A McCullough, Christopher T Chan, Eric D Weinhandl, John M Burkart, George L Bakris
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772642/intensive-hemodialysis-and-treatment-complications-and%C3%A2-tolerability
#17
Jose A Morfin, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Peter A McCullough, Paul Komenda
Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90mmHg and intradialytic decline > 30mmHg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772641/intensive-hemodialysis-and-health-related-quality-of-life
#18
Michael A Kraus, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Michael Copland, Paul Komenda, Fredric O Finkelstein
Diminished health-related quality of life (HRQoL) is common in dialysis patients and associated with increased risks for morbidity and mortality. Patients may present limitations in both physical and mental HRQoL. Poor physical HRQoL may be defined by limited physical function, role limitations due to physical health, dissatisfaction with physical ability, and impaired mobility. Sleep disorders such as obstructive sleep apnea, restless legs, and fatigue are typical manifestations of poor physical HRQoL in dialysis patients...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772640/intensive-hemodialysis-mineral-and-bone-disorder-and-phosphate-binder-use
#19
Michael Copland, Paul Komenda, Eric D Weinhandl, Peter A McCullough, Jose A Morfin
Mineral and bone disorder is a common complication of end-stage renal disease. Notably, hyperphosphatemia likely promotes calcification of the myocardium, valves, and arteries. Hyperphosphatemia is associated with higher risk for cardiovascular mortality and morbidity along a gradient beginning at 5.0mg/dL. Among contemporary hemodialysis (HD) patients, mean serum phosphorus level is 5.2mg/dL, although 25% of patients have serum phosphorus levels of 5.5 to 6.9mg/dL; and 13%, >7.0mg/dL. Treatment of hyperphosphatemia is burdensome...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772639/intensive-hemodialysis-blood-pressure-and-antihypertensive-medication-use
#20
George L Bakris, John M Burkart, Eric D Weinhandl, Peter A McCullough, Michael A Kraus
Hypertension is a cardinal feature of end-stage renal disease (ESRD). Hypertensive nephropathy is the primary cause of ESRD for nearly 30% of patients, and the prevalence of hypertension is >85% in new patients with ESRD. In contemporary hemodialysis (HD) patients, mean predialysis systolic blood pressure (SBP) is nearly 150mmHg, and about 70%, 50%, and 40% use β-blockers, calcium channel blockers, and renin-angiotensin system inhibitors, respectively. Predialysis SBP generally exhibits a U-shaped association with mortality risk...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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