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https://www.readbyqxmd.com/read/29130810/outcomes-after-angiography-with-sodium-bicarbonate-and-acetylcysteine
#1
Steven D Weisbord, Martin Gallagher, Hani Jneid, Santiago Garcia, Alan Cass, Soe-Soe Thwin, Todd A Conner, Glenn M Chertow, Deepak L Bhatt, Kendrick Shunk, Chirag R Parikh, Edward O McFalls, Mary Brophy, Ryan Ferguson, Hongsheng Wu, Maria Androsenko, John Myles, James Kaufman, Paul M Palevsky
Background Intravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy. Methods Using a 2-by-2 factorial design, we randomly assigned 5177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and 5 days of oral acetylcysteine or oral placebo; of these patients, 4993 were included in the modified intention-to-treat analysis...
November 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29121886/the-strange-case-of-mr-h-starting-dialysis-at-90%C3%A2-years-of-age-clinical-choices-impact-on-ethical-decisions
#2
Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre
BACKGROUND: Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at "extreme" ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. CASE PRESENTATION: Mr...
November 9, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29051145/a-discrete-choice-study-of-patient-preferences-for-dialysis-modalities
#3
Rachael C Walker, Rachael L Morton, Suetonia C Palmer, Mark R Marshall, Allison Tong, Kirsten Howard
BACKGROUND AND OBJECTIVES: Improved knowledge about factors that influence patient choices when considering dialysis modality could facilitate health care interventions to increase rates of home dialysis. We aimed to quantify the attributes of dialysis care and the tradeoffs that patients consider when making decisions about dialysis modalities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a prospective, discrete choice experiment survey with random parameter logit analysis to quantify preferences and tradeoffs for attributes of dialysis treatment in 143 adult patients with CKD expected to require RRT within 12 months (predialysis)...
October 19, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28992343/serum-to-dialysate-potassium-gradient-and-its-association-with-short-term-outcomes-in-hemodialysis-patients
#4
Steven M Brunelli, David M Spiegel, Charles Du Mond, Nina Oestreicher, Wolfgang C Winkelmayer, Csaba P Kovesdy
Background: A high serum-to-dialysate potassium (K + ) gradient at the start of dialysis leads to rapid lowering of serum K + and may confer a greater risk of adverse events. Here, we examined the near-term association of K + gradient with clinical outcomes. Methods: This retrospective (2010-11) event-based study considered 830 741 patient-intervals, each defined by a pre-dialysis measurement of serum K + made among adult Medicare Parts A and B enrollees who received in-center hemodialysis on a Monday/Wednesday/Friday schedule at a large US dialysis organization...
August 19, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28992335/how-to-set-the-stage-for-a-full-fledged-clinical-trial-testing-incremental-haemodialysis
#5
Francesco Gaetano Casino, Carlo Basile
Most people who make the transition to maintenance haemodialysis (HD) therapy are treated with a fixed dose of thrice-weekly HD (3HD/week) regimen without consideration of their residual kidney function (RKF). The RKF provides an 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...
July 21, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28975489/use-of-lung-ultrasonography-to-determine-the-accuracy-of-clinically-estimated-dry-weight-in-chronic-hemodialysis-patients
#6
Chuan Jiang, Satyam Patel, Andrew Moses, Maria V DeVita, Michael F Michelis
PURPOSE: The use of lung ultrasound (LUS) to identify extravascular lung water has received increasing acceptance. Sonographic B-lines, discrete vertical lines that originate from the pleura, represent pulmonary edema and are correlated with the accumulation of fluid. The goal of this study was to evaluate the utility of LUS to determine the accuracy of prescribed dry weight (DW) in chronic hemodialysis (HD) patients and to ascertain the adequacy of fluid removal. METHODS: LUS was scheduled to be performed pre- and post-HD in 20 patients...
December 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28970367/a-pilot-study-of-okkidney-a-phosphate-counting-application-in-patients-on-peritoneal-dialysis
#7
Rameez Imtiaz, Katherine Atkinson, Julien Guerinet, Kumanan Wilson, Jullie Leidecker, Deborah Zimmerman
BACKGROUND: Hyperphosphatemia is associated with adverse outcomes in patients treated with peritoneal dialysis (PD). We have shown that a fixed meal phosphate binder dosing schedule is not appropriate. The purpose of this study was to evaluate the beta version of OkKidney, a phosphate counting app that matches meal phosphate content with binder dose. METHODS: A convenience sample of adult patients treated with PD completed a pre-survey that included the technology readiness index (TRI 2...
September 28, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28967968/usefulness-of-questionnaires-on-advance-directives-in-haemodialysis-units
#8
Angel Rodríguez Jornet, Loreley Ana Betancourt Castellanos, Maria Isabel Bolós Contador, Juan Carlos Oliva Morera, José Antonio Ibeas López
Background: As renal replacement therapy has become universal practice in medicine, there is a need to consider whether this treatment is suitable for elderly people. These patients have high comorbidity and may require dialysis withdrawal in certain clinical circumstances. Advance directives (ADs) drawn up by patients facilitate treatment-related decisions if they lose cognitive capacity. Questionnaires dealing with possible extreme clinical circumstances can thus help clinicians and relatives reach pertinent decisions in such cases...
October 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28913721/intraperitoneal-antibiotic-administration-for-prevention-of-postoperative-peritoneal-catheter-related-infections
#9
Margarita Kunin, Dganit Dinour, Danny Rosin
BACKGROUND: It is recommended that systemic prophylactic antibiotics be given immediately prior to peritoneal catheter insertion. This administration requires intravenous access and could be inconvenient in dynamic and unpredictable operation room schedule. Intraperitoneal antibiotics could be an alternative simple way for prevention of postoperative peritoneal catheter infections. METHODS: Medical records from 109 patients undergoing permanent PD catheter placement procedures were reviewed retrospectively...
September 14, 2017: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/28910802/effects-of-expanded-hemodialysis-therapy-on-clinical-outcomes
#10
Sandip Mitra, Kunaal Kharbanda
The invention of dialysis has been a phenomenal advance in the treatment of kidney failure. The introduction of artificial kidneys in clinical care remains one of the most successful lifesaving interventions in modern medicine. Its glory, however, has been tempered by poor long-term outcomes and a negative qualitative impact on the lives of patients who suffer from an extremely complex, burdensome, and restricted life on dialysis. There remains a huge gap in patient well-being and outcomes between artificial kidney treatments and kidney transplantation...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28893419/telenephrology-current-perspectives-and-future%C3%A2-directions
#11
Rajeev Rohatgi, Michael J Ross, Sandawana W Majoni
There is increasing interest in telemedicine among physicians and patients; however, the evidence regarding the quality of care delivered by telemedicine, and telenephrology in particular, compared with in-person care is limited. In this review, different electronic modalities used to deliver nephrology care are reviewed and critiqued, with a focused analysis from the Australian and United States perspectives. Both countries are geographically expansive with significant rural populations where access to nephrology care is limited...
September 8, 2017: Kidney International
https://www.readbyqxmd.com/read/28818188/healthcare-outcomes-in-undocumented-immigrants-undergoing-two-emergency-dialysis-approaches%C3%A2
#12
S Jawad Sher, Waqas Aftab, Ranjani N Moorthi, Sharon M Moe, Christopher S Weaver, Frank C Messina, Nancy M Martinez-Hoover, Melissa D Anderson, Michael T Eadon
BACKGROUND: Current estimates suggest 6,500 undocumented end-stage renal disease (ESRD) patients in the United States are ineligible for scheduled hemodialysis and require emergent dialysis. In order to remain in compliance with Emergency Medicaid, an academic health center altered its emergency dialysis criteria from those emphasizing interdialytic interval to a set emphasizing numerical thresholds. We report the impact of this administrative change on the biochemical parameters, utilization, and adverse outcomes in an undocumented patient cohort...
October 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28810244/increasing-haemodialytic-clearances-as-residual-renal-function-declines-an-incremental-approach
#13
Kamonwan Tangvoraphonkchai, Andrew Davenport
Many patients with chronic kidney disease start undergoing thrice-weekly haemodialysis (HD), aiming for an HD sessional dialyzer urea clearance target, irrespective of whether they have residual renal function (RRF). While increasing sessional dialyzer urea clearance above a target of 1.2 has not been shown to improve patient survival, it has been shown that the preservation of RRF improves patient self-reported outcomes and survival. Observational studies have suggested that initiating twice-weekly HD schedules leads to greater preservation of RRF...
2017: Blood Purification
https://www.readbyqxmd.com/read/28805490/low-employment-and-low-willingness-of-being-reemployed-in-chinese-working-age-maintained-hemodialysis-patients
#14
Bihong Huang, Bihong Lai, Ling Xu, Ying Wang, Yanpei Cao, Ping Yan, Jing Chen
AIM: Returning to society plays an important role in improving the quality of life in maintenance hemodialysis (MHD) patients, and retention of employment is one of the core enablers. The study is to assess the employment status and to determine the variables for unemployment in Chinese MHD patients. METHODS: Prevalent MHD patients from four dialysis centers in Shanghai China were enrolled. We assessed patients' employment status, current social functioning, hemodialysis modality, annual income and general health condition...
November 2017: Renal Failure
https://www.readbyqxmd.com/read/28733096/brachial-vein-transposition-is-a-promising-ultimate-upper-limb-autologous-arteriovenous-angioaccess-despite-its-many-pitfalls
#15
Lamisse Karam, Marek Rawa, Richard Shoenfeld, Pierre Bourquelot
OBJECTIVE: The objective of this study was to retrospectively evaluate the possibility of using the brachial veins despite their deep location, small caliber, and thin wall. METHODS: There were 64 patients without superficial veins who were eligible for two-stage brachial vein transposition (BrVT); 54 patients were on hemodialysis, 9 patients had sickle cell disease, and 1 patient had long-term parenteral nutrition. Preoperative imaging was performed with color duplex ultrasound as well as venography for suspected central vein stenosis...
July 18, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28729968/reproducibility-of-serial-creatinine-excretion-measurements-in-peritoneal-dialysis
#16
Zhi Xu, Glen H Murata, Yijuan Sun, Robert H Glew, Clifford Qualls, Darlene Vigil, Karen S Servilla, Thomas A Golper, Antonios H Tzamaloukas
AIM: To test whether muscle mass evaluated by creatinine excretion (EXCr) is maintained in patients with end-stage kidney disease (ESKD) treated by peritoneal dialysis (PD), we evaluated repeated measurements of EXCr in a PD population. METHODS: One hundred and sixty-six PD patients (94 male, 72 female) receiving the same PD dose for the duration of the study (up to approximately 2.5 years) had repeated determinations of total (in urine plus spent dialysate) 24-h EXCr (EXCr T) to assess the adequacy of PD by creatinine clearance...
July 6, 2017: World Journal of Nephrology
https://www.readbyqxmd.com/read/28724049/hepatitis-b-status-in-hemodialysis-patients
#17
Maia Nogueira Crown Guimarães, Tila Facincani, Sigrid De Sousa Dos Santos
BACKGROUND: Patients on chronic dialysis present a high prevalence of hepatitis B virus infection. Despite infection-control practices, surveillance of serological markers, and hepatitis B vaccination, there are still outbreaks of the disease in dialysis centers. OBJECTIVE: This study aims to assess the serologic and vaccination status for hepatitis B in hemodialysis patients. METHODS: This cross-sectional study assessed serologic markers and hepatitis B vaccination status of chronic kidney disease patients on regular dialysis program in São Carlos, SP, Brazil...
July 13, 2017: Arquivos de Gastroenterologia
https://www.readbyqxmd.com/read/28674854/icodextrin-and-peritoneal-dialysis-advantages-and-new-applications
#18
REVIEW
Periklis Dousdampanis, Carlos Guido Musso, Konstantina Trigka
The impact of icodextrin (ico) on peritoneal dialysis (PD) extension and patient survival is well established. Predominantly, ico-based solutions were prescribed in high-transporter PD patients. Advantages of the ico-based solutions include increased biocompatibility, avoidance of glucotoxicity, enhanced ultrafiltration failure (UF), sodium removal rates, better metabolic and blood pressure control. Bimodal solutions and twice daily exchanges of ico-based solutions are two newly introduced strategies to avoid glucose exposure and/or enhance UF in PD patients with UF failure...
July 3, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28658104/thrombotic-complications-and-tip-position-of-transjugular-chronic-dialysis-catheter-scheduled-into-superior-vena-cava-findings-on-hr-mrcp-and-hr-t2wi
#19
Whenzheng Li, Fang Li, He Wang, Xueying Long, Obin Ghimire, Yigang Pei, Xiangcheng Xiao, Jianping Ning
BACKGROUND: Catheter-related thrombotic complications(TCs) can occur during the long term use of a chronic dialysis catheter (CDC), including fibrin sheath (FS), mural thrombosis (MT), venous thrombosis (VT), and intraluminal clots (IC), which has not been reported with MRI. The aim of our study was to evaluate the determination of catheter tip position (TP) and resolution of TCs in patients with transjugular CDC scheduled into the superior vena cava using high resolution magnetic resonance cholangiopancreatography (HR-MRCP) and T2-weighted imaging (HR-T2WI)...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28620716/factors-affecting-responsiveness-to-hepatitis-b-immunization-in-dialysis-patients
#20
Ali Asan, Huriye Demirhan, Hülya Çetin Sorkun, Sevgi Özkan, Mehtap Aydın, Davut Akın, Bengü Tatar, Binali Çatak, Alper Şener, Şükran Köse
BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are widespread health problems all over the world and have high morbidity and mortality. Hemodialysis patients are more frequently exposed to these viruses as they have poor immune system and frequently undergo parenteral interventions. The vaccination against HBV prevents infection and it has been recommended for the prevention of HBV infection in all susceptible dialysis patients. This study aimed to determine the seroprevalence of HBV and HCV infections and analyzed the factors affecting inadequate response to HBV vaccine in dialysis patients...
October 2017: International Urology and Nephrology
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