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https://www.readbyqxmd.com/read/28893206/efficacy-of-blood-flow-restriction-exercise-during-dialysis-for-end-stage-kidney-disease-patients-protocol-of-a-randomised-controlled-trial
#1
Matthew J Clarkson, Steve F Fraser, Paul N Bennett, Lawrence P McMahon, Catherine Brumby, Stuart A Warmington
BACKGROUND: Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients...
September 11, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28873293/the-role-of-midodrine-for-hypotension-outside-of-the-intensive-care-unit
#2
Lawrence B Gutman, Ben J Wilson
Midodrine is an oral, peripherally acting alpha-adrenergic agonist. After gaining Food and Drug Administration (FDA) approval in 1996 for orthostatic hypotension, its use has evolved to target vasoplegic conditions such as intradialytic hypotension in the end-stage renal disease population, refractory ascites in cirrhotic patients to support diuresis, and in hepatorenal syndrome. Upon oral ingestion, the drug undergoes enzymatic hydrolysis to an active metabolite, desglymidodrine. Its use has been well tolerated at 2...
August 23, 2017: Journal of Population Therapeutics and Clinical Pharmacology
https://www.readbyqxmd.com/read/28852491/captivating-a-captive-audience-a-quality-improvement-project-increasing-participation-in-intradialytic-exercise-across-five-renal-dialysis-units
#3
Lyndsey Abdulnassir, Sara Egas-Kitchener, Daniel Whibley, Tom Fynmore, Gareth D Jones
BACKGROUND: Benefits of exercise on dialysis (EOD) are well established, however, uptake in our local satellite haemodialysis units is low. The implications of the status quo are risks to treatment efficiency, equity and patient centredness in managing personal health risks. The current study aimed to identify and address barriers to exercise participation while on dialysis by substantiating local EOD risks, assigning context, implementing changes and evaluating their impact. Our primary objective was to increase the uptake of EOD across our five dialysis units...
August 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28838226/intradialytic-exercise-improves-physical-function-and-reduces-intradialytic-hypotension-and-depression-in-hemodialysis-patients
#4
So Yon Rhee, Jin Kyung Song, Suk Chul Hong, Jae Won Choi, Hee Jung Jeon, Dong Ho Shin, Eun Hee Ji, Eun-Hee Choi, Jiyeon Lee, Aram Kim, Seung Wook Choi, Jieun Oh
Background/Aims: As numbers of maintenance hemodialysis patients are growing, debilitating conditions of muscle wasting and atrophy are becoming some of the greatest concerns in end-stage renal disease patients. Exercise training has various potential benefits in terms of prevention of a sustained decline in functional status. This study aimed to evaluate the physical, psychological, laboratory, and dialysis-related effects of intradialytic exercise. Methods: We enrolled 22 patients from a hemodialysis center for a 6-month non-randomized prospective trial...
August 25, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28833520/introduction-to-intradialytic-hypotension-perspectives-in-contemporary-practice
#5
EDITORIAL
Steven Brunelli
No abstract text is available yet for this article.
August 21, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28832707/erratum-acute-effects-of-intradialytic-aerobic-exercise-on-solute-removal-blood-gases-and-oxidative-stress-in-patients-with-chronic-kidney-disease
#6
(no author information available yet)
[This corrects the article doi: 10.5935/0101-2800.20170022].
August 17, 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/28832356/blood-pressure-in-hemodialysis-targets
#7
Panagiotis I Georgianos, Rajiv Agarwal
PURPOSE OF REVIEW: In the absence of 'hard' clinical-trial evidence to define optimal blood pressure (BP) targets and validate different BP measurement techniques, management of hypertension in hemodialysis is based on expert opinions. In this review, we provide a comparative evaluation of out-of-dialysis BP monitoring versus dialysis-unit BP recordings in diagnosing hypertension, guiding its management and prognosticating mortality risk. RECENT FINDINGS: Owing to their high variability and poor reproducibility, predialysis and postdialysis BP recordings provide inaccurate reflection of the actual BP load outside of dialysis...
August 21, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28828726/levetiracetam-pharmacokinetics-in-a-critically-ill-anephric-patient-on-intermittent-hemodialysis
#8
Patrick M Wieruszewski, Kianoush B Kashani, Alejandro A Rabinstein, Erin Frazee
BACKGROUND: In patients requiring hemodialysis, the extracorporeal circuit is expected to remove the majority of serum levetiracetam. The preferred levetiracetam dosing regimen in critically ill patients exhibiting complex pharmacokinetic profiles undergoing hemodialysis is unknown. The objective of this case is to describe levetiracetam pharmacokinetics in a critically ill anephric patient receiving intermittent hemodialysis. METHODS: This is a case report of a single patient...
August 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28819317/intradialytic-central-venous-oxygen-saturation-is-associated-with-clinical-outcomes-in-hemodialysis-patients
#9
Lili Chan, Hanjie Zhang, Anna Meyring-Wösten, Israel Campos, Doris Fuertinger, Stephan Thijssen, Peter Kotanko
Central venous oxygen saturation (ScvO2) in the superior vena cava is predominantly determined by cardiac output, arterial oxygen content, and oxygen consumption by the upper body. While abnormal ScvO2 levels are associated with morbidity and mortality in non-uremic populations, ScvO2 has received little attention in hemodialysis patients. From 1/2012 to 8/2015, 232 chronic hemodialysis patients with central venous catheters as vascular access had their ScvO2 monitored during a 6-month baseline period and followed for up to 36 months...
August 17, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28806350/blood-pressure-variability-is-increasing-from-the-first-to-the-second-day-of-the-interdialytic-interval-in-hemodialysis-patients
#10
Antonios Karpetas, Charalampos Loutradis, Athanasios Bikos, Georgios Tzanis, Georgios Koutroumpas, Antonios A Lazaridis, Konstantinos Mavromatidis, Vassilios Liakopoulos, Aikaterini Papagianni, Pantelis Zebekakis, Luis M Ruilope, Gianfranco Parati, Pantelis A Sarafidis
OBJECTIVES: Patients with end-stage renal-disease under hemodialysis have increased cardiovascular risk and experience severe blood pressure (BP) fluctuations during the dialysis session and the subsequent interdialytic period. BP variability (BPV) may be an additional risk factor for cardiovascular events and preliminary data suggest increased BPV with advancing stages of chronic kidney disease. This is the first study to examine BPV during the whole intradialytic and interdialytic period in hemodialysis patients with ambulatory BP monitoring...
August 12, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28805348/levocarnitine-decreases-intradialytic-hypotension-episodes-a-randomized-controlled-trial
#11
Héctor Raúl Ibarra-Sifuentes, Ángel Del Cueto-Aguilera, Daniel Alberto Gallegos-Arguijo, Sergio Andres Castillo-Torres, Raymundo Vera-Pineda, Rolando Jacob Martínez-Granados, Alexandro Atilano-Díaz, Jesus Eduardo Cuellar-Monterrubio, Cesar Octaviano Pezina-Cantú, Edgar de Jesús Martínez-Guevara, Juan Francisco Ortiz-Treviño, Guillermo Rubén Delgado-García, José Guadalupe Martínez-Jiménez, Jesús Cruz-Valdez, Concepción Sánchez-Martínez
Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo-controlled quadruple-blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively...
August 14, 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28803369/volume-balance-and-intradialytic-ultrafiltration-rate-in-the-hemodialysis-patient
#12
REVIEW
Jason A Chou, Kamyar Kalantar-Zadeh
PURPOSE OF REVIEW: Volume management in hemodialysis patients is often challenging. Assessing volume status and deciding how much fluid to remove during hemodialysis, the so-called ultrafiltration rate (UFR), has remained a conundrum. RECENT FINDINGS: To date there is no objective assessment tool to determine the needed UFR during each hemodialysis session. Higher volume overload or higher UFR is associated with poor outcomes including worse mortality and unfavorable clinical outcomes...
August 12, 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28796425/comparison-of-stroke-volume-measurements-during-hemodialysis-using-bioimpedance-cardiography-and-echocardiography
#13
Michael J Germain, Jyovani Joubert, Daniel O'Grady, Brian H Nathanson, Yossi Chait, Nathan W Levin
BACKGROUND: Fluid management remains a major challenge of hemodialysis (HD) care, with serious implications for morbidity and mortality. Intradialytic fluid management is typically guided by blood pressure, an indirect resultant of hemodynamics status. Direct measurements of hemodynamic parameters may improve cardiovascular outcomes by providing rational bases for intervention. We compare stroke volume (SV) measurements using a noninvasive, regional biompedance cardiography device (NiCaS) with Doppler echocardiography (Echo) in HD setting...
August 10, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28762626/adjustment-of-target-weight-based-on-absolute-blood-volume-reduces-the-frequency-of-intradialytic-morbid-events
#14
Susanne Kron, Daniel Schneditz, Jutta Czerny, Til Leimbach, Klemens Budde, Joachim Kron
INTRODUCTION: Adequate volume management removing excess volume and at the same time avoiding intradialytic morbid events (IME) remains a core problem in current hemodialysis (HD) therapy. Recently, we developed a feasible method to determine absolute blood volume (Vs, in mL/kg) in patients on HD. The aim of this study was to investigate the suitability of Vs measurements for volume management. METHODS: Following a 4 week baseline phase to quantify the frequency of IME, volume status was determined in a single specified HD session during which Vs was measured using dialysate dilution, volume overload (Vo, L) was measured using bioimpedance spectroscopy, and the occurrence of IME was recorded...
August 1, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28742531/variable-volume-kinetic-model-to-estimate-absolute-blood-volume-in-patients-on-dialysis-using-dialysate-dilution
#15
Hamed Samandari, Daniel Schneditz, Michael J Germain, Joseph Horowitz, Christopher V Hollot, Yossi Chait
Long- and short-term adverse outcomes in hemodialysis (HD) have been associated with intradialytic hypotension, a common HD complication and significant cause of morbidity. It has been suggested that knowledge of absolute blood volume (ABV) could be used to significantly improve treatment outcomes. Different dilution-based protocols have been proposed for estimating ABV, all relying on the classic mono-exponential back-extrapolation algorithm (BEXP). In this paper, we introduce a dialysate dilution protocol and an estimation algorithm based on a variable-volume, two-compartment, intravascular blood water content kinetic model (VVKM)...
July 24, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28730673/autonomic-dysfunction-as-a-mechanism-of-intradialytic-blood-pressure-instability
#16
Tariq Shafi, Surekha Mullangi, Bernard G Jaar, Harry Silber
The autonomic nervous system (ANS) is the principal endogenous defense mechanism that maintains blood pressure in the setting of hypotension. Disruption of the ANS impairs this ability and can contribute to blood pressure instability, including hypotension and hypertension. In this narrative review, we provide an overview of the ANS and the consequences of its dysfunction in patients with end-stage kidney disease treated with dialysis. We also discuss possible mechanisms of this autonomic dysfunction that may need future investigation...
July 20, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28728576/beneficial-effect-of-kidney-transplantation-from-a-deceased-donor-on-severe-chronic-refractory-intradialytic-hypotension-a-case-report
#17
Ewa Ignacak, Dominik Cieniawski, Alina Bętkowska-Prokop, Czesław Osuch, Marek Kuźniewski, Władysław Sułowicz
BACKGROUND: Chronic refractory hypotension (IDH, intradialytic hypotension) is a rare but serious problem encountered in patients on hemodialysis. Patients with chronic hypotension are often disqualified by transplant teams from renal transplantation. This is due to the possibility of an enormous risk of ischemic complications. CASE PRESENTATION: We describe a 44-year old female patient with severe refractory hypotension (mean BP 60/30 mmHg, the lowest 48/28 mmHg), which appeared after bilateral laparoscopic nephrectomy of the infected kidneys...
July 20, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28707330/the-impact-of-dialysis-modality-and-membrane-characteristics-on-intradialytic-hypotension
#18
Samir Patel, Jochen G Raimann, Peter Kotanko
The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published in English that investigated the association between IDH and dialysis modality and membrane, respectively. This literature search revealed 669 publications on dialysis modality, 64 on dialysis membrane, and 24 on acetate/bicarbonate dialysate...
July 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28707302/dialysate-sodium-and-intradialytic-hypotension
#19
Wael F Hussein, Brigitte Schiller
Intradialytic hypotension (IDH) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain (IDWG), high ultrafiltration rates (UFR), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D-Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG, UFR, and hypertension...
July 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28691195/definitions-of-intradialytic-hypotension
#20
Magdalene M Assimon, Jennifer E Flythe
Intradialytic hypotension (IDH) is a common and often distressful complication of hemodialysis. However, despite its clinical significance, there is no consensus, evidence-based medical definition for the condition. Over the years, numerous definitions have been implemented in both the clinical and research settings. Definition inconsistencies have hindered data synthesis and the development of evidence-based guidelines for the prevention and treatment of IDH, as well as prevented accurate estimation of the population burden of IDH and patient risk assessment...
July 9, 2017: Seminars in Dialysis
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