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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
Hao Yan, Wei Fang, Aiwu Lin, Liou Cao, Zhaohui Ni, Jiaqi Qian
BACKGROUND: Incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) are often prescribed either 3 or 4 exchanges per day. However, the effects on residual kidney function and clinical outcomes of 3 versus 4 exchanges are not known. STUDY DESIGN: Prospective, randomized, controlled, open-label study. SETTING & PARTICIPANTS: Incident CAPD patients aged 18 to 80 years with glomerular filtration rates (GFRs; mean of renal urea and creatinine clearance from a 24-hour urine collection) ≥ 2mL/min and urine volume ≥ 500mL/d...
October 14, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Francesco Gaetano Casino, Carlo Basile
BACKGROUND: The recent interest in incremental haemodialysis (HD) is hindered by the current prescription based on a fixed target model (FTM) for the total (dialytic + renal) equivalent continuous clearance (ECC). The latter is expressed either as standard Kt/V (stdKt/V), i.e. the pre-dialysis averaged concentration of urea-based ECC, or EKRc, i.e. the time averaged concentration-based ECC, corrected for volume (V) = 40 L. Accordingly, there are two different targets: stdKt/V = 2.3 volumes per week (v/wk) and EKRc = 13 mL/min/40 L...
October 14, 2016: Nephrology, Dialysis, Transplantation
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
Suzanne M Boyle, Yimei Li, F P Wilson, Joel D Glickman, Harold I Feldman
♦ Background: Total body water (V) is an imprecise metric for normalization of dialytic urea clearance (Kt). This poses a risk of early mortality/technique failure (TF). We examined differences in the distribution of peritoneal Kt/V when V was calculated with actual weight (AW), ideal weight (IW), and adjusted weight (ADW). We also examined the associations of these Kt/V measurements, Kt/body surface area (BSA), and non-normalized Kt with mortality and TF. ♦ Methods: This is a retrospective cohort study of 534 incident peritoneal dialysis (PD) patients from the Dialysis Morbidity and Mortality Study Wave 2 linked with United States Renal Data System through 2010...
September 28, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
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
Katrin Wacker, Jay W McLaren, Katrina M Kane, Keith H Baratz, Sanjay V Patel
Purpose: To assess corneal hydration control across a range of severity of Fuchs' endothelial corneal dystrophy (FECD) by measuring the percent recovery per hour (PRPH) of central corneal thickness after swelling the cornea and to determine its association with corneal morphologic parameters. Methods: Twenty-three corneas of 23 phakic FECD patients and 8 corneas of 8 healthy control participants devoid of guttae were graded (modified Krachmer scale). Effective endothelial cell density (ECDe) was determined from the area of guttae and local cell density in confocal microscopy images...
September 1, 2016: Investigative Ophthalmology & Visual Science
Manabu Asano, Kenichi Oguchi, Akira Saito, Yoshihiro Onishi, Yosuke Yamamoto, Shunichi Fukuhara, Takashi Akiba, Tadao Akizawa
INTRODUCTION: The relationship between intradialytic ultrafiltration volume and vascular access (VA) patency remains unclear. Using data from the Japan Dialysis Outcomes and Practice Patterns Study, we analyzed whether large-volume ultrafiltration was associated with VA failure in hemodialysis patients. METHODS: We included 2736 patients for whom it was possible to evaluate VA patency and bodyweight change during dialysis. Patients were divided into three groups according to the tertile of intradialytic ultrafiltration by bodyweight: low, -9...
September 20, 2016: Journal of Vascular Access
Yunfeng Yan, Li Liu, Hu Xiong, Jason B Miller, Kejin Zhou, Petra Kos, Kenneth E Huffman, Sussana Elkassih, John W Norman, Ryan Carstens, James Kim, John D Minna, Daniel J Siegwart
Conventional chemotherapeutics nonselectively kill all rapidly dividing cells, which produces numerous side effects. To address this challenge, we report the discovery of functional polyesters that are capable of delivering siRNA drugs selectively to lung cancer cells and not to normal lung cells. Selective polyplex nanoparticles (NPs) were identified by high-throughput library screening on a unique pair of matched cancer/normal cell lines obtained from a single patient. Selective NPs promoted rapid endocytosis into HCC4017 cancer cells, but were arrested at the membrane of HBEC30-KT normal cells during the initial transfection period...
September 27, 2016: Proceedings of the National Academy of Sciences of the United States of America
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
Soraya Abad, Almudena Vega, Borja Quiroga, David Arroyo, Nayara Panizo, Javier Eduardo Reque, Juan Manuel López-Gómez
: Chronic kidney disease is associated with an increased risk of cardiovascular events. In recent years, protein-bound toxins have become more important due to their association with increased morbidity and mortality, characterised by inadequate clearance during dialysis. The purpose of this study is to assess the influence of high convective volumes on postdilution online haemodiafiltration (OL-HDF) on the removal of medium-sized molecules, small molecules and protein-bound molecules...
August 30, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
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
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
Xiaoyang Wang, Xiaoxue Zhang, Shan Lu, Dong Liu, Genyang Chen, Yanna Dou, Wenming Yuan, Shuang Ma, Yansheng Li, Jing Xiao, Zhanzheng Zhao
OBJECTIVES: This study aims to evaluate the safety of mycophenolate mofetil (MMF) and its effect on residual renal function (RRF) during peritoneal dialysis (PD). METHODS: This is a prospective, randomized study comprising 60 PD patients. The patients were assigned either to the MMF group (MMF dosage: 1-1.5 g/day in two divided doses for 6 months, followed by a dose of 0.5-0.75 g/day for another 6 months) or to the control group. The patients close monitoring for 1 year...
August 25, 2016: Nephrology
Rukshana Shroff, Rosalie B Sterenborg, Adam Kuchta, Andrew Arnold, Nicholas Thomas, Lynsey Stronach, Soundrie Padayachee, Francis Calder
BACKGROUND: Arteriovenous fistula (AVF) formation for long-term haemodialysis in children is a niche discipline with little data for guidance. We developed a dedicated Vascular Access Clinic that is run jointly by a transplant surgeon, paediatric nephrologist, dialysis nurse and a clinical vascular scientist specialised in vascular sonography for the assessment and surveillance of AVFs. We report the experience and 2-year outcomes of this clinic. METHODS: Twelve new AVFs were formed and 11 existing AVFs were followed up for 2 years...
August 7, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Ching-Fang Wu, Yee-Fan Lee, Wen-Jeng Lee, Chi-Ting Su, Lukas Jyuhn-Hsiarn Lee, Kwan-Dun Wu, Pau-Chung Chen, Tze-Wah Kao
BACKGROUND/PURPOSE: Vascular calcification can predict cardiovascular (CV) morbidity and mortality in patients with end-stage renal disease. We evaluated the prevalence, association factors, and outcomes of chest X-ray-detected aortic arch calcification (AoAC) in patients undergoing peritoneal dialysis (PD). METHODS: We included 190 patients undergoing PD (mean age, 52.6 ± 14.3 years) for whom chest radiographs were available. AoAC revealed by chest X-ray was graded from 0 to 3 according to an AoAC score (AoACS)...
August 3, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Cheng-Chia Lee, Kun-Hua Tu, Hsiao-Hui Chen, Ming-Yang Chang, Cheng-Chieh Hung
PURPOSE: Refractory peritonitis remains a thorny issue for patients with chronic peritoneal dialysis (PD). Shortly after catheter removal, some patients develop persistent peritoneal inflammation and ascites formation, which require percutaneous drainage for symptom relief. Our study aimed at finding the risk factors for this kind of event. METHODS: A total of 47 PD patients complicated with refractory peritonitis who underwent catheter removal between January 2009 and December 2011 were enrolled in this study...
October 2016: International Urology and Nephrology
Vanesa A Muñoz, Gabriela V Ferrari, M Paulina Montaña, Sandra Miskoski, Norman A García
Visible-light irradiation of aqueous-ethanolic solutions of Riboflavin (Rf) in the individual presence of the flavone chrysin (Chr) and its complex with Cu(2+) ([Chr2Cu]; 2:1 L:M) generates singlet molecular oxygen O2((1)Δg), that concomitantly interact with both flavone derivatives. Overall (kt) and reactive (kr) rate constants in the order of 10(7)M(-1)s(-1) were determined for the process. Metal chelation greatly enhances the scavenging ability of [Chr2Cu] towards O2((1)Δg) through a mechanism dominated, in >80%, by the physical component...
September 2016: Journal of Photochemistry and Photobiology. B, Biology
Jin-Bor Chen, Fong-Fu Chou, Cheng-Hong Yang, Moi-Sin Hua
BACKGROUND: We investigated factors associated with all-cause mortality and cardiovascular disease (CVD)-associated mortality after parathyroidectomy (PTX) in patients on maintenance hemodialysis (HD). METHODS: Our study population consisted of 161 consecutive HD patients who underwent PTX before 2009 and 354 consecutive HD patients without PTX as controls from those visiting the Kaohsiung Chang Gung Memorial Hospital, Taiwan between 2009 and 2013. All-cause and CVD mortality with clinical variables were compared in PTX and non-PTX HD patients...
June 14, 2016: American Journal of Surgery
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