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Dialysis principles

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
Jansy P Sarathy, Fabio Zuccotto, Ho Hsinpin, Lars Sandberg, Laura E Via, Gwendolyn A Marriner, Thierry Masquelin, Paul Wyatt, Peter Ray, Véronique Dartois
The penetration of antibiotics in necrotic tuberculosis lesions is heterogeneous and drug-specific, but the factors underlying such differential partitioning are unknown. We hypothesized that drug binding to macromolecules in necrotic foci (or caseum) prevents passive drug diffusion through avascular caseum, a critical site of infection. Using a caseum binding assay and MALDI mass spectrometry imaging of tuberculosis drugs, we showed that binding to caseum inversely correlates with passive diffusion into the necrotic core...
August 12, 2016: ACS Infectious Diseases
Jochen G Raimann, Antonios H Tzamaloukas, Nathan W Levin, Todd S Ing
Since the beginning of life of the first multicellular organisms, the preservation of a physiologic milieu for every cell in the organism has been a critical requirement. A particular range of osmolality of the body fluids is essential for the maintenance of cell volume. In humans the stability of electrolyte concentrations and their resulting osmolality in the body fluids is the consequence of complex interactions between cell membrane functions, hormonal control, thirst, and controlled kidney excretion of fluid and solutes...
September 9, 2016: Seminars in Dialysis
Shengwen Liu, Nannan Qin, Jieyao Song, Ya Zhang, Weiping Cai, Haimin Zhang, Guozhong Wang, Huijun Zhao
A nanomaterials-based DGT device constructed with commercial dialysis membrane as diffusive layer and nanoparticulate Fe3O4 aqueous suspension as binding phase is developed and validated for in situ aquatic arsenic measurement. The Fe3O4NPs binding phase is capable of quantitatively accumulated both As(III) and As(V) species. As(III) and As(V) species coexist in the vast majority of environmental water samples. The large difference in diffusion coefficients of As(III) (DAs(III)=3.05×10(-7)cm(2)s(-1)) and As(V) (DAs(V)=1...
November 1, 2016: Talanta
Jiacong Luo, Donna E Jensen, Bradley J Maroni, Steven M Brunelli
BACKGROUND: Hemodialysis patients with erythropoiesis-stimulating agent (ESA) hyporesponsiveness have been a topic of active research. However, there have been no studies of ESA hyporesponsiveness among US patients following the dramatic change in anemia management that resulted from the 2011 changes in ESA product labeling and bundling of dialysis remuneration. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: We studied prevalent hemodialysis patients treated at a large dialysis organization in calendar years 2012 to 2013 (N=98,972)...
August 12, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Steven M Brunelli, Scott Sibbel, Paul J Dluzniewski, Kerry Cooper, Mark E Bensink, Brian D Bradbury
PURPOSE: Missed in-center hemodialysis treatments (MHT) are a general indicator of health status in hemodialysis patients. This analysis was conducted to estimate the association between cinacalcet use and MHT rate. METHODS: We studied patients receiving hemodialysis and prescription benefits services from a large dialysis organization. Incident cinacalcet users were propensity score matched to controls on 31 demographic, clinical, and laboratory variables. We applied inverse probability (IP) of censoring and crossover weights to account for informative censoring...
June 27, 2016: Pharmacoepidemiology and Drug Safety
Holger Sennhenn-Reulen, Thomas Kneib
Multi-state models generalize survival or duration time analysis to the estimation of transition-specific hazard rate functions for multiple transitions. When each of the transition-specific risk functions is parametrized with several distinct covariate effect coefficients, this leads to a model of potentially high dimension. To decrease the parameter space dimensionality and to work out a clear image of the underlying multi-state model structure, one can either aim at setting some coefficients to zero or to make coefficients for the same covariate but two different transitions equal...
June 23, 2016: Statistics in Medicine
Vivekanand Jha
No abstract text is available yet for this article.
April 21, 2016: Nephrology
Tae Ik Chang, Dong-Ryeol Ryu, Tae-Hyun Yoo, Hyung Jong Kim, Ea Wha Kang, Hyunwook Kim, Jae Hyun Chang, Dong Ki Kim, Sung Jin Moon, Soo Young Yoon, Seung Hyeok Han
Although icodextrin solution has been highlighted in the fluid management compared to glucose-based solutions, proof of a beneficial effect of icodextrin solution on residual renal function (RRF) is lacking. We conducted a multicenter prospective randomized controlled open-label trial to investigate whether icodextrin solution can preserve RRF.One hundred patients with urine volume ≥750 mL/day from 8 centers in Korea were randomly assigned to receive 1 exchange of icodextrin solution for a ≥8 hour-dwell time and 2 exchanges of 1...
March 2016: Medicine (Baltimore)
Samuel A Silver, Rory McQuillan, Ziv Harel, Adam V Weizman, Alison Thomas, Gihad Nesrallah, Chaim M Bell, Christopher T Chan, Glenn M Chertow
To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Rory Francis McQuillan, Samuel Adam Silver, Ziv Harel, Adam Weizman, Alison Thomas, Chaim Bell, Glenn M Chertow, Christopher T Chan, Gihad Nesrallah
This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Richard D M Allen, Henry C C Pleass, Claudia Woodroffe, Philip A Clayton, Paolo Ferrari
BACKGROUND: The Australian kidney paired donation program adopted the principles of within-chain simultaneous live donor surgery and of organ transport, with the requirement of keeping cold ischemia time (CIT) to <12 h. Whether these principles could be adhered to and what impact on transplant outcome they might have is unknown. METHODS: We evaluated the logistic challenges and outcomes of the first 100 kidney transplants performed in the Australian kidney paired donation program...
March 7, 2016: ANZ Journal of Surgery
Matthew T James, Charles E Hobson, Michael Darmon, Sumit Mohan, Darren Hudson, Stuart L Goldstein, Claudio Ronco, John A Kellum, Sean M Bagshaw
Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label...
2016: Canadian Journal of Kidney Health and Disease
Michel Fischbach, Claus Peter Schmitt, Rukshana Shroff, Ariane Zaloszyc, Bradley A Warady
Optimal fluid removal on peritoneal dialysis (PD) requires removal of water coupled with sodium, which is predominantly achieved via the small pores in the peritoneal membrane. On the other hand, free-water transport takes place through aquaporin-1 channels, but leads to sodium retention and over hydration. PD prescription can be adapted to promote small pore transport to achieve improved sodium and fluid management. Both adequate dwell volume and dwell time are required for small pore transport. The dwell volume determines the amount of "wetted" peritoneal membrane being increased in the supine position and optimized at dwell volumes of approximately 1400 ml/m(2)...
April 2016: Kidney International
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco
During the last few years, due to medical and surgical evolution, patients with increasingly severe diseases causing multiorgan dysfunction are frequently admitted to intensive care units. Therapeutic options, when organ failure occurs, are frequently nonspecific and mostly directed towards supporting vital function. In these scenarios, the kidneys are almost always involved and, therefore, renal replacement therapies have become a common routine practice in critically ill patients with acute kidney injury...
2016: F1000Research
Ana E Figueiredo, Judith Bernardini, Elaine Bowes, Miki Hiramatsu, Valerie Price, Chunyan Su, Rachael Walker, Gillian Brunier
Being aware of controversies and lack of evidence in peritoneal dialysis (PD) training, the Nursing Liaison Committee of the International Society for Peritoneal Dialysis (ISPD) has undertaken a review of PD training programs around the world in order to develop a syllabus for PD training. This syllabus has been developed to help PD nurses train patients and caregivers based on a consensus of training program reviews, utilizing current theories and principles of adult education. It is designed as a 5-day program of about 3 hours per day, but both duration and content may be adjusted based on the learner...
February 25, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Fen Xu, Tianyi Kang, Jie Deng, Junli Liu, Xiaolei Chen, Yuan Wang, Liang Ouyang, Ting Du, Hong Tang, Xiaoping Xu, Shaochen Chen, Yanan Du, Yujun Shi, Zhiyong Qian, Yuquan Wei, Hongxin Deng, Maling Gou
Extracorporeal devices have great promise for cleansing the body of virulence factors that are caused by venomous injuries, bacterial infections, and biological weaponry. The clinically used extracorporeal devices, such as artificial liver-support systems that are mainly based on dialysis or electrostatic interaction, are limited to remove a target toxin. Here, a liver-mimetic device is shown that consists of decellularized liver scaffold (DLS) populated with polydiacetylene (PDA) nanoparticles. DLS has the gross shape and 3D architecture of a liver, and the PDA nanoparticles selectively capture and neutralize the pore-forming toxins (PFTs)...
April 2016: Small
Catherine R Butler, Rajnish Mehrotra, Mark R Tonelli, Daniel Y Lam
Throughout the history of dialysis, four bioethical principles - beneficence, nonmaleficence, autonomy and justice - have been weighted differently based upon changing forces of technologic innovation, resource limitation, and societal values. In the 1960s, a committee of lay people in Seattle attempted to fairly distribute a limited number of maintenance hemodialysis stations guided by considerations of justice. As technology advanced and dialysis was funded under an amendment to the Social Security Act in 1972, focus shifted to providing dialysis for all in need while balancing the burdens of treatment and quality of life, supported by the concepts of beneficence and nonmaleficence...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Franklin W Maddux
The treatment of chronically ill patients with end stage renal disease (ESRD) receiving dialysis therapies has advanced greatly over the years and accomplished many successes in prolonging the life of patients with ESRD, yet has had considerable failures due to the inability to compensate for all functions of the kidneys. In addition, the focus to achieve quality goals for laboratories and vascular access measures may indicate a good quality of care from providers, but meeting these clinical and physiological goals may not fully maximize individual benefit to a patient, may not be aligned with the patient's care goals, and could conceivably impact negatively the patient's experience of care and quality of life...
March 2016: Seminars in Dialysis
Divya Raghavan, Jean L Holley
Palliative care is a branch of medicine dedicated to the relief of symptoms experienced during the course of illness. Renal palliative medicine or kidney supportive care is an evolving branch of nephrology, which incorporates the principles of palliative care into the care of CKD and ESRD (dialysis, transplant, and conservatively managed) patients. Conservative (non-dialytic) management is a legitimate option for frail, elderly CKD patients in whom dialysis may not lead to an improvement in quality or duration of life...
January 2016: Advances in Chronic Kidney Disease
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