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Dialysis principles

Richard N Formica
The kidney allocation system that took effect on December 4, 2014 represents a significant improvement over the prior approach. It seeks to improve outcomes by longevity matching - pairing kidneys expected to function the longest with recipients expected to live the longest. It addresses the biological barriers faced by highly sensitized patients in an evidence based fashion and it begins to introduce the concept of medical need into kidney allocation by crediting time from the starting dialysis to a patient's waiting time...
October 8, 2016: Transplantation Reviews
Brigitta Lutz, Christian Reeps, Gabor Biro, Christoph Knappich, Alexander Zimmermann, Hans-Henning Eckstein
OBJECTIVE: Alloplastic aortic graft infection is a devastating complication following aortic surgery. It is associated with excessively high mortality and morbidity caused by anastomotic rupture or septicemia. Many authors consider in situ replacement after complete surgical graft removal as the method of choice. However, there is an ongoing debate about the most suitable material for reconstruction. We present our first experiences with replacing the descending and infra-renal aorta using custom-made bovine pericardium grafts...
November 26, 2016: Annals of Vascular Surgery
Rongjie Zhuo, Hao Liu, Ningning Liu, Yi Wang
Identification of active compounds from natural products is a critical and challenging task in drug discovery pipelines. Besides commonly used bio-guided screening approaches, affinity selection strategy coupled with liquid chromatography or mass spectrometry, known as ligand fishing, has been gaining increasing interest from researchers. In this review, we summarized this emerging strategy and categorized those methods as off-line or on-line mode according to their features. The separation principles of ligand fishing were introduced based on distinct analytical techniques, including biochromatography, capillary electrophoresis, ultrafiltration, equilibrium dialysis, microdialysis, and magnetic beads...
November 11, 2016: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
Jie Peng, Fang Tang, Rui Zhou, Xiang Xie, Sanwang Li, Feifan Xie, Peng Yu, Lingli Mu
Biological sample pretreatment is an important step in biological sample analysis. Due to the diversity of biological matrices, the analysis of target substances in these samples presents significant challenges to sample processing. To meet these emerging demands on biopharmaceutical analysis, this paper summarizes several new techniques of on-line biological sample processing: solid phase extraction, solid phase micro-extraction, column switching, limited intake filler, molecularly imprinted solid phase extraction, tubular column, and micro-dialysis...
November 2016: Acta Pharmaceutica Sinica. B
Giuseppina D'Onofrio, Mariadelina Simeoni, Paolo Rizza, Mariarita Caroleo, Maria Capria, Giovanni Mazzitello, Tiziana Sacco, Elena Mazzuca, Maria Teresa Panzino, Annamaria Cerantonio, Cristina Segura-Garcia, Michele Andreucci, Pasquale De Fazio, Giorgio Fuiano
RATIONAL: Our aim was to investigate the quality of life (QoL) in 103 patients undergoing chronic hemodialysis (HD) in an integrated assessment of clinical, personological, and adaptation parameters, also in a non-urban context. OBJECTIVES: We collected data from all chronic HD patients attending four HD units. Clinical status was assessed by Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and by Age-adjusted Charlson Comorbidity Index (ACCI). Patients completed the following questionnaires: Kidney Disease Quality of Life Short Form (KDQOL-SF), Pittsburgh Sleep Quality Index (PSQI)...
October 25, 2016: Renal Failure
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
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