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Hemodialysis hypotension

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https://www.readbyqxmd.com/read/28811944/successful-resuscitation-of-a-patient-with-life-threatening-metabolic-acidosis-by-hemodialysis-a-case-of-ethylene-glycol-intoxication
#1
Ikuyo Narita, Michiko Shimada, Norio Nakamura, Reiichi Murakami, Takeshi Fujita, Wakako Fukuda, Hirofumi Tomita
BACKGROUND: Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Here we present a case of ethylene glycol intoxication who successfully recovered with prompt hemodialysis. CASE PRESENTATION: A 52-year-old Japanese male was admitted to a local hospital due to suspected food poisoning. The patient presented with nausea and vomiting, but his condition rapidly deteriorated, with worsening conscious level, respiratory distress requiring mechanical ventilation, hypotension, and severe acute kidney injury...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28805348/levocarnitine-decreases-intradialytic-hypotension-episodes-a-randomized-controlled-trial
#2
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
#3
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/28795535/update-on-postdialysis-rebound-by-a-new-technology-in-hemodialysis
#4
Alicia García Testal, David Hervás Marín, Rafael García Maset, Pilar Royo Maicas, Inmaculada Soledad Rico Salvador, Pau Olagüe Díaz, Jose Enrique Fernández Najera, Eduardo Torregrosa De Juan, Caterina Benedito Carrera
After dialysis ends, urea continued movement causes rebound postdialysis, with values at about 20%. New techniques have been incorporated into hemodialysis, but their relationship with rebound has not yet been studied. This study aimed to quantify urea rebound at 30-min postdialysis during sessions using polysulfone filters and high-flow versus online hemodiafiltration, and to define its correlation with body composition measured by bioimpedance by a cross-sectional study with 69 patients (December 2015 to January 2016)...
August 9, 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28777420/procalcitonin-level-as-a-surrogate-for-catheter-related-blood-stream-infection-among-hemodialysis-patients
#5
Mahmoud Hamada Imam, Eman Gamal
INTRODUCTION: Catheter-related bloodstream infection (CRBSI) is a frequent complication among hemodialysis patients who usually are presented with nonspecific signs such as fever, rigors, and hypotension. Blood culture will take up to 5 days and antimicrobials will be started. Procalcitonin (PCT) is a valid marker in sepsis. Our goal in this study is to evaluate its usefulness as a diagnostic marker in detecting CRBSI among hemodialysis patients who present with suspected CRBSI. PATIENTS AND METHODS: Thirty-one hemodialysis patients with suspected CRBSI were enrolled in this study...
July 26, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28748895/a-case-of-severe-carbamazepine-overdose-treated-successfully-with-combined-hemoperfusion-and-hemodialysis-technique
#6
Natalia Vallianou, Myrto Giannopoulou, Kyriakos Trigkidis, Elefteria Bei, Evangelia Margellou, Theofanis Apostolou
Carbamazepine intoxication manifests as altered mental status ranging from drowsiness to a coma and/or cardiac abnormalities such as sinus tachycardia, prolongation of the QRS interval, ventricular tachycardia, and hypotension. The patient may be agitated, but central nervous system (CNS) depression and presentation with coma is more common and could be lethal. Serious CNS toxicity often requires hemoperfusion and/or hemodialysis (HD). Herein, we present a case of a comatose patient, who was treated with a combination of hemoperfusion and HD in series...
July 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28742531/variable-volume-kinetic-model-to-estimate-absolute-blood-volume-in-patients-on-dialysis-using-dialysate-dilution
#7
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/28729382/recommended-clinical-trial-end-points-for-dialysis-catheters
#8
Michael Allon, Deborah J Brouwer-Maier, Kenneth Abreo, Kevin M Baskin, Kay Bregel, Deepa H Chand, Andrea M Easom, Leonard Mermel, Michele H Mokrzycki, Priti R Patel, Prabir Roy-Chaudhury, Surendra Shenoy, Rudolph P Valentini, Haimanot Wasse
Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration...
July 20, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28728576/beneficial-effect-of-kidney-transplantation-from-a-deceased-donor-on-severe-chronic-refractory-intradialytic-hypotension-a-case-report
#9
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
#10
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
#11
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/28691402/osmolality-and-blood-pressure-stability-during-hemodialysis
#12
Anika T Singh, Finnian R Mc Causland
Homeostatic regulation of plasma osmolality (POsm) is critical for normal cellular function in humans. Arginine vasopressin (AVP) is the major hormone responsible for the maintenance of POsm and acts to promote renal water retention in conditions of increased POsm. However, AVP also exerts pressor effects, and its release can be stimulated by the development of effective arterial blood volume depletion. Patients with end-stage renal disease on hemodialysis, particularly those with minimal or no residual renal function, have impaired ability to regulate water retention in response to AVP...
July 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28691195/definitions-of-intradialytic-hypotension
#13
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
https://www.readbyqxmd.com/read/28682030/-hemodialysis-and-cardiovascular-outcome
#14
Laura Panicali, Fabiana Brigante, Elena Mancini
Hemodialysis patients often present multiple comorbidities and have a high mortality rate (15-20% per year), mostly due to cardiovascular events. Besides predisposing pathological conditions related to uremia (heart failure, coronary heart disease, left ventricular hypertrophy, arrhythmias), they also have specific risk factors linked to the hemodialysis (HD) treatment in itself: chronic inflammation, fluid overload, autonomic nervous system dysfunction, arterovenous fistula. These factors may affect the hemodynamic compensatory systems (vascular refilling, arteriolar and venous tone, autonomic nervous system response) to fluid removal, with high risk of intra-dialysis hypotension (IDH) episodes or arrhythmic events...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28681510/impact-of-drugs-on-intradialytic-hypotension-antihypertensives-and-vasoconstrictors
#15
Tara I Chang
Intradialytic hypotension (IDH) is a common complication of hemodialysis and is associated with numerous adverse outcomes including cardiovascular events, inadequate dialysis, loss of vascular access, and death. It is estimated that approximately 20%-30% of all dialysis sessions are affected by IDH. In seeking ways to reduce the occurrence of IDH, dialysis providers often turn to pharmacological approaches: withholding antihypertensive medications prior to hemodialysis or administering vasoconstrictor medications...
July 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28680827/clinical-analysis-of-single-filtration-plasmapheresis-using-continuous-renal-replacement-therapy-machines-in-kidney-transplantation
#16
Eunsoo Lim, Yujeong Kim, Jong Cheol Jeong, Inwhee Park, Heungsoo Kim, Su Hyung Lee, Chang-Kwon Oh, Gyu-Tae Shin
BACKGROUND: Plasmapheresis has become an essential element of kidney transplantation (KT). In the present study, we report clinical outcomes of filtration plasmapheresis using continuous renal replacement therapy machines with a single filter for the first time in Korea. METHODS: We retrospectively analyzed six patients who underwent filtration plasmapheresis for KT in our center; plasmapheresis was performed using the Plasmaflex (Baxter(®)) with a TPE 2000 filter set (Baxter(®)) in our hemodialysis unit...
June 2017: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/28666082/intradialytic-hypotension-in-acute-kidney-injury-requiring-renal-replacement-therapy
#17
Shilpa Sharma, Sushrut S Waikar
The treatment of severe acute kidney injury (AKI) with dialytic support for renal replacement therapy can be life sustaining and permit recovery from critical illness. Like any interventional therapy, however, renal replacement therapy with intermittent hemodialysis or continuous therapy can cause complications. Intradialytic hypotension is a common complication and can cause further ischemic injury to the recovering kidneys, thereby reducing the probability of renal recovery. The optimal dialytic technique-continuous or intermittent-has not been conclusively demonstrated in randomized controlled trials...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666073/to-cool-or-too-cool-is-reducing-dialysate-temperature-the-optimal-approach-to-preventing-intradialytic-hypotension
#18
John W Larkin, Marta M Reviriego-Mendoza, Len A Usvyat, Peter Kotanko, Franklin W Maddux
Abnormal decreases in blood pressure during hemodialysis are frequent in end stage renal disease (ESRD) patients treated with hemodialysis, and thought to be largely due to an inadequate cardiovascular response to the rapid blood volume decline. Intradialytic hypotension (IDH) and cardiac instability during dialysis can increase risks for negative health consequences and is possibly preventable though several types of interventions. One intervention that holds promise for prevention of IDH in hemodialysis patients is to reduce the temperature of the dialysate to or below the patient's core temperature...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666072/special-situations-intradialytic-hypertension-chronic-hypertension-and-intradialytic-hypotension
#19
Peter Noel Van Buren, Jula K Inrig
Hypertension is a comorbidity that is present in the majority of end-stage renal disease patients on maintenance hemodialysis. This population is particularly unique because of the dynamic nature of blood pressure (BP) during dialysis. Modest BP decreases are expected in most hemodialysis patients, but intradialytic hypotension and intradialytic hypertension are two special situations that deviate from this as either an exaggerated or paradoxical response to the dialysis procedure. Both of these phenomena are particularly important because they are associated with increased mortality risk compared to patients with modest decreases in BP during dialysis...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666069/setting-the-dry-weight-and-its-cardiovascular-implications
#20
Arjun D Sinha, Rajiv Agarwal
Volume overload is common and associated with adverse outcomes in the hemodialysis population including systemic hypertension, pulmonary hypertension, left ventricular hypertrophy, and mortality. Since the beginning of the era of maintenance dialysis, prescribing and maintaining a dry weight remains the standard of care for managing volume overload on hemodialysis. Reducing dry weight even by relatively small amounts has been shown to improve blood pressure and has been associated with reductions in left ventricular hypertrophy...
June 30, 2017: Seminars in Dialysis
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