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https://www.readbyqxmd.com/read/27772644/intensive-hemodialysis-and-potential-risks-with-increasing%C3%A2-treatment
#1
Michael A Kraus, Sheru Kansal, Michael Copland, Paul Komenda, Eric D Weinhandl, George L Bakris, Christopher T Chan, Richard J Fluck, John M Burkart
Although intensive hemodialysis (HD) can address important clinical problems, increasing treatment also introduces risks. In this review, we assess risks pertaining to 6 domains: vascular access complications, infection, mortality, loss of residual kidney function, solute balance, and patient and care partner burden. In the Frequent Hemodialysis Network (FHN) trials, short daily and nocturnal schedules increased the incidence of access complications, although the incidence of access loss was not statistically higher...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772643/intensive-hemodialysis-left-ventricular-hypertrophy-and-cardiovascular-disease
#2
Peter A McCullough, Christopher T Chan, Eric D Weinhandl, John M Burkart, George L Bakris
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772642/intensive-hemodialysis-and-treatment-complications-and%C3%A2-tolerability
#3
Jose A Morfin, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Peter A McCullough, Paul Komenda
Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90mmHg and intradialytic decline > 30mmHg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772641/intensive-hemodialysis-and-health-related-quality-of-life
#4
Michael A Kraus, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Michael Copland, Paul Komenda, Fredric O Finkelstein
Diminished health-related quality of life (HRQoL) is common in dialysis patients and associated with increased risks for morbidity and mortality. Patients may present limitations in both physical and mental HRQoL. Poor physical HRQoL may be defined by limited physical function, role limitations due to physical health, dissatisfaction with physical ability, and impaired mobility. Sleep disorders such as obstructive sleep apnea, restless legs, and fatigue are typical manifestations of poor physical HRQoL in dialysis patients...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772640/intensive-hemodialysis-mineral-and-bone-disorder-and-phosphate-binder-use
#5
Michael Copland, Paul Komenda, Eric D Weinhandl, Peter A McCullough, Jose A Morfin
Mineral and bone disorder is a common complication of end-stage renal disease. Notably, hyperphosphatemia likely promotes calcification of the myocardium, valves, and arteries. Hyperphosphatemia is associated with higher risk for cardiovascular mortality and morbidity along a gradient beginning at 5.0mg/dL. Among contemporary hemodialysis (HD) patients, mean serum phosphorus level is 5.2mg/dL, although 25% of patients have serum phosphorus levels of 5.5 to 6.9mg/dL; and 13%, >7.0mg/dL. Treatment of hyperphosphatemia is burdensome...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27772639/intensive-hemodialysis-blood-pressure-and-antihypertensive-medication-use
#6
George L Bakris, John M Burkart, Eric D Weinhandl, Peter A McCullough, Michael A Kraus
Hypertension is a cardinal feature of end-stage renal disease (ESRD). Hypertensive nephropathy is the primary cause of ESRD for nearly 30% of patients, and the prevalence of hypertension is >85% in new patients with ESRD. In contemporary hemodialysis (HD) patients, mean predialysis systolic blood pressure (SBP) is nearly 150mmHg, and about 70%, 50%, and 40% use β-blockers, calcium channel blockers, and renin-angiotensin system inhibitors, respectively. Predialysis SBP generally exhibits a U-shaped association with mortality risk...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27738089/short-dwell-cycling-intraperitoneal-cefazolin-plus-ceftazidime-in-peritoneal-dialysis-patients
#7
Sadudee Peerapornratana, Pajaree Chariyavilaskul, Talerngsak Kanjanabuch, Kearkiat Praditpornsilpa, Somchai Eiam-Ong, Pisut Katavetin
♦ Background: Current guidelines suggest that intraperitoneal (IP) antibiotics should be administered only in a long peritoneal dialysis (PD) dwell (≥ 6 hours). The long dwell might result in low ultrafiltration and volume overload. We aim to examine plasma and dialysate concentration of cefazolin and ceftazidime after IP administration in a short-dwell (≤ 2 hours) automated cyclingexchange. ♦ Methods: Stable PD patients without peritonitis were invited to participate in the present study. Patients underwent 5 2-liter exchanges of PD fluid over 10 hours by the PD cycling machine without last fill or additional dwell...
October 13, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/27709092/antegrade-cerebral-perfusion-at-25-%C3%A2-c-for-arch-reconstruction-in-newborns-and-children-preserves-perioperative-cerebral-oxygenation-and-serum-creatinine
#8
Bhawna Gupta, Ali Dodge-Khatami, Juan Tucker, Mary B Taylor, Douglas Maposa, Miguel Urencio, Jorge D Salazar
BACKGROUND: Antegrade cerebral perfusion (ACP) typically is used with deep hypothermia for cerebral protection during aortic arch reconstructions. The impact of ACP on cerebral oxygenation and serum creatinine at a more tepid 25 °C was studied in newborns and children. METHODS: Between 2010 and 2014, 61 newborns and children (<5 years old) underwent aortic arch reconstruction using moderate hypothermia (25.0±0.9 °C) with ACP and a pH-stat blood gas management strategy...
July 2016: Translational pediatrics
https://www.readbyqxmd.com/read/27683271/comparison-of-outcomes-between-the-incremental-and-thrice-weekly-initiation-of-hemodialysis-a-propensity-matched-study-of-a-prospective-cohort-in-korea
#9
Ji In Park, Jung Tak Park, Yong-Lim Kim, Shin-Wook Kang, Chul Woo Yang, Nam-Ho Kim, Yun Kyu Oh, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee
BACKGROUND: Recent reports have suggested the possible benefit of beginning hemodialysis (HD) at a rate less frequent than three times weekly and incrementally increasing the dialysis dose. However, the data regarding the benefits and safety of incremental HD are insufficient. METHODS: We analyzed 927 patients with newly initiated HD from the Clinical Research Center for End-Stage Renal Disease cohort from 2008 to 2014. The patients were classified into a thrice-weekly initiation group or an incremental initiation group (one to two sessions per week) according to the frequency of HD per week at baseline...
September 28, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27536678/chronic-hemodialysis-therapy-in-the-west
#10
REVIEW
Michael V Rocco
BACKGROUND: Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5-4 h per session, with occasional additional treatments for volume overload. SUMMARY: When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed...
December 2015: Kidney Diseases
https://www.readbyqxmd.com/read/27342630/association-of-anemia-and-mineral-and-bone-disorder-with-health-related-quality-of-life-in-asian-pre-dialysis-patients
#11
Hwee-Lin Wee, Benjamin Jun Jie Seng, Jia Jia Lee, Kok Joon Chong, Pallavi Tyagi, Anantharaman Vathsala, Priscilla How
BACKGROUND: Patients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL). The association of CKD-related complications such as anemia and mineral and bone disorders (MBD) with HRQoL in pre-dialysis patients is not well-studied. As such, this study aimed to determine the association of anemia and MBD with HRQoL in pre-dialysis patients. METHODS: This was a cross-sectional study involving 311 adult pre-dialysis patients with stage 3-5 CKD from an acute-care hospital in Singapore...
June 24, 2016: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/27260258/continuous-renal-replacement-therapy-versus-intermittent-hemodialysis-in-intensive-care-patients-impact-on-mortality-and-renal-recovery
#12
Anne-Sophie Truche, Michael Darmon, Sébastien Bailly, Christophe Clec'h, Claire Dupuis, Benoit Misset, Elie Azoulay, Carole Schwebel, Lila Bouadma, Hatem Kallel, Christophe Adrie, Anne-Sylvie Dumenil, Laurent Argaud, Guillaume Marcotte, Samir Jamali, Philippe Zaoui, Virginie Laurent, Dany Goldgran-Toledano, Romain Sonneville, Bertrand Souweine, Jean-Francois Timsit
PURPOSE: The best renal replacement therapy (RRT) modality remains controversial. We compared mortality and short- and long-term renal recovery between patients treated with continuous RRT and intermittent hemodialysis. METHODS: Patients of the prospective observational multicenter cohort database OUTCOMEREA™ were included if they underwent at least one RRT session between 2004 and 2014. Differences in patients' baseline and daily characteristics between treatment groups were taken into account by using a marginal structural Cox model, allowing one to substantially reduce the bias resulting from confounding factors in observational longitudinal data analysis...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27055286/revisiting-the-middle-molecule-hypothesis-of-uremic-toxicity-a-systematic-review-of-beta-2-microglobulin-population-kinetics-and-large-scale-modeling-of-hemodialysis-trials-in-silico
#13
REVIEW
Maria Eleni Roumelioti, Thomas Nolin, Mark L Unruh, Christos Argyropoulos
BACKGROUND: Beta-2 Microglobulin (β2M) is a prototypical "middle molecule" uremic toxin that has been associated with a higher risk of death in hemodialysis patients. A quantitative description of the relative importance of factors determining β2M concentrations among patients with impaired kidney function is currently lacking. METHODS: Herein we undertook a systematic review of existing studies reporting patient level data concerning generation, elimination and distribution of β2M in order to develop a population model of β2M kinetics...
2016: PloS One
https://www.readbyqxmd.com/read/26933896/grazoprevir-elbasvir-for-the-treatment-of-hepatitis-c-virus-infection
#14
REVIEW
Laurent Alric, Delphine Bonnet
INTRODUCTION: Hepatitis C virus (HCV)-related liver disease is a cause of significant morbidity and mortality worldwide. Currently, direct-acting antiviral drugs (DAAs) are associated with an increased sustained virologic response (SVR) and are the gold standard for treating HCV infection. AREAS COVERED: The new combination of grazoprevir, an inhibitor of HCV NS3/4A, and elbasvir, an inhibitor of HCV NS5A, once daily will be available for the treatment of HCV infection...
2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/26845004/when-it-s-beneficial-to-defer-dialysis
#15
John Liantonio, Serife Eti
No abstract text is available yet for this article.
December 2015: Journal of Family Practice
https://www.readbyqxmd.com/read/26821893/an-effective-approach-to-chronic-kidney-disease-in-south-africa
#16
Mohammed Rafique Moosa, Anthony M Meyers, Errol Gottlich, Sarala Naicker
Very few patients with end-stage kidney disease in South Africa receive renal replacement treatment (RRT), despite the rapidly growing demand, because of resource constraints. Nephrologists who agonise daily about who to treat and who not to, and have been doing so since the inception of dialysis in this country, welcomed the opportunity to interact with the National Department of Health at a recent summit of stakeholders. The major challenges were identified and recommendations for short- to long-term solutions were made...
February 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/26509855/american-association-of-clinical-endocrinologists-american-college-of-endocrinology-and-androgen-excess-and-pcos-society-disease-state-clinical-review-guide-to-the-best-practices-in-the-evaluation-and-treatment-of-polycystic-ovary-syndrome-part-1
#17
Neil F Goodman, Rhoda H Cobin, Walter Futterweit, Jennifer S Glueck, Richard S Legro, Enrico Carmina
Polycystic Ovary Syndrome (PCOS) is recognized as the most common endocrine disorder of reproductive-aged women around the world. This document, produced by the collaboration of the American Association of Clinical Endocrinologists (AACE) and the Androgen Excess and PCOS Society (AES) aims to highlight the most important clinical issues confronting physicians and their patients with PCOS. It is a summary of current best practices in 2015. PCOS has been defined using various criteria, including menstrual irregularity, hyperandrogenism, and polycystic ovary morphology (PCOM)...
November 2015: Endocrine Practice
https://www.readbyqxmd.com/read/26448381/study-of-the-effect-of-vitamin-d-supplementation-on-glycemic-control-in-type-2-diabetic-prevalent-hemodialysis-patients
#18
RANDOMIZED CONTROLLED TRIAL
Mohamed A Ibrahim, Iman I Sarhan, Mohamed R Halawa, Essam N Afify, Hayam A Hebah, Eman A Al-Gohary, Islam O El-Shazly
Vitamin D is claimed to have an adjuvant effect on glycemic control by dual action on pancreatic β-cells and insulin resistance. The aim of this study was to assess the possible effect of short-term alfacalcidol supply on glycemic control in type 2 diabetic hemodialysis (HD) patients. Twenty type 2 diabetic HD patients (using diet and oral drugs but not insulin) were randomly selected from our dialysis unit as well as 20 non-diabetic HD patients as control. A third group of 12 healthy subjects were studied as well...
October 2015: Hemodialysis International
https://www.readbyqxmd.com/read/26207276/a-paradigm-shift-in-options-education-and-an-online-decision-aid-my-life-my-dialysis-choice
#19
Dori Schatell
Dialysis options education in the United States for patients tends to focus on clinical aspects of ESRD treatment and on how each option is done. The non-profit Medical Education Institute (MEI) has developed an online, patient-centered dialysis decision aid that maps six dialysis options (peritoneal dialysis, standard incenter hemodialysis, conventional home hemodialysis, short daily hemodialysis, and nocturnal hemodialysis--incenter or at home) in four categories onto 24 different lifestyle and health values...
March 2015: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
https://www.readbyqxmd.com/read/26201252/evaluating-the-economic-implications-of-non-adherence-and-antibody-mediated-rejection-in-renal-transplant-recipients-the-role-of-once-daily-tacrolimus-in-the-uk
#20
G Muduma, I Odeyemi, R F Pollock
BACKGROUND AND AIMS: While short-term kidney graft survival has gradually improved over time, improvements in long-term graft survival have been more modest. One key clinical factor limiting improved longer-term outcomes is antibody-mediated rejection (AbMR), the incidence of which appears to be higher in patients who are non-adherent to immunosuppressants. Recent data show that adherence can be improved by reducing pill burden. The aim of the present study was to model the incidence and economic consequences of graft loss and AbMR in patients taking once- vs twice-daily tacrolimus in the UK...
2015: Journal of Medical Economics
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