renal replacement and hémodialyse

Acute renal failure is common in critically ill patients. Many intensive care unit patients require renal replacement therapy (RRT). Hemodialysis can be performed as intermittent treatments or as continuous RRT, which can be customized to clinical goals by the use of carefully designed replacement fluids and hemodialysates. The available forms of RRT are reviewed, with emphasis on the clinical indications that contribute to the choice and design of therapy. Practical issues and troubleshooting are discussed, as are available options for anticoagulation during RRT...

Renal osteodystrophy is a common complication of chronic renal failure and renal replacement therapy. The purpose of the study was to assess whether hemodialysis (HD) or hemodiafiltration (HDF) affects bone turnover. In all, 45 HD and 17 HDF patients were evaluated with respect to bone metabolism markers. We assessed PTH; markers of bone formation-alkaline phosphatase and its bone isoform, osteocalcin; markers of bone resorption- PICP, ICTP; Ctx; beta2-microglobulin; and urinary DPD. BMD were determined for femoral neck and lumbar spine (L2-L4) using DEXA...

Retention of many substances takes place in the pathogenesis of uremic toxicity. There are almost 100 different molecules described and defined as uremic toxins. These substances are divided into three groups according to EUTOX group calssification. Small water soluble molecules with a molecular weight less than 500 D are included into the first group. Derivate of guanidines, purines, pyrimidines and methyloamines appeared in this group. There is also an unclassified subgroup with urea as a "classical" toxin which the real role in the uraemic syndrome is still discussed...

UNLABELLED: The paper's aim is an analysis of the complications related to permanent catheters used as a vascular access in chronically hemodialysed (HD) children. From 1998 to 2005. 34 surgically implanted permanent catheters were used as a vascular access for HD in 21 patients at average age of 13,6 (range 5-26) yrs. The catheters were placed mainly into right internal jugular vein or less often into left i.j.v., left subclavian v. and femoral veins. In 12 patients only one catheter was used for HD, in the others--the catheters had to be replaced...

This study was carried out on 48 patients with ESRD undergoing hemodialysis treatment (29 males and 19 females, mean age 50.8 years) and renal transplantation (15 females and 33 males, mean age 42.2 years). The results were compared with a group of 44 healthy persons (23 females and 21 males, mean age 49.5 years). The aim of our investigation was to examine the content of fluoride in the mixed unstimulated saliva of the patients undergoing renal replacement therapy and in the control group of healthy persons...

A decrease in bone mineral density is common in patients with chronic renal failure. It is also a risk factor for fractures in this population. The aim of the study was to evaluate bone mineral density-BMD and some biochemical markers of bone metabolism in regard to the method of renal replacement therapy: hemodialysis or peritoneal dialysis. The studies were performed in two groups of patients: 2 patients maintained on chronic hemodialyses (HD) and 21 patients treated with chronic ambulatory peritoneal dialysis (CAPD)...

OBJECTIVES: Renal insufficiency in women can cause menstrual disturbances and changes of hormonal profile leading to the decrease of bone mass density. Drug administration during dialysis also influences the bone density and increases the risk of osteoporosis. The aim of the study is to assess the effect of transdermal hormonal replacement therapy (HRT) in hemodialysed patients with secondary amenorrhea on bone density. MATERIAL AND METHODS: 10 women aged from 22 to 45 years old were enrolled in the study...

The chronic dialysis is the way of replacing the lost kidney function. Well functioning vascular access is the prerequisite for chronic hemodialysis treatment. The arteriovenous fistulas are the optimal form of vascular access. In patients, in whom the usual sites for fistula have been exhausted the vascular fistula on the arm was placed. 53 dialysis accesses were performed on the arm between 1989 and 1999. All subcutaneous fistulas were created by the junction of the cephalic vein with brachial artery, just above the cubital fossa on the anterior surface of the arm...

Insulin-like growth factor (IGF) system components appear to be the most important regulators of bone cell function. On the other hand, IGF-1 is shown to be an important regulator for erythropoiesis. The aim of the study was to examine the relationships between IGF system, requirements of erythropoietin, endogenous erythropoietin levels, bone metabolism assessed by biochemical markers, markers of nutrition such as cholesterol and albumin in recombinant human erythropoietin (rHuEPO)-treated patients maintained on chronic hemodialyses or peritoneal dialyses as well as in kidney transplant recipients...

The Equivalent Renal Urea Clearance (EKR) integrates the residual renal function (KR) and the dialysis dose (Kt/V). The present study was performed with these objectives: to calculate EKR in our hemodialysis (HD) patients during a three year follow up, to define its relationship with mortality and to compare its importance as a risk factor among others and to calculate actuarial survival. We analyzed 267 chronic HD patients. We measured Kt/V single pool, TACu, albumin, creatinine, hemoglobin and HD time and we calculated KR, EKR, KRc and EKRc (the last two corrected for V* 401--to compare clearances of different size patients)...

Acute renal failure after major abdominal surgery is a severe complication in critically ill patients in intensive care units (ICU). The aim of the study was to investigate the effect of urodilatin on the peak value and course of serum creatinine in patients with acute renal insufficiency after major abdominal surgery and the necessity of apparatus-based renal replacement treatment. Furthermore, the incidence and nature of adverse events under urodilatin was documented. In a prospective randomized double-blind placebo-controlled study, 12 critically ill patients after major abdominal surgery with acute renal failure in an intensive care unit (ICU) received 20 ng/kg b...

From November 1, 1995, to April 30, 1997, in our outpatient dialysis facility, 7,179 or 24.3% of hemodialyses were performed with soft, cuffed, intravenous catheters as blood accesses. Inadequate blood flow (pump speed < 400 mL/min) was noted in 286 instances (4.0%). Locking of catheter lumina with 5,000 to 9,000 IU urokinase was only partly successful in three of 21 cases. Infusions of 20,000 to 40,000 IU urokinase in 25 instances during dialysis restored catheter function in 10 cases. In nine instances in which blood could not be aspirated from the catheter and dialysis could not be performed, the infusion was done through the catheter while the patient remained in the chair...

Acute myocardial infarction (AMI) is common in patients who have end-stage renal disease. However, the prudent interval after AMI until resuming hemodialysis is unknown. Also incidence and severity of intradialytic morbid events during the initial dialysis treatment after AMI have not been determined. We conducted a retrospective analysis of the course of hemodialyses performed immediately after AMI in 13 maintenance hemodialysis patients (group 1) hospitalized with AMI over the 5-year period 1988-1992. For comparison, the incidence of intradialytic morbid events (hypotension--systolic blood pressure < 90 or diastolic blood pressure < 60 mm Hg or a fall in systolic or diastolic blood pressure of > 30 mm Hg--with and without symptoms, arrhythmias, and unplanned termination of hemodialysis was extracted from the charts of 9 maintenance hemodialysis patients (group 2) admitted during the same period with angina but no AMI, and in 13 stable ambulatory hemodialysis patients (group 3) dialyzed during the same period who had no evidence of heart disease...

The anesthetic management of a hemodialyzed patient with a dopamine producing pheochromocytoma is described. A 56-years old man underwent surgical procedure the day after hemodialysis. Prior to intervention adrenal cortex hormones were normal as well as other endocrine variables (T3-T4-TSH-cortisol-ACTH-parathyroid hormone); epinephrine and norepinephrine, were in a normal range while dopamine was elevated (185 pg/ml). Preoperatively the patient was alpha-blocked with oral phenoxybenzamine (20 mg/day). A balanced anesthesia was performed (isoflurane and fentanyl)...

Slow hemodialysis (HD) was performed for 10 h during the day in 11 critically ill patients with renal failure. The dialysis method was a modification of the pump-driven continuous venovenous HD. A nonsterile bicarbonate-containing hemodialysate was passed into the EVAL membrane dialyzer at a flow rate of 30 ml/min. No patient developed further hemodynamic instability during the treatment. The serum urea level was maintained below 20 mmol/l within 4 days of initiating the treatment. It allowed the patients to rest without interruption at night...

Between 1979 and 1993, 50 patients (33 men and 17 women) receiving chronic haemodialysis, underwent 53 cardiac surgical procedures in the department. The mean age was 56 +/- 13 years. The average duration of preoperative dialysis was 82 +/- 63 months. The average duration of cardiac symptoms before surgery was 35 +/- 52 months. Twenty-seven patients (54%) were in NYHA functional classes III or IV before surgery. Sixteen patients (32%) had preoperative left ventricular ejection fractions of less than 0.40. Twelve patients (24%) were emergency referrals...

Coronary artery revascularization and cardiac valve replacement have been performed with increasing frequency over the past decade in patients maintained on chronic hemodialysis. Hemodialysis is frequently required shortly after surgery for treatment of hyperkalemia or volume overload. Use of low-dose or regional heparinization for hemodialysis may cause bleeding in patients who have recently undergone open-heart surgery. We performed 16 hemodialyses using regional citrate anticoagulation in 4 maintenance dialysis patients who had recently undergone cardiothoracic surgery...

Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period...

The authors devised a new treatment strategy using continuous ambulatory hemofiltration (CAHF) in between short hemodialyses (short HD). For CAHF, a small wearable hemofilter (0.1 m2) was developed using a membrane permeable to low molecular weight proteins. During short HD, no body water was removed, but saline, equivalent to 3% body weight, was administered at a constant rate. During CAHF, 1 L of replacement fluid was administered intravenously after every meal to increase the replacement volume. Switch from the conventional to new strategy resulted in far more stable blood pressure during short HD, a decrease in time averaged body weight, and a decrease in a decrease in time averaged blood urea nitrogen and plasma beta 2-m levels...