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slow low efficiency dialysis

Frances Fothergill Bourbonnais, Sharon Slivar, Sue Malone Tucker
BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices...
2016: Canadian Journal of Critical Care Nursing
Mourad M Alsabbagh, A Ahsan Ejaz, Daniel L Purich, Edward A Ross
BACKGROUND: Slow continuous ultrafiltration (SCUF) is a safe and efficient treatment for fluid overload in patients who are hemodynamically unstable, have low urine output, and are not in need of dialysis or hemofiltration for solute clearance. Sustained anticoagulation is required for these long treatments, thus posing clinically challenges for patients having contraindications to systemic anticoagulation with heparin. Regional citrate anticoagulation would be an alternative option; however, we believed that this would be problematic due to citrate kinetics that predicted the development of metabolic alkalosis...
June 2012: Clinical Kidney Journal
Andrzej Wieczorek, Andrzej Tokarz, Wojciech Gaszynski, Tomasz Gaszynski
Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300-400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT) slow low-efficiency dialysis (SLED) on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis...
2014: Drug Design, Development and Therapy
Alp Akonur, James Sloand, Ira Davis, John Leypoldt
UNLABELLED:BACKGROUND: In recent years, results from clinical studies have changed the focus of peritoneal dialysis (PD) adequacy from small solute clearance to volume control, resulting in continued efforts to improve fluid and sodium removal in PD patients. We used a modified 3-pore model to theoretically predict fluid and solute removal using glucose-based and icodextrin solutions for a wide range of transport characteristics with automated PD (APD) and continuous ambulatory PD (CAPD) therapies...
January 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Zaghloul Gouda
INTRODUCTION: Venous catheters provide access for hemodialysis (HD) when patients do not have functioning access device. Obstruction of jugular, femoral or even external iliac vessels further depletes options. Subclavian approach is prohibited. Catheterization of inferior vena cava requires specialized equipment and skills. PURPOSE: The purpose is to assess a new lifesaving HD vascular access approach for patients with nonfunctioning access device in the ordinary sites...
November 2014: Journal of Vascular Access
Nan Gao, Yingjie Chen, Jiang Jiang
Silver has been utilized as a highly effective and broad-spectrum antibacterial agent in our daily life. However, low stability, poor long-term antibacterial efficiency, and potential environmental hazard of released Ag(+) ions may limit its practical applications. Ag-graphene oxide (GO) nanocomposites have been reported to display highly enhanced antibacterial property, yet their stability and long-term antibacterial properties have not been carefully investigated. Herein, we report the synthesis of Ag@Fe2O3-GO nanocomposites with tunable loading density up to full monolayer coverage by adopting a simple phase transfer method...
November 13, 2013: ACS Applied Materials & Interfaces
Siddiq Anwar, Diptesh Gupta, Muhammad A Ashraf, Syed A Khalid, Syed M Rizvi, Brent W Miller, Daniel C Brennan
Hyperammonemia, post-orthotopic lung transplantation, is a rare but mostly fatal complication. Various therapies, including those to decrease ammonia generation, increase nitrogen excretion, and several dialytic methods for removing ammonia have been tried. We describe three lung transplant recipients who developed acute hyperammonemia early after transplantation. Two of the three patients survived after a multidisciplinary approach including discontinuation of drugs, which impair urea cycle, aggressive ammonia reduction with prolonged daily intermittent hemodialysis (HD), and overnight slow low-efficiency dialysis in conjunction with early weaning of steroids and other therapeutic measures...
January 2014: Hemodialysis International
Fan Yu, Chenghua He, Ayman Y Waddad, Were L L Munyendo, Huixia Lv, Jianping Zhou, Qiang Zhang
CONTEXT: Gambogic acid (GA) can inhibit the growth of various cancer cells. However, the low bioavailability caused by insolubility, limits its clinical application. L-arginine is always used with GA to form a complex to obtain the higher solubility. Moreover, guanidyl group from arginine, which can facilitate the cellular uptake, was identified. OBJECTIVE: In this study, L-arginine and chitosan (CS) were used for the first time to prepare N-octyl-N-arginine CS (OACS), a novel amphiphilic carrier for GA with solubility- and absorption-enhancing functions; the characterization of the GA loaded OACS micelles (GA-OACS) and its absorption-enhancing effect were also investigated...
June 2014: Drug Development and Industrial Pharmacy
Smitha Bhat, Amith D'Souza, Divya Fernandes, Gautam Rajan
An adult male labourer, a smoker and alcoholic was admitted to our hospital with a short history of fever, myalgia, breathlessness and oliguria. On examination he was icteric and hypotensive. Calf muscle tenderness was present. A provisional diagnosis of leptospirosis was made and he was started on treatment with crystalline penicillin. Blood pressure (BP) did not improve with fluids. Inotropes were started. The patient was taken for Slow Low Efficiency Daily Dialysis (SLEDD) during which he developed chest pain...
2013: BMJ Case Reports
Emilio González-Parra, Carolina Gracia-Iguacel, Jesús Egido, Alberto Ortiz
Patients with renal impairment progressively lose the ability to excrete phosphorus. Decreased glomerular filtration of phosphorus is initially compensated by decreased tubular reabsorption, regulated by PTH and FGF23, maintaining normal serum phosphorus concentrations. There is a close relationship between protein and phosphorus intake. In chronic renal disease, a low dietary protein content slows the progression of kidney disease, especially in patients with proteinuria and decreases the supply of phosphorus, which has been directly related with progression of kidney disease and with patient survival...
2012: International Journal of Nephrology
Clotilde Muller, Sandrine Muller, Aicha Sissoko, Alexandre Klein, Bernadette Faller, Francois Chantrel
Lanthanum therapy is an efficient therapy of hyperphosphoremia by chelating phosphore in the digestive tract. Lanthanum is a silvery white metallic element that belongs to group 3 of the periodic table. This drug is lightly absorbed and has low water solubility. It should be borne in mind that abdominal X-rays of patients taking lanthanum carbonate may have a radio-opaque appearance typical of imaging agents. This characteristic is suggested to confirm adherence of the patient by doing an abdominal X-ray. We describe in our case a particular good compliant patient with slow digestive transit, which ends by pseudo-occlusion...
October 2012: Hemodialysis International
Prasad Bichu, Gautam Phadke, Harbaksh Sangha, Madhukar Misra
A 75-year-old Caucasian male presented with generalized seizures half-hour post-transurethral resection of the prostate surgery. The intra-operative course was complicated by perforation of the posterior wall of the bladder neck during a difficult Foley catheter placement. This resulted in intraperitoneal extravasation of the glycine containing bladder irrigation fluid. An emergent laparotomy was performed, and 3.5-4 L of fluid was drained from the peritoneal cavity. Postoperative course was complicated by two seizures within a short interval...
October 2011: Hemodialysis International
Ruben H K Thanacoody
INTRODUCTION: Valproic acid (VPA) is an antiepileptic drug that is now used for a variety of neurological and psychiatric indications. Clinical manifestations of severe VPA poisoning include central nervous system depression, hypotension, electrolyte and acid-base disturbances, and hyperammonemia. Although extracorporeal methods have been used to enhance VPA elimination, the indications for and effectiveness of these methods have not been fully characterized. METHODS: A systematic literature search was performed, which identified 31 reports of the use of extracorporeal elimination in VPA poisoning...
August 2009: Clinical Toxicology
Corey Scurlock, Jayashree Raikhelkar, Jeffrey I Mechanick
PURPOSE OF REVIEW: Technological innovations in the ICU have lead to extraordinary advances in modern critical care. Renal replacement therapy (RRT) innovations and ventricular assist devices (VAD) are now becoming common interventions in the ICU environment. The purpose of this article is to describe the impact of RRT and VAD on critical care medicine with particular reference to metabolic care. RECENT FINDINGS: Continuous venovenous hemofiltration and slow low efficient daily dialysis are effective modalities of RRT in hemodynamically unstable patients...
March 2009: Current Opinion in Clinical Nutrition and Metabolic Care
Sunny Eloot, Wim Van Biesen, Annemieke Dhondt, Erik Billiet, Pascal Verdonck, Raymond Vanholder
BACKGROUND: Since most intensive care units (ICUs) have no access to high-quality water, the Genius system, using ultrapure water and high-flux dialyzers, might be used during slow low efficient daily dialysis (SLEDD). To get an idea about convective removal, internal filtration (IF) was calculated and compared to other modalities. METHODS: Validated with in vivo measurements, IF was calculated for 8 h Genius SLEDD and 4 h Genius standard dialysis with high-flux dialyzers, and for 8 h SLEDD and 4 h both with standard dialysis machines and low-flux as well as high-flux dialyzers...
2008: Blood Purification
Emon Khan, Paul Huggan, Leo Celi, Robert MacGinley, John Schollum, Robert Walker
Hemodialysis is only infrequently used in drug overdosage situations. The efficacy of hemodialysis to remove the drug depends upon the pharmacokinetics and pharmacodynamics of the drug. At normal therapeutic concentrations, valproic acid is predominantly protein bound and therefore removal by hemodialysis is limited. In an overdose situation, protein binding is rapidly saturated and therefore the substantially larger quantities of the free drug can rapidly cause toxicity. Slow low-efficient daily diafiltration (SLEDD) has not previously been utilized in a drug overdose situation...
April 2008: Hemodialysis International
Lúcia Andrade, Sérgio Cleto, Antonio C Seguro
BACKGROUND: Leptospirosis is a public health problem, the severe form of which (Weil's disease) includes acute respiratory distress syndrome, typically accompanied by acute kidney injury (AKI), and is associated with high mortality rates. Recent evidence suggests that dialysis dosage affects outcomes in critically ill patients with sepsis-induced AKI. However, this population varies widely in terms of age, gender, and concomitant conditions, making it difficult to determine the appropriate timing (door-to-dialysis time) and dialysis dosage...
July 2007: Clinical Journal of the American Society of Nephrology: CJASN
Han Khim Tan, Wen Shin Yang, Pierce Chow, Hock Foong Lui, Hui Lin Choong, Kok Seng Wong
The molecular adsorbent recirculating system (MARS) is a blood purification device with renal and hepatic dialytic effects. This study examined the use of low-dose unfractionated heparin in MARS. This was a prospective, observational study of 15 MARS treatment sessions (mean duration per treatment cycle = 12.2 +/- 4.5 h) in four patients with severe acute decompensation of chronic liver disease (n = 3) and fulminant hepatic failure (n = 1) treated with intermittent MARS. All patients were critically ill (APACHE II 24...
March 2007: Artificial Organs
Colin A Hutchison, Paul Cockwell, Steven Reid, Katie Chandler, Graham P Mead, John Harrison, John Hattersley, Neil D Evans, Mike J Chappell, Mark Cook, Hermann Goehl, Markus Storr, Arthur R Bradwell
Of patients with newly diagnosed multiple myeloma, approximately 10% have dialysis-dependent acute renal failure, with cast nephropathy, caused by monoclonal free light chains (FLC). Of these, 80 to 90% require long-term renal replacement therapy. Early treatment by plasma exchange reduces serum FLC concentrations, but randomized, controlled trials have shown no evidence of renal recovery. This outcome can be explained by the low efficiency of the procedure. A model of FLC production, distribution, and metabolism in patients with myeloma indicated that plasma exchange might remove only 25% of the total amount during a 3-wk period...
March 2007: Journal of the American Society of Nephrology: JASN
Véronique Wernert, Oliver Schäf, Valérie Faure, Philippe Brunet, Laetitia Dou, Yvon Berland, Pascal Boulet, Bogdan Kuchta, Renaud Denoyel
Para-cresol CH3C6H4OH is a protein-bound solute which is not eliminated efficiently by hemodialysis systems. In this study, we present adsorption of p-cresol as a complementary process to hemodialysis. The kinetics and isotherms of adsorption onto cellulose-based membranes (cellulose diacetate and triacetate), synthetic membranes (polyamide, polysulfone, polyacrylonitrile and polymethylmethacrylate) and microporous zeolite silicalite (MFI), have been evaluated in static conditions. The results indicate that p-cresol has a low affinity to all membranes but polysulfone and polyamide and that the times to reach equilibrium conditions are slow...
May 17, 2006: Journal of Biotechnology
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