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Hemodialysis guide

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https://www.readbyqxmd.com/read/29772982/randomized-pilot-study-to-compare-metal-needles-versus-plastic-cannulae-in-the-development-of-complications-in-hemodialysis-access
#1
Rosa M Marticorena, Niki Dacouris, Sandra M Donnelly
BACKGROUND: Hemodialysis requires needle insertions every treatment. Needle injury (mechanical or hemodynamic) may cause complications (aneurysms/stenosis) that compromise dialysis delivery requiring interventions. Metal needles have a sharp slanted "V"-shaped cutting tip; plastic cannulae have a dull round tip and four side holes. Preliminary observations demonstrated a difference in intradialytic blood flow images and mean Doppler velocities at cannulation sites between the two devices...
May 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29746711/a-monte-carlo-simulation-approach-for-beta-lactam-dosing-in-critically-ill-patients-receiving-prolonged-intermittent-renal-replacement-therapy
#2
Soo Min Jang, Katherine N Gharibian, Susan J Lewis, William H Fissell, Ashita J Tolwani, Bruce A Mueller
Cefepime, ceftazidime, and piperacillin/tazobactam are commonly used beta-lactam antibiotics in the critical care setting. For critically ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic data are available to inform clinicians on the dosing of these agents. Monte Carlo simulations (MCS) can be used to guide drug dosing when pharmacokinetic trials are not feasible. For each antibiotic, MCS using previously published pharmacokinetic data derived from critically ill patients was used to evaluate multiple dosing regimens in 4 different prolonged intermittent renal replacement therapy effluent rates and prolonged intermittent renal replacement therapy duration combinations (4 L/h × 10 hours or 5 L/h × 8 hours in hemodialysis and hemofiltration modes)...
May 10, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29692934/a-web-based-platform-to-collect-data-from-esrd-patients-undergoing-dialysis-methods-and-preliminary-results-from-the-brazilian-dialysis-registry
#3
Jocemir R Lugon, Pedro A Gordan, Fernando S Thomé, Antonio A Lopes, Yoshimi J A Watanabe, Carmen Tzanno, Ricardo C Sesso
Introduction: The methods and initial results of a web-based platform to collect data from patients receiving maintenance dialysis in Brazil are reported. Methods: Companies providing management software for dialysis centers adapted their system to comply with a formulary of the Brazilian Society of Nephrology. Baseline and follow-up individual patients' data were transmitted via Internet on monthly bases to the coordinating center from 2011 to 2017. Results: 73 dialysis centers provided information of 24,930 patients: 57% were male, 28% were 64 years old or older, and 13% were overweight/obese...
2018: International Journal of Nephrology
https://www.readbyqxmd.com/read/29688512/greater-fluid-overload-and-lower-interdialytic-weight-gain-are-independently-associated-with-mortality-in-a-large-international-hemodialysis-population
#4
Manfred Hecking, Ulrich Moissl, Bernd Genser, Hugh Rayner, Indranil Dasgupta, Stefano Stuard, Andrea Stopper, Charles Chazot, Franklin W Maddux, Bernard Canaud, Friedrich K Port, Carmine Zoccali, Peter Wabel
Background: Fluid overload and interdialytic weight gain (IDWG) are discrete components of the dynamic fluid balance in haemodialysis patients. We aimed to disentangle their relationship, and the prognostic importance of two clinically distinct, bioimpedance spectroscopy (BIS)-derived measures, pre-dialysis and post-dialysis fluid overload (FOpre and FOpost) versus IDWG. Methods: We conducted a retrospective cohort study on 38 614 incident patients with one or more BIS measurement within 90 days of haemodialysis initiation (1 October 2010 through 28 February 2015)...
April 20, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29678651/post-general-anesthesia-ultrasound-guided-venous-mapping-increases-autogenous-access-placement-rates
#5
C Y Maximilian Png, Adam Korayem, David J Finlay
OBJECTIVE: This study investigates the impact of introducing a post-general anesthesia ultrasound mapping (PAUS) on the type of vascular access chosen for hemodialysis in patients without previous accesses. METHODS: 203 of 297 consecutive patients met inclusion criteria and were reviewed. Within-subjects analysis was performed on patients with both an outpatient ultrasound-guided vein mapping and a PAUS using sign tests and Wilcoxon signed ranked tests. Further, a between-subjects analysis added patients with only the outpatient vein mapping; demographic and comorbidity data were analyzed using t-tests and chi-squared tests...
April 17, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29678073/a-decision-support-tool-for-healthcare-professionals-in-the-management-of-hyperphosphatemia-in-hemodialysis
#6
Sisse H Laursen, Amanda A Buus, Lisbet Brandi, Peter Vestergaard, Ole K Hejlesen
Hyperphosphatemia is known as one of the more challenging conditions in end-stage renal disease patients. This study set out to present and evaluate a healthcare-oriented decision support tool in the management of hyperphosphatemia within hemodialysis therapy. A prototype module was designed to fit into the interface of a modern dialysis machine (Fresenius 5008). The prototype included three main functions: 1) immediate bedside blood sample access, 2) a model based prognosis tool with estimates of P-phosphate and 3) an overview of the user's phosphate related activities during dialysis treatments...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29677039/time-to-reconsider-the-role-of-relative-blood-volume-monitoring-for-fluid-management-in-hemodialysis
#7
David F Keane, Paul Baxter, Elizabeth Lindley, Laura Rhodes, Sue Pavitt
Relative blood volume (RBV) monitoring during hemodialysis has been used to help guide fluid management for decades, although with little supporting evidence. The technique relies on the assumption that variation in RBV during fluid removal reflects the capacity for vascular refilling and that efficient refilling is related to fluid overload. This study investigated the relationship between RBV variation and bioimpedance-based fluid overload in 47 patients on stable hemodialysis. Mean treatment ultrafiltration volume (UFV) was 1...
April 18, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29668766/prediction-of-hemoglobin-levels-in-individual-hemodialysis-patients-by-means-of-a-mathematical-model-of-erythropoiesis
#8
Doris H Fuertinger, Franz Kappel, Hanjie Zhang, Stephan Thijssen, Peter Kotanko
Anemia commonly occurs in people with chronic kidney disease (CKD) and is associated with poor clinical outcomes. The management of patients with anemia in CKD is challenging, due to its severity, frequent hypo-responsiveness to treatment with erythropoiesis stimulating agents (ESA) and common hemoglobin cycling. Nonlinear dose-response curves and long delays in the effect of treatment on red blood cell population size complicate predictions of hemoglobin (Hgb) levels in individual patients. A comprehensive physiology based mathematical model for erythropoiesis was adapted individually to 60 hemodialysis patients treated with ESAs by identifying physiologically meaningful key model parameters from temporal Hgb data...
2018: PloS One
https://www.readbyqxmd.com/read/29621026/fluid-status-assessment-in-hemodialysis-patients-and-the-association-with-outcome-review-of-recent-literature
#9
Marijke J E Dekker, Jeroen P Kooman
PURPOSE OF REVIEW: In this review, we will discuss the most recent literature regarding fluids status assessment in hemodialysis patients, and the associations with outcome. RECENT FINDINGS: Research toward technique-assisted assessment of fluid status in hemodialysis patients has been going on for many years. However, there is no absolute agreement between techniques, such as bioimpedance, lung ultrasound, biochemical markers or vena caval diameter, likely because they reflect different fluid compartments with potentially altered distribution in hemodialysis patients...
May 2018: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/29619552/using-dynamic-treatment-regimes-to-understand-erythropoietin-stimulating-agent-hyporesponsiveness
#10
Ari H Pollack, Assaf P Oron, Joseph T Flynn, Raj Munshi
BACKGROUND: Erythropoietin-stimulating agent hyporesponsiveness (ESAH) is associated with increased cardiovascular mortality in patients with end-stage renal disease (ESRD) on hemodialysis. Dynamic treatment regimes (DTR), a clinical decision support (CDS) tool that guides the prescription of specific therapies in response to variations in patient states, have been used to guide treatment for chronic illnesses that require frequent monitoring and therapy changes. Our objective is to explore the role of utilizing a DTR to reduce ESAH in pediatric hemodialysis patients...
April 4, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29482487/two-wire-technique-with-a-gooseneck-snare-to-bail-out-the-tip-separation-of-a-crosser-catheter
#11
Yoshito Kadoya, Kan Zen, Yohei Oda, Satoaki Matoba
Tip separation of a Crosser catheter is a serious complication; however, there is limited information on bailout methods. Here, we describe a case of successful retrieval of the separated tip of a Crosser catheter using a 2-wire technique with a gooseneck snare. A 76-year-old woman with a history of hemodialysis and diabetes mellitus who developed ulcers on her right toes was diagnosed as having critical limb ischemia and underwent transfemoral antegrade endovascular treatment of the anterior tibial artery (ATA)...
May 2018: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29482260/beta-blockers-in-patients-with-end-stage-renal-disease-evidence-based-recommendations
#12
REVIEW
Matthew A Weir, Charles A Herzog
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence...
May 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29461290/volume-resuscitation-in-patients-with-high-voltage-electrical-injuries
#13
Derek M Culnan, Kelley Farner, Genevieve H Bitz, Karel D Capek, Yiji Tu, Carlos Jimenez, William C Lineaweaver
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries...
March 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29459219/home-blood-pressure-guided-antihypertensive-therapy-in-chronic-kidney-disease-more-data-are-needed
#14
EDITORIAL
Panagiotis I Georgianos, Eleni Champidou, Vassilios Liakopoulos, Elias V Balaskas, Pantelis E Zebekakis
In the era of newly introduced hypertension guidelines recommending lower blood pressure (BP) targets for drug-treated hypertensives, the necessity for optimized management of hypertension becomes even more urgent. The concept of home BP-guided antihypertensive therapy is for long suggested as a simple and feasible approach to improve BP control rates and optimize the management of hypertension. Home BP-guided antihypertensive therapy is particularly applicable to hypertensives with chronic kidney disease (CKD) for several reasons including the following: (1) difficult-to-control BP and high BP variability in the CKD setting; (2) poor accuracy of office BP in determining hypertension control status and detecting "white-coat" and "masked" hypertension; (3) poor value of routine office BP recordings in predicting the longitudinal progression of target-organ damage; and (4) superiority of home BP over office BP recordings in prognosticating the risk of incident end-stage renal disease or death...
April 2018: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/29396811/successful-treatment-of-a-venous-pseudoaneurysm-in-a-brachiobasilic-fistula-using-ultrasound-guided-manual-compression-two-case-reports
#15
REVIEW
M A Rahil
A pseudoaneurysm or a false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. In hemodialysis fistula, pseudoaneurysm results from repeated puncturing of the vein at the same site. Surgery and endovascular treatment stay widely used as the treatment of pseudoaneurysm compared to the ultrasound-guided manual compression (UGMC). UGMC is a non-invasive and effective procedure which could be attempted before invasive procedures. We reported two cases of successful treatment of pseudoaneurysm by ultrasound-guided compression...
February 2, 2018: Journal of Ultrasound
https://www.readbyqxmd.com/read/29335321/effectiveness-and-cost-of-weekly-recombinant-tissue-plasminogen-activator-hemodialysis-catheter-locking-solution
#16
Brenda R Hemmelgarn, Braden J Manns, Steven D Soroka, Adeera Levin, Jennifer MacRae, Karthik Tennankore, Jo-Anne S Wilson, Robert G Weaver, Pietro Ravani, Robert R Quinn, Marcello Tonelli, Mercedeh Kiaii, Paula Mossop, Nairne Scott-Douglas
BACKGROUND AND OBJECTIVES: Evidence to guide hemodialysis catheter locking solutions is limited. We aimed to assess effectiveness and cost of recombinant tissue plasminogen activator (rt-PA) once per week as a locking solution, compared with thrice weekly citrate or heparin, in patients at high risk of complications. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used a prospective design and pre-post comparison in three sites across Canada. Pre-post comparisons were conducted using multilevel mixed effects regression models accounting for cluster with site and potential enrollment of patients more than once...
March 7, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29326842/barriers-to-peritoneal-dialysis-in-aboriginal-patients
#17
Anna T Mathew, Joonho Park, Mala Sachdeva, Manish M Sood, Karen Yeates
Background: Aboriginal people in Canada have an unduly high burden of end-stage kidney disease (ESKD) and many live in rural settings. Peritoneal dialysis (PD) is a home-based dialysis modality that may provide a valuable alternative to in-center hemodialysis which is relatively underutilized by the Aboriginal population. Objective: We aim to assess the barriers to PD utilization in Aboriginal patients with ESKD. Design: This article is a prospective observational cohort study...
2018: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/29283177/comparison-of-postoperative-ultrasound-criteria-to-predict-unassisted-use-of-arteriovenous-fistulas-for-hemodialysis
#18
Timmy Lee, Missy Magill, Steven K Burke, Andrew T Blair, Michelle L Robbin, Michael Allon
INTRODUCTION: Arteriovenous fistulas (AVF) frequently fail to mature. Postoperative ultrasounds provide objective measurements to predict unassisted AVF use for hemodialysis (unassisted use) and guide interventions to salvage nonmaturing AVFs. The optimal ultrasound criteria to assess AVF maturation are uncertain. We analyzed data from a multicenter, randomized, controlled, clinical trial to compare 2 published ultrasound maturation criteria used to predict unassisted AVF use for hemodialysis...
March 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29275056/the-pivotal-multicenter-trial-of-ultrasound-guided-percutaneous-arteriovenous-fistula-creation-for-hemodialysis-access
#19
Jeffrey E Hull, William C Jennings, Randy I Cooper, Umar Waheed, Matthew E Schaefer, Rajeev Narayan
PURPOSE: To evaluate safety and efficacy of arteriovenous fistulas (AVFs) created with a thermal resistance anastomosis device. MATERIALS AND METHODS: A prospective single-arm trial at 5 sites enrolled 107 patients. Patients underwent ultrasound (US)-guided anastomosis creation between the proximal radial artery and perforating vein with the Ellipsys Vascular Access System (Avenu Medical, Inc, San Juan Capistrano, California) followed by separate maturation procedures...
February 2018: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29165957/inpatient-dialysis-unit-project-development-redesigning-acute-hemodialysis-care
#20
Jennifer Day
Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency...
May 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
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