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https://www.readbyqxmd.com/read/28264150/blood-pressure-management-in-hemodialysis-patients-what-we-know-and-what-questions-remain
#1
REVIEW
Dana C Miskulin, Daniel E Weiner
Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in the dialysis unit. However, we do not know if using home vs. in-center measurements to guide treatment decisions improves BP control and/or clinical outcomes. Moreover, a recent US study suggests that typical hemodialysis patients are unlikely to adhere to home monitoring over the long term...
March 6, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28209075/investigation-of-optimum-n-terminal-probrain-natriuretic-peptide-level-in-patients-on-maintained-hemodialysis
#2
Lan Chen, Ying-Ying Chen, Yi-Sheng Ling, Chun-Hua Lin, Jin-Xuan He, Tian-Jun Guan
BACKGROUND: Serum N-terminal probrain natriuretic peptide (NT-proBNP) level is known to be strongly associated with fluid overload, and serves as a guide for fluid management in patients on hemodialysis (HD). This study aimed at investigating the relationship between NT-proBNP level and blood pressure (BP), ultrafiltration/dry weight ratio as well as hemoglobin, and to explore the optimal cutoff point of NT-proBNP level in Chinese patients on HD. METHODS: A total of 2306 patients on maintained HD for stage 5 chronic kidney disease (CKD) were included in this prospective study...
November 2017: Renal Failure
https://www.readbyqxmd.com/read/27992875/calf-resistivity-values-in-chronic-kidney-disease-in-a-caucasian-population
#3
Eric Seibert, Stephan G Müller, Johanna Pattmöller, Peter Kotanko, Fansan Zhu, Nathan W Levin, Roman Fiedler, Martin K Kuhlmann, Matthias Girndt
BACKGROUND: Continuous intradialytic calf bioimpedance spectroscopy (cBIS) allows assessment of changes in calf extracellular fluid volume (ECV) to determine dry weight (DW) in hemodialysis patients. During dialysis, calf ECV decreases until excessive ECV has been removed and normalized resistivity ρN,5 rises to values comparable to those of a normal population (cBIS-DW). It is not clear whether chronic kidney disease (CKD) itself influences ρN,5 and whether normal values depend on race and ethnicity...
2017: Nephron
https://www.readbyqxmd.com/read/27951546/clinical-effectiveness-of-intermittent-infusion-hemodiafiltration-using-backfiltration-of-ultrapure-dialysis-fluid-compared-with-predilution-on-line-hemodiafiltration
#4
Michio Mineshima, Kei Eguchi, Kanji Shishido, Susumu Takahashi, Tsukasa Kubo, Hiroshi Kawaguchi, Kouzo Shitomi, Keigo Shibagaki, Kiichi Suga, Hirotomo Nagao, Mikihiko Takada, Masahiro Taoka, Takashi Sato
BACKGROUND: In conventional hemodialysis (HD) treatment, excessive water removal sometimes induces a rapid drop in blood pressure. Intermittent infusion hemodiafiltration (I-HDF) has been developed to improve patients' peripheral circulation by repeated intermittent infusion during HD treatment. SUMMARY: A prospective, multicenter, parallel group comparative trial examined the clinical effectiveness of I-HDF compared with predilution on-line HDF (pre-HDF), the most popular on-line HDF therapy in Japan...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27934551/relationship-between-geriatric-nutritional-risk-index-and-subpopulation-lymphocyte-counts-in-patients-undergoing-hemodialysis-and-peritoneal-dialysis
#5
Gyong Hoon Kang, Ye Na Kim, Ho Sik Shin
We investigated the relationship between geriatric nutritional risk index (GNRI) and subpopulation lymphocyte counts (SLCs) in hemodialysis (HD) and peritoneal dialysis (PD) patients and evaluated whether they can be helpful in the diagnosis of malnutrition in these patients. We examined the GNRI and SLCs of 50 HD patients (mean: 55.8 ± 12.7 years; 28 men and 22 women) and 16 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients (mean: 49.8 ± 14.5 years; 10 men and six women). The GNRI is calculated based on the serum albumin level, dry weight, and ideal body weight and uses the following equation: GNRI = [14...
November 2016: Renal Failure
https://www.readbyqxmd.com/read/27928711/dry-weight-assessment-by-combined-ultrasound-and-bioimpedance-monitoring-in-low-cardiovascular-risk-hemodialysis-patients-a-randomized-controlled-trial
#6
Dimitrie Siriopol, Mihai Onofriescu, Luminita Voroneanu, Mugurel Apetrii, Ionut Nistor, Simona Hogas, Mehmet Kanbay, Radu Sascau, Dragos Scripcariu, Adrian Covic
PURPOSE: Fluid overload is associated with adverse outcomes in hemodialysis (HD) patients. The precise assessment of hydration status in HD patients remains a major challenge for nephrologists. Our study aimed to explore whether combining two bedside methods, lung ultrasonography (LUS) and bioimpedance, may provide complementary information to guide treatment in specific HD patients. METHODS: In total, 250 HD patients from two dialysis units were included in this randomized clinical trial...
January 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/27797886/pharmacotherapy-of-hypertension-in-chronic-dialysis-patients
#7
Panagiotis I Georgianos, Rajiv Agarwal
Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized...
November 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27792838/adsorption-of-shiga-toxin-to-poly-%C3%AE-glutamate-precipitated
#8
Tsukie Goto, Makiko Tsuji, Kaori Kanemaru, Kumio Yokoigawa
We screened foods containing indigestible ingredients in the ability to adsorb Shiga toxin (Stx). When 5 mg of foods and dietary fibers such as dry vegetables and inulin were mixed and incubated with 0.5 mL of Stx solution (100 ng/mL) containing 0.5% bovine serum albumin, both Stx1 and Stx2 seemed to be adsorbed by only a fermented food, natto (a traditional Japanese food prepared from steamed soybeans by the biological action of Bacillus subtilis). We purified the Stx-adsorbing substance from natto by extraction with H2 O, acid treatment, Proteinase K treatment, and an ion exchange chromatography...
December 2016: Journal of Food Science
https://www.readbyqxmd.com/read/27772639/intensive-hemodialysis-blood-pressure-and-antihypertensive-medication-use
#9
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/27573731/epidemiology-diagnosis-and-management-of-hypertension-among-patients-on-chronic-dialysis
#10
REVIEW
Panagiotis I Georgianos, Rajiv Agarwal
The diagnosis and management of hypertension among patients on chronic dialysis is challenging. Routine peridialytic blood pressure recordings are unable to accurately diagnose hypertension and stratify cardiovascular risk. By contrast, blood pressure recordings taken outside the dialysis setting exhibit clear prognostic associations with survival and might facilitate the diagnosis and long-term management of hypertension. Once accurately diagnosed, management of hypertension in individuals on chronic dialysis should initially involve non-pharmacological strategies to control volume overload...
October 2016: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/27350116/transient-mediastinal-mass-from-fluid-overload
#11
David Massicotte-Azarniouch, Joseph P O'Sullivan, Edward G Clark
Mediastinal masses incidentally discovered on chest imaging often suggest underlying malignancy such as lymphoma or metastatic cancer. However, the radiographic appearance of mediastinal edema can mimic a mediastinal mass in the context of acute fluid overload. We describe the case of a 75 year old woman known for end-stage renal disease on hemodialysis who presented with acute pulmonary edema in the context of a Non ST-Elevation Myocardial Infarction. Chest CT imaging showed pulmonary edema, pleural effusions, and a middle mediastinum soft-tissue mass of 4...
June 27, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27284847/-treatment-of-hypertension-in-chronic-kidney-disease
#12
Silvia Palomo-Piñón, Martín Rosas-Peralta, José Ramón Paniagua-Sierra
Systemic arterial hypertension (SAH) is a progressive cardiovascular syndrome caused by complex and interrelated causes. The early markers of this syndrome are often present even before the blood pressure (BP) elevation; therefore, SAH cannot only be classified by the BP elevation threshold, which sometimes is discreet. Its progression is strongly associated with structural and functional cardiovascular abnormalities, which lead to end-organ damage (heart, kidney, brain, blood vessels and other organs), and cause premature morbidity and death...
2016: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/27263809/recurrent-brachiocephalic-vein-stenosis-as-a-cause-for-persistent-left-sided-transudative-pleural-effusion-in-a-hemodialysis-patient
#13
Muhammad Abdul Mabood Khalil, Muhammad Sharoz Rabbani, Noor Rehman Chima, Jackson Tan, Muhammad Ashhad Ullah Khalil, Zia Ur Rehman
BACKGROUND: Effusion is common in dialysis patients. The most common causes include fluid overload due to renal failure and nonrenal causes like congestive heart failure and infection. We here report a case of left side transudative effusion due to brachiocephalic venous stenosis. METHODS: A 34-year-old female who had chronic kidney disease V during transplant work-up was found to be having left arm swelling and left transudative effusion. Work-up for transudative effusion did not show any cardiac cause or liver problem...
August 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27126356/the-effect-of-ambient-temperature-and-humidity-on-interdialytic-weight-gains-in-end-stage-renal-disease-patients-on-maintenance-hemodialysis
#14
Mihály B Tapolyai, Mária Faludi, Klára Berta, Tibor Szarvas, Zsolt Lengvárszky, Miklos Z Molnar, Neville R Dossabhoy, Tibor Fülöp
PURPOSE: Interdialytic weight gain (IDWG) is both a measure of dietary compliance and a well-established predictor of future adverse outcomes in dialysis patients. The impact of environmental conditions on IDWG in end-stage renal disease is little studied to date. METHODS: We retrospectively reviewed IDWG for 100 consenting chronic end-stage renal disease patients undergoing thrice weekly in-center hemodiafiltration under three different climatic conditions in a Central European city: Weekend_1 was humid (93 %) and warm (24 °C); Weekend_2 was dry (38 %) and hot (33 °C); and Weekend_3 was dry (30 %) and warm (24 °C)...
July 2016: International Urology and Nephrology
https://www.readbyqxmd.com/read/27061224/vascular-refilling-is-independent-of-volume-overload-in-hemodialysis-with-moderate-ultrafiltration-requirements
#15
Susanne Kron, Daniel Schneditz, Til Leimbach, Sabine Aign, Joachim Kron
Introduction Blood volume changes and vascular refilling during hemodialysis (HD) and ultrafiltration (UF) have been assumed to depend on volume overload (Vo ). It was the aim to study the magnitude of vascular refilling in stable HD patients with moderate volume expansion in everyday dialysis using novel technical approaches. Methods Patients were studied during routine dialysis and UF based on clinical dry weight assessment. Pre-dialysis Vo was independently measured by bioimpedance spectroscopy. Vascular refilling volume (Vref ) was calculated as: Vref  = Vuf  - ΔV, where ΔV is the absolute blood volume change determined by on-line dialysate dilution using a commercial on-line hemodiafiltration machine incorporating a relative blood volume monitor, and where Vuf is the prescribed UF volume...
July 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27052263/which-dialysis-unit-blood-pressure-is-the-most-accurate-for-predicting-home-blood-pressure-in-patients-undergoing-hemodialysis
#16
In-Cheol Yoon, Hye-Min Choi, Dong-Jin Oh
BACKGROUND/AIMS: We investigated which dialysis unit blood pressure (BP) is the most useful for predicting home BP in patients undergoing hemodialysis (HD). METHODS: Patients undergoing HD who had been treated > 3 months were included in this study. Exclusion criteria were hospitalized patients with acute illness and changes in dry weight and anti-hypertensive drugs 2 weeks before the study. We used the dialysis unit BP recording data, such as pre-HD, intra-HD, post-HD, mean pre-HD, and post-HD (pre-post-HD), mean pre-HD, intra-HD, and post-HD (pre-intra-post-HD) BP...
January 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/26956887/two-successive-pregnancies-in-a-patient-during-14-years-of-hemodialysis-a-case-report
#17
Ayse Seker
BACKGROUND: The incidence of pregnancy in women with end-stage renal disease seems to be increasing. Improvements in dialysis, obstetrical care, and antenatal fetal monitoring over the past two decades appear to have increased fertility rates and successful pregnancies in dialysis-dependent women. A pregnancy with a successful outcome despite the long dialysis period, as in the patient described here, is very rarely reported in the literature. CASE PRESENTATION: I report a case of a 34-year-old white Kurdish woman who had had two uncomplicated pregnancies while on hemodialysis, with delivery of healthy babies...
March 8, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/26912548/apoprotein-b-apoprotein-a-1-ratio-and-mortality-among-prevalent-dialysis-patients
#18
Yuji Sato, Shouichi Fujimoto, Tatsunori Toida, Hideto Nakagawa, Yasuhiro Yamashita, Takashi Iwakiri, Akihiro Fukuda, Shuji Iwatsubo
BACKGROUND AND OBJECTIVES: In dialysis patients, the associations between apoprotein profile and all-cause or cardiovascular disease (CVD)-related mortality are not well known. We, therefore, investigated whether apoprotein levels are associated with these events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We undertook a prospective observational cohort study of prevalent hemodialysis patients aged ≥18 years (n=1081), who were followed for 4 years (2011-2014)...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/26765312/mechanisms-and-treatment-of-intradialytic-hypertension
#19
REVIEW
Peter Noel Van Buren, Jula K Inrig
BACKGROUND: Intradialytic hypertension is a condition where there is an increase in blood pressure (BP) from pre- to post-hemodialysis; this condition has been recently identified as an independent mortality risk factor in hypertensive hemodialysis patients. The mechanisms and management of intradialytic hypertension have been explored in numerous research studies over the past few years. SUMMARY: Patients with intradialytic hypertension have been found to be more chronically volume overloaded compared to other hemodialysis patients, although no causal role has been established...
2016: Blood Purification
https://www.readbyqxmd.com/read/26632642/body-composition-and-mortality-predictors-in-hemodialysis-patients
#20
MULTICENTER STUDY
Cristina Caetano, Ana Valente, Telma Oliveira, Cristina Garagarza
OBJECTIVE: To evaluate how different compartments of body composition can affect survival in hemodialysis (HD) patients. DESIGN: Multicenter longitudinal observational study of a cohort of patients in HD with 12 months of follow-up. SETTING: Patients from 34 Nephrocare dialysis units in Portugal were included. SUBJECTS: A total of 697 patients on maintenance HD during 4 hours 3 days per week were enrolled. INTERVENTION: Dry weight, presence of diabetes, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), albumin and hydration status were recorded at baseline...
March 2016: Journal of Renal Nutrition
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