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https://www.readbyqxmd.com/read/28447486/guidance-to-develop-individual-dose-recommendations-for-patients-on-chronic-hemodialysis
#1
Verena Gotta, Kim Dao, Frédérique Rodieux, Thierry Buclin, Françoise Livio, Marc Pfister
In addition to tailored clinical trials in patients on chronic hemodialysis (HD) during drug development, clinician-initiated post-marketing studies and case reports on individual pharmacokinetic (PK) assessments provide an important source of information about drug dialysability and individualized dose recommendations in this vulnerable population. Areas covered: First, factors that may alter drug exposure in HD patients are explained. Second, available regulatory and methodological guidelines for PK assessments in this population are summarized...
April 27, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28443351/current-and-future-chemical-therapies-for-treating-anaemia-in-chronic-kidney-disease
#2
Francesco Locatelli, Lucia Del Vecchio, Maria Carmen Luise
Erythropoiesis-stimulating agents (ESAs) are not perfect, since they have potential side effects. Iron therapy is also receiving growing attention in recent years. Areas covered: We performed a literature search on PubMed using the following key words: anaemia, chronic kidney disease, HIF stabilisers, sotatercept, actin traps, iron, iron-containing phosphate binders, iron dialysate. We reviewed new drugs that are under clinical development to obtain better safety and activity and/or easier and cheaper manufacturing processes in comparison to available ESAs...
April 26, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28433865/high-sensitivity-hplc-method-for-analysis-of-in-vivo-extracellular-gaba-using-optimized-fluorescence-parameters-for-o-phthalaldehyde-opa-sulfite-derivatives
#3
Shannon L Zandy, James M Doherty, Nathan D Wibisono, Rueben A Gonzales
Reversed-phase HPLC with derivatization using o-phthalaldehyde (OPA) and sulfite allows electrochemical detection of γ-aminobutyric acid (GABA) in microdialysis samples. However, OPA/sulfite derivatives have been reported to produce lower fluorescent yield than OPA derivatives using organic thiols as the nucleophile. To overcome this limitation we examined excitation and emission spectra, reaction time, pH, and concentration of reagents in the derivatization solution. Optimal detection parameters were determined as λex=220nm and λem=385nm for maximal fluorescence...
April 3, 2017: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
https://www.readbyqxmd.com/read/28431568/a-case-report-of-severe-calciphylaxis-suggested-approach-for-diagnosis-and-treatment
#4
Margret Patecki, Gabriele Lehmann, Jan Hinrich Bräsen, Jessica Schmitz, Anna Bertram, Lars Daniel Berthold, Hermann Haller, Wilfried Gwinner
BACKGROUND: Calciphylaxis is a serious complication in patients with chronic kidney disease associated mineral and bone disorder. It can occur in conditions with low and high bone turnover. So far, there are no definite diagnostic and therapeutic guidelines which may prevent the devastating outcome in many calciphylaxis patients. We report a case which clearly illustrates that knowledge of the underlying bone disorder is essential for a directed treatment. Based on this experience we discuss a systematic diagnostic and therapeutic approach in patients with calciphylaxis...
April 21, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28422870/case-report-the-first-case-of-achromobacter-xylosoxidans-related-tunnel-infection-in-a-patient-receiving-peritoneal-dialysis
#5
Jun-Li Tsai, Shang-Feng Tsai
RATIONALE: Achromobacter xylosoxidans infection is mostly reported in immunocompromised patients. Until now, it is still rarely reported in patients undergoing peritoneal dialysis. PATIENT CONCERNS: This is the 1st case of A xylosoxidans infection due to tunnel infection of a Tenckhoff catheter. DIAGNOSIS: The diagnosis was confirmed by the report of culture. INTERVENTIONS: Risk factors for this infection in peritoneal dialysis include uremia with an immunocompromised state, contamination due to inexperienced skills, and aqueous environment of the dialysate...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28422703/differential-hemoglobin-a-sequestration-between-hemodialysis-modalities
#6
Uzma Naseeb, Shamshad Zarina, Theres Jägerbrink, Jawed Shafqat, Hans Jörnvall, Jonas Axelsson
This report evaluates plasma protein patterns, dialysates and protein analysis of used dialysis membranes from the same patient under hemodialysis in three separate modalities, using high-flux membranes in concentration-driven transport (HD), convection-driven hemofiltration (HF) and combined hemodialfiltration (HDF). The plasma protein changes induced by each of the three dialysis modalities showed small differences in proteins identified towards our previous plasma analyses of chronic kidney disease (CKD) patients...
April 19, 2017: Biomolecular Concepts
https://www.readbyqxmd.com/read/28419057/gabaergic-modulation-of-noradrenaline-release-caused-by-blood-pressure-changes-in-the-rat-median-preoptic-area
#7
Makoto Takahashi, Junichi Tanaka
Experiments using in-vivo microdialysis methods were conducted to investigate whether blood pressure changes cause an alteration in the release of noradrenaline (NA) in the median preoptic nucleus (MnPO) and whether the γ-aminobutyric acid (GABA) receptor mechanism is involved in the modulation of the pressure response-induced alteration in the NA release. In urethane-anesthetized male rats, intravenous administration of metaraminol, an α-agonist, significantly produced an increase in dialysate NA concentration in the MnPO area accompanied by an elevation in the mean arterial pressure (MAP)...
April 20, 2017: Neuroreport
https://www.readbyqxmd.com/read/28413966/the-clinical-problems-of-hypertension-treatment-in-hemodialysis-patients
#8
Charalampos N Loutradis, Costas Tsioufis, Pantelis A Sarafidis
Hypertension (HT) is present in more than 80% of patients undergoing hemodialysis (HD). Elevated blood pressure (BP) in hemodialysis patients is associated with cardiovascular events and mortality only when BP is recorded with home or ambulatory monitoring, since pre- and post-dialysis measurements are not valid estimates of BP levels during the inter-dialytic interval. Sodium and water overload is the most important of several mechanisms involved in HT development in HD. In this context, non-pharmacologic measures to ensure water and sodium balance by achieving patient dry weight and decreasing daily sodium intake, through modification of sodium level in the diet or in dialysis dialysate, are fundamental for HT control...
April 14, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28413417/the-dialysis-sodium-gradient-a-modifiable-risk-factor-for-fluid-overload
#9
Emilie Trinh, Catherine Weber
BACKGROUND: Fluid overload in patients on conventional hemodialysis is a frequent complication, associated with increased cardiovascular morbidity and mortality. The dialysate sodium prescription is a potential modifiable risk factor. Our primary objective was to describe associations between dialysate-to-serum sodium gradient and parameters of fluid status. A secondary objective was to evaluate the 6-month risk of hospitalization and mortality in relation to sodium gradient. METHODS: We performed a cross-sectional study of 110 prevalent conventional hemodialysis patients at a single center...
January 2017: Nephron Extra
https://www.readbyqxmd.com/read/28412770/anemia-in-chronic-kidney-disease
#10
Meredith A Atkinson, Bradley A Warady
Anemia is common and associated with adverse outcomes in children with chronic kidney disease (CKD). Many factors contribute to declining hemoglobin as CKD progresses, but impaired production of erythropoietin by failing kidneys is a central cause. Hepcidin-mediated iron restriction also contributes to anemia by downregulating both intestinal iron absorption and release of stored iron for erythropoiesis. The core components of anemia management remain erythropoiesis-stimulating agents (ESA) and iron supplementation, but despite these therapies, a substantial number of children remain anemic...
April 15, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28409034/increased-intracranial-pressure-during-hemodialysis-in-a-patient-with-anoxic-brain-injury
#11
Anton Lund, Mette B Damholt, Ditte G Strange, Jesper Kelsen, Hasse Møller-Sørensen, Kirsten Møller
Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28408714/association-between-peritoneal-glucose-exposure-and-peritonitis-in-peritoneal-dialysis-patients-the-balanz-trial
#12
Melissa Nataatmadja, Yeoungjee Cho, Elaine M Pascoe, Darsy Darssan, Carmel M Hawley, David W Johnson
♦Background: Glucose is the primary osmotic medium used in most peritoneal dialysis (PD) solutions, and exposure to glucose has been shown to exert detrimental effects both locally, at the peritoneal membrane, and systemically. Moreover, high dialysate glucose exposure may predispose patients to an increased risk of peritonitis, perhaps as a result of impaired host defences, vascular disease, and damage to the peritoneal membrane. ♦ Methods: In this post-hoc analysis of a multicenter, multi-national, open-label randomized controlled trial of neutral pH, low-glucose degradation product (GDP) versus conventional PD solutions (balANZ trial), the relationship between peritonitis rates of low (< 123...
April 13, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28408713/the-influence-of-glucose-exposure-load-and-peritoneal-membrane-transport-on-body-composition-and-nutritional-status-changes-after-1-year-on-peritoneal-dialysis
#13
Rafaela S Caron-Lienert, Carlos E Poli-de-Figueiredo, Ana E Figueiredo, Bartira E Pinheiro da Costa, Alessandra C Pizzato, Carlo Crepaldi, Fiorenza Ferrari, Anna Giuliani, Claudio Ronco
♦Background: The characteristics of peritoneal membrane transport differ among patients, affecting the prescription of peritoneal dialysis (PD) modality and glucose exposure in order to achieve an effective dialysis. This study aims to verify the influence of glucose exposure load and peritoneal membrane transport on body composition and nutritional status changes after the first year of PD. ♦ Methods: We examined a cohort of 85 incident PD patients during the first year of treatment. We established a cut-off of 5% to define changes in dry weight (DW), lean tissue mass (LTM), and fat mass (FM)...
April 13, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28408711/a-randomized-controlled-trial-to-determine-the-appropriate-time-to-initiate-peritoneal-dialysis-after-insertion-of-catheter-timely-pd-study
#14
Dwarakanathan Ranganathan, George John, Edward Yeoh, Nicola Williams, Barry O'Loughlin, Thin Han, Lakshman Jeyaseelan, Ramanathan Kavitha, Helen Healy
♦Background: The optimal time for the commencement of peritoneal dialysis (PD) after PD catheter insertion is unclear. If dialysis is started too soon after insertion, dialysate leaks and infection could occur. However, by starting PD earlier, morbidity and costs can be reduced through lesser hemodialysis requirements. This is the first randomized controlled trial to determine the safest and shortest interval to commence PD after catheter insertion. ♦ Methods: All consecutive patients undergoing PD catheter insertion at the Royal Brisbane and Women's Hospital and Rockhampton Hospital from 1 March 2008 to 31 May 2013 who met the inclusion and exclusion criteria were invited to participate in the trial...
April 13, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28407637/pneumatic-compression-but-not-exercise-can-avoid-intradialytic-hypotension-a-randomized-trial
#15
Valeria R C Álvares, Camila D Ramos, Benedito J Pereira, Ana Lucia Pinto, Rosa M A Moysés, Bruno Gualano, Rosilene M Elias
BACKGROUND: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. METHODS: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min...
April 14, 2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28407129/a-noninferiority-trial-comparing-a-heparin-grafted-membrane-plus-citrate-containing-dialysate-versus-regional-citrate-anticoagulation-results-of-the-cited-study
#16
Björn Meijers, Christoph Metalidis, Thomas Vanhove, Ruben Poesen, Dirk Kuypers, Pieter Evenepoel
Background.: Anticoagulation is a prerequisite for successful haemodialysis. Heparin and low-molecular weight heparins are routinely used despite increased bleeding risk. Regional citrate anticoagulation (RCA) is efficacious, but is laborious and may induce metabolic disturbances. Heparin-grafted membranes are less efficacious. It is not known whether combining citrate-containing dialysate and a heparin-grafted membrane is a valid anticoagulation strategy. Methods.: We performed a randomized crossover noninferiority trial, with a prespecified noninferiority threshold of 10% in maintenance dialysis patients ( n  = 25)...
April 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28405068/hemodialysis-failure-secondary-to-hydroxocobalamin-exposure
#17
Kenneth Lim, Eliot Heher, David Steele, Andrew Z Fenves, John Kevin Tucker, Ravi Thadhani, Kenneth Christopher, Nina Tolkoff-Rubin
Hydroxocobalamin is a recently approved antidote for the treatment of cyanide poisoning. The case presented involves a young patient administered empiric hydroxocobalamin due to suspected cyanide overdose. Due to the development of acute kidney injury and severe metabolic derangement, emergent hemodialysis was initiated. Unfortunately, hemodialysis was confounded by a recurrent "blood leak" alarm. This unforeseen effect was secondary to interference from hydroxocobalamin. Hydroxocobalamin causes orange/red discoloration of bodily fluids and permeates the dialysate...
April 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28401422/acetate-free-biofiltration-to-remove-fibroblast-growth-factor-23-in-hemodialysis-patients-a-pilot-study
#18
Valeria Cernaro, Silvia Lucisano, Valeria Canale, Annamaria Bruzzese, Daniela Caccamo, Giuseppe Costantino, Michele Buemi, Domenico Santoro
AIM: Serum levels of 32 kDa-phosphaturic hormone fibroblast growth factor 23 (FGF23) rise early in renal failure in order to keep phosphatemia within the normal range; however, this compensatory mechanism itself contributes to chronic kidney disease-mineral bone disorder. High FGF23 is also associated to left ventricular hypertrophy, vascular calcifications and thus increased cardiovascular risk. The aim of this pilot pre-post study was to evaluate the effects of a single hemodiafiltration session with acetate-free biofiltration (AFB) on FGF23 serum levels...
April 11, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28401301/enhancing-dialyser-clearance-from-target-to-development
#19
Kamonwan Tangvoraphonkchai, Andrew Davenport
Products of metabolism accumulate in kidney failure and potentially have toxic effects. Traditionally these uraemic toxins are classified as small, middle-sized and protein-bound toxins, and clearance during dialysis is affected by diffusion, convection and adsorption. As current dialysis practice effectively clears small solutes, increasing evidence supports a toxic effect for middle-sized and protein-bound toxins. Therefore, newer approaches to standard dialysis practice are required to look beyond urea clearance...
April 12, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28401120/estimating-patient-borne-water-and-electricity-costs-in-home-hemodialysis-a-simulation
#20
Matthew Nickel, Wes Rideout, Nikhil Shah, Frances Reintjes, Justin Z Chen, Robert Burrell, Robert P Pauly
BACKGROUND: Home hemodialysis is associated with lower costs to the health care system compared with conventional facility-based hemodialysis because of lower staffing and overhead costs, and by transferring the treatment cost of utilities (water and power) to the patient. The purpose of this study was to determine the utility costs of home hemodialysis and create a formula such that patients and renal programs can estimate the annual patient-borne costs involved with this type of treatment...
January 2017: CMAJ Open
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