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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Karen M Van de Velde-Kossmann
Renal failure patients have an increased risk of infection, including skin and soft tissue infections. This increased susceptibility is multifactorial, due to the conditions causing the renal failure as well as complications of treatment and renal failure's innate effects on patient health. These infections have a significant impact on patient morbidity, increased hospital and procedural demands, and the cost of health care. Many renal failure patients are seen regularly by their nephrology clinic caregivers due to the need for frequent dialysis and transplant monitoring...
December 5, 2018: Blood Purification
Frank M van der Sande, Karlien J A Ter Meulen, Peter Kotanko, Jeroen P Kooman
BACKGROUND: Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume...
December 5, 2018: Blood Purification
Jeroen P Kooman, Frank M van der Sande
BACKGROUND: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. SUMMARY: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis...
December 5, 2018: Blood Purification
Charles Chazot, Guillaume Jean
Recently the concept that prescription of chronic hemodialysis (HD) start should be tailored based on residual renal function (RRF) and urine output (UO) has been revived from the past and called infrequent or incremental dialysis. It mainly consists in prescribing 1 or 2 HD sessions per week instead of what has become the standard thrice-weekly HD. It is both surprising and fascinating that almost 60 years after the first end-stage kidney disease patient was treated by Scribner et al. [Trans Am Soc Artif Intern Organs 1960; 6: 114-122], the nephrology community still questions the best way to start HD therapy...
December 5, 2018: Blood Purification
Yen-Hung Yao, Yiing-Jenq Chou, Nicole Huang
AIM: Existing studies on the association between hemodialysis facility size/volume and patient survival are mostly limited to freestanding dialysis units in the United States. This study in Taiwan explored the facility size-mortality association in both hospital-based and freestanding hemodialysis units. METHODS: In this nationwide population-based retrospective cohort study, we used the Taiwan National Health Insurance Research Database to patients who began maintenance hemodialysis between 2008 and 2012...
November 29, 2018: Nephrology
Muhammad Irfan, Masooma Irfan, Ani Idris, Nadeem Baig, Tawfik A Saleh, Rozita Nasiri, Younas Iqbal, Nawshad Muhammad, Fozia Rehman, Hamad Khalid
This study focused to optimize the performance of polyethersulfone (PES) hemodialysis (HD) membrane using carboxylic functionalized multiwall carbon nanotubes (c-MWCNT) and lower molecular weight grade of polyvinylpyrrolidone (PVP-k30). Initially, MWCNT were chemically functionalized by acid treatment and nanocomposites (NCs) of PVP-k30 and c-MWCNT were formed and subsequently blended with PES polymer. The spectra of FTIR of the HD membranes revealed that NCs has strong hydrogen bonding and their addition to PES polymer improved the capillary system of membranes as confirmed by Field Emission Scanning Electron Microscope (FESEM) and leaching of the additive decreased to 2% and hydrophilicity improved to 22%...
November 28, 2018: Journal of Biomedical Materials Research. Part A
Dharmenaan Palamuthusingam, David Johnson, Carmel Hawley, Elaine Pascoe, Pal Sivalingam, Magid Fahim
Perioperative medicine is rapidly emerging as a key discipline to address the specific needs of high-risk surgical groups, such as those on chronic dialysis. Crude hospital separations rates for chronic dialysis patients are considerably higher than patients with normal renal function, with up to 15% of admission being related to surgical intervention. Dialysis dependency carries substantial mortality and morbidity risk compared to patients with normal renal function. This group of patients has a high co-morbid burden and complex medical need making accurate perioperative planning essential...
November 28, 2018: Internal Medicine Journal
David M Charytan, Jonathan Himmelfarb, T Alp Ikizler, Dominic S Raj, Jesse Y Hsu, J Richard Landis, Amanda H Anderson, Adriana M Hung, Rajnish Mehrotra, Shailendra Sharma, Daniel E Weiner, Mark Williams, Marcelo DiCarli, Hicham Skali, Paul L Kimmel, Alan S Kliger, Laura M Dember
The safety and efficacy of spironolactone is uncertain in end-stage renal disease. We randomized 129 maintenance hemodialysis patients to placebo (n=51) or spironolactone 12.5 mg (n=27), 25 mg (n=26), or 50 mg (n=25) daily for 36 weeks in a double-blind, placebo-controlled, multiple dosage trial to assess safety, tolerability and feasibility and to explore cardiovascular efficacy. The primary safety endpoints were hyperkalemia (potassium > 6.5 mEq/L) and hypotension requiring emergency department visit or hospitalization...
November 22, 2018: Kidney International
Zbylut J Twardowski, Madhukar Misra
Hemodialysis for chronic renal failure was introduced and developed in Seattle, WA, in the 1960s. Using Kiil dialyzers, weekly dialysis time and frequency were established to be about 30 hours on 3 time weekly dialysis. This dialysis time and frequency was associated with 10% yearly mortality in the United States in 1970s. Later in 1970s, newer and more efficient dialyzers were developed and it was felt that dialysis time could be shortened. An additional incentive to shorten dialysis was felt to be lower cost and higher convenience...
November 20, 2018: Hemodialysis International
John S Gill, Alexander Wiseman
The Dialysis PATIENTS Demonstration Act (DPDA) (H.R 4143/S.2065) is proposed to improve the value of care for dialysis patients. In this issue of AJT,(1) Becker and Nissensen (who work for Da Vita), write to reassure the transplant community that transplantation remains a priority under the DPDA. They express "hope" that the DPDA will be neutral or have little impact on transplantation, while omitting reference to the competitive advantage Da Vita would enjoy under the DPDA. Large dialysis providers such as Da Vita, could more easily assume the risk of all of dialysis patient costs (over $80,000 per patient per year), as envisioned in the DPDA, compared to smaller and non-profit dialysis providers...
November 20, 2018: American Journal of Transplantation
Wendy McCallum, Mark J Sarnak
The appropriate blood pressure (BP) target for dialysis patients remains controversial. Although there have been remarkable advances in this area in the general population, extrapolation of these data to dialysis patients is not possible. Observational studies in dialysis patients suggest that low BP is associated with worse outcomes. However, this is likely a result of confounding, considering that among dialysis patients with fewer cardiovascular comorbidities and longer survival, a more linear relationship exists between BP and mortality...
November 13, 2018: Seminars in Dialysis
Junfeng Luo, Jiuhong Li, Junjie Nie, Pingping Li, Houde Zhang, Yongjian Ma
The aim of this study was to use a CO breath test to investigate hemodialysis effects on red blood cell lifespan in patients with chronic kidney disease. A cohort of 17 non-smoking men with end-stage kidney disease undergoing hemodialysis via a polysolfone dialysis membrane (as opposed to a traditional cellulose acetate membrane) were subjected to a repeated Levitt's CO breath test to compare red blood cell lifespan before versus after dialysis. None of the patients showed significant fluctuations in endogenous CO concentration during the dialysis procedure...
November 13, 2018: Therapeutic Apheresis and Dialysis
Sérgio Gardano Elias Bucharles, Krissia K S Wallbach, Thyago Proença de Moraes, Roberto Pecoits-Filho
Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory...
November 8, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Tessa K Novick, Crystal A Gadegbeku, Deidra C Crews
No abstract text is available yet for this article.
November 5, 2018: JAMA Internal Medicine
Ziye Chen, Fang Sun, Yang Shen, Lijie Ma, Jing Liu, Yilun Zhou
Blood pressure variability is an independent risk factor for mortality and cardiovascular events in hemodialysis patients. Dialysate sodium concentration may not only have effects on blood pressure but also on blood pressure variability. We investigated whether dialysate sodium concentration lowering could decrease home blood pressure variability in hemodialysis patients. Forty-three hemodialysis patients at their dry weight assessed by bioimpedance methods, with pre-dialysis serum sodium >136 mmol/L were recruited...
November 1, 2018: Therapeutic Apheresis and Dialysis
Yuanyuan Shi, Yifeng Wang, Shuai Ma, Tingyan Liu, Huajun Tian, Qiuyu Zhu, Wenji Wang, Yulin Li, Feng Ding
Protein-bound uremic toxins (PBUTs) accumulate at high plasma levels and cause various deleterious effects in end-stage renal disease patients because their removal by conventional hemodialysis is severely limited by their low free-fraction levels in plasma. Here, we assessed the extent to which solute removal can be increased by adding liposomes to the dialysate. The uptake of liposomes by direct incubation in vitro showed an obvious dose-response relationship for p-cresyl sulfate (PCS) and indoxyl sulfate (IS) but not for hippuric acid (HA)...
October 30, 2018: Artificial Organs
Maharajan Raman, Rachel J Middleton, Philip A Kalra, Darren Green
BACKGROUND: The benefits of dialysis in older people with ESKD are not clear. We prospectively evaluated whether dialysis has survival advantage compared to conservative care (CC) in older people who were medically suitable for dialysis therapy. METHODS: This was a prospective observational study of CKD patients aged ≥75 years when eGFR first reached ≤15ml/min/1.73m2. Hazard ratios (HR) for death were compared between patients who chose dialysis versus conservative care (CC) from when first seen in pre-dialysis clinic (eGFR ≤15ml/min/1...
2018: PloS One
Nicholas M Selby, Isma Kazmi
Rates of cardiovascular mortality are disproportionately high in patients with end stage kidney disease receiving dialysis. However, it is now generally accepted that patient survival is broadly equivalent between the two most frequently used forms of dialysis, in-center hemodialysis (HD) and peritoneal dialysis (PD). This equivalent patient survival is notable when considering how specific aspects of HD have been shown to contribute to morbidity and mortality. These include more rapid loss of residual renal function (RRF), HD-induced myocardial and cerebral ischemia, and risk factors associated with the intermittent delivery of HD...
October 23, 2018: Seminars in Dialysis
Raja Mohammed Kaja Kamal, Ken Farrington, Amanda D Busby, David Wellsted, Humza Chandna, Laura J Mawer, Sivakumar Sridharan, Enric Vilar
Background: Initiating twice-weekly haemodialysis (2×HD) in patients who retain significant residual kidney function (RKF) may have benefits. We aimed to determine differences between patients initiated on twice- and thrice-weekly regimes, with respect to loss of kidney function, survival and other safety parameters. Methods: We conducted a single-centre retrospective study of patients initiating dialysis with a residual urea clearance (KRU) of ≥3 mL/min, over a 20-year period...
October 23, 2018: Nephrology, Dialysis, Transplantation
Steven Menez, Bernard G Jaar
No abstract text is available yet for this article.
November 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
2018-10-25 07:18:05
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