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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Jennifer S Scherer, Sara A Combs, Frank Brennan
Maintenance dialysis patients experience a high burden of physical and emotional symptoms that directly affect their quality of life and health care utilization. In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment. Finally, we identify multiple additional areas of further study needed to improve symptom management in dialysis patients...
September 29, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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
Ambreen Gul, Dana Miskulin, Antonia Harford, Philip Zager
PURPOSE OF REVIEW: This review focuses on recent advances in our understanding of intradialytic hypotension (IDH) and measures that may reduce its frequency. RECENT FINDINGS: The frequency and severity of IDH predict the risk for adverse clinical outcomes. The highest mortality risks associated with IDH were observed when the intradialytic systolic blood pressure (SBP) nadirs were <90 and <100 mmHg and the predialysis SBP were ≤159 mmHg or ≥160 mmHg, respectively...
November 2016: Current Opinion in Nephrology and Hypertension
Akeem A Yusuf, Yan Hu, Bhupinder Singh, José A Menoyo, James B Wetmore
BACKGROUND: Hyperkalemia is common in patients receiving maintenance hemodialysis. However, few studies have examined the association between serum potassium level and mortality. METHODS: This study used annual cohorts of hemodialysis patients during 2007-2010. To determine hyperkalemia prevalence, monthly hyperkalemia was defined as serum potassium level ≥5.5 mEq/l; prevalence was calculated as a ratio of hyperkalemia episodes to follow-up time, reported separately by long and short interdialytic interval...
2016: American Journal of Nephrology
Natasa Eftimovska-Otovic, Risto Grozdanovski, Borjanka Taneva, Olivera Stojceva-Taneva
INTRODUCTION: Intradialytic hypertension with a prevalence of 15% among hemodialysis patients is with unknown pathophysiology, demographic, laboratoiy and clinical characteristic of patients, and it's influence on longtenn clinical effects (cardiovascular morbidity and mortality, rate of hospitalization). The aim of the study is to present the clinical, laboratoiy and demographic characteristics of patients with intradialytic hypertension in our dialysis center. MATERIALS AND METHODS: Out of 110 hemodialysis patients, 17 patients (15,45%) had intradialytic hypertension - started at a systolic pressure greater than 140 nun Hg or had an increase in systolic pressure more than 10 mm Hg during the session, and 17 patients were nonnotensive or had a drop in blood pressure dining the dialysis...
2015: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
Dora Zalai, Miqdad Bohra
Chronic fatigue--an overwhelming subjective feeling of mental or physical exhaustion--impacts patients' everyday functioning and quality of life, delays recovery after hemodialysis, and increases mortality. There are a number of factors that may perpetuate clinically significant fatigue among individuals with chronic kidney disease, including sleep disorders, depression, sedentary lifestyle, anemia, and chronic inflammation. Some of these factors (i.e., anemia and inflammation) are in the forefront of clinical attention, whereas the other contributing factors often remain unrecognized...
January 2016: CANNT Journal, Journal ACITN
Sonoko Yasui, Yumiko Shirai, Mayu Tanimura, Sayaka Matsuura, Yu Saito, Kazuaki Miyata, Eiji Ishikawa, Chikao Miki, Yasuhiro Hamada
BACKGROUND AND OBJECTIVES: The International Society of Renal Nutrition and Metabolism (ISRNM) has recently recommended the use of the term "protein-energy wasting" (PEW). PEW is a state of malnutrition with decreased body stores of protein and energy fuel in hemodialysis patients and is known as a risk factor for morbidity and mortality. We examined the prevalence of PEW and the characteristics of PEW patients in a hemodialysis center in Japan. METHODS AND STUDY DESIGN: Fifty-nine outpatients undergoing maintenance hemodialysis at Iga City General Hospital were evaluated...
2016: Asia Pacific Journal of Clinical Nutrition
Tomasz Gołębiowski, Hanna Augustyniak-Bartosik, Wacław Weyde, Marian Klinger
The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than among general population...
2016: Postȩpy Higieny i Medycyny Doświadczalnej
Jeffrey H Lawson, Marc H Glickman, Marek Ilzecki, Tomasz Jakimowicz, Andrzej Jaroszynski, Eric K Peden, Alison J Pilgrim, Heather L Prichard, Malgorzata Guziewicz, Stanisław Przywara, Jacek Szmidt, Jakub Turek, Wojciech Witkiewicz, Norbert Zapotoczny, Tomasz Zubilewicz, Laura E Niklason
BACKGROUND: For patients with end-stage renal disease who are not candidates for fistula, dialysis access grafts are the best option for chronic haemodialysis. However, polytetrafluoroethylene arteriovenous grafts are prone to thrombosis, infection, and intimal hyperplasia at the venous anastomosis. We developed and tested a bioengineered human acellular vessel as a potential solution to these limitations in dialysis access. METHODS: We did two single-arm phase 2 trials at six centres in the USA and Poland...
May 14, 2016: Lancet
Christoph Wanner, Kerstin Amann, Tetsuo Shoji
The heart and the vascular tree undergo major structural and functional changes when kidney function declines and renal replacement therapy is required. The many cardiovascular risk factors and adaptive changes the heart undergoes include left ventricular hypertrophy and dilatation with concomitant systolic and diastolic dysfunction. Myocardial fibrosis is the consequence of impaired angio-adaptation, reduced capillary angiogenesis, myocyte-capillary mismatch, and myocardial micro-arteriopathy. The vascular tree can be affected by both atherosclerosis and arteriosclerosis with both lipid rich plaques and abundant media calcification...
July 16, 2016: Lancet
Mustafa Yaprak, Mehmet Nuri Turan, Ramazan Dayanan, Selçuk Akın, Elif Değirmen, Mustafa Yıldırım, Faruk Turgut
PURPOSE: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients. METHODS: Eighty patients were enrolled in study...
August 2016: International Urology and Nephrology
Fabrizio Fabrizi, Paul Martin, Piergiorgio Messa
The evidence that chronic hepatitis C plays a detrimental role in survival among patients on maintenance dialysis or renal transplant recipients promotes the antiviral treatment of hepatitis C virus (HCV) among chronic kidney disease patients. Also, it seems that HCV infection is associated with an increased risk of developing chronic kidney disease in the adult general population. Interferon-based regimens have provided limited efficacy and safety among chronic kidney disease patients, whereas the advent of the new direct-acting antivirals for the treatment of hepatitis C (launched over the past 5 years) has given the opportunity to reach sustained virologic response rates of 90% for many patient groups...
May 2016: Kidney International
Kian-Guan Lee, Tze-Tec Chong, Nicholette Goh, Shaam Achudan, Yi-Liang Tan, Ru-Yu Tan, Lina Hui-Lin Choong, Chieh-Suai Tan
INTRODUCTION: Vascular access in hemodialysis is critical for effective therapy. We aim to evaluate the outcomes of AVF creation in incident hemodialysis patients, impact of preoperative vein mapping and predictors of successful AVF maturation in our center. METHODS: Data of End-stage Renal Disease (ESRD) patients initiated on hemodialysis from January 2010 to December 2012 in our center were retrospectively obtained from electronic medical records and clinical notes...
April 4, 2016: Nephrology
Stephanie M Toth-Manikowski, Stephen M Sozio
The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension (IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering...
March 6, 2016: World Journal of Nephrology
Ramon Roca-Tey
Heart failure (HF) is the most frequent cardiovascular disease associated with chronic kidney disease and represents a high risk for cardiovascular mortality in incident hemodialysis (HD) patients. This risk is especially high during the arteriovenous fistula (AVF) maturation period due to the marked hemodynamic changes related to the large increase in the blood flow and also within the first 120 days after HD inception because in this period the highest mortality rate occurs. When planning the vascular access for each incident HF patient, the risk of aggravating HF after AVF creation must be evaluated carefully alongside the risk of catheter-related complications, but avoiding a non-selective 'catheter first' approach for all these patients...
March 2016: Journal of Vascular Access
Piergiorgio Bolasco, Adamasco Cupisti, Francesco Locatelli, Stefania Caria, Kamyar Kalantar-Zadeh
Initiation of thrice-weekly hemodialysis often results in a rapid loss of residual kidney function (RKF) including reduction in urine output. Preserving RKF longer is associated with better outcomes including greater survival in dialysis patients. An alternative approach aimed at preserving RKF is an incremental transition with less frequent hemodialysis sessions at the beginning with gradual increase in hemodialysis frequency over months. In addition to favorable clinical and economic implications, an incremental transition would also enhance a less stressful adaptation of the patient to dialysis therapy...
February 28, 2016: Journal of Renal Nutrition
Anna Meyring-Wösten, Hanjie Zhang, Xiaoling Ye, Doris H Fuertinger, Lili Chan, Franz Kappel, Mikhail Artemyev, Nancy Ginsberg, Yuedong Wang, Stephan Thijssen, Peter Kotanko
BACKGROUND AND OBJECTIVES: Intradialytic hypoxemia has been recognized for decades, but its associations with outcomes have not yet been assessed in a large patient cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our retrospective cohort study was conducted between January of 2012 and January of 2015. We recorded blood oxygen saturation every minute during hemodialysis in patients with arteriovenous access. A 6-month baseline period with at least 10 treatments with oxygen saturation measurements preceded a 12-month follow-up...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Carlo Basile, Luigi Rossi, Carlo Lomonte
Metabolic acidosis is a common complication of chronic kidney disease; it is typically caused by the accumulation of sulfate, phosphorus, and organic anions. Metabolic acidosis is correlated with several adverse outcomes, such as morbidity, hospitalization, and mortality. Thus, correction of metabolic acidosis is fundamental for the adequate management of many systemic complications of chronic kidney disease. In patients undergoing hemodialysis, acid-base homeostasis depends on many factors including the following: net acid production, amount of alkali given by the dialysate bath, duration of the interdialytic period, and residual diuresis, if any...
May 2016: Kidney International
John S Thurlow, Christina M Yuan
Intradialytic hypotension is the most common complication associated with hemodialysis. We describe a case of severe intradialytic hypotension during routine chronic dialysis, the presenting symptom of hypocalcemia due to a procedural error involving a zero calcium liquid acid dialysate concentrate. Although human factors were the root cause of this event, we discuss physical and procedural controls that may help to minimize the risk of human error. Citrate anticoagulation for renal replacement therapy is increasingly used, particularly in acute kidney injury...
April 2016: Hemodialysis International
Edward G Clark, Ayub Akbari, Brett Hiebert, Swapnil Hiremath, Paul Komenda, Charmaine E Lok, Louise M Moist, Michael E Schachter, Navdeep Tangri, Manish M Sood
BACKGROUND: Non-tunneled (temporary) hemodialysis catheters (NTHCs) are the least-optimal initial vascular access for incident maintenance hemodialysis patients yet little is known about factors associated with NTHC use in this context. We sought to determine factors associated with NTHC use and examine regional and facility-level variation in NTHC use for incident maintenance hemodialysis patients. METHODS: We analyzed registry data collected between January 2001 and December 2010 from 61 dialysis facilities within 12 geographic regions in Canada...
2016: BMC Nephrology
2016-03-02 15:54:07
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