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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Richard A Ward, Werner Beck, Angelito A Bernardo, Filipa C Alves, Peter Stenvinkel, Bengt Lindholm
Hemodiafiltration (HDF) increases the removal of middle-molecular-weight uremic toxins and may improve outcomes in patients with end-stage kidney disease (ESKD), but it requires complex equipment and comes with risks associated with infusion of large volumes of substitution solution. New high-flux hemodialysis membranes with improved diffusive permeability profiles do not have these limitations and offer an attractive alternative to HDF. However, both strategies are associated with increased albumin loss into the dialysate, raising concerns about the potential for decreased serum albumin concentrations that have been associated with poor outcomes in ESKD...
August 8, 2018: Nephrology, Dialysis, Transplantation
Gokcen Gozubatik-Celik, Derya Uluduz, Baki Goksan, Nazan Akkaya, Melis Sohtaoglu, Ugur Uygunoglu, Fatih Kircelli, Adem Sezen, Sabahattin Saip, Feray Karaali Savrun, Aksel Siva
BACKGROUND: Hemodialysis(HD) may have some adverse effects on the nervous system. Headache is the most commonly reported neurological symptom among HD-patients. AIM: To determine the frequency, clinical characteristics, triggering factors of HD-related headache(HRH); to evaluate preventive strategies for reducing the HRH. METHOD: 494 patients were included. Comparative controls(CC) were classified within the same patients without headache...
August 13, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Nieltje Gedney, Kamyar Kalantar-Zadeh
An exponential interest in incremental transition to dialysis recently has emerged in lieu of outright three times/wk hemodialysis initiation as the standard of care. Incremental dialysis is consistent with precision medicine, given individualized dialysis dose adjustment based on patient's dynamic needs, leading to reduced patient suffering from longer or more frequent dialysis treatments and improved health-related quality of life. It includes twice-weekly or less frequent hemodialysis treatments with or without a low-protein diet on nondialysis days, or a shorter (<3 h) hemodialysis treatment three times per week or more frequent treatments, a useful approach for home hemodialysis initiation...
July 2018: Seminars in Nephrology
Panagiotis I Georgianos, Rajiv Agarwal
Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves clinical outcomes in hemodialysis patients. BP-lowering in these individuals should initially utilize nonpharmacological strategies aiming to control sodium and volume overload. Accordingly, restricting dietary sodium intake, eliminating intradialytic sodium gain via individualized dialysate sodium prescription, optimally assessing and managing dry-weight and providing a sufficient duration of dialysis are first-line treatment considerations to control BP...
August 6, 2018: Seminars in Dialysis
Matthew Tabinor, Simon J Davies
PURPOSE OF REVIEW: To summarize the findings of recent trials and meta-analyses designed to determine whether bioimpedance spectroscopy adds value to the clinical assessment of fluid status in dialysis patients so as to achieve a normally hydrated weight and put these in a contemporary context. RECENT FINDINGS: Eight trials (published 2010-2018) and two meta-analyses (2017) are reviewed. Both haemodialysis and peritoneal dialysis modalities are represented. Despite considerable heterogeneity in intervention, all are open-label randomized comparisons of a bioimpedance intervention with normal clinical practice in which clinicians were blinded to bioimpedance data...
July 30, 2018: Current Opinion in Nephrology and Hypertension
Yan Sun, Yankui Wang, Wenhong Yu, Yan Zhuo, Qian Yuan, Xiongfei Wu
BACKGROUND Dialysis frequency and dose are controversial prognostic factors of hemodialysis morbidity and mortality. The aim of this study was to find out the effect of frequency and dosage of dialysis on mortality and survival in a group of Chinese hemodialysis patients. MATERIAL AND METHODS In total, 183 patients seen from February 2008 to January 2018, who were on maintenance hemodialysis for at least 3 months, were included in the study cohort. An anonymized database of age, gender, diabetic status, comorbidities, date of initiation of dialysis, hematological characters, biochemical variables, and status of survived or died was established from DICOM (Digital Imaging and Communications in Medicine) files of patients...
July 31, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Leigh Anne Keough, Amy Krauss, Joanna Q Hudson
Background Patients requiring SLED are often critically ill and/or hemodynamically unstable, and often need antibiotic therapy for life-threatening infections. Antibiotic dosing recommendations for intermittent hemodialysis and continuous renal replacement therapy are not appropriate for SLED and there is substantial concern for under dosing. Objective To characterize the adequacy of antibiotic dosing during SLED. SETTING: Inpatient adult acute care hospital. Methods A retrospective chart review was performed for the period of October 2010 to August 2013 to identify patients who received SLED and at least one of the selected antibiotics: cefepime, daptomycin, piperacillin/tazobactam, meropenem, and vancomycin...
July 26, 2018: International Journal of Clinical Pharmacy
Toshihide Naganuma, Yoshiaki Takemoto
Cerebrovascular disease is a major cause of death in dialysis patients, who have a much higher incidence of stroke compared to the normal population. Recent studies have shown that asymptomatic cerebral small-vessel disease, including silent brain infarction (SBI), white matter hyperintensities (WMHs), and cerebral microbleeds (CMBs), is related to the future onset of stroke. Cerebral small-vessel disease is caused by microvascular damage to the small penetrating arteries of the middle cerebral artery including arteriolosclerosis, fibrinoid necrosis, and lipohyalinosis attributed to advanced age, hypertension, etc...
2018: Contributions to Nephrology
Kengo Furuichi, Takashi Wada
Plasma exchange or double filtration plasmapheresis for rapidly progressive glomerulonephritis, and low-density lipoprotein (LDL) apheresis or leukocytapheresis for nephritic syndrome are two major apheresis therapies for kidney diseases. In addition to these apheresis therapies, plasma exchange for lupus nephritis or LDL apheresis for refractory focal segmental glomerulonephritis is clinically valuable and established. Although several possibilities of apheresis for kidney diseases were speculated in animal experiments or human studies, clinical applications have thus far been limited...
2018: Contributions to Nephrology
Noriaki Maruyama, Masanori Abe
BACKGROUND: For diabetes patients without nephropathy, glycemic control is important to reduce the risk or delay the progression of diabetes complications, including nephropathy. In diabetes patients on hemodialysis, good glycemic control is necessary to improve prognosis. Many factors influence the blood glucose level of diabetes patients on hemodialysis, such as factors associated with end-stage kidney disease and factors related to hemodialysis. Therefore, since glucose metabolism in diabetes patients on hemodialysis has unique characteristics, it is necessary to manage blood glucose in these patients with specific guidelines...
2018: Contributions to Nephrology
Steven G Achinger, Juan Carlos Ayus
Cardiovascular mortality accounts for most deaths among hemodialysis patients and far exceeds the cardiovascular mortality rate of the general population. One important aspect of cardiovascular risk among dialysis patients is chronic inflammation. Iatrogenic sources of chronic inflammation in the form of failed renal allografts, old clotted arteriovenous grafts, and hemodialysis catheters play important, sometimes, unrecognized roles in this inflammatory state. There is ample observational evidence that these sources of inflammation are associated with hypoalbuminemia, erythropoetin-resistant anemia, and increased markers of chronic inflammation...
July 22, 2018: Seminars in Dialysis
Yuki Tamaura, Masaaki Nishitani, Rie Akamatsu, Nobuyo Tsunoda, Fumiko Iwasawa, Keiko Fujiwara, Takuya Kinoshita, Masashi Sakai, Toru Sakai
OBJECTIVE: This study aimed to identify dietary and fluid behaviors associated with relative interdialytic weight gain (RIDWG) (divided by the respective dry weight [DW]) by stratifying the patients according to body mass index (BMI). DESIGN AND METHODS: This was a cross-sectional, multicenter investigation. Between July 2016 and March 2017, data were collected from 4 Japanese dialysis centers in 3 cities. The patients (n = 577) were asked to reply to a self-completed questionnaire, including questions on perception about DW and dietary and fluid behaviors...
July 17, 2018: Journal of Renal Nutrition
Angelo Karaboyas, Hal Morgenstern, Ronald L Pisoni, Jarcy Zee, Raymond Vanholder, Stefan H Jacobson, Masaaki Inaba, Lisa C Loram, Friedrich K Port, Bruce M Robinson
Background: The Kidney Disease: Improving Global Outcomes guidelines have cautioned against administering intravenous (IV) iron to hemodialysis patients with high serum ferritin levels due to safety concerns, but prior research has shown that the association between high ferritin and mortality could be attributed to confounding by malnutrition and inflammation. Our goal was to better understand the ferritin-mortality association and relative influence of IV iron and inflammation in the USA, where ferritin levels have recently increased dramatically, and in Europe and Japan, where ferritin levels are lower and anemia management practices differ...
July 11, 2018: Nephrology, Dialysis, Transplantation
Pantelis A Sarafidis, Francesca Mallamaci, Charalampos Loutradis, Robert Ekart, Claudia Torino, Antonios Karpetas, Vasileios Raptis, Athanasios Bikos, Aikaterini Papagianni, Olga Balafa, Konstantinos Siamopoulos, Giovanni Pisani, Massimo Morosetti, Antonio Del Giudice, Fillipo Aucella, Luca Di Lullo, Rocco Tripepi, Giovanni Tripepi, Kitty Jager, Friedo Dekker, Gerard London, Carmine Zoccali
Background: Population-specific consensus documents recommend that the diagnosis of hypertension in haemodialysis patients be based on 48-h ambulatory blood pressure (ABP) monitoring. However, until now there is just one study in the USA on the prevalence of hypertension in haemodialysis patients by 44-h recordings. Since there is a knowledge gap on the problem in European countries, we reassessed the problem in the European Cardiovascular and Renal Medicine working group Registry of the European Renal Association-European Dialysis and Transplant Association...
July 10, 2018: Nephrology, Dialysis, Transplantation
Giorgina Barbara Piccoli, Gianfranca Cabiddu, Maria Rita Moio, Antioco Fois, Riccardo Cao, Ida Molfino, Ana Kaniassi, Francoise Lippi, Ludivine Froger, Antonello Pani, Marilisa Biolcati
BACKGROUND: Choice of dialysis is context sensitive, explored for PD and extracorporeal dialysis, but less studied for haemodialysis (HD) and hemodiafiltration (HDF), both widely employed in Italy and France; reasons of choice and differences in prescriptions may impact on dialysis-related variables, particularly relevant in elderly, high-comorbidity patients. METHODS: The study involved two high-comorbidity in-hospital cohorts, treated in Centers with similar characteristics, in Italy (Cagliari) and France (Le Mans)...
July 9, 2018: BMC Nephrology
Peter Ryan, Lauren Le Mesurier, Kelly Adams, Peter Choi, Bobby Chacko
Long-term hemodialysis (HD) imposes a significant burden on the quality of life of end-stage kidney disease patients. Optimizing dialysis dose is an important consideration in this population; however, evidence exists that suggests that attainment of population dialysis targets is associated with increased intradialytic complications. In this prospective, before-after study, the blood flow rate (BFR) of 63 maintenance HD patients was increased by 100 mL/min to a maximum BFR of 400 mL/min to determine the impact on patient tolerability and urea reduction ratio (URR) of an increased BFR...
July 4, 2018: Therapeutic Apheresis and Dialysis
Gaetano La Manna, Gabriele Donati
Coupled plasma filtration adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit with a continuous renal replacement therapy. The circuit consists of a plasma filter, a resin/adsorbent cartridge and a haemofilter. It differs from many other types of extracorporeal therapies in that the upper part of the circuit can be considered a "closed loop". In this manner, the plasma separated by the plasma filter passes through an adsorbent cartridge containing a resin with high affinity to many cytokines, mediators and toxins/poisons...
2018: Blood Purification
Muhammad Nauman Hashmi, Hammad Raza, Wael Elshazly, Fayez Hejaili, Abdullah Al Sayyari
OBJECTIVE: To develop a simple, objective, cheap scoring tool incorporating nutritional parameters and other variables to predict hospitalization and mortality among hemodialysis patients - a tool that could be utilized in low resource countries. METHODS: The following variables were scored according to severity into 0, 1, 2 or 3: BMI, functional capacity, HD vintage in years, serum albumin, serum ferritin, and the number of comorbid conditions (diabetes mellitus, hypertension, ischemic heart disease, cerebrovascular disease)...
July 3, 2018: Blood Purification
Toshiyuki Nakao, Yoshie Kanazawa, Toshimasa Takahashi
BACKGROUND: For patients with end-stage renal failure (ESFR), thrice-weekly hemodialysis is a standard care. Once-weekly hemodialysis combined with low-protein and low-salt dietary treatment (OWHD-DT) have been rarely studied. Therefore, here, we describe our experience on OWHD-DT, and assess its long-term effectiveness. METHODS: We instituted OWHD-DT therapy in 112 highly motivated patients with creatinine clearance below 5.0 mL/min. They received once-weekly hemodialysis on a diet of 0...
June 28, 2018: BMC Nephrology
Guy Rostoker
Parenteral iron is used to restore the body's iron pool before and during erythropoiesis-stimulating agent (ESA) therapy; together these agents form the backbone of anemia management in end-stage renal disease (ESRD) patients undergoing hemodialysis. ESRD patients receiving chronic intravenous iron products, which exceed their blood loss are exposed to an increased risk of positive iron balance. Measurement of the liver iron concentration (LIC) reflects total body iron stores in patients with secondary hemosiderosis and genetic hemochromatosis...
June 28, 2018: Seminars in Dialysis
2018-07-01 11:57:30
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