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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Maurizio Bossola, Gilda Pepe, Anna Picca, Riccardo Calvani, Emanuele Marzetti
Health-related quality of life (HRQOL) in patients on chronic hemodialysis has not improved significantly in the last 20 years. This is largely due to their substantial symptom burden which is rarely assessed and treated in routine clinical practice. This is also consequence of the lack of an appropriate armamentarium for the treatments of such symptoms. Adequate studies on the causes and pathogenesis of the symptoms of hemodialysis patients are needed followed by high-quality studies on possible therapeutic pharmacological and non-pharmacological interventions...
March 19, 2019: International Urology and Nephrology
Sébastien Maggioni, Asma Allal, Nassim Kamar, Martine Hermelin, Eric Faubel, Lionel Rostaing
PURPOSE: We have designed a desensitization program that gives good results and is cost effective for kidney-transplant patients who have a potential living donor, who are ABO incompatible (ABOi), and who may or may not have donor-specific alloantibodies (DSAs). METHODS: Desensitization at pretransplant is based on immunosuppressants (such as rituximab, tacrolimus, and mycophenolic acid) and apheresis to retrieve potentially detrimental isoagglutinins and DSAs from blood...
June 2015: International Journal of Artificial Organs
Stephanie M Toth-Manikowski, Tammy L Sirich, Timothy W Meyer, Thomas H Hostetter, Seungyoung Hwang, Natalie S Plummer, Xin Hai, Josef Coresh, Neil R Powe, Tariq Shafi
BACKGROUND: Residual kidney function (RKF) is thought to exert beneficial effects through clearance of uremic toxins. However, the level of native kidney function where clearance becomes negligible is not known. METHODS: We aimed to assess whether levels of nonurea solutes differed among patients with 'clinically negligible' RKF compared with those with no RKF. The hemodialysis study excluded patients with urinary urea clearance >1.5 mL/min, below which RKF was considered to be 'clinically negligible'...
March 15, 2019: Nephrology, Dialysis, Transplantation
Andrew Davenport, Ayman Guirguis, Michael Almond, Clara Day, Joseph Chilcot, David Wellsted, Ken Farrington
INTRODUCTION: Conventional haemodialysis (HD) involves treatment times of around 4 hours thrice weekly, taking no account of residual kidney function (RKF). In incremental HD the frequency and duration of dialysis sessions are individualized according to RKF. There are no studies comparing these approaches. We utilized data from a recent multicenter study to compare patient characteristics and outcomes between a center practicing incremental HD and others using a conventional approach...
March 12, 2019: Hemodialysis International
Christian Combe, Johannes Mann, David Goldsmith, Frank Dellanna, Philippe Zaoui, Gérard London, Kris Denhaerynck, Andriy Krendyukov, Ivo Abraham, Karen MacDonald
BACKGROUND: DOPPS reported that thousands of life-years could be gained in the US and Europe over 5 years by correcting six modifiable haemodialysis practices. We estimated potential life-years gained across 10 European countries using MONITOR-CKD5 study data. METHODS: The DOPPS-based target ranges were used, except for haemoglobin due to label changes, as well as DOPPS-derived relative mortality risks. Percentages of MONITOR-CKD5 patients outside targets were calculated...
March 5, 2019: BMC Nephrology
Vishal Duggal, Wael F Hussein, Marc Reiterman, Sumi J Sun, Graham E Abra, Brigitte Schiller
INTRODUCTION: A majority of patients with end-stage renal disease (ESRD) on in-center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue as a high priority for improvement. However, evidence for practical interventions to improve recovery time from conventional in-center HD is lacking. The effect of blood flow rate reduction on dialysis recovery time (DRT) is unknown. METHODS: Multicenter, single-blinded, randomized, parallel-design controlled trial of blood flow rate reduction vs...
March 4, 2019: Hemodialysis International
Sharona Johnson, Patricia B Crane, Janice Neil, Cynthia Christiano
Intradialytic events (IDEs), such as cramping, loss of consciousness, bleeding, and allergic reactions, are major stressors for persons on hemodialysis (HD). This study examined the association between coping strategies and stress associated with HD in persons who have experienced an IDE. Using a cross-sectional correlation design, a convenience sample of patients (N=73) completed a Hemodialysis Demographic Form, Ways of Coping Questionnaire, and a Hemodialysis Stress Visual Analog Scale. Most participants were African American (95%), male (52%), with a mean age of 57 (SD=11...
January 2019: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Silvi Shah, Anthony C Leonard, Karthikeyan Meganathan, Annette L Christianson, Charuhas V Thakar
BACKGROUND: Racial minorities and women constitute substantial portions of the incident and prevalent end-stage renal disease (ESRD) population in the United States. Although ESRD is characterized by high mortality, temporal trends, and race and sex differences in mortality have not been studied. METHODS: We evaluated 944,650 adult patients who initiated dialysis between January 1, 2005 and December 31, 2014, using the United States Renal Data System, for sex-related and race-related trends in mortality...
February 28, 2019: American Journal of Nephrology
Yingying Zhang, Xiaoqin Zhang, Jiangtao Li, Xi Liu, Chunli Cui, Aihong Yuan, Ying Yu, Chen Yu
BACKGROUND: The aim of this study was to investigate whether additional volume reduction by ultrafiltration can improve blood pressure in patients with intradialytic hypertension (IDH) defined as at least 10 mmHg systolic blood pressure (SBP) rise during hemodialysis. PATIENTS AND METHODS: This prospective, open-label, single-center study included 11 IDH patients with normal predialytic blood pressure (BP) (group A), 11 IDH patients with high predialytic BP (group B), and 18 patients without IDH as control...
February 21, 2019: Blood Pressure Monitoring
Karthik Madhavan, Lee Onn Chieng, Valerie L Armstrong, Michael Y Wang
OBJECTIVEDiscitis and osteomyelitis are seen in end-stage renal disease (ESRD) patients due to repeated vascular access for hemodialysis and urinary tract infections leading to recurrent bacteremia. Discitis and osteomyelitis are underdiagnosed due to the nonspecific initial presentation of back pain. In this article, we review the literature for better understanding of the problem and the importance of early diagnosis by primary care physicians and nephrologists. In addition, we discuss the decision-making, follow-up, management, and neurological outcomes...
February 15, 2019: Journal of Neurosurgery. Spine
Kyla L Naylor, S Joseph Kim, Eric McArthur, Amit X Garg, Megan K McCallum, Gregory A Knoll
RATIONALE & OBJECTIVE: The mortality rate is high among dialysis patients, but how this compares with other diseases such as cancer is poorly understood. We compared the survival of maintenance dialysis patients with that for patients with common cancers to enhance the understanding of the burden of end-stage kidney disease. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: 33,500 incident maintenance dialysis patients in Ontario, Canada, and 532,452 incident patients with cancer (women: breast, colorectal, lung, or pancreas; men: prostate, colorectal, lung, or pancreas) from 1997 to 2015 using administrative health care databases...
January 28, 2019: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Patrick H Pun, Matthew E Dupre, Monique A Starks, Clark Tyson, Kimberly Vellano, Laura P Svetkey, Steen Hansen, Brian G Frizzelle, Bryan McNally, James G Jollis, Sana M Al-Khatib, Christopher B Granger
BACKGROUND: Out-of-hospital cardiac arrest, the leading cause of death among patients on hemodialysis, occurs frequently within outpatient dialysis centers. Practice guidelines recommend resuscitation training for all dialysis clinic staff and on-site defibrillator availability, but the extent of staff involvement in cardiopulmonary resuscitation (CPR) efforts and its association with outcomes is unknown. METHODS: We used data from the Cardiac Arrest Registry to Enhance Survival and the Centers for Medicare & Medicaid Services dialysis facility database to identify patients who had cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States...
February 7, 2019: Journal of the American Society of Nephrology: JASN
Mabel Aoun, Randa Tabbah
Beta-blockers have numerous indications in the general population and are strongly recommended in heart failure, post-myocardial infarction and arrhythmias. In hemodialysis patients, their use is based on weak evidence because of the lack of a sufficient number of randomized clinical trials. The strongest evidence is based on two trials. The first showed better survival with carvedilol in hemodialysis patients with four sessions per week and systolic heart failure. The second found reduced cardiovascular morbidity with atenolol compared to lisinopril in mostly black hypertensive hemodialysis patients...
February 1, 2019: Néphrologie & Thérapeutique
Małgorzata Gomółka, Longin Niemczyk, Katarzyna Szamotulska, Aleksandra Wyczałkowska-Tomasik, Aleksandra Rymarz, Jerzy Smoszna, Mariusz Jasik, Leszek Pączek, Stanisław Niemczyk
Indoxyl sulfate (IS) and p-cresol sulfate (p-CS) are protein-bound solutes that accumulate in the blood serum in chronic kidney disease and have a detrimental effect on the kidney and other organs' function. This study seeks to define the effectiveness of IS and p-CS clearance after single dialysis sessions and after 8-week-long cycles of hemodialysis using the following different dialysis modalities in succession: low-flux hemodialysis (lfHD), high-flux hemodialysis (hfHD), and post-dilution hemodiafiltration (HDF)...
January 29, 2019: Advances in Experimental Medicine and Biology
Verena Gotta, Olivera Marsenic, Marc Pfister
Urea dialyzer clearance (KD) has been suggested to be underpredicted from blood flow (QB), dialysate flow (QD), and in vitro mass transfer-area coefficient of urea (KoA) in pediatric hemodialysis (HD) patients using a widely accepted mechanistic equation. We characterize factors that could explain this, assuming that it results from a bias between reported in vitro and actual in vivo KoA. An adult urea kinetic model was scaled to 923 patients aged 1-29 years based on pediatric physiologic knowledge (intercompartmental clearance, volumes of distribution)...
January 14, 2019: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Bernard Canaud, Jeroen Kooman, Nicholas M Selby, Maarten Taal, Susan Francis, Pascal Kopperschmidt, Andreas Maierhofer, Peter Kotanko, Jens Titze
Space medicine and new technology such as magnetic resonance imaging of tissue sodium stores (23 NaMRI) have changed our understanding of human sodium homeostasis and pathophysiology. It has become evident that body sodium comprises 3 main components. Two compartments have been traditionally recognized, namely one that is circulating and systemically active via its osmotic action, and one slowly exchangeable pool located in the bones. The third, recently described pool represents sodium stored in skin and muscle interstitium, and it is implicated in cell and biologic activities via local hypertonicity and sodium clearance mechanisms...
February 2019: Kidney International
Julie H Ishida, Charles E McCulloch, Michael A Steinman, Barbara A Grimes, Kirsten L Johansen
BACKGROUND: Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. OBJECTIVES: To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis...
January 10, 2019: Journal of the American Geriatrics Society
Martin J Wolley, Carmel M Hawley, David W Johnson, Mark R Marshall, Matthew A Roberts
BACKGROUND: Haemodialysis is usually started at a frequency of three times a week, with occasional patients starting twice weekly ("incremental dialysis"). Incremental haemodialysis may preserve residual kidney function and has been associated with reduced mortality. In this study we report prevalence and outcomes of incremental dialysis in Australia and New Zealand. METHODS: The cohort was all adults starting renal replacement therapy with haemodialysis in Australia and New Zealand 2004 - 2015...
January 10, 2019: Nephrology
Dimitrie Siriopol, Mihaela Siriopol, Stefano Stuard, Luminita Voroneanu, Peter Wabel, Ulrich Moissl, Daniela Voiculescu, Adrian Covic
Background: Both baseline fluid overload (FO) and fluid depletion are associated with increased mortality risk and cardiovascular complications in haemodialysis patients. Fluid status may vary substantially over time, and this variability could also be associated with poor outcomes. Methods: In our retrospective cohort study, including 4114 haemodialysis patients from 34 Romanian dialysis units, we investigated both all-cause and cardiovascular mortality risk according to baseline pre- and post-dialysis volume status, changes in pre- and post-dialysis fluid status during follow-up (time-varying survival analysis), pre-post changes in volume status during dialysis and pre-dialysis fluid status variability during the first 6 months of evaluation...
January 8, 2019: Nephrology, Dialysis, Transplantation
Samuel A Silver, Abdullah Alaryni, Abdullah Alghamdi, Genevieve Digby, Ron Wald, Eduard Iliescu
RATIONALE & OBJECTIVE: Few data exist revealing how the frequency of routine blood work for patients on maintenance hemodialysis therapy affects patient outcomes and the costs of care. Our objective was to determine the effect of changing the frequency of blood work from 4- to 6-week intervals on the achievement of anemia and chronic kidney disease-mineral and bone disorder (CKD-MBD) targets. STUDY DESIGN: Retrospective interrupted time series from June 1, 2012, to December 31, 2015...
December 28, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
2019-01-03 09:26:08
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