251
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Li JSC, Chan JYH, Tai MMY, Wong SM, Pang SM, Lam FYF, Chu CHM, Ching CSY, Wong JHS, Chak WL. Hydration and nutritional status in patients on home-dialysis-A single centre study. J Ren Care 2018; 44:142-151. [PMID: 29664189 DOI: 10.1111/jorc.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over-hydration (OH) and malnutrition are prevalent among patients on dialysis therapy. The prevalence of OH and malnutrition as well as the risk factors associated with OH and malnutrition in our patients on home peritoneal dialysis (PD) and home haemodialysis (HD) are examined. DESIGN AND METHODS This was a cross-sectional study. The hydration and nutritional status of the study groups were assessed by a Body Composition Monitor. Patients who were stable on home dialysis therapy for over one year were invited to participate. Univariate and multivariate analyses were performed to identify associated factors and determine the predictors of OH and malnutrition, respectively. RESULTS Eighty-eight patients (41 PD and 47 home HD) were recruited. A 32.95% of our patients on home dialysis therapy were in OH status. There was a significance difference in the prevalence of hydration status between patients on PD and home HD (p = 0.014), as overhydration was more common in patients on PD than home HD (46.34 vs. 21.28%). Dehydration was more common in patients on home HD than PD (29.79 vs. 9.76%). Male gender, decreasing haemoglobin level and presence of diabetes mellitus (DM) were risk factors of OH on multivariable analysis. There was no significance difference in the prevalence of malnutrition between patients on PD and home HD (p = 0.27). Increasing Fat Tissue Index (FTI), height and patients on PD therapy were at higher risk of malnutrition. CONCLUSION OH and malnutrition were prevalent patients on home dialysis therapy.
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Affiliation(s)
- Janet S C Li
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - John Y H Chan
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Mandy M Y Tai
- Central Nursing Division, Queen Elizabeth Hospital, Hong Kong
| | - So M Wong
- Central Nursing Division, Queen Elizabeth Hospital, Hong Kong
| | - S M Pang
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Fanny Y F Lam
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Carmen H M Chu
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Chris S Y Ching
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Joseph H S Wong
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - W L Chak
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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252
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Tabinor M, Elphick E, Dudson M, Kwok CS, Lambie M, Davies SJ. Bioimpedance-defined overhydration predicts survival in end stage kidney failure (ESKF): systematic review and subgroup meta-analysis. Sci Rep 2018; 8:4441. [PMID: 29535377 PMCID: PMC5849723 DOI: 10.1038/s41598-018-21226-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/25/2018] [Indexed: 12/13/2022] Open
Abstract
Both overhydration and comorbidity predict mortality in end-stage kidney failure (ESKF) but it is not clear whether these are independent of one another. We undertook a systematic review of studies reporting outcomes in adult dialysis patients in which comorbidity and overhydration, quantified by whole body bioimpedance (BI), were reported. PubMed, EMBASE, PsychInfo and the Cochrane trial database were searched (1990-2017). Independent reviewers appraised studies including methodological quality (assessed using QUIPS). Primary outcome was mortality, with secondary outcomes including hospitalisation and cardiovascular events. Of 4028 citations identified, 46 matched inclusion criteria (42 cohorts; 60790 patients; 8187 deaths; 95% haemodialysis/5% peritoneal dialysis). BI measures included phase angle/BI vector (41%), overhydration index (39%) and extra:intracellular water ratio (20%). 38 of 42 cohorts had multivariable survival analyses (MVSA) adjusting for age (92%), gender (66%), diabetes (63%), albumin (58%), inflammation (CRP/IL6-37%), non-BI nutritional markers (24%) and echocardiographic data (8%). BI-defined overhydration (BI-OH) independently predicted mortality in 32 observational cohorts. Meta-analysis revealed overhydration >15% (HR 2.28, 95% CI 1.56-3.34, P < 0.001) and a 1-degree decrease in phase angle (HR 1.74, 95% CI 1.37-2.21, P < 0.001) predicted mortality. BI-OH predicts mortality in dialysis patients independent of the influence of comorbidity.
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Affiliation(s)
- Matthew Tabinor
- Institute for Applied Clinical Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Emma Elphick
- Institute for Applied Clinical Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Michael Dudson
- Institute for Applied Clinical Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Chun Shing Kwok
- Institute for Applied Clinical Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Simon J Davies
- Institute for Applied Clinical Sciences, Keele University, Newcastle-under-Lyme, UK.
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253
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Kim JK, Song YR, Lee HS, Kim HJ, Kim SG. Repeated Bioimpedance Measurements Predict Prognosis of Peritoneal Dialysis Patients. Am J Nephrol 2018; 47:120-129. [PMID: 29471301 DOI: 10.1159/000486901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fluid overload is a major risk factor for mortality in patients undergoing peritoneal dialysis (PD). However, few studies have investigated the effect of chronic exposure to sustained fluid overload on long-term outcomes. METHOD A total of 284 prevalent PD patients were included in this prospective study. Repeated multifrequency body composition analysis was performed 12 months apart, and 1-year cumulative chronic fluid overload were used to predict all-cause mortality and the risk for transfer to hemodialysis (HD) during the ensuing 15.6 ± 9.1 months. RESULTS The prevalence of fluid overload was approximately 27%. Interestingly, a substantial number of hypervolemic patients at first test were persistently hypervolemic at their second test. With this, chronic fluid overload was observed in 18.3% (n = 52). Notably, most of chronic fluid overload patients had diabetes (86.5%), and it was accompanied by concomitant changes in peritoneal membrane characteristics, a higher progression rate to high transporter. The risk of transfer to HD increased 2.8 times in patients with chronic fluid overload than in those without. Also, it significantly increased the risk of mortality (p = 0.038). Surprisingly, subgroup analysis found that patients with euvolemic status at follow-up experienced no mortality despite being in a fluid overload state at baseline. CONCLUSIONS One-year chronic exposure to fluid overload is a strong independent risk factor for transfer to HD and death in prevalent PD patients. Although the fluid status of most PD patients is not easily changed over time, becoming euvolemic during the entire PD treatment period seems to be very important.
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254
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Kopp C, Linz P, Maier C, Wabel P, Hammon M, Nagel AM, Rosenhauer D, Horn S, Uder M, Luft FC, Titze J, Dahlmann A. Elevated tissue sodium deposition in patients with type 2 diabetes on hemodialysis detected by 23Na magnetic resonance imaging. Kidney Int 2018; 93:1191-1197. [PMID: 29455909 DOI: 10.1016/j.kint.2017.11.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 12/25/2022]
Abstract
Long-term elevated blood sugar levels result in tissue matrix compositional changes in patients with diabetes mellitus type 2 (T2DM). We hypothesized that hemodialysis patients with T2DM might accumulate more tissue sodium than control hemodialysis patients. To test this, 23Na magnetic resonance imaging (23Na MRI) was used to estimate sodium in skin and muscle tissue in hemodialysis patients with or without T2DM. Muscle fat content was estimated by 1H MRI and tissue sodium content by 23Na MRI pre- and post-hemodialysis in ten hemodialysis patients with T2DM and in 30 matched control hemodialysis patients. We also assessed body fluid distribution with the Body Composition Monitor. 1H MRI indicated a tendency to higher muscle fat content in hemodialysis patients with T2DM compared to non-diabetic hemodialysis patients. 23Na MRI indicated increased sodium content in muscle and skin tissue of hemodialysis patients with T2DM compared to control hemodialysis patients. Multi-frequency bioimpedance was used to estimate extracellular water (ECW), and excess ECW in T2DM hemodialysis patients correlated with HbA1c levels. Sodium mobilization during hemodialysis lowered muscle sodium content post-dialysis to a greater degree in T2DM hemodialysis patients than in control hemodialysis patients. Thus, our findings provide evidence that increased sodium accumulation occurs in hemodialysis patients with T2DM and that impaired serum glucose metabolism is associated with disturbances in tissue sodium and water content.
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Affiliation(s)
- Christoph Kopp
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - Peter Linz
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin Maier
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Wabel
- Fresenius Medical Care, Bad Homburg, Germany
| | - Matthias Hammon
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Daniela Rosenhauer
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich C Luft
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jens Titze
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Anke Dahlmann
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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255
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Liu H, Lu R, Shastri S, Sonderman M, Van Buren PN. Assessing Extracellular Volume in Hemodialysis Patients Using Intradialytic Blood Pressure Slopes. Nephron Clin Pract 2018; 139:120-130. [PMID: 29439257 DOI: 10.1159/000487093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Extracellular volume (ECV) overload is a mortality risk factor in hemodialysis patients, but no standard approach exists to objectively assess this clinically. We aimed to quantify relationships between slopes of repeated intradialytic blood pressure (BP) measurements and ECV. METHODS In a cross-sectional study of 71 hemodialysis patients, we calculated BP slopes from all intradialytic measurements using Gaussian regression. We measured extracellular and total body water (TBW) with bioimpedance spectroscopy. We analyzed unconditional and conditional associations between BP slope and volume metrics with mixed linear models and sensitivity analyses using non-linear intradialytic BP trajectory. RESULTS Mean systolic intradialytic BP slope (IBPS) was -0.06 (0.1) mm Hg/min. Post-dialysis extracellular water (ECW)/weight was the volume metric mostly strongly associated with slope (r = 0.34, p = 0.007 for unconditional analysis; β = 1.45, p = 0.001 for conditional analysis). Among subjects with post-dialysis systolic BP ≥130 mm Hg, the association strengthened (r = 0.40, p = 0.006; β = 1.42, p = 0.003). ECV was more strongly associated with the BP slope than with pre-dialysis, post-dialysis, or delta systolic BP (r = -0.07, 0.19, 0.28; p = 0.6, 0.1, 0.03). In nonlinear models, BP trajectory also had the strongest association with post-dialysis ECW/body weight (p < 0.001). CONCLUSIONS In hypertensive hemodialysis patients, measurements of ECV excess are more strongly associated with IBPSs than with pre-dialysis, post-dialysis, or change in systolic BP. Among varying volume metrics, post-dialysis ECW/weight has the strongest association with these slopes. Determining IBPS is a novel method to optimize clinical assessment of ECV in hemodialysis patients.
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Affiliation(s)
- Hao Liu
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA
| | - Rong Lu
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, Dallas, Texas, USA
| | - Shani Shastri
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA
| | - Mark Sonderman
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA
| | - Peter Noel Van Buren
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA.,Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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256
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Lin J, Cheng Z, Ding X, Qian Q. Acid-Base and Electrolyte Managements in Chronic Kidney Disease and End-Stage Renal Disease: Case-Based Discussion. Blood Purif 2018; 45:179-186. [PMID: 29478053 DOI: 10.1159/000485155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acid-base and electrolyte alterations are common in patients with chronic kidney disease (CKD) and end-stage kidney failure (ESRD). The alterations become more complex as CKD advances to ESRD, leading to morbidity and mortality. Three cases are presented illustrating some key prototypic features in CKD and ESRD. Each is accompanied by discussion of pathophysiology, diagnosis, and treatment options. Newer investigational results are integrated into the existing body of knowledge. Although rigorous assessment of various dialysis prescriptions is scanty, in its current state, instituting a well thought-out, multi-pronged management plan to minimize CKD/ESRD and dialysis-related electrolyte and acid-base disruptions is appropriate. There is a pressing need for prospective interventional trials in the future.
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Affiliation(s)
- Jing Lin
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhen Cheng
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Qian
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA
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257
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Hildegard Stancu S, Stanciu A, Lipan M, Capusa C. Renal anemia and hydration status in non-dialysis chronic kidney disease: Is there a link? J Med Life 2018; 11:293-298. [PMID: 30894885 PMCID: PMC6418336 DOI: 10.25122/jml-2019-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale: Anemia, a common feature in chronic kidney disease (CKD), has multiple contributors to its pathogenesis. Besides the well recognized erythropoietin and iron deficiencies, hydration status might be involved. Objective: To assess the prevalence and correlations of anemia, iron deficiency and overhydration in patients with stage 2 to 5 CKD. Methods and Results: This cross-sectional study enrolled 125 erythropoietin and iron therapy naïve non-dialysis CKD patients, without a identifiable cause of anemia. Parameters of hematological, iron, inflammatory and nutritional status were measured. The overhydration parameter (OH) assessed by bioimpedance spectroscopy was used to characterize hydration status. The prevalence of decreased hemoglobin (Hb) <110g/L increased along CKD stages from 0% to 40% (p=0.008). Fluid overload (OH >1L) and lower serum albumin (<40g/L) were more common in stage 5 versus stage 3 CKD (53% vs. 10%, p<0.001, and 27% vs. 3%, p=0.02, respectively), suggesting a potential dilutional reduction in serum proteins. Conversely, decreased iron stores (ferritin <100mcg/L) and iron availability (transferrin saturation, TSAT<0.20) were similarly prevalent irrespective of kidney function decline. Hemoglobin was positively correlated with estimated glomerular filtration rate (eGFR), serum albumin, and transferrin saturation, but inversely with OH. However, in a model of multiple linear regression which explained 32% of hemoglobin variation, only eGFR and overhydration remained the independent predictors of anemia. Discussion: As fluid overload is a common denominator for hemoglobin and TSAT levels, and is closely related to the declining kidney function, it should be considered in the management of renal anemia, at least in advanced CKD.
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Affiliation(s)
- Simona Hildegard Stancu
- “Carol Davila” University of Medicine and Pharmacy, Nephrology Dept., Bucharest, Romania,“Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Ana Stanciu
- “Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Mariana Lipan
- “Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Cristina Capusa
- “Carol Davila” University of Medicine and Pharmacy, Nephrology Dept., Bucharest, Romania,“Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
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258
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Sherman RA. Briefly Noted. Semin Dial 2018. [DOI: 10.1111/sdi.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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259
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Miskulin DC, Gassman J, Schrader R, Gul A, Jhamb M, Ploth DW, Negrea L, Kwong RY, Levey AS, Singh AK, Harford A, Paine S, Kendrick C, Rahman M, Zager P. BP in Dialysis: Results of a Pilot Study. J Am Soc Nephrol 2017; 29:307-316. [PMID: 29212839 DOI: 10.1681/asn.2017020135] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/28/2017] [Indexed: 01/13/2023] Open
Abstract
The optimal BP target for patients receiving hemodialysis is unknown. We randomized 126 hypertensive patients on hemodialysis to a standardized predialysis systolic BP of 110-140 mmHg (intensive arm) or 155-165 mmHg (standard arm). The primary objectives were to assess feasibility and safety and inform the design of a full-scale trial. A secondary objective was to assess changes in left ventricular mass. Median follow-up was 365 days. In the standard arm, the 2-week moving average systolic BP did not change significantly during the intervention period, but in the intensive arm, systolic BP decreased from 160 mmHg at baseline to 143 mmHg at 4.5 months. From months 4-12, the mean separation in systolic BP between arms was 12.9 mmHg. Four deaths occurred in the intensive arm and one death occurred in the standard arm. The incidence rate ratios for the intensive compared with the standard arm (95% confidence intervals) were 1.18 (0.40 to 3.33), 1.61 (0.87 to 2.97), and 3.09 (0.96 to 8.78) for major adverse cardiovascular events, hospitalizations, and vascular access thrombosis, respectively. The intensive and standard arms had similar median changes (95% confidence intervals) in left ventricular mass of -0.84 (-17.1 to 10.0) g and 1.4 (-11.6 to 10.4) g, respectively. Although we identified a possible safety signal, the small size and short duration of the trial prevent definitive conclusions. Considering the high risk for major adverse cardiovascular events in patients receiving hemodialysis, a full-scale trial is needed to assess potential benefits of intensive hypertension control in this population.
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Affiliation(s)
- Dana C Miskulin
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Ronald Schrader
- Quality Management Department, Dialysis Clinic, Inc., Albuquerque, New Mexico
| | - Ambreen Gul
- Quality Management Department, Dialysis Clinic, Inc., Albuquerque, New Mexico
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David W Ploth
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Lavinia Negrea
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raymond Y Kwong
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Andrew S Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Ajay K Singh
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Antonia Harford
- Quality Management Department, Dialysis Clinic, Inc., Albuquerque, New Mexico.,Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Susan Paine
- Quality Management Department, Dialysis Clinic, Inc., Albuquerque, New Mexico
| | - Cynthia Kendrick
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Philip Zager
- Quality Management Department, Dialysis Clinic, Inc., Albuquerque, New Mexico; .,Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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260
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Abstract
Acid-base alterations in patients with kidney failure and on hemodialysis (HD) treatment contribute to (1) intradialytic hypercapnia and hypoxia, (2) hemodynamic instability and cardiac arrhythmia, (3) systemic inflammation, and (4) a number of associated electrolyte alterations including potentiating effects of hypokalemia, hypocalcemia and, chronically, soft-tissue and vascular calcification, imparting poor prognosis and mortality. This paper discusses acid-base regulation and pathogenesis of dysregulation in patients with kidney failure. Major organ and systemic effects of acid-base perturbations with a specific focus on kidney failure patients on HD are emphasized, and potential mitigating strategies proposed. The high rate of HD-related complications, specifically those that can be accounted for by rapid and steep acid-base perturbations imposed by HD treatment, attests to the pressing need for investigations to establish a better dialysis regimen.
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Affiliation(s)
- Qi Qian
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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261
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Abstract
PURPOSE OF REVIEW Volume management in hemodialysis patients is often challenging. Assessing volume status and deciding how much fluid to remove during hemodialysis, the so-called ultrafiltration rate (UFR), has remained a conundrum. RECENT FINDINGS To date there is no objective assessment tool to determine the needed UFR during each hemodialysis session. Higher volume overload or higher UFR is associated with poor outcomes including worse mortality and unfavorable clinical outcomes. We suggest combined use of the following criteria to determine UFR or post-dialysis target dry weight: pre-hemodialysis blood pressure and its intradialytic changes, muscle cramps, dyspnea from pulmonary vascular congestion, peripheral edema, tachycardia or palpitation, headache or lightheadedness, perspiration, and post-dialysis fatigue. Restricting fluid and salt intake-and high-dose loop diuretic use in cases of residual kidney function-can be helpful in controlling fluid gains. More frequent and more severe hypotensive episodes are associated with poor outcomes including higher death risk.
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Affiliation(s)
- Jason A Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
- Division of Nephrology, Department of Medicine, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
- Division of Nephrology, Department of Medicine, University of California, Irvine, School of Medicine, Orange, CA, USA.
- Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
- Harold Simmons Center for Kidney Disease Research & Epidemiology, Division of Nephrology & Hypertension, University of California Irvine, School of Medicine, 101 The City Drive South, City Tower, Suite 400-ZOT: 4088, Orange, CA, 92868-3217, USA.
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262
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Voroneanu L, Gavrilovici C, Covic A. Overhydration, underhydration, and total body sodium: A tricky “ménage a trois” in dialysis patients. Semin Dial 2017; 31:21-25. [DOI: 10.1111/sdi.12649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luminita Voroneanu
- Nephrology Department; Dialysis and Renal Transplant Center; “Dr. C.I. Parhon” University Hospital; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Cristina Gavrilovici
- Center for Health Policy and Ethics; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
| | - Adrian Covic
- Nephrology Department; Dialysis and Renal Transplant Center; “Dr. C.I. Parhon” University Hospital; “Grigore T. Popa” University of Medicine and Pharmacy; Iasi Romania
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263
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Flythe JE. Turning the Tide: Improving Fluid Management in Dialysis through Technology. J Am Soc Nephrol 2017; 28:2260-2262. [PMID: 28620082 DOI: 10.1681/asn.2017050491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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