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Yang B, Yang S, Gong R, Song Y, Wang X, Wang L. Application of blood purification based on a new type of nanofiber membrane in critically ill patients and comparative analysis of its nursing methods. Prev Med 2023; 175:107658. [PMID: 37567368 DOI: 10.1016/j.ypmed.2023.107658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
Blood purification technology is one of the main treatment methods to prolong the life of severe patients. The traditional blood purification membrane materials have the disadvantages of non-selective adsorption, single pore size and low permeability, and need to develop new and efficient blood purification membrane materials. To explore the application of a new type of nanofiber membrane in blood purification of critically ill patients and compare and analyze its nursing methods. When the experimental subjects are performing blood purification, a new nanofiber membrane material is used in the purification machine. The control group adopted conventional nursing methods, while the experimental group adopted targeted nursing methods based on the nursing methods of the control group. After intervention, the eight indicators of quality of life in the experimental group were significantly improved (P < 0.05), for example, the score of physiological function was increased from 41.042 ± 7.625 to 54.236 ± 2.544, and the energy status was increased from 46.094 ± 7.192 to 59.768 ± 4.241. The physiological and biochemical indexes of both groups tend to be normal, but the experimental group is more obvious. The patients in the experimental group were more satisfied with the nursing services provided in the process. The new blood purification method of nanofiber membrane can overcome the shortcomings of traditional purification and remove toxic small and medium-sized molecules to the maximum extent.
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Affiliation(s)
- Bo Yang
- ICU, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Suozhu Yang
- ICU, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Rui Gong
- ICU, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yan Song
- ICU, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Xue Wang
- ICU, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Lei Wang
- ICU, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
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2
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Esper AM, Arabi YM, Cecconi M, Du B, Giamarellos-Bourboulis EJ, Juffermans N, Machado F, Peake S, Phua J, Rowan K, Suh GY, Martin GS. Systematized and efficient: organization of critical care in the future. Crit Care 2022; 26:366. [PMID: 36443764 PMCID: PMC9707068 DOI: 10.1186/s13054-022-04244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Since the advent of critical care in the twentieth century, the core elements that are the foundation for critical care systems, namely to care for critically ill and injured patients and to save lives, have evolved enormously. The past half-century has seen dramatic advancements in diagnostic, organ support, and treatment modalities in critical care, with further improvements now needed to achieve personalized critical care of the highest quality. For critical care to be even higher quality in the future, advancements in the following areas are key: the physical ICU space; the people that care for critically ill patients; the equipment and technologies; the information systems and data; and the research systems that impact critically ill patients and families. With acutely and critically ill patients and their families as the absolute focal point, advancements across these areas will hopefully transform care and outcomes over the coming years.
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Affiliation(s)
- Annette M Esper
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University and Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard Health Affairs, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maurizio Cecconi
- Department of Anaesthesia and Intensive Care, Humanitas University, Milan, Italy
| | - Bin Du
- National Key Laboratory of Rare, Complex and Critical Diseases, Medical ICU, Union Medical College Hospital, Peking/Beijing, China
| | | | - Nicole Juffermans
- Laboratory of Translational Intensive Care Erasmus Medical Center, Rotterdam, the Netherlands
- OLVG Hospital, Amsterdam, the Netherlands
| | - Flavia Machado
- Anesthesiology, Pain and Intensive Care Department, Hospital São Paulo, Federal University of São Paulo, São Paulo, Brazil
| | - Sandra Peake
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jason Phua
- FAST and Chronic Programmes, Alexandra Hospital, Singapore, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Kathryn Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Gee Young Suh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University and Grady Memorial Hospital, Atlanta, Georgia, USA.
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3
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Sarnak MJ, Auguste BL, Brown E, Chang AR, Chertow GM, Hannan M, Herzog CA, Nadeau-Fredette AC, Tang WHW, Wang AYM, Weiner DE, Chan CT. Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e146-e164. [PMID: 35968722 DOI: 10.1161/cir.0000000000001088] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence supports the overarching hypothesis that a more physiological approach to administering dialysis therapy, including in the home through home hemodialysis or peritoneal dialysis, may lead to improvement in several cardiovascular risk factors and cardiovascular outcomes compared with thrice-weekly in-center hemodialysis. The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease.
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4
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Does delivering more dialysis improve clinical outcomes? What randomized controlled trials have shown. J Nephrol 2022; 35:1315-1327. [PMID: 35041196 DOI: 10.1007/s40620-022-01246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
Some randomized controlled trials (RCTs) have sought to determine whether different dialysis techniques, dialysis doses and frequencies of treatment are able to improve clinical outcomes in end-stage kidney disease (ESKD). Virtually all of these RCTs were enacted on the premise that 'more' haemodialysis might improve clinical outcomes compared to 'conventional' haemodialysis. Aim of the present narrative review was to analyse these landmark RCTs by posing the following question: were their intervention strategies (i.e., earlier dialysis start, higher haemodialysis dose, intensive haemodialysis, increase in convective transport, starting haemodialysis with three sessions per week) able to improve clinical outcomes? The answer is no. There are at least two main reasons why many RCTs have failed to demonstrate the expected benefits thus far: (1) in general, RCTs included relatively small cohorts and short follow-ups, thus producing low event rates and limited statistical power; (2) the designs of these studies did not take into account that ESKD does not result from a single disease entity: it is a collection of different diseases and subtypes of kidney dysfunction. Patients with advanced kidney failure requiring dialysis treatment differ on a multitude of levels including residual kidney function, biochemical parameters (e.g., acid base balance, serum electrolytes, mineral and bone disorder), and volume overload. In conclusion, the different intervention strategies of the RCTs herein reviewed were not able to improve clinical outcomes of ESKD patients. Higher quality studies are needed to guide patients and clinicians in the decision-making process. Future RCTs should account for the heterogeneity of patients when considering inclusion/exclusion criteria and study design, and should a priori consider subgroup analyses to highlight specific subgroups that can benefit most from a particular intervention.
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5
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Tennankore KK, Nadeau-Fredette AC, Vinson AJ. Survival comparisons in home hemodialysis: Understanding the present and looking to the future. Nephrol Ther 2021; 17S:S64-S70. [PMID: 33910701 DOI: 10.1016/j.nephro.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 10/21/2022]
Abstract
A number of studies have compared relative survival for home hemodialysis patients (including longer hours/more frequent schedules) and other forms of renal replacement therapy. While informative, many of these studies have been limited by issues pertaining to their observational design including selection bias and residual confounding. Furthermore the few randomized controlled trials that have been conducted have been underpowered to detect a survival difference. Finally, in the face of a growing recognition of the value of patient-important outcomes beyond survival, the focus of comparisons between dialysis modalities may be changing. In this review, we will discuss the determinants of survival for patients receiving home hemodialysis and address the various studies that have compared relative survival for differing home hemodialysis schedules to each of in-center hemodialysis, peritoneal dialysis and transplantation. We will conclude this review by discussing whether there is an ongoing role for survival analyses in home hemodialysis.
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Affiliation(s)
- Karthik K Tennankore
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada.
| | | | - Amanda J Vinson
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada
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Schiffl H. High-volume online haemodiafiltration treatment and outcome of end-stage renal disease patients: more than one mode. Int Urol Nephrol 2020; 52:1501-1506. [PMID: 32488753 PMCID: PMC7378113 DOI: 10.1007/s11255-020-02489-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/29/2020] [Indexed: 12/18/2022]
Abstract
The reduction of the dismally high mortality of current end-stage renal disease patients maintained on conventional standard haemodialysis (HD) remains an unmet medical need. Online haemodiafiltration (HDF) modes with various sites of fluid substitution (post-, pre-, mixed- and mid-dilution) are increasingly used worldwide as promising alternatives to conventional HD. Large scale cohort studies, post hoc analyses of randomized trials, and individual participant meta-analyses suggest that post-dilution and pre-dilution, especially with high substitution volumes, improve outcomes compared with conventional standard HD. However, there is no definitive proof of a survival advantage of HDF over standard HD. The different modes of high-volume HDF should be considered a therapeutic platform allowing to personalize and tailor routine HDF treatment. The selection of the HDF mode should be made according to individual patient characteristics. Utilizing high retention onset membranes, expanded haemodialysis (HDx) can achieve the same solute removal performance as HDF. Subgroups of high-volume OL-HDF patients could benefit from HDx. Ongoing and future trials should provide definitive proof for the superiority of high-volume OL-HDF over conventional HD or HDx to give guidance for the most favourable mode of dialytic therapy for clinical use.
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Affiliation(s)
- Helmut Schiffl
- Department of Internal Medicine IV, University Hospital LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany.
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7
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van Vuuren S, Frank L. Review: Southern African medicinal plants used as blood purifiers. JOURNAL OF ETHNOPHARMACOLOGY 2020; 249:112434. [PMID: 31812645 DOI: 10.1016/j.jep.2019.112434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMALOGICAL RELEVANCE Blood purification practices, also referred to as blood cleansing or detoxification, is an ancient concept which is widespread amongst African traditional medicine, but for which no modern scientific basis exists. There prevails considerable ambiguity in defining what a blood purifier is. AIM OF THE STUDY The purpose of this review is to firstly define what a blood purifier is in the context of African traditional medicine and compare to other cultural and westernized interpretations. Thereafter, this study identifies traditionally used medicinal plants used as blood purifiers in southern Africa and correlates these species to scientific studies, which may support evidence for these "blood purifying plant species". MATERIALS AND METHODS Ethnobotanical books and review articles were used to identify medicinal plants used for blood purification. Databases such as Scopus, ScienceDirect, PubMed and Google Scholar were used to source scientific articles. An evaluation was made to try correlate traditional use to scientific value of the plant species. RESULTS One hundred and fifty nine plant species have been documented as traditional remedies for blood purification. Most of the plant species have some pharmacological activity, however, very little link to the traditional use for blood purification. There has been some justification of the link between blood purification and the use as an antimicrobial and this has been explored in many of the plant species identified as blood purifiers. Other pharmacological studies specifically pertaining to the blood require further attention. CONCLUSION Irrespective of the ambiguity of interpretation, medicinal plants used to "cleanse the blood", play an important holistic role in traditional medicine and this review with recommendations for further study provides some value of exploring this theme in the future.
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Affiliation(s)
- S van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
| | - L Frank
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
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8
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Nishio-Lucar AG, Bose S, Lyons G, Awuah KT, Ma JZ, Lockridge RS. Intensive Home Hemodialysis Survival Comparable to Deceased Donor Kidney Transplantation. Kidney Int Rep 2020; 5:296-306. [PMID: 32154451 PMCID: PMC7056865 DOI: 10.1016/j.ekir.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Kidney transplantation (KT) remains the treatment of choice for end-stage kidney disease (ESKD), but access to transplantation is limited by a disparity between supply and demand for suitable organs. This organ shortfall has resulted in the use of a wider range of donor kidneys and, in parallel, a reexamination of potential alternative renal replacement therapies. Previous studies comparing Canadian intensive home hemodialysis (IHHD) with deceased donor (DD) KT in the United States reported similar survival, suggesting IHHD might be a plausible alternative. Methods Using data from the Scientific Registry of Transplant Recipients and an experienced US-based IHHD program in Lynchburg, VA, we retrospectively compared mortality outcomes of a cohort of IHHD patients with transplant recipients within the same geographic region between October 1997 and June 2014. Results We identified 3073 transplant recipients and 116 IHHD patients. Living donor KT (n = 1212) had the highest survival and 47% reduction in risk of death compared with IHHD (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34–0.83). Survival of IHHD patients did not statistically differ from that of DD transplant recipients (n = 1834) in adjusted analyses (HR: 0.96; 95% CI: 0.62–1.48) or when exclusively compared with marginal (Kidney Donor Profile Index >85%) transplant recipients (HR: 1.35; 95% CI: 0.84–2.16). Conclusion Our study showed comparable overall survival between IHHD and DD KT. For appropriate patients, IHHD could serve as bridging therapy to transplant and a tenable long-term renal replacement therapy.
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Affiliation(s)
- Angie G Nishio-Lucar
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Subhasish Bose
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
| | - Genevieve Lyons
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Kwabena T Awuah
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
| | - Jennie Z Ma
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Robert S Lockridge
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
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SANGEETHA M, KANDASWAMY A, LAKSHMI DEEPIKA C, REVANTH C. FINITE ELEMENT ANALYSIS FOR COMPARING THE PERFORMANCE OF STRAIGHT AND UNDULATED FIBERS IN ALTERING THE FILTERING EFFICIENCY OF HEMODIALYZER MEMBRANES. J MECH MED BIOL 2019. [DOI: 10.1142/s021951941850063x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The hemodialyzer, known as “artificial kidney”, serves as an excellent tool in filtering the impurities from blood. The structure of the hemodialyzer plays a major role in separation of solutes through diffusion. The hemodialyzer module consists of thousands of hollow fibers, which actually filter the toxins such as urea and creatinine from the blood. Many of the commercially available hemodialyzer modules consist of fibers available in different configurations, viz. straight and crimped (undulated). It has been reported that fiber crimping enhances solute clearance. In crimped fibers, the waviness is dictated by two parameters, namely the crimp count and crimp amplitude. These two parameters should be optimized when inducing fiber crimps. However, excessive crimping also leads to fiber damage. In this paper, the hemodialyzer membrane is modeled which describes the structure of Fresenius Polysulfone-Hemoflow (F6HPS) in two configurations, viz. straight and crimped and finite element analysis is carried out using finite element software COMSOL multiphysics5.2a. The solute clearance is studied in straight fibers as well as crimped fibers for the same length while varying the crimp count and crimp amplitude. It has been observed that in crimped fibers, increasing the crimp count and crimp amplitude increases the clearance significantly when compared to straight fibers. While increasing the crimp count as [Formula: see text], the clearance is nearly twice that of straight fiber. This clearly shows that when developing hemodialyzers with undulations, the crimp count and crimp amplitude has to be optimized in order to get a better filtering efficiency.
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Affiliation(s)
- M. S. SANGEETHA
- Department of Biomedical Engineering, PSG College of Technology, Coimbatore 641004, Tamilnadu, India
| | - A. KANDASWAMY
- Industry Sponsored Research and Consultancy, PSG College of Technology, Coimbatore 641004, Tamilnadu, India
| | - C. LAKSHMI DEEPIKA
- Department of Electronics and Communication Engineering, PSG College of Technology, Coimbatore 641004, Tamilnadu, India
| | - C. V. REVANTH
- Department of Biomedical Engineering, PSG College of Technology, Coimbatore 641004, Tamilnadu, India
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10
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Deira J, Suárez MA, López F, García-Cabrera E, Gascón A, Torregrosa E, García GE, Huertas J, de la Flor JC, Puello S, Gómez-Raja J, Grande J, Lerma JL, Corradino C, Musso C, Ramos M, Martín J, Basile C, Casino FG. IHDIP: a controlled randomized trial to assess the security and effectiveness of the incremental hemodialysis in incident patients. BMC Nephrol 2019; 20:8. [PMID: 30626347 PMCID: PMC6325813 DOI: 10.1186/s12882-018-1189-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 12/17/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Most people who make the transition to renal replacement therapy (RRT) are treated with a fixed dose thrice-weekly hemodialysis réegimen, without considering their residual kidney function (RKF). Recent papers inform us that incremental hemodialysis is associated with preservation of RKF, whenever compared with conventional hemodialysis. The objective of the present controlled randomized trial (RCT) is to determine if start HD with one sessions per week (1-Wk/HD), it is associated with better patient survival and other safety parameters. METHODS/DESIGN IHDIP is a multicenter RCT experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 incident patients older than 18 years, with a RRF of ≥4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with incremental HD (1-Wk/HD). The control group includes 76 patients who will start with thrice-weekly hemodialysis régimen. The primary outcome is assessing the survival rate, while the secondary outcomes are the morbidity rate, the clinical parameters, the quality of life and the efficiency. DISCUSSION This study will enable to know the number of sessions a patient should receive when starting HD, depending on his RRF. The potentially important clinical and financial implications of incremental hemodialysis warrant this RCT. TRIAL REGISTRATION U.S. National Institutes of Health, ClinicalTrials.gov . Number: NCT03239808 , completed 13/04/2017. SPONSOR Foundation for Training and Research of Health Professionals of Extremadura.
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Affiliation(s)
- Javier Deira
- Hospital San Pedro de Alcantara, Cáceres, Spain.
| | | | | | | | | | | | | | - Jorge Huertas
- Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador
| | | | - Suleya Puello
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | | | - José L Lerma
- Complejo Asistencial Universitario, Salamanca, Spain
| | | | - Carlos Musso
- Hospital Durand de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlo Basile
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco G Casino
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy.,Dialysis Centre SM2, Potenza, Italy
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11
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Suárez MA, García-Cabrera E, Gascón A, López F, Torregrosa E, García GE, Huertas J, de la Flor JC, Puello S, Gómez-Raja J, Grande J, Lerma JL, Corradino C, Ramos M, Martín J, Basile C, Casino FG, Deira J. Rationale and design of DiPPI: A randomized controlled trial to evaluate the safety and effectiveness of progressive hemodialysis in incident patients. Nefrologia 2018; 38:630-638. [PMID: 30344012 DOI: 10.1016/j.nefro.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Progressive haemodialysis (HD) is a starting regime for renal replacement therapy (RRT) adapted to each patient's necessities. It is mainly conditioned by the residual renal function (RRF). The frequency of sessions with which patients start HD (one or two sessions per week), is lower than that for conventional HD (three times per week). Such frequency is increased (from one to two sessions, and from two to three sessions) as the RRF declines. METHODOLOGY/DESIGN IHDIP is a multicentre randomised experimental open trial. It is randomised in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 patients older than 18 years with chronic renal disease stage 5 and start HD as RRT, with an RRF of ≥4ml/min/1.73m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with one session of HD per week (progressive HD). The control group includes 76 patients who will start with three sessions per week (conventional HD). The primary purpose is assessing the survival rate, while the secondary purposes are the morbidity rate (hospital admissions), the clinical parameters, the quality of life and the efficiency. DISCUSSION This study will enable us to know, with the highest level of scientific evidence, the number of sessions a patient should receive when starting the HD treatment, depending on his/her RRF. TRIAL REGISTRATION Registered at the U.S. National Institutes of Health, ClinicalTrials.gov under the number NCT03239808.
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Affiliation(s)
- Miguel A Suárez
- Unidad de Nefrología, Hospital Virgen del Puerto, Plasencia, España.
| | | | - Antonio Gascón
- Unidad de Nefrología, Hospital Obispo Polanco, Teruel, España
| | - Francisca López
- Unidad de Nefrología, Hospital Costa del Sol, Marbella, España
| | | | | | - Jorge Huertas
- Unidad de Nefrología, Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador
| | - José C de la Flor
- Unidad de Nefrología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - Suleyka Puello
- Unidad de Nefrología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | | | - Jesús Grande
- Unidad de Nefrología, Hospital Virgen de la Concha, Zamora, España
| | - José L Lerma
- Unidad de Nefrología, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | - Manuel Ramos
- Unidad de Nefrología, Hospital de Jerez, Jerez de la Frontera, España
| | - Jesús Martín
- Unidad de Nefrología, Hospital Nuestra Sra. de Sonsoles, Ávila, España
| | - Carlo Basile
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italia
| | - Francesco G Casino
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italia; Dialysis Centre SM2, Potenza, Italia
| | - Javier Deira
- Unidad de Nefrología, Hospital San Pedro de Alcántara, Cáceres, España
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12
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Davenport A. Complications of hemodialysis treatments due to dialysate contamination and composition errors. Hemodial Int 2016; 19 Suppl 3:S30-3. [PMID: 26448385 DOI: 10.1111/hdi.12350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although hemodialysis is a routine outpatient treatment for millions of patients with a proven safety record, accidents and errors do occur from time to time. Many nephrologists are unaware of the technical aspects of providing a safe and reliable dialysate and rely on the support and advice of renal technologists. Complications may arise due to bacterial and chemical contamination of potable water, errors in dialysate acid or bicarbonate solution composition and proportioning, and resetting machine conductivity and temperature controls. As such, clinicians need to be aware of the possible complications of hemodialysis so that these are recognized promptly to provide appropriate management and minimize patient harm.
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Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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13
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Mitsides N, Mitra S, Cornelis T. Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis. Int J Nephrol Renovasc Dis 2016; 9:151-9. [PMID: 27462173 PMCID: PMC4940011 DOI: 10.2147/ijnrd.s89411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.
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Affiliation(s)
- Nicos Mitsides
- Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK
| | - Sandip Mitra
- Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK
| | - Tom Cornelis
- Department of Nephrology, Jessa Hospital, Hasselt, Belgium
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14
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Haemodialysis and haemodiafiltration lead to similar changes in vascular stiffness during treatment. Int J Artif Organs 2016; 39:228-34. [PMID: 27312434 DOI: 10.5301/ijao.5000503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Haemodiafiltration (HDF) has been reported to cause less hypotension than haemodialysis (HD). We hypothesized that HDF causes less change in vascular tone, thereby reducing hypotension. METHODS Aortic pulse wave velocity (PWVao) was measured in 284 patients, during a single dialysis session using cooled dialysate (117 HD, 177 HDF). Patient groups were matched for age, sex and cardiovascular comorbidity. RESULTS Systolic blood pressure (SBP) declined from 144 ± 26 to 133 ± 26 after 20 minutes, and to 131 ± 26 mmHg post HD, and for HDF from 152 ± 26 to 143 ± 27 after 20 minutes, then to 138 ± 27 mmHg post HDF. Net Ultrafiltration rates to achieve weight loss were similar; HD 0.13 ± 0.06 vs HDF 0.12 ± 0.05 mL/kg/min. PWVao did not change after 20 minutes HD 0.42(-0.7 to 1.3), HDF 0.5 (-0.6 to 1.8) or at the end of the session: HD -0.39 (1.5 to 1.2), HDF -0.41(-2.0 to 1.3) m/s. Aortic augmentation index (AiAxo), assessment of vascular tone fell significantly with both HD; 20 minutes by 6.2 (-2.5 to 14), end 5.6 (-6.7 to 13.9), and HDF 20 min by 4.2 (-2.5 to 10), end 7.8 (-0.8 to 19.3), with no difference between HD and HDF. The ultrafiltration rate correlated with % change in aortic SBP (r = 0.28 p = 0.004), but not with changes in PWVao or augmentation indices. CONCLUSIONS Blood pressure declined during both HD and HDF treatments, as did augmentation indices, unrelated to weight loss, suggesting a reduction in vascular stiffness occurs independently of treatment modality. We did not observe an advantage for HDF.
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15
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Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, Weiner DE, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Slinin Y, Wilt TJ, Rocco M, Kramer H, Choi MJ, Samaniego-Picota M, Scheel PJ, Willis K, Joseph J, Brereton L. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis 2015; 66:884-930. [DOI: 10.1053/j.ajkd.2015.07.015] [Citation(s) in RCA: 603] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 12/13/2022]
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16
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Chazot C, Farrington K, Nistor I, Van Biesen W, Joosten H, Teta D, Siriopol D, Covic A. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. Int Urol Nephrol 2015; 47:1809-16. [PMID: 26377489 DOI: 10.1007/s11255-015-1107-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.
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Affiliation(s)
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
- Postgraduate Medical School, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Ionut Nistor
- ERBP, Ghent University Hospital, Ghent, Belgium
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Wim Van Biesen
- ERBP, Ghent University Hospital, Ghent, Belgium
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Hanneke Joosten
- Department of Internal Medicine, UMCG, Groningen, The Netherlands
| | - Daniel Teta
- Service of Nephrology, Department of Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - Dimitrie Siriopol
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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Cerdá J, Liu KD, Cruz DN, Jaber BL, Koyner JL, Heung M, Okusa MD, Faubel S. Promoting Kidney Function Recovery in Patients with AKI Requiring RRT. Clin J Am Soc Nephrol 2015; 10:1859-67. [PMID: 26138260 DOI: 10.2215/cjn.01170215] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AKI requiring RRT is associated with high mortality, morbidity, and long-term consequences, including CKD and ESRD. Many patients never recover kidney function; in others, kidney function improves over a period of many weeks or months. Methodologic constraints of the available literature limit our understanding of the recovery process and hamper adequate intervention. Current management strategies have focused on acute care and short-term mortality, but new data indicate that long-term consequences of AKI requiring RRT are substantial. Promotion of kidney function recovery is a neglected focus of research and intervention. This lack of emphasis on recovery is illustrated by the relative paucity of research in this area and by the lack of demonstrated effective management strategies. In this article the epidemiologic implications of kidney recovery after AKI requiring RRT are discussed, the available literature and its methodologic constraints are reviewed, and strategies to improve the understanding of factors that affect kidney function recovery are proposed. Measures to promote kidney function recovery are a serious unmet need, with a great potential to improve short- and long-term patient outcomes.
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Affiliation(s)
- Jorge Cerdá
- Department of Medicine, Division of Nephrology, Albany Medical College, Albany, New York;
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine University of California, San Francisco, San Francisco, California
| | - Dinna N Cruz
- Department of Medicine, Division of Nephrology, University of California San Diego, San Diego, California
| | - Bertrand L Jaber
- Department of Medicine, St. Elizabeth's Medical Center Tufts University School of Medicine, Boston, Massachussetts
| | - Jay L Koyner
- Department of Nephrology, University of Chicago, Chicago, Illinois
| | - Michael Heung
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Mark D Okusa
- Department of Medicine, University of Virginia, Charlottesville, Virginia; and
| | - Sarah Faubel
- Department of Medicine, Division of Nephrology, University of Colorado Denver, Denver, Colorado
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Tennankore KK, Kim SJ, Baer HJ, Chan CT. Survival and hospitalization for intensive home hemodialysis compared with kidney transplantation. J Am Soc Nephrol 2014; 25:2113-20. [PMID: 24854268 PMCID: PMC4147990 DOI: 10.1681/asn.2013111180] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/10/2014] [Indexed: 12/25/2022] Open
Abstract
Canadian patients receiving intensive home hemodialysis (IHHD; ≥16 hours per week) have survival comparable to that of deceased donor kidney transplant recipients in the United States, but a comparison with Canadian kidney transplant recipients has not been conducted. We conducted a retrospective cohort study of consecutive, adult IHHD patients and kidney transplant recipients between 2000 and 2011 at a large Canadian tertiary care center. The primary outcome was time-to-treatment failure or death for IHHD patients compared with expanded criteria, standard criteria, and living donor recipients, and secondary outcomes included hospitalization rate. Treatment failure was defined as a permanent switch to an alternative dialysis modality for IHHD patients, and graft failure for transplant recipients. The cohort comprised 173 IHHD patients and 202 expanded criteria, 642 standard criteria, and 673 living donor recipients. There were 285 events in the primary analysis. Transplant recipients had a reduced risk of treatment failure/death compared with IHHD patients, with relative hazards of 0.45 (95% confidence interval [95% CI], 0.31 to 0.67) for living donor recipients, 0.39 (95% CI, 0.26 to 0.59) for standard criteria donor recipients, and 0.42 (95% CI, 0.26 to 0.67) for expanded criteria donor recipients. IHHD patients had a lower hospitalization rate in the first year of treatment compared with standard criteria donor recipients and in the first 3 months of treatment compared with living donor and expanded criteria donor recipients. In this cohort, kidney transplantation was associated with superior treatment and patient survival, but higher early rates of hospitalization, compared with IHHD.
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Affiliation(s)
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Heather J Baer
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard School of Public Health, Boston Massachusetts
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Kasiske BL, Wheeler DC. Kidney Disease: Improving Global Outcomes--an update. Nephrol Dial Transplant 2013; 29:763-9. [PMID: 24286979 DOI: 10.1093/ndt/gft441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Kidney Disease: Improving Global Outcomes (KDIGO) was founded in 2003 to fulfill a need for international cooperation and consolidation in the development and implementation of clinical practice guidelines. KDIGO has experienced a rapid growth in the development of guidelines, producing three guidelines in its first 6 years and another six in the last 3 years. In addition, it has held 12 global conferences on important issues in kidney disease and its treatment. A major effort is under way to support the dissemination and implementation of KDIGO guidelines through various channels, including an Implementation Task Force with official representatives in 86 countries. KDIGO is now under its own management and remains committed to the development of evidence-based guidelines. Future challenges include finding adequate sources of funding and building stronger links with other organizations involved in guideline development and implementation.
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Affiliation(s)
- Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
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Tennankore K, Nadeau-Fredette AC, Chan CT. Intensified home hemodialysis: clinical benefits, risks and target populations. Nephrol Dial Transplant 2013; 29:1342-9. [DOI: 10.1093/ndt/gft383] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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