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Lindberg M. SINGLE-CASE EXPERIMENTAL DESIGNS: A CLINICAL RESEARCH OPPORTUNITY IN RENAL CARE. J Ren Care 2019; 45:72-73. [PMID: 31115184 DOI: 10.1111/jorc.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Magnus Lindberg
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Bech AP, Wetzels JFM, Groenewoud H, Nijenhuis T. The Use of N-of-1 Trials to Individualize Treatment in Patients With Renal Magnesium Wasting. Am J Kidney Dis 2018; 73:288-290. [PMID: 30318133 DOI: 10.1053/j.ajkd.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/22/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Anneke P Bech
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jack F M Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans Groenewoud
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tom Nijenhuis
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
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3
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Tai DJ, Leung K, Ravani P, Quinn RR, Scott-Douglas N, MacRae JM. The effect of citrate dialysate on intradialytic heparin dose in haemodialysis patients: study design of a randomised controlled trial. BMC Nephrol 2015; 16:147. [PMID: 26303208 PMCID: PMC4548909 DOI: 10.1186/s12882-015-0144-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 08/13/2015] [Indexed: 11/25/2022] Open
Abstract
Background Unfractionated heparin is the most common anticoagulant used in haemodialysis (HD), although it has many potential adverse effects. Citrate dialysate (CD) has an anticoagulant effect which may allow reduction in cumulative heparin dose (CHD) compared to standard acetate dialysate (AD). Methods This double-blinded, randomised, cross-over trial of chronic haemodialysis patients determines if CD allows reduction in CHD during HD compared with AD. After enrolment, intradialytic heparin is minimised during a two-week run-in period using a standardised protocol based on a visual clotting score. Patients still requiring intradialytic heparin after the run-in period are randomised to two weeks of HD with AD followed by two weeks of CD (Sequence 1) or two weeks of HD with CD followed by two weeks of AD (Sequence 2). The primary outcome is the change in CHD with CD compared with AD. Secondary outcomes include metabolic and haemodynamic parameters, and dialysis adequacy. Discussion This randomised controlled trial will determine the impact of CD compared with AD on CHD during HD. Trial registration ClinicalTrials.gov NCT01466959
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Affiliation(s)
- Davina J Tai
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Kelvin Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Robert R Quinn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | | | - Jennifer M MacRae
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Tiranathanagul K, Tangvoraphonkchai K, Srisawat N, Susantitaphong P, Tungsanga K, Praditpornsilpa K, Eiam-Ong S. Acute intradialytic cardiac function and inflammatory cytokine changes during high-efficiency online hemodiafiltration with acetate-free and standard dialysis solutions. Ther Apher Dial 2014; 19:250-8. [PMID: 25545821 DOI: 10.1111/1744-9987.12271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/01/2014] [Indexed: 11/28/2022]
Abstract
Acetate in standard acetate-containing bicarbonate (AC) dialysis fluid could induce peripheral vasodilatation, suppression of myocardial function, and inflammatory cytokine production, resulting in intradialytic hypotension in conventional hemodialysis (HD) patients. Online hemodiafiltration (HDF) provides superior hemodynamic stability over HD. The potentially additive hemodynamic benefits of the novel acetate-free bicarbonate (AF) dialysis fluid in online HDF have never been explored before. The present randomized, double-blind, crossover study was conducted in 22 online HDF patients to investigate the impact of AF dialysis fluid on hemodynamic and cytokine changes compared with AC dialysis fluid in online HDF. The results demonstrated the comparable changes of arterial pressure between AF and AC online HDF. During the study periods, the incidences of composite intradialytic hypotension and other adverse events were not different. The baseline and hourly changes of cardiac index, cardiac output, and peripheral vascular resistance during dialysis were comparable (P=0.534, 0.199, and 0.641, respectively). The percent reductions of NT-proBNP and cTnT were not significantly different (72.6 ± 12.3 vs. 72.6 ± 12.8%, P=0.99 and 35.2 ± 12.8 vs. 36.7 ± 12.0%, P=0.51). The changes of all pro-inflammatory cytokines (IL-2β, IL-6, IL-8, and TNF-α) and anti-inflammatory cytokine (IL-10) during dialysis were comparable between both groups. In conclusion, AF dialysis solution does not offer additional hemodynamic benefit for stable online HDF patients. The hemodynamic stability provided by online HDF might protect the adverse effects of acetate.
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Affiliation(s)
- Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamonwan Tangvoraphonkchai
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Andrade VM, Dal Pont HS, Leffa DD, Damiani AP, Scaini G, Hainzenreder G, Streck EL, Ferreira GC, Schuck PF. Methylmalonic acid administration induces DNA damage in rat brain and kidney. Mol Cell Biochem 2014; 391:137-45. [DOI: 10.1007/s11010-014-1996-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 02/02/2014] [Indexed: 12/11/2022]
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Abe M, Maruyama N, Matsumoto S, Okada K, Fujita T, Matsumoto K, Soma M. Comparison of sustained hemodiafiltration with acetate-free dialysate and continuous venovenous hemodiafiltration for the treatment of critically ill patients with acute kidney injury. Int J Nephrol 2011; 2011:432094. [PMID: 21660302 PMCID: PMC3108092 DOI: 10.4061/2011/432094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 02/18/2011] [Accepted: 03/04/2011] [Indexed: 11/20/2022] Open
Abstract
We conducted a prospective, randomized study to compare conventional continuous venovenous hemodiafiltration (CVVHDF) with sustained hemodiafiltration (SHDF) using an acetate-free dialysate. Fifty critically ill patients with acute kidney injury (AKI) who required renal replacement therapy were treated with either CVVHDF or SHDF. CVVDHF was performed using a conventional dialysate with an effluent rate of 25 mL·kg−1 · h−1, and SHDF was performed using an acetate-free dialysate with a flow rate of 300−500 mL/min. The primary study outcome, 30 d survival rate was 76.0% in the CVVHDF arm and 88.0% in the SHDF arm (NS). Both the number of patients who showed renal recovery (40.0% and 68.0%, CVVHDF and SHDF, resp.; P < .05), and the hospital stay length (42.3 days and 33.7 days, CVVHDF and SHDF, resp.; P < .05), significantly differed between the two treatments. Although the total convective volumes did not significantly differ, the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm. Our results suggest that compared with conventional CVVHDF, more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
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Zucker DR, Deo A, Schmid CH. Dialysis Research and N-of-1 Trials: Made for Each Other? Am J Kidney Dis 2010; 55:635-8. [DOI: 10.1053/j.ajkd.2009.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/25/2009] [Indexed: 11/11/2022]
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