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Segev G, Foster JD, Francey T, Langston C, Schweighauser A, Cowgill LD. International renal interest society best practice consensus guidelines for intermittent hemodialysis in dogs and cats. Vet J 2024; 305:106092. [PMID: 38442779 DOI: 10.1016/j.tvjl.2024.106092] [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: 06/11/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
Intermittent hemodialysis (IHD) is an advanced adjunctive standard of care for severe acute kidney injury (AKI) and other indications. Most animals with AKI are managed medically, however, when the disease is severe, medical management may not control the consequences of the disease, and animals with a potential for renal recovery may die from the consequences of uremia before recovery has occurred. Extracorporeal therapies aid the management of AKI by expanding the window of opportunity for recovery of sufficient kidney function to become dialysis independent. Intermittent hemodialysis (IHD) was introduced into veterinary medicine over 50 years ago, however, updated guidelines for the delivery of IHD have not been published for several decades. To that end, the International Renal Interest Society (IRIS) constituted a Working Group to establish best practice guidelines for the safe and effective delivery of IHD to animals with indications for dialytic intervention. The IRIS Working Group generated 60 consensus statements and supporting rational for a spectrum of prescription and management categories required for delivery of IHD on designated intermittent dialysis platforms (i.e., AKI, chronic hemodialysis and intoxications). A formal consensus method was used to validate the recommendations by a blinded jury of 12 veterinarians considered experts in extracorporeal therapies and actively performing IHD. Each vote provided a level of agreement for each recommendation proposed by the Working Group. To achieve a consensus, a minimum of 75% of the voting participants had to "strongly agree" or "agree" with the recommendation.
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Affiliation(s)
- Gilad Segev
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Israel.
| | - Jonathan D Foster
- Department of Nephrology and Urology, Friendship Hospital for Animals, Washington DC, USA
| | - Thierry Francey
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Catherine Langston
- Veterinary Clinical Science, The Ohio State University, Columbus, OH, USA
| | - Ariane Schweighauser
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Larry D Cowgill
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
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2
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Okubo A, Doi T, Yamada Y, Morii K, Nishizawa Y, Yamashita K, Fudaba Y, Shigemoto K, Mizuiri S, Usui K, Arita M, Naito T, Masaki T. Early arteriovenous fistula failure associated with mortality and major adverse cardiovascular events in patients undergoing incident hemodialysis. J Vasc Access 2023:11297298231215106. [PMID: 38053252 DOI: 10.1177/11297298231215106] [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: 12/07/2023] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) patency is important for patients undergoing hemodialysis. The association between early AVF failure and the prognosis, including all-cause mortality and major adverse cardiovascular events (MACE), has not been fully investigated. The present study was performed to investigate the association between early AVF failure and 3-year mortality, cardiovascular disease (CVD) mortality, and MACE. METHODS We analyzed 358 patients who started hemodialysis in our institution from October 2008 to February 2020. We defined early AVF failure as cases requiring percutaneous transluminal angioplasty or reoperation within 1 year after AVF surgery. The patients were divided into two groups according to the presence or absence of early AVF failure, and the prognosis of each group was examined. The association between early AVF failure and outcomes (3-year all-cause mortality, CVD mortality, and MACE) was determined using Cox proportional hazards regression analysis. RESULTS During the 3-year follow-up, 75 (20.9%) patients died (cardiovascular death: n = 39) and 145 patients developed MACE. According to the multivariable analysis, the early AVF failure group had a significantly higher risk of 3-year all-cause mortality (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09-1.83; p = 0.009), CVD mortality (HR, 1.54; 95% CI, 1.29-2.08; p < 0.001), and MACE (HR, 1.68; 95% CI, 1.25-2.26; p < 0.001). When the patients were stratified by age, early AVF failure was associated with 3-year all-cause mortality in all groups except for the younger group (<65 years of age). CONCLUSIONS Early AVF failure was associated with an increased risk of 3-year all-cause mortality, CVD mortality, and MACE.
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Affiliation(s)
- Aiko Okubo
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Toshiki Doi
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yumi Yamada
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Kenichi Morii
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiko Nishizawa
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Kazuomi Yamashita
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Yasuhiro Fudaba
- Department of Surgery, Ichiyokai Harada Hospital, Hiroshima, Japan
| | | | - Sonoo Mizuiri
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Koji Usui
- Ichiyokai Ichiyokai Clinic, Hiroshima, Japan
| | | | | | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
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Christou CD, Vasileiadou S, Sotiroudis G, Tsoulfas G. Three-Dimensional Printing and Bioprinting in Renal Transplantation and Regenerative Medicine: Current Perspectives. J Clin Med 2023; 12:6520. [PMID: 37892658 PMCID: PMC10607284 DOI: 10.3390/jcm12206520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
For patients with end-stage kidney disease (ESKD), renal transplantation is the treatment of choice, constituting the most common solid organ transplantation. This study aims to provide a comprehensive review regarding the application of three-dimensional (3D) printing and bioprinting in renal transplantation and regenerative medicine. Specifically, we present studies where 3D-printed models were used in the training of surgeons through renal transplantation simulations, in patient education where patients acquire a higher understanding of their disease and the proposed operation, in the preoperative planning to facilitate decision-making, and in fabricating customized, tools and devices. Three-dimensional-printed models could transform how surgeons train by providing surgical rehearsal platforms across all surgical specialties, enabling training with tissue realism and anatomic precision. The use of 3D-printed models in renal transplantations has shown a positive impact on surgical outcomes, including the duration of the operation and the intraoperative blood loss. Regarding 3D bioprinting, the technique has shown promising results, especially in the field of microfluidic devices, with the development of tissue demonstrating proximal tubules, glomerulus, and tubuloinerstitium function, and in renal organoid development. Such models can be applied for renal disease modeling, drug development, and renal regenerative medicine.
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Affiliation(s)
- Chrysanthos D. Christou
- Department of Transplantation Surgery, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (S.V.); (G.S.); (G.T.)
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Moroșan E, Popovici V, Elian V, Dărăban AM, Rusu AI, Licu M, Mititelu M, Karampelas O. The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5049. [PMID: 36981958 PMCID: PMC10049720 DOI: 10.3390/ijerph20065049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
The treatment and interdisciplinary management of patients with chronic kidney disease (CKD) continue to improve long-term outcomes. The medical nutrition intervention's role is to establish a healthy diet plan for kidney protection, reach blood pressure and blood glucose goals, and prevent or delay health problems caused by kidney disease. Our study aims to report the effects of medical nutrition therapy-substituting foods rich in phosphorus-containing additives with ones low in phosphates content on phosphatemia and phosphate binders drug prescription in stage 5 CKD patients with hemodialysis. Thus, 18 adults with high phosphatemia levels (over 5.5 mg/dL) were monitored at a single center. Everyone received standard personalized diets to replace processed foods with phosphorus additives according to their comorbidities and treatment with prosphate binder drugs. Clinical laboratory data, including dialysis protocol, calcemia, and phosphatemia, were evaluated at the beginning of the study, after 30 and 60 days. A food survey was assessed at baseline and after 60 days. The results did not show significant differences between serum phosphate levels between the first and second measurements; thus, the phosphate binders' initial doses did not change. After 2 months, phosphate levels decreased considerably (from 7.322 mg/dL to 5.368 mg/dL); therefore, phosphate binder doses were diminished. In conclusion, medical nutrition intervention in patients with hemodialysis significantly reduced serum phosphate concentrations after 60 days. Restricting the intake of processed foods containing phosphorus additives-in particularized diets adapted to each patient's comorbidities-and receiving phosphate binders represented substantial steps to decrease phosphatemia levels. The best results were significantly associated with life expectancy; at the same time, they showed a negative correlation with the dialysis period and participants' age.
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Affiliation(s)
- Elena Moroșan
- Department of Clinical Laboratory and Food Safety, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
| | - Violeta Popovici
- Department of Microbiology and Immunology, Faculty of Dental Medicine, Ovidius University of Constanta, 7 Ilarie Voronca Street, 900684 Constanta, Romania
| | - Viviana Elian
- Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050471 Bucharest, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N. C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
| | - Adriana Maria Dărăban
- Faculty of Pharmacy, “Vasile Goldiș” Western University of Arad, 86 Liviu Rebreanu Street, 310045 Arad, Romania
| | - Andreea Ioana Rusu
- Faculty of Pharmacy, “Vasile Goldiș” Western University of Arad, 86 Liviu Rebreanu Street, 310045 Arad, Romania
| | - Monica Licu
- Department of Medical Psychology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Magdalena Mititelu
- Department of Clinical Laboratory and Food Safety, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
| | - Oana Karampelas
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
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Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8160269. [PMID: 35783584 PMCID: PMC9246598 DOI: 10.1155/2022/8160269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 01/26/2023]
Abstract
Acute kidney failure patients while detoxificated by hemodialysis (HD) mostly or continuously faced regular problems such as low blood pressure (hypotension), muscle cramps, nausea, or vomiting. Higher intradialytic symptom leads to low-quality HD treatment. Although more known therapeutic interventions are used to relieve the HD side effects, this study was designed to investigate how intelligent systems can make highly beneficial alterations in dialysis facilities and equipment to ease intradialytic complications and help the staff deliver high-quality treatment. A search was performed among relevant research articles based on nonpharmacological intervention methods considered to prevent adverse effects of renal replacement therapy until 2020 in the PubMed databases using the terms “intradialytic complications,” “intradialytic complication interventions,” “nonpharmacological interventions,” “intradialytic exercises,” and “adequacy calculation methods.” Studies included the prevalence of intradialytic complications, different strategies with the aim of preventing complications, the outcome of intradialytic exercises on dialysis symptoms, and dialysis dose calculation methods. The results showed the incidence of hypotension varying between 5% and 30%, fatigue, muscular cramps, and vomiting as the most common complications during dialysis, which greatly affect the outcome of HD sessions. To prevent hypotension, ultrafiltration profiling, sodium modeling, low dialysate temperature, and changing the position to Trendelenburg are some strategies. Urea reduction ratio (URR), formal urea kinetic modeling (FUKM), formal single-pool urea kinetics, and online clearance monitoring (OCM) are methods for calculating the delivered dose of dialysis in which OCM is a low-cost and accessible way to monitor regularly the quality of dialysis delivered. Integration of the chair and HD machine which is in direct contact with the patient provides an intelligent system that improves the management of the dialysis session to enhance the quality of healthcare service.
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Moustafa BH, ElHatw MK, Shaheen IS. Update on Pediatric Hemodialysis Adequacy. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:323-329. [PMID: 37417185 DOI: 10.4103/1319-2442.379031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
The use of high reflux dialyzers to achieve a Kt/Vurea above 1.2 did not improve patient survival in most literature reports. After an electronic search in many sites, guidelines, systematic reviews, and review articles (cited references): We recommend (1) using the equilibrated double-pool, weekly rather than per session, Kt/Vurea, (2) Use of UF-dry weight to avoid V changes, (3) consider protein catabolic Rate (4) Use of double pool to avoid urea generation rebound effect. Beyond the urea model, other recommended parameters include the middle molecule clearance and patient clinical data as blood pressure control, normal ventricular morphology, and function, absence of anemia, bone mineral disease, vascular calcifications, good nutrition and growth, long-lasting vascular access, less intra-dialysis hypotension, fewer hospitalizations related to complications as infection, long-term patient survival with better life quality. All mentioned parameters are the good markers for adequate dialysis. Since (1) frequent short and (or) slow long dialysis sessions show better solute clearance and hemodynamic stability associated with better control of cardiovascular and bone disease, anemia, nutrition, and growth with better quality of life and survival. (2) The spare in the cost of the antihypertensive medications, erythroid-stimulating drugs, phosphate binders, and frequent hospitalization, compensates for the high dialysis cost. (3) The use of some advisable techniques can minimize access trauma; therefore, HD Model can be changeable according to each patient's clinical and biochemical follow-up dialysis adequacy progress pattern.
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Affiliation(s)
- Bahia H Moustafa
- Department of Pediatric Nephrology, Dialysis/Transplantation Unit, Faculty of Medicine, Cairo University Children Hospital, Cairo University, Cairo, Egypt
| | - Mohamad Khaled ElHatw
- Department of Pediatrics, Northern Area Armed Forces Hospital, Hafr Al Batin, Saudi Arabia
| | - Ihab S Shaheen
- Department of Pediatric Nephrology, Royal Hospital for Children, Glasgow, United Kingdom
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Canaud B, Stuard S, Laukhuf F, Yan G, Canabal MIG, Lim PS, Kraus MA. Choices in hemodialysis therapies: variants, personalized therapy and application of evidence-based medicine. Clin Kidney J 2021; 14:i45-i58. [PMID: 34987785 PMCID: PMC8711767 DOI: 10.1093/ckj/sfab198] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
The extent of removal of the uremic toxins in hemodialysis (HD) therapies depends primarily on the dialysis membrane characteristics and the solute transport mechanisms involved. While designation of ‘flux’ of membranes as well toxicity of compounds that need to be targeted for removal remain unresolved issues, the relative role, efficiency and utilization of solute removal principles to optimize HD treatment are better delineated. Through the combination and intensity of diffusive and convective removal forces, levels of concentrations of a broad spectrum of uremic toxins can be lowered significantly and successfully. Extended clinical experience as well as data from several clinical trials attest to the benefits of convection-based HD treatment modalities. However, the mode of delivery of HD can further enhance the effectiveness of therapies. Other than treatment time, frequency and location that offer clinical benefits and increase patient well-being, treatment- and patient-specific criteria may be tailored for the therapy delivered: electrolytic composition, dialysate buffer and concentration and choice of anticoagulating agent are crucial for dialysis tolerance and efficacy. Evidence-based medicine (EBM) relies on three tenets, i.e. clinical expertise (i.e. doctor), patient-centered values (i.e. patient) and relevant scientific evidence (i.e. science), that have deviated from their initial aim and summarized to scientific evidence, leading to tyranny of randomized controlled trials. One must recognize that practice patterns as shown by Dialysis Outcomes and Practice Patterns Study and personalization of HD care are the main driving force for improving outcomes. Based on a combination of the three pillars of EBM, and particularly on bedside patient–clinician interaction, we summarize what we have learned over the last 6 decades in terms of best practices to improve outcomes in HD patients. Management of initiation of dialysis, vascular access, preservation of kidney function, selection of biocompatible dialysers and use of dialysis fluids of high microbiological purity to restrict inflammation are just some of the approaches where clinical experience is vital in the absence of definitive scientific evidence. Further, HD adequacy needs to be considered as a broad and multitarget approach covering not just the dose of dialysis provided, but meeting individual patient needs (e.g. fluid volume, acid–base, blood pressure, bone disease metabolism control) through regular assessment—and adjustment—of a series of indicators of treatment efficiency. Finally, in whichever way new technologies (i.e. artificial intelligence, connected health) are embraced in the future to improve the delivery of dialysis, the human dimension of the patient–doctor interaction is irreplaceable. Kidney medicine should remain ‘an art’ and will never be just ‘a science’.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, Montpellier, France
- Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office, Fresenius Medical Care, Bad Homburg, Germany
| | - Frank Laukhuf
- Global Medical Office, Fresenius Medical Care, Bad Homburg, Germany
| | | | | | | | - Michael A Kraus
- Indiana University Medical School, Indianapolis, Indiana, USA
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, USA
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Apel C, Hornig C, Maddux FW, Ketchersid T, Yeung J, Guinsburg A. Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability. Clin Kidney J 2021; 14:i98-i113. [PMID: 34987789 PMCID: PMC8711764 DOI: 10.1093/ckj/sfab193] [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: 08/03/2021] [Indexed: 12/31/2022] Open
Abstract
As the prevalence of chronic kidney disease is expected to rise worldwide over the next decades, provision of renal replacement therapy (RRT), will further challenge budgets of all healthcare systems. Most patients today requiring RRT are treated with haemodialysis (HD) therapy and are elderly. This article demonstrates the interdependence of clinical and sustainability criteria that need to be considered to prepare for the future challenges of delivering dialysis to all patients in need. Newer, more sustainable models of high-value care need to be devised, whereby delivery of dialysis is based on value-based healthcare (VBHC) principles, i.e. improving patient outcomes while restricting costs. Essentially, this entails maximizing patient outcomes per amount of money spent or available. To bring such a meaningful change, revised strategies having the involvement of multiple stakeholders (i.e. patients, providers, payers and policymakers) need to be adopted. Although each stakeholder has a vested interest in the value agenda often with conflicting expectations and motivations (or motives) between each other, progress is only achieved if the multiple blocs of the delivery system are advanced as mutually reinforcing entities. Clinical considerations of delivery of dialysis need to be based on the entire patient disease pathway and evidence-based medicine, while the non-clinical sustainability criteria entail, in addition to economics, the societal and ecological implications of HD therapy. We discuss how selection of appropriate modes and features of delivery of HD (e.g. treatment modalities and schedules, selection of consumables, product life cycle assessment) could positively impact decision-making towards value-based renal care. Although the delivery of HD therapy is multifactorial and complex, applying cost-effectiveness analyses for the different HD modalities (conventional in-centre and home HD) can support in guiding payability (balance between clinical value and costs) for health systems. For a resource intensive therapy like HD, concerted and fully integrated care strategies need to be urgently implemented to cope with the global demand and burden of HD therapy.
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Affiliation(s)
- Christian Apel
- Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Carsten Hornig
- Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Frank W Maddux
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | | | - Julianna Yeung
- Health Economics & Market Access Asia-Pacific, Fresenius Medical Care, Hong Kong
| | - Adrian Guinsburg
- Global Medical Office, Fresenius Medical Care, Buenos Aires, Argentina
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Zhao X, Niu Q, Gan L, Hou FF, Liang X, Ni Z, Chen X, McCullough K, Zhao J, Robinson B, Chen Y, Zuo L. Blood flow rate: An independent risk factor of mortality in Chinese hemodialysis patients. Semin Dial 2021; 35:251-257. [PMID: 34550635 DOI: 10.1111/sdi.13023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies suggested the association between blood flow rate (BFR) and mortality might be beyond dialysis adequacy. This study aimed to explore if BFR is an independent predictor of clinical outcomes in Chinese hemodialysis (HD) patients. METHODS This study included data from patients in China Dialysis Outcomes and Practice Patterns Study (DOPPS) Phase 5. Patients with a record of BFR were included, and demographic data, comorbidities, hospitalization, and death records were collected. Associations between BFR and all-cause mortality and hospitalization were analyzed using Cox regression models. RESULTS One thousand four hundred twelve (98.9%) patients were included. Most patients were with BFR < 300 ml/min. After full adjustment, each 10-ml/min increase of BFR was associated with a 6.4% decrease in all-cause mortality risk (HR: 0.936, 95% CI: 0.880-0.996) but not first hospitalization (HR: 0.987, 95% CI: 0.949-1.027). The impact of BFR on mortality may be more prominent in patients who were male gender, nondiabetic, albumin < 4.0 g/dl, and hemoglobin ≥ 9.0 g/dl. CONCLUSION Increased BFR is independently associated with a lower risk of all-cause mortality within the range of BFR 200-300 ml/min. And this effect is more pronounced in patients who were male gender, nondiabetic, albumin < 4.0 g/dl, and hemoglobin ≥ 9.0 g/dl.
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Affiliation(s)
- Xinju Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Qingyu Niu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Liangying Gan
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Fan Fan Hou
- Department of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Keith McCullough
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Yuqing Chen
- Department of Nephrology, Peking University First Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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11
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The Renal Extracellular Matrix as a Supportive Scaffold for Kidney Tissue Engineering: Progress and Future Considerations. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1345:103-118. [PMID: 34582017 DOI: 10.1007/978-3-030-82735-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
During the past decades, diverse methods have been used toward renal tissue engineering in order to replace renal function. The goals of all these techniques included the recapitulation of renal filtration, re-absorptive, and secretary functions, and replacement of endocrine/metabolic activities. It is also imperative to develop a reliable, up scalable, and timely manufacturing process. Decellularization of the kidney with intact ECM is crucial for in-vivo compatibility and targeted clinical application. Contemporarily there is an increasing interest and research in the field of regenerative medicine including stem cell therapy and tissue bioengineering in search for new and reproducible sources of kidneys. In this chapter, we sought to determine the most effective method of renal decellularization and recellularization with emphasis on biologic composition and support of stem cell growth. Current barriers and limitations of bioengineered strategies will be also discussed, and strategies to overcome these are suggested.
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12
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The effect of intradialytic combined exercise on hemodialysis efficiency in end-stage renal disease patients: a randomized-controlled trial. Int Urol Nephrol 2020; 52:969-976. [DOI: 10.1007/s11255-020-02459-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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13
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Peired AJ, Mazzinghi B, De Chiara L, Guzzi F, Lasagni L, Romagnani P, Lazzeri E. Bioengineering strategies for nephrologists: kidney was not built in a day. Expert Opin Biol Ther 2020; 20:467-480. [DOI: 10.1080/14712598.2020.1709439] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Anna Julie Peired
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Benedetta Mazzinghi
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Letizia De Chiara
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Francesco Guzzi
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Laura Lasagni
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Paola Romagnani
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Elena Lazzeri
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), University of Florence, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
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Ashby D, Borman N, Burton J, Corbett R, Davenport A, Farrington K, Flowers K, Fotheringham J, Andrea Fox RN, Franklin G, Gardiner C, Martin Gerrish RN, Greenwood S, Hothi D, Khares A, Koufaki P, Levy J, Lindley E, Macdonald J, Mafrici B, Mooney A, Tattersall J, Tyerman K, Villar E, Wilkie M. Renal Association Clinical Practice Guideline on Haemodialysis. BMC Nephrol 2019; 20:379. [PMID: 31623578 PMCID: PMC6798406 DOI: 10.1186/s12882-019-1527-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022] Open
Abstract
This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: "what does good quality haemodialysis look like?"The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to - most of this is freely available online, at least in summary form.A few notes on the individual sections: 1. This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines "enough" dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term "eKt/V" is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient. 2. This section deals with "non-standard" dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week - this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here. 3. This section deals with membranes (the type of "filter" used in the dialysis machine) and "HDF" (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it's as good as but not better than regular dialysis. 4. This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this. 5. This section deals with dialysate, which is the fluid used to "pull" toxins out of the blood (it is sometimes called the "bath"). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate. 6. This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects. 7. This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful. 8. This section draws together a few aspects of dialysis which don't easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered. There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.
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Affiliation(s)
- Damien Ashby
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England.
| | - Natalie Borman
- Wessex Kidney Centre, Portsmouth NHS Trust, Portsmouth, England
| | - James Burton
- University Hospitals of Leicester NHS Trust, Leicester, England
| | - Richard Corbett
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England
| | | | - Ken Farrington
- Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, England
| | - Katey Flowers
- Wessex Kidney Centre, Portsmouth NHS Trust, Portsmouth, England
| | | | - R N Andrea Fox
- School of Nursing and Midwifery, University of Sheffield, Sheffield, England
| | - Gail Franklin
- East & North Hertfordshire NHS Trust, Stevenage, England
| | | | | | - Sharlene Greenwood
- Renal and Exercise Rehabilitation, King's College Hospital, London, England
| | | | - Abdul Khares
- Haemodialysis Patient, c/o The Renal Association, Bristol, UK
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Jeremy Levy
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Elizabeth Lindley
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Jamie Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Bruno Mafrici
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Kay Tyerman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Enric Villar
- Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, England
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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15
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Pladys A, Bayat S, Couchoud C, Vigneau C, McDonald S. Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study. BMC Nephrol 2019; 20:156. [PMID: 31064344 PMCID: PMC6505110 DOI: 10.1186/s12882-019-1330-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background As patients on daily hemodialysis (DHD) have heterogeneous profiles, DHD benefit in terms of survival is still debated. The aim of this study was to compare DHD practices in France and in Australia and New Zealand. Methods This study was based on data from the French Renal Epidemiology and Information Network (REIN) and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). All incident patients from both registries who underwent DHD (i.e., 5–6 sessions/week, including short daily hemodialysis and long nocturnal hemodialysis) at least once during their trajectories were included, and their characteristics and care trajectories were compared. For survival analyses, one French patient was matched to one Australian or New Zealand patient, based on age, sex and year of dialysis start. Survival was assessed using the Cox proportional hazards model, and access to renal transplantation was evaluated using the Fine & Gray model to take into account death as competing risk. Results Between 2003 and 2012, 523 patients from the AZNDATA and 753 from the REIN registry started DHD. ANZDATA patients were younger (54.8 vs 64.0 years, p < 0.001) and had comorbidities more frequently than French patients. In both registries, one third of patients were on early DHD (i.e., DHD started less than one year after dialysis initiation). Long nocturnal hemodialysis was more frequent in the ANZDATA than in the REIN cohort (20.8 and 3%, respectively). Comparison of the matched subgroups showed comparable survival rates between French and Australian/New Zealand patients (HRadjusted = 1.08; 95%CI: 0.78–1.50). Access to renal transplantation also was similar between matched groups (SHRadjusted = 1.30, 95%CI: 0.86–1.97). Conclusions Our study shows that, despite differences in terms of patients’ characteristics and DHD regimens, the mortality risk and access to renal transplantation are similar in France and Australia and New Zealand. Electronic supplementary material The online version of this article (10.1186/s12882-019-1330-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adélaïde Pladys
- EHESP Rennes, Sorbonne Paris Cité, EA 7449 Reperes, Rennes, France.
| | - Sahar Bayat
- EHESP Rennes, Sorbonne Paris Cité, EA 7449 Reperes, Rennes, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN), Biomedecine Agency, Saint Denis La Plaine, France
| | - Cécile Vigneau
- University of Rennes 1, INSERM U1085-IRSET, Rennes, France.,CHU Pontchaillou, Department of Nephrology, Rennes, France
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,University of Adelaide, Adelaide, Australia
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16
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Yu SY, Tung TW, Yang HY, Chen GY, Shih CC, Lee YC, Chen CC, Zan HW, Meng HF, Lu CJ, Wang CL, Jian WB, Soppera O. A Versatile Method to Enhance the Operational Current of Air-Stable Organic Gas Sensor for Monitoring of Breath Ammonia in Hemodialysis Patients. ACS Sens 2019; 4:1023-1031. [PMID: 30892019 DOI: 10.1021/acssensors.9b00223] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Point-of-care (POC) application for monitoring of breath ammonia (BA) in hemodialysis (HD) patients has emerged as a promising noninvasive health monitoring approach. In this context, many organic gas sensors have been reported for BA detection. However, one of the major challenges for its integration with affordable household POC application is to achieve stable performance for accuracy and high operational current at low voltage for low-cost read-out circuitry. Herein, we exploited the stability of the Donor-Acceptor polymer on the cylindrical nanopore structure to realize the sensors with a high sensitivity and stability. Then, we proposed a double active layer (DL) strategy that exploits an ultrathin layer of Poly(3-hexylthiophene-2,5-diyl) (P3HT) to serve as a work function buffer to enhance the operational current. The DL sensor exhibits a sustainable enhanced operational current of microampere level and a stable sensing response even with the presence of P3HT layer. This effect is carefully examined with different aspects, including vertical composition profile of DL configuration, lifetime testing on different sensing layer, morphological analysis, and the versatility of the DL strategy. Finally, we utilize the DL sensor to conduct a tracing of BA concentration in two HD patients before and after HD, and correlate it with the blood urea nitrogen (BUN) levels. A good correlation coefficient of 0.96 is achieved. Moreover, the feasibility of DL sensor integrated into a low-cost circuitry was also verified. The results demonstrate the potential of this DL strategy to be used to integrate organic sensor for affordable household POC devices.
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Affiliation(s)
- Shang-Yu Yu
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, F-68100 Mulhouse, France
- Université de Strasbourg, 4 rue Blaise Pascal CS 90032, F-67081 Strasbourg cedex, France
| | | | | | | | | | | | - Chang-Chiang Chen
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital Hsin-Chu Branch, 25, Lane 442, Section 1, Jingguo Road, 300 Hsinchu, Taiwan
| | | | | | - Chia-Jung Lu
- Department of Chemistry, National Taiwan Normal University, 162, Heping East Road, Section 1, 106 Taipei, Taiwan
| | | | | | - Olivier Soppera
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, F-68100 Mulhouse, France
- Université de Strasbourg, 4 rue Blaise Pascal CS 90032, F-67081 Strasbourg cedex, France
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17
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The Effect of Mechanically-Generated Vibrations on the Efficacy of Hemodialysis; Assessment of Patients' Safety: Preliminary Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040594. [PMID: 30781708 PMCID: PMC6406417 DOI: 10.3390/ijerph16040594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022]
Abstract
Muscle activity during a hemodialysis procedure improves its efficacy. We have formulated a hypothesis that vibrations generated by a specially-designed dialysis chair can, the same as physical exercise, affect the filtering of various fluids between fluid spaces during the hemodialysis procedure. This prospective and interventional study included 21 dialyzed patients. During a single dialysis session, each patient used a prototype device with the working name “vibrating chair”. The chair’s drive used a low-power cage induction motor, which, along with the worm gear motor, was a part of the low-frequency (3.14 Hz) vibration-generating assembly with an amplitude of 4 mm. Tests and measurements were performed before and after the vibration dialysis. After a single hemodialysis session including five 3-min cycles of vibrations, an increase in Kt/V in relation to non-vibration Kt/V (1.53±0.26 vs. 1.62±0.23) was seen. Urea reduction ratio increased significantly (0.73±0.03 vs. 0.75±0.03). A significant increase in systolic blood pressure was observed between the first and the third measurement (146±18 vs. 156±24). The use of a chair generating low-frequency vibrations increased dialysis adequacy; furthermore, it seems an acceptable and safe alternative to intradialytic exercise.
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Piccoli GB, Nielsen L, Gendrot L, Fois A, Cataldo E, Cabiddu G. Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status. J Clin Med 2018; 7:E331. [PMID: 30297628 PMCID: PMC6210736 DOI: 10.3390/jcm7100331] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022] Open
Abstract
There is no simple way to prescribe hemodialysis. Changes in the dialysis population, improvements in dialysis techniques, and different attitudes towards the initiation of dialysis have influenced treatment goals and, consequently, dialysis prescription. However, in clinical practice prescription of dialysis still often follows a "one size fits all" rule, and there is no agreed distinction between treatment goals for the younger, lower-risk population, and for older, high comorbidity patients. In the younger dialysis population, efficiency is our main goal, as assessed by the demonstrated close relationship between depuration (tested by kinetic adequacy) and survival. In the ageing dialysis population, tolerance is probably a better objective: "good dialysis" should allow the patient to attain a stable metabolic balance with minimal dialysis-related morbidity. We would like therefore to open the discussion on a personalized approach to dialysis prescription, focused on efficiency in younger patients and on tolerance in older ones, based on life expectancy, comorbidity, residual kidney function, and nutritional status, with particular attention placed on elderly, high-comorbidity populations, such as the ones presently treated in most European centers. Prescription of dialysis includes reaching decisions on the following elements: dialysis modality (hemodialysis (HD) or hemodiafiltration (HDF)); type of membrane (permeability, surface); and the frequency and duration of sessions. Blood and dialysate flow, anticoagulation, and reinfusion (in HDF) are also briefly discussed. The approach described in this concept paper was developed considering the following items: nutritional markers and integrated scores (albumin, pre-albumin, cholesterol; body size, Body Mass Index (BMI), Malnutrition Inflammation Score (MIS), and Subjective Global Assessment (SGA)); life expectancy (age, comorbidity (Charlson Index), and dialysis vintage); kinetic goals (Kt/V, normalized protein catabolic rate (n-PCR), calcium phosphate, parathyroid hormone (PTH), beta-2 microglobulin); technical aspects including vascular access (fistula versus catheter, degree of functionality); residual kidney function and weight gain; and dialysis tolerance (intradialytic hypotension, post-dialysis fatigue, and subjective evaluation of the effect of dialysis on quality of life). In the era of personalized medicine, we hope the approach described in this concept paper, which requires validation but has the merit of providing innovation, may be a first step towards raising attention on this issue and will be of help in guiding dialysis choices that exploit the extraordinary potential of the present dialysis "menu".
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Affiliation(s)
- Giorgina Barbara Piccoli
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, Ospedale san Luigi, Regione Gonzole, 10100 Torino, Italy.
| | - Louise Nielsen
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
| | - Lurilyn Gendrot
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
| | - Antioco Fois
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
| | - Emanuela Cataldo
- Néphrologie Centre Hospitalier Le Mans, Avenue Roubillard 196, 72000 Le Mans, France.
- Nefrologia, Università Aldo Moro, Piazza Umberto I, 70121 Bari, Italy.
| | - Gianfranca Cabiddu
- Nefrologia Ospedale Brotzu, Piazzale Alessandro Ricchi, 1, 09134 Cagliari, Italy.
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Chuang MY, Chen CC, Zan HW, Meng HF, Lu CJ. Organic Gas Sensor with an Improved Lifetime for Detecting Breath Ammonia in Hemodialysis Patients. ACS Sens 2017; 2:1788-1795. [PMID: 29124925 DOI: 10.1021/acssensors.7b00564] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this work, a TFB (poly[(9,9-dioctylfluorenyl-2,7-diyl)-co-(4,4'-(N-(4-s-butylphenyl)diphenylamine)]) sensor with a cylindrical nanopore structure exhibits a high sensitivity to ammonia in ppb-regime. The lifetime and sensitivity of the TFB sensor were studied and compared to those of P3HT (poly(3-hexylthiophene)), NPB (N,N'-di(1-naphthyl)-N,N'-diphenyl-(1,1'-biphenyl)-4,4'-diamine), and TAPC (4,4'-cyclohexylidenebis[N,N-bis(4-methylphenyl) benzenamine]) sensors with the same cylindrical nanopore structures. The TFB sensor outstands the others in sensitivity and lifetime and it shows a sensing response (current variation ratio) of 13% to 100 ppb ammonia after 64 days of storage in air. A repeated sensing periods testing and a long-term measurement have also been demonstrated for the test of robustness. The performance of the TFB sensor is stable in both tests, which reveals that the TFB sensor can be utilized in our targeting clinical trials. In the last part of this work, we study the change of ammonia concentration in the breath of hemodialysis (HD) patients before and after dialysis. An obvious drop of breath ammonia concentration can be observed after dialysis. The reduction of breath ammonia is also correlated with the reduction of blood urea nitrogen (BUN). A correlation coefficient of 0.82 is achieved. The result implies that TFB sensor may be used as a real-time and low cost breath ammonia sensor for the daily tracking of hemodialysis patients.
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Affiliation(s)
| | - Chang-Chiang Chen
- Department
of Internal Medicine, Division of Nephrology, National Taiwan University Hospital Hsin-Chu Branch, 25, Ln. 442, Sec. 1, Jingguo Rd., 300 Hsinchu, Taiwan
| | | | | | - Chia-Jung Lu
- Department
of Chemistry, National Taiwan Normal University, 162, Heping East Rd., Section 1, 106 Taipei, Taiwan
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20
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Frequent hemodialysis: history of the modality and assessment of outcomes. Pediatr Nephrol 2017; 32:1293-1300. [PMID: 28396942 DOI: 10.1007/s00467-017-3659-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
About 660,000 individuals have end-stage renal disease in the USA, the vast majority of whom are receiving standard, in-center, thrice-weekly hemodialysis (HD). The morbidity and mortality among patients receiving standard HD remain unacceptably high. Studies conducted over the past two decades have provided a substantial amount of information on the advantages and drawbacks of providing more frequent HD treatment, either in-center or at home. In this article I summarize these studies, focusing special attention on the randomized, cross-over study assessing outcomes in children who received either frequent, in-center HD or traditional, thrice-weekly, in-center HD performed by Laskin et al. (Pediatr Nephrol doi: 10.1007/s00467-017-3656-x , 2017).
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21
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Pladys A, Vigneau C, Hourmant M, Duneau G, Couchoud C, Bayat S. Association between daily haemodialysis, access to renal transplantation and patients' survival in France. Nephrology (Carlton) 2016; 23:269-278. [PMID: 27905676 DOI: 10.1111/nep.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/24/2016] [Accepted: 11/24/2016] [Indexed: 11/28/2022]
Abstract
AIM Daily haemodialysis improves patients' quality of life and blood purification, but its effect on survival remains controversial. The aim of this study was to analyze the association between daily haemodialysis and renal transplantation and survival in France. METHODS This was an observational cohort study based on the French REIN registry. All incident patients ≥18 years old who started daily haemodialysis in France between 2003 and 2012 were included. Using a propensity score, 575 patients on daily haemodialysis were matched with 1696 patients receiving thrice-weekly haemodialysis. Survival analysis was performed using the Cox model. Access to the renal transplant waiting list and renal transplantation were analyzed using the Fine and Gray model. RESULTS Daily haemodialysis was not independently associated with reduced access to transplant waiting list, whereas, major comorbidities remained associated with restricted waitlisting after multivariate analysis adjusted for confounding factors. After being waitlisted, the cumulative incidence of renal transplantation was lower for the daily haemodialysis than for the thrice-weekly haemodialysis group (SHR = 0.72, 95%CI: 0.56-0.91). The risk of death was significantly higher in the daily haemodialysis group (HRadjusted = 1.58, 95%CI: 1.4-1.8). Major comorbidities were associated with higher risk of death and lower likelihood of receiving a renal transplant during the follow-up period. CONCLUSION Our study showed that in France, the likelihood of undergoing renal transplantation after being waitlisted was lower for patients on daily haemodialysis than those on thrice-weekly haemodialysis. Moreover, daily haemodialysis was associated with higher risk of death, even after taking into account age and all major comorbidities.
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Affiliation(s)
- Adélaïde Pladys
- High French School of Public Health (EHESP: Ecole des Hautes Etude de Sante Publique), Rennes, France.,University of Rennes 1, UMR CNRS 6290, Rennes, France
| | - Cécile Vigneau
- University of Rennes 1, UMR CNRS 6290, Rennes, France.,Service of Nephrology, Pontchaillou hospital, Rennes, France
| | | | | | - Cécile Couchoud
- REIN (Renal Epidemiology and Information Network) registry, Biomedecine Agency, Saint Denis La Plaine, France
| | - Sahar Bayat
- High French School of Public Health (EHESP: Ecole des Hautes Etude de Sante Publique), Rennes, France
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22
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Chen W, Laiho S, Vaittinen O, Halonen L, Ortiz F, Forsblom C, Groop PH, Lehto M, Metsälä M. Biochemical pathways of breath ammonia (NH
3
) generation in patients with end-stage renal disease undergoing hemodialysis. J Breath Res 2016; 10:036011. [DOI: 10.1088/1752-7155/10/3/036011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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23
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Pladys A, Bayat S, Kolko A, Béchade C, Couchoud C, Vigneau C. French patients on daily hemodialysis: clinical characteristics and treatment trajectories. BMC Nephrol 2016; 17:107. [PMID: 27473376 PMCID: PMC4966797 DOI: 10.1186/s12882-016-0306-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Increasing the weekly frequency of hemodialysis sessions has positive effects, on the control of several biological data of patients. However, knowledge about Daily HemoDialysis (DHD) practices is limited in France. The aim of the present study was to describe the characteristics and treatment trajectories of all French patients undergoing DHD. METHODS All patients older than 18 years who started DHD between 2003 and 2012 in France were included and followed until December 31, 2013. The patients' demographic and clinical characteristics and treatment modalities were extracted from the French Renal Epidemiological and Information Network (REIN) registry. RESULTS During the inclusion period, 753 patients started DHD in France. Based on their median age (64 years), patients were classified in two groups: "old" group (≥64 years) and "young" group (<64 years). Patients in the old group had more comorbidities than in the young group: 48 % had diabetes (vs 29 % in the young group), 17 % an active malignancy (vs 10 %) and 80 % ≥1 cardiovascular disease (vs 41 %). Concerning patients' treatment trajectories, 496 (66 %) patients started with another dialysis before switching to DHD and 257 (34 %) directly with DHD. At the end of the follow-up, 69 % of patients in the old group were dead (27.4 % in the young group) and kidney transplantation was more frequent in the young group (30.4 % vs 0.5 %). CONCLUSION In France, DHD is proposed not only to young in rather good clinical conditions and waiting for kidney transplantation, but also to old and frail patients with higher mortality.
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Affiliation(s)
- Adélaïde Pladys
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- Université Rennes 1, UMR CNRS 6290, Rennes, France
| | - Sahar Bayat
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- EHESP Rennes, Sorbonne Paris Cité, EA MOS, Rennes, France
| | | | - Clémence Béchade
- CHU Caen, Service de néphrologie, Caen, France
- Université de Caen Normandie, 1086 INSERM, Caen, France
| | - Cécile Couchoud
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Cécile Vigneau
- Université Rennes 1, UMR CNRS 6290, Rennes, France
- CHU Pontchaillou, Service de néphrologie, Rennes, France
| | - on behalf of the REIN registry
- EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- Université Rennes 1, UMR CNRS 6290, Rennes, France
- EHESP Rennes, Sorbonne Paris Cité, EA MOS, Rennes, France
- Association AURA, Paris, France
- CHU Caen, Service de néphrologie, Caen, France
- Université de Caen Normandie, 1086 INSERM, Caen, France
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
- CHU Pontchaillou, Service de néphrologie, Rennes, France
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24
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Cha SM, Min HS. The Effect of Dialysate Flow Rate on Dialysis Adequacy and Fatigue in Hemodialysis Patients. J Korean Acad Nurs 2016; 46:642-652. [DOI: 10.4040/jkan.2016.46.5.642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Sun Mi Cha
- Artificial Kidney Unit, Bethesda Hospital, Yangsan, Korea
| | - Hye Sook Min
- Department of Nursing, Dong-A University, Busan, Korea
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Djukanović L, Dimković N, Marinković J, Andrić B, Bogdanović J, Budošan I, Cvetičanin A, Djordjev K, Djordjević V, Djurić Ž, Lilić BH, Jovanović N, Jelačić R, Knežević V, Kostić S, Lazarević T, Ljubenović S, Marić I, Marković R, Milenković S, Milićević O, Mitić I, Mićunović V, Mišković M, Pilipović D, Plješa S, Radaković M, Stanojević MS, Janković BT, Vojinović G, Šefer K. Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients. Nefrologia 2015; 35:287-95. [PMID: 26299172 DOI: 10.1016/j.nefro.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/22/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. METHODS A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1-1.8mmol/L), calcium (2.1-2.4mmol/L) and iPTH (150-300pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. RESULTS The patients were on regular HD for 5.3±5.3 years, dialyzed 11.8±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death. CONCLUSION Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH.
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Affiliation(s)
| | - Nada Dimković
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | | | - Ivana Budošan
- Department of Nephrology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Anica Cvetičanin
- Nephrology Ward, Health Center Srem, Mitrovica, Srem Mitrovica, Serbia
| | | | | | - Živka Djurić
- Department of Nephrology, Clinical Centre Zvezdara, Belgrade, Serbia
| | | | | | - Rosa Jelačić
- Department of Nephrology, General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Violeta Knežević
- Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia
| | | | - Tatjana Lazarević
- Department of Nephrology, Clinical Center of Kragujevac, Kragujevac, Serbia
| | | | - Ivko Marić
- Department of Nephrology, Lazarevac, Serbia
| | | | | | | | - Igor Mitić
- Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia
| | | | - Milena Mišković
- Hemodialysis Ward, Health Center Obrenovac, Obrenovac, Serbia
| | - Dragana Pilipović
- Hemodialysis Ward, Health Center Bačka Palanka, Bačka Palanka, Serbia
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Current Bioengineering Methods for Whole Kidney Regeneration. Stem Cells Int 2015; 2015:724047. [PMID: 26089921 PMCID: PMC4452081 DOI: 10.1155/2015/724047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 02/07/2023] Open
Abstract
Kidney regeneration is likely to provide an inexhaustible source of tissues and organs for immunosuppression-free transplantation. It is currently garnering considerable attention and might replace kidney dialysis as the ultimate therapeutic strategy for renal failure. However, anatomical complications make kidney regeneration difficult. Here, we review recent advances in the field of kidney regeneration, including (i) the directed differentiation of induced pluripotent stem cells/embryonic stem cells into kidney cells; (ii) blastocyst decomplementation; (iii) use of a decellularized cadaveric scaffold; (iv) embryonic organ transplantation; and (v) use of a nephrogenic niche for growing xenoembryos for de novo kidney regeneration from stem cells. All these approaches represent potentially promising therapeutic strategies for the treatment of patients with chronic kidney disease. Although many obstacles to kidney regeneration remain, we hope that innovative strategies and reliable research will ultimately allow the restoration of renal function in patients with end-stage kidney disease.
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Oviasu O, Rigby JE, Ballas D. Chronic Kidney Disease in Nigeria: An Evaluation of the Spatial Accessibility to Healthcare for Diagnosed Cases in Edo State. J Public Health Afr 2015; 6:394. [PMID: 28299133 PMCID: PMC5349260 DOI: 10.4081/jphia.2015.394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 02/18/2015] [Accepted: 03/04/2015] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) is a growing problem in Nigeria, presenting challenges to the nation’s health and economy. This study evaluates the accessibility to healthcare in Edo State of CKD patients diagnosed between 2006 and 2009. Using cost analysis techniques within a geographical information system, an estimated travel time to the hospital was used to examine the spatial accessibility of diagnosed patients to available CKD healthcare in the state. The results from the study indicated that although there was an annual rise in the number of diagnosed cases, there were no significant changes in the proportion of patients that were diagnosed at the last stage of CKD. However, there were indications that the travel time to the hospital for CKD treatment might be a contributing factor to the number of diagnosed CKD cases. This implies that the current structure for CKD management within the state might not be adequate.
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Affiliation(s)
- Osaretin Oviasu
- Centre for Health and Population Sciences, Hull York Medical School, University of Hull , UK
| | - Janette E Rigby
- Department of Geography, National University of Ireland Maynooth , Co Kildare, Ireland
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Vigotti FN, Teta L, Pia A, Mirasole S, Guzzo G, Giuffrida D, Capizzi I, Avagnina P, Ippolito D, Piccoli GB. Intensive weight loss combining flexible dialysis with a personalized, ad libitum, coach-assisted diet program. A "pilot" case series. Hemodial Int 2014; 19:368-78. [PMID: 25495862 DOI: 10.1111/hdi.12252] [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] [Indexed: 10/24/2022]
Abstract
UNLABELLED Obesity is a growing problem on dialysis. The best approach to weight loss has not been established. The risks of malnutrition may offset the advantages of weight loss. Personalized hemodialysis schedules, with an incremental approach, are gaining interest; to date, no studies have explored its potential in allowing weight loss. This case series reports on combining flexible, incremental hemodialysis, and intensive weight loss. SETTING a small Dialysis Unit, following incremental personalized schedules (2-6 sessions/week, depending on residual function), tailored to an equivalent renal clearance >12 mL/min. Four obese and two overweigh patients (5 male, 1 female; age: 40-63 years; body mass index [BMI] 31.1 kg/m(2)) were enrolled in a coach-assisted weight loss program, with an "ad libitum" approach (3-6 foods/day chosen on the basis of their glycemic index and glycemic load). The diet consists of 8 weeks of rapid weight loss followed by 8-12 weeks of maintenance; both phases can be repeated. This study measures weight loss, side effects, and patients' opinions. Over 12-30 months, all patients lost weight (median -10.3 kg [5.7-20], median ΔBMI-3.2). Serum albumin (pre-diet 3.78; post-diet 3.83 g/dL), hemoglobin (pre-diet 11; post-diet 11.2 g/dL), and acid-base balance (HCO(3) pre-diet: 23.3; post-diet: 23.4 mmol/L) remained stable, with decreasing needs for erythropoietin and citrate or bicarbonate supplements. Calcium-phosphate-parathyroid hormone (PTH) balance improved (PTH-pre 576; post 286 pg/mL). Three out of 4 hypertensive patients discontinued, 1 decreased antihypertensives. None experienced severe side effects. Patient satisfaction was high (9 on a 0-10 analog scale). Personalized, incremental hemodialysis schedules allow patient enrollment in intensive personalized weight loss programs, with promising results.
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Affiliation(s)
| | - Luigi Teta
- BLUE S.r.l., Bioimis Accademia Alimentare, Bassano del Grappa (VI), Italy
| | - Anna Pia
- SCDU Internal Medicine, University of Torino, Torino, Italy
| | - Sara Mirasole
- BLUE S.r.l., Bioimis Accademia Alimentare, Bassano del Grappa (VI), Italy
| | - Gabriella Guzzo
- SS Nephrology, SCDU Urology, University of Torino, Torino, Italy
| | - Domenica Giuffrida
- Obstetrics, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Irene Capizzi
- SSD Dietetics and Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Paolo Avagnina
- SSD Dietetics and Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Davide Ippolito
- BLUE S.r.l., Bioimis Accademia Alimentare, Bassano del Grappa (VI), Italy.,Laboratory of Physiology, Department of Biomedical Sciences, University of Padova, Padova, Italy
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Oshvandi K, Kavyannejad R, Borzuo SR, Gholyaf M. High-flux and low-flux membranes: efficacy in hemodialysis. Nurs Midwifery Stud 2014; 3:e21764. [PMID: 25699283 PMCID: PMC4332995 DOI: 10.17795/nmsjournal21764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 12/01/2022] Open
Abstract
Background: Inadequacy of dialysis is one of the main causes of death in hemodialysis patients. Some studies have suggested that high‐flux membrane improves the removal of moderate-sized molecules while other studies indicate no significant effect on them. Objectives: This study aimed to investigate the dialysis efficacy of low-flux versus high-flux membranes in hemodialysis patients. Patients and Methods: Forty hemodialysis patients participated in this cross-over clinical trial. Two sessions of low-flux and high-flux membrane dialysis were performed consecutively, in the first and second stage of the trial. In both stages, blood samples before and after the dialysis were taken and sent to the laboratory for assessment. Blood urea nitrogen (BUN), KT/V and the urea reduction ratio (URR) indexes were used to determine dialysis efficacy. Data were analyzed using t test and paired t test. Results: The mean KT/V was 1.27 ± 0.28 in high-flux and 1.10 ± 0.32 in low-flux membrane which, these differences were statistically significant (P = 0.017). The mean of URR was 0.65 ± 0.09 in high-flux and 0.61 ± 0.14 in low-flux membrane, which these differences were not statistically significant (P = 0.221). Conclusions: The high-flux membrane had better dialysis adequacy, so we suggest using high-flux membrane in hemodialysis centers.
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Affiliation(s)
- Khodayar Oshvandi
- Research Center for Maternal and Child Care, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Rasol Kavyannejad
- Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Sayed Reza Borzuo
- Research Center for Maternal and Child Care, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mahmoud Gholyaf
- Department of Nephrology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
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Traitement de suppléance rénale par hémodialyse à Constantine (Algérie) : état des lieux. Nephrol Ther 2014; 10:39-43. [DOI: 10.1016/j.nephro.2013.07.371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/19/2013] [Accepted: 07/31/2013] [Indexed: 11/21/2022]
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Kirkman DL, Roberts LD, Kelm M, Wagner J, Jibani MM, Macdonald JH. Interaction between intradialytic exercise and hemodialysis adequacy. Am J Nephrol 2013; 38:475-82. [PMID: 24296748 DOI: 10.1159/000356340] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS According to mathematical modeling, intradialytic exercise of sufficient intensity and duration implemented in the second half of dialysis should be as efficacious as increasing dialysis time for dialysis adequacy. This assumption has not been tested in vivo. METHODS In this controlled trial, 11 hemodialysis (HD) patients (mean (SD) age 56 (13) years) were recruited. Each patient completed three trial arms in a randomized order: routine care (CONT), increased HD time of 30 min (TIME), and intradialytic exercise (EXER), 60 min of cycling at 90% of the lactate threshold in the last 90 min of HD. The primary outcome was eKt/Vurea. Secondary outcomes included reduction and rebound ratios of urea, creatinine, phosphate and β2-microglobulin. Outcomes were calculated from blood sampling collected pre-, post- and 30 min post-HD and confirmed with dialysate sampling. RESULTS Exercise was not as efficacious as increased HD time for eKt/Vurea (EXER vs. CONT, mean change (95% CI): 0.03 (-0.05 to 0.12); TIME vs. CONT: 0.15 (0.05-0.26)). Exercise was less efficacious at improving reduction ratios of urea and creatinine. However, exercise was more efficacious than increased dialysis time for phosphate reduction ratio (EXER vs. CONT: 8.6% (0.5-16.7); TIME vs. CONT: 5.0% (-1.0 to 11.1)). CONCLUSION This study utilized a rigorously controlled in vivo design to test mathematical models and assumptions regarding dialysis adequacy. Intradialytic exercise towards the end of HD cannot replace the prescription of increased HD time for dialysis adequacy, but may be an adjunctive therapy for serum phosphate control.
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Affiliation(s)
- Danielle L Kirkman
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
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Shaw C, Steenkamp R, Williams AJ. Chapter 7 Adequacy of haemodialysis in UK adult patients in 2010: national and centre-specific analyses. Nephron Clin Pract 2012; 120 Suppl 1:c137-43. [PMID: 22964565 DOI: 10.1159/000342850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Outcome in patients treated with haemodialysis (HD) is influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes clinical practice guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose. AIM To determine the extent to which patients received the recommended dose of HD in the UK. METHODS All seventy-two UK renal centres submitted data to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2010 and the incident patient population for 2010. Centres returning data on <50% of their patient population or centres with <20 patients were excluded from centre-specific comparisons. RESULTS Data regarding URR were available from 64 renal centres in the UK. Forty nine centres provided URR data on more than 90% of prevalent patients. The proportion of patients in the UK who met the UK clinical practice guideline for URR (>65%) increased from 56% in 1998 to 86% in 2010. There was persistent variation observed between centres, with 19 centres attaining the RA clinical practice guideline in >90% of patients and 39 centres attaining the guideline in 70-90%. The overall proportion of prevalent patients with a URR >65% has continued to improve over time. CONCLUSIONS The delivered dose of HD for patients with established renal failure has increased over the last decade. Whilst the majority of UK patients achieved the target URR there was considerable variation between centres in the percentage of patients achieving the guideline.
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Bersenas AME. A clinical review of peritoneal dialysis. J Vet Emerg Crit Care (San Antonio) 2011; 21:605-17. [PMID: 22316253 DOI: 10.1111/j.1476-4431.2011.00679.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 08/08/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review the principles and practice of peritoneal dialysis in veterinary medicine. DATA SOURCES Clinical and experimental studies and current guideline recommendations from the human literature; and original case studies, case reports, and previous reviews in the veterinary literature. SUMMARY Peritoneal dialysis involves the exchange of solutes and fluid between the peritoneal capillary blood and the dialysis solution across the peritoneal membrane. It requires placement of a peritoneal dialysis catheter for repeated dialysate exchange. The ideal catheter provides reliable, rapid dialysate flow rates without leaks or infections. Catheter selection and placement are reviewed along with dialysate selection, exchange prescriptions, and overall patient management. PD does not require specific or complex equipment, and it can achieve effective control of uremia and electrolyte imbalances. CONCLUSIONS Peritoneal dialysis is a potential life-saving measure for patients with acute renal failure. Peritoneal dialysis results in gradual decline in uremic toxins. Previously low success rates have been reported. Improved success rates have been noted in dogs with acute kidney injury (AKI) secondary to leptospirosis. Cats also have a good success rate when PD is elected in patients with a potentially reversible underlying disease. Overall, PD remains a viable intervention for patients with AKI unresponsive to medical management. In select patients a favorable outcome is attained whereby PD provides temporary support until return of effective renal function is attained.
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Affiliation(s)
- Alexa M E Bersenas
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
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Piccoli GB. The never-ending search for the perfect dialysis. Should we move from the best treatment to the best system? Nephrol Dial Transplant 2011; 26:1128-31. [PMID: 21460360 DOI: 10.1093/ndt/gfr123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Casula A, Webb L, Feest T. UK Renal Registry 13th Annual Report (December 2010): Chapter 8: adequacy of haemodialysis in UK adult patients in 2009: national and centre-specific analyses. Nephron Clin Pract 2011; 119 Suppl 2:c141-7. [PMID: 21894031 DOI: 10.1159/000331758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Outcome in patients treated with haemodialysis (HD) is influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes Clinical Practice Guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose. AIM To determine the extent to which patients received the recommended dose of HD in the UK. METHODS All seventy-two UK renal centres submitted data to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2009 and the incident patient population for 2009. Centres returning data on <50% of their patient population were excluded from centre-specific comparisons. RESULTS Data regarding URR were available from 63 renal centres in the UK. Fifty-one centres provided URR data on more than 90% of prevalent patients. The proportion of patients in the UK who met the UK Clinical Practice Guideline for URR (>65%) increased from 56% in 1998 to 85.5% in 2009. There was considerable variation between centres, with 19 centres attaining the RA clinical practice guideline in >90% of patients and 5 centres attaining the guideline in <70% of patients. The delivered HD dose (URR) was lower in patients who had just commenced dialysis treatment compared to patients who had survived longer on HD. CONCLUSIONS The delivered dose of HD for patients with established renal failure has increased over the last decade. Whilst the majority of UK patients achieved the target URR there was considerable variation between centres in the percentage of patients achieving the guideline.
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Affiliation(s)
- Anna Casula
- UK Renal Registry, Southmead Hospital, Bristol, UK.
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Kang J, Scholz T, Weaver JD, Ku DN, Rosen DW. Pump Design for a Portable Renal Replacement System. J Med Device 2011. [DOI: 10.1115/1.4004650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This work proposes a small, light, valveless pump design for a portable renal replacement system. By analyzing the working principle of the pump and exploring the design space using an analytical pump model, we developed a novel design for a cam-driven finger pump. Several cams sequentially compress fingers, which compress flexible tubes; thus eliminating valves. Changing the speed of the motor or size of the tube controls the flow rate. In vitro experiments conducted with whole blood using the pump measured Creatinine levels over time, and the results verify the design for the portable renal replacement system. The proposed pump design is smaller than 153 cm3 and consumes less than 1 W while providing a flow rate of more than 100 ml/min for both blood and dialysate flows. The smallest pump of a portable renal replacement system in the literature uses check valves, which considerably increase the overall manufacturing cost and possibility of blood clotting. Compared to that pump, the proposed pump design achieved reduction in size by 52% and savings in energy consumption by 89% with the removal of valves. This simple and reliable design substantially reduces the size requirements of a portable renal replacement system.
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Affiliation(s)
- Jane Kang
- Georgia Institute of Technology, Atlanta, GA
| | | | - Jason D. Weaver
- Georgia Institute of Technology and Emory University, Atlanta, GA
| | - David N. Ku
- Georgia Institute of Technology and Emory University, Atlanta, GA
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Precharattana M, Nokkeaw A, Triampo W, Triampo D, Lenbury Y. Stochastic cellular automata model and Monte Carlo simulations of CD4+ T cell dynamics with a proposed alternative leukapheresis treatment for HIV/AIDS. Comput Biol Med 2011; 41:546-58. [PMID: 21621202 DOI: 10.1016/j.compbiomed.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 01/24/2011] [Accepted: 05/03/2011] [Indexed: 12/23/2022]
Abstract
Acquired Immunodeficiency Syndrome (AIDS) is responsible for millions of deaths worldwide. To date, many drug treatment regimens have been applied to AIDS patients but none has resulted in a successful cure. This is mainly due to the fact that free HIV particles are frequently in mutation, and infected CD4(+) T cells normally reside in the lymphoid tissue where they cannot (so far) be eradicated. We present a stochastic cellular automaton (CA) model to computationally study what could be an alternative treatment, namely Leukapheresis (LCAP), to remove HIV infected leukocytes in the lymphoid tissue. We base our investigations on Monte Carlo computer simulations. Our major objective is to investigate how the number of infected CD4(+) T cells changes in response to LCAP during the short-time (weeks) and long-time (years) scales of HIV/AIDS progression in an infected individual. To achieve our goal, we analyze the time evolution of the CD4(+) T cell population in the lymphoid tissue (i.e., the lymph node) for HIV dynamics in treatment situations with various starting times and frequencies and under a no treatment condition. Our findings suggest that the effectiveness of the treatment depends mainly on the treatment starting time and the frequency of the LCAP. Other factors (e.g., the removal proportion, the treatment duration, and the state of removed cells) that likely influence disease progression are subjects for further investigation.
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Affiliation(s)
- Monamorn Precharattana
- R&D Group of Biological and Environmental Physics (BIOPHYSICS), Department of Physics, Faculty of Science, Mahidol University, Bangkok, Thailand
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Biggar P, Ketteler M. Sevelamer carbonate for the treatment of hyperphosphatemia in patients with kidney failure (CKD III - V). Expert Opin Pharmacother 2011; 11:2739-50. [PMID: 20977406 DOI: 10.1517/14656566.2010.526107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE OF THE FIELD Altered mineral metabolism in chronic kidney disease (CKD) is associated with increased morbidity, mortality, hospitalization, cost of care and reduced quality of life. Phosphorus control, one component of CKD metabolic derangements, is potentially related to impaired outcomes and has significant room for improvement. AREAS COVERED IN THIS REVIEW Historical, present and future aspects of treatment of hyperphosphatemia focusing on sevelamer hydrochloride and sevelamer carbonate. WHAT THE READER WILL GAIN Comprehensive insight into the background and controversies regarding phosphate binders. TAKE HOME MESSAGE While calcium-free phosphate binders with a sevelamer backbone may offer therapeutic advantages for CKD patients at risk, more studies comprising significant patient numbers are warranted to answer compelling clinical questions.
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Affiliation(s)
- Patrick Biggar
- Klinikum Coburg, Nephrological Department, Ketschendorferstrasse 33, 96450 Coburg, Germany.
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TANG HONLOK, WONG JOSEPHHS, POON CLARAKY, TANG CANDICMK, CHU KWOKHONG, LEE WILLIAM, FUNG SAMUELKS, CHAU KAFOON, LI CHUNSANG, TONG KWOKLUNG. One year experience of nocturnal home haemodialysis with an alternate night schedule in Hong Kong. Nephrology (Carlton) 2010; 16:57-62. [DOI: 10.1111/j.1440-1797.2010.01371.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pawlak K, Mysliwiec M, Pawlak D. Impact of residual renal function and HCV seropositivity on plasma CD40/CD40L system and oxidative status in haemodialysis patients. Clin Biochem 2010; 43:1393-8. [DOI: 10.1016/j.clinbiochem.2010.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 08/24/2010] [Accepted: 09/01/2010] [Indexed: 10/19/2022]
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Gabbay E, Meyer KB, Griffith JL, Richardson MM, Miskulin DC. Temporal trends in health-related quality of life among hemodialysis patients in the United States. Clin J Am Soc Nephrol 2009; 5:261-7. [PMID: 20019114 DOI: 10.2215/cjn.03890609] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Health-related quality of life (HRQOL) is a measure of the well being of hemodialysis patients and an independent prognostic predictor. Our aim was to determine whether HRQOL among hemodialysis patients has changed over time. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We retrospectively analyzed data collected by Dialysis Clinic, Inc. from adult patients starting hemodialysis between January 1, 1997 and May 31, 2006. The primary outcome was HRQOL assessed by Short Form 36, 6 to 18 months after and closest to the 1-year anniversary of starting hemodialysis. Secular trends were analyzed by linear regression for continuous variables and logistic regression for categorical ones. Year of starting dialysis was the predictor. A five-point difference on a 0 to 100 scale was considered clinically significant. RESULTS Short Form 36 scores were available for 11,079 patients. Role physical, general health, vitality, social functioning, and physical component summary scores were unchanged among patients over the study period. Statistically significant (P < 0.05) but clinically insignificant changes were observed in physical functioning (-0.2 points/yr), bodily pain (+0.2 points/yr), mental health (+0.15 points/yr), and mental component summary scores (+0.13 points/yr). Only role emotional showed clinically significant improvement. Trends were unchanged after adjusting for age, gender, race, diabetes, hemoglobin, phosphorous, Kt/V, and albumin. CONCLUSIONS Most HRQOL domains showed either no statistically significant change or statistically but not clinically significant change over almost a decade. These results suggest that, despite important developments in hemodialysis care since 1997, little progress was made in improving HRQOL of hemodialysis patients.
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Affiliation(s)
- Ezra Gabbay
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts 02111, USA.
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Okamoto M, Suzuki T, Nobori S, Ushigome H, Yoshimura N. A case of successful kidney transplantation after an extremely long-term maintenance haemodialysis of 38 years. Clin Kidney J 2009; 2:398-400. [PMID: 25949356 PMCID: PMC4421396 DOI: 10.1093/ndtplus/sfp089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 06/24/2009] [Indexed: 11/19/2022] Open
Abstract
We describe herein a case of kidney transplantation after extremely long-term haemodialysis. A 66-year-old male received a kidney transplant from a deceased donor after maintenance haemodialysis for 38 years and 2 months. In spite of long-term haemodialysis, he showed minimal calcification of the iliac vessels, and transplantation was carried out successfully. Other than some difficulties in vesical rehabilitation, his postoperative course was favourable and he was finally discharged from the hospital on the 84th postoperative day. On a review of the literature, this case might represent the longest period of haemodialysis ever prior to kidney transplantation in the world.
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Affiliation(s)
| | - Tomoyuki Suzuki
- Department of Transplantation and Regenerative Surgery, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Shuji Nobori
- Department of Transplantation and Regenerative Surgery, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Hidetaka Ushigome
- Department of Transplantation and Regenerative Surgery, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
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Bayliss G, Danziger J. Nocturnal versus conventional haemodialysis: some current issues. Nephrol Dial Transplant 2009; 24:3612-7. [PMID: 19767631 DOI: 10.1093/ndt/gfp491] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kim JM, Kwon HM, Lim CS, Kim YS, Lee SJ, Nam H. Restless legs syndrome in patients on hemodialysis: symptom severity and risk factors. J Clin Neurol 2008; 4:153-7. [PMID: 19513290 PMCID: PMC2686851 DOI: 10.3988/jcn.2008.4.4.153] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 09/01/2008] [Accepted: 09/01/2008] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Restless legs syndrome (RLS) is a sleep disorder that frequently occurs in dialysis patients, which disturbs the sleep and reduces the quality of life. The aim of this study was to determine the risk factors for RLS in dialysis patients. Methods Patients who visited any of four outpatient dialysis clinics between September 2005 and May 2006 were included in this study. The diagnosis of RLS and the severity assessment were made using the criteria described by the International Restless Legs Syndrome Study Group. We collected basic demographic data, clinical information, and laboratory findings, and then analyzed their association with various aspects of RLS using univariate and multivariate analyses. Results RLS was present in 46 (28.0%) of 164 dialysis patients. We found no significant risk factor for inducing RLS. The predialysis serum blood urea nitrogen (BUN) level in the dialysis patients with RLS was significantly correlated with RLS symptom severity. Conclusions Predialysis BUN is related to RLS symptom severity. Further studies on the underlying mechanism are needed.
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Affiliation(s)
- Jeong-Min Kim
- Department of Neurology, Seoul Metropolitan Boramae Hospital, Seoul, Korea
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Couchoud C, Kooman J, Finne P, Leivestad T, Stojceva-Taneva O, Ponikvar JB, Collart F, Kramar R, de Francisco A, Jager KJ. From registry data collection to international comparisons: examples of haemodialysis duration and frequency. Nephrol Dial Transplant 2008; 24:217-24. [PMID: 18678560 DOI: 10.1093/ndt/gfn442] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate haemodialysis (HD) dose practice patterns in different European countries in the light of the European Best Practice Guidelines (EBPG) and to study the associations of patient characteristics and country with weekly dialysis duration. METHODS Renal registries in Europe were asked to contribute to the study with individual patient data on weekly HD duration, number of HD sessions a week and last measured Kt/V. Additional items were age, sex, date of first renal replacement therapy (RRT), dry weight, height, HD modality, HD technique, diabetes status and vascular access type. Multivariate logistic regression was used to study the probability of receiving HD for <12 h per week. RESULTS Seven registries contributed data on 26 136 patients on HD on 31 December 2005. Eighty-three percent of the patients received HD for at least 12 h per week as recommended by the EBPG (range 49.0-97.3% across countries). Multivariate analysis showed significant differences across countries concerning the risk of receiving <12 h. Other risk factors included age (older), sex (female), BMI (low) and duration of RRT (shorter). Diabetes was associated with longer total HD duration. CONCLUSION This study shows a great international variability in weekly HD duration and some discrepancies between current practices and the EBPG. It also points out the difficulty of obtaining and comparing Kt/V values under current registry practices.
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Affiliation(s)
- Cécile Couchoud
- French ESRD Registry REIN, Agence de la biomedecine, Saint-Denis La Plaine, France.
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Tayyem RF, Mrayyan MT, Heath DD, Bawadi HA. Assessment of nutritional status among ESRD patients in Jordanian hospitals. J Ren Nutr 2008; 18:281-7. [PMID: 18410884 DOI: 10.1053/j.jrn.2007.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Our objective was to assess nutritional status and compare quality of treatment among hemodialysis patients in public and private hospitals in Jordan. DESIGN We utilized a cross-sectional survey. SETTING Our setting involved hospital hemodialysis units. PATIENTS This study was undertaken in five large Jordanian hospitals between 2004 and 2005. One hundred and eighty participants diagnosed with end-stage renal failure (ESRD) were enrolled. These participants (91 women and 89 men) who underwent hemodialysis treatment were recruited using a convenience sampling technique. Data from participants who received hemodialysis treatment in public hospital settings were compared with equivalent data from participants treated in private hospital settings. MAIN OUTCOME MEASURES Subjective global assessment (SGA), anthropometry, and biochemical measurements were used as evaluative tools. RESULTS In the anthropometric measurement of triceps skinfold thickness (TSF), we found a statistically significant difference (P < .05) between participants treated in the two hospital settings. In addition, approximately 62% of all participants, regardless of treatment site, were found to be moderately to severely malnourished. Anthropometric measurements showed some significant increase between prehemodialysis and posthemodialysis weight and body mass index in private hospitals; this was not unexpected. There were no statistically significant differences in the measured mean levels of eight different biochemical parameters, with the exception of plasma phosphorus and sodium levels. CONCLUSIONS The prevalence of malnutrition and the quality of treatment in our two groups of participants were similar.
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Affiliation(s)
- Reema F Tayyem
- Department of Clinical Nutrition and Dietetics, Allied Health Sciences Faculty, Hashemite University, Zarqa, Jordan.
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Pawlak K, Pawlak D, Mysliwiec M. LIGHT--a new member of the TNF superfamily in the plasma, dialysate and urine of uremic patients; the impact of residual diuresis and presence of viral hepatitis. Clin Biochem 2007; 40:1240-4. [PMID: 17826757 DOI: 10.1016/j.clinbiochem.2007.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 06/26/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES LIGHT is a cytokine involved in atherosclerosis and cardiovascular disease in general population. DESIGN AND METHODS We determined the levels of LIGHT in the plasma, dialysate and urine of uremic patients undergoing hemodialysis (HD) and healthy controls. RESULTS There were no significant differences in the pre and post-HD plasma levels of LIGHT between HD patients with residual diuresis (HD-RD) and HD anuric group (HD-A) compared to controls. HD-RD patients had the lower LIGHT values in dialysate compared to HD-A patients (p<0.001), and higher urinary LIGHT excretion compared to controls (p<0.05). Moreover, the presence of RD and chronic viral hepatitis were independent factors influencing the levels of this cytokine in dialysate. CONCLUSIONS The plasma levels of LIGHT seem to be similar in HD patients and healthy subjects and were not affected by gender, age, the mean period of HD history, disease etiology, type of medication and type of using dialysis membrane.
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Affiliation(s)
- Krystyna Pawlak
- Department of Nephrology and Clinical Transplantation, Medical University, Bialystok, Poland.
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Abstract
An increase in the length of the standard in-center hemodialysis treatment by 30 to 45 minutes per session was not associated with an improvement in mortality in long-term hemodialysis patients enrolled in the HEMO study. Testing the possibility that delivering still higher doses of hemodialysis may have a beneficial effect on patient outcomes will require the use of more frequent hemodialysis or a much longer duration for each dialysis session. "Short-daily hemodialysis," actually 6 times per week hemodialysis for 1.5 to 3 hours per session, can provide some increase in small molecule clearance as measured by urea kinetics. "Long nocturnal daily hemodialysis," actually 6 times per week hemodialysis for 6 to 8 hours per session, provides a significant increase in both small-molecular-weight and large-molecular-weight clearance and often alleviates the need to take phosphate binders. The National Institutes of Health is sponsoring 2 clinical trials via the Frequent Hemodialysis Network to determine the impact of these 2 modalities on intermediate outcomes, compared with standard 3-times-per-week hemodialysis.
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Affiliation(s)
- Michael V Rocco
- Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1053, USA.
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