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Nardelli L, Scalamogna A, Cicero E, Tripodi F, Vettoretti S, Alfieri C, Castellano G. Relationship between number of daily exchanges at CAPD start with clinical outcomes. Perit Dial Int 2024; 44:98-108. [PMID: 38115700 DOI: 10.1177/08968608231209849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) continues to be demanding for patients affected by kidney failure. In kidney failure patients with residual kidney function, the employment of incremental PD, a less onerous dialytic prescription, could translate into a decrease burden on both health systems and patients. METHODS Between 1st January 2009 and 31st December 2021, 182 patients who started continuous ambulatory peritoneal dialysis (CAPD) at our institution were included in the study. The CAPD population was divided into three groups according to the initial number of daily CAPD exchanges prescribed: one or two (50 patients, CAPD-1/2 group), three (97 patients, CAPD-3 group) and four (35 patients, CAPD-4 group), respectively. RESULTS Multivariate analysis showed a difference in term of peritonitis free survival in CAPD-1/2 in comparison to CAPD-3 (hazard ratio (HR): 2.20, p = 0.014) and CAPD-4 (HR: 2.98, p < 0.01). A tendency towards a lower hospitalisation rate (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.11 and 0.13, respectively) and decreased mortality (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.13 and 0.22, respectively) in patients who started PD with less than three daily exchanges was detected. No discrepancy of the difference of the mean values between baseline and 24 months residual kidney function was observed among the three groups (p = 0.33). CONCLUSIONS One- or two-exchange CAPD start was associated with a lower risk of peritonitis in comparison to three- or four-exchange start. Furthermore, an initial PD prescription with less than three exchanges may be associated with an advantage in term of hospitalisation rate and patient survival.
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Affiliation(s)
- Luca Nardelli
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonio Scalamogna
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Elisa Cicero
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Tripodi
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Simone Vettoretti
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Carlo Alfieri
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuseppe Castellano
- Division of Nephrology and Dialysis, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Singh V, Mishra SC, Mallikarjuna PA, Rout BB. Peritoneal dialysis: An effective therapeutic modality in acute kidney injury. Med J Armed Forces India 2023; 79:458-463. [PMID: 37441287 PMCID: PMC10334125 DOI: 10.1016/j.mjafi.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Peritoneal dialysis (PD) as a modality of renal replacement therapy (RRT) in acute kidney injury (AKI), continues to be underused. We present our experience with PD in patients with AKI. Method The data of patients with AKI requiring RRT were retrospectively analyzed. The primary end point was the adequacy of dialysis, and the secondary end point included hemodynamic stability and procedure-related complications. Result A total of 32 patients with AKI requiring RRT were included in the study. The mean age and the blood pressure at the time of hospitalization were 65.3 ± 6.73 years and 73.7 ± 8.4 mm Hg, respectively. All the patients required vasopressor support; 26 (81%) patients required ventilator support. RRT was initiated at a mean serum creatinine of 6.24 ± 1.17 mg/dL. Rigid stylet catheter was used in 9 (28.2%) and Tenckhoff catheter in 23 (71.8%) patients. The average daily ultrafiltration and weekly Kt/V achieved were 1701 ± 327 mL and 2.19, respectively; these were significantly higher in survivors. After the initiation of PD, hemodynamic instability was observed in 10 (31.2%) patients. The major therapy-related complication noted was PD peritonitis. Conclusions In a resource-poor environment, PD is an effective modality of RRT for AKI.
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Affiliation(s)
- Vishal Singh
- Senior Advisor (Medicine) & Nephrologist, 7 Air Force Hospital, Kanpur Cantt, UP, India
| | - Satish Chandra Mishra
- Consultant (Medicine) & Cardiologist, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
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Torres R, Flores L, Morales M, Morales R, Machuca E, Gauly A, Atiye S, Stauss-Grabo M, De Los Ríos T. A New Cycler for Automated Peritoneal Dialysis to Provide Efficient Dialysis and Improved Sleep Quality. Blood Purif 2023; 52:668-675. [PMID: 37331338 DOI: 10.1159/000530464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/13/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Automated peritoneal dialysis (APD) employs cyclers to control inflow and outflow of the dialysis fluid to the patient's abdomen. To allow more patients to use this modality, cyclers should support the achievement of an adequate dialysis dose and be easy to use, cost-effective, and silent. The new SILENCIA cycler (Fresenius Medical Care, Bad Homburg, Germany), designed to improve these characteristics in comparison to its predecessor device, was evaluated in this respect in a prospective study. METHODS This cross-over study comprised two 2-week study periods, separated by a 3-week training phase. First, patients underwent APD with their current cycler (PD-NIGHT [Fresenius Medical Care, Bad Homburg, Germany] or HomeChoice Pro [Baxter, Deerfield, IL, USA] as control), followed by training on the SILENCIA cycler. Then, patients were switched to the SILENCIA cycler. During each treatment period, we collected data on total Kt/Vurea, ultrafiltration (UF) volume, patient-reported outcomes (sleep quality, among others), and device handling. RESULTS Sixteen patients were enrolled; 2 patients terminated the study prematurely before study intervention, 1 patient due to a protocol violation. In 13 patients, total Kt/Vurea and UF could be evaluated. Neither Kt/Vurea nor UF differed significantly between control and SILENCIA cyclers. Out of 10 patients answering the questionnaire on sleep quality after the 2-week phase with the SILENCIA cycler, sleep quality improved in 5 patients; in the other patients, sleep quality was rated unchanged compared to the previously used cycler. The average reported sleep time was 5.9 ± 1.8 h with the PD-NIGHT, 7.2 ± 2.1 h with HomeChoice Pro, and 8.0 ± 1.6 h with the SILENCIA cycler. All patients were much or very much satisfied with the new cycler. CONCLUSION The SILENCIA cycler delivers adequate urea clearance and UF. Importantly, sleep quality improved, possibly related to less caution messages and alarms.
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Affiliation(s)
| | - Lorena Flores
- NephroCare San Bernardo & NephoCare Providencia, Santiago, Chile
| | | | | | | | - Adelheid Gauly
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - Saynab Atiye
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - Manuela Stauss-Grabo
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - Tatiana De Los Ríos
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
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Uduagbamen PK, Sanusi M, Soyinka FO, Udom OB, Ogunlade AF, Omokore OA, Emmanuel CC. Vascular Access in Hemodialysis: Peculiarities in a Low-Income Setting, Pattern, Prevalence and Relationship with Intradialysis Events and Dialysis Dose. West Afr J Med 2023; 40:421-427. [PMID: 37120761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVES Dialysis vascular access has remained a major determinant of intra and inter-dialytic events and the dialysis dose, and this impacts the quality of life, morbidity and mortality of dialysis patients. Assessing the different access types would help minimize peri-dialytic events and improve outcome. METHODS This was a retrospective, age and sex-matched, comparative study that assessed dialysis sessions with tunneled dialysis catheters (TDCs) with arteriovenous fistula (AVF). RESULTS Two hundred and four participants with 1062 sessions were involved. The male participants had 66.7% of all sessions, 60.6% of sessions with TDCs and 87.3% of sessions with AVF, P=0.001. The elderly constituted 23.5% of all participants but 37.7% of sessions with AVF, P=0.04. The percentage of the health-insured was more in sessions with AVF compared to the study population, P<0.001. Diabetics were more likely to use the TDCs, P=0.06. Participants using AVF were more likely to receive full dialysis and erythropoietin treatment, P<0.001. Intradialytic hypotension and dialysis termination were commoner with AVF than TDCs, P=0.03 and P=0.04 respectively. The dialysis dose was higher with AVF than TDCs, P=0.02. Predictors of AVF as dialysis access were male gender, advancing age, health insurance and full treatment compliance. CONCLUSION There is predominance of venous catheters in our dialysis population. The AVF gave better BP control, fluid and solute clearance, and dialysis dose, and was commoner with males, the health insured and older participants. Intradialytic hypotension was commoner with AVF as IDHT was commoner with TDCs.
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Affiliation(s)
- P K Uduagbamen
- Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. ; Tel: 2348065505539
| | - M Sanusi
- Tristate Heart and Vascular Centre, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - F O Soyinka
- Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. ; Tel: 2348065505539
| | - O B Udom
- Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. ; Tel: 2348065505539
| | - A F Ogunlade
- Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. ; Tel: 2348065505539
| | - O A Omokore
- Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. ; Tel: 2348065505539
| | - C C Emmanuel
- Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. ; Tel: 2348065505539
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Nardelli L, Scalamogna A, Cicero E, Castellano G. Incremental peritoneal dialysis allows to reduce the time spent for dialysis, glucose exposure, economic cost, plastic waste and water consumption. J Nephrol 2023; 36:263-273. [PMID: 36125629 DOI: 10.1007/s40620-022-01433-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/02/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Incremental peritoneal dialysis (incPD) as the initial PD strategy represents a convenient and resource-sparing approach, but its impact on patient, healthcare and environment has not been thoroughly evaluated. METHODS This study includes 147 patients who started incPD at our institution between 1st January, 2009 and 31st December, 2021. Adequacy measures, peritoneal permeability parameters, peritonitis episodes, hospitalizations and increase in CAPD dose prescriptions were recorded. The savings related to cost, patient glucose exposure, time needed to perform dialysis, plastic waste, and water usage were compared to full-dose PD treatment. RESULTS During the study follow-up 11.9% of the patients transitioned from incremental to full dose PD. Patient cumulative probability of remaining on PD at 12, 24, 36, 48 and 60 months was 87.6, 65.4, 46.1, 30.1 and 17.5%, respectively. The median transition time from 1 to 2 exchanges, from 2 to 3 and 3 to 4 exchanges were 5, 9 and 11.8 months, respectively. Compared to full dose PD, 1, 2, and 3 exchanges per day led to reduction in glucose exposure of 20.4, 14.8 or 8.3 kg/patient-year, free lifetime gain of 18.1, 13.1 or 7.4 day/patient-year, a decrease in cost of 8700, 6300 or 3540 €/patient-year, a reduction in plastic waste of 139.2, 100.8 or 56.6 kg/patient-year, and a decline in water use of 25,056, 18,144 or 10,196 L/patient-year. CONCLUSIONS In comparison with full-dose PD, incPD allows to reduce the time spent for managing dialysis, glucose exposure, economic cost, plastic waste, and water consumption.
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Affiliation(s)
- Luca Nardelli
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy.
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Antonio Scalamogna
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa Cicero
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
| | - Giuseppe Castellano
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
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Valga F, Monzón T, Vega-Diaz N, Rodriguez-Perez JC, Ruiz-Santana S. Inflammation and hemodialysis adequacy: are C-reactive protein levels influenced by the dose of dialysis? Nefrologia 2022; 42:163-170. [PMID: 36153912 DOI: 10.1016/j.nefroe.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/06/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Chronic inflammation and the underlying cardiovascular comorbidity are still current problems in chronic hemodialysis patients. There are few studies comparing the "dialysis dose" with the degree of inflammation in the patient. Our main objective was to determine whether there is a relationship between serum C-reactive protein (CRP) levels and the "dialysis dose" (Kt / V) using ionic dialysance. METHODS Multicenter cross-sectional study. 536 prevalent chronic hemodialysis patients were included. CRP levels, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were collected. Kt was obtained by ionic dialysance and urea distribution volume was calculated from the Watson's formula. The sample was divided into two groups, taking the median CRP as the cut-off point. Dialysis adequacy obtained in each group was compared. Finally, a logistic regression model was carried out to determine the variables with the greatest influence. RESULTS Median CRP was 4.10 mg/L (q25-q75: 1.67-10) and mean Kt/V was 1.48 ± 0.308. Kt/V was lower in the patients included in the high inflammation group (p = 0.01). In the multivariate logistic regression, the "high" levels of CRP were directly correlated with the Log INL (p < 0.001) and inversely proportional with serum albumin values (p = 0.014), Kt/V (p = 0.037) and serum iron (p < 0.001). CONCLUSION The poorer adequacy in terms of dialysis doses, lower Kt / V values, may contribute to a higher degree of inflammation in chronic hemodialysis patients.
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Affiliation(s)
- Francisco Valga
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Tania Monzón
- Centro de Hemodiálisis Avericum Negrín, Las Palmas de Gram Canaria, Spain.
| | - Nicanor Vega-Diaz
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - José Carlos Rodriguez-Perez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Sergio Ruiz-Santana
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
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Abstract
BACKGROUND This retrospective cohort study investigated the characteristics and outcomes of the end-stage kidney disease (ESKD) patients treated with incremental peritoneal dialysis (PD) at a large academic centre. METHODS ESKD patients initiating PD with a dialysate volume ≤6 L/day were analysed. RESULTS One hundred and seventy-five patients were included and were followed up for 352.6 patient-years. The baseline residual kidney function (RKF) was 8.3 ± 3.4 mL/min/1.73 m2. The unadjusted 1- to 5-year patient survival rate was 89.6%, 80.4%, 65.4%, 62.7% and 48.8%, respectively, and the corresponding time on PD therapy rate was 95.1%, 89.1%, 89.1%, 82.4% and 77.6%. Greater initial PD dose (hazard ratio = 1.608, 95% confidence interval 1.089-2.375) was associated with death after adjusting for age, Charlson comorbidity index (CCI), haemodialysis prior to PD, assisted PD and baseline RKF, likely as a result of residual confounding. There was no association with PD discontinuation. The average peritonitis rate and hospitalisation rate were 0.122 and 0.645 episodes per patient-year, respectively. The dialysate volume increased from 4.5 (4.3-5.7) L/day to 8.0 (6.0-9.8) L/day at 5 years. Fifty-seven (32.6%) patients graduated to full-dose PD at a median time of 10.3 (6.2, 15.7) months. Male sex, greater body mass index and lower baseline serum albumin were risk factors for increasing PD dose to over 6 L/day within 1 year. CONCLUSIONS Incremental PD is a safe approach to initiate dialysis, and it offers satisfactory outcomes. Close monitoring, comprehensive evaluation of clinical responses and prompt adjustment of the prescription as needed play a crucial role in this patient-centred treatment.
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Affiliation(s)
- Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, People's Republic of China.,Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Zita Abreu
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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8
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Valga F, Monzón T, Vega-Diaz N, Rodriguez-Perez JC, Ruiz-Santana S. Inflammation and hemodialysis adequacy: Are C-reactive protein levels influenced by dialysis dose? Nefrologia 2021; 42:S0211-6995(21)00112-0. [PMID: 34238598 DOI: 10.1016/j.nefro.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/06/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Chronic inflammation and the underlying cardiovascular comorbidity are still current problems in chronic hemodialysis patients. There are few studies comparing the "dialysis dose" (Kt/V) with the degree of inflammation in the patient. Our main objective was to determine whether there is a relationship between serum C-reactive protein (CRP) levels and the Kt/V using ionic dialysance. METHODS Multicenter cross-sectional study. A total of 536 prevalent chronic hemodialysis patients were included. CRP levels, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were collected. Kt was obtained by ionic dialysance and urea distribution volume was calculated from the Watson's formula. The sample was divided into 2 groups, taking the median CRP as the cut-off point. Dialysis adequacy obtained in each group was compared. Finally, a logistic regression model was carried out to determine the variables with the greatest influence. RESULTS Median CRP was 4.10mg/L (q25-q75: 1.67-10) and mean Kt/V was 1.48±0.308. Kt/V was lower in the patients included in the high inflammation group (P=.01). In the multivariate logistic regression, the "high" levels of CRP were directly correlated with the Log neutrophil-lymphocyte ratio (P<.001) and inversely proportional with serum albumin values (P=.014), Kt/V (P=.037) and serum iron (P<.001). CONCLUSION The poorer adequacy in terms of dialysis doses (lower Kt/V values) may contribute to a higher degree of inflammation in chronic hemodialysis patients.
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Affiliation(s)
- Francisco Valga
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Tania Monzón
- Centro de Hemodiálisis Avericum Negrín, Las Palmas de Gran Canaria, España
| | - Nicanor Vega-Diaz
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - José Carlos Rodriguez-Perez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - Sergio Ruiz-Santana
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España; Programa de Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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9
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Ekart R, Varda L, Vodošek Hojs N, Dvoršak B, Piko N, Bevc S, Hojs R. Early Detection of Arteriovenous Fistula Stenosis in Hemodialysis Patients through Routine Measurements of Dialysis Dose (Kt/V). Blood Purif 2021; 51:15-22. [PMID: 33784665 DOI: 10.1159/000514939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Monitoring of arteriovenous (AV) fistula to detect hemodynamically important stenosis is crucial for the prevention of AV fistula thrombosis. The aim of our study was to analyze the importance of dialysis dose (Kt/V) during online postdilution hemodiafiltration (HDF) for early detection of AV fistula stenosis. METHODS Hemodialysis patients with AV fistula were included in this study. We compared a group of 44 patients who have undergone fistulography and subsequently percutaneous transluminal angioplasty (PTA) of significant AV fistula stenosis (active group) with a group of 44 age- and sex-matched patients without PTA (control group). Observational time in both groups was the same. RESULTS All patients had postdilution online HDF using a F5008 dialysis machine, which can measure online single-pool Kt/V. All data were analyzed during the performance of 2056 HDF procedures. In the active group, we found statistically significantly lower values of Kt/V, all 8 weeks before PTA. In the active group, there was a significant improvement in Kt/V in the first (p < 0.001) and second week (p = 0.049) after PTA. Three and 8 weeks after PTA, we did not find any statistically significant difference in Kt/V between both groups (p = 0.114; p = 0.058). Patients in the active group had statistically significantly lower substitution volumes and blood pump flow rates during HDF over the whole observation period before and after PTA. In contrast, there were no differences in venous pressure in the dialysis circuit between both groups throughout the observation period. CONCLUSION In hemodialysis patients with AV fistula, treated with online HDF, routine measurements of Kt/V during each HDF are a beneficial, quick, and straightforward method for early detection of hemodynamically significant AV fistula stenosis.
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Affiliation(s)
- Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia.,Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Luka Varda
- Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Nina Vodošek Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Benjamin Dvoršak
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Nejc Piko
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Sebastjan Bevc
- Medical Faculty, University of Maribor, Maribor, Slovenia.,Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Radovan Hojs
- Medical Faculty, University of Maribor, Maribor, Slovenia.,Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
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Hernandez-Agudelo SY, Musso CG, González-Torres HJ, Castro-Hernández C, Maya-Altamiranda LP, Quintero-Cruz MV, Corradino C, Terrasa SA, Aroca-Martínez GJ, Cadena-Bonfanti A. Optimizing dialysis dose in the context of frailty: an exploratory study. Int Urol Nephrol 2021; 53:1025-31. [PMID: 33515350 DOI: 10.1007/s11255-020-02757-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function, which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the degree of frailty in a population of adult patients on HD. MATERIALS AND METHODS A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina) was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility, physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman's correlation and a logistic regression. RESULTS CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional tests. However, a significant and inverse correlation between physical activity and CFS was documented (score - 1.41 (CI - 2.1 to - 0.7). CONCLUSION No significant correlation was documented between Kt/V value and different parameters of the frailty status, but this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients was significantly higher in older individuals, although young individuals were not exempt from it.
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Molina-Andújar A, Alcubilla P, Santiago P, Blasco M, Cucchiari D, Piñeiro G, Andrea R, Fernández S, Reverter E, Mercadal J, Quintana E, Poch E; Hospital Clínic Intensive Care Working Group (GMTC). Impact of the intensity of intermittent renal replacement therapy in critically ill patients. J Nephrol 2021; 34:105-12. [PMID: 32495232 DOI: 10.1007/s40620-020-00760-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intermittent renal replacement therapy (IRRT) is prescribed across intensive care units (ICU) worldwide. While research regarding the prescribed dialysis dose has not yielded results concerning mortality, it is still unknown whether the same applies to the actual delivered dose. METHODS We retrospectively analyzed two different cohorts of patients (562 IRRT sessions) who were admitted to the intensive care units at Hospital Clínic of Barcelona and required renal replacement therapy with IRRT. The first cohort included patients with acute kidney injury (AKI) (n = 42) and the second included patients already on chronic hemodialysis (CKD 5D) (n = 47). Only patients who had at least 3 recorded hemodialysis sessions in the ICU and with no previous continuous renal replacement therapy (CRRT) were included. The achieved dose was measured as Kt (L) by ionic dialysance and the primary endpoint was 90-day mortality. RESULTS Ninety-day mortality was 40.5% (n = 17) in the AKI cohort and 23.9% (n = 11) in the CKD 5D cohort with mean Kt of 43 ± 8.27 L and 47 ± 9.65 L respectively. Kt dose of IRRT was associated with 90-day mortality in the AKI cohort in a multivariate surveillance analysis adjusted for confounding factors (HR 0.935 [0.88-0.99], p = 0.02). Only the Kt dose and age remained statistically associated with the outcome in the AKI cohort. CONCLUSIONS Delivered dialysis dose as measured by ionic-dialysance Kt may be associated with survival in critically-ill patients with AKI, while it does not seem to affect outcomes in critically-ill CKD 5D patients. This exploratory analysis will need confirmation in larger prospective studies.
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12
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Arias-Guillén M, Masso E, Gomez M, Rodas L, Broseta J, Vera M, Rios J, Fontseré N, Maduell F. Are Currently Used Bioimpedance Methods in Hemodialysis Comparable for Calculating Dialysis Dose? Ther Apher Dial 2019; 24:154-162. [PMID: 31325207 DOI: 10.1111/1744-9987.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022]
Abstract
Bioelectrical impedance analysis has increasingly been incorporated into hemodialysis units (HD) as a useful, noninvasive technique for evaluating overall fluid status. The aims of this study were to verify whether the information obtained from two different bioelectrical impedance analysis methods (spectroscopy bioimpedance [BCM] and single-frequency bioelectric impedance vector analysis [SF-BIVA]) was comparable for analyzing fluid status, and to determine their impact when used to calculate dialysis dose. This observational cross-sectional study included 78 HD patients who underwent one measurement with BCM and one with SF-BIVA in the same dialysis session. For calculating the dialysis dose, total body water or urea distribution volume (V) was calculated by the Watson formula and compared with the V obtained from the two devices. The difference in V between the two devices was 5.4 L (P < 0.001). Given the existent correlation between VBCM and VSF-BIVA , we were able to apply a formula (corrected V = VSF-BIVA = 1.04 × VBCM + 4.85, r = 0.93), allowing comparison of the two bioimpedance methods. The mean dialysis dose for BCM device (KtID /VBCM ) was 2.49 ± 0.85, much higher than KtID /VSF-BIVA (2.06 ± 0.72) mainly due to the V obtained with the different devices, with KtID /VWatson being 2.03 ± 0.67. The results on volume distribution showed an acceptable correlation but the devices were not comparable due to intermethod differences observed. Dialysis centers using SF-BIVA will obtain much lower dialysis dose, but by applying our formula, the Kt/V would resemble that obtained by the BCM device.
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Affiliation(s)
- Marta Arias-Guillén
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Elisabet Masso
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Miquel Gomez
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Lida Rodas
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain.,Spanish Kidney Research Network, ISCIII-RETIC (REDinREN), Madrid, Spain
| | - Jose Broseta
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain.,Spanish Kidney Research Network, ISCIII-RETIC (REDinREN), Madrid, Spain
| | - Manel Vera
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Jose Rios
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clínic, Barcelona, Spain
| | - Néstor Fontseré
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain
| | - Francisco Maduell
- Hospital Clinic Barcelona - Nephrology and Renal Transplantation, Barcelona, Spain.,Spanish Kidney Research Network, ISCIII-RETIC (REDinREN), Madrid, Spain
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13
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Zhan Z, Smyth B, Toussaint ND, Gray NA, Zuo L, de Zoysa JR, Chan CT, Jin C, Scaria A, Hawley CM, Perkovic V, Jardine MJ, Zhang L. Effect of extended hours dialysis on markers of chronic kidney disease-mineral and bone disorder in the ACTIVE Dialysis study. BMC Nephrol 2019; 20:258. [PMID: 31299919 PMCID: PMC6624904 DOI: 10.1186/s12882-019-1438-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/24/2019] [Indexed: 02/08/2023] Open
Abstract
Background Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD) is a significant cause of morbidity among haemodialysis patients and is associated with pathological changes in phosphate, calcium and parathyroid hormone (PTH). In the ACTIVE Dialysis study, extended hours dialysis reduced serum phosphate but did not cause important changes in PTH or serum calcium. This secondary analysis aimed to determine if changes in associated therapies may have influenced these findings and to identify differences between patient subgroups. Methods The ACTIVE Dialysis study randomised 200 participants to extended hours haemodialysis (≥24 h/week) or conventional haemodialysis (≤18 h/week) for 12 months. Mean differences between treatment arms in serum phosphate, calcium and PTH; and among key subgroups (high vs. low baseline phosphate/PTH, region, time on dialysis, dialysis setting and frequency) were examined using mixed linear regression. Results Phosphate binder use was reduced with extended hours (− 0.83 tablets per day [95% CI -1.61, − 0.04; p = 0.04]), but no differences in type of phosphate binder, use of vitamin D, dose of cinacalcet or dialysate calcium were observed. In adjusted analysis, extended hours were associated with lower phosphate (− 0.219 mmol/L [− 0.314, − 0.124; P < 0.001]), higher calcium (0.046 mmol/L [0.007, 0.086; P = 0.021]) and no change in PTH (0.025 pmol/L [− 0.107, 0.157; P = 0.713]). The reduction in phosphate with extended hours was greater in those with higher baseline PTH and dialysing at home. Conclusion Extended hours haemodialysis independently reduced serum phosphate levels with minimal change in serum calcium and PTH levels. With a few exceptions, these results were consistent across patient subgroups. Trial registration Clinicaltrials.gov NCT00649298. Registered 1 April 2008. Electronic supplementary material The online version of this article (10.1186/s12882-019-1438-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhipeng Zhan
- Department of Nephrology, China-Japan Friendship Hospital, 2 Yinghuayuan E St, Chaoyang Qu, Beijing Shi, 100096, China.,Department of Nephrology, Second Clinical Medical Institution of North Sichuan Medical College, Nanchong, China
| | - Brendan Smyth
- The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, 2042, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Nicholas A Gray
- Sunshine Coast University Hospital, Birtinya, Australia.,Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
| | - Li Zuo
- Peking University People's Hospital, Beijing, China
| | - Janak R de Zoysa
- North Shore Hospital, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Chenggang Jin
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Anish Scaria
- The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, 2042, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, 2042, Australia
| | - Meg J Jardine
- The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, 2042, Australia. .,Renal Unit, Concord Repatriation General Hospital, Sydney, Australia.
| | - Ling Zhang
- Department of Nephrology, China-Japan Friendship Hospital, 2 Yinghuayuan E St, Chaoyang Qu, Beijing Shi, 100096, China.
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Turgut F, Abdel-Rahman EM. Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review. Nephron Clin Pract 2017; 137:172-177. [PMID: 28750367 DOI: 10.1159/000479118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/29/2017] [Indexed: 11/19/2022] Open
Abstract
Obesity has grown into an epidemic across the globe. Mirroring this growth in the number of obese individuals in the general population, the prevalence of obesity and extremely morbid obesity (body mass index >50 kg/m2) is similarly rising in patients with end-stage renal disease (ESRD). Obesity, and more so, extremely morbid obesity, creates additional challenges for clinicians aiming at providing the best treatment options to patients with ESRD. Although literature is available regarding renal replacement therapy (RRT) for obese patients, literature about challenges facing clinicians managing ESRD in the extremely obese patients is lacking. Furthermore, the optimal strategies and goals for managing these patients with ESRD are not well defined. To our knowledge, no study has been done evaluating RRT options available to extremely morbid obese patients and the challenges associated with these options. Here, we report a case series and discuss the potential challenges faced by extremely obese patients with ESRD requiring RRT.
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Affiliation(s)
- Faruk Turgut
- Division of Nephrology, Department of Internal Medicine, Mustafa Kemal University, School of Medicine, Hatay, Turkey
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Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT. The Use of a Multidimensional Measure of Dialysis Adequacy-Moving beyond Small Solute Kinetics. Clin J Am Soc Nephrol 2017; 12:839-847. [PMID: 28314806 PMCID: PMC5477210 DOI: 10.2215/cjn.08460816] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/Vurea, has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to (1) understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and (2) present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis-related measures.
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Affiliation(s)
- Jeffrey Perl
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T, Honore PM, Javouhey E, Krummel T, Lahoche A, Letacon S, Legrand M, Monchi M, Ridel C, Robert R, Schortgen F, Souweine B, Vaillant P, Velly L, Osman D, Van Vong L. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD). Ann Intensive Care 2015; 5:58. [PMID: 26714808 PMCID: PMC4695466 DOI: 10.1186/s13613-015-0093-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022] Open
Abstract
Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.
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Affiliation(s)
| | | | | | | | | | | | - Patrick M Honore
- Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Etienne Javouhey
- Réanimation pédiatrique spécialisée, CHU Lyon, 69677, Bron, France.
| | | | | | | | | | - Mehran Monchi
- Réanimation polyvalente, CH Melun, 77000, Melun, France.
| | | | | | | | | | | | | | - David Osman
- CHU Bicêtre, 94, Le Kremlin Bicêtre, France.
| | - Ly Van Vong
- Réanimation polyvalente, CH Melun, 77000, Melun, France.
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