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Dialysis Modalities (dialysis + modality)
Selected AbstractsSleep apnea and dialysis therapies: Things that go bump in the night?HEMODIALYSIS INTERNATIONAL, Issue 4 2007Mark L. UNRUH Abstract Sleep apnea has been linked to excessive daytime sleepiness, depressed mood, hypertension, and cardiovascular disease in the general population. The prevalence of severe sleep apnea in the conventional thrice-weekly hemodialysis population has been estimated to be more than 50%. Sleep apnea leads to repetitive episodes of hypoxemia, hypercapnia, sleep disruption, and activation of the sympathetic nervous system. The hypoxemia, arousals, and intrathoracic pressure changes associated with sleep apnea lead to sympathetic activation, endothelial dysfunction, oxidative stress, and inflammation. Because sleep apnea has been shown to be widespread in the conventional dialysis population, it may be that sleep apnea contributes substantially to the sleepiness, poor quality of life, and cardiovascular disease found in this population. The causal links between conventional dialysis and sleep apnea remain speculative, but there are likely multiple factors related to volume status and azotemia that contribute to the high rate of severe sleep apnea in dialysis patients. Both nocturnal automated peritoneal dialysis and nocturnal hemodialysis have been associated with reduced severity of sleep apnea. Nocturnal dialysis modalities may provide tools to increase our understanding of the uremic sleep apnea and may also provide therapeutic alternatives for end-stage renal disease patients with severe sleep apnea. In conclusion, sleep apnea is an important, but overlooked, public health problem for the dialysis population. The impact of sleep apnea treatment in this high-risk population may include reduced sleepiness, better mood and blood pressure, and lowered risk of cardiovascular disease. [source] Internet use by end-stage renal disease patientsHEMODIALYSIS INTERNATIONAL, Issue 3 2007Emily SETO Abstract Information on the prevalence and predictors of use of the Internet by patients can be applied to the design and promotion of healthcare Internet technologies. To our knowledge, few studies on Internet use by end-stage renal disease (ESRD) patients have been reported. The objectives of this study are to ascertain the prevalence and predictors of Internet use by ESRD patients among different dialysis modalities. A questionnaire surveying Internet use was delivered in person to 199 conventional hemodialysis patients (57 returned), and mailed to 170 peritoneal dialysis (PD) patients (42 returned), and 65 nocturnal home hemodialysis (NHD) patients (43 returned). Of the respondents, most (58%) have used the Internet to find information on their health condition. The strong majority (76%) of these patients have easy access to the Internet. A higher proportion of NHD patients (86%) used the Internet compared with the PD patients (60%) (p=0.02). Internet use was found to be more prevalent with younger (p<0.001), more educated (p=0.001), and Canadian-born patients (p=0.005). The high prevalence of Internet use and easy access to the Internet by ESRD patients suggest that future Internet information and communication systems for healthcare management in ESRD will likely be well adopted by this patient population. [source] Removal of uremic plasma factors using different dialysis modalitiesHEMODIALYSIS INTERNATIONAL, Issue 2006Mario BONOMINI No abstract is available for this article. [source] ORAL PHOSPHATE BINDERS FOR THE MANAGEMENT OF SERUM PHOSPHATE LEVELS IN DIALYSIS PATIENTSJOURNAL OF RENAL CARE, Issue 2009Ismail Mohammed MBBS, MRCP SUMMARY Hyperphosphataemia is an inevitable consequence of end stage chronic kidney disease and is present in the majority of dialysis patients. Hyperphosphataemia is statistically associated with increased cardiovascular mortality among dialysis patients. Dietary restriction of phosphate and current dialysis modalities are not sufficiently effective to maintain serum phosphate levels within the recommended range so that the majority of dialysis patients require oral phosphate binders. However, benefits of achieving the recommended range have yet to be demonstrated prospectively. Unfortunately, conventional phosphate binders are not reliably effective and are associated with a range of limitations and side effects. Aluminium containing agents are highly efficient but no longer widely used because of well-established and proven toxicity. Calcium-based salts are inexpensive, effective and most widely used but there is now concern about their association with hypercalcaemia and vascular calcification. Sevelamer hydrochloride and lanthanum carbonate are non-aluminium, calcium-free phosphate binders. They are effective and reasonably well tolerated, but still do not control phosphate levels in all patients. Patient education programmes have been shown to be a useful and effective method of improving achievement of serum phosphate targets. [source] On-line Monitoring of Nocturnal Home HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003SJA Stokvis Background. Nocturnal home hemodialysis (NHD, 6,7 times weekly 6,8 hours) is a promising dialysis modality. On-line distant monitoring is complicated and expensive, and its usefulness should be evaluated. Methods. Since December 2001, 15 patients were included in a Dutch NHD project (,Nocturne'). So far, 3 patients received a renal transplant. Patients are assisted by their spouses. The dialysis machine is connected through the public telephone network by a bedside node and routers to the server in a call center. All patients received a dedicated ISDN-connection. Alarms produced by the machine are detected in the call center. For each type of alarm, a period is defined during which the patient can solve the problem. When the alarm continues after this period, the call center will notify the patient. Results. During 4 months, approximately 900 alarms in 1300 dialysis treatments were produced. In only 11 of 900 cases, the partner had to wake up the patient because he/she did not hear the alarm. The call center had to call 13 times, always because the patient resumed sleeping after the end of the treatment. No intervention because of serious problems was required. A majority of patients and personnel consider on-line monitoring nevertheless important as it gives a sense of safety. Additionally, nurses use the real-time connection frequently to check running dialysis treatments. Also, the system enables automatic saving of important treatment data in an electronic patient file. The experience so far is used to design a so-called ,secure bitpipe' for homecare applications, with emphasis on privacy, safety, security and effectivity. Conclusion. On-line monitoring of NHD may not be crucial, but enables good coaching of patients and gives a sense of safety. [source] Effects of late referral to a nephrologist in patients with chronic renal failureNEPHROLOGY, Issue 5 2005EKREM DOGAN SUMMARY: Background: We lack information about the role of late diagnosis of end-stage renal disease (ESRD), late nephrological referral and its impact on biochemical variables and first hospitalization in East Anatolia, Turkey. Methods and Results: For a total of 101 ESRD patients, dialysis was initiated between January 1998 and December 2002 at the Yuzuncu Yil University Hospital. Early referral (ER) and late referral (LR) were defined as the time of first referral or admission to a nephrologist greater or less than 12 weeks, respectively, before initiation of haemodialysis (HD). Results: The need for urgent dialysis was less among the early referral cases compared with the late referral cases (P = 0.03). Patients with LR started dialysis with lower levels of haemoglobin (8.6 vs 9.5 g/dL, P < 0.05) bicarbonate (16 vs 12 mEq/lt, P < 0.03) and albumin (2.9 vs 3.29 mg/dL, P < 0.02) and with higher serum levels of blood urea nitrogen (173 vs 95 mg/dL, P < 0.001), creatinine (10 vs 7.9 mg/dL, P < 0.001) and potassium (5.3 vs 4.8, P < 0.04). Hospitalization duration beginning at dialysis was significantly longer in the LR group (27.3 ± 24) compared with the ER group (13.4 ± 7.5, P < 0.001). When the groups were compared in terms of distance between the patients home and hospital, there were significantly more patients living far away from hospital (i.e. >100 km) in the LR group compared with the ER (P < 0.0001) group. Conclusion: Early referral to a nephrology unit and/or early diagnosis of ESRD results in better biochemical variables, shorter first hospitalization length and a higher percentage of elective construction of AVF and the availability to start with an alternative dialysis modality (i.e. CAPD). [source] Factors modifying stress from adverse effects of immunosuppressive medication in kidney transplant recipientsCLINICAL TRANSPLANTATION, Issue 1 2005Jaroslav Rosenberger Abstract:, Introduction:, The adverse effects of immunosuppression appear in the majority of patients with a negative impact on morbidity, mortality and quality of life. The group of adverse symptoms manifested as changes in appearance, mood and energy are often more stressful than serious metabolic changes because of their direct negative influence on patients' well-being. The aim of this study is to explore the adverse symptoms of immunosuppressive medication which are the most stressful for transplanted patients, and which are the modifying factors. Patients and methods:, A total of 157 adult kidney transplant recipients from two transplant centres in Slovakia with a functioning graft transplanted <7 yr ago were examined. Patients participated in an interview focusing on stress from adverse effects, and their education and social support. Medical records were searched for information about immunosuppression protocols, dialysis treatment before transplantation, type of received organ and period after transplantation. The effect of the selected variables on the total score for stress from adverse effects was tested using ANOVA. The effect of the selected factors on stress from each single adverse effect was explored using t -test and ANOVA. Results:, The most stressful symptoms were pain, weakness, weight gain, facial changes, depression and anxiety. The mean value of the total score for stress from adverse effects was 8.03 ± 6.53 (minimum 0, maximum 30, range: 0,64), indicating low stress. Women and patients with lower education significantly more often felt the adverse effects of immunosuppression as stressful (p < 0.001 and p < 0.05, respectively). Age, social support, dialysis modality before transplantation, time from transplantation and type of immunosuppressive treatment did not affect the total score for stress from adverse effects. However, variables that were not significant in the overall score reached significance in some symptoms. Conclusions:, Women and patients with lower education significantly more often felt the adverse effects of immunosuppression as stressful; in a more detailed analysis the use of new drugs was connected with less stress in some symptoms. The use of these drugs can improve life quality for transplant recipients, decrease non-compliance, and thus prevent graft loss. [source] | ||||||||||