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Dialysis Unit (dialysis + unit)

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Medical Sciences	100%

Selected Abstracts

History of hemodialyzers' designs

HEMODIALYSIS INTERNATIONAL, Issue 2 2008
Zbylut J. TWARDOWSKI
Abstract Accumulation of knowledge requisite for development of hemodialysis started in antiquity and continued through Middle Ages until the 20th century. Firstly, it was determined that the kidneys produce urine containing toxic substances that accumulate in the body if the kidneys fail to function properly; secondly, it was necessary to discover the process of diffusion and dialysis; thirdly, it was necessary to develop a safe method to prevent clotting in the extracorporeal circulation; and fourthly, it was necessary to develop biocompatible dialyzing membranes. Most of the essential knowledge was acquired by the end of the 19th century. Hemodialysis as a practical means of replacing kidney function started and developed in the 20th century. The original hemodialyzers, using celloidin as a dialyzing membrane and hirudin as an anticoagulant, were used in animal experiments at the beginning of the 20th century, and then there were a few attempts in humans in the 1920s. Rapid progress started with the application of cellophane membranes and heparin as an anticoagulant in the late 1930s and 1940s. The explosion of new dialyzer designs continued in the 1950s and 1960s and ended with the development of capillary dialyzers. Cellophane was replaced by other dialyzing membranes in the 1960s, 1970s, and 1980s. Dialysis solution was originally prepared in the tank from water, electrolytes, and glucose. This solution was recirculated through the dialyzer and back to the tank. In the 1960s, a method of single-pass dialysis solution preparation and delivery system was designed. A large quantity of dialysis solution was used for a single dialysis. Sorbent systems, using a small volume of regenerated dialysis solution, were developed in the mid 1960s, and continue to be used for home hemodialysis and acute renal failure. At the end of the 20th century, a new closed system, which prepared and delivered ultrapure dialysis solution preparation, was developed. This system also had automatic reuse of lines and dialyzers and prepared the machine for the next dialysis. This was specifically designed for quotidian home hemodialysis. Another system for frequent home hemodialysis or acute renal failure was developed at the turn of the 21st century. This system used premanufactured dialysis solution, delivered to the home or dialysis unit, as is done for peritoneal dialysis. [source]

Patient preferences for in-center intense hemodialysis

HEMODIALYSIS INTERNATIONAL, Issue 3 2005
Nirupama Ramkumar
Abstract There is a lack of data on patient preferences for intense hemodialysis (IHD). In this study, we conducted a cross-sectional survey to identify patient preferences and patient-centered barriers for IHD. A questionnaire on preferences and anticipated barriers, anticipated benefits, and quality of life for three in-center IHD schedules (daytime 2 hr six times/week [DHD], nocturnal 8 hr three times/week [ND3], and nocturnal 8 hr six times/week [ND6]) was administered to 100 chronic hemodialysis patients. A majority of patients (68%) were willing to undergo DHD for symptomatic benefits or increase in survival. An increase in energy level (94%) and improvement in sleep (57%) were the most common potential benefits that would justify DHD, but only 19% would undergo DHD for an increase in survival of ,3 years. Only 20% and 7% would consider ND3 and ND6, respectively. The most common reported barriers were inadequate time for self (50%) and family (53%), followed by transportation difficulties (53%). Most patients would undergo DHD for symptomatic or survival benefits, but not ND3 or ND6. Disruption of personal time, however, is an important consideration. Success of DHD program would depend on arrangements for transportation to dialysis unit. [source]

Toward a Continuous Quality Improvement Paradigm for Hemodialysis Providers with Preliminary Suggestions for Clinical Practice Monitoring and Measurement

HEMODIALYSIS INTERNATIONAL, Issue 1 2003
Edmund G. Lowrie
Background: Consensus processes using the clinical literature as the primary source for information generally drive projects to draft clinical practice guidelines (CPGs). Most such literature citations describe special projects that are not part of an organized quality management initiative, and the publication/review/consensus process tends to be long. This project describes an initiative to develop and explore a flexible and dedicated data-driven paradigm for deciding new CPGs that could be rapidly responsive to changing medical knowledge and practice. Methods: Candidate Clinical Practice Monitoring Measures (CPMM) were selected using a large, national database according to the natures and strengths of their associations with mortality risk among patients during 1994. Thresholds above or below which risk of death increased were evaluated for each CPMM using risk profile charts and spline functions. The fractions of patients outside of those thresholds in each dialysis unit (the %Var) were determined for the years 1993, 1994, and 1995. A standardized mortality ratio (SMR) was also determined for each year for each facility. The associations between the %Var and SMR were evaluated in several single-variable and multivariable statistical models. Results: Eleven CPMM were selected and evaluated based on their associations with death risk. These included the urea clearance x dialysis time product (Kt); the concentrations of albumin, potassium, phosphate, bicarbonate, hemoglobin, neutrophils, and lymphocytes in the blood; the body weight/height ratio; diastolic blood pressure; and vascular access type. Even though the CPMM were strongly associated with death risk among patients, the %Var were weakly and inconsistently associated with SMR among facilities. Conclusions: The paradigm was flexible, easy to implement, quickly executed, and potentially able to accommodate evolving medical practice assuming the availability of large database systems such as this. The primary associates of death risk were easily identified and the thresholds easily adopted. The SMR and %Var from the CPMM were only weakly associated, however, suggesting that one cannot be reliably predicted from the other. As such, quality management programs should likely monitor both the processes and outcomes of care among dialysis facilities. [source]

THE AUSTRALIAN AND NEW ZEALAND DIALYSIS WORKFORCE STUDY IN THE INTERNATIONAL CONTEXT

JOURNAL OF RENAL CARE, Issue 4 2009
Nick Polaschek RN
SUMMARY Background: Given increasing demand for renal replacement therapy, this study sought to identify of key workforce issues facing dialysis units, based on a "snapshot" of the current workforce. Methods: A web-based survey of all dialysis unit managers in Australia and New Zealand, in October 2008, about their workforce. Results: A significant minority of dialysis staff in most regions were not registered nurses. Many renal registered nurses worked part-time. Staff/patient ratios in dialysis units varied significantly by region, reflecting the relative prevalence of home therapies. Most dialysis units were generally adequately staffed. The proportion of registered nurses with specific renal qualifications varied significantly by region. Conclusion: The changing character of the workforce in the dialysis unit in the future will require clarification of the relationships between different categories of dialysis staff. Specialty education for nurses needs to be oriented to equipping staff to be effective in their changing work environment. [source]

Predicting vascular access failure: A collective review

NEPHROLOGY, Issue 4 2002
Kevan R POLKINGHORNE
SUMMARY: The maintenance of vascular access for haemodialysis contributes a large burden of morbidity and cost to any dialysis unit. Identifying vascular access at risk of thrombosis is an evolving and important aspect to the management of any haemodialysis patient. Haemodynamic profiles of native fistulas and arteriovenous grafts differ significantly, and, as such, the sensitivity of the specific monitoring techniques to detect dysfunction varies depending on access type. Multiple strategies are now available for monitoring vascular access including measuring intra-access pressure and access blood flow, or screening for significant stenoses with Doppler ultrasonography. the ability of each strategy to detect significant stenosis is reviewed by looking at the evidence for both arteriovenous fistula (AVF) and arteriovenous grafts (AVG), separately. the majority of published literature involves AVG, and measuring access blood flow is the modality of choice. the best method for measuring flow is not known. For AVF, much less is known, and it is not clear whether monitoring will decrease the thrombosis risk and prolong access life. Recommendations for AVF cannot be made until more evidence becomes available. [source]

Resource settings have a major influence on the outcome of maintenance hemodialysis patients in South India

HEMODIALYSIS INTERNATIONAL, Issue 2 2010
ABRAHAM Georgi
Abstract Chronic kidney disease is reaching epidemic proportions and the number of patients on renal replacement therapy (RRT) is increasing worldwide and also in developing countries. To meet the challenge of providing RRT, a few charity organizations provide hemodialysis units for underprivileged patients, as the private hospitals are unaffordable for the majority. There is a paucity of information on the outcome of dialysis in these patients. Here, we describe the outcome of hemodialysis patients comparing the middle- and upper-class income group with the lower class income group. A retrospective analysis was carried out in 558 CKD patients initiated on maintenance hemodialysis in two different dialysis facilities. Group A (n=247) included those who belonged to the lowermost socioeconomic status and were undergoing dialysis in two nonprofit, charity (TANKER)-run dialysis units, and Group B (n=311) was undergoing dialysis in a nonprofit hospital setting where no subsidy was given. Those patients of a low socioeconomic status, especially those who are diabetics, have a higher death rate (Group A-38.1%, Group B-4.2%) and loss to follow-up (Group A-25.9%, Group B-0.3%) compared with those who are in the middle- and high-income group. Higher EPO use and hence higher hemoglobin levels (Group A-6.4±1.2, Group B-8.9±1.5 P<0.001) were observed in those who were in the middle and the higher income group. Lower serum phosphorus level was observed in the low-socioeconomic group (Group A-4.7±1.5, Group B-5.5±1.9, P<0.001). Patients belonging to the middle and higher socioeconomic group undergo more transplantations compared with the lower socioeconomic group (Group A-2.4%, Group B-65.6%). [source]

Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy

JOURNAL OF INTERNAL MEDICINE, Issue 5 2002
T. Apeland
Abstract. Apeland T, Mansoor MA, Seljeflot I, Brønstad I, Gøransson L, Strandjord RE (Rogaland Central Hospital, Stavanger; and Ullevål University Hospital, Oslo; Norway). Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy. J Intern Med 2002; 252: 456,464. Objectives. Haemodialysis patients have elevated levels of the atherogenic amino acid homocysteine. We wanted to assess the effects of small doses of intravenous folinic acid (the active form of folic acid) on some biochemical risk factors of cardiovascular disease. Design. Longitudinal and open intervention study. Setting. Two dialysis units in the County of Rogaland. Subjects. All patients on maintenance haemodialysis were invited, and 32 of 35 patients gave their informed consent. Interventions. After each dialysis session, the patients were given 1.0 mg of folinic acid intravenously thrice a week for a period of 3 months. Prior to and during the study, all patients were on maintenance supplementation with small doses of vitamins B1, B2, B3, B5, B6 and B12. Main outcome measures. Changes in the levels of (i) plasma total homocysteine (p-tHcy) and folate, (ii) circulating endothelium related proteins , markers of endothelial activation and (iii) serum malondialdehyde (S-MDA) , a marker of oxidative stress and lipid peroxidation. Results. The p-tHcy levels were reduced by 37% (P < 0.0001), whilst the serum and erythrocyte folate levels increased by 95 and 104%, respectively (P < 0.0001 for both). The circulating levels of endothelium related cellular adhesion molecules and haemostatic factors remained high and unchanged, except the thrombomodulin (TM) levels increased (P = 0.0004). The high levels of S-MDA were reduced by 26% (P = 0.003). Conclusions. Low doses of folinic acid given intravenously to dialysis patients reduced their levels of p-tHcy and S-MDA and thus improved their cardiovascular risk profile. The concurrent increment in TM levels was unexpected and of unknown clinical significance. [source]

THE AUSTRALIAN AND NEW ZEALAND DIALYSIS WORKFORCE STUDY IN THE INTERNATIONAL CONTEXT

Review article: Hepatitis B and dialysis

NEPHROLOGY, Issue 2 2010
MATTHEW EDEY
ABSTRACT: The incidence of hepatitis B virus (HBV) infection in dialysis populations has declined over recent decades, largely because of improvements in infection control and widespread implementation of HBV vaccination. Regardless, outbreaks of infection continue to occur in dialysis units, and prevalence rates remain unacceptably high. For a variety of reasons, dialysis patients are at increased risk of acquiring HBV. They also demonstrate different disease manifestations compared with healthy individuals and are more likely to progress to chronic carriage. This paper will review the epidemiology, modes of transmission and diagnosis of HBV in this population. Prevention and treatment will be discussed, with a specific focus on strategies to improve vaccination response, new therapeutic options and selection of patients for therapy. [source]