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Hemodialysis
Kinds of Hemodialysis Terms modified by Hemodialysis Selected AbstractsCUMULATIVE SURVIVAL RATE BETWEEN ESRD PATIENTS UNDER TREATMENT HEMODIALYSIS AND KIDNEY TRANSPLANTATIONNEPHROLOGY, Issue 1 2002Aditiawardana [source] Hepatitis C infection in hemodialysis patients in Iran: A systematic reviewHEMODIALYSIS INTERNATIONAL, Issue 3 2010Seyed-Moayed ALAVIAN Abstract Hemodialysis (HD) patients are recognized as one of the high-risk groups for hepatitis C virus (HCV) infection. The prevalence of HCV infection varies widely between 5.5% and 24% among different Iranian populations. Preventive programs for reducing HCV infection prevalence in these patients require accurate information. In the present study, we estimated HCV infection prevalence in Iranian HD patients. In this systematic review, we collected all published and unpublished documents related to HCV infection prevalence in Iranian HD patients from April 2001 to March 2008. We selected descriptive/analytic cross-sectional studies/surveys that have sufficiently declared objectives, a proper sampling method with identical and valid measurement instruments for all study subjects, and proper analysis methods regarding sampling design and demographic adjustments. We used a meta-analysis method to calculate nationwide prevalence estimation. Eighteen studies from 12 provinces (consisting 49.02% of the Iranian total population) reported the prevalence of HCV infection in Iranian HD patients. The HCV infection prevalence in Iranian HD patients is 7.61% (95% confidence interval: 6.06,9.16%) with the recombinant immunoblot assay method. Iran is among countries with low HCV infection prevalence in HD patients. [source] Hemodialysis Abstracts from the Annual Dialysis Conference 29th Annual Conference on Peritoneal Dialysis, 15th International Symposium on Hemodialysis, and 20th Annual Symposium on Pediatric Dialysis Houston, Texas March 8,10, 2009HEMODIALYSIS INTERNATIONAL, Issue 1 2009Article first published online: 22 JAN 200 First page of article [source] History of hemodialyzers' designsHEMODIALYSIS INTERNATIONAL, Issue 2 2008Zbylut 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] Dialysis quality and quantity: How much and how often?HEMODIALYSIS INTERNATIONAL, Issue 2007Elaine SPALDING Abstract Hemodialysis is accepted as standard therapy for end-stage renal failure but despite four decades of experience the morbidity and mortality associated with the treatment remains unacceptably high. Quality of dialysis is traditionally measured with reference to urea clearance but it is becoming increasingly apparent that other solutes across the range of molecular size are also important. More prolonged or more frequent therapy may improve dialysis delivery and enhance survival in patients with end-stage renal disease. [source] International Society for Hemodialysis: A message from the presidentsHEMODIALYSIS INTERNATIONAL, Issue 4 2006Article first published online: 3 OCT 200 No abstract is available for this article. [source] Experimental study on a new type citrate anticoagulant hemodialysate in dogsHEMODIALYSIS INTERNATIONAL, Issue 1 2005G. Baosong Objective:,In this study, we initiated a new hemodialysate with citrate buffer, observed the factors that influence the citrate concentration of solution in hollow fibers when using citrate hemodialysate, and observed the anticoagulant effect and safety of the citrate hemodialysate in the experiment in dogs. Methods:,Ten dogs were given intermittent hemodialysis and were divided into 3 groups according to hemodialysis procedures. Group 1 was saline-flush hemodialysed with bicarbonate hemodialysate; Group 2 was hemodialysed with citrate hemodialysis without any anticoagulant; Group 3 was hemodialysed with bicarbonate hemodialysate and heparin. ACT, Ca++, BUN, Cr, ALT, AST, TBIL, DBIL, Na+, Cl,, , and venous pressure were monitored in the animals of each group during hemodialysis. Results:,During the hemodialysis in Group 1, venous pressure increased lastingly, resulting in the failure of hemodialysis for 2 hours. Hemodialysis for 2 hours in Group 2 were all finished successfully. ACT was extended and Ca++ decreased obviously in the venous end during hemodialysis. And ALT, AST, Ca++, K+, Na+, Cl,, after the hemodialysis in Group 2 were not changed (P > 0.05). Moreover, the clearance rate of the dialyzers with citrate dialysate increased significantly compared with those of saline-flush and heparin anticoagulation. Conclusions:,The anticoagulant and dialytic effects of the new type citrate hemodialysis are satisfactory and better than that of saline-flush. [source] Pediatrics Access Problems in hemodialysis with a permanent central venous catheterHEMODIALYSIS INTERNATIONAL, Issue 1 2005J. Muscheites Hemodialysis is a common treatment of chronic renal failure, also in childhood. Due to the high standard of technique there are only few contraindications for this treatment at present. Limitations are given by the vessel access. But in the last years, hemodialysis has been made practicable by the permanent central venous catheter, however, with more problems. As an example for potential complications in the treatment with the permanent catheter we present an unusual case report about a twenty-one- year-old girl suffering from chronic renal failure due to reflux nephropathy, Prader-Willi- syndrome, myelonatrophia of undetermined origin with spastic diplegia of the legs, and increasing sphincter ani dysfunction. We started the renal replacement therapy when the girl was 15 years old. It was not possible to create an AV fistula due to very small vessels. Two Gore-Tex ® implants were clotted in absence of thrombophilia. Afterwards, the hemodialysis was performed by a permanent central venous catheter. The catheter had to be changed 15 times. The reasons for changing the catheter were problems of flow during hemodialysis due to clotting, dislocations, spontaneous removing of the catheter by herself, and infections. Altogether a sepsis occurred four times. The first transplantation failed due to a rupture of the transplanted kidney. A second transplantation was not possible because of the high BMI. Intermittently, the girl was treated with peritoneal dialysis (PD) in the hospital, because the PD couldn't be done at home due to different reasons. Only on weekends could the girl go home. The PD had to be finished after 6 months due to a severe psychotic syndrome. The girl died at age 21, caused by a sepsis following the 15th change of the catheter. A huge problem of frequent catheter changing is the limited availability of vessel accesses , the limits of treatment by hemodialysis. [source] Prevention of hemodialysis-related muscle cramps by intradialytic use of sequential compression devices: A report of four casesHEMODIALYSIS INTERNATIONAL, Issue 3 2004Muhammad Ahsan Background:, Hemodialysis (HD)-related lower extremity (LE) muscle cramps are a common cause of morbidity in end-stage renal disease patients on maintenance HD. Numerous pharmacologic and physical measures have been tried with variable success rates. Methods:, Sequential compression devices (SCD) improve venous return (VR) and are commonly used to prevent LE deep venous thrombosis in hospitals. We hypothesized that LE cramps are triggered by stagnant venous flow during HD and are preventable by improving VR. We prospectively studied four adult patients (mean age 61 ± 14 years) on thrice-weekly HD who experienced two or more episodes of LE cramping weekly in the month before the study. SCD were applied before each HD on both legs and compressions were intermittently applied at 40 mmHg during treatment. Results:, All four patients reported complete resolution of cramping during the study period that lasted 1 month or 12 consecutive dialysis treatments. Conclusion:, Application of SCD to LE may prevent the generation of LE HD-related cramping in a select group of patients. Larger, controlled studies are needed to establish the utility of this noninvasive alternative for the prevention of LE HD-related cramps. [source] Lipoprotein (a) in Chronic Renal Failure: Effect of Maintenance HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 4 2003Om Prakash Kalra Background:,Coronary artery disease accounts for significant morbidity and mortality in patients with chronic kidney disease (CKD). Besides the higher prevalence of traditional risk factors, several uremia-related factors may play a role in accelerated atherosclerosis, such as elevated levels of lipoprotein (a) (Lp(a)). The effect of maintenance hemodialysis (MHD) on Lp(a) levels is not well understood. The present work was carried out to study the Lp(a) levels in Stage 4 and Stage 5 CKD patients as well as the effect of MHD on Lp(a) levels in patients with Stage 5 CKD. Methods:,The study subjects included 15 patients with Stage 4 CKD, 15 patients with Stage 5 CKD, and 15 age- and sex-matched healthy controls. Plasma Lp(a) was measured by ELISA in all the subjects at the time of entry into the study and after 4 weeks of MHD in patients with Stage 5 CKD. Patients on MHD were dialyzed two to three times weekly for 4 hr during each session. Results:,Mean Lp(a) levels were significantly higher in patients with CKD than in control patients. In patients with Stage 4 CKD, the Lp(a) level was 34.0 ± 19.5 mg/dL, whereas in Stage 5 CKD the level was 49.0 ± 30.9 and in healthy controls it was 22.2 ± 16.4. In patients with Stage 5 CKD, 4 weeks of MHD led to a significant fall in Lp(a) levels by 23.6% (P < 0.001). Conclusions:,The results of this study show that increases in Lp(a) levels start early during the course of CKD and become more pronounced with increased severity of disease. Initiation of MHD lowers Lp(a) levels and may have a long-term beneficial effect on cardiovascular morbidity and mortality. [source] Hemodynamic and Volume Changes during HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 3 2003Robert M. Lindsay Background:,Volume overload is a factor in the hypertension of hemodialysis (HD) patients. Fluid removal is therefore integral to the hemodialysis treatment. Fluid removal by hemodialysis ultrafiltration (UF) may cause intradialytic hypotension and leg cramps. Understanding blood pressure (BP) and volume changes during UF may eliminate intradialytic hypotension and cramps. Studies (S1, S2, and S3) were carried out to determine the amount and direction of changes in body fluid compartments following UF and to determine the relationships between BP, changes in blood volume (,BV), central blood volume (CBV), cardiac output (CO), peripheral vascular resistance (PVR) plus total body water (TBW), and intra- and extracellular fluid volumes (ICF, ECF) in both the whole body and body segments (arms, legs, trunk). Methods:,Indicator dilution technology (Transonic) was used for CBV, CO, and PVR; hematocrit monitoring (Crit-Line) was used for ,BV segmental bioimpedance (Xitron) for TBW, ICF, and ECF. Results:,S1 (n = 21) showed UF sufficient to cause ,BV of ,7% and lead to minor changes (same direction) in CBV and CO, and with cessation of UF, vascular refilling was preferential to CBV. S2 (n = 20) showed that predialysis HD patients are ECF-expanded (ECF/ICF ratio = 0.96, controls = 0.74 [P < 0.0001]) and BP correlates with ECF (r = 0.47, P = 0.35). UF to cause ,BV of ,7% was associated with a decrease in ECF (P < 0.0001) and BP directly (r = 0.46, P = 0.04) plus ,BV indirectly (r = ,0.5, P = 0.024) correlated with PVR, while CBV and CO were maintained. S3 (n = 11) showed that following UF, total-body ECF changes were correlated with leg ECF (r = 0.94) and arm ECF (r = 0.72) but not trunk ECF. Absolute ECF reduction was greatest from the legs. Conclusions:,Predialysis ECF influences BP and UF reduces ,BV and ECF, but CBV and BP are conserved by increasing PVR. ECF reduction is mainly from the legs, hence may cause cramps. Intradialytic hypotension is caused by failure of PVR response. [source] Fallacies of High-Speed HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 2 2003Zbylut J. Twardowski Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Financial and logistical pressures related to the overwhelming number of patients requiring hemodialysis created an incentive to shorten dialysis time to four, three, and even two hours per session in a thrice weekly schedule. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/Vurea) equals 0.95,1.0. This number was later increased to 1.3, but the assumption remained unchanged that hemodialysis time is of minimal importance as long as it is compensated by increased urea clearance. Patients accepted short dialysis as a godsend, believing that it would not be detrimental to their well-being and longevity. However, Kt/Vurea measures only removal of low molecular weight substances and does not consider removal of larger molecules. Besides, it does not correlate with the other important function of hemodialysis, namely ultrafiltration. Whereas patients with substantial residual renal function may tolerate short dialysis sessions, the patients with little or no urine output tolerate short dialyses poorly because the ultrafiltration rate at the same interdialytic weight gain is inversely proportional to dialysis time. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Short, high-efficiency dialysis requires high blood flow, which increases demands on blood access. The classic wrist arteriovenous fistula, the access with the best longevity and lowest complication rates, provides "insufficient" blood flow and is replaced with an arteriovenous graft fistula or an intravenous catheter. Moreover, to achieve high blood flows, large diameter intravenous catheters are used; these fit veins "too tightly," so predispose the patient to central-vein thrombosis. Longer hemodialysis sessions (5,8 hrs, thrice weekly), as practiced in some centers, are associated with lower complication rates and better outcomes. Frequent dialyses (four or more sessions per week) provide better clinical results, but are associated with increased cost. It is my strong belief that a wide acceptance of longer, gentler dialysis sessions, even in a thrice weekly schedule, would improve overall hemodialysis results and decrease access complications, hospitalizations, and mortality, particularly in anuric patients. [source] Anticoagulation Options for Pediatric HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 2 2003Andrew Davenport Blood coagulation in the extracorporeal hemodialysis circuit is one of the manifestations of bio-incompatibility that is related to the activation of monocytes, platelets, and the coagulation cascades. Compared to adults, in pediatric patients, the surface area of the extracorporeal circuit is increased relative to blood volume. This is due to the patient's smaller blood volume and the combination of the higher relative surface area of the dialyzer, smaller lumen lines, and small-bore vascular catheters, potentially increasing contact activation of coagulation proteins, platelets, and inflammatory cells. Although unfractionated heparin remains the most commonly used anticoagulant, low molecular weight heparin offers the advantages of a single bolus, less fibrin and platelet deposition in the dialyzer, and perhaps more importantly, less osteoporosis, hyperkalemia, and abnormal lipoprotein profile. Although regional anticoagulants are available, these are often prohibitively expensive or require increased complexity of the dialysis procedure (e.g., citrate), but have the advantage of reducing the risk of bleeding when compared to heparin. Thrombin inhibitors are now available, and with the advent of argatroban, which is metabolized in the liver, have become the anticoagulants of choice for the few patients who develop heparin-induced thrombocytopenia type II. [source] International Society for Hemodialysis: A Message from the PresidentHEMODIALYSIS INTERNATIONAL, Issue 1 2003Article first published online: 27 FEB 200 No abstract is available for this article. [source] Preliminary Results from the Use of New Vascular Access (Hemaport) for HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003J Ahlmén One of the most important factors for an optimal chronic hemodialysis is a well- functioning vascular access. Still the A-V-fistula is the best alternative. When repeated failures arise new access alternatives are needed. The Hemaport combines a PTFE-graft with a percutaneous housing of titan. Starting and stopping the dialysis session is simple and needle-free. The first clinical experiences are presented. Thirteen patients (m-age 60 years) in 6 centres had used the Hemaport system. Out of 11 functioning devices 7 were placed on the upper arm and 4 were located on the thigh. The total days in observation were 2.156 days with 769 dialysis sessions performed. Six patients had used the Hemaport system for more than 6 months. Mean blood flow was 364, range 100,450 ml/min with a mean venous and arterial pressure of 100 mm Hg, range 30,250, and 16 mm Hg respectively, range , 140 to + 259. Thrombosis interventions have been required in 14 percent to obtain a functioning vascular access. Two patients contributed with more than half of these events. Mechanical or pharmacological thrombolysis can be performed through the Hemaport dialysis lid without open surgery. Six implants have been removed and in 5 of these cases a new Hemaport was implanted. The reasons for removing the device were related to insufficient vascular flow, thrombosis, and/or infection. In patients with repeated access problems, a new vascular access (Hemaport) has been clinically used for about 1 year. By its design, Hemaport offers a novel approach. [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] Nocturnal Hemodialysis Is Better Than Quotidian HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003MP Kooistra Background. It is unknown whether long nocturnal (6,7 times weekly 6,8 hours) hemodialysis (NHD) is better than frequent short hemodialysis (,daily', quotidian hemodialysis, QHD). Methods. A Dutch NHD pilot study (,Nocturne') started in December 2001. We can now evaluate effects of 4 months NHD in 14 patients. Baseline dialysis frequency was 3.5 or less (3.13 ± 0.23, M ± SD) in group A (n = 8), and 4 or more (5.0 ± 0.89) in group B (n = 6), weekly dialysis time was equal in both groups. Results. Single pool Kt/V, being higher in group B at baseline, increased in both groups (A: 3.1 ± 0.8/week to 9.5 ± 2.3, B: 3.8 ± 1.0 to 10.9 ± 4.1). Baseline nPCR, being higher in group B, increased in both groups (A: 1.0 ± 0.3 g/kg/week to 1.4 ± 0.3, and B: 1.2 ± 0.5 to 1.8 ± 0.5). Baseline albumin was higher in group B, and increased in group A (39.6 ± 3.7 g/l to 43.2 ± 1.5), not in B (41.4 ± 2.3 to 42.8 ± 2.3). Target weight increased only in group A (71.8 ± 10.5 kg to 75.3 ± 11.9), not in B (71.4 ± 25.5 to 71.3 ± 26.7). NHD resulted in normophosphatemia in both groups despite phosphate supplementation and cessation of phosphate binders. PTH decreased in both groups (A: 40.6 ± 38.0 pmol/l to 14.4 ± 11.7, B: 35.6 ± 37.7 to 22.4 ± 41.5). In both groups, pre- and postdialysis mean arterial pressure decreased (A: 106.8 ± 7.9 mmHg to 94.4 ± 12.1 and 97.3 ± 9.5 mmHg to 86.3 ± 8.2, B: 102.2 ± 28.4 to 89.4 ± 9.5 and 90.3 ± 26.8 to 82.7 ± 12.9). Antihypertensives were discontinued or markedly reduced. Fatigue, insomnia, prurigo, restlessness, appetite, physical condition, working ability and quality of life (SF36) improved significantly in both groups. Conclusion. This small pilot study suggests that phosphate and PTH control, blood pressure, uremic symptoms and quality of life improve when conventional hemodialysis or QHD patients switch to NHD. Nutritional parameters improve only in the previously conventionally treated group. [source] A Comparison of CV-Catheters (CV) Grafts (GR) and Fistulae (FI) in Quotidian HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003C Kjellstrand We studied longevity and complications from CV, GR, and FI in 23 patients on quotidian hemodialysis. There were a total of 409 patient months, mean 18,10 months observation and a total of 9209 dialyses. There were 14 FI, 5 GR and 4 CV. 1, 1 and 2 replacements were necessary during a total observation time of 254, 105 and 50 patient months, respectively. For fistulae there were 0.02 replacements/year vs. 0.30 for GR and 0.41 for CV. P = 0.042 FI vs. other. The cumulative survival at 15 months was 100% for FI, 80% for GR and 20% for CV. P = 0.041. The cumulative survival at 3 years were 80% for fistulae and grafts, no CV lasted beyond 15 months. P = 0.013. There were 27 events requiring hospitalization or outpatient intervention. FI: 0.42/patient year, GR 1.22/patient year and CV 1.36/patient year. P = 0.080, FI vs. Other. Patients reported more problems between dialysis for FI, 3.2% of the days and least on GR (0.2%), CV (0.4%). P < 0.0001. Of the problems 85% were pain and redness. To the contrary there were more problems during dialysis with CV, 9.1% vs. FI 2.7%, and GR 0.9%. P < 0.0001. The complications and survival data are similar to those reported by others for quotidian hemodialysis and no different from reports on conventional 3 times per week dialyses. Conclusion: Daily hemodialysis does not adversely affect the different types of blood access. The survival and intervention need of accesses is best for fistulae, worst for CV, but GR, when functioning, have fewer problems between and during dialyses. [source] Home Hemodialysis: Associations with Modality FailureHEMODIALYSIS INTERNATIONAL, Issue 1 2003BA Young Purpose: To determine risk factors for home hemodialysis (HH) failure. Methods: We conducted a prospective study from 12/2000 to 9/2002 using data from the 1709 patients who received renal replacement therapy at the Northwest Kidney Centers (NWKC). Prevalent and incident Home Hemodialysis (HH) patients were included in the analysis. Baseline demographics, date of entry and date of exit from HH were ascertained for all patients. Differences among groups were assessed by independent t-test for continuous variables and by chi-squared test for categorical variables. Risk of HH failure was assessed with logistic regression. Results: Of the 116 patients who initiated training in the NWKC HH program (6.8%), 77.7% remained in the HH program, 10.3% received a transplant and 10.3% returned to in-center dialysis. Compared to patients who received a transplant or returned to in-center dialysis, HH patients were more likely to be older (65 vs. 54 yrs, P < .05) and were on dialysis longer (3.8 ± 4.7 vs. 2.3 ± 3.0 yrs, p < 0.05). Ethnicity, gender, primary renal disease and helper status were similar between groups, and were not associated with increased risk of HH failure. Unadjusted 3-year mortality was 31.7% for HH patients. HH patients who died were more likely to be older (p < 0.05) and to have diabetes (P < 0.01) than those who returned to in-center dialysis or who received a transplant. Conclusions: In HH patients, older age but not ethnicity, gender or helper status was associated with treatment failure. Older age and diabetes remain risk factors for mortality in the HH population. [source] Amino Acid Transport Kinetics and Protein Turnover in HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003Raj Dominic Background: Protein metabolism is abnormal in patients with end-stage renal disease. However, the etiology of abnormal protein turnover is unclear. Also the role of hemodialysis on protein turnover remains controversial. Abnormal protein metabolism could be due to malnutrition or due to abnormal amino acid transport kinetics Hypothesis: 1) Amino acid transport is abnormal in uremia, 2) Hemodialysis increases fractional protein synthesis rate and c) Net protein accretion is negative during hemodialysis because of increased catabolism. Aim: 1) To study the impact of uremia and hemodialysis on intracellular amino acid transport kinetics and 2) Quantify the fractional protein synthesis rate and degradation in a uremic state and during hemodialysis Methods: Protein turnover and amino acid transport kinetics using stable isotopes of phenylalanine in 2 patients and 2 controls. The patients were placed on a standard diet (1.2 gm/Kg protein and 35 Kcal/Kg) for 2 weeks prior to the study. Acidosis as corrected by NaHCO3 supplementation. Amino acid transport and protein turnover were estimated by compartmental model and precursor product approach respectively. Results: Mean protein intake and HCO3 were 1.4 ± 1 gm/day and 26.8 ± 4.1 meq/L respectively. Inward transport (11.2 ± 2.6 vs. 9.8 ± 2.1 nmol/min,1/100 ml leg,1) and outward transport (10.2 ± 1.2 vs.11.0 ± 1.6 l nmol/min,1/100 ml leg,1) were not different before and during HD. Inward and outward transport in controls were 12.6 ± 3.7 and 16.2 ± 3.5 nmol/min,1/100 ml leg,1 respectively. Protein synthesis was higher than catabolism in the pre-dialysis phase (156.8 ± 66.1 vs. 144.3 ± 53.7 nmol/min/ml leg-1, p = NS), but catabolism was higher than synthesis during HD (172.3 ± 20.5 vs. 186.8 ± 25.8 nmol/min/ml leg-1, p = NS). Protein synthesis and catabolism in controls were 110.8 ± 13.5 and 127.4 ± 12.7 nmol/min/ml leg-1. Conclusion: 1. Inward and outward transport of amino acids are not altered by renal failure or hemodialysis. 2. Protein turnover is increased during hemodialysis, with net balance favoring catabolism [source] Nocturnal Home Hemodialysis: Focus on the PartnerHEMODIALYSIS INTERNATIONAL, Issue 1 2003H Vos Background. Nocturnal home hemodialysis (NHD, 6 times weekly 6,8 hours) results in a better clinical and psychosocial condition of dialysis patients. However, this intensive therapy has important consequences for partners, who bear at least some responsibilities during the treatment. Methods. Since December 2001, we included 15 patients in a Dutch NHD project (,Nocturne'). All patients are assisted by their spouses. An aim of Nocturne is to study the effects of NHD on partners and other family members with questionnaires and interviews by a social worker. Results. NHD affects daily life of partners much more than conventional therapies. Partners feel very involved with the treatment. The invasion of the treatment in bed, the noise and light produced by the machine, the daily assisting of the patient, less freedom, and co-responsibility for the treatment are felt as a burden, specially during the first months of the treatment. However, the improved clinical condition of their spouse, resulting in less fatigue, less disability, less uremic symptoms, less complications, more attention for and contribution to family life, better quality of life and better mood are considered major improvements, with important positive effects for the quality of life of all family members. Additionally, partners consider the fact that they make an important positive contribution to their spouse's health valuable. All partners judged NHD, despite some negative consequences, as a major improvement of their life. Conclusion. The positive effects of NHD are more important than the negative consequences for partners of patients. However, partners need active support by nurses or social workers, specially during the first months of the treatment. [source] Coronary Artery Bypass Surgery Versus Percutaneous Coronary Artery Intervention in Patients on Chronic Hemodialysis: Does a Drug-Eluting Stent Have an Impact on Clinical Outcome?JOURNAL OF CARDIAC SURGERY, Issue 3 2009Susumu Manabe M.D. For chronic hemodialysis (HD) patients, however, the impact of DES on clinical outcome is yet to be determined. Forty-six consecutive chronic HD patients who underwent myocardial revascularization in our institute were retrospectively reviewed. Twenty-eight patients underwent coronary artery bypass surgery (CABG) and 18 patients underwent percutaneous coronary artery intervention (PCI). Patient characteristics were similar between the two groups. In the CABG group, bilateral internal thoracic artery (ITA) bypass grafting was performed in 27 patients and off-pump CABG was performed in 20 patients. In the PCI group, a DES was used in 12 patients. The number of coronary vessels treated per patient was higher in the CABG group (CABG: 4.25 ± 1.32 vs. PCI: 1.44 ± 0.78; p < 0.001). Two-year survival rates were similar between the two groups (CABG: 94.1% vs. PCI: 73.9%; p = 0.41), but major adverse cardiac event-free survival (CABG: 85.9% vs. PCI: 37.1%; p = 0.001) and angina-free survival (CABG: 84.9% vs. PCI: 28.9%; p < 0.001) rates were significantly higher in the CABG group. The one-year patency rate for the CABG grafts was 93.3% (left ITA: 100%, right ITA: 84.6%, sapenous vein: 90.9%, gastro-epiploic artery: 100%), and six-month restenosis rate for PCI was 57.1% (balloon angio-plasty: 75%, bare metal stent 40%, DES: 58.3%). Even in the era of DES, clinical results favored CABG. The difference in clinical results is due to the sustainability of successful revascularization. [source] Pregnancy complicated by Caroli's disease with polycystic kidney disease: A case report and following observationsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4pt2 2008Mika Tsunoda Abstract Caroli's disease and Caroli's syndrome are rare congenital disorders characterized by non-obstructive cystic dilatation of the intrahepatic bile ducts. These disorders are often associated with autosomal recessive polycystic kidney disease. A young woman at 11 weeks of gestation was referred to our hospital for proper management of Caroli's disease during pregnancy. Magnetic resonance imaging and laboratory tests revealed Caroli's disease with chronic renal failure caused by polycystic kidney disease. She received diet control, erythropoietin and prophylactic oral antibiotics. Her pregnancy course was uneventful, and she gave birth at 37 weeks of gestation. Thereafter, her renal function gradually worsened. Hemodialysis was begun 5 years after parturition. Though the courses of pregnancies complicated by Caroli's disease or Caroli's syndrome are variable and can include life-threatening conditions, uneventful outcomes can be expected if careful management prevents biliary and renal infection. [source] Effect of hemodialysis on the plasma levels of clofarabine,,PEDIATRIC BLOOD & CANCER, Issue 1 2010Peter G. Steinherz MD Abstract Clofarabine, a nucleoside analogue for treatment of relapsed leukemia, is 50,60% excreted in urine. Clofarabine has not been studied in patients on hemodialysis. We measured levels in one patient in acute renal failure. Prior to dialysis, 43,hr after a 40,mg/m2 infusion, plasma concentration was 139,ng/ml. One hour after begining hemodialysis, a 20,mg/m2 infusion began. Plasma concentrations were 84.2, 81.1, and 88.0,ng/ml while the dialysis and clofarabine infusion occurred simultaneously. Post-dialysis, while the clofarabine was still infusing, the level was 95.8,ng/ml. Hemodialysis does decrease clofarabine levels, but given its large volume distribution, hemodialysis may not be effective for clofarabine overdose. Pediatr Blood Cancer 2010;55:196,198. © 2010 Wiley-Liss, Inc. [source] Fatigue and associated factors in hemodialysis patients in TaiwanRESEARCH IN NURSING & HEALTH, Issue 1 2006H.E. Liu Abstract The number of patients suffering from end-stage renal disease is increasing rapidly around the world, including in Taiwan. Hemodialysis (HD) patients report fatigue as a major stressor. The purpose of this correlational study with systematic sampling was to explore fatigue and associated physiological, psychological, and situational factors in 119 Taiwanese HD patients. Results indicate that levels of fatigue were mild. Three variables (gender, employment, and depression) had a significant impact on fatigue. Some differences in physiological factors by depression, gender, and employment were found. Stepwise regressions showed that depression, age, and urea reduction ratio were significant predictors for overall fatigue and two of its dimensions. Some relationships from the theory of unpleasant symptoms were supported. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29:40,50, 2006 [source] Exercise Training During Hemodialysis Reduces Blood Pressure and Increases Physical Functioning and Quality of LifeARTIFICIAL ORGANS, Issue 7 2010Maycon De Moura Reboredo Abstract Hypertension and cardiovascular diseases are highly prevalent in hemodialysis patients and are associated with the reduction of physical functioning and quality of life. We evaluated the effects of supervised aerobic exercise training on physical functioning, blood pressure, quality of life, and laboratory data in hemodialysis patients. Fourteen patients were evaluated at the beginning and after 12 weeks of stretching exercises (control phase) and at the end of 12 weeks of aerobic exercise training performed during hemodialysis sessions (intervention phase). Patients underwent a 6-min walking test (6MWT), 24-h ambulatory blood pressure monitoring, a Medical Outcomes Study 36,Item Short-Form Health Survey (SF-36) quality of life questionnaire, and blood sample collections. After the intervention phase, the 6MWT distance increased from 508.7 ± 91.9 m to 554.9 ± 105.8 m (P = 0.001), systolic and diastolic blood pressure decreased respectively from 150.6 ± 18.4 mm Hg to 143.5 ± 14.7 mm Hg and from 94.6 ± 10.5 mm Hg to 91.4 ± 9.7 mm Hg (P < 0.05), while hemoglobin levels increased from 10.8 ± 1.2 g/dL to 11.6 ± 0.8 g/dL (P < 0.05). Moreover, there was a significant increase in the physical functioning, social functioning, and mental health dimensions of the SF-36. Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patients with end-stage renal disease. [source] Asymmetric Dimethylarginine in Hemodialysis, Hemodiafiltration, and Peritoneal DialysisARTIFICIAL ORGANS, Issue 5 2010Jaromír Eiselt Abstract Asymmetric dimethylarginine (ADMA) is a mediator of endothelial dysfunction. Production and elimination of ADMA may be affected by the type of renal replacement therapy used and oxidative stress. Plasma ADMA, advanced glycation end products (AGE), and homocysteine were assessed in 59 subjects: 20 hemodialysis (HD) patients, 19 patients undergoing peritoneal dialysis (PD), and 20 controls. Results were compared between the groups. The effect of 8 weeks of HD and high-volume predilution hemodiafiltration (HDF) was compared in a randomized study. HD patients showed higher ADMA (1.20 [0.90,1.39 µmol/L]) compared to controls (0.89 [0.77,0.98], P < 0.01), while ADMA in PD did not differ from controls (0.96 [0.88,1.28]). AGE and homocysteine were highest in HD, lower in PD (P < 0.01 vs. HD), and lowest in controls (P < 0.001 vs. HD and PD). PD patients had higher residual renal function than HD (P < 0.01). The decrease in ADMA at the end of HD (from 1.25 [0.97,1.33] to 0.66 [0.57,0.73], P < 0.001) was comparable to that of HDF. Switching from HD to HDF led to a decrease in predialysis homocysteine level in 8 weeks (P < 0.05), while ADMA and AGE did not change. Increased ADMA levels in patients undergoing HD, as compared to PD, may be caused by higher oxidative stress and lower residual renal function in HD. Other factors, such as diabetes and statin therapy, may also be at play. The decrease in ADMA at the end of HD and HDF is comparable. Switching from HD to HDF decreases in 8 weeks the predialysis levels of homocysteine without affecting ADMA. [source] Hemodialysis as a Treatment of Severe Accidental HypothermiaARTIFICIAL ORGANS, Issue 3 2010Rogier Caluwé Abstract We describe a case of severe accidental hypothermia (core body temperature 23.2°C) successfully treated with hemodialysis in a diabetic patient with preexisting renal insufficiency. Consensus exists about cardiopulmonary bypass as the treatment of choice in cases of severe accidental hypothermia with cardiac arrest. Prospective randomized controlled trials comparing the different rewarming modalities for hemodynamically stable patients with hypothermia, however, are lacking. In our opinion, the choice of a rewarming technique should be patient tailored, knowing that hemodialysis is an efficient, minimally invasive, and readily available technique with the advantage of providing electrolyte support. [source] Model-Based Analysis of Potassium Removal During HemodialysisARTIFICIAL ORGANS, Issue 10 2009Andrea Ciandrini Abstract Potassium ion (K+) kinetics in intra- and extracellular compartments during dialysis was studied by means of a double-pool computer model, which included potassium-dependent active transport (Na-K-ATPase pump) in 38 patients undergoing chronic hemodialysis. Each patient was treated for 2 weeks with a constant K+ dialysate concentration (K+CONST therapy) and afterward for 2 weeks with a time-varying (profiled) K+ dialysate concentration (K+PROF therapy). The two therapies induced different levels of K+ plasma concentration (K+CONST: 3.71 ± 0.88 mmol/L vs. K+PROF: 3.97 ± 0.64 mmol/L, time-averaged values, P < 0.01). The computer model was tuned to accurately fit plasmatic K+ measured in the course and 1 h after K+CONST and K+PROF therapies and was then used to simulate the kinetics of intra- and extracellular K+. Model-based analysis showed that almost all the K+ removal in the first 90 min of dialysis was derived from the extracellular compartment. The different K+ time course in the dialysate and the consequently different Na-K pump activity resulted in a different sharing of removed potassium mass at the end of dialysis: 56% ± 17% from the extracellular compartment in K+PROF versus 41% ± 14% in K+CONST. At the end of both therapies, the K+ distribution was largely unbalanced, and, in the next 3 h, K+ continued to flow in the extracellular space (about 24 mmol). After rebalancing, about 80% of the K+ mass that was removed derived from the intracellular compartment. In conclusion, the Na-K pump plays a major role in K+ apportionment between extracellular and intracellular compartments, and potassium dialysate concentration strongly influences pump activity. [source] Subcutaneous Transposition of the Superficial Femoral Artery for Arterioarterial Hemodialysis: Technique and ResultsARTIFICIAL ORGANS, Issue 12 2008Octavio J. Salgado Abstract We report the use of subcutaneous transposition of the femoral artery (STFA) for placement of both inflow and outflow needles in 14 hemodialysis (HD) adult patients with difficult access. Follow-up time was 318 months during which a total of 3215 arterioarterial HD sessions were done. Kt/V values ranged between 0.71 and 1.59. Elevated access recirculation and dialysis outflow pressures were common findings to all patients. Complications were: (i) two episodes of bleeding secondary to puncture-related arterial wall laceration, repaired by stitching; (ii) three episodes of thrombosis in two patients, all successfully declotted; (iii) three puncture-related complications needing placement of a vein interposition graft, namely, aneurysm, pseudoaneurysm, and arterial stenosis; and (iv) one case of arterial ligation because of suppurative puncture site infection, without subsequent distal ischemia signs or claudication. The use of STFA should only be reserved for patients in urgent need for vascular access with no remaining options. [source] | ||||||||||||||||||||||||||||||||||