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HD Session (hd + session)
Selected AbstractsBioreactance: A new tool for cardiac output and thoracic fluid content monitoring during hemodialysisHEMODIALYSIS INTERNATIONAL, Issue 4 2009Niloufar KOSSARI Abstract Outpatient hemodialysis therapy (HD) can be associated with hemodynamic compromise. Bioreactance® has recently been shown to provide accurate, noninvasive, continuous, measurements of cardiac output (CO) and thoracic impedance (Zo) from which thoracic fluid content (TFC) can be derived assuming TFC=1000/Zo. This study was designed to evaluate the changes in TFC in comparison with the traditional indices of fluid removal (FR) and to understand the trends in CO changes in HD patients. Minute-by-minute changes in TFC and CO were prospectively collected using the bioreactance system (NICOM®) in HD patients of a single unit. Changes in body weight (,W), hematocrit (,Hct), and amount of FR were also measured. Twenty-five patients (age 77 ± 11 years) were included. The TFC decreased in all patients by an average of 5.4 ± 7.9 k,,1, weight decreased by 1.48 ± 0.98 kg, and FR averaged 2.07 ± 1.93 L over a 3- to 4-hour HD session. There were good correlations between ,TFC and ,W (R=0.80, P<0.0001) and FR (R=0.85, P<0.0001). ,Hct (4.13 ± 3.42%) was poorly correlated with ,TFC (R=0.35, P=0.12) and FR (R=0.40, P=0.07). The regression line between FR and TFC yielded FR=1.0024,0.1985TFC; thus, a 1 k,,1 change of Zo correlates with an ,200 mL change in total body water. The change in CO (,0.52 ± 0.49 L/min m2) during HD did not correlate with FR (R=0.15, P=NS). Changes in TFC represented the monitored variable most closely related to FR. CO remained fairly constant in this stable patient cohort. Further studies in high-risk patients are warranted to understand whether TFC and CO monitoring can improve HD session management. [source] A study of the extracorporeal rate of blood flow and blood pressure during hemodialysisHEMODIALYSIS INTERNATIONAL, Issue 4 2007Hariprasad S. TRIVEDI Abstract Hemodynamic instability is a common problem during hemodialysis (HD). The effect of blood flow rate (BFR) on blood pressure (BP) during HD has not been previously evaluated. Subjects receiving HD for the treatment of renal failure were enrolled (n=34). For each patient, during the last hour of 2 consecutive HD sessions the BFR was set at 200 mL/min for 30 min and at 400 mL/min for 30 min, during which period the fluid removal rate was kept constant. The order of the BFR alterations was randomized. The study procedure was repeated during the next HD session but with reversal of the order of the altered BFR. During each 30-min period, BP was recorded at baseline and subsequently every 10 min. During the BFR of 400 mL/min, subjects had a higher systolic BP by an average of 4.1 mmHg compared with the BFR of 200 mL/min (95% confidence interval [CI] 0.22,7.98; p=0.038). Similarly, during the BFR of 400 mL/min, subjects had a higher diastolic BP by an average of 3.04 mmHg compared with the BFR of 200 mL/min (95% CI 0.55,5.53; p=0.017). Likewise, during the BFR of 400 mL/min, subjects had a higher mean arterial pressure by an average of 3.44 mmHg (95% CI 0.77,6.11; p=0.012). The findings suggest that during HD, BPs are maintained higher at higher BFRs as compared with lower BFRs. [source] Short Daily Dialysis (SDHD) Efficacy : Pilot Multicentric Study with Nine Patients from MadridHEMODIALYSIS INTERNATIONAL, Issue 1 2003G. Barril Interest in quotidian (daily) hemodialysis (HD) seems to be growing. Clinical data consistently showed improved quality of life, better control of blood pressure, less need for medications including erythropoietin (EPO) and better nutrition. We evaluate the SDHD efficacy in 9 patients in conventional HD (3 weekly sesions/4 hours), mean age 57,78 years range (33,75), 6 males and 3 females who needed increased dialysis efficiency by different medical indications: 5 cases with hypertensive miocardiopathy and severe LVH, 2 of them with EFLV 26% and 27%. 2 cases with ischemic cardiopathy symptoms, one of them with anger and restless dysnea with a non resvascularizable coronary lesion, and other with cardiac insufficiency episodes requiring hospitalization once a month. 1 patient with big body surface area and elevated phosphorus levels although without control, with conventional three times/week HD. 1 patient indication was made by 12 years on HD with multiple vascular accesses failed needing a Tessio cathéter being into infradialysis regimen for his malnutrition status. The schedule in all of them was 6 days per week sessions between 2.15 hrs till 3 hours depending of body surface area to obtain a weekly kt/v nearest to 4. HD session were realized in the Hospital (4 pts) or in satellite unit (5 pts) due to the characteristics of the patients. The time remaining in this schedule was between 5 months to 2 years and 9 months. All the patients showed clinical improvement, subjective and objective, since the first weeks of starting SDHD. Sleep symptoms were the first to improve. All patients showing good coping with this HD alternative. Blood pressure levels were controlled without need for antihypertensive drugs, although the dry weight increased significantly in all cases. Albumin serum levels increased as nutrition parameter, controlling also the osteodystrophy and phosphorus. In a patient the EFLV was normalized from 6 months (26%,50%) improving in other. Two patients could be included in Tx waiting list. Again, anemia improved and decreasing EPO was required. No vascular access (autologous AVF) malfunction was detected in relation to daily procedure. Conclusion: Our pilot experience shows a clinical and biochemical improvement in the patients and quality of life as well. Prospective studies to demonstrate the financial benefits of these modalities are needed. [source] Neutrophil gelatinase-associated lipocalin levels in chronic haemodialysis patientsNEPHROLOGY, Issue 1 2010DAVIDE BOLIGNANO ABSTRACT: Neutrophil gelatinase-associated lipocalin (NGAL), a small 25 kDa protein strongly induced in injured renal tubular cells, represents an interesting emerging biomarker in the field of clinical nephrology. The aim of the present pilot study was to analyze circulating NGAL levels in a small cohort of 30 patients on chronic haemodialysis (HD), in order to assess any relationships with different laboratory and clinical parameters. Pre- and post-HD levels were higher in patients than in healthy subjects (485.2 ± 49.7 vs 51.2 ± 4.6 ng/mL; P < 0.001; and 167.4 ± 48.0 vs 51.2 ± 4.6 ng/mL; P = 0.01). Furthermore, a single HD session decreased NGAL levels by approximately fourfold (485.2 ± 49.7 vs 167.4 ± 48.0 ng/mL; p:0.01), with a reduction ratio of 73 ± 14%. At baseline, direct and independent correlations were found between NGAL and, respectively, high-sensitivity C-reactive protein (, = 0.34; P = 0.03) and spKt/V (, = 0.35; P = 0.02). The findings showed that HD patients have chronically increased levels of circulating NGAL. However, with a single HD session, a marked reduction was achieved in circulating NGAL values, probably as a result of an important dialytic removal, similar to that observed for other cytokines. Finally, the direct independent correlation found between NGAL and spKt/V raises the question of whether, in the future, NGAL may also become a useful tool in predicting the adequacy of dialysis and in guiding the management of dialysis prescriptions. [source] Erythrocyte Susceptibility to Oxidative Stress in Chronic Renal Failure Patients Under Different Substitutive TreatmentsARTIFICIAL ORGANS, Issue 1 2005Leonardo Lucchi Abstract:, An increased oxidative stress is now considered one of the major risk factors in chronic renal failure (CRF) patients that may be exacerbated by dialysis. It has been postulated that this increased oxidative stress might cause an augmented red blood cell (RBC) membrane lipid peroxidation with the consequent alteration in membrane deformability. The aim of this study was to evaluate RBC susceptibility to an in vitro induced oxidative stress and RBC antioxidant potential in different groups of CRF patients undergoing different substitutive treatment modalities. Fifteen end-stage CRF patients were evaluated in conservative treatment, 23 hemodialysis (HD) patients, 15 continuous ambulatory peritoneal dialysis (CAPD) patients, 15 kidney transplanted patients, and 16 controls. Their RBCs were incubated with the oxidative stress-inducing agent tert-butylhydroperoxide both in the presence and in the absence of the catalase inhibitor sodium azide, and the level of malondialdehyde (MDA) (a product of lipid peroxidation), was measured at 0, 5, 10, 15, and 30 min of incubation. In addition, the RBC content of reduced glutathione (GSH) was measured by HPLC. As opposed to the controls, RBCs from end-stage CRF patients exhibited an increased sensitivity to oxidative stress induced in vitro, both in the absence and presence of a catalase inhibitor, as demonstrated by a significantly higher level of MDA production at all the incubation times (P < 0.05). Different substitutive treatments had different impacts on this phenomenon; CAPD and kidney transplantation were able to normalize this alteration while HD was not. GSH appeared to be related to the increase in RBC susceptibility to oxidative stress; its content being significantly elevated in end-stage CRF and HD patients as compared with CAPD and transplanted patients and controls (P < 0.05). No significant changes were observed in the RBC glutathione content during the HD session. The increase of GSH in RBCs of end-stage CRF and HD patients seems to indicate the existence of an adaptive mechanism under increased oxidative stress occurring in vivo. Unlike HD, the beneficial effect of CAPD on the anemia of dialysis patients might partly be due to a condition of lower oxidative stress that might in addition counterbalance the cardiovascular negative effects of dislipidemia ,of, CAPD, patients. [source] A study of the extracorporeal rate of blood flow and blood pressure during hemodialysisHEMODIALYSIS INTERNATIONAL, Issue 4 2007Hariprasad S. TRIVEDI Abstract Hemodynamic instability is a common problem during hemodialysis (HD). The effect of blood flow rate (BFR) on blood pressure (BP) during HD has not been previously evaluated. Subjects receiving HD for the treatment of renal failure were enrolled (n=34). For each patient, during the last hour of 2 consecutive HD sessions the BFR was set at 200 mL/min for 30 min and at 400 mL/min for 30 min, during which period the fluid removal rate was kept constant. The order of the BFR alterations was randomized. The study procedure was repeated during the next HD session but with reversal of the order of the altered BFR. During each 30-min period, BP was recorded at baseline and subsequently every 10 min. During the BFR of 400 mL/min, subjects had a higher systolic BP by an average of 4.1 mmHg compared with the BFR of 200 mL/min (95% confidence interval [CI] 0.22,7.98; p=0.038). Similarly, during the BFR of 400 mL/min, subjects had a higher diastolic BP by an average of 3.04 mmHg compared with the BFR of 200 mL/min (95% CI 0.55,5.53; p=0.017). Likewise, during the BFR of 400 mL/min, subjects had a higher mean arterial pressure by an average of 3.44 mmHg (95% CI 0.77,6.11; p=0.012). The findings suggest that during HD, BPs are maintained higher at higher BFRs as compared with lower BFRs. [source] Overproduction of reactive oxygen species in end-stage renal disease patients: A potential component of hemodialysis-associated inflammationHEMODIALYSIS INTERNATIONAL, Issue 1 2005Marion Morena Abstract During the past decade, hemodialysis (HD)-induced inflammation has been linked to the development of long-term morbidity in end-stage renal disease (ESRD) patients on regular renal replacement therapy. Because interleukins and anaphylatoxins produced during HD sessions are potent activators for nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, an example of an enzyme that is responsible for overproduction of reactive oxygen species (ROS), this may constitute a link between leukocyte activation and cell or organ toxicity. Oxidative stress, which results from an imbalance between oxidant production and antioxidant defense mechanisms, has been documented in ESRD patients using lipid and/or protein oxidative markers. Characterization of HD-induced oxidative stress has included identification of potential activators for NADPH oxidase. Uremia per se could prime phagocyte oxidative burst. HD, far from improving the oxidative status, results in an enhancement of ROS owing to hemoincompatibility of the dialysis system, hemoreactivity of the membrane, and trace amounts of endotoxins in the dialysate. In addition, the HD process is associated with an impairment in antioxidant mechanisms. The resulting oxidative stress has been implicated in long-term complications including anemia, amyloidosis, accelerated atherosclerosis, and malnutrition. Prevention of oxidative stress in HD might focus on improving the hemocompatibility of the dialysis system, supplementation of deficient patients with antioxidants, and modulation of NADPH oxidase by pharmacologic approaches. [source] The effects of exercise during hemodialysis on adequacyHEMODIALYSIS INTERNATIONAL, Issue 1 2005C. Caner Pedalling during hemodialysis (HD) has been shown to increase solute clearance in a previous study. In the present study, we aimed to test whether an easy to perform exercise program, not requiring a special device, could yield similar outcomes. Fifteen HD patients with the mean age of 48.4 ± 3.8 years were enrolled into the study. Patients with significant access recirculation (>10%), moderate to severe coronary artery disease, moderate to severe heart failure, severe chronic obstructive lung disease, and history of lower extremity surgery during last three month period were excluded. All patients were studied on two consecutive HD sessions with identical prescriptions. At the first session, standard HD was applied without exercise, whereas in the second session lower extremity exercise of 30 minutes duration was added. Reduction rates and rebound for urea, creatinine, and potassium and Kt/V were calculated. Wilcoxon signed rank test was applied in analysis and p < 0.05 was accepted as significance level. All patients completed the study. When both sessions were compared, mean arterial blood pressure (97 ± 3 mmHg vs 120 ± 4 mmHg, p < 0.001) and heart rate (77 ± 1 beats/min vs 92 ± 3 beats/min, p < 0.001) were higher in the exercise group. On the other hand, urea reduction rates, rebound values of urea, creatinine, and potassium were similar in both groups. Conclusion:,In the study, we did not observe any changes in solute rebound and clearance with the exercise. Shorter duration of the exercise may be the explanation of failure to achieve desired outcomes. Increasing patients' tolerance and fitness levels by means of steadily increasing exercise programs may be of help. Additionally, mode of exercise may also be responsible for different outcomes. [source] RESEARCH INTO PAIN PERCEPTION WITH ARTERIOVENOUS FISTULA (AVF) CANNULATIONJOURNAL OF RENAL CARE, Issue 4 2008Ana E. Figueiredo RN SUMMARY Patients with end-stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients7 perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (±1.7), compared to 3.1 (±2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique. [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] | ||||||||||