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Hemodialysis Therapy (hemodialysis + therapy)

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Medical Sciences	100%

Selected Abstracts

Bioreactance: A new tool for cardiac output and thoracic fluid content monitoring during hemodialysis

HEMODIALYSIS INTERNATIONAL, Issue 4 2009
Niloufar 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]

Pulse Pressure Determinants in Chronic Hemodialysis Patients

HEMODIALYSIS INTERNATIONAL, Issue 1 2003
V Kovacic
Introduction: Hypertension contributes to the cardiovascular morbidity in patients undergoing chronic hemodialysis therapy (PCHD). Pulse pressure (PP) was recognized as a correlate of mortality in PCHD. In order to demonstrate determinants of predialysis and postdialysis PP values in a group of PCHD, we conducted this study. Subjects and methods: Study subjects were 23 PCHD. Study time was 15 months. One hundred thirty six single hemodialysis (HD) treatments were processed. PP was computed as systolic-diastolic blood pressure (mmHg). Statistical methods used were Student's t test for independent data, multivariate analysis of variance, Pearson's correlation, and forward stepwise multiple regression analysis. Results: Postdialysis and predialysis PPs differed significantly (65.51 ± 19.00 vs. 60.55 ± 19.35, p = 0.002). We did not find gender differences in PP before and after HD. PP before HD was in negative correlation with phosphorus concentration (r = , 0.244, p = 0.002), parathyroid hormone (PTH)(r = , 0.177, p = 0.020), hemoglobin (r = , 0.301, p < 0.001), single HD duration (r = , 0.162, p = 0.030), ultrafiltration rate per HD (r = , 0.290, p = 0.001), years on the chronic hemodialysis treatment (r = , 0.261, p = 0.001) and ultrafiltration volume/dry body mass ratio (UF/W)(r = , 0.222, p = 0.005) and in positive concentration with weekly erythropoietin (r = 0.391, p < 001) and age (r = 0.285, p < 0.001). PP after HD was in significant negative correlation with phosphorus concentration (r = , 0.205, p = 0.009), PTH (r = , 0.187, p = 0.015), hemoglobin (r = , 0.238, p = 0.005), ultrafiltration per HD (r = , 0.370, p < 0.001), dry body mass index (r = , 0.225, p = 0.003), years of the chronic hemodialysis treatment (r = 0.330, p < 0.001), UF/W (r = , 0.340, p < 0.001) and in positive concentration with weekly erythropoietin (r = 0.361, p < 0.001) and age (r = 0.227, p = 0.004). Multiple regression analyses unveiled the strongest and negative correlations between PP after HD and UF/W ratio (, = , 0.41, p < 0.001). The strongest, but positive correlation was found between PP before HD and erythropoietin per week (, = 0.51, p < 0.001). Conclusion: Determinants of the pre/post PP values are similar. Ultrafiltration is a strong predictor of postdialysis PP value. [source]

Which patients benefit from hemodialysis therapy in hepatorenal syndrome?

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2004
OLIVER WITZKE
Abstract Background and Aim:, Hepatorenal syndrome (HRS) occurs in patients with advanced liver cirrhosis and has a poor outcome. The aim of the present study was to investigate which patients with HRS are likely to benefit from hemodialysis. Methods:, Data were collected prospectively from 30 patients with Child-Pugh C liver cirrhosis and HRS. Patients were either treated with continuous veno-venous hemodialysis (CVVHD) if they were mechanically ventilated, or with intermittent hemodialysis (HD) if they were not mechanically ventilated. Prognosis was assessed by the Child-Pugh and by the Model for End-Stage Liver Disease (MELD) score. The primary aim of the study was the analysis of overall and 30-day patient survival during hemodialysis therapy. To identify predictive factors of survival, variables obtained before the initiation of dialysis therapy were evaluated. Results:, Patients' 30-day survival was 8/30 (median survival time 21 days). Among patients treated with mechanical ventilation, 30-day survival time was 0/15 while 8/15 patients without mechanical ventilation survived more than 30 days (P < 0.001). Using a multivariate model, the relative hazards for serum albumin, international normalized ratio (INR) and catecholamine therapy were not different from one another (P > 0.05), indicating that these parameters were not independent predictors of survival. Mechanical ventilation was an independent risk factor for 30-day (relative hazard 6.6 [1.6,27.7], P < 0.001) and overall survival (relative hazard 6.3 [1.5,26.5], P = 0.01). Child-Pugh (P < 0.01) and the MELD (P < 0.01) score were predictive for overall survival independent of mechanical ventilation. Conclusions:, Patients with HRS without mechanical ventilation may benefit from hemodialysis, whereas hemodialysis seems to be futile in patients with mechanical ventilation. [source]