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Sample records for two-day dialysis interval

  1. One or two day mifepristone-misoprostol interval for second trimester abortion

    DEFF Research Database (Denmark)

    Nilas, Lisbeth; Glavind-Kristensen, M; Vejborg, Thomas

    2007-01-01

    METHODS: A retrospective 2-year cohort study of 127 women, with gestation between 13 and 24 weeks and a live fetus, seeking induced abortion. The aim was to compare the effect of a 1-day and a 2-day interval between oral mifepristone (200 mg) and vaginal misoprostol (400 microg) every 3 h. RESULTS......: The time to fetal expulsion was longer (9.8 versus 7.5 h; pabortion occurred in 98% within 24 h in both groups The time to abortion was longer in women with a gestation of 17-22 weeks compared to women...

  2. One or two day mifepristone-misoprostol interval for second trimester abortion

    DEFF Research Database (Denmark)

    Nilas, Lisbeth; Glavind-Kristensen, M; Vejborg, Thomas

    2007-01-01

    METHODS: A retrospective 2-year cohort study of 127 women, with gestation between 13 and 24 weeks and a live fetus, seeking induced abortion. The aim was to compare the effect of a 1-day and a 2-day interval between oral mifepristone (200 mg) and vaginal misoprostol (400 microg) every 3 h. RESULTS......: The time to fetal expulsion was longer (9.8 versus 7.5 h; pabortion occurred in 98% within 24 h in both groups The time to abortion was longer in women with a gestation of 17-22 weeks compared to women...

  3. Two days of films

    CERN Document Server

    2011-01-01

    The Chinese community at CERN and the CERN CineClub, on the occasion of the Chinese New Year, invite everyone to two days of films Thursday 3 February 2011 at 20:30 - CERN Council Chamber Eat drink man woman Directed by Ang LEE (Taiwan, 1994) 122 min. With Sihung Lung, Yu-Wen Wang, Chien-Lien Wu, Kuei-Mei Yang Senior Master Chef Chu lives in a large house in Taipei with his three unmarried daughters, Jia-Jen, a chemistry teacher converted to Christianity, Jia-Chien, an airline executive, and Jia-Ning, a student who also works in a fast food restaurant. Life in the house revolves around the ritual of an elaborate dinner each Sunday, and the love lives of all the family members. Original version Mandarin with English subtitles Friday 4 February 2011 at 19:30 - CERN Council Chamber Adieu, ma concubine Directed by Chen KAIGE (China / Hong Kong, 1993) 171 min. With Leslie Cheung, Fengyi Zhang, Li Gong "Farewell, My Concubine" is a movie with two parallel, intertwined stories. It is the story of two performers in t...

  4. Randomized, double-blind, placebo-controlled clinical trial of a two-day regimen of dihydroartemisinin-piperaquine for malaria prevention halted for concern over prolonged corrected QT interval.

    Science.gov (United States)

    Manning, Jessica; Vanachayangkul, Pattaraporn; Lon, Chanthap; Spring, Michele; So, Mary; Sea, Darapiseth; Se, Youry; Somethy, Sok; Phann, Sut-Thang; Chann, Soklyda; Sriwichai, Sabaithip; Buathong, Nillawan; Kuntawunginn, Worachet; Mitprasat, Mashamon; Siripokasupkul, Raveewan; Teja-Isavadharm, Paktiya; Soh, Eugene; Timmermans, Ans; Lanteri, Charlotte; Kaewkungwal, Jaranit; Auayporn, Montida; Tang, Douglas; Chour, Char Meng; Prom, Satharath; Haigney, Mark; Cantilena, Louis; Saunders, David

    2014-10-01

    Dihydroartemisinin-piperaquine, the current first-line drug for uncomplicated malaria caused by Plasmodium falciparum and Plasmodium vivax in Cambodia, was previously shown to be of benefit as malaria chemoprophylaxis when administered as a monthly 3-day regimen. We sought to evaluate the protective efficacy of a compressed monthly 2-day treatment course in the Royal Cambodian Armed Forces. The safety and efficacy of a monthly 2-day dosing regimen of dihydroartemisinin-piperaquine were evaluated in a two-arm, randomized, double-blind, placebo-controlled cohort study with 2:1 treatment allocation. Healthy military volunteers in areas along the Thai-Cambodian border where there is a high risk of malaria were administered two consecutive daily doses of 180 mg dihydroartemisinin and 1,440 mg piperaquine within 30 min to 3 h of a meal once per month for a planned 4-month period with periodic electrocardiographic and pharmacokinetic assessment. The study was halted after only 6 weeks (69 of 231 projected volunteers enrolled) when four volunteers met a prespecified cardiac safety endpoint of QTcF (Fridericia's formula for correct QT interval) prolongation of >500 ms. The pharmacodynamic effect on the surface electrocardiogram (ECG) peaked approximately 4 h after piperaquine dosing and lasted 4 to 8 h. Unblinded review by the data safety monitoring board revealed mean QTcF prolongation of 46 ms over placebo at the maximum concentration of drug in serum (Cmax) on day 2. Given that dihydroartemisinin-piperaquine is one of the few remaining effective antimalarial agents in Cambodia, compressed 2-day treatment courses of dihydroartemisinin-piperaquine are best avoided until the clinical significance of these findings are more thoroughly evaluated. Because ECG monitoring is often unavailable in areas where malaria is endemic, repolarization risk could be mitigated by using conventional 3-day regimens, fasting, and avoidance of repeated dosing or coadministration with other QT

  5. Pediatric Reference Intervals for Free Thyroxine and Free Triiodothyronine by Equilibrium Dialysis-Liquid Chromatography-Tandem Mass Spectrometry

    Science.gov (United States)

    La’ulu, Sonia L.; Rasmussen, Kyle J.; Straseski, Joely A.

    2016-01-01

    Objective: Thyroid hormone concentrations fluctuate during growth and development. To accurately diagnose thyroid disease in pediatric patients, reference intervals (RIs) should be established with appropriate age groups from an adequate number of healthy subjects using the most exact methods possible. Obtaining statistically useful numbers of healthy patients is particularly challenging for pediatric populations. The objective of this study was to determine non-parametric RIs for free thyroxine (fT4) and free triiodothyronine (fT3) using equilibrium dialysis-high performance liquid chromatography-tandem mass spectrometry with over 2200 healthy children 6 months-17 years of age. Methods: Subjects were negative for both thyroglobulin and thyroid peroxidase autoantibodies and had normal thyrotropin concentrations. The study included 2213 children (1129 boys and 1084 girls), with at least 120 subjects (average of 125) from each year of life, except for the 6 month to 1 year age group (n=96). Results: Non-parametric RIs (95th percentile) for fT4 were: 18.0-34.7 pmol/L (boys and girls, 6 months-6 years) and 14.2-25.7 pmol/L (boys and girls, 7-17 years). RIs for fT3 were: 5.8-13.1 pmol/L (girls, 6 months-6 years); 5.7-11.8 pmol/L (boys, 6 months-6 years); 5.7-10.0 pmol/L (boys and girls, 7-12 years); 4.5-8.6 pmol/L (girls, 13-17 years); and 5.2-9.4 pmol/L (boys, 13-17 years). Conclusion: Numerous significant differences were observed between pediatric age groups and previously established adult ranges. This emphasizes the need for well-characterized RIs for thyroid hormones in the pediatric population. PMID:26758817

  6. Pediatric Reference Intervals for Free Thyroxine and Free Triiodothyronine by Equilibrium Dialysis-Liquid Chromatography-Tandem Mass Spectrometry.

    Science.gov (United States)

    La'ulu, Sonia L; Rasmussen, Kyle J; Straseski, Joely A

    2016-03-05

    Thyroid hormone concentrations fluctuate during growth and development. To accurately diagnose thyroid disease in pediatric patients, reference intervals (RIs) should be established with appropriate age groups from an adequate number of healthy subjects using the most exact methods possible. Obtaining statistically useful numbers of healthy patients is particularly challenging for pediatric populations. The objective of this study was to determine non-parametric RIs for free thyroxine (fT4) and free triiodothyronine (fT3) using equilibrium dialysis-high performance liquid chromatography-tandem mass spectrometry with over 2200 healthy children 6 months-17 years of age. Subjects were negative for both thyroglobulin and thyroid peroxidase autoantibodies and had normal thyrotropin concentrations. The study included 2213 children (1129 boys and 1084 girls), with at least 120 subjects (average of 125) from each year of life, except for the 6 month to 1 year age group (n=96). Non-parametric RIs (95th percentile) for fT4 were: 18.0-34.7 pmol/L (boys and girls, 6 months-6 years) and 14.2-25.7 pmol/L (boys and girls, 7-17 years). RIs for fT3 were: 5.8-13.1 pmol/L (girls, 6 months-6 years); 5.7-11.8 pmol/L (boys, 6 months-6 years); 5.7-10.0 pmol/L (boys and girls, 7-12 years); 4.5-8.6 pmol/L (girls, 13-17 years); and 5.2-9.4 pmol/L (boys, 13-17 years). Numerous significant differences were observed between pediatric age groups and previously established adult ranges. This emphasizes the need for well-characterized RIs for thyroid hormones in the pediatric population.

  7. Direct measurement of free estradiol in human serum by equilibrium dialysis-liquid chromatography-tandem mass spectrometry and reference intervals of free estradiol in women.

    Science.gov (United States)

    Ray, Julie A; Kushnir, Mark M; Bunker, Ashley; Rockwood, Alan L; Meikle, A Wayne

    2012-06-14

    Measurement of free estradiol offers a better representation of the bioactive fraction of the hormone. We describe a direct equilibrium dialysis-liquid chromatography-tandem mass spectrometry (ED-LC-MS/MS) method for serum free estradiol. Two hundred fifty microliter aliquots of serum were dialyzed for 22h followed by liquid-liquid extraction and derivatization with dansyl chloride. Free estradiol was measured using LC-MS/MS with an AB SCIEX 5500 mass spectrometer in positive ion and multiple reaction monitoring (MRM) mode. The limits of detection and quantification for free estradiol were 0.25 and 0.5pg/ml (0.9 and 1.8pmol/l) respectively. Total imprecision was less than 10%. Results of method comparison showed 3 times overestimation using indirect methods of measurement. Reference intervals in pre-menopausal women in follicular, mid-cycle, and luteal phases of cycle were <2.4, <3.1 and <2.6pg/ml (8.8, 11.4, 9.5pmol/l) respectively; in post menopausal women the concentrations were ≤0.5pg/ml (1.8pmol/l). ED-LC-MS/MS is a direct method for accurately measuring free estradiol, independent of total estradiol or sex hormone binding globulin concentrations. Imprecision and sensitivity of the method are adequate for clinical diagnostic applications. The degree of variation observed in the method comparison reinforces the relevance of method specific reference ranges. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Dialysis cultures.

    Science.gov (United States)

    Pörtner, R; Märkl, H

    1998-10-01

    Dialysis techniques are discussed as a means for effective removal of low-molecular-mass components from fermentation broth to reach high cell density. Reactor systems and process strategies, the relevant properties of membranes and examples for high-density fermentation with dialysis, and problems related to scale-up are addressed. The dialysis technique has turned out to be very efficient and reliable for obtaining high cell densities. As in dialysis processes the membranes are not perfused, membrane clogging is not a problem as it is for micro- and ultrafiltration. By applying a "nutrient-split" feeding strategy, the loss of nutrients can be avoided and the medium is used very efficiently. The potential of dialysis cultures is demonstrated on the laboratory scale in a membrane dialysis reactor with an integrated membrane and in reactor systems with an external dialysis loop. In dialysis cultures with different microorganisms (Staphylococci, Escherichia coli, extremophilic microorganisms, Lactobacilli) the cell densities achieved were up to 30 times higher than those of other fermentation methods. The technique enables high cell densities to be attained without time-consuming medium optimization. For animal cell cultures the concept of a fixed bed coupled with dialysis proved to be very effective.

  9. Peritoneal Dialysis

    Science.gov (United States)

    Peritoneal dialysis Overview By Mayo Clinic Staff Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste ...

  10. The use of peritoneal dialysis in newborns

    Directory of Open Access Journals (Sweden)

    Stojanović Vesna

    2007-01-01

    Full Text Available Introduction. Acute renal failure is a common complication in critically ill newborn infants. The therapy of acute renal failure is conservative and etiological. Patients not responding to this kind of therapy require peritoneal dialysis. Material and methods. This retrospective study included 6 newborn infants undergoing peritoneal dialysis during the period from January 2004 to June 2006, at the Nephrology Department of the Institute of Child and Youth Health Care in Novi Sad. All patients presented with complications of acute renal failure including hypercalemia and uremic encephalopathy. Results. Complete restoration of kidney function was evident in four patients on peritoneal dialysis. Three patients are still alive, but in one patient acute renal failure progressed to chronic renal failure. One patient died in the third month of life due to multiple organ dysfunction, after just two days of dialysis. Several complications were reported: intra-abdominal hemorrhage, dialysate leakage, peritonitis and dialysis catheter obstruction. Discussion. Periotoneal dialysis catheter placement is a great problem due to the size of the newborn. If it is estimated that it will be a long-lasting dialysis, Tenckhoff catheter is recommended. In very low birth weight newborn infants, in poor overall condition, general anesthesia is too risky, and acute peritoneal dialysis catheter should be placed (i.v. cannula, venous catheter. Conclusion. Peritoneal dialysis is the method of choice in newborns with acute renal failure, and it is used in the treatment of neonatal asphyxia till the restoration of kidney function is achieved. .

  11. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Science.gov (United States)

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  12. Dialysis Facility Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Dialysis Facility Compare helps you find detailed information about Medicare-certified dialysis facilities. You can compare the services and the quality of care that...

  13. Critical Care Dialysis System

    Science.gov (United States)

    1992-01-01

    Organon Teknika Corporation's REDY 2000 dialysis machine employs technology originally developed under NASA contract by Marquardt Corporation. The chemical process developed during the project could be applied to removing toxic waste from used dialysis fluid. This discovery led to the development of a kidney dialysis machine using "sorbent" dialysis, a method of removing urea from human blood by treating a dialysate solution. The process saves electricity and, because the need for a continuous water supply is eliminated, the patient has greater freedom.

  14. [The DIALYSIS AMICA project].

    Science.gov (United States)

    Marchionni, B

    2000-01-01

    The denominated Plan "DIALYSIS FRIEND" organized in the region March in the 1998, has seen involved almost all the centers of Dialysis of the region. He has the purpose of furnish the sanitary operators the tools for face the varied strife-torn situations in first person and emotional that they present themselves in an U.O. to "high tension" like result be the Dialysis and the "particularity" personality of whom affection from chronic uraemia comes subjected to dialysis. Besides through the identification of a "profile of fitness" furnishes data on the compliance of the person dialyzed or in pre-dialysis to the different techniques of dialysis. The share of the doctor, of a chief ward, and of any nurses of the U.O. of Nefro/Dialysis of Fano to such plan has resulted to be a very significance experience. The participants to the course tell their experience.

  15. [Continuous ambulatory peritoneal dialysis: the perfect dialysis?].

    Science.gov (United States)

    Marichal, J F

    1990-06-01

    Among the dialysis method, Continuous Ambulatory Peritoneal Dialysis (CAPD) is considered as simple, efficient, economical and giving autonomy to the patient. After more than ten year using Continuous Ambulatory Peritoneal Dialysis, results are evaluated. The method remains simple, but the obvious simplicity demands a strict medical control. It is efficient, but the hope in anemia and osteodystrophy correction is not confirmed. It offers more freedom but with a lot of restraints: the dietary restriction must be followed and there is only relative moving autonomia. It is economical, but the costs with the use of disconnectable systems which reduce morbidity, bring it near to the home hemodialysis.

  16. Effectiveness of peritonaeal dialysis

    Directory of Open Access Journals (Sweden)

    Jovanović Nataša

    2005-01-01

    Full Text Available Introduction. In the last few years, an increasing number of patients suffering from terminal renal disease of various leading causes was treated with renal replacement therapy. Peritonaeal dialysis involves an exchange of water and solutes between blood in the peritonaeal capillaries and dialysate in the peritonaeal cavum throughout the peritonaeum. Effective dialysis treatment should provide good quality of life, decrease the number of physical complaints, and bring the incidence of morbidity and mortality closer to the incidence of morbidity and mortality in the healthy population. Aim. The aim of this study was the evaluation of peritonaeal transport characteristics and dialysis effectiveness in 58 patients affected by terminal renal disease who underwent peritonaeal dialysis treatment during August 2003 at the Clinic of Nephrology of the Clinical Centre of Serbia. Method. We examined 30 male and 28 female patients, with an average age of 52 years (range 26 to 78 years. The average duration of peritoneal dialysis treatment was 20 months (ranging from 2 to 66 months, and the end-stage renal failure was caused by different leading disease in our patients. We applied different dialysis modalities: continuous ambulatory peritonaeal dialysis (CAPD with three to five 2- or 3-litre exchanges daily, cyclic peritonaeal dialysis (CCPD, intermittent peritonaeal dialysis (IPD, or automatic peritonaeal dialysis (APD, according to the transport characteristics of the peritonaeal membrane, the residual renal function (RRF, and the clinical status of the patients, in order to perform adequate depuration as suggested by the new international criteria. A peritonaeal equilibrium test (PET was performed according to the new international advice; urea and creatinine clearances (Kt/V and Ccr as well as RRF were calculated using the internationally suggested formulas. Results. Most of our patients received effective dialysis treatment, thanks to the modulation of

  17. Patency and Complications of Translumbar Dialysis Catheters.

    Science.gov (United States)

    Liu, Fanna; Bennett, Stacy; Arrigain, Susana; Schold, Jesse; Heyka, Robert; McLennan, Gordon; Navaneethan, Sankar D

    2015-01-01

    Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short- and long-term patency and safety of TLDC. We conducted a retrospective analysis of adult patients who received TLDC for hemodialysis access from June 2006 to June 2013. Patient demographics, comorbid conditions, dialysis details, catheter insertion procedures and associated complications, catheter patency, and patient survival data were collected. Catheter patency was studied using Kaplan-Meier curve; catheter functionality was assessed with catheter intervals and catheter-related complications were used to estimate catheter safety. There were 84 TLDCs inserted in 28 patients with 28 primary insertions and 56 exchanges. All TLDC insertions were technically successful with good blood flow during dialysis (>300 ml/minute) and no immediate complications (major bleeding or clotting) were noted. The median number of days in place for initial catheter, secondary catheter, and total catheter were 65, 84, and 244 respectively. The catheter patency rate at 3, 6, and 12 months were 43%, 25%, and 7% respectively. The main complications were poor blood flow (40%) and catheter-related infection (36%), which led to 30.8% and 35.9% catheter removal, respectively. After translumbar catheter, 42.8% of the patients were successfully converted to another vascular access or peritoneal dialysis. This study data suggest that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access. © 2015 Wiley Periodicals, Inc.

  18. Association of dialysis with the risks of cancers.

    Directory of Open Access Journals (Sweden)

    Ming Yen Lin

    Full Text Available To increase the survival span after dialysis in patients with end-stage renal disease (ESRD, identifying specific cancer risks is crucial in the cancer screening of these patients. The aim of this study was to investigate the risks of various cancers in an incident dialysis group in comparison with a non-dialysis group.We conducted a nationwide cohort study by using data from the Taiwan National Health Insurance Research Database. Patients who initially received long-term dialysis between January 1997 and December 2004, were selected and defined as the dialysis group and were matched with the non-dialysis patients (control group according to age, sex, and index year. Competing risk analysis was used to estimate cumulative incidence and subdistribution hazard ratios (SHRs of the first cancer occurrence.After consideration for the competing risk of mortality, the dialysis group showed a significantly higher 7-year cancer incidence rate than did the control group (6.4%; 95% confidence interval [CI], 6.0%-6.7% vs 1.7%; 95% CI, 1.4%-2.1%; P <0.001.The modified Cox proportional hazard model revealed that the dialysis group had significantly association with increased risks for all cancers (SHR, 3.43; 95% CI, 3.02-3.88. The risk of cancers was dominated in younger and female patients. Specific cancer risks were significantly higher in the dialysis group particularly in the development of oral, colorectal, liver, blood, breast, renal, upper urinary tract, and bladder cancer than in the control group. Multivariable stratified analyses confirmed the association between long-term dialysis and cancer in all subgroups of patients.Dialysis is associated with a higher risk of cancer in patients with ESRD. However, cancer screening in ESRD population should be a selective approach, based on individual patient health condition and life expectancy.

  19. Dialysis Facility Compare Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — These are the official datasets used on the Medicare.gov Dialysis Facility Compare Website provided by the Centers for Medicare and Medicaid Services. These data...

  20. Phosphate control in dialysis

    OpenAIRE

    Cupisti A; Gallieni M; Rizzo MA; Caria S; Meola M; Bolasco P

    2013-01-01

    Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal ...

  1. Dialysis provision in Malaysia.

    Science.gov (United States)

    Lim, T O; Lee, D G; Zaki, M

    2000-06-01

    We determined the provision for dialysis treatment in Malaysia. There were 181 dialysis centres as at 1st June 1999 (161 Haemodialysis (HD) and 20 Continuous Ambulatory Peritoneal Dialysis (CAPD) centres), providing treatment for 5614 patients. This is equivalent to an estimated prevalence rate of 253 patients per million population (pmp) and new dialysis acceptance rate of 49 patients pmp. Dialysis facilities were widely distributed throughout the country though rather unevenly among states. Penang, Selangor/KL, Malacca led with number of dialysis patients pmp ranging from 417 to 480. Kelantan and Sabah had the lowest provision with 51 and 64 patients pmp respectively. There were more centres and HD capacity in the private sector while the Non-Government Organisation and public sectors had about the same capacity. However the public sector had more patients on account of availability of CAPD and home HD services, as well as low HD capacity to patient ratio. The number ofcentres, HD capacity and patients have increased rapidly especially since 1991; the estimated growth rates were 16.5 centres/year, 658 capacity/year, and 392 patients/year respectively. There was also a trend toward increasing over-capacity in the private and NGO sectors. In conclusion, the level of dialysis provision is increasing, indicating increasing accessibility of dialysis treatment in Malaysia. Over-capacity is a concern in the private and NGO sectors. Thus funding agencies should be encouraged to source provision from those sectors. The public sector still has the crucial role of providing for under-served areas in the country.

  2. Initiation of dialysis.

    Science.gov (United States)

    Hakim, R M; Lazarus, J M

    1995-11-01

    The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. There is an increasing need to identify objective criteria for such a decision. Recent evidence suggests that malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, the role of prescribed protein restriction as well as the influence of the progression of renal disease on spontaneous dietary protein intake is examined. It is proposed that the indices of malnutrition such as progressive weight loss, serum albumin levels below 4.0 g/dL, serum transferrin levels below 200 mg/dL, and spontaneous dietary protein intake (using 24-hr urinary nitrogen measurement) below 0.8 to 0.7 g/kg per day be considered as objective criteria for the initiation of dialysis. Studies that have examined the role of "early" versus "late" dialysis have consistently shown a better outcome in the patients starting dialysis early. Other studies also suggest that early referral to nephrologists results in improved morbidity and mortality as well as hospitalization costs. An adequate vascular access, as well as social and psychological preparation of the patient, is an important early step in the process.

  3. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

    Science.gov (United States)

    Nadeau-Fredette, Annie-Claire; Hawley, Carmel M.; Pascoe, Elaine M.; Chan, Christopher T.; Clayton, Philip A.; Polkinghorne, Kevan R.; Boudville, Neil; Leblanc, Martine

    2015-01-01

    Background and objectives Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. Design, setting, participants, & measurements This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile–stratified model, and propensity score–matched model. Results The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the

  4. Dialysis access, infections, and hospitalisations in unplanned dialysis start patients

    DEFF Research Database (Denmark)

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy

    2017-01-01

    Introduction: Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient ou...

  5. Phosphate control in dialysis

    Directory of Open Access Journals (Sweden)

    Cupisti A

    2013-10-01

    Full Text Available Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease–mineral and bone disorder (CKD–MBD management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive–convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200–300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source

  6. Long-term therapy for heart failure with continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    McKinnie, J J; Bourgeois, R J; Husserl, F E

    1985-06-01

    This article reports the treatment with continuous ambulatory peritoneal dialysis of a patient with intractable congestive heart failure secondary to an ischemic cardiomyopathy. Although the use of peritoneal dialysis to treat refractory heart failure is not new, the advent of an effective continuous peritoneal dialysis system has allowed its use over prolonged periods of time. The two-year treatment interval described herein represents the longest reported application of this technique, to the best of our knowledge.

  7. Dialysis centers -- what to expect

    Science.gov (United States)

    ... F (38.0°C) The arm where your catheter is placed swells and the hand on that side feels cold Your hand gets ... kidneys - dialysis centers; Dialysis - what to expect; Renal replacement therapy - ...

  8. The impact of patient preference on dialysis modality and hemodialysis vascular access.

    Science.gov (United States)

    Keating, Patrick T; Walsh, Michael; Ribic, Christine M; Brimble, Kenneth Scott

    2014-02-22

    Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), is associated with improved health related quality of life and reduced health resource costs. It is uncertain to what extent initial preferences for dialysis modality influence the first dialysis therapy actually utilized. We examined the relationship between initial dialysis modality choice and first dialysis therapy used. Patients with chronic kidney disease (CKD) from a single centre who started dialysis after receiving modality education were included in this study. Multivariable logistic regression models were constructed to assess the independent association of patient characteristics and initial dialysis modality choice with actual dialysis therapy used and starting hemodialysis (HD) with a central venous catheter (CVC). Of 299 eligible patients, 175 (58.5%) initially chose a home-based therapy and 102 (58.3%) of these patients' first actual dialysis was a home-based therapy. Of the 89 patients that initially chose facility-based HD, 84 (94.4%) first actual dialysis was facility-based HD. The adjusted odds ratio (OR) for first actual dialysis as a home-based therapy was 29.0 for patients intending to perform PD (95% confidence interval [CI] 10.7-78.8; p dialysis was HD, an initial choice of PD or not choosing a modality was associated with an increased risk of starting dialysis with a CVC (adjusted OR 3.73, 95% CI 1.51-9.21; p = 0.004 and 4.58, 95% CI 1.53-13.7; p = 0.007, respectively). Although initially choosing a home-based therapy substantially increases the probability of the first actual dialysis being home-based, many patients who initially prefer a home-based therapy start with facility-based HD. Programs that continually re-evaluate patient preferences and reinforce the values of home based therapies that led to the initial preference may improve home-based therapy uptake and improve preparedness for starting HD.

  9. Peritoneal dialysis and inflammation.

    Science.gov (United States)

    Velloso, Marina Souza Silva; Otoni, Alba; de Paula Sabino, Adriano; de Castro, Whocely Victor; Pinto, Sérgio Wyton Lima; Marinho, Maria Aparecida Silva; Rios, Danyelle Romana Alves

    2014-03-20

    Peritoneal dialysis (PD) is a kidney replacement therapy for end stage renal disease (ESRD) patients. Despite being a lifesaving treatment, the rate of mortality in patients under PD is elevated, mainly due to the chronic peritoneal dysfunction which is characterized by inflammation, peritoneal fibrosis and neoangiogenesis. The inflammatory process is trigged and modulated by the type of the peritoneal dialysis solutions (PDSs) used during PD. Currently, different PDSs are commercially available: (i) the conventional solutions; (ii) solutions of neutral pH containing low concentration of glucose degradation products (GDPs); (iii) solutions with icodextrin; and (iv) solutions containing taurine. Therefore, the aim of this review is to describe the different types of peritoneal dialysis solutions used during PD and their relationship with systemic and intraperitoneal inflammation. Some studies suggested that solutions of neutral pH containing low concentration of GDPs, icodextrin and taurine have better biocompatibility and lower influence on the inflammatory process compared to the conventional one. On the other hand, the studies, in general, were performed with a small population and for a short period of time. Therefore, further well-designed and -controlled clinical trials with larger number of individuals are required in order to better understand the role of different peritoneal dialysis solution types in the development of inflammation in patients with chronic peritoneal dialysis. Accordingly, studies that are more well-designed, well-controlled and with a larger number of patients are needed to explain and define the role of different types of PDS in the inflammation development in patients with chronic peritoneal dialysis.

  10. Phosphate control in dialysis.

    Science.gov (United States)

    Cupisti, Adamasco; Gallieni, Maurizio; Rizzo, Maria Antonietta; Caria, Stefania; Meola, Mario; Bolasco, Piergiorgio

    2013-10-04

    Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

  11. The wintertime two-day wave in the polar stratosphere, mesosphere and lower thermosphere

    Directory of Open Access Journals (Sweden)

    D. J. Sandford

    2008-02-01

    Full Text Available Recent observations of the polar mesosphere have revealed that waves with periods near two days reach significant amplitudes in both summer and winter. This is in striking contrast to mid-latitude observations where two-day waves maximise in summer only. Here, we use data from a meteor radar at Esrange (68° N, 21° E in the Arctic and data from the MLS instrument aboard the EOS Aura satellite to investigate the wintertime polar two-day wave in the stratosphere, mesosphere and lower thermosphere. The radar data reveal that mesospheric two-day wave activity measured by horizontal-wind variance has a semi-annual cycle with maxima in winter and summer and equinoctial minima. The MLS data reveal that the summertime wave in the mesosphere is dominated by a westward-travelling zonal wavenumber three wave with significant westward wavenumber four present. It reaches largest amplitudes at mid-latitudes in the southern hemisphere. In the winter polar mesosphere, however, the wave appears to be an eastward-travelling zonal wavenumber two, which is not seen during the summer. At the latitude of Esrange, the eastward-two wave reaches maximum amplitudes near the stratopause and appears related to similar waves previously observed in the polar stratosphere. We conclude that the wintertime polar two-day wave is the mesospheric manifestation of an eastward-propagating, zonal-wavenumber-two wave originating in the stratosphere, maximising at the stratopause and likely to be generated by instabilities in the polar night jet.

  12. [Incremental peritoneal dialysis - yes].

    Science.gov (United States)

    Neri, Loris

    2012-01-01

    The incremental modality at the start of peritoneal dialysis (Incr-DP) is implicit in the definition of adequacy, which is expressed as the sum of dialysis clearance and renal clearance.Theoretically, it is possible to demonstrate that with a glomerular filtration rate at the start of dialysis of 6 mL/min, the minimum Kt/V target of 1.70 indicated by the current guidelines is easily exceeded with both 2-exchange of CAPD (incremental CAPD) and APD of 3 or 4 weekly sessions (Incr-APD), with a daytime icodextrin dwell. The GSDP (Peritoneal Dialysis Study Group) census data suggest that Incr-DP favors the choice of peritoneal dialysis. Although limited to a few studies with a relatively small number of patients, data show that Incr- CAPD is associated with a better quality of life, the achievement of Kt/V targets, and satisfactory ultrafiltration. The clearance of medium molecules is equivalent in Incr-DP and full-dose PD as it depends on the duration of the dwell and not on the number of exchanges. The maintenance of body weight, protein intake and peritoneal permeability may be explained by the lower glucose load with Incr-DP. The preservation of residual renal function is similar to that recorded with full-dose PD, while the peritonitis rate seems to be lower. The favorable results reported in the literature and the indications of the most recent guidelines about the importance of reducing the exposure to glucose to a minimum and safeguarding the patient's quality of life in our opinion further justify the use of Incr-DP.

  13. The altered gravity effect on proliferative system of two-day pea germs

    Science.gov (United States)

    Artemenko, O. A.

    The study of clinorotation effect on proliferative system sensibility of plants is very important for understanding and future investigations of their development characteristics and for examination of cell cycle regulation molecular mechanisms. Determination of two-day pea germ mitotic activity of cells, correlation of mitosis phase and DNA content point to decrease of these parameters under clinorotation during the first 12 hours of the factor influence. Cell cycle stabilization after 12 hours of the experiment show high adaptation capacity of plant proliferative system.

  14. Two-Day Curriculum Retreat: An Innovative Response to the Call for Reform.

    Science.gov (United States)

    Lane, Adrianne J; Mitchell, Claudia G

    2015-01-01

    This article outlines processes followed during a two-day offsite retreat for nurse faculty planned for the purpose of curricular redesign and content mapping. Faculty identified and leveled content for all baccalaureate clinical courses and engaged in dialogue specific to promoting student connections between didactic and clinical outcomes. Faculty developed two core simulation scenarios for every clinical course and leveled learning outcomes for each. Faculty defined where within the curriculum key concepts were introduced and planned depth of knowledge, application, and synthesis from sophomore through senior levels. Evaluation revealed the process led faculty to a stronger overall understanding of the curriculum.

  15. [Assisted peritoneal dialysis].

    Science.gov (United States)

    Klarić, Dragan; Prkačin, Ingrid

    2014-04-01

    According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.

  16. PERITONEAL DIALYSIS AFTER REPAIR OF CONGENITAL HEART DISEASE IN CHILDREN

    Institute of Scientific and Technical Information of China (English)

    罗新锦; 许建屏; 沈向东; 陈霞

    2003-01-01

    Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in childrenwho receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwentheart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 pa-tients was (2.9±2.0) years (range, 5 months~7 years) and the mean body weight was (12±3) kg (range,7.4~18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2±11.4)hours (4.4~42 hours). The duration of peritoneal dialysis was (6.3±4.8) days (0.47~15 days). Mortality inthese 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7±17.8) ml@kg1@day-1@ Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easilymanaged. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe method totreat acute renal failure after cardiac operation in children.

  17. Trace elements in dialysis.

    Science.gov (United States)

    Filler, Guido; Felder, Sarah

    2014-08-01

    In end-stage chronic kidney disease (CKD), pediatric nephrologists must consider the homeostasis of the multiple water-soluble ions that are influenced by renal replacement therapy (RRT). While certain ions such as potassium and calcium are closely monitored, little is known about the handling of trace elements in pediatric dialysis. RRT may lead to accumulation of toxic trace elements, either due to insufficient elimination or due to contamination, or to excessive removal of essential trace elements. However, trace elements are not routinely monitored in dialysis patients and no mechanism for these deficits or toxicities has been established. This review summarizes the handling of trace elements, with particular attention to pediatric data. The best data describe lead and indicate that there is a higher prevalence of elevated lead (Pb, atomic number 82) levels in children on RRT when compared to adults. Lead is particularly toxic in neurodevelopment and lead levels should therefore be monitored. Monitoring of zinc (Zn, atomic number 30) and selenium (Se, atomic number 34) may be indicated in the monitoring of all pediatric dialysis patients to reduce morbidity from deficiency. Prospective studies evaluating the impact of abnormal trace elements and the possible therapeutic value of intervention are required.

  18. Visionary Critique. Gender, Self and Relationship in Rosetta and Two Days, One Night

    Directory of Open Access Journals (Sweden)

    Stephanie Knauss

    2016-11-01

    Full Text Available The films of Jean-Pierre and Luc Dardenne stand out for their complex, multi-dimen¬sional female and male characters whose representation disrupts gender stereotypes in numerous ways, both in how the characters themselves are depicted and in how they are shown to relate to other individuals and their social context. In this contri¬bution, I explore the themes of self, relationship, solidarity, family and work – all of them recurring issues in the films by the Dardennes – using gender as my primary category of analysis, and focusing in particular on the treatment of these themes in Rosetta (Jean-Pierre and Luc Dardenne, FR/BE 1999 and Deux jours, une nuit (Two Days, One Night, Jean-Pierre and Luc Dardenne, BE/FR/IT 2014. I argue that whereas Rosetta (1999 offers a critique of the damaging effects of the masculinized capital¬ist system on individuals and their relationships, Two Days, One Night (2014 can be understood as a vision of alternative possibilities of solidarity and women’s empower¬ment and agency even within the persistent context of masculinized capitalism.

  19. Effect of two days treatment with orlistat on plasma leptin in obese patients without weight loss

    Directory of Open Access Journals (Sweden)

    Ana Rodríguez-Valle

    Full Text Available Objective: Little is known about the impact of orlistat on the leptin system. We studied the plasma leptin and satiety sensation response for two days of orlistat treatment without hypocaloric diet and weight loss. Material and methods: Twenty obese female subjects were recruited from our medical outpatient clinics. All of these subjects had previously received advice on dietary restriction and lifestyle modification, but remained obese with a stable body weight for at least six months before recruitment for the study. Results: Subjects were given 120 mg orlistat 3 times daily and were asked to maintain their usual diet. At baseline and two days after the treatment with orlistat, physical examination, hunger and blood analysis were repeated. There were no significant differences observed regarding energy dietary intake, body weight and waist-hip ratio, or in plasma glucose, insulin c-peptide concentrations. Only plasma leptin and triglycerides concentrations decreased (p: 0.0001 and 0.01 respectively. Decrease in plasma leptin concentration was positively correlated with changes observed in plasma triglycerides concentration (p: 0.01, r2: 0.45. Pre-dinner hunger increased and was negatively correlated with decrease in leptin (p: 0.0001, r2: 0.74 and triglycerides (p: 0.02, r2: 0.59. Conclusion: These data suggest that the partial fat malabsorption induced by the treatment with orlistat quickly reduces plasma triglycerides and leptin. This decrease is associated with increased appetite before intake following the main meal of the day.

  20. Renal Dialysis and its Financing.

    Science.gov (United States)

    Borelli, Marisa; Paul, David P; Skiba, Michaeline

    2016-01-01

    The incidence of end-stage renal disease (ESRD) and its associated comorbidities such as diabetes and hypertension continue to increase as the population ages. As most ESRD patients qualify for Medicare coverage, the U.S. government initiated reforms of the payment system for dialysis facilities in an effort to decrease expenditures associated with ESRD reimbursement. The effects of reduced reimbursement rates, bundled payment options, and quality incentives on the current dialysis system, including kidney dialysis units, physicians, and patients, are examined.

  1. Peritoneal Dialysis Dose and Adequacy

    Science.gov (United States)

    ... salt, and other minerals dissolved in water, called dialysis solution, is placed in a person's abdominal cavity through a catheter. The body's peritoneal membrane enclosing the digestive organs ...

  2. Treatment Methods for Kidney Failure: Peritoneal Dialysis

    Science.gov (United States)

    ... During an exchange, you can read, talk, watch television, or sleep. Usually, you change the dialysis solution at least ... During an exchange, you can read, talk, watch television, or sleep. Dialysis Solution Dialysis solution comes in 1.5-, ...

  3. [Effect of a dialysis solution with icodextrin on ultrafiltration and selected metabolic parameters in patients treated with peritoneal dialysis].

    Science.gov (United States)

    Opatrná, S; Racek, J; Stehlík, P; Senft, V; Sefrna, F; Topolcan, O; Opatrný, K

    2002-05-10

    To date, peritoneal dialysis has been performed almost exclusively using dialysis solutions containing glucose as the osmotic agent. Use of these solutions is fraught with problems regarding adequate fluid removal from the body and is also associated with undesirable metabolic effects; hence the search for alternative osmotic agents. A dialysis solution with the glucose polymer icodextrin generates ultrafiltration on the principle of colloidal osmosis. The aim of the study was to establish the effect of icodextrin-base dialysis solution on the magnitude of ultrafiltration and evaluate selected metabolic parameters of patients treated by ambulatory peritoneal dialysis. A total of 9 patients whose glucose-based solution was replaced by an icodextrin-based solution during the night-time exchange were evaluated. A control group of 9 patients used glucose-solution during all exchanges. Night-time bag ultrafiltration, blood pressure, and the serum levels of lipids, insulin, leptin, maltose, and amylase were determined before icodextrin administration (time 0), at one-month intervals (time 1, 2, 3), and one month after study completion (time 4). In icodextrin-treated patients, ultrafiltration rose from 246.5 +/- 60.5 ml (mean +/- SEM) at time 0 to 593.1 +/- 87.4 ml; p Insulin and lipid levels were not affected. There was no change in the above parameters in the control group. Icodextrin-treated patients reduced their antihypertensive medication, but not statistically significantly. Icodextrin administration significantly increase ultrafiltration thus providing for effective control of hydration status without the need for high-level glucose-based dialysis solutions. The use of a glucose polymer-based dialysis solution is associated with a significant yet reversible rise in serum maltose. The decrease in leptin may signal a reduction in body weight after replacing glucose in dialysis solutions with icodextrin, or enhanced rates of leptin elimination as a result of

  4. Corrosive Esophagitis with Benzalkonium Chloride in a Two Days Old Neonate.

    Science.gov (United States)

    Civan, Hasret Ayyildiz; Gulcu, Didem; Erkan, Tulay

    2016-09-01

    Benzalkonium chloride (BAC) is a caustic agent which is used in farms, homes and hospitals for cleaning skin and wounds as an antiseptic solution. It may lead to digestive system injuries in case of ingestion. We present a two-days-old newborn case which was carried to the emergency unit with complaints of poor breastfeeding, uneasiness and crying for 4-6 hours. Her mom confessed that she had given a spoon of 10% BAC solution for her cough. Initial laboratory tests were in normal ranges. A gastroscopy performed in the second hour of her admission revealed an hyperemic and edematous mucosa in the middle third of esophagus and a circumferential ulceration followed in the distal portion. Hereupon, a conservative treatment for 10 days was administered and the control gastroscopy demonstrated that the damage was almost totally improved. She was the youngest case with this etiology and successfully treated with conservative approach.

  5. Metabolic alterations in dialysis patients

    NARCIS (Netherlands)

    Drechsler, Christiane

    2010-01-01

    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney d

  6. Metabolic alterations in dialysis patients

    NARCIS (Netherlands)

    Drechsler, Christiane

    2010-01-01

    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney

  7. Cost analysis of hemodialysis and peritoneal dialysis access in incident dialysis patients.

    Science.gov (United States)

    Coentrão, Luis A; Araújo, Carla S; Ribeiro, Carlos A; Dias, Claúdia C; Pestana, Manuel J

    2013-01-01

    Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD. We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros. Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04). Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.

  8. Dialysis vintage, body composition, and survival in peritoneal dialysis patients.

    Science.gov (United States)

    Avram, Morrell M; Mittman, Neal; Fein, Paul A; Agahiu, Samuel; Hartman, William; Chattopadhyay, Neil; Matza, Betty

    2012-01-01

    The relationship between dialysis vintage (length of time on dialysis), body composition, and survival has been reported in hemodialysis patients. In the present study, we examined the association ofdialysis vintage with body composition and survival in peritoneal dialysis (PD) patients. At enrollment, body composition in 65 PD patients was determined by bioelectrical impedance analysis. Patients (mean age at enrollment: 54 years) were followed for up to 11 years maximum. At enrollment, the mean, median, and maximum dialysis vintages were 51, 34, and 261 months respectively. After adjusting for age, race, sex, and diabetes status, dialysis vintage was indirectly correlated (partial correlation coefficients) with body weight (r = -0.40, p = 0.001), body mass index (r = -0.40, p = 0.002), body surface area (r = -0.39, p = 0.002), body cell mass (r = -0.39, p = 0.002), total body fat weight (r = -0.30, p = 0.02), and fat percentage of body weight (r = -0.31, p = 0.018), and directly correlated with extracellular mass to body cell mass ratio (r = 0.27, p = 0.039). The observed cumulative survival was significantly higher (p = 0.007) in patients with a dialysis vintage at enrollment of 35 months or less, than in patients with dialysis vintage at enrollment of more than 35 months. In the multivariate Cox regression analysis, adjusting for age, race, sex, and diabetes, dialysis vintage at enrollment remained an independent predictor of mortality (relative risk: 1.010; p = 0.002). Increase in relative risk of death with increasing dialysis vintage may be partly explained by the association of vintage with unfavorable changes in body composition and the nutrition status of patients over time.

  9. Testosterone deficiency in dialysis patients: Difference between dialysis techniques.

    Science.gov (United States)

    Cigarrán, Secundino; Coronel, Francisco; Florit, Enrique; Calviño, Jesús; Villa, Juan; Gonzalez Tabares, Lourdes; Herrero, José Antonio; Carrero, Juan Jesús

    Testosterone deficiency is a prevalent condition in male patients with chronic kidney disease. However, it is not known whether the type of renal replacement therapy has an impact on testosterone deficiency that accompanies loss of renal function. The cross-sectional study enrolled 79 prevalent male patients on dialysis; 43 on haemodialysis (HD) and 36 on peritoneal dialysis (PD). The median age was 69 years and 31.6% were diabetics. Endogenous testosterone levels were measured by immunoluminescence assay (normal range 3-10.5ng/ml), while nutritional/inflammatory markers, bone and mineral metabolism markers, anaemia, type of dialysis technique and time on dialysis were also assessed. Body composition was evaluated by bioimpedance vector analysis and bioimpedance spectroscopy. Testosterone deficiency was defined as levels below 3ng/ml. Mean testosterone levels were 8.81±6.61ng/ml. Testosterone deficiency affected 39.5% of HD patients and only 5.6% of PD patients. In the univariate analysis, testosterone levels were directly correlated with type of dialysis technique (HD) (Rho Spearman 0.366; P<.001) and time on dialysis (Rho -0.412; P=.036) and only with the HD technique in the multivariate analysis. No other significant correlations were found. Circulating testosterone levels in men on dialysis were independently associated with HD technique. It can be concluded that a new factor -namely the dialysis technique- may be associated with falling testosterone levels and the associated loss of muscle mass and inflammation. Further studies are needed to establish whether the dialysis technique itself triggers testosterone elimination. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Interannual variation of the quasi-two-day wave at 22.7 S

    Science.gov (United States)

    Lima, Lourivaldo; Jacobi, Christoph; Batista, Paulo; Rodrigues de Araujo, Luciana; Rodrigues, Chayenny E. S.; Lilienthal, Friederike

    2016-07-01

    In the present investigation, the mesosphere/lower thermosphere winds at Cachoeira Paulista (22.7° S, 45.0° W) obtained by a VHF all sky interferometric meteor radar have been used to investigate the interannual variability of the quasi-two-day wave (QTDW) amplitudes at a low latitude in the Southern Hemisphere. The wind data were obtained from December 1999 to July 2006, from September 2007 to October 2008 and from December 2013 to April 2015. The analysis shows that meridional amplitudes for QTDW are larger than zonal amplitudes and the strongest amplitudes occur after austral summer solstice in January-February. Besides semiannual and annual oscillations, the QTDW amplitudes in the meridional winds also show weak quasi-biennial oscillation (QBO). The summer QTDW in the meridional winds also shows a possible correlation with solar activity. The amplitudes are nearly in phase with the 11 year solar cycle, and the solar maxima leads the QTDW maxima by one year. Finally, larger QTDW amplifications have been observed during 2003, 2004, 2006 and 2015 summers. The unusual major sudden stratospheric warming (SSW) event suggests a coupling between QTDW amplification and SSW during Jan-Feb 2006. The mechanistic global circulation model MUAM of the middle and upper atmosphere has been used to simulate the dynamic configuration during January major and minor SSW events.

  11. Determinants of survival among HIV-infected chronic dialysis patients.

    Science.gov (United States)

    Rodriguez, Rudolph A; Mendelson, Michael; O'Hare, Ann M; Hsu, Ling Chin; Schoenfeld, Patricia

    2003-05-01

    Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.

  12. Communicating Leave No Trace ethics and practices: Efficacy of two-day trainer courses

    Science.gov (United States)

    Daniels, M.L.; Marion, J.L.

    2005-01-01

    Heavy recreational visitation within protected natural areas has resulted in many ecological impacts. Many of these impacts may be avoided or minimized through adoption of low-impact hiking and camping practices. Although ?No Trace? messages have been promoted in public lands since the 1970s, few studies have documented the reception and effectiveness of these messages. The U.S. Leave No Trace Center for Outdoor Ethics develops and promotes two-day Trainer courses that teach Leave No Trace (LNT) skills and ethics to outdoor professionals, groups, and interested individuals. This study examined the change in knowledge, ethics, and behavior of LNT Trainer course participants. The respondents were a convenience sample of participants in Trainer courses offered from April through August 2003. Trainer course instructors administered pre-course and post-course questionnaires to their participants, and we contacted participants individually with a followup questionnaire 4 months after completion of their course. Scores for each of the sections increased immediately following the course, and decreased slightly over the 4 months following the course. Overall, more than half of the knowledge and behavior items, and half of the ethics items, showed significant improvement from pre-course measures to the follow-up. Age, reported LNT experience, and backpacking experience affected the participants? pre-course knowledge and behavior scores. Younger, less experienced respondents also showed a greater improvement in behavior following the course. Trainer course participants also shared their LNT skills and ethics with others both formally and informally. In summary, the LNT Trainer course was successful in increasing participants? knowledge, ethics, and behavior, which they then shared with others. Since many low impact skills taught in the LNT curriculum are supported by scientific research, LNT educational programs have the potential to effectively minimize the environmental

  13. Peritoneal dialysis in Asia.

    Science.gov (United States)

    Cheng, I K

    1996-01-01

    The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last

  14. Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation.

    Science.gov (United States)

    Peces, Ramón; Martínez-Ara, Jorge; Miguel, José Luis; Arrieta, Javier; Costero, Olga; Górriz, José Luis; Picazo, Mari-Luz; Fresno, Manuel

    2004-11-01

    Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation. We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups. Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive. ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.

  15. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Yih-Giun Cherng

    Full Text Available BACKGROUND: End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS: Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS: Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33 when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31 and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47 than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION: Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.

  16. Excitation of the Two Day Wave in the MLT by Waves Emanating from the Troposphere

    Science.gov (United States)

    Ortland, D. A.

    2015-12-01

    Mechanistic model experiments will be presented, with the goal of understanding the excitation mechanism and interannual variability of the quasi two day wave (Q2DW) with zonal wavenumber 3. The model is initialized with the observed zonal mean structure of the atmosphere for austral summer solstice for various years. The summer jet contains regions that are baroclinically unstable, in which random wave excitation could stimulate unstable growth of the Q2DW, with rate and magnitude that depends on the variable mean state structure. Unstable modes do exist in linear inviscid model experiments, but they become marginally stable when the damping mechanisms of Newtonian cooling, eddy, and molecular diffusion are included in the model. In nonlinear model simulations with no imposed wave forcing, synoptic waves spontaneously form off of the tropospheric jet structure, and the resulting waves weakly excite and maintain a Q2DW (along with other waves with the same phase speed with zonal wavenumbers 1-4). With the addition of a rich spectrum of waves forced by latent heating (derived from TRMM observations of rainfall rate), a robust Q2DW with amplitude similar to those observed is excited. The unstable regions in the mean flow still play a role in the ease to which QTDWs are excited: The QTDW first appears near the subtropical barotropically unstable region that is associated with the stratopause QTDW. EP flux of the mature QTDW emanates from the baroclinically unstable region in the midlatitude jet. Further experiments, employing artificial local 2DW sources centered at various latitudes and altitudes, show that the QTDW is readily excited by any transient wave source with only moderate variation in efficiency. Furthermore, the amplitude and frequency of the QTDW does not strongly depend on which year the model is initialized. Thus a detailed understanding of the QTDW life cycle in a given year will depend on both the formation of the mean flow that will support resonant

  17. Dialysis and transplantation in Sudan.

    Science.gov (United States)

    Suliman, S M; Beliela, M H; Hamza, H

    1995-01-01

    In this report we present the current status of the renal replacement therapy in Sudan. Sudan is a large country with 30 million inhabitants. Peritoneal Dialysis was started in 1968, while hemodialysis was started in 1973. At present, there are only 16 hemodialysis machines serving 56 patients in two centers in Sudan. There are also 15 peritoneal dialysis beds for 70 intermittent peritoneal dialysis patients in three centers. Continuous ambulatory peritoneal dialysis is not being practiced in Sudan. The first renal transplant was in 1974, and till now more than 30 transplants have been performed in two transplant centers. All the transplants have been from living donors. The scholars of Islam in Sudan oppose to donation from cadavers. There are 200 renal transplant patients being followed up in Sudan and the majority had their renal transplants abroad. We conclude that there is a tremendous shortage of renal services in Sudan. There are more efforts being made to improve these services.

  18. [Peritoneal dialysis today and tomorrow].

    Science.gov (United States)

    Grangier, Jean-Pierre

    2016-01-01

    Peritoneal dialysis was first used in the 1980s. Less well-known than haemodialysis, it represents an important treatment option for elderly patients at home. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. QT Interval and QT Dispersion in Patients Undergoing Hemodialysis: Revisiting the Old Theory

    Directory of Open Access Journals (Sweden)

    Mohamed A. Alabd

    2011-07-01

    Full Text Available Aims: We sought to explore the response of the corrected QT (QTc interval duration and QT dispersion (QTD to hemodialysis. Methods: We enrolled 50 patients with end-stage renal disease undergoing regular hemodialysis. Blood samples were drawn for measurement of serum electrolytes, and a 12-lead ECG was performed to measure the QTc interval duration and QTD, immediately before and just after dialysis sessions. Results: The mean age of the cohort was 42.8 ± 12.2 years (58% males. Both the QTc duration and QTD showed marked variability after hemodialysis. A significant correlation was found between the decrease of both serum potassium and magnesium levels after dialysis and the post-dialysis QTc interval duration, with Pearson’s correlation coefficients r = –0.43 and r = –0.34, p = 0.002 and p = 0.01, respectively. Patients with a post-dialysis increase of QTc interval duration had a significantly higher percentage of reduction of serum potassium (p = 0.029, whereas patients with a post-dialysis increase of QTD had a significantly higher percentage of reduction of serum magnesium (p = 0.03. Conclusion: Our findings suggest a highly variable response of the QTc interval duration and QTD to hemodialysis. The post-dialysis QTc interval duration inversely correlated with the decrease of both serum potassium and magnesium levels after dialysis.

  20. QT Interval and QT Dispersion in Patients Undergoing Hemodialysis: Revisiting the Old Theory

    Science.gov (United States)

    Alabd, Mohamed A.; El-Hammady, Walid; Shawky, Ahmed; Nammas, Wail; El-Tayeb, Mohamed

    2011-01-01

    Aims We sought to explore the response of the corrected QT (QTc) interval duration and QT dispersion (QTD) to hemodialysis. Methods We enrolled 50 patients with end-stage renal disease undergoing regular hemodialysis. Blood samples were drawn for measurement of serum electrolytes, and a 12-lead ECG was performed to measure the QTc interval duration and QTD, immediately before and just after dialysis sessions. Results The mean age of the cohort was 42.8 ± 12.2 years (58% males). Both the QTc duration and QTD showed marked variability after hemodialysis. A significant correlation was found between the decrease of both serum potassium and magnesium levels after dialysis and the post-dialysis QTc interval duration, with Pearson's correlation coefficients r = −0.43 and r = −0.34, p = 0.002 and p = 0.01, respectively. Patients with a post-dialysis increase of QTc interval duration had a significantly higher percentage of reduction of serum potassium (p = 0.029), whereas patients with a post-dialysis increase of QTD had a significantly higher percentage of reduction of serum magnesium (p = 0.03). Conclusion Our findings suggest a highly variable response of the QTc interval duration and QTD to hemodialysis. The post-dialysis QTc interval duration inversely correlated with the decrease of both serum potassium and magnesium levels after dialysis. PMID:22470374

  1. [Comparative study of the operation of two day's Hospitals in Athens].

    Science.gov (United States)

    Mantonakis, J; Karakatsanis, N; Spilioti, E; Karanikoli, I; Stentoumis, C; Stefanis, C

    2014-01-01

    The present paper describes the preparation for the commencement of services by the University Mental Health Research Institute (UMHRI) Day Hospital and Eginition Day Hospital whose operation (in 1977) signifies the beginning of the Psychiatric Reform in our country. The two units' functional characteristics and the type of offered services are mentioned. Psychotherapeutic, biological and sociotherapeutic approaches are practiced on a daily basis within a framework of Therapeutic Community services. Moreover, relations, similarities and differences among the two day hospitals are pointed out. Special mention is given to the problems and difficulties that these two units faced upon their commencement, which took place at different time periods, set 32 years apart. The lack of legislative framework with regards to the operation of Day Hospitals, the bureaucratic obstacles and the skepticism towards the new treatment approach of patients, were the basic obstacles that had to be overcome in order for the first Day Hospital to become operational in 1977. Licensing and funding were the main obstacles that the creation of UMHRI's Day Hospital faced, although these two units had already been established. Emphasis was placed on the staff's training, which mainly consisted of young professionals and at the social environment's and all those services' (health-care, community etc) attitude, in the specific catchment area (6th Mental Health Sector). The study of patients' characteristics hospitalized in Eginition's Day Hospital throughout its first year of operation (1977-1978) and of patients hospitalized at UMHRI's Day Hospital, also at its first year of operation (2009-2010), showed, among other things, that in both cases, the number of hospitalized male patients is larger than the number of female patients. This constitutes an exception compared to other countries, whereby female patients outnumber male patients in Day Hospitals. Especially at UMHRI's Day Hospital, the

  2. Tidal peritoneal dialysis: preliminary experience.

    Science.gov (United States)

    Flanigan, M J; Doyle, C; Lim, V S; Ullrich, G

    1992-01-01

    To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). An open enrollment pilot study. The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 +/- 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).

  3. The Different Association between Serum Ferritin and Mortality in Hemodialysis and Peritoneal Dialysis Patients Using Japanese Nationwide Dialysis Registry.

    Science.gov (United States)

    Maruyama, Yukio; Yokoyama, Keitaro; Yokoo, Takashi; Shigematsu, Takashi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu

    2015-01-01

    Monitoring of serum ferritin levels is widely recommended in the management of anemia among patients on dialysis. However, associations between serum ferritin and mortality are unclear and there have been no investigations among patients undergoing peritoneal dialysis (PD). Baseline data of 191,902 patients on dialysis (age, 65 ± 13 years; male, 61.1%; median dialysis duration, 62 months) were extracted from a nationwide dialysis registry in Japan at the end of 2007. Outcomes, such as one-year mortality, were then evaluated using the registry at the end of 2008. Within one year, a total of 15,284 (8.0%) patients had died, including 6,210 (3.2%) cardiovascular and 2,707 (1.4%) infection-related causes. Higher baseline serum ferritin levels were associated with higher mortality rates among patients undergoing hemodialysis (HD). In contrast, there were no clear associations between serum ferritin levels and mortality among PD patients. Multivariate Cox regression analysis of HD patients showed that those in the highest serum ferritin decile group had higher rates of all-cause and cardiovascular mortality than those in the lowest decile group (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.31-1.81 and HR, 1.44; 95% CI, 1.13-1.84, respectively), whereas associations with infection-related mortality became non-significant (HR, 1.14; 95% CI, 0.79-1.65). Using Japanese nationwide dialysis registry, higher serum ferritin values were associated with mortality not in PD patients but in HD patients.

  4. The dialysis catheter and infectious peritonitis in intermittent peritoneal dialysis

    DEFF Research Database (Denmark)

    Kolmos, Hans Jørn; Hemmeløff Andersen, Karl Erik; Hansen, Lise

    1984-01-01

    118 episodes of infectious peritonitis registered among 156 patients treated with intermittent peritoneal dialysis over a 5-yr period were analysed with special reference to potential routes of infection associated with the dialysis catheter. Peritonitis was randomly distributed among the patients......, and the change of keeping free of peritonitis declined exponentially with time. The main factor determining the individual number of episodes was the total space of time, in which a patient had been wearing a dialysis catheter, whereas the number of catheter disconnections played no significant role. A relative...... preponderance of cases due to Enterobacteriaceae was noted within the first week after catheter implantation. In contrast with this, peritonitis with skin microorganisms was not associated with the implantation of catheters....

  5. Anemia in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Laušević Mirjana

    2006-01-01

    Full Text Available A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13% patients were treated with rHuEPO, 14 (28% underwent continuous ambulatory peritoneal dialysis (CAPD, 2 (100% - automated peritoneal dialysis (APD and 2 (33.3% - intermittent peritoneal dialysis (IPD. Mean hemoglobin level was 98.6±17.82 g/l in patients treated with rHuEPO versus 98.81±15.14 g/I in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85±1211.77 IU/week. AII patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 ±360 μg/l. Transferrin saturation (TSAT was 0.35±0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and

  6. Depression Often Untreated in Dialysis Patients

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_163270.html Depression Often Untreated in Dialysis Patients Sometimes it's the ... 26, 2017 THURSDAY, Jan. 26, 2017 (HealthDay News) -- Depression is common among kidney failure patients undergoing dialysis. ...

  7. Dialysis: MedlinePlus Health Topic

    Science.gov (United States)

    ... Filtering Dialysis Myths from Facts (National Kidney Foundation) Hemodialysis Catheters: How to Keep Yours Working Well (National Kidney ... Thrombotic complications and tip position of transjugular chronic dialysis catheter... Article: Clinical emergency treatment of 68 critical patients ...

  8. [The management of dialysis patients seropositive for HBsAg, anti-HCV, or anti-HIV antibodies].

    Science.gov (United States)

    Fabrizi, Fabrizio; Messa, Piergiorgio

    2012-01-01

    Infections by hepatitis B or hepatitis C virus are still common among patients on maintenance dialysis in Western countries. The natural history of HBV and HCV in the dialysis population remains unclear; however, there is good evidence showing an adverse impact of an anti-HCV seropositive status on survival in dialysis patients. A recent meta-analysis of observational studies (n=7, 11,589 unique patients) reported that anti-HCV-positive patients on dialysis had a higher mortality rate than those who were anti-HCV negative (adjusted hazard ratio=1.35, 95% confidence interval, 1.13; 1.59, pdialysis. Standard precautions and specific procedures against the transmission of blood-borne agents have been recommended to control HCV infection within dialysis units. Isolation by dialysis machines, staff and rooms has been strongly recommended to control HBV. Vaccination is an important tool against transmission of HBV infection among patients on maintenance dialysis; however, the immune response towards the hepatitis B vaccine in uremic patients remains unsatisfactory. Monotherapy with lamivudine is currently used for dialysis patients with hepatitis B whereas combination antiviral therapy (pegylated interferon plus ribavirin) is the standard of care for hepatitis C in the dialysis population, even if various side effects have been observed.

  9. interval functions

    Directory of Open Access Journals (Sweden)

    J. A. Chatfield

    1978-01-01

    Full Text Available Suppose N is a Banach space of norm |•| and R is the set of real numbers. All integrals used are of the subdivision-refinement type. The main theorem [Theorem 3] gives a representation of TH where H is a function from R×R to N such that H(p+,p+, H(p,p+, H(p−,p−, and H(p−,p each exist for each p and T is a bounded linear operator on the space of all such functions H. In particular we show that TH=(I∫abfHdα+∑i=1∞[H(xi−1,xi−1+−H(xi−1+,xi−1+]β(xi−1+∑i=1∞[H(xi−,xi−H(xi−,xi−]Θ(xi−1,xiwhere each of α, β, and Θ depend only on T, α is of bounded variation, β and Θ are 0 except at a countable number of points, fH is a function from R to N depending on H and {xi}i=1∞ denotes the points P in [a,b]. for which [H(p,p+−H(p+,p+]≠0 or [H(p−,p−H(p−,p−]≠0. We also define an interior interval function integral and give a relationship between it and the standard interval function integral.

  10. Alternative dialysis strategies with icodextrin.

    Science.gov (United States)

    Panzer, Sarah E; Teitelbaum, Isaac

    2012-01-01

    Proper volume management continues to be a major challenge in patients requiring renal replacement therapy. In patients performing peritoneal dialysis the introduction of icodextrin represented a major advance in this effort. Recent studies have demonstrated a potential role for the use of novel dialysis strategies employing icodextrin to further enhance ultrafiltration and to improve cardiac indices in patients with ultrafiltration failure. These alternative strategies include the use of icodextrin in non-traditional patient populations (low transporters), the simultaneous use of glucose-based and icodextrin solutions in combination, and the use of icodextrin twice daily rather than for just a single dwell. This paper will briefly review the current status of these alternative dialysis strategies with icodextrin. In addition, the potential role for icodextrin to decrease postoperative adhesions will be discussed as well. Copyright © 2012 S. Karger AG, Basel.

  11. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Science.gov (United States)

    2010-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program...

  12. Impact of weaning from acute dialytic therapy on outcomes of chronic kidney disease following urgent-start dialysis.

    Science.gov (United States)

    Chen, Yung-Ming; Li, Wen-Yi; Wu, Vin-Cent; Wang, Yi-Cheng; Hwang, Shang-Jyh; Lin, Shih-Hwa; Wu, Kwan-Dun

    2015-01-01

    Discontinuation of acute, unplanned dialysis is always an important therapeutic goal in dialysis-requiring patients with existing chronic kidney disease. Only a limited proportion of patients could be weaned off dialysis and remained dialysis-free. Here we performed a multicenter, observational study to investigate factors associated with successful weaning from acute dialysis, and to explore the potential impact of weaning itself on outcomes of patients with chronic kidney disease following urgent-start dialysis. We recruited 440 chronic kidney disease patients with a baseline estimated glomerular filtration rate 1 month died, and 36 (8.6%) were removed from dialysis, with 26 (6.2%) remaining alive and dialysis-free. Logistic regression analysis found that age ≧ 65 years, ischemic acute tubular necrosis, nephrotoxic exposure, urinary obstruction, and higher predialysis estimated glomerular filtration rate and serum hemoglobin were predictors of weaning off dialysis. After adjustment for propensity scores for dialysis weaning, Cox proportional hazards models showed successful weaning from dialysis (adjusted hazard ratio 0.06; 95% confidence interval 0.01 to 0.35), along with a history of hypertension and serum albumin, were independent protectors for early death. Conversely, a history of stroke, peripheral arterial disease and cancer predicted the occurrence of early mortality. In conclusion, this prospective cohort study shows that compared to patients with chronic kidney disease who became end-stage renal disease after acute dialysis, patients who could be weaned off acute dialytic therapy were associated with reduced risk of premature death over a 2-year observation period.

  13. Two-day period fluctuation of PMC occurrence over Syowa Station, Antarctica observed by a ground-based lidar and AIM satellite.

    Science.gov (United States)

    Nakamura, T.; Suzuki, H.; Tsutsumi, M.; Ejiri, M. K.; Tomikawa, Y.; Abo, M.; Kawahara, T.; Tsuda, T. T.; Nishiyama, T.

    2014-12-01

    A Rayleigh/Raman lidar system has been operated by the Japanese Antarctic Research Expedition (JARE) since February, 2011 (JARE 52nd) in Syowa Station Antarctica (69.0S, 39.5E). The lidar system consists of a pulsed Nd:YAG laser (355nm) as a transmitter and two telescopes with four photo multiplier tubes which are to detect Rayleigh scattered light from low and high atmosphere at 355 nm and N2 Raman emission at 387nm. Polar Mesospheric Cloud (PMC) was detected by the lidar at 22:30UT (+3hr for LT) on Feb 4th, 2011, the first day of a routine operation. This event was the first time to detect PMC over Syowa Station by a lidar [Suzuki et al., Ann. Geophys., 2013]. However, signal to noise ratio (SNR) of the PMC event was not so good due to large shot noises from daytime background signals. Moreover, a receiver system was designed mainly for nighttime observations. In this way, observation of PMC during the midnight sun, which also corresponds to most frequent PMC season, was difficult. Thus, to improve SNR of the PMC observation with the lidar during daytime, a narrow band-pass Fabry-Perot etalon unit has been developed and installed in the receiver system on Dec 2013 by JARE 55th. By using this new system, clear PMC signals were successfully detected under daylight condition during the period of summer operation of JARE55th. During this period of 53 days (from 17 Dec. 2013 to 7 Feb. 2014), only 11 days were with a clear sky and suitable for PMC observation. Thus, it was difficult to study temporal variations on a PMC activity only by using the lidar data. Fortunately, NASA's AIM satellite had passed near Syowa Station and provided with complimentary PMC data during observation gap of the lidar. By combining our lidar data with the AIM/CIPS data, nearly continuous monitoring of PMC variability over Syowa Station was achieved for period between 13th and 18th in January 2014. PMC occurrence with an interval of two days over Syowa Station during the period was clearly

  14. Forward osmosis process for dialysis fluid regeneration.

    Science.gov (United States)

    Talaat, Khaled Mohamed

    2009-12-01

    In a preliminary experiment, 38% of the spent dialysis fluid water was reclaimed by a forward osmosis process through a cellulose triacetate membrane. The simplicity of forward osmosis and its minimal external energy requirements may allow the construction of a small bulk device that can reclaim a considerable portion of the water used in the patient's dialysis process. For developing an acceptable ambulatory dialysis system, decreasing the bulk of the fluid and equipment carried on the patient is essential. Forward osmosis may feasibly be used for dialysis fluid regeneration in ambulatory dialysis systems.

  15. Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease.

    Science.gov (United States)

    Morton, Rachael L; Snelling, Paul; Webster, Angela C; Rose, John; Masterson, Rosemary; Johnson, David W; Howard, Kirsten

    2012-03-20

    For every patient with chronic kidney disease who undergoes renal-replacement therapy, there is one patient who undergoes conservative management of their disease. We aimed to determine the most important characteristics of dialysis and the trade-offs patients were willing to make in choosing dialysis instead of conservative care. We conducted a discrete choice experiment involving adults with stage 3-5 chronic kidney disease from eight renal clinics in Australia. We assessed the influence of treatment characteristics (life expectancy, number of visits to the hospital per week, ability to travel, time spent undergoing dialysis [i.e., time spent attached to a dialysis machine per treatment, measured in hours], time of day at which treatment occurred, availability of subsidized transport and flexibility of the treatment schedule) on patients' preferences for dialysis versus conservative care. Of 151 patients invited to participate, 105 completed our survey. Patients were more likely to choose dialysis than conservative care if dialysis involved an increased average life expectancy (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.57-2.15), if they were able to dialyse during the day or evening rather than during the day only (OR 8.95, 95% CI 4.46-17.97), and if subsidized transport was available (OR 1.55, 95% CI 1.24-1.95). Patients were less likely to choose dialysis over conservative care if an increase in the number of visits to hospital was required (OR 0.70, 95% CI 0.56-0.88) and if there were more restrictions on their ability to travel (OR=0.47, 95%CI 0.36-0.61). Patients were willing to forgo 7 months of life expectancy to reduce the number of required visits to hospital and 15 months of life expectancy to increase their ability to travel. Patients approaching end-stage kidney disease are willing to trade considerable life expectancy to reduce the burden and restrictions imposed by dialysis.

  16. Phosphorus balance with daily dialysis.

    Science.gov (United States)

    Kooienga, Laura

    2007-01-01

    Hyperphosphatemia is an almost universal finding in patients with end-stage renal disease and is associated with increased all-cause mortality, cardiovascular mortality, and vascular calcification. These associations have raised the question of whether reducing phosphorus levels could result in improved survival. In light of the recent findings that increased per-session dialysis dose, as assessed by urea kinetics, did not result in improved survival, the definition of adequacy of dialysis should be re-evaluated and consideration given to alternative markers. Two alternatives to conventional thrice weekly dialysis (CHD) are nocturnal hemodialysis (NHD) and short daily hemodialysis (SDHD). The elimination kinetics of phosphorus as they relate to these alternative daily dialysis schedules and the clinical implications of overall phosphorus balance are discussed here. The total weekly phosphorus removal with NHD is more than twice that removed by CHD (4985 mg/week +/- 1827 mg vs. 2347 mg/week +/- 697 mg) and this is associated with a significantly lower average serum phosphorous (4.0 mg/dl vs. 6.5 mg/dl). In spite of the observed increase in protein and phosphorus intake seen in patients on SDHD, phosphate binder requirements and serum phosphorus levels are generally stable to decrease although this effect is strongly dependent on the frequency and overall treatment time.

  17. Pulmonary hypertension in dialysis patients.

    Science.gov (United States)

    Kosmadakis, George; Aguilera, Didier; Carceles, Odette; Da Costa Correia, Enrique; Boletis, Ioannis

    2013-01-01

    Pulmonary hypertension in end-stage renal disease patients is associated with significantly increased morbidity and mortality. The prevalence of pulmonary hypertension in dialysis patients is relatively high and varies in different studies from 17% to 49.53% depending on the mode of dialysis and other selection factors, such as the presence of other cardiovascular comorbidities. The etiopathogenic mechanisms that have been studied in relatively small studies mainly include arteriovenous fistula-induced increased cardiac output, which cannot be accomodated by, the spacious under normal conditions pulmonary circulation. Additionally, pulmonary vessels show signs of endothelial dysfunction, dysregulation of vascular tone due to an imbalance in vasoactive substances, and local as well as systemic inflammation. It is also believed that microbubbles escaping from the dialysis circuit can trigger vasoconstriction and vascular sclerosis. The non-specific therapeutic options that proved to be beneficial in pulmonary artery pressure reduction are endothelin inhibitors, phosphodiesterase inhibitor sildenafil, and vasodilatory prostaglandins in various forms. The specific modes of treatment are renal transplantation, size reduction or closure of high-flow arteriovenous fistulas, and transfer from hemodialysis to peritoneal dialysis-a modality that is associated with a lesser prevalence of pulmonary hypertension.

  18. Discontinuation of rLH two days before hCG may increase the number of oocytes retrieved in IVF

    Directory of Open Access Journals (Sweden)

    Session Donna R

    2010-03-01

    Full Text Available Abstract Background Administration of recombinant luteinizing hormone (rLH in controlled ovarian hyperstimulation may benefit a subpopulation of patients. However, late follicular phase administration of high doses of rLH may also reduce the size of the follicular cohort and promote monofollicular development. Methods To determine if rLH in late follicular development had a negative impact on follicular growth and oocyte yield, IVF patients in our practice who received rFSH and rLH for the entire stimulation were retrospectively compared with those that had the rLH discontinued at least two days prior to hCG trigger. Results The two groups had similar baseline characteristics before stimulation with respect to age, FSH level and antral follicle count. However, the group which had the rLH discontinued at least two days prior to their hCG shot, had a significantly higher number of oocytes retrieved, including a higher number of MII oocytes and number of 2PN embryos. Conclusions When using rLH for controlled ovarian hyperstimulation, administering it from the start of stimulation and stopping it in the late follicular phase, at least two days prior to hCG trigger, may increase oocyte and embryo yield.

  19. Requirement of Emergency Hemodialysis in a Peritoneal Dialysis Patient; Laxative Induced Hypermagnesemia: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa YAPRAK

    2013-01-01

    Full Text Available Hypermagnesemia is rarely seen in peritoneal dialysis (PD patients because PD can lower the plasma magnesium (Mg concentration effectively. In this report, a continuous ambulatory peritoneal dialysis (CAPD patient with life-threatening hypermagnesemia treated by hemodialysis (HD is presented. A 52-year-old male patient on PD treatment was admitted to our clinic with complaints of fatigue and muscle weakness. Decrease in deep tendon reflexes (DTR, decrease in muscle strength at bilateral upper and lower extremities, and increased level of magnesium (7.7 mg/dl were detected. Bradycardia, prolongation of the P-R interval, and an increase in Q-T interval were found on the electrocardiography. HD was performed two times. After HD, all the signs and symptoms of the patient improved. HD is a dialysis modality that should be preferred in the treatment of symptomatic patients with hypermagnesemia, because of providing more rapid clearance of Mg.

  20. Dissolved organic nitrogen measurement using dialysis pretreatment.

    Science.gov (United States)

    Lee, Wontae; Westerhoff, Paul

    2005-02-01

    Dissolved organic nitrogen (DON) is important for ecological and engineering researches. Quantification of low DON concentrations in waters with elevated dissolved inorganic nitrogen (DIN) using existing methods is inaccurate. In this study, a dialysis-based pretreatment technique was optimized and adopted to reduce the interference from DIN to the quantification of DON in natural water. A cellulose ester dialysis tube (nominal molecular weight cutoff = 100 Da) was used in batch and continuous-flow dialysis steps with model compounds, natural organic matter isolates, and bulk waters to develop a dialysis pretreatment approach that selectively reduces DIN from solutions containing DON. By reducing DIN concentrations, propagation of analytical variance in total dissolved nitrogen (TDN) and DIN species concentrations allows more accurate determination of DON (DON = TDN - NO3 - NO2- - NH3/NH4+). Dialysis for 24 h against continuously flowing distilled water reduced DIN species by 70%. With dialysis pretreatment, DON recoveries of more than 95% were obtained for surface water and finished drinking water, but wastewater experienced a slight loss (approximately 10%) of DON possibly due to the adsorption of organics onto the dialysis membrane, permeation of low molecular weight fractions, or biodegradation. Dialysis experiments using surface water spiked with different DIN/TDN ratios concluded that dialysis pretreatment leads to more accurate DON determination than no dialysis when DIN/TDN ratios exceed 0.6 mg of N/mg of N.

  1. Maintenance of employment on dialysis.

    Science.gov (United States)

    Rasgon, S; James-Rogers, A; Chemleski, B; Ledezma, M; Mercado, L; Besario, M; Trivedi, J; Miller, M; Dee, L; Pryor, L; Yeoh, H

    1997-04-01

    This article describes the components of a multidisciplinary effort focused on promoting, among other goals, continued employment during end-stage renal disease (ESRD) treatment. The education and guidance of the patient begin during the pre-ESRD period, intensify through dialysis treatment, and continue even through posttransplantation follow-up. Such focused programs support patients in retaining their usual lifestyle, staying in their current jobs where possible, and maximizing self-esteem and quality of life.

  2. Intraperitoneal pressure in peritoneal dialysis.

    Science.gov (United States)

    Pérez Díaz, Vicente; Sanz Ballesteros, Sandra; Hernández García, Esther; Descalzo Casado, Elena; Herguedas Callejo, Irene; Ferrer Perales, Cristina

    2017-07-21

    The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with "Y" system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10-16 cmH2O, intraperitoneal pressure should never exceed 18 cmH2O. With basal values that depend on body mass index, it increases 1-3 cmH2O/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Prophylactic dialysis in non-dialysis-dependent patients with renal failure after CABG

    Directory of Open Access Journals (Sweden)

    Roghayyeh Borji

    2014-03-01

    Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

  4. [Natural history of HBV in dialysis population].

    Science.gov (United States)

    Fabrizi, F; Martin, P; Lunghi, G; Ponticelli, C

    2004-01-01

    Dialysis patients remain at risk of acquiring hepatitis B virus (HBV) infection. The issue of the natural history of HBV among patients undergoing long-term dialysis remains unclear. Assessing the natural history of hepatitis B in patients on maintenance dialysis is problematic because of the unique characteristics of this population: serum aminotransferase activity is lower in dialysis patients compared with patients without renal disease; also, chronic hepatitis B has an insidious and prolonged natural history, and the competing mortality from complications of end-stage renal disease may obscure the long-term consequences of hepatitis B. HBV-related liver disease frequently runs an asymptomatic course in dialysis patients and the liver-related mortality in this population is very low; thus, the prognosis for chronic HBV infection in dialysis patients has been reported as benign. However, the frequency of liver cancer in dialysis patients appears higher than that observed in the general population, this has been related to a greater exposure to HBV/HCV. Cirrhosis is not a frequent comorbid condition in the dialysis population of industrialised countries, but the death rate for dialysis patients with cirrhosis is 35% higher than for those without it. In addition, it has been observed that liver disease remains a significant cause of mortality among HbsAg-positive carriers on dialysis in developing countries. The low viral load measured in dialysis patients with persistent HBsAg carriage could be accounted for by the relatively benign course of HBV-related liver disease in this population. Prospective clinical trials are under way to better define the virological features of HBV in the dialysis population.

  5. Protein binding studies with radiolabeled compounds containing radiochemical impurities. Equilibrium dialysis versus dialysis rate determination

    DEFF Research Database (Denmark)

    Honoré, B

    1987-01-01

    The influence of radiochemical impurities in dialysis experiments with high-affinity ligands is investigated. Albumin binding of labeled decanoate (97% pure) is studied by two dialysis techniques. It is shown that equilibrium dialysis is very sensitive to the presence of impurities resulting...

  6. Recovery of renal function in dialysis patients

    Directory of Open Access Journals (Sweden)

    Patlovany Matthew

    2003-10-01

    Full Text Available Abstract Background Although recovery of renal functions in dialysis dependent patients is estimated to be greater than 1%, there are no indicators that actually suggest such revival of renal function. Residual renal function in dialysis patients is unreliable and seldom followed. Therefore renal recovery (RR in dialysis dependent patients may remain unnoticed. We present a group of dialysis dependent patients who regained their renal functions. The aim of this project is to determine any indicators that may identify the recovery of renal functions in dialysis dependent patients. Methods All the discharges from the chronic dialysis facilities were identified. Among these discharges deaths, transplants, voluntary withdrawals and transfers either to another modality or another dialysis facility were excluded in order to isolate the patients with RR. The dialysis flow sheets and medical records of these patients were subsequently reviewed. Results Eight patients with a mean age of 53.8 ± 6.7 years (± SEM were found to have RR. Dialysis was initiated due to uremic symptoms in 6 patients and fluid overload in the remaining two. The patients remained dialysis dependent for 11.1 ± 4.2 months. All these patients had good urine output and 7 had symptoms related to dialysis. Their mean pre-initiation creatinine and BUN levels were 5.21 ± 0.6 mg/dl and 72.12 ± 11.12 mg/dl, respectively. Upon discontinuation, they remained dialysis free for 19.75 ± 5.97 months. The mean creatinine and BUN levels after cessation of dialysis were 2.85 ± 0.57 mg/dl and 29.62 ± 5.26 mg/dl, respectively, while the mean creatinine clearance calculated by 24-hour urine collection was 29.75 ± 4.78 ml/min. One patient died due to HIV complications. One patient resumed dialysis after nine months. Remaining continue to enjoy a dialysis free life. Conclusion RR must be considered in patients with good urine output and unresolved acute renal failure. Dialysis intolerance may be

  7. [The specific nutritionnal care in peritoneal dialysis].

    Science.gov (United States)

    Castrale, Cindy; Azar, Raymond; Piquet, Marie-Astrid; Lobbedez, Thierry

    2016-07-01

    Protein energy wasting is a major complication in peritoneal dialysis. It is leading to a poor quality of life and increasing mortality. Diagnosis must be early, according to criteria defined by the International society of renal nutrition and metabolism. It is necessary to appropriate the diagnostic tools with dialysis method. The nutritional care is difficult in peritoneal dialysis. Indeed, studies are limited and practical nutrition is complex. In this point of view, we propose to treat guidelines for protein energy wasting, in peritoneal dialysis patients. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  8. Nursing Experience of Strengthening Health Education and Education on Maintenance Hemodialysis Patients with Dialysis Interval Moisture Contro%强化健康宣教对维持性血透病人透析间期水分控制的护理分析

    Institute of Scientific and Technical Information of China (English)

    夏丽华

    2016-01-01

    Objective To observe the effect of intensive health education of nursing care of patients with hemodialysis dialysis water control effect. Methods From June 2013 to February 2016 in our hospital 120 cases of hemodialysis pa-tients with end-stage renal disease as the research object, randomly divided into the observation group (n=78) and con-trol group (n=42), respectively. To strengthen the health education and routine nursing, observation of cognitive level of the disease and hemodialysis and heart failure events during dialysis mortality and readmission rate and post dialysis capacity, hypertension, hypotension and muscle cramps occur. Results The observation group of patients after intensive health education, cognitive level of the disease and dialysis related knowledge (71.8%) was significantly higher than the control group (52.4%), death (1.3%) and readmission rate (6.4%) was significantly lower than the control group (4.8%, 9.5%), the differences were statistically significant (P< 0.05). The observation group capacity Hypertension (1.3%), hy-potension (1.3%), heart failure (0), and muscle cramps (0) occurrence rates were lower than that of the control group (7.1%, 2.4%, 4.8%, 2.4%), differences were statistically significant(P < 0.05). Conclusion Strengthen health education on maintenance hemodialysis patients during the period of hemodialysis water control effect is more ideal, more conducive to the body's water balance, reduce the complications of hemodialysis, it is worth of clinical application.%目的:探讨健康宣教护理对维持性血透病人透析间期水分控制的效果。方法选择2013年6月—2016年2月在该院进行血液透析的120例终末期肾病患者为研究对象,将其随机分成观察组(n=78)和对照组(n=42),分别采取强化健康宣教护理和常规护理,观察对疾病及血透的认知水平、透析期间死亡事件和再住院率以及透析后容量性高血压、心力衰竭、低血压和肌肉痉

  9. Fully automated dialysis system based on the central dialysis fluid delivery system.

    Science.gov (United States)

    Kawanishi, Hideki; Moriishi, Misaki; Sato, Takashi; Taoka, Masahiro

    2009-01-01

    The fully automated dialysis system (FADS) was developed as an improvement over previous patient monitors used in the treatment of hemodialysis, with the aim of standardizing and promoting labor-saving in such treatment. This system uses backfiltration dialysis fluid to perform priming, blood rinse back and rapid fluid replenishment, and causes guiding of blood into the dialyzer by the drainage pump for ultrafiltration. This requires that the dialysis fluid used be purified to a high level. The central dialysis fluid delivery system (CDDS) combines the process of the creation and supply of dialysis water and dialysis fluid to achieve a level of purity equivalent with ultrapure dialysis fluid. FADS has the further advantages of greater efficiency and streamlined operation, reducing human error and the risk of infection without requiring the storage or disposal of normal saline solution. The simplification of hemodialysis allows for greater frequency of dialysis or extended dialysis, enabling treatment to be provided in line with the patient's particular situation. FADS thus markedly improves the reliability, safety and standardization of dialysis procedures while ensuring labor-saving in these procedures, making it of particular utility for institutions dealing with dialysis on a large scale.

  10. Assessing of Dialysis Adequacy in Patients under Hemodialysis in Dialysis Department of Ekbatan Hospital in Hamadan

    Directory of Open Access Journals (Sweden)

    E. Nadi

    2003-10-01

    Full Text Available Determining reduction proportion of blood urea in patients under hemodialysis in dialysis department of Ekbatan hospital and comparison between obtained results and standard scales. This study was descriptive, cross - Sectional. In this study the number of 100 patient under dialysis in were evaluated and their blood samples were accumitated before and after dialysis and were transferred to the laboratory. Results were calculated by BUN formula, meanwhile the other parameters as, the time of dialysis, speed of blood circulation, percentage of filter clearance, patient weight before and after dialysis, blood pressure before and after dialysis, also evaluated and registered. To consider the obtained results from BUN calculations we found out that 10% of individuals have URR 65%. In that the results are in accord with standard scales, and revealed adequate dialysis. About 34% were near accepted range (55%-64%. The rest of individuals about 56% were lower than accepted URR.

  11. [Immigrants and dialysis: a survey in Piedmont].

    Science.gov (United States)

    Forneris, Giacomo; Boero, Roberto; Massara, Carlo; Quarello, Francesco

    2011-01-01

    The number of immigrants has been rapidly increasing in Italy in the last decade, with potentially profound effects on the national health care system. Yet, few data are available on the clinical and demographic features of these subjects, or on their need for nephrological care and dialysis treatment. A survey was conducted in 19 dialysis facilities of Piedmont (a northwestern Italian region) about immigrants on chronic dialysis treatment. Data on native country, administrative position, clinical and dialysis aspects were anonymously collected. Overall, 93 immigrant dialysis patients coming from 24 foreign countries were registered. Most of them were young (mean age 46∓14 years) and on extracorporeal treatment (87%); late referral (38%) or starting dialysis in emergency (17%) were common modalities of presentation. Glomerular (33%) or unknown (31%) nephropathies were the most representative causes of end stage renal disease. No difference in incidence of HCV, HBV and HIV compared with native Italian patients was observed. Notably, more than 50% of the immigrant patients had low-level knowledge of Italian. As regards administrative position, 69% were regular foreign citizens, 19% were temporary foreign workers, and 9% had a residence permit. Our survey confirms the existence of a young immigrant population on dialysis in Piedmont, whose social and relational problems are more challenging than clinical aspects and call for new organizational models to manage this growing population on dialysis.

  12. Acute Hydrothorax Complicating continuous Ambulatory Peritoneal Dialysis: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Kechrid Mohammad

    1999-01-01

    Full Text Available We describe here hydrothorax that occurred in a patient on continuous ambulatory peritoneal dialysis (CAPD and highlight the problems of diagnosis and management. A 48 years-old man with history of obstructive uropathy secondary to urolithiasis was stared on CAPD when he reached end-stage renal failure. Two months later, he was admitted with two days history of shortness of breath on exertion and dry cough increasing in supine position. Chest examination was suggestive of right sided pleural effusion confusion confirmed by chest X-ray. Radioisotope Technetium 99m labeled albumin instilled through the peritoneal catheter was detected in the right pleural fluid confirming the peritoneo-pleural leak. The peritoneal dialysis (PD was discontinued and the patient was switched to hemodialysis. The pleural effusion subsided and has not recurred for the following three years.

  13. The new Medicare PPS and home dialysis.

    Science.gov (United States)

    Curtis, Jim; Schatell, Dori

    2010-09-01

    Overall, we believe that bundling of payments to dialysis facilities is positive for home dialysis. The incentive for higher utilization of home therapies comes down to the fact that, with treatments for all modalities being paid at the same rate, providers will see that home modalities cost less than facility-based treatments. The adjustment for home training treatments is certainly helpful, but it is not incentive enough on its own. From our perspective, one of the biggest financial incentives for home dialysis and more frequent dialysis therapies is that these patients are statistically known to spend less time in the hospital, over time costing taxpayers and the ESRD Program less money. We will continue to encourage CMS to consider the overall cost implications of more frequent dialysis. We are hopeful that when hospitalization costs are accounted for, CMS will do even more to encourage the use of these modalities.

  14. Update on dialysis economics in the UK.

    Science.gov (United States)

    Sharif, Adnan; Baboolal, Keshwar

    2011-03-01

    The burgeoning population of patients requiring renal replacement therapy contributes a disproportionate strain on National Health Service resources. Although renal transplantation is the preferred treatment modality for patients with established renal failure, achieving both clinical and financial advantages, limitations to organ donation and clinical comorbidities will leave a significant proportion of patients with established renal failure requiring expensive dialysis therapy in the form of either hemodialysis or peritoneal dialysis. An understanding of dialysis economics is essential for both healthcare providers and clinical leaders to establish clinically efficient and cost-effective treatment modalities that maximize service provision. In light of changes to the provision of healthcare funds in the form of "Payment by Results," it is imperative for UK renal units to adopt clinically effective and financially accountable dialysis programs. This article explores the role of dialysis economics and implications for UK renal replacement therapy programs.

  15. The Correlation Analysis of Weight Change of Dialysis Interval Period and the Malnutrition in Maintenance Hemodialysis Patients%透析间期体重变化与透析患者营养状况的关系的临床研究

    Institute of Scientific and Technical Information of China (English)

    曲向阳; 张晓君

    2015-01-01

    目的:探讨透析间期体重增长(IDWG)对维持性血液透析(MHD)患者营养状况的影响并分析相关因素。方法:选取ESRD接受MHD患者71例,根据患者透析间期平均体重变化(IDWG)分两组:控制良好者为A组(平均IDWG%<3.5%),控制不良者为B组(平均IDWG%≥3.5%),分别检测每次透析间期体重增长(IDWG)、干体重(DW)、体重指数BMI、人体学指标、实验室指标。结果:观察1年后A、B两组DW、BMI比较差异有统计学意义,人体学指标比较差异有统计学意义,实验室指标比较HB、RBC、TC、TG、LPɑ、HCO-3、nPCR、SPKT/V、ALB、CRP差异有统计学意义(P<0.05);Ca、P、iPTH、BS、GHB比较差异无统计学意义。结论:血液透析患者营养不良的发生率较高,IDWG控制良好者可减少MHD患者营养不良的发生,控制不良者促进MHD患者营养不良的发生。%Objective: To explore the influence of the intermediate dialysis weight change of maintenance hemodialysis patients and analyze correlative factor of the malnutrition.Method: 71 patients with the end-stage renal disease who requiring maintenance hemodialysis were selected. All patients were divided two groups according to the intermediate dialysis weight change. To detect the indexes respectively. The dry weight (DW), intermediate dialysis weight growth, the change of DW and BMI anthropometric indicators.Result: There were statistically significant of the DW, BMI, between group A and B after 12 months later. There were statistically significant differences in HB, RBC, TC, TG, LPɑ, HCO-3, nPCR, SPKT/V, ALB, and CRP between group A and B, while there were no statistically significant differences in Ca, P, iPTH, BS, GHB.Conclusion: IDWG has advancing effect to the malnutrition of maintenance hemodialysis patients. Correlation with hypertension, hyperlipemia and chronic inflammation state could enhance malnutrition through hypertension

  16. Cell Damage, Antioxidant Status, and Cortisol Levels Related to Nutrition in Ski Mountaineering During a Two-Day Race

    Science.gov (United States)

    Diaz, Elena; Ruiz, Fatima; Hoyos, Itziar; Zubero, Jaime; Gravina, Leyre; Gil, Javier; Irazusta, Jon; Gil, Susana Maria

    2010-01-01

    The aim of this study was to measure the effect of nutrition on cell damage, antioxidant enzymes, and cortisol during a two-day ski mountaineering competition. Twenty-one male skiers participated in the study. Creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), alkaline phosphatase (AP), cortisol and C-reactive protein (CRP), glutathione peroxidase (GPx) and reductase activities (GR) and C-reactive protein (CRP) levels, total antioxidant status, and cortisol levels were measured in serum the day before and immediately after the race. Their diet was also analysed during the competition. Enzymes and cortisol levels significantly increased after the competition. CK and LDH and cortisol levels were negatively correlated to total energy, protein, and fat intake. Intake of vitamin A, B1, B2, B6 and niacin was negatively correlated to LDH and AP. A negative correlation was also found between CK activity and Na, Fe, and Zn intake. Cortisol levels were negatively correlated to the intake of vitamins C, B1 and B2, and niacin. A positive correlation was found between serum GPx and intake of energy, carbohydrates, proteins, A and B vitamins, and folic acid. Skiers with the lowest nutrient intake during the competition were the ones who showed greater cell damage and lower antioxidant enzyme activity and cortisol levels, which may impair performance and also cause injuries and accidents. Particularly, skiers should have high intakes of total energy, macronutrients, vitamins A and B, Na, Zn, and Fe in order to decrease the deleterious effect of strenuous exercise. Key points A two-day ski mountaineering race produced muscle cell damage and oxidative stress and an increase in cortisol levels. There was a marked insufficient intake of carbohydrates which has been shown to affect performance Those skiers with lowest nutrient intake showed greater cell damage, lower antioxidant

  17. Predictive Factors of Hospitalization and Dialysis Requirement in Alcohol Poisoning; a Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Ali Tagizadieh

    2015-02-01

    Full Text Available Introduction: Alcohol abuse is one of the health problems that all societies have involved with. Although in Iran the percent of alcohol consuming due to social and cultural preventions is lesser that other countries, its outcome and predictive factors are not accessible. Thus, this study was designed with the aim of determining the consequences of alcohol consuming and finding its effective factors in Tabriz. Method: This cross-sectional study has been done through September 2013 to July 2014 in Sina Hospital, Tabriz, Iran. All individuals with alcohol poisoning referred to the emergency department were included in the study. Demographic and clinical factors of patients, laboratory tests, dialysis and hospitalization in hospital wards were evaluated. Finally, independent effective factors for dialysis and hospitalization were assessed by using multivariate logistic regression. Results: At the end, 81(91.4% male patients with the mean age of 27.9±10.4 years were entered to the study. Ten (12.3% patients needed dialysis and 34 (42.0% were hospitalized. Increasing the serum creatinine level (OR-1.6; 95% Cl: 1.004-2.4; p-0.048 and time interval between consumption until referring to the emergency (OR-1.1; 95% Cl: 1.03-1.15; p-0.004 were the independent predictive factors of dialysis. Also, predictive agents of hospitalization included smoking (OR-3.4; 95% Cl: 1.6-5.5; p-0.01 and need to do dialysis (OR-7.9; 95% Cl: 5.4-10.5; p<0.001. Conclusion: In the present project 12.3% of patients needed dialysis. Increasing the serum creatinine and time interval between alcohol consuming until referring to the emergency were the most important predictive factors. In addition, the probability of hospitalization for smoking and dialyzed poisoned persons in hospital wards was more than other patients.

  18. Dialysis

    Science.gov (United States)

    ... chap 132. Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 133. Review Date 12/30/2014 Updated by: Deepak Sudheendra, ...

  19. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneal dialysis system and accessories. 876... Peritoneal dialysis system and accessories. (a) Identification. (1) A peritoneal dialysis system and... peritoneal dialysis, a source of dialysate, and, in some cases, a water purification mechanism. After...

  20. Recent Peritonitis Associates with Mortality among Patients Treated with Peritoneal Dialysis

    Science.gov (United States)

    Kemp, Anna; Clayton, Philip; Lim, Wai; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Wiggins, Kathryn J.; Bannister, Kym M.; Brown, Fiona G.; Johnson, David W.

    2012-01-01

    Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days. PMID:22626818

  1. The atrial fibrillation conundrum in dialysis patients.

    Science.gov (United States)

    De Vriese, An S; Caluwé, Rogier; Raggi, Paolo

    2016-04-01

    The burden of atrial fibrillation (AF) and the risk of stroke are high in dialysis patients. The decision to use anticoagulation rests heavily on effective risk stratification. Because both the pathophysiology of the disease and the response to therapy differ in dialysis, data from the general population cannot be extrapolated. The effect of vitamin K antagonists (VKAs) on the risk of stroke in dialysis patients with AF has not been studied in randomized trials. The available observational data provide contradictory results, reflecting differences in the degree of residual confounding, quality of international normalized ratio control, and stroke characterization. Dialysis patients have a high baseline bleeding risk. It remains unclear to what extent VKAs affect the overall bleeding propensity, but they may significantly increase the risk of intracerebral hemorrhage. Vascular calcifications are extremely prevalent in dialysis patients and independently associated with an adverse outcome. Vitamin K antagonists inhibit the activity of key anticalcifying proteins and may thus compound the risk of vascular calcification progression in dialysis. In the absence of evidence-based guidelines for anticoagulation in dialysis patients with AF, we provide recommendations to assist clinicians in individualized risk stratification. We further propose that new oral anticoagulants may have a better benefit-risk profile in dialysis patients than VKA, provided appropriate dose reductions are made. New oral anticoagulant may yield more on-target anticoagulation, reduce the risk of intracerebral bleeding, and not interfere with vascular calcification biology. Clinical trials with new oral anticoagulant in dialysis patients are eagerly awaited, to reveal whether these assumptions can be confirmed.

  2. Being-in-dialysis: The experience of the machine-body for home dialysis users.

    Science.gov (United States)

    Shaw, Rhonda

    2015-05-01

    New Zealand leads the world in rates of home dialysis use, yet little is known about the experience of home dialysis from the patient's perspective. This article contributes to the literature on the self-care of dialysis patients by examining the relevance of the concept of the machine-body and cyborg embodiment for the lived experience of people with end-stage renal failure. The article, which presents a discussion of 24 in-depth interviews undertaken between 2009 and 2012, shows that although dialysis therapy is disruptive of being and time, study participants experience home dialysis in terms of flexibility, control and independence. While they do not use the term machine-body as a descriptor, the concept resonates with felt experience. Data also indicate that positive experience of home dialysis is relative to socio-economic positioning and the lived relation of patients to others, necessitating further research to examine these factors. © The Author(s) 2014.

  3. Collagen markers in peritoneal dialysis patients

    DEFF Research Database (Denmark)

    Graff, J; Joffe, P; Fugleberg, S

    1995-01-01

    (PICP), aminoterminal propeptide of type III procollagen (PIIINP), and carboxyterminal telopeptide of type I collagen (ICTP)] were studied in 19 nondiabetic peritoneal dialysis patients. The absence of correlation between the mass appearance rates of the markers and the duration of dialysis treatment...... as well as the number of peritonitis episodes supports the concept that peritoneal dialysis does not cause persistent changes in the deposition and degradation rates of collagen. A correlation between the D/Pcreatinine 4 hr and the PICP mass appearance rates was found. Since it is unlikely...

  4. Dialysis technicians' perception of certification.

    Science.gov (United States)

    Williams, Helen F; Garbin, Margery

    2015-03-01

    The Nephrology Nursing Certification Commission initiated this research project to study the viewpoint of dialysis technicians regarding the value of certification. A national convenience sample was obtained using both paper-and-pencil and online forms of the survey instrument. Demographic characteristics were obtained concerning age, race, ethnicity, education, and future employment planning. Technicians' primary work settings, the roles they fill, and the types of certification they hold are described. Incentives offered by employers are considered to explore how they contribute to job satisfaction. Understanding the perceptions of technicians regarding the benefits of certification and the limitations of workplace incentives should enable employers to improve their recruitment and retention programs. Information obtained may offer a baseline for future observations of the characteristics of these significant and essential contributors to the nephrology workforce.

  5. Anxiety disorders in dialysis patients

    Directory of Open Access Journals (Sweden)

    Novaković Milan

    2007-01-01

    Full Text Available Introduction. Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. Material and Methods. This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN, and the control group included 405 patients with other diagnoses causing renal insufficiency (N18. The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. Results. Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural (c2 = 23.970 p<0.01; in the incidence of renal comorbidity (c2 = 23.970 p<0.01; familial renal comorbidity (c2 = 23.970 p<0.01; and migrations (c2 = 4.874 p<0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p<0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p<0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examination pointing to generalmental weakness. Conclusion. Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk. .

  6. CELL DAMAGE, ANTIOXIDANT STATUS, AND CORTISOL LEVELS RELATED TO NUTRITION IN SKI MOUNTAINEERING DURING A TWO-DAY RACE

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    Elena Diaz

    2010-06-01

    Full Text Available The aim of this study was to measure the effect of nutrition on cell damage, antioxidant enzymes, and cortisol during a two-day ski mountaineering competition. Twenty-one male skiers participated in the study. Creatine kinase (CK, aspartate aminotransferase (AST, alanine aminotransferase (ALT, ?-glutamyl transpeptidase (GGT, lactate dehydrogenase (LDH, alkaline phosphatase (AP, cortisol and C-reactive protein (CRP, glutathione peroxidase (GPx and reductase activities (GR and C-reactive protein (CRP levels, total antioxidant status, and cortisol levels were measured in serum the day before and immediately after the race. Their diet was also analysed during the competition. Enzymes and cortisol levels significantly increased after the competition. CK and LDH and cortisol levels were negatively correlated to total energy, protein, and fat intake. Intake of vitamin A, B1, B2, B6 and niacin was negatively correlated to LDH and AP. A negative correlation was also found between CK activity and Na, Fe, and Zn intake. Cortisol levels were negatively correlated to the intake of vitamins C, B1 and B2, and niacin. A positive correlation was found between serum GPx and intake of energy, carbohydrates, proteins, A and B vitamins, and folic acid. Skiers with the lowest nutrient intake during the competition were the ones who showed greater cell damage and lower antioxidant enzyme activity and cortisol levels, which may impair performance and also cause injuries and accidents. Particularly, skiers should have high intakes of total energy, macronutrients, vitamins A and B, Na, Zn, and Fe in order to decrease the deleterious effect of strenuous exercise

  7. Impact of advanced dialysis technology on the prevalence of dialysis-related amyloidosis in long-term maintenance dialysis patients.

    Science.gov (United States)

    Schiffl, Helmut

    2014-01-01

    Dialysis-related amyloidosis (DRA) is a unique type of amyloidosis (beta-2 microglobulin) predominantly in end-stage renal disease. Its clinical manifestations add to increased morbidity and reduced quality of life. There seems to be a relative risk reduction in DRA manifestations when hemodialysis (HD) patients are treated with advanced HD technology, but changes of the course of DRA are uncertain. The aim of our investigation was to evaluate the prevalence and severity of carpal tunnel syndrome (CTS) in long-term dialysis patients receiving either conventional or high-flux, online-produced ultrapure dialysis fluid. The cross-sectional study included 147 HD patients (at least 10 years). The definitive diagnosis of CTS was made histologically or by the coexistence of CTS with other radiological DRA manifestations (bone cysts, arthropathies). The two HD patient groups did not differ significantly in age at start of HD, gender, major co-morbid diseases, anuria, and dialysis vintage. The conventional HD group had significantly higher circulating beta-2 microglobulin and C-reactive protein (CRP) levels. The prevalence of DRA was 68% for the conventional HD group and 28% for the advanced HD group. Duration of dialysis treatment was the only significant risk factor for the development of clinical DRA manifestations in both study groups, but CTS, bone cysts, or arthropathies occurred significantly earlier in conventional HD patients. The prevalence and severity of DRA have decreased with advances in dialysis technology during the last two decades, although its occurrence is simply delayed.

  8. Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution

    OpenAIRE

    Hamasaki, Yoshifumi; Doi, Kent; Tanaka, Mototsugu; Kume, Haruki; Ishibashi, Yoshitaka; Enomoto, Yutaka; Fujita, Toshiro; Homma, Yukio; Nangaku, Masaomi; Noiri, Eisei

    2014-01-01

    Background Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical f...

  9. Laughter and humor therapy in dialysis.

    Science.gov (United States)

    Bennett, Paul N; Parsons, Trisha; Ben-Moshe, Ros; Weinberg, Melissa; Neal, Merv; Gilbert, Karen; Rawson, Helen; Ockerby, Cherene; Finlay, Paul; Hutchinson, Alison

    2014-01-01

    Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.

  10. Are Diuretics Underutilized in Dialysis Patients?

    Science.gov (United States)

    Trinh, Emilie; Bargman, Joanne M

    2016-09-01

    While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential benefits and few side effects. Moreover, when diuretics are used, optimal doses are not always prescribed. In peritoneal dialysis, the use of diuretics can improve volume status and minimize the need for higher glucose-containing solutions. In patients on haemodialysis, diuretics can help lessen interdialytic weight gain, resulting in decreased ultrafiltration rates and fewer episodes of intradialytic hypotension. This paper will review the mechanism of action of diuretics in patients with renal insufficiency, quantify the risk of side effects and elaborate on the potential advantages of diuretic use in peritoneal dialysis and hemodialysis patients with residual kidney function.

  11. A case of misplaced permacath dialysis catheter

    Directory of Open Access Journals (Sweden)

    Mohammed Arshad Ali

    2015-01-01

    Full Text Available Central venous placement using ultrasound has significantly reduced the complications associated with blind puncture. The central venous catheter can still get misplaced if it follows an anomalous route after appropriate puncture of desired vessel. We report a case of misplaced dialysis catheter into the accessory hemiazygos vein which resulted in a large hemothorax, and we recommend the routine use of a fluoroscope for placement of dialysis catheters so as to avoid serious complications.

  12. Transmission of HIV in dialysis centre.

    Science.gov (United States)

    Velandia, M; Fridkin, S K; Cárdenas, V; Boshell, J; Ramirez, G; Bland, L; Iglesias, A; Jarvis, W

    1995-06-01

    In August, 1993, 13 dialysis patients at one dialysis centre in Colombia, South America, were found to be HIV positive, and this prompted an epidemiological investigation. We carried out a cohort study of all dialysis centre patients during January, 1992 to December, 1993 (epidemic period) to determine risk factors for HIV seroconversion. Haemodialysis and medical records were reviewed, dialysis centre staff and surviving patients were interviewed, and dialysis practices were observed. Stored sera from all dialysis centre patients were tested for HIV antibody. 12 (52%) of 23 patients tested positive for HIV antibody by enzyme immunoassay and western blot during the epidemic period. Of the 23 tested, 9 (39%) converted from HIV antibody negative to positive (seroconverters) and 10 (44%) remained HIV negative (seronegatives). The HIV seroconversion rate was higher among patients dialysed at the centre while a new patient, who was HIV seropositive, was dialysed there (90% vs 0%; p dialysis centre reprocessed access needles, dialysers, and bloodlines (60% vs 0%). While 2 of 9 HIV seroconverters had had sex with prostitutes, none had received unscreened blood products or had other HIV risk factors. No surgical or dental procedures were associated with HIV seroconversion. Dialysers were reprocessed separately with 5% formaldehyde and were labelled for use on the same patient. Access needles were reprocessed by soaking them in a common container with a low-level disinfectant, benzalkonium chloride; 4 pairs of needles were placed in one pan creating the potential for cross-contamination or use of one patient's needles on another patient. HIV transmission at the dialysis centre was confirmed. Improperly reprocessed patient-care equipment, most probably access needles, is the likely mechanism of transmission. This outbreak was discovered by accident and similar transmission may be occurring in many other countries where low-level disinfectants are used to sterilise critical

  13. Peritoneal Dialysis Registry With 2012 Survey Report.

    Science.gov (United States)

    Hasegawa, Takeshi; Nakai, Shigeru; Moriishi, Misaki; Ito, Yasuhiko; Itami, Noritomo; Masakane, Ikuto; Hanafusa, Norio; Taniguchi, Masatomo; Hamano, Takayuki; Shoji, Tetsuo; Yamagata, Kunihiro; Shinoda, Toshio; Kazama, Junichiro; Watanabe, Yuzo; Shigematsu, Takashi; Marubayashi, Seiji; Morita, Osamu; Wada, Atsushi; Hashimoto, Seiji; Suzuki, Kazuyuki; Kimata, Naoki; Wakai, Kenji; Fujii, Naohiko; Ogata, Satoshi; Tsuchida, Kenji; Nishi, Hiroshi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu; Nakamoto, Hidetomo

    2015-12-01

    Since 2009, the peritoneal dialysis (PD) registry survey has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this report, the current status of PD patients is presented on the basis of the results of the survey conducted at the end of 2012. The subjects were PD patients who lived in Japan and participated in the 2012 survey. Descriptive analysis of various items was performed, which included the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the rates of peritonitis and catheter exit-site infection. From the results of the facility survey in 2012, the number of PD patients was 9514, a decrease of 128 from 2011. Among the entire dialysis patient population, 3.1% were PD patients, a decrease of 0.1%. Among the studied patients, 347 had a peritoneal catheter and underwent peritoneal lavage, 175 were started on PD in 2012 but introduced to other blood purification methods in the same year, and 1932 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with PD vintage: vintage of ≥2 years. The mean rate of peritonitis was 0.22 per patient per year. The mean rate of catheter exit-site infections was 0.36 per patient per year.

  14. Iron Treatment Strategies in Dialysis-Dependent CKD.

    Science.gov (United States)

    Pandey, Richa; Daloul, Reem; Coyne, Daniel W

    2016-03-01

    Iron deficiency is common in patients on chronic dialysis, and most require iron-replacement therapy. In addition to absolute iron deficiency, many patients have functional iron deficiency as shown by a suboptimal response to the use of erythropoietin-stimulating agents. Both absolute and functional iron-deficiency anemia have been shown to respond to intravenous (IV) iron replacement. Although parenteral iron is an efficacious method and superior to standard doses of oral iron in patients on hemodialysis, there are ongoing safety concerns about repeated exposure potentially enhancing infection risk and cardiovascular disease. Each IV iron product is composed of an iron core with a carbohydrate shell. The avidity of iron binding and the type of carbohydrate shell play roles in the safe maximal dose and the frequency and severity of acute infusion reactions. All IV iron products are taken up into the reticuloendothelial system where the shell is metabolized and the iron is stored within tissue ferritin or exported to circulating transferrin. IV iron can be given as large intermittent doses (loading therapy) or in smaller doses at frequent intervals (maintenance dosing regimen). Limited trial data and observational data suggest that a maintenance dosing regimen is more efficacious and possibly safer than loading therapy. There is no consensus regarding the preferred method of iron repletion in patients on peritoneal dialysis, although small studies comparing oral and parenteral iron regimens in these patients have shown the latter to be more efficacious. Use of IV iron in virtually all hemodialysis and many peritoneal dialysis patients remains the standard of care.

  15. [Dialysis adequacy and Kt/V].

    Science.gov (United States)

    Formica, Marco; Bosticardo, Gianmario

    2011-01-01

    Fractional clearance of urea to quantify the adequacy of dialysis was introduced in the late 1980s to allow nephrologists to personalize hemodialysis treatment, assess its effectiveness (dose), and create an index that would represent the concept of adequate dialysis. Since then, the number of nephrologists really involved in this novelty has been rather small, while the majority have been using the new instrument more or less uncritically. At the same time, the dialysis technology has evolved: the extracorporeal techniques have become more diversified, dialyzers have been transformed in terms of materials, hydraulic permeability and purification efficiency, and treatment schedules have been modified in terms of duration and frequency. The purpose of this paper is to evaluate, at a distance of about 30 years, the validity of the control parameter of dialysis - Kt/V - in 2010. In essence, the authors claim that Kt/V is of marginal utility in the quantification of traditional dialysis, while it is wholly inappropriate for frequent or long-term treatment schemes. We maintain that the calculation of Kt/V is still a tool to be used - also recommended by international guidelines - at least until the validation of new and more efficacious solutions, in order to avoid ineffective dialysis sessions (in terms of dose for small molecules), although it does not provide any certainty of a fully adequate performance in terms of reduced morbidity and mortality.

  16. The use of complementary and alternative medicine products in preceding two days among Finnish parents - a population survey

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    Hämeen-Anttila Katri P

    2011-11-01

    Full Text Available Abstract Background The use of complementary and alternative medicines (CAM has been extensively studied globally among adult and paediatric populations. Parents, as a group, had not been studied to assess their knowledge and attitude to CAM and general medicine use. This study is necessary since parents' attitude to medicine use is known to influence their child's attitude to medicine use later in life. We therefore aim to assess the extent and types of CAM use among Finnish parents, and to determine the factors that promote the CAM use. Also, we aim to determine parents' attitude to general medicine use. Methods Children less than 12 years old, as of spring 2007, were identified from the database of the Finnish Population Register Centre and were selected by random sampling. The parents of these children were identified and a questionnaire was sent to them. Only the parent who regularly takes care of the child's medicine was requested to fill the questionnaire. Cross-tabulations and Chi-square test were used to determine the associations between categorical variables. CAMs were defined as natural products that are not registered as medicines, such as homeopathic preparations, dietary food supplements, and traditional medicinal products. Results The response rate of the survey was 67% (n = 4032. The use of CAM was 31% in the preceding two days. The most commonly used CAM products were vitamins and minerals, followed by fish oils and fatty acids. Prescription and OTC medicines were used concomitantly with CAM by one-third of the parents. CAM was frequently used by parents over 30 years (33%, female parents (32%, highly educated parents (35%, and parents with high monthly net income (3000-3999 euros, 34%. The users of CAM had more negative attitudes towards medicines than non-users of CAM. Conclusions Our findings are in accordance with those of previous studies that women over 30 years of age with a high education and income typically use CAMs

  17. Interval arithmetic in calculations

    Science.gov (United States)

    Bairbekova, Gaziza; Mazakov, Talgat; Djomartova, Sholpan; Nugmanova, Salima

    2016-10-01

    Interval arithmetic is the mathematical structure, which for real intervals defines operations analogous to ordinary arithmetic ones. This field of mathematics is also called interval analysis or interval calculations. The given math model is convenient for investigating various applied objects: the quantities, the approximate values of which are known; the quantities obtained during calculations, the values of which are not exact because of rounding errors; random quantities. As a whole, the idea of interval calculations is the use of intervals as basic data objects. In this paper, we considered the definition of interval mathematics, investigated its properties, proved a theorem, and showed the efficiency of the new interval arithmetic. Besides, we briefly reviewed the works devoted to interval analysis and observed basic tendencies of development of integral analysis and interval calculations.

  18. The impact of travel time on geographic distribution of dialysis patients.

    Science.gov (United States)

    Kashima, Saori; Matsumoto, Masatoshi; Ogawa, Takahiko; Eboshida, Akira; Takeuchi, Keisuke

    2012-01-01

    The geographic disparity of prevalence rates among dialysis patients is unclear. We evaluate the association between travel time to dialysis facilities and prevalence rates of dialysis patients living in 1,867 census areas of Hiroshima, Japan. Furthermore, we study the effects of geographic features (mainland or island) on the prevalence rates and assess if these effects modify the association between travel time and prevalence. The study subjects were all 7,374 people that were certified as the "renal disabled" by local governments in 2011. The travel time from each patient to the nearest available dialysis facility was calculated by incorporating both travel time and the capacity of all 98 facilities. The effect of travel time on the age- and sex-adjusted standard prevalence rate (SPR) and 95% confidence intervals (CIs) at each census area was evaluated in two-level Poisson regression models with 1,867 census areas (level 1) nested within 35 towns or cities (level 2). The results were adjusted for area-based parameters of socioeconomic status, urbanity, and land type. Furthermore, the SPR of dialysis patients was calculated in each specific subgroup of population for travel time, land type, and combination of land type and travel time. In the regression analysis, SPR decreased by 5.2% (95% CI: -7.9--2.3) per 10-min increase in travel time even after adjusting for potential confounders. The effect of travel time on prevalence was different in the mainland and island groups. There was no travel time-dependent SPR disparity on the islands. The SPR among remote residents (>30 min from facilities) in the mainland was lower (0.77, 95% CI: 0.71-0.85) than that of closer residents (≤ 30 min; 0.95, 95% CI: 0.92-0.97). The prevalence of dialysis patients was lower among remote residents. Geographic difficulties for commuting seem to decrease the prevalence rate.

  19. Restless legs syndrome in patients on dialysis

    Directory of Open Access Journals (Sweden)

    Al-Jahdali Hamdan

    2009-01-01

    Full Text Available Restless legs syndrome (RLS is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG. This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH, Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC, Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG′s RLS Questionnaire (RLSQ. Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM, coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively. Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS (P= < 0.001 and 0.001, respectively. Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis

  20. Restless legs syndrome in patients on dialysis.

    Science.gov (United States)

    Al-Jahdali, Hamdan H; Al-Qadhi, Waleed A; Khogeer, Haithm A; Al-Hejaili, Fayez F; Al-Ghamdi, Saeed M; Al Sayyari, Abdullah A

    2009-05-01

    Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG's RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 +/- 17.2 years and mean duration on dialysis 40.4 +/- 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and

  1. Is dialysis modality a factor in the survival of patients initiating dialysis after kidney transplant failure?

    Science.gov (United States)

    Perl, Jeffrey; Dong, James; Rose, Caren; Jassal, Sarbjit Vanita; Gill, John S

    2013-01-01

    Kidney transplant failure (TF) is among the leading causes of dialysis initiation. Whether survival is similar for patients treated with peritoneal dialysis (PD) and with hemodialysis (HD) after TF is unclear and may inform decisions concerning dialysis modality selection. Between 1995 and 2007, 16 113 adult dialysis patients identified from the US Renal Data System initiated dialysis after TF. A multivariable Cox proportional hazards model was used to evaluate the impact of initial dialysis modality (1 865 PD, 14 248 HD) on early (1-year) and overall mortality in an intention-to-treat approach. Compared with HD patients, PD patients were younger (46.1 years vs 49.4 years, p data suggest that increased initial use of PD among patients returning to dialysis after TF may be associated with improved outcomes, except among patients with a higher BMI and those who initiate dialysis at lower levels of eGFR. The reasons behind the inferior late survival seen in PD patients are unclear and require further study.

  2. Thiazolidinediones and Risk of Long-Term Dialysis in Diabetic Patients with Advanced Chronic Kidney Disease: A Nationwide Cohort Study.

    Directory of Open Access Journals (Sweden)

    Yu-Hsin Chen

    Full Text Available Thiazolidinediones (TZDs reduce urinary albumin excretion and proteinuria in diabetic nephropathy. The effect of TZDs on hard renal outcome in diabetic patients with chronic kidney disease (CKD is unknown. We investigate the association of TZDs and risk of long-term dialysis or death in diabetic patients with advanced CKD. The nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. From January 2000 to June 2009, 12350 diabetic patients with advanced CKD (serum creatinine levels greater than 6 mg/dL but not yet receiving renal replacement therapy were selected for the study. We used multivariable Cox regression models and a propensity score-based matching technique to estimate hazard ratios (HRs for development of long-term dialysis and the composite outcome of long-term dialysis or death for TZD users (n=1224 as compared to nonusers (n=11126. During a median follow-up of 6 months, 8270 (67.0% patients required long-term dialysis and 2593 (21.0% patients died before starting long-term dialysis. Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86 and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91. The results were consistent across most patient subgroups. Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death. Further randomized controlled studies are required to validate this association.

  3. Serum Indoxyl Sulfate Associates with Postangioplasty Thrombosis of Dialysis Grafts.

    Science.gov (United States)

    Wu, Chih-Cheng; Hsieh, Mu-Yang; Hung, Szu-Chun; Kuo, Ko-Lin; Tsai, Tung-Hu; Lai, Chao-Lun; Chen, Jaw-Wen; Lin, Shing-Jong; Huang, Po-Hsun; Tarng, Der-Cherng

    2016-04-01

    Hemodialysis vascular accesses are prone to recurrent stenosis and thrombosis after endovascular interventions.In vitro data suggest that indoxyl sulfate, a protein-bound uremic toxin, may induce vascular dysfunction and thrombosis. However, there is no clinical evidence regarding the role of indoxyl sulfate in hemodialysis vascular access. From January 2010 to June 2013, we prospectively enrolled patients undergoing angioplasty for dialysis access dysfunction. Patients were stratified into tertiles by baseline serum indoxyl sulfate levels. Study participants received clinical follow-up at 6-month intervals until June 2014. Primary end points were restenosis, thrombosis, and failure of vascular access. Median follow-up duration was 32 months. Of the 306 patients enrolled, 262 (86%) had symptomatic restenosis, 153 (50%) had access thrombosis, and 25 (8%) had access failure. In patients with graft access, free indoxyl sulfate tertiles showed a negative association with thrombosis-free patency (thrombosis-free patency rates of 54%, 38%, and 26% for low, middle, and high tertiles, respectively;P=0.001). Patients with graft thrombosis had higher free and total indoxyl sulfate levels. Using multivariate Cox regression analysis, graft thrombosis was independently predicted by absolute levels of free indoxyl sulfate (hazard ratio=1.14;P=0.01) and free indoxyl sulfate tertiles (high versus low, hazard ratio=2.41;P=0.001). Results of this study provide translational evidence that serum indoxyl sulfate is a novel risk factor for dialysis graft thrombosis after endovascular interventions.

  4. Achieving more frequent and longer dialysis for the majority: wearable dialysis and implantable artificial kidney devices.

    Science.gov (United States)

    Fissell, William H; Roy, Shuvo; Davenport, Andrew

    2013-08-01

    The long-term survival for many chronic kidney failure patients who remain treated by dialysis in economically advanced countries remains similar to that of those with solid-organ malignancy, despite a disproportionate amount of health-care expenditure. As such, the current paradigm of three times weekly in-center hemodialysis for 4 h or shorter sessions needs to change to improve patient outcomes. Although more frequent and longer dialysis sessions have been reported to improve cardiovascular risk surrogates and short-term outcomes, these options are only practically available to a very small fraction of the total dialysis population. As such, radically new approaches are required to improve patient outcomes and quality of life for the majority of dialysis patients. Currently, two different approaches are being developed, wearable devices based on current dialysis techniques and more futuristic implantable devices modeled on the natural nephron.

  5. Optimization of dialysis catheter function.

    Science.gov (United States)

    Gallieni, Maurizio; Giordano, Antonino; Rossi, Umberto; Cariati, Maurizio

    2016-03-01

    Central venous catheters (CVCs) are essential in the management of hemodialysis patients, but they also carry unintended negative consequences and in particular thrombosis and infection, adversely affecting patient morbidity and mortality. This review will focus on the etiology, prevention, and management of CVC-related dysfunction, which is mainly associated with inadequate blood flow. CVC dysfunction is a major cause of inadequate depuration. Thrombus, intraluminal and extrinsic, as well as fibrous connective tissue sheath (traditionally indicated as fibrin sheath) formation play a central role in establishing CVC dysfunction. Thrombolysis with urokinase or recombinant tissue plasminogen activator (rTPA) can be undertaken in the dialysis unit, restoring adequate blood flow in most patients, preserving the existing catheter, and avoiding an interventional procedure. If thrombolytics fail, mainly because of the presence of fibrous connective tissue sheath, catheter exchange with fibrin sheath disruption may be successful and preserve the venous access site. Prevention of CVC dysfunction is important for containing costly pharmacologic and interventional treatments, which also affect patients' quality of life. Prevention is based on the use of anticoagulant and/or thrombolytic CVC locks, which are only partially effective. Chronic oral anticoagulation with warfarin has also been proposed, but its use for this indication is controversial and its overall risk-benefit profile has not been clearly established.

  6. [Focusing on peritoneal dialysis adequacy].

    Science.gov (United States)

    Issad, Belkacem; Durand, Pierre-Yves; Siohan, Pascale; Goffin, Eric; Cridlig, Joëlle; Jean, Guillaume; Ryckelynck, Jean-Philippe; Arkouche, W; Bourdenx, J-P; Cridlig, J; Dallaporta, B; Fessy, H; Fischbach, M; Giaime, P; Goffin, E; Issad, B; Jean, G; Joly, D; Mercadal, L; Poux, J-M; Ryckelynck, J-P; Siohan, P; Souid, M; Toledano, D; Verger, C; Vigeral, P; Uzan, M

    2013-11-01

    The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane. Copyright © 2013. Published by Elsevier SAS.

  7. [Cost of dialysis in France].

    Science.gov (United States)

    Zambrowski, Jean-Jacques

    2016-04-01

    According to latest data published by the French health authority (HAS), nearly 74,000 French patients in end-stage chronic renal disease are following a replacement therapy. They were 61,000 in 2007, amounting to a cost of 4 billions euros for public health insurance. The cost varies depending on the age and comorbidities. Continuous ambulatory peritoneal dialysis is the cheapest mode of treatment, while the heavy haemodialysis centres costs are close to twice as expensive. But these two different treatments are - a priori - not applied for the same patients in terms of level of severity of disease. Moreover, associated costs, medical treatment, transportation, etc. are to be taken into account, as well as losses of income for patients facing major job difficulties. As recommended by HAS experts, it will be important to regularly conduct surveys allowing a regular economic assessment of the various modes of financial healthcare for end-stage chronic renal disease. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  8. Water channels in peritoneal dialysis.

    Science.gov (United States)

    Devuyst, Olivier

    2010-01-01

    Peritoneal dialysis involves diffusive and convective transports and osmosis through the highly vascularized peritoneal membrane. Several lines of evidence have demonstrated that the water channel aquaporin-1 (AQP1) corresponds to the ultrasmall pore predicted by the modelization of peritoneal transport. Proof-of-principle studies have shown that up-regulation of the expression of AQP1 in peritoneal capillaries is reflected by increased water permeability and ultrafiltration, without affecting the osmotic gradient and the permeability for small solutes. Inversely, studies in Aqp1 mice have shown that haploinsufficiency in AQP1 is reflected by significant attenuation of water transport. Recent studies have identified lead compounds that could act as agonists of aquaporins, as well as putative binding sites and potential mechanisms of gating the water channel. By modulating water transport, these pharmacological agents could have clinically relevant effects in targeting specific tissues or disease states. These studies on the peritoneal membrane also provide an experimental framework to investigate the role of water channels in the endothelium and various cell types.

  9. The Association between Peritoneal Dialysis Modality and Peritonitis

    Science.gov (United States)

    Johnson, David W.; McDonald, Stephen P.; Boudville, Neil; Borlace, Monique; Badve, Sunil V.; Sud, Kamal; Clayton, Philip A.

    2014-01-01

    Background and objectives There is conflicting evidence comparing peritonitis rates among patients treated with continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). This study aims to clarify the relationship between peritoneal dialysis (PD) modality (APD versus CAPD) and the risk of developing PD-associated peritonitis. Design, setting, participants, & measurements This study examined the association between PD modality (APD versus CAPD) and the risks, microbiology, and clinical outcomes of PD-associated peritonitis in 6959 incident Australian PD patients between October 1, 2003, and December 31, 2011, using data from the Australia and New Zealand Dialysis and Transplant Registry. Median follow-up time was 1.9 years. Results Patients receiving APD were younger (60 versus 64 years) and had fewer comorbidities. There was no association between PD modality and time to first peritonitis episode (adjusted hazard ratio [HR] for APD versus CAPD, 0.98; 95% confidence interval [95% CI], 0.91 to 1.07; P=0.71). However, there was a lower hazard of developing Gram-positive peritonitis with APD than CAPD, which reached borderline significance (HR, 0.90; 95% CI, 0.80 to 1.00; P=0.05). No statistically significant difference was found in the risk of hospitalizations (odds ratio, 1.12; 95% CI, 0.93 to 1.35; P=0.22), but there was a nonsignificant higher likelihood of 30-day mortality (odds ratio, 1.33; 95% CI, 0.93 to 1.88; P=0.11) at the time of the first episode of peritonitis for patients receiving APD. For all peritonitis episodes (including subsequent episodes of peritonitis), APD was associated with lower rates of culture-negative peritonitis (incidence rate ratio [IRR], 0.81; 95% CI, 0.69 to 0.94; P=0.002) and higher rates of gram-negative peritonitis (IRR, 1.28; 95% CI, 1.13 to 1.46; P=0.01). Conclusions PD modality was not associated with a higher likelihood of developing peritonitis. However, APD was associated with a borderline

  10. Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period.

    Science.gov (United States)

    Hildebrand, Ainslie M; Liu, Kuan; Shariff, Salimah Z; Ray, Joel G; Sontrop, Jessica M; Clark, William F; Hladunewich, Michelle A; Garg, Amit X

    2015-12-01

    Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997-2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes.

  11. Impact on peritoneal membrane of use of icodextrin-based dialysis solution in peritoneal dialysis patients.

    Science.gov (United States)

    Moriishi, Misaki; Kawanishi, Hideki; Tsuchiya, Shinichiro

    2006-01-01

    The usefulness of icodextrin-containing peritoneal dialysis (PD) solution for the management of body fluid and blood pressure has been reported. However, icodextrin PD solution is a foreign solution in the body, and the possible induction of intraperitoneal inflammation has been reported. In this study, we investigated at 6-month intervals the influence of icodextrin solution on peritoneal permeability and inflammatory reactions in patients in whom glucose solution had been changed to icodextrin solution for the overnight dwell. We enrolled 9 anuric PD patients (5 men, 4 women) of mean age 58 +/- 5.9 years (range: 45.6-64.8 years) into the study. The patients' mean duration of PD was 61.9 +/- 42 months (range: 6.7-142.5 months). The cause of end-stage renal disease was chronic glomerulonephritis in all patients. For evaluation ofperitoneal permeability, we performed peritoneal equilibration tests (PETs) immediately after an overnight dwell and determined the dialysate-to-plasma ratios of creatinine (D/P Cr), beta2-microglobulin (D/P beta2m), albumin (D/P Alb), immunoglobulin G (D/P IgG), and alpha2-macroglobulin (D/P alpha2m). We also measured interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) in overnight effluent as indices of inflammation and of the fibrinolysis-coagulation system. The evaluation was performed every 6 months for 24 months. The FDPs in effluent increased significantly at 6 months after the change to icodextrin solution, and IL-6 tended to increase. The D/P beta2m, D/P Alb, D/P IgG, and D/P alpha2m all significantly increased in the course of follow-up. In the PETs, the D/P Cr increased slightly, but the change was nonsignificant. At 30 months after the change to icodextrin solution, 1 patient was diagnosed as having a risk of encapsulating peritoneal sclerosis (pre-EPS). In this patient, rapid increases in IL-6, D/P Cr and macromolecular and small molecular D/P by PET were noted after the change to icodextrin solution. Steroids were

  12. Quasi-two-day wave in an unstable summer atmosphere - some numerical results on excitation and propagation

    Directory of Open Access Journals (Sweden)

    E. G. Merzlyakov

    2004-06-01

    Full Text Available Based on numerical calculations we demonstrate that small changes in the smooth climatological background atmosphere may lead to an unstable mean zonal wind distribution in the summer middle atmosphere. We relate these changes to small ones because locations and power of the main circulation structures are conserved, except for the acceleration of the easterly jet in the stratosphere/mesosphere. The instability forces oscillations propagating westward with a period of about 2 days and zonal wave numbers s=3 and/or 4. There are variations in the mean zonal wind distribution due to the excitation and transient propagation of these waves, and the numerical results correspond to features of these variations observed in experimental studies. The growing waves tend to remove the source of excitation. This process is effective enough to reduce the strong easterly jet and to remove the strong negative gradient of the zonal mean potential vorticity in the region of the instability. Therefore, when these parameters are calculated as mean values over a long time interval, the obtained values are too small to provide the instability. Strong 2-day waves, in turn, are unstable and can generate secondary waves with longer periods and lower zonal wave numbers. This effect is only significant for extremely strong 2-day waves. Another process is found to be more effective to produce secondary waves. We demonstrated that the 2-day wave with s=3 forced by nonlinear interaction between the 10-14 day planetary waves and the 2-day wave of zonal wave number 4 is unstable. This wave instability generates secondary waves with amplitudes that are large enough to be observed by ground-based radars, for example.

  13. Sexual function in women receiving maintenance dialysis.

    Science.gov (United States)

    Seethala, Srikanth; Hess, Rachel; Bossola, Maurizio; Unruh, Mark L; Weisbord, Steven D

    2010-01-01

    While substantial attention has been paid to the issue of sexual dysfunction in men on chronic dialysis, less is known about this problem in women with end-stage renal disease. We sought to assess sexual dysfunction in women on chronic dialysis and determine whether patients discuss this problem with their providers and receive treatment. We prospectively enrolled women receiving chronic hemodialysis or peritoneal dialysis in Pittsburgh, PA. We asked patients to complete the 19-item Female Sexual Function Index (FSFI) to assess sexual function and a 5-item survey that assessed whether patients had discussed sexual dysfunction with their providers and/or received treatment for this problem in the past. We enrolled 66 patients; 59 (89%) on hemodialysis and 7 (11%) on peritoneal dialysis. All patients completed the FSFI, of whom 53 (80%) had FSFI scores <26.55, consistent with the presence of sexual dysfunction. Of 37 patients who were married or residing with a significant other, 27 (73%) had sexual dysfunction. Among 24 participants who reported having been sexually active over the previous 4 weeks, 11 (46%) had sexual dysfunction. Only 21% of patients with sexual dysfunction had discussed this problem with their gynecologist, renal or primary provider, and 3 (6%) reported having received treatment. Sexual dysfunction is common in women on dialysis, even among patients who are married or residing with a significant other and those who are sexually active. However, few women discuss this issue with their providers or receive treatment.

  14. Big Boss Interval Games

    NARCIS (Netherlands)

    Alparslan-Gok, S.Z.; Brânzei, R.; Tijs, S.H.

    2008-01-01

    In this paper big boss interval games are introduced and various characterizations are given. The structure of the core of a big boss interval game is explicitly described and plays an important role relative to interval-type bi-monotonic allocation schemes for such games. Specifically, each element

  15. Peritoneal dialysis in developing countries.

    Science.gov (United States)

    Nayak, K S; Prabhu, M V; Sinoj, K A; Subhramanyam, S V; Sridhar, G

    2009-01-01

    Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 billion and the two fastest growing economies worldwide. A holistic approach to tackle the issues in the developing countries, which may vary from region to region, is critical in popularizing PD and establishing PD as the first-choice RRT for ESRD. At our center, we have been pursuing a 'PD first' policy and promoting PD as the therapy of choice for various situations in the management of renal failure. We use certain novel strategies, which we hope can help PD centers in other developing countries working under similar constraints. The success of a PD program depends on a multitude of factors that are interlinked and inseparable. Each program needs to identify its strengths, special circumstances, and deficiencies, and then to strategize accordingly. Ultimately, teamwork is the 'mantra' for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program.

  16. Dialysis Patients May Walk Their Way to Better Health

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_162312.html Dialysis Patients May Walk Their Way to Better Health ... just be steps away for people on kidney dialysis, a new study suggests. A simple program that ...

  17. Thyroid Problems May Make Things Worse for Dialysis Patients

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167174.html Thyroid Problems May Make Things Worse for Dialysis Patients ... 2017 THURSDAY, July 13, 2017 (HealthDay News) -- Poor thyroid function may diminish kidney dialysis patients' health and ...

  18. Administration of calcimimetics after dialysis: Same effectiveness, better gastrointestinal tolerability

    Directory of Open Access Journals (Sweden)

    Vicent Esteve Simo

    2015-07-01

    Conclusions: Post-dialysis use of calcimimetic was effective in secondary hyperparathyroidism control, improved gastrointestinal tolerability and ameliorated patients’ satisfaction. Based on our findings, post-dialysis use of calcimimetics should be considered in selected patients with low therapeutic compliance.

  19. Institutional and familial cost of patients in continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Enrique Villarreal-Ríos

    2014-07-01

    Full Text Available Objective: to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis. Methods: a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151 was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals. Results: the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35. Conclusion: the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family.

  20. Encapsulating Peritoneal Sclerosis - A rare and serious complication of peritoneal dialysis: Case series.

    Science.gov (United States)

    Mihalache, O; Bugă, C; Doran, H; Catrina, E; Bobircă, F; Pătrașcu, T

    2014-01-01

    Encapsulating peritoneal sclerosis is a pathological entity mainly associated with peritoneal dialysis (PD). The clinical syndrome is characterized by various degrees of intestinal obstruction due to thickening, sclerosis and calcification of peritoneum resulting in the encapsulation and cocooning of the bowel. It is a rare but potentially devastating complication associated with a considerable morbidity and mortality. Cases of encapsulating peritoneal sclerosis (EPS), diagnosed in the Surgical Clinic of "Cantacuzino" Hospital, between 2007 and 2014 were retrospectively reviewed. During this interval, 432 surgical interventions related to peritoneal dialysis were performed: 306 peritoneal access interventions and 124 complications, of which 15 patients with EPS. In all but two cases, the EPS diagnostic was established at the time of the surgical intervention addressed to other complication or pathology. Moreover, in 2 of the 15 patients the diagnostic was established approximately 5 months after PD was discontinued, and, in one of these patients at the time of the extraction of the dialysis catheter. 12 of 15 patients were diabetic. Most patients had a history of multiple peritonitis episodes. All the patients required the passing from peritoneal dialysis to hemodialysis. There were 4 deaths (26,6%) of which one was around two months from the diagnosis. The timely diagnosis of the condition and the appropriate phase-specific treatment is of utmost importance in EPS. In advanced stages, the surgical intervention performed by a well-trained team could achieve good long-term results.

  1. Encapsulating Peritoneal Sclerosis – A rare and serious complication of peritoneal dialysis: Case series

    Science.gov (United States)

    Mihalache, O; Bugă, C; Doran, H; Catrina, E; Bobircă, F; Pătrașcu, T

    2014-01-01

    Introduction. Encapsulating peritoneal sclerosis is a pathological entity mainly associated with peritoneal dialysis (PD). The clinical syndrome is characterized by various degrees of intestinal obstruction due to thickening, sclerosis and calcification of peritoneum resulting in the encapsulation and cocooning of the bowel. It is a rare but potentially devastating complication associated with a considerable morbidity and mortality. Materials and methods. Cases of encapsulating peritoneal sclerosis (EPS), diagnosed in the Surgical Clinic of “Cantacuzino” Hospital, between 2007 and 2014 were retrospectively reviewed. During this interval, 432 surgical interventions related to peritoneal dialysis were performed: 306 peritoneal access interventions and 124 complications, of which 15 patients with EPS. Results. In all but two cases, the EPS diagnostic was established at the time of the surgical intervention addressed to other complication or pathology. Moreover, in 2 of the 15 patients the diagnostic was established approximately 5 months after PD was discontinued, and, in one of these patients at the time of the extraction of the dialysis catheter. 12 of 15 patients were diabetic. Most patients had a history of multiple peritonitis episodes. All the patients required the passing from peritoneal dialysis to hemodialysis. There were 4 deaths (26,6%) of which one was around two months from the diagnosis. Conclusions. The timely diagnosis of the condition and the appropriate phase-specific treatment is of utmost importance in EPS. In advanced stages, the surgical intervention performed by a well-trained team could achieve good long-term results. PMID:25870687

  2. [A rapid dialysis method for analysis of artificial sweeteners in food].

    Science.gov (United States)

    Tahara, Shoichi; Fujiwara, Takushi; Yasui, Akiko; Hayafuji, Chieko; Kobayashi, Chigusa; Uematsu, Yoko

    2014-01-01

    A simple and rapid dialysis method was developed for the extraction and purification of four artificial sweeteners, namely, sodium saccharin (Sa), acesulfame potassium (AK), aspartame (APM), and dulcin (Du), which are present in various foods. Conventional dialysis uses a membrane dialysis tube approximately 15 cm in length and is carried out over many hours owing to the small membrane area and owing to inefficient mixing. In particular, processed cereal products such as cookies required treatment for 48 hours to obtain satisfactory recovery of the compounds. By increasing the tube length to 55 cm and introducing efficient mixing by inversion at half-hour intervals, the dialysis times of the four artificial sweeteners, spiked at 0.1 g/kg in the cookie, were shortened to 4 hours. Recovery yields of 88.9-103.2% were obtained by using the improved method, whereas recovery yields were low (65.5-82.0%) by the conventional method. Recovery yields (%) of Sa, AK, APM, and Du, spiked at 0.1 g/kg in various foods, were 91.6-100.1, 93.9-100.1, 86.7-100.0 and 88.7-104.7 using the improved method.

  3. Dialysate as food as an option for automated peritoneal dialysis

    OpenAIRE

    Tjiong, Hoey Lan; Swart, Roel; Berg, Willem; Fieren, Marien

    2008-01-01

    textabstractProtein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could serve as a source of food. The authors of this article found that such a dialysis solution when administered to fasting patients who were on nightly automated peritoneal dialysis (APD), as part of ...

  4. Sodium Balance During Extra Corporeal Dialysis

    Directory of Open Access Journals (Sweden)

    Locatelli Francesco

    2001-01-01

    Full Text Available In order to reduce intradialytic and interdialytic morbidity, it is important to obtain a zero sodium balance at the end of each dialysis session. This can be achieved by matching exactly the interdialytic sodium and water intake with the intradialytic sodium and water removal. A positive sodium balance can be obtained by using hypernatric dialysis or "sodium ramping" or convective techniques. While reducing the intradialytic side effects (hypotension, cramps, nausea, vomiting, these methods may increase the interdialytic side effects (thirst, weight gain, hypertension and pulmonary edema. Given the highly variable amounts of sodium introduced during the interdialytic periods, the use of sodium-conductivity kinetic models allows removing exactly the amount of sodium accumulated in the interdialytic period. This strategy may be advantageous towards cardiovascular stability in patients prone to dialysis hypotension.

  5. Optimizing home dialysis: role of hemodiafiltration.

    Science.gov (United States)

    Vilar, Enric; Farrington, Ken; Bates, Chris; Mumford, Carol; Greenwood, Roger

    2011-01-01

    Over the last 40 years the technical obstacles which prevented a convective contribution to diffusive dialysis have been overcome. Hemodiafiltration represents a natural evolution of intermittent extracorporeal blood purification and the technology is now available to offer this as standard treatment in-center. The first randomized control trial of dialysis dose (National Cooperative Dialysis Study) showed that for three times weekly dialysis a critical level of urea clearance was necessary to ensure complication-free survival, the effect being noticeable by 3 months. Following this, observational studies suggested that higher doses improved longer term outcome. In a second large randomized controlled study (HEMO), higher small molecule clearance did not further improve outcome, but high-flux membranes, which permitted enhanced clearance of middle molecules, appeared to confer survival benefit in patients who had already been on dialysis > 3.7 years. Recently, outcomes from the Membrane Permeability Outcome study confirmed a survival benefit of high-flux membranes in high-risk patients. These studies indicate that in the medium term survival is critically dependent on achieving a minimum level of small solute removal. However, longer term survival (measured in years or decades) not only requires better small solute clearance but also enhanced clearance of middle molecules, the toxicity of which manifest over longer time scales. The rationale for convective treatment is strongest, therefore in those patients who have the greatest potential for long-term survival. Patients who opt for self-care at home to allow frequent dialysis generally are constituents of this group. Hemodiafiltration is likely to become standard therapy in-center and in the home. Copyright © 2011 S. Karger AG, Basel.

  6. 42 CFR 415.176 - Renal dialysis services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Renal dialysis services. 415.176 Section 415.176 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Renal dialysis services. In the case of renal dialysis services, physicians who are not paid under...

  7. [Should dialysis be for all? Yes indeed!].

    Science.gov (United States)

    Panzetta, G; Grignetti, M; Toigo, G

    2008-01-01

    Clinically compromised patients who must undergo chronic dialysis are, in general, at risk because the procedure can be difficult to perform and give poor results in terms of survival and of rehabilitation. However, it is dialysis of the very elderly which is routinely characterized by misgivings about the indication for and limits of the technique. Patients older than 75 years of age currently represent more than 35% of the population that begin dialysis in most European registries. In our center at least 30 very old patients begin dialysis every year, which represents 45% of the total incident patients. About 30% of these patients, because of severe physical and/or mental disability, often associated with a situation of social deprivation, rarely achieve true clinical stability and depend upon outside caregivers in order to survive. The treatment of these patients strains the resources of the health and social structure, as well as the Nephrology Division, whose organization can be disrupted by their urgent needs, such as hospitalization, transportation, convalescent care, etc. Despite these difficulties and a mean survival of only 28 months, the global clinical conditions of patients older than 75 years of age are not much different than patients in the age bracket of 65 to 75 years. In fact, excluding patients older than 85 years of age (a category which geriatricians consider separately), the survival and rehabilitation of the very elderly appear similar to those of patients 65 to 75 years of age. Many of the clinical problems of the dialyzed elderly, such as sensory, mental and functional impairment, are the result of advanced age per se rather than of uremia or of dialysis. Therefore, ethical considerations of dialysis and of health maintenance in the very elderly are similar to those presented by patients who are afflicted by other serious diseases such as cancer, heart failure, or extensive stroke. As a result of modern technology and the advancement of

  8. [Diabetic patients survival rates in dialysis].

    Science.gov (United States)

    Cano, Noël

    2006-01-01

    Since the beginning of the eighties, the prevalence and incidence of diabetes have been increasing in dialysis units. In France, type 2 diabetes accounts for approximately 90% of diabetic hemodialysis patients. Among the etiologies of renal failure, diabetes is characterized by increased hospitalization rates and reduced quality of life, transplantation rates and survival. In dialysis patients, diabetes mellitus enhances the main factors leading to an increase in cardiovascular and non-cardiovascular deaths: inflammation, dyslipidemia, hypertension, increased energy expenditure, oxidative stress and plasma assymetrical dimethylarginine. The prevention of these complications includes the control of blood glucose, plasma lipids, hypertension, and anemia. The role of antioxidant therapies remains to be evaluated.

  9. Wearable impedance monitoring system for dialysis patients.

    Science.gov (United States)

    Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P

    2016-08-01

    This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

  10. Increasing sodium removal on peritoneal dialysis: applying dialysis mechanics to the peritoneal dialysis prescription.

    Science.gov (United States)

    Fischbach, Michel; Schmitt, Claus Peter; Shroff, Rukshana; Zaloszyc, Ariane; Warady, Bradley A

    2016-04-01

    Optimal fluid removal on peritoneal dialysis (PD) requires removal of water coupled with sodium, which is predominantly achieved via the small pores in the peritoneal membrane. On the other hand, free-water transport takes place through aquaporin-1 channels, but leads to sodium retention and over hydration. PD prescription can be adapted to promote small pore transport to achieve improved sodium and fluid management. Both adequate dwell volume and dwell time are required for small pore transport. The dwell volume determines the amount of "wetted" peritoneal membrane being increased in the supine position and optimized at dwell volumes of approximately 1400 ml/m(2). Diffusion across the recruited small pores is time-dependent, favored by a long dwell time, and driven by the transmembrane solute gradient. According to the 3-pore model of conventional PD, sodium removal primarily occurs via convection. The clinical application of these principles is essential for optimal performance of PD and has resulted in a new approach to the automated PD prescription: adapted automated PD. In adapted automated PD, sequential short- and longer-dwell exchanges, with small and large dwell volumes, respectively, are used. A crossover trial in adults and a pilot study in children suggests that sodium and fluid removal are increased by adapted automated PD, leading to improved blood pressure control when compared with conventional PD. These findings are not explained by the current 3-pore model of peritoneal permeability and require further prospective crossover studies in adults and children for validation. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  11. VASOACTIVE COMPONENTS OF DIALYSIS SOLUTION

    Science.gov (United States)

    Zakaria, El Rasheid; Patel, Anuj A.; Li, Na; Matheson, Paul J.; Garrison, Richard N.

    2008-01-01

    Background Conventional peritoneal dialysis (PD) solutions elicit vasodilation, which is implicated in the variable rate of solute transport during the dwell. The components causing such vasoactivity are still controversial. This study was conducted to define the vasoactive components of conventional and new PD solutions. Methods Three visceral peritoneal microvascular levels were visualized by intravital video microscopy of the terminal ileum of anesthetized rats. Anesthesia-free decerebrate conscious rats served as control. Microvascular diameter and blood flow by Doppler measurements were conducted after topical peritoneal exposure to 4 clinical PD solutions and 6 prepared solutions designed to isolate potential vasoactive components of the PD solution. Results All clinically available PD solutions produced a rapid and generalized vasodilation at all intestinal microvascular levels, regardless of the osmotic solute. The pattern and magnitude of this dilation was not affected by anesthesia but was determined by arteriolar size, the osmotic solute, and the solution’s buffer anion system. The greatest dilation occurred in the small precapillary arterioles and was elicited by conventional PD solution and heat re-sterilized solution containing low glucose degradation products (GDPs). Hypertonic mannitol solutions produced a dilation that was approximately 50% less than the dilation obtained with glucose solutions with identical osmolarity and buffer. Increasing a solution’s osmolarity did not produce a parallel increase in the magnitude of dilation, suggesting a nonlinear relationship between the two variables. Lactate dissolved in an isotonic solution was completely non-vasoactive unless the solution’s H+ concentration was increased. At low pH, isotonic lactate produced a rapid but transient vasodilation. This vascular reactivity was similar in magnitude and pattern to that obtained with the isotonic 7.5% icodextrin solution (Extraneal; Baxter Healthcare

  12. Guidance of technical management of dialysis water and dialysis fluid for the Japan Association for Clinical Engineering Technologists.

    Science.gov (United States)

    Kawasaki, Tadayuki; Uchino, Junji; Shinoda, Toshio; Kawanishi, Hideki

    2009-01-01

    There has been remarkable medical and technological progress in Japanese dialysis therapy where more than 270 thousand patients had been treated with dialysis by the end of 2007. Clinical engineering technologists have played an important role not only in the safety treatment but also in the technological development of dialysis therapy. It is very important to supply pure dialysis fluid for both the efficacy and the safety of hemodialysis in which high permeable dialysis membranes are used. The Japanese Society for Dialysis Therapy recently issued the standard for bacterial management of fluids for hemodialysis and related therapies according to the International Organization for Standardization (ISO)/DIS 23500. In order to achieve the standard, the management of dialysis water treatment is important as well as the role of clinical engineering technologists in daily dialysis practice. Purification is defined as no contamination by chemical substances and/or microorganisms and its components. The purification consists of the design and the system structure of the water treatment equipment and dialysis fluid-supplying equipment, and the operation and management of the equipment. The guideline aims to show the minimum standard and the management method of the water treatment system and dialysis fluid-supplying equipment in order to perform hemodialysis safely. They should outline safer dialysis by the management of purification of dialysis fluid.

  13. The interval ordering problem

    CERN Document Server

    Dürr, Christoph; Spieksma, Frits C R; Nobibon, Fabrice Talla; Woeginger, Gerhard J

    2011-01-01

    For a given set of intervals on the real line, we consider the problem of ordering the intervals with the goal of minimizing an objective function that depends on the exposed interval pieces (that is, the pieces that are not covered by earlier intervals in the ordering). This problem is motivated by an application in molecular biology that concerns the determination of the structure of the backbone of a protein. We present polynomial-time algorithms for several natural special cases of the problem that cover the situation where the interval boundaries are agreeably ordered and the situation where the interval set is laminar. Also the bottleneck variant of the problem is shown to be solvable in polynomial time. Finally we prove that the general problem is NP-hard, and that the existence of a constant-factor-approximation algorithm is unlikely.

  14. Proteomics in extracorporeal blood purification and peritoneal dialysis.

    Science.gov (United States)

    Thongboonkerd, Visith

    2010-01-03

    Extracorporeal blood purification and peritoneal dialysis are widely used in renal replacement therapy for patients with end-stage renal disease (ESRD) and acute kidney injury (AKI). Additionally, extracorporeal blood purification can be used also for treatment of non-renal disorders to remove endogenous or exogenous toxins from the blood circulation. Efforts have been made to characterize these toxins removed by diffusion (dialysis), convection (ultrafiltration), and/or adsorption (toxins are adsorbed onto the dialysis membrane and are thus removed) using different types of dialysis membrane. This review summarizes important findings obtained from recent proteomic studies applied to extracorporeal blood purification and peritoneal dialysis in settings of ESRD, AKI and hepatic failure.

  15. [Dialysis and ecology: can we do better in the future?].

    Science.gov (United States)

    Vuignier, Y; Pruijm, M; Jarrayah, F; Burnier, M

    2013-02-27

    Development of dialysis has saved the lives of many patients. However, haemodialysis and peritoneal dialysis are very demanding in resources such as water and electricity, and generate a large amount of waste. In this article, we will review the environmental aspects of dialysis. Different solutions will be discussed, such as recycling of water discharged during reverse osmosis, the integration of solar energy, recycling of waste plastics, and the use of other techniques such as sorbent dialysis. In a world where natural resources are precious and where global warming is a major problem, it is important that not only dialysis, but all branches of medicine become more attentive to ecology.

  16. Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation.

    Directory of Open Access Journals (Sweden)

    James G Heaf

    Full Text Available Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1 whether, and if so, how, PD and HD prognosis had changed in recent years, (2 whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3 whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation.12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI, and mode of dialysis initiation.Overall adjusted prognosis improved by 34% (HD 30%, PD 42%. PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation.Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.

  17. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: A comparison in patients with ischemic stroke or transient ischemic attack.

    Science.gov (United States)

    Sejr, Michala Herskind; Nielsen, Jens Cosedis; Damgaard, Dorte; Sandal, Birgitte Forsom; May, Ole

    Atrial fibrillation (AF) is the most common cardiac cause of ischemic stroke and transient ischemic attack (IS/TIA). To compare the diagnostic value of seven-day external loop recording (ELR) and two-day Holter recording for detecting AF after IS/TIA. 191 IS/TIA patients without AF history. Endpoint was AF >30s. We started two-day Holter recording and seven-day ELR simultaneously. Seven-day ELR and two-day Holter recording detected the same three AF patients. ELR detected another six patients with AF adjudicated by cardiologists, four detections after Holter (3 vs. 7, p=0.125) and two false-positive detections during Holter. Seven-day ELR automatically classified 50/191 patients (26%) with AF, but only 7/50 (14%) were confirmed as AF by cardiologists. Seven-day ELR did not detect significantly more patients with AF than two-day Holter recording. 86% of patients with ELR-classified AF were false positives, indicating a poor performance of the automatic AF detection algorithm used. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease.

    Directory of Open Access Journals (Sweden)

    Fan Yang

    Full Text Available Studies comparing patient survival of hemodialysis (HD and peritoneal dialysis (PD have yielded conflicting results and no such study was from South-East Asia. This study aimed to compare the survival outcomes of patients with end-stage renal disease (ESRD who started dialysis with HD and PD in Singapore.Survival data for a maximum of 5 years from a single-center cohort of 871 ESRD patients starting dialysis with HD (n = 641 or PD (n = 230 from 2005-2010 was analyzed using the flexible Royston-Parmar (RP model. The model was also applied to a subsample of 225 propensity-score-matched patient pairs and subgroups defined by age, diabetes mellitus, and cardiovascular disease.After adjusting for the effect of socio-demographic and clinical characteristics, the risk of death was higher in patients initiating dialysis with PD than those initiating dialysis with HD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.67-2.59; p<0.001, although there was no significant difference in mortality between the two modalities in the first 12 months of treatment. Consistently, in the matched subsample, patients starting PD had a higher risk of death than those starting HD (HR: 1.73, 95% CI: 1.30-2.28, p<0.001. Subgroup analysis showed that PD may be similar to or better than HD in survival outcomes among young patients (≤65 years old without diabetes or cardiovascular disease.ESRD patients who initiated dialysis with HD experienced better survival outcomes than those who initiated dialysis with PD in Singapore, although survival outcomes may not differ between the two dialysis modalities in young and healthier patients. These findings are potentially confounded by selection bias, as patients were not randomized to the two dialysis modalities in this cohort study.

  19. Fungal peritonitis in children on peritoneal dialysis.

    NARCIS (Netherlands)

    Raaijmakers, R.; Schroder, C.; Monnens, L.A.H.; Cornelissen, E.A.M.; Warris, A.

    2007-01-01

    Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 month

  20. Nutritional status of maintenance dialysis patients

    DEFF Research Database (Denmark)

    Koefoed, Mette Juul; Kromann, Charles Boy; Juliussen, Sophie Ryberg

    2016-01-01

    in maintenance dialysis patients, and compared different methods of nutritional assessment. Methods In a cross-sectional study conducted in 2014 at Roskilde Hospital, Denmark, we performed anthropometry (body weight, skinfolds, mid-arm, waist, and hip circumferences), and determined plasma albumin and normalized...

  1. Peritoneal dialysis peritonitis: risk factors and effects

    Directory of Open Access Journals (Sweden)

    Alikari V.

    2013-07-01

    Full Text Available Introduction: Peritonitis is the most frequent complication of peritoneal dialysis. It is the main cause of failure of the method and inclusion of patients in hemodialysis Purpose: The purpose of this study is to explore the risk factors of peritoneal dialysis peritonitis as well as the acute and long-term effects of peritonitis on peritoneal membrane function and success of the method. Methods: Literature review of relevant articles in the database Pubmed as well as the official website of the International Society of Peritoneal Dialysis (ISPD was carried out. The search included articles published during the period 1986 -2012.Results: Lack of patient compliance with the peritoneal changes protocol, lack of social support, systemic diseases and connection systems are risk factors of peritonitis. Peritonitis causes transient increase of peritoneum permeability, loss of the ability of the peritoneum for ultrafiltration and, consequently, overhydration. Long-term, recurrent episodes of peritonitis resulting in permanent loss of peritoneum capacity for ultrafiltration even fibrosis that leads to failure of the method. Finally, its effect on the reduction of the residual renal function seems to be remarkable. Conclusions: Peritonitis is the most common infectious complication of peritoneal dialysis and the main cause of morbidity associated with the method. Moreover, it is the major cause of failure of the method and patients accession in hemodialysis. Any attempt to prevent peritonitis passes through the careful patient selection and effective patient education on compliance with the rules of asepsis during peritoneal changes.

  2. Laboratory dialysis--past, present and future.

    Science.gov (United States)

    Bansal, Parikshit; Ajay, Dara

    2012-04-01

    Laboratory dialysis, one of the most widely used techniques in biological research is truly a ' gateway technology' . The analogy is to that of a ' gate' of a building through which everybody has to pass, even though they may wish to go to different departments. Similarly, researchers may be working in altogether different areas but all may need to use laboratory dialysis at one stage or the other during the course of their research. Biochemists may use it to purify enzymes, an immunologist may use it to purify monoclonal antibodies from culture supernatants, a chemist may use it as a step in the crystallography process or for purification of ionic liquids, a biotechnologist may use it to study the effectiveness of enzyme immobilization and a drug discovery scientist may use it for determining drug-protein interaction. The present article reviews patents in the field of laboratory dialysis from inception till date, focusing on the various developmental and innovation related milestones during evolution of the technique. It captures the full panorama of a very interesting technique which continues to be as relevant today as it was in 1866 when the term ' dialysis' was first coined.

  3. Fungal peritonitis in children on peritoneal dialysis.

    NARCIS (Netherlands)

    Raaijmakers, R.; Schroder, C.; Monnens, L.A.H.; Cornelissen, E.A.M.; Warris, A.

    2007-01-01

    Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 month

  4. Continuous ambulatory peritoneal dialysis: Indian scenario.

    Science.gov (United States)

    Abraham, Georgi; Mathew, Milli; Hinduja, Anish; Padma, G

    2002-03-01

    Chronic peritoneal dialysis (CPD) has been initiated as a treatment modality for chronic renal failure patients in the Indian subcontinent since 1990. Over a period of 9 years both continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) have emerged as accepted forms of renal replacement therapy in our country. Although there were government restrictions on import of dialysis fluid until 1993, the availability of locally manufactured fluid in collapsible bags had facilitated the expansion of the programme to the far corners of the country and in neighbouring countries. Initially majority (78%) of the patients who were started on this programme were diabetics with other comorbid conditions who were drop-outs from haemodialysis and unfit for transplantation. Both CAPD and CCPD have been used for all age groups and for men and women. Majority of the patients do 3 x 2 l exchanges a day on CAPD; 8-10 l using a cycler at night those who are onCCPD. Peritonitis rate was 1 episode every 18 patient months. With the introduction of new connection and disposable sets the incidence of peritonitis is dropping down. The major cause of drop-out is cardiovascular death followed by peritonitis. Malnutrition is a major problem in both CAPD and haemodialysis patients. The programme has been expanded and there are over one thousand patients on this treatment in the country. The introduction of CPD had a major impact on the treatment of renal failure in India.

  5. Blood pressure management in children on dialysis.

    Science.gov (United States)

    Paglialonga, F; Consolo, S; Edefonti, A; Montini, G

    2017-06-09

    Hypertension is a leading cause of cardiovascular complications in children on dialysis. Volume overload and activation of the renin-angiotensin-aldosterone system play a major role in the pathophysiology of hypertension. The first step in managing blood pressure (BP) is the careful assessment of ambulatory BP monitoring. Volume control is essential and should start with the accurate identification of dry weight, based on a comprehensive assessment, including bioimpedance analysis and intradialytic blood volume monitoring (BVM). Reduction of interdialytic weight gain (IDWG) is critical, as higher IDWG is associated with a worse left ventricular mass index and poorer BP control: it can be obtained by means of salt restriction, reduced fluid intake, and optimized sodium removal in dialysis. Optimization of peritoneal dialysis and intensified hemodialysis or hemodiafiltration have been shown to improve both fluid and sodium management, leading to better BP levels. Studies comparing different antihypertensive agents in children are lacking. The pharmacokinetic properties of each drug should be considered. At present, BP control remains suboptimal in many patients and efforts are needed to improve the long-term outcomes of children on dialysis.

  6. Effect of icodextrin on heart rate variability in diabetic patients on peritoneal dialysis.

    Science.gov (United States)

    Orihuela, Oscar; de Jesús Ventura, María; Ávila-Díaz, Marcela; Cisneros, Alejandra; Vicenté-Martínez, Marlén; Furlong, María-del-Carmen; García-González, Zuzel; Villanueva, Diana; Alcántara, Guadalupe; Lindholm, Bengt; García-López, Elvia; Villanueva, Cleva; Paniagua, Ramón

    2014-01-01

    Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♢ We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♢ This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♢ We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low- and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♢ These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.

  7. Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution.

    Science.gov (United States)

    Hamasaki, Yoshifumi; Doi, Kent; Tanaka, Mototsugu; Kume, Haruki; Ishibashi, Yoshitaka; Enomoto, Yutaka; Fujita, Toshiro; Homma, Yukio; Nangaku, Masaomi; Noiri, Eisei

    2014-11-01

    Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical factors at peritoneal dialysis initiation, including peritoneal transport status, are associated with cardiovascular event in patients using biocompatible peritoneal dialysis solution. This retrospective cohort study of peritoneal dialysis patients using biocompatible solutions with neutral pH assessed relations of clinical parameters at peritoneal dialysis initiation to cardiovascular event during the subsequent five years. Of 102 patients who started peritoneal dialysis, cardiovascular event occurred in 18. Age, history of cardiovascular disease before peritoneal dialysis initiation, hemoglobin, serum albumin, C-reactive protein, peritoneal permeability defined by the ratio of dialysate to plasma creatinine concentration at 4 hr (D/Pcre) in peritoneal equilibration test (PET), number of patients in each PET category defined by D/Pcre, and peritoneal protein clearance significantly differed between patients with and without cardiovascular event. For patients divided according to PET category using Kaplan-Meier method, the group of high average to high peritoneal transporters exhibited significantly high incidence of cardiovascular event and mortality compared with the groups of low and low-average peritoneal transporters (Log rank; p=0.0003 and 0.005, respectively). A Cox proportional hazards model showed independent association of PET category classification with cardiovascular event. Peritoneal permeability expressed as PET category at peritoneal dialysis initiation is an independent

  8. Dose adjustment of carboplatin in patients on peritoneal dialysis.

    Science.gov (United States)

    Guddati, Achuta K; Joy, Parijat S; Marak, Creticus P

    2014-05-01

    The Calvert equation has been extensively used to determine the dosage of carboplatin. However, in patients on dialysis, it predicts the same dosage regardless of the frequency of dialysis. Clearance of carboplatin during hemodialysis has been studied to a lesser extent, but there have been very few studies which have investigated the clearance of carboplatin in patients on peritoneal dialysis. A mathematical formula is proposed here to predict the dose of carboplatin for a given AUC in patients on peritoneal dialysis. This formula takes into account the frequency of dialysis sessions and the time delay between carboplatin infusion and the initiation of dialysis. The formula predicts an approximately similar dosage of carboplatin as that of the Calvert formula in patients undergoing peritoneal dialysis four times per day if dialysis is initiated 12 h after infusion. The formula may help in guiding the adjustment of carboplatin dose in patients who receive a lesser number of dialysis sessions per day and in those patients whose dialysis is initiated at different times (0-24 h) after carboplatin infusion. It is suggested that usage of this formula will result in a better dosage of carboplatin to suit specific dialysis frequencies in specific patients and eventually may result in a better efficacy and toxicity profile.

  9. [Report on chronic dialysis in France in 2016].

    Science.gov (United States)

    Société Francophone de Néphrologie Dialyse Et Transplantation

    2017-04-01

    The report on dialysis in France in 2016 from the French Speaking Society of Nephrology Dialysis and Transplantation (SFNDT) provides an exhaustive and documented inventory on dialysis in France. It underlines the organizations that are important in 2016 to maintain a high quality dialysis. Several measures are proposed to maintain and improve the care of dialysis in France: (1) The regulation of dialysis treatment in France must be maintained; (2) a burden of care indicator is proposed to ensure that patients requiring the most care are treated in the centers. Proposals are also made to stimulate peritoneal dialysis offers, (3) to improve the calculation of the cost of dialysis and warn against lower reimbursement rates of dialysis, (4) to reduce transport costs by minimizing transport by ambulance (5). The SFNDT recalls recent recommendations concerning access to the renal transplant waiting list, are recalled; (6) as well as recommendations that require waiting until clinical signs are present to start dialysis (7). The SFNDT makes the proposal to set up advanced renal failure units. These units are expected to develop care that is not supported today: consultation with a nurse, a dietician, a social worker or psychologist, palliative care, and coordination (8). Finally, the financial and human resources for pediatric dialysis should be maintained. Copyright © 2017. Published by Elsevier Masson SAS.

  10. Survival on home dialysis in New Zealand.

    Directory of Open Access Journals (Sweden)

    Mark R Marshall

    Full Text Available BACKGROUND: New Zealand (NZ has a high prevalence of both peritoneal dialysis (PD and home haemodialysis (HD relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities. METHODS: We analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression. RESULTS: We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (3 years, with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era. CONCLUSION: Our study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.

  11. Pharmacotherapy of Hypertension in Chronic Dialysis Patients.

    Science.gov (United States)

    Georgianos, Panagiotis I; Agarwal, Rajiv

    2016-11-07

    Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third-line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

  12. [Icodextrine peritoneal dialysis solution in clinical practice].

    Science.gov (United States)

    Opatrná, S

    2008-12-01

    Icodextrin, a glucose polymer, is an alternative osmotic agent to glucose in peritoneal dialysis solutions. Icodextrin generates ultrafiltration through colloid osmosis and is thus effective even during long-term (e.g., nighttime) dwells and in cases of high peritoneal permeability, where it prevents dialysate reabsorption into the systemic circulation. Ultrafiltration is maintained even in the presence of peritonitis. The incidence of bacterial peritonitis is not different when using icodextrin- or glucose-based solutions. Some time ago, icodextrin use was implicated in an increased incidence of sterile peritonitis. This was due to contamination of some batches of the solution by peptidoglycan present in the cell wall of G+ bacteria. Using exact isotope methods, treatment with icodextrin-based solution has been shown to improve the hydration status of peritoneal dialysis patients, suggesting a potential for improved blood pressure control. Icodextrin-based dialysis is associated with a reduction of left ventricular mass. Given the methodological flaws of trials conducted to date, the acute hemodynamic effects of icodextrin cannot be conclusively interpreted. Inclusion of icodextrin-based solution instead of the glucose-based one into the prescription of peritoneal dialysis decreases the metabolic load with glucose potentially having a beneficial effect on hyperlipidemia, hyperinsulinemia and hyperleptinemia, with improved glycemic control in patients with diabetes as an additional benefit. Function of the peritoneum as a dialysis membrane is stable during icodextrin-based treatment, possibly longer compared with glucose-based solutions. Data derived from a large-scale registry have shown lower mortality oficodextrin-treated patients; this, however, needs to be confirmed by prospective randomized controlled trials.

  13. Interval Scheduling: A Survey

    NARCIS (Netherlands)

    Kolen, A.W.J.; Lenstra, J.K.; Papadimitriou, C.H.; Spieksma, F.C.R.

    2007-01-01

    In interval scheduling, not only the processing times of the jobs but also their starting times are given. This article surveys the area of interval scheduling and presents proofs of results that have been known within the community for some time. We first review the complexity and approximability o

  14. Estimating duration intervals

    NARCIS (Netherlands)

    Ph.H.B.F. Franses (Philip Hans); B.L.K. Vroomen (Björn)

    2003-01-01

    textabstractDuration intervals measure the dynamic impact of advertising on sales. More precise, the p per cent duration interval measures the time lag between the advertising impulse and the moment that p per cent of its effect has decayed. In this paper, we derive an expression for the duration

  15. Simultaneous Interval Graphs

    CERN Document Server

    Jampani, Krishnam Raju

    2010-01-01

    In a recent paper, we introduced the simultaneous representation problem (defined for any graph class C) and studied the problem for chordal, comparability and permutation graphs. For interval graphs, the problem is defined as follows. Two interval graphs G_1 and G_2, sharing some vertices I (and the corresponding induced edges), are said to be `simultaneous interval graphs' if there exist interval representations R_1 and R_2 of G_1 and G_2, such that any vertex of I is mapped to the same interval in both R_1 and R_2. Equivalently, G_1 and G_2 are simultaneous interval graphs if there exist edges E' between G_1-I and G_2-I such that G_1 \\cup G_2 \\cup E' is an interval graph. Simultaneous representation problems are related to simultaneous planar embeddings, and have applications in any situation where it is desirable to consistently represent two related graphs, for example: interval graphs capturing overlaps of DNA fragments of two similar organisms; or graphs connected in time, where one is an updated versi...

  16. Use of hospice in the United States dialysis population.

    Science.gov (United States)

    Murray, Anne M; Arko, Cheryl; Chen, Shu-Cheng; Gilbertson, David T; Moss, Alvin H

    2006-11-01

    Hospice is recognized for providing excellent end-of-life care but may be underused by dialysis patients. Hospice use and related outcomes were measured among dialysis patients, and factors that were associated with hospice use were identified. The 2-yr US Renal Data System dialysis patients who died between January 1, 2001, and December 31, 2002, and hospice claims from the Centers for Medicare & Medicaid Services were examined to measure prevalence, factors, and costs that were associated with dialysis withdrawal and hospice use. Of the 115,239 deceased patients, 21.8% withdrew from dialysis and 13.5% used hospice. Of those who withdrew, 41.9% used hospice. Failure to thrive was the most common reason for dialysis withdrawal (42.9%). On multivariable logistic regression analysis, factors that were significantly associated with hospice referral among patients who withdrew from dialysis were age, race, reason for withdrawal, ability to walk or transfer at dialysis initiation, and state of residence. Among patients who withdrew from dialysis and used hospice, median cost of per-patient care during the last week of life was $1858, compared with $4878 for nonhospice patients (P < 0.001); hospitalization costs accounted for most of that difference. Only 22.9% of dialysis hospice patients died in the hospital, compared with 69.0% of nonhospice patients (P < 0.001). A minority of dialysis patients use hospice, even among patients who withdrew from dialysis, whose death usually is certain. Increased hospice use may enable more dialysis patients to die at home, with substantial cost savings. Research regarding additional benefits of hospice care for dialysis patients is needed.

  17. Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: report on three cases.

    Science.gov (United States)

    Piccoli, Giorgina Barbara; Guzzo, Gabriella; Vigotti, Federica Neve; Capizzi, Irene; Clari, Roberta; Scognamiglio, Stefania; Consiglio, Valentina; Aroasio, Emiliano; Gonella, Silvana; Veltri, Andrea; Avagnina, Paolo

    2014-07-01

    Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is reported in about 1% of chronic dialysis patients. The role of personalized, intensive dialysis schedules and of resuming low-protein diets has not been studied to date. This report describes three patients with RFR who were recently treated at a new dialysis unit set up to offer intensive hemodialysis. All three patients were females, aged 73, 75, and 78 years. Kidney disease included vascular-cholesterol emboli, diabetic nephropathy and vascular and dysmetabolic disease. At time of RFR, the patients had been dialysis-dependent from 3 months to 1 year. Dialysis was started with different schedules and was progressively discontinued with a "decremental" policy, progressively decreasing number and duration of the sessions. A moderately restricted low-protein diet (proteins 0.6 g/kg/day) was started immediately after dialysis discontinuation. The most recent update showed that two patients are well off dialysis for 5 and 6 months; the diabetic patient died (sudden death) 3 months after dialysis discontinuation. Within the limits of small numbers, our case series may suggest a role for personalized dialysis treatments and for including low-protein diets in the therapy, in enhancing long-term RFR in elderly dialysis patients.

  18. Survival advantage of peritoneal dialysis relative to hemodialysis in the early period of incident dialysis patients: a nationwide prospective propensity-matched study in Korea.

    Directory of Open Access Journals (Sweden)

    Ji-Young Choi

    Full Text Available BACKGROUND: The impact of dialysis modality on survival is still somewhat controversial. Given possible differences in patients' characteristics and the cause and rate of death in different countries, the issue needs to be evaluated in Korean cohorts. METHODS: A nationwide prospective observational cohort study (NCT00931970 was performed to compare survival between peritoneal dialysis (PD and hemodialysis (HD. A total of 1,060 end-stage renal disease patients in Korea who began dialysis between September 1, 2008 and June 30, 2011 were followed through December 31, 2011. RESULTS: The patients (PD, 30.6%; HD, 69.4% were followed up for 16.3 ± 7.9 months. PD patients were significantly younger, less likely to be diabetic, with lower body mass index, and larger urinary volume than HD patients. Infection was the most common cause of death. Multivariate Cox regression with the entire cohort revealed that PD tended to be associated with a lower risk of death compared to HD [hazard ratio (HR 0.63, 95% confidence interval (CI 0.36-1.08]. In propensity score matched pairs (n=278 in each modality, cumulative survival probabilities for PD and HD patients were 96.9% and 94.1% at 12 months (P=0.152 and 94.3% and 87.6% at 24 months (P=0.022, respectively. Patients on PD had a 51% lower risk of death compared to those on HD (HR 0.49, 95% CI 0.25-0.97. CONCLUSIONS: PD exhibits superior survival to HD in the early period of dialysis, even after adjusting for differences in the patients' characteristics between the two modalities. Notably, the most common cause of death was infection in this Korean cohort.

  19. Optimal choice of dialysis access for chronic kidney disease patients: developing a life plan for dialysis access.

    Science.gov (United States)

    Lok, Charmaine E; Davidson, Ingemar

    2012-11-01

    Patient-focused dialysis modality and access selection requires a coordinated teamwork approach that emphasizes chronic kidney disease care to be a continuum of care. Individualized and detailed patient history and examination are the mainstays of dialysis modality and access selection. Preoperative vessel mapping by duplex Doppler ultrasonography can be a useful supplementary investigation to the history and physical examination to determine the optimal dialysis access type and site. Dialysis access modality and choice considers many patient factors that can be aided by a clinical risk score, asking key clinical questions, surgical expert opinion, and a multidisciplinary approach to individualized patient care. In many situations, a lifelong access utilization strategy prioritizes peritoneal dialysis as the first dialysis modality followed by appropriately planned hemodialysis. The goal of an integrated patient-focused approach is to achieve complication-free access to help patients achieve their life goals on and off dialysis. Copyright © 2012. Published by Elsevier Inc.

  20. Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?

    Science.gov (United States)

    Carlos, Christopher A; McCulloch, Charles E; Hsu, Chi-Yuan; Grimes, Barbara; Pavkov, Meda E; Burrows, Nilka R; Shahinian, Vahakn B; Saran, Rajiv; Powe, Neil R; Johansen, Kirsten L

    2017-08-01

    The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages ≥50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening. Copyright © 2017 by the American Society of Nephrology.

  1. Is bilateral internal thoracic artery grafting a safe option for chronic dialysis patients?

    Science.gov (United States)

    Gatti, Giuseppe; Perrotti, Andrea; Fiore, Antonio; Bergoend, Eric; Chocron, Sidney; Couetil, Jean-Paul; Sinagra, Gianfranco; Pappalardo, Aniello

    2017-06-16

    The use of bilateral internal thoracic artery (BITA) grafting has been proposed for dialysis patients with multivessel coronary artery disease, primarily because of hypothetical long-term survival benefits. To investigate the outcome of BITA grafting in dialysis patients. This was a retrospective analysis of the use of BITA grafting in 105 consecutive patients with end-stage renal failure on chronic dialysis in three European centres with extensive experience in BITA. Baseline patient characteristics, operative data, early postoperative complications and late survival were reviewed. Outcomes of patients from one of the three centres who underwent either BITA (n=40) or single internal thoracic artery (SITA) grafting (n=19) were also analysed; a one-to-one propensity score (PS)-matched analysis was performed. There were 19 (18.1%) hospital deaths. Despite differences in preoperative patient characteristics and surgical features, in each centre, hospital mortality was greater than the 75th percentile of expected operative risk (EuroSCORE II). Diseased ascending aorta and extracardiac arteriopathy were found to be predictors of hospital death (odds ratio 9.7; P=0.006) and complicated hospital course (odds ratio 2.54; P=0.035), respectively. The 7-year non-parametric estimates of freedom from all-cause death and cardiac or cerebrovascular death were 59% (95% confidence interval: 52.3-65.7%) and 75.6% (95% confidence interval: 71.2-80%), respectively. There were no significant differences in early and late outcomes between BITA and SITA PS-matched groups. BITA grafting remains a risky operation for chronic dialysis patients, even when performed routinely. No long-term survival benefits for the use of BITA versus SITA were proven. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Serum immunoglobulin G levels and peritonitis in peritoneal dialysis patients.

    Science.gov (United States)

    Courivaud, Cécile; Bardonnet, Karine; Crepin, Thomas; Bresson-Vautrin, Catherine; Rebibou, Jean-Michel; Ducloux, Didier

    2015-08-01

    Peritonitis is a frequent and serious complication of peritoneal dialysis (PD). Whether low immunoglobulin level is associated with PD-related peritonitis is unknown. We conducted a prospective study to assess whether immunoglobulin levels at PD onset could predict the occurrence of peritonitis. All patients starting peritoneal dialysis between 01/2005 and 12/2010 at the University hospital of Besançon, France, were included in the study. Of 240 consecutive PD patients enrolled (mean follow-up 25 ± 12 months), 76 (32%) had at least one episode of peritonitis. Mean immunoglobulin (Ig)G level at PD start was lower in patients who subsequently experienced peritonitis (7.9 + 3.4 vs. 9.7 + 3.4 g/l, p = 0.005). An increased IgG level at PD onset was associated with a reduced risk of peritonitis [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.80-0.97 for each increase of 1 g/l in IgG, p = 0.008]. IgG level ≤6.4 g/l ("low IgG") was the best predictive value for the occurrence of subsequent peritonitis: 52 patients (24%) had low IgG levels. At multivariate analysis, both low IgG level (HR 2.49, 95% CI 1.32-4.69, p = 0.005) and diabetes (HR 2.78, 95% CI 1.49-5.20, p = 0.001) were predictive of the occurrence of peritonitis. Low IgG levels predict the occurrence of PD-related peritonitis. Randomized studies should determine whether such patients could benefit from intravenous immunoglobulin administration.

  3. Predictors and outcomes of transfers from peritoneal dialysis to hemodialysis.

    Science.gov (United States)

    Lan, Patrick G; Clayton, Philip A; Saunders, John; Polkinghorne, Kevan R; Snelling, Paul L

    2015-01-01

    Peritoneal dialysis (PD) patients are commonly required to transfer to hemodialysis (HD), however the literature describing the outcomes of such transfers is limited. The aim of our study was to describe the predictors of these transfers and their outcomes according to vascular access at the time of transfer. A retrospective cohort study using registry data of all adult patients commencing PD as their initial renal replacement therapy in Australia or New Zealand between 2004 - 2010 was performed. Follow-up was until 31 December 2010. Logistic regression models were constructed to determine possible predictors of transfer within both 6 and 12 months of PD commencement. Cox analysis and competing risks regression were used to determine the predictors of survival and transplantation post-transfer. The analysis included 4,781 incident PD patients, of whom 1,699 transferred to HD during the study period. Logistic models did not identify any clinically useful predictors of transfer within 6 or 12 months (c-statistics 0.54 and 0.55 respectively). 67% of patients commenced HD with a central venous catheter (CVC). CVC use at transfer was associated with increased mortality (hazard ratio 1.37, 95% confidence interval (CI) 1.11 - 1.68, p = 0.003) and a borderline significant reduction in the incidence of transplantation (subhazard ratio 0.76, 95% CI 0.58 - 1.00, p = 0.05). It is difficult to predict the transfer to HD for incident PD patients. PD patients who commence HD with a CVC have a higher risk of mortality and a lower likelihood of undergoing renal transplantation. Copyright © 2015 International Society for Peritoneal Dialysis.

  4. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    Science.gov (United States)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1-5) and 6 to 20 (area 6-20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  5. Biofeedback-driven dialysis: where are we?

    Science.gov (United States)

    Santoro, Antonio; Ferramosca, Emiliana; Mancini, Elena

    2008-01-01

    The progressive increase in the mean age and the growing conditions of co-morbidity, especially of cardiovascular pathologies and diabetes, have significantly worsened the patients' clinical status and tolerance to the hemodialysis (HD) treatment. On the other hand, the demand for short treatment times enhances the risk for hemodynamic instability as well as for inadequate depuration. The traditional management of the dialysis session, setting of predefined treatment parameters, with active therapeutic interventions only in the event of complications, is definitely unsuitable for short-lasting treatments, often complicated by hemodynamic instability, especially in critical patients. The first step to improve the management of the dialysis session is the utilization of continuous and uninvasive monitoring systems for hemodynamic or biochemical parameters involved in the dialysis quality. Special sensors for the continuous measurement of blood volume, blood temperature, blood pressure, heart rate, electrolytes, have been realized throughout the last 10 years. As a second step, some of these devices have been implemented in the dialysis instrumentation, mainly with a view to preventing cardiocirculatory instability but also to control the dialysis efficiency (biofeedback control systems). The basic components of a biofeedback system are: the plant, the sensors, the actuators and the controller. The plant is the biological process that we need to control, while the sensors are the devices used for measuring the output variables. The actuators are the working arms of the controller. The controller is the mathematical model that continuously sets the measured output variable against the reference input and modifies the actuators in order to reduce any discrepancies. Yet, in practice there are a number of conceptual, physical and technological difficulties to be overcome. In particular, the behavior of what is to be controlled may be non-linear and time-varying, with

  6. Dialysis and Quality of Dialysate in Southeast Asian Developing Countries

    Directory of Open Access Journals (Sweden)

    Tomotaka Naramura

    2014-04-01

    Full Text Available Background: The number of dialysis patients has been increasing in Southeast Asia, but statistical data about these patients and on the quality of dialysates in Southeast Asian dialysis facilities are still imprecise. For this study, dialysis-related statistical data were collected in Southeast Asia. Methods: A survey of the quality of dialysates was carried out at 4 dialysis facilities in Vietnam and Cambodia. The dialysis patient survey included the numbers of dialysis facilities and patients receiving dialysis, a ranking of underlying diseases causing the initiation of dialysis, the number of patients receiving hemodialysis (HD/on-line hemodiafiltration/continuous ambulatory peritoneal dialysis, the number of HD monitoring devices installed, the cost of each session of dialysis (in USD, the percentage of out-of-pocket payments, and the 1-year survival rates of the dialysis patients (in percent. The dialysate survey covered the endotoxin (ET level and bacterial count in tap water, in water filtered through a reverse osmosis system and in dialysate. Results: In each of the countries, the most frequent reason for the initiation of dialysis is diabetes mellitus. HD is usually carried out according to the ‘reuse' principle. The 1-year survival rates are 70% in Myanmar and about 90% in the Philippines and Malaysia. The ET levels in standard dialysates were satisfactory at 2 facilities. The bacterial counts in dialysates were not acceptable at any of the facilities investigated. Conclusion: There is an urgent need to teach medical workers involved in dialysis how to prepare sterile and ET-free dialysates.

  7. Morganella morganii Peritonitis Associated with Continuous Ambulatory Peritoneal Dialysis (CAPD) after Colonoscopy.

    Science.gov (United States)

    Kimura, Yukihiro; Ito, Ayano; Miyamoto, Kanyu; Suga, Norihiro; Miura, Naoto; Kasagi, Tomomichi; Yamagishi, Yuka; Mikamo, Hiroshige; Imai, Hirokazu

    2016-01-01

    A 79-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and cloudy peritoneal fluid two days after colonoscopy that revealed multiple diverticula. The white blood cell count was 9,000 cells/μL, C-reactive protein level was 6.86 mg/dL, and the white blood cell count of the peritoneal fluid was 7,800 cells/μL, suggesting acute peritonitis. Empiric therapy consisting of cefazolin and ceftazidime slowly improved the patient's symptoms. The initial microbiological examination of the peritoneal fluid demonstrated Morganella morganii. He was changed from CAPD to hemodialysis. It is important to consider M. morganii peritonitis in patients with colonic diverticula.

  8. The possible impact of dialysis modality on cognitive function in chronic dialysis patients.

    Science.gov (United States)

    Radić, J; Ljutić, D; Radić, M; Kovaĉić, V; Sain, M; Curković, K Dodig

    2010-04-01

    Chronic kidney disease (CKD) is a growing public health problem. Individuals in all stages of CKD are at higher risk for development of cognitive impairment and this may be a major determinant in their quality of life (QOL). The prevalence of cognitive deficits is particularly high in subjects with end-stage renal disease (ESRD). While it is sufficiently well documented that ESRD is linked with a change in cognitive function, little is known about the influence of different dialysis modalities on cognitive function. The effect of dialysis modality on risk of cognitive impairment is unclear. Some data suggest that patients with ESRD treated with chronic ambulatory peritoneal dialysis (CAPD) had consistently better cognitive function than patients treated with haemodialysis (HD). We concluded that the previously observed apparent difference between two modalities of dialysis treatments resulted either from very low dialysis delivery or comparison with poorly matched controls. Regarding these data from previous studies we hypothesised that well-dialysed, well-nourished and medically stable HD patients had no cognitive dysfunction in comparison with well-dialysed, well-nourished, medically stable and demographically matched CAPD patients. Also, future studies are needed to differentiate between modality as a risk factor from the factors contributing to selection bias among patients choosing CAPD over HD.

  9. A prime determinant in selecting dialysis modality: peritoneal dialysis patient survival

    Directory of Open Access Journals (Sweden)

    Hyunwook Kim

    2017-03-01

    Full Text Available The number of patients with end-stage renal disease (ESRD has rapidly increased, as has the cost of dialysis. Peritoneal dialysis (PD is an established treatment for ESRD patients worldwide; it has a variety of advantages, including autonomy and flexibility, as well as economic benefits in many countries compared to hemodialysis (HD. However, the long-term survival rate of PD remains poor. Although direct comparison of survival rate between the dialysis modalities by randomized controlled trials is difficult due to the ethical issues, it has always been a crucial point when deciding which dialysis modality should be recommended to patients. Recently, in many countries, including the United States, Brazil, Spain, Australia, and New Zealand, the survival rate in PD patients has significantly improved. PD patient survival in Korea has also improved, but Korean PD patients are known to have higher risk of mortality and major adverse cardiovascular, cerebrovascular events than HD patients. Herein, we further evaluate why Korean PD patients had worse outcomes; we suggest that special attention should be paid to patients with diabetes, coronary artery disease, or congestive heart failure when they choose PD as the first dialysis modality in order to reduce mortality risk.

  10. Sodium removal in peritoneal dialysis: the role of icodextrin and peritoneal dialysis modalities.

    Science.gov (United States)

    Fourtounas, Costas; Hardalias, Andreas; Dousdampanis, Periklis; Papachristopoulos, Basil; Savidaki, Eirini; Vlachojannis, Jannis G

    2008-01-01

    One of the main goals of dialysis is the control of extracellular volume, because inadequate sodium and fluid removal result in fluid overload and increased mortality. In the present study, we evaluated the roles of continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and the use of icodextrin on sodium removal in 29 patients (n = 18 on CAPD, n = 11 on CCPD). Daily removal of sodium by each modality and dialysis adequacy by Kt/V and creatinine clearance were evaluated. A significantly higher amount of sodium was removed in CAPD patients than in CCPD patients, although peritoneal dialysis clearances were lower in CAPD, and no difference in daily ultrafiltration was observed between the modalities. In the CAPD group, patients using icodextrin for the long dwell showed significantly increased 24-hour sodium removal (218 +/- 65 mmol/L) as compared with patients not using icodextrin (96.3 +/- 58 mmol/L, p icodextrin for the long dwell, and they showed significantly increased sodium removal only for the day exchange (43 +/- 49 mmol/L) as compared with patients not using icodextrin (-60 +/- 6, p Icodextrin is an effective tool not only for increasing adequacy, but also for removing more sodium in both modalities.

  11. Berardinelli-Seip syndrome in peritoneal dialysis.

    Science.gov (United States)

    Bande-Fernández, José Joaquín; García-Castro, Raúl; Sánchez-Alvarez, José Emilio; Rodríguez-Suárez, Carmen; Coronel-Aguilar, Diego; Hidalgo, Carlos; Istanbuli, Beatriz; Merino-Bueno, Carmen; Del Rio-García, Laura

    2015-01-01

    A case of Berardinelli-Seip syndrome, a congenital generalised lipodystrophy, is reported. Symptoms first appeared when the patient was 20 years old. She showed severe insulin resistance as well as micro- and macro-angiopathic complications, including chronic kidney disease, which required renal replacement therapy with peritoneal dialysis. The patient's clinical course was reviewed since paediatric age (when initial signs of the disease being already evident) to present time. Berardinelli-Seip syndrome is very uncommon, and the present case is particularly rare because it is the only case (at least as reported in the literature) in a patient receiving dialysis. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Pre-transplant dialysis modality does not influence short- or long-term outcome in kidney transplant recipients: analysis of paired kidneys from the same deceased donor.

    Science.gov (United States)

    Dipalma, Teresa; Fernández-Ruiz, Mario; Praga, Manuel; Polanco, Natalia; González, Esther; Gutiérrez-Solis, Elena; Gutiérrez, Eduardo; Andrés, Amado

    2016-09-01

    Previous studies have reported contradictory results regarding the effect of pre-transplant dialysis modality on the outcomes after kidney transplantation (KT). To minimize the confounding effect of donor-related variables, we performed a donor-matched retrospective comparison of 160 patients that received only one modality of pre-transplant dialysis (peritoneal dialysis [PD] and hemodialysis [HD] in 80 patients each) and that subsequently underwent KT at our center between January 1990 and December 2007. Cox regression models were used to evaluate the association between pre-transplant dialysis modality and primary study outcomes (death-censored graft survival and patient survival). To control for imbalances in recipient-related baseline characteristics, we performed additional adjustments for the propensity score (PS) for receiving pre-transplant PD (versus HD). There were no significant differences according to pre-transplant dialysis modality in death-censored graft survival (PS-adjusted hazard ratio [aHR]: 0.65; 95% confidence interval [95% CI]: 0.25-1.68) or patient survival (aHR: 0.58; 95% CI: 0.13-2.68). There were no differences in 10-year graft function or in the incidence of post-transplant complications either, except for a higher risk of lymphocele in patients undergoing PD (odds ratio: 4.31; 95% CI: 1.15-16.21). In conclusion, pre-transplant dialysis modality in KT recipients does not impact short- or long-term graft outcomes or patient survival.

  13. [Exploration of ultrafiltration failure in peritoneal dialysis].

    Science.gov (United States)

    Bellavia, Salvatore; Coche, Emmanuel; Goffin, Eric

    2008-12-01

    Ultrafiltration failure (UFF) is a common complication of peritoneal dialysis (PD). It may be due to a technical problem (PD catheter obstruction or migration, peritoneal leaks or intraperitoneal adhesions) or because of a peritoneal membrane alteration (hyperpermeability, aquaporin dysfunction, peritoneal sclerosis or enhanced lymphatic reabsorption). We, here, present the case of a patient who developed several consecutive PD complications that eventually led to UFF. We also present an algorithm, which may help clinicians to establish a precise etiological diagnosis of UFF.

  14. Green dialysis: the environmental challenges ahead.

    Science.gov (United States)

    Agar, John W M

    2015-01-01

    The US Environmental Protection Agency Resource Conservation website begins: "Natural resource and energy conservation is achieved by managing materials more efficiently--reduce, reuse, recycle," yet healthcare agencies have been slow to heed and practice this simple message. In dialysis practice, notable for a recurrent, per capita resource consumption and waste generation profile second to none in healthcare, efforts to: (1) minimize water use and wastage; (2) consider strategies to reduce power consumption and/or use alternative power options; (3) develop optimal waste management and reusable material recycling programs; (4) design smart buildings that work with and for their environment; (5) establish research programs that explore environmental practice; all have been largely ignored by mainstream nephrology. Some countries are doing far better than others. In the United Kingdom and some European jurisdictions, exceptional recent progress has been made to develop, adopt, and coordinate eco-practice within dialysis programs. These programs set an example for others to follow. Elsewhere, progress has been piecemeal, at best. This review explores the current extent of "green" or eco-dialysis practices. While noting where progress has been made, it also suggests potential new research avenues to develop and follow. One thing seems certain: as global efforts to combat climate change and carbon generation accelerate, the environmental impact of dialysis practice will come under increasing regulatory focus. It is far preferable for the sector to take proactive steps, rather than to await the heavy hand of government or administration to force reluctant and costly compliance on the un-prepared.

  15. Macrognathia of renal osteodystrophy in dialysis patients.

    Science.gov (United States)

    Damm, D D; Neville, B W; McKenna, S; Jones, A C; Freedman, P D; Anderson, W R; Allen, C M

    1997-04-01

    A multiinstitutional study of macrognathia secondary to renal osteodystrophy in dialysis patients is presented. The nine cases reviewed reveal a variety of radiographic and histopathologic features, some of which resemble fibrous dysplasia and others suggestive of Paget's disease of bone. This article contains diagnostic criteria for differentiating renal osteodystrophy from similar fibro-osseous proliferations along with a discussion of the underlying cause and appropriate therapeutic interventions.

  16. External Approach Microsurgery of Retinal Dialysis

    Institute of Scientific and Technical Information of China (English)

    Ying Zhang; Piqing Hu; Lixin Shun; Xuechun Zhu; Yingwu Yi; Wen Liu

    2005-01-01

    Purpose: To explore the effect of external approach microsurgery in retinal dialysis.Methods: Consecutive 30 eyes of 28 patients with retinal dialysis were enrolled for this study. The progresses of the external approach microsurgery were following. Under the surgical microscopy, the preplacement of mattress sutures for buckling and/or encircling following retrobulbar anesthesia and scleral exposure, draining subretinal fluid, the cryotherapy of retinal breaks, checking the position of breaks on scleral buckle and gases injection were performed in turn.Results: After drainage of subretinal fluid, with scleral depression cryotherapy reaction around breaks could be observed clearly under the microscopy. All breaks were located on anterior slope of the buckle. Intraoperative complications were mild subretinal hemorrhage at drainage site and corneal epithelium exfoliation in 3 eyes, respectively.Postoperative complications were mainly secondary glaucoma and retinal redetachment.The one-operation reattachmentl rate was 96.7% (29 eyes), and the final reattachment rate was 100% after one eye had a second external approach microsurgery. The postoperative vision acuity (VA) was significantly better than the preoperative VA (X2=9.529, P< 0.01).Conclusion: External approach microsurgery has favourable effect on the surgery of retinal dialysis.

  17. Lower Extremity Permanent Dialysis Vascular Access.

    Science.gov (United States)

    Parekh, Vishal B; Niyyar, Vandana D; Vachharajani, Tushar J

    2016-09-07

    Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access.

  18. Satisfaction with care in peritoneal dialysis patients.

    Science.gov (United States)

    Kirchgessner, J; Perera-Chang, M; Klinkner, G; Soley, I; Marcelli, D; Arkossy, O; Stopper, A; Kimmel, P L

    2006-10-01

    Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL.

  19. Nephrologists' professional ethics in dialysis practices.

    Science.gov (United States)

    Ozar, David T; Kristensen, Cynthia; Fadem, Stephen Z; Blaser, Robert; Singer, Dale; Moss, Alvin H

    2013-05-01

    Although the number of incidents is unknown, professional quality-oriented renal organizations have become aware of an increased number of complaints regarding nephrologists who approach patients with the purpose of influencing patients to change nephrologists or dialysis facilities (hereinafter referred to as patient solicitation). This development prompted the Forum of ESRD Networks and the Renal Physicians Association to publish a policy statement on professionalism and ethics in medical practice as these concepts relate to patient solicitation. Also common but not new is the practice of nephrologists trying to recruit their own patients to a new dialysis unit in which they have a financial interest. This paper presents two illustrative cases and provides an ethical framework for analyzing patient solicitation and physician conflict of interest. This work concludes that, in the absence of objective data that medical treatment is better elsewhere, nephrologists who attempt to influence patients to change nephrologists or dialysis facilities fall short of accepted ethical standards pertaining to professional conduct, particularly with regard to the physician-patient relationship, informed consent, continuity of care, and conflict of interest.

  20. Dialysis Modalities and HDL Composition and Function.

    Science.gov (United States)

    Holzer, Michael; Schilcher, Gernot; Curcic, Sanja; Trieb, Markus; Ljubojevic, Senka; Stojakovic, Tatjana; Scharnagl, Hubert; Kopecky, Chantal M; Rosenkranz, Alexander R; Heinemann, Akos; Marsche, Gunther

    2015-09-01

    Lipid abnormalities may have an effect on clinical outcomes of patients on dialysis. Recent studies have indicated that HDL dysfunction is a hallmark of ESRD. In this study, we compared HDL composition and metrics of HDL functionality in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) with those in healthy controls. We detected a marked suppression of several metrics of HDL functionality in patients on HD or PD. Compositional analysis revealed that HDL from both dialysis groups shifted toward a more proinflammatory phenotype with profound alterations in the lipid moiety and protein composition. With regard to function, cholesterol efflux and anti-inflammatory and antiapoptotic functions seemed to be more severely suppressed in patients on HD, whereas HDL-associated paraoxonase activity was lowest in patients on PD. Quantification of enzyme activities involved in HDL metabolism suggested that HDL particle maturation and remodeling are altered in patients on HD or PD. In summary, our study provides mechanistic insights into the formation of dysfunctional HDL in patients with ESRD who are on HD or PD.

  1. Can convective therapies improve dialysis outcomes?

    Science.gov (United States)

    Locatelli, Francesco; Manzoni, Celestina; Cavalli, Andrea; Di Filippo, Salvatore

    2009-11-01

    Convective treatments are characterized by enhanced removal of middle and large molecular weight solutes, important in the genesis of many complications of hemodialysis, compared with conventional low-flux hemodialysis. The availability of these techniques represented an intriguing innovation and a possible means to improve the still poor prognosis of hemodialysis patients. In this study we will critically review the most important published studies evaluating the impact of convective treatments on dialysis outcomes. The Hemodialysis (HEMO) study showed that greater urea removal nonsignificantly reduces the relative risk of mortality and that also high-flux hemodialysis was associated with a nonsignificant reduction, although a secondary analysis pointed to an advantage for high-flux membranes in subgroups of patients. More recently, the Membrane Permeability Outcome (MPO) study found that survival could be improved by use of high-flux membranes compared with low-flux dialysis in high-risk patients as identified by serum albumin Dialysis Outcomes and Practice Patterns (DOPPS) studies are supporting rationales for the use of convective treatments to improve survival and delay long-term complications of hemodialysis patients.

  2. Dialysis Modalities and HDL Composition and Function

    Science.gov (United States)

    Holzer, Michael; Schilcher, Gernot; Curcic, Sanja; Trieb, Markus; Ljubojevic, Senka; Stojakovic, Tatjana; Scharnagl, Hubert; Kopecky, Chantal M.; Rosenkranz, Alexander R.; Heinemann, Akos

    2015-01-01

    Lipid abnormalities may have an effect on clinical outcomes of patients on dialysis. Recent studies have indicated that HDL dysfunction is a hallmark of ESRD. In this study, we compared HDL composition and metrics of HDL functionality in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) with those in healthy controls. We detected a marked suppression of several metrics of HDL functionality in patients on HD or PD. Compositional analysis revealed that HDL from both dialysis groups shifted toward a more proinflammatory phenotype with profound alterations in the lipid moiety and protein composition. With regard to function, cholesterol efflux and anti-inflammatory and antiapoptotic functions seemed to be more severely suppressed in patients on HD, whereas HDL-associated paraoxonase activity was lowest in patients on PD. Quantification of enzyme activities involved in HDL metabolism suggested that HDL particle maturation and remodeling are altered in patients on HD or PD. In summary, our study provides mechanistic insights into the formation of dysfunctional HDL in patients with ESRD who are on HD or PD. PMID:25745027

  3. Periodontal treatment reduces chronic systemic inflammation in peritoneal dialysis patients.

    Science.gov (United States)

    Siribamrungwong, Monchai; Yothasamutr, Kasemsuk; Puangpanngam, Kutchaporn

    2014-06-01

    Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis-related data as well as highly sensitive C-reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C-reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients.

  4. Peritoneal dialysis in acute renal failure in canines: A review

    Directory of Open Access Journals (Sweden)

    R. H. Bhatt

    Full Text Available Peritoneal dialysis is a technique whereby infusion of dialysis solution into the peritoneal cavity is followed by a variable dwell time and subsequent drainage. During peritoneal dialysis, solutes and fluids are exchanged between the capillary blood and the intraperitoneal fluid through a biologic membrane, the peritoneum. Inadequate renal function leads to disturbance in the removal of the extra fluid and waste products. It removes the waste product and extra fluid from the body in renal failure in small animal practice. Peritoneal dialysis is more accessible, more affordable and easier to administer to the small animal patient. The most common indication for peritoneal dialysis in dogs is acute renal failure (ARF. Peritoneal dialysis is an important therapeutic tool for mitigating clinical signs of uremia and giving the kidneys time to recover in cats with acute kidney injury when conventional therapy is no longer effective. [Vet. World 2011; 4(11.000: 517-521

  5. Acute hydrothorax complicating peritoneal dialysis: a case report

    OpenAIRE

    2010-01-01

    Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with ac...

  6. [The diet of the elderly person undergoing dialysis].

    Science.gov (United States)

    Gourc, Christophe; Ramade, Nathalie

    2016-01-01

    The elderly patient undergoing dialysis is often at risk of undernutrition. The condition may already be present at the pre-dialysis stage and can worsen once dialysis starts. Aside from the impact on the patient's quality of life and general health status, undernutrition exposes them to serious risk of complications and can be life-threatening. It is therefore essential that it is diagnosed early. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    Directory of Open Access Journals (Sweden)

    M. Al Eissa

    2010-01-01

    Full Text Available Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients. The mean age was 51.7 years (±15.4; 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2, and Kt/V was 1.3 (±0.44. The mean satisfaction score was (7.41 ± 2.75 and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given.

  8. [Dialysis after graft failure: How to improve survival?].

    Science.gov (United States)

    Mourad, Georges; Szwarc, Ilan; Buzançais, Aurèle

    2016-04-01

    Ten to 15 % of transplant recipients will return to dialysis, or require another transplantation within 5years, rising to 23 % by 10years, and failed transplantation is now one of the major indications for starting dialysis, accounting for almost 5 % of incident dialysis patients in the US and 10 % in France. Patients who resume dialysis post-transplantation have usually experienced an extended period of uraemia and long-term immunosuppressive therapy, and exhibit high rates of anaemia and erythropoietin resistance, hypoalbuminaemia and persistent chronic inflammation from the failed graft. These factors may increase mortality risk during the first year of dialysis, as observed in the US, but not in Canada or France. When compared to a control group of transplant-naive patients followed in the same institution in France, patients with transplant failure have a higher rate of usable arteriovenous fistula or graft, a similar rate of non-planned dialysis, and initiate dialysis with a higher glomerular filtration rate. We suggest that patient survival in dialysis after graft loss is influenced by both patient characteristics and quality of care, and this may explain the favourable outcome of this specific dialysis population in France. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  9. Purification of dialysis water in the central dialysis fluid delivery system in Japan: a prospective observation study.

    Science.gov (United States)

    Uchino, Junji; Kawasaki, Tadayuki

    2009-01-01

    Whereas the main measure of dialysis fluid purity is endotoxin (ET) activity in Japan, it is the viability count in Western countries. Because of this difference, little information is available concerning dialysis fluid purity determined in terms of viability count in Japan. Under these circumstances a fact-finding investigation was planned and conducted concerning dialysis fluid purity to demonstrate the effectiveness of dialysis fluid purification measures. 93 medical institutions are equipped with the central dialysis fluid delivery system (CDDS) unique to Japan. Almost all medical institutions surveyed have achieved the purification level of ultrapure dialysis fluid after ETRF, but the methods of ETRF use and management widely vary with each institution so that early validation of the methods of evaluation of ET inhibition and system management is in urgent need. It is also important that simple universal microbial monitoring and purification procedures be diffused far and wide as suggested by the Purification Guidelines proposed by us.

  10. Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis.

    Science.gov (United States)

    Krishna, A; Singh, R; Prasad, N; Gupta, A; Bhadauria, D; Kaul, A; Sharma, R K; Kapoor, D

    2015-01-01

    Pregnancy-associated acute kidney injury (PAKI) is encountered frequently in developing countries. We evaluated the maternal, fetal and renal outcomes in women with PAKI who needed at least one session of dialysis. Of the total of 98 cases (mean age 28.85 ± 5.13 years; mean parity 2.65 ± 1.28) of PAKI, the most common cause of PAKI was postabortal sepsis. Eighteen patients died; those with oligoanuria, sepsis and central nervous system (CNS) involvement were at greater risk of mortality. The relative risk (RR) of neonatal mortality was lower after with full-term delivery (RR: 0.17, 95% confidence interval (CI): 0.03-0.96, P = 0.02) compared to preterm delivery. Of the 80 surviving patients, 60 (75%) patients achieved complete recovery of renal function at the end of 3 months; and of the remaining 14 had presumed (n = 4) or, biopsy-proven (n = 10) acute patchy cortical necrosis. The RR of non-recovery of renal function was high (RR: 24.7, 95% CI: 3.4- 179.5) in patients who did not recover at 6 weeks. Of the 14 patients with cortical necrosis, 3 (21.42%) became independent of dialysis at 6 months. PAKI patients should be watched for dialysis independency for 6 months.

  11. Product interval automata

    Indian Academy of Sciences (India)

    Deepak D’Souza; P S Thiagarajan

    2002-04-01

    We identify a subclass of timed automata called product interval automata and develop its theory. These automata consist of a network of timed agents with the key restriction being that there is just one clock for each agent and the way the clocks are read and reset is determined by the distribution of shared actions across the agents. We show that the resulting automata admit a clean theory in both logical and language theoretic terms. We also show that product interval automata are expressive enough to model the timed behaviour of asynchronous digital circuits.

  12. China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis

    Directory of Open Access Journals (Sweden)

    Hou Fanfan

    2012-08-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the main cause of death in patients on chronic dialysis. The question whether dialysis modality impacts cardiovascular risk remains to be addressed. China Collaborative Study on Dialysis, a multi-centers cohort study, was performed to evaluate cardiovascular morbidity during maintenance hemodialysis (HD and peritoneal dialysis (PD. Method The cohort consisted of chronic dialysis patients from the database of 9 of the largest dialysis facilities around China. The inclusion period was between January 1, 2005, and December 1, 2010. Cardiovascular morbidity was defined as the presence of clinically diagnosed ischemic heart disease, heart failure, peripheral vascular disease, and/or stroke. The patients who had cardiovascular morbidity before initiation of dialysis were excluded. Data collection was based on review of medical record. Result A total of 2,388 adult patients (1,775 on HD and 613 on PD were enrolled. Cardiovascular morbidity affected 57% patients and was comparable between HD and PD patients. However, clinically diagnosed ischemic heart disease and stroke was more prevalent in PD than HD patients. When the patients were stratified by age or dialysis vintage, the cardiovascular morbidity was significantly higher in PD than HD among those aged 50 years or older, or those receiving dialysis over 36 months. Multivariate analysis revealed that the risk factors for cardiovascular morbidity had different pattern in PD and HD patients. Hyperglycemia was the strongest risk factor for cardiovascular morbidity in PD, but not in HD patients. Hypertriglyceridemia and hypoalbuminemia were independently associated with CVD only in PD patients. Conclusions Cardiovascular morbidity during chronic dialysis was more prevalent in PD than HD patients among those with old age and long-term dialysis. Metabolic disturbance-related risk factors were independently associated with CVD only in PD patients

  13. Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators.

    Science.gov (United States)

    van de Luijtgaarden, Moniek W M; Jager, Kitty J; Stel, Vianda S; Kramer, Anneke; Cusumano, Ana; Elliott, Robert F; Geue, Claudia; MacLeod, Alison M; Stengel, Benedicte; Covic, Adrian; Caskey, Fergus J

    2013-05-01

    An increase in the dialysis programme expenditure is expected in most countries given the continued rise in the number of people with end-stage renal disease (ESRD) globally. Since chronic peritoneal dialysis (PD) therapy is relatively less expensive compared with haemodialysis (HD) and because there is no survival difference between PD and HD, identifying factors associated with PD use is important. Incidence counts for the years 2003-05 were available from 36 countries worldwide. We studied associations of population characteristics, macroeconomic factors and renal service indicators with the percentage of patients on PD at Day 91 after starting dialysis. With linear regression models, we obtained relative risks (RRs) with 95% confidence intervals (CIs). The median percentage of incident patients on PD was 12% (interquartile range: 7-26%). Determinants independently associated with lower percentages of patients on PD were as follows: patients with diabetic kidney disease (per 5% increase) (RR 0.93; 95% CI 0.89-0.97), health expenditure as % gross domestic product (per 1% increase) (RR 0.93; 95% CI 0.87-0.98), private-for-profit share of HD facilities (per 1% increase) (RR 0.996; 95% CI 0.99-1.00; P = 0.04), costs of PD consumables relative to staffing (per 0.1 increase) (RR 0.97; 95% CI 0.95-0.99). The factors associated with a lower percentage of patients on PD include higher diabetes prevalence, higher healthcare expenditures, larger share of private-for-profit centres and higher costs of PD consumables relative to staffing. Whether dialysis modality mix can be influenced by changing healthcare organization and funding requires additional studies.

  14. Early changes in body weight and blood pressure are associated with mortality in incident dialysis patients.

    Science.gov (United States)

    Duranton, Flore; Duny, Yohan; Szwarc, Ilan; Deleuze, Sébastien; Rouanet, Catherine; Selcer, Isabelle; Maurice, François; Rivory, Jean-Pierre; Servel, Marie-Françoise; Jover, Bernard; Brunet, Philippe; Daurès, Jean-Pierre; Argilés, Àngel

    2016-04-01

    While much research is devoted to identifying novel biomarkers, addressing the prognostic value of routinely measured clinical parameters is of great interest. We studied early blood pressure (BP) and body weight (BW) trajectories in incident haemodialysis patients and their association with all-cause mortality. In a cohort of 357 incident patients, we obtained all records of BP and BW during the first 90 days on dialysis (over 12 800 observations) and analysed trajectories using penalized B-splines and mixed linear regression models. Baseline comorbidities and all-cause mortality (median follow-up: 2.2 years) were obtained from the French Renal Epidemiology and Information Network (REIN) registry, and the association with mortality was assessed by Cox models adjusting for baseline comorbidities. During the initial 90 days on dialysis, there were non-linear decreases in BP and BW, with milder slopes after 15 days [systolic BP (SBP)] or 30 days [diastolic BP (DBP) and BW]. SBP or DBP levels at dialysis initiation and changes in BW occurring in the first month or during the following 2 months were significantly associated with survival. In multivariate models adjusting for baseline comorbidities and prescriptions, higher SBP value and BW slopes were independently associated with a lower risk of mortality. Hazard ratios of mortality and 95% confidence intervals were 0.92 (0.85-0.99) for a 10 mmHg higher SBP and 0.76 (0.66-0.88) for a 1 kg/month higher BW change on Days 30-90. BW loss in the first weeks on dialysis is a strong and independent predictor of mortality. Low BP is also associated with mortality and is probably the consequence of underlying cardiovascular diseases. These early markers appear to be valuable prognostic factors.

  15. Older peoples' satisfaction with home-based dialysis.

    Science.gov (United States)

    Derrett, Sarah; Darmody, Maryann; Williams, Sheila; Rutherford, Merrin; Schollum, John; Walker, Rob

    2010-06-01

    The proportion of older people receiving dialysis is rapidly increasing. The typical choice for older patients is between home-based peritoneal dialysis (PD) and clinic-based haemodialysis (HD). Some centres have been successful in encouraging all patients - including older patients - to have home-based self-administered PD or HD. To (i) describe the overall satisfaction with renal services among older patients dialysing, or in training, with HD or PD at home; and (ii) examine the relationship between residential distance from the nephrology unit and satisfaction with home-based dialysis. Participants were aged 60 years or more; and were either dialysing at home or training for dialysis at home. Two methods of cross-sectional data collection were used: (i) structured quantitative interviews with all participants; and (ii) qualitative interviews with a selected subgroup. Participants comprised 45 patients on dialysis (94% of 48 eligible). Their average age was 68 years. Duration of dialysis averaged 28 months (range 3-150 months). Ratings of 'very good or excellent' were reported for dialysis treatment by 40 (89%) patients. Patients on dialysis, despite experiencing frustration with dialysis itself, expressed satisfaction across four categories: staff, information provision, involvement in decision-making and confidence in managing dialysis. Dissatisfaction was infrequent. This pilot study suggests that older patients trained to dialyse at home using PD or HD are highly satisfied with the nephrology service - even when living remote from the nephrology unit. Home-based dialysis is possible in older patients with levels of comorbidity and disease severity as serious as elsewhere.

  16. Signatures of the two day wave and sudden stratospheric warmings in Arctic water vapour observed by ground-based microwave radiometry

    Directory of Open Access Journals (Sweden)

    B. Tschanz

    2015-01-01

    Full Text Available The ground-based microwave radiometer MIAWARA-C recorded the upper stratospheric and lower mesospheric water vapour distribution continuously from June 2011 to March 2013 above the Arctic station of Sodankylä, Finland (67.4° N, 26.6° E without major interruptions and offers water vapour profiles with temporal resolution of one hour for average conditions. Over the measurement period, the instrument monitored the changes in water vapour linked to two sudden stratospheric warmings in early 2012 and 2013. Based on the water vapour measurements, the descent rate in the vortex after the warmings is 364 m d−1 for 2012 and 315 m d−1 for 2013. The water vapour time series of MIAWARA-C shows strong periodic variations in both summer and winter related to the quasi two day wave. In the mesosphere the amplitudes are strongest in summer. The stratospheric wintertime two day wave is pronounced for both winters and reaches a maximum amplitude of 0.8 ppmv in November 2011.

  17. Effects of exercise therapy during dialysis for elderly patients undergoing maintenance dialysis

    Science.gov (United States)

    Chigira, Yusuke; Oda, Takahiro; Izumi, Masataka; Yoshimura, Tukasa

    2017-01-01

    [Purpose] Exercise therapy during dialysis is currently being recommended since it is easy for patients to follow and results in high participation rates. In this study, this therapy was performed for elderly patients undergoing maintenance dialysis, and its effects were examined. [Subjects and Methods] Seven elderly patients (age: 70.6 ± 4.4) with chronic renal failure, who were able to perform exercises during maintenance dialysis, received the exercise therapy 2 or 3 times weekly for 3 months. Lower-limb muscle strength as well as the standardized dialysis dose (Kt/V) was measured before and after intervention. The patients were also evaluated using the 30-sec chair stand test (CS-30), the World Health Organization QOL Assessment 26 (WHO-QOL26), and a questionnaire. [Results] The lower-limb muscle strength and circumference, CS-30 score, and Kt/V values improved after intervention, but the difference was not significant. Significant differences were observed only in the WHO-QOL26 score. [Conclusion] The outcome was particularly favorable in terms of the quality of life (QOL). Based on the results from the questionnaire, the higher QOL may be due to the patients’ development of a positive attitude toward these activities. Although there were no significant differences, the values for the other criteria also improved, thereby supporting the effectiveness of exercise therapy to maintain or improve the patients’ motor functions and activity daily living (ADL) ability. PMID:28210031

  18. Natural history of tunneled dialysis catheters placed for hemodialysis initiation.

    Science.gov (United States)

    Shingarev, Roman; Barker-Finkel, Jill; Allon, Michael

    2013-09-01

    More than 80% of hemodialysis recipients in the United States initiate hemodialysis with a tunneled dialysis catheter (TDC). Published data on TDC outcomes are based on a case mix of prevalent and incident TDCs. The present study analyzes factors affecting patency and complications of first TDCs placed in a large cohort of incident hemodialysis recipients. A prospective, computerized vascular access database was retrospectively queried to identify 472 patients receiving a first-ever TDC. Multiple-variable survival analysis was used to identify clinical parameters affecting TDC patency (from placement to nonelective removal) and infection (from placement to first episode of catheter-related bacteremia [CRB]). The median patency of all TDCs was 202 days. Left-sided placement of TDCs was the only variable associated with inferior TDC patency (hazard ratio, 1.98; 95% confidence interval, 1.39-2.81; P catheters, versus 54% for right internal jugular vein (RIJV) catheters. The 1-year patency rate was 6% for LIJV catheters, versus 35% for RIJV catheters. Catheter patency was not associated with patient age, sex, race, hypertension, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, or heart failure. The median time to the first episode of CRB was 163 days. None of the clinical variables was associated with TDC infection. TDCs are plagued by high rates of infection. RIJV TDCs should be used preferentially to maximize catheter patency. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  19. Dialysis Requiring Acute Kidney Injury in Acute Cerebrovascular Accident Hospitalizations.

    Science.gov (United States)

    Nadkarni, Girish N; Patel, Achint A; Konstantinidis, Ioannis; Mahajan, Abhimanyu; Agarwal, Shiv Kumar; Kamat, Sunil; Annapureddy, Narender; Benjo, Alexandre; Thakar, Charuhas V

    2015-11-01

    The epidemiology of dialysis requiring acute kidney injury (AKI-D) in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) admissions is poorly understood with previous studies being from a single center or year. We used the Nationwide Inpatient Sample to evaluate the yearly incidence trends of AKI-D in hospitalizations with AIS and ICH from 2002 to 2011. We also evaluated the trend of impact of AKI-D on in-hospital mortality and adverse discharge using adjusted odds ratios (aOR) after adjusting for demographics and comorbidity indices. We extracted a total of 3,937,928 and 696,754 hospitalizations with AIS and ICH, respectively. AKI-D occurred in 1.5 and 3.5 per 1000 in AIS and ICH admissions, respectively. Incidence of admissions complicated by AKI-D doubled from 0.9/1000 to 1.7/1000 in AIS and from 2.1/1000 to 4.3/1000 in ICH admissions. In AIS admissions, AKI-D was associated with 30% higher odds of mortality (aOR, 1.30; 95% confidence interval, 1.12-1.48; Pcerebrovascular accident continues to grow and is associated with increased mortality and adverse discharge. This highlights the need for early diagnosis, better risk stratification, and preparedness for need for complex long-term care in this vulnerable population. © 2015 American Heart Association, Inc.

  20. Effects of peritoneal dialysis fluid biocompatibility on baroreflex sensitivity.

    Science.gov (United States)

    John, S G; Selby, N M; McIntyre, C W

    2008-04-01

    Conventional low biocompatibility peritoneal dialysis (PD) fluid composition has been driven by manufacturing expediency and cost limitations. PD is associated with significant acute changes in cardiovascular functional parameters, at least in part influenced by fluid composition. Short-term control of blood pressure (BP) is under control of the baroreflex arc. The aim of this study was to investigate the effects of PD fluid biocompatibility on baroreflex sensitivity (BRS). We studied 10 non-diabetic established continuous ambulatory PD patients, in a randomized crossover trial comparing conventional and biocompatible PD fluids. Systemic hemodynamics were continuously monitored using digital pulse-wave analysis. Plasma glucose and insulin were assessed during treatment with both 1.36% and 3.86% glucose-containing fluids. BRS was calculated offline from continuous BP and interbeat interval data. BRS was significantly higher with conventional PD fluid during both 1.36% (Pinsulin concentrations, and ultrafiltration volumes were significantly higher during the 3.86% dwell than the 1.36% dwell, but there were no differences between standard and biocompatible fluids. We have demonstrated for the first time that PD fluid biocompatibility rapidly affects BRS. These changes occur against a background of cardiovascular variability, hyperinsulinemia, and hyperglycemia. Further research is needed to explore the mechanism and, more importantly, the consequences of these findings.

  1. Entropy of uremia and dialysis technology.

    Science.gov (United States)

    Ronco, Claudio

    2013-01-01

    The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they consume. Death is the thermodynamically favored state: it represents a large increase in entropy as molecular structure yields to chaos. The kidney is an organ dissipating large amounts of energy to maintain the level of entropy of the organism as low as possible. Diseases, and in particular uremia, represent conditions of rapid increase in entropy. Therapeutic strategies are oriented towards a reduction in entropy or at least a decrease in the speed of entropy increase. Uremia is a process accelerating the trend towards randomness and disorder (increase in entropy). Dialysis is a factor external to the patient that tends to reduce the level of entropy caused by kidney disease. Since entropy can only increase in closed systems, energy and work must be spent to limit the entropy of uremia. This energy should be adapted to the system (patient) and be specifically oriented and personalized. This includes a multidimensional effort to achieve an adequate dialysis that goes beyond small molecular weight solute clearance. It includes a biological plan for recovery of homeostasis and a strategy towards long-term rehabilitation of the patient. Such objectives can be achieved with a combination of technology and innovation to answer specific questions that are still present after 60 years of dialysis history. This change in the individual bioentropy may represent a local exception to natural trends as the patient could be considered an isolated universe responding to the classic laws of thermodynamics.

  2. Automated peritoneal dialysis in Brunei Darussalam.

    Directory of Open Access Journals (Sweden)

    Ishrat KAMAL

    2011-04-01

    Full Text Available Introduction: Chronic kidney disease in Brunei Darussalam is a growing problem. The number of patients reaching end stage kidney failure has increased dramatically in the last ten years. Currently, most are managed with haemodialysis while a smaller proportion is managed with continuous ambulatory peritoneal dialysis (CAPD. Automated peritoneal dialysis (APD is a form of peritoneal dialysis and has been used in Brunei Darussalam since May 2008. Materials and Methods: Eight patients participated in this prospective clinical trial. As all APD patients were previously on CAPD, comparisons are made between the outcomes of APD against CAPD. Results: The median and mean age of APD patients were 42 and 45.5 ± 12.73 years respectively. After switching to APD, the serum haemoglobin and albumin improved from 10.56 ± 1.95 gm/L and 27.88 ± 7.71 gm/dL to 12.26 ± 1.82 gm/L and 33.63 ± 6.89 gm/dL respectively (p values <0.05. This corresponded to improvements in seven (87.5% and six (75% patients respectively in both parameters. Erythropoietin requirement was reduced in six (75% patients, including three (37.5% patients who were able to stop erythropoietin completely. There was no peritonitis encountered. All patients reported improved quality of life with better sleep, appetite and general well-being. Conclusions: Our study showed that APD was as good as CAPD with improvement seen in both laboratory and quality of life parameters. There was also reduction in erythropoietin requirement. Based on these findings, we will actively encourage and promote APD usage as oppose to CAPD usage in our population.

  3. [Peritonitis in pediatric patients receiving peritoneal dialysis].

    Science.gov (United States)

    Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar

    2015-12-01

    Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  4. Continuous ambulatory peritoneal dialysis: no longer experimental.

    OpenAIRE

    WU, G.; Khanna, R.; Vas, S I; Digenis, G.; Oreopoulos, D G

    1984-01-01

    Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months ...

  5. Evaluation of dialyzer jacket structure and hollow-fiber dialysis membranes to achieve high dialysis performance.

    Science.gov (United States)

    Hirano, Ayaka; Yamamoto, Ken-ichiro; Matsuda, Masato; Ogawa, Takehito; Yakushiji, Taiji; Miyasaka, Takehiro; Sakai, Kiyotaka

    2011-02-01

    The objective of this study was to determine the optimum dialyzer jacket structure and hollow-fiber dialysis membrane, both of which are indispensable factors for achieving high dialysis performance, by clarifying the relationship between the dialysis performance and the flow of dialysate and blood in a hollow-fiber dialyzer. We evaluated the clearance, dialysate, and blood flow for four commercially available hollow-fiber dialyzers, namely, the APS-15S, APS-15SA, TS-1.6UL, and CX-1.6U. To evaluate dialysate and blood flow, we measured the residence-time distribution of dialysate and blood flow of these dialyzers by the pulse-response method. We also determined the clearances of urea, creatinine, vitamin B(12), and lysozyme to evaluate the dialysis performance of these dialyzers. While the baffle and taper structures allow effective supply of dialysate into the dialyzer jacket, the hollow-fiber shape, inner diameter, and packing density significantly influence the dialysate flow. In dialyzers with long taper-holding slits, the slit area is a key design parameter for achieving optimum dialysate flow. Similarly, the blood flow is significantly influenced by the structure of the inflowing and outflowing blood ports at the header of a dialyzer, and the shape and inner diameter of the hollow fibers. Hollow fibers with smaller inner diameters cause an increase in blood pressure, which causes blood to enter the hollow fibers more easily. The hollow-fiber shape hardly affects the blood flow. While improved dialysate and blood flow cause higher clearance of low molecular-weight substances, higher membrane area and pure-water permeability accelerate internal filtration, thereby causing an increase in the clearance of large molecular-weight substances. © 2010 The Authors. Therapeutic Apheresis and Dialysis © 2010 International Society for Apheresis.

  6. Water-Permeable Dialysis Membranes for Multi-Layered Micro Dialysis System

    Directory of Open Access Journals (Sweden)

    Naoya eTo

    2015-06-01

    Full Text Available This paper presents the development of water-permeable dialysis membranes that are suitable for an implantable microdialysis system that does not use dialysis fluid. We developed a microdialysis system integrating microfluidic channels and nanoporous filtering membranes made of polyethersulfone (PES, aiming at a fully implantable system that drastically improves the quality of life of patients. Simplicity of the total system is crucial for the implantable dialysis system, where the pumps and storage tanks for the dialysis fluid pose problems. Hence, we focus on hemofiltration, which does not require the dialysis fluid but water-permeable membranes. We investigated the water-permeability of the PES membrane with respect to the concentrations of the PES, the additives, and the solvents in the casting solution. Sufficiently water-permeable membranes were found through in vitro experiments using whole bovine blood. The filtrate was verified to have the concentrations of low-molecular-weight molecules, such as sodium, potassium, urea, and creatinine, while proteins, such as albumin, were successfully blocked by the membrane. We conducted in vivo experiments using rats, where the system was connected to the femoral artery and jugular vein. The filtrate was successfully collected without any leakage of blood inside the system and it did not contain albumin but low-molecular-weight molecules whose concentrations were identical to those of the blood. The rat model with renal failure showed 100% increase of creatinine in 5 h, while rats connected to the system showed only a 7.4% increase, which verified the effectiveness of the proposed microdialysis system.

  7. Cardiovascular and noncardiovascular mortality among men and women starting dialysis

    DEFF Research Database (Denmark)

    Carrero, Juan J; de Jager, Dinanda J; Verduijn, Marion;

    2011-01-01

    Although women have a survival advantage in the general population, women on dialysis have similar mortality to men. We hypothesized that this paired mortality risk during dialysis may be explained by a relative excess of cardiovascular-related mortality in women....

  8. Multicystic transformation of the kidneys in dialysis patients

    DEFF Research Database (Denmark)

    Frifelt, J J; Larsen, C; Elle, Birgitte;

    1989-01-01

    In a dialysis population patients who had been treated merely with haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) were examined with ultrasound. The occurrence of multicystic transformation of the kidney was 4/15 in HD patients and 8/25 in CAPD patients with no significant...

  9. Acute hydrothorax complicating peritoneal dialysis: a case report

    Directory of Open Access Journals (Sweden)

    Ranganathan Dwarkanathan

    2010-11-01

    Full Text Available Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis. Conclusion Although our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.

  10. Dialysis modalities as risk factors in the development of atherosclerosis

    Directory of Open Access Journals (Sweden)

    Damjanović Tatjana

    2003-01-01

    Full Text Available Introduction Atherosclerosis is a major risk factor for increased cardiovascular morbidity and mortality in dialysis patients. First clinical symptoms are usually associated with initial atherosclerotic changes of blood vessels. The aim of this study was ultrasound evaluation of intimae media thickness (IMT of carotid arteries in dialysis patients and its correlation with certain risk factors. Patients and methods IMT was measured in 45 dialysis patients with no signs of cardiovascular diseases:15 continuous ambulatory peritoneal dialysis (CAPD patients, 30 haemodialysis (HD patients and in 20 healthy controls. IMT was correlated with certain risk factors for atherosclerosis (general parameters - age, gender, duration of dialysis cause of renal diseases, parameters of nutrition, parameters of calcium and phosphorus metabolism, lipid parameters, blood pressure and smoking. Results The mean carotid artery IMT was significantly higher in dialysis patients than in the control group (p<0.05. In addition, the mean IMT was statistically significantly higher in PD than in HD patients (p<0.05. In CAPD patients there was a significant correlation between IMT and total and LDL cholesterol. In the second group (HD patients IMT was significantly correlated with diastolic blood pressure, BMI and smoking. Conclusion Although atherosclerotic cardiovascular disease may not manifest in dialysis patients, IMT of carotid arteries significantly increases. Major risk factors affecting IMT are lipid disturbances in patients on peritoneal dialysis and hypertension, obesity and smoking in HD patients.

  11. Kidney Dialysis Patients Discover New Hope through ABE Program.

    Science.gov (United States)

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  12. Age-related and prognostic risk factors in dialysis patients

    NARCIS (Netherlands)

    G.L. Tripepi (Giovanni)

    2012-01-01

    textabstractThe replacement of renal function by dialysis is one of the major achievements of modern medicine. However, given the fact that renal failure shares common causes with cardiovascular diseases, dialysis patients are a population with a risk profile of almost unique severity. In fact, it w

  13. Measures of blood pressure and cognition in dialysis patients

    Science.gov (United States)

    There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...

  14. Dialysate as food as an option for automated peritoneal dialysis

    NARCIS (Netherlands)

    H.L. Tjiong (Hoey Lan); R. Swart (Roel); J.W.O. van den Berg (Willem); M.W.J.A. Fieren (Marien)

    2008-01-01

    textabstractProtein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could

  15. Nutritional status over time in hemodialysis and peritoneal dialysis

    NARCIS (Netherlands)

    Jager, KJ; Merkus, MP; Huisman, RM; Boeschoten, EW; Dekker, FW; Korevaar, JC; Tijssen, JGP; Krediet, RT

    2001-01-01

    Malnutrition is a risk factor for mortality in the dialysis population. So far, prospective studies comparing the time course of nutritional status in new hemodialysis (HD) and peritoneal dialysis (PD) patients have not been published. The aims of this study were to compare the time course of nutrit

  16. Current topics of purification and constitutions of dialysis fluid.

    Science.gov (United States)

    Tomo, Tadashi

    2015-01-01

    Dialysis fluid is a fundamental component of hemodialysis treatment, and its roles include the correction of electrolyte levels, pH, and osmolality, as well as the removal of uremic solutes from the blood of patients with renal failure. In recent years, purification of dialysis fluid has become essential due to the use of high-flux membrane dialyzers. Therefore, rigorous standards have been established for the purification of dialysis fluid, which is becoming widely practiced in Japan. The effects of dialysis fluid purification include the prevention of micro-inflammation, preservation of residual renal function, improvement of nutritional status, and resolution of resistance to erythropoiesis-stimulating agents. When purifying the dialysis fluid used in the central dialysis fluid delivery system, validation of the system is also important. Dialysis fluid that does not contain acetate has become available, and there have been reports of decreased micro-inflammation, etc., with this innovation. In addition, dialysis fluid containing a higher concentration of bicarbonate than is conventionally employed has become available. Although correction of acidosis remains important, excess alkalosis may reportedly worsen the survival prognosis of hemodialysis patients. Sufficient attention should be paid to these issues.

  17. Dialysis and renal transplantation in HIV-infected patients

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;

    2010-01-01

    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  18. Microcystin exposure and biochemical outcomes among dialysis patients

    Science.gov (United States)

    Background and aims Dialysis patients appear to be at special risk for exposure to cyanobacteria toxins; episodes of microcystin (MCYST) exposure via dialysate during 1996 and 2001 have been previously reported. During 2001, as many as 44 dialysis patients were exposed to contam...

  19. Shewanella algae Peritonitis in Patients on Peritoneal Dialysis.

    Science.gov (United States)

    Shanmuganathan, Malini; Goh, Bak Leong; Lim, Christopher; NorFadhlina, Zakaria; Fairol, Ibrahim

    Patients with peritonitis present with abdominal pain, diarrhea, fever, and turbid peritoneal dialysis (PD) fluid. Shewanella algae peritonitis has not yet been reported in PD patients in the literature. We present the first 2 cases of Shewanella algae peritonitis in PD patients. Mupirocin cream is applied on the exit site as prophylactic antibiotic therapy. Copyright © 2016 International Society for Peritoneal Dialysis.

  20. Reducing staff turnover: a case study of dialysis facilities.

    Science.gov (United States)

    Tai, T W; Robinson, C D

    1998-01-01

    A multivariate logistic analysis of 42 Texas dialysis facilities indicated that younger, white, short tenure, an LVN/LPN, with less support from family and friends for emotional concerns, and less supervisor support significantly increased the likelihood of turnover (p staff turnover of these dialysis facilities increases costs and impedes the delivery of quality patient care. Managerial strategies to increase staff retention are suggested.

  1. A peritoneal dialysis patient with osmotic demyelination syndrome

    Directory of Open Access Journals (Sweden)

    Hing Ming Cheng

    2016-04-01

    Full Text Available A peritoneal dialysis patient with cirrhosis presented with drowsiness, vomiting, and mild hyponatremia. Despite no active correction of hyponatremia, she developed convulsion and quadriplegia. Magnetic resonance imaging of the brain showed changes of osmotic demyelination syndrome. This case illustrates that osmotic demyelination syndrome may occur in peritoneal dialysis without rapid correction of hyponatremia.

  2. Interval methods: An introduction

    DEFF Research Database (Denmark)

    Achenie, L.E.K.; Kreinovich, V.; Madsen, Kaj

    2006-01-01

    . An important characteristic of the computer performance in scientific computing is the accuracy of the Computation results. Often, we can estimate this accuracy by using traditional statistical techniques. However, in many practical situations, we do not know the probability distributions of different...... the potential for solving increasingly difficult computational problems. However, given the complexity of modern computer architectures, the task of realizing this potential needs careful attention. A main concern of HPC is the development of software that optimizes the performance of a given computer...... measurement, estimation, and/or roundoff errors, we only know estimates of the upper bounds on the corresponding measurement errors, i.e., we only know an interval of possible values of each such error. The papers from the following chapter contain the description of the corresponding '' interval computation...

  3. Varieties of Confidence Intervals.

    Science.gov (United States)

    Cousineau, Denis

    2017-01-01

    Error bars are useful to understand data and their interrelations. Here, it is shown that confidence intervals of the mean (CI M s) can be adjusted based on whether the objective is to highlight differences between measures or not and based on the experimental design (within- or between-group designs). Confidence intervals (CIs) can also be adjusted to take into account the sampling mechanisms and the population size (if not infinite). Names are proposed to distinguish the various types of CIs and the assumptions underlying them, and how to assess their validity is explained. The various CIs presented here are easily obtained from a succession of multiplicative adjustments to the basic (unadjusted) CI width. All summary results should present a measure of precision, such as CIs, as this information is complementary to effect sizes.

  4. Applications of interval computations

    CERN Document Server

    Kreinovich, Vladik

    1996-01-01

    Primary Audience for the Book • Specialists in numerical computations who are interested in algorithms with automatic result verification. • Engineers, scientists, and practitioners who desire results with automatic verification and who would therefore benefit from the experience of suc­ cessful applications. • Students in applied mathematics and computer science who want to learn these methods. Goal Of the Book This book contains surveys of applications of interval computations, i. e. , appli­ cations of numerical methods with automatic result verification, that were pre­ sented at an international workshop on the subject in EI Paso, Texas, February 23-25, 1995. The purpose of this book is to disseminate detailed and surveyed information about existing and potential applications of this new growing field. Brief Description of the Papers At the most fundamental level, interval arithmetic operations work with sets: The result of a single arithmetic operation is the set of all possible results as the o...

  5. Acinetobacter Peritoneal Dialysis Peritonitis: A Changing Landscape over Time

    Science.gov (United States)

    Chao, Chia-Ter; Lee, Szu-Ying; Yang, Wei-Shun; Chen, Huei-Wen; Fang, Cheng-Chung; Yen, Chung-Jen; Chiang, Chih-Kang; Hung, Kuan-Yu; Huang, Jenq-Wen

    2014-01-01

    Background Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD) peritonitis are rare. Methods All PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000). Results Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes) in 25 patients. A. baumannii was the most common pathogen (54%), followed by A. iwoffii (35%), with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01). The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05). All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%). Nearly half of the patients (46%) required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences. Conclusions The temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients. PMID:25314341

  6. Acinetobacter peritoneal dialysis peritonitis: a changing landscape over time.

    Directory of Open Access Journals (Sweden)

    Chia-Ter Chao

    Full Text Available Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD peritonitis are rare.All PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000.Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes in 25 patients. A. baumannii was the most common pathogen (54%, followed by A. iwoffii (35%, with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01. The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05. All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%. Nearly half of the patients (46% required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences.The temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients.

  7. Stability of vancomycin in icodextrin peritoneal dialysis solution.

    Science.gov (United States)

    Nornoo, Adwoa O; Elwell, Rowland J

    2006-11-01

    Icodextrin is a glucose polymer used as an alternative osmotic agent in peritoneal dialysis (PD) solutions. There are few data regarding the long-term stability of vancomycin in icodextrin PD solution. To determine the chemical stability of vancomycin in icodextrin PD solution in polyvinyl chloride containers over a 7 day period at 4, 24, and 37 degrees C. Study samples were prepared by adding 2000 mg vancomycin HCl to commercially available 2.0 L bags of icodextrin 7.5% PD solution. Nine bags were prepared and stored in the following conditions: 3 under refrigeration (5 degrees C), 3 at room temperature (24 degrees C), and 3 at body temperature (37 degrees C). Samples were withdrawn from each bag immediately after preparation and at predetermined intervals over the subsequent 7 days. Solutions were visually inspected for precipitation, cloudiness, or discoloration at each sampling interval. Total concentration of vancomycin in dialysate fluid was determined by high performance liquid chromatography. Under refrigeration, a mean +/- SD of 99.7% +/- 0.5% of the initial vancomycin concentration remained at 168 hours (7 days). At room temperature, 97.5% +/- 3.4% remained at 168 hours. At body temperature, 94.3% +/- 3.9% remained at 24 hours. Stability was not assessed beyond these time points. Premixed vancomycin-icodextrin PD solutions, whether stored refrigerated or at room temperature, were found to be stable for up to 7 days. However, we recommend that these solutions be kept refrigerated whenever possible. Solutions stored at body temperature were stable for up to 24 hours, permitting the practice of prewarming solutions prior to administration.

  8. Use of a simplified spectrophotometric method for quantitative determination of glucose-6-phosphate dehydrogenase activity in normal children from two day-care centers of the city of São Paulo

    Directory of Open Access Journals (Sweden)

    Roberto Muller

    2003-06-01

    Full Text Available Objective: To evaluate the applicability of a simplified method forquantitative determination of glucose-6-phosphate dehydrogenaseactivity in normal children; to determine the mean, standarddeviation and threshold value under which the enzyme activity isconsidered deficient. Methods: Blood samples were collected from201 children from two day-care centers in the city of São Paulo.The subjects were considered normal based on physicalexamination and laboratory tests. The enzyme activity wasdetermined in red blood cells of normal children using the “TestCombination G-6-PDH®” kit. The following statistical analyses werecarried out: the results were submitted to Student’s t test,Kolmogorov-Smirnov test, lower confidence interval (one-tailedtest and Spearman’s correlation coefficient. Results: The meanhemoglobin value for girls was slightly higher than the mean valuefor boys, but this difference was not statistically significant. Therewas no statistical difference in mean enzyme activities for Caucasianand non-Caucasian children. There was no significant correlation amongenzyme activity levels, red blood cells, hemoglobin levels,hematocrit, reticulocytes, white blood cells and age of patients.The mean enzyme activity for boys was 4.448 U/g Hb, standarddeviation = 1.380 U/g Hb. For girls, the mean enzyme activity was4.531 U/g Hb, standard deviation = 1.386 U/g Hb, and the differencewas not statistically significant. Therefore, the two populationgroups were considered as one single population, presenting amean enzyme activity of 4.490 U/g Hb, standard deviation = 1.380 U/g Hb.Since the distribution curve of enzyme activity values was normal,a lower confidence interval was determined (one-tailed test, witha cutoff point of 2.227 U/g Hb. Conclusion: The method used bySolem proved to be simple, fast, very accurate and useful to detectglucose-6-phosphate dehydrogenase activity and to identifychildren with enzyme deficiency.

  9. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis.

    Science.gov (United States)

    Koch, Michael; Kohnle, Matthias; Trapp, Rudolf; Haastert, Burkhard; Rump, Lars Christian; Aker, Sendogan

    2012-01-01

    The impact of dialysis modality on outcome, especially on infection early in the course of dialysis, in unplanned acute dialysis initiation has not been well evaluated. The aim of the study was to compare the rates and causes of mortality and morbidity in incident dialysis patients started unplanned acute peritoneal dialysis (PD) or haemodialysis (HD). In this observational cohort study, incident dialysis patients with initiation of unplanned and acute PD (n = 66) or HD (n = 57) at a single centre from March 2005 to June 2010 were included and followed up for 6 months (0-183 days, mean follow-up time 4.72 months). For PD, surgically placed Tenckhoff catheters were used. All HD patients were dialysed with a central venous catheter (non-tunnelled or tunnelled). There were no significant differences in terms of gender, age and prevalence of diabetes mellitus in either group. The prevalence of heart failure [New York Heart Association (NYHA) Stage III-IV] was significantly higher in the PD group (73 versus 46% in HD group, P dialysis, n = 44 (35.8%) died during the follow-up period of 0-183 days. There were no significant difference in half-year mortality in n = 20 PD patients (30.3%) versus n = 24 HD patients (42.1%) (P = 0.19). The cardiovascular mortality in PD and HD patients were 9.1 and 10.5%, respectively (P = 1.00). Overall mortality due to infection was higher in the HD (17.5%) versus in the PD group (9.1%), however, not significant (P = 0.19). HD patients had significantly higher probability of bacteraemia in the first 183 days compared to PD patients (21.1 versus 3.0%, P dialysis, male sex, heart failure (NYHA III-IV), diabetes, malignancy and peripheral arterial occlusive disease Stage IV. There were high proportions of hospitalization after the initiation of dialysis in both groups (PD 75.0% and HD 67.3%, P = 0.40). Univariate and multiple regression analyses revealed only age at initiation of dialysis to be significantly associated with overall mortality

  10. Peritoneal Dialysis in Diabetics: There Is Room for More

    Directory of Open Access Journals (Sweden)

    P. Cotovio

    2011-01-01

    Full Text Available End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.

  11. A meta-analysis of icodextrin versus glucose containing peritoneal dialysis in metabolic management of peritoneal dialysis patients.

    Science.gov (United States)

    He, Qiang; Zhang, Wei; Chen, Jianghua

    2011-01-01

    The objective of this article is to study the available works on comparison between icodextrin-based solutions (ICO) and glucose-based solutions (GLU) in peritoneal dialysis (PD) patients. The final aim was to get evidence for potential differences in metabolic management of PD patients by comparing the ICO with the GLU for the long dwell once a day. A meta-analysis of included reports, identified by MEDLINE and other sources, containing information on fasting plasma glucose, total cholesterol, triglycerides, and so on in PD patients, was performed. Nine randomized controlled trials (RCTs) (553 patients) were included. The ICO did not differ from the GLU with respect to fasting plasma glucose (weighted mean difference (WMD) = -0.76; 95% confidence interval (CI) = -1.79 to 0.28; Z = 1.43; p = 0.15), triglycerides (WMD = -0.66; 95% CI = -1.40 to 0.09; Z = 1.73; p = 0.08), and body weight (WMD = -2.02; 95% CI = -5.06 to 1.03; Z = 1.30; p = 0.20). But peritoneal creatinine clearance (WMD = 0.49; 95% CI = 0.34-0.64; Z = 6.35; p ICO versus the GLU. The ICO had been shown to have significant advantages over the GLU in small solute clearance and plasma total cholesterol. Patients, no matter what kind of PD solution was used, had no significant difference of plasma triglycerides, fasting plasma glucose, and body weight.

  12. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry.

    Science.gov (United States)

    Benabed, Anais; Bechade, Clemence; Ficheux, Maxence; Verger, Christian; Lobbedez, Thierry

    2016-04-01

    Diabetic patients treated by peritoneal dialysis (PD) have been reported to be at an increased risk of peritonitis. This has been attributed to impairment in host defense, visual impairment, disability and muscle wasting, which could compromise ability to safely perform catheter connections. This study aimed to evaluate whether assisted PD is associated with a lower risk of peritonitis in diabetic patients. This was a retrospective study based on data from the French Language Peritoneal Dialysis Registry. We included diabetic patients starting PD between 1 January 2002 and 31 December 2012. The end of the observation period was 31 December 2013. Using complementary regression analysis (Fine and Gray, Hurdle models), we assessed the relationship between peritonitis occurrence, peritonitis number over time and the type of assisted PD. Of the 3598 diabetic patients, there were 2040 patients on nurse-assisted PD. These patients were older, more comorbid and more frequently on continuous ambulatory peritoneal dialysis (CAPD). In the multivariate analysis, nurse assistance was associated with a reduced risk of peritonitis in the Fine and Gray [subdistribution hazard ratio: 0.78 (95% confidence interval, CI, 0.68-0.89)] and in the first component of the Hurdle models [rate ratio: 0.82 (95% CI 0.71-0.93)], but not a lower incidence of peritonitis after an initial episode [rate ratio: 0.82 (95% CI 0.95-1.38)]. Transplant failure, glomerulonephritis and CAPD were associated with an increased risk. In France, nurse-assisted PD is associated with a lower risk of peritonitis in diabetic patients treated by PD but not a lower incidence of peritonitis. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  13. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Hans U Gerth

    Full Text Available High-cut-off hemodialysis (HCO-HD can effectively reduce high concentrations of circulating serum free light chains (sFLC in patients with dialysis-dependent acute kidney injury (AKI due to multiple myeloma (MM. Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD or HCO-HD.The final cohort consisted of 59 patients treated with HCO-HD (n = 42 or conv. HD (n = 17. A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3% compared with conv. HD patients (29.4%; p = 0.007. The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014. Multivariate regression and decision tree analysis (recursive partitioning revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI 1.5-24.5], p = 0.011 and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045 as independent and paramount variables associated with a favorable renal outcome.In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.

  14. Dialyzer Reuse and Outcomes of High Flux Dialysis.

    Directory of Open Access Journals (Sweden)

    Christos Argyropoulos

    Full Text Available The bulk of randomized trial evidence for the expanding use of High Flux (HF hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO allowed, while the other (Membrane Outcomes Permeability, MPO excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF dialyzers.Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO.In HEMO, minimally reused (< 6 times HF dialyzers were associated with a hazard ratio (HR of 0.67 (95% confidence interval, 95%CI: 0.48-0.92, p = 0.015, 0.64 (95%CI: 0.44 - 0.95, p = 0.03, 0.61 (95%CI: 0.41 - 0.90, p = 0.012, 0.53 (95%CI: 0.28 - 1.02, p = 0.057 relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005 for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively. Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51-0.78 for non-reused HF dialyzers compared with non-reused LF membranes.This secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of

  15. Peritoneal dialysis outcomes after temporary haemodialysis transfer for peritonitis.

    Science.gov (United States)

    Cho, Yeoungjee; Badve, Sunil V; Hawley, Carmel M; McDonald, Stephen P; Brown, Fiona G; Boudville, Neil; Clayton, Philip; Johnson, David W

    2014-10-01

    There has not been a comprehensive examination to date of peritoneal dialysis (PD) outcomes after temporary haemodialysis (HD) transfer for peritonitis. The study included all incident Australian patients who experienced peritonitis between 1 October 2003, and 31 December 2011, using Australia and New Zealand Dialysis and Transplant Registry data. Patients were grouped into three categories: Interim HD, Permanent HD and Never HD based on HD transfer status after the first peritonitis. The independent predictors of HD transfer and subsequent return to PD were determined by multivariable, multilevel mixed-effects logistic regression analysis. Matched case-control analyses were performed to compare clinical outcomes (e.g. patient survival) between groups. Of the 3305 patients who experienced peritonitis during the study period, 553 episodes (16.7%) resulted in transfer to HD and 101 patients subsequently returned to PD. HD transfer was significantly and independently predicted by inpatient treatment of peritonitis [odds ratio (OR) 11.45, 95% confidence interval (CI) 7.14-18.36] and the recovered microbiologic profile of organisms recognized to be associated with moderate (20-40%) to high (>40%) rates of catheter removal (moderate: OR 2.45, 95% CI 1.89-3.17; high: OR 8.63, 95% CI 6.44-11.57). Matched case-control analyses yielded comparable results among Interim, Permanent and Never HD groups in terms of patient survival (P = 0.28), death-censored technique survival [hazard ratio (HR) 0.87, 95% CI 0.59-1.28; P = 0.48] and peritonitis-free survival (HR 0.84, 95% CI 0.50-1.39, P = 0.49). In an observational registry study of first peritonitis episodes, temporary HD transfer was not associated with inferior patient-level clinical outcomes when compared with others who either never required HD transfer or remained on HD permanently if all patient-level and peritonitis-related factors were considered equal. Therefore, return to PD after a temporary HD due to peritonitis

  16. [News on single needle dialysis: technique, indications, precautions and limits].

    Science.gov (United States)

    Ervo, Roberto

    2013-01-01

    The technique of single needle dialysis (SN) was invented in the 1960s and enjoyed great success during the 1970s and '80s in northern Europe, particularly in Belgium. In recent years, the double needle mode has awakened new interest in this technique, as it may represent a good alternative to the use of a central venous catheter at the beginning of dialysis, while waiting for the growth of the arteriovenous fistula. For today's dialysis patients, mostly elderly with ever greater numbers of co-morbid conditions, in particular vascular disease, treatments have become ever more flexible and individually tailored. A single needle approach can be also used in the case of native fistula dislocation. The single needle technique requires careful control of dialysis dose, keeping recirculation into account. If the technique is used for long periods of time, there is the risk of inadequate dialysis dose and it is necessary to pay particular attention to the sampling of post dialysis urea for the KT/V calculation (always 20 minutes after the end of dialysis). Modern dialysis machines have greatly reduced the risk of hemolysis (which can be evaluated with the control of LDH pre and post dialysis) and of back-filtration which no longer represents a problem thanks to ultrapure dialysate. The probability of of blood circuit coagulation has also been greatly reduced thanks to citrate dialysis baths and membranes treated with heparin or vitamin E, and systems often do not require an increase of anticoagulants. The technique is, therefore, particularly reliable and easy to use thanks to its simplicity.

  17. Music Therapy Advances in Neuro-disability - Innovations in Research and Practice: Summary Report and Reflections on a Two-Day International Conference

    Directory of Open Access Journals (Sweden)

    Julian Winn O'Kelly

    2014-03-01

    Full Text Available This article provides a summary of the oral papers presented during a two day international conference, which took place on 7th & 8th June 2013, at the Royal Hospital for Neuro-disability (RHN in London. The summary texts detail innovative research projects and clinical developments across music therapy, music neuroscience and music psychology addressing the needs of those with acquired and degenerative neurological conditions. The diverse and evolving work in this field is reflected in the topics covered, including disorders of consciousness, dementia, stroke, and the use of modern neuro-imaging methods to measure the effects of music therapy at a cortical level. A discussion of the implications of these converging foci highlights the benefits of the cross-disciplinary dialogue that characterised the conference.

  18. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

    DEFF Research Database (Denmark)

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy

    2016-01-01

    Objectives: Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for pat...

  19. Appraising and monitoring a life on dialysis.

    Science.gov (United States)

    Brunier, G

    1990-01-01

    I feel that the adaptation theories proposed by Nerenz and Leventhal (1983) and by Taylor (1983), although offering insights into how chronically sick individuals may interpret and manage their illness, do not capture completely the complexities of how D.R. has successfully learned over the years to live with renal disease and dialysis. I find it interesting that Lazarus and Folkman's theory of stress, adaptation and coping, which is based more on the belief that everyone experiences stress every day and, thereby, does not single out chronically ill people as being different, has more to offer in interpreting D.R.'s own perceptions on how he monitors his health than the illness-based models of Nerenz/Leventhal and Taylor. After eight years of continuous appraisal and reappraisal, D.R. has taught himself, through his own perceptions and interactions with those close to him, how he can live successfully with renal failure. The recording of his insights has helped me appreciate more deeply what an endless challenge a life lived on dialysis is.

  20. [Guidelines for quality management of dialysis solutions].

    Science.gov (United States)

    Pérez García, R; González Parra, E; Ceballos, F; Escallada Cotero, R; Gómez-Reino, Ma I; Martín-Rabadán, P; Pérez García, A; Ramírez Chamond, R; Sobrino, P E; Solozábal, C

    2004-01-01

    A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

  1. Peritoneal Dialysis Tailored to Pediatric Needs

    Directory of Open Access Journals (Sweden)

    C. P. Schmitt

    2011-01-01

    Full Text Available Consideration of specific pediatric aspects is essential to achieve adequate peritoneal dialysis (PD treatment in children. These are first of all the rapid growth, in particular during infancy and puberty, which must be accompanied by a positive calcium balance, and the age dependent changes in body composition. The high total body water content and the high ultrafiltration rates required in anuric infants for adequate nutrition predispose to overshooting convective sodium losses and severe hypotension. Tissue fragility and rapid increases in intraabdominal fat mass predispose to hernia and dialysate leaks. Peritoneal equilibration tests should repeatedly been performed to optimize individual dwell time. Intraperitoneal pressure measurements give an objective measure of intraperitoneal filling, which allow for an optimized dwell volume, that is, increased dialysis efficiency without increasing the risk of hernias, leaks, and retrofiltration. We present the concept of adapted PD, that is, the combination of short dwells with low fill volume to promote ultrafiltration and long dwells with a high fill volume to improve purification within one PD session. The use of PD solutions with low glucose degradation product content is recommended in children, but unfortunately still not feasible in many countries.

  2. Modeling and control of dialysis systems

    CERN Document Server

    2013-01-01

    This book is the first text of its kind that presents both the traditional and the modern aspects of dialysis modeling and control in a clear, insightful and highly comprehensive writing style. It provides an in-depth analysis of the mathematical models and algorithms, and demonstrates their applications in real world problems of significant complexity. It explains concepts in a clear, matter-of-fact style. The material of this book will be useful to advanced undergraduate and graduate biomedical engineering students. Also, researchers and practitioners in the field of dialysis, control systems, soft computing will benefit from it. In order to make the reader aware of the applied side of the subject, the book includes:       Chapter openers with a chapter outline, chapter objectives, key terms list, and abstract.       Solved numerical examples to illustrate the application of a particular concept, and also to encourage good problem-solving skills.       More than 1000 questions to give the rea...

  3. Survival by Dialysis Modality-Who Cares?

    Science.gov (United States)

    Lee, Martin B; Bargman, Joanne M

    2016-06-01

    In light of the recent emphasis on patient-centered outcomes and quality of life for patients with kidney disease, we contend that the nephrology community should no longer fund, perform, or publish studies that compare survival by dialysis modality. These studies have become redundant; they are methodologically limited, unhelpful in practice, and therefore a waste of resources. More than two decades of these publications show similar survival between patients undergoing peritoneal dialysis and those receiving thrice-weekly conventional hemodialysis, with differences only for specific subgroups. In clinical practice, modality choice should be individualized with the aim of maximizing quality of life, patient-reported outcomes, and achieving patient-centered goals. Expected survival is often irrelevant to modality choice. Even for the younger and fitter home hemodialysis population, quality of life, not just duration of survival, is a major priority. On the other hand, increasing evidence suggests that patients with ESRD continue to experience poor quality of life because of high symptom burden, unsolved clinical problems, and unmet needs. Patients care more about how they will live instead of how long. It is our responsibility to align our research with their needs. Only by doing so can we meet the challenges of ESRD patient care in the coming decades.

  4. Arterial Stiffness and Dialysis Calcium Concentration

    Directory of Open Access Journals (Sweden)

    Fabrice Mac-Way

    2011-01-01

    Full Text Available Arterial stiffness is the major determinant of isolated systolic hypertension and increased pulse pressure. Aortic stiffness is also associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease, hypertension, and general population. Hemodynamically, arterial stiffness results in earlier aortic pulse wave reflection leading to increased cardiac workload and decreased myocardial perfusion. Although the clinical consequence of aortic stiffness has been clearly established, its pathophysiology in various clinical conditions still remains poorly understood. The aim of the present paper is to review the studies that have looked at the impact of dialysis calcium concentration on arterial stiffness. Overall, the results of small short-term studies suggest that higher dialysis calcium is associated with a transient but significant increase in arterial stiffness. This calcium dependant increase in arterial stiffness is potentially explained by increased vascular smooth muscle tone of the conduit arteries and is not solely explained by changes in mean blood pressure. However, the optimal DCa remains to be determined, and long term studies are required to evaluate its impact on the progression of arterial stiffness.

  5. Biocompatible Peritoneal Dialysis Fluids: Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Yeoungjee Cho

    2012-01-01

    Full Text Available Peritoneal dialysis (PD is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes.

  6. Evolution of technology for automated peritoneal dialysis.

    Science.gov (United States)

    Ronco, Claudio; Amerling, Richard; Dell'aquila, Roberto; Rodighiero, Maria Pia; Di Loreto, Pierluigi

    2006-01-01

    Automated peritoneal dialysis (APD) is important for the further penetration of PD in the dialysis marketplace. Long dwell, equilibration PD (CAPD) has limited applicability in many patients due to inadequate solute clearance or fast membrane transport characteristics. Providing large volumes of dialysate over circumscribed hours is highly labor intensive without an automated system. Early attempts at APD were crude but effective in reducing labor, which was generally provided by nursing staff. Later evolution of PD technology has been greatly accelerated by the microchip, and by miniaturization of components. Current generation machines allow individualized fill volumes, variable tidal volumes and additional daytime automated exchanges, teledialysis, memorized delivery control, and full portability. The ideal machine should not only be able to perform all treatment schedules, but it should also optimize the performance of a selected treatment strategy. Biocompatible solutions, improved osmotic agents, and sorbent technology are all adaptable to APD. The eventual evolution toward continuous flow PD will resolve many of the current problems with both CAPD and APD.

  7. ELECTROLYTIC MEMBRANE DIALYSIS FOR TREATING WASTEWATER STREAMS

    Energy Technology Data Exchange (ETDEWEB)

    Ronald C. Timpe

    2000-04-01

    This project will determine whether electrolytic dialysis has promise in the separation of charged particles in an aqueous solution. The ability to selectively move ions from one aqueous solution to another through a semipermeable membrane will be studied as a function of emf, amperage, and particle electrical charge. The ions selected for the study are Cl{sup -} and SO{sub 4}{sup 2-}. These ions are of particular interest because of their electrical conduction properties in aqueous solution resulting with their association with the corrosive action of metals. The studies will be performed with commercial membranes on solutions prepared in the laboratory from reagent salts. pH adjustments will be made with dilute reagent acid and base. Specific objectives of the project include testing a selected membrane currently available for electrolytic dialysis, membrane resistance to extreme pH conditions, the effectiveness of separating a mixture of two ions selected on the basis of size, the efficiency of the membranes in separating chloride (Cl{sup 1-}) from sulfate (SO{sub 4}{sup 2-}), and separation efficiency as a function of electromotive force (emf).

  8. Effects of disinfectants in renal dialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Klein, E.

    1986-11-01

    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has let to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe/sup 2 +/ in hemoglobin to Fe/sup 3 +/ forms methemoglobin, which is incapable of carrying either O/sub 2/ or CO/sub 2/. Chloramine can form not only methemoglobin, but can also denature proteins within the red cell, thus forming aggregates (Heinz bodies). Chloramines also inhibit hexose monophosphate shunt activity, a mechanism that makes the red cell even more susceptible to oxidant damage.

  9. Quality of Life and Self-Efficacy in Three Dialysis Modalities: Incenter Hemodialysis, Home Hemodialysis, and Home Peritoneal Dialysis.

    Science.gov (United States)

    Wright, Linda S; Wilson, Linda

    2015-01-01

    Previous research has demonstrated improved outcomes for patients on dialysis who have better quality of life and self-efficacy, but has focused almost exclusively on those receiving hemodialysis. The goal of this study was to describe the quality of life and self-efficacy of patients receiving incenter hemodialysis versus those receiving a home dialysis modality (hemodialysis or peritoneal dialysis). The study utilized a correlational cross-sectional design and quota sampling methods. Participants were recruited from outpatient dialysis facilities and included 77 community dwelling adult patients who had been on dialysis for at least six months. Quality of life was measured using the Kidney Disease Quality of Life instrument, and self-efficacy was measured using the Strategies Used by People to Promote Health instrument. Findings suggest equal outcomes between treatment groups, with no contraindication to the use of home therapies.

  10. The impact of dialysis-requiring acute kidney injury on long-term prognosis of patients requiring prolonged mechanical ventilation: nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Chia-Ter Chao

    Full Text Available BACKGROUND: Prolonged mechanical ventilation (PMV is increasingly common worldwide, consuming enormous healthcare resources. Factors that modify PMV outcome are still obscure. METHODS: We selected patients without preceding mechanical ventilation within the one past year and who developed PMV during index admission in Taiwan's National Health Insurance (NHI system during 1998-2007 for comparison of mortality and resource use. They were divided into three groups: (1 patients with end-stage renal diseases (ESRD before the index admission for PMV onset; (2 patients with dialysis-requiring acute kidney injury (AKI-dialysis during the hospitalization course; and (3 patients without AKI or with non dialysis-requiring AKI during the hospitalization course (non-AKI. We used a random-effects logistic regression model to identify factors associated with mortality. RESULTS: Compared with the other two groups, patients with AKI-dialysis had significantly longer mechanical ventilation, more frequent use of vasopressors, longer intensive care unit/hospital stay and higher inpatient expenditures during the index admission. Relative to non-AKI patients, patients with AKI-dialysis had an elevated mortality hazard; the adjusted relative risk ratios were 1.51 (95% confidence interval [CI]:1.46-1.56, 1.27 (95% CI: 1.23-1.32, and 1.10 (95% CI: 1.08-1.12 for mortality rates at discharge, 3 months, and 4 years after PMV, respectively. Patients with AKI-dialysis also consumed significantly higher total in-patient expenditure than the other two patient groups (p<0.001. CONCLUSIONS: Among patients that need PMV care during an admission, the presence of de novo AKI requiring dialysis significantly increased short and long term mortality, and demand for health care resources.

  11. Interval methods: An introduction

    DEFF Research Database (Denmark)

    Achenie, L.E.K.; Kreinovich, V.; Madsen, Kaj

    2006-01-01

    This chapter contains selected papers presented at the Minisymposium on Interval Methods of the PARA'04 Workshop '' State-of-the-Art in Scientific Computing ''. The emphasis of the workshop was on high-performance computing (HPC). The ongoing development of ever more advanced computers provides....... An important characteristic of the computer performance in scientific computing is the accuracy of the Computation results. Often, we can estimate this accuracy by using traditional statistical techniques. However, in many practical situations, we do not know the probability distributions of different...... '' techniques, and the applications of these techniques to various problems of scientific computing....

  12. Escherichia coli Peritonitis in Peritoneal Dialysis: The Prevalence, Antibiotic Resistance and Clinical Outcomes in a South China Dialysis Center

    Science.gov (United States)

    Feng, Xiaoran; Yang, Xiao; Yi, Chunyan; Guo, Qunying; Mao, Haiping; Jiang, Zongpei; Li, Zhibin; Chen, Dongmei; Cui, Yingpeng; Yu, Xueqing

    2014-01-01

    ♦ Introduction: Escherichia coli (E. coli) peritonitis is a frequent, serious complication of peritoneal dialysis (PD). The extended-spectrum β-lactamase (ESBL)-producing E. coli peritonitis is associated with poorer prognosis and its incidence has been on continuous increase during the last decades. However, the clinical course and outcomes of E. coli peritonitis remain largely unclear. ♦ Methods: All of the E. coli peritonitis episodes that occurred in our dialysis unit from 2006 to 2011 were reviewed. The polymicrobial episodes were excluded. ♦ Results: In total, ninety episodes of monomicrobial E. coli peritonitis occurred in 68 individuals, corresponding to a rate of 0.027 episodes per patient-year. E. coli was the leading cause (59.2%) of monomicrobial gram-negative peritonitis. ESBL-producing strains accounted for 35.5% of E. coli peritonitis. The complete cure rate and treatment failure rate of E. coli peritonitis were 77.8% and 10.0% respectively. Patients with preceding peritonitis had a higher risk of ESBL production as compared to those without peritonitis history [odds ratio (OR): 5.286; 95% confidence interval (CI): 2.018 - 13.843; p = 0.001]. The risk of treatment failure was significantly increased when the patient had a baseline score of Charlson Comorbidity Index (CCI) above 3 (OR: 6.155; 95% CI: 1.198 - 31.612; p = 0.03), or had diabetes mellitus (OR: 8.457; 95% CI: 1.838 - 38.91; p = 0.006), or hypoalbuminemia (≤ 30g/l) on admission (OR: 13.714; 95% CI: 1.602 - 117.428; p = 0.01). Prolonging the treatment course from 2 to 3 weeks or more reduced the risk of relapse and repeat significantly (p peritonitis remains a common complication of PD. The clinical outcomes of E. coli peritonitis are relatively favorable despite the high ESBL rate. A history of peritonitis is associated with increased risk for ESBL development. The severity of baseline comorbidities, the presence of diabetes mellitus and hypoalbuminemia at admission are associated

  13. Interval-based Synthesis

    Directory of Open Access Journals (Sweden)

    Angelo Montanari

    2014-08-01

    Full Text Available We introduce the synthesis problem for Halpern and Shoham's modal logic of intervals extended with an equivalence relation over time points, abbreviated HSeq. In analogy to the case of monadic second-order logic of one successor, the considered synthesis problem receives as input an HSeq formula phi and a finite set Sigma of propositional variables and temporal requests, and it establishes whether or not, for all possible evaluations of elements in Sigma in every interval structure, there exists an evaluation of the remaining propositional variables and temporal requests such that the resulting structure is a model for phi. We focus our attention on decidability of the synthesis problem for some meaningful fragments of HSeq, whose modalities are drawn from the set A (meets, Abar (met by, B (begins, Bbar (begun by, interpreted over finite linear orders and natural numbers. We prove that the fragment ABBbareq is decidable (non-primitive recursive hard, while the fragment AAbarBBbar turns out to be undecidable. In addition, we show that even the synthesis problem for ABBbar becomes undecidable if we replace finite linear orders by natural numbers.

  14. Interval probabilistic neural network.

    Science.gov (United States)

    Kowalski, Piotr A; Kulczycki, Piotr

    2017-01-01

    Automated classification systems have allowed for the rapid development of exploratory data analysis. Such systems increase the independence of human intervention in obtaining the analysis results, especially when inaccurate information is under consideration. The aim of this paper is to present a novel approach, a neural networking, for use in classifying interval information. As presented, neural methodology is a generalization of probabilistic neural network for interval data processing. The simple structure of this neural classification algorithm makes it applicable for research purposes. The procedure is based on the Bayes approach, ensuring minimal potential losses with regard to that which comes about through classification errors. In this article, the topological structure of the network and the learning process are described in detail. Of note, the correctness of the procedure proposed here has been verified by way of numerical tests. These tests include examples of both synthetic data, as well as benchmark instances. The results of numerical verification, carried out for different shapes of data sets, as well as a comparative analysis with other methods of similar conditioning, have validated both the concept presented here and its positive features.

  15. Chaos on the interval

    CERN Document Server

    Ruette, Sylvie

    2017-01-01

    The aim of this book is to survey the relations between the various kinds of chaos and related notions for continuous interval maps from a topological point of view. The papers on this topic are numerous and widely scattered in the literature; some of them are little known, difficult to find, or originally published in Russian, Ukrainian, or Chinese. Dynamical systems given by the iteration of a continuous map on an interval have been broadly studied because they are simple but nevertheless exhibit complex behaviors. They also allow numerical simulations, which enabled the discovery of some chaotic phenomena. Moreover, the "most interesting" part of some higher-dimensional systems can be of lower dimension, which allows, in some cases, boiling it down to systems in dimension one. Some of the more recent developments such as distributional chaos, the relation between entropy and Li-Yorke chaos, sequence entropy, and maps with infinitely many branches are presented in book form for the first time. The author gi...

  16. Interval arithmetic operations for uncertainty analysis with correlated interval variables

    Institute of Scientific and Technical Information of China (English)

    Chao Jiang; Chun-Ming Fu; Bing-Yu Ni; Xu Han

    2016-01-01

    A new interval arithmetic method is proposed to solve interval functions with correlated intervals through which the overestimation problem existing in interval analy-sis could be significantly alleviated. The correlation between interval parameters is defined by the multidimensional par-allelepiped model which is convenient to describe the correlative and independent interval variables in a unified framework. The original interval variables with correlation are transformed into the standard space without correlation, and then the relationship between the original variables and the standard interval variables is obtained. The expressions of four basic interval arithmetic operations, namely addi-tion, subtraction, multiplication, and division, are given in the standard space. Finally, several numerical examples and a two-step bar are used to demonstrate the effectiveness of the proposed method.

  17. 42 CFR 494.120 - Condition: Special purpose renal dialysis facilities.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Special purpose renal dialysis... RENAL DISEASE FACILITIES Patient Care § 494.120 Condition: Special purpose renal dialysis facilities. A special purpose renal dialysis facility is approved to furnish dialysis on a short-term basis at...

  18. Specific opsonic activity for staphylococci in peritoneal dialysis effluent during continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Nielsen, H; Espersen, F; Kharazmi, A

    1992-01-01

    In a prospective study of intraperitoneal opsonins in 30 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), the IgG concentration, the fibronectin concentration, the specific antistaphylococcal antibody level, and the opsonic activity against Staphylococcus epidermidis were...... measured in peritoneal dialysis effluent from the initiation of CAPD and monthly for 6 months. Significant correlation was found between the four assays, but the interindividual and intraindividual variations were considerable. No statistically significant correlation was observed between susceptibility...... of the patients to CAPD-related infectious peritonitis and any of the above-mentioned parameters of humoral defense. We conclude that at the present time it is not feasible to use these assays for the establishment of prognosis with regard to peritonitis in CAPD....

  19. Aliskiren prevents the toxic effects of peritoneal dialysis fluids during chronic dialysis in rats.

    Directory of Open Access Journals (Sweden)

    Juan Pérez-Martínez

    Full Text Available The benefits of long-term peritoneal dialysis (PD in patients with end-stage renal failure are short-lived due to structural and functional changes in the peritoneal membrane. In this report, we provide evidence for the in vitro and in vivo participation of the renin-angiotensin-aldosterone system (RAAS in the signaling pathway leading to peritoneal fibrosis during PD. Exposure to high-glucose PD fluids (PDFs increases damage and fibrosis markers in both isolated rat peritoneal mesothelial cells and in the peritoneum of rats after chronic dialysis. In both cases, the addition of the RAAS inhibitor aliskiren markedly improved damage and fibrosis markers, and prevented functional modifications in the peritoneal transport, as measured by the peritoneal equilibrium test. These data suggest that inhibition of the RAAS may be a novel way to improve the efficacy of PD by preventing inflammation and fibrosis following peritoneal exposure to high-glucose PDFs.

  20. Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia.

    Science.gov (United States)

    Sanabria, M; Muñoz, J; Trillos, C; Hernández, G; Latorre, C; Díaz, C S; Murad, S; Rodríguez, K; Rivera, A; Amador, A; Ardila, F; Caicedo, A; Camargo, D; Díaz, A; González, J; Leguizamón, H; Lopera, P; Marín, L; Nieto, I; Vargas, E

    2008-04-01

    The goal of the Dialysis Outcomes in Colombia (DOC) study was to compare the survival of patients on hemodialysis (HD) vs peritoneal dialysis (PD) in a network of renal units in Colombia. The DOC study examined a historical cohort of incident patients starting dialysis therapy between 1 January 2001 and 1 December 2003 and followed until 1 December 2005, measuring demographic, socioeconomic, and clinical variables. Only patients older than 18 years were included. As-treated and intention-to-treat statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazard model. There were 1094 eligible patients in total and 923 were actually enrolled: 47.3% started HD therapy and 52.7% started PD therapy. Of the patients studied, 751 (81.3%) remained in their initial therapy until the end of the follow-up period, death, or censorship. Age, sex, weight, height, body mass index, creatinine, calcium, and Subjective Global Assessment (SGA) variables did not show statistically significant differences between the two treatment groups. Diabetes, socioeconomic level, educational level, phosphorus, Charlson Co-morbidity Index, and cardiovascular history did show a difference, and were less favorable for patients on PD. Residual renal function was greater for PD patients. Also, there were differences in the median survival time between groups: 27.2 months for PD vs 23.1 months for HD (P=0.001) by the intention-to-treat approach; and 24.5 months for PD vs 16.7 months for HD (P or =65 years (hazard ratio (HR)=2.21; confidence interval (CI) 95% (1.77-2.755); Phistory of cardiovascular disease (HR=1.96; CI 95% (1.58-2.90); P<0.001); diabetes (HR=2.34; CI 95% (1.88-2.90); P<0.001); and SGA (mild or moderate-severe malnutrition) (HR=1.47; CI 95% (1.17-1.79); P=0.001); but no association was found with gender (HR=1.03, CI 95% 0.83-1.27; P=0.786). Similar results were found with the as-treated approach, with additional associations found with Charlson Index (0

  1. Pharmacokinetics of icodextrin in peritoneal dialysis patients.

    Science.gov (United States)

    Moberly, James B; Mujais, Salim; Gehr, Todd; Hamburger, Richard; Sprague, Stuart; Kucharski, Andrew; Reynolds, Robin; Ogrinc, Francis; Martis, Leo; Wolfson, Marsha

    2002-10-01

    Pharmacokinetics of icodextrin in peritoneal dialysis patients. Icodextrin is a glucose polymer osmotic agent used to provide sustained ultrafiltration during long peritoneal dialysis (PD) dwells. A number of studies have evaluated the steady-state blood concentrations of icodextrin during repeated use; however, to date the pharmacokinetics of icodextrin have not been well studied. The current study was conducted to determine the absorption, plasma kinetics and elimination of icodextrin and metabolites following a single icodextrin exchange. Thirteen PD patients were administered 2.0 L of solution containing 7.5% icodextrin for a 12-hour dwell. Icodextrin (total of all glucose polymers) and specific polymers with degrees of polymerization ranging from two to seven (DP2 to DP7) were measured in blood, urine and dialysate during the dwell and after draining the solution from the peritoneal cavity. A median of 40.1% (60.24 g) of the total administered dose (150 g) was absorbed during the 12-hour dwell. Plasma levels of icodextrin and metabolites rose during the dwell and declined after drain, closely corresponding to the one-compartment pharmacokinetic model assuming zero-order absorption and first-order elimination. Peak plasma concentrations (median C peak = 2.23 g/L) were observed at the end of the dwell (median Tmax = 12.7 h) and were significantly correlated with patients' body weight (R2 = 0.805, P insulin or glucose levels during icodextrin administration, indicating that icodextrin does not result in hyperglycemia or hyperinsulinemia as occurs during dextrose-based dialysis. Serum sodium and chloride declined in parallel with the rise in plasma levels of icodextrin, supporting the hypothesis that these electrolyte changes are the result of the increased plasma osmolality due to the presence of icodextrin metabolites. The pharmacokinetics of icodextrin in blood following intraperitoneal administration conforms to a simple, single-compartment model that can be

  2. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure.

    Science.gov (United States)

    Klouche, Kada; Amigues, Laurent; Deleuze, Sebastien; Beraud, Jean-Jacques; Canaud, Bernard

    2007-01-01

    Availability of a functional vascular access is a mandatory prerequisite for extracorporeal renal replacement therapy in patients with acute renal failure. The femoral site of insertion commonly is chosen because it is an easy and convenient access. However, an array of complications may substantially alter the quality of treatment, and it appears that catheter-related morbidity and dysfunction are more frequent with the femoral than internal jugular site. This study is designed to evaluate the potential benefits of using soft silicone tunneled catheters ((ST)Caths) at the femoral site. Thirty patients with acute renal failure treated by intermittent hemodialysis (IHD) and/or continuous venovenous hemodiafiltration (CVVHDF) were assigned to either twin (ST)Caths or twin polyurethane nontunneled femoral catheters. Time necessary for catheter insertion, catheter-related complications, and catheter lifespan were monitored. Catheter performance during IHD and the effect of catheter type on dialysis dose were evaluated. The time necessary for (ST)Cath insertion was significantly longer. The incidence of vein thrombosis and catheter-related infection was lower, and the ratio of venous return pressure to catheter blood flow was better with an (ST)Cath. Recirculation rates were similar for both types of catheters. Whether treated by using IHD or CVVHDF, patients with an (ST)Cath benefited from a greater delivered dialysis dose. Multivariate analysis confirmed that (ST)Cath use was a determinant factor to optimize dialysis dose delivery. (ST)Cath patency was significantly longer. In patients with acute renal failure, use of an (ST)Cath minimizes catheter-related morbidity and improves dialysis efficiency compared with conventional femoral catheters.

  3. Determinants of survival in patients receiving dialysis in Libya.

    Science.gov (United States)

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2013-04-01

    Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice.

  4. Prescription and practice of dialysis in Australia, 1988.

    Science.gov (United States)

    Disney, A P

    1990-05-01

    Facilities for provision of treatment of end-stage renal failure with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) are available in many centers, most of which are government-funded. Medicare provides free treatment for all patients. There are no specific criteria for determining a patient's acceptance for dialysis treatment: age, quality of life, and capacity for independent living are important factors. The usual HD prescription is three dialysis periods weekly, hollow-fiber dialyzer, 1.0-1.2 m2 surface area, for 4 to 5 hours, with blood flow rate 250 mL/min and acetate-based dialysate flow rate 500 mL/min. Reuse of the dialyzer is common, but many units practice single use to reduce the expense and time necessary for processing the dialyzer and the risks of formalin exposure. There is only limited use of hemofiltration, or highly efficient dialyzers for shortened hours at higher blood flow rates. The choice of dialysis prescription is influenced by the physician's preference for the patient to be treated at home or in a self-care center with limited assistance. CAPD is preferred for home dialysis, especially for elderly or diabetic patients. There is no personal financial incentive to the physician to favor any particular form of dialysis. The costs of dialysis do influence the provision and prescription of treatment, causing the reuse of dialyzers and the limited use of bicarbonate-based HD and highly permeable dialyzers. Nevertheless, adequate dialysis should be available to all patients, and noncompliance with prescribed dialysis is infrequent. Quality-assurance programs have been developed both for nursing and medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis.

    Science.gov (United States)

    Decourt, Alexandre; Gondouin, Bertrand; Delaroziere, Jean Christophe; Brunet, Philippe; Sallée, Marion; Burtey, Stephane; Dussol, Bertrand; Ivanov, Vadim; Costello, Regis; Couchoud, Cecile; Jourde-Chiche, Noemie

    2016-03-07

    Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France. All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed. We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97). Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery

  6. Amyloidosis associated with dialysis. Dialyseassoziierte Amyloidosteopathie - radiologische Aspekte

    Energy Technology Data Exchange (ETDEWEB)

    Schadmand, S.; Klose, K.J. (Mainz Univ. (Germany, F.R.). Inst. fuer Klinische Strahlenkunde); Wandel, E. (Mainz Univ. (Germany, F.R.). 1. Medizinische Klinik und Poliklinik)

    1991-06-01

    Amongst the complications of dialysis, amyloid osteopathy is getting increasingly significant. It is due to deposition of {beta}2-microglobulin. To determine the incidence and time of development of this complication, the skeletal radiographs of 185 patients undergoing dialysis, some for up to ten years, were analysed retrospectively. In about 10% of patients, the presence of {beta}2-microglobulin osteopathy may be expected. The radiological features, sites of predilection and differential diagnosis of amyloid osteopathy and of other skeletal changes due to dialysis are discussed. (orig.).

  7. An evidence-based approach to earlier initiation of dialysis.

    Science.gov (United States)

    Churchill, D N

    1997-12-01

    The objective was to review evidence addressing the optimal time to initiate dialysis treatment. The database was derived from an evidence-based review of the medical literature and from the Canada-United States peritoneal dialysis study. The publications were divided into (1) those addressing the clinical impact of early versus late referral to a dialysis program; (2) those evaluating the association between residual renal function at initiation of dialysis and the concurrent nutritional status; (3) those evaluating the association between residual renal function at initiation of dialysis and subsequent clinical outcomes, including patient survival. There were five studies evaluating early versus late referral, three cohort design and two case-control design. Late referrals had worse outcomes than early referrals. The former had more serious comorbidity and many had been noncompliant with follow-up. The latter were more likely to have hereditary renal disease. Renal function was slightly worse at initiation among those referred late. Three studies addressed the association between renal function at initiation of dialysis and concurrent nutritional status. Two showed decreased protein intake with diminished glomerular filtration rate (GFR). Poor nutritional status is associated with decreased patient survival among both incident and prevalent dialysis patients. The third study reported excellent patient survival among patients with late initiation of dialysis. These patients had received a supplemented low-protein diet and were not malnourished at initiation of dialysis. Three groups have studied the association between GFR at initiation of dialysis and clinical outcomes. Decreased GFR at initiation of dialysis is associated with a increased probability of hospitalization and death. None of these studies has used the rigorous randomized clinical trial design, and they are therefore subject to bias. Referral time bias, comorbidity, patient compliance, and starting

  8. Clinical outcomes and mortality in elderly peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Tamer Sakacı

    2015-05-01

    Full Text Available OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50% and cardiovascular events (30%. The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of

  9. Meralgia paraesthetica: an unusual complication in peritoneal dialysis.

    Science.gov (United States)

    Talwar, Ambika; Baharani, Jyoti

    2012-06-12

    A 53-year-old woman with a history of end-stage renal disease on peritoneal dialysis (PD) presented with a 3-month history of intermittent numbness and paraesthesia over the anterior aspect of the right thigh. The patient noticed the pain was worse on walking and related to dialysis sessions. An examination revealed no neurovascular abnormalities or abdominal masses. However, there was subjective paraesthesia in the distribution of the right lateral cutaneous nerve. Subsequent nerve conduction studies revealed the cause of the patient's symptoms. She was diagnosed with meralgia paraesthetica. Her symptoms resolved when the dialysis regime was modified.

  10. Strategies for preserving residual renal function in peritoneal dialysis patients.

    Science.gov (United States)

    Nongnuch, Arkom; Assanatham, Montira; Panorchan, Kwanpeemai; Davenport, Andrew

    2015-04-01

    Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis

  11. Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation

    Science.gov (United States)

    Chau, Elaine M. T.; Manns, Braden J.; Garg, Amit X.; Sood, Manish M.; Kim, S. Joseph; Naimark, David; Nesrallah, Gihad E.; Soroka, Steven D.; Beaulieu, Monica; Dixon, Stephanie; Alam, Ahsan; Tangri, Navdeep

    2016-01-01

    Background: Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published. Objective: The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice. Design: This study is a multicenter, 2-arm parallel, cluster randomized trial. Setting: The study involves 55 advanced chronic kidney disease clinics across Canada. Patients: Patients older than 18 years who are managed by nephrologists for more than 3 months, and initiate dialysis in the follow-up period are included in the study. Measurements: Outcomes will be measured at the patient-level and enumerated within a cluster. Data on characteristics of each dialysis start will be determined by linkages with the Canadian Organ Replacement Register. Primary outcomes include the proportion of patients who start dialysis early with an estimated glomerular filtration rate greater than 10.5 mL/min/1.73 m2 and start dialysis in hospital as inpatients or in an emergency room setting. Secondary outcomes include the rate of change in early dialysis starts; rates of hospitalizations, deaths, and cost of predialysis care (wherever available); quarterly proportion of new starts; and acceptability of the knowledge translation materials. Methods: We randomized 55 multidisciplinary chronic disease clinics (clusters) in Canada to receive either an active knowledge translation intervention or no intervention for the uptake of the guideline on the timing of dialysis initiation. The active knowledge translation intervention consists of audit and feedback as well as patient- and provider-directed educational tools delivered at a comprehensive in

  12. Surveillance and Monitoring of Dialysis Access

    Directory of Open Access Journals (Sweden)

    Lalathaksha Kumbar

    2012-01-01

    Full Text Available Vascular access is the lifeline of a hemodialysis patient. Currently arteriovenous fistula and graft are considered the permanent options for vascular access. Monitoring and surveillance of vascular access are an integral part of the care of hemodialysis patient. Although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have been performed evaluating different surveillance techniques. We performed a study of the recent literature published in the PUBMED, to review the scientific evidence on different methodologies currently being used for surveillance and monitoring and their impact on the care of the dialysis access. The limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistula and graft.

  13. Percutaneous mechanical declotting of thrombosed dialysis graft

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Kim, Dae Ho; Lee, Hae Kyung; Choi, Deuk Lin; Kwon, Kee Hyang; Hong, Hyun Sook; Moon, Chul [College of Medicine, Soonchunhyang University, Seoul (Korea, Republic of)

    2000-10-01

    To evaluate the effectiveness of percutaneous mechanical declotting. Using a 7-F Desilets-Hoffman sheath and the crossed-catheter technique, we aspirated the intragraft clot and pushed the residual clot into the central circulation with balloon catheters. The success rate, procedure time, complications and patency rates were evaluated. Technical success was achieved in 24 of 32 cases, with a procedure time of 30-240 (average, 111) minutes. In five of eight cases in which technical failure occurred, the guide wire failed to reach the stenotic site and in the other three, there was insufficient luminal dilatation. Complications included vein ruptures (n=2), arterial emboli (n=1) and arterial dissection (1), but there was no evidence of clinical symptoms of pulmonary embolism. The six-month patency rate was 67.8%. Mechanical declotting of thrombosed dialysis graft using a balloon catheter is relatively inexpensive, safe and fast, and is well tolerated. (author)

  14. [Quality guide in nephrology and dialysis].

    Science.gov (United States)

    Manno, C; Palmieri, V; Virgilio, M; Palasciano, G; Schena, F P

    2004-01-01

    The Quality Guide, a strategic tool for any nephrologist wishing to initiate a quality policy in his own renal unit, describes to the organisation of total quality management. This article gives a short description of a Quality Guide in Nephrology and Dialysis. According to ISO 9004:2000 Norms, the Quality Guide can be subdivided into four sections: Managerial Accountability, Resource Management; Implementation of Services; Analysis, Evaluation and Continuous Quality Improvement. The quality cycle begins by identifying the customers, who added to the resources constitute the input that will be transformed by the service into output (results). By measuring customer satisfaction the results will be evaluated and analyzed to allow continuous improvement of the service. In conclusion, the drafting of the Guide by all staff members involved has a twofold value: it organizes the quality management within the renal unit and certifies the quality level guaranteed to the customer.

  15. Dialysis membrane for separation on microchips

    Science.gov (United States)

    Singh, Anup K.; Kirby, Brian J.; Shepodd, Timothy J.

    2010-07-13

    Laser-induced phase-separation polymerization of a porous acrylate polymer is used for in-situ fabrication of dialysis membranes inside glass microchannels. A shaped 355 nm laser beam is used to produce a porous polymer membrane with a thickness of about 15 .mu.m, which bonds to the glass microchannel and forms a semi-permeable membrane. Differential permeation through a membrane formed with pentaerythritol triacrylate was observed and quantified by comparing the response of the membrane to fluorescein and fluorescently tagging 200 nm latex microspheres. Differential permeation was observed and quantified by comparing the response to rhodamine 560 and lactalbumin protein in a membrane formed with SPE-methylene bisacrylamide. The porous membranes illustrate the capability for the present technique to integrate sample cleanup into chip-based analysis systems.

  16. [Withdrawal of dialysis--decision-making criterion].

    Science.gov (United States)

    Oehmichen, Frank

    2005-01-01

    Improvement in prolongation and quality of life has been made possible by medical progress, but life for the patient can become ever more dependent on artificial support and death may be prolonged in unwanted ways. The choice between prolongation of life, quality of life and the abatement of suffering is of great importance in decisions on the continuation or cessation of dialysis and is naturally a process of weighing different positions. This process requires not only medical decision-making but also a structure for the organization of communication between all involved parties. Only thus is it possible to reach a satisfactory resolution to such a situation, a resolution that shows medical responsibility on the part of the physician and one that can be borne by all those involved.

  17. Clinical effects of icodextrin in peritoneal dialysis.

    Science.gov (United States)

    Cnossen, Trijntje T; Konings, Constantijn J; van der Sande, Frank M; Leunissen, Karel M; Kooman, Jeroen P

    2008-10-01

    Objective. This study reviews the relevant publications on the clinical effects of icodextrin in peritoneal dialysis (PD). Design. The study provides a systematic review of the literature (MEDLINE search with icodextrin as the keyword). Results. Icodextrin induces sustained transcapillary ultrafiltration during long dwell periods. It also stimulates increased removal of sodium by the peritoneal membrane, reduction of extracellular water (ECW) and total body water (TBW). Effects of icodextrin on blood pressure control and residual renal function are discrepant. Icodextrin induces a reduction in the formation of advanced glycation end-products, while the longitudinal changes in the peritoneal membrane transport are less prominent. Conclusions. Use of icodextrin in PD improves the sodium and fluid balance. Icodextrin is potentially more biocompatible, when compared with the conventional glucose solutions. The side effects are rare.

  18. Sodium management in dialysis by conductivity.

    Science.gov (United States)

    Bosetto, A; Bene, B; Petitclerc, T

    1999-07-01

    The determination of dialysate sodium concentration is one of the challenges of dialysis prescription, because no accurate information on the predialytic sodium overload is available. Too low dialysate sodium is responsible for intradialytic intolerance symptoms, whereas too high sodium may lead to long-term water sodium overload with cardiovascular hazards (hypertension, left heart failure). We propose here a biofeedback system based on noninvasive repeated measures of ionic dialysance and plasma water conductivity used here as a surrogate of plasma water sodium. This system achieves a stable postdialytic sodium pool and subsequently a dialysate sodium concentration adapted to the inter dialytic sodium load. This new tool in dialysate sodium prescription aims at reducing the morbidity related to patient sodium balance impairment.

  19. The kinetics of water transperitoneal transport during long-term peritoneal dialysis performed using icodextrin dialysis fluid.

    Science.gov (United States)

    Olszowska, Anna; Zelichowski, Grzegorz; Waniewski, Jacek; Stachowska-Pietka, Joanna; Weryński, Andrzej; Wańkowicz, Zofia

    2009-05-01

    Dialysis fluid containing icodextrin is used in patients on peritoneal dialysis (PD) because of its significant ultrafiltration properties. The use of the fluid in treating patients with congestive heart failure resistant to diuretics has also been reported. The aim of the study was to evaluate water peritoneal transport during a 16-hour dialysis exchange performed using icodextrin-containing dialysis fluid. Eleven clinically stable patients were enrolled in the study (5 women and 6 men; mean age, 50.4 +/- 18.3 years), treated with PD for 26.9 +/- 22.4 months. Water transperitoneal transport was evaluated using a modified version of Babb-Randerson-Farrell thermodynamic model of membrane transport with human albumin marked with iodine as the marker of intraperitoneal volume. Based on blood and dialysate samples collected during the 16-hour dialysis exchange, the intraperitoneal volume of dialysate and dialysate reverse absorption were calculated. There were no clinical complications associated with the use of icodextrin fluid during the study. A significant increase in intraperitoneal volume of dialysate (950 ml on average) compared to the initial value was observed in the whole group at the 16th hour of the exchange. The study demonstrated that dialysis fluid with icodextrin ensured effective ultrafiltration during a 16-hour dialysis exchange. This indicates its potential usefulness in the treatment of patients with severe congestive heart failure with or without coexisting end-stage renal disease.

  20. INTERVAL ARITHMETIC AND STATIC INTERVAL FINITE ELEMENT METHOD

    Institute of Scientific and Technical Information of China (English)

    郭书祥; 吕震宙

    2001-01-01

    When the uncertainties of structures may be bounded in intervals, through some suitable discretization, interval finite element method can be constructed by combining the interval analysis with the traditional finite element method(FEM). The two parameters,median and deviation, were used to represent the uncertainties of interval variables. Based on the arithmetic rules of intervals, some properties and arithmetic rules of interval variables were demonstrated. Combining the procedure of interval analysis with FEM, a static linear interval finite element method was presented to solve the non-random uncertain structures. The solving of the characteristic parameters of n-freedom uncertain displacement field of the static governing equation was transformed into 2 n-order linear equations. It is shown by a numerical example that the proposed method is practical and effective.

  1. Effects of disinfectants in renal dialysis patients.

    Science.gov (United States)

    Klein, E

    1986-01-01

    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. More recently, reuse of dialyzers has introduced the use of additional sterilants, such as hydrogen peroxide and peracetic acid. The use of these sterilants is recognized by the center staffs and the home patient as a potential risk, and residue tests are carried out for the presence of these sterilants at the ppm level. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. Such reactions probably do not occur with hypochlorite or chloramines. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has led to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe2+ in hemoglobin to Fe3+ forms methemoglobin, which is incapable of carrying either O2 or CO2.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3816735

  2. Bladder perforation in a peritoneal dialysis patient

    Directory of Open Access Journals (Sweden)

    M Ounissi

    2012-01-01

    Full Text Available The dysfunction of the catheter in peritoneal dialysis (PD is a frequent compli-cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re-quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.

  3. A two-day-old hyperthyroid neonate with thyroid hormone resistance born to a mother with well-controlled Graves’ disease: a case report

    Directory of Open Access Journals (Sweden)

    Yatsuga Shuichi

    2012-08-01

    Full Text Available Abstract Introduction Resistance to thyroid hormone is a syndrome caused by thyroid hormone receptor β mutations, which are usually inherited in an autosomal-dominant pattern. Case presentation Our patient, a Japanese neonate boy, showed hyperthyroid symptoms at age two days. Although our patient was diagnosed as having resistance to thyroid hormone, his hyperthyroid symptoms continued for two weeks. Therefore, our patient was treated with methimazole and iodine for two weeks from birth, showing no side effects and no symptoms upon treatment. At age 70 days, an R243W mutation in thyroid hormone receptor β was detected in our patient; while absent in his mother, the mutation was present in his father, who never showed any symptoms. Conclusions To the best of our knowledge this is the first case report of a resistance to thyroid hormone in a neonate presenting with hyperthyroid symptoms born to a mother with Graves’ disease and treated with methimazole and iodine. These results suggest that methimazole and iodine may be a good short-term option for treatment.

  4. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD).

    Science.gov (United States)

    Gorrin, Maite Rivera; Teruel-Briones, José Luis; Vion, Victor Burguera; Rexach, Lourdes; Quereda, Carlos

    2015-01-01

    Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a shortterm life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis. Copyright © 2015. Published by Elsevier España, S.L.U.

  5. Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes

    Science.gov (United States)

    Nessim, Sharon J.; Nisenbaum, Rosane; Bargman, Joanne M.; Jassal, Sarbjit V.

    2012-01-01

    ♦ Background: Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. ♦ Methods: Using data collected in the Canadian multicenter Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. ♦ Results: During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) had at least 2 episodes with the same organism. The organism most commonly causing repeat infection was coagulase-negative Staphylococcus (CNS), accounting for 65.7% of cases. Compared with peritonitis caused by other organisms, a first CNS peritonitis episode was associated with an increased risk of subsequent CNS peritonitis within 1 year (odds ratio: 2.1; 95% confidence interval: 1.5 to 2.8; p peritonitis, 48% of repeat episodes occurred within 6 months of the earlier episode. ♦ Conclusions: In contrast to previous data, we did not find a high proportion of patients with multiple peritonitis episodes caused by the same organism. Coagulase-negative Staphylococcus was the organism most likely to cause peritonitis more than once in a given patient, and a prior CNS peritonitis was associated with an increased risk of CNS peritonitis within the subsequent year. PMID:22215659

  6. Cause-Specific Deaths in Non-Dialysis-Dependent CKD.

    Science.gov (United States)

    Navaneethan, Sankar D; Schold, Jesse D; Arrigain, Susana; Jolly, Stacey E; Nally, Joseph V

    2015-10-01

    CKD is associated with higher risk of death, but details regarding differences in cause-specific death in CKD are unclear. We examined the leading causes of death among a non-dialysis-dependent CKD population using an electronic medical record-based CKD registry in a large healthcare system and the Ohio Department of Health mortality files. We included 33,478 white and 5042 black patients with CKD who resided in Ohio between January 2005 and September 2009 and had two measurements of eGFRCauses of death (before ESRD) were classified into cardiovascular, malignancy, and non-cardiovascular/non-malignancy diseases and non-disease-related causes. During a median follow-up of 2.3 years, 6661 of 38,520 patients (17%) with CKD died. Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the leading causes of death, with malignancy-related deaths more common among those with earlier stages of kidney disease. After adjusting for covariates, each 5 ml/min per 1.73 m(2) decline in eGFR was associated with higher risk of death due to cardiovascular disease (hazard ratio [HR], 1.10; 95% confidence interval [95% CI], 1.08 to 1.12) and non-cardiovascular/non-malignancy diseases (HR, 1.12; 95% CI, 1.09 to 1.14) but not to malignancy. In the adjusted models, blacks had overall-mortality hazard ratios similar to those of whites but higher hazard ratios for cardiovascular deaths. Further studies to confirm these findings and explain the mechanisms for differences are warranted. In addition to lowering cardiovascular burden in CKD, efforts to target known risk factors for cancer at the population level are needed.

  7. Nutritional predictors of mortality in prevalent peritoneal dialysis patients.

    Science.gov (United States)

    Malgorzewicz, Sylwia; Chmielewski, Michal; Kaczkan, Malgorzata; Borek, Paulina; Lichodziejewska-Niemierko, Monika; Rutkowski, Boleslaw

    2016-01-01

    Malnutrition remains one of the major predictors of mortality in peritoneal dialysis (PD) patients. The aim of the study was to evaluate the nutritional status of prevalent PD patients, and to determine the best predictors of outcome among anthropometric and laboratory indices of nutrition. The study included 106 prevalent PD patients from a single university-based unit. Anthropometric assessment at baseline included: body mass, body mass index (BMI), skinfold thickness, lean body mass (LBM), content of body fat (%F), mid-arm muscle circumference (MAMC). Laboratory analysis comprised of albumin and total cholesterol. Additionally, each patient underwent a subjective global assessment (SGA). The patients were followed for 36 months. Survival analyses were made with the Kaplan-Meier survival curve and the Cox proportional hazard model. Following SGA, malnutrition was diagnosed in 30 (28%) patients. Importantly, eight of the malnourished patients (27%) were nevertheless overweight or obese. Body weight and BMI showed complete lack of association with the outcome. In Kaplan-Meier analysis low: LBM, MAMC, albumin and cholesterol were significantly related to mortality. Cox analysis revealed that, following adjustment, LBM below median was independently associated with poor outcome (hazard ratio [HR] 3.15, 95% confidence interval [CI] 1.17-8.49, p=0.02). Moreover, the lowest quartile of total cholesterol showed independent association with mortality (HR 8.68, CI 2.14-35.21, p<0.01). Malnutrition is prevalent in patients undergoing PD, and overweight/obesity does not preclude its appearance. The most valuable nutritional indices in predicting outcome in this cohort were LBM and total cholesterol concentration.

  8. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG

    1998-01-01

    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  9. H1N1 in dialysis units: Prevention and management

    Directory of Open Access Journals (Sweden)

    Karkar Ayman

    2010-01-01

    Full Text Available Dialysis patients are at increased risk of contracting influenza A H1N1 and deve-loping serious illness. Increasing the awareness of dialysis patients and continuous education and training of medical staff on early recognition and management of influenza A H1N1 can help in saving the life of patients. Antiviral drugs and influenza vaccines are effective in providing ade-quate immunity in dialysis patients with strict implementation of infection control policies and procedures can help in preventing and controlling the dissemination of influenza A H1N1 in dia-lysis units. We report a case of a patient who presented with HINI influenza and developed acute kidney injury during his hospitalization and his course with disease.

  10. Feasibility of mesothelial transplantation during experimental peritoneal dialysis and peritonitis

    NARCIS (Netherlands)

    Hekking, L. H. P.; van den Born, J.

    2007-01-01

    The mesothelial cell layer lining the peritoneum orchestrates peritoneal homeostasis. Continuous exposure to peritoneal dialysis fluids and episodes of peritonitis may damage the monolayer irreversibly, eventually leading to adhesion formation and fibrosis/sclerosis of the peritoneum. Autologous mes

  11. Catheters Often to Blame for Blood Infections After Dialysis

    Science.gov (United States)

    ... as an arteriovenous fistula. This is created by connecting a patient's own vein and artery to form ... Dialysis Infection Control About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  12. [Oxidative stress in patients on regular hemodialysis and peritoneal dialysis].

    Science.gov (United States)

    Vostálová, J; Galandáková, A; Strebl, P; Zadražil, J

    2012-06-01

    Hemodialysis and peritoneal dialysis are methods of blood purification, which partially replaced excretory renal function in patients with chronic renal failure, which was depleted regime, dietary and pharmaco-therapeutic remedy, and who are not eligible for kidney transplantation. Both two methods are accompanied by increased oxidative stress. In peritoneal dialysis particularly the composition of dialysis solution contributes to oxidative stress. In extracorporeal hemodialysis the oxidative stress is associated with the character of hemodialysis membranes, non-specific loss of low molecular weight antioxidants, activation of leukocytes (oxidative burst), feroteraphy, supplementation with low molecular weight antioxidants and other factors. To improve and maintain the quality of life of dialysis patients, the continuous monitoring of oxidative stress-related parameters as non-traditional risk factors for cardiovascular complications development is suitable.

  13. Increasing fill volume reduces cardiac performance in peritoneal dialysis

    DEFF Research Database (Denmark)

    Ivarsen, Per; Povlsen, Johan V; Jensen, Jens Dam

    2007-01-01

    BACKGROUND: It is generally accepted that peritoneal dialysis (PD) affects systemic haemodynamics less than haemodialysis, but little is known about changes in haemodynamics during PD. It is unknown if increasing PD volume causes changes in cardiovascular haemodynamics possibly increasing...

  14. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG

    1998-01-01

    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  15. [Maintaining residual renal function in patients on dialysis].

    Science.gov (United States)

    Ryckelynck, Jean-Philippe; Goffin, Éric; Verger, Christian

    2013-11-01

    There are evidences supporting a positive impact of renal residual function (RRF) on survival and quality of life of dialysis patients. Many strategies are available in clinical practices to maintain RRF. Hemodiafiltration seems to be better that conventional hemodialysis and similar to peritoneal dialysis. Arterial hypotension in hemodialysis or dehydration in peritoneal dialysis are deleterious in terms of preservation of RRF. Loop diuretics increase urine volume and natriuresis, not RRF. Radiocontrast and aminoglycosides may be used safely. The benefits of ACE inhibitors and angiotensin II receptor blockers are debated but have positive effect on blood pressure control and cardiac function. Neither biocompatible solutions nor the modality of peritoneal dialysis have demonstrated benefits on RRF. Copyright © 2013 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  16. Diabetic patients treated with dialysis: complications and quality of life

    DEFF Research Database (Denmark)

    Sørensen, V R; Mathiesen, E R; Watt, T

    2007-01-01

    AIMS/HYPOTHESIS: The aim of this study was to describe the prevalence of complications, health-related quality of life (HRQOL) and the influence of beliefs about control over health in diabetic dialysis patients. METHODS: Of 53 eligible diabetic patients on chronic dialysis during January 2004...... in our clinic, 38 (76%) completed a kidney-specific (Kidney Disease Quality of Life) and a generic (SF-36) questionnaire and were characterised in terms of cardiovascular diseases and diabetic complications. Matched groups of non-diabetic dialysis patients (n = 40) and diabetic patients with a long...... population (47 +/- 19). The diabetic dialysis patients had similar levels of kidney-specific quality of life and mental health compared with the control groups. Reduced physical health was predicted by the presence of end-stage renal disease, diabetes and short time spent in education. Among the diabetic...

  17. Risk factors for peritoneal dialysis catheter failure in children ...

    African Journals Online (AJOL)

    Risk factors for peritoneal dialysis catheter failure in children. ... tertiary Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia, from January ... improvement of patients' nutritional status, use of a swan-neck double-cuffed catheter, ...

  18. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    Science.gov (United States)

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established.

  19. Transperitoneal transport of sodium during hypertonic peritoneal dialysis

    DEFF Research Database (Denmark)

    Graff, J; Fugleberg, S; Brahm, J

    1996-01-01

    The mechanisms of transperitoneal sodium transport during hypertonic peritoneal dialysis were evaluated by kinetic modelling. A total of six nested mathematical models were designed to elucidate the presence or absence of diffusive, non-lymphatic convective and lymphatic convective solute transport....... Experimental results were obtained from 26 non-diabetic patients undergoing peritoneal dialysis. The model validation procedure demonstrated that only diffusive and non-lymphatic convective transport mechanisms were identifiable in the transperitoneal transport of sodium. Non-lymphatic convective sodium...

  20. Efficacy of peritoneal dialysis in severe thiazide-induced hyponatraemia

    OpenAIRE

    1981-01-01

    A patient with severe thiazide-induced hyponatraemia (plasma sodium 99 mmol/l) is described, who had signs suggestive of cerebral oedema. Co-existent problems of cardiac and respiratory insufficiency were thought to make treatment with hypertonic saline hazardous. A 40-hr peritoneal dialysis successfully reversed both hyponatraemia and the associated cerebral signs, plasma sodium increasing at a rate of 0·83 mmol/hr. Peritoneal dialysis appears to be a safe and efficacious method of treating ...

  1. High-quality dialysis: a lesson from the Japanese experience

    OpenAIRE

    Masakane, Ikuto

    2010-01-01

    High-quality dialysis does not always mean high efficiency; dialysis should maintain nutritional balance and full biocompatibility. In undergoing treatment with polymethylmethacrylate (PMMA) and/or ethylene vinyl alcohol copolymer (EVAL) membrane dialysers, the body weight decrease caused by polysulfone membrane has been dramatically improved for those receiving predilution online haemodiafiltration (HDF) as well. These membranes are assumed to somewhat suppress the clearance of small molecul...

  2. Clinical reports for peritoneal dialysis-related peritonitis

    Institute of Scientific and Technical Information of China (English)

    任海滨

    2014-01-01

    Objective To investigate causes and risk factors of peritoneal dialysis-related peritonitis,explore the pathogenic bacteria and drug sensitivity.Methods CAPD patients suffered peritoneal dialysis-related peritonitis were recruited in the First Affiliated Hospital of Nanjing Medical University in 2012.Gender,age and possible risk factors were analyzed by unvaried and multivariate logistic regression analysis.The causes,pathogenic bacteria,

  3. Clostridium difficile-associated diarrhea in dialysis patients ☆

    OpenAIRE

    Sook Eui Oh; Seung Min Lee; Young-Ki Lee; Sun Ryoung Choi; Myung-Jin Choi; Jwa-Kyung Kim; Young Rim Song; Soo Jin Kim; Tae Jin Park; Sung Gyun Kim; Jieun Oh; Jang Won Suh; Jong-Woo Yoon; Ja-Ryong Koo; Hyung Jik Kim

    2012-01-01

    Background: Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD). Methods: During the 4-year study period (2004–2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were consi...

  4. Hydration Status of Patients Dialyzed with Biocompatible Peritoneal Dialysis Fluids.

    Science.gov (United States)

    Lichodziejewska-Niemierko, Monika; Chmielewski, Michał; Dudziak, Maria; Ryta, Alicja; Rutkowski, Bolesław

    2016-01-01

    ♦ Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve dialysis and patient outcome in end-stage renal disease. However, their impact on hydration status (HS), residual renal function (RRF), and dialysis adequacy has been a matter of debate. The aim of the study was to evaluate the influence of a biocompatible dialysis fluid on the HS of prevalent PD patients. ♦ The study population consisted of 18 prevalent PD subjects, treated with standard dialysis fluids. At baseline, 9 patients were switched to a biocompatible solution, low in glucose degradation products (GDPs) (Balance; Fresenius Medical Care, Bad Homburg, Germany). Hydration status was assessed through clinical evaluation, laboratory parameters, echocardiography, and bioimpedance spectroscopy over a 24-month observation period. ♦ During the study period, urine volume decreased similarly in both groups. At the end of the evaluation, there were also no differences in clinical (body weight, edema, blood pressure), laboratory (N-terminal pro-brain natriuretic peptide, NTproBNP), or echocardiography determinants of HS. However, dialysis ultrafiltration decreased in the low-GDP group and, at the end of the study, equaled 929 ± 404 mL, compared with 1,317 ± 363 mL in the standard-fluid subjects (p = 0.06). Hydration status assessed by bioimpedance spectroscopy was +3.64 ± 2.08 L in the low-GDP patients and +1.47 ± 1.61 L in the controls (p = 0.03). ♦ The use of a low-GDP biocompatible dialysis fluid was associated with a tendency to overhydration, probably due to diminished ultrafiltration in prevalent PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.

  5. The management of anemia in pediatric peritoneal dialysis patients

    OpenAIRE

    Schröder, Cornelis H.; ,

    2003-01-01

    Anemia is common in chronic renal failure. Guidelines for the diagnosis and treatment of anemia in adult patients are available. With respect to the diagnosis and treatment in children on peritoneal dialysis, the European Pediatric Peritoneal Dialysis Working Group (EPPWG) has produced guidelines. After a thorough diagnostic work-up, treatment should aim for a target hemoglobin concentration of at least 11 g/l. This can be accomplished by the administration of erythropoietin and iron preparat...

  6. Survival trends of US dialysis patients with heart failure: 1995 to 2005.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2012-01-31

    BACKGROUND AND OBJECTIVES: Congestive heart failure (CHF) is a major risk factor for death in end-stage kidney disease; however, data on prevalence and survival trends are limited. The objective of this study was to determine the prevalence and mortality effect of CHF in successive incident dialysis cohorts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a population-based cohort of incident US dialysis patients (n = 926,298) from 1995 to 2005. Age- and gender-specific prevalence of CHF was determined by incident year, whereas temporal trends in mortality were compared using multivariable Cox regression. RESULTS: The prevalence of CHF was significantly higher in women than men and in older than younger patients, but it did not change over time in men (range 28% to 33%) or women (range 33% to 36%). From 1995 to 2005, incident death rates decreased for younger men (<\\/=70 years) and increased for older men (>70 years). For women, the pattern was similar but less impressive. During this period, the adjusted mortality risks (relative risk [RR]) from CHF decreased in men (from RR = 1.06 95% Confidence intervals (CI) 1.02-1.11 in 1995 to 0.91 95% CI 0.87-0.96 in 2005) and women (from RR = 1.06 95% CI 1.01-1.10 in 1995 to 0.90 95% CI 0.85-0.95 in 2005 compared with referent year 2000; RR = 1.00). The reduction in mortality over time was greater for younger than older patients (20% to 30% versus 5% to 10% decrease per decade). CONCLUSIONS: Although CHF remains a common condition at dialysis initiation, mortality risks in US patients have declined from 1995 to 2005.

  7. Serum 25-Hydroxyvitamin D Level Could Predict the Risk for Peritoneal Dialysis-Associated Peritonitis.

    Science.gov (United States)

    Pi, Hai-Chen; Ren, Ye-Ping; Wang, Qin; Xu, Rong; Dong, Jie

    2015-12-01

    ♦ As an immune system regulator, vitamin D is commonly deficient among patients on peritoneal dialysis (PD), which may contribute to their impaired immune function and increased risk for PD-related peritonitis. In this study, we aimed to investigate whether vitamin D deficiency could predict the risk of peritonitis in a prospective cohort of patients on PD. ♦ We collected 346 prevalent and incident PD patients from 2 hospitals. Baseline demographic data and clinical characteristics were recorded. Serum 25-hydroxyvitamin D (25[OH]D) was measured at baseline and prior to peritonitis. The mean doses of oral active vitamin D used during the study period were also recorded. The outcome was the occurrence of peritonitis. ♦ The mean age of patients and duration of PD were 58.95 ± 13.67 years and 28.45 (15.04 - 53.37) months, respectively. Baseline 25(OH)D level was 16.15 (12.13 - 21.16) nmol/L, which was closely associated with diabetic status, longer PD duration, malnutrition, and inflammation. Baseline serum 25(OH)D predicted the occurrence of peritonitis independently of active vitamin D supplementation with a hazard ratio (HR) of 0.94 (95% confidence interval [CI] 0.90 - 0.98) after adjusting for recognized confounders (age, gender, dialysis duration, diabetes, albumin, residual renal function, and history of peritonitis). Compared to the low tertile, middle and high 25(OH)D level tertiles were associated with a decreased risk for peritonitis with HRs of 0.54 (95% CI 0.31 - 0.94) and 0.39 (95% CI 0.20 - 0.75), respectively. ♦ Vitamin D deficiency evaluated by serum 25(OH)D rather than active vitamin D supplementation is closely associated with a higher risk of peritonitis. Copyright © 2015 International Society for Peritoneal Dialysis.

  8. The association between body mass index and mortality in incident dialysis patients.

    Directory of Open Access Journals (Sweden)

    Sunil V Badve

    Full Text Available To study the body mass index (BMI trajectory in patients with incident end-stage kidney disease and its association with all-cause mortality.This longitudinal cohort study included 17022 adult patients commencing hemodialysis [HD] (n = 10860 or peritoneal dialysis [PD] (n = 6162 between 2001 and 2008 and had ≥6-month follow-up and ≥2 weight measurements, using the Australia and New Zealand Dialysis and Transplant Registry data. The association of time-varying BMI with all-cause mortality was explored using multivariate Cox regression models.The median follow-up was 2.3 years. There was a non-linear change in the mean BMI (kg/m2 over time, with an initial decrease from 27.6 (95% confidence interval [CI]: 27.5, 27.7 to 26.7 (95% CI: 26.6, 26.9 at 3-month, followed by increments to 27.1 (95% CI: 27, 27.2 at 1-year and 27.2 (95% CI: 26.8, 27.1 at 3-year, and a gradual decrease subsequently. The BMI trajectory was significantly lower in HD patients who died than those who survived, although this pattern was not observed in PD patients. Compared to the reference time-varying BMI category of 25.1-28 kg/m2, the mortality risks of both HD and PD patients were greater in all categories of time-varying BMI 28.1 kg/m2 among HD patients, but only in the category 28.1-31 kg/m2 among PD patients.BMI changed over time in a non-linear fashion in incident dialysis patients. Time-varying measures of BMI were significantly associated with mortality risk in both HD and PD patients.

  9. Tunneled dialysis catheter exchange with fibrin sheath disruption is not associated with increased rate of bacteremia.

    Science.gov (United States)

    Valliant, Amanda M; Chaudhry, Muhammad K; Yevzlin, Alexander S; Astor, Brad; Chan, Micah R

    2015-01-01

    Tunneled dialysis catheters are the most common form of vascular access among incident dialysis patients in the United States. Fibrin sheath formation is a frequent cause of late catheter dysfunction requiring an exchange procedure with balloon disruption of the fibrin sheath. It is unknown whether fibrin sheath disruption is associated with increased incidence of bacteremia or catheter failure. We reviewed all tunneled dialysis catheter exchange procedures at the University of Wisconsin between January 2008 and December 2011. The primary outcome was incidence of bacteremia, defined as positive blood cultures within 2 weeks of the procedure. Catheter failure, requiring intervention or replacement, was examined as a secondary outcome. Baseline characteristics examined included diabetic status, gender, race and age. A total of 163 procedures were reviewed; 67 (41.1%) had fibrin sheath disruption and 96 did not. Bacteremia occurred in 4.5% (3/67) of those with and 3.1% (3/97) of those without fibrin sheath disruption (p=0.65). Fibrin sheath disruption was not significantly associated with the risk of catheter failure (adjusted hazard ratio [aHR]=1.34; 95% confidence interval [CI]: 0.87-2.10; p=0.18). Diabetes was associated with greater risk of catheter failure (aHR=1.88; 95% CI: 1.19-2.95; p=0.006), whereas higher age was associated with a lower risk of catheter failure (aHR per 10 years=0.83; 95% CI: 0.72-0.96; p=0.01). This study demonstrates that there is no significant increase in bacteremia and subsequent catheter dysfunction rates after fibrin sheath disruption compared to simple over the wire exchange. These results are encouraging given the large numbers of patients utilizing tunneled catheters for initial hemodialysis access and the known rates of fibrin sheath formation leading to catheter failure.

  10. Peritoneal Dialysis is Associated With A Better Survival in Cirrhotic Patients With Chronic Kidney Disease.

    Science.gov (United States)

    Chou, Che-Yi; Wang, Shu-Ming; Liang, Chih-Chia; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Wang, I-Kuan; Hsiao, Lien-Cheng; Muo, Chih-Hsin; Chung, Chi-Jung; Huang, Chiu-Ching

    2016-01-01

    Peritoneal dialysis (PD) can be an ideal treatment in cirrhotic patients with ascites and chronic kidney disease stage 5 (CKD 5D) who require dialysis. The survival of cirrhotic patients with CKD 5D on PD, however, is not clear. We compared the survival of cirrhotic patients with CKD 5D on PD and the survival of those on HD. Two datasets including a cohort study of China Medical University Hospital (CMUH) from 2004 to 2013 and the Longitudinal National Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of Taiwan from 1996 to 2011 were analyzed. The survival of cirrhotic patients on PD and the propensity score matched cirrhotic patients on HD were analyzed using Cox proportional hazards regression. In CMUH cohort of 85 PD and 340 HD patients, the all-cause mortality was lower in PD patients compared to it in HD patients (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.31-0.74, P model for end-stage liver disease (MELD) score, however, was not associated with all-cause mortality. In the LHID-CIP cohort of 285 PD and 1140 HD patients, the HR of all-cause mortality in PD patients was 0.61 (95% CI: 0.47 - 0.79, P < 0.01), as compared with HD patients. PD in cirrhotic patients who need dialysis is associated with lower all-cause mortality than HD is. This association is independent of patients' comorbidity, severity of liver cirrhosis, and serum albumin levels.

  11. Dialysis for undocumented immigrants in the United States.

    Science.gov (United States)

    Rodriguez, Rudolph A

    2015-01-01

    The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane. Published by Elsevier Inc.

  12. Selected indices of peritoneal fibrosis in patients undergoing peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Józef Penar

    2009-04-01

    Full Text Available Peritoneal dialysis is an alternative to hemodialysis in the treatment of patients with end-stage renal disease. Long-term use of peritoneal dialysis is limited by progressive alterations in the peritoneal membrane. The pathological changes in the peritoneum are due to the exposure to traditional nonphysiological peritoneal dialysis fluids that have low pH, high glucose and glucose degradation product content, and high molarity. Repeated episodes of bacterial peritonitis are another cause of peritoneal membrane damage. The characteristic features of peritoneal alterations include peritoneal fibrosis and morphologic changes in the peritoneal microvasculature with the accumulation of extracellular matrix in the submesothelial area and loss of mesothelial cells. These changes in the peritoneal membrane cause ultrafiltration failure and loss of dialysis efficacy. The pathogenesis of the peritoneal membrane damage is very complicated and understanding the processes involved in these alterations will be crucial in improving treatment with peritoneal dialysis. Some points of view on fibrosis of peritoneal membrane in patients undergoing peritoneal dialysis are presented here.

  13. [Interests of advanced systematic evaluation of dialysis session].

    Science.gov (United States)

    Galland, Roula; Hallonet, Patrick; Pachot, Monique; Combe, Corinne; Schoenfelder, Isabelle; Caillette Beaudoin, Agnès

    2013-07-01

    In order to rationalize the cost of care for dialysis patients in Centre, regulatory authorities urge establishments to favor the orientation of the patients in Medical Dialysis Unit where the medical presence is not permanent. This involves clinical skills for nurses in the conduct of the dialysis session. Faced with this changing work patterns, we present two security tools of the dialysis session. The first is a "check-list", simple, quick and easy to use, it enables secure connection phase of the patient. It was quickly integrated practice of all professionals. The second tool developed is a combination of indicators "DEAUP" for Pain, Purification, Blood access, Ultrafiltration and other Problems for assessing the quality of the course of the dialysis session. The aim is to reduce the occurrence of adverse events, the DEAUP rating certain criteria depending on the occurrence of incidents, from 0 to 2, 2 corresponding to the appearance of an incident having required the call of the doctor and constitute a precious tool of evaluation of the session for all the professionals. All nurses have joined the practice of evaluation, 98% of the realized sessions are informed and quoted; 8.4% of sessions required call nephrologists before or at the connection. The evaluation at the end of dialysis session found 15% of the sessions listed 2. Calls have resulted in an adjustment to the prescription of the sessions.

  14. Natural disasters and dialysis care in the Asia-Pacific.

    Science.gov (United States)

    Gray, Nicholas A; Wolley, Martin; Liew, Adrian; Nakayama, Masaaki

    2015-12-01

    The impact of natural disasters on the provision of dialysis services has received increased attention in the last decade following Hurricane Katrina devastating New Orleans in 2005. The Asia-Pacific is particularly vulnerable to earthquakes, tsunami, typhoons (also known as cyclones and hurricanes) or storms and flooding. These events can seriously interrupt provision of haemodialysis with adverse effects for patients including missed dialysis, increased hospitalization and post-traumatic stress disorder. Furthermore, haemodialysis patients may need to relocate and experience prolonged periods of displacement from family and social supports. In contrast to haemodialysis, most literature suggests peritoneal dialysis in a disaster situation is more easily managed and supported. It has become apparent that dialysis units and patients should be prepared for a disaster event and that appropriate planning will result in reduced confusion and adverse outcomes should a disaster occur. Numerous resources are now available to guide dialysis units, patients and staff in preparation for a possible disaster. This article will examine the disaster experiences of dialysis units in the Asia-Pacific, the impact on patients and staff, methods employed to manage during the disaster and suggested plans for reducing the impact of future disasters.

  15. Testing protein permeability of dialysis membranes using SDS-PAGE.

    Science.gov (United States)

    Mann, H; Melzer, H; Al-Bashir, A; Xu, X Q; Stiller, S

    2002-05-01

    Permeability of dialysis membranes for high molecular weight compounds should be similar to that of the glomerular membrane in order to remove uremic toxins like the human kidney does. In order to evaluate permeability of high-flux dialysis membranes SDS-PAGE is applied for examination of filtrate of dialysers during routine dialysis with different membranes. SDS-PAGE analysis is performed with silver staining method according to the modification of Melzer (5) and consecutive laser densitometry. The protein pattern of filtrate from dialysis membranes is similar to that of the glomerular membrane containing IgG, transferrin, albumin, alpha-1-microglobulin, retinol binding protein and beta-2-microglobulin. Comparing different membranes there are considerable differences depending on cut-off, charge and adsorption capacity of the particular membrane. In all membranes tested permeability of proteins decreases during one treatment session. Protein permeability of high-flux dialysis membranes is similar to the gloemerular membrane but modified according to pore-size, surface charge, adsorption and time on dialysis. In contrast to the glomerular membrane in each of the investigated membranes protein permeability decreases during function.

  16. Comparing the incomparable: hemodialysis versus peritoneal dialysis in observational studies.

    Science.gov (United States)

    Foley, Robert N

    2004-01-01

    A randomized trial comparing survival in hemodialysis and peritoneal dialysis remains a utopian aspiration. Dialysis is still relatively rare on a population basis, and a natural tension exists between desirability and feasibility in terms of quality of evidence. In practice, it is very difficult to perform prospective comparisons with large groups of contemporary representative subjects, and much of the literature comes from retrospective national registries. This article considers several questions to address when trying to compare the outcomes of peritoneal dialysis and hemodialysis. Prognostic similarity at baseline is a fundamental issue. Traditionally, adjustment for known prognostic factors has been used in an attempt to minimize the bias caused by nonrandom treatment assignment. Propensity scores have been suggested to be superior, and matched-case analysis may also be a useful method for comparison. Other questions include, when, in relation to starting dialysis, to start the observation clock; the definition and handling of switches of dialysis therapy; and the decision to censor at transplantation. Finally, comparisons are complicated by hazards ratios that vary over time, and time-segmented analysis is obligatory. Many types of analytical approaches are needed to begin to appreciate outcome disparities between dialysis therapies.

  17. Hospitalization rates among dialysis patients during Hurricane Katrina.

    Science.gov (United States)

    Howard, David; Zhang, Rebecca; Huang, Yijian; Kutner, Nancy

    2012-08-01

    Dialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear. The impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated. Data from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations. The rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics. Hospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.

  18. Practical approach to data collection in a European dialysis network

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    @@ Collection of Dialysis Treatment Data and Patient-Related Information in a Single Dialysis Unit State-of-the-art dialysis machines are capable of automatically collecting huge volumes of dialysis treatment data (blood and dialysate flow rates, venous and arterial pressures, ultrafiltration rate, ultrafiltration volume, transmembrane pressure, conductivity, etc.) and displaying the information on the monitor screen. Commercially available software allows this information to be exported to a clinical database on a server through a local network in the clinic, enabling healthcare professionals to further process, display, and evaluate the data. Moreover, on-line sensors can be used to monitor patient-related information, e.g.effective ionic dialysance as a marker of urea clearance[1-3], urea removal and additional parameters(e.g. whole-body Kt/V) based on dialysate urea measurements[4,5], and blood volume changes[6]. Although many of these sensors are available in dialysis machines, their clinical value in routine dialysis is still subject to debate[7].

  19. Stability of tobramycin and ceftazidime in icodextrin peritoneal dialysis solution.

    Science.gov (United States)

    Pallotta, Katie E; Elwell, Rowland J; Nornoo, Adwoa O; Manley, Harold J

    2009-01-01

    The data describing the compatibility of tobramycin and ceftazidime in icodextrin-based peritoneal dialysis (PD) solution is limited. The objective of this study was to assess the chemical stability of tobramycin and ceftazidime in icodextrin PD solution in polyvinyl chloride containers. Commercially available 2-L bags of icodextrin 7.5% PD solution were used for each sample. Nine tobramycin study samples were prepared by adding 80 mg tobramycin HCl to each bag. Nine ceftazidime samples were prepared by adding 1000 mg ceftazidime to each bag. Three bags of tobramycin-icodextrin solution were stored under each of the following conditions: refrigeration (4 degrees C), room temperature (25 degrees C), and body temperature (37 degrees C). Three bags of ceftazidime-icodextrin solution were also stored at each of the respective temperatures. Samples were withdrawn from each bag immediately after preparation and at predetermined intervals (1, 2, 4, 6, 8, 12, 24, 48, 72, 96, 120, 168, and 336 hours after preparation). Solutions were visually inspected for precipitation, cloudiness, and discoloration at each sampling interval. All samples were immediately frozen (-80 degrees C) after collection and stored prior to assay. Total concentrations of tobramycin and ceftazidime in dialysate fluid were determined by high-performance liquid chromatography. The last time point when tobramycin or ceftazidime concentration was >90% from baseline was used to denote stability. All solutions were clear in appearance and no color change or precipitation was observed during the study. For tobramycin, under refrigeration, a mean of 94.6%+/-2.3% of the initial concentration remained at 336 hours (14 days); at room temperature, 90.5%+/-4.3% remained at 168 hours (7 days); at body temperature, 90.0%+/-8.1% remained at 24 hours. For ceftazidime, under refrigeration, a mean of 98.0%+/-0.3% of the initial concentration remained at 168 hours (7 days); at room temperature, 91.6%+/-2.0% remained at

  20. Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Stanković-Popović Verica

    2008-01-01

    Full Text Available Background/Aim. Peritoneal dialysis (PD patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions. Methods. After 3±2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1, average age 47.43±12.87 years, and 21 PD patients on the treatment with biocompatible dialysis solutions (neutral solutions with lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH: PDP-2, average age 68.62±13.98 years, participated in the longitudinal study. The average number of episodes of peritonitis was similare in both groups: 1 episode per 36 months of the treatment. The control group included 21 patients with preterminal phase of chronic renal failure (Glomerular Filtration Rate: 22.19±10.73 ml/min, average age 65.29± 13.74 years. All the patients underwent transthoracal echocardiography (in order to detect: eject fraction (EF, left ventricular hypertrophy (LVH, and valvular calcification (VC and B-mode ultrasonography of common carotid artery (CCA: IMT, lumen narrowing, and plaque detection. Results. The values of EF were: in PDP-1 group 62.05±5.65%, in PDP-2 group 53.43±7.47%, and in the control group 56.71±8.12% (Bonferroni test, p = 0.001. The recorded LVH was: in PDP-1 group in 47.6% of the patients; in PDP-2 group in 61.9% of the patients; and in control the group in 52.4% (χ2 test; p = 0.639. The detected VC was: in PDP-1 in 52.4% of the patients, in PDP-2 group in 42.9% of the patients, and in the control group in 23.8% of the patients (χ2 test; p = 0.776. The IMT was: in PDP-1 group 1.26±0.54 mm, in PDP-2 group 1.23±0.32, and in the control group 1.25±0.27 mm (Bonferroni test; p = 0.981. An average lumen narrowing was: in PDP-1 group 13

  1. Solute clearance measurement in the assessment of dialysis adequacy among African continuous ambulatory peritoneal dialysis patients

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    Aliyu Abdu

    2015-01-01

    Full Text Available Solute clearance measurement is an objective means of quantifying the dose of peritoneal dialysis (PD. Despite continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients, guidelines based on solute clearance values are common in clinical practice. There is limited information on the solute clearance indices and PD adequacy parameters among this predominantly low socioeconomic status PD population. We investigated the solute clearance among continuous ambulatory peritoneal dialysis (CAPD patients at the Charlotte Maxeke Johannesburg Academic Hospital and its relationship with other parameters of PD adequacy. Seventy patients on CAPD were studied in this cross-sectional study. Solute clearance was assessed using urea clearance (Kt/V. Linear regression analysis was used to determine factors associated with solute clearance, while analysis of variance was used to test the influence of weekly Kt/V on blood pressure (BP, hemoglobin (Hb and other biochemical parameters. The mean age of the study population was 37.9 ± 12.4 years, 43% were females and 86% were black Africans. The mean duration on CAPD was 19.7 ± 20.8 months. Mean systolic and diastolic BP were 144 ± 28 and 92 ± 17 mm Hg, respectively. The mean Hb was 11.1 ± 2.2 g/dL and the mean weekly Kt/V was 1.7 ± 0.3. Factors like systolic BP, Hb level, serum levels of cholesterol, calcium, phosphate, parathyroid hormone and albumin were not significantly associated with the weekly Kt/V. We conclude that the dose of PD received by the majority of our patients in terms of the weekly Kt/V is within the recommended values and that this finding is significant considering the low socioeconomic background of our patients. There is no significant association between Kt/V and other indices of dialysis adequacy.

  2. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

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    Jacek Waniewski

    2016-01-01

    Full Text Available During peritoneal dialysis (PD, the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87 years; median time on PD 19 (3–100 months underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS, fraction of ultrasmall pores (αu, osmotic conductance for glucose (OCG, and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters. Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  3. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

    Science.gov (United States)

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  4. [Electro-encephalographic study of the disequilibrium syndrome during bicarbonate dialysis and acetate dialysis].

    Science.gov (United States)

    Hampl, H; Klopp, H W; Michels, N; Mahiout, A; Schilling, H; Wolfgruber, M; Schiller, R; Hanefeld, F; Kessel, M

    1983-01-01

    Continuous long-time electroencephalographic (EEG) monitoring was performed during AHD and BHD in 20 patients. Persisting normal basic activity of the EEG without neurological symptoms could be found only during the course of BHD. However, in AHD, during the decrease of arterial CO2 tension (PaCO2) we registered EEG disturbances with moderate to severe slowing down, dysrythmic activity and high voltage discharges. The decrease in PaCO2 and the deterioration in EEG activity in the patients during AHD was concomitant with severe neurological alterations, e.g. the typical symptoms of so-called "disequilibrium" causing a cessation of dialysis in 3 patients.

  5. [Early kidney transplant failure and return to peritoneal dialysis: preliminary study of permeability and dialysis efficacy].

    Science.gov (United States)

    Coronel, Francisco; Florit, Enrique; Cigarrán-Guldrís, Secundino; Herrero-Calvo, José A; Delgado-Córdova, Margarita; Rodríguez-Cubillo, Beatriz

    2014-01-01

    The return to dialysis after kidney transplant (TX) failure is increasingly common. On returning to dialysis after TX failure, there is usually a similar or worse clinical situation than in patients who are on haemodialysis or peritoneal dialysis (PD) for the first time. Although there are several studies on the clinical situation of patients who return to PD after long periods with a functioning TX, there is hardly any information on the progression of a patient subgroup returning to PD after TX failure a few days or weeks after transplantation. Assess whether a short period of time on suboptimal TX and aggressive treatment/measures may influence membrane permeability, the clinical situation and dialysis efficacy on returning to PD. In 9 patients (53.5 ± 15.4 years of age, 5 males and 4 females) who had previously been on PD before early TX failure and had returned to PD (25 ± 23 days, range 10-64) over the last five years, we studied laboratory data including inflammation, nutrition, kidney function, permeability and PD efficacy, at four points during progression: before TX, immediately after returning to PD and after one month and three months on PD. We did not detect significant differences in the progression of nutrition and inflammation parameters. Diuresis decreased significantly from pre-TX volume to diuresis on return to PD and after one month on PD (p=.032), remaining at low levels after three months on PD. UF decreased from 1407 to 951 ml/day (p=.022) and from 314 to 260 ml/4h (p=.018) in the peritoneal equilibration test after three months on PD, without changes being observed in the creatinine dialysate/plasma ratio. Kt/V and weekly creatinine clearance decreased slightly and remained at adequate efficacy levels. In this small sample of patients, who returned to PD after early TX failure, it does not appear that the measures involved in managing a graft at risk over a short period of time have a major effect on clinical parameters and permeability or

  6. Why does three times per week hemodialysis provide inadequate dialysis for children?

    Science.gov (United States)

    Fischbach, Michel; Zaloszyc, Ariane; Laetitia, Higel; Menouer, Soraya; Terzic, Joelle

    2014-10-01

    The duration of chronic conventional dialysis is a risk factor in children, both in terms of growth retardation and cardiovascular morbidity and mortality. Therefore, we need to develop alternative strategies, such as preemptive kidney transplantation and/or more intensive dialysis prescription. Indeed, conventional hemodialysis could be improved in all children by the use of high permeable membrane and ultrapure dialysis fluids (having very low endotoxin levels); by the addition of a convective dialysis dose to the urea diffusion dialysis dose (Kt/Vurea), i.e., hemodiafiltration; moreover, by the preservation of cardiovascular morphology and function (optimized blood pressure control); and also by the prescription of more frequent/longer dialysis sessions.

  7. John Dique: dialysis pioneer and political advocate.

    Science.gov (United States)

    George, Charles R P

    2016-02-01

    John Dique (1915-1995) epitomized the internationalism of medicine, the intellectual and manual dexterity of many pioneers of dialysis, and the social concern evinced by many nephrologists. Born in Burma of French, German, British and Indian ancestry; educated in India; an Anglo-Indian who described himself as British without ever having visited Britain; he moved to Australia in 1948 to escape the murderous inter-ethnic conflict that befell multicultural India as it and Pakistan became independent. Settling in Brisbane, he pioneered several novel medical techniques. After inventing some simple equipment to facilitate intravenous therapy, he established a neonatal exchange blood transfusion programme. Then, between 1954 and 1963, he personally constructed and operated two haemodialysis machines with which to treat patients suffering from acute renal failure, the first such treatment performed in Australasia. His patients survival results were, for the era, remarkable. He subsequently helped found the Royal Australasian College of Pathologists and went on to establish a successful private pathology practice. The latter years of his life, however, saw him become a social and political advocate. He fiercely opposed the emerging ideologies of multiculturalism and social liberalism that, he predicted, would seriously damage the national fabric of Western society. Public vilification ensued, his medical achievements disregarded. It does seem likely, however, that in none of the areas that he touched - whether medical, social, or political - has the last word yet been said.

  8. Laparoscopic interventions in children on peritoneal dialysis

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    Maria Szczepańska

    2010-12-01

    Full Text Available Introduction: The benefits of peritoneal dialysis (PD are multiple. However, it is connected with the risk of numerouscomplications, both infectious and non-infectious. Laparoscopic interventions in children on PD have seldom been presented.Aim: To analyse laparoscopic interventions in 23 children (mean age 10.2 ±5.2 years treated with PD.Performed procedures (30 included: diagnostic (explorative laparoscopy, laparoscopic replacement of thecatheter and laparoscopic recanalisation of occluded catheter.Results: In 29 cases laparoscopy with reduced invasive procedures was completed. During surgery 5 catheters wereremoved. In 16 cases of catheter malfunction, omental wrap releasing, recanalization and/or reposition was done,including omentectomy in 9 cases. In 6 cases of acute abdomen symptoms, 3 adhesiolysis procedures in bowelobstruction, 2 appendectomies and in 1 case laparoscopic reduction of intussusception were done. There were nointraoperative complications. After surgery PD was continued in 19 children. Catheter survival rate was 261 ±297 days.Conclusion: Laparoscopic surgery had no influence on peritoneal permeability or adequacy of PD treatment.Laparoscopic technique is highly effective in children on PD especially related to catheter malfunction. Itis an excellent option that enables restarting of PD shortly after the surgery.

  9. Long-term outcomes of arteriovenous thigh grafts in hemodialysis patients: a comparison with tunneled dialysis catheters.

    Science.gov (United States)

    Ong, Song; Barker-Finkel, Jill; Allon, Michael

    2013-05-01

    Arteriovenous thigh grafts are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites. This study compared the outcomes of thigh grafts with outcomes obtained with dialysis catheters. A prospective vascular access database was queried to identify 209 thigh grafts placed from January 1, 2003, to June 30, 2011. The following were calculated: secondary graft survival (from graft creation to permanent failure), assisted primary graft survival (from graft creation to first thrombosis), and infection-free graft survival (from graft creation to first graft infection). Graft outcomes were compared with those observed with 472 tunneled internal jugular dialysis catheters. The median duration of patient follow-up was 340 days for grafts and 91 days for catheters. The surgical technical failure rate of thigh grafts was 8.1% and was higher in patients with vascular disease (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.07-8.04; P=0.03). Secondary and assisted primary graft survival rates at 1, 2, and 5 years were 62%, 54%, and 38% and 38%, 27%, and 17%, respectively. Infection-free graft survival rates at 1, 2, and 5 years were 79%, 73%, and 61%. Secondary survival was much worse for dialysis catheters than thigh grafts (HR, 4.44; 95% CI, 3.65-5.22; Pcatheters than for thigh grafts (HR, 3.77; 95% CI, 2.80-4.82; Pdialysis catheters.

  10. Diαgnostic approaches of peritoneal dialysis in peritonitis

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    Alikari V.

    2014-03-01

    Full Text Available Introduction: Peritonitis is the most important and frequent infectious complication of peritoneal dialysis. It is the most common cause of failure of the method and inclusion of patients in hemodialysis. Purpose: Τhe purpose of this study is to explore the diagnostic approaches of peritoneal dialysis peritonitis. Methods: Literature review of relevant articles in the database Pubmed as well as the official website of the International Society of Peritoneal Dialysis (ISPD was carried out. The search included articles published during 1996-2013. Results: According to the International Society of Peritoneal Dialysis, peritonitis requires the presence of two of the following criteria: (a cloudy peritoneal fluid, (b symptoms of inflammation of the peritoneum and (c the presence of microorganisms in the peritoneal fluid (> 100 leukocytes / μL of the solution of which most (> 50 % are polymorphnuclear. Some rules of sampling peritoneal fluid for culture and Gram staining are important for the right and immediate treatment of peritonitis: a the first cloudy peritoneal bag is the best sample b sending of the first bag for cultures should be done as early as possible in order to begin the appropriate antibiotic therapy. Gram stain, although in most cases is negative, it is particularly useful for the diagnosis of fungal peritonitis. Conclusions: Patient education, mainly of new Peritoneal Dialysis patients, about the early recognizing of cloudy fluids and exit-site infection, must be the primary concern of a Peritoneal Dialysis Unit. Careful use of antibiotics will reduce the frequency of negative cultures in order not to exceed the limit of 20% of the tests, as recommended by the International Society of Peritoneal Dialysis.

  11. Endovascular dialysis interventions in the era of DOQI.

    Science.gov (United States)

    Greenberg, Joshua I; Suliman, Ahmed; Angle, Niren

    2008-09-01

    The National Kidney Foundation Dialysis Outcomes and Quality Initiative (DOQI) recommends autogenous fistulae as the preferred access for new dialysis procedures. Unfortunately, despite superior patency rates compared to prosthetic grafts, even autogenous access durability is often undermined by venous stenosis due to intimal hyperplasia at the outflow vein or by central venous stenosis due to long-standing central venous catheters. Salvage interventions, in the form of endovascular treatments such as percutaneous transluminal angioplasty (PTA) and/or stenting, are increasingly utilized for access salvage and maintenance. The objective of this study was to evaluate the efficacy of endovascular dialysis interventions in the era of DOQI. A retrospective review of a database of endovascular interventions for dialysis access during 36 months at an academic medical center was performed. Both central venous and access outflow lesions were included in the analysis. Kaplan-Meier curves and log-rank analysis were used to assess and compare time-dependent variables. Forty-five patients with dialysis access underwent 72 endovascular interventions for access maintenance. There were 27 central venous and 32 outflow endovascular interventions with 98% follow-up. Primary and assisted primary patency rates for outflow balloon PTA were 50% and 72% at 12 months, respectively. There were 1.1 reinterventions required per index outflow PTA procedure. Postintervention primary patency rates for central venous PTA were 30% and 9% at 6 and 12 months, respectively. Postintervention assisted patency for central venous PTA was 100% at 12 months, requiring 1.8 reinterventions per index PTA. Central venous and venous outflow interventions extended overall access patency by 38.5 and 33 months, respectively (p dialysis access. Despite the need for multiple reinterventions and close surveillance, catheter-based interventions positively contribute to dialysis access durability in accordance with

  12. Minimax confidence intervals in geomagnetism

    Science.gov (United States)

    Stark, Philip B.

    1992-01-01

    The present paper uses theory of Donoho (1989) to find lower bounds on the lengths of optimally short fixed-length confidence intervals (minimax confidence intervals) for Gauss coefficients of the field of degree 1-12 using the heat flow constraint. The bounds on optimal minimax intervals are about 40 percent shorter than Backus' intervals: no procedure for producing fixed-length confidence intervals, linear or nonlinear, can give intervals shorter than about 60 percent the length of Backus' in this problem. While both methods rigorously account for the fact that core field models are infinite-dimensional, the application of the techniques to the geomagnetic problem involves approximations and counterfactual assumptions about the data errors, and so these results are likely to be extremely optimistic estimates of the actual uncertainty in Gauss coefficients.

  13. Lower serum potassium associated with increased mortality in dialysis patients: A nationwide prospective observational cohort study in Korea

    Science.gov (United States)

    Lee, Sunhwa; Kang, Eunjeong; Yoo, Kyung Don; Choi, Yunhee; Kim, Dong Ki; Joo, Kwon Wook; Yang, Seung Hee; Kim, Yong-Lim; Kang, Shin-Wook; Yang, Chul Woo; Kim, Nam Ho; Kim, Yon Su; Lee, Hajeong

    2017-01-01

    Background Abnormal serum potassium concentration has been suggested as a risk factor for mortality in patients undergoing dialysis patients. We investigated the impact of serum potassium levels on survival according to dialysis modality. Methods A nationwide, prospective, observational cohort study for end stage renal disease patients has been ongoing in Korea since August 2008. Our analysis included patients whose records contained data regarding serum potassium levels. The relationship between serum potassium and mortality was analyzed using competing risk regression. Results A total of 3,230 patients undergoing hemodialysis (HD, 64.3%) or peritoneal dialysis (PD, 35.7%) were included. The serum potassium level was significantly lower (P < 0.001) in PD (median, 4.5 mmol/L; interquartile range, 4.0–4.9 mmol/L) than in HD patients (median, 4.9 mmol/L; interquartile range, 4.5–5.4 mmol/L). During 4.4 ± 1.7 years of follow-up, 751 patients (23.3%) died, mainly from cardiovascular events (n = 179) and infection (n = 120). In overall, lower serum potassium level less than 4.5 mmol/L was an independent risk factor for mortality after adjusting for age, comorbidities, and nutritional status (sub-distribution hazard ratio, 1.30; 95% confidence interval 1.10–1.53; P = 0.002). HD patients showed a U-shaped survival pattern, suggesting that both lower and higher potassium levels were deleterious, although insignificant. However, in PD patients, only lower serum potassium level (<4.5 mmol/L) was an independent predictor of mortality (sub-distribution hazard ratio, 1.35; 95% confidence interval 1.00–1.80; P = 0.048). Conclusion Lower serum potassium levels (<4.5 mmol/L) occur more commonly in PD than in HD patients. It represents an independent predictor of survival in overall dialysis, especially in PD patients. Therefore, management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia. PMID:28264031

  14. Reference Intervals in Neonatal Hematology.

    Science.gov (United States)

    Henry, Erick; Christensen, Robert D

    2015-09-01

    The various blood cell counts of neonates must be interpreted in accordance with high-quality reference intervals based on gestational and postnatal age. Using very large sample sizes, we generated neonatal reference intervals for each element of the complete blood count (CBC). Knowledge of whether a patient has CBC values that are too high (above the upper reference interval) or too low (below the lower reference interval) provides important insights into the specific disorder involved and in many instances suggests a treatment plan. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

    Directory of Open Access Journals (Sweden)

    Agodoa Lawrence Y

    2003-07-01

    Full Text Available Abstract Background The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN, namely of angiotensin converting enzyme inhibitors (ACE and antiretroviral therapy, has not been reported for a national sample of dialysis patients. Methods We conducted a historical cohort study of the United States Renal Data System (USRDS Dialysis Morbidity and Mortality Study (DMMS Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR with HIVAN as a cause of end stage renal disease (ESRD and its impact on mortality during the study period, adjusted for potential confounders. Results Of the 3374 patients who started dialysis, 36 (1.1% had ESRD as a result of HIVAN. Only 22 (61% of patients with HIVAN received antiretroviral agents, and only nine patients (25% received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60, or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p Conclusions Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.

  16. Benefits and harm of niacin and its analog for renal dialysis patients: a systematic review and meta-analysis.

    Science.gov (United States)

    He, Yuan-Mei; Feng, Li; Huo, Dong-Mei; Yang, Zhen-Hua; Liao, Yun-Hua

    2014-02-01

    Clinical trials have shown that niacin and its analog, niacinamide, significantly reduce serum phosphate in patients undergoing dialysis. This review aimed to assess the benefits and harm of niacin and niacinamide in renal dialysis patients. PubMed, EMBASE, and Cochrane Library were searched, without language limitation, randomized controlled trials (RCTs). Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager software, version 5.2, was used for meta-analysis. Five RCTs with a sample size of 230 patients were included. The meta-analysis showed that niacin and niacinamide significantly decreased serum phosphorus levels [weight mean difference (WMD) -0.88; 95 % confidence interval (CI) -1.19 to -0.57] as well as the calcium × phosphorus product (Ca × P) (WMD -9.15; 95 % CI -13.23 to -5.08), and increased high-density lipoprotein (HDL) levels (WMD 9.30; 95 % CI 5.86-12.74) in renal dialysis patients. Niacin significantly increased the risk of flushing [relative risk (RR) 33; 95 % CI 4.71-232.12] in these patients, while the risk of thrombocytopenia was significantly increased in the niacinamide group (RR 2.82; 95 % CI 1.14-6.94). However, sensitivity analysis showed that our finding regarding thrombocytopenia should be regarded with a low degree of certainty. Niacin and its analog effectively improved phosphorus metabolism in renal dialysis patients. However, niacin can cause flushing and niacinamide probably cause thrombocytopenia. Further larger sample size and well-designed RCTs are needed.

  17. Pediatric Chronic Dialysis in Brazil: Epidemiology and Regional Inequalities.

    Directory of Open Access Journals (Sweden)

    Tulio Konstantyner

    Full Text Available There are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and great need for continuous attention of specialized services with high demand for complex and costly procedures.The aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey.A cross-sectional study was performed in a representative sample of dialysis centers (nc = 239 that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708. We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers' leaders.We estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp (95% CI: 14.8-25.3 and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8-8.4. The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3-48.1 and 11.0 (95% CI: 2.8-19.3 cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2-21.4, and in the Northeast region, 3.8 (95% CI: 1.4-6.3 cases pmarp, respectively.Brazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint

  18. Posteriorly tunneled dialysis catheters for permanent use in cognitively impaired patients undergoing hemodialysis.

    Science.gov (United States)

    Stroz, Marianne J; Nathoo, Bharat; Stroz, Peter M

    2014-10-01

    Cognitively impaired patients often pull at their dialysis catheters when the catheters are tunneled over the anterior chest. To potentially circumvent this, a technique was developed that tunnels the catheter posteriorly, over the patient's shoulder. A total of 32 posteriorly tunneled catheters were placed in 12 patients. The mean catheter use interval was 164 days, with a total of 5,248 catheter use days. Indications for nonelective catheter removals were catheter dysfunction (n = 7; 23.3%), removal by the patient (n = 7; 23.3%), infection (n = 5; 16.7%), and inadvertent dislodgment (n = 1; 3.3%). Only six of the 12 patients were able to dislodge their catheters. The procedure described here reduced catheter manipulation and extended catheter viability in these patients. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  19. Reduction in slow intercompartmental clearance of urea during dialysis

    Energy Technology Data Exchange (ETDEWEB)

    Bowsher, D.J.; Krejcie, T.C.; Avram, M.J.; Chow, M.J.; Del Greco, F.; Atkinson, A.J. Jr.

    1985-04-01

    The kinetics of urea and inulin were analyzed in five anesthetized dogs during sequential 2-hour periods before, during, and after hemodialysis. The distribution of both compounds after simultaneous intravenous injection was characterized by three-compartment models, and the total volumes of urea (0.66 +/- 0.05 L/kg) and inulin (0.19 +/- 0.01 L/kg) distribution were similar to expected values for total body water and extravascular space, respectively. Intercompartmental clearances calculated before dialysis were used to estimate blood flows to the fast and slow equilibrating compartments. In agreement with previous results, the sum of these flows was similar to cardiac output, averaging 101% of cardiac output measured before dialysis (range 72% to 135%). Dialysis was accompanied by reductions in the slow intercompartmental clearances of urea (81%) and inulin (47%), which reflected a 90% attenuation in blood flow supplying the slow equilibrating compartments. This was estimated to result in a 10% average reduction in the efficiency with which urea was removed by dialysis (range 2.0% to 16.4%). Mean arterial pressure fell by less than 5% during dialysis, but total peripheral resistance increased by 47% and cardiac output fell by 35%. In the postdialysis period, total peripheral resistance and cardiac output returned toward predialysis values, but blood flow to the slow equilibrating peripheral compartment was still reduced by 80%. These changes parallel activation of the renin-angiotensin system, but further studies are required to establish causality.

  20. Severe defect in clearing postprandial chylomicron remnants in dialysis patients.

    Science.gov (United States)

    Weintraub, M; Burstein, A; Rassin, T; Liron, M; Ringel, Y; Cabili, S; Blum, M; Peer, G; Iaina, A

    1992-11-01

    Lipid abnormalities have been suggested as a major cause of the accelerated atherosclerosis and the high incidence of coronary heart disease in chronic renal failure patients. In the present work the postprandial lipoprotein metabolism was studied in chronic dialysis patients with or without fasting hypertriglyceridemia using the vitamin A loading test. This method investigates specifically postprandial lipoprotein metabolism. The determination of vitamin A ester level retinyl palmitate (RP) differentiates the circulating plasma chylomicron and chylomicron remnant fractions from the endogenous VLDL and IDL. Subjects with normal renal function with or without fasting hypertriglyceridemia served as control groups. Dialysis patients have significantly higher level of chylomicron remnants for a more prolonged period of time than controls, irrespective of their fasting triglyceride levels. The area below retinyl palmitate chylomicron remnants curve was 26308 +/- 12422 micrograms/liter.hr in the normolipidemic dialysis patients, significantly higher than (6393 +/- 2098 micrograms/liter.hr; P 21021 +/- 4560 micrograms/liter.hr, which was higher than 12969 +/- 2215 micrograms/liter.hr (P < 0.0001) in the hypertriglyceridemic controls. Moreover, the hypertriglyceridemic dialysis patients had an additional defect in the lipolysis metabolic step, that is, accumulation of chylomicrons in circulation. These findings show a severe defect in postprandial lipoprotein metabolism in chronic renal failure patients. The prolonged exposure of the vascular wall to high chylomicron remnant concentrations might be an important pathogenetic factor in the accelerated atherosclerosis seen in chronic dialysis patients.

  1. TOF-SIMS imaging of protein adsorption on dialysis membrane

    Science.gov (United States)

    Aoyagi, Satoka; Hayama, Msayo; Hasegawa, Urara; Sakai, Kiyotaka; Hoshi, Takahiro; Kudo, Masahiro

    2004-06-01

    Time-of-flight secondary ion mass spectrometry (TOF-SIMS) is capable of chemical imaging of proteins on insulated samples such as hollow-fiber dialysis membranes. Albumin loss and a lowering of diffusive permeability caused by protein adsorption on dialysis membranes should be reduced in order to enhance dialysis adequacy of the patients. Bovine serum albumin (BSA)-adsorbed hollow-fiber dialysis membranes were tested in the present study. TOF-SIMS images and spectra of both native membranes and BSA-adsorbed membranes were compared in order to identify secondary ions related to BSA and membranes. Peaks of secondary ions related to BSA and each membrane were selected by means of information theory, and they are characterized by principal component analysis (PCA). Chemical images of BSA adsorption on both native and treated membranes were obtained to find that BSA permeability and interaction between the membranes and BSA definitely depend on the properties of a membrane. TOF-SIMS imaging obtained with information theory is a powerful tool to estimate protein adsorption on the dialysis membranes.

  2. Vitamins in dialysis: who, when and how much?

    Science.gov (United States)

    Kosmadakis, George; Da Costa Correia, Enrique; Carceles, Odette; Somda, Frederic; Aguilera, Didier

    2014-05-01

    Despite the significant technical evolution of the blood purification methods, cardiovascular morbidity and mortality in dialysis patients is still several times higher than that observed in the general population. Vitamins are playing a crucial role in multiple key metabolic pathways. Due to multiple factors, dialysis patients present very often hypo- or hypervitaminosis for a broad range of vitamins. Dialysis in the context of renal replacement therapy is associated with a non-physiological potassium-sparing dietetic regime. Additionally, there is a non-selective intradialytic loss of micro- and macronutrients, deranged intracellular kinetics and gastrointestinal malabsorption due to uratemia. Frequent treatment with antibiotics due to infections associated with the acquired uremia-related immunosuppression may derange the vitamin-producing intestinal microflora. Certain agents prescribed in the context of renal failure or other conditions may reduce the absorption of vitamins from the gastrointestinal tract. These factors may deplete a dialysis patient from vitamins, especially the ones with antioxidant activity that may be associated with cardioprotective properties. In other cases, vitamins metabolized and excreted by the kidneys may be accumulated and exert toxic effects. The scope of this paper is to describe the main issues on vitamin therapy in dialysis patients in view of the ever contradictory opinions and practices.

  3. Intermittent Oral Versus Intravenous Alfacalcidol in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Mitwalli Ahmed

    2000-01-01

    Full Text Available Patients with end-stage renal failure (ESRF on maintenance dialysis, commonly develop secondary hyperparathyroidism and renal osteodystrophy (ROD. Alfacalcidol, taken orally or administered intravenously, is known to reverse these complications. In this study, 19 ESRF patients, who were on dialysis (13 on hemodialysis and six on peritoneal dialysis for longer than six months and having serum parathormone levels at least four times normal and serum calcium less than 2.1 mmol/L, were randomly allocated to treatment with oral or intravenous (i.v. alfacalcidol for a period of 12 months. There were six patients on hemodialysis (HD and three on peritoneal dialysis (PD in the oral treatment group while in the i.v. group there were seven patients on HD and three on PD. Clinical and serial biochemical assessments showed no statistically significant difference between the orally- and i.v.-treated patients in terms of suppressing secondary hyperparathyroidism and osteodystrophy. However, patients with features of mild ROD on bone histology, had more satisfactory changes in biochemistry when compared to others. Our results further support the use of intermittent oral alfacalcidol in ESRF patients because of its cost effectiveness, ease of administration and convenience, especially for peritoneal dialysis patients.

  4. Cooperation and successful outcomes in home dialysis.

    Science.gov (United States)

    MacElveen, P M; Alexander, R A; Hoover, P M

    1975-11-01

    Cooperation among those involved in the triad of patient-partner-health professional is associated with desirable patient outcomes and has been demonstrated in 2 studies with consistent results. In the dyad analysis, cooperation between the patient and partner was associated with work and leisure activity. Spouses often encourage and facilitate the patients ability to engage in work and leisure activities and probably can impede activity equally well. The correlations of cooperation in the patient-doctor dyad with physical status and adherence is also of note. Many of the patients who have been on dialysis for several years and are doing well see their doctor for checkups only a few times a year, which might suggest patients' independence of their physicians or at least some distancing due primarily to the infrequency of contacts with each other. On the contrary, the data suggest some that the patient-doctor relationship remains important. Cooperation in the partner-doctor dyad did not relate to any of the patient outcomes; many of the partners and doctors hardly knew each other personally. Whether this is reflected by the data cannot be determined. How accurately triad members perceived each other (mutual perception) was related to adherence and total activity while trust was related to physical status and adherence. Empirical evidence has been presented to support the long held assumption that cooperation among those caring for a patient is associated with selected patient outcomes. The study also provides an alternative to the traditional model for interactions between health care providers and patients, which includes a family member. While the traditional model fits the needs of emergency and acute care situations effectively, the cooperation model is one alternative that may fit the different needs in the long term, self-care, chronic illness situation, which is the greatest health care delivery challenge of today and tommorrow. Patient and family

  5. Effect of sertraline hydrochloride on dialysis hypotension.

    Science.gov (United States)

    Dheenan, S; Venkatesan, J; Grubb, B P; Henrich, W L

    1998-04-01

    Hemodialysis hypotension (HH) is a very common disorder and has a multifactorial etiology. Autonomic dysfunction occurs in up to 50% of patients with end-stage renal disease (ESRD) and plays a key role in HH in some patients. Sertraline hydrochloride, a central nervous system serotonin reuptake inhibitor, has been shown to be an effective treatment of hypotension caused by autonomic dysfunction in disorders such as neurocardiogenic syncope and idiopathic orthostatic hypotension. This study sought to determine whether sertraline was effective in ameliorating HH. A retrospective chart analysis was performed that included nine consecutive patients (aged > or = 54 years, time on hemodialysis > or = 2.2 years) placed on sertraline (50 to 100 mg/d) for depression who also had HH (defined as prehemodialysis systolic blood pressure [SBP] or = 40 mm Hg decrease in SBP during hemodialysis, SBP sertraline. The data from a 6-week pre-sertraline period were compared with the data from a 6-week sertraline period (defined as 6 weeks after drug begun). Blood pressure medications were unchanged during the trial period of sertraline. However, nadir mean arterial pressure recorded during a given dialysis session in the pre-sertraline period (55+/-4 mm Hg) was significantly lower than that recorded in the sertraline period (68+/-5 mm Hg; P sertraline period was significantly lower than that during the pre-sertraline period (mean, 0.6+/-0.2 episodes per session v 1.4+/-0.3 episodes per session; P sertraline period was also significantly less than that during the pre-sertraline period (mean, 1.7+/-0.8 interventions v 11.0+/-3.0 interventions; P sertraline hydrochloride reduces HH in some patients with ESRD. A possible mechanism for this effect is sertraline-induced attenuation of the paradoxical sympathetic withdrawal that may underlie HH in some patients with ESRD.

  6. Use of unconventional dialysis access in patients with no viable alternative.

    Science.gov (United States)

    Herscu, Gabriel; Woo, Karen; Weaver, Fred A; Rowe, Vincent L

    2013-04-01

    Hemodialysis patients who have exhausted all of the conventionally used veins for vascular access, including arteriovenous fistula, arteriovenous graft, and traditional catheter access sites, present a challenge to the treating physician. Transhepatic and translumbar inferior vena cava catheters have been used in these patients who have no other access site option. The objective of the study was to examine our experience with translumbar and transhepatic approach for catheter-based hemodialysis access in patients who have exhausted all other options. A retrospective review was performed from June 2000 to May 2011 of all patients who underwent transhepatic or translumbar inferior vena cava catheter placement for the purpose of hemodialysis. Data abstracted included previous access procedures, duration of use and patency of dialysis catheters, catheter-related complications, and mortality. Seven patients were identified. Four patients underwent transhepatic access and three underwent translumbar access. Five patients were female and two were male. The mean age was 44 years. The etiology of renal failure was diabetes in four patients, congenital hypoplastic kidneys in two patients, and acute glomerulonephritis in one patient. A mean of 14 (range: 11-18) dialysis access procedures were performed before catheter placement by transhepatic/translumbar interventions. The initial device service interval for all patients ranged from 15 to 658 days, with a mean of 295 days and a median of 245 days. Total access site service interval ranged from 15 to 790 days, with a mean of 380 days and a median of 245 days. Translumbar and transhepatic venous access is a viable long-term alternative route for catheter-based hemodialysis access in patients who have exhausted conventional options. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. [THE RISK FACTORS OF THE DIALYSIS PERITONITIS (THREE-YEARS PROSPECTIVE INVESTIGATION)].

    Science.gov (United States)

    Mishalov, V G; Zavodovskiy, E S; Markulan, L Yu; Goyda, S M

    2015-09-01

    The risk factors of the dialysis peritonitis occurrence were determined in patients with chronic renal disease, to whom a substitute renal therapy, using peritoneal dialysis, was conducted. The results of a three-year prospective investigation and treatment of 73 patients in Kyiv City Oleksandrivska Clinical Hospital on the base of the general surgery and nephrology departments in 2007 - 2010 yrs were studied. The dialysis peritonitis (first episode) have occurred in 42 (57.5%) patients. Cumulative rate of a dialysis peritonitis in accordance to a censored data (the dialysis peritonitis suspension or other causes) have constituted 67.7%. Due to the dialysis peritonitis occurrence the peritoneal dialysis was stopped in 14 (19.2%) patients. The obesity, raising of a serum albumin level, constipation, preliminary injection into the site of the catheter exit site we consider a risk factors for the dialysis peritonitis occurrence.

  8. Intraperitoneal heparin reduces peritoneal permeability and increases ultrafiltration in peritoneal dialysis patients

    National Research Council Canada - National Science Library

    Sjøland, Jonas Angel; Smith Pedersen, Robert; Jespersen, Jørgen; Gram, Jørgen

    2004-01-01

    Patients on long-term treatment with peritoneal dialysis (PD) suffer from increasing peritoneal permeability and loss of ultrafiltration as a result of persistent inflammation, which may be triggered by bioincompatible dialysis fluids...

  9. Automatic Error Analysis Using Intervals

    Science.gov (United States)

    Rothwell, E. J.; Cloud, M. J.

    2012-01-01

    A technique for automatic error analysis using interval mathematics is introduced. A comparison to standard error propagation methods shows that in cases involving complicated formulas, the interval approach gives comparable error estimates with much less effort. Several examples are considered, and numerical errors are computed using the INTLAB…

  10. Explorations in Statistics: Confidence Intervals

    Science.gov (United States)

    Curran-Everett, Douglas

    2009-01-01

    Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This third installment of "Explorations in Statistics" investigates confidence intervals. A confidence interval is a range that we expect, with some level of confidence, to include the true value of a population parameter…

  11. Predictors of mortality in dialysis patients: Association between malnutrition, inflammation and atherosclerosis (Mia syndrome)

    OpenAIRE

    2004-01-01

    Introduction Numerous recent studies have shown increased comorbidity and mortality in dialysis patients with malnutrition. Protein-energy malnutrition with muscle wasting occurs in a large proportion of patients with chronic renal failure and is, in addition to atherosclerosis, a strong risk factor for mortality in patients undergoing dialysis. Malnutrition is also associated with increased cardiovascular mortality in dialysis patients. Pathogenic factors of malnutrition in dialysis patients...

  12. Mortality during first hospital admission in a population that begins chronic dialysis in a general hospital

    OpenAIRE

    Herrera Añazco, Percy; Médico Asistente, Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú; Docente de la Facultad de Medicina, Universidad Científica del Sur, Lima, Perú; Docente de la Facultad de Medicina, Universidad Nacional de Piura, Piura, Perú.; Palacios Guillén, Melissa; Médico Asistente, Servicio de Nefrología, Hospital Daniel Alcides Carrión, Lima, Perú; Docente, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Chipayo Gonzales, David; Médico Residente, Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú.; Silveira Chau, Manuela; Médico Asistente, Unidad Médica Empresarial, Clínica Internacional, Lima, Perú.

    2013-01-01

    The Health Ministry attends Peruvian population without social security and without a national dialysis program. Attention is limited to a few hospitals with dialysis centers. objectives: To determine mortality in the first hospitalization for dialysis in a population without social security. design: Descriptive study. Setting: Hospital Nacional Dos de Mayo, Lima, Peru. Patients: Patients with chronic renal disease. Interventions: We studied patients who started dialysis from January to Decem...

  13. Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

    Directory of Open Access Journals (Sweden)

    Jack Kit-Chung Ng

    2016-10-01

    Full Text Available Background/Aims: Previous studies showed that frailty is prevalent in both pre-dialysis and dialysis patients. However, the prevalence and prognostic implication of frailty in Chinese peritoneal dialysis (PD patients remain unknown. Methods: We used a validated questionnaire to determine the Frailty Score of 193 unselected prevalent PD patients. All patients were then followed for 2 years for their need of hospitalization and mortality. Results: Amongst the 193 patients, 134 (69.4% met the criteria of being frail. Frailty Score significantly correlated with Charlson's comorbidity score (r = 0.40, p Conclusions: Frailty is prevalent among Chinese PD patients. Frail PD patients have a high risk of requiring hospitalization and their hospital stay tends to be prolonged. Early identification may allow timely intervention to prevent adverse health outcomes in this group of patients.

  14. Purification of dialysis fluid: historical background and perspective.

    Science.gov (United States)

    Ledebo, Ingrid

    2009-01-01

    When dialysis became a chronic therapy, certain clinical symptoms could be connected to the fluid quality and some form of water treatment had to be introduced. The required equipment was empirically developed and consisted of sedimentation filters, carbon filters and softeners. In the mid-1970s the toxic effect of aluminum accumulation was discovered and led to the introduction of reverse osmosis modules. When these components - prefilters, softeners and RO modules - are properly maintained, they produce water of a quality that should meet modern standards. However, the water quality could be ruined by bacterial contamination from the distribution pipes, unless the entire flow path is hygienically designed and frequently disinfected. The quality of the concentrate is also important, especially the bicarbonate component which is prone to bacterial growth. The extent of the microbiological burden in water and dialysis fluid has been brought to the attention of the dialysis community through new and sensitive detection and quantification methods for bacteria and endotoxin.

  15. Lymphocyte apoptosis: role of uremia and permeability of dialysis membrane.

    Science.gov (United States)

    Soriano, Sagrario; Martín-Malo, Alejandro; Carracedo, Julia; Ramírez, Rafael; Rodríguez, Mariano; Aljama, Pedro

    2005-01-01

    Uremia is associated to host defense mechanism disorders. Lymphocyte apoptosis, which may cause alteration of the immune system, is increased in uremic patients. The aim of the present study was to determine if, in addition to uremia, dialysis membranes with different biocompatibility and permeability have an effect on lymphocyte apoptosis. Cell apoptosis and Fas expression were assessed using flow cytometry in four groups of patients: (1) uremic non-dialyzed (Non-D) patients; (2) hemodialysis (HD) patients on hemophan; (3) low-flux polysulfone, and (4) high-flux polysulfone membrane. Ten healthy volunteers were used as controls. At baseline, lymphocytes from patients on hemophan showed an increase in apoptosis (18.4 +/- 6.9%) as compared with Non-D (7.2 +/- 2.8%; p dialysis patients lymphocyte apoptosis is influenced not only by the biocompatibility but also by the permeability of the dialysis membrane.

  16. Development and evaluation of a retroperitoneal dialysis porcine model.

    Science.gov (United States)

    Okhunov, Zhamshid; Yoon, Renai; Perez Lanzac, Alberto; Sgroi, Michael; Lau, Wei Ling; Del Junco, Michael; Ordon, Michael; Drysch, Austin; Hwang, Christina; Vernez, Simone L; Fujitani, Roy; Kabutey, Nii-Kabu; Kalantar-Zadeh, Kamyar; Landman, Jaime

    2016-08-01

    We attempted to create a surgical model to evaluate the retroperitoneal space for the ability to transfer solutes through the retroperitoneal membrane. Our dual objectives were to develop a technique to assess the feasibility of retroperitoneal dialysis (RPD) in a porcine model. We incorporated two 35-kg Yorkshire pigs for this pilot study. In the first animal, we clamped renal vessels laparoscopically. In the second animal, we embolized renal arteries. In both animals, we dilated the retroperitoneal space bilaterally and deployed dialysis catheters. We measured serum creatinine (Cr), urea, and electrolytes at baseline 6 hours before the dialysis and every 4 hours after. We successfully created retroperitoneal spaces bilaterally and deployed dialysis catheters in both animals. In the first animal, dialysate and plasma Cr ratio (D/P) on the left and right side were 0.43 and 0.3, respectively. Cr clearance by 40 minutes of dialysis treatment was 6.3 mL/min. The ratio of dialysate glucose at 4 hours dwell time to dialysate glucose at 0 dwell time (D/D0) for left/rights sides were 0.02 and 0.02, respectively. kt/Vurea was 0.43. In the second animal, D/P Cr for left/right sides were 0.34 and 0.33, respectively. kt/Vurea was 0.17. We euthanized the pigs due to fluid collection in the peritoneal space and rapid increase of serum Cr, urea, and electrolytes. We demonstrated the feasibility of creation of a functionally anephric porcine model with successful development of retroperitoneal spaces using balloon inflation. Notwithstanding minimal clearance and limited diffusion capacity in this experiment, additional studies are needed to examine potential use of retroperitoneal space for peritoneal dialysis.

  17. Phosphate binding therapy in dialysis patients: focus on lanthanum carbonate

    Directory of Open Access Journals (Sweden)

    Ismail A Mohammed

    2008-11-01

    Full Text Available Ismail A Mohammed, Alastair J HutchisonManchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, UKAbstract: Hyperphosphatemia is an inevitable consequence of end stage chronic kidney disease and is present in the majority of dialysis patients. Recent observational data has associated hyperphosphatemia with increased cardiovascular mortality among dialysis patients. Dietary restriction of phosphate and current dialysis prescription practices are not enough to maintain serum phosphate levels within the recommended range so that the majority of dialysis patients require oral phosphate binders. 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 hypercalcemia and vascular calcification. Sevelamer hydrochloride is associated with fewer adverse effects, but a large pill burden and high cost are limiting factors to its wider use. In addition, the efficacy of sevelamer as a monotherapy in lowering phosphate to target levels in severe hyperphosphatemia remains debatable. Lanthanum carbonate is a promising new non-aluminium, calcium-free phosphate binder. Preclinical and clinical studies have demonstrated a good safety profile, and it appears well tolerated and effective in reducing phosphate levels in dialysis patients. Its identified adverse events are apparently mild to moderate in severity and mostly GI related. It appears to be effective as a monotherapy, with a reduced pill burden, but like sevelamer, it is significantly more expensive than calcium-based binders. Data on its safety profile over 6 years of treatment are now available.Keywords: hyperphosphatemia, lanthanum

  18. Timing of dialysis initiation in transplant-naive and failed transplant patients

    Science.gov (United States)

    Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

    2017-01-01

    Over the past two decades, most guidelines have advocated early dialysis initiation on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m2, from 20% in 1996 to 52% in 2008. During this period, patients starting dialysis with an eGFR ≥15 ml/min/1.73 m2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes in patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Dialysis reinitiation in patients with a failing renal allograft encounters similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients. In this Review, we will discuss studies of dialysis initiation and compare risks and benefits of early versus late dialysis therapy. PMID:22371250

  19. 42 CFR 414.330 - Payment for home dialysis equipment, supplies, and support services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for home dialysis equipment, supplies, and... dialysis equipment, supplies, and support services. Link to an amendment published at 75 FR 49202, Aug. 12..., Medicare pays for home dialysis equipment and supplies only under the prospective payment rates...

  20. 42 CFR 413.186 - Payment exception: Self-dialysis training costs in pediatric facilities.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment exception: Self-dialysis training costs in....186 Payment exception: Self-dialysis training costs in pediatric facilities. (a) Qualification. To qualify for an exception to the prospective payment rate based on self-dialysis training costs,...

  1. 42 CFR 413.198 - Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.

    Science.gov (United States)

    2010-10-01

    ... outpatient maintenance dialysis. 413.198 Section 413.198 Public Health CENTERS FOR MEDICARE & MEDICAID... § 413.198 Recordkeeping and cost reporting requirements for outpatient maintenance dialysis. (a) Purpose... will enable CMS to determine the costs incurred in furnishing outpatient maintenance dialysis...

  2. 42 CFR 410.50 - Institutional dialysis services and supplies: Scope and conditions.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Institutional dialysis services and supplies: Scope... Medical and Other Health Services § 410.50 Institutional dialysis services and supplies: Scope and... following institutional dialysis services and supplies if they are furnished in approved ESRD facilities:...

  3. Changes of serum leptin levels and the influential factors in peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    晏焕青

    2014-01-01

    Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients.Methods Seventy-six peritoneal dialysis patients were chosen at the time before,and 3months,6 months,12 months,18 months and 24months after they began the peritoneal dialysis therapy,to examine body mass index(BMI),

  4. Fibrin glue used successfully in peritoneal dialysis catheter leakage in children.

    NARCIS (Netherlands)

    Rusthoven, E.; Kar, N.C.A.J. van de; Monnens, L.A.H.; Schröder, C.H.

    2004-01-01

    BACKGROUND: Acute renal failure in infants and small children is generally treated with peritoneal dialysis (PD). Dialysis has to be started immediately after catheter implantation. Early dialysate leakage can complicate the effectiveness of dialysis. Fibrin glue applied to the external part of the

  5. A new paradigm: home therapy for patients who start dialysis in an unplanned way.

    Science.gov (United States)

    Lecouf, Angelique; Ryckelynck, Jean-Philippe; Ficheux, Maxence; Henri, Patrick; Lobbedez, Thierry

    2013-01-01

    Starting dialysis in a non-planned manner or in a 'suboptimal' manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow-up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in-centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD). This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home-based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long-term). This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre-dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  6. Fibrin glue used successfully in peritoneal dialysis catheter leakage in children.

    NARCIS (Netherlands)

    Rusthoven, E.; Kar, N.C.A.J. van de; Monnens, L.A.H.; Schröder, C.H.

    2004-01-01

    BACKGROUND: Acute renal failure in infants and small children is generally treated with peritoneal dialysis (PD). Dialysis has to be started immediately after catheter implantation. Early dialysate leakage can complicate the effectiveness of dialysis. Fibrin glue applied to the external part of the

  7. Differences in survival on chronic dialysis treatment between ethnic groups in Denmark

    DEFF Research Database (Denmark)

    van den Beukel, Tessa O.; Hommel, Kristine; Kamper, Anne-Lise

    2016-01-01

    Background In Western countries, black and Asian dialysis patients experience better survival compared with white patients. The aim of this study is to compare the survival of native Danish dialysis patients with that of dialysis patients originating from other countries and to explore the associ...

  8. Peritoneal transport mechanisms and their application during peritoneal dialysis in children

    NARCIS (Netherlands)

    Rusthoven, Esther

    2005-01-01

    Introduction - Peritoneal dialysis takes an important place as a treatment modality for children with chronic renal failure. This dialysis modality has important advantages compared to hemodialysis: it allows children of all ages to receive dialysis at home with the subsequent experience of a more n

  9. Clinical research: making it work in the outpatient dialysis facility.

    Science.gov (United States)

    Doss, Sheila; Schiller, Brigitte; Fox, Rosemary; Moran, John

    2009-01-01

    Performing clinical research in the outpatient dialysis facility can be very challenging. Research protocols define time-specific and detailed procedures to be performed. In dialysis units where staff members are responsible for the delivery of life-sustaining therapy to an aging end stage renal disease patient population with multiple co-morbidities, these requirements can easily be considered too burdensome to be implemented successfully. In the authors'facility, clinical research has been successfully implemented with a close team approach supported by a dedicated research group and unit staff

  10. Salmon calcitonin in prevention of osteoporosis in maintenance dialysis patients

    Institute of Scientific and Technical Information of China (English)

    WANG Shi-xiang; LI Han

    2008-01-01

    Background Renal osteodystrophy is one of the commonest complications of chronic renal failure. It may have a severe impact on the quality of life of patients on maintenance dialysis therapy. Besides post-menopausal women and elderly people, the dialysis patients are another high risk group. But at present, there is no research on how to prevent osteoporosis in maintenance dialysis patients. This study was conducted to observe the bone density of maintenance dialysis patients and to evaluate the clinical outcomes and safety of different administration dosage of salmon calcitonin to prevent osteoporosis in maintenance dialysis patients.Methods One hundred and forty-eight patients on maintenance dialysis were involved in the 12-month, randomized, controlled trial. Fifty patients (experiment Ⅰ group) received subcutaneous injection of salmon calcitonin (50 U) three times a week for 12 months. Fifty patients (experiment Ⅱ group) received subcutaneous injection of salmon calcitonin (100 U) three times a week for 12 months. At the same time, both of them received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The control group only received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 μg qn for 12 months. The levels of bone mass density (BMD) of the lumbar spine and femoral neck, serum intact parathyroid hormone (iPTH), osteocatcin (OC), calcium, phosphorus, alkaline phosphatase (ALP) were assessed at baseline and then again after 3, 6 and 12 months of treatment.Results The values of BMD at the lumbar spine and femoral neck before the treatment were not significantly different from those 3, 6, and 12 months after the treatment in trial groups I and II (all P >0.05) and there were no significant differences in the BMD values at different time points between trial groups I and I1. In the control group, the BMD values at the lumbar spine and femoral neck 3, 6, and 12 months after the beginning of trial were significantly lower than

  11. Fate of patients during the first year of dialysis

    Directory of Open Access Journals (Sweden)

    Selma Siham El Khayat

    2013-01-01

    Full Text Available Care in dialysis is often associated with significant morbidity and mortality during the first year. Knowledge of its magnitude and causes could improve the prognosis of these patients. The aim of this study was to evaluate the survival and morbidity during the first year of dialysis for patients who initiated their dialysis between January 1, 2009 and December 31, 2009 and to study their possible correlation with baseline status at the beginning of treatment. A multi-center retrospective study was conducted in 11 dialysis centers. Clinical data at the beginning of dialysis and during the following year were collected. Mortality and morbidity risk factors were assessed by comparing different groups. Statistical analysis was performed with SPSS version 11. This study involved 134 patients, 79 men and 55 women, of whom 132 were on hemodialysis and two patients were on peritoneal dialysis. The mean age at initiation of treatment was 54.37 ± 18.09 years. Initial causes of nephropathy were dominated by diabetes (44.02% and hypertension (11.19%. Among these patients, 39.55% had never received prior nephrological follow-up and 64.92% had started renal replacement therapy on an emergency basis. The initial clinical state was dominated by the presence of hypertension (50.74%, diabetes (44.02%, coronary insufficiency (13.43% and heart failure (7.46%. Only 26.86% of the incident patients showed no comorbidity. During the first year of follow-up, 37.31% of the patients experienced at least one episode of comorbidity. Hospitalization was necessary in about half of these cases (17.91% of all patients. The overall mortality rate was 14.17%. One patient received a kidney transplant. The mortality rate in the first year of dialysis was lower in our study than in other series. Regular nephrological follow-up of these patients before they reach end-stage could have a significant influence on survival in dialysis.

  12. Patients in assisted automated peritoneal dialysis develop strategies for selfcare

    DEFF Research Database (Denmark)

    Holch, Kirsten

    Henderson's areas of need and Dorothea Orem's self - care theory combined with problems and symptoms in End Stage Renal Disease (ESRD) patients. Results The results showed that patients in their own home improve their self-care capacity in the period between three and six months after starting AAPD......  Patients in Assisted Automated Peritoneal Dialysis develop strategies for self-care Background: Since 2000 a model for Assisted Automated Peritoneal Dialysis (AAPD) in the patients own home has been developed at Aarhus University Hospital, Skejby. The patient group consists of physically...

  13. Tsukamurella peritonitis associated with continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Shaer, A J; Gadegbeku, C A

    2001-09-01

    A case of Tsukamurella peritonitis associated with peritoneal dialysis in a 23-year-old woman is described. The organism was difficult to identify and was mistaken for Corynebacterium and atypical mycobacteria. Despite prolonged, multidrug, antimicrobial therapy with conventional antibiotics including vancomycin, ciprofloxacin, rifampin, gentamicin and ceftazidime, catheter removal was required to successfully treat peritonitis. Human infection due to this organism is rare and has been previously reported in only 13 cases, 1 of which was peritonitis. We describe here the second case of Tsukamurella peritonitis associated with peritoneal dialysis.

  14. Assessment and Management of Hypertension in Patients on Dialysis

    Science.gov (United States)

    Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

    2014-01-01

    Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

  15. A Patient on Peritoneal Dialysis with Refractory Volume Overload

    Science.gov (United States)

    2016-01-01

    The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status. It requires sequential evaluation of volume status and adjustment of the peritoneal dialysis prescription on the basis of assessments of membrane function and alterations in urine volume. Steps should be taken to preserve residual renal function for as long as possible. Ultimately, in patients who have become anuric and have developed ultrafiltration failure, timely transfer to hemodialysis may be necessary, requiring discussion and planning with the patient. PMID:26185264

  16. Death or dialysis? The risk of dialysis-dependent chronic renal failure after trauma nephrectomy.

    Science.gov (United States)

    Dozier, Kristopher C; Yeung, Louise Y; Miranda, Marvin A; Miraflor, Emily J; Strumwasser, Aaron M; Victorino, Gregory P

    2013-01-01

    Although renal trauma is increasingly managed nonoperatively, severe renovascular injuries occasionally require nephrectomy. Long-term outcomes after trauma nephrectomy are unknown. We hypothesized that the risk of end-stage renal disease (ESRD) is minimal after trauma nephrectomy. We conducted a retrospective review of the following: 1) our university-based, urban trauma center database; 2) the National Trauma Data Bank (NTDB); 3) the National Inpatient Sample (NIS); and 4) the U.S. Renal Data System (USRDS). Data were compiled to estimate the risk of ESRD after trauma nephrectomy in the United States. Of the 232 patients who sustained traumatic renal injuries at our institution from 1998 to 2007, 36 (16%) underwent a nephrectomy an average of approximately four nephrectomies per year. The NTDB reported 1780 trauma nephrectomies from 2002 to 2006, an average of 356 per year. The 2005 NIS data estimated that in the United States, over 20,000 nephrectomies are performed annually for renal cell carcinoma. The USRDS annual incidence of ESRD requiring hemodialysis is over 90,000, of which 0.1 per cent (100 per year) of renal failure is the result of traumatic or surgical loss of a kidney. Considering the large number of nephrectomies performed for cancer, we estimated the risk of trauma nephrectomy causing renal failure that requires dialysis to be 0.5 per cent. National data regarding the etiology of renal failure among patients with ESRD reveal a very low incidence of trauma nephrectomy (0.5%) as a cause; therefore, nephrectomy for trauma can be performed with little concern for long-term dialysis dependence.

  17. Circular Interval Arithmetic Applied on LDMT for Linear Interval System

    Directory of Open Access Journals (Sweden)

    Stephen Ehidiamhen Uwamusi

    2014-07-01

    Full Text Available The paper considers the LDMT Factorization of a general nxn matrix arising from system of interval linear equations. We paid special emphasis on Interval Cholesky Factorization. The basic computational tool used is the square root method of circular interval arithmetic in a sense analogous to Gargantini and Henrici as well as the generalized square root method due to Petkovic which enables the construction of the square root of the resulting diagonal matrix. We also made use of Rump’s method for multiplying two intervals expressed in the form of midpoint-radius respectively. Numerical example of matrix factorization in this regard is given which forms the basis of discussion. It is shown that LDMT even though is a numerically stable method for any diagonally dominant matrix it also can lead to excess width of the solution set. It is also pointed out that in spite of the above mentioned objection to interval LDMT it has in addition , the advantage that in the presence of several solution sets sharing the same interval matrix the LDMT Factorization requires to be computed only once which helps in saving substantial computational time. This may be found applicable in the development of military hard ware which requires shooting at a single point but produces multiple broadcast at all other points

  18. Preventive effect of continuous quality improvement on the malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    赵班

    2013-01-01

    Objective To investigate the preventive effect of continuous quality improvement (CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving

  19. Electroencephalogram investigations of the disequilibrium syndrome during bicarbonate and acetate dialysis.

    Science.gov (United States)

    Hampl, H; Klopp, H W; Michels, N; Mahiout, A; Schilling, H; Wolfgruber, M; Schiller, R; Hanefeld, F; Kessel, M

    1983-01-01

    Continuous long-time electroencephalographic (EEG) monitoring was performed during acetate and bicarbonate dialysis in 20 patients. Persisting normal basic activity of the EEG without neurological symptoms was found only during the course of bicarbonate dialysis. However, in acetate dialysis, during the decrease of arterial CO2 tension (PaCO2), we registered EEG disturbances with moderate to severe slowing, dysrhythmic activity and high voltage discharges. The decrease in PaCO2 and the deterioration in EEG activity in the patients during acetate dialysis was concomitant with severe neurological alterations, e.g. the typical symptoms of so-called 'disequilibrium' causing a cessation of dialysis in three patients.

  20. Peritoneal dialysis in an ageing population: a 10-year experience.

    LENUS (Irish Health Repository)

    Smyth, Andrew

    2012-02-01

    Chronic kidney disease (CKD) is becoming increasingly prevalent and there are increasing numbers of older patients with advanced CKD. Peritoneal dialysis (PD) is a potential treatment. This study aims to compare PD outcomes in age-defined populations in the largest PD centre in the Republic of Ireland over 10 years.

  1. The Dialysis Exercise: A Clinical Simulation for Preclinical Medical Students.

    Science.gov (United States)

    And Others; Bernstein, Richard A.

    1980-01-01

    A clinical decision-making simulation that helps students understand the relationship between psychosocial factors and medical problem-solving is described. A group of medical students and one faculty member comprise a selection committee to agree on the order in which four patients will be selected for renal dialysis. (MLW)

  2. Causes for Withdrawal in an Urban Peritoneal Dialysis Program

    Directory of Open Access Journals (Sweden)

    Biruh Workeneh

    2015-01-01

    Full Text Available Background. Peritoneal dialysis (PD is an underutilized dialysis modality in the United States, especially in urban areas with diverse patient populations. Technique retention is a major concern of dialysis providers and might influence their approach to patients ready to begin dialysis therapy. Methods. Records from January 2009 to March 2014 were abstracted for demographic information, technique duration, and the reasons for withdrawal. Results. The median technique survival of the 128 incident patients during the study window was 781 days (2.1 years. The principle reasons for PD withdrawal were repeated peritonitis (30%; catheter dysfunction (18%; ultrafiltration failure (16%; patient choice or lack of support (16%; or hernia, leak, or other surgical complications (6%; and a total of 6 patients died during this period. Of the patients who did not expire and were not transplanted, most transferred to in-center hemodialysis and 8% transitioned to home-hemodialysis. Conclusions. Our findings suggest measures to ensure proper catheter placement and limiting infectious complications should be primary areas of focus in order to promote technique retention. Lastly, more focused education about home-hemodialysis as an option may allow those on PD who are beginning to demonstrate signs of technique failure to stay on home therapy.

  3. Relative survival of peritoneal dialysis and haemodialysis patients

    DEFF Research Database (Denmark)

    Heaf, James G; Wehberg, Sonja

    2014-01-01

    INTRODUCTION: Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was perfor...

  4. PATIENTS' AND RELATIVES' EXPERIENCES OF PERITONITIS WHEN USING PERITONEAL DIALYSIS.

    Science.gov (United States)

    Baillie, Jessica; Lankshear, Annette

    2015-09-01

    Internationally, increasing numbers of patients are requiring treatment for end-stage kidney disease and greater use of peritoneal dialysis is thus being promoted. However, peritonitis can be a significant problem in this population. It is the leading cause of technique failure in patients using peritoneal dialysis and results in considerable morbidity and mortality. There is a dearth of research exploring patients' and their families' experiences of peritonitis. The aim of this paper is to explore patients' and their families' perspectives and experiences of peritonitis. An ethnographic study was conducted in 2011 in the United Kingdom. Sixteen patients and nine of their relatives were recruited through purposive and convenience sampling. In-depth interviews were undertaken with patients and their families, who were also observed using peritoneal dialysis in their homes. The data were analysed thematically using Wolcott's (1994) three-stage approach. This article describes four themes: learning about the risk of peritonitis; measures taken to prevent the infection; how participants monitored continuously for signs and symptoms of the infection; how they then identified and intervened once peritonitis was suspected. Overall, peritonitis was associated with fear and uncertainty, pain and learning from episodes of the infection. Overall, peritonitis was a distressing experience that participants sought to prevent. However, there was some confusion amongst participants about the signs and symptoms of the infection and further education for patients and their families is thus crucial. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  5. [Technological advances and micro-inflammation in dialysis patients].

    Science.gov (United States)

    Ferro, Giuseppe; Ravaglia, Fiammetta; Ferrari, Elisa; Romoli, Elena; Michelassi, Stefano; Caiani, David; Pizzarelli, Francesco

    2015-01-01

    As currently performed, on line hemodiafiltration reduces, but does not normalize, the micro-inflammation of uremic patients. Recent technological advances make it possible to further reduce the inflammation connected to the dialysis treatment. 
Short bacterial DNA fragments are pro-inflammatory and can be detected in the dialysis fluids. However, their determination is not currently within normal controls of the quality of the dialysate. The scenario may change once the analysis of these fragments yields reliable, inexpensive, quick and easy to evaluate the results. At variance with standard bicarbonate dialysate, Citrate dialysate induces far less inflammation both for the well-known anti-inflammatory effect of such buffer and also because it is completely acetate free, e.g. a definitely pro-inflammatory buffer. However, the extensive use of citrate dialysate in chronic dialysis is prevented because of concerns about its potential calcium lowering effect. In our view, high convective exchange on line hemodiafiltration performed with dialysate, whose sterility and a-pirogenicity is guaranteed by increasingly sophisticated controls and with citrate buffer whose safety is certified, can serve as the gold standard of dialysis treatments in future.

  6. Continuous ambulatory peritoneal dialysis: Nurses′ experiences of teaching patients

    Directory of Open Access Journals (Sweden)

    Amnah Shubayra

    2015-01-01

    In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  7. INVESTIGATION OF SERUM MICROCYSTIN CONCENTRATIONS AMONG DIALYSIS PATIENTS, BRAZIL, 1996

    Science.gov (United States)

    Investigation of Serum Microcystin Concentrations Among Dialysis Patients, Brazil, 1996Elizabeth D. Hilborn 1, Wayne W. Carmichael 2, Sandra M.F.O. Azevedo 31- USEPA/ORD/NHEERL, Research Triangle Park, NC2- Wright State University, Dayton, OH3- Federal Univers...

  8. Prevention of access-related infection in dialysis.

    Science.gov (United States)

    Barraclough, Katherine A; Hawley, Carmel M; Playford, E Geoffrey; Johnson, David W

    2009-12-01

    Access-related infections (ARIs), such as exit-site infections, tunnel infections, bacteremia, fungemia and peritonitis, are the Achilles' heel of dialysis, and contribute significantly to morbidity, mortality and excess healthcare costs in hemodialysis and peritoneal dialysis patient populations. Despite international guidelines recommending the avoidance of catheters for hemodialysis access, hospital admissions for vascular ARIs have doubled in the last decade. Moreover, repeated use of antibiotics to treat ARIs has been associated with the selection of multiresistant organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. ARIs result from direct inoculation of skin organisms during access cannulation/connection, migration of skin organisms along dialysis catheters into the bloodstream or peritoneal cavity, or contamination and colonization of catheter lumens with subsequent biofilm formation. This paper will review the epidemiology, pathogenesis and prevention of ARIs. It will focus specifically on randomized, controlled trial evidence in relation to the safety and efficacy of aseptic techniques, nasal eradication of S. aureus, oral antimicrobial prophylaxis, topical antimicrobial prophylaxis (including disinfectants, antibiotics and antibacterial honey), antimicrobial catheter lock solutions (including gentamicin, citrate and ethanol), antimicrobial-impregnated catheters, catheter design (straight vs coiled, single vs double cuff), peritoneal dialysis catheter connectology, catheter insertion technique, germicidal devices, vaccines and preinsertion antibiotic prophylaxis.

  9. Capnocytophaga cynodegmi peritonitis in a peritoneal dialysis patient

    DEFF Research Database (Denmark)

    Pers, Charlotte; Tvedegaard, Erling; Christensen, Jens Jørgen

    2007-01-01

    The first reported case of peritonitis caused by Capnocytophaga cynodegmi is presented. The patient was treated with peritoneal dialysis and had contact with a cat. C. cynodegmi is part of the normal oral flora of dogs and cats but is very rarely isolated in clinical specimens from humans....

  10. Sonographic detection of a radiolucent object in dialysis vascular access.

    Science.gov (United States)

    Tanemoto, Masayuki; Higaki, Masato; Amano, Keiko; Toyoki, Daigo; Arai, Shigeyuki; Tomioka, Satoru; Uchida, Shunya

    2015-01-01

    Percutaneous endovascular angioplasty is a valuable tool to salvage dialysis vascular access failure, but is accident-prone if performed by unskilled operators. We report a case of vascular access failure caused by the plastic protective tube of a balloon catheter, which had been mistakenly left in the vasculature and was undetectable on radiography but was detected by ultrasonography. © 2014 Wiley Periodicals, Inc.

  11. Estimating residual kidney function in dialysis patients without urine collection.

    Science.gov (United States)

    Shafi, Tariq; Michels, Wieneke M; Levey, Andrew S; Inker, Lesley A; Dekker, Friedo W; Krediet, Raymond T; Hoekstra, Tiny; Schwartz, George J; Eckfeldt, John H; Coresh, Josef

    2016-05-01

    Residual kidney function contributes substantially to solute clearance in dialysis patients but cannot be assessed without urine collection. We used serum filtration markers to develop dialysis-specific equations to estimate urinary urea clearance without the need for urine collection. In our development cohort, we measured 24-hour urine clearances under close supervision in 44 patients and validated these equations in 826 patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. For the development and validation cohorts, median urinary urea clearance was 2.6 and 2.4 ml/min, respectively. During the 24-hour visit in the development cohort, serum β-trace protein concentrations remained in steady state but concentrations of all other markers increased. In the validation cohort, bias (median measured minus estimated clearance) was low for all equations. Precision was significantly better for β-trace protein and β2-microglobulin equations and the accuracy was significantly greater for β-trace protein, β2-microglobulin, and cystatin C equations, compared with the urea plus creatinine equation. Area under the receiver operator characteristic curve for detecting measured urinary urea clearance by equation-estimated urinary urea clearance (both 2 ml/min or more) were 0.821, 0.850, and 0.796 for β-trace protein, β2-microglobulin, and cystatin C equations, respectively; significantly greater than the 0.663 for the urea plus creatinine equation. Thus, residual renal function can be estimated in dialysis patients without urine collections.

  12. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    Science.gov (United States)

    Burton, James O; Hamali, Hassan A; Singh, Ruchir; Abbasian, Nima; Parsons, Ruth; Patel, Amit K; Goodall, Alison H; Brunskill, Nigel J

    2013-01-01

    Cardiovascular (CV) death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs) are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs) are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD), 17 peritoneal dialysis (PD) patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve)) and PMVs (CD42b(+ ve)) were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p0.3). Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients.

  13. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    Directory of Open Access Journals (Sweden)

    James O Burton

    Full Text Available Cardiovascular (CV death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD, 17 peritoneal dialysis (PD patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve and PMVs (CD42b(+ ve were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p0.3. Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients.

  14. Flow-through microsensor array based on semipermeable dialysis tubing

    Science.gov (United States)

    Bohm, Sebastian; Olthuis, Wouter; Bergveld, Piet

    1999-11-01

    In this contribution, a flow-through potentiometric micro sensor is described which is based on semi-permeable tubing. Basically the proposed ion selective electrodes are of the liquid membrane type having an internal electrolyte. Sensors were constructed by guiding 0.3 mm diameter dialysis tube from an artificial kidney through a cavity, precision machined in PerspexTM.

  15. Bone alkaline phosphatase and mortality in dialysis patients

    NARCIS (Netherlands)

    C. Drechsler; M. Verduijn; S. Pilz; R.T. Krediet; F.W. Dekker; C. Wanner; M. Ketteler; E.W. Boeschoten; V. Brandenburg

    2011-01-01

    Serum alkaline phosphatase (AP) is associated with vascular calcification and mortality in hemodialysis patients, but AP derives from various tissues of origin. The aim of this study was to assess the effect of bone-specific AP (BAP) on morbidity and mortality in dialysis patients. From a prospectiv

  16. Dialysis facility joint ventures--current structures and issues.

    Science.gov (United States)

    Riley, James B; Pristave, Robert

    2005-07-01

    With the ongoing consolidation of the health care industry, including renal care, providers and physicians alike are using joint ventures as a means to partner on business transactions. This article discusses the expanding use of joint ventures in health care, including the dialysis industry, and looks at the types of structures being utilized and key legal concerns relating to such structures and issues.

  17. Intraperitoneal treatment with darbepoetin for children on peritoneal dialysis.

    NARCIS (Netherlands)

    Rijk, Y.; Raaijmakers, R.; Kar, N.C.A.J. van de; Schroder, C.

    2007-01-01

    To determine the efficacy and safety of intraperitoneal administration of darbepoetin in children with renal anemia on peritoneal dialysis, we conducted a single-arm, retrospective, two-centre study in which children were treated with intraperitoneal darbepoetin at the end of nightly intermittent

  18. Non Infectious Complications of Continuous Ambulatory Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    K. Flayou

    2015-02-01

    Full Text Available Introduction: Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study is to evaluate the prevalence and outcome of complications in patients treated with peritoneal dialysis at our center. Material and methods: A retrospective study between January 2007 and February 2015 at the nephrology, dialysis and renal transplantation department of Ibn Sina university. Predisposing factors and long-term outcomes were analyzed. Results: Fifty two mechanical complications were noted among thirty eight patients between June 2007 and February 2015. Migration was the most common (23 cases followed by obstruction, hernia and dialysate leakes in respectively 9, 7 and 6 cases. We have also noted 2 cases of hemoperitoneum, 3 catheter perforation and 2 cases of externalization. Onset time of complications was 25,4 ± 12,7 months. Conclusion: this study proves the interest of the prevention of mechanical complications in peritoneal dialysis. This requires a periodic retraining of patients and caregivers.

  19. Severe venous neointimal hyperplasia prior to dialysis access surgery

    Science.gov (United States)

    Lee, Timmy; Chauhan, Vibha; Krishnamoorthy, Mahesh; Wang, Yang; Arend, Lois; Mistry, Meenakshi J.; El-Khatib, Mahmoud; Banerjee, Rupak; Munda, Rino; Roy-Chaudhury, Prabir

    2011-01-01

    Background. Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement. Methods. Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples. Results. Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present. Conclusion. Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created. PMID:21220751

  20. [Clinical characteristics and indicators of care of dialysis patients].

    Science.gov (United States)

    Kolko, A; Hannedouche, T; Couchoud, C

    2013-09-01

    This chapter provides a set of indicators on patients treated by dialysis at December the 31th 2011. Even if ESRD is found in all classes of age, elders account for the great majority of the patients undergoing dialysis (median age: 70.4 years). These patients present a high rate of comorbidity especially diabetes (37% of patients) and cardiovascular comorbidities (59% of patients) that increases with the patient's age. Considering indicators of care, the main dialysis technique was hemodialysis (93.3% of patients). Even if an important inter-region variability remains considering the choices of treatment, more than 50% of the patients are undergoing hemodialysis in a hospital-based in-center unit, and we noticed an increase in hemodialysis in a medical satellite unit with time whereas the rate of self-care hemodialysis decreases. The rate of peritoneal dialysis remains stable. When comparing guidelines to real-life treatments, 77.5% of patients receive adequate dose of treatment (12H/week, KT/V>1.2), the rate of patients with a hemoglobin blood-level lower than 10 g/dl and without erythropoietin treatment is 1.3%, which confirmed a good management of anemia. On the contrary, 34% of patients have a BMI lower than 23 kg/m(2) and only 23% have an albumin blood-level over 40 g/l, which underlines that nutritional management of ESRD patients can be improved. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis

    DEFF Research Database (Denmark)

    Regeur, L; Colding, H; Jensen, H

    1977-01-01

    renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between...

  2. Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Maryam Masoumi

    2013-01-01

    Conclusions: Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients.

  3. Recurrent peritoneal dialysis-related peritonitis caused by Microbacterium resistens.

    Science.gov (United States)

    Gallois, Emmanuelle; Lamy, Thomas; Fines-Guyon, Marguerite; Lobbedez, Thierry; Cattoir, Vincent

    2014-05-01

    We report a case of a recurrent peritonitis due to Microbacterium resistens in a 71-year-old male patient undergoing peritoneal dialysis (PD). Importantly, this Gram-positive rod was intrinsically resistant to cephalosporins and vancomycin, classically used in PD-related peritonitis treatment. His infection resolved after several weeks of appropriate therapy (amoxicillin plus gentamicin) and PD catheter removal.

  4. High fall incidence and fracture rate in elderly dialysis patients

    NARCIS (Netherlands)

    Polinder-Bos, H. A.; Emmelot-Vonk, M. H.; Gansevoort, R. T.; Diepenbroek, A.; Gaillard, C. A. J. M.

    2014-01-01

    Background: Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors f

  5. Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital.

    Science.gov (United States)

    Wilmore, Stephanie M S; Philip, Keir E; Cambiano, Valentina; Bretherton, Christopher P; Harborne, Josephine E; Sharma, Aditi; Jayasena, Shyama D

    2014-02-01

    Patients on dialysis mount reduced immune responses compared with the general population. The Department of Health advises that these patients receive influenza and pneumococcal vaccinations at regular intervals-once yearly and every five years, respectively. This article investigates the uptake of these vaccinations in this patient population and seeks to examine factors that may influence vaccination status such as patient's language and presence of a general practitioner (GP) electronic vaccination reminder system. It also explores preferred site of vaccination for patients and GPs as these are primary care vaccinations yet patients have more frequent contact with their dialysis unit than their GP, blurring the boundaries between primary and specialized care. This is a retrospective study of all patients registered as dialysing at the North Middlesex University Hospital NHS Trust (NMUH) in September 2011. Information was obtained through GP letters, GP and patient questionnaires. Of 154 patients, 133 were included in the data analysis. Nineteen per cent were up-to-date with both vaccinations and 67% with their influenza vaccination. Fifty per cent had received the influenza vaccination in the last two consecutive years. Thirty per cent were not up-to-date with either vaccination. There was no evidence of a difference in uptake in 2009 (P = 0.7564) and in 2010 (P = 0.7435) among those who could and could not speak English. Twenty-five per cent of GPs and 58.6% of patients preferred vaccination to occur in the dialysis unit. Unfortunately a high number of GPs did not provide information on whether they used an electronic vaccination reminder but the analysis from the information provided by the few respondents did not reveal any correlation between the presence of an electronic reminder and vaccination status. Most dialysis patients were not up-to-date with both vaccinations. They were, however, more up-to-date with their influenza than their pneumococcal

  6. Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Nicanor Vega-Diaz

    2015-07-01

    Full Text Available Background: In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD, a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF in patients on peritoneal dialysis (PD is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD patients, with end-stage renal disease (ESRD secondary to diabetic nephropathy (DN in comparison to non-diabetic nephropathy (NDN, using different PD solutions in combination. Design: Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. Results: The fraction of renal urea clearance (Kt relative to distribution volume (V (or total body water (Kt/V, or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively, and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively. Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0

  7. The medical director and quality requirements in the dialysis facility.

    Science.gov (United States)

    Schiller, Brigitte

    2015-03-06

    Four decades after the successful implementation of the ESRD program currently providing life-saving dialysis therapy to >430,000 patients, the definitions of and demands for a high-quality program have evolved and increased at the same time. Through substantial technological advances ESRD care improved, with a predominant focus on the technical aspects of care and the introduction of medications such as erythropoiesis-stimulating agents and active vitamin D for anemia and bone disease management. Despite many advances, the size of the program and the increasingly older and multimorbid patient population have contributed to continuing challenges for providing consistently high-quality care. Medicare's Final Rule of the Conditions for Coverage (April 2008) define the medical director of the dialysis center as the leader of the interdisciplinary team and the person ultimately accountable for quality, safety, and care provided in the center. Knowledge and active leadership with a hands-on approach in the quality assessment and performance improvement process (QAPI) is essential for the achievement of high-quality outcomes in dialysis centers. A collaborative approach between the dialysis provider and medical director is required to optimize outcomes and deliver evidence-based quality care. In 2011 the Centers for Medicare & Medicaid Services introduced a pay-for-performance program-the ESRD quality incentive program (QIP)- with yearly varying quality metrics that result in payment reductions in subsequent years when targets are not achieved during the performance period. Success with the QIP requires a clear understanding of the structure, metrics, and scoring methods. Information on achievement and nonachievement is publicly available, both in facilities (through the facility performance score card) and on public websites (including Medicare's Dialysis Facility Compare). By assuming the leadership role in the quality program of dialysis facilities, the medical

  8. [The contribution of dialysis and laboratoristic methods for the control of phosphates].

    Science.gov (United States)

    Bolasco, Piergiorgio

    2014-01-01

    Prevention and correction of hyperphosphatemia is the first main goal of CKD-MBD management. Therefore, special attention is required to prevent a positive phosphate balance. In addition to a careful use of phosphate binders and dietary, phosphate control is needed to optimize the control of phosphate balance. In well-nourished patients is necessary to provide an optimal dialysis removal schedule. A solution could be the increase of the number of dialysis sessions per week and to carry out longer dialysis session strategies. Nevertheless, many patients have a high phosphate (P) intake linked to the high dietary protein requirement of dialysis patients, hence the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately the phosphate molecule must be considered as a medium molecular toxin. Nowadays it remains difficult to remove with modern dialysis strategies and ones clearance is still dependent on dialysis time. The best solutions are: hemodiafiltration with high-volume reinfusion, daily dialysis, long dialysis and modern peritoneal dialysis. Today, this scheduled strategies are difficult because of logistic and cost problems. However the milestone will be an adequate nutrition surveillance, especially with nursing collaboration toward dialysis treatments. This strategy should start in outpatient pre-dialysis ambulatory.

  9. Hemodialysis versus peritoneal dialysis: epidemiologic and demographic characteristics

    Directory of Open Access Journals (Sweden)

    Hekmat R

    2008-10-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The preferred modality of dialysis is a controversial issue in nephrology. In this study we compare some demographic and epidemiological characteristics of hemodialysis and peritoneal dialysis patients in an attempt to analyze this issue."n"n Methods: The results of the research protocol "A survey of the epidemiological characteristics of chronic dialyzed patients in Khorassan province", was used to compare some demographic and epidemiological aspects of chronic hemodialysis and peritoneal dialysis patients in search of any statistically significant difference."n"n Results: A total of 836 chronic dialysis patients entered this study, 802 (95.9% of which were under chronic hemodialysis, and 34 (4.1% patients were undergoing peritoneal dialysis, with 339 (42.3% and 12 (35.3% being female, respectively. The mean age for each group was 47.57 and 46.75 years, respectively. The causes of end-stage renal disease in hemodialzed patients were most commonly hypertension (32.2%, followed by diabetes mellitus (22.3%, unknown causes (19.6% and chronic glomeru-lonephritis (10.2%. In the peritoneal dialysis group, chronic glomerulonephritis (32.4% was the most common reason for dialysis, followed by diabetes mellitus (26

  10. Historical Study (1986-2014): Improvements in nutritional status of dialysis patients

    DEFF Research Database (Denmark)

    Koefoed, Mette; Kromann, Charles Boy; Hvidtfeldt, Danni

    2016-01-01

    OBJECTIVE: Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct...... historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in 2014. DESIGN: Historical study...... comparing results of two cross-sectional studies performed in 1986 and 2014. SETTING: We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated...

  11. Burnout Syndrome Among Hemodialysis and Peritoneal Dialysis Nurses.

    Science.gov (United States)

    Karakoc, Ayten; Yilmaz, Murvet; Alcalar, Nilufer; Esen, Bennur; Kayabasi, Hasan; Sit, Dede

    2016-11-01

    Burnout, a syndrome with 3 dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment, is very common among hemodialysis nurses, while data are scarce regarding the prevalence of burnout syndrome (BS) among peritoneal dialysis (PD) nurses. This study aimed to assess and compare demographic and professional characteristics and burnout levels in hemodialysis and PD nurses, and to investigate factors that increase the level of burnout in dialysis nurses. A total of 171 nurses from 44 dialysis centers in Turkey were included in a cross-sectional survey study. Data were collected using a questionnaire defining the social and demographic characteristics and working conditions of the nurses as well as the Maslach Burnout Inventory for assessment of burnout level. There was no significant difference in the level of burnout between the hemodialysis and PD nurses groups. Emotional exhaustion and depersonalization scores were higher among the shift workers, nurses who had problems in interactions with the other team members, and those who wanted to leave the unit, as well as the nurses who would not attend training programs. In addition, male sex, younger age, limited working experience, more than 50 hours of working per week, and working in dialysis not by choice were associated with higher depersonalization scores. Personal accomplishment score was lower among the younger nurses who had problems in their interactions with the doctors, who would not regularly attend training programs, and who felt being medically inadequate. Improving working conditions and relations among colleagues, and also providing further dialysis education are necessary for minimizing burnout syndrome. Burnout reduction programs should mainly focus on younger professionals.

  12. Vasoactive Peptide Levels after Change of Dialysis Mode

    Directory of Open Access Journals (Sweden)

    Fredrik Uhlin

    2015-10-01

    Full Text Available Background/Aims: Plasma concentrations of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP are increased in end-stage renal disease. Improvement in hemodynamic stability has been reported when switching from hemodialysis (HD to on-line hemodiafiltration (ol-HDF. The aim of this study was to investigate plasma concentrations of NT-proBNP, BNP and neuropeptide Y (NPY during a 1-year follow-up, after a change from high-flux HD to postdilution ol-HDF. Additional variables were also studied, e.g. pulse wave velocity and ordinary clinical parameters. Method: We conducted a prospective, single-center study including 35 patients who were switched from HD to HDF. Plasma concentrations of NT-proBNP, BNP and NPY before and after dialysis were measured at baseline (i.e. HD and at 1, 2, 4, 6 and 12 months on HDF. Results: All three peptide levels decreased significantly during HD and HDF when comparing concentrations before and after dialysis. Mean absolute value (before/after and relative decrease (% before versus after dialysis was 13.697/9.497 ng/l (31% for NT-proBNP, 62/40 ng/ml (35% for BNP and 664/364 pg/l (45% for NPY. No significant differences were observed when comparing predialysis values over time. However, postdialysis NT-proBNP concentration showed a significant decrease of 48% over time after the switch to HDF. Conclusion: The postdialysis plasma levels of NT-proBNP, BNP and NPY decreased significantly during both dialysis modes when compared to before dialysis. The postdialysis lowering of NT-proBNP increased further over time after the switch to ol-HDF; the predialysis levels were unchanged, suggesting no effect on its production in the ventricles of the heart.

  13. Predicting mortality in patients with diabetes starting dialysis.

    Directory of Open Access Journals (Sweden)

    Merel van Diepen

    Full Text Available BACKGROUND: While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. METHODS: Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD, a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. RESULTS: A total of 394 patients were available for statistical analysis; 82 (21% patients died within one year after baseline (3 months after starting dialysis therapy. The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. CONCLUSIONS: A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary.

  14. Surgical thrombectomy for thrombosed dialysis grafts: comparison of adjunctive treatments.

    Science.gov (United States)

    Liu, Yun-Hen; Hung, Yen-Ni; Hsieh, Hung-Chang; Ko, Po-Jen

    2008-02-01

    Vascular surgeons often encounter dialysis graft failure in hemodialysis patients during their daily practice. Despite advances in percutaneous treatment, there remains a role for surgical thrombectomy of thrombosed dialysis grafts. This study was designed to investigate the long-term outcome of dialysis graft thrombectomy and to examine the indications for and effectiveness of therapies adjuvant to Fogarty thrombectomy. Surgical outcomes of 590 consecutive dialysis graft thrombectomies performed between 2001 and 2003 were retrospectively reviewed. The 590 cases were classified into four groups based on the procedure performed adjuvant to Fogarty thrombectomy: group A, surgical thrombectomy by Fogarty thrombectomy catheter alone; group B, thrombectomy plus intraoperative angioplasty of graft outlet; group C, thrombectomy plus sequential balloon angioplasty in subsequent intervention; group D, thrombectomy plus graft outlet surgical revision. Age, gender, co-morbidity, and primary patency of grafts were reviewed and analyzed. The four groups exhibited similar demographic features and comorbidities (p>0.05). Mean primary patency in the four groups was 1.99+/-4.02, 7.21+/-7.61, 8.35+/-9.53, and 7.26+/-6.99 (months), respectively. Survival curves for each group were determined by Kaplan-Meier methods. Primary patency in group A was statistically inferior to all of the other three groups, whereas groups B, C, and D did not significantly differ with regard to graft patency. Surgical thrombectomy alone is inadequate for treating a thrombosed dialysis graft. The underlying graft outlet stricture requires direct surgical revision or balloon angioplasty during surgery or intervention in the angiography suite to ensure long-term patency of the graft.

  15. [Educational scheme for patients on home peritoneal dialysis in Spain].

    Science.gov (United States)

    Cirera Segura, F; Martín Espejo, J L; Reina Neyra, M

    2008-01-01

    The objective of the present study is to obtain information about the training programme for patients undergoing Domiciliary Peritoneal Dialysis (DPD) in Spain. For the purposes of the study we designed a questionnaire comprising 50 closed-ended items and one open response item. The questionnaire was sent to 104 hospitals and was completed by 78.84% of them (n > or = 82). The average of patients undergoing peritoneal dialysis (PD) in the hospitals under study was 27.6: 15.8 of them receiving Chronic Ambulatory Peritoneal Dialysis (CAPD) and 11.8 Automatic Peritoneal Dialysis (APD). The questionnaire also served to investigate into the training methodology used in the different units, the involvement of the family in the programme, the basic knowledge patients received about Chronic Renal Insufficiency, the procedures associated with the therapy and the preparation they obtained to solve small-scale contingencies and emergency situations as well as the improvement of their quality of life. We also evaluated the training programme of autonomous patients on DPD and at the end of the questionnaire a blank space was left for facilities to add any comments or suggestions they considered relevant. From the results obtained we may conclude that most Spanish hospitals have devised a training planning for patients undergoing PD which helps them or caregivers to perform domiciliary treatment safely, provides them with basic knowledge about the disease and the routine procedures associated with the treatment, enables them to cope with contingencies and emergency situations and improves their quality of life during the dialysis period.

  16. Depression in hemodialysis patients: the role of dialysis shift

    Directory of Open Access Journals (Sweden)

    Flavio Teles

    2014-03-01

    Full Text Available OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years. Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001, although patients in rural areas did not have a higher prevalence of depression (p= 0.30. Patients with depression were more likely to be dialyzed during the morning shift (p= 0.008. Independent risk factors for depression were age (p<0.03, lower levels of hemoglobin (p<0.01 and phosphorus (p<0.01, and dialysis during the morning shift (p= 0.0009. The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008. CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

  17. Quality of life in dialysis: A Malaysian perspective.

    Science.gov (United States)

    Liu, Wen J; Musa, Ramli; Chew, Thian F; Lim, Christopher T S; Morad, Zaki; Bujang, Adam

    2014-04-01

    There is a growing interest to use quality of life as one of the dialysis outcome measurement. Based on the Malaysian National Renal Registry data on 15 participating sites, 1569 adult subjects who were alive at December 31, 2012, aged 18 years old and above were screened. Demographic and medical data of 1332 eligible subjects were collected during the administration of the short form of World Health Organization Quality of Life questionnaire (WHOQOL-BREF) in Malay, English, and Chinese language, respectively. The primary objective is to evaluate the quality of life among dialysis patients using WHOQOL-BREF. The secondary objective is to examine significant factors that affect quality of life score. Mean (SD) transformed quality of life scores were 56.2 (15.8), 59.8 (16.8), 58.2 (18.5), 59.5 (14.6), 61.0 (18.5) for (1) physical, (2) psychological, (3) social relations, (4) environment domains, and (5) combined overall quality of life and general health, respectively. Peritoneal dialysis group scored significantly higher than hemodialysis group in the mean combined overall quality of life and general health score (63.0 vs. 60.0, P income, mode of dialysis, hemoglobin, diabetes mellitus, coronary heart disease, cerebral vascular accident and leg amputation. Subjects on peritoneal dialysis modality achieved higher combined overall quality of life and general health score than those on hemodialysis. Religion and cerebral vascular accident were significantly associated with all domains and combined overall quality of life and general health.

  18. A report of the Malaysian dialysis registry of the National Renal Registry, Malaysia.

    Science.gov (United States)

    Lim, Y N; Lim, T O; Lee, D G; Wong, H S; Ong, L M; Shaariah, W; Rozina, G; Morad, Z

    2008-09-01

    The Malaysian National Renal Registry was set up in 1992 to collect data for patients on renal replacement therapy (RRT). We present here the report of the Malaysian dialysis registry. The objectives of this papar are: (1) To examine the overall provision of dialysis treatment in Malaysia and its trend from 1980 to 2006. (2) To assess the treatment rate according to the states in the country. (3) To describe the method, location and funding of dialysis. (4) To characterise the patients accepted for dialysis treatment. (5) To analyze the outcomes of the dialysis treatment. Data on patients receiving dialysis treatment were collected at initiation of dialysis, at the time of any significant outcome, as well as yearly. The number of dialysis patients increased from 59 in 1980 to almost 15,000 in 2006. The dialysis acceptance rate increased from 3 per million population in 1980 to 116 per million population in 2006, and the prevalence rate from 4 to 550 per million population over the same period. The economically advantaged states of Malaysia had much higher dialysis treatment rates compared to the less economically advanced states. Eighty to 90% of new dialysis patients were accepted into centre haemodialysis (HD), and the rest into the chronic ambulatory peritoneal dialysis (CAPD) programme. The government provided about half of the funding for dialysis treatment. Patients older than 55 years accounted for the largest proportion of new patients on dialysis since the 1990s. Diabetes mellitus has been the main cause of ESRD and accounted for more than 50% of new ESRD since 2002. Annual death rate averaged about 10% on HD and 15% on CAPD. The unadjusted 5-year patient survival on both HD and CAPD was about 80%. Fifty percent of dialysis patients reported very good median QoL index score. About 70% of dialysis patients were about to work full or part time. There has been a very rapid growth of dialysis provision in Malaysia particularly in the older age groups. ESRD

  19. Is Peritonitis Risk Increased in Elderly Patients on Peritoneal Dialysis? Report from the French Language Peritoneal Dialysis Registry (RDPLF).

    Science.gov (United States)

    Duquennoy, Simon; Béchade, Clémence; Verger, Christian; Ficheux, Maxence; Ryckelynck, Jean-Philippe; Lobbedez, Thierry

    2016-01-01

    ♦ This study was carried out to examine whether or not elderly patients on peritoneal dialysis (PD) had an increased risk of peritonitis. ♦ This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 8,396 incident patients starting PD between January 2003 and December 2010. The end of the observation period was 31 December 2012. Patients were separated into 2 age groups: up to 75 and over of 75 years old. ♦ Among 8,396 patients starting dialysis there were 3,173 patients older than 75. When using a Cox model, no association was found between age greater than 75 years and increased risk of peritonitis (hazard ratio [HR]: 0.97 [0.88 - 1.07]). Diabetes (HR: 1.14 [1.01 - 1.28] and continuous ambulatory PD (HR: 1.13 [1.04 - 1.23]) were significantly associated with a higher risk of peritoneal infection whereas nurse-assisted PD was associated with a lower risk of peritonitis (HR: 0.85 [0.78 - 0.94]. In the analysis restricted to the 3,840 self-care PD patients, there was no association between age older than 75 years and risk of peritonitis. ♦ The risk of peritonitis is not increased in elderly patients on PD in a country where assisted PD is available. Copyright © 2016 International Society for Peritoneal Dialysis.

  20. Effects of oral enalapril and verapamil on dialysis adequacy and solute clearance in chronic ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Shahnaz Atabak

    2013-01-01

    Full Text Available Peritoneal dialysis offers several advantages such as better clearance of intermediate/large molecules and better preservation of renal residual function when compared with hemodialysis. However, dialysis adequacy is one of the subjects of concern of this modality. There are some drugs that are capable of influencing solute transport in the peritoneum, such as acetyle co-enzyme inhibitors (ACE-I medications and calcium channel blockers. Captopril and Verapamil are often mentioned, but their use has shown varying conclusions and initial studies were performed with the intra-peritoneal administration of these drugs and there are only a few studies on the effect of the oral administration of these drugs. This study was undertaken with the aim to evaluate the effects of oral administration of Verapamil and Enalapril among continuous ambulatory peritoneal dialysis (CAPD patients. The results of this study showed that Verapamil and Enalapril do not have any effects on glucose, creatinine, sodium, potassium and urea clearance (during the 4-h peritoneal equilibration test (PET test. However, it was shown that Enalapril significantly increased the peritoneal urea Kt/V and caused a meaningful decrease in the diastolic and mean blood pressures. Therefore, we feel that Enalapril may be administered as an anti-hypertensive medication of choice in CAPD patients, which can also result in better dialysis adequacy. However, further studies with larger sample sizes are needed in the future.

  1. [Survey among French dialysis practitioners about the screening and decolonization of nasal Staphylococcus aureus carriage in dialysis patients].

    Science.gov (United States)

    Botelho-Nevers, Élisabeth; Verhoeven, Paul O; Thibaudin, Damien; Gagnaire, Julie; Gagneux-Brunon, Amandine; Lucht, Frédéric; Berthelot, Philippe; Mariat, Christophe

    2016-07-01

    Staphylococcus aureus nasal carriage is frequent in dialysis patients and is associated with an increased risk of staphylococcal infections in this population. Data from the literature showed that decolonization of S. aureus nasal carriers in hemodialysis and peritoneal dialysis reduce S. aureus catheter-related infections. During the last national congress of nephrology, a survey was conducted among volunteer dialysis physicians to evaluate their practice about screening and decolonization of S. aureus nasal carriage among their patients. Only 30 participants (45.5% [30/66]) declared to screen S. aureus nasal carriage in patients of hemodialysis and 59.6% (31/52) in peritoneal dialysis. Participants declared to decolonize their patients before insertion of a vascular catheter in 55.8% of cases. This small study would need to be completed by a national survey. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  2. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

    Science.gov (United States)

    Machowska, Anna; Alscher, Mark Dominik; Reddy Vanga, Satyanarayana; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter A

    2016-01-01

    Objectives Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP). Methods The Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. Results The majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference. Conclusion Education and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on

  3. Haemostatic reference intervals in pregnancy

    DEFF Research Database (Denmark)

    Szecsi, Pal Bela; Jørgensen, Maja; Klajnbard, Anna;

    2010-01-01

    Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. In this study, we establish gestational age......-specific reference intervals for coagulation tests during normal pregnancy. Eight hundred one women with expected normal pregnancies were included in the study. Of these women, 391 had no complications during pregnancy, vaginal delivery, or postpartum period. Plasma samples were obtained at gestational weeks 13......-20, 21-28, 29-34, 35-42, at active labor, and on postpartum days 1 and 2. Reference intervals for each gestational period using only the uncomplicated pregnancies were calculated in all 391 women for activated partial thromboplastin time (aPTT), fibrinogen, fibrin D-dimer, antithrombin, free protein S...

  4. Association of Biocompatible Peritoneal Dialysis Solutions with Peritonitis Risk, Treatment, and Outcomes

    Science.gov (United States)

    Cho, Yeoungjee; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Brown, Fiona G.; Boudville, Neil; Bannister, Kym M.; Clayton, Philip A.

    2013-01-01

    Summary Background and objectives The effect of biocompatible peritoneal dialysis (PD) solutions on PD-related peritonitis is unclear. This study sought to evaluate the relationship between use of biocompatible solutions and the probability of occurrence or clinical outcomes of peritonitis. Design, setting, participants, & measurements The study included all incident Australian patients receiving PD between January 1, 2007, and December 31, 2010, using Australia and New Zealand Dialysis and Transplant Registry data. All multicompartment PD solutions of neutral pH were categorized as biocompatible solutions. The independent predictors of peritonitis and the use of biocompatible solutions were determined by multivariable, multilevel mixed-effects Poisson and logistic regression analysis, respectively. Sensitivity analyses, including propensity score matching, were performed. Results Use of biocompatible solutions gradually declined (from 7.5% in 2007 to 4.2% in 2010), with preferential use among smaller units and among younger patients without diabetes mellitus. Treatment with biocompatible solution was associated with significantly greater overall rate of peritonitis (0.67 versus 0.47 episode per patient-year; incidence rate ratio, 1.49; 95% confidence interval [CI], 1.19 to 1.89) and with shorter time to first peritonitis (hazard ratio [HR], 1.48; 95% CI, 1.17 to 1.87), a finding replicated in propensity score–matched cohorts (HR, 1.36; 95% CI, 1.09 to 1.71). Conclusions In an observational registry study, use of biocompatible PD solutions was associated with higher overall peritonitis rates and shorter time to first peritonitis. Further randomized studies adequately powered for a primary peritonitis outcome are warranted. PMID:23949232

  5. Risk Factors for the First Episode of Peritonitis in Southern Chinese Continuous Ambulatory Peritoneal Dialysis Patients

    Science.gov (United States)

    Fan, Xiaoguang; Huang, Rong; Wang, Juan; Ye, Hongjian; Guo, Qunying; Yi, Chunyan; Lin, Jianxiong; Zhou, Qian; Shao, Fengmin; Yu, Xueqing; Yang, Xiao

    2014-01-01

    Background The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis. Results In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months) of 1117 CAPD patients, 309(27.7%) patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years) [hazard ratio (HR) = 1.427, 95% confidence interval (CI) = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030), lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004) and albumin peritonitis in Southern Chinese CAPD patients. PMID:25222609

  6. Risk factors for the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis patients.

    Directory of Open Access Journals (Sweden)

    Xiaoguang Fan

    Full Text Available The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD patients.This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis.In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months of 1117 CAPD patients, 309(27.7% patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years [hazard ratio (HR = 1.427, 95% confidence interval (CI = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030, lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004 and albumin <38g/L (HR = 1.425, 95% CI: 1.112 to 1.825, P = 0.005.Older age, male, lower educational level and hypoalbuminemia at the commencement of PD were the risk factors associated with the first episode of peritonitis in Southern Chinese CAPD patients.

  7. Intra-peritoneal chronic loculation in peritoneal dialysis patients - a new medical management approach.

    Science.gov (United States)

    Mitoiu, Dan; David, Cristiana; Peride, Ileana; Niculae, Andrei; Mureşan, Alin; Ciocâlteu, Alexandru; Geavlete, Bogdan Florin; Checheriţă, Ionel Alexandru

    2014-01-01

    Peritoneal dialysis (PD) limitation as renal replacement therapy is mostly due to peritonitis and complications. Formation and persistence of intra-abdominal loculations is often under-diagnosed. Encapsulated peritoneal sclerosis (EPS) is a life-threatening complication, but malnutrition, recurrent peritonitis and early membrane failure are insidious enemies that need to be emphasized. It is important to highlight the persistence of intra-abdominal fluid collection after clinical resolution of peritonitis in PD patients and to indicate a new medical management approach for an early diagnosis. During five years, we selected PD peritonitis cases followed by a six months interval free of infections. Ninety-seven subjects were followed at six months and one year after the first peritonitis. Tomography had been performed to patients presenting a positive inflammatory state without a specific infectious cause. Subjects presenting documented localized fluid collection (31 cases) were divided into: drug-treated group and those undergoing laparoscopy by a new surgery technique (seven patients); a comparison regarding the clinical state and biohumoral parameters was assessed in both groups. The prevalence of intra-abdominal loculation following an apparent resolved peritonitis was high (31.9%). The cases undergoing laparoscopy presented a better evolution - improved clinical status (p=0.001), higher hemoglobin values (p=0.06), significant lower doses of erythropoietin requirement (p=0.03), improved dialysis adequacy (p=0.005) and inflammatory state. In cases with confirmed fluid encapsulated loculation, an active attitude (screening imaging protocol and laparoscopic exploration) appears to be mandatory, decreasing the risk of EPS, a serious complication which pathology and treatment are incompletely understood.

  8. Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa.

    Science.gov (United States)

    Gallieni, Maurizio; Giordano, Antonino; Ricchiuto, Anna; Gobatti, Davide; Cariati, Maurizio

    2017-03-06

    ABSTRACTHemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

  9. Almost primes in short intervals

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    In this paper,we prove that the short interval(x-x101/232,x] contains at least an almost prime P2 for sufficiently large x,where P2 denotes an integer having at most two prime factors counted with multiplicity.

  10. Haemostatic reference intervals in pregnancy

    DEFF Research Database (Denmark)

    Szecsi, Pal Bela; Jørgensen, Maja; Klajnbard, Anna

    2010-01-01

    Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. In this study, we establish gestational age-specific refe......Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. In this study, we establish gestational age......-specific reference intervals for coagulation tests during normal pregnancy. Eight hundred one women with expected normal pregnancies were included in the study. Of these women, 391 had no complications during pregnancy, vaginal delivery, or postpartum period. Plasma samples were obtained at gestational weeks 13......-20, 21-28, 29-34, 35-42, at active labor, and on postpartum days 1 and 2. Reference intervals for each gestational period using only the uncomplicated pregnancies were calculated in all 391 women for activated partial thromboplastin time (aPTT), fibrinogen, fibrin D-dimer, antithrombin, free protein S...

  11. Robust misinterpretation of confidence intervals

    NARCIS (Netherlands)

    Hoekstra, Rink; Morey, Richard; Rouder, Jeffrey N.; Wagenmakers, Eric-Jan

    2014-01-01

    Null hypothesis significance testing (NHST) is undoubtedly the most common inferential technique used to justify claims in the social sciences. However, even staunch defenders of NHST agree that its outcomes are often misinterpreted. Confidence intervals (CIs) have frequently been proposed as a more

  12. Robust misinterpretation of confidence intervals

    NARCIS (Netherlands)

    Hoekstra, R.; Morey, R.D.; Rouder, J.N.; Wagenmakers, E.-J.

    2014-01-01

    Null hypothesis significance testing (NHST) is undoubtedly the most common inferential technique used to justify claims in the social sciences. However, even staunch defenders of NHST agree that its outcomes are often misinterpreted. Confidence intervals (CIs) have frequently been proposed as a more

  13. Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals.

    Science.gov (United States)

    Yanik, Elizabeth L; Clarke, Christina A; Snyder, Jon J; Pfeiffer, Ruth M; Engels, Eric A

    2016-05-01

    Among patients with ESRD, cancer risk is affected by kidney dysfunction and by immunosuppression after transplant. Assessing patterns across periods of dialysis and kidney transplantation may inform cancer etiology. We evaluated 202,195 kidney transplant candidates and recipients from a linkage between the Scientific Registry of Transplant Recipients and cancer registries, and compared incidence in kidney function intervals (time with a transplant) with incidence in nonfunction intervals (waitlist or time after transplant failure), adjusting for demographic factors. Incidence of infection-related and immune-related cancer was higher during kidney function intervals than during nonfunction intervals. Incidence was most elevated for Kaposi sarcoma (hazard ratio [HR], 9.1; 95% confidence interval (95% CI), 4.7 to 18), non-Hodgkin's lymphoma (HR, 3.2; 95% CI, 2.8 to 3.7), Hodgkin's lymphoma (HR, 3.0; 95% CI, 1.7 to 5.3), lip cancer (HR, 3.4; 95% CI, 2.0 to 6.0), and nonepithelial skin cancers (HR, 3.8; 95% CI, 2.5 to 5.8). Conversely, ESRD-related cancer incidence was lower during kidney function intervals (kidney cancer: HR, 0.8; 95% CI, 0.7 to 0.8 and thyroid cancer: HR, 0.7; 95% CI, 0.6 to 0.8). With each successive interval, incidence changed in alternating directions for non-Hodgkin's lymphoma, melanoma, and lung, pancreatic, and nonepithelial skin cancers (higher during function intervals), and kidney and thyroid cancers (higher during nonfunction intervals). For many cancers, incidence remained higher than in the general population across all intervals. These data indicate strong short-term effects of kidney dysfunction and immunosuppression on cancer incidence in patients with ESRD, suggesting a need for persistent cancer screening and prevention.

  14. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients.

    Science.gov (United States)

    Capitanini, Alessandro; Lange, Sara; D'Alessandro, Claudia; Salotti, Emilio; Tavolaro, Alba; Baronti, Maria E; Giannese, Domenico; Cupisti, Adamasco

    2014-01-01

    Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal "exercise team" for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.

  15. Peritoneal dialysis as a treatment option in autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Jankowska, Magdalena; Chmielewski, Michał; Lichodziejewska-Niemierko, Monika; Jagodziński, Piotr; Rutkowski, Bolesław

    2015-10-01

    When choosing a dialysis option for ADPKD patients, peritoneal dialysis (PD) is often discouraged, due to its potential drawbacks: risk of abdominal hernias and dialysis fluid leaks, risk of peritonitis and insufficient dialysis adequacy. The present study was designed to compare the outcomes and dialysis efficacy in ADPKD patients treated with PD, in comparison with non-ADPKD subjects. This study was a retrospective analysis of the data from the national PD registry in which 106 ADPKD and 1606 non-ADPKD incident PD patients were evaluated. Data on dialysis adequacy, risk of dialysis-associated complications, as well as patient and technique survival were compared between the groups. The ADPKD patients did not differ from the non-ADPKD controls in terms of dialysis adequacy. After a median observation time of 32 months, there were no differences in patient or technique survival. The risk of abdominal hernias and dialysis fluid leaks was twice as high in ADPKD subjects, compared to the non-ADPKD group. However, these complications did not result in a need for a permanent transfer to hemodialysis. Dialysis adequacy, and patient and technique survival are similar in the ADPKD and non-ADPKD patients treated with PD. PD seems a feasible treatment option for end-stage renal failure in the course of ADPKD.

  16. Dialysis Exercise Team: The Way to Sustain Exercise Programs in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Alessandro Capitanini

    2014-07-01

    Full Text Available Patients affected by end-stage renal disease (ESRD show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a involvement of exercise professionals, b real commitment of nephrologists and dialysis professionals, c individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal “exercise team” for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular, nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.

  17. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

    DEFF Research Database (Denmark)

    Zimakoff, J; Bangsgaard Pedersen, F; Bergen, L

    1996-01-01

    A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age...

  18. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

    NARCIS (Netherlands)

    J. Zimakoff; S. Olesen-Larsen; B. Daldorph; F. Espersen; B. Gahrn Hansen; J. Ladefoged; J. Scheibel; N. Hoiby; O. B. Jepsen; P. Tofte-Jensen; K. Kristoffersen; P. Joffe; M. Klausen; V. T. Rosdahl; H. J. Kolmos; F. Bangsgaard Pedersen; L. Bergen; B. Storm; J. Baago-Nielsen

    1996-01-01

    textabstractA three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, ag

  19. BIRTH INTERVAL AMONG NOMAD WOMEN

    Directory of Open Access Journals (Sweden)

    E.Keyvan

    1976-06-01

    Full Text Available To have an, idea about the relation between the length of birth interval and lactation, and birth control program this study have been done. The material for such analysis was nomad women's fertility history that was in their reproductive period (15-44. The material itself was gathered through a health survey. The main sample was composed of 2,165 qualified women, of whom 49 due to previous or presently using contraceptive methods and 10 for the lack of enough data were excluded from 'this study. Purpose of analysis was to find a relation between No. of live births and pregnancies with total duration of married life (in other word, total months which the women were at risk of pregnancy. 2,106 women which their fertility history was analyzed had a totally of272, 502 months married life. During this time 8,520 live births did occurred which gave a birth interval of 32 months. As pregnancy termination could be through either live birth, still birth or abortion (induced or spontaneous, bringing all together will give No. of pregnancies which have occurred during this period (8,520 + 124 + 328 = 8,972 with an average of interpregnancy interval of 30.3 months. Considering the length of components of birth interval: Post partum amenorrhea which depends upon lactation. - Anovulatory cycles (2 month - Ooulatory exposure, in the absence of contraceptive methods (5 months - Pregnancy (9 months.Difference between the length, of birth interval from the sum of the mentioned period (except the first component, (2 + 5+ 9 = 16 will be duration of post partum amenorrhea (32 - 16 = 16, or in other word duration of breast feeding among nomad women. In this study it was found that, in order to reduce birth by 50% a contraceptive method with 87% effectiveness is needed.

  20. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

    Directory of Open Access Journals (Sweden)

    Machowska A

    2016-11-01

    Full Text Available Anna Machowska,1 Mark Dominik Alscher,2 Satyanarayana Reddy Vanga,3 Michael Koch,4 Michael Aarup,5 Abdul Rashid Qureshi,1 Bengt Lindholm,1 Peter A Rutherford6 1Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; 2Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Krankenhaus, Stuttgart, Germany; 3Department of Renal Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK; 4Center of Nephrology, Nephrologisches Zentrum, Mettmann, Germany; 5Department of Nephrology, Odense University Hospital, Odense, Denmark; 6Baxter Healthcare SA, Zurich, Switzerland Objectives: Unplanned dialysis start (UPS leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP. Methods: The Offering Patients Therapy Options in Unplanned Start (OPTiONS study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. Results: The majority of UPS patients could receive UPS-EP (214/270 patients and were able to make a decision (177/214, although not all patients received their preferred choice (159/177. Regression analysis demonstrated that the initial dialysis modality was a predictive

  1. Two Nobel Prize winners in two days

    CERN Multimedia

    2006-01-01

    Living legend of physics, Professor Chen Ning Yang, delivered his CERN Colloquium in the Main Auditorium on 12th October (see photo). His numerous contributions to physics include the famous Yang-Mills theory, which underlies the Standard Model of particle physics, and the prediction of parity violation in weak interactions, for which he shared the Nobel prize with T. D. Lee in 1957. The day before, another Nobel laureate, Norman Ramsey, gave a TH Exceptional Seminar in the same auditorium. Ramsey shared the Nobel Prize with Hans G. Dehmelt and Wolfgang Paul in 1989 for developments in atomic precision spectroscopy.

  2. Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Tsai, T C; Hsu, J C; Chou, L H; Lee, M L

    1994-01-01

    We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

  3. Treatment of refractory hemodialysis ascites with maintenance peritoneal dialysis.

    Science.gov (United States)

    Ing, T S; Daugirdas, J T; Popli, S; Kheirbek, A O; Humayun, H M; Gandhi, V C; Chapa, S M

    1981-04-01

    In 5 patients who were receiving maintenance hemodialysis, ascites developed that was refractory to treatment by ultrafiltration during hemodialysis. Use of sequential isolated ultrafiltration and hemodialysis therapy either precipitated side effects or else required prolongation of total treatment time which the patients declined to accept. In 4 of the patients, ascites was believed to be primarily responsible for severe, progressive cachexia. Maintenance peritoneal dialysis was instituted in all patients, and abdominal fluid was removed gradually, over a period of 2 to 3 days. Ascites resolved promptly in each case. Three patients noted a dramatic improvement in appetite after relief of abdominal distension. Follow-up periods ranged from 6 to 4 1/2 years. Our results suggest that maintenance peritoneal dialysis can successfully control hemodialysis ascites.

  4. Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

    Science.gov (United States)

    Simões-Silva, Liliana; Correia, Inês; Barbosa, Joana; Santos-Araujo, Carla; Sousa, Maria João; Pestana, Manuel; Soares-Silva, Isabel; Sampaio-Maia, Benedita

    Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated. Copyright © 2016 International Society for Peritoneal Dialysis.

  5. Regulation of Synthesis and Roles of Hyaluronan in Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Timothy Bowen

    2015-01-01

    Full Text Available Hyaluronan (HA is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis.

  6. Chronic peritoneal dialysis in South Asia - challenges and future.

    Science.gov (United States)

    Abraham, Georgi; Pratap, Balaji; Sankarasubbaiyan, Suresh; Govindan, Priyanka; Nayak, K Shivanand; Sheriff, Rezvi; Naqvi, S A Jaffar

    2008-01-01

    Chronic peritoneal dialysis (PD), especially continuous ambulatory PD (CAPD), is being increasingly utilized in South Asian countries (population of 1.4 billion). There are divergent geopolitical and socioeconomic factors that influence the growth and expansion of CAPD in this region. The majority of the countries in South Asia are lacking in government healthcare system for reimbursing renal replacement therapy. The largest utilization of chronic PD is in India, with nearly 6500 patients on this treatment by the end of 2006. A large majority of patients are doing 2 L exchanges 3 times per day, using glucose-based dialysis solution manufactured in India. Chronic PD is not being utilized in Myanmar, Bhutan, or Seychelles. Affirmative action by the manufacturing industry, medical professionals, government policy makers, and nongovernmental organizations for reducing the cost of chronic PD will enable the growth and utilization of this life-saving therapy.

  7. Dialysis Catheter Placement in Patients With Exhausted Access.

    Science.gov (United States)

    Rahman, Syed; Kuban, Joshua D

    2017-03-01

    Patients with end-stage renal disease undergo renal transplant, peritoneal dialysis, or intermittent hemodialysis for renal replacement therapy. For hemodialysis, native fistulas or grafts are preferred but hemodialysis catheters are often necessary. Per KDOQI, the right jugular vein is the preferred vessel of access for these catheters. However, in patients with long-standing end-stage renal disease vein thrombosis, stenosis and occlusion occurs. In these patients with end-stage vascular access, unconventional routes of placement of dialysis catheters are needed. These methods include placing them by means of sharp recanalization, via a translumbar route directly into the inferior vena cava, and via transhepatic and transrenal routes. These difficult, but potentially lifesaving methods of gaining vascular access are reviewed in this article. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. How to persuade peritoneal dialysis - skeptical hemodialysis fans.

    Science.gov (United States)

    Rodrigues, Anabela

    2009-01-01

    Already from its early decades, peritoneal dialysis (PD) has proved to be efficient and able to confer similar or better chronic patient survival in comparison with hemodialysis (HD). More recent years allowed many PD therapy advances with further outcomes improvement: mortality, hospitalizations and clinical complications all have been reduced across patient's vintages. Adequacy parameters of PD also compare advantageously with the erroneously named 'high-efficiency' HD which is now facing the limitations of intermittent procedures, frailty of KT/V as measure of adequacy, importance of sustained fluid removal and time of dialysis. Adequacy should also include life satisfaction and PD also compares favorably as a home therapy. The best approach, also the most intelligent and cost-effective, would be not to underestimate a different therapy, but discover how complementary it can be for success of long term patient treatment.

  9. Dialyzer Reuse and Outcomes of High Flux Dialysis.

    Science.gov (United States)

    Argyropoulos, Christos; Roumelioti, Maria-Eleni; Sattar, Abdus; Kellum, John A; Weissfeld, Lisa; Unruh, Mark L

    2015-01-01

    The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO. In HEMO, minimally reused (dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes.

  10. Dialysis Catheters and Their Common Complications: An Update

    Directory of Open Access Journals (Sweden)

    Satyaki Banerjee

    2009-01-01

    Full Text Available Tunneled dialysis catheters (TDCs are associated with the highest rate of complications, morbidity, and mortality when compared to arteriovenous fistulas or grafts, and this relates to higher costs in their management. Over time, catheters are prone to higher rates of infection, thrombosis, and central venous stenosis, and, thereby, catheter dysfunction. Lower blood flow rates are a consequence of the dysfuncion. Despite efforts to reduce incident and prevalent rates of catheter use for dialysis by the National Kidney Foundation and Fistula First Initiative, they remain a common modality of hemodialysis. The management of common TDC-related complications is discussed, in addition to ways to reduce and prevent morbidity associated with their use.

  11. [Just-in-time initiation of optimal dialysis].

    Science.gov (United States)

    Cornelis, Tom; Kooman, Jeroen P; van der Sande, Frank M

    2010-01-01

    The IDEAL trial shows that the decision to start renal replacement treatment should not depend on GFR alone, but should be taken on the basis of clinical parameters. Quality of Life (QoL) questionnaires and bio-impedance analysis are potential tools for detecting subtle changes in the predialysis clinic. Too early an initiation of dialysis may be deleterious for the patient and the healthcare system. We are convinced that ESRD patients should be informed about intensive haemodialysis (HD), especially nocturnal (home) HD, as the best available dialysis modality. There is substantial evidence which shows that intensive HD improves clinical, biochemical and biological parameters, and may even prolong survival. We believe that 'just-in-time delivery of intensive haemodialysis' may result in optimised QoL and reduced economic burden.

  12. Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients.

    Science.gov (United States)

    Shubayra, Amnah

    2015-03-01

    Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  13. Severe valproate induced hyperammonemic encephalopathy successfully managed with peritoneal dialysis.

    Science.gov (United States)

    Kumar, Amandeep; Suri, Ashish; Sharma, Bhawani S

    2014-07-01

    Valproic acid (VPA) is a commonly used drug for epilepsy, psychiatric disorders and migraine and is frequently used in neurosurgical intensive care units. Though most of its side-effects are mild and transient, certain idiosyncratic side-effects have been attributed to VPA. Valproate induced hyperammonemia (VIH) is one such side-effect. VIH can produce symptoms of encephalopathy known as valproate induced hyperammonemic encephalopathy (VHE). VIH and VHE usually respond to withdrawal of VPA. However, in some cases VHE can be unresponsive to supportive measures and severe enough to be life-threatening. In such cases, dialysis can be used to rapidly reverse hyperammonemia and VHE and can prove to be a lifesaving measure. We report such a case of VIH and life-threatening VHE in a postoperative neurosurgical patient that was managed successfully with peritoneal dialysis.

  14. An overview of regular dialysis treatment in Japan (as of 31 December 2012).

    Science.gov (United States)

    Nakai, Shigeru; Hanafusa, Norio; Masakane, Ikuto; Taniguchi, Masatomo; Hamano, Takayuki; Shoji, Tetsuo; Hasegawa, Takeshi; Itami, Noritomo; Yamagata, Kunihiro; Shinoda, Toshio; Kazama, Junichiro James; Watanabe, Yuzo; Shigematsu, Takashi; Marubayashi, Seiji; Morita, Osamu; Wada, Atsushi; Hashimoto, Seiji; Suzuki, Kazuyuki; Nakamoto, Hidetomo; Kimata, Naoki; Wakai, Kenji; Fujii, Naohiko; Ogata, Satoshi; Tsuchida, Kenji; Nishi, Hiroshi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu

    2014-12-01

    A nationwide statistical survey of 4279 dialysis facilities was conducted at the end of 2012, among which 4238 responded (99.0%). The number of new dialysis patients was 38055 in 2012. Since 2008, the number of new dialysis patients has remained almost the same without any marked increase or decrease. The number of dialysis patients who died in 2012 was 30710; a slight decrease from 2011 (30743). The dialysis patient population has been growing every year in Japan; it was 310007 at the end of 2012, which exceeded 310000 for the first time. The number of dialysis patients per million at the end of 2012 was 2431.2. The crude death rate of dialysis patients in 2012 was 10.0%, a slight decrease from that in 2011 (10.2%). The mean age of new dialysis patients was 68.5 years and the mean age of the entire dialysis patient population was 66.9 years. The most common primary cause of renal failure among new dialysis patients was diabetic nephropathy (44.2%). The actual number of new dialysis patients with diabetic nephropathy has been approximately 16000 for the last few years. Diabetic nephropathy was also the most common primary disease among the entire dialysis patient population (37.1%), followed by chronic glomerulonephritis (33.6%). The percentage of dialysis patients with diabetic nephropathy has been continuously increasing, whereas not only the percentage but also the actual number of dialysis patients with chronic glomerulonephritis has decreased. The number of patients who underwent hemodiafiltration (HDF) at the end of 2012 was 21725, a marked increase from that in 2011 (14115). In particular, the number of patients who underwent on-line HDF increased threefold from 4890 in 2011 to 14069 in 2012. From the results of the facility survey, the number of patients who underwent peritoneal dialysis (PD) was 9514 and that of patients who did not undergo PD despite having a PD catheter in the abdominal cavity was 347. From the results of the patient survey, among the PD

  15. The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program.

    Science.gov (United States)

    Ankawi, Ghada A; Woodcock, Nancy I; Jain, Arsh K; Garg, Amit X; Blake, Peter G

    2016-01-01

    The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described. We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years. This is a cross-sectional observational study. A single large Canadian academic center. This study collected data on 124 prevalent PD patients at a single Canadian academic center. The proportion of patients who achieve the clearance target on a low clearance or incremental PD prescription; the actual PD prescriptions and consequent total, peritoneal, and renal urea clearances [Kt/V] achieved; and patient and technique survival and peritonitis rate in comparison with national and international reports. Of the 124 prevalent PD patients in this PD unit, 106 (86%) were achieving the Kt/V target, and of these, 54 (44% of all patients) were doing so using incremental PD prescriptions. Fifty of these incremental PD patients were using automated PD (APD) with either no day dwell (68%) or less than 7 days a week treatment (12%) or both (20%). Patient survival in our PD unit was not different from that reported in Canada as a whole. Peritonitis rates were better than internationally recommended standards. This is an observational study with no randomized control group. Incremental PD is feasible in a contemporary PD population treated mainly with APD. Almost half of the patients were able to achieve clearance targets while receiving less onerous and less costly low clearance prescriptions. We suggest that incremental PD should be widely used as a cost-effective strategy in PD.

  16. Using (green) bricks and mortar for dialysis clinic construction.

    Science.gov (United States)

    Bednar, Bob

    2011-03-01

    The completed dialysis unit demonstrates that building green means creating and using processes that are environmentally responsible and resource efficient throughout a building's life cycle. The common objective is that green buildings are designed to reduce the overall impact of the environment on human health and the natural environment by: using energy, water and other resources more efficiently; protecting patient health while improving staff productivity; reducing waste.

  17. Peritoneal dialysis and neurological outcome in infants and small children

    OpenAIRE

    Laakkonen, Hanne

    2011-01-01

    Although improved outcomes for children on peritoneal dialysis (PD) have been seen in recent years, the youngest patients continue to demonstrate inferior growth, more frequent infections, more neurological sequelae, and higher mortality compared to older children. Also, maintain-ing normal intravascular volume status, especially in anuric patients, has proven difficult. This study was designed to treat and monitor these youngest PD patients, which are relatively many due to the high pre...

  18. A proposal on auxiliary business insurance for peritoneal dialysis treatment

    Institute of Scientific and Technical Information of China (English)

    WANG Juan; WANG Tao; FANG Ji-qian

    2008-01-01

    Background The peritoneal dialysis (PD) therapy for end stage renal disease (ESRD) is expensive. The main reason for non-acceptance onto dialysis programs is the great cost. In the present study, we design an auxiliary business insurance program to provide the potential ESRD patients who have no access to governmental medical insurance or can not afford the remaining part besides the limited reimbursement for peritoneal dialysis therapy.Methods The information applied in this study was extracted from the medical records of 641 PD patients, who were treated in two dialysis centers of the first and the third teaching hospitals of the Peking University respectively. A collective risk model was employed to estimate the expenses on PD therapy. Survival analyses were performed to obtain the average survival time of PD patients and the average length of time from the onset of the primary disease to the beginning of PD. An annuity method was used to determine the pure premium.Results For chronic nephritis, diabetes mellitus and hyperpietic as primary diseases, the mean survival time ± standard errors were (55.1±3.7) months, (38.9±3.2) months and (61.4±4.6) months respectively, and they were significantly different from each other (all P=0.000). The expenses of whole PD therapy were 242 159.05 Yuan, 182 525.02 Yuan and 284 579.24 Yuan respectively.Conclusions An auxiliary business insurance for PD patients was designed with the pure premium for any individual who had chronic nephritis, diabetes mellitus or hyperpietic as primary disease was RMB 35.94 Yuan/year, 87.73Yuan/year or 7.71 Yuan/year respectively without considering the additional premium for coping with the business expenditures and accidental risks.

  19. Acute Peritoneal Dialysis in Patients with Acute Kidney Injury.

    Science.gov (United States)

    Cho, Seong; Lee, Yu-Ji; Kim, Sung-Rok

    2017-01-01

    The purpose of this study was to evaluate the efficacy, complications, and mortality rate associated with acute peritoneal dialysis (PD) in patients with acute kidney injury (AKI). A total of 75 patients who were treated at Samsung Changwon Hospital between February 2005 and March 2016 were included in the study sample. The outcomes included in-hospital survival, renal recovery, metabolic and fluid control rates, and technical success rates. Refractory heart failure was the most frequent cause of acute PD (49.3%), followed by hepatic failure (20.0%), septic shock (14.7%), acute pancreatitis (9.3%), and unknown causes (6.7%). The hospital survival of patients in the acute PD was 48.0%. Etiologies of acute kidney injury (AKI) (refractory heart failure, acute pancreatitis compared with hepatic failure, septic shock or miscellaneous causes), use of inotropes, use of a ventilator, and simplified acute physiology score (SAPS) II were associated with survival differences. Maintenance dialysis required after survival was high (80.1% [29/36]) due to AKI etiologies (heart or hepatic failures). Metabolic and fluid control rates were 77.3%. The technical success rate for acute PD was 93.3%. Acute PD remains a suitable treatment modality for patients with AKI in the era of continuous renal replacement therapy (CRRT). Nearly all patients who require dialysis can be dialyzed with acute PD without mechanical difficulties. This is particularly true in patients with refractory heart failure and acute pancreatitis who had a weak requirement for inotropes. Copyright © 2017 International Society for Peritoneal Dialysis.

  20. Kinetic Modeling of Incremental Ambulatory Peritoneal Dialysis Exchanges.

    Science.gov (United States)

    Guest, Steven; Leypoldt, John K; Cassin, Michelle; Schreiber, Martin

    2017-01-01

    ♦ BACKGROUND: Incremental peritoneal dialysis (PD), the gradual introduction of dialysate exchanges at less than full-dose therapy, has been infrequently described in clinical reports. One concern with less than full-dose dialysis is whether urea clearance targets are achievable with an incremental regimen. In this report, we used a large database of PD patients, across all membrane transport types, and performed urea kinetic modeling determinations of possible incremental regimens for an individual membrane type. ♦ METHODS: Using a modified 3-pore model of peritoneal transport, various incremental manual continuous ambulatory PD (CAPD) exchanges employing glucose and/or icodextrin were evaluated. Peritoneal urea clearances from those simulations were added to residual kidney urea clearance for patients with various glomerular filtration rates (GFRs), and the total weekly urea clearance was then compared to the total weekly urea Kt/V target of 1.7. All 4 peritoneal membrane types were modeled. For each simulated prescription, net ultrafiltration and carbohydrate absorption were also calculated. ♦ RESULTS: Incremental CAPD regimens of 2 exchanges a day met adequacy targets if the GFR was 6 mL/min/1.73 m(2) in all membrane types. For regimens employing 3 exchanges a day, Kt/V targets were achieved at GFR levels of 4 to 5 mL/min/1.73 m(2) in high transporters to low transporters but higher tonicity 2.5% glucose solutions or icodextrin were required in some regimens. ♦ CONCLUSIONS: This work demonstrates that with incremental CAPD regimens, urea kinetic targets are achievable in most new starts to PD with residual kidney function. Incremental PD may be a less intrusive, better accepted initial treatment regime and a cost-effective way to initiate chronic dialysis in the incident patient. The key role of intrinsic kidney function in incremental regimens is highlighted in this analysis and would warrant conscientious monitoring. Copyright © 2017 International

  1. Cardiovascular morbidity and mortality risk factors in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Jovanović Dijana B.

    2008-01-01

    Full Text Available Cardiovascular (CVS morbidity and mortality in the endstage renal disease (ESRD patients on peritoneal dialysis therapy is 10-30 folds higher than in general population. The prevalence of well known traditional risk factors such as age, sex, race, arterial hypertension, hyperlipidaemia, diabetes, smoking, physical inactivity is higher in the uraemic patients. Besides these, there are specific, nontraditional risk factors for dialysis patients. Mild inflammation present in peritoneal dialysis (PD patients which can be confirmed by specific inflammatory markers is the cause of CVS morbidity and mortality in these patients. Hypoalbuminaemia, hyperhomocysteinaemia and a higher level of leptin are important predictors of vascular complications as well as CVS events in the PD patients. Plasma norepinephrine, an indicator of sympathetic activity, is high in the ESRD patients and higher in the PD patients than in the patients on haemodialysis (HD. Therefore, norepinephrine may be a stronger risk factor in the PD patients. The same applies to asymmetric dimethylargine (ADMA, an endogenous inhibitor of nitric oxide synthase, which is an important risk factor of CVS morbidity and mortality 15 % higher in the PD than the HD patients. Hyperphosphataemia, secondary hyperparathyroidism and high calcium x phosphate product have been associated with the progression of the coronary artery calcification and valvular calcifications and predict all-cause CVS mortality in the PD patients. Residual renal function (RRF declines with time on dialysis but is slower in the PD than the HD patients. RRF decline is associated with the rise of proinflammatory cytokines and the onset of hypervolaemia and hypertension which increase the risk of CVS diseases, mortality in general and CVS mortality. In conclusion, it is very important to establish all CVS risk factors in the PD patients to prevent CVS diseases and CVS mortality in this population.

  2. Recommended Clinical Trial End Points for Dialysis Catheters.

    Science.gov (United States)

    Allon, Michael; Brouwer-Maier, Deborah J; Abreo, Kenneth; Baskin, Kevin M; Bregel, Kay; Chand, Deepa H; Easom, Andrea M; Mermel, Leonard; Mokrzycki, Michele H; Patel, Priti R; Roy-Chaudhury, Prabir; Shenoy, Surendra; Valentini, Rudolph P; Wasse, Haimanot

    2017-07-20

    Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration. Our workgroup suggests diagnosing catheter-related bloodstream infection in catheter-dependent patients on hemodialysis with a clinical suspicion of infection (fever, rigors, altered mental status, or unexplained hypotension), blood cultures growing the same organism from the catheter hub and a peripheral vein (or the dialysis bloodline), and absence of evidence for an alternative source of infection. Catheter dysfunction is defined as the inability of a central venous catheter to (1) complete a single dialysis session without triggering recurrent pressure alarms or (2) reproducibly deliver a mean dialysis blood flow of >300 ml/min (with arterial and venous pressures being within the hemodialysis unit parameters) on two consecutive dialysis sessions or provide a Kt/V≥1.2 in 4 hours or less. Catheter dysfunction is defined only if it persists, despite attempts to reposition the patient, reverse the arterial and venous lines, or forcefully flush the catheter. Central vein obstruction is suspected in patients with >70% stenosis of a central vein by contrast venography or the equivalent, ipsilateral upper extremity edema, and an existing or prior history of a central venous catheter. There is some uncertainty about the specific criteria for these diagnoses, and the workgroup has also proposed future high-priority studies to resolve these questions. Copyright © 2017 by the American Society of

  3. [Acid-base status in patients treated with peritoneal dialysis].

    Science.gov (United States)

    Katalinić, Lea; Blaslov, Kristina; Pasini, Eva; Kes, Petar; Bašić-Jukić, Nikolina

    2014-04-01

    When compared to hemodialysis, peritoneal dialysis is very simple yet low cost method of renal replacement therapy. Series of studies have shown its superiority in preserving residual renal function, postponing uremic complications, maintaining the acid-base balance and achieving better post-transplant outcome in patients treated with this method. Despite obvious advantages, its role in the treatment of chronic kidney disease is still not as important as it should be. Metabolic acidosis is an inevitable complication associated with progressive loss of kidney function. Its impact on mineral and muscle metabolism, residual renal function, allograft function and anemia is very complex but can be successfully managed. The aim of our study was to evaluate the efficiency in preserving the acid-base balance in patients undergoing peritoneal dialysis at Zagreb University Hospital Center. Twenty-eight patients were enrolled in the study. The mean time spent on the treatment was 32.39 ± 43.43 months. Only lactate-buffered peritoneal dialysis fluids were used in the treatment. Acid-base balance was completely maintained in 73.07% of patients; 11.54% of patients were found in the state of mild metabolic acidosis, and the same percentage of patients were in the state of mild metabolic alkalosis. In one patient, mixed alkalosis with respiratory and metabolic component was present. The results of this study showed that acid-base balance could be maintained successfully in patients undergoing peritoneal dialysis, even only with lactate-buffered solutions included in the treatment, although they were continuously proclaimed as inferior in comparison with bicarbonate-buffered ones. In well educated and informed patients who carefully use this method, accompanied by the attentive and thorough care of their physicians, this method can provide quality continuous replacement of lost renal function as well as better quality of life.

  4. 'Flexible' or 'lifestyle' dialysis: is this the way forward?

    Science.gov (United States)

    Agar, John W M; Mahadevan, Kumar; Knight, Richard; Antonis, Michelle L; Somerville, Christine A

    2005-10-01

    Despite the advent of two new dialysis options, nocturnal home haemodialysis and short daily haemodialysis, many units are yet to build them into the modalities on offer to end-stage renal failure patients. The reasons behind this inertia are complex but primarily include anxieties about workload, budgetary implications and outcome data. The Geelong dialysis programme, where both nocturnal home haemodialysis and short daily haemodialysis are offered, is compared with Australian and New Zealand national profiles. Significant profile differences emerge when comparing sessions/week and h/week between the three groups. Most Australian (92.93%) and New Zealand (95.07%) haemodialysis patients dialyse for three sessions/week. This contrasts to Geelong where only 73.6% dialyse for three sessions/week. 18.8% of Geelong haemodialysis patients versus 1.8% (Australia) and 0.9% (New Zealand) dialyse for five or more sessions/week. Australia and New Zealand follow similar h/session patterns although more Australians (44.2%) dialyse for 4 h and fewer (24.2%) for 5 h than their New Zealand counterparts (39.6% and 29.8%, respectively), and few dialyse outside the 3.5-5 h window. In contrast, 6.7% of Geelong patients dialyse for 2-2.5 h/session versus Australia (0.9%) and New Zealand (0.2%). This represents the Geelong short daily dialysis programme. More Geelong patients (>15%) dialyse >/=8 h/week and represent the Geelong nocturnal home haemodialysis programme. The flexible Geelong programme has been supported without exceeding the budget applied to a conventional dialysis programme with the same patient numbers.

  5. Coronary artery calcification in Korean patients with incident dialysis.

    Science.gov (United States)

    Bae, Eunjin; Seong, Eun Yong; Han, Byoung-Geun; Kim, Dong Ki; Lim, Chun Soo; Kang, Shin-Wook; Park, Cheol Whee; Kim, Chan-Duck; Shin, Byung Chul; Kim, Sung Gyun; Chung, Wookyung; Park, Jae Yoon; Lee, Joo Yeon; Kim, Yon Su

    2016-10-05

    Introduction Patients with chronic kidney disease have an extremely high risk of developing cardiovascular disease (CVD). In patients with end-stage renal disease (ESRD), coronary artery calcification (CAC) is associated with increased mortality from CVD. Methods The present study aimed to investigate the risk factors for CAC in Korean patients with incident dialysis. Data on 423 patients with ESRD who started dialysis therapy between December 2012 and March 2014 were obtained from 10 university-affiliated hospitals. CAC was identified by using noncontrast-enhanced cardiac multidetector computed tomography. The CAC score was calculated according to the Agatston score, with CAC-positive subjects defined by an Agatston score >0. Findings Patients' mean age was 55.6 ± 14.6 years, and 64.1% were men. The CAC-positive rate was 63.8% (270 of 423). Results of univariate analyses showed significant differences in age, sex, etiology of ESRD and comorbid conditions according to the CAC score. However, results of multiple regression analysis showed that only a higher age was significantly associated with the CAC score. Receiver operating characteristic curves showed that the sensitivity and specificity of L-spine radiography for diagnosing CAC were 56% and 91%, respectively, for diagnosing CAC (area under the curve, 0.735). Discussion CAC was frequent in patients with incident dialysis, and multiple regression analysis showed that only age was significantly associated with the CAC score. In addition, L-spine radiography could be a helpful modality for diagnosing CAC in patients with incident dialysis.

  6. Growth in Very Young Children Undergoing Chronic Peritoneal Dialysis

    Science.gov (United States)

    Azocar, Marta; Borzych, Dagmara; Watson, Alan R.; Büscher, Anja; Edefonti, Alberto; Bilge, Ilmay; Askenazi, David; Leozappa, Giovanna; Gonzales, Claudia; van Hoeck, Koen; Secker, Donna; Zurowska, Aleksandra; Rönnholm, Kai; Bouts, Antonia H. M.; Stewart, Heather; Ariceta, Gema; Ranchin, Bruno; Warady, Bradley A.; Schaefer, Franz

    2011-01-01

    Very young children with chronic kidney disease often have difficulty maintaining adequate nutrition, which contributes to the high prevalence of short stature in this population. Characteristics of the dialysis prescription and supplemental feeding via a nasogastric (NG) tube or gastrostomy may improve growth, but this is not well understood. Here, we analyzed data from 153 children in 18 countries who commenced chronic peritoneal dialysis at <24 months of age. From diagnosis to last observation, 57 patients were fed on demand, 54 by NG tube, and 10 by gastrostomy; 26 switched from NG to gastrostomy; and 6 returned from NG to demand feeding. North American and European centers accounted for nearly all feeding by gastrostomy. Standardized body mass index (BMI) uniformly decreased during periods of demand feeding and increased during NG and gastrostomy feeding. Changes in BMI demonstrated significant regional variation: 26% of North American children were obese and 50% of Turkish children were malnourished at last observation (P < 0.005). Body length decreased sharply during the first 6 to 12 months of life and then tended to stabilize. Time fed by gastrostomy significantly associated with higher lengths over time (P < 0.001), but adjustment for baseline length attenuated this effect. In addition, the use of biocompatible peritoneal dialysate and administration of growth hormone independently associated with improved length, even after adjusting for regional factors. In summary, growth and nutritional status vary regionally in very young children treated with chronic peritoneal dialysis. The use of gastrostomy feeding, biocompatible dialysis fluid, and growth hormone therapy associate with improved linear growth. PMID:22021715

  7. Physical Activity in Patients Treated With Peritoneal Dialysis

    Science.gov (United States)

    Thangarasa, Tharshika; Imtiaz, Rameez; Hiremath, Swapnil; Zimmerman, Deborah

    2017-01-01

    Background: Patients with chronic diseases are known to benefit from exercise. Despite a lack of compelling evidence, patients with end-stage kidney disease treated with peritoneal dialysis are often discouraged from participating in exercise programs that include resistance training due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for these patients remain unclear. The purpose of this study is to more completely define the risks and benefits of physical activity in the end-stage kidney disease population treated with peritoneal dialysis. Methods/design: We will conduct a systematic review examining the effects of physical activity on end-stage kidney disease patients treated with peritoneal dialysis. For the purposes of this review, exercise will be considered a purposive subcategory of physical activity. The primary objective is to determine if physical activity in this patient population is associated with improvements in mental health, physical functioning, fatigue and quality of life and if there is an increase in adverse outcomes. With the help of a skilled librarian, we will search MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for randomized trials and observational studies. We will include adult end-stage kidney disease patients treated with peritoneal dialysis that have participated in an exercise training program or had their level of physical activity assessed directly or by self-report. The study must include an assessment of the association between physical activity and one of our primary or secondary outcomes measures. We will report study quality using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials and the Newcastle–Ottawa Scale for observational studies. Quality across studies will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The

  8. Self-management support for peritoneal dialysis patients.

    Science.gov (United States)

    Sarian, Mari; Brault, Diane; Perreault, Nathalie

    2012-01-01

    The increasing prevalence of chronic illnesses and kidney disease, in particular, makes it necessary to adopt new approaches towards their management (Wagner, 1998). Evidence suggests that promoting self-management improves the health status of peritoneal dialysis (PD) patients, as they manage upwards of 90% of their own care. Patients who are unable to self-manage suffer from various complications. This project proposes an intervention aimed at improving self-management skills among PD patients. To promote self-management in peritoneal dialysis patients. This is achieved through the following objectives: (a) develop an algorithm that can improve patients' ability to solve the specific problem of fluid balance maintenance, (b) develop an educational session for patients on how to use the algorithm, and (c) develop an implementation strategy in collaboration with the PD nurse. Three measures evaluate the effectiveness of the intervention. First, a telephone call log shows that participating patients call the clinic less to inquire about fluid balance maintenance. Next, a pre- and post-intervention knowledge test measures definite knowledge increase. Finally, a Patient Satisfaction Questionnaire reveals overall satisfaction with the intervention. This project, which proved beneficial to our patient population, could be duplicated in other clinics. The algorithm "How do I choose a dialysis bag" and the slides of the educational sessions can be shared with PD nurses across the country for the benefit of PD patients.

  9. Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

    Directory of Open Access Journals (Sweden)

    C. Kennedy

    2011-01-01

    Full Text Available Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

  10. The need for dialysis in Haiti: dream or reality?

    Science.gov (United States)

    Exantus, Judith; Desrosiers, Florence; Ternier, Alexandra; Métayer, Audie; Abel, Gérard; Buteau, Jean-Hénold

    2015-01-01

    According to the World Health Organization reports, nowadays burden of chronic kidney diseases (CKD) is well documented. The high prevalence of noncommunicable diseases (NCD) such as hypertension, diabetes, and obesity, which are the main causes of CKD, is a big concern in the world health scenario. These NCD can progress slowly to end-stage renal disease (ESRD) and the low-middle income countries (LMIC) like Haiti are not left unscathed by this worldwide scourge. Several well-known public health issues prevalent in Haiti such as acute diarrheal infections, malaria, tuberculosis, cholera, and acquired immunodeficiency syndrome (AIDS), can also impair the function of the kidney. Dialysis, a form of renal replacement therapy (RRT), represents a life-saving therapy for all patients affected with impaired kidney. In Haiti, few patients have access to health insurance or disability financial support. Considering that seventy-two percent (72%) of Haitians live with less than USD 2 per day, survival with CKD can be quite stressful for them. Data on the weight of the dialysis and its management are scarce. Addressing the need for dialysis in Haiti is an important component in decision-making and planning processes in the health sector. This paper is intended to bring forth discussion on the use of this type of renal replacement therapy in Haiti: the past, the present, and the challenges it presents. We will also make some recommendations in order to manage this serious problem. © 2015 S. Karger AG, Basel.

  11. The Effect of Ligustrazine on Peritoneal Transport in Peritoneal Dialysis

    Institute of Scientific and Technical Information of China (English)

    朱忠华; 彭维毅; 王玉梅; 朱红艳; 杨晓; 邓安国

    2002-01-01

    Summary: In order to investigate the effect of ligustrazine (Lig) i.p. on peritoneal permeability inperitoneal dialysis and its side effects, creatinine was given intravenously and continuously tomaintain the high plasma creatinine level. All the rabbits were divided into three groups: normalcontrol group (group A), group B treated with 0. 12 % Lig and group C treated with 0. 24 % Lig.The peritoneal dialysis of all rabbits lasted 2 h. The plasma and dialysate levels of glucose, proteinand creatinine were observed immediate, 30 min, 60 min, 90 min,120 min after dialysis. Creasti-nine dialysate/plasma ratio (D/P), protein D/P ratio, glucose D/Do at different time points afterdialysis and creatinine mass transfer area coefficient (MTAC) at 120 min were calculated. Thestructures of peritoneum were observed under optical microscope and electron microscope aftercontinuously intraperitoneal injection of Lig for 14 days. The results showed that the 90-min and120-min creatinine D/P ratios in the group C were higher than in the group A. The 120-min creatinine MATC in the group C was higher than in the group A. The rabbits treated with Lig did notshow significant structure changes of peritoneum and signs of peritoneal irritation. It was suggest-ed that Lig could increase mass transfer ability of peritoneum without significant side effects.

  12. Residual Renal Function in Children Treated with Chronic Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Maria Roszkowska-Blaim

    2013-01-01

    Full Text Available Residual renal function (RRF in patients with end-stage renal disease (ESRD receiving renal replacement therapy is defined as the ability of native kidneys to eliminate water and uremic toxins. Preserved RRF improves survival and quality of life in adult ESRD patients treated with peritoneal dialysis. In children, RRF was shown not only to help preserve adequacy of renal replacement therapy but also to accelerate growth rate, improve nutrition and blood pressure control, reduce the risk of adverse myocardial changes, facilitate treatment of anemia and calcium-phosphorus balance abnormalities, and result in reduced serum and dialysate fluid levels of advanced glycation end-products. Factors contributing to RRF loss in children treated with peritoneal dialysis include the underlying renal disease such as hemolytic-uremic syndrome and hereditary nephropathy, small urine volume, severe proteinuria at the initiation of renal replacement therapy, and hypertension. Several approaches can be suggested to decrease the rate of RRF loss in pediatric patients treated with chronic peritoneal dialysis: potentially nephrotoxic drugs (e.g., aminoglycosides, episodes of hypotension, and uncontrolled hypertension should be avoided, urinary tract infections should be treated promptly, and loop diuretics may be used to increase salt and water excretion.

  13. Evaluation of biofouling for implantable micro dialysis system.

    Science.gov (United States)

    Ota, T; To, N; Kanno, Y; Miki, N

    2016-08-01

    Implantable artificial kidney can drastically improve the quality of life of the renal disease patients. In previous study, our group has developed a multi-layered micro dialysis device which is composed of micro stainless steel channels and nano-porous polyethersulfone (PES) membranes. The device conducts hemofiltration without dialysis fluids, which is advantageous in miniaturization. We investigated the water-permeability of the PES membrane through in vivo experiments using rat model of renal disease for 5 hours and verified the effectiveness of the device. We investigated the permeability of PES membrane via in vitro experiments for 24 days. Biofouling on the PES membrane was found and caused deterioration of dialysis performance of the membrane. In this research, we investigated the biofouling such as thrombus, coagulation and protein adhesion on the sidewall of the micro fluidic channels. We investigated the micro fluidic channel geometry and surface condition associated with the processing methods. Conducting in vitro experiment for 7 days, biofouling was found to be mainly caused by the surface conditions. The mirror surface formed by electrolytic etching could substantially prevent biofouling.

  14. Hepatitis C risk factor for patients submitted to dialysis

    Directory of Open Access Journals (Sweden)

    Maria Zélia Baldessar

    Full Text Available This article reports the results of the research which has evaluated the prevalence and factors associated to the presence of Hepatitis C in patients submitted to dialysis at the Clinica de Doenças Renais (Clinic of Renal Diseases in Tubarao city (CRDT, Santa Catarina State, Brazil, in the period between January 1st, 2004 to December 31st in the same year. The prevalence of 16.8% of Hepatitis C in the studied population and the time-length of dialysis as significative risk factor have become evident. The non-correlation of seropositivity of the followings factors is also indicated: age, gender, base diseases, infrastructures, the type of clinic machines, the type of dialyser, used membranes, the machine sterilisation and substances for this process as well as the number of times of the dialyser reutilization. The data represented in this project suggest that the Hepatitis C presents high prevalence in patients in dialysis and the time-length of the treatment is a risky factor to acquire the infection.

  15. Hepatitis C risk factor for patients submitted to dialysis.

    Science.gov (United States)

    Baldessar, Maria Zélia; Bettiol, Jane; Foppa, Fabrício; Oliveira, Lúcia Helena das Chagas

    2007-02-01

    This article reports the results of the research which has evaluated the prevalence and factors associated to the presence of Hepatitis C in patients submitted to dialysis at the Clinica de Doenças Renais (Clinic of Renal Diseases) in Tubarao city (CRDT), Santa Catarina State, Brazil, in the period between January 1st, 2004 to December 31st in the same year. The prevalence of 16.8% of Hepatitis C in the studied population and the time-length of dialysis as significative risk factor have become evident. The non-correlation of seropositivity of the followings factors is also indicated: age, gender, base diseases, infrastructures, the type of clinic machines, the type of dialyser, used membranes, the machine sterilisation and substances for this process as well as the number of times of the dialyser reutilization. The data represented in this project suggest that the Hepatitis C presents high prevalence in patients in dialysis and the time-length of the treatment is a risky factor to acquire the infection.

  16. Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Sprague, S.M.; Corwin, H.L.; Tanner, C.M.; Wilson, R.S.; Green, B.J.; Goetz, C.G.

    1988-10-01

    Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

  17. Prognostic Importance of Fibroblast Growth Factor-23 in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Nilgül Akalin

    2014-01-01

    Full Text Available Introduction. In this study, we aimed to demonstrate the correlation of FGF-23 levels with bone-mineral metabolism, anemia, and the treatment in dialysis patients. Methods. Eighty-nine patients with similar age, gender, dialysis duration, and dialysis adequacy who were receiving hemodialysis replacement therapy for at least 6 months were included in the study. Serum iron, iron binding capacity, ferritin, hemoglobin (Hb, hematocrit (Htc, calcium (Ca, phosphorus (P, intact parathormone (iPTH, and FGF-23 levels were studied. In addition, active vitamin D and phosphate binders calcimimetic therapies that patients have received in the last 6 months were recorded. Results. It was determined that there was a positive correlation between serum FGF-23 values and PTH values (P<0,01 and Ca*P values (P<0,01. A positive correlation was found between serum FGF-23 values and Ca values at a rate of 24,6% (P<0,05 and between P values at a rate of 59,1% (P<0,01. A positive correlation was determined between serum FGF-23 values and hemoglobin (Hb values (P<0,05 and hematocrit (Htc values (P<0,05. In multivariate analysis, no significant correlation was found between serum FGF-23 levels and Hb and Htc. Conclusion. The effects of high serum FGF-23 levels on different parameters may be correlated with the development of refractory secondary hyperparathyroidism.

  18. Daytime sleepiness and quality of life in peritoneal dialysis patients.

    Science.gov (United States)

    Bilgic, Ayse; Akman, Beril; Sezer, Siren; Arat, Zubeyde; Ozelsancak, Ruya; Ozdemir, Nurhan

    2011-12-01

    We aimed to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) therapy with regard to patients' excessive daytime sleepiness (EDS) and quality of life (QOL). EDS was assessed with the Epworth Sleepiness Scale (ESS) and QOL with the Medical Outcomes Study 36-Item Short Form (SF-36) health survey. We included 59 patients (CAPD/APD, 30/29; male/female, 33/26; age, 45.3±15.8 years; dialysis duration, 42.0±33.6 months). The CAPD and APD groups were similar with respect to factors that affected sleep quality (age, sex, duration of PD), smoking, alcohol intake, socioeconomic status, body mass index, comorbid disease, and various laboratory parameters. Although one patient (3.3%) treated with CAPD and four patients (13.8%) treated with APD experienced EDS, there was no significant differences in ESS scores between the CAPD and APD patients. There was no difference in the SF-36 total and subscale scores when APD patients were compared with CAPD patients. The independent predictors of ESS were the serum albumin level (β= -2.04, P<0.01), total SF-36 score (β= 0.08, P=0.02), social functioning score (β= -2.47, P=0.01), and role-emotional subscale score (β= -1.12, P=0.05). The incidence of EDS was slightly higher in APD patients, but it did not negatively affect daily activities or QOL.

  19. Pleuroperitoneal leak complicating peritoneal dialysis: a case series.

    LENUS (Irish Health Repository)

    Kennedy, C

    2012-02-01

    Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

  20. Early nuclear alterations and immunohistochemical expression of Ki-67, Erb-B2, vascular endothelial growth factor (VEGF), transforming growth factor (TGF-beta1) and integrine-linked kinase (ILK) two days after tamoxifen in breast carcinoma.

    Science.gov (United States)

    Morena, A M L; Oshima, C T F; Gebrim, L H; Egami, M I; Silva, M R R; Segreto, R A; Giannotti Filho, O; Teixeira, V P C; Segreto, H R C

    2004-01-01

    The purpose of the present study was to evaluate breast carcinoma samples before and two days after treatment with tamoxifen in order to analyse early histopathological alterations--particularlynuclear alterations-- as well as immunohistochemical expression of Ki-67, Erb-B2, VEGF, TGF-beta1 and ILK proteins. Twenty one cases of invasive ductal and lobular breast carcinoma were studied. Patients were submitted to biopsy of the lesion and, after confirmation of the diagnosis, they received 20 mg of tamoxifen a day, beginning two days before surgery. The samples obtained during biopsy and after surgery were stained with HE for histopathological diagnosis. Estrogen receptor was positive in 18 cases and negative in 3. The immunohistochemical method was applied for the detection of Ki-67, Erb-B2, protein, vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-beta1) and integrin linked kinase (ILK). Two days after tamoxifen treatment, the following results were observed: 1) decrease in the cell volume, chomatine condensation, nucleoli less evident and clearly defined nuclear limits; 2) significant reduction in the expression of Erb-B2 protein and significant increase in the expression of TGF-beta1 protein; 3) expression of others proteins (Ki-67, VEGF and ILK) was not altered during the indicated time frame. Our results suggest that analyzing nuclear alterations and expression of Erb-B2 and TGF-beta1 proteins would be useful to assess the initial response to tamoxifen.