Consecutive Chronic Hemodialysis Research Articles

Assessing the Potential and Necessity for Kidney Transplantation in the Democratic Republic of the Congo.

Assessing the Potential and Necessity for Kidney Transplantation in the Democratic Republic of the Congo.

Muscle strength, physical performance, and metabolic changes after subtotal parathyroidectomy for secondary hyperparathyroidism

BackgroundHyperparathyroidism in patients on chronic hemodialysis presents with bone pain, pruritus, and extra-skeletal calcifications. Little attention has been paid to low plasma protein concentrations and muscle weakness in these patients. The present study was undertaken to characterize the impact of subtotal parathyroidectomy for chronic hemodialysis on body composition, muscle strength, plasma proteins, quality of life, and long-term clinical course. MethodsWe performed a prospective observational before-after assessment study of consecutive chronic hemodialysis patients referred for parathyroidectomy. Patients were investigated at baseline before parathyroidectomy and then at 1 and 6 months after surgery, with the aim to assess changes in metabolic parameters, body composition by bioimpedance, muscle strength, and quality of life (36-items Short Form Health Survey questionnaire). Follow-up was terminated when patients reached 1 of the 3 pre-defined end points: recurrence of secondary hyperparathyroidism, transplantation, or death. ResultsA group of 23 patients on hemodialysis were included. Preoperative handgrip strength was diminished by 52.4 ± 17%. After parathyroidectomy, a drop of immunoreactive parathyroid hormone concentrations (1,153 vs 237 pg/mL; P < .001) was observed together with increases in plasma protein (total: 6.8 vs7.8 g/dL, s-albumin 3.7 vs 4.4 g/dL and prealbumin: 31.7 vs 35.2 mg/dL; P < .001), handgrip strength (18.3 vs 22.9 kg: P = .001) as well as an improvement in physical dimension (32.9 vs 35.6; P = .004) and vitality (32.3 vs 47.1; P = .002) domains of the 36-items Short Form Health Survey questionnaire. After10 years, one-third of the patients had died, one-third of the patients had a recurrence of secondary hyperparathyroidism, and one-third of patients had received a kidney transplant and maintained a normal parathyroid function. ConclusionSubtotal parathyroidectomy improves protein metabolic markers, muscle strength, and physical performance in chronic hemodialysis patients.

Mild hyponatremia is associated with functional and cognitive decline in chronic hemodialysis patients.

A high incidence and adverse outcomes of cognitive impairment in dialysis patients have recently become recognized. Classical risk factors, uremia, anemia, metabolic disturbances, and hemodynamic instability during dialysis accelerate vascular cognitive impairment. To evaluate laboratory factors that influence cognitive function in consecutive chronic hemodialysis (CHD) patients over a 2-year period. Between June 2010 and June 2011 we conducted a prospective, single-center trial that evaluated cognitive function in adult chronic hemodialysis (HD) patients. A battery of cognitive function tests was used: modified mini mental state (3MS), trailmaking tests A (trails A) and B (trails B). The 15-item geriatric depression scale (GDS) and the activities of daily living (ADL) test were used, respectively, for assessing symptoms of depression and global functional status. All tests were performed twice at yearly intervals in consecutive HD patients. Global cognitive impairment was defined as a 3MS < 80 and impaired executive function as a Trails A performance time > 75 seconds and Trails B > 180 seconds. 56 chronic HD patients aged 65.00 ± 17.8 years were studied; 57% of them were males. 86% suffered from hypertension (HTN), 40% were diabetics and ~ 1/3 had ischemic heart disease, congestive heart failure (CHF), and dyslipidemia. Average plasma calcium, phosphorus, and PTH were within the recommended range. No features suggestive of malnutrition, severe anemia, inflammation, or inadequate dialysis were detected. 14 patients (24%) had mild chronic hyponatremia (Na ranges 131 - 135 meq/L). Significant disturbances in global cognitive and executive function were detected in the study patients. In 2010, 50% had 3MS < 80, 71% and 91% had severely impaired trails A and B tests (respectively), 54% had symptoms of depression and 50% suffered from impaired ADL. Retesting of the survivors in 2011 revealed increased prevalence of cognitive and functional declines along with worsening depression scoring. Univariate analysis demonstrated significant correlation between cognitive decline and age, female gender, education, poor executive and functional status, inadequate dialysis dose (Kt/V < 1.2, p = 0.023), high plasma phosphorus levels (p > 6 mg/dL, p = 0.034), and hyponatremia (Na < 135 mEq/L, p = 0.001). Multivariate stepwise logistic regression analysis revealed statistically significant associations between hyponatremia and impaired ADL (p = 0.043) and impaired ADL and mortality (p = 0.002). A high prevalence of global cognitive and executive impairment was detected in our hemodialysis cohort. We found an association between mild chronic hyponatremia and impaired functional status. Whether treatments aimed at modifying hyponatremia could mitigate functional decline or mortality remains to be elucidated.

Cyberknife radiosurgery of a renal pelvis tumor to avoid renal dialysis

Transitional cell cancer (TCC) in the renal pelvis is usually treated by nephro-ureterectomy. In functional or anatomical singular renal units, consecutive chronic hemodialysis will be needed. We present a patient treated by image-guided robotic radiosurgery for definitive tumor control of a T2G3 recurrent transitional cell cancer of the renal pelvis in a singular renal unit after nephro-ureterectomy of the contralateral kidney.

Epicardial Cardiac Rhythm Devices for Dialysis Patients: Minimizing the Risk of Infection and Preserving Central Veins

Transvenous leads of cardiac rhythm devices (CRDs) are known to cause central stenosis and are vulnerable to contamination during hemodialysis access-related bacteremia. In this retrospective study, nine consecutive chronic hemodialysis patients with transvenous CRD infection due to dialysis access-related bacteremia and recurrent central stenosis are presented. Four patients with tunneled hemodialysis catheters (TDCs) and three with arteriovenous grafts experienced access-related bacteremia that spread to the transvenous CRD. Two patients required repeated angioplasty procedures (less than 3 months apart) for central venous stenosis. Transvenous CRD was removed and replaced with an epicardial system in all. One patient with TDC switched to peritoneal dialysis and did not experience infection of the epicardial system despite two episodes of peritonitis. The remaining TDC (n=3) and graft patients (n=3) received a new TDC after the resolution of bacteremia. While all six experienced on average 1.5 episodes of catheter-related bacteremia (average follow-up = 14.5 months), none developed infection of the epicardial system. The patients with central stenosis have required only one angioplasty each for the past 8 and 6 months. To the best of our knowledge this is the first study to suggest that an epicardial approach might be a preferred method over transvenous leads for chronic hemodialysis patients.

Efficacy of tissue plasminogen activator administration on patency of hemodialysis access catheters

Patients with end-stage renal disease use hemodialysis catheters for either temporary or permanent blood access. Recurrent thrombosis and fibrin sheath formation are common causes of poor or inadequate blood flow rates that require intervention. We studied the effect of tissue plasminogen activator (tPA) in reestablishing adequate blood flow rates through nonfunctional vascular catheters in 22 consecutive chronic hemodialysis patients. From January 1, 1999, to May 20, 1999, there were 56 instances in which tPA was used in an attempt to improve blood flow rates. In all instances, 2 mg of tPA was infused into each port of a dual-lumen internal jugular catheter. Dwell time ranged between 2 and 96 hours (median, 24 hours), and patient follow-up ranged between 47 and 140 days (median, 133.5 days). tPA was effective in establishing adequate blood flow rates (≥200 mL/min) during the next dialysis session in 49 of 56 cases (87.5%). Seven additional interventions were required because of early or late tPA failure (one fibrin sheath stripping, one catheter replacement for kinking, one catheter replacement for central venous stenosis, and four catheter replacements for persistently poor blood flow rates), and eight catheters were replaced for infection. Thus, further interventions to achieve adequate blood flow rates were required in 12.5% of the cases because of early or late tPA failure. tPA appears to be as effective as urokinase for reestablishing adequate blood flow rates through hemodialysis catheters that are thrombosed or have low blood flow rates.