Modes Of Dialysis Research Articles

Varying association of nutrient intakes with quality of life in patients receiving different modes of dialysis.

Nutrients are crucial for dialysis patients, especially elderly patients. Nutrition-related complications in dialysis patients are often closely related to cardiovascular aging. However, we know little about the effect of different nutrients on the commonly used outcome predictor, health-related quality of life (HRQOL). Therefore, this study investigated the associations between different nutrients and HRQOL among dialysis patients. A cross-sectional study was conducted on 123 dialysis adults at multiple dialysis centers. The Short Form-36 Health Survey (SF-36) assesses HRQOL. Modified quantitative subjective global assessment (MQSGA) evaluates nutritional status. A 3-day dietary record evaluated nutrient intakes. Among the 123 participants, 79 received hemodialysis (HD), and 44 were on peritoneal dialysis (PD). Patients with PD had a higher SF-36 score than HD (525 ± 136 vs. 375 ± 179, P < 0.001). A negative association between nutrition status and HRQOL was observed in HD (regression coefficient β = -17.4, P < 0.001) but not in PD (β = -12.3, P = 0.07). For HD patients, the nutrition status was negatively correlated with intakes of carbohydrates, fiber, selenium, copper, and Manganese (β = -0.02, P = 0.032; β = -0.3, P = 0.031; β = -0.1, P = 0.006; β = -2.3, P = 0.025; β = -1.3, P = 0.003, respectively). Their HRQOL was positively associated with calories, fat, niacin, and vitamin E (β = 2.19, P = 0.035; β = 2.4, P = 0.043; β = 8.5, P = 0.044; β = 6.9, P = 0.017, respectively). Conversely, for patients with PD, only vitamin B2 was found to be adversely correlated with their nutritional status (β = -5.2, P = 0.037), and increased intakes of vitamin A, vitamin C and fiber (β = 0.1, P = 0.031; β = 0.8, P = 0.028; β = 15.8, P = 0.045, respectively) were associated with a better HRQOL. The nutritional intake of PD patients and HD patients affects their quality of life differently. Macronutrients significantly impact HRQOL in HD patients, while vitamins have a more substantial impact on PD patients.

Imaging of Pulmonary Manifestations in Chronic Kidney Disease: A Review

AbstractLungs and kidneys share a symbiotic relationship in maintaining homeostasis of body. Hence, derangement of one system is bound to affect the functioning of the other. The thoracic manifestations of chronic renal failure present a wide spectrum ranging from problems related to fluid and salt balance, calcium–phosphate metabolism, compromised immunity, and additional issues related to different modes of dialysis. In most of the cases, chest radiograph coupled with ultrasound and computed tomography (CT) are sufficient to offer a definitive diagnosis. This review aims to summarize the imaging features of thoracic manifestations of chronic kidney disease (CKD) with emphasis on imaging-based discriminating features.

Kidney Replacement Therapy in Cardiorenal Syndromes.

Cardiorenal syndromes (CRS) have increasingly been recognized as distinct disorders that affect the heart and kidneys simultaneously, either with acute or chronic onset. The different types share common pathophysiological characteristics. The concept “cardiorenal” shall emphasize the inter- or even multidisciplinary approach to respective patients. Anticongestive therapy becomes mandatory in many subjects that suffer from CRS. In recent years, the role of dialysis treatment in a broader sense has been investigated in CRS in more detail. We performed a search for studies related to the topic in the following databases: MEDLINE, PROSPERO, and Web of Science. The following keywords were used for reference identification: “CRS”, “cardiorenal syndrome”, “dialysis”, “hemodialysis”, “hemofiltration”, “renal replacement therapy”, “kidney replacement therapy”, “peritoneal dialysis”, and “aquapheresis”. Finally, a total number of 22 studies, partly performed as retrospective cohort studies, and partly designed as prospective investigations, were included. The selected studies evaluated different modes of peritoneal dialysis (PD) or of non-PD procedures including intermittent hemodialysis, continuous procedures, and so-called aquapheresis. Inclusion and outcome parameters were almost not comparable between selected trials. Some studies revealed dialysis as effective, with reasonable tolerability. Particularly so-called “pure” ultrafiltration (e.g., aquapheresis) was associated with higher rates of adverse events. Future studies should be designed in a more homogenous manner, particularly concerning the inclusion criteria, the respective dialysis procedure applied, and endpoints in the short- and long-term.

Impact of pre-transplant dialysis modality on kidney transplant outcomes: a systematic review and meta-analysis.

For end-stage renal disease (ESRD), patients receiving kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD) are both appropriate modes of pre-transplant dialysis. The aim of this review is to assess the impact of pre-transplant PD compared to HD on kidney transplant outcomes in ESRD patients. A comprehensive search in digital databases, like PubMed, SCOPUS and EMBASE and a manual search were conducted to identify cohort studies comparing the kidney transplant outcomes of both pre-transplant dialysis modalities. The data were subjected to both qualitative and quantitative analysis. A meta-analysis was carried out to calculate the effect estimate for patient survival, graft survival and delayed graft function, death-censored graft survival, acute rejection-free graft survival, graft vessel thrombosis, urological complications, surgical complications, any infections, and onset of diabetes after transplantation. The qualities of the included studies were judged by the New-castle Ottawa scale. The overall patient survival is shown to be better with patients who underwent pre-transplant PD compared to HD with OR 1.34 95% CI [1.11, 1.61], p = 0.002. Delayed graft function was found to be highly associated with HD compared to PD with OR 0.60 [0.52, 0.70], p<0.0001 with moderate heterogeneity (i2 = 48%). However, no difference was observed in terms of graft survival, complications, infections, and new onset of diabetes mellitus compared to patients undergoing pre-transplant HD. Within the limitations of the review, it can be concluded that ESRD patients undergoing pre-transplant PD were found to have better patient survival and lower incidence of delayed graft function.

COVID-19-related acute kidney injury and dialysis: What are the outcomes in South Africa?

Introduction: Acute kidney injury (AKI) in hospitalized patients infected with COVID-19 is associated with an elevated mortality rate compared to non-infected patients (39% versus 24%). This is despite a lower prevalence of AKI in COVID-19-infected patients (17 vs 22%). The reasons are multifactorial and have been well documented in developed countries, whereas in developing countries there are scant data. Methods: This study aimed to document the mortality in COVID-19-infected South African patients who required dialysis for AKI. Exclusion criteria included any chronic kidney replacement therapy (transplantation or dialysis). A REDCap survey of South African nephrologists and nephrology fellows registered with the South African Nephrology Society was conducted. The primary outcome was all-cause in-hospital mortality, while additional points of interest included comorbidities, dialysis modality and intervention required. Univariate analysis of mortality predictors was performed. Results: The COVID-19-related AKI mortality rate was 58.9%. Significant predictors included continuous veno-venous haemodialysis therapy, invasive ventilation, use of inotropes and the presence of shock. Ischaemic heart disease, heart failure and admission to a private healthcare facility were associated with lower mortality. No significant associations were found with ethnicity, sex, hypertension, diabetes, HIV infection or the use of other modes of dialysis. Conclusions: In South African patients, we report similar outcomes in critically ill patients requiring dialysis for AKI, relative to international data. The predictors of mortality most likely reflect the severity of the illness in our patients. The data suggest that continuous veno-venous haemodiafiltration or slow low efficiency dialysis may be the preferred dialysis modalities in these patients.

In-House Production of Dialysis Solutions to Overcome Challenges During the Coronavirus Disease 2019 Pandemic

In-House Production of Dialysis Solutions to Overcome Challenges During the Coronavirus Disease 2019 Pandemic

Survey on available treatment for acute kidney injury in the Southern African Development Community and Nigeria: are we ready for zero deaths by 2025 in sub-Saharan Africa?

ObjectivesThe International Society of Nephrology (ISN) has called for zero deaths by 2025. This survey aimed to determine the preparedness of Southern African Development Community (SADC) countries and Nigeria to...

Organ Transplantation in Argentina.

Organ Transplantation in Argentina.

Albumin Apheresis for Artificial Liver Support: In Vitro Testing of a Novel Filter.

Currently there is no direct therapy for liver failure. We have previously described selective plasma exchange therapy using a hemofilter permeable to substances that have a molecular mass of up to 100 kDa. The proof-of-concept studies and a Phase I study in patients with decompensated cirrhosis demonstrated that hemofiltration using an albumin-leaking membrane is safe and effective in removing target molecules, alleviating severe encephalopathy and improving blood chemistry. In this study a novel large-pore filter for similar clinical application is described. The performance of the filter was studied in vitro; it was found to effectively remove a wide spectrum of pathogenic factors implicated in the pathophysiology of hepatic failure, including protein bound toxins and defective forms of circulating albumin. Data on mass transport characteristics and functionality using various modes of filtration and dialysis provide rationale for clinical evaluation of the filter for artificial liver support using albumin apheresis.

Structural and functional differences in gut microbiome composition in patients undergoing haemodialysis or peritoneal dialysis

Complications of end-stage renal disease (ESRD) are critically related to inflammation. The gut microbiome is a key driver of inflammation. Since dialysis modalities may differently influence the gut microbiome, we aimed to compare the effects of haemodialysis (HD) and peritoneal dialysis (PD) on patients’ gut microbiome composition and function. We therefore studied faecal microbiome composition and function as well as inflammation and gut permeability in 30 patients with ESRD (15 HD, 15 PD) and compared to 21 healthy controls. We found an increase in potentially pathogenic species and a decrease in beneficial species in patients on HD and to a lesser extend in patients on PD when compared to controls. These changes in taxonomic composition also resulted in differences in predicted metagenome functions of the faecal microbiome. In HD but not in PD, changes in microbiome composition were associated with an increase in c-reactive protein (CRP) but not with intestinal inflammation or gut permeability. In conclusion microbiome composition in ESRD differs from healthy controls but also between modes of dialysis. These differences are associated with systemic inflammation and cannot completely be explained by dialysis vintage. The mode of renal replacement therapy seems to be an important driver of dysbiosis in ESRD.

A multi-center study of different modes of peritoneal dialysis on sleep and quality of life

Objective To investigate the continuous ambulatory peritoneal dialysis (CAPD) and daytime ambulatory peritoneal dialysis (DAPD) on sleep and quality of life. Methods In this is a multi-center cross-sectional survey, we used the Pittsburgh Sleep Index Scale (PSQI) and the Chinese version of peritoneal dialysis patient quality of life scale, the unified investigating time, the organized trained peritoneal dialysis nurses qualified to conduct research full-time. Survey content includes general information, sleep and quality of life, laboratory tests, dialysis adequacy and other indicators, and the results were pooled analysis. Results A total of 325 hospitalized peritoneal dialysis patients were included in the study, including 177 patients in CAPD, 148 patients in DAPD. The total scores of QOL, physical function, physical factors, psychological status, social function and life satisfaction were (72.61±10.94), (19.44±3.65), (59.69±7.31), (32.65±5.65), (24.82±6.03), (15.42±5.47)and (74.06±13.59), (20.16±2.95), (58.99±5.86), (34.58±6.17), (25.10±5.01), (15.36±4.28). The score of CAPD in the mental state dimension was significantly lower than that in DAPD patients (t=-3.715, P 0.05). Conclusions Sleep and quality of life in peritoneal dialysis patients are lower than normal adults. Dialysis modes have an impact on sleep and quality of life of patients, health care workers should fully assess the physical and mental state of the patients in order to select the appropriate mode of dialysis. Key words: Peritoneal dialysis; Quality of life; Multicenter study

Therapeutic Guidelines: Antibiotic. Version 15.

Therapeutic Guidelines: Antibiotic is a concise and convenient guide and useful in both clinic and inpatient settings. The new version has many helpful features that make it a must-have. The guidelines begin with brief chapters on appropriate prescribing, optimising therapy, and commonly prescribed classes of antibiotics. The book provides guidance on prophylaxis for surgical, medical, obstetric and immunocompromised patients. The presence of highlighted important information and comprehensive tables makes information easy to find and process. The footnotes are useful and include drug precautions, interactions and further reading. Chapters are allocated by system, making it easy to locate pathology of interest and differential diagnoses. The guidelines give an up-to-date and useful outline of indications for antibiotic use, pathogens, investigations and non-antibiotic therapy. The occasional management flow diagrams also help to show key management steps. Special populations such as aged-care residents, immunocompromised patients and children are covered. There are chapters on malaria, tuberculosis, typhoid, schistosomiasis and other less commonly seen conditions in Australia. Perhaps having a chapter dedicated to infections in the returned traveller would make this information easier to locate. The final chapters on outpatient parenteral antimicrobial therapy, aminoglycoside use and monitoring, and antibiotic desensitisation protocols are probably more useful to infectious disease specialists than to GPs. The concise reference tables with the Therapeutic Goods Administration categorisation in pregnancy and compatibility with breastfeeding are handy. The section on renal impairment gives a guide on dosage adjustment based on the estimated glomerular filtration rate and doses for the different modes of dialysis. In short the book is an up-to-date and easy-to-read guide that has transitioned many a junior medical officer to independent practice. It provides resources for generalist and specialist audiences and is well worth the read.

Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects-an observational study.

BackgroundRegional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy for CRRT was feasible and had not negatively impacted efficacy, safety, metabolic stability, filter lifetime, and cost-effectiveness compared to well-established systemic heparin.MethodsThis observational, retrospective study was performed on a non-cardiac surgical and trauma intensive care unit (ICU) in a university hospital. All charts of patients receiving one of the CRRT techniques from May 2006 to April 2010 were reviewed. The first 60 consecutive patients receiving CRRT with regional citrate anticoagulation after its implementation in February 2008 (continuous veno-venous haemodialysis, Multifiltrate® with integrated CiCa® system, AV 1000 S® filter, n = 60) were included in the study. The last 50 consecutive patients with systemic heparin anticoagulation therapy (continuous veno-venous haemodiafiltration, PRISMAFLEX®, AN69® filter, n = 50), treated immediately before the introduction of RCA, were used as a historic control group.ResultsBoth treatment modalities were effective in terms of uraemia control. Patients in the citrate group presented with significantly higher pH levels, lower ionized calcium levels, and higher sodium levels compared with the heparin treated group, however, without notable adverse clinical events. Interestingly, mean circuit lifetime was significantly longer in the citrate group (48.6 ± 24.2 h vs. 18.8 ± 13.5 h; p < 0.0001). Both treatment modalities were cost-effective.ConclusionsOur results suggest that the implementation of regional citrate anticoagulation was safe and effective. Due to the retrospective design of the study and inherent limitations therein concerning several baseline parameters, i.e. different filters, modes of dialysis, and flow parameters not having been standardized, we were unable to draw a causative effect relationship. Nonetheless, our results warrant further study.

Panorama epidemiológico de la insuficiencia renal crónica en el segundo nivel de atención del Instituto Mexicano del Seguro Social

IntroductionAn institutional register of patients with developing dialysis is currently available. General objectiveThe aim was to identify epidemiological aspects of chronic renal failure (CRF) in the Mexican Institute of Social Security. Material and methodsThis was a retrospective cohort that included the data obtained from the 35 delegations that constitute the second level of medical attention for the month of December 2013. ResultsThere were 56,430 patients, 0.1% of the user population; 32,190 male (57%) and 24,240 females (43%), with an average age of 62 years (range, 18-90). The primary causes of CRF were diabetes, 29,661 (52.6%); high blood pressure, 19,862 (35.2%); and chronic glomerulopathy, 4,089 (7.2%). Of the total, 33,754 (60%) patients received peritoneal dialysis (PD) and 22,676 (40%), haemodialysis (HD). The highest prevalence was seen in Jalisco, the state of México Oriente and the southern Federal District, while the lowest was found in Campeche, southern Baja California and Zacatecas. General incidence was 124 cases per thousand users; the delegations with the highest incidence were Tlaxcala, Morelos and Hidalgo, while those of the lowest were Zacatecas, Sinaloa and the northern Federal District. The most frequent PD complications were peritonitis, fluid overload and mechanical catheter complications; the most frequent in HD were fluid retention, lack of hypertension control and hyperkalemia. Definitive exit in the 2 modes of dialysis were myocardial infarction, sepsis, heart failure and acid-base balance disorders. ConclusionsThese results constitute a referential framework and can provide the guidelines to initiate specific pathways of prevention, treatment and research. These will, in turn, make it possible to improve the quality of life of the patient undergoing dialysis and to optimise institutional resources.

Nocturnal intermittent hemodialysis.

Preemptive renal transplantation is the method of choice for end stage renal disease in childhood and adolescence. However, without preemptive transplantation, waiting time for kidney transplantation might exceed several years. The poor quality of life and the extremely high morbidity and mortality rates of dialysis patients have led to the development of intensified hemodialysis programs in which the modes of dialysis (short daily, nocturnal intermittent or daily nocturnal) are different. Such programs have been shown to significantly improve several uremia-associated parameters, such as blood pressure, phosphate control, anemia and growth retardation, in both adult and pediatric (children and adolescents) patients and lead to a reduction in medications, including phosphate binders, erythropoietin and antihypertensive agents. Fluid limitations and dietary restrictions can also be lifted. With respect to psychosocial rehabilitation and quality of life, nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs. Experiences and practical approaches of our own in-center nocturnal intermittent hemodialysis program in the light of the recent publications are described in this review.

Determinants of Fibroblast Growth Factor-23 and Parathyroid Hormone Variability in Dialysis Patients

Background/Aims: Treatment strategies for abnormal mineral metabolism in chronic kidney disease are largely based on achieving target ranges of biomarkers that vary considerably over time, yet determinants of their variability are poorly defined. Methods: Observational study including 162 patients of three dialysis cohorts (peritoneal dialysis, n = 78; hemodialysis, n = 49; hemodiafiltration, n = 35). Clinical and biochemical determinants of parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) variability were analyzed in the peritoneal dialysis cohort. All cohorts were used for comparison of PTH and FGF23 intra-subject variability (intra-class correlation), and their intra-subject variability in different modes of dialysis was explored. Results: High PTH variability was independently associated with lower 25-hydroxyvitamin D concentration and factors of lipid and glucose metabolism, whereas high FGF23 variability was mainly associated with lower baseline serum phosphorous. These results were consistent in multivariate and sensitivity analyses. The intra-subject variability of FGF23 was lower than for PTH irrespective of dialysis mode. Conclusions: Baseline vitamin D status and serum phosphorous are independent determinants of the longitudinal variation in PTH and FGF23, respectively. The clinical utility of FGF23 measurement remains unknown, yet it appears favorable based on its greater temporal stability than PTH in dialysis patients.

Aberrant Function and Differentiation of Monocytes in End Stage Renal Disease

Patients with end stage renal disease (ESRD) suffer from many disturbances of the immune system. These immunopathologies are related to the higher failure of vaccination, and increased prevalence of infections and neoplasms. In the presented article, we review the current data regarding the role of monocytes in immune dysfunctions which are observed in terminal renal failure. As monocytes play a pivotal role in regulating the function of the immune system, their dysfunction can have a profound effect on the immune system and may lead to accelerated arteriosclerosis and deteriorating overall health conditions. More specifically, we suggest that peripheral blood monocytes in patients with ESRD are chronically activated, and their functional and phenotypical features resemble those of inflammatory macrophages. This state of chronic inflammation is unfavorable for dendritic cells and consequently, the prevalence of dendritic cells is reduced. As these effects are consistent across different modes of dialysis, they are probably mediated by the uremia itself.

Home dialysis first: a new paradigm for new ESRD patients

Patients with end-stage renal disease (ESRD) were treated with either in-center hemodialysis (ICH) or one of the modes of home-based dialysis (HBD)-- peritoneal dialysis (PD) or home hemodialysis (HHD). Home-based dialysis modes showed better outcomes than ICH (PD for the first 2-3 years and HHD for the long-term). Home PD has become more attractive with overnight cyclers for PD and the use of home helpers. Home dialysis (PD or HHD) offers a high quality of life and a high degree of independence and is financially attractive. This review will propose a paradigm shift in the initial form of dialysis offered to new patients with ESRD: instead of selecting between in-center dialysis and PD, patients after they are advised of the advantages of dialysis at home (either PD or HHD) should be offered a choice between dialysis at home (PD or HHD) or in hospital. We will review the advantages of home-based dialysis and the arguments for this simple but vital change in the process by which new patients requiring dialysis choose their treatment option.

The outcomes of continuous ambulatory and automated peritoneal dialysis are similar

Recent reports indicate a decreased mortality risk for patients on chronic peritoneal dialysis in the United States. We sought to determine whether a higher use of automated versus continuous ambulatory peritoneal dialysis was associated with this improvement. Analyses were carried out using data from the United States Renal Data System on 66,381 incident patients on chronic peritoneal dialysis in the years 1996-2004 that were adjusted for demographic, clinical, laboratory and dialysis facility characteristics. Patients were followed until the time of transfer to other modes of dialysis, transplant, or death, whichever occurred first, or until their last follow-up through September 2006. Over time, the risks were substantially reduced such that the adjusted hazard ratios for death or technique failure of these patients in the 2002-2004 period were 0.55 (0.53, 0.57) and 0.62 (0.59, 0.64), respectively, compared with those of incident patients during the years 1996-1998. The risk improvements for both modes of dialysis were, however, found to be similar. Under intent-to-treat, time-dependent, and as-treated analysis, there was little or no difference in risk for death or in technique failure. Thus, the improved chronic peritoneal dialysis outcomes cannot be attributed to a greater use of automated peritoneal dialysis.

Contrasting clinical outcomes between different modes of peritoneal dialysis regimens: Two center experiences in China

In the present study, we compared the clinical outcomes between two different modes of peritoneal dialysis (PD) and explored the possible role of volume overload in continuous ambulatory peritoneal dialysis (CAPD) patients. A longitudinal and a cross-sectional study were included. Patients received either an 'adaptative ultrafiltration (UF)' PD regimen, which focused on gradually increasing peritoneal ultrafiltration (PDi group), or traditional PD treatment (PDt group). Patients' demographic characteristics, nutritional status, fluid removal as well as fluid status were recorded. In the cross-sectional study, all clinically stable patients who were treated with CAPD for at least three months were enrolled and grouped according to their time on dialysis: short term, medium term, and long term. Both studies showed that PDi and PDt patients had distinct fluid removal patterns. PDt patients had decreased total fluid removal with worsening fluid status and deteriorating nutritional status, whereas PDi patients remained rather stable in relation to fluid removal, fluid status, and improving nutritional status. Cox regression analysis confirmed that the PDi group had better patient survival than the PDt group. Our data suggest that traditional and 'adaptative UF' PD therapy may have distinct fluid removal patterns over time on dialysis, and this unique pattern might partly explain the still unacceptable high mortality of long-term CAPD patients.