Amount Of Ultrafiltration Research Articles

Phloretin Improves Ultrafiltration and Reduces Glucose Absorption during Peritoneal Dialysis in Rats.

Harmful glucose exposure and absorption remain major limitations of peritoneal dialysis (PD). We previously showed that inhibition of sodium glucose cotransporter 2 did not affect glucose transport during PD in rats. However, more recently, we found that phlorizin, a dual blocker of sodium glucose cotransporters 1 and 2, reduces glucose diffusion in PD. Therefore, either inhibiting sodium glucose cotransporter 1 or blocking facilitative glucose channels by phlorizin metabolite phloretin would reduce glucose transport in PD. We tested a selective blocker of sodium glucose cotransporter 1, mizagliflozin, as well as phloretin, a nonselective blocker of facilitative glucose channels, in an anesthetized Sprague-Dawley rat model of PD. Intraperitoneal phloretin treatment reduced glucose absorption by >30% and resulted in a >50% higher ultrafiltration rate compared with control animals. Sodium removal and sodium clearances were similarly improved, whereas the amount of ultrafiltration per millimole of sodium removed did not differ. Mizagliflozin did not influence glucose transport or osmotic water transport. Taken together, our results and previous results indicate that blockers of facilitative glucose channels may be a promising target for reducing glucose absorption and improving ultrafiltration efficiency in PD.

Fluid balance assessment in pediatric hemodialysis patients by using whole-body bioimpedance spectroscopy (WB-BIS).

Fluid overload is a major factor in morbidity and mortality in dialysis patients. Whole-body bioimpedance spectroscopy (WB-BIS) is a noninvasive method for assessing fluid status. We hypothesized that fluid status measurement of changes in total body water (TBW), extracellular fluid (ECF), and intracellular fluid (ICF) by WB-BIS would correlate with the weight (Wt) changes before and after hemodialysis (HD) and the amount of ultrafiltration (UF) in pediatric HD patients. We also examined the relationship between the ECF percent of total body water (ECF%) and ECF/ICF ratio with the pre-HD systolic blood pressure percentile (SBP%ile). WB-BIS measurements were made both before and after HD on three separate occasions in each patient. Pre- and post-HD Wt, BP, and UF volumes were collected on the day of BIS measurement. At total of 96 measurements were obtained from 16 HD patients. There were 6 females (mean age: 13.2 ± 4.5 yrs). UF correlated with changes in weight, TBW and ECF (p < 0.001) but not with ICF changes (p = 0.345). Pre-HD SBP%ile correlated with ECF%. Our findings suggest that WB-BIS can be used to monitor the fluid status in pediatric HD patients. The fluid that is removed from the patient during the HD treatment primarily comes from the ECF and not the ICF. Mobilization of fluid from the ICF appears to be delayed. Patients with significantly higher pre-HD ECF% and ECF/ICF ratio had higher pre-HD systolic BP. A higher resolution version of the Graphical abstract is available as Supplementary information.

Pengaruh Besarnya Ultrafiltrasi terhadap Perubahan Tekanan Darah pada Pasien PGK di Unit Hemodialisa RSUD Kabupaten Tangerang

The magnitude of ultrafiltration is the process of transferring dissolved substances and water due to hydrostatic differences in blood and dialysate which are carried out from the patient's body weight. The purpose of this research is of the amount of ultrafiltration on changes in blood pressure in clients with chronic kidney disease at Tangerang Regional Hospital. Methods: This study used a quasi-experimental design with a one group study, the population of all patients in the hemodialysis room, a sample of 150 people. Results: The study showed that the amount of ultrfiltration both experienced changes in normal BP was 17 respondents (50.1%), respondents with a moderate amount of ultrafiltration were experiencing a change in low BP, the most were 2 respondents (66.6%) and the number of respondents, the amount of ultrafiltration, was multiplying changes in high BP, around 42 respondents. (37.2%). Chi Square test obtained an Asymp.Sig. (2-sided) value of 0.035 &lt;0.05, there is an influence between the amount of ultrafiltration on changes in blood pressure in CKD patients at the HD Unit of the Tangerang District Hospital 2020. Conclusion to improve hemodialysis services with restrictions and Monitoring the amount of ultrafiltration can minimize the risk of a drop in blood pressure that can endanger the patient's life.

MO731ASSOCIATION BETWEEN SKELETAL MUSCLE MASS AND INTRADIALYTIC HYPOTENSION IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Patients undergoing hemodialysis showed higher prevalence of sarcopenia than that of the healthy. As an intracellular water reservoir, skeletal muscle mass would be important to predict intradialytic hypotension. This study was designed to reveal the effect of skeletal muscle mass to intradialytic hypotension, which is also an indicator of volume status in patients under hemodialysis. Method 150 patients from three hemodialysis centers in 2016 and 38 patients from one center under maintenance hemodialysis in 2020 were enrolled in this study, and total 177 patients were finally analyzed. We measured skeletal muscle mass, intracellular water, extracellular water, total body water and phase angle in 50 kHz by bio-impedance analysis just after a hemodialysis session. Information including laboratory tests, chest x-ray, handgrip strength, mid-arm circumference and questionnaire to ask the patients’ general condition was collected. Intradialytic hypotension over three months was observed. We analyzed several factors including skeletal muscle mass which would have association with intradialytic hypotension over three months by multivariate logistic regression model. Results Tertile subgroups divided by the ratio of skeletal muscle to body weight defined as skeletal muscle index were compared. Patients in low skeletal muscle index had a higher rate of intradialytic hypotension (41%) while that of intermediate group was 20% and high group was 5%. Patients in low skeletal muscle mass index group was female-dominant, more obese, more diabetic and had lower handgrip strength than higher skeletal muscle index group. In patients who had higher skeletal muscle mass to body weight, the risk of Intradialytic hypotension was decreased (HR: 0.80 [95% CI 0.75-0.88], adjusted HR: 0.73 [95% CI 0.64–0.84]). Comparing tertile groups by skeletal muscle index, patients in the group of higher skeletal muscle mass index showed lower rate of intradialytic hypotension during hemodialysis, which was similar in inverse probability of treatment weighted analysis. Confounders were age, gender, diabetes mellitus, heart failure, ischemic heart disease, the ratio of ultrafiltration amount to body weight and skeletal muscle index. Model including skeletal muscle index and clinical parameters showed highest AUC area (0.877 [95% 0.823-0.930]) when the model including clinical parameters only (AUC area: 0.807 [95% CI 0.735-0.879]) or with each bioimpedance index (skeletal muscle mass to squared height, AUC area: 0.843 [95% CI 0.823-0.931]; the ratio of extracellular water to total water, AUC area: 0.809 [95% CI 0.736-0.883]; the ratio of intracellular water to total water, AUC area: 0.811 [95% CI 0.738-0.885] and phase angle, AUC area: 0.812 [95% CI 0.738-0.886]). Conclusion This study showed correlation between skeletal muscle mass by body weight and intradialytic hypotension. It especially suggested that skeletal muscle mass to weight would be a good predictor of intradialytic hypotension and would be helpful to decide appropriate dry body weight in hemodialysis.

Comparison of Remote Controlled Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis During COVID-19 Pandemic

Objectives: We aimed to show the possible effect of the peritoneal dialysis (PD) modality on the mood and clinical outcomes of the patients during the first official quarantine period applied to control the Coronavirus disease-2019 (COVID-19) in Turkey. Materials and Methods: With the start of quarantine, in our center, we started doing the patient visits by phone. At the end of the quarantine, the patients were asked to complete a questionnaire in order to reveal whether they felt safe or alone, their anxiety status, and their preferred method of communicating with the team. In addition, volume status, biochemical parameters, blood pressure and medications in December 2019 were reviewed and compared with those in June 2020. Results: A total of 60 patients, 32 of whom were female, with a mean age of 53.4±16 years were included in the study. While there were 24 (40%) patients who underwent remote controlled outpatient peritoneal dialysis (RK-APD), there were 36 (60%) patients who underwent continuous APD (CAPD). According to the survey results, 15 (25%) patients did not experience any anxiety, while 45 patients stated that they had varying degrees of anxiety. 85% of the patients reported that they were very pleased that they could continue their dialysis treatment at home. While 69.4% of the patients who underwent CAPD were worried that they could not be followed as closely during the quarantine, 70.8% of the patients who underwent RK-APD stated that they felt safe because their treatment was monitored by the team through the system. While there was only an increase in the daily amount of ultrafiltration in RK-APD patients (December 2019 and June 2020;1,365 vs 1,514 mL, p=0.026), no difference was observed in CAPD patients. CAPD patients tended to communicate with nurses more frequently. While these interviews were done frequently via WhatsApp messages in CAPD patients (20, 37% vs 5, 18.5%;p=0.008), they were in the form of audio phone calls (22, 81%) in APD patients. Conclusion: In conclusion, during the COVID-19 outbreak, maintaining dialysis with PD treatment at home, regardless of the modality, is a safe and effective method and has positive effects on patient satisfaction.

Mechanical activation of TRPV4 channels controls albumin reabsorption by proximal tubule cells.

Defects in protein reabsorption by the proximal tubule are toxic for epithelial cells in the nephron and may result in nephropathy. In this study, we showed that the ion channel TRPV4 modulated the endocytosis of albumin and low-molecular weight proteins in the proximal tubule. TRPV4 was found at the basolateral side of proximal tubule cells, and its mechanical activation by cell stretching induced Ca2+ entry into the cytosol, which promoted endocytosis. Trpv4-/- mice presented with mild proximal tubule dysfunction under basal conditions. To challenge endocytic function, the permeability of the glomerular filter was altered by systemic delivery of angiotensin II. The proteinuria induced by this treatment was more severe in Trpv4-/- than in Trpv4+/+ mice. Injecting antibodies against the glomerular basement membrane to induce glomerulonephritis is a more pathophysiologically relevant method of impairing glomerular filter permeability. Albuminuria was more severe in mice that lacked TRPV4 specifically in the proximal tubule than in control mice. These results emphasize the importance of TRPV4 in sensing pressure in the proximal tubule in response to variations in the amount of ultrafiltrate and unveil a mechanism that controls protein reabsorption.

SUN-081 USE OF HANDHELD ULTRASOUND TO ESTIMATE FLUID STATUS OF HEMODIALYSIS PATIENTS

Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration. Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001). Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done.

Automated Remote Monitoring for Peritoneal Dialysis and Its Impact on Blood Pressure

Introduction: Peritoneal dialysis (PD) provides a safe, home-based continuous renal replacement therapy for patients. The adherence of the patients to the prescribed dialysis fluids cannot always be monitored by physicians. Remote monitoring automated peritoneal dialysis (RM-APD) can affect patients’ compliance with treatment and, thus, clinical outcomes. Objective: We aimed to evaluate the clinical outcomes of patients with a remote access program. Methods: This was an observational study. We analyzed the effect of RM-APD on treatment adherence, dialysis adequacy, and change in blood pressure control, sleep quality, and health-related quality of life during the 6 months of follow-up. Results: A total of 15 patients were enrolled in this study. It was found that there was a significant decrease (99 ± 19 vs. 89 ± 11 mm Hg) in mean arterial blood pressure of patients, and a considerable increase in Kt/V was observed in the sixth month after the RM-APD switch (2.11 ± 0.4 vs. 2.25 ± 0.5). A significant increase was found when comparing the 3-month and 6-month ultrafiltration amounts before RM-APD and the ultrafiltration amount within 6 months after RM-APD (800 mL [500–1,000] and 752 mL [490–986] vs. 824 mL [537–1,183]). The daily antihypertensive pill need (4 [0–7] vs. 2 [0–6]) and alarms received from the device decreased (from 4 [3–8] to 2 [0–3]) at the sixth month of the switch. There was no significant change in sleep quality and health-related quality of life within 6 months. Conclusion: This study showed that treatment adherence and ultrafiltration amounts of patients increased with the use of RM-APD, as well as better blood pressure control with fewer antihypertensive drugs.

Deep Learning for Intradialytic Hypotension Prediction in Hemodialysis Patients

Intradialytic hypotension is a common problem during hemodialysis treatment. Despite several clinical variables have been authenticated for associations during dialysis session, the interaction effects between variables has not yet been presented. Our study aimed to investigate clinical factors associated with intradialytic hypotension by deep learning. A total of 279 participants with 780 hemodialysis sessions on an outpatient in a hospital-facilitated hemodialysis center were enrolled in March 2018. Associations between clinical factors and intradialytic hypotension were determined using linear regression method and deep neural network. A full-adjusted model indicated that intradialytic hypotension is positively associated with body mass index (Beta = 0.17, p = 0.028), hypertension comorbidity (Beta = 0.17, p = 0.008), and ultrafiltration amount (Beta = 0.31, p <; 0.001), and is inversely associated with the ultrafiltration rate in a hemodialysis session (Beta = -0.30, p = 0.001). The 4-factor locus obtained by the deep neural network reached the maximum performance metrics evaluation (accuracy = 64.97± 0.94; true positive rate = 87.97 ± 2.73; positive predictive value = 66.74 ± 0.98; Matthews correlation coefficient = 0.19 ± 0.03). The prediction model obtained by the deep learning scheme could be a potential tool for the management of intradialytic hypotension.

Efficacy of APD in perioperative period of non-abdominal operation for peritoneal dialysis patients.

Objectives: Whether automated peritoneal dialysis (APD) is a feasible strategy in perioperative period of uremic patients undergoing nonabdominal surgery remains unclear. This study was conducted to research the perioperative management and the best choice of dialysis modalities for peritoneal dialysis patients.Materials and methods: A retrospective analysis was made on the clinical data of 58 ESRD patients who had received peritoneal dialysis for more than three months were treated with APD during perioperative period from July 2015 to March 2018 in the Second Affiliated Hospital of Soochow University. The differences of clinical parameters, such as urine volume, ultrafiltration volume, hemoglobin, renal function and electrolytes were collected and analyzed before and after APD.Results: The vital signs of 58 patients were stable after APD treatment, and there were no significant differences in 24-hour urine volume, hemoglobin and electrolytes (calcium, phosphorus, potassium, sodium) before and after surgery (P>0.05). Compared with those before treatment, the amount of ultrafiltration increased significantly (P<0.05), creatinine, urea nitrogen and parathyroid hormone decreased significantly (P<0.05), while albumin decreased (P<0.05).Conclusion: Application of APD for peritoneal dialysis patients undergoing nonabdominal surgery during the perioperative period is safe and effective.

Remote Patient Management in Peritoneal Dialysis: Impact on Clinician's Practice and Behavior.

Peritoneal dialysis (PD) is a self-administered chronic renal replacement therapy. It is a home-based therapy, and thus subject to the risk of discrepancy between prescribed dose and effective dialysis delivery. Till now automated peritoneal dialysis (APD) cyclers have recorded the dialysis treatments on a card that patients bring to the hospital for consultation in the PD unit. This card contains the operative parameters of each APD session. Recently, Baxter Healthcare developed a cloud-based tool for remote patient and treatment management. The new platform named Sharesource® embedded into the cycler HOMECHOICE CLARIA® allows to overcome the problems related to poor compliance and feeling of uncertainty by the patient, reducing the number of hospital visits and the workload for physician and nurses of the PD Unit. This new system uploads all treatment information to a secure cloud-based software. The 2-way communication platform gives remote visibility to patient's treatment and allows for feedback and correction of inadequate treatment program. Remote patient management (RPM) allows to visualize the course of home PD day after day, evaluating adherence to prescription, possible alarms during treatment, drainage times, and ultrafiltration amount. The evaluation of all the data can be done by the physician at his desk in the Hospital in front of the computer. RPM allows a patient's dialytic management in real time and enables the nephrologist to remotely modify treatment operative parameters, leaving the patient at home saving kilometers, money and time. In this chapter, we describe a simple algorithm used in our unit to define alarm thresholds and to describe actions to be instituted to correct any possible problem occurring during APD.

Use of Handheld Ultrasound to Estimate Fluid Status of Hemodialysis Patients

Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results: Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p&lt;0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p&lt;0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p&lt;0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p&lt;0.001).Conclusions: Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done.

Using manual exchanges for an urgent-start peritoneal dialysis program.

ABSTRACTBackgroundUrgent-start peritoneal dialysis (USPD) was designed to avoid temporary hemodialysis initiation with a hemodialysis catheter. In these patients, PD is initiated within 2 weeks of catheter placement, but typically these prescriptions utilize automated peritoneal dialysis (APD) with a cycler. Manual exchanges have not been reported previously for USPD. We hypothesize that using multiple, low-volume manual exchanges, patients will have similar rates of peritonitis, exit-site infection (ESI), pericatheter leaks and discontinuation of PD in the first 3 months after initiation.MethodsThis retrospective study included patients who initiated PD in our unit from May 2014 until August 2016 using our USPD protocol. Patients with a body surface area <1.7 m2 used 750 mL dwell volumes and those >1.7 m2 used 1000 mL dwell volumes during the first 7 days. Dwell times were 2–2.5 h for two to three exchanges per day. After 7 days of successful therapy, the dwell volumes were doubled. All patients were maintained on furosemide 160 mg twice daily.ResultsThere were 20 patients enrolled in our USPD program. Our rates of peritonitis, ESI, pericatheter leak and discontinuation of PD were 5%, 0%, 5% and 5%, respectively.ConclusionsManual exchange during USPD is a viable modality with similar results as APD. Using manual exchanges allows patients to be more ambulatory during the day when they are not dwelling, allows nurses to evaluate the amount of ultrafiltration and effluent characteristics and allows for training in manual exchanges as well.

PS 08-41] EFFECT OF BLOOD PRESSURE AND DIALYSIS PARAMETERS BY DIALYSATE SODIUM CONCENTRATION ON SODIUM GRADIENT IN HEMODIALYSIS PATIENTS

Objective: In chronic hemodialysis (HD) patients, sodium (Na+) balance largely depends on interdialytic dietary salt intake and intradialytic Na+ removal. To preserve a neutral Na+ balance, interdialytic Na+ gain should be removed during HD. We investigate to determine the ranges of the sodium gradient (SG) between the dialysate sodium concentration (DNa) and serum sodium concentration (SNa) in hemodialysis (HD) patients and to examine the relationships between HD parameters over a one year period. Design and Method: Fifty-five clinically stable HD patients, who had been on HD >2 years were enrolled. Monthly HD ultrafiltration (UF) amount, systolic blood pressure (SBP), frequency of intradialytic hypotension (IDH) and laboratory data were collected and 12-month means were subjected to analysis. The SG was calculated by subtracting SNa from prescribed DNa. Results: The mean number of anti-hypertensive drugs being taken was 1.6 ± 1.2. In the 55 patients, SNa values ranged from 130 to 142 mEq/L and the mean CV of SNa was 1.5 ± 0.5%. Mean SG values were 1.5 ± 3.3 mEq/L (range -5.6∼9.1). Significant positive correlations were observed between DNa and SG. In addition, significant positive correlations were noted between mean UF amounts. On the other hand, no relationship was observed between SG was positively related to DNa and the frequency of IDH. A higher SG was associated with larger UF amounts and SBP reduction during HD. The percentages of patients with a SG > 3 mEq/L increased as DNa increased. On the other hand, SG was not found to be associated with SNa or pre-HD SBP. Conclusions: DNa appears to cause a significant increase in SG, and this seems to be related to HD parameters, such as, UF amount and IDH. Numbers of anti-hypertensive drugs tended to be less in patients with a SG of > 3 mEq/L, which might have been due in part to the adjustment of DNa according to BP status.

The effects of intermittent fasting during the month of Ramadan in chronic haemodialysis patients in a tropical climate country.

BackgroundChronic kidney disease is an emerging problem in the majority Muslim countries. Despite the uncertainties of the risks involved, some Muslim patients undergoing chronic haemodialysis choose to observe intermittent fasting during the month of Ramadan. This study aims to investigate the effect of Ramadan fasting in haemodialysis patients residing in a tropical climate country.MethodsThis prospective cross sectional study recruited Muslim patients on regular haemodialysis from three haemodialysis centres in Kuala Lumpur from 15th July 2011 to 29th August 2011. Patients who fasted for any number of days were included (n = 35, 54% female, age 54±11 years). 89% of patients fasted for more than 15 days and 49% were diabetics. Dialysis parameters and blood samples were obtained one week prior to Ramadan and during the last week of Ramadan. The differences in dialysis parameters and biochemical values pre- and end-Ramadan were examined using paired t-test.ResultsBoth pre- and post-dialysis weight were significantly decreased during Ramadan fasting compared to the month prior (p = <0.001). There was a significant decrease in the amount of ultrafiltration (p = 0.002). There were no significant differences in dry weight, inter-dialytic weight gain, mean urea reduction ratio or blood pressure measurements comparing pre- and end of Ramadan fasting. There was a significant increase in serum albumin level (p = 0.006) and decrease in serum phosphate level (p = 0.02) at the end of Ramadan.ConclusionRamadan fasting is associated with reduced weight, improved serum albumin and phosphate level in our population of haemodialysis patients. A larger multi-centre study will allow us to understand more about the effects of fasting in this population.

Objective analysis of voice changes in a hemodialysis session and its correlation with ultrafiltration

Introduction: The aim of the study is to analyze the voice changes occurring during a hemodialysis session objectively and to investigate the statistical correlation between voice changes and ultrafiltration, blood pressure, dry weight and the other variables of the patients. Materials and methods: A total of 169 patients were included in the study. Electronic voice recordings of the patients were performed with the aim of making objective voice analysis before and after dialysis. Fundamental frequency measurements occurring at the level of the larynx (Fo) and harmonic-to-noise ratio (HNR) were measured from these voice recordings. Results: When the voice recordings obtained from 169 hemodialysis patients before and after dialysis were investigated, it was observed that a significant increase occurred in the Fo (from 164.52 ± 43.36 Hz to 193.19 ± 47.08 Hz, p < 0.01). When the change in HNR was investigated, a significant reduction was determined in the post-dialysis measurements (4.6 ± 3.23 dB) compared to the pre-dialysis measurements (16.10 ± 4.06 dB, p < 0.01). Mean 2.49 ± 0.83 L of ultrafiltration was performed and a significant reduction was observed in post-session body weights of the patients (p < 0.01). There was a highly statistical significance between the measurements of post-dialysis Fo and post-dialysis body weights. A highly significant correlation was determined between the amount of ultrafiltration performed and a significant increase observed in Fo before and after dialysis. Also a significant correlation was determined between the reduction in the mean post-session blood pressures and the reduction in the HNRs. Conclusion: Objective voice analysis is suggesting that it can be a simple and applicable method that can be used to determine the dry weight.

Effect of dialysate sodium concentration on sodium gradient and hemodialysis parameters.

This retrospective study was performed to determine the ranges of the sodium gradient (SG) between the dialysate sodium concentration (DNa) and serum sodium concentration (SNa) in hemodialysis (HD) patients and to examine the relationships between HD parameters over a 1 year period. Fifty-five clinically stable HD patients, who had been on HD >2 years were enrolled. Monthly HD [ultrafiltration (UF) amount, systolic blood pressure (SBP), frequency of intradialytic hypotension (IDH)] and laboratory data were collected and 12-month means were subjected to analysis. The SG was calculated by subtracting SNa from prescribed DNa. Mean SG values were 1.5±3.3 (range -5.6~9.1). SG was positively related to DNa and the frequency of IDH. A higher SG was associated with larger UF amounts and SBP reduction during HD. The percentages of patients with a SG ≥3mEq/L increased as DNa increased. On the other hand, SG was not found to be associated with SNa or pre-HD SBP. DNa appears to cause a significant increase in SG, and this seems to be related to HD parameters, such as, UF amount and IDH.

Hemodialysis: Core Curriculum 2014

From the Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN. Received May 1, 2013. Accepted in revised form July 1, 2013. Originally published online November 21, 2013. Address correspondence to Thomas A. Golper, MD, S3303 Medical Center North, Vanderbilt University Medical Center, 21st Ave S, Nashville, TN 37232. E-mail: thomas.golper@vanderbilt. edu 2013 by the National Kidney Foundation, Inc. 0272-6386/$36.00 http://dx.doi.org/10.1053/j.ajkd.2013.07.028 PRINCIPLES OF DIALYSIS AND HOW MODALITIES DIFFER

Clinical outcomes and mortality in peritoneal dialysis patients: A 10-year retrospective analysis in a single center

To evaluate the clinical outcome, identify predictors of patient and technique survival in our peritoneal dialysis (PD) patients in the western region of Turkey. We included all patients who initiated therapy between 2001 and 2010. Socio-demographic characteristics such as who helped to administer the PD as well as conditions under which PD was chosen by patients were investigated from patients' files. Hemodialysis (HD) history and duration, additional systemic diseases, and end-stage renal disease etiologies of all patients were recorded. Clinical data such as blood pressure, amount of ultrafiltration, and laboratory parameters were evaluated before initiation of PD and during the last monitoring period. Infectious complications and their incidences were investigated. Patient and technique survival were investigated for every patient. 322 patients started PD treatment during the study period. 23 patients were excluded. Data from the remaining 299 patients (167 female, mean follow-up time 38.5 ± 26.8 months, mean age 44.7 ± 15.9 years) were evaluated retrospectively. It was determined that 87.3% of the patients made their PD exchanges without help from anyone. 79.9% of patients chose PD as their personal preference. 48 patients had HD history before PD. Peritonitis incidences and catheter exit site/tunnel infection attacks were 27 ± 23 and 32.3 ± 24.9 patient-months, respectively. During the follow-up period, 199 patients (80 patients transferred to HD, 78 patients died and, 41 patients had transplantation) were withdrawn from PD. The most frequent causes of death were cardiovascular events and peritonitis and/or sepsis, whereas most frequent causes of transfer to HD were peritonitis and/or sepsis. Mean survival time was 49.9 ± 2.6 months. The estimation of survival rate was 85.2%, 66.5% and 45.3% at 1, 3, and 5 years, respectively. Preference for PD (RR: 4.77, p < 0.001), presence of HD history (RR: 2.08, p = 0.04), presence of diabetes mellitus (RR: 2.13, p = 0.01), low pretreatment serum albumin (RR: 0.32, p < 0.001), and low serum parathormone levels at last visit (RR: 0.99, p = 0.04) were predictors of mortality. Mean technique survival duration was 48.5 ± 2.4 months. The estimation of technique survival by Kaplan-Meier analyses was 92%, 67% and 43% at 1, 3, and 5 years, respectively. Technique survival was associated with preference for PD (RR: 0.45, p < 0.001), presence of diabetes mellitus (RR: 1.92, p = 0.003), and pretreatment serum albumin levels (RR: 0.58, p = 0.003). Patient survival in the presented institute is similar to that reported in Western countries. Compulsory choice of PD, presence of HD history, presence of diabetes, low pretreatment serum albuminm, and low serum parathormone levels at last visit were the strongest predictors of death. Risk factors for technique failure were compulsory choice of PD, presence of diabetes, low pretreatment serum albumin.

Time to recovery after a hemodialysis session: impact of selected variables.

BackgroundPatients maintained on hemodialysis (HD) have an impaired health-related quality of life (HRQOL). One factor that has been suggested to contribute to this impairment is the prolonged recovery time after completing a conventional HD session. The present study was designed to carefully examine the time to recovery (TTR) in patients maintained on three times/week conventional HD and evaluate the clinical and demographic features associated with the TTR.MethodsTwo hundred and sixty-seven patients on conventional three times/week HD were studied during three successive HD treatments. Patients were asked how long it took them to recover from their previous session. Detailed demographic and clinical data as well as data involving the most recent HD session were reviewed.ResultsThe mean ± SD age was 66.4 ± 15.7 and the mean duration of renal replacement therapy was 40.1 ± 37.6 months. The mean time to recovery was 246 ± 451 min. A multivariate regression analysis including age, gender, number of comorbidities, months on renal replacement therapy, occurrence of hypotension during dialysis, amount of ultrafiltration and duration of dialysis session revealed that none of these covariates was significantly associated with TTR from HD.ConclusionsThe present study is important since it clarifies that the TTR after an HD session is not related to various demographic and clinical factors that one might have expected would impact on this variable.