Seminars in Dialysis最新文献

Here we describe six kinetic modeling programs that allow quantification of removal of urea, creatinine, phosphate, and beta-2-microglobulin. They can be used with asymmetric dialysis treatment schedules ranging from one to seven times per week. Once downloaded, the programs can be run locally from a personal computer without requiring connection to the internet. They have been designed to analyze solute removal in a single patient or in thousands of patients. Each program is contained in a single JavaScript-HTML text file, and all of the assumptions and equations used are easily accessible in uncompressed text format and are accompanied by comments and annotations. Inputs are in the form of comma-delimited files which can be imported from spreadsheets. Outputs appear in the form of web pages or as comma-delimited files that can be exported into spreadsheets for graphing and further analysis. This perspective focuses on describing the potential utility of these programs (two pertaining to urea, two to creatinine, one to phosphate, and one to beta-2-microglobulin) as well as two helper calculators, one that computes dialyzer mass transfer area coefficient for urea (K0A) from dialyzer specification chart urea clearance data, and another that can be used to calculate the phosphate binder equivalent dose.

Background: Anemia is a common occurrence in people with chronic kidney disease and end-stage kidney disease. Intravenous administration of iron is standard treatment for people undergoing maintenance hemodialysis. However, until the recent PIVOTAL randomized control trial, there was uncertainty around clinically effective regimens. This study found that among incident, people receiving hemodialysis in the first year, a proactive high-dose intravenous iron regimen was superior to reactive low-dose regimen, leading to reduced mortality and cardiac events. Our study investigated whether the research and guidelines have been successfully implemented into clinical care across the United Kingdom, identified barriers experienced, and explored our local hemodialysis population's awareness of the treatment they are receiving.

Methods: We conducted a cross-sectional survey using a convenient sample of UK-based kidney physicians working in the NHS and local people receiving hemodialysis. Two preconceived, standardized questionnaires were designed.

Results: Forty physicians responded. Of these, 40% had implemented a proactive iron protocol, whereas 37.5% had not. Respondents acknowledged concerns about doses of iron and the need for local protocols. Thirty-seven patients responded to the patient questionnaire within our own hemodialysis unit. Fifty-one percent of patients reported to be receiving iron supplementation, of which 84% stated it was intravenous through their dialysis machine.

Conclusions: We have not observed a paradigm shift in clinical practice and identified poor patient understanding of their treatment. Strategies to overcome barriers are necessary to introduce treatments that offer both clinical advantages and cost savings. Eliminating futile practice is challenging due to departmental prioritization and economic considerations. Traditionally, efforts to improve care are targeted towards newer therapies; however, there is an opportunity to improve implementation of current evidence.

Background: The long-term efficacy and safety of desidustat in real world are unknown. We conducted a retrospective real-world experience of desidustat in 100 consecutive patients on hemodialysis.

Materials and methods: The first 100 consecutive stable patients on hemodialysis who were prescribed desidustat between May and December 2022, without history of infection, surgery, chronic hepatitis, or HIV infection, 1 month prior to initiation, were eligible for analysis from electronic records. Those who were lost to follow up, underwent transplantation, or discontinued medicine within 6 months were excluded. We looked at mean dose; efficacy at 1, 6, and 12 months; side effects; and adherence of desidustat over a period of 12 months.

Results: Out of 100, 59 patients completed 1 year of the drug and were analyzed. There was statistically significant increase in hemoglobin from baseline to 1 month (9 ± 1.2 vs. 9.4 ± 1.3 g/dL, p = 0.01) and from baseline to 12 months (9 ± 1.2 vs. 9.9 ± 1.5 g/dL, p = 0.02). The percentage of patients who achieved target hemoglobin of 10-12 g/dL was 17% at baseline, which increased to 19.1% at 1 month, 43% at 6 months, and 38.9% at 12 months. Side effects were noted in 20% of patients, with edema being the most common (6%) and infections in 5% of cases. Nonadherence was observed in 15% patients.

Conclusion: Desidustat is effective and safe in management of anemia in hemodialysis patients over a period of 1 year. It helps in achieving target hemoglobin in majority of patients within 6 months.

Background: The optimal time for the salvaging of thrombosed hemodialysis grafts is controversial. This study was aimed at determining the optimal time related to the outcome of percutaneous pharmacomechanical thrombolysis (PMT) for the treatment of thrombosed arteriovenous graft (AVG).

Methods: This was a retrospective study of 191 hemodialysis patients who underwent PMT for thrombosed AVG from April 2014 to December 2021. Demographic data and details of the procedure were recorded. The procedural success rate related to the onset time of PMT was analyzed. The postinterventional circuit primary assisted patency rate was presented by the Kaplan-Meier curve.

Results: A total of 191 hemodialysis patients, 101 females and 90 males, were enrolled. Their median age was 66 years (interquartile range of 58-75 years). The majority type of thrombosed AVG was brachiocephalic loop graft (60.2%). The procedural success rate of PMT that was performed ≤ 48 h was 86.2%. There was a statistically significant procedural success rate of PMT in the group with an onset of treatment ≤ 48 h compared to > 48 h (odds ratio = 2.77; 95% confidence interval = 1.06, 7.28; p = 0.037). The median postintervention circuit primary assisted patency in the group of treatment ≤ 48 and > 48 h was 7.3 and 3.9 months (p = 0.023), respectively.

Conclusion: From this study, the optimal time of PMT for treatment of thrombosed AVG should be within 48 h after onset of thrombosis for enhancing procedural success and patency rates.

Acquired reactive proliferating collagen (ARPC), usually associated with systemic diseases, is a rare skin disease characterized by the elimination of altered dermal collagen through the epidermis. Here, we report two cases of ARPC in maintenance hemodialysis patients, one of which is combined with type 2 diabetes, chronic renal failure, and hypertension and the other is combined with chronic renal failure and hypothyroidism. Two patients were treated with oral thalidomide and ebastine, local application of fluticasone propionate cream, and enhanced dialysis. After treatment, the itching and the rash significantly improved. We report for the first time that ARPC in patients with hemodialysis could be improved by oral thalidomide and antihistamines and local application of steroid. This report provides reference for guiding the understanding of ARPC and the new treatment of ARPC in hemodialysis patients.

Introduction: Mobile applications (apps) and social media could be useful in improving the condition of patients on hemodialysis. Despite the rise of mobile health apps in hemodialysis management, no research has evaluated the quality of these apps with reliable tools. This study aimed to evaluate the quality of apps designed for the self-care of patients on hemodialysis.

Materials and methods: A review of Google Play and App Store mobile platforms was carried out to evaluate the mobile apps used for hemodialysis. These apps were assessed using the mobile application rating scale (MARS), which includes criteria for overall quality, engagement, functionality, aesthetics, and information. Search keywords included "Dialysis," "Kidney Dialysis," "Hemodialysis," "Haemodialysis," and "Peritoneal Dialysis." Eligibility criteria included being related to dialysis, being designed specifically for patients, being free, being available in English, and being developed for Android and iOS platforms. The included apps were independently evaluated and rated by two reviewers using MARS.

Results: Initially, 177 apps were identified, and after the screening and review processes, six apps were selected for qualitative evaluation. The overall scores on MARS varied from 2.33 to 3.67. The "KidneyPal: Kidney Disease Mgmt" app received the highest scores in most MARS items. Moreover, the maximum app quality mean score belonged to "KidneyPal: Kidney Disease Mgmt" (4.26 out of 5).

Conclusion: The findings showed a limited number of apps available for hemodialysis, the majority of which were of low quality. The reviewed apps performed well in functionality but obtained lower scores in terms of app subjective quality. Future studies should focus on developing and testing mobile apps using assessment tools, such as MARS, as well as evaluating their impact on health behaviors and outcomes.

A number of systems of feedback control during dialysis have been developed, which have the shared characteristic of prospectively measuring physiological parameters and then automatically altering dialysis parameters in real time according to a pre-specified dialysis prescription. These include feedback systems aimed at reducing intradialytic hypotension based on relative blood volume monitoring linked to adjustments in ultrafiltration and dialysate conductivity, and blood temperature monitoring linked to alterations in dialysate temperature. Feedback systems also exist that manipulate sodium balance during dialysis by assessing and adjusting dialysate conductivity. In this review article, we discuss the rationale for automated feedback systems during dialysis, describe how the different feedback systems work, and provide a review of the current evidence on their clinical effectiveness.

Introduction: The purity of water and dialysis fluids is of utmost importance in ensuring the safe and effective administration of hemodialysis treatment to patients with chronic kidney disease. It is crucial to enforce compliance with international standards for dialysis water and fluids, as this is mandatory in reducing chemical hazards, mitigating the adverse effects of bioincompatibility resulting from contaminated water and ultimately enhancing long-term patient outcomes.

Standards and risks: Within this comprehensive review, we highlight the presence of water contaminants and thoroughly assess the existing international standards for dialysis water and fluids, spanning from pure to ultrapure. Additionally, we delve into the fundamental components of water purification and present a comprehensive range of water treatment options, encompassing pre-treatment, primary treatment (reverse osmosis), and tertiary water treatment. Furthermore, we outline recommended monitoring and maintenance procedures, ensuring the consistent delivery of high-quality water and dialysis fluids at the point of care. WATER PURIFICATION AND MONITORING SUSTAINABILITY AND FUTURE CHALLENGES: Importantly, we raise concerns regarding the sustainability and conservation of water resources in hemodialysis treatment. It is imperative that these concerns be addressed in the future to avert the potential shortage of this essential resource.

Conclusion: In conclusion, the contemporary landscape of hemodialysis conditions has engendered an urgent necessity for advanced water treatment systems and optimized delivery of dialysis fluids. This review serves as a comprehensive update on the latest technological advancements aimed at meeting these critical demands. Dialysis water and fluids must adhere to increasingly stringent purity constraints, encompassing both biochemical and microbiological perspectives.