Seminars in Dialysis最新文献

Extracorporeal therapies could be required for treatment of life-threatening severe acute intoxication. We present the case of an 82-year-old patient admitted to our Nephrology Unit because of metformin-associated lactic acidosis (MALA) and acute kidney injury (AKI stage III AKIN criteria). The patient also presented severe intoxication of digoxin and apixaban. The electrocardiogram presented a junctional escape rhythm with atrial fibrillation (AF) and lateral ST-segment depression that, despite fab-fragments' administration, has not regress. Due to patient's hemodynamic instability, an 8 h of sustained low-efficiency diafiltration (SLED) was prescribed. This treatment allowed to reduce serum concentration of apixaban and digoxin. Similarly, patient's hemodynamic and ECG trace improved with the resolution of junctional rhythm and persistence of AF. Even if continuous renal replacement therapy (CRRT) is the first choice in critical ill patients, SLED could represent a valid option for patients without indication to ICU.

Introduction: Distal forearm arteriovenous fistulas (AVFs) for hemodialysis (HD) include radiocephalic fistulas (RCFs) and ulnar-basilic fistulas (UBFs). However, due to the unique anatomical peculiarities of the latter approach, UBFs are only established in a limited subset of patients undergoing vascular access procedures. This study aimed to present a retrospective case series detailing the creation of UBFs, emphasizing both the technical challenges and clinical outcomes associated with this approach.

Methods: We conducted a retrospective review of UBFs created between 2008 and 2023. Data collected included patient demographics, comorbidities, patency, functionality, and outcomes. Adequate blood flow and personalized Kt/Vurea levels were prerequisites for defining UBF functionality for HD.

Results: Among 253 patients receiving HD, 82.2% had an AVF, with only 3.3% (n = 5) of the 150 distal AVFs functional for HD being UBFs. In this series, a total of 11 UBF fistulas were created, with nine patients experiencing an immediate thrill. Among those with UBF failure, three patients were aged > 85 years, and three had concurrent diabetes mellitus, peripheral vascular disease, and ischemic heart disease. The survival rate in the UBF group correlated with the duration of dialysis in the three patients for whom the UBF was the sole AVF, with one patient achieving a remarkably prolonged period of > 10 years. No incidences of ischemia, hand edema, or ulnar nerve lesions were noted.

Conclusion: While the difficulties experienced in achieving functional UBFs for HD are highlighted in this long-term perspective, its safety and durability make it a viable option in managing an increasingly comorbid patient population.

Background: Cuff extrusion of tunneled dialysis catheter (TDC) leads to catheter dysfunction, leading to loss of vascular access and the need for new catheter. Definitive management is to remove TDC and reinsert new catheter by new venous puncture and tunnel, which may not be possible in all cases. The study evaluated the surgical experience and early outcomes of a novel "Catheter Exchange with Elongation of Tunnel (CEET)" procedure for cuff extrusion.

Methods: The retrospective study included all cases of hemodialysis with TDC with partial or complete cuff extrusion and excluded complete catheter dislodgement, tunnel infection, or any catheter related infection. All patients also underwent the CEET procedure under fluoroscopy guidance, and the clinical details and outcomes were analyzed.

Results: Eleven cases of TDC cuff extrusion underwent the CEET procedure of which three (27.2%) had previous and four (36.4%) had partial cuff extrusion, and seven cases (63.6%) had short tunnel length, which likely predisposed to cuff extrusion. CEET procedure was successful in 10 cases (success rate 90.1%) with desired position of catheter tip and good blood flow. Study population was divided into early and late cuff extrusion (≥1 month). Short tunnel length was associated with late extrusion (p = 0.05), whereas premature removal of TDC anchor sutures was associated with early cuff extrusion (p = 0.04).

Conclusion: CEET procedure is a successful alternative technique for correction of cuff extrusion of TDC with good success rate. Premature removal of anchor sutures was associated with early cuff extrusion, whereas short tunnel length was associated with late cuff extrusion.

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.

We report the successful application of single pass albumin dialysis (SPAD) and hemoadsorption (HA) in two teenagers with amlodipine poisoning. A 16-year-old girl with amlodipine overdose developed refractory shock and lactic acidosis despite multiple inotropes, calcium, insulin, and glucagon infusion. SPAD was initiated 18 h after the incident for 21 h. She improved dramatically and was able to wean off all inotropes 54 h after admission. Another 16-year-old girl required extracorporeal membrane oxygenation (ECMO) support after deliberate consumption of 1100-mg amlodipine. SPAD was initiated 13 h after the incident for 38 h, followed by two more sessions of HA using the Cytosorb column. All inotropes were stopped 18 h after terminating the HA, and ECMO was weaned off 28 h later. There were no major complications during the therapy. Our cases demonstrated that early extracorporeal removal can be considered as an adjunctive therapy in children with life-threatening amlodipine overdose.

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.

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.