Pub Date : 2022-04-08DOI: 10.3390/kidneydial2020019
M. Alexandrou, Marieta P. Theodorakopoulou, P. Sarafidis
Diabetic kidney disease (DKD) represents a major public health issue, currently posing an important burden on healthcare systems. Renin–angiotensin system (RAS) blockers are considered the cornerstone of treatment of albuminuric DKD. However, a high residual risk of progression to more advanced CKD stages under RAS blockade still remains, while relevant studies did not show significant declines in cardiovascular events with these agents in patients with DKD. Among several other pharmacological classes, mineralocorticoid receptor antagonists (MRAs) have received increasing interest, due to a growing body of high-quality evidence showing that spironolactone and eplerenone can significantly lower blood pressure and albuminuria in patients with CKD. Furthermore, finerenone, a novel nonsteroidal MRA with unique physicochemical properties, was shown to effectively reduce cardiovascular events and death, as well as the incidence of end-stage kidney disease in patients with type 2 diabetes. This review discusses previous and recent clinical evidence on the issue of nephroprotection and cardioprotection in DKD offered by mineralocorticoid receptor antagonism, aiming to aid clinicians in their treatment decisions for diabetic patients.
{"title":"Role of Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease","authors":"M. Alexandrou, Marieta P. Theodorakopoulou, P. Sarafidis","doi":"10.3390/kidneydial2020019","DOIUrl":"https://doi.org/10.3390/kidneydial2020019","url":null,"abstract":"Diabetic kidney disease (DKD) represents a major public health issue, currently posing an important burden on healthcare systems. Renin–angiotensin system (RAS) blockers are considered the cornerstone of treatment of albuminuric DKD. However, a high residual risk of progression to more advanced CKD stages under RAS blockade still remains, while relevant studies did not show significant declines in cardiovascular events with these agents in patients with DKD. Among several other pharmacological classes, mineralocorticoid receptor antagonists (MRAs) have received increasing interest, due to a growing body of high-quality evidence showing that spironolactone and eplerenone can significantly lower blood pressure and albuminuria in patients with CKD. Furthermore, finerenone, a novel nonsteroidal MRA with unique physicochemical properties, was shown to effectively reduce cardiovascular events and death, as well as the incidence of end-stage kidney disease in patients with type 2 diabetes. This review discusses previous and recent clinical evidence on the issue of nephroprotection and cardioprotection in DKD offered by mineralocorticoid receptor antagonism, aiming to aid clinicians in their treatment decisions for diabetic patients.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47992997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-06DOI: 10.3390/kidneydial2020018
R. Vanholder
Dialysis is life-saving for an exponentially growing number of kidney failure patients. Yet, the current concept also has several drawbacks, such as high societal cost, incomplete kidney function replacement, dismal outcomes, low quality of life and a considerable ecologic footprint. In spite of many changes over the last fifty years, the original concept remained largely unmodified and the drawbacks did not disappear. In this article, we present a number of alternative solutions that are currently considered or tested which might have a potential impact on uremic toxin concentration, quality of life or environmental footprint that goes beyond what is currently achieved with traditional dialysis. These comprise applications of regenerative medicine; bioartificial kidney; conceptual changes in extracorporeal removal; energy-neutral, water-limiting dialysis; material recycling; keto-analogues; xenobiotics; and preservation of residual kidney function. As metabolism generating uremic toxins also generates beneficial compounds, some of these options may also maintain or restore this balance in contrast to dialysis that likely removes without distinction. All proposed options are also exemplary of how out-of-the-box thinking is needed to disrupt the status quo in treatment of kidney diseases that has now persisted for too long.
{"title":"Future Directions for Dialysis","authors":"R. Vanholder","doi":"10.3390/kidneydial2020018","DOIUrl":"https://doi.org/10.3390/kidneydial2020018","url":null,"abstract":"Dialysis is life-saving for an exponentially growing number of kidney failure patients. Yet, the current concept also has several drawbacks, such as high societal cost, incomplete kidney function replacement, dismal outcomes, low quality of life and a considerable ecologic footprint. In spite of many changes over the last fifty years, the original concept remained largely unmodified and the drawbacks did not disappear. In this article, we present a number of alternative solutions that are currently considered or tested which might have a potential impact on uremic toxin concentration, quality of life or environmental footprint that goes beyond what is currently achieved with traditional dialysis. These comprise applications of regenerative medicine; bioartificial kidney; conceptual changes in extracorporeal removal; energy-neutral, water-limiting dialysis; material recycling; keto-analogues; xenobiotics; and preservation of residual kidney function. As metabolism generating uremic toxins also generates beneficial compounds, some of these options may also maintain or restore this balance in contrast to dialysis that likely removes without distinction. All proposed options are also exemplary of how out-of-the-box thinking is needed to disrupt the status quo in treatment of kidney diseases that has now persisted for too long.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41341127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-02DOI: 10.3390/kidneydial2020017
G. Tsangalis, Valérie Loizon
Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound systems by clinicians at a patient’s bedside for diagnostic and therapeutic purposes. It is not a substitute but rather a complement to clinical examination, and contrary to the classic ultrasound examination performed by radiologists, POCUS is not a detailed morphologic examination but focuses on answering specific clinical questions in an effort to reduce time to diagnosis and treatment, improve patient safety and decrease complication rates. In this article, we present the POCUS in hemodialysis units for and beyond vascular-access purposes, arguing that its implementation will help the practicing nephrologist who is treating hemodialysis patients on a daily basis to rapidly and efficiently answer several clinical questions that are common to dialysis patients, such as vascular-access assessment and cannulation, and assessment of volume status. POCUS aims to answer specific clinical questions, so a question-answer format is used. This review is divided in two parts. In the first part we will answer specific clinical questions exclusively concerning vascular access. The second part is dedicated to the use of POCUS for the assessment of volume status and dry-weight determination.
{"title":"Point-of-Care Ultrasound (POCUS) for Dialysis Patients: A Step Forward","authors":"G. Tsangalis, Valérie Loizon","doi":"10.3390/kidneydial2020017","DOIUrl":"https://doi.org/10.3390/kidneydial2020017","url":null,"abstract":"Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound systems by clinicians at a patient’s bedside for diagnostic and therapeutic purposes. It is not a substitute but rather a complement to clinical examination, and contrary to the classic ultrasound examination performed by radiologists, POCUS is not a detailed morphologic examination but focuses on answering specific clinical questions in an effort to reduce time to diagnosis and treatment, improve patient safety and decrease complication rates. In this article, we present the POCUS in hemodialysis units for and beyond vascular-access purposes, arguing that its implementation will help the practicing nephrologist who is treating hemodialysis patients on a daily basis to rapidly and efficiently answer several clinical questions that are common to dialysis patients, such as vascular-access assessment and cannulation, and assessment of volume status. POCUS aims to answer specific clinical questions, so a question-answer format is used. This review is divided in two parts. In the first part we will answer specific clinical questions exclusively concerning vascular access. The second part is dedicated to the use of POCUS for the assessment of volume status and dry-weight determination.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41689412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.3390/kidneydial2020016
R. Pecoits-Filho
The current interpretation of the controversial and dynamic nature of the literature reports in this area leads me to lean towards the preference of a standard DNa+ in the upper range (138 mEq/L) of the current international utilization and preference of clinical directors in Brazil. My opinion to individualize (plus and minus 2 mmol/L of DNa+ prescription) would be based on clinically relevant signals of excessive interdialytic weight gain and uncontrolled hypertension (to decrease DNa+ concentration), or intradialytic hypotension episodes (to increase DNa+ concentration). In my experience, the individualization, based on this approach, would be applicable to a minority (less than 15%) of patients. As new data from randomized clinical trials emerge (particularly the robust RESOLVE trial), I would certainly need (and would be happy) to revise my point of view on this issue.
{"title":"Ideal Sodium Dialysate Concentration: A Brazilian Perspective","authors":"R. Pecoits-Filho","doi":"10.3390/kidneydial2020016","DOIUrl":"https://doi.org/10.3390/kidneydial2020016","url":null,"abstract":"The current interpretation of the controversial and dynamic nature of the literature reports in this area leads me to lean towards the preference of a standard DNa+ in the upper range (138 mEq/L) of the current international utilization and preference of clinical directors in Brazil. My opinion to individualize (plus and minus 2 mmol/L of DNa+ prescription) would be based on clinically relevant signals of excessive interdialytic weight gain and uncontrolled hypertension (to decrease DNa+ concentration), or intradialytic hypotension episodes (to increase DNa+ concentration). In my experience, the individualization, based on this approach, would be applicable to a minority (less than 15%) of patients. As new data from randomized clinical trials emerge (particularly the robust RESOLVE trial), I would certainly need (and would be happy) to revise my point of view on this issue.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41905278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-29DOI: 10.3390/kidneydial2020015
A. Simopoulos
Human beings evolved on a diet that was balanced in omega-6/omega-3 fatty acids, and was rich in fruits and vegetables with a ratio of animal to vegetable intake of 35:65. Such a diet is a base-producing anti-inflammatory diet and one in which our genes have been programmed to respond. Current Western diets are acid-producing diets and are also high in omega-6 fatty acids, leading to a proinflammatory state. From an evolutionary perspective a mild systemic metabolic alkalosis, resulting from chronic net-base loading, is the natural and optimal systemic acid–base homeostasis of humans. Western diets that lead to a metabolic acidosis increase susceptibility to kidney disease as has been shown from the proinflammatory biomarkers that produce a cytokine storm. Healthy dietary patterns, including the Dietary Approach to Stop Hypertension (DASH) Study, and Mediterranean diets, such as the diet of Crete, both of which have a healthy dietary pattern, are associated with a lower incidence of chronic kidney disease and may prevent or decrease albuminuria and improve the estimated glomerular filtration rate (eGFR).
{"title":"Dietary Changes and Their Influence in the Development of Kidney Disease","authors":"A. Simopoulos","doi":"10.3390/kidneydial2020015","DOIUrl":"https://doi.org/10.3390/kidneydial2020015","url":null,"abstract":"Human beings evolved on a diet that was balanced in omega-6/omega-3 fatty acids, and was rich in fruits and vegetables with a ratio of animal to vegetable intake of 35:65. Such a diet is a base-producing anti-inflammatory diet and one in which our genes have been programmed to respond. Current Western diets are acid-producing diets and are also high in omega-6 fatty acids, leading to a proinflammatory state. From an evolutionary perspective a mild systemic metabolic alkalosis, resulting from chronic net-base loading, is the natural and optimal systemic acid–base homeostasis of humans. Western diets that lead to a metabolic acidosis increase susceptibility to kidney disease as has been shown from the proinflammatory biomarkers that produce a cytokine storm. Healthy dietary patterns, including the Dietary Approach to Stop Hypertension (DASH) Study, and Mediterranean diets, such as the diet of Crete, both of which have a healthy dietary pattern, are associated with a lower incidence of chronic kidney disease and may prevent or decrease albuminuria and improve the estimated glomerular filtration rate (eGFR).","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47620653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-21DOI: 10.3390/kidneydial2010014
Salumu Mohamedi, I. Mosha
Maintenance hemodialysis services continue to rise globally. We evaluated adherence to hemodialysis therapy and contributing factors among end-stage renal disease patients at Muhimbili National Hospital, Dar es Salaam, Tanzania. A cross-sectional study was done involving 265 end-stage renal disease patients who were being treated at Muhimbili National Hospital, in Dar es Salaam. The study population selected included adult patients (18 years and above) with end-stage renal disease (ESRD) who were on hemodialysis. Data were entered into SPSS and imported into STATA for analysis. Numeric variables were summarized using the mean and standard deviation, and categorical variables were summarized using frequencies and proportions. A log-binomial regression model was used to estimate the risk factors associated with non-adherence, while multivariable log-binomial regression was used to control for confounders and test for the effect modifiers. All tests were two-tailed and the significance level was set at 5%. The parameters used to assess non-adherence to hemodialysis therapy in this study were the skipping of one or more hemodialysis sessions within the most recent 1 month or shortening one or more hemodialysis sessions by 10 or more minutes within the most recent 1 month. A session missed due to hospitalization or other medical reasons was not considered as non-adherence. All 265 patients were included in the analysis, of whom 191 (72.1%) were males. The rate of full adherence to the hemodialysis sessions was 64.2%. However, factors associated with the adherence to hemodialysis were the source of funding for hemodialysis (RR = 0.70, 95% CI: 0.48, 0.96), the occupation of the respondents (RR = 1.59, 95% CI: 1.44, 1.94), marital status (RR = 1.97, 95% CI: 1.03, 3.77), and monthly income (RR = 0.92, 95% CI: 0.62, 1.51). Adherence to hemodialysis therapy among ESRD patients at Muhimbili National Hospital was high and within the range of most published studies. Hemodialysis attendance among participants depended on the source of funding, marital status, occupation, and monthly income. Patients should be informed by the health care workers on the importance of adhering to hemodialysis sessions. Further studies should be done to explore the factors influencing adherence to hemodialysis, as it was noted that adherence was low among some patients.
{"title":"Hemodialysis Therapy Adherence and Contributing Factors among End-Stage Renal Disease Patients at Muhimbili National Hospital, Dar es Salaam, Tanzania","authors":"Salumu Mohamedi, I. Mosha","doi":"10.3390/kidneydial2010014","DOIUrl":"https://doi.org/10.3390/kidneydial2010014","url":null,"abstract":"Maintenance hemodialysis services continue to rise globally. We evaluated adherence to hemodialysis therapy and contributing factors among end-stage renal disease patients at Muhimbili National Hospital, Dar es Salaam, Tanzania. A cross-sectional study was done involving 265 end-stage renal disease patients who were being treated at Muhimbili National Hospital, in Dar es Salaam. The study population selected included adult patients (18 years and above) with end-stage renal disease (ESRD) who were on hemodialysis. Data were entered into SPSS and imported into STATA for analysis. Numeric variables were summarized using the mean and standard deviation, and categorical variables were summarized using frequencies and proportions. A log-binomial regression model was used to estimate the risk factors associated with non-adherence, while multivariable log-binomial regression was used to control for confounders and test for the effect modifiers. All tests were two-tailed and the significance level was set at 5%. The parameters used to assess non-adherence to hemodialysis therapy in this study were the skipping of one or more hemodialysis sessions within the most recent 1 month or shortening one or more hemodialysis sessions by 10 or more minutes within the most recent 1 month. A session missed due to hospitalization or other medical reasons was not considered as non-adherence. All 265 patients were included in the analysis, of whom 191 (72.1%) were males. The rate of full adherence to the hemodialysis sessions was 64.2%. However, factors associated with the adherence to hemodialysis were the source of funding for hemodialysis (RR = 0.70, 95% CI: 0.48, 0.96), the occupation of the respondents (RR = 1.59, 95% CI: 1.44, 1.94), marital status (RR = 1.97, 95% CI: 1.03, 3.77), and monthly income (RR = 0.92, 95% CI: 0.62, 1.51). Adherence to hemodialysis therapy among ESRD patients at Muhimbili National Hospital was high and within the range of most published studies. Hemodialysis attendance among participants depended on the source of funding, marital status, occupation, and monthly income. Patients should be informed by the health care workers on the importance of adhering to hemodialysis sessions. Further studies should be done to explore the factors influencing adherence to hemodialysis, as it was noted that adherence was low among some patients.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46859864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01Epub Date: 2022-03-04DOI: 10.3390/kidneydial2010013
Cortney Steele, Kristen Nowak
Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an increased risk for rapid kidney disease progression. Autosomal dominant polycystic kidney disease causes growth and proliferation of kidney cysts resulting in a reduction in kidney function in the majority of adults. An accumulation of adipose tissue may further exacerbate the metabolic defects that have been associated with ADPKD by affecting various cell signaling pathways. Lifestyle interventions inducing weight loss might help delay disease progression by reducing adipose tissue and systematic inflammation. Further research is needed to determine the mechanistic influence of adipose tissue on disease progression.
{"title":"Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease.","authors":"Cortney Steele, Kristen Nowak","doi":"10.3390/kidneydial2010013","DOIUrl":"10.3390/kidneydial2010013","url":null,"abstract":"<p><p>Obesity remains a growing public health concern in industrialized countries around the world. The prevalence of obesity has also continued to rise in those with chronic kidney disease. Epidemiological data suggests those with overweight and obesity, measured by body mass index, have an increased risk for rapid kidney disease progression. Autosomal dominant polycystic kidney disease causes growth and proliferation of kidney cysts resulting in a reduction in kidney function in the majority of adults. An accumulation of adipose tissue may further exacerbate the metabolic defects that have been associated with ADPKD by affecting various cell signaling pathways. Lifestyle interventions inducing weight loss might help delay disease progression by reducing adipose tissue and systematic inflammation. Further research is needed to determine the mechanistic influence of adipose tissue on disease progression.</p>","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8959086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47281041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01Epub Date: 2022-03-03DOI: 10.3390/kidneydial2010012
Courtney J Lightfoot, Devika Nair, Paul N Bennett, Alice C Smith, Anthony D Griffin, Madeleine Warren, Thomas J Wilkinson
The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one's own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual's level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease.
{"title":"Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease?","authors":"Courtney J Lightfoot, Devika Nair, Paul N Bennett, Alice C Smith, Anthony D Griffin, Madeleine Warren, Thomas J Wilkinson","doi":"10.3390/kidneydial2010012","DOIUrl":"10.3390/kidneydial2010012","url":null,"abstract":"<p><p>The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one's own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual's level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease.</p>","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10127536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9360322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-24DOI: 10.3390/kidneydial2010011
M. Sever
Acute kidney injury (AKI) is frequent, and shows wide variation with regards to the spectrum, etio-pathogenesis and management strategies after natural (e.g., earthquakes) and man-made disasters (e.g., wars). The most important pathogenetic mechanisms in AKI during earthquakes are crush injury-related hypovolemia and myoglobinuria. Therefore, the most effective preventive measures are early and energetic fluid resuscitation (especially isotonic saline due to medical and logistic advantages) and also avoiding nephrotoxic medications. When preventive measures fail and intrarenal AKI develops, dialysis is lifesaving, with a preference towards intermittent hemodialysis due to medical and logistic advantages during disasters. During wars, the most important man-made disaster, prerenal, intrarenal and postrenal AKI may develop both at the battlefield and also in the field- or tertiary care-hospital setting. Overall, pathogenesis and management strategies of AKI in war victims are similar with those of AKI in general and in natural disasters. Logistic planning after disasters is vital for providing the most effective treatment. If patients cannot be coped with locally, either help should be asked from, or, alternatively, patients should be referred to, other regions or countries. Importantly, nephrology units in and around disaster-prone areas should be prepared for disasters for a sudden influx of AKI victims after disasters.
{"title":"Prevention and Treatment of AKI during Various Disasters","authors":"M. Sever","doi":"10.3390/kidneydial2010011","DOIUrl":"https://doi.org/10.3390/kidneydial2010011","url":null,"abstract":"Acute kidney injury (AKI) is frequent, and shows wide variation with regards to the spectrum, etio-pathogenesis and management strategies after natural (e.g., earthquakes) and man-made disasters (e.g., wars). The most important pathogenetic mechanisms in AKI during earthquakes are crush injury-related hypovolemia and myoglobinuria. Therefore, the most effective preventive measures are early and energetic fluid resuscitation (especially isotonic saline due to medical and logistic advantages) and also avoiding nephrotoxic medications. When preventive measures fail and intrarenal AKI develops, dialysis is lifesaving, with a preference towards intermittent hemodialysis due to medical and logistic advantages during disasters. During wars, the most important man-made disaster, prerenal, intrarenal and postrenal AKI may develop both at the battlefield and also in the field- or tertiary care-hospital setting. Overall, pathogenesis and management strategies of AKI in war victims are similar with those of AKI in general and in natural disasters. Logistic planning after disasters is vital for providing the most effective treatment. If patients cannot be coped with locally, either help should be asked from, or, alternatively, patients should be referred to, other regions or countries. Importantly, nephrology units in and around disaster-prone areas should be prepared for disasters for a sudden influx of AKI victims after disasters.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47897168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-14DOI: 10.3390/kidneydial2010009
P. Kopperschmidt, A. Maierhofer
Of the many treatment parameters in hemodialysis care that could be individualised, the dialysate sodium concentration has been identified as a prime candidate for personalisation. Newer hemodialysis machines are equipped with controllers to manage the diffusive balance of sodium between the patient and dialysate. Tailoring of intradialytic sodium transfer is possible in home hemodialysis, where individualization of therapy is particularly appropriate.
{"title":"Keep the Balance at Home","authors":"P. Kopperschmidt, A. Maierhofer","doi":"10.3390/kidneydial2010009","DOIUrl":"https://doi.org/10.3390/kidneydial2010009","url":null,"abstract":"Of the many treatment parameters in hemodialysis care that could be individualised, the dialysate sodium concentration has been identified as a prime candidate for personalisation. Newer hemodialysis machines are equipped with controllers to manage the diffusive balance of sodium between the patient and dialysate. Tailoring of intradialytic sodium transfer is possible in home hemodialysis, where individualization of therapy is particularly appropriate.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42720739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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