RESUMEN
Cool dialysate has variable impact on hemodynamic stability and dialysis adequacy. Hemodynamic stability and dialysis adequacy are crucial indicators for better life expectancy and cardiovascular mortality. This research aims to evaluate the impact of cool dialysate temperature (35.5°C) compared to standard dialysate temperature (37°C) on blood pressures, pulse rate, and dialysis adequacy (Urea reduction ratio and online Kt/V) in a cross over design. Material and Methods. Consenting ESRD patients on maintenance haemodialysis (HD) with minimum 3 months dialysis vintage and functioning permanent vascular access are included for the study. Each participant had two sessions of HD at 37°C followed by two sessions at 35.5° C on a Fresenius 4008S HD machine. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and Pulse rate are measured pre-HD, every hourly and post dialysis. Pre-HD Blood urea nitrogen (BUN) and post-HD BUN are measured, and Urea reduction rate was calculated for each HD session. Kt/V was calculated by ionic conductance by HD machine for each session. Results. 25 patients (5 females and 20 males) were enrolled. The mean age was 54 ± 9.58 years. Dialysis vintage was 21.48 ± 6.9 months for study participants 10 patients (40%) were diabetic nephropathy, 9 patients (36%) were presumed chronic glomerulonephritis, 2 patients (8%) were lupus nephritis and 4 patients (16%) were chronic interstitial nephritis. There was statistically no difference between pre-HD BUN (p = 0.330), post-HD BUN (p = 0.776), URR (p = 0.718) and Kt/V (p = 0.534) among the dialysis sessions done at 37°C and 35.5°C. SBP variability in the low temperature (35.5°C) group at 4th hour and post dialysis assumed statistical significance with p = 0.05 and p = 0.025 respectively. DBP variability in the low temperature (35.5°C) group at 3rd hour, 4th hour and post-dialysis demonstrated statistical significance with p = 0.027, p = 0.36 and p = 0.016 respectively. Pulse rate variability was more in the low temperature (35.5°C) group at 3rd hour and 4th hour which showed statistical significance with p = 0.037 and p = 0.05 respectively. Conclusion. Cool dialysate is non inferior to standard dialysate temperature in terms of dialysis adequacy and is associated with less variability in diastolic blood pressure, systolic blood pressure and more pulse rate variability thereby contributing to better hemodynamic stability.
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Estudios Cruzados , Hemodinámica , Fallo Renal Crónico , Diálisis Renal , Humanos , Femenino , Masculino , Diálisis Renal/métodos , Persona de Mediana Edad , Fallo Renal Crónico/terapia , Fallo Renal Crónico/fisiopatología , Presión Sanguínea , Soluciones para Diálisis/química , Soluciones para Hemodiálisis/química , Temperatura , Frecuencia Cardíaca , Anciano , Frío , Nitrógeno de la Urea SanguíneaRESUMEN
BACKGROUND: Hemodialysis requires reliable, recurrent access to the circulatory system. Central venous tunneled dialysis catheters (TDC) are frequently used for patients receiving hemodialysis as a bridge to permanent vascular access or as a final option. TDC are prone to complications such as infection and dysfunction. OBJECTIVES: To assess the prevalence and predictors of TDC dysfunction in a cohort of chronic hemodialysis patients. METHODS: This single-center, retrospective study was based on data from an electronic database of chronic hemodialysis patients during 5 years of follow-up. RESULTS: A total of 625 TDC were inserted in 361 patients, of which 234 (37.4%) were replaced due to dysfunction. The main insertion site was the right internal jugular vein. Diabetes mellitus was an important predictor of TDC dysfunction and was significantly correlated with TDC extraction. Chronic anticoagulation and antiplatelet treatment did not affect the rate of TDC dysfunction or replacement. CONCLUSIONS: TDC use for chronic dialysis patients is increasing and dysfunction is a major problem. In our study, we highlighted the high prevalence of TDC dysfunction and the need for further research to improve hemodialysis access as well as TDC patency and function.
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Cateterismo Venoso Central , Catéteres de Permanencia , Diálisis Renal , Humanos , Diálisis Renal/métodos , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Prevalencia , Persona de Mediana Edad , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Catéteres de Permanencia/efectos adversos , Anciano , Venas Yugulares , Catéteres Venosos Centrales/efectos adversos , Falla de Equipo/estadística & datos numéricos , Factores de Riesgo , Fallo Renal Crónico/terapia , Fallo Renal Crónico/epidemiología , Israel/epidemiología , Estudios de SeguimientoRESUMEN
Blood purification is one of the commonly used techniques for the rescue of critically ill patients, which is used for acute and chronic kidney injury caused by various causes and renal replacement therapy (RRT) for a variety of critical diseases. Its main working principle is to drain the human blood into a variety of dialyzers through the artificial tube, exchange substances through a variety of ways, and remove harmful substances and some metabolites from patients' body. Then the purified blood is transfused back to the body, so as to maintain the patient's internal environment relatively stable. At present, there are different models of hemodialysis machines in clinical practice, but they are bulky and unable to move, and the method of heat dissipation is single, which cannot meet the needs of hemodialysis treatment in transport patients. Therefore, the medical staff of the Second Affiliated Hospital of Zunyi Medical University designed and developed a hemodialysis machine, which is suitable for patients who demand hemodialysis treatment during transport, and obtained the National Invention Patent of China (ZL 2020 1 0864737.3). The hemodialysis machine comprises a main body of the hemodialysis machine and a mobile vehicle. The main body of the hemodialysis machine is placed in the bottom of the mobile vehicle, and a protective cylinder with fixed airbags is designed around the main body of the hemodialysis machine. The fixed airbag is connected to the air storage tank through the pipeline, the air storage tank is connected to the Venturi tube through the control valve, and the throat of the Venturi tube is connected to the disinfection tank and cooling water tank. The outlet end of the Venturi tube is connected with the cooling pipe inside the main part of the hemodialysis machine and the sprinkler head placed on the top of the main body. By adding a mobile vehicle and designing an airbag and protective cylinder, the hemodialysis machine can be applied to the hemodialysis treatment during the transportation of patients. By designing the heat dissipation pipe, the main body of the hemodialysis machine can be cooled, the temperature of the hemodialysis machine can be reduced, and the hemodialysis machine can still work when the fan is damaged. By designing the sprinkler head, it is convenient to automatically disinfect the main screen and control keys of the hemodialysis machine, reduce the risk of cross infection of medical staff in the operation, and increase the safety and practicability of the hemodialysis machine. The hemodialysis machine is convenient, safe and efficient, which can be widely used in the hemodialysis treatment during transported patient, and is worthy of clinical promotion.
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Diseño de Equipo , Diálisis Renal , Transporte de Pacientes , Diálisis Renal/instrumentación , Diálisis Renal/métodos , Humanos , Transporte de Pacientes/métodosRESUMEN
Chronic kidney disease has become a significant global health issue, with some individuals progressing to endstage renal disease (ESRD) and requiring renal replacement therapy. For ESRD patients undergoing haemodialysis, the first step is to establish vascular access. In emergency situations, inserting a haemodialysis catheter (HDC) into the central vein is often the most appropriate approach; the right internal jugular vein (IJV) is considered the optimal site for catheterisation. However, catheter placement in the right IJV can sometimes lead to inadvertent entry into an abnormal position. Herein, we present a unique case in which the tip of the HDC was noted to have misplaced into the left IJV due to the patient's multiple central venous stenosis (CVS). This case highlights the clinical manifestation of HDC misplacement, with CVS being the underlying cause. Therefore, healthcare providers should pay adequate attention to CVS.
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Cateterismo Venoso Central , Venas Yugulares , Fallo Renal Crónico , Diálisis Renal , Humanos , Diálisis Renal/métodos , Cateterismo Venoso Central/efectos adversos , Venas Yugulares/diagnóstico por imagen , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Constricción Patológica/etiología , Catéteres Venosos Centrales/efectos adversos , Masculino , Persona de Mediana Edad , Catéteres de Permanencia/efectos adversosRESUMEN
Percutaneous transluminal angioplasty (PTA) is the gold standard for treating stenoses with dysfunctional vascular access. Recently, we found that vascular access blood flow (VABF) measured immediately after PTA increased over time without the need for additional procedures in the patients who underwent PTA. Therefore, this study was conducted to confirm an increase in VABF after PTA and identify the factors associated with it. Patients on chronic hemodialysis at a single institution were retrospectively reviewed and those with accesses that had a measurement of VABF immediately after PTA and within 1 month from PTA were included in the study. The relationship between clinical parameters and changes in VABF were analyzed using paired t-test and linear regression. A total of 47 PTA accesses (fistulas, 26; grafts,21) were included. The mean VABF on the day of PTA and the following measurement were 796.9â ±â 329.1 mL/min and 1105.1â ±â 410.3 mL/min, respectively. In the univariate analysis, the diameter of the balloon catheter used in the PTA and serum uric acid (SUA) level were significantly associated with an increase in VABF. Atrial fibrillation was a significant factor for the percentage change in vascular access. In the multivariate analysis, SUA level, balloon catheter diameter, and atrial fibrillation remained independent factors for changes in VABF and percentage change in VABF, respectively. The study identified progressive increases in the VABF after PTA without additional procedures. SUA level, balloon catheter diameter used in PTA, and atrial fibrillation were independently associated with changes in VABF.
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Diálisis Renal , Humanos , Masculino , Femenino , Diálisis Renal/métodos , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Derivación Arteriovenosa Quirúrgica , Angioplastia de Balón/métodos , Angioplastia/métodos , Flujo Sanguíneo Regional/fisiologíaRESUMEN
AIMS: To determine the effect of virtual reality glasses intervention on pain, vital signs, and patient satisfaction of hemodialysis patients undergoing AVF catheter puncture. DESIGN: Randomized controlled study. METHODS: The study was conducted in 60 patients receiving dialysis treatment in the HD unit of a public hospital in Turkey. The data were collected via the "Patient Identification Form", "Visual Analog Scale/VAS" and "Hemodynamics Variables Inspection Form". The patients in the experiment group watched videos through the virtual reality glasses for totally 5 minutes in average, 2 minutes before the AVF cannulation process and 3 minutes during the process. No intervention was applied to the patients in the control group other than the normal nursing interventions in the HD unit. RESULTS: In the intra-group comparisons, the 2nd and 3rd measurement average pain level scores of the patients with in the experimental group were determined to be statistically significantly lower compared to their 1st measurement (p < 0.05); the 3rd measurement average pain level scores of the control group were determined to be statistically significantly lower compared to their 1st and 2nd measurements (p < 0.05). CONCLUSIONS: It was determined that the virtual reality glasses decreased the pain that emerges during the AVF cannulation process and increased the patient satisfaction level. It is suggested that the virtual reality glasses should be used by the nurses in the HD unit since it is easily applicable in coping with pain in the patients and since it is an invasive method.
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Satisfacción del Paciente , Realidad Virtual , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Turquía , Dolor/psicología , Dolor/prevención & control , Manejo del Dolor/métodos , Cateterismo/métodos , Fístula Arteriovenosa , Diálisis Renal/métodos , AnteojosRESUMEN
The frequency of percutaneous transluminal angioplasty (PTA) procedures has substantially increased, but its effect on vascular access recreation (VAR) remains inconclusive. We conducted a population-based retrospective analysis of Taiwan hemodialysis (HD) centers from 2004 to 2012. Data was accumulated into center-level characteristics, including patients' demographics, baseline characteristics, PTA procedures, and VAR. Center-level characteristics were summarized annually using appropriate measures. A mixed model assessed the association between PTA frequency and VAR rates, considering within-center correlation and adjusting for potential confounders. A total of 82,005 patients (mean age 62.7 ± 13.9 years, 50.5% male, 48.5% with diabetes mellitus) from 820 HD centers were analyzed. From 2004 to 2012, PTA frequency significantly increased from 1.24 to 3.23 per 1000 HD sessions, while VAR rates did not decline as expected (0.5-0.8 per 1000 HD sessions). Compared with the HD centers of infrequent use of PTA (annual lowest quartile, range 0.39-1.20 per 1000 HD sessions), the ones of frequent use (annual highest quartile, range 2.52-5.10 per 1000 HD sessions) didn't have lower VAR (range 0.54-0.99 vs. 0.50-0.91 per 1000 HD sessions, respectively). After controlling the potential confounders, the HD centers' PTA rates were not significantly associated with lower VAR rates (- 2.6, 95% confidence interval: - 30.3; 25.0, p = 0.85). Frequent use of PTA does not seem to improve VA patency at the center level, with no significant association identified with lower VAR. The indication of PTA in daily practice should be re-evaluated in terms of its efficiency in lowering VAR.
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Angioplastia , Diálisis Renal , Humanos , Masculino , Femenino , Persona de Mediana Edad , Diálisis Renal/métodos , Anciano , Estudios Retrospectivos , Angioplastia/métodos , Angioplastia/estadística & datos numéricos , Taiwán/epidemiología , Estudios Longitudinales , Dispositivos de Acceso VascularRESUMEN
Objective: To evaluate studies related to pain management associated with arteriovenous fistula cannulation among children. METHODS: The systematic review comprised literature search on Embase, ProQuest, Science Direct, Scopus, SpringerLink and Wiley Online databases for studies published in English between 1998 and 2021. The search used key words, including pain management OR analgesia AND child OR paediatric AND haemodialysis OR dialysis AND arteriovenous fistula OR arteriovenous fistula cannulation OR fistula needle OR arteriovenous fistula insertion OR needle insertion. The quality of the studies was evaluated using the Joana Briggs Institute checklist. General characteristics of the and pain outcomes were noted. RESULTS: Of the 2,877 studies initially identified, 8(0.27%) were analysed; 7(87.5%) quasi-experimental and 1(12.5%) randomised controlled trial. Overall, there were 283 participants aged 6-18 years. The strategies used for reducing arteriovenous fistula puncture-related pain among children undergoing haemodialysis included cryotherapy, lidocaine agents, virtual reality (VR), guided visualisation, balloon inflation, aromatherapy, and other programmed distractions. The strategies had a positive effect on reducing arteriovenous fistula cannulation-related pain among children. Conclusion: Non-pharmacological pain management is an easier, simpler, inexpensive and more effective method of atraumatic care among children undergoing haemodialysis.
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Derivación Arteriovenosa Quirúrgica , Manejo del Dolor , Diálisis Renal , Humanos , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Niño , Derivación Arteriovenosa Quirúrgica/efectos adversos , Manejo del Dolor/métodos , Cateterismo/métodos , Adolescente , Crioterapia/métodos , Realidad Virtual , Lidocaína/uso terapéutico , Anestésicos Locales/uso terapéutico , Dolor Asociado a Procedimientos Médicos/etiología , Dolor Asociado a Procedimientos Médicos/prevención & controlRESUMEN
Regional citrate anticoagulation use in intermittent hemodialysis is limited by the increased risk of metabolic complications due to faster solute exchanges than with continuous renal replacement therapies. Several simplifications have been proposed. The objective of this study was to validate a mathematical model of hemodialysis anticoagulated with citrate that was then used to evaluate different prescription scenarios on anticoagulant effectiveness (free calcium concentration in dialysis filter) and calcium balance. A study was conducted in hemodialyzed patients with a citrate infusion into the arterial line and a 1.25 mmol/L calcium dialysate. Calcium and citrate concentrations were measured upstream and downstream of the citrate infusion site and in the venous line. The values measured in the venous lines were compared with those predicted by the model using Bland and Altman diagrams. The model was then used with 22 patients to make simulations. The model can predict the concentration of free calcium, bound to citrate or albumin, accurately. Irrespective of the prescription scenario a decrease in free calcium below 0.4 mmol/L was obtained only in a fraction of the dialysis filter. A zero or slightly negative calcium balance was observed, and should be taken into account in case of prolonged use.
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Anticoagulantes , Calcio , Ácido Cítrico , Diálisis Renal , Humanos , Diálisis Renal/métodos , Anticoagulantes/administración & dosificación , Femenino , Masculino , Persona de Mediana Edad , Calcio/metabolismo , Calcio/sangre , Anciano , Modelos Teóricos , Simulación por ComputadorRESUMEN
Background: Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. Objective: This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, 50.9% in the web-based HBPM group and n=81, 49.1% in the control group), 145 (87.9%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30% (25/84) to 48% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37% (30/81) to 25% (20/81; χ22=16.82, P<.001; odds ratio 5.11, 95% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; ß=-6.09, 95 % CI -10.94 to -1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; ß=-4.93, 95% CI -7.93 to -1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=-9.18, P<.001), HBPM Perception Scale (t163=-10.65, P<.001), and HBPM Adherence Scale (t163=-8.04, P<.001) were significantly higher after 6 months of intervention. Conclusions: The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings.
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Monitoreo Ambulatorio de la Presión Arterial , Hipertensión , Diálisis Renal , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Diálisis Renal/métodos , Monitoreo Ambulatorio de la Presión Arterial/métodos , Monitoreo Ambulatorio de la Presión Arterial/instrumentación , Hipertensión/psicología , Hipertensión/terapia , Hipertensión/complicaciones , Internet , Encuestas y Cuestionarios , AdultoRESUMEN
BACKGROUND AND OBJECTIVE: Renal replacement therapy (RRT) plays a critical role in antimicrobial removal, particularly for low-molecular-weight drugs with low plasma protein binding, low distribution volume and hydrophilicity. Medium cut-off (MCO) membranes represent a new generation in dialysis technology, enhancing diffusive modality efficacy and increasing the cut-off from 30 to 45 kDa, crucial for middle molecule removal. This monocentric randomized crossover pilot study aimed to evaluate the impact of continuous haemodialysis with MCO membrane (MCO-CVVHD) on the removal of piperacillin, tazobactam and meropenem compared with continuous veno-venous hemodiafiltration with standard high-flux membrane (HFM-CVVHDF). METHODS: Twenty patients were randomized to undergo MCO-CVVHD followed by HFM-CVVHDF or vice versa. Extraction ratio (ER), effluent clearance (Cleff) and treatment efficiency were assessed at various intervals. Antibiotic nadir plasma levels were measured for both treatment days. RESULTS: HFM-CVVHDF showed greater ER compared with MCO-CVVHD for meropenem (ß = - 8.90 (95% CI - 12.9 to - 4.87), p < 0.001) and tazobactam (ß = - 8.29 (95% CI - 13.5 to - 3.08), p = 0.002) and Cleff for each antibiotic (meropenem ß = - 10,206 (95% CI - 14,787 to - 5787), p = 0.001); tazobactam (ß = - 4551 (95% CI - 7781 to - 1322), p = 0.012); piperacillin (ß = - 3913 (95% CI - 6388 to - 1437), p = 0.002), even if the carryover effect influenced the Cleff for meropenem and tazobactam. No difference was observed in nadir plasma concentrations or efficiency for any antibiotic. Piperacillin (ß = - 38.1 (95% CI - 47.9 to - 28.3), p < 0.001) and tazobactam (ß = - 4.45 (95% CI - 6.17 to - 2.72), p < 0.001) showed lower nadir plasma concentrations the second day compared with the first day, regardless the filter type. CONCLUSION: MCO demonstrated comparable in vivo removal of piperacillin, tazobactam and meropenem to HFM.
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Antibacterianos , Terapia de Reemplazo Renal Continuo , Estudios Cruzados , Meropenem , Diálisis Renal , Choque Séptico , Humanos , Antibacterianos/farmacocinética , Antibacterianos/uso terapéutico , Antibacterianos/sangre , Masculino , Femenino , Persona de Mediana Edad , Anciano , Choque Séptico/terapia , Choque Séptico/tratamiento farmacológico , Choque Séptico/sangre , Proyectos Piloto , Terapia de Reemplazo Renal Continuo/métodos , Diálisis Renal/métodos , Meropenem/uso terapéutico , Meropenem/administración & dosificación , Meropenem/farmacocinética , Tazobactam/uso terapéutico , Tazobactam/farmacocinética , Piperacilina/farmacocinética , Piperacilina/uso terapéutico , Piperacilina/administración & dosificación , Hemodiafiltración/métodosRESUMEN
Importance: The acute kidney injury (AKI) electronic alert (e-alert) system was hypothesized to improve the outcomes of AKI. However, its association with different patient outcomes and clinical practice patterns remains systematically unexplored. Objective: To assess the association of AKI e-alerts with patient outcomes (mortality, AKI progression, dialysis, and kidney recovery) and clinical practice patterns. Data Sources: A search of Embase and PubMed on March 18, 2024, and a search of the Cochrane Library on March 20, 2024, to identify all relevant studies. There were no limitations on language or article types. Study Selection: Studies evaluating the specified outcomes in adult patients with AKI comparing AKI e-alerts with standard care or no e-alerts were included. Studies were excluded if they were duplicate cohorts, had insufficient outcome data, or had no control group. Data Extraction and Synthesis: Two investigators independently extracted data and assessed bias. The systematic review and meta-analysis followed the PRISMA guidelines. Random-effects model meta-analysis, with predefined subgroup analysis and trial sequential analyses, were conducted. Main Outcomes and Measures: Primary outcomes included mortality, AKI progression, dialysis, and kidney recovery. Secondary outcomes were nephrologist consultations, post-AKI exposure to nonsteroidal anti-inflammatory drugs (NSAID), post-AKI angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker (ACEI/ARB) prescription, hospital length of stay, costs, and AKI documentation. Results: Thirteen unique studies with 41â¯837 unique patients were included (mean age range, 60.5-79.0 years]; 29.3%-48.5% female). The risk ratios (RRs) for the AKI e-alerts group compared with standard care were 0.96 for mortality (95% CI, 0.89-1.03), 0.91 for AKI stage progression (95% CI, 0.84-0.99), 1.16 for dialysis (95% CI, 1.05-1.28), and 1.13 for kidney recovery (95% CI, 0.86-1.49). The AKI e-alerts group had RRs of 1.45 (95% CI, 1.04-2.02) for nephrologist consultation, 0.75 (95% CI, 0.59-0.95) for post-AKI NSAID exposure. The pooled RR for post-AKI ACEI/ARB exposure in the AKI e-alerts group compared with the control group was 0.91 (95% CI, 0.78-1.06) and 1.28 (95% CI, 1.04-1.58) for AKI documentation. Use of AKI e-alerts was not associated with lower hospital length of stay (mean difference, -0.09 [95% CI, -0.47 to 0.30] days) or lower cost (mean difference, US $655.26 [95% CI, -$656.98 to $1967.5]) but was associated with greater AKI documentation (RR, 1.28 [95% CI, 1.04-1.58]). Trial sequential analysis confirmed true-positive results of AKI e-alerts on increased nephrologist consultations and reduced post-AKI NSAID exposure and its lack of association with mortality. Conclusions and Relevance: In this systematic review and meta-analysis, AKI e-alerts were not associated with a lower risk for mortality but were associated with changes in clinical practices. They were associated with lower risk for AKI progression. Further research is needed to confirm these results and integrate early AKI markers or prediction models to improve outcomes.
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Lesión Renal Aguda , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Humanos , Masculino , Femenino , Persona de Mediana Edad , Sistemas de Entrada de Órdenes Médicas , Anciano , Progresión de la Enfermedad , Diálisis Renal/métodosRESUMEN
This case report highlights the effective use of intermittent hemodialysis (IHD) in warming a 71-year-old female patient with severe hypothermia who presented with a rectal temperature of 25 °C and signs of hemodynamic instability. The patient, found unconscious after prolonged exposure to cold exacerbated by alcohol consumption, initially showed some improvement in core temperature through active external rewarming methods. However, soon, her temperature plateaued at 27 °C. Patient was deemed unsuitable for extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB) due to her age, and urgent IHD was initiated. This approach resulted in a stable increase in core temperature at approximately 2.0 °C/hr, along with normalization of lactic acidosis, creatinine phosphokinase, and correction of electrolyte imbalances, culminating in her full recovery and discharge after seven days in the hospital.After reviewing this case alongside similar ones from before, this case report highlights the efficacy and safety of IHD as an efficient, readily available, and less invasive method for rewarming moderate to severe hypothermic patients who are hemodynamically unstable patients but do not have cardiac arrest or renal dysfunction. IHD is especially useful when less invasive cooling devices (Artic Sun/ CoolGard) are not available or more invasive extracorporeal life support options (ECMO/ CPB) are either not indicated or unavailable. IHD can also help improve concurrent electrolyte imbalances and/or toxin buildup. The report further emphasizes the necessity of monitoring for potential complications, such as post-dialysis hypophosphatemia and rebound hyperkalemia, following successful rewarming.
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Hipotermia , Diálisis Renal , Recalentamiento , Humanos , Femenino , Anciano , Hipotermia/terapia , Hipotermia/complicaciones , Recalentamiento/métodos , Diálisis Renal/métodosRESUMEN
While life-sustaining, hemodialysis is a non-physiological treatment modality that exerts stress on the patient, primarily due to fluid shifts during ultrafiltration. Automated feedback control systems, integrated with sensors that continuously monitor bio-signals such as blood volume, can adjust hemodialysis treatment parameters, e.g., ultrafiltration rate, in real-time. These systems hold promise to mitigate hemodynamic stress, prevent intradialytic hypotension, and improve the removal of water and electrolytes in chronic hemodialysis patients. However, robust evidence supporting their clinical application remains limited. Based on an extensive literature research, we assess feedback-controlled ultrafiltration systems that have emerged over the past three decades in comparison to conventional hemodialysis treatment. We identified 28 clinical studies. Closed loop ultrafiltration control demonstrated effectiveness in 23 of them. No adverse effects of closed loop ultrafiltration control were reported across all trials. Closed loop ultrafiltration control represents an important advancement towards more physiological hemodialysis. Its development is driven by innovations in real-time bio-signals monitoring, advancement in control theory, and artificial intelligence. We expect these innovations will lead to the prevalent adoption of ultrafiltration control in the future, provided its clinical value is substantiated in adequately randomized controlled trials.
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Diálisis Renal , Ultrafiltración , Humanos , Diálisis Renal/métodos , Ultrafiltración/métodos , RetroalimentaciónRESUMEN
INTRODUCTION: Hemodialysis patients rely on stable vascular access to perform effective hemodialysis and reach good dialysis quality. However, an obstructed or under-matured arteriovenous fistula (AVF) may increase infection rate and mortality in hemodialysis patients. Far infrared (FIR) therapy might help to promote AVF maturation and reduce obstruction rate. Therefore, this meta-analysis was conducted to evaluate the effect of FIR therapy on AVF obstruction rate and maturation. MATERIAL AND METHOD: PubMed, Embase, the Cochrane Library, and other databases which provide publications in randomized controlled trials (RCTs) of FIR to improve AVF in patients with CKD (Chronic Kidney Disease) or HD (hemodialysis) were used to collect articles which published before February 2023. Two authors selected relevant articles independently based on pre-defined inclusion and exclusion criteria, and assessed the quality of the articles by using the Cochrane Handbook before performing a meta-analysis in Review Manager (RevMan) 5.4 software. RESULTS: Four RCTs with 475 patients were included. The results of the meta-analysis showed that the FIR therapy groups had better physiological maturation at 3 months (RR = 1.22; 95% CI = 1.07 to 1.39; p = .002) and clinical maturation at 12 months (RR = 1.35; 95% CI = 1.14 to 1.60; p < .001) than the control groups without FIR therapy. The obstruction rates within 12 months were much lower in the FIR therapy groups than in the control groups (RR = 0.24; 95% CI = 0.08 to 0.68; p = .007), also, there was no statistical heterogeneity. CONCLUSIONS: FIR could promote fistula maturation and reduce the incidence of AVF obstruction.
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Derivación Arteriovenosa Quirúrgica , Rayos Infrarrojos , Diálisis Renal , Humanos , Diálisis Renal/métodos , Rayos Infrarrojos/uso terapéutico , Derivación Arteriovenosa Quirúrgica/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Renal Crónica/terapiaRESUMEN
Objective: To evaluate the effects of the multiple single cannulation technique (MUST) on the outcomes of arteriovenous graft (AVG). Methods: A retrospective study of AVG created between January 2018 and December 2021 at the First Affiliated Hospital of Zhengzhou University was conducted. The clinical data of patients and their follow-up data for venous access were analyzed. Subjects were divided into the MUST group or the non-MUST group according to whether MUST was used. The cumulative patency rate and complication incidence were compared between the two groups. Logistic regression was applied to analyze the influencing factors of applying MUST in AVG. Results: The MUST group included 115 AVG and the non-MUST group, 122 AVG. The 1-year, 2-year, 3-year, and 4-year cumulative patency rates of the MUST group were 100%, 99.1%, 95.2%, 85.4%, and 73.2%, respectively, while those for the non-MUST group were 97.5%, 92.7%, 77.7%, 69.7%, and 50.0%, respectively, with the 2-year and 3-year patency rates showing significant difference (P=0.022, P=0.004). The standard intervention rate expressed in (median [interquartile range]) in the MUST group was significantly lower than that in the non-MUST group (0.46 [0.00, 0.94] vs. 0.97 [0.60, 1.59], Z=-5.808, P<0.001). A total of 24 (20.9%) AVG in the MUST group and 60 (49.2%) AVG in the non-MUST group had a standard intervention rate >1.0 per patient-year, with significant difference between the two groups. Three (2.6%) AVG in the MUST group and 7 (5.7%) AVG in the non-MUST group were complicated by aneurysm (χ 2=20.737, P<0.001). One (0.9%) AVG in the MUST group and 6 (4.9%) AVG in the non-MUST group had graft infection, with the difference between the groups showing no significance (P=0.121). Multivariate logistic regression showed that dialysis in the alliance facilities (odds ratio [OR]=2.713, 95% confidence interval [CI]: 1.698-4.336, P<0.001], and excellent follow-up [OR=2.189, 95% CI: 1.221-3.927, P=0.009] were the influencing factors of applying MUST in AVG. Conclusion: MUST improves the cumulative patency of AVG and decreases the intervention frequency and the incidence of aneurysm without increasing the risk of graft infection.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Cateterismo , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Diálisis Renal/métodos , Estudios Retrospectivos , Derivación Arteriovenosa Quirúrgica/métodos , Cateterismo/métodos , Masculino , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiologíaRESUMEN
BACKGROUND: Chronic kidney disease presents global health challenges, with hemodialysis as a common treatment. However, non-dialyzable uremic toxins demand further investigation for new therapeutic approaches. Renal tubular cells require scrutiny due to their vulnerability to uremic toxins. METHODS: In this study, a systems biology approach utilized transcriptomics data from healthy renal tubular cells exposed to healthy and post-dialysis uremic plasma. RESULTS: Differential gene expression analysis identified 983 up-regulated genes, including 70 essential proteins in the protein-protein interaction network. Modularity-based clustering revealed six clusters of essential proteins associated with 11 pathological pathways activated in response to non-dialyzable uremic toxins. CONCLUSIONS: Notably, WNT1/11, AGT, FGF4/17/22, LMX1B, GATA4, and CXCL12 emerged as promising targets for further exploration in renal tubular pathology related to non-dialyzable uremic toxins. Understanding the molecular players and pathways linked to renal tubular dysfunction opens avenues for novel therapeutic interventions and improved clinical management of chronic kidney disease and its complications.
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Túbulos Renales , Insuficiencia Renal Crónica , Biología de Sistemas , Tóxinas Urémicas , Humanos , Insuficiencia Renal Crónica/sangre , Biología de Sistemas/métodos , Túbulos Renales/metabolismo , Túbulos Renales/patología , Tóxinas Urémicas/metabolismo , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Mapas de Interacción de Proteínas , Uremia/sangre , Uremia/metabolismo , TranscriptomaRESUMEN
Background: Management of body fluid volumes and adequate prescription of ultrafiltration (UF) remain key issues in the treatment of chronic kidney disease patients.Objective: This study aims to estimate the magnitude as well as the precision of absolute blood volume (Vb) modeled during regular hemodialysis (HD) using standard data available with modern dialysis machines.Methods: The estimation utilizes a two-compartment fluid model and a mathematical optimization technique to predict UF-induced changes in hematocrit measured by available on-line techniques. The method does not rely on a specific hematocrit sensor or a specific UF or volume infusion protocol and uses modeling and prediction tools to quantify the error in Vb estimation.Results: The method was applied to 21 treatments (pre-UF body mass: 65.57±13.44 kg, UF-volume: 3.99±1.14 L) obtained in ten patients (4 female). Pre-HD Vb was 5.4±0.53 L with an average coefficient of variation of 9.8% (range 1 to 22%). A significant moderate correlation was obtained when Vb was compared to a different method applied to the same data set (r = 0.5). Specific blood volumes remained above the critical level of 65 mL/kg in 17 treatments (80.9%).Conclusion: The method offers the opportunity to detect critical blood volumes during HD and to judge the quality and reliability of that information based on the precision of the Vb estimate.
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Volumen Sanguíneo , Diálisis Renal , Humanos , Femenino , Diálisis Renal/métodos , Masculino , Persona de Mediana Edad , Anciano , Hematócrito , Fallo Renal Crónico/terapia , Determinación del Volumen Sanguíneo/métodos , Adulto , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/sangreRESUMEN
BACKGROUND Crush injury can result in crush syndrome (CS) when the pressure is released from the limb, resulting in ischemia-reperfusion injury and rhabdomyolysis. This retrospective study aimed to evaluate the demographics, clinical findings, management, and outcomes of 377 patients admitted as an emergency with a diagnosis of crush syndrome between February 6 and 16, 2023, following the Türkiye-Syria earthquakes. MATERIAL AND METHODS This observational study retrospectively analyzed CS patients admitted to the emergency service from February 6 to 16, 2023. We collected data on demographics, vital signs, time under debris, blood parameters, hemodialysis needs, outcomes, hospital stay duration, 7-day mortality, diagnoses, and treatments. RESULTS During the study period, 1682 earthquake victims were admitted, with 377 diagnosed with CS included in the study. The mean age was 33.51±0.89 years, with 51.7% male. The mean time under debris was 24.92±1.62 h, and the mean hospital stay was 34.39±1.20 days. Hemodialysis was required for 91 patients (24.1%), and 20 patients (5.3%) died. AKI developed in 23.1% (n=87) of the patients, with 30.5% (n=115) under debris for more than 24 h. Mortality, hospital stay, and AKI rates were higher in those requiring hemodialysis (P<0.001, P=0.003, and P<0.001, respectively). CONCLUSIONS The study highlights a high incidence of AKI, increased hemodialysis needs, and higher mortality in earthquake-related crush syndrome cases. Longer debris entrapment (over 24 h) was common. Early and aggressive fluid resuscitation, beginning in the field and continuing through hospital care, is crucial. Prioritizing this in disaster planning for field personnel is recommended.
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Síndrome de Aplastamiento , Terremotos , Humanos , Síndrome de Aplastamiento/complicaciones , Masculino , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Diálisis Renal/métodos , Tiempo de Internación , Hospitalización , Servicio de Urgencia en Hospital , Turquía/epidemiologíaRESUMEN
BACKGROUND: Nocturnal hemodialysis (nHD) restores the attenuated brachial artery vasodilator responsiveness of patients receiving conventional intermittent hemodialysis (iHD). Its impact on coronary vasodilatation is unknown. METHODS: We evaluated 25 patients on hemodialysis who fulfilled transplant criteria: 15 on iHD (4-hour sessions, 3 d/wk) and 10 on nHD (≈40 h/wk over 8-10-hour sessions) plus 6 control participants. Following diagnostic angiography, left anterior descending (LAD) coronary flow reserve and mean luminal diameter were quantified at baseline and during sequential intracoronary administration of adenosine (infusion and bolus), nitroglycerin (bolus), acetylcholine (infusion), acetylcholine coinfused with vitamin C, and, finally, sublingual nitroglycerin. RESULTS: Coronary flow reserve in those receiving nHD was augmented relative to iHD (3.28±0.26 versus 2.17±0.12 [mean±SEM]; P<0.03) but attenuated, relative to controls (4.80±0.63; P=0.011). Luminal dilatations induced by intracoronary adenosine and nitroglycerin were similar in nHD and controls but blunted in the iHD cohort (P<0.05 versus both). ACh elicited vasodilatation in controls but constriction in both dialysis groups (both P<0.05, versus control); vitamin C coinfusion had no effect. Sublingual nitroglycerin increased mid-left anterior descending diameter and reduced mean arterial pressure in controls (+15.2±2.68%; -16.00±1.60%) and in nHD recipients (+14.78±5.46%; -15.82±1.32%); iHD responses were markedly attenuated (+1.9±0.86%; -5.89±1.41%; P<0.05, all comparisons). CONCLUSIONS: Coronary and systemic vasodilator responsiveness to both adenosine and nitroglycerin is augmented in patients receiving nHD relative to those receiving iHD, whereas vasoconstrictor responsiveness to acetylcholine does not differ. By improving coronary conduit and microvascular function, nHD may reduce the cardiovascular risk of patients on dialysis.