Private Healthcare Facilities & Services Act......

National Kidney Foundation of Malaysia (NKFM) is organizing a workshop on 17th October 2010 entitled "Guidelines on Hemodialysis Treatment" to put forward proposal to the Government of Malaysia to amend the regulations on Hemodialysis under the Private Healthcare Facilities & Services Act.

NKFM is presently sending out invitations to those involved in the industry to participate in working groups (to address different aspects of the Act) to deliberate and submit proposals for the October 2010 workshop.

We support such initiative and advise all those involved in the industry to come forward and be heard. More importantly groups representing patients too should also be included to safeguard their interest.

Thank you NKFM for your initiative and the rest for your active participation.

Managing diabetes in hemodialysis patients....

Managing diabetes in hemodialysis patients: Observations and recommendations


KUMARPAL SHRISHRIMAL, MD, MS
Department of Hospital Medicine, Cleveland Clinic
PETER HART, MD
Division of Nephrology, Department of Medicine, Cook County Hospital, Chicago, IL
FRANKLIN MICHOTA, MD
Department of Hospital Medicine, Cleveland Clinic
Cleveland Clinic Journal of Medicine November 2009 vol. 76 11 649-655

Abstract

Diabetes is challenging to manage in patients who have end-stage renal disease (ESRD), as both uremia and dialysis can complicate glycemic control by affecting the secretion, clearance, and peripheral tissue sensitivity of insulin. The authors summarize the available evidence and make practical recommendations.

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Impact of two types of sodium and ultra filtration profiles.....

Impact of two types of sodium and ultra filtration profiles on Intradialytic hypotension in hemodialysis patients

Nahid Shahgholian*, Mansoor Ghafourifard**, Mohsen Rafieian***, Mozhgan Mortazavi****
* MSc, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
**MSc, Department of Medical Surgical Nursing School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran.
*** MSc, Department Operating Room Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
****MD, Nephrologist, Assistant Professor, School of Medicine, Isfahan University of Medical Sciences. Isfahan, Iran.
Iranian Journal of Nursing and Midwifery Research, Vol 13, No 4 (2008)

Abstract

BACKGROUND: Intradialytic hypotension is the most common complication of haemodialysis (HD) and the main cause for patient's dissatisfaction. One of the new preventive methods for it is the use of sodium profile and ultrafiltration (UF) profile. This study was designed to evaluate the effect of two types of sodium and UF profile on intradialytic hypotension.

METHODS: In this cross-sectional study, 26 stable HD patients from two dialysis center in Isfahan city, underwent three treatments in 3 dialysis sessions: 1. control, constant dialysate sodium concentration of 138 mmol/l with constant UF; 2. linear sodium profile + UF profile (type 1), a linearly decreasing dialysate sodium concentration (138-146 mmol/l) combination with a linearly decreasing UF rate; and 3. stepwise sodium profile + UF profile (type 2), a stepwise decreasing dialysate sodium concentration (138-146 mmol/l) combination with a stepwise decreasing UF rate. Data were analyzed via SPSS-14 by using χ2 test.

RESULTS: In this study a total of 26 patients were participated with the mean age of 46.8 ± 19 years. In each group, 78 dialysis sessions and a total of 234 dialysis sessions were analyzed. The incidence of intradialytic hypotension was significantly reduced during two type of profiles compared with control (p < 0.05). But there was no significant difference between profiles (p > 0.05).

DISCUSSION: Sodium and UF profile is simple and cost effective methods that modulates the dialysate sodium and ultrafiltration rate, and preserve the homodynamic status of patients during dialysis. This method can reduce the incidence of intradialytic hypotension.

KEY WORDS: Intradialytic hypotension (IHD), sodium profile, ultrafiltration profile, hemodialysis patients (HD).

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Sodium Profiling, But Not Cool Dialysate.......

Sodium Profiling, But Not Cool Dialysate, Increases the Absolute Plasma Refill Rate During Hemodialysis

Brummelhuis, Walter J.; van Geest, Rob J.; van Schelven, Leonard J.; Boer, Walther H.
ASAIO Journal: November/December 2009 - Volume 55 - Issue 6 - pp 575-580
doi: 10.1097/MAT.0b013e3181bea710 Kidney Support

Abstract
Intradialytic hypotension is often caused by a discrepancy between ultrafiltration and plasma refilling. Increasing the plasma refill rate could therefore reduce intradialytic hypotension. We used a recently developed method to measure the effect of cool dialysate and sodium (Na) profiling on refill during hemodialysis (HD). Using a Gambro AK200 with blood volume (BV) sensor plus computer-guided external pump, a high ultrafiltration rate quickly induced a preset BV reduction. A software feedback mechanism subsequently adjusted the ultrafiltration rate continuously to maintain BV between very narrow preset boundaries. The continuously changing, software-generated ultrafiltration rate then quantitatively equalled refill. Absolute plasma refill rate was measured in six stable patients without intradialytic hypotension, undergoing HD without intervention, with cool dialysate (1°C below core temperature), and with Na profiling (gradually declining from 150 to 140 mmol/l). Baseline refill rate was 20.1 ± 4.0 ml/min (mean ± SD). Although cool dialysate did not affect refill (22.2 ± 4.1 ml/min, p = 0.27 vs. baseline), Na profiling induced a significant improvement (26.8 ± 3.7 ml/min, p = 0.006 vs. baseline). Using our method to measure absolute plasma refill rate during HD, we demonstrated that Na profiling indeed improves the plasma refill rate. A potential effect of cool dialysate could not be established.

Effect of dialysate temperature.....

Effect of dialysate temperature on hemodynamic stability among hemodialysis patients.

Ahmad Taher Azar
Biomedical Engineering Department, Misr University for Science and Technology, 6th of October City, Egypt
Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2010 Jul 12];20:596-603

Abstract
Cooling the dialysate below 36.5 degrees C is an important factor that contributes to hemodynamic stability in patients during hemodialysis (HD). In this study, the effect of dialysate temperature on hemodynamic stability, patients' perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD. A total of 50 patients, all of whom were on 3-times-per-week dialysis regimen, were studied. Patients were assessed during six dialysis sessions; in three sessions, the dialysate temperature was normal (37 degrees C) and in three other sessions, the dialysate temperature was low (35 degrees C). Specific scale questionnaires were used in each dialysis session, to evaluate the symptoms during the dialysis procedure as well as post-dialysis fatigue, and respective scores were noted. The results showed that usage of low dialysate temperature was associated with the following: higher post dialysis systolic blood pressure (P< 0.05) and lower post dialysis heart rate (P< 0.01), with similar ultrafiltration rates, better intra-dialysis symptoms score and post-dialysis fatigue scores (P< 0.001, and P < 0.001, respectively), shorter post-dialysis fatigue period (P< 0.001) as well as higher urea removal (P< 00001) and Kt/V (P< 0.0001). Patients' perceptions were measured by a questionnaire, which showed that 76% of them felt more energetic after dialysis with cool dialysate and requested to be always dialyzed with cool dialysate. Low temperature dialysate is particularly beneficial for highly symptomatic patients, improves tolerance to dialysis in hypotensive patients and helps increase ultrafiltration while maintaining hemodynamic stability during and after dialysis.

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Dietary Potassium Intake and Mortality......

Dietary Potassium Intake and Mortality in Long-term Hemodialysis Patients.

Authors: Noori N, Kalantar-Zadeh K, Kovesdy CP, Murali SB, Bross R, Nissenson AR, Kopple JD

Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA; Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.

Am J Kidney Dis. 2010 Jun 25

Abstract:

BACKGROUND: Hyperkalemia has been associated with higher mortality in long-term hemodialysis (HD) patients. There are few data concerning the relationship between dietary potassium intake and outcome.

STUDY DESIGN: The mortality predictability of dietary potassium intake from reported food items estimated using the Block Food Frequency Questionnaire (FFQ) at the start of the cohort was examined in a 5-year (2001-2006) cohort of 224 HD patients in Southern California using Cox proportional hazards regression.

SETTING & PARTICIPANTS: 224 long-term HD patients from 8 DaVita dialysis clinics.

PREDICTORS: Dietary potassium intake ranking using the Block FFQ.

OUTCOMES: 5-year survival.

RESULTS: HD patients with higher potassium intake had greater dietary energy, protein, and phosphorus intakes and higher predialysis serum potassium and phosphorus levels. Greater dietary potassium intake was associated with significantly increased death HRs in unadjusted models and after incremental adjustments for case-mix, nutritional factors (including 3-month averaged predialysis serum creatinine, potassium, and phosphorus levels; body mass index; normalized protein nitrogen appearance; and energy, protein, and phosphorus intake) and inflammatory marker levels. HRs for death across the 3 higher quartiles of dietary potassium intake in the fully adjusted model (compared with the lowest quartile) were 1.4 (95% CI, 0.6-3.0), 2.2 (95% CI, 0.9-5.4), and 2.4 (95% CI, 1.1-7.5), respectively (P for trend = 0.03). Restricted cubic spline analyses confirmed the incremental mortality predictability of higher potassium intake.

LIMITATIONS: FFQs may underestimate individual potassium intake and should be used to rank dietary intake across the population.

CONCLUSIONS: Higher dietary potassium intake is associated with increased death risk in long-term HD patients, even after adjustments for serum potassium level; dietary protein; energy, and phosphorus intake; and nutritional and inflammatory marker levels. The potential role of dietary potassium in the high mortality rate of HD patients warrants clinical trials.

Another poem to share......

 We would like to share another poem by a dear old friend:

THE TRUE GIFT

A true gift is like a lift,

It helps move people so swift,

With ease and time so brief.

Everyone is blessed with gifts,

Which are powerful, if only we believe

The wonders they can help achieve -

Changes that create a positive shift

In the lives of others to bring relief.

A gift is not a true gift

If we do not use it to give:

Love, that lightens those in grief,

An apology that mends a rift,

Forgiveness that bring reprieve,

A sound advice to the naive-

So as not to be deceived,

Help, that rid a painful heave.

Mother Teresa is a true gift;

She gives her all for others to live

With love and care for those lives adrift.

A true gift is not the wealth we achieve,

It is not the good we perceive,

It is the part of us that we give

So others can blessedly receive –

Making this world a better place to live.

By: Dr Victor Tan Soo Lim

From: The Secret Of Change