Comparison and causes of transfer from one dialysis modality to other
Submitted by Mr CS Soong
International Urology and Nephrology –
Online First- DOI: 10.1007/s11255-010-9836-2
Aydin Unal, Ismail Kocyigit, Murat Hayri Sipahioglu, Bulent Tokgoz, Oktay Oymak and Cengiz Utas
Abstract
Aim To evaluate the patients transferred from one dialysis modality to another and to compare the patient characteristics on both renal replacement modalities.
Patients and method The data of dialysis patients, who were followed up between January 2000 and December 2009 in our nephrology department, was evaluated retrospectively. Fifty-seven patients were transferred from HD to PD (Group 1) and 94 patients were transferred from PD to HD (Group 2) were included in this study. We recorded patients demographic, clinical, and laboratory findings, and
the cause of transfer from HD to PD or from PD to HD.
Results The mean age of the patients was 52.1 ¡¾ 4.1 years. Eighty-four of the 151 patients were men and 67 were women. The etiology of end-stage renal failure was diabetes mellitus and hypertension in most of the patients. The causes of transfer from HD to PD were vascular access problems in 37 (64.9%), patient preference in 8 (14.0%), cardiovascular
problems in 7 (12.3%), inadequate dialysis in 4 (7.0%) patients, and unknown in 1 (1.8%) patient. On the other hand, the causes of transfer from PD to HD were refractory peritonitis in 61 (64.9%), catheter-related problems in 14 (14.9%), inadequate dialysis in 8 (8.5%), increased intraabdominal pressure-related problems in 7 (7.4%), patient
preference in 2 (2.1%), and ultrafiltration failure in 2 (2.1%) patients. Alkaline phosphatase and calcium ¡¿ phosphorus products were significantly higher in Group 1 compared to Group 2. The presence
of diabetes mellitus, Kt/Vurea, and 24-h residual urine volume were significantly higher in Group 2 than in Group 1. There was no significant difference in terms of other parameters.
Conclusion Vascular access problems were the most frequent cause of transfer from HD to PD. On the
other hand, the most frequent cause of transfer from PD to HD was refractory peritonitis. Preservation of residual urine volume was better in PD patients compared to HD patients.
Abstract read here
Tuesday, September 28, 2010
Friday, September 24, 2010
How Australian Nephrologists View Home Dialysis
How Australian Nephrologists View Home Dialysis: Results of a National Survey
Submitted by Mr CS Soong
Nephrology - Accepted Article (Accepted, unedited articles published online for future issues) -DOI: 10.1111/j.1440-1797.2010.01403.x
Marie J Ludlow 1, Charles RP George 2, Carmel M Hawley 3, Timothy H Mathew 4, John W M Agar 5, Peter G Kerr 6, Lydia A Lauder7
1 Medical Project Manager, Kidney Health Australia
2 Department of Nephrology, Concord Hospital, Concord, New South
3 Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland
4 Medical Director, Kidney Health Australia
5 Department of Renal Medicine, Geelong Hospital, Victoria
6 Department of Nephrology, Monash Medical Centre, Clayton, Victoria
7 National Manager Strategic Health Projects & Publications, Kidney Health Australia
Abstract
Aim Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities.
Methods Between 1 April and 5 August 2009, Australian nephrologists invited to complete an online survey. Seventy-six questions were asked covering characteristics of the dialysis units, responders¡¯ experience, adequacy of facilities and support structures, attitudes to the use of home HD and PD and issues impeding the increased uptake of home dialysis.
Results Completed surveys were received and analyzed from 71 respondents; 27from Heads of Units (35% response rate) and 44 (16%) from other nephrologists. There was strong agreement that HD with long hours was advantageous and that this was most easily accomplished in the home. PD was not considered to be an inferior therapy. A ¡°PD first¡± policy existed in 34 of Renal Units. The most commonly reported impediments to expanding home dialysis services were financial disadvantage for home HD patients, and lack of physical infrastructure for training, support, and education. Areas of concern for expanding home dialysis programs included psychiatry support, access to respite care and home visits, and lack of support from administration and government. The majority of medical nephrologists would recommend home dialysis to more patients if these impediments could be overcome.
Conclusion This survey identified support from nephrologists for the expansion of home dialysis in Australia and highlighted important barriers to improving access to these therapies.
Abstract found here
Submitted by Mr CS Soong
Nephrology - Accepted Article (Accepted, unedited articles published online for future issues) -DOI: 10.1111/j.1440-1797.2010.01403.x
Marie J Ludlow 1, Charles RP George 2, Carmel M Hawley 3, Timothy H Mathew 4, John W M Agar 5, Peter G Kerr 6, Lydia A Lauder7
1 Medical Project Manager, Kidney Health Australia
2 Department of Nephrology, Concord Hospital, Concord, New South
3 Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland
4 Medical Director, Kidney Health Australia
5 Department of Renal Medicine, Geelong Hospital, Victoria
6 Department of Nephrology, Monash Medical Centre, Clayton, Victoria
7 National Manager Strategic Health Projects & Publications, Kidney Health Australia
Abstract
Aim Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities.
Methods Between 1 April and 5 August 2009, Australian nephrologists invited to complete an online survey. Seventy-six questions were asked covering characteristics of the dialysis units, responders¡¯ experience, adequacy of facilities and support structures, attitudes to the use of home HD and PD and issues impeding the increased uptake of home dialysis.
Results Completed surveys were received and analyzed from 71 respondents; 27from Heads of Units (35% response rate) and 44 (16%) from other nephrologists. There was strong agreement that HD with long hours was advantageous and that this was most easily accomplished in the home. PD was not considered to be an inferior therapy. A ¡°PD first¡± policy existed in 34 of Renal Units. The most commonly reported impediments to expanding home dialysis services were financial disadvantage for home HD patients, and lack of physical infrastructure for training, support, and education. Areas of concern for expanding home dialysis programs included psychiatry support, access to respite care and home visits, and lack of support from administration and government. The majority of medical nephrologists would recommend home dialysis to more patients if these impediments could be overcome.
Conclusion This survey identified support from nephrologists for the expansion of home dialysis in Australia and highlighted important barriers to improving access to these therapies.
Abstract found here
Tuesday, September 21, 2010
Daily Hemodialysis Improves Depression
Daily Hemodialysis Improves Depression and Recovery Time
Kidney.org - September 1, 2010Submitted by Mr CS Soong
(New York, NY) – -- Hemodialysis patients who transitioned
from in-center to daily home dialysis regimens experienced
significant improvements in depressive symptoms and
post-dialysis recovery times, according to a new report
published today in the American Journal of KidneyDiseases,
the official journal of the National Kidney Foundation.
Patients who made the switch from the normal, thrice weekly
in-center treatment regimen to a daily schedule, defined as
six times per week, reported more than a 30% decline in
depressive symptoms and an 87% drop in post-dialysis
recovery time over a 12 month period.
The research team assessed 128 patients making the
treatment regimen switch. Patients were assessed upon enrollment
and then again four months and 12 months afterward. The
average training period to complete the transition was 27
days.
“Depression and post-dialysis fatigue are important concerns
for patients with kidney failure,” said Kerry Willis, PhD,
National Kidney Foundation’s Senior Vice President of
Scientific Activities. “These findings suggest that increasing
the number of times a patient dialyzes can improve their
quality of life, which has been linked to fewer trips to the
hospital and a lower mortality rate.”
This report is part of the FREEDOM (Following Rehabilitation,
Economics and Everyday-Dialysis Outcome Measurements)
Study, an ongoing prospective cohort study investigating the
clinical and economic benefits of daily haemodialysis.
“The improvement in depression symptoms may be
directly related to the shortened recovery time and less dramatic
chemical changes with more frequent dialysis,” said Dr.
Fredric Finkelstein, of Yale University School of Medicine and
member of the FREEDOM Study The National Kidney Foundation
is dedicated to preventing andtreating kidney and urinary tract
diseases, improving the health and well being of individuals and
families affected by these diseases and increasing availability of
all organs for transplantation. For more information on kidney
disease, dialysis or a schedule of kidney screenings
visit www.kidney.org.
Friday, September 17, 2010
New Drug Clears Hemodialysis Catheter Clots
New Drug Clears Hemodialysis Catheter Clots
John Schieszer March 31, 2010
Renal & Urology News
TAMPA, Fla.—Tenecteplase, a thrombolytic agent, may significantly improve the function of hemodialysis (HD) catheters blocked by blood clots, according to data from a phase 3 open-label trial.
“It is tremendously promising,” said study investigator Steven Fishbane, MD, Chief of Nephrology at Winthrop University Hospital in Mineola, N.Y. “Clotting has been a big problem. This gives us the first opportunity to help. This agent is a very important development. There are currently no FDA approved agents [for clearing HD catheter clots] so this could become the first approved drug for this purpose.”
Tenecteplase is a recombinant fibrin-specific plasminogen activator and is currently under FDA review. It is derived from tissue plasminogen activator, with modifications at three sites of the protein structure. Tenecteplase binds to the fibrin component of the thrombus and selectively converts thrombus-bound plasminogen to plasmin.
This subsequently degrades the fibrin matrix of the thrombus. The agent is indicated as a thrombolytic therapy for the acute phase of myocardial infarction (MI) for reduction of mortality associated with acute MI.
Read full text here
John Schieszer March 31, 2010
Renal & Urology News
TAMPA, Fla.—Tenecteplase, a thrombolytic agent, may significantly improve the function of hemodialysis (HD) catheters blocked by blood clots, according to data from a phase 3 open-label trial.
“It is tremendously promising,” said study investigator Steven Fishbane, MD, Chief of Nephrology at Winthrop University Hospital in Mineola, N.Y. “Clotting has been a big problem. This gives us the first opportunity to help. This agent is a very important development. There are currently no FDA approved agents [for clearing HD catheter clots] so this could become the first approved drug for this purpose.”
Tenecteplase is a recombinant fibrin-specific plasminogen activator and is currently under FDA review. It is derived from tissue plasminogen activator, with modifications at three sites of the protein structure. Tenecteplase binds to the fibrin component of the thrombus and selectively converts thrombus-bound plasminogen to plasmin.
This subsequently degrades the fibrin matrix of the thrombus. The agent is indicated as a thrombolytic therapy for the acute phase of myocardial infarction (MI) for reduction of mortality associated with acute MI.
Read full text here
Wednesday, September 15, 2010
Tuesday, September 14, 2010
Effect of intravenous ascorbic acid in hemodialysis patients
Effect of intravenous ascorbic acid in hemodialysis patients with anemia and hypeferritinemia
Keyhanian Shahrbanoo1, Omolbanin Taziki2
1 Department of Oncology, Azad University of Tonekabon, Ramsar, Iran
2 Department of Nephrology, Mazandaran University of Medical Science, Sari, Iran
Saudi J Kidney Dis Transpl 2008;19:933-6
Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (Epo). The contributory role of chronic inflammation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with unexplained hyperferritinemia levels.
Thirty-one of 132 with Hb < 11 g/dL were prospectively followed up after exclusion of reasons for Epo hyporesponsiveness. Patients were randomly divided into two groups: 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 15 patients received standard care (group 2). After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%).
Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and adequate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.
Read full text here
Keyhanian Shahrbanoo1, Omolbanin Taziki2
1 Department of Oncology, Azad University of Tonekabon, Ramsar, Iran
2 Department of Nephrology, Mazandaran University of Medical Science, Sari, Iran
Saudi J Kidney Dis Transpl 2008;19:933-6
Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (Epo). The contributory role of chronic inflammation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with unexplained hyperferritinemia levels.
Thirty-one of 132 with Hb < 11 g/dL were prospectively followed up after exclusion of reasons for Epo hyporesponsiveness. Patients were randomly divided into two groups: 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 15 patients received standard care (group 2). After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%).
Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and adequate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.
Read full text here
Thursday, September 9, 2010
Monday, September 6, 2010
Body Composition and Outcomes in Chronic Hemodialysis Patients
Body Composition and Outcomes in Chronic Hemodialysis Patients
Hirachan P, Thijssen S, Levin N, Kotanko P
Ronco C, Cruz DN (eds): Hemodialysis - From Basic Research to Clinical Trials. Contrib Nephrol. Basel, Karger, 2008, vol 161, pp 108-114 (DOI: 10.1159/000130422)
Abstract:
In contrast to epidemiological data from the general population, maintenance hemodialysis (MHD) patients with a naturally small body size experience an increased mortality rate compared to their larger fellow patients. Since body mass index is a poor surrogate of body composition, attempts were made to delineate muscle, fat and visceral organ mass in MHD patients. Several lines of evidence indicate that (a) increased fat and muscle mass exerts protective effects, (b) some markers of inflammation may be increased with fat mass, and (c) a high visceral mass per body weight is associated with a reduced survival time. The reasons for the positive effects of fat and muscle mass on survival are not clear. A novel hypothesis predicts lower uremic toxin concentrations in larger subjects. This is based on the observation that both in healthy subjects and in dialysis patients, visceral organ mass is inversely related to body mass. Since visceral organs are the most prominent source of uremic toxins, large patients may have a lower toxin production rate per unit of body mass. Moreover, large patients have a greater volume of distribution (total body water, fat mass) resulting in lower toxin concentrations. Future studies should aim to tackle the Janus-like duality of obesity by a system biology approach.
PMID: 18451665 [PubMed - indexed for MEDLINE]
Hirachan P, Thijssen S, Levin N, Kotanko P
Ronco C, Cruz DN (eds): Hemodialysis - From Basic Research to Clinical Trials. Contrib Nephrol. Basel, Karger, 2008, vol 161, pp 108-114 (DOI: 10.1159/000130422)
Abstract:
In contrast to epidemiological data from the general population, maintenance hemodialysis (MHD) patients with a naturally small body size experience an increased mortality rate compared to their larger fellow patients. Since body mass index is a poor surrogate of body composition, attempts were made to delineate muscle, fat and visceral organ mass in MHD patients. Several lines of evidence indicate that (a) increased fat and muscle mass exerts protective effects, (b) some markers of inflammation may be increased with fat mass, and (c) a high visceral mass per body weight is associated with a reduced survival time. The reasons for the positive effects of fat and muscle mass on survival are not clear. A novel hypothesis predicts lower uremic toxin concentrations in larger subjects. This is based on the observation that both in healthy subjects and in dialysis patients, visceral organ mass is inversely related to body mass. Since visceral organs are the most prominent source of uremic toxins, large patients may have a lower toxin production rate per unit of body mass. Moreover, large patients have a greater volume of distribution (total body water, fat mass) resulting in lower toxin concentrations. Future studies should aim to tackle the Janus-like duality of obesity by a system biology approach.
PMID: 18451665 [PubMed - indexed for MEDLINE]
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