Treat all patients equally
Letter to the Editor
Darryl S. C. Goon
President, Medico-Legal Society of Malaysia
The Sun ePaper
http://www.sun2surf.com/article.cfm?id=53426
The Medico-Legal Society of Malaysia views with grave concern the report by the auditor-general of shoddy repairs and upgrading work in government clinics. Some of the shortcomings render the facilities unsafe for patients. There are others that are potential health hazards.
It is time for the government to extend the provisions of the Private Healthcare Facilities & Services Act 1998 (ACT 586) to government clinics and hospitals. This legislation sets out what are essentially the minimum acceptable standards to be expected from private healthcare facilities. The provisions are comprehensive.
Why are these minimum standards not required of government hospitals and medical clinics? One cannot countenance double standards in healthcare. It is urged that the government acknowledges that all patients, including those in government hospitals and medical and dental clinics, should be entitled to the benefits of the minimum standards imposed under the Act. While there may be practical problems these should not be allowed to impede an acceptance of the fact that minimum standards for medical and dental care must apply to all patients, whether in government hospitals or private hospitals, without discrimination.
The minimum standards may be brought into effect progressively. The first step is for the government to recognise that all patients are to be treated equally.
Friday, October 29, 2010
Sleep Disorders........
Sleep disorders in hemodialysis patients
Alaa A Sabry1, Hamdy Abo-Zenah2, Ehab Wafa1, Khaled Mahmoud1, Khaled El-Dahshan1, Ahmed Hassan1, Tarek Medhat Abbas1, Abd El-Baset M Saleh3, Kamal Okasha4
1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt
Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2010 Oct 28];21:300-5
Abstract
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni¬versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques¬tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa¬tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno¬graphy, is necessary to confirm our results. Interventional studies for management of sleep disor¬ders in HD patients are warranted.
Read More Here
Alaa A Sabry1, Hamdy Abo-Zenah2, Ehab Wafa1, Khaled Mahmoud1, Khaled El-Dahshan1, Ahmed Hassan1, Tarek Medhat Abbas1, Abd El-Baset M Saleh3, Kamal Okasha4
1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt
Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2010 Oct 28];21:300-5
Abstract
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni¬versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques¬tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa¬tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno¬graphy, is necessary to confirm our results. Interventional studies for management of sleep disor¬ders in HD patients are warranted.
Read More Here
Tuesday, October 26, 2010
Kidney patients overcharged by RM140k .....
Free Malaysia Today
By Stephanie Sta Maria
KUALA LUMPUR: Kidney failure is a heavy load to carry in life. More so when the hospital where treatment is sought overcharges.
The Auditor-General's 2009 report, tabled in Parliament yesterday, found that 10,101 patients at five hospitals nationwide paid a total of RM143, 329 in excess fees between 2007-2009.
The five are Sultanah Bahiyah Hospital in Kedah, Kuala Lumpur Hospital, Malacca Hospital, Sultanah Nur Zahirah Hospital in Terengganu and the Sarawak General Hospital.
Read more here
By Stephanie Sta Maria
KUALA LUMPUR: Kidney failure is a heavy load to carry in life. More so when the hospital where treatment is sought overcharges.
The Auditor-General's 2009 report, tabled in Parliament yesterday, found that 10,101 patients at five hospitals nationwide paid a total of RM143, 329 in excess fees between 2007-2009.
The five are Sultanah Bahiyah Hospital in Kedah, Kuala Lumpur Hospital, Malacca Hospital, Sultanah Nur Zahirah Hospital in Terengganu and the Sarawak General Hospital.
Read more here
Friday, October 22, 2010
Proposed Standards for Hemodialysis Practices - What it means to you?
We are very concerned with the response or should we say "lack of response and participation" from the management of private and NGO dialysis centres and also organizations representing patients during the recently concluded 8th NKF Annual Dialysis Meeting 2010 at Berjaya Times Square Hotel, Kuala Lumpur.
The NKFM (National Kidney Foundation Malaysia) together with the Nephrology Department, HKL should be commended to have initiated works to propose a Standards for Hemodialysis Parctices in Malaysia. Work groups were formed by NKFM with invitations to all stakeholders such as local Medical Consultants, Government agencies, private & NGO Dialysis organizations and suppliers.
The work groups were entrusted to come up with different components of a draft of Standards for Hemodialysis Practices in Malaysia. This draft was presented during the recent NKFM meeting to those involved in the industry for their feedback and opinion. Although the draft presented was not a complete document nevertheless it is a very important document to start with and having very far fetching implications to patients and all concerned in the industry.
During the just concluded NKFM meeting, the representative from the local Medical Consultants were spot on with his views concerning their roles and responsibilities. However representative from the Private & NGO centres were very "silent" to the proposals presented at the meeting. It leads us to conclude that the "right people" from the Private & NGO organizations were missing from the meeting.
It is our hope that once the completed draft document is ready, a roadshow be held to informed all those concerned again of its contents and obtain feedback and opinion before the proposal is presented to the KKM for consideration and approval.
Once again kudos to NKFM and Nephrology Depratment, HKL for initiating the proposal. To the other various players....PLEASE SIT UP, TAKE NOTE AND PARTICIPATE!!!
The NKFM (National Kidney Foundation Malaysia) together with the Nephrology Department, HKL should be commended to have initiated works to propose a Standards for Hemodialysis Parctices in Malaysia. Work groups were formed by NKFM with invitations to all stakeholders such as local Medical Consultants, Government agencies, private & NGO Dialysis organizations and suppliers.
The work groups were entrusted to come up with different components of a draft of Standards for Hemodialysis Practices in Malaysia. This draft was presented during the recent NKFM meeting to those involved in the industry for their feedback and opinion. Although the draft presented was not a complete document nevertheless it is a very important document to start with and having very far fetching implications to patients and all concerned in the industry.
During the just concluded NKFM meeting, the representative from the local Medical Consultants were spot on with his views concerning their roles and responsibilities. However representative from the Private & NGO centres were very "silent" to the proposals presented at the meeting. It leads us to conclude that the "right people" from the Private & NGO organizations were missing from the meeting.
It is our hope that once the completed draft document is ready, a roadshow be held to informed all those concerned again of its contents and obtain feedback and opinion before the proposal is presented to the KKM for consideration and approval.
Once again kudos to NKFM and Nephrology Depratment, HKL for initiating the proposal. To the other various players....PLEASE SIT UP, TAKE NOTE AND PARTICIPATE!!!
Thursday, October 14, 2010
Determining Optimum Hemoglobin Sampling.....
Determining Optimum Hemoglobin Sampling for Anemia Management
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
Abstract read here
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
Abstract read here
Wednesday, October 13, 2010
Congratulations
Datuk Dr. Ghazali Bin Ahmad
Senior Consultant Nephrologist & Head of Nephrology Department,
Hospital Kuala Lumpur
on being confered the
PANGLIMA JASA NEGARA (P.J.N.)
By
Yang Di-Pertuan Agung Malaysia XIII
Seri Paduka Baginda Yang Di-Pertuan Agong
Al-Wathiqu Billah Tuanku Mizam Zainal Abidin Ibni Al-Marhum
Sultan Mahmud Al-Muktafi Billah Shah
on the occasion of His Royal Highness' Birthday
on 5th June 2010 / 22 Jamadilakhir 1431H
Best Wishes and Warmest Regards
MalaysianKidneySPA
Saturday, October 9, 2010
Reader's comments....
We have received with thanks a comment each from a reader, Mr Yudi on the following articles which appeared on this blog, kindly checkout his comments by clicking the articles below:
2. New Drug Clears Hemodialysis Catheter Clots September 17, 2010
Wednesday, October 6, 2010
Amgen Recalls Products......
Amgen Recalls Products for Glass Flakes
Sept. 30, 2010
By: Angie Drakulich
EPT--the Electronic Newsletter of Pharmaceutical Technology
Amgen (Thousand Oaks, CA) issued a voluntary recall last week of certain lots of Epogen and Procrit (epoetin alfa) vials. The injectable products, used to treat anemia related to HIV therapy, chronic renal failure, and chemotherapy, may contain “extremely thin glass flakes (lamellae) that are barely visible,” says the press release. The lamellae, says the release, resulted from the interaction of the formulation with glass vials over the shelf life of the product. Approximately 200 lots of Epogen are being recalled, and 155 of Procrit are being recalled. Potential financial implications have not been released.
The company, along with Centocor Ortho Biotech Products, the authorized distributor of Procrit in the United States, found that the glass flakes have low potential for affecting patients. Although there have been no adverse event reports or complaints [as of Sept. 24, 2010], “potential serious adverse events resulting from the use of a sterile injectable product with particulates by the intravenous route include embolic, thrombotic, and other vascular events (e.g., phlebitis), and by the subcutaneous route include foreign body granuloma, local injection site reactions, and increased immunogenicity,” according to the Amgen release.
The recall is being conducted in cooperation with the US Food and Drug Administration. Of note, Amgen is the manufacturer of both Epoetin alfa products, which are manufactured in Puerto Rico, but Johnson & Johnson licenses and markets the product under the Procrit brand.
Article read here
Sept. 30, 2010
By: Angie Drakulich
EPT--the Electronic Newsletter of Pharmaceutical Technology
Amgen (Thousand Oaks, CA) issued a voluntary recall last week of certain lots of Epogen and Procrit (epoetin alfa) vials. The injectable products, used to treat anemia related to HIV therapy, chronic renal failure, and chemotherapy, may contain “extremely thin glass flakes (lamellae) that are barely visible,” says the press release. The lamellae, says the release, resulted from the interaction of the formulation with glass vials over the shelf life of the product. Approximately 200 lots of Epogen are being recalled, and 155 of Procrit are being recalled. Potential financial implications have not been released.
The company, along with Centocor Ortho Biotech Products, the authorized distributor of Procrit in the United States, found that the glass flakes have low potential for affecting patients. Although there have been no adverse event reports or complaints [as of Sept. 24, 2010], “potential serious adverse events resulting from the use of a sterile injectable product with particulates by the intravenous route include embolic, thrombotic, and other vascular events (e.g., phlebitis), and by the subcutaneous route include foreign body granuloma, local injection site reactions, and increased immunogenicity,” according to the Amgen release.
The recall is being conducted in cooperation with the US Food and Drug Administration. Of note, Amgen is the manufacturer of both Epoetin alfa products, which are manufactured in Puerto Rico, but Johnson & Johnson licenses and markets the product under the Procrit brand.
Article read here
Monday, October 4, 2010
Treatment of secondary hyperparathyroidism in haemodialysis patients...
Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomised clinical trial comparing paricalcitol and alfacalcidol
Ditte Hansen1* email, Lisbet Brandi1,2* email and Knud Rasmussen1,2* email
1 Medical Department, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark
2 Department of Surgery and Internal Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
BMC Nephrology 2009, 10:28doi:10.1186/1471-2369-10-28
Abstract
Background
Secondary hyperparathyroidism is a common feature in patients with chronic kidney disease. Its serious clinical consequences include renal osteodystrophy, calcific uremic arteriolopathy, and vascular calcifications that increase morbidity and mortality.
Reduced synthesis of active vitamin D contributes to secondary hyperparathyroidism. Therefore, this condition is managed with activated vitamin D. However, hypercalcemia and hyperphosphatemia limit the use of activated vitamin D.
In Denmark alfacalcidol is the primary choice of vitamin D analog.
A new vitamin D analog, paricalcitol, may be less prone to induce hypercalcemia and hyperphosphatemia.
However, a randomised controlled clinical study comparing alfacalcidol and paricalcitol has never been performed.
The primary objective of this study is to compare alfacalcidol and paricalcitol. We evaluate the suppression of the secondary hyperparathyroidism and the tendency towards hyperphosphatemia and hypercalcemia.
Methods/Design
This is an investigator-initiated cross-over study. Nine Danish haemodialysis units will recruit 117 patients with end stage renal failure on maintenance haemodialysis therapy.
Patients are randomised into two treatment arms. After a wash out period of 6 weeks they receive increasing doses of alfacalcidol or paricalcitol for a period of 16 weeks and after a further wash out period of 6 weeks they receive the contrary treatment (paricalcitol or alfacalcidol) for 16 weeks.
Discussion
Hyperparathyroidism, hypercalcemia and hyperphosphatemia are associated with increased cardiovascular mortality in patients with chronic kidney disease.
If there is any difference in the ability of these two vitamin D analogs to decrease the secondary hyperparathyroidism without causing hypercalcemia and hyperphosphatemia, there may also be a difference in the risk of cardiovascular mortality depending on which vitamin D analog that are used. This has potential major importance for this group of patients.
Read full text here
Ditte Hansen1* email, Lisbet Brandi1,2* email and Knud Rasmussen1,2* email
1 Medical Department, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark
2 Department of Surgery and Internal Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
BMC Nephrology 2009, 10:28doi:10.1186/1471-2369-10-28
Abstract
Background
Secondary hyperparathyroidism is a common feature in patients with chronic kidney disease. Its serious clinical consequences include renal osteodystrophy, calcific uremic arteriolopathy, and vascular calcifications that increase morbidity and mortality.
Reduced synthesis of active vitamin D contributes to secondary hyperparathyroidism. Therefore, this condition is managed with activated vitamin D. However, hypercalcemia and hyperphosphatemia limit the use of activated vitamin D.
In Denmark alfacalcidol is the primary choice of vitamin D analog.
A new vitamin D analog, paricalcitol, may be less prone to induce hypercalcemia and hyperphosphatemia.
However, a randomised controlled clinical study comparing alfacalcidol and paricalcitol has never been performed.
The primary objective of this study is to compare alfacalcidol and paricalcitol. We evaluate the suppression of the secondary hyperparathyroidism and the tendency towards hyperphosphatemia and hypercalcemia.
Methods/Design
This is an investigator-initiated cross-over study. Nine Danish haemodialysis units will recruit 117 patients with end stage renal failure on maintenance haemodialysis therapy.
Patients are randomised into two treatment arms. After a wash out period of 6 weeks they receive increasing doses of alfacalcidol or paricalcitol for a period of 16 weeks and after a further wash out period of 6 weeks they receive the contrary treatment (paricalcitol or alfacalcidol) for 16 weeks.
Discussion
Hyperparathyroidism, hypercalcemia and hyperphosphatemia are associated with increased cardiovascular mortality in patients with chronic kidney disease.
If there is any difference in the ability of these two vitamin D analogs to decrease the secondary hyperparathyroidism without causing hypercalcemia and hyperphosphatemia, there may also be a difference in the risk of cardiovascular mortality depending on which vitamin D analog that are used. This has potential major importance for this group of patients.
Read full text here
Friday, October 1, 2010
The ultrafiltration coefficient of a dialyser (KUF).....
The ultrafiltration coefficient of a dialyser (KUF) is not a fixed value, and it follows a parabolic function: the new concept of KUF max
Submitted by Mr CS Soong
Nephrol. Dial. Transplant. (2010) - First published online: September 8, 2010 - doi: 10.1093/ndt/gfq510
Alain Ficheux 1, Peter G. Kerr 2, Philippe Brunet 3 and Àngel Argilés1,4
1 RD—Néphrologie, 104, rue de la Galéra, Ecole Nationale Supérieure de Chimie, 34090 Montpellier, France
2 Department of Nephrology, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
3 Service de Néphrologie, Hôpital de La Conception—Université Aix-Marseille, 13005 Marseille, France
4 Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, 3420 4Sète, France
Abstract
Background. Hydraulic permeability (KUF) is an intrinsic characteristic of dialysers, reported by the manufacturer as a single value, which drives and limits fluid removal. High-flux dialysers have been introduced with the appearance of convective techniques, aiming to increase fluid and solute removal. High convective volumes are being employed, although their advantages have not been fully demonstrated.
Methods. We assessed KUF over a pre-selected range of ultrafiltration rates (QUF) in post-dilutional haemodiafiltration and high-flux haemodialysis.
Results. KUF vs QUF was neither a fixed value nor a linear function but followed a parabolic function with a vertex der (y) = 0, which we have called KUF max. This also held true in high-flux routine dialysis.
Conclusions. These findings are completely new and have clear applications in clinics. The vertex point might be used to define the optimal QUF of a dialysis system, which would be that obtained at KUF max and corresponds to the best QUF/transmembrane pressure ratio, as opposed to the maximum QUF (which corresponds to the highest possible QUF), frequently associated with haemoconcentration, clotting, loss in dialyser surface area, and treatment problems. Determining KUF max in vivo could be of help in dialysis prescription and control with automatic systems.
Abstract found here
Submitted by Mr CS Soong
Nephrol. Dial. Transplant. (2010) - First published online: September 8, 2010 - doi: 10.1093/ndt/gfq510
Alain Ficheux 1, Peter G. Kerr 2, Philippe Brunet 3 and Àngel Argilés1,4
1 RD—Néphrologie, 104, rue de la Galéra, Ecole Nationale Supérieure de Chimie, 34090 Montpellier, France
2 Department of Nephrology, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
3 Service de Néphrologie, Hôpital de La Conception—Université Aix-Marseille, 13005 Marseille, France
4 Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, 3420 4Sète, France
Abstract
Background. Hydraulic permeability (KUF) is an intrinsic characteristic of dialysers, reported by the manufacturer as a single value, which drives and limits fluid removal. High-flux dialysers have been introduced with the appearance of convective techniques, aiming to increase fluid and solute removal. High convective volumes are being employed, although their advantages have not been fully demonstrated.
Methods. We assessed KUF over a pre-selected range of ultrafiltration rates (QUF) in post-dilutional haemodiafiltration and high-flux haemodialysis.
Results. KUF vs QUF was neither a fixed value nor a linear function but followed a parabolic function with a vertex der (y) = 0, which we have called KUF max. This also held true in high-flux routine dialysis.
Conclusions. These findings are completely new and have clear applications in clinics. The vertex point might be used to define the optimal QUF of a dialysis system, which would be that obtained at KUF max and corresponds to the best QUF/transmembrane pressure ratio, as opposed to the maximum QUF (which corresponds to the highest possible QUF), frequently associated with haemoconcentration, clotting, loss in dialyser surface area, and treatment problems. Determining KUF max in vivo could be of help in dialysis prescription and control with automatic systems.
Abstract found here
Subscribe to:
Posts (Atom)