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Kidney & Blood Pressure Research 2023Hemodialysis is one of the most resources consuming medical intervention. Due to its concept, the proper amount of dialysis fluid passed through dialyzer is crucial to... (Review)
Review
BACKGROUND
Hemodialysis is one of the most resources consuming medical intervention. Due to its concept, the proper amount of dialysis fluid passed through dialyzer is crucial to obtain the expected outcomes. The most frequent source of dialysis fluid is production from liquid concentrate (delivered in containers or plastic bags) in dialysis machine. Alternatively, concentrates for dialysis may be produced in dialysis center by dilution in mixing devices dry or semidry premixed compounds connected with system of central dialysis fluid delivery system. Dialysate consumption depends on various factors like type of hemodialysis machine, session duration, prescribed flow, etc. Summary: Modern hemodialysis machines are equipped with the modules which automatically reduce flow rate of dialysis fluid to the patient blood flow and minimize dialysate consumption during preparation and after reinfusion. Smart using of available options offered by manufacturers allows to save additional portion of acid concentrate and water. The weight of concentrates to be delivered to the dialysis center is the major factor influencing the cost (financial and environmental) of transportation from the manufacturer to the final consumer. The crisis on the energy carriers market and extremely high fuel prices made the transportation cost one of the significant costs of the treatment, which must be bear by supplier and finally influence on the price of goods.
KEY MESSAGES
The careful choice of the concentrate delivery system can improve cost-effectiveness of dialysis. Such solutions implemented in dialysis unit helps make significant savings and decrease the impact on natural environment by carbon footprint reduction.
Topics: Humans; Renal Dialysis; Dialysis Solutions
PubMed: 37166319
DOI: 10.1159/000530439 -
Critical Care Medicine Nov 2020
Topics: Bicarbonates; Carbon Dioxide; Dialysis Solutions; Renal Dialysis
PubMed: 33038165
DOI: 10.1097/CCM.0000000000004591 -
Clinical Journal of the American... Sep 2018
Topics: Calcinosis; Dialysis Solutions; Humans; Kidney Failure, Chronic; Magnesium
PubMed: 30131426
DOI: 10.2215/CJN.08380718 -
Seminars in Dialysis 2015The control of serum phosphorus by dialysis is made difficult by the fact that intradialytic blood levels tend to be low, and because phosphorus is removed almost... (Review)
Review
The control of serum phosphorus by dialysis is made difficult by the fact that intradialytic blood levels tend to be low, and because phosphorus is removed almost exclusively from the plasma during its passage through the dialyzer. The most practical way to increase phosphorus removal is to extend dialysis time, although attention to dialysis efficiency (surface area, advanced membrane, and higher blood and dialysate flow rates) also plays a role. Benefits of hemodiafiltration in helping control serum phosphorus have been claimed, but not found in all studies. Because serum phosphorus levels tend to plateau during the later parts of a dialysis session, extending weekly dialysis time is of greater benefit for phosphorus removal than for urea removal. Increasing dialysis frequency also probably has a small benefit. It appears that 18-30 hours of dialysis per week are required to obviate the need for phosphorus binders. Several promising models of phosphorus kinetics are under development. These may help predict the change in treatment on serum phosphorus levels, but their ability to do so has not yet been critically assessed.
Topics: Dialysis Solutions; Humans; Kidney Failure, Chronic; Phosphorus; Renal Dialysis
PubMed: 26358370
DOI: 10.1111/sdi.12439 -
American Journal of Kidney Diseases :... Jun 2020
Topics: Dialysis Solutions; Glucose; Humans; Icodextrin; Peritoneal Dialysis; Randomized Controlled Trials as Topic
PubMed: 32276806
DOI: 10.1053/j.ajkd.2019.12.012 -
Blood Purification 2019Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given... (Review)
Review
BACKGROUND
Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume.
SUMMARY
The choice of DCa may have important short- and long-term consequences. While lower DCa (especially < 2.5 mEq/L) concentrations have been associated with an increased risk of sudden cardiac death in observational studies, DCa in the higher ranges (3.0 mEq/L and above) may contribute to vascular pathology. Intra-dialytic hemodynamics may also be affected by the choice of DCa. In general, lower DCa concentrations are associated with an increase, and higher DCa concentrations with a decrease in parathyroid hormone (PTH) levels. Preliminary data has suggested that a DCa of 2.75 mEq/L may help in obtaining a net zero intradialytic Ca balance in individual patients, but clinical experience is still limited. Key Message: The optimal Ca balance depends on multiple parameters including blood Ca levels, PTH and the use of phosphate binders and vitamin D analogues, as well as on the risk of hemodynamic stability and cardiac arrhythmias. Therefore, DCa prescription should be individualised. A DCa of 2.75 mEq/L may be useful adjunct for dialysis providers.
Topics: Calcium; Death, Sudden, Cardiac; Dialysis Solutions; Hemodynamics; Humans; Parathyroid Hormone
PubMed: 30517930
DOI: 10.1159/000494584 -
Critical Care Medicine Feb 2018
Topics: Calcium Citrate; Critical Illness; Dialysis Solutions; Heparin; Humans; Renal Dialysis
PubMed: 29337814
DOI: 10.1097/CCM.0000000000002858 -
Revue Medicale Suisse Feb 2016Peritoneal dialysis is a dialysis modality used worldwide. Despite offering several advantages, its prevalence in Switzerland in end stage renal disease population is... (Review)
Review
Peritoneal dialysis is a dialysis modality used worldwide. Despite offering several advantages, its prevalence in Switzerland in end stage renal disease population is dramatically lower than hemodialysis (7.3% vs 92.7% in 2014) although its incidence has recently progressed. Technically, a catheter is inserted into the Douglas' pouch, enabling dialysate to be infused into the peritoneal cavity. The peritoneum acts as a semi-permeable membrane allowing for the removal of toxic substances and excess water. In the following article we will give an overview of peritoneal dialysis including its technical modalities, indications and main advantages as well as its contraindications and complications.
Topics: Contraindications; Dialysis Solutions; Humans; Kidney; Kidney Failure, Chronic; Peritoneal Dialysis; Renal Insufficiency, Chronic; Switzerland
PubMed: 27039607
DOI: No ID Found -
Clinical Journal of the American... Jun 2019
Topics: Dialysis Solutions; Humans; Peritoneal Dialysis
PubMed: 31123182
DOI: 10.2215/CJN.04660419 -
Pediatric Nephrology (Berlin, Germany) Oct 2017Introduction of the so-called biocompatible peritoneal dialysis (PD) fluids was based on a large body of experimental evidence and various clinical trials suggesting... (Review)
Review
Introduction of the so-called biocompatible peritoneal dialysis (PD) fluids was based on a large body of experimental evidence and various clinical trials suggesting important clinical benefits. Of these, until now, only preservation of residual renal function-likely due to lower glucose degradation product load and, in case of icodextrin, improved fluid and blood pressure control-have consistently been proven, whereas the impact on important clinical endpoints such as infectious complications, preservation of PD membrane transport function, and patient outcome, are still debated. In view of the high morbidity and mortality rates of PD patients, novel approaches are warranted and comprise the search for alternative osmotic agents and enrichment of PD fluids with specific pharmacologic agents, such as alanyl-glutamine, potentially counteracting local but also systemic sequelae of uremia and PD.
Topics: Biocompatible Materials; Blood Pressure; Dialysis Solutions; Glucose; Health Services Needs and Demand; Humans; Icodextrin; Kidney Failure, Chronic; Osmosis; Peritoneal Dialysis; Peritoneum; Treatment Outcome
PubMed: 27722783
DOI: 10.1007/s00467-016-3461-y