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Contributions To Nephrology 2018Most hemodialysis (HD) in Japan is based on the central dialysis fluid delivery system (CDDS). With CDDS, there is an improvement in work efficiency, reduction in cost,... (Review)
Review
Most hemodialysis (HD) in Japan is based on the central dialysis fluid delivery system (CDDS). With CDDS, there is an improvement in work efficiency, reduction in cost, and a reduction in regional and institutional differences in dialysis conditions. This has resulted in an improvement in the survival rate throughout Japan. However, as the number of cases with various complications increases, it is necessary to select the optimal dialysis prescription (including hours and frequency) for each individual in order to further improve survival rates. To perform intensive HD, home HD is essential, and various prescriptions have been tried. However, several challenges remain before widespread implementation of home HD can occur.
Topics: Dialysis Solutions; Hemodialysis, Home; Humans; Japan; Renal Dialysis; Survival Rate
PubMed: 30041223
DOI: 10.1159/000485718 -
Seminars in Dialysis Sep 2022High-volume hemodiafiltration involves filtration of >23 L/treatment and its replacement by sterile non-pyrogenic substitution fluid, while maintaining the patient's...
High-volume hemodiafiltration involves filtration of >23 L/treatment and its replacement by sterile non-pyrogenic substitution fluid, while maintaining the patient's fluid balance. That volume of substitution fluid precludes the use of prepackaged sterile fluid. Instead, substitution fluid must be prepared on-line using machines that incorporate a series of bacteria- and endotoxin-retentive filters. The sterilizing ultrafilters are validated to deliver sterile, non-pyrogenic fluid to the patient when operated according to the machine manufacturer's instructions and in compliance with international standards and regulatory oversight. A successful hemodiafiltration program also places important responsibilities on the user. Specifically, the user is responsible for ensuring that the dialysis water or dialysis fluid delivered to the sterilizing filters of the hemodiafiltration machine meets the machine manufacturer's specifications and is consistent with the quality used in the sterilization validation process. The user is also responsible for ensuring that the treatment prescription allows a filtration volume >23 L/treatment to be achieved by careful selection of a dialyzer, blood flow rate and treatment time. Questions related to assurance that the substitution fluid will routinely be sterile and non-pyrogenic have limited the uptake of on-line hemodiafiltration as a therapeutic option in some countries, such as the United States.
Topics: Dialysis Solutions; Endotoxins; Hemodiafiltration; Humans; Renal Dialysis; Water
PubMed: 35315951
DOI: 10.1111/sdi.13073 -
Advances in Renal Replacement Therapy Oct 2002Fluid composition and management are important parts of continuous renal replacement therapy (CRRT). Most commercially available CRRT solutions are able to reestablish... (Review)
Review
Fluid composition and management are important parts of continuous renal replacement therapy (CRRT). Most commercially available CRRT solutions are able to reestablish electrolyte homeostasis provided some phosphate supplementation is given. Supraphysiologic glucose concentrations should be avoided. Predilution fluid replacement allows higher ultrafiltration rates and can be considered as an adjunct to the anticoagulation regimen. Lactate is an effective buffer in most CRRT patients. Bicarbonate is preferred in patients with lactic acidosis and/or liver failure. When citrate is used as anticoagulant, frequent monitoring of pH is required. The clinical consequences of CRRT-induced decreases of body temperature are not clear. Substitution fluid should be sterile, but the bacteriologic requirements for CRRT dialysate are less clear. There is no consensus on the optimal parameters to monitor fluid management. Integrated balancing systems have theoretical advantages over adaptive use of intravenous fluid pumps. Although there is evidence that volume overload is associated with adverse outcome, there is no evidence that fluid removal per se improves outcome in critically ill patients with or without acute renal failure.
Topics: Buffers; Dialysis Solutions; Humans; Practice Guidelines as Topic; Quality Assurance, Health Care; Renal Dialysis
PubMed: 12382232
DOI: 10.1053/jarr.2002.35572 -
Seminars in Dialysis Sep 2022Environment has become a main issue of human activities. Chronic hemodialysis (HD) therapy saves lives but consumes large amounts of water and power and produces a lot...
Environment has become a main issue of human activities. Chronic hemodialysis (HD) therapy saves lives but consumes large amounts of water and power and produces a lot of care-related waste. On-line hemodiafiltration (HDF) improves patients' outcomes but increases water consumption from ultra-pure water needs and infusion volume. New-generation water treatment systems have much reduced the proportion of reject water that can also be reused. Reducing the dialysate flow in standard HD decreases significantly the water consumption but impacts negatively dialysis efficiency. When on-line HDF is prescribed, reducing the dialysate flow may be applied to decrease water needs while maintaining dialysis efficiency. Nowadays, dialysis prescription cannot ignore its impact on natural resources and environment.
Topics: Dialysis Solutions; Environment; Hemodiafiltration; Humans; Renal Dialysis
PubMed: 35560954
DOI: 10.1111/sdi.13093 -
Seminars in Dialysis 2008Calcium balance during hemodialysis (HD) is important in determining short-term cardiovascular function, this influences the hemodynamic tolerability of dialysis. In the... (Review)
Review
Calcium balance during hemodialysis (HD) is important in determining short-term cardiovascular function, this influences the hemodynamic tolerability of dialysis. In the longer term, calcium flux during HD is an important determinant of overall calcium balance in a patient and may also influence the development and progression of vascular calcification, with its attendant consequences. This article aims to review the assessment and mechanisms of calcium flux during HD, choice of dialysate calcium concentration, influence of HD modality, and potential consequences of therapy choices (cardiovascular and skeletal) resulting from an inappropriate intradialytic calcium balance.
Topics: Biological Transport; Calcium; Dialysis Solutions; Humans; Kidney Failure, Chronic; Renal Dialysis
PubMed: 18251956
DOI: 10.1111/j.1525-139X.2007.00368.x -
Seminars in Dialysis Sep 2022On-line hemodiafiltration (OL-HDF) is currently the most advanced form of blood purification modality leading convective-based therapies in end-stage kidney disease...
On-line hemodiafiltration (OL-HDF) is currently the most advanced form of blood purification modality leading convective-based therapies in end-stage kidney disease patients. By adding a high convective component to the diffusive clearance achieved with highly permeable dialyzers, OL-HDF reinforces removal of small MWt compounds and enlarges the spectrum of uremic compounds cleared up to middle and large MWt compounds. The biological and clinical benefits of convective-based therapy are currently also being explored in a revisited hybrid modality, combining an increased internal filtration process with a more open membrane. Regular use of ultrapure dialysis fluid required by convective-based therapies improves the bio-incompatibility of the extracorporeal circuit so reducing inflammatory responses. On-line production of substitution fluid, relying on a cold sterilization by ultrafiltration, has several advantages: First, it is a safe and established process; and second, it provides an unlimited amount of substitution fluid at the same cost as regular ultrapure dialysis fluid. As such, OL-HDF is adaptable to all substitution modalities (post, pre, or mixed-HDF), thus allowing the dialytic convective dose to be adjusted to the individual patient needs. The development of OL-HDF opens new pathways such as task automation simplifying care workflow. All these features make OL-HDF the most versatile dialysis modality that can be now integrated in various treatment schedules according to session time and frequency (daily, nocturnal, or alternate day) or location (incenter, satellite, or potentially home-based therapy).
Topics: Dialysis Solutions; Hemodiafiltration; Humans; Kidney Failure, Chronic; Renal Dialysis
PubMed: 35511703
DOI: 10.1111/sdi.13092 -
Przeglad Lekarski 2011The number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years.... (Review)
Review
UNLABELLED
The number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years. Various methods of extracorporeal liver support have been described in this paper, with particular emphasis on modified single pass albumin dialysis (SPAD).
CONCLUSIONS
1. Single pass albumin dialysis (SPAD) is a promising method of extracorporeal liver support. 2. Due to widespread availability of continuous renal replacement therapy equipment it can be performed in most units providing intensive care. 3. No additional costs due to purchase of equipment or training of personnel are necessary to perform SPAD. 4. Further studies are necessary to establish optimal concentration of human albumin in dialysate and flow rates of blood and dialysate during the procedure. 5. Development of biocompatible replacement of human albumin would promote more frequent use of SPAD.
Topics: Albumins; Dialysis Solutions; End Stage Liver Disease; Fluid Therapy; Humans; Liver Failure, Acute; Renal Dialysis
PubMed: 22010444
DOI: No ID Found -
Nephrology, Dialysis, Transplantation :... Mar 2021
Topics: Dialysis Solutions; Hemodialysis Solutions; Humans; Nephrology; Renal Dialysis; Sodium
PubMed: 33454785
DOI: 10.1093/ndt/gfaa334 -
Contributions To Nephrology 2011Increased salt intake is related to extracellular fluid expansion and a rise in blood pressure, and has been linked to cardiovascular disease. Several studies have also... (Review)
Review
Increased salt intake is related to extracellular fluid expansion and a rise in blood pressure, and has been linked to cardiovascular disease. Several studies have also suggested that sodium can exert detrimental effects via blood pressure-independent mechanisms. Chronic kidney disease patients are particularly susceptible to the negative consequences of sodium loading. While individuals with normal kidney function are able to regulate their sodium balance, hemodialysis patients have to rely virtually entirely on the dialysis procedure for sodium elimination. Tragically, the dialysis procedure has, in many instances, turned into a de facto source of sodium loading rather than a means for sodium removal. The main sources of sodium related to the dialysis procedure are (1) diffusive influx from the dialysate, including inappropriate use of sodium profiling; (2) the use of saline solution for priming and rinsing; and (3) the treatment of intradialytic hypotension and cramps with saline solution. Creating a positive intradialytic sodium balance is effective in acutely reducing the incidence of intradialytic symptoms, but it also sustains a vicious cycle hampering the attainment of dry weight and predisposes the patient to an increased risk of intradialytic complications during the following dialysis session. Avoiding sodium loading in hemodialysis patients is a cornerstone of blood pressure and fluid status management and, therefore, deserves a conscious effort, bearing in mind not only short-term effects but also long-term goals. In the absence of routine means of quantifying sodium balance, sodium profiling should be viewed critically, as it has been shown to induce a positive sodium balance in the majority of cases. A preferred approach under these circumstances may be simple sodium alignment. In combination with the abdication of saline solution for priming, rinsing, and intradialytic infusions, these measures would go a long way to help reduce sodium overload and achieve a more physiologic sodium balance in this patient population.
Topics: Dialysis Solutions; Humans; Renal Dialysis; Sodium
PubMed: 21625095
DOI: 10.1159/000327333 -
Expert Review of Medical Devices Sep 2013The incidence of kidney disease is rapidly increasing worldwide, and techniques and devices for treating end-stage renal disease (ESRD) patients have been evolving.... (Review)
Review
The incidence of kidney disease is rapidly increasing worldwide, and techniques and devices for treating end-stage renal disease (ESRD) patients have been evolving. Better outcomes achieved by convective treatment have encouraged the use of synthetic membranes with high water permeability in clinical setups, and high-flux hemodialysis (HD) and hemodiafiltration (HDF) are now preferred forms of convective therapy in ESRD patients. Push/pull-based dialysis strategies have also been examined to increase convective mass transfer in ESRD patients. The push/pull technique uses the entire membrane as a forward filtration domain for a period of time. However, backfiltration must accompany the forward filtration to compensate for the fluid depletion resulting from the forward filtration, making it necessary to switch the membranes to a backfiltration domain. This paper attempts to describe the advancement of push/pull-based renal supportive treatments in terms of their technical description, hemodialytic efficacy including fluid management accuracy and applicability for clinical use. How the optimization of push and pull actions could translate into better convective efficiency will also be discussed in depth.
Topics: Biomedical Engineering; Dialysis Solutions; Hemodiafiltration; Humans; Pressure; Renal Dialysis
PubMed: 24053254
DOI: 10.1586/17434440.2013.827504