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Kidney International. Supplement Aug 2000Uremia is characterized by gross contamination of body water with a wide spectrum of retained solutes normally excreted by the kidney. The rationale for dialysis therapy... (Review)
Review
Uremia is characterized by gross contamination of body water with a wide spectrum of retained solutes normally excreted by the kidney. The rationale for dialysis therapy is that these retained solutes have concentration-dependent toxicity, which can be ameliorated through removal by dialysis. Apart from the well-established clinical consequences of abnormalities in fluid, electrolyte, acid base metabolism, and retained beta 2-microglobulin (beta 2 m), there is very little understanding of solute-specific uremic toxicity. Evidence is reviewed to demonstrate the following: (1) Many aspects of the uremic syndrome are controlled by adequate dialysis of low molecular weight solutes. (2) Urea can serve as a generic molecule to quantitate the fractional clearance of body water by dialysis (Kt/V) of retained low molecular weight solutes. (3) Urea has no concentration-dependent toxicity, and the generation rate of putative toxic low molecular weight solutes is not proportional to urea generation. The major clinical consequences and controversies stemming from these interrelationships are reviewed. Kinetic approaches to determine Kt/V dose equivalency between intermittent and continuous dialysis therapy are reviewed. We conclude that Kt/V can and will be generalized to describe the kinetics of other solutes such as beta2m as our knowledge of uremic toxicity grows, and hence, it is predicted that it will goeth and goeth and goeth.
Topics: Dialysis Solutions; Humans; Kidney Failure, Chronic; Nephrology; Renal Dialysis; Uremia
PubMed: 10936795
DOI: 10.1046/j.1523-1755.2000.07602.x -
British Medical Journal Mar 1970
Topics: Arteriovenous Shunt, Surgical; Humans; Methods; Renal Dialysis
PubMed: 5440248
DOI: 10.1136/bmj.1.5696.630-a -
Nephron. Clinical Practice 2013The features of ageing complicate the management of end-stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with... (Review)
Review
The features of ageing complicate the management of end-stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with interventional treatments and quality of life. The presence of other illnesses and comorbidity associated with kidney disease mean that many patients have a poor prognosis. It is therefore important to consider the impact of dialysis on lifestyle and whether survival will actually be improved for frail older patients. This review article considers how haemodialysis and peritoneal dialysis can be adjusted for older patients, and, in particular, how the use of assistance makes peritoneal dialysis more feasible. Most importantly, older patients should be given realistic information about their prognosis and how they can cope with different treatment options, and then they should be involved in the decisions about their management.
Topics: Aged; Humans; Kidney Failure, Chronic; Kidney Transplantation; Peritoneal Dialysis; Quality of Life; Renal Dialysis; Treatment Outcome
PubMed: 24401747
DOI: 10.1159/000357433 -
The Netherlands Journal of Medicine May 2018Home haemodialysis (HHD) has gained popularity in recent years, due to improved clinical outcomes associated with frequent or prolonged haemodialysis sessions, best... (Review)
Review
Home haemodialysis (HHD) has gained popularity in recent years, due to improved clinical outcomes associated with frequent or prolonged haemodialysis sessions, best achievable at home. However, several barriers to HHD are perceived by the physician and patient, among which lack of experience and education, logistic difficulties and reimbursement issues seem to be the most important ones. HHD, in particular when performed with intensified frequency or duration, is associated with improved quality of life, blood pressure control and survival. Serious adverse events are rare; however, more vascular access complications arise due to frequent needling. This emphasises the importance of comprehensive education and training. This review aims to provide the physician with a detailed state of the art overview on HHD in the Netherlands, discussing potential barriers and benefits, and offering practical advice.
Topics: Arteriovenous Shunt, Surgical; Catheters, Indwelling; Fear; Humans; Kidney Failure, Chronic; Netherlands; Patient Acceptance of Health Care; Patient Education as Topic; Patient Selection; Renal Dialysis; Sanitary Engineering; Self Care; Self Efficacy; Survival Rate; Vascular Access Devices
PubMed: 29845936
DOI: No ID Found -
Blood Purification 2015Asia is a huge and populous continent with diverse economies where the status of renal replacement therapy varies among different countries. (Review)
Review
BACKGROUND
Asia is a huge and populous continent with diverse economies where the status of renal replacement therapy varies among different countries.
SUMMARY
The penetration of dialysis is poor among low income countries like India and China. A lack of trained nephrologists and limited numbers of dialysis facilities plague South Asian countries. Most of the hemodialysis centers are in the private sector; the few centers that are government-run or run by charitable organizations cannot meet growing needs. China has shown that twice-a-week hemodialysis can be feasible in female patients with small build. Peritoneal dialysis (PD) has less penetration among the developing countries than the developed countries in Asia. Novel schemes in India including the 'once-in-a-lifetime payment' scheme and an insurance scheme for peritonitis are attracting more patients to PD. New biocompatible PD solutions and home care facilities have brought down the peritonitis rates. The PD-first policy in Thailand alongside the domestic manufacture of PD fluids has decreased the cost of PD there. Iran has shown drastic changes in its PD policy (from 0 to 1,150 recruitments in 5 years) in spite of its high transplantation rate. Home hemodialysis is practiced in mostly affluent countries like Japan, where again it accounts for only 0.1% of all hemodialysis.
KEY MESSAGES
Developing countries should have more budgetary allocation for chronic ailments such as chronic kidney disease that can be utilized for training programs and establishing dialysis units, and thus meet the growing demands for renal replacement therapy. PD should be encouraged and adopted as first modality of renal replacement therapy considering its ease and economy.
Topics: Asia; Delivery of Health Care; Health Facilities; Hemodiafiltration; Hemodialysis, Home; Humans; Peritoneal Dialysis, Continuous Ambulatory; Renal Dialysis; Renal Replacement Therapy; Socioeconomic Factors; Workforce
PubMed: 26656132
DOI: 10.1159/000441574 -
Clinical Journal of the American... May 2018Dialysis technologies have continued to advance over recent decades; however, these advancements have not always been met with improved patient outcomes. In part, the... (Review)
Review
Dialysis technologies have continued to advance over recent decades; however, these advancements have not always been met with improved patient outcomes. In part, the high morbidity and mortality associated with dialysis have been attributed to a group of uremic toxins, which are described as "difficult to remove." With a new generation of hemodialysis membranes now making meaningful clearance of these molecules possible, it is an apt time to review the clinical relevance of these middle molecules. Our review describes the developments in membrane technology that enable the removal of large middle molecules (molecular mass >15 kD) that is limited with high-flux dialysis membranes. Of the known 58 middle molecules, a literature search identified 27 that have molecular mass >15 kD. This group contains cytokines, adipokines, hormones, and other proteins. These molecules are implicated in chronic inflammation, atherosclerosis, structural heart disease, and secondary immunodeficiency in the literature. Single-center safety and efficacy studies have identified that use of these membranes in maintenance dialysis populations is associated with limited loss of albumin and increased clearance of large middle molecules. Larger, robustly conducted, multicenter studies are now evaluating these findings. After completion of these safety and efficacy studies, the perceived clinical benefits of providing clearance of large middle molecules must be assessed in rigorously conducted, randomized clinical studies.
Topics: Atherosclerosis; Cardiomegaly; Cytokines; Humans; Kidney Failure, Chronic; Membranes, Artificial; Renal Dialysis; Uremia
PubMed: 29507008
DOI: 10.2215/CJN.10110917 -
Saudi Journal of Kidney Diseases and... Feb 2022Vascular access (VA) care is considered the "Achilles heel" for the success of hemodialysis operation. Early detection of VA stenosis remains a major challenge for... (Review)
Review
Vascular access (VA) care is considered the "Achilles heel" for the success of hemodialysis operation. Early detection of VA stenosis remains a major challenge for clinical nephrologists. Various studies tried to create methods with robust accuracy for assessing VA blood flow. It is estimated that roughly 80% of VAs fail due to thrombosis. Failure to provide patients with one is a common factor leading to significant morbidity and mortality among hemodialysis (HD) patients with an estimated annual cost around 1 billion US dollars. In the following, we have attempted to review all the available trials and meta-analysis done to date to assess the true effect of VA blood flow monitoring for the purpose of early detection of thrombosis and over-minimizing the rate of intervention. A thorough and systematic search for the available literature was done on several databases such as MEDLINE, EMBASE, Cochrane library and reviewed clinical trials.gov to look for studies involving dialysis access blood flow measurement. We also reviewed the available randomized control trials and meta-analysis done on this subject so far, and the results have a variable outcome. We concluded that arteriovenous access blood flow surveillance using non-invasive ultrasound dilution and Doppler ultrasound methods in detecting stenosis may have a vital and crucial role in lowering the risk of thrombosis, promoting early management and increasing access survival.
Topics: Humans; Arteriovenous Shunt, Surgical; Constriction, Pathologic; Renal Dialysis; Thrombosis; Ultrasonography; Ultrasonography, Doppler
PubMed: 37102526
DOI: 10.4103/1319-2442.367827 -
Blood Purification 2015Improvements in the biocompatibility of dialysis membranes have reduced biological responses elicited by blood-membrane interactions. In this article, recent... (Review)
Review
BACKGROUND
Improvements in the biocompatibility of dialysis membranes have reduced biological responses elicited by blood-membrane interactions. In this article, recent technological developments in dialysis membranes with regard to biocompatibility and recent progress in the evaluation of the biocompatibility of dialysis membranes are reviewed.
SUMMARY
The focus of investigation into dialysis membranes in recent years has focused on not only membrane materials, but also their surface textures, which have been changed, for example, by coating with vitamin E or by changing the amount and type of hydrophilizing agents used. Research and development is directed at altering the chemical and physical properties of membrane surfaces to suppress biological responses that are particularly elicited as a result of platelet activation. To develop membranes with excellent biocompatibility, biocompatibility should be evaluated on a like-for-like basis under conditions that are similar to those in clinical settings. Evaluation using actual dialyzers can be performed using porcine blood, platelet-rich plasma isolated from porcine blood (and platelet-rich plasma with leukocytes), or suspension of neutrophils isolated from porcine blood or cultured human monocytes.
KEY MESSAGES
Highly biocompatible dialysis membranes can be developed when the overall correlations among biological reactions are examined by integrating all data on biological responses elicited by blood-membrane interactions or mutual interactions among blood cells.
Topics: Animals; Biocompatible Materials; Biomarkers; Blood Platelets; Hemodiafiltration; Humans; Leukocytes; Materials Testing; Membranes, Artificial; Platelet Activation; Renal Dialysis
PubMed: 26656534
DOI: 10.1159/000441576 -
Kidney360 Feb 2021
Topics: Hemodialysis, Home; Humans; Peritoneal Dialysis; Renal Dialysis; Spain
PubMed: 35373020
DOI: 10.34067/KID.0005722020 -
Blood Purification 2020The creation of a functional angioaccess is the cornerstone in treatment of chronic hemodialysis patients. The aim of this article is to review the use of vascular... (Meta-Analysis)
Meta-Analysis Review
The creation of a functional angioaccess is the cornerstone in treatment of chronic hemodialysis patients. The aim of this article is to review the use of vascular probes as a simple and cheap tool that could help surgeons in preparation of vessels and with creation of an anastomosis. Autogenous arteriovenous fistula is the best angioaccess available but is hampered by its relatively high non-maturation rate. Guidelines recommend preoperative duplex ultrasonography (USG) and use of vessels with a diameter that is able to maintain sufficient flow and fistula maturation to avoid unsuccessful attempts. Despite recommendations, preoperative duplex USG is not performed in many centers. In such circumstances, the use of vascular probes could help surgeons to create a fistula with a high chance of successful maturation. Vessel probes and dilators could be used to assess vessel diameter and patency, the ability to dilate and resolve a spasm, to stop retrograde blood flow in the vein (to avoid the use of vascular clamps), to avoid torsion of vein, to open and check vessel lumen with each stitch (to avoid using the forceps and possible wall injury), for tightening of continuous suture over the probe (to avoid excessive tightening and possible anastomotic stenosis). To my knowledge, this is the first review article which summaries the experience of using vascular dilators in angioaccess surgery. This information can be very helpful especially when there is the lack of valid preoperative USG of the vessels.
Topics: Anastomosis, Surgical; Clinical Decision-Making; Disease Management; Humans; Patient Outcome Assessment; Renal Dialysis; Vascular Surgical Procedures; Vasodilator Agents
PubMed: 32146469
DOI: 10.1159/000506503