MedWorm: Dialysis

AngioDynamics Launches DuraFlow(TM) 2 Chronic Hemodialysis Catheter

Medical News (via PRIMEZONE) — Wed, 08 Feb 2012 11:30:00 +0100

ALBANY, N.Y., Feb. 8, 2012 (GLOBE NEWSWIRE) -- AngioDynamics (Nasdaq:ANGO), a leading provider of innovative, minimally invasive medical devices for vascular access, surgery, peripheral vascular disease and oncology, has announced the U.S. launch of the next generation DuraFlow(tm) 2 chronic hemodialysis catheter and the upcoming launch of the DuraFlow(tm) 2 VascPak(r) (VP) kit. (Source: Medical News (via PRIMEZONE))

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GLIVEC Tablets (imatinib)- Revised SPC

NeLM - SPC Changes — Wed, 08 Feb 2012 05:00:00 +0100

Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes There have been significant updates to several sections of the SPC, including the following: Change to section 4.2 - Posology and method of administration Patients with renal dysfunction or on dialysis should be given the minimum recommended dose of 400 mg daily as starting dose. However, in these patients caution is recommended. The dose can be reduced if not tolerated. If tolerated, the dose can be increased for lack of efficacy (see sections 4.4 and 5.2). Change to section 4.4 - Special warnings and precautions for Use When Glivec is co-administered with other medicinal products, there is a potential for drug interac...

Clinical Performance and Skill Retention after Simulation‐based Education for Nephrology Fellows

Seminars In Dialysis — Tue, 07 Feb 2012 05:00:00 +0100

AbstractWe previously demonstrated that simulation‐based education (SBE) improved temporary hemodialysis catheter (THDC) insertion skills by nephrology fellows. SBE, featuring deliberate practice and rigorous achievement standards, was a powerful method to enhance THDC insertion skills in nephrology fellows. However, experts have called for further research to evaluate skill transfer from the simulated environment to actual clinical care and skill retention. This is a prospective observational cohort study of THDC insertion skills. Twelve nephrology fellows from three academic centers in Chicago were evaluated using a skills checklist from July 2008 to June 2009. Simulator‐trained fellows were tested after the SBE intervention and expected to meet or exceed a minimum passing score (MPS...

The use of an artificial skin model to study transdermal absorption of drugs in inflamed skin.

Biological and Pharmaceutical Bulletin — Mon, 06 Feb 2012 19:48:04 +0100

Authors: Oshima S, Suzuki C, Yajima R, Egawa Y, Hosoya O, Juni K, Seki T Abstract Studies on drug disposition in inflamed skin are important for safe and effective application of topical drugs. Here, the absorption of flurbiprofen (FP) through inflamed skin was examined in vivo and in a skin-mimicking artificial model system. The model skin system consisted of a silicone membrane acting as a model stratum corneum, laminated dialysis membranes acting as a model of viable skin, and 2 microdialysis probes-one used for determination of FP concentration and one acting as a model vessel. This model system could be used for quantitative evaluation of complicated permeation processes. In the in vivo experiments, FP absorption was suppressed in rats with inflamed skin induced by an intracut...

Home-based Dialysis For Kidney Failure Gaining Popularity In Developing Countries

Health News from Medical News Today — Mon, 06 Feb 2012 08:00:00 +0100

Home-based dialysis treatments are on the rise in both the developing and developed worlds, but developed countries appear to be turning to them less often, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings, which provide a global snapshot of dialysis use among patients with kidney failure, may impact future business and research innovations. Dialysis treatments for kidney failure come in two forms: peritoneal dialysis is usually done at home, while hemodialysis is predominantly clinic-based... (Source: Health News from Medical News Today)

Blood Pressure Measurements and Left Ventricular Mass Index in Hemodialysis Patients

Artificial Organs — Mon, 06 Feb 2012 05:00:00 +0100

AbstractLeft ventricular hypertrophy (LVH) is the most frequent cardiac abnormality in hemodialysis (HD) patients. It is related to cardiovascular diseases and is an important risk factor for mortality in HD patients. Arterial hypertension is an established risk factor for LVH in HD patients. Inferior vena cava (IVC) diameter is a good indicator of circulating fluid volume; hypervolemia is an important pathogenetic factor of hypertension in HD patients. The purpose of our study was to evaluate possible association between LVH, IVC diameter, and different blood pressure (BP) measurements in HD patients. In the present study, 85 HD patients were included. BP was measured with a standard mercury sphygmomanometer before and after the HD session; the average 1‐monthly values of the routine BP...

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Iron therapy in patients with chronic kidney disease

Transfusion Alternatives in Transfusion Medicine — Sun, 05 Feb 2012 05:00:00 +0100

SUMMARYIron deficiency, both functional and absolute, is common in patients with chronic kidney disease and in those requiring dialysis. The Renal National Service Framework and National Institute for Health and Clinical Excellence advocate treatment of anemia in patients with chronic kidney disease. Oral iron is often both insufficient and slow to improve hemoglobin levels while intravenous supplementation replenishes and maintains iron stores more effectively. This leads to a reduction in the use of erythropoietin stimulating agents. This reduction in erythropoietin stimulating agents use may be potentially beneficial in certain cases in particularly reducing stroke risk. In contrast, intravenous iron has the potential to improve quality of life, reduce cardiovascular risk and produce co...

For Kidney Disease Patients, Goals For Blood Pressure May Be Unrealistic

Health News from Medical News Today — Sat, 04 Feb 2012 08:00:00 +0100

An upward revision of the blood pressure numbers used to identify risk of end-stage renal disease (ESRD) might actually help doctors provide better care for their patients, said the authors of a study in patients with chronic kidney disease (CKD). The researchers found that systolic blood pressure - the "upper number" in a blood pressure reading - was the key variable. Current guidelines call for CKD patients to maintain a systolic pressure of 130/80 or lower in order to prevent ESRD, which is complete or almost complete kidney failure, leading to dialysis, kidney transplant, or death... (Source: Health News from Medical News Today)

More home dialysis in developing countries

Health News - UPI.com — Sat, 04 Feb 2012 04:33:58 +0100

LONDON, Ontario, Feb. 3 (UPI) -- Use of home-based dialysis is increasing in developing and developed nations, but more so in developing countries, Canadian researchers said. (Source: Health News - UPI.com)

A prospective randomized open-label crossover trial of regional citrate anticoagulation vs. anticoagulation free liver dialysis by the Molecular Adsorbents Recirculating System

Critical Care — Fri, 03 Feb 2012 05:00:00 +0100

IntroductionThe Molecular Adsorbent Recycling System (MARS) is used to treat patients with liver failure. Observational data suggest that citrate anticoagulation during MARS is feasible. Comparative studies on the optimal anticoagulation regimen during MARS are lacking. The aim of the current study was to evaluate two heparin-free anticoagulation regimens. Methods: We performed a prospective randomized open-label crossover study of regional citrate anticoagulation against no anticoagulation. Ten patients (age 55 +/- 11 years) with liver failure undergoing MARS treatment were included. The primary endpoint was completion of MARS sessions. Secondary endpoints included treatment efficacy and safety. Longevity of MARS treatment was plotted as a Kaplan-Meier estimate. Fisher's exact test was us...

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Necrotizing fasciitis of thigh associated with EscherichiaColi bacteremia in a patient on chronic hemodialysis

Hemodialysis International — Fri, 03 Feb 2012 05:00:00 +0100

We present a 59‐year‐old male on chronic hemodialysis (HD). We made the diagnosis of necrotizing fasciitis of the right thigh due to the crepitus from physical examination and subcutaneous emphysema from an X film. He was successfully treated with antibiotics and surgical debridement. The blood and surgical drainage cultures showed Escherichia coli, which is less commonly seen in cutaneous infection. The colonoscopic finding revealed adenomatous polyps. Necrotizing fasciitis in patients on HD requires early diagnosis and aggressive treatment to ensure the favorable clinical outcomes. (Source: Hemodialysis International)

Caregiver burden among nocturnal home hemodialysis patients

Hemodialysis International — Fri, 03 Feb 2012 05:00:00 +0100

AbstractRecent studies have suggested improvements in quality of life (QOL) in patients on quotidian dialysis compared with conventional hemodialysis. Few studies have focused on the burden and QOL in caregivers of patients with end‐stage renal disease (ESRD) on nocturnal home hemodialysis (NHD). We aim to assess the caregivers’ burden, QOL, and depressive symptoms and to compare these parameters with their patients’ counterparts. Cross‐sectional surveys were sent to 61 prevalent NHD patients and their caregivers. Surveys assessed demographics, general self‐perceived health using the 12‐Item Short Form Health Survey (SF‐12) and the presence of depression using the Beck Depression Inventory. Subjective burden on caregivers was assessed by the Caregiver Burden scale and was com...

Risk Factors Associated with Coronary Artery Calcification Should Be Examined before Kidney Transplantation.

The Tohoku Journal of Experimental Medicine — Thu, 02 Feb 2012 18:24:02 +0100

In conclusion, the examination and prevention of risk factors associated with atherosclerosis should be started at the beginning of renal failure. PMID: 22293651 [PubMed - in process] (Source: The Tohoku Journal of Experimental Medicine)

Peritonitis in recent years: clinical findings and predictors of treatment response of 170 episodes at a single Brazilian center

International Urology and Nephrology — Thu, 02 Feb 2012 18:17:01 +0100

Conclusions The current clinical characteristics and outcome suggest a greater severity of peritonitis episodes and higher risk of death, possibly due to bacterial resistance. Older age is a risk factor for death. Content Type Journal ArticleCategory Nephrology – Original PaperPages 1-9DOI 10.1007/s11255-011-0107-7Authors Luiz Gustavo Oliveira, Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo 18618-970, BrazilJuliana Luengo, Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo 18618-970, BrazilJacqueline C. T. Caramori, Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo 18618-970, Braz...

Low birth weight and end-stage renal disease: demographic analysis by region in Japan

Clinical and Experimental Nephrology — Thu, 02 Feb 2012 18:12:09 +0100

Conclusions The present study, relating regional distribution between LBW and ESRD dynamics in a nationwide population of Japan, revealed that the marked regional differences in the incidence of ESRD within Japan could be explained by a similar regional distribution in the incidence of LBW. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s10157-012-0600-zAuthors Tadashi Ichikawa, Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601 JapanMichio Fukuda, Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601 JapanTamaki Wakamatsu-Yamanaka, Department of Cardio-Renal Me...

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Sepsis Immunopathology: Perspectives of Monitoring and Modulation of the Immune Disturbances

Archivum Immunologiae et Therapiae Experimentalis — Thu, 02 Feb 2012 18:11:05 +0100

Abstract Septic syndromes are the main cause of death in the intensive care units and although the mortality rates is slowly decreasing, the occurrence of the disease has been increasing. The pathogenesis of sepsis includes countless disturbances of the host immune system starting with a harmful, infection-triggered exaggerated inflammatory cascade, followed by the development of an immunoparalysis state. The latter contributes to the failure in pathogen eradication and leads to secondary infections, which are often the cause of fatal complications. In this review, we consider different novel therapeutic strategies for restoration of immune function. The use of glucocorticoids, intravenous immunoglobulins, heparin, recombinant human activated protein C, granulocyte macroph...

Contemporary Status of Home Dialysis in Japan

Karger Publishers — Thu, 02 Feb 2012 15:51:22 +0100

ISBN: (Source: Karger Publishers)

Impact of diabetes and glycaemic control on peripheral artery disease in Japanese patients with end-stage renal disease: long-term follow-up study from the beginning of haemodialysis

Diabetologia — Thu, 02 Feb 2012 06:55:33 +0100

Conclusions/interpretation Diabetes was a strong predictor of PAD after initiation of haemodialysis therapy in patients with ESRD. In addition, higher HbA1c levels were associated with increased risk of developing PAD and requiring limb amputation in such diabetic populations. Content Type Journal ArticleCategory ArticlePages 1-6DOI 10.1007/s00125-012-2473-9Authors H. Ishii, Department of Cardiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JapanY. Kumada, Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, JapanH. Takahashi, Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, JapanT. Toriyama, Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, JapanT. Aoyama, Department of Cardiology, Nagoya...

Baxter Communication: Resumption of distribution of Monosol solution

NeLM - News — Thu, 02 Feb 2012 05:00:00 +0100

Source: Baxter Healthcare Ltd Area: News In January 2011, all batches of Monosol, a haemodialysis, haemodiafiltration and haemofiltration solution, were recalled from the market because of a manufacturing problem at the Baxter site in Castlebar, Ireland. In this communication, Baxter Healthcare has announced that the manufacture and distribution of Monosol will resume at the end of January 2012 following a variety of corrective and preventative measures. (Source: NeLM - News)

Renal Replacement Therapy in Cardiology Wards: Changing Trends in a Transitional Country

Therapeutic Apheresis and Dialysis — Thu, 02 Feb 2012 05:00:00 +0100

AbstractThe leading causes of death in patients with chronic kidney disease (CKD) are cardiovascular diseases, regardless of the stage of disease or method of renal replacement therapy. On the other hand, CKD is a major risk factor for cardiovascular complications after acute myocardial infarction, as well as for adverse outcome in patients with chronic heart failure. In the present study we prospectively followed‐up nephrological interventions in cardiology wards in order to determine changes in indications, treatment possibilities and outcome of patients. All patients treated at cardiology ward of the Clinical Hospital Centre Zagreb and requiring renal replacement therapy from January 2003 to December 2009 were included in the investigation. Cardiology hospital unit (intensive care or ...

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Geriatric Nutritional Risk Index May Be a Significant Predictor of Mortality in Korean Hemodialysis Patients: A Single Center Study

Therapeutic Apheresis and Dialysis — Thu, 02 Feb 2012 05:00:00 +0100

We examined the GNRI of 120 maintenance HD patients and followed these patients for 120 months. Predictors for all‐cause death were examined using life table analysis and the Cox proportional hazards model. Life table analysis revealed that subjects with a GNRI < 90 (n = 19) had a marginally lower survival rate than did those with a GNRI ≥ 90 (n = 101) (Wilcoxon test, P = 0.048). Multivariate Cox proportional hazards analyses demonstrated that the GNRI was a significant predictor of mortality (hazard ratio 0.966, 95% confidence interval 0.945–0.995, P = 0.018), after adjusting for age, sex, presence of diabetes mellitus, and body weight. These results demonstrate that the GNRI may be a significant predictor of mortality in Korean HD patients. (Source: The...

A Model to Predict Optimal Dialysate Flow

Therapeutic Apheresis and Dialysis — Thu, 02 Feb 2012 05:00:00 +0100

AbstractDiffusive clearance depends on blood (Qb) and dialysate flow (Qd) rates and the overall mass transfer area coefficient (KoA) of the dialyzer. In this article we describe a model to predict an appropriated AutoFlow (AF) factor (AF factor = Ratio Qd/Qb), that is able to provide adequate Kt/V for hemodialysis patients (HDP), while consuming lower amounts of dialysate, water and energy during the treatment. We studied in vivo the effects of three various Qd on the delivered dose of dialysis in 33 stable HDP. Hemodialysis was performed at Qd of 700 mL/mn, 500 mL/mn, and with AF, whereas specific dialysis prescriptions (treatment time, blood flow rate [Qb], and type and size of dialyzer) were kept constant. The results showed that increasing the dialysate flow rate more than the ...

Cardiovascular Protective Effects of On‐Line Hemodiafiltration: Comparison With Conventional Hemodialysis

Therapeutic Apheresis and Dialysis — Thu, 02 Feb 2012 05:00:00 +0100

AbstractAtherosclerotic complications have a significant effect on mortality in patients undergoing hemodialysis (HD) therapy. However, anti‐atherosclerotic and cardioprotective effects of on‐line hemodiafiltration (HDF) remain to be elucidated. We prospectively compared the anti‐atherosclerotic and cardioprotective effects in two randomly divided groups, i.e. on‐line HDF group (n = 13) and conventional HD group (n = 9) for 1 year. Surrogate markers were brachial‐ankle pulse wave velocity (baPWV), intima‐media thickness (IMT) of carotid artery as an atherosclerosis marker, and cardiac functional surrogate markers included left ventricular mass index (LVMI), ejection fraction (EF), and LV diastolic capacity represented as E/A and deceleration time (DT). LVMI in on‐li...

A Computerized Treatment Algorithm Trial to Optimize Mineral Metabolism in ESRD.

Clinical Journal of the American Society of Nephrology : CJASN — Thu, 02 Feb 2012 05:00:00 +0100

ConclusionsA greater proportion of dialysis patients achieved improved phosphorus but not parathyroid hormone control by switching from a predominantly active vitamin D analogue-based treatment regimen for mineral and bone disorder to a computer-driven algorithm that incorporated cinacalcet and low-dose active vitamin D analogues as first-line therapy. PMID: 22300740 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)

ADAMTS13 and Von Willebrand factor in patients undergoing hemodialysis

Journal of Thrombosis and Thrombolysis — Wed, 01 Feb 2012 17:11:00 +0100

This study included 195 patients on HD for more than 6 months. HD patients were allocated into two groups according to the occurrence or not of previous episode of VAT; HD with VAT (N = 46) and HD without VAT (N = 149). ADAMTS13 and VWF were performed by ELISA. There was no significant difference between HD patients with and without VAT for ADAMTS13 and VWF levels. However, VWF levels were higher (P < 0.001) and ADAMTS13 were lower (P < 0.001) in HD patients, comparing to the control group composed by healthy subjects without kidney disease, age and sex-matched (N = 80). Taken together our data suggest a potential role of the kidneys function compromised on ADAMTS13 synthesis or metabolism, regardless other known sources of ...

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Left Ventricular End‐Diastolic Diameter is an Independent Predictor of Mortality in Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Wed, 01 Feb 2012 05:00:00 +0100

AbstractLeft ventricular (LV) function is impaired in most hemodialysis (HD) patients. We conducted an observational cohort study to investigate whether LV end‐diastolic diameter (LVDd) could predict all‐cause mortality in a cohort of 166 HD patients. The LVDd values (5.06 ± 0.64 cm) of the non‐survivor group were significantly greater than in the survivor group (4.78 ± 0.71 cm). The area under the receiver operating characteristic curve for an LVDd cut‐off value of 5.01 cm was 0.6145 (P = 0.0234). The sensitivity and specificity of the LVDd threshold of 5.01 cm were 75.7% and 50.4%, respectively. The 4‐year survival rate was significantly lower in the group with LVDd ≥ 5.01 cm than in the group with LVDd < 5.01 cm (log‐rank test, P = ...

Chronic kidney disease stressors influence choice of dialysis modality

Journal of Advanced Nursing — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion. Pre‐dialysis stress levels predicted dialysis modality. Interventional studies are recommended to address chronic kidney disease stressors with the outcome of improving home‐dialysis usage. (Source: Journal of Advanced Nursing)

Does a reduction in dialysate sodium improve blood pressure control in haemodialysis patients?

Nephrology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: Change in clinical practice, amounting to a modest reduction in dialysate sodium was associated with a reduction not only in pre and postdialysis blood pressures, but also ultrafiltration requirements and symptomatic intradialytic hypotension. However this effect on blood pressure was most marked for older patients and women, within minimal effects for younger patients, and lesser effects for men, suggesting that dialysate sodium reduction alone may help improve blood pressure control, but requires additional factors such as dietary sodium restriction to be effective in younger male patients.© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology (Source: Nephrology)

The global role of kidney transplantation.

Archives of Iranian Medicine — Wed, 01 Feb 2012 05:00:00 +0100

Authors: Garcia Garcia G, Harden P, Chapman J Abstract World Kidney Dayon March 8th, 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. ...

Matrix Metalloproteinase (MMP)-2 Genetic Variants Modify the Circulating MMP-2 Levels in End-Stage Kidney Disease.

American Journal of Nephrology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: MMP-2 genotypes or haplotypes modify MMP-2 levels in ESKD patients, and may help to identify patients with increased MMP-2 activity in plasma. Hemodialysis reduces MMP-2 levels independently of MMP-2 genetic variants. PMID: 22302011 [PubMed - as supplied by publisher] (Source: American Journal of Nephrology)

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Imbalanced Matrix Metalloproteinases in Cardiovascular Complications of End‐Stage Kidney Disease: A Potential Pharmacological Target

Basic and Clinical Pharmacology and Toxicology — Wed, 01 Feb 2012 05:00:00 +0100

AbstractEnd‐stage kidney disease (ESKD) is a major health problem associated with very high morbidity and mortality secondary to cardiovascular complications, especially in ESKD patients on dialysis. Therefore, exploring key mechanisms underlying cardiovascular alterations associated with ESKD may offer reasonable pharmacological targets that may benefit these patients. Imbalanced matrix metalloproteinases (MMP) activities have been implicated in many cardiovascular diseases, and growing evidence now indicates that excessive MMP activities contribute to cardiovascular complications in ESKD patients. However, there is no study on the effects of MMP inhibitors (MMPIs) in such patients. MMPIs may prevent against the vascular and cardiac changes associated with ESKD. In this MiniReview, we a...

Effects of Peripheral Blood Mononuclear Cells Morphology on Vascular Calcification in Uremic Patients on Maintenance Hemodialysis

Therapeutic Apheresis and Dialysis — Wed, 01 Feb 2012 05:00:00 +0100

AbstractWe used high‐resolution atomic force microscopy (AFM) to examine possible changes in the morphology of peripheral blood mononuclear cells (PBMCs), and to investigate their influence on vascular calcification in uremic patients on maintenance hemodialysis (MHD). 36 uremic patients had cardiovascular diseases after MHD (MHD group1) and 30 uremic patients did not (MHD group 2), and 20 healthy volunteers were the control group. The extent of coronary artery calcification was assessed with coronary artery calcification score (CACS). AFM was used to analyze PBMCs nuances. Concentrations of bone morphogenetic protein‐2 (BMP‐2) in PBMC supernatants were detected by ELISA. Protein expressions of BMP‐2 were measured by Western blot. No significant differences in PBMC morphology were ...

Outcomes of living‐donor liver transplantation in patients with preoperative type‐1 hepatorenal syndrome and acute hepatic decompensation

Liver Transplantation — Tue, 31 Jan 2012 18:57:13 +0100

In conclusion, HRS patients, compared with non‐HRS patients, had worse postoperative renal function and overall survival. However, their five‐year overall survival rate was still nearly 80%, which is satisfactory. Therefore, living‐donor liver transplantation can be considered for patients who have acute hepatic decompensation with or without HRS. © 2012 American Association for the Study of Liver Diseases (Source: Liver Transplantation)

How to manage HIV-infected patients with chronic kidney disease in the HAART era

Clinical and Experimental Nephrology — Tue, 31 Jan 2012 16:47:49 +0100

Abstract As human immunodeficiency virus (HIV)-infected patients now live longer while receiving highly active antiretroviral therapy (HAART), chronic kidney disease (CKD) has emerged as a significant cause of morbidity and mortality among urban HIV population. Risk factors associated with CKD in such HIV-infected population include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, low CD4 cell count, and high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, rema...

Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients

International Urology and Nephrology — Tue, 31 Jan 2012 07:12:26 +0100

Conclusion Neutrophil to lymphocyte ratio is a strong predictor for overall and cardiovascular mortality in PD patients. Content Type Journal ArticleCategory Nephrology – Original PaperPages 1-8DOI 10.1007/s11255-012-0130-3Authors Xin An, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 People’s Republic of ChinaHai-Ping Mao, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 People’s Republic of ChinaXin Wei, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 People’s Republic of ChinaJie-Hui Chen, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 People’s Republic of...

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A Recurrent D‐strand Association Interface is Observed in β‐2 microglobulin Oligomers

FEBS Journal — Tue, 31 Jan 2012 05:00:00 +0100

Summaryβ‐2 microglobulin (β2m) is an amyloidogenic protein responsible for dialysis related amyloidosis in man. In the early stages of amyloid fibril formation, β2m associates into dimers and higher oligomers, but the structural details of such aggregates are poorly understood. To characterize the protein‐protein interactions supporting formation of oligomers, three individual β2m cysteine mutants and their disulphide‐linked homodimers (DIMC20, DIMC50, DIMC60) were prepared. Amyloid propensity, oligomerization state in solution and crystallogenesis were tested for each β2m homodimer: DIMC20 and DIMC50 display a mixture of tetrameric and dimeric species in solution, yield protein crystals and amyloid fibrils, while DIMC60 is dimeric in solution, does not form protein crystals nor...

Dissecting Aneurysm in A Patient with Autosomal Dominant Polycystic Kidney Disease.

Annals of Thoracic and Cardiovascular Surgery — Tue, 31 Jan 2012 05:00:00 +0100

Authors: Fukunaga N, Yuzaki M, Nasu M, Okada Y Abstract Autosomal dominant polycystic kidney disease (ADPKD) is primarily associated with renal failure, but it also causes systemic diseases, including cysts of other systemic organs and cerebral or visceral aneurysm. To make matters worse, life-threatening aortic diseases are associated with ADPKD in some cases. However, only a few reports of ADPKD-associated with thoracic aortic dissection have been published. Herein, we present a case of dissecting aneurysm in a patient with hypertension and ADPKD. He had been followed up for type B aortic dissection for six years. Preoperative creatinine level ranged from 2.1 to 2.4 mg/dl. We performed replacement of the thoracic aorta with prosthetic graft successfully, and postoperatively, dial...

Antioxidant Therapy in Hemodialysis PatientsAntioxidant Therapy in Hemodialysis Patients

Medscape Today Headlines — Mon, 30 Jan 2012 21:46:47 +0100

How safe are antioxidants for hemodialysis patients? Do they have any impact on oxidative stress and cardiovascular risk factors in this subset of patients? Kidney International (Source: Medscape Today Headlines)

P-4-P and Dialysis Centers: Look Beyond URR P-4-P and Dialysis Centers: Look Beyond URR

Medscape Today Headlines — Mon, 30 Jan 2012 17:27:06 +0100

Jeff Berns reviews a study that looked at whether dialysis centers met the urea reduction ratio (URR) metric required for pay-for-performance and suggests better ways for assessing facilities. Medscape Nephrology (Source: Medscape Today Headlines)

Infectious Complications of Dialysis Access Devices

Infectious Diseases Clinics of North America — Sun, 29 Jan 2012 22:43:12 +0100

This article reviews the important infectious complications associated with dialysis access, including both hemodialysis and peritoneal dialysis. The discussion highlights the epidemiology, management, and prevention of dialysis access infections. (Source: Infectious Diseases Clinics of North America)

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Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome in a Chronic Hemodialysis Patient

Advances in Pharmacological Sciences — Sun, 29 Jan 2012 18:41:46 +0100

A 75-year-old male who was undergoing chronic hemodialysis developed abrupt-onset pitting edema and pain in the dorsum of both hands and feet. Biochemical analysis disclosed increased C-reactive protein, and negative rheumatoid factor and antinuclear antibody. Radiological examination showed no bony erosion. Computed tomography and gallium scintigraphy revealed no active infection or neoplasms. The clinical diagnosis was remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. The pitting edema and inflammatory response quickly subsided after low-dose prednisolone therapy. This case demonstrates that RS3PE syndrome could be a differential diagnosis in elderly patients undergoing dialysis who develop pitting edema and joint pain. (Source: Advances in Pharmacological...

Successful Utilization of High-Flux Hemodialysis for Treatment of Vancomycin Toxicity in a Child

Advances in Pharmacological Sciences — Sun, 29 Jan 2012 18:41:46 +0100

We report a case of a pediatric patient who developed vancomycin toxicity and associated oliguric renal failure who was treated effectively with high-flux hemodialysis for vancomycin toxicity, clearing serum concentrations of vancomycin by over 75% in only 6 hours (213.2 mcg/mL to 51.8 mcg/mL) with subsequent return to baseline renal function and without adverse sequelae. While not historically considered a viable option for drug removal in cases of toxicity, new high-flux hemodialysis techniques can remove significant percentages of vancomycin in short periods of time. (Source: Advances in Pharmacological Sciences)

Dialysate Sodium Concentration and the Association with Interdialytic Weight Gain, Hospitalization, and Mortality

Nephrology Now — Sat, 28 Jan 2012 08:32:30 +0100

This analysis of observational DOPPS data examined the impact of reduced dialysate sodium on clinical outcomes. While lowering dialysate sodium was associated with lower interdialytic weight gain, it was also associated with increased hospitalization. No mortality benefit was associated with reduced dialysate sodium. : Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion Sodium Bicarbonate for the Prevention of Contrast Induced-Acute Kidney Injury: A Systematic Review and Meta-analysis Long Interdialytic Interval and Mortality among Patients Receiving Hemodialysis (Source: Nephrology Now)

Decongestive Treatment of Acute Decompensated Heart Failure: Cardiorenal Implications of Ultrafiltration and Diuretics

Nephrology Now — Sat, 28 Jan 2012 08:28:56 +0100

This review discusses the role of diuretics and ultrafiltration in acute decompensated heart failure. : Diuretic Strategies in Patients with Acute Decompensated Heart Failure Therapeutic Strategies for Heart Failure in Cardiorenal Syndromes The time course of peritoneal transport parameters in peritoneal dialysis patients who develop encapsulating peritoneal sclerosis. (Source: Nephrology Now)

[Case Report] Acute dyspnoea—not always above the diaphragm

LANCET — Sat, 28 Jan 2012 05:00:00 +0100

In October, 2010, a 55-year-old woman was admitted to our department for investigation of recurrent ascites. She had a medical history of adult polycystic kidney disease with hepatic cysts. 9 months earlier, she had started peritoneal dialysis, which was changed to haemodialysis after 5 months because of poor catheter flows and underdialysis. Subsequently, she developed ascites which required frequent drainage. The fluid was borderline for transudate or exudate with no malignant cells and was initially attributed to peritoneal irritation from her dialysis catheter. (Source: LANCET)

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Prediction of Graft Patency and Mortality After Distal Revascularization and Interval Ligation for Hemodialysis Access-Related Hand Ischemia

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:16 +0100

The goals for management of access-related hand ischemia (ARHI) are to reverse symptoms and salvage the access. Many procedures have been described, but the optimal treatment remains unresolved. In an effort to guide clinical decision making, this study was undertaken to document our outcomes for distal revascularization and interval ligation (DRIL) and identify predictors of bypass patency and patient mortality. (Source: Journal of Vascular Surgery)

Balloon angioplasty vs nitinol stent placement in the treatment of venous anastomotic stenoses of hemodialysis grafts after surgical thrombectomy

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

In 2010, CPT code 36147 was created and bundles the work of establishing single catheter access with the diagnostic contrast imaging of the dialysis circuit. In 2012, the introductory wording was updated to clarify reporting concerns voiced by the insurance industry and coding groups. (Source: Journal of Vascular Surgery)

Arteriovenous Graft Placement in Predialysis Patients: A Potential Catheter-Sparing Strategy

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

Arteriovenous grafts placed predialysis have primary failure rates and cumulative survival rates that are similar to grafts placed after starting dialysis therapy. The fistula first initiative (www.fistulafirst.org) strongly encourages dialysis access via arteriovenous fistulas. Some patients, however, have anatomy more suitable for a graft. In such cases the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) suggests grafts be placed three to six weeks prior to the need for dialysis therapy. It is difficult to predict the onset of time for the need of dialysis in patients not undergoing dialysis. Some surgeons postpone graft creation until after the initiation of hemodialysis reasoning graft placement prior to dialysis therapy may result in diminished time of p...

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