MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars In Dialysis' source. Sat, 20 Mar 2010 14:25:15 +0100 http://www.medworm.com/index.php?rid=3351296&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20210913%26dopt%3DAbstract Authors: Locatelli F, Del Vecchio L, Cavalli A Abstract Although the prognosis of patients who have diabetes and are receiving renal replacement therapy has greatly improved, survival and medical rehabilitation rates continue to be significantly worse than those of nondiabetic patients, mainly because of pre-existing severely compromised cardiovascular conditions. In this scenario, the nephrology community had to do its best in order to offer the best treatment options to these patients using a multifaceted approach. The most common RRT modality in patients with diabetes is still hemodialysis, but it gives rise to a number of clinical problems, in particular difficulties in the management of the vascular access and high frequency of intradialytic hypotension. Recent data suggest that e... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3351296 Mon, 22 Feb 2010 00:00:00 +0100 3351296 http://www.medworm.com/index.php?rid=3351295&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20210914%26dopt%3DAbstract In this report, we review the traditional and nontraditional risk factors that underlie the high risk of CV disease in this population, with a particular focus on vascular calcification, mineral metabolism, and therapeutic paradigms for the treatment of cardiovascular disease in this unique and high-risk population. PMID: 20210914 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3351295 Mon, 22 Feb 2010 00:00:00 +0100 3351295 http://www.medworm.com/index.php?rid=3351294&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20210915%26dopt%3DAbstract This article reviews the clinical use of insulin and other antidiabetic therapies, focusing on pharmacokinetic properties and dosing in patients with advanced kidney disease. PMID: 20210915 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3351294 Mon, 22 Feb 2010 00:00:00 +0100 3351294 http://www.medworm.com/index.php?rid=3351293&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20210916%26dopt%3DAbstract Authors: Friedman EA Abstract During the past 50 years, a global pandemic of kidney failure attributed to diabetes mellitus provoked continuously changing treatment strategies based in the belief that micro- and macrovascular complications of diabetes may be preventable. Both patient and physician have revised, and sometimes reversed drug regimens based on inferences extracted from prospective, controlled, properly populated trials. Illustrating this dilemma is a newly relaxed target for glycosylated hemoglobin (HbA1c) of 7%, introduced because of the greater rate of cardiovascular complications noted when striving to reduce attained HbA1c to </=6.5%. Our concept of the natural history of kidney disease in diabetes has repeatedly been modified by a rising mean age of those developin... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3351293 Mon, 22 Feb 2010 00:00:00 +0100 3351293 http://www.medworm.com/index.php?rid=3351292&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20210917%26dopt%3DAbstract Authors: Williams ME Abstract Both in the United States and many regions of the world, chronic kidney disease and end-stage renal disease (ESRD) in patients with diabetes mellitus have reached epidemic proportions in recent years. The large prevalent diabetic ESRD population in the US involves remarkable risk in African Americans and an increasing population of elderly diabetic patients, including many octogenarians. In the US and globally, over 90% of diabetic ESRD patients have type 2 diabetes. The multinational epidemic of diabetic ESRD has been linked to increases in the prevalence of diabetes in many populations, related to obesity, ageing, and physical inactivity. It is anticipated that the worldwide prevalence of diabetes over the next 20 years will reach a level twice that of t... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3351292 Mon, 22 Feb 2010 00:00:00 +0100 3351292 http://www.medworm.com/index.php?rid=3292892&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00698.x Both in the United States and many regions of the world, chronic kidney disease and end-stage renal disease (ESRD) in patients with diabetes mellitus have reached epidemic proportions in recent years. The large prevalent diabetic ESRD population in the US involves remarkable risk in African Americans and an increasing population of elderly diabetic patients, including many octogenarians. In the US and globally, over 90% of diabetic ESRD patients have type 2 diabetes. The multinational epidemic of diabetic ESRD has been linked to increases in the prevalence of diabetes in many populations, related to obesity, ageing, and physical inactivity. It is anticipated that the worldwide prevalence of diabetes over the next 20 years will reach a level twice that of the year 2000. The excessive morbid... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=3292892 Mon, 22 Feb 2010 00:00:00 +0100 3292892 http://www.medworm.com/index.php?rid=3292891&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00699.x During the past 50 years, a global pandemic of kidney failure attributed to diabetes mellitus provoked continuously changing treatment strategies based in the belief that micro- and macrovascular complications of diabetes may be preventable. Both patient and physician have revised, and sometimes reversed drug regimens based on inferences extracted from prospective, controlled, properly populated trials. Illustrating this dilemma is a newly relaxed target for glycosylated hemoglobin (HbA1c) of 7%, introduced because of the greater rate of cardiovascular complications noted when striving to reduce attained HbA1c to [le]6.5%. Our concept of the natural history of kidney disease in diabetes has repeatedly been modified by a rising mean age of those developing uremia (now 64.5 years). Underscor... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=3292891 Mon, 22 Feb 2010 00:00:00 +0100 3292891 http://www.medworm.com/index.php?rid=3292890&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2010.00703.x This article reviews the clinical use of insulin and other antidiabetic therapies, focusing on pharmacokinetic properties and dosing in patients with advanced kidney disease. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=3292890 Mon, 22 Feb 2010 00:00:00 +0100 3292890 http://www.medworm.com/index.php?rid=3292889&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00704.x In this report, we review the traditional and nontraditional risk factors that underlie the high risk of CV disease in this population, with a particular focus on vascular calcification, mineral metabolism, and therapeutic paradigms for the treatment of cardiovascular disease in this unique and high-risk population. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=3292889 Mon, 22 Feb 2010 00:00:00 +0100 3292889 http://www.medworm.com/index.php?rid=3292888&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2010.00709.x Although the prognosis of patients who have diabetes and are receiving renal replacement therapy has greatly improved, survival and medical rehabilitation rates continue to be significantly worse than those of nondiabetic patients, mainly because of pre-existing severely compromised cardiovascular conditions. In this scenario, the nephrology community had to do its best in order to offer the best treatment options to these patients using a multifaceted approach. The most common RRT modality in patients with diabetes is still hemodialysis, but it gives rise to a number of clinical problems, in particular difficulties in the management of the vascular access and high frequency of intradialytic hypotension. Recent data suggest that efficient high-flux treatments have the potential of improvin... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=3292888 Mon, 22 Feb 2010 00:00:00 +0100 3292888 http://www.medworm.com/index.php?rid=3107145&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017827%26dopt%3DAbstract Authors: Fissell WH PMID: 20017827 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107145 Sun, 01 Nov 2009 00:00:00 +0100 3107145 http://www.medworm.com/index.php?rid=3107141&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017828%26dopt%3DAbstract Authors: McFarlane PA The typical dialysis patient faces both a poor quality of life and a significantly shortened survival. This is often blamed on "uremia." However, defining the clinical entity of uremia is surprisingly difficult. It represents the clinical sequelae of the effects of retention products, other effects of renal disease, and the effects of other comorbid conditions. The list of retention products that could act as uremic toxins is lengthy, but it would appear that urea itself does not contribute significantly to the uremic state. Larger molecular weight substances are likely the major contributors to the uremic milieu. Regardless of the causes, the uremic state persists in many patients who are reaching their dialysis adequacy targets as defined by urea clearance. This... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107141 Sun, 01 Nov 2009 00:00:00 +0100 3107141 http://www.medworm.com/index.php?rid=3107140&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017829%26dopt%3DAbstract Authors: Song JH, Humes HD Although current dialysis techniques have transformed acute and chronic renal failure from uniformly fatal clinical disorders into treatable diseases, these therapies replace only the water and solute clearance function of the kidney and have reached a point where little further therapeutic improvement can be anticipated. In addition to their metabolic and endocrine functions, renal tubule cells presumably play an important role in the systemic inflammatory balance by participating in the complex and dynamic network of leukocyte action and pro- and anti-inflammatory cytokines. Loss of this function may result in a propensity to develop systemic inflammatory response syndrome (SIRS), multiorgan dysfunction, and a high risk of death in acute kidney injury (AKI)... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107140 Sun, 01 Nov 2009 00:00:00 +0100 3107140 http://www.medworm.com/index.php?rid=3107139&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017830%26dopt%3DAbstract Authors: Thomas G, Jaber BL The increasing number of patients requiring renal replacement therapy poses a challenge to maintain quality of care in the setting of limited resources. The commonly used modalities include hemodialysis and peritoneal dialysis, and using a "urea-centric" model to increase the clearance of small molecular weight uremic toxins beyond current guidelines does not appear to confer additional clinical benefits in terms of morbidity and mortality. Convective therapies including hemofiltration and hemodiafiltration, which also have higher middle molecule clearances, might offer significant benefits compared to diffusive therapy. We review the available evidence on convective therapies and their effects on middle molecular weight uremic toxins, particularly beta2 mic... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107139 Sun, 01 Nov 2009 00:00:00 +0100 3107139 http://www.medworm.com/index.php?rid=3107138&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017831%26dopt%3DAbstract This article describes the chemical function of the Sorb cartridge, recent improvements, and the methods to predict the chemical function of the column. It also describes a number of improvements made in dialysis machines using sorbent regeneration of the dialysate. Some ongoing improvements in sorbent chemistry are also described. PMID: 20017831 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107138 Sun, 01 Nov 2009 00:00:00 +0100 3107138 http://www.medworm.com/index.php?rid=3107137&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017832%26dopt%3DAbstract Authors: Huang Z, Gao D, Letteri JJ, Clark WR In extracorporeal renal replacement therapies, the dialyzer is not only the site at which solute removal occurs but also the extracorporeal circuit component having the largest surface area exposed to blood. Therefore, it is not surprising that interactions between blood components and the dialyzer membrane influence the dialysis procedure in several ways. Based on engineering principles, fluid flow along a surface such as membrane results in the development of a boundary layer which can influence solute removal. Furthermore, the exposure of blood to any extracorporeal artificial surface results in the activation of several pathways within the body, including those involving coagulation and complement activation. One of the byproducts of th... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107137 Sun, 01 Nov 2009 00:00:00 +0100 3107137 http://www.medworm.com/index.php?rid=3107135&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017833%26dopt%3DAbstract Authors: Imai N, Kaur T, Rosenberg ME, Gupta S The understanding of cellular sources of kidney regeneration has rapidly evolved in the last decade. It is now believed that regeneration occurs predominantly from cells that reside within the injured kidney, with minimal contribution from extra-renal cells. We now know that improved kidney regeneration seen following exogenous administration of stem cells occur predominantly by noncellular paracrine mechanisms. Of all extra-renal stem cells, mesenchymal stem cells (MSC) are the most promising stem cell type for treating kidney diseases. There is an ongoing clinical trial evaluating safety and efficacy of MSC in treating acute kidney injury (AKI). Results of this trial are expected to bring use of MSC closer to the clinical realm. An impro... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107135 Sun, 01 Nov 2009 00:00:00 +0100 3107135 http://www.medworm.com/index.php?rid=3107134&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017834%26dopt%3DAbstract Authors: Himmelfarb J Patients with uremia are subject to greatly increased cardiovascular risk that cannot be completely explained by traditional cardiovascular risk factors. An increase in oxidative stress and inflammation has been proposed as contributory nontraditional uremic cardiovascular risk factors. Oxidative stress reflects the balance between oxidant generation and antioxidant defense mechanisms. Reduction/oxidation (redox) reactions may result in a stochastic process leading to oxidation of neighboring macromolecules. However, in many instances the reactive oxygen species target particular amino acid residues or lipid moieties. This provides a mechanism by which increased oxidative stress and/or alteration of antioxidant mechanisms can alter cell signaling. In individuals w... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107134 Sun, 01 Nov 2009 00:00:00 +0100 3107134 http://www.medworm.com/index.php?rid=3107133&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017835%26dopt%3DAbstract Authors: Vaziri ND End-stage renal disease (ESRD) is associated with accelerated atherosclerosis and premature death from cardiovascular disease. These events are driven by oxidative stress inflammation and lipid disorders. ESRD-induced lipid abnormalities primarily stem from dysregulation of high-density lipoprotein (HDL), triglyceride-rich lipoprotein metabolism, and oxidative modification of lipoproteins. In this context, production and plasma concentration of Apo-I and Apo-II are reduced, HDL maturation is impaired, HDL composition is altered, HDL antioxidant and anti-inflammatory functions are depressed, clearance of triglyceride-rich lipoproteins and their atherogenic remnants is impaired, their composition is altered, and their plasma concentration is elevated in ESRD. The assoc... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107133 Sun, 01 Nov 2009 00:00:00 +0100 3107133 http://www.medworm.com/index.php?rid=3107132&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017836%26dopt%3DAbstract Authors: da Costa JA, Alp Ikizler T Over the last decade, there have been no proven therapies to lower the mortality and morbidity risk for chronic dialysis patients. One of the most important determinants of this poor clinical outcome is protein energy wasting (PEW), a unique and highly prevalent nutritional and metabolic abnormality primarily characterized by increased protein breakdown in the skeletal muscle compartment. Although the etiology and mechanisms leading to increased protein breakdown in chronic dialysis patients are complex and mostly ill-defined, two well-recognized and presumably interrelated metabolic abnormalities, insulin resistance and chronic inflammation, are likely to play a critical role in the pathogenesis of this condition. Multiple studies demonstrate the an... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107132 Sun, 01 Nov 2009 00:00:00 +0100 3107132 http://www.medworm.com/index.php?rid=3107131&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017837%26dopt%3DAbstract Authors: Leonard EF Current efforts to prolong dialysis and make it ambulatory may, but need not, follow the established countercurrent contact of blood and dialysate through a membrane. Avoiding anticoagulation and addressing decremented performance of membranes used over long times suggests gentler blood contact and greatly reduced contact areas. This paper describes a microfluidic fluid-to-fluid contact system, still under development, and suggests that initial attempts at ambulatory support of end-stage renal disease patients may be limited to interdialytic volume control, perhaps with a reduced frequency of dialysis which would then be used only to remove accumulated solutes. PMID: 20017837 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107131 Sun, 01 Nov 2009 00:00:00 +0100 3107131 http://www.medworm.com/index.php?rid=3107130&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017838%26dopt%3DAbstract Authors: Nissenson AR Over one million patients worldwide have end-stage renal disease and require dialysis or kidney transplantation. Despite the availability of these forms of renal replacement therapy for nearly four decades, mortality and morbidity are high and patients often have a poor quality of life. We have developed a human nephron filter (HNF) utilizing bottom-up nanotechnology that would eventually make feasible a continuously functioning, wearable or implantable artificial kidney. The device consists of two membranes operating in series within one device cartridge. The first membrane mimics the function of the glomerulus, using convective transport to generate a plasma ultra filtrate, which contains all solutes approaching the molecular weight of albumin. The second membra... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107130 Sun, 01 Nov 2009 00:00:00 +0100 3107130 http://www.medworm.com/index.php?rid=3107129&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017839%26dopt%3DAbstract Authors: Fissell WH, Roy S The confluence of an increasing prevalence of end-stage renal disease (ESRD), clinical trial data suggestive of benefit from quotidian dialysis, and ongoing cost/benefit reanalysis of healthcare spending have stimulated interest in technological improvements in provision of ESRD care. For the last decade, our group has focused on enabling technologies that would permit a paradigm shift in dialysis care similar to that brought by implantable defibrillators to arrhythmia management. Two significant barriers to wearable or implantable dialysis persist: package size of the dialyzer and water requirements for preparation of dialysate. Decades of independent research into highly efficient membranes and cell-based bioreactors culminated in a team effort to develop a... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107129 Sun, 01 Nov 2009 00:00:00 +0100 3107129 http://www.medworm.com/index.php?rid=3107128&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017840%26dopt%3DAbstract This report presents three cases of tethered TDCs that underwent laser sheath extraction. The TDCs had been in place for an average of 26 months. The patients underwent initial unsuccessful removal attempt using the traction method with surgical exploration all the way to the venotomy site. The laser technique that is used to remove pacemaker/implantable cardioverter defibrillator leads was then applied to these stuck catheters. All three catheters were successfully removed without any damage to the catheter, central veins, or the right atrium. There were no retained catheter fragments left in the central veins or the atrium. One patient demonstrated a significant thrombus that extended from the tip of the catheter all the way to the right ventricle. The external sheath of the laser device... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107128 Sun, 01 Nov 2009 00:00:00 +0100 3107128 http://www.medworm.com/index.php?rid=3107127&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017841%26dopt%3DAbstract Authors: Kulawik D, Sands JJ, Mayo K, Fenderson M, Hutchinson J, Woodward C, Gore S, Asif A Tunneled hemodialysis catheters (TDCs) carry the highest mortality risk for chronic hemodialysis patients of any access modality. Recent data have emphasized that mortality risk decreases when these devices are discontinued. Herein, we present the results of a gap-reduction assisted catheter elimination strategy that Network 7 employed as its quality improvement initiative to reduce the use of TDCs. Hemodialysis facilities with high catheter rates (>90 days) were identified. Interventions included focused vascular access education, monthly follow-up and site visits to assist the facility catheter reduction program. The "goal" of interventions was defined as the gap-reduction of 50% from the b... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107127 Sun, 01 Nov 2009 00:00:00 +0100 3107127 http://www.medworm.com/index.php?rid=3107126&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017842%26dopt%3DAbstract This article presents six cases of fistulas that suffered vascular rupture during RA. In three cases, vascular damage occurred prior to the application of angioplasty. The remaining cases suffered perforation after angioplasty. Balloon tamponade was successful in salvaging two fistulas. Another AVF with a perforation did not require any intervention to maintain flow. The complication was successfully managed in one AVF by the insertion of an endovascular stent graft. Two fistulas were lost due to vascular damage. This report demonstrates that RA performed by occluding the outflow track of an AVF to assess the results of angioplasty of an inflow stenosis can result in vascular rupture. There is a risk of such adversity even before the application of angioplasty in this region. It is suggest... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107126 Sun, 01 Nov 2009 00:00:00 +0100 3107126 http://www.medworm.com/index.php?rid=3107125&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017843%26dopt%3DAbstract Authors: Yevzlin AS PMID: 20017843 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107125 Sun, 01 Nov 2009 00:00:00 +0100 3107125 http://www.medworm.com/index.php?rid=3107123&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017844%26dopt%3DAbstract Authors: Stranz M, Hadaway L PMID: 20017844 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107123 Sun, 01 Nov 2009 00:00:00 +0100 3107123 http://www.medworm.com/index.php?rid=3107122&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D20017845%26dopt%3DAbstract Authors: Sherman RA PMID: 20017845 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=3107122 Sun, 01 Nov 2009 00:00:00 +0100 3107122 http://www.medworm.com/index.php?rid=2856676&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00639.x In conclusion, this is a logical approach for patients who have exhausted their forearm vessels for AVG creation. In addition, it also provides a platform for future creation of a secondary fistula in the upper arm. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2856676 Fri, 02 Oct 2009 23:00:00 +0100 2856676 http://www.medworm.com/index.php?rid=2856679&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00636.x This study finds PTA to be a viable option in the management of PM/ICD lead-induced CVS. Additional studies with appropriate design and sample size are required to conclusively establish the role of PTA in the management of this problem. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2856679 Thu, 01 Oct 2009 23:00:00 +0100 2856679 http://www.medworm.com/index.php?rid=2856678&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00637.x We report three cases of accidental cutting of the peritoneal catheter and present the steps taken to salvage the catheter without discontinuing the technique and avoiding withdrawal of the catheter. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2856678 Thu, 01 Oct 2009 23:00:00 +0100 2856678 http://www.medworm.com/index.php?rid=2856677&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00638.x We report outcomes of arteriovenous fistula (AVF) creation by a single surgeon in pediatric HD patients dialyzed at a single center. We further describe our experience and outcomes with the use of the operating microscope in the United States in children receiving HD under 15 kg in weight and as young as 4 years of age. AVF usage rates as well as short- and long-term patency rates can be quite high with proper management. We further illustrate that the Fistula First principles can be applied to the pediatric population in the setting of a single surgeon with single center experience. As such, we have surpassed the current NKF-DOQI recommendation of 50% fistula use in prevalent HD patients. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2856677 Thu, 01 Oct 2009 23:00:00 +0100 2856677 http://www.medworm.com/index.php?rid=2787334&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00628.x Depression or the presence of significant depressive symptoms remains common in patients with end-stage renal disease (ESRD). It is thought that 20[ndash]30% of ESRD patients have significant depressive symptoms, although there are issues surrounding the assessment of depression among patients with physical illness. Screening tools may be useful in this setting to identify patients with low affect, accompanied by formal diagnostic approaches which are important to consider following a positive screen. Recent evidence highlights the impact of depression upon mortality, and its association with non-adherence and immune parameters, work that supports past investigations. Further studies are required to better our understanding of the mechanisms behind depression in patients with ESRD identify... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787334 Fri, 11 Sep 2009 23:00:00 +0100 2787334 http://www.medworm.com/index.php?rid=2797053&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747171%26dopt%3DAbstract Authors: Mason NA, Bakus JL Abstract Medication-related problems are very common in patients with chronic kidney disease (CKD). These problems are often avoidable and can result in detrimental patient consequences and high financial costs. Despite these risks, it is often medically necessary to prescribe multiple medications to treat the comorbid conditions that accompany CKD. In addition, patients' use of nonprescription medications and changes in pharmacokinetic and pharmacodynamic parameters may further contribute to medication-related problems in CKD, including drug interactions and the need for dosage adjustments. A structured medication assessment process is one approach to reducing the risks associated with medication-related problems. This multifaceted process involves a compre... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797053 Thu, 10 Sep 2009 23:00:00 +0100 2797053 http://www.medworm.com/index.php?rid=2797052&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747172%26dopt%3DAbstract Authors: Chilcot J, Wellsted D, Farrington K Abstract Depression or the presence of significant depressive symptoms remains common in patients with end-stage renal disease (ESRD). It is thought that 20-30% of ESRD patients have significant depressive symptoms, although there are issues surrounding the assessment of depression among patients with physical illness. Screening tools may be useful in this setting to identify patients with low affect, accompanied by formal diagnostic approaches which are important to consider following a positive screen. Recent evidence highlights the impact of depression upon mortality, and its association with non-adherence and immune parameters, work that supports past investigations. Further studies are required to better our understanding of the mechani... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797052 Thu, 10 Sep 2009 23:00:00 +0100 2797052 http://www.medworm.com/index.php?rid=2797051&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747173%26dopt%3DAbstract Authors: Schoenkerman AB, Gimelli G, Yevzlin AS Abstract A case is described in which the inflow of a left radiocephalic arteriovenous fistula was being maintained by retrograde flow from a patent left internal mammary artery bypass graft, distal to a severe left subclavian artery stenosis. The clinical manifestations of this phenomenon were angina, lateral chest wall pain during dialysis, and distal hypoperfusion of the left hand. After stenting of the subclavian lesion, all symptoms resolved. PMID: 19747173 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797051 Thu, 10 Sep 2009 23:00:00 +0100 2797051 http://www.medworm.com/index.php?rid=2797050&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747174%26dopt%3DAbstract This article focuses on arterial interventions performed by interventional nephrologists and describes the epidemiology, techniques, and outcomes of arterial intervention as they relate to the care of patients with hemodialysis access and chronic kidney disease. PMID: 19747174 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797050 Thu, 10 Sep 2009 23:00:00 +0100 2797050 http://www.medworm.com/index.php?rid=2797049&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747175%26dopt%3DAbstract Authors: Samaha A, Salman L, Asif A Abstract A chronic hemodialysis patient was referred to interventional nephrology for evaluation of left hand pain. The patient had been receiving hemodialysis through a left radial-cephalic arteriovenous fistula and reporting hand pain during dialysis. Physical examination demonstrated cold hand and reduced capillary refill compared with the right hand. Clinical features, differential diagnosis, and physical examination findings were consistent with the diagnosis of hand ischemia due to dialysis access. Arteriography revealed >80% stenosis of the distal ulnar artery. Percutaneous balloon angioplasty successfully dilated the lesion with resolution of symptoms. Although uncommon, patients with forearm fistula can also experience symptoms of hand is... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797049 Thu, 10 Sep 2009 23:00:00 +0100 2797049 http://www.medworm.com/index.php?rid=2797048&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747176%26dopt%3DAbstract Authors: Beathard GA PMID: 19747176 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797048 Thu, 10 Sep 2009 23:00:00 +0100 2797048 http://www.medworm.com/index.php?rid=2797047&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747177%26dopt%3DAbstract This report describes arterial stent placement in patients with arteriovenous access and discusses anticoagulation considerations in such cases. PMID: 19747177 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797047 Thu, 10 Sep 2009 23:00:00 +0100 2797047 http://www.medworm.com/index.php?rid=2797046&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747178%26dopt%3DAbstract We report the first known case of combined chylothorax and chylous pericardial tamponade in a dialysis patient associated with catheter-induced superior vena cava (SVC) stenosis. A successful outcome was achieved with drainage of both chylous effusions in combination with angioplasty of the SVC stenosis. PMID: 19747178 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797046 Thu, 10 Sep 2009 23:00:00 +0100 2797046 http://www.medworm.com/index.php?rid=2797045&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19747179%26dopt%3DAbstract Authors: Perakis KE, Stylianou KG, Kyriazis JP, Mavroeidi VN, Katsipi IG, Vardaki EA, Petrakis IG, Stratigis S, Kroustalakis NG, Alegakis AK, Daphnis EK Abstract Considerable controversy currently exists in the literature concerning the mode of catheter placement and its impact on the technical success of peritoneal dialysis (PD). We decided to compare the impact of the surgical versus the percutaneous insertion technique on peritoneal dialysis catheter (PDCs) complications and survival. Our study population comprised 152 patients in whom 170 PDCs were inserted between January 1990 and December 2007 at the main PD unit on the island of Crete. Eighty four catheters were surgically placed (S group) and 86 were placed percutaneously by nephrologists (N group). The total experience accumul... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2797045 Thu, 10 Sep 2009 23:00:00 +0100 2797045 http://www.medworm.com/index.php?rid=2787342&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00621.x Considerable controversy currently exists in the literature concerning the mode of catheter placement and its impact on the technical success of peritoneal dialysis (PD). We decided to compare the impact of the surgical versus the percutaneous insertion technique on peritoneal dialysis catheter (PDCs) complications and survival. Our study population comprised 152 patients in whom 170 PDCs were inserted between January 1990 and December 2007 at the main PD unit on the island of Crete. Eighty four catheters were surgically placed (S group) and 86 were placed percutaneously by nephrologists (N group). The total experience accumulated was 4997 patient-months. The overall complications did not differ between the two groups. Only early leakage was more frequent in N group than S group (10.3 vers... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787342 Thu, 10 Sep 2009 23:00:00 +0100 2787342 http://www.medworm.com/index.php?rid=2787341&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00622.x We report the first known case of combined chylothorax and chylous pericardial tamponade in a dialysis patient associated with catheter-induced superior vena cava (SVC) stenosis. A successful outcome was achieved with drainage of both chylous effusions in combination with angioplasty of the SVC stenosis. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787341 Thu, 10 Sep 2009 23:00:00 +0100 2787341 http://www.medworm.com/index.php?rid=2787340&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00623.x This report describes arterial stent placement in patients with arteriovenous access and discusses anticoagulation considerations in such cases. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787340 Thu, 10 Sep 2009 23:00:00 +0100 2787340 http://www.medworm.com/index.php?rid=2787339&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00624.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787339 Thu, 10 Sep 2009 23:00:00 +0100 2787339 http://www.medworm.com/index.php?rid=2787338&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00625.x A chronic hemodialysis patient was referred to interventional nephrology for evaluation of left hand pain. The patient had been receiving hemodialysis through a left radial-cephalic arteriovenous fistula and reporting hand pain during dialysis. Physical examination demonstrated cold hand and reduced capillary refill compared with the right hand. Clinical features, differential diagnosis, and physical examination findings were consistent with the diagnosis of hand ischemia due to dialysis access. Arteriography revealed >80% stenosis of the distal ulnar artery. Percutaneous balloon angioplasty successfully dilated the lesion with resolution of symptoms. Although uncommon, patients with forearm fistula can also experience symptoms of hand ischemia. This case demonstrates that in addition to t... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787338 Thu, 10 Sep 2009 23:00:00 +0100 2787338 http://www.medworm.com/index.php?rid=2787337&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00626.x This article focuses on arterial interventions performed by interventional nephrologists and describes the epidemiology, techniques, and outcomes of arterial intervention as they relate to the care of patients with hemodialysis access and chronic kidney disease. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787337 Thu, 10 Sep 2009 23:00:00 +0100 2787337 http://www.medworm.com/index.php?rid=2787336&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00627.x A case is described in which the inflow of a left radiocephalic arteriovenous fistula was being maintained by retrograde flow from a patent left internal mammary artery bypass graft, distal to a severe left subclavian artery stenosis. The clinical manifestations of this phenomenon were angina, lateral chest wall pain during dialysis, and distal hypoperfusion of the left hand. After stenting of the subclavian lesion, all symptoms resolved. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787336 Thu, 10 Sep 2009 23:00:00 +0100 2787336 http://www.medworm.com/index.php?rid=2787335&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00629.x Medication-related problems are very common in patients with chronic kidney disease (CKD). These problems are often avoidable and can result in detrimental patient consequences and high financial costs. Despite these risks, it is often medically necessary to prescribe multiple medications to treat the comorbid conditions that accompany CKD. In addition, patients' use of nonprescription medications and changes in pharmacokinetic and pharmacodynamic parameters may further contribute to medication-related problems in CKD, including drug interactions and the need for dosage adjustments. A structured medication assessment process is one approach to reducing the risks associated with medication-related problems. This multifaceted process involves a comprehensive medication history interview, str... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2787335 Thu, 10 Sep 2009 23:00:00 +0100 2787335 http://www.medworm.com/index.php?rid=2790554&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744148%26dopt%3DAbstract Authors: Coyne DW, Brennan DC PMID: 19744148 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790554 Tue, 08 Sep 2009 23:00:00 +0100 2790554 http://www.medworm.com/index.php?rid=2790553&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744149%26dopt%3DAbstract Authors: James MT, Manns BJ, Hemmelgarn BR, Ravani P, Abstract Findings from observational studies have established that the arteriovenous fistula (AVF) is the preferred form of vascular access for chronic hemodialysis. Unfortunately, in a subset of patients with end-stage renal disease, an AVF cannot be placed or fails to mature. In these patients an alternate form of vascular access, either an arteriovenous graft (AVG) or central venous catheter (CVC) must be selected. In this review we discuss the findings and limitations of studies examining the effect of access type (AVG or CVC) on clinical endpoints including mortality, quality of life, occurrence of infections, as well as the impact of the different access types on resource requirements. Specifically, we examine whether finding... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790553 Tue, 08 Sep 2009 23:00:00 +0100 2790553 http://www.medworm.com/index.php?rid=2790552&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744150%26dopt%3DAbstract Authors: Holden RM, Clase CM Abstract Atrial fibrillation, venous thromboembolism, and access malfunction are common clinical problems in dialysis patients that prompt consideration of warfarin therapy. Atrial fibrillation appears to be more common in people with low glomerular filtration rate (GFR) or on dialysis than in the general population, but the risk of stroke in this population is not known. No randomized trials have addressed the safety and efficacy of warfarin in these patients. Deep venous thrombosis and pulmonary embolism are also more common in this population and, again, no randomized trials have addressed the safety and efficacy of warfarin in this group. Pending such information, we suggest an approach that generalizes from large randomized controlled trials in the gen... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790552 Tue, 08 Sep 2009 23:00:00 +0100 2790552 http://www.medworm.com/index.php?rid=2790551&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744151%26dopt%3DAbstract Authors: Yevzlin AS, Urbanes A Abstract A case is described in which an excimer laser is used to assist angioplasty of a severe central venous lesion that is refractory to conventional techniques. Modern laser technology uses the ultraviolet (UV) spectral region to generate nanosecond pulses of energy. This results in photoablation, which is the process by which energy photons cause molecular bond disruption, while minimizing thermal damage to the surrounding vascular tissues. Further investigation of excimer laser assisted angioplasty in the setting of hemodialysis access intervention is needed to rigorously define its potential role. In occlusive disease where no conventional alternative is available, however, laser therapy is a viable option. PMID: 19744151 [PubMed - as supplied... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790551 Tue, 08 Sep 2009 23:00:00 +0100 2790551 http://www.medworm.com/index.php?rid=2790550&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744152%26dopt%3DAbstract Authors: Twardowski ZJ PMID: 19744152 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790550 Tue, 08 Sep 2009 23:00:00 +0100 2790550 http://www.medworm.com/index.php?rid=2790549&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744153%26dopt%3DAbstract Authors: Palmer BF PMID: 19744153 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790549 Tue, 08 Sep 2009 23:00:00 +0100 2790549 http://www.medworm.com/index.php?rid=2790548&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744154%26dopt%3DAbstract Authors: Chazot C PMID: 19744154 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790548 Tue, 08 Sep 2009 23:00:00 +0100 2790548 http://www.medworm.com/index.php?rid=2790547&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744155%26dopt%3DAbstract Authors: Sinha AD, Agarwal R PMID: 19744155 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790547 Tue, 08 Sep 2009 23:00:00 +0100 2790547 http://www.medworm.com/index.php?rid=2790546&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19744156%26dopt%3DAbstract Authors: Locatelli F, Cavalli A, Tucci B, Viganò S, Di Filippo S PMID: 19744156 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2790546 Tue, 08 Sep 2009 23:00:00 +0100 2790546 http://www.medworm.com/index.php?rid=2776276&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00630.x A case is described in which an excimer laser is used to assist angioplasty of a severe central venous lesion that is refractory to conventional techniques. Modern laser technology uses the ultraviolet (UV) spectral region to generate nanosecond pulses of energy. This results in photoablation, which is the process by which energy photons cause molecular bond disruption, while minimizing thermal damage to the surrounding vascular tissues. Further investigation of excimer laser assisted angioplasty in the setting of hemodialysis access intervention is needed to rigorously define its potential role. In occlusive disease where no conventional alternative is available, however, laser therapy is a viable option. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776276 Tue, 08 Sep 2009 23:00:00 +0100 2776276 http://www.medworm.com/index.php?rid=2776275&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00632.x Atrial fibrillation, venous thromboembolism, and access malfunction are common clinical problems in dialysis patients that prompt consideration of warfarin therapy. Atrial fibrillation appears to be more common in people with low glomerular filtration rate (GFR) or on dialysis than in the general population, but the risk of stroke in this population is not known. No randomized trials have addressed the safety and efficacy of warfarin in these patients. Deep venous thrombosis and pulmonary embolism are also more common in this population and, again, no randomized trials have addressed the safety and efficacy of warfarin in this group. Pending such information, we suggest an approach that generalizes from large randomized controlled trials in the general population, modifying the assessment ... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776275 Tue, 08 Sep 2009 23:00:00 +0100 2776275 http://www.medworm.com/index.php?rid=2776274&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00633.x Findings from observational studies have established that the arteriovenous fistula (AVF) is the preferred form of vascular access for chronic hemodialysis. Unfortunately, in a subset of patients with end-stage renal disease, an AVF cannot be placed or fails to mature. In these patients an alternate form of vascular access, either an arteriovenous graft (AVG) or central venous catheter (CVC) must be selected. In this review we discuss the findings and limitations of studies examining the effect of access type (AVG or CVC) on clinical endpoints including mortality, quality of life, occurrence of infections, as well as the impact of the different access types on resource requirements. Specifically, we examine whether findings from previous studies are valid and applicable to patients for who... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776274 Tue, 08 Sep 2009 23:00:00 +0100 2776274 http://www.medworm.com/index.php?rid=2776273&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00635.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776273 Tue, 08 Sep 2009 23:00:00 +0100 2776273 http://www.medworm.com/index.php?rid=2776272&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00640.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776272 Tue, 08 Sep 2009 23:00:00 +0100 2776272 http://www.medworm.com/index.php?rid=2776271&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00641.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776271 Tue, 08 Sep 2009 23:00:00 +0100 2776271 http://www.medworm.com/index.php?rid=2776270&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00642.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776270 Tue, 08 Sep 2009 23:00:00 +0100 2776270 http://www.medworm.com/index.php?rid=2776269&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00643.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776269 Tue, 08 Sep 2009 23:00:00 +0100 2776269 http://www.medworm.com/index.php?rid=2776268&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00644.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2776268 Tue, 08 Sep 2009 23:00:00 +0100 2776268 http://www.medworm.com/index.php?rid=2632125&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00620.x This article expands and clarifies the results of the NHCT, including data that were edited from the original publication, and highlights findings from more recent studies in the field. Paradoxically, none of the randomized trials has reported an association between higher attained hemoglobin concentration and mortality within randomized groups. Mean platelet count did not increase among the patients in the normal-hematocrit group in the NHCT or in two other large trials, CREATE and CHOIR. Exposure to high doses of erythropoietic stimulating agents and/or intravenous iron could be mediating complications in the CKD anemia-normalization studies, but post-hoc analyses to probe such potential associations have yielded conflicting results and are clearly hindered by the risk of confounding by ... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2632125 Thu, 23 Jul 2009 23:00:00 +0100 2632125 http://www.medworm.com/index.php?rid=2674346&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19650856%26dopt%3DAbstract This article expands and clarifies the results of the NHCT, including data that were edited from the original publication, and highlights findings from more recent studies in the field. Paradoxically, none of the randomized trials has reported an association between higher attained hemoglobin concentration and mortality within randomized groups. Mean platelet count did not increase among the patients in the normal-hematocrit group in the NHCT or in two other large trials, CREATE and CHOIR. Exposure to high doses of erythropoietic stimulating agents and/or intravenous iron could be mediating complications in the CKD anemia-normalization studies, but post-hoc analyses to probe such potential associations have yielded conflicting results and are clearly hindered by the risk of confounding by ... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2674346 Wed, 22 Jul 2009 23:00:00 +0100 2674346 http://www.medworm.com/index.php?rid=2516088&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00618.x Atherosclerotic renal artery stenosis (RAS), recognized as a contributor to chronic kidney disease (CKD), may be present in a substantial fraction of dialysis patients. It is generally unknown what proportion of end-stage renal disease patients on dialysis could recover kidney function if RAS were treated. Patients with CKD are often inadequately screened for RAS because of technical limitations of various screening modalities. Multiple small case series and studies have evaluated the role of revascularization for renal salvage in dialysis patients with RAS; these studies are reviewed. Large prospective, randomized multicenter trials of intervention for RAS exclude patients with advanced CKD. The risks of intervention must be weighed against the potential for renal recovery, even when pred... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2516088 Thu, 25 Jun 2009 23:00:00 +0100 2516088 http://www.medworm.com/index.php?rid=2556489&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19558627%26dopt%3DAbstract Authors: Dwyer JP, Greco BA, Lewis JB Atherosclerotic renal artery stenosis (RAS), recognized as a contributor to chronic kidney disease (CKD), may be present in a substantial fraction of dialysis patients. It is generally unknown what proportion of end-stage renal disease patients on dialysis could recover kidney function if RAS were treated. Patients with CKD are often inadequately screened for RAS because of technical limitations of various screening modalities. Multiple small case series and studies have evaluated the role of revascularization for renal salvage in dialysis patients with RAS; these studies are reviewed. Large prospective, randomized multicenter trials of intervention for RAS exclude patients with advanced CKD. The risks of intervention must be weighed against the po... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2556489 Wed, 24 Jun 2009 23:00:00 +0100 2556489 http://www.medworm.com/index.php?rid=2556488&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19558628%26dopt%3DAbstract This article aims to answer these fundamental questions confronting the nephrologist in day to day clinical practice. PMID: 19558628 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2556488 Wed, 24 Jun 2009 23:00:00 +0100 2556488 http://www.medworm.com/index.php?rid=2556487&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19558629%26dopt%3DAbstract Authors: Polaschegg HD Blood damage is an unavoidable side effect of extracorporeal circulation. The effects of blood damage on patients' hematocrit and erythropoietin requirement as well as other potential side effects have not been studied for uneventful treatments. Comparing long nocturnal dialysis with regular 4-hour, three times per week dialysis allows for the conclusion that the influence of blood damage caused by extracorporeal circulation is small compared with biochemical effects. Acute hemolysis is one of the few remaining mechanical problems of dialysis. Acute hemolysis is caused by obstructions within the extracorporeal circuit caused by manufacturing errors, kinking of blood tubing or user errors, or by a combination of excessive flow and improper cannula or catheter dime... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2556487 Wed, 24 Jun 2009 23:00:00 +0100 2556487 http://www.medworm.com/index.php?rid=2516090&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00616.x Blood damage is an unavoidable side effect of extracorporeal circulation. The effects of blood damage on patients' hematocrit and erythropoietin requirement as well as other potential side effects have not been studied for uneventful treatments. Comparing long nocturnal dialysis with regular 4-hour, three times per week dialysis allows for the conclusion that the influence of blood damage caused by extracorporeal circulation is small compared with biochemical effects. Acute hemolysis is one of the few remaining mechanical problems of dialysis. Acute hemolysis is caused by obstructions within the extracorporeal circuit caused by manufacturing errors, kinking of blood tubing or user errors, or by a combination of excessive flow and improper cannula or catheter dimensions. The risk of acute h... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2516090 Wed, 24 Jun 2009 23:00:00 +0100 2516090 http://www.medworm.com/index.php?rid=2516089&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00617.x This article aims to answer these fundamental questions confronting the nephrologist in day to day clinical practice. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2516089 Wed, 24 Jun 2009 23:00:00 +0100 2516089 http://www.medworm.com/index.php?rid=2479779&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00615.x Intradialytic hypotension likely results from hypovolemia as well as patient and dialysis-specific factors. An impaired vasoconstrictive response to volume loss during hemodialysis has been demonstrated and increasing evidence suggests that deficiency in the hormone arginine vasopressin may be a contributing factor. Although vasopressin is widely recognized for its role in the regulation of serum osmolality, vasopressin is also an important regulator of blood pressure in health and in various disease states. That vasopressin deficiency contributes to the pathogenesis of intradialytic hypotension is suggested by several observations. First, vasopressin levels typically fall during hemodialysis when a rise might be expected as a result of volume loss. Second, therapies that prevent a fall in... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2479779 Tue, 16 Jun 2009 04:00:00 +0100 2479779 http://www.medworm.com/index.php?rid=2479780&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00613.x Hemodialysis patients with failed upper extremity (arm) access sites comprise 5[ndash]10% of the dialysis population. In these patients, arm vessels are either unsuitable for access placement due to trauma or peripheral vascular disease, or have been exhausted following dialysis usage. Synthetic grafts in the lower extremity (thigh) would benefit these patients, but surgeons are often reluctant to place them, due to concerns of infection and vascular complications. As a result, these patients receive tunneled central venous catheters as their permanent dialysis access. Recent studies have shown, however, that survival and complication rates of thigh grafts are similar to arm grafts and fistulas. Moreover, thigh grafts have lower infection and mortality rates than catheters and provide high... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2479780 Thu, 11 Jun 2009 04:00:00 +0100 2479780 http://www.medworm.com/index.php?rid=2542199&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19522759%26dopt%3DAbstract Authors: Thompson AM, Oliver JA Intradialytic hypotension likely results from hypovolemia as well as patient and dialysis-specific factors. An impaired vasoconstrictive response to volume loss during hemodialysis has been demonstrated and increasing evidence suggests that deficiency in the hormone arginine vasopressin may be a contributing factor. Although vasopressin is widely recognized for its role in the regulation of serum osmolality, vasopressin is also an important regulator of blood pressure in health and in various disease states. That vasopressin deficiency contributes to the pathogenesis of intradialytic hypotension is suggested by several observations. First, vasopressin levels typically fall during hemodialysis when a rise might be expected as a result of volume loss. Seco... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542199 Wed, 10 Jun 2009 23:00:00 +0100 2542199 http://www.medworm.com/index.php?rid=2542198&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19522760%26dopt%3DAbstract Authors: Abreo KD, Ram SJ Hemodialysis patients with failed upper extremity (arm) access sites comprise 5-10% of the dialysis population. In these patients, arm vessels are either unsuitable for access placement due to trauma or peripheral vascular disease, or have been exhausted following dialysis usage. Synthetic grafts in the lower extremity (thigh) would benefit these patients, but surgeons are often reluctant to place them, due to concerns of infection and vascular complications. As a result, these patients receive tunneled central venous catheters as their permanent dialysis access. Recent studies have shown, however, that survival and complication rates of thigh grafts are similar to arm grafts and fistulas. Moreover, thigh grafts have lower infection and mortality rates than ca... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542198 Wed, 10 Jun 2009 23:00:00 +0100 2542198 http://www.medworm.com/index.php?rid=2432882&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00611.x Until recently, patients on dialysis with low serum albumin levels were characterized as suffering from protein malnutrition suggesting that the cause of this malady was due to an inadequate intake of protein. In fact, these patients tend to suffer from a wasting syndrome similar to cachexia commonly associated with inflammation in which there is loss of lean body mass and fat mass is underutilized. The term protein energy wasting has been used to characterize this syndrome and suggests that the simple addition of protein supplements to the dietary regimen of hemodialysis patients will not cure this malady. Correction of the underlying inflammatory disorder which drives losses of body protein and fuel reserves is far more important and is the single most effective therapy. Protein suppleme... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2432882 Sun, 24 May 2009 04:00:00 +0100 2432882 http://www.medworm.com/index.php?rid=2542200&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19497033%26dopt%3DAbstract Authors: Bailey JL, Franch HA Abstract Until recently, patients on dialysis with low serum albumin levels were characterized as suffering from protein malnutrition suggesting that the cause of this malady was due to an inadequate intake of protein. In fact, these patients tend to suffer from a wasting syndrome similar to cachexia commonly associated with inflammation in which there is loss of lean body mass and fat mass is underutilized. The term protein energy wasting has been used to characterize this syndrome and suggests that the simple addition of protein supplements to the dietary regimen of hemodialysis patients will not cure this malady. Correction of the underlying inflammatory disorder which drives losses of body protein and fuel reserves is far more important and is the sing... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542200 Thu, 21 May 2009 23:00:00 +0100 2542200 http://www.medworm.com/index.php?rid=2419339&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00612.x Arteriovenous grafts used for hemodialysis can produce high-output cardiac failure as a result of shunting of blood through the dialysis access. The following case demonstrates that the problem can occur shortly after graft formation and improved with graft ligation. It caused haemodynamic compromise because of previously undiagnosed, underlying valvular heart disease. It also caused a diagnostic difficulty in the immediate postoperative period as it was mistaken for postsurgical hemorrhage. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2419339 Tue, 19 May 2009 04:00:00 +0100 2419339 http://www.medworm.com/index.php?rid=2419340&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2009.00609.x Percutaneous renal biopsy may be complicated by hemorrhage. Patients are frequently hospitalized for overnight observation. We evaluated prospectively the feasibility and safety of an outpatient renal biopsy protocol. During a 20-month period, 100 consecutive patients underwent outpatient renal biopsy using a standardized protocol. The biopsy was performed by Nephrology Fellows, under direct faculty supervision. All biopsies were carried out under real-time ultrasound guidance with a 16-gauge spring-loaded biopsy gun, and followed immediately by color Doppler ultrasound to exclude active bleeding. Blood pressure, heart rate, hemoglobin, and hematocrit were monitored for 8 hours postbiopsy. If there were no complications, the patients were discharged home after the observation period. A tot... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2419340 Fri, 15 May 2009 04:00:00 +0100 2419340 http://www.medworm.com/index.php?rid=2542202&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19473318%26dopt%3DAbstract Authors: Acharya S, Banerjee D, Fronek J, Fossati N, Chemla ES Arteriovenous grafts used for hemodialysis can produce high-output cardiac failure as a result of shunting of blood through the dialysis access. The following case demonstrates that the problem can occur shortly after graft formation and improved with graft ligation. It caused haemodynamic compromise because of previously undiagnosed, underlying valvular heart disease. It also caused a diagnostic difficulty in the immediate postoperative period as it was mistaken for postsurgical hemorrhage. PMID: 19473318 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542202 Thu, 14 May 2009 23:00:00 +0100 2542202 http://www.medworm.com/index.php?rid=2542201&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19473319%26dopt%3DAbstract Authors: Maya ID, Allon M Percutaneous renal biopsy may be complicated by hemorrhage. Patients are frequently hospitalized for overnight observation. We evaluated prospectively the feasibility and safety of an outpatient renal biopsy protocol. During a 20-month period, 100 consecutive patients underwent outpatient renal biopsy using a standardized protocol. The biopsy was performed by Nephrology Fellows, under direct faculty supervision. All biopsies were carried out under real-time ultrasound guidance with a 16-gauge spring-loaded biopsy gun, and followed immediately by color Doppler ultrasound to exclude active bleeding. Blood pressure, heart rate, hemoglobin, and hematocrit were monitored for 8 hours postbiopsy. If there were no complications, the patients were discharged home after... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542201 Thu, 14 May 2009 23:00:00 +0100 2542201 http://www.medworm.com/index.php?rid=2309565&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00555.x Neuromuscular disease is an extremely common complication of end-stage kidney disease (ESKD), manifesting in almost all dialysis patients, and leading to weakness, reduced exercise capacity, and disability. Recent studies have suggested that hyperkalemia may underlie the development of neuropathy. As such, maintenance of serum K+ within normal limits between periods of dialysis in ESKD patients manifesting early neuropathic symptoms may reduce neuropathy development and progression. For patients with more severe neuropathic syndromes, increased dialysis frequency or a switch to high-flux dialysis may prevent further deterioration, while ultimately, renal transplantation is required to improve and restore nerve function. Exercise training programs are beneficial for ESKD patients with muscl... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2309565 Tue, 07 Apr 2009 04:00:00 +0100 2309565 http://www.medworm.com/index.php?rid=2309567&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00546.x We report three patients with signs and symptoms suggestive of SEP all of whom had normal abdominal CT scans. Nevertheless, each patient underwent diagnostic laparoscopy, which confirmed the clinical suspicion of SEP. In each case, the diagnosis was made before extensive peritoneal fibrosis had occurred allowing therapeutic intervention at an early stage. All three patients subsequently became asymptomatic and thrived. This clinical improvement was supported by the lack of progression to overt peritoneal fibrosis on repeat laparoscopy. We conclude that a high index of suspicion in conjunction with a low threshold for diagnostic laparoscopy may be an effective strategy to establish an early diagnosis and treatment regimen for SEP. Additionally, repeat laparoscopy can be used to guide the le... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2309567 Sun, 05 Apr 2009 04:00:00 +0100 2309567 http://www.medworm.com/index.php?rid=2309566&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00554.x This study will review the key pharmacokinetic/pharmacodynamic considerations in aminoglycoside dosing, the relationship between serum aminoglycoside concentrations and efficacy/toxicity, the influence of renal function and hemodialysis on aminoglycoside pharmacokinetics/pharmacodynamics, and the mounting population pharmacokinetic and clinical study evidence supporting a paradigm shift in aminoglycoside dosing from post dialysis to predialysis. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2309566 Sun, 05 Apr 2009 04:00:00 +0100 2309566 http://www.medworm.com/index.php?rid=2542226&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19386072%26dopt%3DAbstract Authors: Krishnan AV, Pussell BA, Kiernan MC Neuromuscular disease is an extremely common complication of end-stage kidney disease (ESKD), manifesting in almost all dialysis patients, and leading to weakness, reduced exercise capacity, and disability. Recent studies have suggested that hyperkalemia may underlie the development of neuropathy. As such, maintenance of serum K(+) within normal limits between periods of dialysis in ESKD patients manifesting early neuropathic symptoms may reduce neuropathy development and progression. For patients with more severe neuropathic syndromes, increased dialysis frequency or a switch to high-flux dialysis may prevent further deterioration, while ultimately, renal transplantation is required to improve and restore nerve function. Exercise training p... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542226 Sat, 04 Apr 2009 23:00:00 +0100 2542226 http://www.medworm.com/index.php?rid=2542225&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19386073%26dopt%3DAbstract This study will review the key pharmacokinetic/pharmacodynamic considerations in aminoglycoside dosing, the relationship between serum aminoglycoside concentrations and efficacy/toxicity, the influence of renal function and hemodialysis on aminoglycoside pharmacokinetics/pharmacodynamics, and the mounting population pharmacokinetic and clinical study evidence supporting a paradigm shift in aminoglycoside dosing from post dialysis to predialysis. PMID: 19386073 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542225 Sat, 04 Apr 2009 23:00:00 +0100 2542225 http://www.medworm.com/index.php?rid=2542224&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19386074%26dopt%3DAbstract We report three patients with signs and symptoms suggestive of SEP all of whom had normal abdominal CT scans. Nevertheless, each patient underwent diagnostic laparoscopy, which confirmed the clinical suspicion of SEP. In each case, the diagnosis was made before extensive peritoneal fibrosis had occurred allowing therapeutic intervention at an early stage. All three patients subsequently became asymptomatic and thrived. This clinical improvement was supported by the lack of progression to overt peritoneal fibrosis on repeat laparoscopy. We conclude that a high index of suspicion in conjunction with a low threshold for diagnostic laparoscopy may be an effective strategy to establish an early diagnosis and treatment regimen for SEP. Additionally, repeat laparoscopy can be used to guide the le... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542224 Sat, 04 Apr 2009 23:00:00 +0100 2542224 http://www.medworm.com/index.php?rid=2542223&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426411%26dopt%3DAbstract Authors: Tolwani AJ, Palevsky PM PMID: 19426411 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542223 Sun, 01 Mar 2009 00:00:00 +0100 2542223 http://www.medworm.com/index.php?rid=2542222&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426412%26dopt%3DAbstract Authors: Abi Antoun T, Palevsky PM The proliferation of new technologies has led to the availability of a broad range of options for the management of renal replacement therapy (RRT) in patients with acute kidney injury. We provide a review of the published literature comparing the continuous RRTs (CRRT) with other modalities of renal support, including intermittent hemodialysis and the more recently described "hybrid" therapies such as sustained, low efficiency dialysis as well as compare arteriovenous and venovenous and convective and diffusive modalities of CRRT. While there is clear evidence that venovenous therapies are superior to arteriovenous therapies, current evidence does not support superiority of convective when compared with diffusive therapies or greater survival or reco... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542222 Sun, 01 Mar 2009 00:00:00 +0100 2542222 http://www.medworm.com/index.php?rid=2542221&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426413%26dopt%3DAbstract This article focuses on the different modalities of CRRT and reviews both the basic concepts and the newest approaches to the management of the critically ill patient with AKI. PMID: 19426413 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542221 Sun, 01 Mar 2009 00:00:00 +0100 2542221 http://www.medworm.com/index.php?rid=2542220&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426414%26dopt%3DAbstract Authors: Cruz D, Bobek I, Lentini P, Soni S, Chionh CY, Ronco C A significant number of advancements have taken place since the beginning of continuous renal replacement therapy (CRRT). In particular, high volume hemofiltration and high permeability hemofiltration have been successful extensions of the technique. The additional and combined use of sorbent has also been tested successfully. Specific machines have now been designed to permit safe and reliable performance of the therapy. These new devices are equipped with a friendly user interface that allows for easy performance and monitoring. The apparent complexity of the circuit is made simple by a self-loading circuit or a cartridge which includes the filter and the blood and dialysate lines. Priming is performed automatically by t... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542220 Sun, 01 Mar 2009 00:00:00 +0100 2542220 http://www.medworm.com/index.php?rid=2542219&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426415%26dopt%3DAbstract Authors: Vijayan A A working vascular access is essential for performing continuous renal replacement therapy (CRRT) efficiently and without interruption. Dual-lumen temporary hemodialysis catheters are the catheters of choice, although tunneled catheters can also be utilized if therapy is expected to be prolonged. Hemodialysis catheters have to be inserted under ultrasound guidance by trained personnel, using aseptic conditions. The right internal jugular vein is the preferred site. Catheter malfunction and catheter-related infections can be reduced by adhering to preventive guidelines such as ultrasound guidance for placement, strict hand hygiene, gauze dressings, and sterile techniques during catheter handling. Antibiotic or antiseptic-coated catheters and lock solutions may be bene... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542219 Sun, 01 Mar 2009 00:00:00 +0100 2542219 http://www.medworm.com/index.php?rid=2542218&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426416%26dopt%3DAbstract Authors: Kraus MA Often, too little consideration is given to the fluids used in all forms of continuous renal replacement therapy (CRRT). However, errors in fluid prescription, delivery, or creation can be rapidly fatal; in addition, fluid associated expenses can be the overriding cost in continuous renal replacement therapies. While a standard solution is frequently acceptable in most clinical circumstances, specific electrolyte and acid-base disturbances may direct changes in fluid delivery and composition. Decisions regarding fluids, whether dialysate versus replacement, including generation and composition of therapy are discussed in this review. PMID: 19426416 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542218 Sun, 01 Mar 2009 00:00:00 +0100 2542218 http://www.medworm.com/index.php?rid=2542217&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426417%26dopt%3DAbstract Authors: Tolwani AJ, Wille KM Continuous renal replacement therapy (CRRT) has emerged as the preferred dialysis modality for critically ill patients with acute kidney injury, particularly those with hemodynamic instability. Anticoagulation is necessary for effective delivery of CRRT, but this requirement can also present challenges, as many critically ill patients with sepsis and inflammation already have a higher risk of bleeding as well as clotting. Without anticoagulation, CRRT filter and circuit survival are diminished, and therapy becomes less helpful. Heparins are presently the most commonly used anticoagulants worldwide for CRRT. They are widely available and can be easily monitored, but disadvantages include risks of hemorrhage, heparin resistance, and heparin-induced thrombocy... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542217 Sun, 01 Mar 2009 00:00:00 +0100 2542217 http://www.medworm.com/index.php?rid=2542216&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426418%26dopt%3DAbstract Authors: Bouchard J, Mehta RL Volume management is an integral component of the care of critically ill patients to maintain hemodynamic stability and optimize organ function. The dynamic nature of critical illness often necessitates volume resuscitation and contributes to fluid overload particularly in the presence of altered renal function. Diuretics are commonly used as an initial therapy to increase urine output; however they have limited effectiveness due to underlying acute kidney injury and other factors contributing to diuretic resistance. Continuous renal replacement techniques (CRRT) are often required for volume management. In this setting, successful volume management depends on an accurate assessment of fluid status, an adequate comprehension of the principles of fluid mana... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542216 Sun, 01 Mar 2009 00:00:00 +0100 2542216 http://www.medworm.com/index.php?rid=2542215&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426419%26dopt%3DAbstract Authors: Palevsky PM The intensity of continuous renal replacement therapy (CRRT) is generally assessed on the basis of small solute clearance with dosing usually expressed in terms of total effluent volume per unit time (e.g., ml/kg/hour). Although several clinical trials have suggested an improvement in survival with higher doses of CRRT, results have not been consistent across all studies. The results of recent trials of intensity of CRRT are reviewed. The largest and most recent trials suggest that there is no additional benefit to using effluent flow rates in excess of 20 ml/kg/hour, although earlier studies suggested improved survival with doses of 35 to 45 ml/kg/hour. PMID: 19426419 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542215 Sun, 01 Mar 2009 00:00:00 +0100 2542215 http://www.medworm.com/index.php?rid=2542214&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426420%26dopt%3DAbstract Authors: Finkel KW, Podoll AS Continuous renal replacement therapy (CRRT) is commonly used in critically ill patients with acute kidney injury. Many studies show that compared with intermittent hemodialysis, continuous therapy has superior hemodynamic stability, metabolic clearance, and volume control. Despite these benefits, no survival advantage can be demonstrated with its use. Although study design explains much of this paradox, it is also quite plausible that the complications associated with CRRT negate its potential benefits in the critically ill patient. We summarize the common complications associated with the use of CRRT. PMID: 19426420 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542214 Sun, 01 Mar 2009 00:00:00 +0100 2542214 http://www.medworm.com/index.php?rid=2542213&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426421%26dopt%3DAbstract This study reviews the role of continuous renal replacement therapy (CRRT) in sepsis with acute kidney injury (AKI) and septic shock with multiple organ failure. In addition to the conventional aim of replacing renal function in AKI, CRRT is often used with the concept of modulating immune response in sepsis. With the intention of influencing circulating levels of inflammatory mediators like cytokines and chemokines, the complement system, as well as factors of the coagulation system, several modifications of CRRT have been developed over the last years. These include high volume hemofiltration, high adsorption hemofiltration, use of high cut-off membranes, and hybrid systems like coupled plasma filtration absorbance. One of the most promising concepts may be the development of renal assis... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542213 Sun, 01 Mar 2009 00:00:00 +0100 2542213 http://www.medworm.com/index.php?rid=2542212&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426422%26dopt%3DAbstract Authors: Davenport A Acute neurological injury may occur in patients with end-stage kidney disease on dialysis. Less frequently, acute kidney injury requiring renal dialytic support develops following acute neurological injury. Surrounding any site of neurological injury there is a penumbra of damage which is potentially reversible. To maximize full potential neurological recovery in patients requiring renal dialytic support, it is important that treatments do not themselves cause further cerebral ischemia. Standard intermittent hemodialysis is associated with cerebral swelling even in healthy outpatients and often with episodes of intradialytic hypotension. Continuous modes of renal replacement therapy have been shown to cause fewer surges in intracranial pressure and greater stabilit... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542212 Sun, 01 Mar 2009 00:00:00 +0100 2542212 http://www.medworm.com/index.php?rid=2542211&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426423%26dopt%3DAbstract Authors: Davenport A Patients with acute and chronic liver disease are prone to hypotension, and mortality increases when acute kidney injury supervenes. Hypotension during renal replacement therapy compromises cerebral perfusion, which can exacerbate cerebral edema in cases of fulminant hepatic failure and those with encephalopathy due to chronic liver failure. As such, any renal replacement therapy utilized should have minimal adverse effects on cardiovascular and cerebrovascular stability. Continuous modes of renal replacement therapy have been shown to cause less cardiovascular and cerebrovascular instability compared to other modalities, and as such are the treatments of choice for this group of critically ill patients. PMID: 19426423 [PubMed - in process] (Source: Seminars in... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542211 Sun, 01 Mar 2009 00:00:00 +0100 2542211 http://www.medworm.com/index.php?rid=2542210&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426424%26dopt%3DAbstract Authors: Udani SM, Murray PT The worsening of renal function in the context of decompensated heart failure is an increasingly common clinical scenario, dubbed the cardiorenal syndrome. Its development is not completely understood; however, it results from the hemodynamic and neurohumoral alterations that occur in the setting of left ventricular pressure and volume overload with poor cardiac output. Diuretics have been the mainstay of treatment; however, they are often unsuccessful in reversing the vicious cycle of volume overload, worsening cardiac function, and azotemia. Renal replacement therapy (RRT) in the form of isolated or continuous ultrafiltration (UF) with or without a component of solute clearance (hemofiltration or hemodialysis) has been increasingly utilized as a therapeut... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542210 Sun, 01 Mar 2009 00:00:00 +0100 2542210 http://www.medworm.com/index.php?rid=2542209&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426425%26dopt%3DAbstract Authors: Goldstein SL The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980's, intrinsic renal disease and burns comprised the most common pediatric acute kidney injury (AKI) etiologies. More recent data demonstrate that pediatric AKI most often results from complications of other systemic diseases resulting from the advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. In addition, RRT modality preferences to treat critically ill children have shifted from peritoneal dialysis to continuous renal replacement therapy (CRRT) as a result of improvements in CRRT technologies. Currently, multicenter prospective outcome studies for critically ill children with AKI... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542209 Sun, 01 Mar 2009 00:00:00 +0100 2542209 http://www.medworm.com/index.php?rid=2542208&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426426%26dopt%3DAbstract Authors: Churchwell MD, Mueller BA Continuous renal replacement therapy (CRRT) has given clinicians an important option in the care of critically ill patients. The slow and continuous dialysate and ultrafiltrate flow rates that are employed with CRRT can yield drug clearances similar to an analogous glomerular filtration rate of the native kidneys. Advantages such as superior volume control, excellent metabolic control, and hemodynamic tolerance by critically ill patients are well documented, but an understanding of drug dosing for CRRT is still a bit of a mystery. Although some pharmaceutical companies have dedicated postmarket research in this direction, many pharmaceutical companies have chosen not to pursue this information as it is not mandated and represents a relatively small pa... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542208 Sun, 01 Mar 2009 00:00:00 +0100 2542208 http://www.medworm.com/index.php?rid=2542207&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426427%26dopt%3DAbstract Authors: Baldwin I, Fealy N Treatment of critically ill patients with continuous renal replacement therapy (CRRT) requires a set of new skills and knowledge base for the intensive care unit (ICU) nurse. After a decision to treat is made, nurses effectively manage the technique by following a series of steps in sequence. These sequential steps include patient and machine circuit preparation, connection of the extracorporeal circuit (EC) to the patient's vascular access, and nursing management of a treatment in progress. During treatment, nurses prepare fluids, adjust fluid settings to provide fluid balance, prepare electrolyte additives, monitor acid base and electrolyte levels, monitor patient and machine "vital signs," and, when necessary, diagnose circuit clotting and perform a disco... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542207 Sun, 01 Mar 2009 00:00:00 +0100 2542207 http://www.medworm.com/index.php?rid=2542206&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426428%26dopt%3DAbstract Authors: Lomonte C, Casucci F, Antonelli M, Losurdo N, Marchio G, Teutonico A, Libutti P, Basile C An autogenous brachial-basilic arteriovenous fistula (BBAVF) in the upper arm must be considered before placing prosthetic grafts in hemodialysis patients with multiple failures of forearm AVFs. The aim of this observational study was to compare technical and clinical outcomes of a new construction technique for BBAVF (n-BBAVF) with that of the standard one-stage side-artery to end-vein transposed BBAVF (t-BBAVF). A n-BBAVF is constructed in the following way: basilic vein and brachial artery are isolated. Patency of the proximal and distal vein is verified by injecting warmed (37 degrees C) saline solution. A venotomy and an arterotomy of 4-5 mm are performed. The two vessels are prepare... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542206 Sun, 01 Mar 2009 00:00:00 +0100 2542206 http://www.medworm.com/index.php?rid=2542205&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426429%26dopt%3DAbstract Authors: Goh BL, Ganeshadeva Yudisthra M, Lim TO Peritoneal dialysis (PD) catheter insertion success rate is known to vary among different operators, and peritoneoscope PD catheter insertion demands mastery of a steep learning curve. Defining a learning curve using a continuous monitoring tool such as a Cumulative Summation (CUSUM) chart is useful for planning training programs. We aimed to analyze the learning curve of a trainee nephrologist in performing peritoneoscope PD catheter implantation with CUSUM chart. This was a descriptive single-center study using collected data from all PD patients who underwent peritoneoscope PD catheter insertion in our hospital. CUSUM model was used to evaluate the learning curve for peritoneoscope PD catheter insertion. Unacceptable primary failure r... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542205 Sun, 01 Mar 2009 00:00:00 +0100 2542205 http://www.medworm.com/index.php?rid=2542204&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426430%26dopt%3DAbstract Authors: van Hoek F, Scheltinga M, Luirink M, Pasmans H, Beerenhout C A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short- and long-term clinical success of banding in these patient groups. After evaluation using a standard protocol, banding procedures (n = 19) were performed in patients (n = 17) with a hemodialysis access flow > or =2 l/minute or with refractory HAIDI. Various parameters including access flow, digital brachial index (DBI), and symptomatology of hand ischemia using a standard scoring system were determined before and after the operation. Surgical banding in CO patients (n = 9) lower... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542204 Sun, 01 Mar 2009 00:00:00 +0100 2542204 http://www.medworm.com/index.php?rid=2542203&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19426431%26dopt%3DAbstract We present our experience of an incidental discovery of bilateral superior vena cava during routine evaluation of suspected intra-fistula stenosis in a dialysis-dependent patient with end stage renal disease. Our images were consistent with a left-sided venous structure draining into the heart with an independent right side superior vena cava as evidenced by fluoroscopy. There was also evidence of a 60% intra-fistula stenosis. To conclude, twin superior vena cava may be present as draining vessels independent of each other or as part of a duplicate caval drainage. While cases of persistent left superior vena cava have been associated with disturbances of cardiac impulse formation and conduction no such significant associations have been found in patients with bilateral superior vena cava. ... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2542203 Sun, 01 Mar 2009 00:00:00 +0100 2542203 http://www.medworm.com/index.php?rid=2249324&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19266614%26dopt%3DAbstract Authors: Katsikas JL, Nelson FV, Bacchus S, Nissenson AR PMID: 19266614 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2249324 Thu, 01 Jan 2009 05:00:00 +0100 2249324 http://www.medworm.com/index.php?rid=2249323&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19266615%26dopt%3DAbstract Authors: Afolalu B, Finkelstein SH, Finkelstein FO PMID: 19266615 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2249323 Thu, 01 Jan 2009 05:00:00 +0100 2249323 http://www.medworm.com/index.php?rid=2249322&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19266616%26dopt%3DAbstract Authors: Jassal SV PMID: 19266616 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2249322 Thu, 01 Jan 2009 05:00:00 +0100 2249322 http://www.medworm.com/index.php?rid=2241171&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250443%26dopt%3DAbstract Authors: Kooman JP, van der Sande FM, Leunissen KM Whereas clinical assessment remains the mainstay of estimating dry weight in dialysis patients, subtle over- and under-hydration may remain undetected, which may result in increased short- and long-term morbidity. Various technological tools have been developed to aid the clinician in the assessment of fluid state in dialysis patients. Chest X-ray is useful in clinical management, but does not fulfill the need for rapid, noninvasive bedside testing. Vena cava echography provides a reliable estimation of right atrial pressure and was shown to be useful in the clinical management of dialysis patients, but the timing of measurement is of critical importance. New developments in bioimpedance techniques hold great promise for the routine ap... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2241171 Thu, 01 Jan 2009 05:00:00 +0100 2241171 http://www.medworm.com/index.php?rid=2233208&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250443%26dopt%3DAbstract Authors: Kooman JP, van der Sande FM, Leunissen KM Whereas clinical assessment remains the mainstay of estimating dry weight in dialysis patients, subtle over- and under-hydration may remain undetected, which may result in increased short- and long-term morbidity. Various technological tools have been developed to aid the clinician in the assessment of fluid state in dialysis patients. Chest X-ray is useful in clinical management, but does not fulfill the need for rapid, noninvasive bedside testing. Vena cava echography provides a reliable estimation of right atrial pressure and was shown to be useful in the clinical management of dialysis patients, but the timing of measurement is of critical importance. New developments in bioimpedance techniques hold great promise for the routine ap... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2233208 Thu, 01 Jan 2009 05:00:00 +0100 2233208 http://www.medworm.com/index.php?rid=2233207&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250444%26dopt%3DAbstract This article reviews the financial and ethical issues involved in the treatment of dialysis-related anemia and offers recommendations for maintaining ethical patient-centered anemia management. PMID: 19250444 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2233207 Thu, 01 Jan 2009 05:00:00 +0100 2233207 http://www.medworm.com/index.php?rid=2233206&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250445%26dopt%3DAbstract Authors: Navarro-González JF, Mora-Fernández C, García-Pérez J Magnesium (Mg) is the fourth most abundant cation in the body, mainly located within bone and skeletal muscle. The normal total plasma Mg concentration varies in a narrow range, with approximately 60% present as free Mg ions, the biologically active form. The kidney plays a principal role in Mg balance. Approximately 70-80% of plasma Mg is ultrafilterable, and under normal circumstances, 95% of the filtered load of Mg is reabsorbed. As chronic renal failure (CRF) progresses, urinary Mg excretion may be insufficient to balance intestinal Mg absorption and dietary Mg intake becomes a major determinant of serum and total body Mg levels. Until severe reductions in glomerular filtration rate (<30 ml/min), ... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2233206 Thu, 01 Jan 2009 05:00:00 +0100 2233206 http://www.medworm.com/index.php?rid=2233205&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250446%26dopt%3DAbstract Authors: Cordova KB, Oberg TJ, Malik M, Robinson-Bostom L The skin changes reported in patients with end-stage renal disease (ESRD) are diverse and manifold. In this article we focus on a collection of specific cutaneous entities seen most frequently in the setting of ESRD, each presenting with distinctive and unique morphology. These include perforating disorders, porphyria cutanea tarda, pseudoporphyria, calcinosis cutis, calciphylaxis, and nephrogenic systemic fibrosis. The clinical features, histopathology, pathophysiology, differential diagnosis, and management of each entity are reviewed. PMID: 19250446 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2233205 Thu, 01 Jan 2009 05:00:00 +0100 2233205 http://www.medworm.com/index.php?rid=2233204&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250447%26dopt%3DAbstract Authors: Eleftheriadis T, Liakopoulos V, Antoniadi G, Kartsios C, Stefanidis I Anemia is a common complication in hemodialysis (HD) patients. Despite the great success of recombinant human erythropoietin in clinical practice, resistance to this therapy is common. Additionally, nephrologists frequently witness a rapid and significant drop in their patients' hematocrit during the course of various acute events that regularly take place in this sensitive population. Hepcidin, a recently identified peptide, may mediate this development in many instances. Hepcidin production is regulated by hypoxia/anemia, iron status, and importantly, inflammation. This peptide can block iron absorption by the duodenum, iron release from both the liver (the main iron storage pool) and, more significantly, ... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2233204 Thu, 01 Jan 2009 05:00:00 +0100 2233204 http://www.medworm.com/index.php?rid=2233203&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19250448%26dopt%3DAbstract Authors: PMID: 19250448 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2233203 Thu, 01 Jan 2009 05:00:00 +0100 2233203 http://www.medworm.com/index.php?rid=2030752&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00525.x Despite an increased focus on patient safety, changes in resident work rules and contemporary hospital culture often combine to create an environment of potential hazard for the hospitalized dialysis patient. Clinical scenarios are presented to illustrate some of these risks, and suggestions are offered for the protection of patients. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030752 Sat, 13 Dec 2008 03:48:44 +0100 2030752 http://www.medworm.com/index.php?rid=2030759&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00520.x We describe a case in which an unsuccessful attempt to place a left subclavian dialysis catheter resulted in the inadvertent migration and folding of a previously deployed subclavian stent. Attempts to remove the stent with a snare were unsuccessful. Patency was restored to the access circuit by placing a new stent through the struts of the folded one. Clinical vascular practice guidelines for vascular access on the use of fluoroscopy for temporary HD catheter placement may need to be re-evaluated with the reported increase in stent placement in the US HD population. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030759 Fri, 12 Dec 2008 05:00:00 +0100 2030759 http://www.medworm.com/index.php?rid=2030758&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00517.x Aneurysmal degeneration of a hemodialysis arteriovenous fistula (AVF) is common; however, distal digital embolization from an AVF is extremely rare. Even though the ultimate fate of all arteriovenous hemodialysis access is thrombosis with minimal consequences, dislodgement of thrombus at the proximal anastomosis could lead to ischemia of the distal arterial circulation. We here present a case of a renal transplant patient with a thrombosed aneurysmal AVF who presented with acute digital ischemia successfully treated with combination catheter-directed thrombolysis and open repair. No similar report was found describing this entity treated with this approach. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030758 Fri, 12 Dec 2008 05:00:00 +0100 2030758 http://www.medworm.com/index.php?rid=2030757&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00518.x This article reviews factors that affect Hb control, with a focus on management practices (e.g., regular low-dose administration of IV iron) that can help improve anemia management. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030757 Fri, 12 Dec 2008 05:00:00 +0100 2030757 http://www.medworm.com/index.php?rid=2030756&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00524.x There has been a dramatic sea change in the use of erythropoiesis-stimulating agents (ESAs) for anemic persons with chronic kidney disease (CKD) or cancer patients undergoing chemotherapy. An important area that has not been addressed previously is a CKD patient who also has a malignancy. Clinical guidelines exist that outline recommended treatments for each disease, but the intersection of the two disease processes presents difficult decisions for patients and physicians. Herein, we review the background underlying recent revisions in clinical alerts and guidelines for ESAs, and provide guidance for treating anemia among CKD patients who are receiving no therapy, chemotherapy with curative intent, or chemotherapy with palliative intent. The guiding principle is that comprehensive assessme... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030756 Fri, 12 Dec 2008 05:00:00 +0100 2030756 http://www.medworm.com/index.php?rid=2030755&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00519.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030755 Fri, 12 Dec 2008 05:00:00 +0100 2030755 http://www.medworm.com/index.php?rid=2030754&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00521.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030754 Fri, 12 Dec 2008 05:00:00 +0100 2030754 http://www.medworm.com/index.php?rid=2030753&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00523.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=2030753 Fri, 12 Dec 2008 05:00:00 +0100 2030753 http://www.medworm.com/index.php?rid=2147650&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175531%26dopt%3DAbstract Authors: Sandroni S Abstract Despite an increased focus on patient safety, changes in resident work rules and contemporary hospital culture often combine to create an environment of potential hazard for the hospitalized dialysis patient. Clinical scenarios are presented to illustrate some of these risks, and suggestions are offered for the protection of patients. PMID: 19175531 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147650 Fri, 05 Dec 2008 05:00:00 +0100 2147650 http://www.medworm.com/index.php?rid=2147649&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175532%26dopt%3DAbstract Authors: Bennett CL, Becker PS, Kraut EH, Samaras AT, West DP Abstract There has been a dramatic sea change in the use of erythropoiesis-stimulating agents (ESAs) for anemic persons with chronic kidney disease (CKD) or cancer patients undergoing chemotherapy. An important area that has not been addressed previously is a CKD patient who also has a malignancy. Clinical guidelines exist that outline recommended treatments for each disease, but the intersection of the two disease processes presents difficult decisions for patients and physicians. Herein, we review the background underlying recent revisions in clinical alerts and guidelines for ESAs, and provide guidance for treating anemia among CKD patients who are receiving no therapy, chemotherapy with curative intent, or chemotherapy w... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147649 Fri, 05 Dec 2008 05:00:00 +0100 2147649 http://www.medworm.com/index.php?rid=2147648&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175533%26dopt%3DAbstract Authors: Haq NU, Al Shamsi F PMID: 19175533 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147648 Fri, 05 Dec 2008 05:00:00 +0100 2147648 http://www.medworm.com/index.php?rid=2147647&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175534%26dopt%3DAbstract Authors: Tehrani T, Berns JS PMID: 19175534 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147647 Fri, 05 Dec 2008 05:00:00 +0100 2147647 http://www.medworm.com/index.php?rid=2147646&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175535%26dopt%3DAbstract We describe a case in which an unsuccessful attempt to place a left subclavian dialysis catheter resulted in the inadvertent migration and folding of a previously deployed subclavian stent. Attempts to remove the stent with a snare were unsuccessful. Patency was restored to the access circuit by placing a new stent through the struts of the folded one. Clinical vascular practice guidelines for vascular access on the use of fluoroscopy for temporary HD catheter placement may need to be re-evaluated with the reported increase in stent placement in the US HD population. PMID: 19175535 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147646 Fri, 05 Dec 2008 05:00:00 +0100 2147646 http://www.medworm.com/index.php?rid=2147645&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175536%26dopt%3DAbstract Authors: Shrikhande A, Muhs BE, Sergi MA, Brewster UC PMID: 19175536 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147645 Fri, 05 Dec 2008 05:00:00 +0100 2147645 http://www.medworm.com/index.php?rid=2147644&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175537%26dopt%3DAbstract This article reviews factors that affect Hb control, with a focus on management practices (e.g., regular low-dose administration of IV iron) that can help improve anemia management. PMID: 19175537 [PubMed - as supplied by publisher] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147644 Fri, 05 Dec 2008 05:00:00 +0100 2147644 http://www.medworm.com/index.php?rid=2147643&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19175538%26dopt%3DAbstract Authors: Simosa HF, Mudumbi SV, Pomposelli FB, Schermerhorn ML Abstract Aneurysmal degeneration of a hemodialysis arteriovenous fistula (AVF) is common; however, distal digital embolization from an AVF is extremely rare. Even though the ultimate fate of all arteriovenous hemodialysis access is thrombosis with minimal consequences, dislodgement of thrombus at the proximal anastomosis could lead to ischemia of the distal arterial circulation. We here present a case of a renal transplant patient with a thrombosed aneurysmal AVF who presented with acute digital ischemia successfully treated with combination catheter-directed thrombolysis and open repair. No similar report was found describing this entity treated with this approach. PMID: 19175538 [PubMed - as supplied by publisher] (So... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2147643 Fri, 05 Dec 2008 05:00:00 +0100 2147643 http://www.medworm.com/index.php?rid=2047068&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19000120%26dopt%3DAbstract Authors: Dwyer A Almost 30% of prevalent hemodialysis patients use catheters for vascular access although outcomes are superior with the use of either an arteriovenous fistula or a synthetic graft. Catheter complications are a major cause of morbidity and mortality for hemodialysis patients and increase the burden on the health care system. Surface-treated catheters have been developed to combat the three most common causes of catheter failure: infection, fibrin sheath formation, and thrombus formation. Two types of catheter surface treatments are available: antimicrobial coatings and antithrombotic coatings. Surface treatment of central venous catheters with antimicrobial materials reduces both bacterial colonization and the incidence of catheter-related bacteremia in critical care pa... Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2047068 Sat, 01 Nov 2008 04:00:00 +0100 2047068 http://www.medworm.com/index.php?rid=2047067&cid=s_29470_47_f&fid=36081&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19000126%26dopt%3DAbstract Authors: Asif A PMID: 19000126 [PubMed - in process] (Source: Seminars in Dialysis) Seminars in Dialysis journals http://www.medworm.com/rss/comments.php?id=2047067 Sat, 01 Nov 2008 04:00:00 +0100 2047067 http://www.medworm.com/index.php?rid=1898432&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00513.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898432 Fri, 24 Oct 2008 04:00:00 +0100 1898432 http://www.medworm.com/index.php?rid=1898441&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00507.x Once hemodialysis had become established as a treatment for chronic kidney disease, the early pioneers realized the limitations of the treatment, particularly in terms of the impact intermittent thrice weekly hemodialysis had on a patient's quality of life[mdash]not only time spent on dialysis and time traveling to and from treatment, but also dietary and fluid restrictions. This led to the search for the holy grail[mdash]a wearable hemodialysis device (WAK), that would allow patients to receive continuous treatment, while going on with the normal activities of daily life. Such a device would not only provide adequate solute clearances and control both electrolyte and acid[ndash]base status, but also improve blood pressure control[mdash]all while allowing a liberal diet. Despite many attem... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898441 Tue, 21 Oct 2008 04:00:00 +0100 1898441 http://www.medworm.com/index.php?rid=1898440&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00504.x In conclusion, percutaneous treatment of thrombosed fistulas can restore fistula patency about three-fourths of patients. However, the primary fistula patency is fairly short-lived, and the fistulas require repeated interventions to achieve long-term survival. (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898440 Tue, 21 Oct 2008 04:00:00 +0100 1898440 http://www.medworm.com/index.php?rid=1898439&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00505.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898439 Tue, 21 Oct 2008 04:00:00 +0100 1898439 http://www.medworm.com/index.php?rid=1898438&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00511.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898438 Tue, 21 Oct 2008 04:00:00 +0100 1898438 http://www.medworm.com/index.php?rid=1898437&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00512.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898437 Tue, 21 Oct 2008 04:00:00 +0100 1898437 http://www.medworm.com/index.php?rid=1898436&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00508.x Vascular access has been a major problem in the management of end stage renal disease (ESRD) patients on chronic hemodialysis (HD). Native arteriovenous fistulas (AVFs) are the preferred vascular access for ESRD patients on HD. Multiple factors have been evaluated as causes for poor AVF rates. The purpose of this retrospective analysis was to assess the impact of training of nephrologist in interventional nephrology (IN) on vascular access outcomes. We studied the rates of different types of vascular access amongst patients on chronic HD under the care of two nephrology groups over 25 months in a community dialysis unit. In group A, all vascular access were managed directly by an interventional nephrologist, while in group B they were managed by general nephrologist with no exposure to IN ... Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898436 Tue, 21 Oct 2008 04:00:00 +0100 1898436 http://www.medworm.com/index.php?rid=1898435&cid=s_29470_19_f&fid=29470&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1525-139X.2008.00510.x (Source: Seminars In Dialysis) Seminars In Dialysis journals http://www.medworm.com/rss/comments.php?id=1898435 Tue, 21 Oct 2008 04:00:00 +0100 1898435