Archive for the ‘Hemodialysis’ Category

July 13, 2015

A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation

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Using data from the French national prospective registry, the authors developed and validated a clinical screening score to identify ESRD patients over the age of 70 years with an acceptable prognosis and hence most suitable for kidney transplantation. This scoring card can be helping to the practicing nephrologist to select suitable patients over the age […]

Comments Off on A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis, Renal Transplantation
July 13, 2015

Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis

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This retrospective cohort study of Medicare beneficiaries showed that annual incidence of CPR in maintenance dialysis patients from 2000-2010 was 1.4 events per 1000 in-hospital days.  21.9% of CPR recipients survived to hospital discharge with a median postdischarge survival of 5.0 months.  This valuable information should be used to help support patients during advance care […]

Comments Off on Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis Posted in Clinical Nephrology, Hemodialysis
May 8, 2015

Outcomes of Elderly Patients after Predialysis Vascular Access Creation

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A cohort of 3418 CKD patients ≥70 years who underwent predialysis AVF or AVG creation from 2004 to 2009 were assessed and followed.  The results show that 67% of patients with predialysis AVF and 71% of patients with predialysis AVG creation initiated dialysis within 2 years of access placement, but the overall risk of dialysis initiation was modified by patient age and race. Only one half of patients initiated […]

Comments Off on Outcomes of Elderly Patients after Predialysis Vascular Access Creation Posted in Clinical Nephrology, Hemodialysis, Vascular Access
May 8, 2015

Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

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This study using data from the Nationwide Inpatient Sample (2005-2011) compared data from 56 069 patients with ESRD who underwent in hospital CPR to 323 620 patients from the general population.  After adjustment, patients with ESRD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.3; P<0.001). Survival after CPR improved in the […]

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May 8, 2015

Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis

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This important study helps us to understand the outcomes of in-hospital CPR from a Medicare registry in US adults receiving maintenance hemodialysis.  The annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days with a  total of 21.9% CPR recipients surviving to hospital discharge.  The median post discharge survival was 5 months.  

Comments Off on Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis Posted in Clinical Nephrology, Hemodialysis
May 8, 2015

Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis

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This systematic review and meta-analysis shows that extended daily dialysis and continuous renal replacement therapy were associated with similar outcomes in the treatment of AKI in RCT data. The only evidence that EDD was associated with better mortality was from observational data which is potentially subject to bias.  

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May 8, 2015

Long-term Effects of Frequent Nocturnal Hemodialysis on Mortality: The Frequent Hemodialysis Network (FHN) Nocturnal Trial

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This is a long-term follow-up of the FHN Nocturnal trials.  After a median follow-up of 3.7 years, the randomly assigned 87 patients to 1 year of 6 times a week nocturnal and 3 times per week hemodialysis were assessed.  In the nocturnal arm, there were 2 deaths during the 12-month trial period and an additional 12 deaths during the […]

Comments Off on Long-term Effects of Frequent Nocturnal Hemodialysis on Mortality: The Frequent Hemodialysis Network (FHN) Nocturnal Trial Posted in Clinical Nephrology, Hemodialysis, Nocturnal Hemodialysis
May 8, 2015

β-Blocker Dialyzability and Mortality in Older Patients Receiving Hemodialysis

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This propensity-matched retrospective study showed that initiation of a high (atenolol, acebutolol, or metoprolol) versus low (bisoprolol or propranolol) -dialyzability β-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). This study does raise caution, but as the authors indicate, causality is […]

Comments Off on β-Blocker Dialyzability and Mortality in Older Patients Receiving Hemodialysis Posted in Chronic Kidney Disease, Clinical Nephrology, Hemodialysis
March 18, 2015

Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation

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This interesting study of hemodialysis patients on oral anticoagulation for atrial fibrillation showed that although their overall mortality was high – it was not associated with warfarin.  In fact, warfarin was associated with better survival and antiplatelet agents increased overall mortality. .

Comments Off on Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation Posted in Clinical Nephrology, Hemodialysis
January 24, 2015

Con: Frequent haemodialysis for all chronic haemodialysis patients.

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The flipside of this debated is showcased here with the authors taking a more “conservative” approach to the increasing frequency of dialysis debate.

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January 24, 2015

Pro: Should we move to more frequent haemodialysis schedules?

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This article on the pro side of this debate summarizes the evidence supporting more frequent dialysis.  The authors how longer interdialytic intervals may be associated with elevated cardiovascular risk and how this risk may be mitigated with more frequent dialysis.

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January 24, 2015

Effect of Low Versus High Dialysate Sodium Concentration on Blood Pressure and Endothelial-Derived Vasoregulators During Hemodialysis: A Randomized Crossover Study.

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This interesting study looked at the effect of dialysate sodium concentrations (low (5 mEq/L below serum sodium) versus high (5 mEq/L above serum sodium)) and the effect on blood pressure during dialysis.  The results showed that low sodium dialysate significantly decreased systolic BP and ameliorated intradialytic hypertension. However, longer studies are needed to determine the long-term effects.

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December 17, 2014

Survival advantage of lanthanum carbonate for hemodialysis patients with uncontrolled hyperphosphatemia

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This retrospective study of maintenance hemodialysis patients showed that treatment with lanthanum was independently associated with a reduction in all cause mortality in those patients with uncontrolled hyperphosphatemia.

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