Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jan 1996
Withdrawal of renal replacement therapy in Newcastle upon Tyne: 1964-1993.
Termination of renal replacement therapy (RRT) is common in North America and Australia but is considered to be rare in Europe. ⋯ Death from dialysis termination is a relatively common cause of death in RRT patients in Newcastle upon Tyne. These patients are older with a higher prevalence of diabetes. In 89% of cases the decision to stop treatment was related to multiple medical problems with a recent deterioration. Physicians raised the issue of withdrawal in the majority of cases and most patients subsequently received terminal care in hospital.
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Nephrol. Dial. Transplant. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study.
Haemodynamic stability in intensive care unit (ICU) patient with acute renal failure (ARF) during intermittent dialytic support has been the focus for several variations to dialysis delivery. Indeed this has been noted by many as a possible cause for prolonged renal dysfunction created by repeated hypotensive renal insult, as well as a reason for the lower delivered dialysis dose afforded. End-stage renal failure patients supported by intermittent dialysis have benefitted from variable sodium dialysate and variable ultrafiltration rate protocols. The current study has focused upon the response to these dialysis variations in the ICU ARF patient. ⋯ Haemodynamic stability was greater during Protocol B than during Protocol A in all patients. Significantly less intervention was noted during Protocol B, despite the same dialysis delivery during both Protocols. Relative Blood volume changes were less during Protocol B, despite a greater total ultrafiltration. Variable sodium dialysate coupled with a variable ultrafiltration rate seems to be the preferred dialysis prescription for ICU ARF patients undergoing intermittent haemodialysis.
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Nephrol. Dial. Transplant. · Jan 1996
ReviewAutosomal dominant polycystic kidney disease--the patient on renal replacement therapy.
In Europe approximately 6% of all patients on chronic renal replacement therapy suffer from polycystic kidney disease. Survival of patients with polycystic kidney disease on renal replacement therapy is better than for other primary renal diseases, despite a similar cardiovascular risk profile. ⋯ There is no increased risk of renal cell carcinoma in patients with autosomal dominant polycystic kidney disease. Polycystic patients on dialysis should be followed for cardiac valve abnormalities and cerebral aneurysms.
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Nephrol. Dial. Transplant. · Jan 1996
Vena cava diameter measurement for estimation of dry weight in haemodialysis patients.
A correct estimation of volume status and so-called dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the sonographic determination of the diameter and collapse of the inferior vena cava (IVC) has been proposed as a noninvasive method for estimating intravascular volume. ⋯ Intravascular volume changes are reflected by IVC measurements, as shown by the correlation to other indices of intravascular volume, such as CVP and alpha-hANP. IVC sonography is noninvasive and easily available; serial measurements allow an estimation of changes of intravascular volume in patients without cardiac filling impairment. However, unlike with body impedance, interstitial volume is not reflected by IVC diameters.