Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jul 2003
Randomized Controlled Trial Clinical TrialDialysis filter type determines the acute effect of haemodialysis on endothelial function and oxidative stress.
Endothelial function of large arteries is impaired in chronic haemodialysis patients and oxidative stress due to the dialysis procedure has been suggested as a causal factor. However, it is not clear whether different types of dialysis membranes affect endothelial function differently. Therefore we determined endothelium-dependent, flow-mediated dilatation (FMD) of the brachial artery as well as markers of oxidative stress immediately before and after haemodialysis (HD) with either a cellulosic cuprophane or a synthetic polysulphone dialyser in a blinded, randomized, cross-over study. ⋯ The type of dialysis filter membrane determines the acute effect of haemodialysis on arterial endothelial function. Differences in biocompatibility and oxidative stress may account for the observed differential effects, since the decrease of FMD after dialysis with a cellulosic cuprophane membrane-but not with a synthetic polysulphone membrane-was associated with a reduction in serum vitamin E.
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The cornerstone of renal replacement therapy in critically ill patients with acute renal failure (ARF) in our hospital, was intermittent bicarbonate dialysis with synthetic membranes, prescribed daily for anuric patients. Filling of the extracorporeal circuit with 5% human albumin or saline solution before the start of dialysis, as well as hypernatraemic dialysis with profiling, lower dialysate temperature and higher ionized calcium concentration have been used to prevent harmful hypotensive episodes either at the start or during dialysis. Continuous renal replacement therapy (CRRT) in adults was used primarily for anuric, hypotensive patients who might not tolerate standard haemodialysis. ⋯ Although the mortality rate of ARF patients was as high as 88% in adults and 73% in small children due to the lack of reliable criteria for the selection of patients with poor or good prognosis, aggressive treatment for all patients who needed dialysis was recommended recently. Apheresis has dramatically improved the prognosis and outcome in patients with myasthenia gravis, Guillain-Barré syndrome, Goodpasture syndrome and thrombotic thrombocytopenic purpura. The mortality rate of patients with septic shock and fulminant hepatic failure was still very high, and the role of apheresis and dialysis, in spite of some encouraging results, remains controversial.
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Nephrol. Dial. Transplant. · Jul 2003
Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients.
There has been little research on the potential value of palliative care for dialysis patients. In this pilot study, we sought (i) to identify symptom burden, health-related quality of life (HRQoL) and advance directives in extremely ill haemodialysis patients to determine their suitability for palliative care and (ii) to determine the acceptability of palliative care to patients and nephrologists. ⋯ Extremely ill dialysis patients have marked symptom burden, considerably impaired HRQoL and frequently lack advance directives, making them appropriate candidates for palliative care. Patients and nephrologists perceive palliative care favourably despite its lack of effect in this study. A more sustained palliative care intervention with a larger sample size should be attempted to determine its effect on the care of this population.
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Nephrol. Dial. Transplant. · Jul 2003
Clinical TrialTranexamic acid is beneficial as adjunctive therapy in treating major upper gastrointestinal bleeding in dialysis patients.
In a pilot, non-randomized trial we tested the efficacy of tranexamic acid (TXA), a potent fibrinolytic inhibitor, as adjunctive therapy in standard treatment of major upper gastrointestinal bleeding in dialysis patients. ⋯ The results of this pilot study suggest that TXA can be beneficial in the treatment of major upper gastrointestinal bleeding in dialysis patients. This remains to be definitely confirmed in a randomized study.