Seminars in dialysis
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Seminars in dialysis · Jul 2014
ReviewPrinciples and operational parameters to optimize poison removal with extracorporeal treatments.
A role for nephrologists in the management of a poisoned patient involves evaluating the indications for, and methods of, enhancing the elimination of a poison. Nephrologists are familiar with the various extracorporeal treatments (ECTRs) used in the management of impaired kidney function, and their respective advantages and disadvantages. ⋯ This manuscript reviews the various principles that govern poison elimination by ECTR (diffusion, convection, adsorption, and centrifugation) and how components of the ECTR can be adjusted to maximize clearance. Data supporting these recommendations will be presented, whenever available.
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Seminars in dialysis · May 2014
Randomized Controlled Trial Multicenter Study Comparative StudyA comparison between the HeRO graft and conventional arteriovenous grafts in hemodialysis patients.
Venous stenosis and occlusion are a major cause of vascular access dysfunction and failure. The HeRO Graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. A randomized, multicenter study was conducted to evaluate the efficacy and safety of the HeRO Graft relative to conventional AV grafts. ⋯ The rates of intervention were 2.2/year for HeRO Graft and 1.6/year for the control (p = 0.100). Median days to loss of secondary patency was 238 for HeRO Graft versus 102 for the control (p = 0.032). The HeRO Graft appears to provide similar patency, adequacy of dialysis, and bacteremia rates to those of conventional AV grafts.
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Seminars in dialysis · May 2014
Case ReportsHemodialysis for the treatment of severe accidental hypothermia.
Severe hypothermia is defined as a core body temperature <28°C and is associated with in-hospital mortality rates of 50% or higher. Delays in rewarming and slower rates of rewarming are the most important prognostic factors associated with increased mortality. Arrhythmias are the most common cause of mortality in patients with severe accidental hypothermia. ⋯ We describe a case where hemodialysis (HD) was used to treat accidental hypothermia in a patient with an initial temperature of 23.5°C. Average rewarming rates of 1.5°C/hour were achieved. The advantages of HD when compared with CBP are that it is (1) more widely and readily available, (2) less invasive, (3) less expensive, and (4) can correct associated acidosis and electrolyte abnormalities commonly seen in patients with severe hypothermia.
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Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U. S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. ⋯ Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7% to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients.