Journal of nephrology
-
Journal of nephrology · Oct 2018
ReviewChronic hyperkalemia in non-dialysis CKD: controversial issues in nephrology practice.
Chronic hyperkalemia is a major complication of chronic kidney disease (CKD) that occurs frequently, heralds poor prognosis, and necessitates careful management by the nephrologist. Current strategies aimed at prevention and treatment of hyperkalemia are still suboptimal, as evidenced by the relatively high prevalence of hyperkalemia in patients under stable nephrology care, and even in the ideal setting of randomized trials where best treatment and monitoring are mandatory. ⋯ The following topics of clinical interest were addressed: diagnosis, relationship with main comorbidities of CKD, therapy with inhibitors of the renin-angiotensin-aldosterone system, efficacy of current dietary and pharmacological treatment, and the potential role of the new generation of potassium binders. Opinion-based answers are provided for each of these controversial issues.
-
Journal of nephrology · Aug 2018
Anatomical variations of the left anonymous trunk are associated with central venous catheter dysfunction.
Internal jugular vein cannulation has become increasingly widespread. Compared to the left internal jugular vein (LIJV), the right internal jugular vein (RIJV) is the preferred choice for the placement of central venous catheter (CVC) for hemodialysis, mostly due to the major technical difficulties and higher rate of complications of the LIJV approach. We aimed to investigate whether variability in the direction of the LIJV/brachiocephalic vein (BV) axis on the frontal plane could be a decisive factor in determining CVC dysfunctions. ⋯ The anatomical clarification presented in our study provides useful data that could explain the dysfunction rate of CVC inserted in the LIJV. Clinicians who insert high-flow catheters (such as hemodialysis catheters) should be aware of LIJV/BV axis variability and of the possible risks of CVC dysfunction when the angle between the LIJV and ipsilateral BV is ≤ 110°.
-
Journal of nephrology · Feb 2018
Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014-2016).
There are numerous reports in the literature describing acute kidney injury in pregnancy (P-AKI) due to various obstetric complications. However, there is a dearth of studies on AKI related to pregnancy-specific disorders from India. We aimed to analyze clinical features and outcome of P-AKI related to pregnancy-specific disorders compared to total pregnancy, in India. ⋯ PE/E was the commonest cause of P-AKI in our study, similar to the situation in developed countries. Post-partum hemorrhage was the second-most common (21.5%) cause. Puerperal sepsis contributed to AKI in one-fourth of pregnant women. P-TMA was not recorded in this study and AFLP was an uncommon cause of P-AKI in our country. Renal function returned to normal in all patients with P-AKI due to pregnancy-specific disorders. However, perinatal mortality was high despite the good prognosis of P-AKI.
-
Journal of nephrology · Feb 2018
Dialysate temperature of 36 °C: association with clinical outcomes.
Dialysate cooling, either individualized based upon patient body temperature, or to a standardized temperature below 37 °C, has been proposed to minimize hemodynamic insults and improve outcomes among hemodialysis patients. However, low dialysate temperatures (35-35.5 °C) are associated with patient discomfort, and individualized dialysate cooling is difficult to operationalize. Here, we tested whether a standardized dialysate temperature of 36 °C (dT36) was associated with improved clinical outcomes compared to the default temperature of 37 °C (dT37). ⋯ This study therefor showed no benefit of dT36 vs. dT37 with respect to these clinical outcomes. Our results do not favor conversion to a default dialysate temperature of 36 °C. Individualized dialysate cooling may provide a more reliable approach to achieve the hemodynamic benefits associated with reduced dialysate temperature.
-
Journal of nephrology · Aug 2017
Multicenter StudyEffect of oral anticoagulant therapy on mortality in end-stage renal disease patients with atrial fibrillation: a prospective study.
The aim of this study was to evaluate, in a cohort of haemodialysis patients with atrial fibrillation (AF), the relationship between oral anticoagulant therapy (OAT) and mortality, thromboembolic events and haemorrhage. ⋯ In haemodialysis patients with AF, continuously taking warfarin is associated with a reduction of the risk of total and cardiovascular mortality.