Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure

Abstract Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics. Randomized controlled trials comparing isolated ultrafiltration and medical therapy (mainly loop diuretics) in patients with ADHF failed to demonstrate the superiority of isolated ultrafiltration over diuretic therapy with respect to renal function and mortality. Isolated ultrafiltration reduced length of hospital stay in several studies. At this time, there is insufficient evidence to support the use of isolated ultrafiltration as initial therapy of ADHF.
Source: Hemodialysis International - Category: Hematology Authors: Tags: REVIEW ARTICLE Source Type: research

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AbstractA 71-year-old man undergoing hemodialysis (HD) was admitted to our hospital with congestive heart failure (CHF) and pneumonia. After admission, ultrafiltration with HD was urgently performed because of a lack of respiratory improvement despite the use of noninvasive positive pressure ventilation. During HD, cerebral regional saturation of oxygen (rSO2) was monitored by INVOS 5100c oxygen saturation monitor (Covidien Japan, Japan) to evaluate changes in tissue oxygenation. At HD initiation, cerebral rSO2 was very low at 34% under the fraction of inspiratory oxygen (FiO2) of 0.4. Ultrafiltration was performed at the ...
Source: Journal of Artificial Organs - Category: Transplant Surgery Source Type: research
CONCLUSION: Our findings show that CCL2 levels are associated with dyslipidemia, which suggests a role of this cytokine in the pathogenesis of cardiovascular disease in HD patients. A better understanding of this pathogenesis could contribute to the discovery of new therapeutic targets that would reduce cardiovascular complications in these patients. PMID: 31557637 [PubMed - as supplied by publisher]
Source: Cytokine - Category: Molecular Biology Authors: Tags: Cytokine Source Type: research
BURDEN AND CORRELATES OF HOSPITAL READMISSIONS AMONG U.S. PERITONEAL DIALYSIS PATIENTS. Perit Dial Int. 2019 Mar 06;: Authors: Sahlie A, Jaar B, Galarza Paez L, Masud T, Lea J, Burkart J, Plantinga L Abstract BACKGROUND: Hospital readmissions are common among in-center hemodialysis patients, but little is known about readmissions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. METHODS: Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days ...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Objective : To evaluate the relationship between calf bioimpedance measurements and fluid removal in a controlled environment (hemodialysis) as a first step toward using these measurements for remote congestive heart failure (CHF) monitoring. Approach : Calf bioimpedance measurements were recorded in 17 patients undergoing hemodialysis (9/17 (53%) CHF, 5/17 (30%) female). Measurements were performed before and after hemodialysis. Additional parameters related to hemodialysis and patient fluid status such as estimated dry weight were also recorded. Main results : Calf bioimpedance changes depended on calf fluid status...
Source: Physiological Measurement - Category: Physiology Authors: Source Type: research
This study retrospectively looked at 153 patients with peripheral vascular disease who underwent TMA with a minimum of a 3-year follow-up. A total of 102 patients received vascular intervention: 79 endovascular and 23 open bypass. The primary focus of this study was to look at the timing of vascular intervention, incidence of wound healing, and incidence of limb loss. There was an overall 44% rate of limb loss. Patients who underwent open bypass did better than those who underwent endovascular intervention with a lower incidence of limb loss (87% compared with 51%), and quicker time to wound healing. The timing of vascular...
Source: The Journal of Foot and Ankle Surgery - Category: Orthopaedics Source Type: research
ConclusionMitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients.
Source: Critical Ultrasound Journal - Category: Radiology Source Type: research
Conclusion. AYAs with AL who are disease-free survivors at one-year have favorable long-term HCT outcomes. Long-term survival in this population appears unrelated to a TBI vs. CT-based MAC regimen. Development of cataracts is increased in long-term AYA AML HCT survivors receiving TBI-based MAC. Screening for LEs is important in survivors of AYA HCT for AL, regardless of the use of TBI or CT- based MAC regimens.DisclosuresMuffly: Shire Pharmaceuticals: Research Funding; Adaptive Biotechnologies: Research Funding.
Source: Blood - Category: Hematology Authors: Tags: 723. Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence: HSCT Late Effects and Disease Monitoring Source Type: research
Discussion Potassium (K+) is an alkali metal (Group 1 of periodic table with Hydrogen, Lithium and Sodium) with an anatomic number of 19. Its chemical symbol K, comes from the medieval Latin, kalium which means potash (mainly potassium carbonate or potassium hydroxide), the substance it was first isolated from. Potassium is an important cation and it mainly resides in the intracellular fluid with only a small amount in the extracellular fluid. Potassium regulates cell volume, pH and enzyme functions. Hyperkalemia is defined as a potassium level> 5.5 mEq/L in children and> 6.0 mEq/L in newborns. Hyperkalemia incre...
Source: - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
​BY GREGORY TAYLOR, DO, &CHRISTOPHER COOLEY, DOA 66-year-old woman with a history of type 1 diabetes, hypertension, and end-stage renal disease (ESRD) on hemodialysis presented via EMS to the emergency department with altered mental status. She lived with her family, and they noted that she refused to go to dialysis for her past four sessions and had increasing lethargy for two days.She was afebrile, and her other vital signs were blood pressure 136/92 mmHg, heart rate 77 bpm, respiratory rate 20 bpm, and oxygen saturation 96% on room air. She was agitated and reaching for objects in the sky. Her cardiopulmonary exam...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
  Vascular Graft Solutions’ Frame external support Vascular Graft Solutions has reported the first clinical use of its Frame external support technology in high-flow arteriovenous (AV) fistulas. The first five cases were performed by Dr. Vladimir Matoussevitch from Cologne University Hospital in Germany. The braided cobalt chrome, kink-resistant external support was designed for autologous vein grafts in bypass or reconstruction of peripheral arterial blood vessels. Mattoussevitch used them to prevent high-flow AV fistula and aneurysmal enlargement complications, which are common in patients undergoing...
Source: Mass Device - Category: Medical Devices Authors: Tags: Blog Vascular vasculargraftsolutions Source Type: news
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