A need for a paradigm shift in focus: From Kt/Vurea to appropriate removal of sodium (the ignored uremic toxin)

This study committed a Type II statistical error rejecting the time of dialysis as an important factor in determining the quality of dialysis. This study also provided the basis for the establishment of the Kt/Vurea index as a measure of dialysis adequacy. This index having been established in a sacrosanct randomized controlled trial (RCT), was readily accepted by the HD community, and led to shorter dialysis, and higher mortality in the United States. Kt/Vurea is a poor measure of dialysis quality because it combines three unrelated variables into a single formula. These variables influence the clinical status of the patient independent of each other. It is impossible to compensate short dialysis duration (t) with the increased clearance of urea (K), because the tolerance of ultrafiltration depends on the plasma ‐refilling rate, which has nothing in common with urea clearance. Later, another RCT (the HEMO study) committed a Type III statistical error by asking the wrong research question, thus not yielding any valuable results. Fortunately, it did not lead to deterioration of dialysis outcomes in the Unit ed States. The third RCT in this field (“in‐center hemodialysis 6 times per week versus 3 times per week”) did not bring forth any valuable results, but at least confirmed what was already known. The fourth such trial (“The effects of frequent nocturnal home hemodialysis”) too did not show any positive results primarily due to significant subject...
Source: Hemodialysis International - Category: Hematology Authors: Tags: Review Article Source Type: research

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Conclusion: Macular edema and central subfield thickness significantly decreased after initiation of dialysis in patients with diabetic chronic renal failure without any ocular treatment. This may be related to the improvement in uremia and volume overload after the initiation of dialysis.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
Authors: special issue: “Focus on pediatric nephrology”, Bruni V, Petrisano M, Tarsitano F, Falvo F, Parisi F, Cucinotta U, Betta P, Di Benedetto V, Scuderi MG, Pensabene L, Sestito S, Cuppari C, Fede C, Chimenz R, Concolino D Abstract Alport's syndrome (AS, OMIM 301050) is a hereditary disorder characterized by progressive renal failure, hearing impairment and ocular changes. It is clinically and genetically heterogeneous and in its natural history, renal disease progresses from microscopic haematuria to proteinuria, and finally to progressive renal insufficiency. AS is caused by an inherited defect in...
Source: Journal of Biological Regulators and Homeostatic Agents - Category: Biomedical Science Tags: J Biol Regul Homeost Agents Source Type: research
Hypertension is a risk factor for renal disease. Therefore, this study was aimedat estimating the prevalence of hypertension in renal patients in Iran through meta ‑analysis.The search was carried out using authentic Persian and English keywords in national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, Pubmed, Scopus, Cochrane, Embase, Web of Science, Medline, and Google Scholar search engine without any time limitation until 2017. Heterogeneity of studies was assessed using theI2index.Data were analyzed using STATA ver 11.In 35 reviewed studies with a sample of 39,621 sub...
Source: International Journal of Preventive Medicine - Category: International Medicine & Public Health Source Type: research
Authors: Hu T, Wang B, Liao X, Wang S Abstract Dermatological manifestations are common in systemic diseases, such as chronic kidney disease. The present study investigated the clinical features and possible influencing factors of pruritus in patients with chronic renal failure (CRF). A total of 382 inpatients were enrolled from the Department of Nephrology at The Second Affiliated Hospital of Chongqing Medical University. A total of 138 subjects were hemodialysis patients, 41 were peritoneal dialysis patients, and 203 were chronic renal failure patients. The patients' clinical performance was observed, and the dat...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
ConclusionIn DT1 patients, renal transplantation is the best treatment for ESRD despite the use of corticosteroids and anticalcineurins. However, prior explorations of good cardiac function and adequate vascular compliance are essential to reduce the risk of CV.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Authors: Zhan X, Yang M, Chen Y, Zhang L, Yan C, Wang Y Abstract Objective: Accumulating evidence has demonstrated that dialysis patients are at increased risk for stroke. However, the impact of dialysis modalities on stroke risk remains controversial. We conducted a systematic review and meta-analysis to determine the effect of peritoneal dialysis (PD) and hemodialysis (HD) on stroke risk. Methods: A systematic search of PubMed, EMBASE, and Web of Science was performed to identify articles comparing the stroke outcomes of dialysis patients. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were extracted...
Source: Renal Failure - Category: Urology & Nephrology Tags: Ren Fail Source Type: research
We report a child with hyperphosphatemia who presented with multiple episodes of neurologic dysfunction involving lower motor neuron facial nerve palsy along with sequential visual loss. He also had an episode of stroke. There was an extensive metastatic calcification of soft tissue and vasculature. Hyperphosphatemia with normal serum alkaline phosphatase, calcium, parathyroid hormone, and renal function was noted. He was managed with hemodialysis and sevelamer (3 months) without much success in reducing serum phosphate level, requiring continuous ambulatory peritoneal dialysis (3 years). Intact fibroblast growth factor 23...
Source: Annals of Indian Academy of Neurology - Category: Neurology Authors: Source Type: research
Conclusions: The baseline serum TBil and IBil levels were significantly associated with 5-year all-cause mortality among PD patients. PMID: 31240974 [PubMed - in process]
Source: Renal Failure - Category: Urology & Nephrology Tags: Ren Fail Source Type: research
Conclusion: ESRD patients with diabetes may benefit more from HD than PD. PMID: 31216914 [PubMed - in process]
Source: Renal Failure - Category: Urology & Nephrology Tags: Ren Fail Source Type: research
AbstractIntroductionChronic kidney disease (CKD) is a systemic disease affecting many organs. Progression of renal failure aggravates ongoing inflammation and increases oxidative stress. In the final stage of CKD, it is necessary to use renal replacement therapy. A side effect of dialysis therapy is the synthesis of proinflammatory factors and increased oxidative stress, which activates platelets and immune cells.Aim of the studyTo determine the regenerative potential of platelets in patients with CKD based on the analysis of the relationships between substances with potential regenerative action, as well as analysis of th...
Source: International Urology and Nephrology - Category: Urology & Nephrology Source Type: research
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