End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

Recently the concept that prescription of chronic hemodialysis (HD) start should be tailored based on residual renal function (RRF) and urine output (UO) has been revived from the past and called infrequent or incremental dialysis. It mainly consists in prescribing 1 or 2 HD sessions per week instead of what has become the standard thrice-weekly HD. It is both surprising and fascinating that almost 60 years after the first end-stage kidney disease patient was treated by Scribner et al. [Trans Am Soc Artif Intern Organs 1960; 6: 114 –122], the nephrology community still questions the best way to start HD therapy. This comforting process is the result of pieces of evidence accumulated with time such as that RRF is associated with better outcomes that starting HD therapy favors the loss of RRF and/or UO and also results in a hi gh rate of deaths in the first weeks of HD therapy. Through this review, we support the idea that when the decision to start HD therapy is made, ideally with the full collaboration of the patient, it is necessary to be efficient to alleviate uremic symptoms, to correct the fluid overload and to allo w a full recovery from the uremic state associated with the late stages of non-dialysis chronic kidney disease.Blood Purif
Source: Blood Purification - Category: Hematology Source Type: research

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Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular/cerebrovascular events. The aim of this study is to clarify whether stress myocardial perfusion single-photon emission computed tomography (SPECT) could predict cardiovascular/cerebrovascular events. In the Gunma-CKD SPECT Study, a multicenter prospective cohort trial, 311 patients with CKD (estimated glomerular filtration rate #x3c; 60 min/mL/1.73 m2) including 50 patients on hemodialysis underwent stress99mTc-tetrofosmin SPECT for suspected ischemic heart disease and were followed for 2 years. The primary endpoint was the occurren...
Source: Cardiology - Category: Cardiology Source Type: research
Kidney transplantation is the best treatment for patients with end-stage renal disease (ESRD) because of a significant survival benefit conferred compared to patients who remain on haemodialysis.1 Although the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with ESRD has significantly declined over time, it remains at least 4-times higher than in the general population.2,3 Chronic HCV or HBV infection can result in chronic liver disease, cirrhosis, and hepatocellular carcinoma4 –6 and increase the risk of chronic kidney disease (CKD).
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Research Article Source Type: research
Publication date: January 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 1Author(s): A. Mary VilayInfections are an important cause of morbidity and mortality among patients with chronic kidney disease. Therefore, appropriate antibiotic dosing is imperative to achieve positive patient outcomes while minimizing antibiotic dose-related toxicity. Accurately assessing renal function and determining the influence of renal replacement therapy on antibiotic clearance makes drug dosing in this patient population challenging. Furthermore, as technological advances in hemodialysis and peritoneal dialysis occur, res...
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research
Publication date: January 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 1Author(s): Vivek Soi, Chantale Daifi, Jerry Yee, Elizabeth AdamsAn in-depth understanding of viral hepatitis is important to the care of patients with end-stage renal disease undergoing hemodialysis. Both hepatitis B and C viruses are acquired through hematogenous spread and can lead to horizontal transmission. Concurrent hepatic and renal injuries have ominous outcomes with significant morbidity. Hepatitis B incidence has decreased through practices including vaccination of nonimmune individuals and isolation of patients with the d...
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research
Publication date: January 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 1Author(s): Lizbeth J. Cahuayme-Zuniga, Karen B. BrustPatients with chronic kidney disease have impaired immunity that increases their risk of infection. Increased incidence of mycobacterial infections, in particular Mycobacterium tuberculosis, is described in patients undergoing hemodialysis and peritoneal dialysis as well as after kidney transplantation in low-prevalence and high-prevalence settings. Diagnosis of this infection can be challenging because of atypical presentations that may lead to treatment delay and, consequently, ...
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research
This article reviews current knowledge with regards to prevention of PD-associated infections, and the diagnosis and management of exit site infections and peritonitis.
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research
Publication date: January 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 1Author(s): Lalathaksha Kumbar, Jerry YeeInfection-related causes are second only to cardiovascular events for mortality among end-stage renal disease patients. This review will provide an overview of hemodialysis catheter-, graft-, and fistula-related infections with emphasis on diagnosis and management in specific settings. Use of catheters at the initiation of dialysis has remained unchanged at 80%. Of all access-related bloodstream infections (BSIs), 70% occur in patients with catheters. The risk factors for BSIs in tunneled, cuf...
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research
Publication date: January 2019Source: Advances in Chronic Kidney Disease, Volume 26, Issue 1Author(s): Daniel L. Landry, Gregory L. Braden, Jerry Yee
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research
Abstract Antimicrobial pharmacology and its effect on prescribing is quite complex. Selecting an antibiotic that will optimally treat an infection while minimizing adverse effects and the development of resistance is only the first step, as one must also consider the patient's individual pharmacokinetic alterations and the pharmacodynamic properties of the drug when prescribing it as well. Patients with CKD may have alterations in their protein binding, volumes of distribution, kidney clearance, and nonrenal clearance that necessitates antibiotic dose adjustments to prevent the development of toxicity. Knowledge o...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Conclusions: Molidustat was well tolerated for up to 36 months and appears to be an effective alternative to darbepoetin and epoetin in the long-term management of anemia associated with CKD.Am J Nephrol 2019;49:271 –280
Source: American Journal of Nephrology - Category: Neurology Source Type: research
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