The population undergoing haemodialysis continues to expand, with an increasing prevalence of elderly dependent patients including those aged>80 years. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of adequacy of dialysis, based on urea clearance, need to be broadened to encompass parameters including middle molecule clearance, salt and water balance, and patient symptoms and well-being. Haemodiafiltration provides improved middle molecule clearance over haemodialysis, with some evidence of improved survival.
Source: Medicine - Category: Internal Medicine Authors: Tags: Chronic kidney disease Source Type: research

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Purpose of review Pruritus is an important, prevalent but often neglected symptom in patients with advanced chronic kidney disease (CKD) or on dialysis. This review addresses the use of activated charcoal and its analogs in the treatment of uremic pruritus, which can be a sign of uremic toxicity. Recent findings When common causes are corrected and dialysis efficiency is optimized, pruritus is mainly ascribed to the retention of middle and protein-bound molecules, of which indoxyl sulfate and p-cresyl sulfate are the best studied. While hemodialysis and hemodiafiltration are of limited use, activated charcoal and its ...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research
This study seeks to define the effectiveness of IS and p-CS clearance after single dialysis sessions and after 8-week-long cycles of hemodialysis using the following different dialysis modalities in succession: low-flux hemodialysis (lfHD), high-flux hemodialysis (hfHD), and post-dilution hemodiafiltration (HDF). We also investigated to what extent IS and p-CS serum content would associate with some other biochemical indices in patients with chronic kidney diseases. The study included 21 uremic patients. We found that a single session of each modality effectively decreased the content of both IS and p-CS, with the predomin...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Baxter (NYSE:BAX) said today it launched 2 new clinical trials exploring expanded HDx hemodialysis therapy using its Theranova dialyzer. The Deerfield, Ill.-based company’s HDx therapy uses a Theranova dialyzer designed to extend the range of molecules that it filters from the blood, claiming it “more closely mimics the natural kidney.” The therapy works on standard equipment and does not require the generation of replacement fluid, Baxter said. “Millions of patients with chronic kidney disease rely on renal innovations every day, many of whom have ESRD and require HD therapy to stay alive. HDx...
Source: Mass Device - Category: Medical Devices Authors: Tags: Blood Management Clinical Trials Baxter Source Type: news
Authors: Mitra S, Kharbanda K Abstract The invention of dialysis has been a phenomenal advance in the treatment of kidney failure. The introduction of artificial kidneys in clinical care remains one of the most successful lifesaving interventions in modern medicine. Its glory, however, has been tempered by poor long-term outcomes and a negative qualitative impact on the lives of patients who suffer from an extremely complex, burdensome, and restricted life on dialysis. There remains a huge gap in patient well-being and outcomes between artificial kidney treatments and kidney transplantation. The inadequacy of dialy...
Source: Contributions to Nephrology - Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research
CONCLUSION: FGF23 underwent a significant reduction during AFB. Such removal was greater than that induced by conventional hemodialysis as reported in the literature (19%-decrease using modified cellulosic membranes). This difference may be attributed to the ability of AFB hemodiafiltration to efficiently remove middle molecules by convection. Whether a better clearance of FGF23 during hemodialysis may result in improved cardiovascular outcomes in the long term needs to be confirmed by randomized controlled trials. PMID: 28401422 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Authors: Canaud B, Koehler K, Bowry S, Stuard S Abstract Conventional diffusion-based dialysis modalities including high-flux hemodialysis are limited in their capacity to effectively remove large uremic toxins and to improve outcomes for end-stage chronic kidney disease (ESKD) patients. By increasing convective solute transport, hemodiafiltration (HDF) enhances solute removal capacity over a broad range of middle- and large-size uremic toxins implicated in the pathophysiology of chronic kidney disease. Furthermore, by offering flexible convection volume, on-line HDF permits customizing the treatment dose to the pa...
Source: Contributions to Nephrology - Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research
In conclusion, OL‐HDF reduced BPA levels in dialysis patients.
Source: Therapeutic Apheresis and Dialysis - Category: Hematology Authors: Tags: Original Article Source Type: research
In this matched cohort study, 985 patients who underwent bariatric surgery were compared 985 patients that did not.  The mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. In adjusted analyses, bariatric surgery patients had a 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) and 57% lower risk of doubling of serum creatinine/ESRD (hazard ratio 0.43, 95% confidence interval: 0.26-0.71) compared with the matched cohort.   : High-Efficiency Postdilution Online Hemodiafiltrati...
Source: Nephrology Now - Category: Urology & Nephrology Authors: Tags: Chronic Kidney Disease General Nephrology Source Type: research
Background/Aims: Small attention is paid to other types of bone diseases then chronic kidney disease-mineral and bone disorder in dialysis patients. The aim of our study was to assess the occurrence of osteoporosis and bone microarchitecture by trabecular bone score in this population. Methods: 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafIltration underwent densitometry (Lunar Prodigy, TBS software 2.1.2) and laboratory assessment. Results: Osteoporosis was observed in 34% patients, high bone turnover was found in 80% of them, with SHPT (PTH> 300 ng/l) present in 69%. TBS was significantly decr...
Source: Kidney and Blood Pressure Research - Category: Urology & Nephrology Source Type: research
Conclusions The incidence of first-time CTS as proxy for DRA decreased significantly from 1998 to 2010. Several factors may have contributed to this decrease, including improved dialysis methods.
Source: Nephrology Dialysis Transplantation - Category: Urology & Nephrology Authors: Tags: Chronic Kidney Disease Source Type: research
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