This report describes the successful management of a long venous stenosis that resulted from intimal hyperplasia in a synthetic hemodialysis graft. The recurrent stenosis was kept patent with four overlapping, self-expanding metallic stents, which allowed coverage of the 16 cm distance from the axillary vein to the synthetic graft.

Arteriovenous Shunt, Surgical↗

PubMedDate not supplied

A critical review of sodium profiling for hemodialysis.

In sodium profiling, the sodium concentration in the dialysis fluid, instead of being constant, follows a time-dependent profile over the course of a hemodialysis session. The main aim of this manipulation is to avoid osmotic disequilibrium by keeping plasma osmolality in the physiological range. Further advantages of sodium profiling are a reduction in the incidence of muscle cramps, improved sodium removal, and improved vascular stability. Many different profiles have been used by various investigators. However, if sodium profiling is not appropriately conducted, sodium accumulation with resulting augmented thirst, increase of interdialytic weight gain, and hypertension may result. Sodium accumulation may, in fact, explain the reduced intradialytic morbidity reported in some short-term sodium profiling studies. Randomized, double-blind studies meeting strict statistical criteria and providing a careful control to maintain equivalent sodium balances between the compared treatments are difficult to perform and have not yet been published. However, because sodium profiling has potential benefits, provided that sodium balance is carefully controlled, it should nevertheless be regarded as a tool that experienced nephrologists can use for the treatment of patients who experience intolerable side effects during standard dialysis.

Blood Volume↗

PubMedDate not supplied

Urine protein analysis by gel electrophoresis and laser densitometry after chemotherapy in pediatric cancer patients.

A common side effect of chemotherapy is reversible or nonreversible nephrotoxicity. SDS polyacrylamide gel electrophoresis combined with laser densitometry was evaluated as a suitable method to analyze pathologic urine proteins. A total of 52 pediatric patients were followed during and 63 patients were followed after therapy. During therapy renal damage was recorded in 43% of the leukemia patients, in 56% of nephroblastoma patients, and 75% of patients with other tumors. Three or more months after therapy pathologic patterns were seen in 25% of acute lymphoblastic leukemia patients, in 35% of patients with nephroblastoma, and in 62% of other patients. Patients with persistent complete tubular proteinuria and mixed glomerular/tubular proteinuria were found to have a high risk for irreversible renal damage and should be controlled periodically. This method permits a rapid and reliable analysis of urine proteins and is suitable for follow-up tests of renal function during and after chemotherapy.

Adolescent↗

PubMedDate not supplied

Changes in blood volume during dialysis are dependent upon the rate and amount of ultrafiltrate.

Actual circulating blood volume during dialysis therapy can be monitored by continuous hemoglobinometry. Using this method in 15 stable, clinically nonoverhydrated dialysis patients, blood volume was recorded applying different modes of ultrafiltration: constant ultrafiltration (less than 500 ml/hr); high initial (greater than 1,500-2,000 ml/hr), subsequently decreasing ultrafiltration; and intermittently high (greater than 1,500 ml/hr) ultrafiltration. Mean amount of ultrafiltrate in all patients was 3,400 ml. Mean decrease in blood volume by 20% was generally tolerated without a decrease in blood pressure. Irrespective of the different modes of ultrafiltration, a decrease in blood volume was dependent only on the amount of ultrafiltered fluid. A constant, low ultrafiltration rate was not superior to a high ultrafiltration rate. In stable dialysis patients, decrease in blood volume is dependent only on the amount of ultrafiltrate. Up to a 20% decrease in blood volume, fluid can be removed from the patient even at a rate of 2,000 ml/hr.

Blood Flow Velocity↗

PubMedDate not supplied

Characteristic profiles of circulating blood volume during dialysis therapy.

From continuous measurements of the hemoglobin concentration in the arterial blood line during 50 hemodialysis sessions in 20 stable dialysis patients, the influence of the amount of ultrafiltered fluid, the ultrafiltration rate, and overhydration of the patient upon the circulating blood volume was derived. If ultrafiltration is stopped, blood volume increases until equilibrium is obtained. The amount of refilling is proportional to the ultrafiltration rate [2.5%/(L/hr)]. The decrease of blood volume after re-equilibration depends upon the ultrafiltered amount and the degree of overhydration. The mean decrease of blood volume per liter of ultrafiltrate was found to be 5.5% for an average overhydration of 3 L.

Blood Flow Velocity↗