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Biomedical subjects

Richard Amerling

Publications and source records attributed to Richard Amerling.

17 recordsLinked to original sources
PubMed2006

Guidelines for guidelines.

Practice guidelines are proliferating in medicine. In addition to methodological problems that cause guidelines to be outdated rapidly, they are plagued by conflicts of interest. They are largely consensus opinions of panels of experts, most of whom are supported by industry. Professional societies, health insurers, Centers for Medicare and Medicaid Services, and dialysis providers also benefit from guidelines. Little attention is paid to the potential for harm to patients, and to the profession of medicine, from the widespread use of guidelines.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

The 2006 K/DOQI guidelines for peritoneal dialysis adequacy are not adequate.

The 2006 National Kidney Foundation K/DOQI guidelines have lowered the peritoneal dialysis adequacy standard of Kt/V(urea) from 2.1 to 1.7 in anuric patients, largely based on the patient survival results of 2 clinical trials in Mexico and Hong Kong. It is our contention that the guidelines may be misleading since they have chosen to ignore the bias in these trials and have ignored the adverse outcomes in control groups in the trials on which the guidelines are based, as well as the body size of the subjects in these trials. Body size has changed in the US and Canada over the last few decades and there are similar changes worldwide. We suggest that the minimum targets for peritoneal dialysis be reinstituted at the previous standard Kt/V(urea) of 2.0.

Body Mass Index↗
PubMed2006

Evolution of technology for automated peritoneal dialysis.

Automated peritoneal dialysis (APD) is important for the further penetration of PD in the dialysis marketplace. Long dwell, equilibration PD (CAPD) has limited applicability in many patients due to inadequate solute clearance or fast membrane transport characteristics. Providing large volumes of dialysate over circumscribed hours is highly labor intensive without an automated system. Early attempts at APD were crude but effective in reducing labor, which was generally provided by nursing staff. Later evolution of PD technology has been greatly accelerated by the microchip, and by miniaturization of components. Current generation machines allow individualized fill volumes, variable tidal volumes and additional daytime automated exchanges, teledialysis, memorized delivery control, and full portability. The ideal machine should not only be able to perform all treatment schedules, but it should also optimize the performance of a selected treatment strategy. Biocompatible solutions, improved osmotic agents, and sorbent technology are all adaptable to APD. The eventual evolution toward continuous flow PD will resolve many of the current problems with both CAPD and APD.

Humans↗
PubMed2006

Continuous flow peritoneal dialysis: current state-of-the-art and obstacles to further development.

Peritoneal dialysis (PD) is still underutilized as home based renal replacement therapy and in-patient treatment of acute renal failure. Hindering the expansion of PD is poor solute clearance, which is a result of the intermittent dwell technique. Continuous flow PD is an old concept that has demonstrated urea clearances from 2-5 times higher than standard PD. It relies on a 2-3 l dwell volume and continuous dialysate flow at 100-300 ml/min. This high flow rate dictates the need for an efficient dual lumen catheter, or two separate catheters with ports separated maximally, as well as a means to generate or regenerate large volumes of fluid. A modified hemodialysis system can easily be adapted to regenerate sterile peritoneal dialysate, and a dual lumen catheter with excellent flow characteristics has been designed. Ultrafiltration control and a means to accurately balance transperitoneal with external ultrafiltration persist as technical challenges. Continuous flow PD remains an attractive modality for daily home dialysis and treatment of acute renal failure.

Equipment Design↗
PubMed2006

The potential application of sorbents in peritoneal dialysis.

Sorbents have been designed to remove small and middle molecular weight toxins, including low molecular weight proteins, peptides, cytokines and chemokines in patients undergoing renal replacement therapy. Sorbents assist the process of peritoneal dialysate regeneration and have the potential to improve the efficiency of continuous flow peritoneal dialysis.

Humans↗
PubMedDate not supplied

Continuous flow peritoneal dialysis: principles and applications.

Continuous flow peritoneal dialysis (CFPD) is a technique of renal replacement therapy (RRT) dating back to the 1960s. Its essential features are a fixed intraperitoneal volume and rapid, continuous movement of dialysis solution into and out of the peritoneal cavity. Inlet and outlet catheters and a means of generating a large volume of sterile dialysate are required. External regeneration of dialysate via conventional hemodialysis (HD) equipment or sorbent technology mitigates the need for large volumes of sterile fluid and makes the technique feasible. Clearance depends on the peritoneal mass transfer coefficient, rate of dialysate flow, and efficiency of external regeneration. Studies to date all demonstrate small solute clearances three to eight times greater than conventional automated peritoneal dialysis (PD). Catheter design is crucial to the clinical success of the technique and will be discussed. Potential applications include daily home dialysis, treatment of acute renal failure in the intensive care unit (ICU), and ultrafiltration of ascites. Clinical experience with the latter will be presented in detail.

Acute Kidney Injury↗