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PubMed2001

Multidirectional approach to study peritoneal dialysis fluid biocompatibility in a chronic peritoneal dialysis model in the rat.

BACKGROUND: Peritoneal dialysis causes the functional and morphological changes in the peritoneum that result from the bioincompatibility of dialysis solutions. We present a model of chronic peritoneal dialysis in the rat that can be used for testing the biocompatibility of dialysis fluids. Methods and Results. Long-term exposure of the peritoneum to dialysis solutions can be performed in rats with implanted peritoneal catheters. Sampling of the dialysate allows the evaluation of intraperitoneal inflammation by examining cell differential and dialysate cytokine levels. Peritoneal permeability can be evaluated at designed time intervals with the peritoneal equilibration test (PET). At the end of dialysis, peritoneal histology is studied with light and electron microscopy. CONCLUSIONS: Such a multidirectional approach is an effective way to test biocompatibility of dialysis solutions.

Animals↗

PubMedDate not supplied

Smoking, blood pressure and serum albumin are major determinants of carotid atherosclerosis in dialysis patients. CREED Investigators. Cardiovascular Risk Extended Evaluation in Dialysis patients.

AIM: To investigate the relationship between carotid atherosclerosis and some major cardiovascular risk factors in uremic patients on chronic dialysis. METHODS: A cross-sectional study was carried out in 119 unselected dialysis patients (89 on hemodialysis and 30 on chronic ambulatory peritoneal dialysis, CAPD). Fasting blood sampling for serum lipids, albumin, hemoglobin, and echo-colour-Doppler evaluation of common carotid arteries were performed in all patients (during the non-dialysis day in hemodialysis patients). In hemodialysis patients BP was measured before and after dialysis; in CAPD patients home BP values were recorded during the month before the study day. RESULTS: Ninety-five patients had at least one plaque and 57 had at least four plaques. Thirty-eight had mild and eleven severe carotid stenosis. In multiple regression models, the mean internal diameter of carotid arteries was explained (R=0.52, P=0.0001) by systolic pressure (r=0.39), serum cholesterol (r=-0.28), age (r=0.27) and smoking (r=0.24) while the degree of carotid stenosis was predicted (R=0.39, P=0.0001) by age (r=0.36) and smoking (r=0.25). The number of atherosclerotic plaques was explained (R=0.51, P=0.0001) by age (r=0.36), smoking (r=0.25) and pulse pressure (r=0.20), serum albumin just failing to reach statistical significance (P = 0.06). However, serum albumin was a significant and independent predictor of the number of atherosclerotic plaques (r=-0.26) in hemodialysis patients (n=89). Sex, diabetes, Kt/V, duration of dialysis treatment, hemoglobin, serum calcium and phosphate did not add any predictive power to the models. CONCLUSIONS: In dialysis patients arterial pressure and smoking are associated with carotid atherosclerosis. Serum albumin appears to serve as an independent predictor of carotid atherosclerosis.

Arteriosclerosis↗

PubMed2000

[Factors determining the choice of a modality of treatment by dialysis: a study of nine dialysis centers].

BACKGROUND: The objective of this cross-sectional study in a population of 1472 dialysis patients was to identify the main factors involved in the choice of a specific option for dialysis therapy, taking into account three different types of criteria such as medical dependence (DM), nurse care requirement (SI) and independence for dialysis therapy (CA). METHODS: Each patient has been analysed, independently of present treatment modality, according to the above three criteria, namely DM, SI and CA. For each type of parameter, patients have been allocated to one of three levels, each level being established to evaluate whether dialytic treatment should be undertaken as hospital centre dialysis (HDC) or in a facility off the hospital. Level 3 of any one category corresponded to the inability of doing haemodialysis at home (HHD) or in self-care unit (AD). Level 2 included patients who could be treated in AD or by peritoneal dialysis (PD) with the assistance of a nurse. CAPD or HHD were considered as potential treatment modalities only in patients qualifying for level 1 of each criterion. RESULTS: In the patient population as a whole, the following treatment options were observed: HHD 3.6%, CAPD 6%, PD 1.8%, AD 16.3% and HDC 72.2%. For medical dependence (DM) there was a relatively even distribution for the three levels in six centres. In contrast, two centres were characterized by a predominance of DM level 3. Differences in DM levels between centres were greatly reduced when considering separately only those patients who were actually treated by CAPD, HDC and AD. SI levels were more uniformly distributed within all centres, and this was true for HCD and AD patients. When considering CA levels in HDC patients, a large predominance of CA level 3 was observed in all centres whereas CA level 1 was nearly in existent. CONCLUSION: The major finding of this study was that the inability or the refusal of dialysis patients to participate at treatment, independently of medical condition and nurse care requirement, was the main factor in the choice of hospital centre dialysis.

Cross-Sectional Studies↗

PubMedDate not supplied

Adequacy of dialysis in automated peritoneal dialysis: a clinical experience.

OBJECTIVES: To compare the peritoneal clearances of urea and creatinine in continuous ambulatory peritoneal dialysis (CAPD) with three types of automated peritoneal dialysis (APD): continuous cycling peritoneal dialysis (CCPD), 50% tidal peritoneal dialysis (TPD), and 25% TPD and to assess the usefulness of the peritoneal equilibration test (PET) in predicting peritoneal clearances in overnight APD. PATIENTS: Eleven uremic patients (mean age 44.5 +/- 15.45 years with a mean time on dialysis of 42.63 +/- 25.62 months) were included in the study. MEASUREMENTS: PET for urea and creatinine following Twardowski's method. Peritoneal clearances for urea and creatinine CAPD: samples of blood and dialysate within 24 hours. APD: blood mean levels of urea and creatinine before and after nighttime dialysis. Dialysate: urea and creatinine in nocturnal and daytime dialysate. RESULTS: Peritoneal clearance of creatinine was 38.14 +/- 9.99 L/week/1.73 m2 in CAPD, 44.28 +/- 12.4 L/week/1.73 m2 in CCPD, 50.07 +/- 17.86 L/week/1.73 m2 in 50% TPD (p < 0.05) and 40.18 +/- 6.65 L/week/1.73 m2 in 25% TPD. Peritoneal clearance of urea improved significantly in the three modalities of APD: 51.91 +/- 12.58 L/week/1.73 m2 in CAPD; 66.7 +/- 9.9 L/week/1.73 m2 in CCPD (p < 0.05); 76.3 +/- 14.5 L/week/1.73 m2 in 50% TPD (p < 0.001) and 64.4 +/- 11.4 L/week/1.73 m2 in 25% TPD (p < 0.05). The dialysate/ plasma (D/P) ratio of creatinine at 30, 60, 120, 180, and 240 minutes showed significant correlation with nighttime APD clearance. Nevertheless, only the D/P ratio of urea at 30, 60, and 120 minutes correlated with overnight APD clearance. CONCLUSIONS: A remarkable improvement was observed with APD regarding the clearance of urea mainly when 50% tidal peritoneal dialysis was used, whereas it was less noticeable in the clearance of creatinine. The PET is a helpful tool in predicting overnight peritoneal clearances of creatinine but it is less useful in predicting urea clearance.

Adult↗

PubMed2000

Pattern of noncompliance with dialysis exchanges in peritoneal dialysis patients.

The purpose of the study is to evaluate the pattern of noncompliance in peritoneal dialysis (PD) patients using home visit supply inventories. Ninety-two patients were enrolled at the start of dialysis. Noncompliance, defined as performance of less than 90% of prescribed exchanges, was found in 30% of patients during the first 6 months of PD. Patients who were noncompliant with prescribed exchanges at the start of PD had greater rates of death (P = 0.03), transfer to hemodialysis secondary to uremia (P < 0.05), hospitalization (P < 0.001), and days hospitalized (P < 0.001) compared with compliant patients. Delivered Kt/V was 18% less in noncompliant compared with compliant patients (2.1 versus 2.57; P = 0.007). Serial evaluations of compliance in 53 patients showed that 72% were consistently compliant, 2% were consistently noncompliant, 15% were noncompliant at the beginning of PD but became compliant at follow-up, and 11% were intermittently noncompliant. The likelihood of future compliance in a patient compliant at the first home visit was 88%. Patients who were independent with their dialysis exchanges were more likely to be noncompliant (27%) than patients dependent on someone else to perform their dialysis (8%; P = 0.05). Serial 24 hour creatinine excretion was not a useful method to determine compliance. We recommend a home visit during the first 6 months of PD to determine compliance. Those found compliant probably do not need repeated evaluations, whereas noncompliant patients should be reevaluated in a few months. Involving another person in the dialysis might relieve some of the burden on patients who may be initially unable to cope with home dialysis. Identification of noncompliant patients and awareness of risk factors should reduce noncompliance and improve patient outcomes.

Creatinine↗

PubMed2000

Can the DOQI guidelines be met by peritoneal dialysis alone in pediatric patients? Dialysis Outcomes Quality Initiative.

DOQI guidelines recommend minimal standards for automated peritoneal dialysis (APD), with a weekly Kt/V of 2.1 and creatinine clearance (Ccr) of 63 l/1.73 m2. The purpose of this study was to assess if the DOQI guidelines could be met by dialysis alone in children on PD. Dialysis clearance studies were retrospectively analyzed in 20 pediatric patients on APD, all with a dwell volume of at least 1,000 ml/m2. Mean dialytic Kt/V was 2.0; only 45% had a Kt/V above the recommended 2.1. Mean dialytic Ccr was 43.5 l/week per 1.73 m2; only 10% achieved a Ccr above the recommended 63 l/week per 1.73 m2. Despite the significant correlation between total therapy volume (TTV) and both Kt/V and Ccr, only 2 of 10 patients with a TTV over 10 l/m2 per day reached the target Ccr. All patients had currently recommended dwell volumes, therapy times, and nocturnal cycles, but DOQI guidelines were difficult to achieve with dialysis alone. Strict adherence to DOQI guidelines in anephric pediatric PD patients may result in changing dialysis modality. However, without evidence of a correlation between delivered dose of dialysis and improved outcome, adequate dialysis should not be assessed by only measuring Kt/V and Ccr.

Canada↗

PubMed1995

Bacterial peritonitis in continuous ambulatory peritoneal dialysis: effect on dialysis on host defense mechanisms.

We have used an experimental model of continuous ambulatory peritoneal dialysis (CAPD) to investigate the effect of dialysis on host defense mechanisms in the peritoneal cavity. Laboratory rats undergoing regular dialysis were challenged with a single bolus of Staphylococcus epidermidis, Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa. Intraperitoneal challenges with all four microbial strains underwent a rapid clearance during the first 4 hours, irrespective of whether the host was undergoing dialysis. Studies using S epidermidis showed that the rapid clearance was not mediated by the diaphragmatic stomata as might have been expected. Dialysis did, however, cause delays over the following 48 hours with all of the pathogens except C albicans. Bacterial clearance over a 10-day period was strain dependant, and microbial persistence was related to adhesion formation around the cannula. Again C albicans was an exception. Our conclusions are that dialysis does not affect the innate defense mechanisms involved in the early clearance of a bolus challenge to the peritoneal cavity but can cause delays in eradicating microorganisms that survive this phase. Because these experiments were carried out using a bolus inoculum, it may be necessary to reevaluate the effect of dialysis on host defenses in the peritoneal cavity under conditions in which the challenge more closely approximates a touch contamination event.

Animals↗

PubMed1999

Impact of chronic dialysis on serum PSA, free PSA, and free/total PSA ratio: is prostate cancer detection compromised in patients receiving long-term dialysis?

OBJECTIVES: The increased incidence of malignancy (ie, prostate cancer) in patients with end-stage renal failure is well known. However, little is known of the impact of hemodialysis and various membrane types on total and free prostate-specific antigen (PSA). We prospectively studied the impact of high- and low-flux dialysis membranes and kidney function on total PSA (tPSA), free PSA (fPSA), and free/total PSA ratio (f/t PSA). METHODS: A total of 149 men were included. tPSA, fPSA, and f/t PSA were measured before and immediately after dialysis with high-flux (n = 101) and low-flux (n = 48) membranes in the serum and in the dialysis ultrafiltrate. A multivariate analysis of the impact of kidney function and age on the rate of change of all parameters was performed. RESULTS: Overall, a significant decrease of fPSA (from 0.49 +/- 0.3 to 0.35 +/- 0.3 ng/mL, P <0.0001) and f/t PSA (from 45 +/- 19% to 38 +/- 13%, P <0.0001) and a nonsignificant decrease in serum tPSA were observed. However, fPSA (from 0.51 +/- 0.5 to 0.27 +/- 0.3 ng/mL, P <0.0001) and f/t PSA (from 47 +/- 19% to 31 +/- 18%, P <0.0001) decreased significantly in high-flux membranes only. The ultrafiltrate contained 100% fPSA in high-flux membranes and no fPSA in low-flux membranes. Age, serum creatinine, blood urea nitrogen, and dialysis evaluation parameters (Kt/V) had no impact on correlation with changes in tPSA and fPSA. CONCLUSIONS: tPSA molecules do not pass high- and low-flux membranes; fPSA passes high-flux membranes only. The nonsignificant decrease of tPSA is due to adsorption to both dialysis membranes. Although tPSA can safely be used to screen patients on dialysis, independently from the dialysis procedure and membrane, fPSA and f/t PSA are only reliable with low-flux membranes. Finally, we can state that the fPSA is most probably cleared through the kidneys by glomerular filtration.

Adult↗

PubMed1993

Synthesis of beta 2-microglobulin in lymphocyte culture: role of hemodialysis, dialysis membranes, dialysis-amyloidosis, and lymphokines.

Dialysis-amyloidosis (A beta 2M) is a recently recognized chronic complication in long-term dialysis patients, apparently effecting 5% to 10% of all dialysis patients. In 1985, Gejyo et al (Biochem Biophys Res Commun 129:701-706, 1085) and Shirahama et al (Lab Invest 53:705-709, 1985) identified beta 2-microglobulin (beta 2-M) as the major constituent protein of this unique type of systemic amyloidosis. The specific pathogenesis of A beta 2M remains unknown, although beta 2-M has been clearly identified as playing a central role as the amyloidogenic protein. To investigate the factors responsible for in vitro beta 2-M synthesis, we studied beta 2-M production by lymphocyte cultures obtained from dialysis patients and grown under a variety of different conditions, and compared the results to a control group of subjects with normal renal function. We could not demonstrate any stimulatory influence on beta 2-M synthesis by the hemodialysis treatment, the type of dialysis membrane used, or the clinical presence of A beta 2M. Rather, dialysis membranes, sterilized with ethylene oxide or gamma rays, added to the lymphocyte cultures exerted a strong dose-dependent inhibitory effect on beta 2-M synthesis. From the results of this study, we conclude that peripheral blood lymphocytes in uremic patients synthesize beta 2-M normally and that the direct interaction between circulating lymphocytes and the dialysis membrane that occurs during hemodialysis does not seem to contribute directly to beta 2-M synthesis.

Adult↗

PubMed2002

The very elderly dialysis patient: indication and discontinuation of dialysis.

1. When the current available data in the literature is summarized it becomes evident that the majority of it supports the position that it is, at least for medical reasons, not advisable to exclude patients over the age of 80 years from chronic dialysis. 2. It is correct to say that the refusal of dialysis therapy for elderly dialysis patients would lead to a not insignificant cutting of costs, although elderly patients are not as 'expensive' as younger dialysis patients. 3. The decision to exclude patients over 80 from dialysis treatment is difficult, in our opinion, to support ethically. 4. The refusal of therapy by a dialysis patient--independent of his age--can only occur with his/her consent, as long as the patient is clearly conscious of the decision. 5. Should the patient no longer be in the condition to exercise his/her autonomy, and there is no AD, the Surrogate's Court must be consulted. 6. AD can be seen as helpful, since they not only make the decisions for physicians easier, but also because they can be seen as an act of care for family members. 7. Whenever dialysis therapy is discontinued the problematic nature of so-called essential care should be carefully considered, especially if no clear position has been taken in an AD.

Advance Directives↗

PubMed1996

Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters. The Italian Cooperative Dialysis Study Group.

There is increasing evidence that the biochemical and cellular phenomena induced by blood/ membrane/dialysate interactions contribute to dialysis-related intradialytic and long-term complications. However, there is a lack of large, prospective, randomized trials comparing biocompatible and bioincompatible membranes, and convective and diffusive treatment modalities. The primary aim of this prospective, randomized trial was to evaluate whether the use of polysulfone membrane with bicarbonate dialysate offers any advantage (in terms of treatment tolerance, nutritional parameters and pre-treatment beta-microglobulin levels) over a traditional membrane (Cuprophan). A secondary aim was to assess whether the use of more sophisticated methods consisting of a biocompatible synthetic membrane with different hydraulic permeability at different ultrafiltration rate (high-flux hemodialysis and hemodiafiltration) offers any further advantages. Seventy-one Centers were involved and stratified according to the availability of only the first two or all four of the following techniques: Cuprophan hemodialysis (Cu-HD), low-flux polysulfone hemodialysis (LfPS-HD), high-flux polysulfone high-flux hemodialysis (HfPS-HD), and high-flux polysulfone hemodiafiltration (HfPS-HDF). The 380 eligible patients were randomized to one of the two or four treatments (132 to Cu-HD, 147 to LfPS-HD, 51 to HfPS-HD and 50 to HfPS-HDF). The follow-up was 24 months. No statistical difference was observed in the algebraic sum of the end points between bicarbonate dialysis with Cuprophan or with low-flux polysulfone, or among the four dialysis methods under evaluation. There was a significant decrease in pre-dialysis plasma beta 2-microglobulin levels in high-flux dialysis of 9.04 +/- 10.46 mg/liter (23%) and in hemodiafiltration of 6.35 +/- 12.28 mg/liter (16%), both using high-flux polysulfone membrane in comparison with Cuprophan and low-flux polysulfone membranes (P = 0.032). The significant decrease in pre-dialysis plasma beta 2-microglobulin levels could have a clinical impact when one considers that beta 2-microglobulin accumulation and amyloidosis are important long-term dialysis-related complications.

Adolescent↗

PubMed2000

Adequacy of dialysis and differences in hematocrit among dialysis facilities.

Despite the clearly established relationship between adequacy of dialysis and response to erythropoietin, recent guidelines on anemia management in end-stage renal disease (ESRD) omit mention of dialysis adequacy while advocating the use of large amounts of intravenous iron. To determine the relative effects of adequacy of dialysis and intravenous iron on hematocrit, we studied 309 hemodialysis patients and analyzed data from 141 hemodialysis facilities in New York State (ESRD Network 2), as well as data from all 18 ESRD Networks in the United States, for the last quarter of 1997. Among the 309 subjects, mean hematocrit differed between quartiles of urea reduction ratio (URR; F statistic = 4; P: = 0.008). Patients with URRs greater than 70% were 2.6 times more likely to have hematocrits greater than 33% (odds ratio, 2.6; 95% confidence interval [CI], 1.3 to 5.3; P: = 0.009) after adjustment for other factors. Mean dialysis facility (n = 141) hematocrits correlated directly with mean URRs (r = 0.32; P: = 0.001). Facilities with a mean URR greater than 70% were three times more likely to have a mean hematocrit greater than 33% (odds ratio, 3; 95% CI, 1.2 to 7.5; P: = 0.02). The percentage of patients in each of the 18 ESRD Networks with hematocrits of 33% or greater correlated inversely with the percentage of patients administered intravenous iron (r = -0.53; P: = 0.03) after adjustment for dose of erythropoietin. We conclude that adequacy of dialysis predicts the response to erythropoietin at both patient and dialysis facility levels. Patients with low hematocrits primarily because of inadequate dialysis may inappropriately be administered excess intravenous iron intended as a corrective measure.

Hematocrit↗

PubMed2001

Dialysis patients' preferences regarding cardiopulmonary resuscitation and withdrawal of dialysis in Japan.

The aim of this study is to show the preferences of Japanese dialysis patients for receiving cardiopulmonary resuscitation (CPR) in their current health status, if they were severely demented, or if they had terminal cancer and to determine their desires about continuing dialysis if they were severely demented or had terminal cancer. A questionnaire survey including the three scenarios was administered to 450 dialysis patients in 15 hospitals in JAPAN: Three hundred ninety-eight patients completed the questionnaires for a response rate of 88%. The majority of responding patients were men and were undergoing hemodialysis. Only 5% of the patients had discussed their preferences regarding CPR with their physicians, and 29%, with their family members. Forty-two percent of the patients answered that they would want to receive CPR if they experienced cardiopulmonary arrest in their current health status, and 12% answered in the affirmative if they were seriously demented or had terminal cancer. Eighteen percent of the patients would want to continue dialysis if they were demented, and 45%, if they had terminal cancer. Statistical analysis showed that more patients who were working tended to want to continue dialysis if they had terminal cancer than those who were not (53% versus 37%; P < 0.014). Patients' age and preferences did not statistically correlate. Preferences of Japanese dialysis patients for CPR and dialysis vary according to differences in health status, and only a minority would want to receive CPR for cardiopulmonary arrest even in their current health status.

Adult↗

PubMed1977

Home peritoneal dialysis. A major advance in promoting home dialysis.

The institution of a home peritoneal dialysis program has allowed us to increase the number of patients with end-stage renal failure entering our home dialysis program from 42.5% to 67.5% of the total population. This represents a 56.5% increase over the rate achieved by home hemodialysis alone. Twenty-four percent of the home peritoneal dialysis patients could have managed home hemodialysis, but 38 could not and this represents 48% of the total patients who entered our home dialysis program, for the period of the study. These patients would have required institutional dialysis which would not have been practical for 52.6% of them because of the distance they live from Toronto. The results of home peritoneal dialysis have compared favorably with home hemodialysis in the 2 concurrent but unmatched series in respect of training time, failure rate, need for in-hospital back-up and patient survival. A long-term study of matched patients randomized to either treatment group such as that described by Blumenkrantz will finally answer the question as to how valid is our contention that peritoneal dialysis compares favourably to hemodialysis for the treatment of end-stage renal failure.

Adolescent↗

PubMedDate not supplied

Retrospective evaluation of renal kt/V(urea) at the initiation of long-term peritoneal dialysis at the University of Missouri: relationships to longitudinal nutritional status on peritoneal dialysis.

The purpose of this study was to examine the impact of low levels of residual renal function (RRF) on nutritional status in end-stage renal disease patients starting peritoneal dialysis (PD) at baseline and after a year on dialysis. We conducted a single center retrospective analysis of 116 patients who started long-term PD in a university teaching hospital from 1989 to 1998 and were followed for 1 year. Patients were divided into four equal groups according to their initial renal Kt/V(urea) (L/week) levels at the start of PD and followed for 1 year. There were no interventions. The relationship between dialysis adequacy (renal and total Kt/V(urea)) and nutritional status was studied at baseline and at 1 year. Baseline data for patients who survived were compared with the baseline data of those who died and with their own 1 year data. At baseline, the mean serum albumin (3.31 g/dl, p < 0.0001) and lean body mass (47.20% body weight, p < 0.04) of group 1 were significantly lower than in groups 2, 3, and 4. Levels of normalized protein equivalent of nitrogen appearance (nPNA) were significantly lower in group 1 than in groups 3 and 4 (p < 0.005). Although group 1 patients showed trends toward improvement in nutritional parameters, they never caught up with the other groups. At the end of 1 year, the lower total Kt/V(urea) in group 1, with the lowest RRF, was associated with the lowest mean values for nutritional status and the highest death rate. Comparison of baseline and 1 year data of survivors showed that nutritional status improved or remained stable in groups 3 and 4, who exceeded the minimum recommended adequacy targets as per Dialysis Outcome Quality Initiative criteria (mean 12 month total Kt/V(urea) 2.18 and 2.58, respectively). Comparison of baseline data of survivors and those who died showed that patients who died had lower mean values for serum albumin, nPNA, lean body mass, and body weight across all groups. Low RRF at the start of dialysis is associated with poor nutritional status. Also, patients who start dialysis with low RRF and poor nutritional status do not have significantly improved nutritional status even after 1 year on dialysis.

Adult↗

PubMed2004

A single-pass batch dialysis system: an ideal dialysis method for the patient in intensive care with acute renal failure.

PURPOSE OF REVIEW: Conventional intermittent hemodialysis and continuous veno-venous hemofiltration are the opposite poles of current treatment modalities for patients with acute renal failure in the intensive care unit. Because both intermittent and continuous renal replacement techniques have several disadvantages, alternative treatment strategies have been developed. This review summarizes relevant information on these new hybrid techniques, and special attention is paid to the use of a single-pass batch dialysis system in the intensive care unit. RECENT FINDINGS: Prospective controlled studies have been published from several centers that use standard dialysis equipment for hybrid techniques, called sustained low-efficiency dialysis or slow extended dialysis. Their common therapeutic aim is to provide an easy-to-perform treatment with reduced solute clearances maintained for prolonged periods of time. These studies have documented that sustained low-efficiency dialysis offers (1) solute removal that is comparable with that obtained with intermittent hemodialysis and continuous veno-venous hemofiltration, even if high substitution fluid rates are used, (2) cardiovascular tolerability like that observed with continuous veno-venous hemofiltration, (3) significantly reduced heparin use in comparison with continuous veno-venous hemofiltration, (4) simple handling and high acceptance by the intensive care unit staff, (5) reduced treatment costs, and (6) the possibility of nocturnal treatments, allowing unrestricted patient access for daytime procedures. SUMMARY: Sustained low-efficiency dialysis is increasingly being used as renal replacement therapy in critically ill patients in the intensive care unit. It combines several advantages of both intermittent and continuous techniques. The procedural simplicity, particularly if single-pass batch dialysis is used, makes it an ideal treatment for patients with renal failure in the intensive care unit.

Acute Kidney Injury↗

PubMed2006

Residual renal function and dialysis modality: is it really beneficial to preserve residual renal function in dialysis patients?

Residual renal function (RRF) contributes to the achievement of treatment adequacy in stage 5 chronic kidney disease (CKD-5) patients. It may facilitate patients' acceptance of renal replacement therapy (RRT) in allowing reduction of treatment time duration and minimising dietary and fluid restriction. It has been confirmed to improve dialysis patient outcomes. Attempts to preserve RRF in incident Stage 5 chronic kidney disease patients are still subject to intense controversies in the nephrology community. The aim of this review is to analyse the role of renal replacement modalities in the maintenance of RRF in dialysis patients. Under the scope of this manuscript, four questions are explored: Is the preservation of residual renal function an objective for dialysis adequacy? Does dialysis modality affect the decline of RRF? What are the factors implicated by this loss of RRF? At what expense can the maintenance of RRF be achieved in dialysis patients? Preservation of RRF is undoubtedly an interesting means to enhance the efficacy of renal replacement therapy and reduce dietary fluid restriction but it should not be considered as a goal of dialysis adequacy in dialysis patients. Further, preservation of RRF must be considered as a permanent trade-off between patient comfort and chronic fluid volume overload.

Chronic Disease↗

PubMed1982

An assessment of dialysis-associated osteodystrophy in long-term peritoneal dialysis.

To assess the development of dialysis-associated osteodystrophy during intermittent peritoneal dialysis, a study was made of 50 patients with end-stage renal failure. The duration of dialysis therapy ranged from 6 to 37 months, during which the peritoneal dialysis index for creatinine fell from 5.7 to 2.9 ml/min. Serum calcium normalized from predialytic values below normal range. During the period of observation there were no significant changes in serum albumin, phosphate, magnesium, ionized calcium or parathyroid hormone levels. Osteodensitometry, performed on 26 patients, revealed no significant changes. Determination of serum total alkaline phosphatases (TALP) and fractioned alkaline phosphatases showed raised TALP values in 30% of the patients; in only 10% of these patients the increase was due to elevated liver isoenzymes. 6 patients had normal TALP but relatively raised bone isoenzyme values. There was a significant correlation between the bone fraction and TALP, and between the liver fraction and TALP, but none between the bone and liver fraction. Patients on intermittent peritoneal dialysis using a dialysis fluid with a relatively high calcium concentration (2.25 mmol/l) seem less prone to develop dialysis-associated osteodystrophy.

Adult↗