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Transplants: Experiment or Therapy?
Published in David Lamb, Organ Transplants and Ethics, 2020
Not only do kidney transplants provide a better quality of life than dialysis, the cost of transplants is comparatively less expensive than alternative therapy. In the USA in 1983 dialysis cost an individual an estimated $35,000 each year, whereas post-surgery treatment following transplantation was between $5,000 and $8,000, with a better quality of life. In the UK, according to the Director of the UK Transplant Service at Bristol, a kidney transplant lasting five years would save the NHS £60,000 at 1982 prices (Bradley, 1988:1377). As a general rule the cost of a successful transplant plus one year of post-operative therapy amounts to less than the cost of one year of the cheapest form of chronic dialysis. After the first year the costs are negligible (Report of the Conference of European Health Ministers, 1987).
Oncological emergencies
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
In patients who develop metabolic disturbances after chemotherapy, intravenous hydration should be continued. Alkalinization of urine with sodium bicarbonate can increase tubular excretion of potassium and phosphate. Specific measures to reduce very high levels of potassium might be required using insulin and glucose in order to prevent cardiac arrhythmias. In the most severe cases, particularly, if renal function deteriorates, then dialysis may be required.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Renal replacement therapy is commonly started in patients with an eGFR <15 and who are symptomatic. Generally speaking, the three options are haemodialysis, peritoneal dialysis and renal transplant. Haemodialysis involves the formation of an arteriovenous fistula. The patient is then connected to a haemodialysis machine, where their blood and dialysis fluid flow in opposite directions on either side of a semipermeable membrane. Molecules diffuse down their concentration gradients, maintaining normal electrolyte concentrations, a normal extracellular volume and removing nitrogenous waste. Peritoneal dialysis involves the insertion of a Tenckhoff catheter, which allows dialysis fluid to be introduced into the peritoneal cavity. The peritoneal membrane is used as a semipermeable membrane, and molecules again diffuse down their concentration gradients to achieve the same goals. Transplantation is often the treatment of choice, and dialysis may be used until an appropriate donor kidney is found. The transplant may be from a cadaveric donor (a brainstem-dead donor who is still being supported and ventilated), from a non-heart-beating donor, from a living related donor or a live unrelated donor. Patients must be ABO compatible with their donor, and HLA matching increases the chance of graft survival. Lifelong immunosuppressive agents are used following this.
Randomized controlled trial of nalfurafine for refractory pruritus in hemodialysis patients
Published in Renal Failure, 2023
Ping Zhang, Shilong Xiang, Bicheng Liu, Xiaohui Wang, Xiaoping Yang, Chaoyang Ye, Zunsong Wang, Yanlin Li, Li Zhou, Caili Wang, Hongbo Li, Jian Huang, Ai Peng, Xiaoping Wang, Deguang Wang, Jie Xiao, Wenli Chen, Hong Cheng, Nan Mao, Jianqin Wang, Lin Yang, Jianghua Chen
This study enrolled patients on hemodialysis who had been on stable dialysis for 3 months or more, received regular hemodialysis 3 times a week. All patients had ‘existing treatment-resistant’ pruritus, also known as refractory pruritus [19,25,26], defined as pruritus responding inadequately to systemic therapy (with oral or injectable prescription gabapentin, or antihistamines or other anti-allergic drugs, such as glucocorticoids, sodium thiosulfate) at least 2 consecutive weeks and topical treatment (ointments or moisturizers prescribed by physicians), during the 1-year period before signing the informed consent. The study protocol is in accord with the Helsinki declaration. The study protocol was approved by an internal review board at each research center that participated in the study. The clinical trial was registered on clinical trial (https://clinicaltrials.gov/show/NCT04728984, grant number NCT04728984) and China drug trials (http://www.chinadrugtrials.org.cn, grant number: CTR20201271). All subjects provided signed informed consent before participating in the trial. A list of inclusion and exclusion criteria is provided in Table S1 in the Supplementary Appendix.
The effect of rural and urban life on peritonitis rates in chronic peritoneal patients
Published in Renal Failure, 2023
Erdem Çankaya, Murat Altunok, Aycan Mutlu Yağanoğlu
With the Progressive Kidney Health Initiative’s report in 2019, there is a new push for home dialysis in the United States, with the goal that 80% of new patients with kidney failure will receive home dialysis or kidney transplantation by 2025 [7]. A study by American nephrologists found that distances of >50 km between the patient’s residence and the dialysis facility had a significant impact on the choice of modality. With the ability to monitor treatments remotely and make monthly clinic visits, a home dialysis is a convenient option for patients who do not live near a dialysis unit. This is especially valid in rural areas. Studies have reported that peritoneal patients mostly live in rural areas [8–10]. Therefore, it was important to evaluate the relationship between PD and peritonitis, the most important cause of mortality and morbidity in rural areas. This study is one of the rare studies performed on how the life differences of PD patients in rural areas will affect peritonitis. Our peritonitis patient-year rate at our center was 0.42. There is great variation in the rates of PD peritonitis between different centers and countries. Reported rates range from 0.06 to 1.66 episodes/patient-year [4]. Our PD peritonitis culture-negative rate was per the ISPD recommended rate of less than 15% of acceptable culture-negative peritonitis episodes [2].
Machine learning models using non-linear techniques improve the prediction of resting energy expenditure in individuals receiving hemodialysis
Published in Annals of Medicine, 2023
Alainn Bailey, Mohamed Eltawil, Suril Gohel, Laura Byham-Gray
The original studies in the RNKD were convenience-sampled in the Northeast and Midwest regions of the USA and hence the population was not as diverse as the national average. Additionally, those studies imposed strict medical criteria which resulted in the omission of sicker individuals. Many key variables (anthropomorphic and IC) were gathered on a non-dialysis day. This could affect a post-dialysis weight and BMI, dependent on an individual’s fluid intake and residual renal excretion. Only conventional hemodialysis was undertaken in the original studies. This gives limited insight into the clinical feature differences that may be attributable to peritoneal dialysis or more advanced techniques (such as hemodiafiltration or expanded hemodialysis). Future research should undertake a more comprehensive review of dialysis procedures. For the purpose of this study, certain variables were omitted from the ML dataset to preserve the number of subjects available for training and validation. This includes key clinical markers such as CRP, hemoglobin A1c and serum creatinine which have been previously shown to correlate with mREE. Notwithstanding the omissions of variables, the validation set only comprised of 34 individuals, which represents a small sample size. Finally, the best model (SVR) gave substantially improved precision and a glimpse into the features that may contribute. However, the model does not generate an equation and is, therefore, less interpretable as to the direction of effect.