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The Advanced HEART FAILURE Patient
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Eran Kalmanovich, Philippe Gaudard, François Roubille
Driven by a machine-generated transmembrane pressure gradient, ultrafiltration removes plasma water across a semipermeable membrane. This technique lowers right atrial pressure and PCWP and can therefore result in sustained symptomatic improvement. However, the available evidence does not support the use of ultrafiltration as a first-line therapy. In the CARRESS-HF trial, ultrafiltration was inferior to stepped pharmacotherapy.100 A meta-analysis of eight RCTs comparing ultrafiltration to diuretics did not show any significant difference in survival or renal function; only a trend toward a lower readmission rate in patients treated with ultrafiltration was reported. Therefore, the current recommendation is to use ultrafiltration should pharmacotherapy fail to resolve congestion.1,38,80
Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Haemodialysis is usually performed for around 4 hours three times a week. Blood is pumped past a semipermeable membrane and water, ions and small molecules pass across the membrane into dialysis fluid (Figure 8.20). By controlling the composition of this dialysis fluid, it is possible to control the removal of substances from the blood. If blood is forced past the membrane at a higher pressure, ultrafiltration of plasma also occurs. The membrane is usually in the form of small hollow fibres in a large cartridge and heparin is usually given to prevent blood clotting in the dialysis machine. Blood can be pumped from the body through large bore central venous catheters or needles placed in an arteriovenous fistula, which is formed by joining an artery to a vein in the arm.
Fluconazole
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Sharon C. A. Chen, Tania C. Sorrell
Since fluconazole is a low-molecular-weight compound with minimal protein binding, it is effectively removed by dialysis including in continuous venovenous hemofiltration (CVVHF) and continuous venovenous hemodiafiltration (CVVHDF). An earlier study of five patients on long-term hemodialysis found that fluconazole serum concentrations were reduced by approximately 25% during 3-hour hemodialysis sessions (Oono et al., 1992). Based on these results, it is recommended that the dose of fluconazole be administered after hemodialysis. Pharmacokinetic analysis predicted that dosages of 100 and 200 mg administered after dialysis would result in fluconazole serum concentrations of 7–8 and 15–20 µg/ml, respectively. Fluconazole is eliminated more efficiently during CVVHDF compared with CVVHF (reviewed in Sinnollareddy et al., 2011), suggesting the need for higher empricial doses in patients receiving these two treatments. The flow rate of ultrafiltration/dialysis may also influence dosing regimens (Muhl et al., 2000). In general, in terms of daily dosing, empirical doses of at least 12 mg/kg/day followed by 6 mg/kg/day may be necessary in CVVHF-, and CVVHDF-treated patients.
Serum creatine kinase levels are not associated with an increased need for continuous renal replacement therapy in patients with acute kidney injury following rhabdomyolysis
Published in Renal Failure, 2022
Liuniu Xiao, Xiao Ran, Yanxia Zhong, Yue Le, Shusheng Li
All participants underwent early and vigorous fluid resuscitation to the prevention of shock. Sodium bicarbonate therapy was replenished for patients with obvious metabolic acidosis (blood PH < 7.15). CRRT was either continuous venovenous hemodialysis (CVVHD) or continuous venovenous hemodiafiltration (CVVHDF). CVVHD used standard capillary hemofilter (AV 600S; Fresenius Medical Care, Bad Homburg, Germany; blood flow of 150 mL/min, dialysate exchange rate 1,000 mL/min). CVVHDF also used the above hemofilter (AV 600S; Fresenius Medical Care, Bad Homburg, Germany; blood flow of 180 mL/min, dialysate exchange rate 1,500 mL/min). The average CRRT period was 16 h, and intermission was 24 h. Ultrafiltration was adjusted according to clinical need. All materials were employed within the limits of intended use.
Efficacy and safety of expanded hemodialysis in hemodialysis patients: a meta-analysis and systematic review
Published in Renal Failure, 2022
Yuchao Zhao, Liangying Gan, Qingyu Niu, Mengfan Ni, Li Zuo
Six studies compared albumin loss in the dialysate for HDx versus HD and HDF (Figure 8). Albumin loss in the dialysate in the HDx group was significantly higher than that in the HD group (SMD 2.23 g/session, 95% CI 1.58, 2.87, p < .00001). There was no significant difference in albumin loss in the dialysate between the HDx and HDF groups (SMD 0.35 g/session, 95% CI −2.38, 3.09, p = .8). In a trial reported by García-Prieto et al. [13], albumin loss in the HDx group was significantly different to that in other trials. In García-Prieto’s trial [13], HDF was performed using an FX CorDiax 1000 dialyzer, of which the effective surface area and UF coefficient are significantly higher than those of the HDx group of dialyzers (2.3 versus 1.7–2.0 m2, 68 versus 48–59 mL/h/mmHg). It is unclear whether ultrafiltration was considered. A sensitivity analysis was performed that separately excluded this trial, and the results remained unchanged (Supplemental Figure 1). In order to reduce the influence of residual kidney function on pre-dialysis serum levels of albumin, we further compared residual kidney function in related studies. The results showed that there was no difference in residual kidney function between HDx group and HD or HDF group (Supplemental Table 2).
Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study
Published in Renal Failure, 2021
Su Mi Lee, Yoon Sung Min, Young Ki Son, Seong Eun Kim, Won Suk An
In this study, the iPD group showed a lower peritonitis incidence and a longer PD duration, and this is an important advantage for the PD patients, because one major cause of drop-out from PD is a high rate of peritonitis. The lower number of exchange and the longer duration of dry status are associated with a lower peritonitis incidence [19,20]. It also minimizes the gradual accumulation of membrane damage to delay the time of ultrafiltration failure, if the patient complies with proper salt and water intake. Little exposure of dialysate makes little metabolic complications such as hyperglycemia and protein loss into the dialysate [21,22]. Hyperglycemia is caused by using dialysate containing high concentrations of glucose and is thought to be a contributing factor for vascular problems, such as stroke and coronary artery disease. This is another reason the iPD group with DM showed a lower mortality in this study.