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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.
Kidney Disease
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
The medical management of individuals with chronic kidney disease presenting with early kidney failure includes treatment of the underlying disease and comorbidities, as well as education on lifestyle and behavioral management to address comorbid conditions. For individuals with advanced kidney failure, hemodialysis (dialysis) should be considered. Hemodialysis is a process where the blood, and toxins within the blood, normally filtered by the kidneys, are perfused mechanically and filtered by a dialyzer (see Figure 15.2). The filtered blood, after toxins are removed, is then returned to the body. Venous access is required for hemodialysis by either an atrial venous (AV) fistula, AV graft, or central venous catheter. For individuals choosing to forego hemodialysis, maximum medical management and pharmacological interventions should be targeted towards aggressive control of underlying conditions per the individual’s wishes.
Complications of hemodialysis access
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Mia Miller, Prakash Jayanthi, William Oppat
With increased prevalence of ESRD, the associated healthcare expenditure also continues to increase. Medicare fee-for-service spending for ESRD beneficiaries has steadily increased yearly, with over 30 billion in 2013 accounting for 7.1% of the overall Medicare paid claims costs.3 These costs include cardiovascular issues, infection, and, importantly, vascular access-related costs, which include complications and maintenance. Given the substantial representation of vascular access-related costs, it becomes ever more important to gain earlier recognition of the complications to prevent further depletion of Medicare resources. Here, we discuss complications associated with hemodialysis access creation, with appropriate diagnosis and management. We hope to provide education to healthcare providers to improve expertise and optimize management of vascular access, thereby decreasing complications.
Factors associated with subgroups of fatigue in maintenance hemodialysis patients: a cross-sectional study
Published in Renal Failure, 2023
Xiao-Yan Zheng, Zhi-Hong Zhang, You-Ming Cheng, Qi Yang, Bing Xu, Bao-Chun Lai, Lan-Ting Huang
All enrolled patients underwent hemodialysis three times per week for four hours per treatment. At 35.5–36.5 °C, all patients received heparin or low molecular heparin anticoagulant and standard carbonate dialysis fluid. Blood flow ranged from 200 to 300 mL/min with a 500 mL/min dialysis rate. Dialysis liquid ingredients were sodium (Na) 138–140 mmol/L, potassium (K) 2.0 mmol/L, calcium (Ca) 1.25–1.5 mmol/L, chlorine (Cl) 109–110 mmol/L, glucose (GLU) 0 mg/dL, and bicarbonate 35 mmol/L. All patients were treated with disposable synthetic biocompatible dialyzer membranes (polysulfone hollow fiber dialyzer membranes, Fresenius, Bad Homburg vor der Höhe, Germany). Dry weight was targeted for each patient during the HD session. Pre- and post-weight, blood measurements, lung US, inferior vena cava diameter (IVCD) US, and bioimpedance spectroscopy assessment were applied at the same first HD session of the week.
Expanding the evidence for managing metformin poisoning to support decision-making
Published in Clinical Toxicology, 2023
Darren M. Roberts, Marc Ghannoum
Evidence-based consensus recommendations describing when to initiate an extracorporeal treatment were published in 2015 by the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP; https://www.extrip-workgroup.org/) [12]. The recommendations list both clinical and biochemical indications, and they outline the rationale and evidence supporting each recommendation. It is notable that these recommendations were mostly based on case reports and case series. One retrospective study noted similar survival rates in 16 patients with metformin-associated lactic acidosis who received hemodialysis compared to 14 who did not [14], despite the hemodialysis group being sicker at baseline. Although underpowered and retrospective, this result suggested a potential benefit from hemodialysis. The level of evidence for each recommendation was assessed as "very low", according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Practically, this meant that EXTRIP’s estimate of the effect may have been substantially different from the true effect. Despite this low evidence, the Workgroup provided many strong recommendations regarding the use of extracorporeal treatments based on an overwhelming consensus that the desirable effects of adhering to these recommendations outweighed the undesirable effects. The Workgroup acknowledged the limitations of these recommendations and encouraged further discussion and the need for additional research, as well as external validation of the recommendations and suggestions.
The effects of an intradialytic resistance training on lower extremity muscle functions
Published in Disability and Rehabilitation, 2022
Aurel Zelko, Jaroslav Rosenberger, Ivana Skoumalova, Peter Kolarcik, Andrea Madarasova Geckova, Jitse P. van Dijk, Sijmen A. Reijneveld
We found that the intradialytic training improved HE right after the intervention but this effect decreased at follow-up, confirming the beneficial effects of exercise on patient’s muscle functions. This finding shows that generally, exercise should be continued to maintain the improved functioning. Dialysis patients are at high risk of falls, movement disabilities and immobilization. These health risks are closely related to loss of muscle functions that occurred after the initiation of hemodialysis therapy and worsen during the life-time spend on dialysis. The improvements in patient’s muscle strength detected in our study are an important demonstration of how intradialytic exercise intervention acted against health-related risks among HDPs. To improve the effectiveness of interventions and reach the full potential of patient’s adaptability, it is necessary to create personalized activity prescriptions for every patient. Significant improvements in patient’s physical functioning are achievable also by application of endurance training, combined training [35], or training interventions including electrical muscle stimulation [36,37].