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Mathematical Modeling of Dialysis
Published in Sirshendu De, Anirban Roy, Hemodialysis Membranes, 2017
Another parameter used to understand dialysis adequacy is urea reduction ratio (URR). It is defined asCt/C0 is known as urea reduction fraction, denoted by R. Combining Equations 7.28 and 7.29, we haveIt is recommended that for dialysis adequacy, URR ~ 6529; hence, Kt/V ~ 1.2. This explains the reason behind maintaining Kt/V at 1.2, as discussed in Chapter 2.
Maximal inspiratory pressure is associated with health-related quality of life and is a reliable method for evaluation of patients on hemodialysis
Published in Physiotherapy Theory and Practice, 2022
Carlos Filipe Vieira, Henrique S. Costa, Márcia M. O. Lima, Frederico L. Alves, Vanessa G. B. Rodrigues, Emílio Henrique B. Maciel, Maria Cecília S. M. Prates, Vanessa P. Lima, Vanessa A. Mendonça, Ana Cristina R. Lacerda, Pedro Henrique S. Figueiredo
Out of a total of 97 patients on hemodialysis, 65 met the inclusion criteria and 61 patients were evaluated (four did not provide consent). The anthropometric, clinical, and laboratory data of the sample are demonstrated in Table 1. The sample consisted predominantly of young adults, eutrophics, and males. The most common known etiology of ESRD was hypertensive nephropathy. Laboratory data (Kt/v index and urea reduction ratio) demonstrate the efficiency of dialytic treatment. As for antihypertensive treatment, beta-blockers were the most used drugs. Table 2 shows the results of the analyzed variables. The sample had MIP values close to 80% of the predicted for age and sex, but inspiratory muscle weakness was observed in 24.6% of the sample. The most affected KDQOL specific domains were “Burden of ESRD,” “Work status,” and “Sexual function.” “Role physical,” “General health,” and “Role emotional” were the generic domains that presented the lowest scores. The PCS score was the lowest component summary score among the three evaluated.
Lentiform fork sign in a uremic patient after inadvertent exposure to metformin
Published in Clinical Toxicology, 2022
Yen-An Chang, Der-Cherng Tarng, Chih-Yu Yang
On examination, she was afebrile, hemodynamically stable, but lying on the bed uncomfortably. Neurological examination revealed drowsiness, severe dysphagia, and dysarthria. The patient could not sit or stand; muscle strength of flexion and extension was grade 3 in the hips. The handgrip was grade 3 on both sides. The rest of the physical examination was unremarkable. Laboratory tests revealed high anion-gap metabolic acidosis (pH = 7.33, PaCO2 = 29 mmHg, HCO3 = 14.8 mmol/L), elevated lactate level (36.9 mg/dL). Her urea reduction ratio was above 70% throughout the year. Her current medications included valsartan 160 mg, carvedilol 25 mg, amlodipine 5 mg, linagliptin 5 mg, pitavastatin 4 mg. In addition, a physician who was unaware of her end-stage kidney disease prescribed metformin 1,000 mg per day to her one month ago. A brain CT was performed, which revealed a nonspecific low-density change in bilateral lentiform nuclei. Therefore, she received a brain MRI, as shown in Figure 1, including the T2-weighted image (T2WI; panel A), diffusion-weighted image (DWI; panel B), and apparent diffusion coefficient image (ADC; panel C). Brain MRI revealed hyperintense T2WI signal in bilateral lentiform nuclei (putamen and globus pallidus) with a characteristic lentiform fork sign and restricted diffusion in bilateral globus pallidus. Upon admission, we discontinued metformin immediately and initiated intensive hemodialysis. Her neurological deficits fully resolved after eight sessions of hemodialysis therapy within 12 days. The patient was then discharged without any sequelae.
Usefulness of prolonged renal replacement therapy in patients with acute kidney injury requiring dialysis
Published in Baylor University Medical Center Proceedings, 2020
Paula Duran, Luis A. Concepcion
One problematic issue with AKI RRT is the measurement of the dialysis dose. There is no general agreement as to what method to use or what values to use. In this study, the standard measurement of dialysate flow and ultrafiltration were used to calculate the dose of dialysis in mL/kg/h. Our protocol requires measuring pre and post BUN in all dialysis treatments. Based on these values, we calculated the usual measures used for chronic hemodialysis, which include urea reduction ratio, single pool and standardized KT/V, and EKR. The CVVHD dose expressed in mL/kg/h was higher than the accepted 20 to 25 mL/kg/h, but the treatment was short, reflecting also the higher dialysate flow described above. In term of the usual urea reduction ratio and single pool KT/V, the average value obtained was similar to previous studies that showed benefit.11 Extrapolating the urea kinetics for more frequent dialysis, the standardized KT/V value was acceptable and higher than the number recommended for more frequent dialysis in end-stage renal disease patients. This study also calculated the EKR,12 which is used to compare small solute clearance between continuous and intermittent therapies to achieve metabolic control. The values obtained were consistent with those of previous studies.