Renal Disease; Fluid and Electrolyte Disorders
John S. Axford, Chris A. O'Callaghan in 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.
The Patient with Renal Dysfunction
Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler in Heart Failure, 2023
Patients with ESRD are rarely referred for LVAD implantation with only 1.5% of new patients requiring dialysis before surgery, based on data from the INTERMACS database.100 A proportion of LVAD recipients who develop AKI and require hemodialysis after implantation will require long-term maintenance hemodialysis. Outpatient hemodialysis (HD) in this setting, albeit safe, can be an important barrier to discharge as many HD are not acquainted with the care of LVAD patients. A previous analysis of outpatient HD sessions in ten LVAD recipients, showed a low interruption rate of HD, low incidence of low-flow alarms and no serious adverse events or deaths.47,101 Intradialytic hypotension is the main reason to terminate the HD session and some of the hypotensive episodes may be precipitated by catheter-related sepsis. Anecdotal experience suggests that outpatient hemodialysis is safe and feasible in adequately trained hemodialysis centers. Careful assessment of blood pressure with Doppler probes, dosing of antihypertensive medications on non-dialysis days, and use of midodrine in cases of recurrent symptomatic intra-dialytic hypotension are ways to facilitate completion of HD sessions without hypotensive episodes. Although concerns were previously raised, regarding maturation of arterio-venous fistulas in the setting of continuous flow, recent reports suggest normal maturation without hemodynamic or infectious complications.102
Kidney Disease
Amy J. Litterini, Christopher M. Wilson in Physical Activity and Rehabilitation in Life-threatening Illness, 2021
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.
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.
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.
Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life
Published in Disability and Rehabilitation, 2023
Patrícia Cardoso Campos, Ana Caiane Rocha da Silva, Renato Fleury Cardoso, Vanessa Gomes Brandão Rodrigues, Frederico Lopes Alves, Emílio Henrique Barroso Maciel, Maria Cecília Sales Mendes Prates, Henrique Silveira Costa, Pedro Henrique Scheidt Figueiredo, Vanessa Pereira Lima
Hemodialysis is usually performed three times a week, with four hours of duration on average. The main goal of fluid removal is that the patient reaches a dry weight at the end of each dialysis session [57]. According to the PGI, most respondents stated that regulating water intake and restricting certain foods (which are not covered directly in the ICF domain) results in the personal disturbance. The restrictions go beyond the hospital environment. The individual changes the water intake to maintain the weight of 500 ml of fluid per day. This is an important stressor for patients, causing a negative effect on HRQoL. Moreover, the change in their routine and the time speeded with the treatment in hemodialysis sessions [63] are regular complaints. Reduced time to perform other activities, as well as an impossibility and/or difficulties to work, travel/leisure, perform ADL, walk and climb hills, were categories most cited by patients in our study and characterize the ICF activity and participation domains. Consequently, there are disorders in several dimensions, including social, economic, and personal life [64]. The social function domain in KDQoL-SF had a moderate correlation with the PGI. The complaints of patients on hemodialysis are directly contemplated in the ICF construct. Similarly, Thammaiah et al. [65] observed with a self-reported questionnaire that the participation scale showed a moderate to high correlation with the HRQoL questionnaire.
Related Knowledge Centers
- Apheresis
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- Blood
- Kidney
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