Palliative care/hospice and the withdrawal of dialysis.

While the majority of end-stage renal disease (ESRD) patients on dialysis lead satisfying lives, an increasing number are choosing to withdraw from dialysis before death. A partnership between nephrology and palliative care/hospice healthcare teams would seem likely in the care of ESRD patients, yet this is often not the case. In anticipation of increasing participation by palliative care/hospice teams in the care of such patients, this article reviews the decision-making process of withdrawal and the medical care of the patient who withdraws.

Bipedal bioelectrical impedance analysis reproducibly estimates total body water in hemodialysis patients.

Formal kinetic modeling for hemodialysis patients requires accurate determination of in vivo dialyzer clearance, careful measurement of the actual dialysis time, and calculation of the patient's total body water (V) or urea space. Bipedal (BP) bioelectrical impedance analysis (BIA) is a simple method for the determination of V at the same time the patient is weighed. Because of better correlation with the Watson formula volume and a smaller coefficient of variation than urea kinetic volumes, BP-BIA estimates of V may be preferred in dialysis units that meet guidelines by following formal kinetic modeling data or use V estimates in calculating treatment time.

Phonatory effects of body fluid removal.

Adequate body and vocal fold hydration are believed to be critical to phonation. We hypothesized that body fluid reduction, without dehydration, would increase phonation threshold pressure (P(th)) and be associated with patient-perceived increases in phonatory effort and worsening voice quality. Using a single-subject, full-reversal design, a controlled volume of body fluid was repeatedly removed via ultrafiltration from adults with end stage renal disease (2 women, 4 men, ages 40-85 yrs).

High anion gap metabolic acidosis associated with aminocaproic acid.

Objective: To report a case of high anion gap metabolic acidosis related to infusion of aminocaproic acid (ACA) that temporarily corrected during hemodialysis and resolved upon ACA discontinuation.

Case Summary: A 65-year-old white woman with staphylococcal sepsis complicated by acute renal failure was treated with ACA to control a hemorrhagic coagulopathy. After receiving an initial 5-g bolus of ACA, she received a continuous intravenous infusion of 500 mg/h for just over 5 days, then 250 mg/h for a final 12 hours.