Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients.

Introduction: Fluid assessment and management is a key aspect of good dialysis care and is affected by patient-level characteristics and potentially centre-level practices. In this secondary analysis of the BISTRO trial we wished to establish whether centre-level practices with the potential to affect fluid status were stable over the course of the trial and explore if they had any residual associations with participant's fluid status.

Methods: Two surveys (S) of fluid management practices were conducted in 32 participating centres during the trial, (S1: 2017-18 and S2: 2021-22).

Impact of the Preservation of Residual Kidney Function on Hemodialysis Survival: Results from the BISTRO Trial.

Background: Preservation of residual kidney function (RKF) in dialysis patients has been associated with improved survival. RKF in the BISTRO trial was relatively well preserved and here we describe its association with survival during the trial and extended follow-up.

Methods: RKF, measured as the average urea and creatinine clearance (GFR) or 24-hour urine volume was assessed at baseline, one, two and three months and three-monthly up to 2 years in incident haemodialysis patients.

A randomized controlled trial evaluating the erythropoiesis stimulating agent sparing potential of a vitamin E-bonded polysulfone dialysis membrane.

Background: Vitamin E (VE) bonded polysulfone dialysis membranes have putative erythropoiesis stimulating agent (ESA)-sparing and anti-inflammatory properties based on data from a small number of studies. We sought to investigate this in a large, prospective 12-month randomized controlled trial.

Methods: Two-hundred and sixty prevalent haemodialysis (HD) patients were randomized to dialysis with VE-bonded polysulfone membranes or non-VE-bonded equivalents.

A predictive algorithm for the management of anaemia in haemodialysis patients based on ESA pharmacodynamics: better results for less work.

Background: Many anaemia management algorithms recommend changes to erythropoiesis-stimulating agent (ESA) doses based on frequent measurement of haemoglobin levels in keeping with the ESA datasheets. We designed a predictive anaemia algorithm based on ESA pharmacodynamics, which we hoped would improve compliance with haemoglobin targets and reduce workload.

Methods: A new algorithm was designed which predicted the 3-month steady-state haemoglobin concentration following a change in ESA dose and only recommended a change if it was outside the range 10.

Reducing sodium intake in hemodialysis patients.

A low salt diet is beneficial for the whole population but has particular advantages for hemodialyis patients because of the role of salt restriction in the management of hypertension and interdialytic weight gain (IDWG). Education on dietary salt intake based on general healthy eating guidelines, such as the "DASH-sodium" diet, should be provided for staff, families, and carers as well as patients. Anuric hemodialysis patients will need to take in approximately 1 l of water for every 8 g salt consumed.

Should dialysate calcium concentration be standardised or individualised?

The 2003 K/DOQI bone metabolism guidelines recommend a standard dialysate calcium concentration of 1.25 mmol/l. Studies of calcium balance that take ultrafiltration, as well as changes in ionised calcium, into account show that patients lose calcium when treated with this dialysate Ca.

Venous needle dislodgement: how to minimise the risks.

Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes.

A comparison of methods for determining urea distribution volume for routine use in on-line monitoring of haemodialysis adequacy.

Background: The availability of haemodialysis machines equipped with on-line clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume 'V' is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods.

Methods: Ten stable HD patients were monitored monthly for 6 months.

On line UV-adsorbance measurements. Summary of the EDTNA/ERCA journal club discussion. Summer 2006.

The discussion was initiated by a paper comparing the measurement of dialysis dose (Kt/V) and solute clearance using on-line ultra-violet absorbance, blood and dialysate urea and ionic dialysance by Uhlin et al (NDT 2006). Participants from 14 countries discussed the theory behind the UV absorbance technique and the potential for its use in routine practice, the correlation between Kt/V measured using different methods, the use of ionic dialysance and the optimisation of dose monitoring. The 'take-home' messages from the discussion were that UV-absorbance could help ensure the delivery of dialysis dose as it provides real time feedback on the effect interventions such as repositioning of needles.

Merits and limitations of continuous blood volume monitoring during haemodialysis. Summary of the EDTNA/ERCA Journal Club discussion: Winter 2005.

The discussion explored and expanded on the issues raised by Dasselaar et al in their review of the measurement of relative blood volume (RBV) changes during dialysis (NDT 2005). Dialysis machines incorporating blood volume monitoring and control are widely available in Europe. The use of continuous blood volume monitoring (CBVM) to help establish dry weight; problems with CBVM due to connection and use of single needle dialysis; the physiological processes that cause RBV changes during eating, exercise and posture changes; and the application of blood volume based biofeedback control were discussed by participants from ten countries.

A randomized, controlled study of the consequences of hemodialysis membrane composition on erythropoietic response.

Background: Membrane biocompatibility has long been thought to be relevant to hemodialysis outcomes and, possibly, renal anemia.

Methods: We performed a randomized, controlled, single-center study comparing the consequences on renal anemia of 2 dialyzers of equivalent performance, but different composition, during 7 months. Two hundred eleven patients of an unselected dialysis population of 235 patients gave informed consent to undergo random assignment to either group A (SF170E; modified cellulose triacetate/midflux membrane; Nipro, Osaka, Japan) or group B (HF80LS; polysulfone/high-flux membrane; Fresenius, Bad Homburg, Germany).

Treating and monitoring water for dialysis in Europe.

The quality of water used for dialysis is not subject to any mandatory regulations in most European countries. A survey of haemodialysis facilities in 14 countries carried out by the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) showed that the majority of centres aimed to meet the requirements of the European Pharmacopoeia, but only 50% carried out tests to check compliance. The wide variation in policies for maintaining and monitoring the equipment and the distribution system indicates that guidelines for water treatment are urgently needed in Europe.

Information and counselling for patients approaching end-stage renal failure in selected centres across Europe.

The EDTNA/ERCA survey of the provision of pre-ESRF information, education and counselling in renal care was the third project organised through the Collaborative Research Programme (CRP). Data was collected from 35 participating centres in 10 countries. The majority of participating centres had a structured pre-ESRF programme.

Simulating the effect of exercise on urea clearance in hemodialysis.

A two-compartment model of urea kinetics during hemodialysis is used to predict the effect of exercise on hemodialysis dose. It is assumed that the two compartments represent tissues that are perfused by low and high blood flows (initially 1.1 L/min and 3.