High volume online post-dilution hemodiafiltration: how relevant is it in chronic kidney disease?

Online hemodiafiltration is potentially a superior mode of dialysis compared to conventional hemodialysis. However, prospective randomized controlled trials have failed to demonstrate such superiority. Post-hoc analyses of these trials have indicated that high volume post-dilution hemodiafiltration is associated with lower death rates than conventional dialysis.

Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial.

Background: Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight removal and studies suggest better clinical/patient-reported outcomes compared with hemodialysis (HD).

Vascular access cannulation in hemodialysis patients: technical approach.

Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique.

Material And Methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis.

Conservative management for patients with chronic kidney disease refusing dialysis.

Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo dialysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disease, and socioeconomic status. In several occasions nephrologists will intervene, but at times general practitioners or family physicians are on their own.

Reflections on end-of-life dialysis.

The world population is aging and diseases such as diabetes mellitus and systemic arterial hypertension are increasing the risk of patients developing chronic kidney disease, leading to an increase in the prevalence of patients on dialysis. The expansion of health services has made it possible to offer dialysis treatment to an increasing number of patients. At the same time, dialysis survival has increased considerably in the last two decades.

High Dialysate Calcium Concentration May Cause More Sympathetic Stimulus During Hemodialysis.

Background/aims: Acute activation of sympathetic activation during hemodialysis is essential to maintain blood pressure (BP), albeit long-term overactivity contributes to higher mortality. Low heart rate variability (HRV), a measure of autonomic nervous system activity, and abnormal ankle-brachial index (ABI) are associated with higher mortality in patients on hemodialysis. In this study, we assessed HRV and ABI pre and post dialysis in incident patients on hemodialysis using high (1.

Variability in quality of care among dialysis units in the state of São Paulo and the ordinance number 389/2014 of the Health Ministry of Brazil.

Introduction: Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD). Recently, the Ministry of Health of Brazil published the ordinance n° 389/2014, which establishes targets in the care of patients with CKD.

Objective: We evaluate the performance of hemodialysis (HD) clinics in relation to the goals established in this ordinance.

Reprocessing high-flux polysulfone dialyzers does not negatively impact solute removal in short-daily online hemodiafiltration.

There are no studies evaluating the impact of dialyzer reprocessing on solute removal in short-daily online hemodiafiltration (OL-HDF). Our aim was to evaluate the impact of dialyzer reuse on solute removal in daily OL-HDF and compare with that in high-flux short-daily hemodialysis (SDH). Fourteen patients undergoing a SDH program were included.

The perception of sleep quality in kidney transplant patients during the first year of transplantation.

Objective: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation.

Methods: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2).

Importance of the monthly biochemical evaluation to identify patients on hemodialysis with malnutrition.

Introduction: Malnutrition is a frequent complication in patients on hemodialysis and early diagnosis is important to reduce the morbidity and mortality of treatment.

Objective: To investigate the usefulness of biochemical tests performed monthly in order to identify hemodialysis patients with malnutrition.

Methods: The nutritional status of 252 patients was evaluated by objective and subjective global assessment, and the patients classified as malnourished and not malnourished.

Arteriovenous fistula cannulation by buttonhole technique using dull needle.

Introduction: Cannulation of arteriovenous fistula (AVF) may be performed by the following techniques: area puncture, rope ladder, or buttonhole. The ideal technique has not yet been established.

Objective: To assess the complications and difficulties of introducing the buttonhole (BH) technique for cannulation of AVF created with a native vein in a dialysis unit.

Obstetric outcome in pregnant women on long-term dialysis: a case series.

Background: Although still uncommon, pregnancy frequency in women on maintenance hemodialysis therapy has increased in the past 20 years. Most published reports suggest that intensified hemodialysis regimens result in better pregnancy outcomes. The small number of patients investigated in all reported series is the main limitation of the available studies.

Effects of bone remodelling on calcium mass transfer during haemodialysis.

Background: During haemodialysis, calcium balance can affect, or be affected by, mineral metabolism. However, when dialysate calcium concentration (d[Ca]) is chosen or kinetic models are employed to calculate calcium balance, bone remodelling is rarely considered. In this study, we examined whether bone remodelling affects calcium mass transfer during haemodialysis.

[Nephrogenic systemic fibrosis: a severe complication of use to gadolinium in patients with kidney failure].

Nephrogenic systemic fibrosis (NSF), also known as nephrogenic fibrosing dermopathy (NFD), is a condition that has occurred only in patients with renal insufficiency. Besides lesions of the skin, this syndrome include fibrosis of skeletal muscle, joints, liver, lung, and heart, with possible fatal outcomes. This disease was first described in 1997 and several reports described the development of NSF after the exposure to gadolinium-based magnetic resonance imaging contrast agents.

Pruritus in hemodialysis patients: the problem remains.

Pruritus is still one of the most common and disturbing symptoms of end-stage renal disease. The objective of this study is to analyze the prevalence of pruritus in hemodialysis patients and the possible factors implicated in its genesis. In a cross-sectional study, 101 patients on hemodialysis at our center were screened for pruritus.

Obstructive sleep apnea in patients on conventional and short daily hemodialysis.

Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the factors associated with the origin of OSA as well as the cardiovascular consequences in this population are not completely understood. We evaluated, by standard overnight polysomnography, 24-hour ambulatory blood pressure (BP) monitoring and echocardiography in 30 patients (14 males, age 34 +/- 11 years, BMI 23.

Characterization of acid-base status in maintenance hemodialysis: physicochemical approach.

Acidosis is a common and deleterious aspect of maintenance dialysis. Traditionally, it is considered to be an elevated anion gap acidosis caused by the inability to excrete nonvolatile anions. Stewart's approach made it possible to identify real determinants of the acid-base status and allowed quantification of the components of these disturbances, especially the unmeasured anions.