Remote Monitoring of Automated Peritoneal Dialysis Patients: Assessing Clinical and Economic Value.

Background: For chronic kidney disease patients who progress to end-stage renal disease, survival is dependent on renal replacement therapy in the form of kidney transplantation or chronic dialysis. Peritoneal dialysis (PD), which can be performed at home, is both more convenient and less costly than hemodialysis that requires three 4-h visits per week to the dialysis facility and complicated equipment. Remote therapy management (RTM), technologies that collect medical information and transmit it to healthcare providers for patient management, has the potential to improve the outcomes of patients receiving automated peritoneal dialysis (APD) at home.

Arterial compliance in adolescents and young adults receiving chronic hemodialysis.

Increased vascular stiffness is an established risk marker of cardiovascular diseases (CVD) in adults with end-stage renal disease, but its role in pediatric patients remains to be defined. We prospectively examined arterial compliances of adolescents and young adults on hemodialysis (HD) using diastolic pulse wave analysis (DPWA). Each of the ten HD patients (age 17.

Enhanced hemolysis in pediatric patients requiring extracorporeal membrane oxygenation and continuous renal replacement therapy.

Purpose: Hemolysis during extracorporeal membrane oxygenation (ECMO) may be associated with the development of hemoglobinuria (Hb) nephropathy and acute renal failure. For patients requiring ECMO, continuous renal replacement therapy (CRRT) can be simultaneously performed by attaching a hemofilter to the ECMO circuit, thereby shunting part of the ECMO blood flow through the hemofilter. However, the possibility that CRRT may further enhance hemolysis (and the risk of Hb nephropathy) in patients on ECMO has not been previously investigated.

Renal replacement therapy in the treatment of confirmed or suspected inborn errors of metabolism.

Objective: Analysis of mortality and risk factors for mortality in the use of renal replacement therapy to correct metabolic disturbances associated with confirmed or suspected inborn errors of metabolism.

Study Design: A retrospective review of an institutional review board-approved pediatric acute renal failure data base at the University of Michigan. Eighteen patients underwent 21 renal replacement therapy treatments for metabolic disturbances caused by urea cycle defects (n = 14), organic acidemias (n = 5), idiopathic hyperammonemia (n = 1), and Reye syndrome (n = 1).

Hyperosmolar solutions in continuous renal replacement therapy for hyperosmolar acute renal failure: a preliminary report.

Objective: To demonstrate the efficacy of hyperosmolar dialysis and prefilter replacement fluid solutions for continuous renal replacement therapies in the correction of hyperosmolar disorders in acute renal failure.

Data Source: An Institutional Review Board-approved pediatric acute renal failure database at the University of Michigan C. S.

Clearance of amino acids by hemodialysis in argininosuccinate synthetase deficiency.

We determined the dialytic clearance of amino acids involved in ammoniagenesis and nitrogen excretion in a neonate with argininosuccinate synthetase deficiency who underwent acute hemodialysis. Plasma ammonia and plasma and dialysate amino acid concentrations were obtained at baseline, 30-minute intervals during hemodialysis, and 30 minutes after the completion of hemodialysis. Plasma ammonia concentrations declined by 56% during the 90-minute hemodialysis treatment, whereas arginine, citrulline, glutamine, and glycine concentrations decreased by 65%, 55%, 40%, and 34%, respectively.