Seminars in Dialysis最新文献

{"title":"From Venous to Arterial Blood in the Same Tunneled Dialysis Catheter After Starting a Continuous Renal Replacement Therapy: A Case Report.","authors":"Amandine Becquet, Pierre Louis Hermet, Dominique Bertrand, Amandine Verbecke, Maximilien Grall, Christophe Girault, Jonathan Nicolas","doi":"10.1111/sdi.13235","DOIUrl":"https://doi.org/10.1111/sdi.13235","url":null,"abstract":"<p><p>Tunneled dialysis catheter is the alternative for dialysis patients who cannot benefit from an arteriovenous fistula. The insertion of such catheters is usually ultrasound-guided to prevent complications. A 36-year old patient had an unexpected complication following the insertion of a right femoral tunneled dialysis catheter: Although the blood collected from the catheter was venous after insertion, the blood turned arterial few minutes after initiating a continuous renal replacement therapy (CRRT). It became venous again after stopping the therapy. The first, yet unlikely hypothesis, was an arterial location of the catheter. In fact, it turned out not to be. We describe the management of such a case.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Treatment of Two Severe Acute Intoxication and Acute Kidney Injury.","authors":"Fulvia Zappulo, Laura Martano, Ines Ullo, Veronica Catalano, Sara Donini, Anna Scrivo, Anna Laura Croci Chiocchini, Gaetano La Manna","doi":"10.1111/sdi.13233","DOIUrl":"https://doi.org/10.1111/sdi.13233","url":null,"abstract":"<p><p>Extracorporeal therapies could be required for treatment of life-threatening severe acute intoxication. We present the case of an 82-year-old patient admitted to our Nephrology Unit because of metformin-associated lactic acidosis (MALA) and acute kidney injury (AKI stage III AKIN criteria). The patient also presented severe intoxication of digoxin and apixaban. The electrocardiogram presented a junctional escape rhythm with atrial fibrillation (AF) and lateral ST-segment depression that, despite fab-fragments' administration, has not regress. Due to patient's hemodynamic instability, an 8 h of sustained low-efficiency diafiltration (SLED) was prescribed. This treatment allowed to reduce serum concentration of apixaban and digoxin. Similarly, patient's hemodynamic and ECG trace improved with the resolution of junctional rhythm and persistence of AF. Even if continuous renal replacement therapy (CRRT) is the first choice in critical ill patients, SLED could represent a valid option for patients without indication to ICU.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Hypokalemia With Mortality in Patients Undergoing Hemodialysis: A Systematic Review and Meta-Analysis.","authors":"Zhongcui Huo, Xueli Zhu, Yong Yang, Sai Wang","doi":"10.1111/sdi.13234","DOIUrl":"https://doi.org/10.1111/sdi.13234","url":null,"abstract":"<p><strong>Background: </strong>Potassium imbalance, particularly hypokalemia, is a critical risk factor for adverse outcomes in patients undergoing hemodialysis (HD). However, the association between hypokalemia and mortality is unclear.</p><p><strong>Methods: </strong>For this systematic review and meta-analysis, we assessed the association between hypokalemia and mortality in patients undergoing HD. We performed a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Scopus) to identify relevant studies published up to April 2024. Eligible studies were prospective or retrospective cohort studies reporting hazard ratios (HRs) for mortality in association with the presence of hypokalemia among patients undergoing HD. We used the assessed study Newcastle-Ottawa Scale to assess quality of the selected studies.</p><p><strong>Results: </strong>We carried out both qualitative and quantitative assessments. For the meta-analysis, we pooled the HRs for all-cause and cardiovascular mortalities. The overall pooled HR for all-cause mortality and cardiovascular mortality were 1.34 (95% CI, 1.15, 1.55) and 1.49 (95% CI, 1.12, 1.98), respectively, indicating significant associations between hypokalemia and all-cause mortality and cardiovascular mortality in patients undergoing HD. Additionally, we conducted subgroup analyses based on study design, geographical location, type of dialysis, and serum potassium levels.</p><p><strong>Conclusion: </strong>Our findings provide robust evidence of a significant association between hypokalemia and mortality in patients undergoing HD. Early detection and proactive management of hypokalemia are crucial for improving outcomes and reducing mortality risk in these patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Outcomes After Tunneled Dialysis Catheter-Related Bloodstream Infections-Too Dark at the End of This Tunnel?","authors":"Niveditha Pandit, Namrata Rao, Majibullah Ansari, Abhilash Chandra, Sai Saran","doi":"10.1111/sdi.13232","DOIUrl":"https://doi.org/10.1111/sdi.13232","url":null,"abstract":"<p><strong>Background: </strong>Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter-related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear.</p><p><strong>Aims and objectives: </strong>The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI. The composite adverse outcome was recorded as the presence of at least one of three adverse outcomes-death in the index hospital admission, occurrence of recurrent bacteremia, and death within 3 months.</p><p><strong>Results: </strong>During the study period, the TDC CRBSI incidence rate was 6.9/1000 catheter days. Of the 110 study participants, majority were male (63%), with a median age of 35 years, belonging to rural (56%) and agrarian (39%) communities, and 66% were getting dialyzed at stand-alone dialysis units. Gram-negative infections predominated (64%), with 37% of isolates showing resistance to carbapenems. Catheter salvage was practiced in 80%, and immediate catheter removal was done only in the sickest of patients (in seven of eight with in-hospital mortality). Predictors of composite adverse outcomes included sites other than right internal jugular vein (OR 3.6) and resistance to β lactam-β lactamase inhibitors (OR 16.2). At a median follow-up of 7 months, all survivors at 3 months were alive and 46% had recurrent TDC CRBSIs.</p><p><strong>Conclusion: </strong>Up to one-half of patients with end-stage kidney disease experienced composite adverse outcomes after the first episode of TDC CRBSI, with infection-related 3-month mortality of 15%.</p><p><strong>Trial registration: </strong>Clinical trial number: CTRI/2023/10/058556.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A 15-Year Overview.","authors":"Ana Esther Sirvent, María Rosa Vigueras-Hernández, Ricardo Enríquez, Juan Mariano Pérez-Abad, Antonio Pérez-Pérez, Guadalupe Ruiz-Merino, Alberto J Andreu-Muñoz","doi":"10.1111/sdi.13231","DOIUrl":"https://doi.org/10.1111/sdi.13231","url":null,"abstract":"<p><strong>Introduction: </strong>Distal forearm arteriovenous fistulas (AVFs) for hemodialysis (HD) include radiocephalic fistulas (RCFs) and ulnar-basilic fistulas (UBFs). However, due to the unique anatomical peculiarities of the latter approach, UBFs are only established in a limited subset of patients undergoing vascular access procedures. This study aimed to present a retrospective case series detailing the creation of UBFs, emphasizing both the technical challenges and clinical outcomes associated with this approach.</p><p><strong>Methods: </strong>We conducted a retrospective review of UBFs created between 2008 and 2023. Data collected included patient demographics, comorbidities, patency, functionality, and outcomes. Adequate blood flow and personalized Kt/Vurea levels were prerequisites for defining UBF functionality for HD.</p><p><strong>Results: </strong>Among 253 patients receiving HD, 82.2% had an AVF, with only 3.3% (n = 5) of the 150 distal AVFs functional for HD being UBFs. In this series, a total of 11 UBF fistulas were created, with nine patients experiencing an immediate thrill. Among those with UBF failure, three patients were aged > 85 years, and three had concurrent diabetes mellitus, peripheral vascular disease, and ischemic heart disease. The survival rate in the UBF group correlated with the duration of dialysis in the three patients for whom the UBF was the sole AVF, with one patient achieving a remarkably prolonged period of > 10 years. No incidences of ischemia, hand edema, or ulnar nerve lesions were noted.</p><p><strong>Conclusion: </strong>While the difficulties experienced in achieving functional UBFs for HD are highlighted in this long-term perspective, its safety and durability make it a viable option in managing an increasingly comorbid patient population.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological Treatment for Dialysis-Related Muscle Cramps: A Systematic Review.","authors":"Nidia Mantilla-Manosalva, Santiago Guadarrama, Lennis Jazmin Bedoya-Muñoz, Sara Giraldo-Moreno, Laura Cuellar-Valencia, María Fernanda Iriarte-Aristizábal, Marta Ximena León, Fernan Alejandro Mendoza-Montenegro, Juan Esteban Correa-Morales","doi":"10.1111/sdi.13223","DOIUrl":"10.1111/sdi.13223","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-stage renal disease undergoing dialysis suffer from muscle cramps, a prevalent and burdensome symptom for which there is a paucity of efficient and safe treatments.</p><p><strong>Aim: </strong>What is the efficacy and safety of pharmacological interventions for the treatment of dialysis-related muscle cramps?</p><p><strong>Design: </strong>A systematic review was conducted in OVID, CINAHL, PubMed, Web of Science, and Central Cochrane databases up to August 25, 2023.</p><p><strong>Data sources: </strong>Experimental studies reporting on a pharmacological intervention for the treatment of dialysis-related muscle cramps were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the studies quality was assessed with the RoB2 tool.</p><p><strong>Results: </strong>A total of 4660 studies were retrieved, and 13 articles were included. The studies reported on nine interventions: vitamin C, vitamin E, vitamin K2, vitamin B7, dextrose solutions, gabapentin, sodium chloride, creatine monohydrate, and L-carnitine. The studies testing L-carnitine and creatine monohydrate were the only ones deemed to have a low risk of bias. Side effects were reported in only two trials, consisting primarily of gastrointestinal discomfort and hyperglycemia. Vitamins C and E are the two most studied interventions that showed positive results in reducing the frequency, severity, and duration of dialysis-related muscle cramps. L-carnitine is a promising intervention that warrants further investigation.</p><p><strong>Conclusion: </strong>Our review consolidates the existing evidence, elucidating the range of treatments along with their potential benefits and limitations. Future studies should uphold high-quality standards, incorporate patient-reported outcomes, and utilize well-defined, robust samples to improve patient care.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"415-423"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Renal Replacement Therapy Needs Its Own Circuit Diagram.","authors":"Xiankun Sun, Fang Wang, Ling Zhang, Zhiwen Chen","doi":"10.1111/sdi.13222","DOIUrl":"10.1111/sdi.13222","url":null,"abstract":"","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"466-470"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Use of Gastric-Acid Suppressants Increase the Risk of Peritonitis in Patients Undergoing Peritoneal Dialysis? A Meta-Analysis.","authors":"Lili Yao, Linfeng Ni, Xu Wu","doi":"10.1111/sdi.13226","DOIUrl":"10.1111/sdi.13226","url":null,"abstract":"<p><p>Gastric-acid suppressants (GASs) are commonly prescribed to patients undergoing peritoneal dialysis for various gastrointestinal disorders. However, long-term GAS use has been linked with the risk of enteric peritonitis in this patient population. To assess the association between the enteric peritonitis risk and GAS use in patients undergoing peritoneal dialysis for end-stage renal disease, we conducted a systematic search for relevant articles published until December 2023 in PubMed, Embase, and the Cochrane Library databases. We included 11 articles on the association between GAS use and enteric peritonitis risk in patients undergoing peritoneal dialysis. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed and random-effects models to obtain overall effect estimates. We also explored potential sources of heterogeneity through subgroup analyses. We qualitatively analyzed data from 11 studies (n = 1993 participants), out of which, nine studies were included in meta-analysis. The overall results revealed a significant association between the enteric peritonitis risk and the use of GASs (OR, 1.61; 95% CI, 1.26-2.05; p < 0.00001). The analysis of study design subgroups showed a significant association in retrospective cohort studies (OR, 1.70; 95% CI, 1.42-2.03; p < 0.00001) but not in case-control studies. Histamine-2 receptor antagonist (H2RA) use was significantly associated with enteric peritonitis (OR, 1.49; 95% CI, 1.05-2.11, p = 0.03), whereas proton pump inhibitor use was not (OR, 1.13; 95% CI, 0.72-1.77, p = 0.28). Our findings suggest a significant association between the development of enteric peritonitis and GAS use in patients undergoing peritoneal dialysis. However, the observed heterogeneity in study characteristics warrants caution in interpreting the results.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"424-432"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Function Trends in Dialysis: Unveiling Peritoneal and Hemodialysis Disparities.","authors":"Jelić Pranjić Ita, Orlić Lidija, Srdoč Nemarnik Lori, Vrdoljak Margeta Tea, Šimić Jelena, Bubić Ivan","doi":"10.1111/sdi.13228","DOIUrl":"10.1111/sdi.13228","url":null,"abstract":"<p><strong>Background: </strong>The interplay between peritoneal dialysis (PD), residual kidney function (RKF), and thyroid function remains poorly understood, with limited prospective studies comparing thyroid function in PD versus hemodialysis (HD) patients.</p><p><strong>Methods: </strong>This prospective single-center study assessed thyroid function in 18 PD patients over a 24-month follow-up period at the Department of Nephrology, Dialysis, and Kidney Transplantation, UHC Rijeka, Croatia. Data were compared to 24 concurrently treated HD patients.</p><p><strong>Results: </strong>Initially, some PD patients exhibited elevated TSH levels, which normalized during follow-up despite longer dialysis duration. Compared to HD patients, PD patients demonstrated significantly higher T4 concentrations at baseline and higher FT4 concentrations at 12 and 24 months. Furthermore, FT3 levels were significantly higher in PD patients at baseline and at both 12 and 24 months, with T3 levels also within the reference interval after the beginning of the study. Additionally, a positive association was observed between T4 levels and 24-h diuresis after 12 months in PD patients.</p><p><strong>Conclusion: </strong>Recognizing additional risk factors and potential impacts on RKF and cardiovascular comorbidities in dialysis patients can enhance patient care, influence dialysis modality selection, and guide ongoing patient monitoring. Thorough evaluation of thyroid function in PD and HD patients is essential for optimizing clinical outcomes and overall well-being. This study contributes to understanding the complex interplay between thyroid function, RKF, and dialysis modality, emphasizing the need for further research to inform comprehensive patient care strategies.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"438-444"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin Dosing Strategy for the Treatment of Peritonitis in a Child on Automated Peritoneal Dialysis: A First Pediatric Case Report.","authors":"David Haefliger, Hassib Chehade, Francoise Livio, Viviane Rodrigues-Veiga, Léonore Diezi, Catia Marzolini","doi":"10.1111/sdi.13224","DOIUrl":"10.1111/sdi.13224","url":null,"abstract":"<p><strong>Background: </strong>Bacterial peritonitis is a common complication of peritoneal dialysis. In the absence of systemic signs of infection, adult guidelines recommend treatment with intraperitoneal vancomycin either as empiric coverage of gram-positive organisms or as targeted therapy. However, there is no guidance on how to administer vancomycin in children on automated peritoneal dialysis.</p><p><strong>Case report: </strong>We report vancomycin pharmacokinetics upon intraperitoneal administration for the treatment of a Staphylococcus hominis peritonitis in an 11-year-old patient on automated nocturnal intermittent peritoneal dialysis. While the patient was hospitalized, vancomycin was administered intraperitoneally as a continuous treatment. After hospital discharge, the nocturnal peritoneal dialysis was resumed. In the absence of treatment guidelines, intraperitoneal vancomycin was initially administered empirically only during the nocturnal dialysis exchanges which led to repetitive subtherapeutic vancomycin plasma concentrations and the persistence of S. hominis in dialysate cultures. Based on studies in adults, the dosing strategy was subsequently modified to administer vancomycin at a dosage of 15 mg kg^-1 in the dialysate with a 6-h dwell period prior to the nocturnal dialysis thereby allowing to reach optimal peak concentrations. The dosing interval was subsequently individualized using therapeutic drug monitoring to ensure residual vancomycin concentrations > 10 mg L^-1 thereby leading to clinical and microbiological recovery.</p><p><strong>Conclusions: </strong>This case presents a dosing strategy based on a comprehensive review of the literature and highlights that a sufficient dwell period is critical when treating pediatric patients on automated peritoneal dialysis in order to allow vancomycin distribution and equilibration between the dialysate and the plasma.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"461-465"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}