Seminars in nephrology最新文献_第5页

How to Ensure Patency of the Extracorporeal Circuit in Hemodialysis: Global Perspectives. 如何确保血液透析中体外循环的通畅：全球视角。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-11-01 Epub Date: 2024-01-24 DOI: 10.1016/j.semnephrol.2023.151476

Alba Santos, Almudena Vega, Andrew Davenport

{"title":"How to Ensure Patency of the Extracorporeal Circuit in Hemodialysis: Global Perspectives.","authors":"Alba Santos, Almudena Vega, Andrew Davenport","doi":"10.1016/j.semnephrol.2023.151476","DOIUrl":"10.1016/j.semnephrol.2023.151476","url":null,"abstract":"An adequate knowledge of anticoagulants used to prevent clotting in the extracorporeal circuit is crucial to provide optimal hemodialysis. Drugs can potentially prevent extracorporeal circuit clotting, but administration, half-life, and potential side effects differ. However, there is a lack of concise recommendations to guide anticoagulation and to avoid side effects. Because of the development of newer anticoagulant agents, direct thrombin inhibitors, and heparinoids, some of the side effects related to heparin may be overcome, but a deeper knowledge of these newer drugs is necessary. Moreover, types of heparin used, routes of administration, and health care economics vary around the world. We performed an extensive review of the literature, and the present article focuses on available anticoagulant drugs, exploring doses, side effects, particular use in hemodialysis, mechanism of action, pharmacokinetic properties, and use in special situations. Classical anticoagulants are still the standard of anticoagulation, but many questions remain unanswered; for example, is there real superiority of one treatment over another in terms of efficacy, safety, and health care economics? Anticoagulant protocols for hemodialysis need to be standardized and further studies performed to answer all of these questions.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139562630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bleeding Risk in Hemodialysis Patients. 血液透析患者的出血风险。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-11-01 Epub Date: 2024-01-18 DOI: 10.1016/j.semnephrol.2023.151478

Anita van Eck van der Sluijs, Pearl Pai, Wenjuan Zhu, Gurbey Ocak

引用次数: 0

Laboratory Monitoring of Heparin Anticoagulation in Hemodialysis: Rationale and Strategies. 血液透析中肝素抗凝的实验室监测：原理与策略。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-11-01 Epub Date: 2024-01-30 DOI: 10.1016/j.semnephrol.2023.151477

Thita Chiasakul, François Mullier, Thomas Lecompte, Philippe Nguyen, Adam Cuker

{"title":"Laboratory Monitoring of Heparin Anticoagulation in Hemodialysis: Rationale and Strategies.","authors":"Thita Chiasakul, François Mullier, Thomas Lecompte, Philippe Nguyen, Adam Cuker","doi":"10.1016/j.semnephrol.2023.151477","DOIUrl":"10.1016/j.semnephrol.2023.151477","url":null,"abstract":"Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis extracorporeal circuit and optimize hemodialysis adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated partial thromboplastin time, activated clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Regional Citrate Anticoagulation: A Tale of More Than Two Stories. 区域性枸橼酸抗凝：不只是两个故事的故事。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-11-01 Epub Date: 2024-01-11 DOI: 10.1016/j.semnephrol.2023.151481

Thomas Demuynck, Muriel Grooteman, Piet Ter Wee, Mario Cozzolino, Björn Meijers

{"title":"Regional Citrate Anticoagulation: A Tale of More Than Two Stories.","authors":"Thomas Demuynck, Muriel Grooteman, Piet Ter Wee, Mario Cozzolino, Björn Meijers","doi":"10.1016/j.semnephrol.2023.151481","DOIUrl":"10.1016/j.semnephrol.2023.151481","url":null,"abstract":"Calcium is a key clotting factor, and several inorganic molecules that bind to calcium have been found to reduce the clotting propensity of blood. Citrate, a calcium chelator, is used as inhibitor of the coagulation cascade in blood transfusion. Also, it is used as an anaticoagulant during dialysis to maintain patency of the extracorporeal circuit, known as regional citrate anticoagulation (RCA). The amount of citrate should be chosen such that ionized calcium concentrations in the extracorporeal circuit are reduced enough to minimize propagation of the coagulation cascade. The dialytic removal of the calcium-citrate complexes combined with reduced ionized calcium concentrations makes necessary calcium supplementation of the blood returning to the patient. This can be achieved in different ways. In classical RCA, citrate and calcium are infused in the afferent and efferent tubing, respectively, whereas the dialysate does not contain calcium. This setup has been shown to be highly efficacious with a very low clotting propensity. Strict monitoring of blood electrolytes is required. Alternatively, the use of a high-calcium dialysate leads to calcium loading, obviating the need for a separate calcium infusion pump. The main advantages are simplified delivery of RCA and less fluctuation of systemic calcium concentrations. Currently, citric acid is sometimes added to the acid concentrate as a replacement for acetic acid. Differences and similarities between RCA and citrate-containing dialysate are discussed. RCA is an excellent alternative to heparin for patients at high risk of bleeding.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Detection and Scoring of Extracorporeal Circuit Clotting During Hemodialysis. 血液透析过程中体外循环凝血的检测和评分。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-11-01 Epub Date: 2024-01-24 DOI: 10.1016/j.semnephrol.2023.151474

Floris Vanommeslaeghe, Wim Van Biesen, Karlien François

引用次数: 0

Congenital Anomalies of the Kidney and Urinary Tract: A Continuum of Care 肾脏和泌尿道的先天性异常:连续的护理

3区医学

Seminars in nephrology Pub Date : 2023-10-01 DOI: 10.1016/j.semnephrol.2023.151433

Bärbel Lange-Sperandio, Hans-Joachim Anders, Maximilian Stehr, Robert L. Chevalier, Richard Klaus

引用次数: 0

Strategies to Prevent Infections in Dialysis Patients. 预防透析患者感染的策略。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-09-01 Epub Date: 2024-01-09 DOI: 10.1016/j.semnephrol.2023.151467

Daniela Ponce, Dorothea Nitsch, Talat Alp Ikizler

{"title":"Strategies to Prevent Infections in Dialysis Patients.","authors":"Daniela Ponce, Dorothea Nitsch, Talat Alp Ikizler","doi":"10.1016/j.semnephrol.2023.151467","DOIUrl":"10.1016/j.semnephrol.2023.151467","url":null,"abstract":"Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. Vascular access is a major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. Catheter-related bacteremia is the most severe central venous catheter (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. Peritoneal dialysis chronic treatment without the occurence of peritonitis is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal dialysis catheter. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Infection-Related Glomerulonephritis in Children and Adults. 儿童和成人与感染相关的肾小球肾炎。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-09-01 Epub Date: 2024-01-19 DOI: 10.1016/j.semnephrol.2023.151469

Arpana Iyengar, Nivedita Kamath, Jai Radhakrishnan, Blanca Tarragon Estebanez

{"title":"Infection-Related Glomerulonephritis in Children and Adults.","authors":"Arpana Iyengar, Nivedita Kamath, Jai Radhakrishnan, Blanca Tarragon Estebanez","doi":"10.1016/j.semnephrol.2023.151469","DOIUrl":"10.1016/j.semnephrol.2023.151469","url":null,"abstract":"Infection-related glomerulonephritis is an immunologically mediated glomerular injury after an infection. Glomerulonephritis may occur with the infection or after a variable latent period. Poststreptococcal glomerulonephritis (PSGN) is the prototype of infection-related glomerulonephritis. The streptococcal antigens, nephritis-associated plasmin-like receptor and streptococcal exotoxin B, have emerged as major players in the pathogenesis of PSGN. Although PSGN is the most common infection-related glomerulonephritis in children, in adults, glomerulonephritis is secondary to bacteria such as staphylococci, viruses such as hepatitis C, and human immunodeficiency virus, and, rarely, parasitic infections. Supportive therapy is the mainstay of treatment in most infection-related glomerulonephritis. Treatment of the underlying infection with specific antibiotics and antiviral medications is indicated in some infections. Parasitic infections, although rare, may be associated with significant morbidity. Poststreptococcal glomerulonephritis is a self-limiting condition with a good prognosis. However, bacterial, viral, and parasitic infections may be associated with significant morbidity and long-term consequences. Epidemiologic studies are required to assess the global burden of infection-related glomerulonephritis. A better understanding of the pathogenesis of infection-related glomerulonephritis may unravel more treatment options and preventive strategies.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139502954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neglected and Emerging Infections of The Kidney. 被忽视和新出现的肾脏感染。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-09-01 Epub Date: 2024-01-12 DOI: 10.1016/j.semnephrol.2023.151472

Ifeoma I Ulasi, Emmanuel A Burdmann, Chinwuba K Ijoma, Li-Fang Chou, Chih-Wei Yang

{"title":"Neglected and Emerging Infections of The Kidney.","authors":"Ifeoma I Ulasi, Emmanuel A Burdmann, Chinwuba K Ijoma, Li-Fang Chou, Chih-Wei Yang","doi":"10.1016/j.semnephrol.2023.151472","DOIUrl":"10.1016/j.semnephrol.2023.151472","url":null,"abstract":"Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease, and even mortality. Consequences include high health care expenditures, loss of means of support, social stigma, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control neglected tropical diseases: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on kidney diseases, as part of a comprehensive approach to One Health.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139432593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

COVID and the Kidney: An Update. COVID 与肾脏：最新进展。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-09-01 Epub Date: 2024-01-09 DOI: 10.1016/j.semnephrol.2023.151471

Samira Bell, Griffith B Perkins, Urmila Anandh, P Toby Coates

{"title":"COVID and the Kidney: An Update.","authors":"Samira Bell, Griffith B Perkins, Urmila Anandh, P Toby Coates","doi":"10.1016/j.semnephrol.2023.151471","DOIUrl":"10.1016/j.semnephrol.2023.151471","url":null,"abstract":"Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global pandemic that continues to be responsible for ongoing health issues for people worldwide. Immunocompromised individuals such as kidney transplant recipients and dialysis patients have been and continue to be among the most affected, with poorer outcomes after infection, impaired response to COVID-19 vaccines, and protracted infection. The pandemic also has had a significant impact on patients with underlying chronic kidney disease (CKD), with CKD increasing susceptibility to COVID-19, risk of hospital admission, and mortality. COVID-19 also has been shown to lead to acute kidney injury (AKI) through both direct and indirect mechanisms. The incidence of COVID-19 AKI has been decreasing as the pandemic has evolved, but continues to be associated with adverse patient outcomes correlating with the severity of AKI. There is also increasing evidence examining the longer-term effect of COVID-19 on the kidney demonstrating continued decline in kidney function several months after infection. This review summarizes the current evidence examining the impact of COVID-19 on the kidney, covering both the impact on patients with CKD, including patients receiving kidney replacement therapy, in addition to discussing COVID-19 AKI.","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139417993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0