P1861ARTIFICIAL PHOSPHATE- HOW DIFFICULT IS IT TO AVOID IT?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Oonagh Smith ◽  
Sarah Kiernan
Keyword(s):  
Protein Content ◽  
Food Additives ◽  
The Body ◽  
Food Label ◽  
Dietary Phosphate ◽  
Clinically Significant ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Patient ◽  
Cooked Meats

Abstract Background and Aims Hyperphosphataemia has been independently associated with increased morbidity and mortality across the lifecycle of chronic kidney disease. Dietary phosphate restriction is the corner stone of hyperphosphataemia management. Traditionally the focus was on limiting foods that are naturally high in phosphate such as meats, dairy, wholegrain and nut products. However, phosphate-containing additives are a growing concern. Artificial phosphates are thought to be readily absorbed by the body and are increasingly being added to processed foods, at a time when there is an increased desire and reliance on convenience foods. It has been shown that educating patients with end stage renal disease to avoid phosphate-containing food additives can result in a modest but clinically significant improvement in serum phosphorus levels. 1 The aim of this study was to evaluate how feasible it is for a patient to source convenience packaged cooked meats/poultry that are free from artificial phosphate and if such products are a suitable option for the renal patient in relation to salt and protein content. Method Data was manually collected in a branch of the five leading supermarket chains. The ingredient list of each product food label was checked for artificial phosphate (phos), artificial potassium (K) or the corresponding E numbers and the nutrition table examined for salt and protein content (per 100g / 25g portion or slice). The price was checked in store and manually calculated per 7g protein exchange. Results

Abacavir/lamivudine/dolutegravir single tablet regimen in patients with human immunodeficiency virus and end-stage renal disease on hemodialysis

2018 ◽  
Vol 30 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Sarah M Michienzi ◽  
Christopher A Schriever ◽  
Melissa E Badowski
Keyword(s):  
Human Immunodeficiency Virus ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Case Series ◽  
Drug Discontinuation ◽  
Immunodeficiency Virus ◽  
Before And After ◽  
Clinically Significant ◽  
Stage Renal Disease ◽  
End Stage

No single-tablet antiretroviral (ARV) regimens (STRs) are approved for patients with human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) on hemodialysis (HD). Based on known pharmacokinetic (PK) properties, abacavir (ABC)/lamivudine (3TC)/dolutegravir (DTG) STR may represent a promising option. This case series presents the safety and efficacy of ABC/3TC/DTG STR in patients with HIV and ESRD on HD. Patients were included if they were HIV-positive, maintained on intermittent HD for ESRD, switched to an ARV regimen containing ABC/3TC/DTG, and had at least one set of virologic data before and after the switch. Average age (±standard deviation) was 59 (±8) years. The majority of patients were cis-gender male and non-Hispanic Black. Only one demonstrated clinically significant resistance at baseline. All were on multiple-tablet regimens prior to the switch. Five patients (83%) achieved undetectable HIV-RNA after the switch while only four patients (46%) were undetectable immediately prior. No decline in immune function was noted. ABC/3TC/DTG STR was well tolerated. Only one patient self-reported an adverse event (nausea), which resolved without drug discontinuation. Based on these data, it appears that ABC/3TC/DTG may be a safe and effective ARV-STR option for patients with HIV and ESRD on HD. A larger trial including a PK analysis is needed to confirm these findings.

La diagnosi precoce di malattia

2019 ◽  
Vol 31 (1) ◽  
pp. 58-60
Author(s):  
Federica Rossi ◽  
Federico Pieruzzi
Keyword(s):  
Wide Spectrum ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
The Body ◽  
Lysosomal Storage ◽  
Cerebrovascular Complications ◽  
Risk Patients ◽  
Alpha Galactosidase ◽  
Stage Renal Disease ◽  
End Stage

Anderson-Fabry disease is an X-linked, lysosomal, storage disorder characterized by the decreased activity of alpha-Galactosidase A, which results in accumulation of globotriaosylceramide (Gb-3) in cells and tissues throughout the body, leading to a wide spectrum of clinical manifestations. Patients are often misdiagnosed or diagnosed late in their life. This is due to the phenotypic heterogeneity, the poor awareness of this rare disease, and many pitfalls when making a differential diagnosis, in adulthood, as well as in the early stages. Delayed diagnosis has significant clinical implications, because the progression of the disease over time can lead to irreversible end-stage renal disease and life-threatening cardiovascular or cerebrovascular complications. Early diagnosis remains essential in order to start an early treatment and reduce the progression of the disease, thus maximizing the chance to improve patient outcomes. Newborn screening, high-risk patients’ identification, and increasing pediatricians’ and clinicians’ knowledge on this condition, are good strategies to avoid late referrals of Anderson-Fabry patients to reference centers.

Geometric Enhancements of an Arteriovenous Graft

2009 ◽  
Author(s):  
Stephen P. Broderick ◽  
Gráinne Carroll ◽  
Micheal Walsh
Keyword(s):  
United States ◽  
The Elderly ◽  
The United States ◽  
Cost Of Care ◽  
The Body ◽  
Venous Anastomosis ◽  
And Migration ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End Stage Renal Disease (ESRD) is the degeneration of kidney function to remove uremic toxins from the blood. Currently there are over 484,000 sufferers of ESRD in the United States, with this figure predicted to rise to over 800,000 by 2020 [1]. The total cost of care for patients with ESRD was estimated to exceed 1 billion dollars in the United States [2]. A kidney transplant is the ideal solution for ESRD patients; however with the increasing number of ESRD patients the odds of receiving a donor kidney are poor. The alternative is hemodialysis. This process is involves the extraction of blood from the patient to an extracorporal machine. Blood is pumped at a rate of 350 mL/min to ensure effective dialysis. The blood is then returned to the body cleaned. The gold standard for hemodialysis access is the native arteriovenous fistula [3] with the most common type being the Brescia-Cimino fistula at the wrist [4]. In some subgroups the fistula performs poorly. In diabetics and the elderly, specifically over 70s [2] or can’t be constructed because of unsuitable blood vessels [5]. In this case an alternative is the synthetic AV graft. Made of polytetrafluoroethelyne, it has lower patency rates against the fistula [6] [7] mediated by the susceptibility to thrombosis induced by stenosis development and infection [7].The majority of stenosis development is within the venous anastomosis (kanterman1995). The formation of intimal hyperplasia (IH) leading to stenosis formation is caused by smooth cell proliferation and migration as a result of endothelial cells reacting to shear stress receptors. The development of IH has been linked to local hemodynamics and turbulence in the flow, which in turn are heavily influenced by the geometry of the graft.

Autopsy Findings of a Case with Oxalosis

2009 ◽  
Vol 12 (3) ◽  
pp. 229-232 ◽  
Author(s):  
Basak Doganavsargil ◽  
Ipek Akil ◽  
Sait Sen ◽  
Sevgi Mir ◽  
Gulcin Basdemir
Keyword(s):  
Primary Hyperoxaluria ◽  
The Body ◽  
Type I ◽  
Crystal Deposition ◽  
Autopsy Findings ◽  
Hyperoxaluria Type I ◽  
Stage Renal Disease ◽  
End Stage ◽  
Primary Hyperoxaluria Type I ◽  
Hyperoxaluria Type

Oxalosis, deposition of calcium oxalate in tissues, is the final stage of hyperoxaluric syndromes. Being a rare entity, it is often missed, or the diagnosis is delayed, since the definitive diagnosis requires special laboratory tests. Kidneys, the walls of blood vessels, and bones are the major sites for crystal deposition. We report the autopsy findings of a 4-year-old girl who presented with end-stage renal disease in which the clinical presentation was consistent with primary hyperoxaluria Type I. The case is unusual, as there was extensive crystal deposition throughout the body, including in tissues that are rarely involved, such as ovaries, fallopian tubes, uterus, thymus, salivary glands, pancreas, and bladder.

scholarly journals Intradialytic Arrhythmias Among Patients with End Stage Renal Disease on Maintenance Hemodialysis at Muhimbili National Hospital

2021 ◽  
Author(s):  
Wailesy Adam ◽  
Tumaini Nagu ◽  
Reuben Mutagaywa ◽  
Onesmo Kisanga
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Ventricular Hypertrophy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Clinically Significant ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract BackgroundArrhythmias are responsible for almost 2 out of 3 cardiac deaths among patients on hemodialysis. We report the prevalence and risk factors for clinically significant arrhythmias among end stage renal disease (ESRD) patients on maintenance dialysis at a tertiary dialysis facility in Tanzania. MethodsCross-sectional study, involving consenting adults with ESRD was conducted September 2019 to February 2020. Arrhythmias were assessed using standard 5-leads Holter electrocardiography placed 15 minutes before dialysis and connected throughout dialysis. Clinically Significant Arrhythmias (CSA) was defined as ectopic beats in excess of 10 per hour or any of the ventricular tachycardia or Pause lasting for at least 2.5 seconds or paroxysmal supraventricular tachycardia or atrial flutter or atrial fibrillation. ResultsA total of 71 (44.4%) participants had CSA. Factors associated with increased risk for CSA were: age older than 60 years (OR 34; 95% CI: 5.15-236; P< 0.001), intradialytic blood pressure change of ≥ 10mmHg (OR 3.85; 95% CI: 1.27-11.7; P=0.017) and the presence of Left Ventricular Hypertrophy (OR 5.84; 95% CI: 1.85-18.4; P< 0.01). On the contrary, three dialysis sessions per week (OR 0.14; 95% CI: 0.03-0.67; P=0.013) and use of beta-blockers (OR 0.18; 95% CI: 0.05-0.68; P=0.011) were significantly associated with a decreased risk of CSA. ConclusionClinically significant arrhythmias are not uncommon in ESRD patients undergoing maintenance haemodialysis. We recommend increasing vigilance for CSA among older patients (>60 years) as well as those with left ventricular hypertrophy. Beta blockers among hypertensive ESRD patients with ventricular hypertrophy could be helpful.

scholarly journals Calcium Stimulation Test for Insulinoma Localization in an End-stage Renal Disease Patient on Diazoxide

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Stephanie Kim ◽  
Miles Conrad ◽  
Eunice Chuang ◽  
Larry Cai ◽  
Umesh Masharani ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Esrd Patient ◽  
Disease Patient ◽  
The Body ◽  
Stimulation Test ◽  
Delay In Diagnosis ◽  
Calcium Stimulation ◽  
Stage Renal Disease ◽  
End Stage

Abstract Insulinomas are rare, and even rarer in patients with end-stage renal disease (ESRD). Clear criteria for the biochemical diagnosis of insulinomas in patients with renal failure have not been established, and hypoglycemia is often attributed to the renal disease itself, frequently leading to a delay in diagnosis. We describe a case of a patient who presented with asymptomatic recurrent hypoglycemia during hemodialysis. Disease progression and biochemical testing strongly suggested an insulinoma. Computed tomography (CT) of the abdomen and pelvis, 111In-pentetreotide scintigraphy and endoscopic ultrasound did not localize a pancreatic tumor. A calcium stimulation test was performed while the patient was taking diazoxide due to severe hypoglycemia with fasting for a couple of hours without treatment. The test showed a marked increase in insulin after calcium infusion in the dorsal pancreatic artery, localizing the tumor to the body and tail of the gland. Exploratory surgery easily identified a tumor at the body of the pancreas and pathology confirmed an insulin-secreting pancreatic neuroendocrine tumor. On follow-up, there was resolution of the hypoglycemia. We review the challenges of diagnosing an insulinoma in ESRD and describe a successful intra-arterial calcium stimulation test done in an ESRD patient while continuing diazoxide.

A Vascular Access Port for Dialysis With a Polyurethane Foam Seal: A Pilot Study

2017 ◽  
Author(s):  
Robert E. Smith ◽  
Nicole C. Docherty ◽  
P. Alex Smith ◽  
Duncan J. Maitland ◽  
Alan C. Glowczwski
Keyword(s):  
Vascular Access ◽  
Prosthetic Graft ◽  
The Body ◽  
Dialysis Access ◽  
Access Port ◽  
Structural Support ◽  
Tissue Integration ◽  
Aneurysmal Dilation ◽  
Stage Renal Disease ◽  
End Stage

End-Stage Renal Disease (ESRD) is a condition wherein the kidneys are incapable of removing toxins from the body. Over 660,000 Americans suffer from ESRD, with millions more in the early stages, known as chronic kidney disease [1]. The only cure for ESRD is a kidney transplant, but the majority of patients receive dialysis every 2–3 days to filter their blood while on the transplant waitlist. Efficient dialysis requires approximately 600 mL/min of flow, which is commonly achieved by directly connecting an artery to a vein in the arm. Such a shunt may be created with an intervening prosthetic graft or by suturing the vein to the artery directly (termed an arteriovenous fistula, or AVF). Though accepted as the gold standard, AVF’s may take >6 weeks to heal and become useable, and 35–50% will never become accessible [1]. Needle trauma to the AVF can weaken the vessel wall and produce aneurysms or hematomas, which leak blood, potentially causing infection or clotting off the AVF [2]. These complications are costly: hemodialysis patients on average cost Medicare over $84,000 per year, and Medicare is the primary payer for more than 80% of nearly 500,000 dialysis patients in the U.S. [1]. An improved dialysis access method is needed to address the clinical shortcomings and high costs associated with AVF’s. A device has been developed to improve clinical outcomes and to reduce the failure rates associated with AVF’s. This device is a type of vascular access port which integrates with the external wall of the venous portion of the AVF, providing structural support to the vessel and preventing the types of trauma which lead to aneurysmal dilation or hematoma formation. The top and bottom sections are implanted independently within the patient’s soft tissue, allowing them to separate gradually as the AVF dilates during maturation. The result is a palpable and easy-to-access port which should improve AVF longevity (Figure 1). Two unique design features were identified as key to the success of this vascular access port: 1. Type of membrane or seal 2. Proper tissue integration into the implant This technical brief examines the selection of the proper membrane or seal on the port.

Rehabilitating a Dialysis Patient

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 81-83 ◽  
Author(s):  
Yuk-Yee Cheng ◽  
Ying-Fan Wong ◽  
Bonnie Y.C. Chu ◽  
Woon-Or Lam ◽  
Yiu-Wing Ho
Keyword(s):  
Rehabilitation Program ◽  
Social Psychological ◽  
Dialysis Unit ◽  
Patient Support Group ◽  
Group A ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Patient ◽  
Esrd Patients

End-stage renal disease (ESRD) patients undergoing dialysis face much stress and have to make adjustments in their lives. To optimize health and improve quality of life, rehabilitation of renal patients is a necessity. Renal rehabilitation includes physical, social, psychological, and vocational elements. We established a renal rehabilitation program—including predialysis education, in-center training, and community rehabilitation—in our regional dialysis unit. The program is organized by a multidisciplinary team of health professionals with the help of a renal-patient support group. A patient who joined the rehabilitation program showed significant lifestyle change.

Policies Regarding Treatment of End-Stage Renal Disease in the United States and United Kingdom

1986 ◽  
Vol 2 (2) ◽  
pp. 253-274 ◽  
Author(s):  
Susan Klein Marine ◽  
Roberta G. Simmons
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Well Being ◽  
The United States ◽  
The Body ◽  
Stage Renal Disease ◽  
End Stage ◽  
The U.S

The treatment of End-Stage Renal Disease (ESRD) represents a victory for medical technology. Dialysis and kidney transplantation, developed in the early 1960s, offer alternative treatments to patients whose own kidneys no longer function; before, these patients faced a terminal diagnosis. Dialysis is a mechanical treatment in which the patient is connected to a machine that cleanses the blood of impurities and returns it to the body. Although recent innovations (e.g., continuous ambulatory peritoneal dialysis—CAPD) facilitate patient independence from a machine, replacement of the diseased kidneys is the most desirable and least expensive treatment for many patients (33;39). Kidney transplantation remains the most effective and common type of transplantation, and a new kidney (from a living-related or cadaver donor) often dramatically improves the recipient's health and general well-being (20;39). Now, in the mid-1980s, these technologies are no longer new and innovative. Further analysis of these established but costly technologies provides a perspective on the long-range implications of innovations in patient care: while some new issues have emerged, many problems originally associated with these treatments seem to have intensified. Access to treatment remains a central issue, closely linked to the dilemma of equity versus cost. The contrast in the access provided by the United States and Great Britain is dramatic (40); in 1982, the rate of ESRD treatment within the U.S. was twice that of the U.K. (353 versus 160 patients per million) (37). The U.S. policy is basically one of unlimited access, whereas the U.K. has restricted access.

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