scholarly journals Changes in practice patterns in Japan from before to after JSDT 2013 guidelines on hemodialysis prescriptions: results from the JDOPPS

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tadashi Tomo ◽  
Maria Larkina ◽  
Ayumi Shintani ◽  
Tomonari Ogawa ◽  
Bruce M. Robinson ◽  
...  
Keyword(s):  
Cross Sections ◽  
Practice Patterns ◽  
Treatment Time ◽  
Removal Rate ◽  
Blood Flow Rate ◽  
Dialysis Session ◽  
Moderate Increase ◽  
Session Length ◽  
Fluid Removal ◽  
Prescription Practices

Abstract Background The Japanese Society for Dialysis Therapy (JSDT) published in 2013 inaugural hemodialysis (HD) guidelines. Specific targets include 1.4 for single-pool Kt/V (spKt/V) with a minimum dose of 1.2, minimum dialysis session length of 4 hours, minimum blood flow rate (BFR) of 200 mL/min, fluid removal rate no more than 15 mL/kg/hr, and hemodiafiltration (HDF) therapy for certain identified symptoms. We evaluated the effect of these guidelines on actual practice in the years spanning 2005 – 2018. Methods Analyses were carried out to describe trends in the above HD prescription practices from December 2005 to April 2013 (before guideline publication) to August 2018 based on prevalent patient cross-sections from approximately 60 randomly selected HD facilities participating in the Japan Dialysis Outcomes and Practice Patterns Study. Results From April 2006 to August 2017 continual rises occurred in mean spKt/V (from 1.35 to 1.49), and percent of patients having spKt/V>1.2 (71% to 85%). Mean BFR increased with time from 198.3 mL/min (April 2006) to 218.4 mL/min (August 2017) , along with percent of patients with BFR >200 ml/min (65% to 85%). HDF use increased slightly from 6% (April 2006 and August 2009) to 8% by April 2013, but increased greatly thereafter to 23% by August 2017. In contrast, mean HD treatment time showed little change from 2006-2017, whereas mean UFR declined from 11.3 in 2006 to 8.4 mL/Kg/hour in 2017. Conclusions From 2006 – 2018 Japanese HD patients experienced marked improvement in reaching the spKt/V target specified by the 2013 JSDT guidelines. This may have been due to moderate increase in mean BFR even though mean HD session length did not change much. In addition, HDF use increased dramatically in this time period. Other HD delivery changes during this time, such as increased use of super high flux dialyzers, also merit study. While we cannot definitively conclude a causal relationship between the publication of the guidelines and the subsequent practice changes in Japan, those changes moved practice closer to the recommendations of the guidelines.

scholarly journals No Survival Benefit in Octogenarians and Nonagenarians with Extended Hemodialysis Treatment Time

2018 ◽  
Vol 48 (5) ◽  
pp. 389-398 ◽  
Author(s):  
Gang Jee Ko ◽  
Yoshitsugu Obi ◽  
Melissa Soohoo ◽  
Tae Ik Chang ◽  
Soo Jeong Choi ◽  
...  
Keyword(s):  
Treatment Time ◽  
Age Groups ◽  
Treatment Session ◽  
Comorbid Conditions ◽  
Session Length ◽  
Fluid Removal ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage ◽  
Solute Clearance

Background: The population of elderly end-stage renal disease patients initiating dialysis is rapidly growing. Although longer treatment is supposed to benefit for hemodialysis (HD) patients through more solute clearance and slower fluid removal, it is not yet clear how treatment session length affects mortality risk in octogenarians and nonagenarians. Methods: In a cohort of 112,026 incident HD patients between 2007 and 2011, we examined the association of treatment session length with all-cause mortality, adjusting for demographics and comorbid conditions. We also used restricted spline functions for age to evaluate continuous changes in the association of short (< 210 min) and extended (≥240 min) HD treatment (vs. 210 to < 240 min) with all-cause mortality over continuous age. Results: During the first 91 days of dialysis, patients aged ≥80 years tended to have the lowest treatment session length (median [interquartile range] 211 [193–230] min, r > 0.5). Longer treatment was associated with better survival in patients < 65 and 65 to < 80 years but not in octogenarians/nonagenarians. The association of extended treatment (≥240 min) with better survival was attenuated across age and not significant among patients aged ≥80 years with a hazard ratio of 1.10 (95% CI 0.99–1.20). Shorter treatment sessions (< 210 min) was associated with higher mortality across all age groups. Conclusion: Extended HD was not associated with lower mortality among octogenarians and nonagenarians, while it was associated with better survival among younger patients. Further studies are needed to determine the optimal treatment session length in elderly incident HD patients.

Even a Moderate Fluid Removal Rate during Individualised Haemodialysis Session Times Is Associated with Decreased Patient Survival

2017 ◽  
Vol 44 (2) ◽  
pp. 89-97 ◽  
Author(s):  
Charles Chazot ◽  
Cyril Vo-Van ◽  
Christie Lorriaux ◽  
Patrik Deleaval ◽  
Brice Mayor ◽  
...  
Keyword(s):  
Patient Survival ◽  
Removal Rate ◽  
Residual Renal Function ◽  
Dialysis Session ◽  
Dialysis Patients ◽  
Fluid Removal ◽  
Β2 Microglobulin ◽  
Session Time ◽  
Interdialytic Weight Gain ◽  
Kaplan Meier

Background: Several studies report that fluid removal rate (FRR) above 10-13 mL/h/kg is associated with increased mortality in haemodialysis (HD) patients. Aim: The aims of this study are to assess the influence of moderate FRR on survival in a cohort of prevalent dialysis patients with various dialysis session times and to challenge the FRR thresholds associated with increased mortality risk reported previously. Methods: Interdialytic weight gain (IDWG) and FRR (calculated from ultrafiltration [UF], target weight, and session time prescriptions) were studied in 190 prevalent dialysis patients (female: 42%, mean age: 69.5 years, median vintage: 40.2 months, diabetes: 34.7%, loop diuretic prescription: 5.8%) and averaged during the final quarter of 2010. Patient survival was analysed using Kaplan-Meier and Cox-multivariate analyses. Results: The median IDWG, median session time, and median FRR were 2.33 kg (-0.54-4.57), 5.0 h (3.9-8.0 h), 6.8 mL/h/kg (1.3-16.7), respectively, and FRR was ≥10 mL/h/kg in 11.6% of the patients. The Kaplan-Meier analysis showed decreased patient survival when the FRR was above the median (6.8 mL/h/kg; p = 0.012). The FRR was found to be independently associated with increased mortality (hazard ratio 1.15 [95% CI 1.02-1.29]; p = 0.027) using stepwise Cox proportional hazard regression analysis, including age, vintage, gender, body mass index (BMI), serum albumin level, β2-microglobulin level, cardiovascular and diabetes history, and session time. Online haemodiafiltration did not change this result. The role of residual renal function was unlikely because 74% of the patients had a vintage of >18 months, a minority (5.8%) were prescribed loop diuretics (a surrogate of significant urine output) and β2-microglobulin level was not different in patients who were below or above the FRR median. Conclusion: We concluded that the FRR threshold above which there is an increased mortality is lower than what has been reported (7.8 mL/h/kg). It raises the question of the hazard of fluid removal and intermittence of standard HD.

scholarly journals Monitoring skin blood flow to rapidly identify alterations in tissue perfusion during fluid removal using continuous veno-venous hemofiltration in patients with circulatory shock

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wasineenart Mongkolpun ◽  
Péter Bakos ◽  
Jean-Louis Vincent ◽  
Jacques Creteur
Keyword(s):  
Blood Flow ◽  
Blood Lactate ◽  
Skin Blood Flow ◽  
Removal Rate ◽  
Lactate Concentration ◽  
Tissue Perfusion ◽  
Fluid Removal ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B

Abstract Background Continuous veno-venous hemofiltration (CVVH) can be used to reduce fluid overload and tissue edema, but excessive fluid removal may impair tissue perfusion. Skin blood flow (SBF) alters rapidly in shock, so its measurement may be useful to help monitor tissue perfusion. Methods In a prospective, observational study in a 35-bed department of intensive care, all patients with shock who required fluid removal with CVVH were considered for inclusion. SBF was measured on the index finger using skin laser Doppler (Periflux 5000, Perimed, Järfälla, Sweden) for 3 min at baseline (before starting fluid removal, T0), and 1, 3 and 6 h after starting fluid removal. The same fluid removal rate was maintained throughout the study period. Patients were grouped according to absence (Group A) or presence (Group B) of altered tissue perfusion, defined as a 10% increase in blood lactate from T0 to T6 with the T6 lactate ≥ 1.5 mmol/l. Receiver operating characteristic curves were constructed and areas under the curve (AUROC) calculated to identify variables predictive of altered tissue perfusion. Data are reported as medians [25th–75th percentiles]. Results We studied 42 patients (31 septic shock, 11 cardiogenic shock); median SOFA score at inclusion was 9 [8–12]. At T0, there were no significant differences in hemodynamic variables, norepinephrine dose, lactate concentration, ScvO2 or ultrafiltration rate between groups A and B. Cardiac index and MAP did not change over time, but SBF decreased in both groups (p < 0.05) throughout the study period. The baseline SBF was lower (58[35–118] vs 119[57–178] perfusion units [PU], p = 0.03) and the decrease in SBF from T0 to T1 (ΔSBF%) higher (53[39–63] vs 21[12–24]%, p = 0.01) in group B than in group A. Baseline SBF and ΔSBF% predicted altered tissue perfusion with AUROCs of 0.83 and 0.96, respectively, with cut-offs for SBF of ≤ 57 PU (sensitivity 78%, specificity 87%) and ∆SBF% of ≥ 45% (sensitivity 92%, specificity 99%). Conclusion Baseline SBF and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.

scholarly journals Kt/V: achievement, predictors and relationship to mortality in hemodialysis patients in the Gulf Cooperation Council countries: results from DOPPS (2012–18)

2020 ◽  
Author(s):  
Ali AlSahow ◽  
Daniel Muenz ◽  
Mohammed A Al-Ghonaim ◽  
Issa Al Salmi ◽  
Mohamed Hassan ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Treatment Time ◽  
Blood Flow Rate ◽  
Gulf Cooperation Council ◽  
Dialysis Adequacy ◽  
Cox Models ◽  
Lower Blood ◽  
Comorbidity Burden ◽  
The Usa ◽  
Dialysis Outcomes

Abstract Background Dialysis adequacy, as measured by single pool Kt/V, is an important parameter for assessing hemodialysis (HD) patients’ health. Guidelines have recommended Kt/V of 1.2 as the minimum dose for thrice-weekly HD. We describe Kt/V achievement, its predictors and its relationship with mortality in the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates). Methods We analyzed data (2012–18) from the prospective cohort Dialysis Outcomes and Practice Patterns Study for 1544 GCC patients ≥18 years old and on dialysis &gt;180 days. Results Thirty-four percent of GCC HD patients had low Kt/V (&lt;1.2) versus 5%–17% in Canada, Europe, Japan and the USA. Across the GCC countries, low Kt/V prevalence ranged from 10% to 54%. In multivariable logistic regression, low Kt/V was more common (P &lt; 0.05) with larger body weight and height, being male, shorter treatment time (TT), lower blood flow rate (BFR), greater comorbidity burden and using HD versus hemodiafiltration. In adjusted Cox models, low Kt/V was strongly related to higher mortality in women [hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.09–3.34] but not in men (HR = 1.16, 95% CI 0.70–1.92). Low BFR (&lt;350 mL/min) and TT (&lt;4 h) were common; 41% of low Kt/V cases were attributable to low BFR or TT (52% for women and 36% for men). Conclusion Relatively large proportions of GCC HD patients have low Kt/V. Increasing BFR to ≥350 mL/min and TT to ≥4 h thrice weekly will reduce low Kt/V prevalence and may improve survival in GCC HD patients—particularly among women.

Removal of Organic Pollutants from Reverse Osmosis Concentrate by Electro-Fenton Process

2014 ◽  
Vol 955-959 ◽  
pp. 2294-2299 ◽  
Author(s):  
Hui Ling Du ◽  
Bao Yuan Pan ◽  
Jing Li
Keyword(s):  
Organic Pollutants ◽  
Pulse Generator ◽  
Treatment Time ◽  
Removal Rate ◽  
High Voltage Pulse ◽  
Aeration Rate ◽  
Cod Removal ◽  
Fenton Process ◽  
Voltage Pulse Generator ◽  
Cod Removal Rate

The RO concentrate containing non-degradation organic pollutants was treated by electro-Fenton process. The high voltage pulse generator was used as discharge power. The effects of pulsed electric field parameters, aeration rate and pH on COD removal rate was investigated. The results indicate that the COD removal rate is up to 80.71% when pulsed voltage, pulsed frequency, treatment time, aeration rate and pH are 30000 V, 5 Hz, 240 s, 1.0 m3/h and 10, respectively.

Influence of Thermo-Chemical Treatment on the Surface of CP Titanium

2014 ◽  
Vol 1025-1026 ◽  
pp. 597-600
Author(s):  
Chang Lim Kim ◽  
Dong Geun Lee ◽  
Yong Ho Park ◽  
Yong Tae Lee
Keyword(s):  
Cross Sections ◽  
Chemical Treatment ◽  
Treatment Time ◽  
Pure Titanium ◽  
Holding Time ◽  
Specimen Thickness ◽  
Commercially Pure Titanium ◽  
Nitrogen Gas ◽  
Vacuum Atmosphere ◽  
Cp Ti

The effect of the holding time on the surface hardening of commercially pure titanium (CP-Ti) by thermo-chemical treatment (TCT) process was studied in the present paper. Surface treatments with three different times were carried out and investigated. The TCT process using nitrogen gas was carried out under vacuum atmosphere in treatment time (0.5, 1, 2 h) at 800 °C (thermo-chemical nitriding temperatures). The hardened surface was analyzed by scanning electron microscope (SEM) to observe the microstructure of cross-sections of TCT-treated specimens. In observations of the gradient-hardened inner-layer, as the holding time was increased the layer thicker and the depth of the Ti2N + TiNx layer was higher. And the specimen thickness of Ti2N and TiNx layers, measured from cross-section specimen was about 9 μm, 10 μm and 13 μm, respectively.

scholarly journals Assessment of the Role of Lung Ultrasonography for the Accuracy of Clinically Estimated Dry Weight in Chronic Hemodialysis Patients

2021 ◽  
pp. 94-103
Author(s):  
Yasmin S. Hammad ◽  
Samy A. Khodier ◽  
Ghada M. Al-Ghazaly ◽  
Ibrahim A. Nassar
Keyword(s):  
Dry Weight ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Percentage Change ◽  
Dialysis Session ◽  
Lung Ultrasonography ◽  
Cross Sectional ◽  
Fluid Removal ◽  
B Lines ◽  
Positive Significant Correlation

Objective: The aim of this study was to  evaluate  the utility  of lung  ultrasonography  to  determine   the accuracy of prescribed  dry  weight in chronic hemodialysis patients  and  to  ascertain   the  adequacy  of  fluid  removal . Methods: In this cross sectional study LUS was performed immediately before and after (within 15 min) the dialysis session on 60 patients on regular hemodialysis, 4-hours per session, three times weekly at Tanta university hospitals, Internal Medicine Department, Nephrology units, Egypt. The ultrasonography B-lines was tabulated and compared to the intradialytic ultrafltration parameters and dry weight. Results: Positive significant correlation (P 0.02) was achieved between the intradialytic percentage change in B-lines and the percent change in total body weight reduction and also Positive significant correlation (P 0.05) was achieved between the intradialytic percentage change in B-lines and the ultrafiltration rate. Conclusion: LUS is a valuable diagnostic tool for recognizing the adequacy of fluid removal and to avoid inaccurate estimation of dry weight by usual clinical parameters or even radiologic studies including chest X-ray.

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