scholarly journals Safely reducing haemodialysis frequency during the COVID-19 pandemic

2020 ◽  
Author(s):  
Michelle da Silva Lodge ◽  
Thilini Abeygunaratne ◽  
Helen Alderson ◽  
Ibrahim Ali ◽  
Nina Brown ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Bicarbonate ◽  
Systolic Blood Pressure ◽  
Serum Potassium ◽  
Fluid Overload ◽  
Dialysis Patients ◽  
Patient Request

Abstract Background:Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients.Methods:Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice.Results:There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions:Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

scholarly journals Safely reducing haemodialysis frequency during the COVID-19 pandemic

2020 ◽  
Author(s):  
Michelle da Silva Lodge ◽  
Thilini Abeygunaratne ◽  
Helen Alderson ◽  
Ibrahim Ali ◽  
Nina Brown ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Bicarbonate ◽  
Systolic Blood Pressure ◽  
Serum Potassium ◽  
Fluid Overload ◽  
Dietary Advice ◽  
Dialysis Patients ◽  
Short Term ◽  
Dialysis Unit ◽  
Patient Request

Abstract Background: Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients.Methods: Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice.Results: There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. Of 141 eligible patients 113 (80.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions: Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

scholarly journals Safely reducing haemodialysis frequency during the COVID-19 pandemic

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle Da Silva Lodge ◽  
Thilini Abeygunaratne ◽  
Helen Alderson ◽  
Ibrahim Ali ◽  
Nina Brown ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Bicarbonate ◽  
Systolic Blood Pressure ◽  
Serum Potassium ◽  
Fluid Overload ◽  
Dietary Advice ◽  
Dialysis Patients ◽  
Short Term ◽  
Dialysis Unit ◽  
Patient Request

Abstract Background Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. Methods Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0 mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice. Results There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

scholarly journals Safely reducing haemodialysis frequency during the COVID-19 pandemic

2020 ◽  
Author(s):  
Michelle da Silva Lodge ◽  
Thilini Abeygunaratne ◽  
Helen Alderson ◽  
Ibrahim Ali ◽  
Nina Brown ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Bicarbonate ◽  
Systolic Blood Pressure ◽  
Serum Potassium ◽  
Fluid Overload ◽  
Dietary Advice ◽  
Dialysis Patients ◽  
Short Term ◽  
Dialysis Unit ◽  
Patient Request

Abstract Background:Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients.Methods:Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice.Results:There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. Of 141 eligible patients 113 (80.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions:Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

scholarly journals Safely reducing haemodialysis frequency during the COVID-19 pandemic

2020 ◽  
Author(s):  
Michelle da Silva Lodge ◽  
Thilini Abeygunaratne ◽  
Helen Alderson ◽  
Ibrahim Ali ◽  
Nina Brown ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sodium Bicarbonate ◽  
Systolic Blood Pressure ◽  
Serum Potassium ◽  
Fluid Overload ◽  
Dietary Advice ◽  
Dialysis Patients ◽  
Short Term ◽  
Dialysis Unit ◽  
Patient Request

Abstract Background: Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. Methods: Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice. Results: There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. Of 141 eligible patients 113 (80.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions: Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

Management of posaconazole-induced pseudohyperaldosteronism

2020 ◽  
Vol 75 (12) ◽  
pp. 3688-3693
Author(s):  
Matthew R Davis ◽  
Minh-Vu H Nguyen ◽  
Thomas J Gintjee ◽  
Alex Odermatt ◽  
Brian Y Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Dose Reduction ◽  
Serum Potassium ◽  
Continuous Monitoring ◽  
Therapeutic Interventions ◽  
Serum Concentrations ◽  
Average Decrease ◽  
Before And After ◽  
Repeat Assessment

Abstract Background Posaconazole-induced pseudohyperaldosteronism (PIPH) has been associated with elevated posaconazole serum concentrations. Clinicians are faced with the difficult task of managing patients with PIPH while maintaining the efficacy of antifungal therapy. Commonly, modifications to posaconazole therapy are utilized in managing PIPH, including dosage reduction of posaconazole or switch to an alternative antifungal. Objectives To characterize the management of patients diagnosed with PIPH and their response to various therapeutic interventions. Methods We retrospectively reviewed 20 consecutive adult patients diagnosed with PIPH. Patient data collected included blood pressure, electrolytes, endocrine laboratory values and posaconazole serum concentrations collected before and after therapeutic intervention. Results Of 20 patients included, 17 patients (85%) underwent therapeutic modification, with posaconazole dose reduction (n = 11) as the most common change. Other modifications included discontinuation (n = 3), switch to an alternative antifungal (n = 2) and addition of spironolactone (n = 1). Clinical improvement (decrease in systolic blood pressure and increase in serum potassium) was observed in 9 of 17 patients (52.9%). An average decrease in systolic blood pressure of 7.1 mmHg and increase in serum potassium of 0.22 mmol/L was observed following therapeutic modification. Conclusions We report our experience with PIPH management, for which there is no universally effective strategy. We utilized a stepwise approach for management, starting with posaconazole dose reduction and repeat assessment of clinical and laboratory parameters. If resolution of PIPH is not achieved, an alternative triazole antifungal or the addition of an aldosterone antagonist are additional potential interventions. It is possible for PIPH to persist after therapeutic modification despite these interventions. Thus, early diagnosis and continuous monitoring is warranted.

EFFECT OF ALDOSTERONE IN A CASE OF HYPOALDOSTERONISM

1960 ◽  
Vol XXXIII (IV) ◽  
pp. 511-519 ◽  
Author(s):  
Bernt Hökfelt ◽  
Bengt Skanse
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Systolic Blood Pressure ◽  
Serum Sodium ◽  
Serum Potassium ◽  
Sodium Intake ◽  
Potassium Excretion ◽  
Sodium Potassium ◽  
Original Diagnosis ◽  
Body Weight Increase

ABSTRACT A patient previously described by the present authors as having selective hypoaldosteronism has been studied more extensively with special reference to the effect of aldosterone. Additional evidence has also been obtained in support of the original diagnosis of selective hypoaldosteronism. With the patient on a constant sodium intake, aldosterone intramuscularly or intravenously in a dose of 500 to 1000 μg a day was followed by retention of sodium and chloride, gain in body weight, increase in systolic blood pressure, and a rise in the serum sodium. Potassium excretion was increased throughout the period of aldosterone administration. The serum potassium showed a slight decrease. Similar effects were noted on administration of fluorohydrocortisone.

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