Comparison of Blood Gas Analysis on Hemodialysis in Patients with Chronic Kidney Diseases

Chronic Kidney Disease (CKD) is defined as a renal failure that has lasted for more than three months. Hemodialysis is thetype of kidney replacement therapy that is mostly used, and blood gas analysis can be used to identify this condition. Thisstudy is to compare the blood gas analysis on pre-and post-dialysis in patients with CKD using pH, PaCO , PaO , HCO , SO , 2 2 3 2and BE as markers of improvement in the patients'condition. The population was all patients diagnosed with CKD andhemodialysis at Wahidin Sudirohusodo Hospital, and eligible according to the criteria in this study. The sample size wasdetermined using Federer's calculation, and the statistical analysis using paired T-test and Wilcoxon signed-rank test withα=0.05. Subjects were 34 patients, consisting of 18 females (52.9%) and 16 males (47.1%). Hemodialysis had the mostsignificant impact on the PaO and SaO variables. Relation between PaO and SaO was illustrated in a sigmoid curve. 2 2 2 2Oxygen-bound hemoglobin increased after the first molecule was bound. An almost full PaO pressure will cause a slight 2increase in SaO . Whereas at <90% saturation, a slight decrease in PaO will cause a large decrease in SaO . PaO and SaO 2 2 2 2 2determine cardiac efficiency and the markers for assessing the metabolic conditions of the lungs and heart that correlatewith oxygen. Chronic kidney disease patients experienced improved conditions after undergoing hemodialysis withincreased blood gas values, especially in PaO and SaO .

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Assessment of Acid Base and Electrolyte Status in Patients with Chronic Kidney Disease

JMS SKIMS ◽

10.33883/jms.v16i2.216 ◽

2013 ◽

Vol 16 (2) ◽

pp. 86-89

Author(s):

Mahrukh Hameed ◽

Syed Mudassar ◽

Mosin S Khan ◽

Nisar Ahmad Wani

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Electrolyte Imbalance ◽

Common Finding ◽

Blood Gas ◽

Acid Base ◽

Glomerular Diseases ◽

Nephritic Syndrome

Background: Blood gas measurements are being used to evaluate oxygenation and acid/base status. They are typically ordered if a patient has worsening symptoms of an acid/base imbalance, difficulty in breathing or shortness of breath. Blood gas analysis has been a cornerstone in the management of acutely ill patients with presumed acid/base and electrolyte imbalance. Objective: The aim of this study was to study the blood gases and electrolyte status in patients with chronic kidney disorder. Methods: A prospective study was conducted in the department of Clinical Biochemistry, Sher-I Kashmir Institute of Medical Sciences (SKIMS) Srinagar. A total of 171 patients were included in the study of which 91 were males and 80 were females. The age of the patients ranged between 4 - 80 years. These patients were admitted in the Nephrology ward of SKIMS. Out of these 171 patients included in the study 99 had CKD, 42 had ARF, 11 had metabolic acidosis, 6 had nephritic syndrome, 2 had lupus nephritis and 11 had complications like dysuria, HTN, glomerular diseases etc. The medical history of the patients with CKD was recorded and Samples were obtained for blood gas analysis. Venous samples were obtained for VBG analysis and arterial samples were obtained for ABG analysis. These samples were analysed for determining the blood gas status. Hemoglobin levels and kidney function test were performed manually. Hemoglobin was estimated by cyanmet-hemoglobin method. Urea was estimated by Diacetyl monoxime (DAM) method. Creatinine was estimated by Jaffe’s reaction. Results: CKD patients showed acidosis, hypocapnia and hypoxia. Among electrolytes almost all the patients with CKD had hyponatremia and increased anion gap. Conclusion: It was concluded from the observation that male predominance was seen in chronic kidney disease. Blood gas parameters including pH, PCO2, PO2, HCO3 were found to be deranged in most of the patients with CKD. Among electrolytes sodium was found to be mostly deranged in patients with CKD and Anemia was the most common finding in patients with this disorder. JMS 2013; 16(2):86-89

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Cardiovascular, respiratory and sedative effects of intramuscular alfaxalone, butorphanol and dexmedetomidine compared with ketamine, butorphanol and dexmedetomidine in healthy cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x17742289 ◽

2017 ◽

Vol 20 (10) ◽

pp. 973-979 ◽

Cited By ~ 3

Author(s):

Jeannette Cremer ◽

Carolina H Riccó

Keyword(s):

Blood Gas Analysis ◽

Random Order ◽

Gas Analysis ◽

Rank Test ◽

Quality Of Recovery ◽

Arterial Blood ◽

Parametric Data ◽

Signed Rank Test ◽

Over Time

Objectives The aim of the study was to evaluate the cardiorespiratory effects, quality of sedation and recovery of intramuscular alfaxalone–dexmedetomidine–butorphanol (ADB) and ketamine–dexmedetomidine–butorphanol (KDB), in cats. Methods Nine adult, healthy cats (6.63 ± 1.42 kg) were enrolled in a blinded, randomized, crossover experimental design. Cats were sedated twice intramuscularly, once with ADB (alfaxalone 1 mg/kg, dexmedetomidine 0.005 mg/kg, butorphanol 0.2 mg/kg), and once with KDB (ketamine 5 mg/kg, dexmedetomidine 0.005 mg/kg, butorphanol 0.2 mg/kg), in random order. Data collected included heart rate (HR), arterial blood pressure and blood gas analysis, respiratory rate and sedation score. Analysis of variance with Bonferroni post-hoc correction was used for parametric data, and a Wilcoxon signed rank test was used for non-parametric data. Significance was set at P <0.05. Results Total sedation time was shorter for ADB (90.71 ± 15.12 mins vs 147.00 ± 47.75 mins). Peak sedation was observed within 15 mins in both groups. Quality of recovery was excellent in both groups. HR decreased over time in both groups. Diastolic and mean arterial pressure decreased over time for ADB, becoming significant after 30 mins. All cardiovascular variables were within the clinically acceptable range in both groups. Arterial partial pressure of oxygen was significantly decreased from baseline for KDB at all time points (73 ± 2.5 mmHg [9.7 ± 0.3 kPa] vs ADB 83 ± 2.6 mmHg [11 ± 0.3 kPa]). Hypoventilation was not observed. Conclusions and relevance Both protocols produced acceptable cardiovascular stability. Sedation and recovery quality were good, albeit sedation was shorter with ADB. Although oxygenation was better maintained in the ADB group, all sedated cats should receive oxygen supplementation.

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Management of severe baclofen toxicosis using hemodialysis in conjunction with mechanical ventilation in a cat with chronic kidney disease

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/20551169211033770 ◽

2021 ◽

Vol 7 (2) ◽

pp. 205511692110337

Author(s):

Levi Hoffman ◽

Leonel A Londoño ◽

Jenifer Martinez

Keyword(s):

Chronic Kidney Disease ◽

Mechanical Ventilation ◽

Kidney Disease ◽

Venous Blood ◽

Clinical Signs ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Dialysis Session ◽

History Of ◽

Venous Blood Gas

Case summary A 2-year-old castrated male domestic shorthair cat was presented for evaluation of acute and progressive neurologic signs 2–4 h after exposure to baclofen. The suspected ingested dose was 2.1 mg/kg. On admission, the cat was tetraplegic with stuporous mentation, and venous blood gas analysis showed mild hypercapnia (PvCO2 43.4 mmHg) raising concern for hypoventilation. Owing to the acute nature of the ingestion, severity of the clinical signs and reported history of chronic kidney disease, hemodialysis was recommended to remove the toxin. A 5 h hemodialysis session was performed using an intermittent platform without hemoperfusion. At the beginning of hemodialysis, worsening hypoventilation and hypercapnia (PvCO2 88.6 mmHg) required endotracheal intubation and manual ventilation initially, followed by mechanical ventilation. At the end of the dialysis session, the cat was breathing spontaneously and disconnected from the ventilator. The cat was ambulatory and alert 1 h after the end of dialysis. After an additional 12 h of monitoring, the cat had full return of neurologic function and was discharged from hospital. Serum baclofen concentration measured prior to, during and after hemodialysis showed a 77.7% reduction in baclofen levels immediately after hemodialysis. Relevance and novel information This is the first report of baclofen toxicity in a cat successfully treated with hemodialysis and mechanical ventilation simultaneously. Treatment with hemodialysis therapy and mechanical ventilation could be considered in cases of acute baclofen toxicosis to improve outcome and reduce the length of the hospital stay.

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Survey of defecation habits in apparently healthy and chronic kidney disease cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211012684 ◽

2021 ◽

pp. 1098612X2110126

Author(s):

Sarah E Jones ◽

Jessica M Quimby ◽

Stacie C Summers ◽

Sierra M Adams ◽

Sarah MA Caney ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Rank Test ◽

Online Questionnaire ◽

Exact Test ◽

Important Variation ◽

Initial Questionnaire ◽

Bowel Movements ◽

Signed Rank Test ◽

Apparently Healthy

Objectives Changes in bowel movements (BMs) are an important clinical sign in many diseases, including chronic kidney disease (CKD), and the purpose of this study was to collect information on BMs and fecal scores in both apparently healthy and CKD cats. A secondary aim was to assess owner awareness of BM frequency. Methods Owners were asked to complete an initial online questionnaire about their cat’s health and litter box habits (including predicted BM frequency and fecal scores) and were then asked to clean the box daily for 7 days and report results (observed frequency of BMs and fecal scores) daily. Differences in BM frequency and fecal scores between apparently normal and CKD cats were compared using the Mann–Whitney test, and predicted vs observed data were compared using the Wilcoxon signed rank test. Difference in percentage of cats defecating more or less than once daily were assessed with Fisher’s exact test. Results Survey data from 124 owners of apparently healthy cats and 43 owners of CKD cats who submitted two or more days of daily observations (in addition to the initial questionnaire) were analyzed. Eighty-five percent of apparently healthy cats were observed to defecate one or more times per day and 15% defecated less than once per day. Fifty-eight percent of CKD cats defecated one or more times per day and 42% defecated less than once per day. A significantly higher percentage of CKD cats defecated less than once per day in comparison with apparently healthy cats ( P <0.0001). Observed BM frequency was significantly less in CKD cats compared with healthy cats ( P = 0.02). Observed fecal scores were not significantly different between healthy and CKD cats. Conclusions and relevance The observed BM frequency of cats with CKD was less than apparently healthy cats and represents a clinically important variation from normal.

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Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial

Scientific Reports ◽

10.1038/s41598-021-97555-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Karam Nam ◽

Hye-Bin Kim ◽

Young-Lan Kwak ◽

Young Hyun Jeong ◽

Jae-Woo Ju ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cardiac Surgery ◽

Kidney Disease ◽

Oxygen Delivery ◽

Artery Bypass ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Off Pump ◽

Hb Concentration ◽

Inspired Oxygen

AbstractWhen hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac surgery. When patients were hemodynamically stable, FiO2 was alternated between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients (substudy of the CARROT trial). After the patient had stabilized, a blood gas analysis was performed to measure SvO2. The observed change in SvO2 (ΔSvO2) was compared to the expected ΔSvO2 calculated using Fick’s equation. A total 106 changes in FiO2 (two changes per patient; total 53 patients; on-pump, n = 36; off-pump, n = 17) were finally analyzed. While Hb saturation remained near 100% (on-pump, 100%; off-pump, mean [SD] = 98.1% [1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed significantly as FiO2 was changed (the first and second changes in on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9] and 6.2%p [3.9]; all P < 0.001). As a total, regardless of the surgery type, the observed ΔSvO2 after the FiO2 change of 0.5 was ≥ 5%p in 82 (77.4%) changes and ≥ 10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb concentration was not correlated with the observed ΔSvO2 (the first changes, r = − 0.06, P = 0.677; the second changes, r = − 0.21, P = 0.138). The mean (SD) residual ΔSvO2 (observed − expected ΔSvO2) was 0%p (4). Residual ΔSvO2 was more than 5%p in 14 (13.2%) changes and exceeded 10%p in 2 (1.9%) changes. Residual ΔSvO2 was greater in patients with chronic kidney disease than in those without (median [IQR], 5%p [0 to 7] vs. 0%p [− 3 to 2]; P = 0.049). DO2, interrogated by SvO2, may increase to a clinically significant degree as FiO2 is increased during cardiac surgery, and the increase of SvO2 is not related to Hb concentration. SvO2 increases more than expected in patients with chronic kidney disease. Increasing FiO2 can be used to increase DO2 during cardiac surgery.

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Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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