scholarly journals A dialysis doctor’s memories with COVID-19 disease

2021 ◽  
Vol 4 (2) ◽  
pp. 137-143
Author(s):  
Guy Rostoker
Keyword(s):  
Intensive Care Unit ◽  
Oxygen Therapy ◽  
Editorial Staff ◽  
Proper Treatment ◽  
End Stage Kidney Disease ◽  
Home Dialysis ◽  
Long Period ◽  
The Will ◽  
End Stage ◽  
Sufficient Oxygen

This is the testimony of a nephrologist who was infected at the very beginning of the pandemic, in France, while treating his patients. On April 8, 2020, as he was finishing visiting his patients, he experienced myalgia, dyspnea, chills and fever. After two days of trying to stay at home, it became necessary to admit him to the intensive care unit to ensure proper treatment and sufficient oxygen therapy. In this testimony, he describes his own experience as a sick doctor, the effectiveness of the treatments he received, the empathy of his colleagues and the caregivers who took care of him, in a diary kept from day to day. This was followed by a long period of rehabilitation during which he wrote a plea to promote home dialysis methods in order to limit the contamination of end-stage kidney disease patients on dialysis. The editorial staff has deemed it useful to publish this medical testimony full of humanity, written with modesty and the will to bring support and hope to those brutally victimized by the COVID-19 disease.

scholarly journals Hemolysis in a Patient during Hemodialysis

2021 ◽  
pp. 348-354
Author(s):  
Maxime Taghavi ◽  
Lucas Jacobs ◽  
Saleh Kaysi ◽  
Maria do Carmo Filomena Mesquita
Keyword(s):  
Intensive Care Unit ◽  
Blood Transfusion ◽  
Oxygen Therapy ◽  
Artificial Ventilation ◽  
Renal Involvement ◽  
Immunosuppressive Treatment ◽  
Sudden Onset ◽  
End Stage Kidney Disease ◽  
Massive Blood Transfusion ◽  
End Stage

We report a case of hemolysis during a hemodialysis (HD) session in a 71-year-old man. His end-stage kidney disease is secondary to light-chain amyloidosis with renal involvement. Despite immunosuppressive treatment, his renal function continued to decline, and dialysis had to be initiated. Peritoneal dialysis (PD) was started but that had to be converted to HD because of pleural effusion due to PD fluid leakage. On the event day, the patient presented a respiratory distress 2 h after the initiation of HD. He developed a sudden onset of dyspnea with hypoxemia, associated with abdominal pain, nausea, and vomiting. He also presented chest pain with arterial hypertension. The pre-pump arterial and post-pump pressures were, respectively, 40 and 100 mm Hg, with no machine alarm. The blood color in the circuit changed and became darker, so HD was stopped immediately without blood restitution, and then a blood workup was obtained, and the patient was treated with oxygen therapy, IV methylprednisolone 40 mg, and IV furosemide 100 mg. Tubing checkup performed after the incident showed a kinked arterial tube which led to the suspicion of acute hemolysis. Blood transfusion was therefore urgently ordered, and the patient was immediately transferred to the intensive care unit (ICU). Artificial ventilation was required for 4 days, with initial massive blood transfusion. A 24-h treatment with extracorporeal cytokine adsorber CytoSorb<sup>®</sup> was also performed, followed by the regular HD sessions thrice weekly. Evolution was favorable, and the patient was discharged from the ICU 18 days later.

scholarly journals A Randomized Controlled Trial to Evaluate and Assess the Effect of Comprehensive Pre-End Stage Kidney Disease Education on Home Dialysis Use in Veterans, Rationale and Design

2021 ◽  
Author(s):  
Ashutosh M. Shukla ◽  
Jennifer Hale-Gallardo ◽  
Tatiana Orozco ◽  
Ivette Freytes ◽  
Sergio Romero ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Controlled Trial ◽  
End Stage Kidney Disease ◽  
Patient Centered ◽  
Advanced Chronic Kidney Disease ◽  
Home Dialysis ◽  
Clinical Patient ◽  
Randomized Controlled ◽  
The Us ◽  
End Stage

Abstract Background Informed dialysis selection and greater home dialysis use are the two long-desired, underachieved targets of advanced chronic kidney disease care in the US healthcare system. Observational institutional studies have shown that comprehensive pre-end stage kidney disease (ESKD) disease education (CPE) can improve both these outcomes. However, lack of validated protocols, well-controlled studies, and systemic models have limited wide-spread adoption of CPE in the US. We hypothesized that a universal CPE and patient-centered initiation of renal replacement therapy can improve multiple clinical, patient-centered and health service outcomes in advanced chronic kidney disease (CKD) and ESKD.Methods Trial to Evaluate and Assess the effects of CPE on Home dialysis in Veterans (TEACH-VET) is a mixed method randomized controlled trial aimed to evaluate the effects of a system-based approach for providing CPE to all Veterans with advanced CKD across a regional healthcare System. The study will randomize 544 Veterans with non-dialysis stage 4 and 5 CKD in a 1:1 allocation stratified by their annual family income and the stage of CKD to an intervention (CPE) arm or control arm. Intervention arm will receive a two-phase CPE in an intent-to-teach manner. Control arm will receive usual clinical care supplemented by resources for the freely-available kidney disease information. Participants will be followed after intervention/control for the duration of the study or until 90-days post-ESKD, whichever occurs earlier.Results The primary outcome will assess the proportion of Veterans using home dialysis at 90-days post-ESKD, and secondary outcomes will include post-intervention/control CKD knowledge, confidence in dialysis decision and home dialysis selection. Qualitative arm of the study will use semi-structured interviews to in-depth assess Veterans’ satisfaction with the intervention, preference for delivery, and barriers and facilitators to home dialysis selection and use. Several post-ESKD clinical, patient-centered and health services outcomes will be assessed 90-days post-ESKD as additional secondary outcomes.Conclusion The results will provide evidence regarding the need and efficacy of a system-based, patient-centered approach towards universal CPE for all patients with advanced CKD. If successful, this may provide a blueprint for developing such programs across the similar healthcare infrastructures throughout the country.Trial registration: NCT04064086

On the potential of wearable bioimpedance for longitudinal fluid monitoring in end-stage kidney disease

2021 ◽  
Author(s):  
Lucas Lindeboom ◽  
Seulki Lee ◽  
Fokko Wieringa ◽  
Willemijn Groenendaal ◽  
Carlo Basile ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Fluid Management ◽  
Wearable Devices ◽  
Invasive Technique ◽  
Haemodynamic Instability ◽  
End Stage Kidney Disease ◽  
Similar Frequency ◽  
Home Dialysis ◽  
Fluid Status ◽  
End Stage

Abstract Bioimpedance spectroscopy (BIS) has proven to be a promising non-invasive technique for fluid monitoring in haemodialysis (HD) patients. While current BIS-based monitoring of pre- and post-dialysis fluid status utilizes benchtop devices, designed for intramural use, advancements in micro-electronics have enabled the development of wearable bioimpedance systems. Wearable systems meanwhile can offer a similar frequency range for current injection as commercially available benchtop devices. This opens opportunities for unobtrusive longitudinal fluid status monitoring, including transcellular fluid shifts, with the ultimate goal of improving fluid management, thereby lowering mortality and improving quality of life for HD patients. Ultra-miniaturized wearable devices can also offer simultaneous acquisition of multiple other parameters, including haemodynamic parameters. Combination of wearable BIS and additional longitudinal multiparametric data may aid in the prevention of both haemodynamic instability as well as fluid overload. The opportunity to also acquire data during interdialytic periods using wearable devices likely will give novel pathophysiological insights and the development of smart (predicting) algorithms could contribute to personalizing dialysis schemes and ultimately to autonomous (nocturnal) home dialysis. This review provides an overview of current research regarding wearable bioimpedance, with special attention to applications in end-stage kidney disease patients. Furthermore, we present an outlook on the future use of wearable bioimpedance within dialysis practice.

scholarly journals Acute intermittent renal replacement therapy in a rural Scottish intensive care unit – a review of patient and renal outcomes

2021 ◽  
pp. 175114372110186
Author(s):  
Elaine Rutherford ◽  
James F Leach ◽  
Ella JA Bennett ◽  
John S Rutherford ◽  
Leo Urquhart ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
End Stage Kidney Disease ◽  
Patient Admissions ◽  
Icu Discharge ◽  
End Stage ◽  
Intermittent Renal Replacement Therapy

In this study we report 5-year outcomes for patients who received intermittent haemodiafiltration for Acute Kidney Injury (AKI) between 2010 and 2014 in a small Scottish Intensive Care Unit (ICU). Dialysis independence and mortality at ICU discharge, 30 and 90 days, one and five years were determined. There were 1496 admissions to ICU during the study period. 12% of patient admissions required Renal Replacement Therapy (RRT). 56.3% of patients survived to ICU discharge and all were RRT independent at ICU discharge. 30 day, 90 day, 1 year and 5 year survival was 52.3%, 50.6%, 46.6% and 30.7% respectively. By 5 years, 2 patients had developed end stage kidney disease.

scholarly journals Why and how should we promote home dialysis for patients with end-stage kidney disease during and after the coronavirus 2019 disease pandemic? A French perspective

2021 ◽  
Author(s):  
Guy Rostoker ◽  
Belkacem Issad ◽  
Hafedh Fessi ◽  
Ziad A. Massy
Keyword(s):  
Kidney Disease ◽  
Scientific Data ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
Health Crisis ◽  
Home Dialysis ◽  
Objective Information ◽  
Home Haemodialysis ◽  
Renal Replacement Therapies ◽  
End Stage

AbstractThe health crisis induced by the pandemic of coronavirus 2019 disease (COVID-19) has had a major impact on dialysis patients in France. The incidence of infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave of the COVID-19 epidemic was 3.3% among dialysis patients—13 times higher than in the general population. The corresponding mortality rate was high, reaching 21%. As of 19th April, 2021, the cumulative prevalence of SARS-CoV-2 infection in French dialysis patients was 14%. Convergent scientific data from France, Italy, the United Kingdom and Canada show that home dialysis reduces the risk of SARS-CoV-2 infection by a factor of at least two. Unfortunately, home dialysis in France is not sufficiently developed: the proportion of dialysis patients being treated at home is only 7%. The obstacles to the provision of home care for patients with end-stage kidney disease in France include (i) an unfavourable pricing policy for home haemodialysis and nurse visits for assisted peritoneal dialysis (PD), (ii) insufficient training in home dialysis for nephrologists, (iii) the small number of administrative authorizations for home dialysis programs, and (iv) a lack of structured, objective information on renal replacement therapies for patients with advanced chronic kidney disease (CKD). We propose a number of pragmatic initiatives that could be simultaneously enacted to improve the situation in three areas: (i) the provision of objective information on renal replacement therapies for patients with advanced CKD, (ii) wider authorization of home dialysis networks and (iii) price increases in favour of home dialysis procedures.

USING THE INTEGRATE-HTA GUIDANCE: EXPERIENCE FROM CADTH

2017 ◽  
Vol 33 (5) ◽  
pp. 591-596 ◽  
Author(s):  
Ken Bond ◽  
Laura Weeks
Keyword(s):  
Ethical Issues ◽  
Complex Interventions ◽  
Logic Model ◽  
End Stage Kidney Disease ◽  
Steep Learning Curve ◽  
Home Dialysis ◽  
Team Members ◽  
Canadian Health ◽  
End Stage ◽  
Integrated Assessments

Objectives:The aim of this study was to describe an initial exploration by CADTH, Canada's pan-Canadian health technology assessment (HTA) agency, in using the INTEGRATE-HTA guidance in the production of an HTA that examined the use of both in-center and in-home dialysis modalities for the treatment of end-stage kidney disease in adults in Canada.Methods and Results:We outline CADTH's standard HTA production process and context and then describe the experience of the assessment team in using the INTEGRATE-HTA guidance, specifically to help structure and guide the use of a logic model, the identification of implementation issues, and the identification and examination of ethical issues. For each of the aspects, we describe and reflect on how the assessment team used the guidance, challenges that were encountered in its use, and whether and how we might address these challenges when using the INTEGRATE-HTA guidance in the future.Conclusions:INTEGRATE-HTA provided detailed and helpful guidance for truly integrating wide-ranging aspects of HTA. Our agency was challenged by a steep learning curve for assessment team members, tight project timelines, and a misalignment of current HTA processes with those required to implement the guidance. Nevertheless, using the guidance initiated a dialogue about what might be needed to assess complex interventions and the potential process changes that could facilitate conducting more integrated assessments.

Experience with CAPD as Home Dialysis

1985 ◽  
Vol 1 (2) ◽  
pp. 305-313 ◽  
Author(s):  
Norbert H. Lameire
Keyword(s):  
Quality Of Life ◽  
Renal Transplantation ◽  
The Elderly ◽  
End Stage Kidney Disease ◽  
Systemic Complications ◽  
Home Dialysis ◽  
Cadaveric Donor ◽  
Terminal Renal Failure ◽  
End Stage

For patients who have had the misfortune to develop terminal renal failure, three basic modes of treatment can be offered. One is renal transplantation, with a graft taken from either a living or a cadaveric donor. When successful, it offers the best quality of life and treatment for patients with end-stage kidney disease. However, the elderly and those with severe cardiovascular or systemic complications are not always suitable candidates for renal transplantation (1).

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