Dialysis and renal transplantation as renal replacement therapy for end-stage renal failure, with special reference to the ethical problems of living renal donation.

A 21-year-old Japanese male with severe hemophilia A was developed end-stage renal failure. He was placed on combination therapy with peritoneal dialysis (PD) and hemodialysis (HD). Eight months later, he developed a hypertensive cerebral hemorrhage. After emergency surgery, he was managed with PD without HD to avoid cerebral edema. One month later, his renal replacement therapy was switched to HD (three times a week) from PD, since a ventriculoperitoneal shunt catheter was placed to treat his hydrocephalus. HD could be performed safety without anticoagulant agents on condition that factor VIII is given after every HD.

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Pharmacokinetics of Sulfobutylether-Beta-Cyclodextrin and Voriconazole in Patients with End-Stage Renal Failure during Treatment with Two Hemodialysis Systems and Hemodiafiltration

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01540-09 ◽

2010 ◽

Vol 54 (6) ◽

pp. 2596-2602 ◽

Cited By ~ 53

Author(s):

Verena Hafner ◽

David Czock ◽

Jürgen Burhenne ◽

Klaus-Dieter Riedel ◽

Jürgen Bommer ◽

...

Keyword(s):

Renal Failure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Half Life ◽

Repeated Measures ◽

High Flux ◽

Polysulfone Membrane ◽

End Stage Renal Failure ◽

Beta Cyclodextrin ◽

End Stage

ABSTRACT Sulfobutylether-beta-cyclodextrin (SBECD), a large cyclic oligosaccharide that is used to solubilize voriconazole (VRC) for intravenous administration, is eliminated mainly by renal excretion. The pharmacokinetics of SBECD and voriconazole in patients undergoing extracorporeal renal replacement therapies are not well defined. We performed a three-period randomized crossover study of 15 patients with end-stage renal failure during 6-hour treatment with Genius dialysis, standard hemodialysis, or hemodiafiltration using a high-flux polysulfone membrane. At the start of renal replacement therapy, the patients received a single 2-h infusion of voriconazole (4 mg per kg of body weight) solubilized with SBECD. SBECD, voriconazole, and voriconazole-N-oxide concentrations were quantified in plasma and dialysate samples by high-performance liquid chromatography (HPLC) and by HPLC coupled to tandem mass spectrometry (LC-MS-MS) and analyzed by noncompartmental methods. Nonparametric repeated-measures analysis of variance (ANOVA) was used to analyze differences between treatment phases. SBECD and voriconazole recoveries in dialysate samples were 67% and 10% of the administered doses. SBECD concentrations declined with a half-life ranging from 2.6 ± 0.6 h (Genius dialysis) to 2.4 ± 0.9 h (hemodialysis) and 2.0 ± 0.6 h (hemodiafiltration) (P < 0.01 for Genius dialysis versus hemodiafiltration). Prediction of steady-state conditions indicated that even with daily hemodialysis, SBECD will still exceed SBECD exposure of patients with normal renal function by a factor of 6.2. SBECD was effectively eliminated during 6 h of renal replacement therapy by all methods, using high-flux polysulfone membranes, whereas elimination of voriconazole was quantitatively insignificant. The SBECD half-life during renal replacement therapy was nearly normalized, but the average SBECD exposure during repeated administration is expected to be still increased.

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Serum Cholesterol as a Marker of Nutrition in End-stage Renal Failure Patients on Renal Replacement Therapy

International Journal of Pharmacology ◽

10.3923/ijp.2006.184.187 ◽

2006 ◽

Vol 2 (2) ◽

pp. 184-187 ◽

Cited By ~ 1

Author(s):

Azar Baradaran ◽

Hamid Nasri .

Keyword(s):

Renal Failure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Serum Cholesterol ◽

End Stage Renal Failure ◽

End Stage

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Renal failure

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0018 ◽

2019 ◽

pp. 547-560

Keyword(s):

Palliative Care ◽

Renal Failure ◽

Renal Replacement Therapy ◽

Renal Disease ◽

Replacement Therapy ◽

Symptom Management ◽

End Stage Renal Failure ◽

Care Services ◽

Palliative Care Services ◽

End Stage

This chapter describes the issues associated with providing palliative care to patients with renal failure, and covers initiation of renal replacement therapy, conservative treatment, symptom management for patients with advanced renal disease, and issues surrounding stopping renal replacement therapy. As obesity and diabetes increase, so does the incidence of chronic renal disease and end-stage renal failure. Determining the exact number of patients dying of renal failure is challenging. Often the cause of death will be ascribed to an associated contributing factor, e.g. diabetes mellitus, or the final acute event resulting in death, e.g. myocardial infarction. However, we know that renal failure is an independent risk factor for cardiovascular disease and is associated with a high all-cause mortality.1 In addition, patients with end-stage renal failure have a significant symptom burden and therefore it is important that patients have access to palliative care services to assist with symptom management, advanced care planning, and, where appropriate, decisions around dialysis and transplantation.

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Malignant tumors in patients with end stage renal failure undergoing renal replacement therapy

Współczesna Onkologia ◽

10.5114/wo.2012.31765 ◽

2012 ◽

Vol 5 ◽

pp. 382-387 ◽

Cited By ~ 1

Author(s):

Grzegorz Kade ◽

Arkadiusz Lubas ◽

Lubomir Bodnar ◽

Cezary Szczylik ◽

Zofia Wańkowicz

Keyword(s):

Renal Failure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Malignant Tumors ◽

End Stage Renal Failure ◽

End Stage

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Comparison of Hemostatic Disturbances between Patients on Capd and Patients on Hemodialysis

Peritoneal Dialysis International ◽

10.1177/089686080102100209 ◽

2001 ◽

Vol 21 (2) ◽

pp. 158-167 ◽

Cited By ~ 38

Author(s):

Jolanta Malyszko ◽

Jacek S. Malyszko ◽

Michal Mysliwiec

Keyword(s):

Renal Failure ◽

Platelet Aggregation ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Factor Vii ◽

Control Group ◽

End Stage Renal Failure ◽

Lipoprotein A ◽

Uremic Patients ◽

End Stage

Objective Disturbances in hemostasis are common findings in uremic patients. Both bleeding diathesis and thrombosis are observed. The purpose of this study was to assess whether renal replacement therapy in the form of hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) affects coagulation and fibrinolysis in patients with end-stage renal failure. Design Comparison of hemostatic measures in patients on CAPD, HD, and matched healthy controls. Setting Department of Nephrology and Internal Medicine, Bialystok University School of Medicine. Patients and Methods Twenty-four HD patients and 23 CAPD patients were evaluated with respect to platelet aggregation, hemostatic parameters, serum lipids, lipoprotein(a), and cytokines [tumor necrosis factor alpha (TNFα) and interleukin-1 (IL-1)]. Interventions Four exchanges of CAPD per day, using 2.0 L dialysate over a period of 25 ± 31 months; or 4 – 5 hours of HD 3 times per week for a period of 31 ± 22 months. Results Platelet aggregation in whole blood and platelet-rich plasma was significantly impaired in both groups of dialyzed patients compared to healthy volunteers. Markers of endothelial cell injury (thrombomodulin and von Willebrand factor) were significantly higher in HD and CAPD patients compared to the control group. A similar pattern of changes was observed for lipoprotein(a), fibrinogen, tissue factor pathway activity, and factor VII activity. Activity of factor X was significantly enhanced in CAPD compared to HD patients and controls. Euglobulin clot lysis time was significantly prolonged in HD and CAPD patients over controls, being more prolonged in CAPD patients. Markers of ongoing coagulation (thrombin–antithrombin complexes and prothrombin fragments 1+2) were higher in uremic patients, significantly higher in CAPD than in HD. A marker of ongoing fibrinolysis (plasmin–antiplasmin complexes) was higher in uremic patients but was lower in CAPD than in HD patients. Concentrations of TNFα and IL-1 were higher in HD than in CAPD patients. Conclusion Patients on CAPD showed evidence of a higher degree of hypercoagulation than HD patients. Thus, hemostatic abnormalities in end-stage renal failure may be affected to some extent by the choice of renal replacement therapy.

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