Tissue ischemia worsens during hemodialysis in end-stage renal disease patients

2016 ◽  
Vol 18 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Jan Malik ◽  
Jaroslav Kudlicka ◽  
Jana Lachmanova ◽  
Anna Valerianova ◽  
Katarina Rocinova ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cognitive Deficit ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Tissue Ischemia ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Brain ◽  
Esrd Patients

Background Cognitive deficit is a common problem in end-stage renal disease (ESRD) patients. Ultrafiltration and hemodialysis lead to profound hemodynamic changes. The aim of this pilot study was to describe brain and hand oxygenation values in ESRD patients and their changes during hemodialysis. Methods Twenty-seven patients treated by chronic hemodialysis and 17 controls patients of the same age were included in the study. Regional saturation of oxygen (SrO2) was measured at the brain frontal lobe and at the hand with dialysis access using the INVOS 5100C. In 17 of ESRD patients, SrO2 was also monitored throughout hemodialysis. Finger systolic blood pressure and basic hemodialysis and laboratory data were collected. Results Dialysis patients had lower brain and also hand SrO2 values at rest (51.5 ± 10.9 vs. 68 ± 7%, p<0.0001 and 55 ± 16 vs. 66 ± 8%, p = 0.03, respectively). Both values further decreased during the first 35 minutes of hemodialysis (brain SrO2 to 47 ± 8%, p<0.0001 and hand to 45 ± 14%, p<0.0001, respectively). The brain SrO2 decrease was related to the ultrafiltration rate, the hand SrO2 decrease to the finger pressure and to blood hemoglobin. Conclusions Chronic dialysis patients suffer from tissue ischemia and that even worsens after the beginning of hemodialysis. This observation may contribute to the understanding of cognitive deficit etiology.

scholarly journals Pulmonary hypertension in end-stage renal disease patients on dialysis and predialysis patients

2020 ◽  
Vol 43 (3) ◽  
pp. E44-48
Author(s):  
Yifu Li ◽  
Yan Zhang ◽  
Jinjun Wang ◽  
Wenwei Chen ◽  
Yong Cai ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Pulmonary Artery ◽  
Renal Disease ◽  
Pulmonary Artery Pressure ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Purpose: Pulmonary hypertension (PH) is a frequent and serious cardiovascular complication in patients with end-stage renal disease (ESRD) on dialysis. The purpose of this study was to investigate the prevalence of PH and its associated factors in patients with ESRD on maintenance dialysis and predialysis patients. Methods: The medical records of ESRD patients who underwent kidney transplantation between January 2011 and December 2017 were retrospectively reviewed. Demographic and clinical characteristics including echocardiographic findings before joining the waiting list for transplantation were evaluated and compared among groups divided according to dialysis or not and dialysis types. The results of transthoracic Doppler echocardiography were used to determine the pulmonary artery pressure. Pulmonary hypertension was defined as a systolic pulmonary artery pressure (sPAP) greater than 35 mmHg. Univariate and multivariate analyses were used to investigate factors associated with PH. Results: Data from 35 pre-dialysis patients with ESRD, 72 maintenance hemodialysis (HD) and 34 peritoneal dialysis (PD) patients were analysed. Pulmonary hypertension was 20.69% in pre-dialysis patients, 16.7% in HD patients and 14.7% in PD patients (P=0.957). There were negative correlations between sPAP and calcium (r=-0.230, P=0.012), Ca×P(r=-0.210, P=0.021), hemoglobin (r=-0.243, P=0.008) and a positive correlation between sPAP and cardiac output (r=0.481, P=0.000). Cardiac output (CO) was an independent risk factor of sPAP (B=1.431, confidence interval [CI] 95%: 0.687 to 2.175, P=0.000). Conclusion: Incidence of PH was not statistically different in ESRD patients on dialysis and pre-dialysis patients. Uremia may play a major role in the pathogenesis of PH in patients.

scholarly journals Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mohamad Adam Bujang ◽  
Tassha Hilda Adnan ◽  
Nadiah Hanis Hashim ◽  
Kirubashni Mohan ◽  
Ang Kim Liong ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Dialysis Treatment ◽  
Forecasting Models ◽  
Transplant Registry ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background. The incidence of patients with end-stage renal disease (ESRD) requiring dialysis has been growing rapidly in Malaysia from 18 per million population (pmp) in 1993 to 231 pmp in 2013.Objective. To forecast the incidence and prevalence of ESRD patients who will require dialysis treatment in Malaysia until 2040.Methodology. Univariate forecasting models using the number of new and current dialysis patients, by the Malaysian Dialysis and Transplant Registry from 1993 to 2013 were used. Four forecasting models were evaluated, and the model with the smallest error was selected for the prediction.Result. ARIMA (0, 2, 1) modeling with the lowest error was selected to predict both the incidence (RMSE = 135.50, MAPE = 2.85, and MAE = 87.71) and the prevalence (RMSE = 158.79, MAPE = 1.29, and MAE = 117.21) of dialysis patients. The estimated incidences of new dialysis patients in 2020 and 2040 are 10,208 and 19,418 cases, respectively, while the estimated prevalence is 51,269 and 106,249 cases.Conclusion. The growth of ESRD patients on dialysis in Malaysia can be expected to continue at an alarming rate. Effective steps to address and curb further increase in new patients requiring dialysis are urgently needed, in order to mitigate the expected financial and health catastrophes associated with the projected increase of such patients.

scholarly journals The Allocation of Vertical Attention in Patients with End-Stage Renal Disease Receiving Dialysis

2021 ◽  
Vol 11 (12) ◽  
pp. 1549
Author(s):  
Aleksandra Mańkowska ◽  
Kenneth M. Heilman ◽  
Bogdan Biedunkiewicz ◽  
Alicja Dębska-Ślizień ◽  
John B. Williamson ◽  
...  
Keyword(s):  
Renal Disease ◽  
Spatial Attention ◽  
Attentional Bias ◽  
End Stage Renal Disease ◽  
Healthy Controls ◽  
Brain Mechanism ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Brain ◽  
Esrd Patients

Objectives: Alterations of spatial attention can have adverse effects, such a greater probability of accidents. Patients with end-stage renal disease (ESRD) receiving dialysis have stronger left-sided spatial attentional bias, suggesting that this disorder or treatment alters the brain networks that mediate spatial attention. The hemispheric networks that mediate the allocation of horizontal attention may also influence the allocation of vertical attention. However, the allocation of vertical spatial attention has not been studied in ESRD patients. Methods: Twenty-three ESRD patients receiving dialysis and 23 healthy right-handed controls performed line bisections using 24 vertical lines (24 cm long and 2 mm thick) aligned with the intersection of their midsagittal and coronal planes. Results: Hemodialyzed ESRD patients had a significantly greater upward bias than healthy controls. The magnitude of this bias was correlated with the duration of the kidney disease. Conclusions: The reason why upward attentional bias is increased in hemodialyzed ESRD patients is not known. Further research is needed to better understand the brain mechanism that might account for this bias, as well as its treatment. However, hemodialyzed ESRD patients and their families-caregivers should be made aware of this disorder to avoid accidents such as tripping.

scholarly journals One-Year Mortality Rates in US Children with End-Stage Renal Disease

2015 ◽  
Vol 41 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Blanche M. Chavers ◽  
Julia T. Molony ◽  
Craig A. Solid ◽  
Michelle N. Rheault ◽  
Allan J. Collins
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Mortality Rates ◽  
Transplant Recipients ◽  
Dialysis Patients ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background/Aims: Few published data describe survival rates for pediatric end-stage renal disease (ESRD) patients. We aimed to describe one-year mortality rates for US pediatric ESRD patients over a 15-year period. Methods: In this retrospective cohort study, we used the US Renal Data System database to identify period-prevalent cohorts of patients aged younger than 19 for each year during the period 1995-2010. Yearly cohorts averaged approximately 1,200 maintenance dialysis patients (60% hemodialysis, 40% peritoneal dialysis) and 1,100 transplant recipients. Patients were followed for up to 1 year and censored at change in modality, loss to follow-up, or death. We calculated the unadjusted model-based mortality rates per time at risk, within each cohort year, by treatment modality (hemodialysis, peritoneal dialysis, transplant) and patient characteristics; percentage of deaths by cause; and overall adjusted odds of mortality by characteristics and modality. Results: Approximately 50% of patients were in the age group 15-18, 55% were male, and 45% were female. The most common causes of ESRD were congenital/reflux/obstructive causes (55%) and glomerulonephritis (30%). One-year mortality rates showed evidence of a decrease in the number of peritoneal dialysis patients (6.03 per 100 patient-years, 1995; 2.43, 2010; p = 0.0263). Mortality rates for transplant recipients (average 0.68 per 100 patient-years) were consistently lower than the rates for all dialysis patients (average 4.36 per 100 patient-years). Conclusions: One-year mortality rates differ by treatment modality in pediatric ESRD patients.

scholarly journals Preoperative Evaluation in Patients With End-Stage Renal Disease and Chronic Kidney Disease

2017 ◽  
Vol 10 ◽  
pp. 117863291771302 ◽  
Author(s):  
Rabih Nasr ◽  
Sridhar Chilimuri
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Preoperative Evaluation ◽  
Dialysis Session ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Stage Renal Disease ◽  
End Stage

Optimal preoperative management of dialysis patients remains challenging. Patients with end-stage renal disease (ESRD) have higher mortality in the perioperative setting compared with non-ESRD patients. However, it is well established that dialysis should be done on the day before surgery. Additional dialysis session prior to surgery does not improve outcomes. All dialysis patients should undergo blood work to check electrolytes and especially serum potassium prior to any surgery. Some medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics, should be stopped prior to surgery to minimize hemodynamic changes during surgery. The dialysis access should be carefully examined for any signs of infection. The arteriovenous fistula or graft should be evaluated for patency. Glycemic control in diabetic ESRD and chronic kidney disease patients is very important, and clinicians should be aware of the risk of bleeding and the appropriate analgesics that can be used in dialysis patients in the perioperative setting. In conclusion, preoperative evaluation in patients with ESRD should be a multidisciplinary approach.

scholarly journals Low Mortality and Key Aspects of Delivery of Care for End-Stage Renal Disease in Italy

2009 ◽  
Vol 9 ◽  
pp. 349-359 ◽  
Author(s):  
Alexander Lauder ◽  
Arrigo Schieppati ◽  
Ferruccio Conte ◽  
Giuseppe Remuzzi ◽  
Daniel Batlle
Keyword(s):  
Mortality Rate ◽  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Delivery Of Care ◽  
Stage Renal Disease ◽  
Key Aspects ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) is a global health problem. There are differences in mortality among patients with ESRD amid industrialized countries that may be related to their respective systems of delivery of care. A nationwide survey was completed in Italy, a country with low mortality rate for ESRD patients, in order to help understand key aspects of ESRD delivery of care that contribute to mortality. Survey responses were obtained and analyzed from 131 of 575 dialysis centers (23%), covering data from 13,170 dialysis patients in 2006. The mortality rate was 11.2% and the prevalence of diabetes-associated kidney disease was 21%. Of the patients, 88% were on hemodialysis and 12% were on peritoneal dialysis. Most patients were in the age range of 65–75 years (66.7%), were seen by a nephrologist at CKD stage 3, and began dialysis at mean estimated GFR of 9.6 ml/min/1.73 m2. AV fistulae were the prevailing form of vascular access (83%) and were most frequently placed by a nephrologist (61.2%). In 98% of the dialysis centers, a nephrologist was present during dialysis sessions. The following may explain the low mortality for ESRD patients in Italy: low prevalence of diabetes, high use of AV fistulae, delivery of care by nephrologists beginning in pre-ESRD stages, their involvement in placement of dialysis vascular access, and their physical presence requirement during dialysis sessions. These findings portray key aspects of the contemporary delivery of care for Italian dialysis patients and provide a platform for international comparison of healthcare systems for ESRD.

scholarly journals Forecast of the Number of Patients with End-Stage Renal Disease in the United States to the Year 2010

2001 ◽  
Vol 12 (12) ◽  
pp. 2753-2758 ◽  
Author(s):  
Jay L. Xue ◽  
Jennie Z. Ma ◽  
Thomas A. Louis ◽  
Allan J. Collins
Keyword(s):  
United States ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Dialysis Patients ◽  
Forecasting Models ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

ABSTRACT. As the United States end-stage renal disease (ESRD) program enters the new millennium, the continued growth of the ESRD population poses a challenge for policy makers, health care providers, and financial planners. To assist in future planning for the ESRD program, the growth of patient numbers and Medicare costs was forecasted to the year 2010 by modeling of historical data from 1982 through 1997. A stepwise autoregressive method and exponential smoothing models were used. The forecasting models for ESRD patient numbers demonstrated mean errors of −0.03 to 1.03%, relative to the observed values. The model for Medicare payments demonstrated −0.12% mean error. The R2 values for the forecasting models ranged from 99.09 to 99.98%. On the basis of trends in patient numbers, this forecast projects average annual growth of the ESRD populations of approximately 4.1% for new patients, 6.4% for long-term ESRD patients, 7.1% for dialysis patients, 6.1% for patients with functioning transplants, and 8.2% for patients on waiting lists for transplants, as well as 7.7% for Medicare expenditures. The numbers of patients with ESRD in 2010 are forecasted to be 129,200 ± 7742 (95% confidence limits) new patients, 651,330 ± 15,874 long-term ESRD patients, 520,240 ± 25,609 dialysis patients, 178,806 ± 4349 patients with functioning transplants, and 95,550 ± 5478 patients on waiting lists. The forecasted Medicare expenditures are projected to increase to $28.3 ± 1.7 billion by 2010. These projections are subject to many factors that may alter the actual growth, compared with the historical patterns. They do, however, provide a basis for discussing the future growth of the ESRD program and how the ESRD community can meet the challenges ahead.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

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