scholarly journals A system to monitor segmental intracellular, interstitial, and intravascular volume and circulatory changes during acute hemodialysis

2019 ◽  
Vol 8 (1) ◽  
pp. 40-53 ◽  
Author(s):  
Leslie D. Montgomery ◽  
Richard W. Montgomery ◽  
Wayne A. Gerth ◽  
Marty Loughry ◽  
Susie Q. Lew ◽  
...  
Keyword(s):  
Blood Flow ◽  
Fluid Management ◽  
Extracellular Volume ◽  
The Body ◽  
Real Time Measurement ◽  
Management Procedures ◽  
Electrical Bioimpedance ◽  
Stage Renal Disease ◽  
End Stage ◽  
Body Fluid Balance

Abstract This paper describes a new combined impedance plethysmographic (IPG) and electrical bioimpedance spectroscopic (BIS) instrument and software that allows noninvasive real-time measurement of segmental blood flow and changes in intracellular, interstitial, and intravascular volumes during various fluid management procedures. The impedance device can be operated either as a fixed frequency IPG for the quantification of segmental blood flow and hemodynamics or as a multi-frequency BIS for the recording of intracellular and extracellular resistances at 40 discrete input frequencies. The extracellular volume is then deconvoluted to obtain its intra-vascular and interstitial component volumes as functions of elapsed time. The purpose of this paper is to describe this instrumentation and to demonstrate the information that can be obtained by using it to monitor segmental compartment volumes and circulatory responses of end stage renal disease patients during acute hemodialysis. Such information may prove valuable in the diagnosis and management of rapid changes in the body fluid balance and various clinical treatments.

scholarly journals Segmental intracellular, interstitial, and intravascular volume changes during simulated hemorrhage and resuscitation: A case study

2019 ◽  
Vol 10 (1) ◽  
pp. 40-46
Author(s):  
Leslie D. Montgomery ◽  
Richard W. Montgomery ◽  
Wayne A. Gerth ◽  
Michael Bodo ◽  
Julian M. Stewart ◽  
...  
Keyword(s):  
Blood Flow ◽  
Fluid Management ◽  
Extracellular Volume ◽  
The Body ◽  
Intravascular Volume ◽  
Volume Changes ◽  
Management Procedures ◽  
Electrical Bioimpedance ◽  
Simulated Hemorrhage ◽  
Body Fluid Balance

Abstract This paper describes a new combined impedance plethysmographic (IPG) and electrical bioimpedance spectroscopic (BIS) instrument and software that will allow noninvasive real-time measurement of segmental blood flow, intracellular, interstitial, and intravascular volume changes during various fluid management procedures. The impedance device can be operated either as a fixed frequency IPG for the quantification of segmental blood flow and hemodynamics or as a multi-frequency BIS for the recording of intracellular and extracellular resistances at 40 discrete input frequencies. The extracellular volume is then deconvoluted to obtain its intravascular and interstitial component volumes as functions of elapsed time. The purpose of this paper is to describe this instrumentation and to demonstrate the information that can be obtained by using it to monitor segmental compartment volume responses of a pig model during simulated hemorrhage and resuscitation. Such information may prove valuable in the diagnosis and management of rapid changes in the body fluid balance and various clinical treatments.

La diagnosi precoce di malattia

2019 ◽  
Vol 31 (1) ◽  
pp. 58-60
Author(s):  
Federica Rossi ◽  
Federico Pieruzzi
Keyword(s):  
Wide Spectrum ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
The Body ◽  
Lysosomal Storage ◽  
Cerebrovascular Complications ◽  
Risk Patients ◽  
Alpha Galactosidase ◽  
Stage Renal Disease ◽  
End Stage

Anderson-Fabry disease is an X-linked, lysosomal, storage disorder characterized by the decreased activity of alpha-Galactosidase A, which results in accumulation of globotriaosylceramide (Gb-3) in cells and tissues throughout the body, leading to a wide spectrum of clinical manifestations. Patients are often misdiagnosed or diagnosed late in their life. This is due to the phenotypic heterogeneity, the poor awareness of this rare disease, and many pitfalls when making a differential diagnosis, in adulthood, as well as in the early stages. Delayed diagnosis has significant clinical implications, because the progression of the disease over time can lead to irreversible end-stage renal disease and life-threatening cardiovascular or cerebrovascular complications. Early diagnosis remains essential in order to start an early treatment and reduce the progression of the disease, thus maximizing the chance to improve patient outcomes. Newborn screening, high-risk patients’ identification, and increasing pediatricians’ and clinicians’ knowledge on this condition, are good strategies to avoid late referrals of Anderson-Fabry patients to reference centers.

scholarly journals RETRACTED ARTICLE: Prognostic value of heart failure in hemodialysis-dependent end-stage renal disease patients with myocardial fibrosis quantification by extracellular volume on cardiac magnetic resonance imaging

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hua-yan Xu ◽  
Zhi-gang Yang ◽  
Yi Zhang ◽  
Wan-lin Peng ◽  
Chun-chao Xia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Fibrosis ◽  
Prognostic Value ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Cardiac Events ◽  
Native T1 ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients are at high cardiovascular risk, and myocardial fibrosis (MF) accounts for most of their cardiac events. The purpose of this study is to investigate the prognostic value and risk stratification of MF as measured by extracellular volume (ECV) on cardiac magnetic resonance (CMR) for heart failure (HF) in patients with hemodialysis-dependent ESRD. Methods Sixty-six hemodialysis ESRD patients and 25 matched healthy volunteers were prospectively enrolled and underwent CMR to quantify multiple parameters of MF by T1 mapping and late gadolinium enhancement (LGE). All ESRD patients were followed up for 11–30 months, and the end-point met the 2016 ESC guidelines for the definition of HF. Results Over a median follow-up of 18 months (range 11–30 months), there were 26 (39.39%) guideline-diagnosed HF patients in the entire cohort of ESRD subjects. The native T1 value was elongated, and ECV was enlarged in the HF cohort relative to the non-HF cohort and normal controls (native T1, 1360.10 ± 50.14 ms, 1319.39 ± 55.44 ms and 1276.35 ± 56.56 ms; ECV, 35.42 ± 4.42%, 31.85 ± 3.01% and 26.97 ± 1.87%; all p<0.05). In the cardiac strain analysis, ECV was significantly correlated with global radial strain (GRS) (r = − 0.501, p = 0.009), global circumferential strain (GCS) (r = 0.553, p = 0.005) and global longitudinal strain (GLS) (r = 0.507, p = 0.008) in ESRD patients with HF. Cox proportional hazard regression models revealed that ECV (hazard ratio [HR] = 1.160, 95% confidence interval: 1.022 to 1.318, p = 0.022) was the only independent predictor of HF in ESRD patients. It also had a higher diagnostic accuracy for detecting MF (area under the curve [AUC] = 0.936; 95% confidence interval: 0.864 to 0.976) than native T1 and post T1 (all p ≤ 0.002). Kaplan-Meier analysis revealed that the high-ECV group had a shorter median overall survival time than the low-ECV group (18 months vs. 20 months, log-rank p = 0.046) and that ESRD patients with high ECV were more likely to have HF. Conclusions Myocardial fibrosis quantification by ECV on CMR T1 mapping was shown to be an independent risk factor of heart failure, providing incremental prognostic value and risk stratification for cardiac events in ESRD patients. Trial registration Chinese Clinical Trial Registry ChiCTR-DND-17012976, 13/12/2017, Retrospectively registered.

Geometric Enhancements of an Arteriovenous Graft

2009 ◽  
Author(s):  
Stephen P. Broderick ◽  
Gráinne Carroll ◽  
Micheal Walsh
Keyword(s):  
United States ◽  
The Elderly ◽  
The United States ◽  
Cost Of Care ◽  
The Body ◽  
Venous Anastomosis ◽  
And Migration ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End Stage Renal Disease (ESRD) is the degeneration of kidney function to remove uremic toxins from the blood. Currently there are over 484,000 sufferers of ESRD in the United States, with this figure predicted to rise to over 800,000 by 2020 [1]. The total cost of care for patients with ESRD was estimated to exceed 1 billion dollars in the United States [2]. A kidney transplant is the ideal solution for ESRD patients; however with the increasing number of ESRD patients the odds of receiving a donor kidney are poor. The alternative is hemodialysis. This process is involves the extraction of blood from the patient to an extracorporal machine. Blood is pumped at a rate of 350 mL/min to ensure effective dialysis. The blood is then returned to the body cleaned. The gold standard for hemodialysis access is the native arteriovenous fistula [3] with the most common type being the Brescia-Cimino fistula at the wrist [4]. In some subgroups the fistula performs poorly. In diabetics and the elderly, specifically over 70s [2] or can’t be constructed because of unsuitable blood vessels [5]. In this case an alternative is the synthetic AV graft. Made of polytetrafluoroethelyne, it has lower patency rates against the fistula [6] [7] mediated by the susceptibility to thrombosis induced by stenosis development and infection [7].The majority of stenosis development is within the venous anastomosis (kanterman1995). The formation of intimal hyperplasia (IH) leading to stenosis formation is caused by smooth cell proliferation and migration as a result of endothelial cells reacting to shear stress receptors. The development of IH has been linked to local hemodynamics and turbulence in the flow, which in turn are heavily influenced by the geometry of the graft.

Paediatric renal transplantation

2015 ◽  
Author(s):  
Minnie M. Sarwal ◽  
Ron Shapiro
Keyword(s):  
Fluid Management ◽  
Surgical Techniques ◽  
Normal Growth ◽  
Paediatric Population ◽  
The United States ◽  
Immunosuppressive Drugs ◽  
Postoperative Management ◽  
Paediatric Renal Transplantation ◽  
Stage Renal Disease ◽  
End Stage

Approximately 1 in 65,000 children develops end-stage renal disease (ESRD) each year with almost 1200 children (aged 0–19 years) in the United States developing ESRD annually. Kidney transplantation is the primary method of treating ESRD in the paediatric population. The special issues in children and adolescents with ESRD include achieving normal growth and cognitive development. This chapter discusses the advances in surgical techniques, patient selection, transplant evaluation/preparing for transplantation, postoperative management (including fluid management in infants and small children), and the evolution of immunosuppressive drugs that have resulted in improved quality of life and a reduction in the mortality rate of children with chronic renal failure.

Autopsy Findings of a Case with Oxalosis

2009 ◽  
Vol 12 (3) ◽  
pp. 229-232 ◽  
Author(s):  
Basak Doganavsargil ◽  
Ipek Akil ◽  
Sait Sen ◽  
Sevgi Mir ◽  
Gulcin Basdemir
Keyword(s):  
Primary Hyperoxaluria ◽  
The Body ◽  
Type I ◽  
Crystal Deposition ◽  
Autopsy Findings ◽  
Hyperoxaluria Type I ◽  
Stage Renal Disease ◽  
End Stage ◽  
Primary Hyperoxaluria Type I ◽  
Hyperoxaluria Type

Oxalosis, deposition of calcium oxalate in tissues, is the final stage of hyperoxaluric syndromes. Being a rare entity, it is often missed, or the diagnosis is delayed, since the definitive diagnosis requires special laboratory tests. Kidneys, the walls of blood vessels, and bones are the major sites for crystal deposition. We report the autopsy findings of a 4-year-old girl who presented with end-stage renal disease in which the clinical presentation was consistent with primary hyperoxaluria Type I. The case is unusual, as there was extensive crystal deposition throughout the body, including in tissues that are rarely involved, such as ovaries, fallopian tubes, uterus, thymus, salivary glands, pancreas, and bladder.

scholarly journals Effects of Arterial Needle Placement in Arteriovenous Fistula on Dialysis Adequacy of End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis

2016 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Intervention Group ◽  
Maintenance Hemodialysis ◽  
Control Group ◽  
Needle Placement ◽  
Dialysis Adequacy ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

Objective: The arterial needle placement in arteriovenous fistula (AVF) can either be antegrade (in the direction of blood flow or pointing towards the heart) or retrograde (against the direction of blood flow) while venous needle placement should always be in the same direction as the blood flow. This study determined the effects of arterial needle placement in the arteriovenous fistula on dialysis adequacy of End-Stage Renal Disease (ESRD) patients undergoing maintenance hemodialysis in United Candelaria Doctors Hospital - Nephro Synergies Inc. (UCDHNSI) Hemodialysis Center. Methods: A randomized controlled trial design was used in the study. A total of 20 non-diabetic, non-cardiac patients on maintenance hemodialysis for more than 6 months were randomized either to the intervention group (patients’ AVF were cannulated in a retrograde manner) or the control group (patients’ AVF were cannulated in an antegrade manner). Urea reduction ratio (URR) and Kt/V as well as access recirculation percentage were used to determine dialysis adequacy. Pre-dialysis, in the first 30 minutes of dialysis initiation and post-dialysis blood samples were obtained in each patient in 6 succeeding hemodialysis considering dialyzer reuse up to fifth reuse. Means were compared by independent t-test. Results: The findings of the study revealed that the mean URR and Kt/V of the subjects cannulated in retrograde manner and antegrade manner were 69.35% and 1.45, and 74.65% and 1.70, respectively. The mean access recirculation percentage of the subjects was 4.65% in the intervention group and 3.02% in the control group. There was a significant difference on URR and Kt/V of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. There was no significant difference on access recirculation percentage of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. Conclusions: Antegrade arterial needle placement provides more adequate hemodialysis than retrograde arterial needle placement in terms of URR and Kt/V values among non-diabetic, non-cardiac patients undergoing maintenance hemodialysis in 6 succeeding hemodialysis sessions. The directions of the arterial needle either retrograde and antegrade did not have significant effects on access recirculation.

scholarly journals Calcium Stimulation Test for Insulinoma Localization in an End-stage Renal Disease Patient on Diazoxide

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Stephanie Kim ◽  
Miles Conrad ◽  
Eunice Chuang ◽  
Larry Cai ◽  
Umesh Masharani ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Esrd Patient ◽  
Disease Patient ◽  
The Body ◽  
Stimulation Test ◽  
Delay In Diagnosis ◽  
Calcium Stimulation ◽  
Stage Renal Disease ◽  
End Stage

Abstract Insulinomas are rare, and even rarer in patients with end-stage renal disease (ESRD). Clear criteria for the biochemical diagnosis of insulinomas in patients with renal failure have not been established, and hypoglycemia is often attributed to the renal disease itself, frequently leading to a delay in diagnosis. We describe a case of a patient who presented with asymptomatic recurrent hypoglycemia during hemodialysis. Disease progression and biochemical testing strongly suggested an insulinoma. Computed tomography (CT) of the abdomen and pelvis, 111In-pentetreotide scintigraphy and endoscopic ultrasound did not localize a pancreatic tumor. A calcium stimulation test was performed while the patient was taking diazoxide due to severe hypoglycemia with fasting for a couple of hours without treatment. The test showed a marked increase in insulin after calcium infusion in the dorsal pancreatic artery, localizing the tumor to the body and tail of the gland. Exploratory surgery easily identified a tumor at the body of the pancreas and pathology confirmed an insulin-secreting pancreatic neuroendocrine tumor. On follow-up, there was resolution of the hypoglycemia. We review the challenges of diagnosing an insulinoma in ESRD and describe a successful intra-arterial calcium stimulation test done in an ESRD patient while continuing diazoxide.

A Vascular Access Port for Dialysis With a Polyurethane Foam Seal: A Pilot Study

2017 ◽  
Author(s):  
Robert E. Smith ◽  
Nicole C. Docherty ◽  
P. Alex Smith ◽  
Duncan J. Maitland ◽  
Alan C. Glowczwski
Keyword(s):  
Vascular Access ◽  
Prosthetic Graft ◽  
The Body ◽  
Dialysis Access ◽  
Access Port ◽  
Structural Support ◽  
Tissue Integration ◽  
Aneurysmal Dilation ◽  
Stage Renal Disease ◽  
End Stage

End-Stage Renal Disease (ESRD) is a condition wherein the kidneys are incapable of removing toxins from the body. Over 660,000 Americans suffer from ESRD, with millions more in the early stages, known as chronic kidney disease [1]. The only cure for ESRD is a kidney transplant, but the majority of patients receive dialysis every 2–3 days to filter their blood while on the transplant waitlist. Efficient dialysis requires approximately 600 mL/min of flow, which is commonly achieved by directly connecting an artery to a vein in the arm. Such a shunt may be created with an intervening prosthetic graft or by suturing the vein to the artery directly (termed an arteriovenous fistula, or AVF). Though accepted as the gold standard, AVF’s may take >6 weeks to heal and become useable, and 35–50% will never become accessible [1]. Needle trauma to the AVF can weaken the vessel wall and produce aneurysms or hematomas, which leak blood, potentially causing infection or clotting off the AVF [2]. These complications are costly: hemodialysis patients on average cost Medicare over $84,000 per year, and Medicare is the primary payer for more than 80% of nearly 500,000 dialysis patients in the U.S. [1]. An improved dialysis access method is needed to address the clinical shortcomings and high costs associated with AVF’s. A device has been developed to improve clinical outcomes and to reduce the failure rates associated with AVF’s. This device is a type of vascular access port which integrates with the external wall of the venous portion of the AVF, providing structural support to the vessel and preventing the types of trauma which lead to aneurysmal dilation or hematoma formation. The top and bottom sections are implanted independently within the patient’s soft tissue, allowing them to separate gradually as the AVF dilates during maturation. The result is a palpable and easy-to-access port which should improve AVF longevity (Figure 1). Two unique design features were identified as key to the success of this vascular access port: 1. Type of membrane or seal 2. Proper tissue integration into the implant This technical brief examines the selection of the proper membrane or seal on the port.

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