The effect of intensive hemodialysis on pulmonary arterial pressure and left ventricular systolic function in patients with end-stage renal disease; a prospective clinical trial

Introduction: End-stage renal disease (ESRD) requires hemodialysis or kidney transplantation for the patients to survive. Objectives: The present study was conducted to examine whether intensive hemodialysis and hemoglobin (Hb) concentration correction can improve left ventricular (LV) function and pulmonary arterial hypertension in ESRD patients? Patients and Methods: This prospective clinical trial was designed to examine patients referring to public hospitals in Ahvaz, Iran, in 2016-2017. All the patients treated with intensive hemodialysis for two months were included in the study. The Hb concentration was corrected by the subcutaneous injection of erythropoietin at the dose of 50-150 IU/kg three times per week. Results: Thirty-one ESRD patients with high pulmonary arterial pressure participated in this study. After the intervention, blood Hb levels increased significantly in the ESRD patients from 9.20±1.39 g/dL to 10.96±1.01 g/dL (P<0.0001). Pulmonary arterial pressure decreased significantly from 53.52±10.63 mmHg to 43.32±10.92 mm Hg (P<0.0001). Left ventricular ejection fraction increased significantly based on the visual assessment and Simpson’s method (2D echocardiography) from 41.06±10.76 to 43.00±11.28 and 46.26±13.72 to 48.36±13.90, respectively (P<0.0001). Absolute value of two dimensional global longitudinal strain (GLS) increased significantly from 13.99±5.05 to 15.14±5.32 (P<0.0001) after the intervention. Conclusion: Intensive hemodialysis for two months resulted in a significant increase in Hb concentrations, improved the LV systolic function and decreased pulmonary hypertension in ESRD patients. Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20180212038705N1, https://www.irct.ir/trial/29593; Ethic code: IR.AJUMS. REC.1396.911).

A Systematic Approach To Promoting Home Hemodialysis during End Stage Kidney Disease

Home dialysis has garnered much attention since the advent of the Advancing American Kidney Health initiative. For many patients and nephrologists, home dialysis and peritoneal dialysis are synonymous. However, home hemodialysis (HHD) should not be forgotten. Since 2004, HHD has grown more rapidly than other dialytic modalities. The cardinal feature of HHD is customizability of treatment intensity, which can be titrated to address the vexing problems of volume and pressure loading during interdialytic gaps and ultrafiltration intensity during each hemodialysis session. Growing HHD utilization requires commitment to introducing patients to the modality throughout the course of ESKD. In this article, we describe a set of strategies for introducing HHD concepts and equipment. First, patients initiating dialysis may attend a transitional care unit, which offers an educational program about all dialytic modalities during 3–5 weeks of in-facility hemodialysis, possibly using HHD equipment. Second, prevalent patients on hemodialysis may participate in “trial-run” programs, which allow patients to experience increased treatment frequency and HHD equipment for several weeks, but without the overt commitment of initiating HHD training. In both models, perceived barriers to HHD—including fear of equipment, anxiety about self-cannulation, catheter dependence, and the absence of a care partner—can be addressed in a supportive setting. Third, patients on peritoneal dialysis who are nearing a transition to hemodialysis may be encouraged to consider a home-to-home transition (i.e., from peritoneal dialysis to HHD). Taken together, these strategies represent a systematic approach to growing HHD utilization in multiple phenotypes of patients on dialysis. With the feature of facilitating intensive hemodialysis, HHD can be a key not only to satiating demand for home dialysis, but also to improving the health of patients on dialysis.

P1526HOW TO DEAL WITH PREGNANCY IN DIALYSIS? A CENTER EXPERIENCE ABOUT 7 CASES

Background and Aims Outcomes of pregnancy in patients with end-stage renal disease (ESRD) have long been considered to be extremely poor, and the literature concerning pregnancy while on dialysis is rather meagre. We reported our center experience about pregnancy management in patients on hemodialysis: how to deal with hypertension, ultrafiltration rate, dose dialysis in order to improve maternal and fetal outcome. Method We reported pregnancy outcomes of 7 pregnancies in the Tensift Region Pregnancy registry between March 2015 and March. 2019 The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight. Results We reported 7 pregnant women cases on hemodialysis. Mean age of our patients was 29,5 ±6,57 years. It was the first pregnancy for 3 patients (42,9%). In about half of patients dialysis was initiated during their pregnancy. The mean duration of pregnancy was 35±1,2 weeks and mean fetal weight was 1,950 ±0,353 kg. All patients were dialyzed over 20 hours per week. The mean urea value was 0,46 ±0,04g/L. Two patients needed anti hypertensive drugs (33,3%) mainly nicardipine. The live birth rate of our cohort (71,4%), all vaginal delivery, was significantly higher than the rate in the American cohort (61.4%). In your series we reported one fetal death at 28 SA explained by tocolysis failure for preterm labor. At 9 months all children had good cognitive and psychomotor involvement. Conclusion We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis. A multidisciplinary medical care with obstetricians is highly recommended. Despite a trend of increasing live birth rate over recent decades, pregnancies on dialysis high risk, with increased rates of adverse of adverse pregnancy outcomes including pregnancy loss.

Ambulatory Hemodialysis-Technology Landscape and Potential for Patient-Centered Treatment

CKD is a worldwide health problem and the number of patients requiring kidney replacement therapy is rising. In the United States, most patients with ESKD rely on in-center hemodialysis, which is burdensome and does not provide the same long-term benefits as kidney transplantation. Intensive hemodialysis treatments have demonstrated improved clinical outcomes, but its wider adoption is limited by equipment complexity and patient apprehension. Ambulatory devices for hemodialysis offer the potential for self-care treatment outside the clinical setting as well as frequent and prolonged sessions. This article explains the motivation for ambulatory hemodialysis and provides an overview of the necessary features of key technologies that will be the basis for new wearable and implantable devices. Early work by pioneers of hemodialysis is described followed by recent experience using a wearable unit on patients. Finally, ongoing efforts to develop an implantable device for kidney replacement and its potential for implantable hemodialysis are presented.

Home hemodialysis : is there still room for high dialysis solution flow rate ?

The availability in France, for the last decade, of low dialysate flow rate hemodialysis monitors, specifically adapted for daily hemodialysis (5 to 6 sessions per week), is contemporary with a real renewal of home hemodialysis. The clinical benefits of daily hemodialysis with high dialysate flow and of thrice-weekly long nocturnal hemodialysis, which are two intensive hemodialysis modalities, have been demonstrated ; however they are less well demonstrated with low dialysate flow hemodialysis. Thus, some patients may still wish to use conventional hemodialysis monitors in order to limit the number of sessions (and therefore the number of vascular punctures) to 3 per week (or every other day) or wish to benefit from a modality of intensive hemodialysis.

Baclofen Toxicity in a Chronic Kidney Disease Stage 5D Patient

The toxicity of Baclofen is extremely unusual. However, its predominant renal clearance makes its vulnerable in patients with impaired renal function. Clinical manifestations may begin as early as 2-3 days after starting the drug, even with a smaller dosage.A 73-year-old man with end-stage renal disease on maintenance hemodialysis was admitted to our emergency department with progressive confusion, hallucination and a generalized decrease in muscular tone. There was no significant metabolic or infectious etiology that could have clarified his condition. A thorough laboratory and imaging workup was negative too. A detailed history of his medication revealed that he had recently been prescribed baclofen for neck muscular spasm (10mg twice daily). He was then diagnosed with baclofen toxicity and was treated with intensive hemodialysis. During his admission, few sessions of hemodialysis on consecutive days, eventually produced expected clinical improvement and a complete return to his previous baseline mental status.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 54-56