By C. Ronco, N.W. Levin
Reprint of: Blood Purification 2001, Vol. 19, No. 2 during this well timed book, a number of subject matters concerning ESRD are mentioned, together with vascular affliction and atherosclerosis in uremia, results of hemodialysis sufferers in numerous international locations, malnutrition in addition to oxidative rigidity and persistent irritation as probability elements for heart problems. furthermore, the potential for utilizing peritoneal dialysis as a primary therapy modality for ESRD is debated, including the advantages that could be completed with day-by-day dialysis. extra themes contain the main complicated strategies for electrolyte tracking and profiling in hemodialysis in addition to the remedy of acute renal failure, describing the recent acute dialysis caliber initiative. one other very important a part of this e-book is an issue on no matter if hemoglobin degrees in pre-ESRD and hemodialysis sufferers can be normalized or now not, by way of a dialogue of the capability long term advantages of a brand new expertise coupling hemoperfusion with hemodialysis, using a brand new sorbent machine. A definition of the true application of those applied sciences in day-by-day medical perform and whether or not they are economically cheaper with current compensation guidelines rounds off the shows. Being the second one quantity during this sequence (see additionally the volumes for the years 2000, 2002 and 2003), this publication is meant to function a syllabus for meetings in addition to an instructional software for fellows and citizens. even as, it offers a so much worthwhile replace on fresh perform and know-how for all physicians enthusiastic about the sector of hemodialysis.
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Additional info for Advances in End-Stage Renal Diseases 2001: International Conference on Dialysis Iii, Miami Beach, Fla., January 2001
Conclusions The task I was set was to provide a counter-argument to normalization of hemoglobin in renal failure patients. The case I have mounted draws on scientific data obtained from a number of the ‘normalization of hemoglobin’ studies in dialysis patients. The arguments include the fact that there is no evidence that a higher hemoglobin is of significant benefit, the epoetin dose requirements are greater, the cost is significantly greater, the requirements for iron supplementation are greater, there is an increased risk of vascular access clotting, there is less efficient dialyzer clearance of solute, there is an increased risk of clotting in the dialyzer, heparin requirements may increase, there is an exponential increase in whole blood viscosity, and some hemodialysis patients may develop significant hemoglobin overshoot partly due to fluid removal across dialysis.
Of note, the dropout rate in those with pCKD was low. The Canadian Multicenter Trial has also reported on QOL outcomes. At 24 and 48 weeks into the study, improvements in the Kidney Disease Questionnaire and the SF-36 subscales have been noted without a change in the Health Utilities Index. Importantly, normalization had least effect in those with LVH and greatest impact in those with LV dilatation. Changes in depression, fatigue and relationships were the subscales showing the most effect from normalization.
25 Amann K, Breitbach M, Ritz E, Mall G: Myocyte/capillary mismatch in the heart of uremic patients. J Am Soc Nephrol 1998;9:1018– 1022. 26 Rostand SG, Kirk KA, Rutsky EA: Dialysisassociated ischemic heart disease: Insights from coronary angiography. Kidney Int 1984; 25:653–659. 27 Saragoca MA, Canziani ME, Cassiolato JL, Gil MA, Andrude JL, Draibe SA, Martinez EE: Left ventricular hypertrophy as a risk factor for arrhythmias in hemodialysis patients. J Cardiovasc Pharmacol 1991;17(suppl 2):S136– S138.