Browse Ideas with tag 'dialysis':

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  ESRD/DIALYSIS »

  Vaccination Outcomes in ESRD

  Reports from the general population indicate improved hospitalization and/or mortality outcomes associated with influenza +/- pneumococcal vaccination. Annual flu vaccine is recommended but pneumococcal vaccine booster is only recommended at 5 years, without regard for waning titers. Because pulmonary infection is a major source of morbidity and mortality in ESRD, it may be worthwhile to do a cluster-randomized clinical ...more »

  Reports from the general population indicate improved hospitalization and/or mortality outcomes associated with influenza +/- pneumococcal vaccination. Annual flu vaccine is recommended but pneumococcal vaccine booster is only recommended at 5 years, without regard for waning titers. Because pulmonary infection is a major source of morbidity and mortality in ESRD, it may be worthwhile to do a cluster-randomized clinical trial comparing outcomes from patients who receive re-vaccination for pneumococcus based on protective titers vs. standard practice - with all patients in each arm receiving flu vaccine annually.

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  Submitted by Eduardo Lacson 2 years ago

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  Forearm Wearable Artificial Kidney Breakthrough

  “World Conference on Portable-Wearable and Miniaturized Systems for Dialysis and Ultrafiltration” was hosted recently in Vicenza by Prof. Claudio Ronco. Many points of view were expressed over three days. Prominent, to my mind, were wearable and daily and nightly hemodialyses. Either 168 hours/week wearable or 48 hours/week nightly would supply vastly greater time on dialysis. Unobtrusive, under the sleeve forearm ...more »

  “World Conference on Portable-Wearable and Miniaturized Systems for Dialysis and Ultrafiltration” was hosted recently in Vicenza by Prof. Claudio Ronco. Many points of view were expressed over three days. Prominent, to my mind, were wearable and daily and nightly hemodialyses. Either 168 hours/week wearable or 48 hours/week nightly would supply vastly greater time on dialysis. Unobtrusive, under the sleeve forearm wearable, might offer even greater mobility and cost savings (nursing and real estate as well as only two disposables/week). Based on accessing A/V pressure and flow via InSitu Debranched Vein Fistula Graft (VFG). Alternating transcutaneous pressure over isolated vein results in arterial pressure upstream and venous pressure downstream. Eliminates most, if not all, electrical pumps and so encourages high degree of miniaturization. Modulation of extracorporeal blood flow to 20-40 ml/min permits full anticoagulation through the device, resulting in no more than prophylactic anticoagulation of the ambulatory patient. 2,4,8 hour sorbent cartridges or other technologies. Numerous other applications to artificial pancreas, liver, congestive heart failure, phereses. Interesting choice between (1) Early resort to un-intimidating wearable (2) Still restrictive daily or nightly or (3) Transplantation?

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  Submitted by Arnold Lande' 2 years ago

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  Time on Dialysis

  Over 2000 patients nationwide are now on in-center nocturnal hemodialysis with anecdotally improved outcomes reported. It provides a great opportunity for experimentation because it allows for productive use of potential additional capacity of an outpatient facility. In this setting, patients may be randomized to 4 hours vs. 8 hours of nocturnal treatment, 3x/week. NIH may need to consider to compensate dialysis staff ...more »

  Over 2000 patients nationwide are now on in-center nocturnal hemodialysis with anecdotally improved outcomes reported. It provides a great opportunity for experimentation because it allows for productive use of potential additional capacity of an outpatient facility. In this setting, patients may be randomized to 4 hours vs. 8 hours of nocturnal treatment, 3x/week. NIH may need to consider to compensate dialysis staff and patients as incentive to participate.

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  Submitted by Eduardo Lacson 2 years ago

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  Hemodiafiltration with no replacement fluids or special machines

  Since we started using the hollow fiber dialyzer more than 3 decades ago the only change we had was in the membrane quality. A change in the dialyzer design will allow the separation of the plasma ultrafiltrate from other blood components in one compartment then dialyze each component separately in the second compartment. This will result in marked increase in the convective forces that cannot be achieved by regular dialysis ...more »

  Since we started using the hollow fiber dialyzer more than 3 decades ago the only change we had was in the membrane quality. A change in the dialyzer design will allow the separation of the plasma ultrafiltrate from other blood components in one compartment then dialyze each component separately in the second compartment. This will result in marked increase in the convective forces that cannot be achieved by regular dialysis but only by some form of hemodiafiltration. No special replacement fluid is required and no change in the dialysis machine or procedure is required.All what is needed is pure water.

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  Submitted by Noshi Ishak 2 years ago

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  Uremia: What are we treating ? Does size of molecules matter?

  Three types of uremic retention solutes have been described using a classification based on characteristics that influence their dialysis clearance: small water-soluble compounds, protein-bound compounds, and middle-molecules. Small water-soluble compounds are easily removed by diffusion and have an upper molecular weight of 500 D. Protein-bound solutes are hydrophobic compounds that bind to proteins, most commonly albumin. ...more »

  Three types of uremic retention solutes have been described using a classification based on characteristics that influence their dialysis clearance: small water-soluble compounds, protein-bound compounds, and middle-molecules. Small water-soluble compounds are easily removed by diffusion and have an upper molecular weight of 500 D. Protein-bound solutes are hydrophobic compounds that bind to proteins, most commonly albumin. . Middle molecules have a molecular weight higher than 500 D and the classic middle molecule has been beta2-microglobulin and β2M was the middle molecule marker used in the HEMO Study. Substances with lower molecular masses may behave as MM’s because of steric configurations, electric charge, hydrophobicity, or binding to plasma proteins. The recently completed FHN study did not directly address what solute is critical to improving outcomes since volume, phosphate, and small molecule clearance would be improved by daily dialysis. What are we treating with dialysis? What should be the targets of therapy or the marker of adequate dialysis? If we are going to have artificial kidneys, what should these kidneys remove? Does middle molecule clearance matter? It seems to me that a great deal of work is done by the EuTox group in describing more and more potential toxins, but there is little clarity on what we are treating with dialysis.

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  Submitted by Mark Unruh 2 years ago

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  IS AKI Modifiable by dialysis

  What is the true value of dialytic support. There seems to be a fixed outcome regardless of dialysis dose/technique. Thus what is the true value of dialytic support in AKI outcome OR is AKI merely a indicator of poor outcome overall, and dialysis impact is merely at the 4-5% level?

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  Submitted by Emil Paganini 2 years ago

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  Should LDOs become ACOs for ESRD care?

  What are the implications for costs, quality and access to care if large dialysis organizations become Accountable Care Organizations for ESRD patients?

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  Submitted by Manjula Kurella Tamura 2 years ago

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  Early versus late dialysis?

  For patients with AKI, should dialysis be started early versus late? How should early and late be defined - based on novel biomarkers, volume status, or "conventional" parameters (eg, BUN/Cr)?

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  Submitted by Kathleen Liu 2 years ago

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