ABSTRACT
BACKGROUND: Serial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain. METHODS: We studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion. RESULTS: Compared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90-1.40] for AUC > 0-0.5, 1.26 (95% CI 0.99-1.62) for AUC > 0.5-1, 1.44 (95% CI 1.11-1.86) for AUC > 1-2 and 2.03 (95% CI 1.53-2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target). CONCLUSIONS: We conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO's recommendation of serial assessment of phosphorus to guide clinical decisions.
Subject(s)
Cardiovascular Diseases/mortality , Phosphorus/blood , Renal Dialysis/adverse effects , Aged , Area Under Curve , Cardiovascular Diseases/blood , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Female , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Prospective Studies , Survival RateABSTRACT
Covid-19 is a disease caused by a new coronavirus presenting a variability of flu-like symptoms including fever, cough, myalgia and fatigue; in severe cases, patients develop pneumonia, acute respiratory distress syndrome, sepsis and septic shock, that can result in their death. This infection, which was declared a global epidemic by the World Health Organization, is particularly dangerous for dialysis patients, as they are frail and more vulnerable to infections due to the overlap of multiple pathologies. In patients with full-blown symptoms, there is a renal impairment of various degrees in 100% of the subjects observed. However, as Covid-19 is an emerging disease, more work is needed to improve prevention, diagnosis and treatment strategies. It is essential to avoid nosocomial spread; in order to control and reduce the rate of infections it is necessary to strengthen the management of medical and nursing personnel through the early diagnosis, isolation and treatment of patients undergoing dialysis treatment. We cover here a series of recommendations for the treatment of dialysis patients who are negative to the virus, and of those who are suspected or confirmed positive.
Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Renal Dialysis , Renal Insufficiency, Chronic/therapy , COVID-19 , Coronavirus Infections/diagnosis , Early Diagnosis , Humans , Pneumonia, Viral/diagnosis , Renal Insufficiency, Chronic/virology , SARS-CoV-2Subject(s)
Arteriovenous Shunt, Surgical/methods , Renal Dialysis/methods , Renal Insufficiency/therapy , Vascular Access Devices , Anesthesia/methods , Antibiotic Prophylaxis/methods , Anticoagulants/therapeutic use , Blood Loss, Surgical , Blood Vessel Prosthesis , Catheters, Indwelling , Clinical Decision-Making , Constriction, Pathologic/prevention & control , Exercise Therapy/methods , Extremities/blood supply , Graft Occlusion, Vascular , Humans , Intraoperative Complications/prevention & control , Ischemia/prevention & control , Multimodal Imaging/methods , Needles , Nursing Care/methods , Peripheral Nervous System Diseases/prevention & control , Physical Examination/methods , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Care/methods , Postoperative Complications/prevention & control , Preoperative Care/methods , Recurrence , Referral and Consultation , Skin Care/methods , Surgical Instruments , Surgical Wound Infection/prevention & control , Sutures , Thrombosis/prevention & control , Time Factors , Ultrasonography, Interventional/methods , Vascular Surgical Procedures/educationABSTRACT
NxStage System One is a new dialytic technology based on easy setup, simplicity of use and reduced dimensions, which is increasingly in use worldwide for home hemodialysis treatments. The system utilizes a low amount of dialysate, usually 15-30 liters according to anthropometric patients' values. The dialysate is supplied at very low flux, generally about 1/3 of blood flow, in order to obtain an elevated saturation of dialysate for solutes. In these conditions the clearance of urea will be almost equal to dialysate flow rate. In order to achieve an obptimal weekly clearance evaluated by Std Kt/V the dialysis sessions are repeated six times a week. In this way a good control of blood voleme can be reached. In this paper we report our experience of treatment with NxStage System One in 12 patients from May 2011 to Dicember 2016.
Subject(s)
Hemodialysis, Home/instrumentation , Adult , Aged , Antihypertensive Agents/therapeutic use , Blood Volume , Caregivers/psychology , Comorbidity , Equipment Design , Erythropoietin/therapeutic use , Female , Hemodialysis Solutions , Hemodialysis, Home/adverse effects , Hemodialysis, Home/methods , Hemodialysis, Home/statistics & numerical data , Humans , Italy , Kidney Failure, Chronic/therapy , Male , Metabolic Clearance Rate , Middle Aged , Patient Satisfaction , Retrospective Studies , Urea/bloodABSTRACT
Nutrition is a critical issue in the management of patients with stage 5 chronic kidney disease (CKD). Malnutrition is common among these patients and affects their survival and quality of life. A basic knowledge of the nutritional management of stage 5 CKD is essential for all members of the nephrology team to improve patient care. This paper demonstrates that the needs of haemodialysis patients are more complex than those receiving peritoneal dialysis.
Subject(s)
Kidney Failure, Chronic/diet therapy , Malnutrition/diet therapy , Nutritional Status , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Malnutrition/etiology , Nutritional Requirements , Renal DialysisABSTRACT
Pain is an unpleasant sensory and emotional experience and is the most common symptom experienced by renal patients. It can be caused by primary co-morbid diseases, renal replacement therapies, medication or treatment side effects, and its intensity varies from moderate to severe. Pain management in renal patients is difficult, since the distance between pain relief and toxicity is very small. This paper will provide an algorithm for pain management proposed using paracetamol, nonsteroid anti-inflamatory drugs (NSAIDs), mild and stronger opioids as well as complementary techniques. Quality of Life (QoL) and overall enhancement of the patient experience through better pain management are also discussed. To improve pain management it is essential that nurses recognise that they have direct responsibilities related to pain assessment and tailoring of opioid analgesics and better and more detailed education.
Subject(s)
Pain/prevention & control , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/complications , Adult , Aged , Aged, 80 and over , Analgesics/adverse effects , Analgesics/therapeutic use , Female , Humans , Male , Nurse's Role , Pain/drug therapy , Pain/epidemiology , Pain/etiology , Pain Measurement/methods , Palliative Care , Patient Acceptance of Health Care , Quality of LifeABSTRACT
The discussion was initiated by a paper on the influence of a pre-dialysis education programme on the mode of renal replacement therapy by Goovaerts et al (NDT 2005). Barriers to the uptake of self-care treatment modalities, including late referral, limited availability of treatment options, reimbursement, support from staff and families, the requirement for a helper and the length of the training programmes for home haemodialysis (HD) were discussed by 21 participants from 12 countries. The 'take-home' messages from the discussion were that to optimise the uptake of self-care modalities, renal units should try to ensure the all patients who are able to choose are fully informed before starting dialysis, even if they are referred to the unit very late. Offering a wide range of treatment options to new patients, and allowing (or encouraging) home HD without a helper, may also increase the number of patients who start and stay on a self-care modality. It should be possible to provide an acceptable level of training, without compromising on safety, within 3 weeks if the patient is confident with needling.