Abstract:
:The profile of patients on chronic dialysis has shifted. There is a growing group of older patients with comorbid dementia and ESKD, who are at risk of overuse, underuse, and misuse of dialysis. Policy is lacking to help guide treatment decisions in this group. This paper explores clinical considerations specific to patients with comorbid ESKD and dementia. These include: the impact of comorbid dementia on dialysis effectiveness and feasibility; burden of care issues that are specific to patients with dementia; and capacity, autonomy, and consent. A better understanding of these issues may help guide discussions and decision making about treatment. For some older patients with multiple comorbidities including dementia, dialysis does not provide survival or quality of life benefit compared to medical management. These patients also experience additional treatment burden due to a 'dementia unfriendly' environment. However, exceptions may include patients who are younger, more independent, and have fewer comorbidities. Patients with dementia are often inappropriately assumed to lack capacity to participate in treatment decision making, and are at risk of having their preferences overlooked. Many patients with mild-to-moderate dementia remain capable of reporting their preferences and quality of life, and should always be involved in treatment discussions where possible.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
MacPhail A,Ibrahim JE,Fetherstonhaugh D,Levidiotis Vdoi
10.1111/sdi.12392subject
Has Abstractpub_date
2015-09-01 00:00:00pages
490-6issue
5eissn
0894-0959issn
1525-139Xjournal_volume
28pub_type
杂志文章,评审abstract::Although many nephrologists see value in maximizing clearance and time on dialysis, clinical trials have failed to show a clear and consistent benefit of increasing clearance above the minimum threshold level recommended in clinical practice guidelines or of increasing dialysis session length or frequency. Available e...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12938
更新日期:2020-11-01 00:00:00
abstract::We present a case of arteriovenous graft pseudoaneurysms treated endovascularly with stent grafts and make suggestions regarding the technique of evaluating the pseudoaneurysms and choosing the proper location to deploy the stent grafts to maximize the outcomes and minimize the length of the graft covered by the stent...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12142
更新日期:2014-03-01 00:00:00
abstract::In patients receiving hemodialysis, the provision of safe and effective vascular access using an arteriovenous fistula or graft is regarded as a critical priority by patients and health professionals. Vascular access failure is associated with morbidity and mortality, such that strategies to prevent these outcomes are...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12658
更新日期:2018-05-01 00:00:00
abstract::Cancer and kidney disease are linked by causality and comorbidities. Observational data show an increased risk of malignancy as renal function declines. Erythropoietin stimulating agents (ESAs), which are the cornerstone therapy for anemia patients with chronic kidney disease and cancer, are associated with increased ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12841
更新日期:2019-11-01 00:00:00
abstract::Bedside removal of tunneled hemodialysis catheters (TDC) by noninterventional Nephrologists has not been frequently performed or studied. We performed a retrospective review of bedside TDC removal at the University of Mississippi Medical Center between January, 2010 and June, 2013. We collected data on multiple patien...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12364
更新日期:2015-09-01 00:00:00
abstract::Leptin is mainly produced by adipocytes and metabolized in the kidney. Leptin is taken up into the central nervous system by a saturable transport system, and controls appetite in rodents and in healthy subjects. Leptin acts on peripheral tissue and increases the inflammatory response by stimulating the production of ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00334.x
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to perform a comparative analysis of peritoneal dialysis catheter (PDC) insertion between blind and surgical methods by nephrologists. PATIENTS AND METHODS:The present study enrolled 249 peritoneal dialysis patients who received first-time PDC insertion. All PDC insertions w...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12904
更新日期:2020-07-23 00:00:00
abstract::Malnutrition is a frequent complication in hemodialysis patients and is associated with increased mortality and morbidity. Interventions such as oral or intravenous nutritional supplements have often failed to improve nutritional status. We report here the effect that daily dialysis, practiced in our center since 1997...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.0894-0959.2004.17205.x
更新日期:2004-03-01 00:00:00
abstract::Many dialysis machines can compute dialyzer sodium clearances at multiple time points during a dialysis treatment using conductivity. For a given treatment, the average dialyzer sodium clearance (K), when combined with treatment time (t), and the estimated urea distribution volume (V, usually based on either anthropom...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12750
更新日期:2018-11-01 00:00:00
abstract::A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short- and long-term clinical success of banding in these patient groups. After evalua...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2008.00537.x
更新日期:2009-03-01 00:00:00
abstract::Dialysis-related amyloidosis (DRA) is a serious complication in long-term dialysis patients, and presents with carpal tunnel syndrome, cystic bone lesions, destructive spondylarthropathy, diffuse arthritis and periarthritis, systemic organ involvement, and dialysis-related spinal canal stenosis (DSCS). Recently a new ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2001.00031.x
更新日期:2001-03-01 00:00:00
abstract::Extracorporeal elimination of drugs and toxins is a critical component in the management of poisonings, though specific techniques and indications remain a matter of debate. Conventional hemodialysis is frequently the treatment of choice because of its widespread availability and proven effectiveness for certain drugs...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2006.00194.x
更新日期:2006-09-01 00:00:00
abstract::For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12691
更新日期:2018-05-01 00:00:00
abstract::Nephrologists offer renal replacement therapy (RRT) to patients who are unlikely to benefit in part because of our discomfort discussing goals of care in the setting of an uncertain prognosis for a given individual. Permanent neurological impairment, terminal illness (life expectancy <6 months), medical conditions pre...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12492
更新日期:2016-07-01 00:00:00
abstract::Patients on chronic hemodialysis have a shortened survival compared to the general population. There are multiple sources of morbidity and mortality unique to the dialysis population that account for this. Reasons include the effects of blood membrane interactions, intradialytic hypotension, myocardial stunning, exces...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12527
更新日期:2016-11-01 00:00:00
abstract::In this article we deal with three aspects of acidosis in patients with chronic renal insufficiency: clinical characteristics, pathophysiology, and therapeutic approach. ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2000.00064.x
更新日期:2000-07-01 00:00:00
abstract::Patients with end-stage renal disease are more likely to suffer from gastrointestinal (GI) problems, including bleeding from upper and lower sources. Peptic ulcer disease is the most common cause of upper GI bleeding, and although there is some debate in the literature regarding whether the frequency of ulcer disease ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12301
更新日期:2015-01-01 00:00:00
abstract::Dialysis is measured as Kt/V, which scales the dose (Kt) to body water content (V). Scaling dialysis dose to body surface area (S(dub)) has been advocated, but the implications of such rescaling have not been examined. We developed a method of rescaling measured Kt/V to S(dub) and studied the effect of such alternativ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2008.00482.x
更新日期:2008-09-01 00:00:00
abstract::Chronic unexplained inflammation remains a prevalent and clinically significant problem for patients with end-stage kidney disease (ESKD), especially in the dialysis population. The causes of persistent inflammation are likely to be multifactorial, but the underlying mechanisms remain to be elucidated. Endotoxins are ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12280
更新日期:2015-01-01 00:00:00
abstract::We describe the use of directional atherectomy (DA) to restore patency of a thrombosed polytetrafluoroethylene arteriovenous graft with an in-stent restenosis at the venous anastomosis. Technically, the procedure described is not an atherectomy per se, but rather the removal of fibrosis and intimal hyperplasia with sh...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2007.00418.x
更新日期:2008-05-01 00:00:00
abstract::Hemodialysis patients are susceptible to coronavirus disease 2019 (COVID-19). The aim of this study was to describe the epidemiological, clinical characteristics, and mortality-related risk factors for those who undergoing hemodialysis with COVID-19. We conducted a retrospective study. A total of 49 hemodialysis patie...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12928
更新日期:2020-10-29 00:00:00
abstract::Percutaneous peritoneal catheter insertion can be performed by trained nephrologists. The objective of this study was to compare the outcome of peritoneal dialysis (PD) catheters percutaneous inserted with the traditional surgical technique. One hundred twenty-one PD catheters were placed in 121 stage-5 Chronic kidney...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12147
更新日期:2014-05-01 00:00:00
abstract::Until the discovery of calcimimetics, the management of secondary hyperparathyroidism (SHPT) relied exclusively on treatment with phosphate binders, vitamin D derivatives or surgical parathyroidectomy with limited success. The therapeutic use of calcimimetic agents, together with a better understanding of the pivotal ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12357
更新日期:2015-09-01 00:00:00
abstract::The etiology and management of intradialytic hypotension has become an increasingly complex issue. Volume depletion due to ultrafiltration remains the predominant underlying etiologic factor. However, patients vary markedly in their hemodynamic tolerance to fluid removal. While many risk factors have been identified, ...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1046/j.1525-139x.2002.00002.x
更新日期:2002-05-01 00:00:00
abstract::Meta-analyses of the published literature are increasingly being used, allowing similar clinical trials to be combined quantitatively, thereby increasing the precision of the estimation of treatment effect. Four meta-analyses were recently published comparing the impact of dialysis membranes or dialysis modality on cl...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1046/j.1525-139x.2003.16071.x
更新日期:2003-09-01 00:00:00
abstract::The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12636
更新日期:2017-11-01 00:00:00
abstract::While vascular ultrasound (US) has been highlighted to detect vascular access stenosis, its accuracy in the identification of inflow stenosis (IS) (anastomosis and/or juxta-anastomotic area) compared with the gold standard (angiography) has not been evaluated. One hundred three consecutive fistulae referred for interv...
journal_title:Seminars in dialysis
pub_type: 临床试验,杂志文章
doi:10.1111/j.1525-139X.2009.00693.x
更新日期:2010-01-01 00:00:00
abstract::Few elderly patients with end-stage renal disease (ESRD) are treated with peritoneal dialysis (PD). Among dialysis patients >or=65 years of age reported by the U.S. Renal Data System (USRDS), the percentage treated with chronic peritoneal dialysis (CPD) is lower than in any other age group. To evaluate the effectivene...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1046/j.1525-139x.2002.00106.x
更新日期:2002-11-01 00:00:00
abstract::New advances in the pathogenesis of renal osteodystrophy (ROD) change the perspective from which many of its features and treatment are viewed. Calcium, phosphate, parathyroid hormone (PTH), and vitamin D have been shown to be important determinants of survival associated with kidney diseases. Now ROD dependent and in...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00300.x
更新日期:2007-07-01 00:00:00
abstract::Cardiac hypertrophy is a relatively common complication seen in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD). Moreover, cardiac hypertrophy is even more frequently seen in patients with ESRD who have an arteriovenous (AV) access. There has been substantial evidence pertaining ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12313
更新日期:2015-05-01 00:00:00