Abstract:
:Mounting evidence supports a strong association between fluid management and outcomes among individuals receiving maintenance hemodialysis. The speed of fluid removal during dialysis (ultrafiltration, UF) is a modifiable aspect of fluid management that has attracted recent attention as a potential performance measure for facility fluid management practices. Observational data support an association between higher UF rates and adverse outcomes. This association is supported by the plausible pathophysiologic rationale of hypoperfusion-induced ischemic injury to the heart and other end-organs. However, no published clinical trial has studied the impact of lowering UF rates on clinical and patient-centered outcomes. Lowering UF rates requires interdialytic weigh gain reduction and/or extension of dialysis time. Weight gain reduction has proven difficult despite nutritional programs focused on salt and fluid restrictions, and patients are generally averse to longer treatment times. Thus, imposition of UF rate limitations may lead to failed target weight achievement and volume expansion over time. Despite these potential unintended consequences, the National Quality Forum endorsed an UF rate clinical performance measure in 2015. Prior to implementation of quality measure-imposed UF rate limitations, prospective studies of UF rates and outcomes are needed.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Flythe JEdoi
10.1111/sdi.12529subject
Has Abstractpub_date
2016-11-01 00:00:00pages
425-434issue
6eissn
0894-0959issn
1525-139Xjournal_volume
29pub_type
杂志文章abstract::Peritoneal dialysis (PD) is a markedly underutilized modality for permanent renal replacement therapy in the United States owing to a low rate of patient referral and high rate of patient dropout or transfer to hemodialysis. One cause for patient loss from PD is problematic PD catheters that often are removed rather t...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2006.00148.x
更新日期:2006-03-01 00:00:00
abstract::Dysfunction of arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) contribute significantly to morbidity and hospitalization in the dialysis population. Despite advances in endovascular techniques, the incidence of vascular access stenosis remains problematic. Currently, the role of endovascular stent placemen...
journal_title:Seminars in dialysis
pub_type: 杂志文章,meta分析
doi:10.1111/sdi.12314
更新日期:2015-05-01 00:00:00
abstract::Analysis of tissues, plasma, urine, other body fluids, and dialysate for glycation adducts has revealed the presence of two major forms: glycation adduct residues of proteins and related glycated amino acids--called glycation free adducts. The major effect on protein glycation in uremia is loss of clearance of glycati...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2009.00589.x
更新日期:2009-07-01 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
abstract::Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit-site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2001.00014.x
更新日期:2001-01-01 00:00:00
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 p...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12392
更新日期:2015-09-01 00:00:00
abstract::Hemodialysis patients have multiple risk factors for small vessel cerebrovascular disease and cognitive dysfunction. Hemodialysis itself may cause clinically significant neurological injury through repetitive cerebral ischemia. However, supporting evidence to date consists of epidemiological associations, expert opini...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1111/sdi.12679
更新日期:2018-05-01 00:00:00
abstract::While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential ...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/sdi.12483
更新日期:2016-09-01 00:00:00
abstract::Secondary hyperparathyroidism almost universally accompanies end-stage renal disease (ESRD). In some, but not all studies, elevated serum parathyroid hormone (PTH) concentrations are associated with increased fracture rates, cardiovascular disease, and mortality in ESRD. The serum concentration of PTH required for opt...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/sdi.12457
更新日期:2016-05-01 00:00:00
abstract::Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure-specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12937
更新日期:2020-12-09 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::As suggested by its American brand name (Sensipar), the calcimimetic cinacalcet sensitizes the parathyroid cells to the extracellular calcium signal, suppressing parathyroid hormone (PTH) release and synthesis and preventing parathyroid cell proliferation. This primary PTH suppression decreases the release of calcium ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2005.18318.x
更新日期:2005-05-01 00:00:00
abstract::In addition to extracorporeal renal replacement strategies, which in chronic kidney disease (CKD) are largely reserved for the treatment of end-stage kidney failure, conservative measures can be taken to reduce concentration, effects, or both concentration and effects of uremic retention solutes. In this overview, we ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2009.00600.x
更新日期:2009-07-01 00:00:00
abstract::In the United States, presently there are more than 50,000 patients with end-stage renal disease (ESRD) awaiting a cadaveric kidney and each year less than a quarter receive kidney transplantation. Although the real incidence in unknown, a significant number of these patients die due to lack of dialysis access. While ...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1046/j.1525-139x.2002.00001.x
更新日期:2002-01-01 00:00:00
abstract::Recent studies have shown that patients with high peritoneal transport characteristics have substantially increased morbidity and mortality. This finding is counter-intuitive, since HTs will a priori achieve higher clearances. There are many possible causes: increased protein losses with consequent hypoalbuminemia; po...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2000.00051.x
更新日期:2000-05-01 00:00:00
abstract::Severe hypothermia is defined as a core body temperature <28°C and is associated with in-hospital mortality rates of 50% or higher. Delays in rewarming and slower rates of rewarming are the most important prognostic factors associated with increased mortality. Arrhythmias are the most common cause of mortality in pati...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12156
更新日期:2014-05-01 00:00:00
abstract::Nephrogenic systemic fibrosis has now been linked to gadolinium-based contrast exposure in those with compromised kidney function. When present, symptoms can be quite devastating for the patient including severe pain and immobility. Unfortunately there is a lack of a universally effective therapy at this time and the ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00407.x
更新日期:2008-03-01 00:00:00
abstract::Dialysis providers are increasingly being presented with progressively older and frailer patients, in all healthcare settings from the acute hospital to the community dialysis center. These patients commonly bring more than kidney failure with them, with a complex constellation of chronic illness, comorbidity, and fun...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12027
更新日期:2012-11-01 00:00:00
abstract::This review aims to summarize the available evidence of the effectiveness of oral iron in patients receiving dialysis. Four small randomized controlled trials (105 evaluated patients) compared oral iron supplements with placebo or no treatment; hemoglobin and ferritin levels did not differ significantly between groups...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1111/sdi.12149
更新日期:2014-01-01 00:00:00
abstract::Hyperkalemia is common in patients with end-stage renal disease, and may result in serious electrocardiographic abnormalities. Dialysis is the definitive treatment of hyperkalemia in these patients. Intravenous calcium is used to stabilize the myocardium. Intravenous insulin and nebulized albuterol lower serum potassi...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00312.x
更新日期:2007-09-01 00:00:00
abstract::Arteriovenous fistula (AVF) nonmaturation is currently a significant clinical problem; however, the mechanisms responsible for this have remained unanswered. Previous work by our group and others has suggested that anatomical configuration and the corresponding hemodynamic endpoints could have an important role in AVF...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2012.01112.x
更新日期:2013-03-01 00:00:00
abstract::Although monitoring of vascular accesses by physical examination is nearly as sensitive as surveillance measurements by vascular access pressure when performed by examiners, the frequency of examinations is limited by time. We developed intravascular access pressure surveillance as a surrogate to physical examination....
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2010.00755.x
更新日期:2010-09-01 00:00:00
abstract::Dialysis patients are at high risk for fracture, with published rates in excess of a 20% probability of fracture over the next 10 years of dialysis. Unfortunately, there is no accepted methodology for quantifying this risk in advance of the first fracture; conventional bone densitometry performs unreliably in this rol...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/j.1525-139X.2010.00817.x
更新日期:2011-01-01 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::The 180 l of glomerular filtrate formed each day contain some 1100 g (2.5 pounds) of sodium chloride, of which only 5-10 g are excreted in the urine--95% is reabsorbed by the tubules. Some 425 g (nearly a pound) of sodium bicarbonate and 145 g of glucose are filtered, and more than 99% of both are reabsorbed. Also fil...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2010.00788.x
更新日期:2010-11-01 00:00:00
abstract::This article reviews the pharmacokinetic characteristics of calcitriol, paricalcitol, and doxercalciferol, and provides an overview of the metabolism of vitamin D. Calcitriol and paricalcitol have similar pharmacokinetic profiles, with terminal half-lives ranging from 5 to 10 hours in healthy subjects to 15-30 hours i...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2002.00086.x
更新日期:2002-09-01 00:00:00
abstract::The control of serum phosphorus by dialysis is made difficult by the fact that intradialytic blood levels tend to be low, and because phosphorus is removed almost exclusively from the plasma during its passage through the dialyzer. The most practical way to increase phosphorus removal is to extend dialysis time, altho...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12439
更新日期:2015-11-01 00:00:00
abstract::Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Although numerous modifiable risk factors in the pathogenesis of CVD and its associated mortality have been identified, dyslipidemia remains to be a key focus for therapy. In this regard, significant progress has been made in reducing ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12706
更新日期:2018-07-01 00:00:00
abstract::Measurements of the concentration of parathyroid hormone (PTH) in serum or plasma are used widely for the initial diagnostic assessment of patients with renal bone disease, to monitor disease progression, and to gauge responses to treatment. Several analytical methods are used to measure plasma PTH levels, and a varie...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1111/j.1525-139X.2007.00230.x
更新日期:2007-01-01 00:00:00
abstract::Concern over the inherent inefficiency of solute removal by conventional peritoneal dialysis (PD) has led to renewed interest in continuous flow PD (CFPD). We present clinical data from two experiences with CFPD. In the first, two catheters were used to recirculate a fixed intraperitoneal volume through an external ci...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1046/j.1525-139x.2001.00099.x
更新日期:2001-09-01 00:00:00