Abstract:
:There has been a dramatic, worldwide expansion in life expectancy across the last century. This has resulted in a progressively more elderly and comorbid population. It is increasingly recognized that healthcare in this group needs to move to the concept of "adding life to years". Recognition and assessment of frailty is vital in changing our approach in elderly patients. Current guidelines in dialysis have a limited evidence base across all age groups, but particularly the elderly and serve them poorly. Moreover, the burden of guidelines for each comorbidity of the multimorbid patient is increasing and can be conflicting. Finally, there is increasing evidence relating to the harm associated with the delivery of conventional dialysis. In dialysis patients, frailty is the overwhelming determinant in relation to patient-specific outcomes rather than modality of treatment; therefore, the focus should be on promoting quality of life. We need to focus on new priorities of care when we design guidelines "for people not diseases". Patient-centered goal-directed therapy, arising from shared decision making between physician and patient, should allow adaption of the dialysis regime to maximize opportunities while minimizing treatment-related morbidity and concentrating on alleviating symptoms.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Corbett RW,Brown EAdoi
10.1111/sdi.12744subject
Has Abstractpub_date
2018-11-01 00:00:00pages
607-611issue
6eissn
0894-0959issn
1525-139Xjournal_volume
31pub_type
杂志文章,评审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::There are numerous patient, provider, and health system barriers to accessing kidney transplantation. Patient barriers such as sociocultural and clinical characteristics and provider factors such as provider knowledge and awareness of transplantation play important roles in facilitating transplant. Health system facto...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12860
更新日期:2020-01-01 00:00:00
abstract::Calciphylaxis, a disorder of dermal arteriolar calcification with a distinct predilection for patients with advanced kidney disease, remains an enigmatic condition that challenges clinicians. Observations regarding positive associations between levels of circulating parathyroid hormone (PTH) and the risk of calciphyla...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12502
更新日期:2016-07-01 00:00:00
abstract::Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12586
更新日期:2017-05-01 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::Elderly individuals comprise an ever-increasing proportion of patients on renal replacement therapy (RRT). As in younger patients, cardiovascular events are the major cause of death in the elderly on RRT, although the relative proportion succumbing to cardiovascular events is similar to that in young patients. An impo...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2002.00037.x
更新日期:2002-03-01 00:00:00
abstract:INTRODUCTION:Protein-energy wasting (PEW) is common in hemodialysis patients and is linked with a high rate of morbidity and mortality. Regarding importance of nutrition in these patients, a recent study was administered to evaluate the nutritional status of hemodialysis patients. MATERIALS:In this cross-sectional stu...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12917
更新日期:2020-10-14 00:00:00
abstract::The rationale of temperature control during hemodialysis (HD) is to prevent heat accumulation, which increases body temperature and enhances hypotensive susceptibility. Treatments where thermal energy is neither delivered nor removed from the patient through the extracorporeal circulation (so-called extracorporeal the...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2003.16103.x
更新日期:2003-11-01 00:00:00
abstract::Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis pa...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12194
更新日期:2014-09-01 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::Recombinant human erythropoietin (rHuEPO, epoetin) revolutionized the treatment of anemia in patients with chronic kidney disease (CKD) when it was approved for use in the United States in 1989. Among dialysis patients, the mean hemoglobin (Hb) in patients undergoing dialysis rose from 7-8 g/dl prior to 1989 to 11-12 ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2005.18105.x
更新日期:2005-01-01 00:00:00
abstract::The role of peritoneal dialysis (PD) as a modality in renal replacement therapy has been well established. In this article we review various aspects in the evolution of PD, with special emphasis on adequacy. Until the late 1950s PD was still considered as a last resort in the treatment of terminal uremia. The introduc...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2001.00071.x
更新日期:2001-07-01 00:00:00
abstract::Congestive heart failure (CHF) is highly prevalent in patients on renal replacement therapy and is a leading cause of death in such patients. Several studies suggest that therapeutic agents for the treatment of CHF, particularly angiotensin converting enzyme inhibitors and beta-blockers, are underused in end-stage ren...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/j.1525-139X.2007.00313.x
更新日期:2007-09-01 00:00:00
abstract::Presternally exiting peritoneal dialysis (PD) catheters have been described as advantageous compared to abdominally exiting catheters with regard to infection, wound healing, and other complications. Placement of such catheters has only been described with open surgical techniques and not by percutaneous means. In thi...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.0894-0959.2004.17356.x
更新日期:2004-09-01 00:00:00
abstract::Patients on hemodialysis are physically inactive. Less than 50% of hemodialysis patients undertake exercise once a week and such patients have increased mortality compared to patients who undertake regular exercise. The reasons for physical inactivity and reduced functional capacity are complex and inter-related, with...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12789
更新日期:2019-07-01 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::Elderly ESRD patients often lose functionality when they start dialysis, which may be due to a variety of clinical problems. We recently postulated that intensive (longer and/or more frequent) hemodialysis (HD) may be the ideal strategy to try to prevent these ESRD- and dialysis-related complications, including dialys...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12011
更新日期:2012-11-01 00:00:00
abstract::The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined methodology, the subgr...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12227
更新日期:2014-07-01 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::The End-Stage Renal Disease (ESRD) program now serves approximately 675,000 individuals in the United States at a cost of $26.1 billion to the Medicare system. Given the size of this population, healthcare providers from all disciplines will deliver care to patients on dialysis. Mortality remains high among patients o...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12671
更新日期:2018-03-01 00:00:00
abstract::Over the past decade, patients returning to dialysis after a failed transplant comprised of 5-10% of the annual number of dialysis initiations in the United States, whereas retransplant candidates account for 5.0-13% of the annual deceased donor wait-list additions. The United States Renal Data System (USRDS) database...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2011.00864.x
更新日期:2011-05-01 00:00:00
abstract::National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines recommend Doppler ultrasound (DU) for surveillance of vascular access (VA), but trials have not been unanimous about its benefit on VA patency. The aim of this study was to evaluate the accuracy of DU for patency, as well as t...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12334
更新日期:2015-03-01 00:00:00
abstract::Hyperkalemia contributes significantly to high mortality among ESRD patients. Excess intake and inadequate removal are the most common etiologies in HD patients. Although dialysis is the definitive treatment, classical medical therapy must be employed as a temporizing measure to acutely lower serum potassium. Reducing...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12272
更新日期:2014-11-01 00:00:00
abstract::Pulmonary hypertension (PH) is a progressive, fatal pulmonary circulatory disease that accompanies many conditions (including left to right side shunt) with compensatory elevated cardiac output. PH also complicates chronic hemodialysis (HD) therapy immediately after the creation of an arteriovenous (AV) access, even b...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2006.00186.x
更新日期:2006-09-01 00:00:00
abstract::Vancomycin, a glycopeptide antibiotic, has remained a popular antimicrobial agent throughout the past five decades, and is often included in empiric antibiotic regimens. With gram-positive coverage, it has found a niche in the treatment of methicillin-resistant Staphylococcus aureus. Although vancomycin has been in ex...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00333.x
更新日期:2008-01-01 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::Why do functional assessments in patients with end-stage renal disease (ESRD) matter? Multiple studies show that new dialysis patients undergo a substantial decline among activities of daily living. Moreover, poor functional status in ESRD patients is associated with early morality. That is why CMS has developed new c...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12466
更新日期:2016-03-01 00:00:00
abstract::Acute kidney injury (AKI) is common in patients with multiple myeloma (MM), most commonly caused by cast nephropathy resulting from precipitation of free light chains (FLC) in renal tubules. AKI may be irreversible and require dialysis and predicts a poor prognosis. Reduction in serum FLC concentration is thought to b...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/j.1525-139X.2010.00814.x
更新日期:2011-01-01 00:00:00
abstract::Hemodialysis patients with failed upper extremity (arm) access sites comprise 5-10% of the dialysis population. In these patients, arm vessels are either unsuitable for access placement due to trauma or peripheral vascular disease, or have been exhausted following dialysis usage. Synthetic grafts in the lower extremit...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/j.1525-139X.2009.00613.x
更新日期:2009-09-01 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