James Tattersall

James Tattersall
National Health Service | NHS · Leeds Teaching Hospitals

MB,BS, MD

About

99
Publications
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4,436
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Publications

Publications (99)
Article
Full-text available
In haemodialysis, sodium and fluid balance (where intake matches loss) is achieved by ultrafiltration and by diffusion between the plasma water and dialysate. If a patient’s sodium intake does not change, any reduction in fluid gain obtained by lowering dialysate sodium concentration will result in less sodium removal by ultrafiltration. The corres...
Article
Full-text available
This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would n...
Article
Full-text available
Incremental haemodialysis has the potential to allow better preservation of renal function, is less invasive to the patient and has lower cost. Despite these advantages, it is not commonly applied. This may be due to uncertainty about how to account for renal function in the prescription of dialysis and measurement of dose. In this issue, Vartia de...
Article
Full-text available
Current guidelines for dialysis specify a minimum Kt/V. For haemodialysis (HD) patients, minimum treatment time and frequency is also specified. The guidelines allow for modification to take account of renal function. The guidelines are not specifically aimed at the elderly and may not be appropriate for all patients in this group. Increasing age i...
Article
The population of patients with moderate and severe CKD is growing. Frail and older patients comprise an increasing proportion. Many studies still exclude this group, so the evidence base is limited. In 2013 the advisory board of ERBP initiated, in collaboration with European Union of Geriatric Medicine Societies (EUGMS), the development of a guide...
Article
Current guidelines focus on conventional dialysis defined as 3–5 hours, three times per week, and suggest that longer or more frequent dialysis be considered. This paper presents the case for considering that shorter or less frequent dialysis should also be considered. More frequent and/or longer dialysis facilitates control of fluid overload, bloo...
Chapter
On-line haemodiafiltration differs from other forms of haemodialysis in that up to 20 L/h of dialysis fluid can be infused directly into the bloodstream during each treatment. That infused fluid must be free of chemical contaminants, sterile and pyrogen-free. Compliance with that requirement cannot be demonstrated by testing at the time of infusion...
Article
Full-text available
The current concept of an adequate dialysis based only on the dialysis process itself is rather limited. We now have considerable knowledge of uraemic toxicity and improved tools for limiting uraemic toxin accumulation. It is time to make use of these. A broader concept of adequacy that focusses on uraemic toxicity is required. As discussed in the...
Article
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In post-dilution online haemodiafiltration (ol-HDF), a relationship has been demonstrated between the magnitude of the convection volume and survival. However, to achieve high convection volumes (>22 L per session) detailed notion of its determining factors is highly desirable. This manuscript summarizes practical problems and pitfalls that were en...
Article
Low-grade proteinuria and systolic hypertension (SHT) are risk factors for allograft failure. Both are dynamic variables and their relationship is not independent. We have simultaneously analyzed the effects of proteinuria and SHT on graft outcomes in 805 adult Kidney Transplant Recipients and impact of their changes over time. Proteinuria and syst...
Article
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An international group of around 50 nephrologists and scientists, including representatives from large dialysis provider organisations, formulated recommendations on how to develop and implement quality assurance measures to improve individual hemodialysis patient care, population health and cost effectiveness. Discussed were methods thought to be...
Article
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Vitamin E (VE) bonded polysulfone dialysis membranes have putative erythropoiesis stimulating agent (ESA)-sparing and anti-inflammatory properties based on data from a small number of studies. We sought to investigate this in a large, prospective 12-month randomized controlled trial. Two-hundred and sixty prevalent haemodialysis (HD) patients were...
Article
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This paper provides an endorsement of the KDIGO guideline on acute kidney injury; more specifically, on the part that concerns renal replacement therapy. New evidence that has emerged since the publication of the KDIGO guideline was taken into account, and the guideline is commented on from a European perspective. Advice is given on when to start a...
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Article
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EUDIAL OBJECTIVE The general objective assigned to the EUropean DIALlysis (EUDIAL) Working Group by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) was to enhance the quality of dialysis therapies in Europe in the broadest possible sense. Given the increasing interest in convective therapies, the Working Group...
Article
For over thirty years urea clearance, quantified by Kt/V has been used as the rational basis to prescribe and quantify dialysis. The minimal level for adequacy has been defined at a Kt/V of around 1.2 for thrice weekly HD and 1.7 per week for peritoneal dialysis. While there have been significant improvements, dialysis still provides less than 10%...
Article
Unlike the majority of medical treatments, dialysis is defined by well-known physical processes and its effect can be predicted with mathematical certainty. The physical principles involved include the kinetic nature of heat, Brownian motion, diffusion and convection. These principles have been fully described by 19th and early 20th century scienti...
Article
Full-text available
Kidney International aims to inform the renal researcher and practicing nephrologists on all aspects of renal research. Clinical and basic renal research, commentaries, The Renal Consult, Nephrology sans Frontieres, minireviews, reviews, Nephrology Images, Journal Club. Published weekly online and twice a month in print.
Article
For over thirty years urea clearance, quantified by Kt/V has been used as the rational basis to prescribe and quantify dialysis. The minimal level for adequacy has been defined at a Kt/V of around 1.2 for thrice weekly HD and 1.7 per week for peritoneal dialysis. While there have been significant improvements, dialysis still provides less than 10%...
Article
Full-text available
Many anaemia management algorithms recommend changes to erythropoiesis-stimulating agent (ESA) doses based on frequent measurement of haemoglobin levels in keeping with the ESA datasheets. We designed a predictive anaemia algorithm based on ESA pharmacodynamics, which we hoped would improve compliance with haemoglobin targets and reduce workload. A...
Article
Background. Hydraulic permeability (KUF) is an intrinsic characteristic of dialysers, reported by the manufacturer as a single value, which drives and limits fluid removal. High-flux dialysers have been introduced with the appearance of convective techniques, aiming to increase fluid and solute removal. High convective volumes are being employed, a...
Article
Full-text available
Hemodialysis adequacy can be quantified using ultraviolet absorbance of the spent dialysate, or by analysis of dialysate conductivity at the dialyzer inlet and outlet in response to changes in dialysate electrolyte concentration. These measurements can be made at every dialysis, including initial and acute treatments and can help detect access reci...
Article
Late-onset proteinuria after renal transplantation has been universally associated with poor allograft outcomes. However, the significance of early low-grade posttransplant proteinuria remains uncertain. We analyzed the effect of proteinuria 3 months posttransplantation on death-censored graft loss, death with a functioning graft, vascular events w...
Article
Full-text available
The European Renal Best Practice (ERBP) Advisory Board recently decided to follow up existing guidelines, and to publish position statements when new evidence would necessitate a change in the existing guideline [1].The purpose of this document is to provide guidance on the interpretation and relevancy of the current European Best Practice Guidelin...
Article
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We examined the sensitivity of three different equivalent clearances to the spacing of haemodialysis treatments as well as to frequency. One would expect that a well-spaced schedule would be beneficial, and an optimal clearance measure should reflect this. Using a variable volume two-pool urea kinetic model, we derived clearances based on G [urea n...
Article
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Theoretical advantages exist of online hemodiafiltration (HDF) over high-flux hemodialysis (HD), but outcome data are scarce. Our objective was to compare outcomes between these modalities. We studied 858 incident patients in our incremental high-flux HD and online HDF program during an 18-yr period. We compared outcomes, including survival, in tho...
Article
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The disparities of medical practice, together with a growing number of possible interventions, have increased the demand for well-conceived guidance for practitioners [1]. However, this development is hampered by the number and quality of scientific studies that test medical hypotheses, which are often unsatisfactory. This is especially true in nep...
Article
Dialysis must control the body's fluid content accurately in order to maintain optimal health. The only commonly used, practical and objective measurements we have to guide fluid removal are very inaccurate. Recent study has validated bioimpedance (BIA) as an objective measure of fluid and nutritional status in dialysis patients. There are a number...
Article
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The availability of haemodialysis machines equipped with on-line clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume 'V' is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods....
Article
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Although medical guidelines generally are graded according to their evidence level, low evidence 'judgement' are generally perceived as much as absolute truth by the medical community as high evidence 'guidelines' are. Being aware of this bias, a workgroup appointed by the European Renal Association-European Dialysis and Transplantation Association...
Article
Middle molecules, consisting mostly of peptides and small proteins with molecular weight the range of 500-60,000 Da, accumulate in renal failure and contribute to the uraemic toxic state. &Bgr;2-Microglobulin (&Bgr;2-MG) with a molecular weight of 11,000 is considered representative of these middle molecules. These solutes are not well cleared by l...
Chapter
Most of the recent published data linking quality of care to survival in patients with renal failure have concentrated on the care given after the patient has started dialysis. However, many of the medical problems experienced by dialysis patients and causing death in the early years of dialysis, may be preventable by adequate care in the years bef...
Article
Full-text available
Middle molecules, consisting mostly of peptides and small proteins with molecular weight the range of 500-60,000 Da, accumulate in renal failure and contribute to the uraemic toxic state. Beta2-microglobulin (beta2-MG) with a molecular weight of 11,000 is considered representative of these middle molecules. These solutes are not well cleared by low...
Article
The discussion was initiated by a paper comparing the measurement of dialysis dose (Kt/V) and solute clearance using on-line ultra-violet absorbance, blood and dialysate urea and ionic dialysance by Uhlin et al (NDT 2006). Participants from 14 countries discussed the theory behind the UV absorbance technique and the potential for its use in routine...
Article
The discussion was initiated by a paper comparing the measurement of dialysis dose (Kt/V) and solute clearance using on-line ultra-violet absorbance, blood and dialysate urea and ionic dialysance by Uhlin et al (NDT 2006). Participants from 14 countries discussed the theory behind the UV absorbance technique and the potential for its use in routine...
Article
Full-text available
The discussion explored and expanded on the issues raised by Dasselaar et al in their review of the measurement of relative blood volume (RBV) changes during dialysis (NDT 2005). Dialysis machines incorporating blood volume monitoring and control are widely available in Europe. The use of continuous blood volume monitoring (CBVM) to help establish...
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Article
Kt/V can be calculated continuously during dialysis without blood samples using the ionic dialysance method. Unlike the usual method using blood samples, a precise value for the patients' urea distribution volume is required. This study compared different methods for the determination of urea distribution volume (V) to evaluate their use in Kt/V me...
Article
Patients on conventional hemodialysis lose residual renal function more rapidly than patients on continuous ambulatory peritoneal dialysis (CAPD). The effect of dialysis using synthetic membranes and ultrapure water is less clear. The decline of urea clearance was compared in a cohort of 475 incident end-stage renal failure patients who received tr...
Article
The effect of dialysis on patients is conventionally predicted using a formal mathematical model. This approach requires many assumptions of the processes involved, and validation of these may be difficult. The validity of dialysis urea modeling using a formal mathematical model has been challenged. Artificial intelligence using neural networks (NN...
Article
For the majority of the world population, any kind of dialysis technology is economically unfeasible [1]. Only in relatively few affluent countries is dialysis freely available to all ESRD patients. In the United Kingdom, for example, dialysis is seen as poor value for money [2] and has a low priority for healthcare spending. Most UK dialysis units...
Article
Full-text available
Urea rebound results as urea re-equilibrates between intracellular and intravascular compartments post haemodialysis. The mechanism of the rebound is thought to be due to either a reduced diffusion rate or blood flow. It is hypothesized that low blood flow in the skeletal muscles might be responsible. We tested this by studying the effect of exerci...
Article
Three approaches are currently used in kinetic models (UKMs) to account for the postdialysis rebound in urea concentration, and thereby accurately measure the hemodialysis dose, KT/V (where K, T, V denote dialyzer clearance, dialysis duration, and urea distribution volume, respectively). The approach developed by Smye uses an intradialytic sample t...
Article
In patients with kidney failure, adequate control of fluid status remains one of the most difficult routine issues to be addressed in the modern style of dialysis. This is primarily due to the lack of quantitative methods for the assessment of fluid status and the reliance on subjective criteria. Fluid is removed from the blood during dialysis trea...
Article
The occurrence of vitamin B12 (B12) deficiency in chronic haemodialysis patients and the need for its supplementation in these patients are still matters of debate. We measured serial predialysis serum B12 levels, at 3- to 6-month intervals, in 67 unselected patients on our high-flux haemodialysis programme. Over a 12-month period, there was a sign...
Article
Full-text available
The post-hemodialysis rebound: Predicting and quantifying its effect on Kt/V. Immediately after hemodialysis, the urea concentration rebounds upwards as urea continues to be transferred into the arterial circulation from peripheral body compartments. This rebound takes at least 30 minutes to complete. Hemodialysis is quantified as the Kt/V, calcula...
Article
Kidney International aims to inform the renal researcher and practicing nephrologists on all aspects of renal research. Clinical and basic renal research, commentaries, The Renal Consult, Nephrology sans Frontieres, minireviews, reviews, Nephrology Images, Journal Club. Published weekly online and twice a month in print.
Article
Over the past year, our PD unit has found metabolic alkalosis to have become a more common problem than metabolic acidosis. I assume it's related to the new low calcium dialysate now in use widely. Is this a common experience? Is there a danger from this (soft tissue calcifications, kidney stones, hypoxemia)?
Article
Blood urea and serum creatinine levels are important factors in deciding when to start dialysis. Recently, in the assessment of dialysis adequacy, emphasis has shifted from reliance on these parameters to use of kinetic methods. We therefore applied urea kinetic modelling (UKM) to 63 consecutive chronic renal failure (CRF) patients at the time dial...
Article
We studied 43 CAPD patients for 4 months during the change from a high-calcium dialysis fluid (Baxter PD1) to a low-calcium fluid (Baxter PD4), which also contained low magnesium (0.25 mmol/l) and high lactate concentrations (40 mmol/l). Serum calcium fell significantly as did the incidence of hypercalcaemia, whilst the proportion of patients takin...