Hemodialysis - Science topic

When should we use blood transfusion ? is there any cutoff point ? if there is not any , under which circumstances should we order blood transfusion under hemodialysis ?

in the other word is there any contraindication for hemodialysis with anemia if so , what is it ?

In the REDIAL project funded by Kidney research UK We are looking for a dynamic and talented early career researcher in the field of Computational Materials Science with a focus on Separation and Biomedical applications, who can effectively exploit Artificial Intelligence tools for the design of functional Materials and Sustainable Processes in the SusProM Group. https://www.suspromgroup.eng.ed.ac.uk/

Recently, Artificial Intelligence (AI) has transformed healthcare, including hemodialysis care. Do you believe that the future of hemodialysis treatment lies in artificial intelligence-driven technologies, which have the potential to significantly enhance patient outcomes and quality of life?

If yes, How and why?

There seems to be much previous interest in developing haemodynamic monitoring equipement, espcially non-invasive ones, for haemodialysis. However, there is not much over the last decade.

Can anyone give my an update on current practices and development?

how to calculate ktv?

Greetings,

I have two letters to the editor ready to submit. Do you know a professor who is skilled in the field of quality of life among patients undergoing hemodialysis?

Hello everybody. i have a question about standard ACD-A solution. how much citrate (mmol/L) does ACD-A solution contain? 75 mmol/L ? or 110 mmol/L? i could not understand it.

considering the blood transfusion reactions , what would be the recommendation for the safe rate to start PRBC transfusion during hemodialysis ? our current practice is to be given in 30 min to 1hour and in first 15 min 50ml /hour.

A young patient attempted suicide by taking 63 tabs of carbamazepine 200 mg. she was managed with CRRT - CVVH and discharged 10 days later well and couscous.

data supporting the use of hemodialysis in managing carbamazepine poisoning is increasing, so I am not sure if it is worth publishing or not ( if it has a chance to get accepted for publishing)

If it effect the flow and viscosity then how much it can effect in heart rate and blood pressure

Hemodialysis patients are covered by National Health Insurance in most countries. Those are direct costs. However, assessing the comprehensive cost-of-illness (COI) is a challenge for many researchers and practitioners.

Could anyone share the available tool, technique, or method to assess COI in hemodialysis patients?

Hepatitis C infection and chronic kidney disease are major health burden worldwide. Hepatitis C infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A strong association between hepatitis C and chronic kidney disease has come to light. Hemodialysis in supporting the end stage renal disease patients unfortunately carries a risk for hepatitis C infection. Despite much improvement in the care of this group of patients, the prevalence of hepatitis C infection in hemodialysis patients is still higher than the general population. Hepatitis C infection has a negative effect on the survival of hemodialysis and renal transplant patients.

I am currently working on my Thesis about the maximization of the delivered hemodialysis Dose and stumbled about the BoD and PoD techniques mentioned in "Hemodiafiltration: Technical and Clinical Issues" by Claudio Ronco (DOI: 10.1159/000437403).

Those ideas seem very promising to me but i can hardly find anything about BoD or PoD, unfortunately there are also remarks in the Paper itself.

Do you guys know any paper, clinicaltrial or similar, testing or mentioning those techniques?

Thanks in Advance!

Can anyone provide papers or links to research conducted on Metabolic Syndrome Status and Dietary Assessment in Hemodialysis Patients?

Thanks

I have worked on the prevalence of Occult hepatitis B among hemodialysis patient at Th-Qar city south of Iraq (paper in press) and I think this form of the disease represents a serious problem in view of spreading the infection in communities depending on serological methods especially in highly susceptible groups like blood donors or hemodialysis patients. this form of the disease which is serologically silent and can be easily missed can spread to the community. Additionally, the prevalence of occult hepatitis B usually in association with prevalence of overt hepatitis B. \thus now I'm working on review undertake the prevalence of occult hepatitis B infection among Arab countries if anyone like to contribute, please communicate with me

In the case of urgent/emergent hemodialysis, where the patient does not have an AV fistula in place, what is the best site to use for hemodialysis (e.g. internal jugular)?

which is associated with a lower risk of thrombosis? Which one is associated with less blood stream infection?

some article said "As other factors besides fluid overload, such as

sympathetic nervous activity, the renin-angiotensin system,

cardiac function and potentially the interdialytic weight

gain, also contribute to the genesis of arterial hypertension

in hemodialysis patients, it appears challenging to associate

the volume status with blood pressure" but the other article was said "Normally, volume overload and elevation of BP result in suppression of RAAS production." and the other said " Angiotensin (Ang) II and aldosterone, both circulating and produced locally in the heart, may contribute to cardiac remodelling in response to cardiac pressure and volume overload or myocardial infarction."

1. Is it the same explanation?

2. whichever occurs first, does the angiotensin level change first? or fluid overload first?

Hello Researchers',

I am working in computational fluid mechanics problems that investigate the effect of dialysate concentration and flow rate.

Q1: what is the maximum net osmotic pressure (MPa) that we can apply on membrane BC as driving force to the mass transfer along the membrane surface or maximum solute mass fraction for the dialysate (k_gsolute/kg_solvent)?

Q2: why the dialysis flow rate limited by 800 ml/min and some publishable journal used 1000 ml/min and not more than this flow rate?

Q3: what is the clearance of urea or uraemic toxin during one session of hemodialysis in (kg/m^2.hour)?

Thanks in advance for you and if you can provide me with a study/studies that have these pieces of information.

I am going on conducting a study to determine the Prevalence of Metabolic Syndrome (MetS) Among the End-Stage Renal Disease Patients on Hemodialysis in Gaza strip, Palestine, In your opinion; what is the best time to measure the metabolic syndrome criteria (which are: High waist circumference, elevated Fasting Blood Glucose, low high-density lipoprotein cholesterol, elevated triglycerides and elevated blood pressure)?

After my overviewing of many literature reviews; I found that:

1- Few studies measured all MetS criteria randomly.

2- Another one has measured it pre-dialysis.

But I think that I should measure it Pre and post dialysis, because hemodialysis may affect on these criteria (increasing or decreasing), I saw this effects on many studies in the literature which were conducted to evaluate the effect of hemodialysis on many biochemical parameters.

However, I think it will be more accurate if I measure these criteria pre-dialysis and post-dialysis, after that, I will calculate the mean of each parameter for both period, and based on these means I will identify the MetS.

What is your opinion my expert colleagues?

instrument to assess knowledge on self care management of chronic kidney disease under hemodialys

We are currently trying to standardise the assessment of haemodialysis extracorporeal blood circuits and filters when evaluating the correct dose of LMWH (fragmin) for haemodialysis patients. I am looking for a standardised assessment tool to score the level of clot formation in the above mentioned circuit and filter when haemodialysis is complete.

Does anyone know of an existing assessment tool?

Many thanks,

Johnny Hooper

Dialysis Unit

Horsens Hospital

Denmark

Hello, I am trying to set up an in-vitro experiment model for hemodialysis treatment. What is the average concentration of BUN, Crea, and Beta 2- microglobulin concentration observed in chronic renal failure patients?

"Utilization of haemodialysis services by End Stage Renal Disease patients"

questionairre on above or related topic.

Is there a study on it?

How to perform it ? 

Once per week, twice per week, once every 2 weeks?

The idea is : patient is already having UOP, of-course with exclusion of totally anuric, oliguric or HF patients.

SLEDD needs very low dialysate flow ( below 300 cc/min ). which dialysis machine can be adjusted for SLEDD ?

We did a study back in 2008 that showed using Remifentanyl infusion at 1/10 of the maintenance dose (usually at 0.01mcg/kg/min) till the end of the ENT procedure, patients were noticed to have smooth awakening, less coughing and bucking and better hemodynamics. Does anybody use this technique in his practice ?

is there any documented recommendation for disinfection of HBS+ hemodialysis machine ?

Hi

I am evaluating renal recovery pattern among non-dialysis dependent AKI patients especially among patients with AKIN-I and AKIN-II stage of AKI. I am bit confuse because my outcome is renal recovery but available literature has vast variation for definition of renal recovery.

Most of the studies have been done on critically ill patients requiring dialysis. But in my case, patients have mild to moderate severity of AKI. There is no patient with dialysis in my study. So definition of dialysis independence will be excluded. On the other hand, as in my study patients are not critically ill and have less severe stage of AKI, so defining AKI as +/-25% of baseline will show that all patients have full recovery. However, most of the patients have elevated levels of Serum creatinine as compared to baseline. and I am confuse to declare them as fully renal recovery patients because I can not ignore the findings of previous studies that "small increase in serum creatinine is associated with high morbidity and mortality"

Please guide me in this regard, with appropriate reference

There is no way for viral particles to pass through the dialyser pores so why we have isolated HBS+ hemodialysis machine ?

viral infection (HIV-HBV-HCV) in hemodialysis patients are common now the question is : is there any viral particles passage possibility from the pores of dialyser ?

Cardiovascular disease is a leading cause of death in patients with end-stage renal disease (ESRD). Hypertension is a major risk factor for cardiovascular complications in these patients. Angiotensin-converting enzyme (ACE) inhibitors are an effective treatment for hypertension in patients with ESRD and are known to improve prognosis in patients with chronic renal failure.

new recommendation please ?

I work on a haemodialysis unit in Denmark. We currently use metal needles to access AV fistulas for haemodialysis. I am curious to see if there is any convincing evidence for the use of plastic cannulas over trational metal dialysis needles,  for example reduced trauma, haemotomas and extravasion, increased longlevity of fistula,  reduced percieved pain, reduced incidence of needle-stick injuries in health care workers etc.

Many thanks Johnny Hooper

The setting such as QD - QB - Temperature - dialysor ?

Treatment of Thrombosis With Fondaparinux (Arixtra) in a PEDIATRIC Pateint With End-stage Renal Disease Receiving Hemodialysis Therapy

is there any research in this field ( the ways of correcting PH and Hco3 ) and the advantages and disadvantages ?

I'm looking for reimbursement information for the Japanese market. I'm also interested in the structure of reimbursement and also of the healthcare system in relation to dialysis - what is the split between private insurance and public funding.

the normal machine has no QD ( dialysate flow rate ) below 300cc/min . can we use normal machine to do SLEDD while SLEDD needs QD 100 to 200 cc/min ?

I mean who choose the best Ideal mode of RRT ( SLED - CRRT - IHD ) for the patients ? Is there any RRT team in your hospital or nephrologists reply the consultation ? or ICU men ? 

SLED : sustained low efficacy daily dialysis

CRRT : continuous renal replacement therapy

IHD : intermittent hemodialysis

If yes how long can we use isolated UF ?

and in isolated UF can we have reduction of BUN and Creatinine and potasium ?

A large number of admitted patients develop to AKI and need RRT ( renal replacement therapy ) . sometimes we should not move the patient to hemodialysis ward . is there any effective and mobile hemodialysis machine in your medical center ? if yes , what is he mark ?

Sever increase in serum iron for example in iron sucrose parenteral consumption for hemodialysis patients occasionally create iron toxicity. In this situation TIBC has false increase in colorimetric method.

We treat a young boy (13 year old) with severe hypeparatiroidism (PTH 1700) with paricalcitol 6 ug/week. In an adult we would organize parathyroidectomy. We have some doubt about its utility and safety in adolescent boys.

The patients with chronic renal failure have to undergo hemodialysis. These patients usually have AV fistula. The question is if the blood can be collected from this AV fistula on the beginning, during or after the end of hemodialysis in order to avoid further puncture of vein. I suppose that values like mineralogram or pH will be completely different between these two approaches. But what about drug levels? Does anyone know any study dealing with this issue?

Oncology ; Nephrology ; Intensive Care ; Hematology

can we clear a hemodialysis machine after one cycle use by a HBS+ patient ?

so that we can use the machine for HBS- patients ?

I have studied the immunological status in hemodialysis patients , I want to investigate such relation .

what is the differences in complications of Isolated UF and Hemodialysis ?

We use different concentrations of bicarbonate for each patient . How often should we check ABG (arterial blood gases)?

for age group >60 years old

I would like to know is it necessary to  have bacteremia  if patient is diabetic / is there any association between bacteremia and diabetic patients requiring hemodialysis? Can anyone provide me link related to this findings?

Is it possible to have bacteremia in non- diabetic patients more than diabetic patients who are under hemodilaysis course?

.

Thank you.

I am mainly looking at why we are experiencing flow problems with our catheters. Is it the brand of the catheter or is it the technique of inserting them?

Would standardizing coding utilizing accessory modifiers that better describe and discriminate dialysis-related hypotensive episodes improve risk prediction models, result in effective escalation and mitigation strategies, strengthen problem-solving approaches, enhance comparative research, and reduce repeat preventable harm to patients?

Validated research over time may prove that a more stratified hemodialysis hypotension classification will reliably predict impending doom, and effectively crack the code to prevent failure mode.

 A 59 yrs old Woman coming to Conventional hemodialysis session, presenting Itching since 2 week, resistant to habitual treat. Please any suggestions.

Calcium, Vit.D and phosphate balance is of critical importance in both health and disease. Particularly, patients who are undergoing haemodialysis, are prone to disturbances in calcium and phosphate homeostasis. What are the drugs that should be used with caution / and /or avoided in patients who are undergoing haemodialysis which may further compromise calcium and phosphate metabolism/equilibrium? 

What are the underlying mechanisms by which these drugs affect calcium homeostasis in haemodialysis patients? 

In one of my researches, I studied anxiety and depression in hemodialysis patients. But I want to know how much stress and depression can affect on CKD progress? What is your opinion or answer about this question?

Regards,

there are some types of fluid for hemofiltration .can we use ringer lactate as subsitution fluid?

Many problems occur in hemodialysis patient life style? Is there any qualitative study about hemodialysis patient life style?

Periodic testing for HDV infection by anti-HDV antibody in HBsAg positive carriers on chronic hemodialysis treatment is recommendable. Reduction of HBV infection in HD patients would be the best solution to control the HDV infection in HD patients. The transmission of HDV infection between HBV infected in HBs Ag positive carriers on chronic hemodialysis is very critical. Is dedication of HDV/HBV machines and infected patients in HD centers a standard strategy or not? It is obvious that the HDV infection in HD patients has been forgotten! There is an apparent lack of attempts to conduct more investigations and create definite protocols to reduce the incidence of HDV infection in HD patients. The global attempt should start soon. Tomorrow is too late!

is there a risk of transmission of hepatitis B from this patient if he is on negative HBsAG machine?

Raymond vanholder.

Or any topic near to patient to other patients education in chronic disease?

for example for a patient with bicarbonate level of 9 mmol and pH 6.80 how many bicarbonate profile can be useful and safe?

I check VBG and change the bicarbonate concentration for hemodialysis patients . How often should i check VBG . and how often should i change the bicarbonate concentration in dialysate fluid ?

I mean is it necessary to prescribe HBIG to other HBs Ag- patients? Or should inside of dialysis machine which has been used for HBs Ag+ patient be opened and washed?

In Nephrovit (the multivit tablet for dialysis patients ) there is only 500 micro gr to 800 micro gr folic acid but in some paper they recommend 5 to 15 mg folic acid per day . is there any need to add tab folic acid 5 mg to nephrovit or the folic acid in nephrovit is enough ?

Is there any differences between Isolated UF in hemodialysis  and SCUF and CVVH without subsittution in CRRT ?

if they need ZINC , how much ?

Can we relay on HIV Ab and HCV Ab result , to diagnose HIV and HCV while we know ESRD patients are immune compromised?

dialyzer size - pump speed - dialysate speed - max Ultrafiltration and the relation with sex - age - BMI and cardiac health 

Is there equal negative pressure ?

I have a patient with active ankylosing spondylitis(AS) and second (2007;2012) kidney transplantation (due to chronic glomerulonephritis). Ankylosing spondylitis is active with BASDAI . 5,5 -  6,0 during last 3 years, CRO changes from 11 - 25 mg/l (normal value 0 - 5 mg/l), spine ligament calcification has found in 3 cervical and lumbar spine ligaments  on X- ray. Due to kidney transplantation the patient use MMF and prednisolone. 

How much weight gain is acceptable between hemodialysis cycles for ESRD patients?

lower and upper limit of BP for starting hemodialysis?

Thanks for all the great replies from great Professors , I would like to give more information about that real life challenging case. 63 years old lady suffering of DM,HTN and ESRD on regular hemodialysis. She had a coronary stent(DES) 7 months before hospital admission.She presented to ER suffering of heamatemsis and melena and upper endoscopy done revealed reflux esophagitis.During hospital stay ECG showed depressed ST segment on v1-v3 leads and her serial troponin I showed rising levels but there was no chest pain. She was receiving aspirin , clopidogrel, statin , ACEi , B blocker and insulin. Upon examination she was HD stable , in sinus rhythm, with no evidence of heart failure or murmurs.

After stoppage of bleeding GRACE /Crusade scores were measured to assess risk of bleeding and that of cardiovascular events.She has 30% risk of death in 6 months on GRACE score and and risk of 30% of in hospital major bleeding. Conservative medical or early invasive therapy?

1)What do you think is the best management in this patient...keeping in mind that under treatment increases risk of death and cardiac complications with a probably stenosed coronary stent while aggressive treatment is associated with risk of death from significant bleeding.

2)Are there any guidelines or a consensus regarding management of such challenging cases ?

3)If you choose the medical therapy when can we start anticoagulants and platelets after stoppage of bleeding?

Waiting to hear  valuable inputs from my professors and colleagues....Thank you

The use of pre-blood fluid in the reduction of filter clotting in dialysis is well known, but it is also known to reduce the efficiency of the dialysis abilities.

Could you please explain how your unit overcomes the drawback of the use of pre-blood fluid, and how the use of Filtration Fraction determines the use of pre-blood fluid? Some units determine that pre-blood fluid is not needed if the Filtration Fraction is below 30%. 

Does this not then save the unit money if pre-blood fluid is not used? Also, it has been stated that in the use of Heparin in Dialysis, the APTT is irrelevant in the ability to stop the filter clotting off. What APTT therapeutic range does your unit run at?

Any information provided would be appreciated.

What is the real risk of central vein stenosis after short term renal replacement therapy in a critical care unit?

For the past two or three weeks, we've noted a number of cases of vascular access bleeding after dialysis. The dose of the anticoagulant used not changed.

What are the possible and common reasons for this?