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Murviel-lès-Montpellier, France

Morena M.,Biochemistry Laboratory | Morena M.,Montpellier University | Morena M.,Dialysis Research and Training Institute | Jaussent I.,French Institute of Health and Medical Research | And 15 more authors.
Hemodialysis International | Year: 2010

This prospective observational study aimed at evaluating efficacy and biocompatibility performances of the new heparin-coated Evodial dialyzers with/without systemic heparin reduction. After a 4-week wash-out period with reference polysulfone F70S dialyzers, 6 hemodialysis patients were sequentially dialyzed with Evodial, F70S, and Evodial dialyzers using 30% heparin reduction, each period of treatment was 4 weeks. Removal rates (RR) (urea, creatinine, and β2-microglobulin), dialysis dose, and instantaneous clearances (urea and creatinine) were measured as well as inflammatory (C-reactive protein, fibrinogen, interleukin 6, tumor necrosis factor α, and monocyte chemoattractant protein-1) and oxidative stress (OS) (superoxide anion, homocysteine, and isoprostanes) parameters at the end of each study period. Patients treated with Evodial or F70S dialyzers for 4 weeks presented comparable dialysis efficacy parameters including urea and creatinine RR, dialysis dose and instantaneous clearances. By contrast, a significantly lower but reasonably good β2-microglobulin RR was achieved with Evodial dialyzers. Regarding biocompatibility, no significant difference was observed with inflammation and OS except for postdialysis monocyte chemoattractant protein-1 which significantly decreased with Evodial dialyzers. Thirty percent heparinization reduction with Evodial dialyzers did not induce any change in inflammation but led to an improvement in OS as demonstrated by a decrease in postdialysis superoxide production and predialysis homocysteine and isoprostane. This bioactive dialyzer together with heparin dose reduction represents a good trade-off between efficacy and biocompatibility performance (improvement in OS with a weak decrease in efficacy) and its use is encouraging for hemodialysis patients not only in reducing OS but also in improving patient comorbid conditions due to lesser heparin side effects. © 2010 The Authors. Hemodialysis International © 2010 International Society for Hemodialysis.

Peters S.A.E.,University of Oxford | Peters S.A.E.,University Utrecht | Bots M.L.,University Utrecht | Canaud B.,Dialysis and Intensive Care Unit | And 17 more authors.
Nephrology Dialysis Transplantation | Year: 2016

Background Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials (RCTs) comparing HDF with conventional HD on all-cause and cause-specific mortality in end-stage kidney disease (ESKD) patients reported inconsistent results and were at high risk of bias. We conducted a pooled individual participant data analysis of RCTs to provide the most reliable evidence to date on the effects of HDF on mortality outcomes in ESKD patients. Methods Individual participant data were used from four trials that compared online HDF with HD and were designed to examine the effects of HDF on mortality endpoints. Bias by informative censoring of patients was resolved. Hazard ratios (HRs) and 95% confidence intervals (95% CI) comparing the effect of online HDF versus HD on all-cause and cause-specific mortality were calculated using the Cox proportional hazard regression models. The relationship between convection volume and the study outcomes was examined by delivered convection volume standardized to body surface area. Results After a median follow-up of 2.5 years (Q1-Q3: 1.9-3.0), 769 of the 2793 participants had died (292 cardiovascular deaths). Online HDF reduced the risk of all-cause mortality by 14% (95% CI: 1%; 25%) and cardiovascular mortality by 23% (95% CI: 3%; 39%). There was no evidence for a differential effect in subgroups. The largest survival benefit was for patients receiving the highest delivered convection volume [>23 L per 1.73 m2 body surface area (BSA) per session], with a multivariable-adjusted HR of 0.78 (95% CI: 0.62; 0.98) for all-cause mortality and 0.69 (95% CI: 0.47; 1.00) for cardiovascular disease mortality. Conclusions This pooled individual participant analysis on the effects of online HDF compared with conventional HD indicates that online HDF reduces the risk of mortality in ESKD patients. This effect holds across a variety of important clinical subgroups of patients and is most pronounced for those receiving a higher convection volume normalized to BSA. © 2015 The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Azar A.T.,MISR University for Science and Technology | Canaud B.,Dialysis and Intensive Care Unit
Studies in Computational Intelligence | Year: 2013

The function of the dialysis system is to eliminate toxic wastes products, to restore internal milieu composition and to correct extracellular fluid overload. When complete renal failure occurs, the use of an artificial kidney is required. An artificial kidney is a machine that provides a means for removing uremic toxins from the blood and adding deficient components to it (e.g., bicarbonate, calcium). This is done using the principle of dialysis. There are two types of dialysis treatment: peritoneal dialysis (PD) and hemodialysis (HD). The peritoneal dialysis (PD) uses the abdominal cavity and its largely perfused serous membrane as a built-in dialyzer by creating and renewing periodically an artificial ascites. PD is a simple and safe technique that does not imply an extracorporeal blood circuit and usually performed at home. The hemodialysis and its related techniques are a much more complex and risky procedure that requires an extracorporeal blood circuit. HD is usually performed in hemodialysis facilities (center, self-care) but may be alternatively performed at home after training. Hemodialysis machines deliver a patient's dialysis prescription by controlling blood and dialysate flows through the dialyzer. In addition, they incorporate monitoring and alarm systems that protect the patient against adverse events that may arise from equipment malfunction during the dialysis treatment. This chapter will focus on essential principles of hemodialysis, the major components of HD machines and their respective monitoring devices. © 2013 Springer-Verlag Berlin Heidelberg.

Canaud B.,Dialysis and Intensive Care Unit | Canaud B.,Dialysis Research and Training Institute | Vallee A.G.,Dialysis and Intensive Care Unit | Molinari N.,UMR 729 MISTEA | And 12 more authors.
PLoS ONE | Year: 2014

Background and Objectives: Protein-energy wasting is common in long-term haemodialysis (HD) patients with chronic kidney disease and is associated with increased morbidity and mortality. The creatinine index (CI) is a simple and useful nutritional parameter reflecting the dietary skeletal muscle protein intake and skeletal muscle mass of the patient. Because of the complexity of creatinine kinetic modeling (CKM) to derive CI, we developed a more simplified formula to estimate CI in HD patients. Design, Setting, Participants & Measurements: A large database of 549 HD patients followed over more than 20 years including monthly CKM-derived CI values was used to develop a simple equation based on patient demographics, predialysis serum creatinine values and dialysis dose (spKt/V) using mixed regression models. Results: The equation to estimate CI was developed based on age, gender, pre-dialysis serum creatinine concentrations and spKt/V urea. The equation-derived CI correlated strongly with the measured CI using CKM (correlation coefficient = 0.79, p-value <0.001). The mean error of CI prediction using the equation was 13.47%. Preliminary examples of few typical HD patients have been used to illustrate the clinical relevance and potential usefulness of CI. Conclusions: The elementary equation used to derive CI using demographic parameters, pre-dialysis serum creatinine concentrations and dialysis dose is a simple and accurate surrogate measure for muscle mass estimation. However, the predictive value of the simplified CI assessment method on mortality deserves further evaluation in large cohorts of HD patients. © 2014 Canaud et al.

Kwizera A.,Makerere University | Kwizera A.,Dialysis and Intensive Care Unit | Tumukunde J.,Makerere University | Ssemogerere L.,Makerere University | And 6 more authors.
BioMed Research International | Year: 2016

Introduction. Acute kidney injury (AKI) is a common occurrence in the intensive care unit (ICU). Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD) in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT) is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU. Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients' demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality. Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2-17.5, p = 0.028), mechanical ventilation (OR 13.063; 95% CI 2.3-72, p = 0.003), and need for vasopressors (OR 16.8; 95% CI 3.4-82.6, p = 0.001) had statistically significant association with mortality. Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available. © 2016 Arthur Kwizera et al.

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