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Zhao Y.,Peking Union Medical College | Yan B.,Endoscopy Center | Zhao Z.,Hemodialysis Center | Wang S.,Kaiser Permanente | Weng X.,Peking Union Medical College
Renal Failure | Year: 2016

Introduction Cardiovascular disease is an important factor in the mortality and morbidity of patients with end-stage renal disease receiving hemodialysis. Although mineralocorticoid receptor antagonists may have potential benefits on the cardiovascular system, their safety for patients on hemodialysis remains unclear, considering the differences between the results of already performed clinical trials. Methods MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and PubMed databases were searched for relevant clinical trials. The Cochrane Collaboration assessment tool was employed to evaluate the quality of the randomized controlled trials. Revman 5.3 was used to perform the meta-analysis. Results Eleven studies (n=379) were included in the systematic review and five randomized controlled trials were included in the meta-analysis (n=248). Mineralocorticoid antagonists (MRAs) did not increase predialysis potassium levels significantly (0.11, 95% confidence interval-0.03 to 0.25, p = 0.11). However, the studies included in this review reported inconsistently with respect to effects of mineralocorticoid receptor antagonists on blood pressure, left ventricular ejection fraction and left ventricular hypertrophy, and quantitative analysis was not performed due to insufficient data. One trial showed that the mineralocorticoid receptor antagonists were associated with decreased carotid intima-media thickness and other articles concluded that mineralocorticoid receptor antagonists had no effect on aortic stiffness. Conclusion It is safe to use low dose mineralocorticoid receptor antagonists on patients receiving hemodialysis, at the end of each session of hemodialysis, and close monitoring of serum potassium levels and possible side effects is necessary. The cardiovascular actions still need to be explored and large scale RCTs are in progress. © 2016 Taylor & Francis.


Sessa C.,University Hospital Grenoble | De Lambert A.,University Hospital Grenoble | Pirvu A.,University Hospital Grenoble | Palacin P.,Hemodialysis Center | Pichot O.,University Hospital Grenoble
Contributions to Nephrology | Year: 2015

Hand ischemia is rare but complex and multifactorial. Distal arteriopathy below the vascular access (VA) is responsible in the vast majority of patients and not a problem of high flow of the VA. Therefore, surgical technique should focus on improving blood flow and pressure instead of reducing blood flow. We present an overview of the standard techniques which are recommended to treat VA-induced hand ischemia. The banding techniques, most of which empirical and not codified, have been abandoned by the majority of the authors because of a high rate of failure and reintervention. Ligation may be necessary in patients with severe ischemia and diffuse arterial lesions and in case of ischemic monomelic neuropathy. © 2015 S. Karger AG, Basel.


Wu C.-C.,Hsinchu General Hospital | Wu C.-C.,National Yang Ming University | Wen S.-C.,Hsinchu General Hospital | Wen S.-C.,National Yang Ming University | And 5 more authors.
Atherosclerosis | Year: 2010

Objective: The aim of the study was to evaluate the role of atherosclerosis risk factors and baseline inflammatory status in the development of restenosis after successful percutaneous transluminal angioplasty (PTA) of hemodialysis arteriovenous (AV) fistulas. Research design and methods: We obtained baseline plasma biochemistry and inflammatory markers in 140 patients with dysfunctional AV fistulas before the PTA procedures. Patients were followed clinically for 6 months. Results: There was no significant difference in the baseline inflammatory markers between the restenosis and patency group. The Kaplan-Meier analysis showed that non-diabetic patients had higher patency rate than diabetic patients (69% vs. 48%, p=0.02) and diabetic patients with optimal glycemic control had higher patency rate than patients with suboptimal glycemic control (61% vs. 30%, p=0.01). Conclusions: The presence of diabetes mellitus predicted restenosis of AV fistulas after PTA and optimal blood glucose control might be critical to the patency after PTA. © 2009 Elsevier Ireland Ltd.


Lu S.-C.,National Taiwan University Hospital | Chen S.-I.,Nephrology Division | Huang S.-J.,Hemodialysis Center | Su L.-H.,National Taiwan University Hospital
Journal of Nursing and Healthcare Research | Year: 2010

Background: This study was designed to analyze relationships among blood test results, sleep disturbance, depression and quality of life in hemodialysis patients. A total of 114 hemodialysis patients treated at a local teaching hospital in Central Taiwan participated. Methods: Using a cross-sectional descriptive correlational approach, the researcher employed several questionnaires, including WHOQOL-BREF, Beck depression inventory-II, Pittsburgh sleep quality index and PSQI to obtain study data. Statistical analysis was performed using SAS 9.0. Results: Sleep quality: female and diabetic patients suffered from relatively more severe sleep disturbance. Patient hematocrit, calcium, cholesterol, sodium, ferritin, parathyroid hormone and uric acid levels were all highly correlated to sleeping disorders. Depression severity: 60% of hemodialysis patients suffered from depression. HDL, TG, Na and UA serum levels correlated positively to depression severity (p < .05). Quality of life: participants earned the highest scores in the environmental profile and lowest scores in the social profile. Lower levels of education, diabetes and blood test result abnormalities were found to relate positively to patient quality of life. Severity of participant sleep disturbance and depression were highly related to life quality (p < .05). Conclusions: Participant variables and blood test result abnormalities were found to affect sleep quality, depression severity and life quality. Life quality was also found to affect sleep quality and depression severity. This research was intended to provide guidance to nursing staff to adjust doctors' orders and diet, weight control and daily care recommendations in order to improve nursing care quality and patient life quality during hemodialysis treatment.


Nakae H.,Akita University | Eguchi Y.,Shiga University of Medical Science | Yoshioka T.,Nishi Kyoto Hospital | Yoshimura N.,Otsu Municipal Hospital | Isono M.,Hemodialysis Center
Therapeutic Apheresis and Dialysis | Year: 2011

Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside of the hollow fibers. A prospective, multicenter study was undertaken to evaluate the changes in biochemical examination of blood and the 28-day and 90-day survival rates of patients with postoperative liver failure (PLF). Eleven patients with PLF were studied with the therapy performed 98 times. The Model for End-Stage Liver Disease (MELD) score was categorized into three grades: 20-29, 30-39, and 40 or higher. The survival rate was assessed by the severity of MELD score. The 28-day survival rate was 45.5% and that at 90days was 27.3%. The levels of total bilirubin, BUN, and creatinine decreased significantly after treatment. On the other hand, the levels of total protein increased after treatment and those of albumin did not change significantly. PDF may be the useful blood purification therapies for use in cases of PLF in terms of medical economics and the removal of water-soluble and albumin-bound toxins. © 2011 International Society for Apheresis.

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