Hemodialysis Unit

Pompeii, Italy

Hemodialysis Unit

Pompeii, Italy
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Marano M.,Hemodialysis Unit | Marano S.,University of Salerno | Gennari F.J.,University of Vermont
Nephrology Dialysis Transplantation | Year: 2017

Background: Acid-base assessments in hemodialysis patients have been limited almost entirely to measurements of total CO2 concentration, and assumptions have been made about the presence of acid-base disorders. To gain a fuller understanding of the acid-base status of stable hemodialysis patients, we analyzed measurements of pCO2, pH and HCO3 - obtained in a cohort of chronic stable hemodialysis patients over a 5-year period. Methods: We reviewed acid-base measurements taken pre-dialysis from fistula blood in 53 outpatients receiving hemodialysis thrice weekly between 2008 and 2012. In these patients, pH and pCO2 were measured using an onsite blood gas analyzer, and HCO3 - was computed. Relevant clinical and laboratory data were obtained from medical records. Factors affecting serum HCO3 - were identified. Simple and mixed acid-base disorders were diagnosed using accepted rules. Results: Serum HCO3 - was affected by age, normalized protein catabolic rate, interdialytic weight gain and length of interval between treatments. As expected, metabolic acidosis was the most common acid-base disorder, but respiratory acid-base disturbances, as simple or complex disorders, were found in 41% of the measurements. Respiratory alkalosis was seen more frequently than respiratory acidosis, but the latter disorder was more commonly associated with serious comorbidities. Conclusions: Respiratory acid-base disorders are an important component of the acid-base abnormalities seen in hemodialysis patients and are not identified by measuring total CO2 concentration; hence, complete acid-base measurements are needed to determine the components of hemodialysis patients' acid-base status that are contributing to mortality risk. © 2016 The Author.

Mallios A.,Institute Mutualiste Montsouris | Hebibi H.,Hemodialysis Unit | Hebibi H.,University Hospital | Jennings W.,University of Oklahoma
Journal of Vascular Access | Year: 2017

Background: Perioperative ultrasound performed by the operative surgeon can improve outcomes of vascular access surgery. We present the case of a patient referred for dysfunctional vascular access with two separate and patent right arm arteriovenous fistulas (AVF). Pre-operative ultrasound vessel mapping defined the complex anatomy and intraoperative ultrasound allowed the optimal surgical approach for access salvage while avoiding the need for catheter placement. Case report: A 45-year-old male patient of African descent presented with a malfunctioning right forearm AVF and aneurysm formation in the arm. Clinical examination revealed a soft, low-flow forearm fistula merging into a high-flow and pulsatile AVF outflow aneurysm in the arm. Multiple well healed surgical incisions were present. Ultrasound examination revealed two separate AVFs. One was a low-flow radiocephalic AVF at the wrist that was used routinely for cannulation in the forearm, although with some difficulty due to low inflow pressure. The second AVF, a brachiocephalic anastomosis, was pulsatile, aneurysmal, and not in use. Blood flow in the proximal brachial artery was 3.0 L/min. Surgeon-performed ultrasound (SP-US) was used perioperatively to plan the surgical approach and incision, closing the existing brachial anastomosis and creating a veno-venous anastomosis between both outflow veins, establishing a mature and undisturbed cannulation conduit from the wrist through the arm. The revised AVF was immediately usable for hemodialysis with restored normal AVF flow in the forearm and appropriately reduced flow in the arm. Importantly, dialysis catheter placement was avoided. © 2017 Wichtig Publishing.

Marano M.,Hemodialysis Unit | D'Amato A.,Hemodialysis Unit | Cantone A.,Bayview Physicians Group
Annals of Noninvasive Electrocardiology | Year: 2016

A chronic hemodialysis patient—known to have advanced interatrial block (IAB)—had reported symptoms suggesting arrhythmias, hence she underwent hemodialysis treatment while on the cardiac monitor. This allowed us to recognize the occurrence of paroxysmal atrial fibrillation and, in turn, disclose the first case of Bayés syndrome. Even though atrial fibrillation and IAB are very frequent in hemodialysis patients, Bayés syndrome, that comprehends both, has never been described, likely because the IAB is often overlooked and undiagnosed. This case could improve the awareness of IAB and of the Bayés syndrome in hemodialysis population. © 2016 Wiley Periodicals, Inc.

Seck S.M.,University Gaston Berger | Dahaba M.,Hemodialysis Unit | Ka E.F.,University Hospital Aristide Le Dantec | Cisse M.M.,University Hospital Aristide Le Dantec | And 2 more authors.
Nephro-Urology Monthly | Year: 2012

Background: Chronic kidney disease related mineral and bone disease (CKD-MBD) is a worldwide challenge in hemodialysis patients. In Senegal, number of dialysis patients is growing but few data are available about their bone disorders. Objectives: To describe patterns of CKD-MBD in Senegalese dialysis patients. Patients and Methods: We performed a cross-sectional study including patients from three dialysis centres in Senegal. Diagnosis of different types of CKD-MBD relied on clinical, biological and radiological data collected from medical records in dialysis. Results: We included 118 patients and 79 of them presented CKD-BMD (prevalence of was 66.9 %). Mean age of CKD-MBD patients was 47.8 ± 15.7 years (16-81 years) and sex-ratio (Male/Female) was 1.15. Secondary hyperparathyroidism was the most frequent disorder (57 patients) followed by adynamic bone disease (21 patients) and osteomalacia (1 patients). The main clinical manifestations were bone pain (17.5% of cases), pruritus (36.8% of cases) and pathological fractures (2.5% of cases). Bone biopsy was not available. Valvular and peripheral vascular calcification were present in 24.5% and 21.2% of patients respectively. Management of CKD-MBD included optimization of dialysis, calcium bicarbonate, sevelamer, vitamin D analogues and calcimimetics. The NKF/DOQI recommended levels of serum calcium, phosphate and parathormone PTH were not achieved in one third of patients. Six patients presented major cardiovascular events during their dialysis period. Conclusions: CKD-MBD are frequent in Senegalese hemodialysis patients and they are dominated by high turn-over disease. Clinical and biological manifestations are unspecific and accurate diagnoses are often difficult in absence of histomorphometry. Treatment is suboptimal for many patients in a context of limited resources. © 2012 Nephrology and Urology Research Center and Baqiyatallah University of Medical Sciences.

Dousdampanis P.,Hemodialysis Unit | Trigka K.,Hemodialysis Unit | Fourtounas C.,University of Patras
Hemodialysis International | Year: 2014

Magnesium is as an essential metal implicated in numerous physiological functions of human cells. The kidney plays a crucial role in magnesium homeostasis. In advanced chronic kidney disease, serum magnesium levels are increased. Data from experimental and observational studies suggest that low levels of magnesium are associated with several factors, such as insulin resistance, diabetes, oxidative stress, hypertension, atherosclerosis, and inflammation which are implicated in the progression of chronic kidney disease. Moreover, low levels of magnesium have been correlated with cardiovascular disease and all-cause mortality in end-stage renal disease patients. Hypomagnesemia has also been associated with poorer renal allograft and transplant recipients' outcomes. The causality of these relationships has not been completely elucidated. A thorough review of the current literature indicates that low magnesium levels in dialysis patients may reflect a poorer nutritional status and/or are the result of systemic inflammation. Further studies in chronic kidney disease and dialysis patients are needed in order to clarify the causality of these associations. © 2014 International Society for Hemodialysis.

Dousdampanis P.,Hemodialysis Unit | Trigka K.,Hemodialysis Unit | Musso C.G.,Hospital Italiano Of Buenos Aires | Fourtounas C.,University of Thessaly
Renal Failure | Year: 2014

The role of uric acid (UA) on the pathogenesis and progression of chronic kidney disease (CKD) remains controversial. Experimental and clinical studies indicate that UA is associated with several risk factors of CKD including diabetes, hypertension, oxidative stress, and inflammation and hyperuricemia could be considered as a common dominator linking CKD and cardiovascular disease. Notably, the impact of serum UA levels on the survival of CKD, dialysis patients, and renal transplant recipients is also a matter of debate, as there are conflicting results from clinical studies. At present, there is no definite data whether UA is causal, compensatory, coincidental or it is only an epiphenomenon in these patients. In this article, we attempt to review and elucidate the dark side of this old molecule in CKD and renal transplantation. © 2014 Informa Healthcare USA, Inc. All rights reserved.

Morabito S.,Hemodialysis Unit | Pistolesi V.,Hemodialysis Unit | Tritapepe L.,University of Rome La Sapienza | Fiaccadori E.,University of Parma
Clinical Journal of the American Society of Nephrology | Year: 2014

Hemorrhagic complications have been reported in up to 30% of critically ill patients with AKI undergoing RRT with systemic anticoagulation. Because bleeding is associated with significantly increased mortality risk, strategies aimed at reducing hemorrhagic complications while maintaining extracorporeal circulation should be implemented. Among the alternatives to systemic anticoagulation, regional citrate anticoagulation has been shown to prolong circuit lifewhile reducing the incidence of hemorrhagic complications and lowering transfusion needs. For these reasons, the recently published Kidney Disease Improving Global Outcomes Clinical Practice Guidelines for Acute Kidney Injury have recommended regional citrate anticoagulation as the preferred anticoagulation modality for continuous RRT in critically ill patients in whom it is not contraindicated. However, the use of regional citrate anticoagulation is still limited because of concerns related to the risk of metabolic complications, the complexity of the proposed protocols, and the need for customized solutions. The introduction of simplified anticoagulation protocols based on citrate and the development of dialysis monitors with integrated infusion systems and dedicated software could lead to the wider use of regional citrate anticoagulation in upcoming years. Copyright © 2014 by the American Society of Nephrology.

Shemesh D.,Hemodialysis Access Center | Olsha O.,Hemodialysis Access Center | Goldin I.,Hemodialysis Access Center | Danin S.,Hemodialysis Unit
Contributions to Nephrology | Year: 2015

The role of dialysis patients in ensuring their own safety throughout the process of vascular access construction should be far from negligible. Patients can make important contributions to their safety starting in the predialysis stage, via vascular access construction and through the experience of chronic hemodialysis. Currently, patients assume a passive role and their empowerment requires both patients and caregivers to overcome many personal and cultural barriers, thus encouraging safety-related behavior. There are many opportunities for end-stage renal failure patients to be involved in every stage of their disease. In this chapter, we discuss how hemodialysis patients can participate in patient safety, including some of the main opportunities for involvement along the care pathway from the point at which the decision is made that the patient requires vascular access surgery. © 2015 S. Karger AG, Basel.

PubMed | Hemodialysis Unit
Type: Journal Article | Journal: Hippokratia | Year: 2016

The aim of the study was to determine the effect of oral N-acetylcysteine (NAC) on levels of serum oxidative stress biomarkers in hemodialysis patients.Forty eight hemodialysis patients were administered NAC orally for six months. Hematological, biochemical parameters and levels of asymmetric dimethylarginine (ADMA), malondialdehyde (MDA), myeloperoxidase (MPO) and nitrogen oxide (NO) were determined prior to and upon completion of the study period.At the end of the study period white blood cells, neutrophil percentage and C-reactive protein levels were significantly lower. Uric acid, albumin and hemoglobin were significantly higher compared to pre-treatment values. Statistically significant increase in NO, and decrease in MDA and ADMA levels were observed. Serum MPO demonstrated a measurable decrease trend, though not significant.It is suggested that treatment with NAC appears to be associated with restoration of important parameters of antioxidant defence and reduction in the levels of mediators of oxidative cellular damage. Hippokratia 2015; 19 (2):131-135.

PubMed | Hemodialysis Unit
Type: Journal Article | Journal: World journal of transplantation | Year: 2016

Kidney transplantation is recognised as the most effective treatment for patients with end-stage renal disease (ESRD). Kidney transplantation continues to face several challenges including long-term graft and patient survival, and the side effects of immunosuppressive therapy. The tendency in kidney transplantation is to avoid the side effects of immunosuppresants and induce immune tolerance. Regulatory T-cells (Tregs) contribute to self-tolerance, tolerance to alloantigen and transplant tolerance, mainly by suppressing the activation and function of reactive effector T-cells. Additionally, Tregs are implicated in the pathogenesis of diabetes, which is the leading cause of ESRD, suggesting that these cells play a role both in the pathogenesis of chronic kidney disease and the induction of transplant tolerance. Several strategies to achieve immunological tolerance to grafts have been tested experimentally, and include combinations of co-stimulatory blockade pathways, T-cell depletion, in vivo Treg-induction and/or infusion of ex-vivo expanded Tregs. However, a successful regimen that induces transplant tolerance is not yet available for clinical application. This review brings together certain key studies on the role of Tregs in ESRD, diabetes and kidney transplantation, only to emphasize that many more studies are needed to elucidate the clinical significance and the therapeutic applications of Tregs.

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