Hemodialysis international
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Case Reports
Central venous stenosis in a transplant patient due to thyroid pathology: A teachable moment.
Central venous stenosis is a well-recognized complication of central venous catheter use in hemodialysis patients, which may present with significant swelling of the upper limbs, neck, and face. Here, we describe a renal transplant recipient previously on hemodialysis, who underwent endovascular intervention for central venous stenosis after presenting with facial swelling and exertional dyspnoea. ⋯ Ruling out the possible mimics of central venous stenosis is important in preventing unnecessary intervention. This case highlights the role of specialty bias in the process of diagnosis.
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Recently, prolonged intermittent renal replacement therapies (PIRRT) have emerged as cost-effective alternatives to conventional CRRT and their use in the pediatric population has started to become more prominent. However, there is a lack of consensus guidelines on the use of PIRRT in pediatric patients in an intensive care setting. ⋯ Although the literature on the use of PIRRT in children is limited, the current studies give credence to their benefits and these expert recommendations are a valuable first step in the continued study of PIRRT in the pediatric population.
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We report a case of temporary right vocal cord paralysis manifesting as hoarseness after hemodialysis, beginning several hours after placement of a non-cuffed hemodialysis catheter into the right internal jugular vein using prilocaine local anesthesia. Diagnosis of right vocal cord paralysis was confirmed by laryngoscopy. Hoarseness completely resolved that same day, and subsequent laryngoscopy showed normal vocal cord movement, suggesting that the most likely cause of the initial vocal cord paralysis was diffusion of the local anesthetic agent injected during catheter insertion.
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Micronutrient depletion is a major drawback of high-dose continuous renal replacement therapy (CRRT). We tested two novel CRRT modes, double-filtration hemofiltration (DHF) and dialysate-recycling hemodiafiltration (DHDF), aimed at reducing micronutrient loss while maintaining a high clearance rate of midsized solutes comparable to that of high-volume hemofiltration (HVHF). ⋯ Compared to HVHF, DHF, and DHDF have an equal capacity for removal of large solutes but show substantially reduced micronutrient loss.
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Calcium supplementation is one of the most important factors in maintaining the safety and efficacy of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). The aims of this study were to assess the determinants of calcium requirements in RCA-CVVH and to simplify the calcium supplementation approach. ⋯ Calcium supplementation during RCA-CVVH undergoes two phases. We propose mathematical models to quantify the need for calcium supplementation, which enable individualization of the RCA prescription and simplify the management of RCA in the CVVH mode.