Hemodialysis international
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Studies on fever of unknown origin (FUO) in patients of chronic kidney disease and end stage renal disease patients on dialysis were not many. In this study, we used 18 F-FDG PET/CT scan whole body survey for detection of hidden infection, in patients on dialysis, labelled as FUO. ⋯ The present study is first study of 18F-FDG PET/CT scan in patients of end stage renal disease on dialysis with FUO. The study showed that the 18 F FDG PET/CT scan may present an opportunity to attain the diagnosis in end stage renal disease patients on dialysis with FUO.
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Home hemodialysis (HHD) is emerging as an important alternate renal replacement therapy. Although there are multiple clinical advantages with HHD, concerns surrounding increased risks of infection in this group of patients remain a major barrier to its implementation. ⋯ Use of central vein catheters and buttonhole cannulation in HHD are important modifiable risk factors for HHD associated infection. Several preventive measures are suggested in the literature, which will require further prospective validation.
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Randomized Controlled Trial Multicenter Study
Comparison of pregabalin with doxepin in the management of uremic pruritus: a randomized single blind clinical trial.
Pruritus is one of the frustrating skin manifestations of advanced renal failure. Many options have been used for the management of uremic pruritus (UP) such as pregabalin. There are some studies that reported beneficial effects of pregabalin in reducing UP; however, most of them did not have a comparator arm. Therefore, we designed this study to compare antipruritic effects of pregabalin with doxepin in the management of pruritus in hemodialysis patients. ⋯ Pregabalin was more effective than doxepin in reducing the severity of uremic pruritus and improving the quality of life of patients in this study, so we suggest that clinician can consider pregabalin prior to using antihistamine drugs in the management of severe itch in hemodialysis patients.
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Randomized Controlled Trial
Citrate vs. acetate dialysate on intradialytic heparin dose: A double blind randomized crossover study.
Introduction Citrate containing dialysate has a calcium-binding anticoagulant effect compared to standard acetic acid containing dialysate. We performed a randomized, double-blind, crossover trial in maintenance HD patients to determine if citrate dialysate ("citrate") safely allows for a lower cumulative heparin dose ("heparin dose"). Methods Intradialytic heparin was adjusted to the minimum during a 2-week run-in phase. ⋯ There was no difference in the mean heparin dose reduction between the two dialysates (P > 0.05). The intradialytic ionized calcium in the citrate group was lowered by 0.10 mmol/L (95% CI 0.07 to 0.14 mmol/L, P < 0.001), and remained unchanged in the acetate group. Discussion Although citrate is a safe alternative to acetate, it does not result in additional heparin dose reduction.
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Randomized Controlled Trial Comparative Study
Alteplase vs. urokinase for occluded hemodialysis catheter: A randomized trial.
Introduction Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. To compare the efficacy of alteplase vs. urokinase in reestablishing adequate blood flow through completely occluded vascular catheters. Methods In this randomized study, patients with completely occluded tunneled HD catheters received 40 minutes intracatheter dwell with alteplase (1 mg/mL) or urokinase (5000 IU/mL). ⋯ There was no difference between the two groups in infectious complications (P = 0.94). Discussion Alteplase and urokinase are effective thrombolytic agents for restoring HD catheter patency. Our study has revealed a likely slight superiority of alteplase over urokinase for unblocking central lines, but which has enrolled too few patients to be able to detect a difference of this size.