Hemodialysis international
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Use of erythropoiesis-stimulating agents (ESAs) has improved the management of anemia in patients on maintenance hemodialysis (MHD). Iron deficiency and inflammation cause ESAs resistance and are both common among indigenous people of Northern Australia. As part of quality assurance in our Renal Anaemia Management program, we observed that there was use of higher doses of ESAs and adjuvant iron therapy in our MHD patients. ⋯ The high iron use is due to a lack of published evidence to guide the administration of iron in patients with high ferritin. The high ferritin and ESAs resistance could not be fully explained by inflammation and need further evaluation. Further studies are required to determine the safe use of iron and management of ESAs resistance in our hemodialysis population.
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Data on long-term follow up after acute kidney injury (AKI) requiring dialysis are scarce. The aim of this study was to describe and identify factors associated with survival, recovery of kidney function at discharge, and long-term follow up of renal function in AKI patients requiring dialysis. All AKI patients requiring dialysis during calendar year 2000-2011 treated with conventional hemodialysis and daily shift continuous venovenous hemodialysis (8-hour 40 L dialysate) were included. ⋯ AKI requiring dialysis has a significant effect on GFR with almost 80% of the survivors having chronic kidney disease stage 3 or worse. Furthermore, progression was observed on the long-term follow up. Factors affecting the survival included peak creatinine and status of recovery of kidney function at discharge.
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Acute kidney injury (AKI) is associated with increased long-term risk of end-stage kidney disease (ESKD) and mortality. Nephrology care following discharge from hospital may improve survival through prevention of recurrent AKI events. In this study, we examined the factors that were associated with outpatient nephrology follow-up after the development of AKI on patients who had a nephrology in-hospital consultation and were discharged from McGill University Health Centre between January 1, 2006 and December 31, 2010. ⋯ The adjusted HR was 2.04 (95% CI 1.01-4.12) when we adjusted for follow-up with other medical clinics, significant stage 4 and stage 5 chronic kidney disease and diabetes status. Patients with less comorbidities and higher serum creatinine on discharge received outpatient nephrology care. Nephrology outpatient care is associated with decreased risk of recurrence of AKI after discharge from hospital.
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Delivered dialysis dose by continuous renal replacement therapies (CRRT) depends on circuit efficacy, which is influenced in part by the anticoagulation strategy. We evaluated the association of anticoagulation strategy used on solute clearance efficacy, circuit longevity, bleeding complications, and mortality. We analyzed data from 1740 sessions 24 h in length among 244 critically ill patients, with at least 48 h on CRRT. ⋯ Relative to heparin or no anticoagulation, the use of regional citrate for anticoagulation in CRRT was associated with significantly prolonged filter life and increased filter efficacy with respect to delivered dialysis dose. Rates of bleeding complications, transfusions, and mortality were similar across the three groups. While these and other data suggest that citrate anticoagulation may offer superior technical performance than heparin or no anticoagulation, adequately powered clinical trials comparing alternative anticoagulation strategies should be performed to evaluate overall safety and efficacy.
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The superficial cervical plexus block (SCPB) is utilized in pediatric patients to perform certain surgical procedures, but there is no evidence supporting its use in hemodialysis catheter placement. We evaluated the analgesic effectiveness, intraoperative complications, and patient satisfaction associated with SCPB for pediatric patients in renal failure undergoing emergent dialysis catheterization. A total of 52 patients ranging from 1 to 17 years old that required emergent dialysis catheter placement and received SCPB were included in this study. ⋯ No patient required fentanyl for additional analgesia. No intraoperative complications occurred. The benefits gained from using SCPB performed by an experienced anesthesiologist for hemodialysis catheter placement include providing sufficient analgesia and optimal surgical conditions while avoiding the complications associated with general anesthesia for pediatric patients with renal failure.