Hemodialysis international
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Sodium balance across a hemodialysis treatment influences interdialytic weight gain (IDWG), pre-dialysis blood pressure, and the occurrence of intradialytic hypotension, which associate with patient morbidity and mortality. In thrice weekly conventional hemodialysis patients, the dialysate sodium minus pre-dialysis plasma sodium concentration (δDPNa+) and the post-dialysis minus pre-dialysis plasma sodium (δPNa+) are surrogates of sodium balance, and are associated with both cardiovascular and all-cause mortality. However, whether δDPNa+ or δPNa+ better predicts clinical outcomes in quotidian dialysis is unknown. ⋯ However, δPNa+ was better than δDPNa+ in predicting IDWG (R(2)=0.105 vs. 0.019, P=0.04 vs. 0.68) and pre-dialysis systolic blood pressure (R(2)=0.103 vs. 0.007, P=0.02 vs. 0.82). We also found that the intradialytic blood pressure fall was greater in frequent nocturnal hemodialysis patients than in short hours daily patients, when exposed to a dialysate to plasma sodium gradient. These results provide a basis for design of prospective trials in quotidian dialysis modalities, to determine the effect of sodium balance on cardiovascular outcome.
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Regional citrate anticoagulation (RCA) is a valid anticoagulation method in continuous renal replacement therapies (CRRT) and different combination of citrate and CRRT solutions can affect acid-base balance. Regardless of the anticoagulation protocol, hypophosphatemia occurs frequently in CRRT. In this case report, we evaluated safety and effects on acid-base balance of a new RCA- continuous veno-venous hemofiltration (CVVH) protocol using an 18 mmol/L citrate solution combined with a phosphate-containing replacement fluid. ⋯ Protocol A required bicarbonate and sodium phosphate infusion (8.9 ± 2.8 mmol/h and 5 g/day, respectively) while protocol B allowed to stop both supplementations. In comparison to protocol A, protocol B allowed to adequately control acid-base status without additional bicarbonate infusion and in absence of alkalosis, despite the use of a standard bicarbonate concentration replacement solution. Furthermore, the combination of a phosphate-containing replacement fluid appeared effective to prevent hypophosphatemia.
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Review Case Reports
Hemolysis-induced acute kidney injury following cardiac surgery: a case report and review of the literature.
Acute kidney injury is a common complication following cardiac surgery. Even small increases in creatinine levels are associated with increases in morbidity and mortality. Numerous factors such as hemolysis can contribute to the development of acute kidney injury after cardiac surgery. ⋯ The patient's renal function gradually recovered when hemolysis was improved. After follow-up for 3 months, his creatinine levels returned to normal. We discussed the pathogenesis of this hemolysis-related kidney dysfunction, the causes of hemolysis during cardiac surgery, and a new treatment option.
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Continuous renal replacement therapy (CRRT) is used as an alternative to intermittent hemodialysis (IHD) in patients who have acute kidney injury (AKI) and cannot tolerate IHD. Several studies have reported the usefulness of CRRT in treating sepsis, which is a non-renal indication for CRRT. ⋯ By using CRRT, we successfully treated hypernatremia in a patient with severe CHF, without observing any fluid overload. Therefore, we report this case to suggest that CRRT should be considered for the treatment of hypernatremia in patients with severe CHF.
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Traditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of "bath salts." They are beta-ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the "khat" plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. ⋯ They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of "bath salt" pills that improved with hemodialysis.