ABSTRACT
Haemofiltration and its variants are simple procedures which allow the management of patients with renal failure in intensive therapy units without the need for continual support from renal specialists. In order for non-renal specialists to manage the practical aspects of these treatments logically, safely and successfully it is important to understand the basic principles involved.
Subject(s)
Acute Kidney Injury/therapy , Hemofiltration/methods , Anticoagulants/administration & dosage , Blood Coagulation/drug effects , Clinical Protocols , Contraindications , Critical Care , Humans , Patient Selection , Renal Blood Flow, EffectiveABSTRACT
The decline in the use of acute peritoneal dialysis which has followed the recent advances in extracorporeal renal replacement therapy has left many clinicians unfamiliar with an invaluable therapeutic tool. This article is a timely reminder of both the underlying theory and the practical aspects of this technique.
Subject(s)
Dialysis Solutions , Peritoneal Dialysis/methods , Catheters, Indwelling , Glucose , Heparin/therapeutic use , Humans , Peritoneal Dialysis/adverse effects , Potassium Chloride/therapeutic use , Professional PracticeABSTRACT
Radionuclide gastric emptying studies were carried out on 20 patients with end-stage renal failure (ESRF) undergoing continuous ambulatory peritoneal dialysis (CAPD). Nine of the patients had diabetes mellitus. Eight normal volunteers were also studied to establish normal ranges. Solid and liquid emptying patterns were investigated simultaneously using a meal made up of a solid phase labelled with 99mTechnetium and a liquid phase labelled with 111Indium. The solid emptying fitted a model with a lag phase followed by a linear emptying phase and the liquid emptying fitted a single exponential. Nine of the 20 patients (four diabetic, five non-diabetic) were found to have delayed solid emptying, and four of these (two diabetic, two non-diabetic) also had delayed liquid emptying. No correlation was found between any of the parameters studied and the clinical symptoms of the patients. It is concluded that almost half of the patients studied had abnormal gastric emptying, but that many of these did not suffer from severe symptoms.
Subject(s)
Gastric Emptying/physiology , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Diabetic Nephropathies/diagnostic imaging , Diabetic Nephropathies/physiopathology , Diabetic Nephropathies/therapy , Female , Humans , Indium Radioisotopes , Kidney Failure, Chronic/diagnostic imaging , Male , Radionuclide Imaging , Technetium , Time FactorsABSTRACT
Two hundred and fifty consecutive patients with acute renal failure treated by continuous haemofiltration on one intensive care unit (ICU) were studied prospectively to investigate the possibility of predicting outcome at the time of referral. Logistic regression analysis was used to identify important prognostic factors and the regression coefficients were used to weight a scoring system for the severity of illness of patients with acute renal failure. Overall survival was 53% with improvement over the course of the study. Multivariate analysis showed that outcome was related to age, need for artificial ventilation, use of inotropes, urine volume, serum bilirubin, arterial base deficit and serum creatinine. The scoring system based on the first five of these variables had a specificity of predicting death of 67% and a sensitivity of 76%.
Subject(s)
Acute Kidney Injury/therapy , Hemofiltration , Acute Kidney Injury/blood , Acute Kidney Injury/mortality , Adult , Age Factors , Bilirubin/blood , Creatinine/blood , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Regression Analysis , Respiration, ArtificialABSTRACT
Twelve patients with renal failure and type A lactic acidosis were treated with haemofiltration during a 30-month period. The first three patients received only lactate-buffered replacement fluid and rapidly succumbed despite the infusion of large quantities of sodium bicarbonate. Bicarbonate-buffered replacement fluid was used for the remaining nine patients, of whom three survived. Haemofiltration with bicarbonate-buffered replacement fluid is an effective method of replacing renal function for this group of critically-ill patients.
Subject(s)
Acidosis, Lactic/therapy , Acute Kidney Injury/therapy , Hemofiltration/methods , Acidosis, Lactic/metabolism , Acidosis, Lactic/mortality , Acute Kidney Injury/etiology , Acute Kidney Injury/metabolism , Adolescent , Adult , Aged , Bicarbonates/therapeutic use , Child , Evaluation Studies as Topic , Fluid Therapy/methods , Hemofiltration/mortality , Humans , Middle AgedSubject(s)
Erythrocyte Deformability , Erythrocytes/cytology , Uremia/blood , Humans , UltrafiltrationABSTRACT
The red-cell calcium concentration, measured by atomic absorption spectrophotometry, was found to be significantly higher in patients with end-stage renal failure than in healthy volunteers. This provides one possible explanation for some of the abnormalities of red-cell metabolism known to occur in uraemia.
Subject(s)
Calcium/blood , Erythrocytes/analysis , Kidney Failure, Chronic/blood , Humans , Renal Dialysis/adverse effects , Spectrophotometry, AtomicSubject(s)
Calcium/blood , Erythrocytes/analysis , Adult , Female , Humans , Male , Middle Aged , Spectrophotometry, AtomicABSTRACT
Because water is freely exchangeable across most cell membranes, its distribution is largely determined by physical factors and by the relative osmolal concentrations of the extracellular and intracellular fluids. As the major extracellular cation, sodium is a principal determinant of the extracellular fluid volume.
