ABSTRACT
Expanded hemodialysis (HDx), using medium cut-off membrane, is a novel therapy that effectively clears middle molecules (MMs). We aimed to compare HDx to hemodiafiltration (HDF) in an open randomized clinical study. Patients currently on HDF (age 18-80 years; on HDF >3 months) were randomized to switch to HDx (N = 21) or continue HDF (N = 22) with a 24-week follow-up. Pre- to post-dialysis reduction ratios (RR) and changes in pre-dialysis levels over time were evaluated for MMs and clinical biomarkers. Use of erythropoiesis-stimulating agents (ESAs) was assessed. HDx showed greater RR for YKL-40 while RR appeared similar between groups for beta2 -microglobulin, FGF-23, and free light chains. Intradialytic changes in inflammatory biomarkers (IL-6, CRP, PTX3) did not differ between therapies. Changes from baseline to 12 and 24 weeks did not differ between groups for MMs, inflammatory markers, albumin, fibrinogen, hemoglobin, PTH, and phosphorus. Use of ESAs tended to decrease in HDx arm while remaining stable in HDF arm. HDx appeared safe with similar clinical effectiveness as HDF. With fewer requirements and resource needs, HDx provides an attractive alternative to HDF.
Subject(s)
Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Female , Follow-Up Studies , Hemodiafiltration/methods , Humans , Male , Middle Aged , Spain , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Female , Adult , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/etiology , Lupus Nephritis/drug therapy , Hydroxychloroquine/therapeutic use , Prednisone/therapeutic use , Mycophenolic Acid/therapeutic use , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Pulmonary Emphysema/diagnostic imaging , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/immunology , Kidney Glomerulus/pathology , Glucocorticoids/administration & dosage , Cyclophosphamide/administration & dosage , alpha 1-Antitrypsin/analysis , Biopsy , Kidney/pathology , Azathioprine/administration & dosageABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Glomerulonephritis/complications , Glomerulonephritis/drug therapy , Microscopic Polyangiitis/complications , Glucocorticoids/therapeutic use , Arteritis/complications , Cyclophosphamide/therapeutic use , Laparotomy , Anastomosis, Roux-en-Y/methods , Abdominal Pain/etiology , Gastrectomy/methods , Splenectomy/methods , Vasculitis/complicationsABSTRACT
El objetivo del estudio fue analizar las FAV-RC en prediálisis en las que se hizo un seguimiento clínico y ecográfico de la maduración y cuyo fracaso se trató. Material y métodos: Estudiamos 127 FAV-RC en 117 pacientes prediálisis. Todos disponían de un mapa preoperatorio. La FAV-RC era madura si tenía un flujo en la arteria humeral mayor que o igual a 500ml/min y un diámetro en la vena cefálica mayor o igual a 4mm. Se trató el fracaso de maduración según el tipo de lesión. Un total de 58 pacientes iniciaron hemodiálisis durante el seguimiento. Resultados: En las 106 FAV-RC funcionantes, 72 (68%) fueron maduras y 34 (32%) inmaduras. El 97% de las inmaduras presentaron al menos una lesión y la localización más frecuente fue la vena postanastomótica. El 31% de las FAV-RC maduras tenían lesiones y en el 18% precisaron tratamiento. El tratamiento más frecuente del fracaso de maduración fue radiológico. A los 6 meses la permeabilidad primaria y secundaria fue del 59 y del 78%; a los 12 meses del 48 y del 77%, respectivamente. El 80% de los pacientes iniciaron hemodiálisis con una FAV distal (76% radio-cefálicas y 4% cubitobasílicas). Ningún paciente con una FAV-RC inmadura tratada lo hizo con CVC y un 78% lo hizo con dicha FAV. Conclusión: La ecografía en el seguimiento de la maduración aporta ventajas frente al seguimiento clínico. Con nuestro abordaje del AV en prediálisis conseguimos que el 80% de nuestros pacientes inicien hemodiálisis mediante una FAV distal (AU)
The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated. Material and methods: We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow greater than or equal to 500ml/min and a cephalic vein diameter of greater than or equal4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study. Results: In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF. Conclusion: Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF (AU)
Subject(s)
Humans , Arteriovenous Anastomosis , Vascular Access Devices , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Kidney Diseases/congenital , Genetic Diseases, Inborn/epidemiology , Pedigree , Nephrology/organization & administration , Hospital Units/organization & administration , Polycystic Kidney, Autosomal Dominant/epidemiology , Renal Replacement Therapy , Nephritis, Hereditary/epidemiology , Mass Screening/methodsSubject(s)
Inheritance Patterns , Kidney Diseases/genetics , Outpatient Clinics, Hospital/organization & administration , Pedigree , Referral and Consultation , Adolescent , Adult , Aged , Aged, 80 and over , DNA Mutational Analysis , Family Health , Female , Follow-Up Studies , Genetic Testing , Humans , Kidney Diseases/epidemiology , Kidney Diseases/pathology , Male , Middle Aged , Prevalence , Referral and Consultation/organization & administration , Tertiary Care Centers/organization & administration , Young AdultABSTRACT
UNLABELLED: The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated. MATERIAL AND METHODS: We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow ≥500ml/min and a cephalic vein diameter of ≥4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study. RESULTS: In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF. CONCLUSION: Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF.
