Adequate dialysis requirements

Persons using dialysis require restriction of sodium, potassium and water intake. Protein intake is also closely controlled and will vary from 30 to 60 g daily. The aim is to provide about 3/4 of the protein allowance as protein of high biological value. Furthermore, to prevent high blood urea and potassium levels, it is especially important that adequate energy be supplied to prevent the catabolism of body protein. Dialysis patients also require vitamin supplementation in addition to the dietary controls. 

Requirements for Adequate Dialysis The quantitative assessment of efficacy of dialysis therapy and renal function is based on the small solutes, even though the molecular weights range over 3 orders of magnitude. Urea and creatinine are eonsidered to be representative or surrogates for the small molecules and easily measured. Three different methods of accessing urea removal rates are currently used ... 

Diallyl isophthalate (DAIP), 2 258, 261 physical properties of, 2 258t thermoset molding properties of, 2 262t Diallyl phthalates (DAP), 2 258-263 20 110 copolymerization, 2 259-260 Diallyl terephthalate (DATP), 2 259 DIALOG file, 18 246 DIALOG OneSearch, 18 244 -dial suffix, 2 58 Dialysate, 26 814, 815 composition of, 26 817 Dialysis. See also Hemodialysis alternative modes of, 26 832-833 requirements for adequate, 26 821-822 treatment time and frequency of, 26 833-834... 

The absorption and excretion of carbenicillin in man has been reported [396]. The antibiotic is not absorbed intact from the gut intramuscular injection (which is painful) often provides adequate serum levels (approximately 20 Mg/ntl) but infections with Pseudomonas strains having minimum inhibitory concentrations up to, or higher than, 100 Mg/ml require intravenous thbrapy to achieve such levels. No evidence of active metabolite formation has been obtained. Marked reductions in the half-life (and serum levels) of carbenicillin follow extracorporeal dialysis or peritoneal dialysis, the former producing the most striking effect [397]. These results were, of course, obtained in patients with severe renal failure. Patients with normal renal function rapidly eliminate the drug but, as with all penicillins, renal tubular secretion can be retarded by concurrent administration of probenecid. 

Single drug therapy is mostly adequate in lupus nephritis (LN) classified as renal biopsy WHO Class I and II. Single drug therapy in lupus nephritis Class III-V, and in particular Class VI is less or not effective. One immunosuppressant cannot suppress all aspects of autoimmune inflammation in the more serious forms of the disease. The SBC-5-IMNs is not required in Class I, IL and also not in Class VI. In Class VI nothing helps, except renal dialysis or renal transplantation. 

Erythropoietin [ery throw PO eetin] is a glycoprotein, normally made by the kidney, that regulates red cell proliferation and differentiation in bone marrow. Human erythropoietin, produced by recombinant DNA technology, is effective in the treatment of anemia caused by end-stage renal disease, anemia associated with HIV-infected patients, and anemia in some cancer patients. Supplementation with iron may be required to assure an adequate response. The protein is usually administered intravenously in renal dialysis patients, but in others the subcutaneous route is preferred. Side effects such as iron deficiency and an elevation in blood pressure occur. [Note The latter may be due to increases in peripheral vascular resistance and/or blood viscosity.]... 

There are wide variations in the reported incidence of contrast nephrotoxicity because of differences in patient selection, the type of radiological procedure, and the definition of renal impairment. Contrast nephrotoxicity is relatively uncommon in people with normal renal function, in whom it is 0-10%. Pre-existing renal impairment increases the frequency, with a reported incidence of 12-27% in several prospective controlled studies. In some studies the incidence was as high as 50%, in spite of the use of low-osmolar contrast agents and adequate hydration. Dialysis may be required in some of these patients (SEDA-22, 502). 

The utility of continuous renal replacement therapies (CRRT) such as continuous venous-venous hemodialysis (CWHD) in the treatment of poisoning is uncertain. As CRRT provides slower clearance than conventional hemodialysis it may not be appropriate for drug removal in acute intoxications [25]. However, the lower blood flow rates and longer treatment times of continuous modalities may be desirable for vulnerable, hemodynamically unstable, patients who are not candidates for conventional hemodialysis [7]. Unlike hemodialysis, CRRT can give effective clearances in hypotensive patients. If the clinical condition of the patient requires a low intensity treatment that will necessarily decrease diffusive clearance, slow extended dialysis (SLED) or continuous treatment times with additional convective clearance (CVVHF and CVVHDF) can likely provide adequate total drug clearance [24]. 

In overdose, methadone causes CNS and respiratory depression, miosis, bradycardia, hypotension, circulatory collapse, hypothermia, coma, seizures, and pulmonary edema (although less frequently than morphine). Treatment for methadone overdose includes supportive measures to maintain adequate respiration and blood pressure, and the administration of the opioid antagonist naloxone to reverse the effects of methadone. If repeated administration of naloxone is required, patients should be monitored for 48 to 72 hours following overdose. Dialysis is not an effective treatment modality, because methadone has a large volume of distribution (Vj = 4 to 5 L/kg) and is highly protein bound (87%). ... 

Unfortunately, it is easier to describe inadequate PD than it is to provide a universally accepted definition of adequate PD. True PD adequacy requires the identification of an optimal dialysis dose that will result in favorable long-term outcomes, such as survival and quality of life. Compared to hemodialysis, which is used by a much larger patient population, there are few data available regarding the optimal dose of dialysis in PD. As a result, much of the work in this area has focused on establishing the minimum acceptable PD... 

The presence of a trace element-containing species is usually detected by applying analytical techniques that determine the metal or metalloid constituents. The methods and techniques for such determinations have been adequately dealt with in various chapters of this book. No additional comments are required other than to remark that in cases where the concentration of the analyte is at the limit of detection of the analytical technique a preconcentration step (Poole and Schuette 1984) should be considered. This step could involve sample evaporation, solvent extraction, dialysis, ion-exchange chromatography and/or electrolytic preconcentration. If further analytical procedures are contemplated, for example, characterisation of the species, then it is essential that the species is not destroyed during the preconcentration step. 

Issues related to sampling procedures, efficiency of extraction, cross-reactivity, and analyte recovery may often require the use of internal standards. The analyst should also be aware that interference - often unexpected - from other food components is also common in the complex matrices that characterize foods. For this reason, a protocol devised for a particular food (e.g., cow s milk) cannot be transferred to an apparently similar food (e.g., sheep s or goat s milk) without suitable experimentation and adequate validation. Removal of interfering materials - once their nature is known - may also be necessary in some cases, and may call for specific procedures, such as addition of precipitating agents, ultrafiltration, dialysis, etc. The easiest way to detect interference, if suspected, is to prepare analyte standards in buffer and in the food matrix at concentrations compatible with the assay. Assays performed with both sets of standards should produce identical curves in the absence of interference. The effects of these treatments on the analyte itself will have to be assessed by experiment. 

When cadmium exposure continues past the onset of early kidney damage (manifested as proteinuria), chronic nephrotoxicity may occur (Meridian Research, Inc. 1989 Roth Associates, Inc. 1989). Uremia, which is the loss of the glomerulus ability to adequately filter blood, may result. This condition leads to severe disturbance of electrolyte concentrations, which may result in various clinical complications including atherosclerosis, hypertension, pericarditis, anemia, hemorrhagic tendencies, deficient cellular immunity, bone changes, and other problems. Progression of the disease may require dialysis or a kidney transplant. 

It is important to identify patients who may eventually require renal replacement therapy since adequate preparation can decrease morbidity and perhaps mortality. Early identification enables dialysis to be initiated at the optimal time with a functioning chronic access. The placement and adequate maturation of arteriovenous fistula (AVF) before the initiation of hemodialysis therapy requires timely patient education and counselling, selection of the preferred renal replacement modality, selection of an access type and location, and creation of the access at least several weeks to months in advance of its expected need. An early constructed AV fistula could also have a beneficial effect on the rapidity of worsening kidney failure. Reasons for this could be increased heart preload and consequently increased afterload or decreased peripheral resistance with increased renal perfusion. A simpler reason could be that patients after AV fistula construction become aware that situation is serious and they start to follow the therapy more accurately [11]. 

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