Dialysis therapy

Hemodialysis with microencapsulated urease and an ammonia ion adsorbent, zirconium phosphate [13772-29-7], has been used (247) to delay the onset of dialysis therapy in patients retaining some renal function, and to reduce the time between dialysis treatment. 

Considering the evidence for neurobehavioral effects of aluminum in humans exposed occupationally, and during dialysis therapy, and in animals exposed orally and by various unnatural routes of exposure, it... 

Iserson KV, Banner W, Froede RC, et al. 1983. Failure of dialysis therapy in potassium dichromate poisoning. J Emerg Med 1 143-149. 

Treatment should be selected based on the grade of kidney dysfunction. In deciding on conservative therapy, hydration must be controlled. Hydration is normalized according to the presence or absence of overhydration and dehydration, although dehydration is rare. When oliguria, hyperpotassemia, and uremia are observed (21% of the patients), dialysis therapy should be considered according to the indication for dialysis therapy in acute tubular necrosis. 

This disorder shows a good prognosis, involving spontaneous recovery in most patients [4]. However, 29 (21.0%) of 138 patients required dialysis therapy owing to severe acute renal failure. No patient died in our series or in the literature consulted. 

Many patients have non-oliguric acute renal failure, with a good prognosis. However, some patients require dialysis. For treatment, hydration must be controlled, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if possible. When oliguria is observed, dialysis therapy should be performed, as described for acute tubular necrosis. 

Poulos, A.M., Howard, L., Eisele, G., Rodgers, XB Peritoneal dialysis therapy for patients with liver and renal failure with ascites. Amer. J. Gastroenterol. 1993 88 109-112... 

The nephrologist is often consulted in poisoning cases. Although management may involve attention to incident renal failure or electrolyte and acid-hase disorders, hlood purification may also be necessary [1]. The application of dialysis therapies or hemoperfusion to enhance clearance of intoxicants is an essential task for the nephrologist. 

This chapter will outline the principles and use of dialysis and related procedures for the treatment of the poisoned patient. Consideration will be given to criteria for use of dialysis and related modalities, decision among available options, and recent advances. Finally, detailed discussion will follow for specific poisonings for which dialysis therapies are especially effective. 

Liao Z, Zhang W, Flardy PA. Kinetic comparison of different acute dialysis therapies. Art/f Organs. 2003 27 802-807... 

Examination of the urine revealed macroscopic blood and granular casts. Her serum biochemistry was abnormal with hyperkalemia and an elevated urea and creatinine. She ultimately required dialysis but recovered sufficient renal function within 3 days to allow cessation of dialysis therapy. In view of the close association between the exposure to the Jeyes... 

Evolution within the field of dialysis and advances in surgical procedures providing for superior access for shunt placement have made it possible to treat patients with end-stage renal disease with dialysis therapy for more than 50 years. Improved pharmacotherapy of pre- and post- dialysis has also contributed to these remarkable advancements. Drug therapy is also evolving. Health care provider for patients with renal diseases needs to understand the latest drug therapy and ensure appropriateness of therapy in each individual patient [1]. 

Remember that dialysis therapy excretes potassium. 

Gotch F. Urea kinetics modelling to guide hemodialysis therapy in adults. In Nissenson AR, Fine RN, eds. Dialysis therapy. Philadelphia Hanley and Belfus, 2002 117-21. 

In addition to characterization of disease states, NMR-based metabonomic analysis offers an efficient means to monitor the response of patients to drug therapy or other therapeutic interventions. For example, in a study of patients with end-stage renal failure, the response of patients to hemodialysis was monitored. Plasma samples were obtained from healthy subjects and from patients with renal failure immediately preceding and following hemodialysis. Samples were analyzed by NMR spectroscopy and mapped with pattern-recognition methods. Samples obtained from the majority of patients following hemodialysis were observed to map more closely to the cluster of samples obtained from healthy subjects than those samples obtained prior to dialysis therapy, with the exception of one patient who responded badly to the therapy and mapped separately to all other samples [13]. Thus, this methodology can be used to select appropriate therapies for patients. 

ARE is a large burden on the health care system. Much of this cost is due to the fact that many of these patients are in intensive care units where daily costs are high. It has been estimated that the average total hospital cost of a patient with ARP who requires RRT is approximately 50,000. Most patients surviving ARE recover life-sustaining renal function, but the 3% that do not recover renal function continue to incur the costs of a lifetime of dialysis therapy or kidney transplantation. Nonetheless, even in patients who required RRT for their ARP, the quality of life of survivors has been reported to be good. ... 

Vitamin requirements for ESKD patients receiving dialysis differ from those of a healthy person because of dietary modifications, kidney dysfunction, and dialysis therapy. The plasma concentrations of vitamins A and E are elevated in ESKD, while those of the water-soluble vitamins (81,82,8g, 812, niacin, pantothenic acid, folic acid, biotin, and vitamin C) tend to be low in this population, in large part due to the fact that many are dialyzable. The goal for vitamin supplementation in this population should be to prevent subclinical and frank deficiency and to avoid pathology from overdosage. Special vitamin supplements have been formulated for the dialysis population, which primarily include 8 vitamins with C and folic acid. 

Biesenbach G, et al. Predialysis management and predictors for early mortality in uremic patients who die within one year after initiation of dialysis therapy. Ren Fail 2002 24 197-205. 

Mechanical, medical, and infectious problems complicate peritoneal dialysis therapy. Mechanical comphcations include kinking of the catheter and inflow and outflow obstruction excessive catheter motion at the exit site, leading to induration and possible infection and aggravation of tissues pain from impingement of the catheter tip on the viscera or inflow pain resulting from a jet effect of too rapid dialysate inflow. 

Foley RN, Parfrey PS, Harnett JD, et al. Mode of dialysis therapy and mortality in end-stage renal disease. J Am Soc Nephrol 1998 9 267-276. 

Schulman G. Clinical application of high-efficiency hemodialysis. In Nis-senson AR, Fine RN, eds. Dialysis Therapy. Philadelphia, Hanley Bel-fus, 2002 205-210. 

Islam KN, et al. Alpha-tocopherol supplementation decreases the oxidative susceptibility of LDL in renal failure patients on dialysis therapy. Atherosclerosis 2000 150 217-224. 

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