Renal replacement therapy selected therapies

Dosing of Selected Intravenous Anti-Infectives in Patients Receiving Continuous Renal Replacement Therapy... 

TABLE 6.2 Summary of Selected Renal Replacement Therapies... 

Pike, J.W., Yamamoto, H. and Shevde, N.K. (2002) Vitamin D receptor-mediated gene regulation mechanisms and current concepts of vitamin D analog selectivity. Advances in Renal Replacement Therapy, 9, 168-174. 

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]. 

Hemodialysis (HD) catheter-associated bloodstream infections (BSls) are a type of CLABSI due to a central venous catheter (CVC) specifically designed for HD. In 2002, it was estimated that 50,000 CLABSIs occur in dialysis patients in the US annually. A more recent surveillance study found the rate of access-related BSIs to be 0.73 events per 100 patient-months [5]. Aside from catheters, patients in need of renal replacement therapy should eventually use arteriovenous fistula (AVF) or arteriovenous grafts (AVG) for HD, or alternatively, may receive peritoneal dialysis. All renal replacement therapies are associated with a risk of infection however, this risk varies with the method selected. Data from a CDC surveillance program display nicely how the type of access influences the BSI rate per 100 patient-months 0.5 (for AVFs), 0.9 (AVG), 4.2 (permanent CVCs), and an impressive 27.1 for temporary CVCs [6]. Another, more practi-... 

The introduction of minimally invasive thermal ablation techniques offers a safe and accurate alternative to open or laparoscopic surgery in the treatment of renal tumors. Experimental as well as clinical studies proved RF ablation to be a safe and effective treatment option for small RCCs. It is well tolerated in patients with percutaneously accessible lesions. However, the long-term outcome remains to be determined. Until then its use is limited to selected patients. Despite these limitations, published experience with renal RF ablation is continuously growing. As soon as its long-term effectiveness is proven, this technique holds the potential to replace surgery as first-line therapy in small RCCs. 

Isolation of particular cell types that produce renal-specific factors may be a good approach for selective cell therapies to treat aspects of renal failure. For example, cells that produce erythropoietin have been isolated in culture, and these cells could eventually be used to treat the anemia that results from end-stage renal failure (Aboushwareb et al. 2008). Other more ambitious approaches are working towards the goal of total renal functional replacement. To create kidney tissue that would deliver full renal function, a culture containing all of the cell types comprising functional nephron units should be used. Optimal culture conditions to nurture renal cells have been extensively studied and cells grown under these conditions have been reported to maintain their cellular characteristics (Lanza et al. 2002). 

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