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[Non-pharmacological calcium metabolism control in patients undergoing hemodialysis].

Calcium overload has been claimed to be involved in the increased vascular morbidity and mortality of dialysis patients. Conversely, calcium depletion can worsen secondary hyperparathyroidism and reduce bone mass. When residual renal function is null or negligible, the calcium balance is mainly determined by the calcium absorbed from the intestine, and that gained or lost from or into the dialysate. This article aims to review the assessment and mechanisms of calcium flux during hemodialysis (HD) and hemodiafiltration (HDF). Calcium mass transfer in HD is mainly dependent on the ionized calciu…

[Analysis of influencing factors for citrate accumulation in critically ill patients with acute kidney injury undergoing continuous renal replacement therapy with regional citrate anticoagulation].

OBJECTIVE: To investigate the influencing factors of citrate accumulation in critically ill patients with acute kidney injury (AKI) undergoi … n different treatment modes [continuous veno-venous hemodialysis (CVVHD) vs. continuous veno-venous hemodiafiltration (CVVHDF)]. RESULTS: A total of 192 AKI patients were enrolled, with 393 circuits of RCA-CRRT treatment, among which citrate accumulation occurred in 134 circuits (34.1%). Univariate Cox proportional hazards analysis showed that treatment mode, tota …

[High glucose dialysate enhances peritoneal fibrosis through upregulating glucose transporters GLUT1 and SGLT1].

Objective: To investigate the role of glucose transporter 1 (GLUT1) and sodium-glucose cotransporter 1 (SGLT1) in high glucose dialysate-induced peritoneal fibrosis. Methods: Thirty six male SD rats were randomly divided into 6 groups (6 in each):normal control group, sham operation group, peritoneal dialysis group (PD group), PD+phloretin group (PD+T group), PD+phlorizin group (PD+Z group), PD+phloretin+phlorizin group (PD+T+Z group). Rat model of uraemia was established using 5/6 nephrotomy, and 2.5% dextrose peritoneal dialysis solution was used in peritoneal dialysis. Peritoneal equilibrat

Effectiveness of haemodiafiltration with ultrafiltrate regeneration in the reduction of light chains in multiple myeloma with renal failure.

Acute kidney failure in multiple myeloma (MM) occurs in 12%-20% of patients and is a poor prognostic factor for patient survival. Recent studies have shown that dialysis with a High-Cut-Off membrane (HCO) removes free light chains (FLC) effectively although with significant albumin loss. Other adsorption-based techniques, such as haemodiafiltration with ultrafiltrate regeneration by adsorption in resin (SUPRA-HFR), have not been studied. We present three cases of MM, all haemodialysis-dependent since diagnosis. Two cases were IgG kappa and one was IgA lambda. All patients were treated with che

Middle Molecular Uremic Toxin and Blood Purification Therapy.

The purpose of blood purification therapy is to remove uremic toxins, and middle molecules (MMs) are a specific target. An MM is defined as a solute that passes through the glomerulus with a molecular weight in the range of 0.5-58 kDa, and new classifications of "small-middle 0.5-15 kDa," "medium-middle 15-25 kDa," and "large-middle 25-58 kDa" were proposed. In Japan, the removal of α1-microglobulin (αMG) in the large-middle range has been the focus, but a new theory of removal has been developed, emphasizing the antioxidant effect of αMG as a physiological function. Clinical proof of this mec

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… Regulatory Considerations for Hemodiafiltration in the United States. Clin. J. Am. Soc. Nephrol. 2018;13:1444–1449. doi: 10.2215/CJN.12641117. 4. Rindi P., Pilone N., Riccò V., Cioni L. Clinical experience with a new hemodiafiltration (HDF) system. ASAIO Trans. 1988;34:765–768. 5. … Hemodiafiltration in Japan: Current status and future directions. Ren. Replace. Ther. 2023;9:23. doi: 10.1186/s41100-023-00471-6. 42. Kawanishi H. Development of online hemodiafiltration in Japan. Ren. Replace. Ther. 2021;7:51. doi: 10.1186/s41100-021-00370-8. 43. …

Intra-procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure.

BACKGROUND: Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). METHODS: We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization pro

Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients.

OBJECTIVES: The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. METHODS: A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1-1.8mmol/L)

High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury.

Multiple myeloma (MM), an incurable hematological malignancy with clonal proliferation of plasma cells, is mainly characterized by excessive production of monoclonal immunoglobulins and free light chains (FLCs). Kidney injury is one of the main clinical manifestations and is also a significant predictor of the prognosis of symptomatic MM patients, especially those who require dialysis-supported treatment. Overproduction of FLCs is the trigger for kidney injury, as they can induce the transcription of inflammatory and profibrotic cytokines in the proximal tubule and bind to Tamm-Horsfall protei

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… There is also a study that applied HCO membranes in post-dilution hemodiafiltration in MM patients with AKI ( 52 ). Table 3 The protocols of previous high-cutoff hemodialysis or high-cutoff hemodiafiltration. … Medium-cutoff hemodialysis (MCO-HD) has been confirmed to be superior to HF-HD and hemodiafiltration ( 72 , 73 ). …

Extracellular Matrix Tissue Patch for Aortic Arch Repair in Pediatric Cardiac Surgery: A Single-Center Experience.

Introduction: Among aortic diseases in children, congenital defects such as coarctation of the aorta (CoA), interrupted aortic arch (IAA), h … 1% requiring prolonged mechanical ventilation support. Postoperative acute kidney failure requiring hemodiafiltration (HDF) was noticed in 12% of cases. Follow-up data, collected via routine transthoracic echocardiography (TTE) and clinical assessments over a median of 418 (242.3-596.3) days, showed no evidence of patch-related complications such as restenosis, ane …

Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry.

BACKGROUND: Chronic haemodialysis (HD) in small children has not been adequately investigated. METHODS: This was a retrospective investigation of the use of chronic HD in 21 children aged  <2 years (n = 12 aged <1 year) who were registered in the Italian Pediatric Dialysis Registry. Data collected over a period of >10 years were analysed. RESULTS: The median age of the 21 children at start of HD was 11.4 [interquartile range (IQR) 6.2-14.6] months, and HD consisted mainly of haemodiafiltration for 3-4 h in  ≥4 sessions/week. A total of 51 central venous catheters were placed, and the median

Dabigatran anticoagulation and Stanford type A aortic dissection: lethal coincidence: Case report with literature review.

BACKGROUND: Novel oral anticoagulants are now encountered in patients needing emergency surgery. Knowledge and treatment options are limited. METHODS AND RESULT: We present the case of a 76-year-old patient who suffered from an acute Stanford type A aortic dissection, needing emergency surgical aortic repair. He was anticoagulated with dabigatran due to past atrial fibrillation. Despite haemodiafiltration, surgical revision and massive transfusion of packed red blood cells, fresh frozen plasma, platelets, coagulation factors, and recombinant factor VIIa, the patient died from intractable blee

The role of technological progress vs. accidental discoveries and clinical experience.

The 50th anniversary of dialysotherapy celebrated by nephrologists around the world in 2012 provided an opportunity for discussion on the role of clinical experience in relation to technological progress in the evolution of dialysis, especially of recently observed inadequate decrease in mortality/morbidity rates of patients on chronic dialysis. My report, based on almost 50 years of career in nephrology, refers the evolution of dialysis, from catharsis to modern dialysotherapy with special attention devoted to nowadays gravely underestimated role of clinical experience and personalized profes

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… Intensive nephrological therapy was enriched in the 90’s by hemofiltration and hemodiafiltration. Obtaining isotonic ultrafiltrate in case of both those methods equals reduction of hydrostatic pressure and better hemodynamic control of the treatment. … Modifications of standard HD, such as hemofiltration and hemodiafiltration on line are more widely used in intensive care of unstable cardiopulmonary patients. …

Micafungin Sequestration and Late Release During Continuous Renal Replacement Therapy with Polyacrylonitrile- and Polysulfone-Derived Filters.

INTRODUCTION: Adsorption within continuous renal replacement therapy (CRRT) circuits may reduce exposure to echinocandins. Because micafungi … hemofilter (AV™1000). For AV™1000, one run used CVVH (2.5 L/h) and one used continuous veno-venous hemodiafiltration (CVVHDF; dialysis 1.5 L/h plus filtration 1.0 L/h). Initial micafungin concentrations in the central compartment were 2.18 mg/L or approximately 6.8 mg/L. Concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) with …

Respiratory drive and pulmonary mechanics during haemodialysis with ultrafiltration in ventilated patients.

The improvements of respiratory drive and pulmonary mechanics which follow haemodialysis with ultrafiltration in mechanically ventilated renal failure patients seem predictable but have not been studied before. In this study, 14 renal failure patients with stable haemodynamics mechanically ventilated with pressure support ventilation (PSV) were enrolled. Respiratory drive (represented as P0.1), pulmonary mechanics, breathing pattern, arterial blood gas and haemodynamics were measured according to the time schedule: pre-dialysis (Time 0), and at 60, 120, 180, 240 minutes thereafter. Following t

Predictors of mortality in severe malaria: a two year experience in a non-endemic area.

Management of severe malaria is an increasing problem worldwide. This paper reviews the pathophysiology and management documenting two years' experience of admissions of severe malaria to an ICU in a non-endemic area. Clinical and laboratory features of severe malaria were analysed for predictors of mortality Twenty-eight patients had clinical or laboratory features compatible with the WHO criteria for severe malaria and, despite treatment with intravenous quinine and supportive ICU care, mortality was 28.5% (8/28). The three pregnant patients died with 100% foetal mortality and the four paedi

Кассетная нефропатия в СИС: Раннее признание и экстракорпоральные стратегии улучшения результатов.

Острая почечная травма (АКИ), вызванная кастами, является частой, но недостаточно признанной причиной дисфункции почек в отделении интенсивной терапии. Она возникает, когда фильтрованные белки или пигменты - свободные световые цепи (ФЛК) в множестве миеломы, миоглобин в хабдомиолизе, билирубин в тяжелом холестазе или гемоглобин в внутриваскулярном гемолизе - возникают внутри почечных трубок, образуя обструктивные касты и вызывая окислительные и подстрекательские травмы. Раннее распознавание имеет важное значение, поскольку традиционные маркеры (кротинин, мочи) задерживаются. Формирующиеся биом

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… AKI: Acute kidney injury; AAST: American Association for the Surgery of Trauma; CRRT: Continuous renal replacement therapy; CVVHDF: Continuous veno-venous hemodiafiltration; FLC: Free light chain; HD: Hemodialysis; HCO: High-cutoff membrane; HDF: Hemodiafiltration; HFR: Hemodiafiltration with reinfusion … ASFA: American Society for Apheresis; FLC: Free light chains; HFR-SUPRA®: Hemodiafiltration with reinjection–SUPRA (hemodiafiltration plus adsorption cartridge); IgM: Immunoglobulin M; TPE: Therapeutic plasma exchange. …

Indole 3-acetic acid, indoxyl sulfate and paracresyl-sulfate do not influence anemia parameters in hemodialysis patients.

BACKGROUND: The main reason for anemia in renal failure patients is the insufficient erythropoietin production by the kidneys. Beside erythr … quently an IV iron prescription (52.1 versus 65.7%, p = 0.04) and were more frequently treated with hemodiafiltration (53.5 versus 36.7%). In univariate analysis, IAA, IS or PCS plasma concentrations did not differ between the two groups. In the linear model, IAA plasma concentration was not associated with hemoglobin, but was negatively associated with ESA/Hb (p = …

[Cardiovascular risk markers in hemodialysis].

PURPOSE: Although maintenance dialysis prevents death from uremia, patient survival remains an important issue. Cardiovascular (CV) events h … ients (13 males, four females) on standard HD and six patients (four males, two females) on on-line hemodiafiltration (HDF), who were taking folic acid for at least 3 months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. We performed arterial gas-analysis, Na+, K+, Ca++, Mg++, Cl-, P, serum albumin, creatinine (Cr), urea, total …

Acute Kidney Injury in Monoclonal Gammopathies.

Monoclonal gammopathies (MG) encompass a variety of disorders related to clonal expansion and/or malignant transformation of B lymphocytes. Deposition of free immunoglobulin (Ig) components (light or heavy chains, LC/HC) within the kidney during MG may result over time in multiple types and degrees of injury, including acute kidney injury (AKI). AKI is generally a consequence of tubular obstruction by luminal aggregates of LC, a pattern known as "cast nephropathy". Monoclonal Ig LC can also be found as intracellular crystals in glomerular podocytes or proximal tubular cells. Proliferative glom

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… Hemodiafiltration improves free light chain removal and normalizes κ/λ ratio in hemodialysis patients J. Nephrol. 2016 29 251 257 10.1007/s40620-015-0207-z 26022721 125. Wratten M.L. Ghezzi P.M. Hemodiafiltration with endogenous reinfusion Contrib. … Serum free light chains removal by HFR hemodiafiltration in patients with multiple myeloma and acute kidney injury: A case series Kidney Blood Press. Res. 2018 43 1263 1272 10.1159/000492408 30078004 …

Membrane-to-Patient Optimization: Individualized Dialyzer Selection for Extracorporeal Dialysis.

Extracorporeal dialysis for uremic toxin removal and fluid regulation relies on specialized dialyzers whose membranes differ markedly in polymer chemistry, pore architecture, adsorption capacity, surface bioactivity, and convective performance. These structural and material distinctions result in wide variation in the clearance of chemically diverse uremic solutes. Despite the expanding range of dialyzer options, membrane selection in clinical practice remains largely non-individualized. In this review, we propose a phenotype-based model for dialyzer membrane selection. We outline how distinct

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… Comparison of High-Flux, Super High-Flux, Medium Cut-Off Hemodialysis and Online Hemodiafiltration on the Removal of Uremic Toxins Blood Purif. 2023 52 309 318 10.1159/000526891 36215951 25. Kuhlmann M.K. 12—Hemofiltration and Hemodiafiltration Handbook of Dialysis Therapy 6th ed. Nissenson A.R. … High-Volume Hemodiafiltration Versus High-Flux Hemodialysis: A Narrative Review for the Clinician J. Clin. Med. 2025 14 2614 10.3390/jcm14082614 40283444 PMC12027741 72. Ronco C. Maduell F. Kalantar-Zadeh K. Madero M. Reis T. The Role of Online Hemodiafiltration in Contemporary Kidney Care Clin. …