bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training Patients for Nocturnal Home Hemodialysis
Authors: Stokvis S.j.a.m. , Verhallen A.m. , Kooistra M.P. 
Published: December 2004

Purpose:  Nocturnal home hemodialysis (NHHD, 6–7 times weekly 6–9 h) results in better clinical outcome than conventional 3 times weekly hemodialysis. A good training program for patient and partner is a prequisite for success. We developed a training course for patients and partners.Methods:  Since December 2001, we trained 20 patients and their partners to perform NHHD in 2 succeeding groups. The first group, consisting of 15 patients and their partners, started a NHHD pilot study. During this pilot study, we improved the training course. The second group of 5 were trained with this improved program. All 5 participants were home hemodialysis patients for over 1 month before starting the NHHD course. First, they learned how to handle the single needle system. Then, they performed single needle hemodialysis for 2 weeks at home. This was followed by an in‐center NHHD training, consisting of 4 conventional day‐time and 3 long (8 h) nocturnal dialysis treatments. Main targets during this training period are to learn to deal with safety precautions, online monitoring, and special machine features, and to check biochemistry and heparinization during long dialysis. 1 month after the training we evaluated the course with all participants.Results:  For 9 of 15 couples in the first group, the training appeared to be exhausting. Stress factors were an overloaded program and too little experience with several new skills including needle technique before starting NHHD. The second group started the NHHD training 2 weeks after the single needle training. This second group was pleased with the training protocol.Conclusion:  The training course for NHHD should not be overloaded. Patients need time to learn new skills before starting NHHD.
Nocturnal Home Hemodialysis: Patient's Perspective
Authors: Vos H. , Stokvis S.J.A , Verhallen A. , Kooistra. M.P. 
Published: December 2004

Purpose:  Several studies have showed that nocturnal home hemodialysis (NHD, 6 times weekly 6–8 h) results in a better outcome. How do patients and their partners experience this very intensive treatment that has a great impact on daily life?Methods:  We followed a cohort of 12 patients (11 male, 1 female, mean age 46.8 ± 9.4 years, time for renal replacement 11.3 ± 9.4 years) and their partners during a year after starting NHD, using questionnaires and interviews and the SF‐36.Results:  Both the physical and the mental components of the SF‐36 showed an improvement in all aspects (p < 0.05), even in this small group. All couples considered NHD a tremendous improvement over routine thrice weekly dialysis. The drawbacks (such as daily routine and the intrusion of the treatment in bed) are outweighed by the advantages (such as better clinical condition, less fatigue, less uremic symptoms, better quality of life, more time, and free diet). Following are a few comments on NHD: “NHD is a difference of day and night,”“NHD gave me independence,”“Since I do NHD, I do aerobics,”“I am becoming too fat now!,”“My husband now is much faster than I am when we walk or ride the bicycle,”“There is no reason now why I won't live long,”“I got an excellent, but demanding new job, which is possible thanks to NHD,”“Being a good team is a prerequisite for success,”“Don't expect too much. You will remain a chronic patient,”“Become confident with ‘conventional’ home hemodialysis first before you start NHD.”Conclusion:  NHD results in a tremendous improvement of quality of life. However, patients and partners need active support.
Hemodialysis in the Elderly
Authors: Christopoulou S. 
Published: December 2004

During the last decade, the number of patients starting renal replacement therapy has increased for all ages, but the increase for patients over 65 years old has been particularly dramatic.Objective:  The aim of our study was the analysis of the outcome of all the patients who were over 65 years of age at the time they started chronic hemodialysis, in our Center (n, 52).Methods:  A total of 76 patients were treated by the chronic hemodialysis program of 251 Hellenic Air Force and VA General Hospital, between 1992 and 2002, while totally 309 patients were offered dialysis at this time. We found that 52 of them (68.4%) were over 65 years old [40 male (76.9%), 12 female (23.1%)].Results:  Elderly patients manifest more often intradialytic complications, such as hypotensive episodes (28.8%) and arrhythmias (23.1%), due to their hemodynamic instability. Polypharmacy is a big deal for dialysis patients, especially elderly ones. Each patient was taking 9.1 PO and 1.9 IV medications on average, per day. Most of them (84.6%) required recombinant human erythropoietin. The most common co‐morbid factors we observed in this population were cardiovascular diseases (36.5%), neurological problems, respiratory failure, bone disease, malignancy (17.3%), depression, malnutrition, and infections (30.8%). Deaths were often associated with more than one morbid factors. Survival and the quality of life in the elderly patients on hemodialysis are frequently acceptable. The 1, 3 and 5‐year patient survival rates during 1990–2000 were 63.4%, 56.1%, and 26.8%.Conclusion:  We believe that if there are no extracontraindications, elderly patients can benefit from hemodialysis, taking into consideration that we should adapt the therapy to the geriatric special needs.
Central Venous Catheter Access in Children on HD
Authors: George C. , Jones L.L. , Johnson S.L. , Andrews W.S. , Warady B.A. 
Published: December 2004

Central venous catheters (CVC) remain a frequently used form of vascular access in children receiving chronic hemodialysis (HD). Whereas standard dual‐lumen catheters (DL) are used in many centers, the Tesio catheter has proven to be superior to the DL catheter in terms of catheter survival and infection rates in at least one pediatric study (Sheth RD et al. Am J Kidney Dis. 2001). Recently, the Ash Split catheter became available which, while similar to the Tesio internally, being comprised of 2 separate catheters, may be preferable because of the requirement for only one skin puncture for placement vs. two for the Tesio. However, no pediatric data pertaining to the Ash Split catheter have been published to date. Therefore, we reviewed and compared our experience with a small number of Ash Split (# 16) and Tesio (# 8) catheters used for semipermanent vascular access in our chronic HD population with reference to survival, infectious complications, patency, and dialysis adequacy. The results of this experience are as follows:

Tesio
Ash Split

Survival >3 months
6/8
12/15

Sepsis (epi/catheter mo)
1/30
1/25

Exit‐site infection (epi/catheter mo)
1/8.6
1/19

sp Kt/V urea
1.67
1.88

% sp Kt/V urea >1.2
100
90

Reasons for the removal of Tesio catheters were transplant (4), sepsis (1), deterioration of tubing (1), and accidental (1). Ash Split catheter removal resulted from sepsis (2), fistula placement (4), thrombosis (1), and accidental (2). This preliminary experience reveals similar outcome data for the Tesio and Ash Split catheters when used in pediatric HD patients. Definitive statements regarding the superiority of either catheter awaits additional data collection and analysis.
Kinetic Studies on Urea Extraction with Hemodialysis in Adolescents by On‐line Monitoring of Dialysate Urea
Authors: Kreuzer M. , Drossert T. , Stein A. , Arbeiter A. , Vester U. , Bonzel K‐E. 
Published: December 2004

Kinetics of urea extraction during a single dialysis session in children are unknown, because analysis of solutes in dialysate is difficult due to their extreme dilution.>Objective:  A novel urea monitor of the Gambro Company might be of help in studying urea kinetics also in children.Methods:  We studied 107 urea kinetics in 5 adolescents aged 13–19 years, weighing 26–58 kg, and looked for influences of membrane size, blood flow, and duration of one dialysis session. Urea measurement applies to the change of electric dialysate conductivity due to ionization because of urea splitting by urease. Bicarbonate dialysis regimen was 4–5 h each, 3 times a week, using polysulfone high‐flux dialyzers (Fresenius F60 or F80, depending on body size).Results:  Average 4‐h urea Kt/V values for F60 (n = 85) were 1.69±0.53 and for F80 (n = 21) 1.63±0.25, extracted urea mass was 16.0±5.4 g and 32.5±5.4 g, respectively (p < 0.05); Kt/V urea results for blood flows of 180–220 mL/min were 1.36±0.52 and for <180 mL/min 1.10±0.43; extracted urea mass was 17.3±8.0 and 11.7±4.9 g, respectively (p < 0.05). Total average urea extraction ratio after 2 h of dialysis (n = 107) was 64.8±5.6%. Extraction ratio during the 4th h of dialysis was only 15.3±4.1% and during the 5th h not more than 9.0±3.6% of total urea extraction.Conclusion:  Kinetics of urea extraction helps understanding dialysis processes in children. Adapting the size of the dialyzer according to body size raises urea extraction and maintains urea clearance Kt/V at the desired quality level. An inadequate blood flow lowers both urea extraction and urea clearance Kt/V. Prolonging dialysis beyond 4 h is, at least in concern of urea kinetic modelling, a rather ineffective means. We speculate that children with blood flow problems should be dialysed more often.
Experience with the Gambro Phoenix Hemodialysis Machine using Diascan and Exalis in a Pediatric Hemodialysis Unit
Authors: Paille L. , Hann P. , Lirenman D.S. , Carter J.E. 
Published: December 2004

Introduction:  In 2001 our Renal Dialysis Unit underwent a major renovation to five stations. The new space and funding allowed for acquisition of new state‐of‐the‐art hemodialysis machines. We describe our experience with the Gambro Phoenix with Diascan and Exalis. Prior to the move an evaluation was undertaken. Criteria for selection with a scoring tool were utilized to rate machine performance for use in children. The decision for the Gambro Phoenix machine was based on: the performance rated highly due to ease of set up; large viewing touch screen; compatibility with existing equipment; benefits of online clearance monitoring (Diascan); network data management system (Exalis) and the future availability of blood volume monitoring (Hemoscan). Our program was the first center to dialyze a pediatric patient on the Phoenix machine in Canada.Patients and results:  13 patients (age 2–23 years) were hemodialyzed between May 2002 and September 2003 for periods of 2 week to 16 months, greater than 5000 h of dialysis time. The move was not uneventful. During the first months of operation issues such as inadequate electrical supply for the new machines, reverse osmosis (RO) pump failure, leaks, and no emergency power to the RO were prevalent. The new software also exposed glitches. Subsequent Phoenix use proceeded uneventfully. Staff were able to problem solve easily with clinical and technical support from Gambro Canada. Education for the online clearance monitoring, Diascan and Exalis, was necessary. No major problems with dialysis were encountered. The benefits and reliability of Diascan have been previously described (Lindsay RM, Sternby J, Semin Dial. 2001; 14:300). Diascan readings provided real‐time measurement of sodium (Na), which correlated well with laboratory values. Automatic readouts of Kt/V allowed for monitoring of dialysis adequacy which was consistent with calculated percent reduction in urea (PRU). At this point, use of the Phoenix has been demonstrated to work well in a pediatric facility.
Accuracy of Online Conductivity Monitor Compared with Daugirdas (dPVV/Kt/V) Model. Use in the Clinical Field
Authors: Cigarrán S. , Coronel F. , Torrente J. , Sevilla M. , Baylón J.C.D. 
Published: December 2004

The influence of dialysis prescription on outcome is well established. Hemodialysis dose has been shown to have a distinct impact upon the morbidity and mortality rate in patients on regular treatment therapy. Hence, adequacy of dialysis should be guaranteed. New devices based in online conductivity measures have been developed to achieve an adequate dialysis dose. The aim of this study was to compare online conductivity monitor (OCM) with dialysis dose standard methods (Daugirdas Kt/V). 24 anuric patients were included in a cross‐sectional study: 20.8% were diabetics, mean age 64.7 ± 18.2 years; 16% females. Access blood were AVFi and the effective dialyzed blood flow was set at 350 mL/min, with recirculation <5%. BMI was 25.4 ± 3.8 kg/m2 and body weight was 69.7 ± 12 kg. All patients were dialyzed thrice weekly (245 ± 21 min) with dialysis machine 4008H (Fresenius Medical Care) equipped with OCM monitor and the hollow fiber high‐flux polysulfone membrane (HF‐80 1.8 m2) and helixone (Fx‐60, 1.6 m2). Dialysate flow was maintained at 500 mL/min, with standard dialysate liquid. Drug therapy was not varied. Each patient was subjected to OCM on midweek day, during 3 consecutive weeks on the same day that blood Kt/V samples were taken as well. Each patient got 3 OCM measurements and Kt/V samples. Data were processed and statistically analyzed with SPSS 11.0 software package. Kt/V OCM relation to other baseline characteristics was assessed by using contingency tables, t‐tests, analysis of variance, and linear regression, as appropriate. All the tests were performed for a 0.05 significance level.
Descriptives (n = 24)

Mean
SD

Age (year)
64.75
18.243

Dry weight
69.7125
12.01178

Interdialysis weight gain
2266.67
1016.673

BMI
25.4155
3.83630

HD time
245.21
21.340

OCM
1.29921
0.201072

Daugirdas Kt/V
1.3287
0.21043

Watson volume (L)
36.833
6.3095

Linear regression analysis: Kt/V OCM relationship

Variable
Regression coefficient (β)
r2
p

Age (year)
−0.631
0.398
<0.001

Daugirdas Kt/V
−0.981
0.962
<0.001

BMI
−0.327
0.107
NS

Watson volume (L)
−0.833
0.694
<0.001

The OCM option correlates well with Daugirdas Kt/V obtained from blood samples, in 96.2%, and provides a safe and accurate tool for hemodialysis, adding efficiency to dialysis adequacy monitoring in clinical practice. Also, OCM allows for an individualized dialysis dose. Furthers studies are required to evaluate its influence on patients' evolution.
Risk of Inadequate Dialysis Dose in Hemodialysis Patients with High Watson Volume. A Warning
Authors: Cigarrán S. , Coronel F. , Torrente J. , Sevilla M. , Baylón J.C.D. 
Published: December 2004

Quality control of dialysis treatment has received wide attention since inadequate dialysis dose was an independent risk factor of morbidity and mortality in hemodialysis patients. Each 0.1 decrease in Kt/V less than 1.2 is estimated to increase the relative risk of death by 5–7%. A higher Kt/V can be achieved by increasing treatment time, using a larger dialyzer or increasing blood or dialysate flow rates. The aim of this cross‐sectional study was to know, using online conductivity monitor (OCM) routinely, whether a certain subgroup of patients is being treated inadequately. 24 anuric patients were included in a cross‐sectional study: 20.8% were diabetics, mean age 64.7 ± 18.2 years; 16% females. Access blood were AVFI and the effective dialyzed blood flow was set at 350 mL/min, with recirculation <5%. BMI was 25.4 ± 3.8 kg/m2 and body weight was 69.7 ± 12 kg. All patients were dialyzed thrice weekly (245 ± 21 min) with dialysis machine 4008H (Fresenius Medical Care) equipped with OCM monitor and the hollow fiber high‐flux polysulfone membrane (HF‐80 1.8 m2) and helixone (Fx‐60, 1.6 m2). Dialysate flow was maintained at 500 mL/min, with standard dialysate liquid. Drug therapy was not varied. OCM was validated for our population and reported in other abstracts (r2 = 0.96, p < 0.001). Inadequate dialysis dose was considered at OCM Kt/V less than 1.2. Data were processed and statistically analyzed with SPSS 11.0 software package. Watson volume (Wv) to other baseline characteristics was assessed by using contingency tables, t‐tests, analysis of variance, and linear regression, as appropriate. All the tests were performed for a 0.05 significance level. The OCM Kt/V weekly was inversely related to Wv (r = −0.833, p < 0.001). 20.8% of our patients are at risk of inadequate dialysis dose, and it reflects our current practice of dialysis prescription. All of them are anuric young men with a Wv > 40 L. Specific efforts are required to deliver an adequate dialysis dose in this kind of patients. This can be achieved by altering dialysis frequency, increasing membrane surface, and/or increasing dialysis flow. OCM Kt/V device permits a daily dialysis dose delivery and, consequently, an individualized prescription. Prospective studies are required to establish whether adequate dialysis dose in patients with Wv > 40 L may further improve their survival.

Variable
n
OCM Kt/V
Age (year)
THD (min)
Watson volume (L)

OCM Kt/V

<1.2
5 (20.8%)
1.05 ± 0.03*
45.2 ± 12.91*
240 ± 21.21
45.02 ± 3.03*

OCM Kt/V

≥1.2
19 (79.2%)
1.36 ± 0.17
69.89 ± 15.9
246 ± 21.21
34.6 ± 4.9

p < 0.001.
Survival of End‐Stage Renal Disease Diabetic Patients on Hemodialysis
Authors: Maiza H.a. , Thomas M.j. , Dorcely A. 
Published: December 2004

Purpose:  To analyze survival and causes of mortality in end‐stage renal disease (ESRD) diabetic patients treated by hemodialysis.Methods:  Data of 1203 ESRD hemodialyzed patients between 1975 and 2002 were analyzed, 116 patients were excluded and 1087 patients included in the study. We studied the prevalence of the diabetic nephropathy, the rate of survival and causes of death by comparing diabetic patients with a control group of patients without diabetes.Results:  Among the 1087 patients requiring dialysis, 272 (25%) were diabetic and 815 non‐diabetic whose causal nephropathy was nephroangiosclerosis 32%, glomerulonephritis 15%, chronic interstitial nephropathy 14%, and others 14%. The diabetics were older at the beginning of dialysis than non‐diabetic patients: 60.33 ± 11.39 years vs. 52.23 ± 17.20 years, p < 0.001. Average time on dialysis is more important in non‐diabetic than diabetic group [5.90 ± 5.73 years vs. 2.71. ± 2.48 years, p < 0.001]. The rate of death was higher in diabetics than in control group [71.7% vs. 55.8%, respectively, p < 0.003]. The difference in survival between the two groups remains significant for the same age. Death caused by cardiovascular disorders is higher in diabetics (68.8%) than non‐diabetics (31.2%) (p < 0.05). Among death causes, stroke is the most frequent cause in diabetics (18.4% vs. 11.6%) in non‐diabetics, p < 0.05. Death by heart failure and infections is higher in diabetics but the difference is not statistically significant (12.3% in diabetics vs. 9.4% in non‐diabetics for heart failure and 13.8% vs. 11.4% for infections). Death due to neoplasms is higher in non‐diabetics (4.39% vs. 1.02% in diabetics, p < 0.05).Conclusion:  In our cohort, mortality in diabetic patients is higher than in non‐diabetic patients. Cardio‐vascular disorders are the most cause of death in diabetics and above all stroke, whereas mortality due to neoplasms is higher in non‐diabetic patients. Diabetes is an important risk factor of mortality in hemodialysis patients.
Quality of Life in Chronic Kidney Disease Patients and Hemodialysis Patients
Authors: Iliescu E.a. , Yeates K.e. , Holland D.c. 
Published: December 2004

The aim of this cross‐sectional study is to assess quality of life (QOL) in 119 chronic kidney disease (CKD) patients and 89 hemodialysis (HD) patients using the SF‐36 instrument (PF = physical function, RP = role limitations physical, BP = bodily pain, GH = general health perceptions, VT = vitality, SF = social function, RE = role limitations emotional, MH = mental health, MCS = mental summary, and PCS = physical summary). The mean (range) s‐creatinine in the CKD group was 325 μmol/L (133–809 μmol/L). There were no differences in SF‐36 scores between CKD and HD patients (Figure). CKD/HD status did not predict MCS or PCS in multivariate analyses controlling for age (p < 0.01 for PCS), sex, depression (p = 0.01 for PCS), Charlson comorbidity score (p < 0.01 for PCS), s‐albumin (p = 0.05 for PCS), hemoglobin, presence of partner, and level of education.We conclude that QOL is related to comorbid illness and decreases even before dialysis is started. Longitudinal studies of QOL in CKD patients are needed to evaluate the influence of dialysis initiation on QOL.
Physical disturbance of an upland grassland influences the impact of elevated UV‐B radiation on metabolic profiles of below‐ground micro‐organisms
Authors: Avery L. M. , Thorpe P. C. , Thompson K. , Paul N. D. , Grime J. P. , West H. M. 
Published: December 2004

AbstractThis investigation determined the response of soil microbial communities to enhanced UV‐B radiation and disturbance in upland grassland. A factorial field experiment encompassing two levels of UV‐B supplementation (simulating ambient and a 30% increase in stratospheric ozone) and two levels of disturbance (disturbed and undisturbed) was established at Buxton Climate Change Impacts Laboratory, Derbyshire, UK, and maintained for 7 years prior to sampling.Enhanced UV‐B increased microbial utilization of carbohydrates, carboxylic acids, polymers and aromatic compounds present in Biolog® GN plates when inoculated with soils taken from disturbed plots, but did not affect carbon utilization of soil microbial communities associated with undisturbed plots (UV‐B×Disturbance interaction, P<0.05 for each substrate type).UV‐B treatment did not affect numbers of bacteria or fungi. Direct microscopic counts showed fewer bacteria in soil originating from disturbed plots than from undisturbed plots (Disturbance, P<0.001), although a greater number of culturable bacteria and fungi were isolated from disturbed than from undisturbed soils (Disturbance, P<0.001). No UV‐B‐ or disturbance‐related differences in protein, starch or urea hydrolysis were exhibited by bacterial isolates.UV‐B treatment did not affect total plant biomass within undisturbed plots or the biomass of individual groupings of grasses, forbs and mosses. Per cent root length colonized by arbuscular mycorrhizal fungi (AMF) was not affected by enhanced UV‐B radiation in the undisturbed plots. Neither AMF nor plant biomass was measured in disturbed plots.The key findings of this study show that UV‐B‐mediated alterations in carbon utilization occurred in soil microbial communities subjected to disturbance, but such changes were not observed in communities sampled from undisturbed grassland. Differences in the catabolic potential of microbial communities from disturbed grassland subjected to enhanced UV‐B are probably related to plant‐mediated changes in resource availability or quality.