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Your search term(s) "anemia and kidney and dialysis" returned 17 results.

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Comorbid Diseases in Patients on Dialysis: The Impact on Anemia. Nephrology Nursing Journal. 34(01): 72-75. January-February, 2007.

This continuing education article considers the impact of comorbid diseases on anemia in patients on dialysis. The author notes that patients who are on dialysis frequently present with a multitude of comorbid diseases. These diseases include hypertension, coronary artery disease, congestive heart failure, diabetes mellitus, cardiomegaly, left ventricular hypertrophy, peripheral vascular disease, peptic ulcer disease, cellulitis or gangrene, gastrointestinal bleed, and cancer. Many of these conditions can either directly aggravate pre-existing anemia, or lead to acute or chronic inflammatory or infectious conditions that can lower hemoglobin levels. Awareness of these conditions and their compounding effect on anemia can help nurses when interpreting the results of longitudinal trends in hemoglobin. The author concludes that management of these patients requires an individualized approach to assess for the presence of multiple conditions that may be affecting hemoglobin levels and to adjust therapies, as appropriate, to minimize the impact on anemia-related outcomes. 3 tables. 12 references.

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Dialysis Care Clinical Handbook. New York, NY: National Kidney Foundation. 2007. 156 p.

This clinical handbook summarizes the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and recommendations from the 2006 updates regarding hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, anemia in chronic kidney disease (CKD), and cardiovascular disease in adult dialysis patients. The handbook provides a practical strategy for applying the statements and recommendations from the KDOQI in a real-world setting. Specific topics covered include planning for dialysis, initiating dialysis, monitoring dialysis adequacy, quality assurance, patient education, measuring peritoneal membrane function and ultrafiltration volume, preserving residual kidney function, maintaining euvolemia, family and caregiver education, preparation for permanent hemodialysis vascular access, treatment of vascular access complications, identifying patients with anemia in CKD, cardiovascular disease evaluation at initiation of dialysis, vascular heart disease, cardiomyopathy, dysrhythmia, peripheral vascular disease, the management of cardiovascular disease in patients on dialysis, the role of external defibrillation, and the management of cardiovascular risk factors, including smoking, dyslipidemia, and physical activity. The guidelines and recommendations in each section are organized according to the way a patient presents and thus do not follow the numerical sequence of the guidelines. All guideline and recommendation statements, tables, graphs, and figures in each section are identified by the guideline or recommendation number for easy cross-referencing. Clinicians are referred to the full guidelines and recommendations for more detailed analysis of the available data. Readers are referred to the KDOQI website at www.kdogi.org for references. 12 figures. 41 tables.

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New CPM Report Shows Slight Improvements in Hemoglobin Levels. Nephrology News & Issues. 21(11): 50-52, 54. October 2007.

This article reviews the 2006 Clinical Performance Measures (CPM) report, an annual data survey of hemodialysis (HD) and peritoneal dialysis (PD) patients. The author focuses on HD adequacy, vascular access, and anemia management CPMs, presenting data primarily from in-center HD settings. In the area of dialysis adequacy, the report showed that 82 percent of patients had monthly adequacy measurements performed; 76 percent of patients had their dialysis delivery calculated using either UKM or the Daugirdas II formula; and 94 percent of patients on dialysis for 6 months or more and dialyzing three times a week had a mean delivered adequacy dose of spKt/V greater than 1.2, calculated using the Daugirdas II formula. Data for vascular access showed that 54 percent of new patients were dialyzed using an arteriovenous (AV) fistula; 44 percent of prevalent patients were dialyzed using an AV fistula; and 21 percent of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer. In the area of anemia management, 35 percent of targeted patients prescribed epoetin had a mean hemoglobin of 11 to 12 grams per deciliter (g/dL); and 81 percent of patients who met the inclusion criteria were prescribed intravenous iron in at least 1 month during the study period. A table summarizes data on the end-stage renal disease (ESRD) CPM trends from 1998 through 2005. Readers are referred to www.cms.hhs.gov/CPMProject for the complete 2006 end stage renal disease (ESRD) clinical performance measures annual report and reliability report. 3 figures. 1 table.

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2006 Updates Clinical Practice Guidelines and Recommendations. New York, NY: National Kidney Foundation. 2006. 411 p.

This clinical handbook provides the 2006 updates to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and recommendations regarding hemodialysis adequacy, peritoneal dialysis adequacy, and vascular access. The first section starts with clinical practice guidelines and recommendations for hemodialysis adequacy, covering initiation of dialysis, methods for measuring and expressing the hemodialysis dose, methods for postdialysis blood sampling, minimally adequate hemodialysis, control of volume and blood pressure, preservation of residual kidney function, quality improvement programs, and pediatric hemodialysis prescription and adequacy. The guidelines and recommendations outlined in the second section, on peritoneal dialysis adequacy, cover initiation of dialysis, peritoneal dialysis solute clearance targets and measurements, preservation of residual kidney function, maintenance of euvolemia, quality improvement programs, and pediatric peritoneal dialysis. The last section, on vascular access, offers clinical practice guidelines and recommendations covering patient preparation for permanent hemodialysis access, selection and placement of hemodialysis access, cannulation of fistulae and grafts, accession of hemodialysis catheters and port catheter systems, detection of access dysfunction through monitoring, surveillance, and diagnostic testing, treatment of fistula complications, treatment of arteriovenous graft complications, prevention and treatment of catheter and port complications, vascular access in pediatric patients, and clinical outcome goals. Each section includes research recommendations, a list of work group members and their biographies, a list of acronyms and abbreviations, and tables and figures. A list of references concludes each section. Readers are referred to the KDOQI website at www.kdogi.org for more information. 17 figures. 63 tables. 1275 references.

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Hematologic Aspects of Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 691-740.

The most characteristic hematologic abnormality in chronic kidney disease (CKD) is anemia, which results primarily from the failure of the kidneys’ endocrine function. Anemia can persist as a significant problem, even in patients receiving adequate dialysis. This chapter on the hematologic aspects of CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors review the pathogenesis of the anemia associated with CKD, discuss the diagnosis and therapy of this anemia in patients with CKD, and outline selected aspects of granulocyte and platelet function in patients with CKD. Other topics covered include the paradoxical absence of anemia, treatment with epoetin (erythropoietin alfa), transfusion avoidance, quality of life issues, exercise tolerance and rehabilitation, the positive effects of the correction of anemia, special considerations for patients with congestive heart failure (CHF), target hemoglobin levels, newer epoetins, the role of ACE inhibitors, intercurrent illness or surgery, granulocyte number and function in uremic patients, and abnormalities of hemostasis in uremia. The authors include a discussion of treatment issues, particularly the challenges faced by primary care physicians in identifying, treating, and referring patients with CKD and CKD-related complications and comorbidity. 7 figures. 596 references.

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Anemia in CKD: Prevalence, Diagnosis, and Treatment: Case Study of the Anemic Patient. Nephrology Nursing Journal. 29(4): 371-374. August 2002.

This article reports on a point-in-time observational study that was conducted in over 1,000 nephrology (kidney specialty) offices between November 1999 and December 2000 to determine the prevalence of anemia in patients with chronic kidney disease (CKD). Trends in hemoglobin (Hb) and serum creatinine (SCr, a measure of kidney function) levels were assessed among 4,831 evaluable patients to determine the relationship between renal (kidney) function and anemia. Results demonstrated that anemia is common in patients with CKD, with progressive increases in prevalence and severity as renal function deteriorates. Overall, 26.3 percent of these patients had Hb levels below 10 grams per deciliter, 46.7 percent had Hb levels below 11 grams per deciliter, and 63.9 percent had Hb levels below 12 grams per deciliter. Despite the high percentage of patients with anemia, only 31.3 percent were being treated for this condition. These data suggest that anemia is prevalent and undertreated in patients with CKD. The authors conclude that nephrology nurses can be influential in providing proactive management of anemia throughout the spectrum of CKD to improve anemia-related outcomes. 2 figures. 14 references.

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Effects of Hemodialysis Dose on Anemia, Hypertension, and Nutrition. Renal Failure. 24(5): 615-621. 2002.

There is good evidence that by improving dialysis adequacy, the morbidity (related illness) and mortality (death) of hemodialysis (HD) patients decrease. Dialysis adequacy has also been related to the better control of arterial blood pressure (BP), anemia, and improvement of patients' nutritional status. This article reports on a self-control study of 34 patients on HD (23 males, 11 females), aged 52.6 years (plus or minus 15.5 years), HD duration 55.9 months (plus or minus 61.2 months), referring to the effect of increasing delivered dialysis dose, over a 2-year period, on their clinical and laboratory parameters. Delivered HD dose increased, statistical significance, the following: urea reduction ratio (URR), Kt per V, and Hb (hemoglobin); no difference was noticed in weekly EPO (erythropoietin) dose. Both systolic and diastolic BP decreased significantly. The authors conclude that increasing dialysis dose results in both clinical and laboratory improvement regarding hypertension, nutritional status, and control of HD patients' anemia. 2 tables. 25 references.

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Just the FAQs: Frequently Asked Questions About Iron and Anemia in Patients with Chronic Kidney Disease. American Journal of Kidney Diseases. 39(2): 426-432. February 2002.

Anemia in patients with chronic kidney disease is caused by insufficient production of erythropoietin (epoetin). Iron deficiency, chronic inflammation, hyperparathyroidism, and blood loss each may contribute to anemia in these patients. This article answers a series of frequently asked questions, many of which concern the patient who fails to respond to usual doses of epoetin. The authors provide the answers they have given at seminars held during meetings of the National Kidney Foundation (April 2000) and the American Society of Nephrology (October 2000). Questions and issues discussed include the best measure of iron status (hemoglobin tests), handling patients with low or normal transferrin saturation and high serum ferritin, diagnosing infection, patient selection for iron administration, administration and dosage of serum ferritin, the addition of vitamin C to drug regimens, maintenance iron protocols versus periodic iron therapy, maintenance iron therapy administered through dialysis facilities, total dose iron infusion, how to compare adverse reaction rates, and the use of iron and epoetin therapy in patients with chronic kidney disease who are not on dialysis. 3 figures. 33 references.

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Clinical Efficacy of Higher Hematocrit Levels in Children with Chronic Renal Insufficiency and Those Undergoing Dialysis. Seminars in Nephrology. 21(5): 451-462. September 2001.

The optimal hematocrit (the measurement used to determine the volume of red blood cells, i.e., the ability of the blood to carry oxygen) target range in children with end stage renal disease (ESRD), who are receiving recombinant human erythropoietin, is ambiguous due to the lack of compelling, age appropriate studies. This article explores the clinical effectiveness of higher hematocrit levels in children with chronic renal insufficiency (CRI) and in those undergoing dialysis. There are many adult and pediatric studies which show that physical performance as well as morbidity (associated illness) and mortality (death) are positively influenced by partial normalization of the hematocrit to 30 volume percent to 35 volume percent. Cognition studies performed in adults similarly show improvement with partial correction of hematocrit. Normalization of hematocrit studies show lower mortality rates, incremental further improvement in cognition, and greater resolution of cardiac (heart) anomalies when compared with patients with partial correction of anemia. Conversely, cardiac death rates may increase in adult patients receiving hemodialysis who have preexisting cardiac disease, and there are concerns about the effect of recombinant human erythropoietin on catheter or shunt or fistula patency and on blood pressure. The authors stress that the rationale of using adult derived hematocrits in children with ESRD needs to be reexamined in the context of the unique growth and developmental requirements of children. 1 table. 140 references.

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Quick Reference Clinical Handbook for Chronic Kidney Disease. New York, NY: National Kidney Foundation (NKF). 2001. 33 p.

Millions of Americans are at risk for developing renal (kidney) disease or are already experiencing some symptoms of kidney disease. In an effort to prevent development or to delay progression of chronic kidney disease (CKD), these populations must be identified and appropriate treatment initiated early to optimize patient outcomes. This booklet highlights guidelines from the KDOQI 2000 Update that offers clinical practice guidelines for hemodialysis adequacy, peritoneal dialysis, vascular access, and the treatment of anemia in chronic kidney disease. The guidelines are organized according to patient presentation rather than numerical sequence. For easy cross referencing, all guideline recommendations are highlighted in bold text and identified by KDOQI topic and number. This handbook helps health care providers apply the statements and recommendations from KDOQI in their work with kidney patients. Decisions to adopt specific guideline recommendations must be made by practitioners in light of available resources and circumstances presented by individual patients. Specific topics include early patient preparation regarding treatment options, protecting arm veins, the types of and timing for hemodialysis access, patient evaluation prior to access placement, the indications for the initiation of renal replacement therapy, evaluating anemia, assessing and monitoring iron status, administering iron, oral iron, intravenous iron, iron dextran dosing guidelines for pediatric patients, administering epoetin (erythropoietin), hyporesponsiveness to epoetin, and the role of red blood cell transfusions. One section discusses patient education. The booklet concludes with a selected bibliography. 1 figure. 5 tables.

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