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Your search term(s) "Dialysis" returned 150 results.

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Dialyzer Reuse. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 273-292.

Dialyzer reuse is highly prevalent in the United States, with 80 percent of all U.S. dialysis units reprocessing hemodialyzers. This chapter on dialyzer reuse is from a textbook on the clinical management of patients on dialysis. The authors review patterns of dialyzer reuse, methods of dialyzer reprocessing, and the effects of hemodialyzer reprocessing on biocompatibility, solute clearance, and clinical outcomes. Specific topics covered include the effects of reuse on hospitalization and survival, infection risk, the toxicity of germicide exposure, and the issue of informed consent. The authors conclude that economic motivations remain the major reason for widespread dialyzer reuse, but the economic benefits of reuse deserve ongoing re-evaluation as the price of newer membranes decreases and as other aspects of dialysis care and the market forces that influence dialysis providers continue to evolve. Regarding adequacy of delivery dialysis, urea clearance appears to be substantially preserved after multiple uses with reprocessed membranes. However, the possible risks associated with chronic exposure of patients and health care workers to germicides in the modern reuse setting have yet to be fully characterized. 1 table. 124 references.

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Disaster Preparedness for Dialysis Facilities. Nephrology Nursing Journal. 32(6): 676-677. November-December 2005.

This article outlines disaster preparedness basics for dialysis facilities. The author first outlines the different types of disasters and emergencies with which a dialysis clinic may have to cope, then focuses on the need for planning and coordination in order to achieve the best outcome possible. The author emphasizes the importance of forming a multidisciplinary group that includes community utility representatives, American Red Cross workers, and the state Emergency Management Agency. Both the community representatives and the facility need to be aware of each others needs and strengths before any disaster occurs. The author refers readers to some publications available from the National Kidney Foundation and to the website of the Centers for Medicare and Medicaid Services. The author also discusses the potential impact of any disaster to the surrounding geographic area which although undamaged by the disastrous event itself, may still have to accommodate a large influx of dialysis patients needing care. One side bar lists the website addresses of eight resource organizations that can provide disaster preparedness-related information. 4 references.

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Drug Usage in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 891-926.

Patients with compromised renal function are particularly vulnerable to drug accumulation and toxicity. While the exact burden of drug toxicity in patients with renal failure can be difficult to estimate, observational analysis indicates a higher incidence of adverse drug reactions in this population. In addition to drug excretion, drug metabolism and biotransformation can be altered by uremia. This chapter on drug usage in dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. In this chapter, the authors address the principles behind rational drug therapy in patients with chronic kidney disease (CKD) and those on dialysis. Topics include bioavailability, drug distribution, metabolism and biotransformation, elimination and excretion, the assessment of renal function, determining the need for dosage adjustment, loading doses of drugs, maintenance doses, drug concentrations, drug dialyzability, and hemofiltration. The authors conclude that a knowledge of pharmacokinetics and pharmacodynamic variability in renal failure is essential for health care providers, who must make appropriate dosage adjustments to avoid serious adverse drug reactions. Extensive tables that summarize commonly used drugs and their indications in patients with ESRD are included. 14 tables. 39 references.

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Effective and Safe IV Iron and Anemia Management During Home Hemodialysis: A Dialysis Facility's Experience. Nephrology Nursing Journal. 32(6): 659-665. November-December 2005.

Iron therapy, in conjunction with erythropoietin, is essential in managing anemia in patients on hemodialysis. This article reports on a study undertaken to determine the safety of intravenous (IV) iron therapy self-administered during home hemodialysis. The author stresses that nurses should be aware of how to administer this therapy and be knowledgeable of possible allergic-type reactions that have been associated with its clinical use. The author first discusses the importance of IV iron in effective anemia management, then compares the safety profiles of the various IV iron products. The article reports the experiences of five hemodialysis patients who used self-administered IV iron therapy. A total of 223 doses of sodium ferric gluconate were self-administered at home during a 2-year period without any serious reactions occurring due to drug therapy. The findings of this small study are consistent with results from large clinical studies in patients receiving in-center hemodialysis. The article concludes with a section on the role of the nephrology nurse, including addressing patient concerns, selecting appropriate candidates, and providing patient education and training. Allergic-type reactions have been associated with the clinical use of IV iron therapy, with the majority of episodes occurring with IV iron dextran. Of the available IV iron therapies, sodium ferric gluconate and iron sucrose have the most favorable safety profiles. The author also briefly reports the benefits of fostering a safe home hemodialysis program. 2 figures. 3 tables. 45 references.

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Endocrine Dysfunction in Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 795-830.

Patients with advanced chronic kidney disease (CKD) may display a wide range of hormonal and metabolic disturbances. There may be abnormalities in both the secretion and metabolism of the endocrine hormones as well as target-organ sensitivity to these hormones. This chapter on endocrine dysfunction in CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors focus on the abnormalities of pancreatic, thyroid, adrenal, and gonadal hormones (derangements in parathyroid hormone, vitamin D, and erythropoietin metabolism are discussed in other chapters). Topics include carbohydrate and insulin metabolism; the problem of hypoglycemia (low blood glucose); insulin requirements in patients on dialysis; carbohydrate intolerance after kidney transplantation; thyroid hormone and iodide metabolism; normal thyroid hormone physiology; the management of patients with uremia who do not have hypothalamic, pituitary, or thyroid diseases; the management of patients with uremia who have goiter, thyroid nodules, thyroid cancer, hypothyroidism, or hyperthyroidism; the role of cortisol; aldosterone secretion in CKD, including that in patients on dialysis and posttransplantation; and the hypothalamic-pituitary-gonadal axis, including sexual dysfunction in prepubertal boys and men with CKD, sexual dysfunction in girls and adult women with CKD, the effect of dialysis therapy, and the effect of kidney transplantation. 12 figures. 7 tables. 307 references.

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Extracorporeal Blood Purification: Applications in the Renal Transplant Patient. In: Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 113-126.

Several different extracorporeal blood purification methodologies, including hemodialysis, peritoneal dialysis, plasma exchange, and immunoadsorption, have been employed in the perioperative setting in an effort to improve transplant outcomes. This chapter is from a textbook that provides a compendium of the latest advances and understandings regarding the complex medical problems seen in kidney transplant patients. The author of this chapter discusses extracorporeal blood purification and its applications in the renal transplant patient, including pre- and posttransplantation settings. The author covers hemodialysis and peritoneal dialysis in the pretransplantation period; modified hemodialysis and apheresis, including plasma exchange and immunoadsorption; delayed graft function and acute allograft rejection in the immediate posttransplantation period; and chronic allograft nephropathy, recurrent focal segmental glomerulosclerosis, and thrombotic microangiopathy in the longer posttransplantation period. The author concludes that extracorporeal blood purification remains a cornerstone of therapy in the perioperative renal transplantation setting. Information is accumulating regarding the ideal dialysis prescription both preoperatively and in those patients who develop delayed graft function (DGF). 9 figures. 2 tables. 116 references.

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Facts About Kidney Disease. Rockville, MD: American Kidney Fund. 2005. 8 p.

This brochure provides basic information about kidney disease. Topics include the anatomy and physiology of kidneys, common kidney diseases, risks for kidney disease, the symptoms of kidney disease, diagnostic tests used to confirm kidney disease, treatments for kidney failure, and prevention of kidney disease. Kidney diseases discussed include chronic kidney disease (CKD), which can occur from many different causes, kidney stones, polycystic kidney disease (PKD), kidney infections (pyelonephritis), simple kidney cysts, kidney cancer, and the nephritic syndrome. Diagnostic tests described include glomerular filtration rate (GFR), urine tests, blood pressure monitoring, blood glucose testing, kidney biopsy, and imaging tests (CT, MRI). Treatment options include hemodialysis, peritoneal dialysis, and kidney transplantation. Readers are encouraged to contact the American Kidney Fund (AKF) HelpLine (800–638–8299 or HelpLine@kidneyfund.org). The brochure is illustrated with black-and-white photographs. 5 figures.

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Gastrointestinal Diseases in Patients with Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 677-690.

Gastrointestinal (GI) disorders are common in patients with chronic kidney disease (CKD) and encompass the full spectrum of diseases that affect the general population. This chapter on GI disease in patients with CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors review common GI complaints that are often referred to gastroenterologists for further evaluation. These diseases merit special consideration in the patient with ESRD due to their increased incidence and severity. The authors organize their discussion based on clinical presentation and symptom complex, including nausea, vomiting, diarrhea, GI bleeding, and abdominal pain. Disorders discussed include metabolic imbalance, motility disorders, peptic ulcer disease, infection, and side effects of medications. Specific topics covered are gastroparesis, peptic ulcer disease, infection, bowel obstruction and infarction, acute and chronic diarrhea, diabetic enteropathy, upper and lower gastrointestinal bleeding, ischemic colitis, diverticular bleeding, small bowel bleeding, and abdominal pain. The authors conclude that diagnostic tests and treatment strategies are best formulated in conjunction with the radiologist, gastroenterologist, and surgeon. 6 figures. 5 tables. 106 references.

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Growth and Growth Hormone Treatment in Children with Chronic Renal Insufficiency. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 611-652.

As the treatment of children with end stage renal disease (ESRD) has advanced and many children’s lives have consequently been prolonged by dialysis and kidney transplantation, the impact of growth retardation on those with renal insufficiency has emerged. This chapter on growth and growth hormone treatment in children with chronic renal insufficiency (CRI) is from a comprehensive textbook on the clinical management of dialysis patients. The authors note that optimizing nutritional support and medical care with vitamin D and mineral supplements does not uniformly improve growth in children with chronic renal failure (CRF). The authors discuss the pathomechanism of growth failure, growth patterns in children with CRF, and treatment strategies. They conclude that growth hormone therapy has been shown to stimulate growth significantly in prepubertal children with renal failure and ESRD, and does not appear to exhaust growth potential. Therapy should be instituted when the patient falls below the third percentile for height and does not show spontaneous catch-up growth after other factors contributing to uremic growth failure have been adequately stabilized. Therapy is continued until final height is reached or a well-functioning renal transplant is achieved. 29 figures. 286 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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