BACKGROUND: Heart failure (HF) is a frequent cause of morbidity and mortality of end-stage kidney disease (ESKD) patients on hemodialysis. It is not easy to distinguish HF from water overload. The traditional HF definition has low sensitivity and specificity in this population. Moreover, many patients on hemodialysis have exercise limitations unrelated to HF. Therefore, we postulated two new HF definitions ((1) Modified definition of the Acute Dialysis Quality Improvement working group; (2) Hemodynamic definition based on the calculation of the effective cardiac output). We hypothesize that the newer definitions will better identify patients with higher number of endpoints and with more advanced structural heart disease. METHODS: Cohort, observational, longitudinal study with recording predefined endpoints. Patients (n = 300) treated by hemodialysis in six collaborating centers will be examined centrally in a tertiary cardiovascular center every 6-12 months lifelong or till kidney transplantation by detailed expert echocardiography with the calculation of cardiac output, arteriovenous dialysis fistula flow volume calculation, bio-impedance, and basic laboratory analysis including NTproBNP. Effective cardiac output will be measured as the difference between measured total cardiac output and arteriovenous fistula flow volume and systemic vascular resistance will be also assessed non-invasively. In case of water overload during examination, dry weight adjustment will be recommended, and the patient invited for another examination within 6 weeks. A composite major endpoint will consist of (1) Cardiovascular death; (2) HF worsening/new diagnosis of; (3) Non-fatal myocardial infarction or stroke. The two newer HF definitions will be compared with the traditional one in terms of time to major endpoint analysis. DISCUSSION: This trial will differ from others by: (1) detailed repeated hemodynamic assessment including arteriovenous access flow and (2) by careful assessment of adequate hydration to avoid confusion between HF and water overload.

• MeSH
• chronická renální insuficience * komplikace   MeSH
• chronické selhání ledvin * diagnóza   terapie   komplikace   MeSH
• dialýza ledvin škodlivé účinky   MeSH
• lidé MeSH
• longitudinální studie MeSH
• pozorovací studie jako téma MeSH
• srdeční selhání * diagnóza   etiologie   terapie   MeSH
• voda MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• centrální žilní katétry * škodlivé účinky   MeSH
• dialýza ledvin metody   MeSH
• katetrizace centrálních vén metody   škodlivé účinky   MeSH
• lidé MeSH
• pooperační komplikace MeSH
• Check Tag
• lidé MeSH

Vancomycin is frequently used in haemodialysis (HD) patients but generally accepted target serum ranges and dosing strategy are still lacking in this group. Based on retrospective analysis of data from 118 HD patients treated with vancomycin the interdialytic elimination constant (Ke), apparent volume of distribution (Vd) and dialysis efficacy were calculated. The influence of possible clinical variables on the pharmacokinetic parameters of vancomycin have been tested. The median of Ke in interdialytic periods, corresponding half-life and Vd were 0.0073 h-1, 95.0 h and 0.87 L/kg, respectively. We found significant positive correlation between time in dialysis program and Ke. The Vd correlated best with lean body mass (LBM). For high- and low flux membrane HD of 4 hours duration the decline in vancomycin levels was 20.88% and 12.86%, respectively. Based on these data loading dose for vancomycin in HD patient should be calculated as 24.483 × LBM (kg) + 455 mg. The utility of this equation for entire HD population should be also verified prospectively.

• MeSH
• antibakteriální látky MeSH
• dialýza ledvin MeSH
• lidé MeSH
• monitorování léčiv * MeSH
• poločas MeSH
• retrospektivní studie MeSH
• vankomycin * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Data on the anti-Xa efficacy of fondaparinux in dialysis-dependent chronic kidney disease (DD-CKD) patients are scarce. This study characterizes the pharmacokinetics (PK) and pharmacodynamics (PD) of fondaparinux in DD-CKD patients undergoing renal replacement therapy (RRT), to assess dosing strategies. METHODS: A retrospective, observational study was conducted using data on anti-Xa activity (112 samples) from 12 (3 male and 9 female) DD-CKD patients (median (IQR) age 71 years (63-88), weight 73 kg (59-98.5)). Eleven patients underwent high-flux or low-flux hemodialysis (HD) and one patient underwent peritoneal dialysis. Three patients were also treated with therapeutic plasma exchange (TPE). A non-linear mixed effects analysis was performed using NONMEM 7.3.0. RESULTS: The lab-specific slope of the relationship between fondaparinux concentration and anti-Xa levels was 1.18 IU/μg. In a one-compartment model, clearance (CL) and volume of distribution (Vd) were 0.05289 L/h and 5.55 L, respectively. High-flux HD was found to increase the CL of fondaparinux 2.26 times. TPE also considerably increased CL, but the fold-change could not be accurately estimated. Low-flux HD and peritoneal dialysis did not impact PK parameters. CONCLUSIONS: Model-based simulations showed that standard dosing (2.5 mg three times weekly before HD) results in a median anti-Xa activity of 0.55 IU/mL and 0.98 IU/mL, pre- and post-low-flux HD, respectively. In patients undergoing high-flux HD, these values are approximately 27% lower. Additional caution is warranted with TPE, as this treatment can reduce anti-Xa activity even further.

• MeSH
• chronická renální insuficience metabolismus   terapie   MeSH
• fondaparinux farmakokinetika   farmakologie   MeSH
• inhibitory faktoru Xa farmakokinetika   farmakologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada funkce ledvin * MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tělesná hmotnost MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Upper limb ischemia in patients with chronic kidney disease treated by haemodialysis is a known complication, but fortunately its progression into gangrene is not frequent. Ischemia occurs in 3.7-5% of dialysis patients, in dependence on the type of vascular access. The main cause behind the risk of digital upper limb ischemia in dialysis patients is the presence of an arteriovenous fistula. The higher the location of arteriovenous fistula, the higher the risk of onset of ischemia. In case of brachiocephalic and brachiobasilic fistulas, the risk for developing symptomatic ischemia is faced by 10-25% of patients, in case of radiocephalic fistula only by 1-1.8% of patients. In making the diagnosis we rely on the history of symptoms and physical examinations of both upper limbs. The patient may describe subjective symptoms as pain, having cold fingers, cramps during and outside dialysis, altered sensation and impaired finger movement. The therapy includes radiological intervention, removal of high-flow arteriovenous fistula, its closure, and amputation. The treatment aims to provide the patients with maximum possible multidisciplinary care and to prevent amputation. In this respect the orthopaedic examination is critical for further diagnosis and therapy of the patient at risk of upper limb impairment or for upper limb salvage.

• MeSH
• amputace škodlivé účinky   MeSH
• arteriovenózní zkrat * škodlivé účinky   metody   MeSH
• dialýza ledvin škodlivé účinky   MeSH
• ischemie diagnóza   etiologie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• záchrana končetiny MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Hodnocení adekvátnosti dialyzační léčby má odpovědět na otázku „jak moc dialýzy je dost“. To vyžaduje definici hodnoticího ukazatele a stanovení jeho žádané hodnoty. V polovině 80. let byla za takový ukazatel všeobecně přijata tzv. relativní dialyzační dávka Kt/V a její směrné hodnoty byly na přelomu tisíciletí stanoveny studií HEMO pro tehdy nejčastější režim tří dialýz týdně. S ním také pracuje systém sledování kvality dialyzační péče, zavedený v ČR v roce 2018. Tento přístup je ale nepoužitelný pro dialyzační režimy s jiným počtem dialýz týdně než tři, označované jako alternativní nebo frekventní, které se uplatňují zejména při domácí hemodialýze. Pro ně byly vyvinuty univerzálnější ukazatele adekvátnosti, nezávislé na počtu dialýz týdně. Článek popisuje tyto nové ukazatele a jako alternativu k nim rozpracovává i metodu přepočtu dialyzační dávky Kt/V jedné dialýzy frekventního režimu na Kt/V srovnatelného klasického režimu tří dialýz týdně s možností využití jeho stávajících směrných hodnot.

Assessment of haemodialysis treatment adequacy should answer the question on “how much dialysis is enough”. It must define an assessment marker and give also its target values. In the mid-80ies, the relative dialysis dose Kt/V has been generally accepted as such marker and its target values established by the HEMO study at the turn of the millennium for then the most common schedule of 3 haemodialyses per week. It is also used in the dialysis quality evaluation system induced by the Czech insurance in 2018. However, that approach is not applicable for dialysis schedules with more than three sessions in a week, often referred to as alternative or frequent and used mainly for home haemodialysis. For that, more universal adequacy markers have been developed, independent of the number of sessions per week. The article describes those new markers and develops as an alternative to them the method of converting the conventional dialysis dose of a session in the frequent schedule onto a Kt/V of an equivalent schedule of three sessions per week which enables use of well established target values of that regime.

• MeSH
• časové faktory MeSH
• dialýza ledvin * metody   normy   MeSH
• lidé MeSH
• metabolická clearance MeSH
• močovina MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• výsledek terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH

METHODS: Records of 10,000 QVA measurement performed in 549 patients over 20 years were used as retrospective and anonymized data source, making ethical commission involvement unnecessary. Two approaches are used to elucidate association of QVA changes with different factors: analyses of smaller cohorts in which both the QVA and the respective factor were measured (e.g. association of QVA with cardiac output (CO)), or-in case of rare phenomena-a form of a well illustrated case reports was used (e.g. association of QVA and Kt/V). RESULTS: Significant increase in CO after permanent VA creation (3-4-fold of the QVA value) was found. Impact of intradialytic CO changes on QVA is attenuated by relatively stable VA resistance compared to systemic resistance. Blood pressure impact is much stronger and it should therefore be noted at each QVA measurement. As reproducibility of different QVA measurement methods varies, use of the same method should be preferred. Direction of the arterial needle insertion in VA affects the QVA measured, especially in synthetic grafts, too. Also patient's own QVA variability may be quite high. All this makes KDOQI/EBPG recommended acceptable QVA drops too strict, they should be revised. In re-stenoses prone patients, measurement intervals should be shortened, too. CONCLUSION: QVA values are significantly affected by many factors. Their knowledge appears essential for safe and effective VA surveillance and management.

• MeSH
• dialýza ledvin * MeSH
• hemodynamika * MeSH
• lidé MeSH
• minutový srdeční výdej MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Hemodialyzátory i hemodialyzační přístroje se od zavedení hemodialýzy do klinické praxe v polovině minulého století technicky velmi zdokonalily. To sice na jedné straně přispělo k výraznému zvýšení účinnosti a bezpečnosti dialýzy a komfortu obsluhy, na straně druhé ale tento stav může u pacienta i obsluhy vyvolávat pocity falešné jistoty, že vyspělá technika sama ošetří veškerá rizika a nežádoucí situace. Tak tomu, bohužel, není. Z ryze technických příčin nebo v důsledku chyby obsluhy může stále dojít ke snížení kvality dialýzy (např. neúmyslným souproudým zapojením dialyzátoru) nebo přímo k ohrožení pacienta (např. únik krve z mimotělního obvodu do okolí, přílišná nebo příliš rychlá alkalizace pacienta). Článek přehledně probírá tyto nežádoucí situace a stavy a dává návody, jak se jim vyhnout, nebo jak alespoň co nejvíce potlačit jejich negativní dopady.

Since the introduction of haemodialysis in clinical practice in mid of the last century, haemodialyzers and haemodialysis machines underwent remarkable technical improvement. On one side, it has lead to significant increase in dialysis efficiency, patient safety, and higher comfort for the operator. On the other side, those improvements may have induced on the side of the patient and the operator false sense of safety believing that the advanced technology will by itself resolve all risks and adverse situations. However, it is far from being true. Purely technical reasons or an operator ́s fault may still result in compromised dialysis efficiency (e.g. because of erroneously co-current flows in the dialyzer) or may even endanger the patient (e.g. blood loss to the environment, excessive alkalisation or its rate). The article gives an overview of the adverse processes and events and suggests measures to avoid them or at least minimize their negative impacts.

• MeSH
• dialýza ledvin * přístrojové vybavení   škodlivé účinky   MeSH
• jehly MeSH
• kvalita života MeSH
• lidé MeSH
• nemoci ledvin terapie   MeSH
• rizikové faktory MeSH
• rychlost toku krve MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• analgetika terapeutické užití   MeSH
• anemie etiologie   komplikace   terapie   MeSH
• antidepresiva terapeutické užití   MeSH
• antiflogistika nesteroidní farmakologie   škodlivé účinky   MeSH
• anxiolytika terapeutické užití   MeSH
• bolest * etiologie   komplikace   MeSH
• chronické selhání ledvin * farmakoterapie   patofyziologie   terapie   MeSH
• diuretika terapeutické užití   MeSH
• dyspnoe etiologie   komplikace   terapie   MeSH
• glukokortikoidy terapeutické užití   MeSH
• lidé MeSH
• management bolesti metody   MeSH
• metamizol MeSH
• neuralgie etiologie   farmakoterapie   MeSH
• opioidní analgetika farmakologie   klasifikace   terapeutické užití   MeSH
• paracetamol farmakologie   terapeutické užití   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH

• Publikační typ
• abstrakt z konference MeSH