- Klíčová slova
- tandemová terapie CRRT a TPE,
- MeSH
- dialýza ledvin metody MeSH
- dítě MeSH
- selhání jater terapie MeSH
- výměna plazmy metody MeSH
- Check Tag
- dítě MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE: Clinical guidelines call for the inclusion of exercise interventions in every patient's dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE). METHODS: We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®. RESULTS: Participants reported the benefits of IDE as improvements in patients' physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients' exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care. CONCLUSIONS: Safe and sustainable implementation of IDE, which might improve a patient's well-being, need to be prescribed in alignment with the patient's clinical profile, be delivered individually according to the patient's characteristics and requires adjustments in the available resources.
- MeSH
- cvičení * psychologie MeSH
- dialýza ledvin * MeSH
- lidé MeSH
- postoj zdravotnického personálu MeSH
- sebeuplatnění MeSH
- zdravotnický personál MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Chronická obličková choroba sa u pacientov s alebo bez diabetes mellitus spája so zvýšeným rizikom hypoglykémie, hlavne dôsledkom poruchy glukoneogenézy a redukcie degradácie inzulínu v obličkách. Hypoglykémia sa často vyskytuje u hemodialyzovaných pacientov. Riziko hypoglykémie u týchto pacientov sa zvyšuje pri tesnej glykemickej kontrole pri liečbe inzulínom alebo perorálnymi antidiabetikami, použití dialyzačných roztokov bez glukózy a malnutrícii. V prevencii hypoglykémie u hemodialyzovaných pacientov s diabetes mellitus sa odporúča podávanie dialyzačných roztokov s koncentráciou glukózy v rozmedzí 5,5–11,1 mmol/l, individuálna titrácia dávky inzulínu a menej prísne cieľové hodnoty glykovaného hemoglobínu 7–8 % podľa DCCT v prípade opakovaných hypoglykémií.
Chronic kidney disease in patients with or without diabetes mellitus is associated with higher risk of hypoglycemia, mainly due to defect of kidney gluconeogenesis and reduction of renal insulin clearance. Hypoglycemia often occurs in patients on hemodialysis. Risk of hypoglycemia in these patients is increased in the case of strict glycemic control during treatment by insulin or oral antidiabetics, using of dialysate solutions without glucose and malnutrition. In prevention of hypoglycemia in hemodialyzed diabetic patients there is recommended using of dialysate solutions with glucose concentration 5.5–11.1 mM/L, individual titration of insulin dose and less strict goals of glycosylated hemoglobin values 7–8 % according to DCCT in the case of repeated hypoglycemias.
INTRODUCTION: Acute tubulointerstitial nephritis (ATIN) is a well-recognized cause of acute kidney injury (AKI) due to the tubulointerstitial inflammation. The aim of this study was to explore the clinical features, outcomes, and responses to corticosteroid treatment in patients with ATIN. METHODS: Patients with biopsy-proven ATIN, who were diagnosed between 1994 and 2016 at the Department of Nephrology, Charles University, First Faculty of Medicine, and General University Hospital in Prague, were included in the study. Patient demographics, the aetiological and clinical features, the treatment given, and the outcome at 1 year of follow-up were extracted from patient records. RESULTS: A total of 103 ATIN patients were analysed, of which 68 had been treated with corticosteroids. There was no significant difference in the median serum creatinine 280 (169-569) μmol/L in the conservatively managed group versus 374 (249-558) μmol/L in the corticosteroid-treated group, p = 0.18, and dependence on dialysis treatment at baseline at the time of biopsy (10.3 vs. 8.6%). During the 1 year of follow-up, those ATIN patients who had been treated with corticosteroids did better and showed greater improvement in kidney function, determined as serum creatinine difference from baseline and from 1 month over 1-year period (p = 0.001). CONCLUSIONS: This single-centre retrospective cohort study supports the beneficial role of the administration of corticosteroid therapy in the management of ATIN.
- MeSH
- dialýza ledvin * škodlivé účinky MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- intersticiální nefritida * farmakoterapie diagnóza MeSH
- kreatinin MeSH
- ledviny patologie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
INTRODUCTION: The rapid advancement of artificial intelligence and big data analytics, including descriptive, diagnostic, predictive, and prescriptive analytics, has the potential to revolutionize many areas of medicine, including nephrology and dialysis. Artificial intelligence and big data analytics can be used to analyze large amounts of patient medical records, including laboratory results and imaging studies, to improve the accuracy of diagnosis, enhance early detection, identify patterns and trends, and personalize treatment plans for patients with kidney disease. Additionally, artificial intelligence and big data analytics can be used to identify patients' treatment who are not receiving adequate care, highlighting care inefficiencies in the dialysis provider, optimizing patient outcomes, reducing healthcare costs, and consequently creating values for all the involved stakeholders. OBJECTIVES: We present the results of a comprehensive survey aimed at exploring the attitudes of European physicians from eight countries working within a major hemodialysis network (Fresenius Medical Care NephroCare) toward the application of artificial intelligence in clinical practice. METHODS: An electronic survey on the implementation of artificial intelligence in hemodialysis clinics was distributed to 1,067 physicians. Of the 1,067 individuals invited to participate in the study, 404 (37.9%) professionals agreed to participate in the survey. RESULTS: The survey showed that a substantial proportion of respondents believe that artificial intelligence has the potential to support physicians in reducing medical malpractice or mistakes. CONCLUSION: While artificial intelligence's potential benefits are recognized in reducing medical errors and improving decision-making, concerns about treatment plan consistency, personalization, privacy, and the human aspects of patient care persist. Addressing these concerns will be crucial for successfully integrating artificial intelligence solutions in nephrology practice.
- MeSH
- dialýza ledvin MeSH
- lidé MeSH
- nefrologie * MeSH
- nefrologové MeSH
- průzkumy a dotazníky MeSH
- umělá inteligence * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Long-term peritoneal dialysis is associated with the development of peritoneal membrane alterations, both in morphology and function. Impaired ultrafiltration (UF) is the most important functional change, and peritoneal fibrosis is the major morphological alteration. Both are caused by the continuous exposure to dialysis solutions that are different from plasma water with regard to the buffer substance and the extremely high-glucose concentrations. Glucose has been incriminated as the major cause of long-term peritoneal membrane changes, but the precise mechanism has not been identified. We argue that glucose causes the membrane alterations by peritoneal pseudohypoxia and by the formation of advanced glycosylation end products (AGEs). After a summary of UF kinetics including the role of glucose transporters (GLUT), and a discussion on morphologic alterations, relationships between function and morphology and a survey of the pathogenesis of UF failure (UFF), it will be argued that impaired UF is partly caused by a reduction in small pore fluid transport as a consequence of AGE-related vasculopathy and - more importantly - in diminished free water transport due to pseudohypoxia, caused by increased peritoneal cellular expression of GLUT-1. The metabolism of intracellular glucose will be reviewed. This occurs in the glycolysis and in the polyol/sorbitol pathway, the latter is activated in case of a large supply. In both pathways the ratio between the reduced and oxidised form of nicotinamide dinucleotide (NADH/NAD+ ratio) will increase, especially because normal compensatory mechanisms may be impaired, and activate expression of hypoxia-inducible factor-1 (HIF-1). The latter gene activates various profibrotic factors and GLUT-1. Besides replacement of glucose as an osmotic agent, medical treatment/prevention is currently limited to tamoxifen and possibly Renin/angiotensis/aldosteron (RAA) inhibitors.
- MeSH
- dialyzační roztoky škodlivé účinky metabolismus MeSH
- glukosa škodlivé účinky metabolismus MeSH
- glykosylace MeSH
- lidé MeSH
- peritoneální dialýza * škodlivé účinky MeSH
- peritoneum metabolismus MeSH
- ultrafiltrace MeSH
- voda metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Arteriovenous fistula (AVF) is the best method of vascular access for hemodialysis. This approach can lead to several complications, such as hyperkinetic heart failure due to a hyperfunctional AVF or dilatation of the feeding artery. These are late complications, especially in patients after a successful kidney transplantation. An observational study was performed focusing on patients more than 12 months after kidney transplantation. The AVF was evaluated by ultrasound and, if the outflow exceeded 1.5 L/min, an echocardiogram was performed. Surgical management was indicated if the cardiac index was higher than 3.9 L/min/m2 or upon finding a brachial artery aneurysm. A total of 208 post- kidney transplantation patients were examined over a 3-year period, of which 46 subjects (22.11%) had hyperfunctional AVF and 34 cases (16.34%) of feeding artery dilatation were determined. In total, 40 AVF flow reduction and 6 AVF ligation procedures were performed. The median AVF flow before and after the reduction was 2955 mL/min and 1060 mL/min, respectively. Primary patency after flow reduction was 88.3% at 12 months. Late AVF complications in patients following kidney transplantation are quite common. It is necessary to create a screening program to monitor AVFs in these patients.
- MeSH
- arteria brachialis chirurgie MeSH
- arteriovenózní zkrat * škodlivé účinky MeSH
- dialýza ledvin * MeSH
- dospělí MeSH
- echokardiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace etiologie MeSH
- průchodnost cév MeSH
- senioři MeSH
- transplantace ledvin * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: This retrospective real-world study used data from two registries, International Pediatric Peritoneal Dialysis Network (IPPN) and International Pediatric Hemodialysis Network (IPHN), to characterize the efficacy and safety of continuous erythropoietin receptor activator (C.E.R.A.) in pediatric patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) or hemodialysis (HD). METHODS: IPPN and IPHN collect prospective data (baseline and every 6 months) from pediatric PD and HD centers worldwide. Demographics, clinical characteristics, dialysis information, treatment, laboratory parameters, number and causes of hospitalization events, and deaths were extracted for patients on C.E.R.A. treatment (IPPN: 2007-2021; IPHN: 2013-2021). RESULTS: We analyzed 177 patients on PD (median age 10.6 years) and 52 patients on HD (median age 14.1 years) who had ≥ 1 observation while being treated with C.E.R.A. The median (interquartile range [IQR]) observation time under C.E.R.A. exposure was 6 (0-12.5) and 12 (0-18) months, respectively. Hemoglobin concentrations were stable over time; respective means (standard deviation) at last observation were 10.9 (1.7) g/dL and 10.4 (1.7) g/dL. Respective median (IQR) monthly C.E.R.A. doses at last observation were 3.5 (2.3-5.1) μg/kg, or 95 (62-145) μg/m2 and 2.1 (1.2-3.4) μg/kg, or 63 (40-98) μg/m2. Non-elective hospitalizations occurred in 102 (58%) PD and 32 (62%) HD patients. Seven deaths occurred (19.8 deaths per 1000 observation years). CONCLUSIONS: C.E.R.A. was associated with efficient maintenance of hemoglobin concentrations in pediatric patients with CKD on dialysis, and appeared to have a favorable safety profile. The current analysis revealed no safety signals.
- MeSH
- chronická renální insuficience * terapie farmakoterapie MeSH
- chronické selhání ledvin * terapie MeSH
- dialýza ledvin škodlivé účinky MeSH
- dítě MeSH
- erythropoetin * MeSH
- hemoglobiny analýza MeSH
- lidé MeSH
- mladiství MeSH
- prospektivní studie MeSH
- registrace MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
Bolest je častým problémem u hemodialyzovaných pacientů s incidencí v rozmezí od 8 do 82 %. Léčba bolesti u pacientů s chronickým onemocněním ledvin je však často neúčinná a většina jich skutečně uvádí, že jejich bolest je nedostatečně léčena. Dlouhodobá léčba opioidy má nezastupitelnou roli v léčbě některých pacientů se středně silnou až silnou bolestí. Při indikaci opioidů pacientům se selháním ledvin je třeba vzít v úvahu stupeň selhání ledvin, frekvenci dialýzy a farmakokinetiku léků. Stabilita analgezie během dialýzy se u různých analgetik liší. Špatně dialyzovatelné opioidy mají déle trvající analgetický účinek. Farmakologické vlastnosti buprenorfinu mohou být výhodné pro použití u pacientů léčených hemodialýzou. Buprenorfin může být bezpečně podáván pacientům s poruchou funkce ledvin a hemodialyzovaným pacientům, nejlépe v dávkovém rozmezí do 70 μg/h, protože jeho farmakokinetické vlastnosti nejsou ovlivněny
Pain is a common problem in haemodialysis patients, with an incidence ranging from 8 to 82 %. However, pain management in patients with chronic kidney disease is often ineffective and indeed most report that their pain is undertreated. Long-term opioid therapy has an indispensable role in the treatment of some patients with moderate to severe pain. The degree of renal failure, the frequency of dialysis and the pharmacokinetics of the drugs should be taken into account when prescribing opioids to patients with renal failure. The stability of analgesia during dialysis varies between analgesics. Poorly dialyzable opioids have a longer lasting analgesic effect. The pharmacological properties of buprenorphine may be advantageous for use in patients undergoing haemodialysis. Buprenorphine can be safely administered to renally impaired and haemodialysis patients, preferably in a dose range up to 70 μg/h, as its pharmacokinetic properties are not affected.
- MeSH
- buprenorfin * farmakokinetika farmakologie terapeutické užití MeSH
- chronická bolest * farmakoterapie MeSH
- dialýza ledvin MeSH
- kvalita života MeSH
- lidé MeSH
- opioidní analgetika škodlivé účinky toxicita MeSH
- renální insuficience * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
