document.write("<table align=\"center\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"RssITable\"><tr><td class=\"RssITd\" width=\"50%\"><center><b>Категория: Dialysis</b></center><br><a href=\"http://www.rxpgnews.com/dialysis/Intradialytic_hypotension_associated_with_increased_incidence_of_haemodialysis_vascular_access_thrombosis_525391.shtml\" target=\"_blank\">Intradialytic hypotension associated with increased incidence of haemodialysis vascular access thrombosis</a><br>( from http://www.rxpgnews.com )  A sudden drop in blood pressure while undergoing dialysis (intradialytic hypotension) is a long standing problem in haemodialysis patients. Side effects associated with this situation over the long term range from stroke to seizure to heart damage to death. Patients also suffer in the short term with gastrointestinal, muscular and neurologic symptoms.<br/> <br/> A study led by researchers at the Stanford University School of Medicine reports an increased risk of thrombus(clot) formation in the vascular access which is used for haemodialysis as a consequence of intradialytic hypotension. Researchers from the University of Utah also contributed to the study, which is to be published online July 29 in the Journal of the American Society of Nephrology.<br/> <br/> \"Our analysis shows another adverse consequence associated with a fall in blood pressure during dialysis for patients,\" said Tara Chang, MD, a Stanford nephrologist and lead author of the study. \"Vascular access is their lifeline. It&#39;s required for dialysis and without dialysis, they&#39;ll die.\"<br/> <br/> As the kidneys fail, their ability to eliminate the excess fluid and toxins from the body decreases. The function of the kidneys deteriorates to the point at which an alternate form of elimination needs to be provided in the form of hemodialysis or peritoneal dialysis. Hemodialysis involves cleaning out the blood by passing the blood through a dialysis machine. This is ideally done for four-hour sessions, thrice weekly. The blood vessels of the patient are attached to the dialysis machine through a vascular access.<br/> <br/> One of the most common forms of vascular access is a fistula, which is created surgically from the patient&#39;s own blood vessels. The tubes used to take blood to and from the body to the dialysis machine are connected to the body at this access point.<br/> <br/> Clotting is one of the primary complications of an access point and can lead to its closure.<br/> <br/> \"These access points don&#39;t last forever,\" said Chang, a postdoctoral scholar. \"Many patients go through multiple access points moving from the right to left arm, or into the legs if necessary after repeated failures in the arms. When a patient runs out of access points, it becomes an emergency situation. Anything you can do to extend the life of the access point is important.\"<br/> <br/> The study was based on results from the Hemodialysis study, known as HEMO — a National Institutes of Health-sponsored randomized clinical trial that collected data from 1,846 patients on hemodialysis from 1995 to 2000. In the present study, researchers analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. The researchers found that patients who had the most frequent episodes of low blood pressure during dialysis were two times more likely to have a clotted fistula than patients with the fewest episodes.<br/> <br/> About $2 billion a year is spent on vascular access in dialysis patients in the United States. Low blood pressure during dialysis occurs in about 25 percent of dialysis sessions.<br/> <br/> \"Physicians already try to avoid low blood pressure during dialysis through various means,\" Chang said. \"This is just one more good reason to continue these efforts.<br/> <br/> \"There is so much we don&#39;t know about blood pressure in people on dialysis,\" she added. \"We need future blood pressure management studies to look at not only mortality and hospitalization, but also consider vascular access survival as another important endpoint to study.\"<br/> <br/> <br><b>Sat, 30 Jul 2011 19:42:44 PST</b></td><td class=\"RssITd\" width=\"50%\"><center><b>Категория: Dialysis</b></center><br><a href=\"http://www.rxpgnews.com/dialysis/Low_Phosphate_diet_not_helpful_in_dialysis_patients_457372.shtml\" target=\"_blank\">Low Phosphate diet not helpful in dialysis patients</a><br>( from http://www.rxpgnews.com ) Doctors often ask kidney disease patients on dialysis to limit the amount of phosphate they consume in their diets, but this does not help prolong their lives, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results even suggest that prescribing low phosphate diets may increase dialysis patients&#39; risk of premature death. <br/> <br/> Blood phosphate levels are often high in patients with kidney disease, and dialysis treatments cannot effectively remove all of the dietary phosphate that a person normally consumes. Because elevated phosphate can lead to serious complications and premature death, dialysis patients are advised to restrict their phosphate intake and/or take phosphate binder medications. Kidney specialists and dietitians have long espoused dietary phosphate restriction; however, there have been few studies of its long-term effects on patient survival and health. <br/> <br/> To investigate the issue, Steven Brunelli, MD, MSCE (Brigham and Women&#39;s Hospital and Harvard Medical School), Katherine Lynch, MD (Beth Israel Deaconess Medical Center), and their colleagues analyzed data from 1751 patients on dialysis who were followed for an average of 2.3 years. Prescribed daily dietary phosphate was restricted to levels < 870 mg, 871-999 mg, 1000 mg, 1001-2000 mg, and not restricted in 300, 314, 307, 297 and 533 participants, respectively. <br/> <br/> The researchers found that patients who were prescribed more restrictive dietary phosphate levels had poorer nutritional status and were more likely to require nutritional supplements. Also, patients with more liberal dietary phosphate restrictions were less likely to die during the study. Specifically, patients prescribed 1001-2000 mg/day were 27% less likely to die and those with no specified phosphate restriction were 29% less likely to die than patients prescribed < 870 mg/day. <br/> <br/> When comparing different subgroups of patients, the investigators found a more pronounced survival benefit of liberal dietary phosphate prescription among non-blacks, patients without elevated phosphate levels, and those not taking vitamin D.<br/> <br/> \"Our data suggest that prescription of low phosphate diets did not improve survival among hemodialysis patients and may, in fact, be associated with greater mortality,\" said Dr. Brunelli. \"In part, this may relate to compromised intake of other essential macronutrients—such as protein—that occur unintendedly when low phosphate diets are prescribed, which may offset or supersede any beneficial effects on phosphate mitigation.\" <br/> <br/> Dr. Brunelli noted that these findings apply to naturally occurring phosphate only and do not pertain to foods that are high in phosphate due to phosphate-containing food additives, which were much less abundant in foods at the time the study data were collected (1995-2001). This is very important for several reasons: 1) phosphate additives are now exceedingly common in foods and are present in high doses, 2) additive phosphate is more readily absorbed by the body than naturally occurring phosphate, and 3) foods with intrinsically high phosphate tend to be rich in other nutrients, whereas foods rendered high in phosphate are not necessarily so. Therefore, the effects of foods that are high in phosphate-containing food additives should be investigated in future studies.<br/> <br/> <br/> <br><b>Fri, 10 Dec 2010 08:34:21 PST</b></td></tr><tr><td class=\"RssITd\" width=\"50%\"><center><b>Категория: Dialysis</b></center><br><a href=\"http://www.rxpgnews.com/dialysis/Nephrologist_care_prior_to_atarting_dialysis_reduces_risk_of_death_159716.shtml\" target=\"_blank\">Nephrologist care prior to starting dialysis reduces risk of death</a><br>( from http://www.rxpgnews.com ) For patients with end-stage renal disease (ESRD), receiving care from a nephrologist in the months before starting dialysis reduces the risk of death during the first year on dialysis, reports a study in the May 2009 issue of the Journal of the American Society of Nephrology (JASN). The study also shows geographic \"clusters\" where pre-dialysis care for patients with advanced chronic kidney disease (CKD) is not optimal. \"Assistance to improve pre-dialysis care might be profitably targeted to specific treatment centers and the health care systems they serve,\" comments William McClellan, MD (Emory University School of Medicine, Atlanta, GA).<br/> <br/> Dr. McClellan and colleagues analyzed data on more than 30,000 patients starting dialysis in five of the 18 US ESRD Network regions. The researchers evaluated the quality of the patients&#39; medical care in the months before their CKD progressed to ESRD, and how that affected the patients&#39; outcomes on dialysis.<br/> <br/> Just over half of the patients received at least six months of pre-dialysis care from a nephrologist, as recommended by current guidelines. For these patients, the chances of surviving the first year on dialysis were about 50 percent higher than for patients who did not receive at least six months of nephrologist care. Survival rates were higher at dialysis centers where more patients received recommended care.<br/> <br/> The researchers also unexpectedly discovered that dialysis centers with the lowest rates of recommended pre-dialysis care tended to be \"clustered geographically.\" For example, there was a \"significant circular cluster\" of low pre-dialysis care centers located in Alabama and Mississippi.<br/> <br/> Although the reasons for the geographic variations in care are unclear, the results identify specific regions that might benefit from efforts to improve care for advanced CKD patients. \"The Centers for Medicare & Medicaid Services are currently conducting a pilot quality improvement initiative in ten states to determine the feasibility of such efforts,\" says Dr. McClellan<br/> <br><b>Wed, 25 Mar 2009 16:13:58 PST</b></td><td class=\"RssITd\" width=\"50%\"><center><b>Категория: Dialysis</b></center><br><a href=\"http://www.rxpgnews.com/dialysis/Lower_death_rate_in_dialysis_patients_living_at_higher_altitude_148618.shtml\" target=\"_blank\">Lower death rate in dialysis patients living at higher altitude</a><br>( from http://www.rxpgnews.com ) Compared to dialysis patients living near sea level, dialysis patients living at an altitude higher than 4,000 feet have a 12-15 percent lower rate of death, according to a study in the February 4 issue of JAMA.<br/> <br/> A recent study found that patients with end-stage renal (kidney) disease (ESRD) living at higher altitude achieved greater hemoglobin concentrations (a protein in red blood cells that primarily transports oxygen from the lungs to the rest of the body) while receiving lower doses of erythropoietin (a hormone that stimulates the production of red blood cells). Increased iron availability caused by activation of hypoxia-induced (oxygen deficiency) factors at higher altitude may explain this finding, according to background information in the article. <br/> <br/> Wolfgang C. Winkelmayer, M.D., Sc.D., of Brigham and Women&#39;s Hospital and Harvard Medical School, Boston, and colleagues examined whether increased altitude would be associated with a reduced rate of death for patients initiating chronic dialysis. Using a comprehensive dialysis registry, the researchers identified 804,812 patients with ESRD who initiated dialysis between 1995 and 2004 and who met the study entry requirements. Most patients resided below an altitude of 250 ft. (40.5 percent) or between 250-1,999 ft. (54.4 percent). Only 1.9 percent of incident dialysis patients lived between 4,000 and 5,999 ft. and 0.4 percent higher than 6,000 ft. Patients were stratified by the average elevation of their residential zip code.<br/> <br/> Compared with patients living at lower altitudes (less than 250 ft.), the rate of death was reduced for patients living from 250-1,999 ft. by 3 percent; from 2,000 through 3,999 ft. by 7 percent; from 4,000 to 5,999 ft. by 12 percent; and higher than 6,000 ft. by 15 percent.<br/> <br/> Actuarial 5-year survival was 34.8 percent for patients living at or near sea level but was 42.7 percent among those living at an altitude higher than 6,000 ft.; patients in the highest elevation group experienced a 7.9 percent greater absolute or 22.7 percent greater relative 5-year survival. Median (midpoint) survival after initiation of dialysis was 3.1 years for those living lower than 250 ft. but was 4.0 years for those living at an altitude higher than 6,000 ft., for a difference in median survival of 0.9 years between these 2 groups.<br/> <br/> While a decrease in age- and sex-standardized mortality at higher altitude was also observed in the general population, the magnitude of the risk reduction was half of that observed in the ESRD population.<br/> <br/> \"In conclusion, we found a graded reduction in mortality from any cause in ESRD patients residing at greater altitude, a finding that was not explained by differences in observed patient characteristics. The magnitude of this observation was markedly greater than the observed small reduction in mortality at higher altitude in the general population. We propose that hypoxia-inducible factors are persistent at high altitude in patients with ESRD and may confer protective effects,\" the authors write.<br/> <br><b>Tue, 03 Feb 2009 23:16:02 PST</b></td></tr></table>");