Božidar Vujičić

Assessment of Hemodialysis Adequacy by Ionic Dialysance: Comparison to Standard Method of Urea Removal

Background. The hemodialysis adequacy is one of the most important issues influencing the survival of patients on maintenance hemodialysis (HD). Assessment of measuring the delivered dialysis dose using clearance × time/volume (Kt/V) index requires multiple blood sampling. New methods for assessment of dialysis dose based on ionic dialysance (ID) have been suggested. Online conductivity monitoring (using sodium flux as a surrogate for urea) allows the repeated noninvasive measurement of Kt/V on each HD treatment. In this study we have compared this method with the standard method of estimating Kt/V. Methods. We studied 24 established HD patients over a 4 week time period. Patients were dialyzed using Fresenius 4008S dialysis monitors, equipped with modules to measure ID. Data were manually collected and analyzed using the appropriate statistical software. Urea removal (UR) was measured once a week by a two-pool calculation, estimating an eKt/V. Results. The Kt/V measured by ID highly correlated with the one derived from the measurement of the UR (r = 0.8959, p< 0.0001). The ID underestimated UR by the mean of 6%. The ID varied greatly within individual patients with a median of 1.29 ± 0.22. If the eKt/V ≥ 1.2 is considered adequate, 33% of the patients would have been inadequately dialyzed. The mean HD duration to achieve an adequate dialysis was 4 hours and 47 minutes with high interpatient variability. Conclusion. The ID seems to be an easily obtained measure of the delivered dialysis dose, correlating well with standard UR method. Substantial individual variations imply that repeated measures (ideally for all treatments) are necessary to obtain a real answer to the mean treatment dose being delivered to the patients.

Peritoneal Dialysis Catheter Placement Using an Ultrasound-Guided Transversus Abdominis Plane Block

Background: Peritoneal dialysis (PD) catheter placement is usually performed using general or local anesthesia. We present our PD catheter placement experience using an ultrasound-guided transversus abdominis plane (TAP) block, which is a regional anesthesia technique. Methods: In this study, we analyzed 33 patients from our center with ESRD who underwent PD catheter placement using a TAP block between June 2011 and April 2014. Results: The TAP block was successful for 29/33 (87.9%) patients. Four patients (12.1%) had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or catheter-related complications. Conclusion: ESRD patients have a substantial number of comorbidities that can be negatively influenced by general anesthesia. Because regional anesthesia has no systemic effect, this procedure could be recommended for this group of patients. A TAP block is an effective, safe method and can be used as the principal anesthesia technique for PD catheter placement.

Anemia Is Correlated with Malnutrition and Inflammation in Croatian Peritoneal Dialysis Patients: A Multicenter Nationwide Study

Malnutrition, inflammation, and anemia are common in peritoneal dialysis (PD) patients. In this study, correlations between Malnutrition Inflammation Score (MIS), laboratory and anthropometric parameters, and anemia indices in Croatian PD patients were analyzed. One hundred and one PD patients (males/females 54/47, age 58.71 ± 14.68 years, mean PD duration 21.82 ± 21.71 months) were included. Clinical, laboratory, and anthropometric parameters were measured. Statistically significant correlations between MIS and erythropoietin weekly dose per kg of body weight (ESA weekly dose), hemoglobin (Hb), and erythrocytes were found (r = 0.439, p < 0.001; r = -0.032, p < 0.001; r = -0.435, p < 0.001), respectively. Also, statistically significant correlations were found between MIS and mean corpuscular volume (r = 0.344, p < 0.001), iron (r = -0.229, p = 0.021), and total iron binding capacity (TIBC) (r = -0.362, p < 0.001), respectively. Furthermore, statistically significant correlations between ESA weekly dose and serum albumin level and body mass index (BMI) were found (r = -0.272, p = 0.006; r = -0.269, p = 0.006), respectively. When we divided PD patients into 2 groups according Hb level (Hb ≥ 110 [N = 60, 59.41 %]) and Hb < 110 [N = 41, 40.59%]), statistically significant differences were found in MIS score (3.02 ± 2.54 vs 4.54 ± 3.54, p = 0.014), C-reactive protein (CRP) (3.52 ± 6.36 vs 7.85 ± 7.96, p = 0.005), and serum albumin level (44.22 ± 8.54 vs 39.94 ± 8.56, p = 0.003), respectively. Our findings suggest that anemia is correlated with malnutrition and inflammation in Croatian PD patients. Further studies are needed to assess whether modulating inflammatory or nutritional processes can improve anemia management in PD patients.

[PP.LB03.04] THE EFFECT OF DIFFERENT ERYTHROPOIESIS-STIMULATING AGENT TYPE TO THE INCIDENCE OF ARTERIAL HYPERTENSION IN EUVOLEMIC MAINTENANCE HEMODIALYSIS PATIENTS

Objective: Arterial hypertension (AH) is an adverse effect of erythropoiesis-stimulating agent (ESA) treatment among hemodialysis (HD) patients. Among several mechanisms considered in the pathogenesis of ESA-induced hypertension are rise of hematocrit and erythrocyte mass and direct vasopressor action of ESA. The aim of this study was to determine the effect of different ESA type to the incidence of AH among euvolemic HD patients. Design and method: We included all prevalent HD patients from the Department of Nephrology, Dialysis and Kidney Transplantation, Clinical Hospital Centre Rijeka, from January 1, 2014, to December 31, 2015, allocated into four groups – those without ESA, and those with short, medium and long acting ESA, observing weekly dosage in I.U. Every six months, before starting the midweek HD session, multifrequency bioimpedance analysis (MF-BIA) was performed together with serum albumine and hemoglobine levels. Blood pressure (BP) and mean arterial pressure (MAP) were assessed before and at the end of HD treatment. Patients with volume-dependent AH based on MF-BIA assessement (>2.5 litres overhydration) and not reaching two or more measurements were excluded. Results: A number of 350 measurements were eligible for statistical analysis, made on 153 patients (age 69.1 ± 13.8, range 23–92 yrs, 56% male, 25% diabetic, HD duration 61.34 ± 74.61 months). There was no statistically significant difference between the groups at the baseline. Mean weekly ESA dose was 6998.16 ± 4856.86 I.U. In comparison to non-ESA group (25% measurments); short, medium and long acting ESA showed statistically significant higher incidence of AH (42%,p = 0,03; 50%,p = 0.002; and 43%,p = 0,018, respectively) with highest incidence at medium and long acting ESA (p = 0,016). Both BP and MAP before and after HD session strongly correlated with ESA dose but not with serum albumin and hemoglobin levels. Conclusions: Our study showed that all three types of ESA increased the incidence of AH in euvolemic HD patients, with highest incidence related to medium and long acting ESA. Systolic and dyastolic BP and MAP correlated with weekly ESA dose while serum hemoglobine and albumin levels showed no correlation with BP. Further investigations in greater number of patients are needed.

Contents Vol. 39, 2015

Annual Congress of the 230 Chinese Blood Purification Center Administration Committee September 25–28, 2014, Guangzhou Guest Editor: Tao Wei (Beijing) Letter to the Editor 238 The Urokinase Lock-Therapy for Hemodialysis Occluded Central Venous Catheters Li Cavoli, G.; Schillaci, O.; Zagarrigo, C.; Servillo, F.; Li Cavoli, T.V.; Palmeri, M.; Rotolo, U. (Palermo)

Vascular Access for Hemodialysis

In this book chapter are described different types of vascular access for hemodialysis, its forms, indications, placement and complications. The chapter is dedicated to health care professionals dealing with chronic kidney disease patients undergoing hemodialysis treatment.

BODY COMPOSITION MONITOR: A NEW TOOL FOR THE ASSESSMENT OF VOLUME - DEPENDENT HYPERTENSION IN THE PATIENTS ON THE MAINTENANCE HEMODIALYSIS: PP.37.492

Background: The control of blood pressure has been one of the main problems of dry weight management on the basis that fluid accumulation predisposes to hypertension in the end stage renal disease patients. Non-invasive multifrequency bioimpedance spectroscopy with a body composition model has been validated against other methods to assess fluid status. Aim: To evaluate the deviation in hydration status from normal ranges (ÄHS) as the cause of hypertension in the patients on the maintenance hemodialysis (HD) and to identify the different patient groups that result from measurements of pre-dialysis systolic blood pressure (BPsys) and ÄHS alone. Methods: ÄHS is measured in 219 prevalent HD patients from three centers using a new multifrequency bioimpedance spectroscopy device (BCM-Body Composition Monitor, Fresenius Medical Care, Germany), before the second dialysis session in the week. Patients with a pacemaker or implanted defibrillator, amputation of a major extremity, pregnancy or lactation period were excluded. BPsys is measured using the Riva-Rocci-Korotkoff method with the patient in the supine position. The average of the two last measurements by sphygmomanometer was used in the analysis. The data were used to generate a graphical tool (HRP-hydration reference plot) which allows rapid differentiation between hypotensive and hypertensive patients as well as distinguishing fluid overload from the state of normohydration. Results: In normohydration-normotension group (BPsys >150 mmHg, ÄHS <2,5 L) we found 49 (23%) patients. In volume dependent hypertension group (BPsys>150 mmHg, ÄHS >2,5 L) we found 93 (42%) patients. In possible essential hypertension group (BPsys >150 mmHg, ÄHS <1,1 L) we found 35 (16%) patients. In overhydration but not reflected in BPsys group (BPsys <140 mmHg, ÄHS >2,5 L) we found 40 (18%) patients. In underhydration-hypotension group (BPsys <100 mmHg, ÄHS >1,1 L) we found two patients (1%). Conclusion: The multifrequency bioimpedance spectroscopy method allows detecting of fluid overload in a safe and easy manner. According to this, more objective choice of strategies for the optimal treatment of hypertension and fluid overload in the maintenance HD patients can be selected.