Recovery of chronic dialysis hypotension after kidney transplantation: A case report

Chronic dialysis hypotension is described as low systolic blood pressure (<100 mmHg) during interdialytic period. The presence of low predialysis systolic blood pressure, typically <110 mmHg, is significantly associated with increased mortality. Kidney transplantation is the preferred model of renal replacement therapy in the treatment of end-stage renal disease (ESRD) as it improves quality of life and survival. In this article, a long-term hemodialysis (HD) patient with chronic hypotension improved after kidney transplantation is presented. A 39-year-old male patient received a deceased donor kidney transplant. The patient was on HD for 23 years. The patient had suffered from chronic persistent hypotension for the last 8 years. Blood pressure was 70/50 mmHg before dialysis and 60/40 mmHg after dialysis. In the post-transplant period, blood pressure was maintained above 110/70 mmHg by intermittent infusion of dopamine. Hypotension was improved after 24 days and dopamine was discontinued. Various etiologies may cause chronic hypotension in patients receiving long-term HD treatment. Kidney transplantation may improve survival and quality of life by correcting hypotension in these patients. Therefore kidney transplantation should not be avoided as renal replacement therapy in ESRD patients with hypotension

Regression of left ventricular hypertrophy in haemodialysis patient by ultrafiltration and reduced salt intake without antihypertensive drugs

PubMed ID: 9641180Background. Left ventricular hypertrophy (LVH) is very frequent in haemodialysis patients. Only few investigations have reported its regression, and only by the use of antihypertensive drugs. Because volume load is at least as important as pressure load, we investigated whether persistent strict volume control by ultrafiltration alone may be effective in improving LVH. Methods. Using blood pressure (BP) and cardiac dimensions as a guide, we treated all hypertensive patients in our dialysis unit during the 3 times weekly dialysis sessions for 4 h per session with as much ultrafiltration as they could stand. If they gained too much weight an extra isolated ultrafiltration (UF) session was applied. Special attention was given to dietary salt restriction. The study group of all 15 patients in whom echocardiographic assessment had been made at least 1.5 years previously was selected retrospectively, and we acknowledge that important confounding factors might not have been controlled for. Cardiothoracic index (CTI) was estimated on the chest X-ray. Diameters of left atrium (LA), left ventricle systolic (LVS) and diastolic (LVD), interventricular septum (IVS), posterior wall (PW), and left ventricular mass index (LVMI) were estimated by standard echocardiographic methods. Results. Mean arterial pressure of the study group had been lowered by UF before the first echocardiogram from predialysis 136 ± 11 to 101 ± 14 and from postdialysis 119 ± 8 to 92 ± 12 mmHg. During a mean follow-up period of 37 ± 11 months LVMI decreased from 175 ± 60 to 105 ± 11 g/m2 CTI decreased further from 48 ± 3 to 43 ± 4%, while significant decreases of LA (22.5 ± 3 to 19.9 ± 4 mm/m2), LVS (18.7 ± 4 to 15.9 ± 3 mm/m2) and LVD (28.3 ± 4 to 24.0 ± 3 mm/m2) were seen in all patients. There also was a further decrease in both pre- and postdialysis BP to 116 ± 12/73 ± 7 and 105 ± 7/65 ± 3 mmHg respectively. Conclusion. The results of this uncontrolled retrospective study suggest that good long-term BP control and a decrease of LVM can be achieved by continuous efforts to control hypervolaemia. The decrease in volume may be even more important than pressure reduction to achieve this goal

Requirement of emergency hemodialysis in a peritoneal dialysis patient; Laxative induced hypermagnesemia: A case report [Periton Diyalizi Hastasinda Acil Hemodiyaliz Gereksinimi; Laksatif Kullanimina Bagli Hipermagnezemi: Olgu Sunumu]

Hypermagnesemia is rarely seen in peritoneal dialysis (PD) patients because PD can lower the plasma magnesium (Mg) concentration effectively. In this report, a continuous ambulatory peritoneal dialysis (CAPD) patient with life-threatening hypermagnesemia treated by hemodialysis (HD) is presented. A 52-year-old male patient on PD treatment was admitted to our clinic with complaints of fatigue and muscle weakness. Decrease in deep tendon reflexes (DTR), decrease in muscle strength at bilateral upper and lower extremities, and increased level of magnesium (7.7 mg/dl) were detected. Bradycardia, prolongation of the P-R interval, and an increase in Q-T interval were found on the electrocardiography. HD was performed two times. After HD, all the signs and symptoms of the patient improved. HD is a dialysis modality that should be preferred in the treatment of symptomatic patients with hypermagnesemia, because of providing more rapid clearance of Mg

Lactic acidosis secondary to metformin in a patient presenting with acute renal failure due to diarrhea: Case report [Metformin Kullanirken Diyare ve Akut Böbrek Yetmezligi Gelişen Hastada, Metformine Bagli Laktik Asidoz: Olgu Sunumu]

Metformin is a biguanide used in the treatment of type 2 diabetic patients with normal renal function. Lactic acidosis is the most serious side effect of metformin. Renal failure is the most common cause of reduced lactate excretion. It is aimed to present a case of metformin-induced lactic acidosis exacerbated by acute renal failure. A 68-year-old female patient used metformin was admitted to the infectious disease department due to diarrhea, nausea and vomiting. Type B lactic acidosis due to metformin was diagnosed after the detection of high anion gap metabolic acidosis and high lactate level on blood gas analysis. Hemodialysis was performed because of acute renal failure. The patient was discharged on the 11th day of the hospitalization with normal serum parameters. Metformin may cause lactic acidosis among patients with acute renal failure; early hemodialysis provides rapid clinical improvement

The extracellular water corrected for height predicts technique survival in peritoneal dialysis patient

OBJECTIVE: Most patients on peritoneal dialysis (PD) consume a normal Western diet that contains a large amount of salt. This causes increase in extracellular volume ("fluid overload") that has to be removed mostly with the dialysis fluid, as residual renal function (if present) cannot cope with it. In the present study, we prospectively investigated whether an increased extracellular volume (corrected for height) predicted technique survival in PD patients. MATERIAL and METHODS: Ninety-five prevalent PD patients from one center (mean age 50±13 years, 10 of them diabetic) were studied. Extracellular water (ECW), total body water (TBW), and intracellular water (ICW) were measured by multi-frequency bioimpedance analysis (m-BIA). Echocardiography was performed in all patients. Volume status was also evaluated by measuring left atrium diameter (LAD) and left ventricular end-diastolic diameter (LVEDD). Demographical, biochemical analyses, peritoneal equilibration test, weekly total Kt/V urea and weekly total creatinine clearance (CCr) results were obtained from patient chart. We identified a cut-off value for ECW/height by drawing ROC curves that differentiate patients with FO and those without, using LAD and LVEDD measured by echocardiography as confirmatory parameters. Technique survival (TS) was defined as the time on PD treatment until transfer to hemodialysis. Technique survival (TS) was assessed at the end of the follow-up and significant predictors of technique survival were investigated. RESULTS: During the follow-up, 62 patients dropped out. Thirty-six patients were switched to hemodialysis (severe peritonitis in twelve, hernia in one, peritoneal leaks in five, inadequate dialysis in seventeen and unwillingness in one patient), twelve patients received transplants, five patients were transferred to other center and nine patients died (4 patients from infection, 4 patients from cardiovascular disease and 1 patient from malignancy). Patients switched to hemodialysis were older and had higher duration of PD treatment, body mass index, ECW/height and LAD than patients that stayed on PD. Patients that switched to HD also had significantly lower weekly total KT/Vurea, weekly total CCr and daily total urine volume than patients that stayed on PD. On ROC analysis, we found a cut-off value for ECW/height of 10.5 liters/m with specificity of 78 % and sensitivity of 75% for the diagnosis of FO. Patients with the ratio of ECW/height values above the cut-off values had significantly worse technique survival than those with ECW/height below 10.5 L/m (mean survival, 28.7±2.6 vs. 35.1± 1.9 months; p=0.016). On multivariate analysis, weekly total CCr, serum CRP level and ECW/height above 10.5 L/m were independent predictors of technique failure. CONCLUSION: An increased extracellular volume corrected for height as a fluid overload marker is associated with decreased technique survival in PD patients

GB virus C/hepatitis G virus infection among renal transplant recipients in İzmir, Turkey: Molecular analysis of phylogenetic groups [4]

PubMed ID: 12718845[No abstract available

Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients

PMID = 2709396