Document Detail

Treatment time, chronic inflammation, and hemodynamic stability: the overlooked parameters in hemodialysis quantification.
MedLine Citation:
PMID:  18945325     Owner:  NLM     Status:  MEDLINE    
Decades after the introduction of chronic maintenance hemodialysis, the optimal means of quantifying dialysis dose remains controversial. Differences of opinion in the international dialysis community lead to substantial diversity in everyday clinical practice. Several studies suggest that the well-recognized international mortality differences in hemodialysis populations may result from these divergent approaches to dialysis care. One of the main areas of divergence is the different degree of reliance on dialysis clearance when prescribing dialysis. The "clearance approach" implies that treatment quality is primarily dependent on efficient removal of uremic toxins as estimated by dialytic urea clearance. Urea can be rapidly removed by high efficiency dialysis in a relatively short time. The main alternative to this strategy is the "time approach" based on the recognition that longer or more frequent dialysis provides benefits beyond increasing urea removal. Some of the putative benefits are more effective volume and blood pressure control, better maintenance of hemodynamic stability because of slower ultrafiltration and removal of uremic toxins that do not behave like urea. Recently, chronic inflammation has been proposed to be an important predictor of outcome in dialysis patients. Inflammatory markers are commonly elevated in chronic renal failure and levels of these seem to correlate with malnutrition, maintenance of residual renal function, and volume control. The relationships between dialysis clearance, treatment time, chronic inflammation, volume control, and hemodynamic stability are explored in this review. We propose that a better understanding of these complex relationships may provide opportunities for improving outcomes of maintenance hemodialysis patients.
Lajos Zsom; Marianna Zsom; Tibor Fulop; Michael F Flessner
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Publication Detail:
Type:  Editorial; Review    
Journal Detail:
Title:  Seminars in dialysis     Volume:  21     ISSN:  1525-139X     ISO Abbreviation:  Semin Dial     Publication Date:    2008 Sep-Oct
Date Detail:
Created Date:  2008-10-23     Completed Date:  2009-03-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  395-400     Citation Subset:  IM    
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MeSH Terms
Acute-Phase Proteins / metabolism
Blood Pressure / physiology
Blood Volume / physiology
Hemodialysis Solutions / pharmacokinetics
Kidney Failure, Chronic / pathology,  physiopathology,  therapy*
Renal Dialysis / adverse effects,  methods*,  mortality
Time Factors
Urea / metabolism
Reg. No./Substance:
0/Acute-Phase Proteins; 0/Hemodialysis Solutions; 57-13-6/Urea

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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