Intradialytic Hypotension (IDH): Nadir SBP < 90 ππΌ strongest association with β¬οΈ mortality
π Poor long-term Outcomes
π β¬οΈ mortality
π Myocardial stunning
π Incidence is highest in those with low pre-HD BP
π β¬οΈ risk of access thrombosis #Nephpearls#DialysisDirector
Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #Nephpearls#DialysisDirector
Muscle Cramps with hemodialysis
π More common during 1st month of dialysis
π More common in those with low cardiac index
π Consider β¬οΈ Mg, β¬οΈ Ca, β¬οΈ K
π Risks: Hypotension, Hypovolemia, β¬οΈ UF rate, β¬οΈ Dialysate Na #Nephpearls#DialysisDirector
ππΌ google.com/amp/s/www.huffβ¦
Quinine sulfate before dialysis, though effective in preventing intradialytic cramps, is now considered inadvisable because of its association with -
π Thrombocytopenia
π Hypersensitivity reactions
π QT prolongation #Nephpearls#DialysisDirector
Short-term (6 weeks) use of sertraline reduces IDH in some patients
π βPossibleβ mechanism: Sertraline-induced attenuation of the paradoxical sympathetic withdrawal that may underlie IDH in some patients w/ ESKD #Nephpearls#DialysisDirector
ππΌ ajkd.org/article/S0272-β¦
Dysequilbrium Syndrome
π Acute β¬οΈ in brain water content
ππΌ When plasma solute level is rapidly β¬οΈ during HD, plasma becomes hypotonic relative to brain cells & water shifts from plasma into brain tissue
π Acute changes in CSF pH during dialysis #Nephpearls#DialysisDirector
Preventing Dysequilibrium Syndrome in the setting of acute dialysis
π Target reduction in the BUN should initially be limited to about 40%
π Low Dialysate Na (more than 2β3 mmol < Serum Na) may exacerbate cerebral edema and should be avoided #Nephpearls#DialysisDirector
Preventing Dysequilibrium Syndrome in the setting of chronic dialysis
π Use of dialysate Na at least 140 mmol
π Use of high dialysate Na (145β150 mmol) that declines over the course of treatment for patients has been advocated in this setting #Nephpearls#DialysisDirector
Dialyzer reactions
π Type A - Anaplylactic
π² Ethylene oxide
π² AN69-associated
π² Contaminated dialysate
π² Reuse
π² Heparin
π² Complement fragment release
π² Eosinophilia
Hemolysis with HD
π Obstruction or narrowing in the blood line, catheter, or needle - KINKβοΈ
π Problem w/ dialysate
π² Overheated dialysate
π² Hypotonic dialysate
π² Contaminated dialysate (formaldehyde, bleach, Cu, etc) #Nephpearls#DialysisDirector
ππΌ cjasn.asnjournals.org/content/clinjaβ¦
Venous air embolism may arise from possible areas of air entry into the dialysis circuit
π Foam in the venous blood line
π If air has gone into the heart, a peculiar churning sound may be heard on auscultation #Nephpearls#DialysisDirector
ππΌ cjasn.asnjournals.org/content/clinjaβ¦
Management π¨ of venous air embolism during HD
1οΈβ£ Clamp π the venous blood line & stop the blood pumpβΌοΈ
2οΈβ£ Place patient in the recumbent position on the left side w/ the chest & head tilted downward
β‘οΈ Cardiopulmonary support, 100% O2, etc. #Nephpearls#DialysisDirector
KALM-1: Efficacy and Safety of Difelikefalin in Patients Undergoing Hemodialysis with Pruritus: Results from a Phase 3 Randomized, Controlled Study #KidneyWk#Nephpearls
ππΌ nejm.org/doi/pdf/10.105β¦
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IgA Nephropathy: The @goKDIGO treatment algorithm recommends consideration of use of corticosteroids in patients with "persistent proteinuria >1g/day" if the risk/benefit profile is favorable
π A GFR of 30 is considered a threshold for treatment
Nephrolithiasis 101: When to order a 24-hour urine collection #Nephpearls
Multiple or metabolically active stones (stones that increase in size/ number w/in a year)
Children
Demographic groups not typically prone to stone formation
Stones other than those containing calcium
Interpretation of urine chemistries to identify lithogenic risk factors and assess the contribution of diet to the formation of kidney stones ca. 2016 from @ravineja#Nephpearls
PREDNOS 2: Evaluation of Daily Low-Dose Prednisolone During URTI to Prevent Relapse in Children w/ Relapsing Steroid-Sensitive Nephrotic Syndrome ca, 2022 from @JAMAPediatrics#NephJC#IPNAJC#Nephpearls
Low-dose versus conventional-dose prednisolone for nephrotic syndrome relapses: a randomized controlled non-inferiority trial ca. 2022 from @Ped_Neph#NephJC#IPNAJC#Nephpearls
PREDNOS: Sixteen-week versus standard eight-week prednisolone therapy for childhood nephrotic syndrome ca. 2019 from @bmj_latest#NephJC#IPNAJC#Nephpearls