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Introduction: Parathormone (PTH) and phosphorus, which are considered as uremic toxins, are associated with reduced red cell survival, yet with unproven mechanism. We aimed to assess the relation between PTH and phosphorus levels and eryptosis in patients with CKD5d treated by hemodialysis. Methods: In a cohort of 85 patients with CKD5d treated by conventional hemodialysis, the percent of annexin V‐binding RBCs was assessed by flow cytometry to indicate the percent of eryptotic RBCs. Findings The median percent of annexin V‐binding RBCs was 2.3 (1.4–4.7)%. On linear regression analysis, PTH was independently associated with the percent of annexin V‐binding RBCs (β = 0.003; 95% CI: 0.002–0.004; p < 0.001). The percent of annexin V‐binding RBCs differed significantly in patients with low PTH (<150 pg/mL; 27/85, 31.8%), target PTH (150–600 pg/mL; 32/85, 37.6%), and high PTH (>600 pg/mL; 26/85, 30.6%) groups (1.24 [0.65–1.85]; 2.46 [1.73–4.05]; and 4.82 [3.45–5.61]%, respectively; p < 0.001). Considering the tertiles of the percent of annexin V binding RBCs, PTH increased significantly from 85 (50.6–273) in the 1st to 298.3 (172.8–606.8) in the 2nd and 827.6 (357.4–1171.3) pg/mL in the 3rd tertiles (p < 0.001). Phosphorus and calcium levels as well as the CaxPh product were similar among the three tertiles (p > 0.05). Discussion: Patients with CKD5d express high rates of eryptosis. PTH excess in those patients may result in further eryptosis enhancement, and this represents a potential pathogenic mechanism linking hyperparathyroidism with the anemia of CKD. [ABSTRACT FROM AUTHOR]

Severe metabolic alkalosis is rarely seen in end stage renal disease (ESRD) patients on long‐term hemodialysis. This can be life threatening and mortality is exponentially increased when the pH exceeds 7.60. Persistent vomiting, ingestion of alkali for dyspepsia and pica behavior are all potential causes of such severe metabolic alkalosis. The prevalence of pica is increased in chronic kidney disease and ESRD patients, with ice being the most commonly ingested substance. It can cause a myriad of complications including death, but the diagnosis may be elusive unless the pica behavior is witnessed firsthand by others since patients do not typically disclose their behavior. We present the case of a hemodialysis patient with severe alkalemia, hypernatremia, and excessive interdialytic weight gains resulting in recurrent hospitalizations for fluid overload due to baking soda pica behavior. [ABSTRACT FROM AUTHOR]

Introduction: Patients with end‐stage renal disease (ESRD) experience frequent hemodialysis (HD) complications. Intradialytic hypotension (IDH) is a common complication presenting in approximately between 20 and 50% of HD sessions. Available interventions such as volume replacement or vasoactive medications are associated with significant side effects. Intermittent pneumatic compression (IPC) has been proposed as a feasible intervention for the prevention of IDH, treatment of peripheral arterial disease and venous ulcers. These devices apply intermittent pressure to the legs improving arterial blood flow, mobilization of pooled blood with an increase in venous return increasing the effective circulatory volume. Our goal was to identify the published clinical evidence on whether IPC has a circulatory benefit and is it well‐tolerated among patients receiving HD. Methods: We conducted a systematic review to identify studies assessing the efficacy and safety of IPC in patients with ESRD. Our primary outcome was IDH. Secondary outcomes such as HD comfort, ultrafiltration volume, and physical activity were collected. No restrictions where used and we included all observational and interventional studies. Two reviewers performed screening and study quality assessment. Findings: We included seven studies. Out of the seven studies, five addressed IDH, and the rest were included for secondary outcomes such as physical capacity and HD comfort. In one randomized crossover trial comparing exercise against IPC, 21 patients were randomized to 3 different arms (no intervention, cycling, IPC) a decrease in the rates of IDH with IPC was described (43%, 38%, and 24% respectively P = 0.014). The smaller studies corroborated these results. All studies where at high risk of bias. Discussion: IPC might offer significant benefits for patients undergoing HD not limited to prevention of IDH but also improvement of hemodialysis comfort and physical capacity. However, our results should be interpreted in the context of its limitations. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare prospectively the effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelets. Methods: Twenty‐two hemodialysis patients were treated with one high‐flux hemodialysis and one post‐dilution hemodiafiltration procedure. PFA‐100 closure times (collagen/epinephrine—CEPI and collagen/adenosine diphosphate—CADP) were measured before and after the procedure, as well as platelet count, hemoglobin, hematocrit, and red blood cell count. All pre‐dialysis and post‐dialysis samples were taken from the afferent line. Findings: The platelet count after vs. before hemodialysis did not change significantly (229.3 ± 55.0 x109/L vs. 233.6 ± 55.8 × 109/L; P = 0.269), but was significantly lower after post‐dilution hemodiafiltration (215.5 ± 51.7 × 109/L vs. 245.3 ± 59.9 × 109/L; P < 0.0001). CEPI after vs. before hemodialysis was not significantly prolonged (192.9 ± 60.8 s vs. 173.4 ± 52.5 s; P = 0.147), and the same applied to CADP (143.6 ± 40.3 s vs. 142.6 ± 38.4 s; P = 0.897). CEPI after vs. before post‐dilution hemodiafiltration was significantly prolonged (268.3 ± 41.3 s vs. 176.4 ± 54.0 s; P < 0.0001) as was CADP (221.0 ± 53.9 s vs.133.9 ± 31.1 s; P < 0.0001). Discussion: Only after post‐dilution hemodiafiltration, we found a lower platelet count and prolonged platelet closure times. [ABSTRACT FROM AUTHOR]

Skin manifestations are commonly seen in end stage renal disease (ESRD). Skin involvement in this population can be extensive and dramatically worsen quality of life. Close observation of the skin and nails of ESRD patients by clinicians allows for timely diagnosis and treatment, which ultimately improves quality of life and reduces mortality. In this article we focus on the cutaneous changes most commonly seen in ESRD patients. PubMed/Medline database search was done for published literature on skin manifestations in ESRD patients. All the available literature was reviewed and relevant articles were used to discuss about clinical features, pathogenesis, histology and treatment of each skin disorder in ESRD patients. Most commonly encountered skin manifestations in patients with ESRD are pruritus, xerosis, pigmentation changes, nail changes, perforating disorders, calcifying disorders, bullous dermatoses and nephrogenic systemic fibrosis. Skin manifestations in ESRD can be difficult to treat and multiple comorbidities in this patient population can exacerbate these disorders. Many of the treatment options are experimental with evidence largely derived from the case reports and small clinical trials. More large‐scale trials are needed to firmly establish evidence based treatment guidelines. Prompt evaluation and management of these disorders improve morbidity and quality of life in ESRD patients. [ABSTRACT FROM AUTHOR]

Abstract: Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes. First line should be conservative management such as exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy. Analgesics are introduced according to WHO guidelines (by the mouth, by the clock, by the ladder, for the individual, and attention to detail) using three‐step analgesic ladder model. Neuropathic pain can be controlled by gabapentin and pregabalin. Substitution/addition of opioid analgesics are indicated if pain control is not optimal. Commonly used opioids in ESRD patients are tramadol, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Methadone, fentanyl, and buprenorphine are the ideal analgesics in ESRD. However, complex pain syndrome requires multidrug analgesic regimen comprising opioids, non‐opioids, and adjuvant medication, which should be individualized to the patient to achieve adequate pain control. [ABSTRACT FROM AUTHOR]

The 5th congress of International Society for Hemodialysis took place last August 3-5, 2012 at the Grand Hotel in Taipei and focused on ' Save Life and Improve Quality.' It attracted a total of 927 participants from 18 countries. The full spectrum of hemodialysis was covered with plenary lectures and symposiums delivered by experts from different subspecialties in nephrology starting from the history of hemodialysis, mineral bone disease, microinflammation and advanced techniques in hemodialysis. It was followed by critical care in nephrology, anemia, and nutrition in dialysis. Last but not the least, natural disasters and medical economics in hemodialysis were also discussed extensively. This special article will highlight the authentic contributions and innovative clinical presentations from the meeting. [ABSTRACT FROM AUTHOR]