The Experts below are selected from a list of 81 Experts worldwide ranked by ideXlab platform
Dominik N Muller - One of the best experts on this subject based on the ideXlab platform.
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is peritoneal Dialysis still an equal option results of the berlin pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2015Co-Authors: Julia Thumfart, Steffen Wagner, Uwe Querfeld, Tanja Hilliger, Christina Stiny, Dominik N MullerAbstract:Background Peritoneal Dialysis (PD) or conventional hemoDialysis (HD) are considered to be equally efficient Dialysis methods in children and adolescents. The aim of our study was to analyze whether an intensified, Nocturnal HD program (NHD) is superior to PD in an adolescent cohort.
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hemodiafiltration in a pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2014Co-Authors: Julia Thumfart, Christina Von Puttkamer, Steffen Wagner, Uwe Querfeld, Dominik N MullerAbstract:To overcome the deleterious consequences of conventional Dialysis, intensified Dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, Nocturnal hemoDialysis program. After being started on conventional hemoDialysis (HD), seven patients were switched to intermittent Nocturnal hemoDialysis (NHD) for 3 months, then to intermittent Nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered. Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF. The introduction of a Nocturnal Dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
Julia Thumfart - One of the best experts on this subject based on the ideXlab platform.
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is peritoneal Dialysis still an equal option results of the berlin pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2015Co-Authors: Julia Thumfart, Steffen Wagner, Uwe Querfeld, Tanja Hilliger, Christina Stiny, Dominik N MullerAbstract:Background Peritoneal Dialysis (PD) or conventional hemoDialysis (HD) are considered to be equally efficient Dialysis methods in children and adolescents. The aim of our study was to analyze whether an intensified, Nocturnal HD program (NHD) is superior to PD in an adolescent cohort.
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hemodiafiltration in a pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2014Co-Authors: Julia Thumfart, Christina Von Puttkamer, Steffen Wagner, Uwe Querfeld, Dominik N MullerAbstract:To overcome the deleterious consequences of conventional Dialysis, intensified Dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, Nocturnal hemoDialysis program. After being started on conventional hemoDialysis (HD), seven patients were switched to intermittent Nocturnal hemoDialysis (NHD) for 3 months, then to intermittent Nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered. Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF. The introduction of a Nocturnal Dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
Uwe Querfeld - One of the best experts on this subject based on the ideXlab platform.
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is peritoneal Dialysis still an equal option results of the berlin pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2015Co-Authors: Julia Thumfart, Steffen Wagner, Uwe Querfeld, Tanja Hilliger, Christina Stiny, Dominik N MullerAbstract:Background Peritoneal Dialysis (PD) or conventional hemoDialysis (HD) are considered to be equally efficient Dialysis methods in children and adolescents. The aim of our study was to analyze whether an intensified, Nocturnal HD program (NHD) is superior to PD in an adolescent cohort.
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hemodiafiltration in a pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2014Co-Authors: Julia Thumfart, Christina Von Puttkamer, Steffen Wagner, Uwe Querfeld, Dominik N MullerAbstract:To overcome the deleterious consequences of conventional Dialysis, intensified Dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, Nocturnal hemoDialysis program. After being started on conventional hemoDialysis (HD), seven patients were switched to intermittent Nocturnal hemoDialysis (NHD) for 3 months, then to intermittent Nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered. Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF. The introduction of a Nocturnal Dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
Steffen Wagner - One of the best experts on this subject based on the ideXlab platform.
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is peritoneal Dialysis still an equal option results of the berlin pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2015Co-Authors: Julia Thumfart, Steffen Wagner, Uwe Querfeld, Tanja Hilliger, Christina Stiny, Dominik N MullerAbstract:Background Peritoneal Dialysis (PD) or conventional hemoDialysis (HD) are considered to be equally efficient Dialysis methods in children and adolescents. The aim of our study was to analyze whether an intensified, Nocturnal HD program (NHD) is superior to PD in an adolescent cohort.
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hemodiafiltration in a pediatric Nocturnal Dialysis program
Pediatric Nephrology, 2014Co-Authors: Julia Thumfart, Christina Von Puttkamer, Steffen Wagner, Uwe Querfeld, Dominik N MullerAbstract:To overcome the deleterious consequences of conventional Dialysis, intensified Dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, Nocturnal hemoDialysis program. After being started on conventional hemoDialysis (HD), seven patients were switched to intermittent Nocturnal hemoDialysis (NHD) for 3 months, then to intermittent Nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered. Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF. The introduction of a Nocturnal Dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
Michael V Rocco - One of the best experts on this subject based on the ideXlab platform.
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effect of frequent hemoDialysis on residual kidney function
Kidney International, 2013Co-Authors: John T Daugirdas, Michael V Rocco, Tom Greene, George A Kaysen, Thomas A Depner, Nathan W Levin, Glenn M Chertow, Daniel B Ornt, Jochen G Raimann, Brett LariveAbstract:Frequent hemoDialysis can alter volume status, blood pressure, and the concentration of osmotically active solutes, each of which might affect residual kidney function (RKF). In the Frequent HemoDialysis Network Daily and Nocturnal Trials, we examined the effects of assignment to six compared with three-times-per-week hemoDialysis on follow-up RKF. In both trials, baseline RKF was inversely correlated with number of years since onset of ESRD. In the Nocturnal Trial, 63 participants had non-zero RKF at baseline (mean urine volume 0.76 liter/day, urea clearance 2.3ml/min, and creatinine clearance 4.7ml/min). In those assigned to frequent Nocturnal Dialysis, these indices were all significantly lower at month 4 and were mostly so at month 12 compared with controls. In the frequent Dialysis group, urine volume had declined to zero in 52% and 67% of patients at months 4 and 12, respectively, compared with 18% and 36% in controls. In the Daily Trial, 83 patients had non-zero RKF at baseline (mean urine volume 0.43 liter/day, urea clearance 1.2ml/min, and creatinine clearance 2.7ml/min). Here, treatment assignment did not significantly influence follow-up levels of the measured indices, although the range in baseline RKF was narrower, potentially limiting power to detect differences. Thus, frequent Nocturnal hemoDialysis appears to promote a more rapid loss of RKF, the mechanism of which remains to be determined. Whether RKF also declines with frequent daily treatment could not be determined.
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recruitment and training for home hemoDialysis experience and lessons from the Nocturnal Dialysis trial
Clinical Journal of The American Society of Nephrology, 2010Co-Authors: Mary Pipkin, Paul W Eggers, Brett Larive, Michael V Rocco, John B Stokes, Rita S Suri, Robert S LockridgeAbstract:Background and objectives: We assessed perceived barriers and incentives to home hemoDialysis and evaluated potential correlates with the duration of home hemoDialysis training. Design, settings, participants, & measurements: Surveys were sent to the principal investigator and study coordinator for each clinical center in the Frequent HemoDialysis Network Nocturnal Trial. Baseline data were obtained on medical comorbidities, cognitive and physical functioning, sessions required for home hemoDialysis training, and costs of home renovations. Results: The most commonly perceived barriers included lack of patient motivation, unwillingness to change from in-center modality, and fear of self-cannulation. The most common incentives were greater scheduling flexibility and reduced travel time. The median costs for home renovations varied between $1191 and $4018. The mean number of home hemoDialysis training sessions was 27.7 ± 10.4 (11–59 days). Average training time was less for patients with experience in either self-care or both self-care and cannulation. The number of training sessions was unrelated to the score on the Modified Mini Mental Status or Trailmaking B tests or patient's education level. Training time also did not correlate with the SF-36 Physical Function subscale but did with the modified Charlson comorbidity score and older patient age. Conclusions: Lack of patient or family motivation and fear of the Dialysis process are surmountable barriers for accepting home hemoDialysis as a modality for renal replacement therapy. Formal education and scores on cognitive function tests are not predictors of training time.
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effects of reduced intradialytic urea generation rate and residual renal clearance on modeled urea distribution volume and kt v in conventional daily and Nocturnal Dialysis
Seminars in Dialysis, 2010Co-Authors: Joh T Daugirdas, Michael V Rocco, Thomas A Depne, Tom Greene, Natha W Levi, Gle M Chertow, Joh StokesAbstract:: Classic urea modeling assumes that both urea generation rate (G) and residual renal urea clearance (Kru) are constant throughout the week, but this may not be true. Reductions in intraDialysis G could be caused by lower plasma amino acid levels due to preDialysis/intraDialysis fasting and also to losses of amino acids into the dialysate. Intradialytic reductions in Kru could be due to lower intravascular volume, blood pressure, or osmotic load. To determine the possible effects of reduced G or Kru during Dialysis on the calculation of the volume of distribution (V) and Kt/Vurea, we modeled 3 and 6/week Nocturnal, 6/week short daily, and 3/week conventional hemoDialysis. A modified 2-pool mathematical model of urea mass balance with a constant time-averaged G was used, but the model was altered to allow adjustment of the ratio of dialytic/interdialytic G (Gd/Gid) and dialytic/total Kru (Krud/Kru) to vary from 1.0 down to near zero. In patients dialyzed six times per week for 400 minutes per session, when Gd/Gid was decreased from 1.0 to 0.05, the predicted urea reduction ratio (URR) increased from 68.9% to 80.2%. To achieve an increased URR of this magnitude under conditions of constant G (Gd/Gid=1.0) required a decrease in modeled urea volume (V) of 36%. At Gd/Gid ratios of 0.8 or 0.6 (corresponding to 20% or 40% reductions in intraDialysis G), the modeled URR was increased to 71.0% or 73.3%, causing a 7% or 15% factitious decrease in V. The error was intermediate for the 3/week Nocturnal schedule, and was much less pronounced for the 6/week daily and 3/week conventional treatments. Reductions in intradialytic Kru had the opposite effect, lowering the predicted URR and increasing the apparent V, but here the errors were of much lesser amplitude. The results suggest that, particularly for Nocturnal Dialysis, the standard "constant G" urea kinetic model may need to be modified.