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RCA may be a safe and useful form of anticoagulation which is more expensive than heparinization but helps to minimize bleeding risk. The risk of metabolic complications is higher at the beginning of a new RCA program. For centers lacking experienced staff we suggest reserving this technique for patients with rapid clotting of the extracorporeal circuit if treated without anticoagulation.

Pain severity and symptom distress in dialysis patients are important, but underestimated and undertreated. They interfere with sleep quality and daily living. Routine assessment of pain burden, pain management similar to that used in palliative care, and adequate analgesic use to treat specific dialysis-associated pain syndromes should be considered in guidelines.

Introduction: A reliable method of intradialysis calcium mass balance quantification is far from been established. We herein investigated the use of a single-pool variable-volume Calcium kinetic model to assess calcium mass balance in chronic and stable dialysis patients.Methods: Thirty-four patients on thrice-weekly HD were studied during 240 dialysis sessions. All patients were dialyzed with a nominal total calcium concentration of 1.50 mmol/L. The main assumption of the model is that the calcium distribution volume is equal to the extracellular volume during dialysis. This hypothesis is assumed valid if measured and predicted end dialysis plasma water ionized calcium concentrations are equal. A difference between predicted and measured end-dialysis ionized Correspondence to: S. Di Filippo, Division of Nephrology, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900 Lecco, Italy. Email: difilippo.salvatore@libero.it Conflict of Interest: The Authors have nothing to disclose with regards of the present manuscript. Disclosure of grants or other funding: None List of abbreviations: 0-t, Initial and final values; Ca21d, Ionized dialysate calcium concentrations (mmol/L); Ca21di, Dialysate calcium concentration (mmol/L) at the inlet port of dialyzer; Ca21MB, Intra-dialysis ionized calcium mass balance (mmol); Ca21pw, Ionized plasma water calcium concentrations (mmol/L); Ca21pwi, Plasma water calcium concentration (mmol/L) at the inlet port of dialyzer; Ca21pwtM, End-dialysis measured plasma water calcium concentration (mmol/L) normalized at pH 7.40; Ca21pwtP, End-dialysis plasma water calcium concentration (mmol/L) predicted by the model; Ca21pwt(P-M), Difference between end-dialysis plasma water calcium concentration predicted and measured (mmol/L); Ca21uf, Outlet ultrafiltrate stream calcium concentration (mmol/L) normalized at pH 7.40; CaMB, Intra-dialysis global calcium mass balance (mmol); D 0 Ca, Calcium dialysance (L/min) corrected for cardiopulmonary and access recirculation; D 0 cond, Conductivity dialysance (L/ min) corrected for cardiopulmonar and access recirculation; KoAcond, "Intrinsic" dialysance for conductivity (mL/min); MCa21, Mobilization of calcium from extracellular fluid compartment (mmol); Na1d, Ionized dialysate sodium concentrations (mmol/L); Na1pw, Ionized plasma water sodium concentrations (mmol/L); Qbi, Inlet blood flow (mL/min); Qei, Inlet blood water flow (mL/min); Qdi, Inlet dialysate flow (mL/min); Cdi, Inlet dialysate conductivity (mS/cm); Qf, Total ultrafiltrate (L); QfECW, Ultrafiltrate removed from the extracellular fluid compartment (L/min); Qpwi, Inlet plasma water flow (L/min); SPVVCaKM, Single-compartment variable-volume calcium kinetic model; SPVV-NaKM, Single-compartment variable-volume sodium kinetic model; Td, Dialysis session duration (min); VCat, End-dialysis calcium distribution volume (L); Vut, End dialysis urea distribution volume (L); spKt/V, Single Pool Kt/V; a, Donnan factor Predialysis ionized plasma water concentration and total ultrafiltrate were the most imp...

Intensive motivation of patients to maintain good oral hygiene is necessary to reduce the incidence of gingival hyperplasia.

No abstract

Background: The purpose of our study was to investigate whether continuous venovenous hemodiafiltration (CVVHDF) concomitant with radiological procedures (RxP) was feasible, well tolerated and could significantly remove iodinated contrast media (CM). Methods: 26 patients with various degrees of renal insufficiency who were submitted to RxP were included in the study. The CVVHDF session was started immediately before CM administration. All the patients were evaluated for feasibility and tolerability; furthermore a pharmacokinetic study was done on 12 patients to calculate the amount of CM eliminated. The baseline incidence of CM nephropathy was studied in 25 consecutive historical controls. Results: The CM administered was 208 ± 146 g; the fractional removal of CM was 9.2 ± 4.9% during RxP and 30.9 ± 20.7% during the whole CVVHDF session. Hemodynamic tolerance was excellent. The incidence of CM nephropathy in the experimental and control groups was 37 and 24%, respectively. Conclusions: CVVHDF during RxP is feasible and well tolerated but ioversol removal is modest. This fact together with the high incidence of renal function impairment, the complexity of the procedure and its intrinsic risks, and the large amount of resources needed discourage the routine use of CVVHDF as a prophylactic tool to avoid CM nephropathy.

Background. Pure red-cell aplasia (PRCA) after erythropoietin (Epo) administration due to the appearance of neutralizing anti-Epo antibodies has been reported in over