The reduction of blood volume below a critical threshold is assumed to trigger intradialytic morbid events (IME). Recently, we presented a simple method to determine the absolute blood volume during routine hemodialysis (HD) carried out without blood sampling and without injection of dyes or radiolabeled markers. Such information could be used to detect excessive volume reduction during HD and to prevent IME. Therefore, we performed a pilot study in IME-prone patients to identify the absolute blood volume at which they developed clinical symptoms. A volume of 240 mL of ultrapure dialysate was automatically infused into the extracorporeal circulation using the bolus function of a commercial online hemodiafiltration machine incorporating a blood volume monitor (BVM). The increase in relative blood volume (RBV) caused by the infusion was measured and used to determine the absolute blood volume at that time. The blood volume per kilogram body mass at the time of symptomatic IME was also determined. All IME-prone patients of a single-dialysis center were included in the study. Ten out of 12 patients became symptomatic at a specific blood volume between 65 and 56 mL/kg (mean 62 mL/kg) whereas RBV showed a wide scatter (82-97%). A specific blood volume of 65 mL/kg seems to represent the threshold for IME by this method. The technique could be completely automated without altering the hardware of the dialysis device. Present feedback systems for automated blood volume-controlled ultrafiltration could be adapted to maintain absolute blood volume above this critical volume to safely prevent volume-dependent IME.
The aim of this study was to investigate which antihormonal treatment strategies are used in German forensic psychiatric institutions. Forensic clinics were asked about the number of treated patients. Four hundred seventy-four patients were committed for sex offences; 12% received either CPA (n = 29) or LHRH- agonists (n = 29). Differences in efficacy were small. Several side effects confirm the importance of a protocol for minimizing medical complications.
Background: In Germany, every fifth patient starting dialysis is now 80 years of age or older. The question that is currently relevant is not whether we have to treat patients who are older than 80. Rather the question now is how to treat this elderly group of patients. Methods: Single centre data of all dialysis patients aged over 80 were analyzed with regard to survival, social circumstances, vascular access, and pre-dialysis nephrology care. Results: Between 2001 and 2012, 76 patients over 80 years started chronic ambulatory hemodialysis treatment. One-year survival was 87%, 3-year survival 52%, 5-year survival 27% and 10-year survival 9%. Patients (n = 55) with more than 3 months of nephrological care prior to dialysis (3-161 months, median 31 months) survived significantly longer then patients (n = 21) having had less than 3 months contact with nephrologists. On 31st December 2012 there were 38 patients aged ≥80 (median age 84, 80-95 years) in the chronic hemodialysis program accounting for 19% of all dialysis patients of this center. Thirty patients (79%) had been in long-term nephrological care prior to dialysis initiation (3-161 months, median 45 months). Thirty one patients (82%) started the first dialysis treatment with a functioning shunt access. Conclusion: Long-term pre-dialysis nephrology care is of most importance for successful dialysis treatment in the elderly, especially in octogenarians and nonagenarians. It enables the early establishment of functioning vascular access and careful scheduling of first dialysis treatment and increases survival. The long-term use of catheters can be avoided in almost all patients above the age of 80.
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