Improving Clearance for Renal Replacement Therapy

Lee, Seolhyun; Sirich, Tammy L.; Meyer, Timothy W.

doi:10.34067/kid.0002922021

Cited by 6 publications

(5 citation statements)

References 82 publications

(185 reference statements)

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“…They also supported previous cross-sectional studies that dietary potassium explained less than 2% of the variation in serum potassium. These reports suggested potassium intake doesn’t determine the serum potassium in hemodialysis populations [ 30 , 31 , 34 ]. Recently, a Kidney Disease Improving Global Outcomes (KDIGO) conference found a limitation of direct evidence on a relationship between dietary potassium intake and serum potassium concentrations.…”

Section: Discussionmentioning

confidence: 99%

A nomogram to predict hyperkalemia in patients with hemodialysis: a retrospective cohort study

et al. 2022

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Background Hyperkalemia increases the risk of mortality and cardiovascular-related hospitalizations in patients with hemodialysis. Predictors of hyperkalemia are yet to be identified. We aimed at developing a nomogram able to predict hyperkalemia in patients with hemodialysis. Methods We retrospectively screened patients with end-stage renal disease (ESRD) who had regularly received hemodialysis between Jan 1, 2017, and Aug 31, 2021, at Lishui municipal central hospital in China. The outcome for the nomogram was hyperkalemia, defined as serum potassium [K+] ≥ 5.5 mmol/L. Data were collected from hemodialysis management system. Least Absolute Shrinkage Selection Operator (LASSO) analysis selected predictors preliminarily. A prediction model was constructed by multivariate logistic regression and presented as a nomogram. The performance of nomogram was measured by the receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis (DCA). This model was validated internally by calculating the performance on a validation cohort. Results A total of 401 patients were enrolled in this study. 159 (39.65%) patients were hyperkalemia. All participants were divided into development (n = 256) and validation (n = 145) cohorts randomly. Predictors in this nomogram were the number of hemodialysis session, blood urea nitrogen (BUN), serum sodium, serum calcium, serum phosphorus, and diabetes. The ROC curve of the training set was 0.82 (95%CI 0.77, 0.88). Similar ROC curve was achieved at validation set 0.81 (0.74, 0.88). The calibration curve demonstrated that the prediction outcome was correlated with the observed outcome. Conclusion This nomogram helps clinicians in predicting the risk of PEW and managing serum potassium in the patients with hemodialysis.

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Section: Discussionmentioning

confidence: 99%

A nomogram to predict hyperkalemia in patients with hemodialysis: a retrospective cohort study

et al. 2022

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“…Convection increases the elimination of uremic toxins during dialysis, especially medium- or large-sized ones [ 71 ]. However, PBUTs’ clearance with convective techniques has not shown conclusive data on their efficacy.…”

Section: Pbut Clearance Strategiesmentioning

confidence: 99%

Displacing the Burden: A Review of Protein-Bound Uremic Toxin Clearance Strategies in Chronic Kidney Disease

Sánchez-Ospina,

Mas-Fontao,

Gracia-Iguacel

et al. 2024

JCM

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Uremic toxins (UTs), particularly protein-bound uremic toxins (PBUTs), accumulate in chronic kidney disease (CKD) patients, causing significant health complications like uremic syndrome, cardiovascular disease, and immune dysfunction. The binding of PBUTs to plasma proteins such as albumin presents a formidable challenge for clearance, as conventional dialysis is often insufficient. With advancements in the classification and understanding of UTs, spearheaded by the European Uremic Toxins (EUTox) working group, over 120 molecules have been identified, prompting the development of alternative therapeutic strategies. Innovations such as online hemodiafiltration aim to enhance the removal process, while novel adsorptive therapies offer a means to address the high affinity of PBUTs to plasma proteins. Furthermore, the exploration of molecular displacers, designed to increase the free fraction of PBUTs, represents a cutting-edge approach to facilitate their dialytic clearance. Despite these advancements, the clinical application of displacers requires more research to confirm their efficacy and safety. The pursuit of such innovative treatments is crucial for improving the management of uremic toxicity and the overall prognosis of CKD patients, emphasizing the need for ongoing research and clinical trials.

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“…Compared to continuous dialysis, a higher clearance during nocturnal treatment can control average solute levels but will allow wide diurnal variation in the levels of those solutes for which the dialytic clearance is high relative to their volume of distribution. The control of a solute’s plasma level with continuous dialysis compared to intermittent dialysis is highly dependent on the solute’s volume(s) of distribution and compartmental behavior (reproduced with permission from Lee et al [84]).…”

Section: What Nextmentioning

confidence: 99%

“…c Blood passes through two dialyzers in series, and a sorbent cartridge is inserted in the dialysate stream between the two dialyzers. d Sorbent material (gray shaded area) is fixed along the dialysate path within a dialyzer (reproduced with permission from Lee et al [84]).…”

Section: Protein-bound Solutesmentioning

confidence: 99%

Improving Solute Clearances by Hemodialysis

2022

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The adequacy of hemodialysis is now assessed by measuring the removal of the single-solute urea. The urea clearance provided by contemporary dialysis is a large fraction of the blood flow through the dialyzer and therefore cannot be increased much further. Other solutes however likely contribute more than urea to the residual uremic illness suffered by hemodialysis patients. We here review methods which could be employed to increase the clearance of nonurea solutes. We will separately consider the clearances of free low-molecular-mass solutes, free larger solutes, and protein-bound solutes. New clinical studies will be required to test the extent to which increasing the clearance on nonurea solutes with these various characteristics can improve patients' health.

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Improving Clearance for Renal Replacement Therapy

Cited by 6 publications

References 82 publications

A nomogram to predict hyperkalemia in patients with hemodialysis: a retrospective cohort study

A nomogram to predict hyperkalemia in patients with hemodialysis: a retrospective cohort study

Displacing the Burden: A Review of Protein-Bound Uremic Toxin Clearance Strategies in Chronic Kidney Disease

Improving Solute Clearances by Hemodialysis

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