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Desjardins A, Le-Nguyen V, Turgeon-Mallette L, Vo C, Boudreault JS, Rioux JP, Feng X, Veilleux A. Bendamustine-induced nephrogenic diabetes insipidus - A case report. J Oncol Pharm Pract 2021; 28:205-210. [PMID: 33990157 PMCID: PMC8685724 DOI: 10.1177/10781552211013878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In patients with relapsed or refractory lymphoma, high-dose chemoimmunotherapy with subsequent autologous hematopoietic cell transplantation (HCT) is a standard of care. Bendamustine, an alkylating agent, is used in the BeEAM (bendamustine, etoposide, cytarabine, melphalan) protocol for conditioning therapy before autologous HCT in patients with relapsed or refractory lymphoma who are eligible for transplant. There is no consensus regarding an optimal salvage regimen and the approach varies according to toxicity. CASE REPORT We present a case of partial nephrogenic diabetes insipidus after receiving bendamustine, as part of the BeEAM protocol.Management and outcome: The patient was managed with parenteral fluid administration and intranasal desmopressin before the condition resolved on its own. DISCUSSION We summarize published reports of bendamustine-induced diabetes insipidus.
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Affiliation(s)
| | | | | | - Chloé Vo
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Jean-Samuel Boudreault
- Division of Hematology and Oncology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Jean-Philippe Rioux
- Division of Nephrology, Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Xue Feng
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Amélie Veilleux
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
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Rioux JP, De Bortoli B, Quérin S, Déziel C, Troyanov S, Madore F. Measurement of the International Normalized Ratio (INR) in Hemodialysis Patients with Heparin-Locked Central venous Catheters: Evaluation of a Novel Blood Sampling Method. J Vasc Access 2018; 10:180-2. [DOI: 10.1177/112972980901000308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Accurate measurement of the international normalized ratio (INR) may be difficult in hemodialysis (HD) patients with heparin-locked central catheters. Blood contamination with locking solutions may interfere with INR measurement when samples are collected directly from the catheter. Methods The aim of our study was to evaluate a novel sampling method for the measurement of INR in HD patients with heparin-locked central catheters. This novel method consists of measuring the INR directly from the dialysis circuit (arterial bloodline sample port) after 1 hr of treatment regardless of heparin administration during dialysis. We compared this method to the gold standard (peripheral venipuncture prior to dialysis) using the paired t-test. We included 30 patients (23 with warfarin therapy and 7 without). Results INRs obtained using the novel sampling method were only minimally overestimated compared to venipuncture values (mean INR overestimation: 0.2 +/- 0.2). This overestimation was not clinically significant and did not lead to changes in warfarin prescription for any of the patients. Correlation tests confirmed the influence of heparin administration on INR overestimation (R=0.4; p=0.05). This influence was present mostly among patients receiving more than 100 Units/kg of heparin during their treatment. Conclusion This novel sampling technique provides a convenient and simple method of monitoring INR among HD patients.
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Affiliation(s)
- Jean-Philippe Rioux
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec - Canada
| | - Bruno De Bortoli
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec - Canada
| | - Serge Quérin
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec - Canada
| | - Clément Déziel
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec - Canada
| | - Stéphan Troyanov
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec - Canada
| | - François Madore
- Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec - Canada
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Abstract
Patient selection and training is arguably the most important step toward building a successful home hemodialysis (HD) program. We present a step-by-step account of home HD training to guide providers who are developing home HD programs. Although home HD training is an important step in allowing patients to undergo dialysis in the home, there is a surprising lack of systematic research in this field. Innovations and research in this area will be pivotal in further promoting a higher acceptance rate of home HD as the renal replacement therapy of choice.
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Frenette AJ, Bouchard J, Bernier P, Charbonneau A, Nguyen LT, Rioux JP, Troyanov S, Williamson DR. Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis. Crit Care 2014; 18:602. [PMID: 25394836 PMCID: PMC4256900 DOI: 10.1186/s13054-014-0602-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/17/2014] [Indexed: 01/04/2023]
Abstract
Introduction The risk of acute kidney injury (AKI) with the use of albumin-containing fluids compared to starches in the surgical intensive care setting remains uncertain. We evaluated the adjusted risk of AKI associated with colloids following cardiac surgery. Methods We performed a retrospective cohort study of patients undergoing on-pump cardiac surgery in a tertiary care center from 2008 to 2010. We assessed crystalloid and colloid administration until 36 hours after surgery. AKI was defined by the RIFLE (risk, injury, failure, loss and end-stage kidney disease) risk and Acute Kidney Injury Network (AKIN) stage 1 serum creatinine criterion within 96 hours after surgery. Results Our cohort included 984 patients with a baseline glomerular filtration rate of 72 ± 19 ml/min/1.73 m2. Twenty-three percent had a reduced left ventricular ejection fraction (LVEF), thirty-one percent were diabetics and twenty-three percent underwent heart valve surgery. The incidence of AKI was 5.3% based on RIFLE risk and 12.0% based on the AKIN criterion. AKI was associated with a reduced LVEF, diuretic use, anemia, heart valve surgery, duration of extracorporeal circulation, hemodynamic instability and the use of albumin, pentastarch 10% and transfusions. There was an important dose-dependent AKI risk associated with the administration of albumin, which also paralleled a higher prevalence of concomitant risk factors for AKI. To address any indication bias, we derived a propensity score predicting the likelihood to receive albumin and matched 141 cases to 141 controls with a similar risk profile. In this analysis, albumin was associated with an increased AKI risk (RIFLE risk: 12% versus 5%, P = 0.03; AKIN stage 1: 28% versus 13%, P = 0.002). We repeated this methodology in patients without postoperative hemodynamic instability and still identified an association between the use of albumin and AKI. Conclusions Albumin administration was associated with a dose-dependent risk of AKI and remained significant using a propensity score methodology. Future studies should address the safety of albumin-containing fluids on kidney function in patients undergoing cardiac surgery.
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Affiliation(s)
- Anne Julie Frenette
- Department of Pharmacy, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Faculty of Pharmacy, University of Montreal, 2900 Blvd Edouard-Monpetit, H3T 1J4, Montreal, QC, Canada. .,Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada.
| | - Josée Bouchard
- Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Department of Nephrology, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Faculty of Medicine, University of Montreal, 2900 Blvd Edouard-Monpetit, H3T 1J4, Montreal, QC, Canada.
| | - Pascaline Bernier
- Department of Pharmacy, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada.
| | - Annie Charbonneau
- Department of Pharmacy, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada.
| | - Long Thanh Nguyen
- Department of Pharmacy, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada.
| | - Jean-Philippe Rioux
- Department of Nephrology, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Faculty of Medicine, University of Montreal, 2900 Blvd Edouard-Monpetit, H3T 1J4, Montreal, QC, Canada.
| | - Stéphan Troyanov
- Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Department of Nephrology, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Faculty of Medicine, University of Montreal, 2900 Blvd Edouard-Monpetit, H3T 1J4, Montreal, QC, Canada.
| | - David R Williamson
- Department of Pharmacy, Hôpital du Sacré-Coeur de Montreal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada. .,Faculty of Pharmacy, University of Montreal, 2900 Blvd Edouard-Monpetit, H3T 1J4, Montreal, QC, Canada. .,Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Blvd Gouin West, H4J 1C5, Montreal, QC, Canada.
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Pauly RP, Komenda P, Chan CT, Copland M, Gangji A, Hirsch D, Lindsay R, MacKinnon M, MacRae JM, McFarlane P, Nesrallah G, Pierratos A, Plaisance M, Reintjes F, Rioux JP, Shik J, Steele A, Stryker R, Wu G, Zimmerman DL. Programmatic variation in home hemodialysis in Canada: results from a nationwide survey of practice patterns. Can J Kidney Health Dis 2014; 1:11. [PMID: 25780606 PMCID: PMC4349311 DOI: 10.1186/2054-3581-1-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Over 40% of patients with end stage renal disease in the United States were treated with home hemodialysis (HHD) in the early 1970’s. However, this number declined rapidly over the ensuing decades so that the overwhelming majority of patients were treated in-centre 3 times per week on a 3-4 hour schedule. Poor outcomes for patients treated in this fashion led to a renewed interest in home hemodialysis, with more intensive dialysis schedules including short daily (SDHD) and nocturnal (NHD). The relative infancy of these treatment schedules means that there is a paucity of data on ‘how to do it’. Objective We undertook a systematic survey of home hemodialysis programs in Canada to describe current practice patterns. Design Development and deployment of a qualitative survey instrument. Setting Community and academic HHD programs in Canada. Participants Physicians, nurses and technologists. Measurements Programmatic approaches to patient selection, delivery of dialysis, human resources available, and follow up. Methods We developed the survey instrument in three phases. A focus group of Canadian nephrologists with expertise in NHD or SDHD discussed the scope the study and wrote questions on 11 domains. Three nephrologists familiar with all aspects of HHD delivery reviewed this for content validity, followed by further feedback from the whole group. Multidisciplinary teams at three sites pretested the survey and further suggestions were incorporated. In July 2010 we distributed the survey electronically to all renal programs known to offer HHD according to the Canadian Organ Replacement Registry. We compiled the survey results using qualitative and quantitative methods, as appropriate. Results Of the academic and community programs that were invited to participate, 80% and 63%, respectively, completed the survey. We observed wide variation in programmatic approaches to patient recruitment, human resources, equipment, water, vascular access, patient training, dialysis prescription, home requirements, patient follow up, medications, and the approach to non-adherent patients. Limitations Cross-sectional survey, unable to link variation to outcomes. Competition for patients between HHD and home peritoneal dialysis means that case mix for HHD may also vary between centres. Conclusions There is wide variation between programs in all domains of HHD delivery in Canada. We plan further study of the extent to which differences in approach are related to outcomes. Electronic supplementary material The online version of this article (doi:10.1186/2054-3581-1-11) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert P Pauly
- Department of Medicine, Division of Nephrology, Northern Alberta Renal Program and the University of Alberta Hospital, University of Alberta, Edmonton, AB Canada
| | - Paul Komenda
- Department of Medicine, Section of Nephrology, University of Manitoba, Winnipeg, MB Canada
| | | | - Michael Copland
- Division of Nephrology, University of British Columbia, Vancouver General Hospital, Vancouver, BC Canada
| | - Azim Gangji
- Department of Medicine, Division of Nephrology, McMaster University, Hamilton, ON Canada
| | - David Hirsch
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, NS Canada
| | - Robert Lindsay
- Director Home Hemodialysis, London Health Sciences Centre, Western University, London, ON Canada
| | - Martin MacKinnon
- Division of Nephrology, Horizon Heath, St John Regional Hospital, St John, NB Canada
| | - Jennifer M MacRae
- Department of Medicine and Department of Cardiac Sciences, Division of Nephrology, Southern Alberta Renal Program, University of Calgary, Calgary, AB Canada
| | - Philip McFarlane
- Department of Medicine, Division of Nephrology, St Michaels Hospital, Toronto, ON Canada
| | - Gihad Nesrallah
- The Li Ka Shing Knowledge Institute, Keenan Research Centre, St Michael's Hospital, and Nephrology Program, Humber River Hospital, Toronto, ON Canada
| | | | - Martin Plaisance
- Departement de Medecine, Service de Nephrologie, Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, QC Canada
| | - Frances Reintjes
- Department of Medicine, Division of Nephrology, Northern Alberta Renal Program and the University of Alberta Hospital, University of Alberta, Edmonton, AB Canada
| | - Jean-Philippe Rioux
- Department of Medicine, Division of Nephrology, Hopital du Sacre-Coeur de Montreal, University of Montreal, Montreal, QC Canada
| | - John Shik
- Department of Medicine, Division of Nephrology, Health Science Centre, Memorial University of Newfoundland, St Johns, Newfoundland Canada
| | - Andrew Steele
- Division of Nephrology, Lakeridge Health, Oshawa, ON Canada
| | - Rod Stryker
- Department of Medicine, Division of Nephrology, University of Saskachewan, Saskatoon, Saskatchewan Canada
| | - George Wu
- Division of Nephrology, Trillium Health Partners, Mississauga, ON Canada
| | - Deborah L Zimmerman
- Department of Medicine, Division of Nephrology, Ottawa Hospital and the University of Ottawa, Ottawa, ON Canada
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Mustafa RA, Levin A, Akbari A, Foster BJ, Zimmerman D, Nesrallah GE, Knoll GA, Rioux JP, Barton J, Ruzicka M, Muirhead N, Moist L, Pannu N, McFarlane P, Klarenbach S, Samuel S, Clark WF, Hemmelgarn BR. The Canadian Society of Nephrology methods in developing and adapting clinical practice guidelines: a review. Can J Kidney Health Dis 2014; 1:5. [PMID: 25780600 PMCID: PMC4346300 DOI: 10.1186/2054-3581-1-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/26/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The Canadian Society of Nephrology (CSN) was established to promote the highest quality of care for patients with renal diseases and to encourage research related to the kidney and its disorders. The CSN Clinical Practice Guideline (CPG) Committee develops guidelines with clear recommendations to influence physicians' practice and improve the health of patients with kidney disease in Canada. REVIEW In this review we describe the CSN process in prioritizing CPGs topics. We document the CSN experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We then detail the CSN process in developing de novo CPGs and in adapting existing CPGs and developing accompanying commentaries. We also discuss challenges faced during this process and suggest solutions. Furthermore, we summarize the CSN effort in disseminating and implementing their guidelines. Additionally, we describe recent development and partnerships that allow evaluation of the effect of the CSN guidelines and commentaries. CONCLUSION The CSN follows a comprehensive process in identifying priority areas to be addressed in CPGs. In 2010, the CSN adopted GRADE, which enhanced the rigor and transparency of guideline development. This process focuses on systematically identifying best available evidence and carefully assessing its quality, balancing benefits and harms, considering patients' and societies' values and preferences, and when possible considering resource implications. Recent partnership allows wider dissemination and implementation among end users and evaluation of the effects of CPG and commentaries on the health of Canadians.
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Affiliation(s)
- Reem A Mustafa
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, CanadaHSC Room 2C15 1280 Main Street West, Hamilton, Ontario ON L8S 4 K1 Canada
- />Department of Internal Medicine, University of Missouri, Kansas City, USA
| | - Adeera Levin
- />Department of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Ayub Akbari
- />Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada
| | - Bethany J Foster
- />Departments of Pediatrics and Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec Canada
| | - Deborah Zimmerman
- />Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada
| | - Gihad E Nesrallah
- />Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, and Humber River Hospital, Toronto, Ontario Canada
| | - Greg A Knoll
- />Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario Canada
| | - Jean-Philippe Rioux
- />Department of Medicine, Nephrology Division, Hôpital du Sacré-Cœur de Montréal, University of Montreal, Montreal, Quebec Canada
| | - Jim Barton
- />Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan Canada
| | - Marcel Ruzicka
- />Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada
| | - Norman Muirhead
- />Department of Medicine, Western University, London, Ontario Canada
| | - Louise Moist
- />Department of Medicine, Western University, London, Ontario Canada
| | - Neesh Pannu
- />Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta Canada
| | - Phil McFarlane
- />Department of Medicine, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ontario Canada
| | - Scott Klarenbach
- />Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta Canada
| | - Susan Samuel
- />Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - William F Clark
- />Department of Medicine, Western University, London, Ontario Canada
| | - Brenda R Hemmelgarn
- />Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta Canada
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Nesrallah GE, Mustafa RA, MacRae J, Pauly RP, Perkins DN, Gangji A, Rioux JP, Steele A, Suri RS, Chan CT, Copland M, Komenda P, McFarlane PA, Pierratos A, Lindsay R, Zimmerman DL. Canadian Society of Nephrology Guidelines for the Management of Patients With ESRD Treated With Intensive Hemodialysis. Am J Kidney Dis 2013; 62:187-98. [DOI: 10.1053/j.ajkd.2013.02.351] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 11/11/2022]
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Mustafa RA, Zimmerman D, Rioux JP, Suri RS, Gangji A, Steele A, MacRae J, Pauly RP, Perkins DN, Chan CT, Copland M, Komenda P, McFarlane PA, Lindsay R, Pierratos A, Nesrallah GE. Vascular Access for Intensive Maintenance Hemodialysis: A Systematic Review for a Canadian Society of Nephrology Clinical Practice Guideline. Am J Kidney Dis 2013; 62:112-31. [DOI: 10.1053/j.ajkd.2013.03.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 03/27/2013] [Indexed: 11/11/2022]
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Zimmerman DL, Nesrallah GE, Chan CT, Copland M, Komenda P, McFarlane PA, Gangji A, Lindsay R, MacRae J, Pauly RP, Perkins DN, Pierratos A, Rioux JP, Steele A, Suri RS, Mustafa RA. Dialysate calcium concentration and mineral metabolism in long and long-frequent hemodialysis: a systematic review and meta-analysis for a Canadian Society of Nephrology clinical practice guideline. Am J Kidney Dis 2013; 62:97-111. [PMID: 23591289 DOI: 10.1053/j.ajkd.2013.02.357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/01/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients treated with conventional hemodialysis (HD) develop disorders of mineral metabolism that are associated with increased morbidity and mortality. More frequent and longer HD has been associated with improvement in hyperphosphatemia that may improve outcomes. STUDY DESIGN Systematic review and meta-analysis to inform the clinical practice guideline on intensive dialysis for the Canadian Society of Nephrology. SETTING & POPULATION Adult patients receiving outpatient long (≥5.5 hours/session; 3-4 times per week) or long-frequent (≥5.5 hours/session, ≥5 sessions per week) HD. SELECTION CRITERIA FOR STUDIES We included clinical trials, cohort studies, case series, case reports, and systematic reviews. INTERVENTIONS Dialysate calcium concentration ≥1.5 mmol/L and/or phosphate additive. OUTCOMES Fragility fracture, peripheral arterial and coronary artery disease, calcific uremic arteriolopathy, mortality, intradialytic hypotension, parathyroidectomy, extraosseous calcification, markers of mineral metabolism, diet liberalization, phosphate-binder use, and muscle mass. RESULTS 21 studies were identified: 2 randomized controlled trials, 2 reanalyses of data from the randomized controlled trials, and 17 observational studies. Dialysate calcium concentration ≥1.5 mmol/L for patients treated with long and long-frequent HD prevents an increase in parathyroid hormone levels and a decline in bone mineral density without causing harm. Both long and long-frequent HD were associated with a reduction in serum phosphate level of 0.42-0.45 mmol/L and a reduction in phosphate-binder use. There was no direct evidence to support the use of a dialysate phosphate additive. LIMITATIONS Almost all the available information is related to changes in laboratory values and surrogate outcomes. CONCLUSIONS Dialysate calcium concentration ≥1.5 mmol/L for most patients treated with long and long-frequent dialysis prevents an increase in parathyroid hormone levels and decline in bone mineral density without increased risk of calcification. It seems prudent to add phosphate to the dialysate for patients with a low predialysis phosphate level or very low postdialysis phosphate level until more evidence becomes available.
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Affiliation(s)
- Deborah L Zimmerman
- Division of Nephrology, Kidney Research Centre of the Ottawa Hospital Research Institute, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada.
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Chapdelaine I, Goupil R, Azcoitia V, Rioux JP, Raymond-Carrier S, Madore F, Troyanov S. Gene polymorphisms as clinical tools in chronic glomerulopathies: a prospective study. Nephron Clin Pract 2013; 121:c174-c179. [PMID: 23344084 DOI: 10.1159/000346404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/05/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIMS Studies have proposed various polymorphisms of genes implicated in the physiopathology of chronic kidney disease as risk factors of progression and potential clinical tools. We sought to validate and simultaneously compare their predictive value in a prospective cohort of chronic glomerulopathies receiving recommended antihypertensive and antiproteinuric therapies. METHODS Using PubMed, we identified 9 polymorphisms previously associated with progression. These were mostly of the renin-angiotensin-aldosterone and inflammation pathways: MCP-1 A2518G, TGF-β1 T869C and C-509T, ACE I/D, AGT M235T, AT1R A1166C, TSC-22 A-396G, eNOS 4b/a and CYP11β2 C-344T. We hypothesized that their determination would identify individuals at higher risk of progression. RESULTS We recruited 93 predominantly male and Caucasian patients with a mean age of 63 and baseline eGFR of 33 ml/min/1.73 m(2) followed prospectively over a median of 36 months. 61% of patients had diabetic nephropathy, almost all received RAA blockade (90%) and none immunosuppressive therapy. The average blood pressure during follow-up was 140/72 mm Hg, the urinary protein to creatinine ratio 0.15 g/mmol and the rate of renal function decline -3.2 ± 4.1 ml/min/1.73 m(2)/year. Proteinuria and blood pressure strongly predicted progression. However, under recommended therapy, none of the proposed polymorphisms predicted renal function decline. In addition, none showed simple or partial correlations with the severity of proteinuria or blood pressure. Finally, summation variable of risk polymorphisms did not predict progression. CONCLUSION This study does not validate the use of these 9 polymorphisms as individual clinical tools in patients with chronic glomerulopathies on recommended antihypertensive and antiproteinuric therapies.
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Affiliation(s)
- Isabelle Chapdelaine
- Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Que., Canada
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Abstract
Recent studies have suggested improvements in quality of life (QOL) in patients on quotidian dialysis compared with conventional hemodialysis. Few studies have focused on the burden and QOL in caregivers of patients with end-stage renal disease (ESRD) on nocturnal home hemodialysis (NHD). We aim to assess the caregivers' burden, QOL, and depressive symptoms and to compare these parameters with their patients' counterparts. Cross-sectional surveys were sent to 61 prevalent NHD patients and their caregivers. Surveys assessed demographics, general self-perceived health using the 12-Item Short Form Health Survey (SF-12) and the presence of depression using the Beck Depression Inventory. Subjective burden on caregivers was assessed by the Caregiver Burden scale and was compared with perceived burden by the patients. Thirty-six patients and 31 caregivers completed the survey. The majority of caregivers were female (66%), spouse (81%) with no comorbid illness (72%). Their mean age was 51 ± 11 years. Patients were mostly male (64%) with a median ESRD vintage of 60 months (interquartile range [IQR], 18-136 months) and a mean age of 52 ± 10 years. Compared to caregivers, patients had lower perceived physical health score but had similar mental health score. Depression criteria were present in 47% of patients and 25% of caregivers. Total global burden perceived by either caregivers or patients is relatively low. Although there is a relatively low global burden perceived by caregivers and patients undergoing NHD, a significant proportion of both groups fulfilled criteria for depression. Further innovative approaches are needed to support caregivers and patients performing NHD to reduce the intrusion of caring for a chronic illness and the risk of developing depression.
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Affiliation(s)
- Jean-Philippe Rioux
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Rioux JP, Cheema H, Bargman JM, Watson D, Chan CT. Effect of an in-hospital chronic kidney disease education program among patients with unplanned urgent-start dialysis. Clin J Am Soc Nephrol 2011; 6:799-804. [PMID: 21212422 DOI: 10.2215/cjn.07090810] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The effect of in-hospital education on the adoption of home dialysis (peritoneal dialysis [PD] and home hemodialysis [HHD]) after an unplanned dialysis start is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Clinical demographics of consecutive patients acutely initiating hemodialysis (HD) from January 2005 to December 2009 were abstracted using institutional electronic records. All patients received multimedia chronic kidney disease education by the same advanced care nurse practitioner before discharge from the hospital. Clinical characteristics of patients choosing home dialysis or staying on in-center HD were compared. RESULTS Between 2005 and 2009, 228 patients acutely started renal replacement therapy (RRT) at the center. Seventy-one patients chose home dialysis (49 patients adopted PD and 22 adopted HHD), 132 chose to remain on in-center HD, and 25 died before discharge from the hospital. Patients adopting home dialysis tended to be younger than in-center HD patients (55 ± 18 [home dialysis] versus 59 ± 16 [in center] years; P=0.09) and were similar in gender distribution (49% [home dialysis] versus 56% [in center] male; P=0.2). Patients adopting home dialysis were more likely to have a failed kidney transplant (24% [home dialysis] versus 12% [in center]; P=0.045) and less likely to have ischemic nephropathy (9% [home dialysis] versus 21% [in center]; P=0.03). The distribution of comorbid conditions was different between patients adopting home dialysis and in-center HD. CONCLUSIONS Home dialysis is feasible after urgent dialysis start. Education should be promoted among patient experiencing acute-start dialysis.
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Affiliation(s)
- Jean-Philippe Rioux
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Ouellet G, Rioux JP, Leblanc M. Cardiovascular impact of high-flow arteriovenous fistulas. Am J Kidney Dis 2010; 56:600; author reply 600-1. [PMID: 20728792 DOI: 10.1053/j.ajkd.2010.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 05/05/2010] [Indexed: 11/11/2022]
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Cornelis T, Rioux JP, Bargman JM, Chan CT. Home dialysis is a successful strategy in nonrenal solid organ transplant recipients with end-stage renal disease. Nephrol Dial Transplant 2010; 25:3425-9. [PMID: 20576722 DOI: 10.1093/ndt/gfq373] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common complication of solid organ transplantation with a substantial risk of progression to end-stage renal disease (ESRD). The impact of dialysis modality on morbidity and mortality is unknown in these patients. The aim of the present analysis was to describe our experience with home dialysis [peritoneal dialysis (PD) and home haemodialysis (HHD)] to assess the feasibility of this modality in patients who developed ESRD after nonrenal solid organ transplant (NRSOT). METHODS A retrospective observational cohort study with consecutive patients initiated on home dialysis after NRSOT from 2000 to 2009 was conducted. We collected data on patient demographics, laboratory parameters and blood pressure as well as clinical adverse events using our electronic clinical database. RESULTS Between 2000 and 2009, 25 patients [median age, 56 years; interquartile range (IQR), 43-65 years] initiated home dialysis. Ten patients started HHD and 15 patients initiated PD. The types of NRSOT were liver (n = 11), heart (n = 8), lung (n = 5) and heart-lung (n = 1). The median vintage of NRSOT at the time of dialysis initiation was 8.7 years (IQR, 6.3-11.4 years). The median home dialysis follow-up was 24 months (IQR, 15-53 months). The median values of blood pressure, phosphate, calcium, parathyroid hormone and haemoglobin were within the K/DOQI targets. The hospitalization and infection rates were 1 episode every 22 and 29 patient-months, respectively. Three patients switched to in-centre conventional HD during follow-up and eight patients died. CONCLUSIONS . Home dialysis (PD and HHD) is a feasible and sustainable modality for patients with ESRD after NRSOT. Home dialysis offers several potential benefits, such as improved haemodynamic and metabolic control, which may be important in the NRSOT population. Home dialysis in patients who develop ESRD after NRSOT should be actively considered for this cohort.
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Affiliation(s)
- Tom Cornelis
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Rioux JP, Bargman JM, Chan CT. 250: Systematic Differences Among Patients Initiated on Home Hemodialysis and Peritoneal Dialysis: The Fallacy of Potential Competition? Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rioux JP, Faratro R, Chan CT. Nocturnal home hemodialysis: implementation, quality assurance and future challenges. MINERVA UROL NEFROL 2010; 62:103-110. [PMID: 20424574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Nocturnal home hemodialysis (NHHD) has been associated with several clinical benefits compared to conventional thrice-weekly in-center hemodialysis. However, the prevalence of NHHD remains low. To date, few studies have focused on the importance of training and education of a complex medical procedure such as NHHD. In the present review, we will describe guidelines for implementation of a NHHD program by focusing on 1) patients' selection, assessment and training; 2) challenges of adult education; 3) prescription and 4) barriers to adoption of home hemodialysis. Future challenges in research, the importance of quality assurance and innovations in clinical care delivery in NHHD will also be discussed.
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Affiliation(s)
- J P Rioux
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada
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Rioux JP. [The culture of daily life in occupied France]. Contemp Fr Civiliz 1999; 23:177-186. [PMID: 20128119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Two cases of methylene chloride poisoning treated with hyperbaric oxygen are presented and discussed. Both patients were found unconscious in an occupational setting. Carboxyhemoglobin level determination and neuropsychological evaluation confirmed a diagnosis of carbon monoxide intoxication subsequent to methylene chloride exposure. The serial carboxyhemoglobin levels and Carbon Monoxide Neuropsychological Screening Battery scores obtained from these patients suggest that toxicity from methylene chloride-derived carbon monoxide responds well to treatment with hyperbaric oxygen.
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Affiliation(s)
- J P Rioux
- Department of Immunology and Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland
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Abstract
The incidence of reported cases of toxicity resulting from methylene chloride exposure has increased within the last decade. A vast majority of these reports involve acute episodes, and the prevalence of domestic poisoning is relatively high. Diverse pathologic sequelae attributed to methylene chloride or its metabolites have been reported, although a distinct bias for central nervous system effects is evident. paradoxically, detoxification of methylene chloride via the mixed-function oxidase pathway is an inherently intoxicating event. Although the anomalous conversion of methylene chloride into carbon monoxide has increased the popular awareness of methylene chloride poisoning among medical personnel, lack of experience in diagnosis and treatment of methylene chloride poisoning is widespread. This review of 26 cases spanning 50 years reveals that the industrial and domestic use of methylene chloride is equally widespread. A compendium of the clinical experience with methylene chloride poisoning is presented.
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Affiliation(s)
- J P Rioux
- Department of Immunology and Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health Baltimore, MD
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