Expanded Hemodialysis

Despite constant significant advances, cardiovascular as well as more general outcomes of hemodialysis treatment remain unsatisfactory. The introduction of innovative 'high retention onset' membranes has led to the development of a new treatment modality called 'expanded hemodialysis' (HDx), which is the focus of this book. This new therapy is likely to benefit end-stage kidney disease patients, thanks to enhanced removal of molecules retained by current dialysis techniques. HDx is simple to set up and application does not require special hardware or specific nursing skills. This book contains emerging evidence and fascinating new hypotheses on HDx. It is highly recommended for all physicians and healthcare professionals who are caring for dialysis patients and are seeking innovation and improved care solutions. It will also be of considerable interest to students and fellows.

Hemodialysis (HD) is the commonest form of kidney replacement therapy worldwide with a prevalence rate close to 90%. Despite significant improvements in HD techniques and related devices and solutions, the cardiovascular and all-cause mortality of HD patients remains unacceptably elevated. More recently, there have been significant improvements in the creation and maintenance of vascular access as well as the knowledge of types, classification, and monitoring of uremic toxins and their relationship with inflammation, atherosclerosis and vascular classification, and cardiovascular and all-cause mortality. More interesting is the innovation in dialysis membranes/dialyzers, which resulted in the creation of the medium cut-off membrane, which enables the safe, simple, and effective removal of middle- and large-sized uremic toxins. This type of HD treatment is called expanded hemodialysis (HDx) therapy, which so far has resulted in significant improvement in the quality of life of HD patients as well as reductions in hospitalization, medications, and non-fatal cardiovascular events. Updates on Hemodialysis discusses these innovations and how they can be used to improve daily practice and achieve the best possible medical outcomes in HD patients.

The present book contains the Proceedings of a two day Symposium on Uremic Toxins organized at the University of Ghent in Belgium. A series of guest lectures, free communications and posters have been presented. An international audience of 163 scientists from 16 nationalities listened to and discussed extensively a spectrum of topics brought forward by colleagues and researchers who worked for many years in the field of Uremic Toxins. There is a striking contrast between all the new dialysis strategies available in the work to "clean" the uremic patients and the almost non-progression of our knowledge on uremic toxins in the past decade. In this sense the symposium was felt by all participants as a new start for the research in the biochemical field of the definition of uremia. If the present volume would stimulate new work in this field in order to define uremia, or identify the uremic toxins, the purpose of the organizers would be maximally fulfilled.

The leading Textbook on the subject. A completely rewritten and up-to-date fifth edition, based upon the highly respected fourth edition, edited by C. Jacobs, C.M. Kjellstrand, K.M. Koch and J.F. Winchester. This new edition is truly global in scope and features the contributions of the top experts from around the world.

Continuous Renal Replacement Therapy (CRRT) is the standard of care for management of critically ill patients with acute renal failure. Part of the Pittsburgh Critical Care series, Continuous Renal Replacement Therapy provides concise, evidence-based, bedside guidance about this treatment modality, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice. Organized into sections on theory, practice, special situations, and organizational issues, this volume provides a complete view of CRRT theory and practice. Tables summarize and highlight key points, and key studies and trials are included in each chapter. The second edition has been updated to include a new chapter on the use of biomarkers to aid in patient selection and timing, extensive revisions on terminology and nomenclature to match current standards, and the most up-to-date information on newly developed CRRT machines.

A comprehensive summary of high-flux dialyzers and their properties Dialyzers today are developed with high permeability and biocompatibility in mind, even though the definition of these so- called high-flux dialyzers remains controversial. In the Japanese reimbursement system, dialyzers are divided into five types, ranging from I to V, in accordance with their clearance for beta2- microglobulin (beta2-MG). Classes IV and V (beta2-MG clearance greater or equal to 50 and 70 ml/min, respectively, at a blood flow rate of 200 ml/min) are the most common ones, used in more than 90% of Japanese dialysis patients. Membranes used in types IV and V dialyzers are called high-performance membranes (HPMs) and are characterized by an exceptionally high flux rate, permeability and biocompatibility. The book at hand covers all aspects of these HPM dialyzers, including their definitions and characteristics, clinical experiences and basic investigations. Moreover, historical HPMs and several membranes with special characteristics that are not categorized into classes IV or V are discussed. Providing a summary of commercially available HPM dialyzers, this publication not only serves as a textbook for those interested in state-of the-art dialysis treatment, but is also a concise database of the products available.

Recent developments have spurred a renewed interest in novel solutions to access the patient circulation, mainly concentrating on vascular access for renal replacement therapies and on peritoneal dialysis access.Starting with the epidemiology, the focus then shifts to the evolution of new techniques and monitoring procedures with regard to hemodialysis, which are discussed and evaluated. Attention is also paid to the new biomaterials available, concentrating on their improved biocompatibility and surface characteristics. As developments in the field of peritoneal dialysis have taken a similar turn, new devices providing access to the peritoneal cavity which have recently been made available are introduced next. Last but not least, the management of complications and the continuous maintenance and care of the access with regard to both hemodialysis and peritoneal dialysis are highlighted.This book provides a complete overview of the devices, catheters and methods currently available to ensure successful vascular and peritoneal access. Taking into account both the physiology of the extracorporeal circulation and the mechanisms of peritoneal dialysis with regard to the most adequate access techniques, this is a unique resource for clinicians, investigators and researchers in the field of renal replacement therapy.