Additional Information
Book Details
Abstract
Providing practical, immediately useful guidelines that can be applied directly to patient care, Handbook of Dialysis Therapy is a must-have resource for all dialysis caregivers. This new edition has been updated with the latest cutting-edge technology, dialysis techniques, and complications related to various diseases for both pediatric and adult patients. In-depth yet concise, it explains complex dialysis concepts through abundant diagrams, photos, line drawings, and tables, while its readable hands-on approach allows for quick review of key information.
- Presents the practice-proven experience of top experts in the field of dialysis treatment.
- Offers dialysis guidance for both adult and pediatric patients in one convenient source.
- Features a readable hands-on approach, allowing you to quickly review the complicated concepts of dialysis.
- Includes helpful annotated bibliography lists in each section for further in-depth research on any subject.
- Explains complex dialysis concepts through abundant diagrams, photos, line drawings, and tables.
- Features new chapters on care delivery, patient-centric care, rehabilitation, quality of life, geriatrics, and interventional nephrology.
- Includes information on the management of the pediatric patient undergoing dialysis.
- Defines the quality imperatives, roles, and responsibilities of dialysis facility medical directors and attending nephrologists.
- Updates nephrologists on the latest alternative dialysis modalities.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Handbook of Dialysis Therapy | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xxi | ||
| Table Of Contents | xxiii | ||
| I Demographics | 1 | ||
| 1 Demographics of the End-Stage Renal Disease Patient | 3 | ||
| Introduction | 3 | ||
| Growth of the ESRD Population | 3 | ||
| Comorbidity, Expected Survival, and Causes of Death | 5 | ||
| Dialysis Initiation: Predialysis Care and Modality Selection | 15 | ||
| Summary | 18 | ||
| Recommended Reading | 19.e1 | ||
| II Vascular Access for Hemodialysis | 21 | ||
| 2 Vascular Access for Hemodialysis in Adults | 23 | ||
| Introduction | 23 | ||
| History of Vascular Access | 24 | ||
| Multidisciplinary Approach to Vascular Access | 24 | ||
| Strategy and Roles | 24 | ||
| Education | 24 | ||
| Planning and Choice of Vascular Access | 26 | ||
| Timely and Appropriate Referral | 26 | ||
| Patient and Vascular Access History | 28 | ||
| Physical Examination | 28 | ||
| Supportive Investigations | 28 | ||
| Angiogram | 30 | ||
| Access Site Locations | 31 | ||
| Upper Extremity | 31 | ||
| Fistulas | 31 | ||
| Wrist. | 31 | ||
| III Peritoneal Access Devices | 95 | ||
| 9 Peritoneal Access Devices, Placement Techniques, and Maintenance | 97 | ||
| Acute Catheters | 97 | ||
| Rigid Noncuffed Catheters | 97 | ||
| Soft Cuffed Catheters | 98 | ||
| Chronic Catheters | 98 | ||
| Choosing a Chronic Peritoneal Catheter | 101 | ||
| Chronic PD Catheter Placement Procedures | 105 | ||
| Percutaneous Needle-Guidewire Technique | 106 | ||
| Open Surgical Dissection | 106 | ||
| Y-TEC Procedure | 107 | ||
| Surgical Laparoscopy | 107 | ||
| Special Peritoneal Access Methods | 108 | ||
| Extended Two-Piece Catheters | 108 | ||
| Catheter Embedding | 108 | ||
| Acute Complications of Chronic Catheter Placement | 109 | ||
| Catheter Placement Approaches and Best Outcomes | 110 | ||
| Care of the Chronic Peritoneal Catheter | 110 | ||
| Postoperative Catheter Immobilization and Dressings | 110 | ||
| Catheter Irrigation | 111 | ||
| Catheter Break-in Procedures | 111 | ||
| Nonurgent Start | 111 | ||
| Urgent Start | 111 | ||
| Long-Term Catheter and Exit-Site Care | 111 | ||
| Embedded Catheter Care | 112 | ||
| Complications of Chronic Peritoneal Catheters | 112 | ||
| Mechanical Complications and Management | 112 | ||
| Pericatheter Leaks and Hernias | 112 | ||
| Infusion and Drain Pain | 113 | ||
| Flow Failure | 114 | ||
| Catheter Tip Migration | 115 | ||
| Superficial Cuff Extrusion | 116 | ||
| Catheter Infection and Management | 116 | ||
| Exit-Site and Tunnel Infection | 116 | ||
| Catheter Infection-Related Peritonitis | 118 | ||
| PD-Related Peritonitis | 118 | ||
| Removal of Chronic Catheters | 119 | ||
| Secondary Embedding of Chronic Catheters | 119 | ||
| Recommended Reading | 120.e1 | ||
| IV Mechanical Aspects of Dialysis | 121 | ||
| 10 Water Treatment Equipment for In-Center Hemodialysis | 123 | ||
| Introduction | 123 | ||
| Water Contaminants | 124 | ||
| Equipment Used for Water Purification | 126 | ||
| Multimedia Filter (Fig. 10.1) | 126 | ||
| Monitoring the Multimedia Filter | 127 | ||
| Water Softener/Brine Tank (Fig. 10.2) | 127 | ||
| Monitoring the Water Softener | 130 | ||
| Carbon Tanks (Fig. 10.3) | 131 | ||
| Monitoring the Carbon Tanks | 133 | ||
| Reverse Osmosis (Fig. 10.4) | 134 | ||
| Monitoring the RO System | 135 | ||
| Deionization (Fig. 10.5) | 136 | ||
| Monitoring the DI System | 138 | ||
| Ultrafilters/Cartridge Filters/Endotoxin Retentive Filters | 138 | ||
| Monitoring Ultrafilters | 138 | ||
| Ultraviolet Lights | 138 | ||
| Monitoring of UV Lights | 139 | ||
| Water Distribution Loop (Fig. 10.6) | 139 | ||
| Monitoring the Water Distribution Loop | 139 | ||
| Other Water Treatment Components | 141 | ||
| Monitoring for Microbiologic Contamination | 141 | ||
| Recommended Readings | 143.e1 | ||
| 11 Methods and Complications of Dialyzer Reuse | 144 | ||
| Background and Rationale | 144 | ||
| Current Status of Dialyzer Reuse in the United States | 145 | ||
| Dialyzer Reuse Methods | 145 | ||
| Effects of Reprocessing on Dialyzer Performance | 146 | ||
| Reprocessing Using Bleach | 147 | ||
| Reprocessing Using Peracetic Acid | 147 | ||
| Reprocessing Using Heat | 148 | ||
| Dialyzer Reuse Versus Single-Use Comparisons | 148 | ||
| Summary and Conclusions | 151 | ||
| Recommended Reading | 151.e1 | ||
| 12 Dialysate Composition | 152 | ||
| Introduction | 152 | ||
| Dialysate Sodium | 152 | ||
| Dialysate Potassium | 155 | ||
| Dialysate Buffer | 157 | ||
| Dialysate Calcium | 160 | ||
| Dialysate Magnesium | 161 | ||
| Dialysate Phosphate | 161 | ||
| Recommended Reading | 161.e1 | ||
| 13 Safety Monitors in Hemodialysis | 162 | ||
| Definitions and Overview | 162 | ||
| Dialysate Solution | 162 | ||
| Fluid Delivery System | 163 | ||
| Control Panel and Monitor Display | 163 | ||
| Monitor Failure | 164 | ||
| Fail-Safe, a Misnomer | 164 | ||
| Dialysate Circuit | 164 | ||
| Why Discuss the Details of Dialysis Machinery? | 165 | ||
| Water Inlet Solenoid | 165 | ||
| Solenoid Monitoring | 166 | ||
| Dialysate Temperature | 166 | ||
| Heater and Temperature Monitoring | 167 | ||
| Temperatures Greater Than 106°F | 167 | ||
| Temperatures Less Than 98.6°F | 167 | ||
| Deaeration System | 167 | ||
| Deaeration System Monitoring | 168 | ||
| Mixing Device | 168 | ||
| Mixing Device Monitoring | 168 | ||
| Composition and Conductivity of Dialysate | 168 | ||
| Measuring Conductivity | 169 | ||
| Monitoring Conductivity | 169 | ||
| No Intradialytic Conductivity Adjustments | 170 | ||
| Low Conductivity | 170 | ||
| Low-Conductivity Monitoring | 170 | ||
| High Conductivity | 171 | ||
| High-Conductivity Monitoring | 172 | ||
| Acid–Base (pH) Control | 172 | ||
| Monitoring Acid–Base (pH) | 172 | ||
| Bypass System | 172 | ||
| Bypass System Monitoring | 173 | ||
| Rinse Mode | 173 | ||
| Dialysate Pressure Monitor | 173 | ||
| Blood-Leak Detector | 174 | ||
| Blood-Leak Detector Monitoring | 175 | ||
| Dialysate Flow | 175 | ||
| Dialysate Flow Monitoring | 175 | ||
| Effluent Dialysate Line | 175 | ||
| Electrical Safety | 175 | ||
| Other Areas to Monitor in the Dialysate Circuit | 176 | ||
| Dialysate Prescription | 176 | ||
| Dialysate Prescription Monitoring | 176 | ||
| Sterility and Impurities | 176 | ||
| Microbiologic Testing | 177 | ||
| Bacteria in Bicarbonate Concentrate | 177 | ||
| Test for Endotoxins | 177 | ||
| Pyrogens | 178 | ||
| Ultrapure Dialysis Fluid | 178 | ||
| Cleaning and Disinfection | 178 | ||
| Central System Hazard | 178 | ||
| Routine Cleaning | 179 | ||
| Fluid Delivery System Disinfection | 179 | ||
| Heat Disinfection | 179 | ||
| Chemical Disinfection | 179 | ||
| Sodium Hypochlorite | 179 | ||
| Formaldehyde | 180 | ||
| Peracetic Acid | 180 | ||
| General Principles for Chemical Disinfection | 181 | ||
| Documentation of Dialysate Monitoring | 181 | ||
| The Blood Circuit | 182 | ||
| Arterial Pressure Monitor—Pre-Blood Pump | 182 | ||
| Arterial Pressure Monitoring | 184 | ||
| Venous Pressure Monitor | 185 | ||
| Venous Pressure Monitoring | 185 | ||
| Air-Foam Detector | 186 | ||
| Venous Line Clamp | 187 | ||
| Air-Foam Detector and Venous Line Clamp Monitoring | 187 | ||
| Heparin Infusion Pump | 188 | ||
| Heparin Infusion Pump Monitoring | 188 | ||
| Blood Flow Rate | 188 | ||
| Blood Flow Rate Monitoring | 189 | ||
| Blood Pump and Blood Lines | 189 | ||
| Narrowed Blood-Pump Tubing Segment | 189 | ||
| Kinked Arterial Blood Lines | 189 | ||
| IV Saline Infusion | 189 | ||
| IV Saline Infusion Monitoring | 189 | ||
| Conclusion | 190 | ||
| Recommended Reading | 190.e1 | ||
| 14 Methods of Hemodialysis Anticoagulation | 191 | ||
| Introduction | 191 | ||
| Systemic Anticoagulation | 191 | ||
| Standard Heparin Anticoagulation | 191 | ||
| Low-Dose Heparin | 193 | ||
| Low-Molecular-Weight Heparins | 194 | ||
| Recombinant Hirudin Anticoagulation | 195 | ||
| Argatroban | 195 | ||
| Heparinoids: Danaparoid and Fondaparinux | 195 | ||
| Regional Anticoagulation | 196 | ||
| Regional Anticoagulation With Protamine Reversal | 196 | ||
| Regional Citrate Anticoagulation | 196 | ||
| Prostacyclin Regional Anticoagulation | 198 | ||
| Anticoagulant-Free Dialysis | 198 | ||
| Heparin-Free Dialysis | 198 | ||
| Heparin-Grafted Dialyzers | 199 | ||
| Citrate Dialysate | 199 | ||
| Anticoagulation for Continuous Renal Replacement Therapy | 199 | ||
| Heparin | 200 | ||
| Regional Citrate Anticoagulation (RCA) | 200 | ||
| Regional Prostacyclin and LMWHs Anticoagulation | 201 | ||
| Heparin-Induced Thrombocytopenia | 201 | ||
| Catheter Lock in Patients With HIT | 204 | ||
| Recommended Reading | 204.e1 | ||
| V Home Dialysis | 205 | ||
| 15 Home Preparation and Installation for Home Hemodialysis | 207 | ||
| Introduction | 207 | ||
| Basis for Home Hemodialysis | 207 | ||
| Requirements | 207 | ||
| A. Legal | 208 | ||
| B. Water Preparation, Standards, and Plumbing | 208 | ||
| C. Electrical Considerations Including Backup Power Supply | 209 | ||
| D. Dialysis Machine Choice and Other Equipment | 210 | ||
| E. Space Considerations and Siting of Dialysis Machine | 210 | ||
| F. Hygiene and Noise | 212 | ||
| G. Safety | 212 | ||
| H. Medical Staff and Technical Support | 212 | ||
| I. Disposal of Waste | 212 | ||
| J. Storage of Medication | 213 | ||
| Conclusion | 213 | ||
| Recommended Reading | 213.e1 | ||
| 16 Peritoneal Dialysis Cyclers and Other Mechanical Devices | 214 | ||
| Mechanical Aspects and Hydraulics | 214 | ||
| Gravity-Based Cyclers | 214 | ||
| Combined Gravity- and Pump-Based Cyclers | 217 | ||
| Pump-Based Cyclers | 217 | ||
| Connectology | 219 | ||
| Information Technology and Connectivity | 219 | ||
| User Interface and Ease of Use | 220 | ||
| Cost Considerations | 221 | ||
| Current and Future Developments | 222 | ||
| Conclusions | 223 | ||
| Recommended Reading | 223.e1 | ||
| VI Dialyzers | 225 | ||
| 17 Selecting a Dialyzer | 227 | ||
| Introduction | 227 | ||
| Dialyzer Construction | 227 | ||
| Sterilization | 229 | ||
| Dialysis Membrane Structure and Characteristics | 230 | ||
| Cellulose-Based Membranes | 231 | ||
| Synthetic Membranes | 232 | ||
| Polyacrylonitrile (PAN, AN69, AN69ST) | 232 | ||
| Polymethylmethacrylate (PMMA) | 233 | ||
| Ethylenevinylalcohol Copolymer (EVAL) | 233 | ||
| Polyamide | 234 | ||
| Polysulfones | 234 | ||
| Polyarylethersulfones (PEPA, Arylane, DIAPES, Polyamix) | 234 | ||
| Clinical Implication of Membranes, Structure and Characteristics | 234 | ||
| Biocompatibility | 236 | ||
| Solute Removal | 236 | ||
| Dialyzer Choice and Prescription | 237 | ||
| Conclusions | 238 | ||
| Recommended Reading | 238.e1 | ||
| VII Adequacy of Dialysis | 239 | ||
| 18 Uremic Toxicity | 241 | ||
| Uremic Toxicity: The Modern Definition of Uremia | 241 | ||
| Clinical Syndrome of Uremia | 241 | ||
| The Residual Syndrome | 243 | ||
| Uremic Toxins Defined | 243 | ||
| Source of Toxins: Nitrogen Compounds | 245 | ||
| Mechanisms of Toxicity | 246 | ||
| Role of Malnutrition | 248 | ||
| Role of Inflammation and Oxidative Stress | 249 | ||
| Role of Anemia | 249 | ||
| Magnitude of Toxicity | 249 | ||
| Classification of Uremic Toxins | 250 | ||
| Small Water-Soluble (Dialyzable) Solutes | 251 | ||
| Larger Solutes (Molecular Weight > 500 Da) | 253 | ||
| Protein-Bound Solutes | 254 | ||
| Sequestered Solutes | 257 | ||
| Markers of Uremic Toxicity: Role of Urea | 257 | ||
| Role of Salt and Water Accumulation | 259 | ||
| Adverse Effects of Dialysis | 259 | ||
| Renal Toxicity From Uremic Toxins | 260 | ||
| Elimination of Uremic Toxins | 260 | ||
| How Much Removal? | 260 | ||
| Removal of Poorly Dialyzed Solutes | 261 | ||
| Effect of Residual Kidney Function | 262 | ||
| Patient Variability | 263 | ||
| Summary and Future Directions | 263 | ||
| Recommended Reading | 263.e1 | ||
| 19 Urea Kinetic Modeling for Guiding Hemodialysis Therapy in Adults | 264 | ||
| Blood Urea Concentration, Normalized Protein Catabolic Rate, and Fractional Clearance | 264 | ||
| NCDS Domains of Adequate and Inadequate Dialysis Doses | 264 | ||
| The HEMO Study | 267 | ||
| Observational and Randomized Studies | 268 | ||
| Volume as an Independent Predictor of Outcome | 269 | ||
| Role of UKM in Dialysis Therapy | 269 | ||
| Role of UKM in More Frequent and/or Continuous Hemodialysis Therapy and With Residual Renal Function | 271 | ||
| Dosing Recommendations for Adequate HD per CAPD Dosing | 272 | ||
| Recommended Reading | 273.e1 | ||
| 20 The Dialysis Prescription | 274 | ||
| Philosophy of Dialysis Adequacy | 274 | ||
| Kt/V | 275 | ||
| Urea Reduction Ratio | 276 | ||
| Thresholds for spKt/V and URR | 277 | ||
| Equilibrated Kt/V | 277 | ||
| Middle Molecule Clearance | 278 | ||
| Fluid Removal | 278 | ||
| Conclusion | 280 | ||
| Recommended Reading | 280.e1 | ||
| VIII Improving Outcomes in Dialysis Patients | 281 | ||
| 21 Improving Outcomes for End-Stage Renal Disease Patients | 283 | ||
| Recommended Reading | 290.e1 | ||
| 22 Quality, Safety, Accountability, and Medical Director Responsibilities | 291 | ||
| Introduction | 291 | ||
| Quality | 291 | ||
| Patient Safety | 295 | ||
| Accountability | 298 | ||
| Medical Director Responsibilities | 303 | ||
| Recommended Reading | 305.e1 | ||
| 23 Initiation of Dialysis Therapy | 306 | ||
| Historical Criteria for Dialysis Initiation | 306 | ||
| Evidence-Based Criteria for Dialysis Initiation | 306 | ||
| Preparation for Dialysis | 306 | ||
| Timing of Dialysis Initiation | 307 | ||
| Timing of Dialysis Access Placement | 309 | ||
| Conservative Management of End-Stage Renal Disease | 310 | ||
| Writing an Initial Dialysis Prescription: “Full Dose” versus “Incremental” | 311 | ||
| Writing an Initial Dialysis Prescription: Peritoneal Dialysis | 311 | ||
| Writing an Initial Dialysis Prescription: Hemodialysis | 312 | ||
| Conclusion | 313 | ||
| Recommended Reading | 314.e1 | ||
| IX Complications During Hemodialysis | 315 | ||
| 24 Common Clinical Problems During Hemodialysis | 317 | ||
| Background | 317 | ||
| Intradialytic Hypotension | 317 | ||
| Muscle Cramps | 322 | ||
| Dialyzer Reactions | 322 | ||
| Dialysis Disequilibrium Syndrome | 323 | ||
| Air Embolism | 323 | ||
| Falls | 323 | ||
| Recommended Reading | 323.e1 | ||
| 25 Arrhythmias in Hemodialysis Patients | 324 | ||
| Etiology and Prognosis | 324 | ||
| Management | 325 | ||
| General Considerations | 325 | ||
| Unstable Rhythms | 325 | ||
| Avoiding Arrhythmogenic Triggers | 325 | ||
| Treatment of Underlying Cardiac Disease | 325 | ||
| Specific Rhythm Disturbances | 326 | ||
| Ventricular Ectopy | 326 | ||
| Ventricular Tachycardia | 326 | ||
| Paroxysmal Supraventricular Tachycardia | 327 | ||
| Atrial Fibrillation | 327 | ||
| Approach to New-Onset Atrial Fibrillation in the Dialysis Unit | 327 | ||
| Rate Control | 329 | ||
| Stroke Prevention | 329 | ||
| Nonvalvular atrial fibrillation. | 329 | ||
| Valvular atrial fibrillation. | 330 | ||
| New non–vitamin K antagonist anticoagulants. | 330 | ||
| Rhythm Control Versus Rate Control | 330 | ||
| Bradyarrhythmias | 330 | ||
| Cardiac Arrest in the Dialysis Unit | 331 | ||
| Sudden Cardiac Death | 331 | ||
| Digoxin Toxicity | 331 | ||
| Summary | 333 | ||
| Recommended Reading | 333.e1 | ||
| 26 Prevention and Therapeutic Management of Bleeding in Dialysis Patients | 334 | ||
| Pathogenesis of Uremic Bleeding | 334 | ||
| Platelet Dysfunction and Uremic Toxins | 334 | ||
| Anemia | 336 | ||
| Effects of Dialysis | 336 | ||
| Medications | 337 | ||
| Clinical and Laboratory Findings | 338 | ||
| Prevention of Bleeding in Dialysis Patients | 340 | ||
| Dialysis Prescription | 340 | ||
| Anemia Treatment | 341 | ||
| Appropriate Prescription of Antiplatelet and Anticoagulant Medications | 341 | ||
| Proton Pump Inhibitors | 342 | ||
| Preparation for Invasive Procedures | 342 | ||
| Treatment of Dialysis Patients With Active Bleeding | 343 | ||
| Desmopressin Acetate and Cryoprecipitate | 343 | ||
| Conjugated Estrogens | 344 | ||
| Tranexamic Acid | 345 | ||
| Recommended Readings | 345.e1 | ||
| X Alternative Hemodialytic Techniques | 347 | ||
| 27 Hemofiltration and Hemodiafiltration | 349 | ||
| Definitions | 350 | ||
| Preparation of Ultrapure Replacement Fluid: Technical Issues | 350 | ||
| Modes of Hemodiafiltration | 350 | ||
| Postdilution Hemodiafiltration | 350 | ||
| Predilution Hemodiafiltration | 351 | ||
| Mixed-Dilution Hemodiafiltration | 351 | ||
| Mid-Dilution Hemodiafiltration | 351 | ||
| Principles of Hemodiafiltration Dosing | 352 | ||
| Quantifier of Hemodiafiltration Dose | 352 | ||
| Target Dose | 353 | ||
| Prescription of Hemodiafiltration Dose | 353 | ||
| Membrane Selection | 353 | ||
| Blood Flow Rate, Filtration Fraction, and Treatment Time | 354 | ||
| Anticoagulation | 354 | ||
| Selection of Hemodiafiltration Mode | 355 | ||
| Safety of Hemodiafiltration | 355 | ||
| Recommended Reading | 355.e1 | ||
| 28 Continuous Renal Replacement Therapies for Acute Kidney Injury | 356 | ||
| Basic Principles and Operational Characteristics | 356 | ||
| Technical Issues | 358 | ||
| Vascular Access | 358 | ||
| Dialyzer Membranes | 360 | ||
| Dialysate and Replacement Solutions | 361 | ||
| Anticoagulation | 361 | ||
| Treatment Dosing | 362 | ||
| Factors That Impact Dialysis Dose | 364 | ||
| Fluid Management | 365 | ||
| Applications | 366 | ||
| Traditional and Special Indications for Treatment | 368 | ||
| Septic Acute Kidney Injury | 369 | ||
| Increased Intracranial Pressure | 370 | ||
| Heart Failure and Cardiorenal Syndrome | 370 | ||
| Correction of Severe Electrolyte Abnormalities | 371 | ||
| Hypo- and Hypernatremia | 371 | ||
| Hypo- and Hyperkalemia | 372 | ||
| Other Electrolytes | 372 | ||
| Correction of Acid–Base Abnormalities | 372 | ||
| Metabolic Acidosis | 372 | ||
| Metabolic Alkalosis | 373 | ||
| Respiratory Acidosis and Alkalosis | 373 | ||
| Removal of Poisons | 373 | ||
| Initiation of Treatment | 375 | ||
| Monitoring and Complications | 376 | ||
| Outcomes | 378 | ||
| Cost | 379 | ||
| Conclusion | 379 | ||
| Recommended Reading | 379.e1 | ||
| 29 Anticoagulation for Continuous Renal Replacement Therapy | 380 | ||
| Selecting Anticoagulation Approaches for Continuous Renal Replacement Therapy | 380 | ||
| Specific Agents and Anticoagulation Techniques (Table 29.2) | 381 | ||
| Unfractionated Heparin | 381 | ||
| Citrate | 381 | ||
| Regional Unfractionated Heparin With Protamine Reversal | 384 | ||
| Low-Molecular-Weight Heparin | 384 | ||
| Thrombin Antagonists | 384 | ||
| Platelet-Inhibiting Agents | 385 | ||
| Conclusions | 385 | ||
| Recommended Reading | 385.e1 | ||
| 30 Wearable and Implantable Renal Replacement Therapy | 386 | ||
| Limits of Conventional Hemodialysis | 386 | ||
| Solute Removal | 387 | ||
| Urea | 387 | ||
| Phosphorus | 388 | ||
| β2-Microglobulin | 388 | ||
| Salt and Water Removal | 389 | ||
| Wearable Systems | 390 | ||
| Peritoneal Dialysis | 391 | ||
| Hemodialysis | 392 | ||
| Fully Implantable Systems | 393 | ||
| Recellularization Approaches | 393 | ||
| Implantable Renal Assist Device | 394 | ||
| Implantable Filters | 395 | ||
| Bioreactor | 395 | ||
| Recommended Reading | 396.e1 | ||
| XI Peritoneal Dialysis: Clinical Practice | 397 | ||
| 31 Determination of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Prescriptions | 399 | ||
| Rationale for Current Clearance Guidelines | 399 | ||
| Discrepancy Between Kt/V and Creatinine Clearance | 400 | ||
| Peritoneal Transport Characteristics | 402 | ||
| Other Uremic Toxins | 403 | ||
| Blood Pressure and Volume Control | 404 | ||
| Calculation of Prescribed Kt/V for Peritoneal Dialysis | 404 | ||
| Patient Preference for Continuous Ambulatory Peritoneal Dialysis Versus Automated Peritoneal Dialysis | 406 | ||
| Conclusion | 407 | ||
| Recommended Reading | 407.e1 | ||
| 32 Peritoneal Dialysis Solutions | 408 | ||
| Electrolytes | 409 | ||
| Sodium | 409 | ||
| Potassium | 409 | ||
| Calcium | 411 | ||
| Magnesium | 411 | ||
| Osmotic Agents | 412 | ||
| Glucose | 412 | ||
| Icodextrin | 413 | ||
| Amino Acids | 415 | ||
| Glycerol | 415 | ||
| Fructose, Xylitol, and Sorbitol | 415 | ||
| Acid–Base Buffers | 416 | ||
| Nonbicarbonate Buffers | 416 | ||
| Bicarbonate–Lactate Combination Buffers | 417 | ||
| Bicarbonate Buffers | 417 | ||
| Recommended Reading | 417.e1 | ||
| 33 Lymphatics, Peritoneal Fluid Losses, and Peritoneal Dialysis | 418 | ||
| Pathways of Fluid Absorption | 418 | ||
| Rate of Fluid Loss From the Peritoneal Cavity During Peritoneal Dialysis Exchanges | 419 | ||
| Clinical Implications | 419 | ||
| Summary | 420 | ||
| Recommended Reading | 420.e1 | ||
| XII Peritoneal Dialysis: Infectious Complications | 421 | ||
| 34 Abnormalities of Host Defense Mechanisms During Peritoneal Dialysis | 423 | ||
| Host Defense Mechanisms of the Peritoneal Cavity | 424 | ||
| Is Opsonic Activity of Peritoneal Dialysate Important? | 425 | ||
| Phagocytosis and Intracellular Killing | 426 | ||
| Therapeutic Approaches | 427 | ||
| Immunization Strategies | 427 | ||
| Strategies to Enhance Cell Function | 428 | ||
| Peritoneal Membrane Resting | 428 | ||
| Peritoneal Dialysis Solution Biocompatibility | 428 | ||
| Summary | 429 | ||
| Recommended Reading | 429.e1 | ||
| 35 Peritoneal Catheter Exit Site and Tunnel Infections | 430 | ||
| Definitions | 430 | ||
| Frequency | 430 | ||
| Causative Organisms | 431 | ||
| Risk Factors | 431 | ||
| Treatment and Outcomes | 431 | ||
| Prevention | 432 | ||
| Summary | 434 | ||
| Recommended Reading | 434.e1 | ||
| 36 Peritonitis in Peritoneal Dialysis Patients | 435 | ||
| Peritonitis Rate in PD Patients | 435 | ||
| Risk Factors for Peritonitis | 435 | ||
| Pathogenesis and Causative Organisms | 437 | ||
| Diagnosis of Peritonitis in Peritoneal Dialysis Patients | 438 | ||
| Clinical Assessment | 438 | ||
| Collection of Peritoneal Dialysis Effluent for Cell Count and Culture | 438 | ||
| Management of Peritonitis | 439 | ||
| Antibiotic Administration | 439 | ||
| Adjunctive Treatment | 440 | ||
| Treatment of Specific Organisms | 442 | ||
| Gram-Positive Organism Cultured (Fig. 36.2) | 442 | ||
| Gram-Negative Organism Cultured (Fig. 36.3) | 443 | ||
| Culture-Negative Peritonitis | 444 | ||
| Polymicrobial Peritonitis | 444 | ||
| Tuberculous Peritonitis | 444 | ||
| Fungal Peritonitis | 444 | ||
| Indications for Catheter Removal | 444 | ||
| Relapsing, Recurrent, and Repeat Peritonitis | 445 | ||
| Special Considerations in Automated Peritoneal Dialysis | 445 | ||
| Predictors for Treatment Failure in Peritonitis | 445 | ||
| Impact of Peritonitis | 446 | ||
| Prevention of Peritonitis | 446 | ||
| Recommended Reading | 447.e1 | ||
| XIII Peritoneal Dialysis: Noninfectious Complications | 449 | ||
| 37 Peritoneal Membrane Dysfunction | 451 | ||
| Solute Removal | 451 | ||
| Physiology of Solute Transport | 451 | ||
| Measurement of Dialysis Adequacy | 452 | ||
| Management of Underdialysis | 453 | ||
| Ultrafiltration Failure and Peritoneal Fibrosis | 455 | ||
| Clinical Significance of Ultrafiltration | 455 | ||
| Principles of Ultrafiltration | 456 | ||
| Causes of Ultrafiltration Failure | 456 | ||
| Impaired Ultrafiltration Caused by Fast (High) Solute Transport | 456 | ||
| Impaired Ultrafiltration Caused by Reduced Membrane Efficiency and Fibrosis | 457 | ||
| Other Factors Determining Ultrafiltration | 458 | ||
| Encapsulating Peritoneal Sclerosis | 458 | ||
| Pathologic Features | 458 | ||
| Clinical Features | 459 | ||
| Epidemiology of Encapsulating Peritoneal Sclerosis | 459 | ||
| Treatment of Encapsulating Peritoneal Sclerosis | 460 | ||
| Recommended Reading | 460.e1 | ||
| 38 Abdominal Catastrophes, Peritoneal Eosinophilia, and Other Unusual Events in Peritoneal Dialysis | 461 | ||
| Abdominal Catastrophe | 461 | ||
| Pneumoperitoneum | 463 | ||
| Iatrogenic Complications of Gastrointestinal or Gynecologic Procedures | 463 | ||
| Pancreatitis | 464 | ||
| Peritoneal Eosinophilia | 464 | ||
| Hepatic Subcapsular Steatosis | 465 | ||
| Hemoperitoneum | 465 | ||
| Chyloperitoneum | 467 | ||
| Recommended Reading | 467.e1 | ||
| 39 Metabolic Effects of Peritoneal Dialysis | 468 | ||
| Weight Gain | 468 | ||
| Metabolic Syndrome | 469 | ||
| New-Onset Diabetes Mellitus in Nondiabetic Patients | 469 | ||
| Hyperglycemia in Patients With Diabetes Mellitus | 470 | ||
| Lipid Abnormalities | 471 | ||
| Hypokalemia | 471 | ||
| Recommended Reading | 472.e1 | ||
| XIV Peritoneal Dialysis: Intra-Abdominal Pressure-Related Complications | 473 | ||
| 40 Abdominal Hernias in Continuous Ambulatory Peritoneal Dialysis | 475 | ||
| Incidence and Prevalence | 475 | ||
| Types of Abdominal Wall Hernias | 475 | ||
| Risk Factors | 476 | ||
| Complications | 477 | ||
| Diagnosis and Management | 477 | ||
| Continuation of Continuous Ambulatory Peritoneal Dialysis After Hernioplasty | 478 | ||
| Prophylactic Measures | 478 | ||
| Recommended Reading | 478.e1 | ||
| 41 Peritoneal Dialysate Leaks | 479 | ||
| Recommended Readings | 482.e1 | ||
| 42 Hydrothorax and Peritoneal Dialysis | 483 | ||
| Introduction | 483 | ||
| Pathophysiology | 483 | ||
| Symptoms and Presentation | 484 | ||
| Diagnosis | 484 | ||
| Management | 485 | ||
| Recommended Readings | 486.e1 | ||
| XV Acid-Base Homeostasis | 487 | ||
| 43 Acid–Base Homeostasis in Dialysis | 489 | ||
| Determinants of Serum [Total CO2] in Dialysis Patients | 489 | ||
| Hemodialysis | 489 | ||
| Peritoneal Dialysis | 492 | ||
| Normal Values | 492 | ||
| Diagnosis and Management of Acid–Base Disorders | 493 | ||
| The Patient With a Persistently Low Serum [Total CO2] Level | 493 | ||
| The Patient With a Persistently High Serum [Total CO2] Level | 493 | ||
| Identifying Superimposed Acid–Base Disorders | 493 | ||
| Rules for Identification of the Primary Disturbance in Dialysis Patients | 494 | ||
| Evaluation of the Secondary Response | 495 | ||
| Causes of Acid–Base Disorders | 495 | ||
| Metabolic Acidosis | 495 | ||
| Metabolic Alkalosis | 496 | ||
| Respiratory Acidosis | 496 | ||
| Respiratory Alkalosis | 497 | ||
| Mixed Acid–Base Disorders | 497 | ||
| Recommended Reading | 497.e1 | ||
| XVI Nutritional Management of Dialysis Patients | 499 | ||
| 44 Nutritional Management of Hemodialysis Patients | 501 | ||
| Introduction | 501 | ||
| Screening and Assessment of Nutritional Status in MHD | 501 | ||
| Epidemiology of PEW in MHD Patients | 503 | ||
| Etiology and Prevention of PEW in MHD Patients | 503 | ||
| Dietary Nutrient Intake | 503 | ||
| Increased Catabolism Due to Renal Replacement Therapy | 504 | ||
| Chronic Inflammation | 505 | ||
| Metabolic Acidosis and Hormonal Derangements | 506 | ||
| Comorbidities in CKD | 506 | ||
| Treatment of PEW in MHD Patients | 507 | ||
| Oral and Enteral Nutritional Supplementation | 507 | ||
| Anabolic Hormones | 509 | ||
| Exercise | 509 | ||
| Emerging Therapies | 509 | ||
| Antiinflammatory Agents | 509 | ||
| Appetite Stimulants | 510 | ||
| Summary and Recommendations | 510 | ||
| Recommended Reading | 510.e1 | ||
| 45 Intradialytic Parenteral Nutrition and Intraperitoneal Nutrition | 511 | ||
| Introduction | 511 | ||
| Intradialytic Parenteral Nutrition (IDPN) | 511 | ||
| Limitations of Clinical Trials of IDPN therapy | 512 | ||
| Nonrandomized Studies of IDPN | 512 | ||
| Randomized Prospective Controlled Trials of IDPN | 519 | ||
| Indications for Initiation of IDPN | 521 | ||
| Administration of IDPN | 521 | ||
| Monitoring of IDPN Therapy | 521 | ||
| Advantages and Disadvantages of IDPN | 521 | ||
| Intraperitoneal Nutrition | 522 | ||
| Recommended Reading | 523.e1 | ||
| 46 Nutritional Management in Peritoneal Dialysis | 524 | ||
| Protein–Energy Wasting and Its Impact in Peritoneal Dialysis Patients | 524 | ||
| Risk Factors for PEW in PD | 526 | ||
| Protein Loss | 527 | ||
| Early Satiety/Fullness | 528 | ||
| Inflammatory States | 528 | ||
| Diagnosis of PEW in PD Patients | 528 | ||
| Serum Chemistry | 528 | ||
| Body Mass | 530 | ||
| Muscle Mass | 530 | ||
| Dietary Intake | 530 | ||
| nPNA (Also Known as nPCR) | 530 | ||
| Body Composition | 531 | ||
| Nutritional Assessment Scores | 531 | ||
| Management of Protein Energy Malnutrition in PD Patients | 531 | ||
| Daily Energy Intake Goal | 531 | ||
| Daily Protein Intake | 531 | ||
| Dialysis Prescription and Metabolic Acidosis | 532 | ||
| Intraperitoneal Nutrition | 532 | ||
| Appetite and Hormonal Stimulants | 533 | ||
| Oral Nutritional Supplementation | 533 | ||
| Impact of Nutritional Support on Outcome of PD Patients | 533 | ||
| Dietary Counseling | 534 | ||
| Conclusion | 534 | ||
| Recommended Reading | 534.e1 | ||
| XVII Gastrointestinal Disease | 535 | ||
| 47 Liver Disease and Gastrointestinal Disorders in Dialysis Patients | 537 | ||
| Introduction | 537 | ||
| Hepatitis B | 537 | ||
| Interpretation of Diagnostic Tests | 537 | ||
| Natural History of HBV in the Dialysis Population | 538 | ||
| Epidemiology of Hepatitis B Virus in Dialysis Units | 539 | ||
| Strategies to Control HBV Transmission in Dialysis Units | 539 | ||
| Treatment of HBV-Related Liver Disease | 540 | ||
| Hepatitis B Vaccination | 540 | ||
| Hepatitis C | 541 | ||
| Interpretation of Diagnostic Tests | 541 | ||
| Natural History of HCV in Dialysis Population | 541 | ||
| Epidemiology of Hepatitis C Virus in Dialysis Units | 542 | ||
| Strategies to Control HCV Transmission in Dialysis Units | 542 | ||
| Therapy of HCV in the Dialysis Population | 543 | ||
| Nephrogenic Ascites and Other Gastrointestinal Disorders in the Dialysis Population | 544 | ||
| Conclusions | 545 | ||
| Recommended Reading | 546.e1 | ||
| XVIII The HIV-Infected Patient | 547 | ||
| 48 Care of the HIV-Infected Dialysis Patient | 549 | ||
| Improved Survival of the HIV-Infected ESRD Patient | 549 | ||
| Hemodialysis and Vascular Access | 550 | ||
| Infection Control in Hemodialysis | 550 | ||
| Peritoneal Dialysis | 551 | ||
| Medical Management | 551 | ||
| Dialysis Care | 551 | ||
| Nutrition and Diet | 552 | ||
| Hepatitis C and Hepatitis B Coinfection | 552 | ||
| Transplantation | 552 | ||
| HIV Care | 552 | ||
| Antiretroviral Therapy (ART) | 560 | ||
| Recommended Reading | 560.e1 | ||
| XIX Anemia and Epoetin Use | 561 | ||
| 49 Use of Erythropoiesis-Stimulating Agents in Hemodialysis Patients | 563 | ||
| Introduction | 563 | ||
| ESAs Available in the U.S. | 563 | ||
| Dosing and Administration Guidelines | 564 | ||
| Clinical Outcomes Associated With ESA Treatment in Hemodialysis Patients | 567 | ||
| Side Effects of ESA Therapy | 567 | ||
| ESA Hyporesponsiveness in Hemodialysis Patients | 568 | ||
| Biosimilars and Other Future ESAs | 570 | ||
| Summary | 570 | ||
| Recommended Reading | 570.e1 | ||
| 50 Anemia in Patients With End-Stage Kidney Disease | 571 | ||
| Erythropoietin Deficiency | 571 | ||
| Iron Deficiency | 572 | ||
| Reduced Erythrocyte Survival | 572 | ||
| Inflammation | 573 | ||
| Infection | 573 | ||
| Hyperparathyroidism | 573 | ||
| Bleeding | 574 | ||
| Other Hematologic Disorders | 574 | ||
| Role of Red Blood Cell Transfusion in Management of Anemia of ESKD | 574 | ||
| Recommended Reading | 575.e1 | ||
| 51 Iron Use in End-Stage Renal Disease | 576 | ||
| Epidemiology of Iron Deficiency in CKD | 576 | ||
| Pathophysiology | 576 | ||
| Systemic Iron Homeostasis | 576 | ||
| Pathophysiology of Iron Deficiency in Renal Anemia | 580 | ||
| Diagnosis of Iron Deficiency in CKD Patients | 580 | ||
| Emerging Markers of Iron Status | 581 | ||
| Iron Use in CKD Patients | 581 | ||
| Oral Iron Therapy in CKD | 582 | ||
| Intravenous Iron | 584 | ||
| Dialysate Iron Delivery | 584 | ||
| Future Directions for Iron-Restricted Erythropoiesis | 584 | ||
| Independent Benefits of Iron Unrelated to Correction of Anemia | 585 | ||
| Potential Long-Term Concerns of Harm With IV Iron Use | 585 | ||
| Recommended Reading | 587.e1 | ||
| 52 Resistance to Erythropoiesis-Stimulating Agent (ESA) Treatment | 588 | ||
| Historical Background and Current Definitions | 588 | ||
| Disorders Inducing Resistance to Treatment | 590 | ||
| Iron and Other Cofactor Needs | 591 | ||
| Tools for Diagnosis | 591 | ||
| Differential Diagnosis | 592 | ||
| Functional Iron Deficiency | 592 | ||
| Treatment of Iron Deficiency | 593 | ||
| Identifying Clinical Problems in Iron Consumption and Bioavailability | 594 | ||
| Underlying Inflammatory Disease | 595 | ||
| Other Disorders Inducing Resistance to Treatment | 596 | ||
| Aluminum Intoxication | 596 | ||
| Secondary Hyperparathyroidism | 596 | ||
| Hematologic Disorders | 597 | ||
| Angiotensin-Converting Enzyme Inhibitors and Receptor Blockers | 597 | ||
| Carnitine Deficiency | 597 | ||
| Adequacy of Dialysis | 598 | ||
| Hemoglobin Cycling and Variability | 598 | ||
| Pure Red Cell Aplasia | 599 | ||
| Future Developments | 599 | ||
| Recommended Reading | 600.e1 | ||
| XX Cardiovascular Disease | 601 | ||
| 53 The Challenges of Blood Pressure Control in Dialysis Patients | 603 | ||
| Challenges Defining Hypertension and in Establishing Goal Blood Pressure in Dialysis Patients | 603 | ||
| Challenges of Blood Pressure Measurements in Dialysis Patients | 604 | ||
| Importance of 24-Hour Blood Pressure Recording in Dialysis Patients | 604 | ||
| Pulse Pressure and Outcomes in Dialysis Patients | 605 | ||
| Blood Pressure Variability and Cardiovascular Outcome in Dialysis Patients | 605 | ||
| Pathogenesis of Hypertension in End-Stage Renal Disease Patients | 606 | ||
| Management of Hypertension in Dialysis Patients | 606 | ||
| Lifestyle Modifications | 606 | ||
| Control of Fluid and Volume Status With Dialysis | 607 | ||
| Dialysate Sodium Prescription and Blood Pressure Among Hemodialysis Patients | 607 | ||
| Therapy With Antihypertensive Drugs | 608 | ||
| Patient Demographics | 608 | ||
| Coexisting Disease | 608 | ||
| Effects of Dialysis on Antihypertensive Drugs in End-Stage Renal Disease Patients | 613 | ||
| Antihypertensive Drugs in End-Stage Renal Disease Patients | 613 | ||
| Inhibitors of the Renin–Angiotensin–Aldosterone System | 613 | ||
| Angiotensin-Converting Enzyme Inhibitors | 613 | ||
| Sulfhydryl Agents | 613 | ||
| Carboxyl Agents | 613 | ||
| Phosphoryl Agents | 613 | ||
| Side Effects of Angiotensin-Converting Enzyme Inhibitors | 614 | ||
| Angiotensin II Receptor Antagonists | 614 | ||
| Direct Renin Inhibitors | 615 | ||
| Side Effects | 615 | ||
| Mineralocorticoid Receptor Antagonists | 615 | ||
| Potential Beneficial Effect of Drugs That Inhibit the Renin–Angiotensin–Aldosterone System on Cardiovascular Diseases Independent of Blood Pressure | 616 | ||
| Anti-Adrenergic Drugs | 616 | ||
| β-Adrenergic Blocking Agents | 616 | ||
| Lipid Solubility | 617 | ||
| Cardioselectivity | 617 | ||
| Intrinsic Sympathomimetic Activity | 617 | ||
| Side Effects of Beta-Blockers | 618 | ||
| Centrally Acting Antiadrenergic Agents | 618 | ||
| α-Methyldopa | 618 | ||
| Clonidine | 619 | ||
| Guanabenz and Guanfacine | 619 | ||
| Rilmenidine and Moxonidine | 620 | ||
| Peripherally Acting α1-Adrenergic Receptor Blocking Agents | 620 | ||
| Prazosin | 620 | ||
| Terazosin | 620 | ||
| Doxazosin | 620 | ||
| Urapidil | 621 | ||
| Reserpine | 621 | ||
| Guanethidine | 621 | ||
| Guanadrel | 621 | ||
| Direct Vasodilators | 621 | ||
| Calcium Channel Antagonists | 622 | ||
| Sodium Nitroprusside | 623 | ||
| Nitrates | 623 | ||
| Diazoxide | 623 | ||
| Hydralazine | 624 | ||
| Minoxidil | 624 | ||
| Resistant Hypertension in Dialysis Patients | 625 | ||
| Effect of Frequent Hemodialysis on Blood Pressure Control in End-Stage Renal Disease Patients With Refractory Hypertension | 625 | ||
| Intradialytic Hypertension | 625 | ||
| Recommended Reading | 626.e1 | ||
| 54 Management of Ischemic Heart Disease, Heart Failure, and Pericarditis in Hemodialysis Patients | 627 | ||
| Introduction | 627 | ||
| Ischemic Heart Disease | 627 | ||
| Clinical Presentation | 627 | ||
| Diagnosis | 628 | ||
| Cardiac Troponins | 630 | ||
| Noninvasive Stress Testing | 630 | ||
| Coronary Angiography | 631 | ||
| Medical Management | 631 | ||
| Aspirin | 631 | ||
| Antihypertensive Medications | 631 | ||
| Lipid-Lowering Medications | 632 | ||
| Bone and Mineral Metabolism | 633 | ||
| Anemia | 634 | ||
| Coronary Revascularization | 634 | ||
| Hemodialysis-Related Interventions | 635 | ||
| Lifestyle Modification | 635 | ||
| Heart Failure | 635 | ||
| Diagnosis | 636 | ||
| Management | 636 | ||
| Volume Control | 636 | ||
| Antihypertensive Medications | 637 | ||
| Digoxin | 638 | ||
| Uremic Pericarditis | 638 | ||
| Clinical Presentation and Diagnosis | 638 | ||
| Management | 639 | ||
| Recommended Reading | 639.e1 | ||
| 55 Avoidance and Treatment of Cardiovascular Disease in Dialysis | 640 | ||
| Introduction | 640 | ||
| Presentation and Diagnostic Tests for Coronary Arterial Disease | 640 | ||
| Diagnostics | 640 | ||
| Cardiac Enzymes | 641 | ||
| Electrocardiography | 641 | ||
| Exercise Stress Testing | 641 | ||
| Isotope Stress Testing | 641 | ||
| Coronary Angiography | 642 | ||
| Treatment Challenges | 642 | ||
| Antiplatelet Therapy | 642 | ||
| Revascularization Therapy | 643 | ||
| Pharmacologic Management | 643 | ||
| Statins | 643 | ||
| Hypertension | 643 | ||
| Treatment Interactions | 644 | ||
| Peripheral Vasculature | 645 | ||
| Vascular Calcification | 645 | ||
| Inflammation and Oxidative Stress | 645 | ||
| Diagnostics | 646 | ||
| Pulse-Wave Velocity | 646 | ||
| Quantifying Vascular Calcification | 646 | ||
| Treatment Approach | 647 | ||
| Hypertension | 647 | ||
| Vascular Calcification | 647 | ||
| Oxidative Stress | 647 | ||
| Inflammation | 648 | ||
| Peripheral Arterial Disease | 648 | ||
| Diagnostics | 648 | ||
| Special Considerations | 648 | ||
| Other Critical Organ Systems Requiring Protection | 649 | ||
| The Gut | 649 | ||
| Vascular Brain Injury | 649 | ||
| Leukoaraiosis | 650 | ||
| Kidney and Residual Renal Function | 650 | ||
| Conclusion | 651 | ||
| Recommended Reading | 651.e1 | ||
| XXI Metabolic Abnormalities | 653 | ||
| 56 Management of Dyslipidemia in Long-Term Dialysis Patients | 655 | ||
| Diet and Exercise | 655 | ||
| Lipid-Lowering Drugs | 656 | ||
| Other Lipid-Lowering Strategies | 658 | ||
| Summary | 658 | ||
| Recommended Reading | 659.e1 | ||
| 57 Abnormalities of Thyroid Function in Chronic Dialysis Patients | 660 | ||
| Introduction | 660 | ||
| Prevalence of Hypothyroidism | 660 | ||
| Factors Contributing to Thyroid Functional Disease in Kidney Disease | 662 | ||
| Normal Thyroid Hormone Physiology | 662 | ||
| Thyroid Functional Disease Leading to Kidney Disease | 662 | ||
| Kidney Disease Leading to Thyroid Functional Disease | 663 | ||
| Effects of Dialysis on Thyroid Functional Tests | 664 | ||
| Thyroid Functional Test Alterations in Dialysis Patients | 666 | ||
| Low Triiodothyronine (Low T3 Syndrome) | 666 | ||
| Reverse Triiodothyronine | 667 | ||
| Low Thyroxine | 667 | ||
| Elevated Thyrotropin | 667 | ||
| Thyroid Functional Disease and Outcomes in Dialysis Patients | 668 | ||
| Low Triiodothyronine and Outcomes | 668 | ||
| Thyrotropin Elevation and Outcomes | 669 | ||
| Treatment Considerations | 670 | ||
| Exogenous T3 Replacement | 671 | ||
| Exogenous T4 Replacement | 672 | ||
| Recommended Reading | 673.e1 | ||
| 58 Metabolic Abnormalities | 674 | ||
| Introduction | 674 | ||
| Sexual Dysfunction in Uremic Men | 674 | ||
| Evaluation of Sexual Dysfunction in the Uremic Man | 675 | ||
| Treatment of Sexual Dysfunction in the Uremic Man | 677 | ||
| Sexual Dysfunction in Uremic Women | 679 | ||
| Treatment of Sexual Dysfunction in Uremic Women | 679 | ||
| Recommended Readings | 681.e1 | ||
| XXII Uremic Osteodystrophy | 683 | ||
| 59 Chronic Kidney Disease–Mineral and Bone Disorder | 685 | ||
| Pathophysiology of CKD-MBD | 685 | ||
| Review of PTH, Vitamin D, and Fibroblast Growth Factor-23 | 685 | ||
| Development of Secondary Hyperparathyroidism in CKD | 686 | ||
| Epidemiology of Disordered Mineral Metabolism | 687 | ||
| Bone Disease | 689 | ||
| Bone Disease in CKD | 689 | ||
| Patients With CKD Have More Hip Fractures | 690 | ||
| Diagnosing Bone Disease | 690 | ||
| Vascular Calcification | 691 | ||
| Vascular Calcification and Cardiovascular Mortality | 691 | ||
| Diagnosing Vascular Calcification | 693 | ||
| Bone-Vascular Axis | 693 | ||
| Treatment | 693 | ||
| Treatment Targets | 694 | ||
| Dietary Phosphate | 694 | ||
| Medical Management | 695 | ||
| Optimal Dialysis Prescription | 697 | ||
| Conclusion | 697 | ||
| Recommended Reading | 697.e1 | ||
| 60 Phosphate Management in Patients With End-Stage Renal Disease | 698 | ||
| Introduction | 698 | ||
| Phosphate Physiology | 698 | ||
| Phosphate Binder Therapy | 699 | ||
| Heavy Metal Compounds | 700 | ||
| Calcium-Based Compounds | 700 | ||
| Nonabsorbable Polymers | 701 | ||
| Magnesium-Based Binders | 702 | ||
| Iron-Based Therapy | 702 | ||
| Future Therapies | 703 | ||
| Dialytic Control of Hyperphosphatemia | 703 | ||
| Skeletal Health and Phosphate | 704 | ||
| Conclusion | 704 | ||
| Recommended Reading | 705.e1 | ||
| 61 Use of Vitamin D Sterols and Calcimimetics in Patients With End-Stage Renal Disease | 706 | ||
| Role of Vitamin D Sterol Therapy | 707 | ||
| Role of Calcimimetic Therapy | 708 | ||
| Recommended Reading | 708.e1 | ||
| 62 Parathyroidectomy | 709 | ||
| Indications for Parathyroidectomy (Table 62.1) | 709 | ||
| Preoperative Considerations | 711 | ||
| Preoperative Localization of Parathyroid Glands | 711 | ||
| Parathyroidectomy Options | 712 | ||
| Preoperative Medical Management | 713 | ||
| Operative Procedure | 713 | ||
| Postoperative Management | 714 | ||
| Other Postparathyroidectomy Complications | 717 | ||
| Recommended Readings | 718.e1 | ||
| XXIII Acquired Cystic Kidney Disease | 719 | ||
| 63 Acquired Cystic Kidney Disease | 721 | ||
| Epidemiology | 721 | ||
| Pathophysiology | 721 | ||
| Clinical Course and Complications | 722 | ||
| Diagnosis and Screening | 722 | ||
| Treatment | 724 | ||
| Recommended Reading | 724.e1 | ||
| XXIV Diabetes | 725 | ||
| 64 End-Stage Renal Failure in the Diabetic Patient | 727 | ||
| The Diabetic ESRD Population | 727 | ||
| Predialysis Care/Dialysis Initiation | 727 | ||
| Dysglycemia | 728 | ||
| Prediabetes | 729 | ||
| Assessing Glycemic Control in ESRD | 729 | ||
| Achieving Glycemic Control in ESRD | 729 | ||
| Diabetic Ketoacidosis/Hyperosmolar Coma | 730 | ||
| Hypoglycemia | 731 | ||
| Medications | 731 | ||
| Oral Hypoglycemic Agents | 731 | ||
| Insulin | 734 | ||
| Hemodialysis Access | 734 | ||
| Nutrition/Protein–Energy Wasting | 735 | ||
| Hypertension | 736 | ||
| Dialysis-Associated Hypotension | 736 | ||
| Cardiovascular Disease | 737 | ||
| Infection | 737 | ||
| Peripheral Arterial Disease/Foot Ulcers | 738 | ||
| Neuropathy | 739 | ||
| Gastroparesis | 739 | ||
| Ophthalmologic Complications | 740 | ||
| Home Hemodialysis | 740 | ||
| Peritoneal Dialysis | 740 | ||
| Kidney Transplantation | 742 | ||
| Outcomes | 742 | ||
| Quality of Life | 743 | ||
| Recommended Reading | 744.e1 | ||
| XXV Drug Use in Uremia | 745 | ||
| 65 Principles of Drug Usage in Dialysis Patients | 747 | ||
| Pharmacologic Principles and Alterations in Uremia | 747 | ||
| Drug Administration | 749 | ||
| Renal Function Assessment | 749 | ||
| Effects of Dialysis on Drugs | 752 | ||
| Dosing Tables | 753 | ||
| Recommended Reading | 805.e1 | ||
| 66 Medication Management | 806 | ||
| Medication-Related Problems in Dialysis Patients | 807 | ||
| Identifying and Resolving Medication-Related Problems in Dialysis Patients | 809 | ||
| Medication Reconciliation | 809 | ||
| Medication Review | 811 | ||
| Economic Impact | 814 | ||
| Conclusion | 816 | ||
| Recommended Reading | 816.e1 | ||
| XXVI Rehabilitation and Psychosocial Issues | 817 | ||
| 67 Physical Activity, Function, and Exercise-Based Rehabilitation for Dialysis Patients | 819 | ||
| Definitions | 819 | ||
| Physical Activity and Function | 820 | ||
| Exercise Rehabilitation | 820 | ||
| Physical Function Assessment for People With Chronic Kidney Disease | 821 | ||
| Intradialytic Cycling: A Pragmatic Approach to Encourage Exercise Training | 822 | ||
| Patient Suitability for Starting an Exercise Program | 824 | ||
| Staffing | 825 | ||
| Equipment | 825 | ||
| Pragmatic Exercise Prescription | 825 | ||
| Goal Setting | 826 | ||
| Competence | 826 | ||
| Potential Barriers and Solutions to the Provision of Intradialytic Exercise Programs | 827 | ||
| Exercising on Nondialysis Days | 827 | ||
| The Way Forward: Translational Rehabilitation | 828 | ||
| Recommended Reading | 828.e1 | ||
| 68 Physical, Psychosocial, and Vocational Rehabilitation of Adult Dialysis Patients | 829 | ||
| Background | 829 | ||
| Redefining Rehabilitation | 830 | ||
| Prerequisites to Effective Rehabilitation | 833 | ||
| Adequate Dialysis and Anemia Control | 833 | ||
| Comorbid Conditions and High-Risk Lifestyles | 833 | ||
| Family Participation | 834 | ||
| Implementing Renal Rehabilitation | 834 | ||
| Evaluation of Outcomes | 835 | ||
| Conclusions | 836 | ||
| Recommended Reading | 836.e1 | ||
| 69 Ethical Considerations in the Care of Dialysis Patients | 837 | ||
| Who Should and Should Not Receive Dialysis? | 837 | ||
| On What Basis Should Decisions About Renal Replacement Therapy and Modality Be Made? | 839 | ||
| When Should a Time-Limited Trial of Dialysis Be Used? | 840 | ||
| When Should Stopping Dialysis Be Considered? | 841 | ||
| How Should a Nephrologist Respond to a Patient’s Request to Stop Dialysis? | 841 | ||
| How Should a Patient Who Stops Dialysis Be Treated? | 842 | ||
| Recommended Reading | 843.e1 | ||
| 70 Psychosocial Issues in Dialysis Patients | 844 | ||
| Psychopathology | 844 | ||
| Depression | 844 | ||
| Treatment | 845 | ||
| Pharmacologic Treatment | 845 | ||
| Nonpharmacologic Treatment | 845 | ||
| Cognitive Behavioral Therapy | 845 | ||
| Exercise Therapy | 845 | ||
| Anxiety | 846 | ||
| Psychosocial Issues | 846 | ||
| Quality of Life | 846 | ||
| Social Support | 846 | ||
| Sleep Disorders | 847 | ||
| Insomnia | 847 | ||
| Restless Legs Syndrome and Periodic Limb Movement Disorder | 848 | ||
| Sleep Apnea | 848 | ||
| Hemodialysis Treatment Adherence | 849 | ||
| Types of Nonadherence | 850 | ||
| Fluid and Dietary Nonadherence | 850 | ||
| Medication Nonadherence | 850 | ||
| Dialysis Prescription Nonadherence | 850 | ||
| Factors Affecting Hemodialysis Nonadherence | 851 | ||
| Patient Characteristics and Nonadherence | 851 | ||
| Psychosocial Factors and Nonadherence | 851 | ||
| Social Support and Nonadherence | 851 | ||
| Health Beliefs and Nonadherence | 851 | ||
| Depression and Nonadherence | 852 | ||
| Illness and Treatment Perceptions and Nonadherence | 852 | ||
| Dialysis Environment and Nonadherence | 852 | ||
| Patient–Physician Dyad and Nonadherence | 852 | ||
| Health Literacy and Nonadherence | 852 | ||
| Hemodialysis-Specific Knowledge and Nonadherence | 853 | ||
| Addressing Hemodialysis Nonadherence | 853 | ||
| Conclusion | 854 | ||
| Recommended Reading | 854.e1 | ||
| 71 The Care of Elderly Dialysis and End-Stage Renal Disease Patients | 855 | ||
| Cognitive Impairment and Dementia | 855 | ||
| Executive Dysfunction | 855 | ||
| Screening | 856 | ||
| Management | 856 | ||
| Behavioral and Psychological Symptoms of Dementia | 857 | ||
| Depression | 857 | ||
| Presentation | 857 | ||
| Screening | 857 | ||
| Management | 858 | ||
| Instability and Falls | 858 | ||
| Screening | 859 | ||
| Dialysis-Related Risk Factors | 859 | ||
| Postural Hypotension | 859 | ||
| Vitamin D Supplementation | 859 | ||
| Biochemical Abnormalities | 859 | ||
| Environmental Risks Within the Dialysis Unit | 860 | ||
| Polypharmacy | 860 | ||
| Visual Impairment | 860 | ||
| Multifactorial Management | 860 | ||
| Patients With Cognitive Impairment | 860 | ||
| Immobility and Rehabilitation | 860 | ||
| Geriatric Rehabilitation | 861 | ||
| Exercise Training | 861 | ||
| Polypharmacy and Safe Prescribing | 861 | ||
| Advance Care Planning | 862 | ||
| Prognostic Tools | 863 | ||
| Substitute Decision Makers | 863 | ||
| Nondialytic Management | 863 | ||
| Conclusion | 864 | ||
| Recommended Reading | 864.e1 | ||
| XXVII Pediatric Dialysis | 865 | ||
| 72 Vascular Access in Children | 867 | ||
| Arteriovenous Fistulas | 867 | ||
| Preparation | 868 | ||
| Location | 868 | ||
| Preoperative Planning | 869 | ||
| Surgical Considerations | 869 | ||
| Postoperative Care and Maturation | 870 | ||
| Cannulation | 870 | ||
| Complications | 870 | ||
| Long-Term Care and Monitoring of Arteriovenous Fistulas | 871 | ||
| Arteriovenous Graft | 871 | ||
| Comparison With Arteriovenous Fistula | 873 | ||
| Composition | 873 | ||
| Complications | 873 | ||
| Central Venous Catheters | 874 | ||
| Characteristics | 874 | ||
| Location and Placement | 874 | ||
| Infants and Small Children | 875 | ||
| Long-Term Care | 875 | ||
| Complications | 876 | ||
| Recommended Reading | 876.e1 | ||
| 73 Infant Hemodialysis | 877 | ||
| Vascular Access | 877 | ||
| Equipment/Preparation | 878 | ||
| Dialysis Prescription for the Infant: Special Considerations | 879 | ||
| Chronic Hemodialysis | 881 | ||
| Recommended Reading | 881.e1 | ||
| 74 Urea Kinetic Modeling for Hemodialysis Prescription in Children | 882 | ||
| Chronic Hemodialysis in Children | 882 | ||
| The Dialysis Prescription in Children | 883 | ||
| Principles of Urea Kinetic Modeling in Children | 884 | ||
| Data Collection | 885 | ||
| Common Errors in Calculations | 885 | ||
| Application of Urea Kinetic Modeling | 886 | ||
| National Kidney Foundation Kidney Disease Outcomes Quality Initiative Pediatric Recommendations for Dialysis Adequacy | 887 | ||
| Recommended Reading | 888.e1 | ||
| 75 Hemodiafiltration in Children | 889 | ||
| Dialysis: Diffusion, Convection, and Combination Therapy | 889 | ||
| Optimizing the Determined Convective Volume: Pre-, Post-, or Mixed-Dilution Hemodiafiltration | 892 | ||
| Internal Hemodiafiltration Versus Online Hemodiafiltration | 893 | ||
| Safety and Quality Control in Hemodiafiltration | 894 | ||
| The Impact of Hemodiafiltration on Solute Removal | 895 | ||
| Requirements for Hemodiafiltration in Children | 896 | ||
| Writing a Hemodiafiltration Prescription for Children | 896 | ||
| Advantages of Hemodiafiltration Over Conventional Hemodialysis: Pediatric Studies | 897 | ||
| Conclusions | 898 | ||
| Recommended Readings | 898.e1 | ||
| 76 Home Hemodialysis in Children | 899 | ||
| What Is the Optimal Dialysis Dose? | 899 | ||
| Adult Home Hemodialysis Experience | 899 | ||
| Pediatric Home Hemodialysis Experience | 900 | ||
| Infrastructure | 900 | ||
| Finances | 901 | ||
| Staffing and Around-the-Clock Support | 901 | ||
| Training and Education | 901 | ||
| Dialysis Equipment | 902 | ||
| Dialysis Systems Requiring Home Water Conversions | 902 | ||
| Mobile Hemodialysis System: NxStage | 902 | ||
| Patient Selection | 903 | ||
| Prescriptions | 904 | ||
| Dialysis Adequacy | 905 | ||
| Conclusion | 905 | ||
| Recommended Reading | 905.e1 | ||
| 77 Anticoagulation in Children Undergoing Hemodialysis | 906 | ||
| General Considerations | 906 | ||
| Unfractionated Heparin | 907 | ||
| Low-Molecular-Weight Heparins | 908 | ||
| Systemic Anticoagulants as Alternatives to Heparins | 909 | ||
| Regional Anticoagulation With Citrate | 910 | ||
| Other Regional Anticoagulants | 913 | ||
| Central Venous Line Locks and Treatment of Clotted Catheters | 913 | ||
| Recommended Reading | 913.e1 | ||
| 78 Peritoneal Dialysis Catheter Placement in Children | 914 | ||
| Types of Peritoneal Catheters | 914 | ||
| Preoperative Surgical Considerations | 916 | ||
| Omentectomy and Fibrin Sealants | 917 | ||
| Surgical Techniques | 917 | ||
| Open Technique | 918 | ||
| Laparoscopic Technique | 919 | ||
| Postimplantation Care | 920 | ||
| Timing of Catheter Use | 920 | ||
| Mechanical Complications | 921 | ||
| Exit-Site Infection, Tunnel Infection, and Peritonitis | 922 | ||
| Complications With Peritoneal Dialysis Catheter Removal | 922 | ||
| Recommended Reading | 923.e1 | ||
| 79 Prescribing Peritoneal Dialysis in Children | 924 | ||
| Initiation of Dialysis in Children | 924 | ||
| Factors to Consider in Modality Choice in Children | 925 | ||
| Prescription Components | 927 | ||
| Prevalence of Peritoneal Dialysis Use in Children | 929 | ||
| Recommended Reading | 930.e1 | ||
| 80 Nutritional Management of Children Undergoing Peritoneal Dialysis | 931 | ||
| Assessment of Growth and Nutritional Status | 931 | ||
| Growth Parameters | 931 | ||
| Dietary Intake | 932 | ||
| Physical Examination | 933 | ||
| Adequacy of Dialysis | 933 | ||
| Dietary Prescription | 933 | ||
| Energy | 933 | ||
| Lipids | 935 | ||
| Fiber | 935 | ||
| Protein | 935 | ||
| Calcium and Vitamin D | 936 | ||
| Phosphate | 936 | ||
| Micronutrients: Vitamins and Trace Elements | 937 | ||
| Fluids and Electrolytes | 938 | ||
| Fluid | 938 | ||
| Sodium | 938 | ||
| Potassium | 938 | ||
| Carnitine | 939 | ||
| Delivery of Nutrition | 939 | ||
| Use of Recombinant Human Growth Hormone Therapy | 939 | ||
| Summary | 940 | ||
| Recommended Reading | 940.e1 | ||
| 81 Peritoneal Dialysis in Neonates and Infants | 941 | ||
| Introduction | 941 | ||
| Peritoneal Dialysis as a Renal Replacement Modality for AKI | 941 | ||
| Peritoneal Dialysis Access in AKI | 942 | ||
| Prescription Considerations for AKI | 942 | ||
| The Chronic Setting: ESRD | 943 | ||
| Peritoneal Dialysis as a Renal Replacement Modality for ESRD | 943 | ||
| Peritoneal Dialysis Access for ESRD | 944 | ||
| Prescription Considerations in ESRD | 945 | ||
| Outcome in ESRD | 947 | ||
| Conclusion | 947 | ||
| Recommended Reading | 947.e1 | ||
| 82 Dialysis in Inborn Errors of Metabolism | 948 | ||
| Techniques of Metabolite Removal | 949 | ||
| Extracorporeal Blood Purification | 950 | ||
| Dialysis Equipment | 950 | ||
| Catheter | 950 | ||
| Dialyzer | 950 | ||
| Dialysis Device and Tubing | 950 | ||
| Anticoagulation | 951 | ||
| Management Guidelines | 953 | ||
| Peritoneal Dialysis | 954 | ||
| Catheter | 954 | ||
| Dialysis Prescription | 954 | ||
| Recommended Reading | 954.e1 | ||
| 83 Neurocognitive Functioning in Children Undergoing Dialysis | 955 | ||
| Cognitive Function in Pediatric Chronic Kidney Disease | 955 | ||
| Dialysis and Its Effects on Neurocognition | 956 | ||
| Types of Dialysis and Their Impact on Cognition | 956 | ||
| Findings in Infants and Toddlers | 962 | ||
| Findings in Older Children and Adolescents | 962 | ||
| Summary and Conclusions | 963 | ||
| Recommended Reading | 964.e1 | ||
| 84 Growth in Children With End-Stage Renal Disease | 965 | ||
| Introduction | 965 | ||
| Growth Patterns | 967 | ||
| Assessment of Growth | 969 | ||
| Growth Failure in CKD | 969 | ||
| Underlying Renal Disease | 969 | ||
| Protein–Energy Malnutrition | 970 | ||
| Metabolic Acidosis | 970 | ||
| CKD–Mineral Bone Disorder | 971 | ||
| Anemia | 971 | ||
| Endocrine Dysfunction | 971 | ||
| Treatment | 973 | ||
| General Measures | 973 | ||
| Dialysis and Intensified Dialysis | 974 | ||
| Transplant | 974 | ||
| Growth Hormone Therapy | 974 | ||
| Summary | 978 | ||
| Recommended Reading | 978.e1 | ||
| 85 Adequacy of Peritoneal Dialysis/Assessing Peritoneal Function in Pediatric Patients | 979 | ||
| Adequate versus Optimal Dose of Dialysis | 979 | ||
| Prescription of Peritoneal Dialysis | 980 | ||
| Choice of Peritoneal Dialysis Modality | 980 | ||
| Initial Dialysis Prescription | 980 | ||
| Peritoneal Equilibration Test | 981 | ||
| Personal Dialysis Capacity Test | 982 | ||
| Mass Transfer Area Coefficient (MTAC) | 982 | ||
| Measurement of Peritoneal Dialysis Dose | 983 | ||
| Adequacy Recommendations | 988 | ||
| Solute Clearance | 988 | ||
| Maintenance of Euvolemia | 989 | ||
| Timing and Frequency of Solute Clearance and Ultrafiltration Measurement | 989 | ||
| Adjusting the Dialysis Prescription by Computer Modeling | 990 | ||
| Summary | 990 | ||
| Recommended Reading | 992.e1 | ||
| 86 Continuous Renal Replacement Therapy in Pediatric Patients | 993 | ||
| Introduction | 993 | ||
| Indication and Timing of Initiation | 994 | ||
| Mechanism of Clearance and Options for Therapy | 996 | ||
| Access | 999 | ||
| Prescription | 1001 | ||
| Solutions | 1002 | ||
| Anticoagulation | 1003 | ||
| Membrane and Filter | 1006 | ||
| Nutrition | 1006 | ||
| Inborn Errors of Metabolism | 1007 | ||
| Extracorporeal Membrane Oxygenation | 1007 | ||
| Intoxications | 1007 | ||
| Conclusion | 1008 | ||
| Recommended Reading | 1008.e1 | ||
| 87 Prevention and Treatment of Bone Disease in Pediatric Dialysis Patients | 1009 | ||
| Pathogenesis of Abnormal Mineral Metabolism in CKD | 1009 | ||
| Role of Fibroblast Growth Factor 23 | 1009 | ||
| Role of 1,25(OH)2D | 1009 | ||
| Role of 25(OH)D | 1010 | ||
| Role of Phosphorus | 1010 | ||
| Alterations in the Parathyroid Gland Calcium Sensing Receptor Expression | 1010 | ||
| Role of Skeletal Resistance to Parathyroid Hormone | 1011 | ||
| Renal Osteodystrophy | 1012 | ||
| Abnormalities in Bone Turnover, Mineralization, and Volume | 1012 | ||
| Turnover | 1012 | ||
| Mineralization | 1013 | ||
| Volume | 1014 | ||
| Cardiovascular Disease | 1014 | ||
| Clinical Signs and Symptoms | 1015 | ||
| Growth Retardation | 1015 | ||
| Skeletal Deformities and Pain | 1015 | ||
| Myopathy | 1016 | ||
| Prevention and Treatment of CKD-MBD | 1016 | ||
| Dietary Manipulation of Calcium and Phosphorus | 1016 | ||
| Phosphate-Binding Agents | 1017 | ||
| Vitamin D Therapy | 1019 | ||
| Assessment and Treatment of 25(OH)D Deficiency | 1019 | ||
| Treatment With Active Vitamin D Sterols | 1020 | ||
| Calcimimetics | 1020 | ||
| Parathyroidectomy | 1021 | ||
| Growth Hormone Therapy | 1021 | ||
| Summary | 1022 | ||
| Recommended Reading | 1022.e1 | ||
| 88 Management of Anemia in Children Undergoing Dialysis | 1023 | ||
| Introduction | 1023 | ||
| Definition of Anemia | 1023 | ||
| Prevalence of Anemia in Chronic Kidney Disease | 1024 | ||
| The Effects of Anemia | 1024 | ||
| Testing for Anemia | 1025 | ||
| Testing for Iron Deficiency | 1025 | ||
| Vitamin and Mineral Deficiency | 1027 | ||
| Erythrocyte-Stimulating Agents | 1027 | ||
| Lack of Response to ESA | 1029 | ||
| Risk of Adverse Outcomes | 1029 | ||
| Iron Therapy | 1029 | ||
| Oral Iron Supplementation | 1029 | ||
| Intravenous Iron Supplementation | 1030 | ||
| Intradialytic Iron Supplementation | 1032 | ||
| Iron Safety | 1032 | ||
| Recommended Reading | 1033.e1 | ||
| 89 Assessing Quality of Life in Pediatric Patients Undergoing Dialysis | 1034 | ||
| Introduction | 1034 | ||
| Factors Impacting HRQOL Functioning | 1034 | ||
| Evolution of HRQOL Assessment | 1035 | ||
| Best Practice Considerations and Caveats | 1036 | ||
| Broadening the Scope to Include Intervention Planning | 1037 | ||
| Future Directions | 1038 | ||
| Recommended Reading | 1038.e1 | ||
| 90 Immunization in Children Undergoing Dialysis | 1039 | ||
| Vaccine Schedule: Current American Academy of Pediatrics Recommendations | 1039 | ||
| Summary of Recommendations From 2015 Red Book for Children With End Stage Kidney Disease, Including Transplant Candidates | 1039 | ||
| Hepatitis B | 1040 | ||
| Influenza Vaccine | 1040 | ||
| Pneumococcal Vaccine | 1041 | ||
| Special Situations | 1041 | ||
| Household Vaccination | 1042 | ||
| Live Organ Donor Vaccination | 1042 | ||
| Preparing for Transplantation in the Dialysis Patient | 1042 | ||
| Live Vaccines | 1042 | ||
| Varicella Vaccine | 1042 | ||
| Measles, Mumps, Rubella Vaccine | 1042 | ||
| Rotavirus | 1043 | ||
| Recombinant and Inactivated (“Killed”) Vaccines | 1043 | ||
| DTap, Tdap, and dT Vaccines | 1043 | ||
| Poliovirus Vaccine | 1043 | ||
| Haemophilus influenzae Type B Vaccine | 1043 | ||
| Pneumococcus Vaccine | 1043 | ||
| Hepatitis A Vaccine | 1044 | ||
| Hepatitis B Vaccine | 1044 | ||
| Influenza Vaccine | 1044 | ||
| Meningococcal Vaccine | 1044 | ||
| Human Papillomavirus | 1045 | ||
| Updating Immunizations for Dialysis Patients Awaiting Transplant | 1045 | ||
| Vaccine Response in the Dialysis Population: What Is the Evidence? | 1045 | ||
| Summary | 1046 | ||
| Recommended Reading | 1047.e1 | ||
| 91 Prevention and Treatment of Cardiovascular Complications in Children Undergoing Dialysis | 1048 | ||
| Cardiovascular Mortality in Children on Maintenance Dialysis | 1048 | ||
| Development of Cardiovascular Disease in Children With Chronic Kidney Disease | 1049 | ||
| Evaluation and Treatment Recommendations | 1050 | ||
| Echocardiographic Evaluation | 1050 | ||
| Hypertension | 1050 | ||
| Dyslipidemia | 1051 | ||
| Abnormal Calcium–Phosphorus Metabolism | 1052 | ||
| Anemia | 1053 | ||
| Malnutrition and Inflammation | 1053 | ||
| Dialysis Adequacy | 1054 | ||
| Recommended Readings | 1054.e1 | ||
| 92 Surgery in Children With End-Stage Renal Disease | 1055 | ||
| Preoperative Surgical Evaluation | 1055 | ||
| Perioperative Management | 1057 | ||
| Fluid Therapy | 1057 | ||
| Electrolyte Management | 1058 | ||
| Hypertension | 1059 | ||
| Infectious Complications | 1060 | ||
| Bleeding Complications | 1060 | ||
| Anemia | 1060 | ||
| Pain Control | 1061 | ||
| Surgical Considerations | 1061 | ||
| Summary | 1063 | ||
| Recommended Reading | 1063.e1 | ||
| 93 Infectious Complications in Children Undergoing Dialysis | 1064 | ||
| Peritoneal Dialysis | 1064 | ||
| Epidemiology | 1064 | ||
| Microbiology | 1064 | ||
| Preventive Strategies | 1066 | ||
| Diagnosis of Peritonitis | 1067 | ||
| Management of Peritonitis | 1067 | ||
| Adjunctive Therapies | 1071 | ||
| Refractory and Relapsing Peritonitis | 1072 | ||
| Catheter-Related Infections | 1072 | ||
| Postperitonitis | 1073 | ||
| Hemodialysis | 1073 | ||
| Epidemiology and Risk Factors | 1073 | ||
| Preventive Measures | 1073 | ||
| Treatment of Infection | 1074 | ||
| Future Steps | 1075 | ||
| Recommended Reading | 1075.e1 | ||
| 94 Adherence and Transition in the Pediatric Dialysis Patient | 1076 | ||
| Overview of Adherence | 1076 | ||
| Evaluating Nonadherence | 1076 | ||
| Variables Associated With Nonadherence | 1077 | ||
| Addressing Adherence | 1078 | ||
| Overview of Transition | 1079 | ||
| Transitional Procedures for Pediatric Dialysis Patients | 1080 | ||
| Evidence-Based Strategies for Transfer | 1080 | ||
| Functional Outcomes | 1082 | ||
| Conclusions | 1082 | ||
| Recommended Reading | 1082.e1 | ||
| XXVIII The Pregnant Patient | 1083 | ||
| 95 Pregnancy in Dialysis Patients | 1085 | ||
| Frequency of Pregnancy in Dialysis Patients | 1085 | ||
| Contraception | 1086 | ||
| Diagnosis of Pregnancy in Dialysis Patients | 1087 | ||
| Outcome of Pregnancy in Dialysis Patients | 1087 | ||
| Maternal Complications | 1088 | ||
| Hypertension | 1088 | ||
| Drug Therapy | 1088 | ||
| Anemia | 1089 | ||
| Peritonitis | 1089 | ||
| Dialysis Regimen | 1089 | ||
| Dialysis Modality | 1089 | ||
| Hemodialysis | 1090 | ||
| Peritoneal Dialysis | 1090 | ||
| Diet | 1091 | ||
| Obstetric Considerations | 1091 | ||
| Premature Labor | 1091 | ||
| Conclusions | 1092 | ||
| Recommended Reading | 1092.e1 | ||
| XXIX Miscellaneous Areas of Clinical Importance | 1093 | ||
| 96 Treatment of Poisoning With Extracorporeal Methods | 1095 | ||
| General Overview of the Treatment of the Poisoned Patient | 1095 | ||
| Background | 1095 | ||
| Initial Treatment | 1095 | ||
| Risk Assessment | 1096 | ||
| Decontamination | 1096 | ||
| Antidotes | 1096 | ||
| Enhanced Elimination | 1096 | ||
| Characteristics of a Potentially Dialyzable Toxin | 1097 | ||
| Physicochemical | 1097 | ||
| Pharmacokinetics | 1097 | ||
| Choice of Extracorporeal Treatment | 1098 | ||
| Hemodialysis | 1098 | ||
| Hemoperfusion | 1098 | ||
| Hemofiltration | 1100 | ||
| Continuous Renal Replacement Therapy | 1100 | ||
| Peritoneal Dialysis | 1101 | ||
| Therapeutic Plasma Exchange | 1101 | ||
| Exchange Transfusion | 1101 | ||
| Liver Support Devices (Albumin Dialysis) | 1101 | ||
| Technical Considerations | 1102 | ||
| General Principles Regarding the Use of Extracorporeal Treatment in the Treatment of Poisoning | 1102 | ||
| Specific Indications for Poisons That Are Currently Considered Dialyzable | 1104 | ||
| Recommending Reading | 1106.e1 | ||
| 97 Preventive Care in End-Stage Renal Disease | 1107 | ||
| Immunizations | 1107 | ||
| Hepatitis B Vaccine | 1107 | ||
| Influenza and H1N1 Vaccine | 1108 | ||
| Tetanus, Pneumococcal, Human Papillomavirus, and Varicella Zoster Vaccines | 1108 | ||
| Infection Prevention | 1109 | ||
| Diabetic Foot Care | 1109 | ||
| Dental Care | 1109 | ||
| Endocarditis Prophylaxis | 1109 | ||
| Tuberculosis Screening | 1110 | ||
| Screening | 1110 | ||
| Cancer Screening | 1110 | ||
| Falls and Frailty | 1112 | ||
| Falls | 1112 | ||
| Osteoporosis and Bone Mineral Density | 1113 | ||
| Frailty | 1113 | ||
| Abdominal Aortic Aneurysm | 1113 | ||
| Alcohol Abuse | 1113 | ||
| Cognitive Impairment | 1113 | ||
| Depression | 1114 | ||
| Vision | 1115 | ||
| Hearing | 1115 | ||
| Health Care Counseling | 1115 | ||
| Exercise | 1115 | ||
| Obesity and Weight Loss | 1116 | ||
| Tobacco Use and Cessation | 1116 | ||
| Contraception and Sexual Dysfunction | 1116 | ||
| Advance Care Planning and Palliative or Supportive Care | 1116 | ||
| Advance Care Planning | 1116 | ||
| Supportive (Palliative) Kidney Care | 1117 | ||
| Monitoring: Lipids, Glucose, Anemia, and Bone and Mineral Disorders | 1118 | ||
| Recommended Readings | 1118.e1 | ||
| 98 Application of Telemedicine to Patients With End-Stage Renal Disease | 1119 | ||
| Telemedicine in End-Stage Renal Disease: Overview of the Opportunity and Issues | 1119 | ||
| The Health Care System in the United States Presents Particular Challenges | 1120 | ||
| A Framework for Implementation of a Teledialysis Program | 1120 | ||
| Routine Nonemergent Nephrologist Rounding Use Case | 1121 | ||
| Emergent Use Case | 1122 | ||
| Home and Peritoneal Dialysis: Remote Monitoring Use Case | 1123 | ||
| Other Miscellaneous Use Cases | 1123 | ||
| Integrated Kidney Care (Global Capitation) Use Case | 1123 | ||
| Teledialysis Technology Requirements | 1124 | ||
| Bandwidth, Resolution, and Frame Rate Requirements: | 1124 | ||
| Information Technology Security Requirements | 1124 | ||
| Hardware and Video Requirements | 1125 | ||
| Hardware and Functionality | 1125 | ||
| Video | 1125 | ||
| Other | 1125 | ||
| Index | 1129 | ||
| A | 1129 | ||
| B | 1132 | ||
| C | 1134 | ||
| D | 1140 | ||
| E | 1144 | ||
| F | 1147 | ||
| G | 1147 | ||
| H | 1148 | ||
| I | 1151 | ||
| J | 1153 | ||
| K | 1153 | ||
| L | 1154 | ||
| M | 1155 | ||
| N | 1157 | ||
| O | 1158 | ||
| P | 1159 | ||
| Q | 1163 | ||
| R | 1163 | ||
| S | 1165 | ||
| T | 1167 | ||
| U | 1169 | ||
| V | 1170 | ||
| W | 1171 | ||
| X | 1171 | ||
| Y | 1171 | ||
| Z | 1171 | ||
| Inside Back Cover | ibc1 |