The problem and challenge faced by hemodialysis

doi:10.3877/cma.j.issn.2095-3216.2015.03.001

Abstract

Abstract:

Although hemodialysis has been applied to clinical treatment for more than 90 years and become the main treatment for patients with acute and chronic renal failures, nephrologists are still faced with many problems and challenges. The rapid increase of hemodialysis patients in our country will bring serious challenges to China′s health care, which is in urgent need of being supported by more social capital participation and cultivation of qualified hemodialysis medical workers. There are still controversies. From the basic technical level of hemodialysis: when is the best time for hemodialysis initiation? Is intravascular fistula definitely the first choice of vascular access? What is the suitable calcium concentration of dialysate for hemodialysis patients? Besides, from the aspect of prevention and treatment of hemodialysis complications in dialysis patients: what is the target of blood pressure control? How about the target for parathyroid hormone control? In this article, the existing literature evidence was reviewed in order to provide reference for clinical doctors in clinical practice.

Key words: Hemodialysis, Vascular accesss, Dialysate, Complication

Xuefeng Sun. The problem and challenge faced by hemodialysis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(03): 114-117.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2015.03.001

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2015/V04/I03/114

References 27

[1]	Zhang L, Wang F, Wang L，et al. Prevalence of chronic kidney disease in China: a cross-sectional survey [J]. Lancet, 2012, 379(9818): 815-822.
[2]	Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults [J]. JAMA, 2013, 310(9): 948-959.
[3]	Gao Y, Chen G, Tian H, et al. Prevalence of hypertension in china: a cross-sectional study [J]. PLoS One, 2013, 8(6): e65938.
[4]	Imai E, Horio M, Watanabe T, et al. Prevalence of chronic kidney disease in the Japanese general population [J]. Clin Exp Nephrol, 2009, 13(6): 621-630.
[5]	Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006 [J]. Am J Kidney Dis, 2006, 48 (Suppl 1): S2-S90.
[6]	Wright S, Klausner D, Baird B, et al. Timing of dialysis initiation and survival in ESRD [J]. Clin J Am Soc Nephrol, 2010, 5(10): 1828-1835.
[7]	Clark WF, Na Y, Rosansky SJ, et al. Association between estimated glomerular filtration rate at initiation of dialysis and mortality [J]. CMAJ, 2011, 183(1): 47-53.
[8]	Hwang SJ, Yang WC, Lin MY, et al. Impact of the clinical conditions at dialysis initiation on mortality in incident haemodialysis patients: a national cohort study in Taiwan [J]. Nephrol Dial Transplant, 2010, 25(8): 2616-2624.
[9]	Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis [J]. N Engl J Med, 2010, 363(7): 609-619.
[10]	Quinn RR, Ravani P. Fistula-first and catheter-last: fading certainties and growing doubts [J]. Nephrol Dial Transplant, 2014, 29(4): 727-730.
[11]	Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review [J]. J Am Soc Nephrol, 2013, 24(3): 465-473.
[12]	Battistella M, Bhola C, Lok CE. Long-term follow-up of the Hemodialysis Infection Prevention with Polysporin Ointment (HIPPO) Study: a quality improvement report [J]. Am J Kidney Dis, 2011, 57(3): 432-441.
[13]	Blake PG, Quinn RR, Oliver MJ. Peritoneal dialysis and the process of modality selection [J]. Perit Dial Int, 2013, 33(3): 233-241.
[14]	Konner K, Hulbert-Shearon TE, Roys EC, et al. Tailoring the initial vascular access for dialysis patients [J]. Kidney Int, 2002, 62(1): 329-338.
[15]	Bolland MJ, Grey A, Avenell A, et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the women's health initiative limited access dataset and meta-analysis [J]. BMJ, 2011, 342：d2040.
[16]	K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients [J]. Am J Kidney Dis, 2005, 45(4 Suppl 3): S1-S153.
[17]	Tentori F, Hunt WC, Rohrscheib M, et al. Which targets in clinical practice guidelines are associated with improved survival in a large dialysis organization [J]? J Am Soc Nephrol, 2007, 18(8): 2377-2384.
[18]	Robinson BM, Tong L, Zhang J, et al. Blood pressure levels and mortality risk among hemodialysis patients in the dialysis outcomes and practice patterns study [J]. Kidney Int, 2012, 82(5): 570-580.
[19]	Hörl WH. Hypertension in end-stage renal disease: different measures and their prognostic significance [J]. Nephrol Dial Transplant, 2010, 25(10): 3161-3166.
[20]	Chang TI, Friedman GD, Cheung AK, et al. Systolic blood pressure and mortality in prevalent haemodialysis patients in the HEMO study [J]. J Hum Hypertens, 2011, 25(2): 98-105.
[21]	Agarwal R. Managing hypertension using home blood pressure monitoring among haemodialysis patients--a call to action [J]. Nephrol Dial Transplant, 2010, 25(6): 1766-1771.
[22]	Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population [J]. Nephrol Dial Transplant, 2011, 26(6): 1948-1955.
[23]	Naves-Díaz M, Passlick-Deetjen J, Guinsburg A, et al. Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study [J]. Nephrol Dial Transplant, 2011, 26(6): 1938-1947.
[24]	Kalantar-Zadeh K, Shah A, Duong U, et al. Kidney bone disease and mortality in CKD: revisiting the role of vitamin D, calcimimetics, alkaline phosphatase, and minerals [J]. Kidney Int, 2010, Suppl 117: S10-S21.
[25]	Dukkipati R, Kovesdy CP, Colman S, et al. Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients [J]. J Ren Nutr, 2010, 20(4): 243-254.
[26]	Nakai S, Akiba T, Kazama J, et al. Effects of serum calcium, phosphorous, and intact parathyroid hormone levels on survival in chronic hemodialysis patients in Japan [J]. Ther Apher Dial, 2008, 12(1): 49-54.
[27]	Souberbielle JC, Boutten A, Carlier MC, et al. Inter-method variability in PTH measurement: implication for the care of CKD patients [J]. Kidney Int, 2006, 70(2): 345-350.

Please choose a citation manager

Content to export