Tag Archive | "hemodialysis"

Study Finds Another Risk of Fall in Blood Pressure During Dialysis

A recent study led by researchers at the Stanford University School of Medicine found that there is an increased risk of blood clotting at the point where the patient’s blood vessels are connected to the dialysis machine known as the point of vascular access.  Researchers from the University of Utah also contributed to the study.  The study was published in the Journal of the American Society of Nephrology. This is yet another diverse consequence associated with a fall in blood pressure during dialysis for patients

Dialysis is a life-extending procedure for patients with kidney failure.  It involves sitting in a chair three or more times a week connected to an artificial kidney machine.  The patient’s blood is cleansed by exchanging fluid and electrolytes across a membrane during each three to four-hour session.

The fistula is one of the most common forms of vascular access.  It is created surgically from the patient’s own blood vessels.  The tubes used to transport blood to and from the body to the dialysis machine are connected to the body at this access point.  Clotting is one of the problems of an access point and can lead to its closure.

This study was based on results from the Hemodialysis study, known as HEMO, a National Institutes of Health-sponsored randomized clinical trial that collected data from 1,846 patients on hemodialysis from 1995 to 2000.  This study included data from 1,426 of these patients.

The team found that patients who had the most frequent episodes of low blood pressure during dialysis were two times more likely to have a clotted fistula than patients with the least episodes.

Roughly $2 billion a year is spent on vascular access in dialysis patients in the United States. Low blood pressure during dialysis occurs in about 25 percent of dialysis sessions.

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Dialysis At Home Improves Sleep Problems From Restless Legs Syndrome

A study earlier this year published in the Clinical Journal of the American Society of Nephrology (CJASN) found that performing daily dialysis at home for dialysis patients can help alleviate sleep problems related to restless legs syndrome (RLS).  RLS is a common problem for dialysis patients, and it affects hemodialysis patients about four times as often as people in the general population.  The study was conducted by lead author Bertrand L. Jaber, MD, of St. Elizabeth’s Medical Center in Boston and colleagues.

The preliminary report was part of the FREEDOM study, which evaluates SDHD as an alternative to dialysis center treatment.  SDHD allows patients to perform dialysis at home for a few hours, six days per week.  This is the largest U.S.-based observational study examining the potential clinical and economic benefits of home SDHD.

Data on 235 patients was analyzed to reveal how SDHD affected symptoms of RLS.  RLS is manifested by a “pins and needles” or crawling sensation that are relieved by moving the legs.  These symptoms may lead to sleep problems.  Although it is not known what causes, RLS, RLS has been linked to increased rates of heart complications and death.

Switching to SDHS led to significant improvement in RLS-related symptoms for patients in the study.  Jaber reports a decline in the percentage of patients reporting RLS and those reporting moderate-to-severe symptoms over twelve months.  Patients also reported continued improvement in sleep disorders even after adjustment for the presence of RLS and for use of anti-anxiety or sedative drugs.  Future results from this study will determine how SDHD affects hospitalization rates and overall non-treatment related costs in dialysis patients.

Important limitations in the study included selection bias from the recruitment of a relatively young patient population and the absence of a control group.

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Johns Hopkins Students Create Device to Improve Kidney Dialysis Process

Bioengineering graduate students at Johns Hopkins University have invented a device that can reduce the risk of infection, clotting, and narrowing of the blood vessels in kidney dialysis patients.

The students discovered the need for such a device last year when they accompanied physicians on hospital rounds as part of their program.  One doctor had to perform a procedure to open a narrowed blood vessel at a kidney patient’s dialysis access site.  The students found out that this narrowing was a common problem among kidney dialysis patients.

These students learned that 350,000 people in the United States and 1.5 million people worldwide experience kidney failure that requires them to undergo hemodialysis to prevent a fatal buildup of toxins in the bloodstream.  They found out that the three most common ways to connect the machine to the patient’s bloodstream only work for a short time because of problems with infection, blood clots and narrowing of the blood vessels.  The students found these current options to be “grossly inadequate” and lead to increased healthcare expenses and sometimes patient deaths.

While the device, the Hemova Port, has not been tested in human patients, it has been used in tests on animals.  The prototype is designed to be implanted under the skin of a patient’s leg, giving technicians easy access to the patient’s bloodstream and reducing the risk of infection and clotting.  The device’s two valves can be easily opened and closed at the beginning and end of a dialysis procedure with a technician’s syringe from outside the skin.  Furthermore, the devise includes a simple cleaning system, which helps prevent infections.

The students’ device won them a $10,000 first prize in the 2011 American Society of Mechanical Engineers (ASME) showcase.  The five biomedical engineering students on the team were enrolled in a one-year master’s degree program at Johns Hopkins University’s Center for Bioengineering Innovation and Design.  Sherri Hall, Peter Li, Shishira Nagesh, Mary O’Grady and Thora Thorgilsdottir all recently graduated, but Li, along with Brandon Doan, has remained in Baltimore to form a company that will continue to test and develop the project.  The other four team members will serve as consultants for the project.  The team has filed for three provisional patents covering their device and applied for grants for further testing.

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