By C. Ronco, N.W. Levin

Reprint of: Blood Purification 2001, Vol. 19, No. 2 during this well timed booklet, quite a few subject matters on the topic of ESRD are mentioned, together with vascular sickness and atherosclerosis in uremia, results of hemodialysis sufferers in numerous nations, malnutrition in addition to oxidative pressure and persistent irritation as threat elements for heart problems. in addition, the possibility of utilizing peritoneal dialysis as a primary therapy modality for ESRD is debated, including the advantages that may be completed with day-by-day dialysis. extra themes contain the main complicated recommendations for electrolyte tracking and profiling in hemodialysis in addition to the remedy of acute renal failure, describing the recent acute dialysis caliber initiative. one other vital a part of this booklet is an argument on even if hemoglobin degrees in pre-ESRD and hemodialysis sufferers will be normalized or now not, by way of a dialogue of the aptitude long term advantages of a brand new know-how coupling hemoperfusion with hemodialysis, using a brand new sorbent equipment. A definition of the genuine application of those applied sciences in day-by-day scientific perform and whether or not they are economically cheaper with current compensation regulations rounds off the displays. Being the second one quantity during this sequence (see additionally the volumes for the years 2000, 2002 and 2003), this booklet is meant to function a syllabus for meetings in addition to an academic instrument for fellows and citizens. while, it offers a such a lot valuable replace on fresh perform and expertise for all physicians thinking about the sphere of hemodialysis.

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Additional info for Advances in End-Stage Renal Diseases 2001: International Conference on Dialysis Iii, Miami Beach, Fla., January 2001

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It is the purpose of this discourse to make the argument that many of these comorbidities, often seen as inevitable components of kidney failure, could be prevented if relatively normal hemoglobin concentration were maintained during the entire period of pCKD. The optimal hemoglobin (Hb)/hematocrit (Hct) during EPO therapy in both ESRD and pCKD patients should be ABC © 2001 S. com/journals/bpu one that maximizes cardiovascular function and activities of daily life (ADL) while minimizing risk. Different organs respond differently to correction of anemia, an effect that confounds the search for optimum Hb.

16], showed an 80% increase in epoetin dose requirements in the patients targeting a normal hemoglobin. With the current fairly high costs of epoetin therapy, it is difficult to justify this extra expenditure for what may be a limited benefit. Using this 80% increase in epoetin dose requirements, the health economist would be able to calculate that for every 5 patients treated for normalization of hemoglobin, he can treat 9 patients aiming for partial correction of anemia. If the cost of epoetin were to reduce, then this argument may be less strong, but there is no sign of this at the present time.

This makes it impossible to draw any firm conclusions either way regarding this issue. As discussed previously, however, there may be a stronger case for normalizing hemoglobin in pre-ESRD patients who have not been exposed to anemia for such a long time and who have not been rendered severely anemic. There is increasing interest in starting epoetin at an earlier stage in the development of renal failure, and indeed there is an increasing scientific rationale for doing so [27]. We are now aware that by the time the patients are started on regular dialysis treatment, they already have a high chance of having cardiac pathology, either with left ventricular hypertrophy [28], left ventricular dilatation [29], or systolic dysfunction.

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