Present and Future Therapies for End-Stage Renal Disease

The following sections are included:

• Contents

At the close of 2009, as this is revised, the severity and course of progressive chronic kidney disease (CKD) is defined by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative¹ in five stages, with diagnostic and management guidelines for each…

The following sections are included:

• History of Peritoneal Dialysis

• Landmarks in Technologies and Techniques in the Last Half-Century
  • Plastic bags
  • Y system
  • Double bag system
  • Continuous ambulatory peritoneal dialysis
  • Automated peritoneal dialysis
  • Compact cycler machine
  • Dialysate solutions
  • Removal of the high clearance target

• Epidemiology

• Typical Use

• Types of Peritoneal Dialysis

• Specific Requirements for Peritoneal Dialysis

• Drawbacks
  • Peritonitis
  • Protein loss
  • Gastrointestinal complications
  • Advanced glycosylated end products
  • Electrolyte imbalances

• Advantages
  • Residual renal function
  • Cost
  • Better blood pressure and anemia control

• Recent Uses; Innovations in Peritoneal Dialysis Techniques and Technologies
  • Congestive heart failure
  • Solutions
  • Convenience

• The Future of Peritoneal Dialysis

• References

The following sections are included:

• Introduction

• History of Hemodialysis

• Process of Hemodialysis

• Hemodialysis Machine

• Water Treatment System for Hemodialysis

• When is the Time to Initiate Hemodialysis Treatment?

• Dialysis Vascular Access

• Monitoring of Vascular Access

• Hemodialysis Treatment

• Dialysis Prescription

• Complications Related to Hemodialysis

• References

The following sections are included:

• Introduction

• Historical Perspective

• Trends in Kidney Transplantation

• Patient Survival

• Graft Survival

• Approaches to Increasing the Donor Pool

• Global Trends

• Evaluation for Kidney Donation

• Evaluation of Kidney Transplant Candidates
  • Cardiovascular disease
  • Infections
  • Malignancy

• Disease Recurrence

• Histocompatibility
  • Immunosuppression
    • Basics of alloreactivity
  • Immunosuppressive Agents
    • Calcineurin inhibitors
    • Antimetabolites
    • Corticosteroids
    • mTOR inhibitors
    • Monoclonal and polyclonal antibodies
    • Immunosuppression protocols

• Posttransplant Care

• Treatment of acute rejection

• Infections

• Malignancy

• Future Directions

• Summary

• References

The following sections are included:

• Introduction

• Early History

• Benefits of Home Hemodialysis
  • Survival
  • Other advantages

• Cost

• Barriers to Home Hemodialysis

• Present and Future Home Hemodialysis

• Reported Benefits of More Frequent Dialysis

• References

The following sections are included:

• Introduction and Basic Principles
  • Hemodialysis
  • Hemofiltration
  • Hemodiafiltration
    • Substitution fluid

• Intermittent Modes of Therapy: On-Line Intermittent Hemodialysis, Hemofiltration and Hemodiafiltration

• Continuous Renal Replacement Therapies: Continuous Hemofiltration and Hemodiafiltration
  • CRRT access characteristics — venovenous or arteriovenous
  • Anticoagulation during CRRT
    • Heparin
    • Citrate
    • Selection of anticoagulation
  • Forms of continuous renal replacement therapies
    • Slow extended hemofiltration
    • Continuous venovenous hemofiltration
    • Continuous arteriovenous hemofiltration
    • Continuous venovenous hemodialysis
    • Continuous arteriovenous hemodialysis
    • Continuous venovenous hemodiafiltration
    • Continuous arteriovenous hemodiafiltration
  • Choice of therapy
    • Examples
  • Specific indications for CRRT
    • Acute renal failure
    • Contrast-media-induced nephropathy
    • Septic shock

• Conclusions

• References

The purpose of this chapter is to discuss the modality of hemodialysis performed by the patient in the hemodialysis center. This is self-care incenter hemodialysis (SCICHD), a modality which allows the patient to move from a level of near-total dependency to independence. Patient education allows the patient to gain control over the hemodialysis procedure. SCICHD can be performed in the home once the patient is trained in the modality or the patient may continue to perform the modality in the outpatient center. SCICHD is empowering and gives control to patients who have become end-stage…

The following sections are included:

• Historical Perspectives

• Scope of the Problem

• Clinical Aspects of WD: Factors

• Legal and Ethical Aspects of WD

• Palliative Care for People Refusing Dialysis and Opting for Death

• References

The following sections are included:

• Background

• Ethics of the Organ Transplant Center in an Organ Shortage

• Ethics of the Transplant Candidate in an Organ Shortage

• The Black Market in Kidneys Circa 2009

• The Regulated Market in Kidneys Circa 2012

• Conclusions

• References

For the last six decades, dialysis has changed kidney failure from a death sentence to a treatable condition. Yet, as more than 1, 2 million patients sustain life by subjecting themselves to different renal replacement treatments, the outcomes of end stage renal disease (ESRD) treatment remain unacceptably poor, in terms of both mortality¹ and the miserable quality of life of these patients.^2–4 Furthermore, the mortality of ESRD patients on renal replacement therapy (RRT) is similar to that for metastatic carcinomata of the breast or colon. Even though thanks to the development of RRTs the nephrology community succeeded in keeping all these patients alive for quite some time, we have plenty to do to improve the plight of these unfortunate patients in terms of both life span and life quality. Not to be ignored is that RRTs are expensive and the ever-increasing costs of and demand for medical care for ESRD make RRT one of the major cost centers of the healthcare budget of most countries…

Following the first successful syngraft (identical twin–twin kidney transplantation) in 1955,¹ this therapy has been extended to include different types of allografts (nontwin human–human transplantation) from living and deceased donors. The increasing prevalence of end stage renal disease (ESRD)² as well as many other vital organ failures but grossly insufficient number of allografts calls for novel ways, notably xenografts (organs or tissues from different species), to meet this ever-increasing demand. Currently 13 patients die each day in the United States while on the waiting list to receive life-saving vital organ transplants and about 60% of patients with organ failure die without ever receiving a transplant. In this chapter, we will review the concept of xenotransplantation and some of the challenges that need to be met before clinical xenotransplantation becomes a reality.

The following sections are included:

• Bowel as Kidney
  • Bowel as a kidney: Oral sorbents

• Diarrhea Therapy
  • Bacterial enzyme nitrogen recycling within the gut

• References

The following sections are included:

• Index