Ahmed Alayoud

Introduction: The degree of interdialytic weight gain and ultrafiltration may influence anemia results in dialysis. The purpose of this study is to evaluate the utility of a blood volume monitor (BVM) in the management of renal anemia and its ability to avoid the variability of hematocrit (Hct) and hemoglobin values (Hb) depending on plasma volume through a simple method of monitoring the total hemoglobin mass (M_tHb).Methods: Predialysis blood samples for measurement were drawn at both the midweek treatment and the beginning‐of‐the‐dialysis‐week treatment in 30 patients. The M_tHb was calculated as M_tHb = V_b × Hb, where V_b is the absolute blood volume determined by online dialysate dilution using an online hemodiafiltration machine incorporating a relative BVM.Findings: The M_tHb and the total red cell volume (V_RBC) as measured with the bolus method at the starting of the treatment were 540 ± 148 grams and 1544 ± 339 mL, respectively. There were significant differences between the Hb levels and between the hematocrit levels according to the time of dialysis. However, the M_tHb remained constant. There was also an excellent correlation between the Hb measurements by the BVM and the blood sampling method (R = 0.89, P value <0.001).Conclusion: Our study suggests that BVM could be very useful in the management of anemia in dialysis by computing the total Hb mass in clinical practice and may support better and more appropriate assessments of the factors influencing circulating Hb.

Introduction: Chez le patient hémodialysé les réticulocytes sont des marqueurs de l’érythropoïèse et augmentent après la prise d’érythropoïétine. Cependant, leur taux est d’interprétation difficile et leur utilité est mal connue dans la gestion de la prescription d’érythropoïétine (EPO). Le but donc de ce travail est de voir l’intérêt de suivre la cinétique du taux de réticulocytes dans la gestion de l’anémie chez les patients dialysés. Matériels et méthodes Il s’agit d’une étude rétrospective monocentrique réalisée chez 21 hémodialysés chroniques entre avril 2014 et août 2014. Le taux de réticulocytes a été déterminé par cryométrie de flux. Nous avons comparé et suivi la cinétique de réticulocytes chez deux groupes de patient : groupe1 (15 patients), ceux sous agent simulant l’érythropoïèse de façon hebdomadaire (la darbopoïétine alpha : une fois par semaine ou Erytrhpoiting beta au moins une fois par semaine. Groupe 2 (6 patients), ceux sous ASE mensuel ou bimensuel : Mircera (une fois par mois) ou darbopoïétine alpha (une fois tous les 15 jours). Résultats: Aucune différence significative n’a été observée entre le groupe des patients sous EPO hebdomadaire (groupe 1) et le groupe des patients sous ASE mensuel ou bimensuel (groupe 2) concernant : les taux d’hémoglobine (Hb), l’hématocrite, le nombre des globules rouges et la cinétique d’Hb. La différence était significative pour la cinétique de réticulocyte. Aucune corrélation significative entre la cinétique de réticulocyte et celle d’Hb n’a été trouvée dans l’ensemble de la population et dans le groupe 2. Par contre, elle était significative dans le groupe sous EPO hebdomadaire. Discussion: La cinétique reticulocytaire est variable selon l’intervalle de prise d’EPO. Son suivi dans la prise en charge de l’anémie en dialyse ne pourrait être utile que chez les patients sous EPO de courte durée d’action. Conclusion: À l’issue de ces résultats, le taux de réticulocytes en dialyse doit être interprété en fonction de la date de prélèvement après l’injection et du type d’ASE utilisé.

It has been suggested that a dialysate calcium concentration of 1.5 mmol/L is a compromise between bone protection and cardiovascular risk. This study aimed to investigate the effect of reducing dialysate calcium concentration to 1.5 mmol/L on mineral metabolism and hemodynamic parameters. Dialysate calcium concentration was changed from 1.75 mmol/L to 1.5 mmol/L for 9 months and observed the effects on mineral metabolism and dialysis outcome parameters in 52 hemodialysis patients. The results at 9 months demonstrated that postdialytic serum calcium level decreased significantly from 109 ± 7 mg/L to 102 ± 6 mg/L, intact parathyroid hormone (PTH) increased from 372 ± 52 pg/mL to 606 ± 80 pg/mL, and the oral alfacalcidol increased from 1.4 ± 0.3 µg/w to 3.3 ± 0.4 µg/w. In patients with low PTH levels, continuous increase of PTH was observed. There were no significant variation in the oral calcium carbonate dose and serum levels of alkaline phosphatase, predialytic calcium, and pre- and postdialytic phosphorus. The ultrafiltration rate and postdialysis systolic blood pressure were significantly lower after reducing the dialysate calcium concentration to 1.5 mmol/L. Intradialytic hypotension and cramps were more frequent with this dialysate calcium concentration. These findings demonstrated that a decrease in dialysate calcium concentration from 1.75 mmol/L to 1.5 mmol/L improved mineral metabolism by prevention of postdialytic hypercalcemia and releasing oversuppression of PTH, but it was associated with more use of oral alfacalcidol and more hemodynamic impairment.

The Blood Temperature Monitor module (BTM) is used to measure recirculation by thermodilution in dialysis. Numerous studies have confirmed its interest in the measuring of the vascular access flow. In this letter we describe a model to calculate cardiac output in dialysis by the BTM.

Diffusive clearance depends on blood (Qb) and dialysate flow (Qd) rates and the overall mass transfer area coefficient (KoA) of the dialyzer. In this article we describe a model to predict an appropriated AutoFlow (AF) factor (AF factor = Ratio Qd/Qb), that is able to provide adequate Kt/V for hemodialysis patients (HDP), while consuming lower amounts of dialysate, water and energy during the treatment. We studied in vivo the effects of three various Qd on the delivered dose of dialysis in 33 stable HDP. Hemodialysis was performed at Qd of 700 mL/mn, 500 mL/mn, and with AF, whereas specific dialysis prescriptions (treatment time, blood flow rate [Qb], and type and size of dialyzer) were kept constant. The results showed that increasing the dialysate flow rate more than the model of AF predicted had a small effect on the delivered dose of dialysis. The Kt/V (mean ± SD) was 1.52 ± 0.16 at Qd 700, 1.50 ± 0.16 at Qd 500, and 1.49 ± 0.15 with AF. The use of the AF function leads to a significant saving of dialysate fluid. The model predicts the appropriate AF factor that automatically adjusts the dialysate flow rate according to the effective blood flow rate of the patient to achieve an appreciable increase in dialysis dose at the lowest additional cost.

Vascular access management is key and critical in the successful management of hemodialysis patients, and an arteriovenous fistula (AVF) is considered the access of choice. This study was conducted between January 2007 and October 2009 at the Military Hospital in Rabat. Data on 115 patients who underwent 138 AVFs were retrospectively studied. Wrist AVF was the most common site of use. The primary course was uncomplicated in 63% of the patients, while primary failure occurred in 23.9% of the patients. Presence of diabetes was the most important risk factor for primary failure.

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome

The availability of hemodialysis machines equipped with online clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume (V) is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods. A total of 35 patients were studied. Ionic dialysance was measured by conductivity monitoring. The second-generation Daugirdas formula was used to calculate the Kt/V single-pool (Kt/VD). Values of V to allow comparison between OCM and blood-based Kt/V were determined using Watson formula (VWa), bioimpedance spectroscopy (Vimp), and blood-based kinetic data (Vukm). Comparison of Kt/Vw ocm calculated by the ionic dialysance and Vw (Kt/Vw ocm) with Kt/VD shows that using VW leads to significant systematic underestimation of dialysis dose by 24%. Better agreement between Kt/V ocm and Kt/VD was observed when using Vimp and Vukm. Bio-impedancemetry and the indirect method using the second-generation Daugirdas equation are two methods of clinical interest for estimating V to ensure greater agreement between OCM and blood-based Kt/V.