: Peripheral nerve block (PNB) has been successfully used as the sole anesthetic for Peritoneal dialysis (PD) catheter insertion, and has been shown to provide satisfactory anesthesia and analgesia perioperatively, especially among critically – ill patients. : This report describes the anesthetic management of an 18 – year old underweight patient with End-stage renal disease (ESRD) and decompensated heart failure who was scheduled for PD catheter insertion. He was given a left lateral Transversus abdominis plane (TAP) block and a right Rectus sheath (RS) block as the main anesthetic. Fifteen mL of Isobaric Bupivacaine 0.375% with Epinephrine 1:400,000 dilution was injected for the TAP block, and 10mL for the RS block, for a total volume of 25mL (93.7mg). Sedation was given via a Remifentanil infusion at 0.1mcg/kg/min. Intraoperatively, the patient was awake, conversant, and comfortable, no pressors were used, and no conversion to general anesthesia was done. Post-operatively, he had good pain control, with a pain score of 1/10, and successfully underwent dialysis via the PD catheter on the 2nd hospital day. : This pediatric patient who is critically ill is not a good candidate for general or neuraxial anesthesia due to the risk of hemodynamic instability and perioperative decompensation. PNB was done to provide anesthesia, and ensure good pain control post-operatively, and a right TAP and left RS were done instead of a bilateral TAP to lower the LA volume and decrease the risk of LA toxicity. Unilateral TAP with contralateral RS is a safe anesthetic technique among critically-ill pediatric patients who will undergo PD catheter insertion without the risk of hemodynamic instability with general or neuraxial anesthesia.
Human ; Male ; Adolescent: 13-18 yrs old ; End-stage Renal Disease (ESRD) ; kidney failure, chronic ; heart failure

Coexisting end stage liver disease (ESLD) and end stage renal disease (ESRD) for a patient on dialysis is a standard indication for a combined liver-kidney transplantation (CLKT). A survival advantage after CLKT has been verified in liver transplant candidates with significant kidney dysfunction due to chronic kidney disease (CKD) or acute kidney injury (AKI). The severity (glomerular filtration rate (GFR) < or =30 mL/min) and duration (more than 8~12 weeks) of kidney dysfunction are strong determinants for the selection of CLKT candidates. The CLKT patient survival rate is superior to that of liver transplant alone in candidates with a serum creatinine >2.0 mg/dL or who are on dialysis. Because of the immunological modulation effect of the liver graft, post-transplant CLTX results in a lower incidence of acute rejection and higher long-term censored graft survival rate in kidney transplant recipients. Despite the advantages of CLKT, the CLKT waiting list is extremely rare in Korea (0.80%, 67/3,717, from recent Korean Network for Organ Sharing (KONOS) data on March 2010). The narrow indications for CLKT (only ESRD candidates on dialysis are accepted for CLKT) and inferior ranking of CLKT for kidney allocation is a pitfall of the multi-organ allocation rule in KONOS.
Acute Kidney Injury ; Creatinine ; Dialysis ; End Stage Liver Disease ; Filtration ; Graft Survival ; Humans ; Imidazoles ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Liver ; Nitro Compounds ; Rejection (Psychology) ; Renal Insufficiency, Chronic ; Survival Rate ; Transplants ; Waiting Lists

In Malaysia, dialysis-treated end stage renal disease (ESRD) patients have been increasing rapidly. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) use a disproportionately large amount of limited healthcare resources. This study aims to estimate the costs of HD and CAPD from the Ministry of Health (MOH) perspective. One year prospective multicentre study was conducted from October 2016 to September 2017 to assess direct medical costs of 90 HD patients and 73 CAPD patients from five large MOH dialysis centres. A mixed method of activity-based costing and step-down was used. The capital costs included land, building, medical equipment and furnishing. The recurrent costs included staff emoluments, facility utilities, patients’ medical costs and dialysis consumables. One-way sensitivity analysis was performed to investigate variability in the data. One hundred and forty-one patients (82%) completed the study comprising of 77 patients on HD and 64 patients on CAPD. Majority of the patients were between 46-65 years old (n=75, 53.2%). The most common aetiology of ESRD was diabetes mellitus (44.2% in HD and 48.4% in CAPD). Cost per patient per year was RM39,790 for HD and RM37,576 for CAPD. The main cost drivers were staff emoluments (37.6%) and dialysis consumables (70.5%) for HD and CAPD respectively. HD is highly sensitive towards all the variables analysed except for dialysis consumables. In CAPD, there are minimal sensitivities except for the 5% discount rate. Knowledge of the costs of modalities are useful in the context of planning for dialysis services and to optimise the number of kidney failure patients treated by dialysis within the MOH.
Haemodialysis ; continuous ambulatory peritoneal dialysis ; end stage renal disease ; cost ; Malaysia

In cases of acute liver failure or acute or chronic liver failure, extracorporeal albumin dialysis utilizing a Molecular Adsorbent Recirculating System has been used to treat liver failure and to reduce serum total bilirubin concentrations as a bridge therapy until either liver transplantation or spontaneous recovery. However, the procedure is expensive and is not easily administered in clinical practice. Recently, single pass albumin dialysis (SPAD) using continuous renal replacement therapy was introduced, but information is scarce regarding its efficacy in controlling serum bilirubin. The authors report a case of acute hepatitis A, in which SPAD was performed to correct severe hyperbilirubinemia.
Bilirubin ; Dialysis ; End Stage Liver Disease ; Formaldehyde ; Hepatitis ; Hepatitis A ; Hyperbilirubinemia ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Polymers ; Renal Dialysis ; Renal Replacement Therapy ; Resorcinols

BACKGROUND: High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT. METHODS: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively. RESULTS: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively. CONCLUSIONS: Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.
Adult ; End Stage Liver Disease ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Living Donors* ; Medical Records ; Mortality* ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survival Rate ; Transplants ; Ventilators, Mechanical

Study was carried out on 22 advanced chronic renal failure, regular dialysis inpatients with hypertension (21 males, 1 female, ages from 25 - 76) treated in Central Military Hospital No.108. All of patients were treated hypertension with combined regimen or one drug followed convention, periodic dialysis 2-3 times per week, 4 hours per 1 time. The study’s time was 7 days. The results: almost of chronic renal failure patients had stable blood pressure, less daytime fluctuation in all of 7 days (with 462 measurements). Very less measurements (8/462) had systole blood pressure in emergency level (≥180 mmHg), less measurements (25/462) had blood pressure, which was not achieved treatment aim due to systole blood pressure at grade 2 (≥160 mmHg). A good efficacy of treatment with hypertension medications achieved by combined treatment at 6 hours, 10 hours, 16 hours and 21 hours of taken times.
Hypertension ; Kidney Failure, Chronic

15 patients with mild to moderate chronic renal failure treated in the medical examination of friendship hospital during 1996-1998. Benazepril was administrated at dose of 1 tablet every morning. The study found that after 6 months of treatment the blood creatinine concentration and glomerular filtration level were not different from these at the beginning of treatment which prove the capacity of delaying the progress of chronic renal failure. 12/15 patients had a significant reduction of 24 hours urinary protein. 3/15 patients had a negative urinary protein after 6 months of the treatment.
Kidney Failure, Chronic ; Benzazepines

A study on 104 patients with chronic renal failure due to the obstructed urethral stone has shown that this disease in Vietnam was very severe, the nepthrotic creatinine clearance of 10ml/min occurred in 36 patients. The water, electrolyte and acid-base balance were severe. The recovering ability of morphism and rest function of patients with the chronic renal failure was high. A rest of patients that renal function can not be recovered mainly cause by large renal parenchymal lesions. The rest of nephron was very small that can not meet the function of endothelial balance. The patients should receive the kidney transplantation and periodical hemodialysis.
Kidney Failure, Chronic ; therapeutics

A study on 31 patients with chronic renal failure treated by periodical hemodialysis during 1995 - 1999 has shown that the rate of blood lipoprotein disorder was 56 -60%, this disorder was not improved by periodical hemodialysis. Most frequent disorder was disorder of ApoB, followed by triglyceride, HDL-C and LDL-C. Indicator of cholesterol/HDL-C and LDL-C increased significantly as increased time. The blood lipid disorder increased significantly in the group of hypertensive patients with periodical hemodialysis. The major cause of death was cardiovascular complications.
Kidney Failure, Chronic ; Lipoproteins

The study was done to evaluate disturbances in blood gases and acid-base balance in 140 patients with chronic renal failure at the end stage (108 patients with hemodialysis, 32 patients without hemodialysis). The primarily results showed that: 33.3% arterial hypoxemia, 35.1% disturbances in PaCO2, 31.48% SaO2 decreased, 93.5% disturbances in AaDO2, 6.48% chronic respiratory failure with 71.49% type I and 28.51% type II. 77.8% pH decreased, 96.3% BE decreased, 94.45% HCO3 decreased, 92.56% TCO2 decreased. Disturbances in PaO2, PaCO2, AaDO2 of chronic renal failure with hemodialysis were lower than chronic renal failure without hemodialysis.
Kidney Failure, Chronic ; Gases