Table Of ContentHemodialysis – From Basic Research to Clinical Trials
Contributions to Nephrology
Vol. 161
Series Editor
Claudio Ronco Vicenza
Hemodialysis – From
Basic Research to
Clinical Trials
Volume Editors
Claudio Ronco Vicenza
Dinna N. Cruz Vicenza
35 figures, 2 in color, and 14 tables, 2008
Basel·Freiburg·Paris·London·New York·Bangalore·
Bangkok·Shanghai·Singapore·Tokyo·Sydney
Contributions to Nephrology
(Founded 1975 by Geoffrey M. Berlyne)
Claudio Ronco Dinna N. Cruz
Department of Nephrology Department of Nephrology
St. Bortolo Hospital St. Bortolo Hospital
Viale Rodolfi 37 Viale Rodolfi 37
IT-36100 Vicenza (Italy) IT-36100 Vicenza (Italy)
Library of Congress Cataloging-in-Publication Data
Hemodialysis : from basic research to clinical trials / volume editors,
Claudio Ronco, Dinna N. Cruz.
p. ; cm. – (Contributions to nephrology, ISSN 0302-5144 ; v. 161)
Includes bibliographical references and indexes.
ISBN 978-3-8055-8566-8 (hard cover : alk. paper)
1. Hemodialysis. I. Ronco, C. (Claudio), 1951– II. Cruz, Dinna N. III.
Series.
[DNLM: 1. Renal Dialysis–trends. W1 CO778UN v.161 2008 / WJ 378 H4884
2008]
RC901.7.H45H448 2008
617.4(cid:1)61059–dc22
2008015981
Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents®and
Index Medicus.
Disclaimer. The statements, options and data contained in this publication are solely those of the individ-
ual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the
book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness,
quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property
resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and
dosage set forth in this text are in accord with current recommendations and practice at the time of publication.
However, in view of ongoing research, changes in government regulations, and the constant flow of information
relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for
any change in indications and dosage and for added warnings and precautions. This is particularly important when
the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or
utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying,
or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2008 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel
ISSN 0302–5144
ISBN 978–3–8055–8566–8
Contents
IX Preface
Ronco, C.; Cruz, D.N. (Vicenza)
Dialysis Technology
1 Water Treatment for Dialysis: Technology and Clinical Implications
Hoenich, N.A. (Newcastle upon Tyne); Levin, R. (New York, N.Y.)
7 Dialysate Composition
Viganò, S.M.; Di Filippo, S.; Manzoni, C.; Locatelli, F. (Lecco)
Vascular Access
12 Challenge for the Interventional Nephrologist:
Monitoring the Arteriovenous Fistula
Campos, R.; Riella, M.C. (Paraná)
23 Preoperative Hemodialysis Fistula Evaluation: Angiography,
Ultrasonography and Other Studies, Are They Useful?
Weitzel, W.F. (Ann Arbor, Mich.)
30 Endovascular Procedures
Asif, A. (Miami, Fla.)
39 Optimal Management of Central Venous Catheters for
Hemodialysis
Canaud, B.; Chenine, L.; Henriet, D.; Leray, H. (Montpellier)
V
Epidemiology and Practice
48 Trends in Medication Use and Clinical Outcomes in
Twelve Countries: Results form the Dialysis Outcomes
and Practice Patterns Study (DOPPS)
Tentori, F. (Ann Arbor, Mich.)
55 Epigenetics and the Uremic Phenotype: A Matter of Balance
Stenvinkel, P.; Ekström, T.J. (Stockholm)
63 The Burden of Cardiovascular Disease in Patients with
Chronic Kidney Disease and in End-Stage Renal Disease
Zoccali, C. (Reggio Calabria)
Inflammation
68 BNP and a Renal Patient: Emphasis on the Unique Characteristics
of B-Type Natriuretic Peptide in End-Stage Kidney Disease
Haapio, M. (Helsinki); Ronco, C. (Vicenza)
76 Potential Interplay between Nutrition and Inflammation in
Dialysis Patients
Kuhlmann, M.K. (Berlin); Levin, N.W. (New York, N.Y.)
83 Microinflammation and Endothelial Damage in Hemodialysis
Merino, A.; Nogueras, S.; Buendía, P.; Ojeda, R.; Carracedo, J.;
Ramirez-Chamond, R.; Martin-Malo, A.; Aljama, P. (Cordoba)
89 Oxidative Stress and Anemia in Chronic Hemodialysis:
The Promise of Bioreactive Membranes
Cruz, D.N.; de Cal, M.; Ronco, C. (Vicenza)
Fluid Management
99 Consequences of Overhydration and the Need for
Dry Weight Assessment
Raimann, J.; Liu, L.; Ulloa, D.; Kotanko, P.; Levin, N.W. (New York City, N.Y.)
108 Body Composition and Outcomes in Chronic Hemodialysis Patients
Hirachan, P.; Thijssen, S.; Levin, N.W.; Kotanko, P. (New York, N.Y.)
115 Whole-Body Spectroscopy (BCM) in the Assessment of
Normovolemia in Hemodialysis Patients
Wizemann, V.; Rode, C.; Wabel, P. (Bad Homburg)
119 Blood Volume Monitoring
Winkler, R.E.; Pätow, W.; Ahrenholz, P. (Rostock)
Contents VI
Uremic Toxicity
125 From Uremic Toxin Retention to Removal by Convection:
Do We Know Enough?
Vanholder, R.; Meert, N.; Schepers, E.; Glorieux, G. (Gent)
132 Oxidative Stress in Hemodialysis
Himmelfarb, J. (Portland, Me.)
138 Determinants of Insulin Resistance and Its Effects on Protein
Metabolism in Patients with Advanced Chronic Kidney Disease
Siew, E.D.; Ikizler, T.A. (Nashville, Tenn.)
Treatment Efficacy
145 What Is Important in Dialysis? The Frequency of Treatment Sessions
Lindsay, R.M. (London, Ont.)
154 Treatment Time
Chazot, C.; Jean, G. (Tassin)
162 Membrane Characteristics
Viganò, S.M.; Di Filippo, S.; Manzoni, C.; Locatelli, F. (Lecco)
168 What Is Important in Dialysis? Efficiency: Blood Flow, KoA and Kt/V?
Gotch, F. (New York, N.Y.)
178 Cross-Membrane Flux Is a Major Factor Influencing
Dialysis Patient Outcomes
Canaud, B.; Chenine, L.; Henriet, D.; Leray, H. (Montpellier)
Advanced Techniques
185 Inflammatory Pattern in Hemodiafiltration
Panichi, V.; Paoletti, S.; Consani, C. (Pisa)
191 Online Hemodiafiltration: A Multipurpose Therapy for
Improving Quality of Renal Replacement Therapy
Canaud, B.; Chenine, L.; Henriet, D.; Leray, H. (Montpellier)
199 Biofeedback-Driven Dialysis: Where Are We?
Santoro, A.; Ferramosca, E.; Mancini, E. (Bologna)
Calcium/Phosphate Homeostasis
210 Calcium and Phosphorus Kinetics in Hemodialysis Therapy
Gotch, F. (New York, N.Y.)
Contents VII
215 Impact of Ca/P Disorders on Risks and Comorbidities
Messa, P. (Milan)
222 Diagnostic Procedures and Rationale for Specific Therapies in
Chronic Kidney Disease-Mineral and Bone Disorder
Bover, J.; Canal, C.; Marco, H.; Fernandez-Llama, P.; Bosch, R.J.;
Ballarín, J. (Barcelona)
234 Preventive Measures and New Pharmacological Approaches
of Calcium and Phosphate Disorders
Cozzolino, M.; Galassi, A.; Pasho, S., Fallabrino, G.; Gallieni, M.;
Brancaccio, D. (Milan)
Correction of Anemia
240 Insights in Anemia Management
de Francisco, A.L.M.; Piñera, C. (Santander)
247 Red Blood Cell Lifespan, Erythropoiesis and Hemoglobin Control
Kruse, A. (New York, N.Y.); Uehlinger, D.E., (Uppsala/Bern);
Gotch, F.; Kotanko, P.; Levin, N.W. (New York, N.Y.)
255 New Erythropoiesis-Stimulating Agents: How Innovative Are They?
Del Vecchio, L.; Locatelli, F. (Lecco)
261 Is the Advent of Biosimilars Affecting the Practice of
Nephrology and the Safety of Patients?
Ronco, C. (Vicenza)
271 Author Index
272 Subject Index
Contents VIII
Preface
The 17th Annual International Vicenza Course on Hemodialysis has yet
another exceptional group of speakers and we are excited that this volume of
Contributions to Nephrologyis ready to guide attendees through the event and
serve as a valuable tool for the future. All contributions have been collected and
published in this volume as a result of the effort of all authors and the team of
the Department of Nephrology at San Bortolo Hospital in Vicenza.
Hemodialysis today moves towards innovative techniques, biomaterials
and devices with an absolute need for solid evidence around every new treat-
ment or technology. Based on this concept, the course and this book are
focused on innovative technology and new therapies from bench to bedside.
The continuous effort to improve patient care follows the complex pathway
from basic research to clinical trials. We have devoted a good deal of time to
the topic of uremic toxins with contributions dealing with this puzzling prob-
lem from different points of view. Other emphasized areas include cardiovas-
cular disease examined in its many facets and vascular access. As always,
significant attention is placed on the physiological undertakings of treatments.
Part of the program deals with practical questions in the dialysis unit. We are
privileged to have such a superior group of speakers who can elaborate on
these issues and discuss controversies that arise in the world of hemodialysis.
Special attention has been placed on the problems of calcium and phosphate
disorders, on the management of anemia, and finally on different biological
disorders affecting the patients on dialysis. Once more, all these aspects are
debated in light of international surveys, objective expert evaluation and recent
clinical trials.
IX
