DIGITAL VERSION Included DIALYSIS THERAPY Allen R Nissenson | Richard N Fine Rajnish Mehrotra | Joshua Zaritsky ALGRAWANY HANDBOOK OF DIALYSIS THERAPY ALGRAWANY SIXTH EDITION HANDBOOK OF DIALYSIS THERAPY Allen R Nissenson, MD, FACP Rajnish Mehrotra, MD, MS Emeritus Professor of Medicine David Geffen School of Medicine at UCLA Los Angeles, CA, United States Belding H Scribner Endowed Chair Professor of Medicine Head, Division of Nephrology Department of Medicine University of Washington Seattle, WA, United States Richard N Fine, MD Professor of Pediatrics Renaissance School of Medicine at Stony Brook University Stony Brook, NY, United States Joshua Zaritsky, MD, PhD Chief Pediatric Nephrology St Chris Hospital for Children Professor of Pediatrics Drexel University College of Medicine Philadelphia, PA, United States Elsevier 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 HANDBOOK OF DIALYSIS THERAPY, SIXTH EDITION Copyright © 2023 by Elsevier, Inc All rights reserved Ch 9, “Safety Monitors in Hemodialysis,” copyrighted by Joanne D Pittard ISBN: 978-0-323-79135-9 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations, such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found on our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors, or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Previous editions copyrighted 2002, 2008, and 2017 Senior Content Strategist: Nancy Anastasi Duffy Senior Content Development Specialist: Priyadarshini Pandey Publishing Services Manager: Deepthi Unni Senior Project Manager: Manchu Mohan Book Designer: Ryan Cook Printed in The United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 ALGRAWANY This book is dedicated to the heroic patients and care givers who showed courage and perseverance during the COVID-19 pandemic and inspired us all Allen R Nissenson, MD I would like to dedicate this edition of Handbook of Dialysis to my wife of ALMOST 50 years, Shawney, whose encouragement, support, and advice have made the journey to facilitate access to ESRD care for children of all ages possible, as well as our children, one of whom (Jeffrey) is no longer with us, 11 grandchildren, of whom aspire to become physicians AND GREAT-GRANDCHILDREN They have tolerated my conflicting priorities over the years I appreciate their continued understanding Richard N Fine, MD This book is dedicated to my wife, Kushi Mehrotra, who has stood patiently by my side for 29 years, to our two children, Kunaal and Ria, who have grown into amazing young adults in the blink of an eye, and to my parents, Trijugi and Kamini Mehrotra, who are no longer with us but forever in our hearts Rajnish Mehrotra, MD, MS I would like to dedicate this book to my children, Sarah and Ella Joshua J Zaritsky, MD, PhD Contributors Cahyani Gita Ambarsari, MD, FIPNA, FISPD Clinical Nephrology Fellow Princess Alexandra Hospital and Queensland Children’s Hospital, Brisbane, QLD, Australia Member of Medical Technology Indonesia Medical Education and Research Institute (IMERI) Consultant Paediatric Nephrologist Paediatric Nephrology Division Department of Child Health Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo Hospital, Jakarta DKI Jakarta Indonesia Rachel A Annunziato, PhD Professor Psychology Fordham University Bronx, NY United States Associate Professor Pediatrics Icahn School of Medicine at Mount Sinai, New York NY, United States Evamaria Anvari, MD Assistant Professor of Medicine Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Department of Kidney Medicine Glickman Urological & Kidney Institute Cleveland Clinic Cleveland, OH United States Carlos E Araya, MD Associate Professor Department of Pediatrics, Division of Pediatric Nephrology Nemours Children’s Hospital, Orlando FL United States Associate Professor Department of Pediatrics University of Central Florida, Orlando FL United States Rossella Attini, MD, PhD Physician Department of Obstetrics and Gynecology Città della Salute e della Scienza, Ospedale Sant’Anna Turin Italy Rose Mary Ayoob, MD Associate Professor of Pediatrics Division of Pediatric Nephrology Hoops Family Children’s Hospital at Cabell Huntington Hospital Joan C Edwards School of Medicine at Marshall University Huntington, WV, United States Justine Bacchetta, MD, PhD Professor of Pediatrics Pediatric Nephrology, Reference Center for Rare Renal Diseases Hospices Civils de Lyon, Bron France vii ALGRAWANY viii Contributors Rossana Baracco, MD Mei Lin Z Bissonnette, MD, PhD, FRCPC Joanne M Bargman, MD, FRCPC Geoffrey A Block, MD Associate Professor Pediatrics, Division of Pediatric Nephrology Central Michigan University College of Medicine, Detroit MI United States Director Peritoneal Dialysis Program University Health Network, Toronto ON Canada Professor University of Toronto, Toronto ON Canada Antonio Bellasi, MD Research, Innovation and Brand Reputation Ospedale di Bergamo, ASST-Papa Giovanni XXIII, Bergamo Italy Ezequiel Bellorin-Font, MD Instructor of Medicine Division of Nephrology Saint Louis University, Saint Louis MO United States William M Bennett, MD Medical Director Legacy Transplant Services Legacy Health Systems, Portland OR United States Professor of Medicine (Retired) Oregon Health & Science University, Portland OR United States Scott Bieber, DO Physician Nephrology Kootenai Health, Coeur d’Alene ID United States Clinical Associate Professor Department of Pathology and Laboratory Medicine University of British Columbia, St Paul’s Hospital Vancouver BC Canada Associate Chief Medical Officer Medical Office US Renal Care, Plano TX United States Brendan Bowman, MD Associate Professor Department of Medicine University of Virginia School of Medicine, Charlottesville VA United States Patrick D Brophy, MD, MHCDS Chairman Pediatrics University of Rochester, Rochester NY United States Deborah J Brouwer-Maier, RN, CNN Vascular Access Marketing Manager Marketing Transonic, Lansdale PA United States Steven Brunelli, MD, MSCE Vice President for Research DaVita Clinical Research DaVita, Inc, Minneapolis MN United States David Bushinsky, MD Professor of Medicine and of Pharmacology and Physiology Medicine University of Rochester School of Medicine and Dentistry, Rochester NY, New York United States Contributors Jonathan Casavant, PharmD, BCPS Anthony Chang, MD Roberta Cerutti, MD Chaim Charytan, MD Antimicrobial Stewardship Pharmacist Pharmacy Clinical Services VA Puget Sound HealthCare System, Seattle WA United States Nephrology IRCCS Ospedale Maggiore Policlinico, Milan Italy Vimal Chadha, MD Professor of Pediatrics Department of Pediatrics School of Medicine, University of Missouri-Kansas City, Kansas City MO United States Director, Acute Kidney Injury Program MO United States Associate Director, Dialysis and Transplantation Division of Nephrology Children’s Mercy Kansas City, Kansas City MO United States Christopher T Chan, MD, FRCPC Director of Nephrology Nephrology University Health Network, Toronto ON Canada Bipan Chand, MD, MBA Department of Surgery Loyola University, Maywood, IL, United States Deepa H Chand, MD, MHSA Executive Medical Director Global Patient Safety Novartis Gene Therapies, Bannockburn IL United States Attending Pediatric Nephrologist Pediatrics Washington University School of Medicine, St Louis MO United States Professor Department of Pathology University of Chicago, Chicago IL United States Chief Renal Division Renal New York-Presbyterian Med Ctr of Queens, Flushing, Queens NY United States Clinical Professor of Medicine Weill Cornell College of Medicine, New York NY United States Joline L.T Chen, MD, MS Health Sciences Associate Clinical Professor Division of Nephrology and Hypertension University of California, Irvine, Irvine CA United States Wei Chen, MD Associate Professor Department of Medicine Albert Einstein College of Medicine, Bronx NY United States Adjunct Professor Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester NY United States Andrew I Chin, MD Health Science Clinical Professor Division of Nephrology, Department of Internal Medicine University of California, Davis School of Medicine, Sacramento CA United States ALGRAWANY ix x Contributors Yeoungjee Cho, MBBS (Hons), FRACP, PhD Consultant Nephrologist Associate Professor of Medicine, University of Queensland Clinical Trialist (Australian Kidney Trials Network) Department of Nephrology Division of Medicine Metro South Health Princess Alexandra Hospital Brisbane, QLD Australia William R Clark, MD Professor of Engineering Practice Davidson School of Chemical Engineering Purdue University, W Lafayette IN United States John H Crabtree, MD Visiting Clinical Faculty Division of Nephrology and Hypertension Harbor-University of California Los Angeles Medical Center, Torrance CA United States Daniel Cukor, PhD Director Behavioral Health The Rogosin Institute, New York NY United States Serpil Muge Deger, MD, FISN Associate Professor Department of Nephrology Dokuz Eylul University Faculty of Medicine Izmir, Turkey Lucia Del Vecchio, MD Department of Nephrology and Dialysis, Sant’Anna Hospital, ASST Lariana Como Italy Alonso R Diaz, MD Nephrology Fellow Division of Nephrology, Department of Internal Medicine University of California, Davis School of Medicine, Sacramento CA United States Stephanie L Donahue, MSN, FNP-BC Nurse Practitioner Medicine and Behavioral Health The Rogosin Institute New York, New York NY, United States Ramanath Dukkipati, MD Associate Professor of Medicine Nephrology and hypertension Harbor-UCLA Medical Center, Torrance CA United States Claire Dunphy, PhD Postdoctoral Fellow Pediatrics Icahn School of Medicine at Mount Sinai New York, NY United States Mohamed Elbokl, MBBCH Clinical Fellow Nova Scotia Health Authority Nephrology Dalhousie University Halifax, NS Canada Fabrizio Fabrizi, MD Staff Nephrologist Division of Nephrology Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation, Milano Italy Mohammed K Faizan, MD Associate Professor Department of Pediatrics The Warren Alpert Medical School of Brown University, Providence, RI, United States Division Director Pediatric Nephrology Hasbro Children’s Hospital, Providence RI, United States 848 Index Raltegravir, 484–488t, 488 Ramipril, 534–572t Randomized controlled trial (RCT), 19–20, 31, 212 Rate control, 409 Rate of Perceived Exertion (RPE) scale, 585–586 RBPs See Retinol binding proteins RCA See Regional citrate anticoagulation RCC See Renal cell carcinoma RCT See Randomized controlled trial Reactive airway disease, 409 Real-time ultrasound-guided cannulation, 179 Reanimation approaches, 146 Recellularization, 146 Recombinant hirudin, 119f, 121 Recombinant human growth hormone (rhGH), 313, 729, 735–736, 736t, 774 in children, 710 Red blood cell transfusion, 347–348 Red cell half-life, 342 Redsense Medical devices, 176 Reduced erythrocyte survival, 342 REDY system, 144–145 Refeeding syndrome, 326 Refractory hyperparathyroidism, 382, 382f Refractory peritonitis, 798–799 Regional anticoagulation, 121–123 in children, 697–698, 697f, 756 citrate, 122–123, 697–698, 697f, 755–756 prostacyclin, 123 with protamine reversal, 121–122 Regional citrate anticoagulation (RCA), 653–654, 655f in neonates, 721 Regional prostacyclin anticoagulation, 123 Rehabilitation, 590 cognitive, 453–454 equipment for, 591 exercise, 583 geriatric, 452 implementing, 593 outcome evaluation, 593 prerequisites for effective, 592–593 redefining, 590–592 translational, 587 Relapsing peritonitis, 798–799 Remote monitoring, 631 Renal assist device (RAD), 147 Renal cell cancer screening, 599t Renal cell carcinoma (RCC), 389 Renal dysplasia, 700, 712, 732 Renal hypoplasia, 732 Renal insufficiency, antiretroviral drug dosing and, 484–488t Renal osteodystrophy, 366 circulating factors contributing to, 769–770 acidosis, 769–770 calcium and phosphorus, 769 fibroblast growth factor 23, 770 parathyroid hormone, 770 uremic toxins, 770 clinical features of, 768–769 deformities and bone fragility, 768–769 growth failure, 768 pathology of, 769 bone mineralization in, 769 bone turnover in, 769 Renal Physicians Association (RPA), 606, 608–609, 622 Renal rehabilitation, 591 defining, 591t implementing, 593 outcome evaluation, 593 Renal replacement therapy (RRT), 637, 642, 645 catabolism increase from, 310 decision-making for, 608 initiation of, in children, 700 peritoneal dialysis as, 712–716 preparation for, 51–52 predialysis CKD education, 51 timing of dialysis access placement, 51–52 prolonged intermittent, 495 Renal transplantation in children and adolescents, 684 for growth failure, 735 Renin-angiotensin-aldosterone system (RAAS), 400 Renin-angiotensin system inhibitors, 400 Repaglinide, 439–440t, 534–572t Residual kidney function (RKF) deterioration in, 212 role of, 242 significance of, 213 Residual native kidney function, in urea kinetic modeling, 60–61, 60f Residual renal function (RRF), 428 Respiratory acidosis, 306–307, 648 Respiratory alkalosis, 307, 648 Restless leg syndrome (RLS), 128, 499 Retinol binding proteins (RBPs), 29 Retroperitoneal leaks, dialysate leaks and, 286–287, 287f Revascularization therapy, 423 Reverse osmosis (RO), 87–88, 87f Reverse transcriptase-polymerase chain reaction (rt-PCR) testing, 492 Reverse triiodothyronine (rT3), 471t, 472 Index Reviparin, 696t Revision using distal inflow (RUDI), 194 rhGH See Recombinant human growth hormone Rhythm control, 410 Ribavirin, 464, 534–572t Rifabutin, 534–572t Rifampin, 534–572t Rifapentine, 534–572t Right internal jugular vein nontunneled CVC in, 187f tunneled CVC in, 187f Rigid noncuffed catheters, 254 Rilpivirine, 484–488t, 488 Rimantadine, 534–572t Rinse mode, 107 RISCAVID (“RISchio CArdiovascolare nei pazienti afferenti all’Area Vasta In Dialisi”), 354 Risedronate, 534–572t Ritonavir, 484–488t, 534–572t Rivaroxaban, 534–572t Rivastigmine, 534–572t RLS See Restless leg syndrome RO See Reverse osmosis Rope ladder cannulation, 174, 175f, 175t Rosiglitazone, 534–572t Rosuvastatin, 534–572t Routine cleaning, 110 Routine nonemergent nephrologist rounding use case, 631, 632f Rowland University Dementia Assessment Scale (RUDAS), 453 RPA See Renal Physicians Association RPE See Rating of perceived exertion RRF See Residual renal function RRT See Renal replacement therapy rT3 See Reverse triiodothyronine RUDAS See Rowland University Dementia Assessment Scale RUDI See Revision using distal inflow S Safe prescribing, 455 Safety, of HDF, 139 SAKI See Sepsis-associated acute kidney injury Salicylates, treatment of poisoning from, 665t Salt removal, 143–144 Saquinavir, 484–488t, 534–572t SAS See Sleep apnea syndrome SASQ (Single Alcohol Screening Question), 600 Saxagliptin, 439–440t SCD See Sudden cardiac death Screening for dementia and cognitive impairment, 453 for depression, 454 for falls, 456 Scribner Shunt, 141 SCUF See Slow continuous ultrafiltration SDM See Substitute decision maker SDMA See Symmetric dimethylarginine Secondary hyperparathyroidism (sHPT), 364, 364f, 372, 376, 378–380 development of, 381–382 rates of persistent, 385 surgical management of, 383–384 subtotal parathyroidectomy, 383 vitamin D production and, 378 Sedillot’s triangle, 186f Seizures, 128–129 Selective serotonin reuptake inhibitor (SSRI), 497, 534–572t Self-cannulation, 178 Semaglutide, 534–572t Separation, 661t Sepsis, 200, 408–409, 645 Sepsis-associated acute kidney injury (SAKI), 646 Seroma/lymphocele, 192 Serotonin-norepinephrine reuptake inhibitor (SNRI), 534–572t Serratia liquefaciens, 201 Sertaline, 534–572t Serum albumin, PEW and, 332 Serum chemistry, in PEW diagnosis and, 332 Serum creatinine, 532 Serum [total CO2] hemodialysis and, 301–303, 303t normal values of, 304, 304t peritoneal dialysis and, 303–304 persistently high, 304–305 persistently low, 304 Sevelamer hydrochloride, 374–375, 432 Sexual dysfunction, 507 ESRD preventive care, 602 in uremic men, 507 evaluation of, 507–508 pathogenesis of, 507, 508t treatment of, 508–510, 509f in uremic women, 510 treatment of, 510–511, 511f SGA See Subjective global assessment Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, 606–607 on requests to stop dialysis, 610–611, 610t ALGRAWANY 849 850 Index SHARP study (Study of Heart and Renal Protection), 298, 423 sHPT See Secondary hyperparathyroidism SHR See Standardized hospitalization ratio Sildenafil, 509 Simvastatin, 534–572t Single-nephron GFR, 469 Single-pool Kt/V (spKt/V), thresholds for, 68–69 Sirolimus, 533t Sitagliptin, 439–440t, 534–572t Skeletal deformities, 768–769 Skeletal health prediction of, 770–772 alkaline phosphatase, 771 calcium and phosphorus, 771 linear growth, 772 parathyroid hormone, 771 Skeletal mineralization, 769 Sleep apnea syndrome (SAS), 500 Sleep disorders, 499–500 Slow continuous ultrafiltration (SCUF), 637, 638t Small water-soluble compounds asymmetric dimethylarginine, 16–18 carbamylated compounds, 19 physiologic mechanism and organ systems affected by, 20t symmetric dimethylarginine, 18 trimethylamine N-oxide, 19 uric acid, 19–20 SMR See Standardized mortality ratio Social support, 499 nonadherence and, 502 Sodium dietary intake of, 709–710, 710b modeling, 94, 94t removal of dialytic strategies, 248 peritoneal, 243–245 peritoneal dialysis prescription, 245–248 strategies to, 242–243 Sodium bicarbonate ingestion, 306 Sodium concentrations, 93–95, 222 Sodium ferric gluconate, 784 Sodium-glucose cotransporter-2 (SGLT2) inhibitor, 26 Sodium hypochlorite, 110, 270 Sodium valproate, 534–572t Sofosbuvir, 464 Solenoid monitoring, 103 Soluble transferrin receptor, 780 Solute clearance, 70, 745 assessment of, 233 determinants of Solute clearance (Continued) dialysate/plasma concentration ratios for urea, creatinine, inulin, and protein, 230–231, 231f factors affecting clearance, 230 fast and slow peritoneal solute transfer rates, 231–232, 232t, 233f membrane function changes, 232–233 peritoneal equilibration test procedure, 230–231, 231b increasing serum urea concentration, 234, 234t, 235f modified PD prescription, 234–236 Solute removal, 141–143 Somatic cell nuclear transfer, 146 Sorbents, 144 Sotalol, 534–572t Spiraflo HFT02, 720, 722 Spiral of deconditioning, 591 Spironolactone, 534–572t spKt/V See Single-pool Kt/V SSRI See Selective serotonin reuptake inhibitor Standard heparin anticoagulation, 118–120 Standardized hospitalization ratio (SHR), 624–625 Standardized Kt/V, 69 Standardized mortality ratio (SMR), 624–625 Standardized transfusion ratio (STR), 624–625 Staphylococcus aureus, 268–270, 276 nasal carriage of, 269–270, 272, 278 risk of, 270 Staphylococcus epidermidis, 202–203 Statins, 298, 423 Statin therapy, 431–432, 431f Stavudine, 484–488t, 534–572t Steal phenomena, 671 Steam sterilization, 72 Stencil-Based Preoperative Mapping, 257f Sterility, monitoring, 108–109 Sterilization, steam, 72 Stimulants, 534–572t STR See Standardized transfusion ratio Straight-tip catheters, 254, 255f Streptococcus spp., 268–269, 276 Streptokinase, 534–572t Streptomycin, 534–572t Stress testing exercise, 422 isotope, 422 noninvasive, 414–415 Stribild, 484–488t Stroke, prevention in AF, 409–410 Study of Heart and Renal Protection See SHARP study Subjective global assessment (SGA), 333–334 Substitute decision maker (SDM), 458 Index Substitution fluid, 135 Subtherapeutic dosage, 574, 575t Subtotal parathyroidectomy, 383 Successful pregnancy, in dialysis patient, 516 Sucralfate, 534–572t Sucroferric oxyhydroxide, 375 Sudden cardiac death (SCD), 13, 129–130, 410–411, 411t Sufentanil, 534–572t Sulfonylureas, 439–440t Sulindac, 534–572t Superficial cuff extrusion, 265 Supportive kidney care, ESRD preventive care, 602, 603f Supraventricular tachycardia (SVT), 407 SVT See Supraventricular tachycardia Symmetric dimethylarginine (SDMA), 16, 18 Systemic anticoagulation, 118–121 argatroban, 121 in children, 696–697, 696t heparinoids, 121 low-dose heparin, 120 low-molecular-weight heparins, 121 recombinant hirudin, 121 standard heparin, 118–120 Systemic complications, of vascular access, 193t, 196–197 Systemic heparinization, 432 Systemic inflammation, 310–311, 311f T T3 See Triiodothyronine T4 See Thyroxine Tachycardia, 143–144 Tacrolimus, 533t Targeted medication review (TMR), 579 Technetium-99m, 289 Telbivudine, 462, 534–572t Telehealth conceptual model, 631f for COVID-19 pandemic, 629 electronic medical record, 629–631 nontechnology requirements, 634–635 policies and procedures, 634 program management and implementation, 634–635 training, 635 program implementation, 630–631 technology requirements, 632–634 dialysis machine data, 633–634, 634t draft telehealth workflow, 633f hardware and video requirements, 633 relevant network and security requirements, 633 851 Telehealth (Continued) use cases, 631–632 emergent, 631–632 home and peritoneal dialysis, 631 integrated kidney care (global capitation), 632 other miscellaneous, 632 routine nonemergent nephrologist/interdisciplinary rounding, 631, 632f Telemedicine, in kidney failure electronic medical record, 629–631 nontechnology telehealth requirements, 634–635 policies and procedures, 634 program management and implementation, 634–635 training, 635 opportunity and issues, 629 telehealth conceptual model, 631f telehealth currently used, 635 telehealth program implementation, 630–631 telehealth technology requirements, 632–634 dialysis machine data, 633–634, 634t draft telehealth workflow, 633f hardware and video requirements, 633 relevant network and security requirements, 633 United States health care system challenges, 630 physician reimbursement, 630 use cases, 631–632 and virtual intensive care unit, 629–630 Telmisartan, 534–572t Temperature-blending valve, 91 Tenckhoff catheters, 712–713 in infants and neonates, 714 visceral perforation and, 292 Tenofovir, 462, 484–488t, 488, 534–572t Tenofovir disoproxil fumarate (TDF), 483 Terbinafine, 534–572t Teriparatide, 534–572t Testes, CKD and, 507 Test of Non-Verbal Intelligence, 726 Testosterone levels, 507, 509 Tetanus vaccine, 597 Tetracycline, 534–572t Theophylline, 533t treatment of poisoning from, 665t Therabands, 591 Therapeutic antibiotic lock, 204 Therapeutic drug monitoring, 533t Therapeutic plasma exchange (TPE), 661t, 662 Thiazolidinediones, 439–440t Thoracentesis, 289 Thrombin antagonists, 653, 656 Thrombocytopenia, 779 heparin-induced, 124, 124t ALGRAWANY 852 Index Thrombosis central venous catheter-related, 189 venous stenosis and, 671 Thrombotic microangiopathy, 531t Thyroid dysfunction, in kidney disease, 468–471 Thyroid functional disease dialysis and outcomes, 473–476, 473t, 474f kidney disease from, 468–470, 469f kidney disease leading to, 470, 470t Thyroid functional tests dialysis effect on, 471 alterations, 471–472, 471t medication effects on, 470t Thyroid hormone physiology, 468 Thyroid hormone receptors, 466 Thyroid peroxidase (TPO), 472 Thyroid replacement therapy, 476 Thyrotropin (TSH), 466, 468 dialysis and levels of, 472 elevated, 472 prevalence, 467–468t kidney disease and levels of, 470 serum levels and cardiovascular disease, 474, 475–476t and survival, 473–474, 473t Thyrotropin-releasing hormone (TRH), 468 Thyroxine (T4), 466 dialysis and levels of, 472 exogenous replacement of, 477 kidney disease and levels of, 470 Tiagabine, 534–572t TIBC See Total iron-binding capacity Ticagrelol, 534–572t Ticarcillin-clavulanate, 534–572t Ticlopidine, 534–572t Tidal peritoneal dialysis, 215 Tigecycline, 534–572t Time-limited trials of dialysis, 609, 609t Timolol, 534–572t Tinzaparin, 696t Tip migration, 265 Tipranavir, 484–488t TIs See Tunnel infections TMAO See Trimethylamine N-oxide TMP See Transmembrane pressure TMR See Targeted medication review TNF-α See Tumor necrosis factor alpha Tobacco use and cessation, ESRD preventive care, 601–602 Tobramycin, 533–572t To Err Is Human: Building a Safer Health System (IOM), 622 Tolazamide, 534–572t Tolbutamide, 534–572t Tolmetin, 534–572t Topical antimicrobial ointment, 205 Topical ointments, 204 Topiramate, 534–572t Torsemide, 534–572t Tort system, 623 Total AVG excision, 209 Total iron-binding capacity (TIBC), 780 Total parathyroidectomy with parathyroid autotransplantation, 383–384 vs parathyroidectomy with autotransplantation, 384 without autografting, 384 Total performance score (TPS), 625 Toxins See Poisoning treatments TPE See Therapeutic plasma exchange TPS See Total performance score “Trade-off ” hypothesis, 364 TRALI See Transfusion-related acute lung injury Trandolapril, 534–572t Transferrin, ESA resistance and, 352 Transferrin saturation (TSAT), 352, 779 Transfusion, red blood cell, 347–348 Transfusion-related acute lung injury (TRALI), 347–348 Translational rehabilitation, 587 Transmembrane concentration gradient, 301 Transmembrane pressure (TMP), 107 Trazodone, 534–572t Treatment perceptions, 502 TRH See Thyrotropin-releasing hormone Trial to Reduce cardiovascular Events with Aranesp Therapy (TREAT) study, 351–352 Triamcinolone, 534–572t Triamterene, 534–572t Tricyclic antidepressants, 508 Triiodothyronine (T3), 466 exogenous replacement of, 477 kidney disease and levels of, 470 low levels of, 471–472 and cardiovascular disease, 475–476t, 476 Trimethadione, 534–572t Trimethoprim/sulfamethoxazole, 488–489, 534–572t Trimethylamine N-oxide (TMAO), 19 Trisodium citrate, 122, 655 Triumeq, 484–488t Trizivir, 484–488t Truvada, 484–488t TSAT See Transferrin saturation TSH See Thyrotropin Index Tuberculosis screening, 598 Tuberculous peritonitis, 277 Tubular necrosis, acute, 531t Tubular obstruction, 531t Tumor necrosis factor alpha (TNF-α), 22, 25–26 Tunneled cuffed catheters, 185 Tunneled CVCs, 198 Tunnel infections (TIs), 201, 268, 799 catheter-related infections, 265–266 causative organisms, 268–269 definition, 268 frequency of, 268 prevention, 270–271 risk factors, 269 treatment and outcomes, 269–270 Tunnel track, 256, 257f Type I major histocompatibility complex, 142 U UD See Underdose UFH See Unfractionated heparin UFV See Ultrafiltration volume UKM See Urea kinetic modeling Ultrafilters, 89 Ultrafiltration, 68, 93, 135, 141, 637 dialysate composition and, 222–224, 227 dialysis treatment times and, 70–71 impaired peritoneal membrane, 248 in infant hemodialysis, 682 measurement timing, 746–747 mortality risk and, 70 rate, determination of, 397 Ultrafiltration-hemodialysis, 93 Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial (UNLOAD) study, 647 Ultrafiltration volume (UFV), 135 Ultrapure dialysis fluid, 109–110 Ultrapure replacement fluid, preparation of, 135 Ultrasound inferior vena cava, 239–240 lung water, 239 Ultrasound-assisted cannulation, 178 Ultraviolet lights, 89–90 Underdose (UD), 574, 575t Unfractionated heparin (UFH), 118, 119f, 653–654, 694 children use of, 695 common regimens, 120t regional, 656 simplified regimens, 120t United States Renal Data System (USRDS), 3, 590, 610, 613, 615–616, 623, 627 children data in, 704 HIV infection among ESKD, 481 hospitalizations, 199 on thyroid replacement therapy, 476 United States, telemedicine challenges, 630 Unstable rhythms, 406 Urea, 19, 67–68, 141–142 clearance rate, 684–685 generation, 57–58 kinetics of, 57–58 levels, in pregnancy, 519 production, 57, 57–58f production of, 141–142 removal, 58 Urea cycle defects, 719 Urea kinetic modeling (UKM), 68, 685 application of, 686–687 in children, 685–686 estimation, 64–65 for hemodialysis, 55–66 kinetics of urea, 57–58 balance between urea production and removal, 57, 57–58f urea generation and protein catabolism, 57–58 urea removal, 58 parameters, 58–61 residual native kidney function, 60–61, 60f single- versus multiple-compartment models, 59, 59–60f variable volume model, 60, 63t process of, 61, 61–62f reason for using, 56–57 recognizing errors, 65–66 simplified equations, 64–65 Urea reduction ratio (URR), 68 thresholds for, 68–69 Uremia pharmacological principle alterations in, 530–572 sexual dysfunction in men and, 507 evaluation of, 507–508 pathogenesis of, 507, 508t treatment of, 508–510, 509f sexual dysfunction in women and, 510 treatment of, 510–511, 511f Uremic HDL, 28 Uremic osteodystrophy, mixed, 365, 365t Uremic pericarditis, 410, 420 clinical presentation and diagnosis, 420 management, 420 Uremic symptomatology, 47 ALGRAWANY 853 854 Index Uremic syndrome, 16, 17f clinical manifestations of, 47 Uremic toxicity, 16–44 Uremic toxins, 16, 425, 427 biological impact of, 29 classification, 16, 17t middle molecules, 23–29 protein-bound compounds, 20–23 small water-soluble compounds, 16–20 interference among, 31f protein-bound, 143 removal of, 76, 78 toxicity, 17–18t Uric acid, 19–20 Urokinase, 275, 524, 534–572t URR See Urea reduction ratio USRDS See United States Renal Data System USRDS Annual Data Report, 3, 4f V V506, 576 Vaccination See also Immunizations adult immunizations for dialysis patients, 596, 597t HBV, 462–463 for SARS-CoV-2, 492 Valacyclovir, 534–572t Valganciclovir, 534–572t Valproic acid, 533t treatment of poisoning from, 665t Valsartan, 534–572t Valvular AF, 408–409 Vancomycin, 274–275, 533–572t, 758, 799t Variable volume model, in urea kinetic modeling, 60, 63t Varicella zoster vaccine, 597 Vascular access, 7, 154 advantages and disadvantages of, 161–162 arteriovenous, cannulation of, 165–182 in children, 669 in CRRT for pediatric patients, 753–754 technical issues, 639–640, 639t in diabetics, 441–442 examination findings of problems, 162–163 at hemodialysis initiation, 11f history of, 154, 155t HIV-infected ESKD patients and, 482 infants hemodialysis, 680 infections related to, 198, 206 infectious complications from, 198–210 multidisciplinary approach to, 154–158 education, 154–156 strategy and roles, 154, 156t Vascular access (Continued) noninfectious complications from, 192–197, 193t planning and choice of access, 156–158 algorithm for, 157f angiogram in, 158 overall clinical considerations, 160–161 patient and vascular access history, 157 physical examination, 157 supportive investigations, 157–158 timely and appropriate referral, 157 in pregnant women, 524 progression of procedures, 159f site locations, 158–160 CVC, 159–160, 160t grafts, 159 lower, 160 unusual locations, 160 upper extremity, 158–160 wearable HD systems and, 144 Vascular brain injury, 428 Vascular calcification (VC), 366–368, 367f, 372, 374, 385, 425–426, 773 cardiovascular mortality and, 366–367 diagnosing, 367–368 prevention, 427 quantification of, 426 risk factors for, 367, 367f therapeutic approach, 426–427 Vascular endothelin, 26 Vascular Quality Initiative Registry, 482 VATS See Video-assisted thoracoscopy VC See Vascular calcification Venlafaxine, 534–572t Venous hypertension, 197 Venous line clamp, 114 monitoring, 114–115 Venous pressure monitor, 113–114, 113f Venous stenosis, 671 Ventricular ectopy, 407 Ventricular fibrillation (VF), 410 Ventricular tachycardia (VT), 407, 410 Verapamil, 534–572t VF See Ventricular fibrillation Vidarabine, 534–572t Video-assisted thoracoscopy (VATS), 290 Vigabatrin, 534–572t Vildagliptin, 439–440t Viral hepatitis, 460, 461t Virtual intensive care unit, 629–630 Visceral perforation, Tenckhoff catheters and, 292 Vision, screening for, 601 Visual impairment, 456 Vitamin B12 deficiency, 343, 780 Index Vitamin C, 781–782 Vitamin D, 359, 363 CKD-MBD and, 363, 369, 773–774 deficiency, 773 secondary hyperparathyroidism and, 378 sterol therapy, 773–774 supplementation, 456 supplementation, in pregnancies, 525 Vitamin D analogs, 367, 370, 378–380 Vitamin D receptor analogs (VDRAs), 376 Vitamin D receptors (VDRs), 378 Vitamin D sterols, 378–380, 773–774 Vitamin E-coated dialyzers, 359–360 Vocational rehabilitation (VR), 590 Volume control, 418–419 Volume status assessment, in PD patients acute volume overload management, 249 anuric patient, fluid removal in, 249 determination of peritoneal sodium and water removal, 243–245, 244f, 244t EuroBCM study, 237 fluid status examination, 238–241 biochemical markers, 240 bioelectric impedance analysis, 238–239 inferior vena cava ultrasound, 239–240 left ventricular mass, 240–241 lung water ultrasound, 239 physical exam, 238 graphic description of, 240–241, 241f in IPOD-PD, 237 nondialytic management of sodium and water handling, 241–243 Volumetric control systems, 107 Voriconazole, 534–572t VR See Vocational rehabilitation VT See Ventricular tachycardia V-tags, 623–624 Water (Continued) reverse osmosis, 87–88, 87f ultrafilters/cartridge filters/endotoxin retentive filters, 89 ultraviolet lights, 89–90 water distribution loop, 90–91, 90f water softener/brine tank, 83–85, 84f removal of, 143–144 dialytic strategies, 248 peritoneal, 243–245 peritoneal dialysis prescription, 245–248 strategies to, 242–243 required amounts of, 144 treatment systems, 82 disinfection of, 92 monitoring, 83t questions to consider, 82t specifications for, 82t Water distribution loop, 90–91, 90f Water inlet solenoid, 103 Water softener, 83–85, 84f WCT See Wide complex tachycardia Wearable dialysis systems, 144 fully implantable, 146 hemodialysis, 145–146 peritoneal dialysis, 144–145 recellularization approaches, 146 Weight gain, 296 Weight loss, ESRD preventive care, 601 Wide complex tachycardia (WCT), 407 Withdrawal from dialysis, 610 Wolff–Chaikoff effect, 470 Wolff-Parkinson-White (WPW) syndrome, 407–408 World Health Organization, 341 anemia definitions, 778 growth charts, 705 WPW syndrome See Wolff-Parkinson-White syndrome Wrist fistulas, 159 W Warfarin, 408–410, 534–572t Waste disposal, home hemodialysis, 152 Water contaminants in, 80–82 acceptable levels, 81t signs and symptoms of, 82t dialysate amounts of, 80 for home hemodialysis, 149–150, 150t purification equipment, 82–92 carbon tanks, 85–86, 85f deionization, 88–89, 89f microbiologic contamination monitoring, 91–92, 92t multimedia filter, 82–83, 84f X Xylitol, 223 Z Zalcitabine, 534–572t Zanamivir, 534–572t Zidovudine, 484–488t, 534–572t Zinc deficiency, 509–510 Zoledronic acid, 534–572t Zolpidem, 499 Zonisamide, 534–572t ALGRAWANY 855 Notes Notes ALGRAWANY Notes This page intentionally left blank ALGRAWANY This page intentionally left blank This page intentionally left blank ALGRAWANY This page intentionally left blank ...2 HANDBOOK OF DIALYSIS THERAPY ALGRAWANY SIXTH EDITION HANDBOOK OF DIALYSIS THERAPY Allen R Nissenson, MD, FACP Rajnish Mehrotra, MD, MS Emeritus Professor of Medicine David Geffen School of. .. Professor of Medicine Head, Division of Nephrology Department of Medicine University of Washington Seattle, WA, United States Richard N Fine, MD Professor of Pediatrics Renaissance School of. .. Prevention and Treatment of Cardiovascular Complications in Children Undergoing Dialysis, 789 Index, 809 Mark M Mitsnefes ALGRAWANY xxix HANDBOOK OF DIALYSIS THERAPY PART I Dialysis Therapy for Adults