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Cardiac Surgery in Chronic Renal Failure - part 3

Quan tâm gần đây đã tập trung vào "lọc máu" cường độ cao đạt được bằng cách tăng thời gian lọc máu, tần số của chạy thận hoặc cả hai [126]. Bệnh nhân tham gia trong các chương trình cải thiện dinh dưỡng, các triệu chứng dialysisrelated, và chất lượng tổng thể của cuộc sống | Dialysis and the chronic renal failure patient 11 pyridoxine 124 replacing carnitine 83 during dialysis and L-arginine 125 supplementation. Recent interest has focused on high-intensity dialysis achieved by increasing dialysis duration the frequency of dialysis or both 126 . Patients enrolled in these programs reported improvements in nutrition dialysis-related symptoms and overall quality of life 127 128 . Blood pressure control was much easier 127 with a significant decline in the need for antihypertensive therapy 129 and regression of left ventricular hypertrophy 130 131 . Phosphate control improved with some patients requiring phosphate supplementation despite being on a high phosphate diet and off oral phosphate binders 128 . Erythropoietin requirements also declined significantly provided patients were iron replete 128 . Finally a region in Southern France with a large nocturnal hemodialysis program 24 has consistently reported annual mortality rates below 10 . While the number of patients enrolled in some of these programs is relatively small the data are quite compelling and suggest that ESRD patients are inadequately dialyzed. Perhaps high-intensity dialysis represents the most effective strategy of reducing cardiovascular risk in dialysis patients. References 1 U.S. Renal Data System USRDS 2000 Annual Data Report. National Institutes of Health National Institute of Diabetes Digestive and Kidney Diseases Bethesda MD June 2000. 2 van Dijk Paul CW Jager KJ de Charro F et al. Renal replacement therapy in Europe the result of a collaborative effort by the ERA-EDTA registry and six national registries. Nephrol Dial Transplant 2001 16 1120-1129. 3 GA Posen JR Jeffery SS Fenton GS Arbus. Results from the Canadian Renal Failure Registry. Am J Kidney Dis 1990 15 397-401. 4 U.S. Renal Data System USRDS 1998 Annual Data Report. National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Bethesda MD April 1998. 5 U.S. Renal Data .