KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)

https://www.ajkd.org/article/S0272-6386(11)00942-5/pdf

Home Hemodialysis and Mortality Risk in Australian and New Zealand Populations

/pdf/prophylaxis-diagnosis-and-therapy-of-hepatitis-b-virus-15aauo2o37.pdf

[Prophylaxis, diagnosis and therapy of hepatitis B virus infection - the German guideline].

The many factors impacting the efficacy of a vaccine can be broadly divided into three categories: features of the vaccine itself, including immunogen design, vaccine type, formulation, adjuvant and dosing; individual variations among vaccine recipients and vaccine administration-related parameters. While much literature exists related to vaccines, and recently systems biology has started to dissect the impact of individual subject variation on vaccine efficacy, few studies have focused on the role of vaccine administration-related parameters on vaccine efficacy. Parenteral and mucosal vaccinations are traditional approaches for licensed vaccines; novel vaccine delivery approaches, including needless injection and adjuvant formulations, are being developed to further improve vaccine safety and efficacy. This review provides a brief summary of vaccine administration-related factors, including vaccination approach, delivery route and method of administration, to gain a better understanding of their potential impact on the safety and immunogenicity of candidate vaccines.

/pdf/effect-of-vaccine-administration-modality-on-immunogenicity-4ehnfv1mra.pdf

Effect of vaccine administration modality on immunogenicity and efficacy.

OBJECTIVE: Patients with pediatric intestinal failure (IF) depend on parenteral nutrition for growth and survival, but are at risk for complications, such as catheter-related bloodstream infections (CRBSIs). CRBSI prevention is crucial, as sepsis is an important cause of IF-associated liver disease and mortality. We aim to estimate the pooled effectiveness and safety of ethanol locks (ELs) in comparison with heparin locks (HLs) with regard to CRBSI rate and catheter replacements for pediatric IF patients with chronic parenteral nutrition dependence. METHODS: A systematic review without language restriction was performed on Medline (1948–2010), Embase (1980–2010), and conference programs and trial registries up to December 2010. Search terms included “Catheter-Related Infections,” “Catheter,” “Catheters, Indwelling,” “alcohol,” “ethanol,” and “lock.” Two authors identified 4 retrospective studies for the pediatric IF population. Double, independent data extraction using predefined data fields and risk of bias assessment (Newcastle-Ottawa scale) was performed. RESULTS: In comparison with HLs, ELs reduced the CRBSI-rate per 1000 catheter days by 7.67 events and catheter replacements by 5.07. EL therapy decreased the CRBSI rate by 81% and replacements by 72%. One hundred eight to 150 catheter days of EL exposure were necessary to prevent 1 CRBSI and 122 to 689 days of exposure avoided 1 catheter replacement. Adverse events were rare and included thrombotic events. CONCLUSIONS: In pediatric patients with IF, EL is a more effective alternative to HL. Adverse events include thrombotic events.

Ethanol Locks to Prevent Catheter-Related Bloodstream Infections in Parenteral Nutrition: A Meta-Analysis

https://www.ajkd.org/article/S0272-6386(09)00606-4/pdf

Intradermal versus intramuscular hepatitis B vaccination in hemodialysis patients: a prospective open-label randomized controlled trial in nonresponders to primary vaccination.

Background: Poor control of bone mineral metabolism (BMM) is associated with renal osteodystrophy and mortality in dialysis-dependent patients. The authors explored the efficacy of alternate nightly home haemodialysis (ANHHD) in controlling BMM parameters and its effects on bone mineral density and histomorphometry. Methods: In this prospective observational study, 26 patients on home haemodialysis (3-5 h, 3.5-4 sessions weekly) were converted to ANHHD (6-9 h, 3.5-4 sessions weekly). Biochemical parameters of BMM at baseline, 6 and 12 months, radiological parameters at baseline and 12 months and bone histomorphometry at 12 months are described. Results: Pre-dialysis serum phosphate fell from 2.13 ± 0.65 to 1.38 ± 0.35 mmol/L; P 1000 ng/L) did not significantly improve parathyroid hormone status. Abnormal bone turnover and mineralization were present in a significant proportion of patients at 12 months but low turnover was uncommon. Vascular calcification was stabilized or improved in the majority. ANHHD compares favourably with every night and short daily therapy in relation to BMM management and may offer lifestyle advantages for patients.

Mineral metabolism, bone histomorphometry and vascular calcification in alternate night nocturnal haemodialysis.

Catheter-related bacteraemias (CRBs) contribute significantly to morbidity, mortality and health care costs in dialysis populations Despite international guidelines recommending avoidance of catheters for haemodialysis access, hospital admissions for CRBs have doubled in the last decade The primary aim of the study is to determine whether weekly instillation of 70% ethanol prevents CRBs compared with standard heparin saline

/pdf/rationale-and-design-of-the-healthy-cath-trial-a-randomised-48ntylpfyw.pdf

Rationale and design of the HEALTHY-CATH trial: a randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients.

Sally Carpenter

Papers

Intradermal versus intramuscular hepatitis B vaccination in hemodialysis patients: a prospective open-label randomized controlled trial in nonresponders to primary vaccination.

Mineral metabolism, bone histomorphometry and vascular calcification in alternate night nocturnal haemodialysis.

Rationale and design of the HEALTHY-CATH trial: a randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients.