[28] Future strategies will include regional, national, internati

[28] Future strategies will include regional, national, international exchanges, list exchange, three-way, domino chain and non-simultaneous KTx. A regional KPD Pilot Program, involving adjoining/coordinating transplant centre should be implemented before establishment of national KPD program.[29] KPD using virtual crossmatch is a valid and effective solution Daporinad for highly sensitized recipients.[30]

Poverty, paucity of RRT facilities in the government sector and high costs in private sector render the majority of ESKD patients unable to access RRT. The solutions to these problems are alleviating poverty, educating the general population, and expanding the transplant programs in public sector Palbociclib chemical structure hospitals. KPD is viable, legal, rapidly growing modality for facilitating LDKTx for patients who are incompatible with their healthy, willing LD. KPD does not require extra infrastructure and facilities. It avoids transplant tourism and commercial trafficking. Transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy. The transplant community must act now to remove barriers to a broader implementation of international sharing of KPD lists to further optimize the potential of this modality. “

There has been debate as to the value of lower sodium dialysates to control blood pressure in haemodialysis patients, as sodium is predominantly removed by ultrafiltration. Methods:  Re-audit of clinical practice following reduction in dialysate sodium concentration. Results:  Overall dialysate sodium concentration decreased from 138.9 ± 1.7 to 137.8 ± 1.7 mmol/L (mean ± standard deviation),

resulting in a reduction in pre- and post-dialysis mean arterial pressure (MAP) of 4 mmHg (from 100.6 ± 15.6 to 97.1 ± 15.6, P < 0.01 and from 91.7 ± 15.6 LY294002 to 87.1 ± 14.6, P < 0.001 respectively), yet fewer patients were prescribed antihypertensives (49.6 vs 60.6%), and less antihypertensive medications/patient (mean 0.86 vs 1.05), ultrafiltration requirements (2.8% vs 3.2% body weight, P < 0.001), and symptomatic intradialytic hypotension (0.19 vs 0.28 episodes per week, P < 0.001). A multivariable model showed that for a dialysate sodium of 136 mmol/L, younger patients had higher MAP than older patients (0.35 mmHg lower MAP/year older; but with a dialysate sodium of 140 mmol/L, there was minimal association of MAP with age (0.07 mmHg higher MAP/year older). Conclusion:  Change in clinical practice, amounting to a modest reduction in dialysate sodium was associated with a reduction not only in pre- and post-dialysis blood pressures, but also ultrafiltration requirements and symptomatic intradialytic hypotension.

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