Mehrdad Ghahremani‐Ghajar

University of California, Irvine

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Connie M. Rhee

University of California, Irvine

Kamyar Kalantar‐Zadeh

UCLA Medical Center

Yoshitsugu Obi

University of Mississippi Medical Center

Anna Jin

University of California, Irvine

Wei Ling Lau

University of California, Irvine

MÁ

Miguel Ángel Ibáñez-Hernández

Instituto Politécnico Nacional

Uttam Reddy

University of California, Irvine

Joline L.T. Chen

VA Long Beach Healthcare System

Jason Chou

Ochsner Health System

Scott Harada

Cooperative Institutions

University of California, Irvine

University of California, Irvine Medical Center

VA Long Beach Healthcare System

University of California, Los Angeles

Tibor Rubin VA Medical Center

American Heart Association

UC Irvine Health

Novamont (Italy)

Azienda Industriali Municipali di Vicenza (Italy)

Iowa Diabetes and Endocrinology Research Center

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An Unusual Case of Resistant Hepatic Hydrothorax Treated with Octreotide Infusion

McGill Journal of Medicine (2020)

Mehrdad Ghahremani‐Ghajar Mostafa Tabassomi Scott Harada Jose Joseph Vempilly

Hepatic hydrothorax is an uncommon clinical problem observed inpatients with end stage liver disease and portal hypertension. The pathogenesis of pleural effusion in this condition is thought to involve the movement of ascitic fuid across diaphragmatic defects into pleural cavity facilitated by a negative pleural pressure. Therefore, tube thoracostomy is not considered to be a defnitive treatment option in the management of hepatic hydrothorax. We present a case of massive pleural effusion secondary to hepatic hydrothorax not responding to conventional treatment successfully treated with intravenous infusion of octreotide.

Hydrothorax

Thoracostomy

Pleural cavity

Pleurodesis

Thoracic cavity

10.26443/mjm.v14i2.201

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Incremental Hemodialysis: The University of California Irvine Experience

Seminars in Dialysis (2017)

Mehrdad Ghahremani‐Ghajar Vanessa Rojas‐Bautista Wei Ling Lau Madeleine V. Pahl Miguel Ángel Ibáñez-Hernández

Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen. Indeed, several large population-based studies suggest that incremental twice-weekly vs. conventional thrice-weekly hemodialysis has favorable impact upon RKF trajectory and survival among patients with adequate renal urea clearance and/or urine output. In this report, we describe a case series of 13 ambulatory incident ESRD patients enrolled in a university-based center's Incremental Hemodialysis Program over the period of January 2015 to August 2016 and followed through December 2016. Among five patients who maintained a twice-weekly hemodialysis schedule vs. eight patients who transitioned to thrice-weekly hemodialysis, we describe and compare patients' longitudinal case-mix, laboratory, and dialysis treatment characteristics over time. The University of California Irvine Experience is the first systemically examined twice-weekly hemodialysis practice in North America. While future studies are needed to refine the optimal approaches and the ideal patient population for implementation of incremental hemodialysis, our case-series serves as a first report of this innovative management strategy among incident ESRD patients with substantial RKF, and a template for implementation of this regimen.

10.1111/sdi.12591

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Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management

Panminerva Medica (2017)

Connie M. Rhee Mehrdad Ghahremani‐Ghajar Yoshitsugu Obi Kamyar Kalantar‐Zadeh

Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function. Infrequent hemodialysis can also be used for those who prefer a more conservative approach in managing uremia. Clinical practice guidelines support the use of twice-weekly hemodialysis among patients with adequate residual kidney function (renal urea clearance >3 mL/min/1.73 m2), and a growing body of evidence indicates that incremental hemodialysis is associated with better preservation of residual kidney function without adversely impacting survival. Nonetheless, incremental hemodialysis remains an underutilized approach in this population. In this review, we will discuss the history of the twice- versus triweekly hemodialysis schedules; current clinical practice guidelines regarding infrequent hemodialysis; emerging data on incremental treatment regimens and outcomes; and guidelines for the practical implementation of incremental and infrequent hemodialysis in the clinical setting.

Uremia

Dialysis adequacy

Kt/V

Clinical Practice

10.23736/s0031-0808.17.03299-2

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An unusual case of an irretrievable hemodialysis catheter in a patient with end stage renal disease

Hemodialysis International (2017)

Mehrdad Ghahremani‐Ghajar Anna Jin Peyman Borghei Joline L.T. Chen

Abstract Hemodialysis catheters are associated with higher risks of complications compared to arteriovenous fistulas and grafts. Some common complications of dialysis catheters include infection, thrombus formation, central venous stenosis, and mechanical dysfunction. Rarely, catheters can become firmly adhered to a vessel wall. Catheter adhesion is a serious complication that can impact the delivery of safe and effective dialysis to affected patients. Adherent catheters commonly present insidiously with no overt diagnostic signs and symptoms or antecedent catheter malfunction. Prognosis is variable, but can be potentially fatal depending on the severity of adhesion, and sequelae of complications. There are no standardized methods of therapy and treatment strategies are anecdotally reported by interventional radiology, vascular, and cardiothoracic surgery. We hereby describe a case of hemodialysis catheter that has become firmly embedded within the superior vena cava wall. We review the available literature on the epidemiology, risk factors, long‐term sequelae, and known management strategies of adherent catheters. The development of preventative measures will be of great importance given serious complications and limited treatment options. Clinical awareness and understanding of this rare condition is imperative to the prevention and management of adherent catheters.

Hemodialysis Catheter

Dialysis catheter

10.1111/hdi.12584

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Citations (4)