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Biomedical subjects

A Ksiazek

Publications and source records attributed to A Ksiazek.

At least 37 records · Page 2Linked to original sources
PubMed1998

Subcutaneous r-HuEPO therapy in CAPD patients: dose determination and clinical experience.

We present our results on the efficacy and safety of low dose r-HuEPO given subcutaneously in the treatment of anaemia in CAPD. We have studied 10 stable patients (5 males, 5 females) on CAPD. In our study subcutaneous r-HuEPO was administered twice a week for 6 months. Mean initial dose of r-HuEPO was 67.3+/-21.7 U/kg/week, and maintenance dose was 35.8+/-12.1 U/kg/week. The target Hb concentration was 10-12 g/dl. All patients responded to r-HuEPO. During treatment significant increases of haemoglobin concentration (p<0.05), haematocrit (p<0.05), red cell count (p<0.05) and reticulocyte count (p<0.05) were observed. We found no significant changes in total white cell or platelet counts. Long-term r-HuEPO treatment did not influence significantly plasma levels of electrolytes (Na, K, Ca), urea and creatinine. We found no significant changes in ultrafiltration volumes. In the present study the mean systolic and diastolic blood pressures did not change. Liver function tests were normal at the beginning and at the end of the study. r-HuEPO treatment was associated with a decrease of ferritin (455+/-90 vs. 224+/-83 microg/l. Oral or intravenous iron substitution became necessary in 6 patients. Side effects in our study were minimal; one patient had myalgia after the first seven doses but this disappeared as treatment was continued. Two patients reported pain (mild) at the injection site. In the present study, the correction of anaemia was accompanied by a substantial improvement in the quality of life, mainly in capacity for work, household and social activities.

Adult↗
PubMed1997

Influence of some immune factors on the IL-6 and soluble IL-2 receptors in haemodialysed patients.

In respect to the immune deficiency state of long-term haemodialysed patients, both cytokines and their receptor disturbances have been taken into consideration. The purpose of our study was to evaluate the effect of uraemic and haemodialysis factors on the interleukin-6 and interleukin-2 soluble receptor levels and the reactivity after influenza vaccination. We have found that IL-6 and IL-2 receptor levels were statistically significantly elevated (98.8 +/- 39 pg/ml and 1557 +/- 544 U/ml, respectively) in serum of haemodialysed patients. The fact that increased immune complexes statistically correlated with soluble IL-2 receptor levels (p < 0.01) was very interesting for us. In order to study the immunological response after vaccination, 10 patients have been investigated after influenza vaccination. Plasma samples were collected before, as well as 1 and 4 weeks after vaccine administration. Antibody titres measured by haemagglutinin inhibition showed decreased antibody levels in haemodialysed patients. We conclude that the interleukin disturbance and the elevated interleukin-2 receptor levels together with the presence of circulating immune complexes can influence in some way the immune response of haemodialysed patients.

Adult↗
PubMed1997

Influence of intraperitoneal vancomycin on peritoneal dialysis efficiency. A clinical study.

Peritonitis is a major complication of intermittent peritoneal dialysis (IPD); over 70% of the infections are caused by Gram-positive bacteria. Vancomycin (V) is the antibiotic of choice in the treatment of peritonitis caused by G(+). The influence of vancomycin on peritoneal transport in IPD patients has not been described before. We have investigated the effect of intraperitoneal vancomycin on dialysis efficiency in 8 IPD patients using dialysis solutions containing either lactate or acetate. The following parameters were measured: net ultrafiltration (UF), concentration ratios (D/P) of urea, creatinine, potassium, peritoneal clearances (ml/min) of urea, creatinine, potassium, mass transfer of sodium (MTNa), sodium sieving index (SCNa). It has been found that vancomycin significantly decreases D/P urea (p < 0.05) and creatinine (p < 0.05). We found also a significant decrease of mean clearance of urea (p < 0.05) and creatinine (p < 0.05). The mean clearance of potassium did not change significantly. There was no significant change in UF, MTNa, and SCNa. Our preliminary data suggest that vancomycin decreases the permeability of peritoneum for certain low molecules in IPD patients which may have a negative impact on dialysis efficiency.

Adult↗
PubMed1997

Plasma erythropoietin level and iron reserves in haemodialysis patients with and without acquired cystic kidney disease.

Concentration of erythropoietin (Epo) and iron reserves (IR) belong to the essential factors determining erythropoiesis in haemodialysis patients. Patients on dialysis with acquired kidney disease (ACKD+) can control anaemia better than patients without acquired kidney disease (ACKD-). Therefore we decided to check if plasma Epo levels and IR differ significantly in both groups of patients. Forty chronically haemodialyzed patients after ultrasound diagnosis were divided into 18 patients (45%) with ACKD+ and 22 (55%) without ACKD-. In both groups of patients we compared their plasma levels of Epo and IR. Plasma erythropoietin and ferritin levels were measured by enzymatic immunoassay. Iron reserves were estimated by the formula: IR = 400 x [ln (ferritin)-ln (50)]. In the ACKD+ group 72% of patients and in the ACKD- group 32% of patients did not require rHu Epo therapy. Plasma levels of erythropoietin and iron reserves did not differ significantly between ACKD+ and ACKD- patients. There must be also other factors than erythropoietin levels and iron reserves regulating erythropoiesis in these patients.

Adult↗
PubMed1997

Serial cytokine changes in peritoneal effluent and plasma during peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD).

OBJECTIVE AND DESIGN: Secretion of IL-2 and sIL-2R in the peritoneal dialysis fluid and in the peripheral blood during peritonitis with reference to the process of IL-6 and IL-8 release were investigated. SUBJECTS: 17 patients with end-stage renal disease, treated with continuous ambulatory peritoneal dialysis. METHODS: ELISA method using commercial kits, Genzyme Corp Boston and DAKO. RESULTS: Markedly increased IL-6 (mean; 2895 +/- 1360 pg/ml) and IL-8 concentration (1459 +/- 966 pg/ml) in drain dialysate fluid at the onset of peritonitis, started to drop rapidly in the successive samples after antibiotics had been administered. Statistically significant increase of IL-2 (197 +/- 92 pg/ml) and sIL-2R (287 +/- 79 pg/ml) was observed 16 h later and kept increasing until reaching the peak after 24 h. CONCLUSION: Secretion of IL-6 and IL-8 pro-inflammatory cytokines which are mainly synthesized in mesothelium cells is followed by the activation of lymphocytes, their infiltration and the production of T lymphocyte derived IL-2 and sIL-2R.

Adult↗
PubMed1997

[Pulmonary embolism as a complication of nephrotic syndrome--case report and therapeutic management].

A case of a 41-year-old man, who was treated due to severe steroid and immunoresistant nephrotic syndrome is described. During the pulsed steroid therapy the patient underwent a pulmonary embolism and developed the post-infarction cavern and abscess of the lung. In this study the case history, complications, diagnostic procedures and therapeutic management were described. The probable mechanism of the described complications was carefully discussed.

Adult↗
PubMed1996

Comparison of plasma erythropoietin concentrations and iron status in hemodialyzed patients not requiring and requiring rHuEpo therapy.

Fifty patients treated with chronic hemodialysis (HD) were observed for 1 year. 24 of them (48%) did not require treatment with recombinant human erythropoietin (rHuEpo) (group I) because the permanent hemoglobin (Hb) concentration was > 5.9 mmol/l (9.5 g/dl), hematocrit > 30%. The remaining 26 patients (group II) permanently or periodically required rHuEpo treatment. After 6 months of initial observation and after 6 months of clinical study we made a comparison of endogenous erythropoietin (Epo) and iron status in two groups of patients. Patients not requiring treatment with rHuEpo had statistically significant higher Epo concentration and lower iron reserves than patients on rHuEpo treatment. We did not find significant differences in Hb, albumin and creatinine between patients in both groups. Hb concentration did not correlate with the level of Epo, serum creatinine, transferrin saturation, ferritin, iron reserves and time of dialysis therapy in both groups. In both groups we found a significant negative correlation between the concentration of Epo and iron stores. Our results indicate that in patients on HD treatment, plasma Epo level appears to depend either directly or indirectly on iron status.

Adult↗
PubMed1996

[Comparison of the ability to control anemia in patients on hemodialysis and peritoneal dialysis considering iron reserves and plasma erythropoietin].

It is known, that patients undergoing CAPD have less severe anaemia than those receiving hemodialysis (HD). In addition they require smaller doses of rHuEpo to control anaemia than HD pts. We have decided to compare plasma erythropoietin (pEpo) and iron reserves (IR) in these both groups of pts. 17 pts on CAPD and 50 pts on HD were diagnosed. 35% pts on CAPD and 52% pts on HD required permanent rHuEpo treatment to maintain hemoglobin (Hb) concentration above 9.5g/dl and Ht above 30%. Plasma EPO and ferritin levels were measured by enzymatic immunoassay. IR were estimated by formula: IR = 400x [ln (ferritin) - ln(50)]. Compared to CAPD, HD pts had higher IR (405 +/- 76 vs. 358 +/- 120 mg) but differences are not statistically significant. Plasma Epo level (geom. mean) was statistically significant higher p = 0.025 in HD pts compared to CAPD pts (8.68, range 2-53 vs. 5.21 range 2-15 mV/ml) Hb concentrations did not differ significantly between pts on CAPD and HD. CAPD pts controlled anaemia better than HD pts despite lower concentration of endogenous erythropoietin.

Adult↗
PubMed1996

[Complication due to intraperitoneal dialysis catheter insertion].

During the last 6 years 300 stylet and Tenckhoff catheters were inserted into the peritoneal cavity. In 5 cases an abdominal viscus has been perforated or injured. The complications were twice a perforation of bowel, twice a perforation of bladder and once an injury of aorta. The authors discussed the therapeutic procedure (conservative or operative) and the late consequences of those complications.

Aged↗
PubMed1995

[Comparison of selected parameters of dialysis quality in hemodialysis patients not requiring and requiring treatment with erythropoietin].

After 1/2 year long clinical observation 50 maintenance hemodialyzed patients were divided into two groups. Group I consisted of patients with haemoglobin concentration exceeded 9.5 g/dl and hematocrit above 30%, not treated with rHuEPO. Patients of group II permanently or periodically required treatment of rHuEPO to maintain haematological parameters written above. Then mean maintaining dose of rHuEPO was 5,500 units weekly. The concentrations of haemoglobin, albumin, creatinine, transferrin, KT/V and body mass index (BMI) handled as parameters of quality of dialysis therapy (PQD) of two groups were compared. Lack of treatment with rHuEPO in hemodialyzed patients of group I, with adequate Hb concentration, does not change significantly PQD in comparison with patients of group II treated with rHuEPO.

Body Mass Index↗
PubMed1995

[Infection with HCV in patients hospitalized for various causes. I. Prevalence of anti-HCV antibodies in selected groups of patients].

Using the third generation ELISA test UBI HCV (Organon Teknika) we studied the prevalence of anti HCV antibodies among 980 patients (hospitalized of various diseases) in 4 hospitals in district Lublin. The results indicated that 22.3% of patients were positive for anti HCV. The presence of anti HCV in the high-risk group was higher, in hemophiliacs-59% and in hemodialysis patients-57%. The prevalence of anti HCV is closely correlated with age (19.2% in children and 24.4% in adults). This difference was statistically significant (p < 0.001). As nosocomial infections was probably 70% of cases.

Adolescent↗
PubMed1995

[The response to the hepatitis B virus vaccine in patients undergoing hemodialysis and peritoneal dialysis--personal experience].

In 55 hemodialyzed and 15 patients on CAPD the presence of hepatitis B and C markers was estimated before the beginning of the vaccination series against hepatitis B with Engerix B vaccine. The initial anti-H Bs antibody titres was also estimated in these patients. The patients without H Bs Ag who have the anti-Hbs titres below 10 IU/I were qualified for this vaccination. The vaccination was needed by 40% of hemodialyzed patients H Bs(-) and 93% patients on CAPD. After completing the half year lasting series of vaccinations, the serological answer in vaccinated patients was estimated. The protective antibody titres above 10 IU/I was produced by 62.5% of patients on hemodialysis and 64.4% of patients on CAPD. The presence of anti-HCV antibodies had insignificant influence on the ability of producing the protective antibody titres in vaccinated patients.

Adult↗
PubMed1994

[Comparison of clinical parameters of chronically hemodialyzed patients not requiring treatment with erythropoietin and patients treated with erythropoietin].

50 patients with terminal renal failure treated with chronic haemodialysis were examined. 24 of them (48%) did not require treatment with erythropoietin (rHuEPO) because of permanent haemoglobin concentration was 9.5 g/dl (5.91 mmol/l) and hematocrite more than 30%. Clinical data of two groups of patients were compared: 1) patients not requiring treatment with rHu EPO, 2) patients requiring treatment with rHu EPO. Attention was paid to the sex, age, the kind of disease which caused renal failure, the duration of dialysotherapy, liver function, HBs antigenemia, presence anti-HCV antibodies, ultrasonographic estimation of patients own kidneys; liver. Patients who did not require treatment with rHu EPO were older, longer treated with chronic haemodialysis and more frequently cysts in their own kidneys were seen. Any significant differences were not observed in both groups of patients as regards their antigenemia HBs or presence of anti HCV-antibodies. The important cardiovascular disease was observed more frequently in patients requiring treatment with rHu EPO.

Adult↗