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Biomedical subjects

A R Hull

Publications and source records attributed to A R Hull.

86 records · Page 5Linked to original sources
PubMedDate not supplied

Dialysis-related mortality in the United States.

BACKGROUND: In the United States, the gross mortality rate for patients undergoing dialysis in 1992 was 23.6% per year, higher than in any other industrialized country. This mortality rate has been rising slightly for the last 10 years. Wide variations in mortality rates exist among states and among dialysis centers, and smaller dialysis centers have higher mortality rates than larger ones. PURPOSE: To review the possible reasons for the high mortality rate associated with dialysis in the United States. SUMMARY: Differences in patient populations do not explain the variations in mortality rates. The incidence of new patients and the prevalence of older patients and patients with diabetes are higher in the United States than in other countries and are continuing to rise. However, these numbers are rising in other countries as well without a concomitant increase in their mortality rates. Black patients make up a disproportionate number of US dialysis patients, but they are less likely to die than white patients. US patients spend less time per week in dialysis than their European counterparts and use smaller dialyzers, resulting in lower clearance of solutes. CONCLUSION: Approximately two thirds of US patients receive inadequate dialysis. Nephrologists must examine their practices and their outcomes to improve the quality of care they give.

Humans↗
PubMedDate not supplied

Epidemic renal transplant rejection associated with influenza A victoria.

1) IAV infection seems to trigger acute renal allograft rejection frequently, especially in the first few months post-transplant, and these rejections are severe with a high rate of ultimate graft loss; 2) seroconversion occurred in most cases despite high dose steroids; 3) the course of IAV was prolonged and associated with a high incidence of complications in patients on high dose steroids.

Adult↗
PubMedDate not supplied

Recommended clinical practices for maximizing peritoneal dialysis clearances.

Data from the Canada-U.S.A. (CANUSA) Study have recently confirmed a long-suspected linkage between total clearance and patient survival in peritoneal dialysis (PD). Recognizing that what we have historically accepted as adequate PD simply is not, the Ad Hoc Committee on Peritoneal Dialysis Adequacy met in January, 1996. This committee of invited experts was convened by Baxter Healthcare Corporation to prepare a consensus statement that provides clinical recommendations for achieving clearance guidelines for peritoneal dialysis. Through an analysis of 806 PD patients, the group concluded that adequate clearance delivered with PD can be achieved in almost all patients if the prescription is individualized according to the patient's body surface area, amount of residual renal function, and peritoneal membrane transport characteristics. Use of 2.5 L to 3.0 L fill volumes, the addition of an extra exchange, and giving automated peritoneal dialysis patients a "wet" day are all options to consider when increasing weekly creatinine clearance and KT/V. Rather than specify a single clearance or KT/V target, the recommended clinical practice is to provide the most dialysis that can be delivered to the individual patient, within the constraints of social and clinical circumstances, quality of life, life-style, and cost. The challenge to PD practitioners is to make prescription management an integral part of everyday patient management. This includes assessment of peritoneal membrane permeability, measurement of dialysis and residual renal clearance, and adjustment of the dialysis prescription when indicated.

Body Surface Area↗