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Biomedical subjects

C Charytan

Publications and source records attributed to C Charytan.

At least 19 recordsLinked to original sources
PubMed2002

Acute interstitial nephritis secondary to infectious mononucleosis.

Renal involvement in infectious mononucleosis (IM) is infrequent. In most cases it is self-limited and is rarely associated with loss of renal function. The purpose of this case report is to document a case of acute interstitial nephritis (AIN) leading to acute renal failure (ARF) in a patient with Epstein-Barr virus (EBV) infection and to review literature of EBV infection and its renal manifestation. The patient was managed with hemodialysis and steroids and made an uneventful recovery. Renal involvement in IM may be more common than generally appreciated and may occasionally lead to ARF. Therapy with corticosteroids may have role in the management of IM-induced ARF and may shorten the duration of renal failure.

Acute Kidney Injury↗
PubMed2001

Efficacy and safety of iron sucrose for iron deficiency in patients with dialysis-associated anemia: North American clinical trial.

Iron sucrose has been used to provide intravenous (IV) iron therapy to patients outside the United States for more than 50 years. In a multicenter North American clinical trial, we determined the efficacy and safety of iron sucrose therapy in patients with dialysis-associated anemia, evidence of iron deficiency, and below-target hemoglobin (Hgb) levels despite epoetin therapy. Evidence of iron deficiency included a transferrin saturation (Tsat) less than 20% and ferritin level less than 300 ng/mL, and below-target Hgb levels included values less than 11.0 g/dL. We administered iron sucrose in 10 doses, each administered undiluted as 100 mg IV push over 5 minutes, without a prior test dose. We assessed efficacy by determining the subsequent change in Hgb, Tsat, and ferritin values. We assessed safety by recording blood pressure and adverse events after iron sucrose injection and comparing results with those for the same patients during an observation control period. Results showed a significant increase in Hgb level that was first evident after three doses of iron sucrose and persisted at least 5 weeks after the 10th dose. Tsat and ferritin levels also increased significantly and remained elevated. In 77 enrolled patients, including those with previous iron dextran sensitivity, other drug allergies, or concurrent angiotensin-converting enzyme inhibitor use, we saw no serious adverse drug reactions and no change in intradialytic blood pressure associated with iron sucrose administration. We conclude that iron sucrose injection administered as 1,000 mg in 10 divided doses by IV push without a prior test dose is safe and effective for the treatment of iron deficiency in patients with dialysis-associated anemia.

Aged↗
PubMed2001

Role of the nephrologist in the intensive care unit.

Intensive care units (ICUs) are increasingly becoming a focal point for tension between medical specialists. In an extreme approach to this issue, some ICUs have become closed units managed by intensivists, with other specialists, such as nephrologists, having a restricted supportive role. The nephrologist, a subspecialist with broad skills in general internal medicine, has trained and appropriately can serve as the primary physician for patients with significant renal failure and end-stage renal disease in multiple hospital settings, including the ICU. Sick and complex hospitalized patients offer ample opportunity for a collaborative interaction between the nephrologist and intensivist in the ICU.

Continuity of Patient Care↗
PubMed2000

Safety and efficacy of iron sucrose in patients sensitive to iron dextran: North American clinical trial.

Sensitivity to iron dextran is a potent obstacle to maintaining optimum iron status in patients with dialysis-associated anemia. As part of the North American clinical trials for iron sucrose injection, we examined the effect of intravenous (IV) iron sucrose in 23 hemodialysis patients with documented sensitivity to iron dextran, ongoing epoetin alfa therapy, and below-target-range hemoglobin (Hgb) levels (<11.0 g/dL). We assigned patients to treatment groups according to whether reactions they had experienced to iron dextran were judged to be mild (n = 16; group A) or severe (n = 7; group B). We prospectively examined adverse events and vital signs after administering 100 mg of IV iron sucrose in each of 10 consecutive dialysis treatment sessions and compared results with those recorded in each of three consecutive dialysis sessions without iron treatment. We administered iron sucrose by IV push over 5 minutes to group A patients and by IV push over 5 minutes or IV infusion over 15 to 30 minutes to group B patients. We did not administer a test dose. Results showed no serious adverse drug reactions after a total of 223 doses of iron sucrose (184 doses by IV push, 39 doses by IV infusion). Intradialytic blood pressure changes after IV iron sucrose injection did not differ from those recorded during dialysis sessions without treatment. An increase in values for Hgb, hematocrit, transferrin saturation, and ferritin, coupled with no significant change in epoetin dose and a decrease in total iron-binding capacity, confirmed the efficacy of iron sucrose injection in managing anemia. We conclude that iron sucrose injection is safe and effective in the management of anemia in patients sensitive to iron dextran and can be administered without a test dose by IV push or infusion.

Anemia, Iron-Deficiency↗
PubMed1998

Treatment of malnutrition with 1.1% amino acid peritoneal dialysis solution: results of a multicenter outpatient study.

A peritoneal dialysis (PD) solution containing 1.1% amino acids as the osmotic agent was evaluated in a 3-month randomized, prospective, open-label study in malnourished PD patients. Patients in the treatment group (DAA) received one or two exchanges daily with the amino acid solution, depending on tolerance, in place of glucose solutions. Controls (DD) received their usual therapy with glucose dialysate. Fifty-four DAA and 51 DD patients completed the study. In DAA, but not in DD patients, there was a significant increase at month 3 in serum insulin-like growth factor-1 (IGF-1) levels and significant decreases in serum potassium (all 3 months) and inorganic phosphorus levels (months 1 and 3), indicating a general anabolic response. Prealbumin and transferrin levels were significantly increased in DAA but not in DD patients at month 1, but the groups did not differ at months 2 and 3. In patients with baseline albumin levels less than 3.5 g/dL (bromcresol green [BCG] method), DAA patients showed increases in albumin, transferrin (months 1 and 2), and prealbumin levels (all 3 months) relative to baseline values, whereas these serum protein levels were unchanged in DD patients, although the changes from baseline did not differ between groups. In this subgroup, midarm muscle circumference (MAMC) did not change in DD or DAA patients. In patients with baseline albumin levels of 3.5 g/dL or greater, DD patients had decreases in albumin and total protein levels at all 3 months and in prealbumin levels at months 1 and 2, relative to baseline. In DAA patients, there were fewer changes in serum proteins. MAMC increased significantly from baseline in DAA but not in DD patients, although changes from baseline did not differ between DAA and DD groups. DAA patients showed no changes in peritoneal membrane transport characteristics. The results indicate that treatment with one or two exchanges daily of this amino acid-based PD solution is safe and provides nutritional benefit for malnourished PD patients.

Amino Acids↗
PubMed1998

Effect of angiotensin-converting enzyme inhibitors on response to erythropoietin therapy in chronic dialysis patients.

BACKGROUND: Erythropoietin (EPO) therapy is a common and effective treatment for the correction of anemia in patients with end-stage renal disease. Simultaneous treatment with angiotensin-converting enzyme (ACE) inhibitors for the control of hypertension and/or heart failure is often necessary. Recent reports in the literature have raised concern about a potential interaction between these drugs, with a resultant decreased EPO efficacy. METHODS: To investigate whether this interaction occurs in chronic dialysis patients, we retrospectively reviewed the records of 175 patients receiving chronic dialysis. All study patients were treated with EPO for at least 3 months, and had normal iron indices. Patients were treated with ACE inhibitors for at least 3 months, at a constant daily dose for at least 1 month (group 1, n = 32), or did not receive ACE inhibitors (group 2, n = 143). Patients with infections or overt iron deficiency were excluded. Total weekly EPO doses and hematocrit (Hct)/hemoglobin (Hgb) values in the two groups were compared. Variables known to affect response to EPO were compared, including ferritin, transferrin saturation, dialysis dose and serum aluminum. RESULTS: Total weekly EPO dose was 17,358 +/- 6,871 units in group 1 and 17,612 +/- 7,744 units in group 2 (p = 0.854). The achieved Hct was 32.1 +/- 4.4% (group 1) and 30.5 +/- 4.0% (group 2) (p = 0.079). Similarly, Hgb, ferritin, transferrin saturation, Kt/V, and serum aluminum were not different. The dose or duration of ACE inhibitor therapy did not affect Hgb or Hct. Thus, ACE inhibitor therapy does not appear to affect response to EPO in chronic dialysis patients.

Aluminum↗
PubMed1997

Fluoxetine in depressed patients on dialysis.

OBJECTIVE: To test the safety and efficacy of fluoxetine in patients with renal failure on dialysis. METHOD: Fourteen patients with major depression and end stage renal disease on hemodialysis were randomized into two groups for an eight-week study. Subjects as well as investigators were blinded as to which subject received fluoxetine and which placebo. Patients were carefully monitored concerning adverse events, serum fluoxetine and norfluoxetine levels, and psychological measurements of degree of depression. RESULTS: No patients discontinued treatment because of adverse events, all of which were minor. All psychological tests showed improvement in depression at the four-week and eight-weeks point, although statistical significance could only be demonstrated at the fourth week of this study. All patients in the active group had serum plasma concentrations of fluoxetine and norfluoxetine less than 250 ng/ml at eight weeks, similar to levels in patients with normal renal function in a previous open label study. CONCLUSIONS: This study confirms the relative safety of fluoxetine in depressed patients in renal failure on hemodialysis. It also suggests that fluoxetine may be efficacious in depressed patients on dialysis.

Adult↗
PubMed1996

Fractional direct dialysis quantification: a new approach for prescription and monitoring hemodialysis therapy.

We describe a new methodology, fractional direct dialysis quantification (FDDQ) utilizing the Fresinius Dialysate Sampling Module (DSM), for quantitating total solute removal during hemodialysis (HD). Our data demonstrate that this technique and Direct Dialysis Quantification (DDQ) yield virtually identical results. FDDQ, however, obviates the practical obstacles that have limited the applicability of DDQ. We discuss the theoretical and practical advantages of this methodology, as compared to urea kinetic modeling (UKM) with Kt/V, for prescribing and monitoring dialysis therapy. FDDQ provides reliable and accurate quantitative data of dialysis function and protein catabolic rate (PCR) independent of questionable theoretical assumptions and parameters required for UKM with Kt/V. It is simple to comprehend and apply. It permits easy comparison of standard and rapid high efficiency dialyses. It also facilitates the quantitative comparison of HD and continuous therapies (peritoneal dialysis and various types of continuous hemofiltration). FDDQ permits the use of other solutes, in place of or in addition to urea, for the quantitation of HD. Because of its simplicity and probable low cost, it can be used with each HD session. It will thus provide accurate data on delivered versus prescribed therapy. These features should permit more accurate monitoring and lead to a clearer understanding of the relationship of outcomes versus delivered dialysis dose, and consequently more effective adjustment of dialysis therapy.

Creatinine↗
PubMed1993

Cholesterol crystal embolization-associated renal failure after therapy with recombinant tissue-type plasminogen activator.

We report the occurrence of renal failure due to cholesterol crystal embolization following thrombolytic therapy with intravenous recombinant tissue-type plasminogen activator (t-PA). No invasive vascular procedure had been performed. Although there is one case report of cholesterol crystal embolization following t-PA therapy with only extrarenal manifestations (N Engl J Med 321:1270, 1989), this is the first reported case of atheroembolic acute renal failure following t-PA therapy.

Acute Kidney Injury↗
PubMed1993

Dialysis adequacy versus metabolic factors in the clinical assessment of CAPD.

We performed a cross sectional study of our continuous ambulatory peritoneal dialysis (CAPD) patients (n = 98) to examine the relation between parameters of adequacy of dialysis [KT/V, weekly creatinine clearance (Ccr)], urea kinetics (PCR), biochemical parameters (serum albumin), and clinical status of these patients. We also investigated the predictive value of these parameters in the determination of clinical outcomes. The clinical status of each patient was assessed by patient self-assessment and objectively by physicians and nurses. On this basis a total clinical assessment score was assigned. Individuals with a score of 3 or less were judged to be clinically stable (group 1, n = 61), while a score of 4 or more was considered "not doing well" (group 2, n = 37). A good correlation (r = 0.7) between subjective and objective assessments was observed. No correlation between total clinical assessment score and KT/V, PCRN (normalized protein catabolic rate), or Ccr was obtained, while serum albumin levels correlated inversely (r = -0.30; p < 0.003), suggesting that parameters of dialysis adequacy (weekly KT/V, Ccr) and urea kinetics (PCRN) are not predictive of clinical outcome in CAPD patients, in contrast with hemodialysis (HD) patients. Serum albumin levels were observed to be correlated with clinical outcome in CAPD patients. Hypoalbuminemia was observed in group 2 patients, despite statistically insignificant different values of KT/V, Ccr, and PCRN in the two groups. Therefore, clinical assessment and parameters such as serum albumin must be considered when determining the total well-being of CAPD patients.

Creatinine↗
PubMed1993

Dialysis adequacy in hypoalbuminemic continuous ambulatory peritoneal dialysis patients.

We examined the interrelationship between hypoalbuminemia (HA) and the normalized protein catabolic rate (NPCR; g/kg/day) in the face of adequate Kt/V and weekly creatinine clearances in 40 end-stage renal disease patients on long-term continuous ambulatory peritoneal dialysis (CAPD). We also evaluated serum albumin (SA) levels as an additional marker of nutritional status of the PD patients receiving adequate dialysis therapy in terms of Kt/V greater than 1.5 per week. Twenty-three of 40 patients had normal serum albumin (NSA; > or = 3.4 g/dL) and 17 had HA (< g/dL). A correlation between NPCR and SA levels was observed. Also, the NPCR values in patients with NSA (0.98 +/- 0.31) differ significantly (p < 0.0005) from patients with HA (0.80 +/- 0.13). Urea kinetic parameters for adequacy of dialysis, that is, Kt/V, blood urea nitrogen (BUN), and weekly creatinine clearance, did not reveal any statistically significant difference between patients with NSA and HA. These data suggest that low values of NPCR may be seen in hypoalbuminemic CAPD patients despite adequate dialysis therapy and indicate further investigation for associated morbid conditions or supplemental nutrition.

Adult↗
PubMed1991

Impact of epoetin beta on dialyzer clearance and heparin requirements.

The present studies were undertaken to determine whether treatment with recombinant human erythropoietin (epoetin beta [Marogen Sterile Powder, Chugai-Upjohn, Rosemont, IL] ) necessitates an alteration in dialysis prescription or in heparin requirements. All patients had end-stage renal disease (ESRD), were on chronic hemodialysis (either high-flux or conventional) for more than 3 months, and had participated in large-scale, multicenter epoetin beta clinical trials. Nine patients were entered into the clearance study. Blood chemistry values, dialyzer clearances, and hematocrit values were determined before beginning epoetin beta administration and after approximately 40 weeks of treatment. The mean hematocrit value at the beginning of the study was 0.229 (22.9%); by week 40, it averaged 0.313 (31.3%). The mean percent change in urea clearance was -1.9%, and a mean percent change of +12.7% in blood urea nitrogen (BUN) was noted. The mean percent change in creatinine clearance was -15.3, while the mean percent change in serum creatinine was +0.2%. The mean percent change in phosphate clearance was -10.1%, and the mean percent change in serum phosphate was +44.1%. Heparin profiling was performed for nine patients (four participated in the clearance study). Seven patients showed increased requirements for heparin, with a mean percent change of +24.3%. These results underscore the necessity for careful attention to the changing status of the dialysis patient on epoetin beta. While epoetin beta treatment does not, in general, adversely affect either clearance or blood chemistry values, these values may fluctuate in individual patients in response to the increasing hematocrit values and to dietary changes that result from an increased sense of well-being.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia↗
PubMed1987

Subclavian vein stenosis as a complication of subclavian catheterization for hemodialysis.

Thirteen patients had placement of a subclavian vein catheter for temporary vascular access for hemodialysis. Peripheral venography was performed within two to six weeks of catheter placement. Forty-six percent (six of 13 patients) developed subclavian vein narrowing, which resolved in two patients. The duration of catheter placement had no impact on the incidence of this complication. Subclavian vein catheterization can frequently lead to subclavian vein stenosis, which often will resolve spontaneously. Consideration should be given to placement of subclavian lines on the contralateral side of a planned permanent vascular access.

Catheterization↗