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H K Stummvoll

Publications and source records attributed to H K Stummvoll.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Individual dialysis using computer-controlled prescription].

The use of urea kinetics as basis for optimization and individualization of renal replacement therapy has become quite popular over the last decade. The rationale underlying the use of blood urea nitrogen for monitoring or targeting dialysis therapy is based on the report of an American multicentre cooperative dialysis study showing that blood urea nitrogen concentrations are closely correlated to the occurrence of morbidity and complications in dialysis patients. In order to further optimize the accuracy of dialysis prescription we have developed a new algorithm for estimation of the dialysis time needed to reach a certain blood urea nitrogen concentration, which--in contrast to all methods employed so far--enables accurate calculation of ultrafiltration during haemodialysis and of weight changes in the interdialytic period.

Blood Urea Nitrogen↗
PubMed1985

[Intrapulmonary percussion. A new method of respiratory therapy].

Intrapulmonary percussion with a high-frequency jet system is a new method in the treatment of respiratory impairment. It imitates the conventional percussion massage of the thorax by introducing high-frequency gas oscillations (300 impulses per minute) into the tracheobronchial system. In 14 patients with abnormal alveolo-arterial oxygen differences due to bronchial mucostasis ventilation was satisfactorily improved by its application.

Humans↗
PubMed1985

Iron removal by desferrioxamine in patients on chronic hemodialysis--kinetic study and long-term results.

Serum ferritin levels, cumulative number of administered blood transfusions, number of monthly transfused blood units and total months on hemodialysis (HD) treatment differed significantly in 7 patients on hemodialysis with clinical, biochemical and histological evidence of hemosiderosis, when compared to 37 controls (p less than 0.001 for all parameters). As a new treatment method desferrioxamine (DFO) therapy was introduced for iron detoxification in these hemosiderotic chronically hemodialyzed patients. Hence, to maximize the biological half-time, 30 mg/kg body weight DFO were given after the end of HD in the iron-loaded patients. Iron removal during the subsequent HD and the increase of iron excretion by the stool after DFO was measured by atomic absorption spectroscopy. Iron removal by the artificial kidney was calculated by investigating the function (QDi + QF)CDo over the duration of HD treatment, which equals the total amount of iron removal during HD. Using numerical integration of measured data this removal was found to be 21.8 +/- 6.9 mg whereas cumulative iron loss via the feces was found to be 36.5 +/- 14.6 mg. Therefore, total iron elimination was calculated to be on average 50-60 mg after administration of a single dose of DFO. Furthermore, long-term treatment of 5 patients resulted in a significant decrease of serum ferritin levels from 2,309 +/- 295 to 715 +/- 177 ng WHO/ml (p less than 0.001) after a period of 36 +/- 5 months. We conclude, that DFO in a dosage of 30 mg/kg body weight given at the end of HD is able to remove more than 500 mg iron/month if it is administered following each HD. Long-term results indicate negative iron balance without significant change of transfusion frequency if not more than 2 U of blood (500 mg iron) are administered within 1 month. This treatment schedule might be superior compared to the previously used methods of administration where DFO was given at the beginning or throughout HD.

Adolescent↗
PubMed1985

[Hemofiltration and the neurohumoral system in patients with severe heart failure].

6 fluid overloaded patients with congestive heart failure, NYHA classification IV, resistant to drug therapy, were treated by pump driven venovenous hemofiltration. The sympathetic nervous system measured by plasma norepinephrine concentration was stimulated in all patients. 4 of 6 patients had a markedly enhanced plasma renin activity. Between 7 and 20 l of fluid were removed by hemofiltration. The expected increase of plasma norepinephrine did not occur in 4 out of 6 patients. The improvement of cardiac pump function by hemofiltration could be an explanation for this apparent paradoxical regulation. Patients who had almost a normal plasma renin activity prior to hemofiltration showed a marked increase after the procedure. In patients with extremely high levels of plasma renin activity we noted a decrease after hemofiltration. Almost in every patient with a serum sodium concentration lower or equal 132 mmol/l the plasma renin activity was markedly elevated. Patients with normal serum sodium concentrations exhibited only slightly elevated plasma renin activity. Therefore, a hyponatremia in patients with heart failure can be used as a marker for high plasma renin activity. All patients had a significant improvement of the clinical state after hemofiltration. 3 patients, however, showed deterioration within a few weeks, due to the severity of the disease. Their plasma norepinephrine levels remained high or had a tendency to increase.

Adult↗
PubMed1985

[Methods of hemofiltration].

The methods of continuous hemofiltration therapy are described. The various forms of blood access are discussed, especially the pumpdriven venovenous form of hemofiltration utilizing a double lumen catheter in the superior caval vein is demonstrated as an alternative to the spontaneous arteriovenous method. The own experiences in over 140 patients with renal, cardial and pulmonal indications are summarized.

Blood↗
PubMed1985

[Hemofiltration in chronic heart failure].

30 patients with severe congestive heart failure (NYHA IV) unresponsive to medical management were treated by continuous hemofiltration (CHF). 57% of patients received arteriovenous CHF and 43% of patients venovenous, machine assisted CHF over 95 +/- 31 hours. A reduction of body edemas was achieved. The removal of body fluid by CHF between 2 and 40 kg led to a reduction of body edemas and short-term clinical improvement. Furthermore CHF treatment induced hemodynamic improvement with a reduction of central venous pressure (18 +/- 6 cm H2O pre CHF vs 8 +/- 4 cm H2O post CHF p less than 0.01) and a reduction of left ventricular filling pressure (22 +/- 6 mm Hg vs 14 +/- 5 mm Hg, p less than 0.01), while the left ventricular ejection fraction remained unchanged. Patients with low serum sodium levels (less than 132 mval/l) benefited most. While 28/30 of patients has short-term clinical improvement between 2 and 8 weeks, 38% of patients had long-term benefits.

Adult↗
PubMed1984

[Continuous arteriovenous hemofiltration in the therapy of acute renal insufficiency].

30 patients with acute renal failure were treated in an intensive care unit by continuous arterio-venous haemofiltration (CAVH). This procedure has less side effects as compared with intermittent haemodialysis, peritoneal dialysis and haemofiltration (hypotension, bio-incompatibility and lack of biochemical steady state) and CAVH is clearly superior with regard to fluid removal. In removing the uraemic toxins CAVH is more effective than peritoneal dialysis and, in most instances, satisfactory as sole renal replacement therapy in acute renal failure.

Acute Kidney Injury↗
PubMed1984

Chronic hemodialysis: high risk patients for arrhythmias?

UNLABELLED: Patients with end-stage kidney disease undergoing chronic maintenance dialysis (HD) are a high risk group for sudden death due to cardiovascular complications. It was the aim of the study to investigate the quantity and quality of arrhythmias during HD and between two consecutive HD (interval, I) with regard to the reproducibility of the expected results. 15 patients (8 males, 7 females) underwent continuous Holter monitoring (LT-ECG) under ambulatory conditions over 96 h including two HD ( HD1 + HD2 ) and two intervals (I1 + I2). The LT-ECG recordings were analysed with the computer assisted ' Multipass -Scanning' system with regard to heart rate (HR), supraventricular premature beats (SPB), ventricular ectopics (PVC) and malignant ventricular arrhythmias. RESULTS: The HR demonstrated a typical, well-known circadian pattern with remarkable increase of the HR during each HD. Except for rare, single SPB and/or PVC, no supraventricular or ventricular arrhythmias could be detected reproducibly. Single PVC occurred in patients with a lower potassium value. No malignant ventricular arrhythmias were found. In comparison to previously published studies, which demonstrated a high incidence of malignant ventricular arrhythmias, these conflicting results were due to differences in patients' recruitment (underlying disease, age, etc.), the performance of HD (duration, ion concentration of the dialysate etc.), serum potassium levels and drug medication (digitalis, quinidine). In summary, chronic HD per se did not enhance the risk of malignant arrhythmias in patients with end-stage kidney disease.

Adolescent↗
PubMed1984

Effect of desferrioxamine on aluminum kinetics during hemodialysis.

The effects of desferrioxamine administration on aluminum kinetics during hemodialysis were studied. Desferrioxamine leads to an increase of plasma aluminum levels in patients on chronic hemodialysis which could be attributed to mobilization of tissue aluminum. The in vivo protein binding of aluminum was found to be 70% after administration of desferrioxamine vs. 80% without a premedication with desferrioxamine, thus greatly enhancing the concentration gradient between free diffusible plasma aluminum and dialysate aluminum. Desferrioxamine therefore leads to increased aluminum removal during hemodialysis and should be considered in the therapy of aluminum toxicity syndromes.

Adolescent↗
PubMed1983

[Disorders of hormone metabolism in chronic uremia].

Uremia is accompanied by a variety of "true" and "laboratory" endocrine disorders, due in part to impaired degradation of hormones because of failing kidney function and in part to the interference of the uremic environment with extrarenal degradation or synthesis and secretion of certain hormones. "True" endocrine disorders, like hyperparathyroidism or hypogonadism, that are associated with renal insufficiency are in contrast with "laboratory" endocrine disorders in uremia, where pathological serum hormone levels lack clearcut clinical evidence for dysfunction of the respective endocrine organ (e.g. thyroid gland). This lack of a direct cause and effect relationship in uremia may be due to the fact that immunoassayable hormone levels may include cross reacting components without biological activity in uremia and to the fact that the uremic environment may alter hormonal effects on target organs. This review tries to give a survey of the big amount of available clinical and laboratory data for uremia induced changes in the following hormones: growth hormone and somatomedins, prolactin, cortisol and adrenocorticotrope hormone, the gonadal and thyroid function as well as parathyroid hormone action. The knowledge of these uremia-induced changes should facilitate the clinician the diagnosis of an additional primary endocrine ailment in a uremic patient and should, on the other hand, spare these patients unnecessary treatment for a suspected endocrine disorder.

Adrenocorticotropic Hormone↗
PubMed1983

Spontaneous arteriovenous plasma separation.

Plasmapheresis (PP) therapy was carried out by spontaneous arteriovenous membrane plasma separation. By cannulating the femoral artery and vein by Seldinger technique, this method could be performed by natural arteriovenous pressure gradient without blood pumps or special monitoring. Eight patients experienced 44 PP therapies without complication in the ICU. Spontaneous arteriovenous membrane plasma separation can suitably be combined with continuous arteriovenous hemofiltration.

Adult↗
PubMed1983

[The pathophysiology of hemodialysis treatment].

Hemodialysis therapy is the most commonly used renal replacement therapy despite the development of alternative detoxification procedures. As in any therapy hemodialysis treatment shows side effects. These regularly appearing intradialytic complications are essentially responsible for the morbidity of the dialysis patient. Studies were undertaken to clarify the pathomechanisms of the dialysis hypoxemia and dialysis hypotonia. Intradialytic variations of carbohydrate and protein metabolism and of the cellular blood components were analyzed. The exact knowledge of the pathomechanisms of these side-effects should lead to technical improvement in dialysate composition. With this knowledge a more effective treatment and a better prophylaxis of these intradialytic side effects should be possible.

Adult↗