Search PubMed⌕ Search

Biomedical subjects

J Bernardini

Publications and source records attributed to J Bernardini.

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

The influence of demographic factors and modality on loss of residual renal function in incident peritoneal dialysis patients.

OBJECTIVE: To determine whether gender, race, diabetes, peritoneal dialysis (PD) modality, and comorbid conditions influence loss of residual renal function (RRF). DESIGN: Retrospective study of incident PD patients, using database of prospectively collected demographic, laboratory, and clearance data. SETTING: Peritoneal Dialysis Registry of the University of Pittsburgh Medical Center. PATIENTS: The study included 184 continuous ambulatory PD and automated PD patients who had at least two 24-hour urine collections for glomerular filtration rate (GRF) between April 1991 and March 2000. 836 urine collections were analyzed. OUTCOME MEASURES: Loss of RRF was defined as the slope of the decline in GFR as measured by the average of creatinine and urea clearances in 24-hour urine collections. Stepwise forward regression was used to identify demographic and laboratory factors associated with loss of GFR. Spearman correlations were used to assess the significance of associations. RESULTS: The median rate of decline of renal function was -0.17 mL/minute/month. Gender, race, diabetes, automated PD, peritoneal equilibration test, protein equivalent of nonprotein nitrogen appearance normalized to body surface area, and serum albumin did not predict loss of RRF. Cardiac disease was the only variable affecting decline of RRF (p = 0.045). CONCLUSION: Modality of PD and patient demographic factors do not contribute to the rate at which RRF is lost in incident PD patients. Additional study of the factors contributing to the decline and maintenance of RRF is needed.

Adult↗
PubMedDate not supplied

Neither size nor weight predicts survival in peritoneal dialysis patients.

OBJECTIVE: To determine if patient size or weight at the start of PD influences patient or technique survival. DESIGN: A prospective cohort study of adult PD patients. SETTING: A university and a Veterans Administration outpatient dialysis unit. PATIENTS: 343 adults patients with 660 years on PD enrolled from 1979 to 1995. MAIN OUTCOME MEASURES: Patient survival (censoring for transplant, 60 days post-transfer to hemodialysis, and end of study) and technique survival (censoring for death, transplant, or end of the study) for patients as grouped by weight (< or = 64 kg vs. > 64 kg or < or = 82.7 kg vs. > 82.7 kg) or BSA (< or = 2.0 m2 vs > 2.0 m2). RESULTS: Patient survival was 86.3% at one year, 77.0% at two years, 65.2% at three years, and 56.9% at 4 years. Technique survival was 84.9% at one year, 77.5% at two years, 63.5% at three years, and 58.3% at four years. The patient and technique survival curves were not significantly different for patients as grouped by weight or BSA. Using Cox proportional hazards model, age, diabetes, peritonitis rate, and albumin at the start of PD were independent predictors of patient survival, but BSA and weight were not. The only predictor of technique survival was the peritonitis rate. Larger patients had higher initial albumins, which may indicate better nutritional status that may offset the risk of underdialysis. CONCLUSIONS: Large patients do as well as smaller patients on PD. Size alone should not preclude patients from PD.

Adult↗
PubMedDate not supplied

Low seroconversion with hepatitis B vaccination in peritoneal dialysis patients.

OBJECTIVE: To compare seroconversion using hepatitis B vaccine between hemodialysis (HD) and peritoneal dialysis (PD) patients. DESIGN: Data on PD patients vaccinated were collected retrospectively for the period 1992 to 1995. The data on HD patients were collected prospectively from 1991 to 1994. SETTING: A university outpatient dialysis center. PARTICIPANTS: All adult patients who received all four doses of hepatitis B vaccine while on dialysis were included (47 PD and 50 HD patients). INTERVENTION: Recombinant hepatitis B vaccine (Engerix), 40 micrograms IM was administered at 0, 1, 2, and 6 months. MAIN OUTCOME MEASURE: Seroconversion was measured after completion of the vaccination series. RESULTS: 74% of the HD patients seroconverted compared to 53% of PD patients (p = 0.03). Older, heavier patients compared to all the other patients had a lower seroconversion rate in both the HD patients (55% vs. 78 %) and PD patients (38% vs. 59%) (p = 0.03). CONCLUSION: The seroconversion rate to recombinant hepatitis B vaccine is lower in patients on PD than on HD for unclear reasons. Further studies are required to determine the etiology of this difference.

Adult↗
PubMedDate not supplied

Measuring compliance with prescribed exchanges in CAPD and CCPD patients.

OBJECTIVE: To measure compliance with prescribed exchanges in continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) patients using inventories of home dialysis supplies; to determine the reliability of the ratio of measured to predicted creatinine (M/P) in predicting compliance with prescribed exchanges; to determine the effects of the ingestion of performed creatine on the excretion of creatinine. DESIGN: A prospective analysis. SETTING: A university dialysis center. PATIENTS: Twenty patients on home peritoneal dialysis (PD). MEASUREMENTS: An inventory of supplies during two home visits over a 4-8 week interval determined the number of PD exchanges performed. This number was divided by the number of exchanges prescribed for the period to determine the percent compliance. Three consecutive days of the dialysate and urine were measured with all food consumed recorded during those days. M/P creatinine ratios and dietary protein intake (DPI) for each day were calculated. RESULTS: Of the patients tested, 8/20 (4%) were found to be noncompliant with the prescribed number of exchanges based on the home visits inventories, performing a mean of 75% of their exchanges. There was no significant difference in the M/P creatinine ratios of compliant and noncompliant patients, nor were the M/P ratios distributed differently for compliant and noncompliant patients. The M/P ratios did not vary significantly over the past 3 days. There was no correlation between the measured creatinine on a given day and the DPI for the same day. CONCLUSION: Based on assessment of the patient's inventory, 40% of the patients studied were noncompliant with their prescribed exchanges, indicating this is a serious and common problem in PD patients. The M/P creatinine ratio is not a predictor of compliance in PD. We suggest that use of home visit inventories to assess compliance in PD patients.

Adult↗
PubMedDate not supplied

A survey of home visits at peritoneal dialysis centers in the United States.

OBJECTIVE: To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). DESIGN: Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. RESULTS: Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one follow-up visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5-1 hour, while 41% required 1-2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. CONCLUSIONS: Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.

Centers for Medicare and Medicaid Services, U.S.↗