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Biomedical subjects

J D Bower

Publications and source records attributed to J D Bower.

At least 37 records · Page 2Linked to original sources
PubMed1988

15 years of experience with renal replacement therapy in patients starting therapy before age 20.

This study retrospectively evaluates the survival on renal replacement therapy among patients starting dialysis before their twentieth birthday. The cohort included all patients starting therapy from 1972 through August, 1987 at the University of Mississippi or Kidney Care, Inc. Fifty-five patients, median age 17 years, range 5-19 years, underwent 335 patient years of therapy. Nineteen initially received CAPD; 12 home hemodialysis, 2 were transplanted prior to dialysis, and the remaining 22 patients were entered into dialysis in a free standing facility. Thirty-one patients received a cadaveric transplant and four patients received a living related transplant. The median transplant survival was 1360 days. There were 10 patients on renal replacement therapy over 10 years and a survival plot projected a 70% survival at 10 years. Nine patients died. Three percent of the time on renal replacement therapy was spent hospitalized. Although the hospitalization rate is significant, the pediatric patient may be expected to have a long survival on renal replacement therapy.

Adolescent↗
PubMed1987

Diabetes, dialysate losses, and serum lipids during continuous ambulatory peritoneal dialysis.

We evaluated changes in dialysate losses of protein and absorption of glucose, serum chemistries including protein electrophoresis, and serum lipids among patients who had undergone continuous ambulatory peritoneal dialysis (CAPD) for at least 1 year. The patients' race, sex, and the presence of diabetes mellitus did not influence the results. Over a 2-year period, daily protein losses and glucose absorption from dialysate were constant, serum protein electrophoresis did not show changes consistent with the nephrotic syndrome, serum cholesterol increased after 1 year of therapy but stabilized thereafter, and concentrations of high density lipoproteins did not decrease.

Absorption↗
PubMed1987

Mechanism of attenuated hydrochlorothiazide response during indomethacin administration.

Indomethacin antagonizes the natriuretic and chloruretic response to hydrochlorothiazide in most studies. Neither the mechanism nor nephron site of this antagonism has been determined. To identify sites and potential mechanisms, cortical micropuncture was performed during hydrochlorothiazide treatment in control and indomethacin rats. Indomethacin reduced (P less than 0.005) FeCl from 5.20 +/- 0.49% to 2.26 +/- 0.49% (mean +/- SE). MAP, CIn, and plasma volume were not different between groups. SNGFR and fractional proximal fluid and chloride delivery were not different between groups. Fractional chloride delivery to early distal tubules was 10.8 +/- 0.4% in control but 6.2 +/- 0.3% in indomethacin rats (P less than 0.001). Calculated loop chloride reabsorption was greater in indomethacin than control rats during hydrochlorothiazide administration (41.0 +/- 1.6% vs. 34.3 +/- 2.3%; P less than 0.05). Fractional chloride delivery to late distal tubules was 7.8 +/- 0.7% in control and 4.6 +/- 0.3% in indomethacin rats (P less than 0.005), but distal tubule chloride reabsorption was not different between groups. Papillary tissue chloride was less in control than indomethacin rats during hydrochlorothiazide (P less than 0.05). Urinary PGE2 excretion was reduced (P less than 0.001) by indomethacin during hydrochlorothiazide. Thus indomethacin induced reductions in hydrochlorothiazide response result in part from increased chloride reabsorption in the loop segment. This suggests indomethacin antagonizes hydrochlorothiazide by reducing chloride delivery to hydrochlorothiazide's site of action in the distal tubule rather than by effects of indomethacin on hydrochlorothiazide pharmacokinetics.

Animals↗
PubMed1987

CAPD patients as renal transplant patients.

Most authors state that the continuous ambulatory peritoneal dialysis (CAPD) patient is not at increased risk when transplanted. These patients are always exposed to the risk of peritonitis, which may increase if patients are peritoneally dialyzed while immunosuppressed. The postoperative course of patients transplanted from our CAPD program from 1979 through August 1985 was evaluated. The transplant survival of patients dialyzed by CAPD, home hemodialysis, and at a free-standing dialysis facility were compared. Pretransplant dialysis modality did not influence long-term transplant success. Three of seven patients who required dialysis postoperatively developed peritonitis. The dialysis catheter was removed in two patients and one was treated by lavaging the peritoneal cavity with antibiotics. There was one instance of dialysate leaking through a drain in the transplant bed. This patient was converted to hemodialysis for subsequent dialysis. The dialysis catheters were removed at the time of discharge from hospital. Literature review confirmed this experience. Peritoneal dialysis post-transplant exposes the patient to a 10-33% risk of peritonitis and a 10% risk of a wound complication. Peritoneal dialysis patients are subject to risks unique to peritoneal dialysis. These complications do not translate into excessive morbidity or graft loss.

Adolescent↗
PubMed1986

Prostaglandin E2 but not I2 restores furosemide response in indomethacin-treated rats.

Indomethacin attenuates furosemide's natriuretic response. Although this has been attributed to cyclooxygenase inhibition, attempts to correlate prostaglandin (PG) production with furosemide's natriuresis have led some investigators to conclude that prostaglandins are not involved in this response. This study was designed to evaluate the effects of intraaortic administration of PGE2, PGI2 (100 ng X kg-1 X min-1), or the vasodilators secretin or bradykinin (75 microU X kg-1 X min-1) on the furosemide-indomethacin antagonism. Fractional sodium excretion (FENa) during furosemide administration was 4.59 +/- 0.50% in control rats but 1.84 +/- 0.33% in indomethacin-treated rats (Indo) (P less than 0.001). PGE2 prevented indomethacin from attenuating furosemide's response (FENa, 3.91 +/- 0.25%; P = NS vs. control; P less than 0.01 vs. Indo). PGI2, however, failed to prevent the furosemide-indomethacin antagonism (FeNa, 1.94 +/- 0.59%, P less than 0.001 vs. control; P = NS vs. Indo). Inulin clearance, arterial pressure, filtered sodium load, and renal blood flow were not different between groups. Neither secretin nor bradykinin prevented the indomethacin-furosemide antagonism. This study is consistent with the hypothesis that indomethacin antagonizes furosemide's natriuretic response by prostaglandin synthesis inhibition. Furthermore, PGE2 seems to restore furosemide's response through actions other than a vasodilatory effect.

Animals↗
PubMed1985

Demographic factors associated with dialysis technique failures among patients undergoing continuous ambulatory peritoneal dialysis.

We evaluated factors that would predict a successful outcome on continuous ambulatory peritoneal dialysis. We found that poverty, the need for a helper to carry out the dialysis, and physician allocation to therapy was associated with a poorer technique success. Neither age, education, marital status, sex, rural home, nor the presence of diabetes were important risk factors by themselves.

Adolescent↗
PubMed1985

Protection from ischemic renal injury by fructose-1,6-diphosphate infusion in the rat.

Fructose-1,6-diphosphate (FDP) improves survival in experimental shock. To determine if FDP would protect against single organ damage, rats pretreated with an intravenous infusion of 5% FDP were subjected to 30 minutes of bilateral renal artery occlusion. Controls received an equal volume of a dextrose and sodium chloride solution. Renal function and histology were examined in all groups 24 hours after the insult. Following ischemia, FDP-treated rats had inulin clearances (FDP 897 +/- 129 vs control 349 +/- 59 microliter/min/100 gm BW; P less than 0.01) and solute excretion rates (FDP 6,386 +/- 1,346 vs control 2,602 +/- 396 mOsm/kg/min/100 gm BW; P less than 0.05) greater than control and not different (P-NS) from sham-operated rats. Renal histology was better preserved in the FDP-pretreated group. Thus, pretreatment with FDP provides histologic and functional protection from an ischemic renal insult.

Animals↗
PubMed1984

Serial monitoring of T-cell subset ratios with monoclonal antibodies in steroid- and antithymocyte globulin-treated patients with renal allotransplants.

Sequential changes in T-cell subsets or their ratios were employed to predict severity of rejection crises and to identify those patients who might require future antirejection therapy. Forty-two percent of the transplant recipients had a pretransplant OKT4:8 ratio in the range of 1.3 +/- 0.5. By contrast, only 11% had a OKT4:8 ratio of 2.9 or greater. Examination of the entire study group demonstrated that the mean OKT4:8 ratios fell (P less than 0.01) in the first week following the transplant procedure. All patients had at least one episode of acute rejection. There was a marked increase (P less than 0.05) in the OKT4:8 ratio between the first week value and the value immediately preceding (within 3 days) the start of the rejection episode which was 2.64 +/- 0.27. The mean OKT4:8 ratio in the 15 patients leaving the hospital with a functioning transplant was 1.18 +/- 0.35. Three months post-transplant, the OKT4:8 ratio was 1.98 +/- 0.39 in the 12 patients with functioning allografts. This value was not different from those patients' initial pretransplant values. Clinically, the rejection episodes could be divided into two groups based on their response to intravenous methylprednisolone therapy. The first group (n = 9) had milder rejection crises which responded rapidly to administration of one course of methylprednisolone. The second group of patients (n = 9) were also treated initially with methylprednisolone, to which they did not respond, and subsequently received antithymocyte globulin in an attempt to control their ongoing rejection crises. Following the transplant procedure, the OKT4:8 ratio decreased in patients who were destined to have steroid-responsive rejection episodes (P less than 0.01). The OKT4:8 ratio however, failed to fall in those who required ATG for control of their transplant rejection episodes. The onset of rejection episodes was associated with an increase in OKT4:8 ratio in both groups. Following steroid administration, two patterns of OKT4:8 cell responses were observed. Those in whom renal function improved demonstrated a decline in OKT4:8 ratio from 2.4 +/- 0.4 to 1.4 +/- 0.4 (P less than 0.05). However, no change occurred in the OKT4:8 ratios with steroid therapy (2.6 to 2.4 +/- 0.33, P greater than 0.05) in individuals in whom the serum creatinine concentration failed to decline. The patients who failed to respond to steroid therapy were treated with antithymocyte globulin (ATG).(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1984

Long-term hemodialysis at reduced dialysate flow rates.

20 stable hemodialysis patients were maintained on a dialysate flow rate of 300 ml/min (QD 300) to determine the safety of prolonged reductions in dialysate flow rate. After 24 months, QD 300 compared to QD 500 resulted in no change in weight, blood pressure, BUN, hematocrit, creatinine, bicarbonate, potassium, cholesterol, or calcium. Serum phosphate concentration increased between month 13 and month 17 but then stabilized. No adverse symptoms developed. EEGs and motor nerve conduction studies following 24 months at QD 300 were normal. We conclude that QD 300 does not impair dialysis efficiency for most small molecules and saves $1.38 per patient per dialysis.

Adult↗
PubMed1983

Peritonitis in continuous ambulatory peritoneal dialysis patients.

Peritonitis is the most important complication of continuous ambulatory peritoneal dialysis (CAPD). We reviewed our experience with peritonitis over a 2 1/2-year period. Our patients spent 4% of their total time on dialysis in hospital due to peritonitis. Thirty-eight percent of the episodes of peritonitis were treated without hospitalization. We evaluated the dialysate bag change technique as commonly performed with currently available devices (extension tubing and titanium Luerlock Tenckhoff catheter adapter). The aseptic techniques described for dialysis extension tubing changes appear adequate (with no increased incidence of peritonitis demonstrated shortly after an extension tubing set change). Long-term sterility is maintained at the dialysate bag puncture port and at the orifice of the dialysis catheter adapter (no positive cultures from the bag port and orifice of the titanium adapter). Etiologic diagnosis of uremia was not a risk factor predisposing to peritonitis. The incidence of peritonitis was greater among patients with less formal education and lower income. Out data suggest that patients with less formal education and of lower economic status be carefully evaluated before commencing CAPD.

Bicarbonates↗
PubMed1983

Evaluation of continuous ambulatory peritoneal dialysis.

This study was undertaken to ascertain whether 19 patients maintained on continuous ambulatory peritoneal dialysis (CAPD) for at least 1 year experienced any deterioration in peritoneal membrane function. Selected serum chemistries and skinfold measurements were also evaluated to determine whether patients dialyzed by CAPD could maintain a normal nutritional status. This study demonstrates that patients maintained on CAPD had stable dialysate protein losses, glucose absorption from the dialysate, and constant urea, creatinine, and sodium removal. When these patients were subdivided by incidence of peritonitis, the group with a lower incidence of peritonitis (one episode every 349 +/- 155 SEM days) showed stable serum protein concentration and improvement in upper arm area whereas the group with a high incidence of peritonitis (one episode every 95 +/- 7 SEM days) showed a reduction in upper arm muscle area. Thus, our data suggest that over a 1-year period, there is no deterioration in peritoneal membrane characteristics and CAPD is effective in maintaining the nutritional status of the patient. However, both membrane function and nutritional status may be impaired by frequent episodes of infection.

Adolescent↗
PubMed1983

A model of long-term peritoneal dialysis in the dog.

We describe two preparations for chronic peritoneal dialysis in the dog. In one group uremia was induced by nephrectomy and in the other by ureteral ligation. Peritoneal access was obtained using the Ash disc column catheter. Survival of the animals ranged from 27 to 83 days. Using a dialysis schedule similar in concept to continuous ambulatory peritoneal dialysis in man we found that dialysate-induced ultrafiltration, equilibration of solute between serum and dialysate, as well as protein losses into dialysate approximated values found in patients undergoing continuous ambulatory peritoneal dialysis. Careful attention to detail is required in order to maintain these animals. The advantages of these models are their technical simplicity and prolonged survival making intermediate range studies feasible. Disadvantages include anemia, seen in the anephric animals, technical problems with the disc column catheter, the need for maintenance of strict aseptic technique when performing dialysis exchanges, and difficulties maintaining adequate nutrition.

Animals↗
PubMed1983

Host defense mechanisms in continuous ambulatory peritoneal dialysis.

We investigated whether dialyzate obtained from patients undergoing CAPD had any harmful effects on the function of their own lymphocytes and granulocytes and on those of normal controls. When tested in dialyzate obtained after a 4 hr intraperitoneal residence, lymphocyte viability and transformation responses to phytohemagglutinin and protein A were similar for patients and controls. Neutrophil function assessed by the nitroblue tetrazolium test (NBT) was not altered. Our results suggest that dialyzate, after a 4 hr intraperitoneal stay, does not impair lymphocyte and granulocyte function.

Adolescent↗
PubMed1982

Augmentation of peritoneal clearance by dipyridamole.

We performed a double blind crossover trial in which dipyridamole was administered to ten patients undergoing intermittent peritoneal dialysis at 2 liters/hour (10 min infusion, 30 min intraperitoneal dwell of dialysate and 20 min drainage of dialysate). After the patients received the drug for 3 days at a dose of 75 mg three times daily, peritoneal inulin clearance increased by 1.2 ml/min (P less than 0.05), and glucose absorption increased by 12.1 g (P less than 0.05). The mechanism of the observed drug-induced effects is unknown.

Adult↗
PubMed1982

Stereospecific lactate absorption during peritoneal dialysis.

Patients undergoing peritoneal dialysis were studied to determine if peritoneal absorption was selective. Dialysis was performed using dialysate exchange schedules similar to those for intermittent peritoneal dialysis and continuous ambulatory peritoneal dialysis. The clearance rate from the peritoneal cavity during hourly dialysate exchanges was 6.2 ml/min for D (-)-lactate and 8.7 ml/min for L(+)-lactate (p less than 0.01). L(+)-Lactate disappeared more rapidly from the dialysate during the long-cycle exchanges. Our results suggest that clearance of lactate from the peritoneal cavity is relatively stereospecific and raises the question of selective absorption for other organic anions.

Adult↗
PubMed1982

The Tenckhoff catheter for peritoneal dialysis--an appraisal.

We prospectively evaluated early (within 40 days) catheter complications in all patients receiving a dialysis catheter between 1/8/80 and 1/8/81. 50% of patients achieved a functioning catheter at the first insertion and 24% required replacement of the catheter because of poor dialysate flow. Leaking from the catheter exit site occurred in 20%, infection at the exit site in 9% and peritonitis in 19% of patients. In patients who maintain a catheter over 40 days and undergo treatment by long-term peritoneal dialysis median catheter survival was 400 days with delayed cytheter failure primarily due to failure to resolve a clinical episode of peritonitis. Although the Tenckhoff catheter is readily inserted frequent complications occur.

Adolescent↗
PubMed1982

Abdominal hernia in patients undergoing continuous ambulatory peritoneal dialysis.

We found abdominal hernias in 12 of 51 patients trained for continuous ambulatory peritoneal dialysis. Five patients were noted to have abdominal hernias before the start of continuous ambulatory peritoneal dialysis, and the conditions of seven patients were diagnosed during routine clinic visits. Four patients had incarceration. We suggest that a careful search for the presence of a hernia be performed at the initial examination for peritoneal dialysis. Continued monitoring of the patient's condition for the development of a hernia is essential. If a hernia is found, elective repair should be performed.

Adolescent↗