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Biomedical subjects

P Kes

Publications and source records attributed to P Kes.

At least 37 records · Page 2Linked to original sources
PubMed1997

Influence of erythropoietin treatment on dialyzer reuse.

The effects of recombinant human erythropoietin (r-HuEPO) administration on adequacy of hemodialysis (HD) during single-use versus multiple-reuse of hemophan hollow-fiber dialyzers were assessed in 16 stable end-stage renal disease (ESRD) patients. After 12 months of r-HuEPO treatment and maintenance HD with low-flux single-use dialyzers, in the same group of ESRD patients the effectiveness of automated dialyzer reprocessing using peroxyacetic acid was evaluated. Comparison between r-HuEPO-treated patients dialyzed with single-use devices and those treated with reused dialyzers revealed no significant differences in urea kinetic modelling and nutritional status. However, the duration of HD and heparin dosage were significantly (p < 0.05) increased, and the number of dialyzer uses was properly limited during the reuse program. When dialyzer reprocessing was performed, the r-HuEPO dosage and hemoglobin level remained unchanged if compared with the subgroup treated with single-use dialyzers. It was demonstrated that r-HuEPO treatment did not affect the adequacy of HD, even in case of dialyzer reuse.

Adult↗
PubMed1997

Ascites in a patient undergoing maintenance hemodialysis.

Clinical characteristics and course in a patient with end-stage renal disease and nephrogenic ascites are described. The pathophysiology and current treatment options for this rare condition with poor prognosis are discussed.

Ascites↗
PubMed1997

Dialyzer reprocessing with peroxyacetic acid as sole cleansing and sterilizing agent.

In a prospective study, the effectiveness of a newly available peroxyacetic acid solution (Dialox) as a cleansing and sterilizing agent for the reuse of conventional hollow-fiber hemophan dialyzers was evaluated. The effects of reprocessing dialyzers with peroxyacetic acid on leukocyte and platelet counts, dialyzer performance, acute intradialytic symptoms and cost effectiveness were studied. A total of 250 sessions using new dialyzers and 3,227 sessions employing reused dialyzers were monitored. Dialyzers were withdrawn after a maximum of 21 sessions, and the mean number of uses was 13.9 +/- 5.1. It was found that peroxyacetic acid reprocessing of hemophan dialyzer membranes improved hemodialysis leucopenia and thrombocytopenia. It was also proved that, compared to new ones, the reused dialyzers were associated with significantly fewer intradialytic symptoms. Clearances of small molecules and ultrafiltration rate after multiple dialyzer reprocessing remained within the acceptable limits. The duration of hemodialysis has been prolonged 30 min after the 10th dialyzer reuse and dialysis adequacy remained unaffected. About 100,000 DEM were saved during the one year due to the reuse procedure. The authors conclude that automated dialyzer reprocessing with peroxyacetic acid as a sole cleansing and sterilizing agent is a safe, efficacious and money-saving method.

Adult↗
PubMed1997

The effect of hollow-fiber dialyzer Plivadial Altra-Flux 140 on beta-2-microglobulin removal.

A thirty-fold or even greater increase in plasma beta-2-microglobulin (beta 2M), which is commonly found in end-stage renal disease (ESRD) patients on long-term hemodialysis (HD), is most likely a consequence of the inability of the dialysis procedure to remove the dally production of beta 2M. In the present study, a newly developed high-flux membrane composed of cellulose diacetate (CDA) (dialyzer Plivadial Altra-Flux 140, Pliva, Zagreb, Croatia) was evaluated with regard to beta 2M removal capacity during HD in 8 stable ESRD patients. Thera was a drop in the plasma beta 2M concentration (-19.8 +/- 8.4) with a clearance of 22.7 +/- 9.2 ml/min (QB = 250 ml/min, QD = 600 ml/min). Accordingly, the sieving coefficient (SC) was found to be 0.37 +/- 0.1 at 60 min after the start of HD. The CDA membrane was able to remove 100.5 +/- 30 mg of beta 2M during a 4-hour HD session. This data demonstrate an increased percentage removal of beta 2M and significantly decreased postdialysis plasma concentrations of beta 2M which is a potential factor in the development of dialysis-related amyloidosis (DRA).

Adult↗
PubMed1997

Therapeutic plasma exchange in neurologic disorders.

Neurologic diseases are one of the most common indications for therapeutic plasma exchange (TPE). In autoimmune neurologic diseases like Guillain-Barre syndrome, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, and paraprotein-associated polyneuropathy, TPE has been found to be beneficial. In some others (e.g., multiple sclerosis and Eaton-Lambert syndrome), TPE cannot be considered a generally accepted treatment option.

Humans↗
PubMed1996

Undetected excessive ultrafiltration during maintenance haemodialysis.

Undetected excessive ultrafiltration (UF) occurred in 2 patients on maintenance haemodialysis (HD) using a Gambro AK-10 monitor and Ergo 120 A-G blood lines. In spite of alarms present on the monitor, the dialysis staff was not alerted to the faulty condition. Through investigation of the HD 'set-up' at the time of the incidents it was found that a partial obstruction (kinking) had occurred in the extracorporeal blood circuit where the flexible tubing joined the venous chamber. This created a very high positive pressure within the dialyzer compartment and excessive UF, which the blood circuit pressure monitoring transducer was unable to detect. To prevent kinking of the blood lines, dialysis staff and patients should be instructed to ensure that blood lines lie in smooth curves.

Aged↗
PubMed1996

Acute renal failure complicating severe acute pancreatitis.

The records of 563 patients admitted to the hospital with diagnosis of acute pancreatitis have been studied retrospectively. The aim of the study was to investigate the prevalence of acute renal failure (ARF) in these patients, and to evaluate the most important risk factors for ARF development and mortality. The prevalence of ARF in studied population was 14%, but only 3.8% of ARF patients with acute pancreatitis had isolated renal failure. Other patients had additional failure of other organ systems, 68.4% of whom had multiorgan failure (MOF) before the onset of ARF. In only 8.9% of ARF patients was the renal system the first organ system to fail. Patients with ARF were significantly older, had more preexisting chronic diseases (including chronic renal failure), usually had MOF, and local pancreatic complications relative these in the group with normal renal function. The development of ARF was directly influenced by severity of acute pancreatitis. The mortality rate in ARF patients was 74.7%, compared to an 7.4% mortality of patients with acute pancreatitis and normal renal function. Preexisting chronic disease, the presence of MOF and their number, local pancreatic complications, and older age of the patients increased mortality in ARF patients. The prognosis of patients with oliguric ARF requiring renal replacement therapy was extremely poor, indicating the importance of prevention of ARF in the patients with acute pancreatitis.

Acute Disease↗
PubMed1996

An unsuspected cause of excessive ultrafiltration during maintenance hemodialysis.

Undetected excessive ultrafiltration occurred in a patient on maintenance hemodialysis using a Gambro AK-10 monitor and Ergo 120 A-G blood lines. In spite of alarms present on the hemodialysis monitor, the dialysis staff were not alerted of the failure. The patient had nausea, vomiting, abdominal cramps and hypotension. The monitor was withdrawn from service and subjected to careful technical checks, but no failure could be detected. Thorough investigation of the hemodialysis 'set-up' at the time of the incident revealed a partial obstruction (kinking) to have occurred in the extracorporeal blood circuit where the flexible tubing joined the venous chamber. This had created a very high positive pressure within the dialyzer compartment and excessive ultrafiltration, which the blood circuit pressure monitoring transducer was unable to detect. To prevent kinking of the blood lines, dialysis staff and patients should be instructed to ensure that blood lines lie in smooth curves.

Aged↗
PubMed1996

Effect of chronic hemodialysis on thyroid function tests in patients with end-stage renal disease.

In patients with end-stage renal disease (ESRD), serum concentrations of thyroid hormones are often found to be disturbed. The aim of the study was to evaluate the effect of chronic hemodialysis (CHD) on the regulation of decreased levels of thyroid hormones and thyroxine-binding globulin (TBG) in serum of patients with ESRD. This effect was analyzed during two phases of CHD in patients with ESRD. The first period of CHD (FCHD) lasted 14.6 months and the second period (SCHD) was prolonged by additional 16.7 months. The concentrations of thyroid hormones (T4, FT4, T3, FT3, rT3), thyrotropin (TSH) and TBG were determined in serum samples obtained before the patients started hemodialysis (BHD) and at the end of FCHD and SCHD. From the first group of 48 patients with ESRD who had previously been tested BHD, 28 patients received FCHD and only 10 of them continued to receive additional SCHD. The levels of all thyroid hormones were found to be decreased, especially some hormones such as FT3 (87% BHD), T3 (93% FCHD) and FT4/FT3 (90% SCHD). The concentration of TSH did not change significantly during CHD and about 10% of decreased and 10% of increased values were recorded. Only TBG level from decreased values (37% BHD) returned to the normal range at the end of SCHD. Results of rT3 could not be interpreted with certainty, because two different commercial kits were used during the study. Although CHD lasted for 31.3 months, it did not have any positive effect on the regulation of disturbed thyroid hormones to the normal levels.

Adult↗
PubMed1996

The role of arterial hypertension in progression of renal failure.

The effect of arterial hypertension on the progression of chronic renal failure (CRF) was evaluated in 108 patients who eventually required dialysis in the 8 year period of the study. Patients' average serum creatinine (SCr) concentration at first examination was 239.7 +/- 45.3 mumol/liter and at the start of dialysis was 1,661.0 +/- 181.9 mumol/liter. The mean duration of pre-dialysis follow-up was 53.7 +/- 15.7 months. The mean monthly increase in SCr was 18.8 +/- 13.4 and 2.1 +/- 1.4 mumol/liter/month in hypertensive and normotensive CRF patients, respectively (P < 0.001). The CRF patients with a diastolic blood pressure (BP) < 89 mm Hg had a significantly (P < 0.05) slower rate of decline in renal function than the patients with a diastolic BP > or = 90 mm Hg. There was a significant relationship between a mean diastolic BP > or = 90 mm Hg and the rate of monthly increase in SCr (r = 0.81, P < 0.001). These data indicate that control of diastolic BP in CRF patients is a potentially effective way to slow the rate of decline in renal function.

Adult↗
PubMed1996

Clinical evaluation of Altra-Flux 140 cellulose diacetate hollow-fiber dialyzer.

Clinical evaluation of Altra-Flux 140, a new Pliva hollow-fiber type dialyzer showed the clearances and removal rate of small molecular weight solutes to be satisfactory during 4-hour dialysis. The ultrafiltration rate was high, but acceptable when used with volumetric-controlled hemodialysis delivery systems. Biocompatibility was good, and there were no intradialytic symptoms in patients, attributable to the use of Altra-Flux 140. In general, no residual blood was detected. Handling of Altra-Flux 140 was found to be easy and the membrane strength adequate.

Biocompatible Materials↗
PubMed1996

Prescribing hemodialysis using a nomogram approach to urea kinetic modelling.

Several studies have clearly shown that the dose of dialysis is a determining factor for the well-being of dialysis patients. These studies have also suggested that doses of dialysis represented by Kt/V of about 1.4 should be optimal doses. This dose must be measured at the time it is delivered, since for various reasons, the delivered dialysis is often less than the prescribed dose. This report describes a series of nomograms that can be used to estimate the first hemodialysis prescription, to verify the amount of dialysis delivered to the patient, and to estimate the protein catabolic rate. These nomograms should be useful in those dialysis centers where, for one reason or another, computerized urea modelling is not a routine. The nomograms in the present report should be used for evaluating the adequacy of conventional hemodialysis.

Body Height↗
PubMed1996

Treatment of hyperviscosity syndrome in the patients with plasma cell dyscrasias.

A prospective study of 9 patients with plasma cell dyscrasia was performed to evaluate the need of plasma exchange (PE) and its possible effect in the acute and chronic management of hyperviscosity syndrome. The underlying dyscrasia was an IgG myeloma in 5 cases, IgA myeloma in 2 cases, one patient had IgD myeloma and in one patient Waldemström's macroglobulinemia was diagnosed. The main sequelae of circulatory disturbances, caused by increased blood resistance to flow, were fundus alterations (55.6%), neurologic manifestations (88.9%), a tendency to bleeding (44.4%) and renal failure (55.6%). In total, 49 PE procedures were performed. Following PE, hyperviscosity symptoms improved in 88.9% of the treated patients. The improvement in neurologic manifestations and hematologic complications was very fast, within the first PE session. The effect was less evident in ocular fundus alterations. Only one myeloma patient developed chronic renal failure. PE is the most effective method in the treatment of hyperviscosity syndrome often seen with multiple myeloma and Waldenström's macroglobulinemia, and it is therapy of choice for this complication.

Adult↗
PubMed1996

Cardiovascular complications in end-stage renal disease and hemodialysis patients.

The frequency of cardiovascular diseases in patients with end-stage renal disease (ESRD) is high, since hypotension, hyperlipidemia, advanced age, diabetes and other systemic diseases that may affect the heart are common in such patients. In addition to the pre-existing factors for cardiovascular disease, there are also predisposing factors that relate specifically to life on hemodialysis (HD). These include myocardial stress related to recurrent volume expansion and contraction, anemia, secondary hyperparathyroidism, excess or deficit of certain trace metals that may act as enzyme cofactors, and factors that inhibit myocardial ATPase. The prevalence, pathogenesis, and significance of these factors in ESRD patients are examined, and the potential roles of management are reviewed.

Cardiovascular Diseases↗
PubMed1995

A life-threatening complication of extreme hyperkalemia in a patient on maintenance hemodialysis.

A 68-year-old female on two-year chronic hemodialysis for chronic renal failure due to chronic pyelonephritis, was admitted to hospital for weakness, dulled sensorium and dizziness. On examination the patient was in a state of circulatory collapse, the electrocardiogram showed an accelerated idioventricular rhythm and laboratory analysis revealed extreme hyperkalemia (K+ 10.1 mmol/l). There were no common causes of shock, such as hypovolemia, sepsis, heart failure and presence of vasodilator drugs. The patient was treated with calcium gluconate, sodium bicarbonate and sodium chloride (to oppose the effects of hyperkalemia on the cell membrane to minimize cardiac and neuromuscular toxicity), insulin and dextrose (to increase the transport of K+ from the extracellular to the intracellular compartment), and hemodialysis (to remove K+ from the body). At the end of the hemodialysis session, the patient was in a clinically good condition, blood pressure was 160/90 mm Hg and the serum K+ concentration was normal. The case appeared to suggest that extreme hyperkalemia may have direct effects on vascular resistance, causing hypotension and shock.

Aged↗
PubMed1995

Clinical experience with short-time hemodialysis.

To determine the safety and efficiency of short-time hemodialysis (HD), the authors used the urea kinetic method to provide patients with similar amount of dialysis to that received during conventional treatment times. After six months on conventional HD (cellulosa acetate dialyzers, bicarbonate dialysate, and 4-hour treatment time), 8 patients were switched to short-time HD (cellulose triacetate dialyzers, bicarbonate dialysate, and 3-hour treatment time). During short-time HD, treatment time was reduced by 25%, while Kt/V index and protein catabolic rate remained constant. Shorter treatment times were not associated with an increase in intra- or interdialytic complications. When compared with the conventional period, short-time HD did not result in pre- or postdialysis blood pressure changes, interdialytic weight gain, or changes in biochemical parameters. Short-time HD did not result in an increase in hospital admissions. This study demonstrates that short-time HD performed with mandatory attention to the adequacy of dialysis as measured by urea kinetic modeling is compatible with objective improvement in patient welfare. The long-term effects of this treatment modality are not known, but our experience so far has been favorable.

Female↗