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Biomedical subjects

P Keshaviah

Publications and source records attributed to P Keshaviah.

11 recordsLinked to original sources
PubMed1992

Adequacy of peritoneal dialysis: a review of quantitative and qualitative approaches.

This paper reviews the qualitative and quantitative approaches to assessing the adequacy of peritoneal dialysis. The quantitative measures reviewed include the KT/V urea index, the dialysis index, the weekly creatinine clearance, and the creatinine efficiency number. Studies that support as well as refute these measures are reviewed briefly. Many of these studies are retrospective analyses of longitudinal data in small numbers of patients or prospective cross-sectional studies. A prospective, longitudinal study involving large numbers of patients is required to resolve some of the controversies regarding the adequacy of peritoneal dialysis.

Creatinine↗
PubMed1992

Adequacy of CAPD: a quantitative approach.

In prescribing CAPD, general clinical practice is to use the standard regimen of 2L x 4 exchanges/day without regard to patient size, nutritional status, or residual kidney function. The standard regimen is usually adjusted in a trial and error manner reacting to clinical symptoms, life style issues, and patient compliance. The purpose of this paper is to recommend an alternative, quantitative approach based on urea kinetics that is prospective rather than reactive, and objective rather than subjective. The value of urea kinetic-based hemodialysis therapy prescription is well established and applying this knowledge to CAPD is a good starting point. The importance of small solute clearances for CAPD adequacy can be established on both theoretical and clinical grounds. The value of the KT/V urea index, its calculation, scaling factors for CAPD-hemodialysis comparisons, and the correlation between KT/V and weekly creatinine clearances are examined. Residual renal function has a significant impact on small solute clearances, and failure to adjust the therapy prescription to compensate for declining residual kidney function will have a detrimental impact on KT/V and the protein catabolic rate.

Creatinine↗
PubMed1990

Changing risk factor demographics in end-stage renal disease patients entering hemodialysis and the impact on long-term mortality.

Patient survival on hemodialysis has previously been shown to be associated with the presence of comorbid conditions on entrance. Significant comorbid conditions are atherosclerotic heart disease (ASHD), cerebral vascular disease (CVD), nonskin malignancies, chronic obstructive pulmonary disease, diabetes mellitus, and age on entrance to dialysis. Changes in annual mortality have been noted in the United States and at the Regional Kidney Disease Program. The increase in annual mortality was analyzed to determine the impact of risk factors during the time intervals 1976 to 1982 and 1983 to 1987. Patients with no major risk factors have longer survival rates and lower deaths per 1,000 treatment-months from 1983 to 1987 compared with 1976 to 1982. Diabetics have survival rates and deaths per 1,000 treatment-months that are comparable up to age 75. However, over age 75, diabetics have lower survival rates and higher death rates. The presence of comorbid conditions in the diabetic group is high and may account for the increased death rate. The percent of diabetics entering the program has increased from 29% to 48% over the intervals. Nondiabetics with comorbid conditions on entrance had higher deaths per 1,000 treatment-months from 1983 to 1987 compared with 1976 to 1982 across all age categories. Risk factor analysis shows that nondiabetics with major risks are entering with increasing numbers and continuation of comorbid conditions that impact death rates. Peripheral vascular disease, originally not significantly associated with death on dialysis, has dramatically increased from 18% to 60% in nondiabetics with comorbid conditions. In the patients over age 60 with comorbid conditions, 75% of patients now entering dialysis have peripheral vascular disease (PVD). In summary, major shifts in the hemodialysis population have occurred. Diabetics entering dialysis now account for almost 50% of all patients, with the older group having more comorbid conditions. This change alone would increase the annual mortality rate. Patients with comorbid conditions now enter with a higher prevalence of multiple comorbid conditions, which would increase the annual mortality rate. Nondiabetics without comorbid conditions now have better survival across all age categories compared with the previous data. PVD, with its current high prevalence, needs to be reevaluated as a significant risk factor for death on hemodialysis. Therefore, the increase in the annual gross mortality rate is highly predicted based on the change in the diabetic population and the increase in single and multiple comorbid conditions in the nondiabetic population.

Adolescent↗
PubMed1978

The metabolic effects of hemodialysis with and without glucose in the dialysate.

The present study compares some of the metabolic effects of hemodialysis of fasting patients with and without glucose in the dialysate bath. Unlike glucose dialysis, glucose-free dialysis caused marked decreases in blood levels of glucose, insulin, lactate, and pyruvate along with profound increases in acetoacetate and beta-hydroxybutyrate. It is concluded that oxidation of fatty acids increases to meet energy demands and that the combined processes of glycogenolysis and gluconeogenesis serve to prevent critical hypoglycemia during glucose-free dialysis.

Adult↗
PubMed1978

Unsolved technical problems of maintenance dialysis.

The present paper describes some of the technical inadequacies in the clinical practice of dialysis. Problem areas of hemodialysis, i.e., those related to blood access, dialyzer and delivery system, are treated in depth. Corollaries with peritoneal dialysis are obvious. Research priorities, in particular development of a more sophisticated delivery system, are suggested. The intent of this discussion is to outline a rational progression in improvement of care of the end-stage renal disease patient.

Kidneys, Artificial↗
PubMed1975

Depressed in vitro aggregation of platelets of chronic hemodialysis patients (CHDP): a role for cyclic AMP.

1) On log-log-coordiantes a direct correlation has bee shown to exist between plasma cyclic AMP and plasma Cr levels. 2) hemodialysis results in a significant reduction in the arterial plasma cyclic AMP levels, but a return of plasma cyclic AMP to pre-dialysis levels is seen within 30 mins post-dialysis. 3) the dialyzer clearance of cyclic AMP, both in vitro and vivo, is commensurate with its M.W. 4) In vitro platelet aggregation responses, to ADP, EPI, and COLL are not influenced by PRP cell counts between 150,000 and 300,000/mm3. 5) the BT of NC and CHDP are not significantly different, indicating that the in vivo hemostatic properties of the CHDP are otherwise intact. 6)the CHDP have PVPC significantly lower than the NC, a finding commensurate with the usual mold thrombocytopenia of renal failure. 7)the aggreation responses of the CHDP to COLL and to both Lo and Hi concentrations of ADP and EPI are significantly less than those of the NC. 8)A statistically significant inverse correlation between aggregation response and plasma cyclic AMP is observed.

Adenosine Diphosphate↗