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Biomedical subjects

R Gokal

Publications and source records attributed to R Gokal.

At least 109 records · Page 6Linked to original sources
PubMed1993

Quality of life in patients undergoing renal replacement therapy.

Rehabilitation can be achieved by renal replacement therapy. The evidence to date would indicate that most successfully transplanted patients achieve rehabilitation both on objective and subjective criteria and in a cost effective manner; however, unsuccessful transplantation has a poor quality of life outcome. Some home dialysis patients achieve the same goals; these two groups comprise predominantly younger patients free of systemic disease. For the high risk group of patients which are predominantly managed by ICHD and CAPD, the objective evidence of rehabilitation is lacking; however, perceived quality of life on subjective measures shows results comparable to a normal population. Comparisons between ICHD and CAPD populations are difficult with different modality related stressors imparting stress to the patients. CAPD has marginal advantage over ICHD. Overall, from these studies, it seems that while successful transplantation imparts the best quality of life on both objective and subjective parameters, the differentiation between ICHD and CAPD is that much more difficult; what evidence there is would suggest that CAPD patients are marginally to moderately better rehabilitated, certainly on subjective parameters. The results in the studies suggest that patients with end-stage renal disease are able to adapt to very adverse life circumstances, nevertheless expressing considerable satisfaction with their lives.

Female↗
PubMed1992

Low-calcium dialysis fluid and oral calcium carbonate in CAPD. A method of controlling hyperphosphataemia whilst minimizing aluminium exposure and hypercalcaemia.

Oral calcium carbonate is an effective phosphate binder in dialysis patients. Its use minimizes aluminium intake, and by maintaining a high-normal serum ionized calcium, suppresses serum parathyroid hormone levels. However, the dose required to control hyperphosphataemia may cause hypercalcaemia. We performed prospective studies in 50 previously undialysed patients starting CAPD (28 study group, 22 control group). Calcium carbonate was the only phosphate binder used in the study group which utilized a low calcium PD fluid (calcium 1.25 mmol/l), whilst the control group used standard PD solution (calcium 1.75 mmol/l) with calcium carbonate plus aluminium hydroxide phosphate binders as clinically indicated. The study group was able to take larger doses of oral calcium carbonate with no increase in episodes of hypercalcaemia compared to the control group. There were no instances of hypocalcaemia in any patient using the low-calcium dialysis fluid. Phosphate control was better in the study group, despite the additional use of aluminium-containing phosphate binders by some patients in the control group. Serum aluminium levels in the study group were maintained at < 11.5 mumol/l, but increased significantly in the control group from 3 months onward. Mean serum parathyroid hormone in the study group declined significantly from baseline values over the first 6 months, and remained at the lower level. Bone histology showed a tendency towards improvement over the 12 months, in terms of osteoclast numbers and activity. We conclude that using dialysis fluid with a reduced calcium concentration in compliant, well-monitored patients is safe.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

Imipenem versus netilmicin and vancomycin in the treatment of CAPD peritonitis.

Imipenem/cilastatin is a new thienamycin antibiotic with a broad bactericidal spectrum. We undertook a prospective randomised study to compare the safety and efficacy of intraperitoneal (IP) imipenem/cilastatin (2 gm daily) [group A; 21 patients, mean age 49.2 years] with a combination of IP netilmicin and vancomycin (500 and 60-100 mg daily resp.) [group B; 20 patients, mean age 55.2 years] in CAPD peritonitis. Each patient underwent 4 daily CAPD exchanges with antibiotics in alternate exchanges. The causative organisms were similar in both the groups as was the duration of therapy (gr.A: 6.8 +/- 0.27 days; gr.B: 7.2 +/- 0.51 days; p = NS). Complete cure was marginally better with imipenem/cilastatin (gr.A; 94.1%, gr.B: 83.3%) with less relapses (gr.A: 1 episode; gr.B: 3 episodes). One episode in gr.A (S. aureus) and 2 in gr.B (Yeast & Proteus) failed to resolve and required catheter removal. Two gr. A patients developed generalised convulsions which settled after discontinuation of the drug. Whilst the results show no significant difference in the outcome in the two groups, the use of IP imipenem would offer a possible advantage as a single antibiotic. Larger experience is needed before imipenem can be recommended as a 'blind' first line agent for CAPD peritonitis.

Female↗
PubMed1992

Does catheter immobilization reduce exit-site infections in CAPD patients?

This study was undertaken to ascertain the effectiveness of an immobilization device in reducing exit site infections (ESI) in CAPD patients, and whether immuno-suppressive therapy, diabetes, disconnect system and Staphylococcus aureus nasal carriage had any bearing on the incidence of ESI. Sixty-six patients having a Tenckhoff catheter placement were randomly allocated into one of three groups; immobilizer, tape and non-immobilized group. The groups were monitored for the incidence of ESI over a total period of 347 patient months. The results show no significant difference in infection rates between the three groups, nor do the factors mentioned have any bearing on ESI rate. Whilst immobilization is important, the ineffectiveness of this device was probably related to its design problem.

Bacterial Infections↗
PubMed1992

Calcium, magnesium mass transfer and lactate balance study in CAPD patients with reduced calcium/magnesium and high lactate dialysis fluid.

We studied calcium (Ca), magnesium (Mg) mass transfer (MT) in 10 and lactate balance in 5 CAPD patients using standard dialysis solution [(ST) (Ca 1.75 mmol/l; Mg 0.75 mmol/l; lactate 35 mmol/l)] and with reduced Ca/Mg, high lactate solution [(LC) (1.25 mmol/l; 0.25 mmol/l; 40 mmol/l respectively)]. Exchanges were performed with 1.36% and 3.86% glucose solutions. MT was calculated as mmol/exchange. Ca MT was +0.96 and +0.39 with ST 1.36% and 3.86% glucose respectively. Serum ionised Ca (iCa++) levels were less than fluid Ca during these exchanges. With LC 1.36% glucose it was -0.66 when ICa++ was more than dialysate Ca, but +0.66 when iCa++ was less than dialysate Ca. Ca MT was negative with LC 3.86% glucose irrespective of iCa++ levels. All patients were hypermagnesaemic (mean 1.24 mmol/l. Mg MT was +0.21 and -0.04 with ST 1.36% and 3.86% glucose respectively and -0.62 and -1.13 with LC 1.36% and 3.86% glucose respectively. The difference between mean lactate gain and bicarbonate loss was less (-0.4) during exchange with LC 1.36% glucose. Mean plasma TCo2 and plasma pH did not differ between ST and LC solutions. We conclude that reduced Ca/Mg, high lactate solutions should reduce hypercalcaemia/magnesaemia and maintain a better acid base balance in CAPD patients who may require Ca/Mg containing phosphate binders.

Adult↗
PubMed1992

Improved solutions for peritoneal dialysis: physiological calcium solutions, osmotic agents and buffers.

Theoretical and clinical studies suggest that reduction of PD fluid calcium to 1.25 mmol/liter allows administration of larger doses of calcium carbonate, improves phosphate control and obviates the need for aluminum gels in most CAPD patients, without increasing hypercalcemia or hyperparathyroidism. Hypermagnesemia can also be avoided by reducing PD fluid magnesium concentration to 0.25 mmol/liter. Although glucose is a safe, effective an cheap osmotic agent, it provides a short duration of ultrafiltration, and contributes to significant metabolic abnormalities. Amino acids and glucose polymer are potential alternatives to glucose, and early clinical studies are encouraging. The unphysiological concentration of lactate in PD fluids has been shown to have pathological consequences, and undoubtedly bicarbonate would be a preferable buffer. Manufacturing techniques are being developed to produce such a fluid. A fluid containing bicarbonate and the peptide glycylglycine (30:10 mmol/liter) gives a stable buffer with a pH of 7.35, but has only undergone animal studies so far. Glucose solutions have deleterious effects on the peritoneal membrane, particularly during episodes of severe peritonitis, and the high osmolality is toxic to peritoneal host defense cells. Prompt treatment of peritonitis, early removal of the catheter where necessary, and minimization of glucose exposure, may do much to lengthen the dialysis life of the peritoneum.

Amino Acids↗
PubMed1992

Use of oral stable strontium to provide an index of intestinal calcium absorption in chronic ambulatory peritoneal dialysis patients.

Recent interest in the role of oral calcium carbonate and low calcium dialysate has emphasised the need for a simple, safe and inexpensive test of intestinal calcium absorption. The stable, non-radioactive, strontium absorption test fits these requirements. Stable strontium and calcium-45 were administered simultaneously to 19 fasting CAPD patients and their serum levels were subsequently measured. There was a close correlation between the absorption of calcium and strontium at both 60 and 120 min post-ingestion. The two markers resulted in the same classification of patients as normal or malabsorbers in 18 of 19 cases (95%), suggesting that strontium could be substituted for calcium-45 in a 60-min test of absorption enabling safe, simple and repeated measurements in renal failure patients.

Administration, Oral↗
PubMed1992

Quality of life improvements in CAPD patients treated with subcutaneously administered erythropoietin for anemia.

Twenty-two continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 48 years, at 3 U.K. renal units were assessed with the Nottingham Health Profile (NHP) before and after treatment with recombinant human erythropoietin (r-HuEPO). Mean (SD) hemoglobin (Hb) at baseline was 7.5 (1.0) gm/dL and 10.8 (1.5) gm/dL at retest. There were significant improvements in energy (p less than 0.0001), social life (p less than 0.005), relationships at home (p less than 0.05) and leisure pursuits (p less than 0.05). Twelve patients, mean age 51 years, who had already completed more than 9 months on r-HuEPO treatment were reassessed to determine the changes sustained. Mean (SD) Hb at second retest was 12.8 (1.3) gm/dL. Improvement in energy continued to be significant, and emotional wellbeing showed further improvement. Problems with household tasks, which had not shown significant improvement at Test B, were now considerably reduced (p = 0.016). The study showed far-reaching benefits similar to those reported in hemodialysis patients, in a population with a higher mean age and higher potential coexisting illness or disability than most reported hemodialysis studies.

Activities of Daily Living↗
PubMed1992

Netilmycin and vancomycin in the treatment of peritonitis in CAPD patients.

This study was undertaken to evaluate: 1. The efficacy of netilmycin and vancomycin as combined first line antimicrobial regime, compared to cefuroxime, in the treatment of peritonitis. 2. To measure the levels of netilmycin and vancomycin in the serum and dialysate. 3. To report on the use of this combination over a one year period and compare it with that of cefuroxime used during the previous one year.

Adult↗
PubMed1992

The effect of hemoglobin concentration on peritoneal mass transfer and drain volumes in continuous ambulatory peritoneal dialysis.

OBJECTIVE: To determine whether a correlation exists between hemoglobin levels and peritoneal mass transfer or drain volumes in continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: Prospective study of two groups of CAPD patients, identified on the basis of their stable hemoglobin levels. Group A--hemoglobin less than 8.5 g/dL; Group B--hemoglobin greater than 10.5 g/dL. Peritoneal mass transfer and drain volumes were measured for each patient, after which a subgroup of Group A was treated with rHuEPO (forming Group C) and measurements repeated once hemoglobin had risen by at least 2.0 g/dL. SETTING: Single renal unit of a university teaching hospital. PATIENTS: Twenty-seven patients established on CAPD, selected according to their stable hemoglobin level. Group A--14 patients; Group B--13 patients; Group C (subgroup of A)--8 patients. MAIN OUTCOME MEASURES: Difference between peritoneal mass transfer or drain volume in Group A versus Group B, and in Group C before and after rHuEPO therapy. Serum biochemical parameters in Group C before and after rHuEPO therapy. RESULTS: No statistically significant differences in any of the parameters measured were found between groups A and B, or before and after rHuEPO therapy in Group C. CONCLUSIONS: Peritoneal transfer of small solutes and water is not influenced by hemoglobin level, and does not change following otherwise effective treatment with rHuEPO.

Adult↗
PubMed1992

Continuous ambulatory peritoneal dialysis and renal transplantation: a ten-year experience in a single center.

OBJECTIVE: To assess whether a renal graft outcome is dependent on the modality of dialysis prior to transplantation and to assess risk of peritonitis and catheter-related problems posttransplantation. DESIGN: Retrospect analysis of the outcome of a first cadaveric renal transplantation from hemodialysis (HD) and CAPD patients over a ten-year period. PATIENTS: Out of a total of 905 renal transplants over a ten-year period, 699 were first grafts; 500 of these (241 on CAPD, 259 on hemodialysis) were analyzed while the remaining (incomplete data, predialysis, pediatric) were assessed for graft and patient survival only. MAIN OUTCOME: Graft and patient survival cases were identical in the two groups (five-year graft survival: CAPD 67%, hemodialysis 66%; five-year patient survival: CAPD 88%, hemodialysis 87%). CAPD posttransplant was necessary in 37 patients, while 10 developed peritonitis mostly related to CAPD use and responded to appropriate therapy. Routine catheter removal posttransplant was undertaken between 8 and 12 weeks. CONCLUSION: Excellent graft and patient survival is achieved independent of the modality of dialysis prior to transplantation. Peritoneal dialysis can be used postgrafting, but there is a risk of peritonitis, which can be successfully managed with antibiotics and catheter removal. Great care is needed in executing the dialysis and catheter care after transplantation.

Adult↗
PubMed1991

Risk factors for non-ischaemic foot ulceration in diabetic nephropathy.

It is recognized that diabetic patients with nephropathy frequently have macrovascular disease leaving them at risk of ischaemic foot lesions. In order to assess non-vascular risk factors for foot ulceration 64 patients were stratified into four groups: microalbuminuria, albuminuria with creatinine clearance greater than 40 ml min-1, chronic renal failure (clearance less than 40 ml min-1), and a non-nephropathic diabetic control group. Vibration perception threshold was measured by biothesiometry, peroneal nerve conduction velocity by conventional methods, and dynamic foot pressure by pedobarography. Vibration perception threshold was elevated in all three groups when compared with age-matched normal and diabetic control groups. Mean vibration perception threshold was 20.8 +/- 8.6 (+/- SD) in the microalbuminuria group (p less than 0.001 compared with age-matched normal control group), 28.1 +/- 5.6 (p less than 0.001) in the albuminuria group, 38.9 +/- 9.4 (p less than 0.001) in the renal failure group, 14.8 +/- 5.2 in the diabetic control group and 12.3 +/- 2.9 in the normal control group. Peroneal motor conduction velocity was reduced in all three groups when compared with normal control subjects, microalbuminuria 38.6 +/- 4.2 m s-1 (p less than 0.001), albuminuria 38.0 +/- 6.1 m s-1 (p less than 0.01), renal failure 35.5 +/- 1.2 m s-1 (p less than 0.001), diabetic control 40.6 +/- 1.8 m s-1, and normal 43.1 +/- 2.3 m s-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗