Search PubMed⌕ Search

Biomedical subjects

R M Raja

Publications and source records attributed to R M Raja.

62 records · Page 4Linked to original sources
PubMedDate not supplied

Effect of recombinant human erythropoietin on vascular access.

The use of recombinant human erythropoietin (r-HuEPO) corrects the anemia of chronic hemodialysis (HD) patients and improves their quality of life. The role of r-HuEPO in the genesis of graft thrombosis is controversial. A retrospective study was conducted of 46 stable chronic HD patients receiving r-HuEPO. It showed an increase in graft thrombosis in those who received the drug.

Aged↗
PubMedDate not supplied

Kt/V and hemodialysis morbidity revisited.

Analysis of the National Cooperative Dialysis Study (NCDS) showed that dialysis morbidity was related to Kt/V. Recently, various formulae have been shown to be accurate for easier calculation of Kt/V. We calculated Kt/V in an outpatient unit utilizing Kt/V = -In (R - 0.03 - UF/W) in 51 patients. Kt/V was less than 0.8 in 16 patients (Group A), 0.8-1.0 in 20 (Group B), and greater than 1.0 in 15 (Group C). There was no difference in hematocrit (Hct), BUN, creatinine, serum phosphorus, and albumin. Ratio of men to women was 11/5, 15/5, and 4/11; mean age was 54, 63, and 58 years; mean body weight 177, 144, and 122 lb in Groups A, B, and C, respectively. Dialysis-related hospital admissions were similar (p greater than 0.05). These data suggest patients with higher body weights, and men, frequently had a Kt/V less than 0.8. Kt/V that did not influence biochemical parameters or hospitalizations in this population. This indicates that Kt/V may not be a good predictor of morbidity, and/or some heavier patients may do fairly well even with a Kt/V less than 0.8. The search for a better index of dialysis adequacy should be continued.

Blood Flow Velocity↗
PubMedDate not supplied

Various methods for calculation of Kt/V: a clinical comparison.

Analysis of the National Cooperative Dialysis Study (NCDS) showed that dialysis morbidity and mortality was related to Kt/V of urea. Various formulas have been derived to make calculation of Kt/V simpler. We compared the kinetically measured Kt/V (A) to estimated Kt/V derived from approximate total body water (0.6 body weight) and uniform dialyzer clearance (B), Kt/V = 0.04 PRU-1.2 where PRU is % reduction in BUN (C) and Kt/V = In(R-0.03-UF/W) where R is post/pre BUN, UF is ultrafiltration L/HD and W is postdialysis weight (D) in 26 patients. The correlation coefficient (r) was 0.14 (p less than 0.05) for A vs. B; 0.75 (p less than 0.01) A vs. C; 0.77 (p less than 0.01) A vs. D; and 0.97 for C vs. D. In an additional 51 patients, Kt/V was calculated using formulas B, C, and D. The r was 0.91 C vs. D, 0.70 B vs. D, and 0.68 B vs. C. With B, greater than 30% of the patients could have been misclassified using NCDS criteria for adequacy of dialysis. The study suggests that use of formulas C and D, but not B, is appropriate and accurate for Kt/V calculation. Formula C may be simpler and easier than D, as UF and W are not required. Serial Kt/V could be easily and accurately calculated using C and D for quality assurance and quantitation of dialysis.

Blood Flow Velocity↗
PubMedDate not supplied

Measurement of hemodialysis access recirculation: a two-needle method at the start of dialysis.

Conventional methods of measuring recirculation in hemodialysis access include a three site method performed during dialysis, and a two site technique conducted at the end of a hemodialysis treatment. This study describes a two site procedure performed at the beginning of a hemodialysis session. Blood samples are drawn from the arterial side of the hemodialysis access immediately prior to hemodialysis (AIPD), and from the same arterial line (A+5) and venous line (V+5) when maximal blood flows are reached 5 min after starting hemodialysis. Blood urea nitrogen (BUN) is measured in these samples, and the results entered into the formula AIPD - A+5/AIPD - V+5 X 100% to calculate the percent recirculation. Percent recirculation calculated by this method compared favorably with, and may hold several advantages over conventional techniques.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

The role of sequential ultrafiltration and varying dialysate sodium on vascular stability during hemodialysis.

Hypotension is a very common problem during HD. We studied vascular stability during sequential UF with constant and variable dialysate Na. Ten chronic patients underwent HD using two protocols. Protocol A was sequential UF (50% weight loss in the first hour, 30% in the second, and 20% in the third hour) with a dialysate Na of 140 mEq/L. Protocol B was sequential UF as in protocol A with varying dialysate Na (150 mEq/L in the first hr, 142 in the second, and 137 in the third). BP and pulse were monitored every 30 min. Hct, BUN, creatinine, osmolality, and serum albumin were checked every hour. The plasma volume decreased by 5.3% in protocol A as compared with 1.2% in protocol B, as shown by the Hct values. The decrease in serum osmolality during the first and second hours was more marked in protocol A than in protocol B (p < 0.05), but post-dialysis values were similar. The clinical parameters (UF, BP, pulse rate) and serum Na showed no difference. The intradialytic mannitol infusion was 10 ml/HD and 0, whereas saline was 80 ml/HD and 10 for A and B, respectively. These data suggest: (1) Sequential UF with varying dialysate Na could benefit patients who are hemodynamically unstable. (2) The need for mannitol and saline may be more readily alleviated with protocol B than with protocol A. (3) The beneficial effect of varying dialysate Na with sequential UF may be due to improved plasma refilling and decreased early intradialytic osmolar changes.

Aged↗