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Biomedical subjects

S R Acchiardo

Publications and source records attributed to S R Acchiardo.

At least 37 records · Page 2Linked to original sources
PubMed1987

Therapeutic assessment of Slow-K and K-tab potassium chloride formulations in hypertensive patients treated with thiazide diuretics.

Therapeutic equivalency among different drug products is one of the major issues confronting many clinicians today who are functioning as members of pharmacy and therapeutic committees and state Medicaid programs (SMP). Selection of one of the available slow-release potassium chloride formulations for inclusion in a hospital formulary or SMP exemplifies one of these therapeutic equivalency issues. To evaluate this issue, we studied 20 hypertensive adult patients receiving hydrochlorothiazide 50 mg/d to determine if there are significant differences between the administration of 24 mEq of Slow-K given as 8 mEq/tablet tid, and 30 mEq of K-Tab given as a 10 mEq/tablet tid. The study was conducted in a randomized, open-label, crossover design in which the two drug formulations of potassium chloride were compared over two four-week treatment periods. Results from this study indicate that 24 mEq of Slow-K and 30 mEq of K-Tab were equally effective in maintaining serum electrolyte concentrations, blood pressure measurements, and electrocardiogram evaluations within normal limits in all 20 hypertensive patients studied. Furthermore, no adverse effects were noted with either potassium chloride formulation, and patient acceptance, tolerability, and compliance to prescribed dosing regimens were similar for both products. Based on our findings, therefore, we conclude that 24 mEq of Slow-K and 30 mEq of K-Tab given three times daily as 8 mEq and 10 mEq tablets, respectively, are therapeutically equivalent.

Adult↗
PubMed1987

Nutritional effects of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients.

Peritonitis, a major complication of end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), enhances peritoneal protein losses by increasing protein and energy requirements while simultaneously decreasing appetite, usually causing a negative nitrogen balance. The influence of peritonitis on the nutritional status of CAPD patients was evaluated. Fourteen end-stage renal disease patients being treated with CAPD and presenting with peritonitis were randomized to one group with and one without a nutritional supplement. Four CAPD patients without peritonitis served as controls. Anthropometric measurements, laboratory determinations, dietary protein intake, and protein catabolic rate were obtained. The control group lost an average of 9.6 gm protein per 24 hours in the peritoneal fluid vs. an average of 15.1 gm protein per 24 hours lost by patients with peritonitis (p less than .01). Serum albumin did not decrease except in two diabetic patients in whom it dropped an average of 42% and remained low. Nitrogen balance remained positive in all patients except one with diabetes who had very low daily protein intake and caloric intake. The catabolism produced by short uncomplicated peritonitis did not create a negative nitrogen balance in patients eating at least 1 gm protein per kilogram ideal body weight (IBW) and 25 kcal/kg IBW.

Adult↗
PubMed1986

Dialyzability and pharmacokinetics of indomethacin in adult patients with end-stage renal disease.

Indomethacin, a nonsteroidal antiinflammatory drug, has been shown to be effective for the treatment of pericarditis in chronic hemodialysis patients. Data regarding the dialyzability of indomethacin in these patients, however, is lacking. The aim of this study, therefore, was to evaluate (1) the dialyzability, and (2) the absorption and elimination kinetics of indomethacin, using six stable anephric adult patients who were maintained on chronic hemodialysis and were receiving indomethacin for the management of their uremic pericarditis. The results from this study demonstrate that indomethacin is dialyzable, but not to an appreciable extent. The mean predialysis and postdialysis indomethacin plasma levels were 3.4 and 1.6 micrograms/ml, respectively. The mean total amount of indomethacin removed by five hours of hemodialysis was 19.6 percent of the single dose of indomethacin 100 mg po. However, mean Cpmax, tmax, t1/2, and AUC0-infinity during and in the absence of hemodialysis were 5.4 and 5.4 micrograms/ml (not statistically significant [NS]), 1.9 and 2.0 h (NS), 6.1 and 5.3 h (NS), and 30.9 and 35.7 micrograms h ml-1 (NS), respectively. Based on these findings, it can be concluded that although indomethacin is dialyzable, no dosage adjustment is required in patients receiving indomethacin for the management of their uremic pericarditis when undergoing maintenance hemodialysis.

Adult↗
PubMed1986

Does low protein diet halt the progression of renal insufficiency?

We evaluated 15 adult patients with a mean creatinine clearance of 18.35 ml/min and a mean age of 45.7 years. Four patients had glomerulonephritis, two interstitial nephritis and nine had nephrosclerosis. Paired controls were used. Experimental patients were instructed in a diet with 0.55 grams of protein/kilogram body weight/day; the control group was on an unrestricted diet. Protein intake was evaluated with dietary histories. Protein catabolic rates were calculated and were used for reinforcement. Nutritional status was evaluated with anthropometric measurements and laboratory testing. Progression of renal insufficiency was estimated using the reciprocal of the serum creatinine. The mean follow up was 14.9 months. During this period, three patients started dialysis, four had their creatinine clearance remain stable and six improved their renal function 20%. The rate of change of renal function in the treatment group was slower (p less than 0.05) than in the control group. Body weight, anthropometric measurements and chemical parameters did not change significantly. We conclude that a restricted protein diet stabilizes or improves renal function in most patients with end-stage renal failure without producing malnutrition.

Anthropometry↗
PubMed1983

Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment.

The efficacy and safety of a new diuretic-antihypertensive drug, indapamide (2.5 mg/day), were evaluated in hypertensive patients with normal renal function, in patients with various degrees of chronic renal failure, and in hypertensive patients undergoing long-term maintenance hemodialysis. The results obtained from single-blind, placebo-controlled studies indicate that indapamide is a safe and effective agent to use in lowering the blood pressure of hypertensive patients with normal renal function, those with various degrees of renal impairment, and those who are undergoing long-term maintenance hemodialysis. No significant side or toxic effects were noted in these studies. Furthermore, indapamide does not accumulate in the bloodstream of patients with renal impairment and is not dialyzable.

Aldosterone↗
PubMed1983

Malnutrition as the main factor in morbidity and mortality of hemodialysis patients.

We evaluated the nutritional status of 120 hemodialysis patients using the urea kinetic model. Protein catabolic rate (PCR), an indirect measurement of dietary protein intake, and urea volume of distribution were calculated. Their mid-week predialysis BUN was targeted at 80 +/- 10 mg/dl. The risk factors for chronic hemodialysis patients were analyzed, and since the diabetic patients were unevenly distributed we took them out of the study. This report thus comprises 98 patients distributed in four groups according to their mean PCR and BUN: group 1, mean PCR of 0.63 g/kg/day and BUN of 51 mg/dl; group 2, mean PCR of 0.93 g/kg/day and BUN of 60 mg/dl; group 3, mean PCR of 1.02 g/kg/day and BUN of 79 mg/dl; group 4, mean PCR of 1.2 g/kg/day and BUN of 96 mg/dl. Patients in group 1 had a higher morbidity (number of hospitalizations and number of days in the hospital per patient per year) and a higher mortality (percent per year). The most common causes of hospitalization were infection and congestive heart failure. This group also had an unusually high incidence of pericarditis. Because their risk factors were similar to the other groups, the data suggest that malnutrition was the main cause of these patients' high morbidity and mortality. These patients must be considered at high risk and should be treated aggressively.

Adolescent↗
PubMed1981

Procainamide-induced myasthenia-like weakness in a patient with peripheral neuropathy.

Because procainamide hydrochloride (Pronestyl) may block neuromuscular transmission (NMT), this drug is contraindicated in cases of myasthenia gravis. Reduction of the safety factor of NMT is also seen in other conditions, including peripheral neuropathies. A patient with uremic peripheral neuropathy in whom myasthenia-like weakness developed during procainamide therapy is described. Procainamide should be given with caution in cases of peripheral neuropathies in which there may be a reduction of the safety factor of NMT.

Adult↗
PubMed1981

The pharmacokinetics of trichlormethiazide in hypertensive patients with normal and compromised renal function.

The pharmacokinetics of trichlormethiazide (TCZ) was studied in twelve patients after a single 4 mg dose. Seven patients had normal renal function with creatinine clearance greater than 90 ml/min. Five patients had compromised renal function with creatinine clearances averaging 48 +/- 29 ml/min. The TCZ plasma half life and area under the plasma concentration-time curve (AUC) were significantly greater in patients with impaired function, compared to patients with normal renal function. There were no significant differences between the two patient groups in terms of either rate of drug absorption or total urinary recovery of unchanged drug. Furthermore, there was no correlation between peak drug levels or AUC and renal excretion of water or electrolytes.

Female↗
PubMed1980

Porphyria cutanea tarda in a chronic hemodialysis patient.

We have described a patient undergoing long-term hemodialysis who had bullae on the dorsum of the hands, extensor surfaces of the forearms, and the forehead. While clinically indistinguishable from earlier reports of bullous dermatosis of chronic renal failure, laboratory investigation documented prophyria cutanea tarda in this patient.

Humans↗
PubMed1977

Ultrastructural changes in gentamicin nephrotoxicity.

Although described in laboratory animals, the ultrastructural changes in the kidneys of humans with gentamicin-induced acute renal failure have not been well documented. This report details the clinical and pathologic features of a patient with gentamicin-induced nephrotoxicity with special emphasis on the electron microscopic findings.

Acute Kidney Injury↗
PubMed1977

Fluoxymesterone therapy in anemia of patients on maintenance hemodialysis: comparison between patients with kidneys and anephric patients.

Nineteen patients with their kidneys and 11 anephric patients who were stable on maintenance hemodialysis received 20 mg a day of Fluoxymesterone. At the end of four months, there was a significant increase (p less than 0.005) in the mean hematocrit with a parallel increase in the hemoglobin level in both groups of patients. Concomitantly, we observed an increment of the red cell mass that was significant at the level of p less than 0.05. Blood transfusion requirements decreased significantly (p less than 0.1), independent of the presence or absence of kidneys. No changes in body weight, serum albumin, and serum cholesterol levels were observed. Secondary effects were hirsutism and hoarsening of the voice.

Adult↗
PubMed1977

Peritoneal dialysis in the treatment of acetohexamide-induced hypoglycemia.

Severe hypoglycemia in a 67-year-old black male as a result of the ingestion of acetohexamide is described. Because of both his renal status as well as the severity of the hypoglycemia, the patient received peritoneal dialysis. Sequential specimens of serum, urine and dialysate were collected to measure the levels of acetohexamide and its main active metabolite, hydroxyhexamide. The data indicate that these compounds are not dialyzable. In patients with reduced renal function, peritoneal dialysis may be one way to administer large amounts of glucose with very little administration of fluid in the treatment of acetohexamide-induced hypoglycemia. For those azotemic patients whose hypoglycemia is difficult to manage, intensive dialysis might be a means to correct the abnormality of glucose metabolism imposed by uremia.

Acetohexamide↗
PubMed1977

Acetohexamide hypoglycemia: treatment by peritoneal dialysis.

Acetohexamide hypoglycemia in a patient with renal failure has been successfully treated by peritoneal dialysis. Peritoneal dialysis was done in such a patient, and specimens of serum were collected to measure levels of acetohexamide and its main active metabolite, hydroxyhexamide. During dialysis, hypoglycemia was corrected. After 17 1/2 hours of dialysis, serum acetohexamide level was essentially unchanged. Serum hydroxyhexamide level had decreased at a slower rate than the rate of decrease previously measured in a uremic patient not on dialysis. Although peritoneal dialysis may correct the hypoglycemia, the data suggest that acetohexamide and hydroxyhexamide are not dialyzable. Due to these problems this drug should not be used in patients with chronic renal failure. The drug of choice to control hyperglycemia in patients with renal insufficiency is insulin. If for any reason insulin cannot be used, tolbutamide is the oral hypoglycemic agent of choice.

Acetohexamide↗
PubMed1976

Arteriovenous fistulas for hemodialysis: experience with 100 cases.

One hundred radial-cephalic fistulas were surgically created for hemodialysis between April 1970 and September 1973. A side-to-end anastomosis was constructed in 86 per cent of cases. Overall patency interval was 13 months. Factors responsible for shunt failure are outlined. Blood vessel quality and surgical technique are the most important factors in achieving a low failure rate. Use of the fistula for early hemodialysis has not been associated with complications and is advocated.

Arteries↗