摘要:

To assess the predictive value of serum lipid measurements in dialysis patients once the initial decrease on early dialysis had occurred, we obtained random serum cholesterol and triglyceride levels in stable, chronic dialysis patients who were then followed up to 9 years. Derived LDL (DLDL) was estimated by the Friedewald formula, calculated for all HDL levels between 30 and 45 mgldL, and evaluated statistically against a panel of vascular disease markers, including clinical assessment for coronary, peripheral, and cerebrovascular disease; ECG, both standard and ambulatory; two-dimensional echocardiogram; and medications. Survival was calculated from entry (not dialysis onset) for 58 hemodialysis and 33 peritoneal dialysis patients. The 91 patients (49 males, 74 diabetics) were divided by cholesterol levels(≥175mg/dL = 53,<175 = 38), triglyceride (≥175mg/dL = 55,<175 = 36), andDLDL(≥75 = 58,<75 = 24). High total cholesterol was present in a larger proportion of females than low cholesterol, but groups were not different with respect to all vascular determinants, including survival (mean = 33.4 months vs. 43.2, p = NS). High vs. low triglyceride groups were not different with respect to vascular indicators, except for both incidence of abnormal standard ECG (69% vs. 42%, p<0.05) and survivals (mean = 42.0 vs. 30.7, p<0.05; 1 year = 80% vs. 56%, p<0.01). High DLDL measurements identified a group with increased incidence of diabetes (88% vs. 67%, p<0.05), female gender (53% vs. 25%, p<0.01), coronary events (5% vs. 33%, p<0.05), and cerebrovascular events (24% vs. 0%, p<0.01), with a decreased mean survival (31.2 vs. 43.0 months, p<0.07). These results suggest that DLDL levels in the“normal”range may be vasculopathic in a dialysis population.

ISSN:0886-022X    

DOI:10.3109/08860229309046153

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The Sickness Impact Profile (SIP) and the Wechsler Memory Scale—Revised (WMS-R) were administered to a small sample of end-stage renal failure patients. The memory test successfully discriminated between patients who were rated by their nurses to be well adjusted or poorly adjusted to dialysis treatment. It is concluded that this instrument may be useful in investigating cognitive function in this patient population.

ISSN:0886-022X    

DOI:10.3109/08860229309046154

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Studies were performed in oliguric and nonoliguric forms of uranyl acetate (UA)-induced and ischemic acute renal failure (ARF) to examine whether a reduction in GFR is correlated with glomerular morphologic alterations. UA-induced nonoliguric and oliguric ARF were induced in rabbits by i.v. injections of 0.9 and 2 mglkg, respectively. A 60-min renal artery clamping produced nonoliguric ARF in previously uninephrectomized rats, but oliguric ARF in the clamped kidneys of sham-nephrectomized animals. A decline in the whole-kidney Clnrate was more marked in oliguric ARF kidneys of both models than in nonoliguric ARF kidneys. Also, tubular damage was more pronounced in oliguric kidneys when compared with nonoliguric kidneys. Scanning electron microscopic observations revealed glomerular alterations in oliguric and nonoliguric kidneys in both models, evidenced by a flattening and spreading of podocyte cell bodies associated with loss of epithelial foot processes and a reduction in the density and diameter of endothelial fenestrae. There was no significant difference in these glomerular changes between oliguric and nonoliguric kidneys. The findings suggest that less reduction in the whole-kidney GFR in nonoliguric ARF kidneys is ascribed largely to less pronounced tubular damage rather than to less severe glomerular morphologic alterations.

ISSN:0886-022X    

DOI:10.3109/08860229309046155

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

We report experience with O-set and UVXD systems. Sixty-nine O-set patients (34 male; mean age±SD = 45.7±13.2 years) were compared with 54 UVXD patients (27 male; 56.8±16.8 years). Total (mean±SD) experiences were 974 (14.1±10.8) months on O-set and 1010.9 (18.7±15.7) months on UVXD. Thirty-two O-set patients avoided peritonitis; 37 had 91 episodes. Seventeen UVXD patients avoided peritonitis; 37 had 137 episodes. Peritonitis occurred each 10.7 months (O-set) versus 7.4 months (UVXD), which was significantly different (p = 0.032, Z test; 95% confidence interval = -0.142 to + 0.226). There were 18 relapses in 9 O-set patients, 34 in 12 UVXD. Gram-positive organisms caused 58.2% and 66%; gram-negative, 13.2% and 8.8%; and culture negative, 24.2% and 23.4% of peritonitis in O-set and UVXD, respectively. The time to first peritonitis was not different, 7.4±6.6 months O-set and 7.2±7.9 months (UVXD). There was no difference in the peritonitis-free period, 13.0±10.0 months (O-set) and 16.5±14.3 months (UVXD). There were 1.12 (O-set) and 16.1 (UVXD) cases per patient year, and 10.7 (O-set) and 7.43 (UVXD) patient months per episode. The peritonitis rate odds ratio was 1:1.85 (O-set.UVXD).

ISSN:0886-022X    

DOI:10.3109/08860229309046156

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Circadian blood pressure (BP) rhythm was prospectively studied by ambulatory 24-h monitoring in normotensive (n = 27) and hypertensive (n = 41) patients with stable progression of chronic renal insufficiency, and in matched control groups (healthy subjects: n = 28 and patients with essential hypertension: n = 47) without renal disease. The follow-up period lasted 24 months. The renal patients showed a disturbance in the 24-h profile of BP, with significantly blunted nocturnal pressure reduction as compared with the respective control groups (p<0.01 and p<0.001, respectively). In addition to the rearrangement of circadian rhythm, the normotensive and hypertensive renal patients displayed a wider distribution of systolic and diastolic BP values and a greater nocturnal variability. Among the normotensive and hypertensive patients with chronic renal insufficiency, a significant correlation was found between the decline in creatinine clearance over the 24-month period and the average nighttime diastolic BP (r = 0.526; p<0.01 and r—0.613; p = 0.001, respectively) and nocturnal diastolic fall (r = 0.612; p<0.001 and r = 0.496; p<0.07, respectively). These data offer support for the view that renal normotensive patients are exposed to a relative hypertension at nighttime and that renal hypertensive subjects can be underestimated in their hypertensive status if the measurement of BP is confined to daytime. In both groups, nocturnal BP overload can accelerate the progression rate of renal insufficiency.

ISSN:0886-022X    

DOI:10.3109/08860229309046157

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The aim of this study was to examine the saturation patterns of cuprofane and polysulfone membranes in hemodialysis patients, and to correlate that with permeability of the alveolar membrane, unloading of CO2over the membranes, and production of oxygen free radicals. Polysulfone membranes did not have the same desaturation pattern as the cuprofane membranes. Both membranes were equally effective in the unloading of CO2, and so alveolar hypoventilation does not explain oxygen desaturation during hemodialysis. White blood cells have a central role in the parallel development of early leucopenia and hypoxemia. The precise mechanism is still unknown because there were no changes in permeability of the alveolar membrane or production of oxygen free radicals.

ISSN:0886-022X    

DOI:10.3109/08860229309046158

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:0886-022X    

DOI:10.3109/08860229309046159

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor