ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Cyclosporine and tacrolimus are potent inhibitors of the calcineurin-dependent cytokine synthesis in activated lymphocytes. In renal transplant patients tacrolimus is more powerful in preventing severe and refractory rejections, even when compared with the new cyclosporine microemulsion formulation. Both drugs are equally nephrotoxic, but tacrolimus induces less hypertension and less pronounced hyperlipidaemia. Especially in some categories of patients, a higher incidence of de-novo diabetes mellitus is seen with tacrolimus therapy.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Understanding of how antigen-specific signals and costimulatory molecules are involved in T-cell activation has resulted in new strategies to interfere with allograft rejection. The present review focuses on the role of two receptor-ligand pairs: CD28 and cytotoxic T lymphocyte associated antigen-4, which interact with the B7 ligands (CD80, CD86); and CD40, which interacts with the CD40L (CD154). On the basis of the extensive tissue distribution of CD40, it is likely that the CD40/CD40L system plays a much broader role.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Patients with approaching end-stage renal disease often must choose between hemodialysis or peritoneal dialysis as the initial form of renal replacement therapy. Should nephrologists recommend one form of dialysis as superior to the other? This review focuses on studies that compared patient mortality for these two dialysis techniques. Explanations for the disparate findings of these studies will be put forth. Finally, suggestions regarding what we can recommend to patients are made.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Thrombosis in haemodialysis accesses remains a major problem. It is associated with stenosis that causes haemodynamic and anatomical changes. By prospective monitoring it is possible to identify patients at risk of thrombosis. Those patients should be referred for corrective intervention. This approach can result in a thrombosis rate below the advised quality of care standard of 0.5 thromboses/patient-year.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Measurement of dialysis adequacy in patients with end-stage renal disease involves the use of urea kinetic modeling, which is a reflection of both dietary protein intake and efficiency of small solute clearance. Different dialytic modalities are available for patients in acute renal failure, including intermittent hemodialysis, continuous renal replacement therapies and peritoneal dialysis. In recent years, there has been a growing effort to measure dialysis adequacy in patients with acute renal failure using urea kinetic modeling. This initiative has been driven by the persistently high mortality rates in patients with dialysis-requiring acute renal failure, which may partly be related to inadequate dialysis dosing. In the setting of acute renal failure, dialysis adequacy has been measured using both single-pool and double-pool urea kinetics, as well as blood-based and dialysate-based urea kinetic modeling. Unfortunately, current goals and methods of measuring dialysis adequacy have been extrapolated from the end-stage renal disease patient population. These extrapolations are problematic because of differences in total body water, protein catabolic rate, and vascular access. Continuous renal replacement therapy has theoretical advantages over intermittent hemodialysis, including a decreased tendency to induce hypotension, and improved solute clearance and fluid removal, while allowing intensive nutritional support, and a better clearance of medium- to large-size molecules. The latter may play a significant role in patients with sepsis-associated acute renal failure. To date, comparative studies are scant and equivocal in establishing the superiority of a particular dialysis dose or modality.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Continuous renal replacement therapies (CRRTs) allow for gradual solute and fluid removal. In very sick patients with acute renal failure, they may be better tolerated than hemodialysis. The major drawback to CRRTs is the need for anticoagulation to maintain filter patency. The patients who are likely to benefit from CRRTs are also at higher risk for bleeding from systemic anticoagulation. The most commonly used form of anticoagulation for CRRTs, low-dose heparin, causes bleeding in 10-50% of patients. Regional anticoagulation using protamine may reduce the risk of bleeding, but it is difficult to use. Low molecular weight heparin and prostacyclin both may partially reduce bleeding, but are difficult to dose. Regional anticoagulation with citrate is easy to use and has been shown to prolong filter life without systemic anticoagulation. It is the anticoagulant of choice for most patients on CRRT.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Haemodialysis techniques rely on efficient haemodialyzers that are utilized as solute and water exchangers. The haemodialyzer design has not changed significantly for many years. Only recently optimization of the blood compartment design, of the membrane structure and of the dialysate compartment geometry have been sought. This paper briefly reviews the most recent advances in the design and construction of haemodialyzers and points out the clinical impact of such innovations.

ISSN:1062-4821    

出版商:OVID    

年代:1999

数据来源: OVID