Three-year follow-up after withdrawal of iron therapy in uremic patients on regular dialytic treatment

1986 ◽  
Vol 16 (4) ◽  
pp. 517-522
Author(s):  
Alessandra Thea ◽  
Caterina Canavese ◽  
Giovanni Mangiarotti ◽  
Alfonso Pacitti ◽  
Mario Salomone ◽  
...  
Keyword(s):  
Iron Therapy ◽  
Uremic Patients ◽  
Dialytic Treatment

scholarly journals P1145ADEQUACY AND SURVIVAL IN PERITONEAL DIALYSIS: TEN YEARS EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vincenzo Terlizzi ◽  
Elena Pezzini ◽  
Roberta Cortinovis ◽  
Diana Bertoni ◽  
Alessandra Pola ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Protective Factor ◽  
Residual Renal Function ◽  
Dialysis Modality ◽  
Dialysis Adequacy ◽  
Dialysis Treatment ◽  
Increased Risk ◽  
Uremic Patients

Figure: Background and Aims in Italy only a minority of uremic patients perform peritoneal dialysis (PD). In dialysis centers where PD is practiced and proposed the prevalence is no more than 23%. Proposed advantages of PD over HD are a more preserved Residual renal function (RRF), that has been associated with better survival, and better Quality of life (Qol) due to possible more preservation of previous lifestyle, independence, possibility of traveling, and flexibility. Incremental peritoneal dialysis is a promising way to further improve Qol and to preserve RRF. Lastly, PD is less expensive than HD. Aim of this study has been to retrospectively evaluate our ten-years experience of PD treatment on survival, dialysis adequacy, preservation of RRF and nutrition in uremic patients followed at our Dialysis Center. Method We retrospectively evaluated all the incident patients that started PD treatment due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. The exclusion criteria were time of dialysis treatment less than 3 months and absence of previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded. Data on dialysis adequacy, nutrition, RRF and PD dialysis modality performed were also recorded. Results During the observation period 329 patients started PD. 60 were excluded due to follow-up of less than 3 months. Therefore, 269 patients (males 160, 59%) were studied. The average age was 65±16 years, BMI 24±4 kg/m2. Comorbidities were: hypertension (87%), diabetes mellitus (32%), cerebral vascular disease (26%) and ischemic heart disease (25%). The mean duration of dialysis treatment was 2.1±1.5 years. At the end of ten-years follow-up 24% of patients have had a kidney transplant, 18% were on PD treatment, 17% have had a shift towards HD, 39% had died. The main causes of death were: infection (39%) and cardiovascular disease (31%). The most common dialysis modality performed was APD (61%); CAPD was performed in 39% of pts. Dialysis modality (CAPD; APD), nutrition parameters (PNA; BMI), as well as RRF, expressed as an average value during follow-up, are shown in Figure 1. 81 patients (30%) were treated with incremental PD; 85% of them with manual exchanges. The comparison of dialysis parameters between incremental PD and standard PD are shown in Figure 2. Multivariate analysis with survival as dependent variable (Figure 3), showed that age, diabetes mellitus, and low wKt/V were independently associated with an increased risk of mortality. Diuresis volume and male gender were protective factors. No independent influence on mortality of the dialysis treatment modality was found. Conclusion In this ten-years experience of patients undergoing PD at our Center, incremental PD seems to be a protective factor for the maintenance of a preserved diuresis and better dialysis adequacy, and these factors are associated with better survival of the patients.

scholarly journals P570 The burden of anaemia remains significant over time in patients with inflammatory bowel disease at a tertiary referral centre

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
K Singh Singh ◽  
A Al-Khoury ◽  
Z Kurti ◽  
L Gonczi ◽  
P Golovics ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Intravenous Iron ◽  
Severe Anaemia ◽  
Iron Therapy ◽  
Tertiary Referral ◽  
Inflammatory Bowel ◽  
Intravenous Iron Therapy ◽  
Active Disease ◽  
Over Time

Abstract Background Anaemia is an important complication and/or extra-intestinal manifestation of inflammatory bowel disease (IBD), as well as a predictor of poor outcomes. The aim of this study was to determine the occurrence of anaemia and the frequency of anaemia screening over time, at a tertiary referral IBD centre. Methods We retrospectively reviewed the occurrence of anaemia at the time of referral or diagnosis and during follow-up at the McGill University Health Centre (MUHC) IBD centre. Consecutive patients presenting with an outpatient visit (‘index visit’) between July and December 2016 and between December 2018 and March 2019 were included. Disease characteristics, biochemistry and medical management, including the need for intravenous iron therapy were captured. Results 1356 and 1293 CD and UC patients [disease duration: 12 (IQR:6–22) and 10 (IQR: 5–19) years] were included in the 2 periods. The prevalence of moderate or severe anaemia at referral/diagnosis (15.4% and 8.5%) and during the follow-up (11.1% and 8.1%) was higher in CD than in UC patients, with a decrease of anaemia in CD patients between the 2 periods. The prevalence of any anaemia at follow-up was 22.4% and 18.7% in CD and in UC, while 82.7% of patients were tested at least once for anaemia during a 6-month period. UC patients with more extensive disease, treated with steroids or biologics at the time of referral but not during follow-up, active disease, or an elevated calprotectin at the time of assessment, and CD patients with active disease, elevated CRP or calprotectin at the time of assessment, with complicated disease, perianal involvement, previous respective surgery or colonic disease location, had a higher risk of anaemia. Intravenous iron therapy was prescribed in 46 patients (46.8% patients (37/79) with moderate or severe anaemia) with 72.3% having active disease (CD: 65.2%, steroid 83.3%, biological therapy: 78.6%, CRP: 97.8%, FCAL: 73.9%) in the second cohort. 91.3% of patients receiving intravenous iron had an extensive evaluation of anaemia pre- and post-therapy (CBC, ferritin, transferrin, TSAT, B12, folate). Anaemia improved by >2g/l in 56.5% after 4–6 weeks (intravenous iron dose >1000mg in 87% of patients). Four patients required a blood transfusion. Conclusion Anaemia occurred frequently in this IBD cohort, at referral to the centre and during follow-up, and contributes to the burden of IBD in referral populations. Most patients were assessed for anaemia regularly and with accurate anaemia workup in patients prescribed intravenous iron therapy, yet the targeted management of moderate to severe anaemia was suboptimal.

Follow-up of nerve conduction in chronic uremic patients during hemodialysis

1992 ◽  
Vol 13 (4) ◽  
pp. 317-321 ◽  
Author(s):  
M. Leone ◽  
E. Bottacchi ◽  
S. Alloatti ◽  
P. E. Nebiolo ◽  
M. Aimino ◽  
...  
Keyword(s):  
Nerve Conduction ◽  
Uremic Patients

Establishment of an outreach, grouping healthcare system to achieve microelimination of HCV for uremic patients in haemodialysis centres (ERASE-C)

Gut ◽  
2020 ◽  
pp. gutjnl-2020-323277
Author(s):  
Ming-Lung Yu ◽  
Chung-Feng Huang ◽  
Yu-Ju Wei ◽  
Wen-Yi Lin ◽  
Yi-Hung Lin ◽  
...  
Keyword(s):  
Group Treatment ◽  
Care Group ◽  
Hcv Rna ◽  
Staff Members ◽  
Link Type ◽  
End Of Treatment ◽  
Outreach Programme ◽  
Full Analysis ◽  
Uremic Patients

ObjectiveHCV prevails in uremic haemodialysis patients. The current study aimed to achieve HCV microelimination in haemodialysis centres through a comprehensive outreach programme.DesignThe ERASE-C Campaign is an outreach programme for the screening, diagnosis and group treatment of HCV encompassing 2323 uremic patients and 353 medical staff members from 18 haemodialysis centres. HCV-viremic subjects were linked to care for directly acting antiviral therapy or received on-site sofosbuvir/velpatasvir therapy. The objectives were HCV microelimination (>80% reduction of the HCV-viremic rate 24 weeks after the end of the campaign in centres with ≥90% of the HCV-viremic patients treated) and ‘No-C HD’ (no HCV-viremic subjects at the end of follow-up).ResultsAt the preinterventional screening, 178 (7.7%) uremic patients and 2 (0.6%) staff members were HCV-viremic. Among them, 146 (83.9%) uremic patients received anti-HCV therapy (41 link-to-care; 105 on-site sofosbuvir/velpatasvir). The rates of sustained virological response (SVR12, undetectable HCV RNA 12 weeks after the end of treatment) in the full analysis set and per-protocol population were 89.5% (94/105) and 100% (86/86), respectively, in the on-site treatment group, which were comparable with the rates of 92.7% (38/41) and 100% (38/38), respectively, in the link-to-care group. Eventually, the HCV-viremic rate decreased to 0.9% (18/1,953), yielding an 88.3% reduction from baseline. HCV microelimination and ‘No-C HD’ were achieved in 92.3% (12/13) and 38.9% (7/18) of the haemodialysis centres, respectively.ConclusionOutreach strategies with mass screenings and on-site group treatment greatly facilitated HCV microelimination in the haemodialysis population.ClinicalTrials.gov identifierNCT03803410 and NCT03891550

Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up Study

2017 ◽  
Vol 46 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Simone Baiardi ◽  
Susanna Mondini ◽  
Alessandro Baldi Antognini ◽  
Antonio Santoro ◽  
Fabio Cirignotta
Keyword(s):  
Mortality Rate ◽  
Restless Legs Syndrome ◽  
Rank Test ◽  
Control Group ◽  
Dialysis Patients ◽  
Restless Legs ◽  
Cardiovascular Morbidity And Mortality ◽  
Uremic Patients ◽  
Esrd Patients

Background: Restless legs syndrome, also known as Willis/Ekbom disease (RLS/WED), is a sleep-related, sensorimotor disorder with a high prevalence among end-stage renal disease (ESRD) patients undergoing haemodialysis (HD) (about 15-40%). Whether RLS/WED in uremic patients influences cardiovascular morbidity and mortality remains a matter of controversy. The aim of this study was to evaluate the relationship of RLS/WED and mortality in a population of chronically dialyzed patients. Method: In 1996, we studied 128 patients with ESRD undergoing HD; 47 subjects (36.7%) complained RLS/WED symptoms. Fifteen years later we evaluated the mortality of this population. No clinical follow-up examination of the uremic population was made. The Kaplan-Maier curves in dialysis patients with or without RLS/WED (control group matched for age) were constructed for all-cause mortality and compared using log-rank test. Results: The Kaplan-Maier curves disclosed a lower mortality rate in the uremic patients with RLS/WED than in those without RLS/WED (p = 0.04). In our analysis, the mortality rate was not influenced by RLS/WED severity (p = 0.11) or gender (p = 0.15). No difference among the causes of death was found in the 2 groups. Conclusions: Our study suggests that mortality in ESRD patients is not influenced by concomitant RLS/WED. After a 15-year follow-up, survival rates in our cohort were significantly longer in uremic subjects with RLS/WED than in those without RLS/WED. Finally, we found no relationship between RLS/WED severity and mortality.

Hemodialysis and the Acute-Phase Response in Chronic Uremic Patients

1989 ◽  
Vol 12 (12) ◽  
pp. 762-765 ◽  
Author(s):  
K. Trznadel ◽  
M. Luciak ◽  
M. Paradowski ◽  
B. Kubasiewicz-Ujma
Keyword(s):  
Blood Serum ◽  
Acute Phase ◽  
Acute Phase Response ◽  
Phase Reaction ◽  
Serum Concentrations ◽  
Lower Serum ◽  
Acid Glycoprotein ◽  
Uremic Patients ◽  
Healthy Persons

In comparison with healthy persons, chronic uremic patients on regular hemodialysis treatment had significantly higher blood serum concentrations of α1-acid glycoprotein, ceruloplasmin and C4 complement component, while levels of haptoglobin, C3 and transferrin were lower. Serum α2-macroglobulin and α1-antitrypsin levels were similar in both groups. Hemodialysis with cuprophan membrane induced only slight changes in some of these glycoproteins during a 48-hour follow-up period. Seven hours after termination of hemodialysis slight, but significant, decreases in blood serum transferrin and α1-antitrypsin concentrations were observed. Hemodialysis thus does not seem to induce a conspicuous acute-phase reaction.

Serum Levels of Calcitonin in Uremic Patients in the Predialytic Phase and on Regular Dialytic Treatment

2015 ◽  
pp. 101-106 ◽  
Author(s):  
D. Di Landro ◽  
G. Luisetto ◽  
L. Tizian ◽  
C. Pennetta ◽  
M. Urso ◽  
...  
Keyword(s):  
Serum Levels ◽  
Uremic Patients ◽  
Dialytic Treatment

scholarly journals Effect of Iron-Deficiency Anemia on Cognitive Skills and Neuromaturation in Infancy and Childhood

2003 ◽  
Vol 24 (4_suppl_1) ◽  
pp. S104-S110 ◽  
Author(s):  
Tomas Walter
Keyword(s):  
Iron Deficiency ◽  
Brain Stem ◽  
Iron Deficiency Anemia ◽  
Developmental Expression ◽  
Iron Therapy ◽  
Psychomotor Development ◽  
Deficiency Anemia ◽  
Auditory Brain Stem Responses ◽  
Auditory Brain Stem

Iron-deficiency anemia in infancy has been consistently shown to negatively influence performance in tests of psychomotor development. In most studies of short-term follow-up, lower scores did not improve with iron therapy, despite complete hematologic replenishment. The negative impact on psychomotor development of iron-deficiency anemia (IDA) in infancy has been well documented in more than a dozen studies during the last two decades. Two studies will be presented here to further support this assertion. Additionally, we will present some data referring to longer follow-up at 5 and 10 years as well as data concerning recent descriptions of the neurologic derangements that may underlie these behavioral effects. To evaluate whether these deficits may revert after long-term observation, a cohort of infants was re-evaluated at 5 and 10 years of age. Two studies have examined children aged 5 years who had anemia as infants using comparable tools of cognitive development showing persisting and consistent important disadvantages in those who were formerly anemic. These tests were better predictors of future achievement than psychomotor scores. These children were again examined at 10 years and showed lower school achievement and poorer fine-hand movements. Studies of neurologic maturation in a new cohort of infants aged 6 months included auditory brain stem responses and naptime 18-lead sleep studies. The central conduction time of the auditory brain stem responses was slower at 6, 12, and 18 months and at 4 years, despite iron therapy beginning at 6 months. During the sleep-wake-fulness cycle, heart-rate variability—a developmental expression of the autonomic nervous system—was less mature in anemic infants. The proposed mechanisms are altered auditory-nerve and vagal-nerve myelination, respectively, as iron is required for normal myelin synthesis.

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