scholarly journals Low hemoglobin at hemodialysis initiation: an international study of anemia management and mortality in the early dialysis period

2019 ◽  
Vol 13 (3) ◽  
pp. 425-433
Author(s):  
Angelo Karaboyas ◽  
Hal Morgenstern ◽  
Sandra Waechter ◽  
Nancy L Fleischer ◽  
Raymond Vanholder ◽  
...  
Keyword(s):  
International Study ◽  
First Year ◽  
Advanced Chronic Kidney Disease ◽  
Proactive Approach ◽  
Anemia Management ◽  
Iv Iron ◽  
High Doses ◽  
Dialysis Outcomes ◽  
Higher Doses

Abstract Background Anemia at hemodialysis (HD) initiation is common. Correcting low hemoglobin (Hgb) before HD initiation may improve survival by avoiding potential harms of chronic anemia, high doses of erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron in the early HD period, and/or rapid Hgb rise. Methods We included 4604 incident HD patients from 21 countries in the Dialysis Outcomes and Practice Patterns Study Phases 4–5 (2009–15). Because low Hgb at HD start may reflect comorbidity or ESA hyporesponse, we restricted our analysis to the 80% of patients who achieved Hgb ≥10 g/dL 91–120 days after HD start (Month 4). Results About 53% of these patients had Hgb <10 g/dL in Month 1 (<30 days after HD start); they were younger with a similar comorbidity profile (versus Hgb ≥10 g/dL). Month 1 Hgb was associated with first-year HD mortality (adjusted hazard ratio for 1 g/dL higher Hgb was 0.89; 95% confidence interval: 0.81–0.97), despite minimal differences in Month 4 Hgb. Patients with lower Hgb in Month 1 received higher doses of ESA, but not IV iron, over the first 3 months of HD. Results were consistent when excluding catheter users or adjusting for IV iron and ESA dose over the first 3 months. Conclusions Even among patients with Hgb ≥10 g/dL 3 months later, anemia at HD initiation was common and associated with elevated mortality. A more proactive approach to anemia management in advanced chronic kidney disease (CKD) may thus improve survival on HD, though long-term prospective studies of non-dialysis CKD patients are needed.

scholarly journals An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3617
Author(s):  
Fabrizio Fabrizi ◽  
Roberta Cerutti ◽  
Carlo M. Alfieri ◽  
Ezequiel Ridruejo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Early Stage ◽  
Survival Rates ◽  
International Study ◽  
Public Health Issue ◽  
Advanced Chronic Kidney Disease ◽  
Ablative Techniques ◽  
Risk Of Cancer

Chronic kidney disease is a major public health issue globally and the risk of cancer (including HCC) is greater in patients on long-term dialysis and kidney transplant compared with the general population. According to an international study on 831,804 patients on long-term dialysis, the standardized incidence ratio for liver cancer was 1.2 (95% CI, 1.0–1.4) and 1.5 (95% CI, 1.3–1.7) in European and USA cohorts, respectively. It appears that important predictors of HCC in dialysis population are hepatotropic viruses (HBV and HCV) and cirrhosis. 1-, 3-, and 5-year survival rates are lower in HCC patients on long-term dialysis than those with HCC and intact kidneys. NAFLD is a metabolic disease with increasing prevalence worldwide and recent evidence shows that it is an important cause of liver-related and extra liver-related diseases (including HCC and CKD, respectively). Some longitudinal studies have shown that patients with chronic hepatitis B are aging and the frequency of comorbidities (such as HCC and CKD) is increasing over time in these patients; it has been suggested to connect these patients to an appropriate care earlier. Antiviral therapy of HBV and HCV plays a pivotal role in the management of HCC in CKD and some combinations of DAAs (elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir-based regimens) are now available for HCV positive patients and advanced chronic kidney disease. The interventional management of HCC includes liver resection. Some ablative techniques have been suggested for HCC in CKD patients who are not appropriate candidates to surgery. Transcatheter arterial chemoembolization has been proposed for HCC in patients who are not candidates to liver surgery due to comorbidities. The gold standard for early-stage HCC in patients with chronic liver disease and/or cirrhosis is still liver transplant.

scholarly journals P1441SURVIVAL AND RESIDUAL KIDNEY FUNCTION IN HEMODIALYSIS PATIENTS TREATED WITH HIGH DOSES OF FUROSEMIDE. A PROSPECTIVE LONG TERM STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Esteban Siga ◽  
Romina Alcuaz ◽  
Eduardo Nozzi ◽  
Eugenia Melon Gil ◽  
Nora Vivas ◽  
...  
Keyword(s):  
Informed Consent ◽  
Kidney Function ◽  
First Year ◽  
Term Study ◽  
Cutaneous Manifestations ◽  
Long Term Study ◽  
Residual Kidney Function ◽  
Patient Reported ◽  
High Doses

Abstract Background and Aims Many patients (PTS) starting dialysis have significant residual kidney function (RKF), with 45 % having an estimated glomerular filtration rate ≥10 mL/min/1.73 m2 . Preservation of this residual kidney function has been associated with improved outcomes, and nephrologists should try to preserve this residual kidney function as long as possible. In this setting, furosemide (FURO) could play an important role but there are no guidelines for its use and, given the need of high doses, there are safety concerns which limit its use. Besides, its long term utility has not been established. In this study, our first aim was to determine an effective and safe dose for incident PTS; and the second was to evaluate its effects on the RKF in the first year and the survival of these PTS in the long term. Method Protocol I: cross-over, single blind study, consisting of three weekly periods. During the first week (W1), after signing an informed consent, PTS were randomly assigned to receive 250 (F250) or 500 (F500) mg.of oral FURO once a day. W2 was a washout period and patients received placebo (F0). During the third week, the remaining dose was prescribed. At the end of each W, total urinary volume and Natriuresis of 24 hours was measured. All Capsules were identical, made by the Hospital´s Pharmacist, and PTS were not aware of their content. Protocol II: prospective, open label, long term study. Daily diuresis was measured In all Incident PTS from 01/01/11 to 01/06/19. Those PTS with daily diuresis lower than 200 ml. were the control sample. Those with higher than 200 ml.day, after signing an informed consent, received 500 mg. of oral FURO once a day. At the beginning and the end of the FURO period, 24 hours diuresis was colected to measure volume and Na, K y P. In some PTS, Beta 2 seric microglobulin (B2M) was also measured. All PTS ( n = 101 ) were followed until their obitus, or were censored by transplant, change of centre or completion of the follow up period = 4 years. Results Protocol I: n= 34. Basal diuresis (F0) was 970 ml.day. Effect of F250 and F500 on diuresis was similar. Both increased 24 hs urinary volumen by 30%. By contrast, the increase of Sodium excretion was significantly higher with F500 than with F250: 56 vs 7%, P =0.000 Protocol II: The table shows the long term effect (11.8 +/- 4.7 months) of 500 mg. once a day of oral FURO in 33 incident PTS (8 DBT, 8 women). Data are presented as median and interquartil range (IR). In the first year of HD, FURO was able to maintain the basal diuresis and the median excretion of P. Noteworthy, Natriuresis increased by 29%. Seric B2M was asociated with diuresis: r = -0.59, and was significantly lower than B2M measured in control PTS: 36.7 vs. 48.1 mg.dl (P = 0.011). FURO and Control PTS were followed up to four years. Kaplan Meier analisis ( Figure ) ilustrated that survival in FURO PTS was 96, 90,5 and 73,5 % at 2, 3 and 4 years, respectively, whereas In control PTS it was 76, 65 and 53 %. (P = 0.042, logrank test ). Four PTS stopped FURO ingestion before six months and were excluded. One due to cramps and three by cutaneous manifestations. All symptoms remitted when Furosemide was suspended. No patient reported hearing impairments Conclusion Results of this long term prospective study suggest that Furosemide is effective to maintain RKF in the first year of HD, without major adverse effects. Furthermore, survival was significantly higher in those PTS that ingested Furosemide

International Anemia Prevalence and Management in Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Rachel L. Perlman ◽  
Junhui Zhao ◽  
Douglas S. Fuller ◽  
Brian Bieber ◽  
Yun Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
The United States ◽  
Clinical Practices ◽  
Dialysis Patients ◽  
The Us ◽  
Anemia Management ◽  
Iv Iron ◽  
Dialysis Outcomes

Background The optimal treatment for managing anemia in peritoneal dialysis (PD) patients and best clinical practices are not completely understood. We sought to characterize international variations in anemia measures and management among PD patients. Methods The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) enrolled adult PD patients from 6 countries from 2014 to 2017. Hemoglobin (Hb), ferritin levels, and transferrin saturation (TSAT), as well as erythropoiesis stimulating agents (ESAs) and iron use were compared cross-sectionally at study enrollment in Australia and New Zealand (A/NZ), Canada, Japan, the United Kingdom (UK), and the United States (US). Results Among 3,603 PD patients from 193 facilities, mean Hb ranged from 11.0 – 11.3 g/dL across countries. The majority of patients (range 53% – 59%) had Hb 10 – 11.9 g/dL, with 4% – 12% patients ≥ 13 g/dL and 16% – 23% < 10 g/dL. Use of ESAs was higher in Japan (94% of patients) than elsewhere (66% – 79% of patients). In the US, 63% of patients had a ferritin level > 500 ng/mL, compared with 5% – 38% in other countries. In the US and Japan, 87% – 89% of PD patients had TSAT ≥ 20%, compared with 73% – 76% in other countries. Intravenous (IV) iron use within 4 months of enrollment was higher in the US (55% of patients) than elsewhere (6% – 17% patients). Conclusions In this largest international observational study of anemia and anemia management in patients receiving PD, comparable Hb levels across countries were observed but with notable differences in ESA and iron use. Peritoneal dialysis patients in the US have higher ferritin levels and higher IV iron use than other countries.

scholarly journals TOLERANСЕ OF THE DRUG FOR VETERINARY USE TULATRIN

2021 ◽  
Vol 247 (3) ◽  
pp. 90-96
Author(s):  
I.S. Кoba ◽  
◽  
А.Kh. Shantyz ◽  
G.A. Burmenskaya ◽  
I.S. Zholobova ◽  
...  
Keyword(s):  
Large Scale ◽  
Clinical Status ◽  
Clinical Signs ◽  
Live Weight ◽  
Pathological Effect ◽  
Good Tolerability ◽  
Maximum Increase ◽  
High Doses ◽  
Higher Doses

Mass antibacterial therapy carried out according to therapeutic and preventive schemes is considered to be a highly effective and the most rational measure for controlling infectious diseases in the conditions of large-scale industrial pig breeding. It was found that the long-term intramuscular use of the drug Tulatrin in a therapeutic and three-fold therapeutic dose does not have a pronounced pathological effect on pigs. During the experiment, no animal deaths and manifestations of clinical signs of intoxication (depression, vomiting, salivation, diarrhea, etc.) were noted. The animals were active and ate food well. The live weight of piglets in experimental groups does not significantly differ from the animals that were kept in the control groups. The liver is the most sensitive to the action of tulatromyc in with prolonged intake of the drug in higher doses, which is confirmed by the results of biochemical studies. However, the intrinsic hepatotoxicity associated with the use of high doses, or with prolonged use, is characteristic of all drugs of the macrolide group. It should be noted that in this case, the maximum increase in marker liver enzymes does not exceed 10 % of the upper limit of the norm, so we can say that the liver damage is of a trace nature, since the clinical significance is an increase in liver samples by at least 2 times. Also, the increase in total protein was not fatal and did not affect the change in the clinical status of animals. We did not note the death of animals and the manifestation of clinical signs of intoxication and hepatopathy. Tulatrin is one of the safe medicines, and is characterized by good tolerability. The results obtained confirm the safety of using the drug in the recommended dosage regimen.

1608: Long-Term Treatment with High Doses of Sildenafil Does Not Up-Regulate the Levels of Phosphodiesterase 5 (Pde5) in the Rat Penis

2004 ◽  
Vol 171 (4S) ◽  
pp. 424-424 ◽  
Author(s):  
Monica G. Ferrini ◽  
Eliane G. Valente ◽  
Jacob Rajfer ◽  
Nestor F. Gonzalez-Cadavid
Keyword(s):  
Term Treatment ◽  
Long Term Treatment ◽  
High Doses ◽  
Phosphodiesterase 5

CARDIOLOGICAL PROBLEMS IN THE LONG-TERM PERIOD IN CHILDREN AFTER AORTIC COARCTATION SURGERY TREATMENT IN THE FIRST YEAR OF LIFE

2018 ◽  
Vol 97 (3) ◽  
pp. 24-28
Author(s):  
M.R. Tumanyan ◽  
◽  
A.A. Svobodov ◽  
E.G. Levchenko ◽  
A.G. Anderson ◽  
...  
Keyword(s):  
Aortic Coarctation ◽  
First Year ◽  
First Year Of Life

Muenke syndrome: long-term outcome of a syndrome-specific treatment protocol

2019 ◽  
Vol 24 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Bianca K. den Ottelander ◽  
Robbin de Goederen ◽  
Marie-Lise C. van Veelen ◽  
Stephanie D. C. van de Beeten ◽  
Maarten H. Lequin ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
First Year ◽  
Ventricular Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Skull Growth ◽  
Muenke Syndrome ◽  
First Year Of Life

OBJECTIVEThe authors evaluated the long-term outcome of their treatment protocol for Muenke syndrome, which includes a single craniofacial procedure.METHODSThis was a prospective observational cohort study of Muenke syndrome patients who underwent surgery for craniosynostosis within the first year of life. Symptoms and determinants of intracranial hypertension were evaluated by longitudinal monitoring of the presence of papilledema (fundoscopy), obstructive sleep apnea (OSA; with polysomnography), cerebellar tonsillar herniation (MRI studies), ventricular size (MRI and CT studies), and skull growth (occipital frontal head circumference [OFC]). Other evaluated factors included hearing, speech, and ophthalmological outcomes.RESULTSThe study included 38 patients; 36 patients underwent fronto-supraorbital advancement. The median age at last follow-up was 13.2 years (range 1.3–24.4 years). Three patients had papilledema, which was related to ophthalmological disorders in 2 patients. Three patients had mild OSA. Three patients had a Chiari I malformation, and tonsillar descent < 5 mm was present in 6 patients. Tonsillar position was unrelated to papilledema, ventricular size, or restricted skull growth. Ten patients had ventriculomegaly, and the OFC growth curve deflected in 3 patients. Twenty-two patients had hearing loss. Refraction anomalies were diagnosed in 14/15 patients measured at ≥ 8 years of age.CONCLUSIONSPatients with Muenke syndrome treated with a single fronto-supraorbital advancement in their first year of life rarely develop signs of intracranial hypertension, in accordance with the very low prevalence of its causative factors (OSA, hydrocephalus, and restricted skull growth). This illustrates that there is no need for a routine second craniofacial procedure. Patient follow-up should focus on visual assessment and speech and hearing outcomes.

Engineering for good: A case of community driven engineering innovation

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Chinweike Eseonu ◽  
Martin A Cortes
Keyword(s):  
Engineering Students ◽  
Technology Innovation ◽  
Local Communities ◽  
First Year ◽  
Engineering Curriculum ◽  
Engineering Design Process ◽  
The World ◽  
The University ◽  
Social Consideration

There is a culture of disengagement from social consideration in engineering disciplines. This means that first year engineering students, who arrive planning to change the world through engineering, lose this passion as they progress through the engineering curriculum. The community driven technology innovation and investment program described in this paper is an attempt to reverse this trend by fusing community engagement with the normal engineering design process. This approach differs from existing project or trip based approaches – outreach – because the focus is on local communities with which the university team forms a long-term partnership through weekly in-person meetings and community driven problem statements – engagement.

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