Hyperkalaemia prevalence, recurrence and treatment in patients on haemodialysis in China: protocol for a prospective multicentre cohort study (PRECEDE-K)

IntroductionHyperkalaemia (HK) is a potentially life-threatening electrolyte imbalance associated with several adverse clinical outcomes and is common in patients with kidney failure. However, there is no evidence on the occurrence, recurrence and treatment of HK in patients on haemodialysis (HD) in China.Methods and analysisThe HK Prevalence, Recurrence, and Treatment in Haemodialysis Study is a prospective, multicentre, observational, cohort study being conducted across 15–18 sites in China. Approximately 600 patients with end-stage kidney disease on HD are anticipated to be enrolled and will be followed up for 24 weeks. Patients will be in the long interdialytic interval (LIDI) at enrolment and will receive follow-up care every 4 weeks in LIDI for pre-dialysis and post-dialysis (at enrolment only) serum potassium measurements. To obtain pre-dialysis serum potassium levels in the short interdialytic interval (SIDI), a follow-up visit will be performed in the SIDI during the first week. Information on concomitant medications, blood gas analysis and biochemistry measurements will be obtained at enrolment and at each follow-up visit. The primary endpoint will be the proportion of patients experiencing HK (defined as serum potassium level >5.0 mmol/L) at the study enrolment or during the 24-week follow-up. The key secondary endpoint will be the proportion of patients experiencing HK recurrence (defined as any HK event after the first HK event) within 1–6 months (if applicable) during the 24-week follow-up, including enrolment assessment.Ethics and disseminationThis study has been approved by Shanghai Jiaotong University School of Medicine, Renji Hospital Ethics Committee (2020-040). Other participating subcentres must also obtain ethics committee approval prior to the start of the study. The Good Clinical Practice regulations shall be strictly followed during the test implementation. Amendments to the protocol will be reviewed by the ethics committees. Written informed consent will be obtained from all participants before collection of any patient data and patient information. The findings of this study will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT04799067).

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Trends over Time of Lung Function and Radiological Abnormalities in COVID-19 Pneumonia: A Prospective, Observational, Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10051021 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1021

Author(s):

Pierachille Santus ◽

Nicola Flor ◽

Marina Saad ◽

Stefano Pini ◽

Elisa Franceschi ◽

...

Keyword(s):

Cohort Study ◽

Blood Gas Analysis ◽

Gas Analysis ◽

University Hospital ◽

Gas Exchange Parameters ◽

Post Discharge ◽

Alveolar Volume ◽

High Dependency ◽

Severity Of The Disease

Radiological and functional sequelae of Coronavirus Disease 2019 (COVID-19) pneumonia are still poorly understood. This was a prospective, observational, physiological, cohort study on consecutive adult patients with COVID-19 pneumonia admitted in April–May 2020 in the high dependency respiratory unit of L. Sacco University Hospital in Milan (Italy). During hospitalization, patients underwent chest computed tomography (CT), blood gas analysis, spirometry, and lung diffusion capacity for carbon monoxide (DLco), which were repeated 6 weeks post-discharge. Chest CTs were individually read by two expert radiologists, that calculated the total severity score (TSS). Twenty patients completed the study (mean age 58.2 years, 70% males). During the acute phase, mean DLco, alveolar volume (VA), and vital capacity (VC) were 56.0 (16.3), 64.8 (14.0), and 71.7 (16.9) % predicted, respectively, and were inversely associated with PaO2/FiO2 ratio. Fifty percent of patients had a restrictive ventilatory pattern; mean TSS was 7.9 (4.0). At follow up, gas exchange parameters were normalized; consolidations persisted in 10% of cases, while DLco was <80% predicted in 65% of patients and was independently predicted by Log10D-dimer at admission (β −18.675; 95%CI, −28.373–−9.076; p = 0.001). In conclusion, functional abnormalities in COVID-19 pneumonia survivors can persist during follow up and are associated with the severity of the disease.

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Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽

10.1159/000513440 ◽

2021 ◽

pp. 1-8

Author(s):

Clemens F. Hinke ◽

Rudolf A. Jörres ◽

Peter Alter ◽

Robert Bals ◽

Florian Bornitz ◽

...

Keyword(s):

Pulmonary Disease ◽

Predictive Value ◽

Hemoglobin Concentration ◽

Blood Gas Analysis ◽

Study Data ◽

Gas Analysis ◽

Chronic Obstructive ◽

Acute Exacerbations ◽

All Cause Mortality

Background: Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). Objectives: We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). Methods: In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO2, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. Results: During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (p < 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV1 % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (p = 0.006) was superior to that of Hb or SpO2 and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; p = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; p = 0.001) as covariates. Conclusion: The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

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Research Ethics Committees in Europe — Living with Diversity

Research Ethics ◽

10.1177/174701610700300311 ◽

2007 ◽

Vol 3 (3) ◽

pp. 101-102

Author(s):

Frank Wells

Keyword(s):

Research Ethics ◽

Working Party ◽

Ethics Committees ◽

Good Clinical Practice ◽

Ethics Committee ◽

Research Ethics Committees ◽

European Forum ◽

Working Groups ◽

Vulnerable Subjects ◽

The Eu

This paper presents a review, conducted by the ethics working party of the European Forum for Good Clinical Practice, of the structures and functions of research ethics committees across the member states of the EU. The findings demonstrate widespread differences, and further working groups have been established to develop thinking across Europe, in respect of the training of REC members, ethics committee quality assurance and the involvement of vulnerable subjects in research. In practical terms the differences do not matter, but they should be recognized. The review itself is considered a dynamic document and will be updated every six months.

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Factors Associated With The Relapse In Ponseti Treated Congenital Club Foot

10.21203/rs.3.rs-737846/v1 ◽

2021 ◽

Author(s):

Wei Hu ◽

Baoyi Ke ◽

Niansu Xiao ◽

Sen Li ◽

Cheng Li ◽

...

Keyword(s):

Club Foot ◽

Ethics Committee ◽

Ponseti Method ◽

Ethical Standards ◽

Factors Associated ◽

Pirani Score ◽

Walking Age ◽

The Mean ◽

Hospital Ethics

Abstract Objectives. We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method.Methods. We retrospectively reviewed all children with congenital club foot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples’ Hospital Ethics Committee.Results. In this study, there were 148 cases with 164 feet in total that underwent the Ponseti method. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50±2.15 months. The average initial Pirani score was 4.98±1.33, 2 and the average number of casts was 5.71±2.28 times. The mean age of mothers at birth was 25.81±2.38 years old. The walking age of children was at a mean of 14.83±1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 feet (76.4%). The average follow–up period was 7.27±1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group.Conclusion. The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.

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Hospital Ethics Committees in Paris

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100003170 ◽

2000 ◽

Vol 9 (3) ◽

pp. 424-428 ◽

Cited By ~ 5

Author(s):

Jean-Christophe Mino

Keyword(s):

Research Ethics ◽

National Level ◽

Life Sciences ◽

Ethics Committees ◽

Ethics Committee ◽

Institutional Form ◽

Permanent Commission ◽

Hospital Ethics Committees ◽

The World ◽

Hospital Ethics

Even if the term bioethics is used all over the world, its meanings are multiple and different, especially between American and European countries, depending on local cultural and medical contexts. These differences concern the issues discussed or the institutional form bioethics takes. In France, bioethics was used from the end of the 1970s and focused on research ethics and issues at the beginning of life. At the national level, a permanent commission, the “national consultative ethics committee on life sciences and health” (Comité Consultatif National d'Ethique, CCNE) was created by President François Mitterrand in 1983. Its recommendations dealt essentially with procreative medicine and biomedical research ethics.

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Multiculturalism, Medicine, and the Limits of Autonomy: The Practice of Female Circumcision

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100005260 ◽

1994 ◽

Vol 3 (3) ◽

pp. 431-441 ◽

Cited By ~ 5

Author(s):

Robert L. Schwartz ◽

David Johnson ◽

Nan Burke

Keyword(s):

Female Circumcision ◽

Ethics Committees ◽

The United States ◽

Ethics Committee ◽

Horn Of Africa ◽

The Past ◽

Male Power ◽

The World ◽

Committee Decision Making ◽

Hospital Ethics

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma.

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Assessment of Acid Base and Electrolyte Status in Patients with Chronic Kidney Disease

JMS SKIMS ◽

10.33883/jms.v16i2.216 ◽

2013 ◽

Vol 16 (2) ◽

pp. 86-89

Author(s):

Mahrukh Hameed ◽

Syed Mudassar ◽

Mosin S Khan ◽

Nisar Ahmad Wani

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Electrolyte Imbalance ◽

Common Finding ◽

Blood Gas ◽

Acid Base ◽

Glomerular Diseases ◽

Nephritic Syndrome

Background: Blood gas measurements are being used to evaluate oxygenation and acid/base status. They are typically ordered if a patient has worsening symptoms of an acid/base imbalance, difficulty in breathing or shortness of breath. Blood gas analysis has been a cornerstone in the management of acutely ill patients with presumed acid/base and electrolyte imbalance. Objective: The aim of this study was to study the blood gases and electrolyte status in patients with chronic kidney disorder. Methods: A prospective study was conducted in the department of Clinical Biochemistry, Sher-I Kashmir Institute of Medical Sciences (SKIMS) Srinagar. A total of 171 patients were included in the study of which 91 were males and 80 were females. The age of the patients ranged between 4 - 80 years. These patients were admitted in the Nephrology ward of SKIMS. Out of these 171 patients included in the study 99 had CKD, 42 had ARF, 11 had metabolic acidosis, 6 had nephritic syndrome, 2 had lupus nephritis and 11 had complications like dysuria, HTN, glomerular diseases etc. The medical history of the patients with CKD was recorded and Samples were obtained for blood gas analysis. Venous samples were obtained for VBG analysis and arterial samples were obtained for ABG analysis. These samples were analysed for determining the blood gas status. Hemoglobin levels and kidney function test were performed manually. Hemoglobin was estimated by cyanmet-hemoglobin method. Urea was estimated by Diacetyl monoxime (DAM) method. Creatinine was estimated by Jaffe’s reaction. Results: CKD patients showed acidosis, hypocapnia and hypoxia. Among electrolytes almost all the patients with CKD had hyponatremia and increased anion gap. Conclusion: It was concluded from the observation that male predominance was seen in chronic kidney disease. Blood gas parameters including pH, PCO2, PO2, HCO3 were found to be deranged in most of the patients with CKD. Among electrolytes sodium was found to be mostly deranged in patients with CKD and Anemia was the most common finding in patients with this disorder. JMS 2013; 16(2):86-89

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Abstract 89: The Prognostic Factor of Patients with Asystole on Arrival

Circulation ◽

10.1161/circ.116.suppl_16.ii_942-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Tomoki Shokawa ◽

Koich Tanigawa ◽

Hideya Yamamoto

Keyword(s):

Prognostic Factor ◽

Serum Potassium ◽

Potassium Concentration ◽

Univariate Analysis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

University Hospital ◽

Serum Potassium Concentration ◽

Admission Data ◽

Lactate Levels

Background: Patients with asystole on arrival (AOA) at hospital have a poor prognosis. However, little is known about the prognostic factor of patients with AOA. Objective: The purpose of this study was to determine predictors for 24 hours survival in patients with AOA. Methods and results: Consecutive patients with AOA admitted to the Hiroshima University Hospital (Hiroshima, Japan) from April 2002 to January 2007 were retrospectively analyzed. Patients were divided into two groups according to the outcomes, i.e. non-survivors vs. survivors at 24 hours after admission. Data including blood gas analysis, lactate levels, and levels of minerals on admission were obtained and analyzed. Of 102 (male; 60) patients with AOA, fourteen patients survived for 24 hours. Univariate analysis found that pH, PaO2, PaCO2, base excess, lactate, and serum potassium concentration were associated with survival (p< 0.05) (Table ). Multivariate analysis determined that serum potassium concentration independently affected 24 hours survival. Conclusions: These results suggested that the serum potassium level on admission is a strong, independent predictor of survival of patients with AOA. survivors vs. non-survivors

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