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Chronic Dialysis Patients (chronic + dialysis_patient)
Selected AbstractsEndoscopic minilaparotomy radical nephrectomy for chronic dialysis patientsINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2002Yukio Kageyama Abstract Background: To assess the feasibility of laparoscope-guided minilaparotomy (endoscopic minilaparotomy) for renal cell carcinoma in patients on chronic dialysis. Methods: Endoscopic retroperitoneal minilaparotomy using a 30° telescope was carried out through single skin incision (5,8 cm) in eight patients with renal cell carcinoma who were on chronic dialysis. Outcomes of the operations were compared to those in eight patients on chronic dialysis with renal cell carcinoma who underwent standard translumbar radical nephrectomy. Results: Resection of the tumor was successfully completed without complication and the postoperative course was uneventful in both of the treatment groups. No significant difference in mean operative time or mean blood loss was observed between the treatment groups. Wound pain was minimal and analgesics were generally not required in the minilaparotomy group. The endoscopic laparotomy group resumed full diet and began walking earlier than the group that underwent standard radical nephrectomy. Conclusions: Endoscopic minilaparotomy seems to be a valuable alternative treatment for renal cell carcinoma in patients on chronic dialysis. [source] L-carnitine supplementation in the dialysis population: Are Australian patients missing out? (Review Article)NEPHROLOGY, Issue 1 2008STEPHANIE E REUTER SUMMARY: It has been widely established that patients with end-stage renal disease undergoing chronic haemodialysis therapy exhibit low endogenous levels of L-carnitine and elevated acylcarnitine levels; however, the clinical implication of this altered carnitine profile is not as clear. It has been suggested that these disturbances in carnitine homeostasis may be associated with a number of clinical problems common in this patient population, including erythropoietin-resistant anaemia, cardiac dysfunction, and dialytic complications such as hypotension, cramps and fatigue. In January 2003, the Centers for Medicare and Medicaid Services (USA) implemented coverage of intravenous L-carnitine for the treatment of erythropoietin-resistant anaemia and/or intradialytic hypotension in patients with low endogenous L-carnitine concentrations. It has been estimated that in the period of 1998,2003, 3.8,7.2% of all haemodialysis patients in the USA received at least one dose of L-carnitine, with 2.7,5.2% of patients receiving at least 3 months of supplementation for one or both of these conditions. The use of L-carnitine within Australia is virtually non-existent, which leads us to the question: Are Australian haemodialysis patients missing out? This review examines the previous research associated with L-carnitine administration to chronic dialysis patients for the treatment of anaemia, cardiac dysfunction, dyslipidaemia and/or dialytic symptoms, and discusses whether supplementation is warranted within the Australian setting. [source] Skeletal resistance to parathyroid hormone as a background abnormality in uremiaNEPHROLOGY, Issue 2003Masafumi FUKAGAWA SUMMARY: Skeletal resistance to parathyroid hormone (PTH) is a background abnormality underlying uremic bone disease. This abnormality exists even with high PTH. By the suppression of PTH, it has become uncovered, presenting as adynamic bone disease. Since patients with adynamic bone disease have higher risk of hypercalcemia or lumber fracture, mechanisms of this skeletal resistance to PTH need to be elucidated for the optimal management of bone turnover and parathyroid function in chronic dialysis patients. [source] Perspectives of chronic renal failureNEPHROLOGY, Issue 2002Kiyoshi Kurokawa SUMMARY: End-stage renal disease (ESRD) is a major source of morbidity and the increasing number of chronic dialysis patients is a significant health-care issue in many developed as well as developing countries. In the present brief review the current status of chronic dialysis is discussed; and Japan and the USA, two major countries in which chronic dialysis programmes are well developed, are compared. Also discussed is the economic impact, the status of renal transplantation and its future possibilities, recent efforts to halt progression of chronic renal disease, in particular, diabetic nephropathy (which has become the major cause of ESRD in many developed countries), and future perspectives in renal research. It is hoped that, in the future, perhaps by the mid-21st century, chronic dialysis may become the exception in therapy through our efforts. [source] Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcomeCLINICAL TRANSPLANTATION, Issue 1 2003Anna Oliveras Abstract: Background:, Cerebrovascular and cardiovascular diseases are the most important causes of increased morbidity and mortality in patients with end-stage renal disease. Stroke has been widely reported in chronic dialysis patients, but there is scarce information about stroke in renal transplant recipients (RTR), although cerebrovascular events are the most common and potentially life-threatening neurological complications in them. Our aim is to analyze the prevalence, risk factors, etiopathogenia, clinical aspects and outcome of stroke in RTR. Methods:, We analyzed 403 patients who received one or more renal grafts between 1979 and 2000: group A = patients who had stroke (n = 19); group B = those who did not (n = 384). Medical records and pertinent data were compiled. The risk of stroke was studied using univariate and multivariate Cox regression models. Results:, prevalence of stroke in RTR was 7.97% at 10 yr. Time elapsed between renal transplantation (RT) and stroke: 49.3 months. Possible risk factors based on the univariate analyses were: diabetic nephropathy (DN) (p <,0.001) and autosomal-dominant-polycystic-kidney-disease (p =,0.049) as original nephropathies, peripheral vascular disease (PVD) (p <,0.001), diabetes mellitus prior to RT (p =,0.005), age older than 40 yr (p =,0.037) and hypertension (p =,0.049). Other analysed risk factors such as gender, renal function, cytomegalovirus infection, hyperlipidemia, hyperuricemia, erythrocytosis or hypertensive donor failed to show any significant predictive value for stroke in these patients. When multivariate analyses were carried out, we found that DN (OR = 4.8; p = 0.010), PVD (OR = 8.2; p < 0.001) and age > 40 yr (OR = 3.3; p = 0.019) were predictive risk factors for stroke. For group A, hypertension was present in all patients, 68.4% had hyperlipidemia and 42.1% reported previous stroke. Cerebral hemorrhage occurred in seven of 19 (36.84%) of the stroke patients, but no subarachnoid hemorrhage occurred in them. Seven of 12 ischemic strokes were atherotrombotic. Considering all strokes, basal ganglia was the predominant localization. The outcome was poor, as nearly half of the patients died in the 3 months following stroke. Conclusions:, Prevalence of stroke in our RTR population was 7.97%. Cerebral hemorrhage appears to be more prevalent in RTR than in general population. More than that, the cerebral hemorrhage rate we found is higher than that reported elsewhere in RTR. The main predictors of stroke were DN, PVD and age. No patient with interstitial nephropathy suffered stroke. Mortality is high in RTR with stroke. [source] | ||||||||||