bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Value of Vaccination in Chronic Kidney Disease
Authors: Kausz Annamaria , Pahari Dilip 
Published: September 2010

ABSTRACTThere has been much attention directed toward the high mortality of patients with end‐stage renal disease (ESRD), with much of the focus on cardiovascular disease. However, infectious disease is the second most common cause of death in late‐stage chronic kidney disease (CKD) patients. Although CKD patients are immunocompromised, some vaccines such as influenza, retain their efficacy and reduce infection rates with a standard immunization schedule. Other vaccines, such as hepatitis B and pneumococcal vaccines, require more frequent and/or higher doses to produce and maintain protective antibody levels. Attention has recently been given to the efficacy of influenza vaccination in ESRD patients in reducing morbidity and mortality. Centers with vaccination protocols have demonstrated reduced infection rates and resultant decreased morbidity and mortality. It could be extrapolated from this that widespread vaccination would reduce the total cost of ESRD patient care, and potentially improve patient well‐being. However, vaccination appears to be underutilized in CKD patients, and it is a readily available intervention to improve outcomes.
Review Articles: Nondialytic Management of Hyperkalemia and Pulmonary Edema Among End‐Stage Renal Disease Patients: An Evaluation of the Evidence
Authors: Evans Kimberley , Reddan Donal N. , Szczech Lynda Anne 
Published: September 2010

ABSTRACTCongestive heart failure (CHF) and hyperkalemia are the two leading reasons for emergency dialysis among individuals with end‐stage renal disease (ESRD). While hemodialysis provides definitive treatment of both hyperkalemia and volume overload among ESRD patients, for those who present outside of “regular dialysis hours,” institution of dialysis may be delayed. Nondialytic management can be instituted immediately and should be the initial therapy in the management of hyperkalemia and CHF in these individuals. Current available evidence does not allow conclusions as to whether treatment with nondialytic strategies alone results in different outcomes than nondialytic strategies coupled with emergent hemodialysis. Therefore, whether or not nondialytic management alone is appropriate remains a matter of individual judgment that should be decided on a case‐by‐case basis.
Intravenous Iron and the Risk of Infection in End‐Stage Renal Disease Patients
Authors: Perazella Mark A. , Brewster Ursula C. , Perazella Mark A. 
Published: September 2010

ABSTRACTOral iron is typically insufficient for the iron deficiency of hemodialysis patients. Intravenous (IV) iron is well tolerated by most patients and non‐dextran‐containing iron preparations are associated with few allergic reactions. However, there is the potential for an increased risk of infection with IV iron that appears to increase bacterial growth as well as inhibit the host's innate immune response to bacterial infection. Clinical studies suggest a link between iron therapy and infection. Practicing nephrologists should be aware of this issue, but should not hesitate to use IV iron in iron‐deficient patients while avoiding the development of iron overload and administration of iron to patients who have active infection.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Port Catheter Placement by Nephrologists in an Interventional Nephrology Training Program
Authors: Pervez Aslam , Zaman Fahim , Aslam Asim , Petty Suzie , Murphy Sara , Vachharajani Tushar , Abreo Kenneth 
Published: September 2010

ABSTRACTWe retrospectively reviewed all subcutaneous single‐ and double‐lumen port catheters (PCs) inserted by interventional nephrologists at our institution to determine the success rate, immediate and late complications, and functional life. From January 2000 to August 2002, 187 PCs were placed in 187 patients (42% males, 51% Caucasians, mean age 50 ± 14 years). There were no immediate complications related to the procedure such as hemorrhage, pulmonary embolism, or pneumothorax. There were a total of 35,078 catheter‐days of follow‐up. Sixteen catheters were removed during the observation period: three because of infection, seven after completion of chemotherapy, and six for other reasons. The remaining PCs are either functioning or the patients have died. The initial success rate was 100%. Kaplan‐Meier analysis showed a 30‐day survival of 97% and a 1‐year survival of 92%. Interventional nephrologists, who have adequate training in central venous tunneled cuffed catheter placements, can successfully place PCs, with excellent success and minimal complications.
Increasing the Supply of Kidneys for Transplantation
Authors: O'Connor Kevin J. , Delmonico Francis L. 
Published: September 2010

ABSTRACTKidney transplantation confers a survival advantage for patients with end‐stage renal disease (ESRD) when compared to dialysis and improves the quality of life in a cost‐effective manner. Currently there are more than 60,000 patients on the U.S. waiting list for kidney transplantation. In 2004, 16,879 kidney transplants, including 880 simultaneous kidney and pancreas transplants, were performed in this country. Recent strategies for increasing the supply of kidneys hold promise, such as systematic programs designed to improve consent rates for deceased donor organ procurement. Efforts to increase donation after cardiac death (DCD) have been highly successful and now account for more than 5% of all deceased organ donors. Transplantation of kidneys from DCD donors yields 1‐year graft and patient survival rates equivalent to kidneys from brain‐dead donors. Expanded criteria donor (ECD) kidneys from donors ≥ 60 years of age (or donors age 50–59 years with certain comorbidities) confer a survival benefit for end‐stage renal disease (ESRD) patients compared to remaining on dialysis on the waiting list. The number of live donor kidney transplants, both from biologically related and unrelated donors, is increasing. Paired live donor kidney transplants provide yet another transplantation opportunity for ESRD patients with willing but incompatible (by ABO or direct antibody) living donors.
Expanded Criteria Donors: Process and Outcomes
Authors: Ojo Akinlolu O. 
Published: September 2010

ABSTRACTExpanded criteria donor (ECD) kidneys are transplantable deceased donor (DD) kidneys for which the average patient, graft survival, and renal function are inferior when compared to standard criteria DD kidneys. Although the term ECD kidneys has been used since the early 1990s to describe kidneys with various characteristics associated with poorer outcomes, the concept has been formally implemented in U.S. organ allocation. A DD kidney is considered to be an ECD organ if the estimated adjusted risk of graft failure is ≥ 70% (RR ≥ 1.70) compared to DD kidneys with standard characteristics of transplant suitability. The donor characteristics that define an ECD kidney include age ≥ 60 years, or age 50–59 years plus two of the following: cerebrovascular accident as the cause of death, preexisting hypertension, or terminal serum creatinine greater than 1.5 mg/dl. In the aggregate, recipients of ECD kidneys have improved survival compared to end‐stage renal disease (ESRD) patients on the kidney transplant waiting list. Patient survival is 5% lower at 1 year and 8–12% lower at 3–5 years for ECD kidney recipients. Adjusted graft survival in ECD kidneys is 8% lower at 1 year and 15–20% lower at 3–5 years after transplantation compared to standard criteria donor kidneys. However, patients less than 40 years of age, African Americans, Asians for whom the median waiting time is less than 1350 days receive no survival benefit from ECD kidney transplantation. Informed choice by the potential recipient is a prominent feature of the allocation policy regarding ECD kidneys. Since there are recipient characteristics associated with no survival benefit following ECD transplantation, nephrologists who refer patients for kidney transplantation should be familiar with the combination of donor and recipient factors that are likely to yield detrimental results.
Immunosuppression and Immune Monitoring After Renal Transplantation
Authors: Zand Martin S. 
Published: September 2010

ABSTRACTMonitoring of immunosuppression therapy in renal transplant recipients is essential for good patient and graft survival. Monitoring includes frequent laboratory assays of serum immunosuppression levels, patient visits to assess and treat side effects, and vigilance for medication interactions. We review the various immunosuppression medications commonly used in renal transplantation, including usual dosing and side effects. Monitoring assays are discussed, as well as the frequency of monitoring and patient visits. Finally, we discuss several common clinical scenarios that often require adjustment of immunosuppression medications or regimens.
A Patient‐Focused Approach to Thrombolytic Use in the Management of Catheter Malfunction
Authors: Lok Charmaine E. , Thomas Alison , Vercaigne Lavern ,   on behalf of the Canadian Hemodialysis Catheter Working Group
Published: September 2010

ABSTRACTThrombus‐related catheter malfunction is a significant problem for catheter‐dependent dialysis patients. The primary medical intervention is the local luminal installation of thrombolytic agents (TLAs). There are three major TLA installation methodologies: locking, push, and infusion protocols. A systematic literature review of existing TLA protocols for treating dialysis catheter malfunction was performed using the PubMed and EMBASE (Drugs and Pharmacology) databases from the time of each database's inception to August 2005. Thrombolytic administration was then categorized according to the patient's clinical need: (1) an acute/immediate requirement, such as when malfunction prohibits dialysis initiation, and (2) rescue therapy, such as when the thrombus threatens to significantly impair current or subsequent dialysis clearance. Published TLA protocols are discussed in the context of their clinical requirement (acute or rescue therapy). A unifying clinically relevant management algorithm that considers the etiology of catheter malfunction as being thrombus related or not, and an approach to TLA use based on clinical presentation is described. This algorithm was developed after a systematic review of the literature. The application of this treatment algorithm requires prospective validation and study.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Erythropoietin Resistance in the Treatment of the Anemia of Chronic Renal Failure
Authors: Priyadarshi Anumeet , Shapiro Joseph I. 
Published: September 2010

ABSTRACTResistance to erythropoietin therapy is a common complication of the modern management of anemia in chronic kidney disease. Iron deficiency, deficiency of other nutrients, toxins, infections, and inadequate dialysis account for the vast majority of episodes of such resistance.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: The Safety of Heparins in End‐Stage Renal Disease
Authors: Sonawane Samsher , Kasbekar Nishaminy , Berns Jeffrey S. 
Published: September 2010

ABSTRACTIn patients on chronic dialysis, unfractionated heparin (UFH) is the most commonly used agent for anticoagulation of the hemodialysis extracorporeal circuit, for hemodialysis catheter “locking” between dialysis treatments, and for nondialysis indications such as venous thromboembolic disease, peripheral vascular disease, and acute coronary artery disease. Potentially serious complications of UFH, such as hemorrhage, osteoporosis, and thrombocytopenia, have led to consideration of other options for anticoagulation, including low molecular weight heparin (LMWH) and direct thrombin inhibitors (DTIs). LMWH can be used for anticoagulation of the hemodialysis circuit, but whether this has significant benefit compared to UFH remains to be proven. Because of the somewhat unpredictable risk of severe bleeding complications when LMWH is used for other indications in dialysis patients, UFH rather than LMWH is preferred for treatment of thromboembolic disease in these patients. DTIs have been used for anticoagulation in dialysis patients with heparin‐induced thrombocytopenia (HIT), with argatroban being the preferred agent if heparin‐free hemodialysis cannot be performed. UFH still remains the preferred anticoagulant in the vast majority of dialysis patients requiring systemic anticoagulation and for anticoagulation of the extracorporeal hemodialysis circuit.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Anticoagulation and Continuous Renal Replacement Therapy
Authors: Amanzadeh Jamshid , Reilly Robert F. 
Published: September 2010

ABSTRACTMore than half of patients with acute renal failure in the intensive care unit require dialysis, and the majority of them have significant hemodynamic instability. Continuous renal replacement therapy (CRRT) is often the preferred dialysis modality in these patients. One requirement for CRRT is anticoagulation, which can expose patients to the risk of bleeding. However, absence of effective anticoagulation may result in clotting of the CRRT circuit and subsequently less effective treatment. While heparins are widely used for anticoagulation, because of potential side effects such as bleeding and heparin‐induced thrombocytopenia, alternative anticoagulation protocols should be considered. Citrate anticoagulation, regional heparin/protamine, predilution, r‐hirudin, prostacyclin, and nafamostat are among these methods.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Dialysis‐Related Carnitine Disorder
Authors: Hedayati S. Susan 
Published: September 2010

ABSTRACTL‐carnitine plays an essential role in the β‐oxidation of fatty acids by catalyzing their transport into the mitochondrial matrix. The kidney maintains plasma free L‐carnitine levels in the homeostatic range by selective saturable tubular reabsorption. The preferential retention of free L‐carnitine over acyl‐L‐carnitines by the kidney is lost in patients with end‐stage renal disease (ESRD). Loss of renal parenchyma as a site of carnitine synthesis, as well as nonselective clearance of L‐carnitine by the dialysis procedure lead to dialysis‐related carnitine deficiency. Numerous studies investigating whether L‐carnitine supplementation will alleviate several dialysis‐related symptoms, such as intradialytic hypotension, heart failure, muscle weakness, low exercise capacity, and anemia, have reported conflicting results. Many of these studies suffer from a lack of randomization and control groups, heterogeneity in the administration of L‐carnitine, and nonstandardized measures of symptom improvement. More data exist to support the use of L‐carnitine in selected anemic dialysis patients with very large erythropoietin requirements in whom extensive examination for reversible causes of anemia was unrevealing.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Multiple Myeloma in End‐Stage Renal Disease
Authors: Penfield Jeffrey G. 
Published: September 2010

ABSTRACTMultiple myeloma is a common cause of chronic kidney disease (CKD). Patients with myeloma‐related kidney disease but low levels of serum monoclonal proteins can be diagnosed with symptomatic myeloma in a simplified diagnostic classification. The presence and type of renal disease in myeloma is dependent on the light chain secreted. Treatment has recently changed and now includes the use of thalidomide and bisphosphonates. Thalidomide can cause hyperkalemia and bisphosphonates can cause renal failure in patients with CKD. Their use is not contraindicated, but they should be used with caution. High‐dose melphalan with an autologous stem cell transplant is now the standard of care and should not be withheld from patients with CKD, even those on dialysis. This treatment can improve the renal disease, and this is more likely if treatment is started early. In patients with persistent dialysis dependence, renal transplantation can be performed if the patient has a complete remission.
HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Vascular Access Thrombosis Prophylaxis
Authors: Choudhury Devasmita 
Published: September 2010

ABSTRACTVascular access thrombosis in the hemodialysis patient leads to significant cost and morbidity. Fistula patency supersedes graft patency, therefore obtaining a mature functioning fistula in patients approaching end‐stage renal disease (ESRD) by early patient education and referral needs to be practiced. Current methods to maintain vascular access patency rely on early detection and radiologic or surgical prevention of thrombosis. Study of thrombosis biology has elucidated other potential targets for the prophylaxis of vascular access thrombosis. The goal of this review is to examine the current available methods for vascular access thrombosis prophylaxis.
Effects of Intramuscular Administration of Acepromazine on Palmar Digital Blood Flow, Palmar Digital Arterial Pressure, Transverse Facial Arterial Pressure, and Packed Cell Volume in Clinically Healthy, Conscious Horses
Authors: LEISE BRITTA S. , FUGLER LEE ANN , STOKES ASHLEY M. , EADES SUSAN C. , MOORE RUSTIN M. 
Published: September 2010

Objective—To determine the magnitude and duration of effects of acepromazine administered intramuscularly (IM) on digital and systemic hemodynamic variables in clinically healthy horses.Study Design—Experimental study.Animals—Healthy adult horses (n=12).Methods—An ultrasonic Doppler flow probe was surgically implanted around the medial palmar digital artery before the study. Catheters were inserted in the transverse facial artery, lateral palmar digital artery, and jugular vein. A treatment group (n=6) was administered 0.04 mg/kg body weight of acepromazine IM; control horses (n=6) were administered an equivalent volume of saline IM. Palmar digital blood flow, and digital and facial arterial pressures were measured at baseline and for 6 hours after administration. Venous blood was collected for measurement of packed cell volume (PCV).Results—Horses administered acepromazine had significantly lower facial arterial pressure compared with control horses administered saline. Palmar digital arterial blood flow in acepromazine‐treated horses was not significantly different from that in control horses but increased significantly post‐administration, compared with the respective baseline values for acepromazine‐treated horses. PCV significantly decreased in horses administered acepromazine compared with their respective baseline value.Conclusion—IM acepromazine causes hypotension and increases palmar digital blood flow over time but the magnitude of the effect on digital blood flow was not sufficient to yield differences compared with saline‐treated horses.Clinical Relevance—IM acepromazine has a modest effect on palmar digital blood flow, facial arterial pressures and PCV in healthy horses with minimal sedation.
A Modified Ventral Approach to the Atlantoaxial Junction in the Dog
Authors: SHORES ANDY , TEPPER LAURA C. 
Published: September 2010

Objective— To describe and evaluate a surgical technique using a modified ventral approach for stabilization of the atlantoaxial (AA) junction in dogs with AA subluxation.Study Design— Retrospective study.Animals— Dogs (n=5) with AA subluxation.Methods— Medical records (2000–2006) of 5 dogs with AA treated by stabilization via a right parasagittal approach were reviewed and outcome assessed by clinical examination and phone interviews with owners.Results— The AA joint was clearly visualized and fixation devices were placed in all dogs. A right parasagittal approach provided excellent access to the AA junction and avoided dissection around the thyroid gland, trachea, and recurrent laryngeal nerve. Recovery was considered good to excellent by owners, and dogs returned to good function.Conclusions— A right parasagittal approach to the AA junction provides improved exposure and allows for surgical stabilization with minimal complications.Clinical Relevance— In dogs that require surgical stabilization of the AA joint, a right parasagittal approach should be considered. This approach offers advantages over the standard ventral median approach by improved surgical exposure, less dissection, and provides protection of vital structures during insertion of fixation devices used for ventral AA stabilization.
In Vitro Biomechanical Comparison of Equine Proximal Interphalangeal Joint Arthrodesis Techniques: Prototype Equine Spoon Plate Versus Axially Positioned Dynamic Compression Plate and Two Abaxial Transarticular Cortical Screws Inserted in Lag Fashion
Authors: SOD GARY A. , MITCHELL COLIN F. , HUBERT JEREMY D. , MARTIN GEORGE S. , GILL MARJORIE S. 
Published: September 2010

Objectives—To compare in vitro monotonic biomechanical properties of an equine spoon plate (ESP) with an axial 3‐hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws (DCP‐TLS) inserted in lag fashion for equine proximal interphalangeal (PIP) joint arthrodesis.Study Design—Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints.Animal Population—Cadaveric adult equine forelimbs (n=18 pairs).Methods—For each forelimb pair, 1 PIP joint was stabilized with an ESP (8 hole, 4.5 mm) and 1 with an axial 3‐hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion. Six matching pairs of constructs were tested in single cycle to failure under axial compression with load applied under displacement control at a constant rate of 5 cm/s. Six construct pairs were tested for cyclic fatigue under axial compression with cyclic load (0–7.5 kN) applied at 6 Hz; cycles to failure were recorded. Six construct pairs were tested in single cycle to failure under torsional loading applied at a constant displacement rate (0.17 radians/s) until rotation of 0.87 radians occurred. Mean values for each fixation method were compared using a paired t‐test within each group with statistical significance set atP<.05.Results—Mean yield load, yield stiffness, and failure load for ESP fixation were significantly greater (for axial compression and torsion) than for DCP‐TLS fixation. Mean (± SD) values for the ESP and DCP‐TLS fixation techniques, respectively, in single cycle to failure under axial compression were: yield load 123.9 ± 8.96 and 28.5 ± 3.32 kN; stiffness, 13.11 ± 0.242 and 2.60 ± 0.17 kN/cm; and failure load, 144.4 ± 13.6 and 31.4 ± 3.8 kN. In single cycle to failure under torsion, mean (± SD) values for ESP and DCP‐TLS, respectively, were: stiffness 2,022 ± 26.2 and 107.9 ± 11.1 N m/rad; and failure load: 256.4 ± 39.2 and 87.1 ± 11.5 N m. Mean cycles to failure in axial compression of ESP fixation (622,529 ± 65,468) was significantly greater than DCP‐TLS (95,418 ± 11,037).Conclusion—ESP was superior to an axial 3‐hole narrow DCP with 2 abaxial transarticular screws inserted in lag fashion in resisting static overload forces and cyclic fatigue.Clinical Relevance—In vitro results support further evaluation of ESP for PIP joint arthrodesis in horses. Its specific design may provide increased stability without need for external coaptation support.