bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of ventilation inhomogenity with Krypton SPECT and planar imaging
Authors: Stavngaard Trine , Mortensen Jann 
Published: February 2005

SummaryIn 29 chronic obstructive pulmonary disease (COPD) patients and nine lung healthy volunteers, above the age of 50 years, ventilation defects were examined by 81mKr planar scintigraphy and 81mKr single photon emission computed tomography (SPECT) to investigate if SPECT adds information regarding size and extent of visually scored ventilation defects, and to correlate the extent of defects obtained from the two imaging settings with standard pulmonary function tests performed in these patients/volunteers. For testing the reproducibility of the visual defect score of 81mKr scintigraphy additionally 13 patients suspected for pulmonary embolism or lung cancer were included. Each series of planar or SPECT studies were read for the extent (% abnormal lung) and severity (0–3) of ventilation abnormalities. Seventeen scans were read twice for reproducibility studies. The extent of ventilation defect assessed by 81mKr SPECT was higher than by 81mKr planar (slope of regression line 0·60, P<0·0001), likewise severity score (rank signed test: P<0·0001). Correlation between ventilation inhomogeneity and pulmonary function test (residual volume and TL,CO) in the COPD group revealed only significance for the SPECT acquisition. We found good reproducibility of visual assessment of ventilation defect extent (correlation: 0·97, P<0·0001) and severity (Kappa 0·62). In conclusion, visual scoring of extent and severity of ventilation defects was reproducible. Ventilation defects were better demonstrated with SPECT than planar imaging. The correlation to pulmonary function was better with SPECT than planar imaging.
Intradialytic exercise as anabolic therapy in haemodialysis patients – a pilot study
Authors: Macdonald Jamie H. , Marcora Samuele M. , Jibani Mahdi , Phanish Mysore K. , Holly Jeff , Lemmey Andrew B. 
Published: February 2005

SummaryHaemodialysis (HD) patients are characterized by muscle wasting and consequently decreased physical functioning and poor outcome. This pilot study investigated if a novel intradialytic exercise programme could increase lean mass via up‐regulation of the insulin‐like growth factor (IGF) system. Nine HD patients were assessed before (w‐12) and after a 3‐month control phase (w0), after a three‐month intradialytic interval training programme using high intensity cycle exercise (w12), and after a withdrawal of treatment phase (w24). Body composition was determined by dual energy X‐ray absorptiometry (DEXA) and bioelectrical impedance spectroscopy (BIS); physical functioning by knee extensor strength (KES) and 30‐s sit stand test (SST); and IGF‐I and IGFBP‐3 in serum and muscle by radioimmunoassay. Despite significant increases in training load (+274%, P<0·001), peak power output (+71%, P<0·001) and physical function (KES: +19%, P<0·05; SST: +20%, P<0·05) following the intervention phase, lean masses by DEXA, intra cellular water by BIS (a surrogate measure of body cell mass) and serum and muscle IGFs remained unchanged following training. Although this novel exercise programme, utilizing high intensity interval training, was safe, clinically feasible and beneficial in terms of physical functioning, the 12 weeks of intradialytic cycle exercise failed to reverse the muscle atrophy characteristic of this population. Future studies, using primary outcome measures similar to those employed in the present study, should investigate other anabolic interventions to determine potential treatments for the muscle wasting associated with end stage renal disease.
10 Comparison of Four Prognostic Indexes in Severe Acute Renal Failure
Authors: Gubenšek J , Ponikvar R , Buturović‐Ponikvar J 
Published: February 2005

Background  Several prognostic indexes and models are in use for acute renal failure (ARF) patients in intensive care units (ICU). Some were designed on general ICU populations (like APACHE II) and some were made specifically for ICU patients with ARF.The purpose of our prospective clinical study was to compare APACHE II and three ARF‐specific prognostic indexes in their ability to discriminate survivors and non‐survivors among critically ill ARF patients requiring dialysis.Methods  Forty‐four critically ill patients with ARF requiring dialysis were included. Patients with chronic renal insufficiency (creatinine > 200 µmol/L), transplanted kidney or urinary tract obstruction were excluded. Four prognostic indexes were measured at the time of first dialysis: APACHE II score (0–71), Cleveland Clinic Foundation (CCF) score (0–20), predicted mortality by Mehta and by Liano model. Primary end‐points were ICU survival and recovery of renal function.Results  Patients were 65 ± 5 years old, 75% were male, 50% recovered renal function (22/44). Mean APACHE II score was 21.9 ± 6.5, CCF score was 9.2 ± 2.5, predicted mortality by Mehta model was 64 ± 5% and by Liano model 47 ± 20%. Patients that recovered renal function and those that died in ARF did not differ significantly in any of the prognostic indexes measured. Intensive Care Unit survival data was available for 32 patients, this group was not significantly different in prognostic indexes from the group for which ICU survival data was not available. Intensive Care Unit mortality was 75% (24/32). There was significant difference in APACHE II value in ICU survivors and non‐survivors (16.6 ± 6.1 vs. 23.4 ± 6.5, P = 0.015), but no difference in the other three indexes.Conclusions  Only the APACHE II values measured at first dialysis were significantly different between ICU survivors and non‐survivors, whereas other three prognostic indexes were not.
13 Survival of Hemodialysis Patients Older Than 65 years: Influence of Albumin, Hemoglobin, and Cholesterol Concentration
Authors: Orlić L , Glažar Ð Matić , Martinović B Sladoje 
Published: February 2005

More and more patients over 65 years of age are starting dialysis treatment. It is understood that they are a special and more sensitive group, due to their age and correlated diseases. The aim of this work is to analyze the influence of albumin, hemoglobin, and cholesterol concentration at the beginning of treatment on survival of patients over 65 years. Between January 1, 1995 and December 31, 1999, we followed 61 patients starting hemodialysis (31 male and 30 female). All patients were over 65 years old. Their survival was monitored until June 30, 2002. They were divided into four groups, according to years of survival. In the first group were the patients who died during the first year of treatment. The second group consisted of patients who died in the second year of treatment. In the third group were patients still alive in the third year of treatment and up to the fifth year. The fourth group consist of the patients who survived longer than five years. The average albumin values (g/L) for the first group at the beginning of dialysis were 31.9 ± 5.9; for the second 35.3 ± 6.4; the third 38.1 ± 6.6 and the fourth 41.8 ± 6.7 (P = 0.017). Initial hemoglobin (g/L) was, for the first group 81.1 ± 14.3; the second group 85.7 ± 20.5; the third 86.4 ± 14.5 and the fourth 97.2 ± 6.2 (P = 0.021). Cholesterol (mmol/L) in the first group, when they started the treatment, was 4.7 ± 1.1, the second 5.1 ± 1.8, the third 5.2 ± 1.5, and the fourth 5.1 ± 0.7 (P = 0.072).From these results it is obvious that shorter survival of older patients on hemodialysis is in correlation with lower albumin and hemoglobin values in the beginning of treatment. Also, patients with shorter survival rates had lower cholesterol values, but here are no statistically significant differences. It can be concluded that there is a better prognosis for patients starting dialysis when they have good albumin, hemoglobin and cholesterol values.
19 Effect of Intermittent Compression of Upper Arm Veins on Forearm Vessels in Patients with End‐Stage Renal Disease
Authors: Rus R R , Ponikvar R , Kenda R B , Urbančič A , Buturović‐Ponikvar J 
Published: February 2005

Background  Native arteriovenous fistula is the best vascular access for chronic hemodialysis. Primary and long‐term success depends, in part, on the state of arteries and veins at the time of the operation. The aim of our study was to investigate the effects of intermittent compression of upper arm veins on forearm vessels in patients with terminal renal disease.Methods  The study group comprised 16 chronic hemodialysis patients who performed daily intermittent compression of the upper arm without vascular access by elastic band (Eschmarch). Ten chronic hemodialysis patients were included in the control group which performed no specific activity.Forearm measurements were obtained at the beginning of the study and 4 and 8 weeks later during the course of intermittent compression of the upper arm veins. The forearm circumference and maximal handgrip strength were measured. The artery parameters, including endothelium‐dependent vasodilatation and forearm vein parameters, were obtained by ultrasonography measurements.Results  The forearm circumference, maximal handgrip strength and artery parameters, including endothelium‐dependent vasodilatation, remained unchanged. The basal venous diameters (2.29 mm ± 0.19 at the beginning, 2.46 mm ± 0.19 after 4 weeks and 2.53 mm ± 0.18 after 8 weeks) were significantly increased in the study group. The distensibility of veins was preserved in the study group. There were no significant changes in the control group.Conclusions  Our study demonstrated that daily intermittent compression of the upper arm veins increases the forearm vein diameter and preserves the distensibility of veins in patients with end‐stage renal failure.
22 Subcutaneous Compared with Intravenous Epoetin in Patients Receiving Hemodialysis: One Center Study
Authors: Malovrh M , Premru V 
Published: February 2005

Introduction  There is strong evidence from randomized trials that subcutaneous (s.c.) epoetin is as effective as intravenous (i.v.) and may allow a lower dose to be used, thereby reducing costs. Dose requirements for s.c. are reported to be from 22–32% lower than those of i.v. epoetin. The purpose of these analyses was to find out what was increasing the epotein dose after the beginning of i.v. administration.Patients and methods  Patients (pts) on HD treated with epoetin s.c. for 10 months (group A), and then with epoetin i.v. for 10 months (group B) were included in this analysis. Hemoglobin (Hb), epoetin (alpha or beta) dose (EPO), and ferritin were evaluated.Results  46 pts, 25 females and 21 males, mean age 58.2 ± 12.6 (range 30–80) years, HD treatment mean 9.1 ± 7.7 (range 0.2–29.2) years were observed. In Group A, mean Hb was 123.8 g/L ± 2.4 (range 119–127), mean EPO 6914 ± 810 IE/week, ferritin 603.5 ± 46.2 µg/L. In Group B mean Hb was 120.3 g/L ± 2.3 (range 117–125) (P < 0.001), mean EPO 7433 ± 787 IE/week (NS), increasing for 7.5%, ferritin 534.2 ± 126.2 µg/L. Hemoglobin and EPO at different periods are shown in Table A22.

Group A
Group B

Hb (g/L)
EPO (IE/w)
Hb (g/L)
EPO (IE/w)

1
126.1 ± 10.9
8022 ± 5164
124.6 ± 11.1
5913 ± 3740*

2
125.4 ± 9.5
7674 ± 5208
122.7 ± 11.1
6195 ± 3896

3
124.9 ± 9.9
7681 ± 5147
122.2 ± 12.8
7133 ± 4938

4
124.3 ± 11.3
7954 ± 4675
119.3 ± 13.3*
7282 ± 5439

5
124.0 ± 11.5
7340 ± 4435
118.2 ± 9.9*
7521 ± 4636

6
126.2 ± 11.6
7022 ± 44541
118.9 ± 10.7**
7804 ± 4558

7
127.3 ± 11.1
6022 ± 4427
120.2 ± 10.5
8043 ± 4584*

8
125.3 ± 12.0
5777 ± 4567
121.2 ± 10.3
7913 ± 4554*

9
121.2 ± 12.2
6222 ± 4851
118.3 ± 11.1*
8500 ± 4660*

10
119.0 ± 12.5
6232 ± 4374
117.3 ± 9.8
8239 ± 4212

11
120.5 ± 10.5
6200 ± 4634
119.2 ± 9.8
8431 ± 4189**

12
118.9 ± 11.5
6466 ± 4148
121.0 ± 9.7
7717 ± 4166*

w, week; *P < 0.05 **P < 0.001.

Conclusions  We found minor difference between the doses of s.c. and i.v. epoetin needed. There was no significant difference when mean value of whole group was compared, but in 50% this difference was statistically significant. Our results suggest that s.c. epoetin is more effective than i.v., but not in such huge amounts as some studies showed.
23 Review of Treatment with Epoetin: 10 Months Observation
Authors: Malovrh M , Premru V 
Published: February 2005

Introduction  Renal anemia is a major problem of patients with chronic kidney disease (CKD). Target hemoglobin concentration (Hb) in these patients should be > 110 g/dL and hematocrit (Ht) > 0.33. Treatment of renal anemia with epoetin is a well established practice.The purpose of this review in one dialysis center was to analyze the quality of such treatment and to find which parameters could influence success of treatmentPatients and Methods  Patients (pts) on HD were included in this analysis. The properties Hb, Ht, epoetin (alpha or beta intravenously) dose (EPO), ferritin, transferrin saturation (TSAT), hypochromic red cells (HYPO), CRP, albumin, parathyroid hormone (PTH) Kt/V were followed during 10 months period.Results  58 pts, 29 female and 29 male, mean age 60.5 ± 12.5 (range 32–82) years, HD treatment mean 8.4 ± 7.8 (range 0.7–30.7) years were observed. Mean Hb was 119.9 g/L ± 2.1 (range 79–142), mean Ht 0.36 ± 0.01, mean EPO 6970 ± 456.7 IE/week. EPO 110.3 ± 7.9 IE/kgBW/week, ferritin 603.5 ± 46.2 µg/L, TSAT 25.8 ± 3.3%. HYPO 2.1 ± 0.1, CRP 7.4 ± 0.21, albumin 41.9 ± 0.37 g/L, PTH 281.5 ± 47.9, Kt/V 1.68 ± 0.34. The female and male groups were analyzed and compared (Table A23)

Female
Male

Age
61.3 ± 14.6
59.7 ± 10.3

HD
8.0 ± 7.9
8.7 ± 7.7

Hb
119.8 ± 1.9
120.0 ± 1.8

Ht
0.36 ± 0.01
0.36 ± 0.01

EPO/w
6737 ± 336
7276 ± 404*

EPO/kgBW/w
116.5 ± 3.9
111.7 ± 7.0

Ferritin
589.0 ± 69.4
618.5 ± 36.5

TSAT
27.5 ± 3.6
23.6 ± 3.1*

CRP
7.4 ± 0.2
9.6 ± 0.1

Kt/V
1.91 ± 0.31
1.47 ± 0.21**

w, week; *P < 0.05;  **P < 0.001.

Conclusions  Regular evaluation of crucial parameters for anemia correction and strict adaptation of EPO doses and iron therapy enable optimal maintenance of Hb and Ht, recommended by European best practice guidelines. We found significant difference in EPO dose per week, but calculating to kg BW there was no significant difference between females and males.
25 Frequent Low‐Dose Iron Supplementation To Hemodialysis Patients
Authors: Premru V , Malovrh M 
Published: February 2005

Outline  Regular iron supplementation to most hemodialysis (HD) patients is necessary to ensure adequate response to epoetin (Epo). As enteral absorption of ferric compounds is insufficient in uremia, parenteral application is often needed. Usually, a dose of elementary iron is injected intraveneously at the end of an HD session once weekly to monthly according to the individual patient's needs. Doses range from usual 100 mg to several hundred mg. A surplus of iron immediately after application is transported to physiologic stores but might also be deposited at other sites in the body where it becomes inaccessible. In the long term, deposition of iron might lead to hemosiderosis and organ malfunction. Increased oxidative stress and acute toxic effects might supervene along with the increased susceptibility to infection, becoming fatal.Patients and methods  In 59 patients on regular iron supplementation, we examined the effects of frequent low‐dose (25 mg) in comparison to usual regime of 100 mg post‐dialysis i.v. iron on Hb concentration and the required Epo dose to maintain the Hb target (120 g/L).Results  (see Table A25)

Fe++/month

(mg)
Hb  (g/L)
Ht
Epo dose  (I.U./week)

Period 1
267
119.4
0.361
6912

Period 2
165
120.5
0.366
6895

t‐test (p)
0.002
0.278
0.905
0.609

Conclusions  Initial results suggest that stable Hb levels could be maintained at the same Epo dosage with substantially lower dose of i.v. iron. Iron applied at the moment when the requirements are the greatest (i.e., at the same time as Epo is being applied) could enable higher iron bioavailability with less iron burden to body stores. This could possibly result in a better Epo response with avoidance of long‐term iron sequestration and acute toxic effects.
33 Citrate Anticoagulation during Plasma Exchange in Patients with Thrombotic Thrombocytopenic Purpura – Short Heparin‐Free Hemodialysis Helps to Remove Citrate Load
Authors: Buturović‐Ponikvar J , Fejzuli Č , Ponikvar R 
Published: February 2005

Background  Treatment of thrombotic thrombocytopenic purpura (TTP) requires daily or even twice daily plasma exchanges (PE) with fresh frozen plasma as a replacement solution. If citrate anticoagulation is needed, citrate load (both from fresh frozen plasma and citrate as an anticoagulant) can be significant, causing severe alkalosis. Citrate as a small molecule is easily dialyzable, so short heparin‐free hemodialyses performed periodically after or between PE procedures can help to remove citrate load. The aim of our report is to present our experience with citrate anticoagulation in patients with TTP treated with daily PEs.Methods  Fifteen protocols of plasma exchange procedures performed in a 46‐year‐old female with TTP were analyzed. Blood flow in all procedures was 100 mL/min, 4% trisodium citrate was used as anticoagulant, infused into the arterial line at rate 130 mL/h. 1 m CaCl2 was infused into the venous line in a dose adjusted to maintain ionized calcium (iCa) within normal limits (mean dose of 11.5 ± 1.5 mL/h). Fresh frozen plasma was used as a replacement solution, 3258 ± 548 mL per procedure.Results  Ionized calcium before PE ranged from 1.10–1.45 mmol/L (mean 1.27 ± 0.12). The initial iCa level gradually increased after several procedures, as a consequence of citrate‐calcium complex metabolism between the procedures. Levels of iCa during PE were: 1.15 ± 0.09 mmol/L after 1 hour, 1.18 ± 0.06 after 2 hours and 1.16 ± 0.09 after 3 hours. Significant alkalosis occurred after several PEs with plasma pH 7.51 and bicarbonate 40.7 mmol/L. It was corrected by a 2‐hour heparin‐free hemodialysis with dialysate: K 4.0 mmol/L, calcium 1.5 mmol/L, sodium 140 mmol/L and bicarbonate set to 24 mmol/L. After dialysis pH was 7.38 and bicarbonate 28.5 mmol/L. Such hemodialysis was repeated during PE treatment.Conclusion  Citrate anticoagulation can be safely performed in patients treated with PE by daily plasma exchanges. Periodically performed short heparin‐free hemodialysis can remove excess citrate and help to correct and avoid severe metabolic alkalosis.
3 Is Metabolism of Divalent Ions in Our Peritoneal Dialysis Population Optimal?
Authors: Benedik M , Guček A 
Published: February 2005

Introduction  The problems of divalent ions, trace elements and bones are present in chronic dialysis patients despite optimal diet and therapy. Many patients have signs and symptoms of uremic osteopathy.Aim of the study To evaluate divalent ion metabolism and bone diseases in patients of our center for peritoneal dialysis.Methods  In cross‐section study, we studied 41 patients (14 women, 27 men, mean age 56.6 ± 14.2 years) who were at least for 6 months (mean 52.9 ± 34.5 months) in our peritoneal dialysis (PD) program in the year 2003. Besides clinical, ultrasound, and X‐ray data, we evaluated their laboratory data in the last 3 years where available.Results  Twenty‐seven patients used CAPD, 14 CCPD methods, 5/41 used PD1 solution, 34/41 PD4 and 2 both solutions. Thirty‐four patients used CaCO3, 18 aluminum hydroxide, and 9 sevelamer hydrochloride as phosphate binder as monotherapy or in combination. Sixteen patients used calcitriol and 9 sodium bicarbonate. Mean serum Ca in this population was 2.38 ± 0.09 (range 2.16–2.56) mmol/L, mean serum PO4 1.46 ± 0.2 (range 1.13–2.23) mmol/L, mean serum alkaline phosphatase 1.44 ± 0.74 (range 0.61–5.3) µkat/L, mean serum Al 21.7 ± 12.1 (range 6.5–47.3) µg/L, mean i‐PTH was 454.07 ± 484 (range 1–1828) pg/mL and mean product of Ca and PO4 was 3.48 ± 0.53 mmol2/L2 (range 2.52–4.84). We found positive correlation between alkaline phosphatase and i‐PTH (P = 0.000153) and between i‐PTH and serum Ca (P = 0.025291). 25/41 (61%) patients had maximum i‐PTH higher than 200 pg/mL, 13/41 (32%) patients had maximum i‐PTH even higher than 600 pg/mL, 4 patients were waiting for parathyroidectomy, meanwhile 8/41 (19.5%) of patients had i‐PTH < 100 pg/mL, in 4 of them parathyroidectomy was done in the past.Conclusions  Divalent metabolism is quite optimally achieved but secondary hyperparathyroidism still prevails in our PD patients. Management of divalent ions is very important before the beginning of peritoneal dialysis.
43 Conversion To Tacrolimus Due To Cyclosporine‐Related Toxicity in Kidney Graft Recipients – Single Center Study
Authors: Bren A F , Pajek J , Grego K , Kandus A 
Published: February 2005

Aim  The aim of our study was to analyze cyclosporine (Cs)‐related toxic effects that demanded conversion to tacrolimus (Tc), and the influence on blood pressure (BP), glucose control and graft function.Methods  From 1989 to 2003 10 patients (15 to 48 years), were treated with Cs from 2 months to 11 years. The Cs dose was adjusted to maintain the target blood trough levels of 100–170 µg/mL during first three post‐transplant months and 70–100 µg/mL afterwards. Patients were switched to Tc due to following Cs‐related toxic effects: gingival hypertrophy (8), hirsutism (1), hemolytic uremic syndrome (HUS) (3), and tremor (1). The Tc dose was adjusted to maintain a target whole blood trough level of 10–20 ng/mL during the first 3 months after transplantation and 5 to 15 ng/mL afterwards.Results   After 3 to 46 months of follow‐up Cs‐related toxic effects (gingival hypertrophy, hirsutism, HUS, tremor) significantly diminished, systolic and diastolic blood pressure were decreased from 142 mmHg to 130 mmHg and from 87 mmHg to 83 mmHg, respectively (P < 0.005 and P = 0.095, respectively), while no significant change was observed in plasma fasting glucose levels. The calculated GFR (Nankivell formula) was 69 mL/min (range 91 to 44 mL/min) 3 to 6 months before conversion and 67 mL/min (range 37 to 101 mL/min) 3 to 6 months after conversion (P = 0.279).Conclusion  Our results show that kidney allograft function was stable after conversion from Cs to Tc in the short‐term period. The benefits of conversion from Cs to Tc included significant reduction in Cs‐related toxic effects and also reduction of systolic blood pressure.