bluuebunny/crossref_metadata_2025_split huggingface dataset:
21 Review of Treatment with Vitamin D: Ten Month Observation
Authors: Malovrh M , Premru V 
Published: February 2005

Introduction  Hyperparathyroidism continues to be a major problem in patients with chronic kidney disease (CKD). Hypocalcemia and hyperphosphatemia are crucial for the development of secondary hyperparathyroidism (SHP). Preventing hyperphosphatemia ameliorates the progression of SHP. Vitamin D analogs (Alpha D3) per oral after hemodialysis (HD) could be used in the therapy of SHP. The purpose of this review in one dialysis center was to analyze the quality of such treatment.Patients and methods  Patients (pts) on HD in one dialysis center were included in this analysis. Calcium (Ca) and phosphate (P) were followed during a 10 month period every 3 weeks and intact parathyroid hormone (iPTH) every three months. Vitamin D was given after HD per oral under nurse control.Results  Sixty‐four pts, 34 female and 30 male, mean age 59.9 ± 11.5 (range 32–82) years, HD treatment length mean 8.8 ± 7.2 (range 0.7–30.7) years were observed. Mean Ca was 2.46 ± 0.04 mmol/L, (range from 1.06 to 2.72), mean P 1.52 ± 0.08 mmol/L (range from 0.62 to 3.53), mean iPTH 211.9 ± 36.7 ng/L (range from 1 to 699). Mean calcium concentration in dialysis fluid was 1.51 ± 0.02 mmol/L and mean dose of vitamin D was 0.35 ± 0.11 mg.Mean values of parameters during the 10 months observation are shown in Table A21.

December  2003
February  2004
April  2004
June  2004

Ca (mmol/L)
2.46
2.44
2.35
2.38

P (mmol/L/
1.52
1.56
1.71
1.53

iPTH (ng/L)
204.8
173.1
272.3
196.5

Ca in fluid (mmol/L)
1.52
1.53
1.49
1.49

Dose of vitamin D (mg)
0.47
0.28
0.21
0.43

Conclusions  Regular evaluation of Ca, P, iPTH and strict correction of calcium concentration in dialysis fluid, per oral vitamin D are very helpful in prevention of SHP. Critical elevation of iPTH was in pts with low compliance in hypophosphatemic diet and therapy. If concentration of phosphate is normal, elevated iPTH could be diminished very effective by titration of vitamin D.
28 The Influence of Aerobic Training During Hemodialysis Procedure on Blood Pressure, Heart Rate and Aerobic Capacity of Chronic Hemodialysis Patients
Authors: Fazlić S , Ponikvar R , Buturović‐Ponikvar J 
Published: February 2005

Background  Several studies have shown beneficial effect of aerobic exercise performed during hemodialysis procedure. The aim of our prospective clinical study was to evaluate the effect of 2 months aerobic exercise during hemodialysis procedure on blood pressure, heart rate and aerobic capacity of chronic hemodialysis patients.Methods  Eleven adult chronic hemodialysis patients participated the prospective clinical study. Nine of them completed a 2 month aerobic exercise program. Exercise training was carried out during hemodialysis procedure, three times a week, in lying position, on the “bed” cycle ergometer Thera‐Joy (Medica, Germany). The exercise was prescribed based on aerobic capacity and Borg's scale of subjective effort perceiving and corresponded to moderate physical exercise (50–70% of the maximum target heart rate). Heart rate and blood pressure were monitored continuously during the procedure. Aerobic capacity was tested before and after the 2 month exercise program.Results  Mean values of systolic, diastolic blood pressure and heart rate before exercise were 146 ± 9 mmHg, 87 ± 5 mmHg, and 77 ± 7 beats/min, respectively. After the exercise systolic and diastolic blood pressure were significantly lower and heart rate significantly higher than before (142 ± 9 mmHg, 84 ± 6 mmHg, 82 ± 8, P < 0.05). If comparing systolic and diastolic blood pressure before and after the exercise in the first and eighth week of the exercise program, no significant differences were found. However, heart rate was significantly lower before as well as after the exercise in the eighth week compared to the first week of exercise. Mean VO2 increased from 29.2 ± 8.3 to 30.5 ± 9.3 mL/kg/min, mean double product increased from 29.7 × 103 ± 6.4 to 32.0 × 103 ± 6.2, both differences not being statistically significant.Conclusion  Controlled aerobic exercise during hemodialysis procedure was safe and well tolerated. No significant difference in blood pressure, significantly lower heart rate and slight (although statistically not significant) improvement in aerobic capacity were observed.
29 Temporary Hemodialysis Catheters as a Long Term Vascular Access in Chronic Hemodialysis Patients
Authors: Ponikvar R , Likar C , Premru V , Benedik M , Varl J , Knap B , Urbančič A , Marn‐Pernat A , Buturović‐Ponikvar J 
Published: February 2005

Background  In chronic hemodialysis patients with exhausted arteries and veins in whom AV fistula or AV graft can not be performed any more, hemodialysis catheters become the last resort, either tunneled, so called “permanent”, or non‐tunneled, so called “temporary” catheters which can be usefully used for a longer period of time than a permanent vascular access.The aim of our clinical study was to asses temporary, precurved, jugular catheters as permanent vascular access in chronic hemodialysis patients.Methods  Thirty chronic hemodialysis patients, 15 men, 16 women, mean age 65.3 ± 13.5 years (range 30–90), with average dialysis treatment time of 6.3 ± 8.1 years (range 1 month−30 years), have had single lumen, “temporary” precurved nontunneled jugular catheters (Medcomp, USA) as permanent vascular access. Catheters were placed into right internal jugular vein, by Seldinger's technique, in local anesthesia (2% lidocain), locking solution was 4% trisodium citrate. Catheters were placed by experienced nephrologists, with ultrasound assistance, dressing was performed by dialysis nurses. Mupirocin was applied at the exit site after each hemodialysis. In the case of malfunction, thrombosis or infection, the catheter was replaced with the new one, using a guidewire. Prophylactic ceftazidime in a single dose was used after the catheter`s exchange. Unfractionated or fractionated heparin was anticoagulant.Results  Hemodialysis catheters were used for vascular access on average for 9.1 ± 6.5 months, range 1–22.7 months, total 271.7 months or 8151 days. Average catheter running time was 3.1 ± 1.9 months, range 0.5–10 months. Total number of side effects was 57, 7.0/1000 catheter days; 26 thrombosis, 3.2/ 1000 catheter days; 9 ruptures of the catheter, 1.1/1000 catheter days; 15 malfunction, 1.8/1000 catheter days; 2 exit site infections, 0.2/1000 catheter days; 2 bacteremias, 0.2/1000 catheter days; 1 avulsion of the catheter, 0.1/1000 catheter days; and 2 catheters were removed because AV fistula was successfully used.In 21 patients single needle hemodialysis was performed, mean blood flow 251 ± 16 mL/minute, range 250–300, mean KT/V 0.96 ± 0.16, range 0.72–1.27and in 9 patients double needle hemodialysis was performed (catheter and peripheral vein) with mean blood flow 252 ± 14 mL/minute, range 200–300, mean KT/V 1.63 ± 0.25, range 1.21–1.96.Conclusions  ‘Temporary’ jugular single lumen non‐tunneled hemodialysis catheters provide good long term vascular access with acceptable functioning time and low infection rate. KT/V for single needle hemodialysis was rather low, however it significantly improved when double needle hemodialysis was performed. The main reasons for catheter removal was thrombosis, malfunction, and mechanical damage of the catheter.
2 Renal Anemia Treatment In Peritoneal Dialysis Patients: A Multicenter Slovenian Study
Authors: Pajek J , Grego K , Guček A , Bevc S , Ekart R , Vujkovac B , Golob Kosmina P , Kandus A , Bren A F 
Published: February 2005

Objectives  The aim of our study was to: (i) assess the number of patients who need epoetin treatment and the adequacy of iron treatment, (ii) assess the influence of presence of diabetes mellitus, polycystic kidney disease and the influence of therapy with aluminum phosphate binders and angiotensin system antagonists on the epoetin requirements, (iii) assess the role of other factors possibly influencing epoetin resistance – secondary hyperparathyroidism, inflammation, dialysis dose and residual renal function.Design and Methods  Fifty‐one stable peritoneal dialysis (PD) patients (mean age ± SD was 52 ± 13 years, 20 women) without recent bleeding, surgery, bone marrow disease, malignancy, or hypothyroidism were recruited in four Slovenian centers. The dose of epoetin was adjusted to maintain a target hemoglobin of above 110 g/L. At the time of inclusion (median 36 months of PD, range 3–124 months) the PET test results and relevant clinical and laboratory parameters were recorded. Index of epoetin resistance (IRE) was expressed as weekly epoetin dose/body weight/hemoglobin concentration.Results  Twenty four percent of patients did not need epoetin treatment, the rest were treated with Epoetin‐beta at a dose of 70 ± 56 U/kg/week s.c.; hemoglobin concentration was 124 ± 15 g/L; 14% had hemoglobin below 110 g/L. Iron adequacy parameters (ferritin > 100 µg/L and TSAT > 20%) were fulfilled by 63% of patients, and their IRE was lower (0.43 ± 0.5 U/kg/week/g/L vs. 0.6 ± 0.72 U/kg/week/g/L), but not significantly (P = 0.502). Patients with polycystic kidneys had lower IRE (0.13 ± 0.3 vs. 0.52 ± 0.55 U/kg/week/g/L, P = 0.011) and majority of them (71%) did not need epoetin treatment (P = 0.006). No difference was found for diabetic patients. Treatment with angiotensin system antagonists, but not with aluminum phosphate binders, is associated with increased IRE (0.56 ± 0.59 vs. 0.3 ± 0.4 U/kg/week/g/L, P = 0.038). A statistically significant correlation was found for IRE and CRP (r = 0.48, P = 0.001) and iPTH (r = 0.46, P = 0.001). No correlation between IRE and residual renal function was found (r = −0.2, P = 0.173). Stepwise linear regression analysis for multiple variables (residual renal glomerular filtration rate, total weekly creatinine clearance, CRP, iPTH, iron adequacy, angiotensin system antagonist treatment, presence of polycystic kidneys) showed CRP and treatment with angiotensin system antagonists to be the most significant variables influencing IRE.Conclusion  Our results show that systemic inflammation and angiotensin system antagonist treatment are the most important parameters affecting epoetin requirements in stable peritoneal dialysis patients.
32 Chronic LDL Apheresis in Children and Young Adults
Authors: Ponikvar R , Žugić R , Fejzuli Č , Dedič H , Gaber L , Buturović‐Ponikvar J 
Published: February 2005

Background  Familial homozygous hypercholesterolemia is an inherited disease which without therapy, leads to a lethal outcome before the age of 20 due to accelerated atherosclerosis. Therapy is either “gene therapy”, liver transplantation, or chronic low density lipoprotein (LDL) apheresis. The aim of the study is to asses the efficacy of LDL apheresis in two patients with familial homozygous hypercholesterolemia, who have been treated with chronic LDL apheresis in our Dialysis center for more than 10 years.Methods  A girl, born in 1977 entered a chronic LDL apheresis program in 1990, aged 13 years. Apheresis sessions have been carried out every two to three weeks. Vascular access was via cubital peripheral vein, and the anticoagulant used was heparin. LDL apheresis monitor was Kaneka, Japan, with dextran sulphate column. Three volumes of plasma (each 8000 mL) were processed per session, which lasted for about 4 hours.A boy, born in 1988 entered an LDL apheresis programe in 1994, aged 6 years. Vascular access was at first via double lumen hemodialysis catheter, but at age 8, AV fistula was created because of serious access problems. LDL apheresis was performed as membrane plasma exchange up to the age of 10. Since then a monitor Kaneka with dextran sulphate column was used. LDL apheresis was performed every 2 weeks, 3 volumes of plasma being processed, each 6000 mL.Serum concentration of total cholesterol, LDL, high density lipoprotein (HDL), and triglycerides were monitored at the start and end of the LDL apheresis.Results  The girl has been treated for 14 years. In total 302 LDL procedures have been performed. In the year 2004 average concentrations of total cholesterol at start (12.7 mmol/L) and at the end (2.1 mmol/L), as well as time average concentration (TAC; 7.0 mmol/L) were stable and comparable with concentrations in the past. The same was true for the average concentration of LDL cholesterol at the start (10.7 mmol/L), at the end (1.2 mmol/L), and for TAC (5.6 mmol/L).The boy has been treated for 10 years, a total of 135 LDL apheresis procedures being carried out. Average concentration (at start, after LDL apheresis, and TAC) of total cholesterol and LDL cholesterol were 11.0 mmol/L, 2.3 mmol/L, 6.6 mmol/L and 9.4 mmol/L, 1.3 mmol/L, 5.1 mmol/L, respectively.Conclusion  Chronic LDL apheresis performed every 2–3 weeks provides stable metabolism of cholesterol and acceptable concentration of lipids. Up to now there has been no sign of accelerated atherosclerosis in the patients.
38 Long‐term Follow‐up of Renal Transplant Artery Stenosis: Case Controlled Study
Authors: Župunski A , Kandus A , Buturović‐Ponikvar J 
Published: February 2005

Background  Renal transplant artery stenosis is relatively frequent. It can cause hypertension, deterioration of renal function or graft loss. It seems that it can be treated conservatively provided graft perfusion is not jeopardized. The aim of our retrospective clinical study was to assess a long‐term course of renal transplant artery stenosis by duplex‐Doppler and its influence upon serum creatinine, hemoglobin concentration, and hypertension, as well as to investigate possible association between stenosis and the number of acute rejections.Methods  Thirty‐four renal transplant recipients, aged 43 ± 13 years, with significant (>50%) renal transplant artery stenosis on Doppler were compared with 34 renal transplant recipients, in whom stenosis was excluded on Doppler; patients of both groups were matched by age, sex, time of transplantation, type of renal transplant and number of previous transplantations. We analyzed peak systolic velocity in renal transplant artery, resistance index at the level of intrarenal arteries, serum creatinine, hemoglobin concentration, blood pressure, number of antihypertensive medications, and number of acute rejections on a yearly basis.Results  In the stenosis group, peak systolic velocity was 2.1 ± 0.5 m/s at 1 year after transplantation (controls 1.1 ± 0.4 m/s), 1.9 ± 0.5 m/s at 2 years (0.9 ± 0.4 m/s), 1.9 ± 0.5 m/s at 3 years (0.9 ± 0.4 m/s); resistance index was 62 ± 10% at 1 year (controls 68 ± 7%), 65 ± 9% at 2 years (67 ± 7%), 63 ± 9% at 3 years (67 ± 7); serum creatinine was 128 ± 58 µmol/L at 1 year (controls 129 ± 43 µmol/L), 119 ± 47 µmol/L at 2 years (121 ± 33 µmol/L), 125 ± 54 µmol/L at 3 years (127 ± 32).Conclusion  Long‐term course of renal transplant artery stenosis (>50%), treated medically or interventionally, seems to be stable and nonprogressive (during 3‐year follow‐up). Spontaneous regression of stenosis to nonsignificant level is possible. No significant difference in graft function, blood pressure, or the number of acute rejections was observed when comparing the stenotic and nonstenotic group.
50 Twenty‐four‐hour Ambulatory Blood Pressure Monitoring in Healthy Infants
Authors: Varda N Marčun , Gregorič A 
Published: February 2005

Objectives  Ambulatory blood pressure monitoring (ABPM) has been increasingly used in the assessment of elevated blood pressure (BP) in adults as well as in children. Normal ABPM reference values for school children have been published. However, there is little reported experience with this method in children under the age of 6 years, especially in infants. The aim of our study was to investigate the feasibility of ABPM in healthy infants.Design and methods  Ambulatory blood pressure monitoring recordings were performed in 97 infants with no history of disease or drugs affecting BP. The medical history was taken and gender, age, height, and weight were recorded. A minimum of 22 hours of recording time and at least 40 recordings were required. An accurate oscillometric device (SpaceLabs 90207) was used in all infants with an appropriate cuff, attached to the non‐dominant arm. Measurements were performed every 20 minutes during the day and every 30 minutes during the night.Results  Ninety‐seven infants, aged from 2 to 30 months (mean 13 ± 3 months), were included. A satisfactory ABPM profile was obtained in 84 (86.7%) infants. In five infants the number of recordings was < 40, while in eight infants the recording time was too short. There were, on average, 54 (75.4%) satisfactory recordings. The mean ± SD systolic and diastolic BP was 100 ± 6/63 ± 5 mmHg during the day‐time and 96 ± 5/58 ± 4 mmHg at night. The height of the infants ranged from 57 to 95 cm (mean 75 ± 2 cm). The infants were divided into four groups according to height. The mean systolic and diastolic values showed a slight, but significant increase with body height. The day to night decline of the mean systolic BP was 3.0 to 6.0% and the mean diastolic fall was 3.4 to 10.6% in the different height groups.Conclusions  Ambulatory blood pressure monitoring is a useful tool for the assessment of BP in very young children. The method was well tolerated and the measurements were technically acceptable. We confirmed the increase in BP with body height and the nocturnal decrease in BP. To obtain normal data for ABPM for this age group a much larger number of infants are needed.
Treatment of Depression Improves Physical Functioning in Older Adults
Authors: Callahan Christopher M. , Kroenke Kurt , Counsell Steven R. , Hendrie Hugh C. , Perkins Anthony J. , Katon Wayne , Noel Polly Hitchcock , Harpole Linda , Hunkeler Enid M. , Unützer Jürgen ,   for the IMPACT Investigators
Published: February 2005

Objectives: To determine the effect of collaborative care management for depression on physical functioning in older adults.Design: Multisite randomized clinical trial.Setting: Eighteen primary care clinics from eight healthcare organizations.Participants: One thousand eight hundred one patients aged 60 and older with major depressive disorder.Intervention: Patients were randomized to the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) intervention (n=906) or to a control group receiving usual care (n=895). Control patients had access to all health services available as part of usual care. Intervention patients had access for 12 months to a depression clinical specialist who coordinated depression care with their primary care physician.Measurements: The 12‐item short form Physical Component Summary (PCS) score (range 0–100) and instrumental activities of daily living (IADLs) (range 0–7).Results: The mean patient age was 71.2, 65% were women, and 77% were white. At baseline, the mean PCS was 40.2, and the mean number of IADL dependencies was 0.7; 45% of participants rated their health as fair or poor. Intervention patients experienced significantly better physical functioning at 1 year than usual‐care patients as measured using between‐group differences on the PCS of 1.71 (95% confidence interval (CI)=0.96–2.46) and IADLs of −0.15 (95% CI=−0.29 to −0.01). Intervention patients were also less likely to rate their health as fair or poor (37.3% vs 52.4%, P<.001). Combining both study groups, patients whose depression improved were more likely to experience improvement in physical functioning.Conclusion: The IMPACT collaborative care model for late‐life depression improves physical function more than usual care.
Economic Evaluation of Oseltamivir Phosphate for Postexposure Prophylaxis of Influenza in Long‐Term Care Facilities
Authors: Risebrough Nancy A. , Bowles Susan K. , Simor Andrew E. , McGeer Alison , Oh Paul I. 
Published: February 2005

Objectives: To compare the cost‐effectiveness of oseltamivir postexposure prophylaxis during influenza A outbreaks with that of amantadine postexposure prophylaxis or no postexposure prophylaxis in long‐term care facilities (LTCFs).Design: Cost‐effectiveness analysis based on decision analytic model from a government‐payer perspective.Setting: A Canadian LTCF, with high staff vaccination, at the beginning of influenza season.Participants: Elderly, influenza‐vaccinated patients living in a Canadian LTCF.Measurements: Incremental costs (or savings) per influenza‐like illness case avoided compared with usual care.Results: From a government‐payer perspective, this analysis showed that oseltamivir was a dominant strategy because it was associated with the fewest influenza‐like illness cases, with cost savings of $1,249 per 100 patients in 2001 Canadian dollars compared with amantadine and $3,357 per 100 patients compared with no prophylaxis. Costs for amantadine dose calculation and hospitalization for adverse events contributed to amantadine being a more‐expensive prophylaxis strategy than oseltamivir. Both prophylaxis strategies were more cost‐effective than no prophylaxis.Conclusion: Despite high influenza vaccination rates, influenza outbreaks continue to emerge in LTCFs, necessitating cost‐effective measures to further limit the spread of influenza and related complications. Although amantadine has a lower acquisition cost than oseltamivir, it is associated with more adverse events, lower efficacy, and individualized dosing requirements, leading to higher overall costs and more influenza‐like illness cases than oseltamivir. Therefore the use of oseltamivir postexposure prophylaxis is more cost‐effective than the current standard of care with amantadine prophylaxis or no prophylaxis.
Energy Requirements Are Not Greater in Elderly Patients Suffering from Pressure Ulcers
Authors: Dambach Bernd , Sallé Agnès , Marteau Cécile , Mouzet Jean‐Baptiste , Ghali Ali , Favreau Anne‐Marie , Berrut Gilles , Ritz Patrick 
Published: February 2005

Objectives: To estimate energy requirements in diseased elderly patients with pressure ulcers (PUs).Design: Open, case‐control study.Setting: University Hospital of Angers (France).Participants: Twenty‐nine patients with PUs (Norton index risk=14.3±3.3) and 27 controls hospitalized for various diseases (Norton=13.9±3.3).Measurements: Energy requirements were estimated using measured resting metabolic rate (RMR) and multiplied by 1.26 and 1.5 to range between minimal World Health Organization (WHO) requirements and those of adults undergoing light physical activity. Energy intakes were estimated using 3‐day food weight records. Measured RMR was compared with the prediction equations of Harris‐Benedict, WHO, and Schofield.Results: Measured RMR did not differ between the two groups (P=.48), and was not related to grade or size of the PUs. The WHO equation (82 kcal/d, P=.006) and the Schofield formula (57 kcal/d, P=.05) slightly underestimated calculated RMR, but the Harris‐Benedict equation (40 kcal/d, P=.13) accurately estimated it. Energy requirements therefore ranged between 1,536±340 kcal/d and 1,828±405 kcal/d, (25–30 kcal/kg body weight per day). Energy intake was lower than energy requirements by 176 to 479 kcal/d.Conclusion: Diseased elderly patients with PUs do not have greater energy expenditure, with their requirements suggested to range between 25 and 30 kcal/kg body weight per day. Malnutrition within this population is most likely the result of low energy intake.