bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased incidence of dementia with Lewy bodies in patients carrying the ɛ4‐allele of apolipoprotein E
Authors: AKATSU Hiroyasu , KAMINO Kouzin , YAMAGATA Hidehisa , ISOJIMA Daisuke , KONDO Ikuko , YAMAMOTO Takayuki , KIDA Tomoyuki , TAKEDA Masatoshi , MIKI Tetsuro , KOSAKA Kenji 
Published: December 2004

AbstractBackground:  The apolipoprotein ∈4 (APOE4) allele is a risk factor for Alzheimer's disease, but it remains undetermined whether this allele is related to the pathological development of neurofibrillary tangles (NFT) and the formation of Lewy bodies.Methods:  In the present study, we examined the relationship between these changes and the APOE4 allele in 255 consecutive neuropathologically diagnosed cases. APOE genotyping was carried out by the polymerase chain reaction–restriction fragment length polymorphism method.Results:  Nearly all our cases of dementia with Lewy bodies (DLB) showed the common form, having numerous senile plaques in the cerebral cortex and NFT in the parahippocampal and hippocampal regions and were also associated with the APOE4 allele. Limbic neurofibrillary tangle dementia (LNTD), characterized by the presence of NFT in limbic areas as well as the absence of senile plaques, did not appear to be associated with the APOE4 allele.Conclusions:  The APOE4 allele is a risk factor for DLB as well as Alzheimer's disease and cerebral amyloid angiopathy, but not for LNTD.
Problems family caregivers encounter in home care of patients with frontotemporal lobar degeneration
Authors: KUMAMOTO Keigo , ARAI Yumiko , HASHIMOTO Naoki , IKEDA Manabu , MIZUNO Yutaka , WASHIO Masakazu 
Published: December 2004

AbstractAim:  Frontotemporal dementia (FTD) is a degenerative dementia in which primary degeneration of the frontal region of the brain occurs. Because of the behavioral symptoms, the care of FTD patients has numerous problems. However, little has been clarified with regard to the actual care situation, especially in a family care setting. The aim of the present study was to elucidate the caregiver burden and problems associated with the care of FTD patients in home care settings.Methods:  Two patients were diagnosed with FTD on the basis of the Lund and Manchester group criteria at the clinic for outpatients of a hospital located in Aichi Prefecture, Japan. Semi‐structured interviews were conducted with the family caregivers of the FTD patients. The content of the interview covered the patient course and any problems encountered in the home setting regarding activities of daily living (ADL), behavioral disorders and cognitive function.Results:  These FTD patients had abnormal eating behaviors such as cramming of food into one's mouth and the abnormal manner of eating. They had to be fed bit by bit with total caregiver assistance. They were also overactive, restless and distractable, which subsequently caused problems with ADL‐assistance including extreme uncooperativeness toward their caregivers. Other behavioral symptoms associated with FTD, e.g., stereotypic behavior, distractability and high impulsivity, were also considerably burdening to the caregivers.Conclusion:  The behavioral symptoms peculiar to FTD pose huge problems and heavy burden to the family caregiver. More resources should be allocated to specific needs of the FTD patients and their families.
Daily (quotidian) nocturnal home hemodialysis: Nine years later
Authors: Pierratos Andreas 
Published: December 2004

AbstractDaily nocturnal home hemodialysis was developed to satisfy the need for a highly effective, smooth, and cost‐effective home dialysis therapy. It combines the benefits of the following dialysis methods: long, frequent, and home hemodialysis. It provides a high dialysis dose for small, as well as large, molecules including β2‐microglobulin; improves quality if life; and leads to control of hyperphosphatemia without the need for phosphate binders, as well as dissolution for extraosseous calcifications. Furthermore, it controls blood pressure often without medications, is associated with regression of left ventricular hypertrophy, improves cardiac function, improves anemia as well as nutrition, allows an unrestricted diet, and corrects sleep apnea. Finally, it decreases the overall cost of patient care and improves cost utility when compared to conventional hemodialysis. The main obstacle to its wider utilization is the structure of the current reimbursement system. Along with short daily hemodialysis, long intermittent dialysis, and the convective dialysis techniques, daily nocturnal hemodialysis promises to improve dialysis outcomes.
Effect of long‐term increase in the frequency and/or prolongation of dialysis duration on certain clinical manifestations and results of laboratory investigations in patients with chronic renal failure
Authors: Twardowski Zbylut 
Published: December 2004

AbstractThe effects of dialysis frequency increase by one weekly and prolongation of dialysis duration by a mean of 17.5% on certain clinical manifestation and results of laboratory investigations were studied in a group of 14 patients treated with haemodialyses because of chronic renal failure caused by isolated renal diseases.Haemodialyses were carried out using a RSP Travenol artificial kidney and Ultra Flo 145 dialysers. The blood flow was always 200 ml/min and the flow of dialysing fluid was 500 ml/min. One dialyser was used repeatedly during 3 weeks in the same patients. After increasing the frequency or duration of dialyses the patients were not given transfusions of blood donors. The mean length of observation after increasing the frequency of dialyses was 6.4 months and after increasing their duration this length was 6.9 months. The change in the mode of dialysis had no significant effect on the concentration of urea and creatinine before as well as after dialysis. The increase in the frequency of dialyses caused a significant rise in the value of haematocrit by nearly 4%, a rise in the serum albumin concentration by a mean of 0.45 g/100 ml; a mean rise in the velocity of nerve conduction by over 6% of the lower normal range, and a mean rise in dry body weight by nearly 3.5 kg. Prolongation of dialysis time caused a significant mean rise in the haematorcrit value by over 1% before dialysis and in the serum albumin level by a mean of 0.30 g/100 ml. Both, the increase in the frequency and in the duration of dialyses caused a fall in the arterial blood pressure in hypertensive patients. The very favourable effects of increased frequency of dialyses on the clinical state of patients and on important laboratory parameters suggests that in near future the basic form of treatment of chronic renal failure may be daily short‐lasting haemodialysis.
Significance of Measurement for Colloid Osmotic Pressure during Hemodialysis
Authors: Yoshimoto A. , Matsushima Y. , Sakaji I. , Yoshikawa M. , Nitta T. , Okuno M. , Ishida Y. , Kasahara M. , Suzuki T. 
Published: December 2004

Background and Purpose:  Colloid osmotic pressure (COP) in plasma rises by ultrafiltration during hemodialysis, and it consequently causes plasma refilling in which water moves from interstitial tissue to capillary space. Although hemodynamic stability is one of the important factors for good dialysis outcome, no informative and convenient indicators are available other than monitoring of blood pressure. Thus, we measured COP during hemodialysis whether COP can be used as an indicator for the hemodynamic status in comparison with hematocrit (Ht). Plasma osmolality, ultrafiltration volume, and the alteration of blood pressure were also measured to examine whether COP is associated with them.Method:  Sixteen patients hospitalized in this hospital were examined. Amongst them, 10 patients underwent both dialysis and ultrafiltration, while 4 patients received only dialysis and 2 patients were with ultrafiltration only by extracorporeal ultrafiltration method. Ultrafiltration was performed with constant speed to the dry weight for 4 h. The measurements of COP, plasma osmolality, Ht levels, and blood pressure were performed at 30 min (12.5% of the total water removal), 1 h (25%), 2 h (50%), and 3 h (75%) after the start of hemodialysis and also at the end of dialysis (100%).Result:  COP markedly rose by 26.0% (±13.3%) in the patients who received both dialysis and ultrafiltration, whereas Ht rose by only 13.6% (±5.21%). And the curve for COP increase was sigmoid shape, whereas that for Ht showed linear change. On the other hand, in the patients whose Ht levels showed low values, the curves for both COP and Ht showed similar pattern.Conclusion:  These results suggest that COP is a more sensitive indicator to be monitored for the hemodynamic status than Ht during hemodialysis.
Low Serum Parathyroid Hormone Is a Predictor of Early Death after Hip Arthroplasty in Hemodialysis Patients
Authors: Nakai T. , Masuhara K. , Yamasaki S. , Fuji T. , Kanbara N. 
Published: December 2004

A high mortality rate after hip arthroplasty has been reported in hemodialysis patients; however, there has been no previous study on predictors of mortality after hip arthroplasty so far.Objectives:  The purpose of the present study was to identify any risk factors associated with early death in hemodialysis patients undergoing hip arthroplasty.Methods:  We retrospectively reviewed 34 patients on hemodialysis who underwent hip arthroplasty between 1994 and 2001. The average age was 60 years, and the average hemodialysis duration was 116 months at the time of operation. Body mass index (BMI), operating time, and total blood loss were reviewed. Serum levels of albumin (Alb), calcium (Ca), phosphorus (P), alkaline phosphatase (Alp), and intact parathyroid hormone (PTH) were measured preoperatively.Results:  Of these 34 patients, 9 died (26%). There were 2 perioperative deaths and 7 during follow‐up period between 2 and 19 months. No significant difference was found with respect to patient age, hemodialysis duration, Alb, Ca, P, Alp, operating time, and total blood loss. Patients with lower BMI and PTH levels had an earlier mortality than patients with higher BMI and PTH levels (p < 0.05 and p < 0.01).Conclusion:  We conclude that despite an intensive care directed to our hemodialysis patients, the incidence of early death after hip arthroplasty is still high. If low BMI and serum levels of low PTH were detected before operation, we should pay special attention to early mortality after hip arthroplasty.
Clinical Characteristics of Upper Gastrointestinal Bleeding in Hemodialysis Patients
Authors: Bang B.K. , Kim Y.O. , Kim Y.S. , Shin Y.S. , Chae H.S. , Shin Y.S. , Yoon S.A. , Yang C.w. , Kim Y.s. , Chang Y.S. 
Published: December 2004

Upper gastrointestinal bleeding (UGIB) frequently occurs in hemodialysis (HD) patients. But, clinical characteristics of UGIB in HD patients are not well reported yet.Objective:  This study was designed to compare the clinical characteristics of UGIB between HD patients and normal population with intact renal function.Methods:  This study enrolled 24 HD patients with UGIB. Age‐ and sex‐matched 26 patients with UGIB and normal renal function were selected as control group during the same period. Of the cases with UGIB, esophageal variceal bleedings due to liver cirrhosis were excluded in this study. We investigated the results of treatment and UGIB‐associated mortality for 3 months after the event and then compared previous gastrointestinal (GI) symptoms (Sx), endoscopic findings, treatment results, and mortality between HD patients and control.Results:  The results are summarized in the table.

HD patients (n = 24)
Control (n = 26)
p value

Age (years)
60±11
61±11
0.702

Sex [male/female (%)]
62.5/37.5
53.8/46.2
0.536

Previous GI Sx   [asymptomatic/  symptomatic (%)]
33.3/66.7
65.3/34.7
0.024

Endoscopic diagnosis   [vascular ectasia/others (%)]
45.8/54.2
15.3/84.7
0.020

Primary treatment   [endoscopic/medical (%)]
70.8/29.2
61.5/38.5
0.488

Results of treatment

Success/rebleeding (%)
75.0/25.0
92.4/7.6
0.095

Patient survival/UGIB‐

related death (%)
83.3/16.7
100/0
0.046

Conclusion:  Previous gastrointestinal symptoms were less frequent in HD patients than normal population with intact renal function. In contrast, HD patients had higher incidence of vascular ectasia and mortality than normal population with intact renal function.
Pre‐ and Post Hemodialysis Procalcitonin Levels and Their Relationships with Immunoregulatory, Proinflammatory Cytokines in Chronic Hemodialysis Patients
Authors: Karayaylali I. , Seyrek N. , Balal M. , Paydas S. , Cetiner S. , Yaman A. 
Published: December 2004

Background/Aims:  Procalcitonin (PCT) has been described as a new marker of severe infection and sepsis. In this study, we investigated the serum levels of PCT during the hemodialysis (HD) in chronically hemodialyzed patients and whether the PCT levels were correlated with other cytokines.Methods:  We measured pre‐ and post‐HD PCT, interleukin (IL‐1), IL‐2, IL‐6, IL‐10, tumor necrosis factor‐α (TNF‐α) concentrations in 24 stable patients undergoing chronic HD [11 males and 13 females; age 41.2 ± 18.0 years, 12 h/week, with a Kt/V of 1.41 ± 0.35, polysynthane (PSN) membrane being used in all patients, without reuse]. Pre‐ and post‐HD PCT concentrations were compared with cytokines such as IL‐1, IL‐2, IL‐6, IL‐10, TNF‐α, and clinical parameters including age, blood pressure, leukocyte, hemoglobin levels, C‐reactive protein (CRP), epoetin (EPO) doses, BUN, creatinine, parathormone (PTH), ferritin, and transferrin levels.Results:  Pre‐ and post‐HD serum PCT levels were similar (0.77 ± 0.40 and 0.83 ± 0.61 ng/mL), and higher than upper normal level of 0.5 ng/mL. The levels of IL‐2 and IL‐10 decreased and the levels of IL‐1 and TNF‐α increased. Post‐HD PCT correlated with PTH, IL‐1, IL‐2, and IL‐10.Conclusion:  About 60% of patients had elevated PCT levels, HD with low‐flux PSN membrane did not change serum PCT and IL‐6. While IL‐1 and TNF‐α increased, IL‐2 and IL‐10 decreased by PSN membrane during HD. So that PCT levels can be measured just after HD as do prior to start of HD. Is there any relationship between PCT and PTH? PCT may be important in uremic bone disease.
The Effect of Frequent and Occasional Dialysis‐Associated Hypotension on Survival of Patients on Hemodialysis
Authors: Tislér A. , Akócsi K. , Borbás B. , Fazakas L. , Ferenczi S. , Görögh S. , Kulcsár I. , Nagy L. , Sámik J. , Szegedi J. , Tóth E. , Wágner G. , Kiss I. 
Published: December 2004

Frequent or occasional symptomatic intradialytic hypotension during hemodialysis may influence patients' well being, but its effects on survival, independent of comorbidities, have not previously been investigated.Objective:  To assess the effect of frequent (f‐IDH) or occasional (o‐IDH) dialysis‐associated hypotension on survival.Methods:  During the run in period in 1998, 77 patients with f‐IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o‐IDH (1 or 2 events/10 months) were identified among all 958 prevalent chronic hemodialysis patients of a network. Eighty‐five patients who had no hypotensive episodes (no‐IDH) served as controls. Patients were followed for a median of 27 months (range 0.3–37), and survival of patients was compared by log‐rank test. Independent association of f‐IDH and o‐IDH on survival, compared to no‐IDH, was assessed by proportional hazards model that included patient's demographics, laboratory data, comorbidity as well as medications.Results:  Forty‐five patients (58%) with f‐IDH, 47 (47%) with o‐IDH, and 33 (39%) with no‐IDH died during the follow up that represents mortality rates of 37 (p = 0.013 vs. no‐IDH), 26 (p = 0.375 vs. no‐IDH), and 21 deaths/100 patient years in the three groups, respectively. In multivariate proportional hazards regression, where age, sex, time on dialysis, CHD, diabetes, Kt/V, albumin level, use of beta‐blockers, calcium‐channel blockers, and long‐acting nitrates have been adjusted for, neither f‐IDH nor o‐IDH was associated with survival.Conclusion:  Mortality in patients with f‐IDH is significantly higher than in those without such events. Our data, however, did not provide evidence that f‐IDH, independent of age and comorbidities, contributes to mortality in these patients.
Heparin Use in Daily Hemodialysis
Authors: Hynes J. , McComb T. , Young B. 
Published: December 2004

More frequent dialysis is thought to be associated with increased heparin requirements; however, limited data are available which compare heparin requirements of conventional to daily dialysis.Objectives:  To determine differences in heparin dose during conventional thrice‐weekly dialysis (CHD) compared to daily hemodialysis (DHD).Methods:  All patients within the daily home hemodialysis at the Northwest Kidney Centers were evaluated for heparin dose both pre‐ and post initiation of daily hemodialysis. Patients on DHD received an initial bolus of heparin, without a continuous heparin drip, and supplemental heparin midway through the dialysis run as needed to maintain adequate activated clotting times (ACTs). CHD patients received a heparin bolus, followed by initiation of heparin drip as needed to maintain adequate ACTs.Results:  Of the 1117 patients who dialyze at the NKC, 55% were Caucasian, 21% African‐American, 20% Asian/Pacific Islander, and 35% were of other ethnicity. The majority of patients were greater than 60 years (56%), while 36% ranged from 40–60 years and 13% ranged from 20–40 years. Male patients constituted 54% of patients. Diabetes was the primary cause of renal disease (36%), followed by hypertension (21%) and glomerular disease (18%). Of those patients in the home hemodialysis program (n = 45), 10 patients started daily home hemodialysis using the Aksys daily home hemodialysis system. Of those, the majority was male (100%), Caucasian (78.8%) with an average age of 46.7 ± 18 years. Glomerulonephritis was the primary cause of end‐stage renal disease (40%), while the percentages of other diseases were similar [Alport's syndrome (20%), hypertension (20%) and diabetes (10%)]. Compared to initial DHD heparin requirements (10,111 ± 2219 units), CHD heparin dose requirements (6833 ± 2715 units) were significantly lower (p = 0.045); however, total heparin needs were similar between groups (10,166 ± 4380 units vs. 10,778 ± 2959 units) (p = 0.324).Conclusion:  Although patients initiating DHD have greater initial heparin requirements than when on CHD, total heparin doses remain similar to those required on conventional thrice‐weekly hemodialysis. Greater initial heparin doses required during short daily dialysis appear safe compared to those of conventional dialysis.
Survival Advantage of Tailored Dialysis
Authors: Mezza E. , Salomone M. , Burdese M. , Soragna G. , Gai M. , Motta D. , Consiglio V. , Jeantet A. , Segoloni G.P. , Piccoli G. , Piccoli G.B. 
Published: December 2004

Survival has been defined as an index of adequacy of dialysis. These hard data are the basis for comparing results obtained by different schedules or policies. The aim of the study was to assess mortality rate recorded within a system of tailored dialysis (1–6 dialysis per week in out‐of‐hospital settings: home hemodialysis, self‐ and limited care dialysis). Data recorded in a single center (1998–2003) were compared with data gathered in the Registry of Dialysis and Transplantation in the whole Region (1998–2000).Methods:  Out‐of‐hospital dialysis unit is active since 1971, in which a new program integrating self‐ and limited care and home dialysis started since 1998.Patients:  Incident dialysis patients starting renal replacement therapy within the program and all further patients starting dialysis in the Region in the same period were compared in an historical prospective cohort study.Results:  55 patients in the Unit and further 1443 patients in the whole Region started RRT since 1998. Main features of 55 patients were 32 males 23 females; median age 51 years, range 20–76; 72.7% displaying at least 1 comorbid factor. Throughout the period gross mortality rate was 4/125 patient‐years in the Center. Kaplan–Meier curves showed a 1‐year survival of 100% vs. 91%, respectively, in the Center and in the whole Region, and a 2‐year survival of 95.5% vs. 76.6%, respectively, in the Center and in the whole Region (p = 0.001). The main demographic features were remarkably different in both settings (for the whole Region median age 66 years, range 2.2–101, at least 1 comorbidity in 56.9% of patients). In an attempt to correct for the different baseline characteristics, a multivariate Cox regression analysis was performed. The whole model resulted in statistically significant value (p = 0.000) and an increasing mortality risk resulted for age at starting dialysis, diabetes, and collagenopathy. In conclusion, tailored, high‐efficiency dialysis policy may allow superior survival results. A longer follow up is needed to confirm our approach; in larger cohorts, the finding of a low mortality rate in a relatively young population with high comorbidity may underline the need to review our current concepts on dialysis adequacy.
What Influences Cardiovascular Instability and Discomfort during Daily Hemodialysis?
Authors: Kjellstrand C.M. , Twardowski Z.J. , Bower J. , Blagg C.R. 
Published: December 2004

Background:  Daily hemodialysis (DHD) markedly ameliorates cardiovascular instability (CVI) and discomfort (DIS) during dialysis, but patients continue to have some of these problems during DHD. We studied what contributed to these problems during 4445 DHD in 23 patients.Methods:  Dependent variables were increase in pulse rate (PR), maximal (MAX) and overall (OV) fall of systolic blood pressure (BP), and a subjective score of patients' overall evaluation of the quality of dialysis (OEQ), adding a score of 14 symptoms (0 best, 40 worst). Independent variables were ultrapure dialysate and biocompatible dialysis (UP) (1626 dialyses) vs. conventional dialysis (CONV) (2819 dialyses), ultrafiltration (Uf) as percentage of body weight (BW), pre–post BUN (ΔBUN), time on dialysis (T), speed of dialysis (K/V in mL min−1 kg BW−1), and target −post‐dialysis BW (Ta‐Po BW). Relations were analyzed by backward multiple regression analysis.Results:  PR increased by 1.6 ± 13/min; MAX BP fall was 25 ± 20 mmHg; OV BP fall was 13 ± 22 mmHg; OEQ = 0.6 ± 1.2. In multiple stepwise backward regression analysis, independents in order of importance:

PR = ΔBUN × 0.12 + Ta‐Po BW   × 1.8 + K/V × 1.1 − 5
r = 0.13, p < 0.0001

MAX BP = CONV × 8 + T × 0.2 − Ta‐Po BW

× 6 + Uf × 2.7 −13
r = 0.33, p < 0.0001

OV BP = CONV × 11 + Uf × 4 − Ta‐Po BW

× 4 + ΔBUN × 0.3 − 9
r = 0.35, p < 0.0001

OEQ = K/V × 0.3 − Ta‐Po BW × 0.1 − 0.2
r = 0.20, p < 0.0001

Conclusion:  To minimize drop in BP and hypotensive crashes, use of ultrapure dialysate and a biocompatible membrane (UP) was by far the most important factor, followed by slowing dialysis. To avoid post‐dialysis tachycardia and discomfort during dialysis, slow dialysis was most important. Overall, “fast” dialysis and use of “impure” regular dialysate appear to be the major dialysis factors causing CV instability and discomfort during daily hemodialysis.