bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodialysis Central Venous Catheter‐Related Bacteremia: Time to Onset
Authors: Troidle L. , Juergensen P. , Cantey L. , Eisen T. , Finkelstein F.O. 
Published: December 2004

Bacteremia (B) is a well‐known complication of an indwelling central venous catheter (CVC). Although prophylactic measures such as topical and catheter lock antibiotics have been demonstrated to decrease the risk of B in hemodialysis (HD) in patients with a CVC, there are concerns about the development of resistance to these agents when used for long periods of time.Objective:  We wondered if we could limit the use of these agents by identifying the period when B was most common after CVC placement.Method: We prospectively noted all patients with a CVC who developed B in any of our 3 units in CT, U.S.A.; 62 episodes of B occurred between 1/1/03 and 9/18/03. 35% of all of the HD patients had a CVC for access during the study period.Results: Staphylococcus aureus accounted for 22 (35.5%) episodes; Gram‐negative organisms for 21 (33.8%) and other staphylococcal species for 14 (22.6%). The other 3 episodes were other Gram‐positive organisms and 6 patients developed B with more than 1 organism. 3 (4.8%) patients expired while being treated for the B. The average time to onset of B was 96 ± 98 CVC days with a range of 1–365 days. There was no difference in time to onset based on organism. 43.5% of the episodes of B occurred less than 60 days after the CVC was inserted, but 27.4% occurred greater than 100 days after CVC insertion.Conclusion:  The time to onset of CVC‐related B was variable among the patients developing B in this study. Preventative strategies aimed at reducing the risk of B in patients with a CVC must be used for the life of the CVC.
The Influence of C‐Hepatitis on C‐Reactive Protein in a Cohort of Brazilian Hemodialysis Patients
Authors: Nascimento M.M. , Bruchfeld A. , Suliman M.E. , Hayashi S.Y. , Pecoits‐Filho R. , Manfro R.C. , Pachaly M.A. , Renner L. , Stenvinkel P. , Riella M.C. , Lindholm B. 
Published: December 2004

Background:  The aim of this study was to investigate the influence of HCV on two markers of systemic inflammation, serum CRP, and interleukin‐6 (IL‐6) in HD patients.Methods:  The study included 118 HD patients (47% males, age 47 ± 13 years, 9% diabetics) who were treated by on standard HD for at least 6 months. The patients were divided in two groups, depending on the presence (HCV+) or absence (HCV–) of serum antibodies against HCV. Serum albumin (S‐Alb), plasma high sensitivity CRP (hsCRP), IL‐6, and alanine aminotransferase (ALT) were measured, and the values were compared with 22 healthy controls.Results:  The median of hsCRP, IL‐6, and the hsCRP/IL‐6 ratio were: 3.5 vs. 2.1 mg/L, p < 0.05; 4.3 vs. 0.9 pg/mL, p < 0.0001; and 0.8 vs. 2.7 pg/mL, p < 0.0001 for patients and controls, respectively. Age, gender, S‐Alb, IL‐6, and hsCRP did not differ between the HCV+ and HCV– patients. However, HCV+ patients had higher ALT (29 ± 21 vs. 21 ± 25 UI/L) and had been a longer time on HD (6.1 ± 3.0 vs. 4.0 ± 2.0 years) (p < 0.0001), respectively. Moreover, HCV+ patients had a significantly lower median hsCRP/IL‐6 ratio (0.7 vs. 0.9; p < 0.05) as compared to the HCV group.Conclusion:  The finding that the hsCRP/IL‐6 ratio was lower in HCV+ patients than in HCV– patients suggests that hsCRP may be a less useful marker of inflammation in HCV+ patients and that a different cut‐off value for hsCRP may be required to define inflammation in HD patients.
The Safety of Intravenous Ferric Gluconate Self Administered During Routine Home Hemodialysis
Authors: Utley M. , Grundy A. , Gehr T. 
Published: December 2004

Home hemodialysis (HHD) patients are often inconvenienced when intravenous iron preparations are administered. Formerly, these patients received their medication in the clinic on an off‐dialysis day or during in‐center hemodialysis (HD). For the last 2 years, 5 patients in our HHD program have been receiving intravenous ferric gluconate during their routine HD session.Procedure:  All patients were trained in the proper administration of ferric gluconate in‐center. No test dose was administered. Ferric gluconate was infused via the heparin infusion pump on their HD machine at a rate of 31.25 mg/h. Doses were of either 62.5 mg or 125 mg per session. K/DOQI guidelines for intravenous iron use were adhered to. TSATs greater than 25%, ferritin greater than 100 ng/mL and less than 800 ng/mL, and hemoglobin between 11 and 12 g% were the goals of therapy. Both loading doses (8 doses during sequential HD sessions) and maintenance doses every week or every other week were employed.Results:  Over the last 2 years, 223 doses were administered at home. No serious reactions occurred during the course of therapy. One patient experienced minor nausea and vomiting during one dose, which was thought to be possibly related to the iron infusion. This patient subsequently received ferric gluconate again without difficulty.Conclusion:  Ferric gluconate can be safely administered at home during HHD.
6 Years of Experience with Nightly Home Hemodialysis Access
Authors: Lockridge R.s. , Spencer M.o. , Craft V.w. , Pipkin M.f. , Campbell D.l. 
Published: December 2004

Lynchburg Nephrology Dialysis Inc. started its nightly home hemodialysis (NHHD) program in September 1997.Purpose of study:  To evaluate episodes of exit site infections, catheter sepsis, safety, and longevity of accesses for patients doing NHHD.Methods:  If IJ catheter was chosen, patient was started on Coumadin 2 mg/day when catheter was placed. If catheter malfunctioned, it was locked with a thrombolytic agent and Coumadin was adjusted to meet a goal INR of 1.5–2.25. If the problem persisted, the catheter was exchanged. For catheters, the B‐D InterLink device was used to prevent air emboli and infection, and a locking device was used to prevent disconnects. If AV fistula was used, 4 buttonholes were established using 16 gauge needles. If AV graft was used, patients were taught the ladder cannulation technique using 16 gauge needles.Results:  As of September 1, 2003, 45 patients have completed training and have performed 27,063 treatments at home. Total catheter time at home was 930 months. Total AV fistula and AV graft time at home was 190 and 20 months, respectively. Upon completion of training, 34 patients were using tunneled IJ catheters, 10 using AV fistulas, and 1 using an AV graft. The IJ catheter exit site and sepsis infection rate was 0.35 and 0.49 episodes/1000 patient days, respectively. Average catheter life was 8.5 months with the longest 66.7 months and the shortest 0.2 months. The AV fistula and graft exit site and sepsis infection rates were 0.16 and 0 episodes/1000 patient days, respectively. Catheter complications included 1 episode of disconnect due to patient's failure to use locking device, 1 episode of central stenosis, and 1 episode of intracranial hemorrhage, due to prolonged INR, with resolution of symptoms.Conclusion:  Data support that tunneled IJ catheters, AV fistulas, and AV grafts were effective and safe permanent accesses for patients on NHHD.
Regional Anticoagulation with Sodium Citrate in Pediatric Patients on Intermittent Hemodialysis Therapy with Bleeding Risks
Authors: Kreuzer M. , Vester U. , Hörning A. , Bonzel K‐E. , Hoyer P.F. 
Published: December 2004

Heparin‐free anticoagulation in hemodialysis (HD) is advocated for patients with clotting abnormalities and risk of bleeding.Objective:  First publication on regional citrate anticoagulation (RCA) in children. RCA is free from systemic effects, guarantees excellent dialyzer life, but requires careful monitoring.Methods:  We report on 3 patients treated by intermittent RCA HD (4 h each, high‐flux dialyzer F40, Fresenius): (1) 17‐year‐old boy (renal transplant failure, access via cubital Cimino fistula) after hypertensive intra‐cerebral hemorrhage (2 sessions); (2) 13‐year‐old girl (hemolytic uremic syndrome, access via jugular vein Shaldon catheter) after abdominal surgery and bleeding (8 sessions); and (3) 7‐year‐old boy (hyperoxaluria, access via PermCath® jugular vein catheter) after renal transplant biopsy (3 sessions). Sodium citrate 30% was infused into the extra corporeal circuit (blood flow 150 mL/min) before dialyzer (initial flow 30 mL/min) and calcium gluconate 10% for antidote into venous line near of catheter or fistula (initial flow 40 mL/min). Post‐dialyzer extracorporeal serum Ca++ (aim < 0.3 mmol/L) and pre‐dialyzer intra‐corporeal Ca++ (aim > 0.9) were measured for every 30 min. Serum Na+, K+, base excess (BE), blood flow, blood pressure, heart rate, and blood out‐flow and in‐flow pressure were also monitored.Results:  For adequate RCA (mean extracorporeal serum Ca++ 0.24 ± 0.04 mmol/L), a mean citrate flow of 36.1 ± 5.9 mL/h and a mean calcium substitution rate of 40.8 ± 3.4 mL/h were needed. Intra‐corporeal Ca++ was kept at 1.10 ± 0.07 mmol/L. Extracorporeal activated clotting time (ACT) was 194 ± 41 and intra‐corporeal ACT 90 ± 12 sec. Serum Na+, K+, and BE during HD were 138 ± 2, 3.5 ± 0.3, and −0.6 ± 1.1 mmol/L, respectively. Mean arterial blood pressures of patients 1–3 were 117 ± 5, 103 ± 5, and 102 ± 6 mmHg. All patients were stable and without any bleeding during HD. The only adverse event was 1 episode of hypocalcemia (Ca++ < 0.6 mmol/L) cured by stopping dialysis.Conclusions:  Local anticoagulation with sodium citrate during intermittent HD can be applied safely in children and adolescents.
Effective Adherence Contest to Improve Albumin, Phosphorus, and Fluid Levels in Pediatric Hemodialysis Unit
Authors: Fain A. , McPhail K. , Hines. D. 
Published: December 2004

Low serum albumin, high serum phosphorus, and fluid overload are common issues in dialysis patients. This can be attributed to many causes such as inadequate understanding and lack of accountability in the patients' care. These abnormal levels contribute to increased medical complications and increased mortality.Objective:  (i) Improve patient education of albumin, phosphorus, and fluid maintenance. (ii) Improve patients' albumin, phosphorus, and fluid levels by 25 percent.Methods:  A baseline level was collected on all patients by averaging last 3 laboratory findings. All patients were educated recognizing several different learning styles. Educational posters were displayed, one‐on‐one education was provided, as well as educational games on the role of albumin, phosphorus, and fluid. Patients were also educated on the role of diet in these levels. Positive reinforcement, peer pressure, and intensive team approach were used through the 8‐week incentive contest. Feedback on progress was provided in written and verbal format. Prizes were awarded for best shift levels and shift with most improvements.Results:  Levels measured at the end of the educational period and contest showed a 71% improvement in albumin levels, 52% improvement in phosphorus levels, and a 42% improvement in fluid levels.Conclusion:  Significant improvements found in all areas are attributed to three factors: education, consistent, individual, intensive attention, and incentives. Peer pressure was found not to be as effective but that individual tracking for incentives may be more effective if done ongoing. Our follow up several months later found a slight decrease in improvements, and we recognize a need for an ongoing intervention. Yet, we found an overall improvement of level of understanding and commitment to their overall health.
Impact of Ischemic Heart Disease on Early Access Failure in Nondiabetic Hemodialysis Patients
Authors: Kim Y.o. , Shin S.j. , Shin Y.s. , Lee S.h. , Yoon S.a. , Kim Y.s. , Chang Y.s. , Bang B.k. 
Published: December 2004

Atherosclerotic lesion of coronary artery frequently accompanies intimal hyperplasia of radial artery. We have reported that the lesion of radial artery (intimal hyperplasia) in hemodialysis (HD) patients is associated with early access failure (EAF) as well as ischemic heart disease (IHD) (Am J Kidney Dis. 2003; 41: 422–428).Objective:  This study was designed to determine the impact of IHD on the EAF in nondiabetic HD patients.Methods:  This study enrolled 125 nondiabetic HD patients who received radiocephalic arteriovenous fistula operation for the first time. We evaluated IHD before the operation through clinical symptoms and electrocardiography and then investigated EAF within 1 year after the operation. We analyzed the access patency rates between the patients with and without IHD, using Kaplan–Meier method and log‐rank test. Multiple regression analysis was performed to identify independent risk factors of the EAF.Results:  The mean age of the patients was 48 ± 14 years, and the number of females was 54 (43.2%). Of the total 125 patients, 19 patients (15.4%) had IHD before the operation. The EAF developed in 23 patients (18.4%) within 1 years after the operation. The access patency rate in the patients with IHD was lower than that in the patients without IHD (39.7 vs. 88.3%, p < 0.001). IHD and old age were independent risk factors of the EAF in nondiabetic HD patients. But sex, smoking history, hypertension, and the levels of hemoglobin, serum creatinine, albumin, and total cholesterol checked before the operation were not associated with the EAF.Conclusion:  This study suggests that IHD is closely associated with EAF in nondiabetic HD patients.
Thrombotic Events and Pentosidine in Hemodialysis
Authors: Schwing W.D. , Erhard P. , Holloman C. , Weigel K. , Blankshaen S. , Anderson J. , Siegel C. , Seaman D. , Valente J. , DeOreo P. , Weiss M.F. 
Published: December 2004

Poorly functioning dialysis access, whether graft or AV fistula, is a contributor to decreased efficiency of dialysis. Thrombosis results in the need for surgery and increases patient suffering.Objectives:  To determine whether an advanced glycation end product (AGE), pentosidine, might serve as a marker of disease activity and thrombosis of dialysis access. These results were obtained during the blinded phase of a study to evaluate the efficacy of the antioxidant vitamin E in preventing vascular access thrombotic events.Methods:  Twenty‐six patients had blood drawn and access flow evaluated initially and at intervals for up to 1.5 years. In the study design, participants received either 800 IU vitamin E daily by mouth or identical placebo capsules. Blood plasma was examined to determine pentosidine content at baseline and every 3 m. Patients with an access flow of <800 mL/min were referred to a surgeon for evaluation. Access flow was evaluated by using the transonic flow meter and the saline release method. When sequential double dialyzers were used, saline injection method was applied post dialyzers, but before the venous drip chamber.Results:  Mean initial level of pentosidine before the administration of vitamin E was 20.22 pmol/mg (range 5.04–59.62 pmol/mg). During the study period, 5 patients had procedures related to thrombosis performed on their accesses. Blood drawn before the thrombotic event showed an increase above baseline of 6.87 ± 15.47 (range −5.9 to +33.7 pmol/mg). Patients without events showed a mean decrease of 9.7 ± 12.24 pmol/mg pentosidine (p < 0.02).Conclusion:  An increase in levels of pentosidine was associated with clotting of hemodialysis access. This change may reflect the effects of oxidative stress and/or thrombus formation. As these data are gathered from an ongoing double‐blinded study, the effect of vitamin E on thrombus formation and pentosidine levels has not yet been ascertained.
Dialysis Dose Parameters. How Much We Can Improve Them in Our Clinical Practice? Role of Online Conductivity Monitor
Authors: Cigarrán S. , Coronel F. , Torrente J. , Sevilla M. , Baylón J.C.D. 
Published: December 2004

The mortality and morbidity of hemodialysis patients is, to a large extent, determined by demographics and by existing comorbidities, but it is obvious that variations in dialysis dose have substantial effects. Using eKt/V, 1.2 monthly comparisons are recommended by European guidelines, but they assume that dose is maintained during all monthly sessions. Because of dialysis‐related problems like hypotension, reduction of blood flow, dialysis time, microclotting of the dialyzer, and vascular access problems, the delivered dose may vary from session to session. New developed devices based on online conductivity clearance reflect the electrolyte clearance and, thus, clearance of urea. The aim of this prospective study was to show the variability of dialysis dose. 24 anuric patients were studied during 3 months: 20.8% were diabetics, mean age 64.7 ± 18.2 years; 16% females. Access blood were AVFi and the effective dialyzed blood flow was set at 350 mL/min, with recirculation <5%. BMI was 25.4 ± 3.8 kg/m2 and body weight was 69.7 ± 12 kg. All patients were dialyzed thrice weekly (245 ± 21 min) with dialysis machine 4008H (Fresenius Medical Care) equipped with online conductivity monitor (OCM) and the hollow fiber high‐flux polysulfone membrane (HF‐80 1.8 m2) and helixone (Fx‐60, 1.6 m2). OCM was validated for our population and reported in other abstracts (r2 = 0.96, p < 0.001). Dialysate flow was maintained at 500 mL/min, with standard dialysate liquid. Each patient was subjected to OCM on regular sessions during 3 months, and blood Kt/V samples were taken on midweek day, once a month. Data were processed and statistically analyzed with SPSS 11.0 software package. Kt/V OCM relation with other baseline characteristics was assessed by using contingency tables, t‐tests, analysis of variance, and linear regression, as appropriate. All the tests were performed for a 0.05 significance level. The conductivity‐based OCM provides an accurate tool to monitor the dose and control of each hemodialysis session and adds to the efficiency of current dialysis adequacy monitoring. OCM device requires little maintenance, and no extra effort is needed. Monthly Kt/V does not reflect the variability of each session. Further studies are necessary to evaluate its influence on morbidity and mortality.  Descriptives

Variables
Minimum
Maximum
Mean
SD

Age (year)
31
86
64.75
18.243

Membrane surface
1.6
1.8
1.675
0.0989

Interdialysis weight gain
500
4200
2266.67
1016.673

BMI
18.22
31.03
25.4155
3.83630

Time on dialysis (min)
210
320
245.21
21.340

OCM
0.990
1.880
1.29921
0.201072

dPVV/Kt/V (Daugirdas)
1.00
2.09
1.4067
0.21924

Watson volume (L)
25.8
49.3
36.833
6.3095
Hurricane‐induced nitrous oxide fluxes from a wet tropical forest
Authors: Erickson Heather E. , Ayala Gaddiel 
Published: December 2004

AbstractHurricane activity is predicted to increase over the mid‐Atlantic as global temperatures rise. Nitrous oxide (N2O), a greenhouse gas with a substantial source from tropical soils, may increase after hurricanes yet this effect has been insufficiently documented. On September 21, 1998, Hurricane Georges crossed Puerto Rico causing extensive defoliation. We used a before–after design to assess the effect of Georges on N2O emissions, and factors likely influencing N2O fluxes including soil inorganic nitrogen pools and soil water content in a humid tropical forest at El Verde, Puerto Rico. Emissions of N2O up to 7 months post‐Georges ranged from 5.92 to 4.26 ng cm−2 h−1 and averaged five times greater than fluxes previously measured at the site. N2O emissions 27 months after the hurricane remained over two times greater than previously measured fluxes. Soil ammonium pools decreased after Georges and remained low. The first year after the hurricane, nitrate pools increased, but not significantly when compared against a single measurement made before the hurricane. Soil moisture and temperature did not differ significantly in the two sampling periods. These results suggest that hurricanes increase N2O fluxes in these forests by altering soil N transformations and the relative availabilities of inorganic nitrogen.
Short‐ and long‐term greenhouse gas and radiative forcing impacts of changing water management in Asian rice paddies
Authors: Frolking Steve , Li Changsheng , Braswell Rob , Fuglestvedt Jan 
Published: December 2004

AbstractFertilized rice paddy soils emit methane while flooded, emit nitrous oxide during flooding and draining transitions, and can be a source or sink of carbon dioxide. Changing water management of rice paddies can affect net emissions of all three of these greenhouse gases. We used denitrification–decomposition (DNDC), a process‐based biogeochemistry model, to evaluate the annual emissions of CH4, N2O, and CO2 for continuously flooded, single‐, double‐, and triple‐cropped rice (three baseline scenarios), and in further simulations, the change in emissions with changing water management to midseason draining of the paddies, and to alternating crops of midseason drained rice and upland crops (two alternatives for each baseline scenario). We used a set of first‐order atmospheric models to track the atmospheric burden of each gas over 500 years. We evaluated the dynamics of the radiative forcing due to the changes in emissions of CH4, N2O, and CO2 (alternative minus baseline), and compared these with standard calculations of CO2‐equivalent emissions using global warming potentials (GWPs). All alternative scenarios had lower CH4 emissions and higher N2O emissions than their corresponding baseline cases, and all but one sequestered carbon in the soil more slowly. Because of differences in emissions, in radiative forcing per molecule, and in atmospheric time constants (lifetimes), the relative radiative impacts of CH4, N2O, and CO2 varied over the 500‐year simulations. In three of the six cases, the initial change in radiative forcing was dominated by reduced CH4 emissions (i.e. a cooling for the first few decades); in five of the six cases, the long‐term radiative forcing was dominated by increased N2O emissions (i.e. a warming over several centuries). The overall complexity of the radiative forcing response to changing water management could not easily be captured with conventional GWP calculations.
Processing and presentation of HLA class I and II epitopes by dendritic cells after transfection with in vitro–transcribed MUC1 RNA
Authors: Dörfel Daniela , Appel Silke , Grünebach Frank , Weck Markus M. , Müller Martin R. , Heine Annkristin , Brossart Peter 
Published: December 2004

AbstractRNA transfection of dendritic cells (DCs) was shown to be highly efficient in eliciting CD8+ and CD4+ T-cell responses. However, antigen presentation pathways involved in generation of human leukocyte antigen (HLA) class I and class II peptides have remained elusive. To analyze this we incubated mucin 1 (MUC1) RNA-transfected DCs with compounds known to inhibit HLA class I presentation and used these cells in chromium 51 (51Cr)–release assays. As effectors, we used cytotoxic T lymphocyte (CTL) lines specific for the MUC1 peptides M1.1 and M1.2. We observed that the presentation of HLA-A*02 epitopes is inhibited by brefeldin A and lactacystin. To determine the requirement of a functional transporter associated with antigen processing (TAP), we cotransfected DCs with MUC1 and infected cell peptide 47 (ICP47) RNA. ICP47 could only inhibit the presentation of the M1.1 but not the M1.2 peptide, indicating that this epitope derived from the signal sequence is presented independently of TAP. Cocultivation of MUC1 RNA-transfected DCs with MUC1-specific CD4+ T lymphocytes revealed that the presentation of HLA class II peptides is sensitive to proteasomal inhibitors and brefeldin A. Furthermore, the presentation pathway requires lysosomal and endosomal processing and is mediated by autophagy. Our results demonstrate that the efficient presentation of cytosolic proteins on major histocompatibility complex (MHC) class II combines the proteolytic and lysosomal pathways.