bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Calcitriol Improves Anaemia and Reduces the Need for Erythropoietin in Haemodialysis Patients
Authors: Goicoechea M. , Vazquez M.I. , Ruiz M.A. , Gomez-Campdera F. , Perez-García R. , Valderrábano F. 
Published: April 2003

In cases with severe hyperparathyroidism, anaemia improves after parathyroidectomy. The objective of this study was to investigate the influence of treatment with intravenous calcitriol on anaemia in 28 haemodialysis patients. The patients showed moderate to severe hyperparathyroidism (mean parathyroid hormone level 811.6 ± 327 pg/ml) and were treated with calcitriol (2 µg i.v.) after haemodialysis. The follow-up period was 12 months. 21 out of the 28 patients had been receiving erythropoietin (EPO) prior to calcitriol administration; the remaining 7 did not receive EPO. 24 patients received oral or intravenous iron. The doses of EPO and iron were modified throughout the study period to maintain a haematocrit equal to or higher than 30% and ferritin levels above 150 ng/ml, respectively. EPO needs were evaluated according to the relation EPO dose/haematocrit. We found a significant rise in haematocrit and haemoglobin at 3 and 12 months on calcitriol therapy, with no modification of the EPO dose nor ferritin levels. This improvement in anaemia was observed both in those patients who received EPO initially (p < 0.01) and in those who did not (p < 0.05). Upon dividing the patients according to the response of hyperparathyroidism to the intravenous calcitriol treatment, we observed in the responding patients (n = 19) significant increases in haematocrit (from 31.7 ± 4.2 to 36.3 ± 4.9%) and haemoglobin (from 10.6 ± 1.5 to 12.2 ± 1.5 g/dl; p < 0.001) at 12 months on intravenous calcitriol therapy, while this was not true of the non-responding patients. The EPO needs diminished in the group of responding patients and increased in the non-responders, although these changes were not statistically significant. We found no direct correlation between the decrease of parathyroid hormone and EPO needs in the group of responding patients. However, an inverse correlation between parathyroid hormone levels and EPO needs (r = –0.799, p < 0.05) was seen in the group of non-responding patients. Treatment with intravenous calcitriol in patients on haemodialysis controls secondary hyperparathyroidism, improves anaemia, and decreases the need for EPO. Studies including a larger number of patients are necessary to clarify the mechanisms underlying the improvement of anaemia upon control of secondary hyperparathyroidism with intravenous calcitriol treatment and to confirm our findings.
Localization of Parathyroid Glands in Hemodialysis Patients Using Tc-99m Sestamibi Imaging
Authors: Ishibashi Masatoshi , Nishida Hidemi , Okuda Seiya , Suekane Shigetaka , Hayabuchi Naofumi 
Published: April 2003

Tc-99m sestamibi parathyroid imaging was performed in 28 patients with chronic renal failure to localize abnormal parathyroid glands in patients receiving hemodialysis, and compared the localization with ultrasonography and magnetic resonance (MR) imaging. <b>Methods:</b> We imaged 28 patients with secondary hyperparathyroidism using Tc-99m sestamibi (about 600 MBq) at 10 min and 2–3 h following radiotracer injection. In addition, mediastinal images were recorded at approximately 1 h following injection to identify ectopic parathyroid glands. All patients also were evaluated with ultrasonography and MR imaging. <b>Results:</b> Tc-99m sestamibi scans demonstrated focal uptake in 60 glands of the 28 patients, and was categorized as slight uptake in 71.7% (43/60), and intense uptake in 28.3% (17/60). Seventeen of the 28 patients underwent parathyroidectomy. A total of 64 glands were resected. Sestamibi imaging was more sensitive for localizing abnormal parathyroid glands than ultrasonography or MR imaging. Histologic evaluation of 27 resected parathyroid glands revealed that the number of oxyphil or chief cells was not proportional to sestamibi uptake. <b>Conclusion:</b> Our data indicate that Tc-99m sestamibi imaging should be used initially to localize abnormal parathyroid glands in hemodialysis patients with secondary hyperparathyroidism, prior to MR imaging or ultrasonography. Sestamibi uptake in parathyroid glands may not correlate with the degree of hypercellularity of oxyphil cells.
Ultrastructural Study of Anionic Sites in Glomerular Basement Membranes at Different Perfusion Pressures by Quick-Freezing and Deep-Etching Method
Authors: Yu Ying , Leng Chong-Guang , Kato Yasuko , Terada Nobuo , Fujii Yasuhisa , Ohno Shinichi 
Published: April 2003

The ultrastructures of anionic sites in rat glomerular basement membranes (GBM) were studied at different perfusion pressures of 100, 150, 200 or 250 cm H<sub>2</sub>O by a quick-freezing and deep-etching (QF-DE) method, in addition to conventional fixation methods, using polyethyleneimine (PEI) as a cationic tracer. By the QF-DE method, three-dimensional ultrastructures at each pressure were observed more clearly than those seen on conventional ultrathin sections. When the perfusion pressures were changed from low levels to higher ones, the total thickness of GBM with anionic sites became gradually thinner. Many PEI particles were observed around filaments, not only in the laminae lucidae, but also in the lamina densa. These findings indicated the existence of anionic sites in both laminae lucidae and lamina densa of GBM. The numbers of PEI particles in the lamina rara externa were counted on conventional ultrathin sections for morphometric analyses. The numbers per unit length of GBM were significantly decreased at higher perfusion pressures (200 and 250 cm H<sub>2</sub>O) than those seen at both normal (150 cm H<sub>2</sub>O) and lower (100 cm H<sub>2</sub>O) pressures. It is concluded that the ultrastructures of anionic sites in the GBM may be changed in vivo, depending on the hemodynamics in the glomerular capillary.
Soluble P-Selectin Is Released from Activated Platelets in vivo during Hemodialysis
Authors: Kawabata Kenji , Nagake Yoshio , Shikata Kenichi , Fukuda Shinji , Nakazono Hiroshi , Takahashi Maki , Ichikawa Haruo , Makino Hirofumi 
Published: April 2003

During hemodialysis, platelets are activated across a dialyzer. Soluble P-selectin (sP-selectin) is a form of P-selectin which is a glycoprotein relocated from secretory granules to the surfaces of platelets and endothelial cells after these cells have been physiologically activated. To investigate whether sP-selectin is useful as a marker of platelet activation during hemodialysis, we measured the plasma concentration of sP-selectin by enzyme-linked immunosorbent assay in 6 patients hemodialyzed in our institute using regenerated cellulose (RC) membranes and thereafter polysulfone membranes. Concomitantly, we also measured the plasma concentration of platelet factor 4 and β-thromboglobulin which are released from α-granules of activated platelets. During hemodialysis with RC membranes, the β-thromboglobulin level was significantly increased 15 min (p < 0.05) and the sP-selectin level 15 (p < 0.05) and 180 min (p < 0.05) after initiation of dialysis on the venous side as compared with the arterial side of the hemodialyzer. During hemodialysis with polysulfone membranes, no significant variation in plasma β-thromboglobulin and sP-selectin levels was detected. The platelet factor 4 level increased more significantly across a dialyzer 180 min after initiation of dialysis with RC than with polysulfone membranes (p < 0.01). The changes in plasma platelet factor 4 and β-thromboglobulin levels demonstrated that platelets are more activated during hemodialysis with RC than with polysulfone membranes. The changes in plasma sP-selectin levels during hemodialysis with RC confirm that the release of P-selectin purely from activated platelets was detected by enzyme-linked immunosorbent assay. sP-selectin may be a marker of platelet activation during hemodialysis.
Improvement of Nutritional Status in Patients Receiving Maintenance Hemodialysis after Correction of Renal Anemia with Recombinant Human Erythropoietin
Authors: Tarng Der-Cherng , Huang Tung-Po , Doong Tsuey-Ing 
Published: April 2003

Despite a large body of evidence showing the beneficial effects of successful treatment of anemia with recombinant human erythropoietin (EPO) in patients with end-stage renal disease, controversy remains as to whether EPO treatment of anemia can improve the nutritional status in patients on maintenance hemodialysis. This prompted us to conduct a prospective study in 41 hemodialysis patients with basal hemoglobin less than 9 g/dl. The dose of EPO was increased for 12 weeks to achieve the target hemoglobin concentration of 10 g/dl and then titrated in the following 12 weeks to maintain the target value. Nutritional status was assessed at baseline and after 6 months of follow-up, using the global protein-calorie malnutrition (PCM) index proposed by Bilbrey and Cohen. A low global PCM score indicates better nutrition. The results showed that hemoglobin values significantly increased from 8.7 ± 0.8 g/dl at baseline to 10.7 ± 0.5 g/dl in the 6th month (p < 0.001). No significant changes were observed in the normalized protein catabolic rate and Kt/V during the study period. Global PCM scores improved from 30.0 ± 7.5 to 23.6 ± 3.1 (p < 0.001) and paralleled the correction of anemia by EPO treatment. The data were consistent with a major improvement in the nutritional markers of relative body weight, triceps skinfold, midarm circumference, midarm muscle circumference, serum albumin, serum transferrin and total lymphocyte count in the 6th month as compared to baseline. The percentages of mild and moderate-severe PCM at baseline were 32 and 58%, respectively. These percentages were significantly reduced during the 6th month to 20 and 30%, respectively (p = 0.0004). In summary, correction of renal anemia with EPO improves the nutritional status in hemodialysis patients. A postulated mechanism is that EPO may exhibit anabolic effects, with a better utilization of ingested protein.
Accidental Aluminum Intoxication in Patients Undergoing Acetate-Free Biofiltration
Authors: Hdez-Jaras J. , Galán A. , Sánchez P. 
Published: April 2003

Eight patients undergoing acetate-free biofiltration (AFB) suffered aluminum intoxication. The source of this outbreak was parenteral exposition to high concentrations of aluminum in sodium bicarbonate solutions. The manufacturer of bicarbonate solutions used in AFB was substituted in May 1994 and the solutions were stored in glass containers. At the peak of intoxication (July 1994) serum aluminum determination revealed an average value of 147.3 ± 21 µg/l. Aluminum levels in bicarbonate solutions were 400 µg/l. Serum ferritin rose from 307.4 ± 161 to 735.6 ± 206 ng/ml, whereas MCV decreased significantly from 98.4 ± 9 to 90.1 ± 10 fl. No significant changes were found in hemoglobin, neither in plasma iron, nor in iron transferrin saturation. The doses of recombinant human erythropoietin showed a considerable increase. The replacement solutions were changed and a new solution, stored in plastic containers and with aluminum levels lower than 10 µg/l, was used. The biochemical parameters were normalized. This outbreak demonstrates the need for a stringent control of aluminum-containing replacement fluids.
Anti-Idiotype Antibody Directly Interferes with Glomerular IgA Immune Complex Deposition
Authors: Chen Ann , Sheu Lai-Fa , Shaio Men-Fang , Huang Tzu-Hao , Ding Shian-Lin , Lee Wei-Hwa 
Published: April 2003

Data from both animal and clinical studies suggest that anti-idiotype antibodies deposited in glomeruli may be involved in the pathogenesis of glomerulonephritis. This study was conducted to examine the role of a hybridoma-AB1-2-derived IgG anti-T15 idiotype (IgG anti-T15) in the immunopathogenesis of a short-term experimental IgA nephropathy. BALB/c mice (12/group) were administered intravenously with: (1) an equal mass (1 mg) of T15-hybridoma-derived IgA antiphosphorylcholine (PC) and PC-conjugated bovine serum albumin (BSA-PC) antigen; (2) 1 mg of IgA anti-PC, 1 mg of BSA-PC antigen, and 3 mg of IgG anti-T15, or (3) 1 mg of BSA-PC antigen alone. The mice were sacrificed 6 h after the injection. A 6-hour clearance study was performed. The initial phase of elimination of BSA-PC antigen in mice receiving IgA anti-PC/BSA-PC/IgG anti-T15 or those receiving the antigen alone was significantly faster than that in those receiving IgA anti-PC/BSA-PC (p < 0.001). There was no significant difference in the elimination rate of BSA-PC antigen between mice receiving IgA anti-PC/BSA-PC/IgG anti-T15 and those receiving BSA-PC antigen alone. The late phases of elimination of the BSA-PC antigen in mice receiving IgA anti-PC/BSA-PC/IgG anti-T15 showed somewhat similar to those of BSA-PC antigen in mice receiving IgA anti-PC/BSA-PC. Moreover, mice injected with IgA anti-PC/BSA-PC/IgG anti-T15 showed a significantly less glomerular BSA-PC antigen deposition than those injected with IgA anti-PC/BSA-PC (positive control), as demonstrated by light microscopy, autoradiography, and immunohistochemistry (each p < 0.001). It is inferred that the injected IgG anti-T15 could react with the IgA anti-PC in vivo, directly interfering with immune complex formation by the IgA anti-PC and BSA-PC antigen, thereby resulting in diminished glomerular deposition of the BSA-PC antigen. These findings suggest that an anti-idiotype antibody may be protective in the immunopathogenesis of IgA nephropathy, because of its inhibitory effect on glomerular trapping of an antigen.
Effect of Increased Hemodialysis Dose on Endogenous Erythropoietin Production in End-Stage Renal Disease
Authors: Ifudu Onyekachi , Friedman Eli A. 
Published: April 2003

We investigated 20 patients (12 men and 8 women) with end-stage renal disease sustained on hemodialysis to determine the effect of 6 weeks of increased dialysis dose on endogenous erythropoietin production. Increased dialysis dose was achieved by increasing thrice-weekly dialysis treatment time from 4 to 4.5 h and switching from an MCA 160 dialyzer to an F80 dialyzer. The mean age of the study subjects was 51 ± 13.8 years, and the mean duration of end-stage renal disease prior to the study was 31.4 ± 55.5 months. All subjects were receiving recombinant erythropoietin for at least 4 months prior to the study. The dialysis dose was increased from a mean reduction of urea of 60.7 to 72%. At baseline, the group’s mean hematocrit was 28.4 ± 3.4%, the mean predialysis endogenous erythropoietin level was 9.1 ± 4.5 (range 2.5–18.4) mU/ml, the mean reduction of urea was 60.7 ± 4%, and the mean transferrin saturation was 22.6 ± 15.5%. Mean thrice-weekly recombinant erythropoietin injections were administered intravenously after dialysis to each patient at a dose of 51 ± 19 U/kg body weight. After 6 weeks of an increased dialysis dose, the mean hematocrit increased from 28.4 ± 3.4 to 32.3 ± 3.3% (p = 0.0001), while the mean serum endogenous erythropoietin level decreased from 9.1 ± 4.5 (range 2.5–18.4) mU/ml to 6.1 ± 3.2 (range 2.5–13.4) mU/ml (p = 0.0001). We conclude that the serum endogenous erythropoietin levels decrease with increased dialysis dose and that the increase in hematocrit following increased dialysis dose is probably not mediated by changes in endogenous erythropoietin.
Eradication and Follow-Up of Helicobacter pylori Infection in Hemodialysis Patients
Authors: Muñoz de Bustillo E. , Sánchez Tomero J.A. , Sanz J.C. , Moreno J.A. , Jiménez I. , López-Brea M. , Pajares J.M. , Traver J.A. 
Published: April 2003

It is currently accepted that <i>Helicobacter pylori</i> (Hp) infection is crucial in the pathogenesis of peptic ulcer. Therefore, we developed a prospective study to assess the prevalence of Hp infection by the <sup>13</sup>C Urea Breath Test (<sup>13</sup>C UBT) in 52 hemodialysis patients, and we evaluated the efficacy of two consecutive eradication regimens in 23 positive patients with dyspepsia and/or on a transplantation list. The correlation between anti-Hp serology and <sup>13</sup>C UBT results was also analyzed in 34 patients who were followed up during 18 months. The Hp prevalence by <sup>13</sup>C UBT was 63.5% (33/52). The eradication rate after the first cycle of therapy (amoxicillin 500 mg/8 h and omeprazole 20 mg/12 h, 14 days) was 60.8% (14/23). After the second cycle (clarithromycin 500 mg/ 12 h plus omeprazole 20 mg/12 h, 14 days), the eradication rate reached 82.6% (19/23). The serological procedure showed a good correlation with <sup>13</sup>C UBT (about 80% sensitive and specific) when very restrictive diagnostic and eradication criteria were adopted. We conclude that an eradication rate higher than 80% can be reached after two consecutive cycles of dual therapy in hemodialysis patients. Anti-Hp serological tests must be cautiously interpreted in these patients.
The Role of α-Glutathione S-Transferase in the Monitoring of Hemodialysis Patients with Hepatitis C Virus Infection Undergoing High-Dose Interferon-α-2b Therapy
Authors: Boran Mediha , Çetin Selahattin 
Published: April 2003

The study aimed to evaluate the behavior of α-glutathione S-transferase (α-GST) in the serum of hemodialysis patients with hepatitis C virus (HCV) infection following treatment with high-dose IFN-α-2b. Ten patients with detected anti-HCV antibodies and HCV RNA by RT-PCR were selected and treated with high-dose interferon (IFN)-α-2b, 10 million units s.c. daily for 2 weeks followed by 3 times per week for 6 additional weeks. Blood samples were obtained from these patients at baseline for plasma α-GST and hepatic aminotransferases. Patients were monitored with weekly blood counts and monthly liver enzymes. Biochemical (normal α-GST and ALT) and virologic (negative HCV RNA by RT-PCR) responses were observed in 3 (30%) of the 10 patients. At the end of the follow-up (follow-up duration 44 weeks), 3 patients demonstrated long-term biological and virologic responses and 7 had relapses. In the nonresponders plasma AST and ALT approached normal levels on some occasions despite persistent viral RNA. In contrast to transaminases α-GST remained distinctly elevated in nonresponders and provided a more clear distinction between the responders and nonresponders. In conclusion, plasma α-GST, as a sensitive and reliable marker of response, may have a role in the monitoring of hemodialyzed patients undergoing IFN-α-2b therapy.
A New Chemical Preservative That Permits Analysis of Urine Sediment for Light Microscopic Examination 12 h after Emission
Authors: del Rosario Rodríguez Moreno M. , Rodríguez Moreno Irene , León M. Teresa Miranda , Boy Monique , Cowdry Agnieszka Nina 
Published: April 2003

<i>Introduction:</i> Urine diagnosis by light microscopy is considerably more difficult when specimens are analyzed after a certain period of time. <i>Objectives:</i> (1) To investigate whether this change effectively exists at a significant level of 12 h. (2) To apply measures, once the above has been done, allowing for the analysis of samples beyond 12 h in similar conditions. <i>Materials and Methods:</i> Both freshly produced urine and pathological samples were used under certain experimental conditions: initial, 12 h, 12 h + fridge at 4°C (F), 12 h + chemical preservation (S) and 12 h + SF. The chemical preservative was prepared at a 50/50 ratio with 3% formaldehyde and 2.5% glutaraldehyde by the addition of a buffer of pH 7.2–7.4, resulting in a solution of pH 7.35 at 25°C room temperature. Urinalysis was carried out on all samples: glucose (enzymatic method of hexokinase) and total protein in liquid (red pyrogallol method). Centrifugation was followed by sediment analysis with light microscopy. Statistical analysis was done with the Kolmogorov-Smirnov normality test, Friedman nonparametric test and multiple comparisons. <i>Results and Conclusion: </i>Urine samples tested 12 h after having been produced changed significantly (p < 0.0001), making it necessary to adopt certain measures to maintain their initial conditions. In our case, after the addition of the chemical preservative, samples did not present any changes (p > 0.10) in relation to the initial conditions and were seen to be reliable, therefore indicating the suitability and effectiveness of the analytical conditions (urinalysis in particular, sediment analysis).
Potassium Removal Increases the QTc Interval Dispersion during Hemodialysis
Authors: Cupisti Adamasco , Galetta Fabio , Caprioli Raffaele , Morelli Ester , Tintori Gian Carlo , Franzoni Ferdinando , Lippi Alberto , Meola Mario , Rindi Paolo , Barsotti Giuliano 
Published: April 2003

This study was planned to clarify the mechanism(s) by which hemodialysis increases the QTc dispersion, a marker of risk of ventricular arrhythmias. To this aim, 10 uremic patients, without any relevant heart diseases, underwent two different types of hemodialysis schedules. In the first, 1 h of isolated high rate ultrafiltration preceded the standard diffusive procedure. In the second, during the first hour of standard bicarbonate hemodialysis, the decrease of plasma potassium concentration was prevented by increasing K<sup>+</sup> concentration in the dialysate, according to its pre dialysis plasma levels. During the high rate ultrafiltration period, together with ECG signs of increased sympathetic nervous system activity and catecholamines secretion, the QTc dispersion did not change significantly. Instead, an evident increment was observed 1 h after the start of the diffusive hemodialysis, then slowly progressing until the end of the dialysis and finally returning to the pre dialysis values within 2 h after the end of the session. To the contrary, the increase of the QTc dispersion was totally blunted during a standard hemodialysis procedure in absence of plasma K<sup>+</sup> decrease, but appeared again when the K<sup>+</sup> dialysate fluid concentration was restored to 2 mmol/l. This study provides evidence that the increase of QTc dispersion occurring on hemodialysis is mainly related to the diffusive process, more precisely to the K<sup>+</sup> removal. This is one more reason to focus attention on K<sup>+</sup> removal rate especially when hemodialysis treatment is given in uremics affected by cardiac diseases with high risk of arrhythmias.