bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ten‐year study of bacteremia in hemodialysis patients in a single center
Authors: Park J.A. , Jung H.A. , Yoon J.M. , Kim Y.O. , Yoon S.A. , Kim Y.S. , Kim S.Y. , Chang Y.S. , Bang B.K 
Published: January 2005

Background:
The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. Methods: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication, and mortality of bacteremia. We compared clinical factors, morbidity, and mortality between arteriovenous fistula and central venous catheter groups. Results: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%). Staphylococcus aureus was most common organism isolated. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), and aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n = 4), aspiration pneumonia (n = 2), hypoxic brain injury (n = 1), gastrointestinal bleeding (n = 1), and rupture of aortic pseudoaneurysm. The central venous catheter group (n = 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p < 0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p = 0.042) than the arteriovenous group. Conclusion:  This data shows that bacteremia causes high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.
Schistosomiasis could play a role in transmission of HCV infection in dialysis patients
Authors: Badawy L. , Addullah I. , EI Guinaidy M. , Aly M. , Aziz A. , Tarek A.S. , Abdel R.S. 
Published: January 2005

Background:
Both chronic HCV infection and schistosomiasis are major health problems in Egypt. The high prevalence of HCV infection in bilharzial patients had been postulated to be due to HCV transmission during past anti‐bilharzial parental therapy. The aim of the work was to study the possibility of transmission of HCV through the life cycle of schistosomiasis. Subject and Methods: The study included 180 patients divided into four groups: Group I: Included 40 patients with chronic renal failure (CRF) on regular hemodialysis (RH) with hepatic schistosmiasis (HS) and previous history of blood transfusion (BT). Group II: Included 40 patients with CRF on RH with HS and had no previous history of BT. Group III: Included 40 patients with CRF on RH with no evidence of HS and no previous history of BT. Group IV: Included 60 patients with HS with normal renal function and no previous history of BT. In addition 20 healthy persons were included as a control group. In addition to the routine investigations the patient groups were subjected to HCV Ab, HBsAg, HBcAb, HBcAg, anti bilharzial Ab, abdominal ultrasonography, rectal snip for patients positive for anti bilharzial Ab, and in‐situ hybridization (ISH) for HCV RNA and HBV DNA in the rectal snips positive for living schistosoma ova obtained from bilharzial patients positive for markers of HCV and HBV, respectively. Results: HCV Ab was detected in 92.5%, 65%, 55%, and 76.7% in groups I, II, III, IV, respectively, compared to 25% in the control group. Anti‐schistosomal Ab was detected in 75%, 50%, and 71.7% in groups I, II, and IV, respectively. A highly significant correlation was found between HCV Ab and anti‐schistosomal Ab positivity among all bilharzial groups (P < 0.01 in group I and P < 0.001 in groups II & IV). Rectal snips were positive for living schistosoma ova in 76.7%, 90%, and 81.4% of anti‐schistosomal Ab positive cases in groups I, II, and IV, respectively. Moreover, a highly significant correlation was found between HCV Ab and rectal snip positivity among the 3 bilharzial patients groups (P < 0.001 in groups I & II and P < 0.01 in group IV). On the other hand, there was no significant association between HBs Ag and either anti‐schistosomal Ab positivity or rectal snip positivity. ISH revealed HCV RNA in 26.3% of schistosomal ova‐positive rectal snips. In contrast, the examined biopsies were negative for hybridization of HBV DNA. Conclusion: Schistosomiasis might play a role in the transmission of HCV through its life cycle and this also may explain the significant association between HCV and schistosomiasis.
Spontaneous renal rupture in patients on chronic hemodialysis
Authors: Park J.A. , Jung H.A. , Yoon J.M. , Kim Y.S. , Kim Y.O. , Yoon S.A. , Kim S.Y. , Chang Y.S. , Bang B.K. 
Published: January 2005

Background:
Because of high incidence of acquired renal cyst and renal malignancy, it is suggested that spontaneous renal rupture more frequently occurs in patients receiving long‐term hemodialysis than in the general population. This study was performed to evaluate the clinical characteristics of spontaneous renal rupture in hemodialysis patients. Methods: This retrospective study enrolled 12 hemodialysis patients who developed spontaneous renal rupture. We investigated primary renal disease, duration of dialysis, clinical symptoms and signs, radiologic findings, treatment modalities, and histologic findings. Result: The mean age of the patients was 54 ± 10 years old and the number of male was 9. Primary renal disease consisted of autosomal dominant polycystic kidney disease (PCKD)(n = 5), chronic glomerulonephritis (n = 2), diabetic nephropathy (n = 1), hypertensive nephropathy (n = 1), unknown cause (n = 3). Presenting symptoms and signs were sudden onset of flank pain in 9 patients and gross hematuria with mild flank pain in 3 patients. Mean duration from initiation of hemodialysis to development of spontaneous renal rupture was 53 ± 36 months. Abdominal computed tomography showed subcapsular or perinephric hematoma in all patients. Of the 7 non‐PCKD patients, 6 patients had multiple acquired renal cysts. Surgical exploration was undertaken in 9 patients. Pathologic examination demonstrated small sized renal cell carcinoma in 2 of 9 patients. Three patients were only treated with conservative management including blood transfusion. All 12 patients recovered without recurrence. Conclusion: This study demonstrated that genetic or acquired renal cyst was an important cause of spontaneous renal rupture in hemodialysis patients and presenting manifestations were sudden onset of flank pain and gross hematuria.
Death in dialysis
Authors: Concepcion L.A. 
Published: January 2005

Purpose:
To analyze all patients who died while on hemodialysis from a single institution 1995–2004 and determine factors that influence duration on HD (months). Material and Methods: Review of the EMR from the dialysis unit for demographics, treatment parameters, cause of death, laboratory data. Two main groups those who stop dialysis (SHD) vs non stop dialysis (NSHD) data as mean and SD. Observations done at the start/mid/end of the period on dialysis by Kaplan Meier analysis. Results: 348 deaths, reported SMR for 2000–93(0.36,0.48,0.72,0.79), average comorbidity index 7.1–16.4; 49.1% male; age 67.6(12.3); 58.2% DM, 117(33.6%) stop dialysis. Detail analysis from 2000–2004; 187 deaths; 33.6% catheter, 41.1% AV graft at the time of death; 26% on no BP meds at the end, 64% 1–2 BP meds at the end.

Cause
Stop
No Stop

CV
33(28%)
145(62.7%)

Infection
10(8.5%)
41(17.7%)

Other
74(63.5%)
45(19.6%)

Most SHD deaths due to uremia (60%), Cancer 17%, occurred 36% CVA. SHD vs NSHD: older 70.8 (12.9) vs 65.9(12.9) p < 0.001. No difference in average months in dialysis 41.2 (38.9) vs 48.7(47.7)NS, in URR (start/end), UF during Hd, predialysis MAP (start/end: 105(15) 196(15)/95 (20) , 96(20)) albumin, phosphorous. Lower creatinine (at the end 6.2(1.5) 7.4(2.4)) higher Kt/V at end 1.47(0.4) vs 1.29(0.3). BMI lower at star/mid/end of the observation period. Conclusions: A large proportion of deaths were due to discontinuation of dialysis, older patient discontinue dialysis more frequently, the length of time on dialysis (months) is related more to nutritional factors (creatinine, BMI)
Effects of vitamin E‐coated membrane dialyzer on reduction of inflammation
Authors: Jainkiatfu K. 
Published: January 2005

Objective:
Blood‐membrane interaction during hemodialysis may contribute to inflammatory process, which accelerates the development of atherosclerosis in maintenance hemodialysis patients (MHD). Vitamin E has been widely used against oxidative stress in MHD. One of the strategies for the utilization of vitamin E in MHD patients is the usage of vitamin E‐coated membrane dialyzer. We investigated the effects of vitamin E‐coated membrane dialyzer on serum C‐reactive protein and interleukin‐6, the biomarker of inflammation, compared to polysulfone membrane dialyzer. Methods: Vitamin E‐coated membrane dialyzer (1.5‐m2 surface area) and synthetic polysulfone dialyzer (1.5‐m2 surface area) were manipulated in a crossover clinical study for 24 weeks in 10 non‐diabetic MHD patients. Run‐in and wash‐out periods (Cellulose tri‐acetate) were performed for 4 weeks before the treatment. Pre‐ and post‐dialysis blood samples were taken at the begining and the end of each dialyzer period (12 weeks). High‐sensitivity C‐reactive protein (hs‐CRP) and interleukin‐6 (IL‐6) were examined. Results: Mean age of the patients was 54.9 years old. CRP and IL‐6 levels were similarly increased after dialysis in both groups (4.8 ± 0.7 and 37.2 ± 9.4, respectively). The CRP and IL‐6 level in vitamin E‐coated membrane dialyzer treatment were lower than in polysulfone treatment (5.0 ± 1.2, p < 0.008 and 67.2 ± 12.4, p < 0.04, respectively). Serum albumin, hemoglobin level, and white blood cell count were not affected by types of dialyzer membrane. Conclusions: In our study, hemodialysis stimulated the inflammation as the previous study. Vitamin E‐coated membrane dialyzer may diminish the inflammatory process in MHD patients and may also prevent further atherosclerosis.
Acute complicating symptoms during hemodialysis sessions have well correlation with deranged blood pressure regulation
Authors: Iqbal M.M. , Hossain R.M. , Rahman H. , Das S. , Hossain J. , Salam A. , Islam M.N. , Mohsin M. 
Published: January 2005

Objective:
This observational study was undertaken to evaluate the frequency of acute complications occurring during dialysis sessions and their association with other clinical and biochemical parameters. Method: Forty‐six maintenance hemodialysis patients were selected and evaluated. Mean of the weekly evaluations of different parameters over a three‐month period is presented here. Result: Age of study subjects was 39 ± 13 years and body mass index (BMI) 21 ± 4 kg/m2. Duration of hemodialysis was 41 ± 29 months. Most of the patients were hypertensive (98%), taking multiple anti‐hypertensive drugs. Mean of the blood pressures before and at the end of dialysis sessions over the three month period were: systolic blood pressure (SBP) 159 ± 18 vs. 163 ± 22 (p < 0.05) and diastolic blood pressure (DBP) 92 ± 13 vs. 87 ± 7 mmHg (p < 0.003). Frequency of acute complicating symptoms during dialysis sessions were: headache (75%), rise in blood pressure (73%), leg cramps (67%), vomiting (60%), palpitation (58%), sweating (52%), and hypotension (35%). Raised blood pressure showed a positive correlation with headache (r = 0.50, p < 0.01) and sweating (r = 0.53, p < 0.05). Vomiting and palpitation were more frequent at low post‐dialysis blood pressure (vomiting vs. post‐SBP‐r = −0.41, p < 0.05 and palpitation vs. post‐DBP‐r = −0.48, p < 0.05), and these patients were likely to get inadequate dialysis (hypotension vs. Kt/V‐r = −0.63, p < 0.01). Pre and post dialysis weight variation was 53 ± 11 vs. 51 ± 11 kg (p < 0.001), average ultrafiltration during dialysis (UF)−2.39 (0.5–4) liter and single session Kt/V was 0.95 ± 0.38. The rising tendency of post‐dialysis blood pressure correlated positively with increasing UF (SBP vs. UF‐r = 0.36, p < 0.01 and DBP vs. UF‐r = 0.25, p < 0.05). Conclusion: From this study it may be concluded that acute complications during dialysis sessions have a significant correlation with deranged blood pressure regulation, and optimum control of blood pressure could provide better dialysis.
External gamma radiation caused by radon in water used for home haemodialysis (HHD)
Authors: Riitta M.‐K. , Meeri K. , Jyrki H. , Tuukka T. , Hannu A. , Eero H. 
Published: January 2005

Background:
Radon is a natural radioactive element found especially in drilled water wells. It may cause problems in HHD. In this study the occurrence and prevention of radiation exposure to radon among HHD patients was examined. Material and methods: Since 1998, 103 patients have been trained for HHD and drilled wells were used in 7 patients. Apart from routine analyses, radon concentration was also determined. Results: High radon concentration was observed in three drilled wells, in one of these 2000 Bq/L. Water was conducted into the HHD‐equipment through a charcoal filter and reverse osmosis equipment. Radon concentration was less than 50 Bq/L in the purified water. It was thus considered acceptable for dialysis. As the charcoal filter adsorbs radon, its decay products build up in the filter and emit gamma radiation. Considering that the daily through‐put of water is about 375 liters, the estimated dose rate for a radon concentration of 1,000 Bq/L is 0.4 microSv/h at one‐meter distance. At this distance the annual dose would be 1.8 mSv, expecting a daily occupancy time of 12 hours. The average background gamma dose rate in Finnish dwellings is 0.1 microSv/h. National dose constraints of 3 mSv/year for adults and 1 mSv/year for children living in HHD‐households have been recommended. Conclusions: Waterborne radon must be considered when planning of HHD in households where drilled wells are used. Elevated radon concentration should always be removed from household water. In addition, external gamma radiation from charcoal filters requires appropriate restrictions in order to achieve a safe treatment.
Efficacy of percutaneous angioplasty in non‐maturing Brescia‐Cimino fistulas
Authors: Kim Y.S. , Kim Y.O. , Song H.H. , Jung H.W. , Park J.A. , Yoon S.A. , Lee S.H. , Chang Y.S. , Bang B.K. 
Published: January 2005

Purpose:
To evaluate efficacy of percutaneous transluminal angioplasty (PTA) in non‐maturing Brescia‐Cimino fistulas. Methods: Between January 1997 and December 2003, we treated 22 patients with non‐maturing Brescia‐Cimino fistulas by PTA. Retrospective analysis was performed on the findings of fistulogram, techniques and success rate of PTA, and patency rate. Results: Seventeen segmental stenoses and 5 segmental occlusions of cephalic veins were identified. Sixteen stenoses and 2 occlusions were located at the cephalic vein adjacent to the anastomosis site, and 3 occlusions and 1 stenosis were seen at the proximal vein near the elbow joint. In addition to venous stenosis, a focal arterial stenosis at the anastomosis site and two accompanying accessory veins that might hamper maturation of main cephalic vein was seen in each of two patients, respectively. Simultaneous occlusion of left innominate vein as well as occlusion of cephalic vein were noted in one patient. Initial success rate of PTA was 95.5%(21/22). Overall success rate including 11 additional PTAs performed during follow‐up was 96.9%(32/33). No major complication occurred. Primary and secondary patency rates were 72% and 95% at 3 months, and 50% and 77% at 6 months, respectively. Conclusion: PTA is an effective and safe method in salvaging non‐maturing Brescia‐Cimino fistulas.
Effective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter‐related infections
Authors: Redman N. , Schweon S. , Tokars J. , Jahre J. 
Published: January 2005

Purpose:
Identify practices to reduce HD catheter access related bacteremias (ARB). Methods: Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone‐iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results: The catheter‐associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1, 8.6 (13/151) in Cohort 2, and 4.7 (5/107) in Cohort 3(p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3, 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions: Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed.
Shunt surveillance and occlusion, an analysis of efficiency
Authors: Wijnen E 
Published: January 2005

Introduction:
Vascular access failure is one of the greatest sources of morbidity for chronic hemodialysis patients. Prophylactic and repeated measurement of access flow may be of importance in preventing clotting. The aim of the study was therefore to analyse the cost effectiveness of a shunt surveillance program, which reduces the appearance of occlusion of the vascular access. Methods: The number of vascular access interventions (surgery and radiology) in the period 2001 till 2003 (transonic measurement period, TMP; 63 patients) was compared with a reference period (RP, 1996 till 1998) during which no access flow was measured (58 patients). All measurements were done with Transonic® and interventions according to K/DOQI. Results: During the RP, 123 vascular access operations (0.71 per patient year) were performed because of occlusion, whereas in the TMP 58 vascular access operations (0.3 per patient year) were performed. During the TMP, 298 angiographic measurements were performed (1.6 per patient year) in the RP 177, (1.0 per patient year). In the TMP, 1652 access flow measurements were performed. In order to prevent one shunt occlusion, 21 access flow measurements had to be performed. Total costs in the TMP (summary of angiography, angiography and PTA, hospitalization days, and operation costs) are reduced with 31% compared to the RP; costs per patient year in RP: €2315. Costs per patient year in TMP: €1606. Conclusion: By means of a shunt surveillance program (based on access flow measurement), if necessary followed by angiography, it is possible to reduce the number of acute vascular access occlusions. Although a shunt surveillance program may take up a lot of time for the nursing staff, the beneficial effects, lower costs, and reduced morbidity for the patients outweigh this effort.
A case of plasma component exchange using membrane plasma separator EVACURE™
Authors: Sakaji I. , Kasahara M. , Ishida Y. , Yoshikawa M. , Nitta T. , Matsushima Y. , Iwatani Y. , Yoshimoto A. , Suzuki T. 
Published: January 2005

Objective:
We report a patient with urosepsis, Lleptospira syndrome, TTP‐HUS syndrome, fulminant hepatic failure, vasculitis syndrome and TSS treated with plasma component exchange. Methods: Conditions for plasma component exchange were membrane plasma separator (Evacure EC‐3A), substitute fluid (3 % albumin solution), blood flow rate (150 mL/min), filtration rate (30 mL/min), quantity of substitute fluid (4,600 mL) and anticoagulant (nafamostat mesilate 30 mg/hr). Result: Plasma component exchange in combination with hemodiafiltration induced a rapid remission of both hepatic toxicity and renal failure caused by streptococcal sepsis. Membrane plasma separator evacure EC‐3A allowed the use of 3% albumin solution as substitute fluid. Colloid osmotic pressure temporarily increased after the treatment, but within 24 hours, returned to the same level as before the treatment. Conclusion: Plasma component exchange using a membrane plasma separator may allow the use of albumin instead of fresh frozen plasma (FFP) as substitute fluid, which results in a lower risk of infection.
Factors affecting concentration of citrate in dialyzers when using citrate hemodialysate in vitro
Authors: Baosong G. , Ning N. , Ganglian Y. , Lin G. , Liangqi W. , Ruijun G. 
Published: January 2005

Objective:
To observe the factors that affect the citrate concentration in hollow fiber when using citrate hemodialysate. Methods: By modeling hemodialysis in vitro, we studied 6 types of hemodialyzers at different blood flow rates, different dialysate flow‐rate, and different fluids in vitro to detect the citrate concentration in hollow fiber. Results: The citrate concentrations in different hemodialyzers were F60 > FB‐130UGA > GA‐HP130 > F6 > FB‐130AGA > WS‐70 in turn. The concentrations at different blood flow‐rates were different 100 mL/min > 200 mL/min. Conclusions: The concentration of citrate in hollow fiber is affected by different types of hemodialyzers and different blood as well as dialysate flow‐rates. To achieve anticoagulation when using citrate hemodialysate, we must select suitable hemodialyzer such as FB‐130UGA.
Effect of dialyzer reprocessing on glucose homeostasis
Authors: Ibrahim M.A. , Labib B. , Sallam T. , Sarhan I. , El‐Damasy H. 
Published: January 2005

This study was designed to investigate the possible effect of dialyzer re‐use on glucose hemostasis. Twenty patients with end stage renal failure (including ten non insulin dependent diabetes mellitus [NIDDM]) on thrice weekly hemodialysis (using glucose free dialysate), were studied by serial assessment of blood glucose, C‐peptide, interleukin 1‐B (IL‐IB), Ca, Na and K at zero, 1 and 4 hours (end of dialysis) during hemodialysis on new, and then on re‐used (first) cuprophane dialyzers. Our results showed significant rise of C‐peptide, IL‐1B with drop of blood glucose in first hour sample (and was symptomatic in some diabetics) in both groups when using new dialyzers but these changes were less marked and totally asymptomatic when using reprocessed dialyzers. In addition there was a significant positive correlation between IL‐1B level and C‐peptide at 1 and 4 hour samples and negative correlation between IL‐1B and blood glucose at 1 and 4 hour samples.
Conclusion:
Through the effect of IL‐1B on insulin release curophane dialyzers can affect glucose homeostasis especially in diabetics and hypoglycemia might be part of the first use syndrome. It may be recommended that measurement of glucose effect of dialysis membrane on glucose homeostasis might be an important parameter of membrane bioincompatibility.