bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parathyroid hormone and biochemical profile in chronic kidney disease patients in South India
Authors: Sankarasubbaiyan Suresh , Abraham Georgi , Soundararajan P , Chandrasekaran V , Padma G 
Published: January 2005

AbstractRenal osteodystrophy is an important complication of chronic kidney disease characterized by abnormal bone turnover with varied bone histologic changes. Etiology is multifactorial including abnormalities of serum calcium, phosphorus, and 1,25(OH)2‐vitamin D deficiency; secondary hyperparathyroidism; age; cause of kidney disease; diet; renal replacement therapy; and drug therapy. In addition, there is evidence that there may be ethnic differences. Our study is a description of a case series of hormonal and biochemical abnormalities of bone disease in end‐stage renal disease patients in South India. A total of 115 patients were studied; 86% were on hemodialysis and 14% were on peritoneal dialysis (age, 47.31 ± 14.66 years). Sixty‐eight% were men. Diabetes was the cause of end‐stage renal disease in 29.5%. Intact parathyroid hormone (PTH) level was 124.6 ± 174.9 pg/mL and less than twice normal in 69.5% of patients. Hypocalcemia was present in 16.5% and hyperphosphatemia in 35.7% of patients. Empirical vitamin D was prescribed in 40% of patients. Age, sex, diabetic status, and vitamin D use were similar in patients with high PTH (130 pg/mL) and low PTH levels (< 130 pg/mL). Bone histologic studies were not performed owing to economic limitation. But the biochemical and hormonal results are suggestive of a mild form of osteodystrophy in Indian patients. Etiology remains uncertain but differences in dietary intake, tropical climate, vitamin D activation, vitamin D receptor polymorphism, parathyroid gland sensitivity, and PTH target organ sensitivity may account for the difference in pattern in bone disease.
Clearance of small molecules in different dialyzer flow configurations
Authors: Eloot S. , De Vos J.Y. , Hombrouckx R. , Verdonck P. 
Published: January 2005

To overcome problems of insufficient clearance, multiple dialyzers may be placed in series or in parallel. The present study aimed to investigate in vitro the overall clearance of small molecules in different dialyzer configurations in which mutual flow directions were changed.Single pass tests were performed with low flux Fresenius F6HPS dialyzers placed in series (12 tests), in parallel (6) and in single use (2). As blood substitute, either high concentrated (45 mS) bicarbonate dialysate (AB solution – MW20‐180) or a trisodiumphosphate (Na3PO4– MW395) concentration (30 mS) was used. Standard blood and dialysate flows of 250 and 500 mL/min, respectively, were applied. Furthermore, clearance was derived from conductivity measurements in the inlet and outlet bloodline, correcting for the overall ultrafiltration rate of 0.5 L/h (AB) and 0.1 L/h (Na3PO4).Compared to the standard setup using a single dialyzer with counter current flows, clearance increases by 3 to 8%(AB) and by 15 to 18%(Na3PO4) using two dialyzers in parallel and in series, respectively. With co‐current flows in a serial dialyzer set up, clearance increases by 16%(AB) and 22%(Na3PO4) compared to the single dialyzer use. Changing subsequently the counter current flows to co‐current in one and both dialyzers in series, the overall clearance decreases by 2 to 9%, respectively, for the AB solution, and by 8 to 15% for the Na3PO4 concentration. With respect to the parallel dialyzer setup, a split dialysate flow (250 mL/min in each dialyzer) counter current to the blood flow, increases the clearance by 4 and 12%, respectively.In conclusion, overall clearance is most ameliorated using two dialyzers in series with counter current flows.
Effectiveness of catheter hub sanitation prior to dialysis
Authors: Bousquet G 
Published: January 2005

Purpose:
Contamination of catheter hub connectors is known to cause catheter‐related blood stream infections in patients undergoing hemodialysis via central venous catheters (CVC). The effectiveness of cleansing the hub with an antimicrobial agent was assessed by culturing the surface of the hub following sanitation. Methods: The CVC hub connectors of 24 patients were sanitized using the standard hospital protocol of aseptically swabbing the connectors with a solution of bleach or Betadine, and then bathing the hub in sterile gauze soaked with the antimicrobial solution for 5 minutes. The exterior surface of the hub was then cultured for a broad spectrum of microorganisms. Patients were monitored for exit site infection, tunnel infection, and septicemia. In the laboratory, sterile hubs were inoculated with E. coli, staph. aureus neg., and yeast. Hubs were then immersed in Betadine for 5, 10, or 30 min. and cultures were taken. Results: Positive cultures were obtained from the hubs of 17 of the 24 patients. Seven (7) of the patients with positive results developed bacteremia from the cultured organism within 7 weeks. Positive cultures were obtained from 50% of inoculated lab samples after 5 min, 10% after 15 min, and 0% after 30 min. of immersion sanitation. Conclusions: The techniques for cleansing CVC hubs should be revisited.
Clinical Experiences  High‐flux hemodialysis in the treatment of severe valproic acid overdose: A case report
Authors: Chebrolu S.B. , Hou S.H. , Kjellstrand C.M. , Ing T.S. , Hines VA 
Published: January 2005

Introduction:
Hemoperfusion, with or without hemodialysis, has been used to treat patients suffering from severe valproic acid poisoning. We report a patient suffering from severe valproic acid intoxication who was treated effectively with high‐flux hemodialysis alone. Case: A 20‐year‐old man with a history of bipolar disorder was admitted after having ingested unknown amounts of valproic acid (Depakote®), prednisone, and erythromycin. He was agitated and obtunded but hemodynamically stable initially. Serum valproic acid level was 1,028 μg/mL. Urine toxicology screen as well as serum levels of ethanol, acetaminophen, and acetylsalicylic acid levels were negative. A gastric lavage was followed by activated charcoal instillation. Subsequent myoclonic twitchings that progressed to continuous seizure activity were managed with intravenous lorazepam therapy and endotracheal intubation. Serum valproic acid value measured two hours after admission remained elevated at 1,046 μg/mL. Hemodialysis was performed continuously for 10.5 hours using a high‐flux, polysulfone dialyzer (Polyflux 21S, Fresenius Medical Care, Lexington, MA), a dialyzer blood flow of 200–300 mL/min, and a dialysate flow of 500 mL/min. The therapy brought about a fall in serum valproic acid level to 110 μg/mL and a complete recovery of the patient. Discussion: Valproic acid (144 Dalton) is 90–95% protein‐bound at therapeutic serum values. However, in the face of an overdose, the unbound fraction rises because of saturation of protein‐binding sites. This unbound fraction is readily dialyzable. We suggest that high‐flux hemodialysis is effective in the treatment of severe valproic acid poisoning.
Hemodialysis‐induced acute pancreatitis secondary to kinked hemodialysis blood lines
Authors: Abtahi M. , Uzan M. , Souid M. 
Published: January 2005

Introduction:
Hemolytic reactions developing during hemodialysis usually are caused by oxidant damage, reduction injury, and osmolar, thermal, and mechanical injury to the red blood cells. Mechanical injury due to maloccluded blood pumps, arterial line collapse, and use of subclavian hemodialysis catheters has been reported. We report one episode of acute hemolysis due to kinked hemodialysis blood lines complicated with pancreatitis. Case Report: An 18‐year‐old man with end‐stage renal failure of unknown origin had been on hemodialysis since 2002. His past medical history included asthma and hypertension. He was admitted to the hospital because of severe abdominal pain, nausea, and vomiting during the dialysis session. Laboratory examination showed hematocrit −30 %, platelet count of 131,000 per cubic mL, LDH −5151 U/L, haptoglobin −0.09 g/L, lipase −919 U/L, CPK‐ 260, ASAT −584 U/L, ALAT‐ 316 U/L, bilirubin −36 μmol/L, and visible schistocytes on smear. Examination of the abdomen revealed diffuse discomfort and tenderness in epigastrium. The patient was diagnosed as having hemolysis‐induced acute pancreatitis. He was treated symptomatically and recovered within a few days. We found the arterial blood line tightly kinked at the dialyser inlet port, and we excluded other reported causes of intravascular hemolysis during hemodialysis. Discussion: Until a critical pressure is exceeded, despite a kink in the post pump predialyser blood tubing, the blood pump can maintain sufficient blood flow to prevent an increase in the arterial pressure with a triggering of the arterial alarm and a decrease in the venous pressure with a triggering of the venous alarm. Thus, an excessively high pressure can be maintained in this silent segment of the dialyser tubing without activating the pressure alarms, exposing the red blood cells to high sheer stresses and resulting in clinically significant hemolysis. Acute hemolysis can cause a life‐threatening acute pancreatitis. The literature indicates that acute pancreatitis is a complication of massive hemolysis with a prevalence of about 20%. The important role of inflammatory cytokines in the pathogenesis of acute pancreatitis is well known. Heme released from hemoglobin after episodes of vascular hemolysis has the potential to act as a signalling molecule involved in the triggering of the inflammatory processes associated with massive hemolysis. Hemolysis itself may induce acute pancreatitis by all or some pathways of neutrophil activation and chemoattraction, such as oxidative burst, direct proinflammatory effect, microcirculatory disturbance, and increased expression of proinflammatory and immunoregulatory cytokines.
Cutting balloon angioplasty for resistant venous stenoses in hemodialysis patients
Authors: Jung H.W. , Kim Y.O. , Song H.H. , Park J.A. , Kim Y.S. , Kim S.Y. , Choi E.J. , Chang Y.S. , Bang B.K. 
Published: January 2005

Purpose:
To report our initial experience of using cutting balloons angioplasty in the treatment of resistant venous stenoses of Brescia‐Cimino fistulas. Materials and Methods: Forty‐eight patients with Brescia‐Cimino fistulas underwent percutaneous transluminal angioplasty (PTA) of 62 venous stenoses. Of these 48 patients, we encountered 8 venous stenoses (8/62, 12.9%) in 7 patients that were not successfully dilated with 6–8 mm high‐pressure balloons inflated up to 24 atm. In each of 8 stenoses, peripheral cutting balloons with diameters of 5–8 mm were employed to dilate resistant stenoses. Results: The locations of stenoses were 3 at the surgical vein mobilization site (“swing point”), 4 at the cephalic vein downstream from the anastomosis, and 1 at the cephalic arch. The grade of stenosis after high‐pressure balloon angioplasty ranged from 57% to 87%(mean, 76%). Cutting balloons expanded completely in all stenoses and the residual stenosis after cutting balloon PTA ranged from 0% to 24%(mean, 7%). Residual stenosis was virtually nonexisistent at the 3 stenoses of “swing point.” A focal rupture with a large hematoma occurred at the cephalic arch stenosis, which was treated by a stent placement. One minimal rupture that did not require any treatment occurred at the stenosis of downstream cephalic vein. No repeat angioplasty has been needed during follow‐up period (range, 74–249 days). Conclusion: Our early experience demonstrated that when high‐pressure balloons fail to dilate stenoses of Brescia‐Cimino fistulas, peripheral cutting balloons with diameters of 5–8 mm can be effectively used to overcome the resistance of stenoses.
Role of bicarbonate dialysis in prevention of serious arrhythmias in high‐risk cardiac patients undergoing regular hemodialysis
Authors: El Sharkawy M.M. , Shaalan H.S. , Okasha N. , El Gendy M.F. 
Published: January 2005

Background:
Cardiac arrhythmias are considered as one of the most important causes of mortality in patients on hemodialysis. Arrhythmias frequently occur in patients with chronic renal failure on regular hemodialysis with reported incidences varying from 30–48% of patients. These abnormalities can span from supraventricular to severe ventricular arrhythmia. There is an increased frequency of occurrence and clustering of arrhythmias around the dialysis time. Aim of the study: To detect the difference between acetate and bicarbonate dialysis as regard to the type and frequency of arrhythmia in those patients. Study design: This study was done on 20 male patients age 51–73, all have history of heart disease. Patients were divided into 2 equal groups using acetate in group 1 and bicarbonate in group 2. All patients were on regular hemodialysis (4 hours, thrice weekly). Careful history and clinical examination were done. Pre‐dialysis investigations included serum creatinine, blood urea nitrogen, serum sodium, potassium, calcium and phosphorus, serum albumin, hemoglobin, and arterial blood gases. Post‐dialysis serum potassium and arterial blood gases were measured. ECG and forty‐eight hours ambulatory monitor (Holter monitor)(before, during, and after hemodialysis, till the end of the dialysis day and throughout the following day) were performed. Results: Group 1 showed significantly less post‐dialysis supraventricular arrhythmias than in dialysis day (210.9 ± 236 and 62.3 ± 14.4), respectively. Significantly less ventricular arrhythmias in post‐dialysis than in dialysis day (30.7 ± 50.4, and 106.2 ± 128.4), respectively. While in Group 2 there were insignificant differences regarding supraventricular arrhythmias (21.9 ± 28.9 and 16.6 ± 36.3) and ventricular arrhythmias (22.9 + 7.8 and 29.6 + 12.8) in dialysis day than in post‐dialysis day. There was significantly higher frequency of supraventricular and ventricular arrhythmias in the dialysis day in acetate hemodialysis in comparison to bicarbonate hemodialysis. Conclusion: Bicarbonate hemodialysis is less arrhythmogenic in comparison to acetate hemodialysis and has better effect on the blood pH and greater degree of base repletion. Continuous ambulatory ECG recording (Holter) is a useful tool in detecting arrhythmias in dialysis patients.
Infections  Controlling exit site infections: Does it decrease the incidence of catheter‐related bacteremia in children on hemodialysis?
Authors: Onder A.M. , Chandar J. , Coakley S. , Abitbol C. , Montane B. , Zilleruelo G. 
Published: January 2005

The most common complication of tunneled‐cuffed hemodialysis catheters is catheter‐related bacteremia (CRB), which contributes to patient morbidity and loss of vascular access. Gram positive microorganisms are the most common etiologic agents; coagulase negative staphylococcus and corynebacterium species are the two most prevalent strains in our center. These are the common inhabitants of skin flora, suggesting that infection of catheters occur through the exit site. The Biopatch is a chlorhexidine impregnated dressing designed to keep the exit site from colonization with skin flora. This may decrease the incidence of CRB due to organisms from the skin. Objective: To investigate whether the application of the biopatch at the exit site has any effect on the incidence and the etiology of CRB. Methods: Chart review of 63 pediatric chronic hemodialysis patients who were dialysed between January 1999 and December 2003 was performed. The mean age at start of hemodialysis was 13.9 ± 4.6 years. The pre‐Biopatch era started in January 1999 till the end of June 2001, and the Biopatch era started in July 2001 to December 2003. Biopatch was applied at the beginning of every dialysis week after Betadine cleansing of the exit site, which was then covered with a transparent dressing. In the pre‐Biopatch era, the exit site was cleansed with Betadine at every dialysis session and then covered with a transparent dressing. Results: The use of the Biopatch at the exit site caused a significant decrease in the exit site infections. However, contrary to what was expected, there was no decrease in the incidence of CRB.

Pre‐Biopatch Era
Biopatch Era
p value

Gram positive infections %
76%
76%
NS

Gram negative infections %
10%
14%
NS

Polymicrobial infections %
14%
10%
NS

Total number of infections
108 (19 patients)
143 (29 patients)
NS

Exit site infections‐number
20 (9 patients)
5 (3 patients)
p < 0.05

Conclusion:
The use of the Biopatch decreases exit site infections. However, it fails to decrease the incidence of CRB. It has no effect on the etiologic agent of the bacterial infection.
Sodium citrate as a capping for permacaths
Authors: Scott G.E. 
Published: January 2005

Purpose:
Tunneled catheters as chronic dialysis access is a reality of chronic hemodialysis. Infection of the catheter is an unavoidable complication. We researched the possibility of using Na Citrate as capping because of its anticoagulant effects and bactericidal properties. Methods: Rate of infections per 1000 calendar days with heparin capping was recorded for an eight month period before using Na Citrate. Flows <300 ml/min via catheters were also recorded for an eight month period before Na Citrate use, using treatments per 1000 calendar days. Both these parameters were recorded for an eight month period following the initiation of Na Citrate 4% for all catheters. Results: Our infection rate using heparin was 2.2 infections per 1000 catheter days. Infection rate after use of Na citrate was 1.2 infections per 1000 calendar days. Catheter flows <300 were 5.6 per 1000 calendar days using heparin, and 9.2 per 1000 calendar days after use of Na Citrate. There were no reactions related to Na Citrate, and no symptomatic hypocalcemia. Conclusions: Na Citrate is effective at reducing the number of infections when used as a capping solution for tunneled catheters. Na Citrate–capped catheters had more frequent declines in QB compared with heparin capping. Because of the availability of anti‐thrombolytic agents to preserve catheter patency, Na Citrate makes a safe option as a capping agent for long‐term catheter capping.
The effect of dialysis needle size on hemodialysis adequacy
Authors: Kim Y.O. , Song W.J. , Park J.A. , Yoon S.A. , Kim Y.S. , Chang Y.S. , Bang B.K. 
Published: January 2005

Objective:
Dialysis adequacy indexed by Kt/V in hemodialysis (HD) patients is recommended as a single pool Kt/V at least 1.2 per session thrice weekly. But many patients cannot achieve this adequacy target. Although dialysis time is the most important factor influencing Kt/V, it is difficult to prolong dialysis time in practice because of its economic impact and poor patient compliance. This study was performed to investigate the effect of increasing dialysis needle size on dialysis adequacy in HD patients. Methods: This study enrolled 73 patients receiving HD thrice weekly for more than 3 months with arteriovenous fistula (AVF) or graft in a single center. Dialysis blood flow rate was 200 ml/min in 12 patients, 250 ml/min in 32 patients, and 300 ml/min in 29 patients. Surface area of dialyzer was 1.2 m2 in 56 patients and 1.6 m2 in 17 patients. We first performed HD using a 16‐gauge needle. Then we increased needle size up to 15‐gauge without change of any other dialysis conditions such as blood and dialysate flow rates, dialysis time, or distance between needle insertion sites. We compared compression time after removing the needles, venous dialysis pressure (VDP), Kt/V, and urea reduction ratio (URR) between these two methods. Results: The mean age was 54 ± 13 years and the number of patients with diabetes mellitus was 27 (37%). Fifty‐eight patients (79.5%) have native AVF. Mean Kt/V at HD method using a 15‐gauge needle was higher than at HD method using a 16‐gauge needle (1.30 ± 0.18 vs. 1.23 ± 0.18, p < 0.001). URR at HD method using a 15‐gauge needle was also higher than at HD method using a 16‐gauge needle. In contrast, VDP at HD method using a 15‐gauge needle was lower than at HD method using a 16‐gauge needle (88 ± 22 mmHg vs. 118 ± 28 mmHg, p < 0.001). There was no difference in compression time between the two methods. Conclusion: This study suggests that increasing dialysis needle size is a safe and effective method in improving dialysis adequacy without increasing blood flow rate or dialysis time.
Consideration of free coagulant hemodialysis within our facility
Authors: Ishida Y. , Kasahara M. , Sakaji I. , Yoshikawa M. , Nitta T. , Matsushima Y. , Iwatani Y , Yoshimoto A. , Suzuki T. 
Published: January 2005

Purpose:
Performed free coagulant hemodialysis to patients having hemorrhage with the hope to avoid aggravation of bleeding caused by anticoagulant agent from dialysis. Method:  Examined 19 cases of patients with bleeding tendency, whether it is possible to perform free coagulant hemodialysis by using PAES membrane, EVAL membrane, PS membrane, Cellulose triacetate membrane and Vitamin‐E modified‐dialysis membrane. Result: With PAES membrane, the result showed a non‐ blockade rate of 91% after four hours and 100% after two hours. Therefore, blockade was prevented with a fairly high rate. In cases of blockade, most of them were possibly avoidable with a little contrivance as the reason were lack of establish blood flow rate, faulty position of a needle, etc. Conclusions: By using PAES membrane, it was possible to perform free coagulant hemodialysis. In order to completely have no blockade of blood lines in the future, we must strive further on.
Dialyzer reuse and clinical outcomes—A 3‐year comparison between high flux polysulfone and polyflux® dialyzers
Authors: Sorrill M.A. 
Published: January 2005

Purpose:
This study evaluated improvements in dialyzer reuse parameters and clinical outcomes associated with a CQI project in a hospital‐based dialysis center in which high flux polysulfone dialyzers were replaced with high flux Polyflux® dialyzers (GAMBRO® Renal Products). Methods: Dialyzers were reprocessed using a Renatron® II Dialyzer Reprocessing System in conjunction with Renalin® sterilant (Minntech Corp.). Renalog® RM software was used to track dialyzer reprocessing rates and failures. Reasons for dialyzer failure included inadequate dialyzer volume; excess pressure; appearance; clotting during use; and maximum number of uses reached. The average number of dialyzer reuses with polysulfone dialyzers between January and June 2002 were compared to that achieved with Polyflux® dialyzers for the same periods in 2003 and 2004. Analysis periods were separated to avoid the impact of dialyzer transition on clinical parameters. Achievement of URR goals during these same periods was likewise compared. Results: Transition from polysulfone to Polyflux® dialyzers was associated with a >40% increase in average number of reuses between 2002 and 2003 and a >63% increase comparing the 2002 and 2004 periods. During the 2002 analysis period with polysulfone dialyzers the target URR of 65% was achieved in approximately 75% of hemodialysis patients; this increased to nearly 95% with Polyflux® dialyzers in both the 2003 and 2004 periods, despite more reprocessing of these dialyzers. Conclusions: These results demonstrate an improvement in both reuse efficiency and clinical outcomes associated with Polyflux dialyzers. Identifying clinical products through CQI studies that provide an economic and clinical advantage plays an important role in the success of hospital‐based hemodialysis.