bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Vitamin E Dialyzer Membrane on Anemia in Hemodialysis Patients
Authors: Kirmizis D. , Papagianni A. , Belechri A.M. , Alexopoulos E. , Memmos D. 
Published: December 2004

Red blood cell (RBC) survival in patients on chronic maintenance hemodialysis (HD) has been reported to be shortened due to the oxidative damage of RBC membrane. The use of antioxidants might help in the control of anemia and reduce the erythropoietin (EPO) dose needed.Objective:  The objective was to determine the effects of vitamin E‐bonded dialyzer membrane (VEM) on anemia and EPO requirements in chronic HD patients.Patients and methods:  We prospectively studied 19 stable patients on HD (8 males, age 58.47, range 31–76 years) who were shifted from other dialyzer membranes to VEM for 6 months. At baseline they were given a mean dose of EPO of 90.6 ± 51 U kg–1 BW–1 week–1. Clinical data, dry body weight corrected pre‐dialysis RBC, hemoglobin, reticulocytes, serum iron and ferritin, complete biochemistry, iPTH, and CRP were studied at 3 and 6 months, while therapy scheme was reevaluated monthly.Results:  A significant rise, compared to the baseline, was found in hemoglobin and in RBC at 3 months of treatment (12.44 ± 1.16 g/dL vs. 11.2 ± 1.2 g/dL, p = 0.002; and 4.01 ± 0.53 × 106/μL vs. 3.64 ± 0.5 × 106/μL, p < 0.05) and at the end of follow‐up (12.17 ± 1.33 g/dL vs. 11.2 ± 1.2 g/dL, p < 0.05; and 4.03 ± 0.53 × 106/μL vs. 3.64 ± 0.5 × 106/μL, p < 0.05). No significant change in serum iron and ferritin, reticulocytes, EPO dose used, iPTH, Kt/V, or CRP was found at the end of follow‐up compared to the baseline (68.8 ± 17 mg/dL vs. 67.9 ± 18 mg/dL, p = NS; 421 ± 296 mg/dL vs. 478 ± 359 mg/dL, p = NS; 3.76 ± 0.89 × 104/μL vs. 3.82 ± 0.78 × 104/μL, p = NS; 90.2 ± 53 U kg–1 BW–1 week–1 vs. 90.6 ± 51 U kg–1 BW–1 week–1, p = NS; 157 ± 43 pg/dL vs. 148 ± 56 pg/dL, p = NS; 1.21 ± 0.22 vs. 1.2 ± 0.17, p = NS; 7.15 ± 5.42 mg/L vs. 15.38 ± 29.8 mg/L, p = NS, respectively).Conclusions:  Despite the small number of patients and the short time interval of treatment, an antioxidant effect of VEM apparently achieved early a better control of anemia in HD patients.
Establishing a Home Nocturnal Hemodialysis Program: “Starting From Scratch”
Authors: Hryciw E. , Courtney M. , Herian N. , Wales L. , Bainey C. , Adams C. , Foster J. 
Published: December 2004

Purpose:  In April 2001, the Northern Alberta Renal Program (NARP) in Edmonton, Alberta received a government grant to start a Home Nocturnal Hemodialysis program for 17 patients. At that time NARP did not have a home program, so the challenge was to develop and operationalize the program and to stay within the requirements related to the grant.Methods:  We describe our experience with specific reference to funding, infrastructure, human resources, monitoring, and the target population.Results:  Funding from the grant allowed space for one dialysis teaching station and clinic area. A multidisciplinary team of a nurse, technician, social worker, and dietitian were recruited. New procedures were written, and new manuals were prepared for teaching. Several new machines were evaluated. The Bellco Formula machine from Genpharm was chosen. This machine had very limited use in North America and had never been used in a home program or a nocturnal program with monitoring. Initiating the monitoring proved to be one of our main challenges. We initiated monitoring with Capital Health Link, the telephone health information line for our region, to provide the observers for the monitoring. Initially the program was intended to serve people who lived in remote areas not serviced by a satellite hemodialysis unit, but in a population of 600 dialysis patients we were having difficulty recruiting. We widened the criteria and expanded our marketing strategy. Based on a survey of other programs and a patient satisfaction survey, we discontinued the monitoring after one year as it did not prove clinically beneficial and patients viewed it as restrictive.Conclusion:  Through perseverance and teamwork we were able to establish this innovative program “from scratch.” We received an award for innovation from our health authority in 2003. The program now has 15 patients at home enjoying the benefits of home nocturnal hemodialysis, and we are expecting to expand the program. The evaluation to date is encouraging with respect to this therapy being clinically more effective than conventional dialysis and an improved quality of life for the patients.
Long‐Term Transport Study of Bioartificial Tubule Devices in the Development of a Bioartificial Kidney
Authors: Saito A. , Aung T. , Terashima M. , Kakuta T. 
Published: December 2004

Introduction:  A bioartificial kidney, which consists of a continuous hemofilter and a bioartificial tubule device using proximal tubular epithelial cells (LLC‐PK1), is desired to develop for preventing long‐term complications in hemodialysis patients. A bioartificial tubule device should function for a long duration in terms of the simplicity and the economy. Continuous hemofiltration with 10 L/day of filtrate could maintain plasma urea, creatinine and β2‐microglobulin in patients at low levels compared to those in standard hemodialysis patients.Methods:  6 bioartificial tubule devices, in which LLC‐PK1 cells were grown on the inner surfaces of hollow fiber capillaries (membrane area: 0.4 m2, 1600 fibers), were used to evaluate the transport ability of H2O, glucose and Na+, and leak rates of urea and creatinine for 2 weeks when the medium containing 50 mg/dL of urea and 5.0 mg/dL of creatinine was perfused inside of the cell‐attached membranes and another medium containing 2.5 g/dL of albumin was perfused outside of the membranes. Scanning electron micrograph of cross‐sectional findings of the hollow fibers was taken at 6, 10, and 14 days after formation of confluence.Results:  By conversion into 1 m2 of membrane area, transport of H2O, glucose, and Na+ was 6266 ± 995 mL/day, 22832 ± 7240 mg/day, and 941.3 ± 180 mEq/day, respectively at 6 days after confluence. Leak rates of urea and creatinine across the cell‐attached membranes were 22 ± 6.1% and 19.2 ± 4.9 with albumin addition, whereas 13.1 ± 1.9% and 12.2 ± 1.6 without albumin addition. Transport capacity of these components and the leak rates had continued for 10–13 days, and decreased thereafter because of the formation of the multilayers. Bioartificial tubule devices with membrane area 1.0 m2 can reach the targeted amounts of H2O, glucose, and Na+ transports when 6 L of 10 L/day of hemofiltrate has to be regenerated, substituting 4 L with meal and drinks.
Blood Compatibility and Filtration: Characteristics of Newly Developed Polyester Polymer Alloy Membrane
Authors: Yamashita A.C. , Tomisawa N. , Takesawa A. , Sakurai K. , Sakai T. 
Published: December 2004

Many synthetic polymeric membranes have been widely used for blood purification therapies. Among them polyester polymer alloy (PEPA) membrane shows unique blood compatibility and filtration characteristics.Objective:  To evaluate blood compatibility and filtration characteristics of 3 different PEPA membranes, including FLX (PEPA only), FDX (PEPA with polyvinylpyrrolidone, (PVP) as a hydrophilic agent), and FDY (PEPA with PVP) that has larger pore diameter.Methods:  Ultrafilters with 3 PEPA membranes (FLX, FDX, FDY, Nikkiso, Tokyo) were compared with those with polysulfone (PS; NK‐PS, Nikkiso, Tokyo) for blood compatibility in vivo. Also, ultrafilters with PEPA, PS, and cellulose triacetate (CTA; FB‐110GA, Nipro, Osaka) membranes were also investigated for filtration characteristics of albumin in aqueous in vitro.Results:  FDY, the latest version of the three PEPA, showed excellent small changes in C5a concentration during the treatment right after switching from PS membrane, leaving no significant changes in other biocompatible indices. First 60 min of the time course of s.c. for albumin were shown below taken under aqueous low albumin concentration, i.e., 2.42 × 10−3 kg/dm3. The time‐dependent patterns were totally different from each other in 5 filters. Generally speaking, PS takes a peak value 20–40 min after starting the experiment, depending on the flow conditions. Since PEPA is a hydrophobic material, it showed high s.c. for albumin in FLX (PEPA with no PVP) and never reached plateau. With a hydrophilic agent (PVP), the s.c. greatly reduced in FDX and showed little time‐dependent change. By enlarging the pore diameter in FDY, the s.c. increased in accordance with the enlargement.Conclusion:  Newly developed PEPA with PVP has excellent blood compatibility and has unique separation characteristics for albumin.
Hepatocyte Growth Factor and Viral Load Variations in HD Session, Comparison with Molecular Absorbent Recirculating System (MARS) Therapy
Authors: Barril G. , Bartolomé J. , Ruiz M.P. , Sanz P. , Traver J.A. , Selgas R. , Carreño V. 
Published: December 2004

A decrease in hepatitis C viral load in HD patients along HD sessions has been described. It has also been proposed that hepatocyte growth factor (HGF) stimulation by HD could have some protective effect in hepatitis C virus (HCV) liver disease outcome.Aims:  (i) Measurement of HCV viral load variation and quantitation of HGF stimulation in CKD patients (HCV+ and HCV–) on HD, along the HD session. (ii) Study whether albumin HD (MARS) decreases HCV viral load and stimulates HGF, compared to HD sessions.Methods:  We performed two MARS and two HD sessions in vitro by using an extracorporeal circuit with blood bag contaminated with HCV serum with a known HCV viral load. (We used only a single blood bag for each testing.) In vivo we performed three MARS sessions. The total number of treatments was 6 in 2 patients (3 treatments each) and one HD session in 2 HCV+ patients and 5 HCV– patients (included in HD program in our center), taking samples at the start of the following HD session, to compare the results with those obtained in vitro. We took samples at the beginning, middle, and at the end of MARS sessions in vivo and in vitro and starting (15 min) and at the end and before starting the following HD session in vivo. (The interval between 2 HD sessions in HCV+ patients was 2 days.) We determined HCV viral load using Amplicor (Roche) and HGF using ELISA (R&D System).Results:  We found a decrease of viral load in vitro and in vivo both by MARS and HD. HD in vitro: ×decrease HCV viral load, 54.67%. HD in vitro × decrease viral load 30.6% × HD in vivo. We found a decrease of 30% in viral load, remaining 27.9% lower at the start of the following session. MARS in vitro: ×viral load decrease 3% (1 session in 2 experiments). MARS in vivo: ×viral load decrease of 44.5% (6 sessions in 2 patients). We did not find HCV viral load in ultrafiltrate or albumin from MARS procedure. Analyzing HGF stimulation we found the following:

MARS in vitro:
start, 1001; 15 min, 1537; final, 1981

HD in vitro:
start, 476; 15 min, 677; final, 1236

HD in vivo:
start, 2808.57; ×15 min, >8000; final,

2605.28; ×start the following session, 2299.5

MARS in vivo:
HGF starting (first session, 4633; second session,   4390; third session, 4775); at 4 h (first session, 5443; second session, 4167; third session, 5178); final (first session, 4477; second session, 6167; third session, 5078).

Conclusions:  MARS and HD sessions decreased HCV viral load and stimulated HGF both in vitro and in vivo. It is necessary to confirm these results because it could offer protective effect for HCV chronic liver disease outcome. HD seems to be the best option for patients with HCV hepatopathy. On the other hand, patients with liver disease who need to be treated with MARS could obtain not only a good clearance of toxin binding to albumin, but also the positive effects described.
Prevalence of Hepatitis (A–E) and HTLV‐I/II Infection Markers in Hemodialysis Patients of Central Greece
Authors: Stefanidis I. , Zervou E.k. , Rizos C. , Liaskos C. , Zarogiannis S. , Liakopoulos V. , Kyriakopoulos G. , Dalekos G.n. 
Published: December 2004

Objective:  The aim of this study was to assess the prevalence of serological and molecular markers of hepatitis (A–E) and human T‐lymphotropic viruses (HTLV) in hemodialysis (HD) patients of central Greece.Methods:  370 patients (246 males, 60 ± 14 years) attending the renal units (RUs) of central Greece (n = 5) were tested for anti‐HAV IgG, hepatitis B virus markers, anti‐HCV, anti‐HEV, and anti‐HTLV‐I/II with ELISA. In 131 casual samples, regardless of anti‐HCV status, a sensitive, qualitative HCV‐RNA assay (Versant®, Bayer) based on transcription‐mediated amplification (TMA) was applied.Results:  Previous HBV infection (anti‐HBc) was found in 48% and current HBV infection in 5.5% (HbsAg) of the patients. Anti‐HAV was detected in 94% while anti‐HDV and anti‐HTLV were negative. Anti‐HCV prevalence was 23% varying from 11 to 36% in the different RUs. Frequency of anti‐HEV (4.1%) was also highly varying (1.4–9.8%). There was no association between the infection markers and age, sex, or history of transfusion. Anti‐HCV correlated with duration of HD. HCV‐RNA was detected in 44/131 samples. In 15 cases results of anti‐HCV and TMA were contradicting. Two anti‐HCV negative samples were HCV‐RNA positive (2.3%).Conclusion:  In RUs of central Greece, a high prevalence of HCV infection was found, associated with the duration of HD. The high prevalence of anti‐HEV found in 1 RU must be investigated further. In some of anti‐HCV‐negative patients viremia was detected. This result indicates that a considerable number of HCV infections are serologically occult. HCV‐RNA testing, regardless of the anti‐HCV status, has to be considered seriously in HD patients.
6 Month Experience with 1 Nurse Training 2 Patients Together for Nightly Home Hemodialysis
Authors: Pipkin M.F. , Lockridge R.S. , Spencer M.O. , Craft V.W. , Campbell D.L. 
Published: December 2004

Objective:  To have 1 nurse successfully train 2 patients at a time for nightly home hemodialysis (NHHD) within a 7–10 week time period.Methods:  Over the past 6 years, Lynchburg Nephrology Dialysis Inc. has evolved its NHHD program from 1 nurse training 1 patient during an average 6 week period to training 2 patients in a 7–10 week period. Patients came either from our in‐center population or directly from internal medicine. Our pre‐evaluation procedures and manual were revised. Patients were pre‐evaluated for literacy, manual dexterity, strength, hearing and visual deficits, substance abuse, psychiatric disorders, and compliance before being accepted into the program. A home visit was made to evaluate their environment, family interactions, and water source. Our training manual was rewritten to fifth grade level. Every patient was given index cards printed in 20 size font with step‐by‐step procedures for machine setup, put‐on and takeoff, re‐circulation, and power failure. Patients were dialyzed 4 days/week to improve cognitive function and ‘dialyzed the bucket’ 1 day, thus training 5 days/week. One nurse trained 2 patients, staggering their start dates 2 weeks apart to allow for both individual and group teaching. Fistula or IJ catheter was used for access. Patients were trained alone or with a partner. In the last week of training, patients were dialyzed for 7 h and were expected to complete all procedures independently.Results:  From March 2003 to August 2003, 6 patients were trained for NHHD. 2 patients finished training in 7 weeks, 2 in 9 weeks, and 2 in 10 weeks.Conclusion:  One nurse can successfully train 2 patients at a time for NHHD in a 7–10 week time period at a decreased cost to dialysis provider.
Hospital‐Based Nocturnal Hemodialysis—A Novel Approach to Solving Old Problems
Authors: Campbell J. , Hobbs D. 
Published: December 2004

It is unlikely that there is a solitary hospital‐based dialysis unit that can claim an unlimited amount of available chronic spots. Many units, in fact, constantly face a problem of overcrowding, long patient waiting lists, and ongoing shortages of nurses trained in highly specialized areas such as dialysis. In addition, conventional dialysis does not afford the best outcomes to patients with lifestyle, fluid control, hypotension, or hypertension issues.Objective:  We developed an in‐hospital nocturnal program with the goal of solving some of these issues related to wait lists, overcrowding, and shortages of trained hemodialysis nurses.Method:  In the first year, a four‐bed room was converted into a 4 station unit. Nurses from the 24 bed in‐patient Nephrology/Urology/Ophthalmology unit were trained to perform hemodialysis. Stable, hospitalized dialysis patients or in‐center dialysis patients were selected if they met criteria drawn up by the medical director. Staffing for the unit was established at 3 : 1 or 4 : 1 patient to nurse ratio. Support staff included a hemodialysis‐trained ward nurse with an assignment of 5–6 hospitalized patients. Back‐up support included assistance with trouble‐shooting and break coverage for the nocturnal nurse.Results:  We currently have 12 nurses from the ward trained to do hemodialysis. The nocturnal unit has been operating 3 nights/week, with plans to expand to 6 nights/week within the year. We have 3 patients on the program with plans to increase to 6–8 patients as more nurses are trained. Initiation of hospital‐based nocturnal hemodialysis has led to the opening of in‐center dialysis spots as well as shortening wait periods for patients in the Pre‐Renal Clinic, awaiting initiation of chronic dialysis. This model has also provided the in‐center dialysis unit with a greater pool of skilled hemodialysis nurses to draw from during shortages. Anecdotal reports from patients indicate that they feel much better, and 1 patient no longer requires antihypertensives for their blood pressure control.Conclusion:  We conclude that hospital‐based nocturnal hemodialysis is a novel and extremely viable solution for many of the issues facing dialysis units today.
Quality of Life in Chronic Hemodialysis Patients
Authors: Kirmizis D. , Belechri A.m. , Giamalis P. , Zolota A. , Karabatakis P. , Zabioglou G. , Memmos D. 
Published: December 2004

Purpose:  Quality of life (QoL) is a well‐recognized important measure of therapy outcome, as it reflects what patients perceive as their health condition. The aim of this study was to estimate the QoL in patients on HD and to find the factors that mainly affect it.Patients and Methods:  We studied 70 patients on HD (38 male, age 57.86 ± 14.63 years) with the use of kidney disease quality of life short form. Physical health (PH), mental health (MH), kidney disease issues (KDIs), and patient satisfaction (PS) were assessed, as well as Khan comorbidity index, adequacy of dialysis, nutrition, and epidemiologic and laboratory data.Results:  PH was significantly correlated with comorbidity (p < 0001), age (p < 0001), duration of HD (p < 0001), serum albumin (Salb) (p < 0005), the existence of a living relative donor (p < 0001), Hb (p < 0.01), and CRP (p < 0.01). MH was significantly correlated to comorbidity (p < 0001), age (p < 0001), duration of HD (p < 0001), Salb (p = 0002), the existence of a living relative donor (p < 0001) and Hb (p < 0.01). KDI score was significantly correlated with comorbidity (p < 0001), age (p < 0001), duration of HD (p < 0001), and Hb (p < 0.05). The acceptance of the method was significantly lower in patients with AVF dysfunction (p < 0005). As much as 44.3% of patients presented inadequate compliance to dietary and fluid restrictions.Conclusion:  Frequent QoL assessment in patients on HD is a useful tool for professionals involved in patients' care. Older age, long time on HD, malnutrition, elevated CRP, and comorbid conditions are correlated to lower QoL scores.
Health‐Related Quality of Life in Hemodialysis Patients in Taiwan
Authors: Chiang C‐K. , Peng Y‐S. , Chiang S‐S. , Yang C‐S. , He Y‐H. , Tsai T‐J. , Chen W‐Y. 
Published: December 2004

Background:  Health‐related quality of life (HRQOL) is an important outcome of medical treatment effectiveness.Objectives:  Thirty‐six item short‐Form (SF‐36) first has been used in hemodialysis (HD) patients in Taiwan.Method:  HRQOL was measured by using SF‐36 in 497 HD patients in 5 hospitals.Results:  Male sex, age less than 50 years, higher education level (EL), marriage, employed status (EPS), less comorbid medical condition (CMC), and non‐diabetic patients were all predicted a better physical component scale (PCS). Age less than 50 years, BMI greater than 18.5, HEL, EPS, and NDP were all predicted a higher mental component scale (MCS). Scales contributing to a summary measure of physical health, the PCS score, was significantly lower in women (35 ± 12.3) than in men (37.9 ± 12.3). There is no difference in MCS score between women and men. In multivariate analysis, age, CMC, diabetes, serum creatinine (SCr), and erythropoietin responsiveness were significant independent predictors of PCS. Diabetes, EL, SCr, and erythropoietic responsiveness were significant independent predictors of MCS. All of the individual scales, PCS and MCS scores were lower in the Taiwan HD patients than values for the US general population. Each of the individual scales and MCS scores were substantially lower in Taiwan HD group than in the US HD cohort. But the bodily pain of PCS was significantly higher in Taiwan HD group in spite of mean PCS scores for Taiwan HD group and US HD study participants were nearly equal at 36.3 and 36.1, respectively.Conclusion:  Physical and mental aspects of quality of life are substantially reduced among Taiwan HD patients, but higher bodily pain tolerance. A number of demographic and clinical characteristics significantly impact on HRQOL in Taiwan HD patients. To our knowledge, this is the first time we demonstrate the HRQOL by using SF‐36 in Chinese HD patients.
Sickle Cell Ulcer in Hand Attributable to Arterio‐Venous Fistula
Authors: Halker R. , Agraharkar M. 
Published: December 2004

Introduction:  Sickle cell ulcers are a frequent dermatologic manifestation of sickle cell disease. They are almost exclusively described in the legs near the malleoli and are often bilateral. Such ulcers in the upper extremities are not described. We report a case of sickle cell ulcer in hand presumably related to arterio‐venous fistula in the forearm placed for hemodialysis in a patient with chronic kidney disease.Case:  A 45‐year‐old African‐American man with a history of sickle cell disease, hypertension, and kidney failure treated with hemodialysis presented with a painful wound in his left hand near the base of his thumb, which had been present for 6 weeks prior to presentation. There was no history of trauma. 6 months prior to the development of the ulcer, the patient had an arterio‐venous fistula placed in the affected hand. The ulcer did not improve with use of antibiotics. Venous ultrasound of the left upper extremity showed occlusion of the cephalic vein and enlargement of the basilic vein. Subsequently, biopsy of the ulcer showed vascular proliferation with thickening of the vessel and obliteration of the vascular lumen. The blood vessels were plugged with sickled red blood cells, characteristic of sickle cell disease. Histological features of the lesion were indicative of vaso‐occlusive disease, suggesting sickle cell ulcer. Patient was treated with surgical débridement and skin grafting after hyperbaric oxygen therapy that only resulted in partial recovery of the lesion.Discussion:  The pathogenesis of sickle cell ulcer is presumed to be related to a vaso‐occlusive process, leading to tissue necrosis resulting in skin ulcers. Ulcers can occur spontaneously or with local trauma. Low oxygen‐carrying capacity of the blood, impaired venous hemodynamics, and low hemoglobin are recognized contributing factors. The arterio‐venous fistula causing diversion of arterial blood probably contributed to the development of sickle cell ulcer.Conclusion:  Sickle cell ulcers in the hand, although extremely rare, can occur in sickle cell patients with chronic kidney disease on hemodialysis with arterio‐venous fistula. This results from the altered local vascular hemodynamics that predispose to vaso‐occlusive conditions, eventually leading to ulceration.