Biomedical subjects

A M Schrander-vd Meer

Publications and source records attributed to A M Schrander-vd Meer.

4 recordsLinked to original sources

PubMed1999

Improved cardiovascular variables during acetate free biofiltration.

BACKGROUND AND AIM: Acetate free biofiltration (AFB) provides a well-tolerated and efficient renal replacement therapy. Replacement of most of the acetate by bicarbonate in standard hemodialysis has resulted in a decrease in intradialytic hypotensive episodes. This has been attributed to a decrease in the acetate-induced impairment of myocardial contractility. The aim of the present study was to investigate whether the total absence of acetate in AFB would further enhance dialysis stability and improve cardiovascular status. PATIENTS AND METHODS: In a long-term, randomized trial we included 11 patients on AFB and 9 patients on bicarbonate hemodialysis (HD) for one year. Patients were matched for age, sex and urea reduction rate, but not for the presence of hypertension or cardiovascular history. During each dialysis session blood pressure was measured automatically and the presence of significant hypotension was recorded. Antihypertensive medication was registered every three months. Before and at the end of the study M-mode echocardiography was performed and left ventricular mass index (LVMi) was calculated. Every six months serum lipids were measured. RESULTS: At baseline, mean arterial pressure (MAP) before and after dialysis, the percentage of hypotensive dialyses, LVMi and serum lipids did not differ between AFB and HD. Pre-dialysis MAP decreased in AFB (from 112.5 to 107 mmHg) and increased in HD (from 101.7 to 105.3 mmHg; p = 0.01, HD versus AFB). Postdialysis MAP remained stable in both groups (AFB 91.6 mmHg at 0 months and 90.6 mmHg at 12 months, for HD respectively 83.9 and 86.5 mmHg, NS). The percentage of hypotensive dialyses did not differ significantly between the groups during the study. LVMi decreased in AFB from 195.4 to 162.1 gr/m2 and increased in HD patients from 153.8 to 182.5 gr/m2 (p = 0.03 HD versus AFB). The number of antihypertensive medications per patient did not differ between groups. Serum lipids remained unchanged during the trial. CONCLUSION: In conclusion, AFB provided better control of pre-dialysis MAP compared to HD, and stable postdialysis MAP. The percentage of dialysis sessions with hypotension did not differ. LVMi decreased significantly in AFB, but rose in HD.

Acetates↗

PubMed1998

Dialysis efficacy during acetate-free biofiltration.

BACKGROUND: Acetate-free biofiltration (AFB) is a haemodiafiltration technique based on continuous post-dilution infusion of a sterile isotonic bicarbonate solution. We performed a long-term randomized prospective trial to compare dialysis efficacy and metabolic control of AFB versus bicarbonate haemodialysis (HD). METHODS: The AFB group consisted of 11 and the HD group of nine patients, matched for age, sex and urea reduction rate. Biochemical parameters were obtained every 3 months for 1 year (haemoglobin, calcium, phosphate, urea, pre- and post-dialysis bicarbonate, and parathormone (PTH)) and medication was updated. Efficacy of dialysis calculated by KT/V using the dialysate sampling method was determined every 3 months. In AFB patients, the infusion rate of bicarbonate solution was adjusted individually to obtain bicarbonate values of > or = 22 mmol/l before dialysis and < or = 32 mmol/l after dialysis. In the HD group, bicarbonate was added as oral medication to match these bicarbonate concentrations. Statistical analysis was performed using ANOVA for repeated measurements. RESULTS: Pre-dialysis serum bicarbonate levels had risen to the same extent in both groups at the end of the study period (AFB from 21.8 to 26.1 mmol/l, P < 0.001, and HD from 20.8 to 24.9 mmol/l, P < 0.001). Post-dialysis bicarbonate level was higher in the AFB than in the HD group (P < 0.01). Calcium and phosphate levels remained stable in both groups. PTH increased in both groups (AFB from 10.6 to 23.7 pmol/l, and HD from 24.6 to 32.8 pmol/l), with a significant rise only in the AFB patients (P < 0.04). In AFB patients, KT/V increased from 2.73 to 3.17 per week (P < 0.04). In HD patients KT/V did not change (P < 0.38); the difference between the groups was significant at the end of the trial (P < 0.013). Finally, haemoglobin levels and erythropoietin dosage did not change in either group. No significant differences between the two groups were observed. CONCLUSIONS: Acidosis was better corrected in AFB without the need for oral supplementation of bicarbonate. However, neither serum calcium nor phosphate levels changed. The observed increase in PTH in the AFB group remains to be clarified. Dialysis efficacy, measured as KT/V, improved during AFB.

Acetates↗

PubMed1995

The Fitz-Hugh-Curtis syndrome, an unusual presentation.

The Fitz-Hugh-Curtis syndrome consists of adnexitis combined with perihepatitis. Prompt therapy with adequate antibiotics is required to prevent damaging complications. We describe a young woman with an unusual presentation, leading to initial confusion about the proper diagnosis.

Adult↗

PubMed1994

Mycotic aneurysm of the suprarenal abdominal aorta.

Staphylococcus aureus is one of the main causes of bacteriaemia. Haemodialysis patients are likely to develop bacteriaemia due to S. aureus, probably because they are often carriers of S. aureus and also frequently have intravascular catheters. This case report describes a very rare complication of S. aureus sepsis in a 62-year-old haemodialysis patient, namely a suprarenal aneurysm of the abdominal aorta.

Aneurysm, Infected↗