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Anatole Besarab

Publications and source records attributed to Anatole Besarab.

24 records · Page 2Linked to original sources
PubMed2002

Preventing vascular access dysfunction: which policy to follow.

In the USA, three Clinical Performance Measures are currently in place: increasing the number of autologous arteriovenous fistulas (AVFs) among incident hemodialysis patients to 50% and to 40% in prevalent hemodialysis patients; to foster the surveillance of accesses with preemptive correction of problems before accesses thrombose or fail, and to reduce the use of catheters in prevalent patients to less than 10%. Reduction of catheters will automatically result from initiatives that increase the construction of AVFs and preemptive monitoring and surveillance of accesses for dysfunction. Therefore, policies that promote the latter two vascular access aspects are most important to develop and follow. Of these two, however, the most impact will be made by promoting a policy to increase AVF creation in the timeliest manner possible. Strategies and resources needed to achieve these policies are presented. The need for a team approach is emphasized.

Arteriovenous Fistula↗
PubMed2000

Optimization of epoetin therapy with intravenous iron therapy in hemodialysis patients.

Iron deficiency limits the efficacy of recombinant human erythropoietin (rhEPO) therapy in end-stage renal disease (ESRD) patients. Functional iron deficiency occurs with serum ferritin >500 ng/ml and/or transferrin saturation (TSAT) of 20 to 30%. This study examines the effects of a maintenance intravenous iron dextran (ivID) protocol that increased TSAT in ESRD hemodialysis patients from conventional levels of 20 to 30% (control group) to those of 30 to 50% (study group) for a period of 6 mo. Forty-two patients receiving chronic hemodialysis completed a 16- to 20-wk run-in period, during which maintenance ivID and rhEPO were administered in amounts to achieve average TSAT of 20 to 30% and baseline levels of hemoglobin of 9.5 to 12.0 g/dl. After the run-in period, 19 patients randomized to the control group received ivID doses of 25 to 150 mg/wk for 6 mo. Twenty-three patients randomized to the study group received four to six loading doses of ivID, 100 mg each, over a 2-wk period to achieve a TSAT >30% followed by 25 to 150 mg weekly to maintain TSAT between 30 and 50% for 6 mo. Both regimens were effective in maintaining targeted hemoglobin levels. Fifteen patients in the control group and 17 patients in the study group finished the study in which the primary outcome parameter by intention to treat analysis was the rhEPO dose needed to maintain prestudy hemoglobin levels. Maintenance ivID requirements in the study group increased from 176 to 501 mg/mo and were associated with a progressive increase in serum ferritin to 658 ng/ml. Epoetin dose requirements for the study group decreased by the third month and remained 40% lower than for the control group, resulting in an overall cost savings in managing the anemia. Secondary indicators of iron-deficient erythropoiesis were also assessed. Zinc protoporphyrin did not change in either group. Reticulocyte hemoglobin content increased only in the study group from 28.5 to 30.1 pg. It is concluded that maintenance of TSAT between 30 and 50% reduces rhEPO requirements significantly over a 6-mo period.

Dose-Response Relationship, Drug↗
PubMedDate not supplied

Utility of static pressure ratio recording during angioplasty of arteriovenous graft stenosis.

Intra-access static pressure ratio (SPR) (intra-access pressure/mean arterial pressure) can be measured during angioplasty (PTA) to assess the functional importance of an arteriovenous graft (AVG) stenosis. We used SPR in 70 patients with AVGs who underwent 98 angioplasty procedures. SPR was measured during angioplasty by placing a catheter tip at mid-access. Inflow stenosis (IF) = stenosis proximal to the tip of the catheter. Outflow stenosis (OF) = stenosis distal to the tip of the catheter up to the superior vena cava-atrial junction. Post PTA, access flow (Qa) was assessed within 2 weeks. Complete data sets for both SPR and Qa were available in 83 procedures. Using a normal SPR ratio of 0.3-0.4 at mid-graft, three patterns of SPR were noted. In 63 of 83 (76%) cases SPR was elevated prior to PTA (0.71 +/- 0.13 SD). PTA reduced SPR toward normal range (0.44 +/- 0.12) in 53 cases (84%). In the remaining 10 (16%), SPR decreased to a low value (0.22 +/- 0.03) and normalized (0.40 +/- .0.11) only after PTA of a coexisting inflow stenosis. In 12 of 83 (14%) procedures, the initial SPR was low (0.18 +/- 0.04) and increased toward normal (0.3 +/- 0.08) following IF stenosis PTA in seven (58%) cases. For the remaining five (42%) cases SPR increased to a high value (0.70 +/- 0.21) and decreased toward normal range (0.33 +/- 0.07) only after OF stenosis angioplasty. In 8 of 83 (10%) procedures, initial SPR was normal (0.33 +/- 0.02). Angiography revealed coexisting IF and OF stenoses. SPR remained within the normal range after PTA of these lesions (0.33 +/- 0.02). Qa increased significantly in 74 of 83 (89%) procedures (before = 572 +/- 201, after = 1109 +/- 368 ml/min; p < 0.001). SPR measurements can assist in hemodynamic assessment of an AVG during angioplasty procedure.

Aged↗