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Biomedical subjects

B G Delano

Publications and source records attributed to B G Delano.

At least 19 recordsLinked to original sources
PubMed2000

A multicenter study of noncompliance with continuous ambulatory peritoneal dialysis exchanges in US and Canadian patients.

Recent evidence suggested that noncompliance (NC) with continuous ambulatory peritoneal dialysis (CAPD) exchanges may be more common in US than in Canadian dialysis centers. This issue was investigated using a questionnaire-based method in 656 CAPD patients at 14 centers in the United States and Canada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of their individual results. Mean patient age was 56 +/- 16 years, 52% were women, and 39% had diabetes. The overall admitted rate of NC was 13%, with a rate of 18% in the United States and 7% in Canada (P < 0.001). NC was more common in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and Hispanic than in Asian and white patients (P < 0.001). NC was more common in patients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than four exchanges per day, black race, being employed, younger age, and not having diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors.

Adult↗
PubMed2000

Bilateral renal infarction in a black man with medial fibromuscular dysplasia.

We report a case of bilateral renal infarction in a patient with medial fibrous dysplasia of both renal arteries and a thrombosed aneurysmal dilatation of the right renal artery. A previously healthy 40-year-old black man presented to the emergency department with acute onset of bilateral flank pain. Computerized tomography of the abdomen showed bilateral renal infarction, predominantly affecting the anterior distribution of both renal arteries. Estimated loss of renal mass was 50% on the right and 25% on the left. The patient was treated with intravenous heparin, oral warfarin, and antihypertensive therapy with labetolol and long-acting nifedipine. By day 3, his abdominal pain resolved; however, the serum creatinine level increased to a maximum value of 2.6 mg/dL. The serum creatinine level slowly improved and stabilized at 1.9 mg/dL, and he was subsequently discharged on the seventh hospital day. Magnetic resonance angiography performed 2 months later showed "beading2 of both renal arteries consistent with medial fibromuscular dysplasia, a finding confirmed by conventional angiography. To our knowledge, bilateral renal infarction complicating medial fibrous dysplasia of the renal arteries has not been previously reported, nor has medial fibrous dysplasia been reported in blacks.

Adult↗
PubMed2000

Dismal rehabilitation in predominantly type II diabetics on dialysis in Inner-City Brooklyn.

AIM: In order to define their demographics and medical conditions, 218 diabetic patients undergoing hemodialysis in Brooklyn were interviewed and their charts reviewed. METHODS: Patient rehabilitation was assessed with the Karnofsky score, and the urea reduction rate as well as serum albumin and hematocrit levels evaluated adequacy of hemodialysis. RESULTS: The majority of patients (167) were African-American, 25 were Whites, 19 patients were Hispanic and 6 were Asian. One patient was a Native American. The mean age was 60.5 years (range 16-88), and the majority, 52%, were women. Rehabilitation was poor, the mean Karnofsky score being 65.1+/-20.8, and only 6% of patients were working. By linear regression, there was no difference in the Karnofsky score according to gender, age, race, type of diabetes, education, family income or hematocrit level. Only the patients' self-perception of their psyche function, or how well they thought they were doing, was significant. CONCLUSION: Further work is needed to examine the reasons for the poor rehabilitation of diabetics on dialysis in Brooklyn.

Diabetes Mellitus, Type 1↗
PubMed1996

Home hemodialysis offers excellent survival.

In selected patients, home hemodialysis offers excellent patient survival and opportunities for rehabilitation. In this article I review some survival and rehabilitation data from the literature. I then report on our experience with training 204 patients in the inner city since 1969. Cumulative technique survival is 17% at 28 years. In addition, I report the outcome of 13 patients, "long survivors, " who have been maintained on home hemodialysis for 20 or more years.

Adult↗
PubMed1994

Gouty arthritis in end-stage renal disease: clinical course and rarity of new cases.

We studied 201 end-stage renal disease (ESRD) patients sustained on maintenance hemodialysis (MD) (n = 164) and chronic ambulatory peritoneal dialysis (CAPD) (n = 37) to determine (1) the frequency of acute attacks of gouty arthritis (GA) in those ESRD patients who had GA before dialytic therapy, and (2) the incidence of new-onset GA in hyperuricemic long-term (> 12 years) ESRD patients on MD. The 2-month mean of predialysis serum uric acid levels was calculated for each subject and the prevalence of hyperuricemia ascertained. There were 25 patients on MD for more than 12 years, and this group was evaluated and analyzed separately from those patients on dialytic therapy for less than 12 years; the mean of each of their predialysis uric acid values was calculated for each subject for at least 60% of the time they have been on dialysis. Patients who had GA before or after initiation of dialytic therapy were identified, and the frequency of acute attacks of GA determined. The presence of treated hypertension in each subject was noted. Thirteen of 201 patients had clinically active GA before commencing dialytic therapy, and each recalled a minimum of two painful attacks of GA per year before the initiation of ESRD therapy. Mean duration of ESRD for these 13 patients was 25 +/- 3.8 months; painful attacks of GA have not recurred in nine patients (70%), and the frequency of attacks declined by 50% in the remaining four patients (30%), despite persistent hyperuricemia in all 13.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Exercise in hemodialysis patients after treatment with recombinant human erythropoietin.

To assess the effect of substantial increases in blood hemoglobin (Hb) caused by treatment with recombinant human erythropoietin (rhEPO) on exercise capacity in maintenance hemodialysis patients, we evaluated 10 patients (7 men and 3 women) at a mean age of 44.3 +/- 8.4 years on maintenance hemodialysis for a mean of 29.7 +/- 30.2 months by treadmill exercise to exhaustion. The patients were tested before administration of rhEPO and after a minimum 1 g/dl rise in Hb. With a change in Hb from 7.1 +/- 1.4 to 9.8 +/- 2.1 g/dl, peak oxygen consumption (VO2 peak) with exercise increased 50.3 +/- 9% (T1 = 15.1 +/- 5.3, T2 = 22.7 +/- 4.6 ml O2/kg/min, p less than 0.05). Respiratory exchange ratio (RER) at a given submaximal exercise level (3 mph, 6% of elevation) decreased significantly (T1 = 1.13 +/- 0.24, T2 = 0.92 +/- 0.08, p less than 0.05). The rhEPO-mediated increase in Hb was associated with an increased VO2 peak--an improvement of the peak exercise capacity and a reduced submaximal RER--reflecting a reduction in anaerobic metabolism at activities of daily living.

Adult↗
PubMed1989

Recombinant human erythropoietin in anemic patients with end-stage renal disease. Results of a phase III multicenter clinical trial.

STUDY OBJECTIVE: To determine the effectiveness and safety of recombinant human erythropoietin (rHuEpo). PATIENTS: Hemodialysis patients (333) with uncomplicated anemia (hematocrit less than 0.30). All received rHuEpo intravenously, three times per week at 300 or 150 U/kg body weight, which was then reduced to 75 U/kg and adjusted to maintain the hematocrit at 0.35 +/- 0.03 (SD). RESULTS: The baseline hematocrit (0.223 +/- 0.002) increased to 0.35, more than 0.06 over baseline within 12 weeks in 97.4% of patients. Erythrocyte transfusions (1030 within the 6 months before rHuEpo therapy) were eliminated in all patients within 2 months of therapy. Sixty-eight patients with iron overload had a 39% reduction in serum ferritin levels after 6 months of therapy. The median maintenance dose of rHuEpo was 75 U/kg, three times per week (range, 12.5 to 525 U/kg). Nonresponders had complicating causes for anemia, myelofibrosis, osteitis fibrosa, osteomyelitis, and acute or chronic blood loss. Adverse effects included myalgias, 5%; iron deficiency, 43%; increased blood pressure, 35%; and seizures, 5.4%. The creatinine, potassium, and phosphate levels increased slightly but significantly. The platelet count increased slightly but there was no increase in clotting of vascular accesses. CONCLUSIONS: The anemia of hemodialysis patients is corrected by rHuEpo resulting in the elimination of transfusions, reduction in iron overload, and improved quality of life. Iron stores and blood pressure must be monitored and treated to maintain the effectiveness of rHuEpo and to minimize the threat of hypertensive encephalopathy.

Adolescent↗
PubMed1989

Improvements in quality of life following treatment with r-HuEPO in anemic hemodialysis patients.

The quality of life was assessed in 37 maintenance hemodialysis patients during treatment with recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) for correction of anemia. All patients experienced an increase in hematocrit level. The mean hematocrit level in the study population was 19.8% before therapy and 31.5% after therapy. Eighty-four percent of patients reported an increase in their sense of well-being. Better appetite was subjectively noted by 81% of patients. Improvements in sexual function (62%), socializing (70%), sleep (68%), and skin color (51%) were also noted. An increase in exercise capacity was reported by 78% of patients; objective measurements showed that the mean value of VO2max in a subgroup of 11 patients increased by 50% after treatment. The Karnofsky score calculated in 29 patients showed improvement in all patients except those aged greater than 70 years. The group mean Karnofsky score increased from 76 before to 86.6 after therapy, indicating that with r-HuEPO treatment subjects were able to exert themselves to perform ordinary activities. Before therapy 14 of the patients were unemployed; after therapy only two did not work. Those side effects that occurred, predominantly iron deficiencies, hypertension, and hyperkalemia, were controlled by appropriate clinical management. Treatment with r-HuEPO does improve the quality of life and ability to work of uremic patients and does not adversely affect their transplant potential.

Adult↗
PubMed1987

Fatigue, acid-base and electrolyte changes with exhaustive treadmill exercise in hemodialysis patients.

Aerobic conditioning exercises have been shown to be beneficial for maintenance hemodialysis patients, but biochemical changes during exhaustive exercise in these functionally anephric patients have been less thoroughly studied. We evaluated serum biochemical changes in 7 patients during and after treadmill exercise to patient exhaustion. Duration of exercise was limited by lower leg fatigue without claudication. At exhaustion, only mild changes from baseline rest values were noted in arterial pH (7.39 +/- 0.03-7.33 +/- 0.04) and lactate (0.94 +/- 0.3-5.73 +/- 2.68 mmol/l) despite normal exercise-induced intracellular fluid shifts as evidenced by albumin concentration increases (44.9 +/- 2.8-49.3 +/- 3.1 g/l). Increases in serum K+ concentrations are also modest (change in K from baseline = 0.87 +/- 0.22 mmol/l). An explanation for these minimal biochemical alterations at exhaustion is unclear, but could relate to exercise being limited well below estimated maximum cardiac output and muscle O2 extraction levels by early, unexplained muscle fatigue. Fatigue in hemodialysis patients does not appear to be due to muscle hypoxia.

Acid-Base Equilibrium↗
PubMed1984

Response to inhaled beta-agonist in a patient receiving beta-adrenergic blockers.

A 52-year-old man receiving long-term hemodialysis and a beta-adrenergic blocker for hypertension had symptoms of acute bronchospasm when exposed to a new hemodialyzer. Resistant to two doses of subcutaneous epinephrine (1 mL of 1:1000 dilution) and one intravenous dose of aminophylline (250 mg), the bronchospasm was rapidly relieved by metaproterenol sulfate given by inhalation one hour later.

Anaphylaxis↗
PubMed1981

Home and medical center hemodialysis. Dollar comparison and payback period.

Cost of home hemodialysis training was compared with that of continuing hemodialysis at a satellite medical center. The "payback period" was defined as the time after which higher home training and start-up charges equaled and were surpassed by the initially lower satellite charges. This period was 14.4 months. Total cost of home hemodialysis training and start-up at our institution was $15,149.32. Ambulatory medical center hemodialysis during the same period (3 1/2 months) was $6,853.58. Initially, therefore, the cost of home dialysis is $8,295.74 more. However, after 14.4 months, there is an equalization point subsequent to which home hemodialysis costs $7,472.40 less each year. For a subgroup of patients, those with malignant and severe systemic diseases with reduced survival with hemodialysis, home hemodialysis has no economic advantage.

Adult↗
PubMed1981

Absence of anemia in maintenance hemodialysis.

Anemia is usual in untreated uremia. Persistent anemia is thought to be universal in uremic patients treated by maintenance hemodialysis (MH). A retrospective chart analysis of 549 patients on (MH) at five facilities in Brooklyn, found that eleven (2%) of these patients had a hematocrit (Hct) in the normal range (40%). To distinguish this subset of patients from the majority of MH, we compared both groups for: (1) etiology of the renal disease, (2) presence of residual renal function, (3) dialysis prescription, (4) decreased arterial O2 saturation, (5) greater use of vitamins or anabolic steroids, (6) absence of parathyroid disease. The relatively high hematocrit was not explained by any factor evaluated in this small subset of MH patients.

Adult↗