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Biomedical subjects

B G Delano

Publications and source records attributed to B G Delano.

At least 37 records · Page 2Linked to original sources
PubMed1978

Pragmatic realities in uremia therapy.

The present status and future prospects of uremia therapy in the United States are reviewed. Approximately 3500 renal transplants were done in 1976 as compared to 3700 in 1975. Functional two-year survival of grafts has not changed recently (40 to 45 per cent for cadaver donors; 70 to 75 per cent for siblings), but patient survival with cadaver grafts continues to improve (now 65 per cent at two years). Patients on hemodialysis in facilities are increasing rapidly. Only 13 per cent are on home dialysis, as compared with nearly 40 per cent five years ago. Home patients do at least as well as those in centers (80 per cent two-year survival) and cost 40 per cent less. Physician bias probably explains the trend to center dialysis, but pending legislation may provide new incentives for home treatment. Prospects for technical advances are good, but a greater federal investment in research and development is needed. Dollars saved on the center dialysis could be used for this purpose.

Attitude of Health Personnel↗
PubMed1978

Relationship of plasma lipids to renal function and length of time on maintenance hemodialysis.

Significant hypertriglyceridemia, the most common lipid abnormality in renal failure, first occurs when the creatinine clearance falls to 50 ml/min. The prevalence of hypertriglyceridemia continues to rise as creatinine clearance falls further with the highest rate developing at a creatinine clearance less than 10 ml/min. Hypertriglyceridemia is correlated with plasma glucagon levels but not growth hormone or insulin. Plasma cholesterol values remain normal in the face of deteriorating renal function and show no correlation with any of the hormones measured. Although all three hormones became elevated as renal function diminished, none were directly correlated with glomerular filtration rate. There was a distinct decrease in the prevalence of hyperlipidemia after 5 years of maintenance hemodialysis therapy. Plasma growth hormone and glucagon through an effect on plasma triglyceride and plasma insulin by effecting plasma cholesterol may play a role in this decline of hyperlipidemia with duration of hemodialysis.

Adult↗
PubMed1978

Reduction in hyperlipidemia in hemodialysis patients treated with charcoal and oxidized starch (oxystarch).

A combination of two oral sorbents, oxystarch 35 g/day plus activated charcoal 35 g/day, was administered to four patients undergoing maintenance hemodialysis during thrice weekly and once weekly treatments. Patients tolerated oxystarch and charcoal without complaint during the 4-week period of thrice weekly hemodialyses. All four patients became clinically uremic when hemodialyses were reduced to once weekly and only two patients were able to continue through the end of this 4-week period. Mean serum cholesterol concentration diminished significantly from 200 mg/dl during control periods to 140 mg/dl after each 4-week trial of sorbents (P less than 0.02). Hypertriglyceridemia (range 181 to 543 mg/dl) was corrected in three of four patients with triglyceride values falling to less than 150 mg/dl during ingestion of sorbents (P less than 0.05). Activated charcoal, which is inert as an intestinal nitrogen binding sorbent, may lower serum lipids by direct intragut binding of lipids and bile acids. The potential use of oral charcoal in long-term therapy to reduce hyperlipidemia and prevent vascular accidents due to atherosclerosis requires additional study.

Adult↗
PubMed1977

Iron absorption in experimental uremia.

Gastrointestinal absorption of radioactive iron (59Fe) was studied in uremic rats. Duodenal gut sac transport of 59Fe in a group of 12 rats with a mean BUN of 98+/-24.4 mg%, was 2.29+/-1.16. This was significantly lower (p less than 0.01) than the amount of 59Fe transported (4.88+/-1.87) across the duodenum of a group of control rats, mean BUN 22.9+/-3.2 mg%. We conclude that there is diminished absorption of iron in uremia.

Animals↗
PubMed1977

Whatever happened to home hemodialysis?

Advantages of home hemodialysis over center include better patient survival and rehabilitation, more patient convenience, decreased risk of hepatitis, and cheaper costs. Home dialysis places stress on the family and requires a great time commitment of the helper. Ninety-three patients began home dialysis training at our institution. Seventy-eight successfully completed training and five patients are still in training. Of the seventy-eight who completed training, fifty (64%) are still performing home dialysis for periods of from one month to 6 1/2 years. 10% received a kidney transplant, 13% died, and 13% have returned to a center for dialysis. Family stress was the major reason for return to a center in the ten patients who chose to do so. Even though home dialysis is superior to center dialysis, the percentage of patients being treated in the home in this country is diminishing. Possible reasons for this decline are discussed.

Family↗
PubMed1977

Uremic hyperlipoproteinemia: correlation with residual renal function and duration of maintenance hemodialysis.

Our study indicates that in renal failure elevated plasma triglyceride can first be detected when the GFR falls to 50 ml/min. Hypertriglyceridemia is the commonest abnormality found and increases further when the GFR falls below 10 ml/min. Plasma cholesterol levels remain normal even at low levels of renal function. Although plasma growth hormone, glucagon, and insulin levels become elevated when renal function diminishes, there is no definite correlation of their levels and GFR. A decreased incidence of hyperlipidemia observed in patients sustained by maintenance hemodialysis for over 5 yrs may in part be due to the triglyceride lowering effect of growth hormone and glucagon and/or the cholesterol lowering effect of insulin.

Androgens↗
PubMedDate not supplied

Correlates of decade-long technique survival on home hemodialysis.

Since initiating home hemodialysis 20 years ago, the authors have successfully trained 192 selected patients who began self dialysis at home. Of these, 36 patients (19%) have continued uninterrupted home hemodialysis for 10 or more years (mean 14 years). To ascertain which factors might predict long duration on home hemodialysis these 36 long-term patients (LT) were compared to the entire group (all). Mean age at initiation of dialysis was 36 years in LT and 40 years in all. There was no significant difference in gender between LT and all. A significantly greater (p less than 0.01) proportion of LT (72%) were white compared with the whole group (53%). Seventy-eight percent of LT were middle class while 67% of the entire group were middle class (p less than 0.05). Renal diagnosis in LT were glomerulonephritis in ten (28%) polycystic kidney disease in eight (22%) congenital and/or infectious renal disease in eight (22%), miscellaneous or unknown in the rest. Hereditary disease thus accounted for 36% of all LT. Twenty-four LT remain on home hemodialysis, four returned to center dialysis and nine died. The authors conclude that 1) Home hemodialysis for a decade or longer is not rare in selected patients. 2) White, middle class men remain on home hemodialysis the longest. Although declining in popularity, this treatment modality proffers survival advantage for appropriately chosen individuals.

Adult↗