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Biomedical subjects

B von Albertini

Publications and source records attributed to B von Albertini.

At least 19 recordsLinked to original sources
PubMed1998

Equal levels of blood pressure control in ESRD patients receiving high-efficiency hemodialysis and conventional hemodialysis.

The present study compared the status of hypertension and adequacy of blood pressure control in 73 end-stage renal disease (ESRD) patients treated with four different modalities of hemodialysis, namely, conventional hemodialysis (CHD) with cuprophan 1.1 m2 at a blood flow rate of 300 mL/min, high-efficiency hemodialysis (HED) with cuprophan 1.6 m2 at a blood flow rate of 450 to 500 mL/min, high-flux hemodialysis (HFD) with F80 polysulfone 1.8 m2 at a blood flow rate 500 mL/min, and high-flux hemodiafiltration (HDF) with F80 2 x 1.8 m2 in series at a blood flow rate of 600 to 650 mL/min. Thirty of the 73 patients (41%) were receiving one or more antihypertensive agents to control their hypertension. The percentage of patients taking antihypertensive medication was less in the groups treated with HED, HFD, and HDF compared with the CHD group: 38%, 39%, and 39%, respectively, in the HED, HFD, and HDF groups versus 56% in the CHD group. Control of systolic and diastolic hypertension was achieved in a higher percentage of patients treated with HED, HFD, and HDF compared with patients treated with CHD. Sixty-two percent of HED, 58% of HFD, and 61% of HDF patients compared with 44% of CHD patients had systolic blood pressure less than 150 mm Hg, whereas 77% of HED, 76% of HFD, and 78% of HDF patients compared 56% of CHD patients had diastolic blood pressure less than 90 mm Hg. However, the differences in the use of antihypertensive medication and control rates of hypertension did not reach statistical significance. The average blood pressure of all patients was 144/89 mm Hg; this did not differ significantly between the four groups. There also were no significant differences in etiology of ESRD, hematocrit, biochemical data, as well as use and dose of recombinant human erythropoietin between the four groups. Compared with the CHD patients, the average treatment times with high-efficiency treatments were shorter, with HDF patients showing the shortest mean treatment time of 157+/-41 minutes per hemodialysis session. The mean Kt/V was higher in the groups treated with HED, HFD, or HDF (1.31+/-0.3, 1.30+/-0.4, and 1.43+/-0.3, respectively) than in the CHD group (1.12+/-0.3; P < 0.05). Interdialytic weight gain also did not differ among the four groups. There was no correlation between predialysis mean arterial pressure and either treatment time (r = 0.04, P = NS), Kt/V (r = 0.03, P = NS), ultrafiltration rate (r = 0.06, P = NS), or interdialytic weight gain (r= -0.08, P = NS). There also was no significant association between Kt/V and use of antihypertensive medications (chi-square = 1.76, P = NS). There was, however, a significant positive correlation between interdialytic weight gain and treatment time (r = 0.33, P < 0.01). We conclude that the use of short dialysis sessions with efficient hemodialysis treatments, namely, HFD and HDF, was associated with similar levels of blood pressure control in ESRD patients.

Adult↗
PubMed1997

Control of hypertension is better during hemodialysis than during continuous ambulatory peritoneal dialysis in ESRD patients.

This study compared the status and adequacy of blood pressure (BP) control in 21 ESRD patients treated with HD and CAPD at different time periods. Patients were considered to be hypertensive it they were receiving antihypertensive medications during the study period. During HD, 9 of the 21 patients (43%) required antihypertensive drugs to control their hypertension; whereas, during CAPD, the number of patients taking antihypertensive drugs increased to 15 (71%) (p < 0.05). Adequate control of hypertension (systolic BP < 150 mmHg and/or diastolic BP < 90 mmHg) was achieved in 17 patients (81%) during HD compared to 11 patients (52%) during CAPD (p < 0.05). Average ultrafiltration rate was 1.28 +/- 0.1 l/day during HD and 1.30 +/- 0.2 l/day during CAPD (p = NS). Mean Kt/V during HD was 1.24 +/- 0.1; whereas, mean weekly Kt/V during CAPD was 1.81 +/- 0.2. There were no significant differences in hematocrit or usage of recombinant human erythropoietin (rHuEPo) between the two treatment modalities. However, the weekly dose of rHuEpo was higher during HD than during CAPD (p < 0.05). Mean body weight was significantly higher (p < 0.01) and serum albumin was lower (p < 0.05) during CAPD than during HD in the same group of patients. We conclude that hypertension appears to be controlled better by HD than by CAPD in ESRD patients. The gain in body weight observed with CAPD treatment may reflect an increase in total body fluid volume which may partly explain why hypertension is less adequately controlled during CAPD than during HD treatment.

Blood Pressure↗
PubMed1995

Selective removal of plasma low density lipoprotein with the HELP system: biweekly versus weekly therapy.

PURPOSE: Biweekly (once every 2 weeks) heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) therapy was evaluated for safety and efficacy in selectively reducing LDL cholesterol levels compared with weekly HELP therapy. PATIENTS AND METHODS: Biweekly treatments were given to high-risk, diet/drug resistant hypercholesterolemic patients (n = 23) after 6 months of weekly HELP therapy. Lipids, lipoprotein cholesterol, apolipoproteins A-I and B, and fibrinogen were measured on plasma samples before and after treatment. RESULTS: Mean plasma volume treated was 2.8 l and mean treatment duration 1.7 h. Therapy complications were minimal. In 98% of 268 biweekly HELP treatments, LDL cholesterol levels were reduced by > 30%. For patients completing 6 months of biweekly therapy following 6 months' weekly therapy (n = 23), mean LDL cholesterol levels were reduced 138.5 mg/dl (111.2 mg/dl weekly) with a time-averaged decrease from mean pre-apheresis levels of 33% for biweekly therapy (39% weekly). Mean total cholesterol (161.2 mg/dl biweekly versus 132.9 weekly) and apolipoprotein B (104.6 mg/dl versus 92.6) levels were also reduced with each treatment. Mean HDL cholesterol was reduced only 6.1 mg/dl (6.3 mg/dl weekly). CONCLUSIONS: Biweekly HELP treatments can safely reduce LDL cholesterol levels as consistently as weekly HELP treatments. However, the higher pre-treatment LDL cholesterol levels with biweekly treatments may produce less therapeutic benefit than with weekly therapy.

Blood Component Removal↗
PubMed1994

Epidemiology of hepatitis C virus infection in patients with renal disease.

This study was carried out to determine the prevalence of hepatitis C virus (HCV) antibodies and the epidemiologic factors associated with HCV infection in patients with chronic renal failure before the onset of ESRD. Sex, age, type of renal disease, level of renal function, and history of blood transfusions and invasive procedures were analyzed in 226 patients with renal disease, compared with a population of 1,244 normal subjects and 124 patients with impaired immunity (patients having autoimmune diseases and receiving chemotherapy treatment). Eighteen seropositive patients with renal disease (prevalence, 7.9%) were found, which was significantly higher than the prevalence in the normal population (1.03% in blood donors, 0.98% in pregnant women; P < 0.001, chi 2). There was no significant association of sex, number of blood transfusions, or history of invasive procedures with the presence of HCV antibodies. The prevalence of HCV antibodies was higher (16.6%) in patients with glomerulonephritis compared with patients diagnosed with interstitial nephritis, pyelonephritis, nephrosclerosis, diabetes mellitus, polycystic kidney, and miscellaneous renal diseases (P < 0.01, chi 2). There was a higher prevalence of HCV antibodies in patients with creatinine clearance lower than 30 mL/min (13%) compared with patients with creatinine clearance higher than 30 mL/min (2.7%) (P < 0.01, chi 2). These data suggest that HCV infection may be associated with the pathogenesis of glomerulonephritis. Alternatively, glomerulonephritis or severe renal insufficiency may increase the likelihood of HCV infection.

Adult↗
PubMed1993

Weekly treatment of diet/drug-resistant hypercholesterolemia with the heparin-induced extracorporeal low-density lipoprotein precipitation (HELP) system by selective plasma low-density lipoprotein removal.

Heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) weekly therapy was evaluated for safety and efficacy in selectively reducing LDL cholesterol levels. Weekly treatments (25) were given to high-risk hypercholesterolemic patients (n = 33) with screening LDL cholesterol levels > 160 mg/dl despite prior diet and drug therapy. Lipids, lipoprotein cholesterol, apolipoproteins A-l and B, and fibrinogen were measured on plasma samples before and after treatment. Mean plasma volume treated was 2.66 liters and mean treatment duration 1.7 hours. Therapy complications were infrequent and were primarily vascular access problems or hypotension. Treatment goals were > 30% LDL cholesterol reduction with each treatment. In 98% of 686 HELP treatments, LDL cholesterol levels were reduced > or = 30%. Mean LDL cholesterol levels were reduced 111.0 mg/dl (54%) with a time-averaged decrease of 39% over a 25-week course. Mean HDL cholesterol was reduced only 6.2 mg/dl (15%). Total cholesterol (134.4 mg/dl; 47% decrease) and apolipoprotein B (88.7 mg/dl; 53% decrease) levels were also reduced. Fibrinogen decreased 158.2 mg/dl (58%) without bleeding complications. HELP therapy can safely and selectively remove plasma LDL cholesterol, producing consistent reductions in LDL cholesterol, total cholesterol and apolipoprotein B levels.

Apolipoproteins B↗
PubMed1985

Performance characteristics of high flux haemodiafiltration.

With the described technique of high diffusive and convective solute transport an almost threefold increase in efficiency over conventional dialysis was clinically demonstrated. Coupled with the better tolerance to high solute and weight removal rates, this approach permits drastic reduction of treatment time, without sacrificing treatment adequacy.

Blood↗
PubMed1984

Carbon dioxide removal in acetate hemodialysis: effects on acid base balance.

Studies were performed in patients on maintenance acetate hemodialysis to assess the quantity and processes involved in the removal of carbon dioxide (CO2) during the treatment. For this purpose the CO2 losses from whole blood were evaluated in vivo using a mass balance technique. The data demonstrated that the CO2 recovered in the dialysate exceeded the amount calculated to have left the blood in the same period. This observation suggested that CO2 may be generated by the blood cells as they go through the dialyzer. In vitro studies confirmed this observation and established that the uremic blood cells can generate CO2 when exposed to a low PCO2 and/or HCO3. The net effect of this CO2 generation may be hydrogen ion gain by the patient. The contribution of ultrafiltration to the losses of CO2 depends on the volume of ultrafiltrate and the plasma HCO3 concentration. The dialysance of total CO2 was found to be equal to that of urea nitrogen. Treatments with high urea dialysance may interfere with the acute and chronic correction of the acid base balance in these patients. The data presented suggest that multiple factors related to the removal of CO2 during acetate dialysis may be responsible in part for the low plasma bicarbonate observed in patients on chronic maintenance hemodialysis.

Acetates↗
PubMed1984

High-flux hemodiafiltration: under six hours/week treatment.

Better utilization of existing high blood flow in mature vascular accesses with the described new technique of simultaneous high diffusion and convection results in a marked increase of treatment efficiency. Coupled with the better tolerance to high solute and weight removal rates, this approach permits drastic reduction of treatment time over conventional hemodialysis without sacrificing treatment adequacy.

Bicarbonates↗
PubMed1984

Technical aspects of high-flux hemodiafiltration for adequate short (under 2 hours) treatment.

The efficiency of hemodialysis can be more than doubled. This involves deviating from conventional blood and dialysate flows, employing dialyzers with greater surface area and permeability, bicarbonate dialysate, and an apparatus capable of rigid volumetric control of the dialysate. Coupled with the better treatment tolerance described elsewhere in this volume, this self-contained and automated technique providing high diffusive and convective transfer permits drastic reductions in treatment time over conventional dialysis: in our study, to under 6 hrs/wk.

Blood Flow Velocity↗