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Biomedical subjects

C R Blagg

Publications and source records attributed to C R Blagg.

At least 19 recordsLinked to original sources
PubMed1994

Quantitation of hepatitis C viral RNA in sera of hemodialysis patients: gender-related differences in viral load.

Hepatitis C virus (HCV) infection is common in hemodialysis patients, as determined by antibody assays and qualitative polymerase chain reaction (PCR) analysis of serum HCV RNA. To further characterize HCV infection in this population, we measured the viral load in infected hemodialysis patients by a quantitative, competitive PCR assay (QC-PCR) for HCV RNA. Hepatitis C virus RNA levels were correlated with serologic, biochemical, and demographic features of a cohort of hemodialysis patients. Sera from 208 hemodialysis patients were screened for HCV RNA (5' conserved region) by reverse transcriptase PCR (RT-PCR) and HCV-specific antibody. Forty-four patients were antibody positive (21%); among these patients, 34 (77%) were HCV RNA positive. No viremic, seronegative patients were identified. Hepatitis C virus RNA levels quantitated by QC-PCR ranged from 3 x 10(5) to 10(8) molecules of HCV RNA/mL. Male patients had significantly higher mean and median HCV RNA levels (10(7) molecules/mL) compared with female patients (3.6 x 10(6) molecules/mL and 3 x 10(6) molecules/mL, respectfully; P = 0.02). No other demographic or clinical feature of this cohort correlated with HCV RNA levels. Intravenous drug abuse was the most frequently identified risk factor (29% of seropositive patients) for infection with HCV in this population. No association between HCV RNA levels and hepatic enzyme levels (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase) was apparent. Hepatitis C virus infection is highly prevalent in our hemodialysis population, and hemodialysis patients, particularly males, have high levels of HCV in serum.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The socioeconomic impact of rehabilitation.

Rehabilitation of patients with end-stage renal disease (ESRD) should encompass all aspects of the patient's well-being and include vocational, physical, and medical therapies. This would be best achieved by careful management of the patient before the start of dialysis, as well as by provision of adequate dialysis in the most appropriate setting for the individual patient's needs. Before starting dialysis, blood pressure should be well controlled, nutrition maintained, and human recombinant erythropoetin (epoetin) used as necessary to prevent the development of anemia. In patients who are employed, efforts should be made to maintain employment, and vocational counseling should be provided to unemployed patients who are capable of work. Physical well-being should be maintained by encouraging participation in an exercise program. Social, financial, and other counseling should be provided as necessary, together with patient education regarding treatment, including modalities and other aspects of care. The social impact of these efforts primarily will be on the patient's quality of life, and secondarily, on family members and friends. Quality of life depends on many factors, including modality of treatment and adequacy of dialysis. Economic impact also depends on many factors. Providing optimal care before starting dialysis, including the use of epoetin where appropriate, will increase the cost both for drugs and staff. For patients who are able to continue working or can be successfully retrained, these costs will be offset to some degree in the future by taxes paid by the patient and by the patient not participating in the Social Security Disability Insurance (SSDI) and the Supplemental Security Income (SSI) programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1993

The US Renal Data System and the Case-Mix Severity Study.

The US Renal Data System (USRDS), established in 1988 to collect and analyze information on end-stage renal disease (ESRD) patients in the United States and their treatment, is briefly described. A number of special studies have been undertaken by the USRDS. One of these is the Case-Mix Study, which reviewed data from an incident sample of 4,911 patients starting dialysis in 1986 and 1987 who were monitored for 1 to 4 years. Analysis included Cox proportional hazard modeling, which allowed quantification of the effect of various comorbid factors on mortality. Relevant findings included a greater mortality in diabetic patients treated by continuous ambulatory peritoneal dialysis (CAPD) compared with those treated by center hemodialysis. With regard to adequacy of dialysis, prescribed dialysis averaged a Kt/V of 1.0, with 53% of patients having a value of 1.0 or less. Where delivered Kt/V could be calculated, the mean of this was 0.72. The prescribed Kt/V in this sample of patients did not predict mortality, but there was a statistically significant inverse correlation of delivered Kt/V with mortality. It would appear a significant number of patients were being underdialyzed in the United States in 1986 and 1987. The means by which to obtain further information from the USRDS is described.

Databases, Factual↗
PubMed1993

Serum albumin concentration-related Health Care Financing Administration quality assurance criterion is method-dependent: revision is necessary.

The objective of this study was to examine quantitative differences between the two commonly used methods for determining serum albumin concentration, bromcresol green (BCG) and bromcresol purple (BCP), in normal subjects and in 235 unselected dialysis patients in view of recently established Health Care Financing Administration (HCFA) quality assurance review criteria. The mean of normal results by the BCG method was 4.4 g/dL, and 97.5% of values were 3.8 g/dL or higher. The mean of normal results by the BCP method was 3.9 g/dL, and 97.5% of values were 3.3 g/dL or higher. Serum albumin concentrations in samples from the dialysis patients had respectively lower mean values by both methods. For the BCG method, the mean was 3.8 g/dL, and 82% of values were 3.5 g/dL or higher; for the BCP method, the mean was 3.3 g/dL, and 82% of values were 3.0 g/dL or higher. Likewise, for the reference immunonephelometric procedure, the mean value for the dialysis patients was 3.3 g/dL, and 82% of values were 3.0 g/dL or higher. For the samples from the dialysis patients, in comparison with the immunonephelometric method, the BCG method exhibited both constant (intercept = 9.3 g/L) and proportional error (slope = 0.87). The mean albumin value for the BCG method was 3.8 g/dL, 15% higher. In contrast, the BCP method compared closely with the reference method: slope = 1.00, intercept = 0.8 g/L, mean x = 3.3 g/dL, mean y = 3.3 g/dL. The HCFA quality assurance criteria are valid only for the BCG method.(ABSTRACT TRUNCATED AT 250 WORDS)

Bromcresol Green↗
PubMed1992

Hemodialysis 1991.

Hemodialysis remains the principal form of renal replacement therapy worldwide, and increasing numbers of patients have survived for 20 years or more. Future issues include the incorporation of newer technology into dialysis programs, ensuring adequacy of dialysis and optimum quality of care, controlling hypertension, and ensuring adequate nutrition. To maximize survival, hypertension must be controlled from its onset, smoking must be stopped, adequate dialysis provided, normal nutrition maintained, and blood access preserved. Home hemodialysis provides the best quality of life and opportunity for rehabilitation, but opportunities for this treatment may be limited. The long-term care of patients with end-stage renal disease requires careful attention to all aspects of their treatment on an ongoing basis, potentially for many years.

Dietary Proteins↗
PubMed1992

The long-term effects of recombinant human erythropoietin on the cardiovascular system.

Fifty-five hemodialysis patients (pts) received rHuEpo for 3-5 years (51 +/- 11 months, hematocrit 32.5 +/- 3.7). BP medication was required in 42% of pts prior to rHuEpo (Hct 20.8 +/- 3.5) and 69% (38 patients) now require such therapy. BP was controlled with single therapy in 16 pts and only 8 required 3 or more different BP drugs. Vascular access clotting episodes were rare in pts with autologous fistula (17 of 24 pts had no clotting), whereas access clotting episodes were 10 times more common in pts with AV grafts, yet 20% had no clotting after 3-5 years of rHuEpo. Heart size decreased in most who initially had cardiomegaly. Cardiovascular related and other deaths were decreased in this selected group when compared to other dialysis pts matched for age, race and type of renal disease.

Anemia↗
PubMed1992

The dose of hemodialysis according to dialysis prescription in Europe and the United States.

Prior research has shown that, controlling for age and diabetes, patients with end-stage renal disease in Europe generally have better rates of survival than do ESRD patients in the U.S. This analysis compares the dose of hemodialysis prescription in the two regions. Based on the European Dialysis and Transplant Association Registry (EDTA), the U.S. Renal Data System (USRDS), and other sources, European and U.S. ESRD patients were compared by demographic and anthropometric characteristics, dialyzer characteristics, and duration of dialysis treatment times. Average body weight and body mass indices were found to be similar for the ESRD populations of the two societies, suggesting the same overall requirements for dialysis therapy. During 1986 to 1988, dialyzers selected in Europe had a larger surface area by at least 20 percent compared to those selected in the U.S. In addition, duration of hemodialysis treatment times were on average 23.5% longer for EDTA patients. Dialyzer blood flows were not available for EDTA patients, but if EDTA blood flows resemble U.S. practices, total urea clearance per week was at least 29% higher in Europe than in the U.S. Combining similar patient characteristics with substantially greater total urea clearance per week, the hemodialysis prescription in Europe was substantially higher than in the U.S. for the time period of this study.

Europe↗
PubMed1990

Comparison of patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis: a multicenter study.

Patient and technique survival were compared in adult patients new to continuous ambulatory peritoneal dialysis (CAPD) or (primarily) center hemodialysis (HD) in the time period 1981 to 1983, and followed-up in March 1985. Risk factors were identified at entrance into the study, and results were analyzed using Cox's proportional hazards model. For nondiabetic patients, the difference in survival which favored CAPD (relative risk = 0.62) was not significant at the 5% level (p = 0.08). Age was a significant risk factor in both groups. The average number of hospital visits was the same; however, CAPD showed a small but significant increase in average annual hospital days per year (10.14 vs. 9.18). For diabetic patients, there was no significant difference in survival between CAPD and HD. The CAPD group showed a significant increase in hospital visits (relative risk 1.81 vs. 1.40) and average hospital days per year (19.43 vs. 13.41). Both CAPD groups showed significantly higher treatment changeover rates.

Adult↗
PubMed1990

Recent trends in cadaveric renal transplantation.

1. Cadaveric transplantation increased steadily from 1981 through 1986 and then leveled off. The gap between patients awaiting transplant and cadaveric transplants performed increased rapidly after 1986. 2. There has been a trend in the age distribution of cadaveric transplant recipients toward transplantation of older patients. The number of cadaveric transplants to patients 50 and over continued to increase after 1986, while the number to patients under 50 declined. The proportion of transplants to patients 60 and over has shown a particularly dramatic increase. 3. The rate of transplantation is highest in the pediatric age group and declines with age. The rate of transplantation increased in all age groups until 1986 and then declined in all age groups except the 50 and over group. The magnitude of the decline is greatest in the younger age groups. 4. Among all dialysis patients, males have a higher rate of transplantation than females, and Whites have a higher rate than Blacks. These differences in rates increase with increasing recipient age. There are moderate trends toward decreased differences by sex and increased differences by race. 5. Repeat transplants make up about 15% of all cadaveric transplants in 1988, with higher proportions of repeat transplants in the younger age groups. The transplantation rates for repeat transplants has been declining relative to that for first transplants when the relevant pool of dialysis patients is used. For the 50 and over age group, the repeat transplant rate was 3.6 times as high as the first transplant rate in 1988. 6. Compared to the general population, cadaver transplant donors are younger, less often female, and less often Black. There has been a trend toward older donors and toward a smaller difference by sex. 7. There has been a trend toward fewer nephrectomies and splenectomies prior to transplantation. 8. There are no clear time trends in sharing of organs among transplant centers and only a slight increase in the proportion of transplants with 0 HLA-antigen mismatches.

Age Factors↗
PubMed1989

Here are (almost all) the data: the evolution of the US Renal Data System.

The US Renal Data System was established in May 1988 by implementation of a contract with the Urban Institute in Washington, DC, by the National Institute of Diabetes and Digestive and Kidney Diseases. Over the last 16 years, since implementation of the Medicare End-Stage Renal Disease Program, the United States has lacked a comprehensive renal data system analogous to those available in Europe, Canada, and Australia and New Zealand. This essay reviews the history of the development of end-stage renal disease data collection activities and registries in the United States and discusses some of the problems and lessons learned, together with the anticipated objectives of the US Renal Data System.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

End-stage renal disease and the practice of nephrology.

Data from a national survey of 336 nephrologists who provide dialysis care on capitation reimbursement show differences in practice activity associated with the proportion of patients with end-stage renal disease (ESRD). On the average, ESRD patients account for 53% of patients seen by these physicians. Nephrologists who have the majority of their visits with ESRD patients average more than 120 patient encounters per week, approximating the practice workloads of primary care physicians. Nephrologists spend comparable amounts of time providing treatment for ESRD and non-ESRD patients in the same settings, schedule additional office visits for facility dialysis patients, and provide treatment and advice for problems not related to dialysis. Whereas care for acute renal failure patients is primarily based on consultations and involves a narrow focus, treatment for ESRD involves the provision of comprehensive primary medical care by nephrologists to their patients being treated with dialysis.

Ambulatory Care↗
PubMed1988

Case-mix and treatment in end-stage renal disease: hemodialysis v peritoneal dialysis.

The University of Southern California School of Medicine conducted a nationwide survey of 336 nephrologists to obtain demographic and clinical data on 6,411 patients with end-stage renal disease (ESRD). Patient demographic data, along with ESRD etiology and comorbid conditions noted by the physician, were compared across various modalities of dialysis. Characteristics of the treatment provided were differentiated by the mode of dialysis and the location of the patient encounter. Results of the analysis show that patients on peritoneal dialysis are more likely to be female and have higher rates of diabetes compared with hemodialysis (HD) patients. Statistically, patients on intermittent peritoneal dialysis are older, more likely to be black, and have a higher incidence of cardiovascular conditions. Continuous ambulatory peritoneal dialysis patients have greatest problem severity and require more physician time and more complex services, whereas home HD patients require the greatest number of diagnostic tests and therapeutic procedures. Hospital inpatient care shows greater case-mix severity and more intensive treatment, but this does not differ by the mode of dialysis. Finally, patients of freestanding dialysis facilities are more likely to have hypertensive renal disease, whereas patients at hospital-based facilities are older, more likely to be seen in the hospital, have more urgent and severe problems during dialysis rounds, and require more physician time, more complex services, and more diagnostic tests and therapeutic procedures.

Age Factors↗