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Dirk Kuypers

Publications and source records attributed to Dirk Kuypers.

27 records · Page 2Linked to original sources
PubMed2003

Influence of SDZ RAD vs. MMF on gastric emptying in renal transplant recipients.

SDZ RAD and mycophenolate mofetil (MMF) are increasingly used in the prevention of renal allograft rejection. SDZ RAD, having a macrolide structure, and MMF, known with gastrointestinal side-effects, may have gastric motility modifying properties. Gastric emptying was examined 1 yr after renal transplantation in eight patients taking corticosteroids (CS), cyclosporin A (CsA) and SDZ RAD and six patients treated with CS, CsA and MMF. Comparing the two groups, no significant differences in gastric emptying of solids and liquids were noted. Compared with normal volunteers, solid gastric emptying was faster in the SDZ RAD group and similar in the MMF group. It is concluded that in stable renal transplant recipients treated with MMF, gastric emptying was normal. Because of the impact on drug absorption and gastrointestinal symptoms, further studies are indicated to corroborate the potential prokinetic properties of SDZ RAD.

Breath Tests↗
PubMed2003

Detoxifying capacity and kinetics of the molecular adsorbent recycling system. Contribution of the different inbuilt filters.

The molecular adsorbent recycling system (MARS) represents a cell-free, extracorporeal, liver assistance method for the removal of both albumin-bound and water-soluble endogenous toxins. The aim of the present study was to evaluate the short- and long-term removal capacity and selectivity of the different inbuilt dialysers and adsorption columns (uncoated charcoal, anion exchanger resin). Levels of endogenous toxins and parameters of hepatic synthesis and necrosis were therefore monitored before, during and after the MARS treatment phase in 10 patients. Moreover, blood and dialysate clearances of urea, creatinine, bilirubin and bile acids were determined during a single treatment. The significant increasing time course of total bilirubin blood levels before the start of the treatment could be stopped and reversed in a significant decreasing time course. The removal rates of urea nitrogen, bilirubin and bile acids during a single treatment amounted to 55.5 +/- 4.0, 28.3 +/- 3.9, and 55.4 +/- 4.0% (mean +/- SEM), respectively. The efficacy of removal of albumin-bound toxins sharply declined early after initiation of the treatment to become negligible after 6 h. In conclusion, both albumin-bound and water-soluble toxins are adequately removed by the MARS. Our data suggest that the rate and efficacy of removal of albumin-bound toxins are related to both the strength of the albumin binding and the saturation of the adsorption columns.

Adult↗
PubMed2002

Differential effect of diarrhea on FK506 versus cyclosporine A trough levels and resultant prevention of allograft rejection in renal transplant recipients.

Diarrhea is the most frequently reported adverse event in patients treated with mycophenolate mofetil. Twenty-six renal transplant patients on a mycophenolate mofetil-based immunosuppressive regime with persistent afebrile diarrhea were examined. Diarrhea caused a significant rise in FK-506 trough levels despite intake of stable doses, necessitating FK-506 dose reductions of 30% to obtain pre-diarrhea trough levels. In contrast, trough levels of cyclosporine A remained stable without dose adjustments. This suggests that absorption and/or metabolism is differentially altered for FK506 compared with cyclosporine A in patients with diarrhea. In nine patients mycophenolate mofetil was reduced or stopped because of persistent diarrhea without identifiable cause. This resulted in end-stage renal disease because of chronic rejection in two patients, and in acute rejection in two patients, all taking FK506 and steroids. Therefore, dose adjustments of FK506 in patients with diarrhea must be carefully monitored, especially when doses of mycophenolate mofetil are also reduced.

Acute Disease↗
PubMed2002

Regional citrate anticoagulation for hemodialysis using a conventional calcium-containing dialysate.

Regional citrate anticoagulation is currently a frequently applied technique for hemodialysis patients at increased risk of bleeding. Most experience exists with isotonic citrate in combination with a calcium-free dialysate and separate substitution with calcium chloride. This method is effective, but rather cumbersome and laborious. In search for a less demanding, but equally safe and effective technique, we performed 203 double-needle hemodialysis sessions in 45 patients at high risk of bleeding using regional anticoagulation with hypertonic trisodium citrate (TSC) and a conventional calcium-containing dialysate. At the start of dialysis, citrate was infused at a rate of 75 mL/h; adjustments were made during dialysis according to the degree of anticoagulation and level of ionized calcium within the systemic circuit. The efficacy and short-term safety of regional anticoagulation with TSC as compared with heparin anticoagulation was ascertained in a cohort of 19 stable hemodialysis patients. Systemic anticoagulation did not occur, and plasma-ionized calcium remained on a stable level. Manifestations of citrate toxicity or hypocalcemia were not observed. Clotting within the dialyzer was noted in 18 of the 203 sessions (8.87%) and resulted in early termination of dialysis in only 3 cases (1.48%). In conclusion, the use of hypertonic TSC and a conventional calcium-containing dialysate was shown to be safe and effective. The risk of clotting of the extracorporeal circuit is limited and outweighed by the advantage of reduced procedural complexity. Compared with the use of a calcium-free dialysate, the number of analyses can be reduced substantially, making this method financially attractive.

Aged↗
PubMed2002

An uncommon tumor in a renal graft recipient: a diagnostic and therapeutic challenge.

The development of malignancies after solid organ transplantation represents an increasing clinical problem complicating the long-term follow-up of transplant recipients. In this case report the authors describe the rare triple combination of a simultaneous hepatocellular carcinoma with a glucagonoma and a splenic hamartoma in a renal allograft recipient. It is not only the first published report of a glucagonoma occurring after renal transplantation but serves also as an illustration of the therapeutic decision making in the setting of the immune-compromised host. This case report also illustrates the different imaging modalities that can be used for the diagnosis of neuroendocrine tumors.

Carcinoma, Hepatocellular↗
PubMed2002

A new acute inflammatory syndrome related to the introduction of mycophenolate mofetil in patients with Wegener's granulomatosis.

Mycophenolate mofetil (MMF) is increasingly used for prevention of allograft rejection and to treat immune disorders. We report the development of an acute inflammatory syndrome in two patients with Wegener's granulomatosis after MMF was introduced, because of persistent renal and systemic disease activity despite cyclophosphamide treatment. Within 1 week both patients developed an acute inflammatory syndrome, characterized by fever, arthralgias and muscle pain. No infection could be detected and no indications for increased Wegener's activity were present. MMF was stopped resulting in a rapid and complete resolution of the syndrome. A rechallenge with 2 g of MMF in the second patient resulted in a relapse of the syndrome within 4 days. There was an association between symptoms and increased levels of mycophenolic acid (MPA) acyl glucuronide and serum interleukin-6, suggesting the induction of inflammatory cytokines by MPA acyl glucuronide as the cause of the syndrome. Therefore, special attention should be given to side effects such as fever, arthralgias and muscle pain when treating patients with Wegener's granulomatosis during the active phase. Because this side effect of MMF may also occur after solid organ transplantation and in other immune disorders, pharmacokinetic profiling of MPA and MPA acyl glucuronide is needed in future studies with MMF.

Acute Disease↗
PubMed2002

Cessation of steroids in stable renal transplant patients: the Leuven experience.

Because of the major long-term impact of steroids on the quality of life of renal allograft recipients, physicians are attempting to avoid, reduce or eliminate steroids from the immunosuppressive regimen after renal transplantation. In 311 stable renal transplant recipients, transplanted more than one year and with low immunological risk for rejection, an attempt was made to stop steroids. A permanent cessation of steroids succeeded in 274. Cessation of steroids in stable renal transplant patients resulted in a transient rise of serum creatinine over 3 months. This was reflected in a decreased GFR in the first month. A concomitant change in potassium and weight suggested a minor mineralocorticoid deficiency as plausible explanation. After 4 years, serum creatinine again rose slightly; however, this was not reflected in a decreased GFR. This might reflect a metabolic phenomenon rather than immunological one because patients with acute rejection were excluded from this group and also because there was a small rise in weight and blood pressure noted after the second year following cessation of steroids. Only a mild and transient drop in lipids was present after cessation of steroids. Steroid withdrawal was unsuccessful in 12% of patients, and was twice as high in female patients as in males. Adrenal cortical deficiency was the most prominent reason (3%); acute rejection developed in only 5 patients (1.6%) and chronic rejection was documented in only 4 (1.3%). A better graft and patient survival rate and similar renal function, degree of proteinuria and blood pressure 10 years after renal transplantation (and 6 years after cessation of steroids) compared with patients in whom steroids were never stopped, are very promising despite the selection bias. Although longer follow-up is needed to determine whether stopping steroids will result in altered long-term transplant function, these results are reassuring that steroids can be withdrawn in stable renal transplant patients with a low immunological risk in order to diminish the long-term morbidity associated with corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

What is the link between poor ultrafiltration and increased mortality in anuric patients on automated peritoneal dialysis? Analysis of data from EAPOS.

BACKGROUND: Primary analysis of the European Automated Peritoneal Dialysis Outcomes Study (EAPOS) found that patients with daily ultrafiltration (UF) below a predefined target of 750 mL at baseline experienced increased mortality and continuing low UF over 2 years. SETTING: Multicenter, prospective observational study of prevalent, functionally anuric patients on automated peritoneal dialysis (APD) treated to predefined standards. METHODS: Secondary data analysis to determine clinical covariates that might support a link between poor UF and outcome, including pattern of comorbidity, prescription, nutrition as determined by Subjective Global Assessment (SGA), membrane function, and blood pressure (BP). Ultrafiltration was treated as a categorical (comparing patients above and below target at baseline) and continuous dependent variable in univariate and multivariate regression. The relationship between BP and survival was also explored. RESULTS: Of 177 patients recruited from 28 centers across Europe, 43 were below the UF target at baseline. Compared to those above target, there were no differences in the spread of comorbidity, type of APD prescription, SGA, BP, hemoglobin, HCO3, or parathyroid hormone, at baseline or at any later time. At baseline, plasma calcium and, at 12 months, plasma phosphate were lower in the low UF group. There was a weak positive correlation between baseline systolic or diastolic BP and UF, which remained on multivariate analysis but accounted for just 9% of the variability in BP. There was no clear relationship between baseline BP and survival, although, if anything, low BP was associated with earlier death. Poor UF was associated with lower mean dialysate glucose concentration during the first 4 months and with consistently worse membrane function. CONCLUSIONS: The increased mortality associated with poor UF is likely multifactorial and not easily explained by clear differences in comorbidity, nutritional state, or other indices of treatment at baseline. The lower plasma phosphate suggests a subsequent fall in appetite. Poor BP control is unlikely to be the explanation, and a link between lower BP, reduced UF, and earlier death is suggested. Failure to achieve adequate UF due to worse membrane function remains an important and potentially reversible or preventable cause.

Anuria↗