Biomedical subjects

E Spanner

Publications and source records attributed to E Spanner.

21 records · Page 2Linked to original sources

PubMedDate not supplied

A multicenter study of short hour dialysis using AN69S. Preliminary results.

A multicenter prospective study of short hour (SH, less than or equal to 3 hr) dialysis using a high flux membrane (AN69S) plus volumetric control (VC), versus conventional (greater than or equal to 4 hr) (CNV) cellulosic non-VC dialysis, is ongoing. The study hypothesizes that SH treatment over 1 year will provide adequate dialysis, will not increase morbidity, and may improve quality of life. To date, 112 patients have been entered, and 54 have completed 6 months, 30 by SH. There were no differences in biophysiologic parameters at 6 months. Mean hospitalization was 5.24 days per patient. The SH group had a higher (p = 0.0374) hospitalization rate because of two patients. Quality of life was similar in SH and CNV groups. The study indicates that SH dialysis is feasible, safe, and as comfortable as CNV.

Acrylic Resins↗

PubMedDate not supplied

Urea monitoring during dialysis: the wave of the future. A tale of two cities.

The National Cooperative Dialysis Study (NCDS) suggested that the removal of small molecules controls the adequacy of the dialysis prescription, and it would seem appropriate that renal units regularly carry out formal urea kinetic modeling to ensure that the adequacy of dialysis is provided. Current methods of calculating Kt/V (urea) are complex and require the accurate measurement of dialyzer urea clearance and calculation of the volume of distribution of urea. This may be done by the direct measurement of total urea removed or by the use of computer programs that examine plasma urea and weight changes over time. Both methods have inherent problems, and this has stimulated the search for easier "bedside" formulas for the calculation of Kt/V. These newer formulas involve examination of the percentage reduction in blood urea concentration during hemodialysis. Two such formulas were examined and applied to 78 patients undergoing hemodialysis in two centers. One center routinely carried out formal urea kinetic modeling; the other did not. In the first center, it was found that the majority of patients were receiving more dialysis than necessary to achieve Kt/V (urea) = 1 when the latter was judged by those formulas. This suggested the possibility of time savings, with considerable implications for cost efficiency. In the second center, the majority of patients required more dialysis. It was concluded that intermittent formal urea kinetic modeling tends to overshoot the necessary prescription to allow for occasional "imperfect" dialyses and also that it is impossible to base dialysis prescriptions on routine pre-dialysis blood work and a "feel" for patients' needs.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMedDate not supplied

Comparison of measured and predicted creatinine excretion is an unreliable index of compliance in PD patients.

OBJECTIVE: To evaluate the use of the ratio of measured to predicted creatinine excretion as an index of compliance in peritoneal dialysis (PD) patients. DESIGN: A prospective analysis. SETTING: Academic teaching hospital dialysis unit. PATIENTS: Forty-three patients on PD. MEASUREMENTS: Creatinine excretion in daily dialysate and urine collections was measured on one occasion in 10 patients and on two occasions in 33 patients, and, after adding an estimate for extrarenal creatinine degradation, was divided by predicted creatinine excretion to give a creatinine excretion ratio, which has been proposed as an index of compliance with exchanges in PD patients. Values above 1.24 have been suggested to indicate noncompliance. Lean body mass was also estimated from creatinine excretion. RESULTS: The mean creatinine excretion ratio was 1.12, and 30% of patients had a value above 1.3. Only one patient admitted noncompliance. Studies on four consecutive days of guaranteed compliance in 7 patients with high ratios showed that creatinine excretion remained constant, suggesting that the patients were high creatinine producers rather than noncompliant. Creatinine excretion was stable when measured at intervals of days, but over months it tended to change markedly in many patients. Lean body mass estimations using creatinine excretion were low in most patients. CONCLUSION: Comparison of measured and predicted creatinine excretion is not a reliable indicator of noncompliance because many compliant patients consistently excrete more creatinine than predicted. The standard formulas were not validated in dialysis patients and underestimate creatinine excretion significantly in many PD patients. Existing estimates in the literature of noncompliance, using this methodology, may not be accurate. Better methods of detecting this problem are required.

Adolescent↗