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Biomedical subjects

E V Balaskas

Publications and source records attributed to E V Balaskas.

At least 19 recordsLinked to original sources
PubMed1999

Survival and complications of 225 catheters used in continuous ambulatory peritoneal dialysis: one-center experience in Northern Greece.

This study reports our experience with permanent peritoneal catheters. From July 1983 until December 1997, 225 catheters were implanted surgically in 207 patients (120 males, 87 females) with mean age of 58+/-16 years (range: 2-82 years), and a mean duration of continuous peritoneal dialysis (CAPD) of 21.9+/-21.3 months (range: 1-145 months). Two hundred and seventeen catheters were used in 199 patients suffering from end-stage renal disease (ESRD), and 8 catheters in 8 patients with end-stage heart failure resistant to medical therapy. One patient used 3 catheters and 16 patients used 2 catheters. The catheters used were: Tenckhoff, 2; Oreopoulos-Zellerman-1 (OZ-1), 10; OZ-2, 205; and OZ-pediatric, 8. All catheters were implanted by the same surgical team, through a paramedian incision under local anesthesia. By life table analysis, the actuarial survival rates at 1 year, 2 years, 3 years, and 5 years were 97%, 92%, 87%, and 82% respectively for all catheters. The catheter-related complications were: 5 obstructions, 2 dislodgments, 13 dialysate leaks (6 early; 7 late), 90 exit-site/tunnel infections (in 56 patients), 2 cuff extrusions, and 37 hernias (in 31 patients). Eighteen catheters were replaced for persistent peritonitis (15 cases), dislodgment (1 case), obstruction (1 case), and accidental shortening (1 case). The total observation period was 4526 patient-months. The overall incidence of peritonitis was one episode per 15 patient-months, and of exit-site/tunnel infections was one episode per 50 patient-months, with a significant improvement during the last years. We conclude that OZ catheters implanted surgically through a paramedian incision have a very high survival rate and a low complication rate.

Adolescent↗
PubMed1998

Histamine and serotonin in uremic pruritus: effect of ondansetron in CAPD-pruritic patients.

Pruritus is a common, unpleasant symptom of uremic patients. Serotonin and histamine have been reported as possible mediators ofuremic pruritus, and ondansetron is a potent and selective inhibitor of 5-HT3 receptors. The aims of our study were (1) to evaluate the effect of ondansetron on uremic pruritus in continuous ambulatory peritoneal dialysis (CAPD) patients and its safety and (2) to investigate the role of histamine and serotonin in uremic pruritus. To study the prevalence and pathogenesis of uremic pruritus, CAPD and hemodialysis (HD) patients were asked to complete a pruritus questionnaire. The replies were scored based on numerical scales, and the results were evaluated by the same investigator who did not know the patients. Pruritus was graded, according to the total points for each patient, as mild, moderate, or severe. Of 54 patients on HD, 29 (53.7%) had pruritus, and of 43 patients on CAPD, pruritus was present in 21 (48.8%). In HD patients, pruritus was mild in 14 (48.3%), moderate in 12 (41.4%), and severe in 3 (10.3%) patients; the distribution in CAPD patients was 9 (42.9%), 10 (47.6%), and 2 (9.5%), respectively. There was no correlation between the presence and severity of pruritus and age, sex, primary renal disease, duration of dialysis, dialysis solutions used, and hematological and biochemical parameters except for serum histamine and serotonin levels and their product. Plasma histamine levels in CAPD patients were 13.1 +/- 1.1 ng/ml in pruritic and 11.0 +/- 3.9 ng/ml in nonpruritic patients (p = 0.06), serum serotonin levels were 115.6 +/- 43.3 ng/ml and 64 +/- 42.3 ng/ml (p < 0.05), respectively, and the histamine x serotonin product was 1,461 +/- 576 and 646 +/- 545 (p < 0.01), respectively. Eleven CAPD patients (6 males, 5 females) with a mean age of 66 (range 33-83) years and an average time on CAPD of 18 (range 3-31) months with moderate to severe pruritus were treated with ondansetron (4 mg twice daily p.o.) for a mean period of 3 (range 1-5) months. All patients responded to the treatment. There was a significant reduction of the severity of pruritus from the start of treatment, and on the 3rd day the pruritic score (mean value) was 10 (range 5-19) points, while at time 0 (before treatment) it was 26 (range 19-37) points (p < 0.0001). Pruritus disappeared in 7 patients at the end of the 1st week and in all patients at the end of the 2nd week of treatment. This effect was maintained during the study. Plasma histamine levels decreased significantly during the treatment from 12.9 +/- 1.2 to 6.7 +/- 5.9 ng/ml (p < 0.05). Also, serum serotonin levels were reduced from 125.1 +/- 47.8 to 59.3 +/- 27.5 ng/ml (p < 0.05) at the end of the 1st month of treatment, and the histamine x serotonin product showed a more significant reduction: from 1,544 +/- 656 to 454 +/- 436 (p < 0.01). Three patients reported an improvement in their nausea and vomiting during the treatment. Weekly clinical and laboratory examinations showed no side effects, adverse reactions, or other complications. Our data indicate that ondansetron is an effective, safe, and well-tolerated drug for the treatment of uremic pruritus in CAPD patients and that histamine and serotonin may have a crucial role in the appearance or perception of the uremic pruritus.

Administration, Oral↗
PubMed1998

Estimating urea clearance in patients on continuous ambulatory peritoneal dialysis: a multivariate analysis.

The purpose of this study was to determine if Kt/V urea in continuous ambulatory peritoneal dialysis (CAPD) could be estimated by a multivariate model based upon simple clinical observations. The study included 439 clearance studies in 301 CAPD patients followed in 8 dialysis centers. Weekly urea clearance, 24 h urine volume and 24 h drain volume were normalized to body water by the formulae of Watson (Kt/V, UV/V and DV/V respectively). Adequate dialysis was defined as Kt/V > or = 2.0 weekly. Subjects at 2 units were used to derive the models, while others were used for model validation. Stepwise multiple linear regression was performed on the derivation set (DS) to identify the clinical variables that correlated with Kt/V. The model was then used to estimate Kt/V for the validation set (VS). In the DS, 110 clearance studies were performed in subjects with residual renal function. Multiple linear regression showed that weekly Kt/V was defined by the expression: Kt/V=1.48 + 24.1 (UV/V) + 2.92(DV/V) - 0.049 (serum creatinine) (r=0.750, p<0.001). In 204 VS studies, the correlation between estimated and measured Kt/V was 0.633. There were marked differences in the proportion of adequately dialyzed patients when Kt/V estimated from the formula shown was <2.0, between 2.0 and 2.3, and >2.3 weekly (7.9%, 54.7% and 79.7%, respectively; p 2.3 weekly (8.1%, 68.8%, and 100%, respectively; p<0.001). The risk of low Kt/V can be estimated by multivariate linear models requiring only simple clinical measurements.

Female↗
PubMed1997

Serum albumin in continuous peritoneal dialysis: absence of universal predictors.

Factors shown to affect serum albumin concentration in continuous peritoneal dialysis (CPD) were compared between two CPD populations residing in Greece (patient n = 108) and the United States (patient n = 194). Compared to the U.S. group, the Greek CPD population had higher serum albumin levels (35.1 +/- 4.6 vs 33.9 +/- 5.0 g/L, p = 0.031), was older (61.2 +/- 12.0 vs 52.7 +/- 16.5 years, p < 0.001), and had a greater number of high or high-average peritoneal solute transport types (69.4% vs 52.1%, p = 0.003). The American CPD population had a higher number of diabetics (53.1% vs 27.8%, p < 0.001), higher total Kt/Vurea (2.06 +/- 0.57 vs 1.93 +/- 0.46 weekly, p = 0.046), and higher total creatinine clearance (76.3 +/- 38.7 vs 63.4 +/- 23.5 L/1.73 m2 weekly, p < 0.001), while normalized protein nitrogen appearance values were comparable (0.95 +/- 0.21 in the Greeks vs 0.94 +/- 0.22 g/(kg x 24 hr) in the Americans, NS). A logistic regression model developed in the United States identified advanced age, diabetes, and high/high-average peritoneal solute transport as the predictors of hypoalbuminemia (serum albumin < 35 g/L). This model generated the following areas with 95% confidence intervals (CI) under the receiver operating characteristic (ROC) curve: in the Greek CPD population, ROC area 0.594 (95% CI 0.486-0.702); in the American CPD population, ROC area 0.850 (95% CI 0.810-0.890). In Greek CPD patients serum albumin appears to be affected by factors other than those identified in North America. This complicates comparisons of serum albumin, and probably morbidity and mortality, between CPD populations residing in different parts of the world.

Creatinine↗
PubMed1996

Fractional urea clearance in continuous ambulatory peritoneal dialysis: effects of volume disturbances.

The effects of volume disturbances on the KT/V were investigated prospectively in 133 consecutive urea clearance studies on patients on continuous ambulatory peritoneal dialysis (CAPD). Four subjects (group A) had fluid loss (actual weight < dry weight), 57 (group B) were studied on the basis of their dry weight, 58 (group C) had moderate fluid excess (0.5% of dry weight), and 14 patients (group D) had severe fluid excess (> 5% of dry weight). The KT/V was calculated on the basis of dry weight and actual weight with V obtained from the Watson anthropometric formulae which were applied either uncorrected or with a correction for changes in body water from dry weight conditions. The groups compared by variance analysis. The following weekly KT/V estimates were obtained: (1) using dry weight V: group A 1.81 +/- 0.17, group B 2.0 +/- 0.59, group C 1.79 +/- 0.46, group D 1.85 +/- 0.37 (no difference between groups); (2) using uncorrected actual weight V: group A 1.85 +/- 0.15, group B 2.05 +/- 0.59, group C 1.77 +/- 0.45, group D 1.78 +/- 0.37 (group B had a higher KT/V than group C, p < 0.05), and (3) using corrected actual weight V: group A 1.93 +/- 0.14, group B 2.05 +/- 0.59, group C 1.70 +/- 0.43, group D 1.63 +/- 0.36, (group B had a higher KT/V than either group C or group D, both at p < 0.01). In CAPD, fluid deficit is rare and causes a small increase in KT/V, whereas fluid retention is frequent and causes a decrease in KT/V. This decrease is pronounced in patients with severe fluid excess. The uncorrected Watson formulae underestimate V and, consequently, overestimate KT/V in CAPD patients with fluid excess.

Aged↗
PubMed1994

Long-term continuous ambulatory peritoneal dialysis in diabetics.

Of 147 diabetic patients with end-stage renal disease who were treated in our CAPD program between 1978 and 1991, 6 men and 1 woman (5 had type II and 2 type I diabetes) with a mean age of 54 (range 21-70) years have been on CAPD for more than five years (mean: 76 mos, range: 65-109 mos) and on peritoneal dialysis (IPD+CAPD) for an average of 85 (range: 67-118) mos. They had a variety of comorbid conditions at the start of CAPD: Retinopathy (5/7), blindness (3/7), hypertension (5/7), peripheral neuropathy (7/7), peripheral vascular disease (3/7), congestive heart failure (3/7), myocardial infarction (1/7), ischemic heart disease (2/7). Two were smokers and five over the age of 65. Peritonitis rate was 1 episode/11.4 pt mos, exit-site infection 1/76.4 pt mos and average hospitalization rate 32.8 days/patient/year. Hypertension was well-controlled with discontinuation of all medications; after initiation of CAPD two of them remained without medications throughout the study but in the rest, medications had to be restarted. As assessed by HbA1c, blood glucose control improved with IP administration of insulin. Residual renal function progressively decreased. None of them developed severe hyperparathyroidism. Peripheral neuropathy remained stable in four and deteriorated in two. Total protein, albumin, cholesterol and triglycerides decreased during the last two years indicating a degree of malnutrition. Our experience with these seven patients suggests that diabetic patients, even the aged and those with many comorbid conditions and complications, can survive for long periods on CAPD.

Comorbidity↗
PubMed1993

Tidal volume peritoneal dialysis versus intermittent peritoneal dialysis.

In a 12-week crossover study we assessed the effect of tidal volume peritoneal dialysis (TVPD) on serum chemistry, patient well-being, appetite and sleep, blood pressure, and body weight period and compared it with the effect of intermittent peritoneal dialysis (IPD) on these same parameters over a similar period. We used similar volumes of dialysis solutions per exchange and session, and the exchanges were of the same duration in each session. There were 12 patients (6 males, 6 females) with a mean age of 76 years (range 61-88 years), and mean duration of peritoneal dialysis 49 months (range 20-148 months). Five patients started with TVPD and switched to IPD after 3 months; the remaining 7 patients started with IPD and switched to TVPD for the next 3 months. No differences were seen between TVPD and IPD in any of the measured parameters: body weight, appetite, sleep, and well-being by self-assessment, number of transfusions, and complications related to peritoneal dialysis. There were two episodes of peritonitis during the TVPD period and none during the IPD period. Our data indicate that TVPD and IPD are equally effective when applied over similar durations and with similar volumes of dialysis solutions in each session. The improved results with TVPD that others have reported probably can be explained by the use of higher volumes of dialysate.

Aged↗
PubMed1993

Effects of intraperitoneal infusion of dextrose and amino acids on the appetite of rabbits.

We studied the effect of intraperitoneal infusion of various volumes and concentrations of dextrose (D) and amino acid (AA) solutions, in a variety of peritoneal dialysis schedules on food intake and biochemical profile in normal and uremic rabbits. Following omentectomy, a peritoneal catheter was implanted. Animals had free access to food, and consumption was measured daily by weight of the remaining food in the cage. We studied the effect of volume (30-50-100 mL/kg), dextrose concentration (0.5-1.5-2.5-4.25-6.6 g/dL) and AA (Travasol based) (2% in Dianeal or glucose-free solution). Dialysis schedules included once/day, twice/day, or four-daily exchanges similar to CAPD. The durations of the exchanges were 4-6 weeks and in certain groups, amino acid exchanges for a week alternated with dextrose exchanges. Our results indicate the following: omentectomy and catheter implantation significantly decrease food intake. There is a significant decrease in food intake after initiation of dialysis that returns to baseline after 2-4 weeks while dialysis continues. Higher volumes (100 mL/kg) decrease food intake significantly, especially with hypertonic solution of either D or AA. There was no difference in food intake between D and AA infusion in any amount of infused volumes. Amino acids do not seem to have a suppressing effect on appetite. However, large volumes and hypertonicity reduce food intake.

Amino Acids↗
PubMed1993

An animal model for the study of amino acid metabolism in uremia and during peritoneal dialysis.

We tried to determine the suitability of the rabbit as an animal model to study amino acid (AA) metabolism in continuous ambulatory peritoneal dialysis. We also measured the effect of intraperitoneal (ip) infusion of AA on blood AA changes and food consumption. Plasma AA levels were measured in 10 normal rabbits after an overnight fasting and 30, 60, and 120 minutes after a meal. Following these baseline observations, rabbits were randomly divided into two groups. One group of five rabbits was made uremic after surgical partial nephrectomy, whereas the remaining (controls) underwent sham operations. Two weeks after the induction of uremia we measured the effect of chronic renal failure on fasting and postprandial (30, 60, 120 minutes) plasma AA levels. Upon the completion of the second experiment (4 weeks after the induction of uremia) we studied the effect of an ip AA on plasma AA profile 1, 2, 4, and 6 hours after the infusion in both uremic and control rabbits. We also measured the food intake in all experiments. The results of our experiments showed the following: 1. plasma AA in the rabbits decreased after induction of chronic renal failure and increased after food ingestion and ip infusion of AA solution; 2. neither induction of uremia nor ip AA infusion have an effect on food consumption; 3. the majority of the alterations in plasma AA levels we observed in the uremic rabbits were similar to those observed in humans, indicating that the rabbit may be a suitable model for the study of AA metabolism in chronic renal failure and during peritoneal dialysis.

Amino Acids↗
PubMed1993

Pruritus in continuous ambulatory peritoneal dialysis and hemodialysis patients.

To study the prevalence and pathogenesis of uremic pruritus, CAPD and HD patients were asked to complete a questionnaire. The replies were quantitated based on numerical scales, and the results were compared with various hematological and biochemical parameters, underlying disease, and duration of dialysis. There were 113 CAPD patients (63 males and 50 females), mean age 60 (range 20-84) years, average time on CAPD 20 (range 1-163) months and 76 HD patients (44 males and 32 females) mean age 57 (range 23-81) years, mean time on HD 44 (range 2-242) months. Replies to questions were evaluated and graded by the same investigator who did not know the patients. Pruritus was present in 70 (62%) CAPD patients (64% in females and 60% in males p = NS) and in 41 (54%) HD patients (69% in females and 43% in males, p = 0.025). Before starting dialysis pruritus was present in 30% CAPD patients and 28% HD patients. Pruritus was graded as mild, moderate and severe; the distribution was 58.6%, 34.3%, and 7.1% (CAPD) and 43.9%, 41.5%, and 14.6% (HD), respectively. Dry skin was reported by 73% CAPD patients and 72% HD patients. This xeroderma was correlated with the severity of pruritus and was also present in 65% CAPD and 48.5% HD patients without pruritus. Patients with pruritus were older than those without pruritus both for CAPD (63 vs 54 years, p = 0.004) and HD (61 vs 51 years, p = 0.003). A significant correlation was observed only between pruritus score and age for CAPD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Effect of erythropoietin treatment on nutritional status of continuous ambulatory peritoneal dialysis patients.

Seventeen patients--10 females, 7 males--mean age 52 years (range: 21-77 years), on CAPD for an average of 35 months (range 10-160 months) were studied. Mean initial dose of EPO was 114 +/- 45 U/kg/week subcutaneously (range: 59-209). The dose was adjusted to achieve and maintain a target Hb of 100 g/L and Hct 30%. Fifteen of the patients (88.2%) achieved this target within 6 months [baseline to month 6 changes: Hb 72 +/- 10 g/L to 107 +/- 12 g/L (p = 0.0001); Hct 22 +/- 3% to 33 +/- 4% (p = 0.0001)]. Serum total protein also increased significantly over the time of EPO use (p = 0.0133); changes from baseline were significant by the fourth month [68 +/- 9 g/L to 72 +/- 9 g/L (p = 0.0115)]. Serum albumin also increased significantly over time (p = 0.0157). The change from the baseline result (37 +/- 4 g/L) was statistically significant by month 2 (p = 0.0060) and was maintained over the following 4 months [month 6 result: 40 +/- 3 g/L (p = 0.0180)]. The increase was greater for 8 patients with initial serum albumin < 35 g/L (mean change 5.75 g/L) than for the 9 subjects with levels > 35 g/L (mean change 0.11 g/L). In a comparison group of 17 patients (matched for age, sex, duration of CAPD, underlying disease and antihypertensive treatment), who did not receive EPO treatment, albumin and protein did not appear to increase over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Influence of erythropoietin on blood pressure in continuous ambulatory peritoneal dialysis patients.

To assess the effect of erythropoietin (EPO) treatment on blood pressure in continuous ambulatory peritoneal dialysis (CAPD) patients, we analyzed in a retrospective study the results of 6 months of EPO treatment in 17 CAPD patients. There were 10 females and 7 males, mean age 52 years, mean duration on CAPD 35 months. They received subcutaneously a mean initial EPO dose of 114 +/- 45 U/kg/week (range 59-209). This dose was adjusted throughout 6 months to achieve and maintain a target Hb of 100 g/L (Hct 30%). Seven of the patients were hypertensive before starting EPO treatment. Fifteen patients (88.2%) achieved the target hemoglobin. For all subjects (n = 17) there was a significant increase in lying mean blood pressure (MBP) from 93.8 +/- 10.0 to 105.2 +/- 14.4 mmHg (p = 0.0024). Four patients required an increase in their antihypertensive medication, and 4 were not treated before we started antihypertensive treatment (Group I). This group represents 46% (8/17) of the patients. There was no change in the antihypertensive medication status of the remaining 9 patients (Group II). The baseline lying MBP was not significantly different for the two groups (98.8 +/- 9.8 mmHg vs 96.1 +/- 7.2 mmHg). The mean weekly dose of EPO during the first 3 months was higher in Group I (126 vs 100 U/kg) and conversely was lower during the last 3 months (mean dose 108 vs 117 U/kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Long-term continuous ambulatory peritoneal dialysis.

Of 174 patients who entered our CAPD program, 58 received transplants, 7 were transferred to another center, one recovered satisfactory kidney function, 22 were transferred to hemodialysis, 24 to IPD, 52 died and 10 remained on CAPD for at least seven years, when this study was completed. These 10 patients (8 women and 2 men) who are described here in detail had a median age of 46 (range of 24 to 63) years at entry. Their primary renal disease was glomerulonephritis (6), polycystic kidney disease (2), nephrosclerosis (1) and Alport's disease (1). They spent 91 to 134 (average 113) months on CAPD. They had a significant (p = 0.025) increase in body weight from 54.5 +/- 2.8 kg to 59.6 +/- 3.0 kg during the first 3 years, and a decrease in ultrafiltration capacity; BUN and serum creatinine remained relatively stable. Mean total protein and serum albumin remained unchanged at 65 and 35 g/l respectively, throughout the study. There were no significant changes in the hemoglobin and lipid values. Renal osteodystrophy progressed slowly. Peritonitis rate in this group was one episode every 18.9 patient months. These 10 patients had a total of 25 catheters implanted during the study period. The average hospitalization rate was 8.76 days per patient year, 5.34 of which were for peritonitis. Of these 10 patients, one was transferred to hemodialysis, 5 died (4 of or during peritonitis, one of myocardial infarction) and 4 remained on CAPD. Our experience with these 10 patients indicates that CAPD can be carried out over long periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1992

CAPD and pancreatitis: no connection.

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patients on hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and nonphysiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50-60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.

Acute Disease↗
PubMed1992

Is total creatinine clearance a good predictor of clinical outcomes in continuous ambulatory peritoneal dialysis?

The measurement of the adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) is controversial. The use of weekly total creatinine clearance (TCC) has been recommended, but not validated. We analyzed data from our recent urea kinetics in a CAPD study to investigate TCC and its relationship to patient outcomes. TCC was measured over 24 hours by adding residual renal and peritoneal creatinine clearance, correcting for 1.73 m2 surface area and converting to a weekly value. Seventy-six patients had 218 measurements, on starting CAPD and then at 6-month intervals, with mean follow-up of 20 months (range 1-57 months). The mean TCC was 73.62 +/- 32.11 L/week. Due mainly to the loss of residual renal function, the TCC decreased with time (r = -0.40, p < 0.0001), from 88.65 L/week initially to 66.11 at one year, 59.84 at two years, and 50.47 at three years. Dialysate-to-plasma creatinine concentration ratios (D/P Cr) increased with time (r = 0.28, p < 0.0001) from 0.62 initially to 0.66 at one year and 0.73 at two years. The TCC correlated significantly with serum levels of creatinine (r = -0.46, p < 0.0001), urea (r = -0.21, p < 0.001), potassium (r = 0.14, p < 0.05), phosphate (r = 0.25, p < 0.001), and hemoglobin (r = 0.16, p < 0.01), but not with serum albumin or with clinical outcomes including technique failure, hospital days, transfusions, peritonitis rate, nerve conduction velocity, or subjective indices of well-being, except for a weak correlation with the fatigue index (r = 0.19, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Creatinine↗