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Biomedical subjects

F Madore

Publications and source records attributed to F Madore.

At least 19 recordsLinked to original sources
PubMed2001

Soluble Fas is a marker of coronary artery disease in patients with end-stage renal disease.

Coronary artery disease (CAD) is the leading cause of death in patients with end-stage renal disease (ESRD). Recent evidence suggests that the expression of Fas, a molecule implicated in the initiation of apoptosis in various cell types, is increased at sites of atherosclerotic plaques. However, the significance of plasma levels of the soluble form of Fas (sFas) and its ligand (sFas-L) as markers of atherosclerosis has yet to be defined. The present report is a cross-sectional analysis of baseline data from an ongoing prospective study designed to evaluate the role of sFas and sFas-L as markers of CAD in ESRD. We evaluated the association between plasma levels of sFas and sFas-L and evidence of CAD in a cohort of 107 chronic hemodialysis patients. Plasma levels of sFas were significantly greater (P = 0.04) among subjects with (n = 64) than without evidence of CAD (n = 43). Plasma levels of sFas-L were similar in both groups. Using multivariate analysis, sFas level was found to be independently associated with CAD (P = 0.01) after adjustment for classic risk factors for CAD (hyperlipidemia, diabetes, hypertension, and smoking), markers of inflammation (C-reactive protein [CRP], intercellular adhesion molecule 1), and other confounders. An increase of one quintile in plasma concentration of sFas was associated with an odds ratio for CAD of 1.64 (95% confidence interval, 1.11 to 2.41). Models that incorporated sFas were significantly better at identifying patients with CAD than models limited to classic risk factors for atherosclerosis, alone (P = 0.008) or in combination with CRP levels (P = 0.006). In summary, increased plasma levels of sFas are associated with CAD in stable patients with ESRD. These results suggest that sFas may represent a novel and independent marker of CAD.

Aged↗
PubMed2000

Anemia management of adult hemodialysis patients in the US results: from the 1997 ESRD Core Indicators Project.

BACKGROUND: The Health Care Financing Administration's End-Stage Renal Disease (ESRD) Core Indicators Project collects clinical information on prevalent adult patients receiving in-center hemodialysis (HD) care in the United States to assess the quality of care delivered. Although hematocrit values, transferrin saturations, and iron prescription practices have improved over the last five years, we sought to determine whether continued opportunities for improvement of this domain of care exist. METHODS: A random sample of 7292 adult in-center HD patients was selected. Dialysis facility staff provided clinical information for the period of October through December 1996 for 6858 (94%) patients; complete laboratory information was available from 4991 (73%) returned forms. Hematocrit values, transferrin saturations, serum ferritin concentrations, epoetin alfa dosing, and iron prescriptions were abstracted from patient medical records to assess anemia management practices. RESULTS: The mean hematocrit for this cohort was 32.6 +/- 3.5%. Seventy-two percent of patients had hematocrit values> 30%. Forty-two percent had hematocrit values of 33 to 36%, and 10% were severely anemic (hematocrit <28%). Ninety-four percent of the patients received epoetin alfa intravenously (i.v.) and 6% subcutaneously. The mean weekly dose was 202.4 +/- 137.2 units/kg. The mean transferrin saturation was 27.4 +/- 12.6%; 73% of patients had a mean transferrin saturation > or = 20%. The mean serum ferritin concentration was 386 +/- 422 ng/mL; 79 and 12% of patients had a serum ferritin concentration of> 100 and> 800 ng/mL, respectively. Nine percent of the sample (N = 434) had a transferrin saturation <20% and serum ferritin concentration <100 ng/mL. Regardless of the patient's transferrin saturation, approximately three fourths of the patients received either oral or i.v. iron, and only approximately one half of the patients received i.v. iron. Of the subset of patients with transferrin saturation <20% and serum ferritin concentration <800 ng/mL, only 53% were prescribed intravenous iron. Multivariate linear regression analysis revealed that serum albumin, urea reduction ratio, age, and transferrin saturation were significantly positively associated with hematocrit. Epoetin alfa dose and serum ferritin concentration were significantly and negatively associated with the hematocrit (P < 0.001). CONCLUSION: Although substantial improvements have been made in anemia management for adult in-center HD patients over the past five years, significant opportunities persist to improve iron prescription practices.

Adult↗
PubMed2000

Outpatient CAPD catheter salvage for persistent exit-site/tunnel infection.

BACKGROUND: Partial replantation (i.e. replacement of the extraperitoneal portion of the catheter with creation of a new subcutaneous tunnel) has been suggested to avoid catheter removal in patients with persistent exit-site/tunnel infection (ESTI). However, published experience with this technique is limited. METHODS: Partial replantation was performed on an outpatient basis under local anesthesia for seven patients with persistent ESTI of >3 months duration. All patients resumed CAPD immediately following surgery. RESULTS: One patient had dialysate leakage less than 1 week after surgery that required catheter removal. The other patients had no complications and mean catheter survival following surgery was 7. 7 months (range 3.5-13 months). There was no recurrence of ESTI after surgery, although two patients presented with exit-site infection unrelated to the initial episode (i.e. different organism, long latency). Three other patients presented with episodes of peritonitis unrelated to surgery (i.e. delay >1 month) or ESTI (i.e. different organism). CONCLUSIONS: Partial replantation allows significant prolongation of catheter survival without major complications or interruption of CAPD. This novel procedure appears to be an appropriate alternative to catheter removal for the management of persistent ESTI. However, further studies are needed to prospectively compare partial replantation with catheter removal.

Aged↗
PubMed2000

Oral anticoagulant therapy for heart disease: results in actual cardiology practice.

OBJECTIVE: To determine whether the success and complication rates of oral anticoagulation obtained in large, well controlled trials, upon which recommendations are based, are comparable with routine cardiology practice. DESIGN: An observational, prospective cohort study collected data on all patients followed at an anticoagulant clinic over one calendar year. PATIENTS: One thousand and seventy-eight patients anticoagulated for cardiovascular indications, mainly atrial fibrillation, prosthetic valves and ventricular dysfunction, were followed for 804 patient-years of treatment. No patient was lost to follow-up. INTERVENTIONS: Telephone conversations and regular verification of medical files were used to record and classify all bleeding and thromboembolic events according to severity. International normalized ratios (INR) were compared with target ranges. RESULTS: One hundred and twelve bleeding events, ie, 13.9/100 patient-years (% p-y), were recorded, of which 61 required medical attention. Major hemorrhages, defined as those requiring treatment or hospital observation for more than 24 h, occurred in 15 instances (1.9% p-y). Among these, 9 (1.1% p-y) were classified as life threatening, with four being fatal (0,5% p-y). Twenty-two thromboembolic events (2.7% p-y) occurred, of which 10 were major (1.2% p-y), leaving three patients (0.4% p-y) with long term sequelae and causing two deaths (0.25% p-y). INRs were within target range 62.3% of the time, with 2.2% of values recorded above 5 and 0.3% above 10. CONCLUSION: The low failure and complication rates obtained in large, controlled trials are similar to those observed in actual cardiology practice.

Administration, Oral↗
PubMed1998

Nephrolithiasis and risk of hypertension in women.

Cross-sectional and prospective studies of men suggest a positive association between nephrolithiasis and hypertension. However, this association remains controversial in women. We conducted a prospective study of the relation between nephrolithiasis and the risk for hypertension in the Nurses' Health Study, a cohort of 89,376 women aged 34 to 59 years in 1980. Information on the history of nephrolithiasis, physician-diagnosed hypertension, and other relevant exposures was obtained by biennial mailed questionnaire. A history of nephrolithiasis before 1980 was reported by 2,558 women (2.9%), and a history of hypertension was reported by 11,883 women (13.3%). Among women without hypertension before 1980, 12,540 women reported a new diagnosis of hypertension between 1980 and 1992, during 711,039 person-years of follow-up. Compared with those without a history of nephrolithiasis, the age-adjusted relative risk (RR) for incident hypertension in women with such a history was 1.36 (95% confidence interval [CI], 1.20 to 1.43). After further adjustment for body mass index (BMI) and the intake of calcium, sodium, potassium, magnesium, caffeine, and alcohol, the RR was only slightly attenuated (RR=1.24; 95% CI, 1.13 to 1.37). In contrast, the occurrence of incident nephrolithiasis during follow-up was similar in women with hypertension at baseline compared with women without (adjusted odds ratio [OR]=1.01; 95% CI, 0.85 to 1.20). These data are consistent with the results obtained in men and support the hypothesis that a history of nephrolithiasis is associated with an increased risk for subsequent hypertension. Dietary factors, such as the intake of calcium, sodium, and potassium, do not explain this association. Unidentified pathogenic mechanisms common to nephrolithiasis and hypertension may be responsible for the development of both disorders.

Adult↗
PubMed1998

Nephrolithiasis and risk of hypertension.

A positive association between nephrolithiasis and blood pressure has been suggested in previous studies. However, controversy remains, due to methodological problems in some of the previous studies and absence of prospective data. We evaluated the relationship between nephrolithiasis and the risk of hypertension in a cohort of 51,529 men followed prospectively for 8 years. Information was obtained by biennial mailed questionnaires. At baseline in 1986, 4111 (8.0%) subjects reported a history of nephrolithiasis and 11,623 (22.6%) a diagnosis of hypertension. A positive association was found between the two disorders (age adjusted odds ratio [OR]: 1.31; 95% confidence interval [CI]: 1.30 to 1.32). Among men who reported both disorders, 79.5% reported that the occurrence of nephrolithiasis was prior to or concomitant with the diagnosis of hypertension. Among men without hypertension at baseline, the odds ratio for incident hypertension in men with a history of nephrolithiasis compared with those without was 1.29 (95% CI: 1.12 to 1.41; adjusted for age, body mass index, and intake of calcium, sodium, potassium, magnesium, and alcohol). The occurrence of incident nephrolithiasis during follow-up was similar in men with hypertension at baseline compared with that in men without (adjusted OR: 0.99, 95% CI: 0.82 to 1.21). These data support the hypothesis that prior occurrence of nephrolithiasis increases the risk of subsequent hypertension.

Adult↗
PubMed1997

Impact of nitric oxide on blood pressure in hemodialysis patients.

Nitric oxide (NO) is a powerful vasoactive agent that contributes to the regulation of blood pressure (BP). However, the role of NO in uremic patients and during the course of hemodialysis is still debated. Blood L-arginine concentrations and exhaled NO concentrations were measured in 22 healthy controls and in 22 hemodialysis patients before and after dialysis. On the basis of their BP response during hemodialysis, the patients were divided into three groups: 6 of the 22 patients presented with a decrease in BP during dialysis (group 1), eight presented with a stable BP (group 2), and eight with an increase in BP (group 3). The exhaled NO concentration was higher in dialysis patients than in healthy controls (22.7 +/- 2.6 ppb in dialysis patients v 16.7 +/- 0.9 ppb in controls, mean +/- SEM, P = 0.044). The predialysis and postdialysis exhaled NO concentrations were inversely correlated with the change in BP during hemodialysis (r = -0.47, P = 0.013). Patients with a decrease in BP (group 1) had the highest NO concentrations; patients with an increase in BP (group 3) had the lowest values; and patients with a stable BP during the course of dialysis (group 2) had intermediary values (trend test, P = 0.0291). In addition, both the exhaled NO concentration and the blood L-arginine concentration decreased during dialysis in all patients (P = 0.005 and P = 0.001, respectively). These results provide several novel insights into NO metabolism and BP regulation during hemodialysis: (1) maintenance hemodialysis is associated with a chronic increase in NO concentrations; (2) changes in BP during hemodialysis are inversely correlated with exhaled NO concentrations, higher NO levels being associated with a decrease in BP and lower NO levels with an increase in BP during dialysis; (3) blood L-arginine levels decrease during hemodialysis, and this reduction may in turn influence NO production.

Adult↗
PubMed1997

Anemia in hemodialysis patients: variables affecting this outcome predictor.

Despite the prevalent use of recombinant human erythropoietin (rhEPO), anemia is a frequent finding in hemodialysis patients. The goal of this study was to evaluate the impact of anemia on patient survival and characterize the determinants of hematopoiesis that may be amenable to therapeutic manipulation to enhance rhEPO responsiveness and reduce death risk. Patient characteristics and laboratory data were collected for 21,899 patients receiving hemodialysis three times per week in dialysis centers throughout the United States in 1993. Hemoglobin concentrations (Hb) < or =80 g/L were associated with a twofold increase in the odds of death (odds ratio = 2.01; P = 0.001) when compared with Hb 100 to 110 g/L. No improvement in the odds of death was afforded for Hb >110 g/L. Using multiple linear regression, variables of rhEPO administration (rhEPO dose and percentage of treatments that rhEPO was administered), variables of iron status (serum iron, transferrin saturation, and ferritin), variables of nutritional status (serum albumin and creatinine concentration), and the dose of dialysis (urea reduction ratio) were found to be significantly associated with hemoglobin concentration (P < 0.001). Age, race, and gender were also found to be significantly associated with hemoglobin concentrations (P < 0.001). From this report, the following conclusions may be made. (1) Anemia may be predictive of an increased risk of mortality in some hemodialysis patients. (2) Hemoglobin concentrations > 110 g/L are not associated with further improvements in the odds of death. (3) Laboratory surrogates of iron stores, nutritional status, and the delivered dose of dialysis are predictive of hemoglobin concentration. Whether manipulation of the factors that improve anemia will also enhance the survival of patients on hemodialysis is unknown and should be evaluated by prospective, interventional studies.

Adult↗
PubMed1996

An observational study of cardiovascular characteristics of long-term end-stage renal disease survivors.

Long-term survival with end-stage renal disease (ESRD) on dialysis is uncommon, mainly because of the high mortality associated with cardiovascular disease. To define the clinical characteristics of long-term ESRD survivors, especially their cardiovascular risk profile, patients were identified with > or = 15 years of ESRD having at least 10 years on dialysis. Seventeen patients were identified with a duration of ESRD of 21.0 +/- 4.3 years (mean +/- SD). The age of the patients at the initiation of dialysis was 38.4 +/- 14.5 years. Eighty-eight percent of the survivors were white, and 12% were African-American. The primary causes of ESRD were glomerulonephritis, 65%; polycystic kidney disease, 18%; tubulointerstitial/obstructive disorders, 12%; and hypertension, 6%. At the initiation of dialysis, these long-term survivors presented with a low prevalence of cardiovascular risk factors (hypertension, 53%; diabetes mellitus, 0%; active smoking, 11.8%; family history, 25%) and cardiovascular disease (coronary heart disease, 5.9%; congestive heart failure, 5.9%; arrhythmias, 0%; peripheral vascular disease, 0%; and cerebrovascular disease, 5.9%). In addition, only 6.6% of the long-term ESRD survivors presented with systolic blood pressures < 110 mm Hg, a level suggestive of systolic dysfunction. After > or = 15 years of dialysis, these long-term survivors remained with a low prevalence of cardiovascular risk factors and cardiovascular disease. These results suggest that the low cardiovascular risk profile and morbidity experienced by these patients may contribute to their prolonged survival on dialysis.

Adult↗
PubMed1996

Therapeutic plasma exchange in renal diseases.

Plasma exchange has been used extensively for over 2 1/2 decades to treat a variety of renal diseases. In this article, the scientific rationale for therapeutic plasma exchange in primary and secondary glomerulonephritis, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, myeloma cast nephropathy, and allograft rejection are reviewed. The clinical studies that evaluate its efficacy are summarized, with special emphasis on the results of randomized controlled trials, when available. Consensus plasma exchange regimens are presented for diseases in which there is evidence to support its use.

Animals↗
PubMed1995

Determinants of late allograft nephrectomy.

When loss of graft function occurs more than six months after transplantation, allograft nephrectomy is not routinely performed at the time of graft failure. It is usually performed only on those patients who subsequently develop specific complications. However, little is known about the characteristics that make patients more likely to require allograft nephrectomy. The purpose of our study was to identify risk factors for the subsequent need for allograft nephrectomy in patients with graft failure occurring more than 6 months after transplantation. Forty-one patients were studied. Inclusion criteria were: loss of graft function > or = 6 months after transplantation, resumption of dialysis and initiation of weaning from immunosuppression. Thirty patients were treated with cyclosporine + prednisone +/- azathioprine and 11 with azathioprine + prednisone. Mean follow-up time was 17.8 months, ranging from 6 months to 6.1 years. Recipient age, sex and race, original renal disease, donor, donor source (cadaveric vs living related), HLA compatibility, levels of panel reactive antibodies, occurrence of initial delayed graft function, causes of graft failure and tapering of immunosuppression were similar in patients with and without allograft nephrectomy. Using univariate analysis, allograft nephrectomy was found to be significantly more frequent in patients with a history of 2 or more episodes of acute rejection than in patients with no rejection episode: 83% vs 30% (p = 0.03). In addition, allograft nephrectomy was found to be significantly more frequent if the immunosuppressive regimen included cyclosporine (62% vs 27.3%; p = 0.04). Using multivariate analysis however, the number of previous episodes of rejection was found to be the only significant predictor for allograft nephrectomy. None of the other variables considered in the multivariate analysis, including the type of immunosuppressive therapy, was identified as a significant predictor for the need to perform allograft nephrectomy. In summary, the need for late allograft nephrectomy was correlated with the number of previous episodes of acute rejection. Patients with a history of numerous rejection episodes should thus be considered more likely to require allograft nephrectomy once immunosuppression is withdrawn. Possible interventions to reduce or prevent the need for nephrectomy include more gradual tapering of immunosuppression at the time of graft failure or indefinite low-dose immunosuppressive therapy.

Adult↗
PubMed1994

Nutritional evaluation of hemodialysis patients using an impedance index.

Malnutrition is frequent in chronic hemodialysis patients. Standard nutritional evaluation is based on anthropometric, laboratory and clinical parameters from which a malnutrition index can be derived. Bioelectrical impedance, more rapid and practical, can be used to evaluate body composition. The goals of our study were to: 1) evaluate the incidence of and some of the factors associated with malnutrition in hemodialysis patients; 2) assess the accuracy of a scoring system based on impedance results to identify malnourished patients as defined by the malnutrition index (based on anthropometric, laboratory and clinical parameters). Standard nutritional evaluation and impedance measurements were performed on 33 chronic hemodialysis patients. Using malnutrition index, 18 patients (54%) were severely or moderately malnourished. Dietary assessment revealed a high proportion of patients with insufficient protein or calorie intake. By multiple regression analysis, the only factor significantly correlated with the malnutrition index was calorie intake (r = 0.44); age, sex, years on hemodialysis, protein intake were not. Results obtained with impedance were strongly correlated to those obtained with anthropometry for the proportion of fat mass (r = 0.72) and lean body mass (r = 0.71) and for the malnutrition index (r = 0.78). The sensitivity of the scoring system based on impedance to identify moderately or severely malnourished patients as determined by standard nutritional evaluation was 100% and its specificity was 80%. The positive and negative predictive values were respectively 85% and 100%. In summary, malnutrition is frequent and associated with low caloric intake. Bioelectrical impedance, with the use of the scoring system we describe, can be used to correctly evaluate the nutritional status of hemodialysis patients.

Body Composition↗
PubMed1991

Segmental anatomy of the liver: a sonographic approach to the Couinaud nomenclature.

The authors developed a simplified description of the segmental anatomy of the liver on the basis of the Couinaud nomenclature. This approach was demonstrated with normal in vivo sonographic images and livers dissected in corresponding planes. The branches of the portal vein, which lead to the center of individual segments, are used as key landmarks in the determination of segmental location. The hepatic veins, ligaments, fissures, and gallbladder are used as external boundaries of the segments.

Adolescent↗