PubMed Health⌕ Search

Biomedical subjects

F Maduell

Publications and source records attributed to F Maduell.

At least 19 recordsLinked to original sources
PubMed2006

[Estimation of the cost in the farmacologic treatment of chronic renal failure].

The prevalence and incidence of end stage renal disease has increased considerably in the past years. We know that the cost of treatment of these patients is high. Limited information exists on care resource utilization for maintenance of patients before the initiation of replacement therapy. The purpose of this study is determine the cost of pharmaceutic treatment during the predialysis phase. Pharmacy cost was analyzed for 200 patients controlled on outpatient nephrology department. The mean age was 72.4 years, 59% were males, and the comorbidity distribution was: hypertension 87%, hyperlipidemia 56% and diabetes 35%. The per-patient-per-month charges were 215.45 Euro, with a continous increase from 84.64 Euro on stage 1 to 352.59 Euro on stage 5 of chronic kidney disease. Erythropoiesis stimulants were reponsible of 46.5% of these cost. The most frequent prescribed medications were antihypertensive drugs, statins and iron preparations. Patients with end stage renal disease generate significant cost during the predialysis period. The limited resources, and the growth of health care expeditures, particulary the spending for prescriptions drugs, are two of the major problems for Health Care Systems. A better knowledge of the associated costs to the treatment of these patients will help us to increase our efficiency.

Aged↗
PubMed2006

[Middle molecules removal. Beyond beta2-microglobulin].

The uremic toxin removal capacity mainly depends on dialyzer and hemodialysis modes. The low-flux hemodialysis only removes solutes having molecular weights less than 5.000 Da. High-flux hemodyalisis represents a form of low-volume hemodiafiltration because of the internal filtration and back-filtration that can take place within a dialyzer. Hemodiafiltration with large volumes of replacement fluid seems to be the best technique for removing all small, medium-sized and large molecules. The objective of our study was to evaluate the large molecules removal bigger than beta2-microglobuline on high flux haemodialysis and on-line hemodiafiltration with postdilutional infusion, in patients with three times a week dialysis and on short daily dialysis. We studied 24 patients, 15 males and 9 females stable on haemodialysis programme, twelve on standard four to five hours three times a week dialysis and twelve on 2 to 2 1/2 hours six times a week dialysis. All patients were dialysed with Fresenius 4008 monitor, three sessions on high flux haemodialysis (HD) and three sessions on on-line hemodiafiltration (OL-HDF). Two sessions with each filter were performed (polisulfone HF80, polyethersulfone Arylane H9 and new polisulfone APS 900). Pre and postdialysis concentrations of urea, creatinine, (beta2-microglobulin (beta2-m), myoglobin, prolactin and alpha1 microglobulin (alpha1-m) were measured. There was no difference in urea and creatinine small molecules removal. beta2m removal was 68% on HD and 81% on OL-HDF. Myoglobin and prolactin present a similar removal pattern, a higher removal with new filters (60% with Arylane and 59% with APS) in comparison with clasical polisulfone (22% with HF80). The mean alpha1-m reduction rate on HD was 6% and on OL-HDF 22%. OL-HDF with APS 900 filter was the most remove technique (35.4%), significatively higher than the other modes and filters. We can conclude that the new filters generation reach a better uremic toxins removal, specially in large molecules higher than beta2-m and on HD modality.

Adult↗
PubMed2005

[Depurative efficiency of intermediate and large molecules with different hemodialysis modalities].

An accumulation of uremic toxins occurs in renal failure, interfering with different biological functions. Low-flux hemodialysis only clears solutes with a molecular weight lower than 5000 Da. High-flux hemodialysis improves this clearance, being limited from 15,000 Da up. Hemodiafiltration techniques, mid-dilutional, post-dilutional or both, with high reinfusion volumes, are the most efficacious cleaning either large, middle or small uremic toxins. Protein-bound small-size mole cules are not properly removed by any technique. Research in technology and new therapeutic schemes are still needed in order to achieve more physiological depuration methods with better future results.

Forecasting↗
PubMed2005

[Monitoring hemodialysis dose with ionic dialisance in on-line hemodiafiltration].

Until now, with the ionic dialysance measurement, it has been possible to determine hemodialysis dose in each session of hemodialysis (HD) and in the conventional hemofiltration (HDF) but not in the modality of on-line HDF. Recently it is possible with a new biosensor that allows to measure the dose in on-line HDF. The aim of this study was to evaluate the value of this biosensor in different dialysis situations comparing the dialysis dose measured in blood in comparison with the values obtained from the sensor. We have analysed 192 hemodialysis sessions performed in 24 patients, 15 male and 9 female, mean age of 70.2 +/- 12 years, included in on-line HDF. All treatments were done using 4008H (Fresenius) monitor equipped with on-line clearance monitoring (OCM), that measure, with non invasive monitoring, the effective ionic dialysance equivalent to urea clearance. Every patient received eight dialysis sessions: one with dialysate flow (Qd) 500 ml/min, two with HD and Qd 800 ml/min and five with on-line HDF. Other habitual haemodialysis parameters were no changed, dialysis time 200 +/- 63 min (135-300) and blood flow 421 +/- 29 ml/min (350-450). Initial and final ionic dialysance values (K), final Kt, Kt/V measured with OCM using V of Watson, and Kt/V determined in blood pre and postdialysis concentrations of urea (Daugirdas second generation), were measured. The mean of initial K was 251 +/- 21 ml/min and the final K was 234 +/- 24 ml/min. The Kt measured with OCM was 50.6 +/- 17 L, 51.2 +/- 17 in men and 49.7 +/- 16 in women. The V (Watson) was 34.5 +/- 6 L. The Kt/V measured with the Kt of OCM and V was 1,499 +/- 0.54 and Kt/V measured in blood samples was 1,742 +/- 0.58. The correlation between both values was 0.956. The Kt was different according to dialysis modality used: in HD and Qd 500 was 44.7 +/- 15 L, in HD and Qd 800 was 50.7 +/- 17 and in on-line HDF (22.1 +/- 7 L of reposition volume), was 51.8 +/- 17 L. The Kt/V from blood samples also shows variation: in HD and QD 500 was 1.60 +/- 0.55, in HD and Qd 800 was 1,726 +/- 0.56 and in on-line HDF was 1,776 +/- 0.59. In this study has been observed a close correlation between the new biosensor OCM with the measures obtained from the blood samples. For this reason this sensor it is useful in all modalities of dialysis treatment, included on-line HDF. The sensor was able to discriminate the efficacy of different dialysis modalities used in this study.

Adult↗
PubMed2004

[Improvement of nutritional status in patients with short daily on-line hemodiafiltration].

Daily dialysis have showed excellent results because a higher frequency of dialysis is more physiological and it decreases the fluctuation of liquid, solutes and electrolytes. Improvement of certain causes of anorexia such as postdialysis fatigue, reduction in fluid overload, uremic milieu, medium and large-sized molecule removal could be observed with daily dialysis. The aim of this study was to evaluate nutritional parameters when thrice weekly on-line hemodiafiltration (OL-HDF) were switched to daily OL-HDF. 24 patients have been studied. Eight patients, 6 males and 2 females, mean age of 65.9 +/- 14 years, on thrice weekly 4 to 5 hours OL-HDF were switched to 2 to 2.5 hours six times per week. Dialysis parameters were the same in both periods and only frequency and dialysis time were changed. Other sixteen patients, mean age of 68.4 +/- 14 years, were a control group which dialysis parameters were maintained. Clinical and biochemical outcome were carried out over twelve months. Daily OL-HDF group: Dry weight increased from 67.8 +/- 8 kg at baseline to 68.5 +/- 8 kg after three months, 69.3 +/- 8 kg after six months (NS), 69.5 +/- 8 kg after nine months (p < 0.05) and 70.8 +/- 8 (p < 0.01) after one year. Mean nPCR increased from 0.93 +/- 0.2 g/kg/d on baseline to 1.18 +/- 0.3 after three moths (P < 0.0-5), 1.13 +/- 0.2 after six months (NS), 1.06 +/- 0.2 after nine months (NS) and 1.10 +/- 0.2 after twelve months (NS). There were no significant changes in serum protein, albumin, prealbumin, transferrin, total cholesterol, HDL-c, LDL-c and triglycerides (TG). There were no changes in control group. Mean dry weight was 62.3 +/- 9 kg at baseline and 62.1 +/- 10 kg after one year. Mean nPCR was 0.97 +/- 0.2 g/kg/d on baseline and 1.03 +/- 0.2 g/kg/d after one year. Neither there were changes in serum protein, albumin, transferrin, total cholesterol, HDL-c, LDL-c and TG. Improvement in nutrition status has been observed with the change from thrice weekly OL-HDF to short daily OL-HDF. Increased appetite and protein intake was accompanied by a dry body weight increase of three kg after twelve months.

Adult↗
PubMed2004

[Acute interstitial nephritis associated with omeprazole therapy].

From 1 to 3% of acute renal failures are due to acute interstitial nephritis (AIN). Most of them are due to drugs. Nonsteroidal antiinflammatory drugs, penicillins and sulfonamides are the most frequently reported. Clinical presentation of drug-induced AIN has changed over time and with the use of new drugs. In fact actually the classic triad of fever, rash and eosinophilia is uncommon. Omeprazole is a drug widely used in the treatment of gastroesophageal reflux disease and peptic ulcer disease. Serious side effects are rare with this drug, but despite of its safety we can see serious adverse effects such as acute renal failure. We describe two cases of acute interstitial nephritis after use of omeprazole and a review of all the cases published in the last years.

Acute Disease↗
PubMed2003

[Intradialysis hemolysis secondary to hypophosphatemia].

We report a 76-year-old man, stable on a thrice-weekly hemodialysis program over a period of 3 years, who developed acute intradialysis hemolysis secondary to hypophosphatemia, an unusual cause of hemolysis. During the dialysis session we monitored the starting point, the severity and duration of intradialysis hemolysis. Severe hyphosphatemia is a rare cause of intradialysis hemolysis. It is important to think of his possibility to make an adequate diagnosis and treatment. The patient was treated with a phosphorus-enriched acid concentrate, bicarbonate-buffered dialysate, with biochemical and clinical improvement.

Aged↗
PubMed1999

Change from conventional haemodiafiltration to on-line haemodiafiltration.

BACKGROUND: On-line haemodiafiltration (HDF) is a technique which combines diffusion with elevated convection and uses pyrogen-free dialysate as a replacement fluid. The purpose of this study was to evaluate the difference between conventional HDF (1-3 l/h) and on-line HDF (6-12 l/h). METHODS: The study included 37 patients, 25 males and 12 females. The mean age was 56.5 +/- 13 years and duration of dialysis was 62.7 +/- 49 months. Three patients dropped out for transplantation, three patients died and three failed to complete the study period. Initially all patients were on conventional HDF with high-flux membranes over the preceding 34 +/- 32 months. Treatment was performed with blood flow (QB) 402 +/- 41 ml/min, dialysis time (Td) 187 min, dialysate flow (QD) 654 +/- 126 ml/min and replacement fluid (Qi) 4.0 +/- 2 l/session. Patients were changed to on-line HDF with the same filtre and dialysis time, QD 679 +/- 38 ml/min (NS), QB 434 +/- 68 ml/min (P < 0.05) and post-dilutional replacement fluid 22.5 +/- 4.3 l/session (P < 0.001). We compared conventional HDF with on-line HDF over a period of 1 year. Dialysis adequacy was monitored according to standard clinical and biochemical criteria. Kinetic analysis of urea and beta2-micro-globulin (beta2m) was performed monthly. RESULTS: Tolerance was excellent and no pyrogenic reactions were observed. Pre-dialysis sodium increased 2 mEq/l during on-line HDF. Plasma potassium, pre- and post-dialysis bicarbonate, uric acid, phosphate, calcium, iPTH, albumin, total proteins, cholesterol and triglycerides remained stable. The mean plasma beta2m reduction ratio increased from 56.1 +/- 8.7% in conventional HDF to 71.1 +/- 9.1% in on-line HDF (P < 0.001). The pre-dialysis plasma beta2m decreased from 27.4 +/- 8.1 to 24.2 +/- 6.5 mg/l (P < 0.01). Mean Kt/V (Daugirdas 2nd generation) was 1.35 +/- 0.21 in conventional HDF compared with 1.56 +/- 0.29 in on-line HDF (P < 0.01), Kt/Vr (Kt/V taking into consideration post-dialysis urea rebound) 1.12 +/- 0.17 vs 1.26 +/- 0.20 (P < 0.01), BUN time average concentration (TAC) 44.4 +/- 9 vs 40.6 +/- 10 mg/dl (P < 0.05) and protein catabolic rate (PCR) 1.13 +/- 0.22 vs 1.13 +/- 0.24 g/kg (NS). There was a significant increase in haemoglobin (10.66 +/- 1.1 vs 11.4 +/- 1.5) and haematocrit (32.2 +/- 2.9 vs 34.0 +/- 4.4%), P < 0.05, during the on-line HDF period, which allowed a decrease in the erythropoietin doses (3861 +/- 2446 vs 3232 +/- 2492 UI/week), (P < 0.05). Better blood pressure control (MAP 103.8 +/- 15 vs 97.8 +/- 11 mmHg, P < 0.01) and a lower percentage of patients requiring antihypertensive drugs were also observed. CONCLUSION: The change from conventional HDF to on-line HDF results in increased convective removal and fluid replacement (18 l/session). During on-line HDF treatment, dialysis dose was increased for both small and large molecules with a decrease in uraemic toxicity level (TAC). On-line HDF provided a better correction of anaemia with lower dosages of erythropoietin. Finally, blood pressure was easily controlled.

Adult↗
PubMed1998

Urea reduction ratio considering urea rebound.

An American National Study shows that survival benefits from higher dialysis doses appear to be present up to a Kt/V level of 1.3 or a urea reduction ratio (URR) of 70%. The effect of increasing dialysis efficiency magnified urea rebound and the error in URR determinations. Several formulas have been developed to calculate URR considering the urea rebound (URRr). Smye and coworkers have proposed a method whereby the equilibrated blood urea nitrogen is predicted by additional intradialytic urea sample. Maduell and colleagues, based on analysis of postdialysis urea rebound, have proposed a method whereby the urea rebound is predicted. To compare measured URRr to estimated by Smye and Maduell formulas, 384 patients were studied, 211 males and 173 females, who received a dialysis session with their habitual parameters. Measurements of plasma urea concentration were obtained at the beginning, 90-100 min following the start of dialysis, at the end, and 45 min after dialysis. The postdialysis urea rebound was 22.4+/-9.7%. The urea kinetic model Kt/V was 1.365+/-0.26, and Kt/Vr was 1.14+/-0.23. URR was 68.7+/-6.6%, and when it was calculated with urea rebound, it decreased to 61.9+/-7.4%. The URRr correlated with calculations by Smye and Maduell formulas: 60.7+/-8.4 (r = 0.722, p < 0.001) and 61.8+/-6.6 (r = 0.933, p < 0.001), respectively. The precision of estimated limits of agreement and percentage of error by Bland and Altman analysis show that URRr estimated Maduell formula could be used in place of the URRr. Otherwise, the degree of agreement of the Smye method was not clinically acceptable. In conclusion, our results led us to suggest that in actual dialysis, the use of URR is not adequate for delivered hemodialysis dose, and URRr should be used. URRr estimated by Maduell formula could be a simple and accurate method for use in clinical practice. The recommended dialysis dose by the American National Study of URR of 70% could correspond, considering urea rebound, to Kt/Vr 1.18 or URRr of 64%.

Adult↗
PubMed1998

[Vasculitis affecting the kidney: analysis of 18 patients].

OBJECTIVE: Eighteen patients who were judged to have systemic vasculitis (1990 American College of Reumathology criteria) affecting the kidney, from January 1988 to August 1996, were reviewed. METHOD: We analyzed characteristics of clinical, biochemical, histopathological features, the interval between the onset of the symptoms to a diagnosis of disease, treatment and overall outcome. RESULTS: The principal mode of presentation of the vasculitis is general, renal and pulmonary symptoms. The discovery of ANCA has improved the diagnostic procedure in patients with these diseases. Renal biopsy facilitates early diagnosis, prognosis and treatment. The renal lesion typically shows a segmental necrotizing glomerulonephritis and extracapillary proliferation forming crescent. CONCLUSIONS: The systemic vasculitis with renal involvement carries a poor prognosis and high mortality. A variety of treatment has been employed, but their precise role in the management of these vasculitis is still being elucidated.

Aged↗
PubMed1997

Validation of different methods to calculate Kt/V considering postdialysis rebound.

BACKGROUND: The effect of increasing dialysis efficiency magnifies rebound urea and the error in Kt/V determinations from single pool urea kinetics. Several formulae have been developed to calculate Kt/V taking into account the rebound urea (Kt/Vr). Smye et al. proposed a method whereby the equilibrated BUN is predicted by an additional intradialytic urea sample (Kt/VrSmye). Daugirdas et al. proposed a method where a single pool Kt/V is modified according to the speed of dialysis to obtain a double pool Kt/V (Kt/VrDaug). Maduell et al. developed a method based on analysis of post-dialysis urea rebound whereby the Kt/Vr is predicted according to the single pool Kt/V and K/V (Kt/VrMad). DESIGN OF THE STUDY: We compared Kt/Vr estimated by these three formulae (Smye, Daugirdas, and Maduell) in 384 patients consisting of 211 males and 173 females, who received dialysis according to their regular protocols. Plasma urea was measured at the beginning, 90-100 min following the start of dialysis, the end, and 45 min post-dialysis. RESULTS: Post-dialysis rebound urea was 22.4 +/- 9.7%. Kt/V and Kt/Vr obtained with rea kinetic model Kt/V 1.184 +/- 0.22 and 0.984 +/- 0.20, respectively. These was a good correlation between Kt/Vr and the Smye formula (Kt/VrSmye = 0.956 +/- 0.21, r = 0.729, P < 0.001), and a better one for Daugirdas (Kt/VrDaug = 0.984 +/- 0.18, r = 0.931, P < 0.001), and Maduell formulae (Kt/VrMad = 0.980 +/- 0.18, r = 0.946, P < 0.001). Limits of agreement and percentage of error estimated according to Bland and Altman show that Kt/Vr estimated by Daugirdas and Maduell formulae could be used in place of the Kt/Vr. The degree of agreement with the Smye method is not clinically acceptable. CONCLUSION: Our results suggest that the use of a single pool Kt/V is not adequate to estimate the haemodialysis dose delivered and Kt/V taking rebound urea in consideration. Kt/Vr estimated by Daugirdas or Maduell formulae are a simple and accurate method for use in clinical practice.

Adult↗
PubMed1994

Analysis of urea distribution volume in hemodialysis.

According to the urea kinetic model it is considered that the urea distribution volume (V) is that of body water, and that it is distributed in only one compartment. Since the V value is different to measure, it is normal to use 58% of body weight, in spite of the fact that it may range from 35 to 75%. In this study, we have calculated the value of V by using an accurate method based on the total elimination of urea from the dialysate. We have studied the V, and also whether the different dialysis characteristics modify it. Thirty-five patients were included in this study, 19 men and 16 women, under a chronic hemodialysis programme. The dialysate was collected in a graduated tank, and the concentration of urea in plasma and in dialysate were determined every hour. Every patient received six dialysis sessions, changing the blood flow (250 or 350 ml/min), the ultrafiltration (0.5 or 1.5 l/h), membrane (cuprophane or polyacrylonitrile) and/or buffer (bicarbonate or acetate). At the end of the hemodialysis session, the V value ranged from 43 to 72% of body weight; nevertheless, this value was practically constant in every patient. The V value gradually increased throughout the dialysis session, 42.1 +/- 6.9% of body weight in the first hour, 50.7 +/- 7.5% in the second hour and 55.7 +/- 7.9% at the end of the dialysis session. The change of blood flow, ultrafiltration, membrane or buffer did not alter the results. The V value was significantly higher in men in comparison with women, 60.0 +/- 6.6% vs. 50.5 +/- 5.9% of body weight (p < 0.001).

Aged↗
PubMed1994

Is it easier to dialyze women than men?

Since the urea kinetic model is used as an objective method for monitoring dialysis, it has been possible to shorten reasonably its duration. From the usual practice, we have observed that it is easier to reduce the dialysis time in women as compared to men. The purpose of this study is to find out the reason for such observation and to corroborate it. Fourty-two patients, 25 males and 17 females on 3-weekly dialysis (3 h/session) were studied. All patients were dialyzed under the same dialysis characteristics: 3-hour sessions, blood flow 350 ml/min, ultrafiltration 1.5 liters/h, 1.5-m2 cuprophane membrane and bicarbonate buffer. The dialysate was collected in a graduated tank. Urea concentration in plasma and in the dialysate was measured. Then, the urea distribution volume, dialyzer clearance, the KT/V index and protein catabolic rate were calculated. The KT/V value was higher in women with respect to men, 1,017 +/- 0.10 versus 0.82 +/- 0.14 (p < 0.001). The urea distribution volume value was significantly higher in men as compared to women, 60.04 +/- 6.6 versus 51.48 +/- 5.88% (p < 0.001). There were no significant differences in dialyzer clearance, protein catabolic rate or body weight. In conclusion, under identical dialysis conditions, it is easier to dialyze women than men, because women's urea distribution volume is lower than men's.

Adult↗