PubMed Health⌕ Search

Biomedical subjects

G Brunori

Publications and source records attributed to G Brunori.

35 records · Page 2Linked to original sources
PubMed1989

Is CAPD competitive with haemodialysis for long-term treatment of uraemic patients?

Although there are only 10 years of clinical experience with CAPD, compared to about 30 years of clinical practice with haemodialysis, it is time to compare the results obtained from the two methods. In this review, after briefly summarising the state of the art for some worrisome aspects of CAPD (peritonitis, loss of ultrafiltration and peritoneal clearance, malnutritional status), the ability of CAPD and haemodialysis to control the uraemic abnormalities are compared. Anaemia, blood pressure, cardiac function, renal bone disease, beta 2-microglobulin, and uraemic neuropathy are examined in the light of our personal experience and the literature; data so far published seem to indicate that the two methods are roughly similar for controlling these conditions. A survey of the studies comparing patient and method survival is also included. Patient survival on CAPD or on haemodialysis does not differ by more than 6 years. Method survival is better for haemodialysis; this is primarily due to the high drop-out rate from CAPD because of peritonitis, and the difference is very much reduced in CAPD centres with a low incidence of peritonitis. On the whole, CAPD seems to be able to compete, sometimes favourably, with haemodialysis. However, in our opinion the two methods are not in competition; each has its preferential indications, limits and complications, and both should be offered to uraemic patients in accordance with their medical or social needs. One should be ready to shift the patient from one method to the other when necessary, either for short periods of time or indefinitely.

Clinical Trials as Topic↗
PubMed1988

A six-year comparison of patient and technique survivals in CAPD and HD.

Comparisons of patient and technique survival were made for 120 CAPD and 139 HD patients undergoing dialysis between January 1981 and December 1986. Cox's proportional hazard regression model was used to compare patient and technique survival, with an adjustment for pre-treatment prognostic differences. Only the patients' first treatments were considered. The CAPD patients were 10 years older, on the average, than the HD patients and had more complicated conditions (58% with 3 or more co-existing risk factors vs. 35%). Overall patient survival between CAPD and HD did not differ (P = 0.2694). However, when adjusted for patient age, sex and other comorbid complicating conditions, CAPD patients over the age of 66 had a significantly lower risk of death than their HD counterparts (P less than 0.05). There were no differences in the adjusted patient survival for patients aged 30 to 66. Four pre-treatment prognostic factors had statistically significant adverse effects on patient survival: age, diabetes, malignancy and peripheral vascular disease. Survival of the HD technique, when unadjusted, was better than survival of CAPD (P = 0.0457). Even after adjustment for sex and age, this difference was still very nearly significant (P = 0.0656). No risk factors were found to be significantly associated with technique survival. Based on patient and technique survival, CAPD would appear to be an excellent alternative to HD and may be the preferred treatment for high risk patients over the age of 66.

Adult↗
PubMed1988

CAPD is a first class treatment: results of an eight-year experience with a comparison of patient and method survival in CAPD and hemodialysis.

An 8-year experience on CAPD, in a single center with all treatments of ESRF (end-stage renal failure) available, is presented. Method choice was left to the patient, after extensive counselling. However, CAPD selection was very negative, and CAPD patients were older, with a much larger percentage of diabetics and loaded by more risk factors, suggesting an influence of the staff preferences on patient choice. After a first period with unsatisfactory results, we obtained an important improvement of patient and method survival coinciding with the introduction of a new connector with disinfectant (Y-system) which allowed a reduction of peritonitis rate to 1 episode for 36 patient/months. For the period 1.1.81 to 31.12.86 a comparison was made (life table analysis) between new ESRF patients placed initially on CAPD or on HD. The 5-year survival was not statistically different in spite of the very negative CAPD selection of patients, who were 10 years older, on the average. Excluding diabetics, survival curves were identical in the two methods. Age at death and causes of death were not different. Method survival was better on HD (98% vs. 71% on CAPD, at 5 years, p less than 0.01): significance and limits of this evaluation are discussed. Drop-out figures were definitely lower than in the literature and this was attributed to the sharp reduction in peritonitis rate. Only 1.7% of CAPD patients discontinued the method due to inadequate ultrafiltration. In 29 CAPD and 28 HD patients with more than 4 years treatment some biochemical and clinical data were compared. Serum cholesterol was significantly higher and serum proteins lower in CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1987

Plasma concentrations of atrial natriuretic peptide in relation to body fluid status in chronic uraemia.

Basal plasma alpha-human natriuretic peptide (alpha-hANP) values were found to be significantly higher in 7 fluid-overloaded chronic dialysis patients than in 13 non-dialysed renal patients without extracellular fluid (ECF) expansion. Iso-osmotic reduction of the body weight by a single 3-h ultrafiltration caused alpha-hANP to decrease significantly in all anuric patients to values comparable to those of non-dialysed subjects. In this latter group, however, there was a significant inverse relationship between alpha-hANP and glomerular filtration rate but not between alpha-hANP and total blood volume. These findings suggest that both ECF expansion and impaired renal removal of alpha-hANP might be responsible for the high alpha-hANP in chronic uraemia.

Adult↗
PubMedDate not supplied

Diet or dialysis in the elderly? The DODE study: a prospective randomized multicenter trial.

There are no solid data on the real advantage of an early start of dialysis, as suggested by the DOQI guidelines. Uremic patients frequently have a poor nutritional status. However, we cannot distinguish between the detrimental effect on nutrition of too low a residual renal function or too long a period of low protein-diet, per se. However, it appears that a very-low-protein diet (VLPD) supplemented with essential amino acids and keto-analogs of amino acids, and with an adequate quantity of calories, can prevent hypoalbuminemia at the start of dialysis and can slow the progression of chronic renal failure. EDTA and USRDS data suggest that most patients starting dialysis nowadays are elderly, who also have the highest incidence of morbidity and mortality. Moreover, hospitalization rate becomes higher after the start of dialysis compared to the pre-dialysis period. Can an aminoacid-supplemented VLPD, prolonged beyond the GFR limits suggested by DOQI, offer elderly patients better survival and better quality of life than dialysis? The answer can only come from a prospective, randomized trial, in elderly patients, starting at the GFR values suggested by the NKF-DOQI for starting dialysis, comparing outcomes with a vegetarian VLPD supplemented with a mixture of keto-analogs of amino acids and essential amino acids, and with dialysis.

Age Factors↗
PubMedDate not supplied

CAPD viability: a long-term comparison with hemodialysis.

OBJECTIVE: To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD). DESIGN: Retrospective study of patients of our institution starting dialysis between January 1, 1981, and December 31, 1993, and surviving for at least 2 months. PATIENTS: Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD). MAIN OUTCOMES STUDIED: Cox-adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time. RESULTS: Patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987-1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis ("technique success") was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients > or = 75 years. CONCLUSION: CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.

Adolescent↗