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Biomedical subjects

Robert Provenzano

Publications and source records attributed to Robert Provenzano.

11 recordsLinked to original sources
PubMed2006

Relationship between hemoglobin level and quality of life in anemic patients with chronic kidney disease receiving epoetin alfa.

OBJECTIVES: To evaluate the relationship between hemoglobin (Hb) level and quality of life (QOL) in anemic patients with non-dialysis chronic kidney disease receiving epoetin alfa. PATIENTS AND METHODS: A post-hoc analysis using data from a multicenter, open-label, prospective study of epoetin alfa for anemia in patients with chronic kidney disease not on dialysis was conducted. The relationship between Hb and QOL was analyzed using correlation and longitudinal analyses, the latter adjusting for sample selection bias. The Linear Analog Scale Assessment (LASA) and the Kidney Disease Questionnaire (KDQ) subscales were used to measure QOL. The impact of an incremental 1 g/dL increase in Hb level on LASA and KDQ scores was determined using an incremental analysis. RESULTS: A total of 1183 and 1044 patients formed the study populations for the LASA and KDQ analyses, respectively. There was a positive and significant relationship between Hb levels and QOL (p < 0.05). Using non-linear regression analysis, we characterized the sigmoid-shape of the relationship between Hb levels and QOL scores. Hemoglobin change was a statistically significant determinant of QOL improvement for both LASA and KDQ scales (p < 0.05). The model predicted that, based on a 2 unit change in Hb, the greatest incremental QOL improvement per unit of Hb increase occurred when Hb was in the range of 11 to 12 g/dL. CONCLUSIONS: This study demonstrates that, beyond the well-known relationship between Hb increases and QOL improvements, the maximal incremental gain in QOL occurred when Hb reached 11 to 12 g/dL. This suggests that treating anemic patients with non-dialysis chronic kidney disease until their Hb level reaches 12 g/dL will result in the greatest QOL improvement per Hb unit increase. The analyses were conducted based on an open-label study of epoetin alfa and could be further validated using a randomized, controlled trial, comparing incremental gains in QOL associated with treatment initiation at varying levels of Hb across arms.

Aged↗
PubMed2005

A single center experience in the use of polyurethaneurea arteriovenous grafts.

BACKGROUND: Polytetrafluoroethylene (PTFE) grafts often require temporary catheters, which increase costs as well as risk of infection, bleeding, and poor blood flow. Polyurethaneurea (PUU) grafts can be cannulated within 24 hours of placement, avoiding the need for temporary catheters. METHODS: Hemodialysis patients who were not candidates for arteriovenous fistula (AVF) were eligible for the study. Those requiring urgent (<48 hours) hemodialysis access received PUU grafts; all others received PTFE grafts. One surgeon performed all implantations. RESULTS: 133 PUU grafts were implanted, 31 (24%) patients died (unrelated to graft placement). Within the first 4 days after graft placement, 108 of 133 grafts (81%) were cannulated. None required a temporary catheter. Of 102 surviving patients, 50 (49%) had graft thrombosis; 47/50 (94%) underwent successful percutaneous thrombectomy (PT). Primary patency at 6 months and at 1 year was 51% and 33%, respectively. Secondary patency at 6 months and 1 year was 78% and 61%, respectively. Mean bleeding time (after withdrawal of dialysis needle) was 4.0 (range 1-14) minutes in PUU grafts vs. 9.2 (1-30) minutes in PTFE grafts. CONCLUSIONS: Polyurethane graft placement allowed early graft cannulation without temporary catheters. Patency rates are comparable with previous reports. Decreased bleeding time with PUU grafts reduced aggregate blood exposure for patients and staff, lowering the risk of infection and anemia exacerbation and speeding time between treatments.

Adult↗
PubMed2005

Paying fairly for good outcomes: which formula works?

I see the single-based payment systems moving more toward the middle, toward an American-style system using competitive bidding with outcomes-based focus. The American system is moving in the opposite direction despite knowledge of the flaws of a single-payment system. Modernizing our payment system by desegregating Medicare Part A and Part B, applying information technology, and value-based reimbursement along with a bold move toward an HSA methodology could empower patients and physicians, reinvigorate our system with cost savings, and move us in the direction that all industries in a free market system should have the freedom to move.

Humans↗
PubMed2004

Epoetin alfa. Clinical evolution of a pleiotropic cytokine.

Recombinant human erythropoietin (epoetin alfa) has been used in clinical settings for more than a decade. Its indications have expanded considerably from its original use as hormone therapy in the treatment of anemia in adults with chronic kidney disease. Since the introduction of epoetin alfa, a greater understanding of anemia pathophysiology and the interactions of erythropoietin, iron, and erythropoiesis has been elucidated. Anemia is now independently associated with increased mortality and disease progression. Potential survival benefits associated with correction of anemia in various patient populations are leading to consideration of earlier, more aggressive treatment of mild to moderate anemia with epoetin alfa. Moreover, this agent's therapeutic use may extend beyond currently accepted roles. Epoetin alfa is undergoing evaluation with promising results in a variety of new clinical settings, including anemia associated with congestive heart failure, ribavirin-interferon alfa treatment of hepatitis C virus infection, and critical illness. Preclinical studies also have established erythropoietin and its recombinant equivalent to be a pleiotropic cytokine with antiapoptotic activity and neuroprotective actions in the central nervous system. The therapeutic potential of epoetin alfa appears yet to be fully realized.

Anemia↗
PubMed2002

The nephrology nurse's role in improved care of patients with chronic kidney disease.

The care of chronic kidney disease (CKD) patients is suboptimal. This article discusses how nephrology nurses can contribute to multidisciplinary clinics that work in collaboration with primary care providers to identify and manage patients with early CKD. This article will describe the importance of the nephrology nurse as a resource for improved patient outcomes and for the implementation of federal, professional, and corporate CKD initiatives.

Chronic Disease↗
PubMedDate not supplied

Prevalence and treatment of anemia with once-weekly epoetin alfa in patients with diabetes and chronic kidney disease.

OBJECTIVE: To describe the characteristics and prevalence of anemia in patients with diabetes and chronic kidney disease (CKD) not receiving dialysis and to evaluate the efficacy and safety of once-weekly (QW) epoetin alfa for the treatment of anemia in these patients. METHODS: Post hoc subset analyses were conducted for 2 studies: a prospective, multicenter survey evaluating the prevalence of anemia in patients with CKD (the Prevalence of Anemia in Early Renal Insufficiency [PAERI] study) and a prospective, multicenter, open-label trial evaluating the efficacy and safety of QW epoetin alfa for the treatment of anemia associated with CKD (the Clinical Evaluation of Procrit Dosed Once Weekly in Patients With Anemia Due to Early Renal Insufficiency [POWER] study). Patients in the POWER study received epoetin alfa, 10,000 U subcutaneously QW for up to 16 weeks. Each study subset consisted of patients with type 1 or type 2 diabetes. RESULTS: More than 60% of patients in both studies had diabetes. In the PAERI study, 52.4% of the patients with diabetes (N = 3,361) had a hemoglobin (Hb) level < or = 12 g/dL, and 10.5% had Hb < or = 10 g/dL. Female sex, African American race, reduced kidney function, reduced transferrin saturation, and diabetes as the cause of CKD were strongly associated with anemia. In the POWER study, the mean Hb level in the patients with diabetes (N = 816) increased from 9.1 g/dL (baseline) to 11.6 g/dL (final); the mean increase in Hb from baseline was 2.4 g/dL (P<0.0001). Epoetin alfa therapy was associated with significant quality of life improvements and was well tolerated. CONCLUSION: Diabetes is prevalent in patients with CKD not receiving dialysis, and anemia is prevalent among these patients. Epoetin alfa QW is safe and effective in treating anemia in these patients.

Aged↗
PubMedDate not supplied

Comparison of vancomycin versus cefazolin as initial therapy for peritonitis in peritoneal dialysis patients.

The incidence of peritonitis ranges from 1 episode every 24 patient treatment months to 1 episode every 60 patient treatment months [Keane WF, et al. ISPD Guidelines/Recommendations. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int 2000; 20:396-411.]. Gram-positive organisms account for over 80% of continuous ambulatory peritoneal dialysis (PD)-associated peritonitis. Recent fear of vancomycin-resistant enterococci (VRE) has prompted suggestions of limiting vancomycin use. Fifty-one episodes of peritonitis in 30 patients studied over 2 years were evaluated. Cloudiness of the PD fluid and/or abdominal pain were considered suggestive of peritonitis and were confirmed by cell count and culture. Baseline cell count, Gram stain, and cultures were obtained, with periodic follow-up. Patients were randomized to receive either vancomycin 1 g/L intraperitoneally (IP) as loading dose, repeated on day 5 or day 8, depending on residual renal function, for 2 weeks, or cefazolin 1 g in the first PD bag and continued with 125 mg/L every exchange for 2 or 3 weeks, depending on culture results. All patients also received gentamicin 40 mg IP every day until the culture results were available. A similar randomized trial comparing vancomycin and cefazolin in the past used a lower concentration of cefazolin 50 mg/L [Flanigan MJ, Lim VS. Initial treatment of dialysis associated peritonitis: a controlled trial of vancomycin versus cefazolin. Perit Dial /nt 1991; 11:31-7.]. Peritoneal dialysate fluid cultures revealed 31(60.7%) gram-positive organisms, 7(13.7%) gram-negative organisms, and 2 (3.9%) cultured yeast; 11 (21.5%) cultures yielded no growth. The incidence of peritonitis at our center was 1 episode every 42 patient treatment months. No case of VRE was noted. There was no statistical difference in clinical response or relapse rate for the two protocols. It was the authors' and nurses' observation that patient compliance and satisfaction was better with vancomycin, and the cost per treatment was 23% less than cefazolin. Based on these data we believe vancomycin should still be considered for first-line treatment of PD-associated peritonitis.

Adult↗