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Biomedical subjects

S Draibe

Publications and source records attributed to S Draibe.

12 recordsLinked to original sources
PubMed2001

Customized bicarbonate buffered dialysate and replacement solutions for continuous renal replacement therapies: effect of crystallization on the measured levels of electrolytes and buffer.

The aim of this study was to investigate the impact of the addition of calcium to bicarbonate solutions for continuous renal replacement therapy (CRRT). We tested single bag (bicarbonate and calcium mixed 24 h before testing) and double bag solutions (mixed immediately before) with and without the addition of 4 mEq/L of acetate. Prescribed calcium varied from 0 to 5 mEq/L. All test solutions containing calcium showed crystallization at light microscopy. The double bag solutions decreased but did not prevent crystallization. The addition of acetate did not interfere with crystallization. Crystallization, as measured by the weight of the crystals after filtration of the solutions, showed a significant positive correlation with the calcium deficit (prescribed minus measured) and with partial pressure of carbon dioxide. The measured level of calcium was lower than expected and correlated with crystallization. Our results suggest that the use of bicarbonate solutions containing calcium as replacement fluids for CRRT is a potentially unsafe procedure.

Bicarbonates↗
PubMed2000

Quality of life at the initiation of maintenance dialysis treatment--a comparison between the SF-36 and the KDQ questionnaires.

OBJECTIVE: To evaluate the construct validity of the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) and to assess the quality of life of patients with end-stage renal disease (ESRD) at the initiation of maintenance dialysis treatment. METHODS: Cross-sectional study. SETTING: Eight ambulatory dialysis units in São Paulo city, Brazil. STUDY PARTICIPANTS: Eighty ESRD patients at the initiation of chronic dialysis program and consecutively accepted for treatment in selected units in 1998. MAIN OUTCOME MEASURES: Quality of life as measured by the dimensions of the SF-36 questionnaire. The 'Kidney Disease Questionnaire' was used in a subgroup of patients to evaluate the validity of the SF-36. RESULTS: Median (range) scores of the SF-36 dimensions (ranging from 0 to 100, higher scores representing better quality of life) were: Physical Function 70 (0-100), Role Limitations due to Physical Problems 25 (0-100), Bodily Pain 62 (0-100), General Health 57 (5-100), Vitality 55 (10-100), Social Function 63 (0-100), Role Limitations due to Emotional Problems 34 (0-100) and Mental Health 68 (0-100). SF-36 dimensions correlated significantly with those of the 'Kidney Disease Questionnaire' (correlation coefficients ranging from 0.23 to 0.68). CONCLUSIONS: The SF-36 was shown to have construct validity when used in patients with ESRD in Brazil. The quality of life of ESRD patients is impaired at the initiation of dialysis treatment and this was clearly evidenced in the Role Limitations due to Physical Function and Emotional Function items. Greater attention should be given to interventions that could improve the quality of life parameters at the initiation of dialysis treatment.

Adult↗
PubMed1998

Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment.

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

Adolescent↗
PubMed1996

Acceptance for chronic dialysis treatment: insufficient and unequal.

BACKGROUND: Evidence suggests that a number of end-stage renal disease (ESRD) patients die without receiving dialysis. We investigated and compared ESRD patients who died without receiving treatment and those who were accepted for dialysis. METHODS: All patients starting chronic dialysis in 1991 in the city of Sao Paulo and prospectively registered in the Health Secretariat files were studied. From death certificates we obtained data from all patients dying with an underlying cause associated with chronic renal failure. Medical records from a sample of patients who died without receiving dialysis were reviewed. RESULTS: Of 2127 patients, 1582 (74.7%) received dialysis and 545 (25.6%) did not. The best chance of being dialysed occurred in the 20-29 age group. The age groups with the least chance of receiving dialysis were 0-9 years and over 79 years old. The odds ratio (95% Cl) of not receiving dialysis was 12.42 (6.63-23.82) times greater for patients over 60 years old compared to those aged 10-19 years. Patients with renal failure due to congenital diseases, chronic pyelonephritis, unknown cause, and hypertension were less likely to receive dialysis than those with glomerulonephritis or diabetes. CONCLUSIONS: Our results suggest that many ESRD patients die without receiving dialysis. Age and cause of renal disease influence the chance of being accepted for treatment. Restrictions of treatment need to be corrected to guarantee that maintenance dialysis will be accessible to ESRD patients.

Adolescent↗
PubMed1994

Effect of sodium fusidate and ofloxacin on Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis.

The effectiveness of sodium fusidate and ofloxacin to eliminate nasal and catheter exit-site Staphylococcus aureus colonization and to prevent infections was compared in 31 patients on continuous ambulatory peritoneal dialysis (CAPD). In a prospective randomized study, 9 patients were treated with topical 2% sodium fusidate ointment applied in the anterior nares and in the pericatheter skin twice daily for 5 days; 9 subjects received oral ofloxacin 200 mg taken every 48 hours for 5 days and 13 subjects were in the control group. Treatment courses were repeated at one-month intervals. Mean duration of follow-up was 7.8 months (242 patients-month). Follow-up samples from the nares and the catheter exit-site were obtained every month from all participants to determine the presence of S. aureus. Development of S. aureus exit-site infection and peritonitis were assessed. During the study, S. aureus was recovered from 45%, 59% and 52% of the samples from the nares and/or exit-site in the sodium fusidate, ofloxacin and control groups, respectively (p = 0.13). S. aureus grew less frequently (p < 0.01) in samples from the exit-site in the sodium fusidate than in the other two groups. Eradication of nasal colonization (two negative cultures within one month) was observed in 43%, 40% and 33% of the cases in the sodium fusidate, ofloxacin and control groups, respectively (p > 0.50). The corresponding figures for exit-site eradication were 43%, 33% and 11%, respectively (p = 0.34). Twenty-four S. aureus-associated infection episodes (12 of exit-site and 12 of peritonitis) were diagnosed in 16 of the 31 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1990

Cost-effectiveness analysis of the treatment of end-stage renal disease in Brazil.

Cost-effectiveness analysis compared four treatments of end-stage renal disease in Brazil: continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (HD), cadaver donor transplantation (CD-Tx), and living related donor transplantation (LR-Tx). After 2 years, the costs per year of survival were CAPD, $12,134; HD, $10,065; CD-Tx, $6,978; and LR-Tx, $3,022. The HD cost was lower than CAPD partially because of the reuse of hemodialyzers in Brazil. Although less cost-effective, both dialysis treatments yielded more years of survival after 2 years. This analysis reveals a trade-off between cost per year of survival and years of survival.

Adolescent↗
PubMed1989

Staphylococcus aureus skin carriage and development of peritonitis in patients on continuous ambulatory peritoneal dialysis.

We conducted a 15-month prospective study to investigate the skin carriage of Staphylococcus aureus and the development of peritonitis in 43 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Sixteen of 43 patients (37%) were chronic carriers of S. aureus in the anterior nares and/or in the exit-site of the catheter; 12 patients (28%) were intermittent carriers, and 15 (35%) were noncarriers. Fifty episodes of peritonitis occurred during a total of 422 patient-months of observation. S. aureus was responsible for 16 episodes of peritonitis diagnosed in 15 patients. All episodes of S. aureus peritonitis occurred in chronic and intermittent carriers. Phage typing was performed on isolates from 8 patients with S. aureus peritonitis, and they were found to have the same phage type as that previously carried in the skin. We conclude that CAPD patients who are chronic or intermittent carriers of S. aureus are at higher risk of development of peritonitis than noncarriers.

Adolescent↗
PubMed1980

Parenteral nutrition and repeated hemodialysis of bilaterally nephrectomized conscious dogs. I. Experimental model.

The experimental model of the anephric, daily hemodialyzed conscious dog with exclusive nutrition was realized by means of a closed batch hemodialysis system (Rhodial 75) and a highly permeable polyacrylonitrile membrane (RP 6 dialyzer). Technical details, parenteral feeding, hemodialysis, and amino acid solutions preparations were described to realize a stable condition of the animals for further metabolic analyses during the early anephric period.

Amino Acids↗
PubMed1980

Parenteral nutrition and repeated hemodialysis of bilaterally nephrectomized conscious dogs. II. Metabolic studies.

To realize equilibrated metabolic conditions after bilateral Nx, three male mongrel dogs were exclusively fed by parenteral infusions with a dog-specific compound of EAA, glutamate, and/or glucose (0.19 g nitrogen and/or 52-70 kcal per kg and day). Daily dialyses required by infusion volumes up to 65 ml/kg/day were performed by means of a closed batch hemodialysis system (Rhodial 75) and highly permeable membranes (RP 6), which allowed a precise ultrafiltration control and direct dialysate analysis. Comparing the urea nitrogen production in a pre- and post-nephrectomy period with a 4 successive days' schedule of only glucose, followed by amino acid administration, a marked decrease of net urea nitrogen excretion was noted after nephrectomy, when EAA were supplied.

Amino Acids, Essential↗
PubMedDate not supplied

[Sensitivity profile of 147 strains of S. aureus isolated from patients in continuous ambulatory peritoneal dialysis].

Staphylococcus aureus is reported to be the most common organism to cause peritonitis in continuous ambulatorial peritoneal dialysis (CAPD). Staphylococcal nasal carriage is frequently seen in these patients. The authors studied the sensitivity of S. aureus strains isolated from CAPD patients and some close family contacts. Susceptibility of 147 strains of S. aureus to 23 antimicrobial agents were determined based on 348 samples. All strains tested were susceptible to vancomycin. Penicillin resistance was found in nearly all strains. Resistance to rifampicin was seen in just 5% of the strains. A high rate of resistance to ampicillin, amoxicillin, tetracycline, and also to cotrimoxazole, gentamicin, and tobramycin were observed. Cephalosporins and some aminoglycosides (amicacin and netilmicin) have a good in vitro bactericidal activity anti-S. aureus. Knowledge of the susceptibility profile of bacteria frequently isolated at a given hospital ward will provide the basis for a more effective empirical antibiotic treatment in such ward.

Humans↗
PubMedDate not supplied

[Access to chronic dialysis treatment: deficient and unequal].

OBJECTIVE: To determine the fraction of patients with end-stage renal disease (ESRD) who received dialysis treatment in the city of São Paulo in 1991 and to investigate the influence of age in the access to dialysis. MATERIAL AND METHODS: All patients who received dialysis for ESRD in the city of São Paulo during 1991, and were registered in the Secretary of Health of São Paulo files were included in the study. In the same year, information was also collected on individuals who died having as basic cause of death a disease related to chronic renal failure. These data were obtained from death certificates files. Using simultaneously information from both data bases it was possible to ascertain the patients who died without receiving dialysis and to calculate the treated fraction in several age groups. RESULTS: Overall 25.6% of ESRD patients did not receive treatment. There was a progressive reduction in the fraction of patients treated for those older than 40 years. In children less or equal to 9 years of age the percentage of treatment was also reduced (29%). Individuals in the age groups 60-69 and 70-79 years had a chance about 5 and 11 times greater, respectively, of dying without receiving dialysis than those in the 20-29 years group. CONCLUSIONS: We estimate that at least one fourth of the ESRD patients died in São Paulo in 1991 without receiving dialysis treatment. Age is a major factor of discrimination for acceptance in chronic dialysis programs.

Adolescent↗