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Biomedical subjects

S S Chiang

Publications and source records attributed to S S Chiang.

At least 19 recordsLinked to original sources
PubMed2005

Lanthanum carbonate (Fosrenol) efficacy and tolerability in the treatment of hyperphosphatemic patients with end-stage renal disease.

AIMS: High serum phosphorus levels are a common problem in patients receiving long-term dialysis treatment. Lanthanum carbonate (Fosrenol) is a new non-aluminum, non-calcium phosphate binder developed for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). We report data from a recent trial, which, for the first time, assessed the efficacy and tolerability of lanthanum carbonate treatment, compared with placebo, in Chinese patients with ESRD. PATIENTS AND METHODS: Following a one- to three-week washout phase and a four-week, open-label lanthanum carbonate dose-titration phase, male and female hemodialysis patients were randomized (1:1) to receive either lanthanum carbonate or placebo for four weeks. The primary efficacy parameter of the study was the control of serum phosphorus levels (< or =1.8 mmol/l [< or = 5.6 mg/dl]). Secondary endpoints included the profile of serum phosphorus during titration and parathyroid hormone, calcium, and calcium x phosphorus (Ca x P) product levels. The safety and tolerability of lanthanum carbonate were assessed by monitoring adverse events throughout the study. RESULTS: Mean serum phosphorus level at the end of washout was 2.5 +/- 0.5 mmol/l (7.7 +/- 1.5 mg/dl; n=73), and there was no evidence of a difference in levels between the treatment groups pre-randomization. At the end of the study, lanthanum carbonate-treated patients had significantly lower phosphorus levels (1.6 +/- 0.5 mmol/l [5.1 +/- 1.5 mg/dl]; n=30) than those receiving placebo (2.3 +/- 0.4 mmol/l [7.2 +/- 1.3 mg/dl]; n=31; p < 0.001). In addition, a significantly higher proportion of patients receiving lanthanum carbonate had controlled serum phosphorus levels (60%) compared with the placebo group (10%; p < 0.001). Ca x P product levels were also significantly lower in the lanthanum carbonate group at the end of randomized treatment (p < 0.001). Lanthanum carbonate was well tolerated; only one serious adverse event was reported, which was unrelated to treatment. CONCLUSIONS: Lanthanum carbonate was shown to be an effective and well-tolerated phosphate binder for the treatment of hyperphosphatemia in Chinese patients with ESRD. This finding supports the results of previous US and European studies, which have also shown that lanthanum carbonate treatment effectively controls serum phosphorus levels.

Adult↗
PubMed2002

Reduction in erythropoietin doses by the use of chronic intravenous iron supplementation in iron-replete hemodialysis patients.

BACKGROUND: Iron deficiency is the most common cause of suboptimal response to recombinant human erythropoietin (rHuEPO) in chronic hemodialysis (HD) patients. Iron supply can correct this situation, however, optimal dosage, route of administration, and monitoring of iron status during rHuEPO therapy in maintenance HD patients remains controversial. METHODS: We conducted a 12-month intravenous iron substitution trial in 149 iron-replete chronic HD patients receiving subcutaneous rHuEPO therapy. The available iron pool was maintained with 100 mg iron every 2 weeks or 1 month depending on serum ferritin and transferrin saturation levels, the rHuEPO dosage titrated depending on hematocrit (Hct) levels. RESULTS: After 12-month protocol, the Hct increased (28.7 +/- 4.1 vs 27.7 +/- 2.6, p = 0.003), rHuEPO requirement reduced 25% (46.1 +/- 28.9 vs 61.5 +/- 67.8 U/kg/week, p = 0.006), serum ferritin increased (1,383 +/- 727 vs 930 +/- 857 ng/ml, p < 0.001), so did the transferrin saturation (36.1 +/- 12.7 vs 27.5 +/- 12.8%, p < 0.001). The serum albumin decreased slightly but reached statistical significance (4.1 +/- 0.48 vs 4.2 +/- 0.36 g/dl, p = 0.006), so did the cholesterol levels (166 +/- 41 vs 173 +/- 38 mg/dl, p = 0.044) and pre-dialysis creatinine (11.3 +/- 2.3 vs 11.5 +/- 2.4 mg/dl, p = 0.015). Besides, the iPTH levels did not interfere with the rHuEPO dosage reduction and Hct increment in our patients. CONCLUSION: We conclude that maintaining high levels of serum ferritin and transferrin saturation could further reduce the requirement of rHuEPO in chronic HD patients, but the long-term effect of iron overloading to patients' nutritional status must be further evaluated in contrast to the economic saving.

Erythropoietin↗
PubMed2001

The impact of diabetes on economic costs in dialysis patients: experiences in Taiwan.

Diabetes mellitus carries a great burden on healthcare costs due to its growing population and high co-morbidity. This adverse effect sustains even when patients develop end-stage renal disease (ESRD). We here present data showing the effect of diabetes on economic costs in dialysis therapy in Taiwan. As of the end of 1997, we have 22,027 ESRD patients with a prevalence and incidence rate of 1013 and 253 per million populations, respectively. Diabetic nephropathy is the second most common cause of the underlying renal diseases, but accounts for 24.8% of the prevalent patients and 35.9% of the incident cases. The diabetic patients engendered 11.8% more expense for care of dialysis than the non-diabetic patients (US $26,988 vs. US $24,146 per patient-year). Higher inpatient cost mainly account for the difference. As compared to non-diabetic patients, the diabetic patients had 3.5 times more inpatients costs (US $1325 vs. US $4677 per patient-year), and higher proportion of inpatient-to-annualized cost ratio (5.5 vs. 17.3%) resulting from their more frequent hospitalization (0.59 vs. 1.13 times per patient-year) and longer hospital stay (6.7 vs. 18.9 days per patient-year). The major causes responsible for a more frequent hospitalization were cardiovascular disease, poorly controlled hyperglycemia, sepsis and failure of vascular access. The annualized costs for care of dialysis patients in Taiwan, including inpatient and outpatient costs, averaged US $25,576 per patient-year. This value is approximately half of that in most of the western countries and Japan. Thus, a more cost-effective way to achieve savings is to reduce the high incidence rate of dialysis population and to maximize the quality of dialysis treatment for avoiding hospitalization. Recent studies had shown that tight blood pressure control, intensive glycemic control, and use of angiotensin converting enzyme inhibitors in diabetic patients significantly reduced not only the rate of progressive renal failure, but also substantially reduced the cost of complications and led to higher cost effectiveness. Once diabetic patients reach stage of ESRD, an optimized pre-ESRD care and consideration of kidney transplantation are essential in terms of better patient survival and cost savings.

Diabetes Mellitus↗
PubMed2001

Role of aggressivity on reactivity and craving before and after cue exposure in recently detoxified alcoholics: results from an experimental study.

The role of aggressivity and cue exposure in induction of craving were investigated in a clinical setting. Thirty abstinent alcoholic patients were divided into a low and a high aggressive group based on scores on the physical aggression subscale of the Buss-Durkee Hostility Inventory and exposed to alcohol cues. Craving was measured by means of the Alcohol Craving Questionnaire (ACQ) and Visual Analogue Scales (VAS). Important findings are: (1) main effects of aggressivity on 'emotionality', 'purposefulness' and 'expectancy' of ACQ were very significant; (2) on 'drinking intention' and 'craving for alcohol' of VAS, aggressivity and cue exposure showed a significant interaction; (3) the main effect of cue exposure on heart rate also reached a significance level of 0.007. The results were discussed in the context of the Classical, Operant Conditioning Theory, the Cognitive Craving Theory of Tiffany, Gilbert's STAR Model, and the Self-Medication Hypothesis.

Adult↗
PubMed2001

Fibrillary glomerulonephritis.

The occurrence of fibrillary glomerulonephritis is unusual in Taiwan, whereas it occurs in approximately 1% of renal biopsy specimens taken in the United States of American. This disease is characterized by extracellular randomly arranged non-branching Congo red-negative microfibrils within glomeruli. The microfibrils are less than 30 nm in diameter, and electron microscopy is essential for diagnosis. Differential diagnosis of the deposition of extracellular non-branching microfibrils within glomeruli is important because discrete diseases have different therapeutic and prognostic implications. The report will discuss two cases of biopsy-proved fibrillary glomerulonephritis who presented with proteinuria, hematuria, renal insufficiency, and hypertension. It is noteworthy that the renal function persistently went downhill, even though the physician treated the patients with corticosteroids, pulse treatment and immunosuppressive agents.

Aged↗
PubMed2000

Low molecular weight heparin in hemodialysis patients with a bleeding tendency.

Efficacy and safety of a low-molecular-weight heparin (LMWH) were studied in 33 stable maintenance hemodialysis patients who had a bleeding tendency on unfractionated heparin. The optimal dose of LMWH for each patient was titrated before the study; the mean total LMWH dosage was 1,152 +/- 574 IU. No major bleeding or clot formation was noted in a total of 2,470 hemodialysis sessions during 6 months of LMWH administration. The mean value of plasma anti-factor Xa (anti-Xa) activity increased from 0.05 +/- 0.03 IU/ml before dialysis to 0.34 +/- 0.28 IU/ml after 2 h of dialysis and returned to 0.15 +/- 0.09 IU/ml after 4 h of dialysis; the mean activated partial thromboplastin time was 26.1 +/- 4.4 s before dialysis, 30.7 +/- 9.5 s (an 18% increase) after 2 h of dialysis, and 26.2 +/- 4.4 s after 4 h of dialysis. No significant change in serum antithrombin levels was noted throughout the whole study period. We conclude that a low dosage of LMWH is safe and effective in hemodialysis patients who have a risk of bleeding with unfractionated heparin. Serum anti-Xa activity is better than activated partial thromboplastin time and antithrombin in assessing the optimal dose of LMWH. A plasma anti-Xa activity of 0.37 IU/ml after 2 h of hemodialysis may represent an optimal dosage of LMWH for most patients.

Anticoagulants↗
PubMed2000

Cholesterol crystal embolization causing acute renal failure.

Acute renal failure due to cholesterol embolization is a complication of severe generalized arteriosclerotic disease. It occurs spontaneously, or more often, as a complication of major medical or surgical procedures such as angiography and vascular surgery. The demonstration of characteristic cholesterol crystals in tissue biopsy specimens is a pathognomonic finding. However, renal cholesterol embolism may be clinically diagnosed when renal failure develops after known inciting factors or together with systemic manifestations of atheromatous embolization such as lower extremity livedo reticularis and focal digital ischemia. We report two cases of acute renal failure in which cholesterol embolization was found in skin and renal biopsies. One patient's renal function stabilized, but not to the basal level and the other patient developed end-stage renal disease.

Acute Kidney Injury↗
PubMed1996

The efficacy of percutaneous transluminal angioplasty in the treatment of failing vascular access in chronic hemodialysis patients.

BACKGROUND: Failure of vascular access leading to inefficient hemodialysis is the most common cause of morbidity in uremic patients. Careful observation of clinical signs and hemodynamic monitoring are vitally important to prevent complete fistula thrombosis. This study was undertaken to evaluate approaches for early detection and the application of percutaneous transluminal angioplasty in the treatment of failing vascular access. METHODS: From August 1994 to August 1995, 32 uremic patients with failing vascular access (26 native arteriovenous fistulas, 6 polytetrafluroethlene (PTFE) grafts), presented signs of poor arterial flow, high venous pressure, significant recirculation, acute fistula thrombosis and persistent swelling of the access arm. These patients underwent fistulography and subsequent angioplasty in the confirmed obstructed sites. RESULTS: Thirty-seven angioplasty procedures were performed including 32 de novo lesions and 5 restenotic lesions; of the total, 32 (86.5%) were successful. In native arteriovenous (AV) fistulas, the most common problem was inadequate flow with the lesion located within 5 cm from the AV junction (63.6%). In PTFE grafts, the most common presentation was high venous pressure with the lesion located at the PTFE-venous junction (57.1%). CONCLUSIONS: Through clinical surveillance and hemodynamic monitoring during hemodialysis, failing vascular access can be detected early and treated effectively with percutaneous transluminal angioplasty.

Adult↗
PubMed1995

Intracatheter amphotericin B retention for fungal peritonitis in continuous ambulatory peritoneal dialysis.

Two patients who developed fungal peritonitis after receiving continuous ambulatory peritoneal dialysis (CAPD) for various periods were successfully treated with intracatheter retention of amphotericin B and oral flucytosine for 5 weeks. The catheter was not removed and efficient peritoneal permeability was maintained. We suggest that intracatheter retention of antifungal agents to sterilize the catheter along with simultaneous oral antifungal agents be used to eradicate peritoneal infection. The catheter may not need to be removed, and CAPD can be accomplished. The period of hospitalization may, thereby, be shortened, and the efficiency of CAPD can be maintained.

Administration, Oral↗
PubMed1995

Successful treatment of fungal peritonitis with intracatheter antifungal retention.

Two patients who developed fungal peritonitis after receiving continuous ambulatory peritoneal dialysis (CAPD) for various periods were successfully treated with intracatheter retention of amphotericin B 1-2 mg and oral flucytosine or fluconazole 50 mg b.i.d. for 5 weeks. The catheter was not removed and efficient peritoneal permeability was maintained. We suggest that intracatheter retention of antifungal agents to sterilize the catheter with simultaneous oral antifungal agents be used to eradicate peritoneal infection. The catheter may not have to be removed, and CAPD can be accomplished. Period of hospitalization may be shortened, and the efficiency of CAPD can be maintained.

Amphotericin B↗
PubMed1994

Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study.

To examine and compare the efficacy and safety of different routes of administration of salbutamol in treating hyperkalemia, 15 patients with chronic renal failure (blood urea nitrogen > 80 mg/dL, serum creatinine > 8.0 mg/dL) were enrolled to sequentially receive either intravenous infusion (0.5 mg) or nebulization (10 mg) of salbutamol. Five of these patients (33.3%) did not respond to the intravenous salbutamol and were excluded from the study. Both treatments significantly decreased plasma potassium in 10 patients and the decrease was sustained for at least 3 hours. After infusion, the maximal reduction in plasma potassium levels was 0.92 +/- 0.10 mEq/L and occurred after 30 minutes. On the other hand, the maximal reduction in plasma potassium after nebulization (0.85 +/- 0.13 mEq/L) was similar to that after infusion, but it occurred after 90 minutes. Insulin and blood glucose increased, whereas blood pH, PCO2, sodium, osmolality, and blood pressure did not change after either treatment. Heart rate increased significantly after both treatments, but less after nebulization than after infusion. It is concluded that both infusion and nebulization are simple, effective, and safe therapeutic modalities for the treatment of hyperkalemia in patients with chronic renal failure. Infusion should be used in patients requiring a rapid decrease in plasma potassium; nebulization, on the other hand, should be used in patients with coronary artery diseases.

Administration, Inhalation↗
PubMed1994

Comparative effect of oral or intravenous calcitriol on secondary hyperparathyroidism in chronic hemodialysis patients.

The suppressive effects of intravenous (IVC) and oral (ORC) 1,25(OH)2D3 (calcitriol) therapies on parathyroid hormone (PTH) secretion were compared in 10 hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT). These patients were randomized to receive either IVC or ORC therapy for 12 weeks, both followed by a 12-week washout period. After the washout, the patients who received IVC then switched to ORC therapy for another 12 weeks, and the patients who received ORC switched to IVC therapy. The mean dose of IVC was 2.45 +/- 0.30 micrograms/dialysis session (approximately equal to 1.05 micrograms/day) and that of ORC was 0.69 +/- 0.07 micrograms/day. A significant reduction in serum levels of intact PTH was observed after 8 weeks and that of C-PTH after 10 weeks of ORC therapy, but both fell after 6 weeks of IVC treatment. There was a concomitant reduction in serum alkaline phosphatase (AP), but it became significant 4 weeks later than in intact PTH. The maximal reductions of serum levels of intact PTH, C-PTH and AP were 74.28, 64.91, 41.97%, respectively, after IVC, and 31.57, 24.39, 22.50%, respectively, after ORC therapy. Serum calcium rose faster during ORC treatment. There were no significant changes in serum levels of phosphorus, magnesium, and albumin throughout the treatment period. We conclude that both IVC or ORC treatments result in a significant decrement in blood levels of PTH in chronic HD patients with SHPT. However, this PTH-suppressive effect is more pronounced with IVC therapy, and cannot be totally explained by either the higher dose or elevated serum calcium.

Administration, Oral↗
PubMed1994

Intravenous infusion or nebulization of salbutamol for treatment of hyperkalemia in patients with chronic renal failure.

BACKGROUND: Hyperkalemia is one of the frequent medical emergencies in patients with chronic renal failure (CRF). We studied and compared the efficacy and safety of salbutamol either by intravenous infusion (i.v.) or nebulization (NB) in treating CRF patients with hyperkalemia. METHODS: Thirty-four patients (BUN > 80 mg/dl, serum creatinine > 8.0 mg/dl, and plasma potassium > 5.0 mEq/L) were randomly assigned to receive either i.v. (0.5 mg) or NB (10 mg) treatment of salbutamol. Plasma potassium, sodium, osmolarity, glucose, insulin, PCO2, blood pH, blood pressure and heart rate were monitored. RESULTS: One third of i.v. group and one fourth of NB group of patients were resistant to salbutamol treatment and were excluded from the study. All the baseline data were similar between 2 groups. After treatment, significant decrease in plasma potassium was found in both groups. The maximal reduction of plasma potassium was 0.95 +/- 0.14 mEq/L and occurred 30 minutes after i.v. treatment (n = 12) while it was 0.88 +/- 0.13 mEq/L and occurred 90 minutes after NB treatment (n = 12). During the first ninety minutes after treatments, the decrease of plasma potassium in IV group was faster and greater than in NB group. After that, the hypokalemic effect was more profound in NB group till the end of the study. The hypokalemic effects of both treatments sustained for at least 3 hours. Plasma insulin and glucose increased (p < 0.05) in both groups, whereas blood pH, PCO2, sodium, osmolarity and blood pressure did not change significantly. The reduction of potassium was significantly correlated with the elevation of insulin (i.v.: r = -0.56, p < 0.05; NB: r = -0.54, p < 0.05). Heart rate elevated significantly in both groups; nevertheless, this elevation was less marked in NB group. CONCLUSIONS: Both routes of administration of salbutamol resulted in a prompt and significant decrease of plasma potassium concentrations and both are considered as simple, effective and safe alternatives in treating hyperkalemia in patients with CRF. However, i.v. therapy might be preferred in CRF patients requiring a rapid lowering in plasma potassium; nebulization, on the other hand, should be preferred in CRF patients with coronary artery diseases.

Administration, Inhalation↗
PubMed1994

Effect of intravenous calcitriol on secondary hyperparathyroidism in chronic hemodialysis patients.

BACKGROUND: It has become evident that calcitriol can suppress parathyroid hormone (PTH) secretion by direct genomic actions. Intravenous calcitriol that bypasses gastrointestinal degradation might cause less degree of hypercalcemia and greater suppressive effect on PTH secretion. We investigated this PTH-suppressive effect of intravenous calcitriol in hemodialysis patients with secondary hyperparathyroidism. METHODS: Calcitriol was administered at the end of each dialysis session three times a week in 20 uremic patients, for 12 weeks. RESULTS: The mean dosage of calcitriol was 2.72 +/- 0.21 microgram per dialysis session. Serum intact PTH and C-PTH decreased (P < 0.05) after 6 weeks of treatment, while serum alkaline phosphatase (Alk-P) decreased 3 weeks later than PTH did. The individual maximal reduction of intact PTH, C-PTH and Alk-P were 77.80%, 67.36% and 45.98%. This PTH-suppression was dose-dependent. Despite the significant reduction of intact PTH by 58.17% after 6 weeks of treatment, no significant increase of serum calcium was found. An increase in serum calcium is not essential for this PTH-suppressive effect of calcitriol. Our observations thus provide another evidence to support the direct inhibitory effect of calcitriol on PTH secretion. Serum calcium, phosphorus, magnesium, albumin and osteocalcin levels did not change significantly. No side effect was found during treatment. CONCLUSIONS: Intravenous calcitriol is effective and safe in treating hemodialysis patients with secondary hyperparathyroidism. This treatment is more important in patients who are intolerant to oral vitamin D supply and who are candidates for surgical parathyroidectomy.

Adult↗
PubMed1991

Antibodies to hepatitis C virus in uremic patients on continuous ambulatory peritoneal dialysis.

The prevalence of antibody to hepatitis C virus (anti-HCV) among 101 uremic patients receiving continuous ambulatory peritoneal dialysis (CAPD) was evaluated using a synthetic peptide-based HCV antibodies enzyme immunoassay. Thirty (29.7%) were found anti-HCV positive. This is significantly higher than 500 unselected paid blood donors (4.2%, P less than 0.0001). Among CAPD patients, anti-HCV positivity was found more frequently in patients who had received frequent and longer duration of hemodialysis previously (40.4% vs. 20.4%, P less than 0.05). These findings suggest that hemodialysis patients have a higher risk of HCV infection. At present, CAPD may be a suitable way to reduce the incidence of HCV infection in uremic patients.

Adolescent↗