Hemodialysis chronic

A. E. Sizemore, G. W. Arnaud, C. D. "Etiology of Hyperparathyroidism and Bone Disease During Chronic Hemodialysis. III. Evaluation of Parathyroid Suppressability". J. Clin. Invest. (1973), 52, 173-180. 

Received blood transfusions or organ transplantations before 1992 Received clotting factors before 1987 Ever on chronic hemodialysis... 

The most commonly used screening method for HIV is an enzyme-linked immunosorbent assay, which detects antibodies against HIV-1 and is both highly sensitive and specific. False positives can occur in multiparous women in recent recipients of hepatitis B, HIV, influenza, or rabies vaccine following multiple blood transfusions and in those with liver disease or renal failure, or undergoing chronic hemodialysis. False negatives may occur if the patient is newly infected and the test is performed before antibody production is adequate. The minimum time to develop antibodies is 3 to 4 weeks from initial exposure. 

Rostaing, L. et al., Pharmacokinetics of alphaIFN-2b in chronic hepatitis C virus patients undergoing chronic hemodialysis or with normal renal function Clinical implications, J Am Soc Nephrol., 9, 2344, 1998. 

In uremia there are present in the serum a variety of known and unknown metabolites that can produce aberrant laboratory results. Significant differences in glucose concentration have been observed in such specimens analyzed by ferricyanide (F2a) or Fe (II)-5-pyridylbenzo-diazepin-2-one reduction methods compared to glucose oxidase procedures (K7a). In a patient with elevated creatinine (15 mg/100 ml) and uric acid (10 mg/100 ml), the glucose value determined by the automated alkaline ferricyanide procedure was overestimated by 20 mg/100 ml (C4). In uremic patients undergoing chronic hemodialysis there is a decrease in transaminase activity. In 11 of 19 such patients, there was... 

W13. Wolf, P. L., William, D., Coplon, N., and Coulson, A. S., Low aspartate transaminase activity in serum of patients undergoing chronic hemodialysis. Clin. Chem. 18, 567-568 (1972). 

Iron deficiency anemia For the treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy. 

Hemodialysis - Hemodialysis removes cefdinir from the body. In patients maintained on chronic hemodialysis, the recommended initial dosage regimen is a 300 mg or 7 mg/kg dose every other day. At the conclusion of each hemodialysis session, give 300 mg (or 7 mg/kg). Subsequent doses (300 mg or 7 mg/kg) are then administered every other day. 

If the patient presents with acute burning pain, the examination of choice is erythrocytic protoporphyrins. If the free protoporphyrin is significantly elevated (more than 6 pmol/1), the diagnosis of erythropoietic protoporphyria is established. Plasma porphyrins are used in patients on chronic hemodialysis who suffer from skin blisters to differentiate between PCT and pseudoporphyria the latter does not show increased plasma porphyrins. 

Porphyrins in plasma are mainly used to distinguish between PCT and pseudoporphyria in patients with chronic hemodialysis. CEP patients also show characteristic elevations with dominance of I-isomers, especially of uroporphyrin and its decarboxylation products, in both plasma and erythrocytes. Plasma porphyrins may be used for follow-up of the patients. 

Plasma patients on chronic hemodialysis with PCT show typically elevated uro-and heptacarboxyporphyrins. PCT patients without renal disease may also show an identical pattern. Patients with CEP show a predominance of I-isomers. 

The uses and adverse effects of raloxifene have been reviewed (8-12). Current work seems to show an altogether positive effect of raloxifene (for example 60 mg/ day) on bone metabolism and serum lipids in post-meno-pausal women on chronic hemodialysis, without significant adverse effects in the short term. However, even the authors of very promising work in this connection point to the difficulty in assessing the long-term safety of the treatment in such women (13). Longer-term work elsewhere has pointed particularly to the occurrence of thromboembolic disease, but also of hot flushes, influenza-like symptoms, peripheral edema, and leg cramps. With the exception of thromboembolism these are unpleasant rather than serious, but they still need to be recorded and studied in this very susceptible group of users. 

Hernandez E, Valera R, Alonzo E, Bajares-Lilue M, Carlini R, Capriles F, Martinis R, Bellorin-Font E, Weisinger JR. Effects of raloxifene on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis. Kidney Int 2003 63 2269-74. 

Heparin-induced hypoaldosteronism is well documented, both in patients treated with standard heparin, even at low doses, and in patients treated with low molecular weight heparin (477,478). The most important mechanism of aldosterone inhibition appears to be a reduction in both the number and affinity of angiotensin II receptors in the zona glomerulosa (477). A direct effect of heparin on aldosterone synthesis, with inhibition of conversion of corticosterone to 18-hydroxycorticosterone, has also been suggested. This effect is believed to be responsible for the hyperkalemia that can occur in heparin-treated patients with impaired renal function and particularly in patients on chronic hemodialysis (479), or with diabetes mellitus, or who are taking other potentially hyperkalemic drugs. 

Hottelart C, Achard JM, Moriniere P, Zoghbi F, Dieval J, Fournier A. Heparin-induced hyperkalemia in chronic hemodialysis patients comparison of low molecular weight and unfractionated heparin. Artif Organs... 

Huang TL, Lee CT. Serum albumin and ferritin levels in chronic hemodialysis patients with or without major depression. International Congress of Biological Psychiatry, February 9-13, 2004. Sydney, abstract 88. 

I 5 Matsuo T, Matsuo M, Kario K, et al, Characteristics of heparin-induced platelet aggregates in chronic hemodialysis with long-term heparin use. Haemostasis 2000 30 249-257. 

Flaminio LM, Bergia R, De Angelis L, et al. 1988. The fate of leached di-2 (ethylhexyl)phthalate (DEHP) in patients on chronic hemodialysis. Int J Artif Organs 11 428-434. 

Elevated aluminum levels have been implicated as the cause of dialysis encephalopathy or dementia in renal failure patients undergoing long-term hemodialysis [85]. Some patients used aluminum-containing medications. Moreover, patients with renal failure cannot remove aluminum from the blood. Dialysis dementia can arise after three to seven years of hemodialysis treatment. Speech disorders precede dementia and convulsions. Since many hemodialysis units rely on systems to purify fluoridated tap water, it is likely that many patients are being exposed inadvertently to increased concentrations of fluoride and aluminum. Increased serum fluoride concentration and fluoride intoxication have been also observed in chronic hemodialysis patients. Arnow et al. [96] reported that 12 of 15 patients receiving dialysis treatment in one room became acutely ill, with multiple non-specific symptoms and fatal ventricular fibrillation. Death was associated with longer hemodialysis time and increased age compared with other patients who became ill. 

The aluminum concentration in human blood is comparable with that used in the laboratory investigations. The fluoride concentration in human blood is still many times lower than that used in the laboratory. It is difficult to predict the actual concentrations of aluminum and fluoride in intracellular compartments. But the increase of serum concentrations of fluoride in chronic hemodialysis patients to 756 pmol L-1 resulted in illness or death. 

A 20-year-old man had had Goodpasture s syndrome for 2.5 years, end-stage renal disease on chronic hemodialysis for 15 months, and hypertension controlled... 

Hutin, Y.XF., Goldstein, S.T., Varma, XK., Odair, XB., Mast, E.E., Shapiro, C.N., Alter, M.X An outbreak of hospital-acquired hepatitis B virus infection among patients receiving chronic hemodialysis. Inf. Contr. Hosp. Epid. 1999 20 731 -735... 

B. N. Becker, J. Himmelfarb, W. L. Henrich and R. M. Hakim, Reassessing the Cardiac Risk Profile in Chronic Hemodialysis Patients A Hypothesis on the Role of Oxidant Stress and Other Non-Traditional Cardiac Risk Factors, Journal ofAmerican Society of Nephrology 8 (1997) 475-486. 

Aluminium is toxic in patients on chronic hemodialysis and peritoneal dialysis and in those taking oral aluminium-containing medications. Aspects of aluminium safety (9) and metabolism (10) have been reviewed. The association between aluminium in drinking water and Alzheimer s disease continues to be discussed and remains controversial (11). 

Friga V, Linos A, Linos DA. Is aluminum toxicity responsible for uremic pruritus in chronic hemodialysis patients Nephron 1997 75(l) 48-53. 

Bia MJ, Cooper K, Schnall S, Duffy T, Hendler E, Malluche H, Solomon L. Aluminum induced anemia pathogenesis and treatment in patients on chronic hemodialysis. Kidney Int I989 36(5) 852-8. 

Alfrey AC, Mishell JM, Burks J, ContigugUa SR, Rudolph H, Lewin E, Holmes JH. Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Intern Organs 1972 18 257-61,266-7. 

Certain other patients are especially sensitive to the gastrointestinal effects of sorbitol for example, diabetics can be prone to sorbitol intolerance, because of altered gastrointestinal transit time and motility. Some of them also have a higher consumption of sorbitol-containing dietary foods. Patients on chronic hemodialysis can be predisposed to sorbitol intolerance as a result of carbohydrate malabsorption (25). 

In one study of the use of calcium carbonate as a phosphate binder in patients on chronic hemodialysis, there was a low incidence of hypercalcemia at daily doses below 6 g (2), whereas in another report on 26 dialysis patients who used calcium carbonate for 3 years, 42% developed new calcification (3). 

In patients undergoing chronic hemodialysis, the safety profile did not differ from that reported in other populations, except for some rare cases of hypotension during hemodialysis. Hemodialysis does not affect the kinetics of candesartan. Because of the variability of oral clearance and the pronounced influence of hemodialysis-induced volume contraction on the hemodynamic effects of candesartan, careful monitoring is recommended (2). 

An 82-year-old man on chronic hemodialysis had pneumonia, for which he was given intravenous cefepime 1 g/day (32). After 4 days he developed a seizure and cefepime was withdrawn. Hemodialysis was started and his conscious level improved. On the next day, after a second hemodialysis, he recovered completely. 

Bastani B, GalU D, GeUens ME. Cimetidine-induced climacteric symptoms in a young man maintained on chronic hemodialysis. Am J Nephrol 1998 18(6) 538-40. 

Patients on chronic hemodialysis are at risk of gabapentin toxicity. A patient nndergoing hemodialysis and... 

A review of 15 other available reports of renal insufficiency and proteinuria in patients with chronic myeloid leukemia or other malignancies confirmed that the histological spectrum of renal lesions associated with interferon alfa is varied, and includes membranous glomerulonephritis, minimal change glomerulonephritis, acute interstitial nephritis, hemolytic-uremic sjmdrome, and thrombotic microangiopathy. Renal comphcations were reversible in nine patients three patients had persistent proteinuria, and four had persistent renal dysfunction, of whom three required chronic hemodialysis. Two-thirds of the patients developed renal comphcations within 1 month of treatment with interferon alfa, and one-third had received a relatively low dosage of interferon alfa (9-15 MU/week). 

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