Patients dialysis

Maintenance hemodialysis has grown and expanded beyond the expectations of even the most enthusiastic of its eadiest proponents. Figure 7 is a plot of the overall estimated dialysis population by year siace 1970. The population at the end of 1992 exceeded 475,000 another 500,000 patients or so have received therapy at one time but have siace died or had transplants. Maintenance dialysis is now available to some extent ia all but the poorest nations ia economically advanced countries, excepting the United Kingdom, it is rendered as a virtual entitlement. The current worldwide mean cost of a single dialysis patient is about 30,000 per year (47) the aggregate economic magnitude of the medical appHcation of hemodialysis thus approaches 15 biUion. 

Recent applications of HPAEC-PAD are many and varied. A representative list includes quantitation of polyglucose metabolites in plasma of dialysis patients,148 analysis of heat-treated milk,149 carbohydrate content in lipopolysaccharides,150 phosphorylated sugars in tissue samples,151 composition of soybean meal,152 carbohydrate composition of recombinant modified tissue plasminogen activator,153 analysis of cyclization products from an enzyme reaction,154 carbohydrate content of glycoconjugate vaccines,155 and monitoring of patients with rheumatoid arthritis.156... 

Hypotension may be related to alterations in levocarnitine levels during dialysis. Patients who have low levels of levocarnitine may benefit from supplementation. Levocarnitine is administered as doses of 20 mg/kg intravenously at the end of each dialysis session. However, levocarnitine should not be used as a first-line agent for the treatment of hypotension because of the significant cost associated with the treatment. Patients receiving levocarnitine should be evaluated every 3 months for response to therapy.47 Other preventive measures that have not been well studied include caffeine, sertraline, or fludrocortisone. 

Once aluminium has reached the circulation, there seems little doubt that it can cross the blood-brain barrier - the best proof being that in renal dialysis patients... 

Furthermore, pH determination has been used in other clinical research, both alone and in combination with other measurements. This research includes studies into the relationship between extracellular and intracellular pH in an ischemic heart [6, 7], the pH of airway lining fluid in respiratory disease [8], the study of pH as a marker for pyloric stenosis [9], malnutrition in alkalotic peritoneal dialysis patients [10], pH modulation of heterosexual HIV transmission [11, 12], and wound prevention and treatment [13], In addition, pH changes due to blood acidosis have been used to trigger and pace the ventricular rate of an implanted cardiac pacemaker [14], Research using pH measurements... 

Peritoneal dialysis patients may be treated with oral doses of calcitriol (0.5-1 meg) or doxercalciferol (2.5-5 meg) two or three times... 

Kharagjitsingh, A.V. et al., Incidence of recombinant erythropoietin (EPO) hyporesponse, EPO-associated antibodies, and pure red cell aplasia in dialysis patients, Kidney Int., 68, 1215, 2005. 

Erythropoietin release is stimulated by hypoxia (low PO2). Within hours, the hormone ensures that erythrocyte precursor cells in the bone marrow are converted to erythrocytes, so that their numbers in the blood increase. Renal damage leads to reduced erythropoietin release, which in turn results in anemia. Forms of anemia with renal causes can now be successfully treated using erythropoietin produced by genetic engineering techniques. The hormone is also administered to dialysis patients. Among athletes and sports professionals, there have been repeated cases of erythropoietin being misused for doping purposes. 

PhosLo - For adult dialysis patients, the initial dose is 2 tablets/capsules/gelcaps with each meal. The dosage may be increased gradually to bring the serum phosphate value less than 6 mg/dL, as long as hypercalcemia does not develop. Most patients require 3 to 4 tablets with each meal. 

Peritoneal dialysis patients Median dosage of 76 units/kg/week (range, 24... 

Patients with CRF not requiring dialysis Patients with CRF not yet requiring dialysis may require lower maintenance doses of darbepoetin than patients receiving dialysis. Predialysis patients may be more responsive to the effects of darbepoetin, and require judicious monitoring of blood pressure and hemoglobin. Also closely monitor renal function and fluid and electrolyte balance. 

Renal function impairment Renal failure or dialysis patients may require smaller doses closely supervise to prevent cardiac failure or exacerbation of renal failure. Carcinogenesis Dietary administration of minoxidil to mice for up to 2 years was associated with an increased incidence of malignant lymphomas in females at all dose levels (10, 25, and 63 mg/kg/day) and an increased incidence of hepatic nodules in males (63 mg/kg/day). 

Renal function impairment Admn s er 1.25 mg every 6 hours for patients with Cor greater than 30 mL/min. For Ccr 30 mL/min or less, initial dose is 0.625 mg. If there is inadequate clinical response after 1 hour, the 0.625 mg dose may be repeated. May give additional 1.25 mg doses at 6-hour intervals. For dialysis patients, initial dose is 0.625 mg or less administered over 5 minutes or more, preferably longer (no more than 1 hour). 

Renal function impairment - In patients with a creatinine clearance less than 30 mL/min, increase the dosing interval to 12 hours, with a maximum daily dose of 200 mg. Because hemodialysis only removes 7% of an administered dose, dialysis patients can receive their regular dose on the day of dialysis. 

Renal function impairment Use rizatriptan and sumatriptan with caution in dialysis patients because of a decrease in the clearance. 

Hemodialysis - Hemodialysis removes approximately 50% of a dose in 6 hours. In patients maintained by regular dialysis, the usual dose of 1.5 to 2 mg/kg given after every dialysis usually maintains therapeutic, nontoxic serum levels. In patients receiving intermittent peritoneal dialysis, patients dialyzed twice weekly should receive a 1.5 to 2 mg/kg loading dose followed by 1 mg/kg every 3 days. Where dialysis occurs every 2 days, a 1.5 mg/kg loading dose is given after the first dialysis and 0.75 mg/kg after each subsequent dialysis. 

Renal function impairment An additional 200 mg dose of nevirapine following each dialysis treatment is indicated in patients requiring dialysis. Patients with Ccr 20 mL/min or greater do not require an adjustment in nevirapine dosing. 

Most patients should eat a diet with no added salt because of associated hypertension or edema. In dialysis patients, sodium intake should be reduced in patients who gain excessive weight between dialysis. Potassium restriction is not usually necessary until oliguria supervenes. Dialysis patients, however, should be educated to what foods are high in potassium, such as citrus foods, nuts, bananas, in order to avoid very high serum levels of potassium before each dialysis. Water restriction may be necessary if predialysis hyponatremia becomes prominent. 

Hypertension is both a cause and a result of CRF. Most dialysis patients are salt and water sensitive. Thus, if one removes salt and water with the dialysis procedure and minimizes weight gain between dialysis with strict dietary control of salt and water intake, normal blood pressure can be achieved. The availability of newer and effective antihypertensive agents has largely replaced the use of bilateral nephrectomy to control the blood pressure. 

Nickel that has been absorbed into the blood stream is primarily excreted in the urine. Therefore, individuals with kidney dysfunction are likely to be more sensitive to nickel. The increased sensitivity of persons with kidney disfunction is also suggested by increased serum concentrations of nickel in dialysis patients (Hopfer et al. 1989). Because diabetics often have kidney damage, and because of the hyperglycemic effects of nickel observed in animal studies, the sensitivity of diabetics to nickel is also likely to be increased. 

Secondary hyperparathyroidism, dialysis patients IV Titrate dose to lower iPTH to 150-300 pg/ml. Adjust dose at 8-wk intervals to a maximum dose of 18 meg/wk. Initially, if iPTH level is more than 400 pg/ml, give 4 meg 3 times/wk after dialysis, ad-... 

Must be used in conjunction with diuretic (except dialysis patients) and beta-blocker or other sympathetic nervous system depressant (to prevent reflex tachycardia)... 

E. Therapeutic response Two studies have evaluated the efficacy of darbepoetin for the correction of anemia in adult patients with chronic renal failure. In one study, the hemoglobin target was reached by 72% of dialysis patients treated with darbepoetin and 84% treated with recombinant erythropoietin. In the other, the primary end point was achieved by 93% of predialysis patients treated with darbepoetin and 92% of patients treated with recombinant erythropoietin. 

Vaccination against infection caused by all known subtypes of hepatitis B virus Recombivax HB dialysis formulation is indicated for vaccination of adult predialysis and dialysis patients against infection caused by all known subtypes of hepatitis B virus... 

Long-term dialysis patients are likely to experienee elevated exposures to di(2-ethylhexyl) phthalate, through frequent and protracted exposure to substances leached from surgieal tubing during dialysis (see Seetion 1.4.3(e)). 

Mettang et al. (1996b) investigated the relationship between di(2-ethylhexyl) phthalate exposure and uraemic pruritus in dialysis patients. There was no relationship between severity of pmritus and post-dialysis serum concentrations of di(2-ethylhexyl) phthalate, mono(2-ethylhexyl) phthalate, phthalic acid or 2-ethylhexanol. Furthermore, serum concentrations of di(2-ethylhexyl) phthalate and these related compounds were not significantly different between patients with or without uraemic pmritus. 

Ikeda, G.J., Sapienza, PP, Couvillion, J.L., Farber, T.M. Van Loon, E.J. (1980) Comparative distribution, excretion and metabolism of di-(2-ethylhexyl) phthalate in rats, dogs and miniature pigs. Food Gosmet. Toxicol., 18, 637-642 Inamoto, H., Ozaki, R., Matsuzaki, T, Wakui, M., Saruta, T. Osawa, A. (1991) Incidence and mortality pattern of malignancy and factors affecting the risk of malignancy in dialysis patients. Nephron, 59, 611-617... 

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