ABSTRACT
PURPOSE: Compared with the practice of administrating subcutaneous erythropoietin injection two or three times a week in end-stage renal failure, a weekly administration reduces the frequency of injection and the workload in renal units. We investigated whether subcutaneous epoetin alfa administered weekly was as effective as the same weekly dosage given in two or three divided doses. METHODS: Eighty-three patients were randomized to treatment with subcutaneous epoetin alfa either once a week (n=44), or to their original dosage two or three times a week (control, n=39) for 12 weeks. If hemoglobin was out of range (9.0-12.0 g/dL), the dosage was changed. RESULTS: Mean hemoglobin levels at randomization and after 4, 8 and 12 weeks were 10.7, 11.1, 11.3 and 11.0 g/dL, respectively, in the once weekly group compared with 10.5, 11.3, 11.5 and 11.3 g/dL, respectively, in the control group. The mean weekly epoetin alfa dosage at randomization and after 4, 8 and 12 weeks were 142.8, 123.0, 116.7 and 112.3 IU/kg, respectively, in the once-a-week group compared with 128.4, 119.3, 103.5 and 101.2 IU/kg, respectively, in the control group. No statistically significant differences between the groups were apparent in changes in hemoglobin levels or epoetin alfa dosages at week 12. There was no significant difference between the groups in number of patients who maintained stable hemoglobin levels without epoetin alfa dose increases. CONCLUSION: This study demonstrates that a weekly subcutaneous administration of epoetin alfa is as effective and safe as injecting it two or three times a week administration in maintaining hemoglobin levels in stable hemodialysis patients.
Subject(s)
Humans , Anemia , Erythropoietin , Kidney Failure, Chronic , Random Allocation , Renal Dialysis , Epoetin AlfaABSTRACT
BACKGROUND: In ESRD patients, malnutrition and atherosclerosis are strongly associated with inflammation resulting in MIA (Malnutrition-Inflammation-Atherosclerosis) syndrome. As compared with atherosclerosis, arteriosclerosis or arterial stiffening is another important cardiovascular risk factor. Therefore, we speculated on the presence of new MIA syndrome, which is composed of malnutrition, inflammation and arteriosclerosis, and evaluated causal relations among them in 70 chronic hemodialysis patients (age 53+/-13 years, male 53%, diabetes 40%). METHODS: As an indicator of arterial stiffness, brachial-ankle pulse wave velocity (PWV) was measured using a plethysmography. PWV index (measured PWV/nomogram based theoretical PWV) was then calculated to adjust confounding effects of age, blood pressure, and gender by using the PWV nomogram obtained in nonuremic population with same age, blood pressure, and gender. Nutritional status was assessed by serum albumin level, subjective global assessment (SGA) and normalized protein catabolic rate (nPCR). Extracellular fluid and intracellular fluid volume ratio (ECF/ICF) were determined using bioimpedance analysis. The presence of an inflammation was assessed by serum high sensitivity C-reactive protein (CRP) level. RESULTS: PWV index correlated positively with log transformed CRP (LnCRP) level, ECF/ICF and negatively with SGA, nPCR and serum albumin level. Serum albumin level correlated positively with nPCR, BUN, hemoglobin level and negatively with LnCRP level, age and ECF/ICF. Diabetic patients had higher PWV index and lower albumin level than non-diabetic patients. In multiple regression analysis, only LnCRP level was a significant common determinant of the both PWV index (R2=0.419; p >0.001) and serum albumin level (R2=0.543; p<0.001). CONCLUSION: Increased CRP levels are independently associated with arterial stiffening and hypoalbuminemia. Inflammation might be a linking mechanism of arterial stiffening and malnutrition in chronic hemodialysis patients.
Subject(s)
Humans , Male , Arteriosclerosis , Atherosclerosis , Blood Pressure , C-Reactive Protein , Extracellular Fluid , Hypoalbuminemia , Inflammation , Intracellular Fluid , Kidney Failure, Chronic , Malnutrition , Nomograms , Nutritional Status , Plethysmography , Pulse Wave Analysis , Renal Dialysis , Risk Factors , Serum Albumin , Vascular StiffnessABSTRACT
BACKGROUND: Catheter-related bacteremia is a frequent complication among hemodialysis patients using a tunneled cuffed catheter. The standard therapy of catheter-related bacteremia involves both systemic antibiotics and catheter replacement. This study was performed to evaluate the effect of antibiotic lock therapy in conjugation with systemic antibiotics without catheter removal on catheter-related bacteremia. METHODS: Thirty six chronic hemodialysis patients with tunneled cuffed catheter were monitored for infection between July 2001 and July 2005. We analyzed the efficacy of antibiotic lock protocol compared with systemic antibiotics alone. RESULTS: Twenty-nine episodes of catheter-related bacteremia occurred in 27 patients during the study periods. The incidence of catheter-related bacteremia was 1.5 episodes/1000 catheter-days. A single gram-positive coccus grew in the 16 cases (55.2 %), and gram-negative organisms grew in the 69 cases (31.0%). Sixteen of 18 patients (88.9%) treated with antibiotic lock protocol had successful catheter salvage versus only 6 of the 11 patients (54.5%) treated with systemic antibiotics alone (p=0.05). Three patients with Burkholderia pickettii and a patient with Acinetobactor calcoaceticus-baumannii complex were treated with antibiotic lock protocol with systemic ciprofloxacin and imipenem, respectively. CONCLUSION: This study suggests that antibiotic lock protocol in eradicating catheter-related bacteremia is effective treatment without requiring catheter replacement.
Subject(s)
Humans , Anti-Bacterial Agents , Bacteremia , Burkholderia , Catheters , Ciprofloxacin , Imipenem , Incidence , Renal DialysisABSTRACT
Paraquat, a very potent herbicide, has produced many fatalities through indiscriminate usage and suicides. It is known that with ingestion of more than one mouthful of 20% paraquat, death usually occurs by pulmonary fibrosis. We experienced two cases of successful outcome in patients with paraquat poisoning complicated with pulmonary fibrosis through active, intensive treatment from the early phase after ingestion. They swallowed one to two mouthfuls of the 20% commercial paraquat, and received hemoperfusion within 2-3 hours after ingestion. Then, combination therapy with steroid, vitamin C, D-penicillamine, allopurinol, colchicine was administered from the early phase. They showed moderate to severe hypoxemia and pulmonary fibrosis on chest HRCT during hospital course, but recovered from hypoxemia and remained very well on follow up over 3 months and 12 months after ingestion, respectively. We report these cases with literature review on treatment and prognosis of paraquat poisoning.
Subject(s)
Humans , Allopurinol , Hypoxia , Ascorbic Acid , Colchicine , Eating , Follow-Up Studies , Hemoperfusion , Mouth , Paraquat , Penicillamine , Poisoning , Prognosis , Pulmonary Fibrosis , Suicide , ThoraxABSTRACT
Paraquat, a very potent herbicide, has produced many fatalities through indiscriminate usage and suicides. It is known that with ingestion of more than one mouthful of 20% paraquat, death usually occurs by pulmonary fibrosis. We experienced two cases of successful outcome in patients with paraquat poisoning complicated with pulmonary fibrosis through active, intensive treatment from the early phase after ingestion. They swallowed one to two mouthfuls of the 20% commercial paraquat, and received hemoperfusion within 2-3 hours after ingestion. Then, combination therapy with steroid, vitamin C, D-penicillamine, allopurinol, colchicine was administered from the early phase. They showed moderate to severe hypoxemia and pulmonary fibrosis on chest HRCT during hospital course, but recovered from hypoxemia and remained very well on follow up over 3 months and 12 months after ingestion, respectively. We report these cases with literature review on treatment and prognosis of paraquat poisoning.
Subject(s)
Humans , Allopurinol , Hypoxia , Ascorbic Acid , Colchicine , Eating , Follow-Up Studies , Hemoperfusion , Mouth , Paraquat , Penicillamine , Poisoning , Prognosis , Pulmonary Fibrosis , Suicide , ThoraxABSTRACT
BACKGROUND: There is an individual variation in the hepatic injuries following alcohol abuse, which may be partly caused by the diverse activities of enzymes participating in the degradation of alcohol. Polymorphism of cytochrome P450 2E1 (CYP2E1) gene has been reported to affect the degradating activity of the enzyme, which may be eventually associated with the severity of alcoholic liver disease. In this study we were to evaluate the effects of genetic polymorphism of CYP2E1 on hepatocellular injury or fibrosis. METHODS: We analyzed the relationship of CYP2E1 genotypes to the biochemical and clinical characteristics as well as TGFbeta1 expressions in a total of 33 patients (M:F=32:1) with advanced alcoholic liver cirrhosis. CYP2E1 genotypes were determined by RFLP using RsaI and PstI. The amounts of serum TGFbeta1 were measured by ELISA (TGFbetta1 ELISA system, Promega, USA). RESULTS: Out of 33, 23 (70%) had the CYP2E1 of genotype A and all of the remaining 10 (30%) were type B; there was no one who had type C. The serum albumin levels of patients with type A of CYP2E1 gene were lower than those with type B (p=0.01); the Child-Pugh scores were also higher in patients with type A than B (p=0.03). However, there was no difference between the two groups in the serum AST, ALT, gamma-GTP and bilirubin levels. The patients expressed similar amount of serum TGFbetta1 regardless of their CYP2E1 genotypes. CONCLUSION: Our data indicates that the most common genotype of CYP2E1 is type A (70%) in patients with advanced alcoholic liver cirrhosis in Korea. It is also suggested that patients with enotype A of CYP2E1 may be associated with more advanced alcoholic liver cirrhosis compared to those with type B.
Subject(s)
Humans , Alcoholics , Alcoholism , Bilirubin , Cytochrome P-450 CYP2E1 , Cytochrome P-450 Enzyme System , Cytochromes , Enzyme-Linked Immunosorbent Assay , Fibrosis , Genotype , Korea , Liver Cirrhosis , Liver Cirrhosis, Alcoholic , Liver Diseases, Alcoholic , Polymorphism, Genetic , Polymorphism, Restriction Fragment Length , Serum Albumin , Transforming Growth Factor betaABSTRACT
Disseminated intravascular coagulation (DIC) is the result of a severe underlying disorder that initiates massive activation of the coagulation system. We report an unusual case of 79-year-old man who developed DIC after tooth extraction in abdominal aortic aneurysm. He was referred to our hospital because of persistent bleeding after tooth extraction. Physical examination indicated a pulsating mass in abdomen. Abdominal computerized tomography (CT) scan revealed 70 mm diameter aneurysm of the abdominal aorta, extending from the renal infrahilar level to the common iliac artery, and his coagulation profile showed the features of DIC by revealing thrombocytopenia, hypofibrinogenemia, and increased level of fibrinogen degradation product (FDP). After he had received blood component therapy including fresh frozen plasma and continuous intravenous heparin infusion (4,800 U/day), the bleeding diathesis and coagulopathy improved. He refused to have definitive surgery for the aneurysm.
Subject(s)
Aged , Humans , Abdomen , Aneurysm , Aorta, Abdominal , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Dacarbazine , Disease Susceptibility , Disseminated Intravascular Coagulation , Fibrinogen , Hemorrhage , Heparin , Iliac Artery , Physical Examination , Plasma , Thrombocytopenia , Tooth Extraction , ToothABSTRACT
BACKGROUND: In Korea, paraquat accounts for most of fatal poisoning with 500 or more deaths per year. It has been known that patients who ingested more than 1/2 mouthful of 20% concentrate paraquat usually die of multiorgan failure and pulmonary fibrosis. But the effect of charcoal hemoperfusion which can enhance elimination of paraquat remains controversial. Because acute paraquat poisoning is also characterized by multiorgan failure including kidney and marked rebound in plasma paraquat level after hemoperfusion, Continuous veon-venous hemofiltration(CVVH) may have theoretical benefits in the treatment of paraquat poisoning. So we evaluated the effect of early charcoal hemoperfusion and prophylactic CVVH after hemoperfusion in patients with paraquat poisoning. METHODS: There were 80 patients with paraquat poisoning admitted within 24 hours after ingestion (August 1996 - March 1998). All of them were treated with hemoperfusion (duration of hemoperfusion, 6.4+/-3.0 hours) within 24 hours of ingestion. The amount of ingestion was 2.1+/-1.0 mouthful (as 20% concentrate) and 78 (98%) were urine sodium dithionite test positive which is a poor prognosis factor. Forty-four patients received hemoperfusion only and 36 were followed by CVVH (duration, 50.4+/-20.9 hours; ultrafiltration volume, 33.8+/-3.9 L/day) after hemoperfusion. RESULTS: There was no difference between the hemoperfusion group and hemoperfusion+CVVH group in age, sex, initial serum creatinine, arterial oxygen saturation, severity of poisoning (as assessed by serum paraquat level determined by HPLC and amount of ingestion), or in the time elapsed from ingestion to the beginning of hemoperfusion. The total mortality was 65% (52/80) with no difference between the hemoperfusion group (64%, 28/44) and hemoperfusion+CVVH group (67%, 24/36). The mortality according to amount of ingestion was as follows: or = 3 mouthful, 82% (27/33); unknown, 60% (6/10). CONCLUSION: Early hemoperfusion can be effective in reducing mortality in patients who ingest less than 2 mouthful. Even though prophylactic CVVH after hemoperfusion has no additional benefit in reducing mortality in paraquat poisoning, it prolonged the time to death after ingestion.