ABSTRACT
The Renal Network, Inc, (end-stage renal disease [ESRD] Networks 9 and 10) from the states of Illinois, Indiana, Kentucky, and Ohio includes approximately 4,250 peritoneal dialysis patients. To better assess the state of peritoneal dialysis in Networks 9 and 10, we undertook a peritoneal dialysis prescription adequacy quality improvement project. Adequacy and facility practice information were obtained from a 100% sample of peritoneal dialysis patients in the Networks. The mean total Kt/V urea for those facilities with a written policy for adequacy measurement was 2.18 +/- 0.66 versus a mean of 2.13 +/- 0.70 for those facilities without a written policy (P = not significant [NS]). The mean total Kt/V urea for those facilities with a written procedure was 2.17 +/- 0.66 versus a mean of 2.12 +/- 0.70 for those facilities without a written procedure (P = NS). There was a significant positive relationship between the observed total Kt/V urea and the frequency of measurement (P <.001). No relationship existed between the value of the D/P creatinine ratio and the weekly dialysis Kt/V. This study supports the recommendation of frequent measurement of peritoneal dialysis adequacy.
Subject(s)
Peritoneal Dialysis/standards , Quality Assurance, Health Care , Adult , Aged , Centers for Medicare and Medicaid Services, U.S. , Female , Humans , Illinois , Indiana , Kentucky , Kidney Failure, Chronic/therapy , Male , Middle Aged , Ohio , Total Quality Management , United StatesABSTRACT
Posttransplantation lymphoproliferative disorder (PTLD) occurs in approximately 5% of patients after orthotopic heart transplantation. PTLD is frequently fatal. PTLD rarely involves the cardiac allograft. We report the first case of PTLD seen as a mass in the cardiac allograft.
Subject(s)
Echocardiography, Transesophageal , Heart Transplantation , Lymphoproliferative Disorders/diagnostic imaging , Postoperative Complications/diagnostic imaging , Adult , Heart Transplantation/diagnostic imaging , Humans , Immunosuppression Therapy , Male , Transplantation, HomologousABSTRACT
Orthotopic heart transplantation (OHT) is an accepted treatment for heart failure refractory to medical management. International registry data reported a 1-year survival after OHT of 79%. The risk factors associated with requiring continuous venovenous hemofiltration or hemodialysis and mortality in patients requiring continuous venovenous hemofiltration (CVVH)/hemodialysis (HD) have not been studied, since improvements have been made in OHT. We tested the hypothesis that requiring CVVH/HD in the immediate posttransplantation period increases mortality after OHT. We studied pretransplantation factors to predict those patients who would need CVVH/HD. Patients undergoing OHT from 1995 to 1996 were studied. Fifty-two patients underwent OHT. Eight patients (15%) needed CVVH/HD. Initial immunosuppression included cyclosporine, azathioprine, and solumedrol. Patients were changed to antilymphocyte therapy if they had oliguric acute renal failure, T or B cell incompatibility, or biopsy-proven rejection. Overall, survival at 1 year was 84.6%. Survival in patients not needing CVVH/HD was 91%, and survival in patients needing CVVH/HD was 36.5%. For each year of age over 55 years, patients had a relative risk of requiring CVVH/HD of 7.
