Serial prealbumin levels as predictors of outcomes in a retrospective cohort of peritoneal and hemodialysis patients.

OBJECTIVE: Although earlier research has suggested that baseline prealbumin level is an independent predictor of outcome among dialysis patients, the prognostic importance of serial prealbumin levels is less clear. The present study had 3 objectives: first, to determine if prealbumin (a marker of visceral protein stores with a relatively short half-life) predicts subsequent albumin levels taken at least 1 month later; second, to examine the association between serial prealbumin levels and clinical outcome; and third, to examine the association between changes in prealbumin level and outcome. DESIGN: The prognostic value of serial prealbumin levels was examined by linear regression analysis and Cox hazard models in an observational cohort study using a repeated measures design and time-dependent covariates. SETTING: Patients were followed by a tertiary care center, receiving hemodialysis (HD; at either an in-center dialysis unit or one of several satellite units operated by the hospital) or home peritoneal dialysis (PD). PATIENTS: A retrospective cohort was identified consisting of 268 incident and prevalent chronic HD and PD patients receiving dialysis from June 1998 to September 1999. MAIN OUTCOME: The study examined the association between serial prealbumin measurements and future laboratory and clinical outcomes (albumin, hospitalization, and death). RESULTS: Serial prealbumin values were independent predictors of future albumin levels among HD patients (P =.04), but not PD patients. Independent predictors of hospitalization included diabetes for PD patients (P =.0012) and advanced age for HD patients (P =.0008). Advanced age and diabetes were independent predictors of death for both HD (P =.0001 and P =.0368) and PD patients (P =.0014 and P =.0164). Serial prealbumin values, measured as time-dependent covariates, did not predict hospitalization or death. Further analyses examined the prognostic value of changes in prealbumin and albumin values as time-dependent covariates. The final multivariate analysis identified low baseline albumin level as an independent predictor of hospitalization among HD patients (P =.0282), whereas low baseline prealbumin was an independent predictor of death for HD patients (P =.0001). Interestingly, negative changes in serial prealbumin measurements were also independent predictors of death among HD patients (P =.0025). CONCLUSION: Serial prealbumin measurements predict subsequent albumin values among HD patients. As well, low baseline prealbumin level is an independent predictor of adverse outcome among HD patients. Although repeated prealbumin measurements in and of themselves were of no added prognostic value, falling prealbumin values identified by repeated measurements were additional independent predictors of death. These results support the clinical utility of regular prealbumin monitoring among HD patients.

Predictors of hospitalization and death among pre-dialysis patients: a retrospective cohort study.

BACKGROUND: Although there is abundant research describing predictors of patient morbidity and mortality among dialysis patients, predictors of adverse clinical outcomes among pre-dialysis patients are less well defined. The purpose of this study was to identify baseline predictors of first non-elective hospitalization among a retrospective cohort of 362 pre-dialysis patients. METHODS: Univariate and multivariate Cox proportional hazard models were used to identify predictors of hospitalization prior to dialysis initiation, adjusted for baseline creatinine level. Dialysis initiation, loss to follow-up, and study conclusion were censored events. Secondary outcomes included cause-specific hospitalization and death. RESULTS: Univariate analysis indicated that advanced age (RR 1.026, CI 1.016-1.037), number of prescribed anti-hypertensive medications (RR 1.149, CI 1.019-1.296), history of myocardial infarction (RR 1.979, CI 1.339-2.926), congestive heart failure (RR 2.299, CI 1.616-3.270), angina (RR 2.289, CI 1.695-3.091), peripheral vascular disease (RR 1.841, CI 1.282-2.644), renal failure secondary to nephrosclerosis (RR 1.413, CI 1.033-1.933) or renal artery stenosis (RR 1.587, CI 1.036-2.430), lower baseline haemoglobin level (RR 0.986, CI 0.979-0.992), and baseline creatinine greater than 300 micromol/l (RR 1.636, CI 1.233-2.171) were predictors of hospitalization. Gender, diabetes, diastolic blood pressure, mean arterial pressure, history of stroke, and hypoalbuminaemia did not predict outcome. Multivariate analysis, adjusted for baseline creatinine level, selected advanced age (RR 1. 017, CI 1.006-1.027), angina (RR 1.893, CI 1.371-2.613), peripheral vascular disease (RR 1.545, CI 1.054-2.266), and haemoglobin level (RR 0.987, CI 0.944-0.979) as independent predictors of hospitalization. CONCLUSION: Advanced age, co-morbid cardiovascular illness and anaemia are independent predictors of non-elective hospitalization prior to dialysis initiation. Further study is needed to determine the extent to which aggressive pre-dialysis management of anaemia and cardiovascular disease can improve patient outcomes.

Suboptimal dialysis initiation in a retrospective cohort of predialysis patients--predictors of in-hospital dialysis initiation, catheter insertion and one-year mortality.

OBJECTIVE: Previous investigations using univariate study designs have reported that delayed referral to predialysis clinics is associated with adverse outcomes at the time of dialysis initiation. However, the independent effect of delayed referral is poorly defined. Moreover, the optimal time at which to refer patients to predialysis programs remains unclear. The aim of this study was to identify independent predictors of dialysis initiation requiring hospitalization. MATERIALS AND METHODS: A retrospective cohort of 201 predialysis patients was investigated using multivariate logistic regression analysis. RESULTS: Multivariate analysis selected advanced age (odds ratio (OR) 1.038,95% confidence interval (CI) 1.011-1.065), history of congestive heart failure (OR 2.877, 95% CI 1.205-6.871), and shorter predialysis follow-up time (OR 0.945, 95% CI 0.920-0.971) as independent predictors of in-hospital dialysis initiation. The risk of in-hospital dialysis initiation increased by 5.5% for every month lost due to late referral. CONCLUSION: Patients should be referred to predialysis programs as early as 24 months before anticipated dialysis initiation in order to minimize the risk of future adverse outcomes.

Liquid chromatographic determination of flumequine, nalidixic acid, oxolinic acid, and piromidic acid residues in catfish (Ictalurus punctatus).

A peer-verified, liquid chromatographic (LC) method for simultaneous determination of residues of flumequine (FLU), nalidixic acid (NAL), oxolinic acid (OXO), and piromidic acid (PIR) in catfish muscle is presented. Sample workup involves homogenizing tissue with acetone, defatting with hexane, and extracting quinolones into chloroform. Sample is purified further by partitioning into base and then subsequently back-extracting into chloroform after acidifying the aqueous phase. After solvent is evaporated, the residue is diluted with mobile phase, and analytes are introduced into an LC system where separations are made with a 5 microns, reversed-phase polymer column and an isocratic, buffered acetonitrile-tetrahydrofuran mobile phase. Determinations are made by UV detection at 280 nm for PIR and by fluorescence detection (excitation at 325 excitation and emission at 365 nm) for the other 3 analytes. Each quinolone was used to fortify catfish muscle at 5, 10, 20, 40, and 80 ng/g. The following recoveries and relative standard deviation (RSD) values represent an average of the 5 levels for each analyte: FLU, 79.7% (RSD = 5.7%); OXO, 80.8% (RSD = 6.3%); PIR, 75.0% (RSD = 5.9%); and NAL, 87.1% (RSD = 10%). Assay of 5 levels (base incurred catfish, plus 4 dilutions with control catfish) of catfish muscle incurred with the 4 quinolones gave the following averages: FLU: base, 198 ng/g (RSD = 2.3%); dilutions, 98.0 ng/g (RSD = 4.2%), 61.6 ng/g (RSD = 4.4%), 21.6 ng/g (RSD = 2.8%), 9.24 ng/g (RSD = 8.7%); OXO, base, 257 ng/g (RSD = 6.9%); dilutions, 146 ng/g (RSD = 5.5%), 95.0 ng/g (RSD = 4.1%), 30.7 ng/g (RSD = 3.8%), 13.7 ng/g (RSD = 4.6%); PIR, base, 22.1 ng/g (RSD = 4.2%); dilutions, 13.7% ng/g (RSD = 6.7%), 6.49 ng/g (RSD = 15%), 2.65 ng/g (RSD = 15%); and NAL, base, 75.1 ng/g (RSD = 3.8%); dilutions, 42.3 ng/g (RSD = 5.1%), 24.1 ng/g (RSD = 6.3%), 8.59 ng/g (RSD = 4.8%). A second multiresidue analysis of the 4 quinolones was performed by an outside analyst. Average recoveries from catfish fortified at 5, 10, 20, and 40 ng/g were FLU, 75.9% (RSD = 4.0%); OXO, 84.0% (RSD = 5.5%); NAL, 85.6% (RSD = 8.9%); and PIR, 66.2% (RSD = 8.7%).

Determination and confirmation of identities of flumequine and nalidixic, oxolinic, and piromidic acids in salmon and shrimp.

A previously published liquid chromatographic (LC) method for determining residues of flumequine (FLU) and nalidixic (NAL), oxolinic (OXO), and piromidic (PIR) acids in catfish tissue was applied to salmon and shrimp muscle. Identities of all 4 residues in salmon and shrimp were confirmed by gas chromatography/mass spectrometry (GC/MS). The tissue is homogenized with acetone, the acetone extract is defatted with hexane, and the quinolones are extracted into chloroform. The extract is further purified by first partitioning into base and then back-extracting from a solution acidified to pH 6.0. Analytes are determined by LC with simultaneous UV and fluorescence detection. Muscle tissue was fortified with each quinolone at 5, 10, 20, 40, and 80 ng/g. Average recoveries and relative standard deviations (RSDs) for salmon, which represent an average of the 5 levels for each analyte, ranged from 75.9 to 90.8% and from 2.25 to 6.40%, respectively. Average recoveries and RSDs for shrimp ranged from 81.3 to 91.2% and from 7.34 to 10.7%, respectively. Identities of OXO, FLU, NAL, and PIR were confirmed in extracts of salmon and shrimp tissue fortified at 10 ng/g by determination of decarboxylated quinolones by GC/MS. Four diagnostic ions were monitored for OXO, FLU, and PIR, and 5 ions were monitored for NAL. All ion relative abundances were within 10% of those calculated for standard decarboxylated quinolones. Optimum conditions for decarboxylation and GC/MS confirmation are given.

Liquid chromatographic determination of simazine, atrazine, and propazine residues in catfish.

A liquid chromatographic (LC) method is described for the simultaneous determination of the triazine herbicides, simazine (SIM), atrazine (ATZ), and propazine (PRO) in the 12.5-100 ppb range in catfish. The herbicides are extracted from catfish homogenates with ethyl acetate, followed by solvent partitioning between acetonitrile and petroleum ether and additional cleanup on a C18 cartridge. A Supelcosil LC-18-DB column is used for LC separation, and UV determination is at 220 nm. The isocratic mobile phase is a mixture of methanol, acetonitrile, and water. Mean recoveries from catfish were 88.7, 96.9, and 91.7%; standard deviations were 6.84, 7.78, and 6.26%; and coefficients of variation were 7.72, 8.03, and 6.82% for SIM, ATZ, and PRO, respectively.

Determination of flunixin in milk by liquid chromatography with confirmation by gas chromatography/mass spectrometry and selected ion monitoring.

A liquid chromatographic (LC) method was developed for the determination of flunixin (FNX) in raw bovine milk. The milk was acidified and mixed with silica gel, and the mixture was packed into a chromatographic column. The column was defatted with water-saturated dichloromethane-hexane (30 + 70, v/v), and the analyte was eluted with EtOAc. The EtOAc extract was washed with water at pH 3.5, the water was discarded, and the EtOAc layer was then extracted with 0.1M NaOH. The aqueous layer was drained, passed through a primed C18 solid-phase extraction (SPE) column, and eluted with EtOAc. The EtOAc layer was dried under N2, taken up in a solution of MeOH-(5 mM tetrabutylammonium [TBA]-H2PO4 + 2 mM NaOH) (50 + 50), sonicated, and filtered. FNX was determined by LC using a C18 column (ODS Hypersil), a mobile phase mixture of 58% A (MeOH) and 42% B (5 mM TBA-H2PO4 + 2 mM NaOH), and a diode-array ultraviolet detector at 285 nm. FNX was determined in raw milk at 5 spiking levels (5, 10, 20, 40, and 80 ng drug/mL milk). Absolute recoveries ranged from 69.6 to 74.4%, and relative standard deviations ranged from 1.1 to 6.9%. The limit of quantitation was 1.7 ng drug/mL milk. A lactating cow was dosed intravenously (2.2 mg/kg) with flunixin meglumine (Banamine) to generate incurred milk residues. FNX residues ranged from 7.34 ng/mL at 16 h postdose to 1.74 ng/mL at 24 h postdose. Both levels were obtained with additional beta-glucuronidase treatment (almost no incurred drug was detected at these low levels without the enzyme treatment).(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of malachite green and its metabolite, leucomalachite green, in catfish (Ictalurus punctatus) tissue by liquid chromatography with visible detection.

To determine residues of malachite green (MG) and its metabolite, leucomalachite green (LMG), in catfish tissue, analytes are extracted with acetonitrile-buffer and the extract is partitioned into methylene chloride. Final cleanup and isolation are performed on neutral alumina solid-phase extraction (SPE) and propylsulfonic acid cation-exchange SPE columns before analysis by liquid chromatography with visible detection. PbO2 postcolumn oxidation is performed by isocratic elution with a buffered mobile phase from a cyano column. Recoveries and relative standard deviations (RSDs) from fortified catfish tissues were 72.9% (RSD, 1.92%; 23 ppb), 75.5% (RSD, 6.85%; 11 ppb), and 69.6% (RSD, 6.93%; 5.7 ppb) for MG and 87.4% (RSD, 2.92%; 21 ppb), 88.1% (RSD, 5.94%; 10 ppb), and 82.6% (RSD, 11.5%; 5.3 ppb) for LMG. The method was applied to MG-incurred catfish at depuration times of 0, 2, 4, 8, and 24 h. Average levels of residual MG and LMG in the 24 h depuration catfish tissue were 73.4 and 289 ppb, respectively.

Liquid chromatographic determination of the anticoccidial drug halofuginone hydrobromide in eggs.

A liquid chromatographic (LC) method is described for the determination of 5-100 ppb halofuginone hydrobromide (HFG) in eggs. HFG as the free base is extracted from eggs with ethyl acetate. The extract is cleaned up on an acidic Celite 545 column. A Waters C18 column is used for LC separation with UV determination at 243 nm. The isocratic mobile phase is a mixture of water-acetonitrile-ammonium acetate buffer (12 + 5 + 3) and acetic acid. The interassay average recovery from eggs was 90.4%, with a standard deviation of 5.11 and a relative standard deviation of 5.65%.

The relationship between psychometric intelligence and the five-factor model of personality in a rehabilitation sample.

WAIS-R and NEO Personality Inventory (NEO-PI) scores obtained from 85 rehabilitation clients of the Evaluation and Development Center of Southern Illinois University's Rehabilitation Institute were utilized to examine the relationship between psychometric intelligence and personality. Correlational analyses revealed that the NEO-PI Openness domain and its six facets significantly correlated with WAIS-R FSIQ, VIQ, PIQ, and 9 of the 11 subtests. Multiple regression analyses showed that the five NEO-PI domains accounted for significant proportions of WAIS-R, FSIQ, VIQ, and PIQ score variance. The NEO-PI Openness domain was found to be the best predictor of WAIS-R FSIQ, VIQ, and PIQ scores. The study concludes with a discussion of the meaning and implications of the findings and suggestions for future research.

Gas chromatographic determination of chloramphenicol residues in shrimp: interlaboratory study.

An interlaboratory study of a gas chromatographic method for determining chloramphenicol (CAP) residues in shrimp was conducted. An internal standard (Istd), the meta isomer of CAP, was added to the shrimp, and the treated shrimp were homogenized with ethyl acetate. The ethyl acetate extract was defatted with hexane, and the CAP was partitioned into ethyl acetate from an aqueous salt solution. The ethyl acetate was evaporated, and the dried residue was treated with Sylon, a trimethylsilyl derivatizing agent, to yield the trimethylsilyl derivative of CAP. A portion of the solution containing the derivative was injected into a gas chromatograph equipped with an electron capture detector. Levels of fortified and incurred CAP were calculated from the peak area ratio of standard CAP to Istd. Recoveries of CAP from tissue directly fortified at 5 ppb were 102% (within-laboratory relative standard deviation [RSDr] = 5.6%), 104% (RSDr = 5.5%), and 108% (RSDr = 6.3%) from Laboratories 1, 2, and 3, respectively. Incurred-CAP residues at 5 and 10 ppb levels were also determined, with the following results: Laboratory 1: composite A, 4.56 ppb (RSDr = 14.0%); composite B, 8.38 ppb (RSDr = 11.6%); Laboratory 2: composite A, 4.17 ppb (RSDr = 12.5%); composite B, 8.90 ppb (RSDr = 5.60%); Laboratory 3: composite A, 4.66 ppb (RSDr = 14.9%); composite B, 11.0 ppb (RSDr = 11.8%).

Simultaneous determination of xylazine and its major metabolite, 2,6-dimethylaniline, in bovine and swine kidney by liquid chromatography.

A liquid chromatographic (LC) method is described for the simultaneous determination of xylazine (XY) and its major metabolite, 2,6-dimethylaniline (2,6-DMA), in bovine and swine kidney in the 25-100 ppb range. XY and 2,6-DMA are extracted from kidney with chloroform, followed by cleanup on an acidic Celite 545 column. A mu Bondapak phenyl column is used for LC separation with UV determination at 225 nm. The mobile phase is a mixture of acetonitrile, water, sodium acetate, and acetic acid. Mean recoveries from bovine kidney were 78.3% for XY, with a standard deviation (SD) of 7.45 and a coefficient of variation (CV) of 9.51%, and 87.2% for 2,6-DMA, with an SD of 8.38 and a CV of 9.61%. Mean recoveries from swine kidney were 80.8% for XY, with an SD of 5.92 and a CV of 7.33%, and 86.7% for 2,6-DMA, with an SD of 6.16 and a CV of 7.10%.

Liquid chromatographic determination of chlortetracycline hydrochloride in ruminant and poultry/swine feeds.

A liquid chromatographic (LC) method is described for the determination of chlortetracycline hydrochloride (CTC) in poultry/swine and ruminant feeds in the 10-100 ppm range and in premix. CTC is extracted from ground feed/premix with acidified acetone, and the extract is filtered through a Millex-HV filter or disposable C18 column. The filtrate is partitioned with methylene chloride when additional cleanup is necessary. A Nova-Pak C18 column is used for LC separation with determination at 370 nm. The average recovery of CTC from premix was 95% with a standard deviation (SD) of 1.70 and a coefficient of variation (CV) of 1.79%. The overall average recovery from feeds was 77% with an SD of 3.18 and a CV of 4.10%.

Rapid digestion and flameless atomic absorption spectroscopy of mercury in fish: collaborative study.

A collaborative study of the determination of mercury in fish has been completed in which wet oxidation of fish tissue in nitric acid, using vanadium as a catalyst, is compared with the AOAC official final action digestion technique, 25.103-25.105, involving a nitric-perchloric acid mixture. The study used tuna fish samples of known mercury content and included spike recovery studies in which methyl mercury solutions of known composition were provided to each laboratory. The study was designed to provide recovery information that bracketed the regulatory level of mercury in fish. The results indicate that the proposed digestion method is at least as precise and accurate as the AOAC method. The proposed method is also more rapid and less hazardous. It has been adopted as official first action.