Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Nov 2007
Long-term survival of incident hemodialysis patients who are hospitalized for congestive heart failure, pulmonary edema, or fluid overload.
Mortality in patients who are on maintenance hemodialysis and have congestive heart failure is high in small cohort studies. The aim of this study was to determine long-term survival in a large cohort of dialysis patients with congestive heart failure and suspected fluid overload or pulmonary edema. ⋯ This study demonstrates very poor survival in dialysis patients who present with congestive heart failure, pulmonary edema, or fluid overload compared with patients who present with congestive heart failure without renal failure. Meticulous management of cardiovascular risk should improve survival.
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Clin J Am Soc Nephrol · Nov 2007
Comparative StudyCross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis.
Nocturnal home hemodialysis provides excellent biochemical and metabolic control of uremia; however, extensive training is necessary and technical barriers exist for intensive home hemodialysis compared with the relative simplicity of peritoneal dialysis. It was hypothesized that nocturnal home hemodialysis is associated with improved quality of life but higher illness intrusiveness compared with peritoneal dialysis. ⋯ This study suggests that nocturnal home hemodialysis is not perceived as a more intrusive treatment and demonstrates that patients who are on peritoneal dialysis have similar perceived symptomatic control of their kidney disease.
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Clin J Am Soc Nephrol · Nov 2007
Hypertonic saline for hyponatremia: risk of inadvertent overcorrection.
Data regarding dosage-response relationships for using hypertonic saline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to <12 mEq/L per d and <18 mEq/L per 48 h) in treating hyponatremia with hypertonic saline and to determine the predictive accuracy of the Adrogué-Madias formula. ⋯ The Adrogué-Madias formula underestimates increase in sodium concentration after hypertonic saline therapy. Unrecognized hypovolemia and other reversible causes of water retention pose a risk for inadvertent overcorrection. Hypertonic saline should be infused at rates lower than those predicted by formulas with close monitoring of serum sodium and urine output.
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Clin J Am Soc Nephrol · Sep 2007
ReviewSpectrum of renal pathology in hematopoietic cell transplantation: a series of 20 patients and review of the literature.
Hematopoietic cell transplantation is a common treatment option for a variety of hematopoietic malignancies. As a result of the use of total body irradiation and/or chemotherapeutic agents, renal dysfunction often ensues. Many pharmacologic agents, such as cyclosporine and high-intensity conditioning regimens, have been linked with thrombotic microangiopathy. In addition, an association between membranous nephropathy and graft-versus-host disease has been reported in this clinical setting. ⋯ The renal biopsy remains essential for diagnosing the underlying injury that can affect one or more compartments of the kidney in this unique clinical setting.
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Clin J Am Soc Nephrol · Sep 2007
Pain, sleep disturbance, and quality of life in patients with chronic kidney disease.
Few studies have assessed sleep disturbances or perception of pain in patients with early-stage chronic kidney disease. It was hypothesized that perception of pain and sleep disturbance would increase with chronic kidney disease stage, that pain and sleep disturbance would correlate with psychosocial variables, and that there would be a higher prevalence of pain and sleep disturbances in patients with chronic kidney disease compared with general medical patients. ⋯ Pain is common in patients with early-stage chronic kidney disease and is associated with patients' perception of lower quality of life. The prevalence of pain, sleep disturbance, and abnormal psychologic status of patients with chronic kidney disease may be similar to outpatients with other chronic medical illnesses.