American journal of kidney diseases : the official journal of the National Kidney Foundation
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Multicenter Study
Impact of near-death experiences on dialysis patients: a multicenter collaborative study.
People who have come close to death may report an unusual experience known as a near-death experience (NDE). This study aims to investigate NDEs and their aftereffects in dialysis patients. ⋯ NDE is not uncommon in the dialysis population and is associated with positive aftereffects. Nephrology care providers should be aware of the occurrence and aftereffects of NDEs. The high occurrence of life-threatening events, availability of medical records, and accessibility and cooperativeness of patients make the dialysis population very suitable for NDE research.
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Vitamin D insufficiency and deficiency are very common in patients with chronic kidney disease (CKD). The effect of ergocalciferol administration on serum 25-hydroxyvitamin D and plasma intact parathyroid hormone (PTH) levels in these patients is not known. ⋯ Results show that ergocalciferol administration has a favorable effect on PTH levels if therapy results in an increase in 25-hydroxyvitamin D levels; this effect is more evident in patients with CKD stage 3.
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Randomized Controlled Trial Comparative Study
Heparin-coated polyacrylonitrile membrane versus regional citrate anticoagulation: a prospective randomized study of 2 anticoagulation strategies in patients at risk of bleeding.
Hemodialysis requires anticoagulation to prevent clotting of the extracorporeal circuit. Systemic anticoagulation with heparin is contraindicated in patients at high risk of bleeding. In these patients, regional citrate anticoagulation (RCA), with either calcium-free (RCA-Ca0) or calcium-containing dialysate (RCA-Ca3.0), and heparin-coated membranes (1.3 m(2); AN69ST; Nephral 300ST, Gambro-Hospal, Meyzieu, France) may represent valid alternatives. ⋯ Citrate provides superior regional anticoagulation compared with AN69ST membranes.
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Severe acute kidney injury (AKI) that requires dialytic support, a relatively uncommon complication in severely burned adults, is associated with a substantially increased mortality rate. It is not known whether milder forms of AKI have prognostic importance in burns. ⋯ In conclusion, the mortality of patients with burns with severe AKI remains high and unchanged in the modern era of critical care medicine. The RIFLE classification added prognostic information regarding morbidity in patients with milder forms of AKI.