American journal of kidney diseases : the official journal of the National Kidney Foundation
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Conventional lactate (Lac)-buffered peritoneal dialysis (PD) solutions have turned out to be detrimental to human peritoneal cells, especially because of a low pH. In the present study, we focus on potential differences between Lac and bicarbonate (Bic) as a buffer when adjusted to a physiological pH. All test fluids were buffered with either 40 mmol/L of Lac or 34 mmol/L of Bic, sterile filtered, and adjusted to a pH of 7.4. ⋯ Differences in manifest cell cytotoxicity reflected by apoptosis and necrosis rates could not be detected comparing PD solutions buffered with Lac or Bic at a physiological pH. However, distinct parameters of cell metabolism were superior with Bic compared with Lac. Especially Glupoly was inferior in combination with Lac as a buffer.
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Hypothermia is defined as a core body temperature of less than 35 degrees C and is divided further into mild, moderate, and severe depending on the temperature level. Several active internal rewarming modalities have been described in the management of moderate-to-severe accidental hypothermia. ⋯ The patient was switched to hemodialysis that brought his temperature from 30.2 degrees C to 36.7 degrees C during a 3.5-hour dialysis with an average rise of 1.9 degrees C/h. Hemodialysis is a rapid and efficient modality of rapid internal rewarming for moderate-to-severe accidental hypothermia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes.
This study evaluated serum cystatin C as a potential new marker of glomerular filtration rate (GFR) in 49 patients who had steady-state diabetes with early renal impairment. We determined the correlation between GFR measured by chromium 51-labeled EDTA and levels of serum cystatin C, serum creatinine, serum beta(2)-microglobulin, endogenous creatinine clearance, and Cockcroft formula. Sensitivity and specificity for the diagnosis of renal failure, defined as a GFR less than either 80 or 60 mL/min/1.73 m(2), were calculated by receiver operating characteristic (ROC) curves for creatinine, cystatin C, and beta(2)-microglobulin. ⋯ With patients classified into two groups (GFR > or < 80 mL/min/1.73 m(2)), mean values for each parameter were statistically different (P < 0.001). Sensitivity, specificity, and positive and negative predictive values for serum creatinine and serum cystatin C levels were very close for both definitions of renal failure. Serum cystatin C is not better than serum creatinine or serum beta(2)-microglobulin levels for estimating GFR in patients with steady-state diabetes using ROC curves or other validation tests.
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Hypocalcemia has been reported in critically ill patients, most commonly in association with sepsis syndrome. However, the severity and incidence of hypocalcemia in nonseptic but critically ill patients has not been well defined. Therefore, the goal of this study was to identify and compare the frequency and degree of hypocalcemia in critically ill patients with differing underlying illnesses (those admitted to medical, surgical, trauma, neurosurgical, burn, respiratory, and coronary intensive care units [ICUs]; group A; n = 99). ⋯ We conclude that hypocalcemia is extremely common in hospitalized patients (up to 88%) and correlates with severity of illness, but not with a specific illness per se. Whether it directly impacts patient survival remains unknown. Resolution of this issue appears to be critical because of the frequency with which it leads to high-dose IV Ca therapy.
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We tested the hypothesis that a high concentration of serum ferritin, a frequently used marker of iron stores in dialysis patients and an acute-phase reactant, may be a marker of morbidity and mortality in these patients. To evaluate the impact of ferritin on morbidity and mortality, we reviewed the 6-month hospitalization rates in our dialysis patients retrospectively and subsequently reviewed the mortality among these patients over a 12-month period of time prospectively. One hundred one adult hemodialysis patients (59 men and 42 women; age, 54 +/- 15 years) who had been on hemodialysis for 38 +/- 27 months were studied. ⋯ Hence, serum ferritin is a strong predictor of hospitalization in dialysis patients. Although serum albumin is found to be a strong long-term marker of mortality in hemodialysis patients, an increase in serum ferritin appears to be a more reliable short-term marker of death over a 12-month period. Therefore, in the setting of uniform iron administration, a high serum ferritin may be a morbidity risk factor and a recent increase in serum ferritin may carry an increase in the risk of death in these patients.