American journal of kidney diseases : the official journal of the National Kidney Foundation
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Multicenter Study
Quality of life in patients on chronic dialysis: self-assessment 3 months after the start of treatment. The Necosad Study Group.
The aim of the present multicenter study was to assess quality of life of Dutch dialysis patients 3 months after the start of chronic dialysis treatment. The quality of life was compared with the quality of life of a general population sample, and the impact of demographic, clinical, renal function, and dialysis characteristics on patients' quality of life was studied. New end-stage renal disease (ESRD) patients who were started on chronic hemodialysis or peritoneal dialysis in 13 dialysis centers in The Netherlands were consecutively included. ⋯ Comorbid conditions, hemoglobin, and residual renal function could explain poor quality of life only to a limited extent. Further research exploring determinants and indices of quality of life in ESRD patients is warranted. From a clinical perspective, we may conclude that quality of life should be considered in the monitoring of dialysis patients.
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Review Case Reports
Pulmonary mucormycosis in diabetic renal allograft recipients.
Renal allograft recipients are prone to opportunistic infections due to their need of immunosuppression to prevent rejection. Mucormycosis is a rare opportunistic infection caused by a fungi of the order Mucorales. Risk factors predisposing to this disease include prolonged neutropenia, chelation therapy for iron or aluminum overdose, diabetes, and patients who are immunosuppressed. ⋯ Early diagnosis and prompt aggressive therapy is imperative to achieve an improved outcome. We present two cases of pulmonary mucormycosis in diabetic renal allograft recipients who were treated successfully with amphotericin B and surgical resection of the lesions with preservation of their allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in our transplant population.
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Review Case Reports
Paradoxical cerebral air embolism from a hemodialysis catheter.
Air embolism is a rare complication of the use of central venous catheters as vascular access for hemodialysis. We report a patient with an intracardiac shunt who had a paradoxical air embolism following manipulation of her hemodialysis catheter that resulted in transient hemiplegia. This case illustrates the potentially devastating consequences of even a small air leak into the circulation if it gains access to the arterial system.
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Review Case Reports
Pseudopulmonary embolism: acute respiratory distress in the syndrome of heparin-induced thrombocytopenia.
A 73-year-old man with myasthenia gravis was treated with daily plasmapheresis. During the course of treatment, the patient developed progressive thrombocytopenia and an episode of severe acute respiratory distress suggesting pulmonary embolism. ⋯ The time frame of clinical events suggests a heparin-mediated mechanism for both the thrombocytopenia and respiratory compromise. We conclude that acute respiratory distress may be the presenting manifestation of the syndrome of heparin-associated thrombocytopenia in patients treated with dialysis or apheresis.
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Offering financial incentives to families of brain-dead individuals has been proposed as a way to increase the supply of organs for transplantation. However, such incentives may lead to weakening of altruism and exploitation of poor families. We investigated dialysis patient attitudes toward the potential benefits and problems of incentives. ⋯ Subjects thought financial incentives would greatly increase donation by poor families while having little impact on rich families. In conclusion, even though dialysis patients are likely to benefit from increasing the supply of kidneys, many of them want to maintain altruism and protect poor families even if that means fewer kidneys. These concerns should be addressed in proposals to modify the transplant system.