Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Feb 2001
Meta Analysis Comparative StudyDo the Y-set and double-bag systems reduce the incidence of CAPD peritonitis? A systematic review of randomized controlled trials.
Peritonitis is the most frequent serious complication of continuous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably restricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis. This systematic review sought to determine if modifications of the transfer set (Y-set or double-bag systems) used in CAPD exchanges are associated with a reduction in peritonitis and an improvement in other relevant outcomes. ⋯ Double-bag systems should be the preferred exchange systems in CAPD.
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Nephrol. Dial. Transplant. · Feb 2001
Randomized Controlled Trial Comparative Study Clinical TrialEffects of continuous haemofiltration vs intermittent haemodialysis on systemic haemodynamics and splanchnic regional perfusion in septic shock patients: a prospective, randomized clinical trial.
Parameters of splanchnic regional perfusion, like intramucosal pH (pHi) and pCO(2) (pCO(2)i), may predict outcome in septic shock patients. Continuous venovenous haemofiltration (CVVH) has been considered beneficial in haemodynamically unstable septic shock patients. In a prospective, randomized, clinical study, we investigated whether CVVH, in comparison to intermittent haemodialysis (IHD), is able to improve splanchnic regional perfusion in critically ill patients. ⋯ Despite different changes of systemic haemodynamics between CVVH and IHD, CVVH did not improve parameters of splanchnic regional perfusion like pHi, pCO(2)i or pCO(2) gap in septic shock patients.
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Nephrol. Dial. Transplant. · Feb 2001
Comparative StudyLaparoscopic or open surgery for living donor nephrectomy.
The anterior extraperitoneal approach for living donor nephrectomy has been used in more than 700 living cases in the unit and proved to be safe for the donor. In 1998, laparoscopic nephrectomy was introduced as an option when technically feasible. We found it essential to investigate the consequences of the new technique. ⋯ Laparoscopic nephrectomy is safe. Less post-operative pain is a definite advantage for the donor.
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Nephrol. Dial. Transplant. · Jan 2001
ReviewContinuous renal replacement therapy in critically ill patients.
Acute renal failure is an evolving syndrome in which new pathogenetic mechanisms have recently been elucidated. The evolution of the field of haemodialysis has led to a parallel development in the therapeutic approach to patients suffering from this syndrome. In particular, acute renal failure is more frequently seen as part of a more complex syndrome, defined as multiple organ failure. ⋯ Classic indications, but also alternative non-renal indications, have been proposed for these techniques. The most advanced indication is the multiple organ dysfunction occurring in septic patients. The possible removal of proinflammatory mediators may permit a blockade of the systemic inflammation, a modulation of the altered immune response in these patients, and it may lead to a partial or total restoration of the lost homeostasis.
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Nephrol. Dial. Transplant. · Jan 2001
ReviewEffects of nitric oxide synthase blockers on renal function.
Three isoforms of nitric oxide synthase (NOS) [neuronal NOS (bNOS), inducible NOS (iNOS) and endothelial NOS (eNOS)] are expressed in the kidney. The use of pharmacological inhibitors of these enzymes has been a major experimental tool to determine the role of nitric oxide (NO) in renal physiology and pathophysiology. Studies performed in both human and experimental animals demonstrate that NOS blockade increases renal vascular resistances and decreases the glomerular ultrafiltration coefficient. ⋯ Renal iNOS activity is significantly increased in various pathophysiological conditions including autoimmune tubulointerstitial nephritis and sepsis. Interestingly, recent evidence suggests that high NO levels secondary to increased iNOS activity may inhibit eNOS activity and through this mechanism lead to renal vasoconstriction and reductions in glomerular filtration rate. The use of NOS blockers has generated a great deal of information on the role of NO in the control of renal function and has also allowed us to begin to understand the high level of complexity of this system.