Journal of nephrology
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Journal of nephrology · Nov 2007
A Mediterranean age-comorbidity prognostic index for survival in dialysis populations.
The most widely used prognostic indices for estimation of survival, including for dialysis patients, were described by Charlson, and an adaptation was proposed by Hemmelgarn for dialysis patients. We present the first age-comorbidity prognostic index (ACPI) designed in a Mediterranean incident dialysis population and examine its concordance with other prognostic indices. ⋯ Although prospective external validation of this new index is required, this index adequately estimates the probability of survival at 3 years. The prognostic power of ACPI is similar to that of the Charlson index; however, relevant differences were found, concerning the weight of factors age, cardiovascular diseases and myocardial dysfunction. In end-stage renal disease we recommend estimating survival by indices established in incident dialysis patients, due to the particular comorbid conditions of this population.
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Journal of nephrology · Sep 2007
Randomized Controlled TrialRegional citrate versus heparin anticoagulation during venovenous hemofiltration in patients at low risk for bleeding: similar hemofilter survival but significantly less bleeding.
Regional citrate anticoagulation (RCA) may be a valuable alternative to systemic heparin anticoagulation during continuous venovenous hemodialysis (CVVH). RCA does not increase the risk of bleeding, but carries the risk of metabolic derangements. Clotting-free circuit survival may be increased with RCA. ⋯ RCA during CVVH can be performed safely, with a circuit survival similar to systemic heparin anticoagulation, but significantly lower incidence of bleeding. Citrate anticoagulation should be advocated as first choice, also for critically ill patients considered to be at low risk for bleeding.
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Journal of nephrology · Sep 2007
Randomized Controlled TrialComparative immunogenicity of 2 recombinant hepatitis B vaccines (GeneVac-B and Engerix-B) in adult patients with chronic renal failure.
Hepatitis B virus infection is often fatal or results in a carrier state with uremia. Vaccination protects against infection, but immune response may remain low. We aimed to study immune responses to 2 recombinant hepatitis B vaccines (Engerix-B and GeneVac-B) in patients with end-stage chronic renal failure. ⋯ Both vaccines are highly immunogenic in renal failure and did not show significant differences between each other.
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Journal of nephrology · Jul 2007
Serum matrix metalloproteinases MMP-2 and MMP-9 and metalloproteinase tissue inhibitors TIMP-1 and TIMP-2 in diabetic nephropathy.
The regulation of mesangial extracellular matrix (ECM) turnover engages a number of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). High glucose concentration affects ECM degradation and the activities of MMPs and TIMPs. ECM accumulation is involved in the pathogenesis of diabetic nephropathy. ⋯ These data indicate that circulating TIMP-1, TIMP-2 and MMP-2 are decreased in patients with diabetic nephropathy when compared with either CRF or diabetes.
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Journal of nephrology · Jul 2007
Chloride, but not unmeasured anions, is correlated with renal bone disease markers.
Many factors are involved in the progression of secondary hyperparathyroidism, including acidosis. Stewart's approach has made it possible to identify real determinants of acid-base status, making chloride a real etiological factor of acid-base disturbances. In addition, it has allowed the quantification of the components of these disturbances, especially the unmeasured anions. We performed a cross-sectional study to quantify each component of acidosis in hemodialysis patients and correlate them with renal bone disease biochemical markers. ⋯ Although unmeasured anions are considered the main component of acidosis in hemodialysis patients, serum chloride was the only acid-base determinant correlated with bone markers.