Uremia Therapy Research Articles

Theoretical considerations on molecular transport in dialysis and sorbent therapy for uremia.

The technology of uremic blood purification has grown rapidly over the past decade and has provided the clinician with a wide range of therapeutic options. These options involve mass transfer processes which may be primarily due to diffusion or convection, or a combination of both mechanisms. However, regardless of the mechanism of molecular transport, evaluation of the clinical utility of these therapies requires studies which provide sufficient data to solve the appropriate rate equations and to close mass balances. Data from the recent hemodialysis, peritoneal dialysis and sorbent literature are analyzed to show the magnitude of variability in both patient and therapy-related mass balance paramters for urea nitrogen (U) and middle molecules (MM) and to provide unambiguous comparisons for some of these therapies. A theoretical model is developed to describe sorbent-mediated gut elimination of solute as a first-order clearance limited by sorbent saturation. The model is used to analyze data in the literature on AL (OH)3 facilitated gut clearance of phosphate and indicates a gut P clearance of approximately 20 ml/min with maximum removal of approximately 800 mg P/24 hrs. Similar analysis of oxystarch indicated a gut U clearance of 2.5 ml/min and maximum removal of 1.5 gm/24 hrs.

The clinical spectrum of ascites associated with maintenance dialysis

Among 197 patients being treated with maintenance dialysis, six were found to have ascites. Unlike previously reported series, the cause of ascites and the clinical course were variable. Two patients responded to definitive therapy directed against the specific cause. No consistent association was found with the etiology of renal disease or therapy of uremia including the duration of hemodialysis or prior peritoneal dialysis. Nonspecific therapy attempting to alleviate ascites was unsatisfactory. Severe hypertension was not characteristic and bilateral nephrectomy did not influence the course. An extensive diagnostic evaluation is recommended along with skepticism before declaring that idiopathic, refractory ascites exists signaling progressive deterioration.

Calcium and phosphorus in diet therapy of uremia

Significant advances have been made in understanding the pathogenesis of renal osteodystrophy. Several factors play a role in the development of uremic bone disease, such as secondary hyperparathyroidism, PTH resistance at the level of bone, abnormalities in vitamin D metabolism, and factors contributing to extraosseous calcification. Through a better understanding of the pathogenetic mechanisms, a more rational approach to the dietary management of patients with chronic renal failure has been possible. In view of present knowledge, the following preventive and therapeutic interventions can be recommended: provision of liberal calcium intake in the diet, appropriate restriction of phosphorus intake, provision of potent vitamin D analogs, and close attention to the calcium-phosphorus product. With careful attention to these recommendations, the bone lesions of secondary hyperparathyroidism and osteomalacia may be minimized and even prevented.

Impact of HR-1 on the therapy of end-stage uremia. How and where should uremia be treated.

ON July 1, 1973, Section 299-I of the Social Security Amendments of 1972, termed HR-1, will provide for the payment of maintenance hemodialysis and kidney transplantation for over 90 per cent of the population. Assuming that in 50 new patients per million population treatable irreversible uremia will develop each year (an estimate that excludes other potentially treatable patients with renal failure and multiple system diseases, such as diabetes mellitus), HR-1 will subsidize therapy for at least 50,000 patients within a decade. Supervising the distribution of at least two hundred million and, conceivably, 1/2 billion health-care dollars annually for one specific . . .

Uremia Progress in Pathophysiology and Treatment.

The publication of a new volume dealing with the pathophysiology and treatment of uremia, especially from the Peter Bent Brigham group, will be welcomed by all medical readers. Previous books dealing with this subject are now five to ten years old, and great progress has been made in the understanding and therapy of uremia in the past decade. However, this new volume is not an in-depth study of uremia; as the authors point out in the Preface, it makes no claim to being all-inclusive.... It is intended to be an updating of the subject. Accordingly, the book is concise and may be read in its entirety in a single sitting. Roughly half of the volume deals with pathophysiology and the other half with the treatment of uremia. Subsections in each half cover major aspects of the uremic syndrome. The recent literature is reviewed and often put into perspective by comparison

Nonketoacidotic hyperglycemia and coma during intravenous diazoxide therapy in uremia.

Hyperglycemic hyperosmolar nonketoacidotic coma developed in a twenty-year-old female with uremia when treated for hypertension with intravenous diazoxide. Low circulating serum insulin concentrations were found in this patient as well as in four others with this syndrome, thus supporting the recent hypothesis that these concentrations of insulin are adequate to block lipolysis but insufficient to prevent hyperglycemia. In view of the recognized inhibitory effect of diazoxide on pancreatic insulin release and peripheral glucose nietabolism, it is recommended that patients receiving intravenous diazoxide be observed for possible severe disturbances of carbohydrate metabolism and resulting hyperosmolarity.

Cephalexin in patients with renal disease.

Abstract Cephalexin was administered to patients with renal impairment to study kinetics and devise a basis for predictable therapy in uremia. The mean peak serum level of 24 μg milliliter was independent of renal function. Peak levels occurred at 30 minutes after 500 mg orally in normal subjects and were undetectable by four hours. In severe renal failure, peak levels occurred at four to eight hours, and detectable levels for 72 hours. The mean half-life of cephalexin on hemodialysis was 6.3 hours as compared to 30.8 hours without dialysis. A fitted regression line describes the relation between the half-life and creatinine clearance so that if one value is known, the corresponding function may be read and dosage modified individually. The dosage frequency suggested is every 48 to 60 hours with a creatinine clearance of 0–4 ml per minute, every 24 hours for one of 5 to 15 ml per minute and every eight to 12 hours for one of 16 to 30 ml per minute. No modification is necessary at creatinine clearances abo...

Hemodialysis: a successful therapy for chronic uremia.

Excerpt Recurrent hemodialysis has become a successful form of therapy for patients with end-stage chronic renal failure. At the present time, several hemodialysis centers both in the United States...

Hemodialysis: A Successful Therapy for Chronic Uremia.

Hemodialysis: A Successful Therapy for Chronic Uremia.

Anti-Emetic Effect of Chlorpromazine (Thorazine) in Cancer Patients

Summary The effect of chlorpromazine as an anti-emetic and anti-nausea agent was studied, with placebo controls when possible, in 15 chronically ill patients. The drug was found to be effective, greatly surpassing the effectiveness of placebos, in combating the nausea and vomiting due to uremia and radiation therapy. In the presence of partial intestinal obstruction, chlorpromazine usually relieved nausea, but did not relieve vomiting. Side effects were limited to drowsiness and mild xerostomia, and did not necessitate interruption of therapy.

Irrigation of the small intestine in therapy of uremia

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Animal experiments on exchange transfusion in the therapy of acute uremia

Animal experiments on exchange transfusion in the therapy of acute uremia