Hemodialysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

HEMODIALYSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES ...

Author: ICON Health Publications

50 downloads 2215 Views 3MB Size Report

This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below!

Report copyright / DMCA form

DOWNLOAD PDF

HEMODIALYSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

ii

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Hemodialysis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00526-3 1. Hemodialysis-Popular works. I. Title.

iii

Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

iv

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on hemodialysis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

v

About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

vi

About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

vii

Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HEMODIALYSIS ......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hemodialysis............................................................................... 33 E-Journals: PubMed Central ....................................................................................................... 87 The National Library of Medicine: PubMed ................................................................................ 92 CHAPTER 2. NUTRITION AND HEMODIALYSIS ............................................................................. 137 Overview.................................................................................................................................... 137 Finding Nutrition Studies on Hemodialysis.............................................................................. 137 Federal Resources on Nutrition ................................................................................................. 143 Additional Web Resources ......................................................................................................... 143 CHAPTER 3. ALTERNATIVE MEDICINE AND HEMODIALYSIS ....................................................... 145 Overview.................................................................................................................................... 145 National Center for Complementary and Alternative Medicine................................................ 145 Additional Web Resources ......................................................................................................... 162 General References ..................................................................................................................... 164 CHAPTER 4. DISSERTATIONS ON HEMODIALYSIS ......................................................................... 165 Overview.................................................................................................................................... 165 Dissertations on Hemodialysis................................................................................................... 165 Keeping Current ........................................................................................................................ 167 CHAPTER 5. PATENTS ON HEMODIALYSIS .................................................................................... 169 Overview.................................................................................................................................... 169 Patents on Hemodialysis............................................................................................................ 169 Patent Applications on Hemodialysis ........................................................................................ 195 Keeping Current ........................................................................................................................ 230 CHAPTER 6. BOOKS ON HEMODIALYSIS........................................................................................ 231 Overview.................................................................................................................................... 231 Book Summaries: Federal Agencies............................................................................................ 231 Book Summaries: Online Booksellers......................................................................................... 234 Chapters on Hemodialysis.......................................................................................................... 236 Directories.................................................................................................................................. 248 CHAPTER 7. MULTIMEDIA ON HEMODIALYSIS ............................................................................. 251 Overview.................................................................................................................................... 251 Video Recordings ....................................................................................................................... 251 Audio Recordings....................................................................................................................... 252 CHAPTER 8. PERIODICALS AND NEWS ON HEMODIALYSIS .......................................................... 255 Overview.................................................................................................................................... 255 News Services and Press Releases.............................................................................................. 255 Newsletters on Hemodialysis ..................................................................................................... 259 Newsletter Articles .................................................................................................................... 259 Academic Periodicals covering Hemodialysis ............................................................................ 260 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 261 Overview.................................................................................................................................... 261 U.S. Pharmacopeia..................................................................................................................... 261 Commercial Databases ............................................................................................................... 262 Researching Orphan Drugs ....................................................................................................... 263 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 267 Overview.................................................................................................................................... 267 NIH Guidelines.......................................................................................................................... 267 NIH Databases........................................................................................................................... 269

viii Contents

Other Commercial Databases..................................................................................................... 271 APPENDIX B. PATIENT RESOURCES ............................................................................................... 273 Overview.................................................................................................................................... 273 Patient Guideline Sources.......................................................................................................... 273 Finding Associations.................................................................................................................. 286 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 289 Overview.................................................................................................................................... 289 Preparation................................................................................................................................. 289 Finding a Local Medical Library................................................................................................ 289 Medical Libraries in the U.S. and Canada ................................................................................. 289 ONLINE GLOSSARIES................................................................................................................ 295 Online Dictionary Directories ................................................................................................... 295 HEMODIALYSIS DICTIONARY............................................................................................... 297 INDEX .............................................................................................................................................. 381

1

FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with hemodialysis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about hemodialysis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to hemodialysis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on hemodialysis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to hemodialysis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on hemodialysis. The Editors

1

From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

3

CHAPTER 1. STUDIES ON HEMODIALYSIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hemodialysis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hemodialysis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “hemodialysis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Daily Short and Nightly Nocturnal Home Hemodialysis: State of the Art Source: Dialysis and Transplantation. 33(2): 64-67, 70-73, 100. February 2004. Summary: A growing number of studies are showing that longer or more frequent inhome hemodialysis offers not only superior therapy to clinic-based hemodialysis, but also the opportunity to reduce costs. In this article, the author describes his experiences with nearly 100 home hemodialysis (HD) patients, including those on nightly nocturnal HD. Topics include traditional dialysis options, such as in-center hemodialysis, home HD, and peritoneal dialysis; newer dialysis options, including daily short dialysis, and nightly nocturnal dialysis; measurement of dialysis quality indicators, including adequacy of dialysis, bone disease management, and anemia management; and patient management, including complication management, blood pressure control, nutrition measurements, and cost comparison. A final section considers why so few patients are

4

Hemodialysis

on home HD. The author concludes that more frequent and or longer dialysis treatments are superior in many ways to standard in-center dialysis. Patients dialyzing at home have also regained much of their former sense of control over both their treatment and their lives. 6 figures. 2 tables. 11 references. •

Low, Rather than a High, Total Plasma Homocysteine Is an Indicator of Poor Outcome in Hemodialysis Patients Source: Journal of the American Society of Nephrology. 15(2): 442-453. February 2004. Summary: An increased level of total plasma homocysteine (tHcy) is a risk factor for poor cardiovascular outcome in the general population. However, a decreased, rather than an increased, tHcy concentration may predict poor outcome in patients on maintenance hemodialysis (MHD), a phenomenon referred to as reverse epidemiology. This article reports on a study of the associations between tHcy level and markers of malnutrition-inflammation complex syndrome and 12-month prospective hospitalization and mortality in 367 MHD patients, aged 54.5 years (plus or minus 14.7 years). The study included 199 men and 55 percent individuals with diabetes. During 12 months of follow-up, 191 MHD patients were hospitalized, 37 died, 9 underwent renal transplantation, and 38 transferred out. Hospitalization rates were significantly higher in patients with lower tHcy levels. Mortality rate in the lowest tHcy quartile was significantly higher compared with other three quartiles. The authors note that the nutritional feature of tHcy in MHD patients may explain its reverse association with outcome. 4 figures. 6 tables. 55 references.

•

Cardiac Rhythm Disturbances in Children on Hemodialysis Source: Pediatric Nephrology. 17(10): 837-841. October 2002. Contact: Available from Springer-Verlag. Service Center Secaucus, 44 Hartz Way, Secaucus, NJ 07094. (201) 348-4033. Summary: Cardiovascular complications are the leading causes of morbidity (related illness) and mortality (death) in adult dialysis patients. This article reports on a study that evaluated the cardiovascular system of children on hemodialysis (HD), with special focus on rhythm disturbances. The study included nine patients, aged 15.6 years (plus or minus 4.1 years), who underwent electrocardiographic examination (ECG), echocardiography, and 24 hour blood pressure measurement. Patients had been on HD for a median period of 7 months (range 1 to 29 months). The authors found that rhythm disturbances were rare, with slow monomorphic ventricular tachycardias being the only significant finding. The absence of late potentials and normal QT dispersion suggest that myocardial electrical excitability and recovery are preserved in children on HD. 2 tables. 31 references.

•

Preventing Transmission of Infections Among Chronic Hemodialysis Patients Source: Nephrology Nursing Journal. 28(5): 537-543, 585. October 2001. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: Chronic hemodialysis patients are at high risk for infection because the process of hemodialysis requires vascular (blood vessel) access for prolonged periods of time. In an environment where multiple patients receive dialysis concurrently, there are repeated opportunities for person to person transmission of infectious agents, directly or

Studies

5

indirectly, via contaminated devices, equipment and supplies, environmental surfaces, or hands of personnel. Furthermore, hemodialysis patients are immunosuppressed, which increases their susceptibility to infection, and they require frequent hospitalizations and surgery, which increase their opportunities for exposure to nosocomial (hospital acquired) infections. This article on preventing transmission of infections among chronic hemodialysis (HD) patients is an excerpt from a longer article from the Centers for Disease Control and Prevention (CDC), originally published in the MMWR April 27, 2001 (available at www.cdc.gov/hepatitis). The article offers an introduction, a review of infection control precautions for outpatient HD settings compared to inpatient hospital settings, and recommendations for infection control practices, routine serologic testing and immunization, HD staff, surveillance for infections and other adverse events, and infection control training and education. 1 figure. 4 tables. 1 reference (the original article includes 206 references). •

Meta-Analysis of Subcutaneous Versus Intravenous Epoetin in Maintenance Treatment of Anemia in Hemodialysis Patients Source: American Journal of Kidney Diseases. 40(3): 439-446. September 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Clinical and pharmacokinetics studies have shown that target hemoglobin or hematocrit levels can be maintained using a reduced recombinant human erythropoietin (epoetin) dosage by switching from intravenous (IV) to subcutaneous (SC) administration. This article reports on a meta-analysis of comparative studies of epoetin administered IV versus SC undertaken to assess the relative costs of these administration routes. Twenty-seven prospective clinical studies involving 916 patients were included in the analysis. Results indicate that the cost of epoetin is reduced substantially when administered SC in comparison to IV. Recommendations of current US and European guidelines, which encourage the use of SC administration, not only have a sound rationale in terms of efficacy and safety, but also have a sound economic basis. 2 figures. 3 tables. 53 references.

•

Patient Satisfaction with Care and Behavioral Compliance in End-stage Renal Disease Patients Treated with Hemodialysis Source: American Journal of Kidney Diseases. 39(6): 1236-1244. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Compliance with the hemodialysis (HD) prescription is an important predictor of patient outcome. Although there is interest in the concept of patient satisfaction with medical care and caregivers, relatively few such data exist regarding HD patients. This article reports on a study that examined whether associations exist between patient satisfaction with medical personnel, depressive affect, social support levels, and behavioral compliance with prescribed HD treatment. The study included 79 HD patients who went through an interview process that assessed depression, social support, and perception of satisfaction with dialysis staff. Medical and treatment data, Karnofsky functioning and severity of illness scores, and behavioral and laboratory compliance measures were determined. There was no association between patient satisfaction with care and level of depressive affect. A relationship was found between patient satisfaction with care from their nephrologist and attendance at dialysis sessions. Patients who had a poor perception of satisfaction with their nephrologist had poorer

6

Hemodialysis

attendance at dialysis sessions. There was no relationship between behavioral compliance and patient perception of ancillary HD staff. In addition, patient perception of satisfaction with staff was related to perception of social support, protein catabolic rate, and serum albumin concentration, all of which have been linked to survival. The authors conclude that the nephrologist has a crucial role in patient compliance. These results suggest that interventions to improve patient perception of physician support may also improve patient adjustment and possibly survival. 6 tables. 28 references. •

Time and Exercise Improve Phosphate Removal in Hemodialysis Patients Source: American Journal of Kidney Diseases. 43(1): 85-89. January 2004. Summary: Control of serum (blood) phosphate remains a difficult clinical issue in most hemodialysis (HD) patients. This article reports on a study of two nonpharmacologic approaches to improving phosphate control in HD patients. First, 9 stable HD patients underwent dialysis in random fashion for either 4 hours 3 times weekly or 5 hours 3 times weekly. Adjustments were made to blood flow rates such that Kt per V was the same for all sessions, thus allowing independent assessment of the influence of time. The primary end point was weekly dialysate phosphate removal. In the second study, 12 different patients underwent an exercise program in which they pedaled a bicycle ergometer either immediately before or during dialysis. Again, weekly dialysate phosphate removal was measured. In the time study, urea reduction ratio and weekly urea removal were no different between the two groups. However, weekly phosphate removal significantly improved with longer dialysis duration. Serum phosphate levels improved but did not reach statistical significance in this short-term study. In the exercise study, weekly phosphate removal improved with exercise but did not reach significance. There was no significant difference in serum phosphate levels. The authors conclude that both increased dialysis time and exercise result in increased dialytic removal of phosphate and could be expected in the long term to improve phosphate control. 1 figure. 4 tables. 27 references.

•

Survival of Patients Undergoing Hemodialysis with Paricalcitol or Calcitriol Therapy Source: New England Journal of Medicine. Volume 349: 446-56. July 2003. Summary: Elevated calcium and phosphorus levels after therapy with injectable vitamin D for secondary hyperparathyroidism may accelerate vascular disease and hasten death in patients undergoing long-term hemodialysis. Paricalcitol, a new vitamin D analogue, appears to lessen the elevations in serum calcium and phosphorus levels, as compared with calcitriol, the standard form of injectable vitamin D. This article reports on a historical cohort study undertaken to compare the 36 month survival rate among patients undergoing long term hemodialysis (HD) who started to receive treatment with paricalcitol (29,021 patients) or calcitriol (38,378 patients) between 1999 and 2001. The mortality rate among patients receiving paricalcitol was 3,417 per 19,031 personyears, as compared with 6,805 per 30,471 person-years among those receiving calcitriol. The difference in survival was significant at 12 months and increased with time. In adjusted analysis, the mortality rate was 16 percent lower among paricalcitol-treated patients than among calcitriol-treated patients. A significant survival benefit was evident in 28 of 42 strata examined, and in no stratum was calcitriol favored. The authors conclude that patients who receive paricalcitol while undergoing long term HD appear to have a significant survival advantage over those who receive calcitriol. 3 figures. 3 tables. 41 references.

Studies

•

7

Factors Associated With Medication-Related Problems in Ambulatory Hemodialysis Patients Source: American Journal of Kidney Diseases. 41(2): 386-393. February 2003. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Hemodialysis (HD) patients are at risk for medication-related problems. Patient characteristics associated with the number of medication-related problems in HD patients have not previously been investigated. This article reports on a study in which patient records (n = 133) were reviewed to identify medical problems, prescribed medications, medication indication(s), and medication-related problems. Patients were 60.5 years old (plus or minus 15.2 years), prescribed 11.0 medications (plus or minus 4.2 medications), and had 6.0 comorbidities (plus or minus 2.3 comorbidities). Medicationrelated problems were identified in 97.7 percent of patients. Patients with diabetes mellitus had more medication related problems identified than those without DM (303 versus 172 medication-related problems, respectively). Medication-related problems correlated positively with number of patient comorbidities. The most frequent medication-related problems were drug without indication (30.9 percent), laboratory (27.6 percent) indication without drug use (17.5 percent), and dosing errors (15.4 percent). Patients with DM are at increased risk for medication-related problems. The authors conclude that health care providers taking care of HD patients should be aware of this problem, and efforts to avoid or resolve medication-related problems should be undertaken at all HD clinics. 3 figures. 3 tables. 26 references.

•

Hemodialysis Infection Prevention with Polysporin Ointment Source: JASN. Journal of the American Society of Nephrology. 14 (1): 169-179. January 2003. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: Hemodialysis patients in whom permanent vascular access cannot be achieved are dependent on a central venous catheter. In such patients, catheter-related infections are a common and serious complication. This article reports on a randomized clinical trial undertaken to determine if topical Polysporin Triple antibiotic ointment applied to the central venous catheter insertion site could reduce the incidence of catheter related infections. A total of 169 patients receiving hemodialysis through a central venous catheter were randomized to receive Polysporin Triple or placebo. In the 6 month study period, infections were observed in more patients in the placebo group than in the Polysporin Triple group (34 percent versus 12 percent, respectively). The number of infections per 1000 catheter days and the number of bacteremias per 1000 catheter days were also greater in the placebo group. Within the 6 month study period, there were 13 deaths in the placebo group as compared with 3 deaths in the Polysporin Triple group. When all available followup information was included, the difference in survival remained significant (19 versus 9 deaths). Within the first 6 months, infections were observed in 7 of the 13 placebo subjects who died (54 percent) as compared with no infections in the three Polysporin Triple subjects who died. The prophylactic application of topical Polysporin Triple antibiotic ointment to the central venous catheter insertion site reduced the rate of infections and was associated with improved survival in hemodialysis patients. 2 figures. 6 tables. 49 references.

8

•

Hemodialysis

Hepatitis C Screening Strategies in Hemodialysis Patients Source: American Journal of Kidney Diseases. 38(1): 91-97. July 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Hepatitis C virus (HCV) infection is common in patients undergoing chronic hemodialysis, with an estimated yearly incidence on 0.2 percent and prevalence between 8 and 10 percent. Although a screening strategy based on alanine aminotransferase (ALT) values is currently recommended, this strategy has not been evaluated for cost effectiveness compared with other potential screening strategies. This article reports on a comparison study that used a decision analysis model of a simulated cohort of 5,000 hemodialysis patients followed up for 5 years. Using direct medical costs, three strategies were evaluated, including: ALT values with confirmatory testing (biochemical); serial enzyme linked immunosorbent and strip immunoblot assay testing (serological); and polymerase chain reaction (PCR, viral). Under baseline assumptions, the per patient cost of screening hemodialysis patients for HCV was $378 for biochemical based testing, $195 for serological based testing, and $696 for viral based testing. The authors' model was robust when varying the costs of testing, as well as the incidence and prevalence of HCV infection. Results of sensitivity analysis by varying costs, HCV incidence, and HCV prevalence indicated that serological based screening was less costly than biochemical testing. Biochemical testing was in turn less costly than viral based screening. Serological based testing was also more effective in the diagnosis of new HCV infection, with a likelihood ratio of 85, in contrast to the likelihood ratio of 44 with biochemical based testing using viral based screening as the gold standard. A serological based screening strategy is less costly and more effective than biochemical based screening in the diagnosis of new HCV infection. The authors conclude that serological based screening should be considered for HCV screening in hemodialysis populations. 3 figures. 2 tables. 45 references.

•

Serratia Liquefaciens Bloodstream Infections from Contamination of Epoetin Alfa at a Hemodialysis Center Source: New England Journal of Medicine. 344(20): 1491-1497. May 17, 2001. Summary: In one month, 10 bloodstream infections with Serratia liquifaciens (a bacteria) and 6 pyrogenic (fever) reactions occurred in outpatients at a hemodialysis center. This article reports on a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections of pyrogenic reactions. The authors reviewed procedures and cultured samples of water, medications, soaps, and hand lotions and swabs from the hands of personnel. The analysis covered 208 dialysis sessions involving 48 patients. In 12 sessions, patients had S. liquefaciens bloodstream infections, and in 8, patients had pyrogenic reactions without bloodstream infection. Sessions with infections or reactions were associated with higher median doses of epoetin alfa than the 188 other sessions and were more common during afternoon or evening shifts than morning shifts. A review of procedures revealed that preservative free, single use vials of epoetin alfa were punctured multiple times, and residual epoetin alfa from multiple vials was pooled and administered to patients. S. liquefaciens was isolated from pooled epoetin alfa, empty vials of epoetin alfa, antibacterial soap, and hand lotion. After the practice of pooling epoetin alfa was discontinued and the contaminated soap and lotion were replaced, no further S. liquefaciens bloodstream infections or pyrogenic reactions occurred at this hemodialysis facility. 1 figure. 4 tables. 19 references.

Studies

•

9

Atherosclerosis in Patients with End-Stage Renal Failure Prior to Initiation of Hemodialysis Source: Renal Failure. 25(2): 247-254. 2003. Summary: In patients on dialysis, cardiovascular mortality (death) is 10 to 20 times higher than in the general population. It remains uncertain whether atherosclerosis of dialysis patients is effectively accelerated because many dialysis patients have more or less marked vascular lesions present at the start of dialysis treatment. This article reports on a study in which the authors compared intima-media thickness (IMT) and plaque occurrence (indicators of atherosclerosis) in the common carotid arteries (CC) in the area of bifurcation (CB) and in the proximal part of internal carotid arteries (CI) in 28 hemodialysis patients (14 men and 14 women, mean age 49.4 years, mean duration of HD treatment 66.6 months) with that in 28 age-matched patients prior to initiation of hemodialysis. The authors found that the IMT values of CC, CB, and CI were not significantly different in dialysis patients and patients starting dialysis treatment. The results also showed no difference in plaque occurrence and in atherosclerotic risk factors (hypertension, smoking, lipids) between groups. The authors recommend earlier and more aggressive intervention before dialysis treatment in order to reduce the atherosclerotic risk factors. 31 references.

•

Survival of Patients with AIDS and End-Stage Renal Disease Receiving Hemodialysis Source: Dialysis and Transplantation. 33(4): 176, 178, 180-181, 184-186. April 2004. Summary: In the 1980s, most patients with AIDS who progressed to end stage renal disease (ESRD) survived for less than 6 months on maintenance hemodialysis. This article reports on a 68 month (1995 to 2001) prospective, multicenter, case-control cohort study undertaken to determine the present course and survival of patients with AIDS and ESRD receiving hemodialysis in four outpatient dialysis facilities in Brooklyn, NY. The course of all 34 patients with both ESRD and HIV infection in the four outpatient dialysis facilities was compared to that of 131 ESRD patients without known HIV infection who were randomly selected from the same dialysis facilities. At initiation, the mean age of the 34 patients with ESRD and HIV infection was 42 years, compared to 56 years for the control cohort (ESRD alone). During the 68-month observation period, 17 (50 percent) of the 34 patients with HIV and ESRD died, compared with 65 (50 percent) of the 131 patients with ESRD alone. Mean survival was equivalent between groups. Analyses showed that with adjustment for age, patients with both ESRD and HIV infection had a 97 percent higher risk of death than did their counterparts with ESRD alone. The authors conclude that the survival of patients with HIV infection and ESRD receiving hemodialysis has improved significantly compared with the uniformly dismal outcomes in the 1980s. The combination of HIV infection and ESRD no longer signals near-term death; thus, clinicians should not hesitate to refer HIV-infected patients with renal failure for uremia therapy.

•

Correlates of Excess Comorbidity and Major Complications in Diabetic Patients on Maintenance Hemodialysis Source: Dialysis and Transplantation. 24(1): 16-18, 20. January 1995. Contact: Available from Creative Age Publications, Inc. 7628 Densmore Avenue, Van Nuys, CA 91406-2088. (800) 624-4196; (818) 760-8983.

10

Hemodialysis

Summary: In this article, the authors report on their work to identify, by means of multiple regression analysis, any subset of hemodialysis patients with diabetes at increased risk for blindness, limb/digit amputation, wheelchair dependent, hypertension requiring drug treatment, and/or other comorbid medical conditions. They also compared the difference in prevalence of comorbid medical conditions and major complications between the insulin-treated patients with diabetes and those not on insulin. One hundred forty-six patients with diabetes were studied; results show that men were at more risk for blindness than women, and the risk of amputation increased with advancing age in both black men and women. Older patients and those on insulin therapy were more likely to be wheelchair dependent than their respective counterparts. Also, the prevalence of comorbid medical problems increased with advancing age. Among white patients, men and those on hemodialysis for a longer duration were more likely to be receiving antihypertensive therapy than their respective counterparts. 2 tables. 12 references. (AA-M). •

Evaluating Iron Status in Hemodialysis Patients Source: Nephrology Nursing Journal. 29(4): 366-369. August 2002. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: Iron is essential for hemoglobin formation and productive erythropoiesis. In hemodialysis patients, accurately assessing iron status is a prerequisite for diagnosing iron deficiency (anemia), monitoring the response to iron supplementation, and maintaining effective erythropoiesis. This article focuses on strategies to evaluate iron status in hemodialysis patients. Ideal laboratory tests of iron status should accurately indicate whether a patient has an excess or deficiency in stored iron, as well as in iron readily available for erythropoiesis. Serum ferritin and transferrin saturation (TSAT) are iron indices recommended by the KDOQI guidelines for assessing iron deficiency and iron overload. However, since serum (blood) ferritin and TSAT are indirect measures of iron status, they can be unreliable in hemodialysis patients, particularly in those who are receiving recombinant erythropoietin. Relying on inaccurate indices of iron status can lead to false interpretations of iron overload or iron deficiency, which may lead to the unnecessary discontinuation or overdosing of iron supplementation. The author concludes that newer methods of measuring iron status, such as reticulocyte hemoglobin content (CHr), may be less variable and more sensitive and specific than the current iron parameters. 2 tables. 13 references.

•

Perceived Barriers and Motivators to Exercise in Hemodialysis Patients Source: Nephrology Nursing Journal. 31(1): 23-29. January-February 2004. Summary: Kidney failure and hemodialysis are associated with numerous physical and psychological symptoms and complications, some of which can be reduced or eliminated by adequate exercise. Dialysis patients, however, tend to be quite sedentary on average, which can further complicate their physical and mental health. This article reports on a study undertaken to investigate perceptions of barriers and motivators for exercise among hemodialysis patients. The authors hypothesized that increased barriers would be associated with decreased exercise, and increased motivators would be associated with increased exercise. The results indicated that both motivators and barriers were associated with exercise behavior, with motivators being more salient. Contrary to what has been previously postulated, lack of motivation, as opposed to

Studies

11

health-related impairment, appears to be the primary factor impeding dialysis patient exercise practices. 4 tables. 21 references. •

Renal Contraction Therapy for Enlarged Polycystic Kidneys by Transcatheter Arterial Embolization in Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(3): 571-579. March 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Kidneys of patients with autosomal dominant polycystic kidney disease (ADPKD) usually continue to increase in size, even after patients begin dialysis therapy, and the mass effects may lead to severe complications. Such external conventional therapies as surgical and laparoscopic procedures have not yielded satisfactory results. This article reports on a technique in which the authors attempted renal contraction therapy in patients with ADPKD by renal transcatheter arterial embolization (TAE) using intravascular coils. After obtaining informed consent, the authors selected anuric (without urine formation) patients on dialysis therapy with markedly distended abdomens or macroscopic hematuria (blood in the urine) (n = 64). After therapy, renal sizes decreased to 73.8 percent, 61.7 percent, and 53.4 percent of preinterventional values at 3, 6, and 12 months after therapy, respectively. Abdominal circumference and dry weight were significantly decreased at 3, 6, and 12 months, compared with baseline values before therapy. This therapy was effective for all patients. Serious complications were not seen after this treatment, although such minor complications as fever and flank pain were observed within the first week after the procedure. The authors conclude that treatment with TAE is a safe and effective procedure that has resulted in improvement in the quality of life and nutritional status of patients with ADPKD. 8 figures. 16 references.

•

Nutritional Status over Time in Hemodialysis and Peritoneal Dialysis Source: JASN. Journal of the American Society of Nephrology. 12(6): 1272-1279. June 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Website: www.jasn.org. Summary: Malnutrition is a risk factor for mortality (death) in the dialysis population. This article reports on a study undertaken to compare the time course of nutritional status in patients who were starting hemodialysis (HD) or peritoneal dialysis (PD) and to identify the baseline determinants of that time course. In the prospective, multicenter cohort study, baseline data were collected from 3 to 24 months after the start of dialysis. A total of 250 consecutive new patients were included: 132 started on HD, and 118 started on PD. Analyses demonstrated a decrease in serum albumin (protein levels in the blood, SA) in patients who started on HD and an increase in patients who started on PD. Body fat increased in PD; lean body mass (LBM) did not change. The SA at 2 years was 2.0 grams per Liter higher in patients who started on PD compared with patients who started on HD. The increase in body fat was 3.2 kilograms higher in women who started on PD than in others. Patients who had diabetes gained 2.3 kilograms more fat than patients who did not have diabetes. Measures of dialysis adequacy (Kt per V urea) did not affect the time course of nutritional status, but a higher value was associated with a higher SA at 24 months. The authors conclude that nutritional status at the start of dialysis, gender, and diabetes status might be considered in making the choice for dialysis modality. 3 figures. 1 table. 38 references.

12

•

Hemodialysis

Prevalence of Constipation in Continuous Ambulatory Peritoneal Dialysis Patients and Comparison with Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(6): 1292-1299. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Many hemodialysis patients have constipation. The frequency of constipation has not been rigorously evaluated in patients who use continuous ambulatory peritoneal dialysis (CAPD) as their method of kidney (renal) replacement therapy, however. This article reports on a study that featured a survey on constipation in CAPD patients and compared the findings with those in hemodialysis patients through a questionnaire. Daily dietary fiber and potassium intake were calculated from the patient's dietary records. In the questionnaire, patients were asked about bowel frequency, stool consistency, straining, and use of laxatives and resins. The frequency of constipation was 28.9 percent in 204 CAPD patients and 63.1 percent in 268 hemodialysis patients. Only 3.4 percent of CAPD patients needed resin to avoid hyperkalemia (high levels of potassium in the blood). Of hemodialysis patients, 49 percent needed resin. Among the 261 hemodialysis patients, 205 (78.5 percent) suppressed an urge to defecate during hemodialysis therapy. Potassium and total dietary fiber intake per day were higher in CAPD patients than in hemodialysis patients. The results suggest that constipation occurs less frequently in CAPD patients than in hemodialysis patients. The authors hypothesize that the low rate of constipating drug administration, dialysis modality-based lifestyle, and higher total dietary fiber intake may cause the lower prevalence of constipation in CAPD patients. One appendix reprints the questionnaire used in the study. 1 appendix. 2 figures. 4 tables. 15 references.

•

Utility of Hemodialysis in Maple Syrup Urine Disease Source: Pediatric Nephrology. 17(4): 239-242. April 2002. Contact: Available from Springer-Verlag. Service Center Secaucus, 44 Hartz Way, Secaucus, NJ 07094. (201) 348-4033. Summary: Maple syrup urine disease (MSUD) is an inborn error of metabolism stemming from a deficiency in 2-ketoacid dehydrogenase and resulting in the systemic accumulation of branched chain amino acids (BCAAs). Affected children may suffer profound developmental and cognitive impairment from exposure to high levels of BCAA and their associated neurotoxic metabolites. Endogenous renal clearance (by the patient's kidneys) of BCAA is limited and several therapeutic modalities including intensive nutritional regimens, exchange transfusions, peritoneal dialysis, and continuous hemofiltration have been utilized in neonates with MSUD, all of which have had varying success in reducing systemic BCAA levels. In this article, the authors report the case of a symptomatic 7 day old, 3 kilogram neonate with MSUD who underwent treatment with a combination of early hemodialysis and aggressive enteral feedings of a metabolically appropriate formula. This approach results in a 75 percent reduction of systemic toxin levels within 3 hours. When compared to other reported modalities of therapy for symptomatic neonates with MSUD, this approach appears to be most efficacious. Moreover, by minimizing the amount of time that an affected neonate is exposed to neurotoxic (damaging to the nervous system) levels of BCAAs, long term developmental and cognitive capabilities may be preserved. 2 tables. 24 references.

Studies

•

13

Exercise During Hemodialysis Decreases the Use of Antihypertensive Medications Source: American Journal of Kidney Diseases. 39(4): 828-833. April 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Most hemodialysis patients require antihypertensive therapy (high blood pressure medications). Aerobic exercise has been suggested as a nonpharmacologic treatment for hypertension in many patient populations, including those with chronic renal (kidney) failure. This article reports on a study undertaken to test the effectiveness of this therapy in an outpatient long term hemodialysis clinic. The hemodialysis staff instituted a stationary cycling program during dialysis and offered the program to all patients (n = 107). Forty patients agreed to participate, and 35 nonexercising patients served as controls. Predialysis blood pressures, postdialysis blood pressures, and antihypertensive medication use were recorded during a 6 month period. Costs of the medication were analyzed at the end of the study. Of participants, 24 (60 percent) completed 6 months of exercise with a mean increase in total cycling time from 16.9 minutes per session to 45.5 minutes per session. No serious adverse events were reported. Predialysis and postdialysis blood pressures were not statistically different between the two groups at month 0 or month 6, but 13 patients (54 percent) in the exercise group had a reduction in antihypertensive medication versus 4 patients (12.5 percent) in the control group. The average relative benefit of exercise was a 36 percent reduction in antihypertensive medications, with an average annual cost savings of $885 per patient year in the exercise group. The authors conclude that stationary cycling is safe during hemodialysis and can lead to significant reductions in blood pressure medication use and cost savings, justifying the initial capital cost of equipment and small incremental increase in staff time. 2 figures. 2 tables. 21 references.

•

Daytime Sleepiness in Stable Hemodialysis Patients Source: American Journal of Kidney Diseases. 41(2): 394-402. February 2003. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Patients frequently sleep during hemodialysis (HD), a behavior often attributed to treatment-related fatigue or to simple boredom. The possibility that this behavior reflects a more pervasive underlying increase in daytime sleepiness has never been systematically examined. In this article, the authors report on their study of a sample of HD patients on an off-dialysis day to establish the presence or absence of daytime sleepiness independent of effects of treatment, quantify its severity, and identify associated demographic, metabolic, and sleep-related variables. Results showed that one third (n = 15) of subjects had test scores suggesting abnormal levels of physiological daytime sleepiness, and six subjects had scores consistent with severe, pathological sleepiness. Thirty percent (n = 14) had significant subjective daytime sleepiness as measured by the Epworth Sleepiness Scale. Higher indices of sleep apnea and brief arousals correlated significantly with increased physiological, but not subjective, sleepiness. Longer nocturnal sleep latencies and greater percentage of rapideye-movement sleep were associated with decreased physiological sleepiness. The authors conclude that daytime sleepiness is common in HD patients and may be severe despite the absence of obvious clinical risk factors for the condition. Thus, research designed to identify cost-effective indicators of daytime sleepiness and evaluate the detrimental effects of sleepiness on clinical outcomes in HD patients is warranted. 5 tables. 76 references.

14

•

Hemodialysis

Effect of Hemodialysis on Hearing Using Pure-Tone Audiometry and DistortionProduct Otoacoustic Emissions Source: ORL. Journal for Oto-Rhino-Laryngology and Its Related Specialties. 60(6): 306313. November-December 1998. Contact: Available from Karger. Customer Service, P.O. Box, CH-4009, Basel, Switzerland. Fax 41 61 306 12 34. Website: www.karger.com. Summary: Patients who are undergoing hemodialysis (HD) treatment frequently exhibit some degree of sensorineural hearing loss. This article reports on a study in which 15 subjects and 10 controls were tested by using pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAEs), before and after a HD treatment. Other parameters (blood pressure, body weight, blood chemistries) were also evaluated before and after HD. The results from PTA and DPOAE testings showed that hearing was unaffected by HD. However, all 15 subjects revealed significantly poorer hearing, especially in the higher frequencies, compared to that of the controls. It was concluded then that HD is a safe treatment, and that the sensorineural hearing loss in these patients may be attributed to the preexisting renal disease. Patients with chronic renal failure independent of HD are more vulnerable to the ototoxic and nephrotoxic effects of drugs compared to healthy individuals due to their decreased excretion and metabolism. 2 figures. 2 tables. 39 references.

•

Daytime Sleepiness in Patients with CRF: Impact of Nocturnal Hemodialysis Source: American Journal of Kidney Diseases. 41(2): 403-410. February 2003. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Patients with end stage renal disease (ESRD) have a high prevalence of sleep disorders, which are not improved by conventional hemodialysis (CHD). Although sleep disorders are commonly associated with complaints of excessive daytime sleepiness, the severity and pathogenesis of daytime sleepiness has not been evaluated objectively in patients with ESRD. Nocturnal hemodialysis (NHD) is a new technique that provides better clearance of uremic toxins than CHD and consequently, may improve sleep quality and daytime sleepiness. This article reports on a study undertaken to determine the severity and pathogenesis of daytime sleepiness in patients with ESRD and to evaluate the impact of NHD. The majority (54 percent) of patients on CHD were pathologically sleepy (somnolent group) and, in comparison with the remaining patients (alert group), their blood urea nitrogen and periodic limb movement (PLM) index were significantly higher. Furthermore, sleep latency was correlated with blood urea nitrogen (BUN). After conversion to NHD, there was a significant fall in BUN and the severity of sleep apnea, but the overall frequency of PLM and sleep fragmentation remained elevated. Nevertheless, there was a trend for the somnolent group to become less sleepy on NHD, and this was associated with a modest reduction in the frequency of PLM. The authors conclude that excessive daytime sleepiness occurs in approximately 50 percent of patients with ESRD. The etiology (cause) appears to be related both to uremia and sleep fragmentation associated with PLM. 2 figures. 5 tables. 31 references.

•

Chronic Pain in the Hemodialysis Patient Population Source: Dialysis and Transplantation. 33(2): 92-93, 100-101. February 2004.

Studies

15

Summary: People on hemodialysis may experience a variety of pain-producing ailments. This study examined the presence and intensity of chronic pain encountered in the in-center hemodialysis patient population. The author administered a survey to a randomly chosen sample. Sixty percent of the respondents reported that they currently had chronic pain. The location of this pain was most frequently in the joints, back or neck, and legs and feet, thus connoting a propensity toward musculoskeletal ailments. The average level of pain was noted to be of moderate intensity. No statistically significant correlation was found between age and pain or pain and depression. There was very little variation in the presence of intensity of pain based on age or gender. The most notable finding was that women were less satisfied with their physician-provided pain control, and this was consistent regardless of race. 1 table. 17 references. •

Comparison of Mortality Between Private For-Profit and Private Not-For-Profit Hemodialysis Centers Source: Journal of American Medical Association. 288(19): 2449-2457. November 2002. Summary: Private for-profit and private not-for-profit dialysis facilities provide the majority of hemodialysis (HD) care in the United States. There has been extensive debate about whether the profit status of these facilities influences patient mortality (death rates). This article reports on a study undertaken to determine whether a difference in adjusted mortality rates exists between hemodialysis patients receiving care in private for-profit versus private not-for-profit dialysis centers. The authors searched 11 bibliographic databases, reviewed their own files, and contacted experts for this review. The authors found eight observational studies that included more than 500,000 patient-years of data. The studies reported data from January 1973 through December 1997 and included a median of 1,342 facilities per study. Six of the eight studies showed a statistically significant increase in adjusted mortality in for-profit facilities, one showed a nonsignificant trend toward increased mortality in for-profit facilities, and one showed a nonsignificant trend toward decreased mortality in forprofit facilities. The pooled estimate demonstrated that private for-profit dialysis centers were associated with an increased risk of death. This relative risk suggests that there are annually 2,500 (with a plausible range of 1,200 to 4,000) excessive premature deaths in United States for-profit dialysis centers. 2 figures. 3 tables. 40 references.

•

Improvement in Nutritional Parameters After Initiation of Chronic Hemodialysis Source: American Journal of Kidney Diseases. 40(1): 143-151. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Protein-calorie malnutrition is highly prevalent in patients with chronic renal (kidney) failure (CRF) and on chronic dialysis therapy. Longitudinal studies evaluating nutritional outcomes after the initiation of chronic dialysis therapy in incident dialysis patients are limited. This article reports on a prospective cohort study that evaluated time-dependent changes in several well-defined markers of nutritional status before and after initiation of chronic hemodialysis therapy. Fifty hemodialysis (HD) patients were studied; the study population was 60 percent male, 38 percent white, and 32 percent had insulin-dependent diabetes mellitus. At baseline, nutritional markers correlated well with each other. After the initiation of HD therapy, there were marked improvements in most nutritional parameters. The authors conclude that nutritional benefits of increased solute clearance provided by the initiation of chronic dialysis therapy prevail over its potential catabolic effects. However, the extent of improvement was dependent on

16

Hemodialysis

nutritional status at the time of initiation of dialysis therapy, which remained an important determinant of subsequent nutritional improvements during the first year of treatment. 4 figures. 4 tables. 29 references. •

Evaluation of Uremic Pruritus at an Outpatient Hemodialysis Unit Source: Renal Failure. 24(5): 609-614. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Pruritus (itching) is a common complaint among end stage renal disease patients and has been associated with poor outcome. This article reports on a study undertaken to characterize this problem at an outpatient hemodialysis (HD) clinic. The study surveyed 70 patients over a 2-day period. A visual analog scale was used to evaluate the intensity of itching. Location of itching and temporal relationship to dialysis was assessed by questionnaire. Seventy percent of patients reported pruritus either during and or between hemodialysis sessions. Itch intensity ranged from mild to severe. Forty-five percent of patients itched in three or more areas, with the back and legs most commonly reported. Laboratory parameters were unable to differentiate between patients who itched and those who did not itch. The authors conclude that itching remains a common problem in hemodialysis patients. New treatments for patients resistant to standard therapies are needed. The survey instrument is included in an appendix. 1 figure. 2 tables. 9 references.

•

Effects of Regular Exercise on Anxiety, Depression, and Quality of Life in Maintenance Hemodialysis Patients Source: Renal Failure. 24(3): 337-345. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Psychological problems such as depression and anxiety are common in hemodialysis patients. In several studies, exercise programs were effective in relieving depression or anxiety in these patients. This article reports on a study that evaluated the effects of an exercise program on exercise capacity, anxiety, depression, and quality of life in maintenance hemodialysis patients. Twenty hemodialysis patients were enrolled in the study. Six patients were later excluded: two due to anemia, one due to nausea with vomiting during exercise, one due to a neurologic problem, and the other two due to noncompliance. Thus, 14 patients (3 men and 11 women) aged 42 years (plus or minus 10 years) completed the study. The exercise program consisted of bicycle ergometer, treadmill, or upper limb ergometer, 60 minutes per session, 3 times per week, for 12 weeks. During the program, maximal oxygen consumption was increased. Exercise duration was increased, quality of life score, and the score of anxiety was significantly improved after exercise. Though it did not reach statistical significance, there was a trend of improvement in depression after exercise. The authors conclude that an appropriate application of an exercise program would improve the psychological status of long term maintenance hemodialysis patients. 1 figure. 3 tables. 16 references.

•

Improvement of Nutritional Status After Initiation of Maintenance Hemodialysis Source: American Journal of Kidney Diseases. 40(1): 133-142. July 2002.

Studies

17

Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Recent data suggest that serum albumin concentrations (protein levels in the blood) increase during the several month period that follows the initiation of maintenance hemodialysis (MHD) therapy. Some researchers have shown that the rate of increase in serum albumin level is related directly to 24 hour urine protein losses before the initiation of dialysis therapy. However, serum albumin levels increase even in patients starting MHD therapy without significant proteinuria, suggesting that this increase may be one manifestation of improving protein-energy nutritional status associated with commencing MHD therapy. This article reports on a study that examined this issue by reviewing records of all patients (n = 97) admitted to one outpatient dialysis unit within 30 days of initiation of MHD therapy. Between months 1 and 6 after beginning MHD, there was a statistically significant increase in values for Predialysis serum albumin, iron, transferrin saturation, creatinine, and normalized protein equivalent of total nitrogen appearance (nPNA). Many of these values were still increasing by month 6. Body weight declined initially until month 4, then increased. These results suggest that an improvement in nutritional status, including an increase in dietary protein intake and serum albumin level, often occurs with the initiation of MHD therapy. The improvement in nutritional status may be related to the increase in dietary protein intake. 7 figures. 2 tables. 23 references. •

Risk Factors and Risk for Mortality of Mild Hypoparathyroidism in Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(6): 1245-1254. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Relative hypoparathyroidism (low levels of parathyroid hormone, PTH) is prevalent in patients on hemodialysis (HD), with unknown pathogenesis (how the disease develops) and prognosis. This article reports on a study undertaken to clarify the risk factors and prognosis of time-dependent relative hypoparathyroidism in HD patients. The retrospective study was performed for 126 HD patients with four or more PTH determinations and no previous total or subtotal parathyroidectomy. The prevalence of relative hypoparathyroidism at entry into the study was 76 of 126 patients (60.3 percent). Analysis showed that patients with hypoparathyroidism were older, more likely to have diabetes, and had greater ionized calcium levels and lower phosphate, albumin, blood urea nitrogen (BUN), and creatinine levels. Patients with diabetes were older and had a shorter duration of dialysis therapy and lower PTH, phosphate, albumin, BUN, and creatinine levels and urea reduction ratios. Conversely, analysis also showed that PTH levels at entry were associated directly with creatinine levels and inversely with age and ionized calcium levels (but not diabetes). During follow up, PTH levels fluctuated concomitantly with ionized calcium and phosphate levels over time in all patients. The authors note that hypoparathyroidism at entry and lower time-dependent PTH levels predict mortality (death). 3 figures. 4 tables. 49 references.

•

Why Are Hemodialysis Treatments Shortened and Skipped? Development of a Taxonomy and Relationship to Patient Subgroups Source: Nephrology Nursing Journal. 30(2): 209-218. April 2003.

18

Hemodialysis

Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: Shortening and skipping hemodialysis (HD) treatments occur commonly and are associated with inadequate dialysis and increased mortality (death). These behaviors are also frequently equated with patient noncompliance. This article reports on a research study undertaken to determine whether certain patient subgroups are at a disadvantage in achieving optimal dialysis. Semistructured interviews were conducted with 168 selected patients who shortened or skipped treatments. A variety of reasons were responsible for shortening and skipping HD treatments. Content analysis of patient responses revealed five categories of reasons for this: medical problems, technical problems, life tasks, transportation, and patient decisions. The most common reasons for shortening HD were medical problems (38 percent) and life tasks (24 percent), while the most common reasons for skipping were life tasks (33 percent) and transportation (22 percent). Furthermore, patient subgroups differed in the reasons for shortening and skipping. After multivariate adjustment, technical problems were more common among women. Life task problems were more common among men, younger patients, and patients with hypertension. Transportation problems were more common among African Americans. The authors conclude that interventions to optimize HD treatment should identify and target patient-specific reasons for shortening and skipping HD treatments, and not assume patient noncompliance. •

Improvement of Sleep Apnea in Patients with Chronic Renal Failure Who Undergo Nocturnal Hemodialysis Source: New England Journal of Medicine. 344(2): 102-107. January 11, 2001. Summary: Sleep apnea (defined as the absence of airflow for longer than 10 seconds; it usually interrupts sleep) is common in patients with chronic renal failure (CRF) and is not improved by either conventional hemodialysis of peritoneal dialysis. With nocturnal hemodialysis, patients undergo hemodialysis seven nights per week at home, while sleeping. This article reports on a study undertaken to investigate the role of nocturnal hemodialysis in correcting sleep apnea in patients with CRF. Fourteen patients who were undergoing conventional hemodialysis for four hours on each of three days per week underwent overnight polysomnography (a measurement of sleep). The patients were then switched to nocturnal hemodialysis for eight hours during each of six or seven nights a week. They underwent polysomnography again 6 to 15 months later on one night when they were undergoing nocturnal hemodialysis and on another night when they were not. The mean serum creatinine concentration (a measurement of kidney or replacement kidney function) was significantly lower during the period when the patients were undergoing nocturnal hemodialysis than during the period when they were undergoing conventional hemodialysis. The conversion from conventional hemodialysis to nocturnal hemodialysis was associated with a reduction in the frequency of apnea and hypopnea from 25 (plus or minus 25) to 8 (plus or minus 8) episodes per hour of sleep. This reduction occurred predominantly in seven patients with sleep apnea, in whom the frequency of episodes fell from 46 (plus or minus 19) to 9 (plus or minus 9) episodes per hour, accompanied by increases in the minimal oxygen saturation, transcutaneous partial pressure of carbon dioxide, and serum bicarbonate concentration. During the period when these seven patients were undergoing nocturnal hemodialysis, the apnea hypopnea index measured on nights when they were not undergoing nocturnal hemodialysis was greater than that on nights when they were undergoing nocturnal hemodialysis, but it still remained lower than it had been during

Studies

19

the period when they were undergoing conventional hemodialysis. The authors conclude that nocturnal hemodialysis corrects sleep apnea associated with chronic renal failure. 2 figures. 4 tables. 22 references. •

Sleep Pattern Disturbance in Hemodialysis and Peritoneal Dialysis Patients Source: Nephrology Nursing Journal. 28(1): 40-44. February 2001. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: Sleep pattern disturbance (SPD) is problematic among dialysis patients. This article describes a project that investigated the scope of sleep problems in all willing subjects in an outpatient hemodialysis (HD) and peritoneal dialysis (PD) unit in a midsize university teaching hospital. A comparison of the incidence of SPD between the two treatment modalities was also conducted. The authors used a sleep diary that subjects completed each morning for a week. Subjects were asked to describe sleep latency, perceived difficulty falling asleep, number of arousals, use of sedatives, whether they awoke feeling rested, sleep efficiency, and factors preventing or inducing sleep. The sample consisted of 47 HD and 22 PD patients whose average age was 60.6 years. There was a trend for PD subjects to report fewer sleep complaints than HD subjects, but the two groups did not differ significantly on any variable. Factors reported to interfere with sleep were pain for HD subjects, while treatment related factors, such as alarms, predominated for PD subjects. These findings are consistent with reports in the literature that note the incidence of SPD among dialysis patients to be as high as 83 percent. The authors briefly report on practice changes that were undertaken in response to this data. 4 tables. 25 references.

•

Why Hemodialysis Patients Fail to Complete the Transplantation Process Source: American Journal of Kidney Diseases. 37(2): 321-328. February 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The cadaveric renal transplantation (using a kidney from a deceased person) process involves steps related to medical suitability, interest in transplantation, pretransplantation workup, and movement up a waiting list and receiving a transplant. Failure to complete specific steps may be caused by remaining stationary at that step, moving backward to a previous step, or dying. Knowing the relative importance of these types of movement may enable the development of strategies that improve the efficiency and equity of the transplantation process. This article reports on a study of 4,597 new dialysis patients that was undertaken to determine the likelihood of remaining stationary, moving backward, or dying at each of the four steps. Failure to complete a step was generally caused by remaining stationary rather than moving backward or dying. The likelihood of remaining stationary ranged from 78 percent at step A to 90 percent at step D. The likelihood of backward movement ranged from 3 to 7 percent, whereas the likelihood of death ranged from 7 to 22 percent. Compared with whites, blacks were more likely to remain stationary at steps A and B, more likely to move backward at step B, and less likely to die at steps A through C. 2 figures. 6 tables. 20 references.

20

•

Hemodialysis

National Profile of Practice Patterns for Hemodialysis Vascular Access in the United States Source: JASN. Journal of the American Society of Nephrology. 13(8): 2117-2124. August 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: The Centers for Medicare and Medicaid Service's (CMS) national End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project is a data collection initiative to identify opportunities for improvement of care to adult Medicare maintenance dialysis beneficiaries. This article offers an analysis of 1999 CPM data that characterized the profile of hemodialysis vascular access in the United States and identifies determinants of vascular access type 2 years after the translation of vascular access clinical practice guideline statements into national CPMs. A total of 8,154 hemodialysis patients were sampled; 17 percent (n = 1,399) were incident (newly diagnosed). Vascular access methods were autologous arteriovenous fistula (AVF, 28 percent), prosthetic graft (AVG, 49 percent), and percutaneous catheter (23 percent). Independent predictors of having a catheter for hemodialysis were female gender, white race, incident to hemodialysis status, and lower hemoglobin and serum albumin. The authors conclude that despite translation of practice guidelines for hemodialysis vascular access into national CPMs, there is substantial geographic variability and gender and racial disparity in angioaccess allocation in the United States. Quality improvement strategies to improve the prevalence of fistulae should focus on selected regions and include physician education about their practice patterns and potential biases. 4 figures. 6 tables. 35 references.

•

Hemodialysis-Associated Hypertension: Pathophysiology and Therapy Source: American Journal of Kidney Diseases. 39(2): 227-244. February 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The majority of end stage renal disease (ESRD) patients have hypertension (high blood pressure). Hypertension in the hemodialysis patient population is caused by many factors and is associated with increased risk for left ventricular hypertrophy, coronary artery disease, congestive heart failure, cerebrovascular complications, and mortality (death). This review article considers the pathophysiology and therapy of hemodialysis associated hypertension. Antihypertensive medications alone do not adequately control blood pressure (BP) in hemodialysis patients. Several other treatment options are available, including long, slow hemodialysis; short, daily hemodialysis; nocturnal hemodialysis; or, most effectively, dietary salt and fluid restriction in combination with reduction of dialysate sodium concentration. Survival is better in hemodialysis patients with a mean arterial pressure below 99 mm Hg as compared with those with higher BP. Low predialysis systolic BP (less than 110 mm Hg) and low predialysis diastolic BP (less than 70 mm Hg) are associated with increased mortality, primarily because of severe congestive heart failure or coronary artery disease. Patients that experienced repeated intradialytic hypotensive (low blood pressure) episodes should also be viewed with caution, and predialytic BP values should be reevaluated. In selected hemodialysis patients, interdialytic ambulatory blood pressure monitoring (ABPM) may help to determine if the patient is in fact hypertensive. In addition, ABPM provides important information about the change in BP between day and night. The authors recommend home BP monitoring, yearly

Studies

21

echocardiography, and treatment of additional risk factors for cardiovascular disease. 3 figures. 2 tables. 207 references. •

Surgical Bypass for Subclavian Vein Occlusion in Hemodialysis Patients Source: Journal of the American College of Surgeons. 194(4): 416-421. April 2002. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: The majority of patients with end stage renal disease (ESRD) are dependent on hemodialysis. Significant stenosis (narrowing) or occlusion (blockage) of the subclavian vein is known to occur in 20 to 50 percent of patients who have had central venous catheters inserted into the subclavian vein or the internal jugular vein. Surgical bypass of the obstructed venous segment proximal to a functioning dialysis access site is an established treatment to relieve symptoms and salvage the functional dialysis access. This article reports on a retrospective review of all subclavian venous bypass procedures (n = 12) performed at St. Louis University Hospital from May 1987 to May 2000. The mean age of the patients was 55.5 years (range 17 to 72 years). There were 11 men and 1 woman. Before surgical bypass, all patients underwent bilateral venograms to evaluate their central venous systems. An extra-anatomical surgical bypass was performed in all patients, who were followed for a mean of 16 months. At 1 month, 100 percent of hemodialysis access sites remained functional. At 1 year, 80 percent; 2 years, 60 percent; and 3 years, 25 percent of the salvaged arteriovenous hemodialysis access sites provided for functional dialysis. One patient required thrombectomy (removal of a clot) of the bypass graft at 14 months. The authors conclude that surgical bypass of an occluded or stenotic subclavian vein segment is successful in providing both symptomatic relief and salvage of a functioning dialysis access in the hemodialysis patient population. Study of the central venous system is essential in selecting an appropriate bypass procedure in individual patients. 5 figures. 1 table. 16 references.

•

Body Size, Dialysis Dose and Death Risk Relationships Among Hemodialysis Patients Source: Kidney International. 62(5): 1891-1897. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250. Summary: The normalized treatment ratio, Kt over V derived from urea kinetic models (UKM), is a commonly used measure of dialysis dose. This measure assumes that smaller patients with low volume of urea distribution (V) require proportionately less total treatment (Kt) than larger patients. However, it is possible that a relationship exists between Kt and body size whereby a different Kt is required for different sizes. This article reports on a study that explored the relationships among body size, Kt, and death risk, focusing on possible interactions between Kt and size. The sample included 43,334 patients treated on January 1, 1999. The main effects models suggested improved survival with increasing Kt and all of the size measures. The death risk penalties associated with reducing Kt among small patients were as great as or greater than they were among large patients. A similar pattern was observed for V. The authors conclude that evidence supporting the intuition that smaller patients require proportionately lower dialysis dose than larger patients was not found. To the contrary, smaller patients suffer as much risk or more risk than larger patients from reducing Kt. Deciding dialysis treatment using a Kt over V based intuition may lead to avoidable under-dialysis, particularly among small patients. 4 figures. 2 tables. 26 references.

22

•

Hemodialysis

Clinical and Psychological Aspects of Restless Legs Syndrome in Uremic Patients on Hemodialysis Source: American Journal of Kidney Diseases. 41(4): 833-839. April 2003. Summary: The pathogenesis of restless legs syndrome (RLS) is still unclear. This article reports on a study undertaken to determine relationships of the presence of RLS in uremic patients regularly undergoing hemodialysis (HD) with demographic, clinical, and psychological factors. In 490 uremic patients on HD therapy in Japan, RLS was diagnosed based on diagnostic criteria established by the International Restless Legs Syndrome Study Group. Data were compared between patients with and without RLS. There were univariately significant differences in serum phosphorus levels, anxiety levels determined using the Hospital Anxiety and Depression Scale, and degrees of emotion-oriented and avoidance-oriented coping. In additional analyses, low hemoglobin levels, high serum phosphorus levels, high anxiety levels, and a great degree of emotion-oriented coping were independently related to the presence of RLS in uremic patients on HD therapy. 3 tables. 54 references.

•

Hepatitis C Virus in Blood and Dialysate in Hemodialysis Source: American Journal of Kidney Diseases. 37(1): 38-42. January 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The prevalence of hepatitis C virus (HCV) positivity among hemodialysis patients remains high compared with that of the healthy population, and thus the issue of safety and environmental protection must be addressed. This article reports on a study undertaken to evaluate the dynamics of prehemodialysis and posthemodialysis blood HCV levels and HCV escape to spent dialysate (and thus to the environment). A serine protease inhibitor (nafamostat mesilate) was used as the anticoagulant for hemodialysis. High flux polysulfone membrane dialyzers were used; dialyzer reuse was not performed. A portion of total spent dialysate (the fluid used for dialysis) was continuously extracted to measure for HCV. No HCV extravasation to spent dialysis was found, although HCV copy numbers were reduced to a statistically significant level in postdialysis blood compared with predialysis levels. The need to establish standards for risk management in dialysis centers is evident. The data obtained in this study strongly suggest that to minimize the risk for HCV transmission, lower transmembrane pressure (TMP) should be used in the hemodialysis of HCV positive patients, with fresh polysulfone dialyzers and dialysis settings of 180 to 250 milliliters per minute for blood flow, 500 milliliters per minute for dialysate flow, and less than 1.872 mm Hg for TMP. 1 figure. 23 references.

•

Case Against Chronic Venous Hemodialysis Access Source: JASN. Journal of the American Society of Nephrology. 13(8): 2195-2197. August 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: The provision of adequate hemodialysis is dependent on repeated and reliable access to the central circulation of the patient's body. This access to the circulation is best provided by primary arteriovenous fistulas (AVF) and to a lesser extent by AV grafts (AVG). However, due to changing patient demographics, reliance on less desirable modes of vascular access such as synthetic (PTFE) grafts and tunneled,

Studies

23

cuffed catheters (CVC) has increased. These latter two types of access are more prone to both thrombosis (clotting) and infection. Venous access in particular has emerged as a substantial cause of hemodialysis morbidity and mortality. This editorial serves as an introduction to two articles in this issue that deal with these dilemmas. The editorial first considers the development of these types of problems and the guidelines for medical care regarding vascular access practice. The authors then summarize the two articles and conclude that the best way to deal with these venous access problems is by finding mechanisms to limit venous hemodialysis complications with new techniques and devices, but also to use venous access less and for shorter periods of time. 22 references. •

Effect of Hypertension Before Beginning Dialysis on Survival of Hemodialysis Patients Source: American Journal of Kidney Diseases. 41(4): 814-821. April 2003. Summary: The role of hypertension (high blood pressure) as a predictor of mortality (death) in hemodialysis patients is controversial. This article reports on a study that investigated the effect of hypertension before starting hemodialysis therapy on survival of patients without diabetes during renal replacement therapy. The authors reviewed 184 patients starting hemodialysis therapy. Variables studied were age, sex, renal (kidney) disease, hypertension, comorbidity, vascular calcifications, left ventricular hypertrophy, body mass index (BMI), and albumin, cholesterol, and alkaline phosphatase levels. For all-cause mortality, comorbidity and history of uncontrolled hypertension were independent risk factors. For cardiovascular mortality, uncontrolled hypertension was the main risk factor. These results suggest that uncontrolled hypertension in renal patients before starting dialysis therapy is a major risk factor for cardiovascular mortality during hemodialysis. Because hypertension usually starts in the initial stages of renal disease, the authors emphasize the importance of prompt and adequate control of blood pressure in this population. 5 figures. 5 tables. 38 references.

•

Effects of Hemodialysis Dose on Anemia, Hypertension, and Nutrition Source: Renal Failure. 24(5): 615-621. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: There is good evidence that by improving dialysis adequacy, the morbidity (related illness) and mortality (death) of hemodialysis (HD) patients decrease. Dialysis adequacy has also been related to the better control of arterial blood pressure (BP), anemia, and improvement of patients' nutritional status. This article reports on a selfcontrol study of 34 patients on HD (23 males, 11 females), aged 52.6 years (plus or minus 15.5 years), HD duration 55.9 months (plus or minus 61.2 months), referring to the effect of increasing delivered dialysis dose, over a 2-year period, on their clinical and laboratory parameters. Delivered HD dose increased, statistical significance, the following: urea reduction ratio (URR), Kt per V, and Hb (hemoglobin); no difference was noticed in weekly EPO (erythropoietin) dose. Both systolic and diastolic BP decreased significantly. The authors conclude that increasing dialysis dose results in both clinical and laboratory improvement regarding hypertension, nutritional status, and control of HD patients' anemia. 2 tables. 25 references.

•

Pain in Hemodialysis Patients: Prevalence, Cause, Severity, and Management Source: American Journal of Kidney Diseases. 42(6): 1239-1247. December 2003.

24

Hemodialysis

Summary: There is growing evidence that dialysis patients have a high burden of symptoms, including pain. However, the prevalence, cause, severity, and management of pain in dialysis patients have not been described. This article reports on a prospective cohort study of 205 Canadian hemodialysis (HD) patients that describes the prevalence, cause, severity, and management of pain in this population. Of the 205 patients, 103 (50 percent) reported a problem with pain. Patients with pain had been on HD therapy longer (52.2 months) than those without pain (37.7 months). Causes of pain were diverse, and 18.4 percent of patients had more than a single cause of their pain. Musculoskeletal pain was most common (50.5 percent) and equal in severity to pain associated with peripheral neuropathy and peripheral vascular disease. Thirty-two percent of patients with pain were administered no analgesics (painkillers), 29.1 percent were administered nonopioid analgesics, 26.2 percent were administered weak opioids, and 9.7 percent were administered strong opioids. The Pain Management Index describes the effectiveness of pain management and was negative in 74.8 percent of patients, indicating ineffective management. The author concludes that the development of effective pain management strategies, underpinned by appropriate training and education, is necessary to improve the quality of life for dialysis patients. 5 tables. 63 references. •

LifeSite Hemodialysis Access System: Implications for the Nephrology Nurse, The Source: Nephrology Nursing Journal. 29(1): 27-33,72. February 2002. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: This article describes a new subcutaneous device (the LifeSite Hemodialysis Access System) that was designed to overcome limitations of transcutaneous dialysis catheters and is now available for use in the United States. A fully implantable device, the LifeSite System provides immediate, reliable, high flow vascular (blood) access for dialysis. The durable stainless steel and titanium LifeSite valve is implanted in a subcutaneous tissue pocket, typically below the clavicle (collar bone). The valve is connected to a biocompatible silicone cannula that is tunneled to a central vein. The device is cannulated using a virtually pain free, buttonhole technique. The valve is designed to allow cleansing of the valve, valve pocket, and buttonhole site with 70 percent isopropyl alcohol before and after each use to minimize the risk of infection. This article reviews the implications of this access system for the nephrology nurse and reports on results from a study of 150 days of use of this equipment. The results demonstrate that the LifeSite System is associated with statistically significant higher blood flow rates and lower rates of adverse events, infection, and thrombolytic infusions than a standard dialysis catheter. Potential implications of these benefits include improved outcomes, greater convenience for patients, improved efficiency, and time management for the nursing staff, along with reduced direct and indirect costs related to vascular access management. 4 figures. 3 tables. 19 references.

•

Care and Maintenance of Hemodialysis Catheters and Subcutaneous Vascular Access Devices: A Nurse's Perspective Source: Nephrology News and Issues. 16(9): 27-31. August 2002. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635.

Studies

25

Summary: This article discusses the care and maintenance of hemodialysis catheters and subcutaneous (under the skin) vascular access devices from the nephrology (kidney specialty) nurse's perspective. Four types of vascular access are currently used for hemodialysis: native arteriovenous (AV) fistulas, synthetic AV grafts, hemodialysis catheters, and subcutaneous access devices. The author focuses on the nursing care and maintenance of catheters and subcutaneous devices. Catheters may be used when patients are in need of immediate vascular access, or when patients have exhausted all other options for vascular access, or in elderly end stage renal disease (ESRD) patients with comorbid conditions, such as cardiovascular disease or diabetes, that may confound attempts to create an AV fistula. The LifeSite Hemodialysis Access System, currently the only subcutaneous access device commercially available in the U.S. for hemodialysis access, consists of a titanium and stainless steel valve that is implanted in a subcutaneous tissue pocket and connected directly to the vascular system. The author stresses that a better understanding of practical nursing requirements should allow nephrology nurses to optimize the utility of these devices, as well as improve time management in the dialysis unit. One sidebar reviews recommended patient education points for nurses to cover with their patients with the LifeSite system. 2 figures. 1 table. 21 references. •

Case for Short Daily Hemodialysis, Why sDHD Will be the Predominant Modality for Frequent Dialysis Source: ASAIO Journal. 47(5): 443-445. September-October 2001. Contact: Available from Lippincott-Raven Publishers. Journal Fulfillment Department, 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030. Summary: This article is one in a series of articles representing presentations given at the ASAIO Conference on Daily Hemodialysis (New York, NY, June 2000). In this article, the author discusses why short daily hemodialysis (sDHD) will be the predominant modality for frequent dialysis. The generally accepted definition of DHD is five or more treatments per week, with two predominant treatment schedules: sDHD, which averages 2 hours per treatment and is usually performed five to six times per week; and nocturnal DHD (nDHD), which is performed overnight five to seven times a week, and averages 7 to 9 hours per treatment. The author of this article compares these two methods based on a prospective long term study of 32 patients on sDHD. With sDHD, the patients' blood pressure control was maintained with less medication than that required for regular hemodialysis, and hematocrit was maintained with less erythropoietin. Patients felt better, especially in the areas of energy, burden of kidney disease (as measured by the KDQOL) and symptoms during dialysis. The author's study did not provide any data comparing the relative benefits of sDHD with nDHD, but the author offers a commentary section regarding nDHD. Nocturnal DHD will probably be most appropriate for the more independent patient who can cope with home hemodialysis. The author concludes that the compelling issue is not whether sDHD or nDHD is better, but that they are both far superior to conventional dialysis, and both should be available to all patients now. 10 references.

•

Chronic Hemodialysis in Infants and Children Under 2 Years of Age Source: Pediatric Nephrology. 18(4): 378-383. April 2003. Summary: This article reports on a cohort of 18 children who, over the past 16 years, received chronic hemodialysis (HD) at the authors' center. Five children were anuric (not producing urine) at the start of HD and 6 had significant co-morbidity. The most

26

Hemodialysis

common underlying diagnosis was posterior urethral valves. Problems with vascular access were very common, with a revision ratio of 40 percent. Twenty-two line revisions were required for 36 episodes of line infection, with a median rate of line infection of 2.7 infections per patient year. Twenty-three lines needed revision due to poor line function, despite the routine use of heparin. Both growth and developmental outcomes were strongly influenced by existing co-morbidity. Sixteen (89 percent) children were transplanted. Four (22 percent) children died, 3 after successful transplants. None of the deaths occurred on HD or resulted from its complications. The authors conclude that HD in infants and small children is an effective and safe form of renal replacement therapy, but problems with vascular access limit its long-term use. 1 figure. 23 references. •

Survival by Time of Day of Hemodialysis: Analysis of United States Renal Data System Dialysis Morbidity and Mortality Waves III/IV Source: American Journal of Kidney Diseases. 41(4): 796-806. April 2003. Summary: This article reports on a historical cohort study of a national database (US Renal Data System Dialysis Morbidity and Mortality Waves III and IV) of 6,939 patients who started hemodialysis therapy between January 1990 and December 1993. The authors were investigating whether morning shift hemodialysis is associated with improved survival in comparison to patients receiving afternoon shift hemodialysis. For patients aged 60 years and older, the unadjusted 4 year survival rate for patients on morning shift hemodialysis were 28.8 percent versus 24.1 percent for patients on afternoon shift hemodialysis and 38.7 percent for patients on evening shift hemodialysis. Both morning shift and evening shift hemodialysis were independently associated with a lower risk for mortality compared with afternoon shift hemodialysis. No such differences were seen for patients younger than 60 years. 3 figures. 4 tables. 33 references.

•

Short Daily Hemodialysis: A Four-Year Experience Source: Dialysis and Transplantation. 30(2): 76-81, 85-86. February 2001. Contact: Available from Dialysis and Transplantation, Attn.: Subscriptions. P.O. Box 10535, Riverton, NJ 08076. (800) 624-4196 or (609) 786-0871. Summary: This article reports on a series of 15 patients who were converted from standard hemodialysis (SHD) to short daily hemodialysis (SDHD). The same dialysis configuration (i.e., machine, dialyzer, blood and dialysate flows, etc.) and total weekly time were maintained for at least 1 year. Along with increased frequency, the weekly Kt per V was increased by about 10 percent. Clinical and biological improvements were observed in the SDHD group: excellent dialysis tolerance of the ultrashort session, disappearance of post dialysis fatigue, optimal blood pressure control, regression of left ventricular hypertrophy, better nutritional status with an increase in dry body weight, general well being, and better quality of life. Additional manipulation (reducing Kt per V to the same levels as SHD) resulted in the maintenance of the same clinical improvements. Therefore, it appears that frequency of dialysis is the main factor causing these improvements. The optimum Kt per V during SDHD remains to be precisely fixed. The authors conclude that although SDHD can be used as a temporary rescue therapy, it usually should be considered to be a long term therapy in cases of failure of peritoneal dialysis or intractable SHD complications (cardiovascular, nutritional, etc.). Everyday sessions are certainly the most physiological way to treat chronic renal failure. 5 figures. 6 tables. 14 references.

Studies

•

27

Survival Advantage for Adult Hispanic Hemodialysis Patients? Findings from the End-Stage Renal Disease Clinical Performance Measures Project Source: JASN. Journal of the American Society of Nephrology. 14 (1): 180-186. January 2003. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This article reports on a study that examined 1 year followup mortality (death) in Hispanic and non-Hispanic patients and its association with intermediate outcomes of dialysis care. Demographic and clinical information was collected on a national random sample of adult in-center hemodialysis (HD) patients for the period of October through December 1998. Of 8,336 patients, 994 (12 percent) were identified as Hispanic, 3,618 (43 percent) as non-Hispanic white, and 3,111 (37 percent) as nonHispanic black. The adjusted 12 month mortality risk for Hispanics was 0.76 and for non-Hispanic blacks 0.66 compared with non-Hispanic whites (referent group). Similar 12 month mortality risks were noted in the groups with diabetes mellitus or hypertension (high blood pressure) as the causes of end stage renal disease (ESRD) and among patients older than 65 years. These data suggest that adult Hispanic HD patients have a 12 month survival intermediate to non-Hispanic blacks and non-Hispanic whites and experience equivalent or better intermediate outcomes of dialysis care compared with non-Hispanic whites. 3 tables. 31 references.

•

Minority Advantage in Diabetic End-Stage Renal Disease Survival on Hemodialysis: Due to Different Proportions of Diabetic Type? Source: American Journal of Kidney Diseases. 28(2): 226-234. August 1996. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This article reports on a study undertaken to identify predictors of survival on hemodialysis in patients with diabetes-related end-stage renal disease (ESRD) and to explain ethnic differences in survival among non-Hispanic whites, African-Americans, and Mexican-Americans. A population-based, tri-ethnic cohort of 638 adult patients with diabetes and ESRD were studied. Survival length on center hemodialysis was the main outcome measure. In a combined model of insulin-dependent and noninsulindependent diabetes (IDDM and NIDDM, respectively) Mexican-Americans and AfricanAmericans showed a better survival than non-Hispanic whites. Other predictors independently associated with survival were age, high self-reported physical disability, coronary artery disease, lower extremity amputations, and average blood glucose levels prior to ESRD. Non-Hispanic whites had a significantly higher rate of IDDM, but did not have a greater burden of any of the other predictors. The authors reconfirm the survival advantage on dialysis of African-Americans and Mexican-Americans, but note that, among patients with NIDDM, this minority survival advantage disappears. 6 tables. 28 references. (AA-M).

•

Hemodialysis Catheters and Ports Source: Seminars in Nephrology. 22(3): 211-29. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452.

28

Hemodialysis

Summary: This article reviews hemodialysis catheters and ports. Percutaneous (through the skin) placement of cuffed tunnel catheters for hemodialysis (HD) access has become a firmly established method of providing vascular access to patients with end stage renal disease (ESRD). Considerable evidence supports the right internal jugular vein as the preferred site for catheter insertion. The use of real time imaging using both ultrasound and fluoroscopy permits simple, safe, and effective placement of the catheter for hemodialysis. The use of these imaging techniques has significantly reduced the number of and severity of complications associated with catheter placement. The authors describe a specific method of placement, including variations for specific catheter types. The new subcutaneous port as an alternative to the cuffed tunneled catheter appears to provide another option for vascular access; preliminary data suggests higher flow rates and lower infection rates compared with externalized cuffed tunneled catheters. Finally, the authors outline the criteria for obtaining training and proficiency in placement of cuffed tunneled catheters. 3 figures. 48 references. •

ESRD-Associated Cutaneous Manifestations in a Hemodialysis Population Source: Nephrology Nursing Journal. 29(6): 525-527, 531-539. December 2002. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: This article reviews cutaneous (skin) manifestations occurring in patients with end stage renal disease (ESRD). These symptoms can indicate systemic problems that have significant morbidity (related illness) and mortality (death) risks. Skin changes are sometimes a consequence of the disease that caused the renal (kidney) failure or may be an ESRD manifestation. Pruritus (itching) is the most prevalent ESRD cutaneous complaint, but its pathogenesis is not understood. The authors discuss the pathophysiology, presentation, and nursing implications of perforating dermatosis, metastatic calcification, polytetrafluoroethylene graft infection, and lichen planus. Corresponding case reports are presented for each condition. The authors stress that evaluation of the skin and nails of patients with ESRD can give the nurse a window into possible systemic processes that warrant further attention. 6 figures. 1 table. 67 references.

•

HCV Infection and Hemodialysis Source: Seminars in Nephrology. 22(4): 331-339. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: This article reviews hepatitis C virus (HCV) infection and hemodialysis. HCV infections are frequent in hemodialyzed patients and are mainly related to transfusions and nosocomial (due to medical treatment) contamination. HCV infection may result in cirrhosis in 10 percent of dialysis patients and is worsened by transplantation because of the immunosuppressive therapy for prevention of graft rejection. Because there is a risk for significant liver disease and because cirrhosis contraindicates a renal (kidney) transplantation, a liver biopsy should be performed early in HCV-RNA positive hemodialysis patients to evaluate histologic impact of the liver disease. A combined liver-kidney transplantation should be discussed in dialysis patients with cirrhosis (scarring of the liver). Standard alpha interferon is the only treatment for HCV in dialysis patients because ribavirin is contraindicated by a high risk for hemolytic anemia. Interferon leads to an overall 30 percent rate of sustained viral

Studies

29

eradication. Interferon treatment is indicated in dialysis patients with acute hepatitis C, significant liver disease, or symptomatic cryoglobulinemia, and to candidates for renal transplantation, whatever the severity of the liver disease. Indeed, alpha interferon is contraindicated in kidney recipients, given the risk for rejection (so patients should complete any trials of interferon treatment before transplantation). Preventive treatment for HCV requires universal precautions in the dialysis setting because there is no available vaccine. 1 figure. 1 table. 93 references. •

Rationale for Daily Hemodialysis Source: ASAIO Journal. 47(5): 438-442. September-October 2001. Contact: Available from Lippincott-Raven Publishers. Journal Fulfillment Department, 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030. Summary: This article serves as the introduction to a series of articles representing presentations given at the ASAIO Conference on Daily Hemodialysis (New York, NY, June 2000). In this article, the author discusses the rationale behind offering daily hemodialysis, noting that the rationale is based on historic considerations, common sense, physiologic knowledge, and clinical research. The author stresses that the intermittent nature of most clinical dialysis, or its 'unphysiology,' is a major cause of ill effects; this has probably become worse as dialysis populations have become older, with more fragile and less resilient cardiac and vascular systems. The best simulation of natural physiology is with short daily, or preferably, long nightly hemodialysis. And the final rationale, the basis in clinical research, emphasizes that uniformly the use of daily hemodialysis results in higher hematocrits (a measurement of the oxygen-carrying capacity of blood) and less or no use of erythropoietin (to treat anemia) and blood transfusions. Patients on daily hemodialysis experience better blood pressure control with their medications; better nutrition and protein intake; much improved dialysis tolerance; a better sense of well being, energy and absence of fatigue between dialysis; and an overall better quality of life. The author concludes by reiterating that daily hemodialysis should be the standard of care, but that the serious obstacle of reimbursement (payment policies) remains. Economic analysis indicates that the increased cost for daily dialysis is more than offset by savings in hospitalization and medications, yet the peculiarities of different funds prevent the government from realizing these savings. 123 references.

•

Vitamin E Reduced Secondary Cardiovascular Disease Events in Patients Receiving Long-term Hemodialysis Source: ACP Journal Club. p. 91. May-June 2001. Contact: Available from American College of Physicians-American Society of Internal Medicine (ACP-ASIM). 190 North Independence Mall West, Philadelphia, PA 191061572. Summary: This brief article reports on a study of the impact of vitamin E on cardiovascular disease in patients receiving long term hemodialysis. The randomized, blinded, controlled trial included 196 patients (mean age 65 years, 69 percent men) with cardiovascular disease (CVD, including myocardial infarction, ischemic stroke, angina pectoris, transient cerebral ischemia, or peripheral vascular disease) who were stable on hemodialysis. After stratification by sex and age, patients at each center were allocated to 800 IU (international units) of vitamin E to be taken at night (n = 97) or to placebo (n = 99). All cause mortality was 31 percent in the vitamin E group and 29 percent in the placebo group. CVD mortality (including sudden death) was 9 percent in the vitamin E

30

Hemodialysis

group and 15 percent in the placebo group. Fewer total CVD events and myocardial infarctions (MI, heart attack) occurred in the vitamin E group than in the placebo group. The article includes a brief commentary on the research study; the commentary author notes that in three studies, no conclusive evidence has arisen to show that vitamin E supplements reduce the risk for secondary CVD events. Both the researchers and the commentary author call for a larger trial to continue evaluating the potential impact of vitamin for risk reduction for CVD death and fatal and nonfatal MIs. 1 table. 3 references. •

Nutritional Status of Chronic Renal Failure Patients Following the Initiation of Hemodialysis Treatment. (editorial) Source: American Journal of Kidney Diseases. 40(1): 205-207. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This editorial serves as an introduction to two related articles in this journal on the nutritional status of chronic renal failure (CRF) patients following the initiation of hemodialysis treatment. The author notes that the two papers have virtually identical titles and nearly the same conclusion; namely, that the initiation of chronic hemodialysis therapy in incident CRF patients is associated with improvement in nutritional status. The author discusses how these observations are important in a number of areas, including the predialysis management of chronic renal (kidney) insufficiency, when to initiate hemodialysis, subsequent nutritional status of patients on hemodialysis, and the influence of all of these on the long term outcome of patients with chronic renal insufficiency. The author concludes that until further information regarding nutrition, early start, dose and flux is obtained, these current studies certainly give credence to the National Kidney Foundation KDOQI recommendations on the initiation of dialysis therapy on malnourished patients with advanced chronic renal failure in whom other interventions have failed to result in nutritional improvement. 10 references.

•

2001 Annual Report: ESRD Clinical Performance Measures Project: Opportunities to Improve Care for Adult In-Center Hemodialysis, Adult Peritoneal Dialysis, and Pediatric In-Center Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(5 Supplement 2): S4-S61. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This is the summary report of the ESRD Clinical Performance Measures (CPM) Project, an 8 year old national effort to assist dialysis providers to improve patient care and outcomes. The 2001 ESRD CPM Annual Report describes the findings of several important clinical measures or characteristics of a nationally representative random sample of adult in-center hemodialysis patients and peritoneal dialysis patients. New this year is the addition of findings for all in-center hemodialysis patients aged 12 to 18 years. The report also contains a section of background and project methods. The Executive Summary notes that while significant improvements in care have occurred, the opportunities to improve care for dialysis patients in the United States in the area of adequacy of dialysis, vascular access, and anemia management continue. This Report also provides charts of highlights from the 2001 ESRD CPM Data in the areas of dialysis adequacy, vascular access, anemia management, and serum

Studies

albumin. The full report can also (www.hcfa.gov/quality/3m.htm). 15 figures. •

be

found

on

the

31

Internet

Left Ventricular Mass and Hemodynamic Overload in Normotensive Hemodialysis Patients Source: Kidney International. 62(5): 1828-1838. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250. Summary: This study considers whether the hemodynamic parameters are important determinants of left ventricular mass (LVM) in normotensive chronic hemodialysis (NTHD) patients, as has been found in hemodialysis patients who have hypertension (high blood pressure). The study included 40 NTHD patients (mean age 53.7 years plus or minus 14.4 years; 18 males, 22 females) who did not use antihypertensive drugs for at least six months. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46 normotensive subjects with normal renal (kidney) function (NTNR) and thus not on hemodialysis. The results showed that NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical left ventricular dysfunction. Thus optimal HD by adequate fluid removal may not be sufficient for the correction of this flow overload, subclinical LV dysfunction, and the cardiovascular structural abnormalities. Interventions in addition to maintaining optimal HD may be required to reduce the future cardiovascular risk in the NTHD patients. 1 figure. 3 tables. 44 references.

•

Comparing Mortality of Elderly Patients on Hemodialysis Versus Peritoneal Dialysis: A Propensity Score Approach Source: JASN. Journal of the American Society of Nephrology. 13(9): 2353-2362. September 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This study evaluated differences in mortality (death) over the first year of renal replacement therapy (RRT) between elderly patients starting treatment on hemodialysis (HD) versus peritoneal dialysis (PD). For the period of 1991 to mid-1996, this study defined an inception cohort of all patients aged older than 65 years with new onset chronic RRT. Results showed that peritoneal dialysis starters had a 16 percent higher rate of death during the first 90 days of RRT compared with HD patients. Mortality did not differ between day 91 and 180. Thereafter, PD starters again died at a higher rate. These findings were more pronounced among patients with diabetes. Sensitivity analyses using more stringent criteria to ensure that first treatment choice reflected long term treatment choice confirmed the presence of an association between PD and mortality. 4 figures. 4 tables. 40 references.

•

Permanent Hemodialysis Vascular Access Survival in Children and Adolescents with End-Stage Renal Disease Source: Kidney International. 62(5): 1864-1869. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250.

32

Hemodialysis

Summary: Transplantation is the optimal therapy for children with end stage renal disease (ESRD), but in a subset of patients with peritoneal membrane failure, failed transplants, or poor social situations, chronic hemodialysis (HD) remains the only option. Long-term survival of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in pediatric patients has not been well described. This article reports on a study of the survival of permanent vascular access in 34 pediatric ESRD patients treated with chronic HD between 1989 and 1995 and followed through 2000. Twenty-four AVFs and AVGs were created in 19 and 23 patients, respectively. Mean age and weight at insertion were 15.1 years (range 7.1 to 20.9 years) and 46 kilograms (18 to 81 kilograms) for AVFs and 13.3 years (3.8 to 21.1 years) and 41.5 kilograms (10.5 to 145 kilograms) for AVGs. Excluding primary failures, 1-year, 3-year, and 5-year patency rates for AVFs and AVGs were not significantly different. Patency did not correlate with patient weight or age at access creation. Primary access failure occurred more often in AVFs (8 of 24) than in AVGs (1 of 28). Access thrombosis (clotting), stenosis (narrowing), and infection occurred more frequently in AVG. The authors conclude that both AVF and AVG function well even in small pediatric patients and have survival rates equivalent to adult series and longer than cuffed venous catheters in pediatric patients. Both AVFs and AVGs are preferable for long-term HD access in pediatrics. 1 figure. 3 tables. 17 references. •

Prevention of Tunneled Hemodialysis Catheter-Related Infections Using CatheterRestricted Filling with Gentamicin and Citrate: A Randomized Controlled Study Source: JASN. Journal of the American Society of Nephrology. 13 (8): 2133-2139. August 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: Tunneled catheters are widely used for the provision of hemodialysis. Longterm catheter survival is limited by tunneled catheter-related infections (CRI). This article reports on a study that assessed the efficacy of catheter-restricted filling with gentamicin and citrate in preventing CRI in hemodialysis patients. A total of 112 catheters in 83 patients were included in the study; the primary end point was CRI. Infection rates per 100 catheter days were 0.03 in the gentamicin group versus 0.42 in the heparin group. The incidence of catheter malfunction was not significantly different between the gentamicin group and the heparin group. The authors conclude that tunneled hemodialysis catheter-restricted filling with gentamicin and citrate is a highly effective strategy for the prevention of CRI. Although citrate as a catheter lock solution provides adequate anticoagulation for the interdialytic period, gentamicin levels suggest significant risk for chronic aminoglycoside exposure and associated ototoxicity (damage to the ears and hearing). Before this technique is adopted, the authors call for replication in future studies to examine the efficacy and safety of lower doses of gentamicin or alternative agents with a reduced potential for toxicity. 3 figures. 5 tables. 22 references.

•

Homocysteine and Vascular Access Thrombosis in Hemodialysis Patients Source: Renal Failure. 24(2): 215-222. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Vascular access (VA) remains the Achilles' heel of successful hemodialysis, and thrombosis (clotting) is the leading cause of VA failure. Hyperhomocystinemia (high levels of homocysteine in the blood) is common in patients on hemodialysis and is

Studies

33

associated with venous and arterial thrombosis in patients without end stage renal disease (ESRD). In this article, the authors report on a study of 65 hemodialysis patients with native arteriovenous fistulae. Two groups of patients were defined: group A including 45 patients with their VA either never or only once thrombosed, and group B including 20 patients with two or more thromboses of their vascular access. The authors determined serum concentrations of total homocysteine in these patients. In 63 patients (96.9 percent), hyperhomocystinemia was present. There was no statistically significant difference between groups A and B regarding age, gender, and duration of hemodialysis treatment. Total homocysteine concentrations were higher in group A than in group B patients but the difference was small and not statistically significant. These results suggest that thrombosis of native arteriovenous fistulae may not be caused by hyperhomocystinemia in these patients. 40 references. •

Lack of Effect of Long-Term Use of Angiotensin-Converting Enzyme Inhibitors by Hemodialysis Patients on Thirst and Fluid Weight Gain Source: Renal Failure. 24(4): 461-466. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Volume overload is a chronic, troublesome problem in many patients on hemodialysis. These patients suffer from hyperdipsia (excessive thirst) with inability to excrete water. ACE inhibitors have been shown to decrease thirst and interdialytic weight gain in 2 to 4 weeks of usage. This article reports on a study that investigated the effect of long term use of ACE inhibitors. The authors compared hemodialysis patients on ACE inhibitors (n = 7) for more than 6 months to patients not on the drugs (n = 51). Almost one third of patients in each group had an interdialytic weight gain greater than 5 percent of dry weight. No significant difference was found between the two groups with regard to interdialytic weight gain, thirst and mouth dryness scores, and interdialytic mean blood pressure change. There was no demonstrable effect of ACE inhibitors on weight gain or thirst. The authors conclude that long term ACE inhibitor use may not continue to suppress inappropriate thirst and fluid intake after 6 months in hemodialysis patients. 1 figure. 2 tables. 16 references.

Federally Funded Research on Hemodialysis The U.S. Government supports a variety of research studies relating to hemodialysis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to hemodialysis.

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

34

Hemodialysis

For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore hemodialysis. The following is typical of the type of information found when searching the CRISP database for hemodialysis: •

Project Title: AASK COHORT STUDY Principal Investigator & Institution: Hebert, Lee A.; Professor of Medicine; Internal Medicine; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2003; Project Start 15-AUG-1994; Project End 30-JUN-2007 Summary: (provided by applicant): Hypertensive kidney disease commonly progresses. The primary objective of the AASK (African American Study of Kidney Disease and Hypertension) Cohort Study is to determine prospectively the course of kidney function and risk factors for kidney disease progression in African-Americans with hypertensive kidney disease who receive recommended antihypertensive therapy. A secondary objective is to determine the occurrence of cardiovascular disease and assess its risk factors. The AASK Cohort Study is a prospective, observational study that is an extension of the AASK trial. The AASK trial tested the effects on kidney function of 3 medications used as initial antihypertensive therapy (ramipril, metoprolol and amlodipine) and 2 levels of blood pressure control. Of the 1,094 trial participants, approximately 650 to 700 individuals who have not reached end stage renal disease (ESRD) will likely enroll in the Cohort Study. Of the 60 AASK participants at the Ohio State University 6 are deceased and 5 are on hemodialysis. Of the living, non-ESRD AASK participants 44 are expected to enroll in the Cohort study. Of the 5 participants who have reached ESRD all will participate in the genetic component of the study. Risk factors to be studied include environmental, genetic, physiologic, and socio-economic variables. The primary renal outcome is a composite clinical outcome defined by doubling of serum creatinine, ESRD, or death. Medication treatment for hypertension, beginning with the angiotensin converting enzyme inhibitor ramipril, is offered to all participants. In this fashion, the study directly controls two of the major determinants of kidney disease progression (treatment of hypertension and use of reno-protective, antihypertensive medication). The minimum duration of follow-up in the Cohort Study is 5 years (total of 9 to 12 years, including the period of the AASK trial). Ultimately, data from the AASK Cohort Study should enhance our understanding of the risk factors and processes that determine the progression of kidney disease. Such results might eventually lead to new strategies that delay or prevent ESRD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ADHERENCE AND ADJUSTMENT IN END-STAGE RENAL DISEASE Principal Investigator & Institution: Christensen, Alan J.; Professor; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-JAN-1995; Project End 31-DEC-2003 Summary: (adapted from investigator's abstract): Increased quality assurance concerns associated with the Medicare End-Stage Renal Disease (ESRD) program underscore the need for research addressing the adaptation and quality of life of ESRD patients. Patients' levels of psychological adjustment and their degree of adherence with ESRD treatment regimen reflect two important criteria that are examined in the present continuation proposal. One central objective of the research involves identifying psychological characteristics that influence medical regimen adherence and emotional adjustment among patients treated with renal dialysis. This will be accomplished using

Studies

35

a longitudinal study design that considers the effects of patient individual differences (i.e., coping style) and contextual differences among the available dialysis treatment modalities. A key aspect of the study involves the assessment of patients at an early stage of progressive renal insufficiency, before renal dialysis is clinically necessary. We hypothesize that adherence and adjustment will vary as a joint function of the type of dialysis prescribed and patient individual differences assessed at baseline. For example, we predict that patients' possessing a more active or vigilant style of coping will exhibit more favorable adherence when undergoing a self-administered dialysis treatment modality (e.g., continuous ambulatory peritoneal dialysis) but poorer adherence when receiving staff administered dialysis (e.g., center hemodialysis). A second objective involves identifying patient characteristics that are related to adherence to adjustment among renal transplantation patients. Initial psychosocial assessment will be conducted during the pre-transplant evaluation process. A set of hypotheses regarding psychological predictors of patient adherence and changes in emotional well being after transplantation will be tested in a prospective manner. For Example, we hypothesize that patients with a more active style of coping with health-related stress will exhibit better regimen adherence and better emotional adjustment than other transplant patients. We believe the proposed research will extend the role of psychological theory and practice in contributing to the care of ESRD patients. The knowledge generated will add to a growing body of literature that suggests psychosocial assessment information can be useful in the selection f the most beneficial renal treatment modality for a particular patient. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANABOLIC STEROIDS AND EXERCISE IN HEMODIALYSIS Principal Investigator & Institution: Johansen, Kirsten L.; Assistant Professor; Northern California Institute Res & Educ 4150 Clement Street (151-Nc) San Francisco, Ca 941211545 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: The federally-funded End Stage Renal Disease program was initiated in 1972 with the goal of extending the lives of individuals with kidney disease and allowing them to return to the work force. Though dialysis has prolonged the lives of patients with ESRD, it has not produced the expected degree of occupational and physical rehabilitation. A recent study showed that more than one third of hemodialysis patients had a Karnofsky score below 70, meaning that they were unable to perform the normal activities of daily living without assistance. Investigation into the causes of this striking debility has been limited, but muscle atrophy and concomitant weakness probably contribute. Reduced lean body mass (LBM) and muscle weakness have been demonstrated in this population. Since muscle strength correlates with performance measures such as gait speed in elderly subjects, the reduction in LBM in dialysis patients may affect functional status, and treatments designed to increase muscle size and strength could be of benefit to such individuals. Both anabolic steroid treatment and resistance exercise training (RE) increase strength and muscle mass in healthy subjects. RE also resulted in improved functional status in frail elderly subjects. While there have been no reports of the effects of RE in patients on dialysis, we recently showed that nandrolone decanoate (ND), a 19-nortestosterone derivative, increased LBM and improved walking and stair-climbing time in patients on dialysis. Furthermore, ND was safe in this population and resulted in only occasional mild side effects. In the current application, we propose to perform two studies concurrently. In one, to elucidate the mechanisms of the muscle defects of dialysis patients, healthy control subjects and

36

Hemodialysis

patients on dialysis will undergo measurement of physical activity levels, and of muscle size, strength, and oxidative capacity. In the second, we will determine whether RE and/or anabolic steroids can increase muscle size and improve muscle strength and physical performance in patients on hemodialysis. In a 12-week study, 80 hemodialysis patients will be randomly assigned to one of 4 groups as follows: ND, weekly ND injections; EX, resistance exercise training plus placebo injections; ND-EX, ND injections plus RE; and PL, placebo injections only. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANEMIA MANAGEMENT AND SURVIVAL IN A HEMODIALYSIS COHORT Principal Investigator & Institution: Robinson, Bruce M.; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): Background: Despite numerous publications about the management of the anemia of chronic kidney disease (CKD) its best management remains controversial, and the need for continued improvement is a stated priority in the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKFKDOQI) Clinical Practice Guidelines for patients with CKD. Specific aim 1: In hemodialysis patients, determine the relation between hemoglobin concentration and dosing patterns of erythropoietin and parenteral iron. Hypothesis: The erythropoietin and iron doses most closely associated with target hemoglobin are consistent with the NKF-KDOQI guidelines recommended doses. Specific aim 2: In hemodialysis patients, determine the relation between hemoglobin concentration and survival.Hypothesis: Most favorable survival is associated with mean hemoglobins that include the NKFKDOQI guidelines' target range. We will address these aims using prospectively collected individual-level patient data from up to 10,000 hemodialysis patients in the American arm of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Enrollment for the DOPPS began in 1996 and is ongoing. For both specific aims, we will investigate causality by controlling for time-varying and bidirectional associations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ANTIPROLIFERATIVE HYPERPLASIA

RX

FOR

VENOUS

NEOINTIMAL

Principal Investigator & Institution: Roy-Chaudhury, Prabir; Associate Professor; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Hemodialysis vascular access dysfunction is the single most important cause of hospitalization in hemodialysis patients and is responsible for a very significant morbidity within this patient population. Thrombosis of PTFE dialysis grafts due to venous stenosis as a result of venous neointimal hyperplasia (VNH), is the most common cause of vascular access dysfunction. Surprisingly, there are currently no effective therapeutic interventions for VNH despite its clinical importance. Analysis of cell types and cytokines in dialysis patients with venous stenosis due to VNH and data from a validated pig model of venous neointimal hyperplasia, that is very similar to the human lesion have been described. These studies clearly demonstrate that smooth muscle cell (SMC) proliferation and the formation of microvessels (endothelial cell proliferation), within the neointima and adventitia are critical features of VNH. In addition, it is likely that PTFE dialysis grafts are the ideal

Studies

37

clinical model to test out novel local interventions, in view of their superficial location and easy accessibility. It is therefore proposed to test out novel locally delivered antiproliferative therapies in a validated pig model of VNH, in the hope of being able to rapidly translate positive findings into a clinical setting of great need. Three local interventions will be evaluated in this proposal for their anti-proliferative effects. (a) External radiation therapy: Initial studies in the pig model, have demonstrated a reduction in VNH (albeit less than in models of coronary angioplasty), with a single dose of l6Gy. We now plan to optimize a radiation schedule for VNH by testing out 3 different radiation regimens (b) Local polymeric delivery of paclitaxel and TNP-470: A local polymeric delivery system comprising ethylene-vinyl-acetate matrices loaded with paclitaxel and TNP-470 (both are potent anti-proliferative agents) will be developed and tested in vitro against SMC and endothelial cells. Polymeric matrices will then be wrapped around the graft vein anastomosis in a perivascular configuration in an attempt to reduce luminal stenosis and VNH. (c) Combination radiation therapy and local anti-proliferative therapy: The most effective radiation and anti-proliferative regimens from (a) and (b) will be combined in this final analysis, in the hope of achieving a synergistic effect. We believe that the results from this study could transform the clinical care of hemodialysis patients and at the same time result in the successful clinical application of local therapy for the treatment of neointimal hyperplasia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ASSESSING FUNCTIONAL OUTCOMES IN ADOLESCENT WITH ESRD Principal Investigator & Institution: Furth, Susan L.; Associate Professor; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 31-MAR-2004 Summary: provided by applicant): Dr. Furth is seeking the Small Grant Award to expand the study of clinical outcomes for children with end stage renal disease (ESRD) initiated under her KO8 Award DK 02586-01A1. With the support of the KO8 funding, Dr. Furth has completed her PhD in Clinical Investigation and has begun the transition to an independent research career. She has published a number of manuscripts using her training in epidemiology and clinical investigation: examining how clinical and socio-economic factors affect access to different treatment regimens for children with kidney failure, and how clinical experience with ESRD care for children affects treatment decisions. She has examined how poor growth, a crucial pediatric issue, affects mortality, hospitalization rates and educational achievement. She has also initiated a multi-center, cross-sectional study comparing functional outcomes/ health related quality of life (HRQL) for pediatric patients with chronic renal failure or ESRD treated with hemodialysis, peritoneal dialysis or transplant. Resources provided by the RO3 award will allow Dr. Furth to expand the multi-center study of health related quality of life in adolescents with ESRD to a prospective study. A prospective study will allow Dr. Furth to determine whether specific measures of health related quality of life are sensitive to clinical changes, as patients proceed from dialysis to transplantation. The supplementary funding of the R03, additionally will allow Dr. Furth to examine the link between clinical measures such as hematocrit, serum albumin, and dialysis adequacy (Kt/V) and functional outcome/HRQL. Furthermore, the prospective study will assess whether high risk behavior characterized by patterns of response on an adolescent health status questionnaire can predict non-compliance with therapy, increased hospitalization rates, acute rejection or transplant failure. The measures of functional

38

Hemodialysis

outcome studied will include the Child Health and Illness Profile-Adolescent Edition, and the Child Health Questionnaire (Parent report). This research will provide an indepth analysis of a measure of functional outcome in children with ESRD, and will provide valuable information regarding optimal treatment choices for children with kidney disease. If assessments of high risk behavior predict increased rates of hospitalization, rejection or transplant failure, results of this study will allow identification of a high risk population of adolescents with ESRD, who can be targeted for early intervention and close follow-up to improve long term outcomes of care. The proposal addresses several priority areas for Clinical Research highlighted in the NIH Task Force publication, Research Needs in Pediatric Kidney Disease: 2000 and beyond. During this project, Dr. Furth will gain new skills in organizing and coordinating a prospective multi-center clinical research study. This experience will give Dr. Furth the tools she needs to develop into an independent clinical investigator in a nurturing academic environment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BBP EXPOSURE AND RISK FACTORS IN NON-HOSPITAL BASED HCWS Principal Investigator & Institution: Gershon, Robyn R.; Associate Professor; Sociomedical Sciences; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 29-SEP-2004 Summary: Proposed is a three-year collaborative, multidisciplinary, study designed to determine rates and risk factors for blood/body fluid exposure incidents in non-hospital based health care workers (HCWs). This proposal is an extension of studies we have conducted over the past decade involving hospital-based and non-hospital based HCWs. This work augments earlier research by focusing on a large and diverse range of non-hospital settings, including several for which data are particularly sparse. Given that there are both effective primary (e.g., engineering devices) and secondary (e.g., post- exposure prophylaxis) preventive strategies for managing risk and given that the extent of risk and the prevalence of risk management controls in many non-hospital settings is largely unknown, the public health significance of this problem cannot be overstated. This study is designed to address important knowledge gaps by collecting data from a wide variety of non- hospital settings, including: 1) mental disabilities facilities, 2) nursing homes, 3) drug treatment facilities, 4) AIDS clinics, 5) emergency medical services (EMS) , 6) doctors' offices and clinics, 7) hemodialysis clinics, 8) police departments, 9) correctional facilities, and 10) home health care and hospice facilities. These groups were chosen either because of published reports that they may be at high risk (e.g., EMS) or anecdotal reports of potential risk (e.g., correctional officers) or because recent data suggest that they may be at risk (police officers) or simply because there is a lack of information on this population (hospice employees). In order to meet the specific aims and goals of the study we will randomly select a sample of 6000 employees (600 per group) to receive a confidential self-administered mailed survey. Additionally, a sample of 1000 hospital based nurses will also be randomly selected to allow for occupational comparisons between hospital and non-hospital work settings. Participants will be recruited from the following agencies: (a) the New York Public Employees Federation, (b) the New York Patrolmen's Benevolent Association, (c) the New York State Nurses Association, and (d) the New York State Department of Correctional Services. Our overarching goal of the study is to identify data-driven opportunities for risk reduction. This will be accomplished by innovative Participatory

Studies

39

Action Research teams, comprised of both researchers and study participants. An important and novel product of this study will be the development of a Risk grid a simple tool that employees and employers can use to determine exposure risk and, importantly, the steps to take to reduce that risk. This study will improve our understanding of the risks facing non-hospital HCWs and allow us to focus our energies and resources appropriately. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOMECHANICAL MECHANISMS AND VENOUS INTIMAL HYPERPLASIA Principal Investigator & Institution: Bassiouny, Hisham S.; Surgery; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 01-SEP-1996; Project End 31-JUL-2006 Description (provided by applicant): Venous anastomotic intimal hyperplasia (VAIH) is the most prevalent cause of hemodialysis arteriovenous (AV) graft failure. The economic impact of AV access and its related morbidity approaches one billion dollars annually in the US. Previously, this laboratory has demonstrated that hemodynamic forces regulate key in vivo molecular and structural events in artery wall intimal hyperplasia. We will apply and extend this expertise to investigate the independent role(s) of turbulence-induced solid and fluid dynamic forces in inducing VAIH following AV graft implantation. The investigators have established a realistic experimental in vivo model of the human AV circuit and VAIH to test the following hypotheses: 1) VAIH is modulated by turbulence-induced vein wall vibration levels, with elevated vein wall vibration enhancing, and reduced vein wall vibration attenuating, VAIH; 2) This relationship is independent of regional variations in wall shear stress magnitude within venous anastomoses subjected to turbulent flow conditions; 3) Elevated vein wall vibration upregulates the level and activity of the extra-cellular regulatory kinase (ERK1/2) and the stress activated protein kinase (JNK and p38) required for transcriptional activation of the immediate early genes (IEGs) Egr1, c-jun and c-fos involved in VSMC differentiation, proliferation, apoptosis and VAIH. To verify the proposed hypotheses we will correlate the degree and localization (transmural, circumferential, and axial) of the above-mentioned molecular and cellular events with the corresponding magnitude and spatial distribution of the venous anastomotic biomechanical variables under conditions of elevated and reduced levels of vein wall vibration. It is anticipated that the results of these novel investigations will provide seminal information regarding the pathogenesis and detection of AV grafts at risk for accelerated VAIH, and for the design of interventions to inhibit VAIH and extend patency of hemodialysis AV grafts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: CARBOHYDRATE AND PROTEIN METABOLIC PATHWAYS Principal Investigator & Institution: Landau, Bernard R.; Professor of Medicine and Biochemistry; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-MAY-1978; Project End 31-MAR-2005 Summary: (Provided by applicant): Carbohydrate, protein and lipid abnormalities characterize diabetes mellitus. Long-term objectives are to develop and apply novel methods significantly advancing understanding of those metabolic processes and their regulation in physiological and pathological states in human, and particularly in

40

Hemodialysis

diabetes. Advantage is taken of 2H2O use to quantitate the pathways followed. Methods have been introduced for carbohydrate and lipid. The major new goal is to develop and apply a method for quantitating protein metabolism. The method for quantitating carbohydrate metabolism will also be further extended. Focus then is on 1) the quantitation of protein synthesis and proteolysis; 2) the contribution to glucose production of gluconeogenesis whose increase in diabetes has been related to the degree of hyperglycemia and 3) the extent of simultaneous hepatic glycogen synthesis and breakdown, called glycogen cycling, which could help explain decreased liver glycogen content found in type 2 diabetes and exacerbate hyperglycemia on glucose ingestion. There are 4 specific aims: 1) To develop and apply a method for quantitating the extent transaldolase reactions contribute to estimates of gluconeogenesis; 2) To evaluate the validity of a method using glucose isotopomers, introduced as a simple method to measure the contribution of gluconeogenesis, in comparison with 2H2O use; 3) To develop a method for quantitating glycogen cycling in the fed state by measuring, along with the rate of hepatic glycogen deposition on glucose intake, how much of the glycogen is formed directly from the glucose, how much from three carbon compounds, and how much from glycogen that is reconverted to glycogen, i.e. glycogen cycling; 4) To develop a method to estimate protein synthesis from labeling of protein by 2H2O, and proteolysis from loss of that label. Initial application of this method will be to renal failure patients undergoing hemodialysis, in whom ingested 2H2O can be removed by dialysis to readily follow loss of incorporated label without continued synthesis of labeled protein. Application first to the renal failure state is done with recognition that nephropathy is a major complication in the diabetic and the potential benefit of a simple method for evaluating the effects of the therapeutic approaches on protein dynamics in that condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC RENAL DYSFUNCTION AND ISCHEMIC BRAIN DISEASE Principal Investigator & Institution: Seliger, Stephen L.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 30-NOV-2007 Summary: (provided by applicant): Patients with renal dysfunction suffer from extraordinarily high rates of mortality and marked functional and cognitive impairment compared to the general population, in part due to accelerated vascular disease. Although the majority of reports have focused on risk factors and outcomes associated with cardiac disease, the impact of accelerated vascular disease on cerebrovascular outcomes among these patients are not well defined and may contribute significantly to their marked cognitive impairment. Although a few studies have reported an increased risk of stroke among patients with renal dysfunction, risk factors and outcomes associated with clinical and subclinical stroke have not been identified. We hypothesize that patients with renal dysfunction, through factors which promote accelerated vascular disease, are at a higher risk of clinical and subclinical stroke, which contributes to a high prevalence of cognitive dysfunction and dementia in patients with renal disease. The overall objectives of this study are to determine the association between renal dysfunction and risk of clinical and subclinical stroke, identify specific stroke risk factors, and quantify the associated cognitive dysfunction among patients with chronic renal insufficiency (CRI) and end-stage renal disease (ESRD). The proposed research will involve a series of observational studies. First, the association between renal dysfunction and clinical stroke will be estimated and stroke risk factors among CRI and

Studies

41

ESRD pts will be identified, using data from multicenter prospective cohort studies. Next, using MRI and neuropsychiatric data collected as part of one these studies, we will determine whether patients with CRI are at higher risk for subclinical brain infarcts, and whether this contributes to a higher risk of dementia. Finally, MRI imaging and longitudinal measurements of cognitive function will be performed on hemodialysis patients, to determine risk factors for subclinical brain infarcts and define the relationship between these infarcts and cognitive decline. These studies, by clarifying associated risk factors and adverse outcomes of stroke, could result in the development of new strategies to diagnose and prevent ischemic brain disease in patients with renal disease, ultimately leading to an improved prognosis for these patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL OUTCOME OF HEMODIALYSIS IN UTAH Principal Investigator & Institution: Cheung, Alfred K.; Professor of Medicine; Internal Medicine; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: The mortality rate of U.S. chronic hemodialysis patients is higher than that in other industrialized nations. Available data suggest that this high mortality rate is partially a result of inadequate delivery of dialysis. The MMHD is a prospective, randomized, multicenter, two-by-two factorial trial sponsored by NIDDK to determine if increasing the amount of delivered dialysis (as assessed by a two-pool, variablevolume urea kinetic model) and using high flux biocompatible dialysis membranes would improve the clinical outcome of these patients. This application describes the University of Utah Dialysis Program (together with the Salt Lake City VA Medical Center dialysis unit) and proposes that this Program participates as a Clinical Center in the MMHD Full Scale Study. The University of Utah Dialysis Program consists of 7 dialysis units, some of which are located in suburban communities, that have common administrative and medical guidelines originating from the University headquarters. The VA-unit is also closely affiliated and has similar protocols. The investigators in this proposal have significant expertise in their respective areas. Both the institution and the investigators have a long tradition in laboratory and clinical dialysis research. They have recently performed several clinical studies involving patients from the different dialysis units within the Program. The P.I. has also participated in several multicenter clinical trials with centers outside Utah. The ESRD population in this Program has been growing. The number of in-center hemodialysis patients, as of December 31, 1993, was 237, of which 37% were diabetic. The majority of these patients are Caucasian (78%), but there is a significant fraction (5%) of Native Americans. This Program will recruit approximately 108 patients during the first 18 months of the Study and randomly allocate 60 of them to 4 hemodialysis treatment strategies that differ in the amount of delivered dialysis and/or the type of dialysis membrane. Sixty patients will be maintained throughout the study by using a "recruit to replace" strategy. Many of the medical and technical aspects of therapy, including nutritional intake, will be standardized during the baseline and a 60 month follow-up period. The primary outcome is death of the patient; secondary outcomes include non-access related hospitalization, hospitalization for heart disease or infection, and declining serum album in. The results from this trial will guide hemodialysis therapy in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

42

•

Hemodialysis

Project Title: COLLABORATIVE CLINICAL TRIALS IN VASCULAR ACCESS Principal Investigator & Institution: Dixon, Bradley S.; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: The Eastern Iowa Western Illinois Vascular Access Consortium (EIWIVAC) is a consortium of hemodialysis units surrounding the University of Iowa co-founded by a vascular biologist and an expert in clinical trials design to address the problem of vascular access failure. Hemodialysis vascular access failure is a frequent cause of morbidity and a major expense in caring for hemodialysis patients. The cause of access failure is neointimal hyperplasia leading to stenosis and thrombosis. This process occurs in both arteriovenous grafts (AVG) and native fistulas (AVF). The hypothesis underlying the present proposal is that pharmacological agents that inhibit vascular smooth muscle cell (vsmc) proliferation will decrease the neointimal hyperplasia and prolong vascular access survival. Both HMG CoA reductase inhibitors and dipyridamole have been shown to inhibit vascular smooth muscle cell proliferation. HMG CoA reductase inhibitors prevent the isoprenylation of small GTP binding proteins such as Ras that are needed for cell proliferation. Dipyridamole increases extracellular adenosine levels that can inhibit proliferation by unclear mechanisms. Studies from our lab have shown that combined treatment with these agents in low doses is additive or even synergistic at inhibiting vsmc proliferation. Therefore, we propose a randomized placebo controlled primary prevention trial using a factorial design to test whether treatment with either dipyridamole or an HMG CoA reductase inhibitor will increase primary survival of a newly created vascular access: either an AVG or an AVF. In addition, we briefly propose two additional trials. With access monitoring to detect stenosis before access failure, many prevalent accesses will require angioplasty. However, the restenosis rate after angioplasty is very high and resistant to many pharmacological agents. We propose in a second trial to test the hypothesis that the more potent antiproliferative effects of rapamycin in combination with an HMG CoA reductase inhibitor will inhibit the smooth muscle cell proliferation leading to restenosis. Finally, data shows that an upper arm native fistula (UAF) has superior survival to an AVG. However, the UAF appears to be underutilized in part because of concerns over high access flow rates and the possibility of increased heart failure and distal steal syndromes. While a randomized trial is not possible, we propose to establish a registry to examine the safety of a UAF compared to an AVG. If safety issues can be addressed, increased utilization of UAF may be the most cost-effective intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: COLORIMETRIC BREATHALYZER FOR DIALYSIS MONITORING Principal Investigator & Institution: Mcnamara, William B.; Chemsensing, Inc. 1200 Shermer Rd, Ste 104 Northbrook, Il 60062 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JAN-2003 Summary: (provided by applicant): More than 200,000 Americans undergo hemodialysis in order to remove toxins from their blood, but to date there exists no device to monitor the efficiency of dialysis in real-lime. Such a device would be of great value in determining the dialysis state of both patients undergoing hemodialysis in a clinic and peritoneal dialysis at home. ChemSensing, Inc. (CSI) possesses a unique chemical detection technology in which colorimetric changes in an array of dyes constitute a signal much like that generated by the mammalian olfaction system; each dye is a cross-responsive sensor. This technology as been coined "Smell-Seeing."

Studies

43

Previous work has shown that this technology can detect and quantify vapors (including alcohols, amines, ethers, phosphines, phosphites, thioethers and thiols) at the sub-ppm (parts per million) level. This Phase II program is designed to demonstrate that this technology is capable of detecting and quantifying sub-part per million levels of ammonia and therefore Provide an inexpensive, portable, and easily used real-time dialysis breathalyzer. The low cost of this technology makes it feasible for monitoring the efficiency of dialysis every session rather than just once a month, and its portability makes it feasible to monitor urea rebound on a regular basis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMORBIDITY, COSTS AND OUTCOMES IN DIALYSIS PATIENTS Principal Investigator & Institution: Beddhu, Srinivasan; Internal Medicine; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 30-APR-2003 Summary: As the mean age of incident dialysis patients has increased to 60 years and prevalence of comorbid conditions such as diabetes has increased, increasing comorbidity may profoundly impact on morbidity, mortality and costs in the dialysis population. A valid tool that quantifies comorbidity may help to identify high-risk patients with expensive resource utilization, help to flame public health strategies and define optimal dialysis therapeutic interventions targeted towards this high-risk group. To be valid in the dialysis population, the comorbidity tool should be simple, readily verifiable, include certain specific factors that influence outcomes in dialysis patients such as duration of end-stage renal disease and include objective, quantifiable measures of disease severity. None of the currently used indices such as the Charlson Comorbidity Index and the Index of Coexistent Diseases meet all of these criteria. Therefore, the specific aims of this study are to develop and validate in a large sample of dialysis population an index of comorbidity that is simple, specific for dialysis patients and accounts for disease severity. Prior studies showed patients with high comorbidity have higher peritoneal dialysis technique failure. This study will also examine whether the increased mortality observed after peritoneal dialysis technique failure is due to high comorbidity of these patients or the technique failure itself causes higher mortality. This study will use the existing data in the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Studies (DMMS). The comorbidity tool will be developed from a subset of the 6300 prevalent patients in the DMMS III study. By Cox proportional hazards, the relative risk for death, for each of the comorbid conditions will be determined and scores will be given based on the relative risk. This scoring system will be validated in the following sub-populations: prevalent hemodialysis patients with Medicare as the primary or sole payer in the DMMS-IV study, prevalent hemodialysis patients with non-Medicare as the primary or sole payer in the DMMS-IV study, incident hemo and peritoneal dialysis started on dialysis in 1996 or 1997 in the DMMS wave II study irrespective of the insurance status. The outcomes of interest will be hospital days and Medicare hospital costs (by ANOVA) and death (by Cox proportional hazards). Further data from DMMS II will be used to examine the risk of death of incident peritoneal dialysis patients who failed the technique with incident hemodialysis patients. As comorbidity predicts peritoneal dialysis technique failure, the above analysis will help in determining the optimal dialysis modality based on comorbidity at the initiation of dialysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

44

•

Hemodialysis

Project Title: COMPARISON OF EXERCISE RESPONSES IN FOUR ESRD TREATMENTS Principal Investigator & Institution: Painter, Patricia L.; Adjunct Assistant Professor; Physiological Nursing; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 30-JUN-2007 Summary: (provided by applicant): Exercise capacity is extremely low in patients with end stage renal disease (ESRD) treated with conventional hemodialysis, and improves significantly shortly after successful transplantation. It is suspected that factors associated with uremia impair the normal integration of physiological systems required for increased oxygen transport and utilization during exercise. There is growing interest in slow daily hemodialysis(both short daily hemodialysis and slow nocturnal hemodialysis), which increases the dialysis provided and reduces uremic signs and symptoms. We propose to study patients with ESRD treated with 4 different modalities: conventional hemodialysis (CHD) (3days/week, 3 hours/treatment), low nocturnal hemodialysis (SND), short daily hemodialysis (SDD) and living donor transplantation (RTX) to assess differences in physiological responses to and determinants of exercise. The hypothesis is that physiological responses to exercise and the determinants of exercise in patients treated with daily hemodialysis are more normal compared to conventional hemodialysis and similar to those of transplant recipients. Testing will be performed to measure the following: exercise capacity (VO2max), cardiac output, avO2difference, endothelial function (brachial artery reactivity), autonomic function (24 hour heart rate variability), muscle blood flow (calf plethysmography with doppler), leg muscle mass (magnetic resonance imaging), muscle ultrastructure (muscle biopsy analysis), muscle function (isokinetic muscle testing), and oxidative capacity (magnetic resonance spectroscopy), total body composition (dual energy x-ray absorptiomtetry), and quality of life (KDQOL). This study will provide new information on the limitations to functioning in uremic patients and provide physiological comparisons of the various ESRD treatment modes. The relationship between and contributions of the various physiological measures to exercise capacity will also be revealed. The results of this study will be important in guiding the nephrology community in improving dialysis treatments so patients can be directed into therapies that are found to achieve higher levels of functioning and thus possibly improve rehabilitation and quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: CORONARY CALCIFICATION IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Goodman, William G.; Professor; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 29-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Cardiovascular disease accounts for half the deaths in adults undergoing regular dialysis, but the mechanisms responsible remain uncertain. Recent evidence indicates, however, that certain disturbances in mineral metabolism, and/or the therapeutic measures aimed at controlling them, contribute to the development of coronary artery and vascular calcification in patients treated with longterm hemodialysis. Coronary calcification is common in those with end-stage renal disease (ESRD), and the disturbance may account, at least in part, for the high mortality rate from cardiovascular causes in this population. The multi-center, randomized, clinical trial outlined in the current proposal is designed to assess the roles of two

Studies

45

separate, yet potentially related, determinants of coronary artery calcification in patients with ESRD who are treated with hemodialysis. The impact of reducing the amount of calcium given orally to patients with ESRD by using sevelamer (RenaGel) rather than calcium-based compounds to control serum phosphorus will be evaluated. Coronary artery calcification will be measured by electron beam computed tomography (EBCT) before and after 12 months of treatment. In addition, the effect of lowering serum total and LDL cholesterol levels on coronary artery calcification scores will be assessed during treatment with either simvastatin or placebo to inhibit 3-hydroxyl-3methylglutaryl Co-enzyme A reductase (HMG Co-A). Potential interactions between these two therapeutic interventions on coronary artery calcification scores will be examined using a 2 x 2 factorial study design. The primary outcome variable is the coronary artery calcification score after 12 months of treatment in each of four groups. The broad objectives of the project are to determine the efficacy of two therapeutic interventions aimed at modifying factors thought to contribute to the development and progression of coronary artery calcification, and possibly to cardiovascular mortality, in patients undergoing long-term dialysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DETECTING IMPENDING DIALYSIS ACCESS GRAFT FAILURE Principal Investigator & Institution: Vilkomerson, David H.; Professor; Dvx, Llc Box 368 Kingston, Nj 08528 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 30-NOV-2003 Summary: (provided by applicant): The aim of this program is to develop a low-cost, easy-to-use instrument to measure the blood flow in artificial dialysis access grafts. With such an instrument, these grafts could be monitored at frequent enough intervals to detect the falling flow levels that predict graft failure. Such graft failure is a major medical problem for the 250,000 Americans who undergo hemodialysis. The proposed instrument will utilize a new kind of ultrasound transducer, the diffraction-grating transducer, in a special Doppler technique that eliminates the need for imaging the graft during measurement, and is especially suitable for by minimally skilled operators. An early version of this instrument has shown promise in measuring dialysis access graft flow, and has proven that the range of normal physiological variation in graft flow is small enough that the proposed flow measurements should reveal impending graft failure. In the Proposed Phase I of this project, a prototype of the desired instrument will be constructed and its accuracy and ease of use validated in clinical use by comparison with standard flow techniques in a small number of hemodialysis patients. With the feasibility of the instrument so demonstrated, Phase II would continue with construction of a number of such instruments to be used in a multi-center trial to prove that their use can extend the life of artificial dialysis grafts. The economic benefit of such graft life extension can approach a billion dollars a year, ensuringcommercialization of the instrument. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: DEVELOPMENT OF A NOVEL BIOARTIFICIAL LIVER Principal Investigator & Institution: Rozga, Jacek; Arbios Technologies, Inc. 2331 Buckingham Ln Los Angeles, Ca 90077 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 30-NOV-2003 Summary: ARBIOS developed a novel hybrid bioartificial live r(HyBAL) to treat patients with liver failure of various etiologies. In the absence of any other alternative,

46

Hemodialysis

such patients must receive a liver transplant or endure prolonged hospitalization. In treating acute liver failure it is critical to provide whole liver functions. It is believed that liver support at this level of complexity requires utilization of viable isolated liver cells. Our own argument, which dates back to the development of our first-generate bioartificial liver, is that a truly effective system should be a hybrid one, i.e., it should combine liver cell therapy and detoxification using sorbents (e.g., activated charcoal, exchange resin). The HYBAL is the first liver assist system in which these two functions are integrated in a single molecule. Depending on the cause of liver disease, severity of illness and deficiency of specific liver functions, these modes of therapy can be provided individually, simultaneously or sequentially. In addition, the HYBAL's basic commercially available kidney dialysis platform represents a major improvement in efficiency with a concomitant reduction in cost and complexity compared to other existing systems. The goal of this proposal is to validate the HyBAL concept. The prototype HyBAL devices will utilize matrix-anchored rat or pig hepatocytes and sorbents (charcoal and exchange resin particles). They will e perfused for 8 hours with plasma removed with pigs with surgically-induced fulminant hepatic failure(FHF). Changes in plasma levels of ammonia, urea, bilirubin and other liver-specific parameters will be monitored. In addition, the HyBAL will be challenged with exogenous ammonium chloride, galactose and lidocaine. In vivo, he ability of HyBAL to support pigs with FHF will be examined. In both experimental settings, HyBAL devices from which either cell therapy or sorbents have been omitted, will be tested to determine the respective role of cell and sorption therapy in the overall HyBAL performance. PROPOSED COMMERCIAL APPLICATIONS: The National Center for Health Statistics (NCHS) reported that in 1999, over 250,000 patients underwent 340,000 hospitalizations due to acute liver failure; 43,000 patients died (7th leading cause of death). Based on these data, NCHS estimates that more than 200,000 liver support treatments are needed annually in the U.S. lone to keep liver failure patients alive until an organ becomes available for transplantation or the native liver recovers from injury ($1.5-billion market). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVICE FOR ERADICTING & CONTROLLING BIOFILM IN DIALYSIS Principal Investigator & Institution: Lai, Richard C.; Novaflux Technologies, Inc. 1 Wall St Princeton, Nj 08540 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2005 Summary: (provided by applicant): Hemodialysis is a water intensive therapy that presents an enormous challenge to cost effectively produce very large amounts of high purity water. The occurrence of bacteria and endotoxins in dialysis fluids is traced to biofilm that grows at surfaces in contact with water in dialysis water systems. Current liquid circulation maintenance methods are not capable of removing biofilm from dialysis water systems, and thus are incapable of eliminating the main source of biological contamination of dialysis water. Such methods are tedious, labor-intensive, time-consuming and costly. We propose to use a two-phase flow cleaning technology proven to remove biofilm from long and narrow passageways to eradicate biofilm and control its proliferation in dialysis water systems. The specific aims of the study are: 1) To define and build a simulated dialysis unit water system mimicking an actual water system at a dialysis clinic; 2) To define flow and fluid dynamics parameters of the twophase flow process necessary to remove biofilm from pipelines of dialysis unit water systems; 3) To optimize and validate the two-phase cleaning/disinfection process

Studies

47

protocol for a dialysis unit water system using standard microbiology methods; and 4) To define system requirements to be applied at the dialysis units in the clinical setting during the Phase II study. The Phase I study will focus on cleaning and eradicating biofilm from RO water and bicarbonate solution loops of the water system. This approach presents a cardinal new means of producing and maintaining high quality water for use in hemodialysis treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENTS

DIETARY

PROTEIN

REQUIREMENTS

IN

HEMODIALYSIS

Principal Investigator & Institution: Kopple, Joel D.; Professor; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 905022052 Timing: Fiscal Year 2003; Project Start 16-MAY-2003; Project End 31-JAN-2008 Summary: (provided by applicant): A high proportion of maintenance hemodialysis (MHD) patients have protein-energy malnutrition (PEM), which is a powerful predictor of high morbidity and mortality. Although inflammation may contribute to PEM, low dietary protein intake (DPI) is often a contributing factor. The usual DPI of MHD patients is about 1.0 g protein/kg/day, whereas expert groups recommend = 1.20 g protein/kg/day. However, these recommendations are based upon few studies, often of insufficient duration, that were usually carried out with obsolete types of dialysis therapy. This project has two primary aims: Study 1. To assess dietary protein requirements in clinically stable MHD patients. It is hypothesized that the average DPI that will maintain nitrogen balance is 1.00 g protein/kg/day, but that a safe intake that maintains balance in almost all MHD patients is about 1.25 g protein/kg/day. Study 2. To test the hypothesis that in clinically stable MHD patients with PEM, treatment for 5 months with a DPI of 1.30 g/kg/day, but not 1.00 g/kg/day, is associated with a significant increase in urea-free total body nitrogen (TBNuf). In Study 1, 9 patients will be studied in a clinical research center while they are fed, in random order, the following 5 DPIs, each for 17 days: 0.60, 0.80, 1.00, 1.15 and 1.30 g/kg/day. Energy intake for each patient will be based on their indirect calorimetry. The key outcome measure is nitrogen balance. We will assess the effects of these DPIs on total body (13Cleucine) protein synthesis and degradation and 13C-leucine oxidation during fasting and feeding, plasma amino acids, dialysate amino acids, peptides and proteins, and body composition (anthropometry, dual x-ray photon absorptiometry (DXA)). We will attempt to define more precisely the relationships between urea nitrogen appearance (UNA), protein nitrogen appearance (PNA) and DPI and investigate the validity of urea kinetic equations for estimating UNA, PNA, DPI and urea pools. In Study 2, 70 MHD outpatients will be randomly assigned to a DPI of 1.00 or 1.30 g/kg/day for 5 months each, utilizing dietary counseling and food supplements. Before and after these 5 months, total body protein will be assessed by TBNuf, body cell mass (TBK), and other components of body composition using anthropometry, DXA, and near infra-red interactance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIPYRIDAMOLE IN VASCULAR ACCESS FOR HEMODIALYSIS Principal Investigator & Institution: Himmelfarb, Jonathan; Professor; Maine Medical Center 22 Bramhall St Portland, Me 04102 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005

48

Hemodialysis

Summary: The long-term objective of this proposal is to establish whether or not the use of dipyridamole is efficacious in improving the function of expanded polytetrafluoroethylene (ePTFE) grafts used for dialysis access in patients with end stage renal disease on chronic hemodialysis therapy. Currently, there are over 170,000 patients in the US on chronic hemodialysis therapy. For these patients, problems with vascular access patency have been called the "Achilles Heel" of the dialysis procedure. Furthermore, the development of ePTFE graft stenosis and thrombosis reduces the quality of delivered dialysis therapy and increases the infection risk for patients on dialysis. Maintaining vascular access patency costs approximately $7,871 per hemodialysis patient per year at risk with an estimated annual global cost of more than one billion dollars. Recent evidence suggests that in almost all cases, ePTFE graft thrombosis occurs only after the development of a stenosis either at the graft vein anastomosis or more distally in the vein. These venous stenoses occur because of a pathological process known as intimal hyperplasia. Recent evidence from a small, single-center, prospective, randomized, placebo-controlled clinical trial has suggested that dipyridamole may reduce the rate of ePTFE graft thrombosis in chronic hemodialysis patients. The mechanism of dipyridamole efficacy may be by inhibiting vascular smooth muscle cell proliferation and thereby reducing the development of intimal hyperplasia and associated venous stenoses. The specific aims of this proposal are: l) To investigate the efficacy of dipyridamole in preventing the development of anastomotic and venous stenoses in patients on chronic hemodialysis with ePTFE grafts; and 2) To investigate the efficacy of dipyridamole in preventing the development of thrombosis in patients on chronic hemodialysis with new ePTFE grafts. In order to answer the Specific Aims, the proposed study design is a randomized, prospective, double-blind, placebo-controlled, parallel group clinical trial. Patients on chronic hemodialysis therapy who require a new prosthetic ePTFE graft will be randomized to receive either dipyridamole or placebo for a period of 12 months after enrollment or until ePTFE graft failure. Enrolled patients will undergo serial monitoring of vascular access blood flow, known to be a physiologic predictor of impending vascular access failure, with clinically indicated interventions to prevent vascular access failure. The study design will test the null hypothesis that dipyridamole does not affect the development of either venous stenosis or thrombosis in new ePTFE grafts in hemodialysis patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY DIAGNOSIS AND TREATMENT OF DIALYSIS GRAFT STENOSIS Principal Investigator & Institution: Robbin, Michelle L.; Radiology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: The broad long-term objective of this proposal is to improve vascular access longevity in chronic renal failure patients on hemodialysis using ultrasound evaluation. Synthetic graft failure after the first month is primarily due to clotting (thrombosis). After the graft thromboses, an underlying graft or draining vein stenosis is found in greater than 85 percent of patients, despite aggressive clinical monitoring for stenosis. Patent grafts with stenoses treated with percutaneous transluminal angioplasty (PTA) or surgical revision techniques have longer patency than thrombosed grafts after thrombectomy. Therefore, early stenosis detection with treatment of the hemodynamically significant stenoses found (in patent grafts) should increase graft longevity, thereby decreasing the substantial costs associated with graft failure. We

Studies

49

propose to actively test two graft surveillance strategies. This study will test the hypothesis that triannual ultrasound monitoring and percutaneous treatment of detected stenoses will improve hemodialysis graft longevity compared to aggressive clinical monitoring. Specific Aims: To test the hypothesis that: 1). Triannual color flow ultrasound (US) surveillance of hemodialysis grafts can diagnose stenoses that are not detected during aggressive clinical monitoring. 2). PTA of hemodynamically significant stenoses detected by ultrasound surveillance will approximately double graft longevity, from the current 16 months. 3). To determine the ultrasound and angiographic measurement parameters that most accurately predict the longevity of the PTA result. 4). To assess the cost-effectiveness of early color flow US graft stenoses detection and intervention versus aggressive clinical monitoring. Health Relatedness: If color flow US monitoring in addition to aggressive clinical monitoring increases graft longevity and is cost effective as compared to aggressive clinical monitoring alone, this would have important implications for patient management. Increased graft longevity should lead to improved patient quality of life, secondary to a decreased need for thrombectomies, temporary access catheters and surgical placement of new grafts. Research Design and Methods: A randomized, prospective clinical trial will compare triannual color flow US graft monitoring in addition to aggressive clinical monitoring, to aggressive clinical monitoring alone. PTA or surgical revision of hemodynamically significant stenoses detected will be performed. Access patency will be followed for at least 2 years, or until placement of a new access. All other aspects of the patients' medical and dialysis care will follow usual medical standards. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECT OF CLOPIDOGREL ON EARLY PATENCY OF AV FISTULAE Principal Investigator & Institution: Dember, Laura M.; Associate Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: Purpose: The objective of this proposal is to design randomized, controlled rnulticenter trials evaluating interventions to increase the survival of vascular access for hemodialysis and to form a collaborative network of clinical centers and a data coordinating center to perform such studies. Specific Aims: This application has two specific research aims: l) To determine whether the administration of clopidogrel for four weeks beginning on the day prior to native fistula creation reduces the rate of early fistula failure compared with placebo, and 2) To create a Collaborative Boston Area Clinical Center with the patient population and clinical and research expertise necessary to conduct the series of studies of the Hemodialysis Vascular Access Clinical Trials Consortium. Background: Maintenance of vascular access for hemodialysis is one of the major challenges in the care of the hemodialysis patient. Access-related problems are among the most frequent reasons for hospitalization in the end-stage renal disease (ESRD) population, and the cost of vascular access placement and repair in the United States currently exceeds $700 million per year. Despite the well-established advantages of native arteriovenous fistulae (higher unassisted potency rates and lower rates of infection) compared to grafts or catheters, the proportion of the United States hemodialysis population with a native fistula is low. An important factor contributing to this low prevalence is early thrombosis of newly created fistulae. Several small studies of antiplatelet agents have shown a reduction in early thrombosis rates of native fistulae, but have not been powered sufficiently to definitively demonstrate a benefit. Methods: Patients with chronic renal failure who are scheduled to undergo creation of a native fistula and are without contraindication to antiplatelet therapy will be

50

Hemodialysis

randomized to receive either placebo or clopidogrel 75 mg daily beginning the day prior to fistula creation and continuing for an additional 4 weeks. The primary outcome measure will be attainment of a fistula suitable for dialysis without any radiologic or surgical intervention. The secondary outcome measures will be: l) fistula potency at completion of study drug, and 2) attainment of a fistula suitable for dialysis including those fistulae modified radiologically or surgically. The Boston Area Clinical Center will be comprised of five facilities with greater than 600 patients currently on hemodialysis and large pre-ESRD populations from which to draw study subjects. These study sites have extensive successful experience in multicenter clinical trials in ESRD. The Boston Area Clinical Center is organized to efficiently collaborate on the series of clinical trials conducted by the Hemodialysis Vascular Access Clinical Trials Consortium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXTRACORPOREAL ANTICOAGULATION

CIRCULATION

WITHOUT

Principal Investigator & Institution: Bartlett, Robert H.; Professor of Surgery; Surgery; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2004; Project Start 01-AUG-1980; Project End 30-JUN-2007 Summary: (provided by applicant): Extracorporeal Circulation (ECC) of blood is essential to modern medicine (heart surgery, hemodialysis, plasmapheresis, and life support in intensive care). Systemic anticoagulation is required for ECC, but is the major cause of complications and the limiting factor to the technology. Despite solid understanding of the mechanisms of blood -surface interaction, and despite decades of bioengineering research, the non-thrombogenic prosthetic surface remains an unsolved problem. The problems of thrombosis and anticoagulation increase with time on ECC hence are magnified during prolonged ECC. During the past 30 years our research group and others have developed prolonged extracorporeal life support (, ECLS, ECMO) from bench to animal testing to clinical testing to routine clinical application. Our current grant (and the proposed renewal) is focused on the last major issue limiting prolonged ECC: thrombosis and anticoagulation. We believe we can now solve this problem. The goal of this study is extracorporeal circulation without anticoaqulation. The primary approach is make and evaluate a non-thrombogenic surface which releases nitric oxide at a controlled rate sufficient to prevent platelet adhesion and activation. Our current studies on NO releasing polymers demonstrate that this is feasible. Secondary approaches are 1) to evaluate NO releasing surfaces combined with surface bound heparin; 2) to characterize the physiologic and hematologic responses to extracorporeal circulation without anticoagulation. The results will apply to all blood surface interactions including short term ECC, intravascular and implantable devices and all types of extracorporeal blood processing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FIBER HEMODIALYSIS

BUNDLE

VOLUME

AND

CLEARANCE

DURING

Principal Investigator & Institution: Krivitski, Nikolai M.; Staff Scientist; Transonic Systems, Inc. 34 Dutch Mill Rd Ithaca, Ny 14850 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-JAN-2005 Summary: (Provided by Applicant): Failure to deliver an adequate dose of hemodialysis is a major factor contributing to the high mortality rates observed among hemodialysis

Studies

51

patients in the United States. Efforts to improve this situation are limited by the tools available to quantify and troubleshoot hemodialysis dose delivery. Currently there is no inexpensive, reliable screening device on the market that simultaneously monitors the four major parameters that influence hemodialysis adequacy: dialyzer clearance, fiber bundle volume (FBV), true delivered blood flow, and access recirculation. Transonic Systems, Inc. proposes to address this need through the development of a Hemodialysis Adequecy Meter (HDAM). Phase I of the subject application demonstrated the feasibility of using ultrasound dilution technology to make accurate and reproducible measurements of FBV and clearance. During Phase II, we will add out two established measurement methods for delivered blood flow and access recirculation to develop a prototype HDAM. This prototype will be used to perform a multicenter controlled clinical trial of the efficacy of the device. Data from the tril will be used in measurement method optimization. Following FDA clearance, Transonic Systems will proceed to market with the HDAM as a new standard of quality dialysis care. PROPOSED COMMERCIAL APPLICATION: The Transonic Hemodialysis Adequacy Meter will be the only technology capable of fully assessing dialysis adequacy. This technology will improve hemodialysis outcomes, reduce management costs, and improve the quality of life for hemodialysis patients. A low cost, portable device will be successfully marketable in every hemodialysis center and ICU. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FIBRILLOGENESIS PATHWAYS IN DIABETES AND RENAL DISEASES Principal Investigator & Institution: Miranker, Andrew D.; Molecular Biophysics & Biochem; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2004; Project Start 15-AUG-1999; Project End 31-DEC-2007 Summary: (provided by applicant): The conversion of soluble proteins into amyloid fibers is a feature of a number of clinical disorders including Alzheimer's, Huntington's and type II diabetes. In each medical disorder, the precursor protein has distinct primary and tertiary structure. However, the resultant fibers are remarkably similar at the histological and ultrastructural level. Fiber formation kinetics are similar to crystallization in that there exists a prolonged lag phase in which fiber is undetectable. This is followed by a cooperative transition to the fibrous state. Interestingly, both the fibrous state, and the intermediate states sampled during the lag phase have been identified as cytotoxic. Central to all these disorders, therefore, is the need to identify the molecular basis of conformational change. The overall goal of this proposal is to determine the molecular basis for amyloid conversion in two medically relevant systems. First, islet amyloid polypeptide(IAPP), a 37 residue peptide hormone that is cosecreted with insulin by the b-cells of the pancreas. In type II diabetics, it deposits as amyloid resulting in b-cell death. Second, renal diseases which necessitate treatment by dialysis result in the deposition of b-2 microglobulin (b2m) in the joints giving rise to a variety of skeletal pathologies. In both of these systems, it is wild-type, unmodified forms of the protein which aggregate. Our approach is to identify plausible changes in the in vivo environment of theses proteins and to determine the molecular impact of these changes on the folding and fibrillogenesis of these systems. In lAPP, our group recently reported the existence of an obligate intermediate and two nucleation processes. The first major aim is to determine the conformation and oligomeric changes associated with these phenomena. Furthermore, we have also determined that fibrillogenesis of lAPP is significantly perturbed by both insulin and the lipid bilayer of the secretory granule. As both of these components are perturbed in diabetics, we will determine the

52

Hemodialysis

molecular basis for these effects. In Beta2m, our group recently discovered a novel interaction between b2m and Cu(ll) which can uniquely give rise to the nucleation of amyloid fibers under conditions present during hemodialysis therapy. Our second major aim is to determine the structural and energetic basis for divalent induced amyloidosis. Our aims will be met by combined use of mutagenesis, optical, NMR and deuterium exchange techniques to elucidate the perturbation of protein folding and fibrillogenesis pathways. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FREEDOM - FREQUENT DIALYSIS OUTCOMES & MARKERS STUDY Principal Investigator & Institution: Chertow, Glenn M.; Associate Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): The FREEDOM (Frequent Dialysis Outcomes & Markers) Study is a randomized clinical trial designed to test hypotheses related to the feasibility, safety, and efficacy of frequent (>3 times per week) hemodialysis. The recently completed NIDDK-funded HEMO Study demonstrated that survival and many other outcomes were not appreciably influenced by significant increases in equilibrated Kt/Vurea, a parameter of dialysis dose, when hemodialysis was given thrice weekly. Clinical experience and published anecdotal reports suggest that more frequent dialysis may result in reduced frequency and duration of hospitalization, improved control of volume overload, hypertension and anemia, correction of disorders of mineral metabolism, and enhanced quality of life. Given the high mortality rates and significant morbidity associated with end-stage renal disease, a rigorous evaluation of alternative dialysis strategies is warranted. The Investigators have constructed a consortium of University- and community-based nephrologists and dialysis units throughout the state of California - the California Coordinating Clinical Center (CCC). We serve urban and suburban communities with extensive racial, ethnic and socioeconomic diversity. We intend on enrolling 200 subjects {adults and children) as requested by the RFA with a "recruit to replace" strategy to maximize the information gained and resources utilized. Subjects will be randomized in a 1:1:1:1 ratio to hemodialysis three, four, five, or six days per week, with dialysis efficiency targets kept equivalent on a per treatment basis. We will work closely with the General Clinical Research Centers at UCSF, UCLA, and UC San Diego. The sample size will not be sufficient to demonstrate a difference in survival among groups. However, the study should have sufficient power to detect significant differences in several of the planned safety and efficacy outcomes and measures. The California CCC Investigators and Consultants have considerable expertise in many of the selected outcomes and measures, including vascular access, nutritional status, vascular calcification, inflammation and oxidative stress, physical function, cognitive function, quality of life, depression, mineral metabolism, bone density and dynamics, anemia, and dialysis dose quantification. We are committed to working cooperatively and constructively with the other CCC and Data Analysis Coordinating Center-regardless of the final agreed-upon protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: FREQUENT HEMODIALYSIS CLINICAL TRIALS: NOCTURNAL Principal Investigator & Institution: Rocco, Michael V.; Professor of Medicine; Internal Medicine; Wake Forest University Health Sciences Winston-Salem, Nc 27157

Studies

53

Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Wake Forest University has established a clinical consortium to provide six times per week nocturnal home hemodialysis for the NIH RFA for Frequent Hemodialysis Clinical Trials. This consortium consists of ten clinical sites located in the eastern United States, eastern Canada and the Midwestern United States. The consortium includes four of the largest nocturnal home hemodialysis programs in the United States, located in Lynchburg, VA, Saratoga Springs, NY, New York City, NY and Kansas City, MO and one of the largest nocturnal home hemodialysis programs in Canada at London, Ontario. Our clinical centers have more than 190 patient-years of experience with nocturnal home hemodialysis and have provided more than 60,000 home nocturnal hemodialysis treatments. The one year mortality rate for patients receiving nocturnal home hemodialysis at these centers is 4.7% (based on 84.9 patient-years of follow-up), significantly less than the 16.6% mortality rate observed in the NIH sponsored HEMO Study. The observed one year mortality rate for this cohort was 4, compared to an expected mortality rate of 15.8 (chisquare = 8.8, p < 0.005). This consortium proposes to randomize chronic end stage renal disease patients to either six times per week nocturnal home hemodialysis or standard three times per week hemodialysis. Patients will be assessed for the suitability of nocturnal home hemodialysis via a standardized protocol during the baseline period. Those patients that are found to be suitable will then be randomized. Patients will be followed for 12 to 18 months. The primary goals of this study will be to determine the feasibility of randomizing patients into this trial. The primary outcome for the study will be all-cause hospitalizations. Secondary outcomes will include mortality, protein and energy intake, anthropometrics, quality of life, functional status and physical activity. Laboratory data, dialysis parameters and patient medications will also be collected to assess the impact of the interventions on hypertension, anemia, and secondary hyperparathyroidism and electrolyte abnormalities. All hospitalizations, including inpatient and outpatient access interventions, will also be tracked. Direct cost estimates of the two different hemodialysis treatments from a limited societal perspective will also be obtained. Patient safety will be monitored by an external Data Safety and Monitoring Board. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC SUSCEPTIBILITY TO END STAGE RENAL DISEASE Principal Investigator & Institution: Iyengar, Sudha K.; Associate Professor; Epidemiology and Biostatistics; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-SEP-1998; Project End 31-JUL-2003 Summary: (Adapted from applicant's abstract) End-stage renal disease (ESRD) is a lateonset multi-factorial disease that primarily occurs in a subset of patients with diabetes mellitus, hypertension or chronic glomerulonephritis. End-stage renal disease incidence ins rising with an annual mortality of about 20% in incident cases. End-stage renal disease clusters in families and familial aggregation is a more powerful predictor of whether an individual with diabetes mellitus, hypertension or chronic glomerulonephritis will develop ESRD. However, no particular genetic mechanism responsible for the renal function damage that ultimately leads to ESRD as yet been identified. We will recruit 150 affected sib pairs concordant for ESRD and Type 2 diabetes and 200 sib pairs discordant for ESRD (but concordant for Type 2 diabetes mellitus) and 200 additional family members from hemodialysis, peritoneal dialysis and transplant centers as part of a study to identify genetic risk factors for ESRD. We will

54

Hemodialysis

collect extensive family history and medical history as related to ESRD, on all members of the family recruited into the study. Blood will be obtained from consenting family members. The DNA will be extracted from lymphocytes and candidate genes and other markers will be genotyped. More than half the candidate genes/regions being examined are novel candidates and have not been evaluated for linkages with ESRD before. These include the receptors for the growth factors and the human regions syntenic to ESRDrelated loci in rat or mouse models of ESRD. We will also examine regions of human chromosomes 7 and 16, where a genome scan in the Pima Indians shows suggestive evidence for diabetic nephropathy loci. Data will be analyzed using model-free linkage analysis. This dataset is expected to be complex and will have to sub-divide the data by race/ethnicity for analysis. We anticipate that this study will lead to identification of gene(s) for ESRD. This application is intended to provide a core for further, more extensive, acquisition of ESRD phenotype and genotype data. We intend to expand the entire project to include a genome scan and have designed subject collection to accommodate this goal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMODIALYSIS ACCESS PROCEDURES AND INFECTION RISK Principal Investigator & Institution: Korzelius, Cynthia A.; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): Complications associated with hemodialysis vascular access are among the most important causes of morbidity and expense in end stage renal disease (ESRD) hemodialysis patients in the United States today. The most frequent cause of graft failure is thrombosis usually due to venous stenosis. Based on results from nonrandomized studies using historical controls, the National Kidney Foundation - Dialysis Outcomes Quality Initiative (NKF-DOQI) have recommended a program of routine monitoring and prophylactic repair of graft stenosis prior to development of graft thrombosis. The DOQI guidelines are widely considered to be the standard of care for hemodialysis patients. A randomized, controlled study of this prophylactic approach has been conducted at our institution and demonstrates no increase in duration of graft life but, in fact, an increased risk of infection in those patients assigned to angiographic intervention. The proposed study addresses the generalizability of these findings using a large, national database, the United States Renal Data System (USRDS) to examine the association between hemodialysis access procedures (angiograms and angioplasties) and graft infections. We will perform a retrospective, case-control study to determine whether patients who develop a graft infection are more likely to have had a graft angioplasty than a control group without graft infection. The improvement of hemodialysis vascular outcomes is an area of intense interest in the nephrology community and the optimal procedures for monitoring and maintenance have yet to be rigorously tested. The results of the proposed study will have important clinical and economic implications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: HEMODIALYSIS AND OXIDATIVE STRESS Principal Investigator & Institution: Balakrishnan, Vaidyanathapuram; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 30-APR-2006

Studies

55

Summary: (adapted from the application) Cardiovascular disease and bacterial infections are the leading causes of death in patients with end-stage renal disease (ESRD) on hemodialysis (HD). Besides the high prevalence of well established risk factors, these patients are in a state of heightened oxidative stress, characterized by excessive free radical production and/or low antioxidant defenses. The principal hypothesis of this proposal is that exposure of polymorphonuclear cells to the dialysis membrane in the extracorporeal circuit, triggers production of reactive oxygen species (ROS) leading to increased apoptosis and phagocytic cell dysfunction, as well as oxidative endothelial cell injury. Furthermore, the increasingly routine use of parenteral iron, a potent promoter of toxic free radical generation, in these patients may enhance oxidative stress-induced cell injury and dysfunction. This proposal will address these concerns using in vitro models to evaluate the impact of dialysis membrane biocompatibility and various iron preparations on indices of oxidative stress, cell injury and apoptosis. These models will involve PMN (healthy vs. uremic) activation by exposure to dialysis membrane fragments of varying composition plus and minus iron or ROS inhibitors, as well as during circulation through an in vitro dialysis circuit. In addition, a co-culture model will be utilized to assess the effects of dialysis membraneactivated PMN on reporter monolayers of cultured human endothelial cells (plus and minus excess iron) grown under static and flow conditions. The results of this proposal are expected to enhance our understanding of the pathogenesis of ROS-induced cell injury and dysfunction and lay the foundation for the development of novel strategies to combat atherogenesis, vascular access and immune dysfunction in this vulnerable population. The Principal Investigator has designed a comprehensive series of studies to evaluate the hypotheses enunciated in this proposal, and is well qualified to carry them through to completion. In addition to a strong background in clinical nephrology, he has an established track record in laboratory research, and is the recipient of a Ph.D. He is mentored by investigators with extensive experience in laboratory research and advised by a panel of internationally renowned investigators in immune function, endothelial cell biology, free radical and antioxidant research. Within a limited time, he and his mentor have put together an infrastructure tailored to achieve the goals of this proposal. The practical experience from the research proposed, and the comprehensive education program outlined are expected to build on the candidate's current skills and experience, and facilitate his transition to an independent investigator in basic research in the field of nephrology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMODIALYSIS FULL-SCALE TRIAL--DATA COORDINATING CENTER Principal Investigator & Institution: Beck, Gerald J.; Acting Chairman; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2002; Project Start 30-SEP-1992; Project End 31-AUG-2004 Summary: (Directly taken from the application) The Data Coordinating Center (DCC) for the Mortality and Morbidity Among Hemodialysis Patients (MMHD) Full-Scale Study will coordinate the scientific and operational aspects of the Study. This randomized clinical trial will evaluate two aspects of delivering hemodialysis: a low vs. high KT/V and a low flux/bio-incompatible vs. high flux/biocompatible membrane (in a two-by-two factorial design). The effectiveness and safety of these factors in reducing the mortality and morbidity of hemodialysis patients will be studied. In the beginning months of the initial Recruitment and Follow-Up Phase (Phase I), the DCC, in conjunction with the Steering Committee, will review the results of the Pilot Study and

56

Hemodialysis

finalize the design and protocol for the Full-Scale Study. Review and finalization of the Manual of Operations and data forms will take place. The database management system (using Oracle) that we established in the Pilot Study will be revised as necessary to carry out the Full-Scale Study. The randomization schedule for entering patients will be generated. The DCC will provide central training of Clinical Center staff in the areas of entry and follow-up of study subjects, completion of study forms, and use of the distributed data entry system. The Nutrition Consultant Group will provide the training and ongoing evaluation of dietary data and the Health Status and Comorbidity Assessment Group will do the same for these data. Dr. Chumlea will provide training and monitoring of anthropometry data. The DCC will arrange meetings of the Steering Committee and participate in these meetings and report the proceedings. The database management system will be used to assure accurate and complete collection of Study data. A query system will be used to resolve data discrepancies. A major function of the DCC during the Recruitment and Follow-Up phases (Phases I and II) will be to monitor patient recruitment and compliance to the protocol as a whole and by Clinical Center. Study progress will be reported in monthly reports to the Clinical Centers, newsletters, and in presentations to the Steering Committee and External Advisory Committee. Statistical analyses will be performed during the course of the study with final analyses completed and reported during Phase III of the Study. The DCC will develop new statistical methodology, as needed, to properly analyze the data being collected. Since the Study is a multi-centered effort, including several organizational Components, the DCC will be proactive and work to foster a spirit of cooperation so that goals of the Study are met. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMODIALYSIS CONSORTIUM

VASCULAR

ACCESS

CLINICAL

TRIALS

Principal Investigator & Institution: Greenberg, Arthur; Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: This is an application from the Department of Medicine, Divisions of Nephrology and Hematology, and the Department of Surgery at the Duke University Medical Center to participate as a clinical center in the NIH- sponsored Hemodialysis Vascular Access Clinical Trials Consortium. The proposed trial is a randomized prospective evaluation of a series of novel agents such as (Elmiron(R) pentosan polsulfonate sodium see appendix A, or Tissue Factor Pathway Inhibitor TFPI see appendix A or other novel interventional agent) versus placebo in the prevention of hemodialysis vascular access stenosis and thrombosis in hemodialysis AV access. Patients will be randomized to therapy with Elmiron(R) (or other trial agent) versus placebo. Randomization criteria will include whether this is a first or a subsequent AV graft as well as graft location and the presence or absence of diabetes mellitus. All patients entering the study will be screened with AV access flow, determined by the ultrasound dilution technique. Grafts with initial flows less than 1000 ml/min will not be randomized. Patients will be prospectively followed with monthly measurements of hemodialysis vascular access flow by ultrasound dilution. Decrements in AV access flow greater than 25% will prompt evaluation by venography. The primary end point in the study will be the development of a greater than 50% stenosis as determined by biplanar venography when associated with a concurrent flow decrement. All episodes of Access thrombosis will also serve as primary endpoints. Secondary end points will include all other AV access complications and hospitalizations. Ancillary studies will

Studies

57

include response of AV access to intervention, access patency, and the cost of the placebo and intervention arms of the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMODIALYSIS CONSORTIUM

VASCULAR

ACCESS

CLINICAL

TRIALS

Principal Investigator & Institution: Delmez, James A.; Internal Medicine; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 28-FEB-2006 Summary: (adapted from the application) Complications of vascular access in patients treated with chronic hemodialysis are a major source of morbidity. Currently, polytetrafluoroethylene (PTFE) grafts are the most prevalent form of vascular access for hemodialysis in the United States. The most frequent complication of these grafts is thrombosis. Consequences include further access procedures, missed dialysis treatments, and temporary vascular access devices. The costs of maintaining vascular access are approximately one billion dollars a year. In a small study, dipyridamole was shown to decrease the incidence of thrombosis in new PTFE grafts. The objective of this proposal is to determine if the use of dipyridamole is efficacious in decreasing the need for intervention and in prolonging PTFE graft survival in patients undergoing chronic hemodialysis. This will be a prospective, randomized, double blinded trial involving five Clinical Centers. The entrance criteria include patients with a functioning (prevalent) or new (incident) PTFE graft with an access flow of >800 ml/min. One hundred twenty five chronic hemodialysis patients from this center will undergo randomization to receive dipyridamole 75 mg TID or placebo TID. If the graft flow (measured monthly) decreases to 25 percent decrease in flow compared to baseline, patients will undergo diagnostic fistulography. If a significant lesion is found (as defined by strict criteria), the patients will undergo a radiological or surgical intervention. The primary outcome will be the time from initiation of drug until the first intervention for thrombosis or declining access flow rates. The first secondary outcome will be the time from initiation of drug until the graft is irreversibly lost due to thrombosis. The other secondary outcome will be the number of radiological and surgical interventions required to maintain graft patency normalized to patient-year follow-up. If dipyridamole beneficially affects these outcomes, use of the drug in hemodialysis patients with PTFE grafts should decrease patient morbidity and lower healthcare costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPERTENSION IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Agarwal, Rajiv; Associate Professor of Clinical Medicine; Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): There are over 316,000 patients with end-stage renal disease in the USA that cost Medicare about $11 billion/year. Hypertension plays an important role in causing excess cardiovascular morbidity and mortality that accounts for approximately half of all deaths, yet hypertension is poorly controlled in the vast majority of the US hemodialysis patients. There are no guidelines for the diagnosis and treatment of hemodialysis hypertension. We have preliminary evidence that home BP monitoring can accurately diagnose hypertension and that ultrafiltration and supervised

58

Hemodialysis

antihypertensive drug therapies can enhance hypertension control. In Specific Aim 1 we will evaluate the clinical performance of routine hemodialysis unit BP monitoring and home BP monitoring in the diagnosis of hemodialysis hypertension in 150 chronic hemodialysis patients. Interdialytic ambulatory BP will be the gold standard. In Specific Aim 2 we hypothesize that achieving "dry-weight" controls systolic hypertension rapidly in a prevalent hemodialysis cohort, can be predicted by echocardiographic signs of volume overload and can be accurately detected by home BP monitoring. This improvement in BP can be also predicted by demographic factors and parameters of volume excess. We propose an 8-week, prospective, randomized, trial of ultrafiltration therapy, to assess the efficacy, safety and tolerance of ultrafiltration therapy in controlling systolic hemodialysis hypertension. To assist clinicians in decision making, specific markers of volume excess such as plasma BNP (brain natriuretic peptide), plasma renin activity, and change in protein concentration from pre to post dialysis will be evaluated as predictors of improvement in BP with ultrafiltration therapy. In specific aim 3 we hypothesize that an initial strategy of treatment with an ACE inhibitor based therapy is more effective than beta-blocker based therapy in causing regression of echocardiographic left ventricular hypertrophy (LVH) in patients with hemodialysis hypertension. We propose a parallel group, active control, randomized controlled trial comparing the safety and efficacy of initial monctherapy with an ACE inhibitor versus a beta-blocker each administered three times weekly after dialysis to assess BP reduction and LVH regression by echocardiography. In summary, we use simple strategies to diagnose hypertension in hemodialysis patients, evaluate the role of expanded extracellular fluid volume and test supervised drug therapies to impact hypertension control. We also assess the clinical performance of bedside tests to assess an expanded extracellular fluid space. Evaluation of such strategies will improve BP control in hemodialysis patients and, in the long-term, provide cardiovascular protection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IDENTIFICATION OF NOVEL PROTEINS SECRETED BY THE KIDNEY Principal Investigator & Institution: Xu, Jianchao; Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 30-APR-2005 Summary: (provided by applicant): Hemodialysis therapy is a life saving procedure for patients with either chronic end-stage renal disease or acute renal failure. However, the morbidity and mortality associated with this therapy are undesirably high, and many patients suffer from a poor quality of life. The causes for these less than ideal results are not entirely clear. Since the procedure uses an extracorporeal "artificial kidney" to remove excess water and soluble wastes from the blood, it can't replicate the important absorptive, metabolic, endocrine, and immunological functions of the natural organ. Therefore, a very strong possibility is that the incomplete replacement of kidney functions contributes to the dismal prognosis of patients on dialysis. The importance of understanding the kidney's endocrine function is underscored by the discovery of erythropoietin. There is evidence to suggest that the kidney's endocrine function is not limited to the secretion of renin and erythropoietin. The characterization of previously unknown proteins/hormones that are secreted by the kidney will not only provide a more complete understanding of renal physiology but may also significantly improve the way we treat patients with end-stage renal disease. As a first step toward these endeavors, this proposal is aimed at identifying novel proteins that are secreted by the kidney using a human functional genomics database, coupled with an innovative

Studies

59

approach for gene expression, which allows rapid analysis of many genes in parallel. In this proposal, we address three issues: 1) What are the novel candidate genes potentially encoding secreted proteins? 2) Are the candidate genes specifically or highly expressed in the kidney? 3) Do these candidate genes indeed encode secreted proteins? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ILLNESS REPRESENTATION IN ELDERS WITH ESRD Principal Investigator & Institution: Thomas-Hawkins, Charlotte; Scientist; None; Rutgers the State Univ of Nj Newark Blumenthal Hall, Suite 206 Newark, Nj 07102 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): The applicant's immediate research career goals are to explicate the illness representations of elderly individuals with end-stage renal disease (ESRD) and to examine the effect of illness representations on functioning in these individuals. The applicant's longterm research goals are to develop and test the effectiveness of interventions designed to alter illness representations and stop or reverse functional decline in elders with ESRD. To meet these goals, the applicant has proposed a plan of comprehensive, mentored training and research in theoretical perspectives related to aging, aging and functional decline, and aging research, as well as an application of this knowledge to a program of research tailored to illness representations in chronically ill elders. Mentors will be Dr. Howard Leventhal and Dr. Neville Strumpf. The proposed research and training environments are: 1) The Institute of Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey; 2) The Center for Gerontologic Nursing Science, University of Pennsylvania School of Nursing; and 3) The College of Nursing, Rutgers, The State University of New Jersey. Training activities will consist of didactic course work, pre-planned mentor meetings, participation in ongoing seminars, research and scientific meetings, directed readings, and scientific publications and presentations. The aims of the proposed studies are 1) to insure that the terminology used in the Illness Perception Questionnaire matches the experience of ESRD for elderly patients; 2) to explicate the illness representations of elderly ESRD patients; and 3) to examine the effect of their illness representations on their level of functioning. The findings from these studies will be used to support a program of theory-based, tailored, psycho-educational nursing intervention studies designed to alter illness representations and stop or reverse functional decline in elders with ESRD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: IMPROVED REMOVAL OF PROTEIN-BOUND TOXINS IN DIALYSIS Principal Investigator & Institution: Collins, Gregory R.; Nephros, Inc. Audubon Technology Center New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): End Stage Renal Disease (ESRD) is associated with an accumulation of "uremic" toxins in essentially three categories: small water-soluble compounds, larger middle molecules, and small protein bound molecules. Current treatment modalities do not address the removal of small protein-bound substances. This research targets an ionic-hemodiafiltration-based product that removes small protein-bound solutes from blood; this function is not addressed by existing technology. This can be an extension of our unique multistage diafiltration process, with two diafiltration steps in series and substitution fluid added in a middilution mode (US Patent #6303036); or can be integrated with standard dialysis technology. An agent is

60

Hemodialysis

added to dialysate fluid entering a first stage, causing an ionic (pH) shift of the blood, thereby dissociating a significant portion of protein-bound toxins from their conjugated protein counterparts. Once unbound, the small toxins are transported across a semipermeable membrane by diffusive/convective mechanisms. A second stage acts to return the ionic-altered blood to a normal condition before reinfusion. This Phase I research will qualify agents to be added to the dialysate fluid entering the first stage, so as to ensure safety and efficacy. PROPOSED COMMERCIAL APPLICATION: As of 2001, there were over 300,000 ESRD patients in the US, served by over 60,000 dialysis machines; this market is expected to exceed $500 million annually by 2008. Incorporating ionic technology will provide the unique benefit of removing proteinbound toxins, thereby reducing various comorbid conditions associated with toxic accumulation, improving overall patient health, and reducing associated hospitalizations, currently representing a $600 million+ annual expenditure. Additional applications include treatment of patients intoxicated with poisons or drugs with known protein binding characteristics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVED THROMBOLYSIS IN DEEP VENOUS OCCLUSIONS Principal Investigator & Institution: Kini, Vinayak; President; Fluent Cardiovascular Solutions, Inc. 200 Innovation Blvd, Ste 260 University Park, Pa 16803 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JUL-2003 Summary: (provided by applicant): We have developed concepts for improving the efficiency of hydrolytic-aspiration type mechanical thrombectomy device (MTD) catheter systems for use in the treatment of thrombosed Hemodialysis Grafts (HDG). These improved systems are capable of providing higher shear-rates for thrombus maceration, with increased clot-aspiration potential and minimal potential for wall damage and distal embolization. The specific aim of this R&D project is to develop working prototypes of the catheter in order to validate all the design concepts and set the stage for further investments necessary to take the device into practical percutaneous thrombectomy use in the treatment of thrombosed HDG. In the first stage, we will extensively test the ability of the prototypes to generate high shear-rates and adequate aspiration potential under physiologic flow conditions with increased emboliremoval rates and reduced distal embolization. Successful development of proof-ofconcept design prototypes will lead us to attempt to attract further funding for the in vivo trials needed to take the design into the HDG vascular surgery market. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: IN SITU DETECTION OF DENTAL UNIT BIOFILMS Principal Investigator & Institution: Saxena, Indu; Senior Scientist and Group Leader; Intelligent Optical Systems, Inc. 2520 W 237Th St Torrance, Ca 905055217 Timing: Fiscal Year 2002; Project Start 01-NOV-1998; Project End 31-AUG-2004 Summary: (provided by applicant): This Phase II grant application requests funds for developing a portable monitoring system suitable for the general screening of bacterial fouling in water lines used in dental practice or in hemodialysis facilities. In Phase I, Intelligent Optical Systems (lOS) demonstrated the detection of bacteria biofilm on polycarbonate tubes (coupons) using flexible sub-mm optical fiber probe (Bioprobe). This system allows on-line detection, and eliminates the slow, laborious, and complicated microbial counting and microscopic methods currently used to monitor biofilm. Bioprobe is suitable for the real-time detection of sessile and suspended bacteria

Studies

61

in dental unit water and other medical fluid delivery systems. In Phase II, lOS will detect 500 cfu/ml or better of planktonic and sessile bacteria by optimizing Bioprobe's sensitivity and reproducibility. Using a variety of bacterial cultures, the probe will be tested rigorously in the laboratory to establish its versatility. Neural network-based signal processing techniques will be used to remove cross-sensitivity to contaminants such as proteins and polysaccharides. At the end of Phase II, the Bioprobe will be alphatested in medical and dental clinics in preparation for its commercial launch. PROPOSED COMMERCIAL APPLICATIONS: The first commercial application of the on-line Bioprobe will be in the detection of biofilms in dental unit water lines (DUWLs). The Biprobe will also be used to detect biofilm buildup in food processing and hemodialysis systems. Eventually, we visualize the use of the Bioprobe in industrial systems in which biofilm acculation poses problems, including heat exchangers and desalination operations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON DELIVERY VIA HEMODIALYSATE IN ESRD Principal Investigator & Institution: Gupta, Ajay; Internal Medicine; Charles R. Drew University of Med & Sci 1731 East 120Th Street Los Angeles, Ca 900593025 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2006 Summary: (provided by applicant): Erythropoietin (EPO) is an effective therapy for anemia of end-stage renal disease (ESRD) and is used in almost all ESRD patients receiving chronic hemodialysis. EPO stimulated iron utilization, coupled with small but unavoidable loss of extra corporeal blood with hemodialysis, leads to iron deficiency in almost all patients. Adequate iron delivery, by oral or parenteral supplementation, is necessary for optimal EPO action. Compliance with oral iron is poor due to gastrointestinal toxicity. Therefore intravenous (i.v.) iron is administered to 50-75 percent of hemodialysis patients, either intermittently when iron deficiency develops or at regular intervals to prevent iron depletion. Parenteral iron is a pro-oxidant, and may increase the risk of infections, inflammation and atherosclerosis by further enhancing oxidative stress and inflammation present in the majority of hemodialysis patients. Unlike the large polymeric iron complexes that are administered i.v., ferric pyrophosphate (FePPi), a monomeric iron salt (745 Da), can be delivered directly into the circulation when added to dialysis solutions. Fe(III) complexes tightly with pyrophosphate (PPi), thereby reducing dissociation and release of free iron. PPi anion is an antioxidant that promotes direct delivery of iron to transferrin, and iron transfer from transferrin to ferritin. FePPi is highly soluble in the acid concentrate and a concentrate fortified with FePPi can be used to generate a dialysate with defmed concentration of FePPi (Fe-HD). This is a double-blinded, randomized, controlled Phase II clinical trial to determine the safety and efficacy of FePPi added to the hemodialysis solutions in ESRD patients over a period of 9 months. Iron replete patients in=30) with no evidence of iron overload (transferrin saturation or TSAT< 40 percent, and ferritin < 800 lag/L), who have needed intravenous iron in the previous 2 months will be enrolled. Patients will be randomized to receive hemodialysis using Fe-HD or C-HD with every dialysis session for a total period of 9 months. The initial dose of dialysate iron will be 9 lag/dl if TSAT is 30-40 percent, and 11 lag/dl if TSAT is < 30 percent. Serum iron parameters (TSAT and ferritin) will be monitored every month. The dialysate iron concentration will be reduced to 9 lag/dl if pre-dialysis TSAT increases to 35-40 percent, and dialysate iron will be held if TSAT exceeds 40 percent. Dialysate iron will be restarted at 11 lag/dl if TSAT is < 30 percent and at 9 lag/dl if TSAT is 30-40 percent. Patients in both groups will receive 500 mg i.v. iron saccharate (Venofer(r)) in 5 divided doses at 5 consecutive

62

Hemodialysis

dialysis sessions if TSAT is 800 lag/L). The acute and chronic effects of dialysate iron on serum levels of catalytically active iron and markers of inflammation and oxidative stress will be measured at the beginning and the end of the study. This Phase II study will provide preliminary evidence of the safety and efficacy of ferric pyrophosphate infusion via the dialysate, with the aim of preventing iron deficiency, and pave the way for a large, clinical trial of dialysate iron therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IRON IN KIDNEY DISEASE Principal Investigator & Institution: Guadiz, Ramon; Charles R. Drew University of Med & Sci 1731 East 120Th Street Los Angeles, Ca 900593025 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: Patients with chronic kidney disease (CKD) develop anemia due primarily to deficient production of erythropoeitin (EPO). Administration of EPO to patients with end-stage renal disease (ESRD), stimulates erythropoiesis and often leads to functional iron deficiency. Furthermore, iron losses are high, particularly in the hemodialysis patient. Patients are frequently non-compliant with oral iron supplements due to associated gastrointestinal side-effects. Oral iron supplements frequently fail to maintain adequate iron stores in EPO-treated hemodialysis patients. The use of i.v. iron has been shown to increase hemoglobin, and may therefore improve quality of life, and reduce morbidity and mortality in uremic patients. However, life-threatening/serious acute reactions to i.v. iron have been reported. Recent evidence suggests that i.v. iron leads to oxidative stress in ESRD. Oxidative stress, universally present in ESRD, has been implicated as one of the causes of atherosclerosis and resulting high morbidity and mortality from coronary artery disease, strokes and gangrene in these patients. To explore delivery of iron via the dialysate, ferric pyrophosphate (FePPi), the most stable and nontoxic of all monomeric iron salts has been selected. The present study will test the safety and efficacy of FePPi delivery via the dialysate in preventing iron deficiency, in chronic hemodialysis patients. The specific aims of this study are as follows: 1 ) To determine the efficacy of hemodialysis solutions containing ferric pyrophosphate in preventing the development of iron deficiency, compared with the conventional hemodialysis solutions. 2) To determine the safety of hemodialysis solutions containing ferric pyrophosphate, compared with the conventional hemodialysis solutions, by monitoring adverse reactions manifesting clinically or on laboratory testing. 3) To study catalytically active iron on markers of inflammation and oxidative stress 4) To study the effect of dialysate iron on dialyzer reuse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ISOFLAVONES:ACUTE RESPONSE IN CHRONIC RENAL FAILURE Principal Investigator & Institution: Fanti, Paolo; Associate Professor; Internal Medicine; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2002; Project Start 15-JUL-2001; Project End 31-DEC-2003 Summary: (provided by applicant): Up to 40 percent of ESRD patients suffer from a chronic inflammatory process which is not currently amenable to specific treatment and is associated with high morbidity and mortality. High circulating levels and production of pro-inflammatory cytokines are essential part of this ongoing acute-phase response and they are believed to exacerbate many of the clinical manifestations of ESRD, including renal osteodystrophy. Like in all other inflammatory processes that have undergone more extensive investigation, the nuclear factor, Nuclear Factor Kappa-B

Studies

63

(NFKB) promises to be a critical cellular intermediate of this acute-phase response and to be both mediator and target of inflammatory cytokine effects. In the current search for agents that may be able to negate the ongoing acute-phase response of ESRD, the soy isoflavones genistein and daidzein have emerged as potentially useful. These isoflavones are present in many soyfoods, are available as over-the-counter nutritional supplements and have received growing attention due to their biological properties and potential as therapeutic agents. Inhibitory effects of the isoflavones on tyrosine kinase and NFKB activity, on inflammatory cytokine production and on oxidative stress have been demonstrated by this group and by many other investigators and they may be highly relevant to the renal failure population. Additionally, we have found recently that intake of soy food by ESRD patients results in very high blood levels of isoflavones and it is well tolerated. It is our working hypothesis that in chronic renal failure a variety of endogenous and exogenous factors trigger acute-phase response with activation of NFKB and production of pro-inflammatory cytokines, and that intervention with soy isoflavones inhibits NFKB activation and cytokines production, thus blocking the ongoing acute-phase response and affecting positively clinically relevant parameters of disease activity in ESRD. Specific objective of this proposal is to conduct a randomized, double-blinded dietary intervention trial in hemodialysis patients to determine whether: 1. Dietary intake of the soy isoflavones by ESRD patients with clinical signs of ongoing acute-phase response decreases the production of the proinflammatory cytokines TNF-alpha, IL-1 and IL-6 in peripheral blood, thus changing the balance between these cytokines and their antagonists sTNF RI, sTNF RII, and IL1ra. 2. Suppression of inflammatory cytokine production by soy isoflavones is associated with improvement of clinically relevant parameters of disease activity, including improvement of blood markers of acute-phase response, and decreased blood levels of markers of metabolic bone disease. 3. Intake of soy isoflavones suppresses NF-KB activity in peripheral blood monocytic cells of ESRD patients, in a manner consistent with change of cytokine levels and of clinical parameters of disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MALNUTRITION IN DIALYSIS PATIENTS Principal Investigator & Institution: Ikizler, Talat A.; Associate Professor; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2004; Project Start 30-SEP-1992; Project End 31-MAR-2007 Summary: (Revised Abstract) : Nutritional status is an important predictor of clinical outcome in chronic hemodialysis (CHD) patients, as uremic malnutrition is strongly associated with increased risk of death and hospitalization events. Decreased muscle mass is the most significant predictor of morbidity and mortality in these patients. Several factors predispose CHD patients to increased catabolism and loss of lean body mass. Chronic hemodialysis patients suffer from profound anorexia and have decreased dietary protein intake. Further, these patients live a sedentary life-style and their physical activity level is low. In combination, these factors predispose CHD patients to a catabolic state leading to loss of muscle mass. These observations led us to hypothesize that supplementing dietary protein intake along with an anabolic intervention such as exercise will collectively improve uremic malnutrition. The broad goal of this proposal is to identify the mechanism(s) by which CHD patients lose muscle mass and test certain interventions that will either prevent whole-body and muscle protein breakdown or enhance muscle growth. We will perform stable isotope tracer techniques to assess protein and energy homeostasis and compliment these studies proinflammatory cytokine profiles in the muscle tissue. This proposal will test the hypotheses that A)

64

Hemodialysis

Acute exercise protocol combined with adequate nutritional supplementation improves skeletal muscle protein accretion during a single hemodialysis session; B) If performed long-term at increasing intensity, this protocol (exercise combined with adequate nutritional supplementation) will result in net muscle growth in CHD patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICAL MAINTENANCE OF HEMODIALYSIS VASCULAR ACCESS Principal Investigator & Institution: Vazquez, Miguel A.; Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: End-stage renal disease (ESRD) is a devastating illness, and each year in the United States more than 80,000 new patients need initiation of therapy for ESRD. The majority of these patients will receive life-sustaining treatments in the form of hemodialysis. Unfortunately, the quality and duration of the lives of patients on hemodialysis are severely restricted by vascular access. Recent observations suggest that nearly 25% of hospitalizations in the ESRD population are related to vascular access, and problems that emanate from vascular access cost nearly $1 billion annually. Vascular access failure is arguably the most important reversible cause of morbidity in ESRD. This application is in response to RFA DK-00-012 and describes our competence to serve as a clinical center in the Hemodialysis Vascular Access Consortium. We have a strong track record in recruiting for and participating in similar multicenter trials in Nephrology, since we currently serve as large clinical sites for the African American Study of Kidney Disease and Hypertension (AASK) and the Morbidity and Mortality and in Hemodialysis (HEMO) trials. We propose a prevention trial with the cell cycle inhibitor Sirolimus (Rapamycin) in PTFE grafts. We will recruit from our pool of more than 2000 hemodialysis patients, and we will work with the Data Coordinating Center and the other sites to design and conduct a series of multicenter, randomized, placebocontrolled clinical trials of therapies to reduce the complication rate of AV grafts and fistulas in hemodialysis patients over a 5-year period. We anticipate that this consortium will be able to develop new approaches to managing hemodialysis vascular access, and that these new treatments can decrease the costs and complications of hemodialysis care of the US ESRD population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: MENTORED DEVELOPMENT AW

PATIENT-ORIENTED

RESEARCH

CAREER

Principal Investigator & Institution: Mullaney, Scott; Medicine; University of California San Diego La Jolla, Ca 920930934 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: (Adapted from the applicant's abstract): Currently, over 280,000 patients in the U.S. undergo chronic HD for the treatment of end-stage renal disease (ESRD). Technical advances have improved the procedure, yet dialysis- related blood pressure alterations remains a common complication and may contribute to increased morbidity and mortality in HD. Intradialytic hypotension (IH) occurs in up to 48% of HD treatments, contributes to inadequate dialysis and reduces patient comfort and compliance. IH results from a complex interaction between the patient's volume status and the cardiovascular and hemodynamic responses to fluid and solute removal. Several mediators have been incriminated for their likely contribution to IH including

Studies

65

inflammatory cytokines [interleukin 1(IL-1) and tumor necrosis factor alpha (TNFa)], complement, and recently NO. NO, a potent vasodilator formed by nitric oxide synthase (NOS), is released from the vascular endothelium. NO levels are elevated in ESRD, and recent studies have reported a strong association between NO and IH with increased NO being associated with more IH. Although NO may have a significant effect on the hemodynamic response to HD, the mechanisms contributing to elevated NO levels, including the effect of HD have yet to be clearly defined. The applicant proposes to test the hypothesis that NO is an important mediator of the hemodynamic response to HD, and that reducing NO would allow for prevention and treatment of dialysis-related events. The project will provide an evaluation of the prevalence of elevated NO in hemodialysis patients, as well as explore the relationship of these levels to hemodynamic profiles including an assessment of blood volume changes and distribution of fluid in various compartments during dialysis. Additionally, mechanisms that may elevate NO levels will be explored through systematic study of the effect of HD and dialysis-related factors on NO levels. Finally, the effect of reducing NO levels, via NO scavengers or NOS inhibitors, on blood pressure changes will be studied. The proposed work will add to the knowledge and understanding of the pathophysiology of blood pressure changes in the HD patient population, and permit development of better strategies to prevent and treat the occurrence of IH in the HD population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODERN DESIGN SOFTWARE FOR BIOMEDICAL DEVICES Principal Investigator & Institution: Spradley, Lawrence W.; Researchsouth, Inc. 555 Sparkman Dr, Ste 1612 Huntsville, Al 35816 Timing: Fiscal Year 2002; Project Start 06-MAY-2002; Project End 31-OCT-2002 Summary: ResearchSouth is proposing research and development of new biocomputing technology that will enable automated CFD-based design optimizing of biomedical devices. The proposed project will develop innovative software that combines the best technologies available in aerospace optimization with those in cardiovascular device development. Preliminary work by the offerors has demonstrated the effectiveness of such a design approach when applied to new and existing rotary cardiac- assist devices. We anticipate this project to provide a rational basis for analyzing and optimizing biomedical devices with respect to blood hemolysis and thrombosis. In Phase I, we will use automated shape optimization to minimize blood hemolysis in a hemodialysis connector and experimentally validate the results, and we will begin the design and development of next-generation CFD-based design optimization software. In Phase II, a user-friendly commercial-quality software package specifically customized for design and analysis of blood- carrying devices will be implemented. PROPOSED COMMERCIAL APPLICATIONS: The potential users of this design software include any individual, group, or company engaged in biomedical device development. Our software will be the first commercial product to incorporate practical blood damage models for biomedical device analysis and design applications. The majority of the design optimization software tools developed in this project will find immediate application in the aerospace, automotive, and turbomachinery fields. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: MORTALITY & MORBIDITY IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Daugirdas, John T.; Professor; Medicine; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612

66

Hemodialysis

Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: This trial is designed to evaluate survival as well as a number of secondary outcomes (hospitalization for cardiovascular disease, infection, or other non-accessrelated causes, declining body weight, or declining serum albumin level) in patients randomly assigned to one of four groups: (A) moderate-dose dialysis, low-flux cellulose membrane, (B)high-dose dialysis, low-flux cellulose membrane, (C) moderate-dose dialysis, high- flux synthetic membrane, (D)high-dose dialysis, high-flux synthetic membrane. Each Clinical Center will randomize sufficient patients among these 4 groups such that at least 60 patients are enrolled at all times. The patients will be followed for a 5-year period, replacing deaths or dropouts as they occur with new patients. An 18-month recruitment phase is followed by a 5-year follow-up/intervention phase, and a 6-month closeout phase. Our Clinical Center is uniquely qualified to successfully participate in this study. It is a partnership between the University of Illinois College of Medicine and West Suburban Kidney Centers, a corporation of 14 dialysis units treating 1400 patients in the Chicago area. The study will be performed at the University of Illinois dialysis unit, as well as in 3 nearby units of the WSKC. According to the patient eligibility criteria set out by the Draft MMHD Protocol, we already have identified 220 patients in these 4 units who are eligible for the study and who also meet additional desired criteria (no gross non-compliance, no history of substance abuse, feasibility of delivering a 2-pool Kt/V of 1.4). The centralization of the administrative structure of the WSKC units, which extends through nursing, dietetics, social work, and technologists, and the centralized data gathering systems already in place, will greatly facilitate the coordination among units to complete the study. Appropriate technology to carry out high-efficiency dialysis is in place in each of the primary units. More than 80% of the dialysis stations in the primary units have volumetric UF controlled-machines capable of blood flows > 500 ml/min and dialysate flows of 800 ml/min. A dialyzer reuse program with excellent quality controls allows for use of high efficiency dialyzers which will be necessary to deliver the high-dose dialysis treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MORTALITY AND MORBIDITY IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Allon, Michael; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: End-stage renal disease (ESRD) is associated with a markedly reduced patient survival and substantial morbidity. The life expectancy of a 40 year-old dialysis patient is 8.8 years, as compared with 37.4 years for the general U.S. population of the same age. Retrospective studies have suggested that higher Kt/V and use of dialysis membranes with higher flux and greater biocompatibility may decrease morbidity and mortality in maintenance hemodialysis patients, but few prospective studies have evaluated the effects of such manipulations. This prospective, randomized, multicenter investigation will test the following hypotheses: (1) Hemodialysis achieving higher Kt/V results in decreased mortality in ESRD patients undergoing maintenance hemodialysis. (2) Hemodialysis with membranes of higher flux decreases mortality and morbidity. (3) These two interventions are safe and acceptable to hemodialysis patients. In-center hemodialysis patients will be randomized to receive dialysis treatments with either standard or high Kt/V (1.0 vs 1.4, double pool) and using either high flux membranes or low flux membranes. Subjects will be randomized to one of four experimental groups: a. Kt/V 1.40; High flux membrane b. Kt/V 1.40; Low flux

Studies

67

membrane c. Kt/V 1.00; High flux membrane d. Kt/V 1.00; Low flux membrane All other aspects of the patients' medical and dialysis care will follow the usual standards of care. The study subjects will be followed prospectively for five years to determine: a. Patient mortality (primary endpoint) b. Patient morbidity (secondary endpoint) i. Nonaccess related hospitalization (especially cardiovascular events or serious infections) ii. Malnutrition (a decline in serum albumin) The results will be analyzed to determine whether there are significant differences in patient survival or morbidity among the four treatment groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTI-ANALYTE APPLICATIONS

MICRO-DEVICES

FOR

BIOMEDICAL

Principal Investigator & Institution: Andrade, Joseph D.; Professor; Bioengineering; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2004 Summary: (provided by applicant): The investigators propose to develop microdevices for the specific chemical analysis of multiple metabolites in small sample volumes of biological fluids. The specificity and sensitivity is provided by specific reactions that couple analytes to bioluminescent-based enzyme reactions and produce light proportional to the analyte concentration. Bioluminescent analytical assays, in a miniaturized and stable format, can measure sub-microMolar concentrations in microliter sample volumes. The goal of the first phase (R21) is to engineer microfluidic structures, develop enzyme packaging and stabilization techniques, and optimize optical detection systems in order to measure two model analyte solutions (galactose and lactate) using bioluminescent reactions. The goal of the second phase (R33) is to implement other bioluminescent assays in the microfluidic detection system, develop specific diagnostic panels, utilize practical biofluid samples and enhance analytical accuracy and precision. The proposed Micro-Analytical System (microAS) will be convenient to operate in point-of-care (POC) and home environments. It will likely evolve to measure up to 100 different metabolites in the submicroMolar to milliMolar range from one 1-100 microL biofluid sample, and include customized comprehensive diagnostic panels for basic research, clinical research, and for personal disease and health management. These systems would provide rapid results, facilitate patient empowerment, and reduce health care costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER TRIAL OF SYNSORB PK IN E COLI RELATED HUS Principal Investigator & Institution: Trachtman, Howard; Director; Long Island Jewish Medical Center 270-05 76Th Ave New Hyde Park, Ny 11040 Timing: Fiscal Year 2002; Project Start 30-SEP-1996; Project End 30-APR-2002 Summary: Hemolytic uremic syndrome (HUS) is an important cause of acute renal failure (ARF) in children. The most common form of this disease, D+HUS, is associated with exposure to enterohemorrhagic strains of E. coli. These bacteria, both 0157:H7 and non-0157:H7 serotypes, elaborate Shiga-like toxins (SLT) and cause hemorrhagic colitis. The SLT provokes diffuse injury to endothelial cells and a systemic vasculopathy which leads to erythrocyte and platelet destruction and kidney damage. Nearly 15-20% of patients with D+HUS develop severe ARF and require dialysis support. The acute mortality rate is 5-10% and serious extra-renal complications occur in 15-20% of patients with D+HUS. There is currently no specific therapy for D+HUS. All previous

68

Hemodialysis

interventions have been aimed at reversing the pathophysiological events which follow dissemination of SLT. Therapy designed to limit SLT absorption from the gastrointestinal tract before there is systemic exposure to bacterial toxin and cytokine activation might lower the mortality rate, ameliorate ARF, and reduce the severity of organ injury in D+HUS. SYNSORB Pk is an adsorbent agent composed of a platform molecule, diatomaceous silicon dioxide, which is covalently linked to a unique oligosaccharide chain. SYNSORB Pk irreversibly binds enterohemorrhagic E. coli associated SLT. This agent is free of significant toxicity. We propose to test the hypothesis that early treatment with SYNSORB Pk will blunt absorption of SLT, thus reducing the occurrence of catastrophic complications, i.e., mortality and severe extrarenal events, and lower the frequency of ARF requiring dialysis. The validity of this assertion will be tested in a randomized, double-blind clinical trial comparing the effect of SYNSORB, Pk with that of placebo in children with newly diagnosed D+HUS. Patients will be recruited from member institutions of the Council of Pediatric Nephrology of the National Kidney Foundation New York/New Jersey. The effect of the therapy on patient mortality, serious extra-renal complications, and the need for dialysis will be assessed. The results of treatment will be correlated with the microbiological etiology of D+HUS, the duration of stool excretion of free SLT, and the degree of cytokine activation in the stool and plasma. The outcome of this trial may justify the use of SYNSORB PK as a safe therapy to ameliorate D+HUS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEW DESIGN OF GRAFT USED AS DIALYSIS VASCULAR ACCESS Principal Investigator & Institution: Zarate, Alfredo R.; Biomedical Enterprises, Inc. 8128 Hamilton Spring Rd Bethesda, Md 20817 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2003 Description (provided by applicant): This application is re-submitted as Phase I instead of Fast Track per recommendation of reviewers. The Phase I is to perform preliminary tests of new designs of the polytetrafluoroethylene graft (PTFEG) used as vascular access for hemodialysis, in a setting simulating hemodialysis (inside a prototype of the new graft, using flow rates of the venous needle and of the graft similar to the one found during dialysis). The goal is to demonstrate whether the new designs decrease the velocity and turbulence of the post-venous needle flow at the venous anastomosis when compared with the existing graft. The studies will include development of Plexiglas prototypes of the grafts and of a system to simulate hemodialysis, fluid mechanics experiments to measure velocity and turbulence of the post-venous needle flow for flow patterns and qualitative determination of velocity, turbulence and recirculation by flow visualization. If the new grafts cause less velocity/turbulence a Phase II study will include additional fluid dynamic studies and animal and human studies to demonstrate effectiveness and safety. The new PTFEGs are expected to decrease access morbidity, prolong access life, decrease cost of care and improve dialysis efficiency. PROPOSED COMMERCIAL APPLICATION: The new graft should replace the currently used design of the graft. There are about 300,000 ESRD patients in the U.S.A. Approximately 185,000 of existing and new patients receive new grafts every year. Baxter Healthcare, inc. would commercialize the product if proven to be safe and effective. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

69

Project Title: NONINVASIVE RAMAN MONITORING OF UREA DURING HEMODIALYSIS Principal Investigator & Institution: Womble, M Edward.; Raman Systems, Inc. 108 Water St, Ste 2 Watertown, Ma 02472 Timing: Fiscal Year 2003; Project Start 01-MAY-2002; Project End 31-MAY-2005 Summary: (provided by applicant): It is the aim of the present Phase II research program to develop a continuous, noninvasive, on-line process for optically monitoring the levels of urea in a patient's blood during hemodialysis. The ultimate goal of such a process is to provide a direct and continuous measure of the efficiency of dialysis without having to wait for the drawing of a blood sample, thereby providing an assessment of whether dialysis at any point in time has reached an effective stopping point for the patient while still attached to the dialysis equipment. We propose to utilize low-resolution laser Raman scattering for the direct measurement of the urea levels in blood using the optical access provided by the dialysis tubing delivering the patient's blood to the dialyzer. Our Phase I SBIR results have shown that urea has a unique Raman spectroscopic signature in animal blood and can be identified and quantified against a whole blood background. Our Phase II program is designed to assess the capability of Raman to quantify the levels of urea in human blood samples with varying concentrations of urea present. After constructing a suitable multiple regression model for BUN, we will build out an appropriate low-resolution Raman module for attachment to a hemodialysis unit and expand the investigation to human blood analysis for BUN and URR during actual dialysis procedures in the clinical setting. If successful, a Raman measurement approach would allow, for the first time, real-time, direct and continuous monitoring of the progress of urea removal dudng the course of hemodialysis. This would permit more efficient timing of the dialysis procedure for the patient, as well as providing an ongoing readout of the effectiveness of the dialysis system during patient treatment. We anticipate that a commercially viable urea monitor might be produced rapidly, if the Phase II work is successful, by the adaptation for the clinical setting of the Company's present R-2001 Raman module for attachment by fiberoptic probe to existing renal dialysis equipment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: NONINVASIVE SPECTROSCOPIC SENSORS FOR GLUCOSE AND UREA Principal Investigator & Institution: Arnold, Mark A.; Professor; Chemistry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): A research plan is proposed to advance the development of noninvasive sensing technology for the in vivo measurement of glucose and urea in human subjects. The proposed approach is to pass a specific band of nearinfrared light through a selected measurement site on the body and then extract the desired analytical information from the resulting noninvasive spectrum. Results from our previous work demonstrate that 1) the combination spectral region is superior to all other near-infrared spectral regions for distinguishing glucose in complex biological matrices, 2) spectral quality is critical and RMS-noise levels of several micro-absorbance units (pAU) are necessary, and 3) sufficient sample thickness is required to provide distinguishable absorbance signals for analysis. Each of these requirements is satisfied in the proposed research plan. A customized Fourier transform near infrared spectrometer will be used to provide high quality combination spectra through human tissue with

70

Hemodialysis

noise levels on the order of 2 pAU. A fiber-optic interface is proposed for collecting noninvasive spectra through a pinch of skin on the back of the hand or the septal cartilage of the nose. Each of these putative measurement sites possesses the appropriate thickness and chemical composition for successful glucose and urea measurements. For the first time, we have both the instrumentation and putative measurement sites that are compatible with noninvasive measurements with combination spectra. A series of in vitro experiments are proposed to characterize this system for the ability to measure glucose and urea with limits of detection of 2 and 1.5 mM, respectively. Animal models have also been identified for both measurement sites and will be used to rigorously establish the analytical utility of this approach. Finally, human subject experiments are proposed to obtain critical information about the human in vivo environment and to evaluate actual in vivo measurements of glucose and urea. Success will provide tremendous healthcare benefits arising from an improvement in the treatment and management of diabetes and end stage renal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL PYROGEN REMOVAL SYSTEM Principal Investigator & Institution: Nemser, Stuart M.; President; Compact Membrane Systems, Inc. Wilmington, De 18904 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 30-NOV-2004 Summary: DECRIPTION (Provided by applicant): Pyrogen-free water (PFW) is required in many applications. Laboratories use it as solvent for compound preparation, culture media, and equipment rinse. Hospitals use it for cleaning to prepare solutions for injections, lV's, and hemodialysis. Pharmaceutical manufacturers use it to formulate injectable drug preparations. Pyrogens, or fever-inducers, are derived from metabolic byproducts of bacteria, molds, yeasts, viruses, and certain chemicals. Current technology used to prepare PFW include distillation, reverse osmosis, and ultrafiltration. Overall these processes are complicated, prone to failure, and in many cases do not remove sufficient pyrogens and are not ideal for small scale facilities. In this program, Compact Membrane Systems (CMS) has identified a simple (push one button) system that is easily integrated into existing systems for pyrogen removal. The basis of the CMS technology is a novel oxidizing system that both kills microorganisms and oxidizes their endotoxins. In Phase I we will develop this novel oxidizing system and demonstrate superior pyrogen removal compared to existing technologies. PROPOSED COMMERCIAL APPLICATION: Water for Injection including Kidney Dialysis water and pharmaceutical water. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ON-LINE, NEAR-INFRARED UREA SENSOR FOR HEMODIALYSIS Principal Investigator & Institution: Olesberg, Jonathon T.; None; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 28-FEB-2007 Summary: The first component of the development award will be formal training in biochemistry, cellular biology, and physiology. This formal training will be augmented by professional interactions with clinical physicians and a mentored research effort in the development of near-infrared sensors for the monitoring of hemodialysis dose. The initial research component of this work will be the development of an all-optical sensor for the on-line measurement urea concentration in spent dialysate. An effective on-line urea sensor will allow regular, sample-free monitoring and optimization of

Studies

71

hemodialysis dose. The sensor will also be adapted for measurements in the extracorporeal whole blood stream between the patient and the dialyzer. The measurement of urea in whole blood will provide a measurement of dose that is more directly related to current blood-based dose quantitation. Because near-infrared sensing technology permits simultaneous quantification of multiple analytes, the sensor will also be applied to quantification of other blood components, including serum albumin, serum creatinine, hematocrit, and uremic toxins, including hippuric acid and indoxyl sulfate. The capacity to monitor these additional analytes every dialysis session will be of substantial benefit to clinical physicians working with patients suffering from either end-stage or acute renal failure. Finally, the near- infrared sensor will be applied to noninvasive, in vivo measurements of urea in peripheral tissue sites. The information provided by such a measurement will be invaluable for the study of urea disequilibrium during dialysis and as a potentially rebound-free quantification of delivered dose. Initial instrument development will be performed in a laboratory environment using an in vitro model for sensor optimization. Calibration models will be generated for urea and other analytes. Sensor operation will then be validated in the clinical setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OVERCOMING NUTRITIONAL BARRIERS IN HEMODIALYSIS PTNTS Principal Investigator & Institution: Sehgal, Ashwini; Associate Professor of Medicine; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 20-FEB-1996; Project End 30-NOV-2006 Summary: (taken from abstract) American hemodialysis patients are frequently malnourished. This contributes to dialysis patient mortality rates that are the highest in the industrialized world at 22% per year. Poor nutritional status probably also contributes to high health care costs (an average of two hospitalizations annually per patient and total Medicare expenditures of $11 billion per year) and diminished quality of life. Our prior work identified five potentially modifiable nutritional barriers (poor appetite, inadequate dialysis dose, poor nutritional knowledge, low fluid intake, and needing help shopping and cooking) and pilot tested a promising approach to overcome these barriers. This proposed community-based randomized controlled trial extends our prior work by targeting specific nutritional barriers with a tailored feedback and education intervention. Thirty dialysis facilities in northeast Ohio will be randomly assigned to intervention and control groups, with 135 malnourished patients enrolled from 15 intervention facilities and 135 from 15 control facilities. Baseline evaluation will include measures of nutritional status, specific barriers, inpatient expenditures, and quality of life. On a monthly basis for 12 months, intervention patients and their dietitians will receive tailored feedback and education on overcoming patient-specific barriers. They will then meet monthly to jointly formulate a care plan addressing these barriers. Control patients will continue to get usual care. Major analyses will compare changes in nutritional parameters, hospitalization-related costs, and quality of life in intervention vs. control patients with adjustment for nesting of patients within facilities. The proposed project will test a novel intervention that targets patients and providers as they together make nutrition-related decisions. Overcoming specific barriers may lead not only to improved nutritional status but also to better patient survival, decreased health care costs, and increased quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

72

•

Hemodialysis

Project Title: OXIDATIVE STRESS AND HEMODIALYSIS ACCESS FAILURE Principal Investigator & Institution: Weiss, Miriam F.; Professor; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant) Antioxidant treatment of human disease has met with mixed success. Factors that lead to oxidative stress in living systems are complicated, and as a result, the actions of antioxidants may seem paradoxical. There is a great deal of evidence for increased oxidative stress in uremia. The rationale for this proposal stems from emerging evidence for efficacy of vitamin E in uremia. The investigators believe that intimal hyperplasia in hemodialysis vascular access represents a unique model of oxidative damage to vascular tissue. Complications of hemodialysis access are a major cause of morbidity and the most frequent single reason for hospitalization among patients with end stage renal disease (ESRD). In vivo and in vitro, oxidative stress stimulates cell growth factors and regulatory mechanisms that lead to the characteristic lesion of access failure, intimal hyperplasia. The central hypothesis to be tested by this project is that oxidative stress is a major (and modifiable) pathogenetic trigger for vascular access complications in patients with ESRD. In elucidating the roles of oxidative stress in the pathophysiology of access failure, the goal is to discover diagnostic factors that can lead to accurate indications for antioxidant therapy. In testing antioxidant medication, the investigators hope to slow progression of intimal hyperplasia in hemodialysis access. Because antioxidant therapy is not currently routine in patients with uremia, the proposal is a pilot study. Data obtained in these specific aims will be used to design large-scale testing of the efficacy of vitamin E (alpha-tocopherol). Specific Aim A: To identify predictors of vascular access venous outflow stenosis or thrombosis, focusing on circulating and histologic markers indicative of the effects of oxidative stress. Specific Aim B: To determine the efficacy of chronic administration of an antioxidant (alpha-tocopherol) in the prevention of intimal hyperplasia and thrombosis of the hemodialysis access. Specific Aim C: To compare the success rates of prophylactic angioplasty when non-invasive techniques demonstrate decreased flow in the hemodialysis access in alpha-tocopherol-treated versus placebotreated patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: OXIDATIVE STRESS AND SYMPATHETIC NERVE ACTIVITY Principal Investigator & Institution: Campese, Vito M.; Professor and Chief; Medicine; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2003; Project Start 24-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): Hypertension is a common manifestation of renal disease and greatly contributes to its progression as well as to cardiovascular morbidity. Clearly, hypertension is an important etiology in the pathogenesis of renal failure. In the United States, hypertension is the primary cause of end-stage renal disease in approximately 29 percent of dialysis patients. In conjunction with other diseases such as diabetes and chronic glomerulonephritides, hypertension, when uncontrolled, hastens the progression of renal disease. Cardiovascular disease is the leading cause of death in patients receiving maintenance hemodialysis and hypertension is considered the most important factor responsible for cardiovascular events in these patients. Adequate BP control may reduce the progression of renal disease and cardiovascular morbidity in these patients, but often this is difficult to achieve with currently available drugs. The old paradigm is that hypertension in renal disease is the result of activation of the renin-

Studies

73

angiotensin system and/or volume expansion. Our studies strongly support the notion that a renal injury may result in activation of renal afferent pathways that integrate with the central nervous system, and lead to stimulation of efferent SNS activity and hypertension. Locally produced angiotensin II in the brain in response to these afferent stimuli seems to be responsible for SNS activation through inhibition of nitric oxide. Our hypothesis is that angiotensin-II activation of ROS may reduce NO availability in key brain region and result in increased SNS activity in a model of neurogenic hypertension caused by renal injury developed in our laboratory. To test this hypothesis we will pursue 3 specific Aims: 1. Test the hypothesis that locally produced Ang II mediates the activation of central SNS activity caused by phenol-renal injury. To this end, we will measure Ang II concentration in the dialysate collected from the PH using the microdialysis technique, and the expression of renin mRNA in the posterior hypothalamus. 2. Test the hypothesis that radical oxygen species (ROS) activated by Angiotensin II down-regulate nitric oxide production in the brain resulting in increased SNS activity. To this end, we will measure the concentration of reactive oxygen species (ROS) in the hypothalamus or rats with the phenol-renal injury or rats infused with Ang II in the lateral ventricle. In addition, we will evaluate the effects of anti-oxidants, or scavengers of ROS, and Ang II AT1 receptor antagonists on BP, sympathetic activation and ROS concentrations in the hypothalamic region. 3. Test the hypothesis that increased ROS production may result in NO inhibition and SNS activation in other forms of experimental hypertension, such as the DOCA-sait model, and the renovascular hypertension model. If our hypothesis were to be correct, administration of inhibitors of the renin-angiotensin system particularly if combined with antioxidants should result in better control of BP in these models. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT ORIENTED RESEARCH IN KIDNEY DISEASE Principal Investigator & Institution: Powe, Neil R.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-MAY-1999; Project End 31-MAR-2004 Summary: (adapted from the application) Neil R. Powe, M.D., is Associate Professor of Medicine and Director of the Welch Center at the Johns Hopkins University School of Medicine. He holds a joint appointment in the Department of Epidemiology at the Johns Hopkins School of Hygiene and Public Health where he is Director of the Clinical Epidemiology Program. He is seeking this Midcareer Award in Patient-Oriented Research to concentrate his effort in clinical research in kidney disease and build the training program in kidney disease research. Dr. Powe has conducted several clinical investigations in nephrology over the past 12 years including a study of the effectiveness of recombinant human erythropoietin for treatment of anemia of ESRD (end stage renal disease), a study of the incidence, risk factors and prognosis of septicemia in ESRD patients, a study of co-morbid cardiovascular disease in ESRD patients, a study of the natural history and risk factors for ESRD among patients with diabetes mellitus, a study of the impact of dialysis care deficiencies on patient mortality and hospitalization, a study comparing physical examination with color flow Doppler for detection of vascular access failure and a randomized clinical trial and observational studies of high versus low osmolality contrast media-induced nephrotoxicity. Dr. Powe directs the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. This is a national prospective cohort study comparing peritoneal dialysis and hemodialysis and a large versus small dose of dialysis. The study now has over 1034 patients enrolled making it one of the largest and most representative prospective cohorts of dialysis patients ever studied in

74

Hemodialysis

the U.S. Data on medical history, laboratory studies, co-morbidity and severity of disease and clinical outcomes are being collected. The study has also established a specimen bank which provides exciting opportunities for studies examining both the etiology and consequences of kidney disease or its treatment. Dr. Powe has mentored a cadre of trainees and junior faculty in clinical research in kidney disease. This award will permit Dr. Powe to make even a greater contribution to patient-oriented research in nephrology, concentrating his efforts and helping him produce future clinical scientists who are rigorously prepared to becomes independent investigators in kidney disease research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PERMANENT VASODILATORS FOR IMPROVED HEMODIALYSIS ACCESS Principal Investigator & Institution: Franano, F Nicholas.; Proteon Therapeutics, Llc. 1010 W 69Th Ter Kansas City, Mo 64113 Timing: Fiscal Year 2004; Project Start 01-AUG-2004; Project End 31-JUL-2005 Summary: (provided by applicant): The vast majority of patients with end-stage renal disease (ESRD) undergo periodic external blood filtering, a process known as hemodialysis. More than 300,000 patients in the United States currently depend on hemodialysis for their survival, and at least 90,000 new patients will begin hemodialysis this year. To treat ESRD by hemodialysis, vascular surgeons must create access sites in the body that allow the patient's blood to be passed through a hemodialysis machine. Unfortunately, almost 100% of the access sites will fail over time, usually due to inadequate vessel size and narrowing of the vein leading away from the site. Creating and maintaining these access sites is one of the most difficult and expensive components of ESRD treatment, and accounts for up to 50% of the total costs for each patient during the first year of hemodialysis. The annual domestic cost of hemodialysis access is estimated to be $1.5 billion, and is primarily paid through Medicare. Proteon Therapeutics has developed an innovative solution to this longstanding clinical problem. The company's first generation drug improves on current methods by permanently dilating the inflow artery and outflow vein at the time of access site creation, making the access site less susceptible to obstruction and failure. The objective of this Phase I research project is to develop a new, second generation drug candidate with improved pharmaceutical characteristics. To achieve this objective, the project will isolate and complete lab-scale synthesis of the new candidate drug. The candidate will then be purified and subjected to a series of in vitro biochemical assays to demonstrate that it retains its' intended activity. The new drug candidate will then be tested using in vivo models to demonstrate that it can deliver target levels of permanent blood vessel dilation in a clinically relevant model system. Successful completion of this SBIR Phase I research project will provide a rational basis for continuing the development of Proteon's technology into SBIR Phase II, where Proteon will seek to manufacture a cGMP-grade drug preparation, perform non-clinical toxicity and pharmacology studies, and complete a Phase I/II human clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PH CONTROL OF PROTEIN SYNTHESIS Principal Investigator & Institution: Garlick, Peter J.; Professor and Director of Research; Surgery; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2004

Studies

75

Summary: Patients with renal failure, diabetic ketosis, severe trauma or sepsis often become acidotic. Moreover, they are also susceptible to body protein wasting. Experimental acidosis has been shown to result in negative nitrogen balance, and body protein loss in acidotic patients can be alleviated by normalization of pH. Previous work has concentrated on the effects of pH on protein degradation and no systematic studies have been performed on pH and protein synthesis. However, measurements in animals and human volunteers have shown that both metabolic and respiratory acidosis are associated with depressed rates of synthesis of skeletal muscle protein and serum albumin. The purpose of the present proposal is therefore to characterize the relationship between protein synthesis rates in tissues, especially muscle and liver, of rats and humans in relation to changes in intra- and extracellular pH, to confirm the hypotheses: (i) that changes in blood pH, both by metabolic and respiratory means, modify rates of tissue protein synthesis and gene expression and contribute to the protein wasting of patients with acidosis, and (ii) that these effects of pH operate directly via the intracellular pH and do not involve extracellular mediators such as hormones. The studies will employ measurements of rates of protein synthesis in tissues of rats and human volunteers to characterize the responses to changes in intra- and extracellular pH induced by metabolic and respiratory means and to confirm that these effects are rapid, operate over the full range of pH from acidosis to alkalosis and are independent of oxygen supply. In the animals, the responses of gene expression in the liver will be investigated by determining the levels of mRNA for 3 liver proteins. In particular, the treatments studied will produce different changes in the infra- and extracellular pH. Measurements of intracellular pH will be made by nuclear magnetic resonance, to confirm the hypothesis that changes in protein synthesis are determined by the intracellular rather than extracellular pH. A separate set of studies will be performed in isolated tissues and cells, to determine whether responses to changes in pH are direct or act through circulating hormones. The cellular and molecular mechanisms through peptide chain initiation and initiation factors eIF-2 and eIF-4 will also be identified. Finally, the effect of changes in pH on tissue protein synthesis will be measured in human volunteers and hemodialysis patients, to identify the role of pH control of protein synthesis in health and in protein wasting conditions with abnormalities of pH control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHERESIS TREATMENT OF BIOTERRORISM-INDUCED SEPSIS Principal Investigator & Institution: Ash, Stephen R.; Chairman/Director; Hemocleanse, Inc. Suite B Lafayette, in 47904 Timing: Fiscal Year 2004; Project Start 15-APR-2004; Project End 31-MAR-2006 Summary: (provided by applicant): Victims of bacterial bioterrorism agents such as anthrax, plague, and tularemia die very often because of septicemia and subsequent multiple organ dysfunction syndrome (MODS). Viral bioterrorism agents such as smallpox can also induce Systemic Inflammatory Response Syndrome (SIRS) and septic shock because of secondary bacterial infections. An effective therapy for SIRS and MODS would spare many of the victims of bioterrorism from a tragic death. Escalating evidence has implicated cytokines and cytokines mediators, circulating factors produced by the innate immune system, as critical mediators of sepsis-related tissue injury and death. To date, after much research and many clinical trials of drugs targeting individual sepsis mediators, no anti-inflammatory agent has been clinically approved. The goal of this project is to develop a simple extracorporeal sorbent-based pheresis system that can broadly diminish level of pro-inflammatory and anti-inflammatory

76

Hemodialysis

sepsis mediators from plasma, and halt the downhill course of organ failure after sepsis. A novel treatment for sepsis has already been tested in Phase I clinical trials in patients with sepsis and multiple organ failure. This system, the Biologic-DTPF, consisted of a dialysis system (DT) and a pheresis system (PF) in series. In vitro studies indicated clearance of inflammatory sepsis mediators like TNF-alpha at 20- 25 ml/min for up to 6 hours, due entirely to adsorption by sorbent in the PF system. The Phase I trial indicated that one treatment of 2-6 hours with the DTPF system resulted in physiologic improvement in seven of eight patients with sepsis and multiple organ failure. Based on this Phase I trial, it appears that sorbent-based pheresis with powdered sorbent has the potential to alter cytokine concentrations in blood during therapy and improve the outcome of patients with sepsis and multiple organ failure. This therapy offers new promise in the field of immuno-modulation because it is both broad-spectrum (removing both pro and anti inflammatory compounds) and self-regulating by removing substances in relation to their circulating concentrations. This project will modify the PF extracorporeal pheresis system treatment by making it a stand-alone system. A new sorbent mixture will be developed and tested in the laboratory with a broad assortment of sepsis initiators and mediators. The means of contacting plasma and sorbent will be changed to improve the efficacy of the system. The anticoagulation method will be changed to regional citrate anticoagulation. The safety systems of the existing PF system will be modified to meet the needs of the stand-alone system. Finally, an animal model of sepsis will be used to check efficacy and safety of the entire system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHOTOREACTIVE SELF-ASSEMBLED MONOLAYERS Principal Investigator & Institution: Guire, Patrick E.; Surmodics, Inc. 9924 W 74Th St Eden Prairie, Mn 55344 Timing: Fiscal Year 2002; Project Start 01-SEP-1998; Project End 31-AUG-2004 Summary: (provided by applicant): This project is designed to optimize and extend the ultrathin coating technology demonstrated in the Phase I project, which is aimed at facile, cost-effective, and broadly applicable thin-film coatings for the passivation of biosensor and medical device surfaces. Prevention of non-specific binding of proteins and other biomolecules is important for a large variety of biomaterial, optical, electrical and structural surfaces which suffer fouling (protein and cellular adhesion, microbial proliferation, and pore plugging) from functioning in contact with physiological fluids and pharmaceuticals. A new class of block copolymer reagents was prepared and demonstrated to provide self-assembled monolayers which can be photochemically fixed on the surface. After spontaneous formation from aqueous coating fluid, the monolayer film on the hydrophobic surface is stabilized through covalent attachment to the surface and in situ polymerization or crosslinking of diblock polymer molecules. The resulting "field of grass" from the hydrophilic block inhibits biomolecule adsorption and can provide attachment sites for desired biomolecules such as heparin. This Phase II effort will synthesize improved test models of this new class of multifunctional selfassembling monolayer molecules. "Living polymerization" will be used to prepare these photoreactive macromer surfactants, which will be use-tested on distal protection screens and hemodialysis membranes. PROPOSED COMMERCIAL APPLICATION: This effort is expected to provide new reagents and coating methodology for distal protection devices (thrombi collection screens) and hemodialysis membranes. Almost one million patients need hemodialysis three times per week. These coatings would provide reduced fouling and increased flux for microporous medical devices. The proposed work will also extend the block copolymer technology to alternate polymer

Studies

77

backbones for increased lubricity and to biomolecule immobilization for increased hemocompatibility, providing better coatings for a variety of medical devices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT--AN ANALYSIS OF FAMILY RELIGIOUS AND SPIRITUAL BELIEFS Principal Investigator & Institution: Turner-Musa, Jocelyn O.; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: SUBPROJECT ABSTRACT NOT PROVIDED Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PREVENTION OF BIOFILM IN HEMODIALYSIS WATER SYSTEMS Principal Investigator & Institution: Bhatt, Bakul M.; Biomedical Development Corporation 500 Sandau, Ste 200 San Antonio, Tx 78216 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-JUL-2004 Summary: (Provided by applicant): Hemodialysis-related infections and adverse patient outcomes continue to be associated with contaminated fluids often arising from biofilm formation in the tubing of hemodialysis systems. Currently available reagents to disinfect fluid delivery lines are either hazardous to humans, unpleasant to work with, environmentally unsafe, or corrosive to expensive hemodialysis equipment at the required contact times. Biomedical Development Corporation is developing a unique disinfectant to improve the quality of water and dialysate circulating through hemodialysis systems. The disinfectant is biocidal against a broad spectrum of organisms and operates as a biofilm reducing agent in clinical water delivery systems. Preliminary studies demonstrate that the disinfectant is an effective antimicrobial, even in the presence of biofilm, is nontoxic, and inexpensive to produce. This study will involve adaptation of the disinfectant for clinical use, and include extensive safety and efficacy testing in preparation for approval and use in hemodialysis fluid delivery systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: PREVENTION OF GRAFT FAILURE TO DIETARY N-3 FATTY ACIDS Principal Investigator & Institution: Tumlin, James A.; Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-FEB-1999; Project End 31-DEC-2003 Summary: Hemodialysis patients depend on arteriovenous (AV) shunts for angioaccess, usually achieved by surgically implanting vascular grafts composed of expanded polytetrafluroethylene (ePTFE). Unfortunately, approximately half of these AV grafts (AVGs) fail within 1 year due to incremental stenosis arising from vascular lesion formation (VLF). This complex process involves 1) thrombin generation, 2) platelet activation with secretion of platelet-derived growth factor (PDGF) and thrombus formation, 3) monocyte/macrophage accumulation and secretion of PDGF, and 4) intimal migration and proliferation of vascular smooth muscle cells. Since dietary n3FAs down-regulate many of the molecular and cellular interactions underlying the development of VLF, we propose to test the hypothesis that dietary n-3FAs will reduce stenosing thrombo- occlusive graft failure. We have persuasive evidence in baboons that dietary n-3FAs interrupt thrombosis and VLF without impairing hemostatic function.

78

Hemodialysis

We also have direct experimental evidence in dialysis patients implicating thrombosis in the processes of AVG stenosis and thrombo-occlusion, and experience in sickle cell patients receiving dietary n-3FAs demonstrating feasibility, acceptance and reduction in pain episodes. We propose to: 1. Establish the effective antithrombotic dose of dietary n3FAs. During the first year of the project the effects of dietary n-3FAs at 0.1 vs 0.3 g/kg/d will be compared with control olive oil in 24 patients randomly allocated to three 8-patient cohorts, measuring surrogate molecular measures of thrombosis, inflammation and risk factors before and after 3 months of therapy. Differences in platelet deposition on AVGs will be compared using autologous platelets labeled with 111In-oxine and quantitative gamma camera imaging. 2. Evaluate the effects of dietary n-FAs on AVG failure in a randomized, blinded, olive off-controlled clinical trial. During the remaining three years of the project, we propose to carry out a randomized, olive oil-controlled, blinded trial in 180 dialysis patients comparing the effects of dietary n-3FAs vs equivalent control olive oil on AVG failure. The dose of dietary n-3FAs will be either 0.1 g/kg/d or 0.3 g/kg/d, depending on their relative efficacy for interrupting AVG platelet deposition. The primary outcome will be AVG failure. Assuming AVG failure rate of 50 percent per year, treatment benefit of 50 percent, and 25 percent patient loss per year, randomizing 180 dialysis patients will have 90 percent power of detecting a benefit. Secondary outcomes to be compared are molecular markers for thrombosis, inflammation, and vascular risk factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROBIOTICS TO ERADICATE NASAL S AUREUS IN ESRD PATIENTS Principal Investigator & Institution: Hibberd, Patricia L.; Professor of Medicine; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2004; Project Start 15-JUN-2004; Project End 31-MAY-2006 Summary: (provided by applicant): Emergence of antimicrobial resistance is an everincreasing threat to our ability to treat a wide range of infections caused by microbes that thwart or block antimicrobial therapy. Staphylococcus aureus, an organism that is frequently found to be resistant to multiple antibiotics, is a major and increasing cause of morbidity and mortality in patients on chronic dialysis. Since nasal carriage of Staphylococcus aureus generally precedes infection and is a well established risk factor for invasive disease, eradication of this organism from the nares is of major clinical importance. Current strategies, particularly those that use antibiotics, often lead to antimicrobial resistance, side effects and relapse. Probiotics, particularly Lactobacillus GG (LGG) are capable of killing various bacteria, including Staphylococcus aureus, in vitro, by a variety of mechanisms. Preliminary data from one small study in healthy volunteers suggests that LGG may be able to eradicate nasal carriage of S aureus. We propose to conduct a pilot double-blind randomized placebo controlled clinical trial to refine methodology and determine the feasibility of evaluating whether LGG administered orally or topically is effective in eliminating nasal colonization with Staphylococcus aureus in patients on chronic hemodialysis. If safe and effective, LGG may provide an alternative way to eliminate this bacteria without use of antimicrobials that risk emergence of resistance. Fifty patients on hemodialysis will be recruited into the study, 20 will receive oral LGG, 20 will receive topical LGG and 10 will receive oral and topical placebo. The specific aims are to: (1) refine and test feasibility of administering oral and topical probiotics and matching placebo, in preparation for future studies that will investigate the effect of probiotics on eradication of nasal carriage of Staphylococcus aureus; (2) collect pilot data on limination of nasal

Studies

79

colonization with Staphyloccous aureus to power future studies that will evaluate whether LGG is an effective alternative to antimicrobials; and (3) determine whether LGG colonizes the nares as a first step to exploring potential mechanisms by which LGG may influence mucosal Staphylococcus aureus colonization. This study has the potential to provide insight into a novel alternative approach to eradicate and prevent the spread of antimicrobial resistant pathogens. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RAPID PATENCY ASSESSMENT OF DIALYSIS VASCULAR ACCESS Principal Investigator & Institution: Mansy, Hansen A.; Biomedical Acoustics Research Company 719 Forest Ave Evanston, Il 60202 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JAN-2005 Summary: (provided by applicant): Vascular access for renal dialysis is a lifeline for about 120,000 patients in the United States. Detection of access compromise is critical for optimal management. The proposed seeks to develop a new method for early and accurate detection of decreased access patency. The essential hypothesis is that vascular compromise alters blood flow turbulence resulting in diagnostic vibration ("acoustic") changes detectable at the skin surface. The proposed technology is based on computerized analysis of signals from "electronic stethoscopes" placed on the patient?s forearm. This is not an imaging technology. Rather, it is a much less expensive, yet potentially powerful method for immediate and safe diagnosis. Phase 1 research will test feasibility by studying fifteen human subjects before and after vascular access angioplasty. If successful, the novel device would have significant commercial potential with purchase by renal dialysis units and radiology departments. A much larger potential market may exist as the knowledge garnered in this effort is later applied to other vascular applications such as stroke prevention, renal artery stenosis detection, femoral-popliteal bypass graft salvage, and to early diagnosis of abdominal aortic aneurysms. PROPOSED COMMERCIAL APPLICATION: If this technology proves successful, it is anticipated that the device would become standard equipment in renal hemodialysis units world-wide with potential estimated sales in the order $30,000,000. Annual sales of disposable sensors are estimated to total an additional $25 million. A much larger potential market may exist as the knowledge garnered in this effort is later applied to other vascular applications such as stroke prevention, renal knowledge garnered in this effort is later applied to other vascular applications such as stroke prevention, renal artery stenosis detection, femoral-popliteal bypass graft salvage, and to early diagnosis of abdominal aortic aneurysms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: RENAL AND ELECTROLYTE DISEASE AND HYPERTENSION Principal Investigator & Institution: Berl, Tomas; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2003; Project Start 01-JUL-1983; Project End 30-JUN-2008 Summary: (provided by applicant): The training program of the Division of Renal Diseases and Hypertension at the University of Colorado Health Sciences Center provides and integrated 3-4 year experience in clinical nephrology (1 year) and academic research (2-3 years). The program is designed to prepare postdoctoral fellows for careers in academic medicine. The clinical training, by utilizing 3 different hospitals with varied populations (University Hospital, Veterans Affairs Medical Center, and Denver Health Medical Center) exposes the trainees to a great range of patients with

80

Hemodialysis

parenchymal renal disease, fluid and electrolyte disorders, acid-base disorders, hypertension, acute and chronic renal failure, acute renal replacement therapies, and chronic dialysis (peritoneal, hemodialysis both at home and in-center), and all medical aspects of transplantation. Thereafter the fellows choose to pursue their research training in the laboratory of any faculty member in the Division or in other Divisions with which we closely interact, such as rheumatology, immunology. The laboratories have modern, state of the art equipment and staff that provide the best possible research environment. The fellows can choose from a large number of laboratories or clinical investigation projects. Very broadly stated these include: a) laboratories studying the pathogenesis of acute renal failure; b) laboratories exploring the role of aquaporins in disorders of water balance; c) laboratories focused on signaling pathways in vascular smooth muscle cells, tumor cells, inner medullary collecting ducts cells; d) laboratories that study the pathogenesis of renal cyst formation; e) laboratories that study the immunology of graft rejection; and f) clinical studies in patients with diabetes, diabetic nephropathy, acute renal failure, polycystic kidney disease, and graft rejection. Fellows are encouraged to enter a program leading to a Ph.D. in human biology that further broadens the research options available to them. The fellowship program chooses 4 trainees each year, all of who commit to at least a 3-year fellowship and express interest in an academic career. Interviewees are chosen from applicants who have completed at least three years of postdoctoral training in internal medicine. This ensures that the individual is ready for his or her initial clinical training, which is then followed by their research training. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESISTANCE TRAINING DURING MAINTENANCE DIALYSIS Principal Investigator & Institution: Sceppa, Carmen C.; Nutrition Exercise Physiology Sarcopenla (Neps) Lab; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-MAR-2005 Summary: (provided by applicant): There is a rising incidence of kidney failure in the US, with poor outcomes and high cost. End-stage renal disease (ESRD) affects almost 375,000 individuals in the US at a cost of more than $14 billion per year. Despite advances in dialysis and transplantation therapies, kidney failure leads to poor outcomes, poor prognosis and high health care costs. Malnutrition and the underlying systemic inflammatory response developed during the course of chronic kidney disease, worsen during ESRD, and leads to adverse outcomes, increased morbidity and mortality. Muscle wasting, impaired functional capacity and poor quality of life are the most important factors associated with malnutrition and inflammation in renal failure. We have shown in pre-dialysis patients with moderate chronic renal insufficiency that the anabolic effects of resistance exercise training result in significant improvements in protein utilization, nutritional status and functional capacity even in the context of anorexia and prescribed low protein diets. Thus, we propose to develop, test and implement a progressive resistance exercise routine for ESRD patients during the hemodialysis session. Our hypotheses are that the addition of 30-45 min of resistance exercise training during the dialysis session will counteract the burden of renal disease and will result in: 1) A feasible and safe exercise modality for ESRD patients (6-wk feasibility phase tested in 10 patients); 2) Net anabolism as evidenced by: improved nutritional status (i.e. increased protein catabolic rate, muscle mass and muscle strength); and reduced systemic inflammatory response (i.e. reduced C-reactive protein and interleukin-6, and increased serum albumin levels) compared to a randomly assigned control group on hemodilaysis but not exercise training (6-mo efficacy phase

Studies

81

tested in 20 patients/group); and that 3) Improved self-reported physical function (i.e. increased SF-36 physical component scale) observed with resistance training will be associated with the improvements in nutritional status and inflammatory response. The long-term goal is to implement resistance exercise training routines during hemodialysis to overcome the underlying malnutrition and inflammation of ESRD and to improve disease outcome and prognosis. By implementing such intervention, we hope to offer a therapeutic strategy that can be incorporated to the standard of care of ESRD patients by working in conjunction with the dialysis unit staff. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS FOR CV DISEASE IN A DIALYSIS COHORT Principal Investigator & Institution: Coresh, Josef; Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-JUL-2004 Summary: (Adapted from Investigator's Abstract) Atherosclerotic cardiovascular disease (ASCVD) is a leading contributor to the high morbidity and mortality among end-stage renal disease (ESRD) patients, accounting for 36 percent of ESRD deaths (total annual mortality of 23 percent). This application tests the hypothesis that higher levels of several novel risk factors (Lp(a) levels and apo(a) isoforms; homocysteine and related vitamins; Chlamydia pneumoniae and cytomegalovirus; and C-reactive protein and fibrinogen) and traditional risk factors predict higher risk of ASCVD in a prospective study of 925 incident dialysis patients recruited within three months of starting dialysis. Although these factors have been implicated in the etiology of ASCVD in ESRD patients, little prospective data exist. Cross-sectional studies are susceptible to large survival bias because of the high mortality of patients with renal disease. This cohort has already been recruited through a collaboration between Johns Hopkins and 80 Dialysis Clinics Incorporated (DCI) clinics; many of the important predictors and possible confounders have been measured. This application proposes to obtain long term followup (extending mean followup of 2.4 years by four more years) and conduct laboratory assays. The investigators will: 1) extend specimen collection, and follow-up, and institute standardized review of ASCVD events; 2) characterize baseline associations of novel and traditional factors with each other, dialysis modality and dose, nutritional status, and ASCVD prevalence in the full cohort using a cross-sectional design; 3) determine whether baseline levels of risk factors predict subsequent incidence of ASCVD events, and total mortality using a prospective cohort study design and test a priori hypothesized interactions between risk factors and the risk of ASCVD; 4) study the variability of risk factors over time using annual measurements in a random subset of 180 patients (subcohort) using a longitudinal design; and lastly, 5) use a case-cohort design, utilizing the subcohort, to test whether the most recent level before an ASCVD event, the baseline level, or the mean level of each risk factor is most predictive of ASCVD risk. Baseline data collection will include a patient health questionnaire and a standardized review of comorbidity using dialysis chart records. Serum, plasma and DNA will be stored at -80 degrees C. from patient visits at recruitment (month 0), and followup (months 1,2,3,6,12,8,24, etc.). ASCVD will be assessed by review of hospital charts, patients and care providers questionnaires, and HCFA death forms. The investigators state that this study will use state-of-the-art epidemiologic and laboratory methods to identify modifiable risk factors, answer the call of an NKF task force for prospective studies of risk factors for ASCVD in the dialysis population, and lay the essential groundwork for future preventive interventions to reduce the burden of ASCVD in persons with ESRD.

82

Hemodialysis

Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SLEEP AND DAYTIME FUNCTIONING IN CHRONIC KIDNEY DISEASE Principal Investigator & Institution: Unruh, Mark L.; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2004; Project Start 01-AUG-2004; Project End 31-JUL-2009 Summary: (provided by applicant): Poor sleep and fatigue are commonly encountered in the practice of nephrology. In the general population, sleep studies using polysomnography show a substantial prevalence of sleep disordered breathing and other causes of sleep fragmentation in healthy adults that clearly contribute to sleepiness and fatigue, hypertension and cardiovascular disease. Potentially, such disorder could contribute to the very high rates of morbidity and mortality in the chronic kidney disease population. The general hypothesis for the proposed research program is that kidney failure is related to sleep disorders and these sleep disorders impact on daytime functioning. The Principal Investigator has designed a rigorous training program that will provide him with the necessary research skills, hands-on mentoring experiences, and content area expertise to develop into an independent investigator in the field of sleep and daytime functioning in chronic kidney disease. He will take courses designed to provide him the statistical, study design, and measurement methodology to carry out original research. His sponsors have extensive experience in clinical epidemiology, dialysis outcomes research, sleep disorders epidemiology and functioning outcomes methodology and are committed to his career development. The few preliminary studies using polysomnography suggest that sleep disorders may affect the majority in dialysis patients. The proposed study is designed to evaluate the full spectrum of both objectively assessed and self-reported sleep disorders and evaluate daytime functioning before and after kidney transplantation. The Specific Aims are 1) To characterize sleep and daytime functioning in persons with advanced kidney disease and on hemodialysis 2) To characterize changes in sleep and daytime functioning in persons after kidney transplantation. Statistical power demonstrates that the proposed study has an adequate sample size to assess each aim and a pilot project has demonstrated the feasibility of recruiting patients with chronic kidney disease for sleep and daytime functioning assessments. The team of experienced mentors and consulting scientists will monitor his progress in completing his project and his career development. The proposed training program and research projects will serve as a foundation for future projects to improve the sleep and daytime functioning in persons with chronic kidney disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: SYMPTOMS AND QUALITY OF LIFE IN END STAGE RENAL DISEASE Principal Investigator & Institution: Jablonski, Anita M.; None; Michigan State University 301 Administration Bldg East Lansing, Mi 48824 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2005 Summary: (provided by applicant): End-Stage Renal Disease (ESRD) hemodialysis (HD) patients experience a variety of symptoms as a result of both the disease and its treatment. Research to date has focused on the occurrence of these symptoms, but has neglected to investigate how and to what extent they are relieved. This is significant, in that clinical observations suggest that ESRD patients often suffer from unrelieved symptoms to the detriment of their quality of life (QOL). Therefore, the overall purpose

Studies

83

of this study is to document the prevalence of unrelieved symptoms and to determine whether there is a need for improved symptom management in the ESRD HD population. The specific aims that guide this study are: 1) to identify patient characteristics that predict high levels of symptom experience; 2) to describe the symptom experience of ESRD HD patients; 3) to describe strategies used by ESRD HD patients to manage their symptoms and the level of symptom relief achieved; 4) to describe the relationship between symptom experience and self-reported QOL; and 5) to describe the moderating effect of the level of symptom relief on the relationship between symptom experience and QOL. HD patients will complete questionnaires that tap symptom experience, level of symptom relief, and QOL. Should the need for improved symptom management be documented, further research efforts will focus on factors that contribute to inadequate symptom relief as well as interventions to improve symptom control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTOSTERONE:PHYSICAL HEMODIALYSIS

FUNCTION

IN

MEN

ON

Principal Investigator & Institution: Bhasin, Shalender; Professor and Chief; Internal Medicine; Charles R. Drew University of Med & Sci 1731 East 120Th Street Los Angeles, Ca 900593025 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 30-JUN-2005 Summary: Malnutrition and loss of muscle mass (sarcopenia) are common in patients with end stage renal disease on hemodialysis and associated with increased mortality, impaired physical function, disability, and poor quality of life. Therefore, therapeutic interventions that can increase muscle mass and strength might improve physical function, general health perceptions, and reduce disability. Testosterone, when given in physiologic replacement doses, is an attractive anabolic intervention because it has been proven relatively safe, and effective in increasing muscle mass and strength in healthy hypogonadal men, older men with low testosterone levels, and HIV- infected men with weight loss. The primary objective of this study is to determine if testosterone replacement of men on maintenance hemodialysis who have low testosterone levels will increase their fat-free mass, muscle strength, physical function, and health-related quality of life. A second objective is to elucidate the mechanisms by which testosterone increases muscle mass. Men with end stage renal disease, 18-75 yrs of age, with serum testosterone less than 300 ng/dL, who are on maintenance hemodialysis, and free of acute illness, will be randomly assigned to receive either two placebo or two testosterone transdermal patches daily for 16 weeks. Two testosterone patches will nominally delivery 10 mg testosterone daily, and raise serum testosterone levels into the mid-range for healthy young men. Energy and protein intake, hemodialysis regimen, and erythropeitin dose will be standardized. The following outcomes will be measured at baseline and after 16 weeks: body composition by DEXA scan, deuterium oxide and sodium bromide dilution; thigh muscle volume by MRI scan; muscle performance by measurements of 5-repetition maximum strength, power, and endurance in the leg press exercise; and effort independent muscle performance by force:EMG relationship; physical function by stair climbing power, getting up from a chair, and walking speed; self-reported disability and kidney disease quality of life by validated instruments; fractional synthesis rates of mixed skeletal muscle protein and myosin heavy chain during a primed, continuous infusion of L-[1,213C]-leucine. Total and free testosterone and dihydrotestosterone levels will be measured as markers of androgen bioavailability, and LH, FSH, and SHBG as markers of androgen action. For safety, we will follow

84

Hemodialysis

hemoglobin/hematocrit, AST and ALT, PSA, plasma lipids, apolipoproteins, and lipoprotein particles, and insulin sensitivity by the modified Bergman Minimal Model. Muscle biopsies will also be used for measurements of myostatin, IGF-1, and IGFBP-4 mRNA and protein concentrations by RT-PCR and Western blot analyses. A multidisciplinary team of investigators, careful subject selection, access to a large patient pool, attention to potential confounding variables such as dialysis intensity, erythropoeitin dose, dietary intake and exercise stimulus, and power and effect size, and state-of-theart methods should maximize the chances of detecting treatment effects and elucidating the mechanism of androgen action. Therefore, if successful, this study should help identify a therapeutic intervention that might improve physical function and reduce disability in men with end stage renal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE ROLE CARDIOMYOPATHY

OF

ROS

AND

NA/K-ATPASE

IN

UREMIC

Principal Investigator & Institution: Xie, Zijian; Associate Professor; Pharmacology and Therapeutics; Medical College of Ohio at Toledo Research & Grants Admin. Toledo, Oh 436145804 Timing: Fiscal Year 2002; Project Start 25-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Heart disease is the major cause of death in chronic renal failure (CRF) patients. Increases in ROS (reactive oxygen species), stress and circulating inhibitors of Na/K-ATPase have been well documented in CRF patients treated with hemodialysis. Moreover, Na/K-ATPase is an important signal transduction element in cardiac myocytes. Based on our prior work, we believe that interaction between ROS and Na/K-ATPase activates multiple signaling pathways that are important for regulation of cell growth and gene expression in cardiac myocytes. Further, interaction between ROS and other circulating pump inhibitor can cause a significant inhibition of the enzyme through both transcriptional and post-translational mechanisms. Such inhibition of the enzyme will impair the ability of cardiac myocytes to extrude Na+, thus Ca2+ through Na+/Ca2+ exchanger. This certainly represents an important risk factor for development of diastolic dysfunction of the heart in CRF patients. Clearly, it is important to study how ROS interact with Na/K-ATPase and the roles of such interaction in regulation of cardiac growth, gene expression and cardiac contractile function.We, therefore, proposed the following three specific aims to address these issues. Specific Aim I will test the hypotheses that Na/K-ATPase serves as a receptor for ROS and that inhibition of Na/K-ATPase by ROS recruits and activates Src, resulting in assembly of a signaling complex and subsequent activation of the Ras/MAPK cascade. Specific Aim 2 will dissect pathways by which ROS posttranslationally regulate Na/K-ATPase. Specific Aim 3 will test the hypothesis that activation of Ras/MAPKs and inhibition of Na/K-ATPase regulate intracellular Ca2+([Ca2+]i) and contractility in response to increased ROS stress, and profile ROSinduced changes in gene expression and protein structures in cardiac myocytes. We proposed to use a combination of proteomics, adenovirus-mediated gene expression, cDNA expression array, representation difference analysis, confocal fluorescence microscopy, and other molecular biology techniques to critically test our working hypotheses. We expect that these basic investigations will contribute to our understanding of the biology of Na/K-ATPase, uremic cardiomyopathy and provide new information for developing novel therapies addressing the serious and common problem of heart diseases in CRF patients. Ca2+ and contractility in response to increased ROS stress, and profile ROS-induced changes in gene expression and protein

Studies

85

structures in cardiac myocytes. We proposed to use a combination of proteomics, adenovirus-mediated gene expression, cDNA expression array, representation difference analysis, confocal fluorescence microscopy, and other molecular biology techniques to critically test our working hypotheses. We expect that these basic investigations will contribute to our understanding of the biology of Na/K-ATPase, uremic cardiomyopathy and provide new information for developing novel therapies addressing the serious and common problem of heart diseases in CRF patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE SHORT-DAILY HEMODIALYSIS PILOT STUDY Principal Investigator & Institution: Levin, Nathan W.; Renal Research Institute Joint Venture 207 E 94Th St, Ste 3032 New York, Ny 10128 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Background: Hemodialysis is the majority treatment modality for renal disease, and improvements in its delivery are desperately needed to curb the staggering 20% annual mortality rate for patients with endstage renal failure. Recent physiologic and observational studies have highlighted improved outcomes with more frequent hemodialysis. Clinical trials are now needed to establish the efficacy of this promising treatment. Objectives: The Renal Research Institute/University of Western Ontario Clinical Consortium seeks to conduct a randomized controlled trial of 200 patients comparing short daily 6 times per week hemodialysis (target standard Kt/V of 3.5 +/- 0.5 per week) against conventional 3 times per week hemodialysis (target equilibrated KtN of 1.2 +/- 0.1 per session, approximately equal to a standard Kt/V of 2.2 per week). Patients will be followed for 12 to 18 months. The aims of this study include: 1) to determine if the improvements in intermediate cardiovascular, social, nutritional, metabolic, and economic outcomes with daily over conventional hemodialysis, which our consortium has documented in observational studies, persist in a randomized controlled trial, 2) to quantify the adverse events and define potential risks associated with short-daily hemodialysis, and 3) to develop ancillary substudies advancing our knowledge of the physiology of daily hemodialysis. Key design elements to this trial include 1) stratification of the randomization by center and patient preference for in center or home hemodialysis, 2) a run in period of 2 weeks on in center daily hemodialysis, 3) careful standardization of specific co-interventions to provide optimal care and to avoid potential bias associated with the unblinded nature of the trial, and 4) statistical methods which account for missing data due to death and transplantation, and the multiple comparisons on intermediate outcomes used in the trial. Implications: This study will guide the feasibility, sample size and cost of a definitive clinical trial, which examines the effectiveness of daily hemodialysis to prevent death and hospitalization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: THERAPY HOMOCYSTEINEMIA

IN

DIALYSIS

HYPOALBUMINEMIA

AND

Principal Investigator & Institution: Eustace, Joseph A.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-AUG-2001; Project End 31-JUL-2006 Summary: (Adapted from the application) End stage renal disease is associated with several complex nutritional problems. Hypoalbuminemia, the strongest predictor of mortality on dialysis, is related to a combination of nutritional, inflammatory and

86

Hemodialysis

comorbid factors, but the relative importance of these factors has not been prospectively evaluated. Relative vitamin deficiencies, especially that of B6, B12 and folate, also occur. Hyperhomocysteinemia (hyperHcy), a novel cardio-vascular and thrombotic risk factor, is at least partly correctable with folate and vitamin B6 and B12 supplementation but the clinical benefits of this therapy is not established. The projects outlined in this application will allow Dr. Eustace to continue his mentored research into these two major nutritional problems, hypoalbuminemia and hyperHcy. The PI will: (1A) Conduct a longitudinal analysis of risk factors for dialysis-associated hypoalbuminemia focusing on protein intake and inflammation (C-Reactive Protein), using data collected in the CHOICE cohort study. This is a nationally representative cohort of 925 incident dialysis patients in its 5th year of follow-up, headed by Drs. Powe, Klag and Coresh. (1B) Build on a clinical trial, he recently completed, by conducting a two-center, 2 x 2 factorial trial of 280 recently hospitalized hemodialysis patients, with serum albumins of less then 4.0 g/dl, examining in one arm of the trial the efficacy of oral essential amino acids supplements versus placebo at improving serum albumin levels and reducing hospitalization rates and (1C) Use a decision analysis model to compare the costeffectiveness, utility and outcomes of oral supplements versus alternative management strategies, including parenteral nutrition, naso-gastric feeding and anabolic agents. (2A) Compare, in the second arm of the above clinical trial, the efficacy of high versus standard dose folate, B6 & B12 supplementation at reducing all cause cardiovascular endpoints and vascular access thromboses. (2B) Perform a meta-analysis of published trials of the benefit of vitamin therapy on actual patient survival. This combination of observational and experimental research under the mentorship of Drs. Coresh and Klag, combined with didactic course work, in the supportive context of the Welch Center will allow Dr. Eustace to build on his current theoretical knowledge, make the transition into an independent clinical scientist and prepare him for a career investigating the role of nutrition in renal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ULTRASONIC HEMODIALYSIS

AUGMENTATION

OF

MASS

TRANFER

IN

Principal Investigator & Institution: Hovland, Roy S.; Toltec International, Inc. 938 Quail St, Ste a Lakewood, Co 80215 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 30-NOV-2003 Summary: The proposed research investigates the application of ultrasonic, vibrational energy to a hemodialyzer membrane and its effect on mas transfer during hemodialysis. Two physical phenomena are expected to play a part in improving mass transfer: acoustic streaming and dissipation of the protein gel layer. Acoustic streaming refers to enhanced transfer due to microscopic vortices induced by acoustic waves. The protein el layer is a thin layer of protein and blood components that is driven against the dialyzer membrane by the convection inherent in dialysis. This proposal predicts that this layer can be dissipated by vibrational energy, thereby reducing the resistance to solute transfer across the "effective membrane". Both these phenomena will act to improve clearance, and enhance the efficacy of dialysis therapy. During Phase I, laboratory testing is proposed select a configuration optimized for improved clearance. A device will be designed and constructed, and further in vitro testing will be performed to assess improvements in dialysis efficacy that could be realized by employing such a device. Phase II will involve the refinement of the device for human use and clinical trials performed in vivo using clearance measurement of substances of interest to the dialysis community as the measure of efficacy. PROPOSED COMMERCIAL APPLICATIONS:

Studies

87

The successful application of this technology can either be sold directly to dialysis service providers as a stand alone medical device for use with any dialysis monitor, or it can be licensed or sold to dialysis equipment manufacturers for incorporation in their monitors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VASOPRESSIN FOR BLOOD PRESSURE SUPPORT DURING DIALYSIS Principal Investigator & Institution: Thompson, Aliza M.; Medicine; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2006 Summary: Hypertension due to chronic volume expansion is common in end-stage renal disease (ESRD) and a major contributor to the 30-fold higher annual cardiovascular mortality rate in these patients. Dialysis removes volume but adequate volume control is often difficult to achieve because episodes of intradialytic hypotension are common. In response to this hypotension, volume removal is limited and patients are frequently left volume expanded. This, in turn, leads to chronic interdialytic hypertension and its sequellae. Though the normal response to volume depletion is an increase in vascular tone, studies suggest that dialysis patients do not vasoconstdct appropriately during hemodialysis. We suspect a defect in the baroreceptor mediated release of vasopressin likely contributes to this lack of vasoconstriction. Though low-dose vasopressin does not increase blood pressure in normal subjects, recent studies have shown that in states where blood pressure is compromised and there is a deficiency in vasopressin, there is increased pressor sensitivity to vasopressin. In preliminary studies vasopressin was administered to dialysis patients. Vasopressin caused a statistically significant increase in blood pressure of approximately 10 mmHg in patients with ESRD. We hypothesize that low-dose exogenous vasopressin will support blood pressure during dialysis, leading to a lower incidence of intradialytic hypotension, greater fluid removal and ultimately improved long term blood pressure control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “hemodialysis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for hemodialysis in the PubMed Central database:

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

88

Hemodialysis

•

A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients. by Viola RA, Abbott KC, Welch PG, McMillan RJ, Sheikh AM, Yuan CM.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137601

•

Acute hepatitis associated with oral levofloxacin therapy in a hemodialysis patient. by Schwalm JD, Lee CH.; 2003 Apr 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151990

•

Administration of aminoglycosides to hemodialysis patients immediately before dialysis: a new dosing modality. by Matsuo H, Hayashi J, Ono K, Andoh K, Andoh Y, Sano Y, Saruki K, Tanaka J, Yamashita M, Nakamura K, Kubo K.; 1997 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=164175

•

Comparison of microbiologic assay methods for hemodialysis fluids. by Arduino MJ, Bland LA, Aguero SM, Carson L, Ridgeway M, Favero MS.; 1991 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=269824

•

Detection of Hepatitis G Virus (HGV) RNA and Antibodies to the HGV Envelope Protein E2 in a Cohort of Hemodialysis Patients. by Perez-Gracia T, Galan F, GironGonzalez JA, Lozano A, Benavides B, Fernandez E, Rodriguez-Iglesias M.; 2000 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87584

•

Effect of chronic renal failure and hemodialysis on carbohydrate metabolism. by Hampers CL, Soeldner JS, Doak PB, Merrill JP.; 1966 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=292856

•

Effect of Hemodialysis and Renal Failure on Serum and Urine Concentrations of Cephapirin Sodium. by McCloskey RV, Terry EE, McCracken AW, Sweeney MJ, Forland MF.; 1972 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=444174

•

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state. by Nixon JV, Mitchell JH, McPhaul JJ Jr, Henrich WL.; 1983 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=436877

•

Effect of Lovastatin on Lipid peroxidation and total antioxidant concentrations in hemodialysis patients. by Argani H, Ghorbani A, Rashtchizade N, Rahbaninobar M.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=420253

•

Effect of Nandrolone Decanoate on Serum Lipoprotein (a) and its isoforms in hemodialysis patients. by Ghorbanihaghjo A, Argani H, Rohbaninoubar M, Rashtchizadeh N.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=455686

•

Effects of incubation time and temperature on microbiologic sampling procedures for hemodialysis fluids. by Arduino MJ, Bland LA, Aguero SM, Favero MS.; 1991 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=270135

Studies

89

•

Factors That Influence Microbial Contamination of Fluids Associated with Hemodialysis Machines. by Favero MS, Carson LA, Bond WW, Petersen NJ.; 1974 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=186832

•

Genetic and Serological Evidence for Multiple Instances of Unrecognized Transmission of Hepatitis C Virus in Hemodialysis Units. by Mizuno M, Higuchi T, Kanmatsuse K, Esumi M.; 1998 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105089

•

Genotyping of hepatitis C virus isolates from Lebanese hemodialysis patients by reverse transcription-PCR and restriction fragment length polymorphism analysis of 5' noncoding region. by Matar GM, Sharara HM, Abdelnour GE, Abdelnoor AM.; 1996 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229338

•

Hepatitis C in a Hemodialysis Unit: Molecular Evidence for Nosocomial Transmission. by Le Pogam S, Le Chapois D, Christen R, Dubois F, Barin F, Goudeau A.; 1998 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105107

•

Hepatitis C markers in hemodialysis patients. by Huang CS, Ho MS, Yang CS, Lee CL, Tan CA.; 1993 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=265628

•

Hepatitis C Virus Heteroduplex Tracking Assay for Genotype Determination Reveals Diverging Genotype 2 Isolates in Italian Hemodialysis Patients. by Calvo PL, Kansopon J, Sra K, Quan S, DiNello R, Guaschino R, Calabrese G, Danielle F, Brunetto MR, Bonino F, Massaro AL, Polito A, Houghton M, Weiner AJ.; 1998 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=124840

•

High incidence of hepatitis C virus infection in hemodialysis patients in units with high prevalence. by Pujol FH, Ponce JG, Lema MG, Capriles F, Devesa M, Sirit F, Salazar M, Vasquez G, Monsalve F, Blitz-Dorfman L.; 1996 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229084

•

Hormone-fuel concentrations in anephric subjects. Effect of hemodialysis (with special reference to amino acids). by Ganda OP, Aoki TT, Soeldner JS, Morrison RS, Cahill GF Jr.; 1976 Jun; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=436798

•

Influence of hemodialysis on plasma concentration-time profiles of mefloquine in two patients with end-stage renal disease: a prophylactic drug monitoring study. by Crevoisier CA, Joseph I, Fischer M, Graf H.; 1995 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=162850

•

Influence of uremia and hemodialysis on the turnover and metabolic effects of glucagon. by Sherwin RS, Bastl C, Finkelstein FO, Fisher M, Black H, Hendler R, Felig P.; 1976 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=436707

90

Hemodialysis

•

Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients. by Pupim LB, Flakoll PJ, Brouillette JR, Levenhagen DK, Hakim RM, Ikizler TA.; 2002 Aug 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150418

•

Kinetic disposition of intravenous ceftriaxone in normal subjects and patients with renal failure on hemodialysis or peritoneal dialysis. by Ti TY, Fortin L, Kreeft JH, East DS, Ogilvie RI, Somerville PJ.; 1984 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185440

•

Malnutrition: a frequent misdiagnosis for hemodialysis patients. by Mitch WE.; 2002 Aug 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150424

•

Medication-related problem type and appearance rate in ambulatory hemodialysis patients. by Manley HJ, Drayer DK, Muther RS.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=317309

•

Mezlocillin disposition in chronic hemodialysis patients. by Janicke DM, Mangione A, Schultz RW, Jusko WJ.; 1981 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=181757

•

Patency and Life-Spans of Failing Hemodialysis Grafts in Patients Undergoing Repeated Percutaneous De-Clotting. by Mansilla AV, Toombs BD, Vaughn WK, Zeledon JI.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101200

•

Pharmacokinetic Study of an Oral Cephalosporin, Cefdinir, in Hemodialysis Patients. by Hishida A, Ohishi K, Nagashima S, Kanamaru M, Obara M, Kitada A.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105672

•

Pharmacokinetics of Amikacin During Hemodialysis and Peritoneal Dialysis. by Regeur L, Colding H, Jensen H, Kampmann JP.; 1977 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=351955

•

Pharmacokinetics of Cefamandole in Patients Undergoing Hemodialysis and Peritoneal Dialysis. by Ahern MJ, Finkelstein FO, Andriole VT.; 1976 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=429770

•

Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal dialysis. by Dieplinger H, Schoenfeld PY, Fielding CJ.; 1986 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=424441

•

Pre-dialysis clinic attendance improves quality of life among hemodialysis patients. by White CA, Pilkey RM, Lam M, Holland DC.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=103666

•

Prevalence of nontuberculous mycobacteria in water supplies of hemodialysis centers. by Carson LA, Bland LA, Cusick LB, Favero MS, Bolan GA, Reingold AL, Good RC.; 1988 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=204436

Studies

91

•

Prospective study of microbial colonization of the nose and skin and infection of the vascular access site in hemodialysis patients. by Kaplowitz LG, Comstock JA, Landwehr DM, Dalton HP, Mayhall CG.; 1988 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=266588

•

Quantitative microbiological monitoring of hemodialysis fluids: evaluation of methods and demonstration of lack of test relevance in single-pass hemodialysis machines with automatic dialysate proportioning with reverse osmosis-treated tap water. by Doern GV, Brogden BE, DiFederico JD, Earls JE, Quinn ML.; 1982 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=272533

•

Reduced antibody reactivity to hepatitis C virus antigens in hemodialysis patients coinfected with hepatitis B virus. by Devesa M, Khudyakov YE, Capriles F, Blitz L, Fields HA, Liprandi F, Pujol FH.; 1997 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170632

•

Removal of imipenem and cilastatin by hemodialysis in patients with end-stage renal failure. by Konishi K, Suzuki H, Saruta T, Hayashi M, Deguchi N, Tazaki H, Hisaka A.; 1991 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245229

•

Removal of vancomycin by high-flux hemodialysis membranes. by Quale JM, O'Halloran JJ, DeVincenzo N, Barth RH.; 1992 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=191597

•

Reversal of Hemodialysis Granulocytopenia and Pulmonary Leukostasis A CLINICAL MANIFESTATION OF SELECTIVE DOWN-REGULATION OF GRANULOCYTE RESPONSES TO C5adesarg. by Skubitz KM, Craddock PR.; 1981 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=370704

•

The effect of hemodialysis on protein metabolism. A leucine kinetic study. by Lim VS, Bier DM, Flanigan MJ, Sum-Ping ST.; 1993 Jun; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=443302

•

T-lymphocyte number and function and the course of hepatitis B in hemodialysis patients. by De Gast GC, Houwen B, van der Hem GK, The TH.; 1976 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=415505

•

TT Virus Infection in French Hemodialysis Patients: Study of Prevalence and Risk Factors. by Gallian P, Berland Y, Olmer M, Raccah D, de Micco P, Biagini P, Simon S, Bouchouareb D, Mourey C, Roubicek C, Touinssi M', Cantaloube JF, Dussol B, de Lamballerie X.; 1999 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85277

•

Virological features of hepatitis C virus infection in hemodialysis patients. by Silini E, Bono F, Cerino A, Piazza V, Solcia E, Mondelli MU.; 1993 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=266154

92

Hemodialysis

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hemodialysis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “hemodialysis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for hemodialysis (hyperlinks lead to article summaries): •

A comparison of methods for the measurement of hemodialysis access recirculation. Author(s): Basile C, Ruggieri G, Vernaglione L, Montanaro A, Giordano R. Source: Journal of Nephrology. 2003 November-December; 16(6): 908-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14736020

•

A low serum iron level is a predictor of poor outcome in hemodialysis patients. Author(s): Kalantar-Zadeh K, McAllister CJ, Lehn RS, Liu E, Kopple JD. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 April; 43(4): 671-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15042544

•

A prospective evaluation of interrupted nitinol surgical clips in arteriovenous fistula for hemodialysis. Author(s): Lin PH, Bush RL, Nelson JC, Lam R, Paladugu R, Chen C, Quinn G, Lumsden AB. Source: American Journal of Surgery. 2003 December; 186(6): 625-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14672769

•

A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts. Author(s): Ram SJ, Work J, Caldito GC, Eason JM, Pervez A, Paulson WD. Source: Kidney International. 2003 July; 64(1): 272-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12787419

6

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies

93

•

A review of intravenous versus oral vitamin D hormone therapy in hemodialysis patients. Author(s): Mazess RB, Elangovan L. Source: Clinical Nephrology. 2003 May; 59(5): 319-25. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12779092

•

A trial of objective comparison of quality of life between chronic renal failure patients treated with hemodialysis and renal transplantation. Author(s): Tomasz W, Piotr S. Source: Ann Transplant. 2003; 8(2): 47-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626576

•

Activation of hepatocyte growth factor/activin A/follistatin system during hemodialysis: role of heparin. Author(s): Borawski J, Naumnik B, Mysliwiec M. Source: Kidney International. 2003 December; 64(6): 2229-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14633147

•

Acute and chronic inflammation in pediatric patients receiving hemodialysis. Author(s): Goldstein SL, Currier H, Watters L, Hempe JM, Sheth RD, Silverstein D. Source: The Journal of Pediatrics. 2003 November; 143(5): 653-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14615740

•

Adjustment of dry weight in hemodialysis patients using intradialytic continuous multifrequency bioimpedance of the calf. Author(s): Zhu F, Kuhlmann MK, Sarkar S, Kaitwatcharachai C, Khilnani R, Leonard EF, Greenwood R, Levin NW. Source: Int J Artif Organs. 2004 February; 27(2): 104-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15061473

•

Alternative graft materials for hemodialysis access. Author(s): Scher LA, Katzman HE. Source: Semin Vasc Surg. 2004 March; 17(1): 19-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011175

•

Amlodipine-induced gynecomastia in two patients on long-term hemodialysis therapy. Author(s): Komine N, Takeda Y, Nakamata T. Source: Clinical and Experimental Nephrology. 2003 March; 7(1): 85-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14586751

94

Hemodialysis

•

An international registry to compare quotidian dialysis regimens with conventional thrice-weekly hemodialysis: why, how, and potential pitfalls. Author(s): Nesrallah GE, Moist LM, Awaraji C, Lindsay RM. Source: Seminars in Dialysis. 2004 March-April; 17(2): 131-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043615

•

An outbreak of fulminant hepatitis B in immunocompromised hemodialysis patients. Author(s): Igaki N, Nakaji M, Moriguchi R, Akiyama H, Tamada F, Oimomi M, Goto T. Source: Journal of Gastroenterology. 2003; 38(10): 968-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14614604

•

Analysis of options for mitigating hemodialysis access-related ischemic steal phenomena. Author(s): Gradman WS, Pozrikidis C. Source: Annals of Vascular Surgery. 2004 January; 18(1): 59-65. Epub 2004 January 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712381

•

Arteriovenous fistula use and heart disease in long-term elderly hemodialysis patients: analysis of United States Renal Data System Dialysis Morbidity and Mortality Wave II. Author(s): Abbott KC, Trespalacios FC, Agodoa LY. Source: Journal of Nephrology. 2003 November-December; 16(6): 822-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14736009

•

Assessment of iron deficiency in chronic hemodialysis patients: investigation of cutoff values for reticulocyte hemoglobin content. Author(s): Mitsuiki K, Harada A, Miyata Y. Source: Clinical and Experimental Nephrology. 2003 March; 7(1): 52-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14586744

•

Association between brain natriuretic peptide and extracellular water in hemodialysis patients. Author(s): Fagugli RM, Palumbo B, Ricciardi D, Pasini P, Santirosi P, Vecchi L, Pasticci F, Palumbo R. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 95(2): C60-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14610331

Studies

95

•

Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Author(s): Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, Saito A, Rayner HC, Kurokawa K, Port FK, Held PJ, Young EW. Source: Journal of the American Society of Nephrology : Jasn. 2003 December; 14(12): 3270-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14638926

•

Association of decreased quality of life and erectile dysfunction in hemodialysis patients. Author(s): Rosas SE, Joffe M, Franklin E, Strom BL, Kotzker W, Brensinger C, Grossman E, Glasser DB, Feldman HI. Source: Kidney International. 2003 July; 64(1): 232-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12787414

•

Axillary artery to contralateral axillary vein graft fistula in chronic hemodialysis patients. Author(s): Chuang FR, Hsieh MJ, Lee CH, Chen JB, Cheng YF, Hsu KT, Yang BY, Wu MS. Source: Renal Failure. 2003 September; 25(5): 871-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14575295

•

Baclofen neurotoxicity in uremic patients: is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis? Author(s): Chen YC, Chang CT, Fang JT, Huang CC. Source: Renal Failure. 2003 March; 25(2): 297-305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739836

•

Bacteremia and infective endocarditis in patients on hemodialysis. Author(s): Maraj S, Jacobs LE, Maraj R, Kotler MN. Source: The American Journal of the Medical Sciences. 2004 May; 327(5): 242-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15166741

•

Basic steps for increasing the rate of autogenic vascular accesses for hemodialysis. Author(s): Salgado OJ. Source: Ther Apher Dial. 2003 April; 7(2): 238-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12918950

96

Hemodialysis

•

Basilic vein transposition fistula: a good option for maintaining hemodialysis access site options? Author(s): Rao RK, Azin GD, Hood DB, Rowe VL, Kohl RD, Katz SG, Weaver FA. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2004 May; 39(5): 1043-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15111858

•

BB genotype of the vitamin D receptor gene polymorphism postpones parathyroidectomy in hemodialysis patients. Author(s): Borras M, Torregrossa V, Oliveras A, Almirall J, Ma Paz M, Betriu A, Martin M, Muray S, Fibla J, Fernandez E. Source: Journal of Nephrology. 2003 January-February; 16(1): 116-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12649542

•

Behavior of non-protein-bound and protein-bound uremic solutes during daily hemodialysis. Author(s): Fagugli RM, De Smet R, Buoncristiani U, Lameire N, Vanholder R. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 August; 40(2): 339-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12148107

•

Beta2-microglobulin clearance with super high flux hemodialysis: an ex vivo study. Author(s): Lee WC, Uchino S, Fealy N, Baldwin I, Panagiotopoulos S, Goehl H, Morgera S, Neumayer HH, Bellomo R. Source: Int J Artif Organs. 2003 August; 26(8): 723-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14521169

•

Bifidobacterium in gastro-resistant seamless capsule reduces serum levels of indoxyl sulfate in patients on hemodialysis. Author(s): Takayama F, Taki K, Niwa T. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S142-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612972

•

Biphasic effects of hemodialysis on platelet reactivity in patients with end-stage renal disease: a potential contributor to cardiovascular risk. Author(s): Aggarwal A, Kabbani SS, Rimmer JM, Gennari FJ, Taatjes DJ, Sobel BE, Schneider DJ. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 August; 40(2): 315-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12148104

Studies

97

•

Bitter pill it is, but frequent hemodialysis more than thrice weekly may be the answer. Author(s): Salahudeen AK, May W. Source: Kidney International. 2003 May; 63(5): 1961-2; Author Reply 1962. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12675890

•

Blood pressure control and left ventricular hypertrophy in long-term CAPD and hemodialysis patients: a cross-sectional study. Author(s): Gunal AI, Ilkay E, Kirciman E, Karaca I, Dogukan A, Celiker H. Source: Perit Dial Int. 2003 November-December; 23(6): 563-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14703197

•

Blood pressure response to erythropoietin injection in hemodialysis and predialysis patients. Author(s): Miyashita K, Tojo A, Kimura K, Goto A, Omata M, Nishiyama K, Fujita T. Source: Hypertens Res. 2004 February; 27(2): 79-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15005270

•

Blood pressure response to uncomplicated hemodialysis: the importance of changes in stroke volume. Author(s): Boon D, van Montfrans GA, Koopman MG, Krediet RT, Bos WJ. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(3): C82-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15056990

•

Bloody ascites in a patient after transfer from peritoneal dialysis to hemodialysis. Author(s): Pollock CA. Source: Seminars in Dialysis. 2003 September-October; 16(5): 406-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12969397

•

Body fat mass in hemodialysis patients. Author(s): Ishimura E, Okuno S, Marukawa T, Katoh Y, Hiranaka T, Yamakawa T, Morii H, Kim M, Matsumoto N, Shoji T, Inaba M, Nakatani T, Nishizawa Y. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S137-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612971

•

Bone marrow amyloidosis with erythropoietin-resistant anemia in a patient undergoing chronic hemodialysis treatment. Author(s): Cetinkaya R, Odabas AR, Selcuk Y, Erman Z, Kaya H. Source: Southern Medical Journal. 2003 May; 96(5): 491-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12911189

98

Hemodialysis

•

Bone mineral density may be related to atherosclerosis in hemodialysis patients. Author(s): Nakashima A, Yorioka N, Tanji C, Asakimori Y, Ago R, Usui K, Shigemoto K, Harada S. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 June; 14(5): 369-73. Epub 2003 May 24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768278

•

Brown tumor of the spine and progressive paraplegia in a hemodialysis patient. Author(s): Vandenbussche E, Schmider L, Mutschler C, Man M, Jacquot C, Augereau B. Source: Spine. 2004 June 15; 29(12): E251-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15187649

•

Calcitriol pulse therapy and histology of parathyroid glands in hemodialysis patients. Author(s): Lomonte C, Martino R, Selvaggiolo M, Bona RM, Cazzato F, Milano R, Chiarulli G, Basile C. Source: Journal of Nephrology. 2003 September-October; 16(5): 716-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733419

•

Cardiac surgery in patients receiving long term hemodialysis. Short and long term results. Author(s): Jault F, Rama A, Bonnet N, Reagan M, Nectoux M, Petitclerc T, Pavie A, Gandjbakhch I. Source: The Journal of Cardiovascular Surgery. 2003 December; 44(6): 725-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14735034

•

Cardiovascular effects of frequent intensive hemodialysis. Author(s): Chan CT. Source: Seminars in Dialysis. 2004 March-April; 17(2): 99-103. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043609

•

Central blood volume, atrial natriuretic peptide and intermittent hemodialysis. Author(s): Wallin CJ, Rossi P, Jacobson SH, Leksell LG. Source: Scandinavian Journal of Urology and Nephrology. 2004; 38(1): 78-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15204432

•

Central vein hemodialysis catheters and infection: a plea for timely referral and appropriate hygienic measures. Author(s): Vanholder R. Source: Acta Clin Belg. 2003 November-December; 58(6): 342-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15068126

Studies

99

•

Cervical peridural calcification in patients undergoing long-term hemodialysis. Report of two cases. Author(s): Shiraishi T, Ikegami T, Okubo Y, Yato Y, Honda M. Source: J Neurosurg Spine. 2004 March; 100(3): 284-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15029917

•

Cinacalcet for secondary hyperparathyroidism in hemodialysis recipients. Author(s): Urena Torres PA, Chanard J. Source: The New England Journal of Medicine. 2004 July 8; 351(2): 188-9; Author Reply 188-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15250062

•

Cinacalcet for secondary hyperparathyroidism in hemodialysis recipients. Author(s): Owda AK, Alam MG, Kumar J. Source: The New England Journal of Medicine. 2004 July 8; 351(2): 188-9; Author Reply 188-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15247361

•

Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. Author(s): Block GA, Martin KJ, de Francisco AL, Turner SA, Avram MM, Suranyi MG, Hercz G, Cunningham J, Abu-Alfa AK, Messa P, Coyne DW, Locatelli F, Cohen RM, Evenepoel P, Moe SM, Fournier A, Braun J, McCary LC, Zani VJ, Olson KA, Drueke TB, Goodman WG. Source: The New England Journal of Medicine. 2004 April 8; 350(15): 1516-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071126

•

Clearance of amino acids by hemodialysis in argininosuccinate synthetase deficiency. Author(s): McBryde KD, Kudelka TL, Kershaw DB, Brophy PD, Gardner JJ, Smoyer WE. Source: The Journal of Pediatrics. 2004 April; 144(4): 536-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15069407

•

Clinical factors associated with achieving K/DOQI hemoglobin targets in hemodialysis patients. Author(s): Li S, Foley RN, Gilbertson DT, Liu J, Collins AJ. Source: International Urology and Nephrology. 2003; 35(3): 399-405. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15160548

•

Comorbid depression and platelet serotonin in hemodialysis patients. Author(s): Barisic I, Pivac N, Muck-Seler D, Jakovljevic M, Sagud M. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(1): C10-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752248

100

Hemodialysis

•

Comparative study of intravenous ascorbic acid versus low-dose desferroxamine in patients on hemodialysis with hyperferritinemia. Author(s): Deira J, Diego J, Martinez R, Oyarbide A, Gonzalez A, Diaz H, Grande J. Source: Journal of Nephrology. 2003 September-October; 16(5): 703-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733417

•

Comparative study of response to treatment with supraphysiologic doses of Bvitamins in hyperhomocysteinemic hemodialysis patients. Author(s): Nakhoul F, Abassi Z, Plawner M, Khankin E, Ramadan R, Lanir N, Brenner B, Green J. Source: Isr Med Assoc J. 2004 April; 6(4): 213-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15115259

•

Comparison of different techniques of hemodialysis vascular access flow evaluation. Author(s): Lopot F, Nejedly B, Sulkova S, Blaha J. Source: Int J Artif Organs. 2003 December; 26(12): 1056-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14738189

•

Complications of the vascular access for hemodialysis. Author(s): Konner K. Source: Contrib Nephrol. 2004; 142: 193-215. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719394

•

Control of nosocomial acquisition of vancomycin-resistant Enterococcus through active surveillance of hemodialysis patients. Author(s): Axon RN, Engemann JJ, Butcher J, Lockamy K, Kaye KS. Source: Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 2004 May; 25(5): 436-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15188852

•

Coordinated increase in albumin, fibrinogen, and muscle protein synthesis during hemodialysis: role of cytokines. Author(s): Raj DS, Dominic EA, Wolfe R, Shah VO, Bankhurst A, Zager PG, Ferrando A. Source: American Journal of Physiology. Endocrinology and Metabolism. 2004 April; 286(4): E658-64. Epub 2004 January 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14722024

•

Correlation studies of plasma paraoxonase activity and uric acid concentration with AAPH-Induced erythrocyte hemolysis in hemodialysis patients. Author(s): Kirschbaum B. Source: Artificial Organs. 2004 March; 28(3): 259-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15046624

Studies

101

•

Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures. Author(s): Barril G, Traver JA. Source: Antiviral Research. 2003 October; 60(2): 129-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14638409

•

Decreased argatroban clearance unaffected by hemodialysis in anasarca. Author(s): de Denus S, Spinler SA. Source: The Annals of Pharmacotherapy. 2003 September; 37(9): 1237-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12921506

•

Decreased erythropoietin requirements in maintenance hemodialysis patients with statin therapy. Author(s): Sirken G, Kung SC, Raja R. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 2003 JulyAugust; 49(4): 422-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12918584

•

Deep venous thrombosis, myocardial infarction, and occlusion of vascular access associated with heparin-induced thrombocytopenia in a diabetic hemodialysis patient. Author(s): Igaki N, Matsuda T, Yatani H, Kawaguchi T, Kida A, Yanase K, Moriguchi R, Sakai M, Tamada F, Goto T. Source: Clinical and Experimental Nephrology. 2003 December; 7(4): 306-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712362

•

Determinants of exercise encouragement practices in hemodialysis staff. Author(s): Painter P, Carlson L, Carey S, Myll J, Paul S. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2004 January-February; 31(1): 67-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15008075

•

Determinants of prescribed dialysis dose and survival in a cohort of chronic hemodialysis patients. Author(s): Iseki K, Tozawa M, Takishita S. Source: Clinical and Experimental Nephrology. 2003 September; 7(3): 231-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14586720

•

Development of a nocturnal home hemodialysis (NHHD) program for children. Author(s): Geary DF, Piva E, Gajaria M, Tyrrel J, Picone G, Harvey E. Source: Seminars in Dialysis. 2004 March-April; 17(2): 115-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043612

102

Hemodialysis

•

Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index. Author(s): Weisbord SD, Fried LF, Arnold RM, Rotondi AJ, Fine MJ, Levenson DJ, Switzer GE. Source: Journal of Pain and Symptom Management. 2004 March; 27(3): 226-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15010101

•

Development of proximal calciphylaxis with penile involvement after parathyroidectomy in a patient on hemodialysis. Author(s): Oikawa S, Osajima A, Tamura M, Murata K, Yasuda H, Anai H, Kabashima N, Matsushima Y, Nakamoto M, Nakashima Y. Source: Intern Med. 2004 January; 43(1): 63-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14964582

•

Dialysate calcium use in hemodialysis patients. Author(s): Backenroth R. Source: Kidney International. 2003 October; 64(4): 1533. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12969180

•

Dialysis-related hypotension as a cause of progressive frontal lobe atrophy in chronic hemodialysis patients: a 3-year prospective study. Author(s): Mizumasa T, Hirakata H, Yoshimitsu T, Hirakata E, Kubo M, Kashiwagi M, Tanaka H, Kanai H, Fujimi S, Iida M. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 97(1): C23-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15153764

•

Differences between patients receiving peritoneal dialysis vs hemodialysis. Author(s): Goel M. Source: Jama : the Journal of the American Medical Association. 2004 May 26; 291(20): 2429; Author Reply 2429. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15161888

•

Different impact of biomarkers as mortality predictors among diabetic and nondiabetic patients undergoing hemodialysis. Author(s): Hocher B, Ziebig R, Altermann C, Krause R, Asmus G, Richter CM, Slowinski T, Sinha P, Neumayer HH. Source: Journal of the American Society of Nephrology : Jasn. 2003 September; 14(9): 2329-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12937310

Studies

103

•

Different risk factors for the maximum and the mean carotid intima-media thickness in hemodialysis patients. Author(s): Nakashima A, Yorioka N, Asakimori Y, Ito T, Masaki T, Shigemoto K, Harada S. Source: Intern Med. 2003 November; 42(11): 1095-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14686748

•

Diffuse alopecia in a hemodialysis patient caused by a low-molecular-weight heparin, tinzaparin. Author(s): Sarris E, Tsele E, Bagiatoudi G, Salpigidis K, Stavrianaki D, Kaklamanis L, Siakotos M. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 May; 41(5): E15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12778433

•

Does atorvastatin influence serum C-reactive protein levels in patients on long-term hemodialysis? Author(s): Vernaglione L, Cristofano C, Muscogiuri P, Chimienti S. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 March; 43(3): 471-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981605

•

Does monitoring of pre-/post-dialyzer pressure difference improve efficiency in intermittent hemodialysis? Author(s): Gabutti L, Colucci G, Martella A, Schonholzer C, Marone C. Source: Blood Purification. 2003; 21(4-5): 294-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12944729

•

Dosimetry for an Sr90/Y90 source train used for intravascular radiation of a hemodialysis graft. Author(s): Bloch P, Bonan R, Wallner P, Lobdell J. Source: Cardiovascular Radiation Medicine. 2003 April-June; 4(2): 90-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14581089

•

Drug dosing during intermittent hemodialysis and continuous renal replacement therapy : special considerations in pediatric patients. Author(s): Veltri MA, Neu AM, Fivush BA, Parekh RS, Furth SL. Source: Paediatric Drugs. 2004; 6(1): 45-65. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14969569

104

Hemodialysis

•

Dynamics of PTH secretion in hemodialysis patients as determined by the intact and whole PTH assays. Author(s): Santamaria R, Almaden Y, Felsenfeld A, Martin-Malo A, Gao P, Cantor T, Aljama P, Rodriguez M. Source: Kidney International. 2003 November; 64(5): 1867-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14531822

•

Early clinical, quality-of-life, and biochemical changes of "daily hemodialysis" (6 dialyses per week). Author(s): Williams AW, Chebrolu SB, Ing TS, Ting G, Blagg CR, Twardowski ZJ, Woredekal Y, Delano B, Gandhi VC, Kjellstrand CM; Daily Hemodialysis Study Group. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 January; 43(1): 90-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712432

•

Effect of parathyroidectomy on bone mineral density in hemodialysis patients with secondary hyperparathyroidism: possible usefulness of preoperative determination of parathyroid hormone level for prediction of bone regain. Author(s): Yano S, Sugimoto T, Tsukamoto T, Yamaguchi T, Hattori T, Sekita KI, Kaji H, Hattori S, Kobayashi A, Chihara K. Source: Hormone and Metabolic Research. Hormon- Und Stoffwechselforschung. Hormones Et Metabolisme. 2003 April; 35(4): 259-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12778370

•

Effect of tibolone on markers of cardiovascular disease risk in postmenopausal women undergoing hemodialysis: a pilot study. Author(s): Ostberg JE, Damjanovic T, Dimkovic N, Byrne D, Mikhailidis DP, Prelevic GM. Source: Fertility and Sterility. 2004 June; 81(6): 1624-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15193486

•

Effects of 12 months of recombinant growth hormone therapy on parameters of bone metabolism and bone mineral density in patients on chronic hemodialysis. Author(s): Kotzmann H, Riedl M, Pietschmann P, Schmidt A, Schuster E, Kreuzer S, Kainberger F, Frisch H, Geyer G, Horl WH, Mayer G, Luger A. Source: Journal of Nephrology. 2004 January-February; 17(1): 87-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15151263

•

Effects of atorvastatin on lipid profile and non-traditional cardiovascular risk factors in diabetic patients on hemodialysis. Author(s): Navarro JF, Mora C, Muros M, Garcia-Idoate G. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 95(4): C128-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694274

Studies

105

•

Effects of dialyzer membrane on serum albumin levels in patients receiving hemodialysis. Author(s): Rault RM. Source: Int J Artif Organs. 2003 November; 26(11): 1002-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14708829

•

Effects of high-flux hemodialysis on clinical outcomes: results of the HEMO study. Author(s): Cheung AK, Levin NW, Greene T, Agodoa L, Bailey J, Beck G, Clark W, Levey AS, Leypoldt JK, Ornt DB, Rocco MV, Schulman G, Schwab S, Teehan B, Eknoyan G. Source: Journal of the American Society of Nephrology : Jasn. 2003 December; 14(12): 3251-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14638924

•

Effects of reduced dialysate calcium on calcium-phosphorus product and bone metabolism in hemodialysis patients. Author(s): Fiedler R, Deuber HJ, Langer T, Osten B, Mohan S, Jehle PM. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(1): C3-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752247

•

Efficacy and pharmacokinetics of fluvoxamine maleate in patients with mild depression undergoing hemodialysis. Author(s): Kamo T, Horikawa N, Tsuruta Y, Miyasita M, Hatakeyama H, Maebashi Y. Source: Psychiatry and Clinical Neurosciences. 2004 April; 58(2): 133-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15009816

•

Efficacy of reteplase in poorly functioning hemodialysis catheters. Author(s): Falk A, Samson W, Uribarri J, Vassalotti JA. Source: Clinical Nephrology. 2004 January; 61(1): 47-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14964457

•

Efficiency of high-flux hemodialysis in the treatment of valproic acid intoxication. Author(s): Kielstein JT, Woywodt A, Schumann G, Haller H, Fliser D. Source: Journal of Toxicology. Clinical Toxicology. 2003; 41(6): 873-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14677800

•

Elimination of the cardiac natriuretic peptides B-type natriuretic peptide (BNP) and N-terminal proBNP by hemodialysis. Author(s): Wahl HG, Graf S, Renz H, Fassbinder W. Source: Clinical Chemistry. 2004 June; 50(6): 1071-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15161726

106

Hemodialysis

•

Encapsulating peritoneal sclerosis-like findings in a hemodialysis patient without a history of peritoneal dialysis. Author(s): Kawanishi H, Watanabe H, Moriishi M, Tsuchiya S. Source: Adv Perit Dial. 2003; 19: 176-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763057

•

Endothelial function is more impaired in hemodialysis patients than renal transplant recipients. Author(s): Oflaz H, Pusuroglu H, Genchallac H, Demirel S, Bugra Z, Sever MS, Yildiz A. Source: Clinical Transplantation. 2003 December; 17(6): 528-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14756269

•

Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients. Author(s): Aytekin C, Boyvat F, Yagmurdur MC, Moray G, Haberal M. Source: European Journal of Radiology. 2004 January; 49(1): 81-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14975496

•

Epidemic parenteral exposure to volatile sulfur-containing compounds at a hemodialysis center. Author(s): Selenic D, Alvarado-Ramy F, Arduino M, Holt S, Cardinali F, Blount B, Jarrett J, Smith F, Altman N, Stahl C, Panlilio A, Pearson M, Tokars J. Source: Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 2004 March; 25(3): 256-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15061419

•

Epidemiology of vascular access for hemodialysis and related practice patterns. Author(s): Saran R, Pisoni RL, Weitzel WF. Source: Contrib Nephrol. 2004; 142: 14-28. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719384

•

Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis. Author(s): Coronel F, Herrero JA, Montenegro J, Fernandez C, Gandara A, Conesa J, Rivera MT, Torrente J, Portoles J, Gomez-Martino JR. Source: Journal of Nephrology. 2003 September-October; 16(5): 697-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733416

Studies

107

•

Exercise augments the acute anabolic effects of intradialytic parenteral nutrition in chronic hemodialysis patients. Author(s): Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA. Source: American Journal of Physiology. Endocrinology and Metabolism. 2004 April; 286(4): E589-97. Epub 2003 December 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14678952

•

Extrinsic compression of the left innominate vein in hemodialysis patients. Author(s): Itkin M, Kraus MJ, Trerotola SO. Source: Journal of Vascular and Interventional Radiology : Jvir. 2004 January; 15(1 Pt 1): 51-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709688

•

Fabry disease: detection of undiagnosed hemodialysis patients and identification of a "renal variant" phenotype. Author(s): Nakao S, Kodama C, Takenaka T, Tanaka A, Yasumoto Y, Yoshida A, Kanzaki T, Enriquez AL, Eng CM, Tanaka H, Tei C, Desnick RJ. Source: Kidney International. 2003 September; 64(3): 801-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12911529

•

Factors affecting bone mineral density in hemodialysis patients with diabetic nephropathy. Author(s): Kaji H, Hattori S, Sekita K, Sugimoto T, Chihara K. Source: Endocrine Journal. 2003 April; 50(2): 127-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12803232

•

Factors associated with future amputation among patients undergoing hemodialysis: results from the Dialysis Morbidity and Mortality Study Waves 3 and 4. Author(s): O'Hare AM, Bacchetti P, Segal M, Hsu CY, Johansen KL; Dialysis Morbidity and Mortality Study Waves. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 January; 41(1): 162-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500233

•

Factors associated with long-term antibody production induced by hepatitis B vaccine in patients undergoing hemodialysis: a retrospective cohort study. Author(s): Elwell RJ, Neumann M, Bailie GR. Source: Pharmacotherapy. 2003 December; 23(12): 1558-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14695036

108

Hemodialysis

•

Factors associated with medication-related problems in ambulatory hemodialysis patients. Author(s): Manley HJ, McClaran ML, Overbay DK, Wright MA, Reid GM, Bender WL, Neufeld TK, Hebbar S, Muther RS. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 February; 41(2): 386-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12552501

•

Factors contributing to higher hematocrit levels in hemodialysis patients not receiving recombinant human erythropoietin. Author(s): Takeda A, Toda T, Shinohara S, Mogi Y, Matsui N. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 July; 40(1): 104-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12087567

•

Failing hemodialysis access grafts: evaluation of complete vascular tree with 3D contrast-enhanced MR angiography with high spatial resolution: initial results in 10 patients. Author(s): Han KM, Duijm LE, Thelissen GR, Cuypers PW, Douwes-Draaijer P, Tielbeek AV, Wondergem JH, van den Bosch HC. Source: Radiology. 2003 May; 227(2): 601-5. Epub 2003 March 27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663821

•

Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access. Author(s): Patel ST, Hughes J, Mills JL Sr. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 September; 38(3): 439-45; Discussion 445. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12947249

•

Fibrinogen in hemodialysis: the worst of both worlds? Author(s): Goodship TH. Source: Kidney International. 2003 January; 63(1): 379-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12472807

•

Fibrinolysis defect in long-term hemodialysis patients with type 2 diabetes mellitus and its relation to metabolic disorders. Author(s): Opatrny K Jr, Zemanova P, Mares J, Vit L, Opatrna S, Sefrna F, Hejda V, Tomsu M, Eiselt J, Massry SG. Source: American Journal of Nephrology. 2002 September-December; 22(5-6): 429-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12381940

Studies

109

•

Filtration fluid for hemodialysis treatment. Author(s): Ikonomov V, Haase G, Stefanidis I, Melzer H, Mann H. Source: Int J Artif Organs. 2002 May; 25(5): 379-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12074334

•

Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health. Author(s): Molsted S, Eidemak I, Sorensen HT, Kristensen JH. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(3): C76-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15056989

•

Five years' experience of combination therapy: peritoneal dialysis with hemodialysis. Author(s): Kawanishi H, Moriishi M, Tsuchiya S. Source: Adv Perit Dial. 2002; 18: 62-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12402589

•

Free cysteine is increased in plasma from hemodialysis patients. Author(s): Nakanishi T, Hasuike Y, Otaki Y, Hama Y, Nanami M, Miyagawa K, Moriguchi R, Nishikage H, Izumi M, Takamitsu Y. Source: Kidney International. 2003 March; 63(3): 1137-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12631098

•

Frequency of anti-heparin-platelet factor 4 antibodies in hemodialysis patients and correlation with recurrent vascular access thrombosis. Author(s): O'Shea SI, Sands JJ, Nudo SA, Ortel TL. Source: American Journal of Hematology. 2002 January; 69(1): 72-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11835336

•

Frequency of patient-physician contact and patient outcomes in hemodialysis care. Author(s): Plantinga LC, Fink NE, Sadler JH, Levey AS, Levin NW, Rubin HR, Coresh J, Klag MJ, Powe NR. Source: Journal of the American Society of Nephrology : Jasn. 2004 January; 15(1): 210-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694175

•

Frequency of physician visits to patients on in-center maintenance hemodialysis: does one strategy fit all? Author(s): Golper TA. Source: Journal of the American Society of Nephrology : Jasn. 2004 January; 15(1): 238-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694179

110

Hemodialysis

•

Full-dose chemotherapy for esophageal cancer patient under hemodialysis. Author(s): Kurisu A, Hata T, Owada A. Source: Nephron. 2002 December; 92(4): 960. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12399655

•

Fully ringed polytetrafluoroethylene graft for vascular access in hemodialysis. Author(s): Kao CL, Chang JP. Source: Asian Cardiovascular & Thoracic Annals. 2003 June; 11(2): 171-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12878572

•

Gabapentin toxicity requiring intubation in a patient receiving long-term hemodialysis. Author(s): Jones H, Aguila E, Farber HW. Source: Annals of Internal Medicine. 2002 July 2; 137(1): 74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12093261

•

Gadolinium-enhanced digital subtraction angiography of hemodialysis fistulas: a diagnostic and therapeutic approach. Author(s): Le Blanche AF, Tassart M, Deux JF, Rossert J, Bigot JM, Boudghene F. Source: Ajr. American Journal of Roentgenology. 2002 October; 179(4): 1023-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12239059

•

Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Author(s): Miller CD, Robbin ML, Allon M. Source: Kidney International. 2003 January; 63(1): 346-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12472802

•

Gene polymorphism in the promoter region of lipopolysaccharide receptor CD14 and dyslipidemia in hemodialysis patients. Author(s): Fukui M, Shou I, Gohda T, Hamada C, Maeda K, Horikoshi S, Tomino Y. Source: Clinical Nephrology. 2003 September; 60(3): 220-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14524589

•

General or disease specific questionnaire? A comparative study in hemodialysis patients. Author(s): Kutlay S, Nergizoglu G, Kutlay S, Keven K, Erturk S, Ates K, Duman N, Karatan O, Atli T. Source: Renal Failure. 2003 January; 25(1): 95-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12617337

Studies

111

•

Genotype and subtype analyses of hepatitis B virus (HBV) and possible co-infection of HBV and hepatitis C virus (HCV) or hepatitis D virus (HDV) in blood donors, patients with chronic liver disease and patients on hemodialysis in Surabaya, Indonesia. Author(s): Lusida MI, Surayah, Sakugawa H, Nagano-Fujii M, Soetjipto, Mulyanto, Handajani R, Boediwarsono, Setiawan PB, Nidom CA, Ohgimoto S, Hotta H. Source: Microbiology and Immunology. 2003; 47(12): 969-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14695447

•

Gentamicin pharmacokinetics during slow daily home hemodialysis. Author(s): Manley HJ, Bailie GR, McClaran ML, Bender WL. Source: Kidney International. 2003 March; 63(3): 1072-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12631090

•

Glyoxalase I deficiency is associated with an unusual level of advanced glycation end products in a hemodialysis patient. Author(s): Miyata T, van Ypersele de Strihou C, Imasawa T, Yoshino A, Ueda Y, Ogura H, Kominami K, Onogi H, Inagi R, Nangaku M, Kurokawa K. Source: Kidney International. 2001 December; 60(6): 2351-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11737610

•

Gordon Murray: heparin, hemodialysis and hubris. Author(s): Fellner SK, Purkerson ML. Source: American Journal of Nephrology. 2002 July; 22(2-3): 271-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12097752

•

Guarded fistula needle reduces needlestick injuries in hemodialysis. Author(s): McCleary J, Caldero K, Adams T. Source: Nephrol News Issues. 2002 May; 16(6): 66-70, 72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12035629

•

Guidelines for training, certification, and accreditation for hemodialysis vascular access and endovascular procedures. American Society of Diagnostic and Interventional Nephrology. Author(s): American Society of Diagnostic and Interventional Nephrology. Source: Seminars in Dialysis. 2003 March-April; 16(2): 173-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12641883

112

Hemodialysis

•

Heart rate variability, left ventricular functions, and cardiac autonomic neuropathy in patients undergoing chronic hemodialysis. Author(s): Karayaylali I, San M, Kudaiberdieva G, Niyazova-Karben Z, Seyrek N, Balal M, Paydas S, Sagliker Y. Source: Renal Failure. 2003 September; 25(5): 845-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14575292

•

Heart valve calcifications, survival, and cardiovascular risk in hemodialysis patients. Author(s): Panuccio V, Tripepi R, Tripepi G, Mallamaci F, Benedetto FA, Cataliotti A, Bellanuova I, Giacone G, Malatino LS, Zoccali C. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 March; 43(3): 479-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981606

•

Helicobacter pylori infection in hemodialysis patients. Author(s): Tsukada K, Miyazaki T, Katoh H, Yoshikawa M, Masuda N, Ojima H, Tajima K, Fukai Y, Nakajima M, Kamiyama Y, Kuwano H, Tsukada O. Source: Hepatogastroenterology. 2003 November-December; 50(54): 2255-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696511

•

Hemodialysis adequacy and quality of life: how do they relate? Author(s): Hamilton G, Locking-Cusolito H. Source: Cannt J. 2003 October-December; 13(4): 24-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14753099

•

Hemodialysis catheters: materials, design and manufacturing. Author(s): Wentling AG. Source: Contrib Nephrol. 2004; 142: 112-27. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719389

•

Hemodialysis graft for the "hostile" arm. Author(s): Radomski JS. Source: Journal of the American College of Surgeons. 2004 April; 198(4): 676; Author Reply 676-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15051026

•

Hemodialysis using heparin-bound Hemophan in patients at risk of bleeding. Author(s): Lee KB, Kim B, Lee YH, Yoon SJ, Kang WH, Huh W, Kim DJ, Oh HY, Kim YG. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 97(1): C5-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15153761

Studies

113

•

Hemodialysis vascular access and peritoneal dialysis access. Preface. Author(s): Shaldon S. Source: Contrib Nephrol. 2004; 142: X-Xii. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719382

•

Hemodialysis-related venous stenosis: treatment with ultrahigh-pressure angioplasty balloons. Author(s): Trerotola SO, Stavropoulos SW, Shlansky-Goldberg R, Tuite CM, Kobrin S, Rudnick MR. Source: Radiology. 2004 April; 231(1): 259-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15068951

•

Hemodynamics of the hemodialysis access: implications for clinical management. Author(s): Paulson WD, Jones SA. Source: Contrib Nephrol. 2004; 142: 238-53. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719397

•

Hemoglobin levels and erythropoietin doses in hemodialysis and peritoneal dialysis patients in the United States. Author(s): Snyder JJ, Foley RN, Gilbertson DT, Vonesh EF, Collins AJ. Source: Journal of the American Society of Nephrology : Jasn. 2004 January; 15(1): 174-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694170

•

Hepatitis C virus infection in hemodialysis patients from Tunisia: national survey by serologic and molecular methods. Author(s): Ayed K, Gorgi Y, Ben Abdallah T, Aouadi H, Jendoubi-Ayed S, Sfar I, Makni H. Source: Transplantation Proceedings. 2003 November; 35(7): 2573-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14612022

•

Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis. Author(s): Chang CJ, Ko PJ, Hsu LA, Ko YS, Ko YL, Chen CF, Huang CC, Hsu TS, Lee YS, Pang JH. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 January; 43(1): 74-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712430

•

History and evolution of the vascular access for hemodialysis. Author(s): Bonello M, Levin NW, Ronco C. Source: Contrib Nephrol. 2004; 142: 1-13. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719383

114

Hemodialysis

•

Home hemodialysis a la carte: a tailormade program (1998-2003). Author(s): Piccoli GB, Bermond F, Mezza E, Soragna G, Burdese M, Jeantet A, Segoloni GP, Piccoli G. Source: Journal of Nephrology. 2004 January-February; 17(1): 76-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15151262

•

Hydrofluoric acid-induced burns and life-threatening systemic poisoning--favorable outcome after hemodialysis. Author(s): Bjornhagen V, Hojer J, Karlson-Stiber C, Selden AI, Sundbom M. Source: Journal of Toxicology. Clinical Toxicology. 2003; 41(6): 855-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14677796

•

Hypermethylation of the CpG island of connexin 32, a candiate tumor suppressor gene in renal cell carcinomas from hemodialysis patients. Author(s): Yano T, Ito F, Kobayashi K, Yonezawa Y, Suzuki K, Asano R, Hagiwara K, Nakazawa H, Toma H, Yamasaki H. Source: Cancer Letters. 2004 May 28; 208(2): 137-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15142671

•

Hypertension in the hemodialysis patient and the "lag phenomenon": insights into pathophysiology and clinical management. Author(s): Khosla UM, Johnson RJ. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 April; 43(4): 739-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15042553

•

Impaired T cell proliferation and zeta chain phosphorylation after stimulation with staphylococcal enterotoxin-B in hemodialysis patients. Author(s): Eleftheriadis T, Papazisis K, Kortsaris A, Vayonas G, Voyatzi S, Vargemezis V. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(1): C15-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752249

•

Improved detection of HCV Infection in hemodialysis patients using a new HCV RNA qualitative assay: experience of a transplant center. Author(s): Khan N, Aswad S, Shidban H, Aghajani M, Mendez R, Mendez R, Comanor L. Source: Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology. 2004 June; 30(2): 175-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15125874

Studies

115

•

Improved pregnancy outcome in a patient with renal allograft nephropathy undergoing temporary hemodialysis. Author(s): Al-Jayyousi R, Carr S, Hodgett S, Scudamore I, Howarth E, Singlehurst A, Brunskill N. Source: Clinical Nephrology. 2003 December; 60(6): 424-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14690260

•

In vivo validation of glucose pump test for measurement of hemodialysis access flow. Author(s): Ram SJ, Magnasco A, Jones SA, Barz A, Zsom L, Swamy S, Paulson WD. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 October; 42(4): 752-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520626

•

Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Author(s): Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S; Canadian Nosocomial Infection Surveillance Program; Canadian Hospital Epidemiology Committee. Source: American Journal of Infection Control. 2004 May; 32(3): 155-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15153927

•

Increased incidence of carotid artery wall changes and associated variables in hemodialysis patients without symptomatic cardiovascular disease. Author(s): Kiykim AA, Camsari A, Kahraman S, Arici M, Altun B, Cicek D, Erdem Y, Yasavul U, Turgan C, Caglar S, Oto A. Source: Yonsei Medical Journal. 2004 April 30; 45(2): 247-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15118996

•

Increased P wave dispersion and maximum P wave duration after hemodialysis. Author(s): Tezcan UK, Amasyali B, Can I, Aytemir K, Kose S, Yavuz I, Kursaklioglu H, Isik E, Demirtas E, Oto A. Source: Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2004 January; 9(1): 34-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14731214

•

Induction of cytokines and adhesion molecules in stable hemodialysis patients: is there an effect of membrane material? Author(s): Hoffmann U, Fischereder M, Marx M, Schweda F, Lang B, Straub RH, Kramer BK. Source: American Journal of Nephrology. 2003 November-December; 23(6): 442-7. Epub 2003 October 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14583663

116

Hemodialysis

•

Infection-associated hemophagocytic syndrome in a diabetic patient undergoing chronic hemodialysis. Author(s): Wada Y, Sato M, Saito A, Gejyo F. Source: Clinical and Experimental Nephrology. 2003 June; 7(2): 163-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14586736

•

Inflammatory markers are unrelated to physical activity, performance, and functioning in hemodialysis. Author(s): Hung AM, Chertow GM, Young BS, Carey S, Johansen KL. Source: Adv Ren Replace Ther. 2003 July; 10(3): 232-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14708079

•

Influence of relative hypoparathyroidism on the responsiveness to recombinant human erythropoietin in hemodialysis patients. Author(s): Hsu SP, Peng YS, Pai MF, Hung KY, Tsai TJ. Source: Blood Purification. 2003; 21(3): 220-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12784047

•

Influence of sevelamer hydrochloride on serum concentration of whole (1-84) and Nterminally truncated (7-84) parathyroid hormone fragments in hemodialysis uremic patients. Author(s): Chudek J, Piecha G, Kokot F, Wiecek A. Source: Journal of Nephrology. 2003 September-October; 16(5): 710-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733418

•

Initial experience during balloon angioplasty assisted surgical thrombectomy for thrombosed hemodialysis grafts. Author(s): Ko PJ, Liu YH, Hsieh HC, Chu JJ, Lin PJ. Source: Chang Gung Med J. 2003 March; 26(3): 178-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12790221

•

Inpatient rehabilitation of patients requiring hemodialysis. Author(s): Forrest GP. Source: Archives of Physical Medicine and Rehabilitation. 2004 January; 85(1): 51-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14970967

•

Interactions among a stressor, self-efficacy, coping with stress, depression, and anxiety in maintenance hemodialysis patients. Author(s): Takaki J, Nishi T, Shimoyama H, Inada T, Matsuyama N, Kumano H, Kuboki T. Source: Behavioral Medicine (Washington, D.C.). 2003 Fall; 29(3): 107-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15206829

Studies

117

•

Intermediate outcome and risk factor assessment of bovine vascular heterografts used as AV-fistulas for hemodialysis access. Author(s): Widmer MK, Aregger F, Stauffer E, Savolainen H, Heller G, Hakki H, Carrel T, Schmidli J, Mohaupt MG. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2004 June; 27(6): 660-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15121120

•

Intermittent hemodialysis for acute renal failure patients--an update. Author(s): Lameire N, Van Biesen W, Vanholder R, Hoste E. Source: Contrib Nephrol. 2004; 144: 255-63. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15264414

•

Interventional radiology in the conservation of vascular access for hemodialysis. Author(s): Turmel-Rodrigues L, Bourquelot P. Source: Artificial Organs. 2003 June; 27(6): 501-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12780504

•

Intravenous administration of nifekalant hydrochloride for the prevention of ischemia-induced ventricular tachyarrhythmia in patients with renal failure undergoing hemodialysis. Author(s): Myoishi M, Yasuda S, Miyazaki S, Ueno K, Morii I, Satomi K, Otsuka Y, Kawamura A, Kurita T, Kamakura S, Nonogi H. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2003 October; 67(10): 898-900. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14578629

•

Iron storage indices: novel predictors of bacteremia in hemodialysis patients initiating intravenous iron therapy. Author(s): Teehan GS, Bahdouch D, Ruthazer R, Balakrishnan VS, Snydman DR, Jaber BL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2004 April 15; 38(8): 1090-4. Epub 2004 Apr 01. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15095212

•

Job satisfaction and patient care practices of hemodialysis nurses and technicians. Author(s): Perumal S, Sehgal AR. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2003 October; 30(5): 523-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14621631

118

Hemodialysis

•

Kinetics of hepatitis C virus load during hemodialysis: novel perspectives. Author(s): Fabrizi F, Bunnapradist S, Lunghi G, Martin P. Source: Journal of Nephrology. 2003 July-August; 16(4): 467-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696748

•

Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. Author(s): Durose CL, Holdsworth M, Watson V, Przygrodzka F. Source: Journal of the American Dietetic Association. 2004 January; 104(1): 35-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14702581

•

Late-onset X-linked sideroblastic anemia following hemodialysis. Author(s): Furuyama K, Harigae H, Kinoshita C, Shimada T, Miyaoka K, Kanda C, Maruyama Y, Shibahara S, Sassa S. Source: Blood. 2003 June 1; 101(11): 4623-4. Epub 2003 January 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12531813

•

L-carnitine consecutively administered to patients on hemodialysis improves betacell response. Author(s): Vazelov E, Borissova AM, Kirilov G, Assenova B, Tchetirska M, Krivoshiev S. Source: Int J Artif Organs. 2003 April; 26(4): 304-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12757029

•

LCAT-dependent conversion of prebeta1-HDL into alpha-migrating HDL is severely delayed in hemodialysis patients. Author(s): Miida T, Miyazaki O, Hanyu O, Nakamura Y, Hirayama S, Narita I, Gejyo F, Ei I, Tasaki K, Kohda Y, Ohta T, Yata S, Fukamachi I, Okada M. Source: Journal of the American Society of Nephrology : Jasn. 2003 March; 14(3): 732-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12595510

•

Left ventricular hypertrophy and endothelial dysfunction in chronic hemodialysis patients. Author(s): Yildiz A, Oflaz H, Pusuroglu H, Mercanoglu F, Genchallac H, Akkaya V, Ikizler TA, Sever MS. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3): 616-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612985

•

Let it be: Salvage of exposed hemodialysis grafts with fasciocutaneous island flaps. Author(s): Isenberg JS. Source: Microsurgery. 2004; 24(2): 134-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15038019

Studies

119

•

Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy. Author(s): Danielski M, Ikizler TA, McMonagle E, Kane JC, Pupim L, Morrow J, Himmelfarb J. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 August; 42(2): 286-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12900810

•

Lipid oxidation kinetics in hemodialysis patients with and without history of myocardial infarction. Author(s): Boaz M, Smetana S, Matas Z, Bor A, Pinchuk I, Fainaru M, Green MS, Lichtenberg D. Source: Isr Med Assoc J. 2003 October; 5(10): 692-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719461

•

Lipids, blood pressure and bone metabolism after growth hormone therapy in elderly hemodialysis patients. Author(s): Viidas U, Johannsson G, Mattson-Hulten L, Ahlmen J. Source: Journal of Nephrology. 2003 March-April; 16(2): 231-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768070

•

Lipoprotein alterations in hemodialysis: differences between diabetic and nondiabetic patients. Author(s): Gonzalez AI, Schreier L, Elbert A, Berg G, Beresan H, Lopez G, Wikinski R. Source: Metabolism: Clinical and Experimental. 2003 January; 52(1): 116-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12524671

•

Lipoprotein lipase during heparin infusion: lower activity in hemodialysis patients. Author(s): Nasstrom B, Olivecrona G, Olivecrona T, Stegmayr BG. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 2003; 63(1): 45-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12729069

•

Long daily hemodialysis sessions correct systemic complications of oxalosis prior to combined liver-kidney transplantation: case report. Author(s): Diaz C, Catalinas FG, de Alvaro F, Torre A, Sanchez C, Costero O. Source: Ther Apher Dial. 2004 February; 8(1): 52-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15128020

•

Long QT syndrome: first and fatal events provoked by hemodialysis. Author(s): Miller RF, Haley MW, Littmann L. Source: Pacing and Clinical Electrophysiology : Pace. 2003 January; 26(1 Pt 1): 103-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12685147

120

Hemodialysis

•

Longitudinal analysis of intermediate outcomes in adolescent hemodialysis patients. Author(s): Neu AM, Fivush BA, Warady BA, Watkins SL, Friedman AL, Brem AS, Goldstein S, Frankenfield DL. Source: Pediatric Nephrology (Berlin, Germany). 2003 November; 18(11): 1172-6. Epub 2003 August 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12920629

•

Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients. Author(s): Johansen KL, Kaysen GA, Young BS, Hung AM, da Silva M, Chertow GM. Source: The American Journal of Clinical Nutrition. 2003 April; 77(4): 842-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663281

•

Long-term evaluation of nutritional status using dual-energy X-ray absorptiometry in chronic hemodialysis patients. Author(s): Takahashi N, Yuasa S, Fukunaga M, Hara T, Moriwaki K, Shokoji T, Hitomi H, Fujioka H, Kiyomoto H, Aki Y, Hirohata M, Mizushige K, Kohno M. Source: Clinical Nephrology. 2003 May; 59(5): 373-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12779100

•

Long-term results of chronic hemodialysis patients with isolated coronary artery bypass grafting performed by the same surgeon. A comparative study. Author(s): Fujii H, Otani H, Okada T, Oka T, Osako M, Imamura H. Source: The Journal of Cardiovascular Surgery. 2002 October; 43(5): 617-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386572

•

Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Author(s): Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 November; 42(5): 1020-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14582046

•

Loss of captopril-bound Fe by end-stage renal failure patients during hemodialysis. Author(s): Averbukh Z, Berman S, Kishinevsky E, Feldman L, Cohn M, Rapoport M, Galperin E, Dishi V, Weissgarten J. Source: Journal of Nephrology. 2004 January-February; 17(1): 101-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15151265

Studies

121

•

Low dose intravenous ascorbic acid for erythropoietin-hyporesponsive anemia in diabetic hemodialysis patients with iron overload. Author(s): Lin CL, Hsu PY, Yang HY, Huang CC. Source: Renal Failure. 2003 May; 25(3): 445-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12803508

•

Low initial vitamin B12 levels in Helicobacter pylori--positive patients on chronic hemodialysis. Author(s): Trimarchi H, Forrester M, Schropp J, Pereyra H, Freixas EA. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(1): C28-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752251

•

Maintaining higher TSATs and other iron indices is beneficial in management of anemic hemodialysis patients. Author(s): Besarab A, Dalton CL. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2001 August; 28(4): 429-34. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12143465

•

Maintenance of residual renal function 10 years after the start of hemodialysis: the advantage of tailored schedules? Author(s): Piccoli GB, Burdese M, Mezza E, Consiglio V, Mangiarotti G, Thea A, Bermond F, Gai M, Lanfranco G, Jeantet A, Segoloni GP. Source: Int J Artif Organs. 2004 March; 27(3): 251-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15112891

•

Management of a severe carbamazepine overdose using albumin-enhanced continuous venovenous hemodialysis. Author(s): Askenazi DJ, Goldstein SL, Chang IF, Elenberg E, Feig DI. Source: Pediatrics. 2004 February; 113(2): 406-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14754959

•

Management of hemodialysis access infections. Author(s): Ryan SV, Calligaro KD, Dougherty MJ. Source: Semin Vasc Surg. 2004 March; 17(1): 40-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011178

122

Hemodialysis

•

Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Author(s): Espinosa M, Martn-Malo A, Ojeda R, Santamara R, Soriano S, Aguera M, Aljama P. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 April; 43(4): 685-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15042545

•

Massive caffeine overdose requiring vasopressin infusion and hemodialysis. Author(s): Holstege CP, Hunter Y, Baer AB, Savory J, Bruns DE, Boyd JC. Source: Journal of Toxicology. Clinical Toxicology. 2003; 41(7): 1003-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14705850

•

Mechanical hemolysis in a hemodialysis patient with carotid-jugular arteriovenous fistula. Author(s): Kuo KL, Chou YH, Tarng DC. Source: Clinical Nephrology. 2004 January; 61(1): 74-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14964462

•

Metallic stenting for treatment of central venous obstruction in hemodialysis patients. Author(s): Chen CY, Liang HL, Pan HB, Chung HM, Chen WL, Fang HC, Lo A, Chen CK, Lai PH, Yang CF. Source: J Chin Med Assoc. 2003 March; 66(3): 166-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12779037

•

Metastatic calcification of the hand in a patient undergoing hemodialysis. Author(s): Tristano AG. Source: The American Journal of Medicine. 2004 April 15; 116(8): 572-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15063826

•

Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Author(s): Ishibe S, Peixoto AJ. Source: Seminars in Dialysis. 2004 January-February; 17(1): 37-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14717810

•

Modified monorail technique for insertion of tunneled hemodialysis catheters. Author(s): Worthington-Kirsch RL. Source: Journal of Vascular and Interventional Radiology : Jvir. 2004 March; 15(3): 303-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15028818

Studies

123

•

Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study. Author(s): Saray Y, Seckin D, Gulec AT, Akgun S, Haberal M. Source: Journal of the American Academy of Dermatology. 2004 February; 50(2): 197202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14726872

•

Near-infrared spectroscopic measurement of urea in dialysate samples collected during hemodialysis treatments. Author(s): Eddy CV, Flanigan M, Arnold MA. Source: Applied Spectroscopy. 2003 October; 57(10): 1230-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14639750

•

Neither folic nor folinic acid normalize homocysteine levels in hemodialysis patients. Author(s): Armada E, Perez C, Otero A, Esteban J, Camba M, Gayoso P, Suarez D. Source: Clinical Nephrology. 2003 September; 60(3): 168-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14524579

•

Nephrogenic fibrosing dermopathy after five days of hemodialysis. Author(s): Hancox JG, Mengesha YM, Sangueza OP, Yosipovitch G. Source: J Drugs Dermatol. 2003 October; 2(5): 550-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14558404

•

Neurotoxicity induced by Cefepime in a very old hemodialysis patient. Author(s): Ferrara N, Abete P, Giordano M, Ferrara P, Carnovale V, Leosco D, Beneduce F, Ciarambino T, Varricchio M, Rengo F. Source: Clinical Nephrology. 2003 May; 59(5): 388-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12779103

•

New approaches to hemodialysis. Author(s): Pierratos A. Source: Annual Review of Medicine. 2004; 55: 179-89. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14746516

•

New national surveillance system for hemodialysis-associated infections: initial results. Author(s): Tokars JI, Miller ER, Stein G. Source: American Journal of Infection Control. 2002 August; 30(5): 288-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12163863

124

Hemodialysis

•

Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Author(s): Saran R, Bragg-Gresham JL, Rayner HC, Goodkin DA, Keen ML, Van Dijk PC, Kurokawa K, Piera L, Saito A, Fukuhara S, Young EW, Held PJ, Port FK. Source: Kidney International. 2003 July; 64(1): 254-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12787417

•

Non-relation of parathyroid hormone gene polymorphisms to secondary hyperparathyroidism in Chinese hemodialysis patients. Author(s): Chen JB, Chou FF, Hsu KT. Source: Renal Failure. 2004 January; 26(1): 49-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15083922

•

Nutritional requirements in maintenance hemodialysis. Author(s): Fouque D. Source: Adv Ren Replace Ther. 2003 July; 10(3): 183-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14708072

•

Once-weekly hemodialysis helps continuous ambulatory peritoneal dialysis patients who have insufficient solute removal. Author(s): Kanno Y, Suzuki H, Nakamoto H, Okada H, Sugahara S. Source: Adv Perit Dial. 2003; 19: 143-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763051

•

Online measurement of urea concentration in spent dialysate during hemodialysis. Author(s): Olesberg JT, Arnold MA, Flanigan MJ. Source: Clinical Chemistry. 2004 January; 50(1): 175-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709645

•

Optimum dietary protein requirement in nondiabetic maintenance hemodialysis patients. Author(s): Ohkawa S, Kaizu Y, Odamaki M, Ikegaya N, Hibi I, Miyaji K, Kumagai H. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 March; 43(3): 454-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981603

•

Osmotic demyelination syndrome in end-stage renal disease after recent hemodialysis: MRI of the brain. Author(s): Tarhan NC, Agildere AM, Benli US, Ozdemir FN, Aytekin C, Can U. Source: Ajr. American Journal of Roentgenology. 2004 March; 182(3): 809-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14975990

Studies

125

•

Ossifying fibroma of the face and hyperparathyroidism in a chronic hemodialysis patient. Author(s): Aldred MJ, Talacko AA, Savarirayan R. Source: Nephrologie. 2004; 25(1): 33; Author Reply 33. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15022872

•

Outcome and complications of intraoperative hemodialysis during cardiopulmonary bypass with potassium-rich cardioplegia. Author(s): Khoo MS, Braden GL, Deaton D, Owen S, Germain M, O'Shea M, Mulhern J, Rousou J, Flack J, Engleman R. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 June; 41(6): 1247-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776278

•

Outcomes of upper arm arteriovenous fistulas for maintenance hemodialysis access. Author(s): Fitzgerald JT, Schanzer A, Chin AI, McVicar JP, Perez RV, Troppmann C. Source: Archives of Surgery (Chicago, Ill. : 1960). 2004 February; 139(2): 201-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14769581

•

Oxidative stress in patients with chronic renal failure: effects of hemodialysis. Author(s): Durak I, Kacmaz M, Elgun S, Ozturk HS. Source: Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre. 2004 March-April; 13(2): 84-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14755140

•

Oxygen uptake efficiency slope as monitoring tool for physical training in chronic hemodialysis patients. Author(s): Tsuyuki K, Kimura Y, Chiashi K, Matsushita C, Ninomiya K, Choh K, Hase H, Dohi S. Source: Ther Apher Dial. 2003 August; 7(4): 461-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887732

•

Pharmacoeconomic aspects of patients treated by hemodialysis. Author(s): Gazdikova K, Korecka P, Springer V, Gazdik F. Source: Bratisl Lek Listy. 2003; 104(10): 329-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055734

•

Physical and psychosocial adaptation of blacks on hemodialysis. Author(s): Burns D. Source: Applied Nursing Research : Anr. 2004 May; 17(2): 116-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15154124

126

Hemodialysis

•

Possible involvement of macrophage-colony stimulating factor in the pathogenesis of cardiac dysfunction in hemodialysis patients. Author(s): Ito A, Shimokawa H, Meno H, Inou T. Source: Japanese Heart Journal. 2004 May; 45(3): 497-503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15240969

•

Possible involvement of TNF-alpha in left ventricular remodeling in hemodialysis patients. Author(s): Nishimura M, Hashimoto T, Kobayashi H, Fukukda T, Okino K, Yamamoto N, Nakamura N, Yoshikawa T, Takahashi H, Ono T. Source: Journal of Nephrology. 2003 September-October; 16(5): 641-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733409

•

Prediction of cardiovascular risk in hemodialysis patients by data mining. Author(s): Pfaff M, Weller K, Woetzel D, Guthke R, Schroeder K, Stein G, Pohlmeier R, Vienken J. Source: Methods of Information in Medicine. 2004; 43(1): 106-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15026849

•

Pretransplant recipient cytomegalovirus seropositivity and hemodialysis are associated with decreased renal allograft and patient survival. Author(s): Fitzgerald JT, Gallay B, Taranto SE, McVicar JP, Troppmann C, Chen X, McIntosh MJ, Perez RV. Source: Transplantation. 2004 May 15; 77(9): 1405-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15167599

•

Prosecution after an outbreak of subacute aluminum intoxication in a hemodialysis center. Author(s): Berend K, Knoops GJ, De Wolff FA. Source: Legal Medicine (Tokyo, Japan). 2004 March; 6(1): 1-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15177068

•

Prospective study of the immune effects of normalizing the hemoglobin concentration in hemodialysis patients who receive recombinant human erythropoietin. Author(s): Roman RM, Lobo PI, Taylor RP, Goodkin DA, LaBrecque J, Powers KL, Bolton WK. Source: Journal of the American Society of Nephrology : Jasn. 2004 May; 15(5): 1339-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15100375

Studies

127

•

Protein homeostasis in chronic hemodialysis patients. Author(s): Pupim LB, Flakoll PJ, Ikizler TA. Source: Current Opinion in Clinical Nutrition and Metabolic Care. 2004 January; 7(1): 89-95. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15090908

•

Psychosocial factors and quality of life in young hemodialysis patients with low comorbidity. Author(s): Vazquez I, Valderrabano F, Jofre R, Fort J, Lopez-Gomez JM, Moreno F, SanzGuajardo D; Spanish Cooperative Renal Patients Quality of Life Study Group. Source: Journal of Nephrology. 2003 November-December; 16(6): 886-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14736017

•

QT dispersion in hemodialysis and CAPD patients. Author(s): Kantarci G, Ozener C, Tokay S, Bihorac A, Akoglu E. Source: Nephron. 2002 August; 91(4): 739-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12138280

•

Quality of life and daily hemodialysis. Author(s): Kutner NG. Source: Seminars in Dialysis. 2004 March-April; 17(2): 92-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043608

•

Quality of life in male hemodialysis patients. Role of erectile dysfunction. Author(s): Turk S, Guney I, Altintepe L, Tonbul Z, Yildiz A, Yeksan M. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(1): C21-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752250

•

Quality of life in patients treated with hemodialysis or peritoneal dialysis: what are the important determinants? Author(s): Manns B, Johnson JA, Taub K, Mortis G, Ghali WA, Donaldson C. Source: Clinical Nephrology. 2003 November; 60(5): 341-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14640240

•

Quantifying daily hemodialysis. Author(s): Depner TA, Bhat A. Source: Seminars in Dialysis. 2004 March-April; 17(2): 79-84. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043606

128

Hemodialysis

•

Questionnaire to peritoneal dialysis patients undergoing combined therapy (peritoneal dialysis and hemodialysis). Author(s): Igarashi Y, Watanabe E, Mukaiyama S, Iwaya K, Doumen Y, Moriishi M, Kawanishi H. Source: Adv Perit Dial. 2003; 19: 120-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763047

•

Reducing hemodialysis costs: conventional and quotidian home hemodialysis in Canada. Author(s): McFarlane PA. Source: Seminars in Dialysis. 2004 March-April; 17(2): 118-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043613

•

Regarding response to "Vein transposition in the forearm for autogenous hemodialysis access" and "Basilic vein transposition: an underused autologous alternative to prosthetic dialysis angioaccess". Author(s): Chemla E, Chang RS, Calder F. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 December; 38(6): 1446. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14681660

•

Regular hemodialysis reverses gastric mucosal atrophy of patients with chronic renal failure. Author(s): Ohara T, Suzuki H, Kanoh Y, Moriya R, Okayasu I, Morishita T, Ishii H. Source: Hepatogastroenterology. 2004 May-June; 51(57): 679-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15143892

•

Repair of arteriotomy after removal of infected hemodialysis access by venous graft. Author(s): Wu MY, Ko PJ, Hsieh HC, Chu JJ, Lin PJ, Liu YH. Source: Chang Gung Med J. 2003 December; 26(12): 911-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15008326

•

Retrospective assessment of risk factors to predict tunneled hemodialysis catheter outcome. Author(s): Lee O, Raque JD, Lee LJ, Wivell W, Block CA, Bettmann MA. Source: Journal of Vascular and Interventional Radiology : Jvir. 2004 May; 15(5): 457-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15126655

Studies

129

•

Reverse epidemiology and hemodialysis blood pressure. Author(s): Charra B, Chazot C, Jean G, Terrat JC, Vanel T, Hurot JM, Lorriaux C, VoVan C. Source: Kidney International. 2003 December; 64(6): 2323; Author Reply 2323-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14633160

•

Reverse transcriptase/polymerase chain reaction analyses of hemodialysis ultrafiltrates and sera of hepatitis C virus positive patients. Author(s): Simjanovska LJ, Porcu K, Amitov V, Efremov GD, Polenakovic M. Source: Int J Artif Organs. 2004 January; 27(1): 35-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984182

•

Review of combination of peritoneal dialysis and hemodialysis as a modality of treatment for end-stage renal disease. Author(s): Fukui H, Hara S, Hashimoto Y, Horiuchi T, Ikezoe M, Itami N, Kawabe M, Kawanishi H, Kimura H, Nakamoto Y, Nakayama M, Ono M, Ota K, Shinoda T, Suga T, Ueda T, Fujishima M, Maeba T, Yamashita A, Yoshino Y, Watanabe S; PD + HD Combination Therapy Study Group. Source: Ther Apher Dial. 2004 February; 8(1): 56-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15128021

•

Risk assessment of di(2-ethylhexyl)phthalate released from PVC blood circuits during hemodialysis and pump-oxygenation therapy. Author(s): Haishima Y, Matsuda R, Hayashi Y, Hasegawa C, Yagami T, Tsuchiya T. Source: International Journal of Pharmaceutics. 2004 April 15; 274(1-2): 119-29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15072788

•

Risk factors of nontunneled noncuffed hemodialysis catheter malfunction. A prospective study. Author(s): Hryszko T, Brzosko S, Mazerska M, Malyszko J, Mysliwiec M. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(2): C43-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14988597

•

Safety of iron sucrose in hemodialysis patients intolerant to other parenteral iron products. Author(s): Charytan C, Schwenk MH, Al-Saloum MM, Spinowitz BS. Source: Nephron. Clinical Practice [electronic Resource]. 2004; 96(2): C63-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14988600

130

Hemodialysis

•

Serum carnitine concentrations correlated to clinical outcome parameters in chronic hemodialysis patients. Author(s): Steiber AL, Weatherspoon LJ, Spry L, Davis AT. Source: Clinical Nutrition (Edinburgh, Lothian). 2004 February; 23(1): 27-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757390

•

Short daily hemodialysis and nutritional status in patients with chronic renal failure. Author(s): Galland R, Traeger J. Source: Seminars in Dialysis. 2004 March-April; 17(2): 104-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043610

•

Single and serial measurements of cardiac troponin I in asymptomatic patients on chronic hemodialysis. Author(s): Roberts MA, Fernando D, Macmillan N, Proimos G, Bach LA, Power DA, Ratnaike S, Ierino FL. Source: Clinical Nephrology. 2004 January; 61(1): 40-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14964456

•

Skeletal effects of erythropoietin in hemodialysis patients. Author(s): Takenaka T, Itaya Y, Ishikawa I, Kobayashi K, Tsuchiya Y. Source: International Urology and Nephrology. 2003; 35(3): 407-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15160549

•

Successful surgical intervention for active infective endocarditis on a hemodialysis patient with cerebral infarction and disseminated intravascular coagulopathy. Author(s): Sakaki M, Takahashi T, Miyamoto Y, Sawa Y, Matsuda H. Source: Jpn J Thorac Cardiovasc Surg. 2004 February; 52(2): 107-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14997986

•

Successful treatment of severe calciphylaxis in a hemodialysis patient using lowcalcium dialysate and medical parathyroidectomy: case report and literature review. Author(s): Wang HY, Yu CC, Huang CC. Source: Renal Failure. 2004 January; 26(1): 77-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15083927

•

Successful weaning from cardiac extracorporeal membrane oxygenation by banding a hemodialysis arteriovenous fistula. Author(s): Konishi H, Tezuka Y, Misawa Y, Fuse K. Source: Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs. 2004; 7(1): 41-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15083344

Studies

131

•

Super high flux hemodialysis at high dialysate flows: an ex vivo assessment. Author(s): Lee WC, Uchino S, Fealy N, Baldwin I, Panagiotopoulos S, Goehl H, Morgera S, Neumayer HH, Bellomo R. Source: Int J Artif Organs. 2004 January; 27(1): 24-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984180

•

Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Author(s): Perera GB, Mueller MP, Kubaska SM, Wilson SE, Lawrence PF, Fujitani RM. Source: Annals of Vascular Surgery. 2004 January; 18(1): 66-73. Epub 2004 January 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14727162

•

Temporary vascular access for hemodialysis treatment. Current guidelines and future directions. Author(s): Weijmer MC, ter Wee PM. Source: Contrib Nephrol. 2004; 142: 94-111. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719388

•

The impact of nurse understaffing on the transmission of hepatitis C virus in a hospital-based hemodialysis unit. Author(s): Saxena AK, Panhotra BR. Source: Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre. 2004 May-June; 13(3): 129-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15073424

•

The metabolic response to ingested protein is normal in long-term hemodialysis patients. Author(s): Veeneman JM, Kingma HA, Boer TS, Stellaard F, de Jong PE, Reijngoud DJ, Huisman RM. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 February; 43(2): 330-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14750099

•

The role of physiotherapy in a hemodialysis unit. Author(s): Perryman B, Harwood L. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2004 March-April; 31(2): 215-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114803

132

Hemodialysis

•

The use of tissue plasminogen activator infusion to re-establish function of tunneled hemodialysis catheters. Author(s): Dowling K, Sansivero G, Stainken B, Siskin G, Dolen E, Ahn J, Mitchell N. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2004 March-April; 31(2): 199-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114800

•

The vulnerability of middle-aged and elderly patients to hepatitis C virus infection in a high-prevalence hospital-based hemodialysis setting. Author(s): Saxena AK, Panhotra BR. Source: Journal of the American Geriatrics Society. 2004 February; 52(2): 242-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14728634

•

Three-dimensional contrast-enhanced magnetic resonance angiography (3-D CEMRA) in the evaluation of hemodialysis access complications, and the condition of central veins in patients who are candidates for hemodialysis access. Author(s): Paksoy Y, Gormus N, Tercan MA. Source: Journal of Nephrology. 2004 January-February; 17(1): 57-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15151260

•

Totally implantable subcutaneous devices for hemodialysis access. Author(s): Moran JE, Prosl F. Source: Contrib Nephrol. 2004; 142: 178-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719393

•

Transhepatic catheter access for hemodialysis. Author(s): Smith TP, Ryan JM, Reddan DN. Source: Radiology. 2004 July; 232(1): 246-51. Epub 2004 May 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15155895

•

Transient visual loss may anticipate occipital infarction from hemodialysis. Author(s): Wells M, Foroozan R. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 May; 43(5): E29-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15112196

•

Unexpected distribution of hepatitis C virus genotypes in patients on hemodialysis and kidney transplant recipients. Author(s): Perez RM, Ferraz ML, Figueiredo MS, Contado D, Koide S, Ferreira AP, Cendoroglo Neto M, Medina Pestana JO, Silva AE. Source: Journal of Medical Virology. 2003 April; 69(4): 489-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12601756

Studies

133

•

Upper limb vein anatomy before hemodialysis fistula creation: cross-sectional anatomy using MR venography. Author(s): Laissy JP, Fernandez P, Karila-Cohen P, Delmas V, Dupuy E, Chillon S, Mignon F, Schouman-Claeys E. Source: European Radiology. 2003 February; 13(2): 256-61. Epub 2002 June 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12598988

•

Uremic pruritus: a clinical study of maintenance hemodialysis patients. Author(s): Szepietowski JC, Sikora M, Kusztal M, Salomon J, Magott M, Szepietowski T. Source: The Journal of Dermatology. 2002 October; 29(10): 621-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12432992

•

Use of a computer-based application in a pediatric hemodialysis unit: a pilot study. Author(s): Bers MU, Gonzalez-Heydrich J, Demaso DR. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 April; 42(4): 493-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12649637

•

Use of intravenous polymyxin B during continuous venovenous hemodialysis. Author(s): Sarria JC, Angulo-Pernett F, Kimbrough RC, McVay CS, Vidal AM. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2004 April; 23(4): 340-1. Epub 2004 March 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15007705

•

Use of the radial artery for hemodialysis access. Author(s): Goldstein LJ, Gupta S. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 October; 138(10): 1130-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14557132

•

Usefulness of pamidronate in severe secondary hyperparathyroidism in patients undergoing hemodialysis. Author(s): Torregrosa JV, Moreno A, Mas M, Ybarra J, Fuster D. Source: Kidney International. Supplement. 2003 June; (85): S88-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12753274

•

Using a loop configured upper arm hemodialysis graft for the "hostile" arm. Author(s): Barone GW, Lightfoot ML, Eidt JF. Source: J Ark Med Soc. 2003 October; 100(4): 126-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14560472

134

Hemodialysis

•

Using cuffed and tunnelled central venous catheters as permanent vascular access for hemodialysis: a prospective study. Author(s): Cetinkaya R, Odabas AR, Unlu Y, Selcuk Y, Ates A, Ceviz M. Source: Renal Failure. 2003 May; 25(3): 431-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12803506

•

Utility of covered stents for revision of aging failing synthetic hemodialysis grafts: a report of three cases. Author(s): Silas AM, Bettmann MA. Source: Cardiovascular and Interventional Radiology. 2003 November-December; 26(6): 550-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15061180

•

Vascular access for hemodialysis: the impact on morbidity and mortality. Author(s): Di Iorio BR, Bellizzi V, Cillo N, Cirillo M, Avella F, Andreucci VE, De Santo NG. Source: Journal of Nephrology. 2004 January-February; 17(1): 19-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15151255

•

Vascular access practice patterns in the New Zealand hemodialysis population. Author(s): Polkinghorne KR, McDonald SP, Marshall MR, Atkins RC, Kerr PG. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 April; 43(4): 696-704. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15042547

•

Vascular grafts for hemodialysis: types, sites and techniques. Author(s): Warnock DG, Tolwani AJ, Gallichio M, Allon M. Source: Contrib Nephrol. 2004; 142: 73-93. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719387

•

Vascular spiders and paper money skin improved by hemodialysis. Author(s): Satoh T, Yokozeki H, Nishioka K. Source: Dermatology (Basel, Switzerland). 2002; 205(1): 73-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12145441

•

Venous hypertension associated with arteriovenous hemodialysis access. Author(s): Neville RF, Abularrage CJ, White PW, Sidawy AN. Source: Semin Vasc Surg. 2004 March; 17(1): 50-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011180

Studies

135

•

Vibrio vulnificus infection in a hemodialysis patient receiving intravenous iron therapy. Author(s): Barton JC, Coghlan ME, Reymann MT, Ozbirn TW, Acton RT. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 September 1; 37(5): E63-7. Epub 2003 August 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12942420

•

Virus-specific effector CD4+ T-cell responses in hemodialysis patients with hepatitis C virus infection. Author(s): Rico MA, Ruiz S, Subira D, Barril G, Cigarran S, Castanon S, Quiroga JA, Selgas R, Carreno V. Source: Journal of Medical Virology. 2004 January; 72(1): 66-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14635013

•

Volume status and blood pressure during long-term hemodialysis: role of ventricular stiffness. Author(s): Chen CH, Lin YP, Yu WC, Yang WC, Ding YA. Source: Hypertension. 2003 September; 42(3): 257-62. Epub 2003 July 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885797

•

Von Willebrand factor and autoantibodies against oxidized LDL in hemodialysis patients treated with vitamin E-modified dialyzers. Author(s): Bufano G, Usberti M, Mandolfo S, Malberti F, Piroddi M, Galli F. Source: Int J Artif Organs. 2004 March; 27(3): 214-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15112887

•

Warning of high-flux hemodialysis. Author(s): Takenaka T, Kobayashi K, Suzuki H. Source: Renal Failure. 2001 November; 23(6): 819-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11777321

•

Water treatment for hemodialysis, including the latest AAMI standards. Author(s): Amato RL. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2001 December; 28(6): 619-29; Quiz 630-1. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12143471

•

Water treatment for hemodialysis. Author(s): Cappelli G, Inguaggiato P, Ferramosca E, Albertazzi A. Source: Contrib Nephrol. 2002; (137): 317-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12101972

136

Hemodialysis

•

Water treatment for hemodialysis: ensuring patient safety. Author(s): Ouseph R, Ward RA. Source: Seminars in Dialysis. 2002 January-February; 15(1): 50-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11874594

•

Weight loss, fever and a swollen elbow joint in a hemodialysis patient--a case of tuberculous arthritis. Author(s): Singh A, Webb AT. Source: Clinical Nephrology. 2003 May; 59(5): 391-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12779104

•

Which parameter is more influential on the development of arteriosclerosis in hemodialysis patients? Author(s): Seyrek N, Balal M, Karayaylali I, Paydas S, Aikimbaev K, Cetiner S, Seydaoglu G. Source: Renal Failure. 2003 November; 25(6): 1011-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14669860

•

Why do we need a statin trial in hemodialysis patients? Author(s): Fellstrom BC, Holdaas H, Jardine AG. Source: Kidney International. Supplement. 2003 May; (84): S204-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12694345

•

Willingness of patients to switch from conventional to daily hemodialysis: looking before we leap. Author(s): Halpern SD, Berns JS, Israni AK. Source: The American Journal of Medicine. 2004 May 1; 116(9): 606-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15093757

•

Zaleplon improves sleep quality in maintenance hemodialysis patients. Author(s): Sabbatini M, Crispo A, Pisani A, Ragosta A, Cesaro A, Mirenghi F, Cianciaruso B, Federico S. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 94(4): C99-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12972720

•

Zn metabolism affects apoptosis rate and proliferative responsiveness of PBMC from patients on chronic hemodialysis. Author(s): Weissgarten J, Berman S, Modai D, Rosenberg R, Rapoport M, Cohen M, Averbukh Z. Source: Metabolism: Clinical and Experimental. 2002 November; 51(11): 1392-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12404186

137

CHAPTER 2. NUTRITION AND HEMODIALYSIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and hemodialysis.

Finding Nutrition Studies on Hemodialysis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hemodialysis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

138

Hemodialysis

The following information is typical of that found when using the “Full IBIDS Database” to search for “hemodialysis” (or a synonym): •

A controlled trial of intermittent enteral nutrient supplementation in maintenance hemodialysis patients. Author(s): Department of Nephrology, Christian Medical College and Hospital, Vellore, India. Source: Sharma, M Rao, M Jacob, S Jacob, C K J-Ren-Nutr. 2002 October; 12(4): 229-37 1051-2276

•

A cross-sectional study comparing the nutritional status of peritoneal dialysis and hemodialysis patients in Korea. Author(s): Department of Clinical Nutrition, Asan Medical Center, Seoul, Korea. Source: Park, Y K Kim, J H Kim, K J Seo, A R Kang, E H Kim, S B Park, S K Park, J S JRen-Nutr. 1999 July; 9(3): 149-56 1051-2276

•

A dietary survey in Indian hemodialysis patients. Author(s): Department of Dietary Services, Christian Medical College and Hospital, Vellore, India. Source: Sharma, M Rao, M Jacob, S Jacob, C K J-Ren-Nutr. 1999 January; 9(1): 21-5 10512276

•

A new approach to classifying malnutrition in the hemodialysis patient. Author(s): San Diego Dialysis-National City, National City, CA, USA. Source: O'keefe, A Daigle, N W J-Ren-Nutr. 2002 October; 12(4): 248-55 1051-2276

•

Analysis of synovial fluid components of hydrarthrosis in long-term hemodialysis patients. Author(s): Department of Orthopaedic Surgery, Chikushi Hospital, Fukuoka University, Chikushino, Fukuoka 818-8502, Japan. Source: Shiota, E Maekawa, M Ohtani, M J-Orthop-Sci. 1999; 4(3): 171-5 0949-2658

•

Barriers to adequate protein nutrition among hemodialysis patients. Author(s): Division of Nephrology, MetroHealth Medical Center, Cleveland, OH, USA. Source: Sehgal, A R Leon, J Soinski, J A J-Ren-Nutr. 1998 October; 8(4): 179-87 1051-2276

•

Calcium, phosphate, and PTH levels in the hemodialysis population: a multicenter study. Author(s): Renal Unit, San Paolo Hospital, Milan, Italy. [email protected] Source: Gallieni, M Cucciniello, E D'Amaro, E Fatuzzo, P Gaggiotti, A Maringhini, S Rotolo, U Brancaccio, D J-Nephrol. 2002 Mar-April; 15(2): 165-70 1120-3625

•

Carnitine action on red blood cell osmotic resistance in hemodialysis patients. Author(s): Nephrology Department, A. Fleming Hospital, Athens, Greece. [email protected] Source: Vlassopoulo, D A Hadjiyannakos, D K Anogiatis, A G Evageliou, A E Santikou, A V Noussias, C V Papandreou, P T Hadjiconstantinou, V E J-Nephrol. 2002 JanFebruary; 15(1): 68-73 1120-3625

•

Comparison of nutritional status between peritoneal dialysis and hemodialysis patients. Author(s): Department of Clinical Nutrition, Asan Medical Center, Seoul, Korea. Source: Park, Y K Perit-Dial-Int. 1999; 19 Suppl 2S523-6 0896-8608

•

Correlation between plasma carnitine, muscle carnitine and glycogen levels in maintenance hemodialysis patients. Author(s): Department of Nephrology, Medical University of Gdansk, Poland.

Nutrition

139

Source: Debska Slizien Kawecka, A Wojnarowski, K Prajs, J Malgorzewicz, S Kunicka, D Zdrojewski, Z Walysiak Szydlowska Lipinski, J Rutkowski, B Int-J-Artif-Organs. 2000 February; 23(2): 90-6 0391-3988 •

Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. Author(s): Division of Nephrology and Hypertension, Beth Israel Medical Center, New York, NY 10128, USA. [email protected] Source: Burrowes, Jerrilynn D Cockram, David B Dwyer, Johanna T Larive, Brett Paranandi, Lata Bergen, Carol Poole, Diane J-Ren-Nutr. 2002 April; 12(2): 87-95 10512276

•

Diagnosing and treating anemia and iron deficiency in hemodialysis patients. Source: Foret, J P Nephrol-Nurs-J. 2002 June; 29(3): 292-6 1526-744X

•

Dialysis and nutrition practices in Korean hemodialysis centers. Author(s): Division of Nephrology, New England Medical Center, Boston, MA 02111, USA. [email protected] Source: Han, Haewook Bleyer, Anthony J Houser, Robert F Jacques, Paul F Dwyer, Johanna T J-Ren-Nutr. 2002 January; 12(1): 42-8 1051-2276

•

Dietary and fluid compliance in Chinese hemodialysis patients. Author(s): Renal Unit, Princess Margaret Hospital, Hong Kong. Source: Lee, S H Molassiotis, A Int-J-Nurs-Stud. 2002 September; 39(7): 695-704 00207489

•

Dynamic follow-up of the intact parathormone levels in hemodialysis patients treated with Rocaltrol and calcium. Author(s): Department of Nephrology and Hemodialysis, Higher Medical Institute, Plovdiv, Bulgaria. Source: Dimitrakov, D Koumtchev, E Dimitrova, R Stavrev, P Folia-Med-(Plovdiv). 1998; 40(4): 48-53 0204-8043

•

Effect of hemodialysis on carnitine levels in children with chronic renal failure. Author(s): Department of Pediatrics, Ege University Faculty of Medicine, Bornova, Izmir, Turkey. Source: Mir, Sevgi Kantar, Mehmet Yalaz, Mehmet Keskinoglu, Ahmet Coker, Isil HuseyiNovember, Afig Pediatr-Int. 2002 February; 44(1): 70-3 1328-8067

•

Effects of a vitamin E-bonded membrane and of glutathione on anemia and erythropoietin requirements in hemodialysis patients. Author(s): Nephrology and Dialysis Service, Manerbio Hospital, Brescia, Italy. [email protected] Source: Usberti, M Gerardi, G Micheli, A Tira, P Bufano, G Gaggia, P Movilli, E Cancarini, G C De Marinis, S D'Avolio, G Broccoli, R Manganoni, A Albertin, A Di Lorenzo, D J-Nephrol. 2002 Sep-October; 15(5): 558-64 1120-3625

•

Effects of age, gender and hyperparathyroidism on lean body mass in hemodialysis patients. Author(s): Istituto di Medicina Interna e Terapia Medica, Universita di Catania, Italy. Source: Trovato, G M Iannetti, E Carpinteri, G Murgo, A M Catalano, D Eur-Rev-MedPharmacol-Sci. 1998 Mar-April; 2(2): 89-95

•

Evaluating iron status in hemodialysis patients. Author(s): University of Maryland Medical System, Department of Medicine, Nephrology Division, Baltimore, MD, USA.

140

Hemodialysis

Source: Enders, H M Nephrol-Nurs-J. 2002 August; 29(4): 366-70 1526-744X •

Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. Author(s): University of California-Los Angeles School of Medicine, Los Angeles, CA, USA. [email protected] Source: Kalantar Zadeh, Kamyar Kopple, Joel D Deepak, Sunaina Block, Donald Block, Gladys J-Ren-Nutr. 2002 January; 12(1): 17-31 1051-2276

•

Homocysteine, vitamin B12, and serum and erythrocyte folate in peritoneal dialysis and hemodialysis patients. Author(s): Divisione di Nefrologia e Dialisi, IRCCS Ospedale Maggiore, Milano, Italy. [email protected] Source: De Vecchi, A F Bamonti Catena, F Finazzi, S Campolo, J Taioli, E Novembrino, C Colucci, P Accinni, R De Franceschi, M Fasano, M A Maiolo, A T Perit-Dial-Int. 2000 Mar-April; 20(2): 169-73 0896-8608

•

Impaired triglyceride tolerance in hemodialysis patients with different apolipoprotein E (apo E) isoforms. Author(s): 3rd Clinic of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 6, 775 20 Olomouc, Czech Republic. [email protected] Source: Zahalkova, J Vaverkova, H Novotny, D Kosatikova, Z Biomed-Pap-Med-FacUniv-Palacky-Olomouc-Czech-Repub. 2002 December; 146(2): 73-6 1213-8118

•

Implementing continuous quality improvement strategies for improving iron replacement in hemodialysis patients. Author(s): Nephrology Hospital Services and Satellite Services, Dialysis Center at Bethpage, Bethpage, NY, USA. Source: Trenkle, J A Nephrol-Nurs-J. 2001 October; 28(5): 561-5 1526-744X

•

Lack of reaction to ferric gluconate in hemodialysis patients with a history of severe reaction to iron dextran. Author(s): Department of Internal Medicine, Saint Louis University School of Medicine, Missouri 63110, USA. Source: Bastani, B Rahman, S Gellens, M ASAIO-J. 2002 Jul-August; 48(4): 404-6 10582916

•

Maintenance intravenous iron therapy in pediatric hemodialysis patients. Author(s): Department of Pediatrics, Hospital for Sick Children, Toronto, Canada. Source: Morgan, H E Gautam, M Geary, D F Pediatr-Nephrol. 2001 October; 16(10): 77983 0931-041X

•

Monitoring cardiovascular changes during hemodialysis in children. Author(s): 1st Department of Pediatrics, Semmelweis Medical University, Bokay u. 53, 1083 Budapest, Hungary. Source: Miltenyi, G Tory, K Stubnya, G Toth Heyn, P Vasarhelyi, B Sallay, P Szabo, A Tulassay, T Dobos, M Reusz, G S Pediatr-Nephrol. 2001 January; 16(1): 19-24 0931-041X

•

Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. Author(s): Frances Stern Nutrition Center, Tufts-New England Medical Center, Boston, MA 02111, USA Source: Dwyer, J T Larive, B Leung, J Rocco, M Burrowes, J D Chumlea, W C Frydrych, A Kusek, J W Uhlin, L J-Ren-Nutr. 2002 October; 12(4): 213-23 1051-2276

Nutrition

141

•

Pentosidine, carotid atherosclerosis and alterations in left ventricular geometry in hemodialysis patients. Author(s): CNR, Centre of Clinical Physiology and Division of Nephrology, Reggio Calabria, Italy. [email protected] Source: Zoccali, C Mallamaci, F Asahia, K Benedetto, F A Tripepi, G Tripepi, R Nicocia, G Buemi, M Miyata, T J-Nephrol. 2001 Jul-August; 14(4): 293-8 1120-3625

•

Preferences for foods, particularly for hemodialytic diets in hospital of patients on maintenance hemodialysis [Japan]. Source: Matsumoto, K. Okutomi, Z. Ando, M. Chokki, S. Eiyogaku-Zasshi-Jap-J-Nutr. Tokyo, Japan : Kokumin Eiyo Shinkokai. April 1984. volume 42 (2) page 127-133. 00215147

•

Protein-energy malnutrition as a risk factor for increased morbidity in long-term hemodialysis patients. Author(s): Department of Human Nutrition, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa. Source: Herselman, M Moosa, M R Kotze, T J Kritzinger, M Wuister, S Mostert, D J-RenNutr. 2000 January; 10(1): 7-15 1051-2276

•

Reassessing hemodialysis adequacy in children: the case for more. Author(s): Division of Pediatric Nephrology, McGill University/Montreal Children's Hospital, Room E222, 2300 Tupper, Montreal, QC H3H 1P3, Canada. [email protected] Source: Sharma, A K Pediatr-Nephrol. 2001 April; 16(4): 383-90 0931-041X

•

Relationship between serum phosphorus levels and various outcome measures in adult hemodialysis patients. Author(s): Renal Dietitian, Community Limited Care Dialysis Center, Cincinnati, OH, USA. Source: Greene, S V Falciglia, G Rademacher, R J-Ren-Nutr. 1998 April; 8(2): 77-82 10512276

•

Report on the dietary life, state of employment and prognosis of patients on maintenance hemodialysis [Japan]. Source: Matsumoto, K. Okutomi, Z. Ando, M. Chokki, S. Eiyogaku-Zasshi-Jap-J-Nutr. Tokyo, Japan : Kokumin Eiyo Shinkokai. April 1984. volume 42 (2) page 99-105. 00215147

•

Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids. Author(s): Gambro Healthcare, J. B. Zachary Dialysis Unit, Johns Hopkins Bayview Hospital, Baltimore, MD 21205, USA. Source: Bronich, L Te, T Shetye, K Stewart, T Eustace, J A J-Ren-Nutr. 2001 October; 11(4): 194-201 1051-2276

•

The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients. Author(s): Renal Unit, G. Papanikolaou General Hospital, Thessaloniki, Greece. [email protected] Source: Sombolos, K Fragia, T Natse, T Bartholomatos, G Karagianni, A Katsaris, G Christidou, F Bamichas, G Stangou, M Papagalanis, N J-Nephrol. 2002 Nov-December; 15(6): 671-5 1120-3625

142

Hemodialysis

•

The effects of exercise during hemodialysis on physical performance and nutrition assessment. Author(s): University Dialysis Center-Dialysis Clinic Incorporated, Syracuse, NY 13210, USA. Source: Cappy, C S Jablonka, J Schroeder, E T J-Ren-Nutr. 1999 April; 9(2): 63-70 10512276

•

The effects of moderate doses of megestrol acetate on nutritional status and body composition in a hemodialysis patient. Author(s): Division of Nephrology and Hypertension, Beth Israel Medical Center, New York, NY 10128, USA. Source: Burrowes, J D Bluestone, P A Wang, J Pierson, R N J-Ren-Nutr. 1999 April; 9(2): 89-94 1051-2276

•

The effects of zinc supplementation on serum zinc and cholesterol concentrations in hemodialysis patients. Author(s): Food and Nutrition Services, Charlton Methodist Hospital, Dallas, TX, USA. Source: Chevalier, C A Liepa, G Murphy, M D Suneson, J Vanbeber, A D Gorman, M A Cochran, C J-Ren-Nutr. 2002 July; 12(3): 183-9 1051-2276

•

The hemodialysis pilot study: nutrition program and participant characteristics at baseline. The HEMO Study Group. Author(s): Professor of Medicine and Community Health, Tufts University School of Medicine and Nutrition, Boston, MA, USA. Source: Dwyer, J T Cunniff, P J Maroni, B J Kopple, J D Burrowes, J D Powers, S N Cockram, D B Chumlea, W C Kusek, J W Makoff, R Goldstein, D J Paranandi, L J-RenNutr. 1998 January; 8(1): 11-20 1051-2276

•

The impaired immune response to diphtheria vaccination in elderly chronic hemodialysis patients is related to zinc deficiency. Author(s): Department of Internal Medicine, University of Lubeck, School of Medicine, Ratzeburger Allee 160, D-23538 Lubeck, Germany. Source: Kreft, B Fischer, A Kruger, S Sack, K Kirchner, H Rink, L Biogerontology. 2000; 1(1): 61-6 1389-5729

•

The safety of intravenous iron dextran (Dexferrum) during hemodialysis in patients with end stage renal disease. Author(s): Merrimack Valley Dialysis Metheun, MA, USA. Source: Hood, S A O'Brien, M Higgins, R Nephrol-Nurs-J. 2000 February; 27(1): 41-2 1526-744X

•

Time-course of iodine elimination by hemodialysis in patients with renal failure after angiography. Author(s): Department of Medicine, Division of Nephrology and Dialysis, Social Insurance Chuo General Hospital, Tokyo, Japan. [email protected] Source: Shinoda, T Hata, T Nakajima, K Yoshimoto, H Niwa, A Ther-Apher. 2002 December; 6(6): 437-42 1091-6660

•

Treating fluid noncompliance in the hemodialysis population using unit wide contests. Author(s): Gambro Healthcare Lombard, Philadelphia, PA 19146, USA. Source: Bushman, M C J-Ren-Nutr. 1999 January; 9(1): 35-7 1051-2276

•

Treatment of severe theophylline toxicity with hemodialysis in a preterm neonate. Author(s): Department of Nephrology, Marshfield Clinic, WI 54449, USA. [email protected]

Nutrition

143

Source: Gitomer, J J Khan, A M Ferris, M E Pediatr-Nephrol. 2001 October; 16(10): 784-6 0931-041X •

Validation of 24-hour dietary recall: a study in hemodialysis patients. Author(s): Department of Dietary Services, Christian Medical College and Hospital, Vellore, India. Source: Sharma, M Rao, M Jacob, S Jacob, C K J-Ren-Nutr. 1998 October; 8(4): 199-202 1051-2276

•

Why hemodialysis patients are in a prooxidant state? What could be done to correct the pro/antioxidant imbalance. Author(s): Biochemistry Laboratory, Lapeyronie University Hospital, Montpellier, France. Source: Morena, M Cristol, J P Canaud, B Blood-Purif. 2000; 18(3): 191-9 0253-5068

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

•

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

•

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

•

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

144

Hemodialysis

•

Google: http://directory.google.com/Top/Health/Nutrition/

•

Healthnotes: http://www.healthnotes.com/

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

•

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

•

WebMDHealth: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to hemodialysis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Pantothenic Acid and Pantethine Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com

•

Minerals Biotin Source: Integrative Medicine Communications; www.drkoop.com Calcium Acetate Source: Healthnotes, Inc.; www.healthnotes.com Carnitine (L-Carnitine) Source: Integrative Medicine Communications; www.drkoop.com Iron Source: Healthnotes, Inc.; www.healthnotes.com L-Carnitine Source: Integrative Medicine Communications; www.drkoop.com Vitamin H (Biotin) Source: Integrative Medicine Communications; www.drkoop.com

145

CHAPTER 3. ALTERNATIVE MEDICINE AND HEMODIALYSIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to hemodialysis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to hemodialysis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hemodialysis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to hemodialysis: •

A case report of paclitaxel administered to a patient with platinum-refractory ovarian cancer on long-term hemodialysis. Author(s): Balat O, Kudelka AP, Edwards CL, Verschraegen C, Mante R, Kavanagh JJ. Source: Eur J Gynaecol Oncol. 1996; 17(3): 232-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8780924

•

A holistic protocol for management of fluid volume excess in hemodialysis patients. Author(s): Sciarini P, Dungan JM. Source: Anna J. 1996 June; 23(3): 299-305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8716989

•

A protocol for coadministration of i.v. iron dextran and heparin in chronic hemodialysis patients. Author(s): Davis P, Bednarz D, Briglia A, Paganini EP.

146

Hemodialysis

Source: Anna J. 1998 October; 25(5): 533-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9887705 •

Adjustment, spirituality, and health in women on hemodialysis. Author(s): Tanyi RA, Werner JS. Source: Clinical Nursing Research. 2003 August; 12(3): 229-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12918648

•

AM3 (Inmunoferon) as an adjuvant to hepatitis B vaccination in hemodialysis patients. Author(s): Perez-Garcia R, Perez-Garcia A, Verbeelen D, Bernstein ED, Villarrubia VG, Alvarez-Mon M. Source: Kidney International. 2002 May; 61(5): 1845-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11967036

•

Amino acid losses during hemodialysis with polyacrylonitrile membranes: effect of intradialytic amino acid supplementation on plasma amino acid concentrations and nutritional variables in nondiabetic patients. Author(s): Navarro JF, Mora C, Leon C, Martin-Del Rio R, Macia ML, Gallego E, Chahin J, Mendez ML, Rivero A, Garcia J. Source: The American Journal of Clinical Nutrition. 2000 March; 71(3): 765-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10702171

•

Antioxidant status in patients on chronic hemodialysis therapy: impact of parenteral selenium supplementation. Author(s): Koenig JS, Fischer M, Bulant E, Tiran B, Elmadfa I, Druml W. Source: Wiener Klinische Wochenschrift. 1997 January 17; 109(1): 13-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9037743

•

Assessment of thiamin status in chronic renal failure patients, transplant recipients and hemodialysis patients receiving a multivitamin supplementation. Author(s): Frank T, Czeche K, Bitsch R, Stein G. Source: Int J Vitam Nutr Res. 2000 July; 70(4): 159-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10989764

•

Benefits of fish oil supplementation for hemodialysis patients. Author(s): Vergili-Nelsen JM. Source: Journal of the American Dietetic Association. 2003 September; 103(9): 1174-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963947

•

Biofeedback controlled hemodialysis (BF-HD) reduces symptoms and increases both hemodynamic tolerability and dialysis adequacy in non-hypotension prone stable

Alternative Medicine 147

patients. Author(s): McIntyre CW, Lambie SH, Fluck RJ. Source: Clinical Nephrology. 2003 August; 60(2): 105-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12940612 •

Biofeedback regulation of ultrafiltration and dialysate conductivity for the prevention of hypotension during hemodialysis. Author(s): Begin V, Deziel C, Madore F. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 2002 MayJune; 48(3): 312-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12059007

•

Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Author(s): Santoro A, Mancini E, Basile C, Amoroso L, Di Giulio S, Usberti M, Colasanti G, Verzetti G, Rocco A, Imbasciati E, Panzetta G, Bolzani R, Grandi F, Polacchini M. Source: Kidney International. 2002 September; 62(3): 1034-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12164888

•

Blood volume regulation during hemodialysis. Author(s): Santoro A, Mancini E, Paolini F, Cavicchioli G, Bosetto A, Zucchelli P. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1998 November; 32(5): 739-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9820442

•

Breathing-coordinated exercise improves the quality of life in hemodialysis patients. Author(s): Tsai TJ, Lai JS, Lee SH, Chen YM, Lan C, Yang BJ, Chiang HS. Source: Journal of the American Society of Nephrology : Jasn. 1995 November; 6(5): 1392-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8589314

•

Carboplatin-based chemotherapy in patients with gynecological malignancies on long-term hemodialysis. Author(s): Niikura H, Koizumi T, Ito K, Okamura K, Yaegashi N. Source: Anti-Cancer Drugs. 2003 October; 14(9): 735-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14551507

•

Carnitine and hemodialysis. Author(s): Bellinghieri G, Santoro D, Calvani M, Mallamace A, Savica V. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S116-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12612967

148

Hemodialysis

•

Case problem: nutrition issues and wound care in a patient receiving hemodialysis treatment. Author(s): Elfert J, Drees E. Source: Journal of the American Dietetic Association. 1999 December; 99(12): 1582-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10608958

•

Cholesterol metabolism in patients with chronic renal failure on hemodialysis. Author(s): Igel-Korcagova A, Raab P, Brensing KA, Poge U, Klehr HU, Igel M, von Bergmann K, Sudhop T. Source: Journal of Nephrology. 2003 November-December; 16(6): 850-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14736012

•

Chronotherapy of high-dose 1,25-dihydroxyvitamin D3 in hemodialysis patients with secondary hyperparathyroidism: a single-dose study. Author(s): Tsuruoka S, Sugimoto K, Ohmori M, Kawaguchi A, Saito T, Fujimura A. Source: Clinical Pharmacology and Therapeutics. 1999 December; 66(6): 609-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10613617

•

Clinical characteristic of parenteral iron supplementation in hemodialysis patients receiving erythropoietin therapy. Author(s): Kao HH, Chen KS, Tsai CJ, Lee CC, Chang HY. Source: Changgeng Yi Xue Za Zhi. 2000 October; 23(10): 608-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11126152

•

Comparison of the effects of two early intervention strategies on the health outcomes of malnourished hemodialysis patients. Author(s): Wilson B, Fernandez-Madrid A, Hayes A, Hermann K, Smith J, Wassell A. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 July; 11(3): 166-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11466668

•

Developing a nutrition education package for Malaysian hemodialysis patients. Author(s): Karupaiah T, Swee CS, Abdullah R. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 October; 11(4): 220-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11680003

•

Dry weight in hemodialysis: volemic control. Author(s): Zucchelli P, Santoro A. Source: Semin Nephrol. 2001 May; 21(3): 286-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11320496

Alternative Medicine 149

•

Effect of adequacy of dialysis and nutrition on morbidity and working rehabilitation of patients treated by maintenance hemodialysis. Author(s): Stefanovic V, Stojanovic M, Djordjevic V. Source: Int J Artif Organs. 2000 February; 23(2): 83-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10741802

•

Effect of erythropoietin therapy and selenium supplementation on selected antioxidant parameters in blood of uremic patients on long-term hemodialysis. Author(s): Adamowicz A, Trafikowska U, Trafikowska A, Zachara B, Manitius J. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2002 March; 8(3): Cr202-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11887037

•

Effect of high dose folic acid therapy on hyperhomocysteinemia in hemodialysis patients: results of the Vienna multicenter study. Author(s): Sunder-Plassmann G, Fodinger M, Buchmayer H, Papagiannopoulos M, Wojcik J, Kletzmayr J, Enzenberger B, Janata O, Winkelmayer WC, Paul G, Auinger M, Barnas U, Horl WH. Source: Journal of the American Society of Nephrology : Jasn. 2000 June; 11(6): 1106-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10820175

•

Effect of L-carnitine supplementation in hemodialysis patients. Author(s): Vesela E, Racek J, Trefil L, Jankovy'ch V, Pojer M. Source: Nephron. 2001 July; 88(3): 218-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11423752

•

Effect of L-carnitine supplementation on lipid parameters in hemodialysis patients. Author(s): Elisaf M, Bairaktari E, Katopodis K, Pappas M, Sferopoulos G, Tzallas C, Tsolas O, Siamopoulos KC. Source: American Journal of Nephrology. 1998; 18(5): 416-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9730566

•

Effect of L-carnitine supplementation on red blood cells deformability in hemodialysis patients. Author(s): Nikolaos S, George A, Telemachos T, Maria S, Yannis M, Konstantinos M. Source: Renal Failure. 2000 January; 22(1): 73-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10718283

•

Effect of orally administered shao-yao-gan-cao-tang (Shakuyaku-kanzo-to) on muscle cramps in maintenance hemodialysis patients: a preliminary study. Author(s): Hinoshita F, Ogura Y, Suzuki Y, Hara S, Yamada A, Tanaka N, Yamashita A, Marumo F.

150

Hemodialysis

Source: The American Journal of Chinese Medicine. 2003; 31(3): 445-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943175 •

Effect of three sources of long-chain fatty acids on the plasma fatty acid profile, plasma prostaglandin E2 concentrations, and pruritus symptoms in hemodialysis patients. Author(s): Peck LW, Monsen ER, Ahmad S. Source: The American Journal of Clinical Nutrition. 1996 August; 64(2): 210-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8694022

•

Effect of usual doses of folate supplementation on elevated plasma homocyst(e)ine in hemodialysis patients: no difference between 1 and 5 mg daily. Author(s): Spence JD, Cordy P, Kortas C, Freeman D. Source: American Journal of Nephrology. 1999; 19(3): 405-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10393379

•

Effect of weekly or successive iron supplementation on erythropoietin doses in patients receiving hemodialysis. Author(s): Kato A, Hamada M, Suzuki T, Maruyama T, Maruyama Y, Hishida A. Source: Nephron. 2001 September; 89(1): 110-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11528242

•

Effects of astragalus on IL-2/IL-2R system in patients with maintained hemodialysis. Author(s): Qun L, Luo Q, Zhang ZY, Chen YC, Zhang JB, Dong H, Lin DH. Source: Clinical Nephrology. 1999 November; 52(5): 333-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10584999

•

Effects of dietary counseling on vitamin A, B-1, B-2 and zinc status of chronic hemodialysis patients. Author(s): Komindr S, Puchaiwatananon O, Thirawitayakom J, Domrongkitchaiporn S, Songchitsomboon S. Source: J Med Assoc Thai. 1997 November; 80(11): 724-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9385770

•

Effects of high-dose folic acid and pyridoxine on plasma and erythrocyte sulfur amino acids in hemodialysis patients. Author(s): Suliman ME, Divino Filho JC, Barany P, Anderstam B, Lindholm B, Bergstrom J. Source: Journal of the American Society of Nephrology : Jasn. 1999 June; 10(6): 1287-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10361867

Alternative Medicine 151

•

Effects of L-carnitine supplementation in maintenance hemodialysis patients: a systematic review. Author(s): Hurot JM, Cucherat M, Haugh M, Fouque D. Source: Journal of the American Society of Nephrology : Jasn. 2002 March; 13(3): 708-14. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11856775

•

Effects of omega 3-PUFA on plasma fibrinogen levels in hypertriglyceridemic hemodialysis patients. Author(s): Persichetti S, Maggi S, Ponzio R, Punzo G, Clemenzia G, Cottone G. Source: Minerva Urol Nefrol. 1996 September; 48(3): 137-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8913077

•

Effects of oral supplementation with evening primrose oil for six weeks on plasma essential fatty acids and uremic skin symptoms in hemodialysis patients. Author(s): Yoshimoto-Furuie K, Yoshimoto K, Tanaka T, Saima S, Kikuchi Y, Shay J, Horrobin DF, Echizen H. Source: Nephron. 1999 February; 81(2): 151-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9933750

•

Effects of vitamin supplementation on microcirculatory disturbance in hemodialysis patients without peripheral arterial disease. Author(s): Sato M, Matsumoto Y, Morita H, Takemura H, Shimoi K, Amano I. Source: Clinical Nephrology. 2003 July; 60(1): 28-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12872855

•

Effects of zinc supplementation on the immune system and on antibody response to multivalent influenza vaccine in hemodialysis patients. Author(s): Turk S, Bozfakioglu S, Ecder ST, Kahraman T, Gurel N, Erkoc R, Aysuna N, Turkmen A, Bekiroglu N, Ark E. Source: Int J Artif Organs. 1998 May; 21(5): 274-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9684909

•

Energy supplementation in chronic hemodialysis patients with moderate and severe malnutrition. Author(s): Milano MC, Cusumano AM, Navarro ET, Turin M. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 1998 October; 8(4): 212-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9776798

•

Exercise during hemodialysis. Author(s): Daul AE, Schafers RF, Daul K, Philipp T.

152

Hemodialysis

Source: Clinical Nephrology. 2004 May; 61 Suppl 1: S26-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15233244 •

Finding a balance: a grounded theory study of spirituality in hemodialysis patients. Author(s): Walton J. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2002 October; 29(5): 447-56; Discussion 457. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12434451

•

Folate measurements in patients on regular hemodialysis treatment. Author(s): Bamonti-Catena F, Buccianti G, Porcella A, Valenti G, Como G, Finazzi S, Maiolo AT. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1999 March; 33(3): 492-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10070913

•

Folic acid and pyridoxal-5'-phosphate losses during high-efficiency hemodialysis in patients without hydrosoluble vitamin supplementation. Author(s): Leblanc M, Pichette V, Geadah D, Ouimet D. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 October; 10(4): 196-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11070147

•

Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. Author(s): Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002 January; 12(1): 17-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11823990

•

Hematopoietic effect of Radix angelicae sinensis in a hemodialysis patient. Author(s): Bradley RR, Cunniff PJ, Pereira BJ, Jaber BL. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1999 August; 34(2): 349-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10430986

•

Holistic approach to hemodialysis. The triangle of life: the patient, the technology, and the physician. Author(s): Ronco C. Source: Int J Artif Organs. 2004 January; 27(1): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984175

Alternative Medicine 153

•

Hyperbaric oxygenation, plasma exchange, and hemodialysis for treatment of acute liver failure in a 3-year-old child. Author(s): Ponikvar R, Buturovic J, Cizman M, Mekjavic I, Kandus A, Premru V, Urbancic A, Zakotnik B, Bren A, Ivanovich P. Source: Artificial Organs. 1998 November; 22(11): 952-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9821529

•

Hyperhomocysteinemia and oxidative stress in hemodialysis: effects of supplementation with folic acid. Author(s): Chiarello PG, Vannucchi MT, Moyses Neto M, Vannucchi H. Source: Int J Vitam Nutr Res. 2003 November; 73(6): 431-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14743547

•

Hyperhomocysteinemia in hemodialysis patients: effects of 12-month supplementation with hydrosoluble vitamins. Author(s): Tremblay R, Bonnardeaux A, Geadah D, Busque L, Lebrun M, Ouimet D, Leblanc M. Source: Kidney International. 2000 August; 58(2): 851-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10916110

•

Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Author(s): Ronco C, Brendolan A, Milan M, Rodeghiero MP, Zanella M, La Greca G. Source: Kidney International. 2000 August; 58(2): 800-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10916105

•

Increased susceptibility of LDL to in vitro oxidation in patients on maintenance hemodialysis: effects of fish oil and vitamin E administration. Author(s): Panzetta O, Cominacini L, Garbin U, Fratta Pasini A, Gammaro L, Bianco F, Davoli A, Campagnola M, De Santis A, Pastorino AM, et al. Source: Clinical Nephrology. 1995 November; 44(5): 303-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8605710

•

Induction of protein oxidation by intravenous iron in hemodialysis patients: role of inflammation. Author(s): Tovbin D, Mazor D, Vorobiov M, Chaimovitz C, Meyerstein N. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 1005-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407646

•

Intermittent hemodialysis and/or continuous renal replacement therapy: are they complementary or alternative therapies? Author(s): Schiffl H.

154

Hemodialysis

Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 1097-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407657 •

Intradialytic amino acids supplementation in hemodialysis patients with malnutrition: results of a multicenter cohort study. Author(s): Czekalski S, Hozejowski R; Malnutrition Working Group. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2004 April; 14(2): 82-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15060872

•

Intravenous ascorbic acid as an adjuvant therapy for recombinant erythropoietin in hemodialysis patients with hyperferritinemia. Author(s): Tarng DC, Wei YH, Huang TP, Kuo BI, Yang WC. Source: Kidney International. 1999 June; 55(6): 2477-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10354297

•

Is there a role for hemoperfusion/hemodialysis as a treatment option in severe tricyclic antidepressant intoxication? Author(s): Frank RD, Kierdorf HP. Source: Int J Artif Organs. 2000 September; 23(9): 618-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11059884

•

L-Carnitine supplementation in a hemodialysis patient with a mutation in the mitochondrial tRNA(Leu(UUR)) gene. Author(s): Matsumura M, Nakashima A, Araki T, Tofuku Y, Koizumi J, Yagi K, Koni I, Mabuchi H. Source: Nephron. 2000 July; 85(3): 275-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10867544

•

Lipid-lowering effect of polyunsaturated fatty acids in hemodialysis patients. Author(s): Khajehdehi P. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 October; 10(4): 191-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11070146

•

Long-term effects of small doses of calcitriol in hemodialysis patients with moderate secondary hyperparathyroidism. Author(s): Vlassopoulos D, Noussias C, Revenas K, Hadjilouka-Mantaka A, Arvanitis D, Tzortzis G, Hadjiconstantinou V. Source: Renal Failure. 1999 March; 21(2): 199-207. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10088180

Alternative Medicine 155

•

Low dose desferrioxamine can improve erythropoiesis in iron-overload hemodialysis patients without side effects. Author(s): Lee CT, Liao SC, Hsu KT, Lam KK, Chen JB. Source: Renal Failure. 1999 November; 21(6): 665-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10586429

•

Lower erythropoietin and iron supplementation are required in hemodialysis patients with hepatitis C virus infection. Author(s): Altintepe L, Kurtoglu E, Tonbul Z, Yeksan M, Yildiz A, Turk S. Source: Clinical Nephrology. 2004 May; 61(5): 347-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15182130

•

Methylenetetrahydrofolate reductase genotype, vitamin B12, and folate influence plasma homocysteine in hemodialysis patients. Author(s): Nakamura T, Saionji K, Hiejima Y, Hirayama H, Tago K, Takano H, Tajiri M, Hayashi K, Kawabata M, Funamizu M, Makita Y, Hata A. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 May; 39(5): 1032-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11979347

•

Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration. Author(s): Al-Hejaili F, Kortas C, Leitch R, Heidenheim AP, Clement L, Nesrallah G, Lindsay RM. Source: Journal of the American Society of Nephrology : Jasn. 2003 September; 14(9): 2322-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12937309

•

Nutritional effects of carnitine supplementation in hemodialysis patients. Author(s): Chazot C, Blanc C, Hurot JM, Charra B, Jean G, Laurent G. Source: Clinical Nephrology. 2003 January; 59(1): 24-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12572927

•

Oral arginine improves blood pressure in renal transplant and hemodialysis patients. Author(s): Kelly BS, Alexander JW, Dreyer D, Greenberg NA, Erickson A, Whiting JF, Ogle CK, Babcock GF, First MR. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2001 July-August; 25(4): 194202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434650

•

Oral folate reduces plasma homocyst(e)ine levels in hemodialysis patients with cardiovascular disease. Author(s): Stanford JL, Molina H, Phillips J, Kohlman-Trigoboff D, Moore J, Smith BM.

156

Hemodialysis

Source: Cardiovascular Surgery (London, England). 2000 December; 8(7): 567-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11068219 •

Oral glucose tolerance test after high-dose i.v. biotin administration in normoglucemic hemodialysis patients. Author(s): Koutsikos D, Fourtounas C, Kapetanaki A, Agroyannis B, Tzanatos H, Rammos G, Kopelias I, Bosiolis B, Bovoleti O, Darema M, Sallum G. Source: Renal Failure. 1996 January; 18(1): 131-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8820510

•

Oral supplementation with gamma-linolenic acid extracted from Mucor circinelloides improves the deformability of red blood cells in hemodialysis patients. Author(s): Iijima S, Otsuka F, Kikuchi H, Yamada K, Nakajima T, Yahiro K, Kondo A. Source: Nephron. 2000 October; 86(2): 122-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11014980

•

Oral vitamin B(12) and high-dose folic acid in hemodialysis patients with hyperhomocyst(e)inemia. Author(s): Manns B, Hyndman E, Burgess E, Parsons H, Schaefer J, Snyder F, ScottDouglas N. Source: Kidney International. 2001 March; 59(3): 1103-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11231366

•

Ozonated autohemotherapy in patients on maintenance hemodialysis: influence on lipid profile and endothelium. Author(s): Tylicki L, Biedunkiewicz B, Nieweglowski T, Chamienia A, Slizien AD, Luty J, Lysiak-Szydlowska W, Rutkowski B. Source: Artificial Organs. 2004 February; 28(2): 234-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14961966

•

Paclitaxel and carboplatin combination chemotherapy in a hemodialysis patient with advanced ovarian cancer. Author(s): Watanabe M, Aoki Y, Tomita M, Sato T, Takaki Y, Kato N, Kikuchi M, Kase H, Tanaka K. Source: Gynecologic Oncology. 2002 February; 84(2): 335-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11812097

•

Pharmacokinetic analysis of combination chemotherapy with carboplatin and etoposide in small-cell lung cancer patients undergoing hemodialysis. Author(s): Inoue A, Saijo Y, Kikuchi T, Gomi K, Suzuki T, Maemondo M, Miki M, Sato T, Nukiwa T.

Alternative Medicine 157

Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2004 January; 15(1): 51-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14679119 •

Pharmacokinetics of 2-chlorodeoxyadenosine in a child undergoing hemofiltration and hemodialysis for acute renal failure. Author(s): Crews KR, Wimmer PS, Hudson JQ, Howard SC, Ribeiro RC, Razzouk BI. Source: Journal of Pediatric Hematology/Oncology : Official Journal of the American Society of Pediatric Hematology/Oncology. 2002 November; 24(8): 677-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12439044

•

Pharmacokinetics of paclitaxel and cisplatin in a hemodialysis patient with recurrent ovarian cancer. Author(s): Tomita M, Kurata H, Aoki Y, Tanaka K, Kazama JJ. Source: Anti-Cancer Drugs. 2001 June; 12(5): 485-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11395577

•

Phosphotyrosine of macrophage by low-density lipoproteins from hemodialysis patients. Author(s): Sonobe M, Kimura K, Kishino M, Tone Y, Yamada Y, Mune M, Yukawa S, Nishide I. Source: Kidney International. Supplement. 1999 July; 71: S254-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10412792

•

Plasma levels of branched chain amino acids in patients on regular hemodialysis before and after including a high-protein supplement in their diet. Author(s): Vuzelov E, Krivoshiev S, Ribarova F, Boyadjiev N. Source: Folia Med (Plovdiv). 1999; 41(4): 19-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10786200

•

Possible role of new pressor protein in hypertensive anephric hemodialysis patients. Author(s): Pearl RJ, Papageorgiou PC, Goldman M, Amfilochiadis AA, Boomsma F, Rojkjaer R, Geary D, Osmond DH. Source: Pediatric Nephrology (Berlin, Germany). 2003 October; 18(10): 1025-31. Epub 2003 August 12. Erratum In: Pediatr Nephrol. 2003 December; 18(12): 1319. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12920630

•

Psychological effects of aromatherapy on chronic hemodialysis patients. Author(s): Itai T, Amayasu H, Kuribayashi M, Kawamura N, Okada M, Momose A, Tateyama T, Narumi K, Uematsu W, Kaneko S. Source: Psychiatry and Clinical Neurosciences. 2000 August; 54(4): 393-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10997854

158

Hemodialysis

•

Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. Author(s): Patel SS, Shah VS, Peterson RA, Kimmel PL. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 1013-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407647

•

Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation. Author(s): Sloan RS, Kastan B, Rice SI, Sallee CW, Yuenger NJ, Smith B, Ward RA, Brier ME, Golper TA. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1998 August; 32(2): 265-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9708611

•

Reduction in erythropoietin doses by the use of chronic intravenous iron supplementation in iron-replete hemodialysis patients. Author(s): Chang CH, Chang CC, Chiang SS. Source: Clinical Nephrology. 2002 February; 57(2): 136-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11863124

•

Sarcomatoid collecting duct carcinoma arising in the hemodialysis-associated acquired cystic kidney: an autopsy report. Author(s): Aita K, Tanimoto A, Fujimoto Y, Momomura S, Takemoto F, Hara S, Matsushita H. Source: Pathology International. 2003 July; 53(7): 463-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12828612

•

Selenate-supplemented nutritional formula increases plasma selenium in hemodialysis patients. Author(s): Temple KA, Smith AM, Cockram DB. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 January; 10(1): 16-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10671629

•

Serum levels and metabolic clearance of the isoflavones genistein and daidzein in hemodialysis patients. Author(s): Fanti P, Sawaya BP, Custer LJ, Franke AA. Source: Journal of the American Society of Nephrology : Jasn. 1999 April; 10(4): 864-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10203372

•

Supplementation with Alfacalcidol increases protein intake and serum albumin concentration in patients undergoing hemodialysis with hpoalbumineamia. Author(s): Yonemura K, Sugiura T, Yamashita F, Matsushima H, Hishida A.

Alternative Medicine 159

Source: Blood Purification. 2004; 22(2): 210-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15044820 •

Targeting higher ferritin concentrations with intravenous iron dextran lowers erythropoietin requirement in hemodialysis patients. Author(s): DeVita MV, Frumkin D, Mittal S, Kamran A, Fishbane S, Michelis MF. Source: Clinical Nephrology. 2003 November; 60(5): 335-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14640239

•

Tearing down the barriers to daily home hemodialysis and achieving the highest value renal therapy through holistic product design. Author(s): Kenley RS. Source: Adv Ren Replace Ther. 1996 April; 3(2): 137-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8814920

•

The effect of a keto acid supplement on the course of chronic renal failure and nutritional parameters in predialysis patients and patients on regular hemodialysis therapy: the Hungarian Ketosteril Cohort Study. Author(s): Zakar G; Hungarian Ketosteril Cohort Study. Source: Wiener Klinische Wochenschrift. 2001 September 17; 113(17-18): 688-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11603104

•

The effect of an iron supplement on serum aluminum level and desferrioxamine mobilization test in hemodialysis patients. Author(s): Huang JY, Wu MS, Wu CH. Source: Renal Failure. 2001 November; 23(6): 789-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11777318

•

The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients. Author(s): Sombolos K, Fragia T, Natse T, Bartholomatos G, Karagianni A, Katsaris G, Christidou F, Bamichas G, Stangou M, Papagalanis N. Source: Journal of Nephrology. 2002 November-December; 15(6): 671-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12495282

•

The effect of n-3 fatty acids on leukotriene formation from neutrophils in patients on hemodialysis. Author(s): Lossl K, Skou HA, Christensen JH, Schmidt EB. Source: Lipids. 1999; 34 Suppl: S185. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10419143

•

The effect of vitamin B6 and folate supplements on plasma homocysteine and serum lipids levels in patients on regular hemodialysis.

160

Hemodialysis

Author(s): Ziakka S, Rammos G, Kountouris S, Doulgerakis C, Karakasis P, Kourvelou C, Papagalanis N. Source: International Urology and Nephrology. 2001; 33(3): 559-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12230295 •

The effect of vitamin E supplementation on antioxidant enzyme activities and lipid peroxidation levels in hemodialysis patients. Author(s): Giray B, Kan E, Bali M, Hincal F, Basaran N. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 2003 December; 338(1-2): 91-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14637272

•

The effects of aromatherapy on pruritus in patients undergoing hemodialysis. Author(s): Ro YJ, Ha HC, Kim CG, Yeom HA. Source: Dermatology Nursing / Dermatology Nurses' Association. 2002 August; 14(4): 231-4, 237-8, 256; Quiz 239. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12240499

•

The effects of zinc supplementation on serum zinc and cholesterol concentrations in hemodialysis patients. Author(s): Chevalier CA, Liepa G, Murphy MD, Suneson J, Vanbeber AD, Gorman MA, Cochran C. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002 July; 12(3): 183-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12105816

•

The effects of zinc supplementation on serum zinc concentration and protein catabolic rate in hemodialysis patients. Author(s): Jern NA, VanBeber AD, Gorman MA, Weber CG, Liepa GU, Cochran CC. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 July; 10(3): 148-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10921536

•

The immediate effect of Shakuyaku-kanzo-to, traditional Japanese herbal medicine, for muscular cramps during maintenance hemodialysis. Author(s): Hyodo T, Taira T, Kumakura M, Yamamoto S, Yoshida K, Uchida T, Sakai T, Endo T, Baba S, Hidai H. Source: Nephron. 2002 February; 90(2): 240. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11818719

•

The pattern of intracellular free amino acids in granulocytes from hemodialysis patients change to an oral protein supplement (granulocyte amino acids after protein in HD patients). Author(s): Ivarsen P, Frystyk J, Pedersen EB.

Alternative Medicine 161

Source: Clinical Nephrology. 1999 August; 52(2): 110-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10480222 •

The role of technology in hemodialysis. Author(s): Ronco C, Ghezzi PM, La Greca G. Source: Journal of Nephrology. 1999 July-August; 12 Suppl 2: S68-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10688405

•

Therapeutic effects of oral nutritional supplementation during hemodialysis. Author(s): Caglar K, Fedje L, Dimmitt R, Hakim RM, Shyr Y, Ikizler TA. Source: Kidney International. 2002 September; 62(3): 1054-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12164890

•

Treatment of mild hyperhomocysteinemia in renal transplant recipients versus hemodialysis patients. Author(s): Bostom AG, Shemin D, Gohh RY, Beaulieu AJ, Jacques PF, Dworkin L, Selhub J. Source: Transplantation. 2000 May 27; 69(10): 2128-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10852611

•

Treatment options to intensify hemodialysis. Author(s): Haag-Weber M. Source: Kidney & Blood Pressure Research. 2003; 26(2): 90-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12771532

•

Use of in vivo-generated biofilms from hemodialysis catheters to test the efficacy of a novel antimicrobial catheter lock for biofilm eradication in vitro. Author(s): Kite P, Eastwood K, Sugden S, Percival SL. Source: Journal of Clinical Microbiology. 2004 July; 42(7): 3073-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15243062

•

Vitamin B(6) therapy does not improve hematocrit in hemodialysis patients supplemented with iron and erythropoietin. Author(s): Weissgarten J, Modai D, Oz D, Chen Levy Z, Cohn M, Marcus O, Dishi V, Galperin E, Averbukh Z. Source: Nephron. 2001 April; 87(4): 328-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11287776

•

Vitamin C and E as antioxidants in hemodialysis patients. Author(s): Hegbrant J, Hultkvist Bengtsson U.

162

Hemodialysis

Source: Int J Artif Organs. 1999 February; 22(2): 69-73. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10212040 •

Vitamin E supplementation increases LDL resistance to ex vivo oxidation in hemodialysis patients. Author(s): Badiou S, Cristol JP, Morena M, Bosc JY, Carbonneau MA, Dupuy AM, Descomps B, Canaud B. Source: Int J Vitam Nutr Res. 2003 July; 73(4): 290-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12951902

•

Water-soluble vitamin levels in patients undergoing high-flux hemodialysis and receiving long-term oral postdialysis vitamin supplementation. Author(s): Descombes E, Boulat O, Perriard F, Fellay G. Source: Artificial Organs. 2000 October; 24(10): 773-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11091166

•

Weekly irinotecan in a patient with metastatic colorectal cancer on hemodialysis due to chronic renal failure. Author(s): Stemmler J, Weise A, Hacker U, Heinemann V, Schalhorn A. Source: Onkologie. 2002 February; 25(1): 60-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893885

•

Zinc supplementation at conventional doses does not improve the disturbance of taste perception in hemodialysis patients. Author(s): Matson A, Wright M, Oliver A, Woodrow G, King N, Dye L, Blundell J, Brownjohn A, Turney J. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 July; 13(3): 224-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12874748

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

Alternative Medicine 163

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to hemodialysis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Amyloidosis Source: Integrative Medicine Communications; www.drkoop.com Bell's Palsy Source: Healthnotes, Inc.; www.healthnotes.com Capillary Fragility Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com

•

Herbs and Supplements Astragalus Alternative names: Astragalus membranaceus Source: Healthnotes, Inc.; www.healthnotes.com Dong Quai Alternative names: Angelica sinensis Source: Healthnotes, Inc.; www.healthnotes.com Hydroxychloroquine Source: Healthnotes, Inc.; www.healthnotes.com Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com

164

Hemodialysis

Menaquinone Source: Integrative Medicine Communications; www.drkoop.com Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

165

CHAPTER 4. DISSERTATIONS ON HEMODIALYSIS Overview In this chapter, we will give you a bibliography on recent dissertations relating to hemodialysis. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “hemodialysis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hemodialysis, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Hemodialysis ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to hemodialysis. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A COMPARISON OF THE PSYCHOLOGICAL EFFECTS OF HEMODIALYSIS AND CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (ANXIETY, DEPRESSION, SICKNESS IMPACT) by BAUER, BARBARA GRUGER, PHD from UNIVERSITY OF MISSOURI - COLUMBIA, 1984, 135 pages http://wwwlib.umi.com/dissertations/fullcit/8425607

•

A STUDY OF COMPLIANCE BEHAVIOR OF HEMODIALYSIS PATIENTS by SHERWOOD, ROGER JOHN, DSW from COLUMBIA UNIVERSITY, 1981, 332 pages http://wwwlib.umi.com/dissertations/fullcit/8125392

•

Adult hemodialysis patients' perceptions concerning choice among renal replacement therapies by Landreneau, Kandace Jo Costley, PhD from UNIVERSITY OF MISSOURI KANSAS CITY, 2004, 133 pages http://wwwlib.umi.com/dissertations/fullcit/3120317

166

Hemodialysis

•

An examination of empowerment at a kidney center as experienced by persons who receive hemodialysis treatment for end-stage renal disease by Bordelon, Thomas Dominique, EdD from MONTANA STATE UNIVERSITY, 1997, 185 pages http://wwwlib.umi.com/dissertations/fullcit/9729954

•

BIO-PSYCHO-SOCIAL FACTORS AFFECTING COPING AND COMPLIANCE WITH THE HEMODIALYSIS TREATMENT REGIMEN by SWIGONSKI, MARY ELLEN, PHD from RUTGERS THE STATE UNIVERSITY OF NEW JERSEY - NEW BRUNSWICK, 1987, 378 pages http://wwwlib.umi.com/dissertations/fullcit/8803518

•

Counselling hemodialysis patients a social interactional approach by Grossman, Joanne; EdD from UNIVERSITY OF TORONTO (CANADA), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL43511

•

Effect of a nutrition education and incentive program on phosphorus levels in hemodialysis patients by Sato, Kourtney Karmel, MS from RUSH UNIVERSITY, 2003, 117 pages http://wwwlib.umi.com/dissertations/fullcit/1415113

•

Exploration of factors that impact mode of death in the hemodialysis patient by Scott, Mary Botkin, PhD from KENT STATE UNIVERSITY, 1996, 233 pages http://wwwlib.umi.com/dissertations/fullcit/9731568

•

JOB SATISFACTION OF FULL-TIME PROFESSIONAL NURSES EMPLOYED IN HEMODIALYSIS TREATMENT FACILITIES by MULKERNE, DONALD JAMES DENNIS, JR., PHD from UNIVERSITY OF FLORIDA, 1980, 111 pages http://wwwlib.umi.com/dissertations/fullcit/8115659

•

Mexican-American women's perspectives of end-stage renal disease and the hemodialysis regimen: Psychosocial influences on compliance with treatment recommendations by Tijerina, Mary Sylvia, PhD from THE UNIVERSITY OF TEXAS AT AUSTIN, 2000, 254 pages http://wwwlib.umi.com/dissertations/fullcit/9992924

•

Problem solving and coping strategies leading to salutary outcomes of hemodialysis in well-functioning adults by Curren, Sheila Caplan, PhD from INSTITUTE FOR CLINICAL SOCIAL WORK (CHICAGO), 1997, 236 pages http://wwwlib.umi.com/dissertations/fullcit/9717686

•

Quality of life, perceived social support and adherence to fluid restriction and treatment schedule among hemodialysis patients by Schneider, Robert Andrew, PhD from UNIVERSITY OF MARYLAND, BALTIMORE, 1995, 148 pages http://wwwlib.umi.com/dissertations/fullcit/9541556

•

RELATIONSHIP BETWEEN PERCEIVED FAMILY ENVIRONMENT AND MEDICAL STATUS OF LONGTERM HEMODIALYSIS PATIENTS by GRIBBLE, JOANN FREEMAN, EDD from EAST TEXAS STATE UNIVERSITY, 1987, 104 pages http://wwwlib.umi.com/dissertations/fullcit/8808001

•

Social network characteristics, social support, and compliance to a chronic hemodialysis regimen by Burgher, Peter L; PhD from UNIVERSITY OF WINDSOR (CANADA), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK57313

Dissertations 167

•

Social support, coping methods and quality of life in hemodialysis patients by AlArabi, Safa'a Ali, PhD from THE UNIVERSITY OF TEXAS GRADUATE SCH. OF BIOMEDICAL SCI. AT GALVESTON, 2003, 252 pages http://wwwlib.umi.com/dissertations/fullcit/3083536

•

The effect of a continuing education program on the performance of hemodialysis nurses and their patient outcomes by Rao, Cynthia Zane, EdD from NORTHERN ILLINOIS UNIVERSITY, 1988, 208 pages http://wwwlib.umi.com/dissertations/fullcit/8900477

•

THE EFFECTIVENESS OF HYPNOTHERAPY AND BEHAVIORAL COACHING IN IMPROVING MEDICAL COMPLIANCE, ALTERING LOCUS-OF-CONTROL, AND LOWERING ANXIETY AMONG EXTERNALLY-ORIENTED, NONCOMPLIANT HEMODIALYSIS PATIENTS (BEHAVIOR MODIFICATION) by TOBIN, MICHAEL PATRICK, PHD from LOYOLA UNIVERSITY OF CHICAGO, 1987, 247 pages http://wwwlib.umi.com/dissertations/fullcit/8704862

•

THE EFFECTS OF TIME-LIMITED GROUP-COUNSELING ON THE LEVEL OF FUNCTIONING OF CHRONIC HOME HEMODIALYSIS PATIENTS by WILSON, CHARLES JOSEPH, EDD from TEMPLE UNIVERSITY, 1973, 98 pages http://wwwlib.umi.com/dissertations/fullcit/7323370

•

The impact of dietary compliance on the quality of life of hemodialysis patients by Black, Peggy Lou, PhD from UNIVERSITY OF PITTSBURGH, 1999, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9957707

•

The impact of religiosity, social support and health locus of control on the healthrelated quality of life of African-American hemodialysis patients by Thomas, Claudie J., DSW from NORFOLK STATE UNIVERSITY, 2003, 242 pages http://wwwlib.umi.com/dissertations/fullcit/3121113

•

The social networks of people with end stage renal disease: Comparing hemodialysis and peritoneal dialysis patients by Shelley, Gene Ann, PhD from UNIVERSITY OF FLORIDA, 1992, 262 pages http://wwwlib.umi.com/dissertations/fullcit/9304051

•

The spectrum of adherence among the chronically ill: The association between the marital family system and the adherence behavior of hemodialysis patients by Barsa del Alcazar, Christine Louise, PhD from UNIVERSITY OF PENNSYLVANIA, 1996, 181 pages http://wwwlib.umi.com/dissertations/fullcit/9712887

•

THE USE OF GUIDED IMAGERY IN THE CONTROL OF FOOD AND LIQUID INTAKE OF HEMODIALYSIS PATIENTS by HIGGINS, THOMAS EDWARD, EDD from WESTERN MICHIGAN UNIVERSITY, 1984, 100 pages http://wwwlib.umi.com/dissertations/fullcit/8506934

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

169

CHAPTER 5. PATENTS ON HEMODIALYSIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “hemodialysis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hemodialysis, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Hemodialysis By performing a patent search focusing on hemodialysis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

170

Hemodialysis

example of the type of information that you can expect to obtain from a patent search on hemodialysis: •

Anti-occlusion catheter Inventor(s): Teitelbaum; George P. (325 16th St., Santa Monica, CA 90402-2217) Assignee(s): none reported Patent Number: 6,692,459 Date filed: June 13, 2001 Abstract: A catheter for the administration of fluid or pharmaceutical agents, or for hemodialysis comprising a proximal control end comprising a housing with a proximal end and a distal end, a distal delivery end, an elongated intermediate portion between the proximal control end and a distal delivery end, one or more than one delivery lumen within the intermediate portion extending from the proximal control end to the distal delivery end; one or more than one inflation balloon in each delivery lumen, and one or more than one inflation lumen in the intermediate portion extending from the proximal control end to the one or more than one inflation balloon in the one or more than one delivery lumen, and connected to the one or more than one inflation balloon through one or more than one fenestration, where the proximal control end further comprises a mechanism for aspiration and injection of fluids through the distal delivery end, and where the proximal control end further comprises a mechanism for controlling inflation of the one or more than one inflation balloon. Excerpt(s): Catheters, such as central venous catheters, are used for a variety of diagnostic and therapeutic purposes, including the administration of fluid and pharmaceutical agents, and for hemodialysis in patients with renal failure. Unfortunately, central venous catheters lumens are prone to occlusion due to thrombosis from retrograde blood flow. In some cases, the thrombosis can be cleared from the catheter. In other cases, the catheter must be removed and a new catheter placed. Each new catheter placement is associated with a risk of complications, including infection, hemorrhage, pneumothorax and embolus. Some central venous catheters have a unidirectional valve at the distal catheter tip to prevent retrograde blood flow. However, catheters with such valves still occlude due to thrombosis from retrograde blood flow and the valves tend to disadvantageously impede antegrade fluid flow. Therefore, it would be useful to have a catheter that was less prone to thrombosis from retrograde blood flow. Additionally, it would be useful to have a method of delivering fluid and pharmaceutical agents, or for performing hemodialysis, that is associated where a lower incidence of catheter replacement due to thrombosis of the catheter from retrograde blood flow. Web site: http://www.delphion.com/details?pn=US06692459__

•

Apparatus and method for determination of the adequacy of dialysis by non-invasive near-infrared spectroscopy Inventor(s): Robinson; Mark Ries (Albuquerque, NM) Assignee(s): Inlight Solutions, Inc. (Albuquerque, NM) Patent Number: 6,636,759 Date filed: March 28, 2001

Patents 171

Abstract: Methods and apparatus for non-invasive tissue urea concentrations during or subsequent to hemodialysis using near-infrared spectroscopy are discussed. Nearinfrared tissue spectra can be obtained by projecting near-infrared radiation into skin on the underside of human forearms and capturing the light reflected back and out through the tissue. An index matching medium is used to couple the tissue to the analyzer. The tissue spectrum collected preferably includes primarily diffuse reflected light reflected from the inner dermis. Multiple tissue spectra of known urea concentration are used to build a model from which the urea concentration of an unknown sample can be devised. The model is based on a partial least squares algorithm applied to multiple tissue scans and concomitant blood sample urea measurements. This model is then applied to an unknown tissue spectra. Excerpt(s): The present invention relates generally to methods and systems for determining the adequacy of treatment during hemodialysis of a patient utilizing a noninvasive near-infrared tissue analysis. More specifically, the invention relates to direct measurement of urea concentrations in tissue of patients undergoing dialysis with light diffusely reflected by skin in conjunction with a spectrographic model, which relates urea concentration to a diffusely reflected light spectrum. Measurement of the efficacy of hemodialysis treatments is currently time consuming, inaccurate and expensive. Approximately 260,000 Americans suffer from end-stage renal disease (ESRD). Fiftynine percent are treated by thrice-weekly maintenance hemodialysis sessions designed to clear the products of metabolism that are normally excreted by the kidneys in the urine. Since the failure to adequately dialyze a patient has been shown to increase mortality and morbidity and since the process of dialyzing an ESRD patient is complex and variable in terms of the efficiency of the treatment, a number of methods have been developed to quantify the effectiveness of the treatment. The technique used in the overwhelming majority of dialysis centers is based on pre- and post-dialysis measurements of blood urea nitrogen concentrations. Urea, a low-molecular weight molecule, is a product of protein metabolism that is normally cleared from the body by the kidneys. Because it is also cleared from the blood by the dialysis process and easily measured in blood, its disappearance from the blood during hemodialysis is a measure of the efficacy or adequacy of that particular treatment session. The process of removal of toxins from the body by hemodialysis is best represented as a logarithmic function. As such, the coefficient of the natural logarithm termed KT/Vd, which is calculated from pre- and post-dialysis measurements of blood urea concentrations, can be used as a single descriptor of dialysis adequacy. The importance of adequate duration or dose of hemodialysis has been underscored recently by the observation that the adjusted mortality of patients with renal disease in the United States exceeds that of several other countries, despite a longer life expectancy of the general population of the United States. A number of studies have documented the failure to deliver an adequate dose of hemodialysis to many Americans. The failure of delivery of adequate hemodialysis doses in the United States is a result of many factors. Time and financial pressures contribute to the problem. Because the metabolic toxins are removed from the blood, which makes up only a fraction of the total volume of the body in which the toxins are distributed, there are delays as the solutes redistribute and equilibrate after dialysis. Thus, measurement of KT/Vd is highly dependent on the time of the urea measurements and the relative size of the compartments such as blood water, interstitial water and intracellular water, all of which harbor urea and other contaminants. These compartments vary in size from patient to patient, and within a patient depending upon present physiologic state. The best measure of the post-dialysis urea is made at least 15 minutes after hemodialysis, but for some patients it may require 50 to 60 minutes to reach equilibrium. There is no accurate way to predict which patients will have a

172

Hemodialysis

significant blood urea increase following hemodialysis at any given treatment time. Given the time constraints on out-patient hemodialysis centers that commonly are able to dialyze no more than two patients per day on a single machine, one in the morning and one in the afternoon, the need to obtain post-dialysis blood urea concentrations 30 to 60 minutes after dialysis is impractical at best. Finally, the late blood measurement requires an additional venipuncture of the patient who is disconnected from the dialysis machine minutes after cessation of circulation through the machine. Web site: http://www.delphion.com/details?pn=US06636759__ •

Apparatus and method for in vivo hemodialysis Inventor(s): Gorsuch; Reynolds G. (Yountville, CA) Assignee(s): Transvivo, Inc. (Napa, CA) Patent Number: 6,561,996 Date filed: May 19, 1998 Abstract: A method of removing toxins from a patient's blood comprises implanting a filter device having a dialysis membrane with an exterior surface exposed to the patient's blood and a dialysate cavity exposed to an interior surface of the dialysate membrane within a blood vessel of a patient, continuously directing substantially uncontaminated or substantially decontaminated dialysate into the dialysate cavity and in diffusive communication with the patient's blood, dialysing the patient's blood with the dialysate, and continuously removing toxin contaminated dialysate from the filter device. Excerpt(s): Treatment for acute kidney failure and chronic end stage renal disease is accomplished by various forms of continuous ambulatory peritoneal dialysis and hemodialysis, presently the most commonly used form of therapy. In all current hemodialysis procedures, blood is periodically removed from the patient's body, dialyzed ex-vivo and the treated blood returned to the body. Single patient conventional hemodialysis procedures are performed at an out-patient center 2 or 3 times a week in 3 to 4 hour sessions during which the patient's blood toxins are removed by dialysis and filtration to eliminate the toxins generated by the body during the 3 or 4 day period preceding the hemodialysis, and during the time the treatment is carried out. Thus, unlike normal kidney function in which dialysis is carried out continuously, the hemodialysis creates non-uniform toxin removal with "peaks and valleys" of toxin concentrations. Moreover, during the time that the toxins are above normal, the patient feels ill and the consequent buildup of fluid volume in the body caused by lack of urination results in a severe volume load on the right heart stressing an already compromised cardiovascular system, as well as creating an imbalance in the electrolyte system of the blood. During the hemodialysis, blood is pumped from the body and through a dialyzer cartridge at a high flow rate and simultaneously fluid is removed from the blood by ultrafiltration to reduce the blood volume to normality. The resulting procedure causes a massive change in blood hemodynamics in a short period of time and produces additional heavy stress on the human system with severe fluctuations in blood pressure and trauma to other body organs. Yet another serious problem is the persistent and periodic clotting of the blood in the inner lumens of the dialyzer even though the patient is anti-coagulated with drugs such as heparin. The aforesaid current hemodialysis procedures are performed on over 600,000 patients per year in the United States alone at an expense to the healthcare system of over twelve billion dollars per year. In U.S. Pat. Nos. 4,590,224, 5,151,082, 5,152,743, 5,224,926 and 5,735,809 there are

Patents 173

disclosed methods and apparatus for in vivo separation of plasma from blood utilizing one or more hollow elongated microporous fibers implanted within a patient's blood vessel. The fibers are made of a microporous polymeric fiber membrane material having a pore size sufficient to allow diffusion of plasma into the hollow fiber interior but preventing cellular components larger than plasma to diffuse, ultrafiltrate or enter the fiber interior. The fiber or fibers are implanted within the blood vessel without significantly obstructing fluid flow through the vessel while providing the aforesaid in vivo plasma separation. The fiber assembly is secured in fluid communication with a catheter, preferably a dual lumen catheter having a first tube permitting plasma passage from the fiber and a second tube for returning plasma to the blood vessel after treatment. Various configurations and methods of fabrication as well as materials having a variety of characteristics and performance abilities are disclosed in the aforesaid patents and application as are various systems, apparatus, components and methods for use including measurement of blood parameters, kidney dialysis, and separation and removal of a substantial number of specific materials and plasma components, the descriptions of which are incorporated herein by reference. By continuously extracting plasma from the blood in-vivo and dialyzing only the plasma ex-vivo eliminates many of the failings of the present hemodialysis systems and procedures. The present invention is intended to provide further improvement in removing toxins from a patient's blood. In the present invention, all of the function of kidney dialysis therapy can be performed continuously in-vivo and in-situ without removing from the body any blood, plasma or blood components except the toxins and other undesirable elements to be eliminated, thus substantially emulating the natural kidney. Web site: http://www.delphion.com/details?pn=US06561996__ •

Apparatus for implementing hyperthermia Inventor(s): Clupper; Marc (Hampstead, NC), Fausset; Michael (Lafayette, IN), Keeling; Glenn (McMurray, PA), Rainier; Brad (Noblesville, IN) Assignee(s): Viacirq, Inc. (Pittsburgh, PA) Patent Number: 6,579,496 Date filed: May 25, 1999 Abstract: An apparatus and system for extracorporeal treatment utilizes a hemodialysis machine capable of heating dialysis fluid to 48.degree. C., an optional parallel plate hemodialyzer together with a sorbent-based detoxifier, a tubular heat exchanger and a high flow pump--in addition to various probes and catheters--to effect extracorporeal treatment without adverse physiological effect and without the specific need for general anesthesia. The system inheres in the combined high flow of the pump-up to 2400 ml per minute--and the high temperature--52.degree. C.--achievable in the heat exchanger, which together provide unprecedented speed and efficiency in the administration of hyperthemia treatments. The system is also a potentiating system in the administration of heat sensitive pharmaceutically active agents and is praticularly useful in the isolated anatomic areas of a patient. Excerpt(s): The present invention relates to a specialized method for hyperthermia, including extracorporeal blood heating and sorbent-based detoxification, as an antiviral and antineoplasm protocol. Hyperthemia as a treatment of tumors has been carefully studied and applied since the 1960's. Prior to that time there were multiple reports of tumor regression coincident with febrile episodes. Subsequent analysis revealed that

174

Hemodialysis

temperatures greater than 41.degree. C. are ordinarily needed to induce tumor necrosis (tumor death). Although there are multiple methods of inducing hyperthermia by either direct skin contact or radiant heating, many physicians now favor an extracorporeal heat exchange (blood) circuit to raise patient temperatures. Patients may be maintained at 41.5.degree. C. to 42.degree. C. (rectal temperature) for three to four hours without severe cardiovascular compromise, although others report elevation of serum transaminases and bilirubin in patients kept at these temperatures for greater than 10 to 40 minutes. Instances of neurologic damage have been reported in association with serum hypophosphatemia, although no significant problems occurred once phosphate levels were maintained. Deaths have also been reported in two patients receiving hiyperthermia at 41.5.degree. C. to 42.degree. C. for 1-1/2 to 2 hours, presumably from massive liver tumor necrosis. DcMoss, J. L. et al., "Hyperthermia in the Treatment of Cancer," The Journal of Extra-Corporeal Technology, Volume 17, No. 1, pp. 37-43, 1985, explains that tumors are vulnerable to heal and that the goal of hyperthermic treatment therapy is to achieve cytotoxic temperatures in the tumor for a sufficient length of time without damaging the surrounding normal tissue. The rate at which blood flows through any given area of tissue. determines the amount of heat that may be carried away and therefore is a major determinant of the temperature rise in that tissue. In normal tissue, heat causes vasodilation. In a tumor, the microvasculature is made up of an overabundance of capillary beds which are unable to dilate. Blood flow through the area is thus more sluggish and commensurately unable to dissipate heat applied to the area. The inability to respond to heat by dilation, as normal vasculature would, also subjects the tumor to hypoxia, anaerobic metabolism and local acidosis, and these conditions in turn make the tumor tissue more vulnerable to thermal injury. Web site: http://www.delphion.com/details?pn=US06579496__ •

Blood vessel catheter Inventor(s): Quinn; David G. (Grayslake, IL) Assignee(s): Radius International Limited Partnership (Grayslake, IL) Patent Number: 6,540,714 Date filed: August 30, 2000 Abstract: A hemodialysis catheter including a catheter tube and a bolus tip, the bolus having a radially extending main side port. The catheter also has second and third side ports axially spaced from said main side port. The second and third side ports are each axially elongated, with an edge which is semi-circular in cross-section. The second side port is displaced 180.degree. from the main side port. The third side port is axially aligned with the main port. The catheter is thickened in an arch opposite each of the second and third side ports. Excerpt(s): This invention relates in general to medical catheters. It relates, more particularly, to blood vessel catheters. Blood vessel catheters are normally either venous catheters or arterial catheters. Venous catheters, in turn, normally come in several forms. The simplest are short peripheral catheters. Next come midline catheters, central venous catheters and port catheters. Hemodialysis catheters are one form of central venous catheters and are normally placed in the superior vena cava. The present invention may find application in each of the aforementioned venous catheters. However, it finds particularly advantageous application in hemodialysis catheters. Web site: http://www.delphion.com/details?pn=US06540714__

Patents 175

•

Blood vessel catheter Inventor(s): Quinn; David G. (Grayslake, IL) Assignee(s): Radius International Limited Partnership (Grayslake, IL) Patent Number: 6,702,776 Date filed: January 11, 2001 Abstract: A catheter including a catheter tube and a bolus tip, the bolus having a radially extending main side port. In one embodiment the catheter also has second and third side ports axially spaced from said main side port. The second and third side ports are each axially elongated, with an edge which is semi-circular in cross-section. The second side port is displaced 180.degree. from the main side port. The third side port is axially aligned with the main port. The catheter is thickened in a dimple opposite each of the second and third side ports. Another catheter embodiment specifically for hemodialysis includes a dual lumen tube with a bolus at its distal end. A main venous port is formed in one side of the bolus adjacent the bullet nose of the bolus. Variations of this embodiment utilize a bolus with a 13.5 French tube connector section and a 10 French nose section, with the venous port formed in the nose section. Excerpt(s): This invention relates in general to medical catheters and, more particularly, to blood vessel catheters. In one aspect of the invention it relates to hemodialysis catheters. Blood vessel catheters are normally either venous catheters or arterial catheters. Venous catheters, in turn, usually come in several forms. The simplest are short peripheral catheters. Next come midline catheters, central venous catheters and port catheters. A hemodialysis catheter is one form of central venous catheter and is normally placed in the superior vena cava. The present invention may find application in each of the aforementioned venous catheters. However, it finds particularly advantageous application in hemodialysis catheters. Hemodialysis, as practiced today, normally employs one of two types of catheter to remove blood from the patient for processing and return processed blood to the patient. Most commonly, a catheter tube containing two lumens is used, each lumen having a semi-cylindrical configuration. This is frequently referred to as a dual lumen catheter. Alternatively, two separate tubes, each with a full cylindrical configuration, may be used to remove blood for dialysis and return the processed blood. Web site: http://www.delphion.com/details?pn=US06702776__

•

Compressibility probe for monitoring blood volume changes Inventor(s): Lee; Jen-Shih (3375 Blandemar Dr., Charlottesville, VA 22903), Lee; Lian-Pin (3375 Blandemar Dr., Charlottesville, VA 22903) Assignee(s): none reported Patent Number: 6,485,427 Date filed: July 18, 2001 Abstract: An apparatus and method to assess the compressibility of blood includes a combination of ultrasound transducers attached to tubing in which blood is flowing. An indicator medium is injected into the bloodstream of the subject over one or more time points and ultrasound waves are transmitted and monitored using transducers and phase lock amplifier to assess transmission time. Using a linear relationship between compressibility and density, changes in blood density are calculated from changes in

176

Hemodialysis

transmission time to predict blood density changes and then the blood volume and microvascular pooling. This information allows prediction of complications that can occur during hemodialysis or because of post-traumatic fluid replacement and development of therapy to alleviate the complications. Excerpt(s): This invention relates to systems and methods for non-invasive, continuous monitoring of a patient's blood density changes in order to determine the blood volume and microvascular pooling of the patient over time. An apparatus and method are described to monitor the time of sound transmission in the blood stream of a patient and use a linear relationship between compressibility and density for accurate and sensitive assessment of blood density changes due to saline or dialysate dilution. With an appropriate protocol, the density changes are used to determine the blood volume and microvascular pooling of the patient over time. Hypotension and hypovolemia are common circulatory problems that occur during shock (Chien et al, American Journal of Physiology, 210:1411-1418), traumatic injury, dialysis (Amerling et al in Clinical Dialysis 3.sup.rd Edition, Appleton and Lang editors, 1995) and surgical interventions. A variety of disorders and injuries are related to the occurrence of hypotension (Daugirdas, Kidney International 39:233-246). Fluid losses related to burn injury or hemorrhage due to trauma are examples of situations where compensation for such loss is necessary. Compensation is typically done by infusing isotonic saline, plasma or other physiological solutions into the circulation until arterial pressure is elevated to normal. Although blood volume reduction correlates with reduction in arterial pressure under laboratory simulations of injury and anesthesia, actual occurrences of traumatic blood loss often show only slightly reduced arterial pressures due to the body's neural compensation mechanisms. Once these mechanisms reach their limits, arterial pressure can drop rapidly. The management of this subnormal arterial pressure is critical to survival; immediate restoration of arterial pressure after traumatic injury can cause more problems than allowing the pressure to remain subnormal. Rapid restoration of arterial pressure results in higher oxygen demand and can dislodge clots that have started to provide homeostasis. Web site: http://www.delphion.com/details?pn=US06485427__ •

Devices for preparing hemodialysis solutions Inventor(s): Taylor; Michael A. (Napa, CA) Assignee(s): Prismedical Corporation (Napa, CA) Patent Number: 6,605,214 Date filed: March 3, 2000 Abstract: A single housing includes a diluent inlet, a solution outlet, and a plurality of discrete reagent beds comprising at least one reagent in dry form, wherein the reagent is present in the discrete reagent bed in a proportion sufficient for production of a complete hemodialysate solution. Excerpt(s): This invention relates generally to devices for preparing solutions from dry reagent constituents and, more particularly, to the preparation of solutions suited for hemodialysis. Patients with sufficiently impaired kidney function are required to undergo dialysis to remove toxins from their blood. In general, dialysis involves the removal of toxins from body fluids by diffusing the toxins across a permeable membrane into a toxin-free dialysis solution. In the case of hemodialysis, blood is removed from a patient's body and purified of toxins externally in a dialysis machine.

Patents 177

After removal of the toxins, the purified blood is returned to the patient. Patients receiving hemodialysis typically utilize 75 to 150 liters of prepared dialysis solution three times a week. The largest ingredient in these solutions is water. Reducing water in the dialysis solutions thus reduces the amount of solution which needs to be stored or transported. Web site: http://www.delphion.com/details?pn=US06605214__ •

Dialysis access system and method Inventor(s): Johnston, Jr.; Robert H. (303 Pasadena, Victoria, TX 77904) Assignee(s): none reported Patent Number: 6,544,206 Date filed: October 13, 2000 Abstract: A method of and system for providing vascular access in a patient for hemodialysis involves attaching the distal end of an access catheter to the abdominal aorta of the patient and the proximal end of the access catheter to a portion of the patient to allow selective access to an interior portion of the access catheter. A bloodwithdrawal catheter and a blood-return catheter are placed into the access catheter until their distal ends are in the patients abdominal aorta and blood may be removed and return to the aorta. When finished, the blood catheters are removed. Selective access to the proximal end of the access catheter is provided, preferably, by a cutaneous port assembly that includes a screwable cap and anti-infection cuff. Excerpt(s): The present invention relates generally to the design and use of medical devices, and more particularly, to a dialysis access system and method. Access to a patient's vascular system is necessary for a number of treatments such as hemodialysis, which is one of the most critical treatments, and other extra extracorporeal procedures. Hemodialysis, which is used for treatment of end-stage renal disease, involves connecting a patient to a dialysis or kidney machine. The dialysis machine cleanses the patient's blood of waste products such as urea and potassium. Many patients must have this procedure done three or more times per week for the remainder of their lives. Access to the patient's vascular system for the purpose of withdrawing blood to be delivered to the dialysis machine and returning the dialyzed blood to the patient poses many challenges. A number of procedures have been used for this purpose. One method for chronic hemodialysis access is to create an arteria-venous fistula in the arm of a patient. With the fistula, which is a surgical connection of an artery to a vein, a number of changes occur. The connection bypasses flow-resistant capillaries to provide increased blood flow and the vein is caused to enlarge its diameter and the walls to thicken. Fistulas frequently last only about six months or so before clotting. Sometimes they can be de-clotted, but they remain problematic. Considerable resources are expended to keep such access systems in place and operating properly. Web site: http://www.delphion.com/details?pn=US06544206__

178

•

Hemodialysis

Dialysis solutions containing water soluble vitamins and nutrients Inventor(s): Gupta; Ajay (39151 Horton, Farmington Hills, MI 48331) Assignee(s): none reported Patent Number: 6,537,976 Date filed: October 18, 1999 Abstract: The invention relates to methods and compositions for the prevention and treatment of vitamin and other nutrient deficiencies in hemodialysis and peritoneal dialysis patients. Patients are dialyzed with a dialysate solution comprising at least one vitamin. Excerpt(s): This invention generally relates to methods and compositions for hemodialysis and peritoneal dialysis. In particular, the invention relates to the use of a dialysate solution comprising at least one vitamin to improve the nutritional status of a dialysis patient. Dialysis provides a method for supplementing or replacing renal function in patients with renal failure. Therefore, dialysis helps maintain homeostasis in patients with end stage kidney failure. Dialysis is defined as the movement of solute and water through a semipermeable membrane which separates the patient's blood from the dialysate solution. The semipermeable membrane can either be the peritoneal membrane in peritoneal dialysis patients or an artificial dialyzer membrane in hemodialysis patients. Molecules transfer across this semipermeable membrane by the processes of diffusion and convection. In hemodialysis, the patient's blood is passed through an artificial kidney dialysis machine. A membrane in the machine acts as an artificial kidney for cleansing the blood. Because it is an extracorporeal system that requires special machinery, there are certain inherent disadvantages with hemodialysis. To overcome the disadvantages associated with hemodialysis, peritoneal dialysis was developed. Peritoneal dialysis utilizes the patient's own peritoneum as a semipermeable membrane. The peritoneum is the membranous lining of the body cavity that due to the large number of blood vessels and capillaries, is capable of acting as a natural semi-permeable membrane. In peritoneal dialysis, a dialysis solution is introduced into the peritoneal cavity utilizing a catheter. After a sufficient period of time, an exchange of solutes between the dialysate and the blood is achieved. Fluid removal is achieved by providing a suitable osmotic gradient from the blood to the dialysate to permit water outflow from the blood. The dialysis solution is then simply drained from the body cavity through the catheter. Web site: http://www.delphion.com/details?pn=US06537976__

•

Hemodialysis Inventor(s): El Hatu; Mohamed Kaled Mohamed (52 Tayaran Street, Nasr City, Nasr, EG) Assignee(s): El Hatu; Mohamed Kaled Mohamed (Nasr, EG) Patent Number: 6,610,027 Date filed: August 17, 2000 Abstract: Accelerated hemodialysis is a novel method of extracorporeal blood tratment in which a high blood flow rate through the filter and a low blood flow to and from the patient is achieved by using accelerated hemodialysis lines composed of arterial line connecting blood from the patient to the filter, venous line connecting blood from the

Patents 179

filter to the patient and a recirculation line carrying part of the blood from the venous line to the arterial line and is controlled by using 2 adjustable blood pumps or one blood pump and an adjustable valve situated at suitable sites of the circuit, with an optional safety program comparing the blood flow rates in different parts of the blood lines and the ultrafilteration rate to ensure safe operation. Excerpt(s): presented as a talk in the first African Pediatric Nephrology Association meeting in Cairo, March 2000. presented as a Poster in the 34 European Pediatric Nephrology Association meeting in Helsinki June 2000. Hemodialysis is done by passing the patient's blood in semiperniable capillaries or plates impregnated in a physiological solution where toxins pass to the refreshing solution & is discarded. Web site: http://www.delphion.com/details?pn=US06610027__ •

Hemodialysis and vascular access systems Inventor(s): Squitieri; Rafael (Morristown, NJ) Assignee(s): GraftCath, Inc. (Bellevue, WA) Patent Number: 6,582,409 Date filed: January 24, 2000 Abstract: A hemodialysis and vascular access system which includes a catheter having an arteriovenous fistula utilizing an indwelling silastic venous end and an arterial end which is adapted to be anastomosed to an artery is described. The catheter includes a needle receiving s through which a needle is inserted to access fluid flow within the hemodialysis and vascular access system. The invention enables use of an "arterialized" indwelling venous catheter where blood flows from an artery through the hemodialysis and vascular access system and is returned to the venous system via an arrangement wherein the outflow opening is distinct and distant from the site where the catheter enters the vein. The site of blood return to the venous system is not directly fixed to the venous wall but is free floating within the venous system. This system provides a hemodialysis and venous access graft which has superior longevity and performance and is relatively easy to implant. Excerpt(s): Currently, HD (hemodialysis) and vascular access for chemotherapy and plasmapheresis is achieved in one of several ways. Applicant's invention involves a new method and instrumentation for HD and vascular access designed to eliminate the problems of the prior methods and create a new, more durable, easier to use, vascular access system. One prior art method involves a primary arteriovenous fistula. In this method, a native artery is sewn to a native vein creating a high flow system of blood in a vein which over time can be accessed with two hemodialysis needles attached to a dialysis machine. The problem with this method is that few patients are candidates secondary to anatomy and in others the veins or shunt fail to enlarge and mature properly even if the primary fistula remains patent. These arteriovenous fistulas also become aneursymol over time requiring revision. Another method involves a subcutaneous prosthetic conduit (PTFE) in the shape of a tube which is sewn at either end to openings made in an artery and vein. This method causes recurrent stenosis at the venous outflow leading to thrombosis (i.e., graft closure) secondary to intimal hyperplasia at venous anastomosis. Thrombosis also occurs at needle puncture sites along the PTFE. Web site: http://www.delphion.com/details?pn=US06582409__

180

•

Hemodialysis

Hemodialysis catheter Inventor(s): Quinn; David G. (Grayslake, IL) Assignee(s): Radius International Limited Partnership (Grayslake, IL) Patent Number: 6,461,321 Date filed: May 11, 2001 Abstract: A hemodialysis catheter comprising a dual lumen tube with a bullet nose bolus at its distal end. A venous port is formed in one side of the bolus adjacent the bullet nose of the bolus. An arterial port is formed in the bolus circumferentially displaced 180.degree. around the catheter from the venous port. The bolus contains a venous passage which transitions from a smaller diameter D-shaped cross-section to a larger diameter circular cross-section. The bullet nose is thinner than the tube but is inclined on an angle to the axis of the tube so that a portion of its outer periphery is substantially tangent to a hypothetical cylinder containing the trailing edge of the venous port. Excerpt(s): This invention relates in general to hemodialysis. It relates, more particularly, to hemodialysis catheters. Hemodialysis, as practiced today, normally employs one of two types of catheter to remove blood from the patient for processing and return processed blood to the patient. Most commonly, a catheter tube containing two lumens is used, each lumen having a generally semi-cylindrical or D-shape configuration. This type of catheter is frequently referred to as a dual lumen catheter. Alternatively, two tubes, each with a full cylindrical configuration, are used separately to remove blood for dialysis and return the processed blood. Flow rates possible with conventional dual lumen catheters are usually lower than those achievable where separate tubes are used to remove blood from a vein for dialysis and then return processed blood back to the vein. Web site: http://www.delphion.com/details?pn=US06461321__

•

Hollow fiber membrane made of an ethylene-vinyl alcohol polymer Inventor(s): Kakiuchi; Tomoki (Kurashiki, JP), Matsumoto; Yoichi (Kurashiki, JP), Nakaji; Shuhei (Kurashiki, JP), Sekiguchi; Koji (Kurashiki, JP), Suehiro; Takeshi (Kurashiki, JP), Sugo; Nozomu (Kurashiki, JP), Takai; Masato (Kurashiki, JP), Tsuruta; Hitoshi (Kurashiki, JP) Assignee(s): Kuraray Co., Ltd. (Kurashiki, JP) Patent Number: 6,514,409 Date filed: January 10, 2001 Abstract: A hollow fiber membrane made of an ethylene-vinyl alcohol polymer, comprises a dense layer existing in the inner surface and a porous layer existing in the layer other than the dense layer, wherein the hollow fiber membrane has a porosity of 60 to 90%, an overall mass transfer coefficient for myoglobin in a water-based system of not less than 0.003 cm/min., and a rejection rate for albumin in a bovine blood system of not less than 97%. The EVA hollow fiber membrane is useful for hemopurification membranes such as hemodialysis membranes, hemodiafiltration membranes, hemofiltration membranes and continuous hemofiltration membranes, and a process for producing the same.

Patents 181

Excerpt(s): The present invention relates to a hollow fiber membrane made of an ethylene-vinyl alcohol polymer (hereinafter the term "ethylene-vinyl alcohol" is simply referred to as "EVA," and the term "hollow fiber membrane made of an EVA polymer" is simply referred to as "EVA hollow fiber membrane"), and a process for producing the hollow fiber membrane. More particularly, the present invention related to an EVA hollow fiber membrane used for hemopurificafion membranes such as hemodialysis membranes, hemodiafiltration membranes, hemofiltration membranes and continuous hemofiltration membranes, and a process for producing the same. Hollow fiber membranes made of an EVA polymer have been widely used in applications for various separation membranes for industrial, medical and other purposes since the hollow fiber membranes are excellent in hydrophilicity (see Japanese Patent Laid-Open No. Hei 542208). Especially, the hollow fiber membranes are excellent in biocompatibility and chemical stability, and have very little eluted substances, so that the hollow fiber membranes have been widely used for medical applications. Their representative uses include, for instance, hemodialysis filtration membranes. Japanese Examined Patent Publication No. Sho 58-36602, Japanese Patent Laid-Open Nos. Sho 58-45239 and Hei 542208, and the like disclose membranes having an asymmetric structure comprising a dense layer in the inner surface predominantly imparting fractionalization and permeability, and a porous layer supporting the dense layer as an EVA hollow fiber membrane having both high permeability and high fractionalization. Web site: http://www.delphion.com/details?pn=US06514409__ •

Method and apparatus for reprocessing dialyzers Inventor(s): Abe; Tomiya (Wakayama, JP), Tanaka; Noriaki (707, Kitanoda, Sakai-shi, Osaka 588, JP) Assignee(s): Tanaka; Noriaki (Osaka, JP) Patent Number: 6,655,394 Date filed: April 29, 1998 Abstract: This invention provides a method for reprocessing a dialyzer for hemodialysis, the method comprising the steps of rinsing the dialyzer with water and cleaning it with electrolyzed strongly acidic water, or the steps of rinsing the dialyzer with water, cleaning it with electrolyzed strongly alkaline water, rinsing it with water and cleaning it with electrolyzed strongly acidic water, as well as a reprocessing apparatus for carrying out the reprocessing method. Excerpt(s): The present invention relates to a method for reprocessing a dialyzer for hemodialysis, and more particularly, to a method for reprocessing a dialyzer by cleaning the dialyzer for reuse. This invention also concerns with a reprocessing apparatus for carrying out said method for reprocessing a dialyzer. Reuse of dialyzers for hemodialysis is prohibited by law in Japan in order to prevent infection or the like. However, reuse of dialyzers is allowed in the U.S., People's Republic of China, parts of Europe and other countries, wherein it is allowed, above all, to use the same dialyzer for the same patient a number of times. For example, in the U.S., reusing dialyzers is beneficial in terms of cost savings for a dialysis center (unit) from the viewpoint of insurance system. Dialyzer reuse grew rapidly during the 1980s. Currently at least 75% of dialysis centers (units) is reusing dialyzers. Web site: http://www.delphion.com/details?pn=US06655394__

182

•

Hemodialysis

Method and pharmaceutical composition for replacing iron losses in dialysis patients Inventor(s): Gupta; Ajay (39151 Horton, Farmington Hills, MI 48331) Assignee(s): none reported Patent Number: 6,689,275 Date filed: December 31, 1996 Abstract: A method of replacing iron losses during dialysis of patients is accomplished by infusion of a noncolloidal ferric compound, soluble in hemodialysis solutions, during dialysis. A pharmaceutical composition is provided consisting essentially of dialysis solution including a soluble noncolloidial ferric compound, preferably ferric pyrophosphate. Excerpt(s): The present invention relates to hemodialysis and more particularly to methods of supplementing dialysate solutions for the treatment of iron deficiency in diaylsis patients. Patients with chronic renal failure suffer from anemia due to impaired production of erythropoietin [Erslev, 1991]. Clinical manifestations of chronic renal failure improve as uremia and volume overload were corrected by dialysis. However, anemia due to lack of erythropoieatin becomes a major limiting factor in the functional well being of end stage renal disease patients. Molecular cloning of the erythropoietin gene in 1985 [Jacobs et al., 1985] led to commercial production of recombinant erythropoietin, which was a major advance in the treatment of renal anemia [Erslev, 1991; Levin, 1992]. Erythropoietin therapy functions by stimulating red cell production and thereby iron utilization. With the use of erythropoietin therapy, transfusions are avoided in most chronic dialysis patients. However, accelerated iron utilization coupled with small but unavoidable loss of extra corporeal blood with hemodialysis and increased gastrointestinal losses of iron lead to iron deficiency in almost all patients on long term maintenance dialysis. Web site: http://www.delphion.com/details?pn=US06689275__

•

Method of blood flow measurement in arterio-venous hemodialysis shunts by indicator dilution Inventor(s): Drost; Cornelis J. (Ithaca, NY), Krivitski; Nikolai M. (Ithaca, NY) Assignee(s): Transonic Systems Inc. (Ithaca, NY) Patent Number: 6,746,408 Date filed: May 29, 2001 Abstract: The present invention provides a method for measuring the blood flow rate within an A-V shunt via indicator dilution techniques. Unknown flow resistance within the A-V shunt are addressed by adjusting a measured flow rate to provide a flow rate within a predetermined margin of error. The calculated flow rate can be rejected based upon flow conditions of the introduced indicator. Different indicator introduction rates can be used to enhance accuracy of the measured flow. The indicator flow path can include a flow restrictor to limit the flow rate of the indicator to below a predetermined value. Excerpt(s): The present invention relates an apparatus and method for measuring fluid flow, and more particularly, to determining blood flow rates in hemodialysis arteriovenous (A-V) shunts by dilution techniques, including thermodilution. Hemodialysis is a process by which an artificial kidney replaces the function of a kidney in a patient.

Patents 183

Blood is removed from the patient through a patient access such as an arterio-venous (A-V) shunt, passed through a dialyzer and returned to the patient access for normal circulation through the vascular system of the patient. Arterio-venous shunts used in hemodialysis are surgically created by insertion of a specially designed tube (artificial graft or autologous vein) between a peripheral artery and a vein, or by connecting a peripheral artery to a vein to create a native (shunt) fistula. The A-V shunts are designed to supply blood for the dialysis process. Typically, hemodialysis needles are inserted into the A-V shunt during a hemodialysis session and the shunt must provide enough blood flow to allow the dialyzer to effectively perform blood purification. Web site: http://www.delphion.com/details?pn=US06746408__ •

Method of measuring dialysis or clearance of hemodialysis systems Inventor(s): Polaschegg; Hans-Dietrich (Koestenberg, AT) Assignee(s): Fresenius Medical Care Deutschland GmbH (DE) Patent Number: 6,702,774 Date filed: November 2, 2000 Abstract: A method for measurement of mass and energy transfer parameters (clearance and dialysance) in hemodialysis. A sensor is provided in the dialysate flow path downstream of the dialyzer and means are provided to add concentrate upstream of the dialyzer. A pre-determined amount of a substance whose dialysance is to be measured is added upstream of the dialyzer. The amount of substance riot dialyzed in the dialyzer is measured downstream of the dialyzer by said sensor by integrating the concentration over time. Dialysance is calculated from the amount added upstream, the amount measured downstream and the dialysate flow. In case the substance is part of the dialysate the base concentration is subtracted during integration. The addition of the concentrate upstream of the dialyzer can be done manually or, alternatively by the mixing pump of the dialysis machine. Instead of an increase of the concentration with a concentrate dilution with water can be used as well. Excerpt(s): Hemodialysis has developed into a life saving procedure for several hundred thousand patients worldwide. The economic costs have risen dramatically because it is a chronic treatment. To secure treatments for the growing number of patients in the industrial nations and to make treatment possible in emergent countries it is necessary to improve the quality of the method and reduce the costs. Optmization of the method influences costs significantly because a well-treated patient is less morbid and needs less care. In the USA, the NCDS (National Cooperative Dialysis Study) studied the morbidity of a large patient collective as a function of the dialysis dose. Gotch and Sargent (Kidney International 28, 526-534, 1985) found a simple interpretation for the results: The morbidity decreases from a high value to a low constant one when Kt/V increases from 0.8 to >=1. K is the effective clearance for urea, t is the treatment time and V is the total body water. The hypothesis that morbidity and mortality are related to Kt/V for urea has been corrobated for the uniform treatment market in the USA but not the interpretation by Sargent and Gotch. New data indicate that the mortality decreases further up to a Kt/V of 1.5. No reliable data are available for greater values because of lack of sufficient patient numbers (See: Parker Thomas F. Short-Time Dialysis Should Be Used Only With Great Caution. Seminars in Dialysis 1993;6:164-167; Hakim R M, Breyer J, Ismail N, Schulman G. Effects of dose of dialysis on morbidity and mortality. Am J Kidney Dis 1994; 23: 670-80 and others).

184

Hemodialysis

Web site: http://www.delphion.com/details?pn=US06702774__ •

Method to measure blood flow and recirculation in hemodialysis shunts Inventor(s): Krivitski; Nikolai M. (Ithaca, NY) Assignee(s): Transonic Systems, Inc. (Ithaca, NY) Patent Number: 6,514,419 Date filed: December 11, 2000 Abstract: The measurement of blood flow in a dialysis shunt is obtained by injection of an indicator material into a venous line leading from dialysis equipment to the shunt. The blood flow in an arterial line leading from the shunt at a location downstream of the venous line to the dialysis equipment is monitored by an arterial line sensor for the presence of the indicator material. A detector connected to the sensor provides a dilution curve in response to the presence of the indicator material and the blood flow in the shunt is calculated from the area under the dilution curve. The locations of the arterial and venous lines in the shunt can be reversed to obtain a measurement of blood recirculation from the venous line into the arterial line. Excerpt(s): The invention relates to the field of kidney dialysis processes and more particularly to such processes for measuring arterio-venous shunt blood flow and undesirable recirculation during hemodialysis. Dialysis is a process by which an artificial kidney replaces the function of a patient's kidney. Blood is removed from the patient's vascular system via an arterial line, is passed through a dialyzer and is returned to the patient via a venous line for normal circulation through the patient's vascular system. A majority of dialysis patients have an arterio-venous shunt implanted in a location having a high blood flow that simplifies the withdrawal of blood from the part that is closer to the arterial side of the shunt and the return of purified blood downstream of the withdrawal site, closer to venous side of the shunt. In some cases the shunt clots or stenoses and the resulting reduction in blood flow necessitates surgery that is costly and invasive for the patient. In the situation of low blood flow in the shunt or, if there is any other problem with the venous outflow, some part of the freshly dialyzed blood from the venous return line flows directly to the arterial withdrawal line where it is again filtered. If this undesired direct recirculation level is high enough, some amount of blood will be repeatedly refiltered and the rest of the patient's blood will not be sufficiently filtered to provide the patient with adequate dialysis. One method of measuring shunt blood flow currently uses color coded duplex sonography. This is very expensive and involves operation by highly-qualified professionals. Measurements are therefore made only rarely and the onset of reduced flow, when treatment could be made without surgery can be missed. Web site: http://www.delphion.com/details?pn=US06514419__

•

Methods of decreasing the effects of oxidative stress using N-acetylcysteine Inventor(s): Santangelo; Francesco (Milan, IT) Assignee(s): Zambon Group S.p.A. (Vicenza, IT) Patent Number: 6,627,659 Date filed: October 22, 2001

Patents 185

Abstract: The present invention relates to methods of decreasing the effects of oxidative stress in patients undergoing hemodialysis by intravenously administering Nacetylcysteine or a pharmaceutically acceptable salt thereof to the patient. Excerpt(s): This is a 371 of PCT/EP00/63485 filed Apr. 18, 2000. The present invention relates to the use of N-acetylcysteine for intravenous administration in dialysed patients to prevent oxidative stress, which is responsible for the onset of numerous diseases. The number of patients suffering from renal disease is constantly growing all over the world. The number of these patients starting with dialysis is growing too at a rate of 7-9% each year and it has been calculated that there will be more than 350,000 dialysed patients in the USA in 2010. Web site: http://www.delphion.com/details?pn=US06627659__ •

Patient weighing apparatus Inventor(s): Salgo; Peter (200 W. 60th St., Apt. 33A, New York, NY 10023) Assignee(s): none reported Patent Number: 6,396,004 Date filed: December 15, 2000 Abstract: An apparatus for weighing a patient while the patient remains in bed including at least one flexible potentiometer mounted on top of a bed or mattress having a known compliance, i.e. known degree of flexure for a given weight, and connected to an electrical system for detecting and measuring the resistance of the potentiometer, so as to indicate the weight of the patient. The flexible potentiometer may also be adhered to a sheet of plastic, such as Mylar, and placed upon the bed like a protective sheet for the bed. The apparatus may include a multiple of flexible potentiometers. Further, the device to which the flexible potentiometer is connected may be used to help control servo mechanisms in medication dispensing devices such as infusion pumps and/or hemodialysis machines (artificial kidneys). Excerpt(s): This invention relates to weighing patients in a hospital bed and particularly to a new arrangement for weighing sick patients. There are many medical conditions which may be treated more effectively than they are today if the weight of a patient having such a condition could be easily and continuously monitored without the need to either get the patient out of bed or weigh the bed separately from the patient for weighing with the patient in combination at a later time. The present weighing systems for bedridden patients in hospitals and/or long term care facilities include chairs and/or bulky slings coupled with scales in which a patient is moved from his/her bed for purposes of weighing. These systems are cumbersome and require a substantial amount of human intervention to operate. Many sick patients are too unstable to tolerate the amount of motion these systems require of them. Other present devices include a large scale upon which an empty bed is first weighed as a calibration followed by subsequent weighing of the patient/bed combination at a later time. A patient's weight is thus found by subtracting the initial bed weight from the combination total. Such a scale is expensive and thus represents a limited resource. These devices may not be suitable if a patient's stay in a facility extends over a prolonged period of time. Web site: http://www.delphion.com/details?pn=US06396004__

186

•

Hemodialysis

Pressure transmission apparatus Inventor(s): Myers; Jan Willem Marinus (Venlo, NL) Assignee(s): Filtertek Inc. (Hebron, IL) Patent Number: 6,506,237 Date filed: December 4, 2000 Abstract: An apparatus for the transmission of the pressure in the sterile area of a medical appliance, such as a hemodialysis appliance, to a non-sterile pressure gauge having two housing halves and a sterility filter positioned between the two housing halves. The housing half on the sterile side may be made of polycarbonate, and the nonsterile housing half may be made of a polymer, preferably a polyester/polyether copolymer, which provides an easily disconnectable and leak-proof connection with the pressure gauge. The two halves are ultrasonically welded together. Excerpt(s): The present invention relates to an apparatus for the transmission of the pressure in the sterile area of a medical appliance to a non-sterile pressure gauge. Pressure transmission apparatus of this kind, for example, are used in hemo-dialyzers, heart-lung-machines and similar medical appliances, in which a very accurate monitoring of the existing pressures in a sterile hose system is necessary, wherein simultaneously a sterilizing of the corresponding pressure gauges is not possible. Such pressure transmission apparatus has to be absolutely sealed and free of leakage to prevent the non-sterile air from gaining access into the sterile area of the medical appliances, or to prevent mistakes in the measuring of the pressure. Further, such pressure transmission apparatus should have a so-called "Luer-Lock"-connector on the non-sterile side, preferably consisting of a polyester/polyether-copolymer to provide an easily disconnectable but simultaneously absolutely leak-proof connection with the corresponding stainless steel connectors of the pressure gauges in the medical appliance. Prior art pressure transmission apparatus of this kind was constructed such that the housing consisted of a sterile half of polycarbonate having a hose connector and a nonsterile half, wherein between these two halves there was positioned a backing of polytetrafluorethylene carrying a polyfluorethylene sheet for the pressure transmission while simultaneously assuring the absolute impermeability. The corresponding "LuerLock"-connector on the non-sterile side had to be injection molded in a separate injection molding apparatus when producing the non-sterile side half of the housing. The expert in the art was of the opinion that this kind of production cannot be avoided because the expert had the prejudice that an absolutely sealed and leak-free connection between a part consisting of polyester-polyether-copolymer and a part consisting of polycarbonate was only possible by the cumbersome co-injection molding method, and was not possible by ultrasonic welding. Further, a completely sealed fixing of the backing carrying the polytetrafluorethylene sheet was only believed to be possible between two housing halves consisting of polycarbonate because of the fact that the polyester/polyether-copolymer was too soft for this purpose. Web site: http://www.delphion.com/details?pn=US06506237__

Patents 187

•

Process and device for determining the pulse transit time and extracorporeal hemotherapeutic arrangement with such a device Inventor(s): Zhang; Wei (Schweinfurt, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,527,728 Date filed: October 19, 2001 Abstract: A process and a device for improving the determination of the pulse transit time for non-invasive blood pressure measurement. A value, correlating with the blood density, is determined and its influence on the pulse transit time is compensated. In this manner more precise blood pressure data can be obtained. In a further development, a value, correlating with the blood density, is determined by a measuring device for the change in relative blood volume or hematocrit. The device can also be used as part of a hemotherapeutic arrangement such as a hemodialysis device and/or hemofiltration device, in which a blood pressure monitoring as continuous and precise as possible is desired, among other things, because of a blood volume change and thereby a blood density change inherent in the therapy. Excerpt(s): The invention relates to the field of determining the pulse transit time of a patient or donor where a pulse transit time is measured for pulse waves propagating via the patient's or donor's vascular system and created by his/her heart contractions. A patient's or donor's blood pressure is typically measured by means of an inflatable rubber cuff according to the Riva-Rocci method. This method allows a measurement only at a defined time, at which the pressure of the cuff is varied over a certain period of time. Thus, continuous measurement is limited to time intervals that are determined by the measuring method. A quasi continuous measurement would be associated with a constantly alternating expansion and deflation of the rubber cuff, which would be accompanied by unreasonable stress on the patient. As an alternative to the noninvasive Riva-Rocci method, there exists a method for determining the pulse transit time, which can also be carried out non-invasively. This method is based on the knowledge that the time that a pulse wave, produced by a heart contraction of a patient or donor, requires to make its way through the vascular system from a first point to a second place is a function of the blood pressure of the person examined. If the time is measured that passes between the occurrence of a heartbeat (detected, for example, by means of an electrocardiograph (EKG)) and the time of arrival of the related pulse wave at an area of the body at a distance from the heart (detected, for example, by an optical sensor on the ear lobe or finger), this pulse transit time represents a direct measure of the patient's or donor's blood pressure. Since the pulse transit time varies from person to person, a calibration by means of an initial Riva-Rocci measurement is necessary. However, a statement on relative changes can be obtained directly from the relative changes in the pulse transit time. The relation between the blood pressure and the pulse transit time is largely linear (Psychophysiology, Vol. 3,86 (1976)). Since one measurement is possible per heart beat, this measuring method represents a semicontinuous blood pressure measurement. Web site: http://www.delphion.com/details?pn=US06527728__

188

•

Hemodialysis

Single light sensor optical probe for monitoring blood parameters and cardiovascular measurements Inventor(s): Krivitski; Nikolai M. (Ithaca, NY), Starostin; Dimitry (Ithaca, NY) Assignee(s): Transonic Systems, Inc. (Ithaca, NY) Patent Number: 6,493,567 Date filed: March 20, 2000 Abstract: A method and device for the continuous real-time monitoring of relative blood volume change, based on registration of blood hemoglobin concentration, during long periods of time, such as dialysis session. A method and device for cardiac output measurement, based on optical dilution technique, during dialysis, surgeries, intensive care procedure. The effects of blood electrolyte composition change which result in a change of light beam geometry are eliminated by the relative orientation between a light source and a single light or photodetector. An illumination axis and a detection axis are oriented in an offset, non collinear configuration at a sufficient angle to substantially eliminate the scattering properties of the blood. A primary implementation of the device is extracorporeal paths, such as hemodialysis tubing systems, artery-vein extracorporeal artificial shunts, other extracorporeal systems. It also may be applied to vessels, tissues or to body parts being capable of transillumination. Excerpt(s): The present invention relates to the photometric analysis of blood properties to monitor changes in blood volume, blood proteins concentration, cardiac output and other hemodynamic parameters. More particularly, the invention includes a method and apparatus for employing a single light emitter and a single photodetector, the single photodetector is oriented with respect to the emitter to minimize a scattering effect of the light from the electrolyte composition of the blood, blood flow rate, blood hematocrit level and other factors. The optical density of blood corresponds to a number of factors and the measurement of the optical density of the blood has been used to determine certain blood parameters. For example, during a hemodialysis session when fluid is being removed from the blood stream by a dialyzing machine, the concentration of hemoglobin, naturally occurring in the red blood cells, may decrease or, generally increase, with respect to the equilibrium processes of the fluid removal and mobilization from the body tissues. The change in the concentration of hemoglobin results in a corresponding change in the optical density of the blood and may be registered. Web site: http://www.delphion.com/details?pn=US06493567__

•

Solid pharmaceutical preparation for dialysis and a process for producing the same Inventor(s): Harada; Kazuyoshi (Osaka, JP), Kobira; Seigo (Osaka, JP) Assignee(s): Nipro Corporation (Osaka, JP) Patent Number: 6,489,301 Date filed: June 6, 2000 Abstract: There is provided a solid pharmaceutical preparation for dialysis consisting of one composition, which is excellent in uniformity of the ingredients contained therein, is capable of preventing not only a reaction between sodium bicarbonate and a solid organic acid or between sodium bicarbonate and electrolytes but also a reaction between a solid organic acid and sodium acetate, and does not require further pulverization of the respective ingredients in the dialysis composition. The solid pharmaceutical

Patents 189

preparation for dialysis containing an electrolyte for hemodialysis, a solid organic acid and glucose is characterized by a plurality of layers separated from each other on the surface of a nucleating particle of sodium chloride, wherein the plurality of separated layers include a layer (A) comprising sodium acetate but not containing the solid organic acid, a layer (B) comprising the solid organic acid but not containing sodium acetate, and a layer (C) comprising sodium bicarbonate. Excerpt(s): The present invention relates to a solid pharmaceutical preparation for dialysis and, more particularly, to a solid dialysate concentrate for preparing a dialysis solution containing sodium hydrogencarbonate and a process for producing the same. When hemodialysis is carried out for a patient suffering from weakened hepatic function, the blood of the patient is cleaned in an artificial kidney. Generally, a dialysis solution is perfused in this artificial kidney and contacted via a dialysis membrane with the blood of the patient so that wastes in the blood are transferred to the dialysis solution. As this dialysis solution, an acetate dialysis solution has been used widely but has recently been substituted with a dialysis solution containing sodium hydrogencarbonate (i.e., sodium bicarbonate) drastically reducing unpleasant symptoms during dialysis. The dialysis solution containing sodium bicarbonate is usually prepared from two kinds of dialysis solution, that is, a pharmaceutical preparation (referred to hereinafter as composition A) containing electrolytes (e.g. sodium chloride, potassium chloride, calcium chloride, magnesium chloride, and sodium acetate) and a pH adjusting agent (e.g., acetic acid) and a pharmaceutical preparation (referred to hereinafter as composition B) containing sodium bicarbonate. These dialysis solutions may contain sugars such as glucose or may be mixed with another pharmaceutical preparation containing sugars. Web site: http://www.delphion.com/details?pn=US06489301__ •

Solution, in particular for hemodialysis or peritoneal dialysis and a method of preparing same Inventor(s): Knerr; Thomas (St. Wendel, DE) Assignee(s): Fresenius Medical Care Deutschland (Bad Homburg, DE) Patent Number: 6,689,393 Date filed: March 22, 2000 Abstract: A solution, in particular for hemodialysis or peritoneal dialysis that permits attaining a desired glucose concentration without affecting the concentrations of other components in the solution. The solution consists of at least three individual solutions that are combined and administered after heat sterilization. The first solution contains calcium ions, electrolyte salts and optionally glucose in a concentration of 0-1000 mM and is acidified to a pH of less than 4.0 with a physiologically tolerable acid. The second solution contains glucose in a concentration different from that of the first solution and the remaining components of the first solution in the same concentration. The third solution contains a buffer in the physiological range. Also provided is a method of preparing a solution according to the invention, where the desired mixing ratio of the separate solutions is automatically established by a dialysis machine or peritoneal dialysis cycler. Excerpt(s): The present invention relates to a solution, in particular for hemodialysis or peritoneal dialysis and a method for preparing same. The most important functional components of hemodialysis or peritoneal dialysis solutions are electrolytes which

190

Hemodialysis

preferably include calcium ions, sodium ions, magnesium ions and chloride ions, a buffer system, and a suitable osmotic medium. A bicarbonate buffer having the advantage of good physiological tolerability is generally used as the buffer system, but depending on the pH of the solution, it is partially in carbonate form in an alkaline medium and in equilibrium with CO2 in an acidic range. In addition to bicarbonate, other buffers can also be used, providing they have sufficient buffering effect in the physiological pH range of approximately 7. Suitable buffers include lactate and pyruvate, which can be degraded easily to bicarbonate in the body. Web site: http://www.delphion.com/details?pn=US06689393__ •

System and method for determining blood flow rate in a vessel Inventor(s): Messana; Joseph M. (Ann Arbor, MI), Rubin; Jonathan M. (Ann Arbor, MI), Weitzel; William F. (Ypsilanti, MI) Assignee(s): The Regents of the University of Michigan (Ann Arbor, MI) Patent Number: 6,575,927 Date filed: May 12, 1999 Abstract: A system and method are provided for determining the performance of a vessel, such as a hemodialysis access, which communicates blood between two locations of a patient. A conduit, such as an external dialysis circuit or an intravascular catheter, is provided in fluid communication with the vessel, and has a diversion point for diverting blood from the vessel into the conduit. The system further includes means for determining a flow rate of the diverted blood through the conduit. A first sensor in communication with the vessel generates at least one signal that is a function of a blood flow rate in the vessel downstream from the diversion point, wherein the downstream flow rate depends on the determined conduit flow rate and the performance of the vessel can be determined based on the signal. In addition, a processor can be provided in communication with the first sensor for determining a flow rate in the vessel upstream from the diversion point from the signal and the conduit flow rate. In a preferred embodiment, the first sensor is an ultrasonic sensor, and the at least one signal represents a time-averaged mean Doppler velocity of blood flow. Still further, additional sensors may be employed to provide a measure of the upstream flow rate as well as the conduit flow rate. Excerpt(s): This invention relates to the field of hemodynamics, and more particularly to a system and method for measuring blood flow rate in a vessel, such as a hemodialysis access. Hemodialysis is a process by which blood is passed through an external dialysis circuit to replace the function of a patient's kidney. Blood is removed from the patient's vascular system via an arterial line, is passed through a dialysis filter, and is returned to the patient via a venous line. In order to simplify the withdrawal and return of blood, many dialysis patients have an arteriovenous shunt, or access, surgically created between an artery and vein in a location in the body, such as the upper or lower arm. The access provides a permanent site where the arterial line and venous line can be connected to the patient. A vascular access may be constructed from a native arteriovenous fistula, which is a direct connection of a patient's artery to one of his/her veins, or alternatively may be constructed from a synthetic material, typically polytetrafluoroethylene (PTFE). While a permanent vascular access provides a convenient connection site for arterial and venous lines, malfunction of such an access is a frequent occurrence in patients receiving chronic hemodialysis. Specifically, unpredictable thrombosis and stenosis in an access causes a reduction in blood flow

Patents 191

which necessitates correction through angioplasty or other surgical means. If untreated, low blood flow can cause undesired recirculation in the access, where some part of the freshly dialyzed blood from the venous line flows upstream to the arterial line where it is again filtered. Studies have shown that decreased hemodialysis access flow is associated with an increased risk of access thrombosis and stenosis, such that early detection of an access with a low flow rate is essential in order to prevent more serious complications (see May et al., Kidney Int. 52: 1656-1662, 1997). Web site: http://www.delphion.com/details?pn=US06575927__ •

System and method for noninvasive hemodynamic measurements in hemodialysis shunts Inventor(s): Miller; David R. (Morgan, UT), Steuer; Robert R. (Pleasant View, UT) Assignee(s): In-Line Diagnostics Corporation (Riverdale, UT) Patent Number: 6,582,656 Date filed: March 28, 2000 Abstract: Access recirculation in a shunt is determined quantitatively by a method in which a standard solution, such as a saline, is injected into a patient's bloodstream upstream of the shunt. At a point in the access line, a photometric measurement is conducted of the change in hematocrit (.DELTA.H) with respect to time. Electronic circuitry receives signals from the detector and compares the integrated area of.DELTA.H with respect to time of the standard solution initially flowing through the access and of the recirculated solution and provides display of access recirculation. In another aspect, access recirculation and access blood flow are quantitatively determined without injecting a solution into the bloodstream. In this aspect the extent of access recirculation and/or access blood flow is determined quantitatively by a method in which the dialyzer blood flow rate or the ultrafiltration rate (UFR) is changed and the corresponding change in concentration of a blood constituent is measured. In this technique, the concentration of a blood constituent is measured as a function of dialyzer blood flow rate or UFR and electronic circuitry converts these measurements into quantitative determinations of access recirculation and/or access blood flow that can be displayed. Excerpt(s): This invention relates to systems and methods for noninvasively measuring hemodynamic access, access recirculation and blood flow measurements during hemodialysis. More particularly, the present invention relates to noninvasive spectrophotometric systems and methods for quantitatively measuring the shunt (access) recirculation, the access blood flow rate, the dialysis machine blood flow rate and the volumes of priming fluids required by the hemodialysis tubing lines. Modern medical practice utilizes a number of procedures and indicators to assess a patient's condition especially in the dialysis setting. Hemodialysis is a process wherein an artificial kidney is required to function in the place of the patient's normal kidney in order to remove certain biologic waste products. When the human kidney no longer functions correctly removing waste products such as urea, potassium, and even excess water, blood must be removed from the patient via blood tubing lines and filtered through an artificial kidney or dialyzer. In this process blood is passed through the dialyzer, cleansed, then returned to the normal circulatory system of the patient. Access to the patient's circulatory system is achieved through the use of a surgically implanted shunt or fistula. This "access site" is typically located in the arm, leg, or neck of the patient. Typically needles are placed into this "access" in such a way as to facilitate the

192

Hemodialysis

easy removal of blood on the "arterial" or upstream side of the dialyzer and typically return the purified blood downstream of the first needle placement on the "venous" side. Unfortunately, in many cases the fistula, or shunt, will clot or "stenos" over time. This results in decreased blood flow through the access which ultimately necessitates either angioplasty or a surgical replacement of the shunt. As the shunt ceases or "clots off" part of the purified dialyzed blood is forced to flow back into the arterial withdrawal site and, hence, recirculates only to be dialyzed again; this is termed "access recirculation". As this recirculation of purified blood continues, the rest of the patient's circulating blood is not adequately cleansed and, hence, an inadequate delivery of the dialysis dosage is provided to the patient. 3) The dialyzer blood flow rate itself. Web site: http://www.delphion.com/details?pn=US06582656__ •

Thermally enhanced dialysis/diafiltration system Inventor(s): Collins; Gregory R. (Monroe, NY), Spence; Edward (Bronx, NY), Summerton; James (Park Ridge, NJ) Assignee(s): Nephros, Inc. (New York, NY) Patent Number: 6,716,356 Date filed: December 6, 2001 Abstract: The present invention provides a hemodialysis or hemodiafiltration system and method using two dialyzer stages (122, 138), wherein the temperature of a dialysate fluid stream of the first cartridge (122) is increased such that the blood in the first cartridge (122) is dialyzed or diafiltered at an elevated temperature, while blood in the second cartridge (138) is dialyzed or diafiltered against a dialysate stream at normal blood temperature. This results in an increased solute diffusivity and a corresponding increase in removal of blood substances by diffusion. When diafiltration is performed, an additional removal of substances occurs by convection as a larger portion of plasma water from a blood compartment (142) can be filtered across a semi-permeable membrance (140) at the same transmembrane pressure due to the reduced viscosity of the heated blood and plasma water. Excerpt(s): This invention relates to dialysis and hemodiafiltration in general and, more particularly, to improved hemodiafiltration methods and devices for removal of blood toxins. Hemodialysis and Hemodiafiltration are well known methods for removing toxic substances from a patient's blood, thereby reducing the level of toxins in the patient's blood as part of an extracorporeal blood cleansing system. Both these methods are based on flowing blood through a cartridge containing a semi-permeable membrane which separates the cartridge into two compartments. In general, hemodialysis is a process whereby blood flows through a blood-side compartment of the cartridge, while a cleansing solution, i.e., a dialysate solution, flows through a dialysate-side compartment of the cartridge. Toxins are removed from the blood by diffusion across the semipermeable membrane from the blood-side compartment to the dialysate-side compartment. The rate of diffusion is determined by the concentration gradient established between a higher concentration of toxins in the blood relative to the dialysate fluid. Hemodiafiltration is process whereby the normal removal of toxins by diffusion is augmented by a convective flow of plasma water across the semi-permeable membrane which assists in carrying toxins by bulk flow of fluid from the bloodside of the membrane to the dialysate side of the membrane. The transportation of plasma water across the semi-permeable membrane is achieved by establishing a pressure gradient, generally referred to as Transmembrane Pressure (TMP), across the

Patents 193

membrane. In hemodiafiltration, an equivalent amount of a substitution fluid, or replacement fluid, must be added to the blood to replace the plasma water that is filtered across the membrane. This substitution fluid is generally added either before the blood enters the cartridge (pre-dilution mode) or after the blood exits the cartridge (post-dilution mode). Hemodiafiltration systems using two cartridges connected in series are also known in the art. In such systems, a first cartridge is used as a conventional diafiltration cartridge providing simultaneous diffusion and filtration of plasma water across the semi-permeable membrane. In a second cartridge, toxins are diffused from the blood to the dialysate fluid, and a reverse pressure gradient is used to reverse-filter dialysate fluid from the dialysate-side compartment, across the membrane, and into the blood-side compartment. The reverse-filtered dialysate fluid serves as a substitution fluid to replace the amount of plasma water that filtered from the bloodside compartment to the dialysate-side compartment in the first cartridge. Such a method is described in J. H. Miller et al., "Technical Aspects of High-Flux Hemodiafiltration for Adequate Short (Under 2 Hours) Treatment," Transactions of American Society of Artificial Internal Organs (1984), pp. 377-380. Web site: http://www.delphion.com/details?pn=US06716356__ •

Transducer protection device, particularly for hemodialysis processes Inventor(s): Scagliarini; Massimo (Bologna, IT) Assignee(s): GVS S.r.l. (Zola Predosa, IT) Patent Number: 6,536,278 Date filed: May 8, 2000 Abstract: A transducer protection device, particularly for hemodialysis processes, which comprises a first element and a second element made of plastics which are coupled coaxially with respect to a common axis and respectively comprise a first tubular connector and a second tubular connector which are blended with respective flanges which are coaxial to the common axis; the flanges are coupled to each other along their peripheral region by ultrasonic thermal bonding; the device has a recess formed frontally on a first one of the flanges, the recess being coaxial to the common axis and being suitable for accommodating, in a fixed arrangement, a semipermeable membrane by imbibition of melted plastics along a circular border region by the thermal bonding provided on a circular ridge which is shaped complementarily to the border region and protrudes frontally from the second flange so as to achieve bonding between the first and second flanges and the membrane. Excerpt(s): The present invention relates to a transducer protection device, particularly for hemodialysis processes, suitable for measuring the blood pressure in the patient during hemodialysis. It is known that in this field one of the strongly felt problems is to prevent the blood pressure measurement device from becoming infected by any virus present in a patient which may be transmitted to a subsequent patient, to operators and even to the entire hemodialysis machine. In particular, it has been found that the protective devices currently in use consist of elements which, through ducts, are connected at one end to a main duct, which connects the patient to the hemodialysis machine, and at the other end to another duct which leads to a blood pressure measurement device. Said elements comprise two tubular connectors made of plastics being connected to the ducts. The two tubular connectors blend with two respective circular flanges between which, during sealing, a membrane of semipermeable material is interposed, which is suitable for retaining the liquids and/or the viruses present in

194

Hemodialysis

said liquids. The membrane covers the entire circular surface of the two flanges and is fixed thereon during the sealing/gluing of the flanges. Web site: http://www.delphion.com/details?pn=US06536278__ •

Use of citrate-containing dialysate for renal dialysis treatment Inventor(s): Warnock; David G. (Birmingham, AL) Assignee(s): UAB Research Foundation (Birmingham, AL) Patent Number: 6,566,402 Date filed: May 23, 2001 Abstract: The present invention describes trisodium citrate-containing dialysates and production thereof. Also described are the applications of such dialysates as regional anticoagulants during hemodialysis and all modes of continuous renal replacement therapy which utilize any form of dialysis. Excerpt(s): The present invention relates generally to the field of medical therapy of renal disease. More specifically, the present invention relates to the use of trisodium citrate-containing dialysate solutions during hemodialysis and continuous renal replacement therapy, wherein trisodium citrate functions as a regional anticoagulant. Continuous arteriovenous hemodialysis (CAVHD) and other forms of continuous renal replacement therapy (CRRT) are being used increasingly as the major form of renal replacement therapy for critically ill patients with acute renal failure (ARF). Generally, the procedure has required systemic anticoagulation utilizing heparin or, in a few cases, prostacyclin to maintain filter patency. Although heparin is removed by continuous arteriovenous hemodialysis membranes, systemic anticoagulation is usually unavoidable with heparin and has been associated with an increased incidence of bleeding. In order to circumvent this problem, regional heparin anticoagulation has been tried, but this has not gained widespread acceptance due to the difficulty in accurately adjusting protamine doses. Similarly, continuous arteriovenous hemodialysis has been attempted with frequent saline flushes through the filter, but it has been difficult to keep the filter patent for longer than 24 hours. U.S. Pat. No. 5,032,615 describes a technique employing sodium citrate as a regional anticoagulant for continuous arteriovenous hemodialysis (citrate CAVHD) which results in removal of excess water, electrolytes and catabolic toxins without requiring systemic anticoagulation. Citrate is infused at the origin of the extracorporeal circuit, and the citrate-calcium chelate is removed by diffusion across the membrane. The metabolic consequences of the sodium citrate load are compensated for by the use of a special dialysate containing no alkali, subnormal sodium concentration, and no calcium. Calcium homeostasis is restored by a peripheral infusion of calcium chloride into the patient. Web site: http://www.delphion.com/details?pn=US06566402__

Patents 195

•

Vascular access sheath Inventor(s): Lawrence; William K. (4711 Sunningdale Dr., Belden, MS 38826) Assignee(s): none reported Patent Number: 6,508,790 Date filed: October 6, 2000 Abstract: A permanent or semipermanent hemodialysis access sheath that is placed in a central vein, secured and left in place for easy access by a removable hemodialysis catheter. The hemodialysis catheter has an adapter which secures the catheter to the sheath temporarily permitting the easy removal and replacement of the catheter as needed. The sheath has a side tube with a rotating flush valve. The sheath has a threaded opening which may be engaged by a threaded hub on the hemodialysis catheter for temporaraily securing the catheter to the sheath. Excerpt(s): The present invention relates to a permanent or semipermanent hemodialysis access sheath and an adapter for a hemodialysis catheter. Hemodialysis is a procedure for removing metabolic waste products or toxic substances from the bloodstream by dialysis. Dialysis, in terms of hemofiltration, is the process of separating elements in a solution by convective transport of solute through ultrafiltration across a semipermeable membrane down a concentration gradient. Convective solute transport depends on the movement of dissolved substances concomitant with fluid flow through a filtering membrane. Hemodialysis requires extracorporeal circulation of the blood. Blood is removed from the patient via a suitable access and pumped to the membrane unit. Dialyzed blood is returned to the patient through tubing that incorporates an air embolus protector. Web site: http://www.delphion.com/details?pn=US06508790__

Patent Applications on Hemodialysis As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to hemodialysis: •

Amino acid composition for hemodialysis Inventor(s): Drauz, Karlheinz; (Freigericht, DE), Gruenert, Adolf; (Ulm, DE), Kleophas, Werner; (Duesseldorf, DE), Knaup, Guenter; (Bruchkoebel, DE), Richet, Gerard; (SaintQuentin, FR) Correspondence: Oblon Spivak Mcclelland Maier & Neustadt PC; Fourth Floor; 1755 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020144946 Date filed: January 26, 2001 Abstract: An amino acid composition suitable for hemodialysis and a dialysis solution that can be prepared from the amino acid mixture. When the inventive amino acid

9

This has been a common practice outside the United States prior to December 2000.

196

Hemodialysis

composition is used for this purpose, the "shrinking men" phenomenon can be prevented. Also provides are a hemodialysis process and apparatus. Excerpt(s): The present invention relates to a special amino acid mixture and dialysis solution for hemodialysis. The use of the amino acid mixture for preparing a solution suitable for hemodialysis is also set forth. The present invention also relates to a method and an apparatus for hemodialysis. Patients who suffer from impaired kidney function, or who do not even have kidneys, need the assistance of an external blood-purification system to purify the blood of toxic metabolic products. In such cases, peritoneal dialysis and hemodialysis have proved to be the methods of choice. Heretofore, however, neither form of dialysis has completely made up for the lack of kidney function. In the case of hemodialysis, for example, a phenomenon known commonly as "shrinking man" becomes evident after prolonged treatment. This syndrome is blamed substantially on a protein-deficient nutritional condition. This deficiency condition has several causes, such as protein and energy metabolism disorders, hormonal imbalance and poor nutrient intake, and in the case of dialysis patients is greatly exacerbated by the net loss of amino acids from the plasma during dialysis, thus depriving the body of its needs for normal functioning. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and methods for preventing or treating failure of hemodialysis vascular access and other vascular grafts Inventor(s): Iyer, Sriram S.; (New York, NY), Kipshidze, Nicholas N.; (New York, NY), Nikolaychik, Victor V.; (Mequon, WI) Correspondence: Michael Best & Friedrich Llp; One South Pinckney Street; P.O. Box 1806; Madison; WI; 53701-1806; US Patent Application Number: 20030113359 Date filed: January 16, 2002 Abstract: This invention is a prosthetic device generally placed on the outside surface of the vessel or graft which then elutes antiproliferative drugs or agents from a drugeluting matrix material. Methods of perivascular antiproliferative drug administration also are disclosed. Excerpt(s): Failure of hemodialysis vascular access and other vascular grafts becomes evident as compromise of the lumen of the native vessel (vein or artery) or of the prosthetic conduit at or away from the anastamotic site. Compromise of the lumen manifests as either stenosis or occlusion and is a result of either intraluminal thrombus and/or a vasculoproliferative response. The etiology of graft failures may be related to a variety of physical (e.g., shear stress causing hemodynamic disturbance), chemical and/or biological stimuli as well as infection and foreign body rejection which may explain why fistulae which do not involve a foreign body (in this case, for example, polytetrafluroethylene, PTFE) remain patent for a longer time compared to vascular access grafts that involve interposition of a PTFE graft. The present invention relates generally to therapeutic implant, apparatus and methods useful for preventing, suppressing (inhibiting) or treating failure of hemodialysis vascular access and other vascular grafts. Vascular access grafts, specifically, hemodialysis access grafts are well known to the art. Approximately 100,000 vascular access procedures are performed yearly in the United States. Hemodialysis vascular access can be constructed in one of several ways: as an arterio-venous fistula (e.g.; Brecisa-Cimino), or as a graft,

Patents 197

interposing either prosthetic (e.g., PTFE) or biologic tissue (e.g., vein) between the artery and the vein. Such grafts are usually constructed using a tubular or cylindrical segment of suitably bio-compatible, substantially inert material such as polytetrafluoroethylene (PTFE). In fact, PTFE is the most common material used for prosthetic dialysis access. In one approach, a segment of PTFE is surgically interposed between an artery and a vein in the arm, forearm or thigh. The graft is then available for repeated vascular access for performing hemodialysis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus for measuring amount of hemodialysis Inventor(s): Park, Han Chul; (Kwangju, KR) Correspondence: Jacobson, Price, Holman & Stern; Professional Limited Liability Company; 400 Seventh STREET. N.W.; Washington; DC; 20004; US Patent Application Number: 20030031590 Date filed: August 10, 2001 Abstract: An apparatus for measuring an amount of hemodialysis is disclosed. The apparatus comprises a rotation detecting unit for detecting the number of rotations of a dialysis blood pump, the pump being rotated to pump blood; a counting unit for counting the number of rotations of the dialysis blood pump by receiving a rotation detecting signal from the rotation detecting unit; and a display unit for displaying a value counted by the counting unit to determine the entire amount of hemodialysis based on the amount of hemodialysis per unit rotation of the dialysis blood pump. Excerpt(s): The present invention relates to an appratus for measuring an amount of hemodialysis dose, and more particularly, to an appratus capable of easily determining an amount of hemodialysis dose. The use of hemodialysis is to treat kidney failure patients by removing biological wastes accumulted in those patients through an artificial kidney dialyser. In case that human kidneys cannot carry out the function of removing wastes normally produced in the body, such as urea, creatinine, potassium, sodium, water, and the like, the life of the patients may be threatended to death. One of the ways of removing those substances and supplying depleted substances, such as bicarbonate, is hemodialysis treatment. The key part of hemodialysis system is the artificial kidney dialyser which contains semipermeable membrane. On one side of the membrane, blood from the patient flows and on the other side, dialysate, which is equvalent to an ideal body fluid, flows. Through the membrane pores substances are exchanged by diffusion and convection. The blood-side of the membrane is connected from and to the patient by tubings, and the dialysate-side, from and to the dialysate supplyer equipment. In order to assure measured amount of blood flow, a rotating blood pump is placed on the tube from the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

198

•

Hemodialysis

Arterio-venous shunt graft Inventor(s): Henderson, Jamie S.; (Oakland, NJ), Joeckel, Warren A.; (Wayne, NJ), Rakos, Ronald; (Neshanic Station, NJ) Correspondence: Ludomir A. Budzyn; Hoffman & Baron, Llp; 6900 Jericho Turnpike; Syosset; NY; 11791; US Patent Application Number: 20030100859 Date filed: November 27, 2001 Abstract: A graft, for example, an arterio-venous shunt graft, is provided, which in a first aspect of the subject invention, is formed with longitudinal ribs. With fibrotic tissue ingrowth between the ribs, a composite rib/tissue layer is formed about the graft. The ribs provide counteracting lateral force against the embedded tissue to seal punctures formed therethrough during hemodialysis procedures. To provide additional surface area for puncturing, the graft may be formed with a truncated cross-section. With a second aspect of the invention, the graft is mounted onto a strip to prevent kinking, twisting or bending during an implantation procedure. Excerpt(s): This invention relates to implantable prostheses, and, more particularly, to arterio-venous (AV) shunt grafts for hemodialysis applications. Patients suffering from renal failure who undergo hemodialysis treatment require their blood to be readily accessible for such treatment. To avoid repeated puncturing of blood vessels, a technique has been developed in the prior art, wherein a graft is implanted that acts as a shunt between an artery and a vein, such graft being aptly referred to as an arteriovenous (AV) shunt graft. Typically, the AV graft is of relatively long length to provide maximum length for needle puncturing. Because of the relatively long length, the AV graft typically has a longer length than the spacing between the relevant artery and vein, and, as such, is often bent into a U-shape. For implantation, two relatively shallow channels are subcutaneously "tunneled" into the necessary U-shaped pattern, with a tunneller or guidewire being used to draw the AV graft into proper position. The ends of the graft are sutured, or are otherwise connected to, the selected artery and vein. To limit the amount of blood diverted through the AV graft, and away from artery, the AV graft may have a tapered end at its arterial connection. In this manner, blood flow through the AV graft is restricted, without sacrificing surface area for needle puncture sites. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Concurrent dialysate purification cartridge Inventor(s): De Paolis, Potito U.; (Los Angeles, CA), Salehmoghaddam, Saleh; (Los Angeles, CA) Correspondence: Oppenheimer; Oppenheimer Wolff & Donnelly Llp; Suite 3800; 2029 Century Park East; Los Angeles; CA; 90067; US Patent Application Number: 20040099593 Date filed: November 25, 2002 Abstract: The present invention discloses a new concurrent dialysate cartridge purification system for hemodialysis, particularly, a purification system whereby apatite and/or calcium phosphate and sodium polyphosphate are substituted for the standard zirconium oxide and zirconium phosphate, respectively. The concurrent

Patents 199

dialysate cartridge purification system is comprised of multiple layers and at least one or more cation and/or anion exchange layer and at least one or more purification layer. One advantage of the concurrent dialysate cartridge purification system is the cost effectiveness of apatite and/or calcium phosphate and sodium polyphosphate. Excerpt(s): This invention relates generally to a dialysate purification cartridge for use in a hemodialysis system. In one aspect, the present invention identifies and describes a dialysate system of anion exchange layers comprised of apatite and/or calcium phosphate. In another aspect, the present invention describes a dialysate system of cation exchange layers using sodium polyphosphate. Still in another aspect, the present invention identifies and describes a dialysate system of phosphate binding layer using calcium acetate and calcium carbonate. Still in another aspect, the present invention describes a concurrent dialysate system comprising of one or more layers of the above. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device for detecting the presence of chlorine, hypochlorites and other sterilizing products in hemodialysis machines Inventor(s): Rossi, Vincenzo; (Calderara Di Reno, IT) Correspondence: Ostrolenk Faber Gerb & Soffen; 1180 Avenue OF The Americas; New York; NY; 100368403 Patent Application Number: 20030103874 Date filed: October 18, 2002 Abstract: A device for detecting the presence of chlorine in a fluid channeled along a conduit forming part of a hemodialysis machine, the device having:a photoemitting diode for emitting a light beam;a photoreceiving diode for at least partly receiving the light beam emitted by the photoemitting diode;the conduit being at least partly transparent to the light beam;and also having an electronic central control unit for measuring transmittance in the fluid channeled along the conduit, so as to determine the chlorine content of the fluid on the basis of the transmittance value. The device may be used, in particular, on a dialysis machine. Excerpt(s): The present invention relates to a device for detecting the presence of chlorine in a fluid channeled along a conduit forming part of a hemodialysis machine. The present invention also relates to a dialysis machine comprising at least one device for detecting the presence of chlorine in at least one portion of the dialysis circuit. Though frequent reference is made herein to the use of such a device in a dialysis machine, it is understood that it may be used in any purification system employing, in particular, hypochlorite, as for example a swimming-pool water purification system. In addition to hypochlorite, the device according to the present invention also provides for detecting the presence of any sterilizing agent. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

200

•

Hemodialysis

Devices, systems, and methods for subcutaneously placing an article Inventor(s): Ross, John R.; (Bamberg, SC), Tobul, James R.; (Bamberg, SC) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030125789 Date filed: December 4, 2001 Abstract: The present invention provides devices, systems, and methods for positioning an article, such as a graft or catheter, in a subcutaneous tunnel between skin and muscle tissue of a patient to establish improved access to the patient's vascular system for hemodialysis, hemofiltration, or other extracorporeal blood treatments. In particular, the present invention provides devices, systems, and methods which minimize longitudinal forces or friction acting against the vascular graft as it is being subcutaneously positioned while still providing a tight seal between the graft and the subcutaneous tissue, which in turn minimizes hematomas, bleeding, and infections and enhances needle accessibility of the graft for extracorporeal treatment. A system for subcutaneously positioning an article comprises a tunneling tool, a pair of nested tubes coupleable to a trailing end of the tunneling tool, and a flexible article which can be slidably received within the pair of nested tubes. The nested tubes each have a leading end, a trailing end, and a longitudinal opening. Excerpt(s): The present invention relates generally to medical devices, systems, and methods. More particularly, the present invention provides devices, systems, and methods for positioning an article, such as a graft or catheter, in a subcutaneous tunnel between skin and muscle tissue of a patient to establish improved access to the patient's vascular system for hemodialysis, hemofiltration, or other extracorporeal blood treatments. Significant attention has been focused on the specific needs of vascular access for hemodialysis. Hemodialysis is generally the only treatment alternative for patients unable to receive a kidney transplant due to medical conditions, age, or absence of a donor. Hemodialysis, in part, takes up the excretory role of the kidney by drawing blood from the arterial system into a membrane separation device outside of the body, which transfers noxious substances from the blood into dialysate for disposal and returns the cleansed blood into the venous system of the patient. Hemodialysis and other extracorporeal treatment regimens that are repeated periodically, often for the lifetime of the patient, regularly utilize vascular grafts or catheters to improve blood flow characteristics. Vascular grafts, such as the Perma-Seal.TM. graft available from Possis Medical, Inc. and the VAG.TM. (venous arterial graft) available from Thoratec Laboratories Corporation, are permanently implanted in a subcutaneous tunnel, where one end of the graft is typically placed in an artery and the other end of the graft is typically placed in a vein so as to create an anastomosis between the two blood vessels. Access to the graft for hemodialysis is then achieved by percutaneous introduction of a needle or an access tube. Recently, several graft designs have been proposed where the grafts are made of certain materials, such as polytetrafluoroethylene (PTFE), silicone, DACRON, polyurethane, bovine, and the like. These grafts are designed to offer immediate access to the patient's vasculature with reduced complications of hematomas between the subcutaneous tissue and the graft, kinking, thrombosis, pseudoaneurysm formation, or infection. While vascular grafts offer great promise, one issue to be resolved for the success and practical utility of vascular grafts is effective subcutaneous placement of such articles. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 201

•

Dialysis solution system and mixing tank Inventor(s): Matta, John J.; (Shoreview, MN), Peterson, Roger A.; (Maple Grove, MN), Walter, Bert; (Mendota Heights, MN) Correspondence: Suzanne J. London; Minntech Corporation; 14605 28th Avenue North; Minneapolis; MN; 55447-4822; US Patent Application Number: 20030043688 Date filed: October 24, 2002 Abstract: A low-profile tank and system for mixing dry chemicals with water to form a concentrated hemodialysis solution, the tank having a fluid supply nozzle projecting into a cylindrical side wall of the tank, and a drain connection at an apex of a conical bottom wall of the tank. A cavity having a ramp-like bottom wall extends from the cylindrical side wall of the tank. A venturi eductor provides for transfer of dry chemicals to the tank using compressed air to aspirate the chemicals and deliver them to the tank. A plurality of load cells may be used to measure the weight of the tank and contents. Manual transfer of dry chemicals to the tank is facilitated by the low profile of the tank. A tapered shipping container is provided for nesting when empty. Excerpt(s): This patent application claims priority from design patent application U.S. Ser. No. 29/144,403, filed Jul. 2, 2001, with the title LOW PROFILE MIXING TANK. In the past, various efforts were made to provide a system for preparing a hemodialysis solution from dry chemicals and water on a large scale batch basis. Some systems transferred the packaged dry chemicals into a mixing vessel by creating a water slurry from the dry chemicals and aspirating the slurry into a mixing tank where it was dissolved with additional water to form a solution with a desired concentration of chemicals therein. Other systems depended on the user manually adding the dry chemicals to the mixing tank. The ability to rapidly transfer and dissolve the dry chemicals has continued to be an obstacle in both types of systems in that the dry chemicals settle to the bottom of the mixing tank, resulting in prolonged dissolution periods with conventional agitation of the contents of the mixing tank. The present invention provides an improved transfer mechanism to deliver the dry chemicals to a mixing tank, and further provides a mixing tank and recirculation apparatus that create high turbulence at the bottom of the tank that accelerates formation of the desired solution and promotes uniformity in the chemical concentration of the solution. Examples of the chemicals to be mixed in the mixing tank of the present invention are the Renasol.RTM. and Centrisol.RTM. acid concentrates or solutions of bicarbonate for hemodialysis concentrates available from the assignee of the present invention. Existing designs for large tanks that mix solutions suffer from several ergonomic shortcomings. These include the inability to fit through a standard door, excessive tank height that makes it difficult to lift powder bags for pouring, and inadequate mixing of these very large volumes, including the creation of "dead spots" where there is not adequate circulation. The present invention includes a mixing tank for solutions. It has a capacity of up to 110 gallons or more and also has mounting locations for a control panel built into the design that imparts a mixing feature to the tank. The unique shape of the tank includes a forward projecting area with a downward sloping floor which bestows enhanced circulation of the solution. The design increases the volume of the mixer while maintaining a waist height profile. In addition, the narrow width also allows it to fit through a standard door. The location for the addition of solids to be mixed into solution is ergonomically designed to be close to the front of the tank, and there is a shelf on the top of the tank, so that bags of solids can rest on it while being poured into the tank.

202

Hemodialysis

Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Dialysis system and method for automatically priming a dialyzer Inventor(s): Keeling, Scott; (Holiday, FL), Kellam, Benjamin A.; (Clearwater, FL), Pan, Li; (Tampa, FL) Correspondence: Baxter Healthcare Corporation; Renal Division; 1 Baxter Parkway; Df33e; Deerfield; IL; 60015; US Patent Application Number: 20040084371 Date filed: November 6, 2002 Abstract: A dialysis system and a method for automatically priming a dialyzer are provided. The priming of the dialyzer is accomplished in two steps; namely, the use of a blood pump to prime a dialyzer followed by the use of the blood pump and a dialysate pump to prime the dialyzer. The dialysis system filters a fluid through an extracorporeal circuit, a balanced flow loop and a dialysate loop which is connected to the dialyzer. The dialysis system and method may prevent air or air bubbles from entering the blood stream of a patient during dialysmis. Moreover, the dialysis system may be, for example, a hemodialysis or peritoneal dialysis system. Excerpt(s): The present invention generally relates to a dialysis system and a method for automatically priming a dialyzer. More specifically, the present invention relates to a system and a method for sequencing valves and/or pumps to prime the dialyzer. The priming of the dialyzer is accomplished in two steps; namely, the use of a blood pump to prime fibers of the dialyzer followed by the use of the blood pump as well as a dialysate pump to prime a housing of the dialyzer. The dialysis system and method may be used for hemodialysis or peritoneal dialysis. Normally, kidneys of a person cleanse blood within the person. Often, however, kidneys fail or otherwise do not properly function in a person which is generally referred to as "renal disease." As a result, a dialyzer may be implemented to cleanse the blood of the person. Essentially, the dialyzer replaces the natural function of the kidney. Because the person may need to undergo dialysis on a regular basis, prolonged use of the dialyzer to implement the dialysis process may be costly in both time and money. Generally, two methods are available for performing dialysis, namely, peritoneal dialysis and hemodialysis. Peritoneal dialysis is a technique in which the body tissue of the patient acts as a filter for blood-borne toxins and/or excess water. The removal of certain elements, for example, blood-borne toxins and/or excess water, from the blood in dialysis is accomplished by virtue of the differences in rates of their diffusion through a semipermeable membrane. Typically, the blood remains within the semipermeable membrane of a dialyzer while a dialysate solution remains outside the semipermeable membrane, but within the dialyzer. The blood-borne toxins and/or excess water then diffuse and/or are forced across the semipermeable membrane by a pressure gradient into the dialysate and are ultimately discarded. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 203

•

Disposable element for a device for carrying out a medical treatment using a liquid Inventor(s): Brandl, Matthias; (Koenigshofen, DE), Hilgers, Peter; (Schonungen, DE) Correspondence: Kenyon & Kenyon; One Broadway; New York; NY; 10004; US Patent Application Number: 20030135193 Date filed: November 5, 2002 Abstract: The invention relates to a disposable element for a medical treatment device, especially a hemodialysis device. The inventive disposable element comprises a film bag filled with the dialysis liquid that consists of two superimposed flat films or a tubular film with connections for supplying and discharging the liquid. The film bag or the tubular film, in the condition ready for usage, is closed with a first weld on the top end and with a second weld (4, 5) on the lower end and is folded several times parallel to the longitudinal axis that is vertical in the condition ready for usage. The film bag is inserted in a receiving unit that is configured as a shaping dish (15) that has a middle cylindrical section (16) followed by an upper or lower convex section (17, 18). The inventive disposable element, when combined with the receiving unit, unfolds more easily when being filled and has a lesser tendency to form creases. Excerpt(s): The present invention relates to a disposable for a device for carrying out a medical treatment using a fluid. Moreover, the invention relates to a device for carrying out a medical treatment using a fluid, and also indicates the use of the disposable in a hemodialysis device. Hemodialysis devices are known in various designs. The material exchange between the blood and the dialyzing fluid takes place in a dialyzer which has a first flow path for the blood and a second flow path for the dialyzing fluid, both flow paths being separated from each other by a semi-permeable membrane. The first flow path is a component of an extracorporeal blood circulation having a feed line and a return line for the blood, as well as, if desired, a pump supporting the blood flow. The second flow path is connected to devices for feeding and removing the dialyzing fluid. In addition to the so-called single-pass systems, in which the continually supplied dialyzing fluid passes the dialyzer only once and is then discarded, so-called batch systems are also known. The German Patent 31 15 665 C2 describes such a hemodialysis device which works with a volumetrically-fixed container, sealed off against the atmosphere, which is completely filled with fresh dialyzing fluid prior to beginning the treatment. During operation, fluid is pumped out of the container through the dialyzer, and the used fluid is fed back into the container again. Because of the constant volume of the entire system filled with the dialyzing fluid, ultra-filtration can only be carried out when fluid is removed from the system. A mixture of fresh and used dialyzing fluid is avoided in the known hemodialysis device, in that the removal of the dialyzing fluid is carried out in the upper region of the container, while the feedback takes place in the lower container region. The stratification of the fresh dialyzing fluid with the used dialyzing fluid remains stable due to the maintenance of a vertical temperature gradient in the container from top to bottom. The container is made of glass which is substantially resistant to chemicals to be considered, cleans well and is physiologically unobjectionable. However, it is disadvantageous that the glass container is comparatively costly to produce and relatively difficult to clean. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

204

•

Hemodialysis

Drug eluted vascular graft Inventor(s): Wong, Samuel J.; (Orinda, CA) Correspondence: Samuel J. Wong; 3 LA Cuesta Road; Orinda; CA; 94563; US Patent Application Number: 20030229392 Date filed: May 23, 2003 Abstract: A drug Eluted vascular graft where the internal lumen are coated with at least one or more bioerodible polymers capable of releasing at least one or more therapeutic agents in a controlled time-released manner. The therapeutic agent may include an antimicrotubule, an antiproliferative agent, or an antithrombogenic agent.A method for preventing thrombosis of vascular grafts used in vascular access for hemodialysis, vascular reconstruction and coronary bypass grafting. Excerpt(s): The invention relates to vascular grafts which are used in medical practice as an artificial conduit for blood, wherein the Drug Eluted Vascular Graft has at least one bioerodible polymer capable of releasing at least one therapeutic agent in a controlled and sustained manner over a prolonged period of time as a method to prevent restenosis and thrombosis. Vascular grafts are medical devices used as an artificial conduit for bodily fluids, usually blood. When used for hemodialysis the vascular graft serves as a nonstatic reservoir of blood, where blood is readily accessible to a dialysis machine. The vascular graft serves as a life line, an essential interface between the patient and the dialysis machine. When used in the treatment of peripheral vascular disease and coronary artery disease, vascular grafts serve as an artificial conduit for blood bypassing diseased blood vessels and thus supplying blood to the ischemic organ. In coronary artery bypass grafting, artificial vascular grafts are rarely used due to their high incidence of thrombosis. The current graft material of choice is to use a native blood vessel such as the left internal mammary artery or saphenous vein. Unfortunately these also have significant thrombosis rates, although substantially less than artificial grafts. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Filter device, preferably a hollow fibre dialyser, comprising curled hollow fibres Inventor(s): Fritzsche, Steffen; (Aalen, DE), Heilmann, Klaus; (Wendel, DE) Correspondence: Glen K Beaton; Suite 4100; 1801 California Street; Denver; CO; 80202; US Patent Application Number: 20030155294 Date filed: February 3, 2003 Abstract: The invention relates to a filter device, preferably for hemodialysis, that consists of a cylindrical filter housing and a bundle of curled hollow fibers. The bundle is arranged in the filter housing. According to the invention, the curled hollow fibers are provided with an essentially sinusoidal texture and a wavelength that is defined by means of certain limits. The invention also relates to a curled hollow fiber and a method for filling a hollow fiber dialyser. Excerpt(s): The invention relates to filter devices, and more particularly to hollow fiber dialysers for hemodialysis having an essentially sinusoidal texture and curled geometric pattern. Hollow fiber dialysers of a common design have a cylindrical fiber bundle that is arranged in a cylindrical filter housing. Blood flows through the inside of

Patents 205

the fibers, and the dialysate flows in the area between the fibers and the filter housing in a counter flow to the blood. The task of a dialyser is the exchange of matter through the wall of the hollow fibers. The blood usually flows at an even velocity within all fibers. For an optimum of exchange effect, the dialysate should be constantly exchanged externally of the hollow fibers. This way a permanently high concentration difference between the interior and exterior of the fibers is ensured as the driving force for a diffuse exchange of matter. In a common design dialyser, both the inflow and outflow of the dialysate is connected with the externally positioned fibers of the fiber bundle. That is why it cannot be ensured initially that all fibers in the fiber bundle are flushed with the same amount of dialysate. If a laminar flow of the dialysate in the dialysate area is assumed, the entire dialysate can theoretically flow through between the fiber bundle and the housing without the dialysate entering into the bundle interior. The exchange surface provided by the hollow fiber bundle would not be utilized in this way. In this case, the dialysate flows on a route of the least resistance from the entrance along the fibers in-relating to the dialyser-axial direction toward the output. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Hemodialysis emergency-disengagement-device Inventor(s): SUN, JIAN-DONG; (SAN JOSE, CA) Correspondence: Jian-Dong Sun; 1649 Merrill DR. # 3; San Jose; CA; 95124; US Patent Application Number: 20030187379 Date filed: April 2, 2002 Abstract: The HEDD consists of a compressible body--top half (11) with a guide groove (12) and a cutting blade (13), a compressible body--bottom half (18) with a guide pillar (17), and a pair of special clamps (14) which are located to the left side and the right side of the guide pillar between the two halves of the compressible body (11 and 18). Under external compression, the two halves of the compressible body (11 and 18) are squeezed together to compress the special clamps (14) along the direction of the guide pillar (17). After the special clamps (14) completely block the hemodialysis blood-tubes (16) and are locked up due to elasticity, the cutting-blade (13) moves further to cut the hemodialysis blood tubes (16). When the external compression is released, the special clamps (14) and the blood tubes (16) are released from the device. The patient is then completely disengaged from the dialysis machine. Excerpt(s): A Hemodialysis Emergency-Disengagement-Device (HEDD) is an accessory to kidney-dialysis equipment to allow patients to disengage themselves from hemodialysis machine in case of emergency. The idea and/or a real object of the HEDD has never been used in renal clinics and never appeared in any relevant document. The HEDD enables the patients themselves, in an emergency, to simply and rapidly clamp and sever the hemodialysis blood tubing attaching them to the dialysis machines, to expedite their escape from any potential danger. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

206

•

Hemodialysis

Hemodialysis method for improving immune system function Inventor(s): DePaolis, Potito U.; (Los Angeles, CA), Salehmoghaddam, Saleh; (Los Angeles, CA) Correspondence: Oppenheimer Wolff & Donnelly Llp; 2029 Century Park East, Suite 3800; Los Angeles; CA; 90067; US Patent Application Number: 20040057949 Date filed: September 23, 2002 Abstract: An improved method for hemodialysis employing reverse osmosis raises the pH of the blood to preserve the activity of the enzyme lysozyme to improve immune function and reduce the risk of infection in dialysis. In general, this method comprises: (1) removing arterial blood from a patient in need of hemodialysis; (2) increasing the pH of the arterial blood to a value of about 7.8 by adding a sufficient quantity of a 5% solution of sodium chloride buffered to a pH value of 7.9; (3) passing the arterial blood from step (b) through a dialyzer operating by reverse osmosis; (4) adding a pH-reducing agent selected from the group consisting of acetate buffer and dextran sulfate to reduce the pH of the blood to its normal value; (5) passing the blood from step (4) through a dialyzer operating by reverse osmosis to remove antigen; and (6) returning the blood to the patient. Excerpt(s): The invention is directed to methods for improving the immune system in patients treated by hemodialysis. About 300,000 persons in the USA receive some sort of dialysis. Typically, dialysis centers, where dialysis is administered, use a hollow fiber artificial kidney to remove solutes (usually toxins), through membrane pores. Dialysates contain blood ionic substances. Excess ions diffuse down a concentration gradient until equilibrium is reached. A general description of dialysis is given in A. R,. Nissenson & R. N. Fine, "Dialysis Therapy," (3d ed., Hanley & Belfus, Inc., Philadephia, Pa., 2002), incorporated herein by this reference. Infections are one of the most important complications of hemodialysis. Infections are particularly prevalent in patients who have underlying disease states that leave them with increased susceptibility to infection, such as diabetes or immunodeficiency. Many infections are catheter-related. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Hemodialysis system and method Inventor(s): Gertner, Michael; (San Francisco, CA) Correspondence: John P. O'banion; O'banion & Ritchey Llp; 400 Capitol Mall, Suite 1550; Sacramento; CA; 95814; US Patent Application Number: 20030014003 Date filed: June 20, 2002 Abstract: A treatment assembly is positioned along an AV-fistula and couples therapeutic energy to an adjacent area due to a material response to an applied energy field from a remotely located energy source. The treatment assembly may be delivered into the fistula through a hemodialysis needle, or may be secured to the fistula graft itself and implanted therewith within a patient. A cover provides a shield between an anastomosis area and blood flow. Another AV-fistula includes a valved reservoir that receives a fluid agent from a hemodialysis needle while moving the needle into or from the fistula; the agent leaks from the reservoir into the fistula lumen. Another valved

Patents 207

fistula is adjustable between an open condition and closed conditions during and between hemodialysis treatments, respectively. Another AV-fistula has a bladder reservoir coupled to a second refillable fluid reservoir and is adapted to locally deliver a therapeutic agent into the fistula lumen. Excerpt(s): This application claims priority from U.S. provisional application serial No. 60/299,223 filed on Jun. 20, 2001, incorporated herein by reference. This invention pertains generally to hemodialysis, and more particularly to hemodialysis systems and methods including A-V fistula grafts, A-V fistula graft treatment systems, systems for treating a condition associated with an AV-fistula graft, and an A-V fistula graft systems. Renal disease and deficiency has long been a significant problem that continues to plague an enormous population of patients, and the related cost of treatment continues as an ever growing burden on modern society as a whole. For example, in 1996, there were 250,000 patients in the US with end stage renal disease (ESRD), a number expected to grow by 10-15% per year over the next 20 years primarily as a result of an aging population and advances in treatments for other diseases. The cost of ESRD in the US was $20 billion in the year 2000, 5% of all Medicare resources. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Implantable vascular access device Inventor(s): Sherry, John; (Needham, MA) Correspondence: Hoffmann & Baron, Llp; 6900 Jericho Turnpike; Syosset; NY; 11791; US Patent Application Number: 20030109856 Date filed: January 15, 2003 Abstract: An implantable vascular access device includes a housing having an inlet, an outlet, an interior chamber defined therein and a valve positioned between the inlet and the interior chamber. The valve is subcutaneously manipulated between an open position, in which fluid can flow between the inlet and the interior chamber, and a closed position in which the valve occludes the inlet. The device may include any combination of multiple inlets, outlets and/or interior chambers. In the preferred embodiment, the housing includes two separate interior chambers suitable for the inflow and outflow of a typical hemodialysis procedure. A method for accessing a vascular structure is provided which includes the steps of subcutaneously implanting the device connecting one end of a cannula to the outlet of the device and another end of the cannula to a selected vascular structure. The valve of the device is manipulated to permit fluid communication between the inlet of the device and the selected vascular structure. A needle is introduced through the inlet opening to access the selected vascular structure. Excerpt(s): The present invention relates to implantable vascular access devices used in the delivery and/or withdrawal of fluids to and from the body and more particularly relates to a self-sealing device which permits intermittent vascular access. Conventional vascular access devices are surgically implanted under the skin to allow for intermittent access to a selected vascular structure, such as an artery or a vein, for introducing and/or withdrawing fluids to and from the selected vascular structure. Typically, such devices generally include an interior chamber having an outlet opening connected via a cannula to a vascular structure within the body and a penetrable membrane which serves as a cover for the interior chamber of the device. The penetrable membrane or septum is comprised of a material, such as silicone rubber, which automatically reseals

208

Hemodialysis

itself after being penetrated by a hypodermic needle or a needle introduced catheter. In operation, a needle passes through the skin and through the penetrable membrane into the interior chamber allowing fluid to be injected into the chamber and expelled through the cannula into the selected vascular structure or, conversely, fluid may be withdrawn. The advantages of an implantable device over acute catheter procedures include reduced infection, easier patient maintenance and improved aesthetics. Typical implantable vascular access devices are shown in U.S. Pat. No. 5,318,545 to Tucker and U.S. Pat. No. 5,755,780 to Finch, Jr. et al. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Indicator dilution catheter for blood flow measurement in arterio-venous hemodialysis shunts Inventor(s): Drost, Cornelis J.; (Ithaca, NY), Krivitski, Nikolai M.; (Ithaca, NY) Correspondence: Stephen B. Salai, ESQ.; Harter, Secrest & Emery Llp; 1600 Bausch & Lomb Place; Rochester; NY; 14604-2711; US Patent Application Number: 20020183632 Date filed: May 29, 2001 Abstract: The present invention provides a method and apparatus for measuring the blood flow rate within an A-V shunt via indicator dilution techniques. Unknown flow resistance within the A-V shunt are addressed by adjusting a measured flow rate to provide a flow rate within a predetermined margin of error. The calculated flow rate can be rejected based upon flow conditions of the introduced indicator. Different indicator introduction rates can be used to enhance accuracy of the measured flow. The indicator flow path can include a flow restrictor to limit the flow rate of the indicator to below a predetermined value. Excerpt(s): The present invention relates an apparatus and method for measuring fluid flow, and more particularly, to determining blood flow rates in hemodialysis arteriovenous (A-V) shunts by dilution techniques, including thermodilution. Hemodialysis is a process by which an artificial kidney replaces the function of a kidney in a patient. Blood is removed from the patient through a patient access such as an arterio-venous (A-V) shunt, passed through a dialyzer and returned to the patient access for normal circulation through the vascular system of the patient. Arterio-venous shunts used in hemodialysis are surgically created by insertion of a specially designed tube (artificial graft or autologous vein) between a peripheral artery and a vein, or by connecting a peripheral artery to a vein to create a native (shunt) fistula. The A-V shunts are designed to supply blood for the dialysis process. Typically, hemodialysis needles are inserted into the A-V shunt during a hemodialysis session and the shunt must provide enough blood flow to allow the dialyzer to effectively perform blood purification. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 209

•

Ionic enhanced dialysis/diafiltration system Inventor(s): Collins, Gregory R.; (Monroe, NY), Spence, Edward; (Bronx, NY), Summerton, James; (Hillsdale, NJ) Correspondence: Darby & Darby; 805 Third Avenue; New York; NY; 10022-7513; US Patent Application Number: 20030010701 Date filed: July 9, 2002 Abstract: A dual-stage filtration system and methods for using the same include first and second filtration cartridges (122, 138) particularly suited for hemodiafiltration and/or hemodialysis As fluid enters the first filtration carridge (122), the hydrogenion concentration (pH) is reduced by exposing it to an acidic solution such as citric acid across a filter membrane (124). This stage allows for improved removal of certain toxins in the fluid, such as protein-bound substances that disassociate more readily from proteins at a lower pH. As the filtered fluid enters the second filtration cartridge (138), the pH of the fluid is restored to normal levels prior to infusion to a patient Excerpt(s): This invention relates to dialysis and hemodiafiltration in general and, more particularly, to improved hemodiafiltration methods and devices for removal of blood toxins. Hemodialysis and Hemodiafiltration are well known methods for removing toxic substances from a patient's blood, thereby reducing the level of toxins in the patient's blood as part of an extracorporeal blood cleansing system. Both these methods are based on flowing blood through a cartridge containing a semi-permeable membrane which separates the cartridge into two compartments. In general, hemodialysis is a process whereby blood flows through a blood-side compartment of the cartridge, while a cleansing solution, i.e., a dialysate solution, flows through a dialysate-side compartment of the cartridge. Toxins are removed from the blood by diffusion across the semipermeable membrane from the blood-side compartment to the dialysate-side compartment. The rate of diffusion is determined by the concentration gradient established between a higher concentration of toxins in the blood relative to the dialysate fluid. Hemodiafiltration is process whereby the normal removal of toxins by diffusion is augmented by a convective flow of plasma water across the semi-permeable membrane which assists in carrying toxins by bulk flow of fluid from the bloodside of the membrane to the dialysate side of the membrane. The transportation of plasma water across the semi-permeable membrane is achieved by establishing a pressure gradient, generally referred to as Transmembrane Pressure (TMP), across the membrane. In hemodiafiltration, an equivalent amount of a substitution fluid, or replacement fluid, must be added to the blood to replace the plasma water that is filtered across the membrane. This substitution fluid is generally added either before the blood enters the cartridge (pre-dilution mode) or after the blood exits the cartridge (post-dilution mode). Hemodiafiltration systems using two cartridges connected in series are also known in the art. In such systems, a first cartridge is used as a conventional diafiltration cartridge providing simultaneous diffusion and filtration of plasma water across the semi-permeable membrane. In a second cartridge, toxins are diffused from the blood to the dialysate fluid, and a reverse pressure gradient is used to reverse-filter dialysate fluid from the dialysate-side compartment, across the membrane, and into the blood-side compartment. The reverse-filtered dialysate fluid serves as a substitution fluid to replace the amount of plasma water that is filtered from the bloodside compartment to the dialysate-side compartment in the first cartridge. Such a method is described in J. H. Miller et al., "Technical Aspects of High-Flux Hemodiafiltration for Adequate Short (Under 2 Hours) Treatment," Transactions of American Society of Artificial Internal Organs (1984), pp. 377-380.

210

Hemodialysis

Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for determining hemodialysis parameters Inventor(s): Folden, Thomas I.; (Alamo, CA), Gotch, Frank A.; (San Francisco, CA) Correspondence: Gibson, Dunn & Crutcher Llp; Suite 4100; 1801 California Street; Denver; CO; 80202; US Patent Application Number: 20030220600 Date filed: February 27, 2003 Abstract: This invention provides a method and apparatus for calculating a hemodialysis parameter, especially blood access flow rate, using multiple dialysance values. The dialysance values may be calculated based upon either sodium or urea concentrations. One dialysance value can be determined for conditions in which a patient's arterial line withdraws blood from an upstream location in a patient's fistula and treated blood is returned by a venous line to a downstream location in a patient's fistula. The second dialysance value can be determined when the lines have been reconfigured so that the arterial line withdraws blood from a downstream portion of a patient's fistula and the venous line returns treated blood to an upstream portion of a patient's fistula. Since it is possible to determine the dialysance values solely from concentration measurements made on the dialysate side of the dialysis apparatus, the present method and apparatus provide a non-invasive means for determining hemodialysis parameters such as blood access flow rate and recirculation. Excerpt(s): This application is a contination of U.S. patent application Ser. No. 09/003,798, filed Jan. 7, 1998, which is hereby incorporated herein by reference and a claim to priority is made hereby. Hemodialysis (or simply dialysis) is a process which employs an artificial kidney to aid patients whose renal function has deteriorated to the point where their body cannot adequately rid itself of toxins. In hemodialysis a dialyzer is used which contains a semi-permeable membrane, the membrane serving to divide the dialyzer into two chambers. Blood is pumped through one chamber and a dialysis solution through the second. As the blood flows by the dialysis fluid, impurities, such as urea and creatinine, diffuse through the semi-permeable membrane into the dialysis solution. The electrolyte concentration of the dialysis fluid is set so as to maintain electrolytic balance within the patient. Further purification in an artificial kidney is possible through ultrafiltration. Ultrafiltration results from the normal situation wherein there is a positive pressure differential between the blood and the dialysis fluid chambers. This pressure differential causes water in the blood to pass through the membrane into the dialysis solution. This provides the benefit of reducing a dialysis patient's excess water load which normally would be eliminated through proper kidney functioning. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 211

•

Method and apparatus to measure blood flow and reirculation in hemodialysis shunts Inventor(s): Krivitski, Nikolai M.; (Ithaca, NY) Correspondence: Stephen B. Salai, ESQ.; Harter, Secrest & Emery Llp; 1600 Bausch & Lomb Place; Rochester; NY; 14604-2711; US Patent Application Number: 20030111423 Date filed: January 31, 2003 Abstract: The measurement of blood flow in a dialysis shunt is obtained by injection of an indicator material into a venous line leading from dialysis equipment to the shunt. The blood flow in an arterial line leading from the shunt at a location downstream of the venous line to the dialysis equipment is monitored by an arterial line sensor for the presence of the indicator material. A detector connected to the sensor provides a dilution curve in response to the presence of the indicator material and the blood flow in the shunt is calculated from the area under the dilution curve. The locations of the arterial and venous lines in the shunt can be reversed to obtain a measurement of blood recirculation from the venous line into the arterial line. Excerpt(s): The present application is a continuation of U.S. Ser. No. 09/734,352 filed Dec. 11, 2000, now U.S. Pat. No. 6,514,419 issuing Feb. 4, 2003, which is a continuation of U.S. Ser. No. 09/348,130 filed Jul. 2, 1999, now U.S. Pat. No. 6,210,591 issuing Apr. 3, 2001, which is a continuation of U.S. Ser. No. 09/010,697 filed Jan. 22, 1998, now U.S. Pat. No. 6,153,109 issuing Nov. 28, 2000, which is a continuation-in-part of U.S. Ser. No. 08/965,975 filed Nov. 7, 1997, now abandoned, which is a continuation of U.S. Ser. No. 08/305,953 filed Sep. 16, 1994, now U.S. Pat. No. 5,685,989 issuing Nov. 11, 1997, each of which is expressly incorporated by reference. Not Applicable. The invention relates to the field of kidney dialysis processes and more particularly to such processes for measuring arterio-venous shunt blood flow and undesirable recirculation during hemodialysis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Method of measuring transcutaneous access blood flow Inventor(s): Bell, David A.; (Farmington, UT), Miller, David R.; (Morgan, UT), Steuer, Robert R.; (Pleasant View, UT) Correspondence: Jacobson Holman Pllc; 400 Seventh Street N.W.; Suite 600; Washington; DC; 20004; US Patent Application Number: 20020128545 Date filed: December 29, 2000 Abstract: Indicator dilution techniques are used to measure vascular access flow rates during routine hemodialysis. A bolus injection port is used to infuse a specific volume (V.sub.i) of an indicator diluent, such as saline or dye, into the patient cardiovascular circuit by one of the following:1. Needle injection of a known volume (bolus) of indicator diluent directly into the access site in the presence or absence of the hemodialysis circuit.2. Infusion of an indicator diluent into the arterial, venous line upstream of the venous needle.3. Turning the ultrafiltration of the dialysis delivery system from OFF to ON and OFF again over a predetermined time period.4. In a hemodialysis circuit, turning on the hemodialysis pump and using the priming saline

212

Hemodialysis

volume as a single saline bolus.A transdermal sensor is used to measure the percent change in a blood parameter. The sensor is positioned directly over the vascular access site a prescribed distance downstream of the injection site and upstream of the accessvein connection. The sensor employs emitter and detector elements at multiple spacings (d.sub.1, d.sub.2) for the purpose of measuring the bulk absorptivity (.alpha.) of the area immediately surrounding and including the access site, and the absorptivity (.alpha.sub.0) of the tissue itself. Excerpt(s): The present invention relates to a method for transcutaneously measuring access blood flow. More specifically, the invention relates to a method for measuring access blood flow through the optical measurement of percentage change in a blood parameter and application of the Ficke dilution principle. Modern medical practice utilizes a number of procedures and indicators to assess a patient's condition especially in the dialysis setting. Hemodialysis is a process wherein an artificial kidney is required to function in the place of the patient's normal kidney in order to remove certain biologic waste products. When the human kidney no longer functions correctly removing waste products such as urea, potassium, and even excess water, blood must be removed from the patient via blood tubing lines and filtered through an artificial kidney or dialyzer. In this process blood is passed through the dialyzer, cleansed, then returned to the normal circulatory system of the patient. Access to the patient's circulatory system is achieved through the use of a surgically implanted shunt or fistula (access). This "access site" is typically located in the arm, leg, or neck of the patient. Typically needles are placed into the access in such a way as to facilitate the easy removal of blood on the "arterial" or upstream side of the dialyzer and typically return the purified blood downstream of the first needle placement on the "venous" side. Unfortunately, in many cases the access will clot or "stenos" over time. This results in decreased blood flow through the access site which ultimately necessitates either angioplasty or a surgical replacement of the shunt. As the access flow ceases or "clots off" part of the purified dialyzed blood is forced to flow back into the arterial withdrawal site and, hence, recirculates only to be dialyzed again; this is termed "access recirculation". Access Blood Flow (ABF, represented by the variable Q.sub.a) is the rate at which blood passes through an arteriovenous (AV) graft or fistula. Poor or low Q.sub.a rates are generally indicative of hemo-dynamically significant access stenosis and/or thrombosis, which can reduce the adequacy of dialysis therapy and endanger the patient. In 1997 Dialysis Outcomes Quality Initiative (DOQI) Guidelines, the National Kidney Foundation (NKF) sets forth both the rationale and the procedural guidelines for the monitoring and maintenance of AV grafts and fistulas. These guidelines suggest that regular assessment of ABF may be predictive of access stenosis, which in turn may facilitate early intervention, thereby reducing the rate of thrombosis and loss. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of thrombolysis by local delivery of reversibly inactivated acidified plasmin Inventor(s): Jesmok, Gary J.; (Raleigh, NC), Landskroner, Kyle A.; (Raleigh, NC) Correspondence: Womble Carlyle Sandridge & Rice; P.O. Box 7037; Atlanta; GA; 303570037; US Patent Application Number: 20030175264 Date filed: October 25, 2002

Patents 213

Abstract: Methods of thrombolysis that allow the use of a fibrinolytic composition comprising reversibly inactivated acidified plasmin and the localized delivery of the plasmin to a vascular thrombotic occlusion are disclosed. Further disclosed is a method for administering a therapeutic dose of a fibrinolytic composition substantially free of plasminogen activator to a human or animal having a vascular thrombotic occlusion. The fibrinolytic composition includes a reversibly inactivated acidified plasmin substantially free of plasminogen activator. Intravascular catheter delivery of the fibrinolytic composition directly into or in the immediate vicinity of the thrombus is disclosed to minimize the systemic degradation of fibrin while retaining the maximum plasmin activity against the thrombus. The method is applicable to the dissolution of thrombi in artificial devices, e.g., hemodialysis grafts. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 10/143,157, filed May 10, 2002, which in turn is a continuation of International Application PCT/US00/31115 published in English on May 25, 2001, which in turn is a continuation-in-part of U.S. patent application Ser. No. 09/438,331, filed Nov. 13, 1999. The present invention relates generally to a method of thrombolysis using reversibly inactivated acidified plasmin that is substantially free of plasminogen activators and its local delivery of the acidified plasmin proximal to, or directly within, a thrombus. The therapeutic method is particularly applicable to the dissolution of thrombi wherever catheter-directed delivery is feasible. The present invention also relates to a method of dissolving thrombotic occlusions in artificial devices, especially in tube-like devices that enter a human or animal body or are implanted within the body, e.g., a hemodialysis graft. Thrombotic disease is a major cause of morbidity and mortality in the modern world. Acute myocardial infarction and ischemic stroke are the first and third causes of death and disability in Western societies. Occlusive thrombosis results in loss of blood flow to vital organs producing local oxygen deprivation, cell necrosis and loss of organ function. There are major benefits to the rapid destruction of a thrombus, resulting in early re-canalization: it prevents cell death, reduces infarct size, preserves organ function, and reduces early and late mortality. Thrombolytic therapy is now administered to more than 750,000 patients per year worldwide, while many times that number could potentially benefit from such treatment. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and devices for preparing hemodialysis solutions Inventor(s): Taylor, Michael A.; (Napa, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20040031741 Date filed: August 12, 2003 Abstract: A single housing comprising a diluent inlet, a solution outlet, and a plurality of discrete reagent beds comprising at least one reagent in dry form, wherein said reagent is present in the discrete reagent bed in a proportion sufficient for production of a complete hemodialysate solution. Excerpt(s): This application is a continuation of U.S. application Ser. No. 09/518,482, filed Mar. 3, 2000 (now U.S. Pat. No. 6,605,614), and claims priority under 35 U.S.C.sctn. 119(e) to U.S. Provisional Patent Application No. 60/122,510, entitled "Methods and Devices for Preparation Hemodialysis Solutions," filed Mar. 3, 1999. This invention

214

Hemodialysis

relates generally to devices for preparing solutions from dry reagent constituents and, more particularly, to the preparation of solutions suited for hemodialysis. Patients with sufficiently impaired kidney function are required to undergo dialysis to remove toxins from their blood. In general, dialysis involves the removal of toxins from body fluids by diffusing the toxins across a permeable membrane into a toxin-free dialysis solution. In the case of hemodialysis, blood is removed from a patient's body and purified of toxins externally in a dialysis machine. After removal of the toxins, the purified blood is returned to the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and systems for subcutaneous graft implantation Inventor(s): Ross, John; (Bamberg, NC) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20020138031 Date filed: March 22, 2001 Abstract: The present invention provides improved methods for establishing vascular access to a patient's body lumen or other target location, particularly blood vessels, for performing extracorporeal treatments, such as hemodialysis, hemofiltration, hemodiafiltration, plasmapheresis, apheresis, and the like, on circulating blood. In particular, the present invention provides improved methods which may enhance extracorporeal blood flow rates, reduce instances of fibrin sheath or thrombosis formation, and minimize recirculation effects. Methods for recirculating blood to a patient include placing a draw catheter so that a distal tip thereof is positioned in a right atrium of the patient's heart. A return catheter is placed so that a distal tip thereof is positioned in a superior vena cava. Extracorporeal blood flow from the draw catheter to the return catheter may then be established. Excerpt(s): The present invention relates generally to medical methods. More particularly, the present invention provides improved methods, apparatus, and kits for establishing access to a patient's vascular system for hemodialysis and other extracorporeal blood treatments. Access to a patient's vascular system can be established by a variety of temporary and permanently implanted devices. Most simply, temporary access can be provided by the direct percutaneous introduction of a needle through the patient's skin and into a blood vessel. While such a direct approach is relatively simple and suitable for relatively short procedures, such as intravenous feeding, intravenous drug delivery, and the like, they are not suitable for hemodialysis, hemofiltration, or other extracorporeal procedures that must be repeated periodically, often for the lifetime of the patient. For hemodialysis and other extracorporeal treatment regimens, a variety of transcutaneous catheters and implantable ports have been proposed over the years. Transcutaneous catheters, such as the Tesio catheter available from Med Comp and the Perm-Cath.TM. available from Quinton, comprise a single catheter tube having a distal end placed in a vein in an in-dwelling manner and a proximal end which extends through the skin and which is available for connection to a hemodialysis or other blood treatment system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 215

•

Methods for the diagnosis of hemodialysis patients and utilization of such methods to improve the administration of intravenous levocarnitine treatments to hemodialysis patients Inventor(s): Lewis, Vyonne T.; (New Orleans, LA), Schreiber, Brian; (Neenah, WI) Correspondence: Hogan & Hartson Llp; IP Group, Columbia Square; 555 Thirteenth Street, N.W.; Washington; DC; 20004; US Patent Application Number: 20030225162 Date filed: January 31, 2003 Abstract: The disclosed invention pertains to methods for diagnosing clinical conditions that are common in hemodialysis patients and that may be related to abnormal carnitine metabolism resulting from hemodialysis. Further, the present invention pertains to methods for monitoring and improving the administration of therapeutic intravenous levocarnitine to such patients. Clinical algorithms have been developed for the clinical symptoms seen in end-stage renal disease (ESRD) patients that may be related to carnitine deficiency. Monitoring tools to assist healthcare professionals in implementing the clinical algorithms are also provided. Excerpt(s): The present application claims priority from U.S. Provisional Patent Application Serial No. 60/352,505, METHODS FOR THE DIAGNOSIS OF HEMODIALYSIS PATIENTS AND UTILIZATION OF SUCH METHODS TO IMPROVE THE ADMINISTRATION OF INTRAVENOUS LEVOCARNITINE TREATMENTS TO HEMODIALYSIS PATIENTS, filed Jan. 31, 2002, which is hereby incorporated by reference. Furthermore, the present application is related in subject matter to U.S. Pat. No. 6,335,369, TREATING CHRONIC UREMIC PATIENTS UNDERGOING PERIODICAL DIALYSIS, issued Jan. 1, 2002, the specification of which is hereby incorporated by reference in its entirety. The present invention relates to methods for diagnosing and treating various conditions prevalent in hemodialysis patients with end stage renal disease. In particular, the present invention pertains to methods for diagnosing clinical conditions that are common in hemodialysis patients and that may be related to abnormal carnitine metabolism resulting from hemodialysis; thus, the present invention provides methods for monitoring and improving the administration of therapeutic intravenous levocarnitine to such patients. Studies indicate that more than 70% of the carnitine present in the plasma of a hemodialysis patient can be removed during a dialysis session. Carnitine is a naturally occurring substance in the human body required for energy metabolism at the cellular level because it transports fatty acid-derivatives into the inner aspect of the mitochondrionia to produce energy and removes various acyl moeities from the mitochondria and cells. Dialytic loss of carnitine by patients undergoing hemodialysis is thought to be attributable to the compound's relatively small molecular weight, high water solubility, and poor protein binding. Carnitine levels are further diminished in end stage renal disease patients by reduced renal synthesis and reduced intake of meat and dairy foods. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

216

•

Hemodialysis

Modified hollow-fiber membrane Inventor(s): Imamura, Kazuo; (Fujisawa-shi, JP), Ishihara, Kazuhiko; (Tokyo, JP), Kamenosono, Koji; (Nishinomiya-shi, JP), Miyazaki, Shinji; (Nobeoka-shi, JP), Nakabayashi, Nobuo; (Chiba, JP), Suzuki, Ken; (Tsukuba-shi, JP) Correspondence: Young & Thompson; 745 South 23rd Street 2nd Floor; Arlington; VA; 22202 Patent Application Number: 20040045897 Date filed: June 2, 2003 Abstract: A modified hollow-fiber membrane which has improved surface hydrophilicity without increasing the amount of components released therefrom, is less apt to interact with living-body components, does not adsorb proteins, and is less apt to deteriorate in performance. The hollow-fiber membrane has a copolymer of 2methacryloyloxyethylphosphorylcholine and other polymerizable vinyl monomer held on a surface of the membrane, the copolymer being present on the surface in a higher concentration than in other parts of the membrane. The modified hollow-fiber membrane is useful in medical applications such as hemodialysis and blood filtration and in the medical industry, food industry etc. Excerpt(s): The present invention relates to a hollow-fiber membrane with a modified membrane surface. More particularly, the present invention relates to a hollow fiber membrane of which the surface has been modified to control adsorption of proteins onto the surface or to suppress interaction of blood components on the surface, and to a method for preparing the hollow-fiber membrane. The hollow fiber membrane of the present invention can be used as a membrane for medical treatment suitable for purification of blood such as hemodialysis and blood filtration or as a permselective membrane used in the pharmaceutical industry or the food industry. Hollow fiber membranes made from various materials are widely used as permselective membranes for medical applications such as hemodialysis and blood filtration, as well as for the pharmaceutical industry, food industry, and the like. The hollow fiber membranes used in such applications must have superior mechanical strength and chemical stability, possess easily controllable permeability, release a minimal amount of materials, exhibit almost no interaction with biological components, and be safe for living bodies. However, there have been no hollow fiber membranes completely satisfying all of these requirements. When the material is a synthetic polymer, for example, the surface is generally hydrophobic. Unduly weak hydrophilic properties tend to cause the material to react with blood components, cause the blood to easily coagulate, and impair the permeability performance of the hollow fiber membrane due to adsorption of protein components. A study for providing the hollow fiber membrane made from such a synthetic polymer with compatibility with blood by incorporating a polymer with hydrophilic properties has been undertaken. For instance, a permselective membrane made from a polysulfone-based polymer with a hydrophilic polymer incorporated therein and a method of manufacturing such a membrane have been proposed. Such a membrane, however, exhibits only poor wetting properties and tends to coagulate blood due to decreased compatibility with blood, if the content of the hydrophilic polymer is small. On the other hand, if the content of the hydrophilic polymer is large, the amount of the hydrophilic polymer dissolved from the membrane increases, although the blood coagulation can be suppressed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 217

•

No-needle blood access device for hemodialysis Inventor(s): Kawamura, Akio; (Sapporo-shi, JP) Correspondence: Griffin & Szipl, PC; Suite Ph-1; 2300 Ninth Street, South; Arlington; VA; 22204; US Patent Application Number: 20040122346 Date filed: December 3, 2003 Abstract: A no-needle blood access device for hemodialysis comprising, an elongated metallic body (20), the body being provided at its upper surface with a recess (22), a periphery of the recess being formed with a peripheral wall (24) defining a well (26) therein; a pair of shutters (40, 42) slidably housed within opposed pockets (36, 38) respectively, the pockets being formed at the upper part of the body so that each of their lower surfaces flush with the bottom surface of the recess, each of the shutters including through-holes (40c, 42c) respectively; a longitudinally extending through-hole (30) disposed in the lower part of the body, each of first and second artificial conduits (12, 14) being fitted into respective ends of the longitudinally extending through-hole, the artificial conduits being anastomosed to a targeted artery or vein; and a pair of vertical through-holes (44, 46) disposed at portions of the body each communicating to the respective through-holes of the shutters when they are opened; whereby the device is arranged such that, when each of the shutters is slided in a direction away from each other, the well is in communication with each of the artificial conduits through the logitudinally extending through-hole and the vertical through-holes of the body and each of the through-holes of the shutters, and when each of the shutters is slided in a direction near to each other, the well is out of communication with each of the artificial conduits. Excerpt(s): The present invention generally relates to a no-needle blood access device for hemodialysis. More specifically, the present invention relates to a no-needle blood access device for hemodialysis which has a mechanism of simple structure and does not need a caregiver. Hemodialysis is used widely as a remedy for treating kidney insufficiency. In many cases, a surgical short circuit which is commonly referred to as "shunt" is implanted in a blood vessel or blood vessels of the patient suffering from serious kidney disease so as to acquire a plentiful blood flow immediately during hemodialysis, because such a patient must receive hemodialysis treatment periodically over a long period of time. Shunts are divided broadly into two categories, an internal shunt and an external shunt. The internal shunt has a drawback that needle puncture is required during hemodialysis. On the other hand, the external shunt has a high rate of thrombosis and infection, and makes daily life more inconvenient. To overcome these drawbacks of the aforementioned shunts, a blood access device for hemodialysis given the tradename "Hemasite" (described in U.S. Pat. No. 4,496,350) has been developed. This Hemasite blood access device has an advantage that needle puncture is not required, but due to its complicated structure, is costly and troublesome to handle. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

218

•

Hemodialysis

Occlusion-resistant catheter Inventor(s): Berry, Michelle M.; (Franklin, MA), Heath, Kevin R.; (Weston, MA) Correspondence: Christopher R. Lewis; Ratner & Prestia; One Westlakes, Berwyn, Suite 301; P.O. Box 980; Valley Forge; PA; 19482-0980; US Patent Application Number: 20030144623 Date filed: January 29, 2002 Abstract: A catheter comprises an elongated tube having an interior defined by a sidewall having openings. At least a portion of the catheter is spirally formed into a corkscrew pattern or has an inwardly spiraling portion with at least one opening coincident therewith. Additionally or alternatively, the catheter comprises a septum that divides the interior into at least first and second lumens. The first and second lumens may form a double helix in a portion of the catheter coincident with the plurality of openings or along the entire length of the catheter. Methods of manufacturing the catheters involve extruding the portion of the catheter having the openings, making this portion separately then attaching it to another catheter, or heating and deforming a portion of a catheter to form a tip portion. The catheter can be used for hemodialysis by drawing blood through one lumen and returning it through another. Excerpt(s): This invention relates generally to perfusion catheters and, more specifically, to a catheter that is resistant to occlusion of its sidewall openings. Perfusion catheters used for introducing or removing fluids from a body lumen are well known in the art. Such catheters may be used in drug therapy, such as chemotherapy, where the fluid to be introduced is a pharmaceutical agent. Perfusion catheters have also been used to allow for bypassing occlusions in blood vessels. For example, during angioplasty, plaque may become partially or completely dislodged and may form a restriction that at least partially occludes an arterial passage. A perfusion catheter may be positioned in the occluded blood vessel across the restriction, such as is described in U.S. Pat. No. 4,661,094, incorporated herein by reference, to allow blood to flow into the catheter through a first opening upstream of the restriction and flow out through a second opening downstream of the restriction. As described in the '094 patent, the openings may be distributed in a helical pattern in the sidewalls of the catheter. During the intake of fluids, however, the sidewall hole orientation may have certain disadvantages. For example, the holes may contact and seal against the walls of the duct or vessel in which the catheter resides, thereby blocking the holes and minimizing flow. One typical use for perfusion catheters for fluid intake is in extracorporeal blood purification procedures, such as hemodialysis. Modern procedures favor the use of dual-lumen catheters such as those described in U.S. Pat. No. 4,134,402, incorporated herein by reference, or other multi-lumen catheters, such as those described in U.S. Pat. No. 4,995,865, incorporated herein by reference. In a standard dialysis procedure using a dual- or multi-lumen catheter, blood is withdrawn from a blood vessel in a patient through one or more lumens of the multi-lumen catheter and supplied to a hemodialysis unit that purifies the blood. The purified blood is then returned to the patient through another lumen of the catheter. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 219

•

Portable hemodialyzer Inventor(s): Kim, Kyoung Jin; (Incheon-shi, KR) Correspondence: Staas & Halsey Llp; 700 11th Street, NW; Suite 500; Washington; DC; 20001; US Patent Application Number: 20020179504 Date filed: May 28, 2002 Abstract: Disclosed is a portable hemodialyzer, which not only can relieve a patient from the pain of putting injection needles into two portions of the patient's body for hemodialysis, but also enables the hemodialysis to be safely performed even at home, so as to reduce the times by which the patient must visit the hospital, thereby largely reducing time and expense. In the portable hemodialyzer, an injection needle contains a separation film separating an introduction channel and a discharge channel from each other, which are formed in the injection needle. A blood exit is formed at a predetermined left side portion of the injection needle, while a blood entrance is formed at a predetermined right side portion of the injection needle. Therefore, the blood introduced through the blood entrance by the pumping operation by the driving force of the driving section is delivered through the introduction channel to the hemodialysis filter, filtered by the hemodialysis filter, and then supplied through the discharge channel and the blood exit to the blood vessel. Excerpt(s): The present invention relates to a hemodialyzer, and more particularly to a portable hemodialyzer, which not only can relieve a patient from the pain of putting injection needles into two portions of the patient's body for hemodialysis, but also enables the hemodialysis to be safely performed even at home, so as to reduce the times by which the patient must visit the hospital, thereby largely reducing time and expense. As generally known in the art, blood means a liquid system flowing in a blood vessel. Blood has a clear red color, is opaque, and looks homogeneous. However, when a small drop of blood is spread thinly on a glass plate and observed through a microscope, it is noticed that blood-corpuscles float in transparent liquid, which means the blood is not homogeneous. A main function of the blood is to carry various materials. That is, the blood delivers oxygen absorbed through the lungs and nutritive substance absorbed through the digestive canal to all cells of the body, and carries and discharges carbonic acid gas or waste materials, produced in the cells, out of the body through the lungs, kidneys, or skin. Further, the blood transfers heat from portions such as the skeletal muscles and liver, in which heat is vigorously produced, to other portions, thereby equalizing the distribution of the body heat. Moreover, the blood helps the skin to discharge heat, thereby maintaining the body temperature constant. The blood consists of hematocyte, leucocyte, thrombocyte, and blood plasma. The hematocyte is shaped like a disc and has no nucleus. The leucocyte has no specific shape and a nucleus. The thrombocyte is relatively small and has no nucleus. The blood plasma is the liquid component of the blood. The hematocyte takes 45% of the entire blood and performs the function of carrying the oxygen. Further, the leucocyte performs phagocytosis, the thrombocyte relates to coagulation of the blood, and the blood plasma relates to the transfer of materials. The leucocyte, which is largest among said components of the blood, has no regular shape and a size between 12 and 25.mu.m, and the hematocyte has a diameter of 8.mu.m and is shaped like a disc, central portions of which are concave. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

220

•

Hemodialysis

Prevention of indwelling device related infection: composition and methods Inventor(s): Polaschegg, Hans-Dietrich; (Kostenberg, AT) Correspondence: Mark J. Pandiscio; Pandiscio & Pandiscio, P.C.; 470 Totten Pond Road; Waltham; MA; 02451-1914; US Patent Application Number: 20040156908 Date filed: February 2, 2004 Abstract: Catheters used for medical treatment, e.g., hemodialysis are filled with a locking solution, usually heparin between treatments. To prevent infections, antimicrobial or antibiotic substances have been used as locking solution alone or in combination with antithrombotic substances. It has been found that these locking solutions are rapidly washed out from the catheter tip. The invention describes a thixotropic gel that can be used as locking solution. Beneficial substances, e.g., antimicrobial or antibiotic substances can be added to the gel. A preferred antimicrobial substance is taurolidin alone or in combination with salicylic acid or one of its salts. Excerpt(s): This invention relates to methods and compositions, which prevent biofilm formation on or near medical prosthetic devices in order to reduce patient infection related to indwelling devices. The invention further addresses the complete life cycle of medical applications of an indwelling device teaching means to reduce or prevent infection. A new sub-study branch has developed in Microbiology to study Biofilm (Costerton JW, Stewart PS, Greenberg EP. Bacterial Biofilms: A Common Cause of Persistent Infections. Science 1999;284: 1318-22) The Biofilm specialty has adopted new methods of imaging and quantification techniques to study this form of microbial populations. These new techniques helped elucidate the sequencing steps of Biofilm formation and show how most infections in patients with indwelling medical devices can be traced to the Biofilm adhering to the device. In the last years scientists have discovered that microbes in a Biofilm are considerably different from the microbes in the planktonic form, which were the only microbes studied previously. Devices that have the highest rate of nosocomial infection include various catheters including ports and peripheral inserted central catheters (PICC) lines used for administration of liquids to the venous system such as saline, electrolytes, medications, imaging enhancers, chemotherapy drugs, and parenteral nutritional products as well as hemodialysis and hemofiltration. Other types of catheter devices such as enteral feeding tubes, spinal catheters, various shunts, urinary catheters, peritoneal dialysis catheters, intratracheal tubes for assisted breathing as well as diagnostic monitoring arterial catheters also carry high risk of Biofilm formation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Process for providing dialysis and other treatments Inventor(s): Bosch, Juan P.; (Washington, DC), Hegbrant, Maria Alquist; (Bjarred, SE) Correspondence: Welsh & Katz, LTD.; Thomas W. Tolpin; 22nd Floor; 120 South Riverside Plaza; Chicago; IL; 60606; US Patent Application Number: 20030083901 Date filed: June 22, 2001 Abstract: A beneficial process is provided to improve operations of clinics and other medical facilities to enhance care and treatment of patients, for those patients needing

Patents 221

dialysis, hemodialysis, or other treatments. The effectiveness, efficiency, frequency and costs of treatment can be determined for each treatment and each patient. Data on various factors which can affect the effectiveness, efficiency, and costs of treatment and operations of the medical facilities are accumulated and considered. Variations concerning the preceding can be calculated and a statistically analyzed to correlate the preceding, as well as to compute a sigma comprising a standard deviation of the data to determine the performance of the process. Excerpt(s): This patent application relates to blood purification and more particularly to dialysis. Many people require replacement or supplementation of their natural renal function in order to remove excess fluid or fluids containing dissolved waste products from their blood for various reasons, including illness, injury or surgery. Several procedures known for this purpose are dialysis, hemodialysis, hemofiltration, hemodiafiltration ultrafiltration; and plasmapherisis. The specific procedure employed depends upon the needs of the particular patient. For example, dialysis is used to remove soluble waste and solvent from blood; hemofiltration is used to remove plasma water from blood; hemodiafiltration is used to remove both unwanted solute (soluble waste) and plasma water from blood; ultrafiltration is a variation of hemofiltration; and plasmapherisis is used to remove blood plasma by means of a plasmapherisis filter. Because the replacement of renal function may affect nutrition, erythropoiesis, calciumphosphorus balance and solvent and solute clearance from the patient, it is beneficial if the procedure is controlled specifically for the particular patient's needs. The accurate control of the rate of removal of intravascular fluid volume is also useful to maintain proper fluid balance in the patient and minimize hypertension and hypotension. Because hemodialysis should be performed frequently, it is important to keep the cost of each treatment as low as possible. Further, it is desirable to minimize the amount of blood outside a patient's body in the extracorporeal circuit, thereby minimizing the stress on the patient as well as minimizing the potential for trauma to the blood. Bubble traps typically retain a relatively large volume of blood during normal operation. Blood trauma also can occur at an air-blood interface such as are found in typical bubble traps and drip chambers. It is advantageous to reduce the need to add anticoagulant to the blood, and decrease the physical stress on the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Reusable blood lines Inventor(s): Sheehan, Neil J.; (Palo Alto, CA), Utterberg, David S.; (Seattle, WA) Correspondence: Garrettson Ellis; Seyfarth Shaw; Suite 4200; 55 East Monroe Street; Chicago; IL; 60603; US Patent Application Number: 20030100858 Date filed: December 6, 2002 Abstract: Blood lines for hemodialysis and other blood handling procedures may be reused by placing connectors intermediately along the length of the blood lines so that the lines can be disconnected to separate out reusable portions thereof. Specifically, the bulk of the blood lines used may comprise branchless lengths of tubing which are easily reusable, and may be cleaned and stored along with a dialyzer or similar device by connection to a conventional reuse machine. Also, the connectors on the blood lines which are reused may have first and second sealing surfaces. The first sealing surfaces are used in the connections made to form the blood line in its normal form for use. Then, during cleaning and sterilization for reuse, the reusable connectors can connect first and

222

Hemodialysis

second lengths of blood lines together making use of a second sealing surface, in which the first sealing surfaces are exposed to cleaning/storing solution to cause cleaning and antibacterial action on the first sealing surfaces. Excerpt(s): This application is a division of application Ser. No. 09/664,432, filed Sep. 18, 2000, which is a division of application Ser. No. 08/892,685, filed Jul. 14, 1997, now U.S. Pat. No. 6,165,149, which is a division of application Ser. No. 08/504,457, filed Jul. 20, 1995, now U.S. Pat. No. 5,772,624. In the field of blood treatment, hemodialysis is the most widely used technique, although other techniques are also available such as plasmapheresis, hemoperfusion, blood oxygenation, and techniques for passing blood through blood treatment media such as an absorptive agent for the removal of toxins or the like. Typically, an arterial blood set delivers blood from the patient to the hemodialyzer or other desired blood treatment unit. After the blood has passed through the hemodialyzer, it is conveyed through a venous blood set back to the patient. The arterial and venous blood sets typically each have about two meters of tubing, extending from patient connectors to other set components such as bubble removal chambers, a length of roller pump tubing or another pump device fitment, branch connection sites, a pressure pillow, and the like. Also, typically another meter of tubing extends between these various other set components and the dialyzer or other blood treatment device. Numerous other known devices may also be positioned on the blood sets, such as filters. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Sensor for transcutaneous measurement of vascular access blood flow Inventor(s): Bell, David A.; (Farmington, UT), Cox, Douglas L.; (Morgan, UT), Miller, David R.; (Morgan, UT), Zhang, Songbiao; (Sandy, UT) Correspondence: Jacobson Holman Pllc; Professional Limited Liability Company; 400 Seventh Street, N.W.; Washington; DC; 20004; US Patent Application Number: 20020133066 Date filed: March 19, 2002 Abstract: An optical sensor includes a sensing pair of complementary emitter and detector elements for measuring the bulk absorptivity (.alpha.) of an area parallel to and including a hemodialysis access site, and a normalizing pair of complementary emitter and detector elements for measuring the absorptivity (.alpha.sub.o) of the tissue itself perpendicular to the access site. The pairs of emitter and detector elements define two lines at right angles to each other, and one of the pairs lies to one side of the line defined by the other of the pairs, such that the two pairs of emitter and detector elements form a "T" shape. Indicator dilution techniques are used to measure vascular access flow rates during routine hemodialysis, using the sensor. Excerpt(s): This application is a continuation-in-part of application Ser. No. 09/750,076, filed Dec. 29, 2000; and a continuation-in-part of application Ser. No. 09/771,596, filed Jan. 30, 2001, which is a continuation of application Ser. No. 09/244,756, filed Feb. 5, 1999, now U.S. Pat. No. 6,181,958, which claims the benefit of Provisional Application No. 60/073,784, filed Feb. 5, 1998), all of which are incorporated herein by reference in their entireties. The present invention relates to apparatus for non-invasively measuring one or more blood parameters. More specifically, the invention relates to apparatus for the transcutaneous measurement of vascular access blood flow ("TQA") that is capable of generating accurate TQA measurements, even when the volume of access being measured is extremely small in size or extremely deep or when the access is of varying

Patents 223

nature, such as a synthetic or native fistula. Further, it is possible to infer additional information about the access area, such as collateral veins or competing vessels. Access blood flow for hemodialysis patients can now be measured non-invasively through a novel photo-optic transcutaneous technique as described in co-pending application Ser. No. 09/750,122, filed Dec. 29, 2000 (which is incorporated herein by reference in its entirety), using a transcutaneous TQA sensor as disclosed in application Ser. No. 09/750,076, filed Dec. 29, 2000 (which is also incorporated herein by reference in its entirety), and more particularly, the transcutaneous TQA sensor described in connection with FIGS. 2-6 thereof (hereinafter, "the prior art linear sensor"). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Sensor for transcutaneous measurement of vascular access blood flow Inventor(s): Bell, David A.; (Farmington, UT), Miller, David R.; (Morgan, UT), Steuer, Robert R.; (Pleasant View, UT) Correspondence: Jacobson Holman Pllc; 400 Seventh Street N.W.; Suite 600; Washington; DC; 20004; US Patent Application Number: 20040116790 Date filed: December 9, 2003 Abstract: An optical sensor includes photoemitter and photodetector elements at multiple spacings (d.sub.1, d.sub.2) for the purpose of measuring the bulk absorptivity (.alpha.) of an area immediately surrounding and including a hemodialysis access site, and the absorptivity (.alpha.sub.o) of the tissue itself. At least one photoemitter element and at least one photodetector element are provided, the total number of photoemitter and photodetector elements being at least three. The photoemitter and photodetector elements are collinear and alternatingly arranged, thereby allowing the direct transcutaneous determination of vascular access blood flow. Excerpt(s): The present patent application is a continuation-in-part of application Ser. No. 09/084,958, filed May 28, 1998, which is a continuation of application Ser. No. 08/479,352, filed Jun. 7, 1995 (now U.S. Pat. No. 5,803,908), which is a continuation of application Ser. No. 08/317,726, filed Oct. 4, 1994 (now U.S. Pat. No. 5,499,627), which is a divisional of application Ser. No. 08/011,882, filed Feb. 1, 1993 (now U.S. Pat. No. 5,372,136), which is a continuation of application Ser. No. 07/598,169, filed Oct. 16, 1990 (abandoned); and a continuation-in-part of application Ser. No. 09/244,756, filed Feb. 5, 1999, which claims the benefit of Provisional Application No. 60/073,784, filed Feb. 5, 1998), all of which are incorporated herein by reference in their entireties. The present invention relates to apparatus for non-invasively measuring one or more blood parameters. More specifically, the invention relates to apparatus for the transcutaneous measurement of vascular access blood flow. The invention can also be used for precise access location, as a "flow finder," and also can be used to locate grafts and to localize veins in normal patients for more efficient canulatization. Routine determination of the rate of blood flow within the vascular access site during maintenance hemodialysis is currently considered an integral component of vascular access assessment. While the relative importance of vascular access flow rates and venous pressure measurements in detecting venous stenoses is still somewhat controversial, both the magnitude and the rate of decrease in vascular access flow rate have been previously shown to predict venous stenoses and access site failure. The traditional approach for determining the vascular access flow rate is by Doppler flow imaging; however, these procedures are

224

Hemodialysis

expensive and cannot be performed during routine hemodialysis, and the results from this approach are dependent on the machine and operator. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Shear-enhanced system and methods for removing waste materials and liquid from the blood Inventor(s): Kunas, Gretchen; (Pleasanton, CA), Moriarty, Julie; (Evanston, IL), Vishnoi, Rohit; (Deerfield, IL) Correspondence: Baxter Healthcare Corporation; Bradford R.L. Price; Fenwal Division Rlp-30; Route 120 And Wilson Road; Round Lake; IL; 60073; US Patent Application Number: 20030146154 Date filed: February 2, 2002 Abstract: Systems and methods convey the blood through a gap defined between an inner surface that is located about an axis and an outer surface that is concentric with the inner surface. At least one of the inner and outer surfaces carries a membrane that consists essentially of either a hemofiltration membrane or a hemodialysis membrane. The systems and methods cause relative movement between the inner and outer surfaces about the axis at a selected surface velocity, taking into account the size of the gap. The relative movement of the two surfaces creates movement of the blood within the gap, which creates vortical flow conditions that induce transport of cellular blood components from the membrane while plasma water and waste material are transported to the membrane for transport across the membrane. Shear-enhanced transport of waste materials and blood plasma water results. Excerpt(s): This invention relates to systems and methods that remove waste materials and liquid from the blood of an individual whose renal function is impaired or lacking. For various reasons, including illness, injury or surgery, patients may require replacement or supplementation of their natural renal function in order to remove excess fluid or fluids containing dissolved waste products from their blood. Several procedures known for this purpose are hemodialysis, hemofiltration, hemodiafiltration and ultrafiltration. The invention provides shear-enhanced systems and methods for removing waste materials and liquid from the blood. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Spin-hemodialysis assembly and method Inventor(s): Ivansons, Ivars V.; (Wilmington, DE), Spencer, Dudley W.C.; (Wilmington, DE) Correspondence: Connolly Bove Lodge & Hutz Llp; P.O. Box 2207; Wilmington; DE; 19899-2207; US Patent Application Number: 20030155312 Date filed: February 15, 2002 Abstract: Blood is purified by removing the whole blood from a patient and feeding the blood into a manifold in a centrifuge. A purifying chamber is formed in the centrifuge from a plurality of co-arcuately arranged modules. The blood is supplied from the manifold to each of the modules. Each module contains a stack of dialysate membranes.

Patents 225

Fresh dialysate is fed into the manifold and then to each of the modules. Under centrifugal force the cells are separated from the plasma. The plasma is purified by removing contaminants as a result of the action of the dialysate and membranes. The purified blood is returned to the patient by being fed back to the manifold and then to the patient. The used dialysate/contaminants are fed from the modules back to the manifold and out of the centrifuge. Excerpt(s): Hemodialysis was advanced as a life sustaining therapy for end-stage renal failure, when in about 1925 it was discovered that a thin film of re-constituted cellulose (cellophane.RTM.) had the ability to separate chemical substances while in solution by means of their unequal diffusion through a permeable membrane. This phenomenon performed particularly well with blood to differentially separate out urea molecules. Over the years there have been many changes to incrementally improve the hemodialysis process. The fundamentals, however, remained the same. Hemodialysis essentially mimics the kidney function of processing whole blood, however, man-made membranes are a poor substitute for one's kidney function. Whole blood is made up of four major components: a) red blood cells, b) white blood cells, c) platelets, and d) plasma fluid. Since the toxins or ureas to be removed are in the plasma solution liquid portion of the whole blood, the cells just go along for the ride. The cells are also very fragile, so although they do not participate in the dialysis process directly, they do come in contact with the dialyzing membrane. Their presence, therefore, dominates the rate at which hemodialysis can proceed. Generally, a hemodialysis process takes place over a four to six hour time period for treatment and generally such treatments would be required 3 times per week. The dialyzer is also patient specific. During each treatment the patient's total blood volume is drawn from the patient, passed through a urea separation device and returned in a continuous fashion to the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Substantially inertia free hemodialysis Inventor(s): Wellman, Parris S.; (Hillsborough, NJ) Correspondence: Parris S. Wellman; 61-31 Taurus Drive; Hillsborough; NJ; 08844; US Patent Application Number: 20040009096 Date filed: June 5, 2003 Abstract: This invention is a membraneless filtration device and a method for performing hemodialysis on a patient using it and methods of manufacturing the filtration device. In a preferred embodiment, the filter is composed of at least one channel where the dialysate circumferentially surrounds the blood to reduce or eliminate the need for anticoagulation through reduced hemolysis and thrombogenicity. In the preferred embodiment the filter is configured to be used with a typical dialysis machine and hemodialysis is separated into an iso- or hyper-volemic filtration phase, followed by a phase where the patient's blood volume is reduced to normal levels. In another embodiment the device is adapted to be implanted or worn externally to serve as a portable artificial kidney. The device described herein could also find application as a blood oxygenator in cardiopulmonary bypass, or for use as an artificial liver or lung. Excerpt(s): This invention is generally related to the field of blood filtration and more particularly to hemodialysis. The invention is particularly useful for providing extracorporeal filtration of blood contaminants in a physiologically compatible manner, for example as a portable artificial kidney or artificial liver. End stage renal disease,

226

Hemodialysis

ESRD, afflicts some 977 patients per million in the United States alone. This implies that there are approximately 280,000 patients in the US, and there are an equal number in Europe. The disease has a prevalence of 329 per million, implying that 90,000 new patients are afflicted with ESRD a year. However, given the high mortality rate in the United States (approaching 25%/year) the actual population growth rate is about 9%. There are a number of treatments for ESRD including hemodialysis, peritoneal dialysis and kidney transplantation. Nearly 70% of the patients having ESRD are on chronic, maintenance hemodialysis. The aim of treatment is to replace the function of the kidneys in removing contaminants from the blood and to maintain the appropriate blood volume, whether hemodialysis or peritoneal dialysis is employed. Hemodialysis (HD) was invented early in the.sub.20th century, with the first successful chronic cases being performed in the 1950s. It is also known as the artificial kidney. It is based on the mechanism of diffusion through a semi-permeable membrane. The blood is brought in contact with one side of the membrane, and a dialysate solution (purified water with various concentrations of potassium, sodium and other agents designed to balance the diffusion from the blood across the membrane) is put on the other side of the membrane. Diffusion drives the solutes through the membrane until equilibrium is reached. Volume control is achieved by controlling the pressure differential across the membrane--osmosis drives water out of the blood and into the dialysate. This type of dialysis is typically performed 3-4 days a week for 3-4 hours each day in the United States. In the United States, approximately 200,000 ESRD patients receive hemodialysis, and this number is growing at an annual rate of approximately 9%. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and a method for tracking patients undergoing treatment and/or therapy for renal disease Inventor(s): Anderson, Jennifer; (Kenilworth, IL), Antkowiak, Steven; (Lake Zurich, IL), DeLaCruz, Rich; (Largo, FL), Firanek, Catherine; (Villa Park, IL), Grohe, Ed; (Largo, FL), Hayward, Mark; (Safety Harbor, FL), McCulloch, Kevin; (Wilmette, IL), McNally, Larry; (Mundelein, IL), Mujais, Salim; (Northbrook, IL), Schuh, Tom; (Wheaton, IL), Thomas, William; (Safety Harbor, FL), Wiggins, Curtis; (Brandon, FL) Correspondence: Patents+tms; A Professional Corporation; 1914 North Milwaukee Avenue; Chicago; IL; 60647; US Patent Application Number: 20040111293 Date filed: December 9, 2002 Abstract: A system and a method for tracking patients having renal disease, particularly Chronic Kidney Disease (CKD), are provided. The system and method track patients through a common system with multiple healthcare professionals, such as doctors, nurses and the like, having access to the system and updating the system based on information regarding the care, treatment, diagnosis, therapy, or the like provided to the patients. The system and method interface with remote machines and supply chains by a modem, via the internet or by wireless devices. The system and method provide a continuum of care for renal patients, i.e., CKD, peritoneal dialysis (PD), home hemodialyis (HHD), in-center hemodialysis and transplant within a single database associated with the system. Excerpt(s): The present invention generally relates to a system and method for tracking a patient. More specifically, the present invention relates to a system and a method for tracking patients throughout their therapy lifetime. Specifically, the system and the

Patents 227

method of the present invention is particularly applicable for patients whose care and/or treatment may vary in location or types of treatment which may result from the changing conditions of the patient. More specifically, the present invention relates to a system and method for tracking patient history for renal patients from the initial diagnosis of the patient of chronic kidney disease (CKD) through a therapy lifetime of a patient, i.e. CKD, peritoneal dialysis (PD), hemodialysis (HD) and/or transplant. It is, of course, generally known to track the history of a patient treated for a specific disease, ailment, condition, therapy, or the like. Usually, information regarding the patient is recorded by a healthcare professional, such as, a doctor, a nurse, or the like. Typically, paper or a chart is used for the doctor or nurse to input information regarding the patient during treatment and/or therapy. More recently, computers are implemented to record and to store information regarding a patient. The information may be input during a patient's visit or subsequently by office personnel, for example. Typically, in the case of a patient suffering from renal disease, often the various therapies required by the patient throughout the lifetime of the patient are separately tracked but not otherwise combined. Often, information from previous therapies are necessary to completely ascertain and/or to accurately evaluate the patient, the history of therapy to the patient and to diagnose and/or advise further treatment or the like for the patient. To do this, information recorded on paper or the separate software systems must be entered into other databases or other software tools and/or re-entered by viewing the appropriate history of interest of a particular patient. Further consideration in the treatment or therapy which the patient is seeking through an appropriate physician, facility, or other healthcare technician, professional, or the like may then be necessary. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System for determining blood flow rate in a vessel using diverted flow measurements Inventor(s): Messana, Joseph M.; (Ann Arbor, MI), Rubin, Jonathan M.; (Ann Arbor, MI), Weitzel, William F.; (Ypsilanti, MI) Correspondence: Brooks & Kushman; 1000 Town Center 22nd FL; Southfield; MI; 48075 Patent Application Number: 20030167030 Date filed: February 21, 2003 Abstract: A system and method are provided for determining the performance of a vessel, such as a hemodialysis access, which communicates blood between two locations of a patient. A conduit, such as an external dialysis circuit or an intravascular catheter, is provided in fluid communication with the vessel, and has a diversion point for diverting blood from the vessel into the conduit. The system further includes means for determining a flow rate of the diverted blood through the conduit. A first sensor in communication with the vessel generates at least one signal that is a function of a blood flow rate in the vessel downstream from the diversion point, wherein the downstream flow rate depends on the determined conduit flow rate and the performance of the vessel can be determined based on the signal. In addition, a processor can be provided in communication with the first sensor for determining a flow rate in the vessel upstream from the diversion point from the signal and the conduit flow rate. In a preferred embodiment, the first sensor is an ultrasonic sensor, and the at least one signal represents a time-averaged mean Doppler velocity of blood flow. Still further, additional sensors may be employed to provide a measure of the upstream flow rate as well as the conduit flow rate.

228

Hemodialysis

Excerpt(s): This application is a divisional of U.S. application Ser. No. 09/310,673 filed May 12, 1999, which is a continuation-in-part of U.S. application Ser. No. 09/160,685 filed Sep. 25, 1998, now U.S. Pat. No. 6,167,765. This invention relates to the field of hemodynamics, and more particularly to a system and method for measuring blood flow rate in a vessel, such as a hemodialysis access. Hemodialysis is a process by which blood is passed through an external dialysis circuit to replace the function of a patient's kidney. Blood is removed from the patient's vascular system via an arterial line, is passed through a dialysis filter, and is returned to the patient via a venous line. In order to simplify the withdrawal and return of blood, many dialysis patients have an arteriovenous shunt, or access, surgically created between an artery and vein in a location in the body, such as the upper or lower arm. The access provides a permanent site where the arterial line and venous line can be connected to the patient. A vascular access may be constructed from a native arteriovenous fistula, which is a direct connection of a patient's artery to one of his/her veins, or alternatively may be constructed from a synthetic material, typically polytetrafluoroethylene (PTFE). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Transcutaneous hemodialysis access system Inventor(s): De Paolis, Potito U.; (Los Angeles, CA), Salehmoghaddam, Saleh; (Los Angeles, CA) Correspondence: Alan C. Rose; Oppenheimer Wolff & Donnelly Llp; Suite 3800; 2029 Century Park East; Los Angeles; CA; 90067; US Patent Application Number: 20040064079 Date filed: September 30, 2002 Abstract: The present invention discloses a vascular access device for hemodialysis, particularly, a transcutaneous access device. The transcutaneous access is optionally connected to one or more subcutaneous blood tubing and one or more sterile connectors which attach to the device and keeps the device sterile from external contamination when not in use. Advantages of the transcutaneous access include the elimination of the need to apply local anesthetic to the patient in order locate the access, the unnecessary bleeding or bruising of the patient and the reduction of total time of the dialysis procedure. Excerpt(s): This invention relates generally to a transcutaneous hemodialysis access system. Specifically, the present invention identifies and describes a transcutaneous hemodialysis access system to eliminate the need for local anesthetic injections in order to locate the access. About 300,000 persons in the United States receive some sort of dialysis. A general description of dialysis is given in A. R., Nissenson & R. N. Fine, "Dialysis Therapy," (3d ed., Hanley & Belfus, Inc., Philadelphia, Pa., 2002), incorporated herein by this reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 229

•

Use of inhibitors of soluble epoxide hydrolase to inhibit vascular smooth muscle cell proliferation Inventor(s): Hammock, Bruce D.; (Davis, CA), Weiss, Robert H.; (Vacaville, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030139469 Date filed: January 23, 2002 Abstract: The present invention provides methods of slowing or inhibiting vascular smooth muscle (VSM) cell proliferation to slow the development or recurrence of atherosclerosis by contacting VSM cells with soluble epoxide hydrolase (sEH) inhibitors. Further, the methods of the invention can be used to slow or to inhibit vascular restenosis after angioplasty and the stenosis of vascular stents. Further, the methods of the invention can be used to slow or to inhibit the stenosis of hemodialysis grafts and other natural and synthetic vascular grafts. Excerpt(s): This invention relates to slowing or inhibiting the proliferation of vascular smooth muscle cells and the consequent slowing or inhibiting of the development of atherosclerosis. Eicosanoids serve both paracrine and autocrine functions in a variety of cells, including those of the vasculature. The cis-epoxyeicosatrienoic acids (EETs), epoxides of arachidonic acid comprising one class of eicosanoid, consist of four regioisomers which are synthesized from arachidonic acid in a reaction catalyzed by the cytochrome P-450 system (Capdevila et al., FASEB J., 6:731-736 (1992)). These compounds are synthesized by endothelial cells and are rapidly taken up by arterial vascular smooth muscle (VSM) cells (Fang et al., Prostaglandins Leukot. Essent. Fatty Acids, 57:367-371 (1997); Fang et al., Circ. Res., 79:784-793 (1996); Rosolowsky et al., Biochim. Biophys. Acta, 1299:267-277 (1996)). Epoxide hydrolases are enzymes which, broadly defined, convert epoxides to diols by the addition of water (Fretland et al., Chem. Biol. Interact. 2000Dec. 1; 129(1-2):41.-59., 129:41-59 (2000)). While these enzymes have been studied largely in light of their roles in degrading and de-toxifying mutagenic xenobiotics, at least the soluble epoxide hydrolase also is critical in the control of EET levels, due to its ability to catalyze the degradation of the EETs into diols (Chacos et al., Arch. Biochem. Biophys., 223:639-648 (1983)). Pharmacological attenuation of sEH activity causes a secondary increase in EET levels (Yu et al., Circ. Res. 2000. Nov. 24.; 87(11):992.-8, 87:992-998 (2000). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Waste liquid treatment apparatus for hemodialysers Inventor(s): Ishibashi, Junko; (Tsukuba-shi, JP), Kimura, Kenichiro; (Tokyo, JP), Sun, Xulin; (Tsukuba-shi, JP) Correspondence: Linda K. Russell; Air Liquide; Suite 1800; 2700 Post Oak BLVD.; Houston; TX; 77056; US Patent Application Number: 20040069718 Date filed: July 28, 2003 Abstract: ProblemsA dialysis waste liquid treatment apparatus is provided, in which the formation of plugs in lines can be restrained and in which COD and BOD of hemodialysis waste liquid can be effectively reduced, without requiring a wide

230

Hemodialysis

space.Means for SolutionA waste liquid treatment apparatus for hemodialyzers, which comprises a transport pipe for transporting dialysis waste liquid produced from a hemodialyzer, a bacteriostatic treatment tank for restraining the propagation of bacteria caused by the dialysis waste liquid transported by said transport pipe and an ozone water ejection nozzle for ejecting ozone water into said bacteriostatic treatment tank. Excerpt(s): The present invention relates to a waste liquid treatment apparatus for hemodialyzers. Waste liquid of hemodialyzers is rich in nutrients such as grape sugar and its chemical oxygen demand (COD) and biochemical oxygen demand (BOD) are higher, and hence it is preferred to lower COD and BOD before the waste liquid is discharged to a sewer. Hemodialysis waste liquid can be subjected to biological treatment if equipment such as an activated sludge tank is disposed. Since a wide space is required for installation of an activated sludge tank, however, it is almost impossible to install an activated sludge tank in a clinic or the like which is in a tenant building positioned in an urban area or particularly at the center of a city. In the existing condition, accordingly, hemodialysis waste liquid produced in most of the clinic in an urban area is directly discharged to a sewerage or public water zone, as it is, not subjected to any special treatment, or after only pH thereof has been regulated. As an apparatus for treating hemodialysis waste liquid, there has been hitherto known, for example, one disclosed in the official gazette of Japanese Patent Application Laid-open (KOKAI) No. 14,947/2001. This is an apparatus of effectively mixing dialysis waste liquid and ozone water in a tank. This apparatus is aimed at removing odors of dialysis waste liquid and decomposing nutrients contained in the dialysis waste liquid. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with hemodialysis, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “hemodialysis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on hemodialysis. You can also use this procedure to view pending patent applications concerning hemodialysis. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

231

CHAPTER 6. BOOKS ON HEMODIALYSIS Overview This chapter provides bibliographic book references relating to hemodialysis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on hemodialysis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “hemodialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on hemodialysis: •

Clinical Practice Guidelines for Hemodialysis Adequacy Source: New York, NY: National Kidney Foundation. 1997. 158 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax (212) 689-9261. PRICE: $13.00. ISBN: 0962972142. Summary: In March 1995, the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) was established, with the objective of improving patient outcomes and survival by providing recommendations for optimal clinical practices in four areas: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and the treatment of anemia of chronic renal failure (CRF). This document presents 16 clinical practice guidelines for hemodialysis adequacy. They are categorized in six sections: measurement of hemodialysis adequacy, hemodialysis dose, blood urea nitrogen (BUN) sampling, hemodialyzer reprocessing and reuse, hemodialysis dose troubleshooting, and maximizing patient compliance to the hemodialysis prescription.

232

Hemodialysis

Each guideline is accompanied by a rationale, enabling dialysis caregivers to make informed decisions about the proper care plan for each individual patient. This document also includes a list of acronyms and abbreviations, a description of the guideline development methodology, endnotes, references, biographical sketches of the NKF-DOQI hemodialysis adequacy work group members, and a complete listing of the articles reviewed by the hemodialysis adequacy work group. 3 figures. 7 tables. 185 references. (AA-M). •

Diet Guide for Hemodialysis Source: Springfield, MO: Ozarks Dialysis Services. 199x. 22 p. Contact: Available from Ozarks Dialysis Services. 330 East Division, Springfield, MO 65803. (417) 836-3443. PRICE: $5. Summary: This book provides an easy-to-read introduction to the diet therapy typically prescribed for people on hemodialysis. Topics covered include general information about diet therapy; the role of protein, sodium, potassium, fluids, phosphorus, calories, vitamins, and minerals; sample meal plans; exchange list information for the meat, starch, vegetable, fruit, and fat groups; meat and vegetable preparation; beverages; suggestions for adding calories to the meal plan; foods to avoid; and tips for eating out in restaurants.

•

Prescribing Hemodialysis: A Guide to Urea Modeling Source: Hingham, MA: Kluwer Academic Publishers. 1991. 313 p. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018. (617) 871-6600. PRICE: $87.50. ISBN: 0792308336. Summary: This book provides the practicing nephrologist with both the theoretical and the practical approaches to the prescription of dialysis, and the monitoring of its delivery and outcome. Early chapters review the understanding of uremic toxins, with a focus on urea as a toxin and as a surrogate for other highly dialyzable toxins. Chapter 3 introduces urea modeling, the clinical requirements and advantages of modeling, and various models used in the past. Chapters 4 and 5 provide an in-depth discussion of the single-compartment model and a more complex, two compartment model. Chapter 6 is a guide to UREAKIN, a user-friendly computer program for rapid implementation of urea modeling. Chapter 7 outlines the refinements and application of urea modeling, while Chapter 8 reviews the most controversial aspect of urea modeling, the criteria for establishing ideal or target outcomes. Final chapters provide concrete examples of urea modeling and presents projections for the future. Each chapter includes numerous tables, figures, and references. Nine appendixes, a listing of variables and abbreviations used, and a subject index are included. 344 references.

•

Diet for Hemodialysis Source: West Linn, OR: Oregon Council on Renal Nutrition. 1991. 28 p. Contact: Available from Oregon Council on Renal Nutrition. Nancy Frazeur, R.D., 5431 Windsor Terrace, West Linn, OR 97068. PRICE: $5 (bulk prices available). Also available as one of three books in a series for $10. Summary: This book, part of a series of three books for renal patients, presents a basic guide to the diet therapy commonly prescribed for patients on hemodialysis. Numerous charts and lists cover the basics of a renal diet, including: common abbreviations;

Books

233

protein; potassium; phosphorus and calcium; sodium and fluids; caloric intake; appetite; eating in restaurants; vitamins; constipation; and sick day rules. Color-coded charts list the exchange information for dairy, meat, breads and starches, vegetables, fruits, fats, beverages, and free foods. The book is written at the 5th grade reading level and is also appropriate for patients with diabetes. 5 references. •

Urea Kinetics in Nutritional Management of Pre-End-Stage Renal Disease, Including Hemodialysis Applications Source: Morgan Hill, CA: Council on Renal Nutrition, Northern California-Northern Nevada. 1993. 30 p. Contact: Available from Council on Renal Nutrition, Northern California-Northern Nevada. c/o Elaine Rodgers, 560 Caprice Court, Morgan Hill, CA 95037. PRICE: $14.95 plus $2.50 postage (as of 1995). ISBN: 1883146518. Summary: This handbook describes the clinical use of urea kinetics in the nutritional management of the pre-ESRD patient. The handbook includes formulas and examples needed to calculate protein requirements and nitrogen balance in this patient population. Topics include the nutritional applications of protein catabolic rate; the calculation of protein catabolic rate; the calculation of creatinine clearance and creatinine generation rate; the use of creatinine data; spot urine; prediction of BUN on a prescribed level of protein intake and known renal function; the differences created by patient size; and practical guidelines for the use of urea kinetics. Also included are a summary of formulas and abbreviations; a clinical nutritional assessment summary; a urea kinetics summary worksheet; guidelines for determining lean body weight; and urine collection instructions. The booklet concludes with a brief glossary. 14 references.

•

Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed Source: St. Louis, MO: Mosby. 1999. 371 p. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: This text poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. Twenty-three chapters cover the hemodialysis team, the basic chemistry of body fluids and electrolytes, renal physiology and the pathology of renal failure, principles of hemodialysis, dialyzers and dialysate, water treatment, dialyzer preparation and reprocessing, access to the bloodstream, patient and machine monitoring and assessment, anticoagulation and heparin administration, medication problems and dialysis, nutrition management, acute renal failure and dialysis, complications of chronic dialysis therapy, transplantation, peritoneal dialysis and home dialysis therapies, diabetes and hemodialysis, infection control and universal precautions, the psychosocial aspects of dialysis therapy, pediatric hemodialysis, end stage renal disease (ESRD) in the elderly, management of quality in dialysis care, and renal care and information technology. The text concludes with references and recommended readings, a listing of nephrology organizations and resources, a glossary of terms, a subject index, and three appendices: conversion factors used in hemodialysis, conversion table for pounds to kilograms of body weight, and the sodium and potassium content of selected foods. The text offers charts and drawings where appropriate. The authors focus on giving members of the dialysis team (including

234

Hemodialysis

nurses, technicians, dietitians, pharmacologists, social workers, and patients) a strong foundation of basic information and an understanding on the necessary interdisciplinary approach to quality care in the dialysis field. 117 references. •

Treatment Methods for Kidney Failure: Hemodialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2001. 14 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 014666. Summary: When the kidneys fail, harmful wastes build up in the body, the blood pressure may rise, and the body may retain excess fluid and not make enough red blood cells. When this happens, treatment is required to replace the work of the failed kidneys. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. This booklet helps readers recently diagnosed with kidney failure understand hemodialysis. Topics include how hemodialysis works, adjusting to changes, getting the vascular access ready, equipment and procedures, tests to monitor how well the dialysis is working, conditions related to kidney failure and their treatments (anemia, renal osteodystrophy, itching, sleep disorders, amyloidosis), how diet can help, financial issues, and current research in this area. Medical or technical terms are defined in the text. The booklet concludes with a list of resources for additional information and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 6 figures.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “hemodialysis” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “hemodialysis” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “hemodialysis” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Adequacy of Hemodialysis by Rpa Singer, Renal Physicians Association; ISBN: 0787218804; http://www.amazon.com/exec/obidos/ASIN/0787218804/icongroupinterna

•

An Assessment Study of the Effect of Cost and Dose on the Hemodialysis Treatment in Colombia by Victor Hugo Nunez; ISBN: 158112077X; http://www.amazon.com/exec/obidos/ASIN/158112077X/icongroupinterna

Books

235

•

Biocompatibility in Hemodialysis (Contributions to Nephrology) by C. A. Baldamus; ISBN: 3805536011; http://www.amazon.com/exec/obidos/ASIN/3805536011/icongroupinterna

•

Biological Reactions Within the Extracorporeal Blood Circuit During Hemodialysis (Contributions to Nephrology, Vol 59) by K.M. Koch; ISBN: 3805545789; http://www.amazon.com/exec/obidos/ASIN/3805545789/icongroupinterna

•

Chronic Hemodialysis As a Way of Life by J.W. Czaczkes; ISBN: 0876301650; http://www.amazon.com/exec/obidos/ASIN/0876301650/icongroupinterna

•

Chronic Inflammation in Hemodialysis by J. Botella, et al; ISBN: 380557083X; http://www.amazon.com/exec/obidos/ASIN/380557083X/icongroupinterna

•

Competency Based Orientation Manual for Hemodialysis Nursing by Roberta A. Stokes; ISBN: 0080406963; http://www.amazon.com/exec/obidos/ASIN/0080406963/icongroupinterna

•

Death on Hemodialysis by Eli A. Friedman; ISBN: 0792326520; http://www.amazon.com/exec/obidos/ASIN/0792326520/icongroupinterna

•

First-use syndrome and hypersensitivity in hemodialysis; ISBN: 0936022302; http://www.amazon.com/exec/obidos/ASIN/0936022302/icongroupinterna

•

Long-Term Hemodialysis by N. K. Man, et al; ISBN: 0792334779; http://www.amazon.com/exec/obidos/ASIN/0792334779/icongroupinterna

•

Maintenance hemodialysis by Lucius F Wright; ISBN: 0816121729; http://www.amazon.com/exec/obidos/ASIN/0816121729/icongroupinterna

•

Membranes and Filters for Hemodialysis Database 2001 by C. Ronco, et al; ISBN: 3805570627; http://www.amazon.com/exec/obidos/ASIN/3805570627/icongroupinterna

•

Membranes And Filters For Hemodialysis Database 2004 by C. Ronco; ISBN: 3805577788; http://www.amazon.com/exec/obidos/ASIN/3805577788/icongroupinterna

•

Memory Bank for Hemodialysis by Oscar M Cairoli; ISBN: 0935236198; http://www.amazon.com/exec/obidos/ASIN/0935236198/icongroupinterna

•

Pathology of Maintenance Hemodialysis by Majid Ali; ISBN: 0398045887; http://www.amazon.com/exec/obidos/ASIN/0398045887/icongroupinterna

•

Prescribing Hemodialysis by Thomas A. Depner; ISBN: 0792308336; http://www.amazon.com/exec/obidos/ASIN/0792308336/icongroupinterna

•

Review of Hemodialysis for Nurses and Dialysis Personnel by C. F., MD Gutch, et al; ISBN: 0815120990; http://www.amazon.com/exec/obidos/ASIN/0815120990/icongroupinterna

•

Textbook of Hemodialysis for Patient Care Personnel by Mark A. Newberry; ISBN: 0398055165; http://www.amazon.com/exec/obidos/ASIN/0398055165/icongroupinterna

•

The Reuse of hemodialysis devices labeled “for single use only.” (SuDoc HE 20.6512/7:986/11) by U.S. Dept of Health and Human Services; ISBN: B000102J8U; http://www.amazon.com/exec/obidos/ASIN/B000102J8U/icongroupinterna

•

Vascular access for hemodialysis by Bruce G Sommer; ISBN: 0944496032; http://www.amazon.com/exec/obidos/ASIN/0944496032/icongroupinterna

236

Hemodialysis

•

Vascular Access for Hemodialysis by Mitchell L. Henry; ISBN: 0944496679; http://www.amazon.com/exec/obidos/ASIN/0944496679/icongroupinterna

•

Vascular access for hemodialysis (SuDoc HE 20.3302:H 37/5) by U.S. Dept of Health and Human Services; ISBN: B0001128TY; http://www.amazon.com/exec/obidos/ASIN/B0001128TY/icongroupinterna

•

Vascular Access for Hemodialysis II by Bruce G. Sommer, Mitchell Henry; ISBN: 0944496202; http://www.amazon.com/exec/obidos/ASIN/0944496202/icongroupinterna

•

Vascular Access for Hemodialysis III by Mitchell Henry; ISBN: 0944496369; http://www.amazon.com/exec/obidos/ASIN/0944496369/icongroupinterna

•

Vascular Access for Hemodialysis VI by Mitchell L. Henry, Mitchell L., M.D. Henry; ISBN: 094449661X; http://www.amazon.com/exec/obidos/ASIN/094449661X/icongroupinterna

•

Vascular Access for Hemodialysis-IV (Vascular Access for Hemodialysis IV) by Mitchell L., M.D. Henry, Ronald M., M.D. Ferguson; ISBN: 0944496458; http://www.amazon.com/exec/obidos/ASIN/0944496458/icongroupinterna

•

World renal and hemodialysis equipment and supply markets; ISBN: 0788900153; http://www.amazon.com/exec/obidos/ASIN/0788900153/icongroupinterna

Chapters on Hemodialysis In order to find chapters that specifically relate to hemodialysis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hemodialysis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “hemodialysis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on hemodialysis: •

Cardiac Disease in Hemodialysis and Peritoneal Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 269-302. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Cardiac disease exerts a major influence on the morbidity and mortality of dialysis patients, as demonstrated by the frequent occurrence of heart failure and ischemic heart disease, very high mortality (death) rates, and the high proportion of cardiac deaths. This chapter on cardiac disease in hemodialysis and peritoneal dialysis patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. Most reports point to similar survival in chronic ambulatory peritoneal dialysis (CAPD) and in center hemodialysis (HD) patients. On average, hospital admission rates per patient year were 14 percent higher for peritoneal dialysis

Books

237

(PD) patients than for HD patients after adjustment for race, age, gender, and cause of end stage renal disease (ESRD). However, the causes of this higher hospital admission rate in PD patients were not studied. The authors discuss myocardial disease, disorders of perfusion, cardiac structure and function, cardiac arrhythmias, and risk factors for cardiac disease. Hemodynamic risk factors discussed include volume overload, salt and water retention, anemia, hypertension, and aortic stenosis; metabolic risk factors discussed include hypoalbuminemia, abnormal calcium phosphate homestasis, dyslipidemia, hyperhomocysteinemia, and oxidant stress. The authors consider other risk factors, notably smoking, diabetes mellitus, and valvular calcifications in PD patients. The authors offer guidelines for screening patients for cardiovascular disease, including the clinical assessment of cardiac status, noninvasive testing for cardiomyopathy, noninvasive testing for coronary artery disease, coronary angiography, and screening for cardiac arrhythmias. The chapter concludes with guidelines for patient management in the areas of volume overload, anemia, hypertension, hyperlipidemia, hyperhomocysteinemia, management of heart failure, coronary artery revascularization, cardiac arrhythmias, and pericarditis. 12 figures. 7 tables. 287 references. •

Surveillance, Revision, and Outcome of Vascular Access Procedures for Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 149-154. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: Chronic hemodialysis patients undergo revision of a thrombosed graft or placement of a temporary central venous catheter an average of once a year. This chapter on surveillance, revision, and outcome of vascular access (VA) procedures for hemodialysis (HD) is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The authors discuss patency rates, site selection, prediction of access failure, venous return pressure, graft revision and thrombectomy (removal of blood clots), and anticipated outcome. The authors conclude that the goals of establishing and maintaining long term hemodialysis access in end stage renal disease (ESRD) patients have remained elusive. The authors recommend a collaborative effort among the vascular surgeon, interventional radiologists, and dialysis staff that is aimed at standardizing graft surveillance and optimizing function. 1 table. 25 references.

•

Diabetes and Hemodialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 254-263. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Diabetes mellitus is the leading cause of end stage renal disease (ESRD) in the United States. This chapter on diabetes and hemodialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter describe the two

238

Hemodialysis

types of diabetes and review diabetes monitoring and care, then discuss diabetic nephropathy, a kidney disease caused by diabetes. The pathology in diabetic nephropathy is glomerulosclerosis, a fibrotic thickening of the glomeruli. As the disease progresses, the glomeruli lose their ability to filter blood effectively, resulting in the accumulation of waste products such as urea and creatinine in the body. Progression of diabetic nephropathy can be delayed by the use of an ACE (angiotensin converting enzyme) inhibitor medication. Initiation of dialysis depends on the individual needs and condition of the patient, but a clear indicator is a low creatinine clearance combined with symptomatic edema (fluid accumulation). It is particularly important to maintain blood pressure control in patients with diabetes, in order to reduce the risks of diabetic retinopathy (eye disease), as well as cardiovascular and peripheral vascular disease. The authors conclude by reviewing other assessments and nursing care strategies that can be useful in patients with diabetes. 2 tables. •

Hemodialysis Team Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 1-9. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Dialysis, the process of cleansing the blood of accumulated waste products, is a complex treatment requiring a team of highly trained individuals with a variety of skills. This chapter on the hemodialysis team is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The author of the chapter stresses that for dialysis to be successful, the interdisciplinary team must work with the patient and family, supporting them in the areas of clinical need, psychosocial needs, and religious beliefs. Team members will include, but not be limited to, the physician (nephrologist), nurse, technician, dietitian, social worker, and administrator. Other team members might include a biomedical technician, psychologist, dentist, child development specialist, pharmacist, physician's assistant, vocational rehabilitation counselor, member of the clergy, coach, school teacher, or others who have special skills needed to help the patient reach maximum potential. The author outlines the functions of each member, standards of practice, education and training considerations, and ethics, rights, and responsibilities. The chapter emphasizes that the patient and family members are also integral components of the dialysis team.

•

What is Hemodialysis? Source: in KT/DA (Kidney Transplant/Dialysis Association, Inc.). KT/DA Patient Handbook. 4th ed. Boston, MA: KT/DA (Kidney Transplant/Dialysis Association, Inc.). 2003. p. 7-11. Contact: Available from KT/DA (Kidney Transplant/Dialysis Association, Inc.). P.O. Box 51362 GMF, Boston, MA 02205-1362. (781) 641-4000. Email: [email protected]. Website: www.ktda.org. PRICE: Full-text available online at no charge. Summary: Hemodialysis has long ago gone from an experimental procedure and last ditch stand against end stage renal disease (ESRD) to a well-established and effective therapy for the rehabilitation of the patient with chronic kidney disease. Although the

Books

239

artificial kidney approximates only some of the human kidney's many functions, the body nevertheless adjusts remarkably well to the state maintained by the machine. This chapter on hemodialysis is from a book that was written to help kidney patients understand the forms of treatment available for their kidney disease and the impact of each form of treatment on the patient's quality of life. This chapter provides readers with an understanding of the working of the hemodialysis equipment, its usefulness, and its limitations. The book is created and published by the Kidney Transplant/Dialysis Association, a non-profit, all-volunteer organization of dialysis and transplant patients, their families, and friends. •

Hemodialysis Source: in Schena, F.P., ed. Nephrology. New York, NY: McGraw-Hill, Inc. 2001. p. 439450. Contact: Available from McGraw-Hill, Inc. Shoppenhangers Road, Maidenhead, Berkshire SL6 2QL. 44 (0)1628 502700. Fax: +44 (0)1628 635895 E-mail: [email protected]. Website: www.mcgraw-hill.co.uk. PRICE: $79.95; plus shipping and handling. ISBN: 0077095251. Summary: Hemodialysis is a process that removes unwanted solutes from the body by continuous treatment of the blood at a location outside the body. Blood is routed from a blood vessel that has a high blood flow rate to an external device where the blood goes across a semipermeable membrane with a buffered physiologic salt solution, called the dialysate. The returning dialyzed blood then equilibrates with tissues throughout the body, effectively reducing tissue concentrations of solutes that are not contained in the dialysate. This chapter on hemodialysis is from a book on nephrology (the study of the kidney and kidney diseases) designed for general practitioners and family care providers that offers strategies for the management of patients with renal (kidney) damage. Hemodialysis is the most common form of renal replacement therapy. Although kidney transplantation is the preferred method of treatment for kidney failure, the supply of donor organs is limited, so hemodialysis is and will continue to be the predominant form of renal replacement in the foreseeable future. Mortality (death) rates are high and rise steeply with age, but indefinite survival is possible on hemodialysis. The most common causes of mortality are cardiovascular disease and infections. Mortality is highly correlated with patient characteristics such as age and diabetes and with dialysis factors such as the amount of dialysis. Improved quality of life and reduced risk from hemodialysis have resulted from developments in membrane chemistry, water preparation, and dialysate delivery systems and from reversal of severe anemia with recombinant erythropoietin. The vascular access device continues to be a source of expense and hospitalization. The author notes that psychological adjustments to end stage renal disease (ESRD) and to dialysis can be major hurdles for the patient. 3 tables. 12 references.

•

Hematological Problems and Their Management in Hemodialysis and Peritoneal Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 303-325. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710.

240

Hemodialysis

Summary: It has long been recognized that the major hematological (blood) complication of chronic renal failure (CRF) is a progressive and often severe chronic anemia. Although this has many causes, the primary cause is inadequate production of the hormone erythropoietin by the diseased kidneys. This chapter on hematological problems and their management in hemodialysis (HD) and peritoneal dialysis (PD) patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The advent of recombinant human erythropoeitin (epoetin) transformed the clinical situation, and millions of patients have experienced the secondary benefits of having their anemia corrected. Many studies have confirmed the improvements in quality of life, exercise capacity, and cardiac function associated with epoetin treatment, and preliminary evidence now shows a reduction in long term cardiovascular morbidity and mortality. The author also discusses problems associated with epoetin therapy, including functional iron deficiency and epoetin resistance. The author briefly discusses adjuvant therapies that may be used in combination with epoetin, including the development of other erythorpoietic substances. 7 figures. 5 tables. 144 references. •

Arthropathies and Bone Diseases in Hemodialysis and Peritoneal Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 343-359. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Renal osteodystrophy refers to a collection of bone disorders that affect virtually all patients with end stage renal disease (ESRD). This chapter on arthropathies and bone diseases in hemodialysis (HD) and peritoneal dialysis (PD) patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The authors of this chapter describe the clinical and pathological features of the bone disorders collectively referred to as renal osteodystrophy. The additive role that metabolic acidosis may play in these disorders is also covered. The most common form of renal osteodystrophy is osteitis fibrosa cystica (OFC), a lesion defined by changes including bone marrow fibrosis, a parathyroid hormone stimulated increase in the number and activity of osteoclasts, and an increase in osteoid and nonlamellar bone. OFC is typically asymptomatic until ESRD, when bone pain and fractures may occur. Treatment (of both predialysis and dialysis patients) focuses on the control of serum (blood) phosphate, with control of dietary phosphate, and the use of phosphorus binding agents and calcitriol. The chapter also considers the manifestation, diagnosis, and treatment of aluminum induced bone disease; dialysis related amyloidosis; and metabolic acidosis and bone disease. 6 figures. 1 table. 99 references.

•

Home and Center Hemodialysis Source: in KT/DA (Kidney Transplant/Dialysis Association, Inc.). KT/DA Patient Handbook. 4th ed. Boston, MA: KT/DA (Kidney Transplant/Dialysis Association, Inc.). 2003. p. 21-22.

Books

241

Contact: Available from KT/DA (Kidney Transplant/Dialysis Association, Inc.). P.O. Box 51362 GMF, Boston, MA 02205-1362. (781) 641-4000. Email: [email protected]. Website: www.ktda.org. PRICE: Full-text available online at no charge. Summary: The patient who is unable to have, or does not want, a transplant in the foreseeable future and who has a spouse or other family member willing and able to assist in the treatments, may be a candidate for home dialysis. This chapter on home dialysis is from a book that was written to help kidney patients understand the forms of treatment available for their kidney disease and the impact of each form of treatment on the patient's quality of life. The author notes that home dialysis affords the patient a degree of flexibility in scheduling not possible in a center. However, home dialysis involves and restricts the family, in particular the family member-therapist. This chapter explores the advantages and disadvantages of home dialysis. The book is created and published by the Kidney Transplant/Dialysis Association, a non-profit, all-volunteer organization of dialysis and transplant patients, their families, and friends. •

Disaster Diet Information for Hemodialysis Patients Source: in American Dietetic Association. Clinical Guide to Nutrition Care in End-Stage Renal Disease. Chicago, IL: American Dietetic Association. 1994. p. 227-228. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard Chicago, IL 60606-6995. (312) 899-0040. PRICE: $24 for members; $28 for non-members; plus shipping and handling. ISBN: 0880911247. Summary: This appendix chapter, from a manual that provides guidelines for the clinical nutrition care of patients with end-stage renal disease (ESRD), provides diet information to teach hemodialysis patients what to do in the event a natural disaster occurs and dialysis becomes unavailable in their local area. The author lists 10 recommendations, covering topics including selecting foods and limiting fluids; protein intake; avoiding foods that are high in sodium and/or potassium; and considerations for patients with diabetes. The article concludes with a suggested emergency food list, with size of servings noted for each of eight sections: milk; meat and protein; fruit; beverages; fats; vegetables; breads, cereal and pasta; and sweets.

•

Hemodialysis Access Source: in KT/DA (Kidney Transplant/Dialysis Association, Inc.). KT/DA Patient Handbook. 4th ed. Boston, MA: KT/DA (Kidney Transplant/Dialysis Association, Inc.). 2003. p. 49-60. Contact: Available from KT/DA (Kidney Transplant/Dialysis Association, Inc.). P.O. Box 51362 GMF, Boston, MA 02205-1362. (781) 641-4000. Email: [email protected]. Website: www.ktda.org. PRICE: Full-text available online at no charge. Summary: This chapter on hemodialysis access is from a book that was written to help kidney patients understand the forms of treatment available for their kidney disease and the impact of each form of treatment on the patient's quality of life. A vascular access device connects the patient's blood stream, or circulation, to the machine. Blood flows from the patient to the machine, is cleansed, and returned. Temporary access devices are plastic tubes (catheters) which are inserted directly into a large vein. More permanent access is obtained by creating a high flow connection between an artery and a vein, typically in the patient's arm, which can be hooked up quickly and easily to the dialysis machine. The authors answer many of the most common questions patients ask about vascular access devices: what they are, how they work, what to expect during and after

242

Hemodialysis

the operation to place an access device, and what can go wrong. The book is created and published by the Kidney Transplant/Dialysis Association, a non-profit, all-volunteer organization of dialysis and transplant patients, their families, and friends. •

Anemia in Patients with Chronic Renal Failure and in Patients Undergoing Chronic Hemodialysis Source: in KT/DA (Kidney Transplant/Dialysis Association, Inc.). KT/DA Patient Handbook. 4th ed. Boston, MA: KT/DA (Kidney Transplant/Dialysis Association, Inc.). 2003. p. 131-134. Contact: Available from KT/DA (Kidney Transplant/Dialysis Association, Inc.). P.O. Box 51362 GMF, Boston, MA 02205-1362. (781) 641-4000. Email: [email protected]. Website: www.ktda.org. PRICE: Full-text available online at no charge. Summary: This chapter on anemia in patients with chronic renal (kidney) failure (CRF) and in patients undergoing chronic hemodialysis is from a book that was written to help kidney patients understand the forms of treatment available for their kidney disease and the impact of each form of treatment on the patient's quality of life. The authors define anemia as a reduction in the oxygen-carrying capacity of blood. The typical anemia in kidney disease is a result of a decreased production of red blood cells by the bone marrow. This defect in red blood cell production is largely explained by the inability of the failing kidneys to secrete the hormone erythropoietin. The authors describe the symptoms of anemia, the role of hemodialysis in this anemia, and treatment options, notably treatment with recombinant erythropoietin. The book is created and published by the Kidney Transplant/Dialysis Association, a non-profit, allvolunteer organization of dialysis and transplant patients, their families, and friends.

•

Autologous Arteriovenous Fistulas: Direct Anastomosis for Hemodialysis Access; Autogenous Vein for Fistulas and Interpositional Grafts Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 82-96. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on autologous (using the patient's own tissues) arteriovenous fistulas is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The first part of the chapter discusses the techniques used in constructing a BresciaCimino fistula. The second part reviews some of the other autogenous fistulas commonly constructed. The author describes the complications and their management that may be encountered in each type of fistula. The Brescia-Cimino fistula continues to be regarded as the ideal form of access because it offers superior long-term patency rates, lower incidence and ease of managing infectious complications, and a relatively low incidence of other complications such as aneurysm formation. However, this technique is used only in a minority of patients, for reasons such as urgency of dialysis and poor-quality vessels (particularly in the elderly and diabetes populations). The author encourages the access surgeon to familiarize him or herself with a larger range of possibilities from which to choose an appropriate autogenous fistula for the individual patient. 14 figures. 1 table. 59 references.

Books

•

243

Central Venous Cannulation for Hemodialysis Access Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 114-131. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on central venous cannulation for hemodialysis (HD) access is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The authors note that although surgically created arteriovenous (AV) shunts and fistulas offer many advantages over percutaneous catheters for long-term hemodialysis, percutaneous catheters offer simplicity, safety, and immediacy, as well as a different scope of applicability. The use of percutaneous catheters is the method of choice for initiating hemodialysis in the setting of acute renal (kidney) failure (ARF). Dual-lumen catheters can be placed virtually on demand and used immediately after placement. The authors discuss equipment and insertion techniques, equipment selection, vascular access routes, site selection, nonstandard approaches, indications and patient selection, and complications. The authors conclude that there still is no truly ideal vascular access site or method; the best choice for a specific patient always involves balancing tradeoffs by assessing the overall clinical situation, prior vascular access history, planned surgical access creation, and any renal transplant history or plans, based on a thorough understanding of the available options. 7 figures. 1 table. 37 references.

•

Nutrition in Maintenance Hemodialysis Patients Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 563-600. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on nutrition in maintenance hemodialysis patients is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The authors first consider factors altering nutrient requirements in this patient population, including anorexia, financial difficulties, depression or other psychological problems, comorbid illnesses, and losses of nutrients during hemodialysis. The authors then provide specific considerations for the dietary therapy of patients on maintenance hemodialysis, a therapy undertaken to achieve and maintain good nutritional status and to prevent or ameliorate uremic toxicity and other nutritionally influenced metabolic disorders that occur in renal failure. Compliance with special diets is often a challenging endeavor for many patients and their families. The authors discuss protein, calorie intake, sodium and water, lipids, potassium, magnesium, calcium, vitamin D, phosphorus, other vitamins, trace elements, and carnitine requirements. They conclude with a discussion of assessment of nutritional status, both prior to and during dietary therapy. Additional topics include the adequacy of dialysis and its impact on malnutrition, acidosis and protein wasting, management of protein and calorie malnutrition, and treatment of acute catabolic illness. 3 figures. 3 tables. 183 references. (AA-M).

244

•

Hemodialysis

Epidemiology of Chronic Renal Failure and Guidelines for Initiation of Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 76-81. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on the epidemiology of chronic renal (kidney) failure (CRF) and guidelines for initiation of hemodialysis (HD) is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. Decisions concerning the timing of the initiation of dialysis are based on careful monitoring and evaluation of various clinical and biochemical features of renal failure. In this chapter, the authors provide a brief overview of the main clinical and biochemical manifestations of CRF. Topics include biochemical abnormalities, cardiovascular features, neurologic features, hematologic (blood) abnormalities, gastrointestinal abnormalities, immunologic abnormalities, endocrine abnormalities, and dermatologic (skin) abnormalities. The chapter concludes with brief sections offering guidelines for initiation of HD in CRF patients, and recommendations for vascular access. 1 table. 35 references.

•

Vascular Interposition (Bridge Fistulas) for Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 101-113. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on vascular interposition (bridge fistulas) for hemodialysis is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The author notes that fistulas constructed from vascular (blood vessel) grafts provide the best second choice for the patient who cannot have a simple radiocephalic fistula. Prosthetic conduits can be placed from almost any artery to any vein of sufficient size to permit an anastomosis (a connection between two vessels) and are readily available in various lengths, diameters, and configurations. With care, early use (within 24 hours) can be accomplished without a higher incidence of complications, so it is technically possible to use the graft for dialysis immediately after surgery. This may eliminate the need for the placement of a central dialysis catheter, as was previously done to allow incorporation of the graft material. The author reviews considerations including site, graft materials, size of graft, precautions, and different surgical techniques used. 14 references. 32 references.

•

Nutritional Requirements of Hemodialysis Patients Source: in Mitch, W.E. and Klahr, S., eds. Nutrition and the Kidney. 2nd ed. Boston, MA: Little, Brown and Company. 1993. p. 263-289. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $94.95. ISBN: 0316575003.

Books

245

Summary: This chapter, from a book about nutritional requirements during kidney disease, discusses the nutritional requirements of hemodialysis patients. The author stresses that readers should keep in mind that many patients starting dialysis are suffering from malnutrition and wasting. Topics discussed include protein-energy malnutrition in hemodialysis (HD) patients; amino acid abnormalities; glucose and insulin metabolism; hyperglucagonemia; disturbances in lipid metabolism; carnitine depletion; hyperparathyroidism; anemia and erythropoietin; vitamins and trace elements; low-protein intake, malnutrition, and clinical outcome; protein requirements in HD patients; energy requirements; low nutritional intake and anorexia; the evaluation of nutritional status and intakes in HD patients; general aspects of nutritional therapy; and recommended intakes and treatment of malnutrition. 3 tables. 118 references. •

Psychological and Social Adaptation of CAPD and Center Hemodialysis Patients Source: in Hardy, M.A., et al., eds. Psychosocial Aspects of End-Stage Renal Disease: Issues of Our Times. Binghamton, NY: Haworth Press. 1991. p. 47-68. Contact: Available from Haworth Press. 10 Alice Street, Binghamton, NY 13904-1580. (607) 722-2493. PRICE: $32.95 plus $2.75 shipping and handling. ISBN: 1560241497. Summary: This chapter, from a book about the psychosocial aspects of end-stage renal disease (ESRD), discusses the psychological and social adaptation of continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis patients. After a literature review, the authors report on their own work in studying psychological and social status variables cross-sectionally in 16 matched patient pairs from a single university dialysis program. The instruments used in this study were the Profile of Mood States, the Simmons Scale, the Multidimensional Health Locus of Control, the Antonovsky Sense of Coherence Scale, a general disease/treatment stress scale, and a modality-specific disease/treatment stress scale. Several measures of social and role function were also used. The authors discuss their results, with the goal of identifying profiles of individuals who can be predicted to achieve a higher level of adaptation on one of the available ESRD treatment modalities. 1 figure. 4 tables. 64 references.

•

Hemodialysis and Hemofiltration Source: in Greenberg, A., et al., eds. Primer on Kidney Diseases. New York, NY: National Kidney Foundation. 1994. p. 258-265. Contact: Available from Academic Press. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 321-5068. PRICE: Paperback $49.95 (paper). ISBN: 0122992318. OR $99 (hardback). ISBN: 012299230X. Summary: This chapter, from a comprehensive textbook of clinical nephrology, focuses on hemodialysis and hemofiltration. Topics covered include the structure of hemodialyzers and hemofilters; the types of extracorporeal therapy for renal failure; hemodialysis and hemofiltration membranes and machines; water transport and solute clearance profiles; dialysate; vascular access; anticoagulants; indications for hemodialysis and hemofiltration; quantitation of hemodialysis; complications of hemodialysis; dialyzer reuse; and drug usage in hemodialysis. 2 figures. 2 tables. 11 references.

•

Nutrition Management of the Adult Hemodialysis Patient Source: in American Dietetic Association. Clinical Guide to Nutrition Care in End-Stage Renal Disease. Chicago, IL: American Dietetic Association. 1994. p. 25-36.

246

Hemodialysis

Contact: Available from American Dietetic Association. 216 West Jackson Boulevard Chicago, IL 60606-6995. (312) 899-0040. PRICE: $24 for members; $28 for non-members; plus shipping and handling. ISBN: 0880911247. Summary: This chapter, from a manual that provides guidelines for the clinical nutrition care of patients with end-stage renal disease (ESRD), discusses the nutrition management of the adult hemodialysis patient. Topics include artificial kidneys and the dialysate bath; hemodialysis access; home hemodialysis versus in-center or staff assisted hemodialysis; and specific nutrition considerations, including for protein, caloric intake, sodium and fluids, potassium, phosphorus, calcium and vitamin D, magnesium, iron, zinc, and vitamins. 1 table. 53 references. •

Center and Home Chronic Hemodialysis Source: in Schrier, R.W. and Gottschalk, C.W. Diseases of the Kidney. Boston, MA: Little, Brown and Company. 1992. p. 3031-3068. Contact: Available from Little, Brown and Company. Order Department, 200 West Street, Waltham, MA 02154. (800) 343-9204. PRICE: $400 for 3 volumes, plus $15 shipping and handling if not prepaid. ISBN: 0316775010. Summary: This chapter, from a medical reference book about diseases of the kidney, discusses center and home chronic hemodialysis. After a brief history of chronic hemodialysis, the authors discuss circulatory access, including the native CiminoBrescia fistula, arteriovenous grafts, femoral vein catheterization, and subclavian vein cannulation; equipment, notably the blood circuit and the dialysate circuit; ultrafiltration characteristics; dialysate, including acetate versus bicarbonate dialysis; water quality; anticoagulation agents, notably heparin; various dialysis techniques and the complications associated with each; measuring the adequacy of dialysis; additional components of therapy, including control of blood pressure and adequate nutrition; and acute complications associated with hemodialysis. The latter section of the chapter discusses home hemodialysis, including patient selection; home hemodialysis training; support services; quality of life; and patient survival. 9 figures. 6 tables. 377 references.

•

Special Problems of Hemodialysis and Peritoneal Dialysis in Adults Source: in Chan, J.C.M.; Gill, J.R., Jr., eds. Kidney Electrolyte Disorders. New York, NY: Churchill Livingstone Inc. 1990. p. 507-526. Contact: Available from Churchill Livingstone Inc. Promotion Department, 1560 Broadway, New York, NY 10109-0005. PRICE: $97.50. ISBN: 0443086397. Summary: This chapter, from a medical textbook about kidney electrolyte disorders, discusses the special problems of hemodialysis and peritoneal dialysis in adults. The authors begin with a short history of hemodialysis and peritoneal dialysis. They then review the technology of the most common forms of dialysis equipment in use, followed by an outline of several special clinical problems faced by patients receiving chronic dialysis. The chapter concludes with a discussion of the need for research pertaining to yet-unsolved problems in long-term human life extension by chronic dialysis therapy. Special problems encountered with dialysis in the patient with heart disease, diabetes, or in the geriatric patient are also discussed. 3 figures. 1 table. 57 references.

•

Development of Hemodialysis and Peritoneal Dialysis Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E., eds. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 1-25.

Books

247

Contact: Available from Appleton and Lange. 25 Van Zant Street, P.O. Box 5630, Norwalk, CT 06856. (800) 423-1359 or (203) 838-4400. PRICE: $175.00. ISBN: 0838513794. Summary: This chapter, from a textbook of clinical dialysis, presents a discussion of the development of hemodialysis and peritoneal dialysis. Topics include the ancient history of diuresis; the first investigators; the first dialyzer, proposed by Thomas Graham; the work of other membrane researchers; vividiffusion; the high-flow dialyzer; other membrane research; the first plate dialyzer; the first clinical dialysis, including the work of George Haas; the emergence of manufactured membranes; the first use of cellophane for dialysis; the Kolff era; the first dialysis in the United States; the development of the Kolff-Brigham kidney; other artificial kidney developers, such as Nils Alwall, Gordon Murray, Leonard Skeggs, Jack Leonards, Stephen Rosenak, the Malinow-Korzon group, Bodo Von Garrelts, the MacNeill-Collins group, Muirhead and Reed, and the KirwinLowsley group; the use of the Skeggs-Leonards dialyzer in Norway; the beginning of the Seattle artificial kidney program; the development of dialyzing fluids; other artificial kidney developments in the 1950s; the Kolff twin-coil kidney; prophylactic dialysis; the beginnings of chronic dialysis in the 1960s; the first Seattle home dialysis patient; the age of the hollow fiber kidney; development of peritoneal dialysis, including the work of Fred Boen, Russell Palmer, Harold McDonald, Henry Tenckhoff, Norman Lasker, Dimitrios Oreopoulos, Jack Moncrief, and Robert Popovich; and the use of dialysis in patients with diabetes mellitus. 16 figures. 82 references. •

Pediatric Hemodialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 288-299. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Treating children who need hemodialysis is complicated by the fact that they are still growing and developing, and chronic renal insufficiency and end stage renal disease (ESRD) interfere with this normal growth and development. Thus, pediatric nephrology nurses must have a comprehensive knowledge of pediatric nursing and childhood growth and development. This chapter on pediatric hemodialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter emphasize that the hybrid of services that a pediatric dialysis facility provides necessitates a good method of matching resources to patient workload activity. Acute renal failure in children usually results from hypoperfusion of the kidneys due to septic shock, hypotension, severe dehydration from gastroenteritis, or from acute blood loss from surgery or an accident. The pathology is that of acute tubular necrosis (ATN). The causes of end stage renal disease (ESRD) are different for children than for adults. About two thirds of the cases in children are caused by congenital urinary tract anomalies, or hereditary diseases; the other third are caused by acquired kinds of glomerulonephropathy. Unlike ESRD in adults, diabetic nephropathy, chronic hypertension, autosomal dominant polycystic kidney disease, and membranous glomerulonephritis are rarely causes of ESRD in childhood and adolescence. The preferred modality of treatment for ESRD for most pediatric patients is renal transplantation. If a pediatric patient needs chronic dialysis, home peritoneal dialysis is the usual choice, but may not always be possible. The authors review the details of in-

248

Hemodialysis

center hemodialysis, including preferred measures of weight, isolation, limits for extracorporeal volume, vascular access considerations, special dialyzers, equipment and supplies, pain with hemodialysis, ultrafiltration, determining blood flow rate, intradialytic monitoring, high blood pressure in children, anemia management, growth and development concerns, toileting concerns, school scheduling, and emergency preparedness. •

Complications During Hemodialysis Source: in Nissenson, A.R.; Fine, R.N. Dialysis Therapy. Philadelphia, PA: Hanley and Belfus, Inc. 2002. p. 171-179. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: With improving outcomes, replacement of renal (kidney) function by hemodialysis (HD) is a well established therapy, but it is not free of complications. This chapter is one part of a section on complications during hemodialysis, from a textbook on dialysis therapy. The chapter covers hypotension (low blood pressure), muscle cramps, dialyzer reactions, hypoxemia (low levels of oxygen in the blood), febrile (fever) reactions, dialysis disequilibrium syndrome (DDS, a neurologic disorder characterized by headaches and nausea in the mild form and confusion, blurred vision, seizures and even coma in the more severe forms), bleeding, pruritus (itching), heart rate disturbances, cardiopulmonary arrest (heart stopping) during dialysis, air embolism (a rare complication), hemolysis (the breakdown of red blood cells), and electrolyte disturbances. The author concludes that the incidence of clinical problems during HD has been greatly reduced, thanks to technological advances and to higher standards in the routine delivery of therapy. Despite these advances, clinical problems may still occur, especially in elderly or unstable patients, or in individuals with underlying comorbid (other illness present at the same time) conditions. Accurate supervision and physical examination of the patient may prevent several of these problems. Hemodialysis can be better tolerated and done more smoothly when potential clinical problems are anticipated and appropriate countermeasures are instituted in a timely fashion. 3 figures.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to hemodialysis have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:10 •

ESRD Provider Listing Source: Midlothian, VA: Mid-Atlantic Renal Coalition. 1997. 32 p.

10

You will need to limit your search to “Directory” and “hemodialysis” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “hemodialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

Books

249

Contact: Available from Mid-Atlantic Renal Coalition. 1527 Huguenot Road, Midlothian, VA 23113. (804) 794-3757. PRICE: $50.00. Summary: This document lists end-stage renal disease (ESRD) service providers in network 5 (mid-Atlantic region, covering the District of Columbia, Maryland, Virginia, and West Virginia). Organized by geographic location, the directory lists the provider address and telephone number, the provider number, facility type, and services offered. Services offered can include hemodialysis, isolation, and training services (notably in peritoneal dialysis). The directory concludes with an alphabetical listing of facilities by city within each State.

251

CHAPTER 7. MULTIMEDIA ON HEMODIALYSIS Overview In this chapter, we show you how to keep current on multimedia sources of information on hemodialysis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on hemodialysis is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “hemodialysis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “hemodialysis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on hemodialysis: •

Human Factors in Hemodialysis Source: Washington, DC: Health Sciences Consortium. 1991. Contact: Available from Health Sciences Consortium (HSC). 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. PRICE: $276.50 for HSC members; $395 for nonmembers. Order Number: R911-VI-040. Summary: Hemodialysis is a very complex therapy. Health care workers must be aware of the possibility of accidents and do all they can to prevent mistakes from happening. This videotape program promotes awareness of the problems of human error during hemodialysis treatment and presents methods and procedures which can reduce or eliminate these problems. (AA).

•

Infection Control for Hemodialysis Source: Washington DC: Health Industry Manufacturers Association. 1991.

252

Hemodialysis

Contact: Available from Health Sciences Consortium (HSC). 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. PRICE: $276.50 for HSC members; $395 for nonmembers. Order Number: R911-VI-039. Summary: The failure of staff to follow universal infection control measures in any part of the dialysis setting can lead to a vicious cycle of blood-borne infection transmission throughout the entire unit. This program focuses on preventing the transmission of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in the dialysis setting by adhering to universal precautions. (AA). •

Core Curriculum for the Dialysis Technician: A Video Review of Hemodialysis Source: Thousand Oaks, CA: Amgen Inc., and Medical Media Publishing, Inc. 1994. Contact: Available from Amgen Professional Services at (800) 772-6436 or contact local service representative. Available in limited quantities to Amgen customers only. PRICE: Free to Amgen customers in individual dialysis facilities. Summary: This program, designed for the dialysis technician, presents an overview of the hemodialysis process. Three sections cover kidney disease and dialysis; hemodialysis devices, procedures, and circulatory access; and reprocessing, water treatment, and quality improvement. Specific topics include kidney function and kidney failure; the principles of dialysis; the dialyzer and dialysate; hemodialysis delivery systems; vascular access; dialyzer reprocessing and water treatment; and quality assurance issues. The videotape is designed to accompany a training manual with the same title. (AA-M).

•

Hemodialysis Series Source: Washington, DC: Health Industry Manufacturers Association. 1991. Contact: Available from Health Sciences Consortium (HSC). 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. PRICE: $884.80 for HSC members; $1,264 for nonmembers. Order Number: R911-VI-0385. Summary: This series consists of four videocassettes regarding hemodialysis. Topics include infection control for hemodialysis; human factors in hemodialysis; water treatment in hemodialysis; and reprocessing of hemodialyzers. The series was created through a collaboration of the Health Industry Manufacturers Association; the Food and Drug Administration; the Renal Physicians' Association; and the American Nephrology Nurses' Association. The videotapes are designed for the continuing education of the staff members of dialysis units.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “hemodialysis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on hemodialysis:

Multimedia 253

•

Use of Intradialytic Parenteral Nutrition in the Malnourished Hemodialysis Patient Source: Bethlehem, PA: St. Luke's Hospital. 1991. Contact: Available from St. Luke's Hospital. Nutrition Services-Renal. 801 Ostrum Street, Bethlehem, PA 18015. (215) 954-4000. PRICE: contact directly for details. Summary: This audiocassette presents a program from a one-day symposium, held in October 1991, that focuses on the nutritional assessment and nutritional intervention in the treatment of patients with chronic renal failure (CRF). The speaker, Anita Knerr, a clinical nutritionist, discusses the use of intradialytic parenteral nutrition in the malnourished hemodialysis patient. The symposium was designed for dietitians and for students studying to become dietitians.

255

CHAPTER 8. PERIODICALS AND NEWS ON HEMODIALYSIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover hemodialysis.

News Services and Press Releases One of the simplest ways of tracking press releases on hemodialysis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “hemodialysis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to hemodialysis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “hemodialysis” (or synonyms). The following was recently listed in this archive for hemodialysis: •

Older hemodialysis patients at greater risk of hepatitis C Source: Reuters Medical News Date: March 26, 2004

•

Heart valve calcification does not predict mortality in hemodialysis patients Source: Reuters Medical News Date: March 19, 2004

256

Hemodialysis

•

Atorvastatin cuts C-reactive protein levels in hemodialysis patients Source: Reuters Industry Breifing Date: March 12, 2004

•

FDA clears new Baxter hemodialysis device Source: Reuters Industry Breifing Date: June 24, 2003

•

High troponin I levels linked to increased mortality risk in hemodialysis patients Source: Reuters Medical News Date: March 21, 2003

•

Warfarin-induced skin necrosis reported in hemodialysis patient Source: Reuters Industry Breifing Date: December 04, 2002

•

ACE inhibitors improve survival of hemodialysis patients Source: Reuters Medical News Date: December 02, 2002

•

Periodontal disease linked to elevated CRP levels in hemodialysis patients Source: Reuters Medical News Date: November 29, 2002

•

Collagen propeptide a good bone metabolic marker in hemodialysis patients Source: Reuters Medical News Date: November 05, 2002

•

Spire cleared to sell hemodialysis catheter Source: Reuters Industry Breifing Date: November 01, 2002

•

Arteriovenous access for hemodialysis contributes to left ventricular hypertrophy Source: Reuters Medical News Date: October 25, 2002

•

Aksys gets EU clearance for personal hemodialysis system Source: Reuters Industry Breifing Date: October 07, 2002

•

Intradialytic parenteral nutrition may benefit chronic hemodialysis patients Source: Reuters Medical News Date: September 09, 2002

•

Pregnancy success for women on hemodialysis has improved Source: Reuters Medical News Date: July 22, 2002

•

Exercise during hemodialysis reduces use of antihypertensive medications Source: Reuters Medical News Date: April 18, 2002

•

Pulse pressure predicts mortality in hemodialysis patients Source: Reuters Medical News Date: March 26, 2002

•

Poor nutrition common in hemodialysis patients Source: Reuters Medical News Date: March 22, 2002

Periodicals and News

257

•

Daily hemodialysis reduces mortality in acute renal failure patients Source: Reuters Medical News Date: January 30, 2002

•

Prophylactic hemodialysis may be harmful following radiocontrast studies Source: Reuters Medical News Date: January 15, 2002

•

Lisinopril reduces hypertension in chronic hemodialysis patients Source: Reuters Industry Breifing Date: December 31, 2001

•

ACE inhibitors improve survival of vascular grafts in hemodialysis patients Source: Reuters Industry Breifing Date: December 27, 2001

•

New score correlates with morbidity, mortality in long-term hemodialysis patients Source: Reuters Medical News Date: December 26, 2001

•

Time of day of hemodialysis delivery affects survival Source: Reuters Medical News Date: December 04, 2001

•

Nocturnal hemodialysis lowers blood pressure, reverses LV hypertrophy in ESRD Source: Reuters Medical News Date: October 15, 2001

•

Any residual renal function decreases mortality risk in hemodialysis patients Source: Reuters Medical News Date: August 02, 2001

•

Adverse events from iron dextran appear to be rare in hemodialysis patients Source: Reuters Industry Breifing Date: May 10, 2001

•

Daily hemodialysis may improve clinical outcomes Source: Reuters Medical News Date: April 19, 2001

•

Investigational staph vaccine reduces bacteremia in hemodialysis patients Source: Reuters Medical News Date: April 05, 2001

•

Nocturnal hemodialysis effective for sleep apnea in chronic renal failure patients Source: Reuters Medical News Date: January 10, 2001

•

Short-term mortality rate high in hemodialysis patients with infective endocarditis Source: Reuters Medical News Date: November 24, 2000

•

Aksys completes trial of Personal Hemodialysis System, plans regulatory filing Source: Reuters Industry Breifing Date: November 17, 2000

•

Inadequate hemodialysis costs Medicare $150 million a year Source: Reuters Medical News Date: October 20, 2000

258

Hemodialysis

•

ECG changes during hemodialysis useful for diagnosing and predicting heart disease Source: Reuters Medical News Date: September 22, 2000

•

HAART lowers viral load, improves survival in HIV-infected hemodialysis patients Source: Reuters Medical News Date: September 19, 2000

•

FDA approves Vasca's LifeSite hemodialysis system Source: Reuters Industry Breifing Date: August 29, 2000 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “hemodialysis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “hemodialysis” (or synonyms). If you know the name of a company that is relevant to hemodialysis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

Periodicals and News

259

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hemodialysis” (or synonyms).

Newsletters on Hemodialysis Find newsletters on hemodialysis using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “hemodialysis.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “hemodialysis” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Kidney Disease? Know Your Options Source: Lexington, MA: Kidney Options. 2002. 2 p. Contact: Available from Kidney Options. 95 Hayden Avenue, Lexington, MA 124209192. (866) 543-6391. Website: www.kidneyoptions.com. PRICE: Full-text available online at no charge. Summary: Kidney disease happens when there is damage to the filters in the kidneys. These filters remove waste products and excess fluid from the blood. There are many causes of kidney disease, including high blood pressure (hypertension) and diabetes mellitus. This newsletter briefly outlines the treatment options for people with kidney disease. Topics include hemodialysis, peritoneal dialysis, kidney transplants, the role of pre-dialysis education, social services, the importance of appropriate diet therapy, and commonly asked questions about transplants. The newsletter includes a brief profile of a transplant patient. Readers are referred to a web site (www.kidneyoptions.com) for more information.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “hemodialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on hemodialysis: •

Malnutrition in the Hemodialysis Patient Source: Renal Nutrition Forum. 14(4): 1-4. Fall 1995. Contact: Available from Renal Nutrition Forum. 2246 Poinciana Road, Winter Park, FL 32792. (407) 774-0631.

260

Hemodialysis

Summary: This article presents a brief overview of research addressing nutritional status in the hemodialysis (HD) patient and the relationship between malnutrition, morbidity, and mortality. The article is also intended to help the dietitian in preventing malnutrition in the HD patient by offering suggestions for therapy. Dialysis factors which may contribute to malnutrition include an increase in muscle protein degradation caused by blood contact with the dialyzer membrane; inadequate dialysis resulting in a uremic state which leads to nausea, vomiting, and loss of appetite; and loss of amino acids and peptides in dialysate. Hormonal disturbances include insulin resistance, increased circulating levels of catabolic hormones such as insulin and parathyroid hormone, and decreased levels of anabolic hormones such as growth factor and erythropoietin caused by deterioration of kidney function. Gastrointestinal factors include gastroparesis, malabsorption, gastritis, esophagitis, and constipation. The author reports on studies documenting that malnutrition greatly increases morbidity and mortality in the HD patient. HD patients should ingest 1.2 grams of protein per kilogram of actual body weight, where 50 percent is high biological value protein. An adequate energy intake is vital for the efficient utilization of dietary protein. The most important factor in improving malnutrition in this population is to assure adequate dialysis. The author concludes with a section on interventions for patients who continue to have poor appetites, even if dialysis delivery is optimal. 1 table. 15 references.

Academic Periodicals covering Hemodialysis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to hemodialysis. In addition to these sources, you can search for articles covering hemodialysis that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

261

CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for hemodialysis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with hemodialysis. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

262

Hemodialysis

following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hemodialysis: Ascorbic Acid (Vitamin C) •

Vitamin C - U.S. Brands: Ascorbicap; Cebid Timecelles; Cecon; Cecore 500; Cee500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Mega-C/A Plus; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html

Folic Acid (Vitamin B 9) •

Vitamin B 9 - U.S. Brands: Folvite http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202250.html

Hepatitis A Virus Vaccine Inactivated and Hepatitis B Virus Vaccine Recombinant •

Systemic - U.S. Brands: Twinrix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500307.html

Iron Supplements •

Systemic - U.S. Brands: DexFerrum; Femiron; Feosol Caplets; Feosol Tablets; Feostat; Feostat Drops; Feratab; Fer-gen-sol; Fergon; Fer-In-Sol Drops; Fer-In-Sol Syrup; Fer-Iron Drops; Fero-Gradumet; Ferospace; Ferralet; Ferralet Slow Release; Ferralyn Lanacaps; Ferra-TD; Ferretts; Ferrlecit; Fumasorb; Fumerin; Hemocyte; Hytinic; InFeD; Ircon; Mol-Iron; Nephro-Fer; Niferex; Niferex-150; Nu-Iron; Nu-Iron 150; Simron; Slow Fe; Span-FF; Venofer http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202305.html

Levocarnitine •

Systemic - U.S. Brands: Carnitor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202325.html

Thiamine (Vitamin B 1) •

Vitamin B 1 - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

Researching Medications

263

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to hemodialysis by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “hemodialysis” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for hemodialysis: •

Epoprostenol (trade name: Flolan) http://www.rarediseases.org/nord/search/nodd_full?code=405

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

265

APPENDICES

267

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

268

Hemodialysis

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

269

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

270

Hemodialysis

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hemodialysis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 69599 999 467 180 759 72004

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “hemodialysis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

271

Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

273

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on hemodialysis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to hemodialysis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to hemodialysis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “hemodialysis”:

274

Hemodialysis

Diabetic Kidney Problems http://www.nlm.nih.gov/medlineplus/diabetickidneyproblems.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Kidney Failure http://www.nlm.nih.gov/medlineplus/kidneyfailure.html Kidney Transplantation http://www.nlm.nih.gov/medlineplus/kidneytransplantation.html

Within the health topic page dedicated to hemodialysis, the following was listed: •

Nutrition Eat Right to Feel Right on Hemodialysis http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm Na-K-Phos Counter Source: American Association of Kidney Patients http://www.aakp.org/AAKP/nakphos.htm Nutrition and Peritoneal Dialysis Source: National Kidney Foundation http://www.kidney.org/atoz/pdf/nutri_pd.pdf Protein/Calorie Counter Source: American Association of Kidney Patients http://www.aakp.org/AAKP/protcal.htm

•

Children Treatment Methods for Kidney Failure in Children Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/childkidneydiseases/treatment_me thods/index.htm What's the Deal with Dialysis? Source: Nemours Foundation http://kidshealth.org/kid/feel_better/things/dialysis.html

•

From the National Institutes of Health Treatment Methods for Kidney Failure: Peritoneal Dialysis Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/peritoneal/index.htm

•

Law and Policy Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Source: Dept. of Health and Human Services http://www.medicare.gov/Publications/Pubs/pdf/esrdCoverage.pdf

Patient Resources

•

275

Organizations Life Options Rehabilitation Program http://www.lifeoptions.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ National Kidney and Urologic Diseases Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/ National Kidney Foundation http://www.kidney.org/

•

Research Hemodialysis Study Results Published Confirms Current Recommended Practice Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.nih.gov/news/pr/dec2002/niddk-18.htm Preventing Worsening Kidney Function in Patients Receiving Peritoneal Dialysis Source: American College of Physicians http://www.annals.org/cgi/content/full/139/2/I-32

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hemodialysis. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Healthy Eating for Hemodialysis Source: Rockville, MD: American Kidney Fund. 2002. 20 p. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. Fax (301) 881-0898. E-mail: [email protected]. Website: www.kidneyfund.org. PRICE: Single copy free; additional copies available. Summary: A healthy diet is particularly important for people who are beginning hemodialysis, a treatment in which their blood is cleansed of waste products and excess fluid using an artificial kidney and a dialysis machine. This brochure describes the

276

Hemodialysis

recommended dietary strategy for people going on hemodialysis. Topics covered include the rationale for a special diet; the need to limit fluids; how waste products can build up when the kidneys are not working properly; handling sodium, potassium, phosphorus and urea; managing calories, carbohydrates and fats; the importance of vitamins and minerals; the risk of anemia; and special precautions for people with diabetes who are going on hemodialysis. The brochure includes a sample menu for a man weighing 150 pounds. The brochure concludes with a summary of the recommended strategies for healthy eating for hemodialysis. 6 tables. 12 references. •

Home Hemodialysis: Weighing the Odds Source: Glendale, CA: Hartwell Communications. 2002. 4 p. Contact: Available from Hartwell Communications. 1102 N. Brand Boulevard, Number 74, Glendale, CA 91202. (818) 244-9041. Fax (818) 244-9540. Email: [email protected]. Website: www.ikidney.com or www.lorihartwell.com. PRICE: Single copy free; full-text available online at no charge. Summary: Choosing a modality of care can be a difficult decision for many dialysis patients. This fact sheet describes one patient's nearly 30 years' experience with home hemodialysis. The author reports the history of his treatment, including early equipment and supplies, the impact of dialysis on his employment situation, the results of home hemodialysis in terms of morbidity, mortality, and quality of life, how to get medical support for home hemodialysis, and the need for help at home (from a spouse or other competent assistant). The author honestly describes the advantages and difficulties of his experiences with home hemodialysis. Simple line graphics illustrate the fact sheet.

•

Pediatric ESRD Fact Sheet: Hemodialysis Source: Pitman, NJ: American Nephrology Nurses' Association. 2003. 4 p. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071. (856) 256-2320 or (888) 600-2662. Website: www.annanurse.org. PRICE: Single copy free. Summary: Chronic renal failure (CRF) or end stage renal disease (ESRD) may occur as a result of many systemic disorders or congenital malformations. Children with ESRD may experience fatigue, sluggishness, decreased urine output, anemia, bone disease, and hypertension (high blood pressure). The treatment involves the use of medications, special diet, and dialysis or transplantation. This brochure educates teachers about hemodialysis, particularly as it may apply to a student in their classroom. The brochure describes hemodialysis, the equipment used, the arteriovenous fistula and graft, the use of central venous catheters, hypertension in children, and common medications used for children on dialysis. The brochure includes space for the nephrology nurse's telephone number for the teacher to contact with any questions.

•

Understanding Your Hemodialysis Access Options Source: Tampa, FL: American Association of Kidney Patients. 2001. 12 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. PRICE: Single copy free.

Patient Resources

277

Summary: During a hemodialysis treatment, a machine pumps blood from the patient's body through a flexible plastic tube, cleans it, and then returns it to the patient's body through a separate tube. There are two types of dialysis accesses, the site through which blood can be safely removed and returned to the patient's body. The first type involves the creation of a permanent connection between artery and a vein under the skin. This connection can be either a fistula or a graft and is used for patients who are expected to need long term dialysis treatment. The other type of access involves the direct placement of a tube into a large vein in the neck, chest, or groin. This type, which uses a catheter or other subcutaneous (under the skin) device, is most appropriately reserved for patients needing short term dialysis or patients on long term dialysis who no longer have a place to insert a fistula or graft. This brochure contains a brief description of the most common types of accesses. The brochure is divided into two sections covering permanent and temporary access options and provides information on how each type of access is placed, when they are used, and the limitations of each. Quotations from patients and detailed self care tips are included. The brochure is illustrated with simple line drawings. The brochure concludes with a brief glossary of terms and a description of the benefits of membership in the American Association of Kidney Patients (AAKP); a membership form is included. 4 figures. •

Getting the Best Out of Your Hemodialysis Treatment Source: New York, NY: National Kidney Foundation, Inc. 1995. 3 p. Contact: Available from National Kidney Foundation. U.S. Materials Orders, 30 East 33rd Street, New York, NY 10016. (212) 889-2210. Fax (212) 689-9261. PRICE: $7.00 for 25 copies. Item number: 03-129. Summary: Normal kidneys help to remove wastes and excess fluid from the body. When kidneys fail, dialysis is needed to take the place of healthy kidneys. This fact sheet helps readers to get the most out of their hemodialysis treatment. The fact sheet begins with a list of the signs and symptoms of waste buildup, including tiredness, trouble sleeping, poor appetite, nausea, weight loss, anemia, abnormal bleeding, poor memory, and confusion. The fact sheet then answers common questions about hemodialysis, covering topics including how to know if the treatment is adequate, the Kt per V and urea reduction ratio measurements, how the dialysis prescription is altered based on these test results, the role of the protein catabolic rate (PCR), and where to get more information. The fact sheet encourages readers to keep all scheduled treatments, known their own dialysis prescription, follow the diet plan, know what the blood test results are and what they mean, stick to the recommended fluid intake between dialysis treatments, and take responsibility as a member of the health care team. (AA-M).

•

AAKP Advisory: Inadequate Hemodialysis Increases the Risk of Premature Death Source: Tampa, FL: American Association of Kidney Patients. 1995. 4 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-2257 or (813) 223-7099. PRICE: Single copy free. Summary: Recent research has shown that many hemodialysis patients may not be receiving enough dialysis to prevent uremic symptoms, serious medical complications, and, in some cases, premature death. This brochure provides patients with information about hemodialysis and quality of care. Written in a question and answer format, the brochure covers determining how much dialysis is enough; the symptoms of inadequate amounts of dialysis; the urea reduction ratio (URR) and how it is used to check on the

278

Hemodialysis

adequacy of dialysis treatments; how to calculate the URR; the use of KT/V ratios instead of URR; drawing blood samples for BUN values; the need to maintain proper nutrition; and the importance of a good blood access (fistula or graft). The brochure concludes with a list of recommended questions to ask the health care provider; a wallet card that summarizes these questions is also provided. •

Assessment of Iron Status in Hemodialysis Patients Source: Morristown, NJ: Watson Pharma, Inc. 2003. 12 p. Contact: Available from Watson Pharma Inc. Commercial Headquarters, 360 Mt. Kemble Avenue, P.O. Box 1953, Morristown, NJ 07962. (973) 355-8300. Fax: (973) 3558301. Website: www.watsonpharm.com. PRICE: Contact organization for print copies. Summary: The majority of patients starting hemodialysis are anemic and iron deficient. During hemodialysis, patients experience significant blood loss due to frequent phlebotomy, blood remaining in the dialyzer and dialysis tubing, and gastrointestinal lesions. In addition to iron repletion, hemodialysis patients who require exogenous (outside the body) erythropoietin need iron to support the intense stimulation of red blood cell production induced by this therapy. This brochure helps physicians assess the iron status of hemodialysis patients. The brochure describes how the use of multiple iron status parameters along with hemoglobin values can increase diagnostic specificity and sensitivity and provide a more accurate clinical assessment of iron stores, iron availability, and iron use for erythropoiesis. The brochure discusses the currently used iron status parameters, their limitations, and other potential indicators of iron status in hemodialysis patients. 8 figures. 1 table. 15 references.

•

Your Kidneys, Your Bones, and You: A Guide to Healthier Bones From Your Hemodialysis Team Source: Abbott Park, IL: Abbott Laboratories. 1994. 20 p. Contact: Available from Abbott Laboratories. Renal Care, Abbott Park, IL 60064-3500. (708) 937-6100 or (800) 457-9472. PRICE: Single copy free. Available to health professionals only. Summary: This booklet provides hemodialysis patients with information about renal osteodystrophy and its prevention. Topics include the functions of the bones; how kidney disease affects the bones; the interplay of calcitriol and parathyroid hormone (PTH); how calcitriol therapy helps to overcome bone problems; oral versus injectable calcitriol; why diet affects the bones; phosphorus, calcium, and aluminum; and how patients can take charge of their own bone health. The booklet concludes with a brief subject index and a copy of the insert information for Calcijex (Abbott Laboratories) brand of injectable calcitriol. The booklet includes numerous full-color photographs.

•

What You Should Know About Infectious Diseases: A Guide for Hemodialysis Patients and Their Families Source: New York, NY: National Kidney Foundation. 1996. 13 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: Single copy free. Summary: This booklet reviews information about infectious diseases that is relevant to hemodialysis patients and their families. Written in nontechnical language, the booklet discusses hepatitis B, hepatitis C, human immunodeficiency virus (HIV), other

Patient Resources

279

infectious diseases (flu, pneumonia, and tuberculosis), vaccinations, and preventing infection of the hemodialysis access site. For each infectious disease, the author describes the symptoms, the transmission, treatment options, and preventive measures. 1 table. •

Getting the Most from Your Treatment: What You Need to Know about Hemodialysis Source: New York, NY: National Kidney Foundation. 1998. 31 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This booklet summarizes the use of hemodialysis to treat kidney diseases. The booklet tells readers why it is important to get the right amount of hemodialysis, how to care for the hemodialysis access, the complication of anemia and how it is treated, why diet restrictions must be followed carefully, how to help prevent bone disease and heart problems, how to cope with kidney disease and its treatment, how to get involved in one's own treatment plan and additional resources that are available. The brochure outlines the roles of each of the various health care team members who may be involved in the care of a person on hemodialysis. One section encourages readers to educate themselves about their disease and its treatment and to be very involved in their own health care. The brochure concludes with a section that summarizes the 13 laboratory tests commonly used to monitor patients with kidney disease: Kt per V and URR, nPNA, albumin (BCG test), hematocrit, hemoglobin, TSAT and serum ferritin, parathyroid hormone (PTH), calcium, phosphorus, potassium, target weight, average daily weight gain, and blood pressure. The brochure is written in nontechnical language and illustrated with simple line drawings. The brochure is one in a series of materials from an educational program of the National Kidney Foundation Dialysis Outcomes Quality Initiative.

•

Hemodialysis Fact Sheet Source: Pitman, NJ: American Nephrology Nurses' Association. 2003. 4 p. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071. (856) 256-2320 or (888) 600-2662. Website: www.annanurse.org. PRICE: Single copy free. Summary: This brochure describes hemodialysis (HD), a dialysis option for patients with chronic kidney disease (CKD). The brochure first describes CKD and end stage renal disease (ESRD), their causes and complications. The brochure then focuses on hemodialysis, a process that is usually performed in an outpatient clinic. The brochure describes how hemodialysis works, the need for vascular access for HD (arteriovenous fistula, arteriovenous graft, and central vein catheter), nutritional management (typical guidelines), typical medications, the benefits of exercise for patients on HD, and the importance of the patient being an active part of their own health care team. The brochure helps nurses understand CKD and its implications for nursing care.

•

Nutrition and Hemodialysis Source: New York, NY: National Kidney Foundation. 2002. 9 p. Contact: National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax (212) 689-9261. E-mail: [email protected]. Website: www.kidney.org. PRICE: Full-text available online at no charge.

280

Hemodialysis

Summary: This brochure explains dietary changes that are recommended for patients who are beginning hemodialysis treatments for the first time. Written in a question and answer format, the brochure presents guidelines for maintaining adequate levels of protein, potassium, sodium, fluid, phosphorus, calories, and vitamins and minerals in the diet. The brochure emphasizes the importance of close cooperation between the hemodialysis patient, the physician, and the renal dietitian in planning and following a healthy diet. •

What You Should Know About Dialyzer Reuse: A Guide for Hemodialysis Patients and Their Families Source: New York, NY: National Kidney Foundation. 1999. 11 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, Suite 1100, New York, NY 10016. (800) 622-9010 or (212) 889-2210. Fax (212) 689-9261. E-mail: [email protected]. Website: www.kidney.org. PRICE: Single copy free; $10.00 for 50 copies. Summary: This brochure familiarizes hemodialysis patients and their families with dialyzer reuse, in which the same hemodialyzer (filter) is used more than once for the same patient. Written in a question and answer format, the brochure describes how dialyzer reuse can reduce or eliminate the physical reaction some patients have to certain dialyzer membranes. In addition, dialyzer reuse allows the dialysis center to use high efficiency dialyzers, which are expensive. The brochure describes the guidelines of the Association for the Advancement of Medical Instrumentation (AAMI) regarding dialyzer reuse, which cover four areas: dialyzers should be labeled carefully so they are always used for the same patient; dialyzers should be tested after rinsing to make sure all disinfectants have been removed; patients should be checked for any bad reactions caused by reuse; and dialyzers that are reused should be well tested after each use to make sure they are still working well. Other issues covered include how to know if the dialyzer is working well, how many times a dialyzer can be safely reused, how the dialyzer should look before treatment, and how to know if one is getting the right amount of treatment from the reused dialyzer and the dialysis process. The brochure encourages patients to talk with their dialysis care team if they have any questions. A list of publications from the National Kidney Foundation (NKF) is offered, with a brief description of the organization and its activities. 4 figures.

•

Understanding Iron: Important Information Every Hemodialysis Patient Should Know Source: Morristown, NJ: Watson Pharma, Inc. 2002. 8 p. Contact: Available from Watson Pharma Inc. Commercial Headquarters, 360 Mt. Kemble Avenue, P.O. Box 1953, Morristown, NJ 07962. (973) 355-8300. Fax: (973) 3558301. Website: www.watsonpharm.com. PRICE: Contact organization for print copies. Summary: This brochure helps readers with kidney disease understand the importance of iron in dialysis therapy. Topics covered include the role of iron in the body, iron deficiency, the interrelationship between erythropoietin and iron, how to increase the amount of iron in the body, the differences between oral iron and injectable iron, the side effects of injectable iron, diagnostic tests that monitor iron levels in the body, and how patients can be an active member of their own patient care team. The brochure is produced by the manufacturer of Ferrlecit, an iron replacement therapy for chronic hemodialysis patients taking epoetin. The brochure concludes with the package insert information. The brochure is illustrated with colorful line graphics. 5 figures.

Patient Resources

•

281

Adequacy of Hemodialysis: Quick Reference Guide for Clinicians Source: Washington, DC: Renal Physicians Association. 1993. 2 p. Contact: Available from Renal Physicians Association. 2011 Pennsylvania Avenue, Suite 800, Washington DC 20006-1808. (202) 835-0436. PRICE: Single copy free. Summary: This brochure provides a quick reference guide to the Clinical Practice Guideline developed on the adequacy of hemodialysis. The guideline was developed under the sponsorship of the Renal Physicians Association (RPA), undertaken because certain studies have suggested that some of the unfavorable U.S. hemodialysis (HD) survival may be the consequence of inadequate HD. Based on available data, the variables involved with the delivery and outcomes of HD were identified and utilized in a probabilistic model to assess how variations in the dialysis prescription and delivery of HD affect quality-adjusted life expectancy and 'marginal' cost-effectiveness. The brochure summarizes the guideline parameters in six areas: patient criteria; guideline audience; parameters of the dialysis prescription; confirmation that adequate dialysis is being delivered; recommended KTVd levels (at least 1.2); and corrective action for KTVd which falls below guideline parameters.

•

It's Your Life: Know Your Number: A Patient Guide to Two Important Measures That Show How Well Your Hemodialysis Is Working Source: Baltimore, MD: Health Care Financing Administration. 199x. 2 p. Contact: Available from Health Care Financing Administration. 7500 Security Boulevard, Baltimore, MD 21244. (410) 786-3000. PRICE: Single copy free. Summary: This brochure provides information for kidney patients about two diagnostic numbers that can help them understand how well their hemodialysis is working. The two measures discussed are urea reduction ratio (URR) and KT/V. Written in a question and answer format, the brochure discusses why these numbers are important; guidelines as to what the numbers should be after dialysis; finding out what the numbers are from one's chart; and recommendations for patient behaviors that help to keep the numbers reflecting positive hemodialysis treatments. The brochure concludes with 2 charts on which patients can record their URR and KT/V results. The tollfree telephone numbers of three resource organizations are also provided.

•

Understanding Adequacy of Hemodialysis: Consumer Guide Source: Washington, DC: Renal Physicians Association. 1993. 4 p. Contact: Available from Renal Physicians Association. 2011 Pennsylvania Avenue, Suite 800, Washington DC 20006-1808. (202) 835-0436 PRICE: Single copy free. Summary: This brochure provides patients with an understanding of the issues regarding the adequacy of hemodialysis. The guideline was developed under the sponsorship of the Renal Physicians Association (RPA), undertaken because certain studies have suggested that some of the unfavorable U.S. hemodialysis (HD) survival may be the consequence of inadequate HD. After a description of the problem, the brochure discusses the importance of measuring adequate hemodialysis and recommendations for care, including number of dialysis treatments, the amount of prescribed and delivered hemodialysis, and ways to determine adequacy of dialysis. The brochure includes a question-and-answer section, which addresses topics including missing dialysis treatments; treatments that are shorter than prescribed; and blood flow rates.

282

•

Hemodialysis

Hemodialysis and Childbirth Source: Glendale, CA: Hartwell Communications. 2001. 3 p. Contact: Available from Hartwell Communications. 1102 N. Brand Boulevard, Number 74, Glendale, CA 91202. (818) 244-9041. Fax (818) 244-9540. Email: [email protected]. Website: www.ikidney.com or www.lorihartwell.com. PRICE: Single copy free; full-text available online at no charge. Summary: This fact sheet describes one hemodialysis patient's experience with pregnancy and childbirth. The author describes her kidney disease, her successful transplantation (for 2 years) then loss of the donor kidney, her use of peritoneal dialysis, her switch to hemodialysis during her pregnancy, the premature birth of her son, and their adjustment after his birth. Simple line graphics illustrate the fact sheet. Readers are encouraged to contact the American Association of Kidney Patients (www.aakp.org) for more information and other stories of patients on dialysis.

•

Hemodialysis Dose and Adequacy Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2001. 4 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-148. Summary: This fact sheet describes the need to determine the adequacy of hemodialysis (HD) used to treat chronic kidney failure (end stage renal disease, or ESRD). To see whether dialysis is removing enough waste products such as urea, the clinic periodically (normally once a month) tests the patient's blood to measure dialysis adequacy. Blood is sampled at the start of dialysis and at the end. The levels of urea in the two blood samples are then compared. The fact sheet describes the two methods that are generally used to assess dialysis adequacy: URR and Kt per V. The URR is the reduction in urea as a result of dialysis. In the Kt per V measurement, K stands for the dialyzer clearance, expressed in milliliters per minute (mL per min) and the lowercase t stands for time. Kt, then, is clearance multiplied by time. This top part of the fraction represents the volume of fluid completely cleared of urea during a single treatment. In the bottom part of the fraction, V is the volume of water a patient's body contains. The Kt per V is more accurate than the URR in measuring how much urea is removed during dialysis. The fact sheet considers the figures that are used as standards and what to do if one's particular numbers fall below the recommendations. The fact sheet concludes with a description of current research efforts in this area, a brief list of resource organizations for more information, and a brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) and its contact information. 2 figures.

•

Home Hemodialysis Source: New York, NY: National Kidney Foundation, Inc. 1991. 2 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Order number KU-8. PRICE: Single copy free.

Patient Resources

283

Summary: This fact sheet from the National Kidney Foundation presents a brief overview of home hemodialysis. Written in a question-and-answer format, the fact sheet includes information on the requirements for home hemodialysis, the training required to perform home hemodialysis, the advantages and disadvantages of the procedure, the support structure available for home hemodialysis patients, medical insurance, and the activities of the National Kidney Foundation. •

Hemodialysis Alarms: What Do They Mean? Source: Glendale, CA: Hartwell Communications. 2001. 2 p. Contact: Available from Hartwell Communications. 1102 N. Brand Boulevard, Number 74, Glendale, CA 91202. (818) 244-9041. Fax (818) 244-9540. Email: [email protected]. Website: www.ikidney.com or www.lorihartwell.com. PRICE: Single copy free; full-text available online at no charge. Summary: This fact sheet helps hemodialysis patients understand the alarms that they may hear on the dialysis unit. The fact sheet covers the arterial monitor alarm, the venous monitor alarm, and the air foam or air detector alarm. For each type, the author describes what is being measured and why, then discusses the possible solutions for the problem that caused the alarm to sound. Simple line graphics illustrate the fact sheet.

•

Just the Facts: Getting Enough Hemodialysis Source: Madison, WI: Life Options Rehabilitation Program. 1999. 2 p. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This fact sheet is part of the Life Options Rehabilitation Program, a patient education service of Amgen, Inc. The Keys to a Long Life materials were developed to motivate patients on dialysis and teach them how to optimize their dialysis care and improve their quality of life. This fact sheet on getting enough dialysis is one of six fact sheets providing general information about living well on dialysis. Each fact sheet contains research based information about the topic and why it is important for patients; simple illustrations; and a table of problems, prevention strategies, and questions for patients to ask. Topics covered in this fact sheet include a definition of adequate dialysis, the urea reduction ratio (URR), the Kt over V measurement, the importance of adequate dialysis, achieving adequate dialysis goals, the importance of attending all scheduled dialysis treatments for the entire time, and the symptoms of inadequate dialysis. The fact sheet defines medical terms in nontechnical language. 'The Keys to a Long Life' materials are based on the real life experiences and advice of long term dialysis patients, as well as on data from a telephone opinion survey of dialysis patients. 1 figure. 1 table. 2 references.

•

53 Tips for the Hemodialysis Patient Source: Glendale, CA: Hartwell Communications. 2000. 5 p. Contact: Available from Hartwell Communications. 1102 N. Brand Boulevard, Number 74, Glendale, CA 91202. (818) 244-9041. Fax (818) 244-9540. Email: [email protected]. Website: www.ikidney.com or www.lorihartwell.com. PRICE: Single copy free; full-text available online at no charge.

284

Hemodialysis

Summary: This fact sheet offers 55 practical tips for living well while on hemodialysis. The suggestions are categorized into topics: phosphorus control, avoiding nausea, avoiding constipation, fluid control, potassium control, sodium control, and eating out at restaurants. The fact sheet refers readers to the National Kidney Foundation (800-6229010) for more information, especially about food and work. Simple line graphics illustrate the fact sheet. •

What Every Hemodialysis Patient Should Know about Renal Bone Disease: A Patient Booklet on Calcijex (Calcitriol Injection) Source: Abbott Park, IL: Abbott Laboratories. 1990. 10 p. Contact: Available from Abbott Laboratories. Renal Care, One Abbott Park Road, Department H10, Building J14, Abbott Park, IL 60064-3500. (708) 937-6100. PRICE: Single copy free. Order Number 90-1453-40-Feb., 91. Summary: This patient education booklet describes calcitriol injections for patients on hemodialysis. Written in a question-and-answer format, it describes renal bone disease (osteodystrophy), discusses how renal bone disease starts, how kidney function is related to renal bone disease, the role of calcitriol and parathyroid hormone (PTH) in the body, what happens when the kidneys stop making calcitriol, how to replace missing calcitriol through oral medication or injection, what lab tests are used to monitor calcium levels, and the effects of injected calcitriol therapy. The last page of the brochure includes the pharmaceutical information for Calcijex.

•

Anemia in Hemodialysis and CAPD Source: McGaw Park, IL: Baxter Healthcare Corporation, Renal Division. 1995. 4 p. Contact: Available from Baxter Healthcare Corporation, Renal Division. 1620 Waukegan Road, McGaw Park, IL 60085. (800) 284-4060. PRICE: Single copy free. Summary: This physician fact sheet discusses anemia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Topics include the incidence of anemia in patients with end-stage renal disease (ESRD); the effects of HD versus CAPD on anemia in chronic renal failure; the use of erythropoietin (EPO) to manage anemia in the dialysis population, including dosage and administration and quality of life issues; the adverse side effects of EPO, including hypertension and seizures, access clotting, and dialysis efficiency; and the cost implications of EPO. The fact sheet includes reports from research studies in this area. The author concludes that the degree of anemia in patients on CAPD is less severe than for patients on chronic hemodialysis; this may become an important consideration in the selection of dialysis modality as the cost of health care continues to be scrutinized. The fact sheet is printed on cardstock, with 3color charts. 2 figures. 2 tables. 15 references.

•

Vascular Access for Hemodialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2001. 4 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 014554.

Patient Resources

285

Summary: When the kidneys fail, harmful wastes build up in the body, the blood pressure may rise, and the body may retain excess fluid and not make enough red blood cells. When this happens, treatment is required to replace the work of the failed kidneys. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. This brochure helps readers recently diagnosed with kidney failure understand the vascular access that is required for hemodialysis. Topics include the need for establishing vascular access a few weeks or months before dialysis is started, the arteriovenous fistula, the synthetic tube graft, a catheter used for temporary access, what to expect during hemodialysis, and how to take care of the vascular access. The brochure concludes with the contact information for the National Kidney Foundation (www.kidney.org) and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 3 figures. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “hemodialysis” (or synonyms). The following was recently posted: •

NKF-K/DOQI clinical practice guidelines for hemodialysis adequacy: update 2000 Source: National Kidney Foundation - Disease Specific Society; 1997 (updated 2000); 58 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2781&nbr=2007&a mp;string=hemodialysis

•

Recommendations for preventing transmission of infections among chronic hemodialysis patients Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2001 April; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2789&nbr=2015&a mp;string=hemodialysis Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Treatment Methods for Kidney Failure: Hemodialysis Summary: Describes how hemodialysis works, how people prepare for it, and the equipment and tests involved. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6540

286

Hemodialysis

The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hemodialysis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to hemodialysis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hemodialysis. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about hemodialysis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

Patient Resources

287

Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hemodialysis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “hemodialysis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “hemodialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “hemodialysis” (or a synonym) into the search box, and click “Submit Query.”

289

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

290

Hemodialysis

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

291

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

292

Hemodialysis

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

293

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

294

Hemodialysis

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

295

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

297

HEMODIALYSIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH]

298

Hemodialysis

Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]

Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Afferent Pathways: Nerve structures through which impulses are conducted from a peripheral part toward a nerve center. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of

Dictionary 299

antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Air Embolism: Occurs when the lungs over expand to the point that air bubbles are forced through the air sacs of the lungs into the circulatory system. [NIH] Air Sacs: Thin-walled sacs or spaces which function as a part of the respiratory system in birds, fishes, insects, and mammals. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alloys: A mixture of metallic elements or compounds with other metallic or metalloid elements in varying proportions. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH]

300

Hemodialysis

Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ammonium Chloride: An acidifying agent that is used as an expectorant and a diuretic. [NIH]

Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anabolic Steroids: Chemical derivatives of testosterone that are used for anabolic promotion of growth and repair of body tissues and the development of male sexual characteristics. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH]

Dictionary 301

Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anecdotal report: An incomplete description of the medical and treatment history of one or more patients. Anecdotal reports may be published in places other than peer-reviewed, scientific journals. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

302

Hemodialysis

Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anthrax: An acute bacterial infection caused by ingestion of bacillus organisms. Carnivores may become infected from ingestion of infected carcasses. It is transmitted to humans by contact with infected animals or contaminated animal products. The most common form in humans is cutaneous anthrax. [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidote: A remedy for counteracting a poison. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH]

Dictionary 303

Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiproliferative: Counteracting a process of proliferation. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Apheresis: Components plateletpheresis. [NIH]

being

separated

out,

as

leukapheresis,

plasmapheresis,

Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aquaporins: Membrane proteins which facilitate the passage of water. They are members of the family of membrane channel proteins which includes the lens major intrinsic protein and bacterial glycerol transporters. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Archaea: One of the three domains of life (the others being bacteria and Eucarya), formerly called Archaebacteria under the taxon Bacteria, but now considered separate and distinct. They are characterized by: 1) the presence of characteristic tRNAs and ribosomal RNAs; 2) the absence of peptidoglycan cell walls; 3) the presence of ether-linked lipids built from branched-chain subunits; and 4) their occurrence in unusual habitats. While archaea resemble bacteria in morphology and genomic organization, they resemble eukarya in their

304

Hemodialysis

method of genomic replication. The domain contains at least three kingdoms: crenarchaeota, euryarchaeota, and korarchaeota. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arterial embolization: The blocking of an artery by a clot of foreign material. This can be done as treatment to block the flow of blood to a tumor. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atrial: Pertaining to an atrium. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH]

Dictionary 305

Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds, and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Autogenic: A type of succession when the developing vegetation itself is the cause for the succession. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Autopsy: Postmortem examination of the body. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterial toxin: A toxic substance, made by bacteria, that can be modified to kill specific tumor cells without harming normal cells. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH]

306

Hemodialysis

Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH]

Dictionary 307

Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bioterrorism: The use of biological agents in terrorism. This includes the malevolent use of bacteria, viruses, or toxins against people, animals, or plants. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH]

308

Hemodialysis

Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bolus injection: The injection of a drug (or drugs) in a high quantity (called a bolus) at once, the opposite of gradual administration (as in intravenous infusion). [EU] Bone Cements: Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. [NIH] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Brachiocephalic Veins: Large veins on either side of the root of the neck formed by the junction of the internal jugular and subclavian veins. They drain blood from the head, neck, and upper extremities, and unite to form the superior vena cava. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain

Dictionary 309

stem; and cerebellum. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bupivacaine: A widely used local anesthetic agent. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcifediol: The major circulating metabolite of vitamin D3 produced in the liver and the best indicator of the body's vitamin D stores. It is effective in the treatment of rickets and osteomalacia, both in azotemic and non-azotemic patients. Calcifediol also has mineralizing properties. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcitriol: The physiologically active form of vitamin D. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH]

310

Hemodialysis

Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Chloride: A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning. [NIH] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Camptothecin: An alkaloid isolated from the stem wood of the Chinese tree, Camptotheca acuminata. This compound selectively inhibits the nuclear enzyme DNA topoisomerase. Several semisynthetic analogs of camptothecin have demonstrated antitumor activity. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU]

Dictionary 311

Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Causality: The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors. [NIH] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges,

312

Hemodialysis

eyes, inner ears, and urinary tract. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell motility: The ability of a cell to move. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellular adhesion: The close adherence (bonding) to adjoining cell surfaces. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Angiography: Radiography of the vascular system of the brain after injection of a contrast medium. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH]

Dictionary 313

Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Cilastatin: A renal dehydropeptidase-I and leukotriene D4 dipeptidase inhibitor. Since the antibiotic, imipenem, is hydrolyzed by dehydropeptidase-I, which resides in the brush border of the renal tubule, cilastatin is administered with imipenem to increase its effectiveness. The drug also inhibits the metabolism of leukotriene D4 to leukeotriene E4. [NIH]

Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood

314

Hemodialysis

system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citric Acid: A key intermediate in metabolism. It is an acid compound found in citrus fruits. The salts of citric acid (citrates) can be used as anticoagulants due to their calcium chelating ability. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clavicle: A long bone of the shoulder girdle. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the

Dictionary 315

high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements,

316

Hemodialysis

megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted

Dictionary 317

beyond normal dimensions. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]

Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services.

318

Hemodialysis

Savings may be incurred by the provider or the consumer. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Cryoglobulinemia: A condition characterized by the presence of abnormal or abnormal quantities of cryoglobulins in the blood. They are precipitated into the microvasculature on exposure to cold and cause restricted blood flow in exposed areas. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystathionine beta-Synthase: A multifunctional pyridoxal phosphate enzyme. In the second stage of cysteine biosynthesis it catalyzes the reaction of homocysteine with serine to form cystathionine with the elimination of water. Deficiency of this enzyme leads to hyperhomocysteinemia and homocystinuria. EC 4.2.1.22. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH]

Dictionary 319

Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermal: Pertaining to or coming from the skin. [NIH] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Deuterium Oxide: The isotopic compound of hydrogen of mass 2 (deuterium) with oxygen. (From Grant & Hackh's Chemical Dictionary, 5th ed) It is used to study mechanisms and rates of chemical or nuclear reactions, as well as biological processes. [NIH] Dextran Sulfate: Long-chain polymer of glucose containing 17-20% sulfur. It has been used as an anticoagulant and also has been shown to inhibit the binding of HIV-1 to CD4+ Tlymphocytes. It is commonly used as both an experimental and clinical laboratory reagent and has been investigated for use as an antiviral agent, in the treatment of hypolipidemia, and for the prevention of free radical damage, among other applications. [NIH]

320

Hemodialysis

Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Dialysis Solutions: Solutions prepared for exchange across a semipermeable membrane of solutes below a molecular size determined by the cutoff threshold of the membrane material. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietetics: The study and regulation of the diet. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Diffusivity: Of a reverberant sound field. The degree to which the directions of propagation of waves are random from point to point. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH]

Dictionary 321

Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Dipyridamole: A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the

322

Hemodialysis

back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drip: The continuous slow introduction of a fluid containing nutrients or drugs. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elbow Joint: A hinge joint connecting the forearm to the arm. [NIH] Electrocardiograph: Apparatus which, by means of currents produced by contractions of the cardiac muscle, records heart movements as electro-cardiograms. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU]

Dictionary 323

Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embolectomy: Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called thrombectomy. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emergency Medical Services: Services specifically designed, staffed, and equipped for the emergency care of patients. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH]

324

Hemodialysis

Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Enhancers: Transcriptional element in the virus genome. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH]

Dictionary 325

Epoetin alfa: A colony-stimulating factor that is made in the laboratory. It increases the production of red blood cells. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Ergometer: An instrument for measuring the force of muscular contraction. [NIH] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoiesis: The production of erythrocytes. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excrete: To get rid of waste from the body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expectorant: 1. Promoting the ejection, by spitting, of mucus or other fluids from the lungs and trachea. 2. An agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives).

326

Hemodialysis

[EU]

Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation. [NIH] Extracorporeal Membrane Oxygenation: Application of a life support system that circulates the blood through an oxygenating system, which may consist of a pump, a membrane oxygenator, and a heat exchanger. Examples of its use are to assist victims of smoke inhalation injury, respiratory failure, and cardiac failure. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femoral Vein: The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH]

Dictionary 327

Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibroma: A benign tumor of fibrous or fully developed connective tissue. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibrotic tissue: Inflamed tissue that has become scarred. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flank Pain: Pain emanating from below the ribs and above the ilium. [NIH] Flatus: Gas passed through the rectum. [NIH] Flexor: Muscles which flex a joint. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH]

328

Hemodialysis

Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Fulminant Hepatic Failure: Liver failure that occurs suddenly in a previously healthy person. The most common causes of FHF are acute hepatitis, acetaminophen overdose, and liver damage from prescription drugs. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU]

Dictionary 329

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Genital: Pertaining to the genitalia. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH]

330

Hemodialysis

Glomerulosclerosis: Scarring of the glomeruli. It may result from diabetes mellitus (diabetic glomerulosclerosis) or from deposits in parts of the glomerulus (focal segmental glomerulosclerosis). The most common signs of glomerulosclerosis are proteinuria and kidney failure. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Gonadal: Pertaining to a gonad. [EU]

Dictionary 331

Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Graft Survival: The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Granulocyte: A type of white blood cell that fights bacterial infection. Neutrophils, eosinophils, and basophils are granulocytes. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts

332

Hemodialysis

may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematuria: Presence of blood in the urine. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis Solutions: Solutions prepared for hemodialysis. The composition of the predialysis solution may be varied in order to determine the effect of solvated metabolites on anoxia, malnutrition, acid-base balance, etc. Of principal interest are the effect of the choice of buffers (e.g., acetate or carbonate), the addition of cations (Na+, K+, Ca2+), and addition of carbohydrates (glucose). [NIH] Hemodialysis, Home: Long-term maintenance hemodialysis in the home. [NIH] Hemodialyzer: Apparatus for hemodialysis performing the functions of human kidneys in place of the damaged organs; highly specialized medical equipment used for treating kidney failure by passing the body's toxic substances through an external artificial kidney. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity

Dictionary 333

of erythrocytes. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatocyte: A liver cell. [NIH] Hepatocyte Growth Factor: Multifunctional growth factor which regulates both cell growth and cell motility. It exerts a strong mitogenic effect on hepatocytes and primary epithelial cells. Its receptor is proto-oncogene protein C-met. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small

334

Hemodialysis

intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrofluoric Acid: A solution of hydrogen fluoride in water. It is a colorless fuming liquid which can cause painful burns. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolases: Any member of the class of enzymes that catalyze the cleavage of the substrate and the addition of water to the resulting molecules, e.g., esterases, glycosidases (glycoside hydrolases), lipases, nucleotidases, peptidases (peptide hydrolases), and phosphatases (phosphoric monoester hydrolases). EC 3. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH]

Dictionary 335

Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine betasynthase and is a risk factor for coronary vascular disease. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypodermic: Applied or administered beneath the skin. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypovolemia: An abnormally low volume of blood circulating through the body. It may result in hypovolemic shock. [NIH] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Iliac Vein: A vein on either side of the body which is formed by the union of the external and internal iliac veins and passes upward to join with its fellow of the opposite side to form the inferior vena cava. [NIH] Imaging procedures: Methods of producing pictures of areas inside the body. [NIH] Imipenem: Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with cilastatin, a renal dipeptidase inhibitor. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been

336

Hemodialysis

immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inertia: Inactivity, inability to move spontaneously. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized,

Dictionary 337

subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Infusion Pumps: Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (insulin infusion systems is also available), and other disorders. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insecticides: Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin Infusion Systems: Portable or implantable devices for infusion of insulin. Includes open-loop systems which may be patient-operated or controlled by a pre-set program and are designed for constant delivery of small quantities of insulin, increased during food ingestion, and closed-loop systems which deliver quantities of insulin automatically based

338

Hemodialysis

on an electronic glucose sensor. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Dictionary 339

Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Islet: Cell producing insulin in pancreas. [NIH] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Isopropyl: A gene mutation inducer. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal

340

Hemodialysis

function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levofloxacin: A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics. [NIH] Lichen Planus: An inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized. It is characterized by distinctive purplish, flattopped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or

Dictionary 341

spore to the fertilized ovum or spore of the next generation. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Local therapy: Treatment that affects cells in the tumor and the area close to it. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH]

342

Hemodialysis

Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lovastatin: A fungal metabolite isolated from cultures of Aspergillus terreus. The compound is a potent anticholesteremic agent. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It also stimulates the production of low-density lipoprotein receptors in the liver. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnesium Chloride: Magnesium chloride. An inorganic compound consisting of one magnesium and two chloride ions. The compound is used in medicine as a source of magnesium ions, which are essential for many cellular activities. It has also been used as a cathartic and in alloys. [NIH] Magnetic Resonance Angiography: Non-invasive method of vascular imaging and determination of internal anatomy without injection of contrast media or radiation exposure. The technique is used especially in cerebral angiography as well as for studies of

Dictionary 343

other vascular structures. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Man-made: Ionizing radiation emitted by artificial or concentrated natural, radioactive material or resulting from the operation of high voltage apparatus, such as X-ray apparatus or particle accelerators, of nuclear reactors, or from nuclear explosions. [NIH] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Mean blood pressure: The average blood pressure, taking account of the rise and fall that occurs with each heartbeat. It is often estimated by multiplying the diastolic pressure by two, adding the systolic pressure, and then dividing this sum by three. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Mefloquine: A phospholipid-interacting antimalarial drug (antimalarials). It is very effective against Plasmodium falciparum with very few side effects. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Megestrol: 17-Hydroxy-6-methylpregna-3,6-diene-3,20-dione. A progestational hormone used most commonly as the acetate ester. As the acetate, it is more potent than progesterone both as a progestagen and as an ovulation inhibitor. It has also been used in the palliative treatment of breast cancer. [NIH] Megestrol Acetate: A drug that belongs to the group of hormones called progestins, used as hormone therapy to block estrogen and to suppress the effects of estrogen and androgens.

344

Hemodialysis

[NIH]

Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic acidosis: (met-ah-BOL-ik as-id-O-sis): A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream). [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular

Dictionary 345

animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA,

346

Hemodialysis

can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple Organ Failure: A progressive condition usually characterized by combined failure of several organs such as the lungs, liver, kidney, along with some clotting mechanisms, usually postinjury or postoperative. [NIH] Multivalent: Pertaining to a group of 5 or more homologous or partly homologous chromosomes during the zygotene stage of prophase to first metaphasis in meiosis. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle

Dictionary 347

known as cardiac muscle. [NIH] Myoglobin: A conjugated protein which is the oxygen-transporting pigment of muscle. It is made up of one globin polypeptide chain and one heme group. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Needlestick Injuries: Penetrating stab wounds caused by needles. They are of special concern to health care workers since such injuries put them at risk for developing infectious disease. [NIH] Nephrologist: A doctor who treats patients with kidney problems or hypertension. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrotoxic: Toxic or destructive to kidney cells. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine,

348

Hemodialysis

epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleotidases: A class of enzymes that catalyze the conversion of a nucleotide and water to a nucleoside and orthophosphate. EC 3.1.3.-. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutrition Assessment: Evaluation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual. Nutrition surveys may be used in making the assessment. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of

Dictionary 349

nutrients. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obsessive-Compulsive Disorder: An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behavior which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Olfaction: Function of the olfactory apparatus to perceive and discriminate between the molecules that reach it, in gas form from an external environment, directly or indirectly via the nose. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a

350

Hemodialysis

solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteitis Fibrosa Cystica: A fibrous degeneration, cyst formation, and the presence of fibrous nodules in bone, usually due to hyperparathyroidism. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteodystrophy: Defective bone formation. [EU] Ototoxic: Having a deleterious effect upon the eighth nerve, or upon the organs of hearing and balance. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [NIH]

Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the

Dictionary 351

action of the proto-oncogene proteins c-mos. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pamidronate: A drug that belongs to the family of drugs called bisphosphonates. Pamidronate is used as treatment for abnormally high levels of calcium in the blood. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Paradoxical: Occurring at variance with the normal rule. [EU] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Particle Accelerators: Devices which accelerate electrically charged atomic or subatomic

352

Hemodialysis

particles, such as electrons, protons or ions, to high velocities so they have high kinetic energy. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pediatric Nursing: The nursing care of children from birth to adolescence. It includes the clinical and psychological aspects of nursing care. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pentosephosphate Pathway: A pathway of hexose oxidation in which glucose-6-phosphate undergoes two successive oxidations by NADP, the final one being an oxidative decarboxylation to form a pentose phosphate. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Chain Initiation: The process whereby the formation of a peptide chain is started. This process requires (1) the 30s subunit, (2) the mRNA coding for the polypeptide to be made, (3) Met-tRNAi, (4) initiation factors, and (5) GTP. [NIH] Peptide Hydrolases: A subclass of enzymes from the hydrolase class that catalyze the hydrolysis of peptide bonds. Exopeptidases and endopeptidases make up the sub-subclasses for this group. EC 3.4. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH]

Dictionary 353

Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericarditis: Inflammation of the pericardium. [EU] Peridural: Around or external to the dura mater. [EU] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Perivascular: Situated around a vessel. [EU] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH]

354

Hemodialysis

Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Pheresis: A procedure in which blood is collected, part of the blood such as platelets or white blood cells is taken out, and the rest of the blood is returned to the donor. Also called apheresis. [NIH] Phlebotomy: The letting of blood from a vein. Although it is one of the techniques used in drawing blood to be used in diagnostic procedures, in modern medicine, it is used commonly in the treatment of erythrocytosis, hemochromocytosis, polycythemia vera, and porphyria cutanea tarda. Its historical counterpart is bloodletting. (From Cecil Textbook of Medicine, 19th ed & Wintrobe's Clinical Hematology, 9th ed) Venipuncture is not only for the letting of blood from a vein but also for the injecting of a drug into the vein for diagnostic analysis. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphoric Monoester Hydrolases: A group of hydrolases which catalyze the hydrolysis of monophosphoric esters with the production of one mole of orthophosphate. EC 3.1.3. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase

Dictionary 355

"physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the

356

Hemodialysis

platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelet Factor 4: A high-molecular-weight proteoglycan-platelet factor complex which is released from blood platelets by thrombin. It acts as a mediator in the heparin-neutralizing capacity of the blood and plays a role in platelet aggregation. At high ionic strength (I=0.75), the complex dissociates into the active component (molecular weight 29,000) and the proteoglycan carrier (chondroitin 4-sulfate, molecular weight 350,000). The molecule exists in the form of a dimer consisting of 8 moles of platelet factor 4 and 2 moles of proteoglycan. [NIH]

Platelet-Derived Growth Factor: Mitogenic peptide growth hormone carried in the alphagranules of platelets. It is released when platelets adhere to traumatized tissues. Connective tissue cells near the traumatized region respond by initiating the process of replication. [NIH] Plateletpheresis: The preparation of platelet concentrates with the return of red cells and platelet-poor plasma to the donor. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Pneumothorax: Accumulation of air or gas in the space between the lung and chest wall, resulting in partial or complete collapse of the lung. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis

Dictionary 357

with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polymyxin: Basic polypeptide antibiotic group obtained from Bacillus polymyxa. They affect the cell membrane by detergent action and may cause neuromuscular and kidney damage. At least eleven different members of the polymyxin group have been identified, each designated by a letter. [NIH] Polyneuritis: Inflammation of several peripheral nerves at the same time. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Popliteal Vein: The vein formed by the union of the anterior and posterior tibial veins; it courses through the popliteal space and becomes the femoral vein. [NIH] Population Growth: Increase, over a specific period of time, in the number of individuals living in a country or region. [NIH] Porosity: Condition of having pores or open spaces. This often refers to bones, bone implants, or bone cements, but can refer to the porous state of any solid substance. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may

358

Hemodialysis

be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Chloride: Potassium chloride. A white crystal or crystalline powder used as an electrolyte replenisher, in the treatment of hypokalemia, in buffer solutions, and in fertilizers and explosives. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH]

Dictionary 359

Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protective Devices: Devices designed to provide personal protection against injury to individuals exposed to hazards in industry, sports, aviation, or daily activities. [NIH] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH]

360

Hemodialysis

Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Folding: A rapid biochemical reaction involved in the formation of proteins. It begins even before a protein has been completely synthesized and proceeds through discrete intermediates (primary, secondary, and tertiary structures) before the final structure (quaternary structure) is developed. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protein-Energy Malnutrition: The lack of sufficient energy or protein to meet the body's metabolic demands, as a result of either an inadequate dietary intake of protein, intake of poor quality dietary protein, increased demands due to disease, or increased nutrient losses. [NIH]

Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]

Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU]

Dictionary 361

Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychological Theory: Principles applied to the analysis and explanation of psychological or behavioral phenomena. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Pyridoxal: 3-Hydroxy-5-(hydroxymethyl)-2-methyl-4- pyridinecarboxaldehyde. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Pyrogenic: Inducing fever. [EU] Pyrogens: Substances capable of increasing body temperature; they may be of microbial origin, often polysaccharides and may contaminate distilled water. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH]

362

Hemodialysis

Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radial Artery: The direct continuation of the brachial trunk, originating at the bifurcation of the brachial artery opposite the neck of the radius. Its branches may be divided into three groups corresponding to the three regions in which the vessel is situated, the forearm, wrist, and hand. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH]

Dictionary 363

Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative

364

Hemodialysis

risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal cell carcinoma: A type of kidney cancer. [NIH] Renal Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal Replacement Therapy: Procedures which temporarily or permanently remedy insufficient cleansing of body fluids by the kidneys. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Restless legs: Legs characterized by or showing inability to remain at rest. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines

Dictionary 365

with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Reverberant: The sound field prevailing in a large enclosure with moderately reflecting surfaces. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Salicylic: A tuberculosis drug. [NIH] Saline: A solution of salt and water. [NIH]

366

Hemodialysis

Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an

Dictionary 367

essential component of glutathione peroxidase. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sessile: Attached directly by the base, denoting a tumor without penduncle or stalk; in zoology, attached so that it is not possible to move about. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH]

368

Hemodialysis

Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Simvastatin: A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL-cholesterol (lipoproteins, LDL cholesterol). [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Sludge: A clump of agglutinated red blood cells. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smallpox: A generalized virus infection with a vesicular rash. [NIH] Smoke Inhalation Injury: Pulmonary injury following the breathing in of toxic smoke from burning materials such as plastics, synthetics, building materials, etc. This injury is the most frequent cause of death in burn patients. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH]

Dictionary 369

Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Acetate: The trihydrate sodium salt of acetic acid, which is used as a source of sodium ions in solutions for dialysis and as a systemic and urinary alkalizer, diuretic, and expectorant. [NIH] Sodium Bicarbonate: A white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Soybean Oil: Oil from soybean or soybean plant. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or

370

Hemodialysis

dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stethoscopes: An instrument used for the detection and study of sounds within the body that conveyed to the ears of the observer through rubber tubing. [NIH] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are

Dictionary 371

coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclavian Vein: The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subcutaneous port: A tube surgically placed into a blood vessel and attached to a disk placed under the skin. It is used for the administration of intravenous fluids and drugs; it can also be used to obtain blood samples. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Superior vena cava: Vein which returns blood from the head and neck, upper limbs, and thorax. It is formed by the union of the two brachiocephalic veins. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the

372

Hemodialysis

beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic pressure: The highest pressure to which blood pressure rises with the contraction of the ventricles. [NIH] Tachyarrhythmia: Tachycardia associated with an irregularity in the normal heart rhythm. [EU]

Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermodilution: Measurement of blood flow based on induction at one point of the circulation of a known change in the intravascular heat content of flowing blood and detection of the resultant change in temperature at a point downstream. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH]

Dictionary 373

Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic

374

Hemodialysis

proteases. EC 3.4.21.68. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Topoisomerase inhibitors: A family of anticancer drugs. The topoisomerase enzymes are responsible for the arrangement and rearrangement of DNA in the cell and for cell growth and replication. Inhibiting these enzymes may kill cancer cells or stop their growth. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Traction: The act of pulling. [NIH] Transaldolase: An enzyme of the transferase class that catalyzes the reaction sedoheptulose 7-phosphate and D-glyceraldehyde 3-phosphate to yield D-erythrose 4-phosphate and Dfructose phosphate in the pentosephosphate pathway. (Dorland, 27th ed) EC 2.2.1.2. [NIH] Transaminases: A subclass of enzymes of the transferase class that catalyze the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally a 2-keto acid). Most of these enzymes are pyridoxyl phosphate proteins. (Dorland, 28th ed) EC 2.6.1. [NIH]

Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA

Dictionary 375

molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transillumination: Passage of light through body tissues or cavities for examination of internal structures. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tularemia: A plague-like disease of rodents, transmissible to man. It is caused by Francisella tularensis and is characterized by fever, chills, headache, backache, and weakness. [NIH]

376

Hemodialysis

Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tumor suppressor gene: Genes in the body that can suppress or block the development of cancer. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Universal Precautions: Prudent standard preventive measures to be taken by professional and other health personnel in contact with persons afflicted with a communicable disease, to avoid contracting the disease by contagion or infection. Precautions are especially applicable in the diagnosis and care of AIDS patients. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [NIH]

Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in

Dictionary 377

which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Valproic Acid: A fatty acid with anticonvulsant properties used in the treatment of epilepsy. The mechanisms of its therapeutic actions are not well understood. It may act by increasing GABA levels in the brain or by altering the properties of voltage dependent sodium channels. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venous Pressure: The blood pressure in a vein. It is usually measured to assess the filling pressure to the ventricle. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Ventricular Remodeling: The geometric and structural changes that the ventricle undergoes, usually following myocardial infarction. It comprises expansion of the infarct and dilatation of the healthy ventricle segments. While most prevalent in the left ventricle, it

378

Hemodialysis

can also occur in the right ventricle. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenobiotics: Chemical substances that are foreign to the biological system. They include naturally occurring compounds, drugs, environmental agents, carcinogens, insecticides, etc. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

Dictionary 379

Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

381

INDEX A Abdominal, 11, 79, 177, 297, 328, 344, 351, 353, 364 Abortion, 297, 358 Abscess, 297, 367 Acceptor, 297, 341, 350, 374 Acetaminophen, 297, 328 Acetylcholine, 297, 347, 348 Acetylcysteine, 184, 185, 297 Acidity, 297, 353 Acidosis, 75, 174, 240, 243, 297, 339 Acoustic, 79, 86, 297 Acrylonitrile, 297, 365 Actin, 297, 347, 375 Activities of Daily Living, 35, 297 Acuity, 297, 305 Acute renal, 58, 67, 71, 80, 117, 157, 194, 233, 243, 247, 257, 297, 333 Acyl, 215, 297 Adaptability, 297, 312 Adaptation, 34, 69, 77, 125, 245, 298, 355 Adenine, 298, 361 Adenosine, 42, 298, 304, 309, 354, 372 Adenovirus, 84, 298 Adjustment, 6, 9, 18, 34, 71, 93, 146, 237, 282, 298 Adjuvant, 146, 154, 240, 298, 329 Adjuvant Therapy, 154, 298 Adolescence, 247, 298, 313, 352 Adrenal Glands, 298, 300, 364 Adsorption, 76, 216, 298 Adsorptive, 298 Adverse Effect, 298, 354, 368 Aerobic, 13, 109, 298, 335, 345 Afferent, 73, 298 Afferent Pathways, 73, 298 Affinity, 298, 369 Agar, 299, 318, 355 Age of Onset, 299, 376 Air Embolism, 248, 299 Air Sacs, 299 Airway, 299, 368 Alanine, 8, 299 Albumin, 17, 23, 86, 100, 121, 180, 279, 299, 344, 355, 372 Alertness, 299, 309 Algorithms, 215, 299, 307 Alimentary, 299, 320, 351

Alkaline, 23, 181, 190, 297, 299, 300, 309, 372 Alkaline Phosphatase, 23, 299 Alkalosis, 75, 299, 372 Allogeneic, 299, 331 Allograft, 115, 126, 299 Alloys, 299, 342 Alopecia, 103, 299 Alpha Particles, 299, 362 Alprenolol, 299, 344 Alternative medicine, 258, 300 Aluminum, 126, 159, 240, 278, 300 Amino acid, 12, 47, 86, 89, 99, 141, 146, 150, 154, 157, 160, 195, 196, 245, 260, 299, 300, 301, 302, 304, 318, 330, 340, 342, 344, 352, 354, 357, 360, 365, 367, 371, 373, 374, 375, 376 Amino Acid Sequence, 300, 302 Amlodipine, 34, 93, 300 Ammonia, 43, 46, 300, 372, 376 Ammonium Chloride, 46, 300 Amnestic, 300, 327 Amputation, 10, 107, 300 Amyloid, 51, 300 Amyloidosis, 52, 97, 163, 234, 240, 300 Anabolic, 35, 63, 80, 83, 86, 107, 260, 300, 320 Anabolic Steroids, 36, 300 Anaerobic, 174, 300, 335 Anal, 300, 342 Analgesics, 24, 300 Analog, 16, 300, 327 Analytes, 67, 71, 301 Anaphylatoxins, 301, 315 Anastomosis, 37, 48, 68, 179, 200, 206, 242, 244, 301 Anatomical, 21, 301, 304, 313, 316, 320, 336, 366 Androgens, 301, 343 Anecdotal report, 38, 52, 301 Anemic, 121, 278, 301 Anesthesia, 173, 176, 299, 300, 301, 359 Aneurysm, 242, 301, 303, 377 Angina, 29, 300, 301, 344 Angina Pectoris, 29, 300, 301, 344 Angiography, 108, 110, 142, 301 Angiotensin converting enzyme inhibitor, 34, 301

382

Hemodialysis

Angiotensinogen, 301, 364 Animal model, 70, 76, 301 Anions, 299, 301, 339, 367 Annealing, 301, 356 Anomalies, 247, 302 Anorexia, 63, 80, 243, 245, 302, 328 Anoxia, 302, 332 Antagonism, 302, 309, 372 Anthrax, 75, 302 Anthropometry, 47, 56, 302 Antibacterial, 8, 222, 302, 321, 335, 369, 377 Antibiotic, 7, 220, 302, 309, 311, 313, 357, 365, 369 Antibodies, 88, 109, 302, 305, 333, 334, 335, 342, 355 Antibody, 91, 107, 151, 299, 302, 315, 333, 336, 343, 346, 362, 369 Anticoagulant, 22, 194, 221, 302, 319, 360 Anticonvulsant, 302, 310, 354, 377 Antidote, 302, 310 Antigen, 206, 298, 302, 315, 333, 335, 336, 343 Antigen-Antibody Complex, 302, 315 Antihypertensive, 10, 13, 20, 31, 34, 58, 256, 299, 302 Anti-infective, 302, 334, 338, 368 Anti-inflammatory, 75, 297, 302 Antimetabolite, 302, 327, 365 Antimicrobial, 77, 78, 161, 220, 303 Antineoplastic, 303, 310, 327, 329, 337, 350, 356 Antineoplastic Agents, 303, 337 Antioxidant, 55, 61, 72, 88, 143, 146, 149, 160, 303, 304, 350 Antiproliferative, 42, 196, 204, 303 Antithrombotic, 78, 220, 303 Antiviral, 101, 173, 297, 303, 319, 338, 365 Anus, 300, 303, 308, 315, 333, 363 Anxiety, 16, 22, 116, 303, 327, 349, 351 Aorta, 177, 303, 311, 364, 371, 377 Aortic Aneurysm, 79, 303 Apheresis, 214, 303, 354 Apnea, 18, 303 Apolipoproteins, 84, 303, 341 Apoptosis, 39, 55, 136, 303 Applicability, 243, 303 Aquaporins, 80, 303 Aqueous, 76, 303, 319, 334, 340 Arachidonic Acid, 229, 303, 359 Archaea, 303, 345 Arginine, 155, 301, 304, 348, 376

Arterial embolization, 11, 304 Arteries, 9, 303, 304, 307, 308, 311, 317, 339, 342, 344, 346, 373 Arterioles, 304, 307, 310, 345, 346 Arteriolosclerosis, 304 Arteriosclerosis, 136, 304, 335, 346 Artery, 20, 27, 39, 44, 62, 74, 79, 95, 115, 120, 177, 179, 183, 188, 190, 196, 198, 200, 204, 207, 208, 217, 228, 237, 241, 244, 277, 301, 304, 311, 317, 323, 326, 339, 361, 371 Ascites, 97, 304 Ascorbic Acid, 100, 121, 154, 262, 304, 334 Aseptic, 304, 370 Aspiration, 60, 170, 304 Assay, 8, 88, 89, 114, 304, 365 Asymptomatic, 130, 240, 304 ATP, 304, 321, 329, 354, 360, 375 Atrial, 98, 304 Atrium, 214, 304, 311, 377 Atrophy, 35, 102, 128, 304 Attenuated, 304, 321, 377 Attenuation, 229, 304 Audiometry, 14, 305 Autoantibodies, 135, 305 Autoantigens, 305 Autogenic, 95, 305 Autologous, 20, 78, 128, 183, 208, 242, 305 Autonomic, 44, 112, 297, 305, 353 Autonomic Neuropathy, 112, 305 Autopsy, 158, 305 Axillary, 95, 305, 308, 371 Axillary Artery, 305, 308 Axillary Vein, 95, 305, 371 B Bacillus, 302, 305, 357 Bacteremia, 95, 117, 257, 305 Bacterial Infections, 55, 75, 305, 340 Bacterial Physiology, 298, 305 Bacterial toxin, 68, 305 Bacteriophage, 305, 355, 375 Bacteriostatic, 230, 305 Bacterium, 305, 333 Basophils, 306, 331, 340 Benign, 304, 306, 327, 331, 362 Benign tumor, 306, 327 Benzene, 306, 339 Beta-Lactamases, 306, 335 Beta-pleated, 300, 306 Bewilderment, 306, 316 Bilateral, 21, 306, 351 Bile, 306, 328, 341, 370

383

Bilirubin, 46, 174, 299, 306 Binding agent, 240, 306 Bioavailability, 83, 306 Biochemical, 8, 74, 104, 230, 244, 302, 306, 339, 360, 367 Bioengineering, 50, 67, 268, 306 Biofilms, 61, 161, 220, 306 Biological therapy, 306, 331 Biological Transport, 306, 320 Biomarkers, 102, 306 Biopsy, 28, 44, 307, 353 Biosynthesis, 303, 307, 318, 342, 367, 368 Biotechnology, 87, 92, 258, 269, 307 Bioterrorism, 75, 307 Biotransformation, 307 Bladder, 207, 305, 307, 316, 359, 376 Bloating, 307, 329 Blood Cell Count, 307, 332 Blood Coagulation, 216, 307, 309, 365, 373 Blood Coagulation Factors, 307 Blood Glucose, 27, 307, 332, 338 Blood Platelets, 307, 356, 367, 373 Blood pressure, 3, 4, 13, 14, 20, 23, 25, 26, 27, 29, 31, 34, 64, 87, 97, 119, 129, 135, 155, 172, 187, 193, 234, 238, 246, 248, 257, 259, 276, 279, 285, 302, 307, 310, 311, 320, 335, 343, 346, 348, 353, 369, 372, 377 Blood transfusion, 29, 307 Blood urea, 14, 17, 171, 231, 307, 339 Blood Volume, 65, 98, 172, 175, 176, 187, 188, 225, 226, 307 Blot, 84, 307 Body Composition, 44, 47, 83, 120, 142, 307 Body Fluids, 176, 214, 233, 299, 306, 308, 309, 322, 364, 369, 376 Body Mass Index, 23, 308 Bolus, 174, 175, 180, 211, 308 Bolus infusion, 308 Bolus injection, 211, 308 Bone Cements, 308, 357 Bone Conduction, 305, 308 Bone Density, 52, 308 Bone Marrow, 240, 242, 306, 308, 325, 329, 336, 342 Bone scan, 308, 366 Bowel, 12, 300, 308, 338, 353, 370 Bowel Movement, 308, 370 Brachial, 44, 305, 308, 362 Brachial Artery, 44, 308, 362 Brachiocephalic Veins, 308, 371

Brachytherapy, 308, 338, 362 Bradykinin, 308, 348, 355 Brain Diseases, 308, 351 Broad-spectrum, 76, 309, 311 Bronchi, 309, 324, 325, 372 Bronchial, 309, 372 Buffers, 190, 309, 332 Bupivacaine, 309, 340 Burns, 114, 125, 309, 334 Burns, Electric, 309 Bypass, 21, 79, 120, 204, 309 C Caffeine, 122, 309, 361 Calcifediol, 309 Calcification, 28, 44, 52, 99, 122, 255, 304, 309 Calcitriol, 6, 98, 154, 240, 278, 284, 309 Calcium Carbonate, 199, 308, 309 Calcium channel blocker, 300, 310 Calcium Chloride, 189, 194, 310 Calibration, 71, 185, 187, 310 Caloric intake, 233, 246, 310 Camptothecin, 310, 339 Cannula, 24, 207, 310 Capillary, 163, 174, 308, 310, 377, 378 Captopril, 120, 310 Carbamazepine, 121, 310 Carbohydrate, 39, 88, 310, 330, 357 Carbon Dioxide, 18, 310, 328, 364, 377 Carboplatin, 147, 156, 310 Carcinogenic, 306, 310, 337, 359, 370 Carcinogens, 310, 349, 350, 378 Carcinoma, 158, 310 Cardiac, 4, 29, 40, 44, 65, 84, 98, 105, 112, 126, 130, 188, 236, 240, 309, 310, 322, 323, 324, 325, 326, 328, 332, 340, 344, 346, 347, 370, 371 Cardiac Output, 44, 188, 310 Cardiomyopathy, 84, 237, 310 Cardiopulmonary, 125, 225, 248, 311 Cardiopulmonary Bypass, 125, 225, 311 Cardiovascular disease, 21, 25, 29, 34, 44, 55, 66, 72, 73, 81, 82, 104, 115, 155, 237, 239, 311 Cardiovascular System, 4, 172, 305, 311 Carnitine, 118, 130, 138, 139, 144, 147, 149, 151, 154, 155, 158, 215, 243, 245, 311 Carotid Arteries, 9, 311 Case report, 28, 119, 130, 145, 311, 314 Case series, 311, 314 Catabolism, 63, 311 Catheterization, 246, 311, 338

384

Hemodialysis

Cations, 311, 332, 339 Caudal, 311, 320, 335, 358 Causal, 311, 333, 338, 367 Causality, 36, 311 Cause of Death, 46, 72, 84, 311, 368 Caustic, 311, 368 Ceftriaxone, 90, 311 Cell Cycle, 64, 312, 314, 325, 360 Cell Death, 51, 213, 303, 312, 325, 347 Cell Division, 305, 312, 325, 331, 344, 345, 355, 359 Cell membrane, 306, 312, 354, 357, 369 Cell motility, 312, 333 Cell proliferation, 42, 48, 113, 114, 229, 304, 312 Cell Respiration, 312, 345, 364 Cell Survival, 312, 331 Cellobiose, 312 Cellular adhesion, 76, 312 Cellulose, 66, 225, 312, 355 Central Nervous System, 73, 297, 299, 306, 308, 309, 312, 322, 328, 330, 331, 367, 372 Centrifugation, 312, 332 Cerebral, 29, 130, 308, 312, 324, 325, 328, 342, 361 Cerebral Angiography, 312, 342 Cerebrospinal, 312, 368 Cerebrospinal fluid, 312, 368 Cerebrovascular, 20, 40, 311, 312 Cerebrum, 312 Character, 301, 312, 319 Chemotactic Factors, 313, 315 Chemotherapeutic agent, 313, 321 Chemotherapy, 110, 147, 179, 218, 220, 237, 242, 243, 244, 298, 313 Chest wall, 313, 356 Child Development, 238, 313 Chin, 122, 125, 313, 344 Chlorine, 199, 313 Cholera, 313, 367 Cholesterol, 23, 45, 90, 142, 148, 160, 306, 313, 317, 322, 334, 341, 342, 368, 370 Cholesterol Esters, 313, 341 Chromatin, 303, 313, 324, 348 Chromosome, 313, 341 Chylomicrons, 313, 341 Cilastatin, 91, 313, 335 Circulatory system, 191, 212, 299, 313 Cirrhosis, 28, 314 CIS, 229, 314, 364 Cisplatin, 157, 314 Citric Acid, 209, 314

Clamp, 205, 314 Clavicle, 24, 314 Clinical Medicine, 57, 314, 358 Clinical study, 133, 314, 317 Cloning, 182, 307, 314 Clot Retraction, 314, 355 Coenzyme, 304, 314, 342, 368 Cofactor, 314, 360, 373 Cohort Studies, 41, 314 Colitis, 67, 314 Collagen, 256, 300, 314, 327, 329, 356 Collapse, 315, 356, 368 Colloidal, 299, 315, 367 Colon, 314, 315, 340 Colorectal, 162, 315 Colorectal Cancer, 162, 315 Combination chemotherapy, 156, 315 Communicable disease, 315, 376 Comorbidity, 9, 23, 43, 56, 81, 120, 127, 139, 315 Complement, 65, 301, 315, 329, 355 Complementary and alternative medicine, 145, 164, 315 Complementary medicine, 145, 315 Compliance, 5, 37, 56, 61, 64, 66, 118, 139, 166, 167, 185, 243, 316 Compress, 205, 316 Computational Biology, 269, 316 Computed tomography, 45, 308, 316, 366 Computerized axial tomography, 316, 366 Computerized tomography, 316 Concentric, 224, 304, 316 Conception, 297, 316, 327, 358, 370 Concomitant, 35, 46, 171, 195, 316 Conduction, 305, 316 Confounding, 84, 316 Confusion, 248, 277, 316, 321, 376 Congestive heart failure, 20, 316 Conjugated, 60, 316, 318, 347 Conjunctiva, 316, 337 Connective Tissue, 304, 308, 314, 316, 319, 327, 328, 329, 342, 360, 365 Consciousness, 300, 316, 319, 321, 361 Constipation, 12, 233, 260, 284, 316 Constriction, 316, 339, 377 Constriction, Pathologic, 316, 377 Contamination, 8, 28, 46, 89, 228, 317, 333 Continuous infusion, 83, 317 Continuum, 226, 317 Contractility, 84, 317 Contraindications, ii, 317 Contralateral, 95, 317, 349

385

Contrast Media, 73, 317, 342 Contrast medium, 301, 312, 317 Control group, 13, 54, 71, 80, 317, 358, 362 Controlled clinical trial, 48, 51, 64, 78, 317 Controlled study, 54, 317 Coordination, 66, 317 Coronary, 20, 27, 37, 44, 62, 120, 204, 237, 301, 311, 317, 335, 344, 346 Coronary Angiography, 237, 317 Coronary Circulation, 301, 317 Coronary heart disease, 311, 317 Coronary Thrombosis, 317, 344, 346 Cortex, 308, 317, 325, 359, 364 Cortical, 317, 366 Cortisol, 299, 317 Cost Savings, 13, 181, 317 Creatinine, 17, 18, 34, 71, 197, 210, 233, 238, 318, 339 Creatinine clearance, 233, 238, 318 Critical Care, 237, 242, 243, 244, 318 Cryoglobulinemia, 29, 318 Crystallization, 51, 318 Culture Media, 70, 299, 318 Curative, 318, 365, 372 Cutaneous, 28, 177, 302, 318 Cyclic, 309, 318, 331, 348, 372 Cyst, 80, 318, 350 Cystathionine beta-Synthase, 318, 335 Cysteine, 109, 297, 318, 371 Cystine, 318 Cytochrome, 229, 318 Cytokine, 63, 68, 76, 318 Cytomegalovirus, 81, 126, 318 Cytoplasm, 303, 306, 312, 319, 324, 348, 365 Cytotoxic, 51, 174, 319, 362 Cytotoxicity, 314, 319 D Data Collection, 20, 81, 319 Deamination, 319, 376 Decision Making, 58, 319 Degenerative, 319, 333, 342, 365 Dehydration, 247, 313, 319 Deletion, 303, 319 Delivery of Health Care, 319, 331 Dementia, 40, 319 Denaturation, 319, 356 Density, 98, 104, 107, 175, 176, 187, 188, 308, 312, 319, 322, 341, 349 Deprivation, 213, 319 Dermal, 319, 340 Dermatosis, 28, 319

Dermis, 171, 319, 372, 375 Detoxification, 46, 173, 319 Deuterium, 52, 83, 319, 334 Deuterium Oxide, 83, 319 Dextran Sulfate, 206, 319 Diabetes Mellitus, 7, 27, 39, 53, 56, 73, 237, 247, 259, 320, 330, 332, 337 Diabetic Retinopathy, 238, 320 Diagnostic Imaging, 320, 361 Diagnostic procedure, 169, 258, 320, 354 Dialysis Solutions, 61, 177, 189, 320 Diarrhoea, 320, 328 Diastole, 320 Diastolic, 20, 23, 84, 320, 335, 343 Diastolic pressure, 320, 335, 343 Diencephalon, 320, 335 Dietary Fats, 320, 341 Dietary Fiber, 12, 320 Dietetics, 66, 320 Dietitian, 141, 238, 260, 280, 320 Diffusion, 173, 178, 192, 194, 197, 202, 209, 225, 226, 306, 320, 321, 337, 364, 376 Diffusivity, 192, 320 Digestion, 299, 306, 308, 320, 329, 338, 341, 370 Digestive tract, 305, 320, 368 Dihydrotestosterone, 83, 320, 363 Dilatation, Pathologic, 320, 377 Dilate, 174, 321 Dilation, 74, 174, 308, 321, 377 Dilution, 51, 56, 83, 176, 182, 183, 184, 188, 193, 208, 209, 211, 212, 222, 321, 325, 355 Diphtheria, 142, 321 Dipyridamole, 42, 48, 57, 321 Discrete, 176, 213, 321, 340, 341, 360 Disinfectant, 77, 321 Disinfection, 46, 321 Disorientation, 316, 321 Disparity, 20, 321 Disposition, 90, 321 Dissociation, 61, 88, 298, 321 Dissociative Disorders, 321 Distal, 42, 60, 76, 170, 175, 177, 180, 214, 321, 353 Diuresis, 247, 309, 321, 372 Diuretic, 300, 310, 321, 369 DNA Topoisomerase, 321, 329 Dorsal, 321, 358 Double-blind, 48, 61, 63, 68, 78, 322 Double-blinded, 61, 63, 322 Drip, 221, 322 Drug Interactions, 262, 263, 322

386

Hemodialysis

Drug Monitoring, 89, 322 Drug Tolerance, 322, 374 Duct, 158, 193, 218, 310, 311, 322, 325, 366, 370, 372 Dura mater, 322, 353 Dyes, 42, 300, 306, 322, 348 Dyslipidemia, 110, 237, 322 E Echocardiography, 4, 21, 58, 322 Edema, 238, 320, 322 Effector, 135, 297, 315, 322 Efferent, 73, 322 Elasticity, 205, 304, 322 Elbow Joint, 136, 322 Electrocardiograph, 187, 322 Electrolyte, 53, 80, 172, 188, 189, 210, 246, 248, 322, 332, 340, 358, 369 Electrons, 303, 323, 339, 343, 350, 352, 362 Electrophysiological, 323, 377 Elementary Particles, 323, 343, 348, 360 Embolectomy, 323, 373 Emboli, 11, 60, 323 Embolization, 11, 60, 323 Embolus, 170, 195, 323, 336 Embryo, 297, 323, 336, 358, 370 Embryo Transfer, 323, 358 Emergency Medical Services, 38, 323 Endocarditis, 95, 130, 257, 323 Endocardium, 323 Endocrine Glands, 323, 351 Endogenous, 12, 63, 305, 307, 323, 350, 359 Endothelial cell, 36, 55, 67, 229, 323, 373 Endothelium, 65, 156, 323, 324, 348, 355 Endothelium, Lymphatic, 323, 324 Endothelium, Vascular, 323, 324 Endothelium-derived, 324, 348 Endotoxic, 324, 341 Endotoxins, 46, 70, 315, 324, 339 Energetic, 52, 324 Energy Intake, 53, 139, 260, 324 Enhancers, 220, 324 Environmental Health, 268, 270, 324 Enzymatic, 300, 309, 315, 324, 327, 356, 364 Eosinophils, 324, 331, 340 Epidermal, 324, 340 Epidermis, 319, 324, 340 Epigastric, 324, 351 Epinephrine, 324, 348, 376 Epithelial, 306, 324, 333 Epithelial Cells, 324, 333 Epithelium, 323, 324, 328 Epoetin alfa, 8, 325

Equipment and Supplies, 5, 248, 276, 325 Erectile, 95, 127, 325 Erection, 325 Ergometer, 6, 16, 325 ERV, 270, 283, 325, 326 Erythrocyte Volume, 307, 325 Erythrocytes, 301, 307, 308, 325, 333, 363 Erythropoiesis, 10, 62, 155, 221, 278, 325 Esophageal, 110, 325 Esophagitis, 260, 325 Esophagus, 320, 325, 354, 370 Estrogen, 325, 343 Etoposide, 156, 325 Evacuation, 316, 325, 328 Evoke, 325, 370 Excitability, 4, 325 Excrete, 33, 325, 339 Exocrine, 325, 351 Exogenous, 46, 63, 87, 278, 298, 307, 310, 323, 325, 359, 376 Expectorant, 300, 325, 369 Expiratory, 325, 326 Expiratory Reserve Volume, 325, 326 External-beam radiation, 326, 362 Extracellular, 42, 58, 75, 94, 300, 306, 316, 326, 327, 345, 369, 372 Extracellular Space, 326, 345 Extracorporeal Circulation, 50, 195, 326 Extracorporeal Membrane Oxygenation, 130, 326 Extravasation, 22, 326 Extremity, 27, 106, 326 Eye Infections, 298, 326 F Family Planning, 269, 326 Fat, 11, 83, 97, 232, 303, 307, 308, 317, 323, 326, 339, 341, 357, 369, 372, 375 Fatigue, 13, 26, 29, 82, 276, 326, 332 Febrile, 173, 248, 326 Feces, 316, 326, 370 Femoral, 79, 246, 311, 326, 357 Femoral Artery, 311, 326 Femoral Vein, 246, 326, 357 Femur, 326 Ferritin, 10, 61, 159, 279, 326 Fertilization in Vitro, 326, 358 Fertilizers, 326, 358 Fetus, 297, 325, 327, 342, 370, 377 Fibrinogen, 81, 100, 108, 151, 327, 355, 373 Fibrinolytic, 213, 327 Fibroblasts, 327, 338 Fibroma, 125, 327

387

Fibrosis, 240, 327, 366 Fibrotic tissue, 198, 327 Fibula, 327, 357 Filtration, 109, 172, 181, 193, 203, 209, 216, 225, 327, 339 Flank Pain, 11, 327 Flatus, 327, 328 Flexor, 327, 340 Fluorescence, 84, 327 Fluoroscopy, 28, 327 Fluorouracil, 321, 327 Flush, 195, 217, 327 Fluvoxamine, 105, 327 Folate, 86, 140, 150, 152, 155, 159, 327 Fold, 87, 327 Folic Acid, 141, 149, 150, 153, 156, 159, 262, 327 Foramen, 313, 327, 353 Forearm, 79, 128, 197, 307, 322, 328, 362 Free Radicals, 303, 321, 328 Friction, 200, 328 Frontal Lobe, 102, 328 Fulminant Hepatic Failure, 46, 328 Fungi, 326, 328, 331, 345, 377, 379 G Gait, 35, 328 Gallbladder, 297, 328 Gamma Rays, 328, 362 Ganglia, 297, 308, 328, 347, 353 Gangrene, 62, 328 Gangrenous, 328, 367 Gas, 219, 300, 310, 313, 320, 325, 327, 328, 334, 348, 349, 356, 364, 371, 377 Gas exchange, 328, 364, 377 Gastric, 86, 128, 311, 328, 329 Gastric Emptying, 328, 329 Gastric Mucosa, 128, 328 Gastrin, 328, 333 Gastritis, 260, 328 Gastroenteritis, 247, 328 Gastrointestinal, 61, 62, 68, 182, 244, 260, 278, 308, 324, 329, 367, 370, 371, 376 Gastrointestinal tract, 68, 329, 367, 370, 376 Gastroparesis, 260, 329 Gelatin, 318, 329, 330, 373 Gene, 54, 59, 75, 84, 96, 110, 124, 154, 167, 182, 298, 307, 329, 339, 349, 355 Gene Expression, 59, 75, 84, 329 Gene Therapy, 298, 329 General practitioner, 239, 329 Genetic Engineering, 307, 314, 329

Genetic testing, 329, 357 Genistein, 63, 158, 329 Genital, 305, 329 Genomics, 58, 329 Genotype, 54, 89, 96, 111, 155, 329, 354 Geriatric, 246, 329 Gland, 329, 342, 343, 351, 359, 366, 370, 372, 373 Glomerular, 329, 339, 364 Glomeruli, 238, 329, 330 Glomerulonephritis, 53, 247, 329 Glomerulosclerosis, 238, 330 Glomerulus, 329, 330 Gluconeogenesis, 40, 330 Glucose, 40, 69, 115, 156, 189, 245, 304, 307, 312, 319, 320, 330, 332, 337, 338, 352, 366 Glucose Intolerance, 320, 330 Glucose tolerance, 156, 330 Glucose Tolerance Test, 156, 330 Glucuronic Acid, 330, 333 Glutamic Acid, 327, 330, 332, 348 Glutathione Peroxidase, 330, 367 Glycerol, 303, 330, 354 Glycine, 300, 330, 348, 367 Glycogen, 40, 138, 330 Glycoprotein, 325, 327, 330, 346, 373, 376 Glycoside, 330, 334, 366 Gonadal, 330, 370 Governing Board, 331, 358 Grade, 74, 233, 331 Graft Rejection, 28, 80, 331 Graft Survival, 57, 331 Grafting, 120, 204, 331, 336 Gram-negative, 324, 331, 335 Gram-positive, 331, 335 Granule, 51, 331, 365 Granulocyte, 160, 331 Grasses, 327, 331 Groin, 277, 331 Growth factors, 54, 72, 331 Guanylate Cyclase, 331, 348 H Hair follicles, 319, 331 Half-Life, 311, 331 Headache, 309, 331, 337, 375 Health Care Costs, 67, 71, 80, 331, 332 Health Expenditures, 331 Health Status, 37, 56, 332 Heart attack, 30, 311, 332 Heart failure, 20, 42, 236, 332 Heartbeat, 187, 332, 343, 371

388

Hemodialysis

Hematocrit, 5, 25, 37, 71, 84, 108, 161, 187, 188, 191, 279, 307, 332 Hematuria, 11, 332 Heme, 306, 318, 332, 347, 357 Hemodiafiltration, 59, 180, 181, 192, 209, 214, 221, 224, 332, 376 Hemodialysis Solutions, 61, 62, 176, 182, 213, 332 Hemodialysis, Home, 3, 332 Hemodialyzer, 86, 173, 219, 222, 230, 231, 280, 332 Hemodynamics, 113, 172, 190, 228, 332 Hemofiltration, 12, 157, 180, 181, 187, 195, 200, 214, 220, 221, 224, 245, 332, 376 Hemoglobin A, 20, 36, 332 Hemoglobin C, 10, 36, 94, 126, 188, 301, 332 Hemolysis, 65, 100, 122, 225, 248, 333 Hemolytic, 28, 67, 333 Hemorrhage, 170, 176, 331, 333, 371, 378 Hemorrhoid, 333, 373 Hemostasis, 333, 367 Heparin, 26, 32, 50, 76, 93, 101, 103, 109, 111, 112, 119, 145, 172, 194, 220, 233, 246, 333, 356 Hepatic, 40, 189, 299, 330, 333, 357, 368 Hepatitis A, 88, 262, 333 Hepatocyte, 93, 333 Hepatocyte Growth Factor, 93, 333 Hepatovirus, 333 Hereditary, 247, 333 Heredity, 329, 333 Histology, 98, 333, 342 Homeostasis, 63, 90, 127, 176, 178, 194, 333 Homogeneous, 219, 304, 317, 333 Homologous, 329, 333, 346 Hormonal, 196, 260, 304, 333, 378 Hormone therapy, 93, 104, 119, 298, 334, 343 Hospice, 38, 334 Hospital Charges, 334 Hospital Costs, 43, 334 Humoral, 331, 334 Hybrid, 45, 247, 334 Hybridomas, 334, 338 Hydrofluoric Acid, 334, 368 Hydrogen, 297, 309, 310, 319, 330, 334, 341, 345, 348, 350, 353, 360 Hydrogen Peroxide, 330, 334, 341 Hydrolases, 229, 334, 354 Hydrolysis, 306, 307, 312, 314, 334, 352, 354, 357, 360

Hydrophobic, 76, 216, 334, 341 Hydroxylation, 309, 334 Hydroxyproline, 300, 314, 334 Hygienic, 98, 334 Hypercholesterolemia, 322, 334 Hyperglycemia, 40, 334 Hyperhomocysteinemia, 86, 149, 153, 161, 237, 318, 335 Hyperlipidemia, 237, 322, 335 Hyperplasia, 36, 39, 42, 48, 72, 179, 335, 340 Hypersensitivity, 235, 335 Hyperthermia, 173, 335 Hypertriglyceridemia, 322, 335 Hypertrophy, 20, 23, 26, 58, 97, 118, 256, 257, 335 Hypodermic, 208, 335 Hypotension, 64, 87, 102, 146, 147, 176, 221, 247, 248, 335 Hypotensive, 20, 335 Hypothalamic, 73, 335 Hypothalamus, 73, 308, 320, 335 Hypovolemia, 176, 335 Hypoxemia, 248, 335 Hypoxia, 174, 301, 335 I Iliac Vein, 326, 335 Imaging procedures, 335, 374 Imipenem, 91, 313, 335 Immune function, 55, 206, 335 Immune response, 142, 298, 302, 305, 331, 335, 336, 371, 377, 378 Immune Sera, 335, 336 Immune system, 75, 151, 206, 306, 335, 336, 342, 353, 378 Immunization, 5, 336, 359 Immunocompromised, 94, 336 Immunodeficiency, 206, 252, 278, 336 Immunogenic, 336, 341 Immunologic, 244, 313, 336, 362 Immunology, 80, 111, 298, 336 Immunosuppressive, 28, 336 Immunosuppressive therapy, 28, 336 Impairment, 11, 12, 40, 306, 326, 336, 344 Implant radiation, 336, 338, 362 Implantation, 39, 198, 214, 316, 336 Impotence, 325, 336 In situ, 76, 336 In vitro, 37, 55, 70, 71, 72, 74, 76, 78, 86, 153, 161, 323, 329, 336, 356, 365

389

In vivo, 39, 46, 51, 60, 69, 71, 72, 74, 86, 115, 161, 172, 173, 329, 333, 336, 345, 350, 373 Incision, 336, 338, 361 Incubation, 88, 336 Induction, 115, 153, 301, 336, 368, 372 Inertia, 225, 336 Infarction, 130, 132, 336 Infection Control, 5, 100, 106, 115, 123, 233, 251, 252, 337 Infiltration, 329, 337, 359 Inflammation, 4, 47, 52, 61, 62, 78, 80, 86, 93, 119, 153, 235, 299, 302, 314, 319, 325, 326, 327, 328, 333, 337, 346, 353, 356, 357, 365 Influenza, 151, 337 Informed Consent, 11, 337 Infuse, 211, 337 Infusion, 62, 119, 122, 132, 182, 185, 194, 209, 211, 308, 337, 375 Infusion Pumps, 185, 337 Ingestion, 40, 302, 327, 330, 337, 356, 372 Inhalation, 337, 356 Initiation, 9, 15, 16, 17, 30, 43, 57, 64, 75, 238, 244, 337, 352 Inner ear, 308, 312, 337, 377 Inorganic, 314, 337, 342 Insecticides, 337, 378 Insight, 79, 337 Insulin, 10, 15, 27, 51, 84, 245, 260, 330, 337, 338, 339, 376 Insulin Infusion Systems, 337 Insulin-dependent diabetes mellitus, 15, 337, 338 Intensive Care, 50, 188, 338 Interferon, 28, 338 Interferon-alpha, 338 Interleukin-6, 80, 338 Intermittent, 29, 95, 98, 103, 117, 138, 153, 207, 338, 353 Internal radiation, 338, 362 Interstitial, 171, 308, 326, 338, 364 Intervention Studies, 59, 338 Intestinal, 309, 330, 338, 343, 378 Intestine, 308, 315, 338, 340 Intoxication, 105, 126, 154, 338, 378 Intracellular, 75, 84, 160, 171, 309, 336, 338, 348, 358, 363, 366 Intramuscular, 338, 351 Intravascular, 11, 50, 103, 130, 190, 213, 221, 227, 338, 372 Intrinsic, 299, 303, 338

Intubation, 110, 311, 338 Invasive, 71, 72, 78, 170, 171, 176, 184, 187, 210, 338, 342, 343 Iodine, 142, 338 Ions, 189, 190, 206, 297, 309, 321, 322, 334, 339, 342, 345, 352, 360, 369 Irinotecan, 162, 339 Ischemia, 29, 117, 304, 339 Ischemic stroke, 29, 213, 339 Islet, 51, 339 Isoflavones, 63, 158, 339 Isopropyl, 24, 339 K Kb, 268, 339 Keto, 12, 159, 339, 374 Ketoacidosis, 339 Ketone Bodies, 339 Ketosis, 75, 339 Kidney Failure, Acute, 339 Kidney Failure, Chronic, 339 Kidney stone, 340, 376 Kidney Transplantation, 28, 82, 119, 226, 239, 274, 340 Kinetic, 21, 41, 47, 90, 91, 340, 352 L Labile, 315, 340 Lag, 51, 61, 114, 340 Large Intestine, 315, 320, 338, 340, 363, 368 Latency, 14, 19, 340 Least-Squares Analysis, 340, 363 Lens, 303, 340 Lesion, 36, 57, 72, 77, 240, 340, 341 Leucine, 47, 83, 91, 340 Leucocyte, 219, 340 Leukapheresis, 303, 340 Leukocytes, 306, 307, 308, 313, 324, 338, 340, 348, 376 Levofloxacin, 88, 340 Lichen Planus, 28, 340 Lidocaine, 46, 340 Life cycle, 220, 328, 340 Life Expectancy, 66, 171, 281, 341 Ligaments, 317, 341 Likelihood Functions, 341, 363 Linear Models, 341, 363 Linkage, 54, 119, 312, 341 Lipase, 119, 341 Lipid, 39, 51, 88, 104, 119, 149, 154, 156, 160, 245, 303, 304, 330, 337, 339, 341, 350, 375 Lipid A, 39, 341 Lipid Peroxidation, 160, 341, 350

390

Hemodialysis

Lipopolysaccharide, 110, 331, 341 Lipoprotein, 84, 88, 119, 322, 331, 341, 342 Liver scan, 341, 366 Lobe, 187, 341, 351 Local therapy, 37, 341 Localization, 39, 341 Localized, 213, 297, 300, 321, 336, 340, 341, 355, 373 Logistic Models, 341, 363 Longitudinal study, 35, 120, 342 Loop, 133, 202, 337, 342 Lovastatin, 88, 342, 368 Low-density lipoprotein, 157, 322, 341, 342 Lymph, 305, 313, 323, 324, 342 Lymph node, 305, 342 Lymphatic, 324, 337, 342, 370, 373 Lymphocyte, 91, 302, 342, 343 Lymphoid, 302, 340, 342 Lysine, 332, 342 Lytic, 342, 367 M Maceration, 60, 342 Macrophage, 77, 126, 157, 342 Magnesium Chloride, 189, 342 Magnetic Resonance Angiography, 132, 342 Magnetic Resonance Imaging, 44, 343, 366 Magnetic Resonance Spectroscopy, 44, 343 Malabsorption, 260, 343 Mammary, 204, 343 Mammogram, 309, 343, 345 Man-made, 225, 343 Mastitis, 343, 367 Mean blood pressure, 33, 343 Meat, 215, 232, 233, 241, 320, 343 Medial, 304, 343, 349 Mediator, 63, 65, 343, 356, 367 Medical Records, 343, 365 Medical Staff, 322, 343 MEDLINE, 269, 343 Medullary, 80, 343 Mefloquine, 89, 343 Megaloblastic, 327, 343 Megestrol, 142, 343 Megestrol Acetate, 142, 343 Meiosis, 344, 346 Melanin, 344, 354, 376 Memory, 235, 277, 302, 319, 344 Meninges, 311, 312, 322, 344, 370, 371 Menopause, 344, 358

Mental, iv, 10, 33, 38, 268, 270, 313, 316, 319, 321, 326, 344, 359, 360, 361, 366, 376 Mental Disorders, 344, 359 Mental Health, iv, 10, 33, 268, 270, 344, 359, 361 Mental Processes, 321, 344, 361 Mentors, 59, 82, 344 Mesentery, 344, 353 Meta-Analysis, 5, 86, 344 Metabolic acidosis, 240, 344 Metabolic disorder, 108, 243, 344 Metabolite, 307, 309, 342, 344, 359, 362 Metastasis, 344 Metastatic, 28, 122, 162, 344 Methionine, 344, 371 Metoprolol, 34, 344 MI, 23, 30, 111, 138, 178, 182, 190, 227, 295, 344 Microbe, 344, 374 Microbiology, 47, 111, 133, 161, 220, 298, 306, 345 Microcalcifications, 309, 345 Microcirculation, 345, 355 Microdialysis, 73, 345 Microorganism, 314, 345, 352, 378 Microtubules, 345, 350 Migration, 77, 345 Milliliter, 308, 345 Mitochondria, 215, 345 Mitochondrial Swelling, 345, 347 Mitosis, 303, 345 Mitotic, 325, 345 Mobilization, 159, 188, 345 Modeling, 232, 345 Modification, 300, 329, 345, 361 Molecular Structure, 345, 375 Monitor, 42, 56, 60, 69, 71, 82, 87, 149, 176, 188, 234, 279, 280, 283, 284, 318, 346, 348 Monoclonal, 334, 346, 362 Monocyte, 77, 346 Mononuclear, 346, 376 Motility, 346, 367 Motion Sickness, 346, 347 Mucolytic, 297, 346 Multicenter study, 106, 138, 149, 346 Multiple Organ Failure, 76, 346 Multivalent, 151, 346 Muscle Fibers, 346, 347, 375 Muscular Diseases, 346, 351 Mutagenesis, 52, 346 Mutagenic, 229, 346 Mutagens, 346

391

Myalgia, 337, 346 Mydriatic, 321, 346 Myocardial infarction, 29, 101, 119, 213, 317, 344, 346, 377 Myocardial Ischemia, 301, 346 Myocarditis, 321, 346 Myocardium, 301, 344, 346 Myoglobin, 180, 347 Myosin, 83, 347, 375 N Nasal Mucosa, 337, 347 Nausea, 16, 248, 260, 277, 284, 328, 329, 339, 347, 351, 376 NCI, 1, 267, 314, 347 Necrosis, 174, 213, 247, 256, 303, 336, 344, 346, 347 Needlestick Injuries, 111, 347 Nephrologist, 5, 232, 236, 238, 240, 347 Nephropathy, 40, 54, 80, 107, 115, 238, 247, 339, 347 Nephrotoxic, 14, 347 Nerve, 298, 301, 313, 322, 329, 343, 347, 350, 353, 357, 359, 364, 366, 370, 375 Nervous System, 12, 298, 312, 343, 347, 353 Networks, 167, 347 Neural, 61, 176, 298, 300, 334, 347, 369 Neurologic, 16, 174, 244, 248, 347 Neuromuscular, 297, 347, 351, 357 Neuropathy, 305, 347, 353 Neurotoxic, 12, 347 Neurotoxicity, 95, 123, 347 Neurotransmitter, 297, 298, 300, 308, 330, 347, 371 Neutrons, 299, 348, 362 Neutrophils, 159, 331, 340, 348 Nitric Oxide, 50, 65, 73, 348 Nitrogen, 14, 17, 47, 75, 171, 231, 233, 301, 339, 348, 375 Normotensive, 31, 348 Nosocomial, 5, 28, 89, 100, 115, 220, 348 Nuclear, 62, 75, 310, 319, 323, 328, 343, 347, 348 Nuclei, 299, 323, 329, 343, 345, 348, 360 Nucleic acid, 346, 348, 361, 365 Nucleotidases, 334, 348 Nucleus, 219, 303, 306, 313, 318, 319, 323, 324, 328, 344, 346, 348, 359, 360, 370 Nursing Care, 25, 238, 279, 348, 352 Nursing Staff, 24, 348 Nutrition Assessment, 142, 348

O Observational study, 34, 349 Obsessive-Compulsive Disorder, 327, 349 Obstetrics, 342, 349 Odds Ratio, 349, 364 Ointments, 349, 368 Olfaction, 42, 349 Oliguria, 339, 349 Oncogene, 333, 349 On-line, 60, 69, 70, 295, 349 Opacity, 319, 349 Optic Chiasm, 335, 349 Osmolality, 73, 349 Osmoles, 349 Osmosis, 70, 91, 206, 226, 349 Osmotic, 124, 138, 178, 190, 299, 345, 349, 367 Osteitis Fibrosa Cystica, 240, 350 Osteoclasts, 240, 350 Osteodystrophy, 62, 234, 240, 278, 284, 350 Ototoxic, 14, 350 Outpatient, 5, 9, 13, 16, 17, 19, 53, 279, 350 Overdose, 121, 122, 328, 350 Ovulation, 343, 350 Ovum, 340, 350, 359 Oxidants, 73, 350 Oxidation, 47, 119, 153, 162, 297, 303, 307, 318, 330, 341, 350, 352 Oxidation-Reduction, 307, 350 Oxidative Stress, 52, 55, 61, 62, 63, 72, 119, 153, 184, 185, 350 Oxygen Consumption, 16, 350, 364 Oxygenation, 129, 153, 222, 335, 350 Oxygenator, 225, 311, 326, 350 P Paclitaxel, 37, 145, 156, 157, 350 Palliative, 343, 351, 372 Pamidronate, 133, 351 Pancreas, 51, 297, 306, 337, 339, 341, 351, 376 Pancreatic, 311, 351 Panic, 327, 351 Panic Disorder, 327, 351 Paradoxical, 72, 351 Paraplegia, 98, 351 Parathyroid, 17, 98, 104, 116, 124, 240, 260, 278, 279, 284, 309, 351, 365, 372 Parathyroid Glands, 98, 351, 365 Parathyroid hormone, 17, 104, 116, 124, 240, 260, 278, 279, 284, 309, 351 Parenteral, 36, 55, 61, 86, 90, 106, 107, 129, 146, 148, 155, 220, 253, 256, 324, 351

392

Hemodialysis

Parenteral Nutrition, 86, 90, 107, 220, 253, 256, 351 Parietal, 351, 353 Paroxysmal, 301, 351 Particle, 189, 343, 351, 375 Particle Accelerators, 343, 351 Patch, 352, 375 Pathogen, 336, 352 Pathogenesis, 14, 17, 22, 28, 39, 55, 72, 80, 126, 352 Pathologic, 297, 303, 307, 308, 317, 335, 352, 364, 369 Pathologic Processes, 303, 352 Pathologies, 51, 352 Pathophysiology, 20, 28, 65, 72, 114, 352 Patient Care Team, 280, 352 Patient Compliance, 6, 231, 352 Patient Education, 25, 275, 283, 284, 290, 292, 295, 352 Patient Satisfaction, 5, 352 Patient Selection, 243, 246, 352 Pediatric Nursing, 247, 352 Pediatrics, 32, 37, 93, 99, 121, 139, 140, 352 Pentosephosphate Pathway, 352, 374 Peptide, 51, 58, 75, 94, 98, 105, 300, 334, 352, 356, 357, 359, 360 Peptide Chain Initiation, 75, 352 Peptide Hydrolases, 334, 352 Perception, 5, 59, 162, 352, 366 Percutaneous, 20, 28, 48, 60, 90, 113, 200, 214, 243, 353 Perfusion, 218, 237, 335, 353 Pericarditis, 237, 353 Peridural, 99, 353 Peripheral blood, 63, 338, 353 Peripheral Nervous System, 347, 351, 353, 371 Peripheral Nervous System Diseases, 351, 353 Peripheral Neuropathy, 24, 353 Peripheral Vascular Disease, 24, 29, 204, 238, 353 Peritoneal Cavity, 178, 304, 353 Peritoneal Dialysis, 3, 11, 12, 18, 19, 26, 30, 31, 35, 37, 42, 43, 53, 73, 90, 95, 97, 102, 106, 109, 113, 124, 127, 128, 129, 138, 140, 167, 172, 178, 189, 196, 202, 220, 226, 227, 231, 233, 236, 239, 240, 245, 246, 247, 249, 259, 274, 275, 282, 284, 320, 353 Peritoneum, 178, 344, 353 Perivascular, 37, 196, 353

PH, 47, 73, 74, 92, 122, 308, 353 Phagocyte, 350, 353 Phagocytosis, 219, 353 Pharmaceutical Preparations, 312, 329, 354 Pharmacist, 238, 354 Pharmacokinetic, 90, 156, 354 Pharmacologic, 301, 331, 354, 374 Pharynx, 337, 354 Phenotype, 54, 107, 354 Phenylalanine, 354, 376 Phenytoin, 310, 354 Pheresis, 75, 354 Phlebotomy, 278, 354 Phospholipids, 326, 341, 354 Phosphoric Monoester Hydrolases, 334, 354 Phosphorus, 6, 22, 45, 105, 141, 166, 221, 232, 233, 240, 243, 246, 276, 278, 279, 280, 284, 309, 351, 354 Phosphorylation, 114, 354, 360 Physical Examination, 73, 248, 354 Physiologic, 29, 34, 48, 50, 60, 76, 83, 85, 171, 239, 307, 320, 331, 354, 363, 364 Physiology, 29, 58, 70, 80, 85, 100, 107, 141, 176, 233, 323, 347, 355 Pigment, 306, 347, 355 Pilot study, 72, 104, 133, 142, 355 Plague, 75, 207, 355, 375 Plants, 307, 310, 330, 355, 357, 366, 374, 375 Plaque, 9, 218, 355 Plasma cells, 302, 355 Plasma protein, 299, 324, 355, 360, 367 Plasma Volume, 307, 355 Plasmapheresis, 50, 179, 214, 222, 303, 355 Plasmin, 212, 213, 355, 373, 376 Plasminogen, 213, 355, 373, 376 Plasminogen Activators, 213, 355 Plasticity, 332, 355 Platelet Activation, 77, 355 Platelet Aggregation, 301, 348, 356, 373 Platelet Factor 4, 109, 356 Platelet-Derived Growth Factor, 77, 356 Plateletpheresis, 303, 356 Platelets, 78, 225, 348, 354, 356, 373 Platinum, 145, 314, 342, 356 Plethysmography, 44, 356 Pneumonia, 279, 317, 356 Pneumothorax, 170, 356 Podophyllotoxin, 325, 356

393

Poisoning, 114, 163, 310, 328, 338, 347, 356, 367 Polycystic, 11, 80, 247, 356 Polymerase, 8, 129, 356 Polymerase Chain Reaction, 8, 129, 356 Polymers, 50, 204, 306, 357, 360, 371 Polymorphism, 89, 96, 110, 357 Polymyxin, 133, 357 Polyneuritis, 321, 357 Polypeptide, 51, 300, 314, 327, 347, 352, 355, 357, 379 Polyposis, 315, 357 Polysaccharide, 302, 312, 357, 360 Polytetrafluoroethylene, 28, 48, 57, 68, 110, 190, 197, 200, 228, 357 Polyunsaturated fat, 154, 357, 373 Popliteal, 79, 326, 357 Popliteal Vein, 326, 357 Population Growth, 226, 357 Porosity, 180, 357 Porphyria, 354, 357 Porphyria Cutanea Tarda, 354, 357 Port, 95, 124, 174, 175, 177, 180, 211, 357 Port-a-cath, 357 Posterior, 26, 73, 300, 322, 351, 357, 358 Postmenopausal, 104, 358 Postoperative, 346, 358 Post-translational, 84, 358 Post-traumatic, 176, 358 Potassium Chloride, 189, 358 Potentiating, 173, 358 Practice Guidelines, 20, 36, 231, 270, 285, 358 Precipitating Factors, 311, 358 Precursor, 51, 301, 303, 322, 324, 354, 355, 358, 359, 360, 375, 376, 378 Pregnancy Outcome, 115, 358 Prejudice, 186, 358 Preoperative, 104, 358 Primary endpoint, 56, 67, 358 Primary Prevention, 42, 359 Probe, 60, 69, 175, 188, 345, 359 Procaine, 340, 359 Prodrug, 359, 362 Progesterone, 343, 359, 370 Progression, 34, 45, 72, 238, 301, 359, 378 Progressive, 35, 80, 98, 102, 240, 304, 313, 314, 319, 322, 339, 346, 347, 355, 359, 364 Promoter, 55, 110, 359 Prone, 23, 70, 146, 147, 170, 359 Prophase, 346, 359 Prophylaxis, 38, 359, 365, 377

Prospective Studies, 66, 81, 359 Prospective study, 37, 81, 91, 102, 126, 129, 134, 342, 359 Prostaglandins, 229, 303, 359 Prostate, 306, 359, 376 Protease, 22, 359, 373 Protective Devices, 193, 359 Protein Binding, 60, 215, 359 Protein C, 6, 58, 60, 80, 84, 160, 216, 233, 277, 299, 300, 303, 305, 326, 341, 360, 375, 376 Protein Folding, 52, 360 Protein S, 40, 47, 75, 84, 100, 157, 160, 307, 360, 365 Protein-Energy Malnutrition, 47, 245, 360 Protein-Tyrosine Kinase, 329, 360 Proteinuria, 17, 330, 360 Proteoglycan, 356, 360 Proteolytic, 315, 327, 355, 360, 373, 376 Prothrombin, 360, 373 Protocol, 47, 52, 53, 56, 64, 66, 145, 173, 176, 360 Protons, 299, 334, 343, 352, 360, 362 Proto-Oncogene Proteins, 351, 360 Proto-Oncogene Proteins c-mos, 351, 360 Pruritic, 340, 360 Pruritus, 16, 28, 133, 150, 160, 248, 360 Psychic, 344, 360, 361, 366 Psychoactive, 361, 378 Psychological Theory, 35, 361 Psychology, 34, 321, 361 Psychomotor, 310, 361 Public Health, 38, 43, 73, 270, 361 Public Policy, 269, 361 Publishing, 87, 252, 361 Pulmonary, 91, 307, 313, 332, 339, 361, 368, 377 Pulmonary Artery, 307, 361, 377 Pulmonary Edema, 313, 339, 361 Pulse, 98, 187, 256, 346, 361 Punctures, 198, 361 Pupil, 321, 346, 361 Purifying, 224, 361 Purines, 361, 367 Putrefaction, 328, 361 Pyridoxal, 152, 318, 361 Pyrimidines, 361, 367 Pyrogenic, 8, 361 Pyrogens, 70, 361 Q Quaternary, 360, 362

394

Hemodialysis

R Race, 15, 20, 54, 237, 345, 362 Radial Artery, 133, 362 Radiation, 37, 103, 171, 298, 301, 323, 326, 327, 328, 335, 338, 342, 343, 362, 366, 378 Radiation therapy, 37, 298, 326, 338, 362 Radioactive, 308, 331, 334, 336, 338, 341, 343, 348, 362, 366 Radiography, 301, 312, 317, 362 Radioisotope, 325, 362, 374 Radiolabeled, 362 Radiological, 57, 353, 362 Radiology, 48, 79, 106, 107, 108, 113, 117, 122, 128, 132, 133, 134, 362 Radiotherapy, 308, 362 Ramipril, 34, 362 Random Allocation, 362 Randomization, 56, 57, 85, 362 Randomized clinical trial, 7, 52, 55, 73, 363 Reactive Oxygen Species, 55, 73, 84, 363 Reagent, 176, 213, 214, 313, 319, 363 Receptor, 73, 84, 96, 110, 298, 302, 333, 363, 367 Receptors, Serotonin, 363, 367 Recombinant, 5, 10, 73, 104, 108, 116, 126, 154, 182, 239, 240, 242, 262, 363, 377 Rectal, 174, 363 Rectum, 303, 308, 315, 320, 327, 328, 333, 340, 359, 363 Recurrence, 229, 363 Red blood cells, 149, 156, 188, 225, 234, 242, 248, 285, 325, 333, 357, 363, 366, 368 Reductase, 42, 45, 155, 342, 363, 368 Refer, 1, 9, 315, 328, 341, 348, 357, 363, 367, 374 Refraction, 363, 369 Refractory, 145, 363 Regimen, 34, 83, 141, 166, 322, 352, 363 Regression Analysis, 10, 363 Relapse, 78, 363 Relative risk, 15, 43, 363 Remission, 363, 364 Renal Artery, 79, 364 Renal cell carcinoma, 114, 364 Renal Dialysis, 34, 69, 79, 194, 364 Renal Replacement Therapy, 23, 26, 31, 103, 153, 194, 239, 364 Renin, 58, 72, 301, 310, 364 Renin-Angiotensin System, 73, 310, 364 Renovascular, 73, 364 Reproduction Techniques, 358, 364 Resorption, 309, 350, 364

Respiration, 303, 310, 346, 364 Respiratory failure, 326, 364 Restless legs, 22, 364 Retina, 320, 340, 349, 364, 365 Retinal, 320, 321, 349, 364 Retinoids, 365, 378 Retrograde, 170, 365 Retrospective, 17, 21, 54, 66, 107, 128, 365 Retrospective study, 17, 365 Reverberant, 320, 365 Rheumatoid, 350, 365 Rheumatology, 80, 365 Rhinitis, 365, 367 Ribavirin, 28, 365 Ribose, 298, 365 Ribosome, 365, 375 Rickets, 309, 365, 378 Risk patient, 43, 365 Ristocetin, 365, 377 Rod, 305, 314, 365 Rubber, 187, 207, 297, 365, 370 S Salicylic, 220, 365 Saline, 176, 191, 194, 211, 220, 365 Salivary, 318, 366 Salivary glands, 318, 366 Saphenous, 204, 366 Saphenous Vein, 204, 366 Saponins, 366, 370 Scans, 171, 366 Schizoid, 366, 378 Schizophrenia, 366, 378 Schizotypal Personality Disorder, 366, 378 Sclerosis, 106, 304, 366 Screening, 8, 51, 60, 237, 314, 366 Sebaceous, 319, 366 Sebaceous gland, 319, 366 Secretion, 58, 77, 104, 338, 366 Secretory, 51, 366 Sedentary, 10, 63, 366 Segmental, 330, 366 Seizures, 248, 284, 310, 351, 354, 366 Selenium, 146, 149, 158, 366 Self Care, 277, 297, 367 Semisynthetic, 310, 325, 335, 367 Sensor, 42, 70, 183, 184, 187, 188, 190, 211, 212, 222, 223, 227, 338, 367 Sepsis, 75, 344, 367 Septal, 70, 367 Septic, 75, 247, 304, 367 Septicaemia, 367 Septicemia, 73, 75, 367

395

Septum, 207, 218, 367 Septum Pellucidum, 367 Sequencing, 202, 220, 357, 367 Serine, 22, 318, 360, 367, 373 Serologic, 5, 113, 367 Serotonin, 99, 327, 348, 363, 367, 375 Serotypes, 67, 367 Serous, 323, 367 Serum Albumin, 6, 11, 17, 20, 31, 37, 66, 67, 71, 75, 80, 86, 105, 158, 367 Sessile, 60, 367 Sex Characteristics, 298, 301, 367, 372 Shock, 75, 176, 247, 335, 368, 375 Shunt, 179, 182, 183, 184, 190, 191, 198, 208, 211, 212, 217, 228, 368 Side effect, 35, 78, 155, 261, 263, 280, 284, 298, 306, 343, 368, 374 Signs and Symptoms, 44, 277, 363, 364, 368 Silicon, 68, 368 Silicon Dioxide, 68, 368 Simvastatin, 45, 368 Skeletal, 51, 64, 75, 83, 130, 219, 301, 314, 346, 368, 375 Skeleton, 297, 326, 368 Skull, 308, 368, 372 Sleep apnea, 13, 14, 18, 257, 368 Sludge, 230, 368 Small intestine, 313, 334, 338, 368 Smallpox, 75, 368 Smoke Inhalation Injury, 326, 368 Smooth muscle, 36, 42, 48, 77, 80, 229, 301, 309, 346, 364, 368, 371 Soaps, 8, 368 Social Environment, 361, 368 Social Support, 5, 166, 167, 369 Social Work, 66, 234, 238, 369 Sodium Acetate, 188, 189, 369 Sodium Bicarbonate, 188, 189, 369 Sodium Channels, 369, 377 Soft tissue, 308, 368, 369 Solvent, 70, 221, 306, 330, 349, 369 Somatic, 298, 334, 344, 345, 353, 369 Soybean Oil, 357, 369 Specialist, 238, 286, 321, 369 Species, 73, 299, 305, 324, 328, 334, 344, 345, 346, 362, 363, 369, 371, 375, 378 Specificity, 67, 278, 299, 369 Spectrometer, 69, 369 Spectroscopic, 69, 123, 343, 369 Spectrum, 69, 77, 82, 167, 171, 335, 369

Spinal cord, 308, 312, 313, 322, 344, 347, 351, 353, 369, 371 Spinal Cord Diseases, 351, 369 Spleen, 300, 318, 342, 370 Spontaneous Abortion, 358, 370 Stabilization, 67, 354, 370 Staging, 366, 370 Statistically significant, 15, 17, 22, 24, 33, 87, 370 Steel, 24, 25, 186, 314, 370 Stem Cells, 325, 370 Stenosis, 21, 32, 36, 42, 48, 54, 56, 72, 77, 79, 92, 113, 179, 190, 196, 212, 229, 237, 370, 371 Stent, 106, 370 Sterile, 186, 228, 304, 351, 370 Sterility, 104, 186, 370 Sterilization, 189, 221, 370 Steroid, 35, 317, 366, 368, 370 Stethoscopes, 79, 370 Stillbirth, 358, 370 Stimulant, 309, 370 Stimulus, 84, 317, 340, 370, 373 Stomach, 297, 320, 325, 328, 329, 330, 333, 339, 347, 353, 354, 368, 370 Stool, 12, 68, 315, 340, 370 Strand, 356, 370 Stricture, 370, 371 Stroke, 40, 79, 97, 268, 310, 311, 339, 371 Styrene, 365, 371 Subacute, 126, 337, 371 Subclavian, 21, 246, 305, 308, 371 Subclavian Artery, 305, 371 Subclavian Vein, 21, 246, 305, 308, 371 Subclinical, 31, 40, 337, 366, 371 Subcutaneous, 5, 24, 25, 28, 132, 179, 200, 214, 228, 277, 322, 328, 351, 371 Subcutaneous port, 28, 371 Subspecies, 369, 371 Substance P, 344, 365, 366, 371 Substrate, 334, 371 Suction, 327, 371 Sudden death, 29, 371 Sulfur, 106, 150, 319, 344, 371 Superior vena cava, 174, 175, 214, 308, 371 Survival Rate, 6, 26, 32, 371 Sweat, 319, 372 Sweat Glands, 319, 372 Symptomatic, 12, 21, 29, 115, 238, 372 Synergistic, 37, 42, 372 Synovial, 138, 372 Synovial Fluid, 138, 372

396

Hemodialysis

Synovial Membrane, 372 Systolic, 20, 23, 58, 335, 343, 372 Systolic pressure, 343, 372 T Tachyarrhythmia, 117, 372 Tachycardia, 305, 372 Tachypnea, 305, 372 Temporal, 16, 372 Testosterone, 83, 300, 363, 372 Tetany, 351, 372 Theophylline, 142, 361, 372 Therapeutics, 74, 84, 148, 263, 372 Thermal, 174, 193, 321, 348, 356, 372 Thermodilution, 182, 208, 372 Thigh, 83, 197, 326, 331, 372 Thorax, 371, 373 Threonine, 360, 367, 373 Threshold, 320, 325, 335, 373 Thrombectomy, 21, 48, 60, 116, 237, 323, 373 Thrombin, 77, 327, 356, 360, 373 Thrombocytes, 356, 373 Thrombocytopenia, 101, 373 Thrombolytic, 24, 213, 355, 373 Thrombomodulin, 360, 373 Thrombosed, 33, 48, 60, 116, 237, 373 Thromboses, 33, 48, 86, 373 Thromboxanes, 303, 373 Thrombus, 60, 77, 196, 213, 317, 336, 339, 346, 356, 373, 377 Thymus, 336, 342, 373 Thyroid, 338, 351, 373, 376 Thyroid Gland, 351, 373 Thyroxine, 299, 354, 373 Tissue Plasminogen Activator, 132, 373 Tolerance, 26, 29, 58, 140, 153, 297, 330, 374 Tomography, 343, 374 Tone, 14, 87, 157, 348, 374 Tonicity, 333, 374 Tonus, 374 Tooth Preparation, 298, 374 Topical, 7, 78, 334, 368, 369, 374 Topoisomerase inhibitors, 339, 374 Torsion, 336, 374 Toxicity, 32, 61, 68, 74, 110, 142, 243, 322, 365, 374 Toxicokinetics, 374 Toxicology, 105, 114, 122, 270, 374 Toxin, 12, 172, 176, 214, 232, 321, 324, 374 Trace element, 243, 245, 368, 374 Tracer, 63, 374

Traction, 314, 374 Transaldolase, 40, 374 Transaminases, 174, 374 Transcriptase, 129, 374 Transcutaneous, 18, 24, 211, 214, 222, 223, 228, 375 Transdermal, 83, 212, 375 Transduction, 84, 375 Transfection, 307, 329, 375 Transfer Factor, 336, 375 Transfusion, 375 Transillumination, 188, 375 Translation, 20, 300, 375 Translational, 375 Transmitter, 297, 343, 375 Transplantation, 3, 4, 9, 14, 19, 26, 28, 32, 35, 37, 44, 46, 80, 82, 85, 93, 106, 113, 126, 161, 233, 247, 276, 282, 313, 323, 336, 375 Trauma, 75, 172, 176, 221, 325, 331, 347, 375 Trees, 365, 375 Tricyclic, 154, 375 Triglyceride, 140, 335, 375 Tropomyosin, 375 Troponin, 130, 256, 375 Tryptophan, 314, 367, 375 Tuberculosis, 279, 365, 375 Tularemia, 75, 375 Tumor marker, 306, 376 Tumor Necrosis Factor, 65, 376 Tumor suppressor gene, 114, 376 Type 2 diabetes, 40, 53, 108, 376 Tyrosine, 63, 360, 376 U Ultrafiltration, 57, 70, 147, 172, 191, 195, 210, 211, 221, 224, 246, 248, 332, 376 Universal Precautions, 29, 233, 252, 376 Uremia, 9, 14, 44, 72, 89, 182, 339, 364, 376 Ureters, 340, 364, 376 Urethra, 359, 376 Uric, 100, 361, 376 Urinary, 220, 247, 312, 349, 369, 373, 376 Urinary Plasminogen Activator, 373, 376 Urinary tract, 247, 312, 376 Urine, 11, 12, 17, 25, 88, 171, 233, 276, 307, 318, 321, 332, 339, 340, 349, 360, 376 Uterus, 297, 342, 359, 376 V Vaccination, 142, 146, 377 Vaccines, 377, 378 Valproic Acid, 105, 377

397

Valves, 26, 170, 202, 377 Vancomycin, 91, 100, 377 Vasoconstriction, 87, 324, 377 Vasodilation, 174, 377 Vasodilator, 65, 308, 377 VE, 56, 95, 133, 134, 377 Vector, 375, 377 Vena, 335, 377 Venous blood, 222, 307, 377 Venous Pressure, 223, 377 Venous Thrombosis, 101, 377 Ventricle, 73, 335, 361, 372, 377 Ventricular, 4, 20, 23, 26, 31, 58, 88, 97, 112, 117, 118, 126, 135, 141, 256, 377 Ventricular Dysfunction, 31, 377 Ventricular Function, 88, 112, 377 Ventricular Remodeling, 126, 377 Venules, 307, 310, 324, 345, 378 Vesicular, 368, 378 Veterinary Medicine, 269, 378 Viral, 8, 28, 75, 258, 297, 337, 375, 378 Viral Load, 258, 378 Virulence, 304, 374, 378

Visceral, 305, 353, 378 Viscosity, 192, 297, 378 Vitamin A, 178, 378 Vitamin D, 86, 365, 378 Vitreous, 320, 340, 364, 378 Vitreous Hemorrhage, 320, 378 Vitro, 55, 333, 378 Vivo, 39, 70, 96, 131, 162, 172, 378 W White blood cell, 225, 302, 331, 340, 342, 346, 354, 355, 378 Withdrawal, 177, 184, 190, 192, 207, 212, 228, 378 X Xenobiotics, 229, 378 Xenograft, 301, 378 X-ray, 44, 47, 120, 308, 316, 317, 327, 328, 343, 348, 362, 366, 378 Y Yeasts, 70, 328, 354, 379 Z Zymogen, 360, 379

398

Hemodialysis

399

400

Hemodialysis

Hemodialysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Butternut Squash: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Facial Paralysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Wine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Breast Augmentation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Premenstrual Dysphoric Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Body Dysmorphic Disorder: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lymphedema - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Dermabrasion: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Septra: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Vaginitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Feet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Glioblastoma Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Female Infertility - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Living Will - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hip Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Benzene - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Marburg Virus: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Erythema Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Alopecia Areata - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Endometritis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hemodialysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Butternut Squash: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Facial Paralysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Wine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Breast Augmentation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Premenstrual Dysphoric Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Body Dysmorphic Disorder: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lymphedema - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Dermabrasion: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Septra: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Vaginitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Feet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Glioblastoma Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Female Infertility - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Living Will - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hip Pain: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Benzene - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Marburg Virus: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Erythema Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Alopecia Areata - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Endometritis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Recommend Documents