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Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery

I. Stefanidis, R. Bach, P.R. Mertens, V. Liakopoulos, G. Liapi, H. Mann and B. Heintz

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Volume 64 (2005) p. 129 - 137

Abstract

I. Stefanidis, R. Bach, P.R. Mertens, V. Liakopoulos, G. Liapi, H. Mann and B. Heintz

¹Division of Nephrology, University of Thessalia, Greece, ²Clinic of Nephrology and Clinical Immunology, RWTH Aachen, and ³KfH Aachen, Germany
Aims: To determine if there has been improvement in survival of HIV-infected patients with end-stage renal failure subsequent to widespread use of highly active antiretroviral therapy. Methods: The United States Renal Data System is a national data system funded by the National Institute of Diabetes and Digestive and Kidney Disease with the Centers for Medicare and Medicaid. Using the United States Renal Data System Standard Analysis Files, we analyzed all African-American end-stage renal failure patients in the United States from 1990 – 2001. We compared survival rates for patients with HIV disease, sickle cell anemia, diabetes, and all other diagnoses for the time periods 1990 – 1994 and 1995 – 2001. The main outcome measure was one- and five-year survival in each cohort. Results: One-year survival of African-American patients with end-stage renal disease and HIV increased from 46.6% during 1990 – 1994 to 65.1% during 1995 – 2001 (odds ratio 2.139). One-year survival decreased in the sickle cell group (odds ratio 0.595) and decreased slightly in the diabetic group (odds ratio 0.927) and all others (odds ratio 0.941). Five-year survival in the HIV group increased from 13.3% in 1990 – 1995 to 30.4% in 1995 – 2001 (odds ratio 2.847). There was no corresponding increase in survival for the sickle cell group (odds ratio 0.987), the diabetic group (odds ratio 1.06), or all others (odds ratio 1.137). Conclusions: We conclude that survival in African-American end-stage renal disease patients and HIV infection has substantially improved subsequent to introduction of highly active antiretroviral therapy. Our data support aggressive multi-drug treatment of end-stage renal failure patients with HIV infection.Correspondence to:
Dr. I. Stefanidis
Assistant Professor of Internal Medicine/Nephrology
University of Thessalia
School of Medicine
Papakyriazy 22
41222 Larissa, Greece
Email: [email protected]

Therapy of bone-disorders

Alfacalcidol in the therapy of renal bone disease

M. Ritzerfeld, M. Klasser and H. Mann

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Volume 39 p. 546 - 550

Abstract

M. Ritzerfeld¹, M. Klasser² and H. Mann¹

¹Dialysezentrum Aachen, and ²gwd consult, Mühlheim/Main

Parathyroid hormone increases due to hypocalcemia even in the early phases of renal insufficiency. At the same time, hyperphosphatemia develops due to decreasing renal excretion which, in turn, intensifies secondary hyperparathyroidism. The cornerstones for prevention and therapy of renal osteopathy are, therefore, efficient lowering of phosphate levels and the early substitution of vitamin-D3 metabolites. In a post marketing surveillance (PMS) of almost 2000 dialysis patients with renal osteopathy, the course of therapy with Alfacalcidol (Bondiol®) was observed over a 6-month period. In 55.9% of cases, Alfacalcidol was administered at a daily dose of 0.25 mg. In 26.6% of patients, Alfacalcidol was administered every second day at a dose of 0.25 – 1 mg/d. In 16.1% of patients, Alfacalcidol was administered as pulse-therapy, mostly at a dose of 1 – 2 mg once or twice per week. To lower phosphate levels, 54.8% of patients received calcium compounds, 9.2% aluminium compounds, and 21.7% aluminium compounds in combination with calcium compounds. 14.3% of patients did not receive phosphate binding agents. Two thirds of patients had received active vitamin-D3-metabolites prior to commencing therapy with alfacalcidol, most frequently calcitrol. In 58.1%, the dialysis solution used had a calcium concentration of 1.5 mmol/l (44.8%) or lower; whereas in 41.9%, a higher calcium concentration was used – mostly 1.75 mmol/l (38%). During the observation period, serum concentrations of calcium and phosphate remained constant, suggesting that the risk of hypercalcemia due to therapy with Alfacalcidol was not increased. It was found that elevated alkaline phosphatase and parathyroid hormone levels could be significantly lowered (statistically). These effects could be observed both in patients who had been previously treated with vitamin-D3-metabolites and in patients without prior therapy. Efficacy and tolerability of therapy with Alfacalcidol was assessed to be very high by the attending nephrologists.Correspondence to:
Dr. med. M. Ritzerfeld; Dialysezentrum, Schurzelter Straße 564, 52074 Aachen, Germany

Revolution der gastrointestinalen Endoskopie – Teil I

Endosonographie – Fortschritte in Bildgebung und endoskopischer Therapie

H. Manner

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Jahrgang 34 p. 275 - 282

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