Clin Nephrol
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Cardiovascular mortality is still high and many risk factors are inadequately controlled in patients on conventional chronic hemodialysis. Recent studies on intensified treatment schedules by either increasing length or frequency of dialysis sessions have shown promising results with better control of blood pressure, reduction of left ventricular hypertrophy and easier control of calcium/phosphate metabolism. ⋯ While reduction in 24-h blood pressure was not achieved by intensified dialysis, both schedules showed favourable effects on LVMI and FS with less antihypertensive medication. This was independent of reduction in dry weight. These effects were more pronounced in DHD patients. In contrast, in SHD patients, stable 24-h blood pressure and reduction in LVMI were achieved on the expense of an increasing amount of antihypertensive medication and with worsening of FS.
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Case Reports
Metformin and antihypertensive therapy with drugs blocking the renin angiotensin system, a cause of concern?
The burden of diabetes mellitus type 2 (DM2) is increasing worldwide. The combination of DM2 and hypertension (HT) is frequently encountered. Concurrent use of drugs blocking the renin angiotensin system (angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB)) and metformin have become frequent in this group of patients. That combination can become life-threatening under certain circumstances. ⋯ We believe that the incidence of metformin-associated lactic acidosis in Norway may become more frequent due to increased use of metformin and drugs blocking the renin angiotensin system. The awareness of lactic acidosis as a complication to the use ofmetformin in predisposed individuals is important. General advice should be given to patients regarding reduction of dosage or withdrawal of the drugs during acute intercurrent illness with dehydration. Early diagnosis and treatment of metformin-associated lactic acidosis are crucial for the patient outcome. Hemodialysis can be life-saving and should be started without delay.
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We report on a 67-year-old female patient who was admitted to our intensive care unit with acute renal failure and severe hypoxemia. Transiently, the patient had to be treated with kidney replacement therapies and artificial ventilation. The actual illness started with general weakness, recurrent bloody diarrhea and intermittent dermatitis of the lower legs. ⋯ A cryoglobulinemic vasculitis type II was histologically found in biopsy specimen of the kidney. Thus, the present case reports on a coincidence of a monoclonal gammopathy causing a cryoglobulinemia type II with extensive organ involvement and a florid CMV infection. We hypothesize that the CMV infection has triggered the cryoglobulinemia and its particular severe organ involvement.
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Comparative Study
Respiratory evaluation of patients on continuous ambulatory peritoneal dialysis prior to renal transplantation.
Pulmonary function tests (PFTs) and cardiopulmonary exercise tests (CPETs) are important in predicting preoperative pulmonary complications and mortality rate in potentially renal transplant recipients. There is no adequate clinical research aimed at learning the effect of empty and full status of the peritoneal cavity on PFTs and CPET for estimating decide PFTs and CPET timing in preoperative evaluation. The aim of this study was to investigate whether PFT and CPET results are altered in patients on continuous ambulatory peritoneal dialysis (CAPD) according to the presence of dialysis solution in the abdomen. ⋯ FEV1, %FEV1/FVC, % predicted DLCO and CPET test results do not differ according to abdomen status in CAPD patients suggesting that the timing of PFT maneuver does not affect preoperative transplantation evaluation. Therefore, when evaluating the results of these tests prior to transplantation period, the presence of dialysis solution in the abdomen may be ignored.
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Comparative Study
Performance of creatinine clearance equations on the original Cockcroft-Gault population.
Prediction of endogenous creatinine clearance by mathematical equations such as the Cockcroft-Gault formula is used in clinical practice in spite of the reported concern for their limited predictability. The aim of this study is to determine whether the measured creatinine clearance can be predicted accurately by a number of published equations including the recently modified Cockcroft-Gault formula = Cockcroft-Gault formula x 1.73 m2/body surface area from the original Cockcroft-Gault population. ⋯ The current creatinine clearance equations and even the original Cockcroft-Gault formula did not accurately predict the measured creatinine clearance. Normalization for body surface area in the original Cockcroft-Gault formula demonstrated more accuracy to estimate creatinine clearance, particularly in patients with diminished renal function and is recommended to physicians who wish to use the Cockcroft-Gault formula in their practice until more credible formulas are developed.