Efficacy of Oral Nicorandil to Prevent Contrast-Induced Nephropathy in Patients with Chronic Renal Dysfunction Undergoing an Elective Coronary Procedure.

OBJECTIVES: This prospective, randomized study was to investigate the role of nicorandil in the prevention of contrast-induced nephropathy (CIN) in patients with chronic renal dysfunction undergoing an elective coronary procedure. METHODS: A total of 252 eligible patients were enrolled in this study and allocated into the control group (n = 125) or nicorandil group (n = 127). Both groups received the standard hydration treatment, and patients in the nicorandil group were orally administrated 10 mg of nicorandil (t.i.d.) beginning 2 days before and continuing for 2 days after an elective coronary procedure. Serum creatinine (SCr) and cystatin C (CysC) were measured at 24 h before and 24, 48, and 72 h after the procedure. The occurrences of CIN and adverse events within 1 year were recorded. RESULTS: The nicorandil group had relatively lower SCr and CysC levels and a higher eGFR at 24 and 48 h after the procedure than the control group (p < 0.05). The incidence of CIN was significantly decreased in the nicorandil group compared to the control group. The multivariate logistic regression model revealed that nicorandil treatment was an independent protective factor for CIN (OR 0.669, 95% CI 0.522-0.857, p = 0.001). The multivariate COX proportional hazard model showed that nicorandil treatment was an independent protective predictor for adverse events (HR 0.881, 95% CI 0.781-0.993, p = 0.037). CONCLUSIONS: Nicorandil could exhibit a protective effect against CIN in patients with chronic renal dysfunction undergoing an elective coronary procedure and reduce the adverse events within 1 year after the procedure, which is superior to hydration treatment only.

Subcutaneous fluid administration and the hydration of older people.

Hypodermoclysis, or the subcutaneous administration of fluids, is a method of rehydration that is not routinely used in the UK. Yet it is a simple and effective method of fluid administration for individuals with mild-to-moderate dehydration, especially for the frail and elderly (Sasson and Shvartzman, 2001). Subcutaneous infusion is an alternative route of parenteral administration. It provides a number of advantages over the intravenous route for those individuals unable to tolerate enteral fluids, as it is associated with fewer complications, as well as a wider range of infusion sites. This makes it particularly advantageous for frail and/or older patients requiring low-volume hydration in the community setting. This article discusses indications and contraindications for subcutaneous infusions, as well as patient assessment, placement, securement and potential complications.

[Nutrition and fluid management in palliative medicine: do food and drink keep body and soul together?]. / Ernährung und Flüssigkeitsmanagement in der Palliativmedizin: Halten Essen und Trinken Leib und Seele zusammen?

Induction, implementation and continuation of an invasive nutrition or fluid administration in patients with advanced, life-limiting illnesses is an often controversial but also very emotionally discussed topic. This article summarizes the current state of knowledge based mainly on the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines and is intended as a simple guide for clinical practice. In the early phase of disease the induction of an invasive food and fluid administration may be indicated in order to prevent undernutrition and cachexia, to enhance compliance with anti-tumor treatment, to control some adverse effects of anti-tumor therapy and to improve the quality of life. If oral or enteral feeding is possible this should be preferred. Patients in the final stage of a disease rarely suffer from hunger or thirst. In this phase of the disease other things, such as monitoring of patients and relatives play a much more important role.

[Hypodermoclysis hydration in the elderly]. / Idratazione con ipodermoclisi nel paziente anziano.

Hydration with hypodermoclysis in elderly patients. Hypodermoclysis is a technique which consists in the administration of fluids into the subcutaneous tissue for the treatment of mild to moderate dehydration. The article starts from the case of a 74 year old man that, after a stroke, was unable to eat or drink, and was then hydrated with continuous hypodermoclysis for 45 days, obtaining a recovery of the clinical and psychological conditions. An update of the available knowledge on hypodermoclisis, together with some comments on the clinical case are presented.

Primary hyperparathyroidism in pregnancy treated with cinacalcet: a case report and review of the literature.

BACKGROUND: The efficacy and safety of various modes of medical treatment for primary hyperparathyroidism in pregnancy are largely unknown. CASE PRESENTATION: We report the case of a 34-year-old white woman with primary hyperparathyroidism symptomatic for nephrolithiasis. Her serum calcium was 3.15 mmol/l and parathyroid hormone was 109.0 ng/L. Neck imaging found no pathological parathyroid tissue. Cinacalcet and cholecalciferol were started. She became pregnant 17 months later. The calcimimetic was stopped. During pregnancy, she was admitted for hydration administered intravenously two to three times per week. In her 24th week of pregnancy, cinacalcet was restarted. In her 32nd week, a cesarean section was carried out as planned. CONCLUSIONS: Only three cases of primary hyperparathyroidism in women on cinacalcet therapy in pregnancy have been published in the literature. In the present case, hydration was useful in controlling serum calcium. Cinacalcet therapy helped to control serum calcium.

Extracorporeal CO2 removal--a way to achieve ultraprotective mechanical ventilation and lung support: the missing piece of multiple organ support therapy.

Extracorporeal therapies are able to sustain life through different mechanisms. This approach, called multiple organ support therapy, can in fact obtain blood purification by hemodialysis/hemofiltration to replace kidney function, temperature control, electrolyte and acid-base control to mimic homeostatic regulation of the kidney and circulation, fluid balance control to support the right hydration and cardiac performance, cardiac support removing cardiodepressant substances and equilibrating potassium levels, blood detoxification and liver support by coupled plasma filtration and adsorption or direct adsorption on blood (hemoperfusion), immunomodulation and endothelial support in the presence of sepsis by cutting the peaks of pro- and anti-inflammatory mediators, and immunoadsorption or adsorption of specific substances such as endotoxin. A missing piece of this group of therapies was the protective lung support. Today this is made possible by removal of CO(2) either by complete extracorporeal membrane oxygenation or by using decapneization in conjunction with hemofiltration in a system called DECAP/DECAPSMART. In conclusion, circulating blood outside the body and treating it with different filters or cartridges in a multiple organ support therapy may represent an important support for multiple organ dysfunction conditions induced by sepsis, acute respiratory distress syndrome and in recent times by complicated H1N1-related infections.