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1.
Int J Artif Organs ; 38(3): 126-32, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25744193

RESUMO

PURPOSE: Phosphorus removal is a major issue to assess for physicians engaging in hemodialysis. A pseudo-one-compartment model was reported as a novel model for phosphorus kinetics. We aimed to evaluate the adequacy of this model from the standpoint of the total mass of removed phosphorus during prolonged treatment. METHODS: Dialysate was collected during 6-h hemodialysis and hemodiafiltration treatment in 5 patients. Later-phase (from 4 to 6 h) dialysate was collected separately. Mobilization clearance (K(m)) and dialyzer clearance (K) were calculated by simple arithmetic operations utilizing stable serum phosphorus concentrations in this later phase. Volume of the accessible compartment (V(0)) was estimated by a fitting method. Amounts of removed phosphorus were calculated with these parameters and compared with measured values. The best sampling time points during treatment were also assessed, when the parameters were determined by serial serum phosphorus concentrations alone. RESULTS: Pearson's correlation coefficient (R) between calculated and measured values of removed phosphorus was 0.991 and the concordance correlation coefficient (ρ) was 0.987. When K(m), K and V(0) were determined by serial serum concentrations alone, including those at 0, 1, 4, and 6 h, the calculated mass of removed phosphorus had high R (0.974-0.975) or ρ (0.966-0.972) with the measured values. CONCLUSIONS: We confirmed that a pseudo-one-compartment model is useful for the estimation of removed phosphorus mass during prolonged blood purification by collecting dialysate. When the parameters are determined by a fitting method using serial serum concentrations alone, sampling at 0, 1, 4, and 6 h seems to be adequate.


Assuntos
Soluções para Diálise , Modelos Biológicos , Fósforo/farmacocinética , Diálise Renal , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
BMC Res Notes ; 5: 441, 2012 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-22894761

RESUMO

BACKGROUND: Under-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed non-psychiatric doctors' attitude toward depression. METHODS: The inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (G-P) network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis. RESULTS: We received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs. CONCLUSIONS: Japanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Atitude do Pessoal de Saúde , Depressão/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/diagnóstico , Depressão/terapia , Análise Fatorial , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
4.
Contrib Nephrol ; 177: 133-142, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22613924

RESUMO

We started our home hemodialysis (HHD) program in July 2005 and have been promoting overnight HHD. As more than 6 years have passed since we started our HHD program, we review our HHD program and 8 overnight HHD patients (5 males and 3 females). Their underlying disease differs in each and none have diabetic nephropathy. Their average age was 49.2 ± 6.0 years (mean ± SD). Average duration of dialysis treatment, HHD, and overnight HHD was 9.4 ± 4.4, 3.5 ± 2.4, and 2.2 ± 1.7 years, respectively. Average treatment time per dialysis session was 6.9 ± 0.8 h/treatment, average treatment days weekly was 4.5 ± 0.8 days/week, and average treatment time weekly was 31.2 ± 7.0 h/week. Laboratory data were good and their blood pressure was well controlled without any antihypertensive drugs excluding a patient who was recently introduced to dialysis with some residual kidney function. Severe problems did not occur in these 6 years except for blood access infection twice, slipping out of a needle during dialysis with small blood loss once, and a drop in blood pressure at the end of dialysis once, which was recovered by her assistant's help. According to our HHD training program, the average training duration for HHD was 106 ± 42 days. The shortest was 60 days and longest 198 days. These differences among training durations might be because of the frequency of training and having a better hand of puncturing. We did not instruct any additional issues and points for overnight HHD, because performing overnight HHD is similar to standard HHD. Some patients moved to overnight HHD slowly starting with once weekly and the others started overnight HHD several days after they had started HHD.


Assuntos
Hemodiálise no Domicílio , Adulto , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Fatores de Tempo
5.
Blood Purif ; 32(4): 317-22, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21934303

RESUMO

BACKGROUND/AIMS: The aim of this study was to determine whether treatment with ß(2)-microglobulin adsorption column (Lixelle) affects bone cysts and clinical symptoms in patients with dialysis-related amyloidosis (DRA). METHODS: Radiographic changes in the number and area of bone cysts of the wrist and the hip joint were compared between 39 hemodialysis (HD) patients treated with Lixelle (Lixelle group) and 28 HD patients treated with conventional therapy as retrospective control (HD group). Clinical symptoms of DRA were also evaluated. RESULTS: In the Lixelle group, the number of bone cysts and the cystic area in wrist joints were significantly decreased, although the changes in these parameters in hip joints were not significant. In the HD group, the corresponding parameters in the hip joints even significantly increased. Clinical symptoms notably improved after Lixelle treatment. CONCLUSION: Treatment with Lixelle reduces the radiolucency of bone cysts in the wrist joints, and improves clinical symptoms associated with DRA.


Assuntos
Amiloidose/etiologia , Amiloidose/terapia , Diálise Renal/efeitos adversos , Microglobulina beta-2/uso terapêutico , Adsorção , Idoso , Amiloidose/diagnóstico por imagem , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/etiologia , Cistos Ósseos/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento
6.
Ther Apher Dial ; 10(6): 476-97, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17199880

RESUMO

A statistical survey of 3932 nationwide hemodialysis (hereafter, dialysis) facilities was carried out at the end of 2004, and 3882 facilities (98.73%) responded. The population undergoing dialysis at the end of 2004 was 248 166, an increase of 10 456 patients (4.4%) from that at the end of 2003. The number of dialysis patients per million people was 1943.5. The crude death rate of dialysis patients from the end of 2003 to the end of 2004 was 9.4%. The mean age of patients who underwent dialysis in 2004 was 65.8 years, and that of the total dialysis population was 63.3 years. The percentage distribution of patients who underwent dialysis according to a newly underlying disease showed that 41.3% of patients had diabetic nephropathy and 28.1% had chronic glomerulonephritis. The frequency of calcium carbonate use for dialysis patients was 75.1% and that of sevelamer hydrochloride use was 26.2%. The frequency of sevelamer hydrochloride use does not necessarily have a strong correlation with the dose of calcium carbonate. Patients who received high doses of sevelamer hydrochloride tended to have a low concentration of arterial blood HCO(3-). Approximately 15% of dialysis patients used an intravenous vitamin D preparation, generally maxacalcitol. The longer the patients had been on dialysis, the higher the frequency of use of an intravenous vitamin D preparation. When the concentration of serum intact parathyroid hormone (PTH) was more than 200 pg/mL, the frequency of use of an orally administered vitamin D preparation decreased; but that of intravenous vitamin D preparation increased. The percentage of dialysis patients who received percutaneous ethanol injection therapy (PEIT) was 1.4%. The percentage was more than 50% in the patients who had been on dialysis for more than 10 years. The percentage of patients who received PEIT again was 35.0%. The percentage of patients who had been on hemodialysis for more than 10 years and received PEIT again was more than 50%.


Assuntos
Diálise Renal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Soluções para Hemodiálise , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Japão/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/mortalidade , Taxa de Sobrevida , Vitamina D/administração & dosagem
7.
Pathophysiol Haemost Thromb ; 35(6): 445-50, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17565238

RESUMO

The aim of this study was to determine the frequency of heparin/platelet factor (PF) 4 complex antibodies in 305 uremic patients treated with chronic intermittent hemodialysis using unfractionated heparin or low-molecular-weight heparin for 3 months. Heparin-induced thrombocytopenia (HIT) antibodies were detected by ELISA in 7 patients (2.3%) who had no history of HIT. Two patients abruptly developed HIT associated with the formation of clots in the extracorporeal circuit after they were found to be carrying HIT antibodies. These patients were suspected to have a similar trigger: an increased dose of recombinant human erythropoietin (rHuEPO). The drug might induce parallel changes in hematocrit (Ht) levels and platelet counts until the onset of HIT. After the onset of HIT, a parallel phenomenon between Ht and platelet counts was not found because of the thrombocytopenia due to HIT. Although HIT onset has been reported during the initial phase of dialysis sessions, there have been few reports on the onset of HIT in uremic patients on dialysis with long-term heparin anticoagulation. In this study, HIT was observed in 2 uremic patients on chronic dialysis with intermittent use of heparin. In some patients on chronic intermittent dialysis carrying HIT antibodies, HIT may occur following rHuEPO treatment. The presence of HIT should be borne in mind in chronic dialysis patients carrying HIT antibodies for 3 months or more.


Assuntos
Autoanticorpos/sangue , Heparina de Baixo Peso Molecular/efeitos adversos , Fator Plaquetário 4/sangue , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/induzido quimicamente , Diálise Renal , Uremia/sangue , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/imunologia , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Fator Plaquetário 4/imunologia , Púrpura Trombocitopênica Idiopática/imunologia , Diálise Renal/efeitos adversos , Trombose/sangue , Trombose/induzido quimicamente , Trombose/tratamento farmacológico , Trombose/imunologia , Uremia/complicações , Uremia/imunologia , Uremia/terapia
8.
Ther Apher Dial ; 8(1): 3-32, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15128016

RESUMO

Questionnaire forms for an annual survey conducted at the end of 2001 were sent out to 3520 institutions, and 3485 replies were received (response rate, 99.00%). According to the survey, the dialysis population of Japan at year end was 219 183 patients, up 6.3% (13 049) over the year before. This equals 1721.9 dialysis patients per million population. The gross mortality rate was 9.3% for the year extending from the end of 2000 to the end of 2001. The mean age of patients beginning dialysis was 64.2 years (+/- 13.7 SD). The mean age of the overall dialysis population in the study year was 61.6 years (+/- 13.1 SD), which was also a higher age than the year before. Among dialysis patients, the primary disease was diabetic nephropathy in 38.1% of patients, slightly down from 39.1% the previous year. Chronic glomerulonephritis was the primary disease in 32.4% of cases, a decrease from 34.7% the previous year. This survey included for the first time the items of the lowest blood pressure during hemodialysis session, vasopressor therapy before dialysis and vasopressor therapy during dialysis session. An analysis of the relationship between the type of vascular access used at the initiation of dialysis and the survival prognosis revealed a significantly higher risk of death in patients undergoing dialysis with synthetic arterio-venous (AV) fistula, AV shunt, or catheter implantation into a central vein than in those receiving dialysis treatments with a native fistula. There was a significantly lower risk of death in the patient group in whom the vascular access was created at 3-6 months before initiation of dialysis than in those in whom such access was created at the time of initiation or within 3 months before the initiation of dialysis. An analysis of the risk factors affecting survival prognosis in maintenance hemodialysis patients showed that risk factors for death are post-dialysis systolic blood pressure over 180 mm Hg and lower than 120 mm Hg, blood pressure elevating progressively from the start to the end of dialysis, serum high density lipoprotein cholesterol concentration of less than 30 mg/dL, and a higher ultrafiltration rate. In comparisons of the death risk between the patient group with a history of intervention for ischemic heart disease and the patient group with a history of myocardial infarction or heart failure but without such intervention, among diabetes patients, those who underwent percutaneous transluminal coronary angioplasty had a significantly lower risk of death than those in whom no intervention was made.


Assuntos
Falência Renal Crônica/terapia , Diálise Renal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Causas de Morte , Criança , Pré-Escolar , Diabetes Mellitus/etiologia , Feminino , Humanos , Japão , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Isquemia Miocárdica/etiologia , Prognóstico , Inquéritos e Questionários , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento , Vasoconstritores/uso terapêutico
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