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    2nd Posting (treatment and medication)


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    Post  rodel_perez_rn on Tue 23 Jun 2009, 10:59 pm

    Nocturnal Hemodialysis Does not Improve Overall Measures of Quality of Life Compared to Conventional Hemodialysis
    Braden J Manns; Michael W Walsh; Bruce F Culleton; Brenda Hemmelgarn; Marcello Tonelli; Melissa Schorr; Scott Klarenbach; for the Alberta Kidney Disease Network
    Published: 03/20/2009

    The discovery of hemodialysis greatly improves the management of patient with ESRD (CIHI, 2005). Regardless of the development in dialysis therapy, morbidity and mortally remains high among ESRD patients and there is seen discrepancy with the quality of life for these patients. Since 1940s, the discovery of Noturnal hemodialysis provided improvements to overcoming some limitations of conventional hemdialysis (Walsh M, et al, 2005). The article wanted to further describe the impact of nocturnal hemodialysis on ESRD patients and its effect to the quality of life. A total of 69 patients agreed to participate in the study. Upon selection, only 51met the inclusion criteria in which they are randomized whether they are going to receive conventional or nocturnal hemodialysis. Patients assigned to nocturnal hemodialysis were monitored and given 5-6 hemodialysis per night for a minimum of 6 hours per night. Patients assigned to conventional hemodialysis received treatment thrice weekly. The study utilized an experimental research method having a experimental group (nocturnal hemodialysis) and a controlled group (conventional hemodialysis). The primary analysis used an intention-to-treat approach, Secondary analyses considered an 'observed cases' approach, and finally, a 'per protocol' analysis was considered only to patients who were actually receiving their assigned therapy at 6 months.

    The study revealed that the quality of life did not exhibit a significant change among patients receiving nocturnal hemodialysis and conventional hemodialysis. Conversely, statistics provided clinical significance in the changes associated with kidney disease. The magnitude of difference in EQ-5D (subjective quality of life measurement questionnaire) supported the use of nocturnal hemodialysis over conventional hemodialysis.

    The result of the study would provide patients with ESRD more options when choosing from available dialysis modalities. Patient will be able to consider the difference in therapies which may affect there lifestyle in the context of their individual preference and circumstances. If another follow up study will be conducted and shows significant cost-efficiency of nocturnal hemodialysis, then it would be more reasonable to suggest the latter treatment for patients who are willing to give-up a more demanding therapy for a potential of improved quality of life.

    Canadian Organ Replacement Registry: Treatment of End-Stage Organ Failure in Canada 2002 and 2003. Canadian Institutes of Health Information: Ottawa 2005.

    Walsh M, Culleton B, Tonelli M et al. A systematic review of the effect of nocturnal hemodialysis on blood pressure, left ventricular hypertrophy, anemia, mineral metabolism, and health-related quality of life. Kidney Int 2005; 67: 1500-1508.

    Authors and Disclosures
    Braden J Manns,1,2 Michael W Walsh,1,2 Bruce F Culleton,1 Brenda Hemmelgarn,1,2 Marcello Tonelli,3 Melissa Schorr,1 Scott Klarenbach,3 for the Alberta Kidney Disease Network
    1Department of Medicine, University of Calgary, Calgary, Alberta, Canada
    2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
    3Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

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    Post  guomanman on Wed 24 Jun 2009, 11:22 am

    Dyad 6 guomanman and chenya

    Sleep Patterns for Hemodialysis Patients

    Parker KP, Bliwise DL, Bailey JL, Rye DB. Daytime sleepiness in stable hemodialysis patients. American Journal of Kidney Diseases. 2003;41:394-402.

    Patients on hemodialysis are noted to sleep frequently during their daytime treatment. While this sleepiness may be due to normal fatigue or boredom, it may also indicate the presence of underlying mechanisms that disturb normal nighttime sleep. A sample of 46 hemodialysis patients, screened to exclude those with identified sleep disturbances or taking medications that may alter sleep patterns, underwent sleep testing on a nondialysis day. First, all subjects maintained a 2-week sleep diary. Then, on the night following a dialysis treatment, they completed a sleepiness inventory and underwent a sleep polysomnography test. The following morning, daytime sleepiness was measured using the Multiple Sleep Latency Test (MSLT), testing time to fall asleep during a nap opportunity. From the sleep diaries, average reported nighttime sleep was 6.2 hours, and there was no indication of a lingering sleep debt. Polysomnography results revealed some episodes of mild sleep apnea, respiratory events, and abnormal limb movements in roughly half of the subjects. The MSLT showed abnormal levels of daytime sleepiness in 33% of the subjects. Longer sleep latency periods and more time spent in rapid-eye-movement (REM) sleep at night helped decrease daytime sleepiness. By quantifying daytime sleepiness, these results show that sleep disturbances may be common in hemodialysis patients, and may contribute to cardiovascular problems and a decreased quality of life.

    Last edited by guomanman on Thu 25 Jun 2009, 10:05 pm; edited 1 time in total

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    Post  YangChunHua on Wed 24 Jun 2009, 4:18 pm

    Pharmacokinetics of gemcitabine in a patient with end-stage renal disease: effective clearance of its main metabolite by standard hemodialysis treatment
    Published online: 4March2003 Springer_verlag2003
    Purpose. Gemcitabine (2',2'-difluorodeoxycytidine) is a cytotoxic agent with a low toxicity profile and proven activity against a number of solid tumors. It is not known whether gemcitabine is safe to administer to patients with kidney failure, and if dose adjustment is necessary. We determined the tolerability and pharmacokinetics of gemcitabine and its noncytotoxic metabolite 2',2'-difluorodeoxyuridine (dFdU) in a patient with end-stage renal disease on maintenance hemodialysis therapy.
    Patient and methods. A 64-year-old patient with pancreatic cancer and end-stage renal disease received two cycles of gemcitabine at a standard dose of 1000 mg/m2 given as a 30-min infusion on days 1 and 10. A regular 3.5-h hemodialysis treatment was performed 24 h after each infusion. Plasma and dialysate concentrations of gemcitabine and dFdU were determined by HPLC. The tolerability of gemcitabine treatment was assessed by clinical and laboratory parameters.
    Results. For gemcitabine, the maximal plasma concentration, terminal half-life (t1/2) and area under the concentration-time curve (AUC) were similar to those reported for patients with normal renal function. In contrast, end-stage renal disease resulted in a five- to tenfold prolongation of terminal half-life and a distinct increase in the AUC of plasma dFdU in this patient. Plasma dFdU was effectively eliminated by hemodialysis treatment. Both cycles of gemcitabine were tolerated well with no unexpected side effects observed.
    Conclusions. Gemcitabine treatment in end-stage renal disease with intermittent standard hemodialysis treatment is safe and well tolerated. The pharmacokinetic data suggest that dose adjustment of gemcitabine should be avoided to ensure its full cytotoxic activity, and that hemodialysis treatment should be initiated 6-12 h after its administration to minimize the potential side effects of the metabolite dFdU.

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    Post  gillegarda/joanalynbalino on Thu 25 Jun 2009, 4:18 pm

    By: D2- Gil Legarda and Joanalyn Balino

    Research Title: Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis: A Randomized, Double-Blind, Multicenter Study

    Authors: Jill S. Lindberg, Bruce Culleton, Gordon Wong, Michael F. Borah, Roderick V. Clark, Warren B. Shapiro, Simon D. Roger, Fred E. Husserl, Preston S. Klassen, Matthew D. Guo, Moetaz B. Albizem, and Jack W. Coburn

    Jill S. Linberg et. al. had a quiasi-experimental multicenter, randomized, controlled, double-blind study to evaluate the efficacy and safety of cinacalcet in peritoneal dialysis and haemodialysis patients with a PTH less than or equal to 300 pg/mL despite of traditional therapy. The purpose of this study was to evaluate the safety and efficacy of cinacalcet compared with control among patients who have secondary HPT and were on Peritoneal Dialysis or Hemodialysis and receiving traditional therapy. There was a total of 395 subjects in this study, in the experimental group consist of 260 hemodialysis and 34 peritoneal dialysis patients and in control group consist of 89 hemodialysis and 12 peritoneal dialysis patients. The researchers used a cluster random sampling separating the experimental group using a cinacalcet to control group using placebo. The major inclusion criteria were age greater than or equal to 18 years mean of 2 plasma intact PTH or iPTH values should be greater or equal to 300 pg/ml and mean of two serum calcium values is less than or equal to 8.4 mg/dl during the screening phase; and treatment with continuous ambulatory peritoneal dialysis or automated PD, treatment with hemodialysis for at least 1 month before beginning study medication. Patients who received vitamin D therapy must have been treated with a stable dose for at least 30 days before enrolment. Patients were excluded from the study if they had an unstable medical condition or if when they had undergone parathyroidectomy or experienced a myocardial infarction within 3 months before the study began. The setting of this research study was held in Covance Central Laboratory Services, Indianapolis, IN. This research study was conducted in accordance with the declaration of Helsinki. Laboratory exams and findings are used to assess and evaluate the results comparing te outcome for those taking cinacalcet to those taking placebo. Laboratory assessments of serum calcium, plasma iPTH, and serum phosphorus were performed at a central laboratory. Blood collections were performed before the dose of study medication on study visit days, approximately 24 hours after the previous dose. A double-antibody immunoradiometric assay was used to determine the plasma iPTH levels.

    There is a similar proportions of patients in the control group and cinacalcet completed the dose-titration 83 versus 81% respectively. And efficacy assessment phases 76 versus 74% respectively. The baseline demographics were comparable between treatment groups and across the randomization starta among cinacalcet-treated patients. Patients treated by cinacalcet were significantly more likely than control patients to achieve each of the therapeutic targets for iPTH reduction. 30 versus 7% achieved an iPTH level. The results of this research study showed that once-daily oral cinacalcet is effective and safe for the management of secondary HPT in patients who are receiving Hemodialysis or Peritoneal Dialysis. Cinacalcet was finer to control treatment for all targets of iPTH reduction in this research study.

    It further demonstrates in this research study that cinacalcet is effective regardless of the modality of dialysis. Also patients who were undergoing Peritonral and hemodialysis and treated with cinacalcet experienced significant reductions in both serum calcium and phosphorus. The traditional therapies for secondary HPT are limited by side effects that may place patients at a higher risk for vascular calcification. Vitamin D increases phosphorus and calcium absorption from the intestine. Poor control of mineral metabolism is also associated with a higher risk for death, calcification of the aorta and arteries can increase arterial stiffness and cardiac valve calcifications.

    Jill S. Lindberg, Bruce Culleton, Gordon Wong, Michael F. Borah, Roderick V. Clark, Warren B. Shapiro, Simon D. Roger, Fred E. Husserl, Preston S. Klassen, Matthew D. Guo, Moetaz B. Albizem, and Jack W. Coburn (2005). Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis: A Randomized, Double-Blind, Multicenter Study. Journal of American Society Nephrology Vol 16, Pages 800-807.Retrieved June 24, 2009 from http://jasn.asnjournals.org/cgi/reprint/16/3/800?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT

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    Post  alkhaloidz on Thu 25 Jun 2009, 9:45 pm

    DYAD 4

    We find this study very essential for early detection and prompt treatment of undesirable side effects of Hemodialysis

    Japanese haemodialysis anaemia management practices and outcomes (19992006): results from the DOPPS

    Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. The utilized the longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients.

    This study yields the following results: From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb ≥10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, P = 0.003). Facilities with median Hb ≥10.4 displayed a lower mortality risk (RR = 0.77, P = 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.

    These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide. The Nursing profession can benefit from this study by correlating the management to Filipino patients undergoing HD and if needed, modify the management to suit the need of the Filipino patients.

    Reference: Akizawa T et. al. Japanese haemodialysis anaemia management practices and outcomes (19992006): results from the DOPPS. PMC. May 2008
    byron webb romero
    byron webb romero

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    2nd Posting (treatment and medication) Empty DYAD RESPONSE TO: TREATMENT/ MEDICATION HD

    Post  byron webb romero on Wed 08 Jul 2009, 12:57 am



    As patients undergoing HD are prone to alterations in the serum calcium and phosphorus, hyperphosphatemia is a common feature of patients in their advanced stages of renal failure. The phosphate concentration in the blood rises when the GFR falls below 20ml/min. In the study conducted by Choy and Cheng (1998), evidences show that calcium acetate is effective in decreasing the ionized phosphate in the blood by acting as phosphate binders

    In addition, another electrolyte problem that patients with ESRD experience is hypocalcemia. This is a result of decreased intestinal absorption of calcium due to vitamin D deficiency. Also, because there is an increase in the serum phosphate, calcium phosphate tends to be deposited in the soft tissues, thus serum calcium declines. It has been a standard procedure to inject calcitriol in order to augment the serum calcium in the body. However, injectable vitamin D (calcitriol) is found to cause elevations in the serum calcium and phosphate, leading to speed up vascular disease causing death in patients undergoing long-term hemodialysis (Teng, et al, 2003). In the same cohort study, they tried to prove the effectiveness of paricalcitol (a synthetic vitamin D analogue) compared to calcitriol. Results showed a lower mortality rate among patients receiving paricalcitol compared to that of patients receiving calcitriol.

    Anemia is also one of the common complications of undergoing HD. A study by Shaheen, Akeel, Alfi, et.al (2006) compared the short acting recombinant human erythropoietin (rHuEPO) and Darbapoeitin, which is a long acting type of erythropoietin. It has an effect which is three times longer as the short acting erythropoietin. The study population from Saudi Arabia consists of 33 subject, 18 men and 15 women. The result of the study suggests that long acting erythropoietin is as effective and safe as rHuEPO. The treatment for anemia will have a lesser dosage but the effect is still the same. Darbopoietin did not provide a long term side effects for clients with anemia and it is cost effective rather than the utilization of rHuEPO.

    In view hereof, the study can be conducted utilizing a larger range of study population inorder to come up with a conclusion of which type of erythropoietin is best for treatment of patients experiencing anemia during the course of HD.


    Choy, B.Y. & Cheng, I.K.P. (1998). Effectiveness of calcium phosphate as phosphate binders in patients undergoing dialysis. Hong Kong Medical Journal..4:23-6 http://www.hkmj.org/article_pdfs/hkm9803p23.pdf

    Shaheen, F., Akeel, N., Alfi, A., Harbi,A., Tarif, N. & Ziad Souqiyyeh M., (2006). Darbepoetin Use for the Treatment of Anemia in Hemodialysis Patients in Saudi Arabia, Saudi Journal of kidney diseases and transplantation. 17 (3): 365-372

    Teng, M. , Wolf, M., Lowrie, E, Ofsthun, N., Lazarus, M. & Thadhani, R. (2003). Survival of Patients Undergoing hemodialysis with Paricalcitol or Calcitriol Therapy. The New England Journal of Medicine. 349 (5):446-56. Retrieved July 6, 2009, from http://content.nejm.org/cgi/content/abstract/349/5/446.

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