E-learning modules for Integrated Virtual Learning



    Posts : 31
    Join date : 2009-06-19
    Age : 32


    Post  gillegarda/joanalynbalino on Tue 23 Jun 2009, 11:33 pm

    2nd Posting TREATMENT
    By: D2- Gil Legarda/ Joanalyn Balino

    Francisco J. Cano,1 Marta A. Azocar,1 Jose Luis Guerrero,1 Maria A. Delucchi,1 Ana Maria Lillo,1 Marcos Emilfork,2 and Eugenio E. Rodríguez1

    This research study is done in an experimental design. The purpose of this study is to assess the safety, effectiveness and efficacy of the intraperitoneal calcitrol for infants undergoing peritoneal dialysis. The researcher used a purposive sampling just to study the efficacy and safety of Intraperitoneal calcitrol use for infants undergoing peritoneal dialysis. There were 6 infants undergoing domiciliary peritoneal dialysis included in this research study. This study used a multi stage random sampling, the patients undergoing peritoneal dialysis is the big cluster and the infants using intraperitoneal calcitrol in peritoneal dialysis is the small cluster. The protocol for the subjects to be included in the study should have an iPTH plasma level less than 1000 pg/mL for the past 3 months follow up check up. Patients excluded in this study are those who had any conditions such as peritonitis for 2 months previous to the entry, intestinal absorption disease, nephrotic syndrome, endocrine or metabolic disease, chronic diarrhea,allergic reaction to calcitrol or other Vitamin D compound, serum calcium level and plasma phosphate. The settings of this study held inLuis Calvo Mackenna Children’s Hospital, University of Chile. The residual kidney function was measured in a 24-hour urine sample. A urine collection pad was installed and connected to a urine-collecting bag system on an outpatient basis until the next day, when the patient was cited again to the hospital with the collected 24-hour sample. If the collected sample was not reliable, the procedure was repeated for a second time. If it failed again, a Foley catheter was installed for 24 hours under antibiotic prophylaxis therapy. Growth hormone was not used before or during the study in any patient included in this protocol. Biochemical determinations were done before starting IP calcitriol and at monthly intervals over a 12-month follow-up. Gathered data were reported as mean ± standard error. The Wilcoxon signed rank test was used to assess differences in the measurements for each pair of values. The interval differences between median in terms of confidence was 96.9 percent.

    There are 6 male children on peritoneal dialysis range 7 to 18 months were included. All the patients completed the 12 months of follow up. 12 hypercalcemic episodes were observed during therapy and serum phosphorus was found to be higher then DOQI recommendation on 10 occasions. After 9 months of therapy the serum iPTH levels showed a significant decrease although the said decrease was found each month.

    As the main therapy for secondary hyperparathyroidism in end stage renal disease, calcitrol has been long used especially in those patients having dialysis. Most of the pediatric patient manifest a high turnover bone disease with a high iPTH plasma levels and enhanced number of osteoclast leading to increased bone resorption and growth failure. This condition often progresses therefore an alternative therapeutic intervention has been used to improve the clinical and biochemical response to active vitamin D. The present study was planned to determine whether P administration of calcitriol would be a more effective and safer treatment of secondary hyperparathyroidism than oral administration in PD infants with high iPTH levels. The results showed that IP administration was safe and effective for suppressing hyperparathyroidism in these patients.


    Cano, J. et. al. ( 2007). Intraperitoneal calcitrol in infants on peritoneal dialysis. Peritoneal Dialysis International Vol 27 pages 681-686.Retrieved June 22,2009 from http://www.pdiconnect.com/cgi/reprint/27/6/681?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT

    Goodman W, Coburn J, Slatopolsky E, Salusky I. (1999) Renal Osteodystrophyin adults and children Lippincott Williams & Wilkins347–63.

    Malluche HH, Faugere M.(1990) Renal bone disease. An unmet challenge for the nephrologist. Kidney Int ; 38: 193–211.

    Kuizon B, Salusky I.(2002) Cell biology of renal osteodystrophy. Pediatr Nephrol 17:777–89.

    Coburn J.(2003) An update on vitamin D as related to nephrology practice:. Kidney Int Suppl 87:S125–30..

    By: D2- Gil Legarda and Joanalyn Balino

    Title: Repetitive Fragmentation Products of Albumin and
    α1-Antitrypsin in Glomerular Diseases Associated with
    Nephrotic Syndrome

    Giovanni Candiano,* Luca Musante,*† Maurizio Bruschi,*† Andrea Petretto,‡
    Laura Santucci,*† Piero Del Boccio,§_¶ Barbara Pavone,§_¶ Francesco Perfumo,**
    Andrea Urbani,§_¶ Francesco Scolari,†† and Gian Marco Ghiggeri*

    There were 23 participants involved in the study. These patients have nephrotic syndrome and have different pathologic backgrounds. Clinical data and renal histology are the basis of diagnosis. The criteria were there should be a presence of nephrotic syndrome (proteinuria >40 mg/h per m2) with onset at less than 16 yr of age and in cases of steroid dependence and/or resistance, availability of a renal biopsy; there is absence of familial traits of nephrotic syndrome and/or relevant mutations of slit-diaphragm genes (NPHS2, CD2AP, and ACTN4); and presence of nephrotic syndrome at any age with MGN.

    Albumin fragments account for 25 to 30% of total albumin in urine of nephrotic patients while their proportion in serum does not exceed 5%. There are almost 30 g of fragments is cleared monthly from plasma, accounting for 30% of the albumin pool in a patient who weighs 30 kg considering that in nephrotic syndrome at least 2 to 3 g of albumin is lost every day in urine and that up to 1 g (30%) is represented by fragments.

    Albumin fragments in nephrotic urine high concentration suggests a preferential urinary excretion and it reflects the partial maintenance of size selectivity properties of the kidney. Preferential urinary excretion of albumin fragments in nephrotic patients represents an efficient depurative mechanism that restores normal albumin composition in plasma, and similar considerations apply to 1AT.

    Candiano et al. (2006). Repetitive Fragmentation Products of Albumin and α1-Antitrypsin in Glomerular Diseases Associated with Nephrotic Syndrome. J Am Soc Nephrol 17: 3139-3148. Retrieved June 21, 2009 from http://jasn.asnjournals.org/cgi/reprint/17/11/3139?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT

    Last edited by gillegarda/joanalynbalino on Tue 07 Jul 2009, 2:12 am; edited 3 times in total

    Posts : 30
    Join date : 2009-06-23
    Age : 36
    Location : China

    2ND POSTING: ---------- TREATMENT AND MEDICATION Empty by guomanman and chenya

    Post  guomanman on Wed 24 Jun 2009, 11:36 am

    Peritoneal Dialysis
    [Key investigators : Prof KN Lai, Dr WK Lo, Prof DTM Chan, Dr FK Li, Dr S Yung]

    Peritoneal dialysis (PD) is a major mode of treatment for patients with kidney failure. Our group has ongoing clinical and basic research projects to investigate the prevention and treatment of complications, ways to improve patient outcome, peritoneal transport mechanisms, and fibrosis of the peritoneal membrane.

    Representative publications

    1. Lo WK, Ho YW, Li CS, Wong KS, Chan DTM, Yu AWY, Ng FSK, Cheng IKP. Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study. Kidney Int 2003; 64: 649-656.
    2. Li FK, Chan LYY, Woo JCY, Ho SKN, Lo WK, Lai KN, Chan DTM. A 3-year prospective randomized controlled study on amino acid dialysate in patients on CAPD. Am J Kidney Dis 2003; 42: 173-183.
    3. Chan DTM, Leung JKH, Sun YL, Lai KN, Tsang R, Yung S. Different Effects of Amino Acid-Based and Glucose-Based Dialysate from Peritoneal Dialysis Patients on Mesothelial Cell Ultrastructure and Function. Nephrol Dial Transplant 2003; 18: 1086-1094.
    4. Lo WK, Tong KL, Li CS, Chan DTM, Wong AKM, Ho YW, Cheung KO, Kwan TH, Wong KS, Ng FSK, Cheng IKP. Relationship between adequacy of dialysis and nutritional status and their impact on patient survival in CAPD in Hong Kong. Perit Dial Int 2001; 21: 441-447.
    5. Lui SL, Tang S, Li FK, Choy BY, Chan DTM, Lo WK, Lai KN. Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2001; 38: 1055-1060.
    6. Yung S, Chan DTM. Peritoneal mesothelial cells and the extracellular matrix. Nephrology 2001; 6: 250-258.
    7. Lai KN, Lai KB, Chan DTM, Lam CWK, Li FK, Leung JCK. Changes of cytokine profiles during peritonitis in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2000; 35(4): 644-652.

    Posts : 20
    Join date : 2009-06-23

    2ND POSTING: ---------- TREATMENT AND MEDICATION Empty Continuous ambulatory peritoneal dialysis by YuanShuHua&Yang

    Post  YangChunHua on Wed 24 Jun 2009, 6:10 pm

    Superior patient survival for continuous ambulatory peritoneal dialysis patients treated with a peritoneal dialysis fluid with neutral pH and low glucose degradation product concentration (Balance)
    Perit Dial Int 2005; 25:248–255 www.PDIConnect.com

    In recent years, laboratory and clinical research has suggested the need for peritoneal dialysis fluids (PDFs) that are more biocompatible than the conventional PDFs commonly used today. Bioincompatibility of PDF has been attributed to low pH, lactate, glucose, glucose degradation products (GDPs), and osmolality. PDFs with neutral pH and low GDPs are now available commercially. In vitro and early clinical studies suggest that these solutions are indeed more biocompatible but, as of now, there is no evidence that their use improves patient outcome.
    Using a dedicated database of over 2000 patients treated with PD in Korea, we were able to conduct a retrospective observational study comparing outcomes for incident continuous ambulatory PD patients treated with a standard, conventional, heat-sterilized PDF to the outcomes for patients treated with a novel, low GDP, neutral-pH PDF prepared in a dual-compartment, double-bag PD system (Balance; Fresenius Medical Care, St. Wendel, Germany). In an intention-to-treat analysis, patient and technique survival, peritonitis-free survival, and peritonitis rates were compared in 611 patients treated with Balance for up to 30 months and 551 patients with a standard PDF (stay• safe; Fresenius Medical Care) treated in the same era and with equivalent follow-up.
    The patients were well matched for most relevant characteristics except older age distribution for the patients treated with the standard PDF. Patients treated with Balance had significantly superior survival compared to those treated with the standard PDF (74% vs 62% at 28 months, p = 0.0032). In a multivariate Cox regression model including age, diabetes, and gender, the survival advantage persisted (relative risk of death for Balance 0.75, 95% confidence interval 0.56 – 0.99,p = 0.0465). Modality technique survival was similar in Kaplan–Meier analysis for both PDFs. No differences were detected in peritonitis-free survival or in peritonitis rates between the two solutions.
    This study, for the first time, suggests that treatment with a novel biocompatible PDF with low GDP concentration and neutral pH confers a significant survival advantage. The exact mechanisms for such a survival advantage cannot be determined from this study. The usual criticisms of observational studies apply and the results reported here strongly warrant the undertaking of appropriately designed, randomized, controlled clinical trials.


    1. Williams JD, Craig KJ, Topley N, Von Ruhland C, Fallon M, Newman GR, et al. Morphologic changes in the peritoneal membrane of patients with renal disease.J Am Soc Nephrol 2002; 13:470–9.
    2. Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, et al. Effects of increased peritoneal clear- ances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized controlled trial. J Am Soc Nephrol 2002; 13:1307–20.
    3. Piraino B. How much peritoneal dialysis is needed for optimal outcomes? Semin Dial 2003; 16:367–9.
    4. Stenvinkel P. Interactions between inflammation, oxidative stress and endothelial dysfunction in end-stage renal disease. J Ren Nutr 2003; 13:144–8.
    5. Witowski J, Bender TO, Wisniewska-Elnur J, Ksiazek K Passlick-Deetjen J, Breborowicz A, et al. Mesothelial toxicity of peritoneal dialysis fluids is related primarily to glucose degradation products, not to glucose per se.Perit Dial Int 2003; 23:381–90.
    6 . Alscher DM, Pauli-Magnus C, Kirchgessner J, Kuhlmann U, Mettang T. A new lactate-based, plasticizer-free, neutral peritoneal dialysis fluid provided in a two-compartment system: effect on peripheral leukocyte function. Nephron 2000; 86:62–9.
    7 . Mortier S, De Vriese AS, Van de Voorde J, Schaub TP, Passlick-Deetjen J, Lameire NH. Hemodynamic effects of peritoneal dialysis solutions on the rat peritoneal membrane: role of acidity, buffer choice, glucose concentration, and glucose degradation products [Erratum published in J Am Soc Nephrol 2002; 13(5):1419–22].J Am Soc Nephrol 2002; 13:480–9.
    8 . Witowski J, Korybalska K, Ksiazek K, Wisniewska-Elnur J, Jorres A, Lage C, et al. Peritoneal dialysis with solutions low in glucose degradation products is associated with improved biocompatibility profile towards peritoneal mesothelial cells. Nephrol Dial Transplant 2004; 19:917–24.
    9 . Wieczorowska-Tobis K, Brelinska R, Witowski J, Passlick Deetjen J, Schaub TP, Schilling H, et al. Evidence for less
    irritation to the peritoneal membrane in rats dialyzed with solutions low in glucose degradation products. Perit Dial
    Int 2004; 24:48–57.
    10 . Williams JD, Topley N, Craig KJ, Mackenzie RK, Pischetsrider M, Lage C, et al. The Euro-Balance Trial: the effect of a new biocompatible peritoneal dialysis fluid (Balance) on the peritoneal membrane. Kidney Int 2004; 66:408–18.

    Posts : 22
    Join date : 2009-06-19

    2ND POSTING: ---------- TREATMENT AND MEDICATION Empty D2 (reply #2)

    Post  rodel_perez_rn on Thu 25 Jun 2009, 2:04 am

    Intravenous C.E.R.A. Maintains Stable Haemoglobin Levels in Patients on Dialysis Previously Treated With Darbepoetin alfa: Results From STRIATA, A Randomized Phase III Study
    Bernard Canaud; Giulio Mingardi; Johann Braun; Pedro Aljama; Peter G. Kerr; Francesco Locatelli; Giuseppe Villa; Bruno Van Vlem; Alan W. McMahon; Cécile Kerloëguen; Ulrich Beyer; and on behalf of the STRIATA Study Investigators*
    Published: 12/09/2008

    One of the most prevalent problems on patients receiving dialysis is Anemia, this is according to the study conducted by DOPPS. As a response to the problem, it is a must to increase the fraction of patients accomplishing hemoglobin targets (Locatelli F, et al. 2004). A continuous erythropoietin receptor activator (C.E.R.A) was first used by the European Union as a monthly maintenance of Hb levels in patients with ESRD. the goal of the study is to determine the primary efficacy and safety results of C.E.R.A among clients with ESRD. The participants were selected at random sampling. The total population of 249 adult patients with renal anemia and is receiving adequate hemodialysis participated the study. Inclusion criteria includes recommendation of anemia treatment within the duration of the study, adequate serum ferritin (>100ng/ml or transferring saturation of >20%). The study design was a multicenter, parallel-group, open-label, randomized study to investigate efficacy and safety of intravenous C.E.R.A. Non inferiority testing will be conducted to calculate the primary efficacy parameter. 95% level of confidence will be established upon testing the two-sided result with ANCOVA.

    The results show that during the evaluation period, there was a significant difference in the Mean Hb levels between the treatment groups. The assessment of the mean standard deviation of patient’s Hb level also resulted to similar intrapatient Hb variability among C.E.R.A and DA groups during the titration, evaluation and safety observation. The result findings of the statistical analysis revealed consistently that the efficacy of Hb control was successfully maintained once the client is converted to C.E.R.A which is receiving DA before the study.

    This study would provide an important contribution to the body of science related to the clinical practice. The results will further increase the efficiency of anemia management and enables the healthcare providers to allocate their time on the other important aspects of care towards their clients. Since anemia is one of the primary concerns of clients undergoing dialysis, giving them other options for their treatment will enable them to maximize their resources towards a preferable treatment measures which would result to better prognosis of their conditions.

    Locatelli F, Pisoni RL, Akizawa T, et al. Anemia management for hemodialysis patients: Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines and Dialysis Outcomes and Practice Patterns study (DOPPS) findings. Am J Kidney Dis (2004) 44(Suppl 2):27-33.

    Authors and Disclosures:
    Bernard Canaud,1 Giulio Mingardi,2 Johann Braun,3 Pedro Aljama,4 Peter G. Kerr,5 Francesco Locatelli,6 Giuseppe Villa,7 Bruno Van Vlem,8 Alan W. McMahon,9 Cécile Kerloëguen,10 Ulrich Beyer,10 and on behalf of the STRIATA
    Study Investigators*

    1Service de Nephrologie, Hôpital Lapeyronie, Montpellier, France
    2Unita' Operativa di Nefrologia e Dialisi, Ospedali Riuniti di Bergamo, Bergamo, Italy
    3KFH-Dialysezentrums, Nuernberg, Germany
    4Hospital Reina Sofia, Servicio de Nefrologia, Cordoba, Spain
    C.E.R.A. Maintains Stable Haemoglobin Levels in Patients on Dialysis (pr...
    byron webb romero
    byron webb romero

    Posts : 25
    Join date : 2009-06-19
    Age : 32
    Location : Pasay City

    2ND POSTING: ---------- TREATMENT AND MEDICATION Empty Response: Treatment in Peritoneal Dialysis

    Post  byron webb romero on Tue 07 Jul 2009, 1:13 am

    Dyad 3
    Byron Webb A. Romero
    Von Deneb H. Vitto
    Raymond C. Ursal

    Response: Treatment in Peritoneal Dialysis

    Because hypertension is the main contributor for cardiovascular mortality in patients going through dialysis, blood pressure (BP) control has been one of the goals in acute peritoneal dialysis. According to earlier researches, short-term effects of peritoneal dialysis include improvement in the control of BP. On the other hand, the study conducted by Menon et al (2001) looked into the long-term effects of peritoneal dialysis on BP control. Early instigation of peritoneal dialysis results in primary improvement of hypertension in patients with end-stage renal disease. After which, steady deterioration in blood pressure control was observed. Efforts must be made to preserve the residual renal function to make an improvement in controlling blood pressure that would lead to decrease in cardiovascular morbidity and mortality in patients undergoing peritoneal dialysis.


    Menon, M., Naimark, D., Bargman, J., Vas, S., Oreopoulos, D. (2001). Long-term blood pressure control in a cohort of peritoneal dialysis patients and its association with residual renal function. Nephrology Dialysis Transplantation (2001) 16: 2207-2213. Retrieved July 6, 2009 from http://ndt.oxfordjournals.org/cgi/content/full/16/11/2207?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=peritoneal+dialysis+blood+pressure&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

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