1/31. Cardiovascular consequences of renal anaemia and erythropoietin therapy.Cardiovascular disease is the leading cause of increased mortality in patients with renal failure and vigorous attention to cardiovascular risk factors is therefore required to improve patient outcome. The availability of recombinant human Epo has focused the interest on the role of chronic anaemia in the pathogenesis of cardiovascular disease. Severalfold evidence indicates that anaemia can contribute to cardiac volume overload and together with overhydration, fistula flow and the pressure overload secondary to arterial hypertension, it may play a significant role in the development of cardiac hypertrophy. As in the general population left ventricular hypertrophy is a severe adverse risk factor in renal patients. In addition, in the presence of ischaemic heart disease anaemia may further worsen cardiac oxygen supply. This dual effect of anaemia probably explains why epidemiological studies have shown that a 1 g/dl decrease in haemoglobin levels is an independent, statistically significant risk factor for the development of cardiac morbidity and mortality. Follow-up examinations have demonstrated that partial correction of anaemia with recombinant Epo can improve cardiac oxygen supply and partially reverse pathological changes in left ventricular geometry. However, although partial anaemia correction regularly reduces left ventricular volume, the effects on wall thickness are far less significant. Moreover, in patients with advanced cardiac disease it has recently not been possible to demonstrate that a normalization of haemoglobin levels provides further benefit. It is not unlikely therefore that the development of severe anaemia has to be prevented by early implementation of Epo therapy in order to achieve the maximum benefit with respect to the cardiovascular system.- - - - - - - - - - ranking = 1keywords = anaemia (Clic here for more details about this article) |
2/31. endoscopy as a tool for diagnosing and treating gastrointestinal angiodysplasia in haemodialysis patients.Gastroenteric angiodysplasia is an important cause of haemorrhage in chronic renal failure patients. This paper reports on 2 patients on maintenance haemodialysis with upper gastrointestinal bleeding due to different manifestations of angiodysplasic lesions (sudden appearance of haematemesis and melaena in one case, progressive anaemia with apparent resistance to erythropoietin in the other case). Exploratory endoscope examination of the first digestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiological salt solution plus adrenaline 1/10000 and 1% polydocanol. In one patient, bleeding occurred again ten days later, making renewed surgical endoscopy necessary. In the course of this an elastic ligature was made to the superangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the treated lesions to be sclerosed. endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session. In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
3/31. How to improve survival in pre-dialysis patients.AIMS: This survey was performed to determine how anaemia in pre-dialysis patients is currently managed. methods: A random sample of 200 nephrologists attending the 1999 ERA/EDTA Congress participated in an interactive survey session. Participants were questioned on their current prescribing attitudes and preferences, and asked to select a preferred answer from a number of alternatives by means of an electronic key-pad. RESULTS: Three quarters of the audience treated their pre-dialysis patients with erythropoietin. However, approximately 50% treated patients and only 8% of respondents treated >/=75%. In addition, more than half of the respondents said that very few of their patients currently self-administer erythropoietin. Increased healthcare expenditure was the main reason given for limiting treatment. CONCLUSIONS: The survey highlighted important gaps in long-term treatment strategies for pre-dialysis patients. It indicated that new approaches to the treatment of renal anaemia are needed to minimise disease progression and to prevent cardiac dysfunction and associated mortality. erythropoietin has already been shown to significantly improve the survival of dialysis patients with renal anaemia, and new strategies might, therefore, include the prevention of anaemia in pre-dialysis patients by earlier initiation of erythropoietin therapy.- - - - - - - - - - ranking = 0.36363636363636keywords = anaemia (Clic here for more details about this article) |
4/31. erythropoietin-dependent anaemia: a possible complication of diabetic neuropathy.We report the case of a 52-year-old woman with long-term type 1 diabetes mellitus, complicated with proliferative retinopathy, autonomic neuropathy and microalbuminuria and moderate renal failure. A normochromic, normocytic are generative anaemia had been diagnosed for three years. Clinical and biological investigations for the aetiology of anaemia remained normal or negative. Anaemia was associated with a concentration of erythropoietin (EPO) in the normal range, but inappropriately low regarding anaemia. Treatment with recombinant EPO induced a rapid increase in haemoglobin level and improved the patient's quality of life. The role of diabetic neuropathy in the genesis of anaemia, in conjunction with a modest renal impairment is discussed.- - - - - - - - - - ranking = 0.72727272727273keywords = anaemia (Clic here for more details about this article) |
5/31. Improving the nurse-patient relationship: a multi-faceted approach.AIM: A Corporate education Session was held to provide concrete strategies for overcoming several specific barriers in the daily nurse-patient relationship that negatively affect the patient, nurse, or both, and to provide the latest information about best practice as it affects nurses in renal care. METHODOLOGY: The session was led by a moderator who presented three video case studies to the audience. Communication strategies for recognising and overcoming nurse-patient communication barriers were presented. The audience expressed their views about each case study using voting pads, and a panel of experts addressed the comments of the audience and discussed guidelines for best practice in renal care. The panel comprised three experienced renal nurses, a senior nephrologist, and an expert in social interaction. CONCLUSIONS: Optimal treatment of patients with renal disease should include early treatment of anaemia, adequate levels of dialysis, and a multidisciplinary approach, responding to both the medical and the social needs of the patient.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
6/31. Management of a pregnant woman dependent on haemodialysis.This is a case study of a woman who became pregnant whilst receiving haemodialysis in a london teaching hospital. She courageously disregarded the doctors' advise to abort the fetus. The doctors advised her to wait until she had a kidney transplant to become pregnant again, rather than increase maternal and fetal risk on dialysis. She was due to have a live-related transplant from her father in the spring. The case study describes a practical account in detailed measure to equip nurses with the knowledge to provide specialised care to high-risk dialysis expecting mothers. The main problems in this case study were trying to manage the mother's dialysis regime, control her anaemia, ensure good nutritional levels and gain accurate daily weights.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
7/31. Improved haemoglobin concentrations with IV darbepoetin alfa--case studies of haemodialysis patients.This paper presents two case histories of patients receiving intravenous (IV) darbepoetin alfa for the treatment of anaemia in chronic renal failure. The paper sets these cases against the general clinical picture of patients receiving intravenous darbepoetin alfa in our renal unit.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
8/31. Immune haemolysis after renal transplantation secondary to ABO minor-mismatch between donor and recipient.Immune haemolysis following renal transplantation has been reported and known causes include infection, medication and metabolic disturbances (1,2). Autoimmune haemolysis after renal transplantation secondary to ABO minor mismatch is an uncommon but important cause that should be considered in the differential diagnosis of post-transplantation haemolysis. A case of haemolytic anaemia caused by graft versus host antibody formation is presented. We suggest that direct Coomb's test should be done as a routine in all cases of ABO mismatch renal transplantation and red cells compatible with both donor and recipient or group "O" packed cells should be transfused if transfusion is indicated.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
9/31. role of osteoclastic dysfunction in the development of renal bone disease.A 47-year-old-man was referred for treatment for end-stage renal failure. He had been diagnosed with type II adult onset osteopetrosis before the deterioration of his renal function. He presented with anaemia, severe hypocalcaemia, secondary hyperparathyroidism and azotaemia. An iliac bone biopsy revealed increased bone volume, disturbed osteoid calcification, active osteoclastic bone resorption and fibrous transformation in the bone marrow space. Incomplete osteoclastic dysfunction strongly suggested hypocalcaemia and secondary hyperparathyroidism, and the osteoclastic bone resorption also indicated secondary hyperparathyroidism, even though bone resorption was potentially suppressed. The present case shows that evidence of the involvement of osteoclastic dysfunction in the development of renal bone disease can be found in bone histology.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
10/31. Decreased aortic valve prosthesis-associated haemolysis after changing from haemodialysis to peritoneal dialysis.We report here a chronic haemodialysis patient who had severe anaemia following replacement of his aortic valve. The investigations confirmed a traumatic valve effect. The surgeons were reluctant to replace the valve because of the high cardiothoracic risk and absence of significant leak or stenosis. Furthermore, the patient refused to consider additional surgery. We changed his modality of dialysis to continuous ambulatory peritoneal dialysis; subsequently, there was a dramatic decrease in his transfusion requirement, and the patient was symptomatically and functionally better. A literature search indicates that this therapeutic response has not been reported before.- - - - - - - - - - ranking = 0.090909090909091keywords = anaemia (Clic here for more details about this article) |
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