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Are CSN and NKF-K/DOQI mineral metabolism guidelines for hemodialysis patients achievable? Results from a provincial renal program.

https://arctichealth.org/en/permalink/ahliterature155898
Source
CANNT J. 2008 Apr-Jun;18(2):36-41, 44-50; quiz 42-3, 51-2
Publication Type
Article
Author
Lori D Wazny
Colette B Raymond
Esther M Lesperance
Keevin N Bernstein
Author Affiliation
Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, MB. Lwazny@hsc.mb.ca
Source
CANNT J. 2008 Apr-Jun;18(2):36-41, 44-50; quiz 42-3, 51-2
Language
English
French
Publication Type
Article
Keywords
Aged
Calcium - blood
Cross-Sectional Studies
Drug Utilization
Female
Guideline Adherence - standards
Hemodialysis Solutions - therapeutic use
Humans
Kidney Failure, Chronic - etiology - metabolism - therapy
Male
Manitoba
Medical Audit
Middle Aged
Monitoring, Physiologic
Outcome Assessment (Health Care)
Parathyroid Hormone - blood
Phosphorus - blood
Practice Guidelines as Topic
Quality Indicators, Health Care
Renal Dialysis - methods - standards
Serum Albumin - metabolism
Treatment Outcome
Abstract
The calcium, phosphorus, and parathyroid hormone targets recommended by the Canadian Society of Nephrology (CSN) encompass a wider range of values as compared to the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines. We sought to compare mineral metabolism parameters within the Manitoba Renal Program (MRP) to the CSN and NKF-K/DOQI guidelines. Medication use was also examined.
All hemodialysis patients in Manitoba were evaluated. Values for serum albumin, phosphorus, calcium, intact parathyroid hormone (PTH) and pertinent medications were collected.
Five hundred and forty-six patients were included in the analysis. Fifty-three per cent to 81% of MRP patients met individual CSN targets. However, only 26% of patients achieved all targets, despite high usage of phosphate (85.5% calcium carbonate, 16.1% sevelamer, 1.3% aluminum) and PTH-lowering drug therapies (30.2% calcitriol, 2.7% cinacalcet).
Only a small proportion of patients were able to achieve all three CSN mineral metabolism targets simultaneously. The majority of outliers presented with hyperphosphatemia or hypoparathyroidism.
PubMed ID
18669010 View in PubMed
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Autoimmune hepatitis in a North American Aboriginal/First Nations population.

https://arctichealth.org/en/permalink/ahliterature154684
Source
Can J Gastroenterol. 2008 Oct;22(10):829-34
Publication Type
Article
Date
Oct-2008
Author
G Y Minuk
S. Liu
K. Kaita
S. Wong
E. Renner
J. Rempel
J. Uhanova
Author Affiliation
Department of Medicine, University of Manitoba, Winnipeg, Manitoba. gminuk@cc.umanitoba.ca
Source
Can J Gastroenterol. 2008 Oct;22(10):829-34
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Bilirubin - metabolism
Canada - epidemiology
Cholestasis - complications - epidemiology - ethnology
Complement System Proteins - metabolism
European Continental Ancestry Group
Female
Follow-Up Studies
Hemoglobins - metabolism
Hepatitis, Autoimmune - epidemiology - ethnology - physiopathology
Humans
Immunoglobulin A - blood
Indians, North American
Liver Cirrhosis - complications - epidemiology - ethnology
Male
Middle Aged
Risk factors
Serum Albumin - metabolism
Severity of Illness Index
Sex Factors
Urban Population
Abstract
North American Aboriginal populations are at increased risk for developing immune-mediated disorders, including autoimmune hepatitis. In the present study, the demographic, clinical, biochemical, serological, radiological and histological features of autoimmune hepatitis were compared in 33 First Nations (FN) and 150 predominantly Caucasian, non-FN patients referred to an urban tertiary care centre. FN patients were more often female (91% versus 71%; P=0.04), and more likely to have low serum albumin (69% versus 36%; P=0.0006) and elevated bilirubin (57% versus 35%; P=0.01) levels on presentation compared with non-FN patients. They also had lower hemoglobin, and complement levels, more cholestasis and higher serum immunoglobulin A levels than non-FN patients (P=0.05 respectively). Higher histological grades of inflammation and stages of fibrosis, and more clinical and radiological evidence of advanced liver disease were observed in FN patients, but the differences failed to reach statistical significance. The results of the present study suggest that in addition to being more common, autoimmune hepatitis may be more severe in FN populations, compared with predominantly Caucasian, non-FN populations.
Notes
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PubMed ID
18925307 View in PubMed
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The Canadian Red Cross plasmapheresis donor safety program: changes in plasma proteins after long-term plasmapheresis.

https://arctichealth.org/en/permalink/ahliterature227088
Source
Vox Sang. 1991;60(2):82-7
Publication Type
Article
Date
1991
Author
S. Wasi
T. Santowski
S A Murray
R A Perrault
P. Gill
Author Affiliation
Canadian Red Cross Society, National Reference Laboratory, Ottawa, Ont.
Source
Vox Sang. 1991;60(2):82-7
Date
1991
Language
English
Publication Type
Article
Keywords
Blood Donors
Blood Proteins - metabolism
Canada
Humans
Immunoglobulin A - metabolism
Immunoglobulin G - metabolism
Immunoglobulin M - metabolism
Monitoring, Physiologic
Plasmapheresis - adverse effects
Red Cross
Risk factors
Serum Albumin - metabolism
Time Factors
Abstract
The Canadian Red Cross Blood Services have been harvesting plasma from whole blood by plasmapheresis procedure for the last 10 years. To date, we have performed approximately 230,000 procedures. To determine whether this procedure is a health hazard to an individual, a donor safety program was established in 1979 at the National Reference Laboratory. Serum levels of total protein, albumin, and immunoglobulins are monitored at intervals set by the Bureau of Biologics, Health and Welfare Canada. In this communication, we present a 10-year evaluation of this program. A comparison of the protein concentration distributions between first-time and long-term plasmapheresis donors showed no significant differences. Therefore, we have demonstrated that the donors are not at risk as the result of changes in the measured plasma protein levels following plasmapheresis procedure as performed over the last 10 years at The Canadian Red Cross Blood Services.
PubMed ID
2031342 View in PubMed
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Canadian survey of clinical status at dialysis initiation 1998-1999: a multicenter prospective survey.

https://arctichealth.org/en/permalink/ahliterature188002
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Publication Type
Article
Date
Oct-2002
Author
B M Curtis
B J Barret
K. Jindal
O. Djurdjev
A. Levin
P. Barre
K. Bernstein
P. Blake
E. Carlisle
P. Cartier
C. Clase
B. Culleton
C. Deziel
S. Donnelly
J. Ethier
A. Fine
G. Ganz
M. Goldstein
J. Kappel
G. Karr
S. Langlois
D. Mendelssohn
N. Muirhead
B. Murphy
G. Pylpchuk
E. Toffelmire
Author Affiliation
Division of Nephrology, Memorial University of Newfoundland, Canada.
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Canada
Creatinine - urine
Cross-Sectional Studies
Diabetes Mellitus - metabolism - physiopathology - therapy
Female
Food Habits
Glomerular Filtration Rate - physiology
Health Surveys
Humans
Kidney Failure, Chronic - metabolism - physiopathology - therapy
Male
Middle Aged
Prospective Studies
Renal Dialysis
Serum Albumin - metabolism
Treatment Outcome
Urban health
Abstract
The current growth in end-stage kidney disease populations has led to increased efforts to understand the impact of status at dialysis initiation on long-term outcomes. Our main objective was to improve the understanding of current Canadian nephrology practice between October 1998 and December 1999.
Fifteen nephrology centers in 7 provinces participated in a prospective data collection survey. The main outcome of interest was the clinical status at dialysis initiation determined by: residual kidney function, preparedness for chronic dialysis as measured by presence or absence of permanent peritoneal or hemodialysis access, hemoglobin and serum albumin. Uremic symptoms at dialysis initiation were also recorded, however, in some cases these symptom data were obtained retrospectively.
Data on 251 patients during 1-month periods were collected. Patients commenced dialysis at mean calculated creatinine clearance levels of approximately 10 ml/min, with an average of 3 symptoms. 35% of patients starting dialysis had been known to nephrologists for less than 3 months. These patients are more likely to commence without permanent access and with lower hemoglobin and albumin levels. Even of those known to nephrologists, only 66% had permanent access in place.
Patients commencing dialysis in Canada appear to be doing so in relative concordance with published guidelines with respect to timing of initiation. Despite an increased awareness of kidney disease, a substantial number of patients continues to commence dialysis without previous care by a nephrologist. Of those who are seen by nephrologists, clinical and laboratory parameters are suboptimal according to current guidelines. This survey serves as an important baseline for future comparisons after the implementation of educational strategies for referring physicians and nephrologists.
PubMed ID
12400843 View in PubMed
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Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial.

https://arctichealth.org/en/permalink/ahliterature266383
Source
Br J Gen Pract. 2014 Apr;64(621):e208-16
Publication Type
Article
Date
Apr-2014
Author
James A Black
Stephen J Sharp
Nicholas J Wareham
Annelli Sandbæk
Guy E H M Rutten
Torsten Lauritzen
Kamlesh Khunti
Melanie J Davies
Knut Borch-Johnsen
Simon J Griffin
Rebecca K Simmons
Source
Br J Gen Pract. 2014 Apr;64(621):e208-16
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Biological Markers - blood
Body mass index
Cardiovascular Diseases - blood - prevention & control
Cholesterol, HDL - blood
Cluster analysis
Cohort Studies
Creatinine - blood
Denmark
Diabetes Mellitus, Type 2 - blood - diagnosis - drug therapy
Early Diagnosis
England
Female
Follow-Up Studies
Hemoglobin A, Glycosylated - metabolism
Humans
Hypoglycemic agents - therapeutic use
Male
Middle Aged
Netherlands
Questionnaires
Risk assessment
Risk factors
Serum Albumin - metabolism
Triglycerides - blood
Abstract
There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.
To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.
Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.
A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.
The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.
Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
Notes
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PubMed ID
24686885 View in PubMed
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[Changes of biochemical blood parameters under conditions of treatment with vaulen and polysorb enterosorbents]

https://arctichealth.org/en/permalink/ahliterature14372
Source
Ukr Biokhim Zh. 1994 May-Jun;66(3):110-3
Publication Type
Article
Author
O B Iaremenko
S Kh Ter-Vartan'ian
L G Lopushenko
H A Mikhal'chuk
Source
Ukr Biokhim Zh. 1994 May-Jun;66(3):110-3
Language
Ukrainian
Publication Type
Article
Keywords
Adult
Aged
Alanine Transaminase - blood
Arthritis, Rheumatoid - blood - therapy
Blood Glucose - metabolism
Case-Control Studies
Charcoal - therapeutic use
English Abstract
Enterosorption
Humans
Lupus Erythematosus, Systemic - blood - therapy
Middle Aged
Polymers - therapeutic use
Serum Albumin - metabolism
Transaminases - blood
Urea - blood
Uric Acid - blood
Abstract
Alteration of the biochemical blood indices has been studied in patients with rheumatoid arthritis and lupus erythematosus that were treated with vaulen (V) and polysorb (P) enterosorbents. It was determined that alanine aminotransferase activity grew and albumin, urea, uric acid levels enhanced after the V treatment. Glucose level and alanine-, asparagine aminotransferases activities decreased after the P treatment. It is necessary to take into consideration these results when choosing an enterosorbent for treatment of patients with the immunocomplex rheumatic diseases accompanied by the liver parenchyma lesion and hyperuricemia.
PubMed ID
7754550 View in PubMed
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Do cardiac troponins provide prognostic insight in hemodialysis patients?

https://arctichealth.org/en/permalink/ahliterature184366
Source
Can J Cardiol. 2003 Jul;19(8):907-11
Publication Type
Article
Date
Jul-2003
Author
Jonathan B Choy
Paul W Armstrong
Raymond A Ulan
Patricia M Campbell
Sita Gourishankar
Connie I Prosser
Wayne J Tymchak
Author Affiliation
Division of Cardiology, University of Alberta Hospital, Edmonton, Canada.
Source
Can J Cardiol. 2003 Jul;19(8):907-11
Date
Jul-2003
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta - epidemiology
Biological Markers - blood
Cohort Studies
Disease-Free Survival
Endpoint Determination
Female
Follow-Up Studies
Heart Failure - blood - mortality - therapy
Humans
Incidence
Kidney Failure, Chronic - blood - mortality - therapy
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - blood - mortality - therapy
Predictive value of tests
Prognosis
Prospective Studies
Renal Dialysis
Serum Albumin - metabolism
Treatment Outcome
Troponin I - blood - diagnostic use
Troponin T - blood - diagnostic use
Abstract
The diagnosis of myocardial necrosis in patients with chronic renal failure is often difficult because biochemical markers of cardiac damage such as creatine kinase MB (CKMB) and cardiac troponin T (cTnT) may be spuriously elevated. Recent small studies also report unexplained elevations in cardiac troponin I (cTnI) in chronic renal failure patients undergoing hemodialysis. The relative incidence of elevated cardiac troponins in this population and their relationship to clinical events remain unknown.
To determine the incidence and prognostic significance of asymptomatic elevations of cTnT and cTnI in patients undergoing hemodialysis for chronic renal failure.
Prospective cohort study.
University tertiary care teaching hospital.
One hundred thirteen patients over 21 years of age undergoing onsite hemodialysis were enrolled between December 1997 and February 1998.
All-cause and cardiovascular mortality, hospitalization for acute myocardial infarction, unstable angina or congestive heart failure, new onset sustained arrhythmia or need for unscheduled emergency hemodialysis due to volume overload at 30 days and six months.
The incidence of abnormal results for cTnT, cTnI and CKMB were 42%, 15% and 4%, respectively. Independent predictors of mortality at six months were median age greater than 63 years (odds ratio 14.3, 95% CI 1.5 to 130.3, P=0.019) and positive cTnT (odds ratio 13.6, 95% CI 2.5 to 73.2, P=0.002). Diabetics were more likely to have positive cTnI and cTnT results than nondiabetics (P
Notes
Comment In: Can J Cardiol. 2003 Dec;19(13):1545-6; author reply 154614763460
PubMed ID
12876611 View in PubMed
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Dosing recommendations in liver disease.

https://arctichealth.org/en/permalink/ahliterature201075
Source
Clin Pharmacol Ther. 1999 Aug;66(2):201-4
Publication Type
Article
Date
Aug-1999
Author
C. Bergquist
J. Lindegård
T. Salmonson
Source
Clin Pharmacol Ther. 1999 Aug;66(2):201-4
Date
Aug-1999
Language
English
Publication Type
Article
Keywords
Area Under Curve
Bilirubin - blood
Humans
Linear Models
Liver Diseases - blood
Pharmacokinetics
Pilot Projects
Prothrombin Time
Serum Albumin - metabolism
Sweden
Notes
Comment On: Clin Pharmacol Ther. 1998 Oct;64(4):353-49797790
PubMed ID
10460074 View in PubMed
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41 records – page 1 of 5.