Abstract:
BACKGROUND:The ongoing necessity for systemic heparinization is a well-known disadvantage of continuous renal replacement therapies (CRRT), and alternative methods of anticoagulation may be required. Our aim was to evaluate, in patients with a high risk of bleeding, the possibility of an acceptable filter life with non-anticoagulation CRRT and, in case of early filter failure, the efficacy and safety of bedside monitored regional anticoagulation with heparin and protamine. METHODS:Fifty-nine patients underwent CRRT for acute renal failure (ARF) following cardiac surgery. Patients who fulfilled one of the following criteria were selected for non-anticoagulation CRRT: spontaneous bleeding, aPTT > 45 sec, thrombocytopenia and recent surgery (< 48 hr). Filter life < 24 hr without anticoagulation was the cut-off point for starting the regional anticoagulation CRRT. Heparin was infused pre-filter and protamine post-filter at an initial ratio of 1 mg protamine:100 IU heparin. The ratio was adjusted to achieve a patient aPTT < 45 sec and a circuit > 55 sec. RESULTS:Twenty-two (37.3%) patients had been selected for non-anticoagulation. Of them, 12 patients continued to receive non-anticoagulation (filter life: 38.3 +/- 30.5 hr) while 10 switched to regional anticoagulation (filter life: 38.6 +/- 25 hr). During regional anticoagulation no statistical difference was found between baseline aPTT (36.7 +/- 6.4 sec) and patient aPTT (41.5 +/- 12.6 sec) while circuit aPTT (77.7 +/- 43.3 sec) was significantly higher than patient aPTT (p < 0.0001). The probabilities of the circuits remaining free from clotting after 24, 48 and 72 hr were: a) non-anticoagulation: 55.5%, 30.1% and 16.6%, b) regional anticoagulation: 76.2%, 39.6% and 19.8%. There was no rebound anticoagulation observed after regional anticoagulation CRRT ended. CONCLUSIONS:Non-anticoagulation CRRT allowed an adequate filter life in most patients with a high risk of bleeding for prolonged aPTT and/or thrombocytopenia. Despite concerns regarding the need for careful monitoring, regional anticoagulation with heparin and protamine can be considered as a safe and valid alternative when non-anticoagulation is unsuitable because of early filter failure.
journal_name
J Nephroljournal_title
Journal of nephrologyauthors
Morabito S,Guzzo I,Solazzo A,Muzi L,Luciani R,Pierucci Asubject
Has Abstractpub_date
2003-07-01 00:00:00pages
566-71issue
4eissn
1121-8428issn
1724-6059journal_volume
16pub_type
杂志文章abstract:BACKGROUND:IgA nephropathy is one of the most common primary glomerulonephritides, and the clinical course of almost 40% of the patients progresses to end-stage renal disease (ESRD) within 20 years. Angiotensin-converting enzyme (ACE) inhibitors and/ or angiotensin II receptor blockers (ARBs) induce a marked renoprotec...
journal_title:Journal of nephrology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:
更新日期:2009-03-01 00:00:00
abstract:AIMS:The management of chronic kidney disease (CKD) complications is not always adequate in patients with a failed kidney transplant. We aimed to evaluate the frequency of CKD complications and assess whether they may lead to worse outcomes in this patient population. METHOD:We analyzed 49 kidney transplant recipients...
journal_title:Journal of nephrology
pub_type: 杂志文章,多中心研究
doi:10.1007/s40620-017-0449-z
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Inadvertent sodium (Na(+)) flux may occur during renal replacement therapy (RRT) in ICU. The objective of this study was to estimate sodium flux during RRT. METHODS:Between September 2011 to December 2012 we studied 60 ICU patients receiving extended daily dialysis (EDD, Fresenius 4008S) or continuous renal...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-014-0041-8
更新日期:2014-08-01 00:00:00
abstract::Renal transplantation is associated with better survival and improved quality of life compared to maintenance dialysis. Although many sleep disorders improve or even disappear after a successful transplantation, sleep quality remains low, and the prevalence of sleep complaints, although lower than in dialysis patients...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:The patient characteristics and course of HlV/AIDS-associated nephropathy (HIVAN) are presented for a national sample of end-stage renal disease (ESRD). METHODS:375,152 patients in the United States Renal Data System were initiated on ESRD therapy between 1 January 1992 and 30 June 1997 and analyzed in an h...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2001-09-01 00:00:00
abstract::Membranous nephropathy (MN) is a glomerular disease characterized by proteinuria, usually in a nephrotic range, and variable natural course. The etiology is unknown in many cases, while in some patients, MN may be secondary to infection, to other diseases, or to exposure to drugs and toxic substances. In idiopathic MN...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2007-05-01 00:00:00
abstract::The authors review the antineoplastic effect of mammalian target of rapamycin (mTOR) inhibitors and their biological basis. mTOR is an intracellular serine/threonine kinase that is a central controller of cell growth and proliferation. mTOR integrates signals from sources such as nutrients and growth factors. mTOR reg...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2009-07-01 00:00:00
abstract:INTRODUCTION:We measured serum creatinine concentrations in 17 male athletes of the Italian national rugby team. METHODS:Blood was obtained before the start of training and during the competitive season. Serum creatinine level was measured by Jaffé reaction at 4 time points during the season, with a formal measure of ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.5301/jn.5000094
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:Accurate assessment of kidney function level is the key to the identification and management of chronic kidney disease (CKD). Glomerular filtration rate (GFR) is the best measure of overall kidney function in health and disease. There is no consensus about the method to be used routinely to measure and/or es...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Chronotropic incompetence (CI) is an independent predictor of cardiovascular events and overall mortality. The prevalence and significance of CI in renal transplant patient has not been examined. METHODS:38 non-heart failure renal transplant recipients were recruited for a transthoracic echocardiogram and t...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-014-0091-y
更新日期:2014-08-01 00:00:00
abstract::The most common cause of liver disease worldwide is now non-alcoholic fatty liver disease (NAFLD). NAFLD refers to a spectrum of disease ranging from steatosis to non-alcoholic steatohepatitis, causing cirrhosis, and ultimately hepatocellular carcinoma. However, the impact of NAFLD is not limited to the liver. NAFLD h...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.1007/s40620-020-00751-y
更新日期:2020-05-21 00:00:00
abstract:BACKGROUND:Coronary artery disease (CAD) and chronic kidney disease (CKD) lead to high morbidity and mortality rates. Traditional and nontraditional risk factors, hypertension, fluid overloading and anemia can lead to myocardial ischemia, chamber hypertrophy and dilatation, and low left ventricular ejection fraction (L...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:The risks connected with dialysis fluid contamination are well established. Epidemiological studies have demonstrated just how difficult it is to obtain permanently satisfactory quality standards. Therefore, dialysis centers must have effective and regular quality control programs, particularly with the grow...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:This study is part of a 3-country study testing whether normal levels of hemoglobin (Hgb) delay the progression of left ventricular (LV) growth in chronic kidney disease (CKD) patients not on dialysis. METHODS:This was an open-label, randomized, multicenter, controlled trial conducted in 27 tertiary-care ho...
journal_title:Journal of nephrology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:
更新日期:2008-11-01 00:00:00
abstract::Late-presenting end-stage renal disease is a significant problem worldwide. Up to 70% of patients start dialysis in an unplanned manner without a definitive dialysis access in place. Haemodialysis via a central venous catheter is the default modality for the majority of such patients, and peritoneal dialysis is usuall...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.1007/s40620-018-0485-3
更新日期:2019-02-01 00:00:00
abstract::The clinical manifestations of diabetic nephropathy are similar in type 1 and type 2 diabetes, while the renal lesions may differ. Indeed, diabetic glomerulopathy is the predominant renal lesion in type 1 diabetes, although also tubular, interstitial and arteriolar lesions are present in the advanced stages of renal d...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.1007/s40620-020-00797-y
更新日期:2020-10-01 00:00:00
abstract::Cutaneous periarteritis nodosa (PAN) is a clinical feature characterized by chronic, benign course; its pathogenesis is unknown. In patients submitted to renal transplantation cutaneous PAN is a rare complication. We report a case of cutaneous PAN associated with the reappearance of hepatitis B antigen 16 years after ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2001-09-01 00:00:00
abstract::The Liber medicine orinalibus (codex 69 Montecassino) of Hermogenes is the first known manuscript to have a Latin translation from the original Greek work of Magnus of Emesa (or Nisibis). The particular text here translated, from the so-called Commentatio, mentions direct transliteration of Greek concepts such as chym...
journal_title:Journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.5301/JN.2011.6461
更新日期:2011-05-01 00:00:00
abstract::Bisphosphonates inhibit bone resorption and are widely used to treat osteolytic metastases and osteoporosis. Renal osteodystrophy patients have continuous bone loss due to chronically elevated parathyroid hormone (PTH). In this open-label study, ibandronate was evaluated for the treatment of reduced bone density in re...
journal_title:Journal of nephrology
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:The clinical benefits of on-line hemodiafiltration (HDF) versus high-flux membranes hemodialysis (hf-HD) are still debated. In fact, although a superiority of one treatment over the other, especially in terms of mortality, did not emerge from the analysis of clinical trials, improved intradialytic vascular s...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-018-00581-z
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND AND AIMS:Arterial stiffness is a risk factor for chronic kidney disease progression (CKD). Pulse pressure is a surrogate marker of arterial stiffness. It is unclear if pulse pressure predicts CKD progression in type 2 diabetes mellitus. METHODS:This was prospective study involving 1494 patients with estimat...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-020-00954-3
更新日期:2021-01-25 00:00:00
abstract:BACKGROUND:The therapeutic effects of immunosuppressive agents such as cyclosporin A, mycophenolate mofetil, rituximab and sirolimus on primary focal segmental glomerulosclerosis (FSGS) remain controversial. The present study was intended to review and analyze the treatment results of immunosuppressive agents for prima...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.5301/jn.5000092
更新日期:2012-09-01 00:00:00
abstract:INTRODUCTION:During potassium (K) depletion, many adaptive responses are likely mediated through a complex network that involves expression of a variety of genes. We identified that the Nrf2 gene was differentially expressed between normal and K-depleted rat kidney. METHODS:To investigate the effect of Nrf2 on colonic...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.5301/JN.2011.8448
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) progression is associated with significant comorbidities and costs. In Italy, limited evidence of healthcare resource consumption and costs is available. We therefore aimed to investigate the direct healthcare costs in charge to the Lombardy Regional Health Service (RHS) for the ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-016-0291-8
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The success of guidelines depends largely on effective implementation and uptake in clinical practice. The Optimal Renal Anemia Management Assessment (ORAMA) study investigated the impact of European Best Practice Guideline (EBPG) prompting on patient outcomes. METHODS:ORAMA was a prospective, international...
journal_title:Journal of nephrology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:
更新日期:2009-09-01 00:00:00
abstract::Primary renal non-Hodgkin's lymphoma is very rare in childhood. A six-year-old boy presented with bilateral non-obstructive multinodular nephromegaly and renal failure. Percutaneous needle biopsy showed large-cell lymphoma. The patient was started on chemotherapy. A right nephrectomy was done when systemic hypertensio...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Detailed analyses on crush syndrome resulting from earthquakes is scarce. This study aimed to analyze the effect of gender on clinical course of the renal victims of the catastrophic Marmara earthquake that struck Northwestern Turkey in 1999. METHODS:Questionnaires were prepared within the first week of dis...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:In older patients with chronic kidney disease (CKD), the risk of progression to end stage renal disease and cardiovascular death both differ compared to younger patients. This likely reflects differences in case mix and co-morbid burdens. We sought to establish the extent to which age itself is an independen...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-018-0529-8
更新日期:2018-12-01 00:00:00
abstract::On September 11, 1945, Maria Schafstaat was the first patient who successfully underwent a dialysis treatment for acute kidney injury (AKI). The ingenious design of the first dialysis machine, made of cellophane tubing wrapped around a cylinder that rotated in a bath of fluid, together with the brave determination to ...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2010-09-01 00:00:00
abstract::Wilson's disease is an autosomal recessive disorder of hepatobiliary copper metabolism. Glomerular diseases can ensue during the course of Wilson's disease and membranous nephropathy is the eventual pathology in the majority of these cases. Membranoproliferative glomerulonephritis (MPGN) has rarely been reported in pa...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2006-11-01 00:00:00