Abstract:
BACKGROUND:Renal insufficiency is a well-described risk factor for perioperative morbidity and shortened survival after major vascular procedures. Due to the potential inaccuracy of serum creatinine levels alone in measuring kidney function, our aim was to determine whether estimated creatinine clearance more consistently predicted long-term survival. METHODS:A retrospective review of one institution's vascular registry was performed. Logistic regression analysis was conducted to determine independent predictors of 1-, 2- and 3-year postoperative mortality. Creatinine clearance was estimated as [140 - age (years)] x weight (kg)/72 x serum creatinine (mg/dl), multiplied by 0.85 for women. RESULTS:A total of 252 consecutive patients underwent infrainguinal bypass procedures between August 1999 and May 2000. Demographics included average age 68 years, 65% male, 74% diabetic, 12% dialysis-dependent, 23% history of congestive heart failure, 12% history of stroke and 20% serum creatinine >2 mg/dl. One-year mortality was 16% (n = 40), 2-year mortality was 25% (n = 64), and 3-year mortality was 35% (n = 88). There was no difference in serum creatinine values between survivors and non-survivors at 1 year (1.8 vs. 1.9, p = 0.80), 2 years (1.8 vs. 2.0, p = 0.62) or 3 years (1.8 vs. 2.0, p = 0.24), and creatinine >2 mg/dl did not predict long-term adverse outcomes. In contrast, reduced creatinine clearance (< or =60 ml/min) was an independent predictor of mortality regardless of dialysis status (1 year: OR = 2.53, p = 0.014; 2 years: OR = 2.46, p = 0.004; 3 years: OR = 2.45, p = 0.001), and creatinine clearance was higher for survivors versus non-survivors at all 3 time points (1 year: 70.2 vs. 49.5, p = 0.003; 2 years: 72.3 vs. 51.2, p < 0.0001; 3 years: 74.7 vs. 52.6, p < 0.0001). Other independent predictors of mortality included a history of stroke (1 year: OR = 3.28, p = 0.008; 2 years: OR = 2.55, p = 0.025; 3 years: OR = 2.35, p = 0.038) and congestive heart failure (1 year: OR = 2.86, p = 0.006; 2 years: OR = 2.54, p = 0.005; 3 years: OR = 2.13, p = 0.017). CONCLUSIONS:Independent of dialysis status, a decreased creatinine clearance, but not elevated serum creatinine alone, is an independent predictor of mortality after lower extremity arterial reconstruction. Determination of creatinine clearance should replace serum creatinine in the preoperative risk evaluations of patients undergoing major vascular surgical procedures.
journal_name
Am J Nephroljournal_title
American journal of nephrologyauthors
Maithel SK,Pomposelli FB,Williams M,Sheahan MG,Scovell SD,Campbell DR,LoGerfo FW,Hamdan ADdoi
10.1159/000098150subject
Has Abstractpub_date
2006-01-01 00:00:00pages
612-20issue
6eissn
0250-8095issn
1421-9670pii
000098150journal_volume
26pub_type
杂志文章abstract::A multicentre trial (11 nephrology centres) was carried out to test the effects of ibopamine, an orally active dopamine-like drug, on the progression of chronic renal failure. For a 2-year period 189 chronic renal failure patients (serum creatinine level 1.5-4.0 mg/dl) were observed. They were homogeneous for basic ne...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1159/000169049
更新日期:1996-01-01 00:00:00
abstract::We retrospectively reviewed the course of 1,000 renal transplants performed in 835 recipients (758 nondiabetics) to assess the incidence of new onset posttransplant diabetes in former nondiabetics. A total of 119 (15.7%) recipients manifested posttransplant diabetes, of whom 64 (53.8%) became hyperglycemic within 3 we...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166932
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Tacrolimus is mainly metabolized by cytochrome P450 3A5 (CYP3A5), which is expressed in the liver. However, CYP3A5 is also expressed in the kidney tissue and may contribute to local tacrolimus clearance in the kidney allograft. We aimed to evaluate the association between the allograft CYP3A5 genotype and tr...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000487857
更新日期:2018-01-01 00:00:00
abstract::To verify if exogenous prostaglandin E2 (PGE2) is able to release antidiuretic hormone (ADH) and if endogenous angiotensin II plays a role in this eventual PGE2-induced stimulation of vasopressin, increasing doses of PGE2 were infused in 6 normal volunteers before (PGE2 study) and after the administration of 100 mg of...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167982
更新日期:1989-01-01 00:00:00
abstract::Recent studies have focused attention on the possible role of zinc depletion in the pathogenesis of uremic symptoms such as dysgeusia and impotence. The present studies were undertaken to evaluate the prevalence of zinc deficiency and abnormalities of zinc metabolism in patients with end-stage renal disease. A total o...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167247
更新日期:1986-01-01 00:00:00
abstract::To elucidate the relationship between the renal regulation of sodium and calcium excretion at extremes of sodium intake, we studied 6 normal men ingesting a fixed, 400 mg/day calcium intake and four levels of sodium intake from 10 to 1,500 mEq/day. Serum ionized calcium was not influenced by sodium intake. Blood press...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166496
更新日期:1981-01-01 00:00:00
abstract::Radioisotopic methods for the determination of the glomerular filtration rate (GFR) are highly accurate but require the collection of multiple blood and urine samples and are costly to perform due to personnel, material, and analysis costs. Nonradioactive methods of GFR determination have the potential of minimizing p...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168985
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:The objective of this study was to investigate the role of bone morphogenetic protein (BMP) signal transduction in the pathogenesis of calciphylaxis. METHODS:Skin biopsy specimens were obtained from 18 patients with, and 12 patients without, calciphylaxis. Tissue sections were stained with antibodies direct...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000484418
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Hyperkalemia is common in patients receiving maintenance hemodialysis. However, few studies have examined the association between serum potassium level and mortality. METHODS:This study used annual cohorts of hemodialysis patients during 2007-2010. To determine hyperkalemia prevalence, monthly hyperkalemia ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000448341
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Contemporary prevalence of chronic kidney disease (CKD) and thrombotic cardiovascular (CV) events remains unclear in Veterans enrolled in the Veterans Affairs Health Care System (VA) care. Although oral P2Y12 inhibitors (P2Y12i) are increasingly being prescribed to this patient population, the overall prescr...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000486647
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Fatigue is an important symptom to patients with advanced chronic kidney disease (CKD). The aim of this study is to examine the prevalence and severity of fatigue among non-dialysis-dependent CKD and end-stage renal disease (ESRD) patients, to examine the association of fatigue with subjective and objective ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000356939
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND/AIMS:There is a critical need for more noninvasive biomarkers to identify nephritis in patients with systemic lupus erythematosus (SLE). Recent studies in a model mouse and an adult SLE patient cohort suggest that anti-basement membrane antibody levels correlate well with lupus activity and kidney injury. Th...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000381965
更新日期:2015-01-01 00:00:00
abstract::Investigations of biopsy material from human kidneys with different forms of glomerulonephritis (n = 1,240) and with diabetic glomerulosclerosis (n = 406) performed in order to find changes caused by hyperperfusion of the kidney tissue gave the following results: (1) Hyperperfusion injury occurs in the different forms...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167579
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND/AIMS:Recent retrospective studies suggest an association of therapy with erythropoiesis-stimulating agents (ESAs) and increased mortality in renal transplant recipients (RTR). Large artery structure and function are significantly impaired in RTR which contributes to their high cardiovascular morbidity and co...
journal_title:American journal of nephrology
pub_type: 杂志文章,随机对照试验
doi:10.1159/000343140
更新日期:2012-01-01 00:00:00
abstract::Shortage of kidney donor is still a major limitation for renal transplantation programs. This review focuses on the emerging practices, adopted to increase transplant activities, of expanding the criteria for donor and recipient selection without exposing the recipient to the drawbacks of a graft with inadequate nephr...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000072055
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Various medications are cleared by the kidneys, therefore patients with impaired renal function, especially dialysis patients are at risk for adverse drug events (ADEs). There are limited studies on ADEs in maintenance dialysis patients. METHODS:We utilized a nationally representative database, the Nationwi...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000489703
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Henoch-Schönlein purpura (HSP) is a form of systemic vasculitis that can progress to Henoch-Schönlein purpura nephritis (HSPN), and the most effective treatment remains controversial. Our aim was to compare the effects of oral mycophenolate mofetil (MMF) with low-dose prednisone and the full-dose corticoster...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000341914
更新日期:2012-01-01 00:00:00
abstract::The removal of phenytoin by plasmapheresis in a patient with compromised renal function is described. The results indicate that plasma concentrations of total phenytoin increase after plasmapheresis, while unbound phenytoin plasma concentrations and free fraction decrease. The amount of phenytoin removed was 36 mg and...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167179
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:Detection of chronic kidney disease (CKD) with urine albumin-to-creatinine ratio (UACR) among patients with hypertension (HTN) provides an opportunity for early treatment, potentially mitigating risk of CKD progression and cardiovascular complications. Differences in UACR testing patterns among racial/ethnic...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000500706
更新日期:2019-01-01 00:00:00
abstract::The treatment of the bleeding diathesis of renal failure remains unsatisfactory. 1-Deamino-8-D-arginine vasopressin (DDAVP) has recently been shown to shorten the prolonged bleeding time of renal failure and may as a result diminish the risk of clinical hemorrhage. We describe 2 cases where DDAVP was used successfully...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166773
更新日期:1984-01-01 00:00:00
abstract::A young woman presented with nephrotic syndrome due to membranous nephropathy and a localized form of giant lymph node hyperplasia (Castleman's disease) occurring as a large intra-abdominal mass. Five months after surgical removal of the mass, only mild proteinuria persisted. Twenty months later a second kidney biopsy...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000168127
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:Although there is a very high mortality rate (>50%) with acute renal failure (ARF) in the intensive care unit (ICU), there is no general consensus on the best dialysis treatment for this condition. METHODS:We surveyed by mail questionnaire, all adult academic and community registered Canadian nephrology cen...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000046671
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Kidney failure is believed to have a negative impact on cognitive function, and cognitive impairment is common among maintenance hemodialysis (HD) patients. Previous studies have shown a beneficial effect of kidney transplantation in certain cognitive tests but not across all cognitive domains assessed. But,...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000330849
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVES AND METHODS:Altered plasma high-sensitivity C-reactive protein (hs-CRP) and adiponectin (ADP) may contribute to increased vascular inflammation and accelerated atherosclerosis in patients with end-stage renal disease (ESRD) and co-morbid diabetes. Common carotid artery intima-media thickness (CCA-IMT) and at...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000094403
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND/AIMS:Post-renal transplant recurrent glomerulonephritis (GN) contributes to allograft loss. Rituximab treatment has been used in a multidose strategy with variable efficacy and toxicity. We investigated a novel single-dose approach. METHODS:A single center, retrospective, cohort study was conducted between ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000371587
更新日期:2015-01-01 00:00:00
abstract:AIMS:This study was conducted prospectively to ascertain the prevalence of anticardiolipin antibodies (ACAs) in patients with lupus nephritis and to determine whether this subgroup of patients differed clinically and histologically from patients without the antibody. PATIENTS AND METHODS:40 SLE patients (26 Blacks, 14...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013615
更新日期:2000-09-01 00:00:00
abstract:BACKGROUND/AIMS:Cisplatin (CIS) induces nephrotoxicity partly through renal vasoconstriction and decreased glomerular filtration effects thought to involve adenosine acting on adenosine A(1) receptors (A1Rs). We studied the effect of the orally active, A1R antagonist tonapofylline (BG9928) on biochemical measures of re...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000248762
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Living donor liver transplantation (LDLT) patients run the risk of developing acute kidney injury (AKI) and subsequent chronic kidney disease, affecting morbidity and mortality. Sevoflurane has anti-inflammation properties, and renal ischemia/reperfusion under sevoflurane anesthesia resulted in drastic impro...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000319623
更新日期:2010-01-01 00:00:00
abstract::Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothel...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013611
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time. METHODS:We employed a Cox model using up-...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000319861
更新日期:2010-01-01 00:00:00