Patients' representations of their end-stage renal disease: relation with mortality.

Background: Self-regulation theory explains how patients' illness perceptions influence self-management behaviour (e.g. via adherence to treatment).

[Diagnostic image (352). A man with spots, dyspnoea and lethargy].

A 54-year-old man with Down's syndrome presented with petechiae, hypoxia and lethargy due to a collum fracture and a secondary fat embolism syndrome.

Ionic dialysance and the assessment of Kt/V: the influence of different estimates of V on method agreement.

Background: Ionic dialysance was recently introduced as a means to assess Kt/V (K(ID)t/V). With this method, urea distribution volume (V) has to be estimated. The primary aim of the present study was to assess the agreement between equilibrated Kt/V assessed by urea kinetic modelling (eKt/V) with K(ID)t/V taking into account different estimates of V, and to assess the monthly variation in V.

[Estimating renal function based on creatinine clearance: application of different formulas and correction for obese patients].

Objective: To determine whether glomerular filtration rate (GFR) is best estimated by the Cockcroft-Gault formula or the formula used in the 'Modification ofdiet in renal disease' (MDRD) study.

Design: Descriptive inventory.

Method: Passing-Bablok regression analysis was performed using the statistics program 'Analyse it' for the estimated GFR derived by both formulas based on 467 patients who had data on height, weight and creatinine clearance entered into the laboratory information system of the Máxima Medical Centre, Veldhoven, the Netherlands, during a 2-year period.

Urine flow cytometry and detection of glomerular hematuria.

Background: The UF-100 is a flow cytometer designed for automated cellular urinalysis. In this study, the usefulness of the UF-100 in laboratory investigation into the origin of hematuria was evaluated.

Methods: Results from flow cytometric urinalysis were used to classify urinary red blood cells (RBCs) according to glomerular and non-glomerular origin and the classification was compared to the patient's clinical diagnosis as the gold standard.

Idiopathic focal segmental glomerulosclerosis: a favourable prognosis in untreated patients?

Background: Patients with focal segmental glomerulosclerosis (FSGS) are considered to have a poor prognosis and spontaneous remissions are seldom reported. However, FSGS is not a single disease entity. Our aim was to describe the clinical course in initially untreated patients with recently diagnosed idiopathic FSGS.

The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients.

Background: Sodium profiling improves haemodynamic tolerance in haemodialysis (HD) patients but may also influence sodium homeostasis. Changes in blood volume and plasma conductivity (PC) during HD can be modelled by feedback technology, but their effects on sodium homeostasis are not widely studied.

Methods: This randomized crossover study compared PC and ionic mass balance (IMB) as surrogate markers of sodium balance between standard HD [dialysate conductivity (DC) 14.

Restrictive use of immunosuppressive treatment in patients with idiopathic membranous nephropathy: high renal survival in a large patient cohort.

Background: Immunosuppressive treatment initiated at an early stage in patients with idiopathic membranous nephropathy (iMN) improves renal survival. Treatment should ideally be restricted to high-risk patients.

Aim: To evaluate the efficacy of a restrictive immunosuppressive treatment strategy for patients with iMN.

Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study.

Overhydration is a risk factor for hypertension and left ventricular hypertrophy in peritoneal dialysis patients. Recently, a high prevalence of subclinical overhydration was observed in peritoneal dialysis patients. Aim of the present open-label randomized study was to assess the effect of a icodextrin 7.

Assessment of fluid status in peritoneal dialysis patients.

Objectives: To assess the influence of abnormalities in fluid status and body composition on agreement between multifrequency bioimpedance analysis (MF-BIA), segmental BIA (sigmaBIA), the Watson formula, and tracer dilution techniques.

Design: Cross-sectional.

Setting: Multicenter.

Blood volume control by biofeedback and dialysis-induced symptomatology. A short-term clinical study.

In earlier studies, a reduction in intradialytic procedures was observed in patients with severe intradialytic hypotension symptomatology by the use of blood volume controlled biofeedback systems. However, few data are present on the use of biofeedback-controlled treatments in patients experiencing minor intradialytic symptoms. In the present study, 157 standard and 158 biofeedback-controlled treatments were compared during a 2-month period in 16 hemodialysis patients.

Ionic mass balance and blood volume preservation during a high, standard, and individualized dialysate sodium concentration.

Background: Although a higher dialysate sodium concentration (DNa) is frequently used to improve haemodynamic stability during haemodialysis, few studies have compared ionic mass balance (IMB) during different DNa. Moreover, DNa is usually a standard prescription, whereas inter-individual pre-dialytic serum sodium levels may differ widely. The aims of the study were to assess IMB and the decline in blood volume (DeltaBV) during isovolaemic HD as well as during HD combined with ultrafiltration (UF) during DNa [140], DNa [144], and an individualized DNa [ind], in which DNa is equal to pre-HD plasma conductivity x 10.

Hemolytic uremic syndrome after capnocytophaga canimorsus (DF-2) septicemia.

A 66-year-old man developed a hemolytic uremic syndrome (HUS) with acute renal failure, thrombocytopenia, fragmented red cells in the blood film and elevated serum LDH following a capnocytophaga canimorsus (DF-2) infection after a dog bite. He was treated with antibiotics, plasmapheresis and hemodialysis. Although hematologic values improved, the patient remained hemodialysis-dependent for six months.

Combination diuretic therapy in severe congestive heart failure.

Severe congestive heart failure (CHF) is often characterised by fluid retention. A (chronic) state of overhydration has a negative influence on both the quality of life and prognosis of these patients. Therefore, the use of diuretics remains a cornerstone in the treatment of heart failure.

The influence of bicarbonate supplementation on plasma levels of branched-chain amino acids in haemodialysis patients with metabolic acidosis.

Background: It has been hypothesized that correction of metabolic acidosis might improve the nutritional state of acidotic haemodialysis (HD) patients partly because of a reduced oxidation of branched-chain amino acids (BCAA).

Aim: We investigated whether bicarbonate (Bic) supplementation in acidotic HD patients results in increased plasma levels of BCAA.

Methods: In a longitudinal study (run-in period, 2 months; study period, 6 months), the effect of Bic supplementation on plasma levels of BCAA was studied in 12 acidotic HD patients (7 men, 5 women, mean age 54 +/- 18 years) with a predialysis bicarbonate (Bic) concentration smaller or equal to 22 mmol/l.

[Failing diuretics in severe chronic heart failure].

Three patients with chronic heart failure, men aged 29, 78 and 69 years, developed severe dyspnoea and oedema in spite of reduced sodium and fluid intake and medication including furosemide. Heart failure may become 'resistant to diuretics' due to pharmacokinetic and pharmacodynamic causes. High-dose continuous intravenous administration of a loop diuretic may afford relief in such cases, if necessary in combination with a thiazide derivative, an ACE inhibitor, an inotropic agent or an extracorporal technique.

Vascular reactivity during combined ultrafiltration-hemodialysis: influence of dialysate-derived contaminants.

It has been suggested that hemodynamic instability and impaired vascular reactivity during combined ultrafiltration-hemodialysis are related to bioincompatibility factors such as dialysate-derived contaminants or the dialyzer. The study presented here investigated whether vascular reactivity could be improved by the use of sterile dialysate. Forearm vascular resistance and venous tone (measured by strain-gauge plethysmography) as well as arterial blood pressure (by Dinamap) and heart rate (by electrocardiogram) were measured in ten stable dialysis patients (age range, 28 to 71 yr) during 2 h of combined ultrafiltration-hemodialysis (bicarbonate; ultrafiltration rate 1.

Combination of high-dose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure.

Objective: We studied the synergism between high-dose furosemide and hydrochlorothiazide in patients with severe congestive heart failure and impaired renal function showing diuretic resistance to a daily dose of furosemide of at least 250 mg.

Design And Setting: An open study. A general hospital in The Netherlands.

Renal replacement therapy in the elderly.

Background And Methods: In a retrospective study the medical records of 122 patients aged over 65 years at the start of renal replacement therapy (RRT) in our dialysis centre were analysed.

Results: The mean age at the start of RRT was 72.7 +/- 5.

Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion.

Objectives: The efficacy of high dose furosemide as a continuous infusion was compared with a bolus injection of equal dose in patients with severe heart failure.

Background: The delivery rate of furosemide into the nephron has been proved to be a determinant of diuretic efficacy in healthy volunteers.

Methods: In a randomized crossover study we compared the efficacy of a continuous infusion of high dose furosemide (mean daily dosage 690 mg, range 250 to 2,000) versus a single bolus injection of an equal dose in 20 patients with severe heart failure.

Chronic intermittent haemofiltration and haemodialysis in end stage chronic heart failure with oedema refractory to high dose frusemide.

Objective: To assess the benefits and problems of chronic intermittent treatment with haemofiltration or haemodialysis or both in patients with severe chronic heart failure (New York Heart Association class III or IV) and oedema refractory to pharmacological treatment.

Design And Setting: A retrospective case-cohort study. A general hospital in The Netherlands.