Alkalemia and Hepatic Encephalopathy in a Chronic Dialysis Patient.

Hepatic encephalopathy (HE) includes cognitive, psychiatric and neuromotor abnormalities observed from brain dysfunction secondary to liver disease and/or porto-systemic shunting. HE can have a wide range of clinical manifestations ranging from trivial lack of awareness, decreased attention span, personality changes to confusion, seizures, coma, and death. The onset of HE in cirrhosis is a poor prognostic factor.

Factors associated with the receipt of antimicrobials among chronic hemodialysis patients.

Background: Antimicrobial use is common among patients receiving chronic hemodialysis (CHD) and may represent an important antimicrobial stewardship opportunity. The objective of this study is to characterize CHD patients at increased risk of receiving antimicrobials, including not indicated antimicrobials.

Methods: We conducted a prospective cohort study over a 12-month period among patients receiving CHD in 2 outpatient dialysis units.

Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project.

Background: The Renal Physicians Association's clinical practice guideline recommends that physicians address advance care planning with dialysis patients. However, data are lacking about how best to implement this recommendation.

Study Design: Quality improvement project.

Alendronate associated focal segmental glomerulosclerosis: a case report and review of the literature.

Although kidney injury associated with intravenous bisphosphonate therapy is well documented, there are very few reported instances of oral bisphosphonate therapy leading to focal segmental glomerulosclerosis (FSGS) and kidney failure. We report the case of a 79-year-old woman who developed acute kidney injury due to collapsing FSGS while receiving therapy with weekly oral alendronate therapy for osteoporosis. Withdrawal of alendronate and treatment with corticosteroids resulted in partial recovery of kidney function for a period of 16 months until she developed progressive kidney failure needing long-term dialysis.

Cognitive function and all-cause mortality in maintenance hemodialysis patients.

Background: Cognitive impairment is common in hemodialysis patients and is associated with significant morbidity. Limited information exists about whether cognitive impairment is associated with survival and whether the type of cognitive impairment is important.

Study Design: Longitudinal cohort.

Acute oxalate nephropathy associated with Clostridium difficile colitis.

We report the case of a 69-year-old man who presented with acute kidney injury in the setting of community-acquired Clostridium difficile-associated diarrhea and biopsy-proven acute oxalate nephropathy. We discuss potential mechanisms, including increased colonic permeability to oxalate. We conclude that C difficile-associated diarrhea is a potential cause of acute oxalate nephropathy.

Antimicrobial use in outpatient hemodialysis units.

Objective: To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.

Design: Retrospective and prospective observational study.

Setting: Two outpatient hemodialysis units.

Frequency of and risk factors for poor cognitive performance in hemodialysis patients.

Objective: There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing.

Methods: In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwent detailed cognitive assessment.

Design and evaluation of D-α tocopheryl polyethylene glycol 1000 succinate emulsified poly-ϵ-caprolactone nanoparticles for protein/peptide drug delivery.

Background: Incorporation of proteins/peptide drugs into nanoparticulate drug delivery system is one of the effective approaches to increase the stability of protein/peptide drugs against enzymatic degradation, to release them in a controlled fashion and to achieve site-specific drug delivery.

Objective: Our goal was to design and evaluate poly-ϵ-caprolactone (PCL) nanoparticles using bovine serum albumin (BSA) as a model protein. d-α-tocopheryl polyethylene glycol 1000 (vitamin E TPGS) was used as an emulsifier in the fabrication of these nanoparticles.

Recovery of kidney function following delayed use of Theralite™ dialyzer in a patient with myeloma cast nephropathy.

We report the case of a 60- year- old man who presented with newly diagnosed multiple myeloma complicated by biopsy-proven acute cast nephropathy, requiring hemodialysis, plasmapheresis and chemotherapy. After remaining dialysis dependent for 5 weeks, a high cut-off (HCO) dialyzer, intended to use for the removal of plasma substances with a molecular weight of up to 45 kDa such as free light chains, was introduced to his outpatient 4-hour hemodialysis regimen with an increase in treatment frequency to 4 sessions per week. Following 6 weeks of dialysis with the HCO dialyzer, serum levels of free κ light chains declined by more than 75%.

Oral delivery of low molecular weight heparin microspheres prepared using biodegradable polymer matrix system.

Parenteral route is preferred for low molecular weight heparin (LMWH) due to poor oral bioavailability. Biodegradable formulation components were evaluated for possible interactions between the physical mixtures using differential scanning calorimetry. LMWH and an absorption enhancer papain were encapsulated in bovine serum albumin matrix and four formulations were spray-dried (MS.

Multidrug-resistant gram-negative bacteria among patients who require chronic hemodialysis.

Background And Objectives: Multidrug-resistant gram-negative bacteria are rapidly spreading throughout the world. The epidemiology of multidrug-resistant gram-negative bacteria in patients who require chronic hemodialysis has not been previously studied.

Design, Setting, Participants, & Measurements: A prospective cohort study of an outpatient hemodialysis unit was conducted.

A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis.

Study Design: Parallel design, prospective, double-blind, randomized, controlled trial composed of two independent groups treated with a continuous infusion catheter (saline vs. Marcaine) placed into the iliac crest bone graft (ICBG) site.

Objective: To determine the effects of postoperative continuous local anesthetic agent infusion at the ICBG harvest site in reducing pain, narcotic demand and usage, and improving early postoperative function after spinal fusion.

Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens.

Background: Parenteral iron replacement and maintenance are frequently required in hemodialysis patients. However, serious adverse events have been reported after single doses of some intravenous iron products. This multicenter phase IV clinical trial examined the safety of iron sucrose for the treatment of iron deficiency and for the maintenance of iron sufficiency in hemodialysis patients.

Infections associated with use of the LifeSite Hemodialysis Access System.

We observed infection rates associated with the LifeSite Hemodialysis Access System, a novel dialysis device consisting of 2 subcutaneously implanted valves accessed by repeated use of fibrous tissue tracts, of 4.8 total infections and 8.1 first episodes per 1000 patient-days.

Hemodialysis-associated methemoglobinemia in acute renal failure.

Patients on maintenance hemodialysis are vulnerable to chloramine toxicity if chloramines are inadequately removed. We report two critically ill patients with acute renal failure who developed methemoglobinemia during hemodialysis in the intensive care unit. During the same period, methemoglobin levels measured from 30 patients in the outpatient dialysis facility were undetectable.