Mary Carter

Renal Research Institute, New York, New York, United States

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Publications (31)112.07 Total impact


  • No preview · Article · Nov 2015 · The Lancet
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    ABSTRACT: Inflammation is common and associated with morbidity and mortality in hemodialysis (HD) patients. Exposure to endotoxin contained in the dialysate may trigger inflammation. Dialysate volume is substantially reduced in sorbent HD compared to standard single-pass dialysis. In this prospective study (Clinicaltrials.gov, number: NCT00788905) we compared the inflammatory response to single-pass and sorbent HD.Patients receiving single pass-HD were studied during one week of sorbent HD (Allient system; Renal Solutions, Warrendale, PA) and one week of single pass HD. Patients were dialyzed using high flux polysulfone dialyzers. Midweek pre- and post-HD serum levels of high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-1β, IL-6, IL-10, interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), and eotaxin were determined and their intradialytic change corrected for hemoconcentration during single pass HD and sorbent HD compared by paired t test.We enrolled 18 patients, nine completed the study. While TNF-α decreased during both single-pass and sorbent HD (P<0.001), none of the other biomarkers changed significantly during HD. We observed no difference between single-pass and sorbent HD.For the markers investigated in this study, there was no difference in the acute intradialytic inflammatory response to single-pass or sorbent HD.
    No preview · Article · Feb 2015 · ASAIO journal (American Society for Artificial Internal Organs: 1992)
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    ABSTRACT: Background and aims: Measurement of saliva urea nitrogen (SUN) may be valuable in the screening of kidney failure. Here we evaluate the diagnostic performance of SUN dipsticks in patients with acute kidney injury (AKI). Material and methods: We measured SUN and blood urea nitrogen (BUN) in hospitalized patients diagnosed with AKI based on Acute Kidney Injury Network (AKIN)-criteria. After collection, saliva was transferred to a colorimetric SUN dipstick. We then compared the resultant test-pad color to six standardized color fields indicating SUN of 5 - 14 (#1), 15 - 24 (#2), 25 - 34 (#3), 35 - 54 (#4), 55 - 74 (#5), and ≥ 75 (#6) mg/dL, respectively. We assessed the performance of SUN and BUN to discriminate AKIN 3 from earlier stages by the area under receiver operating characteristic curves (AUC ROC). Results: We enrolled 44 patients (59.5 ± 18 years, 58% female; pre-renal AKI: 67%; renal 24%; post-renal 9%) in AKIN stages 1 (59%), 2 (16%), and 3 (25%). SUN and BUN levels were correlated (Spearman rank Rs = 0.69; p < 0.001, n = 44) with the highest correlation in AKIN 1 (Rs = 0.63, p = 0.001, n = 26). SUN allowed a significant discrimination of AKIN 3 from earlier stages (AUC ROC 0.91; 95% CI 0.80 - 1.0), which was comparable to the diagnostic performance of BUN (AUC ROC 0.90; 95% CI 0.78 - 1.0). Conclusions: SUN dipsticks allow the discrimination of AKIN 3 from earlier AKI stages. This low-technology approach may aid the screening of severe AKI in areas where laboratory resources are scarce.
    No preview · Article · Oct 2014 · Clinical nephrology

  • No preview · Article · Jul 2014 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    ABSTRACT: Introduction and Aims: Acute kidney injury (AKI) is an important public health problem. AKI is a risk factor for progression of kidney disease, incidence of chronic kidney disease (CKD) and mortality. The aim of the study was to assess characteristics, renal survival and mortality of patients who developed AKI stage 3, according to KDIGO guidelines, and needed renal replacement therapy (RRT), not in intensive care unit. Methods: All patients who required RRT due to AKI stage 3 along two years were included, excluding patients in intensive care unit. Demographic and personal history data, previous renal function, cause of AKI, renal function, renal survival, and mortality at one, three, six and twelve months after AKI were recorded. Results: A total of 107 patients were enrolled (incidence 134 patients/106 population/year). Mean age 72.2±13.9 (range 25-92), 57.9% men. Patient’s characteristics: 77.6% were hypertensive, 40.2% were diabetics, 45.8% were dyslipemics, 41.1% were obese, 27.1% were smokers, and 61.2% with chronic renal failure (eFG<60mil/min) of which 54% stage 3, 36.5% stage 4, and 9.5% stage 5. Cause of AKI: renal disease 63.6%, prerrenal 28.9% and obstructive causes 7.5%.Renal function: Serum creatinine before AKI 1.78±1.12 mg/dL; maximum serum creatinine during AKI hospitalization 7.39±4.43mg/dL; at discharge, 2.64±1.62mg/dL; one month later, 2.07±1.36mg/dL; three months later, 2.35±1.60mg/dL; six months later, 2.25±1.85mg/dL and one year later, 1.95±1.14 mg/dL.During hospitalization, 24.3% died, 16.8% kept on RRT at discharge, and 58.9% recovered partial or completely renal function. One month after AKI, 31.7% had died, 15.8% kept on RRT, and 52.5% preserved renal function, 5.6% was missing. Three months later, 45.7% died, 10.9% kept on RRT, and 43.5% preserved renal function, 14% was missing. Six months later, 48.3% had die, 10% kept on RRT, and 33.3% preserved renal function, 8.3% were missing. Finally, one year after AKI, 71.8% of patients had died, 9.9% needed RRT, 18.3% recovered partial or completely renal function and 33.6% missing. AKI in diabetic or dyslipemic patients has an increased mortality (p=0.03 and p=0.06 respectively). CKD before AKI is not associated with increased mortality.Renal function according to KDOQI classification of patients who had AKI stage 3 was: at discharge: stage 1 1.6%, 2 16.1%, 3 24.2%, 4 37.1% and 5 21.0%; three months after AKI : stage 1 2.5%, 2 15%, 3 30%, 4 32.5% and 5 17.5%; six months after AKI: 1 6.5%, 2 12.9%, 3 38.7%, 4 19.4% and 5 19.4% and one year after AKI, renal function was: 2 25%, 3 41.7%, 4 25% and 5 8.3%. Conclusions: In our health area AKI stage 3 requiring RRT have a incidence similar to other studies. Mortality in AKI patients exceeds 70% one year after AKI episode and renal survival decreases in this period. Nephrology follow-up must be established in patients who survive AKI. The develop of tools to identify high-risk patients and to promote renal recovery is important to reduce burden of CKD and mortality.
    Full-text · Article · May 2014 · Nephrology Dialysis Transplantation
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    ABSTRACT: Unlabelled: Bioimpedance (BI) is maturing as a clinical technique for assessing fluid volume status. The aim of this study was to compare the sensitivity of four BI methods to detect changes in fluid status in hemodialysis patients. Methods: Forty-five patients were studied twice in the same week, i.e. once after the long and short interdialytic intervals, respectively. The four BI methods used were: (a) calf normalized resistivity (CNR) at a 5-kHz frequency, (b) whole-body multifrequency BI spectroscopy (MF-BIS) to estimate the normal hydration weight (NHWWBM), (c) whole-body MF-BIS to estimate the ratio of extracellular volume to total body water (wECV/wTBW), and (d) whole-body single-frequency (50 kHz) BI analysis to compute the ratio of ECV (sfECV) to TBW (sfTBW). Results: The relationship (slope of the regressive line) between relative changes (%) in the above mentioned four BI parameters and differences in weight (kg) was most pronounced with CNR (5.2 ± 1.6%/kg), followed by wECV/wTBW (1.7 ± 0.7%/kg) and NHWWBM (0.73 ± 0.2%/kg). Changes in sfECV/sfTBW and differences in weight were not correlated. Conclusions: CNR is more sensitive than whole-body BIS for detecting differences in fluid status.
    No preview · Article · Feb 2014 · Blood Purification
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    ABSTRACT: Background: Developing sustainable treatment programs for kidney failure in most countries of sub-Saharan Africa continues to remain an imposing challenge. While long-term renal replacement therapies in end-stage renal disease appear beyond national financial capabilities, there exist opportunities for a short-term and affordable treatment of acute kidney injury (AKI). Peritoneal dialysis (PD) is an effective and simpler modality compared to hemodialysis (HD) and can be performed without the need for machinery or electricity, making it an ideal choice in a low-resource setting. Methods: Since cost of treatment is the major obstacle, the goal is to develop a program that is cost effective. Developing an HD program requires a large capital investment by the hospital, needing water treatment systems and machinery and providing for their ongoing repair and maintenance. Gravity-driven PD is a simple, effective modality and can be performed in low-resource locales. Results: In a pediatric program that we started in the Komfo Anokye Teaching Hospital in Kumasi, Ghana, 28 patients have been treated with PD for AKI so far. Half of them were treated successfully and were discharged having fully recovered kidney function. Seven patients (25%) were determined to have end-stage renal disease, whereas 7 others (25%) died during hospitalization. In these cases, late presentation for dialysis may have contributed to the inability to recover. Conclusion: For individuals and governments alike, who are concerned about the cost of providing or paying for dialysis, using PD to treat AKI is an effective and simpler modality compared to HD and can be performed without the need for machinery or electricity, making it an ideal choice in a low-resource setting.
    No preview · Article · Dec 2013 · Blood Purification
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    ABSTRACT: Various biochemical and physiological variables are related to outcome in hemodialysis (HD) patients. However, the prognostic implications of trends in body temperature (BT) in this population have not yet been studied. The aim of this study was to assess the relationship between trends in BT and outcome in incident HD patients. Six thousand seven hundred and forty-two incident HD patients without thyroid disease from the Renal Research Institute were followed for 1 year. Patients were divided into tertiles of initial pre-dialysis BT (Tertile 1: ≤ 36.47°C, Tertile 2: > 36.47 to 36.71°C and Tertile 3: > 36.7°C) and further classified according to the change in BT (increased: > 0.01°C/month, decreased: less than -0.01°C/month and stable, with change between - 0.01 and + 0.01°C/month) during the first year of treatment. The reference group is Tertile 2 of initial temperature with stable BT. Cox regression was used for survival analyses. Analyses were repeated for patients who survived the first year and were treated for ≥ 1 month in Year 2. BT decreased in 2903 patients, remained stable in 2238 patients and increased in 1601 patients. After adjustment for multiple risk factors, hazard ratios (HRs) for mortality were higher for those groups in whom, irrespective of the initial BT, BT increased or declined, as compared to the reference group during follow-up (HR between 1.46 and 2.27). The best survival was observed in the group with the highest BT at baseline and stable BT during the follow-up period (HR 0.50).
    No preview · Article · May 2012 · Nephrology Dialysis Transplantation
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    ABSTRACT: Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania.
    Full-text · Article · May 2012
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    ABSTRACT: Kidney International aims to inform the renal researcher and practicing nephrologists on all aspects of renal research. Clinical and basic renal research, commentaries, The Renal Consult, Nephrology sans Frontieres, minireviews, reviews, Nephrology Images, Journal Club. Published weekly online and twice a month in print.
    No preview · Article · Feb 2012 · Kidney International
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    ABSTRACT: Citrasate®, citric acid dialysate (CD), contains 2.4 mEq of citric acid (citrate), instead of acetic acid (acetate) as in standard bicarbonate dialysate. Previous studies suggest CD may improve dialysis adequacy and decrease heparin requirements, presumably due to nonsystemic anticoagulant effects in the dialyzer. We prospectively evaluated 277 hemodialysis patients in eight outpatient facilities to determine if CD with reduced heparin N (HN) would maintain dialyzer clearance. Subjects progressed through four study periods [baseline (B): bicarbonate dialysate + 100% HN; period 1 (P1): CD + 100% HN; period 2 (P2): CD + 80% HN; period 3 (P3): CD + 66.7% HN]. The predefined primary endpoint was noninferiority (margin -8%) of the percent change in mean dialyzer conductivity clearance between baseline and P2. Subjects were 57.4% male, 41.7% white, 54.3% black, and 44.4% diabetic; mean age was 59 ± 14.4 years; mean time on dialysis was 1,498 ± 1,165 days; 65.7% had arteriovenous fistula, 19.9% arteriovenous graft, 14.4% catheters, and 27.8% used antiplatelet agents. Mean dialyzer clearance increased 0.9% (P1), 1.0% (P2), and 0.9% (P3) with CD despite heparin reduction. SpKt/V remained stable (B: 1.54 ± 0.29; P1: 1.54 ± 0.28; P2: 1.55 ± 0.27; P3: 1.54 ± 0.26). There was no significant difference in dialyzer/dialysis line thrombosis, post-HD time to hemostasis, percent of subjects with adverse events (AEs), or study-related AEs. CD was safe, effective, and met all study endpoints. Dialyzer clearance increased approximately 1% with CD despite 20-33% heparin reduction. Over 92% of P3 subjects demonstrated noninferiority of dialyzer clearance with CD and 33% HN reduction. There was no significant difference in dialyzer clotting, bleeding, or adverse events.
    No preview · Article · Jan 2012 · Blood Purification
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    ABSTRACT: The literature abounds with attestations about the lack of treatment programs for kidney injury in developing countries. To date, no sustainable treatment program exists for acute kidney injury (AKI) in many of the 48 countries in the sub-Saharan region of Africa. The Sustainable Kidney Care Foundation, together with industry, universities, and funding organizations, has been working on establishing peritoneal dialysis treatment programs for AKI in East Africa, starting with the countries comprising the East African Community and with a special focus on treating children and women of childbearing age.
    No preview · Article · Jan 2012 · Blood Purification
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    ABSTRACT: Mortality varies seasonally in the general population, but it is unknown whether this phenomenon is also present in hemodialysis patients with known higher background mortality and emphasis on cardiovascular causes of death. This study aimed to assess seasonal variations in mortality, in relation to clinical and laboratory variables in a large cohort of chronic hemodialysis patients over a 5-year period. This study included 15,056 patients of 51 Renal Research Institute clinics from six states of varying climates in the United States. Seasonal differences were assessed by chi-squared tests and univariate and multivariate cosinor analyses. Mortality, both all-cause and cardiovascular, was significantly higher during winter compared with other seasons (14.2 deaths per 100 patient-years in winter, 13.1 in spring, 12.3 in autumn, and 11.9 in summer). The increase in mortality in winter was more pronounced in younger patients, as well as in whites and in men. Seasonal variations were similar across climatologically different regions. Seasonal variations were also observed in neutrophil/lymphocyte ratio and serum calcium, potassium, and platelet values. Differences in mortality disappeared when adjusted for seasonally variable clinical parameters. In a large cohort of dialysis patients, significant seasonal variations in overall and cardiovascular mortality were observed, which were consistent over different climatic regions. Other physiologic and laboratory parameters were also seasonally different. Results showed that mortality differences were related to seasonality of physiologic and laboratory parameters. Seasonal variations should be taken into account when designing and interpreting longitudinal studies in dialysis patients.
    Full-text · Article · Nov 2011 · Clinical Journal of the American Society of Nephrology
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    ABSTRACT: Automated peritoneal dialysis (APD) is being increasingly used as an alternative to continuous ambulatory peritoneal dialysis (CAPD). However, there has been concern regarding reduced sodium removal leading to hypertension and resulting in a faster decline in residual renal function (RRF). The objective of the present study was to compare patient and technique survival and other relevant parameters between patients treated with APD and patients treated with CAPD. Data for incident patients were retrieved from the database of the Renal Research Institute, New York. Treatment modality was defined 90 days after the start of dialysis treatment. In addition to technique and patient survival, RRF, blood pressure, and laboratory parameters were also compared. 179 CAPD and 441 APD patients were studied. Mean as-treated survival was 1407 days [95% confidence interval (CI) 1211 - 1601] in CAPD patients and 1616 days (95% CI 1478 - 1764) in APD patients. Adjusted hazard ratio (HR) for mortality was 1.31 in CAPD compared to APD (95% CI 0.76 - 2.25, p = NS). Unadjusted as-treated technique survival was lower in CAPD compared to APD, with HR 2.84 (95% CI 1.65 - 4.88, p = 0.002); adjusted HR was 1.81 (95% CI 0.94 - 3.57, p = 0.08). Peritonitis rate was 0.3 episodes/patient-year for CAPD and APD; exit-site/tunnel infection rate was 0.1 and 0.3 episodes/patient-year for CAPD and APD respectively (p = NS). Patient survival was not significantly different between APD and CAPD patients, whereas technique survival appeared to be higher in APD patients and could not be explained by differences in infectious complications. No difference in blood pressure control or decline in RRF was observed between the 2 modalities. Based on these results, APD appears to be an acceptable alternative to CAPD, although technique prescription should always follow individual judgment.
    Full-text · Article · Nov 2011
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    ABSTRACT: Thermal changes during dialysis strongly influence intra-dialytic hemodynamics. The mechanisms behind the increase in body temperature during hemodialysis (HD) are still not completely understood. The objective of this retrospective observational cohort study is to assess the effect of circadian variation on body temperature changes during HD by comparing results in patients treated on different treatment shifts. Data from the Renal Research Institute, New York, clinical database encompassing patients treated in six states in the USA were used. Data from January and August 2008 were used for analysis. Body temperature changes during HD were categorized by dialysis shifts. Patients with morning shifts (n = 1064), afternoon shifts (n = 730) and evening shifts (n = 210) were compared. Pre-dialysis body temperatures were significantly different among the different shifts [morning, 36.41 (95% confidence interval: 36.39-36.43°C), afternoon, 36.47 (36.45-36.49°C), evening, 36.67 (36.64-36.70°C), P < 0.001]. In August, but not in January, intra-dialytic increases in body temperature were significantly different between patients treated during morning [0.07 (0.058-0.082°C)], afternoon [0.03 (0.016-0.044°C)] and evening shifts [-0.01 (-0.032 to 0.012°C); P < 0.001 analysis of variance], although in January, treatment shift was a significant predictor of the intra-dialytic increase in body temperature. The intra-dialytic change in body temperature was related not only to the pre-dialysis body temperature (r(2) = 0.31; P < 0.001) but also to microbiological dialysate quality, treatment time and dialysate temperature. The intra-dialytic change in blood pressure (BP) was significantly related to changes in intra-dialytic body temperature irrespective of the study month. Both pre-dialytic body temperature as well as changes in body temperature are significantly related to the timing of the dialysis shifts, in phase with the circadian body temperature rhythm. Due to the relationship between body temperature changes and changes in intra-dialytic BP, these findings might be of additional relevance in the pathogenesis of intra-dialytic hypotension.
    No preview · Article · Jul 2011 · Nephrology Dialysis Transplantation
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    ABSTRACT: A noninvasive test for determining elevated levels of blood urea nitrogen (BUN) may be useful under circumstances in which there is limited access to laboratories. Because saliva urea nitrogen (SUN) parallels BUN, we investigated the diagnostic performance of a semiquantitative SUN dipstick to test for elevated BUN levels in patients with chronic kidney disease (CKD). Patients with CKD Stages 1 to 5D were studied. 50 µl of saliva were transferred onto the SUN test strip (Integrated Biomedical Technology, Elkhart, Indiana, IN, USA). SUN was determined after 1 minute by visual comparison of the color of the moistened test pad with 6 calibrated color blocks. Interobserver reproducibility was evaluated by independent observers, masked to urea concentrations of 6 calibrated urea solutions. Correlation between SUN and BUN was quantified by Spearman's rank correlation coefficient (RS), Kappa Statistic was employed to evaluate within-sample reproducibility of duplicates. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of SUN. 68 patients (31 females, 60 ± 14 years; 34 hemodialysis patients, 34 patients CKD Stages 1 - 4) were studied. Interobserver coefficient of variation was 4.9% at SUN levels > 50 mg/dl; within-sample reproducibility was 90%. SUN and BUN were correlated significantly (RS = 0.63; p < 0.01). Elevated BUN was diagnosed with high accuracy by SUN determination (area under the ROC curve: 0.90 (95% CI 0.85 - 0.95)). Semiquantitative dipstick measurements of SUN can reliably identify CKD patients with elevated BUN levels.
    No preview · Article · Jul 2011 · Clinical nephrology
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    ABSTRACT: Prescription of an appropriate dialysis target weight (dry weight) requires accurate evaluation of the degree of hydration. The aim of this study was to investigate whether a state of normal hydration (DW(cBIS)) as defined by calf bioimpedance spectroscopy (cBIS) and conventional whole body bioimpedance spectroscopy (wBIS) could be characterized in hemodialysis (HD) patients and normal subjects (NS). wBIS and cBIS were performed in 62 NS (33 m/29 f) and 30 HD patients (16 m/14 f) pre- and post-dialysis treatments to measure extracellular resistance and fluid volume (ECV) by the whole body and calf bioimpedance methods. Normalized calf resistivity (ρ(N)(,5)) was defined as resistivity at 5 kHz divided by the body mass index. The ratio of wECV to total body water (wECV/TBW) was calculated. Measurements were made at baseline (BL) and at DW(cBIS) following the progressive reduction of post-HD weight over successive dialysis treatments until the curve of calf extracellular resistance is flattened (stabilization) and the ρ(N)(,5) was in the range of NS. Blood pressures were measured pre- and post-HD treatment. ρ(N)(,5) in males and females differed significantly in NS. In patients, ρ(N)(,5) notably increased with progressive decrease in body weight, and systolic blood pressure significantly decreased pre- and post-HD between BL and DW(cBIS) respectively. Although wECV/TBW decreased between BL and DW(cBIS), the percentage of change in wECV/TBW was significantly less than that in ρ(N)(,5) (-5.21 ± 3.2% versus 28 ± 27%, p < 0.001). This establishes the use of ρ(N)(,5) as a new comparator allowing a clinician to incrementally monitor removal of extracellular fluid from patients over the course of dialysis treatments. The conventional whole body technique using wECV/TBW was less sensitive than the use of ρ(N)(,5) to measure differences in body hydration between BL and DW(cBIS).
    No preview · Article · Jul 2011 · Physiological Measurement
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    ABSTRACT: INTRODUCTION AND AIMS: There is currently no consensus about the indications for therapeutic apheresis, also due to the lack of large clinical trials. A registry where all the data can be organized and analyzed therefore becomes a priority for all professionals involved in apheresis. METHODS: The Apheresis Study Group of the Italian Society of Nephrology has instituted a registry for data collection. This report describes data collected from 1994 to 2010 by 89 units of different specialties in 18/20 Italian regions. RESULTS: Data about 36,093 treatments on 3,097 patients were recorded. Plasma exchange accounted for 40.7% of the procedures; 34.3% of these were performed by filtration. Plasma treatment was used in 48.8% of procedures, in particular with protein A immunoadsorption (8.9%), LDL-cholesterol apheresis by dextran sulfate adsorption (13.9%), and semiselective cascade or double filtration (13.9%). Cell apheresis, limited to photopheresis and leukocytapheresis, was used in 4.9% of cases, and whole blood treatment, with different techniques, in 5.7% of cases for the treatment of dyslipidemia, liver failure and sepsis. These procedures account for about 20% of the estimated therapeutic apheresis performed in Italy according to the national survey performed for the year 2005 by the Italian Apheresis and Cell Manipulation Society. CONCLUSIONS: The data collected are sufficiently informative to show a definite trend to use plasma/whole blood treatments as often as possible. The registry not only is a tool for consultation and information, but also a platform to plan and realize interdisciplinary and multicenter clinical trials.
    No preview · Article · Jun 2011 · CKJ: Clinical Kidney Journal
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    ABSTRACT: Prescription of an appropriate post hemodialysis (HD) dialysis target weight requires accurate evaluation of the degree of hydration. The aim of this study was to investigate whether a state of normal hydration as defined by calf bioimpedance spectroscopy (cBIS) could be characterized in HD and normal subjects (NS). cBIS was performed in 62 NS (33 m/29 f) and 30 HD patients (16 m /14 f) pre-and post-dialysis to measure extracellular resistance. Normalized calf resistivity at 5 kHz (ρ N,5) was defined as resistivity divided by body mass index. Measurements were made at baseline (BL) and at a state of normal hydration (NH) established following the progressive reduction of post-HD weight over successive dialysis treatments until the ρ N,5 was in the range of NS. Blood pressures were measured pre-and post-HD treatment. ρ N,5 in males and females differed significantly in NS (20.5±1.99 vs 21.7±2.6 10 -2 Ωm 3 /kg, p<0.05). In patients, ρ N,5 notably increased and reached NH range due to progressive decrease in body weight, and systolic blood pressure (SBP) significantly decreased pre-and post-HD between BL and NBH respectively. This establishes the use of ρ N,5 as a new comparator allowing the clinician to incrementally monitor the effect of removal of extracellular fluid from patients over a course of dialysis treatments.
    Full-text · Article · Apr 2010 · Journal of Physics Conference Series
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    ABSTRACT: Accurate estimation of body muscle, fat and fluid volumes in dialysis patients is an important factor to predict outcomes of the disease. Bioimpedance spectroscopy (BIS) has been used to measure extracellular (Re) and intracellular resistance (Ri) with whole body (wBIS) and segmental (sBIS) measurement. 40 stable HD patients (22 m / 18 f, age 54.7 plusmn11 yrs, height (H) 1.67 plusmn 0.94 m, weight (Wt) 77.7 plusmn 17 kg) were studied with wBIS and sBIS compared to the gold standard measurements by MRI and tracer dilution assays (D2O and NaBr) pre dialysis. Multiple linear regression models were constructed with body compartment estimates from the gold standard methods as the dependent variables and bioimpedance-derived resistances, Wt, H, and age as independent variables. The results of estimation for fat (r2 = 0.96 and r2 = 0.91), for muscle (r2 = 0.9 and r2 = 0.88) and for ECV (r2 = 0.73 and r2 = 0.59) were from sBIS and wBIS model respectively. In conclusion, the sBIS model is useful to assess body composition in dialysis patients.
    No preview · Article · Jun 2009

Publication Stats

300 Citations
112.07 Total Impact Points

Institutions

  • 2003-2015
    • Renal Research Institute
      New York, New York, United States
  • 2011
    • Beth Israel Deaconess Medical Center
      Boston, Massachusetts, United States
  • 2010
    • University of Massachusetts Lowell
      Lowell, Massachusetts, United States
  • 2005
    • Beth Israel Medical Center
      • Division of Nephrology and Hypertension
      New York, New York, United States