The Experts below are selected from a list of 228 Experts worldwide ranked by ideXlab platform
Lance D Dworkin - One of the best experts on this subject based on the ideXlab platform.
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residual Renal Function and mortality risk in hemodialysis patients
American Journal of Kidney Diseases, 2001Co-Authors: Douglas Shemin, Andrew G Bostom, Priscilla Laliberty, Lance D DworkinAbstract:Abstract Residual Renal Function, defined as the urinary clearance of urea and creatinine, is minimal in many patients treated with hemodialysis (HD) and tends to be ignored in most outcome studies involving HD patients. Recent studies showed that residual Renal Function, even at a low level, is influential in preventing mortality in the minority of patients with end-stage Renal disease treated with peritoneal dialysis. This issue generally has not been examined in patients treated with HD. This prospective observational study of all 114 patients at a single community-based freestanding HD center is designed to examine the impact of residual Renal Function (defined as Renal urea clearance and Renal creatinine clearance derived from 24-hour urinary volumes) on mortality over a 2-year period. During that period, 50 deaths occurred in 114 patients. The presence of residual Renal Function was protective against mortality (odds ratio for death, 0.44; 95% confidence interval, 0.24 to 0.81; P = 0.008), even after adjustment for duration of dialysis treatment, age, smoking, presence of diabetes, presence of cardiovascular disease, serum albumin level, and urea reduction rate. In conclusion, the presence of residual Renal Function, even at a low level, is associated with a lower mortality risk in HD patients. © 2001 by the National Kidney Foundation, Inc .
Angela Yeemoon Wang - One of the best experts on this subject based on the ideXlab platform.
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the importance of residual Renal Function in dialysis patients
Kidney International, 2006Co-Authors: Angela Yeemoon WangAbstract:Preserving residual Renal Function has always been the primary clinical goal for every nephrologist managing patients with chronic kidney disease. There is no reason why this important goal should not extend to patients with stage 5 chronic kidney disease receiving dialysis. Indeed, there is now clear evidence that preserving residual Renal Function remains important after the commencement of dialysis. Residual Renal Function contributes significantly to the overall health and well-being of dialysis patients. It not only provides small solute clearance but also plays an important role in maintaining fluid balance, phosphorus control, and removal of middle molecular uremic toxins, and shows strong inverse relationships with valvular calcification and cardiac hypertrophy in dialysis patients. Decline of residual Renal Function also contributes significantly to anemia, inflammation, and malnutrition in patients on dialysis. More importantly, the loss of residual Renal Function, especially in patients on peritoneal dialysis, is a powerful predictor of mortality. In addition, there is increasing evidence that residual Renal and peritoneal dialysis clearance cannot be assumed to be equivalent qualitatively, thus indicating the need to preserve residual Renal Function in patients on dialysis. In this article, we will review evidence that residual Renal Function is important in dialysis patients (especially peritoneal dialysis) and outline potential strategies that may better preserve residual Renal Function in dialysis patients.
Paul E. De Jong - One of the best experts on this subject based on the ideXlab platform.
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Drawbacks of the Use of Indirect Estimates of Renal Function to Evaluate the Effect of Risk Factors on Renal Function
Journal of The American Society of Nephrology, 2004Co-Authors: Jacobien C. Verhave, Ron T. Gansevoort, Hans L. Hillege, Dick De Zeeuw, Gary C. Curhan, Paul E. De JongAbstract:Many epidemiologic studies presently aim to evaluate the effect of risk factors on Renal Function. As direct measurement of Renal Function is cumbersome to perform, epidemiologic studies generally use an indirect estimate of Renal Function. The consequences of using different methods of Renal Function measurement in studies that evaluate the effect of cardiovascular risk factors on Renal Function were questioned. Data of the 8592 Prevention of Renal and Vascular End-stage Disease study participants, in whom the association was plotted between various cardiovascular risk factors and Renal Function measured either by creatinine clearance based on two 24-h urine collections or by the Cockcroft-Gault or Modification of Diet in Renal Disease formula were used. A repeated measurement analysis was used to compare the slopes of the linear regression lines of the risk factors and the different methods of Renal Function measurements. The relation between cardiovascular risk factors and Renal Function seems to be different when different methods for Renal Function are used. This was most pronounced for age, weight, and body mass index and less pronounced (but still statistical significant) for BP, cholesterol, and glucose. The relation between weight or body mass index and Renal Function showed completely different directions, depending on the Renal Function method used. In conclusion, the interpretation of the relation of cardiovascular risk factors and Renal Function is affected by the method selected to estimate Renal Function. For studying the relation of risk factors and Renal Function in large population studies, indirect estimates of Renal Function should be used with caution.
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factors influencing serum cystatin c levels other than Renal Function and the impact on Renal Function measurement
Kidney International, 2004Co-Authors: Eric L Knight, Jacobien C. Verhave, Hans L. Hillege, Dick De Zeeuw, Gary C. Curhan, Donna Spiegelman, Paul E. De JongAbstract:Factors influencing serum cystatin C levels other than Renal Function and the impact on Renal Function measurement. Background It is well known that serum creatinine may be used as a marker of Renal Function only if taking into account factors that influence creatinine production, such as age, gender, and weight. Serum cystatin C has been proposed as a potentially superior marker than serum creatinine, because serum cystatin C level is believed to be produced at a constant rate and not to be affected by such factors. However, there are limited data on factors that may influence serum cystatin C levels, and there are limited data comparing cystatin C-based estimates of Renal Function with creatinine-based estimates that adjust for such factors, especially in individuals with normal, or mildly reduced, Renal Function. Methods This was a cross-sectional study of 8058 inhabitants of the city of Groningen, The Netherlands, 28 to 75years of age. Serum cystatin C and serum creatinine levels were measured, and creatinine clearance was determined from the average of two separate 24-hour urine collections. We performed multivariate analyses to identify factors independently associated with serum cystatin C levels after adjusting for creatinine clearance. Then, partial Spearman correlations were obtained after adjusting for factors that may influence serum cystatin C and creatinine levels. We also compared the goodness-of-fit ( R 2 ) of different multivariate linear regression models including serum cystatin C level and serum creatinine level for the outcome of creatinine clearance. Results Older age, male gender, greater weight, greater height, current cigarette smoking, and higher serum C-reactive protein (CRP) levels were independently associated with higher serum cystatin C levels after adjusting for creatinine clearance. After adjusting for age, weight, and gender, the partial Spearman correlations between creatinine and, respectively, serum cystatin C level and serum creatinine level were -0.29 ( P P R 2 values for serum cystatin C level and serum creatinine level adjusted for age, weight, and gender were 0.38 and 0.42, respectively. The addition of cigarette smoking and serum CRP levels did not improve the R 2 value for the multivariate serum cystatin C-based model. Conclusion Serum cystatin C appears to be influenced by factors other than Renal Function alone. In addition, we found no evidence that multivariate serum cystatin C–based estimates of Renal Function are superior to multivariate serum creatinine-based estimates.
Douglas Shemin - One of the best experts on this subject based on the ideXlab platform.
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residual Renal Function and mortality risk in hemodialysis patients
American Journal of Kidney Diseases, 2001Co-Authors: Douglas Shemin, Andrew G Bostom, Priscilla Laliberty, Lance D DworkinAbstract:Abstract Residual Renal Function, defined as the urinary clearance of urea and creatinine, is minimal in many patients treated with hemodialysis (HD) and tends to be ignored in most outcome studies involving HD patients. Recent studies showed that residual Renal Function, even at a low level, is influential in preventing mortality in the minority of patients with end-stage Renal disease treated with peritoneal dialysis. This issue generally has not been examined in patients treated with HD. This prospective observational study of all 114 patients at a single community-based freestanding HD center is designed to examine the impact of residual Renal Function (defined as Renal urea clearance and Renal creatinine clearance derived from 24-hour urinary volumes) on mortality over a 2-year period. During that period, 50 deaths occurred in 114 patients. The presence of residual Renal Function was protective against mortality (odds ratio for death, 0.44; 95% confidence interval, 0.24 to 0.81; P = 0.008), even after adjustment for duration of dialysis treatment, age, smoking, presence of diabetes, presence of cardiovascular disease, serum albumin level, and urea reduction rate. In conclusion, the presence of residual Renal Function, even at a low level, is associated with a lower mortality risk in HD patients. © 2001 by the National Kidney Foundation, Inc .
Roland C. A. Heintz - One of the best experts on this subject based on the ideXlab platform.
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Tenoxicam and Renal Function
Drug Safety, 1995Co-Authors: Roland C. A. HeintzAbstract:The association of some nonsteroidal anti-inflammatory drugs (NSAIDs) with adverse effects on Renal Function has led to the need to systematically determine the risk of clinically relevant Renal effects in patients treated with these drugs. Tenoxicam, an NSAID with established efficacy in the treatment of rheumatic diseases, has been studied in a variety of patient populations to evaluate its effects on Renal Function.
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Tenoxicam and Renal Function
Drug Safety, 1995Co-Authors: Roland C. A. HeintzAbstract:The association of some nonsteroidal anti-inflammatory drugs (NSAIDs) with adverse effects on Renal Function has led to the need to systematically determine the risk of clinically relevant Renal effects in patients treated with these drugs. Tenoxicam, an NSAID with established efficacy in the treatment of rheumatic diseases, has been studied in a variety of patient populations to evaluate its effects on Renal Function. Investigational studies, up to 5 years’ duration, evaluated glomerular filtration rate, Renal blood flow and tubular Function. There was no evidence of clinically relevant Renal toxicity in patients with normal Renal Function, in elderly patients with age-related Renal Function, or in patients with mild to moderate Renal impairment. There was, however, one patient with pre-existing Renal pathology, who experienced raised plasma creatinine after 5 years of treatment. These findings are supported by an analysis of urinary system adverse effects in clinical trials that included over 67 000 patients, 25% of whom were elderly. The prevalence of these events, 0.07%, was similar in patients in both age groups. The most common events were dysuria and Renal pain. Thus, patients treated long term with tenoxicam are at low risk for nephrotoxic effects. It is not recommended, however, that patients with severe pre-existing Renal insufficiency receive tenoxicam.
