No abstract available.

BACKGROUND/AIMS: Short hemofilter survival and anticoagulation-related life-threatening complications are major problems in systemic anticoagulation with heparin (SAH) for continuous renal replacement therapy (CRRT). The present study examined if regional anticoagulation with citrate (RAC) using commercially available solutions can overcome the associated problems of SAH to produce economical benefits. METHODS: Forty-six patients were assigned to receive SAH or RAC. We assessed the coagulation state, clinical outcomes, and adverse events. A Kaplan-Meier analysis was used to estimate hemofilter life span. The economical benefit related to the prolonged hemofilter survival was examined on the basis of the average daily cost. RESULTS: The mean age of patients was 66.5 +/- 13.8 years and the majority were male (60.9%). While elective discontinuation was most common cause of early CRRT interruption in the RAC group (34.3%, p < 0.01), hemofilter clotting was most prevalent in the SAH group (82.2%, p < 0.01). The patient metabolic and electrolyte control and survival rate were not different between the two groups. When compared with the RAC group, the anticoagulation-associated bleeding was a major complication in the SAH group (15.0% vs. 61.5%, p < 0.01). Regional anticoagulated hemofilters displayed a significantly longer survival time than systemic anticoagulated hemofilters (59.5 +/- 3.8 hr vs. 15.6 +/- 1.3 hr, p < 0.01). Accordingly, the mean daily continuous venovenous hemodiafiltration costs in the RAC and SAH groups were $575 +/- 268 and $1,209 +/- 517, respectively (p < 0.01). CONCLUSIONS: RAC prolonged hemofilter survival, displaying an economical benefit without severe adverse effects. The present study therefore demonstrates that RAC, using commercially available solutions, may be advantageous over SAH as a cost-effective treatment in CRRT.
Adult ; Aged ; Anticoagulants/*pharmacology ; Citric Acid/*pharmacology ; Critical Illness ; Female ; Health Care Costs ; *Hemodiafiltration/adverse effects/economics/mortality ; Heparin/*pharmacology ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged

BACKGROUND/AIMS: Although high-flux (HF) dialyzers with enhanced membrane permeability are widely used in current hemodialysis (HD) practice, urea kinetic modeling is still being applied to indicate the adequacy of both low-flux (LF) and HF HD. In comparison with urea (molecular weight, 60 Da) and beta2-microglobulin (beta2MG, 12 kDa), cystatin C (CyC, 13 kDa) is a larger molecule that has attractive features as a marker for assessing solute clearance. We postulated that CyC might be an alternative for indicating the clearance of middle molecules (MMs), especially with HF HD. METHODS: Eighty-nine patients were divided into LF and HF groups. Using single pool urea kinetic modeling, the urea reduction ratio (URR) and equilibrated Kt/Vurea (eKt/Vurea) were calculated. The serum CyC concentrations were measured using particle-enhanced immunonephelometry. As indices of the middle molecular clearance, the reduction ratios of beta2MG and CyC were calculated. RESULTS: The beta2MG reduction ratio (beta2MGRR) and CyC reduction ratio (CyCRR) were higher in the HF group compared to the LF group. However, the URR and eKt/Vurea did not differ between the two groups. The CyCRR was significantly correlated with the eKt/Vurea and beta2MGRR (r = 0.47 and 0.69, respectively, both p < 0.0001). CONCLUSIONS: Compared to the LF dialyzer, the HF dialyzer removed CyC and beta2MG more efficiently. Unlike the beta2MGRR, the CyCRR was correlated with the eKt/Vurea and beta2MGRR. This study suggests a role for the CyCRR as an alternative indicator of the removal of MMs.
Adult ; Aged ; Biological Markers/blood ; Case-Control Studies ; Cystatin C/*blood ; Female ; Hemodialysis Solutions ; Humans ; Kidney Failure, Chronic/*blood/*therapy ; Male ; Middle Aged ; Models, Biological ; Nephelometry and Turbidimetry/*methods ; Renal Dialysis/*methods ; Urea/blood ; Uremia/blood/therapy ; beta 2-Microglobulin/blood

OBJECTIVES: Diffuse tensor imaging (DTI) was applied to explore the difference in regional distribution and extent of white matter (WM) abnormalities in boys with Attention-deficit/hyperactivity disorder (ADHD) versus boys with comorbid ADHD and tic disorders. METHODS: Fifteen boys with ADHD (mean age 9.3+/-1.8), 24 ADHD boys with chronic tic disorder or Tourette's disorder (9.9+/-1.2) and 9 age-, gender-matched controls (9.2+/-1.8) received DTI assessments. Fractional Anisotropy (FA) maps of WM were compared between groups with a voxel-wise analysis after intersubject registration to MNI space. RESULTS: Both groups, ADHD group and ADHD with tic disorder group, commonly showed decreased FA than healthy control group in left cerebellar middle peduncle and right frontal lobe, increased FA in right middle occipital WM. In the common areas of left cerebellar middle peduncle and right middle occipital WM, comorbid group showed broader areas of significant FA. The comorbid group also showed increased FA in right cerebellar peduncle, additionally. CONCLUSION: The findings in ADHD group support previous ADHD hypothesis of the functional abnormalities in corticocerebellar circuit, and suggest that ADHD might have more complicated pathology of neuronal circuit including occipital visual system. The comorbid group showed common areas of overlapping but more extensive abnormalities and also had additional WM abnormalities. ADHD with chronic tic disorders may represent a severe form of ADHD with additional regions of abnormal connectivity.
Anisotropy ; Attention Deficit Disorder with Hyperactivity ; Diffusion ; Diffusion Tensor Imaging ; Frontal Lobe ; Humans ; Neurons ; Tic Disorders ; Tics ; Tourette Syndrome

PURPOSE: Clinical treatment for lupus nephritis largely depends upon histological renal biopsy classification. But it has been reported that serologic biochemical markers are not strongly associated with pathologic classification. The aim of this study is to see whether serologic markers could predict pathologic class of lupus nephritis for appropriate treatment. METHODS: We investigated 67 patients, who underwent renal biopsy with lupus nephritis at Hanyang University Hospital between January, 2005 and August, 2007. Biological markers for this study are hematuria, proteinuria, serologic data of lupus activity and azotemia. They were retrospectively analyzed from patients grouped by ISN/RPS 2003 lupus nephritis classification. RESULTS: Total 67 patients (men 5, women 62) were enrolled and the mean age of the patients was 30.6+/-9 years. The number of patient group by pathologic classification was 4 cases for class II, 15 cases for class III, 30 cases for class IV and 15 cases for class V. Spot urine protein to creatinine ratio more than 3 increased in class IV group statistically (p=.007). C3 level decreased more in class IV group than class III, V groups. Ten patients showed azotemia, and 9 of them were class IV group (p=.048). CONCLUSION: The patients with more increased proteinuria, decreased C3 level and azotemia showed more frequently in class IV group. Hence those three biological markers may be a clinical clue to pathologic diagnosis.
Azotemia ; Biomarkers ; Biopsy ; Creatinine ; Female ; Hematuria ; Humans ; Lupus Nephritis ; Proteinuria ; Retrospective Studies