Pharmacokinetics and haemodynamic effects of the angiotensin converting enzyme inhibitor cilazapril in hypertensive patients with normal and impaired renal function

Contains fulltext : 22708.PDF (publisher's version ) (Open Access

Cytokine profiles in bronchoalveolar lavage fluid and blood in HIV-seronegative patients with Pneumocystis carinii pneumonia

Contains fulltext : 23621___.pdf (publisher's version ) (Open Access

Economic impact of extended time on peritoneal dialysis as a result of using polyglucose: the application of a Markov chain model to forecast changes in the development of the ESRD programme over time

BACKGROUND: The use of polyglucose as a peritoneal dialysis (PD) fluid extends time on PD treatment. It is anticipated, therefore, that the share of patients treated with PD will be positively influenced. The relationship between extension of PD treatment time and an increase of the PD treatment share, however, is complex and needs further investigation. In this paper, a Markov chain model was applied to investigate the impact of extended time on PD treatment for the PD share in all dialysis patients in The Netherlands. Furthermore, the economic impact of the extended time on treatment (ETOT) was explored. METHODS: Scenarios were forecast over a 10 year period using aggregate data from the End-Stage Renal Registry in The Netherlands (Renine). Three scenarios were simulated in which the median PD technique survival was extended by 8, 10 and 12 months. Two other scenarios explored the impact of the combined effect of ETOT of 10 months together with a 10% and 20% increase of PD inflow shares. Reductions of costs to society due to ETOT were estimated using Dutch cost data on renal replacement therapies. RESULTS: PD share increases from 30.0% in the null scenario to 34.5% in the scenario with an ETOT of 10 months and an increased PD inflow share of 20%. The reduction in total costs to society of the renal replacement therapies is 0.96%. The average societal costs per discounted patient year for haemodialysis (HD) are 84 100 euros. For PD, these costs are 60 300 euros. A shift from HD to PD results in average cost savings of 28% per patient year. CONCLUSIONS: In view of high dialysis costs to society, a reduction of 0.96% can be considered to be relevant for healthcare policy makers

Predicting health-related quality of life in dialysis patients: factors related to negative outcome expectancies and social support

Health and self-regulatio

Natriuretic effects of dihydropyridine calcium entry blockers

Contains fulltext : mmubn000001_173541305.pdf (publisher's version ) (Open Access)Promotores : R. Koene, F. Huysmans en J. Wetzels144 p

Outcome of Kidney Allografts in Recipients With a Femoral Arteriovenous Fistula: Report of Two Cases

Contains fulltext : 171106.pdf (publisher's version ) (Open Access)Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min) led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion

Oedema formation with the vasodilators nifedipine and diazoxide : direct local effect or sodium retention?

Contains fulltext : 22615__.PDF (publisher's version ) (Open Access

Sensitive and practical screening instrument for malnutrition in patients with chronic kidney disease

Item does not contain fulltextOBJECTIVES: The aims of this study were to examine the diagnostic accuracy of the Malnutrition Universal Screening Tool (MUST) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF) for detecting malnutrition in chronic kidney disease (CKD), study individual contributions of MUST and PG-SGA screening items to the explained variance in nutritional status (NS), and examine whether the PG-SGA-SF score, in combination with one of the items of the clinician's part of the cPG-SGA, can be used as a valid and compact nutrition assessment tool in patients with CKD. METHODS: This was a cross-sectional observational study with 123 patients with CKD who were screened for malnutrition risk by MUST and PG-SGA-SF. NS was determined by complete PG-SGA. Overall accuracy was calculated by the receiver operating curve area under the curve (ROC-AUC). Explained variance of individual screening items was assessed by Nagelkerke's R(2), total explained variance was assessed by the increase of R(2) after addition of items in manual stepwise forward selection. RESULTS: Of the patients, 44% were malnourished, which was detected by MUST in 24% and by PG-SGA-SF in 78%. Items "body mass index (BMI)" and "no food intake" of the MUST together explained only 3.7% of the variance in NS, whereas the item "nutrition impact symptoms" (NIS) of the PG-SGA-SF explained 57%. Total explained variance in NS by MUST and PG-SGA-SF were 15% and 74%, respectively. The PG-SGA-SF combined with the "metabolic stress" item explained most (87%) and had a sensitivity of 94% to detect malnutrition. CONCLUSIONS: Most malnourished patients with CKD failed to be identified with the MUST, whereas the PG-SGA-SF detected the majority of them with the screening item "NIS" having the highest individual contribution to the explained variance in NS. Combination of PG-SGA-SF with the item "metabolic stress" had the highest overall accuracy to detect malnutrition

Initial spontaneous remission of posttransplantation Epstein Barr virus-related B-cell lymphoproliferative disorder of the skin in a renal transplant recipient: case report and review of the literature on cutaneous B-cell posttransplantation lymphoproliferative disease.

Primary cutaneous posttransplantation B-cell lymphoproliferative disorder is rare. The few previously reported patients were all treated with surgery, radiotherapy, or lowering of immunosuppression. We describe a 65-year-old woman presenting with an intermammary skin ulcer 21 years after renal transplantation, proving on biopsy to be an Epstein Barr virus (EBV)-related posttransplantation B-cell lymphoproliferative disorder. A few weeks later, the skin ulcer showed complete clinical regression. Hematologic staging evaluation showed no evidence of extracutaneous involvement. Despite continuation of immunosuppression, the patient stayed free of disease until 18 months after initial diagnosis, when she developed a progressive hemiparesis and died of acute myocardial infarction. At autopsy, a recurrent B-cell posttransplantation lymphoproliferative disorder in the left side of the thalamus region (measuring 1 x 0.8 cm) was established. The long interval between the primary cutaneous lesion and the localized brain recurrence supports primary skin posttransplantation lymphoproliferative disorder, especially because the patient was not treated for her posttransplantation lymphoproliferative disorder. Review of the literature on primary cutaneous posttransplantation B-cell lymphoproliferative disorder and this case gives the impression that cutaneous posttransplantation B-cell lymphoproliferative disorders of B-cell lineage behave in a more benign manner than identical lesions arising extracutaneously. Because of the rare occurrence of posttransplantation B-cell lymphoproliferative disorder primarily involving the skin, extracutaneous origin should be excluded. If B-cell lineage can be established, EBV is present, alterations in oncogenes or tumor suppressor genes associated with malignant lymphoma are absent, and bcl-6 gene mutation associated with progression is absent, initially aggressive treatment might be avoided. However, long-term clinical follow-up with prolonged maintenance therapy (reduction of immunosuppression or antiviral therapy) for prevention of recurrent posttransplantation lymphoproliferative disorder seems indicated, as is demonstrated by the case reported in the current study