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      Another Call for Timely Initiation of Dialysis

      a , b

      Blood Purification

      S. Karger AG

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          Most cited references 3

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          Low Protein Diets Are Not Needed in Chronic Renal Failure

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            Timing of Initiation of Uremia Therapy and Survival in Patients with Progressive Renal Disease

            We conducted a prospective cohort study to detect any relationships between specific clinical features and laboratory indices at initiation of hemodialysis and long-term survival. One hundred and thirty-nine consecutive patients with chronic renal failure hospitalized to start maintenance hemodialysis between January 1990 and December 1994 were enrolled, and follow-up was completed through December 1995. At baseline, subjects were assigned to one of five groups based on their major indication for initiation of hemodialysis. The indications were: (a) nausea and vomiting; (b) severe weakness; (c) no major symptom (dialysis started because of ‘high’ serum creatinine and blood urea nitrogen concentrations); (d) volume overload, and (e) miscellaneous (angina, pericarditis, seizure, pruritus, and hyperkalemia). Blood urea nitrogen, serum creatinine and serum albumin concentrations were measured once before the first dialysis. The main outcome measure was death. The 139 study subjects included 77 women and 62 men comprising 116 Blacks (83%), 15 Hispanics (11%), and 8 Whites (6%) of mean age 54 ± 15 years. Mean length of follow-up was 39 months. At baseline, mean blood urea nitrogen concentration was 121 ± 38 mg/dl, mean serum creatinine concentration was 12.6 ± 5.2 mg/dl, and mean serum albumin concentration was 3.5 ± 0.62 g/dl. Forty-two subjects (30%) died during follow-up. Cox regression analysis showed that there was no significant association between mortality and any of the indicators evaluated (indication for initiation of dialysis (p = 0.2), serum creatinine concentration (<10 vs. ≥10 mg/dl) (p = 0.8), blood ure nitrogen concentration (<100 vs. ≥100 mg/dl) (p = 0.68) and serum albumin concentration (<4 vs. ≥4 g/dl) (p = 0.62). All analyses included adjustment for age and diabetes.We conclude that in patients with chronic renal failure, the clinical features and laboratory indices used as guidelines for initiation of renal replacement therapy do not correlate with survival. Objective parameters that will permit initiation of dialysis at a time that will maximize survival in patients with chronic renal failure are needed.
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              Impact of Chronic Renal Failure on Nitrogen Metabolism

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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                978-3-8055-7080-0
                978-3-318-00581-3
                0253-5068
                1421-9735
                2000
                2000
                18 August 2000
                : 18
                : 4
                : 313-316
                Affiliations
                aDivision of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, Calif., and bDivision of Nephrology, University of Missouri-Columbia, Mo., USA
                Article
                14454 Blood Purif 2000;18:313–316
                10.1159/000014454
                10965073
                © 2000 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                References: 60, Pages: 4
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/14454
                Categories
                Paper

                Cardiovascular Medicine, Nephrology

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