Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighteen patients with chronic renal failure had their cardiac status monitored during hemodialysis (HD). Ten studies were carried out using an ambulatory nuclear vest to assess ejection fraction (EF), heart rate (HR), relative end-systolic (ESV) and end-diastolic (EDV) volumes every 60 s. A total of 36 episodes of EF falls occurred in 9 patients, all asymptomatic. These EF falls were associated with a rise in ESV, while HR, BP, and EDV remained unchanged. The EF falls correlated best with the volume of ultrafiltrate removed. Ten patients had on-line ST-segment monitoring with sestamibi injection either at the time of ST depression (STD) or at the end of dialysis, if no STD occurred, in order to detect the presence of transient ischemia. Seven of ten patients had perfusion defects after dialysis, with STD occurring in 3 of 10 patients. Predialysis imaging was available in only 8 of 10 patients, and 6 of these patients had perfusion defects. Changes in perfusion defects were not significantly different in the 3 patients with STD compared with those without STD. EF falls and perfusion defects are common in HD patients even in the absence of known coronary artery disease; however, ST segment monitoring is not a sensitive tool for its detection. These changes in function and perfusion may represent myocardial ischemia and contribute to the high incidence of cardiovascular morbidity and mortality in this patient population.
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PMID:Myocardial alterations during hemodialysis: insights from new noninvasive technology. 797 76

This study investigated whether social and/or psychologic factors help to predict older dialysis patients' continued survival. A stratified (by race and sex) random sample of patients aged 60+ years was selected from the ESRD Network census of all patients in that age category residing in a single southeastern state (Georgia) and receiving chronic dialysis as of November 1987; personal interviews with patients were completed in 1988. This analysis includes 287 patients (mean age, 69 years) receiving outpatient hemodialysis for whom primary cause of renal failure and functional status data were complete. Patient tracking and vital statistics data determined that 49% of the sample survived as of October 31, 1990. Study variables included demographic, dialysis, health status, social situation, and psychologic outlook variables reported at the patients' 1988 interviews. Log rank tests showed univariate associations between patients' continued survival and race/gender, recovery time following dialysis treatments, cardiovascular co-morbidity, exercise activity score, freedom from health limitation of daily activity, functional status, leisure activity score, self-rated health status, overall life satisfaction, depression, and public religiosity. The Cox proportional hazards model was fit to the data, with continued survival from the time of the 1988 interview as the dependent variable. There was a significantly increased mortality risk for white men relative to the other race/gender groups and for patients reporting severely impaired functional status at the 1988 interview. With functional status in the model, no other social or psychologic variables were significant predictors of mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continued survival of older hemodialysis patients: investigation of psychosocial predictors. 802 23

Anemia is an inevitable and potentially serious complication of chronic renal failure and one of the most important limiting factors in patient rehabilitation. Although adequate dialysis can control many of the symptoms of uremia, dialysis does not reverse anemia-associated fatigue, and thus, many patients are not rehabilitated. Human recombinant erythropoietin (epoetin) therapy has proven to be effective in reversing anemia and increasing hematocrit levels in the majority of patients with chronic renal failure. Among this patient population, increases in hematocrit level have resulted in improvements in the symptomatology of organ hypoxia, neurobehavioral indices, anorexia, insomnia, depression, and sexual disinterest and dysfunction, as well as a reduction in cardiomegaly. However, despite the availability of epoetin and the dramatic improvements in the complications associated with the anemic state observed following therapy, it appears that patient rehabilitation remains a challenge. One aspect of the continuing problem of rehabilitation appears to be the reluctance of the medical community to increase hematocrit levels above 30%, despite the fact that higher hematocrit levels are associated with greater improvements and that potential adverse events related to hemodynamic adaptation are manageable. Indeed, a comparison of the results from two Epoetin alfa clinical trials, one in which hematocrit levels were maintained at 35% and a large phase IV study in which the target hematocrit level appears to have been approximately 30%, clearly demonstrate the benefits of optimizing hematocrit levels and thus improving the potential for rehabilitation.
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PMID:In search of an optimal hematocrit level in dialysis patients: rehabilitation and quality-of-life implications. 802 33

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.
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PMID:Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients. 816 27

Depression has been identified at the most prevalent psychologic problem in patients with ESRD treated with hemodialysis (HD). Depression has been associated with mortality in HD patients; however, the similarity of the symptoms of depressive disorders to those of uremia and the difficulties in measuring depression and dissociating psychologic from physical aspects of depression in such patients render these studies difficult to evaluate. Conflicting data regarding the effects of depression on survival in HD patients may be the result of using somatic symptoms in quantifying the extent of depression. In this review, studies regarding the diagnosis of depression in HD patients, the association of depression and survival in HD patients in light of recent work on factors related to the morbidity and mortality in the ESRD population, and aspects of therapy for depression in HD patients are considered. Specifically, depression may affect immunologic function, nutrition, and compliance factors that may affect the prescription and delivery of dialysis, which may, in turn, influence outcome. Alternatively, depression may be an independent factor in influencing survival. Cognitive depression measures may be more useful in predicting outcome in HD patients than standard measures used in nonmedically ill populations. Although there are few studies of the effect of treatment of depression on outcome in HD patients, it is reasonable to hypothesize that treatment of depressive disorders in HD patients might effect outcome. Further studies on the association of depression and its treatment and mortality in ESRD patients are warranted.
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PMID:Survival in hemodialysis patients: the role of depression. 840 64

The proper means of measuring quality of life in chronically ill patients is unclear. Because different measures may assess varied aspects of patients' experience and because they may be interrelated in different ways, the relationship between several of these quality-of-life measures, including indices of psychological well-being, social support, and severity of illness in ESRD patients treated with hemodialysis (HD), was prospectively assessed. In addition, it was determined whether patients' assessment of quality of life, along any dimension, was related to patient compliance in three urban HD units, in a population largely composed of African-American patients. Severity of illness scores correlated with both attendance and compliance with the dialysis prescription. Karnofsky scores correlated inversely with age, depression, social environment, and level of severity of illness, as expected, but not with behavioral compliance measures. Social support scores correlated with perception of illness, depression, satisfaction with life, and adjustment to illness scores, but not with behavioral or standard compliance measures. Perception of illness scores correlated with depression, social support, adjustment to illness, and satisfaction with life scores, but not with Karnofsky ratings, severity scores, or standard and/or behavioral compliance measures. Social environment scores correlated with almost all assessed variables, with the exception of anthropometric measurements, predialysis phosphorus levels, and behavioral compliance measures. Satisfaction with life scores (a global, subjective measure of quality of life) correlated with advancing age, level of social support, severity of illness, and the presence of a relationship, but were not correlated with Karnofsky scores. These data suggest that quality of life in patients treated with HD must be measured in several ways. The Psychological Adjustment to Illness Scale Social Environment score may be a useful, generalizable adjunct measure of quality of life in HD patients, in addition to the Satisfaction With Life Scale. Quality of life and perception of the effects of illness are not necessarily associated with functional ability in HD patients. These findings must be considered where making decisions about the discontinuation of HD treatment.
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PMID:Aspects of quality of life in hemodialysis patients. 858 17

Patients with Cushing's disease are not cured by transsphenoidal microsurgery in about 30% of the cases. Beside the problem of invasive macroadenomas, these failures are due either to diagnostic errors, or to very small microadenomas that could no be found. Positive diagnosis of hypercortisolism is quite straightforward and the problem is sensitivity rather than specificity. Primary adrenocortical hypercortisolism should not be mistaken. Depression-related hypercortisolism can be difficult to distinguish from Cushing disease: most cases are recognized after clinical story and CRF stimulation test. Ectopic ACTH secretion by a carcinoid tumor represents at least 8% of ACTH-dependant hypercortisolism. It cannot be reliably distinguished from corticotroph microadenoma by either classical dynamic tests or anterior pituitary imaging. However measurements of ACTH in the inferior petrosal sinus under basal condition and CRF stimulation allow the diagnosis of central or peripheral ACTH secretion with a quasi 100% sensitivity and specificity. In contrast this technique is of poor help for the diagnosis of lateralization of corticotroph microadenomas, for which it gives erroneous results in 25 to 50% of the cases. Rapid intraoperative measurement of ACTH in peripituitary blood seems a more reliable approach. In our series it gave correct results in 11 out of 12 cases. In 1995 hormonal exploration of Cushing disease should limit the failures of anterior pituitary surgery to the cases of invasive macroadenomas that cannot be completely removed.
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PMID:[Role of hormonal exploration in avoiding of the failures of anterior pituitary gland surgery in Cushing disease]. 878 56

Chronic renal failure is characterized by a resistance to the hypercalcemic action of parathyroid hormone (PTH). This resistance probably involves several mechanisms, including a disturbance of vitamin D metabolism, a desensitization of the skeleton by high PTH levels, hyperphosphatemia, uremic toxins, and acidosis. We have explored the possibility that a downregulation of the recently cloned PTH/PTHrp receptor might also be involved. We found a marked decrease in the expression of the receptor mRNA in the kidney and the bone of uremic rats; other authors have found a decrease in the heart and the liver. The reduced expression in the kidney was accompanied by a diminished stimulability of renal adenylate cyclase activity, suggestive of a functional depression of the hormonal response in this target tissue. It is probable that the downregulation of the PTH/PTHrp receptor plays an important role in the skeletal resistance to the calcemic effect of PTII in chronic renal failure.
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PMID:Abnormal skeletal response to parathyroid hormone and the expression of its receptor in chronic uremia. 879 3

A case of hypophosphatemia in a 55-year-old black female on maintenance hemodialysis is described. She developed multiple bone fractures and congestive heart failure during her 10-year period on hemodialysis. Iliac crest bone biopsy revealed osteomalacia with absent aluminium stores. Management was difficult due to her noncompliance secondary to severe depression. Though osteomalacia and cardiomyopathy due to hypophosphatemia are described in patients with end stage renal disease on dialysis, it is an uncommon entity.
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PMID:Hypophosphatemia in end stage renal disease. 885 68

Magnesium ions (Mg2+) are pivotal in the transfer, storage and utilization of energy; Mg2+ regulates and catalyzes some 300-odd enzyme systems in mammals. The intracellular level of free Mg2+ ([Mg2+]i) regulates intermediary metabolism, DNA and RNA synthesis and structure, cell growth, reproduction, and membrane structure. Mg2+ has numerous physiological roles among which are control of neuronal activity, cardiac excitability, neuromuscular transmission, muscular contraction, vasomotor tone, blood pressure and peripheral blood flow. Mg2+ modulates and controls cell Ca2+ entry and Ca2+ release from sarcoplasmic and endoplasmic reticular membranes. Since the turn of this century, there has been a steady and progressive decline of dietary Mg intake to where much of the Western World population is ingesting less than an optimum RDA. Geographic regions low in soil and water Mg demonstrate increased cardiovascular morbidity and mortality. Dietary deficiency of Mg2+ results in loss of cellular K+ and gain of cellular Na+ and calcium ions (Ca2+). Blood normally contains Mg2+ bound to proteins, Mg2+ complexed to small anion ligands and free ionized Mg2+ (IMg2+). Most clinical laboratories only now assess the total Mg, which consists of all three Mg fractions. Estimation of the IMg2+ level in serum or plasma by analysis of ultrafiltrates (complexed Mg + IMg2+) is somewhat unsatisfactory, as the methods employed do not distinguish the truly ionized form from Mg2+ bound to organic and inorganic anions. Because the levels of these ligands can vary significantly in numerous pathological states, it is desirable to directly measure the levels of IMg2+ in complex matrices such as whole blood, plasma and serum. Using novel ion selective electrodes (ISE's), we have found that there is virtually no difference in IMg2+, irrespective of whether one samples whole blood, plasma or serum. These data demonstrate that the mean concentration of IMg2+ in blood is about 600 mumoles/litre (0.54-0.65 mmol/L, 95% Cl); 65-72% of total Mg being free or biologically-active Mg2+. Use of the NOVA and KONE ISE's for IMg2+ on plasma and sera from patients with a variety of pathophysiologic and disease syndromes (e.g., long-term renal transplants, liver transplants, during and before cardiac surgery, ischemic heart disease [IHD], headaches, pregnancy, neonatal period, non-insulin dependent diabetes (NIDDM), end-stage renal disease [ESRD], hemodialyse [HEM], and continuous ambulatory peritoneal dialysis (CAPD), hypertension, myocardial infarction [AMI] and after excessive dietary intake of Mg), has revealed interesting data. The results indicate that long-term renal transplant patients, headache, pregnant, NIDDM, ESRD, HEM, CAPD, AMI, hypertensive, and IHD subjects exhibit, on the average significant depression in IMg2+ but not TMg. Use of 31P-NMR spectroscopy on red blood cells, from several of these disease states, to assess free intracellular Mg ([Mg2+]i demonstrates a high correlation (r = 0.5-0.8) between IMg2+ and [Mg2+]i. Increased dietary load of Mg, for only 6 days, in human volunteers, resulted in significant elevations in serum IMg2+ but not TMg. Correlations between the clinical course of several of the above disease syndromes and the fall in IMg2+ and [Mg2+]i were found. The ICa2+/IMg2+ ratio appears, from our data, to be an important guide for signs of peripheral vasoconstriction, ischemia or spasm and possibly atherogenesis. Overall, our data point to important uses for ISE's for IMg2+ in the diagnosis and treatment of disease states.
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PMID:Role of magnesium in patho-physiological processes and the clinical utility of magnesium ion selective electrodes. 886 38


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