Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hemodynamic response to treatment with erythropoietin has been analyzed on two different groups of patients. The first group of 25 patients was treated with hemodialysis. The second group of 27 was treated with peritoneal dialysis. Both groups were studied before starting the treatment with erythropoietin, after reaching the hemoglobin target point, and after one year of treatment. The following parameters were recorded: basal and hemoglobin target point, time and dosage of response, incidence of arterial hypertension, diastolic and systolic left ventricular diameters, interventricular septum and posterior wall thickness, ejection fraction, fractional fiber shortening, left ventricular mass index, cardiac output index and peripheral resistance index. The incidence of hypertension was 28.8% and, in both techniques, stabilization of left ventricular mass index occurred a year later. When the hemoglobin target point was reached, a decrease in cardiac output and an increase in peripheral resistance was found. These changes were more evident in the group of patients treated with HD. After a year of treatment, both peripheral resistance and cardiac output were similar to basal values in both groups of patients.
Adv Perit Dial 1992
PMID:Could CAPD modulate the hemodynamic changes induced by rHuEPO treatment? 136 42

Treatment with rHuEpo can eliminate many symptoms that had been attributed to uremia. Repetitive punctures in children undergoing three times weekly subcutaneous (SC) rHuEpo can result in noncompliance with the therapeutic regimen. The aim of this study was to evaluate the efficacy of once weekly SC injection of rHuEpo in children with end-stage renal disease (ESRD) on CAPD. Six children (5 males, 1 female, mean-age: 6.0 years, range: 0.5 to 15.8 years) with ESRD on CAPD were treated with a regimen of rHuEpo 150 U/Kg/week SC for 12 weeks. All patients received oral iron supplementation. All children had improved appetite and well-being. The adolescents showed an increased ability to engage in regular activities. The hematocrit increased from 20.3 +/- 1.2% to 31.7 +/- 3.8% in 12 weeks. The mean weekly increase in hematocrit was 0.95 +/- 0.34%. There was no significant differences in iron indice prior to and during rHuEPO treatment. Side effects related to rHuEpo included transient pain at the site of injection in all, pruritus at the site of injection in 1 child, hyperphosphatemia in 1 infant, iron relative deficiency in 2 children and an asymptomatic increase in blood pressure in 1 hypertensive child. None of the 5 normotensive patients developed hypertension. We concluded that once weekly 150U/kg SC rHuEpo is effective in correcting anemia in children on CAPD. This regimen results in few side effects, decreases the cost of treatment and produces less distress to the patients by avoiding repetitive injections.
Adv Perit Dial 1992
PMID:Once weekly subcutaneous administration of recombinant erythropoietin in children treated with CAPD. 136 43

The major side effect of rHuEPO is hypertension, which is reported to occur in 10-75% of adult patients. The aim of the present study is to evaluate the effect of rHuEPO on blood pressure in pediatric dialysis patients. Nine CAPD patients (mean age 7.4 +/- 3.6 years) and fourteen HD patients (mean age 13.8 +/- 5.5 years) were treated with rHuEPO. The hematocrits increased significantly from 20.7 +/- 1.8 to 28.3 +/- 4.1 in HD patients and from 19.7 +/- 2.9 to 26.7 +/- 4.4 in CAPD patients. The final maintenance dose required to correct the anemia was 47.6 +/- 11.7 units/kg/week for CAPD patients and 122.6 +/- 75.2 U/kg/week foe HD patients. Six (66.6%) out of nine CAPD patients, and five (35.7%) of fourteen HD patients developed or worsened hypertension. Younger CAPD patients tended to develop hypertension. Correction of anemia was poor in two hypertension-exacerbated patients, since rHuEPO dose increase was withheld for fear of aggravating hypertension. A four-year-old girl developed hypertensive encephalopathy after 13 months of rHuEPO therapy. No difference was observed in plasma level of aldosterone or plasma renin activity. Hypertension is observed frequently among pediatric dialysis patients treated with rHuEPO therapy. Careful monitoring and management of hypertension is required, especially in the first three months of rHuEPO therapy.
Adv Perit Dial 1992
PMID:Erythropoietin associated hypertension among pediatric dialysis patients. 136 45

This study assesses the role of prednisone and endogenous digoxin-like immunoreactivity (EDLI) in the increased Na+ pump activity in renal allograft patients. Red blood cell (RBC) Na+ transport activities and plasma concentrations of EDLI were measured in ten controls and ten renal allograft recipients (5 hypertensive) while undergoing treatment with cyclosporin, prednisone, and azathioprine, and also after prednisone withdrawal. As compared to controls, prednisone-treated patients showed an increased Na+ pump activity (0.323/h vs 0.571, P less than 0.05) and decreased RBC Na+ concentration (6.69 mM vs 4.99, P less than 0.05). They also showed a decrease in the activity of cotransport, countertransport, and passive Na+ efflux (0.02/h vs 0.005, P less than 0.05; 207 mumol/l vs 35, P less than 0.05; 0.02/h vs 0.005 respectively, P less than 0.05). After prednisone withdrawal, normotensive and hypertensive patients showed RBC Na+ transport system activities and RBC Na+ concentration similar to those of controls. EDLI was not detected in controls or in patients. We conclude that prednisone treatment increased the Na+ pump activity, and decreased the RBC Na+ concentration. Moreover, it induced a decrease in the activity of secondary RBC Na+ transport systems. This study provides no evidence for a modulatory role of EDLI in the RBC Na+ pump activity. Neither parameters can be presumed to be a marker of hypertension in these patients.
Nephrol Dial Transplant 1991
PMID:Renal transplantation and red blood cell sodium transport: role of prednisone treatment. 131 82

To evaluate patient survival among geriatric patients by dialytic treatment of choice we assigned all patients aged 65 years and older treated in Michigan to either CAPD at home or center hemodialysis (HD) according to the treatment used on day 120 of ESRD therapy. Michigan Kidney Registry files on all 308 CAPD and 1244 HD patients who started ESRD therapy during 1980-1987 were used for this study. The Cox proportional hazards model revealed a significantly increased relative death rate (RR) for patients with diabetes (RR = 1.91, p less than 0.001) and hypertension (RR 1.4, p less than 0.01) as cause of ESRD when adjusting for age, sex, race, treatment and year of incidence. White patients had a 51% higher relative death rate overall when compared to black patients (p less than 0.001) and specifically among hypertensive (RR = 1.65, p less than 0.001) and diabetic patients (RR = 1.59, p less than 0.001). Those differences were still significant when taking higher rates of withdrawal from dialysis among white patients into account. The relative death rates for CAPD patients was essentially the same as for HD patients overall, however, diabetic CAPD patients appeared to have a higher than diabetic HD patients (RR = 1.58, p = 0.1). This statistically not significant difference may be related to selection of patients with cardiovascular risk into CAPD. There was no trend in mortality over time. By modality on day 120, CAPD has similar outcomes as HD in geriatric non diabetic patients.
Adv Perit Dial 1991
PMID:Comparison of mortality risk by choice of CAPD versus hemodialysis among elderly patients. 168 Apr 60

Intraperitoneal and subcutaneous routes of administration for diabetics on CAPD were compared. The comparison included: (1) Control of blood glucose concentration: both methods can provide satisfactory glycemic control for most patients. Changing the method of insulin administration is warranted when one method fails. (2) Effect on plasma insulin levels: intraperitoneal administration can produce a plasma insulin profile similar to the normal profile. This is unusual with subcutaneous administration. Consequences of hyperinsulinemia (hyperlipidemia, hypertension) seem, however, to be similar between the two methods of insulin administration. (3) Effect on peritoneal permeability: permeability characteristics are maintained unchanged, usually, with either method after long-term CAPD. However, insulin is mitogenic in vitro. Theoretically, intraperitoneal insulin could lead to peritoneal fibrosis. (4) Effect on infectious complications of CAPD: a difference in the rate of peritonitis or overall PD catheter-related infections has not been convincingly demonstrated between the two methods of insulin administration. Exit site and tunnel infections with staphylococcus aureus may be more frequent in diabetics receiving insulin subcutaneously. (5) Effect on hepatic structure and function: subcapsular hepatic steatosis was described in diabetics receiving insulin intraperitoneally. The clinical significance of this finding remains to be demonstrated. We conclude that both methods can be applied for insulin administration in diabetics on CAPD. The intraperitoneal method should be tried first in most instances. Prospective studies comparing the two methods are needed.
Adv Perit Dial 1991
PMID:Subcutaneous versus intraperitoneal insulin in the management of diabetics on CAPD: a review. 168 Apr 63

This multicentre study in 142 transfusion-dependent patients with chronic renal failure maintained by haemodialysis was performed to establish the appropriate dose regimen of rHuEpo and define its long-term safety profile. Only one of 132 patients eligible for efficacy analysis did not achieve the haemoglobin target of greater than or equal to 10 g/dl; this particular patient had folate deficiency and overt hyperparathyroidism. Regular blood transfusions were no longer necessary in any patients, however five patients needed blood transfusions only once, not due to rHuEpo failure: two for iron deficiency and three for intercurrent disease. In parallel with the haemoglobin increase a statistically significant improvement in quality of life scores was observed. The weekly dose required to maintain median haemoglobin between 10 and 10.5 g/dl for 1 year (n = 79) was 200-225 U/kg, applied as two or three i.v. injections. Mean serum ferritin decreased from 1900 to 1300 ng/ml and transferrin saturation from 60% to 30%; this feature was associated with statistically significant decrease of pre-study elevated liver enzymes. The treatment had no untoward effect on the outcome of renal transplantation (n = 24). Of the 56 patients who experienced hypertensive episodes during rHuEpo therapy, 47 had a history of hypertension and nine had not. The patient incidence during the first 3 months was 28.9% and fell markedly to 4% after 1 year. Only two hypertensive episodes could not be controlled and the patients dropped out. Seizures occurred in 11 patients, most of them during early treatment; annualised incidence during the first 3 months was 7.78 per year vs 2.07 per year for seizures beyond 3 months treatment. Clinical presentation, patients' history, haemoglobin pattern, BP recordings, brain scan, and EEG indicated that the pathophysiology is multifactorial, with emphasis on rate of haemoglobin increase. Therefore a smooth haemoglobin increase rate, induced by a conservative starting dose regimen (50 U/kg thrice weekly) is recommended, to allow the circulation to adapt to changes in haematocrit/viscosity and O2 delivery. The majority of the observed adverse reactions were related to rHuEpo's therapeutic effect, i.e. increase the haematocrit. The side-effects are therefore largely predictable and can be successfully managed.
Nephrol Dial Transplant 1991
PMID:Treatment of transfusion-dependent anaemia of chronic renal failure with recombinant human erythropoietin. A European multicentre study in 142 patients to define dose regimen and safety profile. 179 95

Renal biopsies were examined from 17 renal transplant recipients before and after conversion from cyclosporin to azathioprine, and in 17 patients who remained on cyclosporin. All patients had stable renal function. We used an immunoperoxidase technique with an antiserum to human renin to identify renin-containing cells. We demonstrated hyperplasia of renin-containing cells in patients treated with cyclosporin. Numbers of renin-containing cells decreased after conversion to azathioprine. We suggest that local activation of the intrarenal renin-angiotensin system could mediate the effects of cyclosporin on renal haemodynamics. This could play a role in the pathogenesis of cyclosporin nephrotoxicity and cyclosporin hypertension.
Nephrol Dial Transplant 1991
PMID:The effect of conversion from cyclosporin to azathioprine on renin-containing cells in renal allograft biopsies. 187 Jul 54

Sixteen anaemic CAPD patients (Hb less than 9 g/dl) were treated with thrice-weekly subcutaneous recombinant erythropoietin, epoetin-alfa. The dose was adjusted to induce a stepwise increase in haemoglobin. Fourteen patients reached a first target haemoglobin of 11.0-11.5 g/dl and eight of these a second of 13.0-13.5 g/dl, but one could not be maintained at this level. Failure to reach or maintain the second target in nine subjects was accounted for by incomplete responses associated with infection in one, extreme shortening of red-cell survival in another, and was unexplained in one subject. These three received the maximum dose studied of 450 IU/kg per week. Six other subjects were withdrawn from the study for reasons unrelated to treatment with erythropoietin. The median dose required to maintain the haemoglobin at 11.0-11.5 g/dl was 75 IU/kg per week and at 13.0-13.5 g/dl was 150 IU/kg per week. Quality of life, assessed in 12 patients at haemoglobin 11.0-11.5 g/dl, showed significant improvement in energy, and at 13.0-13.5 g/dl improvements in sleep and emotional wellbeing became significant. Twelve subjects required either institution of, or an increase in, treatment for hypertension. The thrice-weekly subcutaneous doses of erythropoietin were well tolerated and were a convenient and effective treatment for anaemia in patients on CAPD.
Nephrol Dial Transplant 1991
PMID:Stepwise correction of anaemia by subcutaneous administration of human recombinant erythropoietin in patients with chronic renal failure maintained by continuous ambulatory peritoneal dialysis. 192 10

EPO is an effective therapy of anaemia in CAPD patients. Monitoring serum iron level during EPO therapy is essential. Hypertension is frequently seen in patients with EPO therapy.
Adv Perit Dial 1990
PMID:Treatment of anaemia in CAPD patients with recombinant human erythropoietin. 198 34


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>