Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We carried out a prospective study of the safety and efficacy of daclizumab combined with triple immunosuppression in adult recipients of at least one HLA-mismatched cadaveric renal allograft. All studied patients received the same immunosuppression: a daclizumab infusion of 1 mg/kg immediately before transplantation, and at 2, 4, 6, and 8 weeks following the transplantation. Infusion of cyclosporine (CsA) (0.08 mg/kg/h) was started at the time of the operation and continued by CsA microemulsion (CsA-Neoral), 3 mg/kg twice daily on day 2, methylprednisolone, 0.4 mg/kg intravenously at operation, and mycophenolate mofetil started on day 1. The dose of CsA-Neoral was adjusted to maintain target blood trough levels. Oral methylprednisolone was tapered by 4 mg per week to achieve a maintenance dose of 0.08 mg/kg/day. Fifty-five patients, with a mean age of 48 +/- 11 years, were studied. Six of them received a second renal allograft. The mean donor age was 38 +/- 14 years. Mean cold ischemia time was 19.5 +/- 6.5 h, mean value of HLA-antigen mismatches was 2.7 +/- 0.9, mean latest PRA value was 3 +/- 7%. Fifteen patients experienced delayed graft function. During a follow-up period of 3 months three acute rejection episodes occurred. One patient died because of systemic aspergillosis. After 3 months mean serum creatinine was 104 +/- 38 micromol/L. Five renal allografts failed, one of them due to rejection. Patient and graft survival was 98.2% and 90.9%, respectively. Daclizumab with this triple therapy represents safe and efficient immunosuppression strategy, demonstrated with low incidence of early acute rejection episodes and an acceptable adverse event profile in cadaveric renal allograft recipients.
Ther Apher Dial 2005 Jun
PMID:Prevention of early acute rejection with daclizumab and triple immunosuppression in cadaveric renal allograft recipients. 1596 3

Rheopheresis is a specifically designed application of double filtration plasmapheresis, for extracorporeal treatment of microcirculatory disorders. Safety and efficacy of Rheopheresis for wound healing and skin oxygenation were investigated in patients with critical limb ischemia. Twelve patients of Fontaine stage III-IV were treated with a series of 10 Rheopheresis sessions over 17 weeks. Transcutaneous oxygen pressure (tcpO(2)) and ankle-brachial index (ABI) were repeatedly determined to monitor the effects of the Rheopheresis treatment series on microcirculation and skin blood flow. Laboratory parameters of blood rheology were measured in addition to safety parameters and course of the pain syndrome was documented. In four patients (baseline Fontaine stage III) Rheopheresis was associated with an improvement of Fontaine stage, a pronounced increase in tcpO(2) and complete regression of the rest pain. As an adjunct therapeutic option, Rheopheresis may preserve a functional lower extremity, delay amputation or reduce the extent of amputation.
Ther Apher Dial 2005 Dec
PMID:Rheopheresis in patients with critical limb ischemia--results of an open label prospective pilot trial. 1635 79

In this retrospective study, we evaluated the impact of automated peritoneal dialysis (APD) on initial graft function after cadaveric renal transplantation. Each patient on APD was matched for donor age, donor serum creatinine, and cold ischemia time with one control patient on HD. The study sample consisted of 67 cases and 67 controls. The rate of delayed graft function--defined as a need for dialysis within the first week following renal transplantation-was 16% in the APD group and 10% in the HD group [p = nonsignificant (NS)]. The proportion of patients with a creatinine clearance below 10 mL/min 6 days after renal transplantation was 7% in the APD group and 3% in the HD group. Of the 67 APD patients, 12 had slow graft function as compared with 13 of the 67 HD patients (p=NS). Weight changes 3 days after transplantation were +2.1% +/- 3.7% of dry weight in HD patients and -0.1% +/- 4.6% of dry weight in APD patients (p < 0.05). The total amount of fluid infused during the surgical procedure was similar in the two groups (55.8 +/- 14.3 mL/kg vs. 60.7 +/- 14.8 mL/kg). Compared with HD, APD was not associated with a lower rate of delayed graft function.
Adv Perit Dial 2005
PMID:Impact of automated peritoneal dialysis on initial graft function after renal transplantation. 1668 93

Arteriovenous fistulas (AVFs) are the preferred type of vascular access, but relatively little is known regarding their effects on cardiovascular remodeling and cardiac function. The following is a review regarding the immediate and long-term complications associated with AVF creation, including the development of left ventricular hypertrophy, high-output cardiac failure, exacerbation of coronary ischemia, and the possible contribution to the development of central vein stenosis.
Semin Dial
PMID:The cardiovascular effects of arteriovenous fistulas in chronic kidney disease: a cause for concern? 1697 Jul 29

Nonocclusive mesenteric ischemia (NOMI) is a relatively uncommon disorder, seen primarily in elderly patients with cardiac disease, and is characterized by progressive intestinal ischemia leading to infarction, sepsis, and death. It is suspected of being the underlying cause in at least 20% - 30% of acute mesenteric ischemia patients. End-stage renal disease patients are among the highest risk populations for developing this lethal complication; however, NOMI is not unique to hemodialysis and can occur in peritoneal dialysis patients as well. Unfortunately, the presentation of NOMI is very similar to that of peritonitis. The key to correct diagnosis is a high index of suspicion in predisposed patients. The high mortality rate is a clear reflection of failure to recognize the syndrome at an earlier, treatable stage. We present our case experience and an extensive review of the literature regarding this dreadful complication that may be reversible if considered early as a possible etiology and the appropriate diagnostic maneuvers undertaken.
Perit Dial Int
PMID:Nonocclusive mesenteric ischemia: a lethal complication in peritoneal dialysis patients. 1729 46

Measurement of skin perfusion pressure (SPP) using laser Doppler has become available for the assessment of peripheral arterial disease. We studied whether measurements of SPP can be used to identify hemodialyzed patients with peripheral arterial disease by comparing it with measurements of the ankle brachial pressure index (ABI). The ABI at rest and the SPP in the foot were measured in 59 Japanese hemodialyzed patients (118 limbs). Twenty-one patients had diabetes mellitus. Five had intermittent claudication; however, 20 patients were accompanied by other exertional leg symptoms. The SPP could not be measured in three limbs because of involuntary movement due to previous stroke or restless leg syndrome. The SPP was correlated with the ABI. Depending upon these results of the ABI, the 114 limbs from which both the ABI and the SPP could measured were divided into three groups: (A) ABI > or = 1.3, (B) 0.9 < or = ABI < 1.3, and (C) ABI < 0.9. The average SPP of group C was significantly decreased among the three groups. All subjects of the three groups were divided into an extra two groups according to the presence of diabetes (non-diabetes groups, -I; diabetes groups, -II). The average SPP of group B-II was significantly decreased compared with those of group B-I. The SPP measurement is a noninvasive, useful screening method for limb ischemia that can be applied to exercise tolerance limited patients. The SPP measurements are expected to be useful for the evaluation of limb ischemia in hemodialyzed patients at risk.
Ther Apher Dial 2007 Jun
PMID:Assessment of lower limb ischemia with measurement of skin perfusion pressure in patients on hemodialysis. 1787 52

Since the beginning of organ transplantation, graft preservation has been one of the most important concerns. Ischemia reperfusion injury (IRI), which plays an important role in the quality and function of the graft, is a major cause for increased length of hospitalization and decreased long term graft survival. Among numerous attempts which have been made to minimize graft damage associated with IRI, the use of Thymoglobulin (TG) seems to offer potential benefits. TG is a polyclonal antibody which blocks multiple antigens related to IRI, in addition to its better known T cell depleting effects. This review will focus on the use of TG in preventing IRI in kidney transplantation (KTx) and liver transplantation (LTx). Different studies in experimental and clinical transplantation have shown that TG protects renal and liver grafts from IRI. Improvement in early graft function and decreased delayed graft function (DGF) rates are some of the clinical benefits of TG. Additionally, it is used in patients with hepatorenal syndrome to support the recovery of kidney function after LTx, by allowing reduced exposure to nephrotoxic calcineurin inhibitors as well as improving liver graft function by minimizing IRI. TG can reduce acute rejection rates in kidney and liver transplant recipients, decrease the length of hospital stay, and hence reduce transplantation costs. TG can play an important role in expanding the donor pool in both KTx and LTx by improving long-term graft and patient survival rates which increases the possibility of using marginal donors. Although controversial, the development of post-transplant lymphoproliferative disorder is a potential side effect of TG. No single optimal immunosuppressive regimen has given consistent results in decreasing the graft damage following IRI; however, TG usage in KTx and LTx appears to have some benefits in reducing IRI.
Nephrol Dial Transplant 2007 Sep
PMID:Thymoglobulin and ischemia reperfusion injury in kidney and liver transplantation. 1789 Feb 65

Microbubbles have been detected in the human circulation of end-stage renal disease patients who are treated by hemodialysis throughout the past decade as a result of advanced ultrasound and Doppler technology. These detection tools uncovered signals of microbubbles, which originate in extracorporeal lines and tubing of hemodialysis machine, circulate in the blood stream until lodging in the capillary bed of various organs, mainly the lungs. During its course within the capillary, a bubble abrades the glycocalyx layer lining the surface of the vessels and thereafter obstructs blood flow through the capillary. This causes tissue ischemia, inflammatory response, and complement activation. Aggregation of platelets and clot formation occurs as well, leading to further obstruction of the microcirculation and subsequent tissue damage. In this review, we describe the biological and clinical effects of microbubbles during hemodialysis and discuss management with regard to prevention and treatment.
Semin Dial
PMID:Pathophysiology and clinical implications of microbubbles during hemodialysis. 1836 2

Aneurysmal degeneration of a hemodialysis arteriovenous fistula (AVF) is common; however, distal digital embolization from an AVF is extremely rare. Even though the ultimate fate of all arteriovenous hemodialysis access is thrombosis with minimal consequences, dislodgement of thrombus at the proximal anastomosis could lead to ischemia of the distal arterial circulation. We here present a case of a renal transplant patient with a thrombosed aneurysmal AVF who presented with acute digital ischemia successfully treated with combination catheter-directed thrombolysis and open repair. No similar report was found describing this entity treated with this approach.
Semin Dial
PMID:Distal digital embolization from a thrombosed aneurysmal hemodialysis arteriovenous fistula: the benefit of a hybrid approach. 1917 38

A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short- and long-term clinical success of banding in these patient groups. After evaluation using a standard protocol, banding procedures (n = 19) were performed in patients (n = 17) with a hemodialysis access flow > or =2 l/minute or with refractory HAIDI. Various parameters including access flow, digital brachial index (DBI), and symptomatology of hand ischemia using a standard scoring system were determined before and after the operation. Surgical banding in CO patients (n = 9) lowered access flows by 2 l (Flow(preop) 3.2 +/- 0.3 l/minute vs. Flow(postop) 1.2 +/- 0.1 l/minute, p < 0.001). Banding in HAIDI patients (n = 10) increased DBI from 0.52 +/- 0.08 to 0.65 +/- 0.08 (p = 0.05), whereas ischemic symptomatology was attenuated (153 +/- 33 to 42 +/- 15, p < 0.02). All patients successfully continued dialysis, and immediate access occlusions (<3 months) were not observed. Access flows remained at acceptable levels after a mean follow-up of 30 months in surviving patients (n = 11, flow: 1.0 +/- 0.1 l/min). Two patients were reoperated for recurrent CO (one and 28 months postoperatively). Surgical banding monitored by measurement of flow and finger pressures is an effective short- and long-term treatment modality for hemodialysis access related CO or distal ischemia.
Semin Dial
PMID:Banding of hemodialysis access to treat hand ischemia or cardiac overload. 1942 30


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