Objective: We investigated the effect of the vitamin D receptor agonist (VDRA), paricalcitol on b... more Objective: We investigated the effect of the vitamin D receptor agonist (VDRA), paricalcitol on biomarkers of endothelial dysfunction in patients with chronic kidney disease (CKD). Methods: This was an 8-week, randomized, blinded, controlled trial of paricalcitol versus placebo in 40 CKD patients. Serum chemistry, asymmetric dimethyl arginine (ADMA), soluble intracellular adhesion molecule (ICAM), vascular adhesion molecule (VCAM), biomarkers of vascular reactivity (Regulated on activation, normal T cell expressed and secreted (RANTES), vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP-1)) and pro-inflammatory cytokines (interleukin-1(IL-1) interleukin (IL-6), tumor necrosis factor-ii (TNFii)) at baseline, week 4 and week 8. Results: Paricalcitol treated patients had significant reductions in asymmetric dimethylarginine (ADMA) serum concentrations after 4 weeks of treatment. There were no statistically significant changes in mean concentrations of cy...
Background: Patients with chronic kidney disease (CKD) might be at high risk for bone disease. De... more Background: Patients with chronic kidney disease (CKD) might be at high risk for bone disease. Decreased functional kidney mass contributes to renal osteodystrophy, which might be exacerbated by certain drug therapies. Long-term (_>6 months) corticosteroid treatment is commonly prescribed in patients with glomerular disease, possibly causing bone loss both indirectly and directly, putting the patient at increased risk for fracture. The dual-energy x-ray absorptiometry (DXA) is the current "gold standard" for measuring osteoporosis-related fractures and works by passing ultrasound waves through bone to determine the structural anisotropy in the heel. Objective: This pilot study was designed to determine whether there is a correlation between DXA and quantitative ultrasound (QUS) in detecting corticosteroidinduced osteoporosis.
Older adults represent one of the fasting growing age groups in many countries including the Unit... more Older adults represent one of the fasting growing age groups in many countries including the United States [1]. This rate of growth is mirrored in the dialysis population. The number of incident dialysis patients over the age of 65 years is greater than 50 %. The number of incident dialysis patients greater than 75 years of age represents the fasting growing population of dialysis patients.
Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-t... more Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-the-counter misuse. Limited health literacy is associated with poor health outcomes. Identification of new strategies to assess literacy and numeracy could be useful in targeting effective education initiatives. Objective: To characterize numeracy and literacy skills related to non-steroidal anti-inflammatory drug labels in primary care patients. Methods: Patients were recruited and consented over an 8-month period after their regular primary care visit. Demographic information was collected and two instruments were administered to assess literacy and numeracy skills: (1) a medication label literacy instrument focused on non-steroidal anti-inflammatory drugs (MedLit-NSAID) and (2) a general healthy literacy-screening tool, the Newest Vital Sign. Two questions on the MedLit-NSAID instrument evaluated understanding of the Food and Drug Administration medication guide for non-steroidal anti-...
PURPOSE: Simplification of medication regimens may improve medication adherence, which is poor in... more PURPOSE: Simplification of medication regimens may improve medication adherence, which is poor in end stage kidney disease patients. Daily nocturnal home hemodialysis (DNHD) has proven benefits, however its effect on medication burden is unknown. We examined medication regimen changes in patients who changed from another form of kidney replacement to DNHD. METHODS: A retrospective analysis of 41 DNHD patients over a 2 year period was conducted. Demographic and medication regimen information was collected at baseline (prior to DNHD training), on day 1 of DNHD (following training), and at 3, 6, 12, 18, and 24 months of DNHD. Medication regimen changes, including number of medications, daily pill burden (PB), and number of total administration times per day were determined at each time point for each patient. Home medications used to treat anemia, renal osteodystrophy (ROD), and cardiovascular (CV) disease were analyzed for number of medications and PB. RESULTS: The mean age at the sta...
Purpose: Hemodialysis (HD) patients are at high risk for medication-related problems (MRPs). Rele... more Purpose: Hemodialysis (HD) patients are at high risk for medication-related problems (MRPs). Relevant MRPs can only be found if an accurate medication list is available. Electronic medication records (EMR) are often thought to improve medication reconciliation efforts. The goal of this study was to determine the accuracy of the EMR at an outpatient HD clinic. Methods: Medication reconciliation processes were applied at a local HD clinic to ensure accurate medication lists. A rigorous interview process was conducted to obtain medication lists for all clinic patients. The medication reconciliation process was completed by pharmacy interns during a 5-week advanced practice experience. Interns were trained and observed by a pharmacist preceptor. Reconciled medication lists were retrospectively compared with records from the EMR at the HD clinic. EMR medication entries were classified as correct or discrepant. HD clinic staff were provided with copies of reconciled medication lists and i...
The purpose of this study was to evaluate the feasibility of utilizing an in-vitro, closed loop h... more The purpose of this study was to evaluate the feasibility of utilizing an in-vitro, closed loop hemodialysis system as a method to assess drug clearance. Secondarily, this study tested the influence of variables (blood flow rate, dialysate flow rate, and type of filter) in the hemodialysis procedure on the clearance of vancomycin and gentamicin. An in-vitro, closed loop hemodialysis system was constructed. The vancomycin (30 mg/L) and gentamicin (25 mg/L) were added to a simulated blood system (SBS). Four conditions (C1-C4) were tested by defining the filter (Polyflux 170H or F180) and the blood and dialysate flow rates (BFR and DFR). All hemodialysis sessions were 3 hours in length and each condition was completed in duplicate. Dialysate effluent was collected in a 50 gallon polyethylene drum. Samples were collected (in duplicate) from the SBS and the dialysate effluent at baseline and at the end of the hemodialysis session. Samples were analyzed for vancomycin and gentamicin with ...
The use of natural products is increasing, but healthcare professionals may underestimate the use... more The use of natural products is increasing, but healthcare professionals may underestimate the use of these agents by patients. It is unknown whether natural product use differs between primary care and specialty clinic patients, such as those in a nephrology clinic. To compare patterns of natural product use between primary care and nephrology clinic patients. One thousand adult patients from each clinic were randomly mailed an anonymous questionnaire to determine current and past use of natural products. A total of 491 surveys were returned, for an overall response rate of 26% (25% primary care; 28% nephrology clinic). Current use of natural products was similar between the primary care and nephrology groups (34% vs 29%, respectively; p = NS). Primary care patients were more likely to have taken a natural product in the past (57% vs 45%; p < 0.05); Echinacea was the most common product taken by those patients (26%). Green tea was the most common natural product taken by nephrolo...
Intravenous iron is typically administered during the hemodialysis (HD) procedure. HD patients ma... more Intravenous iron is typically administered during the hemodialysis (HD) procedure. HD patients may be prescribed high-flux (HF) or high-efficiency (HE) dialysis membranes. The extent of iron sucrose and iron dextran removal by HD using HF or HE membranes and by ultrafiltration rate (UFR) is unknown. Two in vitro HD systems were designed and constructed to determine the dialyzabiltiy of iron from a simulated blood system (SBS) containing 100 mg iron sucrose or iron dextran (system A) or 1000 mg iron sucrose (system B). Both in vitro systems utilized a 6-L closed-loop SBS system that was subject to 4 different HD conditions conducted over 4 hours: HE membrane + 0 ml/hr UFR; HE membrane + 500 ml/hr UFR; HF membrane + 0 ml/hr UFR; HF membrane + 500 ml/hr UFR. Blood flow and dialysate flow rates were 500 ml/min and 800 ml/min, respectively. The dialysate compartment was a 192-L open system for system A and a 6-L closed-loop system for system B. Samples from the SBS and dialysate compartm...
Objective: We investigated the effect of the vitamin D receptor agonist (VDRA), paricalcitol on b... more Objective: We investigated the effect of the vitamin D receptor agonist (VDRA), paricalcitol on biomarkers of endothelial dysfunction in patients with chronic kidney disease (CKD). Methods: This was an 8-week, randomized, blinded, controlled trial of paricalcitol versus placebo in 40 CKD patients. Serum chemistry, asymmetric dimethyl arginine (ADMA), soluble intracellular adhesion molecule (ICAM), vascular adhesion molecule (VCAM), biomarkers of vascular reactivity (Regulated on activation, normal T cell expressed and secreted (RANTES), vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP-1)) and pro-inflammatory cytokines (interleukin-1(IL-1) interleukin (IL-6), tumor necrosis factor-ii (TNFii)) at baseline, week 4 and week 8. Results: Paricalcitol treated patients had significant reductions in asymmetric dimethylarginine (ADMA) serum concentrations after 4 weeks of treatment. There were no statistically significant changes in mean concentrations of cy...
Background: Patients with chronic kidney disease (CKD) might be at high risk for bone disease. De... more Background: Patients with chronic kidney disease (CKD) might be at high risk for bone disease. Decreased functional kidney mass contributes to renal osteodystrophy, which might be exacerbated by certain drug therapies. Long-term (_>6 months) corticosteroid treatment is commonly prescribed in patients with glomerular disease, possibly causing bone loss both indirectly and directly, putting the patient at increased risk for fracture. The dual-energy x-ray absorptiometry (DXA) is the current "gold standard" for measuring osteoporosis-related fractures and works by passing ultrasound waves through bone to determine the structural anisotropy in the heel. Objective: This pilot study was designed to determine whether there is a correlation between DXA and quantitative ultrasound (QUS) in detecting corticosteroidinduced osteoporosis.
Older adults represent one of the fasting growing age groups in many countries including the Unit... more Older adults represent one of the fasting growing age groups in many countries including the United States [1]. This rate of growth is mirrored in the dialysis population. The number of incident dialysis patients over the age of 65 years is greater than 50 %. The number of incident dialysis patients greater than 75 years of age represents the fasting growing population of dialysis patients.
Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-t... more Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-the-counter misuse. Limited health literacy is associated with poor health outcomes. Identification of new strategies to assess literacy and numeracy could be useful in targeting effective education initiatives. Objective: To characterize numeracy and literacy skills related to non-steroidal anti-inflammatory drug labels in primary care patients. Methods: Patients were recruited and consented over an 8-month period after their regular primary care visit. Demographic information was collected and two instruments were administered to assess literacy and numeracy skills: (1) a medication label literacy instrument focused on non-steroidal anti-inflammatory drugs (MedLit-NSAID) and (2) a general healthy literacy-screening tool, the Newest Vital Sign. Two questions on the MedLit-NSAID instrument evaluated understanding of the Food and Drug Administration medication guide for non-steroidal anti-...
PURPOSE: Simplification of medication regimens may improve medication adherence, which is poor in... more PURPOSE: Simplification of medication regimens may improve medication adherence, which is poor in end stage kidney disease patients. Daily nocturnal home hemodialysis (DNHD) has proven benefits, however its effect on medication burden is unknown. We examined medication regimen changes in patients who changed from another form of kidney replacement to DNHD. METHODS: A retrospective analysis of 41 DNHD patients over a 2 year period was conducted. Demographic and medication regimen information was collected at baseline (prior to DNHD training), on day 1 of DNHD (following training), and at 3, 6, 12, 18, and 24 months of DNHD. Medication regimen changes, including number of medications, daily pill burden (PB), and number of total administration times per day were determined at each time point for each patient. Home medications used to treat anemia, renal osteodystrophy (ROD), and cardiovascular (CV) disease were analyzed for number of medications and PB. RESULTS: The mean age at the sta...
Purpose: Hemodialysis (HD) patients are at high risk for medication-related problems (MRPs). Rele... more Purpose: Hemodialysis (HD) patients are at high risk for medication-related problems (MRPs). Relevant MRPs can only be found if an accurate medication list is available. Electronic medication records (EMR) are often thought to improve medication reconciliation efforts. The goal of this study was to determine the accuracy of the EMR at an outpatient HD clinic. Methods: Medication reconciliation processes were applied at a local HD clinic to ensure accurate medication lists. A rigorous interview process was conducted to obtain medication lists for all clinic patients. The medication reconciliation process was completed by pharmacy interns during a 5-week advanced practice experience. Interns were trained and observed by a pharmacist preceptor. Reconciled medication lists were retrospectively compared with records from the EMR at the HD clinic. EMR medication entries were classified as correct or discrepant. HD clinic staff were provided with copies of reconciled medication lists and i...
The purpose of this study was to evaluate the feasibility of utilizing an in-vitro, closed loop h... more The purpose of this study was to evaluate the feasibility of utilizing an in-vitro, closed loop hemodialysis system as a method to assess drug clearance. Secondarily, this study tested the influence of variables (blood flow rate, dialysate flow rate, and type of filter) in the hemodialysis procedure on the clearance of vancomycin and gentamicin. An in-vitro, closed loop hemodialysis system was constructed. The vancomycin (30 mg/L) and gentamicin (25 mg/L) were added to a simulated blood system (SBS). Four conditions (C1-C4) were tested by defining the filter (Polyflux 170H or F180) and the blood and dialysate flow rates (BFR and DFR). All hemodialysis sessions were 3 hours in length and each condition was completed in duplicate. Dialysate effluent was collected in a 50 gallon polyethylene drum. Samples were collected (in duplicate) from the SBS and the dialysate effluent at baseline and at the end of the hemodialysis session. Samples were analyzed for vancomycin and gentamicin with ...
The use of natural products is increasing, but healthcare professionals may underestimate the use... more The use of natural products is increasing, but healthcare professionals may underestimate the use of these agents by patients. It is unknown whether natural product use differs between primary care and specialty clinic patients, such as those in a nephrology clinic. To compare patterns of natural product use between primary care and nephrology clinic patients. One thousand adult patients from each clinic were randomly mailed an anonymous questionnaire to determine current and past use of natural products. A total of 491 surveys were returned, for an overall response rate of 26% (25% primary care; 28% nephrology clinic). Current use of natural products was similar between the primary care and nephrology groups (34% vs 29%, respectively; p = NS). Primary care patients were more likely to have taken a natural product in the past (57% vs 45%; p < 0.05); Echinacea was the most common product taken by those patients (26%). Green tea was the most common natural product taken by nephrolo...
Intravenous iron is typically administered during the hemodialysis (HD) procedure. HD patients ma... more Intravenous iron is typically administered during the hemodialysis (HD) procedure. HD patients may be prescribed high-flux (HF) or high-efficiency (HE) dialysis membranes. The extent of iron sucrose and iron dextran removal by HD using HF or HE membranes and by ultrafiltration rate (UFR) is unknown. Two in vitro HD systems were designed and constructed to determine the dialyzabiltiy of iron from a simulated blood system (SBS) containing 100 mg iron sucrose or iron dextran (system A) or 1000 mg iron sucrose (system B). Both in vitro systems utilized a 6-L closed-loop SBS system that was subject to 4 different HD conditions conducted over 4 hours: HE membrane + 0 ml/hr UFR; HE membrane + 500 ml/hr UFR; HF membrane + 0 ml/hr UFR; HF membrane + 500 ml/hr UFR. Blood flow and dialysate flow rates were 500 ml/min and 800 ml/min, respectively. The dialysate compartment was a 192-L open system for system A and a 6-L closed-loop system for system B. Samples from the SBS and dialysate compartm...
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