The effects of 18 milligrams elemental zinc as zinc sulfate were investigated in 24 hemodialysis patients during a double blind study. The study was conducted at two different dialysis centers in Utah. Each patient was evaluated for a 12 week period. The effects of zinc supplementation were evaluated using the parameters of serum zinc, hair zinc, dialysate zinc, and objective and subjective taste evaluation procedures. To possibly clearify the above determination in zinc status, copper determination were made of the same parameters. In addition, determinations of serum ferritin, transferrin and iron levels were made. A three day diet record was used to document the dietary intakes of calories, protein, and zinc as well as indicate the balance of food groups in the diets. Patients were evaluated biweekly throughout the study period. There were a total of six evaluations made on each participant during the investigation. Complete data were collected on six patients in the treatment group, and on ten patients in the control group. Even though the sample size was small, results were very steady and values fell within narrow ranges for most parameters examined. The mean baseline serum zinc value (n = 24) was 56 micrograms per deciliter. Patients, by this value would be classified as zinc deficient. However, the hair zinc levels were within the normal range, and no other signs or symptoms of zinc deficiency were evident in any patient, other than altered taste. There were no differences between pre and post dialysis serum zinc levels, nor were there any consistent increases in zinc levels cleared from the plasma during dialysis. There were no increases seen in the serum zinc or hair levels in response to zinc supplementation. Furthermore, there was no significant improvement in the taste acuities of the treatment group patients compared to the controls. The low serum levels maintained were probably due to the redistribution of body zinc known to occur in uremia. Most patients improved their taste test scores. This displayed the learning phenomena that was inherent in the taste testing technique. Furthermore, hemodialysis patients and the failure of many subjects to identify all four tastants (sweet, sour, bitter, and salt) correctly. Daily dietary intakes of high bioglogical value protein and zinc by the patients were less than the amounts recommended by the National Dietary Counsil and the physicians. However, the daily intakes of protein (55 grams) and zinc (7.9 milligrams) were not limited to the level where deficiency signs or symptoms of either nutrient were seen. Copper serum levels were all within the normal range. The mean baseline level for all patients was 113 micrograms per deciliter. Copper status appeared unaffected by uremia or hemodialysis. Body stores of iron, determined by serum ferritin levels, ranged from possibly indicating iron deficiency to iron overload. The body iron stores did not correlate with patients’ responses to the oral zinc supplementation.

A insuficiência renal crônica (IRC) pode ocasionar uma série de alterações metabólicas no organismo, das quais o comprometimento do metabolismo do cálcio pode acarretar em desmineralização óssea e mineralização de tecidos moles, inclusive renal, favorecendo a perda ainda maior de néfrons. Na rotina, a avaliação do cálcio é geralmente realizada pela mensuração do cálcio sérico total, entretanto, a única fração biologicamente ativa deste mineral é representada pelo cálcio ionizado. Assim, o presente estudo teve como objetivo avaliar o cálcio ionizado em gatos sadios e em gatos com IRC, com o intuito de se obter subsídios para o melhor entendimento da homeostase do cálcio. Foram analisados 25 gatos sadios (grupo controle) e 19 gatos com IRC (grupo de estudo) em que foram determinadas as concentrações séricas de cálcio ionizado, cálcio total, sódio, potássio, cloreto, fósforo inorgânico, albumina, como também do pH sangüíneo e das variáveis da hemogasometria. Não foram observadas diferenças significantes entre os grupos controle e estudo no que se relaciona aos valores de cálcio total (controle = 9,52 ± 0,96; IRC = 9,48 ± 0,96) e cálcio ionizado (controle = 5,24 ± 0,18; IRC = 5,29 ± 0,53). Em ambos os grupos observou-se que o valor da fração de cálcio ionizado foi superior a 50% do valor do cálcio total, dado este que difere da literatura, principalmente quando se compara com a espécie canina. Quando da avaliação individual dos dados, foi constatado nos gatos com IRC que o valor de cálcio sérico ionizado encontrava-se aumentado em 31,6% dos animais e diminuído em 15,8%; entretanto, quando foi considerado o cálcio sérico total, a hipercalcemia não foi detectada em nenhum dos animais e a hipocalcemia observada em 5,3%. Ainda, nos gatos com IRC que apresentaram normocalcemia relacionada ao cálcio ionizado, quando da mensuração do cálcio sérico total, a normocalcemia só foi constatada em 50% daqueles animais. Diferença significante também foi observada entre os dois grupos no que se refere aos valores de fósforo inorgânico e algumas variáveis da hemogasometria, caracterizando discreta hiperfosfatemia e acidose metabólica nos gatos com IRC. Apesar da presença de acidose, que poderia resultar na diminuição do cálcio ligado à albumina e assim justificar o desenvolvimento de hipercalcemia relacionada ao cálcio ionizado nos gatos com IRC, a normocalcemia e a hipocalcemia também foram detectadas, demonstrando-se, assim, a importância de se mensurar o cálcio ionizado, pois somente a mensuração do cálcio sérico total não refletiu a real condição do cálcio biologicamente ativo e, ainda, que devem ser investigados outros mecanismos que possam influenciar a fração de cálcio ionizado. / Chronic renal failure (CRF) can cause many metabolic abnormalities in the body, and one of these is represented by alteration in calcium metabolism, and the animal can develop demineralization and calcification of soft tissues, including renal parenchyma, which can facilitate the progression of renal damage. In routine, calcium is usually evaluated by measurement of total serum calcium, however, the biologically active fraction is represented by ionized calcium. Thus, the aim of the present study was to evaluate serum ionized calcium in healthy cats and in cats with chronic renal failure. Twenty-five clinically normal cats (control group) and nineteen cats with CRF were evaluated, and serum ionized calcium, total calcium, sodium, potassium, chloride, phosphorus, albumin, as well as blood pH and blood gases parameters were measured. No difference between normal cats and cats with CRF concerning total calcium (control = 9.52 ± 0.96; CRF = 9.48 ± 0.96) and ionized calcium (control = 5.24 ± 0.18; CRF = 5.29 ± 0.53) were observed. In both groups, the fraction of ionized calcium represented more than 50% of total calcium value, and the data were different from those reported in the literature, mainly concerning dogs. In cats with CRF, when the data were evaluated individually, serum ionized calcium was increased in 31.6% of the animals and decreased in 15.8%; however considering serum total calcium, hypercalcemia was not detected in any of those cats and hypocalcemia was observed in 5.3%. In addition, from the cats with CRF that presented normocalcemia related to ionized calcium, only 50% of those animals showed normocalcemia when total calcium was determined. Difference between control group and the group of cats with CRF concerning phosphorus and some parameters of blood gases were detected, observing slight phosphatemia and metabolic acidosis. The presence of acidosis can possible result in decrease of albumin bound to calcium and in consequence justify the hypercalcemia related to ionized calcium observed in cats with CRF, but normocalcemia and hypocalcemia were also observed, showing the importance of the measurement of ionized calcium, because total serum calcium did not reflect the real status of calcium that is considered the biologically active form; in addition, other mechanisms that can compromise the ionized calcium fraction should be investigated.

No description available.

No description available.

This dissertation describes how to apply pharmacokinetic simulations and modeling in a clinical setting to monitor and adjust drug dosing in special patient populations. Pharmacokinetic simulations were used to investigate efficacy and risk of drug toxicity of a new dosing regimen for aminoglycoside antibiotics when administered to renal failure patients. The current method of administering aminoglycosides to renal failure patients is to dose the drug during the last half hour of dialysis sessions. The new proposed method suggests dosing the drug during the first half hour of the dialysis session. Using one-compartment model infusion equations, both methods were simulated to predict drug peaks, troughs and area under the curves. These parameters were used to compare both dosing regimens to find out if the proposed dosing regimen can be suggested in a clinical setting to obtain the same efficacy and lower risk of drug toxicity. The dissertation then describes a prospective clinical study in chronic renal failure patients who received the same tobramycin dose using current and proposed dosing regimens. Results from the clinical study confirm pharmacokinetic simulations and modeling outcomes. Results suggest that both regimens have the same efficacy, but the new proposed method is expected to have lower risk of drug toxicity. The dissertation also describes a retrospective study for vancomycin dosing in renal failure patients. The objective was to confirm that pharmacokinetic modeling could be used to predict and adjust vancomycin dosing for this special population. Vancomycin trough concentrations obtained from patient medical records were compared to predictions obtained using a pharmacokinetic model. It was concluded that there was no statistically significant difference between actual and predicted vancomycin trough concentrations. These results suggest that the pharmacokinetic model can be used to predict and adjust vancomycin dosing to chronic renal failure population. The last part of this dissertation describes evaluation of insulin glargine effect on glycemic control and weight change in a diabetic population. Glycemic control and weight of patients before and after initiation of insulin glargine were evaluated retrospectively. Results showed that initiation of insulin glargine improved glycemic control while weight remained relatively stable. / Graduation date: 2005

Thesis (M. Nurs.)--University of Hong Kong, 2006.

No description available.

To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).

The purpose of this cross-sectional, descriptive, correlational study was to describe the relationships among demographic factors (age, gender, education, income), perceived severity of illness, perceived barriers to action, perceived self-efficacy, and interpersonal influences (social support) and health-promoting behaviors (HPB) and to identify predictors of HPB. A nonprobability sample of 110 participants with Chronic Renal Failure (CRF) was recruited from the outpatient clinic of Burirum hospital and Surin hospital located in north-eastern Thailand. All participants were individually interviewed by the principal investigator in a private area within an outpatient clinic. Six variables were significantly correlated with the HPB. They were age, education, perceived severity of illness, perceived barriers to action, perceived self-efficacy and social support. According to the results from the analyses of demographic data and HPB, participants who were younger and had higher educational levels practiced more HPB. From the analyses of perceived severity of illness, perceived barriers to action, perceived self-efficacy, and social support and HPB, the results showed that participants with lower levels of perceived severity of illness and lower levels of perceived barriers to action reported better HPB. In contrast, the participants with higher levels of perceived self-efficacy and social support reported better HPB. By using a stepwise multiple regression analysis, two predictors were identified from 8 predictor variables, and those two accounted for 78.2% (p < 0.01) of the variance in HPB. Two variables that contributed significantly to the variance in the HPB were perceived self-efficacy ([beta] =.769, p < 0.01), and social support ([beta] = .162, p < 0.01); whereas age, gender, income, educational level, perceived severity of illness, and perceived barriers did not contribute to the variance in the HPB. The study found that participants who experienced better perceived self-efficacy and social support reported better HPB. In contrast age, gender, income, educational level, perceived severity of illness, and perceived barriers did not enter as predictors in this stepwise regression equation. / text

No description available.