Mortality from cardiovascular disease in patients on chronic hemodialysis (HD) is 10 to 20 times greater than in the general population. One major risk factor is renal dyslipidemia, characterised by an impaired catabolism of triglyceride (TG)-rich lipoproteins with accumulation of atherogenic remnant particles. A contributing factor may be derangement of the lipoprotein lipase (LPL) system, the major lipase in the catabolism of TG-rich lipoproteins. The functional pool of LPL is located at vascular surfaces, and is released by heparin into the circulating blood and extracted and degraded by the liver. Unfractionated heparin (UFH) is commonly used during dialysis to avoid clotting in the extracorporeal devices, but is increasingly replaced by various low molecular weight heparin (LMWH) preparations. Plasma LPL activity is usually lower after injection of LMWH which is therefore said to release less LPL and cause less disturbance of lipoprotein metabolism than UFH. However, animal studies have revealed that LMWH is as efficient as UFH in releasing LPL but is less efficient in retarding hepatic uptake. The aim of this study was to explore the effects of UFH and a LMWH (dalteparin) on LPL activity and TG concentrations in HD-patients compared with healthy controls, matched for age and gender. A disturbed LPL system might contribute to an impaired lipoprotein metabolism, and hence, an aggravated cardiovascular condition. An 8-hour primed infusion of UFH to controls gave rise to an initial peak of LPL activity within 30 minutes. The activity then dropped by almost 80% over the next two hours and levelled off to a plateau that corresponded to 15% of the peak level. When UFH was infused to HD-patients the curve for LPL activity resembled that for controls, but was reduced by 50% during the peak, while the plateau activities were comparable. The interpretation was that the functional pool, represented by the initial peak, was impaired in HD-patients, while the production of lipase molecules, reflected by the plateau, was only marginally reduced. During the peak of LPL activity TG decreased in both groups, but less in HD-patients, as was expected from the lower circulating lipase activity. During the plateau phase with low lipase activity, TG increased towards and beyond baseline values. When dalteparin was infused, the same pattern of plasma LPL activity was observed, although remarkably reduced. In controls the peak was only 30% and the subsequent plateau 40% compared with the activities during the UFH infusion. A bolus of UFH given when the LPL activity had levelled off to a plateau brought out about the same amount of activity, regardless of whether dalteparin or UFH had been infused. The conclusion was that both heparin preparations had reduced endothelial LPL to a similar extent, but that dalteparin less efficiently retarded the hepatic uptake of the enzyme. As a consequence to this, TG tended to reach higher levels after the dalteparin infusion. The LPL activities were further reduced in HD-patients during infusion with dalteparin, the peak was only 27% and the plateau 35% compared with the activities when UFH was infused. There was no decrease in TG, but rather a continuous increase, suggesting a profound depletion of functional LPL. In another study in HD-patients, two anticoagulation regimes based on present clinical practice were compared, and the doses were adjusted to the respective manufacturers recommendation. UFH was administered as a primed infusion, whereas dalteparin was given only as a single bolus pre-dialysis, not followed by an infusion. The results were in line with those in the experimental studies and indicate that also in the clinical setting LMWH interferes with the LPL system as least as much as an infusion of UFH does, and temporarily impairs lipolysis of TG. This interference might, in consequence, contribute to an aggravated cardiovascular condition in HD-patients.

ABSTRACT According to the annual report of Gambro, there were about 1,153,080 ESRD ( End Stage Renal Disease ) in the world-wide market; meanwhile, there were 294,050 ESRD in US market, 244,450 in European market, 206,000 in Japanese market. From Brooke Hollis¡¦ research report ( 1998 ), it indicated about 34% of Dialysis Center belonging to Dialysis Provider in the US market, and it forecasted the percentage should be increased up to 71% until 2001. Actually, there is about 66% of Dialysis Center hold by Dialysis Provider in the US market in 2001. In the Taiwan market, there were 31,106 ESRD ( 1999 ), depending on the statistic from Taiwan Society of Nephrology. The total expense of the dialysis therapy was about 13.37 billion in 1998. It increased about 14% per year, therefore, it expanded to 15.22 billion in 1999, then up to 17.57 billion in 2000. Since the fast growth of the Dialysis market in Taiwan and its potential, some of famous global industries, such as Fresenius, Gambro, and Baxter has get involved in Taiwan market and has directly entered the competition in the management of channel. Originally, Dialysis Agent was prototypical style for the Multiple-national industry in the Dialysis Market to develop cross-aboard. But, the competition type has became to be Dialysis Provider. Enfield Medical Inc. is one of successful companies during the development. During the thesis, the writer is interested in the strategy changing and developing, and make the research to analyze and to conclude the changing and the developing strategy of dialysis Industry.

No description available.

No description available.

Chronic Kidney Disease (CKD) is a risk factor for cardiovascular disease, early mortality, and kidney failure. There is a substantial burden of CKD in Manitoba’s rural and remote First Nations. Early detection and treatment of CKD in this population may be cost-effective. We constructed a Markov model comparing screening for CKD, by both estimated glomerular filtration rate and albuminuria, to usual care using the perspective of the health care payer. Patients were classified into initial risk groups based on results from the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis initiative. Screening in Manitoba’s rural and remote First Nations was associated with a $33,500/QALY incremental cost-effectiveness ratio in comparison to usual care. Restricting to communities accessible primarily by air travel, this ratio fell to $16,180/QALY. In conclusion, at a willingness-to-pay threshold of $50,000/QALY, screening for CKD in Manitoba’s rural and remote First Nations is likely cost-effective.

Die Bestimmung des Sollgewichts von Dialysepatienten stellt einen Balanceakt zwi-schen Hyper- und Hypovolämie und damit zwischen ischämischen Ereignissen durch Hypotonie und kardiovaskulären Komplikationen dar. Derzeit wird es anhand gering sensitiver bzw. unspezifischer und meist subjektiver klinischer Methoden ermittelt. Die Bioimpedanzanalyse als objektives, nicht invasives und zeitsparendes Verfahren steht zunehmend im Mittelpunkt von Studien, die der Behandlung von Dialysepatienten gewidmet sind. In dieser Arbeit wird die Untersuchung von 40 Patienten mit den Bioimpedanzanalysatoren Body Composition Monitor von Fresenius und Nutriguard-M von Data Input sowie mit klinischen Methoden beschrieben. Der Body Composition Monitor errechnet die Überwässerung des Patienten im Rahmen der Messung. Für die Berechnung der Überwässerung aus vom Nutriguard-M gemessenen Daten wurde eigens eine Formel erstellt. Obgleich hohe absolute Unterschiede zwischen den mittels der Bioimpedanzanalysatoren und der klinisch bestimmten Werte für die Überwässerung beobachtet wurden, waren positive Korrelationen der durch Bioimpedanzsanalyse gemessenen Überwässerung mit klinischen Parametern, wie dem Durchmesser der V. cava inferior, der Ausprägung von Unterschenkelödemen und dem mittleren arteriellen Blutdruck zum Nadir der Dialyse feststellbar. Verglichen wurden die Geräte nicht nur auf der Ebene der gemessenen Überwässerung, sondern auch auf den Ebenen der Rohwerte und der Anteile der Körperkompartimente am Körpergewicht. Dabei zeigten sich in Abhängigkeit des Verarbeitungsgrades der durch die Geräte gemessenen bzw. berechneten Größen sowohl geringe als auch hohe Abweichungen. Diese Erkenntnisse relativieren die Euphorie über die Möglichkeit der Anwendung der BIA in der Dialysetherapie.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Also available in print.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references. Also available in print.

Thematic paper (M.C.T.M. (Clinical Tropical Medicine))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services. LIRV has E-Thesis 0012 ; please contact circulation services.