Dialysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DIALYSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P...

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DIALYSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Dialysis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83885-2 1. Dialysis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on dialysis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DIALYSIS ................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Dialysis ....................................................................................... 33 E-Journals: PubMed Central ....................................................................................................... 93 The National Library of Medicine: PubMed ................................................................................ 99 CHAPTER 2. NUTRITION AND DIALYSIS........................................................................................ 147 Overview.................................................................................................................................... 147 Finding Nutrition Studies on Dialysis ...................................................................................... 147 Federal Resources on Nutrition ................................................................................................. 160 Additional Web Resources ......................................................................................................... 161 CHAPTER 3. ALTERNATIVE MEDICINE AND DIALYSIS ................................................................. 163 Overview.................................................................................................................................... 163 National Center for Complementary and Alternative Medicine................................................ 163 Additional Web Resources ......................................................................................................... 196 General References ..................................................................................................................... 198 CHAPTER 4. DISSERTATIONS ON DIALYSIS ................................................................................... 199 Overview.................................................................................................................................... 199 Dissertations on Dialysis ........................................................................................................... 199 Keeping Current ........................................................................................................................ 203 CHAPTER 5. CLINICAL TRIALS AND DIALYSIS .............................................................................. 205 Overview.................................................................................................................................... 205 Recent Trials on Dialysis ........................................................................................................... 205 Keeping Current on Clinical Trials ........................................................................................... 210 CHAPTER 6. PATENTS ON DIALYSIS .............................................................................................. 213 Overview.................................................................................................................................... 213 Patents on Dialysis .................................................................................................................... 213 Patent Applications on Dialysis ................................................................................................ 247 Keeping Current ........................................................................................................................ 271 CHAPTER 7. BOOKS ON DIALYSIS .................................................................................................. 273 Overview.................................................................................................................................... 273 Book Summaries: Federal Agencies............................................................................................ 273 Book Summaries: Online Booksellers......................................................................................... 286 The National Library of Medicine Book Index ........................................................................... 293 Chapters on Dialysis .................................................................................................................. 295 Directories.................................................................................................................................. 317 CHAPTER 8. MULTIMEDIA ON DIALYSIS ....................................................................................... 319 Overview.................................................................................................................................... 319 Video Recordings ....................................................................................................................... 319 Audio Recordings....................................................................................................................... 323 Bibliography: Multimedia on Dialysis....................................................................................... 324 CHAPTER 9. PERIODICALS AND NEWS ON DIALYSIS .................................................................... 327 Overview.................................................................................................................................... 327 News Services and Press Releases.............................................................................................. 327 Newsletters on Dialysis ............................................................................................................. 331 Newsletter Articles .................................................................................................................... 333 Academic Periodicals covering Dialysis .................................................................................... 338 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 339 Overview.................................................................................................................................... 339 U.S. Pharmacopeia..................................................................................................................... 339

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Commercial Databases ............................................................................................................... 341 Researching Orphan Drugs ....................................................................................................... 342 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 345 Overview.................................................................................................................................... 345 NIH Guidelines.......................................................................................................................... 345 NIH Databases........................................................................................................................... 347 Other Commercial Databases..................................................................................................... 353 APPENDIX B. PATIENT RESOURCES ............................................................................................... 355 Overview.................................................................................................................................... 355 Patient Guideline Sources.......................................................................................................... 355 Finding Associations.................................................................................................................. 385 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 387 Overview.................................................................................................................................... 387 Preparation................................................................................................................................. 387 Finding a Local Medical Library................................................................................................ 387 Medical Libraries in the U.S. and Canada ................................................................................. 387 ONLINE GLOSSARIES................................................................................................................ 393 Online Dictionary Directories ................................................................................................... 395 DIALYSIS DICTIONARY............................................................................................................ 397 INDEX .............................................................................................................................................. 499

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with dialysis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about dialysis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to dialysis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on dialysis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to dialysis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on dialysis. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DIALYSIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on dialysis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and dialysis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “dialysis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Cardiac Rhythm Disturbances in Children on Hemodialysis Source: Pediatric Nephrology. 17(10): 837-841. October 2002. Contact: Available from Springer-Verlag. Service Center Secaucus, 44 Hartz Way, Secaucus, NJ 07094. (201) 348-4033. Summary: Cardiovascular complications are the leading causes of morbidity (related illness) and mortality (death) in adult dialysis patients. This article reports on a study that evaluated the cardiovascular system of children on hemodialysis (HD), with special focus on rhythm disturbances. The study included nine patients, aged 15.6 years (plus or minus 4.1 years), who underwent electrocardiographic examination (ECG), echocardiography, and 24 hour blood pressure measurement. Patients had been on HD for a median period of 7 months (range 1 to 29 months). The authors found that rhythm

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disturbances were rare, with slow monomorphic ventricular tachycardias being the only significant finding. The absence of late potentials and normal QT dispersion suggest that myocardial electrical excitability and recovery are preserved in children on HD. 2 tables. 31 references. •

Cost Analysis of Ongoing Care of Patients with End-Stage Renal Disease: The Impact of Dialysis Modality and Dialysis Access Source: American Journal of Kidney Diseases. 40(3): 611-622. September 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Care of patients with end stage renal (kidney) disease (ESRD) is important and resource-intense. To enable ESRD programs to develop strategies for most costefficient care, an accurate estimate of the cost of caring for patients with ESRD is needed. This article reports on a study undertaken to develop an updated and accurate itemized description of costs and resources required to treat patients with ESRD on dialysis therapy and to contrast the differences in resources required for various dialysis modalities. The study included 166 patients who had been on dialysis therapy for longer than 6 months. Costs considered included those related to outpatient dialysis care, inpatient care, outpatient nondialysis care, and physician claims. Results showed overall annual cost of care for in-center care was US $51,252; for satellite care, $42,057; for home care hemodialysis $29,961; and for peritoneal dialysis $26,959. Among patients treated with hemodialysis, the costs of vascular access related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft. The authors conclude that, to maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home or self care hemodialysis and peritoneal dialysis. 4 tables. 41 references.

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Back to Basics: The Arteriovenous Graft: How to Use it Effectively in the Dialysis Unit Source: Nephrology News and Issues. 16(12): 41-42, 44,46, 48-49. December 2002. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635. Summary: Compared to the arteriovenous (AV) fistula (using the patient's own veins and arteries), the use of an AV graft (made from polytetrafluoroethylene) as a patient's dialysis lifeline leads to a shorter lifespan for the access, with more complications and potentially more procedures to keep the access functional. However, many patients still require the placement of an AV graft as their vascular access for hemodialysis. An AV graft requires special care and use to help prolong its life span and prevent complications. This article reviews basic nursing care and cannulation (insertion of the tube for dialysis) of an AV graft. Topics include materials, implantation, puncturing, physical assessment (inspection, palpation, auscultation), direction of blood flow, the National Kidney Foundation quality guidelines, cannulation of the AV graft, and hemostasis. One sidebar lists a sample dialysis policy and procedure format that combines all the graft cannulation information into a procedure for dialysis staff for use in proper AV graft cannulation. 2 tables. 7 references.

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Patient Satisfaction with Care and Behavioral Compliance in End-stage Renal Disease Patients Treated with Hemodialysis Source: American Journal of Kidney Diseases. 39(6): 1236-1244. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Compliance with the hemodialysis (HD) prescription is an important predictor of patient outcome. Although there is interest in the concept of patient satisfaction with medical care and caregivers, relatively few such data exist regarding HD patients. This article reports on a study that examined whether associations exist between patient satisfaction with medical personnel, depressive affect, social support levels, and behavioral compliance with prescribed HD treatment. The study included 79 HD patients who went through an interview process that assessed depression, social support, and perception of satisfaction with dialysis staff. Medical and treatment data, Karnofsky functioning and severity of illness scores, and behavioral and laboratory compliance measures were determined. There was no association between patient satisfaction with care and level of depressive affect. A relationship was found between patient satisfaction with care with their nephrologist and attendance at dialysis sessions. Patients who had a poor perception of satisfaction with their nephrologist had poorer attendance at dialysis sessions. There was no relationship between behavioral compliance and patient perception of ancillary HD staff. In addition, patient perception of satisfaction with staff was related to perception of social support, protein catabolic rate, and serum albumin concentration, all of which have been linked to survival. The authors conclude that the nephrologist has a crucial role in patient compliance. These results suggest that interventions to improve patient perception of physician support may also improve patient adjustment and possibly survival. 6 tables. 28 references.

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Influence of Dialysis Membranes on Outcomes in Acute Renal Failure: a MetaAnalysis Source: Kidney International. 62(5): 1819-1823. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250. Summary: Considerable controversy exists as to whether synthetic (more biocompatible) dialysis membranes improve outcome in patients with acute renal (kidney) failure (ARF) compared to cellulose-based membranes. This article reports on a meta-analysis performed on all previously published prospective trials comparing the use of synthetic membranes with cellulose-based membranes for hemodialysis (HD) in patients with ARF. Of the 10 prospective trials identified, 8 trials (867 patients) provided survival data and six trials (641 patients) provided data on recovery of renal function. The authors conclude that synthetic membranes appear to confer a significant survival advantage over cellulose-based membranes. The authors could not demonstrate a similar benefit with use of synthetic membranes over cellulose-based membranes for recovery of renal function, but sample size was limited. The authors note that the survival disadvantage for cellulose-based membranes may be limited to unsubstituted cellulose (cuprophane) membranes. 2 figures. 1 table. 18 references.

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Predialysis Management and Predictors for Early Mortality in Uremic Patients who Die Within One Year After Initiation of Dialysis Therapy Source: Renal Failure. 24(2): 197-205. 2002.

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Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Despite improvements in dialysis therapy, the mortality (death) rate of patients with end stage renal (kidney) disease (ESRD) has remained high. A relatively high proportion of uremic patients dies within one year after the initiation of dialysis treatment. This article reports on a study that evaluated predictors for this early mortality in patients with ESRD. A total of 66 uremic (having toxic levels of urea in the blood) patients were included in the study. Patients were divided into those who survived less than 1 year (n = 17) and those who survived more than 1 year (n = 49). The authors compared the prevalence of diabetes and hypertension and of vascular diseases as well as the prevalence of heart insufficiency and left ventricular hypertrophy (LVH, an overgrowth of one of the heart chambers). The patients with survival of less than 1 year were significantly older and showed a lower BMI (body mass index) than those who survived longer than 1 year. The prevalence of diabetes, cardiac insufficiency, cardiovascular disease, and peripheral vascular diseases was significantly higher in the patients with early mortality. The prevalence of hypertension (high blood pressure) was similar in both groups, however, the prevalence of LVH was significantly higher in the patients who survived less than one year. Hyperhydration was the most common indication for the start of dialysis in patients with early mortality. Cardiac insufficiency was the most common cause of death in these subjects (n = 10). Six individuals (12 percent) died within four weeks after initiating dialysis therapy. The authors conclude that there are several predictors for early mortality in ESRD patients, including high age, low BMI, the presence of diabetes, coronary heart disease, heart insufficiency and LVH, as well as low serum albumin (blood protein) levels. 4 tables. 20 references. •

Analysis of Renal Bone Disease Treatment in Dialysis Patients Source: American Journal of Kidney Diseases. 39(6): 1270-1277. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: End Stage Renal Disease Network 11 initiated a renal (kidney) osteodystrophy quality improvement activity in 1999. One component was the collection and assessment of dialysis facility renal osteodystrophy protocols, whereas another component was the analysis of bone disease-related medication use. Dialysis facilities (n = 288) were invited to submit protocols. A model bone disease and mineral metabolism protocol was developed as the standard for comparison. This article discusses the analysis of renal bone disease treatment in dialysis patients. From the model protocol, an instrument was created to evaluate eight key areas: baseline screening of key laboratory data, dietary intervention, phosphate binder use, vitamin D use, monitoring of key laboratory indicators, management of hypercalcemia (too much calcium in the blood), oversuppression of parathyroid hormone (PTH), and guidelines for both hemodialysis and peritoneal dialysis patients. A bone disease related prescription survey was completed for 749 randomly selected patients. Although 45 percent of facilities had six or more points on the evaluation tool, protocols were still incomplete compared with the model. Most patients were prescribed a phosphate binder; however, 31.8 percent had average phosphorus levels greater than the guidelines during the 3 month period. The authors conclude that there is opportunity to improve renal osteodystrophy protocols in Network 11 and reinforce potential hazards of sustained hyperphosphatemia and hyperparathyroidism. 2 figures. 6 tables. 22 references.

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Preliminary Observations of Sildenafil Treatment for Erectile Dysfunction in Dialysis Patients Source: American Journal of Kidney Diseases. 37(1): 134-137. January 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Erectile dysfunction (ED, formerly called impotence) is common in dialysis patients. This article reports the authors' experience with sildenafil citrate (Viagra) in patients who are undergoing dialysis therapy. Male subjects attending the Outpatient Dialysis Unit at the University of Pennsylvania who were prescribed sildenafil by their primary physician or nephrologist were asked to complete the International Index of Erectile Function before their first dose of sildenafil and after at least 4 weeks of therapy. Subjects' mean age was 50.3 years (plus or minus 14.63 years). Ninety-three percent of the subjects were black. Based on a global efficacy question, 66.7 percent of the subjects believed that treatment had improved their erections. Subjects reported no increase sexual desire despite experiencing a significant increase in erectile function, orgasmic function, and satisfaction with intercourse. The authors summarize that sildenafil was well tolerated in a selected group of patients who reported improved sexual function with no major adverse effects. The authors stress that as advances are made to improve survival on hemodialysis therapy, improvement in quality of life should also be of utmost importance and should include an evaluation for ED. 1 table. 19 references.

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Determinants of Modality Selection Among Incident US Dialysis Patients: Results from a National Study Source: JASN. Journal of the American Society of Nephrology. 13(5 ): 1279-1287. May 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: Few studies have comprehensively addressed the association of social factors and elements of pre end stage renal disease (ESRD) care with the selection of dialysis modality. This article reports on a study that examined the relative contribution of demographic, medical, social, pre-ESRD, and geographic factors to modality assignment (hemodialysis versus peritoneal dialysis) among new ESRD patients. Data were collected from the Dialysis Mortality and Morbidity Wave 2 Study, a national random sample of 4,025 patients in 1996 and 1997. In multivariate analyses, the selection of peritoneal dialysis (PD) over hemodialysis (HD) was significantly associated with younger age, white race, fewer comorbid conditions, and lower serum albumin (levels of protein in the blood). Greater use of PD was seen in patients who were employed, married, and living with someone before the start of ESRD and in those who were more autonomous and more accomplished educationally. Patients referred earlier to a nephrologist (kidney specialist) and seen more frequently by a nephrologist in the pre ESRD period had greater PD use. Of the factors listed, 25 percent of the variability in PD use was explained by demographic factors (4.1 percent), comorbid factors (1.2 percent), social and pre-ESRD factors (14.5 ercent), and geographic (5.2 percent) factors. This study underscores the importance of patient education, autonomy, and a strong social support system in improving rates of PD use in the United States. The author concludes that since pre-ESRD patient care is an important contributor to PD use in the United States, greater efforts should be expended in improving its delivery earlier in the preESRD period. 2 figures. 5 tables. 23 references.

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Travel Tips for Dialysis Patients on How to Prepare for and Enjoy a Dream Vacation Source: For Patients Only. 15(1): 16-18. February 2002. Contact: Available from For Patients Only. 18 East 41st Street, New York, NY 10017. (818) 704-5555. Fax (818) 704-6500. Summary: For patients on hemodialysis or peritoneal dialysis, planning a vacation or business trip can seem like a huge task. This article walks readers through the process of planning a trip in six steps: before purchasing the plane tickets (early arrangements), finding a dialysis facility, making contact with the dialysis center away from home, sending medical records, two weeks before the departure date, and steps to take upon arrival at the vacation destination. The author encourages readers to use the services of their dialysis coordinator at home. He or she can help schedule the trip, locate a suitable dialysis center, handle medical forms and payment information, and locate doctors for emergencies. The article concludes with a brief list of resources for traveling patients. 2 references.

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30 Years of Learning: Dialysis Patient Shares a Lifetime of Seeking and Finding Answers Source: Renal Rehabilitation Report. 10(3): S4-S5. Fall 2002. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635. Summary: From the moment of diagnosis, people with kidney disease confront a wide range of questions about their condition, its treatment, and the effects each will have on their lives. This article shares the experiences of one patient who has been on dialysis for 30 years and who explains how he has spent a lifetime seeking and finding answers. The author contends that information has helped him become involved in self care, maintain a regular exercise program, and continue working.

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Dialysis Catheters: How and When to Use Them Source: Nephrology News and Issues. 16(7): 54-57. June 2002. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635. Summary: Hemodialysis catheters allow immediate vascular access for urgent hemodialysis. Careful attention and cooperation from the entire dialysis team is required to keep hemodialysis catheters performing at their maximum potential. This article is intended to provide dialysis staff with a good working knowledge base of proper hemodialysis catheter care and use to prevent potential life threatening complications. Topics include guidelines for the use of hemodialysis catheters in acute care, the types of catheters recommended, the use of ultrasound to direct the insertion of these catheters, and the symptoms of exit site, tunnel tract, or systemic infections (all of which require prompt removal of noncuffed catheters). The article also addresses the goals of access placement and use of catheters for chronic dialysis. The author covers blood flow rates, pre-dialysis patient assessment, catheter related occlusion, definitions of catheter dysfunction, and sources for continuing education for nurses and other dialysis staff members. 1 table. 3 references.

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Hemofiltration and Peritoneal Dialysis in Infection-Associated Acute Renal Failure in Vietnam Source: New England Journal of Medicine. 347(12): 895-902. September 19, 2002. Summary: In some parts of the world, peritoneal dialysis (PD) is widely used for renal replacement therapy (RRT) in acute renal (kidney) failure (ARF). In resource-rich countries, it has been supplanted in recent years by hemodialysis (HD) and, most recently, by hemofiltration and associated techniques. This article reports on an open, randomized comparison study of pumped venovenous hemofiltration and peritoneal dialysis in patients with infection-associated ARF in an infectious disease referral hospital in Vietnam. The study included 70 adult patients with severe falciparum malaria (n = 48) or sepsis (n = 22); 34 were assigned to hemofiltration and 36 to PD. The mortality rate was 47 percent (17 patients) in the group assigned to PD, compared to 15 percent (5 patients) in the group assigned to hemofiltration. The rates of resolution of acidosis and of decline in the serum creatinine concentration in the group assigned to hemofiltration were more than twice those in the group assigned to peritoneal dialysis and RRT was required for a significantly shorter period. The cost of hemofiltration per survivor was less than half that of PD, and the cost per life saved was less than one third. The authors conclude that hemofiltration is superior to peritoneal dialysis in the treatment of infection-associated acute renal failure. 2 figures. 2 tables. 11 references.

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What Do American Nephrologists Think About Dialysis Modality Selection? Source: American Journal of Kidney Diseases. 37(1): 22-29. January 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: In the United States, 87.3 percent of the patients with end stage renal disease (ESRD) requiring dialysis are treated with hemodialysis (HD) and 12.7 percent with peritoneal dialysis (PD). This represents a greater use of HD than in many other nations. This article reports on a survey questionnaire mailed to members of the National Kidney Foundation NKF Council on Dialysis to better understand the attitudes of American nephrologists toward dialysis modality decisions. The authors received responses from 240 of 507 nephrologists (47.3 percent). The respondents were heavily involved in clinical dialysis work. Results showed that decisions regarding modality selection were strongly based on patient preference (4.54 on a scale of 1 to 5), quality of life (4.18), morbidity (4.02), and mortality (3.90), whereas the least important factors reported were facility reimbursement (2.09) and physician reimbursement (1.98). When asked about the current use of modalities, hospital based HD and full care HD were believed to be overused (2.63 for each on a scale of 1 to mean vastly overused to 5 meaning vastly underused), whereas home HD (4.29), continuous ambulatory PD (3.71), and cycler PD (3.59) were underused. A hypothetical question about optimal modality distribution to maximize survival or cost effectiveness showed that HD should constitute 71 or 66 percent of dialysis. PD use would increase between two and threefold over current practices. These results suggest that American nephrologists believe home therapies are underused. Because modality distribution is an important determinant of costs and possibly of outcomes in patients with ESRD, there is an urgent need for further research in this area. 5 figures. 1 table. 27 references.

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Correlates of Excess Comorbidity and Major Complications in Diabetic Patients on Maintenance Hemodialysis Source: Dialysis and Transplantation. 24(1): 16-18, 20. January 1995.

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Contact: Available from Creative Age Publications, Inc. 7628 Densmore Avenue, Van Nuys, CA 91406-2088. (800) 624-4196; (818) 760-8983. Summary: In this article, the authors report on their work to identify, by means of multiple regression analysis, any subset of hemodialysis patients with diabetes at increased risk for blindness, limb/digit amputation, wheelchair dependent, hypertension requiring drug treatment, and/or other comorbid medical conditions. They also compared the difference in prevalence of comorbid medical conditions and major complications between the insulin-treated patients with diabetes and those not on insulin. One hundred forty-six patients with diabetes were studied; results show that men were at more risk for blindness than women, and the risk of amputation increased with advancing age in both black men and women. Older patients and those on insulin therapy were more likely to be wheelchair dependent than their respective counterparts. Also, the prevalence of comorbid medical problems increased with advancing age. Among white patients, men and those on hemodialysis for a longer duration were more likely to be receiving antihypertensive therapy than their respective counterparts. 2 tables. 12 references. (AA-M). •

Why Patients With ESRD Do Not Select Self-Care Dialysis as a Treatment Option Source: American Journal of Kidney Diseases. 41(2): 380-385. February 2003. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: In-center hemodialysis (HD) is the most prevalent and resource-intensive form of dialysis in North America, despite many patients being capable of performing dialysis themselves. This article reports on a study undertaken to describe reasons why in-center HD patients choose not to perform self-care dialysis and to identify variables associated with a negative attitude toward self-care dialysis. Results found that the most prevalent knowledge barrier was a lack of a satisfactory explanation of the various techniques. The most prevalent attitude barriers were that patients should not dialyze without direct supervision, fear of failure to perform self-care dialysis adequately, and fear of social isolation. The most prevalent skill barriers were needle phobia and lack of space at home. Variables significantly associated with a negative attitude toward selfcare dialysis were the interaction of age and fear of substandard care, needle phobia, fear of change, fear of social isolation, and unwillingness to remain awake during dialysis. The authors note that these results are being used to direct changes to their own treatment program, changes that are aimed at increasing the uptake of self-care hemodialysis. More self care HD will benefit both patients and health care providers and may offer a solution to nursing and resource shortages. 2 tables. 22 references.

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Acute Pancreatitis in Peritoneal Dialysis and Haemodialysis: Risk, Clinical Course, Outcome, and Possible Aetiology Source: Gut. 46(3): 385-389. March 2000. Contact: Available from BMJ Publishing Group. P.O. Box 590A, Kennebunkport, ME 04046. (800) 236-6265. Summary: It has been suggested that the incidence of acute pancreatitis (pancreas infection) in patients with end stage renal disease (ESRD, kidney failure) is increased. This article reports on a study undertaken to assess the risk of acute pancreatitis in patients on long term peritoneal dialysis (PD) and long term hemodialysis (HD) compared with the general population, to evaluate its clinical course and outcome, and

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to identify possible etiological factors. All patients from a large general hospital in The Netherlands who were maintained on long term PD or HD (total dialysis time more than six weeks) from January 1989 to March 1998 were included. In 269 patients on HD (total of 614 person years), one patient developed an attack of acute pancreatitis. Patients on hemodialysis did not show an increased risk for acute pancreatitis compared with the general population. In 128 patients on PD (total of 241 person years), seven patients had nine attacks of acute pancreatitis. Patients on PD had a significantly and highly increased risk for acute pancreatitis. Mortality in this series of nine attacks was 11 percent. No single etiological risk factor could be identified. The authors conclude that the risk of acute pancreatitis in patients on long term PD is significantly and highly increased compared with the general population. 3 tables. 22 references. •

Mortality Differences by Dialysis Modality Among Incident ESRD Patients With and Without Coronary Artery Disease Source: JASN. Journal of the American Society of Nephrology. 14(2): 415-424. February 2003. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: It is unclear whether peritoneal dialysis (PD) compared with hemodialysis (HD) confers a survival advantage in end stage renal disease (ESRD) patients with coronary artery disease (CAD). This hypothesis was tested in a national cohort of 107,922 patients starting dialysis therapy between May 1, 1995, and July 31, 1997. Patients with and without diabetes mellitus (DM) were analyzed separately. Among DM patients, those with CAD treated with PD had a 23 percent higher relative risk (RR) of death compared with similar HD patients, whereas patients without CAD receiving PD had a 17 percent higher RR compared with HD. Among non-DM patients, those with CAD treated with PD had a 20 percent higher RR compared with HD patients, whereas patients without CAD had similar survival on PD or HD. The authors conclude that the mortality (death) risk for new ESRD patients with CAD differed by treatment modality. In both DM and nonDM patients, those with CAD treated with PD had significantly poorer survival compared with HD. Whether differences in solute clearance or cardiac risk profiles between PD and HD may explain these findings deserves further investigation. 2 figures. 6 tables. 41 references.

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Renal Contraction Therapy for Enlarged Polycystic Kidneys by Transcatheter Arterial Embolization in Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(3): 571-579. March 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Kidneys of patients with autosomal dominant polycystic kidney disease (ADPKD) usually continue to increase in size, even after patients begin dialysis therapy, and the mass effects may lead to severe complications. Such external conventional therapies as surgical and laparoscopic procedures have not yielded satisfactory results. This article reports on a technique in which the authors attempted renal contraction therapy in patients with ADPKD by renal transcatheter arterial embolization (TAE) using intravascular coils. After obtaining informed consent, the authors selected anuric (without urine formation) patients on dialysis therapy with markedly distended abdomens or macroscopic hematuria (blood in the urine) (n = 64). After therapy, renal sizes decreased to 73.8 percent, 61.7 percent, and 53.4 percent of preinterventional

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values at 3, 6, and 12 months after therapy, respectively. Abdominal circumference and dry weight were significantly decreased at 3, 6, and 12 months, compared with baseline values before therapy. This therapy was effective for all patients. Serious complications were not seen after this treatment, although such minor complications as fever and flank pain were observed within the first week after the procedure. The authors conclude that treatment with TAE is a safe and effective procedure that has resulted in improvement in the quality of life and nutritional status of patients with ADPKD. 8 figures. 16 references. •

Effect of Increased Dialysate Volume on Peritoneal Surface Area Among Peritoneal Dialysis Patients Source: JASN. Journal of the American Society of Nephrology. 13 (10): 2554-2559. October 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: Large dialysate volumes are often required to increase solute clearance for peritoneal dialysis patients. The resulting increase in solute clearance might be attributable to an increased plasma to dialysate concentration gradient or to an increased effective peritoneal surface area. One of the factors affecting the latter is the peritoneal surface area in contact with dialysate (PSA-CD). This study was undertaken to estimate the change in PSA-CD after a 50 percent increase in the instilled dialysate volume for patients undergoing peritoneal dialysis. The peritoneal cavity of 10 peritoneal dialysis patients was filled with a solution containing dialysate, half-isotonic saline solution, and contrast medium. Peritoneal function tests and CT scanning of the abdomen were performed twice for each patient, after instillation of a 2 liter or 3 liter solution. The data demonstrate that increasing the instilled dialysate volume by 50 percent for peritoneal dialysis patients results in significant increases in the PSA-CD and Kbd (the permeability-surface area product or mass area transfer coefficient at time 0 of the dwell). 1 figure. 41 references.

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Prevalence of Constipation in Continuous Ambulatory Peritoneal Dialysis Patients and Comparison with Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(6): 1292-1299. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Many hemodialysis patients have constipation. The frequency of constipation has not been rigorously evaluated in patients who use continuous ambulatory peritoneal dialysis (CAPD) as their method of kidney (renal) replacement therapy, however. This article reports on a study that featured a survey on constipation in CAPD patients and compared the findings with those in hemodialysis patients through a questionnaire. Daily dietary fiber and potassium intake were calculated from the patient's dietary records. In the questionnaire, patients were asked about bowel frequency, stool consistency, straining, and use of laxatives and resins. The frequency of constipation was 28.9 percent in 204 CAPD patients and 63.1 percent in 268 hemodialysis patients. Only 3.4 percent of CAPD patients needed resin to avoid hyperkalemia (high levels of potassium in the blood). Of hemodialysis patients, 49 percent needed resin. Among the 261 hemodialysis patients, 205 (78.5 percent) suppressed an urge to defecate during hemodialysis therapy. Potassium and total dietary fiber intake per day were higher in CAPD patients than in hemodialysis patients.

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The results suggest that constipation occurs less frequently in CAPD patients than in hemodialysis patients. The authors hypothesize that the low rate of constipating drug administration, dialysis modality-based lifestyle, and higher total dietary fiber intake may cause the lower prevalence of constipation in CAPD patients. One appendix reprints the questionnaire used in the study. 1 appendix. 2 figures. 4 tables. 15 references. •

Utility of Hemodialysis in Maple Syrup Urine Disease Source: Pediatric Nephrology. 17(4): 239-242. April 2002. Contact: Available from Springer-Verlag. Service Center Secaucus, 44 Hartz Way, Secaucus, NJ 07094. (201) 348-4033. Summary: Maple syrup urine disease (MSUD) is an inborn error of metabolism stemming from a deficiency in 2-ketoacid dehydrogenase and resulting in the systemic accumulation of branched chain amino acids (BCAAs). Affected children may suffer profound developmental and cognitive impairment from exposure to high levels of BCAA and their associated neurotoxic metabolites. Endogenous renal clearance (by the patient's kidneys) of BCAA is limited and several therapeutic modalities including intensive nutritional regimens, exchange transfusions, peritoneal dialysis, and continuous hemofiltration have been utilized in neonates with MSUD, all of which have had varying success in reducing systemic BCAA levels. In this article, the authors report the case of a symptomatic 7 day old, 3 kilogram neonate with MSUD who underwent treatment with a combination of early hemodialysis and aggressive enteral feedings of a metabolically appropriate formula. This approach results in a 75 percent reduction of systemic toxin levels within 3 hours. When compared to other reported modalities of therapy for symptomatic neonates with MSUD, this approach appears to be most efficacious. Moreover, by minimizing the amount of time that an affected neonate is exposed to neurotoxic (damaging to the nervous system) levels of BCAAs, long term developmental and cognitive capabilities may be preserved. 2 tables. 24 references.

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Peritoneal Dialysis in Acute Renal Failure: Why the Bad Outcome? (editorial) Source: New England Journal of Medicine. 347(12): 933-935. September 19, 2002. Summary: Mortality rates among patients with acute renal (kidney) failure (ARF) can be quite high, but because this diagnosis encompasses a broad mix of patients, optimal treatment strategies are sometimes not clear. This editorial comments on a research study (published in the same journal issue) that provides evidence of the superiority of venovenous hemofiltration over peritoneal dialysis in patients with ARF. The editorial author considers whether some adverse factor associated with peritoneal dialysis as it was used in this study may also have affected survival. The editorial discusses the equipment and supplies used and the problem of high glucose levels in peritoneal dialysis fluid. The author concludes that, in addition to comparing the ability of peritoneal dialysis, continuous renal replacement therapy, and hemodialysis to remove solute, salt, and water in patients with ARF, it must also be determined whether there are technique-specific factors that affect outcome. 8 references.

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Exercise During Hemodialysis Decreases the Use of Antihypertensive Medications Source: American Journal of Kidney Diseases. 39(4): 828-833. April 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000.

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Summary: Most hemodialysis patients require antihypertensive therapy (high blood pressure medications). Aerobic exercise has been suggested as a nonpharmacologic treatment for hypertension in many patient populations, including those with chronic renal (kidney) failure. This article reports on a study undertaken to test the effectiveness of this therapy in an outpatient long term hemodialysis clinic. The hemodialysis staff instituted a stationary cycling program during dialysis and offered the program to all patients (n = 107). Forty patients agreed to participate, and 35 nonexercising patients served as controls. Predialysis blood pressures, postdialysis blood pressures, and antihypertensive medication use were recorded during a 6 month period. Costs of the medication were analyzed at the end of the study. Of participants, 24 (60 percent) completed 6 months of exercise with a mean increase in total cycling time from 16.9 minutes per session to 45.5 minutes per session. No serious adverse events were reported. Predialysis and postdialysis blood pressures were not statistically different between the two groups at month 0 or month 6, but 13 patients (54 percent) in the exercise group had a reduction in antihypertensive medication versus 4 patients (12.5 percent) in the control group. The average relative benefit of exercise was a 36 percent reduction in antihypertensive medications, with an average annual cost savings of $885 per patient year in the exercise group. The authors conclude that stationary cycling is safe during hemodialysis and can lead to significant reductions in blood pressure medication use and cost savings, justifying the initial capital cost of equipment and small incremental increase in staff time. 2 figures. 2 tables. 21 references. •

Association of Fish Intake and Survival in a Cohort of Incident Dialysis Patients Source: American Journal of Kidney Diseases. 39(5): 1018-1024. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Multiple studies in the general population have shown cardioprotective (protective of the heart) and survival benefits associated with dietary fish intake, but little is known about outcomes associated with dietary fish intake in patients with chronic renal failure (CRF). This article reports on a study that investigated fish consumption and survival in 216 incident dialysis patients. Fish consumption was identified in a 24 hour dietary recall and a 3 day food diary collected at baseline (near treatment start) and a 3 day food diary collected 1 year later. Patients who reported fish intake had higher average serum albumin levels at baseline than patients who did not report fish intake. Patient survival was followed up for an average of 3 years from baseline. In analyses, younger age, black race, peritoneal dialysis rather than hemodialysis as initial treatment modality, absence of cardiovascular comorbidity (the presence of other illnesses of the cardiovascular system), higher self-assessed physical functioning, and fish consumption were significantly associated with patient survival. Additional analysis showed that dietary fish consumption independently predicted patient survival. Patients who reported fish consumption were approximately 50 percent less likely to die during the study interval. The authors conclude that health outcomes associated with fish consumption merit continued study in patients with chronic renal failure. 1 figure. 4 tables. 24 references.

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Stages of Change and Fluid Intake in Dialysis Patients Source: Patient Education and Counseling. 49(1): 5-12. January 2003.

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Contact: Available from Elsevier Science, Inc. Journal Information Center, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3750. Fax (212) 633-3764. Website: www.elsevier.com/locate/pateducou. Summary: Nutrition professionals constantly strive to improve adherence to dietary recommendations in hemodialysis patients. This article reports on a study undertaken to evaluate the effects of a 12 week intervention based on stages of change to decrease fluid gain in dialysis patients. Readiness to change, knowledge of appropriate weight gain, and mean weight gains were obtained from patients in five intervention (n = 216) and five control (n = 100) dialysis units. Intervention had more participants in the maintenance and precontemplation stages at the end of the intervention compared to the control group. Knowledge scores significantly increased in the intervention group during the course of the intervention. However, fluid gains did not decrease in either group. Although this intervention did not produce behavior change, the results can aid other educators in planning intervention programs for renal failure and other chronic diseases. 5 tables. 37 references. •

Incident Acute Coronary Syndromes in Chronic Dialysis Patients in the United States Source: Kidney International. 62(5): 1799-1805. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250. Summary: Patients on dialysis have a disproportionately high rate of cardiovascular disease (CVD). However, the incidence and risk factors for incident (new) acute coronary syndromes (ACS) have not been previously assessed in dialysis patients. This article reports on a historical cohort study of ACS in the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave II. The authors analyzed data from 3,374 patients who started dialysis in 1996 and who were followed until March 2000. The incidence of ACS was 29 per 1000 person-years. Factors associated with ACS were older age, the extreme high and low ranges of serum cholesterol level, history of coronary heart disease (CHD), male gender, and diabetes. No cardioprotective medications including statins had a significant association with ACS in this study. However, medications known to reduce mortality (death) after ACS were used in less than 50 percent of patients with known CHD at the start of the study, and statins were used in less than 10 percent of patients with CHD. The authors conclude that dialysis patients had similar risk factors for ACS compared to the general population. Cardioprotective medications were not associated with a significant benefit, possibly due to their striking underutilization in this at-risk population. 5 tables. 30 references.

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Hepatitis C in Dialysis Patients Source: Advances in Renal Replacement Therapy. 3(4): 275-283. October 1996. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: Patients on hemodialysis have a higher prevalence of hepatitis C virus (HCV) infection compared with the general population. This review article focuses on the prevalence of HCV infection in patients on chronic dialysis and possible routes of transmission of HCV in the hemodialysis unit. Several factors have been associated with an increased risk of HCV infection in hemodialysis patients, including number of blood transfusions, duration of hemodialysis, previous transplantation, intravenous drug abuse, male gender, and in-center hemodialysis. In addition, there is mounting evidence

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to suggest nosocomial transmission within hemodialysis units. Although the precise modes of transmission have not been identified, breakdown in standard infection control practices, physical proximity to an infected patient, and sharing of dialysis machines are possible causes. Nonetheless, at the present time, the Centers for Disease Control and Prevention (CDC) does not recommend dedicated machines, patient isolation, or a ban on reuse in hemodialysis patients with HCV infection. Consequently, strict adherence to universal precautions and careful attention to hygiene are recommended to reduce the transmission of HCV in dialysis units. 2 tables. 83 references. (AA-M). •

Daytime Sleepiness in Patients with CRF: Impact of Nocturnal Hemodialysis Source: American Journal of Kidney Diseases. 41(2): 403-410. February 2003. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Patients with end stage renal disease (ESRD) have a high prevalence of sleep disorders, which are not improved by conventional hemodialysis (CHD). Although sleep disorders are commonly associated with complaints of excessive daytime sleepiness, the severity and pathogenesis of daytime sleepiness has not been evaluated objectively in patients with ESRD. Nocturnal hemodialysis (NHD) is a new technique that provides better clearance of uremic toxins than CHD and consequently, may improve sleep quality and daytime sleepiness. This article reports on a study undertaken to determine the severity and pathogenesis of daytime sleepiness in patients with ESRD and to evaluate the impact of NHD. The majority (54 percent) of patients on CHD were pathologically sleepy (somnolent group) and, in comparison with the remaining patients (alert group), their blood urea nitrogen and periodic limb movement (PLM) index were significantly higher. Furthermore, sleep latency was correlated with blood urea nitrogen (BUN). After conversion to NHD, there was a significant fall in BUN and the severity of sleep apnea, but the overall frequency of PLM and sleep fragmentation remained elevated. Nevertheless, there was a trend for the somnolent group to become less sleepy on NHD, and this was associated with a modest reduction in the frequency of PLM. The authors conclude that excessive daytime sleepiness occurs in approximately 50 percent of patients with ESRD. The etiology (cause) appears to be related both to uremia and sleep fragmentation associated with PLM. 2 figures. 5 tables. 31 references.

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Dialysis, Kidney Transplantation, or Pancreas Transplantation for Patients with Diabetes Mellitus and Renal Failure: A Decision Analysis of Treatment Options Source: Journal of the American Society of Nephrology. 14(2): 500-515. February 2003. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Website: www.jasn.org/. Summary: Patients with type 1 diabetes mellitus and end stage renal (kidney) disease (ESRD) may remain on dialysis or undergo cadaveric kidney transplantation, living kidney transplantation, sequential pancreas-after-living kidney transplantation, or simultaneous pancreas-kidney transplantation. This article reports on a study undertaken to determine the optimal treatment strategy for type 1 diabetes patients with kidney failure. The outcome measures were life expectancy in life-years (LY) and quality-adjusted life expectancy in quality-adjusted life-years (QALY). Living kidney transplantation was associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation, 17.21 LY and 10.00 QALY; simultaneous pancreas-kidney

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transplantation, 15.74 LY and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY; dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of several key variables. Simultaneous pancreas-kidney transplantation had the greatest life expectancy and quality-adjusted life expectancy when living kidney transplantation was excluded from the analysis. The data indicate that living kidney transplantation is associated with the greatest life expectancy and quality-adjusted life expectancy for type 1 diabetes patients with renal failure. Treatment strategies involving pancreas transplantation should be considered for patients with frequent metabolic complications of diabetes. For patients without a living donor, simultaneous pancreas-kidney transplantation is associated with the greatest life expectancy. 5 figures. 4 tables. 162 references. •

Chronic Peritoneal Dialysis Catheters: Procedures for Placement, Maintenance, and Removal Source: Seminars in Nephrology. 22(3): 221-236. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: Peritoneal dialysis (PD) is an integral part of the practice of most nephrologists (kidney specialists), and a life-sustaining therapy for many patients. As in hemodialysis (HD), the success of PD is often determined by the success of the access device. For the nephrologist placing and removing PD catheters, or for the nephrologist advising surgeons in this role, this article provides a review of the types of PD catheters and differences in function and complications, of the PD catheter and benefits of this technique, and step-by-step techniques for removing PD catheters. The authors reiterate that the success of peritoneal catheters depends more on placement technique than on their design. Peritoneoscopic placement results in the lowest incidence of catheter complications and a catheter half-life of over 3 years. This may relate to the decreased amount of tissue trauma and smaller incision size of the peritoneoscopic placement versus dissective placement, and better assurance that the cuff is placed within the muscle versus blind placement. 7 figures. 2 tables. 23 references.

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Improvement in Nutritional Parameters After Initiation of Chronic Hemodialysis Source: American Journal of Kidney Diseases. 40(1): 143-151. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Protein-calorie malnutrition is highly prevalent in patients with chronic renal (kidney) failure (CRF) and on chronic dialysis therapy. Longitudinal studies evaluating nutritional outcomes after the initiation of chronic dialysis therapy in incident dialysis patients are limited. This article reports on a prospective cohort study that evaluated time-dependent changes in several well-defined markers of nutritional status before and after initiation of chronic hemodialysis therapy. Fifty hemodialysis (HD) patients were studied; the study population was 60 percent male, 38 percent white, and 32 percent had insulin-dependent diabetes mellitus. At baseline, nutritional markers correlated well with each other. After the initiation of HD therapy, there were marked improvements in most nutritional parameters. The authors conclude that nutritional benefits of increased solute clearance provided by the initiation of chronic dialysis therapy prevail over its potential catabolic effects. However, the extent of improvement was dependent on nutritional status at the time of initiation of dialysis therapy, which remained an

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important determinant of subsequent nutritional improvements during the first year of treatment. 4 figures. 4 tables. 29 references. •

Evaluation of Uremic Pruritus at an Outpatient Hemodialysis Unit Source: Renal Failure. 24(5): 609-614. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Pruritus (itching) is a common complaint among end stage renal disease patients and has been associated with poor outcome. This article reports on a study undertaken to characterize this problem at an outpatient hemodialysis (HD) clinic. The study surveyed 70 patients over a 2-day period. A visual analog scale was used to evaluate the intensity of itching. Location of itching and temporal relationship to dialysis was assessed by questionnaire. Seventy percent of patients reported pruritus either during and or between hemodialysis sessions. Itch intensity ranged from mild to severe. Forty-five percent of patients itched in three or more areas, with the back and legs most commonly reported. Laboratory parameters were unable to differentiate between patients who itched and those who did not itch. The authors conclude that itching remains a common problem in hemodialysis patients. New treatments for patients resistant to standard therapies are needed. The survey instrument is included in an appendix. 1 figure. 2 tables. 9 references.

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Chronic Dialysis Patients Have High Risk for Pulmonary Embolism Source: American Journal of Kidney Diseases. 39(5): 1011-1017. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Pulmonary embolism (a blood clot in the lungs) has been considered uncommon in chronic dialysis patients, but has not been adequately studied in a large population. In the United States Renal Data System (USRDS), 76,718 patients presenting with end stage renal disease (ESRD) between January 1996 and December 1996 were analyzed in a historical cohort study. The outcome was hospitalizations with a primary discharge diagnosis of pulmonary embolism occurring within 1 year of the first ESRD treatment and excluding those occurring after renal (kidney) transplantation. For dialysis patients, hospitalization rates for pulmonary embolism were obtained from the National Hospital Discharge Survey for 1996. In 1996, the overall incidence rate of pulmonary embolism was 149.90 per 100,000 dialysis patients compared with 24.62 per 100,000 persons in the U.S. population, with an age adjusted incidence ratio of 2.34 in dialysis patients. Younger dialysis patients had the greatest relative risk for pulmonary embolism. The age-adjusted incidence ratio of pulmonary embolism after excluding dialysis patients with known risk factors for pulmonary embolism was 2.11. Ninety-five percent confidence intervals for all age categories in both models were statistically significant. The authors conclude that chronic dialysis patients have high risk for pulmonary embolism, independent of comorbidity (the presence of other illnesses). 2 tables. 37 references.

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Improvement of Nutritional Status After Initiation of Maintenance Hemodialysis Source: American Journal of Kidney Diseases. 40(1): 133-142. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000.

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Summary: Recent data suggest that serum albumin concentrations (protein levels in the blood) increase during the several month period that follows the initiation of maintenance hemodialysis (MHD) therapy. Some researchers have shown that the rate of increase in serum albumin level is related directly to 24 hour urine protein losses before the initiation of dialysis therapy. However, serum albumin levels increase even in patients starting MHD therapy without significant proteinuria, suggesting that this increase may be one manifestation of improving protein-energy nutritional status associated with commencing MHD therapy. This article reports on a study that examined this issue by reviewing records of all patients (n = 97) admitted to one outpatient dialysis unit within 30 days of initiation of MHD therapy. Between months 1 and 6 after beginning MHD, there was a statistically significant increase in values for Predialysis serum albumin, iron, transferrin saturation, creatinine, and normalized protein equivalent of total nitrogen appearance (nPNA). Many of these values were still increasing by month 6. Body weight declined initially until month 4, then increased. These results suggest that an improvement in nutritional status, including an increase in dietary protein intake and serum albumin level, often occurs with the initiation of MHD therapy. The improvement in nutritional status may be related to the increase in dietary protein intake. 7 figures. 2 tables. 23 references. •

'Goodbyes' of Dialysis: Dealing with Loss Covers a Broad Spectrum of Issues Source: For Patients Only. 14(1): 26-28. January-February 2001. Contact: Available from For Patients Only. 18 East 41st Street, New York, NY 10017. (818) 704-5555. Fax (818) 704-6500. Summary: Rehabilitation is the goal for people with kidney disease. The dialysis or transplant health care team helps by encouraging patients to exercise and return to former activities. This article explains how rehabilitation may also include emotional rehabilitation and coping with living with kidney disease. The author stresses that emotional rehabilitation is an ongoing process. Even for those in the dying process needing to make decisions regarding end of life care, emotional rehabilitation can continue to happen when these decisions are made with the patient's involvement and support of the family and health care team. The author outlines the various 'goodbyes' that need to be accomplished before one can move forward in emotional rehabilitation. A positive attitude about living with kidney disease includes acknowledging losses. The author also encourages patients to practice talking about less serious skills in order to develop skills for dealing with more serious decisions that may arise later. Patients can enlist the help of the dialysis or transplant social worker for support in talking with family or health care providers about issues of loss. Support groups can also be very helpful, especially in helping spouses or family members with handling their own losses. The author concludes that there are some positive things that can come out of the changes that kidney disease may prompt. Any kind of life changing event can cause one to reevaluate life and set priorities, including more positive and rewarding approaches to health and daily activities.

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Risk Factors and Risk for Mortality of Mild Hypoparathyroidism in Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(6): 1245-1254. June 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000.

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Summary: Relative hypoparathyroidism (low levels of parathyroid hormone, PTH) is prevalent in patients on hemodialysis (HD), with unknown pathogenesis (how the disease develops) and prognosis. This article reports on a study undertaken to clarify the risk factors and prognosis of time-dependent relative hypoparathyroidism in HD patients. The retrospective study was performed for 126 HD patients with four or more PTH determinations and no previous total or subtotal parathyroidectomy. The prevalence of relative hypoparathyroidism at entry into the study was 76 of 126 patients (60.3 percent). Analysis showed that patients with hypoparathyroidism were older, more likely to have diabetes, and had greater ionized calcium levels and lower phosphate, albumin, blood urea nitrogen (BUN), and creatinine levels. Patients with diabetes were older and had a shorter duration of dialysis therapy and lower PTH, phosphate, albumin, BUN, and creatinine levels and urea reduction ratios. Conversely, analysis also showed that PTH levels at entry were associated directly with creatinine levels and inversely with age and ionized calcium levels (but not diabetes). During follow up, PTH levels fluctuated concomitantly with ionized calcium and phosphate levels over time in all patients. The authors note that hypoparathyroidism at entry and lower time-dependent PTH levels predict mortality (death). 3 figures. 4 tables. 49 references. •

Risk of Hip Fracture Among Dialysis and Renal Transplant Recipients Source: JAMA. Journal of the American Medical Association. 288(23): 3014-3018. December 18, 2002. Summary: Renal failure places people at particularly high risk of hip fracture. However, the possible differential impact of dialysis and renal (kidney) transplantation on this risk is not well understood. This article reports on a study undertaken to determine if patients who receive kidney transplants are at greater risk of hip fracture compared with those who continue to undergo dialysis. The data is from a cohort study of 101,039 patients with end stage renal disease (ESRD) placed on the renal transplant waiting list in the United States between January 1990 and December 1999. Among the patients included in this analysis, 971 hip fractures were observed during the followup period of 314,767 person-years. The incidence rate of hip fracture in patients receiving dialysis was 2.9 per 1000 patients per year compared with 3.3 hip fractures per 1000 patients per year in those who had previously received a renal transplant. Initially, the relative risk of hip fracture associated with transplantation was 1.34 fold greater when compared with dialysis, but then decreased by 1 percent per month until the estimated risk became equal for dialysis and transplant recipients approximately 630 days after transplantation. Among transplant recipients, risk of fracture was relatively higher in persons with a prolonged period of dialysis before transplantation. 1 figure. 3 tables. 26 references.

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Improving Dialysis Access Management Source: Seminars in Nephrology. 22(6): 507-514. November 2002. Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: Renal replacement therapy requires either placement of a functional hemodialysis vascular access or peritoneal dialysis catheter. This article reviews the current literature on the planning of dialysis access, with particular emphasis on issues pertaining to vascular access. Early provision of a dialysis access improves patient care with reduction in morbidity and reduces the economic burden incurred as a result of

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delayed access placement. Vascular access dysfunction, including thrombosis (clotting) and infection, poses the greatest burden on the end stage renal disease (ESRD) population. The authors highlight current concepts used to maximize access patency and to efficiently manage vascular access complications. 1 table. 59 references. •

Why Are Hemodialysis Treatments Shortened and Skipped? Development of a Taxonomy and Relationship to Patient Subgroups Source: Nephrology Nursing Journal. 30(2): 209-218. April 2003. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: Shortening and skipping hemodialysis (HD) treatments occur commonly and are associated with inadequate dialysis and increased mortality (death). These behaviors are also frequently equated with patient noncompliance. This article reports on a research study undertaken to determine whether certain patient subgroups are at a disadvantage in achieving optimal dialysis. Semistructured interviews were conducted with 168 selected patients who shortened or skipped treatments. A variety of reasons were responsible for shortening and skipping HD treatments. Content analysis of patient responses revealed five categories of reasons for this: medical problems, technical problems, life tasks, transportation, and patient decisions. The most common reasons for shortening HD were medical problems (38 percent) and life tasks (24 percent), while the most common reasons for skipping were life tasks (33 percent) and transportation (22 percent). Furthermore, patient subgroups differed in the reasons for shortening and skipping. After multivariate adjustment, technical problems were more common among women. Life task problems were more common among men, younger patients, and patients with hypertension. Transportation problems were more common among African Americans. The authors conclude that interventions to optimize HD treatment should identify and target patient-specific reasons for shortening and skipping HD treatments, and not assume patient noncompliance.

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Sleep Pattern Disturbance in Hemodialysis and Peritoneal Dialysis Patients Source: Nephrology Nursing Journal. 28(1): 40-44. February 2001. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: Sleep pattern disturbance (SPD) is problematic among dialysis patients. This article describes a project that investigated the scope of sleep problems in all willing subjects in an outpatient hemodialysis (HD) and peritoneal dialysis (PD) unit in a midsize university teaching hospital. A comparison of the incidence of SPD between the two treatment modalities was also conducted. The authors used a sleep diary that subjects completed each morning for a week. Subjects were asked to describe sleep latency, perceived difficulty falling asleep, number of arousals, use of sedatives, whether they awoke feeling rested, sleep efficiency, and factors preventing or inducing sleep. The sample consisted of 47 HD and 22 PD patients whose average age was 60.6 years. There was a trend for PD subjects to report fewer sleep complaints than HD subjects, but the two groups did not differ significantly on any variable. Factors reported to interfere with sleep were pain for HD subjects, while treatment related factors, such as alarms, predominated for PD subjects. These findings are consistent with reports in the literature that note the incidence of SPD among dialysis patients to be as high as 83

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percent. The authors briefly report on practice changes that were undertaken in response to this data. 4 tables. 25 references. •

National Profile of Practice Patterns for Hemodialysis Vascular Access in the United States Source: JASN. Journal of the American Society of Nephrology. 13(8): 2117-2124. August 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: The Centers for Medicare and Medicaid Service's (CMS), national End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project is a data collection initiative to identify opportunities for improvement of care to adult, Medicare maintenance dialysis beneficiaries. This article offers an analysis of 1999 CPM data that characterized the profile of hemodialysis vascular access in the United States and identifies determinants of vascular access type 2 years after the translation of vascular access clinical practice guideline statements into national CPMs. A total of 8, 154 hemodialysis patients were sampled; 17 percent (n = 1,399) were incident (newly diagnosed). Vascular access methods were autologous arteriovenous fistula (AVF, 28 percent), prosthetic graft (AVG, 49 percent), and percutaneous catheter (23 percent). Independent predictors of having a catheter for hemodialysis were female gender, white race, incident to hemodialysis status, and lower hemoglobin and serum albumin. The authors conclude that despite translation of practice guidelines for hemodialysis vascular access into national CPMs, there is substantial geographic variability and gender and racial disparity in angioaccess allocation in the United States. Quality improvement strategies to improve the prevalence of fistulae should focus on selected regions and include physician education about their practice patterns and potential biases. 4 figures. 6 tables. 35 references.

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Diabetes Education and Care Management Significantly Improve Patient Outcomes in the Dialysis Unit Source: American Journal of Kidney Diseases. 40(3): 566-575. September 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The incidence of diabetes mellitus, particularly type 2, is increasing in the general population. Similarly, the incidence of patients with diabetes mellitus who develop end stage renal disease (ESRD) has increased concomitantly in the dialysis facility to 44 percent of patients starting dialysis therapy with diabetes mellitus as their primary diagnosis. This article reports on a study undertaken to determine whether intensive education and care management of diabetes could improve glycemic (blood glucose levels) control, alter patient behavior, and reduce complications in the setting of the dialysis unit. Patients in the study group underwent a diabetes education program and were followed up by a care manager who provided self-management education, diabetes self-care monitoring and management, motivational coaching, and foot checks. The control group baseline foot risk category worsened, whereas it was unchanged in the study group. There were no amputations in the study group, versus five amputations in the control group. Ten patients in the control group were hospitalized with diabetes or vascular related admissions versus one patient in the study group. There was a significant improvement in self-management behavior in all six categories evaluated in the study group versus the control group. The authors conclude that a

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program of intensive diabetes education and care management in a dialysis unit is effective in providing significant improvements in patient outcomes, glycemic control, and better quality of life in patients with diabetes mellitus. 1 figure. 4 tables. 30 references. •

Hemodialysis-Associated Hypertension: Pathophysiology and Therapy Source: American Journal of Kidney Diseases. 39(2): 227-244. February 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The majority of end stage renal disease (ESRD) patients have hypertension (high blood pressure). Hypertension in the hemodialysis patient population is caused by many factors and is associated with increased risk for left ventricular hypertrophy, coronary artery disease, congestive heart failure, cerebrovascular complications, and mortality (death). This review article considers the pathophysiology and therapy of hemodialysis associated hypertension. Antihypertensive medications alone do not adequately control blood pressure (BP) in hemodialysis patients. Several other treatment options are available, including long, slow hemodialysis; short, daily hemodialysis; nocturnal hemodialysis; or, most effectively, dietary salt and fluid restriction in combination with reduction of dialysate sodium concentration. Survival is better in hemodialysis patients with a mean arterial pressure below 99 mm Hg as compared with those with higher BP. Low predialysis systolic BP (less than 110 mm Hg) and low predialysis diastolic BP (less than 70 mm Hg) are associated with increased mortality, primarily because of severe congestive heart failure or coronary artery disease. Patients that experienced repeated intradialytic hypotensive (low blood pressure) episodes should also be viewed with caution, and predialytic BP values should be reevaluated. In selected hemodialysis patients, interdialytic ambulatory blood pressure monitoring (ABPM) may help to determine if the patient is in fact hypertensive. In addition, ABPM provides important information about the change in BP between day and night. The authors recommend home BP monitoring, yearly echocardiography, and treatment of additional risk factors for cardiovascular disease. 3 figures. 2 tables. 207 references.

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Surgical Bypass for Subclavian Vein Occlusion in Hemodialysis Patients Source: Journal of the American College of Surgeons. 194(4): 416-421. April 2002. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: The majority of patients with end stage renal disease (ESRD) are dependent on hemodialysis. Significant stenosis (narrowing) or occlusion (blockage) of the subclavian vein is known to occur in 20 to 50 percent of patients who have had central venous catheters inserted into the subclavian vein or the internal jugular vein. Surgical bypass of the obstructed venous segment proximal to a functioning dialysis access site is an established treatment to relieve symptoms and salvage the functional dialysis access. This article reports on a retrospective review of all subclavian venous bypass procedures (n = 12) performed at St. Louis University Hospital from May 1987 to May 2000. The mean age of the patients was 55.5 years (range 17 to 72 years). There were 11 men and 1 woman. Before surgical bypass, all patients underwent bilateral venograms to evaluate their central venous systems. An extra-anatomical surgical bypass was performed in all patients, who were followed for a mean of 16 months. At 1 month, 100 percent of hemodialysis access sites remained functional. At 1 year, 80 percent; 2 years, 60 percent; and 3 years, 25 percent of the salvaged arteriovenous hemodialysis access sites provided

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for functional dialysis. One patient required thrombectomy (removal of a clot) of the bypass graft at 14 months. The authors conclude that surgical bypass of an occluded or stenotic subclavian vein segment is successful in providing both symptomatic relief and salvage of a functioning dialysis access in the hemodialysis patient population. Study of the central venous system is essential in selecting an appropriate bypass procedure in individual patients. 5 figures. 1 table. 16 references. •

Body Size, Dialysis Dose and Death Risk Relationships Among Hemodialysis Patients Source: Kidney International. 62(5): 1891-1897. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250. Summary: The normalized treatment ratio, Kt over V derived from urea kinetic models (UKM), is a commonly used measure of dialysis dose. This measure assumes that smaller patients with low volume of urea distribution (V) require proportionately less total treatment (Kt) than larger patients. However, it is possible that a relationship exists between Kt and body size whereby a different Kt is required for different sizes. This article reports on a study that explored the relationships among body size, Kt, and death risk, focusing on possible interactions between Kt and size. The sample included 43,334 patients treated on January 1, 1999. The main effects models suggested improved survival with increasing Kt and all of the size measures. The death risk penalties associated with reducing Kt among small patients were as great as or greater than they were among large patients. A similar pattern was observed for V. The authors conclude that evidence supporting the intuition that smaller patients require proportionately lower dialysis dose than larger patients was not found. To the contrary, smaller patients suffer as much risk or more risk than larger patients from reducing Kt. Deciding dialysis treatment using a Kt over V based intuition may lead to avoidable under-dialysis, particularly among small patients. 4 figures. 2 tables. 26 references.

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Analysis of Dialysis Training in the United States and Canada Source: American Journal of Kidney Diseases. 40(1): 152-160. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The prevalence of end stage renal disease (ESRD) has progressively increased in both the United States and Canada, and patients with ESRD are likely to constitute progressively larger proportions of nephrology practices. This article reports on a study of dialysis training in the U.S. and Canada. The authors mailed a questionnaire to U.S. and Canadian nephrology program methods to determine methods used in dialysis training; 53 percent of U.S. and 73 percent of Canadian programs responded. Training programs in the U.S. enrolled a larger median number of fellows and had a lower median faculty-fellow ratio compared with programs in Canada. However, the availability of faculty in providing training in the care of patients undergoing maintenance hemodialysis (MHD) or chronic peritoneal dialysis (CPD) was similar in the two countries. There were wide variations in availability of patients in both the U.S. and Canada. U.S. training programs offered trainees significantly lower numbers of MHD and CPD patients; 29 percent of U.S. programs had less than five CPD patients per fellow. Similarly, there were wide variations in the amount of time trainees spent providing care to MHD and CPD patients; in 14 percent of U.S. training programs, fellows spent less than 5 percent of their time receiving training for patients undergoing

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CPD. Only a small proportion of training programs had faculty resources or ensured training for fellows in the placement of percutaneous tunneled venous hemodialysis catheters or peritoneal dialysis catheters. The authors conclude by voicing concerns that many U.S. training programs either do not have an appropriate number of CPD patients or do not allocate appropriate time to ensure the preparedness of fellows in providing independent care for patients with ESRD undergoing CPD. One appendix reprints the survey instrument. 3 figures. 6 tables. 9 references. •

Hepatitis C Virus in Blood and Dialysate in Hemodialysis Source: American Journal of Kidney Diseases. 37(1): 38-42. January 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: The prevalence of hepatitis C virus (HCV) positivity among hemodialysis patients remains high compared with that of the healthy population, and thus the issue of safety and environmental protection must be addressed. This article reports on a study undertaken to evaluate the dynamics of prehemodialysis and posthemodialysis blood HCV levels and HCV escape to spent dialysate (and thus to the environment). A serine protease inhibitor (nafamostat mesilate) was used as the anticoagulant for hemodialysis. High flux polysulfone membrane dialyzers were used; dialyzer reuse was not performed. A portion of total spent dialysate (the fluid used for dialysis) was continuously extracted to measure for HCV. No HCV extravasation to spent dialysis was found, although HCV copy numbers were reduced to a statistically significant level in postdialysis blood compared with predialysis levels. The need to establish standards for risk management in dialysis centers is evident. The data obtained in this study strongly suggest that to minimize the risk for HCV transmission, lower transmembrane pressure (TMP) should be used in the hemodialysis of HCV positive patients, with fresh polysulfone dialyzers and dialysis settings of 180 to 250 milliliters per minute for blood flow, 500 milliliters per minute for dialysate flow, and less than 1.872 mm Hg for TMP. 1 figure. 23 references.

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Early Initiation of Dialysis Fails to Prolong Survival in Patients With End-Stage Renal Failure Source: JASN. Journal of the American Society of Nephrology. 13 (8): 2125-2132. August 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: There is a trend to start dialysis earlier in patients with chronic renal (kidney) failure (CRF). Studies that suggest improved survival from earlier initiation are flawed in that they have measured survival from start of dialysis rather than from a time point before dialysis, when patients have the same renal function. This flaw is termed leadtime bias. This article reports on a study that used the electronic patient record at the renal unit of Glasgow Royal Infirmary to identify all patients who had received dialysis for CRF and who had sufficient data to calculate the time point that they reached a certain level of creatinine clearance (a measure of kidney function). This date was used to time survival. Results showed no significant benefit in patient survival from earlier initiation of dialysis. Patients who started dialysis with a lower estimated creatinine clearance tended to survive longer. This relationship retained significance when gender, age, weight, presence of diabetes, mode of first dialysis, initial dialysis access, hemoglobin, serum albumin, blood leukocyte count, Wright Khan index, and estimated

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creatinine clearance at the start of dialysis were taken into account. The authors conclude that their study fails to support a policy of earlier initiation of dialysis for patients with end stage renal disease (ESRD). 3 figures. 4 tables. 30 references. •

Effects of Hemodialysis Dose on Anemia, Hypertension, and Nutrition Source: Renal Failure. 24(5): 615-621. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: There is good evidence that by improving dialysis adequacy, the morbidity (related illness) and mortality (death) of hemodialysis (HD) patients decrease. Dialysis adequacy has also been related to the better control of arterial blood pressure (BP), anemia, and improvement of patients' nutritional status. This article reports on a selfcontrol study of 34 patients on HD (23 males, 11 females), aged 52.6 years (plus or minus 15.5 years), HD duration 55.9 months (plus or minus 61.2 months), referring to the effect of increasing delivered dialysis dose, over a 2-year period, on their clinical and laboratory parameters. Delivered HD dose increased, statistical significance, the following: urea reduction ratio (URR), Kt per V, and Hb (hemoglobin); no difference was noticed in weekly EPO (erythropoietin) dose. Both systolic and diastolic BP decreased significantly. The authors conclude that increasing dialysis dose results in both clinical and laboratory improvement regarding hypertension, nutritional status, and control of HD patients' anemia. 2 tables. 25 references.

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LifeSite Hemodialysis Access System: Implications for the Nephrology Nurse, The Source: Nephrology Nursing Journal. 29(1): 27-33,72. February 2002. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: This article describes a new subcutaneous device (the LifeSite Hemodialysis Access System) that was designed to overcome limitations of transcutaneous dialysis catheters and is now available for use in the United States. A fully implantable device, the LifeSite System provides immediate, reliable, high flow vascular (blood) access for dialysis. The durable stainless steel and titanium LifeSite valve is implanted in a subcutaneous tissue pocket, typically below the clavicle (collar bone). The valve is connected to a biocompatible silicone cannula that is tunneled to a central vein. The device is cannulated using a virtually pain free, buttonhole technique. The valve is designed to allow cleansing of the valve, valve pocket, and buttonhole site with 70 percent isopropyl alcohol before and after each use to minimize the risk of infection. This article reviews the implications of this access system for the nephrology nurse and reports on results from a study of 150 days of use of this equipment. The results demonstrate that the LifeSite System is associated with statistically significant higher blood flow rates and lower rates of adverse events, infection, and thrombolytic infusions than a standard dialysis catheter. Potential implications of these benefits include improved outcomes, greater convenience for patients, improved efficiency, and time management for the nursing staff, along with reduced direct and indirect costs related to vascular access management. 4 figures. 3 tables. 19 references.

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Is Peritoneal Dialysis a Viable Treatment Alternative for the ESRD Patient? Source: For Patients Only. 14(1): 24-25. January-February 2001.

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Contact: Available from For Patients Only. 18 East 41st Street, New York, NY 10017. (818) 704-5555. Fax (818) 704-6500. Summary: This article describes the development and use of peritoneal dialysis (PD) as a viable treatment option for the patient with end stage renal disease (ESRD). The author first offers statistics about the use of PD, then describes how continuous ambulatory PD (CAPD) works. During the CAPD procedure, dialysis fluid enters the patient's peritoneal cavity through a surgically implanted catheter; fluid and waste material pass across the peritoneal membrane into the dialysis fluid, which is drained from the abdomen. This draining and replacing process is called an exchange; most patients must complete 4 to 5 exchanges each day. Since the treatment does not depend on using a machine, it requires only a place from which to hang the bag of dialysis solution. CAPD can be done at home, at work, or on vacation. Automated PD (APD) depends on a portable machine called a cycler to perform the fluid exchanges. Most patients are attached to the cycler for 8 to 10 hours every night. All the patient has to do is connect the catheter to the APD machine, then switch the machine on; the cycler does the rest. The author concludes by remarking that one advantage of PD is that of a less restrictive diet. PD allows the patient to have more protein, fluids, and potassium, compared to patients on hemodialysis. Readers are encouraged to discuss their own health care options with their renal health care team. •

Care and Maintenance of Hemodialysis Catheters and Subcutaneous Vascular Access Devices: A Nurse's Perspective Source: Nephrology News and Issues. 16(9): 27-31. August 2002. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635. Summary: This article discusses the care and maintenance of hemodialysis catheters and subcutaneous (under the skin) vascular access devices from the nephrology (kidney specialty) nurse's perspective. Four types of vascular access are currently used for hemodialysis: native arteriovenous (AV) fistulas, synthetic AV grafts, hemodialysis catheters, and subcutaneous access devices. The author focuses on the nursing care and maintenance of catheters and subcutaneous devices. Catheters may be used when patients are in need of immediate vascular access, or when patients have exhausted all other options for vascular access, or in elderly end stage renal disease (ESRD) patients with comorbid conditions, such as cardiovascular disease or diabetes, that may confound attempts to create an AV fistula. The LifeSite Hemodialysis Access System, currently the only subcutaneous access device commercially available in the U.S. for hemodialysis access, consists of a titanium and stainless steel valve that is implanted in a subcutaneous tissue pocket and connected directly to the vascular system. The author stresses that a better understanding of practical nursing requirements should allow nephrology nurses to optimize the utility of these devices, as well as improve time management in the dialysis unit. One sidebar reviews recommended patient education points for nurses to cover with their patients with the LifeSite system. 2 figures. 1 table. 21 references.

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Initiation into a Dialysis-Dependent Life: An Examination of Rites of Passage Source: Nephrology Nursing Journal. 29(4): 347-352, 376. August 2002. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org.

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Summary: This article explores the conceptual and empirical application of the rites of passage model in contemporary health care for those who are dialysis dependent. The study used a collective case study design and narrative methodology. A purposive sample yielded 10 participants who were receiving dialysis. Prolonged observation and immersion in the culture of dialysis dependency occurred in the settings of the participants' home and renal (kidney) units in Queensland, Australia. In-depth interviews and narrative analysis were used. The criteria of reflexivity, voice, and verisimilitude established the rigor of the study. The findings illuminated the three stages of rites of passage (ROP), separation, liminality, and reincorporation, with each stage evident in the participants' stories. Commencing dialysis is an initiation that delineates the transition from one social status to another. The authors argue that there is a metaphoric usefulness of the application of the ROP model that might influence the quality of care to dialysis initiates. A commentary and response are appended to the article. 15 references. •

Importance of Starting, and Sticking with, an Exercise Program for Dialysis Patients Source: For Patients Only. 15(2): 13-15. March-April 2002. Contact: Available from For Patients Only. 18 East 41st Street, New York, NY 10017. (818) 704-5555. Fax (818) 704-6500. Summary: This article reminds readers with kidney disease of the importance of starting and maintaining an exercise program. Written primarily for patients on dialysis, the article reviews the benefits of exercise and stressing the need to work closely with a health care provider when starting a new exercise program. The author recommends a variety of strategies to keep the exercise fun and interesting, so it will be easier to stick with. One sidebar lists resources (books, pamphlets, videos) to help get started with an exercise program. 1 figure.

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Staphylococcal Peritonitis in Continuous Ambulatory Peritoneal Dialysis: Colonization with Identical Strains at Exit Site, Nose, and Hands Source: American Journal of Kidney Diseases. 37(1): 43-48. January 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article reports on a prospective study of 59 consecutive peritonitis episodes in patients using a twin bag system for continuous ambulatory peritoneal dialysis (CAPD). The study was undertaken to evaluate the relationship of nasal or skin Staphylococcus carrier status with identical strains and the development of staphylococcus peritonitis. Dialysate samples and exit site, nose, and nail swabs from patients and their dialysis partners were obtained on the same day for culture. When bacteria belonging to the same species of the Staphylococcus genus were isolated from dialysate and at least one extraperitoneal anatomic site, pulsed field gel electrophoresis typing was performed. The isolated bacterial strains were classified as identical or different. Of the 59 peritonitis episodes, 27 (46 percent) were caused by staphylococci. Nineteen of these 27 patients carried the same Staphylococcus species causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63 percent) carried an identical strain. Four of the 5 dialysis partners carried the same Staphylococcus species causing the peritonitis episode at nose or nails, but the strain was identical for only 3 dialysis partners (60 percent). Four patients and 1 dialysis partner carried unrelated strains of the Staphylococcus species causing the peritonitis episode. The most frequently colonized site with strains identical to that causing the peritonitis episode

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was the catheter exit site, followed by nose and nails. This finding may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations. For example, local application of mupirocin ointment or povidone iodine ointment at the catheter exit site is effective in reducing both exit site infections and peritonitis caused by S. aureus. 2 figures. 3 tables. 33 references. •

Effect of the Use or Nonuse of Long-Term Dialysis on the Subsequent Survival of Renal Transplants from Living Donors Source: New England Journal of Medicine. 344(10): 726-731. March 8, 2001. Summary: This article reports on a retrospective cohort study of 8,481 patients who were or who were not treated by long term dialysis before receiving a kidney transplant from a living donor. The relative rate of allograft failure was assessed, with adjustment for potential confounding variables, including the transplantation center and median household income. Results showed that transplantation of a kidney from a living donor into a recipient who had not undergone long term dialysis was associated with a 52 percent reduction in the risk of allograft failure during the first year after transplantation, an 82 percent reduction during the second year, and an 86 percent reduction during subsequent years, as compared with transplantation after dialysis. The reduction in the rate of allograft failure during the first year was attenuated when adjustment was made for the timing of acute rejection within the first year. Increasing duration of dialysis was associated with increasing odds of rejection within six months of transplantation. The authors conclude that preemptive transplantation of kidneys from living donors without the previous initiation of dialysis is associated with longer allograft survival than transplantation performed after the initiation of dialysis. 1 figure. 5 tables. 22 references.

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Survival Advantage for Adult Hispanic Hemodialysis Patients? Findings from the End-Stage Renal Disease Clinical Performance Measures Project Source: JASN. Journal of the American Society of Nephrology. 14 (1): 180-186. January 2003. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This article reports on a study that examined 1 year followup mortality (death) in Hispanic and non-Hispanic patients and its association with intermediate outcomes of dialysis care. Demographic and clinical information was collected on a national random sample of adult in-center hemodialysis (HD) patients for the period of October through December 1998. Of 8,336 patients, 994 (12 percent) were identified as Hispanic, 3,618 (43 percent) as non-Hispanic white, and 3,111 (37 percent) as nonHispanic Black. The adjusted 12 month mortality risk for Hispanics was 0.76 and for non-Hispanic Blacks 0.66 compared with non-Hispanic whites (referent group). Similar 12 month mortality risks were noted in the groups with diabetes mellitus or hypertension (high blood pressure) as the causes of end stage renal disease (ESRD) and among patients older than 65 years. These data suggest that adult Hispanic HD patients have a 12 month survival intermediate to non-Hispanic Blacks and non-Hispanic whites and experience equivalent or better intermediate outcomes of dialysis care compared with non-Hispanic whites. 3 tables. 31 references.

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Minority Advantage in Diabetic End-Stage Renal Disease Survival on Hemodialysis: Due to Different Proportions of Diabetic Type? Source: American Journal of Kidney Diseases. 28(2): 226-234. August 1996. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This article reports on a study undertaken to identify predictors of survival on hemodialysis in patients with diabetes-related end-stage renal disease (ESRD) and to explain ethnic differences in survival among non-Hispanic whites, African-Americans, and Mexican-Americans. A population-based, tri-ethnic cohort of 638 adult patients with diabetes and ESRD were studied. Survival length on center hemodialysis was the main outcome measure. In a combined model of insulin-dependent and noninsulindependent diabetes (IDDM and NIDDM, respectively) Mexican-Americans and AfricanAmericans showed a better survival than non-Hispanic whites. Other predictors independently associated with survival were age, high self-reported physical disability, coronary artery disease, lower extremity amputations, and average blood glucose levels prior to ESRD. Non-Hispanic whites had a significantly higher rate of IDDM, but did not have a greater burden of any of the other predictors. The authors reconfirm the survival advantage on dialysis of African-Americans and Mexican-Americans, but note that, among patients with NIDDM, this minority survival advantage disappears. 6 tables. 28 references. (AA-M).

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HCV Infection and Hemodialysis Source: Seminars in Nephrology. 22(4): 331-339. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: This article reviews hepatitis C virus (HCV) infection and hemodialysis. HCV infections are frequent in hemodialyzed patients and are mainly related to transfusions and nosocomial (due to medical treatment) contamination. HCV infection may result in cirrhosis in 10 percent of dialysis patients and is worsened by transplantation because of the immunosuppressive therapy for prevention of graft rejection. Because there is a risk for significant liver disease and because cirrhosis contraindicates a renal (kidney) transplantation, a liver biopsy should be performed early in HCV-RNA positive hemodialysis patients to evaluate histologic impact of the liver disease. A combined liver-kidney transplantation should be discussed in dialysis patients with cirrhosis (scarring of the liver). Standard alpha interferon is the only treatment for HCV in dialysis patients because ribavirin is contraindicated by a high risk for hemolytic anemia. Interferon leads to an overall 30 percent rate of sustained viral eradication. Interferon treatment is indicated in dialysis patients with acute hepatitis C, significant liver disease, or symptomatic cryoglobulinemia, and to candidates for renal transplantation, whatever the severity of the liver disease. Indeed, alpha interferon is contraindicated in kidney recipients, given the risk for rejection (so patients should complete any trials of interferon treatment before transplantation). Preventive treatment for HCV requires universal precautions in the dialysis setting because there is no available vaccine. 1 figure. 1 table. 93 references.

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Is There A Risk of Human Immunodeficiency Virus (HIV) Transmission in Dialysis Centres? Source: International Journal of STD & AIDS; Vol. 6, No. 2, Mar/Apr 1995.

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Contact: Royal Society of Medicine Services Limited, 1 Wimpole St, London. Summary: This editorial considers the prevalence of HIV infection in dialysis units in the United Kingdom. Screening for HIV in dialysis centers is neither a universally adopted nor an accepted policy, often making detection difficult. The rate of seroconversion after patients develop end-stage renal disease and begin dialysis is unknown. Even though they conclude that transmission in the dialysis setting does not appear to be a cause for concern, the authors state that as there are no general recommendations to screen routinely, all dialysis center patients should be treated as if they are HIV positive, and procedures for environmental control, disinfection, and sterilization should be applied. •

Success and Challenge in Dialysis Therapy Source: New England Journal of Medicine. 347(25): 2068-2070. December 19, 2002. Summary: This editorial reviews the successes and challenges of the Medicare End Stage Renal Disease Program, a 30 year old program that extended disability provisions in Medicare coverage to those with end stage renal (kidney) disease (ESRD). The program has been highly successful in providing life-sustaining therapy to ever-increasing numbers of patients, irrespective of race, socioeconomic factors, and other factors that frequently limit access to health care. Moreover, cost containment for dialysis and dialysis quality factors have clearly been achieved. Despite the many successes, there is concern about the steady growth in the numbers of patients who require dialysis and associated health care costs in the United States. The author comments on a recent study, the results of which are published in this same journal issue, the HEMO Study. The HEMO study was undertaken to determine whether providing a dose of dialysis above and beyond that currently recommended could reduce mortality. The results of the study suggest that there is no quick fix for the high mortality among patients receiving dialysis. The author concludes by outlining recommendations that can help improve outcomes in dialysis. 15 references.

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Nutritional Status of Chronic Renal Failure Patients Following the Initiation of Hemodialysis Treatment. (editorial) Source: American Journal of Kidney Diseases. 40(1): 205-207. July 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This editorial serves as an introduction to two related articles in this journal on the nutritional status of chronic renal failure (CRF) patients following the initiation of hemodialysis treatment. The author notes that the two papers have virtually identical titles and nearly the same conclusion; namely, that the initiation of chronic hemodialysis therapy in incident CRF patients is associated with improvement in nutritional status. The author discusses how these observations are important in a number of areas, including the predialysis management of chronic renal (kidney) insufficiency, when to initiate hemodialysis, subsequent nutritional status of patients on hemodialysis, and the influence of all of these on the long term outcome of patients with chronic renal insufficiency. The author concludes that until further information regarding nutrition, early start, dose and flux is obtained, these current studies certainly give credence to the National Kidney Foundation KDOQI recommendations on the initiation of dialysis therapy on malnourished patients with advanced chronic renal failure in whom other interventions have failed to result in nutritional improvement. 10 references.

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2001 Annual Report: ESRD Clinical Performance Measures Project: Opportunities to Improve Care for Adult In-Center Hemodialysis, Adult Peritoneal Dialysis, and Pediatric In-Center Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(5 Supplement 2): S4-S61. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This is the summary report of the ESRD Clinical Performance Measures (CPM) Project, an 8 year old national effort to assist dialysis providers to improve patient care and outcomes. The 2001 ESRD CPM Annual Report describes the findings of several important clinical measures or characteristics of a nationally representative random sample of adult in-center hemodialysis patients and peritoneal dialysis patients. New this year is the addition of findings for all in-center hemodialysis patients aged 12 to 18 years. The report also contains a section of background and project methods. The Executive Summary notes that while significant improvements in care have occurred, the opportunities to improve care for dialysis patients in the United States in the area of adequacy of dialysis, vascular access, and anemia management continue. This Report also provides charts of highlights from the 2001 ESRD CPM Data in the areas of dialysis adequacy, vascular access, anemia management, and serum albumin. The full report can also be found on the Internet (www.hcfa.gov/quality/3m.htm). 15 figures.

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Left Ventricular Mass and Hemodynamic Overload in Normotensive Hemodialysis Patients Source: Kidney International. 62(5): 1828-1838. November 2002. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden, MA 02148. (781) 388-8250. Summary: This study considers whether the hemodynamic parameters are important determinants of left ventricular mass (LVM) in normotensive chronic hemodialysis (NTHD) patients, as has been found in hemodialysis patients who have hypertension (high blood pressure). The study included 40 NTHD patients (mean age 53.7 years plus or minus 14.4 years; 18 males, 22 females) who did not use antihypertensive drugs for at least six months. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46 normotensive subjects with normal renal (kidney) function (NTNR) and thus not on hemodialysis. The results showed that NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical left ventricular dysfunction. Thus optimal HD by adequate fluid removal may not be sufficient for the correction of this flow overload, subclinical LV dysfunction, and the cardiovascular structural abnormalities. Interventions in addition to maintaining optimal HD may be required to reduce the future cardiovascular risk in the NTHD patients. 1 figure. 3 tables. 44 references.

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Comparing Mortality of Elderly Patients on Hemodialysis Versus Peritoneal Dialysis: A Propensity Score Approach Source: JASN. Journal of the American Society of Nephrology. 13(9): 2353-2362. September 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423.

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Summary: This study evaluated differences in mortality (death) over the first year of renal replacement therapy (RRT) between elderly patients starting treatment on hemodialysis (HD) versus peritoneal dialysis (PD). For the period of 1991 to mid-1996, this study defined an inception cohort of all patients aged older than 65 years with new onset chronic RRT. Results showed that peritoneal dialysis starters had a 16 percent higher rate of death during the first 90 days of RRT compared with HD patients. Mortality did not differ between day 91 and 180. Thereafter, PD starters again died at a higher rate. These findings were more pronounced among patients with diabetes. Sensitivity analyses using more stringent criteria to ensure that first treatment choice reflected long term treatment choice confirmed the presence of an association between PD and mortality. 4 figures. 4 tables. 40 references. •

Hepatitis: Implications for Dialysis Personnel Source: Advances in Renal Replacement Therapy. 3(4): 284-286. October 1996. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: Viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV), constitutes an important cause of morbidity and mortality in both dialysis patients and staff. In this article, the author discusses the current recommendations for control of these hepatitis viruses in the dialysis setting. Although the availability and use of hepatitis B vaccine has somewhat lessened the risk of HBV, data shows that only 29 percent of dialysis patients and 76 percent of dialysis staff had received the recommended vaccine. The author lists the five current Centers for Disease Control and Prevention (CDC) recommendations for control of HCV. They include monthly monitoring for elevations of liver enzymes and control of blood-borne pathogens by use of universal precautions. Anti-HCV-positive patients do not require dedicated machines or isolation and they may participate in dialyzer reuse programs. The author notes that the rational for the relatively relaxed recommendations for HCV patients is that this virus circulates in relatively low titers in infected serum, and efficiency of transmission is much lower than that of HBV. Implementing a patient isolation and separation protocol for HCV may enhance patients becoming reinfected with the same of another strain. Infection control strategies in dialysis centers should include comprehensive surveillance, record keeping, infection control precautions, good housekeeping practices, disinfection, and sterilization. 4 tables. 6 references.

Federally Funded Research on Dialysis The U.S. Government supports a variety of research studies relating to dialysis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions.

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to dialysis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore dialysis. The following is typical of the type of information found when searching the CRISP database for dialysis: •

Project Title: A PROSPECTIVE STUDY OF YOUNG ADULTS WITH ESRD Principal Investigator & Institution: Parekh, Rulan S.; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2005 Summary: (adapted from the application) The candidate, Rulan Parekh, is on the faculty at Johns Hopkins University, in the Division of Nephrology, Departments of Pediatrics and Medicine. She is trained in both adult and pediatric nephrology and has obtained a Masters of Science in Biostatistics and Clinical Research Design at the University of Michigan. Her goal is to become a clinician-scientist focused on cardiovascular disease and ESRD using the tools of epidemiology and biostatistics. To realize this goal, she has designed a program of course work that supplements previous training, and which includes structured mentoring by senior investigators, and the conduct of supervised, innovative research. Advanced Ph.D. level courses in genetic and cardiovascular epidemiology, among other topics will be taken. The structured mentoring will take place within the Welch Center for Prevention, Epidemiology, and Clinical Research. This center bridges the Schools of Public Health and Medicine and is a very rich research and mentoring environment. The research training vehicle proposed includes: 1) describing patterns of ASCVD risk factors in young adults with ESRD from the United States Renal Data Systems (USRDS) database; 2) an analyses of the incidence of ASCVD in young adults and its associated risk factors in the USRDS during five-years of follow-up; 3) a case-control study to compare the prevalence of sub-clinical ASCVD in 125 young adults ages 18-35 with ESRD treated in the Johns Hopkins/Gambro Outpatient Dialysis Units compared to 125 age matched type I DM controls treated in the Johns Hopkins Outpatient Center. The prevalence of sub-clinical atherosclerotic cardiovascular disease will be measured by two innovative non-invasive approaches of Doppler sonography of the carotid vessels to assess carotid intimal medial wall thickness, and ECG-triggered helical CT of the coronary vessels to assess coronary calcification. The prevalence of sub-clinical ASCVD will be determined, and correlated with traditional and novel ASCVD risk factors; and 4) a prospective three-year followup of the 125 ESRD cases above to quantify the progression of sub-clinical ASCVD and its predictors. This application has been thoroughly revised in response to the previous review. The proposed study of observational research will fill a major gap in our understanding of cardiovascular disease of young adults in this high-risk ESRD population. The incidence of ASCVD and the prevalence of modifiable and unmodifiable ASCVD risk factors will aid in the development of risk stratification for young adults with ESRD. The information generated from this work is essential to design clinical trials to prevent ASCVD in young adults with ESRD. The career development plan and research project described in this application will build a foundation for a successful career as an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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35

Project Title: A RANDOMIZED, CONTROLLED TRIAL FOR HOMOCYSTEINE Principal Investigator & Institution: Bostom, Andrew G.; Associate Professor of Medicine; Rhode Island Hospital (Providence, Ri) Providence, Ri 02903 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JAN-2006 Summary: (Adapted from the application) This multicenter, randomized, double-blind controlled clinical trial has been designed to determine whether total homocysteine (tHcy)-lowering treatment with a standard multivitamin augmented by a high dose combination of folic acid, vitamin B12, and vitamin B6, versus treatment with a standard multivitamin devoid of these three B-vitamins, reduces the pooled rate of recurrent and de novo cardiovascular disease outcomes (i.e., pooled occurrence of non-fatal and fatal arteriosclerotic outcomes, including coronary heart, cerebrovascular, and peripheral vascular disease events= primary outcome), among clinically stable renal transplant recipients who have mild to moderately elevated tHcy levels. The basic eligibility criteria are age 35 to 75 years old, functioning renal allograft for greater than six-months with serum creatinine based creatinine clearance greater than 30 mL/min, and a screening random tHcy level greater than12 uM/L. Patients will be stratified based on the presence/absence of clinical CVD, and randomly assigned to treatment with a standard multivitamin containing a high dose combination of folic acid, vitamin B6, and vitamin B12, or an identical multivitamin devoid of these three micronutrients. Randomized patients will also undergo a methionine loading test. All patients will receive standard clinical management for traditional CVD risk factor reduction. The study is designed to recruit 4000 patients (2000 in each group) over a two-year period for 83% power to detect a 25% treatment effect. Follow-up continues until occurrence of de novo or recurrent non-fatal CVD, or death, or a maximum of four-years. Data analysis will be performed on the basis of original randomization (intention to treat) using the log-rank test of difference in survival-without-endpoint curves. In the current era of cereal grain flour fortified with physiologic amounts of folic acid, RTRs comprise a patient population particularly well-suited to test the tenable hypothesis that tHcylowering treatment will reduce CVD outcomes, given: a) their persistent excess prevalence of mild hyperhomocysteinemia post-fortification, in contrast, for example, to coronary heart disease patients with normal renal function; b) the demonstrated capability of B-vitamin treatment regimens featuring supraphysiologic amounts of folic acid to successfully "normalize" tHcy levels in RTRs. Furthermore, overall "conditions" in the RTR population (i.e., renal impairment, mild to moderate hyperhomocysteinemia which can be normalized by supraphysiologic dose B-vitamin supplements, and high CVD event rates) are representative of the larger population of patients with chronic renal insufficiency, who are not yet dialysis-dependent. Accordingly, findings from the proposed trial are very likely to be generalizable to the much more sizable population of patients with renal insufficiency progressing to end-stage renal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ADHERENCE AND ADJUSTMENT IN END-STAGE RENAL DISEASE Principal Investigator & Institution: Christensen, Alan J.; Professor; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-JAN-1995; Project End 31-DEC-2003 Summary: (adapted from investigator's abstract): Increased quality assurance concerns associated with the Medicare End-Stage Renal Disease (ESRD) program underscore the need for research addressing the adaptation and quality of life of ESRD patients. Patients' levels of psychological adjustment and their degree of adherence with ESRD

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treatment regimen reflect two important criteria that are examined in the present continuation proposal. One central objective of the research involves identifying psychological characteristics that influence medical regimen adherence and emotional adjustment among patients treated with renal dialysis. This will be accomplished using a longitudinal study design that considers the effects of patient individual differences (i.e., coping style) and contextual differences among the available dialysis treatment modalities. A key aspect of the study involves the assessment of patients at an early stage of progressive renal insufficiency, before renal dialysis is clinically necessary. We hypothesize that adherence and adjustment will vary as a joint function of the type of dialysis prescribed and patient individual differences assessed at baseline. For example, we predict that patients' possessing a more active or vigilant style of coping will exhibit more favorable adherence when undergoing a self-administered dialysis treatment modality (e.g., continuous ambulatory peritoneal dialysis) but poorer adherence when receiving staff administered dialysis (e.g., center hemodialysis). A second objective involves identifying patient characteristics that are related to adherence to adjustment among renal transplantation patients. Initial psychosocial assessment will be conducted during the pre-transplant evaluation process. A set of hypotheses regarding psychological predictors of patient adherence and changes in emotional well being after transplantation will be tested in a prospective manner. For Example, we hypothesize that patients with a more active style of coping with health-related stress will exhibit better regimen adherence and better emotional adjustment than other transplant patients. We believe the proposed research will extend the role of psychological theory and practice in contributing to the care of ESRD patients. The knowledge generated will add to a growing body of literature that suggests psychosocial assessment information can be useful in the selection f the most beneficial renal treatment modality for a particular patient. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANTIPROLIFERATIVE HYPERPLASIA

RX

FOR

VENOUS

NEOINTIMAL

Principal Investigator & Institution: Roy-Chaudhury, Prabir; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Hemodialysis vascular access dysfunction is the single most important cause of hospitalization in hemodialysis patients and is responsible for a very significant morbidity within this patient population. Thrombosis of PTFE dialysis grafts due to venous stenosis as a result of venous neointimal hyperplasia (VNH), is the most common cause of vascular access dysfunction. Surprisingly, there are currently no effective therapeutic interventions for VNH despite its clinical importance. Analysis of cell types and cytokines in dialysis patients with venous stenosis due to VNH and data from a validated pig model of venous neointimal hyperplasia, that is very similar to the human lesion have been described. These studies clearly demonstrate that smooth muscle cell (SMC) proliferation and the formation of microvessels (endothelial cell proliferation), within the neointima and adventitia are critical features of VNH. In addition, it is likely that PTFE dialysis grafts are the ideal clinical model to test out novel local interventions, in view of their superficial location and easy accessibility. It is therefore proposed to test out novel locally delivered antiproliferative therapies in a validated pig model of VNH, in the hope of being able to rapidly translate positive findings into a clinical setting of great need. Three local interventions will be evaluated in this proposal for their anti-proliferative effects. (a)

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External radiation therapy: Initial studies in the pig model, have demonstrated a reduction in VNH (albeit less than in models of coronary angioplasty), with a single dose of l6Gy. We now plan to optimize a radiation schedule for VNH by testing out 3 different radiation regimens (b) Local polymeric delivery of paclitaxel and TNP-470: A local polymeric delivery system comprising ethylene-vinyl-acetate matrices loaded with paclitaxel and TNP-470 (both are potent anti-proliferative agents) will be developed and tested in vitro against SMC and endothelial cells. Polymeric matrices will then be wrapped around the graft vein anastomosis in a perivascular configuration in an attempt to reduce luminal stenosis and VNH. (c) Combination radiation therapy and local anti-proliferative therapy: The most effective radiation and anti-proliferative regimens from (a) and (b) will be combined in this final analysis, in the hope of achieving a synergistic effect. We believe that the results from this study could transform the clinical care of hemodialysis patients and at the same time result in the successful clinical application of local therapy for the treatment of neointimal hyperplasia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOENGINEERING FOR IN VIVO-VIRAL GENE DELIVERY Principal Investigator & Institution: Longmuir, Kenneth J.; Physiology and Biophysics; University of California Irvine Irvine, Ca 926977600 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Non-viral gene delivery systems must overcome the following sequential "barriers" in order to effectively deliver genetic material. 1) Effective self-assembly of the delivery system with the genetic material, 2) stability of the delivery system in the extracellular (serum and blood) environment, 3) escape from the endosomal/lysosomal compartments of the cell, and 4) delivery into the nucleus without the requirement for cell division. We have found that no single barrier is predominant. Instead, effective non-viral gene delivery systems will become therapeutic realities only with a multidisciplinary research effort that addresses all four of these barriers in an integrated fashion, and only with an integrated delivery system with chemical and biophysical properties that allow all these barriers to be overcome. In this regard, we have developed a delivery system that has several extraordinary features, making it a highly attractive candidate for systemic administration in mammals. These features include resistance to inactivation by serum, releasable serum protection components, multiple endosomal escape mechanisms with low cytotoxicity, and most uniquely, the ability to transfect cells equally well with or without cell division. For this project, we have assembled a multidisciplinary team to address the sequential barriers to non-viral gene delivery in an integrated fashion. 1) Effective self-assembly will be achieved by developing fully automated microfluidic technology to carry out reconstitution, mixing, dialysis, and concentration. Stability in serum will be achieved by polyethyleneglycol (PEG) stabilization, with triggered release of the PEG chains upon entry into endosomal compartments. Endosomal escape will be achieved with multiple membrane fusion mechanisms, including fusogenic peptide mimetics designed to eliminate protease inactivation and immune response. Nuclear entry, without cell division, will be achieved with nuclear targeting signals that by-pass classical nuclear targeting pathways, and instead bind directly to the nuclear pore - a mechanism used by those viruses that are the most effective at nuclear entry without cell division. These signals will also be in the form of peptide mimetics to eliminate protease degradation and immune response. The development of this technology will have broad implications

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for the controlled self-assembly of a wide range of nanoparticle systems, particularly those intended for in vivo drug delivery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOINORGANIC DEHYDROGENASE

CHEMISTRY--CARBON

MONOXIDE

Principal Investigator & Institution: Lindahl, Paul A.; Professor; Chemistry; Texas A&M University System College Station, Tx 778433578 Timing: Fiscal Year 2001; Project Start 01-APR-1993; Project End 31-MAR-2003 Summary: This proposal aims to elucidate the catalytic mechanism of carbon monoxide dehydrogenase from Clostridium thermoaceticum. The structure of the enzyme's nickel and iron-sulfur clusters, their redox and spectroscopic properties, their roles in catalysis, and their relationship to the structure of the protein are of particular interest. Only four nickel containing enzymes are known, and the biochemical properties of Ni are not well understood. Ni complexes are widely used as industrial catalysts, and they serve to cleave DNA site specifically. More detailed knowledge of the catalytic properties of Ni may facilitate development of improved artificial enzymes with biomedical and biotechnological applications. The enzyme catalyses two types of reactions, the reversible oxidation of CO to CO2 and the synthesis of acetyl-coenzyme A. The enzyme has an a2b2 quaternary structure with 2Ni, 11-13 Fe, and approximately 14 S2- ions per ab. The metal ions are organized into three types of clusters, called A,B, and C. The Cand A-clusters are novel Ni-Fe-S clusters that serve as the active sites, while the Bcluster is an Fe4S4 cluster that serves to transfer electrons to external electron-accepting agents. The predominant approach to be taken involves and has involved separating the subunits of the enzyme in a manner that does not destroy the metal clusters. By studying individual subunits and other dissociation products, the desired properties of individual clusters will be elucidated. A variety of physical methods will be used, including Electron Paramagnetic Resonance, Mossbauer, Electron Nuclear Double Resonance, X-ray Absorption, Electronic Absorption, Circular Dichroism, Fluorescence, Mass Spectrometry, and possibly Nuclear magnetic Resonance. Other methods, including kinetics, potentiometric titrations, activity assays, radioactivity and isotope labeling, analytical ultracentrifugation, equilibrium dialysis, and peptide sequencing will also be employed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOMEMS MATERIALS FOR RENAL TISSUE ENGINEERING Principal Investigator & Institution: Fissell, William H.; Internal Medicine; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): End-stage renal disease (ESRD) affects 378,000 Americans and is increasing in prevalence at 8% / year. Of the three treatment options (transplant, peritoneal, and hemo dialysis) none is ideal, as transplant is severely limited by scarcity of donor organs and both dialytic modalities are expensive and confer significant morbidity and mortality. Advances in the treatment of ESRD will involve the tissue engineering of nephronal units; indeed, a tissue-engineered renal tubule cell device is presently in clinical trials. For this technology to be generally applicable, devices must be compact, inexpensive, and self-monitoring. An eventual goal of this line of research is an implantable tissue engineered device for renal replacement therapy. The advent of Microelectromechanical Systems (MEMS) technology has produced

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practical surface and bulk micromachining techniques with the ability to manufacture mechanical devices (pores, valves, gears etc.) with feature sizes on the same order of magnitude as subcellular organelles, in combination with on-chip electronics and sensors. This combination allows MEMS devices to sense their local environment and intelligently act upon the local environment by changing electrical and mechanical properties of the devices. Preliminary testing of a MEMS ultrafilter for use in renal replacement therapy has begun, as well as definition of the biocompatibilty of MEMS materials. This project seeks to demonstrate attachment and stable growth of renal proximal tubule cells (RPTCs) on silicon and other MEMS materials. Specific Aim 1: Demonstrate attachment of porcine and human RPTCs to mono- and poly-crystalline silicon, silicon dioxide, silicon nitride, and polydimethoxysilane ("MEMS materials"), with and without extracellular matrix proteins. Specific Aim 2: demonstrate the RPTCs on MEMS materials are able to form stable monolayers with tight junctions. Specific Aim 3: demonstrate metabolic activity, includingammoniagenesis, Vitamin D hydroxylation, and glutathione metabolism by RPTCs on MEMS materials. Specific Aim 4: Demonstrate attachment, growth, and differentiated function of RPTCs on nanoporous substrates. This project has a high likelihood of success, and provides a necessary first step in the tissue engineering of an implantable nephronal unit. Failure of RPTCs to grow on these substrates despite a variety of suface modifications would be extremely important, as it would indicate a need for new materials in bioengineering. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOSENSOR BIOCOMPATIBILITY Principal Investigator & Institution: Reichert, William M.; Professor; Biomedical Engineering; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 15-FEB-1999; Project End 31-DEC-2002 Summary: Considerable effort has gone into developing in-dwelling therapeutic devices that depend on closed loop feedback control. In many cases, e.g. the artificial pancreas, a biosensor is needed to continuously monitor crucial physiological parameters. Although several studies have discussed biosensors which successfully functioned for several weeks in vivo, no sensor appears capable of reliably surviving long-term implantation, primarily owing to the deleterious consequences of wound healing and the foreign body response. This proposal test the hypothesis that easing the analyte transport limitations imposed by the wound healing process on implanted sensors will significantly improve biosensor performance in vivo. We will examine two factors associated with wound healing that limit biosensor access for blood borne analytes: (1) diffusion barriers imposed by sensor membrane biofouling and the densely fibrous capsular tissue that forms around implanted sensors, and (2) perfusion barriers imposed by the avascularity of the fibrous capsule. In pursuing this hypothesis, we intend to examine the efficacy of the following design modifications on in vivo biosensor performance: (1) incorporate textured angiogenic layer into the sensor packaging to disrupt formation of the fibrous capsule and promote neovascularization; (2) incorporate degradable polymers that release angiogenic factors into the textured angiogenic layer to further promote neovascularization; and (3) incorporate dialysis membranes (possibly with hydrogel modification) into the active sensing surface to minimize cellular deposition and protein absorption. The rt animal model will be used to test the influence of these modifications on the performance of long term implanted (i.e. 3-4 months) sensors. Finally, these modifications will be examined in functioning glucose biosensors developed in parallel with the biomaterials work. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ASSESSMENT

BREATH

AMMONIA

MEASUREMENTS

FOR

DIALYSIS

Principal Investigator & Institution: Patel, C Kumar.; Pranalytica, Inc. 1101 Colorado Ave Santa Monica, Ca 90401 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-JAN-2003 Summary: We propose that breath ammonia is a surrogate measure of nitrogenous waste loading in the blood of patients suffering from End Stage Renal Disease. We present preliminary infrared spectroscopic data of human breath from a limited study of n=7 patients undergoing kidney dialysis. Breath ammonia concentration drops from approximately 2000ppb+/- 10% to approximately 200ppb+/-10% between the beginning and the end of the treatment session. We show correlations with reductions in blood urea nitrogen (BUN: approximately 90mg/dL to approximately 30mg/dL) and creatinine (approximately 14mg/dL to approximately 5mg/dL) determined by assaying blood samples taken at every breath measurement. We propose in Phase I to expand the study to n=50 patients to 1) validate the use of breath ammonia as a surrogate measure of BUN and creatinine, 2) refine breath collection and spectroscopic methods, 3) further miniaturize the spectrometer. We will use the Phase I results to design an n equal to or > 500 Phase II patient study to obtain FDA Approval of the spectrometer and to engineer the system into a package small enough to be 1) incorporated into dialysis machines for continuous in-situ assessment of dialysis efficacy and 2) used in the homes of ESRD patients and those at risk of ESRD, such as diabetics and hypertensives. PROPOSED COMMERCIAL APPLICATIONS: Provide every kidney dialysis patient and nephrologist with an instantaneous measure of the progress and efficiency of dialysis treatment. Substitute regular breath measurement for currently-used infrequent blood panels to determine when to begin and stop treatment. Integrate instrument into dialysis machines for in-situ analysis. U.S. Market: >220,000 dialysis patients treated 3 times per week corresponding to 34.32 million dialysis sessions per year Painlessly assess and screen the well-being of diabetics, hypertensives, and premature babies with potential kidney/liver trouble. U.S. Market > 2,000,000 individuals per year Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CALCIUM ACTIVATED MEMBRANE TARGETING BY THE C2 DOMAIN Principal Investigator & Institution: Falke, Joseph J.; Professor; Chemistry and Biochemistry; University of Colorado at Boulder Boulder, Co 80309 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: Description (applicant's description): The conserved C2 domain has been recognized in over 500 proteins, where it plays a central role in targetting proteins to new cellular locations during Ca2+ signals. The most common type of targetting driven by this ubiquitous motif is Ca2+-triggered membrane docking, which initiates critical signaling processes including neurotransmitter and hormone release, activation or inactivation of phosphorylation and G protein signaling cascades, inflammation, and cell cycle control. The present new research proposal aims to develop a molecular picture of C2 domain function, mechanism and structure. The five broad goals of the research are as follows. (i) Distinct classes of C2 domains, differing in their Ca2+ activation parameters and even their mechanisms, will be resolved by comparative equilibrium and kinetic studies of isolated C2 domains from functionally diverse proteins. (ii) The mechanisms by which these different C2 domain classes dock to membranes will be elucidated, and residues essential for membrane docking will be

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identified. (iii) A medium resolution structure of the protein-membrane interface will be determined via a novel strategy. (iv) The mechanism by which Ca2+ triggers membrane docking will be investigated. Finally, (v) activation parameters and mechanistic models developed by studies of isolated C2 domains will be tested in multi-domain proteins and in living cells. To achieve these goals, a range of methods will be employed. Equilibrium dialysis, fluorescence titrations and stopped flow kinetics will be used to quantitate the equilibrium and kinetic features of selected C2 domains. Scanning cysteine mutagenesis and careful solution measurements will identify critical residues and forces that drive membrane docking. A novel combination of EPR distance measurements and constraint-based modelling will reveal the structure of the proteinmembrane interface, and will probe the Ca2+ triggering mechanism. Finally, hypotheses arising from in vitro studies of isolated C2 domains will be tested in multi-domain proteins and in living cells. Overall, this research will provide the first detailed molecular portrait of one of the most prevalent signaling motifs in nature, and will develop new methods to probe the challenging protein-membrane interface. Furthermore, comparative studies of C2 domains will provide information crucial to genomic analyses of many signaling pathways. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARBOHYDRATE AND PROTEIN METABOLIC PATHWAYS Principal Investigator & Institution: Landau, Bernard R.; Professor of Medicine and Biochemistry; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-MAY-1978; Project End 31-MAR-2005 Summary: (Provided by applicant): Carbohydrate, protein and lipid abnormalities characterize diabetes mellitus. Long-term objectives are to develop and apply novel methods significantly advancing understanding of those metabolic processes and their regulation in physiological and pathological states in human, and particularly in diabetes. Advantage is taken of 2H2O use to quantitate the pathways followed. Methods have been introduced for carbohydrate and lipid. The major new goal is to develop and apply a method for quantitating protein metabolism. The method for quantitating carbohydrate metabolism will also be further extended. Focus then is on 1) the quantitation of protein synthesis and proteolysis; 2) the contribution to glucose production of gluconeogenesis whose increase in diabetes has been related to the degree of hyperglycemia and 3) the extent of simultaneous hepatic glycogen synthesis and breakdown, called glycogen cycling, which could help explain decreased liver glycogen content found in type 2 diabetes and exacerbate hyperglycemia on glucose ingestion. There are 4 specific aims: 1) To develop and apply a method for quantitating the extent transaldolase reactions contribute to estimates of gluconeogenesis; 2) To evaluate the validity of a method using glucose isotopomers, introduced as a simple method to measure the contribution of gluconeogenesis, in comparison with 2H2O use; 3) To develop a method for quantitating glycogen cycling in the fed state by measuring, along with the rate of hepatic glycogen deposition on glucose intake, how much of the glycogen is formed directly from the glucose, how much from three carbon compounds, and how much from glycogen that is reconverted to glycogen, i.e. glycogen cycling; 4) To develop a method to estimate protein synthesis from labeling of protein by 2H2O, and proteolysis from loss of that label. Initial application of this method will be to renal failure patients undergoing hemodialysis, in whom ingested 2H2O can be removed by dialysis to readily follow loss of incorporated label without continued synthesis of labeled protein. Application first to the renal failure state is done with recognition that

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nephropathy is a major complication in the diabetic and the potential benefit of a simple method for evaluating the effects of the therapeutic approaches on protein dynamics in that condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARDIAC OSTEODYSTROPHY

OUTCOMES

ASSOCIATED

WITH

RENAL

Principal Investigator & Institution: Kestenbaum, Bryan R.; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-JAN-2008 Summary: (provided by applicant):Cardiovascular disease (CVD) accounts for nearly half the mortality, and extensive morbidity, among patients with renal failure. Comorbid illness and traditional cardiac risk factors do not fully explain the epidemic proportion of CVD observed among dialysis patients. Secondary hyperparathyroidism (SHPTH) is a disorder of calcium metabolism found in renal failure that has been linked to cardiovascular (CV) pathology in experimental models of disease. Clinical evidence relating SHPTH with CV outcomes is limited.The three major aims of the proposed study are 1) to estimate the relationship between serum markers of SHPTH and clinical CV outcomes among patients with renal disease, 2) to estimate the relationship between medications regimens used to treat SHPTH and cardiovascular outcomes, and 3) to recruit a new cohort of dialysis patients to participate in pilot studies and serve as a foundation for future research into the relationship between SHPTH and clinical CVD. Two parallel activities will be conducted to address out scientific aims. First, we will study an established cohort of dialysis patients from the United States Renal Database System (USRDS) and an established cohort of chronic renal insufficiency (CRI) patients from the Veterans' Administrations' Consumer Health Information and Performance Sets (CHIPS) database. The serum markers of interest are intact PTH, calcium, and phosphate. Medication exposures of interest are dosages of phosphate binders and calcitriol. Second, we will recruit a new cohort of 100 dialysis patients from the Northwest Kidney Center and the Veterans' Administration Medical Center dialysis centers.We will ascertain traditional and novel serum markers of SHPTH among our patient cohorts, and then follow them for the development of subsequent CV related hospitalizations. The primary outcome is time to first cardiovascular hospitalization or cardiovascular death. The proposed study aims to shed light on the relationship between a common renal related metabolic disorder and the epidemic burden of CVD found among this patient population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CELL GRAFTS FOR PARKINSON'S DISEASE Principal Investigator & Institution: Collier, Timothy J.; Professor; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2005 Summary: (provided by applicant): In vitro expansion of neural progenitor cells followed by induction of dopaminergic phenotype may provide a limitless source of cells for grafting into patients with Parkinson's disease (PD). However, the signals controlling the conversion of these cells into dopamine (DA) neurons must be identified. In an effort to accomplish this, single cells isolated from ventral mesencephalon were clonally expanded and exposed to hematopoeitic cytokines and neurotrophic molecules. Analysis of cell differentiation in response to this treatment yielded conversion of a high

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percentage (72 to 98 percent) of cells in some clones to a tyrosine hydroxylase (TH)positive phenotype. Of the 24 clones generated, the best conversion to TH cells occurred with exposure to a combination of interleukin-1 (IL-1), interleukin- 11 (IL-11), leukemia inhibitory factor (LIF), and glial cell line-derived neurotrophic factor (GDNF). Positive clones expressed TH, the DA transporter, Nurr-1 and released DA in culture. Other cells in cytokine-exposed clones expressed GFAP (astrocyte marker) or MAP-2 (neuron marker) indicating that the original neurospheres were also capable of producing clones that differentiate into glial and nondopaminergic neurons. Initial neural grafting studies m the rat model of PD using a clone with the highest conversion rate to TH indicated that converted progenitor cell grafts produced complete amelioration of amphetamineinduced rotational behavior and continued to express the TH phenotype. However, the survival rate of these grafted progenitor cells was reduced (26 percent) compared to embryonic ventral mesencephalon (VM). The experiments proposed here will develop protocols for optimal survival of Wafted cytokine-converted mesencephalic progenitor cells. Once survival of grafted mesencephalic progenitor cells is optimized, direct comparisons will be made to fresh embryonic VM grafts on measures of behavior, in vivo dialysis, post-mortem DA biochemistry, DA receptors, cell survival and neurite extension. Lastly, this proposal will test the efficacy of the DA conversion cocktail on clonal progenitors derived from embryonic mesencephalon of nonhuman primate brain. If successful, cytokine-converted mesencephalic progenitor cells could potentially replace embryonic tissue as the primary source of cells for grafting in PD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL OUTCOME OF HEMODIALYSIS IN UTAH Principal Investigator & Institution: Cheung, Alfred K.; Professor of Medicine; Internal Medicine; University of Utah 200 S University St Salt Lake City, Ut 84112 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: The mortality rate of U.S. chronic hemodialysis patients is higher than that in other industrialized nations. Available data suggest that this high mortality rate is partially a result of inadequate delivery of dialysis. The MMHD is a prospective, randomized, multicenter, two-by-two factorial trial sponsored by NIDDK to determine if increasing the amount of delivered dialysis (as assessed by a two-pool, variablevolume urea kinetic model) and using high flux biocompatible dialysis membranes would improve the clinical outcome of these patients. This application describes the University of Utah Dialysis Program (together with the Salt Lake City VA Medical Center dialysis unit) and proposes that this Program participates as a Clinical Center in the MMHD Full Scale Study. The University of Utah Dialysis Program consists of 7 dialysis units, some of which are located in suburban communities, that have common administrative and medical guidelines originating from the University headquarters. The VA-unit is also closely affiliated and has similar protocols. The investigators in this proposal have significant expertise in their respective areas. Both the institution and the investigators have a long tradition in laboratory and clinical dialysis research. They have recently performed several clinical studies involving patients from the different dialysis units within the Program. The P.I. has also participated in several multicenter clinical trials with centers outside Utah. The ESRD population in this Program has been growing. The number of in-center hemodialysis patients, as of December 31, 1993, was 237, of which 37% were diabetic. The majority of these patients are Caucasian (78%), but there is a significant fraction (5%) of Native Americans. This Program will recruit approximately 108 patients during the first 18 months of the Study and randomly allocate 60 of them to 4 hemodialysis treatment strategies that differ in the amount of

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delivered dialysis and/or the type of dialysis membrane. Sixty patients will be maintained throughout the study by using a "recruit to replace" strategy. Many of the medical and technical aspects of therapy, including nutritional intake, will be standardized during the baseline and a 60 month follow-up period. The primary outcome is death of the patient; secondary outcomes include non-access related hospitalization, hospitalization for heart disease or infection, and declining serum album in. The results from this trial will guide hemodialysis therapy in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL TRIAL TO SLOW THE PROGRESSION OF ADPKD Principal Investigator & Institution: Schrier, Robert W.; Professor; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-JAN-2009 Summary: (provided by applicant): Autosomal dominant polycystic kidney disease (ADPKD) affects one in 500-1000 Americans and leads to end-stage renal disease (ESRD) in 50% of patients by age 60 years. Moreover, the life expectancy of ADPKD patients is significantly reduced compared with the general population, despite the availability of dialysis and transplantation, due to premature cardiovascular mortality. Recent advances have lead to greater understanding of the mechanisms of ADPKD, and several agents have been found to slow cyst growth in animal models. However, clinical interventions to ameliorate the course of ADPKD in humans are lacking. Therefore, the National Institute of Diabetes and Digestive and Kidney Diseases has proposed a PKD Clinical Trials Network to design and implement clinical trials to slow the progressive loss of renal function in PKD, including a large trial on blockade of the reninangiotensin-aldosterone system (RAAS). The PKD Research Center at the University of Colorado Health Sciences Center maintains a database of nearly 800 families with ADPKD, and over 1000 family members have participated in previous clinical studies at our Center. Additional patients with ADPKD are available for recruitment from the Polycystic Kidney Research Foundation and from agreements with local health care providers. Thus, we are confident we can identify 500 patients with ADPKD who are eager and eligible to participate in a clinical trial. We propose both a large randomized controlled clinical trial featuring blockade of the RAAS and a pilot study to determine if treatment with an antiangiogenic agent slows the rate of renal growth in patients with ADPKD. Working in collaboration with the PKD Clinical Trials Network, our goal is to identify interventions that not only slow but prevent progression of ADPKD to ESRD, and interventions that ameliorate the cardiovascular complications in ADPKD. A 2 X 2 factorial design is proposed to examine the hypothesis that RAAS inhibition and rigorous blood pressure control will slow progression in advanced ADPKD and prevent progression of renal and cardiovascular disease in early ADPKD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COLORIMETRIC BREATHALYZER FOR DIALYSIS MONITORING Principal Investigator & Institution: Mcnamara, William B.; Chemsensing, Inc. 1200 Shermer Rd, Ste 104 Northbrook, Il 60062 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JAN-2003 Summary: (provided by applicant): More than 200,000 Americans undergo hemodialysis in order to remove toxins from their blood, but to date there exists no device to monitor the efficiency of dialysis in real-lime. Such a device would be of great

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value in determining the dialysis state of both patients undergoing hemodialysis in a clinic and peritoneal dialysis at home. ChemSensing, Inc. (CSI) possesses a unique chemical detection technology in which colorimetric changes in an array of dyes constitute a signal much like that generated by the mammalian olfaction system; each dye is a cross-responsive sensor. This technology as been coined "Smell-Seeing." Previous work has shown that this technology can detect and quantify vapors (including alcohols, amines, ethers, phosphines, phosphites, thioethers and thiols) at the sub-ppm (parts per million) level. This Phase II program is designed to demonstrate that this technology is capable of detecting and quantifying sub-part per million levels of ammonia and therefore Provide an inexpensive, portable, and easily used real-time dialysis breathalyzer. The low cost of this technology makes it feasible for monitoring the efficiency of dialysis every session rather than just once a month, and its portability makes it feasible to monitor urea rebound on a regular basis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTROL OF BREATHING DURING PHYSIOLOGIC CONDITIONS Principal Investigator & Institution: Forster, Hubert V.; Professor; Physiology; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2001; Project Start 01-JUN-1986; Project End 31-MAY-2005 Summary: Several theories on the neural control of breathing that were based on data from reduced preparations were not supported by our recent findings in awake and asleep goats on the effects of rostral medullary neuronal dysfunction and/or carotid body denervation (CBD). Some findings mimicked the altered breathing found in obstructive sleep apnea (OSA) and congenital central hypoventilation syndrome (CCHS). The mechanisms that mediated these effects are not established, but one likely mechanism is through intracranial chemoreceptors for years thought to exist only near the ventral medullary surface (including the retrotrapezoid nucleus RTN)). However, findings in reduced preparations of chemoreceptors at widespread brain sites have raised questions related to the location and role of chemoreceptors that affect breathing in awake and asleep states and whether brain chemoreceptor sensitivity is altered by CBD. One recently identified site of chemoreception is the medullary raphe nuclei (MRN) whose role in the control of breathing during awake and asleep states remains speculative. Accordingly, to study chemosensitivity and the role of the RTN and MRN in the control of breathing, we will implant microtubules into these nuclei of goats to: a) create a focal acidosis by dialysis of mock cerebrospinal fluid with different PCO2's, or b) induce neuronal dysfunction through injection of glutamate or serotonin receptor antagonists or agonists, or a neurotoxin. Major hypotheses are: 1) focal acidosis (equivalent to that breathing 7 percent inspired CO2, delta brain pH approximately -.05) in the RTN will increase breathing in awake, but not asleep states, while acidosis in the MRN will increase breathing in asleep, but not awake states, 2) at RTN sites where focal acidosis increases breathing, neuronal dysfunction will attenuate whole body CO2 sensitivity, but not alter rest and exercise breathing, 3) neuronal dysfunction in the MRN will attenuate CO2 sensitivity and rest and exercise breathing, 4) during the first 10 days after CBD, the effect of RTN and MRN focal acidosis will be attenuated but 15 plus days after CBD, the effect of focal acidosis will be accentuated. and 5) at most RTN and MRN sites, the acute effects of neurotoxic lesions will be hypoventilation (rest and exercise) and attenuated CO2 sensitivity; the acute effects of these lesions will be greater in CBD than in intact goats, but recovery after lesioning will be greater in intact than in CBD goats. Our unique studies are important because hypotheses generated largely from reduced preparations will be tested in awake and asleep states to enhance the

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understanding of medullary chemoreceptor contribution to the control of breathing and how abnormalities in this contribution may underlie diseases such as OSA, CCHS, and the Sudden Infant Death Syndrome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORONARY CALCIFICATION IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Goodman, William G.; Professor; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 29-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Cardiovascular disease accounts for half the deaths in adults undergoing regular dialysis, but the mechanisms responsible remain uncertain. Recent evidence indicates, however, that certain disturbances in mineral metabolism, and/or the therapeutic measures aimed at controlling them, contribute to the development of coronary artery and vascular calcification in patients treated with long-term hemodialysis. Coronary calcification is common in those with end-stage renal disease (ESRD), and the disturbance may account, at least in part, for the high mortality rate from cardiovascular causes in this population. The multi-center, randomized, clinical trial outlined in the current proposal is designed to assess the roles of two separate, yet potentially related, determinants of coronary artery calcification in patients with ESRD who are treated with hemodialysis. The impact of reducing the amount of calcium given orally to patients with ESRD by using sevelamer (RenaGel) rather than calcium-based compounds to control serum phosphorus will be evaluated. Coronary artery calcification will be measured by electron beam computed tomography (EBCT) before and after 12 months of treatment. In addition, the effect of lowering serum total and LDL cholesterol levels on coronary artery calcification scores will be assessed during treatment with either simvastatin or placebo to inhibit 3-hydroxyl-3methylglutaryl Co-enzyme A reductase (HMG Co-A). Potential interactions between these two therapeutic interventions on coronary artery calcification scores will be examined using a 2 x 2 factorial study design. The primary outcome variable is the coronary artery calcification score after 12 months of treatment in each of four groups. The broad objectives of the project are to determine the efficacy of two therapeutic interventions aimed at modifying factors thought to contribute to the development and progression of coronary artery calcification, and possibly to cardiovascular mortality, in patients undergoing long-term dialysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COX-2 METHYLENEDIANILINE

MEDIATED

VASCULAR

TOXICITY

OF

Principal Investigator & Institution: Dugas, Tammy R.; Pharmacology and Therapeutics; Louisiana State Univ Hsc Shreveport P. O. Box 33932 Shreveport, La 71103 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (Taken from the Investigator's Abstract) Vascular medial hyperplasia is an important event in the etiologies of many cardiovascular diseases (CVD), including hypertension, atherosclerosis, and restenosis. CVD continues to kill more Americans each year than any other disease, and since 1984, more women are dying from CVD than men (AHA, 2000). The candidate's laboratory has recently discovered a previously unknown effect of exposure to the aromatic amine 4,4'-diaminodiphenylmethane (DAPM, 4,4'methylenedianiline): vascular medial hyperplasia in both the liver and lung

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following intermittent, low-dose exposure of rats, with greater effects in females than males. DAPM is a compound used in the production of polyurethanes, which are made into a plethora of products ranging from floor coverings to dialysis tubing and breast implants. This new discovery raises the possibility that other aromatic amines, ubiquitous compounds found in a variety of sources, including cigarette smoke, dyes, cured meats, and grilled food, may also have roles in the onset of CVD. In the candidate's preliminary studies, she has shown that treatment of vascular smooth muscle cells (VSMC) in culture with DAPM leads to VSMC proliferation. Relevant to this newly revealed toxicity, a recent report suggested that greater than 50% of DAPM metabolite bound to protein in the blood is likely formed through metabolism by extrahepatic peroxidase enzymes. Peroxidase enzymes metabolize aromatic amines like DAPM to their corresponding imines, which are highly reactive intermediates capable of binding covalently to DNA and protein. The candidate has shown that VSMC express the peroxidase enzyme cyclooxygenase-2 (COX-2), and that treatment of VSMC with DAPM results in increased peroxidase activity detected 12h after exposure. DAPM or its metabolites thus appear to upregulate the expression of COX-2. Finally, VSMC proliferation is attenuated when cells are simultaneously treated with N- acetylcysteine, a nonprotein thiol capable of reacting with electrophilic intermediates, thus preventing reactions of these intermediates with endogenous molecules and possibly preventing cell damage. These results suggest that VSMC are capable of metabolizing or bioactivating DAPM to toxic intermediates. Thus, the candidate will test the following hypotheses: 1) DAPM is metabolized to reactive intermediates by VSMC cyclooxygenase; 2) reactive metabolites of DAPM produced by COX further upregulate the expression of COX-2; and 3) this increase in expression of COX-2, and/or phospholipase A2 (PLA2), contributes to increases in rates of VSMC proliferation in response to DAPM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CSF AND THE CENTRAL CHEMICAL CONTROL OF BREATHING Principal Investigator & Institution: Nattie, Eugene E.; Professor of Physiology; Physiology; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 01-DEC-1981; Project End 31-MAY-2004 Summary: Appropriate breathing requires 1) feedback concerning the level of CO2 from central chemoreceptors, and 2) a tonic 'drive', partly from CO2, and partly from other sources including the rostral ventrolateral medulla (RVLM). Recent work established that 1) central chemoreception is present at many brainstem locations, and 2) the retrotrapezoid nucleus (RTN) is a key RVLM site that provides both chemoreception and a tonic drive to breathe. We ask: Why are there so many central chemoreceptor sites? How do they work? What is the physiological role of the RTN in the control of breathing? We will evaluate chemoreceptor and RTN function during sleep and wakefulness in a chronic unanesthetized rat model using a microdialysis probe to deliver substances to the RTN (or other site). The probe tip is 1 mm in length and 240 mum in diameter, a volume of 45 nl. It allows repeated application of neuroactive substances at the same site in the same animal with continuous measurement of ventilation and oxygen consumption (whole body plethysmograph), arousal state (EEG, nuchal EMG), body temperature and blood pressure (telemetry), and, in some cases, blood gases and pH. Approximately 2/3 of the experiments use this model; 1/3 an anesthetized, ventilated rat with phrenic activity as the measure of respiratory output. For studies of chemoreception physiology, we produce focal tissue acidosis by CO2 microdialysis in both models. For studies of mechanism, we alter neural function by

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injection/dialysis within the focal region of acidosis in the anesthetized rat. For studies of the RTN, we inhibit neurons reversibly by dialysis with muscimol, a GABA-A receptor agonist, in the chronic model. Central chemoreceptor physiology is significant; CO2 is a key component of the respiratory control system and CO2 retention in disease causes morbidity. Chemoreception and RTN function vary with arousal state, and thus are likely to be important in sleep disordered breathing, and the RTN is hypothesized to be an animal homologue for the arcuate nucleus, described as abnormal in SIDS victims. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CYTOKINE GENE POLYMORPHISMS IN ACUTE RENAL FAILURE Principal Investigator & Institution: Jaber, Bertrand L.; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Acute renal failure (ARF) is a serious complication in hospitalized patients, with an incidence of 5-10%, and mortality exceeding 50% among those who require dialysis. Pro- and anti-inflammatory cytokines play a pivotal role in the host inflammatory responses that mediate the severity of ARF. Yet, the importance of susceptibility genetic factors such as cytokine gene polymorphisms has remained largely unexplored. The principal investigator (PI) has designed a rigorous training program that will provide him with the necessary skills, experience, and opportunities to develop into an independent investigator in the field of inflammatory genetic markers and epidemiology of acute renal failure. He will obtain a Masters of Science in Clinical Care Research, participate in projects utilizing a broad range of study designs for clinical research, and carry out an original research project from its inception to completion. His mentors have extensive experience in clinical and laboratory investigation of ARF and clinical care research in Nephrology. Single nucleotide polymorphisms (SNP) in the promoter region of the human tumor necrosis factor-alpha (TNF-alpha) (position -308), interleukin-6 (IL-6) (position -174) and interleukin-10 (IL-10) (position -1082) genes affect transcriptional activity and have functional relevance. These genetically determined differences might influence variations in host inflammatory responses to stressful stimuli. The hypotheses to be investigated are that SNP involving these cytokines predetermine the severity of ARF, and are independent risk factors for adverse clinical outcomes. The specific aims are to: 1) characterize the frequency of these pro- (TNF-alpha and IL-6) and anti-inflammatory (IL-10) cytokine gene polymorphisms in a cohort of patients with ARF; 2) Examine their relationship to leukocyte production and plasma levels of cytokines as well as clinical and laboratory variables; and 3) Evaluate whether these genetic markers individually or in combinations, predict adverse clinical outcomes, mainly dialysis requirement and mortality. The research project is achievable and promises to provide new insights into the importance of genetic markers as novel susceptibility factors for severity of disease in ARF. The results may help identify target patients who may benefit from anti-cytokine therapies. The PI has assembled a team of scientists to assist in the conduct of the project, and convened and internal and external scientific advisory committee to monitor his progress. The proposed training program and research project will prepare him for a career as an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIALYSIS FACILITY MANAGEMENT Principal Investigator & Institution: Eisenstein, Eric L.; Medicine; Duke University Durham, Nc 27706

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Timing: Fiscal Year 2002; Project Start 12-SEP-2002; Project End 31-AUG-2004 Summary: Taken by Applicant): Medicare's End-Stage Renal Disease (ESRD) program is the only public program that provides health insurance coverage for a specific disease. ESRD patients typically survive fewer than five years after beginning renal dialysis. During this time they average 1.9 hospitalizations per year, for a total of 14 days. Previous studies have reported significant variations in a dialysis facility management practices, treatment costs and profitability. However, little is known about the relationships between dialysis facility characteristics and long-term dialysis patients' clinical and economic outcomes. We hypothesize that dialysis facility characteristics primarily influence total medical costs by modifying dialysis patient hospital events (frequency and type). Additionally, we hypothesize that changes in dialysis facility management practices may improve long-term clinical outcomes for dialysis patients and for the ESRD system as a whole. However, these changes may also increase dialysis facility operational costs. Using information from three consecutive years of incident dialysis patients with a minimum of one and a maximum of three years follow up on all patients, this project will evaluate these hypotheses. Follow-up will begin on the 91 days after dialysis initiation and continue until death or renal transplantation. After adjusting for differences in patient clinical characteristics, we will define the impact of dialysis facility characteristics on dialysis patients: (1) mortality (survival and life expectancy), (2) morbidity (hospitalization rates and event-free survival, death, or hospitalization) and (3) total medical costs (dialysis treatment, hospitalization, physician and supplies). We will then assess the economic attractiveness (cost-effectiveness or cost-savings) of dialysis facility management practices that improve dialysis patient long-term clinical outcomes and develop decision models for the dissemination of study results. Through these aides, dialysis patients, providers, payers and policy maker will be able to: determine how dialysis facility management practices impact long-term clinical and economic outcomes and identify optimal management practices to improve survival or decrease total medical costs for dialysis patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIFFUSE OPTICAL IMAGING OF INTRACRANIAL PRESSURE CHANGES Principal Investigator & Institution: Strangman, Gary E.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Elevated intracranial pressure (ICP) poses a significant risk in patients with traumatic brain injury, intracranial hemorrhage, massive stroke, and brain edema from multiple causes. Rises in ICP (i) can develop at any time following such conditions, (ii) often occur without clinical correlation (Matz and Pitts, 1997), and (iii) are associated with significant morbidity and mortality All three attributes make continuous monitoring an important goal in at-risk populations, resulting in tens of thousands of neurosurgical procedures performed per year for such monitoring (AANS, 1999). The standard means of monitoring such patients is ICP measurement involving an invasive, intracranial sensor. This approach provides a continuous, global pressure measurement. However permanent brain injury does not occur due to the pressure itself but due to the metabolic and structural consequences: impaired brain perfusion and tissue shifts. MRI and PET have identified regional ICPrelated pathophysiology but only at single points in time. Intracerebral dialysis, oxygen and pH sensors have identified and monitored markers of insufficient perfusion but only at a point source. Critically, both pressure sensors and these imaging methods are

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costly--involving major surgery (including associated medical risks), or requiring expensive instrumentation. Diffuse optical imaging (DOI) is a potential major advance for patients with altered ICP. It is non-invasive and can be made an order of magnitude less expensive than current techniques. It is sensitive to the perfusion and oxygenation state of the brain--core concerns associated with ICP alterations--and it is an imaging technique that can be used in continuous, real-time, bedside settings. The goal of this exploratory/developmental (R21) research proposal, therefore, is to evaluate the feasibility of using DOI to perform brain imaging in altered ICP patients as a potential replacement for the existing, more expensive approaches. We will achieve this goal via two primary aims: (1) Evaluate the sensitivity and specificity of DOI-derived hemodynamic changes to ICP changes via recordings in neurointensive care patients before, during and after ICP interventions, and (2) Image the spatial components of hemodynamic modulations relative to CT-defined tissue status. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIPYRIDAMOLE IN VASCULAR ACCESS FOR HEMODIALYSIS Principal Investigator & Institution: Himmelfarb, Jonathan; Professor; Maine Medical Center 22 Bramhall St Portland, Me 04102 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: The long-term objective of this proposal is to establish whether or not the use of dipyridamole is efficacious in improving the function of expanded polytetrafluoroethylene (ePTFE) grafts used for dialysis access in patients with end stage renal disease on chronic hemodialysis therapy. Currently, there are over 170,000 patients in the US on chronic hemodialysis therapy. For these patients, problems with vascular access patency have been called the "Achilles Heel" of the dialysis procedure. Furthermore, the development of ePTFE graft stenosis and thrombosis reduces the quality of delivered dialysis therapy and increases the infection risk for patients on dialysis. Maintaining vascular access patency costs approximately $7,871 per hemodialysis patient per year at risk with an estimated annual global cost of more than one billion dollars. Recent evidence suggests that in almost all cases, ePTFE graft thrombosis occurs only after the development of a stenosis either at the graft vein anastomosis or more distally in the vein. These venous stenoses occur because of a pathological process known as intimal hyperplasia. Recent evidence from a small, single-center, prospective, randomized, placebo-controlled clinical trial has suggested that dipyridamole may reduce the rate of ePTFE graft thrombosis in chronic hemodialysis patients. The mechanism of dipyridamole efficacy may be by inhibiting vascular smooth muscle cell proliferation and thereby reducing the development of intimal hyperplasia and associated venous stenoses. The specific aims of this proposal are: l) To investigate the efficacy of dipyridamole in preventing the development of anastomotic and venous stenoses in patients on chronic hemodialysis with ePTFE grafts; and 2) To investigate the efficacy of dipyridamole in preventing the development of thrombosis in patients on chronic hemodialysis with new ePTFE grafts. In order to answer the Specific Aims, the proposed study design is a randomized, prospective, double-blind, placebo-controlled, parallel group clinical trial. Patients on chronic hemodialysis therapy who require a new prosthetic ePTFE graft will be randomized to receive either dipyridamole or placebo for a period of 12 months after enrollment or until ePTFE graft failure. Enrolled patients will undergo serial monitoring of vascular access blood flow, known to be a physiologic predictor of impending vascular access failure, with clinically indicated interventions to prevent vascular access failure. The study design will test the null hypothesis that dipyridamole does not affect the

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development of either venous stenosis or thrombosis in new ePTFE grafts in hemodialysis patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY DIAGNOSIS AND TREATMENT OF DIALYSIS GRAFT STENOSIS Principal Investigator & Institution: Robbin, Michelle L.; Radiology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: The broad long-term objective of this proposal is to improve vascular access longevity in chronic renal failure patients on hemodialysis using ultrasound evaluation. Synthetic graft failure after the first month is primarily due to clotting (thrombosis). After the graft thromboses, an underlying graft or draining vein stenosis is found in greater than 85 percent of patients, despite aggressive clinical monitoring for stenosis. Patent grafts with stenoses treated with percutaneous transluminal angioplasty (PTA) or surgical revision techniques have longer patency than thrombosed grafts after thrombectomy. Therefore, early stenosis detection with treatment of the hemodynamically significant stenoses found (in patent grafts) should increase graft longevity, thereby decreasing the substantial costs associated with graft failure. We propose to actively test two graft surveillance strategies. This study will test the hypothesis that triannual ultrasound monitoring and percutaneous treatment of detected stenoses will improve hemodialysis graft longevity compared to aggressive clinical monitoring. Specific Aims: To test the hypothesis that: 1). Triannual color flow ultrasound (US) surveillance of hemodialysis grafts can diagnose stenoses that are not detected during aggressive clinical monitoring. 2). PTA of hemodynamically significant stenoses detected by ultrasound surveillance will approximately double graft longevity, from the current 16 months. 3). To determine the ultrasound and angiographic measurement parameters that most accurately predict the longevity of the PTA result. 4). To assess the cost-effectiveness of early color flow US graft stenoses detection and intervention versus aggressive clinical monitoring. Health Relatedness: If color flow US monitoring in addition to aggressive clinical monitoring increases graft longevity and is cost effective as compared to aggressive clinical monitoring alone, this would have important implications for patient management. Increased graft longevity should lead to improved patient quality of life, secondary to a decreased need for thrombectomies, temporary access catheters and surgical placement of new grafts. Research Design and Methods: A randomized, prospective clinical trial will compare triannual color flow US graft monitoring in addition to aggressive clinical monitoring, to aggressive clinical monitoring alone. PTA or surgical revision of hemodynamically significant stenoses detected will be performed. Access patency will be followed for at least 2 years, or until placement of a new access. All other aspects of the patients' medical and dialysis care will follow usual medical standards. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECT OF CLOPIDOGREL ON EARLY PATENCY OF AV FISTULAE Principal Investigator & Institution: Dember, Laura M.; Associate Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: Purpose: The objective of this proposal is to design randomized, controlled rnulticenter trials evaluating interventions to increase the survival of vascular access for

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hemodialysis and to form a collaborative network of clinical centers and a data coordinating center to perform such studies. Specific Aims: This application has two specific research aims: l) To determine whether the administration of clopidogrel for four weeks beginning on the day prior to native fistula creation reduces the rate of early fistula failure compared with placebo, and 2) To create a Collaborative Boston Area Clinical Center with the patient population and clinical and research expertise necessary to conduct the series of studies of the Hemodialysis Vascular Access Clinical Trials Consortium. Background: Maintenance of vascular access for hemodialysis is one of the major challenges in the care of the hemodialysis patient. Access-related problems are among the most frequent reasons for hospitalization in the end-stage renal disease (ESRD) population, and the cost of vascular access placement and repair in the United States currently exceeds $700 million per year. Despite the well-established advantages of native arteriovenous fistulae (higher unassisted potency rates and lower rates of infection) compared to grafts or catheters, the proportion of the United States hemodialysis population with a native fistula is low. An important factor contributing to this low prevalence is early thrombosis of newly created fistulae. Several small studies of antiplatelet agents have shown a reduction in early thrombosis rates of native fistulae, but have not been powered sufficiently to definitively demonstrate a benefit. Methods: Patients with chronic renal failure who are scheduled to undergo creation of a native fistula and are without contraindication to antiplatelet therapy will be randomized to receive either placebo or clopidogrel 75 mg daily beginning the day prior to fistula creation and continuing for an additional 4 weeks. The primary outcome measure will be attainment of a fistula suitable for dialysis without any radiologic or surgical intervention. The secondary outcome measures will be: l) fistula potency at completion of study drug, and 2) attainment of a fistula suitable for dialysis including those fistulae modified radiologically or surgically. The Boston Area Clinical Center will be comprised of five facilities with greater than 600 patients currently on hemodialysis and large pre-ESRD populations from which to draw study subjects. These study sites have extensive successful experience in multicenter clinical trials in ESRD. The Boston Area Clinical Center is organized to efficiently collaborate on the series of clinical trials conducted by the Hemodialysis Vascular Access Clinical Trials Consortium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECT OF RENAL INSUFFICIENCY ON CARDIOVASCULAR OUTCOMES Principal Investigator & Institution: Schwab, Steve J.; Professor; Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 15-JUN-2001; Project End 31-MAY-2003 Summary: (Verbatim from the application): Cardiovascular disease accounts for almost half of the reported deaths for patients receiving maintenance dialysis. Because incident dialysis patients often have advanced coronary artery disease that is less amenable to treatment as compared with patients with normal renal function, the greatest impact of therapy will be obtained through invention among patients with renal insufficiency, prior to their development of ESRD and earlier in the development of the coronary artery lesions. This proposal will define the impact of varying degrees of chronic renal insufficiency on five-year survival among patients with significant coronary artery disease. This study will further compare patient survival following treatment for coronary artery disease (medical, percutaneous coronary artery intervention and coronary artery bypass grafting) among patients with mild, moderate, and severe renal insufficiency. After evaluating these clinical outcomes, this proposal will estimate the

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cumulative five-year medical resource utilization (rehospitalizations and cardiac procedures) and costs for patients with chronic renal insufficiency and significant coronary artery disease to compare costs among major patient subgroups. A retrospective cohort design will be used to take advantage of the Duke Databank for Cardiovascular Diseases (DDCD), a large, comprehensive patient database, maintained by the Duke Clinical Research Institute (DCRI) and its associated hospital and physician administrative databases. This study will examine the cardiovascular outcomes that affect the survival of patients with chronic renal insufficiency and patients receiving chronic dialysis. The results of this study will provide evidence for early intervention among the pre-ESRD population with chronic renal insufficiency to improve maximize the efficacy of coronary revascularization and improve survival. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF ALCOHOL ON MESOACCUMBAL DOPAMINE LEVELS Principal Investigator & Institution: Kirstein, Cheryl L.; Director, Cognitive and Neurosciences; Psychology; University of South Florida 4202 E Fowler Ave Tampa, Fl 33620 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2002 Summary: The role of the mesolimbic dopaminergic pathway (specifically the nucleus accumbens septi, NAcc) in reward has been well-documented in ,adult animals. Dnigs of abuse, such as alcohol increase dopamine (DA) levels in the NAcc of adult rats. Similarly, in many studies drug ,expectancy has been shown to increase DA in the adult NAcc. As a result, several studies have implicated this pathway as a potential neural substrate for drug abuse. In humans, drug abuse patterns are often established in adolescence, not adulthood; this is especially true of alcohol. A limited number of studies have examined changes in the NAcc in response to alcohol during development. The establishment of an animal model to study this reward system during early development and adolescence is critical. The data show that drug use begins around adolescence and continues into adulthood. Moreover, development of the brain is still ongoing during this period and this may be critical in elucidating the development of addiction. To this end, we modified and adapted the in vivo micro dialysis procedure to enable us to effectively and reliably recover DA from the NAcc of young rat pups. The dialysis procedure allows measurement of the neurochemical changes resulting from drug administration. The present studies propose to use in vivo micro dialysis to examine: 1. the effects of ethanol on the NAcc in preadolescent rats (postnatal day 25; PND 25) and 2. the function of the mesolimbic pathway in periadolescent (PND 35, 45) and adult animals (PND 60) after repeated ethanol exposure (n=bidaily injections for 4 days at each age) during these different periods of development. The principal goals of these proposed studies are: first, to isolate the dose-response effects of ethanol exposure on the mesolimbic DA pathway in male and female preadolescent rats to determine appropriate low and high doses for use in the repeated administration experiments; second, to examine the acute vs. repeated effects of ethanol on the mesolimbic DA pathway in preadolescent, periadolescent and adult animals; third to see how these processes are altered in periadolescent and adult animals following repeated administration of ethanol during adolescence and adulthood; and fourth to determine the effects of ethanol expectancy on the function of the mesolimbic DA system in preadolescent, pefiadolescent and adult animals. We will examine how this system responds to ethanol administration, how these responses differ between preadolescent, periadolescent and adult animals, and whether drug expectancy following repeated administration is sufficient to elicit the same neurochemical responses (ie., whether there

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are "expectancy-induced" increases in accumbal DA in response to saline alone after repeated ethanol). These studies will provide insight as to alterations in mesolimbic DA function following repeated exposure during a time when the brain reward system is developing. We have previously reported ethanol-induced increases in DA efflux in the NAcc of preadolescent rats. The proposed studies will allow us to examine the underlying mechanism of ethanol's effects in young animals which is critical in order to understand how these processes control the initiation of drug use. Moreover, we will be able to compare these responses across ages which is critical to understand the mechanisms which may underlie the continued maintenance of ethanol abuse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: END-STAGE LIVER DISEASE/PREVALENCE & TREATMENT VARIATION Principal Investigator & Institution: Bryce, Cindy L.; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: (adapted from the application) The primary purpose of this proposal is to provide the applicant with means and structure for achieving two goals. The immediate goal is to evaluate the effect of gender, race and income on access to liver transplant services. The long-term goal is to gain independence as a health services researcher by developing methodological expertise in decision sciences and multivariate statistical modeling and research expertise in organ transplantation and health policy evaluation. The applicant will obtain further instruction in computer simulation, geographic information systems, and advanced statistical analysis; in addition, she will receive clinical education to better understand the liver transplantation process and overall delivery of patient care. This training will be provided through formal coursework, directed readings, seminars and conferences, a clinical preceptorship, and research. Most activities will take place at the University of Pittsburgh's School of Medicine, Graduate School of Public Health, and Center for Research on Health Care. The applicant's research project evaluates the role of gender, race, and income in determining access to liver transplantation and explaining variation in liver transplant rates. To date, most studies on access to transplantation have focused on renal transplant services; few researchers have studied hepatic transplantation because of serious data limitations. Whereas the federal government maintains a comprehensive database of persons with renal disease from the time they receive dialysis, there is no centralized, population-based registry for persons with end-stage liver disease (ESLD). Most information on ESLD patients is collected on liver transplant candidates by the United Network for Organ Sharing. The hypothesis of this project is that demographic and economic factors significantly affect early access to transplant services, namely referral rates to transplant centers and listing rates by transplant centers. To address this issue, better information is needed. Therefore, the project will satisfy two aims: (1) develop and validate a population-based methodology for identifying and tracking a cohort of "transplant potential" patients with ESLD; and (2) estimate the effect of gender, race and income on movement through the transplantation process. This project will collect new information on patients with ESLD and combine it with existing data resources made available through The Optimal Timing of Liver Transplantation Project (AHCPR, R01 HS09694-02). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY OF DEMENTIA IN OLDER DIALYSIS PATIENTS Principal Investigator & Institution: Murray, Anne M.; Minneapolis Medical Research Fdn, Inc. 600 Hfa Bldg Minneapolis, Mn 55404 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Candidate: Anne Murray, M.D., M.Sc., is a fellowship-trained geriatrician with a Masters in Epidemiology and a staff physician at Hennepin County Medical Center, a teaching hospital affiliated with the University of Minnesota. She is also an investigator with Nephrology Analytical Services, an epidemiology laboratory and repository for the NIH's United States Renal Data System (USRDS) database. Dr. Murray's immediate goal is to pursue research in the epidemiology and prevention of cognitive impairment in dialysis patients. Career Objectives: Dr. Murray's immediate career objectives include: 1) advanced coursework in neuropsychology, study design, longitudinal analysis, and ethical conduct of research, 2) work with her mentors to further develop her research skills in the area of cognitive impairment in renal disease through regularly scheduled meetings and directed readings, 3) conduct a three-year longitudinal study of the prevalence and progression of cognitive impairment in dialysis patients under the guidance of her mentors, 4) continue to conduct analyses on the epidemiology of dementia in dialysis patients using the USRDS database, and 5) during the last year of the award, develop a proposal to obtain funding for a prospective study of the incidence of and risk factors for cognitive impairment in patients with chronic kidney disease, formerly called chronic renal insufficiency. Dr. Murray's long-term career objective is to attain independence as an investigator in the area of epidemiology of cognitive impairment in renal disease and other chronic diseases. Research Plan: During the five-year award period, Dr. Murray plans to use findings from analyses of her pilot data and the USRDS database to conduct a prospective longitudinal study of the prevalence and progression of cognitive impairment in dialysis patients in the Twin Cities. The study will test the hypotheses that 1) dialysis patients have a higher prevalence of cognitive impairment than the general population, 2) the risk of cognitive impairment increases with duration in years of dialysis, and 3) age, Modified Mini-Mental State Examination (3MS) score at baseline, education, and history of stroke will be strong predictors of the rate of progression of cognitive impairment in dialysis patients. Subsequently, Dr. Murray plans to collaborate with her mentors to write a major proposal to examine the epidemiology of cognitive impairment in patients with chronic kidney disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FACTORS STABILIZING RNA STRUCTURES Principal Investigator & Institution: Draper, David E.; Professor; Chemistry; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2003 Summary: Because RNA carries a high negative charge, its folding into secondary and tertiary structures can be exquisitely sensitive to salt concentration. Folding of RNA tertiary structures is particularly affected by the concentration of divalent ions and the types of mono- and divalent ions presents. Investigation ion association with an RNA is a difficult problem, as binding in the sample molecule may vary from entirely delocalized interactions with the RNA electrostatic field to chelation of partially dehydrated ions at specific sites. How one views the role of ions in directing RNA folding depends on the relative importance assigned to such non-specific and specific binding modes. The purpose of the proposed work is to systematically examine ion-

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RNA interactions in a series of RNAs of known and increasingly complex noncanonical and tertiary structures. Approaches that will be used are calorimetric and UV melting experiments (which report the differences in the extent of ion association between folded and unfolded states, and provide a direct measure of ion-induced stabilization), and methods that detect the extent of monovalent or divalent ion association with the folded RNA structure (equilibrium dialysis or titrations using fluorescent indicators of free ion concentrations). Specific aims of the work include (i) Investigation of divalent ion interactions at specific RNA sites, including the affinity, monovalent ion salt dependence of binding, and selectivity for different alkaline earth ions; (ii) Determination of what RNA structures develop selectivity for monovalent ions (alkali metal and ammonium), and whether selectivity can be attributed to one or a few specific coordination sites; (iii) Initial attempts to compare calculated and experimentally measured electrostatic potentials in an RNA. These experiments should provide a picture of how ions are distributed around each RNA and the degree to which different classes of associated ions contribute to thermodynamic stability of RNA structures. This information will fill in a crucial aspect of non-canonical and tertiary RNA folding energetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAST AND SLOW DOPAMINE SIGNALING IN PREFRONTAL CORTEX Principal Investigator & Institution: Seamans, Jeremy K.; Professor; Anesthesiology; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Dopamine (DA) neurons in the ventral tegmental area (VTA) are thought to encode an error prediction signal, in that the firing of DA neurons and release of DA may encode errors in predictions about rewards. In order for this to occur, DA release must be temporally precise to ensure that the errors in reward prediction provide information about the reward and the associated events that had just occurred. This theory assumes the VTA DA signal is fast acting and brief. This simple assumption has not been adequately tested, and evidence for fast DA signaling is in fact lacking. Within the prefrontal cortex (PFC) at least, both pre-and postsynaptic indicies of DA function in vivo or in vitro, suggest that DA signaling is slow in onset and slow to recover, and is therefore inconsistent with the properties required for an error prediction signal. On the other hand, although DA receptors are typically not ionotropic, in vivo intracellular recordings show that PFC neurons respond to VTA stimulation with a fast EPSP. Preliminary data suggest this EPSP has properties similar to glutamate mediated EPSPs, is blocked by destruction of DA cells in the VTA and peripheral administration of a glutamate antagonist. These findings suggest that VTA DA cells may encode a fast signal in the PFC via co-release of another transmitter, possibly glutamate. This idea has a long and controversial history but co-release of glutamate by VTA DA neurons would remove the burden of concurrently encoding fast and slow signals by postsynaptic DA receptors. Moreover, glutamate release due to VTA firing could produce fast changes in the membrane potential of PFC neurons that would provide the temporally precise signal required for the error prediction theory. The first part of this proposal will test the hypothesis that the EPSP in the VTA-PFC pathway is mediated by glutamate. The second part will test the temporal limits of DA signaling in the PFC. Part 1 will involve in vivo intracellular recordings from PFC neurons in combination with administration of pharmacological agents (either applied peripherially or via a dialysis probe in PFC) that block DA, glutamate or GABA receptors in an attempt to block the EPSP in the

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VTA-PFC pathway. Additional experiments will be performed in VTA-PFC organotypic slice co-cultures to test the properties of the EPSP in a more rigorous manner. These experiments will also determine the validity of the organotypic slice co-culture as a means of studying the VTA-PFC pathway based on its similarities to the in vivo preparation. Part 2 will involve simultaneous measurements of DA release in PFC and the electrophysiological response of PFC neurons to VTA stimulation in an attempt to determine the parameters of this release and how quickly it can alter the properties of PFC neurons. A new theory will be proposed that incorporates fast and slow signaling from VTA neurons and that explains the existing literature while providing a new way to think about normal and pathological states involving PFC DA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FLUID COMPLIANCE IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Welch, Janet L.; None; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2003 Summary: Fluid compliance is critically important to the continued health and wellbeing of hemodialysis patients. These patient must limit their fluid intake in order to improve quality of life and to avoid severe medical complications or premature death. There is, however, high rates of fluid noncompliance in this population. Most studies have considered fluid compliance to be a dichotomous variable, with individuals either compliant or noncompliant. The literature, however, suggests that stages of change may be used to categorize behaviors in a more complete way. Moreover, when intervening to promote complex behavior change, attending to the distinct differences in the stages may be important. Specifically, in the context of hemodialysis patients, identifying stage differences in relation to fluid compliance is important for developing interventions to improve such compliance. The central aim of the proposed study is to identify factors associated with stage of fluid compliance in hemodialysis patients. The factors to be explored include cognitive functioning (attention, language, construction, memory, calculations, and abstract reasoning), perceptions (benefits, barriers, seriousness, susceptibility, and self- efficacy), self-care strategies (use and perceived effectiveness of strategies to reduce fluid intake and relieve thirst), thirst, physiological variables (hemoglobin, serum albumin, serum glucose, adequacy of dialysis, and comorbid conditions), and demographic variables (age and gender). The sample will be 230 adults who receive out-patient hemodialysis therapy. Data will be collected two times over a four-month interval to (a) describe the distribution across stage of fluid compliance and the extent to which stage of fluid compliance changes over time and (b) identify the factors that are associated with stage of fluid compliance and the change in stage of fluid compliance over a four-month period, if a change exists. The participants will be 18 years of age or older, alert and oriented, English speaking, residing independently in the community, and receiving out-patient hemodialysis as their permanent end-stage renal disease treatment modality. Face-to-face interviews will be conducted with each participant to collect data on stage of fluid compliance, cognitive functioning, perceptions, thirst, and self-care strategies. Laboratory values and pre- and post-dialysis weights will be obtained from the clinical record. Data on comorbid conditions will be obtained from the attending nephrologist or nurse practitioner. The duration of the proposed study is 24 months. Refinement of scales will precede all other data analyses. Nonparametric and univariate statistical methods will be used to analyze the data. No previous studies have investigated all of these important variables together within the context of stage of fluid compliance in hemodialysis patients. Findings will greatly

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increase the understanding of fluid compliance in hemodialysis patients that is needed for the development of effective interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FREEDOM - FREQUENT DIALYSIS OUTCOMES & MARKERS STUDY Principal Investigator & Institution: Chertow, Glenn M.; Associate Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): The FREEDOM (Frequent Dialysis Outcomes & Markers) Study is a randomized clinical trial designed to test hypotheses related to the feasibility, safety, and efficacy of frequent (>3 times per week) hemodialysis. The recently completed NIDDK-funded HEMO Study demonstrated that survival and many other outcomes were not appreciably influenced by significant increases in equilibrated Kt/Vurea, a parameter of dialysis dose, when hemodialysis was given thrice weekly. Clinical experience and published anecdotal reports suggest that more frequent dialysis may result in reduced frequency and duration of hospitalization, improved control of volume overload, hypertension and anemia, correction of disorders of mineral metabolism, and enhanced quality of life. Given the high mortality rates and significant morbidity associated with end-stage renal disease, a rigorous evaluation of alternative dialysis strategies is warranted. The Investigators have constructed a consortium of University- and community-based nephrologists and dialysis units throughout the state of California - the California Coordinating Clinical Center (CCC). We serve urban and suburban communities with extensive racial, ethnic and socioeconomic diversity. We intend on enrolling 200 subjects {adults and children) as requested by the RFA with a "recruit to replace" strategy to maximize the information gained and resources utilized. Subjects will be randomized in a 1:1:1:1 ratio to hemodialysis three, four, five, or six days per week, with dialysis efficiency targets kept equivalent on a per treatment basis. We will work closely with the General Clinical Research Centers at UCSF, UCLA, and UC San Diego. The sample size will not be sufficient to demonstrate a difference in survival among groups. However, the study should have sufficient power to detect significant differences in several of the planned safety and efficacy outcomes and measures. The California CCC Investigators and Consultants have considerable expertise in many of the selected outcomes and measures, including vascular access, nutritional status, vascular calcification, inflammation and oxidative stress, physical function, cognitive function, quality of life, depression, mineral metabolism, bone density and dynamics, anemia, and dialysis dose quantification. We are committed to working cooperatively and constructively with the other CCC and Data Analysis Coordinating Center-regardless of the final agreed-upon protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FREQUENT HEMODIALYSIS NETWORK DATA COORDINATING CENTER Principal Investigator & Institution: Beck, Gerald J.; Acting Chairman; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): The Data and Analysis Coordinating Center (DACC) for the Frequent Hemodialysis Clinical Trial Network (FHN) will coordinate the scientific and operational aspects of two clinical trials: one comparing short daily

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dialysis with conventional dialysis and one comparing long nocturnal dialysis with conventional dialysis. In the planning phase (Phase I), the DACC, in conjunction with the FHN, will design and develop the protocols and data forms for the two trials. A detailed proposal is suggested for one trial. Systems for data acquisition (via a secure web-based data entry) and data management will be established. The DACC will develop procedures for enhancing quality and completeness of the data collected. A detailed Manual of Operations will be developed describing the data collection procedures and other procedures for the Coordinating Clinical Centers (CCC) and their associated dialysis units. The DACC will provide centralized training of CCC staff on the entry of trial patients, the completion of trial forms, and the use of the data management system. A web site will be created for study information available to FHN investigators and a portion for public access. Central facilities will be established as necessary. The DACC will arrange and actively participate in meeting and conference calls of the Steering and Planning Committee and its subcommittees. A major function of the DACC during the Recruitment and Follow-Up (Phase II) of each trial will be to monitor patient recruitment and compliance as a whole and by CCC. The database management system developed in Phase I will be used to assure accurate and complete collection of trial data. An inquiry system will be used to resolve data discrepancies. Trial progress will be reported in reports to the CCC, Steering and Planning Committee, and External Advisory Committee. Statistical and interim analyses will be performed during the course of each trial with final analyses completed and reported in Phase II1. The DACC will develop new statistical methodology as needed to properly analyze the data being collected. Biological specimens and data will be transferred to repositories elsewhere as required. Since the FHN is a multi-centered effort on two trials, the DACC will provide leadership to coordinate the trial designs and conduct them to optimize the efficiency of the information gained. The DACC will work to foster a spirit of cooperation, which is important in this network. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GATING OF INFORMATION FLOW WITHIN THE NUCLEUS ACCUMBENS Principal Investigator & Institution: Grace, Anthony A.; Professor; Neuroscience; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 15-AUG-1997; Project End 31-JUL-2007 Summary: (provided by applicant): This proposal represents a competing continuation of a grant to investigate the basic science aspects of schizophrenia as it relates to limbic system function. Pharmacological evidence has implicated the dopamine (DA) system in schizophrenia; however, there is little evidence for a direct pathology within the DA system itself. Instead, evidence has amassed to suggest a primary deficit within limbic cortical structures, each of which supplies a glutamatergic input that overlaps with the DA system within the nucleus accumbens (NAc). Three regions in particular have been associated with several aspects of schizophrenia, including the prefrontal cortex, the hippocampus subiculum and the basolateral amygdala. In the previous proposal, we examined how each of these systems provides synaptic influences in the NAc. In the current proposal, we will extend this to examine, using in vivo intracellular recording methods, how tonic activation of these afferent systems affects the state of the neurons in the NAc, and moreover how these activity patterns are modulated by selective DA drugs administered locally via reverse dialysis. We will also investigate how the NAc system in turn modulates the FA system, and how these systems are altered in a developmental disruption model of schizophrenia. This will be done according to the

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following four specific aims: 1) Examine how tonic activation of NAc neuron afferents affects baseline activity and response of NAc neurons to afferent stimulation, 2) Examine the DA receptor subtypes involved in modulating afferent interactions within the NAc, 3) Examine how the NAc system modulates the activity of DA neurons in the ventral tegmental area and how this correlates with DA release, and 4) Examine the effects of developmental neurotoxic disruptions on the integration of information flow within the NAc and its projections to the ventral tegmental area, and how this differs in prepubertal vs postpubertal rats. In this way, we hope to extend our knowledge of cortical-subcortical interactions in modulating the state of NAc neurons, how this state is regulated in an interactive manner by the DA system, and how developmental disruptions lead to a reorganization of limbic systems during development in a manner that may contribute to the pathophysiology of schizophrenia in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS OF HYPERTENSION IN THE FRAMINGHAM HEART STUDY Principal Investigator & Institution: Lifton, Richard P.; Chairman, Department of Genetics; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-FEB-1996; Project End 31-JAN-2006 Summary: (Adapted from the applicant's abstract) Work of the SCOR has demonstrated the key role of inherited variation in renal salt handling in blood pressure variation in humans. These findings from rate Mendelian diseases raise the question of whether more common variants in genes of this same pathway alter blood pressure in the general population. This project investigates the causes of inherited variation in blood pressure, end-stage renal disease and left ventricular hypertrophy. Study populations are 4100 members of the Framingham Heart Study and multiplex kindreds with endstage renal disease recruited from the GAMBRO dialysis centers. Specific Aim 1 will investigate the impact of single nucleotide polymorphisms in genes in which mutations cause inherited forms of high or low blood pressure on blood pressure and LVH in 4000 subjects from the Framingham Heart Study. This Study has substantial power to detect even modest effects imparted by these variants. Specific Aim 2 will work toward the positional cloning of a blood pressure locus on chromosome 17 that demonstrated a lod score of 4.7 for linkage to systolic blood pressure in families from Framingham Study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GLOBAL POPULATIONS

EPIDEMIC

OF

KIDNEY

DISEASE

IN

DIVERSE

Principal Investigator & Institution: Fogo, Agnes B.; Professor; Pathology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 29-SEP-2001; Project End 31-JAN-2004 Summary: provided by applicant): The International Society of Nephrology (ISN) and the American Society of Nephrology (ASN) have agreed that a 2 day satellite symposium:THE GLOBAL EPIDEMIC OF KIDNEY DISEASE IN DIVERSE SUSCEPTIBLE POPULATIONS should be held at Santa Fe on 19 - 20 October 2001 immediately following the joint congress of the two societies at San Francisco. The symposium is designed to address all aspects of the rapidly increasing burden of chronic renal disease which is evident in developing nations and indigenous and migrant populations around the world. This major problem has received little attention over the years, and it is probable that the contribution of renal disease to high rates of

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morbidity and mortality in such populations has not hitherto been appreciated. The meeting will consist of a series of plenary seminars addressing the following: the scope of the problem in countries around the world; pathophysiology and etiological (genetic and environmental) factors; development of screening programmes, disease registration methodology, and strategies for disease prevention; management of end stage disease by dialysis and renal transplantation; renal health economics and the role of governments and funding bodies; preparation of a consensus document regarding future directions anal new initiatives. Speakers addressing these topics, and delegates will encompass a wide range of expertise, extending beyond nephrologists. The conjunction of the symposium with the ASN/ISN congress will facilitate the attendance of nephrologists from many parts of the world. Funding is sought to support this meeting, and particularly to support the attendance of young, minority delegates, including those from developing nations with travel grants to encourage wide participation in this important meeting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTHY JOURNEY REBIRTH PROJECT Principal Investigator & Institution: Belcourt, Janet M.; Principal Investigator; None; Stone Child College Box 1082, Rocky Boy Rte Box Elder, Mt 59521 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant) As of October 1,2001 (latest fiscal year report), the Rocky Boy Health Center reported a total of 284 patients identified within the Registered Patient Management System (RPMS) being diagnosed with Diabetes Mellitus, with a gender breakdown of 128 males and 156 females. During the past ten years, the mortality rate for diabetics has been 57 or an average of six deaths per year. Currently, as of June 1, 2002, three patients are on dialysis and two patients have had kidney transplants. Forty-six patients have been diagnosed with retinopathy, of whom 17 are males and 29 are females. Furthermore, 34 neuropathy patients have been diagnosed, of whom 20 are males and 14 are female. The Healthy Journey Rebirth Project will have researched, developed, and field tested a culturally appropriate science based prevention curriculum for K-12 tribal schools; provided the necessary training for teachers to implement the curriculum; stimulated the interest of students in diabetics science and related health careers; and collaborated with other TCUs and local tribal collaborators in the development of said curriculum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HIGH EFFICIENCY DIALYZER DEVELOPMENT Principal Investigator & Institution: Litwak, Philip; Ension 240 William Pitt Way Pittsburgh, Pa 15238 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2002 Summary: The goal of this project is develop a highly efficient active mixing hemodialyzer for patients in renal failure. We intend to replicate our active mixing membrane oxygenator (AMMO) technology currently under development to this device. Mass transfer in AMMO devices has proven to be 5-8 times more efficient than currently available static oxygenators, while not causing more blood damage than these clinical devices. In addition, the rotational movement of AMMO has resulted in it being a very efficient pump, thereby incorporating two basic functions in a single device. Active mixing functions to increase efficiency by imparting interstitial convection within the hollow fiber array and reducing blood phase resistance, resulting in increased mass

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transfer efficiency. In other words, motion of the fiber bundle disrupts the concentration boundry layer that impedes mass transfer across the membrane. This Phase I program is designed to evaluate the feasibility of our design. Specifically, using fabrication techniques developed for AMMO we will fabricate multiple active mixing dialyzer prototype variations with appropriate dialysis microporous fibers and dialysate fluid pathways. These units will then be evaluated in vitro per AAMI standards. Based on clearance data obtained we will select the most efficient dialyzer and fabricate a set of identical units for further functional evaluation. Finally, three ex-vivo animal trials to assess basic biocompatibility of the active mixing dialyzer are proposed. PROPOSED COMMERCIAL APPLICATION: Hemodialysis is required by over 200,000 Americans. The active mixing hemodialyzer has the potential to provide for more efficient, hence less time-consuming and lower biomaterials exposure, hemodialysis treatments. In addition, this device will pump blood thereby eliminating another element of current systems. It will be integratable into today's dialysis machines thereby eliminating the need for costly capital expenditures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEMBRANES

HIGH-PERFORMANCE

STERILANT

GAS

FOR

DIALYSIS

Principal Investigator & Institution: Nimitz, Jonathan S.; Environmental Technology & Education Ctr and Education Center Albuquerque, Nm 87109 Timing: Fiscal Year 2001; Project Start 15-MAY-2001; Project End 31-MAR-2002 Summary: (Unedited Applicant's Abstract):When people with diabetes reach end-stage renal disease they must undergo either dialysis or transplantation. About 200,000 Americans need artificial kidney machines to stay alive. These machines rely on sterile dialysis membranes to remove toxic materials from the bloodstream. More than 30 different polymers or polymer blends are used in dialysis membranes, and most of these degrade under conditions of steam or gamma radiation sterilization. Ethylene oxide (EO) remains the sterilant of choice for these membranes. However, the traditional blend used 88 percent CFC-12 as a fire suppressant and propellant, and CFCs have been phased out of production because of their high ozone-depletion potentials (ODPs). Alternatives include explosive 100 percent EO and blends of EO with high global warming potential (GWP) hydrofluorocarbons (HFCs), less effective carbon dioxide, or hydro chlorofluorocarbon (HCFC) compounds facing future phase out. This proposed Phase I effort wilt determine the feasibility of using blends containing EO, trifluoromethyl iodide (CF3I), and HFCs for sterilizing dialysis membranes. Trifluoromethyl iodide is an excellent combustion suppressant and has physical properties similar to CFC-12 with zero ODP and extremely low GWP. Flammability and fractionation tests will be conducted to determine optimal blend compositions. Compatibility and residual CF3I measurements with common membrane materials will be conducted. PROPOSED COMMERCIAL APPLICATION: The research, if successful, will develop a new nonflammable sterilant gas for dialysis membranes that does not contain ozone-depleting substances, is more effective that current alternatives, and has reduced GWP. The new sterilant gas should also be useful for sterilizing many other types of medical equipment. The new sterilant gas should be marketable worldwide and should allow use of existing EO sterilizing equipment, thus reducing costs of medical care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ICU ARF DIALYSIS DOSE QUANTIFICATION AND PATIENT OUTCOMEN Principal Investigator & Institution: Paganini, Emil P.; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2002 Summary: Acute renal failure (ARF) has been the subject of increased attention. While comorbid factors affect patient outcome, the impact of nutrition, timing of initial support or acute dialytic dosing have not been adequately evaluated. Dialysis frequency has been derived from the stable End Stage Renal Failure population. Dialysis dosage measurements, which include patient-side surrogate marker (urea) toxin levels (Time averaged concentration-TACurea), marker substance removed (Solute removal Index (SRI), or the fractional clearance of urea for the dialysis session (Kwurea), have never been established in acute renal failure. While the ESRD Pt is at steady urea generation (G) and has a known urea space (V), the pt with ARF has large swings in G and enormous V variations. Also, the use of continuous hemodialytic modalities have not been subject to dosing evaluation. As a participant in an interactive Research Project Grant (IRPG), this study will establish a methodology describing dose delivery of either intermittent or continuous dialysis support to pts with ARF. The method will be used to investigate a possible link between delivered dialysis dose and pt outcome. All ICU pts with ARF requiring dialytic support will be targeted during the observational period (phase I). Demographic and comorbidity data will be gathered, and acuity scoring systems will classify each patient. Residual renal function (creatinine clearance or iothalamate clearance) will be measured. Dialysis support will be offered via ~customary~ prescription (with uniformed dialysis membrane and dialysate composition) as either intermittent hemodialysis (IHD) or continuous venovenous hemodialysis (CWHD). Each dialysis period will be described using urea by clearancebased (Kwurea derived from equilibrated urea kinetics), mass transfer-based (SRIurea derived from direct dialysate quantification (DDQ)), or resulting pt-based (TACurea) methodology. [Different collection techniques will be evaluated for direct dialysate quantification. Further a unified method of describing dialysis delivery based upon equivalent renal clearance [ekr] will be developed.] Gurea will be measured using normalized protein catabolic rates, while total body water (Vurea) will be measured using normalized protein catabolic rates, while total body water (Vurea) will be both calculated from DDQ and attempted to be measured by Bio-electrical impedance analysis (BIA) or DEXA scanning. [A final six month feasibility period will be utilized to establish the practicality, functionality and applicability of the unified mathematical algorithm used to monitor and readjust the dialysis prescription. Give a pre=determined aggressive eKRurea, compliance with the protocol, and impediments in achieving full implementation will be determined. It is expected that this project, along with the other IRPG generated data, will provide the building blocks for the design and implementation of future multi-centered interventional trials in Acute Renal Failure.] Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPROVED REMOVAL OF PROTEIN-BOUND TOXINS IN DIALYSIS Principal Investigator & Institution: Collins, Gregory R.; Nephros, Inc. Audubon Technology Center New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): End Stage Renal Disease (ESRD) is associated with an accumulation of "uremic" toxins in essentially three categories: small water-soluble

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compounds, larger middle molecules, and small protein bound molecules. Current treatment modalities do not address the removal of small protein-bound substances. This research targets an ionic-hemodiafiltration-based product that removes small protein-bound solutes from blood; this function is not addressed by existing technology. This can be an extension of our unique multistage diafiltration process, with two diafiltration steps in series and substitution fluid added in a middilution mode (US Patent #6303036); or can be integrated with standard dialysis technology. An agent is added to dialysate fluid entering a first stage, causing an ionic (pH) shift of the blood, thereby dissociating a significant portion of protein-bound toxins from their conjugated protein counterparts. Once unbound, the small toxins are transported across a semipermeable membrane by diffusive/convective mechanisms. A second stage acts to return the ionic-altered blood to a normal condition before reinfusion. This Phase I research will qualify agents to be added to the dialysate fluid entering the first stage, so as to ensure safety and efficacy. PROPOSED COMMERCIAL APPLICATION: As of 2001, there were over 300,000 ESRD patients in the US, served by over 60,000 dialysis machines; this market is expected to exceed $500 million annually by 2008. Incorporating ionic technology will provide the unique benefit of removing proteinbound toxins, thereby reducing various comorbid conditions associated with toxic accumulation, improving overall patient health, and reducing associated hospitalizations, currently representing a $600 million+ annual expenditure. Additional applications include treatment of patients intoxicated with poisons or drugs with known protein binding characteristics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVED RENAL PRESERVATION Principal Investigator & Institution: Fahy, Gregory M.; Twenty First Century Medicine, Inc. 10844 Edison Ct Rancho Cucamonga, Ca 91730 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): The ultimate aim of the proposed research is to enable a substantial improvement in human kidney preservation prior to transplantation by extending the safe storage time and improving outcomes after any given period of storage. This proposal will build upon existing results indicating that a new renal preservation solution developed at 21st Century Medicine (Renasol) is superior to the industry standard, UW solution, in both canine and leporine renal transplant models. The proposal will explore a combination of Renasol and a specific new formulation of protein factors ("trophic factors") that dramatically improve hypothermic storage of dog kidneys. More information will be obtained on the appropriate concentration of trophic factors using the rabbit renal transplant model. A potentially valuable additive for Renasol that may help protect human kidneys from the effects of agonal hypotension will also be evaluated. Canine renal transplants will also be performed using kidneys preserved by simple cold storage for 4 days with Renasol and with Renasol + trophic factors. In anticipation of clinical application, and resulting stability requirements, tests will be conducted, using both the canine and leporine models, to show Renasol retains its effectiveness after months of prior storage at 4 deg. C. These studies will result in a final formulation that will be taken into human clinical trials in Phase II and marketed in Phase Ill. During the course of the proposed studies, urine samples will be collected on a routine basis and subjected to protein profiling using an in-house proteomics workstation. These observations will determine whether the degree of hypothermic injury observed is correlated with definable relative or absolute changes in urinary protein concentrations. This may provide a new predictive

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diagnostic marker of renal preservation injury. The ability to preserve kidneys with less damage prior to transplantation will significantly reduce the costs and risks of posttransplant dialysis, reduce rejection episodes, and increase the net organ supply. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MALNUTRITION IN DIALYSIS PATIENTS Principal Investigator & Institution: Ikizler, Talat A.; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-MAR-2003 Summary: Protein-energy malnutrition, a well-established major risk factor for morbidity and mortality, is found in 40% of patients with end-stage-renal disease. Investigators have shown that malnutrition develops before the initiation of dialysis in a large portion of patients, particularly when residual renal function declines to less than 25% of normal. Despite advances in renal replacement therapy, no significant improvement has been observed in the nutritional status of ESRD patients. To overcome this problem, three promising interventions have been highlighted. These include: 1) timely initiation of dialysis; 2) increased dose of hemodialysis; and 3) treatment with anabolic agents. The applicant proposed to investigate these three approaches to improve nutritional status of patients with chronic renal failure (CRF). The applicant will test a hypothesis that using "early" versus "conventional" criteria for initiation of dialysis preserves nutrient homeostasis and subsequent morbidity. Patients with moderate CRF will be randomized to dialysis using either early or conventional criteria for initiation to evaluate how nutritional status, hospitalization rate and death are altered over a two-year period. The applicant will also test the hypothesis that a higher than "adequate" dose of dialysis improves nutritional status in patients with CRF using patients who will be randomized to receive two doses of dialysis over a two-year period. Furthermore, the effect of the administration of recombinant-human- growth hormone on nutritional status will be evaluated in patients with ESRD. These three studies will establish the link between malnutrition and renal failure, and provide the basis for intervention to improve nutritional status. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEASURING HEMODYNAMICS

INTRA/EXTRACELLULAR

VOLUME

AND

Principal Investigator & Institution: Montgomery, Leslie D.; Ldm Associates 1764 Emory St San Jose, Ca 95126 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): A device capable of noninvasive real-time measurement of intravascular and extravascular fluid volumes and blood flows does not currently exist. Such a device would provide vital information in the treatment of diverse pathophysiologic fluid volume and hemodynamic states including, for example, the management of increased intracranial pressure following trauma, the treatment of disequilibrium and hypotension during renal dialysis, the monitoring of hydrational state of premature infants, and the investigation and diagnosis of orthostatic intolerance associated with dysautonomia and space flight. Currently employed methods are either invasive, such as tracer dilution techniques, or bulky and expensive such as MRI technologies, and often do not yield easily used real-time data during physiologic stress. The central objective of this proposal is to perfect and test a bioelectric impedance device capable of measuring blood flows by impedance plethysmography (IPG) and of

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measuring compartmental fluid volumes by electrical impedance spectrography (EIS). Fixed frequency bioimpedance by IPG has been reliably used to estimate blood flow and intravascular volume shifts. Swept frequency bioimpedance by EIS has been used to estimate intravascular, interstitial and intracellular fluid volumes. We will base the IPG module of the device on the fixed frequency Tetrapolar High Resolution Impedance Monitor (THRIM Model 2994-D) digital impedance plethysmograph that was developed by UFi, Inc. This employs a fixed frequency of 50 KHz and has been extensively benchmarked in animal and human blood flow studies. For EIS operation, 40 different frequencies will be provided, at log intervals, between 3 and 300 KHz. EIS will use a constant current transformer coupled excitation stage in conjunction with a digital demodulation stage to supply both resistive and reactive impedance components. This will be controlled by a microprocessor system connected via an RS-232 serial interface to PC analysis software. The microprocessor control system will store impedance parameters and signal waveform segments prior to supplying the data to the host for on-line real time analysis and display. Host software will use a deconvolution algorithm to obtain parameters for an R-C equivalent circuit used to model the intravascular, interstitial and intracellular fluid spaces. In this first stage of development we will test the device against a Whitney strain gauge system using occlusion cuffs to 1) measure forearm and calf blood flows in order to validate the IPG module; 2) produce controlled increases in interstitial and intravascular volumes by stepwise venous occlusion to validate the EIS module. It is hoped that the instrument may be further validated during statistically significant clinical trials during a Phase II NIH SBIR grant. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS OF DRUG ABUSE--DA AND CS REWARD LEARNING Principal Investigator & Institution: Horvitz, Jon C.; Psychology; Columbia Univ New York Morningside 1210 Amsterdam Ave, Mc 2205 New York, Ny 10027 Timing: Fiscal Year 2001; Project Start 01-JUN-1998; Project End 31-MAR-2003 Summary: (Applicant's Abstract) Dopamine (DA) activity is strongly implicated in the reinforcing properties of drugs of abuse. The reinforcing properties of such drugs appear to result from pharmacological activation of DA substrates which mediate natural reinforcement processes. Critical gaps exist in the experimental literature, however, regarding the precise function(s) of DA in reinforcement, particularly within specific brain target sites. Humans acquire associations between A) their behaviors and reward events (response-reward) and B) between environmental stimuli and rewards (CS-reward); rats acquire similar associations. Is DA involved in the acquisition of response-reward, CS-reward, and/or stimulus-response associations during reinforcement? What is the precise role of DA within these associative mechanisms at different brain target sites? In light of recent information from single-unit and dialysis studies of DA activity in behaving animals, the studies in this application examine the precise nature of DA's role in the acquisition of CS-reward associations, within three brain target structures, the nucleus accumbens, caudate, and prefrontal cortex. The studies will examine, for each brain target site, whether DA disruption of CS-reward learning is dependent upon the intensity of the CS, the time interval between CS and reward, and whether DA disruptions impair aversive as well as appetitive CS-outcome associations under varying intensities of the aversive outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS OF HYPOALBUMINEMIA IN ENDSTAGE RENAL DISEASE Principal Investigator & Institution: Kaysen, George A.; Professor; Internal Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 25-AUG-1997; Project End 31-MAY-2003 Summary: (Adapted from the application) The NIH has funded a multi-year multicenter study to establish the relationship between dialysis dose delivered (KT/V), dialyzer permeability and outcome in a group of hemodialysis patients studied in several centers to identify causes of increased mortality in end stage renal disease (ESRD) patients in the US - the HEMO study. While hypoalbuminemia is the most powerful predictor of death in ESRD, the cause of hypoalbuminemia in these patients is supplements do not increase albumin levels and intravenous amino acids are only partially and inconsistently beneficial. In contrast albumin synthesis and serum albumin increase promptly when patients are fed following starvation, suggesting that malnutrition may not be the primary case of hypoalbuminemia in ESRD. We propose to test an alternative hypothesis, that hypoalbuminemia results from suppressed albumin synthesis as part of the acute phase response rather than from malnutrition. Albumin concentration correlates with alpha2 macroglobulin (alpha2 M), C reactive protein (CRP) and serum amyloid A (SAA) in ESRD patients, and CRP predicts death better than does albumin concentration. Albumin synthesis correlates negatively with alpha2 M and not nutritional status, further supporting the hypothesis. We propose to determine the relative contributions of albumin synthesis, catabolism, redistribution and external albumin loss on baseline albumin levels in patients participating in the HEMO study using kinetic modeling of [125 1] albumin. We will measure albumin homeostasis in an equal number of patients with albumin levels in the lowest quartile and in the upper 3 quartiles in 3 participating centers. We will determine the relative effect of nutritional factors (dietary history, PCRn, anthropometrics) and the acute phase response (measurement of SAA, CRP, alpha2M, fibrinogen, IL-Beta and TNF theta) and albumin losses in establishing baseline albumin levels and synthesis rate using multiple regression models. We will then establish whether changes in nutritional status or inflammation precede changes in albumin concentration measuring nutritional status and acute phase proteins and cytokines monthly and loss of albumin across dialysis membranes bi-weekly. We will repeat kinetic albumin modeling after either a change in albumin concentration of 0.3 g/dL or after 24 months if albumin remains unchanged to identify changes in albumin homeostasis responsible for changes in albumin concentration. We will further establish the effect of KT/V, dialyzer permeability and reuse on changes in albumin, nutritional status and acute phase response. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEDULLARY THERMOREG

SEROTONERGIC

INVOLVEMENT

IN

SLEEP,

Principal Investigator & Institution: Darnall, Robert A.; Professor; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2003; Project Start 07-JUL-2003; Project End 31-MAR-2008 Summary: The important findings that a substantial subset of SIDS infants have decreases in serotonin receptor binding the ventral medulla form the basis for the hypothesis that abnormalities in the 'medullary 5-HT system' play an important rote in SIDS. Neurons in this region participate in widespread autonomic functions including cardiorespiratory control, thermoregutation, and based on recent new information from

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our laboratory, sleep. The overall aim of this proposal is to investigate the roles of phenotypically specific neurons in the medullary 5-HT system on sleep homeostasis, responses to a thermal stress, and on cardiorespiratory variability. Our strategy will be to use novel neurochemicals to locally inhibit or destroy serotonergic neurons and/or neurons expressing the 5-HT(1A), NK1, or m1 muscarinic receptor in chronically instrumented piglets. 8-OH DPAT will be used to selectively activate 5-HT(1A) autoreceptors on 5-HT neurons, and 5,7-DHT or the neurotoxin saporin conjugated to an antibody to the serotonin transporter protein (SERT-SAP) will be used to selectively destroy serotonergic neurons. Analogous methods will be usedto inhibit or destroy neurons expressing the NK1 or m1 muscarinic receptor with SP-SAP or a powerful toxin obtained from the venom of the green mamba highly selective for m1 muscarinic receptors (m1-toxin1). We will evaluate the effects of these specific 'lesions' on sleep architecture in piglets using EEG wavelet analysis and behavioral observations during short (6 hr) plethysmograph recordings, and long (12-24 hr) recordings in their natural habitat (with the sow and siblings) using telemetry. We will also evaluate responses to thermal stresses focusing on shivering and non-shivering thermogenesis, skin blood flow, and hyperpnea. Finally, we will use the sensitive techniques of fractal analysis to evaluate the complexity of cardiorespiratory variability, the decrease in which is associated with decreased ability of a control system to respond to a perturbation. Indeed, infants who subsequently die of SIDS have decreases in heart rate variability. Lesions will be made in the midline and lateral columns and all areas simultaneously to test the hypothesis that neurons are organized in a functionally specific manner. We hypothesize that the medullary 5-HT system is a major site for the integration of cardiorespiratory, thermoregulatory, and sleep and arousal mechanisms, and that abnormalities in this region could produce local or widespread effects that might contribute to sudden death. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODULATION OF REPEATED ETHANOL ADMINISTRATION Principal Investigator & Institution: Gonzales, Rueben A.; Associate Professor; Neurobiology; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, Tx 78712 Timing: Fiscal Year 2001; Project Start 27-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Our goals are to identify alterations in neurochemistry that occur in the extended amygdala following chronic alcohol administration and examine the hypothesis that endogenous K-opioid receptor (KOR) systems attenuate the neurochemical and behavioral effects of alcohol. We postulate that activation of KOR systems by alcohol is a key homeostatic mechanism that opposes the development of alcohol dependence, and that dysregulation of KOR systems results in altered vulnerability to the reinforcing effects of alcohol and to alcohol addiction. We will test these postulates pharmacologically in wild-type mice, and by using mice with constitutive deletion of the gene encoding the KOR-1 receptor or dynorphin, the endogenous KOR ligand. Specific Aim 1 will characterize alterations in dopamine, GABA and glutamate neurotransmission that occur in the nucleus accumbens (Acb) and central nucleus of the amygdala during abstinence from chronic alcohol administration and determine whether hypofunction of KOR systems exacerbates these effects. The no net flux method of quantitative microdialysis will be used to monitor extracellular dopamine concentrations and changes in dopamine uptake and release. Conventional dialysis will be used to measure basal and stimulus (alcohol, KCI)- evoked dopamine, GABA and glutamate efflux. Specific Aim 2 will determine whether hypofunction of KOR systems alters adaptations in behavior that occur following chronic alcohol

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administration. We will measure somatic signs of alcohol withdrawal and sensitization of the withdrawal response that occurs after repeated bouts of alcohol intoxication and withdrawal. Specific Aim 3 will determine whether KOR system hypofunction results in increased sensitivity to the rewarding effects of ethanol and whether dopamine dynamics are altered in the Acb and amygdala of mice self-administering alcohol. Operant oral alcohol self- administration will be used to characterize the rewarding effects of alcohol and microdialysis will be used to monitor neurotransmitter dynamics in self-administering mice. The data derived from these studies will delineate neuroadaptations that occur in the extended amygdala following both contextdependent and independent alcohol administration and the role of endogenous opioid systems in modulating the neurochemical effects of alcohol, alcohol dependence, and reward. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MONOAMINERGIC SCHIZOPHRENIA

REGULATION

OF

GABA

AND

Principal Investigator & Institution: Deutch, Ariel Y.; Professor; Psychiatry; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 05-APR-1997; Project End 31-MAR-2005 Summary: Dopamine (DA) axons in the prefrontal cortex (PFC) synapse with GABAergic interneurons as well as pyramidal cells. These investigators have reported that D2-like DA receptor agonists increase extracellular GABA levels in the PFC of the rat: in vitro data also suggest that D2 agonists increase GABA release in the PFC. This D2 receptor-mediated excitatory drive over GABAergic cells is surprising, since D2 receptors are typically inhibitory and couple to K+ channels that hyperpolarize neurons. Dopamine is co-localized with the peptide transmitter neurotensin (NT) in certain PFC axons. They hypothesize that the ability of D2 agonists to increase PFC GABA release is due to actions at D2 auto receptors and subsequent release of NT from cortical dopaminergic axons. In Specific Aim I they will determine if systemic or local infusion of the D2 agonist quinpirole increases extracellular NT levels in the PFC, using in vivo microdialysis couple with GS-MS determination of NT in dialysis samples; GABA levels in the same samples will be assayed by HPLC. They will then assess if D2 agonists elicit NT release form DA axons by examining the effects of quinpirole (levels?) in rats with 6 hydroxydopamine lesions of the PFC DA innervation. In Specific Aim II they will determine if administration of NT or the NT agonist PD149163 increase extracellular GABA levels in the PFC, and if such effects are blocked by pretreatment with NT receptor antagonists. Similarly, they will determine if the NT receptor antagonists block quinpirole-elicited increases in GABA levels. The investigators will also determine if PD149163 administration induces Fos in PFC GABAergic interneurons. In specific aim III, the investigators will determine if D2 agonists elicit GABA release in PFC slices obtained from transgenic mice in which NT is not expressed, and determine if NT agonists induce Fos in PFC interneurons in wild-type and mutant mice. Recent data have suggested a dysfunction of GABAergic neurons in the PFC of schizophrenic subjects; it is not clear if this is a primary defect or one related to a decrease in the dopaminergic innervation of the cortex. Moreover, a large literature suggest that NT may have atypical antipsychotic drug like properties, the proposed studies address current hypotheses of schizophrenia and may increase our knowledge of the pathophysiology of schizophrenia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MORTALITY & MORBIDITY IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Daugirdas, John T.; Professor; Medicine; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: This trial is designed to evaluate survival as well as a number of secondary outcomes (hospitalization for cardiovascular disease, infection, or other non-accessrelated causes, declining body weight, or declining serum albumin level) in patients randomly assigned to one of four groups: (A) moderate-dose dialysis, low-flux cellulose membrane, (B)high-dose dialysis, low-flux cellulose membrane, (C) moderate-dose dialysis, high- flux synthetic membrane, (D)high-dose dialysis, high-flux synthetic membrane. Each Clinical Center will randomize sufficient patients among these 4 groups such that at least 60 patients are enrolled at all times. The patients will be followed for a 5-year period, replacing deaths or dropouts as they occur with new patients. An 18-month recruitment phase is followed by a 5-year follow-up/intervention phase, and a 6-month closeout phase. Our Clinical Center is uniquely qualified to successfully participate in this study. It is a partnership between the University of Illinois College of Medicine and West Suburban Kidney Centers, a corporation of 14 dialysis units treating 1400 patients in the Chicago area. The study will be performed at the University of Illinois dialysis unit, as well as in 3 nearby units of the WSKC. According to the patient eligibility criteria set out by the Draft MMHD Protocol, we already have identified 220 patients in these 4 units who are eligible for the study and who also meet additional desired criteria (no gross non-compliance, no history of substance abuse, feasibility of delivering a 2-pool Kt/V of 1.4). The centralization of the administrative structure of the WSKC units, which extends through nursing, dietetics, social work, and technologists, and the centralized data gathering systems already in place, will greatly facilitate the coordination among units to complete the study. Appropriate technology to carry out high-efficiency dialysis is in place in each of the primary units. More than 80% of the dialysis stations in the primary units have volumetric UF controlled-machines capable of blood flows > 500 ml/min and dialysate flows of 800 ml/min. A dialyzer reuse program with excellent quality controls allows for use of high efficiency dialyzers which will be necessary to deliver the high-dose dialysis treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NONINVASIVE RAMAN MONITORING OF UREA DURING HEMODIALYSIS Principal Investigator & Institution: Womble, M E.; Raman Systems, Inc. 108 Water St, Ste 2 Watertown, Ma 02472 Timing: Fiscal Year 2003; Project Start 01-MAY-2002; Project End 31-MAY-2005 Summary: (provided by applicant): It is the aim of the present Phase II research program to develop a continuous, noninvasive, on-line process for optically monitoring the levels of urea in a patient's blood during hemodialysis. The ultimate goal of such a process is to provide a direct and continuous measure of the efficiency of dialysis without having to wait for the drawing of a blood sample, thereby providing an assessment of whether dialysis at any point in time has reached an effective stopping point for the patient while still attached to the dialysis equipment. We propose to utilize low-resolution laser Raman scattering for the direct measurement of the urea levels in blood using the optical access provided by the dialysis tubing delivering the patient's blood to the dialyzer. Our Phase I SBIR results have shown that urea has a unique Raman

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spectroscopic signature in animal blood and can be identified and quantified against a whole blood background. Our Phase II program is designed to assess the capability of Raman to quantify the levels of urea in human blood samples with varying concentrations of urea present. After constructing a suitable multiple regression model for BUN, we will build out an appropriate low-resolution Raman module for attachment to a hemodialysis unit and expand the investigation to human blood analysis for BUN and URR during actual dialysis procedures in the clinical setting. If successful, a Raman measurement approach would allow, for the first time, real-time, direct and continuous monitoring of the progress of urea removal dudng the course of hemodialysis. This would permit more efficient timing of the dialysis procedure for the patient, as well as providing an ongoing readout of the effectiveness of the dialysis system during patient treatment. We anticipate that a commercially viable urea monitor might be produced rapidly, if the Phase II work is successful, by the adaptation for the clinical setting of the Company's present R-2001 Raman module for attachment by fiberoptic probe to existing renal dialysis equipment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL ADENOSINE A2A AGONISTS IN RENAL TISSUE PROTECTION Principal Investigator & Institution: Olsson, Ray A.; Professor of Medicine; Adenosine Therapeutics, Llc 300 Preston Ave, 5Th Fl Charlottesville, Va 22902 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2004 Summary: (provided by applicant): The development of new treatments for the effective reduction of renal injury associated with acute renal failure and kidney transplantation will have a great impact on health care delivery to patients with renal disease. Acute ischemic renal failure affects 5 percent of hospitalized patients and has a mortality rate approaching 50 percent. At present, dialysis is the only FDA-approved treatment for acute renal failure. lschemia-reperfusion injury at the time of kidney transplantation causes delayed graft function and shortens graft survival. The long-term goal of this project is to evaluate the ability of a proprietary A2A adenosine receptor (A2A-AR) agonist, ATL146e to reduce renal injury in humans. The current proposal aims at completing the preclinical characterization of ATL 146e, a potent and selective A2A-AR agonist that has optimum pharmacological characteristics. Aim I addresses FDA requirements for toxicology, pharmacokinetics and metabolism. Aim 2 devises more efficient synthetic methods so that scale-up can support expanded preclinical studies and guide synthesis by certified Good Manufacturing Practices to support human studies. Aim 3 develops an in vivo assay for ATL 146e-mediated anti-inflammatory activity. Aim 4 tests the efficacy of ATL 146e in reducing injury in model of acute ischemia-reperfusion associated with kidney transplantation. PROPOSED COMMERCIAL APPLICATION: The incidence of azotemia, which includes all cases of acute renal failure (volume depletion, obstruction and intrinsic causes such as ischemia and toxins), was estimated in 1997 to be 275,000 patients per year. Additionally, it is estimated that all cases of azotemia are increasing at rate of 16,000 patients/year. The goal of this research is to develop a pharmaceutical product which will address this unmet medical need. All of the specific aims in this project are required by the FDA and ICH for drug development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NOVEL HYPEROXALURIA

ENZYME

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TREATMENT

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Principal Investigator & Institution: Shenoy, Bhami C.; Altus Biologics, Inc. 625 Putnam Ave Cambridge, Ma 021394807 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2002 Summary: (provided by applicant): Design of new efficient drug delivery systems for proteins is one of the major themes of modern biotechnology and biopharmaceutical industry. We found that crosslinked enzyme crystals (CLECs) show stability under low pH, on storage and against proteolysis. These properties make them ideal for gut lumenal therapy. The patient would swallow a tablet or liquid suspension of CLEC particles composed of a needed metabolic enzyme or protein. The CLEC agent would survive the harsh acidic pH and proteolytic environment of the stomach, and pass into the proximal small intestine. The CLEC particle would then carry out its therapeutic biochemistry within the gut lumen while remaining resistant to degradation by endogenous proteases. In this Phase I study, we propose to develop two types of CLECs: Oxalyl-CoA decarboxylase for oral lumenal therapy and Oxalate oxidase to be used in the extracorporeal device/dialysis equipment. The Oxalyl-CoA decarboxylaseCLEC will perform its action in the duodenum while remaining as crystalline material or by release of activity by dissolution of the CLEC particle. This target was chosen to address the problems of current therapies of hyperoxaluna caused by excessive absorption of oxalate due to the absence of Oxalobacter formigenes bacterium in the intestine or due to inflammatory bowel disease. In addition, Oxalate oxidase-CLEC may be used in dialysis equipment or extracorprealdevices to reduce the oxalate content of blood in patients with Primary Hyperoxaluria. If successful, these approaches will lead to the introduction of novel, efficient enzyme therapy for the prevention of Oxalate Kidney Stones. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL THERAPEUTIC STRATEGIES FOR PKD Principal Investigator & Institution: Wilson, Patricia D.; Professor of Medicine; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: Polycystic kidney diseases (PKD) affect greater than or equal too 500,000 patients in the US and > 6 million worldwide, but the only form of "therapy" is renal replacement by dialysis or transplantation. The most common and important renal malformations are genetic in origin. Autosomal dominant (AD)PKD has an incidence of greater than or equal too1:500 and accounts for greater than or equal too 7% of all patients on dialysis, while autosomal recessive (AR)PKD) has an incidence of greater than or equal too 1: 20,000 with a mortality of greater than or equal too50% in the newborn period and accounts for >5% cases of endstage renal failure in children. The overall goal of this program project is to establish a multidisciplinary team to develop and apply the expanding new understanding of the molecular cellular and physiological basis of polycystic kidney diseases to the development of novel, rational therapeutic approaches. The ultimate goal is to develop preventive and/or therapeutic treatments to slow disease progression and thus offer treatment that is at present lacking. Medical scientists from the Departments of Medicine, Pediatrics, Urology, Gene Therapy Institute and Cancer Center have established a critical mass with a multifaceted approach to study renal morphogenesis and malformations ranging from molecular,

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cellular, physiological, genetic and clinical approaches, thus constituting a combined basic and translational program. The five projects and two cores will be highly interactive and are scientifically integrated in a scheme that focuses on the regulation of the function of the PKD 1 gene product, polycystin by phosphorylation, Project 1; the role of polycystin- 1 in the control of renal morphogenesis, Project 2; the role of the WTltarget protein "sprouty" in cystic kidney devlopment, Project 3; the analysis of sodium and potassium transport in ARPKD, project 4; and the functional consequences of apical EGF receptor signalling in ARPKD, Project 5. The Core will provide and develop viral vectors, renal cell lines and organ cultures as well as transgenic, knock-out and other mouse models In addition, this Core will centralize services and functional assays including adhesion, migration, 3D gel tubulogenesis, embryonic mouse kidney organ culture and microinjections. These integrated studies will increase our understanding of the underlying biology of polycystic kidney diseases sufficiently to lead to testing of therapeutic approaches in human cells in vitro and mice in organ culture and in vivo by small molecule and/or gene therapy strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NUTRITIONAL/INFLAMMATORY EVALUATION OF DIALYSIS PATIENTS Principal Investigator & Institution: Kalantar-Zadeh, Kamyar; Assistant Professor of Medicine and Pedi; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2006 Summary: (adapted from the application) The 250,000 chronic dialysis patients in the US have an increased rate of malnutrition and inflammation, which are felt to be major risk factors for their high morbidity and mortality. The risk of cardiovascular death appears to be especially high among these individuals. To date, there is no uniform, practical tool for assessment of nutritional status, inflammation and food intake in dialysis patients. The goals of this prospective cohort study are to determine whether the nutritional and inflammatory states in dialysis population affect the mortality, morbidity, and other clinical outcomes in a predictable way and to ascertain how the deterioration of these indices over time is associated with poor outcome. To achieve these goals, we will study a cohort of dialysis patients in the San Francisco Bay Area prospectively. Nutritional assessment will be performed periodically. A convenient but reliable nutritional scoring system to predict the mortality and clinical outcome in the dialysis population will be developed and validated. The following specific questions will be answered: 1) Are the dialysis mortality and risk of cardiovascular death associated with malnutrition or inflammation? 2) Do malnutrition and/or inflammation and their deterioration over time have measurable, distinct impact on relevant clinical outcomes in dialysis patients such as hospitalization and erythropoietin resistance? 3) Can a numerical result of a uniform nutritional scoring system be a reliable predictor of dialysis morbidity and mortality? 4) Can a food questionnaire reliably detect deficient nutrient intake in dialysis patients? As a Mentored Patient-Oriented Research Career Development Award, this proposal also aims to develop the research abilities of the PI, and enables him to be a productive independent researcher. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OLD AGE, LIFE EXTENSION, AND GERIATRICS Principal Investigator & Institution: Kaufman, Sharon R.; Professor; Institute for Health and Aging; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): The goal of this 4-year qualitative anthropological study is to investigate first, how physicians, patients age 70 and over and their families make decisions regarding the use of three groups of life-extending medical procedures (cardiac bypass, angioplasty and stent; kidney and liver transplant; and renal dialysis) and how they each respond to those procedures; and second, to identify socio-cultural issues of relevance to physicians and to society regarding the growing use of lifeextending medical procedures on elderly patients. This will be an empirical, ethnographic study based on the collection of data by in-depth interviews with physicians, patients and their families, and by participant-observation of support groups for cardiac and transplant patients and of physician-patient discussions where lifeextending procedures are discussed. There are 4 specific aims:1) to provide a descriptive account of physician, patient, and family understandings of relationships among changing conceptions of old age, health in late life and expectations about life-extending medical care; 2) to learn how physicians in different specialties are extending the lives of their elderly patients and the values underlying their decisions; 3) to learn the structural and cultural constraints on their choices for life-extending procedures; and 4) to describe patient and family choices, knowledge and values. Coding-based qualitative data analysis will be used: cross-sectional comparison, thematic analysis, case studies, and frequencies of response. The interpretive goal is to examine in detail the social, structural and medical practices and values brought to bear on the extension of life at progressively older ages. This will be the first research that comprehensively addresses medical and lay decision-making surrounding life-extending medical procedures for older persons, and the responses and experiences of physicians, patients and families to those procedures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OXIDATIVE STRESS AND SYMPATHETIC NERVE ACTIVITY Principal Investigator & Institution: Campese, Vito M.; Medicine; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2003; Project Start 24-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): Hypertension is a common manifestation of renal disease and greatly contributes to its progression as well as to cardiovascular morbidity. Clearly, hypertension is an important etiology in the pathogenesis of renal failure. In the United States, hypertension is the primary cause of end-stage renal disease in approximately 29 percent of dialysis patients. In conjunction with other diseases such as diabetes and chronic glomerulonephritides, hypertension, when uncontrolled, hastens the progression of renal disease. Cardiovascular disease is the leading cause of death in patients receiving maintenance hemodialysis and hypertension is considered the most important factor responsible for cardiovascular events in these patients. Adequate BP control may reduce the progression of renal disease and cardiovascular morbidity in these patients, but often this is difficult to achieve with currently available drugs. The old paradigm is that hypertension in renal disease is the result of activation of the reninangiotensin system and/or volume expansion. Our studies strongly support the notion that a renal injury may result in activation of renal afferent pathways that integrate with

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the central nervous system, and lead to stimulation of efferent SNS activity and hypertension. Locally produced angiotensin II in the brain in response to these afferent stimuli seems to be responsible for SNS activation through inhibition of nitric oxide. Our hypothesis is that angiotensin-II activation of ROS may reduce NO availability in key brain region and result in increased SNS activity in a model of neurogenic hypertension caused by renal injury developed in our laboratory. To test this hypothesis we will pursue 3 specific Aims: 1. Test the hypothesis that locally produced Ang II mediates the activation of central SNS activity caused by phenol-renal injury. To this end, we will measure Ang II concentration in the dialysate collected from the PH using the microdialysis technique, and the expression of renin mRNA in the posterior hypothalamus. 2. Test the hypothesis that radical oxygen species (ROS) activated by Angiotensin II down-regulate nitric oxide production in the brain resulting in increased SNS activity. To this end, we will measure the concentration of reactive oxygen species (ROS) in the hypothalamus or rats with the phenol-renal injury or rats infused with Ang II in the lateral ventricle. In addition, we will evaluate the effects of anti-oxidants, or scavengers of ROS, and Ang II AT1 receptor antagonists on BP, sympathetic activation and ROS concentrations in the hypothalamic region. 3. Test the hypothesis that increased ROS production may result in NO inhibition and SNS activation in other forms of experimental hypertension, such as the DOCA-sait model, and the renovascular hypertension model. If our hypothesis were to be correct, administration of inhibitors of the renin-angiotensin system particularly if combined with antioxidants should result in better control of BP in these models. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARVOVIRUS STRUCTURE, CAPSID ASSEMBLY, AND RECEPTORS Principal Investigator & Institution: Parrish, Colin R.; Associate Professor; J a Baker Inst for Animal Hlth; Cornell University Ithaca Office of Sponsored Programs Ithaca, Ny 14853 Timing: Fiscal Year 2001; Project Start 01-DEC-1992; Project End 31-JAN-2003 Summary: These studies will combine the efforts of three laboratories - at Cornell, Purdue and Warwick Universities - in continued studies of the structures and functions of parvovirus capsids. Parvoviruses are the cause of disease in many animals, including humans. The B19 human parvovirus causes the childhood fifth disease, as well as rarer but more severe disease of adults and fetuses. Canine parvovirus (CPV), the primary subject of these studies, is an example of an emerging virus that gained its new canine host range through mutation of the capsid protein. The parvovirus capsid is very simple, being comprised of 60 copies of essentially one protein yet it performs a wide variety of structural and biological functions. The objectives of these studies are: 1) Virus Purification. Continue to produce purified capsids for use in crystallographic and biochemical studies in the three cooperating laboratories. 2) Assembly of the Capsid in vivo and in vitro. Define the assembly and disassembly processes of the virus capsid using in vitro translation, as well as in different in vivo expression systems. The applicants will define the kinetics and concentration-dependence of the assembly of empty and full capsids, and will use mutants blocked in specific assembly interactions to identify the pathways involved. 3) Define Antibody Neutralization mechanisms. Antibodies are the primary protective immunity against parvoviruses. They will examine in detail the binding of two neutralizing antibodies which recognize different antigenic sites on the capsid. They will produce single chain antibodies, and examine their interactions with the capsid using co-crystallization, and by mutagenisis of the interacting sites on the virus and the antibody. 4) Structural flexibility in the Parvovirus

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Capsid. Examine for transient changes in the structure of the CPV capsid under altered environmental conditions, including treatment at low pH, dialysis with EDTA to remove predicted Ca++ ions, and reduction of disulfide bonds. In this work they would use crystallography of the capsid, as well as structure-specific antibodies and fluorescent chemical probes. 5) Cell Surface and other Receptors required for Binding Infection. Purify and identify the 42 kDa and 116 kDa proteins which bind to CPV in virus-overlay blots of cell membrane proteins. Genetic transfer methods will also be used to screen cDNA libraries or genome DNA for the presence of genes that can render cells susceptible to infection - some of which may encode virus receptors or possibly coreceptors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT ORIENTED RESEARCH IN KIDNEY DISEASE Principal Investigator & Institution: Powe, Neil R.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 15-MAY-1999; Project End 31-MAR-2004 Summary: (adapted from the application) Neil R. Powe, M.D., is Associate Professor of Medicine and Director of the Welch Center at the Johns Hopkins University School of Medicine. He holds a joint appointment in the Department of Epidemiology at the Johns Hopkins School of Hygiene and Public Health where he is Director of the Clinical Epidemiology Program. He is seeking this Midcareer Award in Patient-Oriented Research to concentrate his effort in clinical research in kidney disease and build the training program in kidney disease research. Dr. Powe has conducted several clinical investigations in nephrology over the past 12 years including a study of the effectiveness of recombinant human erythropoietin for treatment of anemia of ESRD (end stage renal disease), a study of the incidence, risk factors and prognosis of septicemia in ESRD patients, a study of co-morbid cardiovascular disease in ESRD patients, a study of the natural history and risk factors for ESRD among patients with diabetes mellitus, a study of the impact of dialysis care deficiencies on patient mortality and hospitalization, a study comparing physical examination with color flow Doppler for detection of vascular access failure and a randomized clinical trial and observational studies of high versus low osmolality contrast media-induced nephrotoxicity. Dr. Powe directs the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. This is a national prospective cohort study comparing peritoneal dialysis and hemodialysis and a large versus small dose of dialysis. The study now has over 1034 patients enrolled making it one of the largest and most representative prospective cohorts of dialysis patients ever studied in the U.S. Data on medical history, laboratory studies, co-morbidity and severity of disease and clinical outcomes are being collected. The study has also established a specimen bank which provides exciting opportunities for studies examining both the etiology and consequences of kidney disease or its treatment. Dr. Powe has mentored a cadre of trainees and junior faculty in clinical research in kidney disease. This award will permit Dr. Powe to make even a greater contribution to patient-oriented research in nephrology, concentrating his efforts and helping him produce future clinical scientists who are rigorously prepared to becomes independent investigators in kidney disease research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHOSPHOENOLPYRUVATE: GLYCOSE PHOSPHOTRANSFERASE SYSTEM Principal Investigator & Institution: Roseman, Saul; Professor; Biology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-SEP-1987; Project End 31-AUG-2005 Summary: (provided by applicant): When bacteria grow on glucose, the rate of Glc transport is stringently regulated and is a major determinant of the rate of cell division. The E. coli Glc (or Me alpha-glucoside (MeGlc)) permease is part of the phosphoenolpyruvate:glycose phosphotransferase system (PTS), and catalyzes simultaneous Glc uptake and phosphorylation. The P-transfer sequence is via 4 proteins: PEP Enzyme I (EI) HPr IIAGlc (or IIIGlc) IICBGlc -> Glc. The permease mechanism is not understood or how it is regulated. Regulation is manifested in the uptake of MeGlc by whole cells, where the rate declines virtually immediately until a steady state is attained, unlike in vitro phosphorylation, where the rate remains constant. A mathematical model has now been constructed that explains the initial rate of uptake of MeGlc by whole cells from in vitro data, but does not explain the decline in rate and steady state. One difference between in vivo and in vitro conditions is the protein concentrations. The model predicts that at high in vivo concentrations, most of the proteins exist as complexes with other PTS proteins or boundary metabolites. Since in vivo regulation may be implemented via one or more of these complexes, the principal investigator will study the following interactions: (a) Binding of the membrane Glc receptor, IICBGlc, to Glc (or MeGlc), primarily by flow dialysis and rapid quench kinetics. (b) Binding of IICBGlc to IIAGlc and P-IIAGlc, which may be mediated by the 18 amino acid N-terminal unstructured domain of IIAGlc. Fluorescence anisotropy will be used to determine whether the terminal polypeptide binds to IICBGlc, the bilayer or both. (c) Interaction of El monomer (M) with itself to form dimer (D). Only D is autophosphorylated by PEP, and dimerization of (M) is far slower than catalysis. Because of this slow process, sugar transport would virtually stop if all D were converted to M. The mechanism for the slow dimerization is unknown, and will be studied with the C-terminal domain of El by analytical sedimentation, CD spectroscopy, and fluorescence anisotropy. If successful, these experiments should lead toward a molecular explanation for sugar uptake and its regulation by many pathogens. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PMN ACTIVATION AND OXIDATIVE STRESS IN HEMODIALYSIS Principal Investigator & Institution: Hu, Susie I.; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Cardiovascular disease and bacterial infections are the leading causes of death in patients with end-stage renal disease (ESRD) on hemodialysis (HD). Besides the high prevalence of well established risk factors, these patients are in a state of heightened oxidative stress, characterized by excessive free radical production and/or low antioxidant defenses. The principal hypothesis of this proposal is that exposure of polymorphonuclear cells to the extracorporeal circuit, triggers production of reactive oxygen species (ROS) leading to leukocyte dysfunction, as well as oxidative endothelial cell injury. Furthermore, the increasingly routine use of parenteral iron, a potent promoter of toxic free radical generation, in these patients may enhance oxidative stressinduced cell injury and dysfunction. This proposal will address these concerns using in vitro models to evaluate the impact of dialyzer biocompatibility and various iron

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preparations on indices of oxidative stress, and cell injury. These models will involve PMN (healthy vs uremic) activation by exposure to dialysis membrane fragments of varying composition t iron or ROS inhibitors, as well as during circulation through an in vitro dialysis circuit. In addition, a coculture model will be utilized to assess the effects of dialyzer membrane-activated PMN on reporter monolayers of cultured endothelial cells (t excess iron) grown under static and flow conditions. The results of this proposal are expected to enhance our understanding of the pathogenesis of ROS-induced cell injury and dysfunction and lay the foundation for the development of novel strategies to combat atherogenesis, vascular access and immune dysfunction in this vulnerable population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POSTTRANSPLANT QUALITY OF LIFE INTERVENTION STUDY Principal Investigator & Institution: Hathaway, Donna K.; Professor/Dean; Nursing; University of Tennessee Health Sci Ctr Health Science Center Memphis, Tn 38163 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 31-JAN-2003 Summary: Nearly 12,000 people annually choose kidney transplantation as treatment for end-stage renal disease in an effort to improve their quality of life (QoL). We previously examined 5 different QoL outcomes in kidney recipients, identifying factors predictive of enhanced posttransplant QoL. This investigation found that, regardless of the dimension examined, early posttransplant morbidity, employment, and social support predicted a significant portion of the variance in QoL. We therefore propose to build on our previous work and use these predictors of QoL as the basis for an experimental posttransplant program of care. The primary objective of this study will be to demonstrate how an experimental posttransplant care program influences the QoL experienced by kidney recipients. Three sets of interventions will emphasize 1) proactive patient-initiated care designed to prevent transplant morbidities, 2) maintenance of vocational productivity, and 3) enhancement of social support. Research aims will seek to determine if the experimental program improves QoL by decreasing morbidity, increasing employment, and enhancing social support compared to standard care. Cost effectiveness will also be determined. Fortunately, a cohort of patients already exists which as received standard transplant care and completed all study instruments, enabling us to use a sequential cohort design, saving time and cots associated with this investigation. Data will be retrieved from existing records for cohort 1 (control). The experimental program will be put in place and pilot tested prior to beginning data collection for cohort 2 (experimental). Data from both cohorts will be collected at transplantation, one year, and two years. Outcome measures will include 5 QoL measures, frequency of morbid events, posttransplant employment, and perceived social support. Quality adjusted life days will be the cost effectiveness outcome. Although QoL is often cited as the reason for choosing transplantation as opposed to remaining on maintenance dialysis, there has yet to be a prospective study designed to test interventions aimed at improving QoL outcomes. Such a study is particularly timely in the current era of health care where efforts are focused on assuring patients derive maximum benefit, both physiologically and psychosocial, at a minimum cost. In addition, because allocation policies for the equitable distribution of organs seeks to consider QoL outcomes, it is important that data-based interventions be established to assure all patients equal opportunity to achieve optimal QoL. Finally, by demonstrating an effective way to improve transplant outcomes, we will both increase the life of the transplanted organ and the productivity of the recipient, resulting in reduced costs for the patient and society.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTORS AND INTERVENTION FOR NONCOMPLIANCE Principal Investigator & Institution: Nevins, Thomas E.; Professor of Pediatrics; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: Medication noncompliance is a serious, but under-investigated problem in solid organ transplantation. This project takes advantage of electronic medication monitoring to obtain dynamic records of medication compliance after renal transplantation. This proposal will: expand studies of the natural history of posttransplant compliance in relation to discrete outcomes (acute rejection, graft loss, or death); continue a randomized study of intensive intervention to improve posttransplant compliance; and begin the examination of pre-transplant behaviors and psychological attributes predicting acute rejection, graft loss, or death. Aim 1 - In a prospective cohort of 134 renal transplants, who have completed 4 years of monitored medication compliance, the association of noncompliance with chronic graft dysfunction will be further investigated. The role of medication noncompliance and "drug holidays" in triggering late, acute transplant rejection will be more completely elucidated. Aim 2 195 renal transplant patients are enrolled in a prospective intervention study aimed at improving medication compliance. "High-risk" patients, with declining compliance, were randomized to intensive intervention or standard care. This study will continue to recruit patients and use discrete outcomes (acute rejection, graft loss, or death) to test intervention efficacy. Aim 3 - A prospective study of 250 pre-transplant dialysis patients will monitor their medical compliance and measure behavioral characteristics while receiving dialysis therapy. Post-transplant, medication monitoring will continue, and patients will be followed for acute rejection, graft loss, or death. Identifying specific pretransplant factors associated with post-transplant behaviors and outcomes may result in new strategies for pre-transplant interventions which could improve outcomes for both dialysis and renal transplant patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF GRAFT FAILURE TO DIETARY N-3 FATTY ACIDS Principal Investigator & Institution: Tumlin, James A.; Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-DEC-2002 Summary: Hemodialysis patients depend on arteriovenous (AV) shunts for angioaccess, usually achieved by surgically implanting vascular grafts composed of expanded polytetrafluroethylene (ePTFE). Unfortunately, approximately half of these AV grafts (AVGs) fail within 1 year due to incremental stenosis arising from vascular lesion formation (VLF). This complex process involves 1) thrombin generation, 2) platelet activation with secretion of platelet-derived growth factor (PDGF) and thrombus formation, 3) monocyte/macrophage accumulation and secretion of PDGF, and 4) intimal migration and proliferation of vascular smooth muscle cells. Since dietary n3FAs down-regulate many of the molecular and cellular interactions underlying the development of VLF, we propose to test the hypothesis that dietary n-3FAs will reduce stenosing thrombo- occlusive graft failure. We have persuasive evidence in baboons that dietary n-3FAs interrupt thrombosis and VLF without impairing hemostatic function. We also have direct experimental evidence in dialysis patients implicating thrombosis in the processes of AVG stenosis and thrombo-occlusion, and experience in sickle cell

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patients receiving dietary n-3FAs demonstrating feasibility, acceptance and reduction in pain episodes. We propose to: 1. Establish the effective antithrombotic dose of dietary n3FAs. During the first year of the project the effects of dietary n-3FAs at 0.1 vs 0.3 g/kg/d will be compared with control olive oil in 24 patients randomly allocated to three 8-patient cohorts, measuring surrogate molecular measures of thrombosis, inflammation and risk factors before and after 3 months of therapy. Differences in platelet deposition on AVGs will be compared using autologous platelets labeled with 111In-oxine and quantitative gamma camera imaging. 2. Evaluate the effects of dietary n-FAs on AVG failure in a randomized, blinded, olive off-controlled clinical trial. During the remaining three years of the project, we propose to carry out a randomized, olive oil-controlled, blinded trial in 180 dialysis patients comparing the effects of dietary n-3FAs vs equivalent control olive oil on AVG failure. The dose of dietary n-3FAs will be either 0.1 g/kg/d or 0.3 g/kg/d, depending on their relative efficacy for interrupting AVG platelet deposition. The primary outcome will be AVG failure. Assuming AVG failure rate of 50 percent per year, treatment benefit of 50 percent, and 25 percent patient loss per year, randomizing 180 dialysis patients will have 90 percent power of detecting a benefit. Secondary outcomes to be compared are molecular markers for thrombosis, inflammation, and vascular risk factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROSPECTIVE INSUFFICIENCY

COHORT

STUDY

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CHRONIC

RENAL

Principal Investigator & Institution: Ojo, Akinlolu O.; Associate Professor; Internal Medicine; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 31-AUG-2008 Summary: provided by applicant): AIMS: We propose the use of a multi-center, prospective, cohort design with standardized, open, outcome variable evaluation technique to non-experimentally study patients aged 18-75 years with chronic renal insufficiency (CRI) defined as 125I-Iothalamate GFR 30-70cc/min/1.73m2. The primary goals of the Chronic Renal Insufficiency Cohort Study will be: (1) to determine the risk factors for accelerated decline in renal function; and (2) to evaluate the incidence and risk factors for cardiovascular disease (CVD). METHODS: We propose to recruit 500 patients of which at least 30% are African American and 50% have diabetic nephropathy. We will recruit the study participants from 12,729 prescreened patients with CRI from our integrated clinical research units consisting of: The University of Michigan Health System (n=5,807); Veteran Affairs Medical Center, Ann Arbor (n=358); St. Johns Health System, Detroit (n=1,430); and The Wellness Plan, Detroit (n=5,134). Ongoing clinical research efforts of the proposing team (including CRI Pilot Study of 105 patients and AASK) have documented an overall participation potential of 17.6% in the 12,729 prescreened subjects which enables a final pool of 2,321 subjects. Our recruitment strategies and retention/adherence techniques have been previously tested and logistically refined. Proposed primary outcomes variables are: (1) the mean rate of GFR decline; (2) time to end stage renal disease (ESRD); (3) composite fatal and nonfatal CVD events; and (4) all-cause mortality rate. Key explanatory variables to be studied include: Left Ventricular imaging (Echocardiography); Carotid Intima/Media Thickness (B-mode ultrasonography); and Cardiac Dysautonomia ([11C]-hydroxyephedrine {HED} Positron Emission Tomography). All key study measurements will be obtained during a single 24-hour in-patient GCRC yearly visit supplemented with standardized, regularly scheduled interval ascertainment non-visit procedures. ANALYSIS PLAN: For analytic

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efficiency, we propose a stratified recruitment scheme that allows broad distribution over the entire inclusion GFR range. We propose a two-stage analysis of the slope of GFR consisting of within-patient GFR slope estimates and across-patient slope analysis to evaluate the determinants of variation in the slope using repeated measures analysis and linear regression analysis, respectively. Time to event analyses will be carried out until ESRD, denovo/recurrent CVD event or death using a multivariate Cox regression technique. A sample of 3,000 patients will be sufficient to yield 90% power to detect differences in rates of decline of GFR as small as 12% to 15% of the mean, and to detect increases as small as 16% to 40% in the rates of events (ESRD, death, CVD). SIGNIFICANCE: This study will lead improved patient care and generate new hypotheses about potential predictors of CRI progression and CVD complications. The most promising of these hypotheses will require testing in randomized clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: QUALITY OF LIFE, HEALTH, AND VALUATION OF LIFE BY ELDERS Principal Investigator & Institution: Mossey, Jana M.; Director; Madlyn/Leonard Abramson Ctr/Jewish Life Center for Jewish Life North Wales, Pa 19454 Timing: Fiscal Year 2001; Project Start 25-JAN-1995; Project End 31-DEC-2004 Summary: (adapted from the investigator's abstract): The course of frailty and chronic illness will be tracked over 6 years in terms of changes in a set of characteristics that are related to quality of life and potentially to end-of-life attitudes and behavior. The research hypothesizes a cognitive-affective schema, valuation of life (VOL) that is influenced by background factors, health, quality of life, and mental health. VOL is the person's transformations of these inputs and suggested as the major determinant of attitudes and behaviors relevant to the extension versus foreshortening of life. The major hypotheses are that the wish to live is not only decreased by distress but may be incremented by some positive features in the person's daily life. Six hundred elders in good and poor health were recruited for participation in a structured interview, and are beginning the second round of interviews. The present proposal will extend the followup period to 6 years, with 270 expected to remain independent, 170 to be ADLdependent, and 160 to die. Changes over 6 years in Years of Desired Life will be analyzed in terms o changes in health, quality of life, mental health, and VOL. Although multiple comorbidities are the rule, disease-specific trajectories will be sought for 5 illness groups: Congestive heart failure, bowel cancer, diabetes, arthritis, and renal disease among dialysis patients. All analyses will be performed by race (50% African American) and gender. The results will contribute both to clinical practice directed toward the well-being of individuals and to social policy issues where quality of life is involved as a rationale for the distribution of health care costs. A form of religious coping, trusting relationship God, is hypothesized as a moderator of health threat as it influences mental health and VOL. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUANTIFICATION ULTRASOUND

OF

BLOOD

VOLUME

FLOW

USING

Principal Investigator & Institution: Fowlkes, Jeffrey B.; Assoicate Professor; Radiology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 20-SEP-2001; Project End 31-JUL-2004

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Summary: (Provided by Applicant): The goal of this proposal is to develop, analyze, and test an innovative technique for measuring volume blood flow ultrasonically. The quantification of volumetric flow is useful for a number of clinical applications including estimation of cardiac output, monitoring of cerebrovascular diseases, and evaluation of intrauterine growth restriction (IUGR) during pregnancy. Current techniques for measuring volumetric flow are either invasive (i.e. insertion of a SwanGanz catheter) or have limited accuracy (i.e. calculations based on Doppler measurements). The long term goal of this project is to defme a real-time, angleindependent volumetric flow measurement technique that can be implemented with current clinical scanner architecture. The proposed algorithm incorporates steered Doppler with the decorrelation of the raw ultrasound RF signals to compute the 3-D vector velocity profile of a vessel using a single transducer. Integration of the normal flow component over a cross-section of the vessel provides the total volume flow. This study will test implementation using modified pulsing sequences and digital correlators currently used in standard Doppler ultrasound machines. The algorithm will initially be verified on steady flow of blood-mimicking fluids in phantoms. A permutation test will be used to determine optimal parameter settings and ifitering schemes. Pulsatile waveforms and velocities in physiological ranges will be examined for accuracy and temporal resolution. Validation of the technique in vivo will be done by measuring flow in canine arteries and comparing with electromagnetic flow cuff results. Final evaluation of the technique will involve a pilot study quantifying flow in grafts of human subjects undergoing dialysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RAPID PATENCY ASSESSMENT OF DIALYSIS VASCULAR ACCESS Principal Investigator & Institution: Mansy, Hansen A.; Biomedical Acoustics Research Company 719 Forest Ave Evanston, Il 60202 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JAN-2004 Summary: (provided by applicant): Vascular access for renal dialysis is a lifeline for about 120,000 patients in the United States. Detection of access compromise is critical for optimal management. The proposed seeks to develop a new method for early and accurate detection of decreased access patency. The essential hypothesis is that vascular compromise alters blood flow turbulence resulting in diagnostic vibration ("acoustic") changes detectable at the skin surface. The proposed technology is based on computerized analysis of signals from "electronic stethoscopes" placed on the patient?s forearm. This is not an imaging technology. Rather, it is a much less expensive, yet potentially powerful method for immediate and safe diagnosis. Phase 1 research will test feasibility by studying fifteen human subjects before and after vascular access angioplasty. If successful, the novel device would have significant commercial potential with purchase by renal dialysis units and radiology departments. A much larger potential market may exist as the knowledge garnered in this effort is later applied to other vascular applications such as stroke prevention, renal artery stenosis detection, femoral-popliteal bypass graft salvage, and to early diagnosis of abdominal aortic aneurysms. PROPOSED COMMERCIAL APPLICATION: If this technology proves successful, it is anticipated that the device would become standard equipment in renal hemodialysis units world-wide with potential estimated sales in the order $30,000,000. Annual sales of disposable sensors are estimated to total an additional $25 million. A much larger potential market may exist as the knowledge garnered in this effort is later applied to other vascular applications such as stroke prevention, renal knowledge garnered in this effort is later applied to other vascular applications such as stroke

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prevention, renal artery stenosis detection, femoral-popliteal bypass graft salvage, and to early diagnosis of abdominal aortic aneurysms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF THE SQUID AXON NA, K, C1 COTRANSPORTER Principal Investigator & Institution: Russell, John M.; Professor; Biology; Syracuse University Syracuse, Ny 13210 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: (Applicant's Abstract) It is currently believed that much of the regulation and modulation of the Na,K,Cl cotransporter (NKCC) involves phosphorylation of the NKCC protein. Using the internally dialyzed squid giant axon, we have recently made two novel phosphorylation-related observations about the NKCC. In the nominal absence of ATP and ADP, arginine phosphate (Arg-P) supports NKCC fluxes across the squid axolemma. We will pursue this unexpected finding by testing whether Arg-P will support phosphorylation of the NKCC using a squid-specific antibody (which we will develop) to perform immunoprecipitation studies. We will test for whether the effect of arginine phosphate may be due to the replenishment of a compartment of ATP which is poorly accessible to dialysis, but readily accessible to the NKCC. We will perform a series of functional studies to determine whether the Arg-P activated NKCC behaves qualitatively different from the ATP activated NKCC. A second unexpected finding involves the ability of two inhibitors (A3 and DRB) of protein kinase CK2 (aka casein kinase 2) to completely block NKCC-mediated ion fluxes. This is particularly interesting given that the squid NKCC and those from mammalian sources have numerous CK2 consensus phosphorylation sites. To date, we have not identified any other types of protein kinase inhibitors capable of inhibiting the squid NKCC. We will take advantage of the fact that CK2 uses GTP almost as effectively as ATP to test whether GTP can support NKCC fluxes. We will again use the squid-specific antibody to test for whether treatment with A3 or DRB reduces the phosphorylation of the NKCC. Axonal shrinkage stimulates the squid NKCC by shifting the intracellular Cl- inhibition curve toward higher [Cl-]I values. We will test for roles for CK2 and for actin polymerization in NKCC activation by shrinkage. Axonal shrinkage leads to an increase of axoplasmic ionic strength which is known to facilitate the polymerization of actin. A series of studies examining the effects of several known modulators of F-actin on NKCC-mediated flux will be performed to test for a role for actin polymerization in activation of the NKCC. Another series of studies will be directed toward obtaining the functional expression of a clone of the squid NKCC using both mammalian cell and Xenopus oocyte expression systems. We will also develop a cut-open oocyte preparation for the characterization of the cloned squid NKCC. It will be used to functionally compare the squid NKCC with that from mammalian sources. In addition, the cut-open oocyte model will permit the year-round study of squid NKCC in a preparation that gives reasonably good access to intracellular regulatory sites on the NKCC protein. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RENAL BONE DISEASE Principal Investigator & Institution: Malluche, Hartmut H.; Professor of Medicine; Medicine; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2001; Project Start 15-AUG-1996; Project End 31-JUL-2005 Summary: (provided by applicant): The proposed continuation studies are designed to investigate the most important current issues of bone disease in patients with end-stage

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renal disease (ESRD) requiring dialysis: 1) the relationship between parathyroid hormone (PTH) and bone turnover and 2) the need for noninvasive diagnosis of the various types of renal bone disease. ESRD has a prevalence rate of 1,105 per million Americans, and African-Americans make up 30 percent of ESRD patients in contrast to 12.6 percent of the general population. In addition, African-Americans have lower bone turnover than Caucasians. ESRD patients with low bone turnover have been shown to have higher morbidity and mortality, and, under this grant, it was established that incidence of this form of renal bone disease is increasing. Identification of ESRD patients with high bone turnover is also important because they can benefit from several current treatment modalities. Employing a novel PTH assay recognizing the 1-84 PTH molecule, preliminary studies from this grant revealed differing ratios between 1-84 PTH and its amino-terminally truncated (NT-2-t PTh) fragment(s) in ESRD patients with high and low bone turnover. The central hypothesis of the application is that NH2-t PTH fragment(s) antagonize(s) 1:84 PTH effects on bone. Since NH2-t PTH fragments have been suggested to blunt 1-84 PTH effects, the proposed studies will investigate the antagonistic role and the potential mechanism(s) of NH2-t PTH on 1-84 PTH effects on bone. Moreover, the diagnostic value of 1-84:NH2-t PTH ratio for assessment of bone turnover will be established in ESRD patients. In addition, the effect of calcium on 184:NH2-t PTH ratio will be investigated. Studies will be done in ESRD patients and experimental rats with normal and reduced kidney function employing a) the novel 1-84 PTH assay and the established "intact" PTH assay for calculation of NH2-t PTH fragment(s), b) classical histomorphometry for assessment of bone turnover, and c) molecular morphometry of bone cells to assess apoptosis and osteoprotegerin ligand expression for evaluation of PTH action on bone. The anticipated results of the proposed studies will help understand the clinically relevant relationship between 1-84 PTH, NH2-t PTH fragment and bone turnover. It will be established whether AfricanAmerican ESRD patients are at particular risk to accumulate NH2-t PTH and thus are prone to develop adynamic bone disease with its far-reaching clinical consequences. Moreover, the forthcoming data will open new avenues for rational approaches to diagnosis and therapy of renal bone disease, one of the major unresolved problems in ESRTI) patients Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RENAL TRAINING GRANT IN CLINICAL INVESTIGATION Principal Investigator & Institution: Rosenberg, Mark E.; Professor; Medicine; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2005 Summary: (adapted from the application) The proposed training program will be provided to trainees who have completed a year of clinical nephrology training and who will enter the Clinical Research Masters Program at the University of Minnesota. Each trainee will identify a research mentor prior to entering the program. Research will be initiated concurrently with course work in the Masters program. This program includes 38 credit hours of study in epidemiology, biostatistics, clinical trials, literature review and grant writing. It is a new course of study directed by Stephen Glasser who will also sit on the Selection and Steering Committees for the proposed training grant. The research project required for this degree will be combined with an additional year of research with a mentor of the Nephrology training faculty; all projects will be approved by Glasser and the Masters Program Executive Committee. Drs. Rosenberg and Glasser will coordinate communication between the faculty of the Masters and Nephrology Clinical Research programs as is related to these research projects. Trainees will be

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evaluated on a quarterly basis by the mentor and annually on the basis of scientific presentations and publications by the advisory committee and Steering Committee. In addition to the formal course work and individual research project, trainees will attend conferences in the Renal Division and the Department of Medicine and will participate in a continuity clinic in Nephrology. Administrative structure of the program will include a Steering Committee with representation from the clinical Masters Program, Hennepin County, and the Divisions of Nephrology and Pediatric Nephrology and from the Berman Center for Outcomes and Clinical Research. The Selection Committee will include Division Directors at each of the clinical sites and the Vice Chair of Medicine. Individual Advisory Committees will be provided for each trainee and will be comprised of the advisor and four faculty members. The committee will meet annually and provide review of progress, guidance in use of Core facilities, and advice in seeking continued research funding at the end of the training period. Six research units are described including Transplantation, headed by Dr. Kasiske; ESRD, Dr. Colllins; Progression of Renal Disease, Dr. Hostetter; Diabetic Nephropathy, Dr. Mauer; Hypertension, Dr. Grimm; and Pediatric Nephrology, Dr. Kashtan. Core Resources include: the Clinical Outcomes Research Center (CORC), a joint venture of the Medical School and the School of Public Health, the Berman Center for Outcomes and Clinical Research, Total Renal Research, the NIH funded General Clinical Research Center (GCRC), the Academic Health Center Research Service Organization, Nephrology Analytical Services, and the Coordinating Center for Biometric Research. The CORC provides an epidemiological approach with an emphasis on outcomes of survival and satisfaction, physical and social functioning and quality of life. Support is also provided for prospective studies of therapies with systematic collection of follow-up data. The Berman Center is the research arm of the Division of Clinical Epidemiology at Hennepin County and has been a site for clinical trials since 1965. Total Renal Research is a clinical research facility with emphasis on Phase I through IV trials in patients with hypertension, renal insufficiency, on dialysis, or with renal transplants. The GCRC has a long history of success with NIH funding and includes inpatient and outpatient facilities; over 60 protocols are active. The Research Services Organization provides support to researchers in research protocols, management and performance and interface with industry. Involvement in over 100 proposals has led to initiation of 44 trials in the last two years. Nephrology Analytical Services receives data from HCFA and performs outcomes research regarding ESRD patients. The coordinating Center for Biometric Research is a subunit of the Division of Biostatistics of the School of Public Health. This center will provide access to large databases including several relating to hypertension as well as the USRDS data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESISTANCE TRAINING DURING MAINTENANCE DIALYSIS Principal Investigator & Institution: Sceppa, Carmen C.; Nutrition Exercise Physiology Sarcopenla (Neps) Lab; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-MAR-2005 Summary: (provided by applicant): There is a rising incidence of kidney failure in the US, with poor outcomes and high cost. End-stage renal disease (ESRD) affects almost 375,000 individuals in the US at a cost of more than $14 billion per year. Despite advances in dialysis and transplantation therapies, kidney failure leads to poor outcomes, poor prognosis and high health care costs. Malnutrition and the underlying systemic inflammatory response developed during the course of chronic kidney disease, worsen during ESRD, and leads to adverse outcomes, increased morbidity and

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mortality. Muscle wasting, impaired functional capacity and poor quality of life are the most important factors associated with malnutrition and inflammation in renal failure. We have shown in pre-dialysis patients with moderate chronic renal insufficiency that the anabolic effects of resistance exercise training result in significant improvements in protein utilization, nutritional status and functional capacity even in the context of anorexia and prescribed low protein diets. Thus, we propose to develop, test and implement a progressive resistance exercise routine for ESRD patients during the hemodialysis session. Our hypotheses are that the addition of 30-45 min of resistance exercise training during the dialysis session will counteract the burden of renal disease and will result in: 1) A feasible and safe exercise modality for ESRD patients (6-wk feasibility phase tested in 10 patients); 2) Net anabolism as evidenced by: improved nutritional status (i.e. increased protein catabolic rate, muscle mass and muscle strength); and reduced systemic inflammatory response (i.e. reduced C-reactive protein and interleukin-6, and increased serum albumin levels) compared to a randomly assigned control group on hemodilaysis but not exercise training (6-mo efficacy phase tested in 20 patients/group); and that 3) Improved self-reported physical function (i.e. increased SF-36 physical component scale) observed with resistance training will be associated with the improvements in nutritional status and inflammatory response. The long-term goal is to implement resistance exercise training routines during hemodialysis to overcome the underlying malnutrition and inflammation of ESRD and to improve disease outcome and prognosis. By implementing such intervention, we hope to offer a therapeutic strategy that can be incorporated to the standard of care of ESRD patients by working in conjunction with the dialysis unit staff. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RETURNING TO DIALYSIS TO SUSTAIN LIFE Principal Investigator & Institution: Sloan, Rebecca S.; None; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: The proposed study explores the experience of end stage renal disease (ESRD) patients as they readapt to dialysis for a second time. Findings will enhance nursing knowledge of the concerns or burdens of patients with this chronic illness, and will provide new information for future development and testing of nursing interventions, which will influence patient health outcomes. In the U.S., nearly 79,000 patients enter dialysis therapy annually. An important nursing outcome for these patients is a positive adaptation to the necessity for dialysis dependence. The only ways to avoid dialysis are through kidney transplantation or death. At least 1/4 will lose the transplanted kidney within 3 years, requiring them to again become dependent on dialysis to survive. An additional group of ESRD patients experiencing 'loss' of a transplant has been identified from persons notified to come to the hospital 'as the back up candidate' for a potential transplant. They also must return to dialysis once the organ has been given to someone else. The specific aims are: 1) describe the meaning of the experience of readaptation to ESRD patients who return to dialysis, 2) describe any changes in the meaning of the experience for ESRD patients at specific times over the first year of returning to dialysis, 3) describe how the meaning of the experience for two different groups of ESRD patients are similar or different, and 4) describe the patients' perceptions of nurses' actions as they experience "loss" of a kidney transplant and readaptation to dialysis. Audiotaped interviews (1, 4, 8 and 12 months) will be transcribed verbatim and analyzed by hermeneutic analysis techniques. In this 7-stage procedure: a) themes within and b) patterns across narratives will be identified. A

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computerized qualitative research program will be used to assist with data management. Findings will be useful in future research in nursing interventions for assisting readaptation to dialysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS FOR CV DISEASE IN A DIALYSIS COHORT Principal Investigator & Institution: Coresh, Josef; Associate Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-JUL-2004 Summary: (Adapted from Investigator's Abstract) Atherosclerotic cardiovascular disease (ASCVD) is a leading contributor to the high morbidity and mortality among end-stage renal disease (ESRD) patients, accounting for 36 percent of ESRD deaths (total annual mortality of 23 percent). This application tests the hypothesis that higher levels of several novel risk factors (Lp(a) levels and apo(a) isoforms; homocysteine and related vitamins; Chlamydia pneumoniae and cytomegalovirus; and C-reactive protein and fibrinogen) and traditional risk factors predict higher risk of ASCVD in a prospective study of 925 incident dialysis patients recruited within three months of starting dialysis. Although these factors have been implicated in the etiology of ASCVD in ESRD patients, little prospective data exist. Cross-sectional studies are susceptible to large survival bias because of the high mortality of patients with renal disease. This cohort has already been recruited through a collaboration between Johns Hopkins and 80 Dialysis Clinics Incorporated (DCI) clinics; many of the important predictors and possible confounders have been measured. This application proposes to obtain long term followup (extending mean followup of 2.4 years by four more years) and conduct laboratory assays. The investigators will: 1) extend specimen collection, and follow-up, and institute standardized review of ASCVD events; 2) characterize baseline associations of novel and traditional factors with each other, dialysis modality and dose, nutritional status, and ASCVD prevalence in the full cohort using a cross-sectional design; 3) determine whether baseline levels of risk factors predict subsequent incidence of ASCVD events, and total mortality using a prospective cohort study design and test a priori hypothesized interactions between risk factors and the risk of ASCVD; 4) study the variability of risk factors over time using annual measurements in a random subset of 180 patients (subcohort) using a longitudinal design; and lastly, 5) use a case-cohort design, utilizing the subcohort, to test whether the most recent level before an ASCVD event, the baseline level, or the mean level of each risk factor is most predictive of ASCVD risk. Baseline data collection will include a patient health questionnaire and a standardized review of comorbidity using dialysis chart records. Serum, plasma and DNA will be stored at -80 degrees C. from patient visits at recruitment (month 0), and followup (months 1,2,3,6,12,8,24, etc.). ASCVD will be assessed by review of hospital charts, patients and care providers questionnaires, and HCFA death forms. The investigators state that this study will use state-of-the-art epidemiologic and laboratory methods to identify modifiable risk factors, answer the call of an NKF task force for prospective studies of risk factors for ASCVD in the dialysis population, and lay the essential groundwork for future preventive interventions to reduce the burden of ASCVD in persons with ESRD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SOCIAL SUPPORT AND DEPRESSION AMONG DIALYSIS PATIENTS Principal Investigator & Institution: Brown, Stephanie L.; Survey Research Center; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): The proposed three-year research and training plan is designed to foster the academic development of the candidate in preparation for her career as a translation research scientist. Specifically, the plan is intended to (a) foster the candidate's transition from conducting experimental research on interpersonal relationships to conducting pre-intervention research on depression in chronically ill populations and (b) enable the candidate to design an intervention for depression that is informed by her program of research. The research plan is described below. The purpose of the proposed research project is to identify malleable factors that influence depression among patients undergoing dialysis therapy for renal failure. We direct special focus on the exchange of emotional and practical support between dialysis patients and their caregivers in order to isolate the unique effects of giving and receiving. We intend to examine whether giving has beneficial effects for the giver, and whether receiving has adverse effects for recipients who feel like a burden. These possibilities have typically been overlooked. Instead, investigations have focused on the benefits of receiving support from relationship partners (House, Landis, & Umberson, 1988). A longitudinal study consisting of two waves of data collection--baseline and an eight-month follow-up-is proposed to examine the unique effects of giving and receiving social support, feeling like a burden, and a number of other personality and relationship measures on depression, health, and well-being. 160 dialysis patients within the University of Michigan Health Care System will be invited to participate in two 1-hour interviews over the course of eight months. Participants will be asked to respond to questions about their current mental health status (e.g., depression, anxiety), and about their relationship to a caregiver (e.g., social bonds, the exchange of social support). In addition, caregiver reports and medical records indicating patient health and compliance will be correlated with interpersonal relationship measures. The results of this project will be used to develop and test a mental health intervention for dialysis patients that takes into consideration the potential risks and benefits of social support. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SPECIFICITY OF INTERCALATION REACTIONS Principal Investigator & Institution: Chaires, Jonathan B.; Professor; Biochemistry; University of Mississippi Medical Center 2500 N State St Jackson, Ms 39216 Timing: Fiscal Year 2003; Project Start 01-MAR-1984; Project End 31-DEC-2007 Summary: (provided by applicant): DNA is an underrepresented target for small molecule therapeutic agents. One reason for the dearth of DNA-targeted drugs is that the fundamental molecular mechanisms that govern sequence and structural-selective ligand binding to DNA are poorly understood. The rational design of new DNAtargeted drugs requires a thorough understanding of the binding mechanisms of existing compounds that bind to DNA with unique types of specificity. The long-range goal of the proposed research is to understand the molecular mechanism of intercalation reactions, with emphasis on the energetic basis of their sequence and structural selective binding. Renewal is sought for a successful and highly productive basic science program that has produced several promising avenues for DNA-targeted drug development.

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Research in the next funding period will focus on innovative studies designed to clarify the mechanisms that govern structural and sequence selective ligand binding to nucleic acids. Specific aims include: 1. Use and refinement of a highthroughput competition dialysis assay for the identification and characterization of structural selective ligand binding to nucleic acids. 2. Characterization of ligand binding to DNA:RNA hybrid structures. 3. Characterization of regional-selective drug binding by a novel calorimetric "bootprinting" method. The results of these studies will: 1. Provide a definitive taxonomy of structural selective ligand binding to nucleic acids, along with a description of the energetic basis of that structural selectivity, 2. Provide fundamental information to guide the rational design of compounds targeted to DNA:RNA hybrid structures, a target of enormous biological significance. 3. Provide a new tool for the quantitative study of drug-DNA interaction in long (genomic) pieces of DNA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANALYSIS

STATISTICAL

PROBLEMS

IN

MULTIVARIATE

SURVIVAL

Principal Investigator & Institution: Cai, Jianwen; Associate Professor; Biostatistics; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-JAN-1997; Project End 31-DEC-2005 Summary: (provided by applicant): This project will develop and investigate new methodology for analyzing recurrent event data from cardiovascular disease, asthma study and other biomedical research. The proposal describes four projects. The first project concerns statistical inferences for multiple-type recurrent events data. Parameter estimation will be based on an estimating equations approach. To increase efficiency, weighted estimating equations will be developed with weights inversely proportional to intra-subject covariance; parametric and non-parametric correlation estimators will be developed. Inference will be based on the multivariate central limit theorem and modern empirical processes theory. Asymptotic and finite sample properties will be examined. The proposed methods will be used to analyze data from a clinical study of left ventricular dysfunction patients and a retrospective cohort study of childhood asthma. The second project considers an accelerated failure time marginal means model and conditional multiplicative means model for analyzing censored recurrent event data which allow for terminating events. Parameter estimation will be based on an estimating equation approach. The strengths and weaknesses of the proposed method will be critically examined via theoretical investigations and simulation studies. Data from a study of kidney transplant patients will be analyzed using the proposed methods. The third project concerns marginal and conditional means models for analyzing censored recurrent event data, which accommodate both terminating events and dependent censoring. Parameter estimation will be conducted through an estimating equation approach, with inference based on the multivariate central limit theorem and empirical processes. Asymptotic and finite sample properties will be examined. Methods proposed will be applied to analyze data from a clinical study of dialysis patients. The fourth project investigates additive means models for censored recurrent event data. We will propose methods of estimation, which are applicable for recurrent events with independent censoring only, with terminal events and independent censoring, and with both terminal events and dependent censoring. Asymptotic and finite sample properties will be examined. Data sets from asthma, dialysis and renal transplant studies will be analyzed using the proposed methods. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SUB-OPTIMAL PRE-ESRD CARE AND ITS IMPACT ON OUTCOMES Principal Investigator & Institution: Kausz, Annamaria T.; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-DEC-2004 Summary: (adapted from the application) The prevalence of end-stage renal disease (ESRD) continues to increase, and mortality among ESRD patients remains high. The principal hypothesis of this proposal is that care of patients with chronic renal failure prior to ESRD (pre-ESRD) is sub-optimal, and this adversely influences outcomes after initiation of ESRD therapy, such as morbidity, mortality and cost. The research will include a macro viewpoint using data from large databases such as the United States Renal Data System (USRDS) and Health Care Financing Administration (HCFA), and a micro viewpoint using detailed primary data collection at a single tertiary care hospital-New England Medical Center (NEMC). USRDS and HCFA files will be used to determine the prevalence and predictors of malnutrition, anemia, late initiation of dialysis and delayed referral to the nephrologist, and their impact on subsequent clinical variables. Separate analyses of pediatric and transplant patients will be undertaken, and compared with dialysis patients. NEMC data will be used to study the impact of delayed nephrology referral and delayed vascular access placement on hospitalization and cost. The results of this proposal are expected to provide important information regarding pre-ESRD care, and for the development of strategies to improve ESRD outcomes. The principal investigator has designed a comprehensive series of studies to evaluate the hypotheses enunciated in this proposal, and is well qualified to carry them through to completion. In addition to a combined fellowship in Adult and Pediatric Nephrology, she holds a Master's degree in Epidemiology. She is mentored by investigators with extensive experience in clinical investigation and advised by a panel of world leaders in epidemiology, clinical trials and health services research. Within a limited time, she and her mentor have put together an infrastructure tailored to achieve the goals of this proposal. The practical experience from the research proposed, and the comprehensive education program outlined are expected to build on the candidate's current skills and experience, and facilitate her transition to an independent investigator in Pediatric and Adult Renal epidemiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THERAPY HOMOCYSTEINEMIA

IN

DIALYSIS

HYPOALBUMINEMIA

AND

Principal Investigator & Institution: Eustace, Joseph A.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 15-AUG-2001; Project End 31-JUL-2006 Summary: (Adapted from the application) End stage renal disease is associated with several complex nutritional problems. Hypoalbuminemia, the strongest predictor of mortality on dialysis, is related to a combination of nutritional, inflammatory and comorbid factors, but the relative importance of these factors has not been prospectively evaluated. Relative vitamin deficiencies, especially that of B6, B12 and folate, also occur. Hyperhomocysteinemia (hyperHcy), a novel cardio-vascular and thrombotic risk factor, is at least partly correctable with folate and vitamin B6 and B12 supplementation but the clinical benefits of this therapy is not established. The projects outlined in this application will allow Dr. Eustace to continue his mentored research into these two major nutritional problems, hypoalbuminemia and hyperHcy. The PI will: (1A) Conduct a longitudinal analysis of risk factors for dialysis-associated hypoalbuminemia focusing

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on protein intake and inflammation (C-Reactive Protein), using data collected in the CHOICE cohort study. This is a nationally representative cohort of 925 incident dialysis patients in its 5th year of follow-up, headed by Drs. Powe, Klag and Coresh. (1B) Build on a clinical trial, he recently completed, by conducting a two-center, 2 x 2 factorial trial of 280 recently hospitalized hemodialysis patients, with serum albumins of less then 4.0 g/dl, examining in one arm of the trial the efficacy of oral essential amino acids supplements versus placebo at improving serum albumin levels and reducing hospitalization rates and (1C) Use a decision analysis model to compare the costeffectiveness, utility and outcomes of oral supplements versus alternative management strategies, including parenteral nutrition, naso-gastric feeding and anabolic agents. (2A) Compare, in the second arm of the above clinical trial, the efficacy of high versus standard dose folate, B6 & B12 supplementation at reducing all cause cardiovascular endpoints and vascular access thromboses. (2B) Perform a meta-analysis of published trials of the benefit of vitamin therapy on actual patient survival. This combination of observational and experimental research under the mentorship of Drs. Coresh and Klag, combined with didactic course work, in the supportive context of the Welch Center will allow Dr. Eustace to build on his current theoretical knowledge, make the transition into an independent clinical scientist and prepare him for a career investigating the role of nutrition in renal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TOWARDS RENAL REGENERATION Principal Investigator & Institution: Little, Melissa; University of Queensland Cumbrae Stewart Building Brisbane, Queensland, 4072 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2005 Summary: (provided by applicant): Chronic renal failure is both devastating to the individual and expensive to treat. In 1998, there were 87,000 new cases of end-stage renal disease (ESRD) in the US, taking the total patient number to 400,000. This resulted in 63,000 deaths and cost $US16.74 billion. Current treatment options for ESRD are dialysis and renal transplantation. Dialysis is expensive (($USD1525,000/year/patient), results in a poor quality of life and a high yearly mortality rate ((16%). Kidney transplantation, although requiring immunosuppression, is preferable to dialysis, but due to a decrease in cadaveric donors worldwide only a quarter of patients awaiting transplantation will receive this treatment. Compounding the problem is a steady increase in the rate of ESRD worldwide primarily due to an increase in Type II diabetes. Several alternative treatment options are being investigated to treat chronic renal disease, including pig xenotransplantation and bioartificial kidney devices. In this application we will investigate the ability to treat chronic renal disease using stem cells. Two long-term approaches to renal regeneration will be investigated: de novo renal generation and endogenous renal repair. Both of these will require the induction of embryonic or adult stem cells to adopt a renal progenitor fate and then the isolation of these cells via specific markers. De novo generation of a replacement organ would then involve aggregation of renal progenitors and implantation of these aggregates into the omentum for vascularisation, together with reconnection to the excretory tract via a replacement ureter. Endogenous renal repair would involve the reintroduction and integration of induced and isolated renal progenitor cells into the damaged kidney. To reach these clinical objectives, we propose the following basic research objectives: (1) Use expression profiling to further dissect the processes of commitment to a renal fate during normal development;(2) Examine the potential for embryonic and adult stem cells to be differentiated into the lineages necessary for renal regeneration; (3) Identify

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novel renal progenitor cell markers and growth factors to assist in the identification, isolation and / or reactivation of renal stem cells; and (4) Utilize pathological and functional assays to determine the in vivo outcomes of de novo organ generation and renal repair. Human ES cell work will be performed using ES01, 02, 03, 04, 05 & 06 listed on the NIH ES cell line registry. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ULTRASONIC ENHANCEMENT OF HEMODIALYSIS Principal Investigator & Institution: Africk, Steven A.; Prodyne Corporation 30 Fenwick Rd Newton, Ma 02468 Timing: Fiscal Year 2001; Project Start 15-SEP-2001; Project End 31-MAR-2003 Summary: The goal of this project is the development of innovative ultrasonic technology and commercial devices to increase efficiency of hemodialysis performed with existing dialysis machines, dialyzers and clinical protocols. This will enable more efficacious or possibly shorter dialysis treatments. Specific aims for Phase I are to fully characterize ultrasonic enhancement of flux in standard hollow fiber dialyzers with emphasis on that of phosphorous, to make a preliminary assessment of the safety of the ultrasound required on human blood, and to formulate a preliminary device design for prototyping in Phase II. Dialyzers will be placed in a testbed containing an ultrasonically insonified water bath. A blood substitute of saline spiked with urea, vitamin B-12 and sodium phosphate will be dialyzed over a range of acoustic frequencies and amplitudes. "Blood out" concentrations will be sampled periodically to measure clearance and total solute removal. Dialyzers will then be tested for reuse. Ultrasound regimes found effective without damaging dialyzers will be incorporated into a preliminary device design. Small blood samples will be exposed to ultrasound in these regimes to explore safety. Phase I data will be relevant to further study of dialysis kinetics of phosphorous and to ultrasonic enhancement of diffusion in general. PROPOSED COMMERCIAL APPLICATIONS: The flux enhancement device to be developed in this project will be compatible with existing dialysis equipment without modification. Its use would entail merely inserting a dialyzer - with the usual lines attached - into the device instead of the usual clamp on the side of the dialysis machine. This approach should simplify regulatory acceptance and make it attractive to hospitals and dialysis units. The device itself will be very simple (similar to an ultrasonic cleaner), relatively inexpensive (with price on the order of $3000 $5000) and easy to operate and maintain. An annual market of 10,000 units worldwide may be possible. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VASCULAR ACCESS IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Allon, Michael; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant) Vascular access procedures and their subsequent complications represent a major cause of morbidity, hospitalization and cost for chronic hemodialysis patients. Over 20% of hospitalizations in hemodialysis patients in the United States are access-related, and the annual cost of access morbidity has been estimated at close to $1 billion. A-V fistulas have a lower incidence of stenosis, thrombosis, and infection than grafts, and increased longevity, but a large proportion of new fistulas never mature adequately to be usable for dialysis. A-V grafts are prone to frequent stenosis and thrombosis, requiring multiple radiologic and surgical

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interventions to maintain their long-term patency. Dialysis catheters are plagued with low blood flows and frequent thrombosis that impair the adequacy of dialysis, as well as frequent infections that result in bacteremia and life-threatening systemic complications. During the past few years the applicant has developed a multidisciplinary approach to vascular access at his institution, including a prospective, computerized database of all access procedures. In the context of this collaborative effort, the applicant has developed novel approaches to vascular access that have improved the standard of care and overall clinical outcomes related to vascular access. The goal of this grant is to optimize the applicant?s ability to pursue investigations regarding novel approaches aimed at improving vascular access outcomes in dialysis patients. Some of the specific questions that will be addressed include: (1) How can we increase the proportion of new A-V fistulas that mature adequately to be usable for dialysis? (2) How can we decrease the frequency of stenosis and thrombosis of A-V grafts? (3) How can we improve the blood flows and decrease the frequency of thrombosis of dialysis catheters? (4) How can we improve the clinical management of dialysis catheter-associated bacteremia? (5) How can we prevent the occurrence of dialysis catheter-associated infections? In the process of performing this clinical research, the candidate will also mentor Nephrology Fellows in the conduct of patientoriented clinical research. The applicant will assist the trainees in acquiring the conceptual skills, research experience, and motivation required to pursue a successful career in Academic Nephrology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “dialysis” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for dialysis in the PubMed Central database: •

A case of peritonitis caused by Roseomonas gilardii in a patient undergoing continuous ambulatory peritoneal dialysis. by Sandoe JA, Malnick H, Loudon KW.; 1997 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229922

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A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients. by Viola RA, Abbott KC, Welch PG, McMillan RJ, Sheikh AM, Yuan CM.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137601

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Acute hepatitis associated with oral levofloxacin therapy in a hemodialysis patient. by Schwalm JD, Lee CH.; 2003 Apr 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151990

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Administration of aminoglycosides to hemodialysis patients immediately before dialysis: a new dosing modality. by Matsuo H, Hayashi J, Ono K, Andoh K, Andoh Y, Sano Y, Saruki K, Tanaka J, Yamashita M, Nakamura K, Kubo K.; 1997 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=164175

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Analysis of ceftriaxone and ceftazidime distribution in cerebrospinal fluid of and cerebral extracellular space in awake rats by in vivo microdialysis. by Granero L, Santiago M, Cano J, Machado A, Peris JE.; 1995 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=163019

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Atrial fibrillation in chronic dialysis patients in the United states: risk factors for hospitalization and mortality. by Abbott KC, Trespalacios FC, Taylor AJ, Agodoa LY.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149358

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Calciphylaxis in chronic, non-dialysis-dependent renal disease. by Pliquett RU, Schwock J, Paschke R, Achenbach H.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=222929

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Case of Peritonitis Caused by Ewingella americana in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis. by Kati C, Bibashi E, Kokolina E, Sofianou D.; 1999 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85743

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Characterization of peripheral-compartment kinetics of antibiotics by in vivo microdialysis in humans. by Muller M, Haag O, Burgdorff T, Georgopoulos A, Weninger W, Jansen B, Stanek G, Pehamberger H, Agneter E, Eichler HG.; 1996 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=163607

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Continuous Ambulatory Peritoneal Dialysis Peritonitis due to Enterococcus cecorum. by De Baere T, Claeys G, Verschraegen G, Devriese LA, Baele M, Van Vlem B, Vanholder R, Dequidt C, Vaneechoutte M.; 2000 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87422

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Correlation of breath ammonia with blood urea nitrogen and creatinine during hemodialysis. by Narasimhan LR, Goodman W, Patel CK.; 2001 Apr 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31883

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Dearth of dialysis feared in UK. by Spooner MH.; 2003 Apr 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=153710

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Detection of Hepatitis G Virus (HGV) RNA and Antibodies to the HGV Envelope Protein E2 in a Cohort of Hemodialysis Patients. by Perez-Gracia T, Galan F, GironGonzalez JA, Lozano A, Benavides B, Fernandez E, Rodriguez-Iglesias M.; 2000 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=87584

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Determinants of Ceftazidime Clearance by Continuous Venovenous Hemofiltration and Continuous Venovenous Hemodialysis. by Matzke GR, Frye RF, Joy MS, Palevsky PM.; 2000 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=89925

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Dialysis culture enables more accurate determination of MIC of benzylpenicillin for Borrelia burgdorferi than does conventional procedure. by Stiernstedt SH, Wretlind B.; 1996 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163640

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Differential prevalence of hepatitis C virus subtypes in healthy blood donors, patients on maintenance hemodialysis, and patients with hepatocellular carcinoma in Surabaya, Indonesia. by Soetjipto, Handajani R, Lusida MI, Darmadi S, Adi P, Soemarto, Ishido S, Katayama Y, Hotta H.; 1996 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229426

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Expanded CD14 + CD16 + Monocyte Subpopulation in Patients with Acute and Chronic Infections Undergoing Hemodialysis. by Nockher WA, Scherberich JE.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108270

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Fatal Hormonema dematioides Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis: Criteria for Organism Identification and Review of Other Known Fungal Etiologic Agents. by Shin JH, Lee SK, Suh SP, Ryang DW, Kim NH, Rinaldi MG, Sutton DA.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105020

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Genetic and Serological Evidence for Multiple Instances of Unrecognized Transmission of Hepatitis C Virus in Hemodialysis Units. by Mizuno M, Higuchi T, Kanmatsuse K, Esumi M.; 1998 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105089

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Hepatitis C in a Hemodialysis Unit: Molecular Evidence for Nosocomial Transmission. by Le Pogam S, Le Chapois D, Christen R, Dubois F, Barin F, Goudeau A.; 1998 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=105107

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Hepatitis C Virus Heteroduplex Tracking Assay for Genotype Determination Reveals Diverging Genotype 2 Isolates in Italian Hemodialysis Patients. by Calvo PL, Kansopon J, Sra K, Quan S, DiNello R, Guaschino R, Calabrese G, Danielle F, Brunetto MR, Bonino F, Massaro AL, Polito A, Houghton M, Weiner AJ.; 1998 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=124840

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Hepatitis C Virus Infections in Dialysis Centers in The Netherlands: a National Survey by Serological and Molecular Methods. by Schneeberger PM, Keur I, van der Vliet W, van Hoek K, Boswijk H, van Loon AM, van Dijk WC, Kauffmann RH, Quint W, van Doorn LJ.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=104905

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Heterogeneously Vancomycin-Resistant Staphylococcus epidermidis Strain Causing Recurrent Peritonitis in a Dialysis Patient during Vancomycin Therapy. by Sieradzki K, Roberts RB, Serur D, Hargrave J, Tomasz A.; 1999 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=84162

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High incidence of hepatitis C virus infection in hemodialysis patients in units with high prevalence. by Pujol FH, Ponce JG, Lema MG, Capriles F, Devesa M, Sirit F, Salazar M, Vasquez G, Monsalve F, Blitz-Dorfman L.; 1996 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229084

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HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study. by Abbott KC, Trespalacios FC, Agodoa LY, Ahuja TS.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=166168

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Hydrogen peroxide generation by polymorphonuclear leukocytes exposed to peritoneal dialysis effluent. by Daniels I, Bhatia KS, Porter CJ, Lindsay MA, Morgan AG, Burden RP, Fletcher J.; 1996 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170431

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Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload. by Johnson DW, Arndt M, O'Shea A, Watt R, Hamilton J, Vincent K.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=60994

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Identification of Pentosidine as a Native Structure for Advanced Glycation End Products in [beta] 2-Microglobulin-Containing Amyloid Fibrils in Patients with Dialysis-Related Amyloidosis. by Miyata T, Taneda S, Kawai R, Ueda Y, Horiuchi S, Hara M, Maeda K, Monnier VM.; 1996 Mar 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=39800

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Improved detection of bacterial growth in continuous ambulatory peritoneal dialysis effluent by use of BacT/Alert FAN bottles. by Alfa MJ, Degagne P, Olson N, Harding GK.; 1997 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229691

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In vitro susceptibility testing of Borrelia burgdorferi by a dialysis culture method. by Dever LL, Jorgensen JH, Barbour AG.; 1997 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=163886

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Influence of hemodialysis on plasma concentration-time profiles of mefloquine in two patients with end-stage renal disease: a prophylactic drug monitoring study. by Crevoisier CA, Joseph I, Fischer M, Graf H.; 1995 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=162850

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Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients. by Pupim LB, Flakoll PJ, Brouillette JR, Levenhagen DK, Hakim RM, Ikizler TA.; 2002 Aug 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150418

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Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. by Chandna SM, Schulz J, Lawrence C, Greenwood RN, Farrington K.; 1999 Jan 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27700

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Malnutrition: a frequent misdiagnosis for hemodialysis patients. by Mitch WE.; 2002 Aug 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150424

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Molecular Identification of Pasteurella dagmatis Peritonitis in a Patient Undergoing Peritoneal Dialysis. by Wallet F, Toure F, Devalckenaere A, Pagniez D, Courcol RJ.; 2000 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87666

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On-Line Analysis of Penicillin Blood Levels in the Live Rat by Combined Microdialysis/Fast-Atom Bombardment Mass Spectrometry. by Caprioli RM, Lin S.; 1990 Jan 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=53237

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Patency and Life-Spans of Failing Hemodialysis Grafts in Patients Undergoing Repeated Percutaneous De-Clotting. by Mansilla AV, Toombs BD, Vaughn WK, Zeledon JI.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101200

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Peritoneal Dialysis-Associated Peritonitis Caused by Dermabacter hominis. by Radtke A, Bergh K, Oien CM, Bevanger LS.; 2001 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88363

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Peritonitis Associated with Vancomycin-Resistant Lactobacillus rhamnosus in a Continuous Ambulatory Peritoneal Dialysis Patient: Organism Identification, Antibiotic Therapy, and Case Report. by Klein G, Zill E, Schindler R, Louwers J.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=104921

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Peritonitis Caused by Haemophilus parainfluenzae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis. by Betriu C, Coronel F, Martin P, Picazo JJ.; 1999 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85465

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Peritonitis Due to Brevibacterium otitidis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis. by Wauters G, Van Bosterhaut B, Avesani V, Cuvelier R, Charlier J, Janssens M, Delmee M.; 2000 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=87589

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Peritonitis Due to Roseomonas fauriae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis. by Bibashi E, Sofianou D, Kontopoulou K, Mitsopoulos E, Kokolina E.; 2000 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88750

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Peritonitis involving a Capnocytophaga sp. in a patient undergoing continuous ambulatory peritoneal dialysis. by Esteban J, Albalate M, Caramelo C, Reyero A, Carriazo MA, Hernandez J, Ortiz A, Soriano F.; 1995 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=228442

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Pharmacokinetic behavior of intraperitoneal teicoplanin during treatment of peritonitis complicating continuous ambulatory peritoneal dialysis. by Finch RC, Holliday AP, Innes A, Burden RP, Morgan AG, Shaw PN, Harding I, Wale MC.; 1996 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=163456

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Pharmacokinetic Study of an Oral Cephalosporin, Cefdinir, in Hemodialysis Patients. by Hishida A, Ohishi K, Nagashima S, Kanamaru M, Obara M, Kitada A.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105672

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Pharmacokinetics and Distribution over the Blood-Brain Barrier of Zalcitabine (2[prime prime or minute],3[prime prime or minute]-Dideoxycytidine) and BEA005 (2[prime prime or minute],3[prime prime or minute]-Dideoxy-3[prime prime or minute]-Hydroxymethylcytidine) in Rats, Studied by Microdialysis. by Borg N, Stahle L.; 1998 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=105766

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Pharmacokinetics of fleroxacin after multiple oral dosing in patients receiving regular hemodialysis. by Uehlinger DE, Schaedeli F, Kinzig M, Sorgel F, Frey FJ.; 1996 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=163437

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Pharmacokinetics of Piperacillin-Tazobactam in Anuric Intensive Care Patients during Continuous Venovenous Hemodialysis. by Mueller SC, Majcher-Peszynska J, Hickstein H, Francke A, Pertschy A, Schulz M, Mundkowski R, Drewelow B.; 2002 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=127124

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Pharmacokinetics of Quinupristin-Dalfopristin in Continuous Ambulatory Peritoneal Dialysis Patients. by Johnson CA, Taylor CA III, Zimmerman SW, Bridson WE, Chevalier P, Pasquier O, Baybutt RI.; 1999 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89036

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Pharmacokinetics of Single-Dose Oral Stavudine in Subjects with Renal Impairment and in Subjects Requiring Hemodialysis. by Grasela DM, Stoltz RR, Barry M, Bone M, Mangold B, O'Grady P, Raymond R, Haworth SJ.; 2000 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=90027

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Pre-dialysis clinic attendance improves quality of life among hemodialysis patients. by White CA, Pilkey RM, Lam M, Holland DC.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=103666

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Primary Shewanella alga Septicemia in a Patient on Hemodialysis. by Iwata M, Tateda K, Matsumoto T, Furuya N, Mizuiri S, Yamaguchi K.; 1999 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85050

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Recovery of renal function in dialysis patients. by Agraharkar M, Nair V, Patlovany M.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=270015

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Reduced antibody reactivity to hepatitis C virus antigens in hemodialysis patients coinfected with hepatitis B virus. by Devesa M, Khudyakov YE, Capriles F, Blitz L, Fields HA, Liprandi F, Pujol FH.; 1997 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170632

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Role of Arachidonic Acid and Its Metabolites in the Priming of NADPH Oxidase in Human Polymorphonuclear Leukocytes by Peritoneal Dialysis Effluent. by Daniels I, Lindsay MA, Keany CI, Burden RP, Fletcher J, Haynes AP.; 1998 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95640

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Role of p38 in the Priming of Human Neutrophils by Peritoneal Dialysis Effluent. by Daniels I, Fletcher J, Haynes AP.; 1999 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95792

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Steady-State Pharmacokinetics of Lamivudine in Human Immunodeficiency VirusInfected Patients with End-Stage Renal Disease Receiving Chronic Dialysis. by Bohjanen PR, Johnson MD, Szczech LA, Wray DW, Petros WP, Miller CR, Hicks CB.; 2002 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=127386

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TT Virus Infection in French Hemodialysis Patients: Study of Prevalence and Risk Factors. by Gallian P, Berland Y, Olmer M, Raccah D, de Micco P, Biagini P, Simon S, Bouchouareb D, Mourey C, Roubicek C, Touinssi M', Cantaloube JF, Dussol B, de Lamballerie X.; 1999 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85277

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Use of Phylogenetic Analysis of Hepatitis C Virus (HCV) Hypervariable Region 1 Sequences To Trace an Outbreak of HCV in an Autodialysis Unit. by Halfon P, Roubicek C, Gerolami V, Quentin Y, Khiri H, Pepe G, Berland Y.; 2002 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=140339

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with dialysis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “dialysis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for dialysis (hyperlinks lead to article summaries): •

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A model to evaluate the pharmacokinetic and pharmacodynamic variables of extended-release products using in vivo tissue microdialysis in humans: bupivacaineloaded microcapsules. Author(s): Kopacz DJ, Bernards CM, Allen HW, Landau C, Nandy P, Wu D, Lacouture PG. Source: Anesthesia and Analgesia. 2003 July; 97(1): 124-31, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818954&dopt=Abstract

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique. Author(s): Shenoy S, Miller A, Petersen F, Kirsch WM, Konkin T, Kim P, Dickson C, Schild AF, Stewart L, Reyes M, Anton L, Woodward RS. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 August; 38(2): 229-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891102&dopt=Abstract

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A preliminary investigation of balloon angioplasty versus surgical treatment of thrombosed dialysis access grafts. Author(s): McCutcheon B, Weatherford D, Maxwell G, Hamann MS, Stiles A. Source: The American Surgeon. 2003 August; 69(8): 663-7; Discussion 668. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953823&dopt=Abstract

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Aberrant T cell activation and heightened apoptotic turnover in end-stage renal failure patients: a comparative evaluation between non-dialysis, haemodialysis, and peritoneal dialysis. Author(s): Moser B, Roth G, Brunner M, Lilaj T, Deicher R, Wolner E, Kovarik J, BoltzNitulescu G, Vychytil A, Ankersmit HJ. Source: Biochemical and Biophysical Research Communications. 2003 August 29; 308(3): 581-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914790&dopt=Abstract

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Accelerated progression of calcific aortic stenosis in dialysis patients. Author(s): Perkovic V, Hunt D, Griffin SV, du Plessis M, Becker GJ. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 94(2): C40-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845236&dopt=Abstract

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Accelerated progression of calcific aortic stenosis in dialysis patients: what we still need to learn. Author(s): Bakri K, Goldsmith DJ. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 94(2): C27-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845233&dopt=Abstract

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Access to dialysis in New Zealand renal services. Author(s): Collins J, Metcalf P. Source: N Z Med J. 2003 June 6; 116(1175): U455. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838351&dopt=Abstract

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Adenosine extracellular levels in human brain gliomas: an intraoperative microdialysis study. Author(s): Melani A, De Micheli E, Pinna G, Alfieri A, Corte LD, Pedata F. Source: Neuroscience Letters. 2003 July 31; 346(1-2): 93-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850556&dopt=Abstract

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Adjustment, spirituality, and health in women on hemodialysis. Author(s): Tanyi RA, Werner JS. Source: Clinical Nursing Research. 2003 August; 12(3): 229-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918648&dopt=Abstract

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Albumin-based dialysis as an effective treatment for severe traumatic hepatic necrosis. Author(s): Ben-Abraham R, Szold O, Nimrod A, Sorkine P. Source: Isr Med Assoc J. 2003 June; 5(6): 455-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841026&dopt=Abstract

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Aldosterone blockade and vascular calcification in hemodialysis patients. Author(s): Nitta K, Akiba T, Nihei H. Source: The American Journal of Medicine. 2003 August 15; 115(3): 250. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12935835&dopt=Abstract

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An evaluation of 1-84 PTH measurement in relation to bone alkaline phosphatase and bone Gla protein in hemodialysis patients. Author(s): Miwa N, Nitta K, Kimata N, Watanabe Y, Suzuki K, Kawashima A, Haga M, Watanabe R, Aoki T, Akiba T, Nihei H. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 94(2): C29-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845234&dopt=Abstract

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An unusual cause of peripheral neuropathy in a diabetic patient on dialysis: “a sural surprise”. Author(s): Slack A, Goldsmith DJ. Source: Postgraduate Medical Journal. 2003 August; 79(934): 477, 480-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954965&dopt=Abstract

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Anaemia management prior to dialysis: cardiovascular and cost-benefit observations. Author(s): Collins AJ. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18 Suppl 2: Ii2-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819293&dopt=Abstract

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Antibiotic-coated hemodialysis catheters for the prevention of vascular catheterrelated infections: a prospective, randomized study. Author(s): Chatzinikolaou I, Finkel K, Hanna H, Boktour M, Foringer J, Ho T, Raad I. Source: The American Journal of Medicine. 2003 October 1; 115(5): 352-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14553869&dopt=Abstract

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Arguments in favour of a homologous concept for hemodialysis access procedures. Feasibility and results. Author(s): Sulkowski U, Schulte H. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 July; 26(1): 96-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819655&dopt=Abstract

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Association between troponin I levels and mortality in stable hemodialysis patients. Author(s): Farkouh ME, Robbins MJ, Urooj Zafar M, Shimbo D, Davidson KW, Puttappa R, Winston J, Halperin JL, Epstein EM, Patel M, Talor Z, Chesebro JH. Source: The American Journal of Medicine. 2003 February 15; 114(3): 224-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12637137&dopt=Abstract

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Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Author(s): Ketteler M, Bongartz P, Westenfeld R, Wildberger JE, Mahnken AH, Bohm R, Metzger T, Wanner C, Jahnen-Dechent W, Floege J. Source: Lancet. 2003 March 8; 361(9360): 827-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642050&dopt=Abstract

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Atheroembolic renal failure requiring dialysis: potential for renal recovery? A review of 43 cases. Author(s): Theriault J, Agharazzi M, Dumont M, Pichette V, Ouimet D, Leblanc M. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 94(1): C11-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806187&dopt=Abstract

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Atherosclerotic and hemostatic abnormalities in patients undergoing hemodialysis. Author(s): Kushiya F, Wada H, Sakakura M, Mori Y, Gabazza EC, Nishikawa M, Nobori T, Noguchi M, Izumi K, Shiku H. Source: Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2003 January; 9(1): 53-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643324&dopt=Abstract

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Baclofen neurotoxicity in uremic patients: is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis? Author(s): Chen YC, Chang CT, Fang JT, Huang CC. Source: Renal Failure. 2003 March; 25(2): 297-305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739836&dopt=Abstract

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Baseline levels of glucose metabolites, glutamate and glycerol in malignant glioma assessed by stereotactic microdialysis. Author(s): Roslin M, Henriksson R, Bergstrom P, Ungerstedt U, Bergenheim AT. Source: Journal of Neuro-Oncology. 2003 January; 61(2): 151-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622454&dopt=Abstract

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Basic steps for increasing the rate of autogenic vascular accesses for hemodialysis. Author(s): Salgado OJ. Source: Therap Apher Dial. 2003 April; 7(2): 238-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918950&dopt=Abstract

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BB genotype of the vitamin D receptor gene polymorphism postpones parathyroidectomy in hemodialysis patients. Author(s): Borras M, Torregrossa V, Oliveras A, Almirall J, Ma Paz M, Betriu A, Martin M, Muray S, Fibla J, Fernandez E. Source: Journal of Nephrology. 2003 January-February; 16(1): 116-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649542&dopt=Abstract

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Belgian peer review experience on the Achille's Heel in haemodialysis care: vascular access. Author(s): Theelen B, Rorive G, Krzesinski JM, Collart F; Nursing Peer Review Commmitte-ORPADT. Source: Edtna Erca J. 2002 October-December; 28(4): 164-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638928&dopt=Abstract

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Beneath the skin. The workings of a dedicated dialysis vascular access center. Author(s): Siegel JB. Source: Nephrol News Issues. 2003 July; 17(8): 54-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882113&dopt=Abstract

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Benefits of fish oil supplementation for hemodialysis patients. Author(s): Vergili-Nelsen JM. Source: Journal of the American Dietetic Association. 2003 September; 103(9): 1174-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963947&dopt=Abstract

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Beta2-microglobulin-selective adsorbent column (Lixelle) for the treatment of dialysis-related amyloidosis. Author(s): Suzuki K, Shimazaki M, Kutsuki H. Source: Therap Apher Dial. 2003 February; 7(1): 104-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12921124&dopt=Abstract

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Bifidobacterium in gastro-resistant seamless capsule reduces serum levels of indoxyl sulfate in patients on hemodialysis. Author(s): Takayama F, Taki K, Niwa T. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S142-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612972&dopt=Abstract

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Bilateral renal rupture in a patient on hemodialysis. Author(s): Carlson CC, Holsten SJ, Grandas OH. Source: The American Surgeon. 2003 June; 69(6): 505-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12852508&dopt=Abstract

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Biochemical effects of high dialysate calcium in hemodialysis patients with hyperparathyroidism: a 10 month study. Author(s): Haris A, Richardson RM. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 2003 January-February; 49(1): 70-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12558310&dopt=Abstract

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Biofilm infections in peritoneal dialysis-related peritonitis: comparison of standard MIC and MBEC in evaluation of antibiotic sensitivity of coagulase-negative staphylococci. Author(s): Sepandj F, Ceri H, Gibb AP, Read RR, Olson M. Source: Perit Dial Int. 2003 January-February; 23(1): 77-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691511&dopt=Abstract

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Blood extracellular superoxide dismutase levels in hemodialysis patients pre- and post-hemodialysis and its association with lipoprotein lipase mass and free fatty acid. Author(s): Shimomura H, Maehata E, Takamiya T, Adachi T, Komoda T. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 2003 February; 328(1-2): 113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559606&dopt=Abstract

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Body composition analysis by bioelectrical impedance in chronic maintenance dialysis patients: comparisons to the National Health and Nutrition Examination Survey III. Author(s): Dumler F, Kilates C. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 April; 13(2): 166-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671844&dopt=Abstract

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Body fat mass in hemodialysis patients. Author(s): Ishimura E, Okuno S, Marukawa T, Katoh Y, Hiranaka T, Yamakawa T, Morii H, Kim M, Matsumoto N, Shoji T, Inaba M, Nakatani T, Nishizawa Y. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S137-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612971&dopt=Abstract

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Bone marrow amyloidosis with erythropoietin-resistant anemia in a patient undergoing chronic hemodialysis treatment. Author(s): Cetinkaya R, Odabas AR, Selcuk Y, Erman Z, Kaya H. Source: Southern Medical Journal. 2003 May; 96(5): 491-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911189&dopt=Abstract

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Bone mineral density may be related to atherosclerosis in hemodialysis patients. Author(s): Nakashima A, Yorioka N, Tanji C, Asakimori Y, Ago R, Usui K, Shigemoto K, Harada S. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 June; 14(5): 369-73. Epub 2003 May 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768278&dopt=Abstract

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Bowel perforation during catheter removal after the sixth month of peritoneal dialysis termination. Author(s): Borazan A, Ustun H, Akkas M, Ozbay O, Yilmaz A. Source: Acta Medica (Hradec Kralove). 2003; 46(2): 77-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926605&dopt=Abstract

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Brachiobasilic arteriovenous fistula: different surgical techniques and their effects on fistula patency and dialysis-related complications. Author(s): Hossny A. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 April; 37(4): 821-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663983&dopt=Abstract

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Bridging the “theory-practice gap” in renal nursing: establishing a renal professional practice model. Experiences of the Adam Linton Dialysis Unit. Author(s): Bevan J. Source: Cannt J. 2003 January-March; 13(1): 27-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705188&dopt=Abstract

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Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. Author(s): deFilippi C, Wasserman S, Rosanio S, Tiblier E, Sperger H, Tocchi M, Christenson R, Uretsky B, Smiley M, Gold J, Muniz H, Badalamenti J, Herzog C, Henrich W. Source: Jama : the Journal of the American Medical Association. 2003 July 16; 290(3): 353-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865376&dopt=Abstract

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Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. Author(s): Cice G, Ferrara L, D'Andrea A, D'Isa S, Di Benedetto A, Cittadini A, Russo PE, Golino P, Calabro R. Source: Journal of the American College of Cardiology. 2003 May 7; 41(9): 1438-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742278&dopt=Abstract

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Causes of late leaks in peritoneal dialysis patients. Author(s): Albaz M, Kantaci G, Tuglular S, Tercuman N, Tetik G, Ozener C. Source: Edtna Erca J. 2002 October-December; 28(4): 170-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638930&dopt=Abstract

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Central vein obstruction in hemodialysis patients: results of radiological and surgical intervention. Author(s): Dammers R, de Haan MW, Planken NR, van der Sande FM, Tordoir JH. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 September; 26(3): 317-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509897&dopt=Abstract

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Cerebral microdialysis as a monitoring method in subarachnoid hemorrhage patients, and correlation with clinical events--a systematic review. Author(s): Peerdeman SM, van Tulder MW, Vandertop WP. Source: Journal of Neurology. 2003 July; 250(7): 797-805. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883920&dopt=Abstract

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Changes in individual serum beta2-microglobulin in regular hemodialysis. Author(s): Yamada T, Satoh T. Source: Clinical Nephrology. 2003 July; 60(1): 63-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872863&dopt=Abstract

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Chronotherapy of high-dose active vitamin D3 in haemodialysis patients with secondary hyperparathyroidsm: a repeated dosing study. Author(s): Tsuruoka S, Wakaumi M, Sugimoto K, Saito T, Fujimura A. Source: British Journal of Clinical Pharmacology. 2003 June; 55(6): 531-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814446&dopt=Abstract

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Circulating levels of thrombopoietin and erythropoietin in hemodialysis patients. Author(s): Otsubo Y, Nitta K, Otsubo S, Kimata N, Miwa N, Watanabe Y, Uchida K, Kawashima A, Yumura W, Akiba T, Nihei H. Source: Acta Haematologica. 2003; 109(4): 209-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12853697&dopt=Abstract

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Circulating N-terminal pro-brain natriuretic peptide and cardiac troponin T in chronic dialysis patients. Author(s): Leowattana W, Ong-Ajyooth L, Taruangsri P, Pokum S. Source: J Med Assoc Thai. 2003 May; 86 Suppl 1: S52-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866769&dopt=Abstract

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Clinical effect of short daily in-center hemodialysis. Author(s): Koshikawa S, Akizawa T, Saito A, Kurokawa K. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 95(1): C23-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520018&dopt=Abstract

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Clinical epidemiology of cardiac disease in dialysis patients: left ventricular hypertrophy, ischemic heart disease, and cardiac failure. Author(s): Foley RN. Source: Seminars in Dialysis. 2003 March-April; 16(2): 111-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641874&dopt=Abstract

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Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Author(s): Levin A. Source: Seminars in Dialysis. 2003 March-April; 16(2): 101-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641872&dopt=Abstract

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Clinical management of dialysis-related carnitine deficiency: three case studies. Author(s): Lindberg J, Sadler R, Slowik M. Source: Nephrol News Issues. 2003 April; 17(5): 73-6, 78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715628&dopt=Abstract

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Combined peritoneal dialysis and hemodialysis: our experience compared to others. Author(s): Agarwal M, Clinard P, Burkart JM. Source: Perit Dial Int. 2003 March-April; 23(2): 157-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713083&dopt=Abstract

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Combined treatment with nafamostat mesilate and aspirin prevents heparin-induced thrombocytopenia in a hemodialysis patient. Author(s): Takahashi H, Muto S, Nakazawa E, Yanagiba S, Masunaga Y, Miyata Y, Tamba K, Kusano E, Matsuo M, Matsuo T, Asano Y. Source: Clinical Nephrology. 2003 June; 59(6): 458-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834179&dopt=Abstract

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Comparison of apparent efficiency of haemodialysis satellite units in England and Wales using data envelopment analysis. Author(s): Gerard K, Roderick P. Source: International Journal of Technology Assessment in Health Care. 2003 Summer; 19(3): 533-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962340&dopt=Abstract

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Comparison of magnesium and zinc levels in blood in end stage renal disease patients treated by hemodialysis or peritoneal dialysis. Author(s): Pietrzak I, Bladek K, Bulikowski W. Source: Magnes Res. 2002 December; 15(3-4): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635877&dopt=Abstract

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Comparison of oral versus intravenous iron therapy in predialysis patients of chronic renal failure receiving recombinant human erythropoietin. Author(s): Aggarwal HK, Nand N, Singh S, Singh M, Hemant, Kaushik G. Source: J Assoc Physicians India. 2003 February; 51: 170-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725261&dopt=Abstract

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Comparison of prognostic value of atrial fibrillation versus sinus rhythm in patients on long-term hemodialysis. Author(s): Vazquez E, Sanchez-Perales C, Lozano C, Garcia-Cortes MJ, Borrego F, Guzman M, Perez P, Pagola C, Borrego MJ, Perez V. Source: The American Journal of Cardiology. 2003 October 1; 92(7): 868-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516897&dopt=Abstract

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Cutaneous microdialysis of uric acid level in the dermis: modification of in vitro recovery. Author(s): Lee YS, Kim SJ, Oh JK, Chung JH, Eun HC. Source: Acta Dermato-Venereologica. 2003; 83(1): 10-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636015&dopt=Abstract

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Dealing with the noncompliant dialysis patient: 10 steps to achieving compliance. Author(s): Valdez R. Source: Nephrol News Issues. 2003 April; 17(5): 65-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715627&dopt=Abstract

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Dearth of dialysis feared in UK. Author(s): Spooner MH. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 April 29; 168(9): 1174. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719344&dopt=Abstract

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Decreased argatroban clearance unaffected by hemodialysis in anasarca. Author(s): de Denus S, Spinler SA. Source: The Annals of Pharmacotherapy. 2003 September; 37(9): 1237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12921506&dopt=Abstract

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Deficiencies of calcium-regulatory proteins in dialysis patients: a novel concept of cardiovascular calcification in uremia. Author(s): Ketteler M, Wanner C, Metzger T, Bongartz P, Westenfeld R, Gladziwa U, Schurgers LJ, Vermeer C, Jahnen-Dechent W, Floege J. Source: Kidney International. Supplement. 2003 May; (84): S84-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694317&dopt=Abstract

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Dental diseases in a Jordanian population on renal dialysis. Author(s): Al-Wahadni A, Al-Omari MA. Source: Quintessence Int. 2003 May; 34(5): 343-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795352&dopt=Abstract

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Depressive symptoms in hemodialysis patients with silent cerebral infarction. Author(s): Fukunishi I, Koyama K, Iyoda S, Ogawa H, Ota Y, Nagaya K, Okayama M, Ushizaki R, Fujita E, Ezaki M, Nishitani S, Miyashita Y. Source: Psychosomatics. 2003 July-August; 44(4): 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832607&dopt=Abstract

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Determinants of successful synthetic hemodialysis vascular access graft placement. Author(s): Rosas SE, Joffe M, Burns JE, Knauss J, Brayman K, Feldman HI. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 May; 37(5): 1036-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756351&dopt=Abstract

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Determinants of survival among HIV-infected chronic dialysis patients. Author(s): Rodriguez RA, Mendelson M, O'Hare AM, Hsu LC, Schoenfeld P. Source: Journal of the American Society of Nephrology : Jasn. 2003 May; 14(5): 1307-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707399&dopt=Abstract

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Determination of alpha-amylase activity in serum and dialysate from patients using icodextrin-based peritoneal dialysis fluid. Author(s): Anderstam B, Garcia-Lopez E, Heimburger O, Lindholm B. Source: Perit Dial Int. 2003 March-April; 23(2): 146-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713081&dopt=Abstract

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Diacap alpha-polysulfone HI PS: a new dialysis membrane with optimum beta2microglobulin elimination. Author(s): Mann H, Al-Bashir A, Melzer H, Stiller S. Source: Int J Artif Organs. 2003 June; 26(6): 461-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866651&dopt=Abstract

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Diagnostic value of serum prostate-specific antigen in hemodialysis patients. Author(s): Sumura M, Yokogi H, Beppu M, Honda H. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 2003 May; 10(5): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694463&dopt=Abstract

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Dialysate-side urea kinetics. Neural network predicts dialysis dose during dialysis. Author(s): Fernandez EA, Valtuille R, Willshaw P, Perazzo CA. Source: Medical & Biological Engineering & Computing. 2003 July; 41(4): 392-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892360&dopt=Abstract

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Dialysis crisis. Author(s): Ayling J. Source: Emerg Med Serv. 2003 August; 32(8): 40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12942911&dopt=Abstract

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Dialysis disequilibrium: another reversible posterior leukoencephalopathy syndrome? Author(s): Sheth KN, Wu GF, Messe SR, Wolf RL, Kasner SE. Source: Clinical Neurology and Neurosurgery. 2003 September; 105(4): 249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954540&dopt=Abstract

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Dialysis modalities and dyslipidemia. Author(s): Attman PO, Samuelsson O, Johansson AC, Moberly JB, Alaupovic P. Source: Kidney International. Supplement. 2003 May; (84): S110-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694322&dopt=Abstract

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Diet monotony as a correlate of poor nutritional intake among hemodialysis patients. Author(s): Zimmerer JL, Leon JB, Covinsky KE, Desai U, Sehgal AR. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 April; 13(2): 72-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671828&dopt=Abstract

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Different effects of amino acid-based and glucose-based dialysate from peritoneal dialysis patients on mesothelial cell ultrastructure and function. Author(s): Chan TM, Leung JK, Sun Y, Lai KN, Tsang RC, Yung S. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18(6): 1086-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748339&dopt=Abstract

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Do cardiac troponins provide prognostic insight in hemodialysis patients? Author(s): Choy JB, Armstrong PW, Ulan RA, Campbell PM, Gourishankar S, Prosser CI, Tymchak WJ. Source: The Canadian Journal of Cardiology. 2003 July; 19(8): 907-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12876611&dopt=Abstract

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Dose conversion from epoetin alfa to darbepoetin alfa for patients with chronic kidney disease receiving hemodialysis. Author(s): Barnett AL, Cremieux PY. Source: Pharmacotherapy. 2003 May; 23(5): 690-3; Discussion 693-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741447&dopt=Abstract

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Dose of dialysis, convection and haemodialysis patients outcome--what the HEMO study doesn't tell us: the European viewpoint. Author(s): Locatelli F. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18(6): 1061-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748335&dopt=Abstract

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Echography of left ventricular end-diastolic diameter as a reliable tool for estimating “dry weight” in hemodialysis patients. Author(s): Yoshimura R, Goto T, Tsuchida K, Takemoto Y, Wada S, Sano H, Kishimoto T, Yamamoto K, Nakatani T. Source: Renal Failure. 2003 January; 25(1): 31-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12617331&dopt=Abstract

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Effect of changing s.c. epoetin alfa administration from thrice weekly to once weekly in hemodialysis patients. Author(s): To LL, Stoner CP. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 May 1; 60(9): 931-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756944&dopt=Abstract

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Effect of doxercalciferol (1alpha-hydroxyvitamin D2) on PTH, bone turnover and bone mineral density in a hemodialysis patient with persistent secondary hyperparathyroidism post parathyroidectomy. Author(s): Parisi MS, Oliveri B, Somoza J, Mautalen C. Source: Clinical Nephrology. 2003 June; 59(6): 471-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834181&dopt=Abstract

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Effect of epoetin on HO-1 mRNA level and plasma antioxidants in hemodialysis patients. Author(s): Calo LA, Stanic L, Davis PA, Pagnin E, Munaretto G, Fusaro M, Landini S, Semplicini A, Piccoli A. Source: Int J Clin Pharmacol Ther. 2003 May; 41(5): 187-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776808&dopt=Abstract

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Effect of glutamate carboxypeptidase II and reduced folate carrier polymorphisms on folate and total homocysteine concentrations in dialysis patients. Author(s): Fodinger M, Dierkes J, Skoupy S, Rohrer C, Hagen W, Puttinger H, Hauser AC, Vychytil A, Sunder-Plassmann G. Source: Journal of the American Society of Nephrology : Jasn. 2003 May; 14(5): 1314-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707400&dopt=Abstract

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Effect of hemodialysis on the antioxidative properties of serum. Author(s): Mayer B, Zitta S, Greilberger J, Holzer H, Reibnegger G, Hermetter A, Oettl K. Source: Biochimica Et Biophysica Acta. 2003 July 30; 1638(3): 267-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878328&dopt=Abstract

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Effect of preload reduction by haemodialysis on new indices of diastolic function. Author(s): Graham RJ, Gelman JS, Donelan L, Mottram PM, Peverill RE. Source: Clinical Science (London, England : 1979). 2003 October; 105(4): 499-506. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816536&dopt=Abstract

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Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. A randomized, controlled study. Author(s): Li PK, Chow KM, Wong TY, Leung CB, Szeto CC. Source: Annals of Internal Medicine. 2003 July 15; 139(2): 105-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859160&dopt=Abstract

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Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients. Author(s): Righetti M, Ferrario GM, Milani S, Serbelloni P, La Rosa L, Uccellini M, Sessa A. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2003 April; 9(4): Pi19-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709680&dopt=Abstract

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Effects of renal insufficiency and hemodialysis on the pharmacokinetics of rofecoxib. Author(s): Gottesdiener K, Agrawal N, Porras A, Wong P, Rogers JD, Gertz BJ, Redfern JS, Marbury T. Source: American Journal of Therapeutics. 2003 July-August; 10(4): 252-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845388&dopt=Abstract

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Effects of vitamin supplementation on microcirculatory disturbance in hemodialysis patients without peripheral arterial disease. Author(s): Sato M, Matsumoto Y, Morita H, Takemura H, Shimoi K, Amano I. Source: Clinical Nephrology. 2003 July; 60(1): 28-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872855&dopt=Abstract

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Efficacy and safety of midodrine in the treatment of dialysis-associated hypotension. Author(s): Perazella MA. Source: Expert Opinion on Drug Safety. 2003 January; 2(1): 37-47. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904123&dopt=Abstract

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Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis. Author(s): Jacob S, Agarwal A, Agarwal A, Agarwal S, Patel N, Lal V. Source: Journal of Cataract and Refractive Surgery. 2003 February; 29(2): 315-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648643&dopt=Abstract

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Elderly patients on chronic hemodialysis: effect of the secondary hyperparathyroidism on the hemoglobin level. Author(s): Neves PL, Trivino J, Casaubon F, Romao P, Mendes P, Bexiga I, Pinto I, Santos V, Bernardo I. Source: International Urology and Nephrology. 2002; 34(1): 147-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12549658&dopt=Abstract

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Electrolyte profiles within the ileoanal pouch: measurement by an in vivo equilibrium dialysis technique. Author(s): Reissman P, Ehrenpreis ED, Cohen S, Nogueras JJ, Zaitman D, Wexner SD. Source: Dig Liver Dis. 2003 April; 35(4): 251-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801036&dopt=Abstract

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Endogenous formate elimination and total body clearance during hemodialysis. Author(s): Yip L, Jacobsen D. Source: Journal of Toxicology. Clinical Toxicology. 2003; 41(3): 257-8; Author Reply 25960. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807308&dopt=Abstract

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Evaluation of blood recirculation in catheters for haemodialysis and its relation to blood circuit pressures. Author(s): Crespo Montero R, Casas Cuesta R, Munoz Navarro MC, Contreras MD, Alguacil Garrido I, Lopez Bermudez E. Source: Edtna Erca J. 2002 October-December; 28(4): 167-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638929&dopt=Abstract

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Evaluation of topiramate neuroprotective effect in severe TBI using microdialysis. Author(s): Alves OL, Doyle AJ, Clausen T, Gilman C, Bullock R. Source: Annals of the New York Academy of Sciences. 2003 May; 993: 25-34; Discussion 48-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12853292&dopt=Abstract

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Exit-site infection in children on peritoneal dialysis: comparison of two types of peritoneal catheters. Author(s): Warchol S, Ziolkowska H, Roszkowska-Blaim M. Source: Perit Dial Int. 2003 March-April; 23(2): 169-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713085&dopt=Abstract

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Expression of concern: Schiffl H, et Al. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002;346:305-10. Author(s): Drazen JM, Ingelfinger JR, Curfman GD. Source: The New England Journal of Medicine. 2003 May 22; 348(21): 2137. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761371&dopt=Abstract

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Factors associated with future amputation among patients undergoing hemodialysis: results from the Dialysis Morbidity and Mortality Study Waves 3 and 4. Author(s): O'Hare AM, Bacchetti P, Segal M, Hsu CY, Johansen KL; Dialysis Morbidity and Mortality Study Waves. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 January; 41(1): 162-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500233&dopt=Abstract

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Factors associated with medication-related problems in ambulatory hemodialysis patients. Author(s): Manley HJ, McClaran ML, Overbay DK, Wright MA, Reid GM, Bender WL, Neufeld TK, Hebbar S, Muther RS. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 February; 41(2): 386-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552501&dopt=Abstract

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Factors associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis. Author(s): Lui SL, Ng F, Lo WK. Source: Perit Dial Int. 2002 November-December; 22(6): 677-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556069&dopt=Abstract

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Factors that affect albumin concentration in dialysis patients and their relationship to vascular disease. Author(s): Kaysen GA, Don BR. Source: Kidney International. Supplement. 2003 May; (84): S94-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694319&dopt=Abstract

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Failed peritoneal dialysis in a dehydrated nephrotic child, in acute renal failure: a case report. Author(s): Olowu WA. Source: Niger Postgrad Med J. 2002 September; 9(3): 158-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501270&dopt=Abstract

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Failing hemodialysis access grafts: evaluation of complete vascular tree with 3D contrast-enhanced MR angiography with high spatial resolution: initial results in 10 patients. Author(s): Han KM, Duijm LE, Thelissen GR, Cuypers PW, Douwes-Draaijer P, Tielbeek AV, Wondergem JH, van den Bosch HC. Source: Radiology. 2003 May; 227(2): 601-5. Epub 2003 March 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663821&dopt=Abstract

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Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access. Author(s): Patel ST, Hughes J, Mills JL Sr. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 September; 38(3): 439-45; Discussion 445. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12947249&dopt=Abstract

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Fatal peritonitis due to Trichoderma sp. in a patient undergoing continuous ambulatory peritoneal dialysis. Author(s): Esel D, Koc AN, Utas C, Karaca N, Bozdemir N. Source: Mycoses. 2003 February; 46(1-2): 71-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588489&dopt=Abstract

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Feasibility of combination chemotherapy with cisplatin and etoposide for haemodialysis patients with lung cancer. Author(s): Watanabe R, Takiguchi Y, Moriya T, Oda S, Kurosu K, Tanabe N, Tatsumi K, Nagao K, Kuriyama T. Source: British Journal of Cancer. 2003 January 13; 88(1): 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556954&dopt=Abstract

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Flexibility as an implementation strategy for a daily dialysis program. Author(s): Piccoli GB, Mezza E, Quaglia M, Bermond F, Bechis F, Burdese M, Gai M, Pacitti A, Jeantet A, Segoloni GP, Piccoli G. Source: Journal of Nephrology. 2003 May-June; 16(3): 365-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832735&dopt=Abstract

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Flumazenil and dialysis for gabapentin-induced coma. Author(s): Butler TC, Rosen RM, Wallace AL, Amsden GW. Source: The Annals of Pharmacotherapy. 2003 January; 37(1): 74-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12503937&dopt=Abstract

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FOSIDIAL: a randomised placebo controlled trial of the effects of fosinopril on cardiovascular morbidity and mortality in haemodialysis patients. Study design and patients' baseline characteristics. Author(s): Zannad F, Kessler M, Grunfeld JP, Thuilliez C; FOSInopril in DIALysis Investigators. Source: Fundamental & Clinical Pharmacology. 2002 October; 16(5): 353-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602460&dopt=Abstract

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Free thyroxine measured by equilibrium dialysis and nine immunoassays in sera with various serum thyroxine-binding capacities. Author(s): Sapin R, d'Herbomez M. Source: Clinical Chemistry. 2003 September; 49(9): 1531-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928239&dopt=Abstract

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Frequency of administration of recombinant human erythropoietin for anaemia of end-stage renal disease in dialysis patients. Author(s): Cody J, Daly C, Campbell M, Donaldson C, Grant A, Khan I, Vale L, Wallace S, MacLeod A. Source: Cochrane Database Syst Rev. 2002; (4): Cd003895. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519614&dopt=Abstract

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Functioning dialysis fistulae. Author(s): Funaki B. Source: J Invasive Cardiol. 2003 March; 15(3): 176. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653115&dopt=Abstract

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Fungal peritonitis complicating peritoneal dialysis during an 11-year period: report of 46 cases. Author(s): Bibashi E, Memmos D, Kokolina E, Tsakiris D, Sofianou D, Papadimitriou M. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 April 1; 36(7): 927-31. Epub 2003 March 18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12652395&dopt=Abstract

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General or disease specific questionnaire? A comparative study in hemodialysis patients. Author(s): Kutlay S, Nergizoglu G, Kutlay S, Keven K, Erturk S, Ates K, Duman N, Karatan O, Atli T. Source: Renal Failure. 2003 January; 25(1): 95-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12617337&dopt=Abstract

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Generation of TNFalpha and interleukin-6 by peritoneal macrophages after overnight dwells with bicarbonate- or lactate-buffered dialysis fluid. Author(s): Liberek T, Lichodziejewska-Niemierko M, Knopinska-Posluszny W, Schaub TP, Kirchgessner J, Passlick-Deetjen J, Rutkowski B. Source: Perit Dial Int. 2002 November-December; 22(6): 663-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556067&dopt=Abstract

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Genotypic and phenotypic properties of coagulase-negative staphylococci causing dialysis catheter-related sepsis. Author(s): Spare MK, Tebbs SE, Lang S, Lambert PA, Worthington T, Lipkin GW, Elliott TS. Source: The Journal of Hospital Infection. 2003 August; 54(4): 272-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12919757&dopt=Abstract

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Getting beyond cross-sectional studies of abnormal nutritional indexes in dialysis patients. Author(s): Mitch WE. Source: The American Journal of Clinical Nutrition. 2003 April; 77(4): 760-1. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663268&dopt=Abstract

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Glucose degradation products in peritoneal dialysis fluids: do they harm? Author(s): Witowski J, Jorres A, Korybalska K, Ksiazek K, Wisniewska-Elnur J, Bender TO, Passlick-Deetjen J, Breborowicz A. Source: Kidney International. Supplement. 2003 May; (84): S148-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694333&dopt=Abstract

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Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients. Author(s): Fukagawa M, Kitaoka M, Tominaga Y, Akizawa T, Kakuta T, Onoda N, Koiwa F, Yumita S, Kurokawa K; Japanese Society for Parathyroid Intervention. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18 Suppl 3: Iii31-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771296&dopt=Abstract

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Guidelines for training, certification, and accreditation for hemodialysis vascular access and endovascular procedures. American Society of Diagnostic and Interventional Nephrology. Author(s): American Society of Diagnostic and Interventional Nephrology. Source: Seminars in Dialysis. 2003 March-April; 16(2): 173-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641883&dopt=Abstract

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Haemodialysis and H.I.V. infection--therapeutic management. Author(s): Chamton N, Tellier E, Zins DB, Dubreuil-Lemaire, Zazemp V. Source: Edtna Erca J. 2001 January-March; 27(1): 34-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12603072&dopt=Abstract

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Haemodialysis in a rural area: a demanding form of treatment. Author(s): Brammah A, Young G, Allan A, Robertson S, Norrie J, Isles C. Source: Health Bull (Edinb). 2001 September; 59(5): 294-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664742&dopt=Abstract

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Headache associated with dialysis: the International Headache Society criteria revisited. Author(s): Antoniazzi AL, Bigal ME, Bordini CA, Speciali JG. Source: Cephalalgia : an International Journal of Headache. 2003 March; 23(2): 146-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12603372&dopt=Abstract

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Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Author(s): Lopes AA, Bragg-Gresham JL, Satayathum S, McCullough K, Pifer T, Goodkin DA, Mapes DL, Young EW, Wolfe RA, Held PJ, Port FK; Worldwide Dialysis Outcomes and Practice Patterns Study Committee. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3): 605-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612984&dopt=Abstract

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Hemodialysis arteriovenous fistula maturity: US evaluation. Author(s): Turmel-Rodrigues LA, Bourquelot P, Pengloan J. Source: Radiology. 2003 June; 227(3): 906-7; Author Reply 907. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773692&dopt=Abstract

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Hemodialysis patients' symptom experiences: effects on physical and mental functioning. Author(s): Curtin RB, Bultman DC, Thomas-Hawkins C, Walters BA, Schatell D. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2002 December; 29(6): 562, 567-74; Discussion 575, 598. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596605&dopt=Abstract

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Hemodialysis vascular access dysfunction: from clinical stenosis to specific cell types. Author(s): Roy-Chaudhury P, Munda R, Edwards J, Kelly BS. Source: Journal of Nephrology. 2003 March-April; 16(2): 277. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768077&dopt=Abstract

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Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies. Author(s): Roy-Chaudhury P, Kelly BS, Zhang J, Narayana A, Desai P, Melham M, Duncan H, Heffelfinger SC. Source: Blood Purification. 2003; 21(1): 99-110. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596755&dopt=Abstract

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Hemofiltration and peritoneal dialysis in infection-associated acute renal failure. Author(s): Bazari H. Source: The New England Journal of Medicine. 2003 February 27; 348(9): 858-60; Author Reply 858-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608400&dopt=Abstract

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Hemofiltration and peritoneal dialysis in infection-associated acute renal failure. Author(s): Fruchter O. Source: The New England Journal of Medicine. 2003 February 27; 348(9): 858-60; Author Reply 858-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608399&dopt=Abstract

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Hemofiltration and peritoneal dialysis in infection-associated acute renal failure. Author(s): Casserly LF. Source: The New England Journal of Medicine. 2003 February 27; 348(9): 858-60; Author Reply 858-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608398&dopt=Abstract

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Hemofiltration and peritoneal dialysis in infection-associated acute renal failure. Author(s): Rao PS, Modi KS. Source: The New England Journal of Medicine. 2003 February 27; 348(9): 858-60; Author Reply 858-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12606745&dopt=Abstract

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Hepatic encephalopathy and cerebral blood flow improved by liver dialysis treatment. Author(s): Huang KW, Chao A, Chou NK, Ko WJ. Source: Int J Artif Organs. 2003 February; 26(2): 149-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653349&dopt=Abstract

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Hepatitis B and C in the hemodialysis unit of Tocantins, Brazil: serological and molecular profiles. Author(s): Souza KP, Luz JA, Teles SA, Carneiro MA, Oliveira LA, Gomes AS, Dias MA, Gomes SA, Yoshida CF, Martins RM. Source: Memorias Do Instituto Oswaldo Cruz. 2003 July; 98(5): 599-603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677340&dopt=Abstract

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Hepatitis B vaccination: addressing a drug-related problem in hemodialysis outpatients with a collaborative initiative. Author(s): Elwell RJ, Neumann M, Manley HJ, Carpentier L, Bailie GR. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2003 June; 30(3): 310-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861899&dopt=Abstract

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Holiday dialysis. Author(s): Smith K. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 August 13-19; 17(48): 18-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14515534&dopt=Abstract

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Hyperhomocysteinemia and oxidative stress during dialysis treatment. Author(s): Chiarello PG, Vannucchi MT, Vannucchi H. Source: Renal Failure. 2003 March; 25(2): 203-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739827&dopt=Abstract

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Hyperkalemia most likely associated with massive cephalhematoma in a newborn infant who was treated with urgent peritoneal dialysis: case report. Author(s): Kirimi E, Tuncer O, Atas B, Arslan S. Source: The Journal of Emergency Medicine. 2003 April; 24(3): 277-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676297&dopt=Abstract

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Hypertension in chronic dialysis patients: pathophysiology, monitoring, and treatment. Author(s): Morse SA, Dang A, Thakur V, Zhang R, Reisin E. Source: The American Journal of the Medical Sciences. 2003 April; 325(4): 194-201. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695724&dopt=Abstract

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Hypothermia in a hemodialysis patient treated with olanzapine monotherapy. Author(s): Fukunishi I, Sato Y, Kino K, Shirai T, Kitaoka T. Source: Journal of Clinical Psychopharmacology. 2003 June; 23(3): 314. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826994&dopt=Abstract

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Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. Author(s): Allon M, Depner TA, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne DW, Gassman JJ, Kaufman AM, Kaysen GA, Lewis JA, Schwab SJ; HEMO Study Group. Source: Journal of the American Society of Nephrology : Jasn. 2003 July; 14(7): 1863-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819247&dopt=Abstract

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Impaired taste acuity in patients with diabetes mellitus on maintenance hemodialysis. Author(s): Matsuo S, Nakamoto M, Nishihara G, Yasunaga C, Yanagida T, Matsuo K, Sakemi T. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 94(2): C46-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845237&dopt=Abstract

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Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study. Author(s): Brunkhorst R, Lufft V, Dannenberg B, Kliem V, Tusch G, Pichlmayr R. Source: Transplantation. 2003 July 15; 76(1): 115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865796&dopt=Abstract

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In our haemodialysis unit when using the Critline haemoscan, there are problems using this device when administrating transfusions. Any ideas on how to solve this? Author(s): Lopot F. Source: Edtna Erca J. 2002 October-December; 28(4): 180. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638933&dopt=Abstract

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In vivo assessment of brain interstitial fluid with microdialysis reveals plaqueassociated changes in amyloid-beta metabolism and half-life. Author(s): Cirrito JR, May PC, O'Dell MA, Taylor JW, Parsadanian M, Cramer JW, Audia JE, Nissen JS, Bales KR, Paul SM, DeMattos RB, Holtzman DM. Source: The Journal of Neuroscience : the Official Journal of the Society for Neuroscience. 2003 October 1; 23(26): 8844-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523085&dopt=Abstract

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Incidence of gallstones in chronic renal failure patients undergoing hemodialysis: experience of a center in Turkey. Author(s): Altiparmak MR, Pamuk ON, Pamuk GE, Celik AF, Apaydin S, Cebi D, Mihmanli I, Erek E. Source: The American Journal of Gastroenterology. 2003 April; 98(4): 813-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738461&dopt=Abstract

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Infective tricuspid valve endocarditis with septic pulmonary emboli due to puncture of an endogenous arteriovenous fistula in a chronic hemodialysis patient. Author(s): Brueck M, Rauber K, Wizemann V, Kramer W. Source: The Journal of Infection. 2003 April; 46(3): 188-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643870&dopt=Abstract

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Inflammation, infection and cardiovascular events in chronic hemodialysis patients: a prospective study. Author(s): Bellomo G, Lippi G, Saronio P, Reboldi G, Verdura C, Timio F, Timio M. Source: Journal of Nephrology. 2003 March-April; 16(2): 245-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768072&dopt=Abstract

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Influence of fluid status on techniques used to assess body composition in peritoneal dialysis patients. Author(s): Konings CJ, Kooman JP, Schonck M, van Kreel B, Heidendal GA, Cheriex EC, van der Sande FM, Leunissen KM. Source: Perit Dial Int. 2003 March-April; 23(2): 184-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713087&dopt=Abstract

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Influence of peritoneal transport rate, inflammation, and fluid removal on nutritional status and clinical outcome in prevalent peritoneal dialysis patients. Author(s): Chung SH, Heimburger O, Stenvinkel P, Wang T, Lindholm B. Source: Perit Dial Int. 2003 March-April; 23(2): 174-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713086&dopt=Abstract

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Initial experience during balloon angioplasty assisted surgical thrombectomy for thrombosed hemodialysis grafts. Author(s): Ko PJ, Liu YH, Hsieh HC, Chu JJ, Lin PJ. Source: Chang Gung Med J. 2003 March; 26(3): 178-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12790221&dopt=Abstract

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Initiation of dialysis: is the problem solved by NECOSAD? Author(s): Korevaar JC, Dekker FW, Krediet RT. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18(6): 1228-9; Author Reply 1229-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748363&dopt=Abstract

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Interferon monotherapy for dialysis patients with chronic hepatitis C: an analysis of the literature on efficacy and safety. Author(s): Russo MW, Goldsweig CD, Jacobson IM, Brown RS Jr. Source: The American Journal of Gastroenterology. 2003 July; 98(7): 1610-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873587&dopt=Abstract

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Internal jugular vein thrombosis associated with hemodialysis catheters. Author(s): Wilkin TD, Kraus MA, Lane KA, Trerotola SO. Source: Radiology. 2003 September; 228(3): 697-700. Epub 2003 July 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881582&dopt=Abstract

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Interventional radiology in the conservation of vascular access for hemodialysis. Author(s): Turmel-Rodrigues L, Bourquelot P. Source: Artificial Organs. 2003 June; 27(6): 501-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12780504&dopt=Abstract

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Intratendinous glutamate levels and eccentric training in chronic Achilles tendinosis: a prospective study using microdialysis technique. Author(s): Alfredson H, Lorentzon R. Source: Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the Esska. 2003 May; 11(3): 196-9. Epub 2003 April 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712235&dopt=Abstract

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Intravenous heparin did not prevent exacerbations of hereditary angioedema in a patient on maintenance hemodialysis. Author(s): Perricone R, De Carolis C, Fontana L. Source: The Journal of Allergy and Clinical Immunology. 2003 May; 111(5): 1137; Reply 1137. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12743585&dopt=Abstract

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Intravital videomicroscopy in peritoneal dialysis research. Author(s): Lameire N, De Vriese A, Mortier S. Source: Nefrologia. 2003; 23 Suppl 3: 28-31. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901189&dopt=Abstract

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Involvement of TGF-beta signal for peritoneal sclerosing in continuous ambulatory peritoneal dialysis. Author(s): Naiki Y, Maeda Y, Matsuo K, Yonekawa S, Sakaguchi M, Iwamoto I, Hasegawa H, Kanamaru A. Source: Journal of Nephrology. 2003 January-February; 16(1): 95-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649540&dopt=Abstract

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Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients? Author(s): Wang AY, Woo J, Lam CW, Wang M, Sea MM, Lui SF, Li PK, Sanderson J. Source: Journal of the American Society of Nephrology : Jasn. 2003 July; 14(7): 1871-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819248&dopt=Abstract

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Lack of improvement in cerebral metabolism after hyperoxia in severe head injury: a microdialysis study. Author(s): Magnoni S, Ghisoni L, Locatelli M, Caimi M, Colombo A, Valeriani V, Stocchetti N. Source: Journal of Neurosurgery. 2003 May; 98(5): 952-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744353&dopt=Abstract

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Lactobacillus paracasei continuous ambulatory peritoneal dialysis-related peritonitis and review of the literature. Author(s): Neef PA, Polenakovik H, Clarridge JE, Saklayen M, Bogard L, Bernstein JM. Source: Journal of Clinical Microbiology. 2003 June; 41(6): 2783-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791931&dopt=Abstract

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Laparoscopic implantation of swan neck presternal peritoneal dialysis catheters. Author(s): Crabtree JH, Fishman A. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 April; 13(2): 131-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737731&dopt=Abstract

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Laparoscopic radical nephrectomy for suspected renal cell carcinoma in dialysisdependent patients. Author(s): Gulati M, Meng MV, Freise CE, Stoller ML. Source: Urology. 2003 September; 62(3): 430-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946741&dopt=Abstract

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Laparoscopic salpingectomy: the definitive treatment for peritoneal dialysis catheter outflow obstruction caused by oviductal fimbriae. Author(s): Klein Z, Magen E, Fishman A, Korzets Z. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 February; 13(1): 65-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676026&dopt=Abstract

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L-carnitine consecutively administered to patients on hemodialysis improves betacell response. Author(s): Vazelov E, Borissova AM, Kirilov G, Assenova B, Tchetirska M, Krivoshiev S. Source: Int J Artif Organs. 2003 April; 26(4): 304-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757029&dopt=Abstract

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L-carnitine use in dialysis patients: is national coverage for supplementation justified? What were CMS regulators thinking--or were they? Author(s): Steinman TI, Nissenson AR, Glassock RJ, Dickmeyer J, Mattern WD, Parker TF 3rd, Hull AR. Source: Nephrol News Issues. 2003 April; 17(5): 28-30, 32-4, 36 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715624&dopt=Abstract

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Lean mass estimation by creatinine kinetics and dual-energy x-ray absorptiometry in peritoneal dialysis. Author(s): Negri AL, Barone R, Veron D, Fraga A, Arrizurieta E, Zucchini A, Zanchetta JR. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 95(1): C9-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520016&dopt=Abstract

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Leptin and proinflammatory cytokines in patients undergoing peritoneal dialysis. Author(s): Hilkens MG, Netea MG, Van der Meer JW, Koolen MI. Source: European Journal of Clinical Investigation. 2003 June; 33(6): 525-6; Author Reply 527-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795651&dopt=Abstract

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Levofloxacin elimination during albumin dialysis. Author(s): Bellmann R, Egger P, Pechlaner C, Feistritzer C, Vogel W, Joannidis M, Wiedermann CJ. Source: Int J Artif Organs. 2003 April; 26(4): 358-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757036&dopt=Abstract

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Lipids, blood pressure and bone metabolism after growth hormone therapy in elderly hemodialysis patients. Author(s): Viidas U, Johannsson G, Mattson-Hulten L, Ahlmen J. Source: Journal of Nephrology. 2003 March-April; 16(2): 231-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768070&dopt=Abstract

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Listeria monocytogenes peritonitis complicated by septic shock in a patient on continuous ambulatory peritoneal dialysis. Author(s): Tse KC, Li FK, Chan TM, Lai KN. Source: Clinical Nephrology. 2003 July; 60(1): 61-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872862&dopt=Abstract

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Long QT syndrome: first and fatal events provoked by hemodialysis. Author(s): Miller RF, Haley MW, Littmann L. Source: Pacing and Clinical Electrophysiology : Pace. 2003 January; 26(1 Pt 1): 103-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685147&dopt=Abstract

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Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients. Author(s): Johansen KL, Kaysen GA, Young BS, Hung AM, da Silva M, Chertow GM. Source: The American Journal of Clinical Nutrition. 2003 April; 77(4): 842-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663281&dopt=Abstract

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Long-term (3 years) prognosis of parathyroid function in chronic dialysis patients after percutaneous ethanol injection therapy guided by colour Doppler ultrasonography. Author(s): Tanaka R, Kakuta T, Fujisaki T, Tanaka S, Sakai H, Kurokawa K, Saito A. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18 Suppl 3: Iii58-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771303&dopt=Abstract

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Long-term catheters for apheresis and dialysis with surface treatment with infection resistance and low thrombogenicity. Author(s): Bambauer R, Mestres P, Schiel R, Bambauer S, Sioshansi P, Latza R. Source: Therap Apher Dial. 2003 April; 7(2): 225-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918948&dopt=Abstract

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Long-term catheters for dialysis and apheresis: a double-edged weapon. Author(s): Canaud B. Source: Therap Apher Dial. 2003 April; 7(2): 147-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918934&dopt=Abstract

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Long-term evaluation of nutritional status using dual-energy X-ray absorptiometry in chronic hemodialysis patients. Author(s): Takahashi N, Yuasa S, Fukunaga M, Hara T, Moriwaki K, Shokoji T, Hitomi H, Fujioka H, Kiyomoto H, Aki Y, Hirohata M, Mizushige K, Kohno M. Source: Clinical Nephrology. 2003 May; 59(5): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779100&dopt=Abstract

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Long-term prognosis of parathyroid function for chronic dialysis patients after minimally invasive radioguided parathyroidectomy (MIRP). Author(s): Kakuta T, Suzuki Y, Tadaki F, Tanaka R, Tanaka S, Sakai H, Kurokawa K, Saito A. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18 Suppl 3: Iii71-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771306&dopt=Abstract

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Long-term therapy with paricalcitol for secondary hyperparathyroidism in hemodialysis patients. Author(s): Barton Pai A, Lin S, Arruda JA, Lau AH. Source: Int J Artif Organs. 2003 June; 26(6): 484-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866654&dopt=Abstract

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Malnutrition, chronic inflammation and atherosclerosis in dialysis patients. Author(s): Phanish MK, Marcora SM, Lemmey AB. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 February; 18(2): 446. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543910&dopt=Abstract

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Management of peritonitis in children receiving chronic peritoneal dialysis. Author(s): Schaefer F. Source: Paediatric Drugs. 2003; 5(5): 315-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716218&dopt=Abstract

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Massive coronary artery calcification in a young adult with end-stage renal disease undergoing hemodialysis. Author(s): Rubboli A, La Vecchia L, Fontanelli A. Source: Ital Heart J. 2003 February; 4(2): 142-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762280&dopt=Abstract

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Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients. Author(s): Kovacic V, Roguljic L, Kovacic V, Bacic B, Bosnjak T. Source: Journal of Human Hypertension. 2003 May; 17(5): 353-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756409&dopt=Abstract

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Mechanical thrombectomy devices to treat thrombosed hemodialysis grafts. Author(s): Vesely TM. Source: Techniques in Vascular and Interventional Radiology. 2003 March; 6(1): 35-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772127&dopt=Abstract

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Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. Author(s): Loghman-Adham M. Source: Am J Manag Care. 2003 February; 9(2): 155-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597603&dopt=Abstract

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Metabolism and clinical interest of serum transthyretin (prealbumin) in dialysis patients. Author(s): Cano NJ. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2002 December; 40(12): 1313-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553436&dopt=Abstract

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Metallic stenting for treatment of central venous obstruction in hemodialysis patients. Author(s): Chen CY, Liang HL, Pan HB, Chung HM, Chen WL, Fang HC, Lo A, Chen CK, Lai PH, Yang CF. Source: J Chin Med Assoc. 2003 March; 66(3): 166-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779037&dopt=Abstract

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Microbial contamination of dialysate and its prevention in haemodialysis units. Author(s): Oie S, Kamiya A, Yoneda I, Uchiyama K, Tsuchida M, Takai K, Naito K. Source: The Journal of Hospital Infection. 2003 June; 54(2): 115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818584&dopt=Abstract

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Microdialysis: a new technique to monitor perioperative human peritoneal mediator production. Author(s): Riese J, Boecker S, Hohenberger W, Klein P, Haupt W. Source: Surgical Infections. 2003 Spring; 4(1): 11-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744762&dopt=Abstract

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Midodrine improves chronic hypotension in hemodialysis patients. Author(s): Lin YF, Wang JY, Denq JC, Lin SH. Source: The American Journal of the Medical Sciences. 2003 May; 325(5): 256-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792244&dopt=Abstract

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Modified range of alanine aminotransferase is insufficient for screening of hepatitis C virus infection in hemodialysis patients. Author(s): Milotic I, Pavic I, Maleta I, Troselj-Vukic B, Milotic F. Source: Scandinavian Journal of Urology and Nephrology. 2002; 36(6): 447-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623510&dopt=Abstract

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Molecular investigation of GB virus C RNA in hemodialysis and thalassemics patients from Brazil. Author(s): Watanabe MA, Milanezi CM, Silva WA Jr, de Lucena Angulo I, Santis G, Kashima S, da Costa JA, Neto MM, Covas DT. Source: Renal Failure. 2003 January; 25(1): 67-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12617334&dopt=Abstract

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Molecular mechanisms involved in the peritoneal membrane exposed to peritoneal dialysis. Author(s): Devuyst O. Source: Nefrologia. 2003; 23 Suppl 3: 32-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901190&dopt=Abstract

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Molecular mechanisms modifying the peritoneal membrane exposed to peritoneal dialysis. Author(s): Gillerot G, Devuyst O. Source: Clinical Nephrology. 2003 July; 60(1): 1-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872851&dopt=Abstract

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Morbus Teutschlander - a massive soft-tissue calcification of the foot in a patient on long-term hemodialysis. Author(s): Baums MH, Klinger HM, Otte S. Source: Archives of Orthopaedic and Trauma Surgery. 2003 February; 123(1): 51-3. Epub 2002 November 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12582798&dopt=Abstract

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Morpho-functional study of peritoneum in peritoneal dialysis patients. Author(s): Bertoli SV, Buzzi L, Ciurlino D, Maccario M, Martino S. Source: Journal of Nephrology. 2003 May-June; 16(3): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832736&dopt=Abstract

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Multicenter clinical trial of 22-oxa-1,25-dihydroxyvitamin D3 for chronic dialysis patients. Author(s): Yasuda M, Akiba T, Nihei H. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S108-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612965&dopt=Abstract

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Multidimensional construct of health-related quality of life for Chinese dialysis patients. Author(s): Luk WS. Source: Outcomes Management. 2003 January-March; 7(1): 39-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593125&dopt=Abstract

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Multidisciplinary contributions to rehabilitation: a National Kidney Foundation survey of the dialysis health care team. Author(s): King K. Source: Adv Ren Replace Ther. 2003 January; 10(1): 78-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616466&dopt=Abstract

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N-acetylcysteine reduces malondialdehyde levels in chronic hemodialysis patients--a pilot study. Author(s): Trimarchi H, Mongitore MR, Baglioni P, Forrester M, Freixas EA, Schropp M, Pereyra H, Alonso M. Source: Clinical Nephrology. 2003 June; 59(6): 441-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834176&dopt=Abstract

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Neuropeptide-Y and atrial natriuretic peptide as prognostic markers in patients on hemodialysis. Author(s): Odar-Cederlof I, Ericsson F, Theodorsson E, Kjellstrand CM. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 2003 January-February; 49(1): 74-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12558311&dopt=Abstract

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Neurotoxicity induced by Cefepime in a very old hemodialysis patient. Author(s): Ferrara N, Abete P, Giordano M, Ferrara P, Carnovale V, Leosco D, Beneduce F, Ciarambino T, Varricchio M, Rengo F. Source: Clinical Nephrology. 2003 May; 59(5): 388-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779103&dopt=Abstract

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New concepts in peritoneal dialysis: new wine in old barrels? Author(s): Van Biesen W, Veys N, Vanholder R, Lameire N. Source: Artificial Organs. 2003 May; 27(5): 398-405. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752197&dopt=Abstract

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New insights in dialysis membrane biocompatibility: relevance of adsorption properties and heparin binding. Author(s): Chanard J, Lavaud S, Randoux C, Rieu P. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 February; 18(2): 252-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543877&dopt=Abstract

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No acute impact of haemodialysis treatment on free radical scavenging enzyme gene expression in white blood cells. Author(s): Schettler V, Kuhn W, Kleinoeder T, Armstrong VW, Oellerich M, Muller GA, Wieland E. Source: Journal of Internal Medicine. 2003 February; 253(2): 201-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12542561&dopt=Abstract

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No need to measure serum aluminum in patients starting chronic ambulatory peritoneal dialysis. Author(s): Musso CG, Bailey S, Shu M, Liakopoulos VC, Savaj S, Ghareeb S, Sahu K, Oreopoulos DG. Source: Perit Dial Int. 2002 November-December; 22(6): 738. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556085&dopt=Abstract

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Noctural dialysis. A freedom worth fighting for. Author(s): Weintraub J. Source: Nephrol News Issues. 2003 February; 17(3): 26-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655994&dopt=Abstract

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Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients. Author(s): Liu M, Takahashi H, Morita Y, Maruyama S, Mizuno M, Yuzawa Y, Watanabe M, Toriyama T, Kawahara H, Matsuo S. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 March; 18(3): 563-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584280&dopt=Abstract

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Non-high-density lipoprotein cholesterol: a target of lipid-lowering in dialysis patients. Author(s): Wanner C, Krane V. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S72-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612957&dopt=Abstract

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Normalized protein nitrogen appearance is correlated with hospitalization and mortality in hemodialysis patients with Kt/V greater than 1.20. Author(s): Kalantar-Zadeh K, Supasyndh O, Lehn RS, McAllister CJ, Kopple JD. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 January; 13(1): 15-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12563619&dopt=Abstract

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Not-for-profit dialysis center care carries lower mortality risk, study says. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 December 13; 13(24): 7-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747367&dopt=Abstract

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Novel microlaparoscopic technique for peritoneal dialysis catheter placement. Author(s): Yun EJ, Meng MV, Brennan TV, McAninch JW, Santucci RA, Rogers SJ. Source: Urology. 2003 May; 61(5): 1026-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12736031&dopt=Abstract

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Nutrition in daily hemodialysis. Author(s): Schulman G. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S112-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612966&dopt=Abstract

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Nutritional effect of dialysis therapy. Author(s): Sanaka T. Source: Artificial Organs. 2003 March; 27(3): 224-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662206&dopt=Abstract

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Nutritional effects of carnitine supplementation in hemodialysis patients. Author(s): Chazot C, Blanc C, Hurot JM, Charra B, Jean G, Laurent G. Source: Clinical Nephrology. 2003 January; 59(1): 24-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12572927&dopt=Abstract

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Nutritional intervention in a hemodialysis pregnant woman: a case report. Author(s): Guida B, Pollio F, Nastasi A, Trio R, Laccetti R, Di Lieto A, Citarella F, Memoli B. Source: Clinical Nutrition (Edinburgh, Lothian). 2003 April; 22(2): 205-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706139&dopt=Abstract

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Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status. Author(s): Nakao T, Matsumoto H, Okada T, Kanazawa Y, Yoshino M, Nagaoka Y, Takeguchi F. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S133-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612970&dopt=Abstract

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Occurrence and antimicrobial resistance of Gram-negative bacteria isolated in haemodialysis water and dialysate of renal units: results of a Greek multicentre study. Author(s): Arvanitidou M, Vayona A, Spanakis N, Tsakris A. Source: Journal of Applied Microbiology. 2003; 95(1): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807469&dopt=Abstract

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Off-pump coronary artery bypass grafting in patients with end-stage renal disease on hemodialysis. Author(s): Tashiro T, Nakamura K, Morishige N, Iwakuma A, Tachikawa Y, Shibano R, Iwahashi H, Zaitsu R, Hayashida Y, Koga S, Takeuchi K, Kimura M. Source: Journal of Cardiac Surgery. 2002 September-October; 17(5): 377-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630533&dopt=Abstract

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One-year growth hormone therapy improves granulocyte function without major effects on nutritional and anthropometric parameters in malnourished hemodialysis patients. Author(s): Kotzmann H, Schmidt A, Lercher P, Schuster E, Geyer G, Frisch H, Horl WH, Mayer G, Luger A. Source: Nephron. Clinical Practice [electronic Resource]. 2003; 93(2): C75-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616034&dopt=Abstract

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On-line haemodiafiltration decreases serum TNFalpha levels in haemodialysis patients. Author(s): Gil C, Lucas C, Possante C, Jorge C, Gomes F, Candeias M, Lages H, Arranhado E, Ferreira A. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 February; 18(2): 447-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543911&dopt=Abstract

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Operative management of distal ischemia complicating upper extremity dialysis access. Author(s): Diehl L, Johansen K, Watson J. Source: American Journal of Surgery. 2003 July; 186(1): 17-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842741&dopt=Abstract

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Original report. Pulse-spray thrombolysis of thrombosed hemodialysis grafts with tissue plasminogen activator. Author(s): Cooper SG. Source: Ajr. American Journal of Roentgenology. 2003 April; 180(4): 1063-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646455&dopt=Abstract

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Outcome of preemptive renal transplantation versus waiting time on dialysis. Author(s): Nishikawa K, Terasaki PI. Source: Clin Transpl. 2002; : 367-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12971463&dopt=Abstract

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Outcome of surgery for vascular access in patients commencing haemodialysis. Author(s): Fisher CM, Neale ML. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 April; 25(4): 342-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12651173&dopt=Abstract

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Outcomes research in dialysis. Author(s): Dhingra H, Laski ME. Source: Semin Nephrol. 2003 May; 23(3): 295-305. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838498&dopt=Abstract

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Oxidant stress in hemodialysis patients: what are the determining factors? Author(s): Ward RA, McLeish KR. Source: Artificial Organs. 2003 March; 27(3): 230-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662208&dopt=Abstract

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Paricalcitol as compared with calcitriol in patients undergoing hemodialysis. Author(s): Drueke TB, McCarron DA. Source: The New England Journal of Medicine. 2003 July 31; 349(5): 496-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890849&dopt=Abstract

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Pathogenicity of GB virus C on virus hepatitis and hemodialysis patients. Author(s): Zhu WF, Yin LM, Li P, Huang J, Zhuang H. Source: World Journal of Gastroenterology : Wjg. 2003 August; 9(8): 1739-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918111&dopt=Abstract

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Periodontal status of chronic renal failure patients receiving hemodialysis. Author(s): Marakoglu I, Gursoy UK, Demirer S, Sezer H. Source: Yonsei Medical Journal. 2003 August 30; 44(4): 648-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12950121&dopt=Abstract

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Peritoneal dialysis in children with acute renal failure after open heart surgery. Author(s): Lin MC, Fu YC, Fu LS, Jan SL, Chi CS. Source: Acta Paediatr Taiwan. 2003 March-April; 44(2): 89-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845849&dopt=Abstract

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Peritonitis due to the dermatiaceous mold Exophiala dermatitidis complicating continuous ambulatory peritoneal dialysis. Author(s): Greig J, Harkness M, Taylor P, Hashmi C, Liang S, Kwan J. Source: Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2003 July; 9(7): 713-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925114&dopt=Abstract

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Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: a microdialysis study. Author(s): Vespa PM, McArthur D, O'Phelan K, Glenn T, Etchepare M, Kelly D, Bergsneider M, Martin NA, Hovda DA. Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2003 July; 23(7): 865-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12843790&dopt=Abstract

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Pharmacokinetics of all-trans retinoic acid in acute promyelocytic leukemia patients on dialysis. Author(s): Takitani K, Nagai K, Kanbe E, Inoue A, Kawakami C, Kuno T, Tamai H. Source: American Journal of Hematology. 2003 October; 74(2): 147-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508808&dopt=Abstract

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Prediction of malignant course in MCA infarction by PET and microdialysis. Author(s): Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J, Neveling M, Brinker G, Heiss WD. Source: Stroke; a Journal of Cerebral Circulation. 2003 September; 34(9): 2152-8. Epub 2003 July 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881606&dopt=Abstract

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Prevalence of hepatitis C virus infection among haemodialysis patients in West Java, Indonesia. Author(s): Saketi JR, Boland GJ, van Loon AM, van Hattum J, Abdurachman SA, Sukandar E. Source: Advances in Experimental Medicine and Biology. 2003; 531: 201-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12916792&dopt=Abstract

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Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Author(s): Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Source: The American Journal of Medicine. 2003 September; 115(4): 291-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967694&dopt=Abstract

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Quality of care in profit vs not-for-profit dialysis centers. Author(s): Kalantar-Zadeh K, Mehrotra R, Kopple JD. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3089; Author Reply 3089-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813114&dopt=Abstract

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Quality of care in profit vs not-for-profit dialysis centers. Author(s): Lyons JS. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3088; Author Reply 3089-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813113&dopt=Abstract

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Quality of care in profit vs not-for-profit dialysis centers. Author(s): Blake PG, Mendelssohn DC. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3088-9; Author Reply 3089-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813112&dopt=Abstract

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Quality of care in profit vs not-for-profit dialysis centers. Author(s): Bosch J, Hakim RM, Lazarus JM, McAllister CJ. Source: Jama : the Journal of the American Medical Association. 2003 June 18; 289(23): 3087-8; Author Reply 3089-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813111&dopt=Abstract

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Quality of sleep and health-related quality of life in haemodialysis patients. Author(s): Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM, Singer MA, Hopman WM. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 January; 18(1): 126-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12480970&dopt=Abstract

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Quinine pharmacokinetics in chronic haemodialysis patients. Author(s): Roy L, Bannon P, Villeneuve JP; Martine Leblanc. Source: British Journal of Clinical Pharmacology. 2002 December; 54(6): 604-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492607&dopt=Abstract

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Radial artery remodeling in response to shear stress increase within arteriovenous fistula for hemodialysis access. Author(s): Ene-Iordache B, Mosconi L, Antiga L, Bruno S, Anghileri A, Remuzzi G, Remuzzi A. Source: Endothelium : Journal of Endothelial Cell Research. 2003; 10(2): 95-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791517&dopt=Abstract

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Radial bone mineral density in hemodialysis patients with adynamic bone disease. Author(s): Nakashima A, Yorioka N, Doi S, Ueda C, Usui K, Shigemoto K, Harada S. Source: Int J Artif Organs. 2003 March; 26(3): 200-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703885&dopt=Abstract

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Rapid diagnosis of peritonitis in peritoneal dialysis patients. Author(s): Cropper E, Coleclough S, Griffiths S, Saunders S, Williams J, Rutherford PA. Source: Journal of Nephrology. 2003 May-June; 16(3): 379-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832737&dopt=Abstract

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Recovery of renal function and the discontinuation of dialysis in patients treated with continuous peritoneal dialysis. Author(s): Goldstein A, Kliger AS, Finkelstein FO. Source: Perit Dial Int. 2003 March-April; 23(2): 151-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713082&dopt=Abstract

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Redo off-pump coronary artery bypass grafting for high risk hemodialysis patients. Author(s): Osaka S, Ohsawa H, Nabuchi A. Source: Journal of Cardiac Surgery. 2002 September-October; 17(5): 383-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630534&dopt=Abstract

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Relative importance and interrelations between psychosocial factors and individualized quality of life of hemodialysis patients. Author(s): Tovbin D, Gidron Y, Jean T, Granovsky R, Schnieder A. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2003 September; 12(6): 709-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516180&dopt=Abstract

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Renal transplantation for the hemodialysis patient with axillofemoral bypass. Author(s): Nakatani T, Uchida J, Iwai T, Kuratsukuri K, Matsumura K, Takahara Y, Naganuma T, Sugimura K. Source: Transplantation. 2003 April 15; 75(7): 1048-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698097&dopt=Abstract

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Retinal light sensitivity in haemodialysis patients. Author(s): Pahor D. Source: Eye (London, England). 2003 March; 17(2): 177-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640403&dopt=Abstract

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Risks of using internal thoracic artery grafts in patients in chronic hemodialysis via upper extremity arteriovenous fistula. Author(s): Gaudino M, Serricchio M, Luciani N, Giungi S, Salica A, Pola R, Pola P, Luciani G, Possati G. Source: Circulation. 2003 June 3; 107(21): 2653-5. Epub 2003 May 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756161&dopt=Abstract

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Running water: measuring water quality in a dialysis facility. Part 2. Author(s): Levin R, Hoenich NA. Source: Nephrol News Issues. 2003 June; 17(7): 25-6, 78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847959&dopt=Abstract

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Salt restriction and not length of dialysis is the key to drug free blood pressure control in ESRD patients. Author(s): Shaldon S. Source: Journal of Nephrology. 2003 January-February; 16(1): 159. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649549&dopt=Abstract

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Salvaging prosthetic dialysis fistulas with stents: forearm versus upper arm grafts. Author(s): Kolakowski S Jr, Dougherty MJ, Calligaro KD. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 October; 38(4): 719-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14560220&dopt=Abstract

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Screening for depression in chronic hemodialysis patients. Author(s): al-Hihi E, Awad A, Hagedorn A. Source: Mo Med. 2003 May-June; 100(3): 266-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847869&dopt=Abstract

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Selective interaction of ethidium derivatives with quadruplexes: an equilibrium dialysis and electrospray ionization mass spectrometry analysis. Author(s): Rosu F, De Pauw E, Guittat L, Alberti P, Lacroix L, Mailliet P, Riou JF, Mergny JL. Source: Biochemistry. 2003 September 9; 42(35): 10361-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12950163&dopt=Abstract

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Serum soluble Fas levels and coronary artery disease in hemodialysis patients. Author(s): Sato M, Kogure T, Yanagisawa N, Haizuka H, Nakashima Y. Source: Clinical Nephrology. 2003 June; 59(6): 480. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834183&dopt=Abstract

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Simvastatin and markers of endothelial function in patients undergoing continuous ambulatory peritoneal dialysis. Author(s): Malyszko J, Malyszko JS, Hryszko T, Brzosko S, Mysliwiec M. Source: Int J Tissue React. 2002; 24(3): 111-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635864&dopt=Abstract

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Spurious hyperglycaemia and icodextrin in peritoneal dialysis fluid. Author(s): Riley SG, Chess J, Donovan KL, Williams JD. Source: Bmj (Clinical Research Ed.). 2003 September 13; 327(7415): 608-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969932&dopt=Abstract

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Subcutaneous nodules on the buttocks as a manifestation of dialysis-related amyloidosis: a clinicopathological entity? Author(s): Shimizu S, Yasui C, Yasukawa K, Nakamura H, Shimizu H, Tsuchiya K. Source: The British Journal of Dermatology. 2003 August; 149(2): 400-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932251&dopt=Abstract

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Surgical outcome of abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis. Author(s): Umeda Y, Mori Y, Takagi H, Iwata H, Matsuno Y, Hirose H. Source: Heart and Vessels. 2003 March; 18(1): 7-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12644875&dopt=Abstract

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Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. Author(s): Teng M, Wolf M, Lowrie E, Ofsthun N, Lazarus JM, Thadhani R. Source: The New England Journal of Medicine. 2003 July 31; 349(5): 446-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890843&dopt=Abstract

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Technical innovation. Using a covered stent (wallgraft) to treat pseudoaneurysms of dialysis grafts and fistulas. Author(s): Ryan JM, Dumbleton SA, Doherty J, Smith TP. Source: Ajr. American Journal of Roentgenology. 2003 April; 180(4): 1067-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646456&dopt=Abstract

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Technical innovation. Using a cutting balloon to treat resistant high-grade dialysis graft stenosis. Author(s): Ryan JM, Dumbleton SA, Smith TP. Source: Ajr. American Journal of Roentgenology. 2003 April; 180(4): 1072-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646457&dopt=Abstract

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Thalidomide treatment for immunoglobulin D multiple myeloma in a patient on chronic hemodialysis. Author(s): Hayashi T, Yamaguchi I, Saitoh H, Takagi M, Nonaka Y, Nomura T. Source: Intern Med. 2003 July; 42(7): 605-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879955&dopt=Abstract

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The effect of hemodialysis on visual field test in patients with chronic renal failure. Author(s): Pelit A, Zumrutdal A, Akova Y. Source: Current Eye Research. 2003 May; 26(5): 303-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854059&dopt=Abstract

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The experience of living on dialysis: a literature review. Author(s): Polaschek N. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2003 June; 30(3): 303-9, 313. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861898&dopt=Abstract

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The impact of nocturnal hemodialysis on sleep apnea in ESRD patients. Author(s): Hanly P, Chan C, Pierratos A. Source: Nephrol News Issues. 2003 June; 17(7): 19-21. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847958&dopt=Abstract

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The LifeSite Hemodialysis Access System in patients with limited access. Author(s): Rayan SS, Terramani TT, Weiss VJ, Chaikof EL. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 October; 38(4): 714-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14560219&dopt=Abstract

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Topical capsaicin therapy in humans with hemodialysis-related pruritus. Author(s): Weisshaar E, Dunker N, Gollnick H. Source: Neuroscience Letters. 2003 July 24; 345(3): 192-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842288&dopt=Abstract

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Total hip arthroplasty in chronic dialysis patients in the United States. Author(s): Abbott KC, Bucci JR, Agodoa LY. Source: Journal of Nephrology. 2003 January-February; 16(1): 34-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649533&dopt=Abstract

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Treatment of “swing point stenoses” in hemodialysis arteriovenous fistulae. Author(s): Falk A, Teodorescu V, Lou WY, Uribarri J, Vassalotti JA. Source: Clinical Nephrology. 2003 July; 60(1): 35-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872856&dopt=Abstract

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Underestimated drawbacks of combined simple dilation and thrombolytics for restoration of thrombosed brescia-cimino dialysis fistulas. Author(s): Turmel-Rodrigues LA. Source: Radiology. 2003 March; 226(3): 925; Author Reply 926-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616027&dopt=Abstract

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Unexpected distribution of hepatitis C virus genotypes in patients on hemodialysis and kidney transplant recipients. Author(s): Perez RM, Ferraz ML, Figueiredo MS, Contado D, Koide S, Ferreira AP, Cendoroglo Neto M, Medina Pestana JO, Silva AE. Source: Journal of Medical Virology. 2003 April; 69(4): 489-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601756&dopt=Abstract

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Unmasking a hot dialysis issue. Author(s): Nicholas M. Source: Nursing. 2003 June; 33(6): 12; Author Reply 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803226&dopt=Abstract

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Upper limb vein anatomy before hemodialysis fistula creation: cross-sectional anatomy using MR venography. Author(s): Laissy JP, Fernandez P, Karila-Cohen P, Delmas V, Dupuy E, Chillon S, Mignon F, Schouman-Claeys E. Source: European Radiology. 2003 February; 13(2): 256-61. Epub 2002 June 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598988&dopt=Abstract

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Utilization of lacrimal urea assay in the monitoring of hemodialysis: conditions, limitations and lacrimal arginase characterization. Author(s): Farkas A, Vamos R, Bajor T, Mullner N, Lazar A, Hraba A. Source: Experimental Eye Research. 2003 February; 76(2): 183-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12565806&dopt=Abstract

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Vaccination against hepatitis B in patients on chronic haemodialysis. Author(s): Kovacic V. Source: Int J Clin Pract. 2003 April; 57(3): 161-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723714&dopt=Abstract

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Vascular access and patient outcomes in hemodialysis: questions answered in recent literature. Author(s): Anel RL, Yevzlin AS, Ivanovich P. Source: Artificial Organs. 2003 March; 27(3): 237-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662209&dopt=Abstract

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Vascular access for dialysis in the elderly. Author(s): Ridao-Cano N, Polo JR, Polo J, Perez-Garcia R, Sanchez M, Gomez-Campdera FJ. Source: Blood Purification. 2002; 20(6): 563-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566673&dopt=Abstract

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Vascular access use and outcomes in the U.S., Europe, and Japan: results from the Dialysis Outcomes and Practice Patterns Study. Author(s): Pisoni RL, Young EW, Mapes DL, Keen ML, Port FK. Source: Nephrol News Issues. 2003 May; 17(6): 38-43, 47. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778616&dopt=Abstract

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Vascular brachytherapy for hemodialysis vascular access dysfunction: exploring an unmet clinical need. Author(s): Roy-Chaudhury P, Duncan H, Barrett W, Elson H, Narayana A, Foley J, Misra S, Lynch PM, Zuckerman D. Source: J Invasive Cardiol. 2003 January; 15 Suppl A: 25A-30A. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668839&dopt=Abstract

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Vascular calcification in dialysis patients: pathogenesis and consequences. Author(s): Reslerova M, Moe SM. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S96-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612962&dopt=Abstract

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Venous hypertension following average arterious-venous fistula for haemodialysis. Author(s): Kojecky Z, Utikal P, Sekanina Z, Kocher M, Buriankova E. Source: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2002 December; 146(2): 77-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12572902&dopt=Abstract

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Vibrio vulnificus infection in a hemodialysis patient receiving intravenous iron therapy. Author(s): Barton JC, Coghlan ME, Reymann MT, Ozbirn TW, Acton RT. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 September 1; 37(5): E63-7. Epub 2003 August 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12942420&dopt=Abstract

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Viraemia, cryoglobulins and autoantibodies in haemodialysis patients infected with hepatitis C virus. Author(s): Siagris D, Labropoulou-Karatza C, Christofidou M, Goumenos D, Thomopoulos K, Lekkou A, Gogos CA, Vlachojannis J. Source: European Journal of Gastroenterology & Hepatology. 2003 February; 15(2): 1337. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12560756&dopt=Abstract

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Volume control, blood pressure and cardiovascular function. Lessons from hemodialysis treatment. Author(s): Charra B, Chazot C. Source: Nephron. Physiology [electronic Resource]. 2003; 93(4): P94-101. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759570&dopt=Abstract

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Waiting time or wasted time? The case for using time on dialysis to determine waiting time in the allocation of cadaveric kidneys. Author(s): Danovitch GM, Cohen B, Smits JM. Source: American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2002 November; 2(10): 891-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12482138&dopt=Abstract

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Weight loss, fever and a swollen elbow joint in a hemodialysis patient--a case of tuberculous arthritis. Author(s): Singh A, Webb AT. Source: Clinical Nephrology. 2003 May; 59(5): 391-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779104&dopt=Abstract

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What is the role of access monitoring in the dialysis clinic? Author(s): Sands JJ, Tatarek M, Updyke D. Source: Nephrol News Issues. 2003 July; 17(8): 69, 72-6, 81 Passim. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882115&dopt=Abstract

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When your patient needs peritoneal dialysis. Brush up on this necessary but infrequently used skill that you may need if your patient has chronic renal failure. Author(s): Zabat E. Source: Nursing. 2003 August; 33(8): 52-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900672&dopt=Abstract

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White blood cells as a novel mortality predictor in haemodialysis patients. Author(s): Reddan DN, Klassen PS, Szczech LA, Coladonato JA, O'Shea S, Owen WF Jr, Lowrie EG. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18(6): 1167-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748351&dopt=Abstract

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Why do we need a statin trial in hemodialysis patients? Author(s): Fellstrom BC, Holdaas H, Jardine AG. Source: Kidney International. Supplement. 2003 May; (84): S204-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694345&dopt=Abstract

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Why patients with ESRD do not select self-care dialysis as a treatment option. Author(s): McLaughlin K, Manns B, Mortis G, Hons R, Taub K. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 February; 41(2): 380-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552500&dopt=Abstract

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Withholding and withdrawing therapy: humanity, human rights and access to renal dialysis. Author(s): Roake J. Source: N Z Med J. 2003 June 6; 116(1175): U454. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838350&dopt=Abstract

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CHAPTER 2. NUTRITION AND DIALYSIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and dialysis.

Finding Nutrition Studies on Dialysis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “dialysis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on dialysis: •

A controlled trial of intermittent enteral nutrient supplementation in maintenance hemodialysis patients. Author(s): Department of Nephrology, Christian Medical College and Hospital, Vellore, India. Source: Sharma, M Rao, M Jacob, S Jacob, C K J-Ren-Nutr. 2002 October; 12(4): 229-37 1051-2276

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A new approach to classifying malnutrition in the hemodialysis patient. Author(s): San Diego Dialysis-National City, National City, CA, USA. Source: O'keefe, A Daigle, N W J-Ren-Nutr. 2002 October; 12(4): 248-55 1051-2276

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Calcium, phosphate, and PTH levels in the hemodialysis population: a multicenter study. Author(s): Renal Unit, San Paolo Hospital, Milan, Italy. [email protected] Source: Gallieni, M Cucciniello, E D'Amaro, E Fatuzzo, P Gaggiotti, A Maringhini, S Rotolo, U Brancaccio, D J-Nephrol. 2002 Mar-April; 15(2): 165-70 1120-3625

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Carnitine action on red blood cell osmotic resistance in hemodialysis patients. Author(s): Nephrology Department, A. Fleming Hospital, Athens, Greece. [email protected] Source: Vlassopoulo, D A Hadjiyannakos, D K Anogiatis, A G Evageliou, A E Santikou, A V Noussias, C V Papandreou, P T Hadjiconstantinou, V E J-Nephrol. 2002 JanFebruary; 15(1): 68-73 1120-3625

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Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. Author(s): Division of Nephrology and Hypertension, Beth Israel Medical Center, New York, NY 10128, USA. [email protected] Source: Burrowes, Jerrilynn D Cockram, David B Dwyer, Johanna T Larive, Brett Paranandi, Lata Bergen, Carol Poole, Diane J-Ren-Nutr. 2002 April; 12(2): 87-95 10512276

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Diagnosing and treating anemia and iron deficiency in hemodialysis patients. Source: Foret, J P Nephrol-Nurs-J. 2002 June; 29(3): 292-6 1526-744X

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Dialysis bone disease. Author(s): Imaging Science and Biomedical Engineering, University of Manchester, England. [email protected] Source: Adams, J E Semin-Dial. 2002 Jul-August; 15(4): 277-89 0894-0959

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Dietary and fluid compliance in Chinese hemodialysis patients. Author(s): Renal Unit, Princess Margaret Hospital, Hong Kong. Source: Lee, S H Molassiotis, A Int-J-Nurs-Stud. 2002 September; 39(7): 695-704 00207489

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Eating out guidelines for dialysis patients. Author(s): Fresenius Medical Care, Collin County Dialysis Center, Plano, TX, USA. Source: Chan, C J-Ren-Nutr. 2002 October; 12(4): 259-62 1051-2276

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Effect of erythropoietin therapy and selenium supplementation on selected antioxidant parameters in blood of uremic patients on long-term hemodialysis. Author(s): Department of Nephrology, Medical University, Bydgoszcz, Poland. Source: Adamowicz, Andrzej Trafikowska, Urszula Trafikowska, Anna Zachara, Bronislaw Manitius, Jacek Med-Sci-Monit. 2002 March; 8(3): CR202-5 1234-1010

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Effect of vitamin C and zinc on osmotic fragility and lipid peroxidation in zincdeficient haemodialysis patients. Author(s): University of Cumhuriyet, Faculty of Science and Art, Department of Chemistry, Sivas, Turkey. [email protected] Source: Candan, Ferda Gultekin, Fusun Candan, Ferhan Cell-Biochem-Funct. 2002 June; 20(2): 95-8 0263-6484

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Effects of a vitamin E-bonded membrane and of glutathione on anemia and erythropoietin requirements in hemodialysis patients. Author(s): Nephrology and Dialysis Service, Manerbio Hospital, Brescia, Italy. [email protected] Source: Usberti, M Gerardi, G Micheli, A Tira, P Bufano, G Gaggia, P Movilli, E Cancarini, G C De Marinis, S D'Avolio, G Broccoli, R Manganoni, A Albertin, A Di Lorenzo, D J-Nephrol. 2002 Sep-October; 15(5): 558-64 1120-3625

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Effects of peritoneal dialysis solutions on the secretion of growth factors and extracellular matrix proteins by human peritoneal mesothelial cells. Author(s): Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea. Source: Ha, H Cha, M K Choi, H N Lee, H B Perit-Dial-Int. 2002 Mar-April; 22(2): 171-7 0896-8608

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Effects of terbium and pH on structure of anticoagulation factor II from Agkistrodon acutus venom probed by fluorescent spectroscopy and equilibrium dialysis. Author(s): Department of Chemistry, University of Science and Technology of China, Hefei 230026, China. Source: Xu, X L Liu, Q L Wu, B Xie, Y S Biopolymers. 2002; 67(6): 387-93 0006-3525

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Efficacy of a low-dose intravenous iron sucrose regimen in peritoneal dialysis patients. Author(s): Department of Medicine III, University of Vienna, Austria. Source: Dittrich, E Schillinger, M Sunder Plassmann, G Horl, W H Vychytil, A PeritDial-Int. 2002 Jan-February; 22(1): 60-6 0896-8608

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Endoscopic minilaparotomy radical nephrectomy for chronic dialysis patients. Author(s): Department of Urology and Reproductive Medicine, Graduate School Tokyo Medical and Dental University, Japan. [email protected] Source: Kageyama, Yukio Kihara, Kazunori Ishizaka, Kazuhiro Okuno, Tetsuo Hayashi, Tetsuo Kawakami, Satoru Masuda, Hitoshi Suzuki, Masahito Hyochi, Nobuhiko Arai, Gaku Int-J-Urol. 2002 February; 9(2): 73-6 0919-8172

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Evaluating iron status in hemodialysis patients. Author(s): University of Maryland Medical System, Department of Medicine, Nephrology Division, Baltimore, MD, USA. Source: Enders, H M Nephrol-Nurs-J. 2002 August; 29(4): 366-70 1526-744X

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Glucose degradation products in peritoneal dialysis fluids: how they can be avoided. Author(s): Gambro Corporate Research, Lund, Sweden. [email protected] Source: Wieslander, A Linden, T Kjellstrand, P Perit-Dial-Int. 2001; 21 Suppl 3: S119-24 0896-8608

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Herbs, menopause, and dialysis. Author(s): Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA. [email protected]

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Source: Roemheld Hamm, B Dahl, N V Semin-Dial. 2002 Jan-February; 15(1): 53-9 08940959 •

High glucose dialysis solutions increase synthesis of vascular endothelial growth factors by peritoneal vascular endothelial cells. Author(s): Hyonam Kidney Laboratory, Seoul, Korea. Source: Seo, M J Oh, S J Kim, S I Cho, K W Jo, I Schaub, T Schilling, H Passlick Deetjen, J Han, D C Perit-Dial-Int. 2001; 21 Suppl 3: S35-40 0896-8608

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How should hyperphosphatemia be managed in dialysis patients? Author(s): Denver Nephrology, Denver, Colorado. [email protected] Source: Block, G Uribarri, J Coladonato, J A Fan, S L Cunningham, J Nolan, C R Qunibi, W Y Lindberg, J S Semin-Dial. 2002 Sep-October; 15(5): 315-28 0894-0959

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Impaired triglyceride tolerance in hemodialysis patients with different apolipoprotein E (apo E) isoforms. Author(s): 3rd Clinic of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 6, 775 20 Olomouc, Czech Republic. [email protected] Source: Zahalkova, J Vaverkova, H Novotny, D Kosatikova, Z Biomed-Pap-Med-FacUniv-Palacky-Olomouc-Czech-Repub. 2002 December; 146(2): 73-6 1213-8118

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In vitro superiority of dual-chambered peritoneal dialysis solution with possible clinical benefits. Author(s): Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany. [email protected] Source: Passlick Deetjen, J Pischetsrieder, M Witowski, J Bender, T O Jorres, A Lage, C Perit-Dial-Int. 2001; 21 Suppl 3: S96-101 0896-8608

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Inflammation and malnutrition as predictors of mortality in patients on hemodialysis. Author(s): Servicio de Nefrologia, H. General, Segovia, Spain. [email protected] Source: Fernandez Reyes, M J Alvarez Ude, F Sanchez, R Mon, C Iglesias, P Diez, J J Vazquez, A J-Nephrol. 2002 Mar-April; 15(2): 136-43 1120-3625

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Inflammatory markers are unrelated to physical activity, performance, and functioning in hemodialysis. Author(s): San Francisco VA Medical Center, Division of Nephrology, San Francisco, CA 94121, USA. Source: Hung, A M Chertow, G M Young, B S Carey, S Johansen, K L J-Ren-Nutr. 2002 July; 12(3): 170-6 1051-2276

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Influence of dialysate on gastric emptying time in peritoneal dialysis patients. Author(s): Department of Internal Medicine, Ghent University Hospital, Belgium. [email protected] Source: Van, V Schoonjans, R S Struijk, D G Verbanck, J J Vanholder, R C Van, B Lefebvre, R A De, V Lameire, N H Perit-Dial-Int. 2002 Jan-Feb; 22(1): 32-8 0896-8608

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Influence of neutral-pH dialysis solutions on the peritoneal membrane: a long-term investigation in rats. Author(s): Department of Pathophysiology, Poznan Medical School, Poland. [email protected] Source: Wieczorowska Tobis, K Polubinska, A Schaub, T P Schilling, H Wisniewska, J Witowski, J Passlick Deetjen, J Breborowicz, A Perit-Dial-Int. 2001; 21 Suppl 3: S108-13 0896-8608

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Influence of self-efficacy and other factors on dietary behaviours in Japanese haemodialysis patients. Author(s): Department of Nursing, Yamagata University School of Medicine, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan. [email protected] Source: Oka, M Chaboyer, W Int-J-Nurs-Pract. 2001 December; 7(6): 431-9 1322-7114

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Intracellular free calcium in the neutrophils of maintenance haemodialysis patients. Author(s): Department of Physiology, University of Pretoria, Pretoria, Gauteng, South Africa. [email protected] Source: Koorts, A M Kruger, M C Potgieter, C D Viljoen, M Clin-Physiol-Funct-Imaging. 2002 July; 22(4): 285-94 1475-0961

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Is growth a valid outcome measure of dialysis clearance in children undergoing peritoneal dialysis? Author(s): Section of Nephrology, Children's Mercy Hospital, University of Missouri, Kansas City 64108, USA. Source: Chadha, V Blowey, D L Warady, B A Perit-Dial-Int. 2001; 21 Suppl 3: S179-84 0896-8608

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Is there a relationship between diet and nutrition status in continuous ambulatory peritoneal dialysis patients? Author(s): Wessex Renal and Transplant Unit, Portsmouth, UK. [email protected] Source: Sutton, D Talbot, S T Stevens, J M Perit-Dial-Int. 2001; 21 Suppl 3: S168-73 08968608

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Lack of reaction to ferric gluconate in hemodialysis patients with a history of severe reaction to iron dextran. Author(s): Department of Internal Medicine, Saint Louis University School of Medicine, Missouri 63110, USA. Source: Bastani, B Rahman, S Gellens, M ASAIO-J. 2002 Jul-August; 48(4): 404-6 10582916

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Maintaining higher TSATs and other iron indices is beneficial in management of anemic hemodialysis patients. Author(s): West Virginia University School of Medicine, Dialysis Unit, Ruby Memorial Hospital, Morgantown, WV, USA. Source: Besarab, A Dalton, C L Nephrol-Nurs-J. 2001 August; 28(4): 429-34 1526-744X

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Microbubble potentiated ultrasound as a method of declotting thrombosed dialysis grafts: experimental study in dogs. Author(s): University of Nebraska Medical Center, Omaha 68198-1045, USA. Source: Culp, W C Porter, T R Xie, F Goertzen, T C McCowan, T C Vonk, B N Baxter, B T Cardiovasc-Intervent-Radiol. 2001 Nov-December; 24(6): 407-12 0174-1551

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Monitoring cardiovascular changes during hemodialysis in children. Author(s): 1st Department of Pediatrics, Semmelweis Medical University, Bokay u. 53, 1083 Budapest, Hungary. Source: Miltenyi, G Tory, K Stubnya, G Toth Heyn, P Vasarhelyi, B Sallay, P Szabo, A Tulassay, T Dobos, M Reusz, G S Pediatr-Nephrol. 2001 January; 16(1): 19-24 0931-041X

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Normal or low initial PTH levels are not a predictor of morbidity/mortality in patients undergoing chronic peritoneal dialysis. Author(s): Toronto Western Hospital, and Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada.

152 Dialysis

Source: Dimkovic, N B Bargman, J Vas, S Oreopoulos, D G Perit-Dial-Int. 2002 MarApril; 22(2): 204-10 0896-8608 •

Nutrition, adequacy of dialysis, and clinical outcome in Indo-Asian and White European patients on peritoneal dialysis. Author(s): Renal Services, University Hospital Coventry, Walsgrave Hospital, Coventry, UK. [email protected] Source: Bakewell, A Higgins, R Edmunds, M QJM. 2002 December; 95(12): 811-20 14602725

•

Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. Author(s): Frances Stern Nutrition Center, Tufts-New England Medical Center, Boston, MA 02111, USA Source: Dwyer, J T Larive, B Leung, J Rocco, M Burrowes, J D Chumlea, W C Frydrych, A Kusek, J W Uhlin, L J-Ren-Nutr. 2002 October; 12(4): 213-23 1051-2276

•

Oxidative stress in haemodialysis--intradialytic changes. Author(s): Department of Biochemistry, S. V. Institute of Medical Sciences, Tirupati, India. [email protected] Source: Srinivasa Rao, P V Dakshinamurty, K V Saibaba, K S Raghavan, M S Vijayabhaskar, M Sreekrishna, V Ambekar, J G Jayaseelan, L Redox-Repage 2001; 6(5): 303-9 1351-0002

•

Patient education about self-assessment of need for dialysis and the use of Kayexalate. Author(s): Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, USA. Source: Dinwiddie, L C Nephrol-Nurs-J. 2001 October; 28(5): 573 1526-744X

•

Pharmacologic B-vitamin therapy for hyperhomocysteinemia in dialysis patients: has the time come? Author(s): Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Division of Nephrology, New England Medical Center, 711 Washington Street, Room 829, Boston, MA 02111, USA. [email protected] Source: Friedman, A N Nutr-Clin-Care. 2002 Jan-February; 5(1): 20-4 1096-6781

•

Prevalence of protein malnutrition in children maintained on peritoneal dialysis. Author(s): Division of Pediatric Nephrology, Rhode Island Hospital APC-942, 593 Eddy Street, Providence 02903, USA. [email protected] Source: Brem, A S Lambert, C Hill, C Kitsen, J Shemin, D G Pediatr-Nephrol. 2002 July; 17(7): 527-30 0931-041X

•

Relationship between the serum parathyroid hormone and magnesium levels in continuous ambulatory peritoneal dialysis (CAPD) patients using low-magnesium peritoneal dialysate. Author(s): Department of Internal Medicine, Chonnam National University Medical School, Kwangju, Korea. Source: Cho, M S Lee, K S Lee, Y K Ma, S K Ko, J H Kim, S W Kim, N H Choi, K C Korean-J-Intern-Med. 2002 June; 17(2): 114-21 0494-4712

•

Role of selenium depletion in the effects of dialysis on mood and behavior. Source: Sher, L Med-Hypotheses. 2002 July; 59(1): 89-91 0306-9877

•

Safety of oral carnitine in dialysis patients. Source: Schreiber, B Semin-Dial. 2002 Jan-February; 15(1): 71-2 0894-0959

Nutrition

153

•

Selenium metabolism in patients on continuous ambulatory peritoneal dialysis. Author(s): First Department of Propaedeutic Surgery, Athens University Medical School, Hippocration Hospital, Athens, Greece. [email protected] Source: Apostolidis, N S Panoussopoulos, D G Stamou, K M Kekis, P B Paradellis, T P Karydas, A G Zarkadas, C Zirogiannis, P N Manouras, A J Perit-Dial-Int. 2002 MayJune; 22(3): 400-4 0896-8608

•

Small-solute and middle-molecule clearances during continuous flow peritoneal dialysis. Author(s): Research Service, Salt Lake City VA Health Care System, Departments of Internal Medicine and Bioengineering, University of Utah, Salt Lake City, Utah, USA. Source: Leypoldt, J K Burkart, J M Adv-Perit-Dial. 2002; 18: 26-31 1197-8554

•

Stress factors and coping strategies of parents with children treated by hemodialysis: A qualitative study. Author(s): Marmara University School of Nursing, Department of Child Health Nursing, Istanbul-Turkey. [email protected] Source: Cimete, G J-Pediatr-Nurs. 2002 August; 17(4): 297-306 0882-5963

•

Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids. Author(s): Gambro Healthcare, J. B. Zachary Dialysis Unit, Johns Hopkins Bayview Hospital, Baltimore, MD 21205, USA. Source: Bronich, L Te, T Shetye, K Stewart, T Eustace, J A J-Ren-Nutr. 2001 October; 11(4): 194-201 1051-2276

•

The effect of icodextrin-based solutions on peritoneal transport in rats undergoing chronic peritoneal dialysis. Author(s): Department of Clinical Science, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. [email protected] Source: Pawlaczyk, K Garcia Lopez, E Kuzlan Pawlaczyk, M Heimburger, O Bergstrom, J Breborowicz, A Lindholm, B Perit-Dial-Int. 2001; 21 Suppl 3: S359-61 0896-8608

•

The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients. Author(s): Renal Unit, G. Papanikolaou General Hospital, Thessaloniki, Greece. [email protected] Source: Sombolos, K Fragia, T Natse, T Bartholomatos, G Karagianni, A Katsaris, G Christidou, F Bamichas, G Stangou, M Papagalanis, N J-Nephrol. 2002 Nov-December; 15(6): 671-5 1120-3625

•

The effects of zinc supplementation on serum zinc and cholesterol concentrations in hemodialysis patients. Author(s): Food and Nutrition Services, Charlton Methodist Hospital, Dallas, TX, USA. Source: Chevalier, C A Liepa, G Murphy, M D Suneson, J Vanbeber, A D Gorman, M A Cochran, C J-Ren-Nutr. 2002 July; 12(3): 183-9 1051-2276

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The impact of increasing the daytime dialysis exchange frequency on peritoneal dialysis adequacy and nutritional status of Chinese anuric patients. Author(s): Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin. [email protected] Source: Szeto, C C Wong, T Y Chow, K M Leung, C B Wang, A Y Lui, S F Li, P K PeritDial-Int. 2002 Mar-April; 22(2): 197-203 0896-8608

154 Dialysis

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Time-course of iodine elimination by hemodialysis in patients with renal failure after angiography. Author(s): Department of Medicine, Division of Nephrology and Dialysis, Social Insurance Chuo General Hospital, Tokyo, Japan. [email protected] Source: Shinoda, T Hata, T Nakajima, K Yoshimoto, H Niwa, A Ther-Apher. 2002 December; 6(6): 437-42 1091-6660

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True deficiency of antioxidant vitamins E and A in dialysis patients. Relationship with clinical patterns of atherosclerosis. Author(s): Servicio de Nefrologia, Hospitales Universitarios La Paz, Spain. Source: Aguilera, A Bajo, M A del Peso, G Diez, J J Codoceo, R Rebollo, F Mariano, M Selgas, R Adv-Perit-Dial. 2002; 18: 206-11 1197-8554

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Weekly administration of high-dose sodium ferric gluconate is safe and effective in peritoneal dialysis patients. Author(s): University of Illinois Medical Center, Chicago, IL, USA. Source: Javier, A M Nephrol-Nurs-J. 2002 April; 29(2): 183-6 1526-744X

The following information is typical of that found when using the “Full IBIDS Database” to search for “dialysis” (or a synonym): •

A controlled trial of intermittent enteral nutrient supplementation in maintenance hemodialysis patients. Author(s): Department of Nephrology, Christian Medical College and Hospital, Vellore, India. Source: Sharma, M Rao, M Jacob, S Jacob, C K J-Ren-Nutr. 2002 October; 12(4): 229-37 1051-2276

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A new approach to classifying malnutrition in the hemodialysis patient. Author(s): San Diego Dialysis-National City, National City, CA, USA. Source: O'keefe, A Daigle, N W J-Ren-Nutr. 2002 October; 12(4): 248-55 1051-2276

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Calcium, phosphate, and PTH levels in the hemodialysis population: a multicenter study. Author(s): Renal Unit, San Paolo Hospital, Milan, Italy. [email protected] Source: Gallieni, M Cucciniello, E D'Amaro, E Fatuzzo, P Gaggiotti, A Maringhini, S Rotolo, U Brancaccio, D J-Nephrol. 2002 Mar-April; 15(2): 165-70 1120-3625

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Carnitine action on red blood cell osmotic resistance in hemodialysis patients. Author(s): Nephrology Department, A. Fleming Hospital, Athens, Greece. [email protected] Source: Vlassopoulo, D A Hadjiyannakos, D K Anogiatis, A G Evageliou, A E Santikou, A V Noussias, C V Papandreou, P T Hadjiconstantinou, V E J-Nephrol. 2002 JanFebruary; 15(1): 68-73 1120-3625

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Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. Author(s): Division of Nephrology and Hypertension, Beth Israel Medical Center, New York, NY 10128, USA. [email protected] Source: Burrowes, Jerrilynn D Cockram, David B Dwyer, Johanna T Larive, Brett Paranandi, Lata Bergen, Carol Poole, Diane J-Ren-Nutr. 2002 April; 12(2): 87-95 10512276

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Diagnosing and treating anemia and iron deficiency in hemodialysis patients. Source: Foret, J P Nephrol-Nurs-J. 2002 June; 29(3): 292-6 1526-744X

Nutrition

155

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Dialysis bone disease. Author(s): Imaging Science and Biomedical Engineering, University of Manchester, England. [email protected] Source: Adams, J E Semin-Dial. 2002 Jul-August; 15(4): 277-89 0894-0959

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Dietary and fluid compliance in Chinese hemodialysis patients. Author(s): Renal Unit, Princess Margaret Hospital, Hong Kong. Source: Lee, S H Molassiotis, A Int-J-Nurs-Stud. 2002 September; 39(7): 695-704 00207489

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Eating out guidelines for dialysis patients. Author(s): Fresenius Medical Care, Collin County Dialysis Center, Plano, TX, USA. Source: Chan, C J-Ren-Nutr. 2002 October; 12(4): 259-62 1051-2276

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Effect of erythropoietin therapy and selenium supplementation on selected antioxidant parameters in blood of uremic patients on long-term hemodialysis. Author(s): Department of Nephrology, Medical University, Bydgoszcz, Poland. Source: Adamowicz, Andrzej Trafikowska, Urszula Trafikowska, Anna Zachara, Bronislaw Manitius, Jacek Med-Sci-Monit. 2002 March; 8(3): CR202-5 1234-1010

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Effect of vitamin C and zinc on osmotic fragility and lipid peroxidation in zincdeficient haemodialysis patients. Author(s): University of Cumhuriyet, Faculty of Science and Art, Department of Chemistry, Sivas, Turkey. [email protected] Source: Candan, Ferda Gultekin, Fusun Candan, Ferhan Cell-Biochem-Funct. 2002 June; 20(2): 95-8 0263-6484

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Effects of a vitamin E-bonded membrane and of glutathione on anemia and erythropoietin requirements in hemodialysis patients. Author(s): Nephrology and Dialysis Service, Manerbio Hospital, Brescia, Italy. [email protected] Source: Usberti, M Gerardi, G Micheli, A Tira, P Bufano, G Gaggia, P Movilli, E Cancarini, G C De Marinis, S D'Avolio, G Broccoli, R Manganoni, A Albertin, A Di Lorenzo, D J-Nephrol. 2002 Sep-October; 15(5): 558-64 1120-3625

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Effects of peritoneal dialysis solutions on the secretion of growth factors and extracellular matrix proteins by human peritoneal mesothelial cells. Author(s): Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea. Source: Ha, H Cha, M K Choi, H N Lee, H B Perit-Dial-Int. 2002 Mar-April; 22(2): 171-7 0896-8608

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Effects of terbium and pH on structure of anticoagulation factor II from Agkistrodon acutus venom probed by fluorescent spectroscopy and equilibrium dialysis. Author(s): Department of Chemistry, University of Science and Technology of China, Hefei 230026, China. Source: Xu, X L Liu, Q L Wu, B Xie, Y S Biopolymers. 2002; 67(6): 387-93 0006-3525

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Efficacy of a low-dose intravenous iron sucrose regimen in peritoneal dialysis patients. Author(s): Department of Medicine III, University of Vienna, Austria. Source: Dittrich, E Schillinger, M Sunder Plassmann, G Horl, W H Vychytil, A PeritDial-Int. 2002 Jan-February; 22(1): 60-6 0896-8608

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Endoscopic minilaparotomy radical nephrectomy for chronic dialysis patients. Author(s): Department of Urology and Reproductive Medicine, Graduate School Tokyo Medical and Dental University, Japan. [email protected]

156 Dialysis

Source: Kageyama, Yukio Kihara, Kazunori Ishizaka, Kazuhiro Okuno, Tetsuo Hayashi, Tetsuo Kawakami, Satoru Masuda, Hitoshi Suzuki, Masahito Hyochi, Nobuhiko Arai, Gaku Int-J-Urol. 2002 February; 9(2): 73-6 0919-8172 •

Evaluating iron status in hemodialysis patients. Author(s): University of Maryland Medical System, Department of Medicine, Nephrology Division, Baltimore, MD, USA. Source: Enders, H M Nephrol-Nurs-J. 2002 August; 29(4): 366-70 1526-744X

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Glucose degradation products in peritoneal dialysis fluids: how they can be avoided. Author(s): Gambro Corporate Research, Lund, Sweden. [email protected] Source: Wieslander, A Linden, T Kjellstrand, P Perit-Dial-Int. 2001; 21 Suppl 3: S119-24 0896-8608

•

Herbs, menopause, and dialysis. Author(s): Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA. [email protected] Source: Roemheld Hamm, B Dahl, N V Semin-Dial. 2002 Jan-February; 15(1): 53-9 08940959

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High glucose dialysis solutions increase synthesis of vascular endothelial growth factors by peritoneal vascular endothelial cells. Author(s): Hyonam Kidney Laboratory, Seoul, Korea. Source: Seo, M J Oh, S J Kim, S I Cho, K W Jo, I Schaub, T Schilling, H Passlick Deetjen, J Han, D C Perit-Dial-Int. 2001; 21 Suppl 3: S35-40 0896-8608

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How should hyperphosphatemia be managed in dialysis patients? Author(s): Denver Nephrology, Denver, Colorado. [email protected] Source: Block, G Uribarri, J Coladonato, J A Fan, S L Cunningham, J Nolan, C R Qunibi, W Y Lindberg, J S Semin-Dial. 2002 Sep-October; 15(5): 315-28 0894-0959

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Impaired triglyceride tolerance in hemodialysis patients with different apolipoprotein E (apo E) isoforms. Author(s): 3rd Clinic of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 6, 775 20 Olomouc, Czech Republic. [email protected] Source: Zahalkova, J Vaverkova, H Novotny, D Kosatikova, Z Biomed-Pap-Med-FacUniv-Palacky-Olomouc-Czech-Repub. 2002 December; 146(2): 73-6 1213-8118

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In vitro superiority of dual-chambered peritoneal dialysis solution with possible clinical benefits. Author(s): Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany. [email protected] Source: Passlick Deetjen, J Pischetsrieder, M Witowski, J Bender, T O Jorres, A Lage, C Perit-Dial-Int. 2001; 21 Suppl 3: S96-101 0896-8608

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Inflammation and malnutrition as predictors of mortality in patients on hemodialysis. Author(s): Servicio de Nefrologia, H. General, Segovia, Spain. [email protected] Source: Fernandez Reyes, M J Alvarez Ude, F Sanchez, R Mon, C Iglesias, P Diez, J J Vazquez, A J-Nephrol. 2002 Mar-April; 15(2): 136-43 1120-3625

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Inflammatory markers are unrelated to physical activity, performance, and functioning in hemodialysis. Author(s): San Francisco VA Medical Center, Division of Nephrology, San Francisco, CA 94121, USA.

Nutrition

157

Source: Hung, A M Chertow, G M Young, B S Carey, S Johansen, K L J-Ren-Nutr. 2002 July; 12(3): 170-6 1051-2276 •

Influence of dialysate on gastric emptying time in peritoneal dialysis patients. Author(s): Department of Internal Medicine, Ghent University Hospital, Belgium. [email protected] Source: Van, V Schoonjans, R S Struijk, D G Verbanck, J J Vanholder, R C Van, B Lefebvre, R A De, V Lameire, N H Perit-Dial-Int. 2002 Jan-Feb; 22(1): 32-8 0896-8608

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Influence of neutral-pH dialysis solutions on the peritoneal membrane: a long-term investigation in rats. Author(s): Department of Pathophysiology, Poznan Medical School, Poland. [email protected] Source: Wieczorowska Tobis, K Polubinska, A Schaub, T P Schilling, H Wisniewska, J Witowski, J Passlick Deetjen, J Breborowicz, A Perit-Dial-Int. 2001; 21 Suppl 3: S108-13 0896-8608

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Influence of self-efficacy and other factors on dietary behaviours in Japanese haemodialysis patients. Author(s): Department of Nursing, Yamagata University School of Medicine, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan. [email protected] Source: Oka, M Chaboyer, W Int-J-Nurs-Pract. 2001 December; 7(6): 431-9 1322-7114

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Intracellular free calcium in the neutrophils of maintenance haemodialysis patients. Author(s): Department of Physiology, University of Pretoria, Pretoria, Gauteng, South Africa. [email protected] Source: Koorts, A M Kruger, M C Potgieter, C D Viljoen, M Clin-Physiol-Funct-Imaging. 2002 July; 22(4): 285-94 1475-0961

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Is growth a valid outcome measure of dialysis clearance in children undergoing peritoneal dialysis? Author(s): Section of Nephrology, Children's Mercy Hospital, University of Missouri, Kansas City 64108, USA. Source: Chadha, V Blowey, D L Warady, B A Perit-Dial-Int. 2001; 21 Suppl 3: S179-84 0896-8608

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Is there a relationship between diet and nutrition status in continuous ambulatory peritoneal dialysis patients? Author(s): Wessex Renal and Transplant Unit, Portsmouth, UK. [email protected] Source: Sutton, D Talbot, S T Stevens, J M Perit-Dial-Int. 2001; 21 Suppl 3: S168-73 08968608

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Lack of reaction to ferric gluconate in hemodialysis patients with a history of severe reaction to iron dextran. Author(s): Department of Internal Medicine, Saint Louis University School of Medicine, Missouri 63110, USA. Source: Bastani, B Rahman, S Gellens, M ASAIO-J. 2002 Jul-August; 48(4): 404-6 10582916

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Maintaining higher TSATs and other iron indices is beneficial in management of anemic hemodialysis patients. Author(s): West Virginia University School of Medicine, Dialysis Unit, Ruby Memorial Hospital, Morgantown, WV, USA. Source: Besarab, A Dalton, C L Nephrol-Nurs-J. 2001 August; 28(4): 429-34 1526-744X

158 Dialysis

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Microbubble potentiated ultrasound as a method of declotting thrombosed dialysis grafts: experimental study in dogs. Author(s): University of Nebraska Medical Center, Omaha 68198-1045, USA. Source: Culp, W C Porter, T R Xie, F Goertzen, T C McCowan, T C Vonk, B N Baxter, B T Cardiovasc-Intervent-Radiol. 2001 Nov-December; 24(6): 407-12 0174-1551

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Monitoring cardiovascular changes during hemodialysis in children. Author(s): 1st Department of Pediatrics, Semmelweis Medical University, Bokay u. 53, 1083 Budapest, Hungary. Source: Miltenyi, G Tory, K Stubnya, G Toth Heyn, P Vasarhelyi, B Sallay, P Szabo, A Tulassay, T Dobos, M Reusz, G S Pediatr-Nephrol. 2001 January; 16(1): 19-24 0931-041X

•

Normal or low initial PTH levels are not a predictor of morbidity/mortality in patients undergoing chronic peritoneal dialysis. Author(s): Toronto Western Hospital, and Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada. Source: Dimkovic, N B Bargman, J Vas, S Oreopoulos, D G Perit-Dial-Int. 2002 MarApril; 22(2): 204-10 0896-8608

•

Nutrition, adequacy of dialysis, and clinical outcome in Indo-Asian and White European patients on peritoneal dialysis. Author(s): Renal Services, University Hospital Coventry, Walsgrave Hospital, Coventry, UK. [email protected] Source: Bakewell, A Higgins, R Edmunds, M QJM. 2002 December; 95(12): 811-20 14602725

•

Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. Author(s): Frances Stern Nutrition Center, Tufts-New England Medical Center, Boston, MA 02111, USA Source: Dwyer, J T Larive, B Leung, J Rocco, M Burrowes, J D Chumlea, W C Frydrych, A Kusek, J W Uhlin, L J-Ren-Nutr. 2002 October; 12(4): 213-23 1051-2276

•

Oxidative stress in haemodialysis--intradialytic changes. Author(s): Department of Biochemistry, S. V. Institute of Medical Sciences, Tirupati, India. [email protected] Source: Srinivasa Rao, P V Dakshinamurty, K V Saibaba, K S Raghavan, M S Vijayabhaskar, M Sreekrishna, V Ambekar, J G Jayaseelan, L Redox-Repage 2001; 6(5): 303-9 1351-0002

•

Patient education about self-assessment of need for dialysis and the use of Kayexalate. Author(s): Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, USA. Source: Dinwiddie, L C Nephrol-Nurs-J. 2001 October; 28(5): 573 1526-744X

•

Pharmacologic B-vitamin therapy for hyperhomocysteinemia in dialysis patients: has the time come? Author(s): Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Division of Nephrology, New England Medical Center, 711 Washington Street, Room 829, Boston, MA 02111, USA. [email protected] Source: Friedman, A N Nutr-Clin-Care. 2002 Jan-February; 5(1): 20-4 1096-6781

•

Prevalence of protein malnutrition in children maintained on peritoneal dialysis. Author(s): Division of Pediatric Nephrology, Rhode Island Hospital APC-942, 593 Eddy Street, Providence 02903, USA. [email protected]

Nutrition

159

Source: Brem, A S Lambert, C Hill, C Kitsen, J Shemin, D G Pediatr-Nephrol. 2002 July; 17(7): 527-30 0931-041X •

Relationship between the serum parathyroid hormone and magnesium levels in continuous ambulatory peritoneal dialysis (CAPD) patients using low-magnesium peritoneal dialysate. Author(s): Department of Internal Medicine, Chonnam National University Medical School, Kwangju, Korea. Source: Cho, M S Lee, K S Lee, Y K Ma, S K Ko, J H Kim, S W Kim, N H Choi, K C Korean-J-Intern-Med. 2002 June; 17(2): 114-21 0494-4712

•

Role of selenium depletion in the effects of dialysis on mood and behavior. Source: Sher, L Med-Hypotheses. 2002 July; 59(1): 89-91 0306-9877

•

Safety of oral carnitine in dialysis patients. Source: Schreiber, B Semin-Dial. 2002 Jan-February; 15(1): 71-2 0894-0959

•

Selenium metabolism in patients on continuous ambulatory peritoneal dialysis. Author(s): First Department of Propaedeutic Surgery, Athens University Medical School, Hippocration Hospital, Athens, Greece. [email protected] Source: Apostolidis, N S Panoussopoulos, D G Stamou, K M Kekis, P B Paradellis, T P Karydas, A G Zarkadas, C Zirogiannis, P N Manouras, A J Perit-Dial-Int. 2002 MayJune; 22(3): 400-4 0896-8608

•

Small-solute and middle-molecule clearances during continuous flow peritoneal dialysis. Author(s): Research Service, Salt Lake City VA Health Care System, Departments of Internal Medicine and Bioengineering, University of Utah, Salt Lake City, Utah, USA. Source: Leypoldt, J K Burkart, J M Adv-Perit-Dial. 2002; 18: 26-31 1197-8554

•

Stress factors and coping strategies of parents with children treated by hemodialysis: A qualitative study. Author(s): Marmara University School of Nursing, Department of Child Health Nursing, Istanbul-Turkey. [email protected] Source: Cimete, G J-Pediatr-Nurs. 2002 August; 17(4): 297-306 0882-5963

•

Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids. Author(s): Gambro Healthcare, J. B. Zachary Dialysis Unit, Johns Hopkins Bayview Hospital, Baltimore, MD 21205, USA. Source: Bronich, L Te, T Shetye, K Stewart, T Eustace, J A J-Ren-Nutr. 2001 October; 11(4): 194-201 1051-2276

•

The effect of icodextrin-based solutions on peritoneal transport in rats undergoing chronic peritoneal dialysis. Author(s): Department of Clinical Science, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. [email protected] Source: Pawlaczyk, K Garcia Lopez, E Kuzlan Pawlaczyk, M Heimburger, O Bergstrom, J Breborowicz, A Lindholm, B Perit-Dial-Int. 2001; 21 Suppl 3: S359-61 0896-8608

•

The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients. Author(s): Renal Unit, G. Papanikolaou General Hospital, Thessaloniki, Greece. [email protected] Source: Sombolos, K Fragia, T Natse, T Bartholomatos, G Karagianni, A Katsaris, G Christidou, F Bamichas, G Stangou, M Papagalanis, N J-Nephrol. 2002 Nov-December; 15(6): 671-5 1120-3625

160 Dialysis

•

The effects of zinc supplementation on serum zinc and cholesterol concentrations in hemodialysis patients. Author(s): Food and Nutrition Services, Charlton Methodist Hospital, Dallas, TX, USA. Source: Chevalier, C A Liepa, G Murphy, M D Suneson, J Vanbeber, A D Gorman, M A Cochran, C J-Ren-Nutr. 2002 July; 12(3): 183-9 1051-2276

•

The impact of increasing the daytime dialysis exchange frequency on peritoneal dialysis adequacy and nutritional status of Chinese anuric patients. Author(s): Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin. [email protected] Source: Szeto, C C Wong, T Y Chow, K M Leung, C B Wang, A Y Lui, S F Li, P K PeritDial-Int. 2002 Mar-April; 22(2): 197-203 0896-8608

•

Time-course of iodine elimination by hemodialysis in patients with renal failure after angiography. Author(s): Department of Medicine, Division of Nephrology and Dialysis, Social Insurance Chuo General Hospital, Tokyo, Japan. [email protected] Source: Shinoda, T Hata, T Nakajima, K Yoshimoto, H Niwa, A Ther-Apher. 2002 December; 6(6): 437-42 1091-6660

•

True deficiency of antioxidant vitamins E and A in dialysis patients. Relationship with clinical patterns of atherosclerosis. Author(s): Servicio de Nefrologia, Hospitales Universitarios La Paz, Spain. Source: Aguilera, A Bajo, M A del Peso, G Diez, J J Codoceo, R Rebollo, F Mariano, M Selgas, R Adv-Perit-Dial. 2002; 18: 206-11 1197-8554

•

Weekly administration of high-dose sodium ferric gluconate is safe and effective in peritoneal dialysis patients. Author(s): University of Illinois Medical Center, Chicago, IL, USA. Source: Javier, A M Nephrol-Nurs-J. 2002 April; 29(2): 183-6 1526-744X

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

Nutrition

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to dialysis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Pantothenic Acid Source: Integrative Medicine Communications; www.drkoop.com Pantothenic Acid and Pantethine Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B1 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B5 (pantothenic Acid) Source: Integrative Medicine Communications; www.drkoop.com Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com

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Minerals Biotin Source: Integrative Medicine Communications; www.drkoop.com Calcium Acetate Source: Healthnotes, Inc.; www.healthnotes.com Carnitine (L-carnitine) Source: Integrative Medicine Communications; www.drkoop.com Creatine Source: Prima Communications, Inc.www.personalhealthzone.com Iron Source: Healthnotes, Inc.; www.healthnotes.com L-carnitine Source: Integrative Medicine Communications; www.drkoop.com Vitamin H (Biotin) Source: Integrative Medicine Communications; www.drkoop.com

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Food and Diet Betaine (Trimethylglycine) Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND DIALYSIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to dialysis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to dialysis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “dialysis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to dialysis: •

A 100-kg man on peritoneal dialysis (PD) with a borderline kt/V: to PD or not to PD. Author(s): Tzamaloukas AH, Bunting D. Source: Perit Dial Int. 2003 March-April; 23(2): 200-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713092&dopt=Abstract

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A comparative study on the skin penetration of pure tryptanthrin and tryptanthrin in Isatis tinctoria extract by dermal microdialysis coupled with isotope dilution ESI-LCMS. Author(s): Oberthur C, Heinemann C, Elsner P, Benfeldt E, Hamburger M. Source: Planta Medica. 2003 May; 69(5): 385-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802716&dopt=Abstract

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A comparison of hetastarch and peritoneal dialysis solution for intraperitoneal chemotherapy delivery. Author(s): Mohamed F, Marchettini P, Stuart OA, Yoo D, Sugarbaker PH.

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Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2003 April; 29(3): 261-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657237&dopt=Abstract •

A comparison of the biocompatibility of phosphate-buffered saline and dianeal 3.86% in the rat model of peritoneal dialysis. Author(s): Wieczorowska-Tobis K, Polubinska A, Breborowicz A, Oreopoulos DG. Source: Adv Perit Dial. 2001; 17: 42-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510294&dopt=Abstract

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A long-term study of a bicarbonate/lactate-based peritoneal dialysis solution--clinical benefits. The Bicarbonate/Lactate Study Group. Author(s): Tranaeus A. Source: Perit Dial Int. 2000 September-October; 20(5): 516-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11117242&dopt=Abstract

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A microdialysis study of the noradrenergic response in rat frontal cortex and hypothalamus to a conditioned cue for aversive, naturalistic environmental stimuli. Author(s): Mc Quade R, Stanford SC. Source: Psychopharmacology. 2000 February; 148(2): 201-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10663436&dopt=Abstract

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A randomized, double-blind, placebo-controlled trial of supplementary vitamins E, C and their combination for treatment of haemodialysis cramps. Author(s): Khajehdehi P, Mojerlou M, Behzadi S, Rais-Jalali GA. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 July; 16(7): 1448-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11427639&dopt=Abstract

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A survey of herbal product use in a dialysis population in Northwest Ohio. Author(s): Kleshinski JF, Crews C, Fry E, Stewart B, Reinhart C, Tolliver J, Khuder S. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2003 April; 13(2): 93-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671831&dopt=Abstract

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Activated charcoal is more effective than equilibrium dialysis in removing Chinese medicines Chan Su and Dan Shen from serum and activated charcoal also prevents further absorption of these agents from G.I. tract in mice: monitoring the effect in clinical laboratory by measuring digoxin activity in serum. Author(s): Dasgupta A, Wahed A, Culton L, Olsen M, Wells A, Actor JK.

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Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 2002 October; 324(1-2): 51-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12204425&dopt=Abstract •

Adequacy and nutrition in the absence of residual renal function in peritoneal dialysis. Author(s): Canale R, Barone RJ, Gimenez NS, Santopietro M, Ramirez L, Palliotti A, Romero P, Amado D. Source: Adv Perit Dial. 2001; 17: 230-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510282&dopt=Abstract

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Adjustment, spirituality, and health in women on hemodialysis. Author(s): Tanyi RA, Werner JS. Source: Clinical Nursing Research. 2003 August; 12(3): 229-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918648&dopt=Abstract

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Advanced glycosylation end-products in diabetic rats on peritoneal dialysis using various solutions. Author(s): Lee JH, Reddy DK, Saran R, Moore HL, Twardowski ZJ, Nolph KD, Khanna R. Source: Perit Dial Int. 2000 November-December; 20(6): 643-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216553&dopt=Abstract

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Albumin-corrected calcium and ionized calcium in stable haemodialysis patients. Author(s): Clase CM, Norman GL, Beecroft ML, Churchill DN. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2000 November; 15(11): 1841-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11071975&dopt=Abstract

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Alpha-tocopherol supplementation decreases the oxidative susceptibility of LDL in renal failure patients on dialysis therapy. Author(s): Islam KN, O'Byrne D, Devaraj S, Palmer B, Grundy SM, Jialal I. Source: Atherosclerosis. 2000 May; 150(1): 217-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10781654&dopt=Abstract

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AM3 (Inmunoferon) as an adjuvant to hepatitis B vaccination in hemodialysis patients. Author(s): Perez-Garcia R, Perez-Garcia A, Verbeelen D, Bernstein ED, Villarrubia VG, Alvarez-Mon M. Source: Kidney International. 2002 May; 61(5): 1845-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11967036&dopt=Abstract

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Amino acid losses during hemodialysis with polyacrylonitrile membranes: effect of intradialytic amino acid supplementation on plasma amino acid concentrations and nutritional variables in nondiabetic patients. Author(s): Navarro JF, Mora C, Leon C, Martin-Del Rio R, Macia ML, Gallego E, Chahin J, Mendez ML, Rivero A, Garcia J. Source: The American Journal of Clinical Nutrition. 2000 March; 71(3): 765-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10702171&dopt=Abstract

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Analysis of extracellular gamma-aminobutyric acid, glutamate and aspartate in cat visual cortex by in vivo microdialysis and capillary electrophoresis-laser induced fluorescence detection. Author(s): Li YM, Qu Y, Vandenbussche E, Arckens L, Vandesande F. Source: Journal of Neuroscience Methods. 2001 February 15; 105(2): 211-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11275278&dopt=Abstract

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Assessment of DNA strand breakage by the alkaline COMET assay in dialysis patients and the role of Vitamin E supplementation. Author(s): Kan E, Undeger U, Bali M, Basaran N. Source: Mutation Research. 2002 September 26; 520(1-2): 151-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12297155&dopt=Abstract

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Assessment of thiamin status in chronic renal failure patients, transplant recipients and hemodialysis patients receiving a multivitamin supplementation. Author(s): Frank T, Czeche K, Bitsch R, Stein G. Source: Int J Vitam Nutr Res. 2000 July; 70(4): 159-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10989764&dopt=Abstract

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Association between residual renal function, inflammation and patient survival in new peritoneal dialysis patients. Author(s): Chung SH, Heimburger O, Stenvinkel P, Qureshi AR, Lindholm B. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 March; 18(3): 590-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584284&dopt=Abstract

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Benefits of fish oil supplementation for hemodialysis patients. Author(s): Vergili-Nelsen JM. Source: Journal of the American Dietetic Association. 2003 September; 103(9): 1174-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963947&dopt=Abstract

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Biofeedback controlled hemodialysis (BF-HD) reduces symptoms and increases both hemodynamic tolerability and dialysis adequacy in non-hypotension prone stable


patients. Author(s): McIntyre CW, Lambie SH, Fluck RJ. Source: Clinical Nephrology. 2003 August; 60(2): 105-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12940612&dopt=Abstract •

Biofeedback regulation of ultrafiltration and dialysate conductivity for the prevention of hypotension during hemodialysis. Author(s): Begin V, Deziel C, Madore F. Source: Asaio Journal (American Society for Artificial Internal Organs : 1992). 2002 MayJune; 48(3): 312-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12059007&dopt=Abstract

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Blood flow limitation in vivo of small solute transfer during peritoneal dialysis in rats. Author(s): Rosengren BI, Rippe B. Source: Journal of the American Society of Nephrology : Jasn. 2003 June; 14(6): 1599-604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761261&dopt=Abstract

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Blood volume control by biofeedback and dialysis-induced symptomatology. A shortterm clinical study. Author(s): Wolkotte C, Hassell DR, Moret K, Gerlag PG, van den Wall Bake AW, van der Sande FM, Kooman JP. Source: Nephron. 2002; 92(3): 605-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12372944&dopt=Abstract

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Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Author(s): Santoro A, Mancini E, Basile C, Amoroso L, Di Giulio S, Usberti M, Colasanti G, Verzetti G, Rocco A, Imbasciati E, Panzetta G, Bolzani R, Grandi F, Polacchini M. Source: Kidney International. 2002 September; 62(3): 1034-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12164888&dopt=Abstract

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By reducing production of vascular endothelial growth factor octreotide improves the peritoneal vascular alterations induced by hypertonic peritoneal dialysis solution. Author(s): Gunal AI, Celiker H, Akpolat N, Ustundag B, Duman S, Akcicek F. Source: Perit Dial Int. 2002 May-June; 22(3): 301-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12227386&dopt=Abstract

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Calciphylaxis in chronic, non-dialysis-dependent renal disease. Author(s): Pliquett RU, Schwock J, Paschke R, Achenbach H. Source: Bmc Nephrology [electronic Resource]. 2003 September 29; 4(1): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514359&dopt=Abstract

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Can malnutrition in predialysis patients be prevented by dietetic intervention? Author(s): Cliffe M, Bloodworth LL, Jibani MM. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 July; 11(3): 161-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466667&dopt=Abstract

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Can recovered protein from the CAPD patient's own dialysis effluent substitute for dextrose? Author(s): Sakai A, Takesawa S, Kumano K, Nakamoto M, Horiuchi T, Sakai T, Hidai H. Source: Adv Perit Dial. 1998; 14: 44-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10649689&dopt=Abstract

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Carnitine and hemodialysis. Author(s): Bellinghieri G, Santoro D, Calvani M, Mallamace A, Savica V. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3 Suppl 1): S116-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612967&dopt=Abstract

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Carnitine supplementation improves apolipoprotein B levels in pediatric peritoneal dialysis patients. Author(s): Kosan C, Sever L, Arisoy N, Caliskan S, Kasapcopur O. Source: Pediatric Nephrology (Berlin, Germany). 2003 November; 18(11): 1184-8. Epub 2003 October 02. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523637&dopt=Abstract

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Challenges for chronic dialysis in the new millennium. Author(s): Polaschegg HD, Levin NW. Source: Semin Nephrol. 2000 January; 20(1): 60-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10651219&dopt=Abstract

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Changes in peritoneal equilibration test values during long-term peritoneal dialysis in peritonitis-free children. Author(s): Yoshino A, Honda M, Fukuda M, Araki Y, Hataya H, Sakazume S, Tanaka Y, Kawamura K, Murai T, Kamiyama Y. Source: Perit Dial Int. 2001 March-April; 21(2): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11330563&dopt=Abstract

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Chronic peritoneal dialysis in iron-deficient rats with solutions containing iron dextran. Author(s): Reddy DK, Moore HL, Lee JH, Saran R, Nolph KD, Khanna R, Twardowski ZJ.


Source: Kidney International. 2001 February; 59(2): 764-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11168960&dopt=Abstract •

Chronotherapy of high-dose active vitamin D3 in haemodialysis patients with secondary hyperparathyroidsm: a repeated dosing study. Author(s): Tsuruoka S, Wakaumi M, Sugimoto K, Saito T, Fujimura A. Source: British Journal of Clinical Pharmacology. 2003 June; 55(6): 531-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814446&dopt=Abstract

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Clinical characteristic of parenteral iron supplementation in hemodialysis patients receiving erythropoietin therapy. Author(s): Kao HH, Chen KS, Tsai CJ, Lee CC, Chang HY. Source: Changgeng Yi Xue Za Zhi. 2000 October; 23(10): 608-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11126152&dopt=Abstract

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Clinical experience with a new bicarbonate (25 mmol/L)/lactate (10 mmol/L) peritoneal dialysis solution. Author(s): Otte K, Gonzalez MT, Bajo MA, del Peso G, Heaf J, Garcia Erauzkin G, Sanchez Tomero JA, Dieperink H, Povlsen J, Hopwood AM, Divino Filho JC, Faict D. Source: Perit Dial Int. 2003 March-April; 23(2): 138-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713080&dopt=Abstract

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Clinical outcome in continuous ambulatory peritoneal dialysis patients is not influenced by high peritoneal transport status. Author(s): Park HC, Kang SW, Choi KH, Ha SK, Han DS, Lee HY. Source: Perit Dial Int. 2001; 21 Suppl 3: S80-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887869&dopt=Abstract

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Clinical outcomes of nocturnal dialysis. Author(s): Sherer M. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2002 October; 29(5): 487-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434455&dopt=Abstract

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Comparing peritonitis in continuous ambulatory peritoneal dialysis patients versus automated peritoneal dialysis patients. Author(s): Locatelli AJ, Marcos GM, Gomez MG, Alvarez SA, DeBenedetti LC. Source: Adv Perit Dial. 1999; 15: 193-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682100&dopt=Abstract

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Comparison of the effects of two early intervention strategies on the health outcomes of malnourished hemodialysis patients. Author(s): Wilson B, Fernandez-Madrid A, Hayes A, Hermann K, Smith J, Wassell A.

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Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 July; 11(3): 166-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466668&dopt=Abstract •

Continuous ambulatory peritoneal dialysis (CAPD) adequacy influences serum free carnitine level. Author(s): Grzegorzewska AE, Mariak I, Dobrowolska-Zachwieja A. Source: International Urology and Nephrology. 1999; 31(4): 533-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10668949&dopt=Abstract

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Correlation between peritoneal equilibration test and dialysis adequacy and transport test, for peritoneal transport type characterization. Mexican Nephrology Collaborative Study Group. Author(s): Paniagua R, Amato D, Correa-Rotter R, Ramos A, Vonesh EF, Mujais SK. Source: Perit Dial Int. 2000 January-February; 20(1): 53-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10716584&dopt=Abstract

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Daily use of the physio dialysis system: long-term experience. Author(s): Pastore C, Ruggieri G, Pastore A, Siliberto P, Cristofaro V. Source: Edtna Erca J. 2002 January-March; 28(1): 16-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035896&dopt=Abstract

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Detection of cardiac calcinosis in hemodialysis patients by whole-body scintigraphy with 99m-technetium methylene diphosphonate. Author(s): Eguchi M, Tsuchihashi K, Takizawa H, Nakahara N, Hagiwara M, Ohnishi H, Torii T, Hashimoto A, Marusaki S, Nakata T, Ura N, Shimamoto K. Source: American Journal of Nephrology. 2000 July-August; 20(4): 278-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10970980&dopt=Abstract

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Developing a nutrition education package for Malaysian hemodialysis patients. Author(s): Karupaiah T, Swee CS, Abdullah R. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 October; 11(4): 220-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11680003&dopt=Abstract

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Dialysis adequacy and transport test for characterization of peritoneal transport type in Chinese peritoneal dialysis patients receiving three daily exchanges. Author(s): Szeto CC, Wong TY, Chow KM, Leung CB, Li PK. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 June; 39(6): 1287-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12046043&dopt=Abstract


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Dialysis and gel filtration of isolated low density lipoproteins do not cause a significant loss of low density lipoprotein tocopherol and carotenoid concentration. Author(s): Chopra M, Fitzsimons P, Hopkins M, Thurnham DI. Source: Lipids. 2001 February; 36(2): 205-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11269702&dopt=Abstract

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Dialysis delivery of an adenosine A1 receptor agonist to the pontine reticular formation decreases acetylcholine release and increases anesthesia recovery time. Author(s): Tanase D, Baghdoyan HA, Lydic R. Source: Anesthesiology. 2003 April; 98(4): 912-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657853&dopt=Abstract

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Dialysis-related spondyloarthropathy. Author(s): Brahee DD, Guebert GM, Virgin B. Source: Journal of Manipulative and Physiological Therapeutics. 2001 February; 24(2): 127-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11208225&dopt=Abstract

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Diet or dialysis in the elderly? The DODE study: a prospective randomized multicenter trial. Author(s): Maiorca R, Brunori G, Viola BF, Zubani R, Cancarini G, Parrinello G, De Carli A. Source: Journal of Nephrology. 2000 July-August; 13(4): 267-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10946805&dopt=Abstract

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Differences in assessment of patients with satisfactory or complicated continuous ambulatory peritoneal dialysis courses. Author(s): Grzegorzewska AE, Mariak I, Dobrowolska-Zachwieja A. Source: Adv Perit Dial. 1999; 15: 116-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682084&dopt=Abstract

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Do dialysis patients need extra folate supplementation? Author(s): Lee EY, Kim JS, Lee HJ, Yoon DS, Han BG, Shim YH, Choi SO. Source: Adv Perit Dial. 1999; 15: 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682112&dopt=Abstract

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Dry weight in hemodialysis: volemic control. Author(s): Zucchelli P, Santoro A. Source: Semin Nephrol. 2001 May; 21(3): 286-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11320496&dopt=Abstract

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Early prediction of response to intravenous iron supplementation by reticulocyte haemoglobin content and high-fluorescence reticulocyte count in haemodialysis

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patients. Author(s): Chuang CL, Liu RS, Wei YH, Huang TP, Tarng DC. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 February; 18(2): 370-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543894&dopt=Abstract •

Effect of adequacy of dialysis and nutrition on morbidity and working rehabilitation of patients treated by maintenance hemodialysis. Author(s): Stefanovic V, Stojanovic M, Djordjevic V. Source: Int J Artif Organs. 2000 February; 23(2): 83-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10741802&dopt=Abstract

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Effect of dialyser membrane pore size on plasma homocysteine levels in haemodialysis patients. Author(s): Vriese AS, Langlois M, Bernard D, Geerolf I, Stevens L, Boelaert JR, Schurgers M, Matthys E. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 December; 18(12): 2596-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14605283&dopt=Abstract

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Effect of erythropoietin therapy and selenium supplementation on selected antioxidant parameters in blood of uremic patients on long-term hemodialysis. Author(s): Adamowicz A, Trafikowska U, Trafikowska A, Zachara B, Manitius J. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2002 March; 8(3): Cr202-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887037&dopt=Abstract

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Effect of high dose folic acid therapy on hyperhomocysteinemia in hemodialysis patients: results of the Vienna multicenter study. Author(s): Sunder-Plassmann G, Fodinger M, Buchmayer H, Papagiannopoulos M, Wojcik J, Kletzmayr J, Enzenberger B, Janata O, Winkelmayer WC, Paul G, Auinger M, Barnas U, Horl WH. Source: Journal of the American Society of Nephrology : Jasn. 2000 June; 11(6): 1106-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820175&dopt=Abstract

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Effect of hyperbaric oxygen on striatal metabolites: a microdialysis study in awake freely moving rats after MCA occlusion. Author(s): Badr AE, Yin W, Mychaskiw G, Zhang JH. Source: Brain Research. 2001 October 19; 916(1-2): 85-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11597594&dopt=Abstract


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Effect of L-carnitine supplementation in hemodialysis patients. Author(s): Vesela E, Racek J, Trefil L, Jankovy'ch V, Pojer M. Source: Nephron. 2001 July; 88(3): 218-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11423752&dopt=Abstract

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Effect of L-carnitine supplementation on red blood cells deformability in hemodialysis patients. Author(s): Nikolaos S, George A, Telemachos T, Maria S, Yannis M, Konstantinos M. Source: Renal Failure. 2000 January; 22(1): 73-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718283&dopt=Abstract

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Effect of P-glycoprotein modulators on the pharmacokinetics of camptothecin using microdialysis. Author(s): Tsai TH, Lee CH, Yeh PH. Source: British Journal of Pharmacology. 2001 November; 134(6): 1245-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704644&dopt=Abstract

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Effect of repeated peritonitis on peritoneal membrane function in children on chronic peritoneal dialysis. Author(s): Wang HH, Lin CY. Source: Zhonghua Yi Xue Za Zhi (Taipei). 2002 May; 65(5): 205-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12166764&dopt=Abstract

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Effect of weekly or successive iron supplementation on erythropoietin doses in patients receiving hemodialysis. Author(s): Kato A, Hamada M, Suzuki T, Maruyama T, Maruyama Y, Hishida A. Source: Nephron. 2001 September; 89(1): 110-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11528242&dopt=Abstract

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Effects of L-carnitine supplementation in maintenance hemodialysis patients: a systematic review. Author(s): Hurot JM, Cucherat M, Haugh M, Fouque D. Source: Journal of the American Society of Nephrology : Jasn. 2002 March; 13(3): 708-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11856775&dopt=Abstract

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Effects of methionine loading on plasma and erythrocyte sulphur amino acids and sulph-hydryls before and after co-factor supplementation in haemodialysis patients. Author(s): Suliman ME, Filho JC, Barany P, Anderstam B, Lindholm B, Bergstrom J.

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Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 January; 16(1): 102-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11209001&dopt=Abstract •

Effects of transient forebrain ischemia and radix Salviae miltiorrhizae (RSM) on extracellular levels of monoamine neurotransmitters and metabolites in the gerbil striatum--an in vivo microdialysis study. Author(s): Cheng J, Kuang P, Wu W, Zhang F. Source: J Tradit Chin Med. 1999 June; 19(2): 135-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10681874&dopt=Abstract

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Effects of vitamin supplementation on microcirculatory disturbance in hemodialysis patients without peripheral arterial disease. Author(s): Sato M, Matsumoto Y, Morita H, Takemura H, Shimoi K, Amano I. Source: Clinical Nephrology. 2003 July; 60(1): 28-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872855&dopt=Abstract

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Efficacy and safety of haemodialysis treatment with the Hemocontrol biofeedback system: a prospective medium-term study. Author(s): Basile C, Giordano R, Vernaglione L, Montanaro A, De Maio P, De Padova F, Marangi AL, Di Marco L, Santese D, Semeraro A, Ligorio VA. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 February; 16(2): 328-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11158408&dopt=Abstract

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Efficacy of methylcobalamin on lowering total homocysteine plasma concentrations in haemodialysis patients receiving high-dose folic acid supplementation. Author(s): Koyama K, Usami T, Takeuchi O, Morozumi K, Kimura G. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 May; 17(5): 91622. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11981084&dopt=Abstract

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Elevated plasma vascular endothelial growth factor levels in non-diabetic predialysis uraemia. Author(s): Harper SJ, Downs L, Tomson CR, Dwight JS, Bolton C. Source: Nephron. 2002 March; 90(3): 341-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867956&dopt=Abstract

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Evaluation of an antimicrobial-impregnated continuous ambulatory peritoneal dialysis catheter for infection control in rats. Author(s): Kim CY, Kumar A, Sampath L, Sokol K, Modak S.


Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 January; 39(1): 165-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774116&dopt=Abstract •

Evaluation of changes in serum and dialysate levels of cancer antigen 125 in stable continuous ambulatory peritoneal dialysis patients. Author(s): Passadakis P, Panagoutsos S, Thodis E, Tsivara I, Sopassi F, Kartali S, Vargemezis V. Source: Adv Perit Dial. 1999; 15: 40-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682070&dopt=Abstract

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Evaluation of the effect of uremia on peritoneal permeability in an experimental model of continuous ambulatory peritoneal dialysis in anephric rats. Author(s): Pawlaczyk K, Kuzlan-Pawlaczyk M, Wieczorowska-Tobis K, Polubinska A, Breborowicz A, Oreopoulos D. Source: Adv Perit Dial. 1999; 15: 32-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682068&dopt=Abstract

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Evidence that gender difference affects peritoneal dialysis capacity in continuous ambulatory peritoneal dialysis patients. Author(s): Takane H, Nakamoto H, Moriwaki K, Nemoto H, Sugahara S, Okada H, Suzuki H. Source: Adv Perit Dial. 1999; 15: 156-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682093&dopt=Abstract

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Excess cardiovascular mortality in chronic dialysis patients. Author(s): Abbott KC. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 December; 40(6): 1349-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12460060&dopt=Abstract

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Experience with a large dose (500 mg) of intravenous iron dextran and iron saccharate in peritoneal dialysis patients. Author(s): Prakash S, Walele A, Dimkovic N, Bargman J, Vas S, Oreopoulos D. Source: Perit Dial Int. 2001 May-June; 21(3): 290-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11475345&dopt=Abstract

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Failure of icodextrin to provide adequate ultrafiltration in continuous ambulatory peritoneal dialysis patients. Author(s): Thodis E, Passadakis P, Panagoutsos S, Marinopoulos D, Vargemezis V. Source: Adv Perit Dial. 1999; 15: 171-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682096&dopt=Abstract

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Feasibility of combination chemotherapy with cisplatin and etoposide for haemodialysis patients with lung cancer. Author(s): Watanabe R, Takiguchi Y, Moriya T, Oda S, Kurosu K, Tanabe N, Tatsumi K, Nagao K, Kuriyama T. Source: British Journal of Cancer. 2003 January 13; 88(1): 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556954&dopt=Abstract

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Finding a balance: a grounded theory study of spirituality in hemodialysis patients. Author(s): Walton J. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2002 October; 29(5): 447-56; Discussion 457. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434451&dopt=Abstract

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Folate supplementation in peritoneal dialysis patients with normal erythrocyte folate: effect on plasma homocysteine. Author(s): De Vecchi AF, Patrosso C, Novembrino C, Finazzi S, Colucci P, De Franceschi M, Fasano MA, Bamonti-Catena F. Source: Nephron. 2001 November; 89(3): 297-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598393&dopt=Abstract

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Folic acid and pyridoxal-5'-phosphate losses during high-efficiency hemodialysis in patients without hydrosoluble vitamin supplementation. Author(s): Leblanc M, Pichette V, Geadah D, Ouimet D. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 October; 10(4): 196-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11070147&dopt=Abstract

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Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. Author(s): Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002 January; 12(1): 17-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11823990&dopt=Abstract

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Ginkgo biloba extract preserves pyruvate and enhances ascorbate in the cortex of gerbils during focal cerebral ischemia. A microdialysis-liquid chromatography study. Author(s): Lee MS, Yang DY, Cheng CL, Liang YJ, Yang LL, Cheng FC. Source: J Chromatogr A. 2003 January 24; 985(1-2): 387-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580507&dopt=Abstract

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Hamster bite peritonitis: Pasteurella pneumotropica peritonitis in a dialysis patient. Author(s): Campos A, Taylor JH, Campbell M.


Source: Pediatric Nephrology (Berlin, Germany). 2000 November; 15(1-2): 31-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095007&dopt=Abstract •

Health care management strategies of long-term dialysis survivors. Author(s): Curtin RB, Mapes DL. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2001 August; 28(4): 385-92; Discussion 393-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12143460&dopt=Abstract

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Herbs and supplements in dialysis patients: panacea or poison? Author(s): Dahl NV. Source: Seminars in Dialysis. 2001 May-June; 14(3): 186-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422925&dopt=Abstract

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Herbs, menopause, and dialysis. Author(s): Roemheld-Hamm B, Dahl NV. Source: Seminars in Dialysis. 2002 January-February; 15(1): 53-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11874595&dopt=Abstract

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High peritoneal permeability predisposes to hepatic steatosis in diabetic continuous ambulatory peritoneal dialysis patients receiving intraperitoneal insulin. Author(s): Nevalainen PI, Kallio T, Lahtela JT, Mustonen J, Pasternack AI. Source: Perit Dial Int. 2000 November-December; 20(6): 637-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216552&dopt=Abstract

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High-transport membrane is a risk factor for encapsulating peritoneal sclerosis developing after long-term continuous ambulatory peritoneal dialysis treatment. Author(s): Yamamoto R, Nakayama M, Hasegawa T, Miwako N, Yamamoto H, Yokoyami K, Ikeda M, Kato N, Hayakawa H, Takahashi H, Otsuka Y, Kawaguchi Y, Hosoya T. Source: Adv Perit Dial. 2002; 18: 131-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12402604&dopt=Abstract

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How to improve survival in pre-dialysis patients. Author(s): Macdougall IC. Source: Nephron. 2000; 85 Suppl 1: 15-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10754423&dopt=Abstract

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Human microdialysis. Author(s): Stahl M, Bouw R, Jackson A, Pay V.

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Source: Current Pharmaceutical Biotechnology. 2002 June; 3(2): 165-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022259&dopt=Abstract •

Hydroxyl radicals detected via brain microdialysis in rats breathing air and during hyperbaric oxygen convulsions. Author(s): Amiridze N, Dang Y, Brown OR. Source: Redox Report : Communications in Free Radical Research. 1999; 4(4): 165-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10658821&dopt=Abstract

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Hyperhomocysteinemia in hemodialysis patients: effects of 12-month supplementation with hydrosoluble vitamins. Author(s): Tremblay R, Bonnardeaux A, Geadah D, Busque L, Lebrun M, Ouimet D, Leblanc M. Source: Kidney International. 2000 August; 58(2): 851-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916110&dopt=Abstract

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Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Author(s): Ronco C, Brendolan A, Milan M, Rodeghiero MP, Zanella M, La Greca G. Source: Kidney International. 2000 August; 58(2): 800-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916105&dopt=Abstract

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Impact of fill volume changes on peritoneal dialysis tolerance and effectiveness in children. Author(s): Fischbach M, Terzic J, Menouer S, Bergere V, Ferjani L, Haraldsson B. Source: Adv Perit Dial. 2000; 16: 321-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045320&dopt=Abstract

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Improving the outcome of dialysis--opinion vs scientific evidence. Report on the Dialysis Opinion Symposium at the ERA-EDTA Congress, 6 September 1999, Madrid. Author(s): Ledebo I, Lameire N, Charra B, Locatelli F, Kooistra M, Kessler M, Jacobs C. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2000 September; 15(9): 1310-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10978384&dopt=Abstract

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In vivo microdialysis in the visual cortex of awake cat. I: surgery, animal training and sampling. Author(s): Qu Y, Arckens L, Vandesande F, Vandenbussche E. Source: Brain Research. Brain Research Protocols. 2001 April; 7(1): 38-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11275522&dopt=Abstract


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In vivo microdialysis in the visual cortex of awake cat. III: histological verification. Author(s): Qu Y, Van der Gucht E, Massie A, Vandenbussche E, Vandesande F, Arckens L. Source: Brain Research. Brain Research Protocols. 2001 April; 7(1): 52-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11275524&dopt=Abstract

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Incidence of peritonitis in chronic peritoneal dialysis patients infused with intravenous iron dextran. Author(s): Allen JR, Troidle LK, Juergensen PH, Kliger AS, Finkelstein FO. Source: Perit Dial Int. 2000 November-December; 20(6): 674-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216558&dopt=Abstract

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Incorporating spirituality into the delivery of dialysis care: one team's perspective. Author(s): Carosella J. Source: Adv Ren Replace Ther. 2002 April; 9(2): 149-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085392&dopt=Abstract

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Induction of protein oxidation by intravenous iron in hemodialysis patients: role of inflammation. Author(s): Tovbin D, Mazor D, Vorobiov M, Chaimovitz C, Meyerstein N. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 1005-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407646&dopt=Abstract

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Infusion of total dose iron versus oral iron supplementation in ambulatory peritoneal dialysis patients: a prospective, cross-over trial. Author(s): Ahsan N. Source: Adv Perit Dial. 2000; 16: 80-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045266&dopt=Abstract

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Initiation of dialysis-opinions from an international survey: Report on the Dialysis Opinion Symposium at the ERA-EDTA Congress, 18 September 2000, Nice. Author(s): Ledebo I, Kessler M, van Biesen W, Wanner C, Wiecek A, Prichard S, Argiles A, Ritz E. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 June; 16(6): 1132-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11390711&dopt=Abstract

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Interaction of daunomycin antibiotic with histone H(1): ultraviolet spectroscopy and equilibrium dialysis studies. Author(s): Zargar SJ, Rabbani A.

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Source: International Journal of Biological Macromolecules. 2002 April 8; 30(2): 113-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11911902&dopt=Abstract •

Intermittent hemodialysis and/or continuous renal replacement therapy: are they complementary or alternative therapies? Author(s): Schiffl H. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 1097-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407657&dopt=Abstract

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Is absorption of high-dose oral iron sufficient in peritoneal dialysis patients? Author(s): Dittrich E, Puttinger H, Schneider B, Horl WH, Haag-Weber M, Vychytil A. Source: Perit Dial Int. 2000 November-December; 20(6): 667-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216557&dopt=Abstract

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Is there a role for hemoperfusion/hemodialysis as a treatment option in severe tricyclic antidepressant intoxication? Author(s): Frank RD, Kierdorf HP. Source: Int J Artif Organs. 2000 September; 23(9): 618-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11059884&dopt=Abstract

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L-carnitine in dialysis patients. Author(s): Ahmad S. Source: Seminars in Dialysis. 2001 May-June; 14(3): 209-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422928&dopt=Abstract

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L-Carnitine supplementation in a hemodialysis patient with a mutation in the mitochondrial tRNA(Leu(UUR)) gene. Author(s): Matsumura M, Nakashima A, Araki T, Tofuku Y, Koizumi J, Yagi K, Koni I, Mabuchi H. Source: Nephron. 2000 July; 85(3): 275-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10867544&dopt=Abstract

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L-carnitine use in dialysis patients: is national coverage for supplementation justified? What were CMS regulators thinking--or were they? Author(s): Steinman TI, Nissenson AR, Glassock RJ, Dickmeyer J, Mattern WD, Parker TF 3rd, Hull AR. Source: Nephrol News Issues. 2003 April; 17(5): 28-30, 32-4, 36 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715624&dopt=Abstract

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Lipid-lowering effect of polyunsaturated fatty acids in hemodialysis patients. Author(s): Khajehdehi P.


Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 October; 10(4): 191-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11070146&dopt=Abstract •

Lipid-lowering therapy and coagulation/fibrinolysis parameters in patients on peritoneal dialysis. Author(s): Yorioka N, Masaki T, Ito T, Kushihata S, Nishida Y, Taniguchi Y, Oda H, Yamakido M. Source: Int J Artif Organs. 2000 January; 23(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12118834&dopt=Abstract

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Longitudinal study of peritoneal membrane function in continuous ambulatory peritoneal dialysis: relationship with peritonitis and fibrosing factors. Author(s): Wong TY, Szeto CC, Lai KB, Lam CW, Lai KN, Li PK. Source: Perit Dial Int. 2000 November-December; 20(6): 679-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216559&dopt=Abstract

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Low-density lipoprotein (LDL)-induced monocyte-endothelial cell adhesion, soluble cell adhesion molecules, and autoantibodies to oxidized-LDL in chronic renal failure patients on dialysis therapy. Author(s): O'Byrne D, Devaraj S, Islam KN, Collazo R, McDonald L, Grundy S, Jialal I. Source: Metabolism: Clinical and Experimental. 2001 February; 50(2): 207-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11229431&dopt=Abstract

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Matrix metalloproteinases are active following guanidine hydrochloride extraction of cartilage: generation of DIPEN neoepitope during dialysis. Author(s): Stanton H, Fosang AJ. Source: Matrix Biology : Journal of the International Society for Matrix Biology. 2002 August; 21(5): 425-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12225807&dopt=Abstract

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Measurement and pharmacokinetics of unbound 20(S)-camptothecin in rat blood and brain by microdialysis coupled to microbore liquid chromatography with fluorescence detection. Author(s): Tsai TH, Chen YF, Chou CJ, Chen CF. Source: J Chromatogr A. 2000 February 18; 870(1-2): 221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722080&dopt=Abstract

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Methylenetetrahydrofolate reductase genotype, vitamin B12, and folate influence plasma homocysteine in hemodialysis patients. Author(s): Nakamura T, Saionji K, Hiejima Y, Hirayama H, Tago K, Takano H, Tajiri M, Hayashi K, Kawabata M, Funamizu M, Makita Y, Hata A.

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Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 May; 39(5): 1032-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979347&dopt=Abstract •

Microdialysis in the study of drug transporters in the CNS. Author(s): Sawchuk RJ, Elmquist WF. Source: Advanced Drug Delivery Reviews. 2000 December 15; 45(2-3): 295-307. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11108981&dopt=Abstract

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Modifying the dialysis prescription to reduce intradialytic hypotension. Author(s): Sherman RA. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2001 October; 38(4 Suppl 4): S18-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11602457&dopt=Abstract

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Morpho-functional study of peritoneum in peritoneal dialysis patients. Author(s): Bertoli SV, Buzzi L, Ciurlino D, Maccario M, Martino S. Source: Journal of Nephrology. 2003 May-June; 16(3): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832736&dopt=Abstract

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Multidirectional approach to study peritoneal dialysis fluid biocompatibility in a chronic peritoneal dialysis model in the rat. Author(s): Wieczorowska-Tobis K, Polubinska A, Wisniewska J, Pawlaczyk K, KuzlanPawlaczyk M, Filas V, Breborowicz A, Oreopoulos DG. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 March; 16(3): 655-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11239060&dopt=Abstract

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Natural changes in peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients: a retrospective, seven year cohort survey. Author(s): Hung KY, Huang JW, Tsai TJ, Chen WY. Source: Artificial Organs. 2000 April; 24(4): 261-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10816198&dopt=Abstract

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Nephrology, dialysis and transplantation in Turkey. Author(s): Erek E, Suleymanlar G, Serdengecti K. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 December; 17(12): 2087-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12454217&dopt=Abstract


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Nutritional effects of carnitine supplementation in hemodialysis patients. Author(s): Chazot C, Blanc C, Hurot JM, Charra B, Jean G, Laurent G. Source: Clinical Nephrology. 2003 January; 59(1): 24-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12572927&dopt=Abstract

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Nutritional status in dialysis patients: a European consensus. Author(s): Locatelli F, Fouque D, Heimburger O, Drueke TB, Cannata-Andia JB, Horl WH, Ritz E. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 April; 17(4): 563-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11917047&dopt=Abstract

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Off-pump Coronary Artery Bypass Grafting in patients on chronic hemodialysis. Author(s): Osaka S, Ohsawa H, Miyazawa M, Honda J. Source: Journal of Cardiac Surgery. 2001; 16(4): 302-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11833703&dopt=Abstract

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Online and at home with dialysis. Author(s): Flowers J. Source: Nephrol News Issues. 2003 February; 17(3): 36. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655997&dopt=Abstract

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Optimal hematocrit for the maximum oxygen delivery to the brain with recombinant human erythropoietin in hemodialysis patients. Author(s): Hirakata H, Kanai H, Fukuda K, Tsuruya K, Ishida I, Kubo M, Hirano T, Hirakata E, Kuwabara Y, Fujishima M. Source: Clinical Nephrology. 2000 May; 53(5): 354-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11305808&dopt=Abstract

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Optimization of peritoneal dialysis prescription using computer models of peritoneal transport. Author(s): Haraldsson B. Source: Perit Dial Int. 2001; 21 Suppl 3: S148-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887810&dopt=Abstract

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Oral arginine improves blood pressure in renal transplant and hemodialysis patients. Author(s): Kelly BS, Alexander JW, Dreyer D, Greenberg NA, Erickson A, Whiting JF, Ogle CK, Babcock GF, First MR. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2001 July-August; 25(4): 194202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11434650&dopt=Abstract

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Oral folate reduces plasma homocyst(e)ine levels in hemodialysis patients with cardiovascular disease. Author(s): Stanford JL, Molina H, Phillips J, Kohlman-Trigoboff D, Moore J, Smith BM. Source: Cardiovascular Surgery (London, England). 2000 December; 8(7): 567-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11068219&dopt=Abstract

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Oral intake and serum levels of ascorbic acid in continuous ambulatory peritoneal dialysis patients. Author(s): Lim SL, Lee EJ, Myint CC, Ong KT, Tay ME, Yusuf N, Ong CN. Source: Adv Perit Dial. 2001; 17: 215-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510279&dopt=Abstract

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Oral nutritional supplementation increases caloric and protein intake in peritoneal dialysis patients. Author(s): Boudville N, Rangan A, Moody H. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 March; 41(3): 658-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612990&dopt=Abstract

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Oral supplementation of branched-chain amino acid improves nutritional status in elderly patients on chronic haemodialysis. Author(s): Hiroshige K, Sonta T, Suda T, Kanegae K, Ohtani A. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 September; 16(9): 1856-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11522870&dopt=Abstract

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Oral supplementation with gamma-linolenic acid extracted from Mucor circinelloides improves the deformability of red blood cells in hemodialysis patients. Author(s): Iijima S, Otsuka F, Kikuchi H, Yamada K, Nakajima T, Yahiro K, Kondo A. Source: Nephron. 2000 October; 86(2): 122-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11014980&dopt=Abstract

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Oral versus intravenous iron supplementation in peritoneal dialysis patients. Author(s): Johnson DW, Herzig KA, Gissane R, Campbell SB, Hawley CM, Isbel NM. Source: Perit Dial Int. 2001; 21 Suppl 3: S231-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887827&dopt=Abstract

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Oral vitamin B(12) and high-dose folic acid in hemodialysis patients with hyperhomocyst(e)inemia. Author(s): Manns B, Hyndman E, Burgess E, Parsons H, Schaefer J, Snyder F, ScottDouglas N.


Source: Kidney International. 2001 March; 59(3): 1103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11231366&dopt=Abstract •

Oral vitamin intake in children receiving long-term dialysis. Author(s): Pereira AM, Hamani N, Nogueira PC, Carvalhaes JT. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 January; 10(1): 24-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10671630&dopt=Abstract

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Outcome for continuous ambulatory peritoneal dialysis patients is not predicted by peritoneal permeability characteristics. Author(s): Passadakis PS, Thodis ED, Panagoutsos SA, Selisiou CA, Pitta EM, Vargemezis VA. Source: Adv Perit Dial. 2000; 16: 2-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045251&dopt=Abstract

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Paclitaxel and carboplatin combination chemotherapy in a hemodialysis patient with advanced ovarian cancer. Author(s): Watanabe M, Aoki Y, Tomita M, Sato T, Takaki Y, Kato N, Kikuchi M, Kase H, Tanaka K. Source: Gynecologic Oncology. 2002 February; 84(2): 335-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11812097&dopt=Abstract

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Pasteurella multocida as a rare cause of peritonitis in peritoneal dialysis. Author(s): Van Langenhove G, Daelemans R, Zachee P, Lins RL. Source: Nephron. 2000 July; 85(3): 283-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10867548&dopt=Abstract

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Pasteurella multocida in peritoneal dialysis: a rare cause of peritonitis associated with exposure to domestic cats. Author(s): Kanaan N, Gavage P, Janssens M, Avesani V, Gigi J, Goffin E. Source: Acta Clin Belg. 2002 September-October; 57(5): 254-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534132&dopt=Abstract

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Patients' experiences of a dialysis diet and their implications for the role of the dietitian. Author(s): Sussmann K. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 July; 11(3): 172-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466669&dopt=Abstract

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Patterns of CD4/CD8 T-cell ratio in dialysis effluents predict the long-term outcome of peritonitis in patients undergoing peritoneal dialysis. Author(s): Wang HH, Lin CY, Huang TP. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 June; 18(6): 1181-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748353&dopt=Abstract

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Peritoneal accumulation of advanced glycosylation end-products in diabetic rats on dialysis with icodextrin. Author(s): Lee JH, Reddy DK, Saran R, Moore HL, Twardowski ZJ, Nolph KD, Khanna R. Source: Perit Dial Int. 2000; 20 Suppl 5: S39-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11229611&dopt=Abstract

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Peritoneal equilibration test in Indian patients on continuous ambulatory peritoneal dialysis: does it affect patient outcome? Author(s): Agarwal DK, Sharma AP, Gupta A, Sharma RK, Pandey CM, Kumar R, Masih SP. Source: Adv Perit Dial. 2000; 16: 148-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045281&dopt=Abstract

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Peritoneal sclerosis in peritoneal dialysis patients related to dialysis settings and peritoneal transport properties. Author(s): Plum J, Hermann S, Fussholler A, Schoenicke G, Donner A, Rohrborn A, Grabensee B. Source: Kidney International. Supplement. 2001 February; 78: S42-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11168981&dopt=Abstract

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Peritoneal transport kinetics of proteins in children on chronic peritoneal dialysis. Author(s): Arbeiter K, Stemberger R, Greenbaum L, Mueller T, Konstantin A, Herkner K, Aufricht C. Source: Perit Dial Int. 2003 March-April; 23(2): 162-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713084&dopt=Abstract

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Persistent elevation of C-reactive protein and ischemic heart disease in patients with continuous ambulatory peritoneal dialysis. Author(s): Kim SB, Min WK, Lee SK, Park JS, Hong CD, Yang WS. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 February; 39(2): 342-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11840375&dopt=Abstract


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PGE1 induced transcapillary transport of 51Cr-EDTA in rat skin measured by microdialysis. Author(s): Iversen VV, Reed RK. Source: Acta Physiologica Scandinavica. 2002 December; 176(4): 269-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444932&dopt=Abstract

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Pharmacokinetic study of free mangiferin in rats by microdialysis coupled with microbore high-performance liquid chromatography and tandem mass spectrometry. Author(s): Lai L, Lin LC, Lin JH, Tsai TH. Source: J Chromatogr A. 2003 February 14; 987(1-2): 367-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613830&dopt=Abstract

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Pharmacokinetics of 2-chlorodeoxyadenosine in a child undergoing hemofiltration and hemodialysis for acute renal failure. Author(s): Crews KR, Wimmer PS, Hudson JQ, Howard SC, Ribeiro RC, Razzouk BI. Source: Journal of Pediatric Hematology/Oncology : Official Journal of the American Society of Pediatric Hematology/Oncology. 2002 November; 24(8): 677-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439044&dopt=Abstract

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Pharmacokinetics of paclitaxel and cisplatin in a hemodialysis patient with recurrent ovarian cancer. Author(s): Tomita M, Kurata H, Aoki Y, Tanaka K, Kazama JJ. Source: Anti-Cancer Drugs. 2001 June; 12(5): 485-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11395577&dopt=Abstract

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Pharmacologic B-vitamin therapy for hyperhomocysteinemia in dialysis patients: has the time come? Author(s): Friedman AN. Source: Nutrition in Clinical Care : an Official Publication of Tufts University. 2002 January-February; 5(1): 20-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134715&dopt=Abstract

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Plasma levels of branched chain amino acids in patients on regular hemodialysis before and after including a high-protein supplement in their diet. Author(s): Vuzelov E, Krivoshiev S, Ribarova F, Boyadjiev N. Source: Folia Med (Plovdiv). 1999; 41(4): 19-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10786200&dopt=Abstract

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Possible factors contributing to similar peritoneal dialysis outcome in patients over 60 years of age and the younger ones. Author(s): Grzegorzewska AE, Leander M.

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Source: International Urology and Nephrology. 2002-2003; 34(4): 565-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14577506&dopt=Abstract •

Prevention of haemodialysis-induced hypotension by biofeedback control of ultrafiltration and infusion. Author(s): Schmidt R, Roeher O, Hickstein H, Korth S. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 March; 16(3): 595-603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11239038&dopt=Abstract

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Prolonged administration over six hours of large doses of intravenous iron saccharate (500 mg) prevents severe adverse reactions in peritoneal dialysis patients. Author(s): Aggarwal HK, Tziviskou E, Bellizzi V, Khandelwal M, Moupas L, Bargman JM, Jassal SV, Oreopoulos DG. Source: Perit Dial Int. 2002 September-October; 22(5): 636-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12455582&dopt=Abstract

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Psychological effects of aromatherapy on chronic hemodialysis patients. Author(s): Itai T, Amayasu H, Kuribayashi M, Kawamura N, Okada M, Momose A, Tateyama T, Narumi K, Uematsu W, Kaneko S. Source: Psychiatry and Clinical Neurosciences. 2000 August; 54(4): 393-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10997854&dopt=Abstract

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Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. Author(s): Patel SS, Shah VS, Peterson RA, Kimmel PL. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 November; 40(5): 1013-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407647&dopt=Abstract

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Quantification and characterization of protein loss in continuous ambulatory peritoneal dialysis. Author(s): Cueto-Manzano AM, Gamba G, Correa-Rotter R. Source: Revista De Investigacion Clinica; Organo Del Hospital De Enfermedades De La Nutricion. 2000 November-December; 52(6): 611-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11256103&dopt=Abstract

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Rate dependence of acute PTH release and association between basal plasma calcium and set point of calcium-PTH curve in dialysis patients. Author(s): De Cristofaro V, Colturi C, Masa A, Comelli M, Pedrini LA.


Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 June; 16(6): 1214-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11390723&dopt=Abstract •

Re: Experience with a large dose (500 mg) of intravenous iron dextran and iron saccharate in peritoneal dialysis patients. Author(s): Horl WH. Source: Perit Dial Int. 2001 September-October; 21(5): 527-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11757843&dopt=Abstract

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Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis. Author(s): Tse KC, Yip PS, Lam MF, Li FK, Choy BY, Chan TM, Lai KN. Source: Perit Dial Int. 2002 July-August; 22(4): 488-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12322820&dopt=Abstract

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Reduction in erythropoietin doses by the use of chronic intravenous iron supplementation in iron-replete hemodialysis patients. Author(s): Chang CH, Chang CC, Chiang SS. Source: Clinical Nephrology. 2002 February; 57(2): 136-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11863124&dopt=Abstract

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Report on training sessions at the Prishtina University Hospital Department of Nephrology and Dialysis Unit, 22-29 July 2000, by the Joint Action Nephrology Eastern Europe of ISN and EDTA/ERA. Author(s): Claus S, De Roose J, Lemaire J, Spatzker S, Veys N, Zeier M. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2001 April; 16(4): 701-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11274262&dopt=Abstract

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Results of peritoneal equilibration test during treatment with polyglucose dialysis solution. Author(s): Grzegorzewska AE, Antczak-Jedrzejczak D, Leander M. Source: Perit Dial Int. 2002 May-June; 22(3): 357-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12227394&dopt=Abstract

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Retinal lesions affect extracellular glutamate levels in sensory-deprived and remote non-deprived regions of cat area 17 as revealed by in vivo microdialysis. Author(s): Qu Y, Massie A, Van der Gucht E, Cnops L, Vandenbussche E, Eysel UT, Vandesande F, Arckens L.

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Source: Brain Research. 2003 February 7; 962(1-2): 199-206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543470&dopt=Abstract •

Selected growth factors in peritoneal dialysis: their relationship to markers of inflammation, dialysis adequacy, residual renal function, and peritoneal membrane transport. Author(s): Stompor T, Zdzienicka A, Motyka M, Dembinska-Kiec A, Davies SJ, Sulowicz W. Source: Perit Dial Int. 2002 November-December; 22(6): 670-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556068&dopt=Abstract

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Selenate-supplemented nutritional formula increases plasma selenium in hemodialysis patients. Author(s): Temple KA, Smith AM, Cockram DB. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2000 January; 10(1): 16-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10671629&dopt=Abstract

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Serum isoflavones and soya food intake in Japanese, Thai and American end-stage renal disease patients on chronic haemodialysis. Author(s): Fanti P, Stephenson TJ, Kaariainen IM, Rezkalla B, Tsukamoto Y, Morishita T, Nomura M, Kitiyakara C, Custer LJ, Franke AA. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 September; 18(9): 1862-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12937236&dopt=Abstract

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Severe lead-induced peripheral neuropathy in a dialysis patient. Author(s): Barats MS, Gonick HC, Rothenberg S, Balabanian M, Manton WI. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2000 May; 35(5): 963-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10793035&dopt=Abstract

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Stability of parathyroid hormone ex vivo in haemodialysis patients. Author(s): Teal TK, Reed M, Stevens PE, Lamb EJ. Source: Annals of Clinical Biochemistry. 2003 March; 40(Pt 2): 191-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662412&dopt=Abstract

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Stability of parathyroid hormone in blood from renal patients on haemodialysis. Author(s): Walker KS, Seth J. Source: Annals of Clinical Biochemistry. 2000 November; 37 ( Pt 6): 800-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11085628&dopt=Abstract


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Telecare support for patients undergoing chronic peritoneal dialysis. Author(s): Cargill A, Watson AR. Source: Perit Dial Int. 2003 January-February; 23(1): 91-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691517&dopt=Abstract

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The choice of the dialysate calcium concentration in the management of patients on haemodialysis and haemodiafiltration. Author(s): Malberti F, Ravani P. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 August; 18 Suppl 7: Vii37-40; Discussion Vii57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953028&dopt=Abstract

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The effect of a keto acid supplement on the course of chronic renal failure and nutritional parameters in predialysis patients and patients on regular hemodialysis therapy: the Hungarian Ketosteril Cohort Study. Author(s): Zakar G; Hungarian Ketosteril Cohort Study. Source: Wiener Klinische Wochenschrift. 2001 September 17; 113(17-18): 688-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11603104&dopt=Abstract

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The effect of an iron supplement on serum aluminum level and desferrioxamine mobilization test in hemodialysis patients. Author(s): Huang JY, Wu MS, Wu CH. Source: Renal Failure. 2001 November; 23(6): 789-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11777318&dopt=Abstract

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The effect of high dose losartan on erythropoietin resistance in patients undergoing haemodialysis. Author(s): Odabas AR, Cetinkaya R, Selcuk Y, Keles S, Bilen H. Source: Panminerva Medica. 2003 March; 45(1): 59-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12682621&dopt=Abstract

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The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients. Author(s): Sombolos K, Fragia T, Natse T, Bartholomatos G, Karagianni A, Katsaris G, Christidou F, Bamichas G, Stangou M, Papagalanis N. Source: Journal of Nephrology. 2002 November-December; 15(6): 671-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495282&dopt=Abstract

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The effect of oxidative stress inhibition with trimetazidine on the peritoneal alterations induced by hypertonic peritoneal dialysis solution. Author(s): Gunal AI, Celiker H, Ustundag B, Akpolat N, Dogukan A, Akcicek F.

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Source: Journal of Nephrology. 2003 March-April; 16(2): 225-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768069&dopt=Abstract •

The effect of vitamin B6 and folate supplements on plasma homocysteine and serum lipids levels in patients on regular hemodialysis. Author(s): Ziakka S, Rammos G, Kountouris S, Doulgerakis C, Karakasis P, Kourvelou C, Papagalanis N. Source: International Urology and Nephrology. 2001; 33(3): 559-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230295&dopt=Abstract

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The effect of vitamin E supplementation on antioxidant enzyme activities and lipid peroxidation levels in hemodialysis patients. Author(s): Giray B, Kan E, Bali M, Hincal F, Basaran N. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 2003 December; 338(1-2): 91-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14637272&dopt=Abstract

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The effects of aromatherapy on pruritus in patients undergoing hemodialysis. Author(s): Ro YJ, Ha HC, Kim CG, Yeom HA. Source: Dermatology Nursing / Dermatology Nurses' Association. 2002 August; 14(4): 231-4, 237-8, 256; Quiz 239. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12240499&dopt=Abstract

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The effects of intercessory prayer, positive visualization, and expectancy on the wellbeing of kidney dialysis patients. Author(s): Matthews WJ, Conti JM, Sireci SG. Source: Alternative Therapies in Health and Medicine. 2001 September-October; 7(5): 4252. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11565401&dopt=Abstract

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The effects of zinc supplementation on serum zinc and cholesterol concentrations in hemodialysis patients. Author(s): Chevalier CA, Liepa G, Murphy MD, Suneson J, Vanbeber AD, Gorman MA, Cochran C. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002 July; 12(3): 183-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12105816&dopt=Abstract

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The effects of zinc supplementation on serum zinc concentration and protein catabolic rate in hemodialysis patients. Author(s): Jern NA, VanBeber AD, Gorman MA, Weber CG, Liepa GU, Cochran CC.



The immediate effect of Shakuyaku-kanzo-to, traditional Japanese herbal medicine, for muscular cramps during maintenance hemodialysis. Author(s): Hyodo T, Taira T, Kumakura M, Yamamoto S, Yoshida K, Uchida T, Sakai T, Endo T, Baba S, Hidai H. Source: Nephron. 2002 February; 90(2): 240. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818719&dopt=Abstract

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The long-term effects of single peritonitis episodes on peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients. Author(s): Hung SY, Chung HM. Source: Adv Perit Dial. 2001; 17: 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510273&dopt=Abstract

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The pre-dialysis experience--are individual needs being met? Author(s): Andrew J. Source: Edtna Erca J. 2001 April-June; 27(2): 72-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868751&dopt=Abstract

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The relationship between dialysate protein loss and membrane transport status in peritoneal dialysis patients. Author(s): Cooper S, Iliescu EA, Morton AR. Source: Adv Perit Dial. 2001; 17: 244-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510285&dopt=Abstract

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The role of technology in hemodialysis. Author(s): Ronco C, Ghezzi PM, La Greca G. Source: Journal of Nephrology. 1999 July-August; 12 Suppl 2: S68-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10688405&dopt=Abstract

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The value of gallium-67 and thallium-201 whole-body and single-photon emission tomography images in dialysis-related beta 2-microglobulin amyloid. Author(s): Yen TC, Tzen KY, Chen KS, Tsai CJ. Source: European Journal of Nuclear Medicine. 2000 January; 27(1): 56-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10654148&dopt=Abstract

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Therapeutic effects of oral nutritional supplementation during hemodialysis. Author(s): Caglar K, Fedje L, Dimmitt R, Hakim RM, Shyr Y, Ikizler TA.

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Source: Kidney International. 2002 September; 62(3): 1054-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12164890&dopt=Abstract •

Treatment of mild hyperhomocysteinemia in renal transplant recipients versus hemodialysis patients. Author(s): Bostom AG, Shemin D, Gohh RY, Beaulieu AJ, Jacques PF, Dworkin L, Selhub J. Source: Transplantation. 2000 May 27; 69(10): 2128-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10852611&dopt=Abstract

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Treatment options to intensify hemodialysis. Author(s): Haag-Weber M. Source: Kidney & Blood Pressure Research. 2003; 26(2): 90-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771532&dopt=Abstract

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Ultrafiltration with icodextrins in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Author(s): Neri L, Viglino G, Cappelletti A, Gandolfo C, Cavalli PL. Source: Adv Perit Dial. 2000; 16: 174-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045287&dopt=Abstract

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Use of a catheter-based system to measure blood flow in hemodialysis grafts during angioplasty procedures. Author(s): Vesely TM, Gherardini D, Gleed RD, Kislukhin V, Krivitski NM. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 April; 13(4): 371-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11932367&dopt=Abstract

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Use of bolus intraperitoneal aminoglycosides for treating peritonitis in end-stage renal disease patients receiving continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis. Author(s): Mars RL, Moles K, Pope K, Hargrove P. Source: Adv Perit Dial. 2000; 16: 280-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045311&dopt=Abstract

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Use of bolus intraperitoneal iron dextran in continuous ambulatory peritoneal dialysis or continuous cyclic peritoneal dialysis patients receiving recombinant human erythropoietin. Author(s): Mars RL, Moles K, Pope K, Hargrove P. Source: Adv Perit Dial. 1999; 15: 60-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10682073&dopt=Abstract

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Various clinical approaches to minimise complications in peritoneal dialysis. Author(s): Stegmayr B.


Source: Int J Artif Organs. 2002 May; 25(5): 365-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074332&dopt=Abstract •

Vitamin B(6) therapy does not improve hematocrit in hemodialysis patients supplemented with iron and erythropoietin. Author(s): Weissgarten J, Modai D, Oz D, Chen Levy Z, Cohn M, Marcus O, Dishi V, Galperin E, Averbukh Z. Source: Nephron. 2001 April; 87(4): 328-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287776&dopt=Abstract

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Vitamin B6 supplementation can improve peripheral polyneuropathy in patients with chronic renal failure on high-flux haemodialysis and human recombinant erythropoietin. Author(s): Okada H, Moriwaki K, Kanno Y, Sugahara S, Nakamoto H, Yoshizawa M, Suzuki H. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2000 September; 15(9): 1410-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10978399&dopt=Abstract

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Water-soluble vitamin levels in patients undergoing high-flux hemodialysis and receiving long-term oral postdialysis vitamin supplementation. Author(s): Descombes E, Boulat O, Perriard F, Fellay G. Source: Artificial Organs. 2000 October; 24(10): 773-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091166&dopt=Abstract

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Weekly administration of high-dose sodium ferric gluconate is safe and effective in peritoneal dialysis patients. Author(s): Javier AM. Source: Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association. 2002 April; 29(2): 183-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11997953&dopt=Abstract

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Weekly irinotecan in a patient with metastatic colorectal cancer on hemodialysis due to chronic renal failure. Author(s): Stemmler J, Weise A, Hacker U, Heinemann V, Schalhorn A. Source: Onkologie. 2002 February; 25(1): 60-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11893885&dopt=Abstract

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Zinc supplementation at conventional doses does not improve the disturbance of taste perception in hemodialysis patients. Author(s): Matson A, Wright M, Oliver A, Woodrow G, King N, Dye L, Blundell J, Brownjohn A, Turney J.

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Zora: a pilot virtual community in the pediatric dialysis unit. Author(s): Bers MU, Gonzalez-Heydrich J, Raches D, DeMaso DR. Source: Medinfo. 2001; 10(Pt 1): 800-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11604845&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to dialysis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Abdominal Wall Inflammation Source: Integrative Medicine Communications; www.drkoop.com Amyloidosis Source: Integrative Medicine Communications; www.drkoop.com


Atherosclerosis Source: Healthnotes, Inc.; www.healthnotes.com Bell's Palsy Source: Healthnotes, Inc.; www.healthnotes.com Capillary Fragility Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com High Homocysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperkalemia Source: Integrative Medicine Communications; www.drkoop.com Intermittent Claudication Alternative names: Peripheral Vascular Disease Source: Prima Communications, Inc.www.personalhealthzone.com Peritonitis Source: Integrative Medicine Communications; www.drkoop.com •

Herbs and Supplements Aristolochia Alternative names: Snakeroot, Guaco; Aristolochia sp Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Astragalus Alternative names: Astragalus membranaceus Source: Healthnotes, Inc.; www.healthnotes.com Chitosan Source: Healthnotes, Inc.; www.healthnotes.com Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Dong Quai Alternative names: Angelica sinensis Source: Healthnotes, Inc.; www.healthnotes.com

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Hydroxychloroquine Source: Healthnotes, Inc.; www.healthnotes.com Lepidium Sp Alternative names: Cress; Lepidium sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com Menaquinone Source: Integrative Medicine Communications; www.drkoop.com N-acetyl Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Valproic Acid Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON DIALYSIS Overview In this chapter, we will give you a bibliography on recent dissertations relating to dialysis. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “dialysis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on dialysis, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Dialysis ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to dialysis. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Comparison of Psychosocial Adaptation to Chronic Renal Failure between Middle Aged and Elderly Hemodialysis Patients by Mathers, Terran Reid; Dns from Louisiana State Univ. Health Sciences Center School of Nursing, 2002, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3056870

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A Comparison of the Psychological Effects of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis (anxiety, Depression, Sickness Impact) by Bauer, Barbara Gruger, PhD from University of Missouri - Columbia, 1984, 135 pages http://wwwlib.umi.com/dissertations/fullcit/8425607

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A Hermeneutical Study of the Medical Treatment Decision for End Stage Renal Disease Patients and Their Families (organ Transplantation, Dialysis) by Sloan, Rebecca S., PhD from University of Kentucky, 1996, 232 pages http://wwwlib.umi.com/dissertations/fullcit/9616128

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A Model of Treatment for Machine-dependent Patients (hemodialysis, Dialysis) by Hadge, Andrea, Dsw from New York University, 1986, 198 pages http://wwwlib.umi.com/dissertations/fullcit/8706804

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A Study of Compliance Behavior of Hemodialysis Patients by Sherwood, Roger John, Dsw from Columbia University, 1981, 332 pages http://wwwlib.umi.com/dissertations/fullcit/8125392

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Behavioral Treatment of Depressed Mood in Dialysis Patients by Marcus, Margaret Deirdre, PhD from Washington University, 1983, 134 pages http://wwwlib.umi.com/dissertations/fullcit/8320563

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Children on Dialysis: a Study of Cognitive, Physiological and Psychological Aspects by Rosen, Pola Auerbach, Edd from Columbia University Teachers College, 1980, 103 pages http://wwwlib.umi.com/dissertations/fullcit/8022152

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Chronic Renal Failure : a Study of Death Anxiety in Dialysis and Kidney Transplant Patients by Blakely, Karen B; PhD from The University of Manitoba (canada), 1977 http://wwwlib.umi.com/dissertations/fullcit/NK35825

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Clinical Decisions to Forego Treatment of End Stage Renal Disease: Quality of Life Criteria and Roman Catholic Medical Ethics (dialysis, Renal Disease) by Mullen, Kevin Joseph, PhD from The Catholic University of America, 1989, 484 pages http://wwwlib.umi.com/dissertations/fullcit/9016095

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Cognitive-behavioral Mediators of Dysphoric Mood among Persons Receiving Incenter Hemodialysis by Whitmire, Christina Diann, PhD from University of Denver, 1992, 174 pages http://wwwlib.umi.com/dissertations/fullcit/9306249

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Determining the Calorie Needs of Peritoneal Dialysis Patients Using Indirect Calorimetry by Wunschl, Christine Lynette; Ms from Rush University, 2002, 65 pages http://wwwlib.umi.com/dissertations/fullcit/1411270

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Dialysis or Kidney Transplantation: Factors Associated with the Decision by Bodmer, Susanne Carol; Dsw from Adelphi University, School of Social Work, 2000, 260 pages http://wwwlib.umi.com/dissertations/fullcit/9968168

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Ethical Dilemmas in Medicine: an Anthropological Perspective (intensive Care Nursery, Hemodialysis) by Swyter, Judith L., PhD from The American University, 1984, 399 pages http://wwwlib.umi.com/dissertations/fullcit/8413220

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Evaluation of Microdialysis As a Tool for Studying Percutaneous Drug Absorption and Cutaneous Metabolism by Keene, Warren E.; PhD from University of Southampton (united Kingdom), 2002 http://wwwlib.umi.com/dissertations/fullcit/f745073

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Exploration of the Cooperative Triad in the Investigation of Home Dialysis Patient Outcomes by Macelveen, Patricia Marchman, PhD from University of Colorado at Boulder, 1971, 303 pages http://wwwlib.umi.com/dissertations/fullcit/7217284

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Factors Affecting Treatment Choice in Patients with End Stage Renal Disease (kidney Dialysis, Transplantation) by Phillips, Kevin P., PhD from New York University, 1994, 189 pages http://wwwlib.umi.com/dissertations/fullcit/9531695

Dissertations 201

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Factors Influencing Nursing Turnover and Intent to Stay in Renal Dialysis Units by Sakulkoo, Suwadee; PhD from University of Kansas, 2002, 198 pages http://wwwlib.umi.com/dissertations/fullcit/3082671

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Family Stress and Hemodialysis: an Analysis of Family Stress Variables by Molumphy, Susan Ann Dornacker, PhD from Virginia Polytechnic Institute and State University, 1981, 163 pages http://wwwlib.umi.com/dissertations/fullcit/8126275

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Four Essays on the Dialysis Industry (health Care, Suicide) by Ford, Jon Mark, PhD from Auburn University, 1996, 74 pages http://wwwlib.umi.com/dissertations/fullcit/9629907

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Hemodialysis in Alternative Settings: Case-mix in Freestanding, Hospital-based and Veterans Administration Facilities and Employability of End-stage Renal Disease Patients (freestanding Clinics) by Carter, Stuart, PhD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1991, 184 pages http://wwwlib.umi.com/dissertations/fullcit/9129516

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Interpersonal Competence, Compliance, and Person-centered Speech: Communication in the Delivery of Nursing Care (renal, Dialysis) by Kasch, Chris Randall, PhD from University of Illinois at Urbana-champaign, 1984, 203 pages http://wwwlib.umi.com/dissertations/fullcit/8502198

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Job Satisfaction of Full-time Professional Nurses Employed in Hemodialysis Treatment Facilities by Mulkerne, Donald James Dennis, Jr., PhD from University of Florida, 1980, 111 pages http://wwwlib.umi.com/dissertations/fullcit/8115659

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Mexican-american Women's Perspectives of End-stage Renal Disease and the Hemodialysis Regimen: Psychosocial Influences on Compliance with Treatment Recommendations by Tijerina, Mary Sylvia; PhD from The University of Texas at Austin, 2000, 254 pages http://wwwlib.umi.com/dissertations/fullcit/9992924

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Near Infrared Measurements of Urea and Glucose in Hemodialysis Solutions and Whole Bovine Blood and an Optical Carbon Monoxide Sensor by Eddy, Christopher V.; PhD from The University of Iowa, 2002, 102 pages http://wwwlib.umi.com/dissertations/fullcit/3050792

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Neurochemical Studies of the Pathogenesis of Four Central Nervous System Disorders Parkinson's Disease, Huntington's Chorea, Dialysis Encephalopathy, and Hallervorden-spatz Syndrome by Yong, Voon Wee; PhD from The University of British Columbia (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL36939

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Nutrition-related Variables Reflective of Protein-energy Malnutrition That Predict Morbidity and Mortality in Younger, Middle-aged, and Older Adults Receiving Maintenance Hemodialysis by Burrowes, Jerrilynn Denise; PhD from New York University, 2002, 185 pages http://wwwlib.umi.com/dissertations/fullcit/3045703

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Patient and Spouse Adjustment to Home Hemodialysis: a Test of the Balance Theory of Coordination by Peterson, Kathryn Jean, Dsw from Columbia University, 1981, 415 pages http://wwwlib.umi.com/dissertations/fullcit/8211125

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Personality, Marital, and Family Characteristics of Patients Receiving Dialysis Treatment In-center or at Home by Weisberg, Mark B; PhD from University of Windsor (canada), 1984 http://wwwlib.umi.com/dissertations/fullcit/NK65550

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Problem Solving and Coping Strategies Leading to Salutary Outcomes of Hemodialysis in Well-functioning Adults by Curren, Sheila Caplan, PhD from Institute for Clinical Social Work (chicago), 1997, 236 pages http://wwwlib.umi.com/dissertations/fullcit/9717686

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Quality of Care, Asymmetric Information, and Patient Outcomes in United States Forprofit and Not-for-profit Renal Dialysis Facilities by Irvin, Renee A., PhD from University of Washington, 1998, 168 pages http://wwwlib.umi.com/dissertations/fullcit/9907911

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Quality of Life, Perceived Social Support and Adherence to Fluid Restriction and Treatment Schedule among Hemodialysis Patients by Schneider, Robert Andrew, PhD from University of Maryland at Baltimore, 1995, 148 pages http://wwwlib.umi.com/dissertations/fullcit/9541556

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Relationship between Perceived Family Environment and Medical Status of Longterm Hemodialysis Patients by Gribble, Joann Freeman, Edd from East Texas State University, 1987, 104 pages http://wwwlib.umi.com/dissertations/fullcit/8808001

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Social Support, Coping Methods and Quality of Life in Hemodialysis Patients by Alarabi, Safa'a Ali; PhD from The University of Texas Graduate Sch. of Biomedical Sci. at Galveston, 2003, 252 pages http://wwwlib.umi.com/dissertations/fullcit/3083536

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Surface Characterization of Hollow Fiber Dialysis Membranes Used in Artificial Kidney by Asmanrafat, Mehrdad; Masc from University of Ottawa (canada), 2002, 124 pages http://wwwlib.umi.com/dissertations/fullcit/MQ67789

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The Cost of Maintenance Haemodialysis: Implications for Dialysis Planning by Soroka, Steven Demetri; Msc from University of Alberta (canada), 2002, 145 pages http://wwwlib.umi.com/dissertations/fullcit/MQ69762

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The Diffusion of New Medical Technology in the Presence of Health Insurance: the Cases of Renal Dialysis and Home Total Parenteral Nutrition by De Lissovoy, Gregory V., PhD from The University of North Carolina at Chapel Hill, 1987, 244 pages http://wwwlib.umi.com/dissertations/fullcit/8722284

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The Effect of a Continuing Education Program on the Performance of Hemodialysis Nurses and Their Patient Outcomes by Rao, Cynthia Zane, Edd from Northern Illinois University, 1988, 208 pages http://wwwlib.umi.com/dissertations/fullcit/8900477

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The Effect of Education on Adherence with Oral Iron Supplementation among Hemodialysis Patients by Jones, Ann M.; Ms from D'youville College, 2002, 184 pages http://wwwlib.umi.com/dissertations/fullcit/1410120

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The Effect of Medicaid Prescription Drug Copayment Policy on Health Outcomes and Expenditures in a Dually Enrolled Dialysis Population by Jordan, Neil; PhD from University of Minnesota, 2002, 107 pages http://wwwlib.umi.com/dissertations/fullcit/3047639

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The Effectiveness and Metabolic Consequences of the Use of Amino Acid Versus Glucose Based Dialysis Solutions in Infants and Children Receiving Continuous Ambulatory Peritoneal Dialysis (capd) by Hanning, Rhona Mary; PhD from University of Toronto (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL31412

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The Effectiveness of Hypnotherapy and Behavioral Coaching in Improving Medical Compliance, Altering Locus-of-control, and Lowering Anxiety among Externallyoriented, Noncompliant Hemodialysis Patients (behavior Modification) by Tobin, Michael Patrick, PhD from Loyola University of Chicago, 1987, 247 pages http://wwwlib.umi.com/dissertations/fullcit/8704862

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The Impact of Dietary Compliance on the Quality of Life of Hemodialysis Patients by Black, Peggy Lou; PhD from University of Pittsburgh, 1999, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9957707

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The Long-term Effectiveness of Dialysis, Kidney Transplantation and Pancreas Transplantation for Patients with Diabetes Mellitus and Renal Failure: a Decision Analysis by Knoll, Gregory Allan; Msc from University of Ottawa (canada), 2002, 122 pages http://wwwlib.umi.com/dissertations/fullcit/MQ72774

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The Minnesota Multiphasic Personality Inventory-2 in Assessing Personality Traits Associated with Dietary Non-adherence to Dialysis by Vinci, Lorraine Grace; Psyd from Carlos Albizu University, 2002, 93 pages http://wwwlib.umi.com/dissertations/fullcit/3054228

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The Social Networks of People with End Stage Renal Disease: Comparing Hemodialysis and Peritoneal Dialysis Patients (hemodialysis Patients) by Shelley, Gene Ann, PhD from University of Florida, 1992, 262 pages http://wwwlib.umi.com/dissertations/fullcit/9304051

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The Spectrum of Adherence among the Chronically Ill: the Association between the Marital Family System and the Adherence Behavior of Hemodialysis Patients by Barsa Del Alcazar, Christine Louise, PhD from University of Pennsylvania, 1996, 181 pages http://wwwlib.umi.com/dissertations/fullcit/9712887

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Time Perspective of Dialysis Patients: an Interpretive Study by Stodola, Edward M., PhD from University of Kentucky, 1986, 198 pages http://wwwlib.umi.com/dissertations/fullcit/8705305

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND DIALYSIS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning dialysis.

Recent Trials on Dialysis The following is a list of recent trials dedicated to dialysis.8 Further information on a trial is available at the Web site indicated. •

Comparison of daily nocturnal hemodialysis with daily hemodialysis Condition(s): Kidney Failure, Chronic Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: Hemodialysis remains associated with a high mortality (approximately 22% per year) and many complications despite improvements over the last twenty years. Several nephrologists have suggested that increasing the frequency and amount of dialysis will result in improved outcomes. In fact, various forms of daily dialysis have been performed in over 300 patients in the last 30 years with improvements in blood pressure, quality-of-life, bone disease, and other complications of renal failure. Whether this form of treatment can be expanded to the 220,000 Americans on hemodialysis is unknown. The primary outcome of this study is to determine the effectiveness of nocturnal dialysis in hemodialysis patients in St. Louis. If the pilot study is effective, then participation in a larger, multicenter trial is expected. The endpoints measured are use of antihypertension medications, improvement in secondary hyperparathyroidism and use of phosphorus binders, quality-of-life measured by SF-36 surveys, and improvement in physical function as measured by maximal oxygen uptake. Study Type: Interventional Contact(s): see Web site below

8

These are listed at www.ClinicalTrials.gov.

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Web Site: http://clinicaltrials.gov/ct/show/NCT00012441 •

Evaluate the Survival Benefits of Zemplar versus Calcijex in Subjects w/ Stage V Chronic Kidney Disease on Hemodialysis Condition(s): End-Stage Kidney Disease Study Status: This study is currently recruiting patients. Sponsor(s): Abbott Laboratories Purpose - Excerpt: To evaluate the survival benefit associated with Zemplar therapy as compared to Calcijex for the treatment of secondary hyperparathyroidism in subjects with Stage V chronic kidney disease on hemodialysis as measured by time to death. Phase(s): Phase IV Study Type: Observational Contact(s): Julie Rock 847-937-3286 [email protected] Web Site: http://clinicaltrials.gov/ct/show/NCT00062699

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Hypertension in Hemodialysis Condition(s): Hypertension; hemodialysis; Left Ventricular Hypertrophy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: How we should diagnose high blood pressure in hemodialysis patients and treat it using medications or without medications is the purpose of this study Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00067665

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Randomized Study of Folic Acid Therapy for Hyperhomocysteinemia in Patients with End Stage Renal Disease Receiving Hemodialysis Condition(s): End Stage Renal Disease; Hyperhomocysteinemia Study Status: This study is currently recruiting patients. Sponsor(s): FDA Office of Orphan Products Development; Georgetown University Purpose - Excerpt: Objectives: I. Compare the efficacy of two doses of folic acid in normalizing plasma total homocysteine concentration in patients with end stage renal disease receiving regular hemodialysis therapy resulting in hyperhomocysteinemia. II. Determine the requirement of cosupplementation with extra pyridoxine (vitamin B6) and cyanocobalamin (vitamin B12) daily in these patients. III. Assess the safety and tolerability of this therapy in these patients. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004495

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Randomized Study of Recombinant Human Growth Hormone in Patients on Chronic Hemodialysis or Peritoneal Dialysis Condition(s): Kidney Failure, Chronic Study Status: This study is currently recruiting patients. Sponsor(s): FDA Office of Orphan Products Development; Vanderbilt University Medical Center Purpose - Excerpt: Objectives: I. Assess the clinical safety and long term effects of recombinant human growth hormone on a defined range of nutritional indices in malnourished chronic hemodialysis and continuous ambulatory peritoneal dialysis patients. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004429

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Study to evaluate the effectiveness of StaphVAX in adults on hemodialysis Condition(s): Staphylococcal Infections; Kidney Failure, Chronic Study Status: This study is currently recruiting patients. Sponsor(s): Nabi Biopharmaceuticals Purpose - Excerpt: Two part study testing the effectiveness and safety of StaphVAX vaccine in chronic hemodialysis patients against infection by Staphylococcus aureus Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00071214

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A Study of an Investigational Medication for the Treatment of Secondary Hyperparathyroidism in Patients on Dialysis Condition(s): Secondary Hyperparathyroidism; End Stage Renal Disease Study Status: This study is no longer recruiting patients. Sponsor(s): Amgen Purpose - Excerpt: This 6 month study will assess an investigational medication for patients on dialysis with secondary hyperparathyroidism. The study will look at the effects on parathyroid hormone, calcium and phosphorus levels. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00042653

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An study of switching from maintenance treatment with intravenous epoetin alfa to maintenance treatment with intravenous Ro 50-3821 in hemodialysis patients with chronic renal anemia Condition(s): Anemia

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Study Status: This study is no longer recruiting patients. Sponsor(s): Hoffmann-La Roche Purpose - Excerpt: The purpose of this study is to evaluate switching from i.v. epoetin alfa to Ro 50-3821 in hemodialysis patients with chronic renal anemia. How often Ro 503821 needs to be administered to provide a stable hemoglobin levels after switching from epoetin alfa will also be evaluated. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00048035 •

Risk Factors for CV Disease in a Dialysis Cohort Condition(s): Cardiovascular Diseases; Heart Diseases; Atherosclerosis; Kidney Failure, Chronic Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate whether traditional risk factors and novel risk factors predict higher risk of atherosclerotic cardiovascular disease (ASCVD) in a prospective study of incident dialysis patients. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006297

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A Study of an Investigational Medication for the Treatment of Secondary Hyperparathyroidism in Dialysis Patients Condition(s): Secondary Hyperparathyroidism; End Stage Renal Disease Study Status: This study is completed. Sponsor(s): Amgen Purpose - Excerpt: This 6 month long study will assess an investigational medication for patients on dialysis with secondary hyperparathyroidism. The study will look at the effects on parathyroid hormone, calcium and phosphorus levels. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00037635

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Pharmacokinetics/Pharmacodynamics of Argatroban Injection in End-Stage Renal Disease Patients Undergoing Hemodialysis Condition(s): Kidney Failure, Chronic; Renal Disease, End-Stage Study Status: This study is completed. Sponsor(s): Texas Biotechnology Corporation

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Purpose - Excerpt: The primary goals of this investigation are to provide guidance on how to dose Argatroban in patients undergoing hemodialysis and to assess the safety and tolerability of Argatroban in hemodialysis patients. The secondary goal of the study will be to assess the adequacy of anticoagulation during hemodialysis. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00035178 •

Phase II Randomized Study of Standard vs High Amount of Hemodialysis Using Low vs High Flux Dialyzer Membranes for End Stage Renal Disease Condition(s): End Stage Renal Disease Study Status: This study is completed. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); University of Rochester Purpose - Excerpt: Objectives: I. Evaluate whether hemodialysis providing a 2-pool, variable volume urea kinetic modelling value of 1.05 versus 1.45 reduces mortality and morbidity in patients with end stage renal disease. II. Compare the efficacy of high versus low flux dialyzer membranes. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004285

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Phase II Randomized Study of the Effects of Growth Hormone on Children and Adolescents on Maintenance Dialysis Condition(s): Renal Osteodystrophy; End Stage Renal Disease Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); University of California, Los Angeles Purpose - Excerpt: Objectives: I. Evaluate the separate and combined skeletal effects of recombinant human growth hormone (GH) and calcitriol in patients with adynamic renal osteodystrophy. II. Assess whether calcium-regulated changes in parathyroid hormone secretion predict changes in bone formation. III. Characterize the response to GH in cancellous bone and in growth plate cartilage in patients with secondary hyperparathyroidism during calcitriol therapy. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004340

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Safety and Effectiveness of Zemplar Injection in decreasing iPTH levels in pediatric ESRD subjects on hemodialysis Condition(s): Secondary Hyperparathyroidism; End Stage Renal Disease Study Status: This study is completed. Sponsor(s): Abbott Laboratories Purpose - Excerpt: The purpose of this study is to see if Zemplar, a vitamin D medication, safely and effectively decreases parathyroid hormone in children ages 2-20 with End Stage Renal Disease. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00053547

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “dialysis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON DIALYSIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “dialysis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on dialysis, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Dialysis By performing a patent search focusing on dialysis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on dialysis: •

Activated immunoglobulin Inventor(s): Fukata; Yuriko (Hyogo, JP), Naiki; Mitsuru (Hyogo, JP), Yoshii; Haruo (Hyogo, JP) Assignee(s): Nippon Zoki Pharmaceutical Co., Ltd. (Osaka, JP) Patent Number: 6,627,194 Date filed: August 8, 1996 Abstract: Activated immunoglobulin which is useful as an eosinophilia-suppressing agent, immunomodulating agent, therapeutic agent for autoimmune diseases, anfiinflammatory agent and antiallergic agent is obtained by admixing immunoglobulin with a histamine component and then substantially or completely removing the histamine component. The histamine component may be removed or separated by dialysis, gel filtration, adsorption chromatography, ion exchange chromatography, or affinity chromatography. The method imparts pharmacological activity which is not inherently available in immunoglobulin of the natural type to immunoglobulin. The activated immunoglobulin of the present invention has an immunomodulating action which is clearly different from that of conventional immunosuppressive agents. It is useful as a therapeutic agent for autoimmune diseases such as chronic rheumatoid arthritis, systemic lupus erythematodes and multiple sclerosis as well as for various immunodeficiency syndromes wherein the immune system is not functioning properly. The activated immunoglobulin of the present invention may be also used as a pharmaceutical agent for eosinophilia caused by infectious diseases, parasitic diseases, diseases of respiratory organs, autoimmune diseases, malignant tumors, etc. In addition, the product of the invention may be used as an excellent antiinflammatory agent and antiallergic agent, and so is highly useful as a pharmaceutical. Excerpt(s): The present invention relates to a method for imparting pharmacological activities to immunoglobulin such as eosinophilia-suppressive action, immunomodulating action, therapeutic action for autoimmune disease, antiinflammatory action, antiallergic action, etc. which are not inherent to naturally occurring immunoglobulin. The present invention also relates to activated immunoglobulin obtained by said method and to pharmaceutical compositions containing said activated immunoglobulin. When a foreign substance invades a living organism, various reactions take place in the organism for removing the foreign substance. One of the reactions is the immune reaction whereby a specific protein (antibody) corresponding to the foreign substance (antigen) is produced. The immune reaction is a vital reaction for defending the organism against the invasion of foreign substances such as pathogens and various other proteins, polysaccharides, etc. The nature of the immune reaction is based upon an antigen-antibody reaction in which antibody is bonded to antigen in a specific manner. The main activity of an antibody is a binding activity which is specific to an antigen. When an antigen is in the form of particles such as bacteria, an agglutination reaction due to the formation of cross-linking of the antibody among the particles is induced. When an antigen has toxicity, enzymatic activity, etc., a neutralization reaction due to binding of the antibody or a hemolytic reaction, bacteriolytic reaction, immune adherence reaction, immunophagocytosis, etc. due to activation by binding of an antigen-antibody complex with complement

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components in the blood are induced. These reactions constitute immune response reactions in a living organism against the invasion of a foreign substance. Web site: http://www.delphion.com/details?pn=US06627194__ •

Apparatus and method for determination of the adequacy of dialysis by non-invasive near-infrared spectroscopy Inventor(s): Robinson; Mark Ries (Albuquerque, NM) Assignee(s): Inlight Solutions, Inc. (Albuquerque, NM) Patent Number: 6,636,759 Date filed: March 28, 2001 Abstract: Methods and apparatus for non-invasive tissue urea concentrations during or subsequent to hemodialysis using near-infrared spectroscopy are discussed. Nearinfrared tissue spectra can be obtained by projecting near-infrared radiation into skin on the underside of human forearms and capturing the light reflected back and out through the tissue. An index matching medium is used to couple the tissue to the analyzer. The tissue spectrum collected preferably includes primarily diffuse reflected light reflected from the inner dermis. Multiple tissue spectra of known urea concentration are used to build a model from which the urea concentration of an unknown sample can be devised. The model is based on a partial least squares algorithm applied to multiple tissue scans and concomitant blood sample urea measurements. This model is then applied to an unknown tissue spectra. Excerpt(s): The present invention relates generally to methods and systems for determining the adequacy of treatment during hemodialysis of a patient utilizing a noninvasive near-infrared tissue analysis. More specifically, the invention relates to direct measurement of urea concentrations in tissue of patients undergoing dialysis with light diffusely reflected by skin in conjunction with a spectrographic model, which relates urea concentration to a diffusely reflected light spectrum. Measurement of the efficacy of hemodialysis treatments is currently time consuming, inaccurate and expensive. Approximately 260,000 Americans suffer from end-stage renal disease (ESRD). Fiftynine percent are treated by thrice-weekly maintenance hemodialysis sessions designed to clear the products of metabolism that are normally excreted by the kidneys in the urine. Since the failure to adequately dialyze a patient has been shown to increase mortality and morbidity and since the process of dialyzing an ESRD patient is complex and variable in terms of the efficiency of the treatment, a number of methods have been developed to quantify the effectiveness of the treatment. The technique used in the overwhelming majority of dialysis centers is based on pre- and post-dialysis measurements of blood urea nitrogen concentrations. Urea, a low-molecular weight molecule, is a product of protein metabolism that is normally cleared from the body by the kidneys. Because it is also cleared from the blood by the dialysis process and easily measured in blood, its disappearance from the blood during hemodialysis is a measure of the efficacy or adequacy of that particular treatment session. The process of removal of toxins from the body by hemodialysis is best represented as a logarithmic function. As such, the coefficient of the natural logarithm termed KT/Vd, which is calculated from pre- and post-dialysis measurements of blood urea concentrations, can be used as a single descriptor of dialysis adequacy. The importance of adequate duration or dose of hemodialysis has been underscored recently by the observation that the adjusted mortality of patients with renal disease in the United States exceeds that of several other countries, despite a longer life expectancy of the general population of the United States.

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A number of studies have documented the failure to deliver an adequate dose of hemodialysis to many Americans. The failure of delivery of adequate hemodialysis doses in the United States is a result of many factors. Time and financial pressures contribute to the problem. Because the metabolic toxins are removed from the blood, which makes up only a fraction of the total volume of the body in which the toxins are distributed, there are delays as the solutes redistribute and equilibrate after dialysis. Thus, measurement of KT/Vd is highly dependent on the time of the urea measurements and the relative size of the compartments such as blood water, interstitial water and intracellular water, all of which harbor urea and other contaminants. These compartments vary in size from patient to patient, and within a patient depending upon present physiologic state. The best measure of the post-dialysis urea is made at least 15 minutes after hemodialysis, but for some patients it may require 50 to 60 minutes to reach equilibrium. There is no accurate way to predict which patients will have a significant blood urea increase following hemodialysis at any given treatment time. Given the time constraints on out-patient hemodialysis centers that commonly are able to dialyze no more than two patients per day on a single machine, one in the morning and one in the afternoon, the need to obtain post-dialysis blood urea concentrations 30 to 60 minutes after dialysis is impractical at best. Finally, the late blood measurement requires an additional venipuncture of the patient who is disconnected from the dialysis machine minutes after cessation of circulation through the machine. Web site: http://www.delphion.com/details?pn=US06636759__ •

Apparatus and method for in vivo hemodialysis Inventor(s): Gorsuch; Reynolds G. (Yountville, CA) Assignee(s): Transvivo, Inc. (Napa, CA) Patent Number: 6,561,996 Date filed: May 19, 1998 Abstract: A method of removing toxins from a patient's blood comprises implanting a filter device having a dialysis membrane with an exterior surface exposed to the patient's blood and a dialysate cavity exposed to an interior surface of the dialysate membrane within a blood vessel of a patient, continuously directing substantially uncontaminated or substantially decontaminated dialysate into the dialysate cavity and in diffusive communication with the patient's blood, dialysing the patient's blood with the dialysate, and continuously removing toxin contaminated dialysate from the filter device. Excerpt(s): Treatment for acute kidney failure and chronic end stage renal disease is accomplished by various forms of continuous ambulatory peritoneal dialysis and hemodialysis, presently the most commonly used form of therapy. In all current hemodialysis procedures, blood is periodically removed from the patient's body, dialyzed ex-vivo and the treated blood returned to the body. Single patient conventional hemodialysis procedures are performed at an out-patient center 2 or 3 times a week in 3 to 4 hour sessions during which the patient's blood toxins are removed by dialysis and filtration to eliminate the toxins generated by the body during the 3 or 4 day period preceding the hemodialysis, and during the time the treatment is carried out. Thus, unlike normal kidney function in which dialysis is carried out continuously, the hemodialysis creates non-uniform toxin removal with "peaks and valleys" of toxin concentrations. Moreover, during the time that the toxins are above normal, the patient feels ill and the consequent buildup of fluid volume in the body caused by lack of

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urination results in a severe volume load on the right heart stressing an already compromised cardiovascular system, as well as creating an imbalance in the electrolyte system of the blood. During the hemodialysis, blood is pumped from the body and through a dialyzer cartridge at a high flow rate and simultaneously fluid is removed from the blood by ultrafiltration to reduce the blood volume to normality. The resulting procedure causes a massive change in blood hemodynamics in a short period of time and produces additional heavy stress on the human system with severe fluctuations in blood pressure and trauma to other body organs. Yet another serious problem is the persistent and periodic clotting of the blood in the inner lumens of the dialyzer even though the patient is anti-coagulated with drugs such as heparin. The aforesaid current hemodialysis procedures are performed on over 600,000 patients per year in the United States alone at an expense to the healthcare system of over twelve billion dollars per year. In U.S. Pat. Nos. 4,590,224, 5,151,082, 5,152,743, 5,224,926 and 5,735,809 there are disclosed methods and apparatus for in vivo separation of plasma from blood utilizing one or more hollow elongated microporous fibers implanted within a patient's blood vessel. The fibers are made of a microporous polymeric fiber membrane material having a pore size sufficient to allow diffusion of plasma into the hollow fiber interior but preventing cellular components larger than plasma to diffuse, ultrafiltrate or enter the fiber interior. The fiber or fibers are implanted within the blood vessel without significantly obstructing fluid flow through the vessel while providing the aforesaid in vivo plasma separation. The fiber assembly is secured in fluid communication with a catheter, preferably a dual lumen catheter having a first tube permitting plasma passage from the fiber and a second tube for returning plasma to the blood vessel after treatment. Various configurations and methods of fabrication as well as materials having a variety of characteristics and performance abilities are disclosed in the aforesaid patents and application as are various systems, apparatus, components and methods for use including measurement of blood parameters, kidney dialysis, and separation and removal of a substantial number of specific materials and plasma components, the descriptions of which are incorporated herein by reference. By continuously extracting plasma from the blood in-vivo and dialyzing only the plasma ex-vivo eliminates many of the failings of the present hemodialysis systems and procedures. The present invention is intended to provide further improvement in removing toxins from a patient's blood. In the present invention, all of the function of kidney dialysis therapy can be performed continuously in-vivo and in-situ without removing from the body any blood, plasma or blood components except the toxins and other undesirable elements to be eliminated, thus substantially emulating the natural kidney. Web site: http://www.delphion.com/details?pn=US06561996__ •

Apparatus and method for preparation of a peritoneal dialysis solution Inventor(s): Taylor; Michael A. (Napa, CA) Assignee(s): PrISMedical Corporation (Napa, CA) Patent Number: 6,623,709 Date filed: July 30, 2002 Abstract: The invention provides an apparatus and method for storing and transporting peritoneal dialysate in dry or lyophilized form, and for forming a deliverable peritoneal dialysis solution therefrom. In one embodiment, a dry reagent bed, including reagents sufficient to produce a dialysis solution, is suspended in a diluent flow path through the

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apparatus housing. Continuous pressure on the reagent bed causes the bed to compact as it erodes when purified water is passed through the housing. The pressure ensures complete and even dissolution of the reagents. Through dry storage and simple dissolution, even in a home, the invention enables a wider variety of solution constituents, including reduced acid content and the use of bicarbonate as a stable buffer component. The latter is illustrated in a double-bed embodiment, where bicarbonate is stored separately from calcium or magnesium salts within a single housing. Excerpt(s): The invention generally relates to peritoneal dialysis, and more particularly to devices and methods for producing a peritoneal dialysis solution from dry reagents. Treatments for patients having substantially impaired renal function, or kidney failure, are known as "dialysis." Either blood dialysis ("hemodialysis") or peritoneal dialysis methods may be employed. Both methods essentially involve the removal of toxins from body fluids by diffusion of the toxins from the body fluids into a toxin free dialysis solution. Hemodialysis involves removing blood from the patient, circulating the blood through a dialysis machine outside the body, and returning the blood to the patient. As the blood is directly in contact with the hemodialysis membrane, the patient ordinarily needs to be treated only 3-5 hours at a time, about three times per week. Unfortunately, hemodialysis requires the use of complex and expensive equipment, and can therefore normally only be performed under controlled conditions of a hospital or other specialized clinic. Web site: http://www.delphion.com/details?pn=US06623709__ •

Apparatus and method for the dialysis of blood Inventor(s): Estabrook; Brian K. (Foxboro, MA), Prosl; Frank R. (Duxbury, MA) Assignee(s): Biolink Corporation (Mansfield, MA) Patent Number: 6,620,118 Date filed: November 23, 1999 Abstract: Improved apparatus and method for the dialysis of blood. The improved apparatus comprises a subcutaneous port and catheter assembly comprising a connector portion comprising a subcutaneous port element, and a catheter portion comprising a catheter element. The improved apparatus also comprises a novel percutaneous catheter assembly comprising a catheter portion comprising a catheter element, and a connector portion comprising an extracorporeal connector element. Excerpt(s): This invention relates to the dialysis of blood in general, and more particularly to apparatus and methods for use in the same. A healthy kidney removes toxic wastes and excess water from the blood. In End Stage Renal Disease ("ESRD"), or chronic kidney failure, the kidneys progressively stop performing these essential functions over a long period of time. When the kidneys fail, a patient dies within a short period of time unless that patient receives dialysis treatment for the rest of that patient's life or undergoes transplantation of a healthy, normal kidney. Because few kidneys are available for transplantation, the overwhelming majority of patients with ESRD receive dialysis treatment. Hemodialysis therapy is an extracorporeal (i.e., outside the body) process which removes toxins and water from a patient's blood. A hemodialysis machine pumps blood from the patient, through a dialyzer, and then back to the patient. The dialyzer removes the toxins and water from the blood by a membrane diffusion principle. Typically, a patient with chronic kidney disease requires hemodialysis three times per week for 3-6 hours per session. Removing blood from the body requires a

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vascular access to the patient's blood system. This vascular access can be accomplished by surgically modifying the patient's own blood vessels or attaching an artificial device to the vessels. If the vascular access site is entirely beneath the skin, the skin and the vascular site must be punctured by a needle attached to blood tubing. This needle and tubing is typically called a "set". Web site: http://www.delphion.com/details?pn=US06620118__ •

Apparatus for implementing hyperthermia Inventor(s): Clupper; Marc (Hampstead, NC), Fausset; Michael (Lafayette, IN), Keeling; Glenn (McMurray, PA), Rainier; Brad (Noblesville, IN) Assignee(s): Viacirq, Inc. (Pittsburgh, PA) Patent Number: 6,579,496 Date filed: May 25, 1999 Abstract: An apparatus and system for extracorporeal treatment utilizes a hemodialysis machine capable of heating dialysis fluid to 48.degree. C., an optional parallel plate hemodialyzer together with a sorbent-based detoxifier, a tubular heat exchanger and a high flow pump--in addition to various probes and catheters--to effect extracorporeal treatment without adverse physiological effect and without the specific need for general anesthesia. The system inheres in the combined high flow of the pump-up to 2400 ml per minute--and the high temperature--52.degree. C.--achievable in the heat exchanger, which together provide unprecedented speed and efficiency in the administration of hyperthemia treatments. The system is also a potentiating system in the administration of heat sensitive pharmaceutically active agents and is praticularly useful in the isolated anatomic areas of a patient. Excerpt(s): The present invention relates to a specialized method for hyperthermia, including extracorporeal blood heating and sorbent-based detoxification, as an antiviral and antineoplasm protocol. Hyperthemia as a treatment of tumors has been carefully studied and applied since the 1960's. Prior to that time there were multiple reports of tumor regression coincident with febrile episodes. Subsequent analysis revealed that temperatures greater than 41.degree. C. are ordinarily needed to induce tumor necrosis (tumor death). Although there are multiple methods of inducing hyperthermia by either direct skin contact or radiant heating, many physicians now favor an extracorporeal heat exchange (blood) circuit to raise patient temperatures. Patients may be maintained at 41.5.degree. C. to 42.degree. C. (rectal temperature) for three to four hours without severe cardiovascular compromise, although others report elevation of serum transaminases and bilirubin in patients kept at these temperatures for greater than 10 to 40 minutes. Instances of neurologic damage have been reported in association with serum hypophosphatemia, although no significant problems occurred once phosphate levels were maintained. Deaths have also been reported in two patients receiving hiyperthermia at 41.5.degree. C. to 42.degree. C. for 1-1/2 to 2 hours, presumably from massive liver tumor necrosis. DcMoss, J. L. et al., "Hyperthermia in the Treatment of Cancer," The Journal of Extra-Corporeal Technology, Volume 17, No. 1, pp. 37-43, 1985, explains that tumors are vulnerable to heal and that the goal of hyperthermic treatment therapy is to achieve cytotoxic temperatures in the tumor for a sufficient length of time without damaging the surrounding normal tissue. The rate at which blood flows through any given area of tissue. determines the amount of heat that may be carried away and therefore is a major determinant of the temperature rise in that tissue. In normal tissue, heat causes vasodilation. In a tumor, the microvasculature is made up of

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an overabundance of capillary beds which are unable to dilate. Blood flow through the area is thus more sluggish and commensurately unable to dissipate heat applied to the area. The inability to respond to heat by dilation, as normal vasculature would, also subjects the tumor to hypoxia, anaerobic metabolism and local acidosis, and these conditions in turn make the tumor tissue more vulnerable to thermal injury. Web site: http://www.delphion.com/details?pn=US06579496__ •

Blood treatment device and disposable kit for a blood treatment device Inventor(s): Beden; Josef (Mainz-Kastel, DE), Hahmann; Uwe (Bad Homburg, DE), Herklotz; Martin (Heusenstamm, DE), Lauer; Martin (St. Wendel, DE), Manke; Joachim (Lohnberg, DE), Scheunert; Peter (Friedrichsdorf, DE), Weis; Manfred (St. Wendel, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,645,166 Date filed: August 27, 2001 Abstract: A blood treatment device, in particular a dialysis machine, which permits both single-needle and dual-needle operation. The device has a blood treatment unit, in particular a dialyzer that has an inlet connected to a feed line and an outlet connected to a return line. The feed line has two parallel line branches with a positive displacement pump being connected into the first and second line branches. To produce a fluid connection between the outlet of the dialyzer and one of the two pumps, a connection line is provided. For dual-needle operation, the feed and return lines are connected to an arterial and a venous needle. For single-needle operation, the feed and return lines are brought together and connected to a common needle. The connection line permits single-needle operation without great changes to the structure of the blood treatment device. Excerpt(s): The invention relates to a blood treatment device, in particular a dialysis machine, which has a blood treatment unit, in particular a dialyzer. The invention further relates to a disposable kit for such a blood treatment device. Various dialysis methods are known. In dual-needle dialysis, blood is drawn off from a patient via one needle and returned to the patient via another needle. In this case, the blood is pumped continuously through the dialyzer. Single-needle dialysis requires only one needle in order to draw off and return blood cyclically, as the arterial and venous blood lines are connected to the same needle. Single-needle and dual-needle dialysis machines generally make use of occluding tube pumps. Dialysis machines are known, however, in which positive displacement pumps are used to pump the blood. Web site: http://www.delphion.com/details?pn=US06645166__

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Buffered compositions for dialysis Inventor(s): Callan; Robin (Bellevue, WA), Cole; James J. (Arlington, WA), van Schalkwijk; Walter A. (Issaquah, WA) Assignee(s): Advanced Renal Technologies (Bellevue, WA) Patent Number: 6,610,206 Date filed: October 19, 1999

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Abstract: Acid concentrates, and dialysate compositions prepared therefrom, contain citric acid and an effective amount of a buffering agent selected from acetate and/or lactate. The buffering agent allows a physiologically acceptable amount of citrate to maintain the desired pH of the dialysate. Excerpt(s): The present invention relates to therapeutic compositions, and particularly to dialysate compositions. When functioning correctly, the kidneys help the body maintain a normal internal environment called homeostasis. Kidneys help accomplish this normal balance by ridding the body of excess fluids and metabolic waste products (toxins) as well as maintaining precise levels of glucose and electrolytes. Kidney failure can be caused by multiple factors. However, regardless of why a person's kidneys fail, the failure results in the accumulation of excess fluid and toxic waste in that person's body. This uremic poisoning eventually causes death unless the waste material is removed by some artificial means. Hemodialysis is the most common therapeutic measure for a person whose kidneys no longer perform their blood purifying function. Another common type of dialysis is peritoneal dialysis (PD). Dialysate is the fluid utilized in dialysis, where dialysate serves to `clean` the blood of kidney failure patients. During hemodialysis, the patient's blood is circulated on one side of a membrane within a dialyzer (i.e., artificial kidney), while dialysate flows on the other side of the membrane. Since blood and dialysate are separated by a semipermeable membrane, movement of molecules can occur between the blood and dialysate. Although the membrane pores are too small to permit blood cells and proteins to leave the blood, the pores allow waste products to be transferred from the blood to the dialysate. Web site: http://www.delphion.com/details?pn=US06610206__ •

Central venous catheter with heat exchange properties Inventor(s): Evans; Scott M. (Santa Ana, CA), Luo; Xia (Los Angeles, CA), Pecor; Robert (Aliso Viejo, CA), Shimada; Lynn M. (Orange, CA), Walker; Blair D. (Mission Viejo, CA), Worthen; William J. (Coto de Caza, CA) Assignee(s): Alsius Corporation (Irvine, CA) Patent Number: 6,652,565 Date filed: August 24, 2001 Abstract: An introducer sheath for a central venous catheter includes a sheath body and a temperature sensor mounted distally on the body. Either the catheter or sheath has a heat exchange region through which coolant is circulated to effect heat exchange with the body, with the coolant temperature being controlled in response to signals from the temperature sensor. Arterial dialysis heat exchange catheters and jugular bulb heat exchange catheters are also disclosed. Excerpt(s): The present invention relates generally to methods and apparatus for cooling patients for therapeutic purposes, and more particularly to systems for establishing central venous access while providing a means for cooling a patient. It has been discovered that the medical outcome for a patient suffering from severe brain trauma or from ischemia caused by stroke or heart attack is degraded if the patient's body temperature rises above normal (38.degree. C.). It is further believed that the medical outcome for many such patients might be significantly improved if the patients were to be cooled relatively quickly for a short period, e.g., 24-72 hours. Apart from the therapeutic benefits of hypothermia, the outcomes for brain trauma or ischemia patients that develop fevers is worse than for patients that do not develop fevers. Consequently,

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temperature management for such patients is important, even when hypothermia is not to be used to treat the patients. Moreover, prophylactic short-term hypothermia might help patients undergoing minimally invasive heart surgery and aneurysm surgery. The affected organ, in any case, is the brain. Accordingly, systems and methods have been disclosed that propose cooling blood flowing to the brain through the carotid artery. An example of such systems and methods is disclosed in co-pending U.S. pat. app. Ser. No. 09/063,984, filed Apr. 21, 1998, owned by the present assignee and incorporated herein by reference. In the referenced application, various catheters are disclosed which can be advanced into a patient's carotid artery and through which coolant can be pumped in a closed circuit, to remove heat from the blood in the carotid artery and thereby cool the brain. The referenced devices have the advantage over other methods of cooling (e.g., wrapping patients in cold blankets) of being controllable, relatively easy to use, and of being capable of rapidly cooling and maintaining blood temperature at a desired set point. Web site: http://www.delphion.com/details?pn=US06652565__ •

Clamp device, method and system for exchanging a solution Inventor(s): Quah; Eric (Singapore, SG) Assignee(s): Baxter International Inc. (Deerfield, IL) Patent Number: 6,592,558 Date filed: December 28, 2000 Abstract: A device, method and system are provided which simplify the selfadministered peritoneal dialysis solution exchange procedure performed by a patient receiving continuous ambulatory peritoneal dialysis (CAPD). The device, method and system reduce the training time required for each patient provided by medical personnel in the operation of the device and performance of the exchange procedure which reduces healthcare costs. A method of instructing a patient regarding the exchange procedure is also provided which can be utilized by any patient, including those visually impaired. Excerpt(s): The present invention generally relates to medical procedures and treatments. More specifically, the present invention relates to peritoneal dialysis. It is, of course, generally known to store a dialysis solution in a flexible plastic bag for use in continuous ambulatory peritoneal dialysis (CAPD). The solution bag is generally completely filled and ready for use after a sterilization procedure is performed. The dialysis solution is transferred from the solution bag to a patient during a peritoneal dialysis exchange procedure. A second empty bag is provided for draining liquid from the peritoneal cavity of the individual undergoing the procedure. In conventional twin bag systems, the empty bag and the solution bag are interconnected by at least one set of tubing that ultimately connects to a patient catheter or dialysis bag/pouch. The tubing set provides fluid communication between an interior of the solution container and allows transfer of that solution from the interior of the container to a remote location, such as the patient or dialysis bag/pouch. Web site: http://www.delphion.com/details?pn=US06592558__

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Device and method for monitoring and controlling physiologic parameters of a dialysis patient using segmental bioimpedence Inventor(s): Levin; Nathan W. (New York, NY), Zhu; Fansan (Flushing, NY) Assignee(s): Renal Research Institute, LLC (New York, NY) Patent Number: 6,615,077 Date filed: August 14, 2000 Abstract: The present invention includes a method of determining the dry body weight of a patient undergoing dialysis by means of segmental bioimpedance analysis. In preferred embodiments, dry body weight is determined by comparison to the bioimpedance values of normal subjects or by monitoring changes in bioimpedance during dialysis. One embodiment of the present invention is a device for determining dry body weight during dialysis. Excerpt(s): The present invention relates to a device and method that utilize segmental bioimpedance for monitoring and controlling physiologic parameters of a dialysis patient. Accurate assessment of a dialysis patient's hydration status and prediction of dry body weight (DW or dry weight) is a major problem in the clinical management of the dialysis patient. In both hemodialysis and peritoneal dialysis patients, dry weight is the target weight at the end of dialysis treatment which best reflects removal of excess water from the body. In clinical practice, estimation of DW is an imprecise undertaking, and depends to a large extent on the treating physician's interpretation, based on his or her medical experience and familiarity with the particular patient's condition, of clinical symptoms and signs such as changes in the blood pressure, pulse, and weight of the patient. The correct interpretation of such signs and symptoms is complicated by the fact that the pre-treatment body weight varies for each treatment, the amount of excess fluid is not constant and the amount of fluid that can or should be removed from any particular patient during any particular dialysis treatment may be limited by an individual's cardiovascular tolerance, often manifested by clinical signs and symptoms, such as pretibial edema, dyspnea, cramps and/or a decline in blood pressure. Alternatively, an overestimation of the amount of fluid to be removed may result in potentially avoidable symptoms, unnecessarily lengthy dialysis treatments and often prolonged stays at the dialysis facility. Therefore, over- or underestimation of DW will significantly affect both the efficiency of dialysis treatment and patients' quality of life. Bioelectrical impedance analysis (BIA) has been recognized as a noninvasive and simple technique to measure body hydration and hydration status (i.e. over-, under- or normal hydration) of subjects for more than twenty years. There is substantial literature on using BIA for the study of dry weight. Kouw et al proposed a method to measure changes in regional conductivity, and then to measure regional extracellular volume (ECV) and intracellular volume (ICV) by BIA. See, P. M. Kouw, et al, Assessment of post-dialysis dry weight: an application of the conductivity measurement method. Kidney Int. 41:440-444,1992. However, Kouw's method cannot be used to measure interstitial fluid alone as it does not distinguish between interstitial fluid and plasma, both of which make up the ECV compartment. Piccoli published a method of BIA vector analysis which uses the ratio of resistance to reactance to identify dry weight. While this technique could be used to compare the subjects' body hydration, it is unable to predict individual patient's dry weight because of the significant variation in measured values. See, Piccoli A: Identification of operational clues to dry weight prescription in hemodialysis using bioimpedance vector analysis. Kidney Int. 5 3:1036-1043,1998. Web site: http://www.delphion.com/details?pn=US06615077__

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Device for peritoneal dialysis and method for using said device Inventor(s): Neftel; Frederic (Lausanne, CH) Assignee(s): Debiotech S.A. (Lausanne, CH) Patent Number: 6,558,343 Date filed: September 29, 2000 Abstract: The present invention relates to the treatment of kidney insufficiency and more particularly to a peritoneal dialysis device. The device is adapted to function in tidal peritoneal dialysis (TPD) mode, the device being characterized by the fact that it is provided with a variation system for varying the parameters of dialysate exchange over time. The system is designed in such a manner as to vary the duration between two cycles for exchanging fractions of dialysate. Excerpt(s): The present invention relates to the treatment of kidney insufficiency and more particularly to a peritoneal dialysis device. Peritoneal dialysis uses the peritoneum of the patient as a semi-permeable membrane in order to filter the blood. During peritoneal dialysis, a sterile aqueous solution (dialysate) is administered into the peritoneal cavity. The cavity is separated from the blood flow by the peritoneum, in particular, so that diffusive and osmotic exchanges can take place between the dialysate and the blood. Those exchanges result in the elimination of harmful substances such as urea, potassium, and creatinine, which are normally excreted by the kidneys. The diffusion of water through the peritoneum during dialysis is called "ultrafiltration", and the volume of water lost by the patient is called "ultrafiltrate". Web site: http://www.delphion.com/details?pn=US06558343__

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Dialysis apparatus for independently controlling the concentration of at least two ionic substances inside a patient's body Inventor(s): Bene; Bernard (Irigny, FR), Burtin; Jacques (Feyzin, FR) Assignee(s): Hospal Industrie (Meyzieu, FR) Patent Number: 6,623,442 Date filed: June 12, 2001 Abstract: A dialysis apparatus includes a dialysis liquid circuit for circulating sodium chloride and sodium bicarbonate through a haemodialyzer and a circuit for infusing a patient with at least one solution containing at least one ionic substance "A" absent from the dialysis liquid. The substance "A" has a determined concentration (A)sol in the infusion solution. A dialysance detector determines the actual dialysance "D" of the haemodialyzer for sodium, and a flow rate detector determines the flow rate Qinf of infusion solution such that the concentration of the substance "A" inside the patient's body tends towards a desired concentration (A)des, as a function of the dialysance "D", the concentration (A)sol of the substance "A" in the infusion solution and the desired concentration (A)des, A regulator regulates the flow rate of infusion solution, and a controller drives the regulator to control the flow rate of the infusion solution such that this flow rate is substantially equal to the determined flow rate Qinf. Excerpt(s): The present invention relates to a dialysis apparatus for independently controlling the concentration of at least two ionic substances inside a patient's body. The kidneys fulfill many functions, including the removal of water, the excretion of catabolites (or waste from the metabolism, for example urea and creatinine), the

Patents 225

regulation of the concentration of the electrolytes in the blood (sodium, potassium, magnesium, calcium, bicarbonates, phosphates, chlorides) and the regulation of the acid/base equilibrium within the body, which is obtained in particular by the removal of weak acids (phosphates, monosodium acids) and by the production of ammonium salts. In individuals who have lost the use of their kidneys, since these excretion and regulation mechanisms no longer work, the body accumulates water and waste from the metabolism and exhibits an excess of electrolytes (in particular sodium), as well as, in general, acidosis, the pH of the blood plasma shifting towards 7 (the blood pH normally varies within narrow limits of between 7.35 and 7.45). Web site: http://www.delphion.com/details?pn=US06623442__ •

Dialysis apparatus using a blood pressure meter and a controller Inventor(s): Roeher; Otfried (Dresden, DE) Assignee(s): B. Braun Melsungen Medizintechnologie GmbH (Melsungen, DE) Patent Number: 6,579,241 Date filed: January 24, 2002 Abstract: In a dialysis apparatus the blood pressure is normally monitored at intervals of 5 minutes. According to the invention the current blood pressure curve (33) is measured only during the first 45 minutes at intervals of 5 minutes and then compared with the stored blood pressure curves of previous treatments of the same patient. On the basis of statistical analyses that blood pressure curve is determined from a data storage, which shows the largest similarity to the current blood pressure curve and used as the basic curve (35) for blood pressure control during the current treatment. During further treatment the blood pressure measurement is carried out at intervals from 15 minutes to 30 minutes. This considerably reduces the number of blood pressure measurements and the resultant discomfort of the patient. Excerpt(s): The present invention relates to a therapy means comprising a blood pressure meter and a controller, and in particular to a therapy means for extracorporeal blood cleaning. In various therapies, such as the hemodialysis, it is necessary to continuously monitor the patient's blood pressure. For this purpose means for noninvasive blood pressure measurement are used, said means comprising a cuff which is placed around the patient's arm, inflated and then slowly deflated with the blood pressure being measured. During this process the systolic and diastolic blood pressures are measured. To realize a quasi-continuous blood pressure measurement, measurements must be performed at intervals of a few minutes. In automatic blood pressure meters the cuff inflates automatically. During a therapy of several hours thus frequent repetitions of the described measuring process are required. According to the present invention the blood pressure measurement is left undone at some of the times provided for this purpose and the measured values are substituted by hypothetical values gathered from a former blood pressure curve determined during a therapy undergone by the same patient. Web site: http://www.delphion.com/details?pn=US06579241__

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Dialysis machine and method of operating a dialysis machine Inventor(s): Balschat; Klaus (Schwebheim, DE), Koch; Michael (Schweinfurt, DE), Wolter; Elmar (Estenfeld, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,595,944 Date filed: June 15, 2001 Abstract: A machine and method for preparing dialysis fluid for a dialysis machine. Fresh water is mixed with one or more dialysis fluid concentrates. The mixture of water and concentrates is conveyed into an equalizing chamber by a proportioning unit at a predetermined flow rate independent of the dialysate flow rate. Metered addition of the concentrates is performed volumetrically and is monitored on the basis of the conductivity of the dialysis fluid, which is measured by conductivity sensors. Because the mixture of water and concentrates is always conveyed at the same flow rate, the composition of the dialysis fluid can be determined with a high accuracy and the proportioning can be performed accurately. Excerpt(s): The present invention relates to a dialysis machine having a proportioning device for supplying dialysis fluid for a dialysis treatment and a method of operating a dialysis machine. To prepare dialysis fluid today it is customary in most cases to use prefabricated dialysis concentrates that need only be diluted with an appropriate amount of water. To avoid removing heat from blood during dialysis, the dialysis fluid is heated to body temperature. Furthermore, air dissolved in the dialysis fluid is removed by degassing. The operation of mixing water and concentrate in a certain quantity ratio is referred to in general as proportioning. There are known proportioning devices where the metering is based not on a predetermined volume ratio but instead on reaching a certain electric conductivity in the resulting mixture. For conveying water and concentrate, proportioning devices that operate according to conductivity have pumps whose flow rates are regulated as a function of the measured conductivity to yield a dialysis fluid having the desired composition. Web site: http://www.delphion.com/details?pn=US06595944__

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Dialysis machine, in particular for home use Inventor(s): Traeger; Jules (Lyons, FR) Assignee(s): Valemont Participation Corp. (Tortola, VG) Patent Number: 6,558,340 Date filed: December 15, 2000 Abstract: The invention concerns a dialysis machine (10) comprising a dialyzer (20) having a first inlet (21) and a first outlet (22) for the bloodstream, dialysate supply mechanism (25), an arterial line (16) connected between the patent's arteriovenous fistula and the dialyzer, a venous line (17) connected between the arteriovenous fistula and the dialyzer, a pump (28) coupled with the arterial line, a dialysate supply line (31), connected between the dialysate supply mechanism and the dialyzer, a dialysate evacuation line (33) connected between a dialysate recuperating container (27) and the dialyzer. The sterile dialysate bags are arranged in a chamber (26) under a gas pressure. Excerpt(s): The present invention concerns a dialysis machine, particularly for home use, comprising a dialyzer, for example, a hollow fiber type dialyzer, with a first blood

Patents 227

circulation inlet and a first blood circulation outlet, a dialysate supply means, an arterial line connected between the patient's arteriovenous fistula and said first dialysis inlet, a venous line connected between said arteriovenous fistula and said first dialyzer outlet, a pump associated with said artery line, a dialysate inlet line connected between said dialysate supply means and a second dialyzer inlet, and a dialysate evacuation line connected between the dialysate collection container and a second dialysis outlet. Chronic dialysis traditionally requires large quantities of dialysate. Approximately 120 liters of dialysate are necessary for proper diffusion exchange at the dialyzer membrane in order to purify the patient's blood. Dialysis is currently performed three times a week in a hospital for about four hours and requires complex machinery, particularly water treatment equipment to provide water of sufficiently high quality in terms of mineral level and bacterial count. This purified water is added to a concentrate to make the amount of dialysate needed. Despite this, and despite daily disinfection of the dialysis machines, the risk of contamination remains high. Web site: http://www.delphion.com/details?pn=US06558340__ •

Dialysis wall station Inventor(s): Dillon; Jack R. (14303 W. 99th St., Shawnee Mission, KS 66215) Assignee(s): none reported Patent Number: 6,581,627 Date filed: June 29, 2001 Abstract: A dialysis wall station is disclosed which presents a recessed solutions distribution area having a valve panel, an intermediate cantilevered connections panel and drain area. The drain area includes a back wall, an inclined floor that extends downwardly to a rear corner drain and a front lip. The wall station also includes a valve clamping block for securely mounting the solution valves to the wall station. Excerpt(s): This invention relates to a dialysis wall station having a drain and a recessed solution distribution center which includes a valve panel and a cantilever style connections panel for easy, efficient and safe dispensing of the dialysis solutions and water. Hemodialysis is a critical care medical technique which sustains the lives of thousands of patients who suffer from acute or chronic kidney failure. Ease of administration by healthcare professionals before, during and after the procedure helps to reduce the procedure's inherent complexity and avoidable adverse patient events. Accordingly, a primary object of the subject invention is to provide a dialysis wall station that includes a recessed solution distribution center having a valve panel and a cantilevered connections panel. Web site: http://www.delphion.com/details?pn=US06581627__

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Filtration unit for a dialysis machine Inventor(s): Vinci; Luca (Poggio Rusco, IT) Assignee(s): Hospal AG (Basel, CH) Patent Number: 6,630,068 Date filed: August 13, 2001

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Abstract: A filtration unit is disclosed for a dialysis machine. The unit includes a casing with a number of first connecting elements and a support provided with a number of second connecting elements. Structure is provided for locking the filter on the support when the first and second connecting elements engage each other. The lock structure may include a pair of slides movable between a locking position, in which locking parts interact with stopping portions, and a release position, in which the filter is not locked to the support. An elastic structure may be provided for resiliently urging the slides into the locking position. Excerpt(s): This application is a 371 of PCT/IB00/01062 filed Jul. 27, 2000. The present innovation relates to a filtration unit for a dialysis machine. Filtration units are known that comprise a filter, for example an ultrafilter or a dialysis filter, provided with connecting elements, and a support for the filter that can be fixed to a panel of the dialysis machine or to the dialysis machine itself and provided with complementary connecting elements capable of interacting with the connecting elements of the filter when the latter is mounted on the support. Web site: http://www.delphion.com/details?pn=US06630068__ •

Fluid passage change-over apparatus for medical treatment Inventor(s): Doi; Hiroyuki (Sapporo, JP), Fujii; Zyunya (Hatsukaichi, JP), Shinmoto; Kazuhiro (Iwakuni, JP), Tanaka; Seishin (Hiroshima, JP) Assignee(s): JMS Co., Ltd. (Hiroshima, JP) Patent Number: 6,589,197 Date filed: February 20, 2001 Abstract: A medical fluid passage switching apparatus comprising: at least, a rotatable shaft F; a cam C which is rotated in relation to the rotating movement of the shaft F to close and open divided tubes for determining a passage of a fluid; and a housing L having tube accepting holes I and so arranged to enable the holding of the cam C, is provided. More particularly, provided are such a medical fluid passage switching apparatus in a continuous ambulatory peritoneal dialysis (CAPD) system and a tube which is decreased in the diameter and/or thinned in the wall at a region where the cam or a combination of the cam and the clamp is engaged for closing and opening. Excerpt(s): The second aspect of the invention relates to components of the medical fluid passage switching apparatus of the first aspect and particularly to a tube employed in the apparatus. The third aspect of the invention relates to a CAPD system employing the medical fluid passage switching apparatus of the first aspect or the medical fluid passage switching apparatus equipped with the tube of the second aspect. (1) In a conventional back-free, twin-bag system of the CAPD technology, it is necessary to operate three clamps K1, K2, and K3 in a specific order shown in Table 1, wherein said clamp K1 is mounted to a first tube 1 connected at one end to a catheter implanted in the body of a patient, said clamp K2 is mounted to a second tube 2 connected at one end to a Y-shaped joint 4 joined to the other end of the first tube 1 and at the other end to a dialysis liquid bag 5 for supplying a fresh charge of a dialysis liquid to the patient, and clamp K3 is mounted to a third tube 3 connected at one end to a drain bag 6 for collecting and discarding the charge of the dialysis liquid stored in a peritoneal cavity of the patient for a given period of time. Web site: http://www.delphion.com/details?pn=US06589197__

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Hemodialyzer having improved dialysate perfusion Inventor(s): Prisco; Michael R. (Geneva, IL), Slepicka; James S. (Spring Grove, IL), Watkins; Randolph H. (Wonder Lake, IL) Assignee(s): Baxter International Inc. (Deerfield, IL) Patent Number: 6,623,638 Date filed: June 1, 2001 Abstract: A dialyzer is provided comprising a casing defining an interior and including a dialysate inlet and a dialysate outlet. A plurality of fibers are located in the interior of the casing and define a fiber bundle. A dialysate inlet fluid channel is provided in fluid communication with the dialysate inlet and includes a plurality of flutes that extend into a portion of the fiber bundles, the flutes define an opening for allowing dialysate to flow from the inlet fluid channel into the interior of the casing. Methods of providing dialysis are also provided. Excerpt(s): The present invention relates generally to medical treatments. More specifically, the present invention relates to dialysis therapies and dialyzers. Due to diseases, insult or other causes, the renal system can fail. In renal failure of any cause, there are several physiological derangements. The balance of water, minerals (Na, K, Cl, Ca, P, Mg, SO.sub.4) and the excretion of daily metabolic load of fixed hydrogen ions is no longer possible in renal failure. During renal failure, toxic end products of nitrogen metabolism (urea, creatinine, uric acid, and others) can accumulate in blood and tissues. Dialysis processes have been devised for the separation of elements in a solution by diffusion across a semi-permeable membrane (diffusive solute transport) down a concentration gradient. Principally, dialysis comprises two methods: hemodialysis; and peritoneal dialysis. Web site: http://www.delphion.com/details?pn=US06623638__

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Lipid-nucleic acid particles prepared via a hydrophobic lipid-nucleic acid complex intermediate and use for gene transfer Inventor(s): Bally; Marcel B. (Bowen Island, CA), Cullis; Pieter R. (Vancouver, CA), Hope; Michael (Vancouver, CA), Reimer; Dorothy L. (Vancouver, CA), Scherrer; Peter (Vancouver, CA), Wheeler; Jeffery J. (Richmond, CA), Zhang; Yuan-Peng (Vancouver, CA) Assignee(s): Inex Pharmaceuticals Corporation (Burnaby, CA) Patent Number: 6,586,410 Date filed: May 8, 2000 Abstract: Novel lipid-nucleic acid particulate complexes which are useful for in vitro or in vivo gene transfer are described. The particles can be formed using either detergent dialysis methods or methods which utilize organic solvents. Upon removal of a solubilizing component (i.e., detergent or an organic solvent) the lipid-nucleic acid complexes form particles wherein the nucleic acid is serum-stable and is protected from degradation. The particles thus formed have access to extravascular sites and target cell populations and are suitable for the therapeutic delivery of nucleic acids. Excerpt(s): This invention relates to lipid-nucleic acid particles which are useful for the introduction of nucleic acids into cells, and methods of making and using them. The invention provides a circulation-stable, characterizable delivery vehicle for the

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introduction of plasmids or antisense compounds into cells. These vehicles are safe, stable, and practical for clinical use. Gene transfer into genetically impaired host cells in order to correct the genetic defects has vast potential for successfully treating a variety of thus far hitherto untreatable medical conditions. There are currently six major nonviral methods by which genes are introduced into host cells: (i) direct microinjection, (ii) calcium phosphate precipitation, (ii) DEAE-dextran complexes, (iv) electroporation, (v) cationic lipid complexes and (vi) reconstituted viruses and virosomes (see Chang, et al., Focus 10:88 (1988)). Most reported examples of gene transfer have been performed in vitro. In vivo gene transfer is complicated by serum interactions, immune clearance, enzymatic degradation of the genes, toxicity and biodistribution. In in vivo administration, selection is not possible, and a reasonably high frequency of transformation is necessary to achieve sufficient expression to compensate for a defective endogenous gene. Web site: http://www.delphion.com/details?pn=US06586410__ •

Method and apparatus for leak detection in a fluid line Inventor(s): Brugger; James M. (Newburyport, MA), Burbank; Jeffrey H. (Boxford, MA), Treu; Dennis M. (Bedford, NH) Assignee(s): NxStage Medical, Inc. (Lawrence, MA) Patent Number: 6,572,576 Date filed: July 7, 2001 Abstract: One of the most significant safety concerns in the automation of extracorporeal blood treatments such as dialysis is the risk of blood leakage. Such systems draw blood at such a high rate that a loss of integrity in the blood circuit can be catastrophic. The most reliable leak detection method known is the detection of infiltrated air in a blood line, but this only works in blood lines under negative pressure. According to the invention, a leak detector for return lines is provided by periodically generating a negative pressure, which may be brief or at a 50% duty cycle, in the blood return line to draw air into it and thereby reveal the leaks using an air sensor. Although the return line is ordinarily under positive pressure, during the negative pressure cycle, the blood return line draws air through any leaks or disconnects. If air is detected, the system is shut down and an alarm generated. Excerpt(s): The present invention relates to the detection of leaks (including needledisconnects and other causes of loss of integrity) in extracorporeal blood circuits and more particularly to the application of air infiltration detection techniques to the detection of leaks in positive pressure return lines. Many medical procedures involve the extraction and replacement of flowing blood from, and back into, a donor or patient. The reasons for doing this vary, but generally, they involve subjecting the blood to some process that cannot be carried out inside the body. When the blood is outside the patient it is conducted through machinery that processes the blood. The various processes include, but are not limited to, hemodialysis, hemofiltration, hemodiafiltration, blood and blood component collection, plasmaphresis, aphresis, and blood oxygenation. One technique for extracorporeal blood processing employs a single "access," for example a single needle in the vein of the patient or a fistula. A volume of blood is cyclically drawn through the access at one time, processed, and then returned through the same access at another time. Single access systems are uncommon because they limit the rate of processing to half the capacity permitted by the access. As a result, two-access systems, in which blood is drawn from a first access, called an arterial access, and returned

Patents 231

through a second access, called a venous access, are much faster and more common. These accesses include catheters, catheters with subcutaneous ports, fistulas, and grafts. Web site: http://www.delphion.com/details?pn=US06572576__ •

Method and apparatus for preventing protein loss with peritoneal dialysis Inventor(s): Haraldsson; Borje (Landvetter, SE), Jeppsson; Jan-Bertil (Lomma, SE), Thell; Bengt-Olov (Fyinge, SE) Assignee(s): Gambro AB (SE) Patent Number: 6,585,682 Date filed: July 5, 2001 Abstract: Methods of peritoneal dialysis are disclosed including draining spent peritoneal dialysis solution from a patient to a drain bag, passing the spent peritoneal dialysis solution from the drain bag through a filter so as to separate a protein rich fraction and a protein lean fraction therefrom, and supplying the protein enriched fraction to the fresh peritoneal dialysis solution for supply to the patient. Apparatus for peritoneal dialysis is also disclosed. Excerpt(s): The invention relates to the field of peritoneal dialysis, so-called PD, and in particular to automatic peritoneal dialysis, so-called APD. A problem with peritoneal dialysis is loss of protein, particularly albumin. More particularly, the invention relates to a method and an apparatus for preventing protein loss with PD. Peritoneal dialysis means that dialysis occurs by using one of the body's own membranes in the peritoneal cavity, the peritoneal membrane. A PD solution is placed in the peritoneal cavity inside the peritoneal membrane by means of a catheter which passes through the skin and into the peritoneal cavity. Slightly more than two liters of fluid can often be placed in the peritoneal cavity without the patient feeling any great discomfort. The most common form of PD today is CAPD, continuous ambulatory peritoneal dialysis. With CAPD, a set of bags is used which are coupled to the patient's catheter, in order, with the aid of gravity, to drain the spent PD solution from the patient's peritoneal cavity into a waste bag and to add new PD solution to the patient from a sterile storage bag. Web site: http://www.delphion.com/details?pn=US06585682__

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Method and device for supplying ready-to-use dialysis fluid Inventor(s): Muller; Carsten (Euerbach, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,607,697 Date filed: January 19, 1999 Abstract: A method of supplying ready-to-use dialysis fluid in a machine for extracorporeal blood treatment, is described, said machine having, in addition to a dialyzer, at least one sterile filter divided by a microbe-retaining membrane into a first and second chamber. The temperature and/or conductivity of the dialysis fluid flowing through the sterile filter is monitored. To prevent dialysis fluid whose temperature and/or conductivity does not correspond to a preset temperature and/or conductivity value from flowing out of the second chamber of the sterile filter into the dialyzer after rinsing off the membrane of the sterile filter, the dialysis fluid flowing out of the sterile

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filter is first removed into the drain through a bypass line until the proper values are established. Only then is the dialyzer connected to the dialysis fluid path. In addition, the invention relates to a machine for extracorporeal blood treatment with a device for supplying ready-to-use dialysis fluid. Excerpt(s): The present invention relates to a method of supplying ready-to-use dialysis fluid in a machine for extracorporeal blood treatment, and it concerns a machine for extracorporeal blood treatment with a device for supplying ready-to-use dialysis fluid. Dialysis fluid is usually prepared online from fresh water and an electrolyte concentrate, the latter being inherently sterile and freshwater usually being free of microorganisms. However, there is no guarantee that dialysis fluid prepared in this way will be absolutely sterile. German Patent No. 3,641,843 describes a hemodialysis machine in which the dialysis fluid circuit has a sterile filter upstream from the dialysis fluid chamber to supply an absolutely sterile dialysis fluid to the dialyzer. In hemodiafiltration, dialysis fluid can be prepared online from fresh water and an electrolyte concentrate, and the replacement fluid can be prepared online from the dialysis fluid. Although the electrolyte concentrate is usually sterile, and fresh water does not usually contain any microorganisms, this does not guarantee that the dialysis fluid prepared online will be absolutely sterile and pyrogen-free, which is why dialysis fluid for preparing the replacement fluid is converted to an absolutely sterile and pyrogen-free condition. This is done by preparing dialysis fluid upstream from the dialyzer and passing it through at least one filter which is divided into two chambers by a hydrophilic membrane that retains microorganisms. Such a device with two sterile filters arranged in the dialysis fluid system is known from German Patent No. 3,444,671 A and European Patent No. 692,268 A, for example. Web site: http://www.delphion.com/details?pn=US06607697__ •

Method for treating renal disease, and pharmaceutical composition for treating renal disease Inventor(s): Nakanishi; Tsutomu (Kanagawa, JP) Assignee(s): Kureha Chemical Industry Co., Ltd. (Tokyo, JP) Patent Number: 6,558,667 Date filed: April 24, 2001 Abstract: A method for treating a patient suffering from a renal failure progressed to a stage at which an initiation of a dialysis therapy is required, comprising combining a peritoneal dialysis and an administration of a spherical carbon, is disclosed. Excerpt(s): The present invention relates to a method for treating a renal disease, and a pharmaceutical composition for treating a renal disease. More particularly, a method for ameliorating a chronic renal failure by a combination of a dialysis therapy and a spherical activated carbon administration, and a pharmaceutical composition for treating a chronic renal failure by a combination of a dialysis therapy and a spherical activated carbon administration. A normal kidney excretes waste materials, regulates an amount of humors (water content), provides an electrolyte balance, an acid-base equilibrium, and blood pressure, and produces hormones. A condition wherein the kidney is prevented from functioning normally, as above, and thus a homeostasis is not maintained, is called a renal failure. An acute renal failure is curable, whereas a chronic renal failure is an irreversible and progressively pathologic state. When a patient suffers a chronic renal failure, the renal functions are not recovered, and he or she will

Patents 233

inevitably suffer from uremia. It is believed that it is impossible to heal or recover a chronic renal failure, but only to delay a worsening rate, or retard a presence of symptoms of uremia. The functions of a kidney can be evaluated by one of several indexes, i.e., an excreting function, which is one of the most important functions. The index of the excreting function is, usually, an endogenous creatinine clearance (Ccr) that corresponds nearly to an amount of a glomerular filtration. Ccr indicates a renal excreting function for a creatinine that is a metabolite of a muscle, and can be regarded as a representative or standard value of the excreting function of a kidney. A normal value of Ccr is 70 to 130 mL/min. Web site: http://www.delphion.com/details?pn=US06558667__ •

Method of cleaning and priming dialysis system Inventor(s): Nikaido; Taku (Osaka, JP), Ueda; Mistutaka (Osaka, JP) Assignee(s): Nipro Corporation (Osaka, JP) Patent Number: 6,582,604 Date filed: June 25, 2001 Abstract: A dialysis system which does not need to use a physiological saline in replenishing a solution or cleaning and priming the dialysis system, does not need a troublesome setting operation and can easily and accurately set a flow rate of a replenisher solution. The dialysis system includes a closed-type water-removal control apparatus 1, a dialyzer 2, a fresh dialysate line 3 as well as a used dialysate line 4, an RO water pressurizing line 5, an RO water pressurizing pump 51 provided in the RO water pressurizing line 5, an artery side blood line 6, a blood pump 61 provided at the artery side blood line 6 and a vein side blood line 7. According to the dialysis system, by pressurizing RO water into a communication line of the used dialysate, dialysate is made to flow from a dialysate flow path 21 into a blood flow path 22 through a dialysis membrane 23 of the dialyzer 2 and the inside of a blood circulation path can be cleaned and primed. Excerpt(s): The present invention relates to a dialysis system and a method of cleaning and priming a blood circulation path of the dialysis system. More particularly, the invention relates to a dialysis system capable of using a dialysate in place of physiological saline as a replenisher solution when blood pressure is lowered and capable of using a dialysate in place of physiological saline in a cleaning and priming operation and in a blood returning operation in blood dialysis treatment, and relates to a method of cleaning and priming of the dialysis system. A dialysate is used in blood dialysis. Air or filled sterilized water is contained in a dialyzer before the dialyzer is used in blood dialysis and the air or the sterilized water needs to be removed. Therefore, as a pretreatment, conventionally, the inside of a dialyzer and the inside of a blood line connected to the dialyzer (hereinafter, referred to as the inside of a blood circulation path) are cleaned and primed by using, for example, physiological saline (normally, about 500 through 1000 ml). Further, after finishing blood dialysis, blood remaining in the inside of the blood circulation path needs to be returned into the body of a patient who has undergone the blood dialysis treatment (referred to as blood returning) as much as possible, and as a post treatment, conventionally, blood is returned into the human body by using, for example, physiological saline (about 300 ml). Web site: http://www.delphion.com/details?pn=US06582604__

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Method of monitoring a vascular access and an apparatus for extracorporeal treatment of blood with a device for monitoring the vascular access Inventor(s): Kleinekofort; Wolfgang (Kelkheim, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,595,942 Date filed: January 31, 2001 Abstract: A method and device for monitoring a vascular access during a dialysis treatment in which the pressures in both the arterial and venous branches of the extracorporeal blood system are monitored by pressure sensors. Characteristic values for the condition of the vascular access are calculated in a computer unit from the pressures in the arterial and venous branches of the extracorporeal system, and these values are analyzed in an analyzer unit to detect a defective vascular access. Excerpt(s): The present invention relates to a method of monitoring a vascular access during an extracorporeal blood treatment, in particular a chronic blood purification therapy such as hemodialysis, hemofiltration and hemodiafiltration and an apparatus for extracorporeal blood treatment, in particular for hemodialysis, hemofiltration and hemodiafiltration with a device for monitoring the vascular access. With the known methods of chronic blood purification therapy such as hemodialysis, hemofiltration and hemodiafiltration, the patient's blood is passed through an extracorporeal system. Arteriovenous fistulas, vascular implants and/or various catheters are used as access to the patient's vascular system. Typical flow rates in a vascular access are in the range of 1100 mL/min. The patient is usually connected to the extracorporeal system by dialysis cannulas which are used to tap into the fistula or the vascular implant. If the connection between the extracorporeal system and the vascular system becomes undone or a blood leak occurs in the extracorporeal system, the patient can be prevented from bleeding to death only if the extracorporeal blood flow is stopped within a few minutes. Therefore, extracorporeal blood systems are generally equipped with protective systems to constantly monitor the arterial and venous pressure (P.sub.art and P.sub.ven) within the system as well as the admission of air into the extracorporeal system. Web site: http://www.delphion.com/details?pn=US06595942__

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Methods and apparatus for performing flow-through peritoneal dialysis Inventor(s): Brugger; James (Newburyport, MA), Burbank; Jeffrey (Boxford, MA), Finch; Charles (Clinton, MS), Kuiper; Hendrik (Edwards, MS) Assignee(s): Vasca, Inc. (Tewksbury, MA) Patent Number: 6,585,681 Date filed: March 30, 2001 Abstract: Methods, apparatus, and kits are provided for performing peritoneal dialysis. In a first aspect, subcutaneous and transcutaneous systems are described for performing continuously cycling peritoneal dialysis. In a second aspect, fully implanted systems are described for performing flow-through peritoneal dialysis. Excerpt(s): The present invention is generally related to medical methods, apparatus, and kits. More particularly, the present invention is related to methods, systems, and kits for performing discontinuous flow-through peritoneal dialysis. Patients afflicted with end stage renal disease where kidney transplantation is unavailable may be treated

Patents 235

by hemodialysis or peritoneal dialysis to remove toxic products from the patient's blood. Both techniques operate by the principles of diffusion across semipermeable membranes. In the case of peritoneal dialysis, the membrane that is used is the patient's peritoneal membrane. Peritoneal Dialysis (PD) periodically infuses sterile aqueous solution into the peritoneal cavity. This solution is called peritoneal dialysis solution, or dialysate. Diffusion and osmosis exchanges take place between the solution and the bloodstream across the natural body membranes. These exchanges remove the waste products that the kidneys normally excrete. The waste products typically consist of solutes like sodium and chloride ions, and the other compounds normally excreted through the kidneys like urea, creatinine, and water. The diffusion of water across the peritoneal membrane during dialysis is called ultrafiltration. Conventional peritoneal dialysis solutions include dextrose in concentrations sufficient to generate the necessary osmotic pressure to remove water from the patient through ultrafiltration. Web site: http://www.delphion.com/details?pn=US06585681__ •

Methods for arousing dormant bacteria Inventor(s): Marshall; William E. (Bedford Hills, NY) Assignee(s): Immunom Technologies, Inc. (Bedford Hills, NY) Patent Number: 6,589,771 Date filed: October 28, 1999 Abstract: A method for arousing dormant bacteria. The method comprises inducing diffusion of intracellular solutes from dormant bacteria and then allowing an adjustment period for a length of time sufficient to initiate arousal. The decrease in intracellular osmolality or pH can be induced by methods such as extraction, dilution, or dialysis. The method has been standardized using Dulbecco's phosphate buffered saline as the solution. The aroused bacteria can then be selected or recovered by growing them on media for a period of time. If the adjustment period is prolonged, many bacteria can become hypermutative. Excerpt(s): This invention relates to methods and compositions for arousing dormant bacteria. More particularly, this invention relates to methods and compositions for arousing dormant bacteria for the purpose of detecting their presence, evaluating their threat to health, and, if warranted, killing them. Even more particularly, the invention relates to arousing dormant bacteria by altering their internal osmolality and/or pH and allowing adjustment time for the arousal mechanism to be initiated. Dormant populations of bacteria are formed during the normal growth cycles of non-spore forming genera. Dormant bacteria were first described in 1925 as cells formed during the stationary phase of normal microbial growth (Burke, Sprague & Barnes, J. Inf. Dis., 36:555-560 (1925)). By definition, they do not grow on nutrient-rich media selected for their proliferation and classification. Since growth on selected media defines viability, confusion and disbelief continue to surround the existence of dormant bacteria. The phrase "viable but not culturable" (VBNC) is frequently used as a descriptor. Dormancy is different from sporulation. Late in the stationary phase vegetative cells of the genera Bacillus and Clostridium form spores, dense particles resistant to adverse conditions. For example, Clostridial spores can withstand 100.degree. C. for more than one hour, therefore, saturated steam at 121.degree. C. for 15 minutes is required to kill them. Germination of these spores is induced by heating neutral suspensions of these cells at 65.degree. C. for 20 minutes. If L-alanine, L-tyrosine, or adenosine is added to the buffer, 100% of the spores will germinate.

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Web site: http://www.delphion.com/details?pn=US06589771__ •

Methods for external treatment of blood Inventor(s): Blatter; Duane D. (Salt Lake City, UT) Assignee(s): Integrated Vascular Interventional Technologies, L.C. (Salt Lake City, UT) Patent Number: 6,595,941 Date filed: January 11, 2000 Abstract: Vascular access systems, devices and methods for facilitating repeated access to a blood vessel. These systems, devices and methods can be used in external blood treatment, such as dialysis, and in intra-venous administration of medicines, such as heparin, for extended periods of time, while avoiding deleterious effects such as those derived from repeated puncturing of the blood vessel tissues or exposure of such tissues to abnormal fluid flows. The vascular access systems comprise an anastomosis graft vessel, an occlusal device, such as an occlusal balloon, and a port device for accessing the occlusal device. Occlusal devices can be self-contained, they can rely on osmosis, and they can serve as the support of an agent to which the blood stream is exposed, either by transport or by mere contact. In addition, occlusal devices can adopt a distended and a collapsed configuration, the latter allowing for blood flow through the anastomosis graft vessel. Excerpt(s): The present invention relates to external treatment of blood. In particular, the present invention relates to methods for externally treating blood without having to repeatedly puncture the blood vessels being accessed. Procedures that require the repeated access to blood vessels include dialysis and the delivery of medicines for an extended period of time. The multiple punctures that such repeated access necessitates eventually render the blood vessel unsuitable for further effective injections. In addition, some external blood treatment methods rely on the extraction of blood from an artery and on the subsequent injection of the treated blood into a vein. The characteristics of the fluid flow in an artery are significantly different from the characteristics in the fluid flow in a vein. These fluid flow dissimilarities may lead to additional adverse effects that detrimentally affect the long term accessibility of the blood vessels that must be accessed for the external blood treatment to be effectively performed. For example, in an arterio-venous graft constructed as a vascular access for dialysis, the blood flow and blood pressure characteristic of the arterial circulation are so different from the blood flow and blood pressure in the vein into which the blood of the AV graft flows, that the vein usually develops hyperplasia and stenoses. It is desirable to provide a device that permits multiple access to a blood vessel for the purpose of delivering medicines into the patient's blood stream in such a way that the receiving blood vessel is not so severely damaged that it becomes unavailable after a few medicine administrations. Web site: http://www.delphion.com/details?pn=US06595941__

Patents 237

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Microdialysis system Inventor(s): Hoerauf; Christian (Oftersheim, DE), Roeper; Josef (Neuhofen, DE), Schoemaker; Michael (Mannheim, DE) Assignee(s): Roche Diagnostics Corporation (Indianapolis, IN) Patent Number: 6,591,126 Date filed: July 20, 2001 Abstract: The invention concerns a microdialysis system comprising a microdialysis probe (12) that can be inserted into organic tissue (10) and has a dialysis membrane (28) to separate a probe channel (18) filled with perfusion fluid from the tissue (10), a sensor cell (14) to determine the concentration of components and especially glucose in the perfusion fluid that is conveyed from the microdialysis probe (12) and a transport device (16) to convey the perfusion fluid through the probe channel (18) of the microdialysis probe (12) to the sensor cell (14). In order to enable a substantially pressureless transport of perfusion fluid through the microdialysis probe and thus to prevent undesired passage of fluid through the dialysis membrane (28), it is proposed that the transport device (16) has a pressure pump unit (30) connected on the pressure side to the inlet (20) of the probe channel (18) and a suction pump unit (31) connected on the suction side to the outlet (24) of the probe channel (18) that can be operated simultaneously with the pressure pump unit (30). Excerpt(s): The invention concerns a microdialysis system comprising a microdialysis probe that can be inserted in organic tissue and has a dialysis membrane to separate a probe channel filled with perfusion fluid from the tissue, a sensor cell for the preferably electrochemical detection of components and especially glucose in the perfusion fluid that is conveyed from the microdialysis probe and a transport device to convey the perfusion fluid through the probe channel of the microdialysis probe to the sensor cell. In a measuring system of this type known from WO 97/42868, the transport device has a dialysate pump downstream of the microdialysis probe embedded in the body tissue which sucks perfusion fluid from a reservoir through the probe and passes it on to the extracorporeal sensor cell while dialysate is formed. In this suction transport the operating pressure of the pump is adjusted according to the desired delivery rate to overcome the obstacles to flow in the suction branch. The small bore flow cross-sections thus result in a significant negative pressure difference (underpressure) of the perfusion fluid in the probe channel relative to the interstitial fluid. Consequently tissue fluid is practically sucked by ultrafiltration through the dialysis membrane into the probe. It has even been observed in in vitro experiments that the entire solution at the outlet of the probe is derived from ultrafiltration. Although in suction operation the actual flow rate of the dialysate solution leaving the microdialysis probe corresponds to the set value, the origin of the liquid (ultrafiltrate from body tissue or perfusate) is uncertain. Another disadvantage is that the function of the dialysis membrane can be impaired by a negative pressure gradient. In particular this can lead to a reduction of the active exchange surface by accumulation of macromolecules on the tissue side or by constructional factors and thus the amount of dialysate obtained is also reduced. Conversely when the perfusion fluid is pressure fed by a perfusate pump in the delivery branch of the microdialysis probe, the problem arises that perfusion fluid, and hence essentially water, is discharged through the dialysis membrane into the tissue as a result of the required overpressure. This is disadvantageous since the tissue fluid around the probe is diluted, the tissue glucose has to diffuse into the probe channel against a counterflow of water molecules and the flow rate of perfusion fluid at the outlet cannot be determined due to the loss of liquid. A further disadvantage is that when the pump

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fails there is a risk that reagent solution added to the outlet branch can eventually pass into the body tissue via the microdialysis probe. Web site: http://www.delphion.com/details?pn=US06591126__ •

Modification of polymers with basic N-groups and ion exchange groups in the lateral chain Inventor(s): Haring; Thomas (Stuttgart, DE), Kerres; Jochen (Ostfildern, DE), Ullrich; Andreas (Esslingen, DE) Assignee(s): Universitaet Stuttgart (Stuttgart, DE) Patent Number: 6,590,067 Date filed: February 12, 2001 Abstract: A method for lateral chain modification of aryl main chain polymers with aromatic ketones or aldehydes containing tertiary basic N-groups is described. The modification can be accomplished via addition of an aromatic carboxylic acid or an acid derivative containing a tertiary amine moiety to a metallized polymer. The tertiary amines on the modified polymer can be converted to quaternary amines with halogen alkanes. Modification of the aryl main chain polymers with aromatic groups containing sulphonic acid radicals is also described. The polymers formed can be crosslinked and prepared for use in a wide variety of membrane technologies including ion exchange, dialysis, reverse osmosis, nanofiltration. Excerpt(s): The present invention is in the field of polymers containing basic groups and ion-exchange groups. The invention relates in particular to methods for lateral chain modification of aryl main chain polymers with aromatic ketones and aldehydes containing basic nitrogen (N) groups and to the polymers made according to the methods. poly(4-vinyl pyridine), poly-2-vinyl pyridine) and copolymers. These two polymers are commercially available, also as block copolymers with polystyrene. They are used for example as pre-stages for anion exchange membranes (Reiner, Ledjeff.sup.1, Gudernatsch, Krumbholz.sup.2) or complexed with Schiff's bases containing cobalt for selective oxygen permeation.sup.3. The drawback with this class of polymer is the tertiary C--H-bond in the polymer main chain, which is susceptible to oxidation. Web site: http://www.delphion.com/details?pn=US06590067__

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Multi-chamber container with a concentrated glucose compartment and a concentrated hydrochloric acid compartment Inventor(s): Knerr; Thomas (St. Wendel, DE), Pott; Harald (Illingen, DE) Assignee(s): Fresenius Medical Care Deutschland GmbH (Bad Homburg, DE) Patent Number: 6,645,191 Date filed: November 17, 2000 Abstract: A multi-chamber renal dialysis container having at least two compartments and containing concentrated glucose in a first compartment and a hydrochloric acid solution containing electrolytes in a second compartment. The compartments are separated from one another during storage and transportation by separable peel seals, and the solutions can only be mixed with one another by the opening of the peel seals.

Patents 239

An outlet of the multi-chamber container is separated by a further peelable seal, whereby a substantially empty third chamber is formed. Excerpt(s): The present invention relates to a multi-chamber container having at least two compartments for storing hemodialysis concentrates that, when diluted and mixed, serve to absorb toxic substances from the blood of patients suffering from renal disorders. More specifically, one compartment contains a first partial concentrate of glucose, and the other compartment contains a second partial concentrate of electrolytes and hydrochloric acid. Different types of multi-chamber containers are known, and are designed to hold different solutions in their compartments. While these solutions must be dispensed in mixed form, they are often storage incompatible. For this reason, the individual compartments of these multi-chamber containers are separated until just before the application of the solutions. In some cases, liquid communication channels are provided between the compartments, and are opened just prior to application so that the liquids can be mixed. The fluid communication channel used in a multichamber container can be a breakable connector or a peelable seal, as described in German patent DE 44 10 876 C. The peelable seal opens as the result of pressure on the container so that the solutions can be easily mixed with one another in a single space, without dead volume. A typical application of such multi-compartment containers can be found in the field of renal dialysis, especially peritoneal dialysis, where solutions serve as the absorption medium for the body's toxic substances as a replacement for non-functional kidneys. Web site: http://www.delphion.com/details?pn=US06645191__ •

Peritoneal dialysis apparatus Inventor(s): Hirota; Kazuhiko (Nagano, JP), Makiuchi; Yoshikazu (Nagano, JP), Minagawa; Akira (Fuji, JP), Suzuki; Hironobu (Fuji, JP), Suzuki; Minoru (Fuji, JP), Tsubota; Jun (Tokyo, JP) Assignee(s): Terumo Kabushiki Kaisha (Tokyo, JP) Patent Number: 6,595,948 Date filed: October 4, 2001 Abstract: The invention aims to provide a compact peritoneal dialysis apparatus using a disposable cassette integrally formed with a diaphragm and heating portion, in which a flow path can be switched quietly and a heating ability is high. By using a disposable cassette (8) integrally formed with a diaphragm, heating portion, and flow path switching portion, a predetermined amount of dialysis fluid is heated to a predetermined temperature with the heating portion. Clamps (111-118) for opening/closing a flow path switching portion are provided in order to form flow paths through which the heated peritoneal dialysis fluid is distributed into the peritoneal cavity of a patient almost continuously and is sucked and drained from the peritoneal cavity of the patient. The invention also aims to provide a peritoneal dialysis apparatus with which automatic dialysis treatment can be performed by the patient himself and the operation procedures of which are very clear and easy to understand, so treatment can be performed with optimal conditions, and even if a trouble should occur, it can be coped with easily. Excerpt(s): The present invention relates to a peritoneal dialysis apparatus using a disposable cassette (peritoneal dialysis circuit) integrally formed with a diaphragm and heating portion. The recent dialysis process employing peritoneal dialysis has been

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attracting attention because the cost of treatment is less expensive than with the dialysis process employing an artificial kidney and peritoneal adhesion can be prevented. According to a peritoneal dialysis apparatus used in the dialysis process employing peritoneal dialysis, generally, a fluid infusing bag connected to a dialysis fluid container (bag) containing a peritoneal dialysis fluid (to be referred to as a dialysis fluid hereinafter) to be infused or delivered to inside the patient's peritoneum (peritoneal cavity) and a reservoir bag connected to a drained fluid container (bag) for recovering the dialysis fluid drained from the patient are placed in a pressure chamber and are used. More specifically, the pressure chamber for accommodating the fluid infusing bag and reservoir bag is formed in the dialysis apparatus body of the peritoneal dialysis apparatus. When the pressure in the pressure chamber is increased or decreased, the fluid infusing bag or reservoir bag pumps. The dialysis apparatus body has a heater for heating the dialysis fluid in the fluid infusing bag to a temperature within a predetermined temperature range. Web site: http://www.delphion.com/details?pn=US06595948__ •

Prosthesis for continuous internal peritoneal dialysis and continuous method of providing peritoneal dialysis Inventor(s): Levin; John M. (819 Chauncey Rd., Penn Valley, PA 19072) Assignee(s): none reported Patent Number: 6,613,095 Date filed: October 20, 2000 Abstract: Continuous internal peritoneal dialysis prosthesis and method employing an abdominal sac adapted to be retained in the abdominal region of a patient's body and including dialyzate therein for permitting unconcentrated urine within the peritoneal region to pass through a semi-permeable membrane wall of the abdominal sac. The unconcentrated urine within the abdominal sac is directed through a section of the patient's bowel and is communicated with the internal wall of the bowel to thereby concentrate the urine. The concentrated urine is then directed into the urinary bladder for subsequent excretion from the patient's body. In the preferred prosthesis and method of this invention the normal breathing pattern of the patient is employed to assist in the circulation of the unconcentrated urine from the abdominal sac into and through the section of the patient's bowel. In alternative embodiments, the dialyzate may be contained within the abdominal sac, contained within the prosthesis, or allowed to directly contact the peritoneum. Excerpt(s): This invention relates to generally to prosthesis for continuous internal peritoneal dialysis and a continuous method of carrying out peritoneal dialysis. More specifically, this invention relates to artificial kidneys, and more specifically to artificial kidneys implantable within a person's body with the intent that the patient be free from dialysis and transplantation. The artificial kidneys of this invention employ the normal operation of the person's body (i.e., breathing cycle of the person) to cause the flow of fluid within the prosthesis for the removal of toxic substances or other fluids from the person's body. For the treatment of edema states that are refractory to treatment with diuretics the dialysate can be a selected hypertonic solution for removing excess fluids; principally water. The dialysis art is a highly developed one; providing a variety of teachings for dialyzing a patient. In accordance with a related dialysis procedure (e.g., hemodialysis) for purifying blood in a patient experiencing kidney failure, the contaminated blood is directed from a blood vessel of the patient's arm through a

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dialyzing membrane located extracorporeally of the body, in which the blood gives up its impurities to the dialyzing fluid. The purified blood is then directed back into the patient's body through another blood vessel. A representative disclosure of a system for use in purifying arterial blood and providing a venous return is disclosed in U.S. Pat. No. 3,579,441, issued to Brown. Web site: http://www.delphion.com/details?pn=US06613095__ •

Pyrrolopyridinium derivatives Inventor(s): Araki; Norie (Kumamoto, JP), Horiuchi; Seikoh (Kumamoto, JP), Nakamura; Ko (Hyogo, JP) Assignee(s): Nippon Zoki Pharmaceutical Co., Ltd. (Osaka, JP) Patent Number: 6,613,537 Date filed: February 28, 2001 Abstract: The present invention is drawn to pyrrolopyridinium derivatives having a new structural skeleton, preferably containing an intramolecular hemiacetal, which is clearly different from any known Advanced Glycation Endproduct (AGE) and which, when present in an organism, has a bioactivity unlike the conventional AGE. The present invention provides pyrrolopyridinium derivatives and pharmaceutically acceptable salts thereof, an antibody prepared from said derivatives as a hapten, a method for the diagnosis of diabetes, diabetic complications, renal failure, dialysisrelated complications, amyloidosis, aging, diseases accompanied by aging, etc. using said derivatives or an antibody prepared therefrom and a method for evaluating effectiveness of pharmaceuticals used to treat diabetes, diabetes-related diseases, dialysis-related complications, aging, diseases accompanied by aging, etc. Excerpt(s): The present invention relates to novel pyrrolopyridinium derivatives; an antibody prepared from said derivatives as a hapten; a method for the diagnosis of diseases including diabetes, diabetic complications, amyoidosis, renal failure, dialysisrelated complications, aging, and diseases accompanied by aging, such as Alzheimer's disease, etc. by measuring said derivative or by measuring reactivity in the subject with an antibody prepared therefrom; and a method for evaluating the effectiveness of pharmaceuticals which are effective for treating diabetes, diabetic complications, amyloidosis, renal failure, dialysis-related complications, aging, and diseases accompanied by aging, such as Alzheimer's disease, etc. In 1968, glycosylhemoglobin (HbAlc), which is one of the minor components of hemoglobin was identified in vivo and was found to increase in patients diagnosed as having diabetes. With this discovery, the Maillard reaction was shown to occur with proteins in vivo. Despite having been studied mainly in the field of food chemicals, the biological and medical meaning of the Maillard reaction would now receive greatly increased public attention. The Maillard reaction may be classified into a former stage and a latter stage. In the former stage, a Schiff base is formed by the condensation of an amino group of a protein with an aldehyde group of a reducing sugar and is stabilized as a result of the Amadori rearrangement. In the latter stage, the rearranged Schiff Base is transferred, after a long series of reactions, to an Advanced Glycation Endproduct (AGE). The latter stage end products are characterized by fluorescence, a color change to brown and molecular crosslinking. In recent years, several studies on AGE have investigated the relationship between various diseases and AGE, which is produced particularly in the advanced stages of various diseases.

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Web site: http://www.delphion.com/details?pn=US06613537__ •

Reversing flow blood processing system Inventor(s): Schnell; William J. (Libertyville, IL), Utterberg; David S. (Seattle, WA), Yu; Ting Ting (Grayslake, IL) Assignee(s): DSU Medical Corp. (Las Vegas, NV) Patent Number: 6,596,234 Date filed: July 28, 2000 Abstract: A tubular set is provided for the extracorporeal treatment of blood, for example hemodialysis. The set has a patient arterial line and a patient venous line, each line having a patient connector at one end thereof. Each patient line connects at its other end to a reversing flow valve. The valve also connects to respective first ends of a blood processing unit arterial line and a blood processing unit venous line. Each of the unit lines carry a connector at ends opposed to the first ends for connection respectively to arterial and venous ports of a blood processing device, typically a dialyzer. The reversing flow valve has a first position that respectively connects the patient and unit arterial lines with the patient and unit venous lines. The reversing flow valve has a second position that connects the patient arterial line with the unit venous line, and the unit arterial line with the patient venous line. Thus, blood flow between the two patient lines can be reversed without reversing flow through the two unit lines and the connected dialyzer. This permits the easy performance of dialysis access site patency tests, or may be used to avoid blood flow blockage in an implanted catheter. Excerpt(s): Hemodialysis and other forms of extracorporeal blood treatment require the removal of blood from a patient by means of an arterial set, passing of the blood to a blood processing device such as a dialyzer, and returning of the blood to the patient again through a venous blood set. Maintenance of a good blood set access is a major cost of dialysis, which is the most common extracorporeal blood treatment, although other types of blood treatment are also used, for example passing of the blood through an absorption bed for removal of toxins and the like, hemoperfusion, and other forms of blood treatment. Beyond the initial cost of the surgical procedure to establish a fistula or graft in the patient, the keeping of adequate blood flow in a modified peripheral blood vessel of the patient frequently involves secondary surgical intervention for reconstruction of an old blood vessel site on the patient. Alternatively, it may be necessary to establish an entirely new fistula or graft at a new site if the old one fails. Web site: http://www.delphion.com/details?pn=US06596234__

•

Sterile fluid filtration cartridge and method for using same Inventor(s): Collins; Gregory R. (Monroe, NY), Summerton; James (Park Ridge, NJ) Assignee(s): Nephros, Inc. (New York, NY) Patent Number: 6,635,179 Date filed: December 30, 1999 Abstract: A filtration assembly is presented which removes bacteria and endotoxin from a solution so that a sterile fluid is produced. The sterile fluid is suitable for direct on-line infusion to a patient from a device, such as a dialysis machine. The filtration assembly is

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constructed so that two separate filtration compartments exist, resulting in redundant filtration of the fluid prior to infusion. Each compartment holds a filter which preferably consists of a longitudinal bundle of semipermeable hollow fibers. The filter is sized so that it creates a separate area within the compartment for filtrate and infusate flow. This redundant filtration produces a lower risk of creating a pyrogenic or septic condition in the patient due to filter failure. Excerpt(s): This invention relates to an apparatus and method for disinfecting and sterilizing, and relates more particularly to an apparatus and method with filtering means for providing sterile infusion fluid. In general, patients who require certain medications, re-hydration, blood replenishment, nutritional supplements, and the like, receive appropriate sterile fluids by infusion directly into the patient's bloodstream. This is typically accomplished through use of an intravenous (IV) bag connected via a plastic tubing to a needle with is inserted into a patient's vein or artery. IV bags usually provide from one to two liters of sterile fluid before their supply is spent, after which a new IV bag must be provided. Changing IV bags can be a time-consuming process. Thus, IV infusion may work well for slow infusion rate and/or small volume procedures. However for certain procedures which require large volumes and/or rapid supplies of fluid, such as providing replacement fluid for hemofiltration and providing transfer fluid for peritoneal dialysis, infusion using IV bags is not desirable. Instead, with hemofiltration, non-sterile fluid is filtered through one or a series of filtering devices and then infused directly into the patient's bloodstream. The filtered fluid may be a patient ultrafiltrate or a non-sterile substitution fluid received from an outside source, so as to minimize a patient's fluid loss. In any event, to accomplish filtration with minimal risk to the patient, the filter arrangement used in the process must remove endotoxins, bacteria and other pyrogen-inducing compounds. If a filter should fail during the process, a patient may suffer a septic or pyrogenic reaction due to inadequately filtered fluid. Web site: http://www.delphion.com/details?pn=US06635179__ •

System and method for determining blood flow rate in a vessel Inventor(s): Messana; Joseph M. (Ann Arbor, MI), Rubin; Jonathan M. (Ann Arbor, MI), Weitzel; William F. (Ypsilanti, MI) Assignee(s): The Regents of the University of Michigan (Ann Arbor, MI) Patent Number: 6,575,927 Date filed: May 12, 1999 Abstract: A system and method are provided for determining the performance of a vessel, such as a hemodialysis access, which communicates blood between two locations of a patient. A conduit, such as an external dialysis circuit or an intravascular catheter, is provided in fluid communication with the vessel, and has a diversion point for diverting blood from the vessel into the conduit. The system further includes means for determining a flow rate of the diverted blood through the conduit. A first sensor in communication with the vessel generates at least one signal that is a function of a blood flow rate in the vessel downstream from the diversion point, wherein the downstream flow rate depends on the determined conduit flow rate and the performance of the vessel can be determined based on the signal. In addition, a processor can be provided in communication with the first sensor for determining a flow rate in the vessel upstream from the diversion point from the signal and the conduit flow rate. In a preferred embodiment, the first sensor is an ultrasonic sensor, and the at least one signal

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represents a time-averaged mean Doppler velocity of blood flow. Still further, additional sensors may be employed to provide a measure of the upstream flow rate as well as the conduit flow rate. Excerpt(s): This invention relates to the field of hemodynamics, and more particularly to a system and method for measuring blood flow rate in a vessel, such as a hemodialysis access. Hemodialysis is a process by which blood is passed through an external dialysis circuit to replace the function of a patient's kidney. Blood is removed from the patient's vascular system via an arterial line, is passed through a dialysis filter, and is returned to the patient via a venous line. In order to simplify the withdrawal and return of blood, many dialysis patients have an arteriovenous shunt, or access, surgically created between an artery and vein in a location in the body, such as the upper or lower arm. The access provides a permanent site where the arterial line and venous line can be connected to the patient. A vascular access may be constructed from a native arteriovenous fistula, which is a direct connection of a patient's artery to one of his/her veins, or alternatively may be constructed from a synthetic material, typically polytetrafluoroethylene (PTFE). While a permanent vascular access provides a convenient connection site for arterial and venous lines, malfunction of such an access is a frequent occurrence in patients receiving chronic hemodialysis. Specifically, unpredictable thrombosis and stenosis in an access causes a reduction in blood flow which necessitates correction through angioplasty or other surgical means. If untreated, low blood flow can cause undesired recirculation in the access, where some part of the freshly dialyzed blood from the venous line flows upstream to the arterial line where it is again filtered. Studies have shown that decreased hemodialysis access flow is associated with an increased risk of access thrombosis and stenosis, such that early detection of an access with a low flow rate is essential in order to prevent more serious complications (see May et al., Kidney Int. 52: 1656-1662, 1997). Web site: http://www.delphion.com/details?pn=US06575927__ •

Use of citrate-containing dialysate for renal dialysis treatment Inventor(s): Warnock; David G. (Birmingham, AL) Assignee(s): UAB Research Foundation (Birmingham, AL) Patent Number: 6,566,402 Date filed: May 23, 2001 Abstract: The present invention describes trisodium citrate-containing dialysates and production thereof. Also described are the applications of such dialysates as regional anticoagulants during hemodialysis and all modes of continuous renal replacement therapy which utilize any form of dialysis. Excerpt(s): The present invention relates generally to the field of medical therapy of renal disease. More specifically, the present invention relates to the use of trisodium citrate-containing dialysate solutions during hemodialysis and continuous renal replacement therapy, wherein trisodium citrate functions as a regional anticoagulant. Continuous arteriovenous hemodialysis (CAVHD) and other forms of continuous renal replacement therapy (CRRT) are being used increasingly as the major form of renal replacement therapy for critically ill patients with acute renal failure (ARF). Generally, the procedure has required systemic anticoagulation utilizing heparin or, in a few cases, prostacyclin to maintain filter patency. Although heparin is removed by continuous arteriovenous hemodialysis membranes, systemic anticoagulation is usually

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unavoidable with heparin and has been associated with an increased incidence of bleeding. In order to circumvent this problem, regional heparin anticoagulation has been tried, but this has not gained widespread acceptance due to the difficulty in accurately adjusting protamine doses. Similarly, continuous arteriovenous hemodialysis has been attempted with frequent saline flushes through the filter, but it has been difficult to keep the filter patent for longer than 24 hours. U.S. Pat. No. 5,032,615 describes a technique employing sodium citrate as a regional anticoagulant for continuous arteriovenous hemodialysis (citrate CAVHD) which results in removal of excess water, electrolytes and catabolic toxins without requiring systemic anticoagulation. Citrate is infused at the origin of the extracorporeal circuit, and the citrate-calcium chelate is removed by diffusion across the membrane. The metabolic consequences of the sodium citrate load are compensated for by the use of a special dialysate containing no alkali, subnormal sodium concentration, and no calcium. Calcium homeostasis is restored by a peripheral infusion of calcium chloride into the patient. Web site: http://www.delphion.com/details?pn=US06566402__ •

Use of PDT to inhibit intimal hyperplasia Inventor(s): Allison; Beth Anne (Vancouver, CA), Hsiang; York N. (Vancouver, CA), Margaron; Philippe Maria Clotaire (Burnaby, CA) Assignee(s): QLT Inc. (CA), The University of British Columbia (CA) Patent Number: 6,609,014 Date filed: November 17, 2000 Abstract: Long-term dialysis requires provision of safe and reliable vascular access, often in the form of an arteriovenous (AV) fistula. The primary cause of AV fistula loss or failure is stenosis caused by intimal hyperplasia (IH) in the graft at the venous anastomosis or the distal vein. Disclosed are methods of using photodynamic therapy (PDT) to inhibit IH in blood vessels which may also be used to inhibit IH and SMC growth at the anastomosis of an AV fistula in vivo. Excerpt(s): The invention relates to the use of low-dose photodynamic therapy (PDT) to inhibit or reduce stenosis caused by intimal hyperplasia (IH) in blood vessels. In particular, the treatment of IH at an anastomosis of a graft or conduit providing vascular access, such as an arteriovenous (AV) fistula, is disclosed. The invention also relates to inhibiting or reducing the smooth muscle cell (SMC) growth component of IH by lowdose PDT. Patients with chronic renal failure in the United States number approximately 2 million, with 220,000 receiving dialysis therapy as of 1998 (1). The current annual increase in the number of patients receiving chronic hemodialysis is 6 to 7 percent due to acceptance of older candidates, patients living longer, the scarcity of transplantable kidneys, and the loss of transplanted kidneys, returning people to dialysis (1,2). Longterm dialysis requires provision of safe and reliable vascular access, often in the form of an arteriovenous (AV) fistula or an AV conduit, usually made of polytetrafluoroethylene (PTFE)(3,4,5). Unfortunately the failure rate of access fistulae can be as high as 60% at one year, with the mean time from insertion to first repair being only 10 months (6,7). The primary cause of AV fistula or AV conduit loss or failure is stenosis caused by intimal hyperplasia (IH), which includes a smooth muscle cell (SMC) growth component, in the graft at the venous anastomosis or the distal vein (8). IH leads to formation of a thickened fibromuscular layer between the vein endothelium and the inner elastic lamina (IEL). Excessive thickening of the intima can lead to luminal

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narrowing and reduction of blood flow to such an extent that thrombosis occurs (9). This early failure represents the destruction of a useful access site, ultimately compromising the life of a patient dependent on dialysis (10). Mortality among dialysis patients, although slowly declining, remains at 20 percent per year (11). Web site: http://www.delphion.com/details?pn=US06609014__ •

Valve port assembly with coincident engagement member for fluid transfer procedures Inventor(s): Peavey; Todd (Watertown, MA) Assignee(s): SciMed Life Systems, Inc. (Maple Grove, MN) Patent Number: 6,620,124 Date filed: December 3, 1999 Abstract: An improved valve port system provides blood access in a patient through a subcutaneous fluid flow conduit during a dialysis procedure. The system includes several elements, including a engagement member defined by a tubular body having a proximal end, a distal end and a tubular lumen therebetween. The distal end has a tapered bevel defined thereat and a tapered protrusion proximate thereto defined upon an exterior surface of the tubular body. In addition, the system provides a dialysis port member having a housing with a generally cylindrical valve rotatably positioned therein. The valve includes an open end, a closed end and an orifice near the closed end. The valve further includes a longitudinal groove defined along an interior surface thereof. The groove, which is capable of being in registry with the protrusion, is coincident with the protrusion so as to intussuscept the protrusion therein. In this manner, rotation of the engagement member effects rotation of the valve between an open position wherein the orifice is in fluid communication with the fluid flow conduit and a closed position wherein fluid communication between the orifice and the conduit is precluded. Excerpt(s): The present invention relates generally to a device that provides percutaneous access to a patient's vascular system during frequently performed fluid transfer procedures such as kidney dialysis. More particularly, the present invention relates to a valve port system having a port member and rotatable valve in combination with an extractable engagement member for insertable accommodation of the member therein. End stage renal disease (ESRD) is a debilitating disorder characterized by the steady decline of kidney function. Healthy kidneys not only clean the blood by filtering out extra water and wastes, but they also produce hormones that maintain strong bones and healthy blood. When the kidneys fail, numerous debilitating effects are experienced, including rising blood pressure, accumulation of fluids and toxic wastes in the body and insufficient red blood cell production. Treatment is therefore required to replace the work of the failed kidneys. Due to the lack of donor organs and high rate of rejection in kidney transplantation procedures, the majority of ESRD patients rely on one of two dialysis therapies to replace kidney function. The most common treatment is hemodialysis, is a procedure that uses a machine and an artificial kidney to remove toxins and water from a patient's blood. Hemodialysis requires a special filter called a dialyzer to clean the blood. During treatment, blood travels through tubes into the dialyzer, which then filters out waste and extra fluids. The newly cleaned blood flows through another set of tubes and back into the body. Hemodialysis patients typically travel to a dialysis clinic three times per week for 3-4 hours per session.

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Web site: http://www.delphion.com/details?pn=US06620124__

Patent Applications on Dialysis As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to dialysis: •

Access disconnection systems and methods Inventor(s): Falkvall, Thore; (Helsingborg, SE), Han, James; (Palm Harbor, FL), Hartranft, Thomas P.; (Clearwater, FL), Lamberson, George; (New Port Richey, FL), Wariar, Ramesh; (Tampa, FL) Correspondence: Baxter Healthcare Corporation; Renal Division; 1 Baxter Parkway; Df33e; Deerfield; IL; 60015; US Patent Application Number: 20030194894 Date filed: April 10, 2002 Abstract: Apparatuses, devices, systems and methods for detecting access disconnection are provided. The present invention includes electrical contacts in fluid and electrical communication with a fluid passing between a patient and a medical system during therapy. In this regard, the present invention can use a direct-contact measurement to detect access disconnection, such as dislodgment of an access device from the patient through which fluid can flow during therapy including, for example, medication delivery, dialysis therapy and the like. Excerpt(s): The present invention relates generally to patient access disconnection systems and methods for medical treatments. More specifically, the present invention relates to the detection of patient access disconnection, such as dislodgment of a patient access device during medical treatments or therapies including dialysis therapy. A variety of different medical treatments relate to the delivery of fluid to and/or from a patient, such as the delivery of blood between a patient and an extracorporeal system connected to the patient via a needle or needles or any suitable access device inserted within the patient. For example, hemodialysis, hemofiltration and hemodiafiltration are all treatments that remove waste, toxins and excess water directly from the patient's blood. During these treatments, the patient is connected to an extracoporeal machine, and the patient's blood is pumped through the machine. Waste, toxins and excess water are removed from the patient's blood, and the blood is infused back into the patient. Needles or other suitable access devices are inserted into the patient's vascular access in order to transfer the patient's blood to and from the extracoporeal machine. Traditional hemodialysis, hemofiltration and hemodiafiltration treatments can last several hours and are generally performed in a treatment center about three to four times per week. During any of these hemo treatments, dislodgment of the access device can occur, such as dislodgment of a needle inserted into the patient's vascular access including an arterio-venous graft or fistula. If not detected immediately, this can produce a significant amount of blood loss to the patient. The risks associated with a needle dislodgment are considerable. In this regard, important criteria for monitoring blood loss include, for example, the sensitivity, specificity and response time with respect to the detection of

10

This has been a common practice outside the United States prior to December 2000.

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needle dislodgment. With increased levels of sensitivity, specificity, and response time, the detection of needle dislodgment can be enhanced, and blood loss due to dislodgment can be minimized. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Aminoguanidines and alkoxyguanidines as protease inhibitors Inventor(s): Fedde, Cynthia L.; (Warrington, PA), Illig, Carl R.; (Phoenixville, PA), Lu, Tianbao; (Kennet Square, PA), Markotan, Thomas P.; (Morgantown, PA), Soll, Richard M.; (Lawrenceville, NJ), Stagnaro, Thomas P.; (Riva, MD), Tomczuk, Bruce E.; (Collegeville, PA) Correspondence: Sterne, Kessler, Goldstein & Fox Pllc; 1100 New York Avenue, N.W.; Washington; DC; 20005; US Patent Application Number: 20030158252 Date filed: February 6, 2003 Abstract: Aminoguanidine and alkoxyguanidine compounds, including compounds of the formula: 1wherein X is O or NR.sup.9 and R.sup.1-R.sup.4, R.sup.6-R.sup.9, R.sup.11, R.sup.12, R.sup.a, R.sup.b, R.sup.c, Y, Z, n and m are set forth in the specification, as well as hydrates, solvates or pharmaceutically acceptable salts thereof, that inhibit proteolytic enzymes such as thrombin are described. Also described are methods for preparing the compounds of Formula I. The novel compounds of the present invention are potent inhibitors of proteases, especially trypsin-like serine proteases, such as chymotrypsin, trypsin, thrombin, plasmin and factor Xa. Certain of the compounds exhibit antithrombotic activity via direct, selective inhibition of thrombin, or are intermediates useful for forming compounds having antithrombotic activity. The invention includes a composition for inhibiting loss of blood platelets, inhibiting formation of blood platelet aggregates, inhibiting formation of fibrin, inhibiting thrombus formation, and inhibiting embolus formation in a mammal, comprising a compound of the invention in a pharmaceutically acceptable carrier. Other uses of compounds of the invention are as anticoagulants either embedded in or physically linked to materials used in the manufacture of devices used in blood collection, blood circulation, and blood storage, such as catheters, blood dialysis machines, blood collection syringes and tubes, blood lines and stents. Excerpt(s): This application claims benefit under 35 U.S.C.sctn. 119(e) of U.S. Provisional Application No. 60/031,822, filed Nov. 26, 1996, the contents of which are fully incorporated by reference herein. The present invention relates to novel compounds that function as enzyme inhibitors, and particularly to a new class of non-peptidic inhibitors of proteolytic enzymes. Proteases are enzymes that cleave proteins at single, specific peptide bonds. Proteases can be classified into four generic classes: serine, thiol or cysteinyl, acid or aspartyl, and metalloproteases (Cuypers et al., J. Biol. Chem. 257:7086 (1982)). Proteases are essential to a variety of biological activities, such as digestion, formation and dissolution of blood clots, reproduction and the immune reaction to foreign cells and organisms. Aberrant proteolysis is associated with a number of disease states in man and other mammals. The human neutrophil proteases, elastase and cathepsin G, have been implicated as contributing to disease states marked by tissue destruction. These disease states include emphysema, rheumatoid arthritis, corneal ulcers and glomerular nephritis. (Barret, in Enzyme Inhibitors as Drugs, Sandler, ed., University Park Press, Baltimore, (1980)). Additional proteases such as plasmin, C-1 esterase, C-3 convertase, urokinase, plasminogen activator, acrosin, and kallikreins play

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key roles in normal biological functions of mammals. In many instances, it is beneficial to disrupt the function of one or more proteolytic enzymes in the course of therapeutically treating a mammal. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus for the dialysis of blood, method for fabricating the same, and method for the dialysis of blood Inventor(s): Estabrook, Brian K.; (Foxboro, MA), Martins, Harold M.; (Newton, MA), Prosl, Frank R.; (Duxbury, MA), Smith, Paul J.; (West Kingston, RI) Correspondence: Mark J. Pandiscio; Pandiscio & Pandiscio; 470 Totten Pond Road; Waltham; MA; 02154; US Patent Application Number: 20030163083 Date filed: September 10, 2002 Abstract: Improved apparatus for the dialysis of blood, a method for fabricating the same, and an improved method for the dialysis of blood. Excerpt(s): This invention relates to the dialysis of blood in general, and more particularly to apparatus and methods for use in the same. A healthy kidney removes toxic wastes and excess water from the blood. In End Stage Renal Disease ("ESRD"), or chronic kidney failure, the kidneys progressively stop performing these essential functions over a long period of time. When the kidneys fail, a patient dies within a short period of time unless that patient receives dialysis treatment for the rest of that patient's life or undergoes transplantation of a healthy, normal kidney. Since relatively few kidneys are currently available for transplantation, the overwhelming majority of patients with ESRD receive dialysis treatment. Hemodialysis therapy is an extracorporeal (i.e., outside the body) process which removes toxins and water from a patient's blood. A hemodialysis machine pumps blood from the patient, through a dialyzer, and then back to the patient. The dialyzer removes the toxins and water from the blood by a membrane diffusion process. Typically, a patient with chronic kidney disease requires hemodialysis three times per week, for 3-6 hours per session. Removing blood from the body requires a vascular access to the patient's blood system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Automated dialysis system Inventor(s): Alvaro, Jose; (Vernon Hills, IL), Bowman, Joseh H. JR.; (Lake Villa, IL), Busby, Don; (Tampa, FL), Childers, Robert; (New Port Richey, FL), Din, Shahid; (Palm Harbor, FL), Eu, Bruce Ming-Da; (Vernon Hills, IL), Hopping, Peter; (Lutz, FL), Kienman, Rick; (Tampa, FL), Lauman, Brian; (Clearwater, FL), Lundtveit, Loren M.; (Wadsworth, IL), Richardson, Ian; (Clearwater, FL), Shang, Sherwin; (Vernon Hills, IL) Correspondence: Baxter Healthcare Corporation; Renal Division; 1 Baxter Parkway; Df33e; Deerfield; IL; 60015; US Patent Application Number: 20030220598 Date filed: May 24, 2002 Abstract: The present invention provides automated peritoneal dialysis systems, methods of operating the systems and devices for performing same. A typical therapy

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performed by the present invention begins by draining dialysis solution that is already in the patient's peritoneal cavity. The system pumps fresh dialysate from one of a plurality of supply bags, through an in-line heater to the patient's peritoneal cavity. After a dwell period, the spent dialysate in the cavity is pumped out of the patient to a drain or other disposal means. The system then pumps fresh dialysate from the supply bags to the patient and the procedure is repeated as defined in the therapy protocol. The system can pump a last bag of dialysate to the peritoneal cavity for an extended dwell, such as a daytime dwell. Excerpt(s): The present invention generally relates to dialysis systems. More specifically, the present invention relates to automated peritoneal dialysis systems. The present invention also relates to methods of performing automated peritoneal dialysis and devices for performing same. Due to disease, insult or other causes, a person's renal system can fail. In renal failure of any cause, there are several physiological derangements. The balance of water, minerals and the excretion of daily metabolic load is no longer possible in renal failure. During renal failure, toxic end products of nitrogen metabolism (urea, creatinine, uric acid, and others) can accumulate in blood and tissues. Kidney failure and reduced kidney function have been treated with dialysis. Dialysis removes waste, toxins and excess water from the body that would otherwise have been removed by normal functioning kidneys. Dialysis treatment for replacement of kidney functions is critical to many people because the treatment is life saving. One who has failed kidneys could not continue to live without replacing at least the filtration functions of the kidneys. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Biosensor and method for production thereof Inventor(s): Aoyagi, Katsuei; (Tokyo, JP), Mitsubayashi, Kohji; (Tokyo, JP) Correspondence: Frishauf, Holtz, Goodman & Chick, PC; 767 Third Avenue; 25th Floor; New York; NY; 10017-2023; US Patent Application Number: 20030164024 Date filed: September 4, 2002 Abstract: A biosensor comprising an enzyme immobilized membrane in intimate contact with the front end of an optical fiber is disclosed. The biosensor can be produced by coating and impregnating a dialysis membrane with an enzyme and a photocrosslinkable resin, and then crosslinking the photocrosslinkable resin to immobilize the enzyme in the dialysis membrane, thereby obtaining an enzyme immobilized membrane; and bringing the enzyme immobilized membrane into intimate contact with the front end of an optical fiber. Since the optical fiber and the enzyme (enzyme immobilized membrane) are used in combination, the biosensor is highly sensitive and selective and can serve as an excellent odor sensor. Excerpt(s): The entire disclosure of Japanese Patent Application No. 2002-057130 filed on Mar. 4, 2002 including specification, claims, drawings and summary is incorporated herein by reference in its entirety. This invention relates to a biosensor, and more particularly, to a biosensor with high sensitivity and excellent selectivity which uses an optical fiber and an enzyme in combination. The biosensor of the present invention is used for detecting and measuring an odor component, in particular. Many biosensors, which utilize optical reactions such as luminescence, fluorescence and quenching, have been reported in recent years. Biosensors refer to sensors which utilize the molecular

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recognition function of biological materials, such as microorganisms, enzymes and antibodies, and apply the biological materials as molecular recognition elements. In other words, biosensors are designed such that reactions, which occur when immobilized biological materials recognize the target substrates, for example, consumption of oxygen by respiration of microorganisms, enzyme reaction, and luminescence, are converted into electrical signals by physical and chemical devices, and measurements are made based thereon. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Biosensor for dialysis therapy Inventor(s): Wariar, Ramesh; (Tampa, FL), Childers, Robert; (New Port Richey, FL), Din, Shahid; (Palm Harbor, FL), Holmes, Cliff; (Glenview, IL), Martis, Leo; (Long Grove, IL), Pan, Li; (Tampa, FL) Correspondence: Baxter Healthcare Corporation; Renal Division; 1 Baxter Parkway; Df33e; Deerfield; IL; 60015; US Patent Application Number: 20030216677 Date filed: May 15, 2002 Abstract: A biosensor capable of monitoring a number of different constituents of a dialysate solution used during dialysis therapy is provided. The biosensor of the present invention includes an integrated array of reactive elements and sensing elements that can be hydraulically coupled to the dialysate solution. In this regard, the biosensor can be utilized to provide on-line monitoring of total solutes removed from a patient during dialysis therapy, infection levels and/or other desirable parameters such that an overall assessment of dialysis therapy can be readily evaluated. Excerpt(s): The present invention relates generally to medical treatment. More specifically, the present invention relates to dialysis therapies. Due to disease or insult or other causes, the renal system can fail. In renal failure of any cause, there are several physiological derangements. The balance of water, electrolytes (e.g., Na, K, Cl, Ca, P, Mg, SO.sub.4) and the excretion of a daily metabolic load of fixed ions is no longer possible in renal failure. During renal failure, a variety of metabolic end products (e.g., urea, creatinine, uric acid, and the like) can accumulate in blood and tissues. Dialysis processes have been devised for the separation of elements in a solution by diffusion as well as convection across a semi-permeable membrane. Principally, dialysis comprises two methods: hemodialysis; and peritoneal dialysis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Blood treatment catheter and method Inventor(s): Appling, William M.; (Granville, NY), Beyer, Ted; (Queensbury, NY), Geer, Donald R.; (Queensbury, NY), Rosenblatt, Melvin; (New Rochelle, NY) Correspondence: Reed Smith Llp; 375 Park Avenue; New York; NY; 10152; US Patent Application Number: 20030191425 Date filed: April 4, 2002 Abstract: Disclosed are various embodiments of a hemo-dialysis catheter in which the aspirating port at the end of the aspirating tube is distal of the infusion port or ports at

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the end of the infusion lumen. The infusion port or ports are arranged circumferentially so that the infused filtered blood is a substantially 360.degree. jet of fluid with a substantial radial component. This jet of fluid serves to abrade the occlusive material that is composed of fibrin and other components that grows down along the outer wall of the catheter that would otherwise tend to block off the ports. Stopping occlusion growth at the zone of the infusion ports prevents further growth distally to the aspirating port and protects the aspirating port from being blocked by the growth of occlusion. Excerpt(s): This invention relates in general to blood treatment catheters and more particularly to a design for use in hemo-dialysis in which the occlusion of the distal ports due to fibrin buildup is substantially eliminated. Hemo-dialysis is the process of mass transfer, in which certain chemical substances, accumulated in the blood because of kidney failure, are transferred from the blood across a semi permeable dialysis membrane to a balanced salt solution. The efficiency of a hemo-dialysis procedure depends on the amount of blood brought into contact with the dialysis membrane. A flow of 250 milliliters of blood per minute under a pressure gradient of 100 millimeters of mercury is considered a minimum requirement for adequate dialysis. Over the past several years, flow rate between 350 milliliters per minute and 400 milliliters per minute have become common. At the place where the catheter is inserted into the patient, the body reacts by creating a sheath of material that includes fibrin and other materials that grow down the outer wall of the catheter from the point of insertion in the vein. This material is referred to herein as occlusive material. This occlusive material when it grows down to the site of ports, and most particularly the aspirating port, tends to block the ports rendering the catheter essentially useless. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Carbohydrate medical solution and sulphite stabilisator in a multiple compartment container and use thereof Inventor(s): Linden, Torbjorn; (Linderod, SE), Olsson, Lars-Fride; (Lund, SE), Wieslander, Anders; (Lund, SE) Correspondence: Finnegan, Henderson, Farabow, Garrett & Dunner; Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20030159953 Date filed: March 3, 2003 Abstract: The invention relates to a multiple compartment container for sterile medical solutions, particularly solutions for peritoneal dialysis containing a carbohydrate stabilisation compound, a carbohydrate medical solution containing said carbohydrate stabilisation compound and a method for the preparation thereof. Excerpt(s): The present invention relates to multiple compartment containers including sterile medical solutions, in which at least one solution contains carbohydrate compounds. The invention further relates to stabilising carbohydrates in a sterile medical solution. Sterilisation of medical solutions such as, for example, peritoneal dialyses (PD) solutions, is commonly performed through the addition of energy, either in the form of radiation or heat. WO-A-9705852 discloses a multiple compartment container including sterile peritoneal dialyses solutions, which is heat-sterilised in an autoclave. In recent years scientists have become aware of the toxicity of decomposition compounds of carbohydrates in PD solutions. Wieslander et al., reported that all major

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brands of commercial PD solutions were toxic in contrast to PD solutions sterilised by filtration (Wieslander et al., 1991, Kidney Int, 40:77-79). The PD solutions were tested after dilution with cell growth media on cultured fibroblasts. Furthermore, Wieslander et al. have reported that the glucose degradation products also affect the functional responses involved in host defence (Wieslander et al., 1995, Peritoneal Dialysis Int, 15 (suppl). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Connector, container with such a connector and fluid preparation device with a mating connector for such a container Inventor(s): Brehm, Winfried; (Hofheim, DE), Dupin, Thierry; (Bessenay, FR), Eggert, Ilona; (Schweinfurt, DE), Faulhaber, Thomas; (Bergrheinfeld, DE), Graf, Thomas; (St. Jean des Vignes, FR), Laffay, Philippe; (Sainte Foy Les Lyon, FR) Correspondence: Jacobson Holman Pllc; 400 Seventh Street N.W.; Suite 600; Washington; DC; 20004; US Patent Application Number: 20030168120 Date filed: March 11, 2003 Abstract: The invention relates to the field of connectors for connecting a container with a fluid preparation device for preparing a fluid, in particular a container with a concentrate for the preparation of dialysis fluid. In order to simplify the handling during both the manufacturing process of such containers and the connection of such containers to the fluid preparation devices, the invention proposes a design of a connector (1) for connecting a first and second fluid line of the container with a third and fourth fluid line of the fluid preparation device with two lateraly spaced-apart mounting means (2, 4) which each incorporate one of two orifices (3, 5) terminating the first and second fluid lines. The invention also concerns a corresponding container and fluid preparation device. Excerpt(s): The invention relates to the field of connectors for connecting a container with a fluid preparation device for preparing a fluid. The invention also relates to such containers and fluid preparation devices, in particular to dialysis devices. Most hemodialysis devices used for routine treatment prepare the required dialysis fluid themselves by a fluid preparation part which is contained in the device and where the mixing of adequate concentrates with water takes place. These concentrates are commonly distributed in liquid form and filled in canisters. Both the handling and the transportation of such canisters filled with fluid concentrate is posing various problems. Special and rather spatial connectors are necessary on the dialysis device to couple such canisters so that the device can suck the required concentrate. During exchange of a canister fluid may be spilled. Special chambers for accommodating or even rinsing the connector during any periodes no canister is connected may be required. As far as the weight is concerned it is primarily only water which is delivered from the manufacturer to the patient. Furthermore, the empty canisters represent an environmental problem as only special material with certain blocking and stability properties should be used. It is also known to provide concentrates, for instance in a clinic, from a central preparation unit to various treatment sites by an installed piping network. Though this simplifies the working load at the treatment sites in these clinics it is obvious that such a piping network is expensive, both for installation and maintenance, and not applicable for more flexible conditions.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Dialysis solution including polyglycol osmotic agent Inventor(s): Simon, Jaime; (Angleton, TX), Strickland, Alan D.; (Lake Jackson, TX) Correspondence: The Dow Chemical Company; Intellectual Property Section; P. O. Box 1967; Midland; MI; 48641-1967; US Patent Application Number: 20030202958 Date filed: March 25, 2003 Abstract: Dialysis solutions comprising aqueous solutions including physiologically acceptable salts and a polyglycol osmotic agent are disclosed. The subject solutions provide an improved osmotic gradient resulting in reduced dialysis times and/or reduced volumes of required dialysis solution. Moreover, the subject osmotic agents do not significantly migrate into the patient's blood over the time period of dialysis nor are the subject osmotic agents as susceptible to forming detrimental degradation products during gamma sterilization. The use of free radical scavengers is also described along with the use of a filter to reduce the introduction of bacteria into the peritoneal cavity. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/687,512 filed Oct. 13, 2006, which claims the benefit of U.S. Provisional Application No. 60/159,810, filed Oct. 15, 1999. Renal dialysis involves the diffusion of water and waste products, (e.g., urea, excess salts, toxins, impurities, etc.) from a patient's blood, through a semipermeable membrane, and into a dialysis solution. Dialysis most commonly takes one of two forms: hemodialysis involves contacting a portion of the patient's blood with a synthetic semipermeable membrane wherein water and waste products diffuse from the blood through the membrane and into a dialysis solution. The "cleansed" blood is then returned to the patient. Peritoneal dialysis involves infusing a dialysis solution into the patient's peritoneum. The peritoneum comprises a cavity surrounded by blood vessels and capillary beds allowing it to act as a natural semipermeable membrane. Water and waste products diffuse from the blood, through the peritoneum and into the dialysis solution, which is subsequently removed from the patient. Dialysis solutions are typically aqueous solutions including electrolytes, bicarbonate buffer, and an osmotic agent, i.e., a constituent utilized to create an osmotic gradient between a patient's blood and the dialysis solution. The most commonly used osmotic agents include a carbohydrate containing osmotic agent such as glucose and dextrose. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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General means of labeling protein by using wheat embryo cell-free protein synthesis system Inventor(s): Endo, Yaeta; (Ehime, JP), Kumar, Penmetcha; (Ibaraki, JP), Nishikawa, Shigemichi; (Shiga, JP) Correspondence: Luke A Kilyk; Kilyk & Bowersox; 53a Lee Street; Warrenton; VA; 20186; US Patent Application Number: 20030162245 Date filed: March 17, 2003

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Abstract: Utilizing a what embryo cell-free protein synthesis system, there are provided a process for the production of selenomethionine-labeled protein, characterized in that, methionine in a wheat embryo extract for a cell-free protein synthesis obtained by a complete removal of endosperm contaminated is changed to selenomethionine and a cell-free protein synthesis is carried out using a reaction solution composition for protein synthesis containing selenomethionine instead of methionine under a batch condition or a dialysis condition and also the said protein produced as such. There are further provided a process for the production of heavy hydrogen-labeled protein using the same means and also the said protein produced as such. Excerpt(s): This application claims priority from Japanese Patent Application No. 2000220127, 2000-306119, which is incorporated herein by reference. The present invention relates to a labeling means for protein by selenomethionine utilizing a wheat embryo cell-free protein synthesis system and also to a labeling means for protein using heavy hydrogen. As the completion of the genome project is coming near, focus of the research task has been quickly developing from analysis of gene structures to analysis of gene functions. It is presumed that intracellular protein does not function solely but its function comes into effect as a result of interaction with various protein factors, nucleic acids, lower molecular species, cell membrane components, etc. in a cooperative manner and further that a biological function takes place as a total sum of the said interaction. One of the focuses of the research task after the genome project is to analyze the relation between function of various kinds of protein factor complexes and its structure. Fruit obtained therefrom is expected from research of basic biology, etc. including structural biology and biochemistry to clarify the relation between etiology and gene translation product in a medical field as its application and also to provide extremely important findings in developments of pharmaceuticals. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Hemodialysis emergency-disengagement-device Inventor(s): SUN, JIAN-DONG; (SAN JOSE, CA) Correspondence: Jian-dong Sun; 1649 Merrill DR. # 3; San Jose; CA; 95124; US Patent Application Number: 20030187379 Date filed: April 2, 2002 Abstract: The HEDD consists of a compressible body--top half (11) with a guide groove (12) and a cutting blade (13), a compressible body--bottom half (18) with a guide pillar (17), and a pair of special clamps (14) which are located to the left side and the right side of the guide pillar between the two halves of the compressible body (11 and 18). Under external compression, the two halves of the compressible body (11 and 18) are squeezed together to compress the special clamps (14) along the direction of the guide pillar (17). After the special clamps (14) completely block the hemodialysis blood-tubes (16) and are locked up due to elasticity, the cutting-blade (13) moves further to cut the hemodialysis blood tubes (16). When the external compression is released, the special clamps (14) and the blood tubes (16) are released from the device. The patient is then completely disengaged from the dialysis machine. Excerpt(s): A Hemodialysis Emergency-Disengagement-Device (HEDD) is an accessory to kidney-dialysis equipment to allow patients to disengage themselves from hemodialysis machine in case of emergency. The idea and/or a real object of the HEDD has never been used in renal clinics and never appeared in any relevant document. The

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HEDD enables the patients themselves, in an emergency, to simply and rapidly clamp and sever the hemodialysis blood tubing attaching them to the dialysis machines, to expedite their escape from any potential danger. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Hemodialyzer Inventor(s): Endo, Takuma; (Tokyo, JP), Fukui, Kiyozumi; (Tokyo, JP) Correspondence: Akin Gump Strauss Hauer & Feld L.L.P.; One Commerce Square; 2005 Market Street, Suite 2200; Philadelphia; PA; 19103-7013; US Patent Application Number: 20030141227 Date filed: December 10, 2002 Abstract: It is an object to solve problems incidental to the passage piping of a hemodialyzer, and more specifically to provide a hemodialyzer which is small-sized and inexpensive and has a great safety. As means for solving the problems, there is provided a hemodialyzer comprising dialytic basic devices such as a dialyzer, and fluid control devices such as a valve to be provided in a dialysis circuit, wherein a fluid passage block provided with a port for connecting the various devices is included and a fluid connecting circuit is formed between the ports in the block. Excerpt(s): The present invention relates to a hemodialyzer, and more specifically to a hemodialyzer which manifolds a dialysis fluid circuit to reduce the size and cost of the whole apparatus and to have a high durability and can be used at home. A conventional hemodialyzer comprises a large number of components having various sizes, for example, dialytic basic devices such as a dialyzer, a pyrogen filter, a dialysate tank and a pump, and fluid control devices such as a valve, a pressure gauge and a flowmeter which are provided in a dialysis fluid circuit, and these devices are connected to each other through a pipe. In such a conventional apparatus, however, even if the costs of various devices constituting the conventional apparatus are reduced, a large number of various piping components and a considerable working man-hour are required for the pipe connection of the devices. For this reason, the conventional apparatus is expensive and there is a high possibility that piping errors in manufacture might be made or functions might be deteriorated earlier after the start of use. Accordingly, there is a problem in that it is actually hard for an individual patient to purchase the apparatus and to carry out a dialysis at home or a considerable economical burden is imposed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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High flow rate dialysis catheters and related methods Inventor(s): Davey, Christopher T.; (Boston, MA), McCarthy, Matthew N.; (Waltham, MA), Sansoucy, Michael R.; (Ayer, MA) Correspondence: Testa, Hurwitz & Thibeault, Llp; High Street Tower; 125 High Street; Boston; MA; 02110; US Patent Application Number: 20030204179 Date filed: April 22, 2003 Abstract: High flow rate catheters, and related methods, are useful in dialysis and other procedures. A catheter according to the invention comprises a hub and a generally

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elongated conduit. The conduit has a substantially continuous and smooth wall. The conduit also defines at least one lumen and has a length extending from a proximal end to a distal end of the conduit. The proximal end is coupled to a hub and the distal end has an opening in communication with the lumen. The conduit has a conical shape which tapers along the length. Excerpt(s): This incorporates by reference, and claims priority to and the benefit of, U.S. provisional patent application serial No. 60/075,724 which was filed on Feb. 24, 1998. This invention relates to catheter designs and methods of positioning and making catheter designs. More particularly, the invention relates to catheter designs that increase flow through a catheter as well as methods for positioning a catheter of these designs and making a catheter of these designs. Dialysis procedures, for example, frequently use dual lumen catheters to transport blood from a patient to a dialysis machine and then return processed blood back to the patient. See, e.g., McIntosh et al., JAMA 169(8): 137-38(1959). Functionality, comfort, ease of manufacture, and ease of use are all important considerations for catheter designs. Specifically, high flow rates through catheters are necessary to maximize the efficiency of dialysis procedures. Both the physiology of blood and the designs of conventional catheters limit flow rate. Blood cells cannot survive high pressure differentials or excessive mechanical shear. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Medical device Inventor(s): Takahashi, Masahiro; (Haibara-Gun, JP), Yokoyama, Kazumi; (HaibaraGun, JP) Correspondence: Darby & Darby P.C.; P. O. Box 5257; New York; NY; 10150-5257; US Patent Application Number: 20030212314 Date filed: April 15, 2003 Abstract: ObjectsTo provide a medical device that achieves ease of operation an its operation input unit and patient's safety simultaneously.Mean of Achieving the ObjectA medical device comprising an operation input unit 12 for an operator to enter instructions and a operation unit for performing prescribed operations required for medical treatment based on input from said operation input unit 12, consisting of a dialysis device that purifies patient's blood by means of extracorporeal circulation, further comprising a human body detection means 18 for detecting the operator's presence in the vicinity of operation input unit 12, and a control unit 19 that provides control for allowing input operation unit 12 to instruct the operation unit's operations, or allowing the operation unit to operate based on the input entered into operation input unit 12, only when said human body detection means 18 is detecting the operator. Excerpt(s): The invention relates to a blood purifying device for purifying the patient's blood by means of extracorporeal circulation or an infusion device for administering drugs into the patient's body. In a conventional dialysis treatment, a puncture needle attached to the distal end of the blood circuit is caused to puncture into the patient's body, while the patient's blood is caused to make an extracorporeal circulation in order to purify the blood by means of a dialyzer connected to the circuit. Such a dialyzer is connected to a dialysis device, wherein said dialysis device provides a dialysate and discharges the dialysate containing waste products of the blood. In other words, a blood passage (the ends of which are connected to the arterial side blood circuit and the venous side blood circuit respectively), through which the patient's blood flows, and a

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dialysate passage (the ends of which are connected to the dialysate induction line and the dialysate discharge line respectively), through which the dialysate flows, are formed in the dialyzer, and these passages are separated by a hollow thread membrane, so that it is possible to diffuse the products contained in the blood flowing through the blood passage across the membrane into the dialysate, thus purifying the blood, and return the purified blood back to the patient's body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for determining hemodialysis parameters Inventor(s): Folden, Thomas I.; (Alamo, CA), Gotch, Frank A.; (San Francisco, CA) Correspondence: Gibson, Dunn & Crutcher Llp; Suite 4100; 1801 California Street; Denver; CO; 80202; US Patent Application Number: 20030220600 Date filed: February 27, 2003 Abstract: This invention provides a method and apparatus for calculating a hemodialysis parameter, especially blood access flow rate, using multiple dialysance values. The dialysance values may be calculated based upon either sodium or urea concentrations. One dialysance value can be determined for conditions in which a patient's arterial line withdraws blood from an upstream location in a patient's fistula and treated blood is returned by a venous line to a downstream location in a patient's fistula. The second dialysance value can be determined when the lines have been reconfigured so that the arterial line withdraws blood from a downstream portion of a patient's fistula and the venous line returns treated blood to an upstream portion of a patient's fistula. Since it is possible to determine the dialysance values solely from concentration measurements made on the dialysate side of the dialysis apparatus, the present method and apparatus provide a non-invasive means for determining hemodialysis parameters such as blood access flow rate and recirculation. Excerpt(s): This application is a contination of U.S. patent application Ser. No. 09/003,798, filed Jan. 7, 1998, which is hereby incorporated herein by reference and a claim to priority is made hereby. Hemodialysis (or simply dialysis) is a process which employs an artificial kidney to aid patients whose renal function has deteriorated to the point where their body cannot adequately rid itself of toxins. In hemodialysis a dialyzer is used which contains a semi-permeable membrane, the membrane serving to divide the dialyzer into two chambers. Blood is pumped through one chamber and a dialysis solution through the second. As the blood flows by the dialysis fluid, impurities, such as urea and creatinine, diffuse through the semi-permeable membrane into the dialysis solution. The electrolyte concentration of the dialysis fluid is set so as to maintain electrolytic balance within the patient. Further purification in an artificial kidney is possible through ultrafiltration. Ultrafiltration results from the normal situation wherein there is a positive pressure differential between the blood and the dialysis fluid chambers. This pressure differential causes water in the blood to pass through the membrane into the dialysis solution. This provides the benefit of reducing a dialysis patient's excess water load which normally would be eliminated through proper kidney functioning. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for improving in vitro measurement of membrane permeability of chemical compounds Inventor(s): Avdeef, Alex; (Boston, MA), Du, Chau M.; (Allston, MA), Nielsen, Per E.; (Westlake, OH) Correspondence: Weingarten, Schurgin, Gagnebin & Lebovici Llp; Ten Post Office Square; Boston; MA; 02109; US Patent Application Number: 20030219716 Date filed: January 23, 2003 Abstract: The invention described here improves the PAMPA (parallel artificial membrane permeability assay) high-throughput method used in lead compound selection and optimization in pharmaceutical and biotechnological research and development, and for identifying active compounds with the right plant distribution properties in agrochemical research and development. The invention described here is a robust method and apparatus for measurement of two physical properties, permeability and membrane retention of compounds, which overcomes several of the shortcomings in the prior art. This invention includes reagents specifically designed for enhancing the sensitivity of the assay, to allow a UV detection system to be used for concentration measurements, to accurately estimate and compensate for the effects of membrane retention and unstirred water layer, and to increase the speed of the assay. In this invention, concentrated phospholipid membrane barriers are used, consisting of 10-74% wt/vol commercially-available soybean lecithin extract dissolved in dodecane. Sample concentrations in both the donor and the acceptor compartments of the permeation cells are quickly measured by direct UV spectrophotometry. To reduce the excessive membrane retention of compounds by the concentrated phospholipid membrane barriers, an artificial sink state is created in the acceptor compartment of the permeation cells, by using surfactants, cyclodextrins, or water-soluble lipophilic polymers, which have low absorption of UV energy. A secondary sink state is created with ionizable molecules when the permeation cell contains a pH gradient between the donor and the acceptor solutions. The resultant "double-sink" condition forms a basis for successful modeling of the passive-diffusion transport of molecules in the human gastrointestinal tract (GIT). Also, this condition accelerates the transport of certain molecules across membranes, shortening the measurement time, and increasing the assay throughput. A new permeability equation is used, that takes into account (a) pH gradients between the two sides of the membrane barrier and (b) the retention of the molecules by the membrane, which the pH-gradient sink condition is unable to eliminate entirely. When combined with the prior art PAMPA practice of placing solubilizers, such as surfactants, bile salts, and water-soluble lipophilic polymers, into the donor compartment to overcome problems of low aqueous solubility of sample molecules, the said GIT model becomes modified to serve as a blood-brain barrier (BBB) absorption model. This invention can also improve performance in prior art PAMPA membrane barriers, and in several other types of membranes, such as, (i) nonporous synthetic membrane material (e.g., silicone rubber), (ii) dialysis membranes with a particular molecular weight cutoff, and (iii) monolayers of cultured cells (e.g., Caco-2, MDCK, or HT29) deposited onto the surface of porous microfilter supports. Excerpt(s): This application claims priority to U.S. Provisional Application No. 60/353,914 filed Jan. 31, 2002, which is incorporated in its entirety herein. The measurement of physicochemical properties, such as permeability, in a high-throughput screening environment plays an important role in the selection of the most promising biologically-active molecules for lead optimization in pharmaceutical and

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biotechnological research and development, and in identifying active compounds with the right plant distribution properties in agrochemical research and development. In this context, PAMPA (parallel artificial membrane permeability assay) has been used for measuring the in vitro permeability of molecules across artificial phospholipid membrane barriers supported by a high-porosity microfilter, separating a solution of test molecules from a solution initially free of them. The invention described here is an improvement of PAMPA. This invention is a robust method and apparatus for the measurement of two physical properties, permeability and membrane retention of compounds. It includes reagents specifically designed for enhancing the sensitivity of the assay, to allow a UV detection system to be used for concentration measurements, to accurately estimate and compensate for the effects of membrane retention and unstirred water layer, and to increase the speed of the assay. In pharmaceutical research, looking for a new drug takes place in three stages: exploration, discovery, and development. In the first stage, the understanding of the disease state is accumulated, a therapeutic target is selected, and a biological screening assay is developed. The discovery stage begins with `hits` finding, where a company's library of compounds is screened for the IC50 value, the concentration of the compound required to displace 50% of a reference ligand from a target receptor. In the course of a year at a large pharmaceutical company, it is not uncommon to have 100,000 to 1,000,000 library compounds tested against a particular target, which is usually a receptor site on a protein molecule. Of the molecules tested for biological activity, about 3000 to 10,000 are found to be active (hits). The initial part of the discovery step is called `lead` generation, where the most promising subset of the hits is selected for further testing. Of the 3000-10,000 potent molecules, about 400 make it to this step. The selection of leads takes into account biopharmaceutic properties of the hits, such as measured aqueous solubility, octanol-water partition coefficients, plasma stability, human serum protein binding, cytochrome P450 inhibition (oxidative metabolism), liver microsome assay (general metabolism), and membrane permeability, using an in vitro cultured-cell model, such as Caco-2. These various tests filter out many molecules with unfavorable biopharmaceutic ADME properties (absorption, distribution, metabolism, and excretion). Most companies perform fast ADME screens in the hits-to-leads transition to aid in "go--no go" decisions. The selected 400 lead compounds are expected to have good in vivo pharmacokinetic (PK) behavior in animal models developed later. But many of the molecules will underperform in laboratory animals, and will be rejected. In lead optimization, the compounds are rigorously tested for in vitro ADME properties, CNS penetration, selectivity against other similar targets, as well as for cytotoxicity. In the final stages of optimization, where rodent in vivo PK measurements are done, metabolic profiles are developed, and additional animal model toxicity tests are performed, about twelve promising `candidate` molecules survive to enter pre-clinical development, where dosage form design and human PK, safety, and effectiveness testing begin. During the subsequent clinical phases, the number of clinical development molecules dwindles down to about one, a considerable and expensive downsizing from the original 400 promising leads. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 261

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Method and apparatus for monitoring and controlling peritoneal dialysis therapy Inventor(s): Balteau, Patrick; (Bothey, BE), Belongie, Duane; (Minneapolis, MN), Childers, Robert Warren; (New Port Richey, FL), Eerlingen, Vital; (Leuven, BE) Correspondence: Joseph P. Reagen; Baxter Healthcare Corporation; One Baxter Parkway, Df3-3e; Deerfield; IL; 60015; US Patent Application Number: 20030204162 Date filed: May 27, 2003 Abstract: Peritoneal Dialysis systems, methods, and catheters are provided for performing peritoneal dialysis therapies. Multiple fluid pathways are provided to a patient's peritoneal cavity for conveying dialysis fluid to and from the patient. Excerpt(s): The present invention relates generally to the treatment of end stage renal disease. More specifically, the present invention relates to methods and apparatus for monitoring the performance of peritoneal dialysis. Using dialysis to support a patient whose renal function has decreased to the point where the kidneys no longer sufficiently function is known. Two principal dialysis methods are utilized: hemodialysis; and peritoneal dialysis. In hemodialysis, the patient's blood is passed through an artificial kidney dialysis machine. A membrane in the machine acts as an artificial kidney for cleansing the blood. Because it is an extracorporeal treatment that requires special machinery, certain inherent disadvantages exist with hemodialysis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and device for sensing the detachment of the venous needle from a patient during dialysis Inventor(s): Canini, Enrico; (Mirandola, IT), Francesco, Paolini; (Ganaceto, IT), Lodi, Carlo Alberto; (Novi Di Modena, IT) Correspondence: Finnegan, Henderson, Farabow, Garrett & Dunner; Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20030176829 Date filed: February 14, 2003 Abstract: A method of sensing the detachment of the venous needle (13) from a patient (P) during an extracorporeal blood treatment in a dialysis machine (1) having an extracorporeal blood circuit (2), in which an electric current is made to flow along a closed-loop path (P1) of an electrical circuit (37) formed by an electrical line (21, 22, 23) external to the extracorporeal circuit (2), a portion of extracorporeal circuit (2) directly connected to the venous needle (13), and the patient (P); a signal correlated with the electric current along the electrical line (21, 22, 23) is detected; and the signal is compared with a threshold value by means of a control unit (15). Excerpt(s): The present invention relates to a method of sensing the access to a patient's cardiovascular system during an extracorporeal blood treatment in a dialysis machine. As is known, blood consists of a liquid component called the blood plasma and a corpuscular component formed by the blood cells, including the red corpuscles among other components. In renal insufficiency, the blood has, in addition to the aforesaid components, particles of low molecular weight (referred to below as solute) which have to be eliminated by a dialysis treatment carried out with a dialysis machine. A dialysis machine of the known type generally comprises an extracorporeal blood circuit, a

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dialysate circuit and a filter, which is located in the aforesaid circuits and comprises a blood compartment and a dialysate compartment, which are separated from each other by a semi-permeable membrane, and through which pass, respectively, the blood to be treated and the dialysate, generally flowing in counter-current mode. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for measuring hemoglobin concentration ( hgb) in the blood in a circuit of a dialysis machine, measuring device and circuit for the application of the method Inventor(s): Delnevo, Annalisa; (Correggio, IT), Fava, Massimo; (Mirandola, IT), Paolini, Francesco; (Modena, IT) Correspondence: Finnegan, Henderson, Farabow, Garrett & Dunner; Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20030138961 Date filed: October 21, 2002 Abstract: A method for measuring the hemoglobin concentration (HGB) in the blood in a circuit (2) of a dialysis machine (1), the method comprising the measurement of the values of absorption (A) of electromagnetic waves by the blood conveyed along a specified section (5a) of the said circuit (2), the measurement of the values of a physical quantity iron the group comprising the blood pressure (1)), the blood temperature (T) and the rate of flow (Q.sub.b) of the blood along the aforesaid section (5a), and the calculation of the hemoglobin concentration (HGB) as a function of the values of absorption (A) and of the aforesaid physical quantity Excerpt(s): The present invention relates to a method for measuring hemoglobin concentration in the blood in a circuit of a dialysis machine. There is a known way of determining the concentration of hemoglobin in the red corpuscles during the dialysis treatment, by means of highly accurate measurements of an intrusive kind, which require the laboratory examination of blood samples. Other dialysis machines enable non-intrusive measurements of the hemoglobin concentration to be made within the machine. The non-intrusive measurements made within the machine are markedly less accurate than laboratory measurements, but have the advantage of being provided in real time in such a way that the operating parameters of the dialysis machine can be corrected instantaneously. The patent IT 1,240,489 discloses a method of measuring the hemoglobin concentration within the machine and in a non-intrusive way, by measuring the absorption of electromagnetic waves of the blood flowing in the arterial branch of the first circuit. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods for encapsulating plasmids in lipid bilayers Inventor(s): Hope, Michael; (Vancouver, CA), Wheeler, Jeffery J.; (Richmond, CA), Bally, Marcel B.; (Bowen Island, CA), Cullis, Pieter R.; (Vancouver, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030181410 Date filed: February 24, 2003

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Abstract: Plasmid-lipid particles which are useful for transfection of cells in vitro or in vivo are described. The particles can be formed using either detergent dialysis methods or methods which utilize organic solvents. The particles are typically 65-85 nm, fully encapsulate the plasmid and are serum-stable. Excerpt(s): This invention relates to formulations for therapeutic nucleic acid delivery and methods for their preparation, and in particular to lipid encapsulated plasmids or antisense constructs. The invention provides a circulation-stable, characterizable delivery vehicle for the introduction of plasmids or antisense compounds into cells. These vehicles are safe, stable, and practical for clinical use. Gene therapy is an area of current interest which involves the introduction of genetic material into a cell to facilitate expression of a deficient protein. There are currently five major methods by which this is accomplished, namely: (i) calcium phosphate precipitation, (ii) DEAEdextran complexes, (iii) electroporation, (iv) cationic lipid complexes and (v) reconstituted viruses or virosomes (see Chang, et al., Focus 10:88 (1988)). Cationic lipid complexes are presently the most effective generally used means of effecting transfection. A number of different formulations incorporating cationic lipids are commercially available, namely (i) LIPOFECTIN.RTM. (which uses 1,2-dioleyloxy-3(N,N,N-trimethyfamino)propane chloride, or DOTMA, see Eppstein, et al., U.S. Pat. No. 4,897,355); LIPOFECTAMINE.RTM. (which uses DOSPA, see Hawley-Nelson, et al., Focus 15(3):73 (1993)); and LIPOFECTACE.RTM. (which uses N,N-distearyl-N,Ndimethyl-ammonium bromide, or DDAB, see Rose, U.S. Pat. No. 5,279,833). Others have reported alternative cationic lipids that work in essentially the same manner but with different efficiencies, for example 1,2-dioleoyloxy-3-(N,N,N-trimeth- ylamino)propane chloride, or DOTAP, see Stomatatos, et al., Biochemistry 27:3917-3925 (1988)); glycerol based lipids (see Leventis, et al., Biochem. Biophys. Acta 1023:124 (1990); lipopolyamines (see, Behr, et al., U.S. Pat. No. 5,171,678) and cholesterol based lipids (see Epand, et al., WO 93/05162, and U.S. Pat. No. 5,283,185). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods for providing kidney dialysis equipment and services Inventor(s): Bedient, Robert A.; (Portland, OR), Connell, Mark E.; (Sandy, OR), Elsen, Raymond; (Antwerp, BE), Hogard, Michael E.; (Oregon City, OR), Johnson, Harley D.; (Portland, OR), Kelly, Thomas D.; (Portland, OR), Long, Jean McEvoy; (Portland, OR), Perterson, Bruce A.; (Milwaukee, OR), Preston, William G. JR.; (Portland, OR), Smejtek, Dalibor J.; (Beaverton, OR) Correspondence: Baxter Healthcare Corporation; Renal Division; 1 Baxter Parkway; Df33e; Deerfield; IL; 60015; US Patent Application Number: 20030209475 Date filed: June 13, 2003 Abstract: A number of improvements relating to methods and apparatuses for kidney dialysis are disclosed. These include a method providing an apparatus for dialyzing to a consumer, with the apparatus including a controller for controlling a dialysate parameter, a delivery system for delivering the dialysate to a dialysate compartment of a dialyzer, and a user/machine interface having a touch screen to display an indicium corresponding to a parameter pertinent to operation of the apparatus for use in dialysis and to enable a user though touching the indicium to effect a change in the parameter. The method also includes providing supplies that are useable with the apparatus to the consumer.

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Excerpt(s): This application is a continuation of U.S. patent application Ser. No. 09/711,240 filed on Nov. 13, 2000, now pending, which is a continuation of U.S. patent application Ser. No. 09/067,922 filed on Apr. 28, 1998, now abandoned, which is a continuation of U.S. patent application Ser. No. 08/479,688, filed on Jun. 7, 1995, now U.S. Pat. No. 5,744,027, which is a divisional of U.S. patent application Ser. No. 08/122,047, filed on Sep. 14, 1993, now U.S. Pat. No. 5,486,286, which is a divisional of U.S. patent application Ser. No. 07/688,174, filed on Apr. 19, 1991, now U.S. Pat. No. 5,247,434. The present invention relates to improvements in kidney dialysis machines. Kidney dialysis machines are well known in the art and are illustrated, for example, in U.S. Pat. Nos., 3,598,727, 4,172,033, 4,267,040, and 4,769,134. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods for the on-line, on-demand preparation of sterile, water-for-injection grade water Inventor(s): Grandics, Peter; (Carlsbad, CA) Correspondence: Paul, Hastings, Janofsky & Walker Llp; P.O. Box 919092; San Diego; CA; 92191-9092; US Patent Application Number: 20030173297 Date filed: March 14, 2002 Abstract: A new method is described to produce large volumes of low cost sterile, Water-for-Injection (WFI) grade water on-line, on-demand from potable water in order to meet the needs of dialysis therapies and other biological applications for sterile, injectable grade water. The source water is processed by a combination of membrane and column chromatographic methods including reverse osmosis, chemical sterilization, reduction of iodine sterilant to iodide, deionization, endotoxin-specific adsorption and polishing filtration in order to reduce contaminant levels below those specified by the US Pharmacopoeia. Excerpt(s): This invention is directed to methods for the on-line, on-demand preparation of sterile, water-for-injection grade water and water preparations produced by such methods. In the first decades of artificial kidney treatment, technical efforts focused on developing effective dialysis membranes, machines and water systems. In the 1970s, some articles discussing the importance of pyrogenic reactions during hemodialysis induced installation of reverse osmosis systems for preparation of more pure dialysis fluid. In the last decade, growing knowledge of the function of endothelial cells and their role in disease has helped to understand the possible alterations in endothelial cell structure and function evoked by uremia and its dialytic therapy. Factors injuring the vascular endothelium during hemodialysis include complement activation due to membrane contact, bacterial endotoxins, endotoxin containing immunocomplexes, hyperlipidemia, and cell adhesions. The activated monocytes migrate through endothelial intracellular junctions becoming macrophages; the filtered LDL particles transform them into foam cells. Bacterial endotoxin activates monocytes and the other white blood cells, increasing the chance for endothelial cell injury, arteriosclerosis and inflammatory problems such as amyloidosis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods of using and compositions comprising cacao extract including dietary fiber Inventor(s): Kwon, Ik Boo; (Seoul, KR), Lee, Jung-Suk; (Leecheon-si, KR), Lee, ShinYoung; (Chuncheon-si, KR) Correspondence: Pennie And Edmonds; 1155 Avenue OF The Americas; New York; NY; 100362711 Patent Application Number: 20030206981 Date filed: May 5, 2003 Abstract: The present invention relates to cacao extract including dietary fiber, more specifically cacao extract including dietary fiber useful for the treatment of diabetes obtained as a residue of solvent extraction of the cacao bean husk (CBH) conventionally wasted after using only cacao bean (CB), which has the following characteristics:(a) A high content of dietary fiber is included, and especially, insoluble dietary fiber (IDF) is in excess of soluble dietary fiber (SDF);(b) The physical and chemical properties of these fibers, such as water holding capacity (WHC), oil binding capacity (OBC), viscosity characteristics and dialysis retardation index of glucose and bile acid; and(c) It improves the physiological activity of intestinal disease and metabolic disease, for example, blood sugar depression and cholesterol metabolism enhancement. Excerpt(s): This application is a division of U.S. patent application Ser. No. 09/958,873 filed on Dec. 28, 2001, the entirety of which is incorporated herein by reference. c) It improves the physiological activity of intestinal disease and metabolic disease, for example, blood sugar depression and cholesterol metabolism enhancement. Cacao (Theobroma cacao L.) is a Latin America originated perennial belonging to Byttneriaceae family, which grows as high as 6-8 m. It produces an oval-type pod, in which about 3040 seeds are embedded by pulp. Cacao comprises a shell (or testa), a nib (or cotyledon) and a germ, and the main ingredient of chocolate is a ground mass made by grinding the nib with high butter content. This mass is called cacao liquor or cacao mass (CM) because it is in a paste phase below the melting point of butter. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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MICROPOROUS MEMBRANES AND USES THEREOF Inventor(s): CHILDS, RONALD F.; (ONTARIO, CA), DICKSON, JAMES M.; (ONTARIO, CA), MIKA, ALICJA M.; (ONTARIO, CA) Correspondence: Sim & Mcburney; 330 University Avenue; 6th Floor; Toronto; M5g1r7; CA Patent Application Number: 20030168404 Date filed: June 17, 1999 Abstract: Charged membranes comprise a porous substrate and a cross-linked polyelectrolyte or hydrogel located in the pores of the substrate and are useful in a variety of membrane separation processes including pressure driven membrane separation, diffusion dialysis. Donnan dialysis, electrodialysis, electrochemical synthesis and pervaporation. Excerpt(s): The present invention relates to certain novel membranes and the novel uses of certain membranes. This application is a continuation-in-part of U.S. patent application Ser. No. 08/733,792 filed Oct. 18, 1996. Membranes are used, for instance, in separation processes as selective barriers that allow certain chemical species to pass, i.e.,

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the permeate, while retaining other chemical species, i.e., the retentate. Membranes are used in many applications, for example as biosensors, heparinized surfaces, facilitated transport membranes utilizing crown ethers and other carriers, targeted drug delivery systems including membrane-bound antigens, catalyst-containing membranes, treated surfaces, sharpened resolution chromatographic packing materials, narrow band optical absorbers, and in various water treatments which involve removal of a solute or contaminant, for example, dialysis, electrodialysis, microfiltration, ultrafiltration, reverse osmosis, nanofiltration and in electrolysis and in fuel cells and batteries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Multi-well equilibrium dialysis systems Inventor(s): Creasey, Andrew; (Bedford, MA) Correspondence: Edward D. Grieff, ESQ.; Hale And Dorr Llp; 1455 Pennsylvania Avenue, NW; Washington; DC; 20004; US Patent Application Number: 20030213740 Date filed: December 4, 2002 Abstract: This invention relates to equilibrium dialysis systems in multi-well formats for simultaneously preparing multiple samples. The equilibrium dialysis systems described herein may be made in 8-well, 12-well, 96-well, 384-well, 1536-well or other multi-well formats. The equilibrium dialysis systems can be used for protein binding assays, molecule-molecule interaction studies, tissue cultures and many other biological and chemical applications. Excerpt(s): This application is a continuation of PCT/US01/18070 filed Jun. 5, 2001, which claims priority to U.S. application Ser. No. 09/586,985 filed Jun. 5, 2000, issued as U.S. Pat. No. 6,458,275, the disclosures of which are incorporated by reference herein in its entirety. Current and developing drug discovery and biomedical research applications, such as high throughput screening, rely on the simultaneous preparation of large numbers of samples for the rapid purification and identification of desired molecules and samples. In such applications, hundreds or even thousands of samples often need to be prepared simultaneously using techniques such as equilibrium dialysis. The equilibrium dialyzers currently available on the market are single well or single chamber systems designed for the preparation of a single sample at any given time. The present invention satisfies the need for an equilibrium dialysis system that can be used for simultaneously preparing large numbers of samples. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Single access dialysis needle Inventor(s): Tal, Michael; (Woodbridge, CT) Correspondence: Reed Smith Llp; 29th Floor; 599 Lexington Avenue; New York; NY; 10022; US Patent Application Number: 20030158514 Date filed: February 5, 2003 Abstract: A single access dialysis needle system comprises a first cannula, a second cannula or sheath, and a barrier arranged on the outer surface of the first cannula. The

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distal end of the first cannula extends distal to the distal end of the second cannula or outer sheath, and the barrier is positioned between the respective distal ends. When the barrier is inflated or otherwise activated, it prevents or minimizes recirculation. Excerpt(s): This application is based upon co-pending U.S. provisional patent application Serial No. 60/354,467, filed Feb. 5, 2002, incorporated herein by reference. The invention relates to extracorporeal hemodialysis. More particularly, the invention related to a method and apparatus for dialyzing a patient's blood with a single venipuncture or cannulation. Historically, kidney diseases have been of critical concern to human life. Many kinds of kidney diseases interfere with the function of the kidney such that the kidney ceases to remove waste and excess water from the blood. When the kidney is sufficiently impaired that large portions of the waste products and water are not removed from the blood, the life of the patient cannot be preserved unless a way is provided for artificially performing the function of the impaired kidney. Even today, the same general procedure is used for dialyzing patients' blood that was used very early in the treatment of kidney disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Split tip dialysis catheter Inventor(s): Zawacki, John A.; (Salt Lake City, UT) Correspondence: Morrison & Foerster Llp; 755 Page Mill RD; Palo Alto; CA; 94304-1018; US Patent Application Number: 20030149395 Date filed: February 7, 2002 Abstract: A split tip dialysis catheter having an outer tube and an inner tube, the two tubes which can be arranged over at least a portion of their length in a coaxial configuration. The inner tube may be connected to the outer tube at a proximal bifurcation, secured at a distal end of the outer tube or both, but generally the inner tube will remain free to move relative to the outer tube to optimize functionality. In addition, the inner tube can be arranged to be removable from the catheter for replacement thereof. Excerpt(s): The present invention relates to catheters and more particularly to catheters used for introduction and removal of fluids from a body. Multi-lumen catheters are used for a variety of applications where it is necessary to have two or more separate fluid pathways. One such application for a multi-lumen catheter is for use in hemodialysis. During hemodialysis, a dual-lumen catheter can be employed to simultaneously accommodate opposing blood flow. More specifically, one lumen aspirates blood from a blood vessel of a patient to a dialysis machine where it is processed for the removal of toxins, while the other lumen infuses the purified blood to the patient. The primary problem in many dialysis catheters is that related to clotting and fibrin sheath formation. Thrombus and fibrin can occlude distal tips of the catheter lumens, resulting in loss of catheter function when such an occlusion prevents blood flow. This typically occurs initially in the arterial lumen used for aspiration of blood from a patient. A secondary problem is that related to the arterial lumen "sucking" against the vessel wall in which it resides. This problem can occur if the arterial lumen ports become fully occluded by the patient's vasculature. When either of the aforementioned problems is observed clinically, the first attempt at salvaging the catheter is to reverse the bloodlines (i.e., to aspirate through the longer lumen, and to

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infuse through the shorter lumen, contrary to normal blood flow). While such a scenario causes cleaned blood to flow directly toward the lumen that is under vacuum, line reversal in certain catheters can result in inefficient flow (high re-circulation). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System for determining blood flow rate in a vessel using diverted flow measurements Inventor(s): Messana, Joseph M.; (Ann Arbor, MI), Rubin, Jonathan M.; (Ann Arbor, MI), Weitzel, William F.; (Ypsilanti, MI) Correspondence: Brooks & Kushman; 1000 Town Center 22nd FL; Southfield; MI; 48075 Patent Application Number: 20030167030 Date filed: February 21, 2003 Abstract: A system and method are provided for determining the performance of a vessel, such as a hemodialysis access, which communicates blood between two locations of a patient. A conduit, such as an external dialysis circuit or an intravascular catheter, is provided in fluid communication with the vessel, and has a diversion point for diverting blood from the vessel into the conduit. The system further includes means for determining a flow rate of the diverted blood through the conduit. A first sensor in communication with the vessel generates at least one signal that is a function of a blood flow rate in the vessel downstream from the diversion point, wherein the downstream flow rate depends on the determined conduit flow rate and the performance of the vessel can be determined based on the signal. In addition, a processor can be provided in communication with the first sensor for determining a flow rate in the vessel upstream from the diversion point from the signal and the conduit flow rate. In a preferred embodiment, the first sensor is an ultrasonic sensor, and the at least one signal represents a time-averaged mean Doppler velocity of blood flow. Still further, additional sensors may be employed to provide a measure of the upstream flow rate as well as the conduit flow rate. Excerpt(s): This application is a divisional of U.S. application Ser. No. 09/310,673 filed May 12, 1999, which is a continuation-in-part of U.S. application Ser. No. 09/160,685 filed Sep. 25, 1998, now U.S. Pat. No. 6,167,765. This invention relates to the field of hemodynamics, and more particularly to a system and method for measuring blood flow rate in a vessel, such as a hemodialysis access. Hemodialysis is a process by which blood is passed through an external dialysis circuit to replace the function of a patient's kidney. Blood is removed from the patient's vascular system via an arterial line, is passed through a dialysis filter, and is returned to the patient via a venous line. In order to simplify the withdrawal and return of blood, many dialysis patients have an arteriovenous shunt, or access, surgically created between an artery and vein in a location in the body, such as the upper or lower arm. The access provides a permanent site where the arterial line and venous line can be connected to the patient. A vascular access may be constructed from a native arteriovenous fistula, which is a direct connection of a patient's artery to one of his/her veins, or alternatively may be constructed from a synthetic material, typically polytetrafluoroethylene (PTFE). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Use of N-acetylcysteine for the preparation of a medicament suitable for the intravenous administration to prevent oxidative stress in dialysed patients Inventor(s): Santangelo, Francesco; (Milan, IT) Correspondence: Oblon, Spivak, Mcclelland, Maier & Neustadt, P.C.; 1940 Duke Street; Alexandria; VA; 22314; US Patent Application Number: 20030139472 Date filed: January 30, 2003 Abstract: The present invention relates to methods of decreasing the effects of oxidative stress in patients undergoing dialysis by intravenously administering N-acetylcysteine or a pharmaceutically acceptable salt thereof to the patient. Excerpt(s): The present invention relates to the use of N-acetylcysteine for intravenous administration in dialysed patients to prevent oxidative stress, which is responsible for the onset of numerous diseases. The number of patients suffering from renal disease is constantly growing all over the world. The number of these patients starting with dialysis is growing too at a rate of 7-9% each year and it has been calculated that there will be more than 350,000 dialysed patients in the USA in 2010. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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User wearable device having sterile environment for connecting peritoneal dialysis tubes Inventor(s): Irish, Douglas H.; (Morris, MI) Correspondence: Brooks & Kushman; 1000 Town Center 22nd FL; Southfield; MI; 48075 Patent Application Number: 20030158528 Date filed: February 20, 2002 Abstract: A user wearable device for providing a sterile environment for connecting a user's catheter to a fill-drain tube for performing an exchange of used and fresh peritoneal dialysis fluid includes a pouch. The pouch has exposeable openings for inserting the catheter and a fill-drain tube into the interior of the pouch from the exterior of the pouch. The user connects the catheter to the fill-drain tube within the interior of the pouch for draining and feeding dialysis fluid in a sterile environment. Hand covering elements in communication with the exterior of the pouch are disposed internal to the pouch such that the user can insert his hands into the hand covering elements and connect the catheter to the fill-drain tube within the interior of the pouch. The hand covering elements enable the user to manipulate the catheter and the fill-drain tube from a non-sterile environment external to the pouch. Excerpt(s): The present invention relates generally to continuous ambulatory peritoneal dialysis (CAPD) methods and systems and, more particularly, to a user wearable device such as a pouch or bag which provides a sterile environment for connecting a catheter to a fill-drain tube for feeding and draining dialysis fluid. Continuous ambulatory peritoneal dialysis (CAPD) is a method for performing dialysis for users with kidney failure. CAPD occurs in the user's peritoneal cavity using dialysis fluid. CAPD functions the same way kidneys do by constantly cleansing the blood as long as there is dialysis fluid in the peritoneal cavity. The dialysis fluid is left in the peritoneal cavity for several hours to collect waste from the blood. The used dialysis fluid is then drained from the peritoneal cavity into a drain bag. Fresh dialysis fluid from a fill bag is then

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supplied into the peritoneal cavity for the process to start over. In order to exchange used and fresh dialysis fluid in the peritoneal cavity, a catheter tube (catheter) is permanently attached to the user. An interior end of the catheter is surgically inserted through the user's abdomen into the user's peritoneal cavity. An exterior end of the catheter extends out about four inches from the user's abdomen. The user connects the exterior end of the catheter to the fill bag via a fill-drain tube for receiving fresh dialysis fluid into the user's peritoneal cavity. Similarly, the user connects the exterior end of the catheter tube to the drain bag via the fill-drain tube for draining used dialysis fluid from the user's peritoneal cavity. Once the draining and filling operations are completed, the user disconnects the catheter from the fill-drain tube and seals the catheter. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Zero headspace extractor and method for determining partitioning and contaminant release rates of volatile and semi-volatile compounds Inventor(s): Hayes, Thomas D.; (Schaumburg, IL), Soni, Bhupendra K.; (Westmont, IL) Correspondence: Mark E. Fejer; Gas Technology Institute; 1700 South Mount Prospect Road; Des Plaines; IL; 60018; US Patent Application Number: 20030162303 Date filed: February 22, 2002 Abstract: A method and device for measuring release rates of contaminants in at least one of a fast release mode and a slow release mode in which a volatile liquid sample is introduced into a sealed transparent reactor vessel having at least one sorbent contained within the transparent reactor vessel and a separator for preventing direct contact between the at least one adsorbent and the at least one volatile liquid sample in the transparent reactor vessel, whereby substantially zero headspace is maintained within the transparent reactor vessel. At least one solvent soluble constituent present in the at least one volatile liquid sample is passed through the separator, resulting in sorption of the at least one solvent soluble constituent by the at least one sorbent. In accordance with one preferred embodiment, the separator is a dialysis bag contained in the transparent reactor vessel into which the resin is placed. The at least one solvent soluble constituent is then removed from the at least one sorbent through the separator. Excerpt(s): This invention relates to a method and apparatus for determining release rates of contaminants from soils. More particularly, this invention relates to a method and apparatus that allows the use of sorptive resins for determining the release rates of contaminants from soils while avoiding direct contact between the sorptive resin and the soil/NAPL (nonaqueous phase liquid) complexes. The apparatus is a zero headspace extraction device which, in addition to enabling the determination of release rates of contaminants from soils also provides for easy determination of partitioning constants and the conducting of serial dilution partition tests to determine the rapid release fraction of contaminants in soils and soil/NAPL complexes. Contamination of subsurface soil and its environmental impact is the subject of considerable attention and causes much concern with respect to the storage and disposal of materials such as waste with the potential for contamination. When exposed to soil, it is common for such contaminating or hazardous materials to lodge in the interstices or pore space of the soil, or to become part of the soil solutions, generally defined as the interstitial water in the soil together with solutes and dissolved gases. It will be apparent that the presence of such contaminating or hazardous materials may not be visually detectable as a result of which problems associated with the presence of such contaminating or hazardous

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materials may not manifest themselves until they have reached a critical point. Thus, there is a need for methods and devices for obtaining samples of liquid and gas from subsurface soil in order to subsequently analyze some samples for the possible presence of hazardous materials. It is well known that a substantial amount of subsurface contamination has been caused by the leakage of tanks storing a variety of liquids. One particular problem is the wide spread use of underground storage tanks for various petroleum products with it being known that many of these tanks leak due to corrosion and/or other reasons. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with dialysis, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “dialysis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on dialysis. You can also use this procedure to view pending patent applications concerning dialysis. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON DIALYSIS Overview This chapter provides bibliographic book references relating to dialysis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on dialysis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “dialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on dialysis: •

Clinical Practice Guidelines for Peritoneal Dialysis Adequacy Source: New York, NY: National Kidney Foundation. 1997. 214 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax (212) 689-9261. PRICE: $13.00. ISBN: 0962972150. Summary: In March 1995, the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) was established, with the objective of improving patient outcomes and survival by providing recommendations for optimal clinical practices in four areas: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and the treatment of anemia of chronic renal failure (CRF). This document presents 32 clinical practice guidelines for peritoneal dialysis adequacy. They are categorized in eight sections: initiation of dialysis, measures and measurement of peritoneal dialysis dose, assessment of nutritional status (as it relates to peritoneal dialysis), adequate dose of peritoneal dialysis, strategies for increasing the likelihood of achieving the prescribed

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dose of peritoneal dialysis, clinical outcome goals for adequate peritoneal dialysis, and suitable patients for peritoneal dialysis. Each guideline is accompanied by a rationale, enabling dialysis caregivers to make informed decisions about the proper care plan for each individual patient. This document also includes a list of acronyms and abbreviations, a description of the guideline development methodology, endnotes, references, biographical sketches of the NKF-DOQI peritoneal dialysis adequacy work group members, and a complete listing of the articles reviewed by the peritoneal dialysis adequacy work group. 4 figures. 6 tables. 137 references. (AA-M). •

Employment, Insurance, and Finance: Facts and Resources for the Dialysis Patient Source: Madison, WI: Medical Media Publishing, Inc. 1992. 33 p. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free. Summary: In this patient education monograph, the authors provide an overview about the Medicare system, the Social Security disability program, private insurance, and employment for dialysis patients. Specific topics include employment and dialysis, including scheduling dialysis, making changes to a job, finding a new job, vocational rehabilitation, and the Americans With Disabilities Act; Medicare and health insurance, including how Social Security works, how the Medicare ESRD program works, the role of private insurance, and Medigap insurance plans; and Social Security disability and SSI, including determining disability, the trial work period, and SSI work incentives. The brochure includes brief vignettes of patients and their experiences with the Medicare system. The last half of the booklet presents a list of resources and how to obtain them; state kidney disease programs; pharmacy assistance programs; and state vocational rehabilitation agencies.

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Dialysis Therapy Source: Philadelphia, PA: Hanley and Belfus, Inc. 2002. 561 p. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: It has recently been estimated that the end stage renal (kidney) disease (ESRD) population in the United States alone will approach 700,000 by the end of 2010. The trend for patients to be older and to have significant comorbidities (other diseases at the same time) such as diabetes and hypertension (high blood pressure) is continuing and unlikely to change. Children continue to be treated with extended dialysis, especially in-center hemodialysis, despite the increased use of living related donors and being given priority for cadaver donor kidneys. So argue the editors of this textbook on dialysis therapy, which focuses on changes in the field of nephrology over the past decade. In the text, recognized experts in the field have written concise, focused chapters, emphasizing practical approaches to dialysis and management. Chapters are categorized into 33 sections: demographics, vascular access for hemodialysis, peritoneal access devices, the mechanical aspects of dialysis, dialyzers, kinetic modeling in hemodialysis, improving outcomes in dialysis patients, the hemodialysis procedure, complications during hemodialysis, reuse of hemodialyzers, alternative hemodialytic techniques, the clinical practice of peritoneal dialysis (PD), infectious complications of PD, noninfectious complications of PD, intraabdominal pressure related complications

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of PD, acid-base homeostasis, the nutritional management of dialysis patients, gastrointestinal disease, care of the HIV positive dialysis patient, anemia and Epoetin (erythropoietin) use, cardiovascular disease, metabolic abnormalities, the neurologic aspects of uremia (excessive waste products in the blood), uremic osteodystrophy (bone disease associated with kidney disease), dialysis amyloidosis, acquired cystic kidney disease, diabetes, drug therapy in uremia, rehabilitation and psychosocial issues, pediatric dialysis, surgery in end stage renal disease (ESRD) patients, the pregnant patient on dialysis, and the use of dialysis for drug overdose. Each chapter includes charts and diagrams; each section offers a selected reading list; and the text concludes with a subject index. •

Ambulatory Peritoneal Dialysis Source: New York, NY: Plenum Publishing Corporation. 1990. 351 p. Contact: Available from Plenum Publishing. 233 Spring Street, New York, NY 100131578. (800) 221-9369 or (212) 620-8000. Fax (212) 647-1898. E-mail: [email protected]. PRICE: $85.00. ISBN: 0306433516. Summary: Peritoneal dialysis delivered as continuous ambulatory peritoneal dialysis (CAPD) has emerged worldwide as the most utilized dialysis performed at home, as well as the mainstay therapy for about 15 to 20 percent of all patients who develop endstage renal disease (ESRD). This monograph presents 83 chapters on the current state of CAPD worldwide. Chapters are in eight categories: status of the science; physiology, pharmacology, and morphology; nutrition metabolism; technology; peritonitis; clinical experience; and experience in infants and children. Each chapter includes figures, tables, and ample references. A subject index is appended.

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AAMI Standards and Recommended Practices. Volume 3: Dialysis Source: Arlington, VA: Association for the Advancement of Medical Instrumentation. 1993. 332 p. Contact: Available from Association for the Advancement of Medical Instrumentation. 3330 Washington Boulevard, Suite 400, Arlington, VA 22201. (703) 525-4890 or (800) 3322264. PRICE: $115 (members) or $150 (nonmembers) plus shipping and handling (as of 1995). ISBN: 157020005X. Summary: The Association for the Advancement of Medical Instrumentation (AAMI) Standards and Recommended Practices consists of more than 45 documents compiled in three reference volumes; this volume presents 8 documents on dialysis standards. It includes four American National Standards covering first use hemodialyzers, hemodialysis systems, hemodialyzer blood tubing, and reuse of hemodialyzers; an AAMI technical information report on the reuse of hemodialyzer blood tubing; AAMI monographs on water quality for dialysis and current concepts in hemodialyzer reprocessing; and an AAMI technology assessment report on the issues surrounding hemodialyzer reuse. A subject index is appended.

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Dialysis Access: Current Practice Source: London, England: Imperial College Press. 2001. 400 p. Contact: Available from World Scientific Publishing Co., Inc. 1060 Main Street, River Edge, NJ 07661. (800) 227-7562 or (201) 487-9655. Fax (888) 977-2665 or (201) 487-9656. Email: [email protected]. Website: www.wspc.com. PRICE: $75.00 plus shipping and handling. ISBN: 1860941699.

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Summary: The incidence of treated end stage renal disease (ESRD) continues to rise, particularly in the western world. Although renal (kidney) transplantation is the treatment of choice for ESRD, the decline in the number of cadaveric organs, coupled with the rising demand for transplantation, means that an increasing number of patients will have to depend on dialysis. Vascular (blood system) and peritoneal (abdominal cavity) access remains the primary issue of concern for dialysis. This book offers a description of the state of the art in providing and preserving a durable and reliable access for dialysis. The contributing authors are drawn from a wide background, with expertise in various aspects of dialysis access, including its history, the technique of placement, anesthesia, radiology, nursing care, and training of vascular access surgeons. Sixteen chapters cover the history of dialysis access; modality selection and patient outcome; continuing quality improvement; the access clinic; recirculation and dialysis access; the value of ultrasonic imaging in defining the anatomy for vascular access; anesthetic management; arteriovenous fistulas; use of autogenous (from the patient) vein or synthetic grafts; complications of vascular access; revision access surgery; central venous catheters; access for pediatric patients (children); radiology of access; peritoneal dialysis access; and the nursing care for patients with dialysis access. Each chapter concludes with a lengthy list of references, and a subject index concludes the volume. The book is intended for use by transplant surgeons, general surgeons with an interest in vascular access, vascular surgeons, nephrologists, trainees, and nurses. •

Understanding Your New Life With Dialysis Source: Springfield, IL: Charles C. Thomas Publisher. 1992. 186 p. Contact: Available from Charles C. Thomas, Publisher. 2600 South First Street, Springfield, IL 62794-9265. (217) 789-8980. PRICE: $31.95 plus $5.50 shipping and handling (as of 1995). ISBN: 0398057745. Summary: This book for dialysis patients, written by a physician who has been on dialysis for over 20 years and by his wife, provides comprehensive information for both new and veteran dialysis patients. Twelve chapters cover an overview of dialysis, kidney failure, the function of both human and artificial kidneys, preparation for hemodialysis, peritoneal and hemodialysis at home, avoiding and treating chronic medical conditions, the role of diet, medication and exercise, adjustment and rehabilitation, employment, insurance and financial issues, dialysis and transplantation, a history of dialysis, and an account of the authors' own story. Also included is a detailed listing of resources and how to obtain them, an appendix listing food exchange information, and a subject index.

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Dialysis Diet Source: Glendale, AZ: ADL Publishing Company. 2002. 141 p. Contact: Available from ADL Publishing Company. P.O. Box 2791, Glendale, AZ 853112791. ISBN: 0971999708. PRICE: $14.95, plus shipping and handling. Summary: This book helps patients and their caregivers follow dietary recommendations for the low sodium, low potassium, low phosphorus, low fluid diet that is required for patients on dialysis. Sodium, potassium, and phosphorus are found in nearly all foods. The nutrition labels required by the FDA on most food products list the sodium content in the product, but only a few products list the potassium content and virtually none list the phosphorus content. The author notes that since monitoring of these minerals is so critical to the patient's health and well being, meal planning and preparation becomes a full time job. The book includes a text section of helpful tips,

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which provides information on abbreviations and symbols, protein, sodium, potassium, phosphorus, consuming enough calories, eating away from home, soaking vegetables, monitoring fluid intake, relief of constipation, emergency diet plan, and a seasoning guide. The remainder of the book offers charts of food values, listing protein, sodium, potassium, phosphorus values for foods grouped as follows: beverages, breads, candy, cereals, cheese and dairy, desserts, eggs, frozen or homemade entrees, fast foods, fish, fruits, juices, meats, miscellaneous items, nuts and seeds, pasta, rice and beans, poultry, salad dressings, sauces and gravies, snacks, soups, and vegetables. •

Complications of Dialysis Source: New York, NY: Marcel Dekker, Inc. 2000. 888 p. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: This book is a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies. The editors have developed the book on the premise that complications result from the interaction of the patient, the technique, and the environment in which dialysis is provided. Therefore, the complications of dialysis are discussed from three angles: patient related, technique related, and those contributed to by the organization of care reflecting the changing relationship between providers and beneficiaries of dialysis. Forty eight chapters, written by experts in the field, cover topics including complications and problems of vascular access, water treatment and substitution fluids, biocompatibility of hemodialysis membranes, inadequate delivered dose, anticoagulation, hemoperfusion, peritoneal access, peritoneal membrane failure, continuous renal replacement therapy, fluid management, and solute removal; patient related complications, including cardiac disease, hematological (blood) problems, arthropathies, acid base problems, infectious problems, immune dysfunction, nutritional complications, endocrine and sexual problems, dermatological (skin) problems, hypertension (high blood pressure), pulmonary (lung) problems, quality of life and functional status, neurological complications, psychiatric and psychosocial complications, gastrointestinal complications, and ocular (eye) complications; and special situations, including renal replacement therapy in the ICU (intensive care unit), acute and chronic dialysis in children, dialysis in patients with HIV infections, hepatitis (liver inflammation) and dialysis, patients with diabetes mellitus on dialysis, women on dialysis, complications during plasma exchange, economic issues in dialysis (including in the United States, in Europe, in Canada, and in developing countries), the environmental aspects of dialysis, and perioperative anesthetic management of the high risk renal patient. Each chapter includes black and white figures, tables, and extensive references; a subject index concludes the book.

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Patient's Guide to Dialysis and Transplantation. 4th ed Source: Hingham, MA: Kluwer Academic Publishers. 1990. 173 p. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station. Hingham, MA 02018. (617) 871-6600. PRICE: $24.50. ISBN: 0792389506. Summary: This book is a patient's guide to the treatment of renal failure. The author notes that treatment policies may vary considerably from one renal unit to another. Topics include an introduction to the anatomy and function of the kidneys; a basic

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primer to dialysis, both hemodialysis and peritoneal dialysis; a discussion of transplantation; and lifestyle issues, including diet, sexuality, pregnancy, holidays, and impact on day-to-day life. Two final chapters cover social service support that is available and a brief history of dialysis and transplantation. A detailed glossary and subject index are included. •

Introduction to Dialysis. 2nd ed Source: Naperville, IL: Churchill Livingstone. 1991. 394 p. Contact: Available from Churchill Livingstone. 5 S 250 Frontenac Road, Naperville, IL 60563-1711. (708) 416-3939 or (800) 553-5426. PRICE: $58. ISBN: 0443087202. Summary: This book is designed to acquaint health professionals with the principles of sound dialytic therapy. Six chapters, each written by experts in the field, cover dialyzers and delivery systems; access for dialysis; care of the patient on hemodialysis; care of the patient on peritoneal dialysis; care of the patient between dialyses; and drug overdose and pharmacologic considerations in dialysis. Also included is a discussion of the clinical indications, physiology, dosing kinetics, and complications of the recombinant drug erythropoietin. In addition, a special section discusses the technical features of water purification. One appendix presents a chart of drug dialysis reference data and a subject index concludes the volume.

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Peritoneal Dialysis: New Concepts and Applications Source: New York, NY: Churchill Livingstone Inc. 1990. 266 p. Contact: Available from Churchill Livingstone Inc. 650 Avenue of the Americas, New York, NY 10011. (800) 553-5426. PRICE: $63 plus shipping and handling. ISBN: 0443087164. Summary: This book presents scholarly reviews on peritoneal dialysis. Eleven chapters, each written by experts in the field, cover the following topics: the functional anatomy of the peritoneum as a dialyzing membrane; the kinetics of ultrafiltration with glucose and alternative osmotic agents; pharmacologic manipulations of peritoneal transport; dialysis adequacy and new cycler techniques; peritoneal dialysis access; clinical results with peritoneal dialysis; risk assessment for and management of peritonitis; experiences with the Y-system; bone and mineral metabolism; peritoneal dialysis in end-stage renal disease with diabetes; and pediatric CAPD/CCPD in the United States.

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Diet Guide for Peritoneal Dialysis Source: Springfield, MO: Ozarks Dialysis Services. 199x. 19 p. Contact: Available from Ozarks Dialysis Services. 330 East Division, Springfield, MO 65803. (417) 836-3443. PRICE: $5. Summary: This book provides an easy-to-read introduction to the diet therapy typically prescribed for the person on continuous ambulatory peritoneal dialysis (CAPD). Topics include general information about diet therapy; the role of protein, calories, sodium, potassium, phosphorus, fluids, and vitamins in meal planning and nutrition; sample meal plans; exchange list information for the milk, meat, starch, vegetable, fruit, and fat groups; and foods to avoid.

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Principles and Practice of Dialysis Source: Baltimore, MD: Williams and Wilkins. 1994. 478 p.

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Contact: Available from Williams and Wilkins. 428 East Preston Street, Baltimore, MD 21202. (800) 638-0672. PRICE: $129; plus shipping and handling. ISBN: 06830399733. Summary: This book provides dialysis practitioners, trainees, and students with current information about the most pressing issues confronting the practice of dialysis. Thirtyone chapters are presented in two sections: technical and procedural considerations in dialysis therapy and clinical considerations in the evaluation of dialysis patients. Topics in the first section include the choice of the hemodialysis membrane; dialysate composition; hemodialysis vascular access; hemodialysis urea modeling; high-flux, high-efficiency procedures; prescribing drugs for dialysis patients; continuous therapeutic techniques; and the causes, diagnosis, and treatment of peritoneal membrane failure. Topics discussed in the second section include hypertension in dialysis patients; left ventricular dysfunction; coronary artery disease in end-stage renal disease (ESRD); autonomic function and hemodynamic stability; infection and immunity in ESRD; amyloidosis; renal osteodystrophy; dsylipidemias of ESRD; malnutrition and intradialytic parenteral nutrition in ESRD patients; disorders of hemostasis in dialysis patients; treatment of anemia; acquired cystic kidney disease; geriatric dialysis patients; dialysis patients with diabetes; hemodialysis and hemoperfusion for poisoning; dialysis in children; infections in patients on continuous ambulatory peritoneal dialysis; and balancing outcomes in dialysis with economic realities. •

Prescribing Hemodialysis: A Guide to Urea Modeling Source: Hingham, MA: Kluwer Academic Publishers. 1991. 313 p. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018. (617) 871-6600. PRICE: $87.50. ISBN: 0792308336. Summary: This book provides the practicing nephrologist with both the theoretical and the practical approaches to the prescription of dialysis, and the monitoring of its delivery and outcome. Early chapters review the understanding of uremic toxins, with a focus on urea as a toxin and as a surrogate for other highly dialyzable toxins. Chapter 3 introduces urea modeling, the clinical requirements and advantages of modeling, and various models used in the past. Chapters 4 and 5 provide an in-depth discussion of the single-compartment model and a more complex, two compartment model. Chapter 6 is a guide to UREAKIN, a user-friendly computer program for rapid implementation of urea modeling. Chapter 7 outlines the refinements and application of urea modeling, while Chapter 8 reviews the most controversial aspect of urea modeling, the criteria for establishing ideal or target outcomes. Final chapters provide concrete examples of urea modeling and presents projections for the future. Each chapter includes numerous tables, figures, and references. Nine appendixes, a listing of variables and abbreviations used, and a subject index are included. 344 references.

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Healthy Eating for Dialysis Source: Wichita, KS: St. Francis Dialysis Facility. 1990. 80 p. Contact: Available from St. Francis Dialysis Facility. Dietitian's Office, 1007 North Emporia, Wichita, KS 67214. (800) 362-0070 ext. 5847 or ext. 5817 or (316) 268-5847 or (316) 268-5817. PRICE: $15 (plus $2.50 shipping). Summary: This book was designed to help the dialysis patient understand the importance of a proper diet. The first section explains how sodium, fluid, potassium, protein and phosphorus relate to the dialysis treatment and why they need to be

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controlled by diet. The second section provides information about a wide variety of foods, using a point system to help the patient make wise food choices. The authors stress that healthy eating for patients undergoing dialysis doesn't mean that eating must be bland or dull; successful new eating habits are those that are enjoyable. The book is contained in a loose-leaf binder. •

Adventure at Riverside Park: A Story About Pediatric Dialysis Source: Indianapolis, IN: National Kidney Foundation of Indiana, Inc. 1997. 52 p. Contact: Available from National Kidney Foundation of Indiana, Inc. 850 North Meridian Street, Indianapolis, IN 46204-1109. (800) 382-9971 or (317) 693-6534. Fax (317) 693-6538. E-mail: [email protected]. PRICE: Free to Indiana residents; $9.00 outside of Indiana. Summary: This book, designed for 8 to 12 year old children with kidney disease, serves as a tool for families to discuss and develop a better understanding of dialysis. The story explains in familiar terminology what young people experience in a dialysis unit. The narrative style of writing helps youngsters learn about each member of the health care team and their role in dialysis treatment. The book also points out that the patient is the most important member of the health care team. The National Kidney Foundation of Indiana (NKFI) produced the pediatric book after learning from professionals at the Riley Children's Hospital dialysis unit that there was a need for such a learning tool. The story describes the experiences of a young adolescent girl named Marcy as she undergoes surgery for a peritoneal access tube (catheter). Readers then follow Marcy through the postoperative care period, learning about CAPD (continuous ambulatory peritoneal dialysis) and how to do the exchanges, meeting other children who are undergoing dialysis (including hemodialysis), and learning about the health care providers (including the dialysis nurses, the nutritionist, the physician, and the social worker). The story also depicts children from the dialysis unit on their annual trip to a local amusement park. Through these activities, Marcy begins to accept her situation and to realize that life is more than just kidney disease and dialysis. The book is illustrated with watercolor paintings of the children. Appendices offer a list of resource organizations for more information, a list of issues children may want to talk about, a description of the various types of treatments for kidney disease, a glossary explaining the health care providers who may be involved in the treatment of kidney disease, and two lined pages for children to record their questions, concerns, thoughts and feelings.

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Diet for Peritoneal Dialysis Source: West Linn, OR: Oregon Council on Renal Nutrition. 1991. 32 p. Contact: Available from Madelyn Koontz, 3030 SW Lawnridge Street, Albany, OR 97321. Also available from Jessie Pavlinac. (503) 494-3762. PRICE: $5; bulk prices available. Also available as one of three books in a series for $10. Summary: This book, part of a series of three books for renal patients, presents a basic guide to the diet therapy commonly prescribed for patients on peritoneal dialysis. Numerous charts and lists cover the basics of a renal diet, including: common abbreviations; protein; potassium; phosphorus and calcium; sodium and fluids; caloric intake; appetite; eating in restaurants; vitamins; constipation; and sick day rules. Colorcoded charts list the exchange list information for dairy, meat, breads and starches, vegetables, fruits, fats, beverages, and free foods. The book is written at the 5th grade reading level and is also appropriate for patients with diabetes. 5 references.

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Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Source: Baltimore, MD: Health Care Financing Administration (HCFA), U.S. Department of Health and Human Services. August 2000. 60 p. Contact: Available from Health Care Financing Administration (HCFA). 7500 Security Boulevard, Baltimore, MD 21244-1850. (800) MEDICARE or (800) 633-4227. TTY/TDD (877) 486-2048. Website: www.medicare.gov. PRICE: Free. Publication Number HCFA10128. Summary: This booklet explains how Medicare helps pay for kidney dialysis and kidney transplant services in the Original Medicare Plan, also known as fee-for-service. This booklet does not have detailed information about kidney failure, dialysis treatments, and kidney transplants; rather, it focuses on cost considerations of each of these treatment options and how patients can use the Medicare system. The booklet includes ten sections: Medicare basics, kidney dialysis, kidney transplants, how Medicare pays for blood, appeals and grievances (complaints), other kinds of health insurance, where to get more information, Medicare coverage charts, definitions of important words (a glossary), and a subject index. Patients can get Medicare no matter how old they are if their kidneys no longer work and they need regular dialysis or have had a kidney transplant; eligibility includes participation in the Social Security system. The booklet briefly outlines eligibility requirements and offers readers the toll free telephone number of the Social Security Administration (800-772-1213). Patients are encouraged to learn about Medicare and other insurance coverage and to take an active part in their own health care decisions. The booklet includes space for important telephone numbers and a few blank pages for patient notes.

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Employment: A Guide to Work, Insurance, and Finance for People on Dialysis Source: Madison, WI: Life Options Rehabilitation Program. 1998. 56 p. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free. Summary: This booklet helps people with end stage renal disease (ESRD) understand the issues of employment and finances. The booklet introduces the Life Options Rehabilitation Advisory Council (LORAC), which offers a program based on the Five E's of renal rehabilitation: encouragement, education, exercise, employment, and evaluation. The booklet discusses employment, insurance, finances, Medicare, health insurance, disability programs, and employment and disability. The booklet features seven case studies of different people with ESRD and how each handles employment and rehabilitation. Each case study includes a photograph of the person and direct quotations on how they handle everyday challenges. The booklet helps people with ESRD understand how work, Medicare, the Social Security disability program, and private insurance can fit together to provide a financial basis for health care and rehabilitation. The booklet concludes with an appendix to help determine impairment related work expenses (IRWE), an appendix on work incentives for SSDI and SSI, a glossary of terms, a listing of renal rehabilitation resources, a list of general resources, a listing of materials in Spanish, and a directory of kidney disease organizations, other resources, and State kidney disease programs.

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Healthy Food Guide: Peritoneal Dialysis Source: Chicago, IL: American Dietetic Association. 1993. 28 p.

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Contact: Available from American Dietetic Association (ADA). 216 West Jackson Boulevard, Chicago, IL 60606-6995. (312) 899-0040. PRICE: $19.95 for 1-10 copies for ADA members; $23.50 for nonmembers; plus shipping and handling. ISBN: 0880911212. Summary: This booklet is a guide to help patients with kidney disease and who are on continuous ambulatory peritoneal dialysis (CAPD) or continuous cyclic peritoneal dialysis CCPD, plan nutritious meals and stay as healthy as possible. The booklet opens with a blank form for the health care provider to use with the patient's individualized daily meal plan. Meal planning is discussed in four sections: the use of exchange lists; fitting the kidney diet into everyday lifestyles; detailed information about protein and calories, phosphorus and calcium, potassium, and sodium; and a practice section for applying dietary guidelines to sample situations. The authors of the booklet encourage readers to ask questions and meet with a dietitian often as they learn to follow their recommended diet. The booklet concludes with a glossary and the answers to the practice questions. •

Eating Right: A Nutritional Guide for the Diabetic Dialysis Patient (3rd ed.) Source: Minneapolis, MN Minneapolis Medical Research Foundation, Inc. 1993. 21 p. Contact: Available from Dialyrn Renal Education System. 914 South Eighth Street, Minneapolis, MN 55404. (612) 347-5949. PRICE: $3.50 each for 1-9 copies; $3 each for 10 or more. Order Number: 330. Summary: This booklet provides food and meal planning guidelines and information for people with diabetes who undergo dialysis treatment. Food choices, daily allowable portions, and foods to avoid are covered for the various food groups: meat and meat substitutes; milk and milk products; starches; fruits, fruit juices, and vegetables; fats; and fluids. The text also summarizes important dietary guidelines, tips for controlling fluid intake, and guidelines concerning insulin reactions, eating away from home, eating ethnic foods, and for developing a personal daily meal plan.

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Dietary Guidelines for Peritoneal Dialysis Source: Birmingham, AL: Department of Food and Nutrition Services, University Hospital. 1992. 11 p. Contact: Available from Department of Food and Nutrition Services, University Hospital. 619 South 19th Street, Birmingham, AL 35233. (205) 934-8055. Fax (205) 9342987. PRICE: $2.50 per copy; bulk copies available; plus shipping and handling. Summary: This booklet provides guidelines for a diet for patients using peritoneal dialysis to treat their decreased kidney function. Normally the kidneys act as filters, helping the body get rid of waste products, excess water, and sodium. When the kidneys begin to fail, these substances build up to dangerous levels in the blood. It then becomes necessary to utilize dialysis, a special diet, and prescribed medications. The booklet includes space for the dietitian to record the patient's individual recommendations or prescription for protein (low phosphorus), sodium, and fluid. The booklet reviews each of five categories of nutrients and the foods that are high in each nutrient. The categories are protein, potassium, sodium and fluid, phosphorus, and cholesterol and triglycerides. After a summary of the general guidelines for this type of diet, the booklet offers extensive charts of food choices, from which readers can create breakfast, lunch, dinner, and snack menus. The booklet emphasizes the importance of replacing the protein and potassium often lost in dialysis therapy and of following all prescribed medication guidelines.

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Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis Source: Washington, DC: Renal Physicians Association. 2000. 87 p. Contact: Available from Renal Physicians Association (RPA). 4701 Randolph Road, Suite 102, Rockville, MD 20852. (301) 468-3515. Fax (301) 468-3511. E-mail: [email protected]. Website: www.renalmd.org. PRICE: $35.00 for members; $50.00 for nonmembers. Summary: This clinical practice guideline from the Renal Physicians Association (RPA) on Shared Decision Making in the Appropriate Initiation of and Withdrawal from Dialysis presents nine recommendations concerning withholding or withdrawing from dialysis in adult patients with either acute renal failure or end stage renal disease. These nine recommendations cover issues including shared decision making, informed consent or refusal, estimating prognosis, conflict resolution, advance directives, withholding or withdrawing from dialysis, special patient groups, time limited trials, and palliative care. The guideline includes a summary of the recommendations, a description of the guideline development process, guideline recommendations and the rationale for each, suggestions for implementing the recommendations in practice, prognostic tables, strategies for dealing with disruptive patients, and research directions. In addition, the document includes a toolkit in which suggestions for the dissemination and local implementation of the guideline recommendations are presented. Suggested steps for dealing with disruptive patients are also included. The guideline was developed by the RPA and the American Society of Nephrology in conjunction with representatives from multiple organizations and disciplines in the dialysis community, kidney patients and family members, and internal medicine physicians, with the assistance of a bioethicist and public policy analyst. The guideline concludes with a list of acknowledgments, a glossary of key terms, and references. 11 figures. 29 tables. 302 references.

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Cooking for David: A Culinary Dialysis Cookbook Source: Kearney, NE: Morris Press. 2000. 253 p. Contact: Available from Culinary Kidney Books. P.O. Box 468, Huntington Beach, California 92648. Website: www.CulinaryKidneyCooks.com. PRICE: Single copy $24.00 plus shipping and handling. Summary: This cookbook was written to support cooks who are providing meals for people on renal hemodialysis and following a strict renal (kidney) diet. A preface, written by a medical doctor, offers a brief overview of the function of the kidneys and the various diseases that can cause kidney dysfunction and failure; this preface reminds readers of the power that diet can have in slowing progression of kidney disease. Two additional introductory chapters cover food selection, preparation, and portioning; and meal planning tools, including sample menus, a food pyramid for a renal dialysis diet, and average calculated nutrients for food choice lists. The recipes are then offered in ten categories: appetizers, snacks, and beverages; breakfasts; desserts; meats; fish and seafood; poultry; rice, pasta, and breads; salads and salad dressings; sauces, gravies, and seasonings; and vegetables. Each recipe notes the number of servings, serving size, ingredients and directions, nutrients per serving (for calories, protein, carbohydrate, fat, cholesterol, sodium, potassium, and phosphorus), and the values for the renal and renal diabetic food exchanges. The cookbook also includes a glossary of cooking terms, tables of equivalents, an appendix, a list of references, a quick recipe reference, ingredient footnotes, and an index of recipes by title. 9 references.

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Guidelines for the Nutritional Intervention of the Adult Dialysis Patient Source: Marina del Rey, CA: R and D Laboratories, Inc. 1990. 88 p. Contact: Available from R and D Laboratories, Inc. 4640 Admiralty Way, Suite 710, Marina del Rey, CA 90292. (800) 338-9066. PRICE: Contact directly for current price. Summary: This handbook is designed to assist the renal dietitian through the complex steps of evaluating the nutrition status of a dialysis patient. The guidelines are arranged by individual diagnoses or problems, and are based primarily on laboratory chemistries, presented as a quick reference. Expected patient outcome criteria are listed for each problem, along with a list of appropriate dietary interventions. A patient education documentation sheet suitable for use in the medical record is provided for each of the problems. Topics include hyperlipidemia, body weight changes, hyper-and hypocalcemia, hyperphosphatemia, elevated BUN, depressed serum albumin, hyperkalemia, fluid overload, and low hematocrit. 18 references.

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Handbook of Dialysis. 2nd ed Source: Boston, MA: Little, Brown and Company. 1994. 743 p. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $37.95. ISBN: 0316173835. Summary: This handbook outlines all aspects of dialysis therapy, emphasizing the management of dialysis patients. Forty-four chapters are presented in five sections: indications for dialysis, hemodialysis, peritoneal dialysis, special problems in the dialysis patient, and special problems pertaining to various organ systems. Specific topics include vascular access, hemodialysis apparatus, acute and chronic hemodialysis, anticoagulation, dialyzer reuse, complications during hemodialysis, the physiology of peritoneal dialysis, apparatus for peritoneal dialysis, acute and chronic peritoneal dialysis, peritonitis, psychology and rehabilitation, nutrition, acid-base and electrolyte disturbances, diabetes, hypertension, hematologic abnormalities, infections, endocrine disturbances, bone disease, aluminum toxicity, cancer, surgery, dialysis in infants and children, and the use of dialysis and hemoperfusion in treatment of poisoning. A subject index concludes the handbook.

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Your New Life with Dialysis: A Patient Guide for Physical and Psychological Adjustment. 4th ed Source: Springfield, IL: Charles C. Thomas, Publisher. 1991. 210 p. Contact: Available from Charles C. Thomas, Publisher. 2600 South First Street, Springfield, IL 62794-9265. (217) 789-8980. PRICE: $29.75. Summary: This patient handbook discusses the technological, psychological, and philosophical aspects of dialysis. Topics include history of dialysis; explanation of kidney failure; human artificial kidneys; preparation for dialysis; new concepts in peritoneal dialysis, in particular, Continuous Ambulatory Peritoneal Dialysis (CAPD); chronic medical conditions; diet and medication; adjustment and rehabilitation; and alternatives to and within dialysis. The authors' own personal encounters and successful experiences of others with dialysis are related. 43 illustrations. 2 tables.

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Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed Source: St. Louis, MO: Mosby. 1999. 371 p. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: This text poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. Twenty-three chapters cover the hemodialysis team, the basic chemistry of body fluids and electrolytes, renal physiology and the pathology of renal failure, principles of hemodialysis, dialyzers and dialysate, water treatment, dialyzer preparation and reprocessing, access to the bloodstream, patient and machine monitoring and assessment, anticoagulation and heparin administration, medication problems and dialysis, nutrition management, acute renal failure and dialysis, complications of chronic dialysis therapy, transplantation, peritoneal dialysis and home dialysis therapies, diabetes and hemodialysis, infection control and universal precautions, the psychosocial aspects of dialysis therapy, pediatric hemodialysis, end stage renal disease (ESRD) in the elderly, management of quality in dialysis care, and renal care and information technology. The text concludes with references and recommended readings, a listing of nephrology organizations and resources, a glossary of terms, a subject index, and three appendices: conversion factors used in hemodialysis, conversion table for pounds to kilograms of body weight, and the sodium and potassium content of selected foods. The text offers charts and drawings where appropriate. The authors focus on giving members of the dialysis team (including nurses, technicians, dietitians, pharmacologists, social workers, and patients) a strong foundation of basic information and an understanding on the necessary interdisciplinary approach to quality care in the dialysis field. 117 references.

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Atlas of Diseases of the Kidney. Volume 5: Dialysis as Treatment of End-Stage Renal Disease/Transplantation as Treatment of End-Stage Renal Disease Source: Philadelphia, PA: Current Medicine, Inc. 1999. [270 p.]. Contact: Available from Blackwell Science, Inc. 350 Main Street, Malden, MA 02148. (800) 215-1000 or (781) 388-8250. Fax (781) 388-8270. E-mail: [email protected]. PRICE: $75.00 plus shipping and handling. ISBN: 0632043911. Summary: This volume is the last in a series of five that make up the Atlas of Diseases of the Kidney, a set that offers educational images including colored photographs, schematics, tables, and algorithms. In Volume 5, 7 chapters consider dialysis as treatment of end stage renal disease (ESRD), and 10 chapters cover transplantation as treatment of ESRD. The first section is organized to provide a systematic overview of dialytic procedures. The first chapter discusses the principles of dialysis and the mechanics of practical therapy. One essential feature of the dialysis procedure is the composition of dialysate, which is discussed in detail in the second chapter. Newer dialytic therapies such as high efficiency dialysis and continuous dialysis therapy techniques are discussed next; these treatments have resulted in shorter dialysis times in patients with chronic renal failure and have been useful in the management of complicated acute renal failure (ARF) patients. Other chapters cover peritoneal dialysis, problems with arteriovenous fistula access, dialysis prescription and methods of measuring urea, and several complications that afflict patients with renal failure who are on dialysis, including blood pressure regulation and chronic inflammation. The

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second section details transplantation, including several chapters on the evaluation of donors and recipients, including their posttransplant complications. One chapter addresses the technical aspects of transplantation, shows the operation, and provides the basis for making the diagnostic and therapeutic decisions necessary when a patient develops postoperative renal dysfunction. Other chapters cover combined kidney and pancreas transplantation, tissue typing and organ sharing, immunosuppressive drugs, and the management of renal transplant rejection. Finally, the special needs of pediatric transplantation and the intriguing area of recurrent disease are covered. Each chapter features a detailed introduction and lengthy captions for each of the illustrations and diagrams offered. A subject index for Volume 5 and a section of full color plates concludes the book. •

Treatment Methods for Kidney Failure: Hemodialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2001. 14 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 014666. Summary: When the kidneys fail, harmful wastes build up in the body, the blood pressure may rise, and the body may retain excess fluid and not make enough red blood cells. When this happens, treatment is required to replace the work of the failed kidneys. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. This booklet helps readers recently diagnosed with kidney failure understand hemodialysis. Topics include how hemodialysis works, adjusting to changes, getting the vascular access ready, equipment and procedures, tests to monitor how well the dialysis is working, conditions related to kidney failure and their treatments (anemia, renal osteodystrophy, itching, sleep disorders, amyloidosis), how diet can help, financial issues, and current research in this area. Medical or technical terms are defined in the text. The booklet concludes with a list of resources for additional information and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 6 figures.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “dialysis” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “dialysis” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “dialysis” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):

Books

287

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2003 Dialysis Weekly Planner by Thomas Masters, Susie Q Lew; ISBN: 1588082016; http://www.amazon.com/exec/obidos/ASIN/1588082016/icongroupinterna

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2004 Dialysis Calendar by Thomas Masterson, Susie Lew; ISBN: 1588084566; http://www.amazon.com/exec/obidos/ASIN/1588084566/icongroupinterna

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A Healthy Food Guide for People on Dialysis by Kathy Schiro Harvey (Editor), et al (2002); ISBN: 0880914025; http://www.amazon.com/exec/obidos/ASIN/0880914025/icongroupinterna

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A Healthy Food Guide: Diabetes and Peritoneal Dialysis (Package of 10) by American Dietetic Association (1993); ISBN: 0880911220; http://www.amazon.com/exec/obidos/ASIN/0880911220/icongroupinterna

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A History of the Treatment of Renal Failure by Dialysis by J. Stewart Cameron; ISBN: 0198515472; http://www.amazon.com/exec/obidos/ASIN/0198515472/icongroupinterna

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A Manual of Peritoneal Dialysis: Practical and Procedures for Medical and Nursing Staff by G. A. Coles (1988); ISBN: 0746200811; http://www.amazon.com/exec/obidos/ASIN/0746200811/icongroupinterna

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A Patient's Guide to Dialysis and Transplantation (1990); ISBN: 085200981X; http://www.amazon.com/exec/obidos/ASIN/085200981X/icongroupinterna

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Aami Standards & Recommended Practices: Dialysis (1990); ISBN: 0910275505; http://www.amazon.com/exec/obidos/ASIN/0910275505/icongroupinterna

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Access for Dialysis: Surgical and Radiologic Procedures, 2nd edition by Ingemar J. A., Md., Phd, Facs Davidson (Editor), et al; ISBN: 1570596271; http://www.amazon.com/exec/obidos/ASIN/1570596271/icongroupinterna

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Advances in End-Stage Renal Diseases 2000: International Conference on Dialysis Ii, January 13-14, 2000, Tarpon Springs, Fla. (Reprint of 'Blood Purification', Volume 18, Number 4, 2000) by Nathan W. Levin (Editor), Claudio Ronco (Editor) (2000); ISBN: 3805570805; http://www.amazon.com/exec/obidos/ASIN/3805570805/icongroupinterna

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Advances in End-Stage Renal Diseases 2001: International Conference on Dialysis Iii, Miami Beach, Fla., January 2001 (Blood Purification, 2) by N. W. Levin (Editor), C. Ronco (Editor) (2001); ISBN: 3805571860; http://www.amazon.com/exec/obidos/ASIN/3805571860/icongroupinterna

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Advances in End-Stage Renal Diseases 2002: International Conference on Dialysis Iv, January 23-25, 2002, Phoenix, Ariz. by Claudio Ronco (Editor), Nathan W. Levin (Editor) (2002); ISBN: 3805573723; http://www.amazon.com/exec/obidos/ASIN/3805573723/icongroupinterna

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Advances in End-Stage Renal Diseases 2003: International Conference on Dialysis V, Miami, Fla., January 2003 by C. Ronco (Editor), N. W. Levin (Editor) (2003); ISBN: 3805575351; http://www.amazon.com/exec/obidos/ASIN/3805575351/icongroupinterna

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Advances in Nephrology and Dialysis (Contributions to Nephrology, Vol 45) by G D'Amico (Editor), G. Colasanti (Editor) (1985); ISBN: 3805539630; http://www.amazon.com/exec/obidos/ASIN/3805539630/icongroupinterna

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Advances in peritoneal dialysis : proceedings of the Second International Symposium on Peritoneal Dialysis : Berlin (-West), June 16-19, 1981; ISBN: 0444902325; http://www.amazon.com/exec/obidos/ASIN/0444902325/icongroupinterna

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Ambulatory Peritoneal Dialysis by Carmelo Giordano (Editor), Morrell Michael Avram (1990); ISBN: 0306433516; http://www.amazon.com/exec/obidos/ASIN/0306433516/icongroupinterna

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Automated Peritoneal Dialysis (Contributions to Nephrology) by C. Ronco (Editor), et al (1999); ISBN: 3805569343; http://www.amazon.com/exec/obidos/ASIN/3805569343/icongroupinterna

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Bio-Incompatibility and Dialysis (Contributions to Nephrology, Vol 62) by G. Laurent (Editor), M. E. De Broe (1988); ISBN: 3805546955; http://www.amazon.com/exec/obidos/ASIN/3805546955/icongroupinterna

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CAPD update : continuous ambulatory peritoneal dialysis; ISBN: 0893521345; http://www.amazon.com/exec/obidos/ASIN/0893521345/icongroupinterna

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Cardiovascular Aspects of Dialysis Treatment: The Importance of Volume Control by Evert J. Dorhout Mees (Editor), Evert J. Dorhout Mees (Editor); ISBN: 0792362675; http://www.amazon.com/exec/obidos/ASIN/0792362675/icongroupinterna

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Chronic Ambulatory Peritoneal Dialysis and Chronic Cycling Peritoneal Dialysis in Children by Richard N. Fine (1987); ISBN: 0898388597; http://www.amazon.com/exec/obidos/ASIN/0898388597/icongroupinterna

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Clinical aspects of uremia and dialysis; ISBN: 0398034621; http://www.amazon.com/exec/obidos/ASIN/0398034621/icongroupinterna

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Clinical Dialysis (1990); ISBN: 0838511287; http://www.amazon.com/exec/obidos/ASIN/0838511287/icongroupinterna

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Clinical Technologist Companion Renal Dialysis: Water System, Peripheral Equipment, Machine by Frank Sikapa (2003); ISBN: 141071473X; http://www.amazon.com/exec/obidos/ASIN/141071473X/icongroupinterna

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Complications of Dialysis by Norbert Lameire (Editor), et al; ISBN: 0824788710; http://www.amazon.com/exec/obidos/ASIN/0824788710/icongroupinterna

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Complications of Long-Term Dialysis by Edwina Brown (Editor), Patrick S. Parfrey (Editor) (1999); ISBN: 0192628291; http://www.amazon.com/exec/obidos/ASIN/0192628291/icongroupinterna

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Continuous Ambulatory Peritoneal Dialysis by R. Gokal (Editor) (1987); ISBN: 0443036349; http://www.amazon.com/exec/obidos/ASIN/0443036349/icongroupinterna

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Continuous Ambulatory Peritoneal Dialysis in the Usa-Final Report of the National Capd Registry 1981-1988 (Developments in Nephrology) by J.W. Novak, et al (1989); ISBN: 079230179X; http://www.amazon.com/exec/obidos/ASIN/079230179X/icongroupinterna

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Cooking for David: A Culinary Dialysis Cookbook by Sara Colman, Dorothy Gordon (2000); ISBN: 0970161700; http://www.amazon.com/exec/obidos/ASIN/0970161700/icongroupinterna

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Coping with Kidney Disease : A 12-Step Treatment Program to Help You Avoid Dialysis by Mackenzie Walser (Author), Betsy Thorpe (Author) (2004); ISBN: 0471274232; http://www.amazon.com/exec/obidos/ASIN/0471274232/icongroupinterna

Books

289

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Courage to Survive: The Life Career of the Chronic Dialysis Patient by Mary Elizabeth O'Brien; ISBN: 0808916041; http://www.amazon.com/exec/obidos/ASIN/0808916041/icongroupinterna

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Current Studies in Nephrology, Dialysis and Transplantation (Contributions to Nephrology, Vol 48) by G. D'Amico (Editor), G. Colasanti (Editor) (1986); ISBN: 3805541414; http://www.amazon.com/exec/obidos/ASIN/3805541414/icongroupinterna

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Dialysis (Aami Standards and Recommended Practices, Vol 3) (1994); ISBN: 9994057502; http://www.amazon.com/exec/obidos/ASIN/9994057502/icongroupinterna

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Dialysis Access: Current Practice by J. A. Akoh (Editor), N. S. Hakim (Editor); ISBN: 1860941699; http://www.amazon.com/exec/obidos/ASIN/1860941699/icongroupinterna

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Dialysis Amyloid by Charles Van Ypersele De Strihou (Editor), et al; ISBN: 0192624946; http://www.amazon.com/exec/obidos/ASIN/0192624946/icongroupinterna

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Dialysis and the Treatment of Renal Insufficiency by John C. Van Stone; ISBN: 0808915665; http://www.amazon.com/exec/obidos/ASIN/0808915665/icongroupinterna

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Dialysis Membranes: Structure and Predictions: International Workshop, Marseille, June 25, 1994 (Contributions to Nephrology, Vol. 113) by V. Bonomini, Y. Berland (Editor) (1995); ISBN: 3805560613; http://www.amazon.com/exec/obidos/ASIN/3805560613/icongroupinterna

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Dialysis Prescription (American Journal of Nephrology, 1996) by G. Schulman (Editor) (1973); ISBN: 3805562500; http://www.amazon.com/exec/obidos/ASIN/3805562500/icongroupinterna

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Dialysis Therapy by A.R. Nissenson MD (Editor), R.N. Fine MD (Editor); ISBN: 093288301X; http://www.amazon.com/exec/obidos/ASIN/093288301X/icongroupinterna

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Dialysis Therapy by Allen R., Md. Nissenson (Editor), Richard N., Md. Fine (Editor); ISBN: 1560534265; http://www.amazon.com/exec/obidos/ASIN/1560534265/icongroupinterna

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Dialysis Therapy in the 1990's: International Symposium on Dialysis Therapy in the 1990's Osaka October 1989 (Contributions to Nephrology Vol 82) by Hiroshi Tanaka (Editor) (1990); ISBN: 3805551886; http://www.amazon.com/exec/obidos/ASIN/3805551886/icongroupinterna

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Dialysis, Dialyzers and Sorbents. Where Are We Going? by C. Ronco (Author), J. F. Winchester (Author) (2001); ISBN: 3805572255; http://www.amazon.com/exec/obidos/ASIN/3805572255/icongroupinterna

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Dialysis-Related Amyloidosis: International Symposium, Nagoya, May 28-29, 1994 (Contributions to Nephrology, Vol 112) by Kenji Maeda (Editor), T. Shinzato (1995); ISBN: 380556046X; http://www.amazon.com/exec/obidos/ASIN/380556046X/icongroupinterna

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Drug Therapy in Dialysis Patients by K. Schaefer (Editor), Eberhard Ritz (Editor) (1986); ISBN: 3805542887; http://www.amazon.com/exec/obidos/ASIN/3805542887/icongroupinterna

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Ethical Problems in Dialysis and Transplantation (Developments in Nephrology, Vol 33) by Carl M. Kjellstrand (Editor), John B. Dossetor (Editor) (1992); ISBN: 0792316258; http://www.amazon.com/exec/obidos/ASIN/0792316258/icongroupinterna

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Evolution and Trends in Peritoneal Dialysis (Contributions to Nephrology, Vol 84) by L. Lino Scarpioni, S. Ballocchi (Editor) (1990); ISBN: 3805552068; http://www.amazon.com/exec/obidos/ASIN/3805552068/icongroupinterna

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Evolution in Dialysis Adequacy: International Workshop, Bologna, May 16, 1992 (Contributions to Nephrology, Vol 103) by V. Bonomini (Editor) (1993); ISBN: 3805556837; http://www.amazon.com/exec/obidos/ASIN/3805556837/icongroupinterna

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Handbook of Dialysis by John T., MD Daugirdas (Editor), et al; ISBN: 0316173819; http://www.amazon.com/exec/obidos/ASIN/0316173819/icongroupinterna

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Handbook of Dialysis; ISBN: 0316173827; http://www.amazon.com/exec/obidos/ASIN/0316173827/icongroupinterna

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Hemodialysis Technology (Contributions to Nephrology, 137) by Claudio Ronco Vicenza, et al (2002); ISBN: 3805574231; http://www.amazon.com/exec/obidos/ASIN/3805574231/icongroupinterna

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Hemodialysis, Vascular Access, and Peritoneal Dialysis Access (Contributions to Nephrology, V. 142) by C. Ronco (Editor) (2003); ISBN: 380557651X; http://www.amazon.com/exec/obidos/ASIN/380557651X/icongroupinterna

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Improvements in Dialysis Therapy (Contributions to Nephrology, Vol 74) by C.A. Baldamus, et al (1989); ISBN: 3805549814; http://www.amazon.com/exec/obidos/ASIN/3805549814/icongroupinterna

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International Yearbook of Nephrology Dialysis Transplantation 1996 (Annual) by Vittorio E. Andreucci (Editor), Leon G. Fine (Editor) (1996); ISBN: 0192627716; http://www.amazon.com/exec/obidos/ASIN/0192627716/icongroupinterna

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Introduction to Dialysis; ISBN: 0443083053; http://www.amazon.com/exec/obidos/ASIN/0443083053/icongroupinterna

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Kidney and Urinary Tract Diseases and Disorders Sourcebook: Basic Information About Kidney Stones, Urinary Incontinence, Bladder Disease, End Stage Renal Disease, Dialysis, and More, Along With Statistical and (Health Reference Series, Vol 21) by Linda M. Ross (Editor), Peter Dresser (Editor) (1997); ISBN: 0780800796; http://www.amazon.com/exec/obidos/ASIN/0780800796/icongroupinterna

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Kidney Dialysis and Transplants - the 'at Your Fingertips' Guide (At Your Fingertips) by Andy Stein, Janet Wild (2002); ISBN: 1859590462; http://www.amazon.com/exec/obidos/ASIN/1859590462/icongroupinterna

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Kidney Failure Explained: Everything You Always Wanted to Know About Dialysis and Transplants But Were Afraid to Ask by Andy Stein, et al; ISBN: 1872362907; http://www.amazon.com/exec/obidos/ASIN/1872362907/icongroupinterna

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Manual of Clinical Dialysis by Suhail Ahmad (1999); ISBN: 1858733456; http://www.amazon.com/exec/obidos/ASIN/1858733456/icongroupinterna

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MarketLooks: The U.S. Market for Home Kidney Dialysis Products [DOWNLOAD: PDF] by MarketLooks - Kalorama Information (Author); ISBN: B00006BNSV; http://www.amazon.com/exec/obidos/ASIN/B00006BNSV/icongroupinterna

Books

291

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Micro-Dialysis As a Tool in Pharmacokinetic-Pharmacodynamic Studies Investigating the Brain Distribution and Effect Delay of Morphine and (Comprehensive Summaries of Uppsala Dissertations, 221) by Marcel Rene Bouw (2000); ISBN: 9155446590; http://www.amazon.com/exec/obidos/ASIN/9155446590/icongroupinterna

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Microdialysis in the Neurosciences by J.B. Justice (Editor), Terry E. Robinson; ISBN: 044481194X; http://www.amazon.com/exec/obidos/ASIN/044481194X/icongroupinterna

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National Dialysis Standards Reference Book: Collective Work by Assn for the Advancement of Medical Instrumentation Staff (1986); ISBN: 0910275548; http://www.amazon.com/exec/obidos/ASIN/0910275548/icongroupinterna

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National Listing of Medicare Providers Furnishing Kidney Dialysis & Transplant Services by Barry Leonard (Editor) (1998); ISBN: 0788175661; http://www.amazon.com/exec/obidos/ASIN/0788175661/icongroupinterna

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New Perspectives in Hemodialysis, Peritoneal Dialysis, Arteriovenous Hemofiltration and Plasmapheresis (Advances in Experimental Medicine and Biology, 260) by Walter Horl (Editor), P. J. Schollmeyer (Editor) (1990); ISBN: 0306433761; http://www.amazon.com/exec/obidos/ASIN/0306433761/icongroupinterna

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Osmosis and Dialysis by Conrad L. Stanitski, Gayle N. Sauer (1995); ISBN: 0875404545; http://www.amazon.com/exec/obidos/ASIN/0875404545/icongroupinterna

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Peritoneal Dialysis by Karl D. Nolph (Editor) (1989); ISBN: 0898384060; http://www.amazon.com/exec/obidos/ASIN/0898384060/icongroupinterna

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Peritoneal dialysis in the geriatric patient; ISBN: 0969225954; http://www.amazon.com/exec/obidos/ASIN/0969225954/icongroupinterna

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Peritoneal Dialysis Today (Contributions to Nephrology, 140) by Claudio Ronco (Editor), et al (2003); ISBN: 3805575815; http://www.amazon.com/exec/obidos/ASIN/3805575815/icongroupinterna

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Peritoneal Dialysis: New Concepts and Applications (Contemporary Issues in Nephrology, 22) by Zbylut J. Twardowski, et al; ISBN: 0443087164; http://www.amazon.com/exec/obidos/ASIN/0443087164/icongroupinterna

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Persistent Renal-Genitourinary Disorders: Current Concepts in Dialysis and Management: Proceedings of Pediatric Nephrology Seminar XII Held at Bal (Developments in Nephrology, 17.) by Fla.)/ Strauss, Louise Pediatric Nephrology Seminar 1985 Bal Harbour (Editor) (1987); ISBN: 0898388457; http://www.amazon.com/exec/obidos/ASIN/0898388457/icongroupinterna

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Pmma: A Flexible Membrane for a Tailored Dialysis (Contributions to Nephrology, V. 125) by C. Ronco (Editor) (1998); ISBN: 380556760X; http://www.amazon.com/exec/obidos/ASIN/380556760X/icongroupinterna

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Present Day Concepts in the Treatment of Chronic Renal Failure: Dialysis and Transplantation (Contributions to Nephrology, Vol 71) by Jules Traeger, et al (1989); ISBN: 3805549466; http://www.amazon.com/exec/obidos/ASIN/3805549466/icongroupinterna

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Principles and Practice of Dialysis by William L., Md. Henrich (Editor) (2003); ISBN: 0781738814; http://www.amazon.com/exec/obidos/ASIN/0781738814/icongroupinterna

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Proceedings of the European Dialysis and Transplant Association by A. M. Davison (1984); ISBN: 0272797693; http://www.amazon.com/exec/obidos/ASIN/0272797693/icongroupinterna

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Proceedings of the European Dialysis and Transplant Association - European Renal Association by Alex M. Davison (Editor), et al (1985); ISBN: 0272798045; http://www.amazon.com/exec/obidos/ASIN/0272798045/icongroupinterna

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Proceedings of the European Dialysis and Transplant Nurses Association by Mary Selsby, Elizabeth Stevens (1986); ISBN: 0272797766; http://www.amazon.com/exec/obidos/ASIN/0272797766/icongroupinterna

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PULSE Plus: Dialysis Case Study by Primedia; ISBN: 1401858864; http://www.amazon.com/exec/obidos/ASIN/1401858864/icongroupinterna

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Quality Assurance in Dialysis (Developments in Nephrology, Vol. 39) by L. W. Henderson (Editor), Richard S. Thuma (Editor) (1999); ISBN: 0792352815; http://www.amazon.com/exec/obidos/ASIN/0792352815/icongroupinterna

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Renal Dialysis by J.F. Winchester (Editor), et al (1994); ISBN: 0412313103; http://www.amazon.com/exec/obidos/ASIN/0412313103/icongroupinterna

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Renal dialysis; ISBN: 095014584X; http://www.amazon.com/exec/obidos/ASIN/095014584X/icongroupinterna

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Replacement of Renal Function by Dialysis by Walter H. Horl (Editor) (2003); ISBN: 1402000839; http://www.amazon.com/exec/obidos/ASIN/1402000839/icongroupinterna

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Replacement of Renal Function by Dialysis by Claude Jacobs (Editor) (1996); ISBN: 0792336100; http://www.amazon.com/exec/obidos/ASIN/0792336100/icongroupinterna

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Replacement of Renal Function by Dialysis (1989); ISBN: 0898385539; http://www.amazon.com/exec/obidos/ASIN/0898385539/icongroupinterna

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Replacement of Renal Function by Dialysis: A Text Book of Dialysis by John F. Maher (Editor) (1989); ISBN: 0898384141; http://www.amazon.com/exec/obidos/ASIN/0898384141/icongroupinterna

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Review of Hemodialysis for Nurses and Dialysis Personnel by C. F., Md Gutch, et al; ISBN: 0815120990; http://www.amazon.com/exec/obidos/ASIN/0815120990/icongroupinterna

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Review of Hemodialysis for Nurses and Dialysis Personnel; ISBN: 0801619939; http://www.amazon.com/exec/obidos/ASIN/0801619939/icongroupinterna

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Satellite Dialysis Unit (Health Building Note: 53) by Great Britain (1996); ISBN: 011322026X; http://www.amazon.com/exec/obidos/ASIN/011322026X/icongroupinterna

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Short Dialysis (Topics in Renal Medicine) by Vincenzo Cambi (Editor) (1987); ISBN: 0898388589; http://www.amazon.com/exec/obidos/ASIN/0898388589/icongroupinterna

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Surgery in Chronic Renal Failure: Experiences With Dialysis and Transplant Patients, International Symposium, February 1983 by Friedrich Wilhelm Eigler, Hans Dieter Jakubowski (Editor); ISBN: 0865771553; http://www.amazon.com/exec/obidos/ASIN/0865771553/icongroupinterna

Books

293

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Textbook of Peritoneal Dialysis by R. Gokal (Editor), et al; ISBN: 0792359674; http://www.amazon.com/exec/obidos/ASIN/0792359674/icongroupinterna

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The Courage to Fail: A Social View of Organ Transplants and Dialysis by Renee C. Fox, Judith P. Swazey (2001); ISBN: 0765807416; http://www.amazon.com/exec/obidos/ASIN/0765807416/icongroupinterna

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The Essentials of Peritoneal Dialysis by Ramesh, M.D. Khanna, et al; ISBN: 0792318137; http://www.amazon.com/exec/obidos/ASIN/0792318137/icongroupinterna

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The Oxford Handbook of Dialysis (Oxford Medical Publications) by Jeremy Levy, et al (2001); ISBN: 0192631608; http://www.amazon.com/exec/obidos/ASIN/0192631608/icongroupinterna

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Today's Art of Peritoneal Dialysis by Alejandro Treviino-Becerra (1979); ISBN: 3805530064; http://www.amazon.com/exec/obidos/ASIN/3805530064/icongroupinterna

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Understanding your new life with dialysis : a patient guide for physical and psychological adjustment to maintenance dialysis by Edith T. Oberley; ISBN: 0398037973; http://www.amazon.com/exec/obidos/ASIN/0398037973/icongroupinterna

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Understanding Your New Life With Dialysis: A Patient Guide for Physical and Psychological Adjustment by Edith T. Oberley, Terry D. Oberley; ISBN: 0398057745; http://www.amazon.com/exec/obidos/ASIN/0398057745/icongroupinterna

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Vascular Access for Hemodialysis by Mitchell L. Henry (Editor); ISBN: 0944496679; http://www.amazon.com/exec/obidos/ASIN/0944496679/icongroupinterna

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Vascular and Peritoneal Access for Dialysis (Topics in Renal Medicine) by Vittorio E. Andreucci (Editor) (1990); ISBN: 0792301196; http://www.amazon.com/exec/obidos/ASIN/0792301196/icongroupinterna

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Vitamin E-Bounded Membrane: A Further Step in Dialysis Optimization (Contributions to Nephrology) by C. Ronco (Editor), G. LA Greca (Editor) (1999); ISBN: 3805569068; http://www.amazon.com/exec/obidos/ASIN/3805569068/icongroupinterna

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Willem Kolff and the Invention of the Dialysis Machine (Unlocking the Secrets of Science) by Kathleen Tracy (2002); ISBN: 1584151358; http://www.amazon.com/exec/obidos/ASIN/1584151358/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “dialysis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button

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A dialysis symposium for nurses. Author: American Society for Artificial Internal Organs.; Year: 1970; [Washington] U. S. Health Services and Mental Health Administration [For sale by the Supt. of Docs., U. S. Govt. Print. Off., 1968]

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A second look at life; transplantation and dialysis patients: their own stories, edited by Felix T. Rapaport. Author: Rapaport, Felix T.; Year: 1972; New York, Grune; Stratton [c1973]; ISBN: 0808908251 http://www.amazon.com/exec/obidos/ASIN/0808908251/icongroupinterna

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Chronic hemodialysis in California [by] W. C. Berry [and] Harold B. Jamison. Author: Berry, Wilbur C.,; Year: 1964; [Berkeley] Dept. of Public Health, Bureau of Adult Health and Chronic Diseases, 1969

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Chronic hemodialysis. Author: Schmitt, Gunther W.,; Year: 1966; [New York] National Kidney Foundation, 1967

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Dialysis and renal transplantation; proceedings of the fourth conference held in Paris, France, June 1967. Editor: David N. S. Kerr; associate editors: Daniel Fries [and] R. Walker Elliott. Author: European Dialysis and Transplant Association.; Year: 1968; Amsterdam, New York, Excerpta Medica Foundation [c1968]

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Dialysis, transplantation, nephrology; proceedings of the tenth congress of the European Dialysis and Transplant Association, held in Vienna, Austria, 1973. Editor: J. F. Moorhead; associate editors: R. A. Baillod [and] C. Mion. Author: European Dialysis and Transplant Association.; Year: 1967; [London] Pitman Medical [1973]; ISBN: 0273003119 http://www.amazon.com/exec/obidos/ASIN/0273003119/icongroupinterna

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Haemodialysis; experimental and clinical studies on the Skiggs-Leonards haemodialyzer, with a follow-up by Hans Ejlif Jørgensen. Author: Jørgensen, Hans Ejlif.; Year: 1970; Copenhagen, Munksgaard, 1967

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Hemodialysis: principles and practice. Author: Bailey, George L.,; Year: 1969; New York, Academic Press, 1972; ISBN: 0120729504 http://www.amazon.com/exec/obidos/ASIN/0120729504/icongroupinterna

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Intermittent hemodialysis, by H. Earl Ginn and Phillip J. Walker. Author: Ginn, H. Earl,; Year: 1967; [New York] National Kidney Foundation, 1974

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Living or dying; adaptation to hemodialysis. Author: Levy, Norman B.; Year: 1968; Springfield, Ill., Thomas [c1974]; ISBN: 0398029873 http://www.amazon.com/exec/obidos/ASIN/0398029873/icongroupinterna

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Long-term hemodialysis; the management of the patient with chronic renal failure, by Constantine L. Hampers and Eugene Schupak. Author: Hampers, Constantine L.,; Year: 1967; New York, Grune; Stratton [c1967]

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Peritoneal dialysis in clinical medicine. Author: Boen, San Tjiang.; Year: 1966; Springfield, Ill., Thomas [c1964]

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Proceedings, the Conference on Dialysis as a "practical workshop". Author: National Dialysis Committee.; Year: 1966; New York, National

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Psychological response to hemodialysis. Jan. 1967-May 1970. 52 citations. Author: National Library of Medicine (U.S.); Year: 1965; [Bethesda, Md.] 1970

that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Summary report on the development of an improved hemodialysis membrane, by M. Luttinger [et al.]. Author: Battelle Memorial Institute.; Year: 1965; Columbus, 1965

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Surgical aspects of haemodialysis [by] P. R. F. Bell and K. C. Calman. Author: Bell, Peter R. F. (Peter Robert Frank); Year: 1972; Edinburgh, Churchill Livingstone, 1974; ISBN: 0443010498 http://www.amazon.com/exec/obidos/ASIN/0443010498/icongroupinterna

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The artificial kidney; a guide to understanding for the physician and for the patient. Author: Nosé, Yukihiko,; Year: 1964; St. Louis, Mosby, 1969; ISBN: 801636906

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The courage to fail; a social view of organ transplants and dialysis [by] Renée C. Fox and Judith P. Swazey. Author: Fox, Renée C. (Renée Claire),; Year: 1968; Chicago, Univ. of Chicago Press [1974]; ISBN: 0226259471 http://www.amazon.com/exec/obidos/ASIN/0226259471/icongroupinterna

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The feasibility of chronic hemodialysis in California. Author: California. Dept. of Public Health.; Year: 1967; Berkeley, 1966-

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The hemodialysis manual, edited by Jerry P. Pendras and Gerald W. Stinson. Author: Pendras, Jerry P.; Year: 1969; [Seattle, Wash., Edmark Corp., 1970]

Chapters on Dialysis In order to find chapters that specifically relate to dialysis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and dialysis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “dialysis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on dialysis: •

Ethical Considerations in the Care of Dialysis Patients Source: in Nissenson, A.R.; Fine, R.N. Dialysis Therapy. Philadelphia, PA: Hanley and Belfus, Inc. 2002. p. 451-454. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: Although dialysis therapy is very effective in controlling uremia (the generalized term for waste products in the blood, due to chronic kidney failure), certain patients are unlikely to benefit from dialysis and, in fact, these patients might sustain a great burden of suffering even while undergoing a therapy that is physiologically 'successful.' Guidelines are available to help renal (kidney) professionals in dealing with the ethical problems of the initiation of and withdrawal from dialysis. This chapter is one part of a section on rehabilitation and psychosocial issues, from a textbook on dialysis therapy. The chapter covers ethical considerations in the care of dialysis patients, discussing the tenets of ethical decision making and clinical practice guidelines for shared decision making in dialysis, as established by the Renal Physicians Association and the American Society of Nephrology. The authors stress that, in the end, patients and their surrogates have total authority over the care that they wish to

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receive. Principles of autonomy, beneficence, nonmalfeasance, and justice must be used and tempered by informed consent, shared decision making, and professional duties and obligations. Patients with a life expectancy greater than 60 days who possess the ability to meaningfully (according to the patient's values) interact with the environment and who are not in the process of dying from a nonrenal cause should be offered dialysis. In situations that are not clear, short term dialysis (30 days) should be offered and the patient fully reassessed at the end of the 30 days. Patients may withdraw from dialysis or surrogates may request their withdrawal. Acute illnesses (including underdialysis and depression) must be eliminated; there can be no coercion; and patients must be reassured that they can return to dialysis if they change their mind. 1 table. •

Hypertension in Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 471-484. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Arterial hypertension (high blood pressure) remains one of the major public health problems of industrialized nations, resulting in a great burden of morbidity (illness), mortality (death), and cost. For patients with end stage renal disease (ESRD), hypertension poses a particular problem, notably contribution to the high rates of cardiovascular disease and mortality experienced by dialysis patients. This chapter on hypertension in hemodialysis (HD) and peritoneal dialysis (PD) patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. In this chapter, the authors review the complicated subject of hypertension management for patients treated with HD or PD. The authors cover the measurement of blood pressure in dialysis patients; target blood pressure values; pathogenesis; the role of sodium and volume excess and the renin angiotensin axis; sympathetic activity; the role of erythropoietin; the role of divalent ions and parathyroid hormone; the vascular endothelium; and outcomes and treatment of hypertension in dialysis patients. Nonmedicinal treatments of hypertension can include aerobic exercise, control of salt and fluid intake, cessation of smoking, weight reduction, and avoidance of alcohol. The authors stress that the approach to the control of hypertension in dialysis patients should be multidisciplinary (medical, nursing, social work, and dietary). The mainstay of therapy for the control of hypertension in dialysis patients is adequate fluid removal. The use of antihypertensive medications is summarized in table format. 7 tables. 127 references.

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Cardiac Disease in Hemodialysis and Peritoneal Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 269-302. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710.

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Summary: Cardiac disease exerts a major influence on the morbidity and mortality of dialysis patients, as demonstrated by the frequent occurrence of heart failure and ischemic heart disease, very high mortality (death) rates, and the high proportion of cardiac deaths. This chapter on cardiac disease in hemodialysis and peritoneal dialysis patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. Most reports point to similar survival in chronic ambulatory peritoneal dialysis (CAPD) and in center hemodialysis (HD) patients. On average, hospital admission rates per patient year were 14 percent higher for peritoneal dialysis (PD) patients than for HD patients after adjustment for race, age, gender, and cause of end stage renal disease (ESRD). However, the causes of this higher hospital admission rate in PD patients were not studied. The authors discuss myocardial disease, disorders of perfusion, cardiac structure and function, cardiac arrhythmias, and risk factors for cardiac disease. Hemodynamic risk factors discussed include volume overload, salt and water retention, anemia, hypertension, and aortic stenosis; metabolic risk factors discussed include hypoalbuminemia, abnormal calcium phosphate homestasis, dyslipidemia, hyperhomocysteinemia, and oxidant stress. The authors consider other risk factors, notably smoking, diabetes mellitus, and valvular calcifications in PD patients. The authors offer guidelines for screening patients for cardiovascular disease, including the clinical assessment of cardiac status, noninvasive testing for cardiomyopathy, noninvasive testing for coronary artery disease, coronary angiography, and screening for cardiac arrhythmias. The chapter concludes with guidelines for patient management in the areas of volume overload, anemia, hypertension, hyperlipidemia, hyperhomocysteinemia, management of heart failure, coronary artery revascularization, cardiac arrhythmias, and pericarditis. 12 figures. 7 tables. 287 references. •

Complications of Chronic Dialysis Therapy Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 192-212. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Chronic dialysis therapy has extended the lives of hundreds of thousands of patients. The treatment, however, can be associated with significant acute and chronic complications. This chapter on the complications of chronic dialysis therapy is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. Many complications in patients with end stage renal disease (ESRD) are part of the uremic syndrome and are unrelated to the dialysis treatment itself. Dialysis related complications include central nervous system (CNS) abnormalities (headache, weakness, fatigue, apathy, nausea), hypotension (low blood pressure), fluid overload (edema), hypertension (high blood pressure), congestive heart failure, arrhythmias, muscle cramping, chills and fever (febrile reactions), allergic reactions, and itching (pruritis). The author discusses medical problems associated with ESRD, including anemia and its treatment (often with erythropoietin or transfusions), the complications of blood transfusions, renal osteodystrophy (bone disease related to abnormalities of calcium and phosphorus metabolism), joint disorders (including pseudogout, which is related to elevated uric acid levels), dialysis amyloidosis, carpal

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tunnel syndrome (CTS), gastrointestinal problems (peptic ulcer disease, constipation, and ascites, or fluid collection in the peritoneal cavity), hepatitis, neuropathy, reproduction problems, and insomnia (inability to sleep). The authors concludes with a discussion of dialysis in the elderly, the role of exercise for dialysis patients, dialysis for people with diabetes mellitus, and the psychological consequences of long term dialysis. •

Surveillance, Revision, and Outcome of Vascular Access Procedures for Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 149-154. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: Chronic hemodialysis patients undergo revision of a thrombosed graft or placement of a temporary central venous catheter an average of once a year. This chapter on surveillance, revision, and outcome of vascular access (VA) procedures for hemodialysis (HD) is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The authors discuss patency rates, site selection, prediction of access failure, venous return pressure, graft revision and thrombectomy (removal of blood clots), and anticipated outcome. The authors conclude that the goals of establishing and maintaining long term hemodialysis access in end stage renal disease (ESRD) patients have remained elusive. The authors recommend a collaborative effort among the vascular surgeon, interventional radiologists, and dialysis staff that is aimed at standardizing graft surveillance and optimizing function. 1 table. 25 references.

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Chronic Peritoneal Dialysis Source: in Schena, F.P., ed. Nephrology. New York, NY: McGraw-Hill, Inc. 2001. p. 429438. Contact: Available from McGraw-Hill, Inc. Shoppenhangers Road, Maidenhead, Berkshire SL6 2QL. 44 (0)1628 502700. Fax: +44 (0)1628 635895 E-mail: [email protected]. Website: www.mcgraw-hill.co.uk. PRICE: $79.95; plus shipping and handling. ISBN: 0077095251. Summary: Continuous ambulatory peritoneal dialysis (CAPD) is the most often used form of chronic peritoneal dialysis. The principle is the continuous presence of dialysis fluid, generally 2 liters in adults, in the peritoneal cavity. This fluid is exchanged four to five times per 24 hours, seven days a week. Both instillation and drainage are achieved by gravity. This chapter on chronic peritoneal dialysis is from a book on nephrology (the study of the kidney and kidney diseases) designed for general practitioners and family care providers that offers strategies for the management of patients with renal (kidney) damage. The ability of the peritoneal membrane to transport low molecular weight solutes mainly depends on the vascular (blood vessel) peritoneal surface area. Glucose is an effective osmotic agent because it induces water transport through water channels located in endothelial cells. The sieving of sodium can provide an estimation of this channel mediate water transport. The authors recommend the 'flush before fill' technique of performing a dialysis exchange, to help reduce the incidence of peritonitis (infection). Icodextrin based dialysis solutions are especially effective in the induction of ultrafiltration during long dwells and in patients with a large vascular peritoneal surface area. The initial treatment of peritonitis should consist of a first generation cephalosporin combined with an aminoglycoside, both administered intraperitoneally.

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Ultrafiltration failure is the main functional abnormality in long term peritoneal dialysis. This failure is often associated with a large vascular surface area and impaired channel mediated water transport. 3 figures. 1 table. 15 references. •

Management of Quality in Dialysis Care Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 307-311. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Continuous Quality Improvement (CQI) is a method to address concerns raised by increased competition in the managed care environment, including demands that providers be responsive to quality and cost issues. This chapter on the management of quality in dialysis care is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter describe CQI and its use in the dialysis care setting. CQI involves collecting data about the current situation, identifying ways to improve the performance, introducing new and better approaches and methods to achieve desired outcomes, and then evaluating the interventions. The core indicators used in the dialysis setting are adequacy of dialysis, desirable hematocrit value, optimal nutritional status, and control of blood pressure. All personnel contribute to CQI by being vigilant in recognizing care practices in need of improvement. The authors also outline the role that the ESRD (end stage renal disease) Networks play in quality management and discuss the quality improvement initiative of the National Kidney Foundation (NKF).

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Diabetes and Hemodialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 254-263. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Diabetes mellitus is the leading cause of end stage renal disease (ESRD) in the United States. This chapter on diabetes and hemodialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter describe the two types of diabetes and review diabetes monitoring and care, then discuss diabetic nephropathy, a kidney disease caused by diabetes. The pathology in diabetic nephropathy is glomerulosclerosis, a fibrotic thickening of the glomeruli. As the disease progresses, the glomeruli lose their ability to filter blood effectively, resulting in the accumulation of waste products such as urea and creatinine in the body. Progression of diabetic nephropathy can be delayed by the use of an ACE (angiotensin converting enzyme) inhibitor medication. Initiation of dialysis depends on the individual needs and condition of the patient, but a clear indicator is a low creatinine clearance combined with symptomatic edema (fluid accumulation). It is particularly important to maintain blood pressure control in patients with diabetes, in order to reduce the risks of diabetic

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retinopathy (eye disease), as well as cardiovascular and peripheral vascular disease. The authors conclude by reviewing other assessments and nursing care strategies that can be useful in patients with diabetes. 2 tables. •

Acute Renal Failure and Dialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 173-191. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Dialysis is often necessary for the treatment of acute kidney (renal) failure. The most common indications include uremia, hyperkalemia, acidosis, fluid overload, and drug overdose. This chapter on acute renal failure and dialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter define acute renal failure (ARF) as the rapid deterioration of kidney function and note that ARF is usually reversible if diagnosed and treated early. ARF is divided into three categories: prerenal, intrarenal, and postrenal. The most common indications for acute dialysis include uremia, pulmonary edema (fluid overload in the lungs), hyperkalemia (high amounts of potassium in the blood), acidosis, neurologic changes, and drug overdoses and poisonings. Treatment options for ARF include hemodialysis, isolated ultrafiltration, peritoneal dialysis, continuous renal replacement therapy (CRRT), and charcoal hemoperfusion. The chapter concludes with a brief section discussing the use of dialysis for patients undergoing rejection of a transplanted kidney. 4 figures.

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Medication Problems and Dialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 142-160. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Dialysis patients routinely take an average of ten different medications and experience adverse drug reactions at least three times more frequently than the general population. This chapter on medication problems and dialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The author of the chapter reviews several problematic reactions to medications that clinicians encounter in providing care to patients on dialysis and other patients with renal impairment. These problem areas are presented in five categories: drugs can damage the kidneys, initiating or worsening renal failure; the pharmacologic activity of drugs is altered by renal failure; the amount of medication removed from the body during dialysis varies; some poisons or drugs taken in overdose can be removed wholly or in part by dialysis; and medications may increase risks associated with the dialysis procedure. All of these problem areas are complex and require consideration of multiple factors unique to each situation, including patient characteristics, drug properties, and the dialysis procedures. The

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author concludes that the importance of clinical monitoring and observation cannot be overstated. Knowledge of the usual pattern of responses of the patient enables the clinician to recognize at an early stage deviations that suggest the need to evaluate the drug regimen. 5 tables. •

Complications of Dialysis in Diabetic Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 697-704. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Dialysis patients with diabetes mellitus comprise the largest subgroup of patients in end stage renal disease (ESRD) treatment programs in developed countries. This patient population is unfortunately also subject to greater morbidity and mortality when compared to nondiabetic dialysis patients. This chapter on the complications of dialysis in patients with diabetes is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The authors of this chapter note that older age at the time of dialysis initiation and the presence of often advanced microvascular and macrovascular disease account for this excess rate of complications and death on dialysis. The management of dialysis patients with diabetes requires an aggressive, preemptive, multidisciplinary, and patient education oriented approach, which must often be led by the nephrologist (kidney specialist) who has the most frequent contact with the patient. Peripheral vascular, cardiovascular, and cerebrovascular disease, retinopathy (eye disease), gastropathy, and dialysis associated complications are the major contributors to co-morbidity in diabetic dialysis patients. Hemodialysis related complications include hypotension (low blood pressure), hypertension (high blood pressure), high interdialytic weight gain, vascular access problems, access thrombosis (clotting), ischemic monomelic neuropathy, and venous hypertension. Other problems discussed include bone disease, diabetic retinopathy, undernutrition, and hyperglycemia (high blood sugar levels). The complications of peritoneal dialysis in patients with diabetes including peritonitis, underdialysis, undernutrition, and hyperglycemia. The authors conclude by noting that the increasing prevalence of type 2 diabetes will require that nephrologists target the problems prevalent in this population in order to reduce morbidity (illness) and mortality (death). 2 tables. 46 references.

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Hemodialysis Team Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 1-9. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Dialysis, the process of cleansing the blood of accumulated waste products, is a complex treatment requiring a team of highly trained individuals with a variety of skills. This chapter on the hemodialysis team is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the

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basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The author of the chapter stresses that for dialysis to be successful, the interdisciplinary team must work with the patient and family, supporting them in the areas of clinical need, psychosocial needs, and religious beliefs. Team members will include, but not be limited to, the physician (nephrologist), nurse, technician, dietitian, social worker, and administrator. Other team members might include a biomedical technician, psychologist, dentist, child development specialist, pharmacist, physician's assistant, vocational rehabilitation counselor, member of the clergy, coach, school teacher, or others who have special skills needed to help the patient reach maximum potential. The author outlines the functions of each member, standards of practice, education and training considerations, and ethics, rights, and responsibilities. The chapter emphasizes that the patient and family members are also integral components of the dialysis team. •

Dialysis or Transplantation: Fitting the Treatment to the Patient Source: in Coggins, C.H., ed. Annual Review of Medicine: Selected Topics in the Clinical Sciences, Volume 50. Palo Alto, CA: Annual Reviews. 1999. p. 193-205. Contact: Available from Annual Reviews. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (650) 493-4400. E-mail: [email protected]. Website: www.AnnualReviews.org. PRICE: $60.00 plus shipping and handling. ISBN: 0824305507. Summary: Early referral of the patient with chronic renal failure (CRF) will give the nephrologist time to fit the treatment to the patient. This article emphasizes the importance of this strategy of patient care management. The authors contend that planning for dialysis and transplantation should be undertaken concurrently. If the patient is not of advanced age and is not afflicted with severe comorbid illness, renal transplantation is the preferred form of renal replacement therapy. Living donor transplantation is preferred to cadaveric transplantation. For the patient who awaits or who cannot undergo transplantation, either peritoneal dialysis or hemodialysis may be chosen. Although the mortality rate for peritoneal dialysis appears to be higher than that for hemodialysis, especially among older patients with diabetes, peritoneal dialysis remains an acceptable therapy for the highly motivated patient. In the United States, the mortality rate for chronic dialysis patients is high. The authors conclude that mortality rates for both peritoneal dialysis and hemodialysis will fall, as physicians strive to achieve optimal solute clearance and more effectively treat comorbid illness. 21 references. (AA-M).

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Psychosocial Rehabilitation of Adult Dialysis Patients Source: in Nissenson, A.R.; Fine, R.N. Dialysis Therapy. Philadelphia, PA: Hanley and Belfus, Inc. 2002. p. 445-450. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: Expecting people on dialysis to return to active lifestyles (whether employed or not) is not always successful, but expecting passivity, depression, and progressive physical deterioration will usually lead to just those outcomes. The matrix of effective technology, good nutrition, appropriate medication, and medical monitoring is fundamental to dialysis care and essential for effective rehabilitation. This chapter is one

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part of a section on rehabilitation and psychosocial issues, from a textbook on dialysis therapy. The chapter covers the psychosocial rehabilitation of adult dialysis patients, discussing the definitions and parameters of rehabilitation; the 'Five E's' of renal (kidney) rehabilitation, i.e., encouragement, evaluation, education, exercise, employment); prerequisites to effective rehabilitation, including adequate dialysis and anemia control, control of comorbid conditions (other illnesses present at the same time) such as hypertension and of high risk lifestyles, and family participation; implementing renal rehabilitation; and the evaluation of outcomes. The author stresses that health promotion and rehabilitation have to be a central part of therapy, not an additional or peripheral aspect of care that receives attention only after other steps are complete. When physical, social, and sometimes vocational rehabilitation are the goals of treatment, dialysis can become holistic therapy. The rewards of improved productive living for patients, improved satisfaction for staff, and stabilizing the patient population, which preserves facility income, make renal rehabilitation a positive experience for all concerned. •

Nutrition in Patients with Chronic Renal Failure and Patients on Dialysis Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 518-534. Contact: Available from Appleton and Lange. 25 Van Zant Street, East Norwalk, CT 06855. PRICE: $215.00. ISBN: 0838513794. Summary: For many years, dietary manipulation has been an important therapeutic intervention for patients with advanced renal disease. Nutritional factors play a role in the morbidity and mortality of these patients, as well as in their quality of life and ultimate rehabilitative potential. This chapter, from a medical text on clinical dialysis, investigates the role of nutrition in patients with chronic renal failure (CRF) and patients on dialysis. The authors first outline the syndrome of malnutrition in patients with renal failure. Next, they discuss the causes of malnutrition in renal failure, including reduced nutritional intake, intercurrent illness, dialysis losses, and uremia. The authors stress the importance of accurately assessing the nutritional status of all patients with advanced renal disease in order to identify those patients who may need nutritional intervention and to monitor the effects of any therapeutic regimen. Assessment tools include history and physical examination, dietary history, anthropometry, serum proteins, and plasma amino acids. Protein restriction in patients with CRF can slow the progression of renal failure and delay the onset of uremic symptoms and associated metabolic disturbances once glomerular filtration rate (GFR) has fallen below 15 ml per minute. When the GFR falls below 5 ml per minute, dialysis therapy is usually required. Because dialysis therapy is associated with losses of protein and amino acids, the diet should be liberalized and protein intake increased. Additional topics include vitamin therapy and other supplements, nutrition in patients treated with peritoneal dialysis (PD), and intraperitoneal dialysis. 5 tables. 153 references. (AA-M).

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Cardiac Disease in Dialysis Patients Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 652-698. Contact: Available from Appleton and Lange. 25 Van Zant Street, East Norwalk, CT 06855. PRICE: $215.00. ISBN: 0838513794. Summary: Heart disease is the leading cause of death in the dialysis population, accounting for nearly 40 percent of deaths among these patients. In this chapter, from a

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medical text on clinical dialysis, the authors examine disorders of the heart that are most prevalent in patients with chronic kidney failure. The authors also put into perspective the factors associated with end-stage renal disease (ESRD) and its treatment that adversely affect myocardial performance. They also discuss methods of evaluating these diseases in the dialysis population, and assess methods that may be useful in the management of heart disease in such individuals. Specific disorders include extracellular fluid and plasma volume overload, anemia, arteriovenous fistulas (for circulatory access), uremic cardiomyopathy, acquired valvular disease, and infective endocarditis. The results of dialysis on cardiac function include acute hemodynamic effects, effects in patients with normal and abnormal left ventricular function, recurrent hypotension, and disturbances of heart rhythm. The chapter concludes with a section discussing uremic pericarditis, a less frequent but more dramatic cardiac complication of uremia. 3 figures. 1 table. 570 references. •

Hemodialysis Source: in Schena, F.P., ed. Nephrology. New York, NY: McGraw-Hill, Inc. 2001. p. 439450. Contact: Available from McGraw-Hill, Inc. Shoppenhangers Road, Maidenhead, Berkshire SL6 2QL. 44 (0)1628 502700. Fax: +44 (0)1628 635895 E-mail: [email protected]. Website: www.mcgraw-hill.co.uk. PRICE: $79.95; plus shipping and handling. ISBN: 0077095251. Summary: Hemodialysis is a process that removes unwanted solutes from the body by continuous treatment of the blood at a location outside the body. Blood is routed from a blood vessel that has a high blood flow rate to an external device where the blood goes across a semipermeable membrane with a buffered physiologic salt solution, called the dialysate. The returning dialyzed blood then equilibrates with tissues throughout the body, effectively reducing tissue concentrations of solutes that are not contained in the dialysate. This chapter on hemodialysis is from a book on nephrology (the study of the kidney and kidney diseases) designed for general practitioners and family care providers that offers strategies for the management of patients with renal (kidney) damage. Hemodialysis is the most common form of renal replacement therapy. Although kidney transplantation is the preferred method of treatment for kidney failure, the supply of donor organs is limited, so hemodialysis is and will continue to be the predominant form of renal replacement in the foreseeable future. Mortality (death) rates are high and rise steeply with age, but indefinite survival is possible on hemodialysis. The most common causes of mortality are cardiovascular disease and infections. Mortality is highly correlated with patient characteristics such as age and diabetes and with dialysis factors such as the amount of dialysis. Improved quality of life and reduced risk from hemodialysis have resulted from developments in membrane chemistry, water preparation, and dialysate delivery systems and from reversal of severe anemia with recombinant erythropoietin. The vascular access device continues to be a source of expense and hospitalization. The author notes that psychological adjustments to end stage renal disease (ESRD) and to dialysis can be major hurdles for the patient. 3 tables. 12 references.

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Hematological Problems and Their Management in Hemodialysis and Peritoneal Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 303-325.

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Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: It has long been recognized that the major hematological (blood) complication of chronic renal failure (CRF) is a progressive and often severe chronic anemia. Although this has many causes, the primary cause is inadequate production of the hormone erythropoietin by the diseased kidneys. This chapter on hematological problems and their management in hemodialysis (HD) and peritoneal dialysis (PD) patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The advent of recombinant human erythropoeitin (epoetin) transformed the clinical situation, and millions of patients have experienced the secondary benefits of having their anemia corrected. Many studies have confirmed the improvements in quality of life, exercise capacity, and cardiac function associated with epoetin treatment, and preliminary evidence now shows a reduction in long term cardiovascular morbidity and mortality. The author also discusses problems associated with epoetin therapy, including functional iron deficiency and epoetin resistance. The author briefly discusses adjuvant therapies that may be used in combination with epoetin, including the development of other erythorpoietic substances. 7 figures. 5 tables. 144 references. •

Hepatitis and Dialysis Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 673-696. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Patients on maintenance hemodialysis are at increased risk for parenterally transmitted hepatitis viruses. This chapter on hepatitis and dialysis is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The authors of this chapter focus mainly on hepatitis B virus (HBV) and hepatitis C (HCV), which remain the most problematic viral hepatic (liver) infections in hemodialysis patients; hepatitis G virus (HGV) is discussed briefly in the final section of the chapter. For each of these types, the authors consider pathogenesis, transmission and preventive measures, epidemiology (prevalence and incidence), vaccination, and implications for kidney transplantation. Besides the known parenterally transmitted hepatitis viruses, other yet undefined but potentially dangerous viruses may exist. Every nephrologist (kidney specialist) faces some dialysis patients who have inexplicable liver disease in which no responsible virus has been identified. The authors stress that it is therefore advisable to consider all patients as potentially infectious, especially since the level of transaminase is not always a reliable marker for the detection of liver damage in the dialysis population. Isolation procedures are warranted not only for viral infection but also for bacterial infection such as certain drug resistant strains. 2 figures. 4 tables. 243 references.

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Peritoneal Dialysis and Home Dialysis Therapies Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 230-253. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Peritoneal dialysis (PD) is an alternative dialytic modality for the patient with end stage renal disease (ESRD). PD is primarily a home dialysis therapy for chronic kidney (renal) failure, but it can also be a treatment option for the patient with acute renal failure (ARF) in the hospital setting. This chapter on peritoneal dialysis and home dialysis therapies is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter describe PD as a process during which the peritoneal cavity acts as the reservoir for the dialysate and the peritoneum serves as the semipermeable membrane across which excess body fluid and solutes, including uremic toxins, are removed. The peritoneal membrane is in contact with the rich blood supply to the abdominal organs. Dialysate is infused into the peritoneal cavity via a catheter, allowed to dwell for a predetermined amount of time and then drained; this process is called an exchange. The authors describe the solutions used for PD, the different ways to perform PD, automated PD, the kinds of catheters used for PD, how adequacy of PD is determined, complications that may be encountered in PD, the use of PD in people with diabetes, patient selection for home dialysis, patient education for home PD, monitoring quality of care in PD, the history of home hemodialysis in the United States, the role of the Medicare ESRD program on home dialysis, and the advantages of home hemodialysis. The authors conclude that home dialysis is once again becoming more popular and, with the advent of safe, effective, and easily used equipment, patients will have the opportunity for better and more frequent dialysis and improved quality of life. 3 figures. 5 tables.

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Arthropathies and Bone Diseases in Hemodialysis and Peritoneal Dialysis Patients Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 343-359. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Renal osteodystrophy refers to a collection of bone disorders that affect virtually all patients with end stage renal disease (ESRD). This chapter on arthropathies and bone diseases in hemodialysis (HD) and peritoneal dialysis (PD) patients is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The authors of this chapter describe the clinical and pathological features of the bone disorders collectively referred to as renal osteodystrophy. The additive role that metabolic acidosis may play in these disorders is also covered. The most common form of renal osteodystrophy is osteitis fibrosa cystica (OFC), a lesion defined by changes including bone marrow fibrosis, a parathyroid hormone stimulated increase in the number and activity of osteoclasts, and an increase in osteoid and nonlamellar bone.

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OFC is typically asymptomatic until ESRD, when bone pain and fractures may occur. Treatment (of both predialysis and dialysis patients) focuses on the control of serum (blood) phosphate, with control of dietary phosphate, and the use of phosphorus binding agents and calcitriol. The chapter also considers the manifestation, diagnosis, and treatment of aluminum induced bone disease; dialysis related amyloidosis; and metabolic acidosis and bone disease. 6 figures. 1 table. 99 references. •

Problems of Women on Dialysis Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 705-719. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: The care of dialysis patients has been focused first on survival and then on decreased morbidity (illness or complications). Rehabilitation has generally emphasized return to employment or family and community activities. The attention to gynecological problems affecting dialysis patients has been overshadowed by attention to cardiovascular disease, infection, and other life threatening complications of dialysis. This chapter on the problems of women on dialysis is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The authors of this chapter note that with the increasing length of survival of young dialysis patients and the increasing wait for transplantation, the problems associated with child bearing and contraception have become more important. The possibility and implications of conception need to be addressed with each patient. While rarely life threatening, the problems of sexual dysfunction, dysfunctional uterine bleeding, and gynecological infections contribute to a diminished quality of life. When pregnancy occurs, it requires extreme vigilance to minimize the risk to pregnant women and increase the likelihood of a successful outcome. With increased understanding of the causes of infertility in women with renal failure and development of management strategies that result in healthy mothers and infants, nephrologists may reach the point of actively helping these women attempt pregnancy. 2 tables. 45 references.

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Disaster Diet Information for Hemodialysis Patients Source: in American Dietetic Association. Clinical Guide to Nutrition Care in End-Stage Renal Disease. Chicago, IL: American Dietetic Association. 1994. p. 227-228. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard Chicago, IL 60606-6995. (312) 899-0040. PRICE: $24 for members; $28 for non-members; plus shipping and handling. ISBN: 0880911247. Summary: This appendix chapter, from a manual that provides guidelines for the clinical nutrition care of patients with end-stage renal disease (ESRD), provides diet information to teach hemodialysis patients what to do in the event a natural disaster occurs and dialysis becomes unavailable in their local area. The author lists 10 recommendations, covering topics including selecting foods and limiting fluids; protein intake; avoiding foods that are high in sodium and/or potassium; and considerations for patients with diabetes. The article concludes with a suggested emergency food list, with size of servings noted for each of eight sections: milk; meat and protein; fruit; beverages; fats; vegetables; breads, cereal and pasta; and sweets.

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Pregnancy and Dialysis: a Discussion and Case Review Source: in American Dietetic Association. Clinical Guide to Nutrition Care in End-Stage Renal Disease. Chicago, IL: American Dietetic Association. 1994. p. 199-205. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard Chicago, IL 60606-6995. (312) 899-0040. PRICE: $24 for members; $28 for non-members; plus shipping and handling. ISBN: 0880911247. Summary: This appendix, from a manual that provides guidelines for the clinical nutrition care of patients with end-stage renal disease (ESRD), briefly discusses pregnancy and dialysis. The author then presents a case study of a pregnant hemodialysis patient. Some observations and aspects of management in her care are discussed. The author identifies considerations for the renal dietitian involved in the assessment and management of pregnant patients with chronic renal failure. 23 references.

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Psychosocial Adaptation of Dialysis Patients Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 827-838. Contact: Available from Appleton and Lange. 25 Van Zant Street, East Norwalk, CT 06855. (800) 423-1359. PRICE: $215.00. ISBN: 0838513794. Summary: This chapter from a textbook on clinical dialysis discusses the psychosocial adaptation of dialysis patients. The author notes that the perception of a continuous chronic illness combined with the intrusive nature of dialysis treatments can interfere with many aspects of a patient's life. The degree to which an individual patient can adapt to these medical and psychosocial stresses will be reflected in the quality of life of that individual. The chapter covers measurement issues (how to quantify quality of life), global or overall quality of life, disease-specific quality of life, neuropsychological function, psychological function, social functioning, functional status (including the impact of erythropoietin treatment), vocational rehabilitation, and patient compliance. The major psychological abnormalities associated with hemodialysis treatment of uremia are dependence and independence conflicts, depression, anger, anxiety, frustration, and denial. In each subject area, the author reviews major research studies that have been performed. 1 table. 91 references. (AA-M).

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Nutritional Effects and Nutritional Management of Chronic Peritoneal Dialysis Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 619-668. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The chapter covers the nutritional effects and nutritional management of chronic peritoneal dialysis (PD). The authors stress that, when evaluating the nutritional effects of dialysis therapies, it should be kept in mind that the patient starting dialysis is often suffering from malnutrition and wasting. CAPD involves several catabolic factors, such as loss of appetite, insufficient removal of small solutes, dialysate loss of proteins and amino acids, and recurrent peritonitis. In addition, the continuous supply of glucose and lactate from the dialysate represents a sizable and

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perhaps undesirable energy load. These factors, in addition to the already deranged metabolism and nutritional state of patients with chronic renal failure, may have serious consequences in the form of aggravated malnutrition and wasting, susceptibility to infection, anemia, progressive neuropathy, hyperlipidemia, failure of rehabilitation, and increased morbidity and mortality. The authors encourage clinicians to monitor protein intake and nutritional status in CAPD patients. Malnourished CAPD patients should be advised to increase protein intake as well as energy intake; acidosis should be corrected; and, if these measures are not effective, the dialysis dose should be increased. 4 figures. 6 tables. 251 references. (AA-M). •

Autologous Arteriovenous Fistulas: Direct Anastomosis for Hemodialysis Access; Autogenous Vein for Fistulas and Interpositional Grafts Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 82-96. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on autologous (using the patient's own tissues) arteriovenous fistulas is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The first part of the chapter discusses the techniques used in constructing a BresciaCimino fistula. The second part reviews some of the other autogenous fistulas commonly constructed. The author describes the complications and their management that may be encountered in each type of fistula. The Brescia-Cimino fistula continues to be regarded as the ideal form of access because it offers superior long-term patency rates, lower incidence and ease of managing infectious complications, and a relatively low incidence of other complications such as aneurysm formation. However, this technique is used only in a minority of patients, for reasons such as urgency of dialysis and poor-quality vessels (particularly in the elderly and diabetes populations). The author encourages the access surgeon to familiarize him or herself with a larger range of possibilities from which to choose an appropriate autogenous fistula for the individual patient. 14 figures. 1 table. 59 references.

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Diabetes and Dialysis Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E., eds. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 795-805. Contact: Available from Appleton and Lange. 25 Van Zant Street, P.O. Box 5630, Norwalk, CT 06856. (800) 423-1359 or (203) 838-4400. PRICE: $175.00. ISBN: 0838513794. Summary: This chapter on diabetes and dialysis is from a textbook of clinical dialysis. Topics include the progression of renal disease and choice of uremia therapy, particularly for those patients with diabetes; extrarenal disease; hemodialysis, including mortality and comorbid conditions, vascular access, blood glucose and hyperlipidemia, the control of intravascular volume, and progression of retinopathy; the use of continuous ambulatory peritoneal dialysis (CAPD), including control of intravascular volume, blood glucose and hyperlipidemia, and managing the higher risk of infection; specific concerns regarding kidney transplantation in the patient with diabetes; pancreas transplantation; and the rehabilitation status of patients with diabetes who have endstage renal disease (ESRD). 3 tables. 79 references.

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Dialysis in Infants and Children Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. p. 553-568. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $37.95. ISBN: 0316173835. Summary: This chapter on dialysis in infants and children is from a handbook that outlines all aspects of dialysis therapy, emphasizing the management of dialysis patients. Topics include indications for dialysis; choice of a dialysis modality; peritoneal dialysis (PD) considerations, including physiology, apparatus, access, acute PD prescription, chronic PD prescription, complications, monitoring, and clinical response; and hemodialysis considerations, including physiology, apparatus, vascular access, technique, slow continuous therapies, and associated problems of nutrition, hypertension, anemia, growth, and renal osteodystrophy. The authors present information in outline form, for easy reference. 2 figures. 1 table. 12 references.

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Dialysis at Home Source: in Horman, R.J., ed. Patient Care in Community Practice. Binghamton, NY: Pharmaceutical Products Press. 2002. p.245-268. Contact: Available from Pharmaceutical Products Press. 10 Alice Street, Binghamton, NY 13904-1580. (800)429-6784. E-mail: [email protected]. Website: www.haworthpressinc.com. PRICE: $39.95 plus shipping and handling. ISBN: 0853694508. Summary: This chapter on home dialysis is from a text for pharmacists on patient care in community practice. It is unlikely that community pharmacists will have a significant input into the care and management of patients who are undergoing dialysis at home, as the majority of patients receive their dialysis equipment and fluids direct from a manufacturer or from the local hospital pharmacy. However, patients who have been selected for one of the forms of dialysis may have been and continue to be regular visitors to the community pharmacy with prescriptions necessary for the satisfactory management of their condition (e.g., for the treatment of hypertension beforehand and the supply of low protein foods after starting dialysis). This chapter considers the theoretical and practical aspects of the treatment the patient is receiving and the problems that may be encountered. Topics include the classification and symptoms of end stage renal disease (ESRD), the causes of ESRD (including glomerulonephritis, pyelonephritis, vascular disease and hypertension, diabetes mellitus, and analgesic abuse); treatment of hypertension; drug restrictions in the patient with ESRD; the principles of dialysis; peritoneal dialysis; CAPD (continuous ambulatory peritoneal dialysis); APD (automated peritoneal dialysis); home hemodialysis; kidney transplantation; and organ donor cards. 5 figures. 4 references.

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Malnutrition as a Risk Factor for Morbidity and Mortality in Maintenance Dialysis Patients Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 257-276.

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Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on malnutrition as a risk factor for morbidity and mortality in maintenance dialysis patients is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The authors note that protein energy malnutrition is distressingly common among patients with end-stage renal disease (ESRD) and is often multifactorial. Contributing causes include reduced nutrient intake due to anorexia, depression, financial obstacles, or prescribed dietary restrictions; increased nutrient loss due to phlebotomy and amino acid dialysance; and hypercatabolism due to intercurrent infection and surgical procedures; as well as the dialysis procedure itself. The author concludes that the prevalence and severity of malnutrition remain extraordinarily high, despite recent improvements in dialytic technology and the recognition of malnutrition as a life-threatening clinical syndrome in dialysis patients. Potential interventions should not be limited to enteral and parenteral nutrition sources but should include counseling and social services (e.g., nursing, home care, meals-on-wheels) for needy, elderly, or disabled patients. Lastly, it is imperative to explore the effects of nutritional status not only on mortality and convenient measures of morbidity, such as hospitalization, but also on patient-centered outcomes, such as rehabilitation potential, functional status, vitality, and health-related quality of life. 2 tables. 54 references. (AA-M). •

Nutrition in Maintenance Hemodialysis Patients Source: in Kopple, J.D. and Massry, S.G. Nutritional Management of Renal Disease. Baltimore, MD: Williams and Wilkins. 1997. p. 563-600. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. PRICE: $99.00. ISBN: 068304740X. Summary: This chapter on nutrition in maintenance hemodialysis patients is from a medical textbook on nutrition and metabolism of individuals with renal disease or renal failure. The authors first consider factors altering nutrient requirements in this patient population, including anorexia, financial difficulties, depression or other psychological problems, comorbid illnesses, and losses of nutrients during hemodialysis. The authors then provide specific considerations for the dietary therapy of patients on maintenance hemodialysis, a therapy undertaken to achieve and maintain good nutritional status and to prevent or ameliorate uremic toxicity and other nutritionally influenced metabolic disorders that occur in renal failure. Compliance with special diets is often a challenging endeavor for many patients and their families. The authors discuss protein, calorie intake, sodium and water, lipids, potassium, magnesium, calcium, vitamin D, phosphorus, other vitamins, trace elements, and carnitine requirements. They conclude with a discussion of assessment of nutritional status, both prior to and during dietary therapy. Additional topics include the adequacy of dialysis and its impact on malnutrition, acidosis and protein wasting, management of protein and calorie malnutrition, and treatment of acute catabolic illness. 3 figures. 3 tables. 183 references. (AA-M).

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Assuring Quality of Care in Dialysis Patients Source: in Nissenson, A.R.; Fine, R.N.; Gentile, D.E. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 864-881.

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Contact: Available from Appleton and Lange. 25 Van Zant Street, East Norwalk, CT 06855. (800) 423-1359 or (203) 838-4400. PRICE: $175.00. ISBN: 0838513794. Summary: This chapter on quality of care is from a medical textbook on clinical dialysis. In the text, the authors stress basic pathophysiology and mechanical principles in the context of clinically useful approaches to patient management. The author of this chapter notes that quality assessment in general, and in dialysis in particular, is a concept that is here to stay and must be embraced by every member of the health care team. Although health care is behind the industrial sector in applying quality assessment strategies, there is increasing recognition that appropriately applied quality methodologies are based on science, employ hard data, and do improve patient outcomes. The author begins with a lengthy consideration of definitions and quality assessment paradigms; a brief history of quality assessment in the health care setting is also provided. A free standing dialysis facility is a self-contained system and can employ systemwide methodologies for quality assessement and improvement within its own management structure. A hospital based dialysis facility, on the other hand, must interrelate with other hospital functions, which may be under a different management structure from that of the dialysis facility. The author addresses philosophical issues in total quality management or continuous quality improvement, including: appropriateness, effectiveness, efficiency, safety, consistency, patient satisfaction, internal and external customer orientations, management by fact, respect for people, teamwork, and a disciplined problem solving process. The remainder of the chapter walks the reader through the implementation of a total quality management model at the dialysis facility level, focusing on tools and techniques to measure and assess the program as implemented. The author concludes that, in an environment where large numbers of providers are competing for increasingly regulated and managed health care dollars, only those who can consistently demonstrate high quality, cost effective care will receive contracts for participation in managed care programs. 10 figures. 5 tables. 26 references. (AA-M). •

Epidemiology of Chronic Renal Failure and Guidelines for Initiation of Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 76-81. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on the epidemiology of chronic renal (kidney) failure (CRF) and guidelines for initiation of hemodialysis (HD) is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. Decisions concerning the timing of the initiation of dialysis are based on careful monitoring and evaluation of various clinical and biochemical features of renal failure. In this chapter, the authors provide a brief overview of the main clinical and biochemical manifestations of CRF. Topics include biochemical abnormalities, cardiovascular features, neurologic features, hematologic (blood) abnormalities, gastrointestinal abnormalities, immunologic abnormalities, endocrine abnormalities, and dermatologic (skin) abnormalities. The chapter concludes with brief sections offering guidelines for initiation of HD in CRF patients, and recommendations for vascular access. 1 table. 35 references.

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Psychosocial Aspects of Dialysis Therapy Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 279-287. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: This chapter on the psychosocial aspects of dialysis therapy is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter note that some of the psychosocial factors include changes in an individual's work and family situation, financial concerns, and the stress of living with a life challenging illness. However, little research has been done to help health care professionals predict how patients will react to the multiple changes and stresses associated with life on dialysis. An individual's method of coping with past life stresses remains the best single indicator of his or her adaptability to daily life with dialysis. Frustration tolerance, aggression, denial of the sick role, and obsessive compulsive characteristics are personality traits that can be evaluated and used to help predict a patient's potential adjustment to dialysis. In the ideal situation, an indepth psychosocial evaluation that includes interviews with both the patient and his or her family is conducted by the social worker at the initiation of chronic dialysis treatment. Based on this evaluation, a treatment plan is formulated to include psychosocial counseling and community resource referrals that can enhance the patient's ability to cope. Patients who previously led very independent lives may be at increased risk for psychosocial difficulties with the onset of dialysis treatment. It is especially important that these individuals be given opportunities to participate in their treatment regimens as much as possible.

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Vascular Interposition (Bridge Fistulas) for Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 101-113. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on vascular interposition (bridge fistulas) for hemodialysis is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The author notes that fistulas constructed from vascular (blood vessel) grafts provide the best second choice for the patient who cannot have a simple radiocephalic fistula. Prosthetic conduits can be placed from almost any artery to any vein of sufficient size to permit an anastomosis (a connection between two vessels) and are readily available in various lengths, diameters, and configurations. With care, early use (within 24 hours) can be accomplished without a higher incidence of complications, so it is technically possible to use the graft for dialysis immediately after surgery. This may eliminate the need for the placement of a central dialysis catheter, as was previously done to allow incorporation of the graft material. The author reviews considerations including site, graft materials, size of graft, precautions, and different surgical techniques used. 14 references. 32 references.

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Nutritional Requirements of Hemodialysis Patients Source: in Mitch, W.E. and Klahr, S., eds. Nutrition and the Kidney. 2nd ed. Boston, MA: Little, Brown and Company. 1993. p. 263-289. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $94.95. ISBN: 0316575003. Summary: This chapter, from a book about nutritional requirements during kidney disease, discusses the nutritional requirements of hemodialysis patients. The author stresses that readers should keep in mind that many patients starting dialysis are suffering from malnutrition and wasting. Topics discussed include protein-energy malnutrition in hemodialysis (HD) patients; amino acid abnormalities; glucose and insulin metabolism; hyperglucagonemia; disturbances in lipid metabolism; carnitine depletion; hyperparathyroidism; anemia and erythropoietin; vitamins and trace elements; low-protein intake, malnutrition, and clinical outcome; protein requirements in HD patients; energy requirements; low nutritional intake and anorexia; the evaluation of nutritional status and intakes in HD patients; general aspects of nutritional therapy; and recommended intakes and treatment of malnutrition. 3 tables. 118 references.

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Haemodialysis in Type 1 and Type 2 Diabetic Patients with End Stage Renal Failure Source: in Mogensen, C.E. Kidney and Hypertension in Diabetes Mellitus. 3rd ed. Norwell, MA: Kluwer Academic Publishers. 1997. p. 481-488. Contact: Available from Kluwer Academic Publishers. 101 Philip Drive, Assinippi Park, Norwell, MA 02061. (617) 871-6600. Fax (617) 871-6528. PRICE: $130.00. ISBN: 0792343530. Summary: This chapter, from a book on the kidney and hypertension in diabetes mellitus, addresses the use of hemodialysis in patients with end-stage renal disease (ESRD) and type 1 or type 2 diabetes. The authors consider epidemiology, survival and causes of death, predictors of survival, metabolic control while on renal replacement therapy (dialysis), managing diabetic complications while on renal replacement therapy, and kidney transplantation in the patient with diabetes. The authors note that the number of patients with diabetes entering renal replacement programs has increased in all Western countries. Hemodialysis is the preferred modality of treatment, hemofiltration and CAPD being used only in a minority of cases. The proportion of patients undergoing renal or combined renal and pancreatic transplantation is rising. Survival in patients with diabetes compared to nondiabetic patients is worse for all renal replacement modalities. This is mainly due to cardiovascular death. Cardiac death is poorly predicted by the level of blood pressure and blood pressure related target organ damage, while cholesterol and other lipid parameters are potent predictors. Common clinical problems in the dialysis patient with diabetes include metabolic control, visual disturbance, sequelae of autonomic polyneuropathy, amputation, and vascular access. 1 figure. 2 tables. 36 references. (AA-M).

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Nutrition Management of the Adult Peritoneal Dialysis Patient Source: in American Dietetic Association. Clinical Guide to Nutrition Care in End-Stage Renal Disease. Chicago, IL: American Dietetic Association. 1994. p. 37-55.

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Contact: Available from American Dietetic Association. 216 West Jackson Boulevard Chicago, IL 60606-6995. (312) 899-0040. PRICE: $24 for members; $28 for non-members; plus shipping and handling. ISBN: 0880911247. Summary: This chapter, from a manual that provides guidelines for the clinical nutrition care of patients with end-stage renal disease (ESRD), discusses the nutrition management of the adult peritoneal dialysis (PD) patient. Topics include the regimen of peritoneal dialysis care; measuring dialysis adequacy; specific nutritional considerations, including for protein, caloric intake, sodium and fluid, potassium, phosphorus, calcium, fiber, vitamins and minerals, and cholesterol and triglycerides; PD therapy for patients with diabetes; the role of exercise; and preventing and managing peritonitis. 5 tables. 94 references. •

Nutritional Management of Pediatric Patients on Chronic Dialysis Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 535-548. Contact: Available from Appleton and Lange. 25 Van Zant Street, East Norwalk, CT 06855. PRICE: $215.00. ISBN: 0838513794. Summary: This chapter, from a medical text on clinical dialysis, outlines the role of nutritional management in the treatment regimen for children with chronic renal insufficiency. The author considers the two opposing objects that confront the physician attempting to prescribe an optimal diet for such a child. The need to limit certain dietary constituents (such as protein) in order to minimize the biochemical consequences of uremia must be weighed against the desire to avoid protein and calorie malnutrition. Optimal dietary management is required in order to minimize hypertension, hyperkalemia, vitamin deficiencies, and the uremic syndrome in children undergoing dialysis. In addition, this dietary manipulation must occur within the context of anorexia, which frequently accompanies uremia in children. The author describes current methods available for assessing the nutritional status of children undergoing dialysis and provides recommendations for optimizing nutritional management. Topics include energy requirements (caloric intake), protein requirements, lipid requirements (fats), sodium, potassium, water, renal osteodystrophy, vitamin D therapy, vitamins, and trace elements. The chapter concludes with a discussion of nutritional considerations for the infant receiving CAPD or CCPD treatment. 3 figures. 2 tables. 94 references. (AA-M).

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Development of Hemodialysis and Peritoneal Dialysis Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E., eds. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 1-25. Contact: Available from Appleton and Lange. 25 Van Zant Street, P.O. Box 5630, Norwalk, CT 06856. (800) 423-1359 or (203) 838-4400. PRICE: $175.00. ISBN: 0838513794. Summary: This chapter, from a textbook of clinical dialysis, presents a discussion of the development of hemodialysis and peritoneal dialysis. Topics include the ancient history of diuresis; the first investigators; the first dialyzer, proposed by Thomas Graham; the work of other membrane researchers; vividiffusion; the high-flow dialyzer; other membrane research; the first plate dialyzer; the first clinical dialysis, including the work of George Haas; the emergence of manufactured membranes; the first use of cellophane for dialysis; the Kolff era; the first dialysis in the United States; the development of the Kolff-Brigham kidney; other artificial kidney developers, such as Nils Alwall, Gordon

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Murray, Leonard Skeggs, Jack Leonards, Stephen Rosenak, the Malinow-Korzon group, Bodo Von Garrelts, the MacNeill-Collins group, Muirhead and Reed, and the KirwinLowsley group; the use of the Skeggs-Leonards dialyzer in Norway; the beginning of the Seattle artificial kidney program; the development of dialyzing fluids; other artificial kidney developments in the 1950s; the Kolff twin-coil kidney; prophylactic dialysis; the beginnings of chronic dialysis in the 1960s; the first Seattle home dialysis patient; the age of the hollow fiber kidney; development of peritoneal dialysis, including the work of Fred Boen, Russell Palmer, Harold McDonald, Henry Tenckhoff, Norman Lasker, Dimitrios Oreopoulos, Jack Moncrief, and Robert Popovich; and the use of dialysis in patients with diabetes mellitus. 16 figures. 82 references. •

Home Dialysis: Lessons in Patient Education Source: in Assal, J., Golay, A., and Visser, A.P., eds. New Trends in Patient Education: A Trans-Cultural and Inter-Disease Approach. Amsterdam, The Netherlands: Elsevier Science B.V. 1995. p. 17-24. Contact: Available from Elsevier Science. Regional Sales Office, Customer Support Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Fax (212) 633-3680. E-mail: [email protected]. PRICE: $209.50. ISBN: 0444822348. Summary: This chapter, from the proceedings of an international patient education conference, discusses home dialysis and patient education. The author describes the epidemiology of renal failure, the reasons for home hemodialysis, and the educational support necessary to ensure its success. Continuous ambulatory peritoneal dialysis (CAPD), or autonomous dialysis, is a self-care peritoneal treatment which developed after 1978 for a wider age range of patients. Its rapid expansion necessitated a professional approach to patient education. The author also discusses the problems patients may encounter with conceptual skills, as opposed to practical skills. The chapter demonstrates how people, without formal medical and nursing education, can master complex treatment skills. 13 references. (AA-M).

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Pediatric Hemodialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 288-299. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Treating children who need hemodialysis is complicated by the fact that they are still growing and developing, and chronic renal insufficiency and end stage renal disease (ESRD) interfere with this normal growth and development. Thus, pediatric nephrology nurses must have a comprehensive knowledge of pediatric nursing and childhood growth and development. This chapter on pediatric hemodialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter emphasize that the hybrid of services that a pediatric dialysis facility provides necessitates a good method of matching resources to patient workload activity. Acute renal failure in children usually results from hypoperfusion of the kidneys due to septic shock, hypotension, severe dehydration from gastroenteritis, or from acute blood loss from surgery or an accident. The pathology is that of acute tubular necrosis (ATN). The

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causes of end stage renal disease (ESRD) are different for children than for adults. About two thirds of the cases in children are caused by congenital urinary tract anomalies, or hereditary diseases; the other third are caused by acquired kinds of glomerulonephropathy. Unlike ESRD in adults, diabetic nephropathy, chronic hypertension, autosomal dominant polycystic kidney disease, and membranous glomerulonephritis are rarely causes of ESRD in childhood and adolescence. The preferred modality of treatment for ESRD for most pediatric patients is renal transplantation. If a pediatric patient needs chronic dialysis, home peritoneal dialysis is the usual choice, but may not always be possible. The authors review the details of incenter hemodialysis, including preferred measures of weight, isolation, limits for extracorporeal volume, vascular access considerations, special dialyzers, equipment and supplies, pain with hemodialysis, ultrafiltration, determining blood flow rate, intradialytic monitoring, high blood pressure in children, anemia management, growth and development concerns, toileting concerns, school scheduling, and emergency preparedness. •

Complications During Hemodialysis Source: in Nissenson, A.R.; Fine, R.N. Dialysis Therapy. Philadelphia, PA: Hanley and Belfus, Inc. 2002. p. 171-179. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: With improving outcomes, replacement of renal (kidney) function by hemodialysis (HD) is a well established therapy, but it is not free of complications. This chapter is one part of a section on complications during hemodialysis, from a textbook on dialysis therapy. The chapter covers hypotension (low blood pressure), muscle cramps, dialyzer reactions, hypoxemia (low levels of oxygen in the blood), febrile (fever) reactions, dialysis disequilibrium syndrome (DDS, a neurologic disorder characterized by headaches and nausea in the mild form and confusion, blurred vision, seizures and even coma in the more severe forms), bleeding, pruritis (itching), heart rate disturbances, cardiopulmonary arrest (heart stopping) during dialysis, air embolism (a rare complication), hemolysis (the breakdown of red blood cells), and electrolyte disturbances. The author concludes that the incidence of clinical problems during HD has been greatly reduced, thanks to technological advances and to higher standards in the routine delivery of therapy. Despite these advances, clinical problems may still occur, especially in elderly or unstable patients, or in individuals with underlying comorbid (other illness present at the same time) conditions. Accurate supervision and physical examination of the patient may prevent several of these problems. Hemodialysis can be better tolerated and done more smoothly when potential clinical problems are anticipated and appropriate countermeasures are instituted in a timely fashion. 3 figures.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to dialysis have been published that consolidate information across

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various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 •

Nephrology Resource Directory. 7th ed., 1997-1998 Source: Lexington, KY: Health Information Library, Virgil Smirnow Associates. 1997. [1,000 p.]. Contact: Available from Nephrology Resource Directory. Health Information Library, P.O. Box 55109, Lexington, KY 40555. (606) 299-8475. Fax: (606) 299-8985. PRICE: $34.95 postpaid. Summary: This directory, which is regularly revised, provides a ready reference to information about more than 8,000 physicians in the United States and Canada. It includes not only nephrologists, but also transplant surgeons, vascular surgeons, urological surgeons, pediatric nephrologists, internists, pathologists, physiologists, psychiatrists, and even several veterinarians. The directory also provides basic information about all dialysis and transplant facilities in the U.S. and Canada, with a separate section for dialysis facilities in many other countries. Other groups included are organ procurement organizations, companies, organizations, publishers and periodicals, ESRD networks, and state kidney programs.

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ESRD Provider Listing Source: Midlothian, VA: Mid-Atlantic Renal Coalition. 1997. 32 p. Contact: Available from Mid-Atlantic Renal Coalition. 1527 Huguenot Road, Midlothian, VA 23113. (804) 794-3757. PRICE: $50.00. Summary: This document lists end-stage renal disease (ESRD) service providers in network 5 (Mid-Atlantic region, covering the District of Columbia, Maryland, Virginia, and West Virginia). Organized by geographic location, the directory lists the provider address and telephone number, the provider number, facility type, and services offered. Services offered can include hemodialysis, isolation, and training services (notably in peritoneal dialysis). The directory concludes with an alphabetical listing of facilities by city within each State.

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You will need to limit your search to “Directory” and “dialysis” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “dialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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CHAPTER 8. MULTIMEDIA ON DIALYSIS Overview In this chapter, we show you how to keep current on multimedia sources of information on dialysis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on dialysis is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “dialysis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “dialysis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on dialysis: •

End-Stage Renal Disease: Preventing Dialysis Through Early Recognition and Intervention Source: Secaucus, NJ: Network for Continuing Medical Education (NCME). 1992. Contact: Available from NCME. One Harmon Plaza, Secaucus, NJ 07094. (800) 223-0272 or, in New Jersey, (800) 624-2102, or (201) 867-3550. PRICE: $50 for 2-week rental or $75 for purchase. Available only to NCME subscribers; subscriber fees as of 1995 are $1,920 for VHS subscription, $2,120 for U-matic subscription. Summary: Although deaths in the United States from stroke and coronary artery disease are declining, the incidence of renal failure, another major consequence of hypertension, continues to grow. In this continuing education videotape program, viewers are taught early recognition of end-stage renal disease (ESRD) and appropriate intervention, in an attempt to eliminate or reduce the need for dialysis in hypertensive and diabetic patients. The program focuses on the identification of the very early signs of kidney impairment and the appropriate modes of therapy. (AA-M).

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Help! Peritoneal Dialysis! Source: Cypress, CA: Medcom/Trainex. 1992. Contact: Available from Medcom/Trainex. P.O. Box 6003, Cypress, CA 90630. (800) 8771443. Fax (714) 891-3140. PRICE: $199 plus $1.95 shipping (as of 1995). Order No. 50152. Summary: The advent of patient-friendly equipment has made peritoneal dialysis a viable treatment for end-stage renal disease (ESRD). This videotape program is designed to help the nurse viewer understand the difference between peritoneal dialysis and hemodialysis; the chemical principles involved in a dialysis exchange; and how to perform the three types of bag exchanges, i.e., spike connection, manual disconnection, and mechanical disconnection. Four focuses on patient care are presented: prevention of infection, fluid and sodium balance, nutrition, and patient education and support.

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Infection Control for Hemodialysis Source: Washington DC: Health Industry Manufacturers Association. 1991. Contact: Available from Health Sciences Consortium (HSC). 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. PRICE: $276.50 for HSC members; $395 for nonmembers. Order Number: R911-VI-039. Summary: The failure of staff to follow universal infection control measures in any part of the dialysis setting can lead to a vicious cycle of blood-borne infection transmission throughout the entire unit. This program focuses on preventing the transmission of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in the dialysis setting by adhering to universal precautions. (AA).

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It's Just Part of My Life: A Kid's View of Dialysis Source: New York, NY: National Kidney Foundation. 1992. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: $13.95. Summary: This educational program for children and their families presents information about chronic kidney failure in children. Throughout the videotape, narrated by an adolescent, children and their parents discuss how they deal with school; social life; diet, medication and medical problems; family changes and demands; and overall coping. It presents the reality of dealing with the everyday physical, emotional, and societal aspects of kidney failure for kids, and it is all told through personal interviews with children and their parents.

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Exercise for the Dialysis Patient: A Comprehensive Program Source: Madison, WI: Life Options Rehabilitation Advisory Council. Medical Education Institute, Inc. 1995. (program resource kit). Contact: Available from Medical Media Associates, Inc. University Research Park, 603 Science Drive, Madison, WI 53711. (608) 232-2333 or (800) 468-7777 (Rehabilitation Resource Center). PRICE: Contact directly for details. Also available from Amgen Customer Service. (800) 282-6436. PRICE: Contact sales representatives for information. Summary: This exercise program kit provides physicians, dialysis team members, and patients with information about the benefits of exercise for end-stage renal disease patients and how to help patients increase physical activity. The kit includes four guidebooks, including one for the nephrologist, one for the dialysis team, a prescribing

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guide for physicians and staff, and a guide for people on dialysis. One videotape (for the dialysis team) features exercise physiologist Dr. Patricia Painter speaking to dialysis team members on how critical a role they play in encouraging patients to reach their fitness goals. A second video features dialysis patients talking about the difference that exercise has made in their lives. These patients also demonstrate the same exercises described in the patient written guide. The program reinforces the value of physical activity in the dialysis population. •

Partners in Care: You and Your Dialysis Machine Source: Waltham, MA: National Medical Care, Inc., Dialysis Services Division. 1991. Contact: Available from Patient Videotapes, NMC Dialysis Services Division. 1601 Trapelo Road, Waltham, MA 02154. (617) 466-9850. PRICE: $24.95 (as of 1995). Summary: This program takes an entertaining approach to teaching patients the mechanics of dialysis. A 'talking' dialysis machine captures the attention of a patient and explains its monitors, gauges, and alarm systems as well as how a dialyzer works. The information conveyed can be applied to any brand of dialysis machine. The video also discusses patient monitoring, including the routines of weighing in, blood pressure checks, and temperature checks. (AA-M).

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Core Curriculum for the Dialysis Technician: A Video Review of Hemodialysis Source: Thousand Oaks, CA: Amgen Inc., and Medical Media Publishing, Inc. 1994. Contact: Available from Amgen Professional Services at (800) 772-6436 or contact local service representative. Available in limited quantities to Amgen customers only. PRICE: Free to Amgen customers in individual dialysis facilities. Summary: This program, designed for the dialysis technician, presents an overview of the hemodialysis process. Three sections cover kidney disease and dialysis; hemodialysis devices, procedures, and circulatory access; and reprocessing, water treatment, and quality improvement. Specific topics include kidney function and kidney failure; the principles of dialysis; the dialyzer and dialysate; hemodialysis delivery systems; vascular access; dialyzer reprocessing and water treatment; and quality assurance issues. The videotape is designed to accompany a training manual with the same title. (AA-M).

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Hemodialysis Series Source: Washington, DC: Health Industry Manufacturers Association. 1991. Contact: Available from Health Sciences Consortium (HSC). 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. PRICE: $884.80 for HSC members; $1,264 for nonmembers. Order Number: R911-VI-0385. Summary: This series consists of four videocassettes regarding hemodialysis. Topics include infection control for hemodialysis; human factors in hemodialysis; water treatment in hemodialysis; and reprocessing of hemodialyzers. The series was created through a collaboration of the Health Industry Manufacturers Association; the Food and Drug Administration; the Renal Physicians' Association; and the American Nephrology Nurses' Association. The videotapes are designed for the continuing education of the staff members of dialysis units.

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Dialysis Connection Source: Waltham, MA: National Medical Care, Inc. 199x. Contact: Available from Patient Videotapes, NMC Dialysis Services Division. 1601 Trapelo Road, Waltham, MA 02154. (617) 466-9868. PRICE: $24.95. Summary: This video for patients, nurses, and patient care technicians covers care of the hemodialysis patient's access. Dr. Edmund Lowrie discusses the high percentage of hospitalizations due to access complications and the need to reduce them. The program then gives an in-depth description of good venipuncture technique. Also covered are the ways that patients and caregivers can best preserve accesses and prevent problems. (AA).

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Nutrition Needs for Peritoneal Dialysis Source: Iowa City, IA: University of Iowa Hospitals and Clinics, Dietary Department. 199x. Contact: Available from University of Iowa Hospitals and Clinics. Publications, Dietary Department, Iowa City, IA 52242. (319) 356-2692. PRICE: $100 (purchase), $35 (rental). Summary: This videotape discusses basic nutrition guidelines for the peritoneal dialysis patient and demonstrates how these guidelines can be incorporated into three typical meals. The videotape is useful for educating peritoneal dialysis patients, as well as students and professionals who work with these patients. Topics include protein, sodium, fluids, energy, potassium, phosphorus, cholesterol, fiber, and alcohol use. (AAM).

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Living with Dialysis: Getting the Most Out of Life Source: Madison, WI: Life Options Rehabilitation Program. 1998. (videocassette). Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This videotape program is part of the Life Options Rehabilitation Program, a patient education service of Amgen, Inc. The Keys to a Long Life materials were developed to motivate patients on dialysis and teach them how to optimize their dialysis care and improve their quality of life. The 40 minute video features conversations with six patients and is narrated by a long term hemodialysis patient. The conversation highlights the keys to successful rehabilitation, including a positive attitude, patient education, and active participation. The video offers a look into the lives of people who refuse to let dialysis hold them back. The program includes five stand alone segments, which can be watched separately or all together. Topics covered include adjustment to a chronic illness, the reactions of family and friends, coping with fears about dialysis, the impact of attitude (positive and negative), activities that can be accomplished while on dialysis, patient education and how to find more information, and dialysis as a life saving therapy, not just a waiting period until transplantation. The program is designed to show that a long, satisfying life is possible for dialysis patients and to motivate patients to take steps to enhance their own quality of life.

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Real Rap About Dialysis Source: Boston, MA: Renal Rap Group. 1993.

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Contact: Available from Renal Rap Group. Evelyn Corsini, Dialysis Unit, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. (617) 735-7631. PRICE: $10 includes shipping and handling. Summary: This videotape was made by members of the Renal Rap Group, teenagers and young adults who are receiving chronic hemodialysis treatment at Children's Hospital in Boston. The video is a home movie, made with simple equipment and little professional help. It is upbeat, but very realistic, portraying the dietary and time limits dialysis patients face. There is one scene set in the hemodialysis unit showing a teenager having two needles inserted into his fistula. The tape is designed to educate young people who will need, or who receive dialysis treatments. (AA-M).

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “dialysis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on dialysis: •

Working Effectively with Your Dialysis Team Source: Madison, WI: Life Options Rehabilitation Program. 2000. (audiocassette). Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free. Summary: This audiocassette is part of a free educational program for people with kidney disease. Narrated by a dialysis social worker who is on the Life Options staff, the program focuses on helping kidney patients to live active productive lives, despite the fact that they are on dialysis. The program notes that end stage renal disease (ESRD) is a life threatening illness that, for most people, means living with dialysis. The program features interviews with three patients (Harold, Jim, and Kelly), Dr. Brian Becker (a nephrologist), and Janet Shu (a dialysis clinic nurse). The narrator notes that many people feel overwhelmed by how much they have to learn and do not try because they know the dialysis team will be there to take care of the patient. But the program emphasizes that the patient is the most important member of the team and that patients who take an active part in their own care usually get better results from dialysis. The program consists of five chapters: becoming a member of the team; the other members of the health care team and what each person does; the patient's role on the health care team; communication from patients to staff; and staff communication with patients. Specific strategies are provided on how to participate in one's own health care, recordkeeping, how to counteract depression and feeling overwhelmed by kidney disease, questions to ask the dialysis team (including those seemingly not related to dialysis, such as sexuality, rehabilitation, psychosocial issues), and how best to work within the framework of the dialysis unit. The program concludes with the contact information for the Life Options Rehabilitation Program (800-468-7777 or www.lifeoptions.org).

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Voices of Experience: Personal Stories of Living with Dialysis Source: Madison, WI: Life Options Rehabilitation Program. 1998. (audiocassette). Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This audiotape program is part of the Life Options Rehabilitation Program, a patient education service of Amgen, Inc. The Keys to a Long Life materials were developed to motivate patients on dialysis and teach them how to optimize their dialysis care and improve their quality of life. The 90 minute audio recording contains interviews with four dialysis patients who are living full and productive lives, despite their end stage renal disease (ESRD). In their own words, they talk about how it felt to get a diagnosis of ESRD, what it was like to do dialysis in the early days, how they overcame feelings of frustration and anger, and how they continue to make adjustments so they can fit dialysis and the things they love into their lives. The personal stories of these people demonstrate the importance of learning about dialysis and taking an active part in dialysis treatment, as well as the unlimited power of a positive attitude.

Bibliography: Multimedia on Dialysis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in dialysis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on dialysis: •

Continual ambulatory peritoneal dialysis [videorecording] Source: presented by Department of Nursing, Grady Memorial Hospital; Year: 1982; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1982

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Dialysis and transplantation for end-stage renal failure in diabetic patients [videorecording] Source: Dept. of Medicine, Emory University, School of Medicine; Year: 1978; Format: Videorecording; Atlanta: Georgia Regional Medical Television Networks: [for loan and sale by A. W. Calhoun Medical Library], 1978

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Dialysis, an overview [videorecording] Source: Trainex Corporation; Year: 1980; Format: Videorecording; Garden Grove, Ca.: Trainex, c1980

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Exercise in hemodialysis [videorecording]: things work out when I work out Source: [Andrew P. Goldberg]; Year: 1979; Format: Videorecording; St. Louis, Mo.: Washington University, c1979

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Hemodialysis [videorecording] Source: Medical TV Center, Teaching Laboratories, School of Medicine, Univ. of North Carolina; Year: 1973; Format: Videorecording; Chapel Hill: The Center, [1973]

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Hemodialysis for the treatment of schizophrenia [sound recording] Source: Huxley Institute for Biosocial Research; Year: 1978; Format: Sound recording; New York: The Institute, [1978]

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Hemodialysis, the nurse's role [videorecording] Source: Trainex Corporation; Year: 1980; Format: Videorecording; Garden Grove, Ca.: Trainex, c1980

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Introductory concepts in dialysis [slide] Source: David M. Roxe; Year: 1982; Format: Slide; [New York]: Medcom, c1982

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Kidney failure and hemodialysis [videorecording]: should everyone be treated Source: [UCLA School of Medicine]; Year: 1974; Format: Videorecording; Los Angeles: Univ. of California: [for loan or sale by its Instructional Media Library], 1974

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Nursing care of the patient undergoing peritoneal dialysis [sound recording] Source: District I, New York State Nurses' Association; Year: 1977; Format: Sound recording; Buffalo: Communications in Learning, 1977

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Nursing support during dialysis therapy [videorecording] Source: Trainex Corporation; Year: 1980; Format: Videorecording; Garden Grove, Ca.: Trainex, c1980

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Nutritional care for the patient on hemodialysis [sound recording] Source: Communications in Learning; Year: 1978; Format: Sound recording; [Buffalo, NY]: Communications in Learning, [1978]

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Peritoneal dialysis [filmstrip] Source: Trainex Corporation; Year: 1970; Format: Filmstrip; [Garden Grove, Calif.]: Trainex, c1970

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Peritoneal dialysis [videorecording]: the nurse's role Source: Trainex Corporation; Year: 1980; Format: Videorecording; Garden Grove, Ca.: Trainex, c1980

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Placement of the Parker peritoneal dialysis cannula [videorecording] Source: University of California at Davis, School of Veterinary Medicine; Year: 1978; Format: Videorecording; [Berkeley, Calif.]: Regents of the University of California; [Davis: for loan and sale by Univ. of California, Davis, Health Sciences Television], c1978

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Psychological adaptation to hemodialysis [sound recording]: problems and their treatment Source: Norman B. Levy.; [made by] Sigma Information; Year: 1975; Format: Sound recording; Leonia, N.J.: Sigma, c1975

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Psychosocial aspects of hemodialysis and kidney transplantation [videorecording] Source: Academy of Health Sciences; Year: 1975; Format: Videorecording; Fort Sam Houston, Tex.: The Academy, 1975

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Sequential dialysis therapy [videorecording] Source: Dialyrn; Year: 1980; Format: Videorecording; [S.l.: s.n., 1980]

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The Influence of a dialysis program on post transplant hypercalcemia [videorecording] Source: Academy of Health Sciences; Year: 1975; Format: Videorecording; Fort Sam Houston, Tex.: The Academy, [1975]

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Use of the modified bovine artery heterograft for hemodialysis [videorecording] Source: Edward T. Haines; produced by WRMC-TV; Year: 1974; Format: Videorecording; Washington: Walter Reed Army Medical Center: [for sale by WRAMCTV, 1974]

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CHAPTER 9. PERIODICALS AND NEWS ON DIALYSIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover dialysis.

News Services and Press Releases One of the simplest ways of tracking press releases on dialysis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “dialysis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to dialysis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “dialysis” (or synonyms). The following was recently listed in this archive for dialysis: •

Mortality rate high among dialysis patients with atrial fibrillation Source: Reuters Medical News Date: October 28, 2003

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Paricalcitol therapy may improve survival in dialysis patients Source: Reuters Industry Breifing Date: July 30, 2003

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Dialysis patients live longer with newer vitamin D Source: Reuters Health eLine Date: July 30, 2003

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FDA clears new Bard dialysis catheter Source: Reuters Industry Breifing Date: July 08, 2003

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Low estrogen levels common in older dialysis-dependent women Source: Reuters Medical News Date: July 04, 2003

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FDA clears new Baxter hemodialysis device Source: Reuters Industry Breifing Date: June 24, 2003

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Carvedilol ups survival in dialysis patients with dilated cardiomyopathy Source: Reuters Industry Breifing Date: May 19, 2003

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Soluble Fas levels predict atherosclerosis in dialysis patients Source: Reuters Medical News Date: May 16, 2003

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Dialysis modality does not influence survival from HIV-associated nephropathy Source: Reuters Medical News Date: May 14, 2003

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Depression may be an independent risk factor for malnutrition in dialysis patients Source: Reuters Medical News Date: May 09, 2003

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Hypertension at start of dialysis associated with increased mortality risk Source: Reuters Medical News Date: April 11, 2003

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Morning and evening dialysis sessions linked to improved survival Source: Reuters Medical News Date: April 04, 2003

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Endothelium-independent dilatation contributes to LVH in dialysis patients Source: Reuters Medical News Date: March 27, 2003

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High troponin I levels linked to increased mortality risk in hemodialysis patients Source: Reuters Medical News Date: March 21, 2003

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Baxter subpoenaed over kidney dialysis deaths Source: Reuters Industry Breifing Date: March 13, 2003

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Despite bleeding risk, anticoagulants may benefit dialysis patients with AF Source: Reuters Industry Breifing Date: March 10, 2003

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High phosphate levels in dialysis patients linked with more valvular procedures Source: Reuters Medical News Date: March 05, 2003

Periodicals and News

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Dialysis improvements have not eliminated racial, gender gaps in outcomes Source: Reuters Medical News Date: February 26, 2003

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Dialysis study shows US race, gender gaps persist Source: Reuters Health eLine Date: February 25, 2003

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Calcium supplements tied to prolonged QT dispersion in dialysis patients Source: Reuters Medical News Date: February 19, 2003

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Unplanned dialysis tied to severely impaired quality of life in older patients Source: Reuters Medical News Date: February 07, 2003

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Mesothelial cell changes contribute to failure of ultrafiltration in peritoneal dialysis Source: Reuters Medical News Date: January 31, 2003

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Homocysteine levels linked with arterial calcification in dialysis patients Source: Reuters Medical News Date: January 29, 2003

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Dialysis capacity seen stretched in UK Source: Reuters Medical News Date: January 15, 2003

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AstraZeneca to launch major study of Crestor in dialysis patients Source: Reuters Industry Breifing Date: January 13, 2003

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Baxter dialysis solution approved by FDA Source: Reuters Industry Breifing Date: December 23, 2002

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Dialysis dose and membrane flux do not influence patient outcomes Source: Reuters Medical News Date: December 18, 2002

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Aseptic peritonitis seen with icodextrin-based peritoneal dialysis fluid Source: Reuters Medical News Date: December 16, 2002

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FMC doesn't want full takeover of Baxter dialysis Source: Reuters Industry Breifing Date: December 06, 2002

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Efficient haemodialysis boosts response to HBV vaccine Source: Reuters Medical News Date: December 05, 2002

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Warfarin-induced skin necrosis reported in hemodialysis patient Source: Reuters Industry Breifing Date: December 04, 2002

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Baxter to sell most of its dialysis centers Source: Reuters Industry Breifing Date: December 03, 2002

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ACE inhibitors improve survival of hemodialysis patients Source: Reuters Medical News Date: December 02, 2002

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Diuretics may be deleterious in oliguric acute renal failure, by delaying dialysis Source: Reuters Industry Breifing Date: November 26, 2002

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More people die at for-profit dialysis centers, study alleges Source: Reuters Medical News Date: November 19, 2002

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Lanthanum carbonate helps prevent hyperphosphatemia in dialysis patients Source: Reuters Medical News Date: November 04, 2002

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Spire cleared to sell hemodialysis catheter Source: Reuters Industry Breifing Date: November 01, 2002

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Eccentric LVH in dialysis patients seems resistant to ACE-inhibitor treatment Source: Reuters Medical News Date: October 22, 2002

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Aksys gets EU clearance for personal hemodialysis system Source: Reuters Industry Breifing Date: October 07, 2002

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UK's NICE issues guidance on home dialysis Source: Reuters Industry Breifing Date: October 04, 2002

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UK's NICE issues guidance on home dialysis care Source: Reuters Medical News Date: October 04, 2002

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Peritoneal dialysis patients often do not adhere to erythropoietin therapy Source: Reuters Industry Breifing Date: October 04, 2002

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Lasker Awards go to pioneers in cell protein transport, renal dialysis, gene regulation Source: Reuters Medical News Date: September 23, 2002

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Baxter warns of dialysis tubing amid safety probe Source: Reuters Industry Breifing Date: September 13, 2002

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Baxter probing role of Medisystems blood tubing in dialysis deaths -- FDA Source: Reuters Industry Breifing Date: September 12, 2002

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Intradialytic parenteral nutrition may benefit chronic hemodialysis patients Source: Reuters Medical News Date: September 09, 2002

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NICE to recommend home dialysis option Source: Reuters Industry Breifing Date: August 27, 2002


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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “dialysis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “dialysis” (or synonyms). If you know the name of a company that is relevant to dialysis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “dialysis” (or synonyms).

Newsletters on Dialysis Find newsletters on dialysis using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following

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hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “dialysis.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “dialysis” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Kidney Disease? Know Your Options Source: Lexington, MA: Kidney Options. 2002. 2 p. Contact: Available from Kidney Options. 95 Hayden Avenue, Lexington, MA 124209192. (866) 543-6391. Website: www.kidneyoptions.com. PRICE: Full-text available online at no charge. Summary: Kidney disease happens when there is damage to the filters in the kidneys. These filters remove waste products and excess fluid from the blood. There are many causes of kidney disease, including high blood pressure (hypertension) and diabetes mellitus. This newsletter briefly outlines the treatment options for people with kidney disease. Topics include hemodialysis, peritoneal dialysis, kidney transplants, the role of pre-dialysis education, social services, the importance of appropriate diet therapy, and commonly asked questions about transplants. The newsletter includes a brief profile of a transplant patient. Readers are referred to a web site (www.kidneyoptions.com) for more information.

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Kidney Disease Source: Sarcoidosis Networking. 8(3): 2. May-June 2000. Contact: Available from Sarcoid Network Association. Sarcoidosis Networking, 13925 80th Street East, Puyallup, WA 98372-3614. Email: [email protected]. Summary: Sarcoidosis is a chronic, progressive systemic granulomatous (causing lesions) disease of unknown cause (etiology), involving almost any organ or tissue, including the skin, lungs, lymph nodes, liver, spleen, eyes, and small bones of the hands or feet. This brief article, from a newsletter for patients with sarcoidosis, reviews kidney disease, its types, diagnosis, and management. The article begins with a summary of the anatomy and function of the kidneys, which filter the blood (removing waste and excess body fluids), and maintain the balance of some essential nutrients helping to regulate blood pressure, red blood cells, and elements such as potassium and calcium. Without functioning kidneys, one cannot live without dialysis, the mechanical filtration of the blood. Kidneys fail for a variety of reasons, including trauma to the kidney, toxins, heart failure, obstruction (kidney stones), overuse of some medications, and diseases that invade the kidney, such as sarcoidosis. Diabetes and high blood pressure are the most common causes for loss of kidney function. Warning signs of kidney disease are high blood pressure (hypertension), blood or protein in the urine, creatinine level greater than 1.2 in women or 1.4 in men, more frequent urination (especially at night), difficult or painful urination, and puffy eyes or swelling of the hands or feet (especially in children). Loss of kidney function can produce symptoms including fatigue, weakness, nausea, vomiting, diarrhea or constipation, headaches, loss of appetite, increased edema (fluid retention), and fever or chills. Kidney failure is characterized as acute kidney failure, chronic kidney insufficiency, and chronic kidney failure. The need to put a person on dialysis depends upon the levels of creatinine and urea nitrogen in the blood and the evaluation of body parameters such as fluid status, and symptoms of toxicity. The author encourages readers to practice preventive measures which include drinking 8 to 10 glasses of water per day, preventing or treating diabetes and high blood


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pressure, avoiding tobacco, eating a well balanced diet, practicing good hygiene, treating wounds and infections, limiting exposure to heavy metals and toxic chemicals, and avoiding unnecessary over the counter drug use.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “dialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on dialysis: •

Overcoming the Changes of Kidney Failure and Dialysis Source: Renal Rehabilitation Report. 9(2): 1, 6-8. Summer 2001. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. Summary: From the moment individuals become aware they are beginning to lose kidney function, their lives change. Schedules that may have been relatively free of day to day health care concerns must soon be adapted to include a changing diet, new medications, multiple medical appointments, and eventually a complex regimen of life saving dialysis treatments. This article reviews the changes that a patient undergoes when coming to terms with a chronic illness such as kidney failure. The author emphasizes that, to enjoy a long and full life, people with kidney disease must not only receive good clinical care, they must also commit to rehabilitation. Because there is no cure, complete recovery is not a realistic goal, but rehabilitation can be. To return to a near normal life, people with a chronic illness must be willing to take responsibility for their own care. A recent study identified four changed circumstances that people on dialysis commonly face on their way to rehabilitation: an uncertain future and the risk of death; constraints on such usual activities as eating, drinking, traveling, and exercising; dialysis treatment itself; and repeated setbacks in health. One sidebar offers tips to help patients come to terms: recognize oneself as a changed person, acknowledge that circumstances have changed, see the value in one's changed self and changed life, learn to adjust, and take control of one's own health and life. Health care providers are encouraged to help patients face kidney failure with optimism and self determination, recognizing that these may not be easy tasks to achieve. 10 references.

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Vascular Access Procedures for American Indian Dialysis Patients Source: IHS Primary Care Provider. 25(10): 153-158. October 2000. Contact: Available from Indian Health Service Clinical Support Center. Two Renaissance Square, Suite 780, 40 North Central Avenue, Phoenix, AZ 85004. (602) 3647777. Fax (602) 364-7788. E-mail: [email protected]. Website: www.ihs.gov. Summary: More than 300,000 patients are currently receiving treatment for chronic renal failure with chronic dialysis in the United States. Access complications are the leading

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cause for hospitalizations in this population. This article examines renal (kidney) failure and the complications of dialysis access in two groups of patients from two southwestern Native American tribes. As in the general population, comorbid conditions (illnesses in addition to the kidney disease) were common. In the group from Tribe A, 84 percent had diabetes and 97 percent had hypertension (high blood pressure). In the Tribe B group, 66 percent had diabetes and 80 percent had hypertension. Renal failure associated with diabetes mellitus and hypertension is largely preventable by maintaining strict control of serum glucose and blood pressure. There are three general treatment options for end stage renal disease (ESRD): no therapy (which results in death), peritoneal dialysis, and hemodialysis. In this article, the authors review results from 60 patients from Tribe A who had 81 primary dialysis access procedures over a 6 year period, and from 58 patients from Tribe B who had 94 primary dialysis access procedures over a three year period. The authors discuss the types of grafts and fistulas used, and the complications that can be encountered, including thrombosis (clotting), infection, and arterial insufficiency. In the groups covered in this paper, arteriovenous fistulas had a higher initial failure rate than PTFE (polytetrafluoroethylene) grafts in both patient populations, but those that last a year have longer patency than grafts. The primary and secondary patency rates for Tribe B are less than those for Tribe A patients for PTFE grafts. Radiologic thrombectomy with angioplasty has as good results as surgical revisions as a treatment for graft thrombosis. The authors conclude that early placement of access in patients with progressive ESRD reduces the need for temporary access procedures and may reduce the incidence of subclavian vein stenosis. 5 figures. 3 tables. 28 references. •

From Diagnosis to Dialysis: Kidney School Helps Patients Cope with Kidney Disease Source: Renal Rehabilitation Report. 10(2): S2. Summer 2002. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. Summary: People affected by kidney disease encounter a wide range of emotions: sadness, anger, fear and uncertainty about the future, even depression. This brief newsletter article describes Kidney School, an online, interactive learning center that can be accessed free, 24 hours a day, at www.kidneyschool.org. Kidney School is designed to inspire, motivate, and empower people with chronic kidney disease and with kidney failure to take an active role in their health care and to improve their chances of living long and well. Kidney School consists of 16 interactive modules, addressing a wide range of topics, from exploring treatment options and anemia to vascular access care and understanding lab tests. Module 5, Coping with Kidney Disease, deals directly with the emotional aspects of kidney disease. Topics include the typical stages of adjustment, practical strategies for coping, and resources for assistance. Throughout each module, practical tips and quotes from patients help users begin to develop their own coping strategies.

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Patient as Partner in Health Care: Self Care Dialysis Source: Clinical Strategies: The AKF Newsletter for Nephrology Professionals. 3(1): 6, 10. Summer 1996. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. Fax (301) 881-0898.


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Summary: This article explores the concept of self-care hemodialysis and the role of patient as full partner in his or her own health care. After a brief discussion of developmental stages, the author describes the impact of patient self-care on the issues of volume control, medication compliance, commitment, and schedule adherence. Other topics include family issues, how to implement and support a self-care hemodialysis program, self-care hemodialysis as a step to home hemodialysis, and the impact on patient education. The article includes the experiences of two dialysis patients as they learn about self-care hemodialysis. 3 references. •

Caution: Heart at Work!: Tips on Potassium Control for Hemodialysis Patients Source: AAKP Patient Plan Newsletter. 1(2): 5, 7. 2000. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. Summary: This article is from a newsletter that guides kidney patients through the treatment process for their illness. The newsletter is part of a program that encourages patients to stay active and learn as much as they can about kidney disease and their treatment. The program stresses that the more patients know, the better they are able to make choices that are best for themselves and their families. The program was created by the American Association of Kidney Patients (AAKP), a national organization directed by kidney patients for kidney patients, with the mission of helping kidney patients and their families deal with the physical, emotional, and social impacts of kidney disease. This article discusses potassium, a mineral that is important in heart function, and the need for kidney patients to control their intake of potassium. A healthy kidney will regulate the amount of potassium in the bloodstream by excreting any extra potassium in the urine. When kidney function is reduced, potassium builds up in the blood to high levels. A high potassium level can make the heart stop without warning; other problems can include weak muscles (especially leg muscles), irregular heartbeat, diarrhea, and nausea or vomiting. Going to dialysis and staying for the full treatment is one of the ways to control potassium levels; diet is the other way. The author provides a list of eight tips to become aware of and control the level of potassium in one's diet. The article concludes with the instructions for 'dialyzing' vegetables to reduce their potassium content (soaking them in water for 4 hours or overnight).

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Malnutrition in the Hemodialysis Patient Source: Renal Nutrition Forum. 14(4): 1-4. Fall 1995. Contact: Available from Renal Nutrition Forum. 2246 Poinciana Road, Winter Park, FL 32792. (407) 774-0631. Summary: This article presents a brief overview of research addressing nutritional status in the hemodialysis (HD) patient and the relationship between malnutrition, morbidity, and mortality. The article is also intended to help the dietitian in preventing malnutrition in the HD patient by offering suggestions for therapy. Dialysis factors which may contribute to malnutrition include an increase in muscle protein degradation caused by blood contact with the dialyzer membrane; inadequate dialysis resulting in a uremic state which leads to nausea, vomiting, and loss of appetite; and loss of amino acids and peptides in dialysate. Hormonal disturbances include insulin resistance, increased circulating levels of catabolic hormones such as insulin and parathyroid hormone, and decreased levels of anabolic hormones such as growth factor and erythropoietin caused by deterioration of kidney function. Gastrointestinal factors

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include gastroparesis, malabsorption, gastritis, esophagitis, and constipation. The author reports on studies documenting that malnutrition greatly increases morbidity and mortality in the HD patient. HD patients should ingest 1.2 grams of protein per kilogram of actual body weight, where 50 percent is high biological value protein. An adequate energy intake is vital for the efficient utilization of dietary protein. The most important factor in improving malnutrition in this population is to assure adequate dialysis. The author concludes with a section on interventions for patients who continue to have poor appetites, even if dialysis delivery is optimal. 1 table. 15 references. •

Living a Full Life on Dialysis Source: Renal Rehabilitation Report. 5(5): 1, 7, 8. September-October 1997. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. Summary: This article presents an introduction to a special issue on vocational rehabilitation and employment for dialysis patients. The author notes that, for most working-age Americans, being productive means, in part, being employed. There are, however, various factors that can make employment a challenge for dialysis patients. The article first reviews the symptoms of end-stage renal disease (ESRD) that may interfere with employment. Factors that are considered to be prerequisites to renal rehabilitation include anemia control, appropriate access management, dialysis adequacy, and optimum nutrition. The article then outlines and dispels five common misconceptions about the employment of people on dialysis. These are: patients with ESRD do not want to work; dialysis patients use too many sick days and are not as productive; hiring a dialysis patient will cause the employer's health insurance premiums to increase; dialysis patients require expensive employment accommodations; and dialysis patients who work automatically lose disability payments. The article concludes by offering strategies by which dialysis team members can play a role in combating the myths about ESRD and employment and helping patients manage the symptoms of ESRD. 4 references. (AA-M).

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Rehabilitation and Clinical Management: Keys to a Long Life for Dialysis Patients Source: Renal Rehabilitation Report. 6(3): 1, 8. May-June 1998. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. Summary: This article reviews the issues of rehabilitation and clinical management and their impact in supporting a long life for patients on dialysis. From a patient's perspective, improving outcomes often means returning to as normal a life as possible, despite chronic disease. To a caregiver, improving outcomes includes not only ensuring survival and wellness, but also optimizing physical functioning and emotional well being. The article discusses the value of rehabilitation, better physical functioning, improved emotional health associated with rehabilitation interventions (including exercise programs, participation in self care, and educational interventions), the importance of linking rehabilitation to long term health care goals, and the clinical prerequisites to renal rehabilitation. These prerequisites include anemia management, adequate dialysis, vascular access function, and proper nutrition. The author notes that there is evidence that improvements in quality of life are linked with important (and cost saving) health care goals, including lowered patient morbidity and mortality,


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reduced need for institutionalization or custodial care, and higher rates of gainful employment. 9 references. •

Adequate Dialysis: The First Step Toward Renal Rehabilitation Source: Renal Rehabilitation Report. 6(3): 5. May-June 1998. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. Summary: This brief article reviews the importance of dialysis adequacy in any renal rehabilitation undertaking. Increasing evidence that dose of dialysis affects both survival and quality of life led the Renal Physicians Association (RPA) and the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) to make recommendations about how to measure and prescribe a minimum dose of hemodialysis. According to these recommendations, hemodialysis dosage below the minimum recommended level is associated with decreased survival. The author addresses problems with patient compliance with the full dialysis prescription and emphasizes the link between adequacy and renal rehabilitation. The article concludes with a brief discussion of the need for people with kidney disease to consult with a nephrologist early in the course of their disease, before they need hemodialysis. The issues of anemia, diet, hypertension, bone disease, and education can all be addressed before dialysis begins. 3 references.

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Dialysis: Need for Artificial Kidney Treatment is Increasing Source: Mayo Clinic Health Letter. 15(2): 1-3. February 1997. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article reminds readers of the kidney's role in 'removing the garbage' from the body. The author explains how dialysis takes over the kidney's role. The author first describes how many different diseases or events can damage the kidneys and cause them to fail. Common conditions include diabetes, high blood pressure, and an inflammation of the kidneys called glomerulonephritis. The author goes on to describe hemodialysis and peritoneal dialysis. Hemodialysis removes waste and fluid by filtering the blood through an artificial kidney, called a dialyzer. Peritoneal dialysis uses the network of blood vessels in the abdominal cavity (the peritoneal membrane) to clean waste and excess fluid out of the body. The author concludes with a brief discussion on factors to consider when choosing a method of dialysis. Combined with medications and an appropriate diet, dialysis gives those with kidney failure a chance to live and enjoy life long after these organs have stopped working. 2 figures.

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New Techniques for Improving Quality of Life on Dialysis Source: Clinical Strategies: The AKF Newsletter for Nephrology Professionals. 3(1): 4, 13-14. Summer 1996. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. Fax (301) 881-0898. Summary: This newsletter article reviews new techniques for improving quality of life on dialysis. The author emphasizes that, although the focus of this article is on techniques, some of the more recent advances in managing ESRD have come from better

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understanding the pathogenesis and clinical manifestations of uremia, the state of toxicity resulting from loss of kidney function. Topics include the use of erythropoietin; the importance of nutrition in the ESRD patient; prevention issues for the predialysis patient; dialysis amyloidosis; renal osteodystrophy; monitoring serum albumin concentration; peritoneal dialysis; advances in equipment design and function; vascular access complications; the importance of hemodialysis adequacy; and advances in other biomedical disciplines that impact dialysis therapy. 34 references. •

Optimal Vascular Access for American Indian Dialysis Patients: The Primary Care Provider's Role Source: IHS Primary Care Provider. 25(10): 158-159. October 2000. Contact: Available from Indian Health Service Clinical Support Center. Two Renaissance Square, Suite 780, 40 North Central Avenue, Phoenix, AZ 85004. (602) 3647777. Fax (602) 364-7788. E-mail: [email protected]. Website: www.ihs.gov. Summary: Vascular access (VA) complications are a major cause of morbidity (illness) for patients treated with hemodialysis and represent a large cost burden for the health care system. Current efforts to improve outcomes for patients are based on clinical practice guidelines developed by the National Kidney Foundation as part of the Dialysis Outcomes Quality Initiative (DOQI). This article reviews the guidelines on VA that Indian Health Service (HIS) should be familiar with. The guidelines include preservation of the veins for AV (arteriovenous) access, timing of access placement, access maturation, and goals of access placement (maximizing primary AV fistulas). The author stresses that the most important goal is to increase the proportion of patients with native AV fistulas. This is likely to occur if patients are referred early for vascular access placement. Primary AV fistulae should be constructed in at least 50 percent of all new patients electing to receive hemodialysis as their initial form of renal replacement therapy. A primary AV fistula is mature and suitable for use when the vein's diameter is sufficient to allow successful cannulation, but not sooner than 1 month (and preferably 3 to 4 months) after construction. Ultimately, 40 percent of prevalent patients should have a native AV fistula.

Academic Periodicals covering Dialysis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to dialysis. In addition to these sources, you can search for articles covering dialysis that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for dialysis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with dialysis. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to dialysis: Ascorbic Acid (Vitamin C) •

Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html

Calcium Supplements •

Systemic - U.S. Brands: Alka-Mints; Amitone; Calcarb 600; Calci-Chew; Calciday 667; Calcilac; Calci-Mix; Calcionate; Calcium 600; Calglycine; Calphosan; CalPlus; Caltrate 600; Caltrate Jr; Chooz; Citracal; Citracal Liquitabs; Dicarbosil; Gencalc 600; Liquid Cal-600; Liquid-Ca http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202108.html

Epoetin •

Systemic - U.S. Brands: Epogen; Procrit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202214.html

Folic Acid (Vitamin B 9 ) •

Systemic - U.S. Brands: Folvite http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202250.html

Heparin •

Systemic - U.S. Brands: Calciparine; Liquaemin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202280.html

Hepatitis B Vaccine Recombinant •

Systemic - U.S. Brands: Engerix-B http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202281.html

Iron Supplements •

Systemic - U.S. Brands: DexFerrum; Femiron; Feosol; Feostat; Feostat Drops; Feratab; Fer-gen-sol; Fergon; Fer-In-Sol Capsules; Fer-In-Sol Drops; Fer-In-Sol Syrup; Fer-Iron Drops; Fero-Gradumet; Ferospace; Ferralet; Ferralet Slow Release; Ferralyn Lanacaps; Ferra-TD; Ferretts; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202305.html

Levocarnitine •

Systemic - U.S. Brands: Carnitor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202325.html

Midodrine •

Systemic - U.S. Brands: ProAmatine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203640.html

Pyridoxine (Vitamin B 6 ) •

Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202493.html

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Sevelamer •

Oral - U.S. Brands: Renagel http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203741.html

Thiamine (Vitamin B 1 ) •

Systemic - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html

Thrombolytic Agents •

Systemic - U.S. Brands: Abbokinase; Abbokinase Open-Cath; Activase; Eminase; Retavase; Streptase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202565.html

Vitamin D and Related Compounds •

Systemic - U.S. Brands: Calciferol; Calciferol Drops; Calcijex; Calderol; DHT; DHT Intensol; Drisdol; Drisdol Drops; Hectorol; Hytakerol; Rocaltrol; Zemplar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202597.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

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Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to dialysis by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “dialysis” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for dialysis: •

Levocarnitine (trade name: Carnitor) http://www.rarediseases.org/nord/search/nodd_full?code=235

•

Epoprostenol (trade name: Flolan) http://www.rarediseases.org/nord/search/nodd_full?code=405

•

Dianeal peritoneal dialysis solution with 1.1% ami (trade name: Nutrineal (Peritoneal Dialysis Solution with 1.1% ) http://www.rarediseases.org/nord/search/nodd_full?code=484

•

Icodextrin 7.5% with Electrolytes Peritoneal Dialy (trade name: Extraneal (with 7.5% Icodextrin) Peritoneal Dialys) http://www.rarediseases.org/nord/search/nodd_full?code=841

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute13: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

13

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:15 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

14

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 15 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “dialysis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “dialysis” (or synonyms) into the “For these words:” box. The following is a sample result: •

Carnitine in Dialysis Source: in Exceptional Parent. End Stage Renal Disease: A Practical Guide for Physicians, Dietitians, Nurses, Patients, Families, and Caregivers. Englewood Cliffs, NJ: Exceptional Parent. 1999. p. 18-19. Contact: Available from Exceptional Parent. P.O. Box 1807, Englewood Cliffs, NJ 07632. (800) 535-1910. Fax (201) 947-9376. E-mail: [email protected]. Website: www.eparent.com. PRICE: $5.95. Summary: Carnitine is a substance necessary for production of energy. It occurs naturally in foods (meat and dairy products) and also is produced by the body. In certain illnesses, the normal dietary intake of carnitine may not be enough. This article is from a monograph written to soften the blow of receiving the diagnosis of kidney failure by providing patients, caregivers, and their families some practical, easy to read information. The articles are written to be practical enough for patients to use, yet informative enough that professionals can refer to them as well. This article considers the use of carnitine supplementation for patients on dialysis therapy for chronic kidney failure. A person with impaired energy production is easily fatigued, weak, and has poor endurance. The author reports on studies of patients on dialysis who were treated with carnitine supplementation, noting that the results have been mixed. Some researchers report improvement in both muscle structure and function with carnitine supplementation; other studies did not find any significant improvement. The author concludes that carnitine is not necessary for all dialysis patients, but may be of some use for certain conditions, such as muscle weakness and fatigue; weakness of the heart muscle; anemia that does not respond to erythropoietin; and severe muscle cramps or low blood pressure experienced during dialysis sessions. Before initiating carnitine supplementation, however, these problems should be thoroughly investigated by a physician, and other more common and well understood treatments should be tried. 1 figure.

•

Clinical Practice Guidelines for Hemodialysis Adequacy Source: New York, NY: National Kidney Foundation. 1997. 158 p.

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Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax (212) 689-9261. PRICE: $13.00. ISBN: 0962972142. Summary: In March 1995, the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) was established, with the objective of improving patient outcomes and survival by providing recommendations for optimal clinical practices in four areas: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and the treatment of anemia of chronic renal failure (CRF). This document presents 16 clinical practice guidelines for hemodialysis adequacy. They are categorized in six sections: measurement of hemodialysis adequacy, hemodialysis dose, blood urea nitrogen (BUN) sampling, hemodialyzer reprocessing and reuse, hemodialysis dose troubleshooting, and maximizing patient compliance to the hemodialysis prescription. Each guideline is accompanied by a rationale, enabling dialysis caregivers to make informed decisions about the proper care plan for each individual patient. This document also includes a list of acronyms and abbreviations, a description of the guideline development methodology, endnotes, references, biographical sketches of the NKF-DOQI hemodialysis adequacy work group members, and a complete listing of the articles reviewed by the hemodialysis adequacy work group. 3 figures. 7 tables. 185 references. (AA-M). •

Medicare: Options to Provide Home Dialysis Aides Source: Gaithersburg, MD: General Accounting Office. 1990. 11 p. Contact: Available from General Accounting Office. Information Handling and Support Facility, Box 6015, Gaithersburg, MD 20877. (202) 275-6241. PRICE: Single copy free. GAO/HRD 90-153. Summary: In responde to Congressional inquiry, this document reviews the transitio n of former Home Intensive Care, Inc. (HIC) patients to other sources of dialysis service. The report identifies circumstances where it might be appropriate to adjust Medicare payments to provide for home dialysis aides to these patients. The document also reviews increased indirect costs, such as transportation, incurred by HIC patients after the firm ceased furnishing paid aides for home dialysis.

•

Laboratory Tests in End Stage Renal Disease Patients Undergoing Dialysis Source: Health Technology Assessment. Number 2: 1-12. May 1994. Contact: Available from Agency for Health Care Policy and Research. AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. (800) 358-9295. PRICE: Single copy free. Order Number: 94-0053. Summary: The Office of Health Technology Assessment (OHTA) evaluates the risks, benefits, and clinical effectiveness of new or unestablished medical technologies. The report is the OHTA report on laboratory tests used in end stage renal disease (ESRD) patients undergoing dialysis. The author reassesses the clinical usefulness, necessity, and frequency requirements for four laboratory tests in this population. The four tests are in a category titled 'other than routinely performed' and comprise nerve conduction velocity tests, electrocardiograms (ECGs), chest x-rays, and tests for hepatitis-associated antigens. The author reviews the literature and information regarding these tests from groups both within and outside the federal government. The author concludes that, although the government allows reimbursement for the routine performance of these tests at specified frequencies, there is no reliable evidence to support the usefulness of such tests. Only in the case of nerve conduction tests (NCT) is there substantial literature

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that addresses the usefulness of this type of test in a manner specific for ESRD. 4 tables. 42 references. •

Dialysis Therapy for Patients with Chronic Kidney Failure Source: in Exceptional Parent. End Stage Renal Disease: A Practical Guide for Physicians, Dietitians, Nurses, Patients, Families, and Caregivers. Englewood Cliffs, NJ: Exceptional Parent. 1999. p. 15-17. Contact: Available from Exceptional Parent. P.O. Box 1807, Englewood Cliffs, NJ 07632. (800) 535-1910. Fax (201) 947-9376. E-mail: [email protected]. Website: www.eparent.com. PRICE: $5.95. Summary: This article is from a monograph written to soften the blow of receiving the diagnosis of kidney failure by providing patients, caregivers, and their families some practical, easy to read information. The articles are written to be practical enough for patients to use, yet informative enough that professionals can refer to them as well. This article considers the role of dialysis therapy for patients with chronic kidney failure. The authors stress that, whenever possible, dialysis should be started early enough to prevent the development of severe symptoms of uremia. The authors first describe hemodialysis, which is performed with a dialysis machine that moves blood through a dialysis filter (dialyzer) and dialysate, a fluid that removes waste products and excess water. The vascular access is a crucial component for successful hemodialysis; there are three types of accesses: fistula, graft, and catheter. The fistula is the preferred method of access for adults because it lasts the longest and has the fewest potential complications. Peritoneal dialysis takes place entirely within the body. The dialysate is infused into the peritoneal (abdominal) cavity by way of a catheter. Peritoneal dialysis is provided almost universally as a home therapy. There are two types: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). The authors then describes how dialysis works and the concept of a dialysis prescription, which includes the size of the dialyzer to be used, how fast the blood and dialysate should flow, and how long the treatment should last. In both peritoneal dialysis and hemodialysis, tests are performed on the blood and dialysate to monitor the delivered dose of dialysis. The article concludes with a brief discussion of the potential complications of dialysis and how to prevent them. 3 figures. 1 table.

•

NIH Consensus Statement: Morbidity and Mortality of Dialysis Source: Bethesda, MD: National Institutes of Health (NIH). 1993. 33 p. Contact: Available from National Institutes of Health (NIH). Office of Medical Applications of Research, Federal Building, Room 618, Bethesda, MD 20892. (800)6446627. Also available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 907-8906. E-mail: [email protected]. This publication is also available at http://www.niddk.nih.gov/. PRICE: Single copy free; bulk copies available. Summary: This document is the report of the NIH Consensus Conference panel, convened in November 1993 to consider the morbidity and mortality of dialysis. The Conference addressed five areas of interest: how early medical intervention in predialysis patients affects morbidity and mortality; the relationship between delivered dialysis dose and morbidity/mortality; how co-morbid conditions can be altered by nondialytic interventions to improve morbidity and mortality in dialysis patients; how to reduce dialysis-related complications; and the future directions for research in

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dialysis. Following two days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared this statement. The report also includes a list of the panel members and their affiliations. (AA-M). •

2001 Annual Report: ESRD Clinical Performance Measures Project: Opportunities to Improve Care for Adult In-Center Hemodialysis, Adult Peritoneal Dialysis, and Pediatric In-Center Hemodialysis Patients Source: American Journal of Kidney Diseases. 39(5 Supplement 2): S4-S61. May 2002. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This is the summary report of the ESRD Clinical Performance Measures (CPM) Project, an 8 year old national effort to assist dialysis providers to improve patient care and outcomes. The 2001 ESRD CPM Annual Report describes the findings of several important clinical measures or characteristics of a nationally representative random sample of adult in-center hemodialysis patients and peritoneal dialysis patients. New this year is the addition of findings for all in-center hemodialysis patients aged 12 to 18 years. The report also contains a section of background and project methods. The Executive Summary notes that while significant improvements in care have occurred, the opportunities to improve care for dialysis patients in the United States in the area of adequacy of dialysis, vascular access, and anemia management continue. This Report also provides charts of highlights from the 2001 ESRD CPM Data in the areas of dialysis adequacy, vascular access, anemia management, and serum albumin. The full report can also be found on the Internet (www.hcfa.gov/quality/3m.htm). 15 figures.

The NLM Gateway16 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “dialysis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

16 17

Items Found 90406 1325 941 223 20 92915

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

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HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.20 Simply search by “dialysis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists21 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.22 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.23 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for 18

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

19

The HSTAT URL is http://hstat.nlm.nih.gov/.

20

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 21 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 22

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 23 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on dialysis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to dialysis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to dialysis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “dialysis”:

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•

Other guides Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Diabetic Kidney Problems http://www.nlm.nih.gov/medlineplus/diabetickidneyproblems.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Kidney Failure and Dialysis http://www.nlm.nih.gov/medlineplus/kidneyfailureanddialysis.html Kidney Stones http://www.nlm.nih.gov/medlineplus/kidneystones.html Kidney Transplantation http://www.nlm.nih.gov/medlineplus/kidneytransplantation.html

Within the health topic page dedicated to dialysis, the following was listed: •

General/Overviews Dialysis Keeps People with Kidney Failure Alive: Are You Getting Adequate Hemodialysis? http://www.medicare.gov/Publications/Pubs/pdf/dialysise.pdf Kidney Failure http://www.nlm.nih.gov/medlineplus/tutorials/kidneyfailureloader.html Kidney Failure Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00280

•

Nutrition Na-K-Phos Counter Source: American Association of Kidney Patients http://www.aakp.org/na-k-pho.htm Protein/Calorie Counter Source: American Association of Kidney Patients http://www.aakp.org/Prot/cal.htm

•

Specific Conditions/Aspects Amyloidosis and Kidney Disease Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/amyloidosis/index.htm Financial Help for Treatment of Kidney Failure Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/financialhelp/index.htm

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Inadequate Hemodialysis Increases the Risk of Premature Death Source: American Association of Kidney Patients http://www.aakp.org/hd-adv.htm JAMA Patient Page: Acute Renal Failure Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZCFVFA09D& sub_cat=323 Keeping Fit: Why Dialysis Patients Should Exercise Source: American Association of Kidney Patients http://www.aakp.org/Keeping_Fit.htm Kidney Failure and Cardiovascular Disease http://circ.ahajournals.org/cgi/reprint/108/16/e114.pdf Medigap Policies for People Under Age 65 with a Disability or End-Stage Renal Disease (ESRD) Source: Centers for Medicare & Medicaid Services http://www.medicare.gov/medigap/under65.asp Preparing for Emergencies: A Guide for People on Dialysis http://www.medicare.gov/Publications/Pubs/pdf/10150.pdf Renal Osteodystrophy Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/renalosteodystrophy/index.htm What do I Need to do Before Traveling as a Dialysis Patient? Source: American Association of Kidney Patients http://www.aakp.org/Traveling.htm •

Children What's the Deal with Dialysis? Source: Nemours Foundation http://kidshealth.org/kid/feel_better/things/dialysis.html When Your Child Has a Chronic Kidney Disease Source: Nemours Foundation http://kidshealth.org/parent/medical/kidney/chronic_kidney_disease.html

•

From the National Institutes of Health Hemodialysis Study Results Published Confirms Current Recommended Practice Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.nih.gov/news/pr/dec2002/niddk-18.htm Kidney Failure: Choosing a Treatment That's Right for You Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/choosingtreatment/index.htm

•

Journals/Newsletter AAKP Kidney Beginnings: The Electronic Newsletter Source: American Association of Kidney Patients http://www.aakp.org/KidneyBegin.htm

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E-Kidney: Online Newsletter of the NKF Source: National Kidney Foundation http://www.kidney.org/general/eleckid/ Renal Flash Source: American Association of Kidney Patients http://www.aakp.org/Renal_Flash_Issues.htm •

Organizations American Association of Kidney Patients http://www.aakp.org/ American Kidney Fund http://www.akfinc.org/ Life Options Rehabilitation Program http://www.lifeoptions.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ National Kidney and Urologic Diseases Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/ National Kidney Foundation http://www.kidney.org/

•

Research Hemodialysis Study Results Published Confirms Current Recommended Practice Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.nih.gov/news/pr/dec2002/niddk-18.htm Preventing Worsening Kidney Function in Patients Receiving Peritoneal Dialysis Source: American College of Physicians http://www.annals.org/cgi/content/full/139/2/I-32 Timing of Evaluation by Specialists for Patients with Chronic Kidney Disease Source: American College of Physicians http://www.annals.org/cgi/content/full/137/6/I-24

•

Statistics Kidney and Urologic Disease Statistics for the United States Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/index.htm Kidney Center Data Profile Source: Organ Procurement and Transplantation Network http://www.optn.org/organDatasource/stateData.asp?type=state&mqsd=1&displ ay=Kidney Kidney Disease Facts & Statistics: New Cases Statistics Source: American Society of Nephrology http://www.asn-online.org/data/modules/pbm/rendered/newcases.asp

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Kidney Disease Facts & Statistics: Prevalence Source: American Society of Nephrology http://www.asn-online.org/data/modules/pbm/rendered/prevalence.asp You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on dialysis. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Healthy Eating for Hemodialysis Source: Rockville, MD: American Kidney Fund. 2002. 20 p. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. Fax (301) 881-0898. E-mail: [email protected]. Website: www.kidneyfund.org. PRICE: Single copy free; additional copies available. Summary: A healthy diet is particularly important for people who are beginning hemodialysis, a treatment in which their blood is cleansed of waste products and excess fluid using an artificial kidney and a dialysis machine. This brochure describes the recommended dietary strategy for people going on hemodialysis. Topics covered include the rationale for a special diet; the need to limit fluids; how waste products can build up when the kidneys are not working properly; handling sodium, potassium, phosphorus and urea; managing calories, carbohydrates and fats; the importance of vitamins and minerals; the risk of anemia; and special precautions for people with diabetes who are going on hemodialysis. The brochure includes a sample menu for a man weighing 150 pounds. The brochure concludes with a summary of the recommended strategies for healthy eating for hemodialysis. 6 tables. 12 references.

•

Anemia in Kidney Disease and Dialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2001. 4 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov/health/kidney/nkudic.htm PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-146.

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Summary: Anemia (low levels of red blood cells) is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin (EPO) which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often do not make enough EPO. Other common causes of anemia include loss of blood from hemodialysis and low levels of iron and folic acid. This fact sheet describes anemia in kidney disease and dialysis. The presence of anemia is determined by a complete blood count (CBC), which includes a determination of hematocrit (Hct) level, which is the percentage of the blood that consists of red blood cells. Anemia can begin with chronic renal insufficiency, and tends to worsen as kidney disease progresses. Treatment includes EPO injections, and iron supplements; a few people may also need vitamin B12 and folic acid supplements to keep anemia under control and let patients feel better, live longer, and have more energy. The fact sheet concludes with a description of current research projects in this area, a brief list of resource organizations for more information, and a brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) and its contact information. 2 figures. 1 table. •

Pediatric ESRD Fact Sheet: Peritoneal Dialysis Source: Pitman, NJ: American Nephrology Nurses' Association. 2003. 4 p. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071. (856) 256-2320 or (888) 600-2662. Website: www.annanurse.org. PRICE: Single copy free. Summary: Chronic renal failure (CRF) or end stage renal disease (ESRD) may occur as a result of many systemic disorders or congenital malformations. Children with ESRD may experience fatigue, sluggishness, decreased urine output, anemia, bone disease, and hypertension (high blood pressure). The treatment involves the use of medications, special diet, and dialysis or transplantation. This brochure educates teachers about peritoneal dialysis, particularly as it may apply to a student in their classroom. The brochure describes peritoneal dialysis, the equipment used, the use of nocturnal peritoneal dialysis, care of the peritoneal dialysis catheter, blood pressure control, and medications (and their potential effects). The brochure includes space for the nephrology nurse's telephone number, for the teacher to contact with any questions.

•

Understanding Your Hemodialysis Access Options Source: Tampa, FL: American Association of Kidney Patients. 2001. 12 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. PRICE: Single copy free. Summary: During a hemodialysis treatment, a machine pumps blood from the patient's body through a flexible plastic tube, cleans it, and then returns it to the patient's body through a separate tube. There are two types of dialysis accesses, the site through which blood can be safely removed and returned to the patient's body. The first type involves the creation of a permanent connection between artery and a vein under the skin. This connection can be either a fistula or a graft and is used for patients who are expected to need long term dialysis treatment. The other type of access involves the direct placement of a tube into a large vein in the neck, chest, or groin. This type, which uses a catheter or other subcutaneous (under the skin) device, is most appropriately reserved for patients needing short term dialysis or patients on long term dialysis who no longer have a place to insert a fistula or graft. This brochure contains a brief description of the

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most common types of accesses. The brochure is divided into two sections covering permanent and temporary access options and provides information on how each type of access is placed, when they are used, and the limitations of each. Quotations from patients and detailed self care tips are included. The brochure is illustrated with simple line drawings. The brochure concludes with a brief glossary of terms and a description of the benefits of membership in the American Association of Kidney Patients (AAKP); a membership form is included. 4 figures. •

If You Choose Not to Start Dialysis Treatment Source: New York, NY: National Kidney Foundation. 2000. 10 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, Suite 1100, New York, NY 10016. (800) 622-9010 or (212) 889-2210. Fax (212) 689-9261. E-mail: [email protected]. Website: www.kidney.org. PRICE: Single copy free; $17.00 for 50 copies. Summary: For many people with kidney failure, dialysis greatly improves quality of life. For some patients, however, dialysis may not improve quality of life significantly, often because of their serious health problems. It is important for patients to understand that in such a situation, patients have the right to decide not to start dialysis. This booklet was written to answer general questions about not starting dialysis. The booklet stresses the importance of discussing decisions about dialysis with one's physician and loved ones. Topics include naming a health care surrogate or proxy, the role of the physician in deciding about whether to start dialysis, undergoing dialysis for a trial period (usually 30 days), the role of mental health professionals and counseling in the decision making process, the prognosis for someone who needs dialysis but decides against it, death from kidney failure, the ongoing role of the physician in light of a decision against dialysis, choosing where to die, the role of hospice, the legal factors and documents that should be considered, and where to get more information. People who have end stage kidney failure and are in need of dialysis may live for one week or for several weeks, depending on the amount of kidney function they have left and their overall medical condition. Death from kidney failure is usually painless; medications can be prescribed to ease the complications that may occur.

•

Getting the Best Out of Your Hemodialysis Treatment Source: New York, NY: National Kidney Foundation, Inc. 1995. 3 p. Contact: Available from National Kidney Foundation. U.S. Materials Orders, 30 East 33rd Street, New York, NY 10016. (212) 889-2210. Fax (212) 689-9261. PRICE: $7.00 for 25 copies. Item number: 03-129. Summary: Normal kidneys help to remove wastes and excess fluid from the body. When kidneys fail, dialysis is needed to take the place of healthy kidneys. This fact sheet helps readers to get the most out of their hemodialysis treatment. The fact sheet begins with a list of the signs and symptoms of waste buildup, including tiredness, trouble sleeping, poor appetite, nausea, weight loss, anemia, abnormal bleeding, poor memory, and confusion. The fact sheet then answers common questions about hemodialysis, covering topics including how to know if the treatment is adequate, the Kt per V and urea reduction ratio measurements, how the dialysis prescription is altered based on these test results, the role of the protein catabolic rate (PCR), and where to get more information. The fact sheet encourages readers to keep all scheduled treatments, known their own dialysis prescription, follow the diet plan, know what the blood test results

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are and what they mean, stick to the recommended fluid intake between dialysis treatments, and take responsibility as a member of the health care team. (AA-M). •

AAKP Advisory: Inadequate Hemodialysis Increases the Risk of Premature Death Source: Tampa, FL: American Association of Kidney Patients. 1995. 4 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-2257 or (813) 223-7099. PRICE: Single copy free. Summary: Recent research has shown that many hemodialysis patients may not be receiving enough dialysis to prevent uremic symptoms, serious medical complications, and, in some cases, premature death. This brochure provides patients with information about hemodialysis and quality of care. Written in a question and answer format, the brochure covers determining how much dialysis is enough; the symptoms of inadequate amounts of dialysis; the urea reduction ratio (URR) and how it is used to check on the adequacy of dialysis treatments; how to calculate the URR; the use of KT/V ratios instead of URR; drawing blood samples for BUN values; the need to maintain proper nutrition; and the importance of a good blood access (fistula or graft). The brochure concludes with a list of recommended questions to ask the health care provider; a wallet card that summarizes these questions is also provided.

•

AAKP Advisory: Inadequate Peritoneal Dialysis May Increase the Risk of Malnutrition, Hospitalization and Premature Death Source: Tampa, FL: American Association of Kidney Patients (AAKP). 199x. [10 p.]. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. PRICE: $0.30 per copy. Summary: Research has shown that many peritoneal dialysis patients may not be receiving enough dialysis to prevent uremic symptoms (such as weight loss, poor appetite, and nausea), serious medical complications, hospitalizations and, in some cases, premature death. This brochure from the American Association of Kidney Patients (AAKP) provides a special advisory to inform and advise patients that inadequate peritoneal dialysis may increase their risk of malnutrition, hospitalization, and premature death. Topics include how to determine if dialysis is adequate, how the adequacy of peritoneal dialysis (PD) is measured, how important maintaining proper nutrition is, how to monitor the peritoneal access, and what to ask the doctor and PD staff. The brochure recommends that residual renal function (RRF) be measured every 2 months during the first year of dialysis and every 4 months after that; peritoneal membrane function (PET) should be measured during the first month after beginning PD and when the patient notices decreased drain volumes or longer drain times; the weekly KT over V and creatinine clearance levels should be measured at least every 4 months; and a routine clinic visit should be undertaken monthly or at least every 2 months. This routine clinic visit should be used to check for symptoms of inadequate dialysis, to determine that the peritoneal exchanges are going smoothly, to confirm that the patient's blood chemistries are stable, and to evaluate general health and nutrition. The brochure includes a tear out section of those questions for patients to carry with them to their health care provider. It concludes with a section describing the American Association of Kidney Patients (AAKP) and a membership form.

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Managing the Elderly Patient on Dialysis Source: McGaw Park, IL: Baxter Healthcare Corporation, Renal Division. 1995. 4 p. Contact: Available from Baxter Healthcare Corporation, Renal Division. 1620 Waukegan Road, McGaw Park, IL 60085. (800) 284-4060. PRICE: Single copy free. Summary: The author covers considerations in managing the elderly patient on dialysis. After differentiating between the 'young-old' and the 'old-old', the author discusses growth in the elderly end-stage renal disease (ESRD) population; mortality; morbidity; quality of life; choice of dialysis modality, notably hemodialysis (HD) versus peritoneal dialysis (PD); factors favoring HD; and factors favoring PD. The author concludes that, as substantial evidence now exists showing the success of PD in the elderly, there is no justification at the present time for systematically excluding the elderly from PD therapy. 4 figures. 2 tables. 21 references.

•

Diagnostic Considerations in Interstitial Dialysis Source: Miami, FL: Baker Norton Pharmaceuticals, Inc. 1992. 7 p. Contact: Available from Baker Norton Pharmaceuticals, Inc. 8800 Northwest 36th Street, Miami, FL 33178-2404. (800) 347-4774. PRICE: Single copy free to health care providers. Summary: The flowchart and notes contained in this booklet outline steps for evaluating a patient with suspected interstitial cystitis (IC). The authors stress that, if the physician learns to recognize typical IC symptoms and has a high degree of suspicion, the diagnosis of IC can be made with reasonable clarity. Topics include the presenting signs and symptoms; patient history; the patient's self-assessment, including the use of a 3 day voiding diary; urine culture; urine cytology; the physical examination; radiography; cystoscopy; inconclusive cystoscopy; biopsy; and urodynamic studies. The booklet includes a detachable, detailed flowchart for physician reference. 2 tables. 5 references.

•

Assessing Dialysis Adequacy Source: McGaw Park, IL: Baxter Healthcare Corporation, Renal Division. 1993. 4 p. Contact: Available from Baxter Healthcare Corporation, Renal Division. 1620 Waukegan Road, McGaw Park, IL 60085. (800) 284-4060. PRICE: Single copy free. Summary: The issue of adequacy of dialysis has assumed considerable importance in light of unfavorable comparisons between the mortality of dialysis patients in the United States relative to those in Europe and Japan. This report addresses dialysis adequacy from two perspectives: the minimum acceptable prescription versus the optimum therapy prescription. Topics include the findings from the National Cooperative Dialysis Study (NCDS); the use of the KT/V index for assessing the minimum therapy prescription; peritoneal dialysis (PD) versus hemodialysis (HD); the peak concentration hypothesis; creatinine clearance as a quantitative index of PD adequacy; and the applicability of urea kinetics to PD. 4 figures. 2 tables. 8 references.

•

Implementing Advance Directives: Suggested Guidelines for Dialysis Facilities Source: New York, NY: National Kidney Foundation, Inc. 1993. 13 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: Single copy free. Summary: The Patient Services Committee of the National Kidney Foundation has developed these guidelines to assist dialysis facilities in formulating policies on advance

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directives. The guidelines emphasize that all patients should have the opportunity to discuss their individual health care issues with the medical professionals involved in their care. The guidelines cover facility implementation; the approach to new patients; the approach to current patients in the dialysis unit at the time these guidelines are first implemented; the documentation of advance directives; and facilities unable to implement a specific patient's advance directives. Extensive implementation checklists are included. 10 references. •

Interaction of Prescription Drugs With Commonly-Abused Drugs Among Dialysis Patients Source: American Kidney Fund Newsletter for Health Professionals. 7(1): [p. 9-14]. 1990. Summary: This article consists of a comprehensive chart detailing the effects of commonly abused drugs on dialysis patients. This chart is intended as a reference guide, and pulls together information heretofore unavailable in a single place. For each of fifteen drugs, the common name, generic name, class of drug, actions, indictions, methods of abuse, side effects, signs and symptoms of overdose, interactions, capability of dialyzing (if known), addictive potential, and signs and symptoms of withdrawal are provided. The fifteen drugs covered are: heroin; morphine; Demerol; codeine; Talwin; Quaalude; Nembutal; Seconal; phenobarbital; Restoril (temaepam); alium (diazepam); Dalmane (flurazepam); crank and ice (amphetamine, methamphetamine); cocaine; and crack (cocaine).

•

Emotional Problems of Dialysis and Transplant Patients Source: Bethesda, MD: Virgil Smirnow Associates, Inc. 1992. 14 p. Contact: Available from Virgil Smirnow Associates, Inc. Health and Public Affairs, 8501 Burdette Road, P.O. Box 34425, Bethesda, MD 20817. (301) 469-7933. PRICE: $1.95. Summary: This booklet describes some common emotional issues faced by end-stage renal disease (ESRD) patients. The author focuses on some of the ways in which ESRD patients, their families, and those associated with them can deal with such issues. Topics include emotional problems related to chronic illness, how the patient's emotional state affects medical progress and quality of life, where to find help for emotional problems, three stages of adjusting to artificial kidney treatment, anxiety, depression, denial, how ESRD affects brain function, problems with noncompliant patients, disturbances of sexual function, kidney transplantation and the emotional stages involved, the role of treatment center staff, and the role of families of ESRD patients.

•

Treatment Methods for Kidney Failure: Peritoneal Dialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2001. 24 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-153. Summary: This booklet describes the option of peritoneal dialysis (PD) as a treatment for people with advanced and permanent kidney failure (end stage renal disease or ESRD). Healthy kidneys clean the blood by removing excess fluid, minerals, and wastes.

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They also make hormones to keep the bones strong and the blood healthy. In kidney failure, medical treatments must be used to perform these functions of the kidneys. This booklet describes how PD works, getting ready for PD, the different types of PD, customizing PD to the individual patient, preventing problems, equipment and supplies for PD, testing the effectiveness of the dialysis, conditions related to kidney failure and their treatments, and the psychosocial adjustments that occur as one learns to cope with kidney failure. In PD, a soft tube (catheter) is used to fill the abdomen with dialysis solution; the peritoneum (lining of the abdomen) serves as a membrane to allow waste products and extra fluid to pass from the blood into the dialysis solution. These wastes and fluid then leave the patient's body when the dialysis solution is drained. The most common form of PD, continuous ambulatory peritoneal dialysis (CAPD), does not require a machine; other forms use a cycler to perform the exchanges. Infection is the most common problem for people on PD, but equipment advances and strict adherence to infection control measures can reduce this complication. Monitoring tests are performed on the used solution, urine, and blood measurements to determine whether the dialysis is adequate. Conditions related to kidney failure and their treatments include anemia, renal osteodystrophy (bone disease associated with kidney failure), itching (pruritus), sleep disorders, and dialysis related amyloidosis. The booklet concludes with a description of current research efforts devoted to improving treatment for patients with progressive kidney disease and permanent kidney failure. The booklet also includes a list of resources (organizations and instructional materials) and a brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) and its contact information. 4 figures. •

Disaster and Diet Information for Dialysis Patients Source: New Haven, CT: End Stage Renal Disease Network of New England, Inc. 199x. 13 p. Contact: Available from End Stage Renal Disease Network of New England, Inc. P.O. Box 9484, New Haven, CT 06534. (203) 387-9332. PRICE: Single copy free. Summary: This booklet is designed as a quick reference guide to help dialysis patients understand what to do in the event of a natural disaster when they cannot reach the dialysis unit for treatment. The booklet includes lists of suggested behaviors, supplies to keep in an emergency kit, medications to have on hand, diet suggestions (grocery list and a 3-day meal plan), a place to record individual patient information, and a place to record important phone numbers. Since natural disasters happen without warning, it is important that kidney disease patients know and understand the disaster plan in their own dialysis unit. The diet provided in the booklet is designed to keep toxic poisons from building up in the body when dialysis is delayed, or in the event of a disaster that prevents a patient from using his or her own kitchen for food preparation. The sample meal plans given contain approximately 40 grams of protein, 1500 mg of sodium, and 1500 mg of potassium; they can be adjusted to individual tastes with the help of a dietitian. Space is also provided to record one's vascular access method and location. 1 table. (AA-M).

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Disaster and Diet Information for a Dialysis Patient with Diabetes Source: New Haven, CT: ESRD Network of New England, Inc. 199x. 13 p. Contact: Available from ESRD Network of New England, Inc. P.O. Box 9484, New Haven, CT 06534. (203) 387-9332. PRICE: Single copy free.

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Summary: This booklet is designed educate people with diabetes who are being treated with dialysis about what to do when a natural disaster makes it impossible to reach the dialysis unit for treatment. The authors provide the following: a natural disaster action plan for patients; a list of do's and don'ts; recommended contents for an emergency kit; medication and dietary suggestions; a grocery list for emergencies; a suggested three day meal plan for emergencies; and a nutritional chart and menu pattern. They provide space to include important phone numbers, storm procedures, information specific to the person's medical condition, and a diagram of vascular access and location. The authors urge readers to prepare food, important phone numbers, an emergency kit, and medications, in the event that they find themselves temporarily inconvenienced by a natural disaster. The booklet notes that the emergency meal plans provided are stricter than a normal renal diabetic diet in order to prevent poisons from building up in the blood. The booklet concludes with a page for notes. (AA-M). •

Facts About Dialysis and the Artificial Kidney Source: Bethesda, MD: Virgil Smirnow Associates. 199x. 11 p. Contact: Available from Health Information Library. P.O. Box 55109, Lexington, KY 40555. (606) 299-8475. Fax (606) 299-8985. PRICE: $1.95 plus shipping and handling, prepaid, for 1-99 copies (as of 1996); discounts available for larger quantities. Summary: This booklet provides general information about artificial kidney treatment for renal (kidney) failure. The booklet is designed to help patients and the general public understand this treatment. Topics covered include definitions of kidney failure and endstage renal disease (ESRD); statistics about dialysis and patients treated with dialysis; the option of kidney transplantation; patient selection for dialysis versus kidney transplantation; dialysis equipment; home dialysis; the role of diet and fluids for the patient on dialysis; the potential side effects of dialysis, including sexual dysfunction; and the use of erythropoietin therapy.

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Peritoneal Dialysis: Including CAPD Source: Bethesda, MD: Virgil Smirnow Associates. 199x. 19 p. Contact: Available from Health Information Library. P.O. Box 55109, Lexington, KU 40555. (606) 299-8475. Fax (606) 299-8985. PRICE: $1.95 plus shipping and handling, prepaid, for 1-99 copies (as of 1996); discounts available for larger quantities. Summary: This booklet provides information about peritoneal dialysis. The publication is intended patients with acute or chronic kidney failure and their families. Topics include end-stage renal disease (ESRD), the types of dialysis, peritoneal dialysis, peritonitis, advantages and disadvantages of peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD), and financial considerations.

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Getting the Most from Your Treatment: What You Need to Know about Hemodialysis Source: New York, NY: National Kidney Foundation. 1998. 31 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This booklet summarizes the use of hemodialysis to treat kidney diseases. The booklet tells readers why it is important to get the right amount of hemodialysis, how to care for the hemodialysis access, the complication of anemia and how it is treated, why diet restrictions must be followed carefully, how to help prevent bone

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disease and heart problems, how to cope with kidney disease and its treatment, how to get involved in one's own treatment plan and additional resources that are available. The brochure outlines the roles of each of the various health care team members who may be involved in the care of a person on hemodialysis. One section encourages readers to educate themselves about their disease and its treatment and to be very involved in their own health care. The brochure concludes with a section that summarizes the 13 laboratory tests commonly used to monitor patients with kidney disease: Kt per V and URR, nPNA, albumin (BCG test), hematocrit, hemoglobin, TSAT and serum ferritin, parathyroid hormone (PTH), calcium, phosphorus, potassium, target weight, average daily weight gain, and blood pressure. The brochure is written in nontechnical language and illustrated with simple line drawings. The brochure is one in a series of materials from an educational program of the National Kidney Foundation Dialysis Outcomes Quality Initiative. •

Rehabilitation for Dialysis and Transplant Patients Source: Bethesda, MD: Virgil Smirnow Associates, Inc. 1992. 17 p. Contact: Available from Virgil Smirnow Associates, Inc. Health and Public Affairs, 8501 Burdette Road, P.O. Box 34425, Bethesda, MD 20817. (301) 469-7933. PRICE: $1.50. Summary: This booklet was written to help patients with chronic renal failure (CRF) and their families understand that they can live reasonably normal, productive, and satisfying lives despite their illness. The booklet is also designed to help professional staff who work with end-stage renal disease (ESRD) patients better understand the rehabilitation process. Topics include a definition of rehabilitation, what is involved in the rehabilitation process, who is responsible for rehabilitation, the psychological issues of rehabilitation, rehabilitation for children, physical restoration, emotional restoration, social rehabilitation, vocational and economic rehabilitation, and sources of rehabilitation help. Throughout the booklet, the author returns to the idea that there is much more to life than just staying alive.

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Help! I'm a New Dialysis Patient. What Can I Eat? Source: Los Gatos, CA: BMA Dialysis. October 1990. 2 p. Contact: Available from BMA Dialysis. Attn: Elaine Rodgers, 14651 South Bascon Avenue, Number 100, Los Gatos, CA 95032. PRICE: $2.50 for 25 copies (minimum order 25 copies), $1.75 up to 100 copies. Summary: This brief brochure presents introductory information about diet and nutrition for the person newly started on dialysis. The brochure focuses on two elements in the diet: potassium and fluids. A sample menu for one day is provided. Also included is a list of suggestions for controlling thirst. The brochure is designed to help the new dialysis patient cope until he or she is able to meet with a dietitian and design an individualized meal plan.

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Peritoneal Dialysis Source: Montreal, Quebec: Kidney Foundation of Canada. 199x. [4 p.]. Contact: Available from Kidney Foundation of Canada. 300-5165, rue Sherbrooke Ouest, Montreal, QC H4A 1T6. (514) 369-4806. Fax (514) 369-2472. Website: www.kidney.ca. PRICE: Single copy free.

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Summary: This brochure answers questions that readers may have as they become candidates for peritoneal dialysis, a treatment for people whose kidneys have failed. Peritoneal dialysis (PD) works on the same principle as hemodialysis, but the blood is cleaned inside the body rather than through a machine. The abdomen has a peritoneal cavity, lined by a thin membrane called the peritoneum that surrounds the intestines and other internal organs. In PD, the peritoneal cavity is filled with dialysis fluid that enters the body through a permanently implanted catheter. Excess water and wastes pass through the peritoneum into the dialysis fluid. Then this fluid is drained from the body and discarded. The brochure describes two types of peritoneal dialysis: continuous peritoneal dialysis (CPD) and intermittent peritoneal dialysis (IPD). Other topics include access to the peritoneal cavity (the catheter), diet and fluid intake restrictions, the impact of peritoneal dialysis on daily life, issues regarding travel, and choosing the most appropriate treatment. The brochure concludes with a brief description of the Kidney Foundation of Canada, including patient services and public education programs. 1 figure. •

Hawaii: Aloha Dialysis Center: Exclusively for Visitors Source: Honolulu, HI: Intercontinental Medical Services, Inc. 199x. 2 p. Contact: Available from Intercontinental Medical Services, Inc. Professional Plaza of the Pacific, 1520 Liliha Street, Suite 607, Honolulu, HI 96817. (808) 521-8061. PRICE: Single copy free. Summary: This brochure describes a dialysis treatment center that is available exclusively for visitors to Hawaii. Convenient to Waikiki, the dialysis center provides a cheerful Hawaiian environment, with twenty dialysis stations enabling the staff to assist in coordinating visitors' dialysis and vacation schedules. The modern dialysis equipment utilizes both bicarbonate and acetate dialysis capabilities. Reverse osmosis water treatment is standard for all units. Complete medical-surgical support is provided by a major hospital just minutes away from the treatment center. The brochure also briefly mentions 3 additional dialysis facilities located in Hawaii that are affiliated with the Aloha Dialysis Center.

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Hemodialysis Fact Sheet Source: Pitman, NJ: American Nephrology Nurses' Association. 2003. 4 p. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071. (856) 256-2320 or (888) 600-2662. Website: www.annanurse.org. PRICE: Single copy free. Summary: This brochure describes hemodialysis (HD), a dialysis option for patients with chronic kidney disease (CKD). The brochure first describes CKD and end stage renal disease (ESRD), their causes and complications. The brochure then focuses on hemodialysis, a process that is usually performed in an outpatient clinic. The brochure describes how hemodialysis works, the need for vascular access for HD (arteriovenous fistula, arteriovenous graft, and central vein catheter), nutritional management (typical guidelines), typical medications, the benefits of exercise for patients on HD, and the importance of the patient being an active part of their own health care team. The brochure helps nurses understand CKD and its implications for nursing care.

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Peritoneal Dialysis Fact Sheet Source: Pitman, NJ: American Nephrology Nurses' Association. 2003. 4 p.

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Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071. (856) 256-2320 or (888) 600-2662. Website: www.annanurse.org. PRICE: Single copy free. Summary: This brochure describes peritoneal dialysis (PD), a dialysis option for patients with chronic kidney disease (CKD). An alternative treatment to hemodialysis, this form of dialysis is usually performed by the patient at home. PD occurs inside the body, using the peritoneal membrane (the lining of the abdomen) as a filter. The peritoneal membrane is semipermeable, allowing certain size substances to pass through it. The brochure describes how peritoneal dialysis works, the two types of PD (continuous ambulatory peritoneal dialysis or CAPD, and continuous cycling peritoneal dialysis or CCPD), the advantages and disadvantages of PD, likely candidates for PD, a list of the knowledge a home PD patient must have, and the role of the PD nurse (who works with the home PD patient). •

Dialysis Unit for Penn State Students Source: State College, PA: Dialysis Unit for Pennsylvania State University Students. 1990. 4 p. Contact: Available from Dialysis Unit for Pennsylvania State University Students. 3901 South Atherton Street, Suite 5, State College, PA 16801. (814) 466-7911. PRICE: Single copy free. Summary: This brochure describes the Dialysis Unit for Penn State Students, a unique facility specifically designed for individuals with chronic kidney disease who want to pursue higher education. By providing academic assistance, counseling, and medical support, the program helps students work toward degrees and prepare for careers, while developing independence in managing their illnesses. This brochure describes the academic opportunities available, the physical location, the facilities and staff members of the program, and the costs of the program. An information request card is included to send for more details about the programs described.

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Nutrition and Peritoneal Dialysis Source: New York: National Kidney Foundation. 1998. 7 p. Contact: National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free; bulk copies available. Summary: This brochure explains dietary changes recommended for patients who are beginning peritoneal dialysis treatments for the first time. Written in a question and answer format, the brochure presents guidelines for maintaining adequate levels of protein, potassium, sodium, fluid, phosphorus, calories, and vitamins and minerals in the diet. The brochure emphasizes the importance of close cooperation between the hemodialysis patient, the physician, and the renal dietitian in planning and following a healthy diet.

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Importance of Having Enough Iron: A Guide for Dialysis Patients and Their Families Source: Tampa, FL: American Association of Kidney Patients (AAKP). 1995. 9 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-2257 or (813) 223-7099. Fax (803) 223-0001. PRICE: Single copy free.

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Summary: This brochure explains how erythropoietin (EPO) works with iron to help correct dialysis-associated anemia. Written for patients on dialysis, the booklet also explains why patients may be given iron supplements in addition to EPO. Topics include the physical effects of chronic renal failure (CRF); the impact of anemia; how anemia is measured; the importance of having enough iron; the side effects of iron therapy; how hematocrit and iron levels are measured; how to improve the absorption of oral iron supplements; managing sick days; the impact of surgery on iron levels; and reimbursement issues for EPO and iron supplementation. The booklet concludes with a brief glossary of terms. 1 figure. 1 table. •

What You Should Know About Dialyzer Reuse: A Guide for Hemodialysis Patients and Their Families Source: New York, NY: National Kidney Foundation. 1999. 11 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, Suite 1100, New York, NY 10016. (800) 622-9010 or (212) 889-2210. Fax (212) 689-9261. E-mail: [email protected]. Website: www.kidney.org. PRICE: Single copy free; $10.00 for 50 copies. Summary: This brochure familiarizes hemodialysis patients and their families with dialyzer reuse, in which the same hemodialyzer (filter) is used more than once for the same patient. Written in a question and answer format, the brochure describes how dialyzer reuse can reduce or eliminate the physical reaction some patients have to certain dialyzer membranes. In addition, dialyzer reuse allows the dialysis center to use high efficiency dialyzers, which are expensive. The brochure describes the guidelines of the Association for the Advancement of Medical Instrumentation (AAMI) regarding dialyzer reuse, which cover four areas: dialyzers should be labeled carefully so they are always used for the same patient; dialyzers should be tested after rinsing to make sure all disinfectants have been removed; patients should be checked for any bad reactions caused by reuse; and dialyzers that are reused should be well tested after each use to make sure they are still working well. Other issues covered include how to know if the dialyzer is working well, how many times a dialyzer can be safely reused, how the dialyzer should look before treatment, and how to know if one is getting the right amount of treatment from the reused dialyzer and the dialysis process. The brochure encourages patients to talk with their dialysis care team if they have any questions. A list of publications from the National Kidney Foundation (NKF) is offered, with a brief description of the organization and its activities. 4 figures.

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AIDS: Information for the Dialysis Patient Contact: US Department of Health and Human Services, Public Health Service, Food and Drug Administration, Center for Devices and Radiological Health, 5600 Fishers Lane, Rockville, MD, 20852, (301) 436-8450. Summary: This brochure gives patients receiving kidney dialysis treatment information about Acquired immunodeficiency syndrome (AIDS) and how the Human immunodeficiency virus (HIV) spreads. It looks at infection-control precautions for a dialysis unit, and assures readers that there is little chance of contracting HIV from a health-care worker. The brochure assures readers that blood transfusions and kidney transplants are relatively safe. It looks at the rights of HIV-infected patients.

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On the Road.Again: A Travel Guide for Dialysis Patients Source: Lexington, MA: Patient Travel Service, Fresenius Medical Care North America. 2001. 9 p. Contact: Available from Patient Travel Service, Fresenius Medical Care North America. Two Ledgemont Center, 95 Hayden Avenue, Lexington, MA 02173 (800) 634-6254 or (781) 402-9000 Ext. 6583. Fax (781) 402-9707. PRICE: Single copy free. Summary: This brochure helps people who are on dialysis make travel plans and arrangements for dialysis away from home. The brochure, written in a question and answer format, explains the basics of traveling, the importance of advance planning, how to find out where dialysis centers are located, cost and payment considerations, the need for flexibility, sending medical records, handling the emotional stresses of dialyzing in a strange setting, and considerations for patients using Continuous Ambulatory Peritoneal Dialysis (CAPD). The brochure also briefly explains the Patient Travel Service, a free referral program using a continuing updated database of dialysis providers worldwide.

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Help! I'm a New Dialysis Patient Source: Sunnyvale, CA: Council on Renal Nutrition. 1997. 2 p. Contact: Available from Council on Renal Nutrition. 1542 Queenstown Court, Sunnyvale, CA 94087. (408) 236-4137. PRICE: $5.00 for 20 brochures. Summary: This brochure helps readers newly placed on dialysis to begin their meal planning. Designed to help readers cope until they can meet with a dietitian and plan a more individualized menu, the brochure provides tips on potassium and liquids. Potassium is a mineral found in large amounts in fruit, vegetables, and milk. The brochure advises eating no more than four servings of fruit and vegetables daily, selecting less than one cup daily of milk or milk products, and consuming no more than half a cup daily of certain potassium rich foods (the brochure lists oranges or orange juice, bananas, potatoes, and tomatoes or tomato sauces). Fluid can build up in the body between dialysis treatments, causing shortness of breath or swelling of the ankles, eyes, fingers. The brochure provides strategies for preventing fluid buildup. The brochure concludes with a sample daily diet, including suggestions for snack foods.

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Emergency Care for Dialysis Patients Source: Morgan Hill, CA: Council on Renal Nutrition of Northern California-Northern Nevada. 1994. 2 p. Contact: Available from Council on Renal Nutrition of Northern California-Northern Nevada. Elaine Rodgers, 560 Caprice Court, Morgan Hill, CA 95037. PRICE: 25 copies (minimum order) for $5 plus $1.75 postage (as of 1995). Summary: This brochure highlights the key ideas of an emergency diet for renal patients who rely on dialysis. It provides a brief discussion of the need for an emergency diet. The brochure then lists suggested emergency foods in the following categories: meat and protein, milk, fruits and vegetables, beverages, breads, cereals and pastas, fats, and sweets. The final section provides recommendations for the areas of potassium, fluid intake, salt, protein, medications, and special care for people with diabetes.

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Dialysis Patient: An Informative Guide for the Dentist Source: Rockville, MD: American Kidney Fund. 1995. 13 p.

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Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. Fax (301) 881-0898. PRICE: Single copy free. Summary: This brochure is for dentists who come in contact with dialysis patients. The specific medical problems dialysis patients may have that require special consideration are discussed, which include bleeding tendencies, abnormal drug metabolism, and the potential for hepatitis transmission. Precautions and prophylaxis against transmission of the hepatitis virus are provided. These include properly cleaning work areas, instrument sterilization, and isolation techniques. Post-exposure prophylaxis is also described indepth. Management of bleeding tendencies of dialysis patients and medications that are routinely prescribed for patients on dialysis are discussed. •

About Kidney Dialysis and Transplants Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1995. 7 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $1.25 plus shipping and handling (as of 1996); bulk prices available. Order number 18986. Summary: This brochure presents basic information about dialysis and kidney transplantation. Topics include the anatomy and physiology of the kidneys; end-stage renal disease (ESRD) and its causes; three forms of treatment for ESRD (hemodialysis, peritoneal dialysis, and kidney transplantation); medication; diet therapy; lifestyle adjustments, including emotional, financial, and physical changes; and breakthroughs in renal research. The brochure is illustrated with simple, line drawings of cartoon figures and includes definitions of many medical terms used.

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AIDS: Information for the Dialysis Health Professional Contact: US Department of Health and Human Services, Public Health Service, Food and Drug Administration, Center for Devices and Radiological Health, 5600 Fishers Lane, Rockville, MD, 20852, (301) 436-8450. Summary: This brochure presents information about the Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS) to health professionals who work with dialysis patients. It discusses routes of HIV transmission, and specifies how HIV can spread in a dialysis setting. It urges readers to deal with their own and patients' anxieties about HIV, and addresses their risk of becoming infected through contact with a patient. Methods of HIV prevention are discussed.

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Good News for Snackers!: Low Phosphorus, Low Potassium Choices for People on Dialysis Source: Morgan Hill, CA: Council on Renal Nutrition of Northern California-Northern Nevada. 199x. 2 p. Contact: Available from Council on Renal Nutrition of Northern California-Northern Nevada. Elaine Rodgers, 560 Caprice Court, Morgan Hill, CA 95037. PRICE: 25 copies (minimum order) for $5 plus $1.75 postage (as of 1995). Summary: This brochure presents low phosphorus, low potassium snack ideas for people on dialysis. It consists primarily of lists of treats, including treats that are less sweet; fluid snacks; desserts and baked goods; and candy treats. Each item is listed with

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a recommended amount or serving. The brochure also includes recipes for soft pretzels and popcorn balls. •

Adequacy of Hemodialysis: Quick Reference Guide for Clinicians Source: Washington, DC: Renal Physicians Association. 1993. 2 p. Contact: Available from Renal Physicians Association. 2011 Pennsylvania Avenue, Suite 800, Washington DC 20006-1808. (202) 835-0436. PRICE: Single copy free. Summary: This brochure provides a quick reference guide to the Clinical Practice Guideline developed on the adequacy of hemodialysis. The guideline was developed under the sponsorship of the Renal Physicians Association (RPA), undertaken because certain studies have suggested that some of the unfavorable U.S. hemodialysis (HD) survival may be the consequence of inadequate HD. Based on available data, the variables involved with the delivery and outcomes of HD were identified and utilized in a probabilistic model to assess how variations in the dialysis prescription and delivery of HD affect quality-adjusted life expectancy and 'marginal' cost-effectiveness. The brochure summarizes the guideline parameters in six areas: patient criteria; guideline audience; parameters of the dialysis prescription; confirmation that adequate dialysis is being delivered; recommended KTVd levels (at least 1.2); and corrective action for KTVd which falls below guideline parameters.

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Understanding Adequacy of Hemodialysis: Consumer Guide Source: Washington, DC: Renal Physicians Association. 1993. 4 p. Contact: Available from Renal Physicians Association. 2011 Pennsylvania Avenue, Suite 800, Washington DC 20006-1808. (202) 835-0436 PRICE: Single copy free. Summary: This brochure provides patients with an understanding of the issues regarding the adequacy of hemodialysis. The guideline was developed under the sponsorship of the Renal Physicians Association (RPA), undertaken because certain studies have suggested that some of the unfavorable U.S. hemodialysis (HD) survival may be the consequence of inadequate HD. After a description of the problem, the brochure discusses the importance of measuring adequate hemodialysis and recommendations for care, including number of dialysis treatments, the amount of prescribed and delivered hemodialysis, and ways to determine adequacy of dialysis. The brochure includes a question-and-answer section, which addresses topics including missing dialysis treatments; treatments that are shorter than prescribed; and blood flow rates.

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Nutrition for Pre-Dialysis Patients Source: Montreal, Quebec: Kidney Foundation of Canada. 199x. [4 p.]. Contact: Available from Kidney Foundation of Canada. 300-5165, rue Sherbrooke Ouest, Montreal, QC H4A 1T6. (514) 369-4806. Fax (514) 369-2472. Website: www.kidney.ca. PRICE: Single copy free. Summary: This brochure reviews strategies for appropriate nutrition for predialysis patients (patients with kidney disease that has not yet progressed to require dialysis). Kidneys remove wastes from the blood via the urine. They regulate the levels of water and different minerals needed by the body for good health. They also produce hormones that control other body functions. The brochure describes acute kidney failure, in which kidney function usually returns to normal, but dialysis may be needed

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until the kidneys begin to work again; and chronic kidney failure, resulting from conditions such as diabetes and high blood pressure (hypertension). In the early stages of chronic kidney failure, the only treatment needed may be a special diet or medication. Changes in the diet may be recommended in order to meet nutritional needs, cut down the kidney's workload, help keep the kidney function that remains, control the build up of food wastes and water, and improve symptoms of kidney failure, such as fatigue, nausea, itching, and bad taste in the mouth. The brochure describes restrictions in protein, sodium, phosphorus, and potassium that may need to be adjusted. It is not usually necessary for predialysis patients to restrict fluids. The brochure concludes with a brief description of the Kidney Foundation of Canada, including patient services and public education programs. 1 figure. •

Your Diet on Dialysis Source: Morgan Hill, CA: Council on Renal Nutrition of Northern California-Northern Nevada. 1994. 4 p. Contact: Available from Council on Renal Nutrition of Northern California-Northern Nevada. Elaine Rodgers, 560 Caprice Court, Morgan Hill, CA 95037. PRICE: 25 copies (minimum order) for $5 plus $1.75 postage (as of 1995). Summary: This brochure summarizes a recommended diet for renal patients who are on dialysis. It unfolds to a chart which is designed to be individualized by the patient's dietitian. The chart lists food groups of milk, meat, bread and starches, vegetables, fruits, fats, and fluids. The chart includes space for the number of servings in each food group. It also provides recommended serving sizes and notes foods to avoid in each food group. Brief textual material reminds readers of the importance of following the recommended diet.

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Dialysis Report Card: Understanding Your Lab Values Source: New York, NY: National Kidney Foundation. 1998. (chart). Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This chart helps patients on dialysis track important laboratory data and visualize where they stand in relation to established goals. The report card format offers room to record lab values for a 1-year period and is intended to help discussion among patients and the renal health care team about adequacy of treatment. The report card offers space to record 16 values: Kt per V, URR, nPNA, albumin (BCG test), hematocrit, hemoglobin, TSAT, serum ferritin, parathyroid hormone, calcium, phosphorus, potassium, target weight, average daily weight gain, predialysis blood pressure, and postdialysis blood pressure. The card also includes a space for the patient's individual goal numbers in each of these tests. The reverse side of the chart offers a few sentences of explanation for each of the 16 tests. These explanations focus primarily on the daily steps that patients can take to help their own health care be more successful. This report card is one of a series of materials from an educational program of the National Kidney Foundation Dialysis Outcomes Quality Initiative.

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Peritoneal Dialysis Dose and Adequacy Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2001. 4 p.

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Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-149. Summary: This fact sheet describes the need to determine the adequacy of peritoneal dialysis (PD) used to treat chronic kidney failure (end stage renal disease, or ESRD). In PD, a soft tube (catheter) is used to fill the abdomen with dialysis solution (dextrose, salt, and other minerals dissolved in water); the peritoneum (lining of the abdomen) serves as a membrane to allow waste products and extra fluid to pass from the blood into the dialysis solution. These wastes and fluid then leave the patient's body when the dialysis solution is drained. Many factors affect how much waste and extra fluid are removed from the blood, including the patient's capacity for dialysis solution and the permeability of their peritoneum. Controllable factors include the number of daily exchanges and the dwell time (how long the fluid stays in the abdomen). The fact sheet describes the three types of PD and the tests that are used to determine if the exchanges are removing enough wastes and fluid. The PD prescription usually also considers the amount of residual kidney function the patient retains. Patients sometimes do not perform all of the exchanges recommended by their medical team; this lack of compliance can increase the risk of hospitalization and death. The fact sheet concludes with a description of current research efforts in this area, a brief list of resource organizations for more information and a brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) and its contact information. 1 figure. •

Home Hemodialysis Source: New York, NY: National Kidney Foundation, Inc. 1991. 2 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Order number KU-8. PRICE: Single copy free. Summary: This fact sheet from the National Kidney Foundation presents a brief overview of home hemodialysis. Written in a question-and-answer format, the fact sheet includes information on the requirements for home hemodialysis, the training required to perform home hemodialysis, the advantages and disadvantages of the procedure, the support structure available for home hemodialysis patients, medical insurance, and the activities of the National Kidney Foundation.

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Just the Facts: The Dialysis Machine Source: Madison, WI: Life Options Rehabilitation Program. 1999. 2 p. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This fact sheet is part of the Life Options Rehabilitation Program, a patient education service of Amgen, Inc. The Keys to a Long Life materials were developed to motivate patients on dialysis and teach them how to optimize their dialysis care and improve their quality of life. This fact sheet on the dialysis machine is one of six fact sheets providing general information about living well on dialysis. Each fact sheet contains research based information about the topic and why it is important for patients; simple illustrations; and a table of problems, prevention strategies, and questions for

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patients to ask. Topics covered in this fact sheet include the parts of the hemodialysis machine, how much blood is circulated outside the body during dialysis, the role of the air detector, the blood flow rate, the dialysate concentration or prescription, how to learn about the machinery and the alarms, how to manage feeling cold during dialysis, and how to handle low blood pressure and muscle cramps during dialysis. The fact sheet is written in nontechnical language. The 'Keys to a Long Life' materials are based on the real life experiences and advice of long term dialysis patients, as well as on data from a telephone opinion survey of dialysis patients. 1 figure. 1 table. •

Just the Facts: Skin and Hair Problems on Dialysis Source: Madison, WI: Life Options Rehabilitation Program. 2000. [2 p.]. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This fact sheet offers information for patients on dialysis about skin and hair problems that they may encounter. Many people on dialysis have skin changes, primarily an increased tendency to bruise and dry, itching, or cracking skin. The fact sheet answers common questions related to skin and hair problems. Bruising can occur if the patient's dose of blood thinner (heparin) is too high, or if the blood level of platelets (clotting cells) is too low. Some drugs, such as prednisone or coumadin, can increase bruising. Itching has many causes, including high blood levels of phosphorus, not enough dialysis, dry skin, allergy to drugs or other products used at the dialysis center. Other skin problems can indicate porphyria, which needs to be treated by a skin specialist. Hair loss can be due to malnourishment, zinc deficiency, thyroid problems, or drug reactions. The reverse side of the fact sheet offers a chart that summarizes the problems under discussion, how each can be prevented, and recommended questions to ask the health care provider about each problem. The fact sheet includes the contact information for the Life Options Rehabilitation Program (800-468-7777, [email protected]).

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Just the Facts: Traveling on Dialysis Source: Madison, WI: Life Options Rehabilitation Program. 2000. [2 p.]. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This fact sheet offers tips for readers on dialysis who wish to incorporate travel into their lifestyle. The fact sheet reminds readers that it is important to change one's routines and see new places; travel can also play a role in helping people feel as if they are living a normal life. The fact sheet reviews the pre travel steps recommended for patients on hemodialysis as well as those on peritoneal dialysis (PD). The fact sheet describes the paper work that may be needed, reminds readers of the need to call ahead, and suggests that patients hand carry their home doctor's phone number, all their medicines, the log sheet from their last dialysis treatment, and any lab results that were not sent ahead. For patients on PD planning a short trip (one or two days), the fact sheet recommends simply packing supplies and going. For a longer visit, or travel including airplane travel, the PD nurse should be consulted. The second page of the fact sheet consists of a chart that summarizes potential problems, how to prevent them, and questions that readers should ask of the various facilities where they will be traveling.

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The fact sheet concludes with a listing of three information resources (including travel websites) for readers who wish additional assistance. 1 table. •

Renal Career Fact Sheet: Dialysis Technician Source: New York, NY: National Kidney Foundation, Inc. 1996. 2 p. Contact: Available from National Kidney Foundation. U.S. Materials Orders, 30 East 33rd Street, New York, NY 10016. (212) 889-2210. Fax (212) 689-9261. PRICE: $7.00 for 25 copies. Item number: 08-12. Summary: This fact sheet, one in a series that describes allied health personnel who work with kidney patients, discusses the role of the dialysis technician. Dialysis technicians function in multiple roles. In patient care roles, the technician's responsibilities include assisting, under supervision by a registered nurse, in the care of patients undergoing hemodialysis treatment. The fact sheet discusses qualifications and experience required, tasks and recordkeeping aspects of the job, the work setting, salary potential, and educational and training opportunities. Among other tasks, the technician assembles necessary supplies, prepares dialysate, assembles and prepares the dialysis equipment, obtains predialysis vital signs, initiates dialysis, monitors the patient and equipment, documents findings and actions, responds to emergencies, obtains and records postdialysis vital signs, communicates closely with the nursing supervisor, and maintains professional conduct, good communication skills, and confidentiality in the care of patients. The fact sheet concludes with a brief description of the National Kidney Foundation and its activities. (AA-M).

•

Aloha Dialysis Centers Welcomes You to Hawaii Source: Honolulu, HI: Intercontinental Medical Services, Inc. 199x. (information packet). Contact: Available from Aloha Dialysis Centers, Intercontinental Medical Services. Professional Plaza of the Pacific, 1520 Liliha Street, Suite 607, Honolulu, HI 96817. (808) 521-8061 or FAX (808) 531-7462. PRICE: Single copy free. Summary: This information packet provides information for people on hemodialysis who are considering travel to Hawaii. The bulk of the materials provided describe the care available at the facilities of Aloha Dialysis Centers. Fact sheets include information on the prerequisite medical information, financial obligations, vacation planning, commonly asked questions, and application forms. Additional brochures include the benefits of Aloha Dialysis Centers, a brochure introducing the staff of the Aloha Dialysis Centers, a nutrition guide to traditional Hawaiian foods, and several sample issues of a quarterly newsletter published for dialysis patients traveling to Hawaii.

•

Sources of Help for Dialysis and Transplant Patients Source: Bethesda, MD: Virgil Smirnow Associates, Inc. 1992. 22 p. Contact: Available from Virgil Smirnow Associates, Inc. Health and Public Affairs, 8501 Burdette Road, P.O. Box 34425, Bethesda, MD 20817. (301) 469-7933. PRICE: $1.50. Summary: This pamphlet describes various sources of help for people with end-stage renal disease (ESRD). Topics include how to locate a social worker; the role of the social worker; how to contact referral services; what kinds of information the patient can expect; the costs of ESRD treatment; how the financial stability of a family is affected by ESRD treatment; the role of Medicare; what Social Security disability benefits provide; the role of Medicaid; services provided through each state, through the Veterans

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Administration, and through county or city government agencies; how to obtain help for emotional problems; how to locate support groups of other dialysis and transplant patients; and what kinds of help are available from the American Kidney Fund, the American Red Cross, Homemaker Services, Meals-on-Wheels, the National Kidney Foundation, the Visiting Nurse Association, and CHAMPUS. •

Self-Care Dialysis at Home or in a Facility Source: Bethesda, MD: Virgil Smirnow Associates. 24 p. Contact: Available from Health Information Library. P.O. Box 55109, Lexington, KY 40555. (606) 299-8475. Fax (606) 299-8985. PRICE: $1.95 plus shipping and handling, prepaid, for 1-99 copies (as of 1996); discounts available for larger quantities. Summary: This pamphlet provides general information on self-care dialysis in a question and answer format. It discusses the appropriateness of home self-dialysis; training and supplies needed; the differences between self-care dialysis at home or in a facility; limited-care dialysis; costs; and motivational factors.

•

Getting the Most from Your Treatment: What You Need to Know About Peritoneal Dialysis Source: New York, NY: National Kidney Foundation. 1998. 31 p. Contact: Available from National Kidney Foundation (NKF). 30 East 33rd Street, New York, NY 10016. (212) 889-2210. (212) 686-8916. Website: www.kidney.org. PRICE: $0.50 each plus shipping and handling; bulk copies available. Summary: This patient education booklet informs readers about peritoneal dialysis (PD) and how patients can participate in making their PD treatment successful. The information in the booklet is based on the National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF DOQI), a program developed to help patients get the most from their treatments, feel better, and live longer. The booklet describes PD and how it relates to living with kidney failure. PD cleans wastes from the blood by using the patient's peritoneal membrane (the lining of the belly) as a natural filter. The authors guide readers in caring for themselves using PD, answer common questions about how PD works, describe the types of PD available (CAPD or continuous ambulatory peritoneal dialysis, CCPD or continuous cycling peritoneal dialysis, and NIPD or nighttime intermittent peritoneal dialysis), explain why it is important to get enough dialysis, explain why it is important to follow the prescribed dietary restrictions, tell about how anemia is treated, explain about preventing and treating bone disease, provide important facts about preventing heart problems, and stress the importance of patients taking an active role in their own health care. The booklet concludes with a checklist of points that summarize the concepts covered, a list of other sources of information, and a guide to understanding common laboratory test values, including Kt per V, creatinine clearance, albumin, hematocrit, hemoglobin, and blood pressure. The booklet is illustrated with simple line drawings. 7 figures. 2 tables.

•

Patient Diary Living with Dialysis: Now with a Section on Peritoneal Dialysis Source: Nutley, NJ: Roche Laboratories. 1993. 35 p. Contact: Available from Roche Laboratories. 340 Kingsland Street, Nutley, NJ 071101199. (201) 235-5000. PRICE: Single copy free. Distribution may be limited to health professionals.

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Summary: This patient education brochure provides a general introduction to the everyday details of living on dialysis. Written for the patient just starting on maintenance dialysis, the brochure covers topics including the anatomy and function of the kidneys; a definition of dialysis and how it works; possible reactions during dialysis; protecting oneself from bone disease, including preventive measures to take; the use of erythropoietin (EPO); daily medicine schedule; diet for the dialysis patient; adjusting to dialysis, including emotional, physical, financial, and social considerations; and peritoneal dialysis. The brochure includes a basic glossary of terms and space for health care providers to individualize information for each patient. The brochure is written in clear, easy-to-understand language. •

Managing the Cardiovascular Patient on Dialysis Source: McGaw Park, IL: Baxter Healthcare Corporation, Renal Division. 1995. 4 p. Contact: Available from Baxter Healthcare Corporation, Renal Division. 1620 Waukegan Road, McGaw Park, IL 60085. (800) 284-4060. PRICE: Single copy free. Summary: This physician fact sheet covers managing the cardiovascular patient on dialysis and choice of dialysis modality between continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD). Topics include the interaction between dialysis and the cardiovascular system; patients with left ventricular hypertrophy and considerations of prognosis, pathophysiology, HD effects, and CAPD effects; and dialysis choices for patients with coronary artery disease. The fact sheet includes reports from research studies in this area. The author concludes that nonaggressive CAPD is probably the method of choice in these two cardiac conditions, when compared with HD therapy of less than 4 hours duration. The fact sheet is printed on cardstock, with 3color charts. 4 figures. 12 references.

•

Managing the Diabetic Patient on Dialysis Source: McGaw Park, IL: Baxter Healthcare Corporation, Renal Division. 1995. 4 p. Contact: Available from Baxter Healthcare Corporation, Renal Division. 1620 Waukegan Road, McGaw Park, IL 60085. (800) 284-4060. PRICE: Single copy free. Summary: This physician fact sheet discusses managing the patient with diabetes on dialysis. Topics include the incidence of renal disease due to diabetes; therapeutic options for these patients; insulin administration; blood pressure control; preservation of residual renal function (RRF); determining whether hemodialysis (HD) or peritoneal dialysis (PD) is more appropriate for each patient; and the mortality rates for these patients. The fact sheet includes reports from research studies in this area. The author concludes that PD offers the patient with diabetes and end-stage renal disease (ESRD) advantages in terms of enhanced preservation of RRF, improved metabolic control through use of intraperitoneal insulin, and long-term antiatherogenic benefits from better blood pressure control. The fact sheet is printed on cardstock, with 3-color charts. 3 figures. 1 table. 16 references.

•

Protein and Calories Counter: A Reference for the Dialysis Patient Source: Tampa, FL: American Association of Kidney Patients (AAKP). 1998. 14 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. PRICE: $0.25 per copy.

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Summary: This pocket guide helps patients on dialysis keep track of their protein and caloric intake. The guide consists of an alphabetical list of foods and beverages, along with portion size, protein (in grams), and calories. After the main list, the guide lists food supplements (such as Ensure) and fast foods from restaurants including Burger King, Hardees, Kentucky Fried Chicken, McDonald's, Pizza Hut, Taco Bell, and Wendy's. A final section offers a Spanish language version of the main food list, with a focus on more culturally common foods (such as beans and plantains). The introductory material encourages patients to consult with their dietitian before restricting protein or calories, noting that the diet for dialysis is not necessarily low calorie and is not low protein. 1 reference. •

Medicare Coverage of Kidney Dialysis and Kidney Transplant Services: A Supplement to Your Medicare Handbook. Revised ed Source: Baltimore, MD: Health Care Financing Administration, U.S. Department of Health and Human Services. May 1996. 13 p. Contact: Available from Health Care Financing Administration Medicare hotline. (800) 638-6833. TTY (800) 820-1202. Also available on the World Wide Web at http://www.hcfa.gov/. PRICE: Single copy free. Summary: This supplement to 'Your Medicare Handbook' explains the special rules that apply to Medicare coverage and payment for maintenance kidney dialysis and transplant services. People who have end-stage renal disease (ESRD) can get these services. The supplement describes the two parts of Medicare (hospital insurance and medical insurance), enrollment in Medicare for people with permanent kidney failure, when Medicare protection begins and ends, and Medicare payment for beneficiaries covered by employer group health plans. Topics related to dialysis include providers of maintenance dialysis and transplant surgery; coverage and payment for outpatient and inpatient dialysis; doctor's services and maintenance dialysis; self-dialysis training; and home dialysis, including payment options, equipment, supplies, and support services. The booklet also discusses how both types of Medicare help to pay for kidney transplant surgery and how Medicare pays for blood. Topics briefly covered include what Medicare does not pay for, other payment sources, the grievance and complaint process, and sources of additional help and information. Contact information is given for the 18 ESRD Network Organizations.

•

Nonsurgical Treatment of Benign Prostatic Disease: News Briefings for Science Writers on Transplantation, Dialysis and Kidney Research (memorandum) Source: New York, NY: National Kidney Foundation, Inc. March 26-27, 1990. 7 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010 or (212) 889-2210. Summary: This technical paper prepared for the National Kidney Foundation's 1990 science writers news briefing on transplantation, dialysis, and kidney/urology research discusses benign prostatic hyperplasia (BPH), a benign condition of the prostate that develops in the aging male population. The benign enlargement of the prostate may block the free passage of urine. This paper reports on studies characterizing the physiology and pharmacology of the enlarged prostate. These studies have supported the rationale for using alpha adrenergic blockers for the treatment of urinary obstruction secondary to BPH. One research study evaluating the safety and efficacy of terazosin for the treatment of symptomatic BPH is discussed in detail. Directions for future research are also mentioned.

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Vascular Access for Hemodialysis Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2001. 4 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 014554. Summary: When the kidneys fail, harmful wastes build up in the body, the blood pressure may rise, and the body may retain excess fluid and not make enough red blood cells. When this happens, treatment is required to replace the work of the failed kidneys. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. This brochure helps readers recently diagnosed with kidney failure understand the vascular access that is required for hemodialysis. Topics include the need for establishing vascular access a few weeks or months before dialysis is started, the arteriovenous fistula, the synthetic tube graft, a catheter used for temporary access, what to expect during hemodialysis, and how to take care of the vascular access. The brochure concludes with the contact information for the National Kidney Foundation (www.kidney.org) and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 3 figures. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “dialysis” (or synonyms). The following was recently posted: •

Chronic kidney disease (non-dialysis) medical nutrition therapy protocol Source: American Dietetic Association - Professional Association; 2002 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3293&nbr=2519&a mp;string=dialysis

•

Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis Source: American Society of Nephrology - Professional Association; 2000 January; 124 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2195&nbr=1421&a mp;string=dialysis

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•

NKF-K/DOQI clinical practice guidelines for hemodialysis adequacy: update 2000 Source: National Kidney Foundation - Disease Specific Society; 1997 (updated 2000); 58 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2781&nbr=2007&a mp;string=dialysis

•

NKF-K/DOQI clinical practice guidelines for peritoneal dialysis adequacy: update 2000 Source: National Kidney Foundation - Disease Specific Society; 1997 (updated 2000); 72 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2782&nbr=2008&a mp;string=dialysis

•

Recommendations for preventing transmission of infections among chronic hemodialysis patients Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2001 April; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2789&nbr=2015&a mp;string=dialysis Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Anemia in Kidney Disease and Dialysis Summary: Describes when anemia begins, its diagnosis, treatment, and causes other than kidney disease. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6490

•

Dialysis Facility Compare Summary: Locate and compare dialysis services available in your area by looking at dialysis facility location, shifts that start or continue after 5 PM, adequacy of hemodialysis, anemia management and patient Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6015

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Dialysisfinder™ Summary: Dialysis patients can use this free online service to locate dialysis units near where they live, or in places to which they travel. Source: Commercial Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4129

•

Eat Right to Feel Right on Hemodialysis Summary: Describes the effects that food, fluids, potassium, phosphorous, protein, sodium, and calories have on patients undergoing hemodialysis. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6499

•

Hemodialysis Dose and Adequacy Summary: A resource for patients undergoing dialysis. Explains periodic tests and measurements such as the Kt/V and the URR. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6510

•

Kidney Failure: Choosing a Treatment That's Right for You Summary: Thorough description, with illustrations, of hemodialysis, peritoneal dialysis, kidney transplantation, and refusal of or withdrawal from treatment. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6518

•

Living Day-to-Day with Kidney Dialysis: Quality Improvements Continue for Devices and Clinics Summary: This online document reports on kidney dialysis equipment usage in the United States from the perspective of the patients, care givers and treatment centers/clinics. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2108

•

Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3191

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•

Peritoneal Dialysis Dose and Adequacy Summary: Describes the types of peritoneal dialysis, tests to determine efficiency, patient compliance with medical recommendations, and amounts of residual kidney function. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6523

•

Treatment Methods for Kidney Failure: Hemodialysis Summary: Describes how hemodialysis works, how people prepare for it, and the equipment and tests involved. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6540

•

Treatment Methods for Kidney Failure: Peritoneal Dialysis Summary: Describes how peritoneal dialysis works, how people prepare for it, and the equipment and tests involved. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6541

•

Vascular Access for Hemodialysis Summary: Explains how vascular access is created for hemodialysis, including arteriovenous fistulas, grafts, and catheters. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6547 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to dialysis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to dialysis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with dialysis. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about dialysis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “dialysis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received

386 Dialysis

your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “dialysis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “dialysis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “dialysis” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.24

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

24

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)25: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

25

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on dialysis: •

Basic Guidelines for Dialysis Dialysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003421.htm

•

Signs & Symptoms for Dialysis Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Hypotension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm

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•

Diagnostics and Tests for Dialysis Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm Heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm

•

Nutrition for Dialysis Vitamins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002399.htm

•

Surgery and Procedures for Dialysis Kidney transplant Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003005.htm

•

Background Topics for Dialysis Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Electrolyte Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm Fistula Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002365.htm Peripheral Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002273.htm Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm Toxins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002331.htm

Online Glossaries 395

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

397

DIALYSIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acid-Base Equilibrium: The balance between acids and bases in the blood plasma. Normally it results in a slightly alkaline state with an excess of hydroxyl ions in comparison to hydrogen. The balance is achieved by the offset of the ingestion and production of acidic and basic material by the amount of acidic and basic material metabolized and excreted by the body. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acrosin: A trypsin-like enzyme of spermatozoa which is not inhibited by alpha 1 antitrypsin. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acute tubular: A severe form of acute renal failure that develops in people with severe illnesses like infections or with low blood pressure. Patients may need dialysis. Kidney

398 Dialysis

function often improves if the underlying disease is successfully treated. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH]

Dictionary 399

Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Age-Adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Air Embolism: Occurs when the lungs over expand to the point that air bubbles are forced through the air sacs of the lungs into the circulatory system. [NIH] Air Sacs: Thin-walled sacs or spaces which function as a part of the respiratory system in birds, fishes, insects, and mammals. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU]

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Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Aldehydes: Organic compounds containing a carbonyl group in the form -CHO. [NIH] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allied Health Personnel: Health care workers specially trained and licensed to assist and support the work of health professionals. Often used synonymously with paramedical personnel, the term generally refers to all health care workers who perform tasks which must otherwise be performed by a physician or other health professional. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alpha-Amylase: An enzyme that catalyzes the endohydrolysis of 1,4-alpha-glycosidic linkages in starch, glycogen, and related polysaccharides and oligosaccharides containing 3 or more 1,4-alpha-linked D-glucose units. EC 3.2.1.1. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and

Dictionary 401

herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino-terminal: The end of a protein or polypeptide chain that contains a free amino group (-NH2). [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU]

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Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anecdotal report: An incomplete description of the medical and treatment history of one or more patients. Anecdotal reports may be published in places other than peer-reviewed, scientific journals. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH]

Dictionary 403

Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anisotropy: A physical property showing different values in relation to the direction in or along which the measurement is made. The physical property may be with regard to thermal or electric conductivity or light refraction. In crystallography, it describes crystals whose index of refraction varies with the direction of the incident light. It is also called acolotropy and colotropy. The opposite of anisotropy is isotropy wherein the same values characterize the object when measured along axes in all directions. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anterior Cerebral Artery: Artery formed by the bifurcation of the internal carotid artery. Branches of the anterior cerebral artery supply the caudate nucleus, internal capsule, putamen, septal nuclei, gyrus cinguli, and surfaces of the frontal lobe and parietal lobe. [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antiangiogenic: Having to do with reducing the growth of new blood vessels. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidote: A remedy for counteracting a poison. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte.

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Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Apheresis: Components plateletpheresis. [NIH]

being

separated

out,

as

leukapheresis,

plasmapheresis,

Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to

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which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arcuate Nucleus: A nucleus located in the middle hypothalamus in the most ventral part of the third ventricle near the entrance of the infundibular recess. Its small cells are in close contact with the ependyma. [NIH] Arginase: A ureahydrolase that catalyzes the hydrolysis of arginine or canavanine to yield L-ORNITHINE and urea. Deficiency of this enzyme causes hyperargininemia. EC 3.5.3.1. [NIH]

Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arterial embolization: The blocking of an artery by a clot of foreign material. This can be done as treatment to block the flow of blood to a tumor. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Artificial Pancreas: A large machine used in hospitals that constantly measures glucose (sugar) in the blood and, in response, releases the right amount of insulin. Scientists are also working to develop a small unit that could be implanted in the body, functioning like a real pancreas. [NIH]

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Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspartate: A synthetic amino acid. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Auscultation: Act of listening for sounds within the body. [NIH] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Autoclave: Apparatus using superheated steam under pressure. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is

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digested by the gastric juice. [NIH] Autogenic: A type of succession when the developing vegetation itself is the cause for the succession. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autoreceptors: Transmitter receptors on or near presynaptic terminals (or varicosities) which are sensitive to the transmitter(s) released by the terminal itself. Receptors for the hormones released by hormone-releasing cells are also included. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus

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and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Beta 2-Microglobulin: An 11 kDa protein associated with the outer membrane of many cells including lymphocytes. It is the small subunit of the MHC class I molecule. Association with beta 2-microglobulin is generally required for the transport of class I heavy chains from the endoplasmic reticulum to the cell surface. Beta 2-microglobulin is present in small amounts in serum, csf, and urine of normal people, and to a much greater degree in the urine and plasma of patients with tubular proteinemia, renal failure, or kidney transplants. [NIH] Beta Rays: A stream of positive or negative electrons ejected with high energy from a disintegrating atomic nucleus; most biomedically used isotopes emit negative particles (electrons or negatrons, rather than positrons). Cathode rays are low-energy negative electrons produced in cathode ray tubes, also called television tubes or oscilloscopes. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bicarbonates: Inorganic salts that contain the -HCO3 radical. They are an important factor in determining the pH of the blood and the concentration of bicarbonate ions is regulated by the kidney. Levels in the blood are an index of the alkali reserve or buffering capacity. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological

Dictionary 409

problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Bioluminescence: The emission of light by living organisms such as the firefly, certain mollusks, beetles, fish, bacteria, fungi and protozoa. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level

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increases. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blood-Borne Pathogens: Infectious organisms in the blood, of which the predominant medical interest is their contamination of blood-soiled linens, towels, gowns, bandages, other items from individuals in risk categories, needles and other sharp objects, and medical and dental waste, all of which health workers are exposed to. This concept is differentiated from the clinical conditions of bacteremia, viremia, and fungemia where the organism is present in the blood of a patient as the result of a natural infectious process. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Body Weight Changes: A clinical manifestation consisting of alterations in an individual's weight from his or her norm. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Cements: Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or

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within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast Implants: Implants used to reconstruct and/or cosmetically enhance the female breast. They have an outer shell or envelope of silicone elastomer and are filled with either saline or silicone gel. The outer shell may be either smooth or textured. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchial: Pertaining to one or more bronchi. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bupivacaine: A widely used local anesthetic agent. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cacao: A tree of the family Sterculiaceae (or Byttneriaceae), usually Theobroma cacao, or its seeds, which after fermentation and roasting, yield cocoa and chocolate. [NIH] Cadaver: A dead body, usually a human body. [NIH] Calcifediol: The major circulating metabolite of vitamin D3 produced in the liver and the best indicator of the body's vitamin D stores. It is effective in the treatment of rickets and osteomalacia, both in azotemic and non-azotemic patients. Calcifediol also has mineralizing properties. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcinosis: Pathologic deposition of calcium salts in tissues. [NIH] Calcitriol: The physiologically active form of vitamin D. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Chloride: A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning. [NIH]

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Calcium Oxalate: The calcium salt of oxalic acid, occurring in the urine as crystals and in certain calculi. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Camptothecin: An alkaloid isolated from the stem wood of the Chinese tree, Camptotheca acuminata. This compound selectively inhibits the nuclear enzyme DNA topoisomerase. Several semisynthetic analogs of camptothecin have demonstrated antitumor activity. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Canonical: A particular nucleotide sequence in which each position represents the base more often found when many actual sequences of a given class of genetic elements are compared. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capital Expenditures: Those funds disbursed for facilities and equipment, particularly those related to the delivery of health care. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsid: The outer protein protective shell of a virus, which protects the viral nucleic acid. [NIH]

Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotid Body: A small cluster of chemoreceptive and supporting cells located near the bifurcation of the internal carotid artery. The carotid body, which is richly supplied with fenestrated capillaries, senses the pH, carbon dioxide, and oxygen concentrations in the blood and plays a crucial role in their homeostatic control. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catalyse: To speed up a chemical reaction. [EU] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Caudate Nucleus: Elongated gray mass of the neostriatum located adjacent to the lateral ventricle of the brain. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH]

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Ceftazidime: Semisynthetic, broad-spectrum antibacterial derived from cephaloridine and used especially for Pseudomonas and other gram-negative infections in debilitated patients. [NIH]

Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Adhesion Molecules: Surface ligands, usually glycoproteins, that mediate cell-to-cell adhesion. Their functions include the assembly and interconnection of various vertebrate systems, as well as maintenance of tissue integration, wound healing, morphogenic movements, cellular migrations, and metastasis. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH]

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Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cephaloridine: A cephalosporin antibiotic. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Chlorides: Inorganic compounds derived from hydrochloric acid that contain the Cl- ion. [NIH]

Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH]

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Chromatography, Ion Exchange: Separation technique in which the stationary phase consists of ion exchange resins. The resins contain loosely held small ions that easily exchange places with other small ions of like charge present in solutions washed over the resins. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Chymotrypsin: A serine endopeptidase secreted by the pancreas as its zymogen, chymotrypsinogen and carried in the pancreatic juice to the duodenum where it is activated by trypsin. It selectively cleaves aromatic amino acids on the carboxyl side. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citric Acid: A key intermediate in metabolism. It is an acid compound found in citrus fruits. The salts of citric acid (citrates) can be used as anticoagulants due to their calcium chelating ability. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clavicle: A long bone of the shoulder girdle. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Cleave: A double-stranded cut in DNA with a restriction endonuclease. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH]

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Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]

Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Coculture: The culturing of normal cells or tissues with infected or latently infected cells or tissues of the same kind (From Dorland, 28th ed, entry for cocultivation). It also includes culturing of normal cells or tissues with other normal cells or tissues. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU]

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Colloidal: Of the nature of a colloid. [EU] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complement Activation: The sequential activation of serum components C1 through C9, initiated by an erythrocyte-antibody complex or by microbial polysaccharides and properdin, and producing an inflammatory response. [NIH] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up

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secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: Use of agents, devices, methods, or procedures which diminish the

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likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]

Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneal Ulcer: Loss of epithelial tissue from the surface of the cornea due to progressive erosion and necrosis of the tissue; usually caused by bacterial, fungal, or viral infection. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corrosion: Irreversible destruction of skin tissue. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in

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the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Cross Infection: Any infection which a patient contracts in a healthcare institution. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryoglobulinemia: A condition characterized by the presence of abnormal or abnormal quantities of cryoglobulins in the blood. They are precipitated into the microvasculature on exposure to cold and cause restricted blood flow in exposed areas. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] CSF: Cerebrospinal fluid. The fluid flowing around the brain and spinal cord. CSF is produced in the ventricles of the brain. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Custodial Care: Board, room, and other personal assistance services generally provided on a long term basis. It excludes regular medical care. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclodextrins: A homologous group of cyclic glucans consisting of alpha-1,4 bound glucose units obtained by the action of cyclodextrin glucanotransferase on starch or similar substrates. The enzyme is produced by certain species of Bacillus. Cyclodextrins form inclusion complexes with a wide variety of substances. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cystathionine beta-Synthase: A multifunctional pyridoxal phosphate enzyme. In the second stage of cysteine biosynthesis it catalyzes the reaction of homocysteine with serine to form cystathionine with the elimination of water. Deficiency of this enzyme leads to

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hyperhomocysteinemia and homocystinuria. EC 4.2.1.22. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH]

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Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Waste: Any waste product generated by a dental office, surgery, clinic, or laboratory including amalgams, saliva, and rinse water. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU]

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Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Dialysis Solutions: Solutions prepared for exchange across a semipermeable membrane of solutes below a molecular size determined by the cutoff threshold of the membrane material. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the

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alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietetics: The study and regulation of the diet. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilate: Relax; expand. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Dimerization: The process by which two molecules of the same chemical composition form a condensation product or polymer. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Dipyridamole: A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a

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molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier, route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dwell time: In peritoneal dialysis, the amount of time a bag of dialysate remains in the patient's abdominal cavity during an exchange. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH]

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Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elastomers: A generic term for all substances having the properties of natural, reclaimed, vulcanized, or synthetic rubber, in that they stretch under tension, have a high tensile strength, retract rapidly, and recover their original dimensions fully. [NIH] Elbow Joint: A hinge joint connecting the forearm to the arm. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electric Conductivity: The ability of a substrate to allow the passage of electrons. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their

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functional activity. [EU] Electroporation: A technique in which electric pulses of intensity in kilovolts per centimeter and of microsecond-to-millisecond duration cause a temporary loss of the semipermeability of cell membranes, thus leading to ion leakage, escape of metabolites, and increased uptake by cells of drugs, molecular probes, and DNA. Some applications of electroporation include introduction of plasmids or foreign DNA into living cells for transfection, fusion of cells to prepare hybridomas, and insertion of proteins into cell membranes. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embolectomy: Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called thrombectomy. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into

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the circulation and which influence metabolism and other body functions. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Enteropeptidase: A specialized proteolytic enzyme secreted by intestinal cells. It converts trypsinogen into its active form trypsin by removing the N-terminal peptide. EC 3.4.21.9. [NIH]

Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Environmental Pollutants: Substances which pollute the environment. Use environmental pollutants in general or for which there is no specific heading. [NIH]

for

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a

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slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Ependyma: A thin membrane that lines the ventricles of the brain and the central canal of the spinal cord. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithalamus: The dorsal posterior subdivision of the diencephalon. The epithalamus is generally considered to include the habenular nuclei (habenula) and associated fiber bundles, the pineal body, and the epithelial roof of the third ventricle. The anterior and posterior paraventricular nuclei of the thalamus are included with the thalamic nuclei although they develop from the same pronuclear mass as the epithalamic nuclei and are sometimes considered part of the epithalamus. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epoetin alfa: A colony-stimulating factor that is made in the laboratory. It increases the production of red blood cells. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

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Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethanolamine: A viscous, hygroscopic amino alcohol with an ammoniacal odor. It is widely distributed in biological tissue and is a component of lecithin. It is used as a surfactant, fluorimetric reagent, and to remove CO2 and H2S from natural gas and other gases. [NIH] Ethidium: A trypanocidal agent and possible antiviral agent that is widely used in experimental cell biology and biochemistry. Ethidium has several experimentally useful properties including binding to nucleic acids, noncompetitive inhibition of nicotinic acetylcholine receptors, and fluorescence among others. It is most commonly used as the bromide. [NIH] Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excrete: To get rid of waste from the body. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH]

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Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extrarenal: Outside of the kidney. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH]

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Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectins: Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fish Products: Food products manufactured from fish (e.g., fish flour, fish meal). [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flank Pain: Pain emanating from below the ribs and above the ilium. [NIH]

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Flatus: Gas passed through the rectum. [NIH] Fleroxacin: A third-generation fluoroquinolone derivative with a broad antimicrobial spectrum. The drug strongly inhibits the DNA-supercoiling activity of DNA gyrase which may account for its antibacterial activity. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Flurazepam: A benzodiazepine derivative used mainly as a hypnotic. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Foam Cells: Lipid-laden macrophages originating from monocytes or from smooth muscle cells. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Food Exchange: See: Exchange lists. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fosinopril: A phosphinic acid-containing angiotensin-converting enzyme inhibitor that is effective in the treatment of hypertension. It is a prodrug that is converted to its active metabolite fosinoprilat. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Free Radical Scavengers: Substances that influence the course of a chemical reaction by ready combination with free radicals. Among other effects, this combining activity protects pancreatic islets against damage by cytokines and prevents myocardial and pulmonary perfusion injuries. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Fungemia: The presence of fungi circulating in the blood. Opportunistic fungal sepsis is seen most often in immunosuppressed patients with severe neutropenia or in postoperative patients with intravenous catheters and usually follows prolonged antibiotic therapy. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to

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those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallium: A rare, metallic element designated by the symbol, Ga, atomic number 31, and atomic weight 69.72. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base

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sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Germ-free: Free of bacteria, disease-causing viruses, and other organisms that can cause infection. [NIH] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glioma: A cancer of the brain that comes from glial, or supportive, cells. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glomerulosclerosis: Scarring of the glomeruli. It may result from diabetes mellitus (diabetic glomerulosclerosis) or from deposits in parts of the glomerulus (focal segmental glomerulosclerosis). The most common signs of glomerulosclerosis are proteinuria and kidney failure. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucans: Polysaccharides composed of repeating glucose units. They can consist of branched or unbranched chains in any linkages. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

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Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]

Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH]

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Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Graft Survival: The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Gram-Positive Bacteria: Bacteria which retain the crystal violet stain when treated by Gram's method. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Growth Plate: The area between the epiphysis and the diaphysis within which bone growth occurs. [NIH] Guanidine: A strong organic base existing primarily as guanidium ions at physiological pH. It is found in the urine as a normal product of protein metabolism. It is also used in laboratory research as a protein denaturant. (From Martindale, the Extra Pharmacopoeia, 30th ed and Merck Index, 12th ed) It is also used in the treatment of myasthenia and as a fluorescent probe in HPLC. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gyrase: An enzyme that causes negative supercoiling of E. coli DNA during replication. [NIH]

Gyrus Cinguli: One of the convolutions on the medial surface of the cerebral hemisphere. It surrounds the rostral part of the brain and interhemispheric commissure and forms part of the limbic system. [NIH] Habitat: An area considered in terms of its environment, particularly as this determines the type and quality of the vegetation the area can carry. [NIH] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a

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haemodialyzer. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematuria: Presence of blood in the urine. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have

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failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodialyzer: Apparatus for hemodialysis performing the functions of human kidneys in place of the damaged organs; highly specialized medical equipment used for treating kidney failure by passing the body's toxic substances through an external artificial kidney. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemoperfusion: Removal of toxins or metabolites from the circulation by the passing of blood, within a suitable extracorporeal circuit, over semipermeable microcapsules containing adsorbents (e.g., activated charcoal) or enzymes, other enzyme preparations (e.g., gel-entrapped microsomes, membrane-free enzymes bound to artificial carriers), or other adsorbents (e.g., various resins, albumin-conjugated agarose). [NIH] Hemoperitoneum: Hemorrhage into the peritoneal cavity. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood

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clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatitis Viruses: Any of the viruses that cause inflammation of the liver. They include both DNA and RNA viruses as well viruses from humans and animals. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hetastarch: A derivative of starch used as a plasma substitute in the treatment of hemorrhage. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hip Fractures: Fractures of the femur head, the femur neck, the trochanters, or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region. For the fractures of the femur neck the specific term femoral neck fractures is available. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Holidays: Days commemorating events. Holidays also include vacation periods. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin

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help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Housekeeping: The care and management of property. [NIH] Human growth hormone: A protein hormone, secreted by the anterior lobe of the pituitary, which promotes growth of the whole body by stimulating protein synthesis. The human gene has already been cloned and successfully expressed in bacteria. [NIH] Human Rights: The rights of the individual to cultural, social, economic, and educational opportunities as provided by society, e.g., right to work, right to education, and right to social security. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydration: Combining with water. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrofluoric Acid: A solution of hydrogen fluoride in water. It is a colorless fuming liquid which can cause painful burns. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU]

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Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine betasynthase and is a risk factor for coronary vascular disease. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperlipoproteinemia: Metabolic disease characterized by elevated plasma cholesterol and/or triglyceride levels. The inherited form is attributed to a single gene mechanism. [NIH] Hyperoxia: An abnormal increase in the amount of oxygen in the tissues and organs. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hyperpnea: Increased ventilation in proportion to increased metabolism. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertension, Renal: Hypertension due to renal diseases, especially chronic parenchymal disease. Hypertension as a result of compression or obstruction of the renal artery or its branches is hypertension, renovascular. [NIH] Hypertension, Renovascular: Hypertension due to compression or obstruction of the renal artery or its branches. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic

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chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoventilation: A reduction in the amount of air entering the pulmonary alveoli. [NIH] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Ibotenic Acid: Neurotoxic isoxazole substance found in Amanita muscaria and A. pantherina. It causes motor depression, ataxia, and changes in mood, perceptions and feelings, and is a potent excitatory amino acid agonist. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileum: The lower end of the small intestine. [NIH] Imaging procedures: Methods of producing pictures of areas inside the body. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune Adherence Reaction: A method for the detection of very small quantities of antibody in which the antigen-antibody-complement complex adheres to indicator cells, usually primate erythrocytes or nonprimate blood platelets. The reaction is dependent on the number of bound C3 molecules on the C3b receptor sites of the indicator cell. [NIH] Immune Complex Diseases: Group of diseases mediated by the deposition of large soluble complexes of antigen and antibody with resultant damage to tissue. Besides serum sickness and the arthus reaction, evidence supports a pathogenic role for immune complexes in many other systemic immunologic diseases including glomerulonephritis, systemic lupus erythematosus and polyarteritis nodosa. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience

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with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive Agents: Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of suppressor T-cell populations or by inhibiting the activation of helper cells. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of interleukins and other cytokines are emerging. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues

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caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Information Systems: Integrated set of files, procedures, and equipment for the storage, manipulation, and retrieval of information. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] In-line: A sexually-reproducing population derived from a common parentage. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Instillation: . [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

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Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interneurons: Most generally any neurons which are not motor or sensory. Interneurons may also refer to neurons whose axons remain within a particular brain region as contrasted with projection neurons which have axons projecting to other brain regions. [NIH] Interpersonal Relations: The reciprocal interaction of two or more persons. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intramuscular: IM. Within or into muscle. [NIH]

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Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intraperitoneal chemotherapy: Treatment in which anticancer drugs are put directly into the abdominal cavity through a thin tube. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Invertebrates: Animals that have no spinal column. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ion Exchange Resins: High molecular weight, insoluble polymers which contain functional groups that are capable of undergoing exchange reactions (ion exchange) with either cations or anions. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Isopropyl: A gene mutation inducer. [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU]

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Isotope Labeling: Techniques for labeling a substance with a stable or radioactive isotope. It is not used for articles involving labeled substances unless the methods of labeling are substantively discussed. Tracers that may be labeled include chemical substances, cells, or microorganisms. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kallikreins: Proteolytic enzymes from the serine endopeptidase family found in normal blood and urine. Specifically, Kallikreins are potent vasodilators and hypotensives and increases vascular permeability and affects smooth muscle. They act as infertility agents in men. Three forms are recognized, plasma kallikrein (EC 3.4.21.34), tissue kallikrein (EC 3.4.21.35), and prostate-specific antigen (EC 3.4.21.77). [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lacrimal: Pertaining to the tears. [EU] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH]

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Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocyte Count: A count of the number of white blood cells per unit volume in venous blood. A differential leukocyte count measures the relative numbers of the different types of white cells. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukoencephalopathy: A condition with spongy holes in the brain's white matter. [NIH] Levofloxacin: A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a

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linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Bilayers: Layers of lipid molecules which are two molecules thick. Bilayer systems are frequently studied as models of biological membranes. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoprotein Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. The enzyme hydrolyzes triacylglycerols in chylomicrons, very-low-density lipoproteins, low-density lipoproteins, and diacylglycerols. It occurs on capillary endothelial surfaces, especially in mammary, muscle, and adipose tissue. Genetic deficiency of the enzyme causes familial hyperlipoproteinemia Type I. (Dorland, 27th ed) EC 3.1.1.34. [NIH] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Local therapy: Treatment that affects cells in the tumor and the area close to it. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lod: The lowest analyte content which, if actually present, will be detected with reasonable statistical certainty and can be identified according to the identification criteria of the method. If both accuracy and precision are constant over a concentration range. [NIH] Lod Score: The total relative probability, expressed on a logarithmic scale, that a linkage relationship exists among selected loci. Lod is an acronym for "logarithmic odds." [NIH]

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Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lovastatin: A fungal metabolite isolated from cultures of Aspergillus terreus. The compound is a potent anticholesteremic agent. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It also stimulates the production of low-density lipoprotein receptors in the liver. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Luminescence: The property of giving off light without emitting a corresponding degree of heat. It includes the luminescence of inorganic matter or the bioluminescence of human matter, invertebrates and other living organisms. For the luminescence of bacteria, bacterial luminescence is available. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH]

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Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as health maintenance organizations and preferred provider organizations. [NIH] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU]

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Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Mefloquine: A phospholipid-interacting antimalarial drug (antimalarials). It is very effective against Plasmodium falciparum with very few side effects. [NIH] Megakaryocytes: Very large bone marrow cells which release mature blood platelets. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Fusion: The adherence of cell membranes, intracellular membranes, or artifical membrane models of either to each other or to viruses, parasites, or interstitial particles through a variety of chemical and physical processes. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH]

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Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesencephalic: Ipsilateral oculomotor paralysis and contralateral tremor, spasm. or choreic movements of the face and limbs. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Mesothelial: It lines the peritonealla and pleural cavities. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methamphetamine: A central nervous system stimulant and sympathomimetic with actions and uses similar to dextroamphetamine. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Mice Minute Virus: The type species of parvovirus prevalent in mouse colonies and found as a contaminant of many transplanted tumors or leukemias. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable

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membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microsome: One of the specific metabolic pathways of the liver. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Midodrine: An ethanolamine derivative that is an adrenergic alpha agonist. It is used as a vasoconstrictor agent in the treatment of hypotension. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Probes: A group of atoms or molecules attached to other molecules or cellular structures and used in studying the properties of these molecules and structures. Radioactive DNA or RNA sequences are used in molecular genetics to detect the presence of a complementary sequence by molecular hybridization. [NIH] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration,

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pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple Myeloma: A malignant tumor of plasma cells usually arising in the bone marrow; characterized by diffuse involvement of the skeletal system, hyperglobulinemia, Bence-Jones proteinuria, and anemia. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [NIH] Muscimol: Neurotoxic isoxazole isolated from Amanita muscaria and A. phalloides and also obtained by decarboxylation of ibotenic acid. It is a potent agonist at GABA-A receptors and is used mainly as an experimental tool in animal and tissue studies. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the

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function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Natural Disasters: Sudden calamitous events producing great material damage, loss, and distress. They are the result of natural phenomena such as earthquakes, floods, etc. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the

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adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephrologist: A doctor who treats patients with kidney problems or hypertension. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropsychology: A branch of psychology which investigates the correlation between experience or behavior and the basic neurophysiological processes. The term neuropsychology stresses the dominant role of the nervous system. It is a more narrowly defined field than physiological psychology or psychophysiology. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurosurgical Procedures: Surgery performed on the nervous system or its parts. [NIH] Neurotensin: A biologically active tridecapeptide isolated from the hypothalamus. It has been shown to induce hypotension in the rat, to stimulate contraction of guinea pig ileum and rat uterus, and to cause relaxation of rat duodenum. There is also evidence that it acts as

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both a peripheral and a central nervous system neurotransmitter. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Nickel: A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Pore: An opening through the nuclear envelope formed by the nuclear pore complex which transports nuclear proteins or RNA into or out of the cell nucleus and which,

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under some conditions, acts as an ion channel. [NIH] Nuclear Proteins: Proteins found in the nucleus of a cell. Do not confuse with nucleoproteins which are proteins conjugated with nucleic acids, that are not necessarily present in the nucleus. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleocapsid: A protein-nucleic acid complex which forms part or all of a virion. It consists of a capsid plus enclosed nucleic acid. Depending on the virus, the nucleocapsid may correspond to a naked core or be surrounded by a membranous envelope. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus Accumbens: Collection of pleomorphic cells in the caudal part of the anterior horn of the lateral ventricle, in the region of the olfactory tubercle, lying between the head of the caudate nucleus and the anterior perforated substance. It is part of the so-called ventral striatum, a composite structure considered part of the basal ganglia. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Olfaction: Function of the olfactory apparatus to perceive and discriminate between the molecules that reach it, in gas form from an external environment, directly or indirectly via the nose. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH]

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Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organ Procurement: The administrative procedures involved with acquiring organs for transplantation through various programs, systems, or organizations. It includes obtaining consent and arranging for transportation of donor organs, after tissue harvesting, to the hospital for processing and transplant. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osmotic Fragility: Red blood cell sensitivity to change in osmotic pressure. When exposed to a hypotonic concentration of sodium in a solution, red cells take in more water, swell until the capacity of the cell membrane is exceeded, and burst. [NIH] Osteitis Fibrosa Cystica: A fibrous degeneration, cyst formation, and the presence of fibrous nodules in bone, usually due to hyperparathyroidism. [NIH]

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Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteodystrophy: Defective bone formation. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxalate: A chemical that combines with calcium in urine to form the most common type of kidney stone (calcium oxalate stone). [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [NIH]

Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the

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outlines of organs. [NIH] Panacea: A cure-all. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreas Transplant: A surgical procedure that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. The healthy pancreas comes from a donor who has just died or from a living relative. A person can donate half a pancreas and still live normally. [NIH] Pancreas Transplantation: The transference of a pancreas from one human or animal to another. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct exposure. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parathyroidectomy: Excision of one or both of the parathyroid glands. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the

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parietal bone, as the parietal lobe. [EU] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Particle: A tiny mass of material. [EU] Parvovirus: A genus of the family Parvoviridae, subfamily Parvovirinae, infecting a variety of vertebrates including humans. Parvoviruses are responsible for a number of important diseases but also can be non-pathogenic in certain hosts. The type species is mice minute virus. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Isolation: The segregation of patients with communicable or other diseases for a specified time. Isolation may be strict, in which movement and social contacts are limited; modified, where an effort to control specified aspects of care is made in order to prevent cross infection; or reverse, where the patient is secluded in a controlled or germ-free environment in order to protect him or her from cross infection. [NIH] Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pediatric Nursing: The nursing care of children from birth to adolescence. It includes the clinical and psychological aspects of nursing care. [NIH] Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pentosephosphate Pathway: A pathway of hexose oxidation in which glucose-6-phosphate undergoes two successive oxidations by NADP, the final one being an oxidative

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decarboxylation to form a pentose phosphate. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perennial: Lasting through the year of for several years. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericarditis: Inflammation of the pericardium. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peripheral vision: Side vision; ability to see objects and movement outside of the direct line of vision. [NIH]

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Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneal Dialysis, Continuous Ambulatory: Portable peritoneal dialysis using the continuous (24 hours a day, 7 days a week) presence of peritoneal dialysis solution in the peritoneal cavity except for periods of drainage and instillation of fresh solution. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Perivascular: Situated around a vessel. [EU] Peroxidase: A hemeprotein from leukocytes. Deficiency of this enzyme leads to a hereditary disorder coupled with disseminated moniliasis. It catalyzes the conversion of a donor and peroxide to an oxidized donor and water. EC 1.11.1.7. [NIH] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory GABA subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions

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between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phlebotomy: The letting of blood from a vein. Although it is one of the techniques used in drawing blood to be used in diagnostic procedures, in modern medicine, it is used commonly in the treatment of erythrocytosis, hemochromocytosis, polycythemia vera, and porphyria cutanea tarda. Its historical counterpart is bloodletting. (From Cecil Textbook of Medicine, 19th ed & Wintrobe's Clinical Hematology, 9th ed) Venipuncture is not only for the letting of blood from a vein but also for the injecting of a drug into the vein for diagnostic analysis. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phosphates: Inorganic salts of phosphoric acid. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorous: Having to do with or containing the element phosphorus. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of

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skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma Exchange: Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (PPF), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. [NIH] Plasma Kallikrein: A peptidohydrolytic enzyme that is formed from prekallikrein by factor XIIA. It activates factor XII, factor VII, and plasminogen. It is selective for both arginine and to a lesser extent lysinebonds. EC 3.4.21.34. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH]

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Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelet-Derived Growth Factor: Mitogenic peptide growth hormone carried in the alphagranules of platelets. It is released when platelets adhere to traumatized tissues. Connective tissue cells near the traumatized region respond by initiating the process of replication. [NIH] Plateletpheresis: The preparation of platelet concentrates with the return of red cells and platelet-poor plasma to the donor. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleomorphic: Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells or their nuclei. [NIH] Plethysmograph: An instrument for measuring swelling or expansion of the body or part of it, such as a limb or digit, commonly used for the indirect measurement of blood flow or other displacement of internal fluids. [NIH] Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Point System: A way to plan meals that uses points to rate food. The foods are placed in four classes: calories, carbohydrates, proteins, and fats. Each food is given a point value within its class. A person with a planned diet for the day can choose foods in the same class that have the same point values for meals and snacks. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working

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kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Kidney Diseases: Diseases that are characterized by the progressive expansion of a large number of tightly packed cysts within the kidney. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Polyurethanes: A group of thermoplastic or thermosetting polymers containing polyisocyanate. They are used as elastomers, as coatings, as fibers and as foams. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Pontine: A brain region involved in the detection and processing of taste. [NIH] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Porosity: Condition of having pores or open spaces. This often refers to bones, bone implants, or bone cements, but can refer to the porous state of any solid substance. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be

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infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prealbumin: A tetrameric protein, molecular weight between 50,000 and 70,000, consisting of 4 equal chains, and migrating on electrophoresis in 3 fractions more mobile than serum albumin. Its concentration ranges from 7 to 33 per cent in the serum, but levels decrease in liver disease. [NIH] Preceptorship: Practical experience in medical and health-related services that occurs as part of an educational program wherein the professionally-trained student works outside the academic environment under the supervision of an established professional in the particular field. [NIH] Precipitation: The act or process of precipitating. [EU] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Preferred Provider Organizations: Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients. [NIH]

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Prefrontal Cortex: The rostral part of the frontal lobe, bounded by the inferior precentral fissure in humans, which receives projection fibers from the mediodorsal nucleus of the thalamus. The prefrontal cortex receives afferent fibers from numerous structures of the diencephalon, mesencephalon, and limbic system as well as cortical afferents of visual, auditory, and somatic origin. [NIH] Preload: The tension in the heart muscle at the end of diastole (before the contraction). [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Professional Practice: The use of one's knowledge in a particular profession. It includes, in the case of the field of biomedicine, professional activities related to health care and the actual performance of the duties related to the provision of health care. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Promyelocytic leukemia: A type of acute myeloid leukemia, a quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. [NIH]

Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all

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free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate-Specific Antigen: Kallikrein-like serine proteinase produced by epithelial cells of both benign and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. EC 3.4.21.77. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [NIH] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protein Transport: The process of moving proteins from one cellular compartment (including extracellular) to another by various sorting and transport mechanisms such as gated transport, protein translocation, and vesicular transport. [NIH] Protein-Energy Malnutrition: The lack of sufficient energy or protein to meet the body's metabolic demands, as a result of either an inadequate dietary intake of protein, intake of poor quality dietary protein, increased demands due to disease, or increased nutrient losses. [NIH]

Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other

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aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychological Theory: Principles applied to the analysis and explanation of psychological or behavioral phenomena. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH]

Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotomimetic: Psychosis miming. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of

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literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Alveoli: Small polyhedral outpouchings along the walls of the alveolar sacs, alveolar ducts and terminal bronchioles through the walls of which gas exchange between alveolar air and pulmonary capillary blood takes place. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Pyramidal Cells: Projection neurons in the cerebral cortex and the hippocampus. Pyramidal cells have a pyramid-shaped soma with the apex and an apical dendrite pointed toward the pial surface and other dendrites and an axon emerging from the base. The axons may have local collaterals but also project outside their cortical region. [NIH] Pyridoxal: 3-Hydroxy-5-(hydroxymethyl)-2-methyl-4- pyridinecarboxaldehyde. [NIH] Pyrogenic: Inducing fever. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Quinpirole: A dopamine D2/D3 receptor agonist. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a

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machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Raphe Nuclei: Collections of small neurons centrally scattered among many fibers from the level of the trochlear nucleus in the midbrain to the hypoglossal area in the medulla oblongata. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of

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diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Reconstitution: 1. A type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. The restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Rehabilitation, Vocational: Training of the mentally or physically disabled in work skills so they may be returned to regular employment utilizing these skills. [NIH] Rehabilitative: Instruction of incapacitated individuals or of those affected with some

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mental disorder, so that some or all of their lost ability may be regained. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal Osteodystrophy: Decalcification of bone due to hyperparathyroidism secondary to chronic kidney disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renal Replacement Therapy: Procedures which temporarily or permanently remedy insufficient cleansing of body fluids by the kidneys. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any

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of its parts. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Reticular: Coarse-fibered, netlike dermis layer. [NIH] Reticular Formation: A region extending from the pons & medulla oblongata through the mesencephalon, characterized by a diversity of neurons of various sizes and shapes, arranged in different aggregations and enmeshed in a complicated fiber network. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH]

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Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salpingectomy: Excision if a uterine tube. [NIH] Salvage Therapy: A therapeutic approach, involving chemotherapy, radiation therapy, or surgery, after initial regimens have failed to lead to improvement in a patient's condition. Salvage therapy is most often used for neoplastic diseases. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Seafood: Marine fish and shellfish used as food or suitable for food. (Webster, 3d ed) shellfish and fish products are more specific types of seafood. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter.

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They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Selenomethionine: Diagnostic aid in pancreas function determination. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septal Nuclei: Neural nuclei situated in the septal region. They have afferent and cholinergic efferent connections with a variety of forebrain and brainstem areas including the hippocampus, the lateral hypothalamus, the tegmentum, and the amygdala. Included are the dorsal, lateral, medial, and triangular septal nuclei, septofimbrial nucleus, nucleus of diagonal band, nucleus of anterior commissure, and the nucleus of stria terminalis. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU]

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Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shivering: Involuntary contraction or twitching of the muscles. It is a physiologic method of heat production in man and other mammals. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Sick Role: Behavior patterns consistent with those expected of an individual functioning in a state of ill health. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH]

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Simvastatin: A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL-cholesterol (lipoproteins, LDL cholesterol). [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Bicarbonate: A white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH]

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Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Space Flight: Travel beyond the earth's atmosphere. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Spectrophotometry: The art or process of comparing photometrically the relative intensities of the light in different parts of the spectrum. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Stabilization: The creation of a stable state. [EU]

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Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steady state: Dynamic equilibrium. [EU] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Stereotactic: Radiotherapy that treats brain tumors by using a special frame affixed directly to the patient's cranium. By aiming the X-ray source with respect to the rigid frame, technicians can position the beam extremely precisely during each treatment. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stethoscopes: An instrument used for the detection and study of sounds within the body that conveyed to the ears of the observer through rubber tubing. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH]

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Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Striatum: A higher brain's domain thus called because of its stripes. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroke Volume: The amount of blood pumped out of the heart per beat not to be confused with cardiac output (volume/time). [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclavian Vein: The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subcutaneous port: A tube surgically placed into a blood vessel and attached to a disk placed under the skin. It is used for the administration of intravenous fluids and drugs; it can also be used to obtain blood samples. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Subtrochanteric: Below a trochanter. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S,

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atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU]

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Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Technetium: The first artificially produced element and a radioactive fission product of uranium. The stablest isotope has a mass number 99 and is used diagnostically as a radioactive imaging agent. Technetium has the atomic symbol Tc, atomic number 43, and atomic weight 98.91. [NIH] Teicoplanin: Glycopeptide antibiotic complex from Actinoplanes teichomyceticus active against gram-positive bacteria. It consists of five major components each with a different fatty acid moiety. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Terbium: Terbium. An element of the rare earth family of metals. It has the atomic symbol Tb, atomic number 65, and atomic weight 158.92. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermogenesis: The generation of heat in order to maintain body temperature. The uncoupled oxidation of fatty acids contained within brown adipose tissue and shivering are examples of thermogenesis in mammals. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]

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Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombopoietin: A humoral factor that controls blood platelet production through stimulation of megakaryocyte populations. Bone marrow megakaryocytes increase in both size and number in response to exposure to thrombopoietin. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tissue Harvesting: The removal of organs or tissue for reuse, for example, for transplantation. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in

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many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Topoisomerase inhibitors: A family of anticancer drugs. The topoisomerase enzymes are responsible for the arrangement and rearrangement of DNA in the cell and for cell growth and replication. Inhibiting these enzymes may kill cancer cells or stop their growth. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Total Quality Management: The application of industrial management practice to systematically maintain and improve organization-wide performance. Effectiveness and success are determined and assessed by quantitative quality measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicity Tests: An array of tests used to determine the toxicity of a substance to living systems. These include tests on clinical drugs, foods, and environmental pollutants. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transaldolase: An enzyme of the transferase class that catalyzes the reaction sedoheptulose 7-phosphate and D-glyceraldehyde 3-phosphate to yield D-erythrose 4-phosphate and Dfructose phosphate in the pentosephosphate pathway. (Dorland, 27th ed) EC 2.2.1.2. [NIH] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that

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catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU]

Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricuspid Valve: The valve consisting of three cusps situated between the right atrium and right ventricle of the heart. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trimetazidine: A vasodilator used in angina of effort or ischemic heart disease. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by

Dictionary 493

conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubercle: A rounded elevation on a bone or other structure. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Universal Precautions: Prudent standard preventive measures to be taken by professional and other health personnel in contact with persons afflicted with a communicable disease, to avoid contracting the disease by contagion or infection. Precautions are especially applicable in the diagnosis and care of AIDS patients. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Uranium: A radioactive element of the actinide series of metals. It has an atomic symbol U, atomic number 92, and atomic weight 238.03. U-235 is used as the fissionable fuel in nuclear weapons and as fuel in nuclear power reactors. [NIH]

494 Dialysis

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [NIH]

Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH]

Dictionary 495

Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning involuntarily or unconsciously, as the vegetative nervous system. 3. Resting; denoting the portion of a cell cycle during which the cell is not involved in replication. 4. Of, pertaining to, or characteristic of plants. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venom: That produced by the poison glands of the mouth and injected by the fangs of poisonous snakes. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venous Pressure: The blood pressure in a vein. It is usually measured to assess the filling pressure to the ventricle. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventral Tegmental Area: A region in the mesencephalon which is dorsomedial to the substantia nigra and ventral to the red nucleus. The mesocortical and mesolimbic dopaminergic systems originate here, including an important projection to the nucleus accumbens. Overactivity of the cells in this area has been suspected to contribute to the positive symptoms of schizophrenia. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinarians: Individuals with a degree in veterinary medicine that provides them with training and qualifications to treat diseases and injuries of animals. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH]

496 Dialysis

Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral vector: A type of virus used in cancer therapy. The virus is changed in the laboratory and cannot cause disease. Viral vectors produce tumor antigens (proteins found on a tumor cell) and can stimulate an antitumor immune response in the body. Viral vectors may also be used to carry genes that can change cancer cells back to normal cells. [NIH] Viremia: The presence of viruses in the blood. [NIH] Virosomes: Semi-synthetic complex derived from nucleic-acid free viral particles. They are essentially reconstituted viral coats, where the infectious nucleocapsid is replaced by a compound of choice. Virosomes retain their fusogenic activity and thus deliver the incorporated compound (antigens, drugs, genes) inside the target cell. They can be used for vaccines (vaccines, virosome), drug delivery, or gene transfer. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Visual Cortex: Area of the occipital lobe concerned with vision. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly

Dictionary 497

used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

499

INDEX A Abdominal Pain, 397, 435, 467 Acceptor, 259, 397, 451, 463, 492 Accommodation, 246, 397 Acetylcholine, 171, 397, 415, 431, 460 Acetylcysteine, 47, 130, 269, 397 Acid-Base Equilibrium, 232, 397 Acidosis, 9, 45, 47, 220, 225, 300, 306, 309, 311, 397 Acoustic, 82, 92, 397 Acrosin, 248, 397 Acrylonitrile, 397, 481 Actin, 83, 397, 458, 492 Acuity, 63, 122, 397 Acute myeloid leukemia, 397, 473 Acute tubular, 316, 397 Adaptability, 313, 398, 414 Adaptation, 35, 71, 86, 199, 294, 308, 325, 398, 446, 469 Adenine, 398, 476 Adenocarcinoma, 398, 441 Adenosine, 71, 101, 171, 235, 398, 468 Adipose Tissue, 398, 451, 489 Adjustment, 5, 21, 29, 35, 101, 165, 201, 235, 276, 284, 293, 297, 313, 322, 334, 397, 398 Adjuvant, 165, 305, 398 Adolescence, 53, 317, 398, 415, 465 Adrenal Cortex, 398, 400, 420, 479 Adrenal Glands, 398, 401, 479 Adrenergic, 380, 398, 404, 426, 430, 456, 488 Adsorption, 131, 214, 264, 398 Adsorptive, 398 Adverse Effect, 7, 88, 236, 398, 483 Aerobic, 14, 296, 398, 399, 456, 463 Aerobic Exercise, 296, 398 Aerobic Metabolism, 398, 399, 463 Aerobic Respiration, 398, 399, 463 Aerosol, 399, 488 Afferent, 59, 74, 399, 473, 482 Affinity, 56, 214, 399, 406, 451, 484 Affinity Chromatography, 214, 399 Agar, 399, 469 Agarose, 399, 440 Age of Onset, 399, 493 Age-Adjusted, 18, 399

Agonist, 48, 69, 71, 171, 399, 426, 444, 456, 457, 476 Agoraphobia, 399, 468 Air Embolism, 317, 399 Air Sacs, 399, 401 Airway, 399, 484 Akathisia, 399, 404 Alanine, 129, 235, 400 Albumin, 19, 20, 67, 91, 101, 115, 126, 165, 231, 367, 374, 378, 400, 440, 469 Aldehydes, 238, 400 Aldosterone, 44, 101, 400 Algorithms, 285, 400, 409 Alimentary, 400, 425, 464, 466 Alkaline, 56, 101, 166, 397, 400, 401, 411, 489 Alkaline Phosphatase, 101, 400 Alkaloid, 400, 412, 417, 457 Allergen, 400, 482 Allied Health Personnel, 377, 400 Allogeneic, 400, 438 Allograft, 29, 35, 400 Allylamine, 400, 401 Alpha Particles, 400, 476 Alpha-1, 400, 421 Alpha-Amylase, 110, 400 Alternative medicine, 331, 400 Aluminum, 131, 191, 284, 307, 401 Alveoli, 401, 495 Ameliorating, 232, 401 Amine, 46, 238, 401, 441 Amino Acid Sequence, 401, 403, 436 Amino-terminal, 84, 401 Ammonia, 40, 45, 94, 401, 494 Amphetamine, 43, 364, 401, 424 Amputation, 10, 115, 314, 401 Amygdala, 59, 68, 401, 450, 482 Amyloid, 67, 96, 122, 193, 289, 401 Amyloidosis, 96, 104, 105, 140, 196, 241, 264, 275, 279, 286, 289, 297, 307, 338, 356, 365, 401 Anabolic, 65, 86, 91, 335, 401, 425 Anaemia, 101, 117, 402, 454 Anaerobic, 220, 402, 486 Anaesthesia, 402, 445 Anal, 61, 80, 402, 433, 452 Analgesic, 310, 402, 417, 457, 462 Analog, 18, 402, 434, 461

500 Dialysis

Analogous, 68, 402, 492 Analytes, 39, 402 Anaphylatoxins, 402, 418 Anastomosis, 37, 50, 236, 245, 309, 313, 402 Anatomical, 23, 402, 406, 425, 445, 451, 481 Anecdotal report, 58, 402 Anemic, 151, 157, 402 Anesthesia, 99, 171, 219, 276, 399, 402, 428 Aneurysm, 222, 309, 402, 404, 494 Angina, 402, 492 Angiography, 116, 154, 160, 402 Angioplasty, 37, 51, 74, 82, 100, 123, 194, 244, 334, 402, 458 Angiotensinogen, 402, 479 Animal model, 39, 44, 53, 260, 403 Anions, 400, 403, 448, 483, 488 Anisotropy, 77, 403 Anomalies, 317, 403 Anorexia, 86, 311, 314, 315, 403, 435, 493 Anterior Cerebral Artery, 403, 415 Anthropometry, 303, 403 Antiallergic, 214, 403 Antiangiogenic, 44, 403 Antibacterial, 403, 414, 425, 434, 485 Antibiotic, 97, 102, 104, 179, 403, 411, 414, 415, 434, 457, 485, 489 Antibodies, 75, 94, 251, 403, 406, 439, 440, 442, 453, 469, 483 Anticoagulant, 25, 244, 403, 474 Antidepressant, 180, 403 Antidote, 403, 411 Antiemetic, 403, 404 Antigen, 175, 214, 399, 403, 404, 418, 436, 441, 443, 444, 445, 454, 482 Antigen-Antibody Complex, 214, 404, 418 Antihypertensive, 10, 13, 14, 23, 32, 296, 404 Anti-infective, 404, 442, 448 Anti-inflammatory, 48, 71, 404, 406, 436, 472 Anti-Inflammatory Agents, 404, 406 Antimetabolite, 404, 434, 480 Antimicrobial, 133, 174, 404, 434 Antineoplastic, 404, 412, 434, 463, 470 Antioxidant, 77, 148, 154, 155, 160, 172, 192, 404, 406, 463 Antipsychotic, 69, 404, 459 Antithrombotic, 80, 248, 404 Antiviral, 219, 397, 404, 431, 447, 466, 480 Anuria, 404, 449 Anus, 402, 404, 410, 440, 478

Anxiety, 88, 199, 200, 203, 308, 364, 399, 404, 468 Aorta, 404, 420, 479, 487, 495 Aortic Aneurysm, 82, 140, 404 Apathy, 297, 404, 459 Apheresis, 127, 404 Apnea, 404 Apolipoproteins, 404, 451 Apoptosis, 84, 405 Applicability, 63, 363, 405 Aqueous, 224, 235, 254, 259, 260, 405, 407, 422, 442, 450, 451 Arcuate Nucleus, 48, 405 Arginase, 142, 405 Arginine, 83, 183, 402, 405, 460, 469, 493, 494 Aromatic, 46, 238, 405, 416, 468, 487 Arterial embolization, 11, 405 Arteries, 4, 82, 404, 405, 409, 410, 420, 452, 455 Arteriolar, 405, 411, 479 Arterioles, 405, 410, 412 Arteriolosclerosis, 405 Arteriosclerosis, 264, 405, 443 Arthroplasty, 141, 405 Artificial Pancreas, 39, 405 Ascites, 298, 406 Ascorbic Acid, 184, 340, 406 Aseptic, 329, 406, 462, 486 Aspartate, 166, 406 Aspirate, 267, 406 Aspiration, 267, 406 Aspirin, 108, 406 Assay, 71, 84, 89, 95, 142, 166, 259, 260, 406 Astringents, 406, 455 Astrocytes, 406, 457 Asymptomatic, 307, 406, 464 Atmospheric Pressure, 406, 443 Atrial, 94, 108, 131, 327, 406 Atrial Fibrillation, 108, 327, 406 Atrium, 406, 492, 495 Attenuated, 29, 45, 47, 406, 425 Atypical, 69, 406 Auditory, 406, 473 Auscultation, 4, 406 Autoantibodies, 144, 181, 406 Autoantigens, 406 Autoclave, 252, 406 Autodigestion, 406, 464 Autogenic, 103, 407 Autoimmune disease, 214, 407, 457, 469 Autologous, 22, 80, 309, 407

Index 501

Autonomic, 67, 132, 279, 314, 397, 404, 407, 460 Autoreceptors, 68, 407 Axillary, 407, 487 Axillary Vein, 407, 487 Axons, 69, 407, 423, 447, 462, 473, 476 Azotemia, 71, 407, 493 B Bacteremia, 93, 407, 410 Bacterial Infections, 77, 407, 414, 450 Bacterial Physiology, 398, 407 Bactericidal, 407, 431 Bacteriophage, 407, 469 Bacterium, 72, 407, 440 Basal Ganglia, 404, 407, 415, 450, 461 Base, 8, 66, 101, 225, 241, 275, 277, 284, 398, 407, 412, 423, 435, 438, 449, 476, 489, 493 Basement Membrane, 407, 432, 449 Basophils, 407, 438, 450 Benign, 380, 405, 408, 439, 474, 477 Benign prostatic hyperplasia, 380, 408 Benzene, 408, 448 Beta 2-Microglobulin, 193, 408 Beta Rays, 408, 427 Beta-pleated, 401, 408 Bewilderment, 408, 419 Bicarbonates, 225, 408 Bilateral, 23, 104, 408 Bile, 259, 265, 408, 435, 451, 486 Bile Acids, 408, 486 Bile Acids and Salts, 408 Bile Ducts, 408, 435 Biliary, 408, 464 Biliary Tract, 408, 464 Bilirubin, 219, 400, 408, 435 Binding agent, 307, 408 Biochemical, 38, 75, 100, 104, 312, 315, 404, 408, 409, 437, 449, 483 Bioengineering, 39, 153, 159, 346, 408 Biological response modifier, 409, 447 Biological therapy, 409, 438 Biological Transport, 409, 425 Bioluminescence, 409, 452 Biopsy, 30, 363, 409, 466 Biosynthesis, 409, 421, 452, 474, 483, 484 Biotechnology, 72, 93, 99, 178, 208, 293, 331, 347, 409 Biotin, 162, 409 Bladder, 240, 290, 356, 408, 409, 422, 457, 459, 474, 479, 494 Blastocyst, 409, 419

Bloating, 409, 435 Blood Cell Count, 409, 439 Blood Coagulation, 409, 411, 433, 490 Blood Glucose, 22, 30, 309, 409, 440, 446 Blood Platelets, 248, 409, 444, 454, 483, 490 Blood transfusion, 15, 297, 370, 409 Blood urea, 16, 20, 40, 94, 215, 349, 409, 449 Blood Volume, 217, 410, 472 Blood-Borne Pathogens, 33, 410 Blood-Brain Barrier, 98, 259, 410 Body Composition, 123, 126, 410 Body Fluids, 218, 285, 332, 410, 411, 426, 479, 484 Body Mass Index, 6, 410 Body Weight Changes, 284, 410 Bolus, 194, 410 Bolus infusion, 410 Bone Cements, 410, 471 Bone Density, 58, 410 Bone Marrow, 306, 360, 397, 408, 410, 430, 444, 452, 454, 457, 473 Bone scan, 410, 481 Bowel, 12, 81, 105, 240, 402, 410, 425, 446, 447, 461, 467, 486 Bowel Movement, 410, 425, 486 Brachytherapy, 143, 410, 447, 477 Bradykinin, 411, 460, 469 Branch, 237, 262, 391, 411, 422, 427, 435, 452, 459, 465, 475, 479, 485, 488, 489 Breakdown, 16, 41, 61, 317, 409, 411, 425, 435, 484 Breast Implants, 47, 411 Broad-spectrum, 411, 414 Bronchial, 411, 441 Buccal, 411, 452 Bupivacaine, 99, 411 Bypass, 23, 74, 82, 138, 232, 411, 458 C Cacao, 265, 411 Cadaver, 274, 411 Calcifediol, 411 Calcification, 34, 46, 58, 101, 109, 128, 130, 143, 329, 405, 411 Calcinosis, 170, 411 Calcitriol, 42, 135, 140, 209, 307, 411 Calcium Chloride, 245, 411 Calcium Oxalate, 412, 463 Caloric intake, 280, 315, 380, 412 Camptothecin, 173, 181, 412, 448 Cannula, 26, 266, 325, 412 Canonical, 56, 412

502 Dialysis

Capillary, 166, 197, 220, 254, 411, 412, 436, 451, 476, 495 Capital Expenditures, 62, 412 Capsaicin, 141, 412 Capsid, 75, 412, 461 Capsular, 39, 114, 412 Capsules, 340, 412, 436 Carbohydrate, 41, 252, 254, 283, 412, 436, 437, 471 Carbon Dioxide, 62, 412, 413, 423, 433, 435, 479, 495 Carboplatin, 185, 412 Carcinogenic, 408, 412, 446, 473, 486 Carcinogens, 412, 463 Carcinoma, 125, 412 Cardiac Output, 82, 412, 487 Cardiomyopathy, 106, 297, 304, 412 Cardiopulmonary, 317, 412 Cardiorespiratory, 67, 398, 412 Cardiovascular disease, 6, 15, 23, 27, 34, 35, 42, 44, 46, 52, 70, 74, 76, 77, 80, 87, 89, 107, 184, 208, 275, 296, 297, 304, 307, 413 Cardiovascular System, 3, 14, 217, 261, 379, 413 Carnitine, 108, 125, 133, 148, 152, 154, 159, 162, 168, 170, 173, 180, 183, 311, 314, 348, 413 Carotid Body, 45, 413, 415 Carpal Tunnel Syndrome, 298, 413 Case report, 115, 121, 133, 413, 416 Case series, 413, 416 Catabolism, 67, 413 Catalyse, 413, 492 Catecholamine, 413, 426 Catheterization, 402, 413, 458 Cathode, 408, 413, 427 Cations, 413, 448 Caudal, 413, 424, 444, 461, 472 Caudate Nucleus, 403, 413, 461 Causal, 413, 440 Cause of Death, 6, 74, 303, 413 Ceftazidime, 94, 95, 414 Ceftriaxone, 94, 414 Cell Adhesion, 181, 264, 414 Cell Adhesion Molecules, 181, 414 Cell Cycle, 40, 414, 416, 431, 475, 495 Cell Death, 405, 414, 431, 436, 458 Cell Differentiation, 42, 414 Cell Division, 37, 77, 407, 414, 422, 431, 438, 454, 456, 469, 473, 482

Cell membrane, 76, 255, 409, 414, 428, 448, 454, 462, 468 Cell proliferation, 50, 405, 414, 447 Cell Respiration, 398, 399, 414, 456, 463, 479 Cell Survival, 43, 414, 438 Cellobiose, 414 Cellulose, 5, 70, 414, 469 Central Nervous System Infections, 414, 439 Centrifugation, 415, 439 Cephaloridine, 414, 415 Cerebral Infarction, 109, 415 Cerebrospinal, 45, 94, 415, 421, 483 Cerebrospinal fluid, 45, 94, 415, 421, 483 Cerebrovascular, 23, 35, 82, 301, 413, 415 Cerebrum, 415 Chelation, 55, 415 Chemoreceptor, 45, 47, 404, 415 Chemotactic Factors, 415, 418 Chemotherapy, 298, 309, 312, 313, 415, 481 Child Development, 302, 415 Chlorides, 225, 415 Cholesterol Esters, 415, 451 Cholinergic, 404, 415, 482 Chorea, 201, 404, 415 Chromatin, 405, 415, 430, 485 Chromatography, Ion Exchange, 214, 414, 416 Chromosomal, 415, 416, 469, 481 Chromosome, 60, 416, 451, 481, 482 Chronic Disease, 15, 55, 128, 294, 336, 416 Chylomicrons, 416, 451 Chymotrypsin, 248, 416 Circulatory system, 399, 416, 447 Cisplatin, 116, 176, 187, 416 Citric Acid, 221, 416 Citrus, 406, 416 Clamp, 92, 222, 228, 256, 416 Clavicle, 26, 416 Clear cell carcinoma, 416, 423 Cleave, 38, 248, 416 Clinical Medicine, 294, 416, 472 Clinical Protocols, 92, 416 Clinical study, 89, 167, 416, 420 Clone, 43, 83, 417 Cloning, 60, 409, 417 Clot Retraction, 417, 469 Coagulation, 181, 409, 417, 440, 469, 490 Cobalt, 238, 417 Coca, 417 Cocaine, 364, 417

Index 503

Coculture, 78, 417 Codeine, 364, 417, 462 Coenzyme, 38, 197, 406, 417, 452, 484 Cofactor, 417, 460, 474, 490 Colitis, 417, 446 Collagen, 407, 417, 432, 433, 470 Collapse, 411, 417, 484 Colloidal, 400, 418, 427, 431, 483, 488 Colorectal, 195, 418 Colorectal Cancer, 195, 418 Combination chemotherapy, 116, 176, 185, 418 Communicable disease, 418, 493 Comorbidity, 9, 14, 18, 63, 87, 148, 154, 418 Complement, 214, 264, 402, 418, 436, 444, 469, 482 Complement Activation, 264, 402, 418 Complementary and alternative medicine, 163, 198, 418 Complementary medicine, 163, 418 Compress, 255, 418 Computational Biology, 347, 419 Computed tomography, 46, 410, 419, 481 Computer Simulation, 54, 419 Computerized axial tomography, 419, 481 Computerized tomography, 419 Conception, 307, 419, 420, 433, 486 Concomitant, 215, 419 Conduction, 349, 419 Confidence Intervals, 18, 419 Confounding, 29, 419 Confusion, 235, 317, 361, 419, 425, 459, 493, 494 Congestion, 404, 419 Congestive heart failure, 23, 81, 297, 419 Conjugated, 64, 68, 408, 419, 422, 440, 461 Connective Tissue, 406, 410, 417, 419, 433, 435, 452, 480 Consciousness, 402, 419, 423, 426 Constipation, 12, 277, 280, 298, 332, 336, 404, 419, 467 Constriction, 419, 448, 481 Consumption, 14, 251, 419, 424, 435, 461, 463 Contamination, 30, 129, 227, 270, 410, 419, 441 Contraception, 307, 419 Contraindications, ii, 420 Contralateral, 420, 455, 462, 478 Contrast Media, 76, 420 Control group, 14, 15, 22, 86, 420, 477

Controlled clinical trial, 35, 44, 50, 80, 420 Controlled study, 113, 420 Convulsions, 178, 420 Coordination, 56, 70, 201, 420, 457 Cornea, 420 Corneal Ulcer, 248, 420 Coronary Angiography, 297, 420 Coronary Artery Bypass, 52, 133, 138, 183, 420 Coronary heart disease, 6, 15, 35, 413, 420 Coronary Thrombosis, 420, 455 Coronary Vessels, 34, 420 Corrosion, 271, 420 Cortex, 69, 164, 176, 420, 429, 431, 433, 473, 476, 478 Cortical, 59, 69, 420, 431, 473, 476, 482 Cortisol, 400, 420 Cortisone, 420, 472 Cost Savings, 14, 421 Cost-benefit, 101, 421 Cranial, 421, 439, 447, 461 Craniocerebral Trauma, 421, 439 Creatinine clearance, 25, 35, 63, 233, 299, 362, 363, 378, 421 Critical Care, 227, 298, 309, 312, 313, 421 Cross Infection, 421, 465 Cross-Sectional Studies, 118, 421 Cryoglobulinemia, 30, 421 Crystallization, 75, 421 CSF, 47, 408, 415, 421, 447 Cultured cells, 259, 421 Curative, 421, 480, 489 Custodial Care, 337, 421 Cutaneous, 109, 200, 421, 452 Cyclic, 194, 282, 421, 438, 460, 471, 482 Cyclodextrins, 259, 421 Cyst, 44, 406, 421, 462 Cystathionine beta-Synthase, 421, 443 Cysteine, 41, 198, 397, 421, 422, 429, 488 Cystine, 422 Cystitis, 363, 422 Cystoscopy, 363, 422 Cytochrome, 260, 422 Cytogenetics, 422, 481 Cytokine, 43, 48, 422 Cytomegalovirus, 87, 422 Cytoplasm, 405, 408, 414, 422, 430, 438, 480 Cytoskeleton, 422, 456 Cytotoxic, 219, 412, 422, 445, 477 Cytotoxicity, 37, 260, 400, 416, 422

504 Dialysis

D Dairy Products, 348, 422 Data Collection, 22, 59, 78, 87, 88, 90, 422 Databases, Bibliographic, 347, 422 De novo, 35, 91, 422 Deamination, 423, 494 Decarboxylation, 423, 441, 457, 466 Decision Making, 283, 295, 361, 423 Degenerative, 423, 441, 457, 480 Dehydration, 316, 423 Deletion, 68, 405, 423 Delirium, 404, 423 Delivery of Health Care, 412, 423, 439 Dementia, 55, 404, 423 Dendrites, 423, 459, 476 Dendritic, 423, 485 Density, 105, 112, 132, 137, 171, 410, 415, 423, 427, 451, 462, 485 Dental Waste, 410, 423 Dentate Gyrus, 423, 441 Dentists, 372, 423 Dermal, 163, 423 DES, 224, 253, 402, 423 Detoxification, 219, 423 Deuterium, 424, 442 Developed Countries, 301, 424 Developing Countries, 277, 424 Dextroamphetamine, 401, 424, 455 Diabetic Retinopathy, 300, 301, 424, 468 Diagnostic Imaging, 424, 476 Diagnostic procedure, 213, 331, 424, 468 Dialysis Solutions, 149, 150, 155, 156, 157, 203, 227, 235, 298, 424 Diaphragm, 239, 424, 470 Diarrhea, 332, 335, 424 Diarrhoea, 424, 435 Diastole, 424, 473 Diastolic, 23, 26, 112, 113, 225, 424, 443 Diastolic blood pressure, 225, 424 Diencephalon, 424, 430, 443, 473, 489 Dietary Fiber, 12, 265, 424 Dietetics, 70, 425 Dietitian, 185, 279, 282, 284, 302, 308, 335, 365, 367, 369, 371, 374, 380, 425 Digestion, 248, 400, 408, 410, 424, 425, 435, 447, 451, 466, 486, 494 Digestive system, 211, 425 Digestive tract, 425, 484 Dihydrotestosterone, 425, 478 Dilatation, 328, 402, 425, 473, 494 Dilatation, Pathologic, 425, 494 Dilate, 220, 425

Dilated cardiomyopathy, 106, 328, 425 Dilation, 142, 220, 411, 425, 494 Dilution, 65, 163, 235, 253, 270, 425, 430, 469 Dimerization, 77, 425 Dimethyl, 263, 425 Dipyridamole, 50, 425 Disease Progression, 72, 425 Disinfectant, 425, 431 Disinfection, 31, 33, 227, 425 Disorientation, 419, 423, 425 Disparity, 22, 425 Dissociation, 38, 399, 425, 448 Dissociative Disorders, 426 Distal, 134, 245, 246, 251, 252, 257, 267, 420, 426, 466, 473, 475 Diuresis, 315, 426 Diuretic, 411, 426 Dopamine, 42, 53, 56, 59, 66, 68, 69, 401, 404, 417, 424, 426, 457, 468, 476 Dorsal, 426, 430, 472, 482 Drug Delivery Systems, 72, 266, 426 Drug Interactions, 341, 426 Drug Monitoring, 96, 426 Drug Tolerance, 426, 491 Duct, 412, 413, 426, 431, 481 Duodenum, 72, 408, 416, 426, 435, 459, 464, 486 Dwell time, 375, 426 Dyes, 45, 47, 401, 408, 426 Dyskinesia, 404, 427 Dyslipidemia, 111, 297, 427 Dyspnea, 223, 427 Dystonia, 404, 427 E Echocardiography, 3, 23, 80, 427 Edema, 49, 223, 240, 297, 299, 332, 424, 427, 458, 493 Effector, 397, 418, 427, 460 Effector cell, 427, 460 Efficacy, 7, 39, 40, 43, 46, 50, 53, 57, 58, 64, 71, 79, 80, 86, 91, 113, 114, 123, 149, 151, 155, 157, 174, 206, 209, 215, 380, 427 Elasticity, 255, 405, 427 Elastin, 417, 427, 432 Elastomers, 427, 471 Elbow Joint, 144, 427 Elective, 139, 427 Electric Conductivity, 226, 403, 427 Electrocoagulation, 417, 427 Electrolysis, 266, 403, 413, 427

Index 505

Electrolyte, 114, 217, 232, 258, 284, 317, 394, 400, 423, 427, 440, 449, 472, 484, 493 Electrons, 38, 404, 407, 408, 413, 427, 448, 463, 476, 477 Electrophoresis, 28, 166, 427, 472 Electrophysiological, 57, 427, 495 Electroporation, 230, 263, 428 Elementary Particles, 427, 428, 460, 475 Embolectomy, 428, 490 Emboli, 11, 122, 428 Embolism, 18, 428, 476 Embolization, 11, 428 Embolus, 248, 428, 445 Embryo, 254, 255, 409, 414, 428, 445 Emollient, 428, 437 Emphysema, 248, 428 Empirical, 28, 74, 89, 428 Encapsulated, 263, 428 Encephalopathy, 120, 201, 428 Endarterectomy, 402, 428 Endemic, 428, 453 Endocarditis, 122, 304, 428 Endocardium, 428 Endocrine Glands, 428, 464 Endopeptidases, 429, 474 Endothelial cell, 36, 77, 150, 156, 181, 264, 298, 410, 428, 429, 490 Endothelium, 137, 245, 264, 296, 328, 429, 460, 469 Endothelium, Lymphatic, 429 Endothelium, Vascular, 429 Endothelium-derived, 429, 460 Endotoxic, 429, 451 Endotoxin, 242, 264, 429, 493 Energetic, 88, 429 Energy Intake, 148, 154, 309, 336, 429 Enteropeptidase, 429, 493 Entorhinal Cortex, 429, 441 Environmental Health, 346, 348, 429 Environmental Pollutants, 429, 491 Enzymatic, 214, 230, 411, 418, 429, 433, 441, 480 Enzyme Inhibitors, 248, 429, 469 Eosinophilia, 214, 429 Eosinophils, 429, 438, 450 Ependyma, 405, 430, 489 Epidemic, 42, 430 Epidemiological, 85, 430 Epigastric, 430, 464 Epinephrine, 398, 426, 430, 460, 493 Epithalamus, 424, 430, 450 Epithelial, 398, 409, 420, 430, 441, 449, 474

Epithelial Cells, 430, 441, 449, 474 Epithelium, 407, 429, 430, 435 Epoetin alfa, 111, 112, 207, 208, 430 Equipment and Supplies, 13, 317, 365, 430 Erectile, 7, 430 Erection, 430 ERV, 352, 370, 372, 430, 431 Erythrocyte Volume, 410, 430 Erythrocytes, 402, 409, 410, 430, 440, 444, 478, 482 Esophagitis, 336, 430 Esophagus, 425, 430, 486 Estrogen, 328, 431 Ethanol, 53, 69, 118, 127, 431, 432 Ethanolamine, 431, 456 Ethidium, 139, 431 Etoposide, 116, 176, 431 Eukaryotic Cells, 431, 462 Evacuation, 226, 227, 419, 431, 435 Evoke, 431, 486 Excitability, 4, 431 Excitation, 66, 415, 431 Excitatory, 69, 431, 437, 444 Excrete, 235, 404, 431, 449 Exhaustion, 431, 453 Exocrine, 431, 464 Exogenous, 398, 431, 474, 493 Expander, 431, 472 Expiration, 431, 479 Expiratory, 430, 431 Expiratory Reserve Volume, 430, 431 External-beam radiation, 431, 477 Extracellular, 37, 39, 68, 69, 94, 101, 104, 136, 149, 155, 166, 174, 189, 223, 304, 401, 406, 419, 432, 433, 455, 474, 484, 489 Extracellular Matrix, 39, 149, 155, 419, 432, 433 Extracellular Matrix Proteins, 39, 149, 155, 432 Extracellular Space, 94, 432, 456 Extracorporeal Circulation, 257, 432 Extraction, 181, 230, 235, 236, 265, 270, 432 Extrapyramidal, 399, 404, 426, 432 Extrarenal, 309, 432 Extravasation, 25, 432 Extravascular, 65, 229, 432 Extremity, 30, 134, 138, 432, 454 F Family Planning, 347, 432 Fat, 105, 278, 283, 398, 408, 410, 420, 428, 432, 451, 457, 471, 480, 484, 492 Fatigue, 297, 332, 348, 360, 374, 432, 439

506 Dialysis

Fatty acids, 400, 432, 489 Febrile, 219, 297, 317, 432, 453 Feces, 419, 432, 486 Femoral, 82, 432, 441 Femoral Neck Fractures, 432, 441 Femur, 432, 441 Fermentation, 411, 432 Ferritin, 367, 374, 433 Fetus, 430, 433, 473, 494 Fibrillation, 94, 433 Fibrin, 248, 252, 267, 409, 417, 433, 467, 469, 490, 491 Fibrinogen, 67, 87, 433, 469, 490 Fibrinolysis, 181, 433 Fibroblasts, 253, 433, 447 Fibronectins, 432, 433 Fibrosis, 306, 400, 433, 481 Fibula, 433, 471 Filtration, 171, 214, 216, 227, 228, 233, 242, 243, 250, 253, 264, 332, 433, 449 Fish Products, 433, 481 Fissure, 423, 433, 473 Fixation, 433, 482 Flank Pain, 12, 433 Flatus, 434, 435 Fleroxacin, 98, 434 Fluorescence, 38, 41, 77, 166, 171, 181, 241, 250, 431, 434 Fluorouracil, 425, 434 Flurazepam, 364, 434 Flush, 298, 434 Foam Cells, 264, 434 Folate, 90, 112, 171, 176, 181, 184, 192, 434 Fold, 20, 433, 434, 462 Folic Acid, 35, 113, 153, 159, 172, 174, 184, 191, 206, 340, 360, 434 Food Exchange, 276, 283, 434 Foramen, 434, 467 Forearm, 66, 82, 139, 409, 427, 434, 454 Fosinopril, 117, 434 Fractionation, 62, 434 Free Radical Scavengers, 254, 434 Frontal Lobe, 403, 415, 434, 473 Fructose, 434, 448, 491 Fungemia, 410, 434 Fungi, 409, 434, 438, 455, 456, 485, 497 G Gallbladder, 397, 408, 425, 435 Gallium, 193, 435 Gallstones, 122, 408, 435 Gamma Rays, 435, 476, 477 Ganglia, 397, 435, 459

Gas, 62, 226, 271, 401, 412, 425, 430, 431, 434, 435, 442, 460, 461, 476, 487, 488, 495 Gas exchange, 435, 476, 495 Gastric, 91, 150, 157, 407, 413, 435, 441, 442, 466 Gastric Emptying, 150, 157, 435 Gastric Juices, 435, 466 Gastric Mucosa, 435, 466 Gastrin, 435, 441 Gastritis, 336, 435 Gastroenteritis, 316, 435 Gastrointestinal, 259, 275, 277, 298, 312, 335, 411, 430, 431, 435, 453, 483, 485, 486, 487 Gastrointestinal tract, 259, 431, 435, 483, 485, 486 Gastroparesis, 336, 435 Gene Expression, 131, 435 General practitioner, 298, 304, 435 Genetic Code, 435, 461 Genetic Engineering, 409, 417, 436 Genetic Markers, 48, 436 Genital, 416, 436, 494 Genotype, 95, 103, 181, 436, 468 Geriatric, 279, 291, 436 Germ-free, 436, 465 Giant Cells, 436, 481 Ginseng, 198, 436 Gland, 398, 420, 436, 452, 459, 464, 465, 474, 482, 486, 490 Glioma, 103, 436 Glomerular, 233, 248, 303, 436, 448, 449, 479 Glomerular Filtration Rate, 303, 436, 449 Glomeruli, 299, 436, 476 Glomerulonephritis, 310, 317, 337, 436, 444 Glomerulosclerosis, 299, 436 Glomerulus, 436, 459 Glucans, 421, 436 Glucocorticoid, 436, 472 Gluconeogenesis, 41, 436 Glucose Intolerance, 424, 437 Glucuronic Acid, 437, 440 Glutamate, 45, 56, 68, 103, 112, 124, 166, 189, 437, 467 Glutamic Acid, 434, 437, 440 Glutathione Peroxidase, 437, 482 Glycerol, 103, 263, 437, 468 Glycine, 408, 437, 483 Glycogen, 41, 400, 437

Index 507

Glycoprotein, 173, 430, 433, 436, 437, 449, 457, 490, 493 Glycosaminoglycans, 432, 437 Glycosidic, 400, 414, 437, 461 Glycosylation, 165, 186, 437 Goats, 45, 422, 437 Governing Board, 437, 472 Government Agencies, 378, 437, 472 Gp120, 437, 466 Grade, 140, 264, 280, 437 Graft Rejection, 30, 438 Graft Survival, 71, 438 Grafting, 42, 52, 133, 138, 183, 420, 438, 445 Gram-negative, 133, 414, 429, 438 Gram-positive, 438, 457, 486, 487, 489 Gram-Positive Bacteria, 438, 489 Granulocytes, 438, 496 Grasses, 434, 438 Groin, 360, 438 Growth, 31, 39, 44, 65, 82, 92, 96, 126, 134, 149, 151, 155, 157, 190, 207, 209, 235, 245, 252, 253, 310, 316, 335, 363, 398, 403, 404, 405, 409, 414, 415, 424, 438, 442, 447, 453, 458, 461, 462, 469, 470, 475, 482, 490, 491, 493, 495 Growth factors, 92, 149, 155, 190, 438 Growth Plate, 209, 438 Guanidine, 181, 438 Guanylate Cyclase, 438, 460 Gyrase, 434, 438 Gyrus Cinguli, 403, 438, 450 H Habitat, 68, 438 Half-Life, 17, 122, 414, 439 Haptens, 399, 439 Headache, 119, 297, 439 Headache Disorders, 439 Health Care Costs, 31, 81, 85, 439, 453 Health Expenditures, 439 Health Policy, 54, 439 Health Promotion, 303, 439 Health Services, 54, 90, 294, 423, 439 Heart attack, 221, 413, 439 Heart failure, 23, 297, 332, 439 Heartbeat, 335, 439, 487 Hematocrit, 183, 195, 284, 299, 360, 367, 370, 374, 378, 409, 439 Hematuria, 11, 439 Heme, 408, 422, 439, 471 Hemodiafiltration, 64, 230, 232, 234, 247, 439, 493

Hemodialyzer, 61, 219, 229, 256, 275, 349, 370, 440 Hemodynamics, 217, 244, 268, 440 Hemofiltration, 9, 13, 95, 120, 187, 230, 234, 243, 247, 291, 314, 439, 440, 493 Hemoglobin, 22, 25, 26, 57, 114, 208, 241, 262, 367, 374, 378, 402, 409, 430, 439, 440, 471 Hemoglobin A, 22, 440, 471 Hemoglobin C, 262, 402, 440 Hemolysis, 317, 440 Hemolytic, 30, 214, 440 Hemoperfusion, 180, 242, 277, 279, 284, 300, 440 Hemoperitoneum, 189, 440 Hemorrhage, 49, 106, 421, 427, 439, 440, 441, 458, 487, 496 Hemorrhoid, 440, 490 Hemostasis, 4, 102, 279, 440, 483 Heparin, 108, 124, 131, 217, 236, 244, 285, 340, 376, 440 Hepatic, 41, 54, 101, 120, 177, 305, 400, 423, 441, 471, 484 Hepatitis A, 94, 135, 305, 441 Hepatitis Viruses, 33, 305, 441 Hepatocellular, 95, 441 Hepatocellular carcinoma, 95, 441 Hepatocytes, 441 Hepatovirus, 441 Hereditary, 124, 317, 441, 457, 467 Heredity, 435, 441 Hetastarch, 163, 441 Heterogeneity, 399, 441 Hip Fractures, 20, 432, 441 Hippocampus, 59, 423, 441, 450, 476, 482, 487 Histamine, 214, 402, 404, 441 Histidine, 441 Holidays, 79, 278, 441 Homeostasis, 65, 67, 68, 96, 221, 232, 245, 275, 441 Homologous, 102, 421, 441, 482, 488 Hormonal, 335, 441, 496 Hormone therapy, 126, 134, 442 Hospice, 361, 442 Host, 48, 66, 75, 230, 253, 407, 438, 442, 444, 494, 496 Housekeeping, 33, 442 Human growth hormone, 207, 209, 442, 485 Human Rights, 145, 442 Humoral, 438, 442, 490

508 Dialysis

Hybrid, 89, 316, 417, 442 Hybridomas, 428, 442, 447 Hydration, 223, 243, 442 Hydrochloric Acid, 238, 239, 415, 442 Hydrofluoric Acid, 442, 483 Hydrogel, 39, 265, 442 Hydrogen Peroxide, 437, 442, 451, 488 Hydrolysis, 405, 414, 416, 442, 471, 474, 493 Hydrophilic, 232, 442 Hydrophobic, 229, 442, 451 Hydroxylation, 39, 411, 442 Hyperbaric, 172, 178, 443 Hyperbaric oxygen, 172, 178, 443 Hypercalcemia, 6, 325, 443 Hypercholesterolemia, 427, 443 Hyperglycaemia, 140, 443 Hyperglycemia, 41, 301, 443 Hyperhomocysteinemia, 35, 90, 121, 152, 158, 172, 178, 187, 194, 206, 297, 422, 443 Hyperlipidemia, 264, 284, 297, 309, 427, 443 Hyperlipoproteinemia, 443, 451 Hyperoxia, 124, 443 Hyperplasia, 36, 46, 50, 236, 245, 443 Hyperpnea, 68, 443 Hypersensitivity, 400, 443, 480, 482 Hypertension, Renal, 85, 443 Hypertension, Renovascular, 443 Hyperthermia, 219, 443 Hypertriglyceridemia, 427, 443 Hypertrophy, 6, 23, 60, 107, 206, 379, 408, 443 Hypnotic, 434, 443 Hypotensive, 23, 443 Hypothalamic, 75, 443 Hypothalamus, 75, 164, 405, 424, 443, 450, 459, 482, 485, 489 Hypothermia, 121, 221, 444 Hypoventilation, 45, 444 Hypoxemia, 317, 444 Hypoxia, 220, 402, 423, 444 I Ibotenic Acid, 444, 457 Id, 151, 157, 161, 196, 356, 381, 382, 385, 390, 392, 444 Idiopathic, 444, 481 Ileum, 444, 459 Imaging procedures, 444, 491 Imidazole, 409, 441, 444 Immersion, 28, 444 Immune Adherence Reaction, 214, 444

Immune Complex Diseases, 404, 444, 469 Immune function, 444, 445 Immune response, 37, 215, 398, 403, 406, 407, 421, 438, 439, 444, 445, 482, 487, 494, 496 Immune system, 214, 409, 427, 444, 445, 453, 457, 467, 494, 496 Immunity, 75, 279, 400, 444 Immunization, 444, 482, 483 Immunodeficiency, 30, 99, 214, 320, 370, 372, 444 Immunodeficiency syndrome, 214, 370, 372, 444 Immunogenic, 444, 451 Immunoglobulin, 140, 214, 403, 444, 457 Immunologic, 312, 415, 444, 477 Immunology, 124, 398, 399, 445 Immunosuppressive, 30, 214, 286, 436, 445 Immunosuppressive Agents, 214, 445 Immunosuppressive therapy, 30, 445 Impairment, 13, 35, 55, 98, 281, 300, 319, 408, 423, 427, 445, 454, 475 Implant radiation, 445, 447, 477 Implantation, 4, 39, 91, 125, 419, 445 Impotence, 7, 430, 445 In vitro, 37, 41, 42, 56, 62, 69, 73, 75, 77, 96, 109, 150, 156, 229, 230, 237, 259, 260, 263, 445, 490 Incision, 17, 445, 448, 476 Indicative, 286, 445, 465, 494 Induction, 42, 91, 179, 258, 298, 404, 445, 477, 484 Infarction, 136, 415, 420, 445, 455, 479 Infection Control, 16, 33, 174, 285, 320, 321, 365, 445 Infertility, 307, 445, 449, 494 Infiltration, 230, 436, 445 Inflammatory bowel disease, 72, 446 Information Systems, 54, 446 Informed Consent, 11, 283, 296, 446 Infuse, 268, 446 Infusion, 69, 179, 188, 224, 242, 243, 245, 251, 257, 446, 458, 492 Ingestion, 41, 397, 434, 446, 470, 489 Inhalation, 399, 446, 470 Initiation, 5, 6, 17, 18, 19, 25, 27, 28, 29, 31, 49, 54, 65, 85, 90, 123, 179, 232, 273, 283, 295, 299, 301, 312, 313, 381, 446 Inlay, 446, 480 In-line, 250, 446 Inner ear, 414, 446 Innervation, 69, 446, 454

Index 509

Inorganic, 408, 415, 416, 446, 452, 468 Inotropic, 426, 446 Insight, 54, 111, 446 Insomnia, 298, 446 Instillation, 12, 298, 446, 467 Institutionalization, 337, 446 Insulator, 446, 457 Insulin, 10, 17, 30, 177, 282, 314, 335, 379, 405, 446, 464, 493 Insulin-dependent diabetes mellitus, 17, 446 Intensive Care, 98, 277, 349, 446 Interferon, 30, 123, 447 Interferon-alpha, 447 Interleukin-1, 43, 48, 447 Interleukin-10, 48, 447 Interleukin-2, 447 Interleukin-6, 48, 86, 118, 447 Interleukins, 445, 447 Intermittent, 47, 63, 103, 148, 154, 180, 197, 294, 368, 378, 447, 452, 467 Internal Medicine, 36, 38, 43, 67, 80, 113, 131, 150, 151, 152, 153, 156, 157, 159, 283, 447, 459 Internal radiation, 447, 477 Interneurons, 69, 447 Interpersonal Relations, 88, 447 Interstitial, 61, 66, 122, 216, 223, 237, 270, 363, 410, 432, 447, 454, 459, 479 Intestinal, 265, 411, 429, 447, 453, 496 Intestine, 72, 408, 410, 418, 447, 450, 487 Intoxication, 69, 180, 423, 447, 497 Intracellular, 56, 59, 66, 83, 151, 157, 216, 223, 235, 255, 264, 445, 447, 454, 460, 472, 478, 481, 482 Intracellular Membranes, 447, 454 Intracranial Pressure, 49, 65, 447 Intramuscular, 447, 464 Intraperitoneal, 97, 163, 177, 194, 303, 379, 448 Intraperitoneal chemotherapy, 163, 448 Intravascular, 11, 65, 243, 268, 309, 448 Intrinsic, 71, 399, 407, 448 Inulin, 436, 448 Invasive, 34, 49, 65, 82, 117, 127, 143, 215, 222, 225, 258, 444, 448, 453 Invertebrates, 448, 452 Involuntary, 415, 433, 448, 458, 483, 485 Iodine, 29, 154, 160, 264, 448 Ion Channels, 406, 448, 460 Ion Exchange, 238, 416, 448 Ion Exchange Resins, 416, 448

Ionization, 139, 448 Ions, 38, 55, 76, 229, 235, 251, 296, 397, 407, 408, 416, 426, 427, 438, 442, 448, 456, 474 Irinotecan, 195, 448 Ischemia, 71, 134, 174, 176, 221, 448, 458, 479 Isoflavones, 190, 448 Isopropyl, 26, 448 Isotonic, 12, 448, 456 Isotope Labeling, 38, 449 J Joint, 36, 60, 76, 85, 189, 228, 297, 405, 427, 449, 488 K Kallikreins, 248, 449 Kb, 346, 449 Keto, 13, 191, 449, 492 Kidney Failure, Acute, 449 Kidney Failure, Chronic, 205, 207, 208, 332, 449 Kidney Pelvis, 449, 494 Kidney stone, 332, 449, 463, 494 Kinetic, 24, 40, 43, 67, 209, 274, 449 L Labile, 418, 449 Lacrimal, 142, 449 Laminin, 407, 432, 449 Large Intestine, 418, 425, 447, 450, 478, 484 Latency, 16, 21, 450 Least-Squares Analysis, 450, 478 Lens, 412, 450 Lesion, 36, 79, 306, 420, 450, 489 Leukapheresis, 404, 450 Leukemia, 43, 397, 450 Leukocyte Count, 25, 450 Leukocytes, 96, 98, 407, 409, 410, 415, 429, 438, 447, 450, 467, 493 Leukoencephalopathy, 111, 450 Levofloxacin, 94, 126, 450 Library Services, 390, 450 Life Expectancy, 16, 44, 49, 215, 296, 373, 450 Ligament, 450, 474 Ligands, 414, 450 Likelihood Functions, 450, 478 Limbic, 59, 401, 438, 450, 473 Limbic System, 59, 401, 438, 450, 473 Linear Models, 450, 478 Linkage, 60, 414, 436, 451 Lip, 227, 451 Lipid A, 41, 451 Lipid Bilayers, 262, 451

510 Dialysis

Lipid Peroxidation, 149, 155, 192, 451, 463 Lipophilic, 259, 451 Lipopolysaccharides, 451 Lipoprotein, 104, 132, 171, 427, 438, 451, 452 Lipoprotein Lipase, 104, 451 Liquor, 265, 451 Lithium, 404, 451 Liver scan, 451, 481 Liver Transplantation, 54, 451 Lobe, 403, 415, 442, 451, 465 Local therapy, 37, 451 Localized, 69, 401, 428, 433, 445, 449, 451, 469, 490 Lod, 60, 451 Lod Score, 60, 451 Logistic Models, 452, 478 Longitudinal Studies, 421, 452 Longitudinal study, 36, 55, 88, 126, 181, 452 Long-Term Care, 55, 452 Loop, 39, 261, 452 Lovastatin, 452, 484 Low-density lipoprotein, 181, 427, 451, 452 Lubricants, 452, 467 Lumen, 72, 217, 246, 252, 257, 267, 412, 429, 452 Luminescence, 250, 452 Lupus, 214, 444, 452 Lymph, 332, 407, 416, 429, 452, 459, 481 Lymph node, 332, 407, 452, 459, 481 Lymphatic, 429, 445, 452, 485 Lymphatic system, 452, 485 Lymphocyte, 403, 453, 454 Lymphoid, 403, 453 Lysine, 440, 453, 493 M Macrophage, 79, 447, 453 Magnetic Resonance Imaging, 453, 481 Malabsorption, 336, 453 Malaria, 9, 453 Malaria, Falciparum, 453 Malaria, Vivax, 453 Malignant, 103, 136, 214, 398, 404, 405, 453, 457, 474, 477 Malignant tumor, 214, 453, 457 Malondialdehyde, 130, 453 Mammary, 420, 451, 453 Mammogram, 411, 453, 455 Managed Care Programs, 312, 453 Manic, 404, 451, 453, 475

Manifest, 271, 453 Meat, 278, 280, 282, 307, 348, 371, 374, 454 Medial, 34, 46, 405, 438, 454, 462, 482 Median Nerve, 413, 454 Mediate, 48, 66, 298, 414, 426, 454 Mediator, 129, 447, 454, 483 Medical Records, 8, 88, 371, 454, 480 Medicament, 269, 454 MEDLINE, 347, 454 Medullary, 45, 67, 454 Mefloquine, 96, 454 Megakaryocytes, 454, 490 Megaloblastic, 434, 454 Meiosis, 454, 488 Melanin, 454, 468, 493 Membrane Fusion, 37, 454 Memory, 57, 361, 403, 423, 454 Meninges, 414, 421, 454, 487 Menopause, 149, 156, 177, 454 Menstruation, 454 Mental Disorders, 211, 454, 475 Mental Health, iv, 33, 81, 88, 211, 294, 346, 352, 361, 454, 475 Mental Processes, 426, 454, 475 Mentors, 48, 55, 455 Mercury, 252, 455 Mesencephalic, 43, 455, 478 Mesentery, 455, 467 Mesolimbic, 53, 404, 455, 495 Mesothelial, 111, 149, 155, 329, 455 Meta-Analysis, 5, 91, 455 Metabolic disorder, 42, 311, 455 Metabolite, 47, 233, 411, 425, 434, 452, 455, 473 Metastasis, 414, 455 Metastatic, 195, 455 Methamphetamine, 364, 455 Methionine, 35, 173, 255, 425, 455, 488 MI, 95, 126, 148, 154, 243, 268, 269, 395, 455 Mice Minute Virus, 455, 465 Microbe, 231, 455, 491 Microbiology, 125, 133, 135, 398, 406, 455 Microcalcifications, 411, 455 Micronutrients, 35, 456 Microorganism, 417, 456, 496 Microsome, 260, 456 Microtubules, 45, 456, 463 Midodrine, 113, 129, 340, 456 Migration, 73, 79, 456 Milliliter, 410, 456 Mitochondria, 456, 458, 462

Index 511

Mitochondrial Swelling, 456, 458 Mitosis, 405, 456 Mitotic, 431, 456 Mobilization, 191, 456 Modeling, 54, 67, 259, 274, 279, 456 Modification, 39, 92, 109, 203, 238, 436, 456, 476 Molecular Probes, 428, 456 Molecular Structure, 456, 492 Monoamine, 174, 401, 424, 457 Monoclonal, 442, 457, 477 Monocyte, 79, 95, 181, 457 Mononuclear, 457, 493 Monotherapy, 121, 123, 457 Morphine, 291, 364, 417, 457, 458, 462 Morphogenesis, 72, 457 Morphological, 428, 457 Morphology, 275, 457 Motility, 457, 483 Motion Sickness, 457, 458 Motor Activity, 420, 457 Movement Disorders, 404, 457 Mucolytic, 397, 457 Mucosa, 435, 452, 457 Multicenter study, 100, 148, 154, 172, 457 Multiple Myeloma, 140, 457 Multiple sclerosis, 214, 457 Mupirocin, 29, 457 Muscimol, 48, 457 Mutagenesis, 41, 457 Mutagens, 457 Myasthenia, 438, 458 Mydriatic, 425, 458 Myelin, 457, 458 Myocardial Reperfusion, 458, 479 Myocardial Reperfusion Injury, 458, 479 Myocardium, 455, 458 Myosin, 458, 492 N Narcotic, 457, 458 Natural Disasters, 365, 458 Nausea, 297, 317, 332, 335, 361, 362, 374, 403, 404, 435, 458, 493, 494 NCI, 1, 210, 345, 458 Necrosis, 101, 219, 316, 329, 405, 415, 420, 445, 455, 458, 479, 481 Neoplastic, 442, 458, 481 Nephrectomy, 125, 149, 155, 458 Nephritis, 248, 459 Nephropathy, 42, 80, 85, 299, 317, 328, 449, 459 Nephrosis, 459

Nephrotic, 115, 459 Nervous System, 13, 75, 201, 297, 397, 399, 400, 401, 408, 414, 417, 424, 435, 437, 454, 455, 457, 459, 460, 467, 471, 473, 483, 485, 487, 488, 495 Networks, 203, 299, 318, 324, 459 Neural, 42, 45, 47, 53, 110, 399, 401, 442, 459, 482 Neurogenic, 75, 459 Neuroleptic, 399, 404, 459 Neurologic, 219, 275, 300, 312, 317, 459 Neuromuscular, 397, 459, 493 Neuromuscular Junction, 397, 459 Neuronal, 45, 459 Neurons, 42, 48, 56, 59, 67, 69, 417, 423, 431, 435, 447, 459, 460, 476, 477, 480, 488 Neuropathy, 61, 298, 301, 309, 459, 466 Neuropsychology, 55, 459 Neurosis, 459, 468 Neurosurgical Procedures, 49, 459 Neurotensin, 69, 459 Neurotoxic, 13, 45, 60, 444, 457, 460 Neurotoxicity, 103, 131, 460 Neurotoxin, 45, 68, 460 Neurotransmitters, 174, 460, 473 Neutralization, 75, 214, 460 Neutrons, 400, 460, 476 Neutrophil, 248, 460 Nickel, 38, 460 Nitric Oxide, 75, 460 Norepinephrine, 398, 426, 460 Normotensive, 32, 460 Nosocomial, 16, 30, 95, 460 Nuclear, 37, 38, 193, 407, 412, 417, 427, 431, 435, 450, 458, 460, 461, 477, 489, 493 Nuclear Pore, 37, 460 Nuclear Proteins, 460, 461 Nuclei, 45, 400, 401, 427, 430, 436, 453, 456, 460, 461, 470, 475, 482 Nucleic acid, 89, 229, 255, 263, 412, 431, 435, 458, 460, 461, 476, 480 Nucleocapsid, 461, 496 Nucleus Accumbens, 53, 59, 66, 68, 461, 495 Nursing Care, 4, 27, 201, 276, 300, 368, 461, 465 Nursing Staff, 26, 287, 461 O Occipital Lobe, 461, 496 Octreotide, 167, 461 Ocular, 277, 461 Oculomotor, 455, 461

512 Dialysis

Odds Ratio, 461, 479 Odour, 405, 461, 493 Olfaction, 45, 461 Oligosaccharides, 400, 461 Oliguria, 449, 462 Omentum, 91, 462 On-line, 66, 70, 134, 242, 251, 264, 393, 462 Opacity, 423, 462 Opium, 457, 462 Optic Chiasm, 444, 462 Optic Disk, 424, 462 Organ Culture, 73, 462, 490 Organ Procurement, 318, 358, 462 Organ Transplantation, 54, 79, 462 Organelles, 39, 415, 422, 462, 470 Orthostatic, 65, 404, 461, 462 Osmolality, 76, 235, 462 Osmoles, 462 Osmosis, 235, 236, 238, 264, 266, 291, 368, 462 Osmotic, 148, 149, 154, 155, 224, 235, 254, 278, 298, 400, 456, 462, 483 Osmotic Fragility, 149, 155, 462 Osteitis Fibrosa Cystica, 306, 462 Osteoclasts, 306, 463 Osteodystrophy, 6, 275, 306, 463 Outpatient, 4, 7, 14, 18, 19, 21, 34, 85, 368, 380, 453, 463 Overdose, 275, 278, 300, 364, 463 Oxalate, 72, 463 Oxidants, 75, 463 Oxidation, 38, 179, 238, 397, 404, 422, 437, 451, 463, 465, 489 Oxidation-Reduction, 463 Oxidative metabolism, 260, 398, 399, 463 Oxidative Stress, 58, 77, 121, 191, 269, 463 Oxygen Consumption, 47, 463, 479 Oxygenation, 50, 230, 444, 463 Oxygenator, 61, 463 P Paclitaxel, 37, 185, 187, 463 Palliative, 283, 463, 489 Palpation, 4, 463 Panacea, 177, 464 Pancreas, 10, 16, 203, 286, 309, 397, 405, 409, 416, 425, 446, 464, 482, 485, 493 Pancreas Transplant, 16, 17, 203, 286, 309, 464 Pancreas Transplantation, 16, 17, 203, 286, 309, 464 Pancreatic, 314, 413, 416, 434, 464 Pancreatic Juice, 416, 464

Pancreatitis, 10, 464 Paralysis, 455, 464 Parasite, 464 Parasitic, 214, 464 Parasitic Diseases, 214, 464 Parathyroid Glands, 118, 464, 480 Parathyroid hormone, 6, 20, 84, 152, 159, 190, 207, 208, 209, 210, 296, 306, 335, 367, 374, 411, 464 Parathyroidectomy, 20, 103, 112, 127, 464 Parenteral, 77, 91, 96, 169, 183, 202, 279, 311, 330, 429, 464 Parenteral Nutrition, 91, 96, 202, 279, 311, 330, 464 Parietal, 403, 464, 467, 470 Parkinsonism, 404, 465 Parotid, 465, 481 Particle, 72, 465, 485 Parvovirus, 75, 455, 465 Pathogenesis, 16, 20, 74, 78, 143, 201, 296, 305, 338, 465 Pathologic, 232, 397, 405, 409, 411, 420, 443, 465, 479 Pathologic Processes, 405, 465 Pathophysiology, 23, 49, 60, 61, 69, 120, 121, 150, 157, 312, 379, 465 Patient Care Management, 302, 465 Patient Compliance, 5, 308, 337, 349, 384, 465 Patient Isolation, 16, 33, 465 Patient Satisfaction, 5, 312, 465 Patient Selection, 306, 366, 465 Pediatric Nursing, 316, 465 Peer Review, 103, 147, 465 Pelvic, 465, 474 Pentosephosphate Pathway, 465, 491 Pepsin, 466 Pepsin A, 466 Peptic, 298, 466 Peptic Ulcer, 298, 466 Peptide, 37, 38, 69, 107, 131, 248, 429, 466, 470, 471, 474 Peptide T, 69, 466 Perception, 5, 195, 308, 466, 481 Percutaneous, 22, 25, 51, 52, 97, 118, 127, 200, 218, 246, 466 Perennial, 265, 466, 492 Perforation, 105, 434, 466 Perfusion, 39, 49, 229, 237, 297, 434, 444, 466 Pericarditis, 297, 304, 466 Pericardium, 466

Index 513

Perioperative, 129, 277, 466 Peripheral blood, 242, 447, 466 Peripheral Neuropathy, 101, 190, 466 Peripheral Vascular Disease, 6, 35, 197, 300, 466 Peripheral vision, 466, 496 Peritoneal Dialysis, Continuous Ambulatory, 366, 467 Peritoneum, 130, 182, 224, 240, 254, 278, 306, 365, 368, 375, 455, 462, 467 Perivascular, 37, 467 Peroxidase, 47, 451, 467 Peroxide, 96, 467 Petroleum, 271, 467 PH, 75, 129, 163, 173, 179, 193, 380, 410, 467 Phagocyte, 463, 467 Pharmaceutical Preparations, 414, 431, 467 Pharmacist, 302, 467 Pharmacodynamic, 99, 291, 467 Pharmacokinetic, 97, 98, 99, 187, 260, 291, 467 Pharmacologic, 152, 158, 187, 278, 300, 402, 439, 467, 491 Phenobarbital, 364, 467 Phenotype, 42, 467 Phenylalanine, 466, 468, 493 Phlebotomy, 311, 468 Phobia, 10, 468 Phobic Disorders, 468 Phosphates, 225, 468 Phospholipids, 432, 451, 468 Phosphorous, 92, 383, 468 Phosphorylated, 417, 468 Phosphorylation, 40, 73, 77, 83, 468 Photocoagulation, 417, 468 Photodynamic therapy, 245, 468 Physical Examination, 76, 303, 317, 363, 468 Physiology, 37, 45, 47, 85, 144, 151, 157, 257, 275, 278, 284, 285, 310, 372, 380, 427, 459, 468 Pigment, 408, 468 Pilot study, 44, 82, 130, 205, 469 Plants, 400, 412, 416, 417, 436, 437, 448, 457, 460, 469, 471, 485, 491, 492, 495 Plaque, 122, 402, 469 Plasma cells, 403, 457, 469 Plasma Exchange, 277, 469 Plasma Kallikrein, 449, 469 Plasma protein, 400, 429, 469, 474, 483

Plasma Volume, 304, 410, 469 Plasmapheresis, 291, 404, 469 Plasmid, 263, 469, 495 Plasmin, 248, 469, 491, 494 Plasminogen, 248, 469, 491, 494 Plasminogen Activators, 469 Plasticity, 440, 469 Plastids, 462, 470 Platelet Activation, 79, 470 Platelet Aggregation, 402, 460, 470 Platelet-Derived Growth Factor, 79, 470 Plateletpheresis, 404, 470 Platelets, 80, 376, 460, 470, 490 Platinum, 416, 452, 470 Pleomorphic, 461, 470 Plethysmograph, 47, 66, 68, 470 Plethysmography, 65, 470 Pleural, 455, 470 Podophyllotoxin, 431, 470 Point System, 280, 470 Poisoning, 197, 221, 279, 284, 411, 423, 435, 447, 455, 458, 470, 482 Policy Making, 437, 470 Polycystic, 11, 44, 72, 317, 470, 471 Polycystic Kidney Diseases, 72, 471 Polymers, 39, 62, 238, 259, 448, 471, 474, 487 Polymorphism, 103, 471 Polypeptide, 77, 401, 417, 433, 466, 469, 471, 485, 497 Polyposis, 418, 471 Polysaccharide, 399, 403, 414, 471, 474 Polytetrafluoroethylene, 4, 50, 244, 245, 268, 334, 471 Polyunsaturated fat, 180, 471 Polyurethanes, 47, 471 Pons, 471, 480 Pontine, 171, 471 Popliteal, 82, 471 Porosity, 260, 471 Porphyria, 376, 468, 471 Porphyria Cutanea Tarda, 468, 471 Porphyrins, 471 Port, 119, 143, 218, 236, 246, 247, 249, 251, 252, 256, 261, 471, 472 Port-a-cath, 472 Posterior, 75, 111, 402, 426, 430, 461, 464, 472 Postnatal, 53, 472, 486 Postoperative, 280, 286, 434, 472 Postsynaptic, 56, 472, 488 Potentiates, 447, 472

514 Dialysis

Potentiating, 219, 472 Povidone, 29, 472 Practice Guidelines, 22, 273, 295, 338, 348, 349, 352, 381, 382, 472 Prealbumin, 128, 472 Preceptorship, 54, 472 Precipitation, 230, 263, 472 Preclinical, 71, 472 Precursor, 402, 426, 427, 429, 460, 468, 469, 472, 473, 474, 493, 496 Prednisolone, 472 Prednisone, 376, 472 Preferred Provider Organizations, 453, 472 Prefrontal Cortex, 56, 59, 66, 69, 473 Preload, 113, 473 Prenatal, 428, 473 Presynaptic, 407, 473, 488 Presynaptic Terminals, 407, 473 Probe, 41, 47, 56, 71, 237, 330, 438, 455, 473 Problem Solving, 202, 312, 473 Prodrug, 434, 473 Professional Practice, 106, 473 Progression, 34, 44, 46, 55, 74, 81, 85, 100, 283, 299, 303, 309, 403, 473 Progressive, 36, 44, 86, 302, 305, 309, 332, 334, 365, 405, 414, 416, 420, 423, 426, 438, 449, 458, 470, 471, 473, 479 Projection, 447, 460, 473, 476, 478, 495 Promoter, 48, 77, 473 Promyelocytic leukemia, 136, 473 Prone, 84, 92, 166, 167, 473 Prophase, 473, 488 Prophylaxis, 372, 473, 494 Proportional, 89, 462, 473 Prospective Studies, 85, 87, 473 Prospective study, 28, 55, 78, 79, 87, 123, 124, 208, 452, 473 Prostate, 110, 380, 408, 449, 474 Prostate-Specific Antigen, 110, 449, 474 Prostatic Hyperplasia, 474 Prosthesis, 240, 474 Protease, 25, 37, 248, 474, 490 Protease Inhibitors, 248, 474 Protein Binding, 64, 260, 266, 474 Protein C, 5, 63, 64, 77, 86, 192, 361, 400, 401, 404, 407, 433, 451, 474, 492, 494 Protein S, 40, 41, 187, 254, 255, 293, 409, 436, 442, 474, 480 Protein Transport, 330, 474 Protein-Energy Malnutrition, 314, 474 Proteinuria, 19, 436, 457, 474

Proteoglycans, 407, 432, 474 Proteolytic, 72, 248, 400, 418, 429, 433, 449, 469, 474, 490, 494 Prothrombin, 474, 490 Protocol, 6, 33, 58, 63, 70, 219, 250, 381, 474 Protons, 400, 442, 475, 476 Proto-Oncogene Proteins, 463, 475 Proto-Oncogene Proteins c-mos, 463, 475 Protozoa, 409, 456, 475, 485 Proximal, 23, 39, 72, 246, 257, 267, 426, 473, 475, 482 Proxy, 361, 475 Pruritus, 18, 141, 192, 365, 475, 493 Psychiatric, 277, 454, 475 Psychiatry, 69, 188, 433, 475, 495 Psychic, 459, 475, 482 Psychological Theory, 36, 475 Psychology, 35, 53, 66, 284, 426, 459, 475 Psychophysiology, 459, 475 Psychosis, 404, 475 Psychotomimetic, 401, 424, 475 Public Health, 34, 54, 76, 85, 294, 295, 296, 352, 370, 372, 475 Public Policy, 283, 347, 475 Publishing, 10, 93, 274, 275, 276, 321, 475 Pulmonary, 18, 122, 277, 300, 409, 419, 434, 440, 444, 449, 476, 495 Pulmonary Alveoli, 444, 476 Pulmonary Artery, 409, 476, 495 Pulmonary Edema, 300, 449, 476 Pulmonary Embolism, 18, 476 Pulse, 128, 134, 223, 457, 476 Punctures, 236, 476 Pupil, 420, 425, 458, 476 Purifying, 221, 240, 257, 476 Purines, 476, 483 Pyelonephritis, 310, 476 Pyramidal Cells, 69, 423, 476 Pyridoxal, 176, 421, 476, 492 Pyrogenic, 243, 264, 476 Q Quaternary, 38, 238, 476 Quinpirole, 69, 476 R Race, 7, 14, 22, 31, 54, 81, 297, 329, 456, 476 Radiation, 37, 62, 215, 252, 421, 428, 431, 434, 435, 443, 447, 476, 477, 481, 497 Radiation therapy, 37, 431, 434, 443, 447, 476, 481 Radioactive, 410, 439, 442, 445, 447, 448, 449, 451, 456, 460, 477, 481, 489, 493 Radioactivity, 38, 477

Index 515

Radiography, 363, 402, 420, 477 Radioisotope, 430, 477, 491 Radiolabeled, 477 Radiological, 106, 370, 372, 466, 477 Radiology, 51, 81, 82, 116, 119, 123, 124, 128, 142, 194, 276, 477 Radiotherapy, 410, 477, 486 Random Allocation, 477 Randomization, 35, 477 Randomized clinical trial, 58, 76, 81, 477 Raphe Nuclei, 45, 477 Reactivation, 92, 477 Reactive Oxygen Species, 75, 77, 477 Reagent, 217, 238, 431, 442, 478 Receptor, 45, 48, 60, 67, 68, 69, 71, 73, 75, 77, 103, 171, 260, 398, 403, 415, 426, 437, 444, 466, 467, 476, 478, 483 Receptors, Serotonin, 478, 483 Recombinant, 65, 76, 108, 117, 183, 194, 195, 207, 209, 278, 304, 305, 340, 478, 495 Recombination, 436, 478 Reconstitution, 37, 478 Rectal, 219, 478 Rectum, 404, 410, 418, 425, 434, 435, 440, 446, 450, 474, 478 Red blood cells, 173, 184, 286, 317, 332, 360, 381, 430, 440, 471, 478 Red Nucleus, 478, 495 Reductase, 46, 181, 452, 478, 484 Refer, 1, 250, 348, 350, 411, 418, 433, 434, 447, 459, 460, 471, 475, 478 Refraction, 403, 478, 485 Refractory, 96, 240, 427, 478 Regeneration, 91, 478 Regimen, 36, 149, 153, 155, 159, 201, 301, 303, 315, 333, 416, 427, 465, 478 Regression Analysis, 10, 81, 478 Rehabilitation, Vocational, 367, 478 Rehabilitative, 303, 478 Relative risk, 11, 18, 20, 479 Renal Artery, 82, 443, 479 Renal Dialysis, 36, 49, 65, 71, 74, 82, 109, 145, 201, 202, 238, 239, 244, 283, 288, 292, 330, 479 Renal Osteodystrophy, 6, 209, 279, 286, 297, 306, 310, 315, 338, 357, 365, 479 Renal pelvis, 449, 479 Renal Replacement Therapy, 9, 13, 15, 33, 38, 65, 180, 244, 277, 300, 302, 304, 314, 338, 479 Renin, 44, 74, 296, 402, 479 Renin-Angiotensin System, 74, 479

Renovascular, 75, 479 Reperfusion, 71, 458, 479 Reperfusion Injury, 71, 479 Resorption, 411, 463, 479 Respiration, 251, 404, 412, 415, 456, 479 Respiratory Physiology, 479, 495 Restoration, 142, 367, 458, 477, 478, 479, 480, 497 Reticular, 171, 480 Reticular Formation, 171, 480 Retina, 424, 450, 462, 480, 481 Retinal, 138, 189, 424, 425, 462, 480 Retinopathy, 61, 301, 309, 424, 480 Retrospective, 20, 23, 29, 53, 89, 182, 480 Retrospective study, 20, 480 Rheumatism, 480 Rheumatoid, 214, 248, 463, 480 Rheumatoid arthritis, 214, 248, 480 Ribavirin, 30, 480 Ribose, 398, 480 Ribosome, 480, 492 Rickets, 411, 480, 496 Rigidity, 447, 465, 469, 480 Rod, 407, 416, 481 Rubber, 259, 397, 427, 481, 486 S Saline, 12, 54, 92, 164, 233, 235, 245, 411, 469, 481 Salivary, 422, 425, 481 Salivary glands, 422, 425, 481 Salpingectomy, 125, 481 Salvage Therapy, 96, 481 Saphenous, 420, 481 Saphenous Vein, 420, 481 Sarcoidosis, 332, 481 Satellite, 4, 60, 108, 292, 481 Scans, 215, 481 Schizoid, 481, 496 Schizophrenia, 59, 69, 324, 481, 495, 496 Schizotypal Personality Disorder, 481, 496 Sclerosis, 177, 186, 405, 457, 481 Screening, 6, 31, 35, 61, 129, 139, 259, 266, 297, 416, 481 Seafood, 283, 481 Second Messenger Systems, 460, 481 Secretion, 79, 149, 155, 209, 441, 446, 447, 461, 482, 494 Sedative, 417, 482 Segmental, 223, 436, 482 Segmentation, 482 Segregation, 465, 478, 482 Seizures, 317, 423, 482

516 Dialysis

Selenium, 148, 152, 153, 155, 159, 172, 190, 482 Selenomethionine, 255, 482 Self Care, 4, 8, 10, 334, 336, 361, 482 Semen, 474, 482 Semisynthetic, 412, 414, 431, 482 Sensitization, 69, 482 Sensor, 39, 45, 49, 201, 221, 230, 237, 243, 250, 268, 482 Sepsis, 9, 118, 434, 482 Septal, 403, 450, 482 Septal Nuclei, 403, 450, 482 Septic, 122, 126, 243, 316, 406, 482 Septicemia, 76, 98, 482 Sequence Homology, 466, 483 Sequencing, 38, 483 Serine, 25, 248, 416, 421, 429, 449, 474, 475, 483, 490, 493 Seroconversion, 31, 483 Serologic, 483 Serotonin, 45, 67, 404, 478, 483, 493 Serous, 429, 483 Serum Albumin, 5, 6, 7, 14, 19, 22, 25, 32, 57, 67, 70, 86, 91, 284, 338, 351, 472, 483 Sex Characteristics, 398, 483, 489 Shivering, 68, 483, 489 Shock, 126, 316, 394, 483, 492 Shunt, 244, 268, 483 Sick Role, 313, 483 Side effect, 339, 342, 364, 366, 370, 398, 399, 404, 409, 454, 483, 491 Signs and Symptoms, 223, 361, 363, 364, 483, 493 Silicon, 39, 483 Silicon Dioxide, 39, 483 Simvastatin, 46, 139, 484 Skeletal, 209, 416, 457, 484, 485, 492 Skeleton, 241, 397, 432, 449, 484 Skull, 421, 447, 484, 489 Sleep apnea, 16, 45, 141, 484 Small intestine, 72, 408, 416, 426, 442, 444, 447, 484, 493 Smooth muscle, 36, 47, 50, 79, 245, 400, 402, 434, 441, 449, 457, 479, 484, 485, 487 Social Environment, 476, 484 Social Isolation, 10, 481, 484 Social Support, 5, 7, 78, 88, 202, 484 Social Work, 19, 70, 200, 202, 280, 285, 296, 302, 313, 323, 377, 484 Socioeconomic Factors, 31, 484 Sodium, 23, 73, 92, 154, 160, 195, 224, 225, 235, 245, 258, 276, 278, 279, 280, 282,

283, 285, 296, 298, 307, 311, 315, 320, 322, 359, 365, 369, 374, 383, 400, 410, 462, 484 Sodium Bicarbonate, 224, 484 Soft tissue, 410, 484 Solvent, 229, 265, 270, 408, 431, 437, 462, 484 Soma, 476, 484, 485 Somatic, 69, 398, 442, 450, 454, 456, 466, 473, 485 Somatostatin, 461, 485 Sound wave, 419, 485 Soybean Oil, 471, 485 Space Flight, 65, 485 Spasm, 455, 485, 489 Specialist, 7, 301, 302, 305, 376, 385, 425, 485 Specificity, 50, 88, 247, 399, 429, 485 Spectrometer, 40, 485 Spectrophotometry, 259, 485 Spectrum, 19, 203, 215, 434, 485 Sperm, 416, 485, 493 Spermatozoa, 397, 482, 485 Spike, 320, 485 Spinal cord, 406, 414, 415, 421, 430, 454, 459, 485, 487 Spleen, 332, 401, 422, 452, 481, 485 Spores, 235, 485 Stabilization, 37, 56, 485 Staging, 481, 486 Staphylococcus, 28, 95, 207, 435, 486 Statistically significant, 18, 19, 25, 26, 66, 486 Steady state, 77, 486 Steatosis, 177, 486 Steel, 26, 27, 416, 486 Stem Cells, 91, 430, 486 Stent, 74, 140, 486 Stereotactic, 103, 486 Sterile, 62, 224, 226, 231, 232, 235, 242, 243, 252, 264, 269, 406, 464, 486 Sterility, 445, 486 Sterilization, 31, 33, 62, 222, 254, 264, 372, 486 Steroid, 408, 420, 484, 486 Stethoscopes, 82, 486 Stimulant, 401, 424, 441, 455, 486 Stimulus, 66, 68, 426, 427, 431, 446, 448, 450, 468, 486, 490 Stomach, 72, 397, 406, 425, 430, 435, 442, 458, 462, 466, 467, 484, 485, 486 Stool, 12, 450, 486

Index 517

Strand, 166, 486 Streptococci, 457, 487 Striatum, 174, 461, 487 Stroke, 49, 55, 82, 136, 211, 221, 319, 346, 412, 413, 487 Stroke Volume, 412, 487 Styrene, 481, 487 Subacute, 445, 487 Subarachnoid, 106, 439, 487 Subclavian, 23, 334, 407, 487 Subclavian Artery, 487 Subclavian Vein, 23, 334, 407, 487 Subclinical, 32, 445, 482, 487 Subcutaneous, 26, 27, 140, 218, 231, 234, 246, 360, 427, 464, 487 Subcutaneous port, 218, 231, 487 Subiculum, 59, 441, 487 Subspecies, 485, 487 Substance P, 455, 478, 482, 487 Substrate, 53, 265, 427, 429, 487 Subtrochanteric, 441, 487 Suction, 237, 433, 487 Sudden death, 68, 487 Sulfur, 38, 432, 455, 487 Superoxide, 104, 488 Superoxide Dismutase, 104, 488 Support group, 19, 74, 378, 488 Suppression, 488 Suppressive, 214, 488 Survival Rate, 43, 488 Suspensions, 235, 488 Sympathomimetic, 401, 424, 426, 430, 455, 460, 488 Symphysis, 474, 488 Symptomatic, 13, 24, 30, 299, 380, 464, 488 Symptomatology, 167, 488 Synapses, 460, 485, 488 Synapsis, 488 Synaptic, 59, 488 Synergistic, 37, 488 Systemic, 8, 13, 37, 69, 85, 93, 214, 244, 332, 340, 341, 360, 401, 404, 409, 423, 430, 440, 444, 445, 472, 477, 481, 482, 484, 488 Systolic, 23, 26, 60, 225, 443, 488, 489 Systolic blood pressure, 60, 489 T Tachycardia, 407, 489 Tachypnea, 407, 489 Tardive, 404, 489 Technetium, 170, 489 Teicoplanin, 97, 489 Temporal, 18, 56, 82, 401, 439, 441, 489

Temporal Lobe, 401, 489 Terbium, 149, 155, 489 Testosterone, 478, 489 Tetany, 464, 489 Thalamus, 424, 430, 450, 473, 489 Therapeutics, 46, 71, 113, 153, 160, 171, 341, 489 Thermal, 68, 220, 403, 426, 460, 489 Thermogenesis, 68, 489 Thigh, 432, 438, 489 Third Ventricle, 405, 430, 444, 489 Thoracic, 138, 424, 454, 487, 489, 496 Thorax, 397, 489 Threonine, 466, 475, 483, 489 Threshold, 261, 424, 431, 443, 490 Thrombectomy, 24, 51, 123, 128, 298, 334, 428, 490 Thrombin, 79, 248, 433, 470, 474, 490 Thrombocytes, 470, 490 Thrombocytopenia, 108, 490 Thrombolytic, 26, 341, 469, 490 Thrombomodulin, 474, 490 Thrombopoietin, 107, 490 Thrombosed, 51, 100, 123, 128, 134, 142, 151, 158, 298, 490 Thromboses, 51, 91, 490 Thrombosis, 21, 36, 50, 51, 52, 79, 92, 102, 123, 244, 246, 301, 334, 474, 487, 490 Thrombus, 79, 248, 267, 420, 445, 458, 470, 490 Thyroid, 376, 448, 464, 490, 493 Thyroid Gland, 464, 490 Thyroxine, 117, 400, 468, 490 Time Management, 26, 27, 490 Tin, 413, 466, 470, 490 Tissue Culture, 266, 490 Tissue Harvesting, 462, 490 Tissue Plasminogen Activator, 134, 490 Tolerance, 150, 156, 178, 223, 313, 398, 437, 491 Tomography, 80, 193, 491 Tonic, 47, 59, 491 Tonicity, 427, 440, 448, 491 Tooth Preparation, 398, 491 Topical, 141, 406, 431, 442, 484, 491 Topoisomerase inhibitors, 448, 491 Torsion, 445, 491 Total Quality Management, 312, 491 Toxicity, 47, 214, 230, 252, 260, 284, 311, 332, 338, 426, 455, 491 Toxicity Tests, 260, 491 Toxicology, 71, 114, 348, 491

518 Dialysis

Trace element, 311, 314, 315, 417, 460, 483, 490, 491 Tracer, 65, 491 Trachea, 490, 491 Traction, 416, 491 Transaldolase, 41, 491 Transaminase, 305, 491 Transcutaneous, 26, 234, 492 Transfection, 263, 409, 428, 492 Transferases, 437, 492 Transfusion, 431, 492 Translation, 22, 75, 88, 255, 492 Translational, 73, 492 Translocation, 474, 492 Transmitter, 56, 397, 406, 407, 426, 448, 454, 460, 488, 492 Trauma, 17, 65, 130, 217, 221, 332, 423, 430, 458, 464, 492 Trees, 481, 492 Tremor, 455, 465, 492 Tricuspid Valve, 122, 492 Tricyclic, 180, 492 Trigger zone, 404, 492 Triglyceride, 150, 156, 443, 492 Trimetazidine, 191, 492 Trophic, 64, 492 Tropomyosin, 492 Troponin, 102, 106, 107, 328, 492 Trypsin, 248, 397, 416, 429, 493 Tryptophan, 417, 483, 493 Tubercle, 461, 493 Tuberculosis, 419, 452, 493 Tubulin, 456, 493 Tumor Necrosis Factor, 48, 493 Type 2 diabetes, 41, 301, 314, 493 Tyrosine, 43, 235, 426, 493 U Ultrasonography, 80, 127, 493 Unconscious, 444, 493 Universal Precautions, 16, 30, 33, 285, 320, 493 Uraemia, 174, 464, 493 Uranium, 489, 493 Ureter, 91, 449, 479, 494 Urethra, 408, 474, 494 Uric, 109, 229, 250, 251, 297, 476, 494 Urinary, 64, 240, 290, 317, 380, 414, 422, 462, 491, 494 Urinary Plasminogen Activator, 491, 494 Urinary tract, 317, 414, 494 Urodynamic, 363, 494 Urokinase, 248, 494

Urology, 72, 110, 114, 125, 129, 132, 149, 155, 170, 188, 192, 380, 494 Uterus, 454, 459, 494 V Vaccination, 121, 142, 165, 305, 494 Vaccine, 30, 33, 207, 329, 340, 398, 474, 494 Vacuoles, 462, 494 Vagina, 423, 454, 494 Valves, 39, 227, 494 Vascular endothelial growth factor, 150, 156, 167, 174, 494 Vasculitis, 464, 494 Vasodilation, 219, 494 Vasodilator, 411, 426, 441, 458, 492, 495 VE, 142, 495 Vector, 82, 223, 464, 495 Vegetative, 235, 495 Venom, 68, 149, 155, 495 Venous blood, 220, 242, 409, 415, 450, 495 Venous Pressure, 234, 495 Ventilation, 47, 443, 495 Ventral, 42, 45, 56, 60, 67, 405, 443, 461, 471, 495 Ventral Tegmental Area, 56, 60, 495 Ventricle, 75, 401, 413, 441, 461, 476, 488, 489, 492, 495 Ventricular, 4, 6, 23, 32, 60, 80, 89, 107, 112, 206, 279, 304, 379, 458, 495 Ventricular Dysfunction, 32, 89, 279, 495 Ventricular Function, 304, 495 Venules, 410, 412, 429, 495 Vesicular, 474, 495 Veterinarians, 318, 495 Veterinary Medicine, 325, 347, 495 Viral, 30, 33, 37, 73, 230, 305, 397, 412, 420, 433, 436, 496 Viral vector, 73, 496 Viremia, 410, 496 Virosomes, 230, 263, 496 Virulence, 406, 491, 496 Virus, 15, 25, 30, 33, 75, 94, 95, 96, 98, 99, 129, 135, 136, 142, 144, 305, 320, 370, 372, 407, 412, 414, 436, 437, 447, 461, 469, 496 Viscera, 455, 485, 496 Visceral, 450, 467, 496 Viscosity, 265, 397, 496 Visual Cortex, 166, 178, 179, 496 Visual field, 141, 462, 496 Vitamin D, 39, 90, 315, 341, 480, 496 Vitreous Hemorrhage, 424, 496 Vitro, 75, 77, 78, 260, 441, 496

Index 519

Vivo, 38, 39, 43, 53, 56, 59, 62, 69, 71, 73, 75, 77, 82, 92, 94, 99, 114, 122, 166, 167, 174, 178, 179, 189, 190, 216, 229, 230, 241, 245, 260, 263, 441, 445, 455, 463, 496 W Wakefulness, 47, 423, 496 Weight Gain, 15, 301, 367, 374, 496 White blood cell, 131, 145, 264, 403, 450, 452, 453, 457, 460, 469, 496 Windpipe, 490, 496

Withdrawal, 69, 244, 268, 283, 295, 364, 381, 383, 423, 496 Wound Healing, 39, 414, 457, 497 X Xenograft, 403, 497 X-ray, 38, 126, 127, 349, 410, 413, 419, 434, 435, 453, 460, 476, 477, 481, 486, 497 Y Yeasts, 434, 468, 497 Z Zygote, 419, 497 Zymogen, 416, 474, 497

520 Dialysis

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