20 results on '"Der-Cherng Tarng"'
Search Results
2. Iron supplementation associates with low mortality in pre-dialyzed advanced chronic kidney disease patients receiving erythropoiesis-stimulating agents: a nationwide database analysis
- Author
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Der Cherng Tarng, Jia Sin Liu, Yu Kang Chang, Szu Chun Hung, Chih Cheng Hsu, and Ko Lin Kuo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,medicine.drug_class ,Iron ,medicine.medical_treatment ,Statistics as Topic ,Taiwan ,Disease ,Young Adult ,chemistry.chemical_compound ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,Intensive care medicine ,Prospective cohort study ,Dialysis ,Aged ,Aged, 80 and over ,Transplantation ,Creatinine ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Erythropoiesis-stimulating agent ,Survival Rate ,chemistry ,Nephrology ,Case-Control Studies ,Dietary Supplements ,Injections, Intravenous ,Disease Progression ,Hematinics ,Erythropoiesis ,Female ,Hemodialysis ,business ,Kidney disease - Abstract
A risk/benefit analysis of iron supplementation in pre-dialysis advanced chronic kidney disease (CKD) patients has not been conducted. We aim to assess the effectiveness and the safety of iron supplementation in patients with CKD Stage 5 who have not yet received dialysis (CKD 5 ND).A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From 1 January 2000 to 30 June 2009, we enrolled 31 971 adult patients who had a serum creatinine6 mg/dL and a haematocrit28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without iron supplementation within 90 days after starting ESA therapy. Patient follow-up took place until dialysis, death before initiation of dialysis or 31 December 2009. The primary outcomes were death before initiating dialysis, hospitalization before death or long-term dialysis.After propensity score matching, the patients who received iron supplementation were associated with a lower risk of all-cause death [hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.80-0.90] compared with non-users. The survival benefit of iron use was consistent across the majority of dosage groups, except for those who were treated with monthly IV iron200 mg. Moreover, compared with the non-users, the iron users were associated with a lower risk of hospitalizations (HR, 0.97; 95% CI, 0.94-0.99) but with a higher risk of faster progression to end-stage renal disease (HR, 1.05; 95% CI, 1.01-1.08).Iron supplementation is associated with 15% risk reduction in death among CKD 5 ND patients who received ESA treatment. Randomized studies are needed to validate this association.
- Published
- 2015
3. SP438BIOPSY OR NOT? PREDICTORS OF PURE DIABETIC NEPHROPATHY IN TYPE 2 DIABETES PATIENTS
- Author
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Chih Yu Yang, Der-Cherng Tarng, Jyh-Tong Hsieh, and An-Hang Yang
- Subjects
Diabetic nephropathy ,Transplantation ,medicine.medical_specialty ,medicine.diagnostic_test ,Nephrology ,business.industry ,Internal medicine ,Biopsy ,Medicine ,Type 2 diabetes ,business ,medicine.disease ,Gastroenterology - Published
- 2018
4. SP076INDOXYL SULFATE IMPAIRS VALSARTAN-INDUCED NEOVASCULIZATION IN MICE OF REMNANT KIDNEY
- Author
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Ko Lin Kuo, Tzong Shyuan Lee, and Der-Cherng Tarng
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Remnant kidney ,chemistry.chemical_compound ,Endocrinology ,Valsartan ,chemistry ,Nephrology ,Internal medicine ,medicine ,Sulfate ,business ,medicine.drug - Published
- 2018
5. FO024PHYSICAL ACTIVITY AND REDUCED RISKS FOR END-STAGE RENAL DISEASE AND MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS
- Author
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Wei-Cheng Tseng, Der-Cherng Tarng, and Chou-Pin Kuo
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Internal medicine ,medicine ,medicine.disease ,business ,Kidney disease ,End stage renal disease - Published
- 2018
6. SP501A COMPETING RISK ANALYSIS OF CARDIOVASCULAR COMPLICATION AFTER CENTRAL VENOUS CATHETERS IN HEMODIALYSIS PATIENTS
- Author
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Pei-Hung Chuang, Der-Cherng Tarng, Chi-Hao Liu, and Jinn-Yang Chen
- Subjects
Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Cardiovascular Complication ,medicine.medical_treatment ,Medicine ,Hemodialysis ,business ,Intensive care medicine ,Competing risks - Published
- 2016
7. Early prediction of response to intravenous iron supplementation by reticulocyte haemoglobin content and high-fluorescence reticulocyte count in haemodialysis patients
- Author
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Ren Shyan Liu, Yau-Huei Wei, Tung Po Huang, Chiao Lin Chuang, and Der Cherng Tarng
- Subjects
Male ,medicine.medical_specialty ,Reticulocytes ,Anemia ,Ferric Compounds ,Gastroenterology ,Fluorescence ,Glucaric Acid ,Hemoglobins ,Reticulocyte Count ,Reticulocyte ,Predictive Value of Tests ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Erythropoiesis ,Prospective Studies ,Erythropoietin ,Ferric Oxide, Saccharated ,Transplantation ,Univariate analysis ,Anemia, Iron-Deficiency ,biology ,business.industry ,Transferrin saturation ,Middle Aged ,Prognosis ,medicine.disease ,Recombinant Proteins ,Ferritin ,medicine.anatomical_structure ,Nephrology ,Injections, Intravenous ,Immunology ,biology.protein ,Female ,Hemoglobin ,business ,medicine.drug - Abstract
Background. Optimal response to recombinant human erythropoietin (rHuEpo) in haemodialysis (HD) patients requires provision of sufficient available iron. However, a balance between iron requirements and supplements remains a challenge in clinical practice. Reticulocyte parameters, i.e. reticulocyte haemoglobin content (CHr) and reticulocytes in a high-fluorescence intensity region (HFR), have been shown to be accurate predictors of iron-deficient erythropoiesis as compared with traditional markers. Therefore, the aim of this study was to appraise the diagnostic power of these two parameters in the early prediction of response to intravenous iron (IVFE) medications in HD patients receiving rHuEpo. Methods. Sixty-five HD patients with a serum ferritin level of -500 mgul and on rHuEpo therapy for )6 months were enrolled for IVFE supplementation (100 mg iron saccharate three times a week for 4 weeks, then 100 mg every 2 weeks for 5 months). Haemoglobin, haematocrit, serum ferritin, transferrin saturation, reticulocyte count, percentage of hypochromic red cells, CHr and HFR were measured before and following iron supplementation. Response was defined as a rise in haematocrit of )3% anduor a reduction in rHuEpo dose of )30% over the baseline values at the end of the study. Results. Forty-two patients had a dramatic response to IVFE therapy with a 13.5% increase in mean haematocrit and a 38% reduction in rHuEpo dose at the end of the study (P-0.001). This paralleled a statistically significant rise in CHr and HFR (P0.001). Univariate analyses showed that ferritin (P-0.010) and CHr (P-0.001) at baseline, changes in CHr (DCHr2W, P-0.001) and HFR (DHFR2W, P-0.010) at 2 weeks, as well as changes in CHr (DCHr4W, P-0.001) and HFR (DHFR4W, P-0.001) at 4 weeks, strongly correlated with response to IVFE supplementation. Stepwise discriminant analysis disclosed that DCHr4W in conjunction with DHFR4W exhibited an r 2 value of 0.531 (P-0.001) to predict response to IVFE therapy. Analyses by receiver operating characteristic curves and logistic regression further revealed that DCHr4W at a cut-off value of )1.2 pg and DHFR4W of )500uml were more specific to the status of iron-deficient erythropoiesis following IVFE medications. Combined use of the two cut-off values allowed for the highest accuracy in the early prediction of the response toIVFE therapy,with a sensitivity of 96% and a specificity of 100%. Conclusions. Our study shows that changes in CHr and HFR at either 2 or 4 weeks are superior to the conventional erythrocyte and iron metabolism indices and may serve as reliable parameters to detect irondeficient erythropoiesis in HD patients undergoing rHuEpo therapy. During aggressive IVFE treatment, early identification of non-responsiveness and subsequent discontinuation of treatment can avoid the inadvertent iron-related toxicity due to over-treatment.
- Published
- 2003
8. Determinants of circulating soluble transferrin receptor level in chronic haemodialysis patients
- Author
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Tung Po Huang and Der Cherng Tarng
- Subjects
Male ,medicine.medical_specialty ,Iron ,Renal function ,Cohort Studies ,Renal Dialysis ,Internal medicine ,Receptors, Transferrin ,medicine ,Humans ,Erythropoiesis ,Erythropoietin ,Soluble transferrin receptor ,chemistry.chemical_classification ,Transplantation ,biology ,medicine.diagnostic_test ,Transferrin saturation ,business.industry ,Complete blood count ,Middle Aged ,Recombinant Proteins ,Epoetin Alfa ,Cross-Sectional Studies ,Endocrinology ,chemistry ,Nephrology ,Transferrin ,Hematinics ,biology.protein ,Serum iron ,Kidney Failure, Chronic ,Regression Analysis ,Female ,business ,Biomarkers ,medicine.drug - Abstract
Background. The aim of this study was to identify the factors determining the circulating soluble transferrin receptor (sTf R) concentrations in haemodialysis (HD) patients on maintenance recombinant human erythropoietin (rHuEpo) treatment. Methods. In a prospective cross-sectional study, 91 chronic HD patients and 18 anaemic controls with normal renal function were recruited. For each subject, blood samples were measured for complete blood count, reticulocyte count, percentage of hypochromic red cells (% HRC), serum ferritin, serum iron, transferrin saturation (TS), serum erythropoietin (sEpo), C-reactive protein (CRP), and sTf R. HD patients received constant rHuEpo doses and basal sEpo was measured P86 h after the last injection. The age, gender, dialysis vintage, and the above-mentioned parameters were used as independent variables and logarithmic sTfR (log10 sTfR) as a dependent variable in the forward stepwise multiple regression model. Results. HD patients were similar to controls regarding haematocrit, serum ferritin, TS, and % HRC, but had significantly lower sTf R, sEpo, and reticulocyte index. Univariate analyses showed that the sTf R level strongly correlated with sEpo (rs0.60, P-0.001) and % HRC (rs0.60, P-0.001), and significantly with serum ferritin (rs0.29, P-0.01), TS (rs0.27, P-0.05), and dose of rHuEpo administered (rs0.27, P-0.05) in HD patients. sTf R also had a positive correlation with haematocrit (rs0.26, P-0.05), red blood cell (RBC) count (rs0.23, P-0.05), and reticulocyte count (rs0.24, P-0.05), but not with CRP (rs0.16, P)0.05). Multivariate regression analysis disclosed that sEpo, HRC, and serum ferritin were the independent predictors of sTf R level. Overall, the model explained 58.8% of the variability in sTfR (R 2 s0.588, P-0.001). Conclusions. Circulating sTf R is a good index of marrow erythropoietic activity in HD patients during rHuEpo treatment. Its level is also independently up-regulated by functional iron deficiency in the process of enhanced erythropoiesis. Our study showed that sTf R levels quantitatively reflect the integrated effects of iron availability, iron reserves, and erythropoietic stimulation.
- Published
- 2002
9. SP260HIGH SALT DIET ALTERS GUT MICROBIOTA LEADING TO INFLAMMATION AND PROGRESSION OF CKD
- Author
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Szu-Chun Hung, Tzu-Min Yang, and Der-Cherng Tarng
- Subjects
Transplantation ,biology ,business.industry ,Inflammation ,030204 cardiovascular system & hematology ,Gut flora ,biology.organism_classification ,Salt diet ,03 medical and health sciences ,0302 clinical medicine ,Nephrology ,Immunology ,medicine ,030212 general & internal medicine ,Microbiome ,medicine.symptom ,business - Published
- 2017
10. Erythropoietin and iron: the role of ascorbic acid
- Author
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Tung Po Huang, Yau-Huei Wei, and Der Cherng Tarng
- Subjects
medicine.medical_specialty ,Antioxidant ,Anemia ,Iron ,medicine.medical_treatment ,Ascorbic Acid ,chemistry.chemical_compound ,Internal medicine ,medicine ,Humans ,Erythropoietin ,Transplantation ,business.industry ,Drug Synergism ,Metabolism ,Iron deficiency ,medicine.disease ,Ascorbic acid ,Recombinant Proteins ,Endocrinology ,chemistry ,Nephrology ,Injections, Intravenous ,Kidney Failure, Chronic ,Erythropoiesis ,Protoporphyrin ,business ,medicine.drug - Abstract
Provision of sufficient available iron is a prerequisite to ensure the optimal response to recombinant human erythropoietin (rHuEpo). Functional iron deficiency (a state when iron supply is reduced to meet the demands for increased erythropoiesis) is the common cause of rHuEpo hyporesponsiveness in dialysis patients who have normal iron status, even when they are iron-overloaded. Iron supplementation is not justified for this hyporesponsiveness in patients with iron overload due to the potential hazards of iron overload aggravated by intravenous iron therapy. Furthermore, in vivo studies indicated that the promising effect of intravenous iron medication to overcome iron-deficient erythropoiesis is not observed in iron-overloaded haemodialysis (HD) patients. Ascorbic acid, a water-soluble antioxidant as well as a reducing agent, has a number of associations with iron metabolism. Recent research highlights that ascorbic acid can potentiate the mobilization of iron from inert tissue stores and facilitates the incorporation of iron into protoporphyrin in iron-overloaded HD patients being treated with rHuEpo. Interest has turned towards the use of ascorbic acid as an adjuvant therapy in this field. This review focuses on the improvement of rHuEpo response by administration of ascorbic acid and discusses its clinical implications and potential issues for nephrologists.
- Published
- 2001
11. Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients
- Author
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Gau Jun Tang, Bing Shi Lin, Chi Woon Kong, Tung Po Huang, and Der Cherng Tarng
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheters, Indwelling ,Renal Dialysis ,Jugular vein ,medicine ,Humans ,Internal jugular vein ,Dialysis ,Aged ,Ultrasonography ,Uremia ,Transplantation ,business.industry ,Ultrasound ,Middle Aged ,medicine.disease ,Occult ,Surgery ,Catheter ,Nephrology ,Female ,Hemodialysis ,Jugular Veins ,business ,Kidney disease - Abstract
Background. Creation of a reliable haemoaccess is a critical problem for practicing nephrologists once haemodialysis has been considered. A double-lumen internal jugular-vein catheter is favoured in most cases requiring temporary haemoaccess. However, numerous complications, even lethal ones, may occur with the cannulating procedure. Using ultrasound, we attempted to describe the occult anatomical variations of vessels which may be responsible for complications. Methods. A 'SiteRite' ultrasonographic device was used to inspect the anatomical structure of the internal jugular veins (IJV) in 104 consecutive uraemic patients undergoing creation of internal jugular vein temporary angioaccess. Images of the vessels and demographic data of patients were recorded and analysed. Results. Anatomical variations of the right and left IJVs were found in 19 (18.3%) and 17 (16.4%) uraemic patients respectively. Unilateral IJV variations were found in 18 patients (17.3%) and bilateral variations were discovered in nine patients (8.7%). A total of 27 patients (26.0%) had IJV anatomical variations that might contribute to difficulty in external landmark guided IJV cannulation. Conclusions. The external anatomical landmarks for cannulating the IJV are not reliable in about one quarter of uraemic patients. An ultrasound survey on the IJV anatomy is recommended for selecting proper puncture site and reducing risks of insertion complica tions for IJV dialysis catheters.
- Published
- 1998
12. A lady with a broken haemodialysis catheter fragment
- Author
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Po Hsun Huang, Ching Chang Hu, Su Chen Lin, Der Cherng Tarng, and Shiou Shan Tseng
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Catheters, Indwelling ,Renal Dialysis ,medicine ,Humans ,Internal jugular vein ,Uremia ,Transplantation ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Catheter ,Nephrology ,Haemodialysis catheter ,Angiography ,Kidney Failure, Chronic ,Equipment Failure ,Female ,Radiography, Thoracic ,Hemodialysis ,Complication ,business - Abstract
Double-lumen haemodialysis catheters are commonly used for temporary venous access in end-stage renal failure patients who require urgent haemodialysis but who do not have mature vascular access. However, catheter dysfunction, such as thrombosis and infection, is not uncommon. Because the replacement of a nonfunctional double-lumen catheter into a new site exposes patients to greater risk of mechanical complications, guide wire exchange of the catheter is an alternative technique to reduce risk, as long as no exitsite or tunnel infection is present w1x. Here, we report a case of accidental migration of a double-lumen catheter fragment into the internal jugular vein during a guide wire exchange. Immediate retrieval of the fragment was successful by way of a percutaneous transfemoral venous approach. Both surgical removal of the intravascular catheter fragment and prolonged hospitalization after surgery were avoided.
- Published
- 2002
13. Fever and backache in a haemodialysis patient
- Author
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Ko Lin Kuo, Der Cherng Tarng, and Szu Chun Hung
- Subjects
Transplantation ,medicine.medical_specialty ,Lumbar Vertebrae ,Fever ,business.industry ,Middle Aged ,Tuberculosis, Central Nervous System ,Magnetic Resonance Imaging ,Radiography ,Text mining ,Back Pain ,Renal Dialysis ,Nephrology ,medicine ,Humans ,Female ,Intensive care medicine ,business - Published
- 2001
14. Peritonitis in CAPD patients—do not always use antibiotics!
- Author
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Chin Huang Chen, Tzen Wen Chen, and Der Cherng Tarng
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Peritonitis ,Peritoneal dialysis ,Peritoneal Dialysis, Continuous Ambulatory ,Internal medicine ,medicine ,Humans ,Mycosis ,Aged ,Transplantation ,business.industry ,Continuous ambulatory peritoneal dialysis ,Bacterial Infections ,Acute Kidney Injury ,Peritoneal eosinophilia ,medicine.disease ,Anti-Bacterial Agents ,Surgery ,Nephrology ,Dialisis peritoneal ,business - Published
- 2001
15. Post‐infectious glomerulonephritis in a patient with vesicorenal malacoplakia—coincidence or causal relationship?
- Author
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Jinn Yang Chen, An Hang Yang, Shing Hwa Lu, and Der Cherng Tarng
- Subjects
Pathology ,medicine.medical_specialty ,Kidney Glomerulus ,Malacoplakia ,Glomerulonephritis ,Post-infectious glomerulonephritis ,medicine ,Humans ,Escherichia coli Infections ,Transplantation ,Kidney ,biology ,business.industry ,Histology ,Middle Aged ,medicine.disease ,biology.organism_classification ,Enterobacteriaceae ,medicine.anatomical_structure ,Nephrology ,Female ,business ,Complication ,Kidney disease - Published
- 2000
16. FP343RENOPROTECTIVE EFFECT OF COMBINING PENTOXIFYLLINE WITH RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKADE IN PRE-DIALYZED ADVANCED CHRONIC KIDNEY DISEASE PATIENTS -A NTIONWIDE DATABASE ANALYSIS
- Author
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Ko Lin Kuo, Szu-Chun Hung, Jia-Sin Liu, Der-Cherng Tarng, Chih-Cheng Hsu, and Yu-Kang Chang
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Database analysis ,Pharmacology ,medicine.disease ,Blockade ,Pentoxifylline ,Endocrinology ,Nephrology ,Internal medicine ,Renin–angiotensin system ,Medicine ,business ,Kidney disease ,medicine.drug - Published
- 2015
17. Resistance to recombinant human erythropoietin treatment in thalassaemic patients on chronic haemodialysis: a real clinical entity?
- Author
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C.-Y. Fan, J.-G. Chang, Tung Po Huang, Tzen-Wen Chen, and Der Cherng Tarng
- Subjects
Transplantation ,medicine.medical_specialty ,Pediatrics ,business.industry ,law.invention ,Nephrology ,law ,Erythropoietin ,Internal medicine ,Recombinant DNA ,Medicine ,Chronic hemodialysis ,business ,medicine.drug - Published
- 1996
18. A rare cause of oedema
- Author
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Szu Chun Hung and Der Cherng Tarng
- Subjects
Male ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Lymphography ,Pulmonary Edema ,medicine.disease ,Surgery ,Nephrology ,medicine ,Edema ,Humans ,Lymphedema ,Hemodialysis ,business ,Aged ,Kidney disease - Published
- 2004
19. Fistulizing TB peritonitis during CAPD (Section Editor: G. H. Neild)
- Author
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Szu Chun Hung, Der Cherng Tarng, and Wu Chang Yang
- Subjects
Transplantation ,medicine.medical_specialty ,Tuberculosis ,business.industry ,medicine.medical_treatment ,Peritoneal fluid ,Continuous ambulatory peritoneal dialysis ,Peritonitis ,Pyrazinamide ,medicine.disease ,Peritoneal dialysis ,Surgery ,Nephrology ,medicine ,Chills ,medicine.symptom ,business ,Ethambutol ,medicine.drug - Abstract
A 42-year-old woman who was receiving long-term continuous ambulatory peritoneal dialysis (CAPD) for renal failure was admitted to the hospital because of high fever and chills. Five years earlier, she had been diagnosed to have tuberculous (TB) lymphadenitis based on neck lymph-node biopsy and had been treated with rifampicin, isoniazid and ethambutol for 9 months. She remained well until 1 month before admission, when she began to develop fatigue and body-weight loss. On physical examination, the patient’s abdomen was generally tender, with guarding and rebound tenderness. Initial peritoneal fluid cell count was 18uml and then became 300uml with neutrophil predominance on day 3. Peritoneal fluid for Gram stain and acid-fast bacilli smear were negative. Specimens of blood and peritoneal fluid were obtained for culture and empirical antibiotic therapy was started. However, daily fever spikes persisted, with nightly shaking chills and sweats despite changing antibiotics to a combination of vancomycin, ceftazidime and metronidazole for possible septic syndrome. A computed tomographic scan of the abdomen and pelvis showed ascitic fluid, thickening and oedema of the mesentery and omentum, and multiple enlarged lymph nodes. Repeated peritoneal fluid cultures were sterile. The peritoneal catheter was removed and the patient was transferred to haemodialysis. Six weeks after admission, the peritoneal fluid culture grew Mycobacterium tuberculosis, which was found to be sensitive to isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin on susceptibility testing. The patient was placed on anti-TB medications consisting of isoniazid, rifampicin and pyrazinamide. The patient was readmitted 3 months later, however, with recurrence of fever and pus discharge from the umbilicus. The pus smear was positive with a moderate (2q) amount of acid-fast bacilli present. A fistulogram (Figure 1), performed under fluoroscopy with contrast injection into the umbilical orifice through an 8 Fr. Foley’s catheter, revealed even dispersion of the contrast medium into the peritoneal cavity, suggesting a direct communication. To our knowledge, umbilical fistula formation has never been observed in association with TB peritonitis during CAPD [1]. The umbilicus is the thinnest part of the lower abdomen. As the peritoneal granulomatous inflammation expands due to non-compliance or development of
- Published
- 2003
20. Iron supplementation associates with low mortality in pre-dialyzed advanced chronic kidney disease patients receiving erythropoiesis-stimulating agents: a nationwide database analysis.
- Author
-
Ko-Lin Kuo, Szu-Chun Hung, Jia-Sin Liu, Yu-Kang Chang, Chih-Cheng Hsu, and Der-Cherng Tarng
- Subjects
TREATMENT of chronic kidney failure ,IRON in the body ,HEMODIALYSIS ,ERYTHROPOIESIS ,MEDICAL databases ,RISK assessment - Abstract
Background. A risk/benefit analysis of iron supplementation in pre-dialysis advanced chronic kidney disease (CKD) patients has not been conducted. We aim to assess the effectiveness and the safety of iron supplementation in patients with CKD Stage 5 who have not yet received dialysis (CKD 5 ND). Methods. A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From 1 January 2000 to 30 June 2009, we enrolled 31 971 adult patients who had a serum creatinine >6 mg/dL and a haematocrit <28% and who were treated with erythropoiesis- stimulating agents (ESAs). All patients were further divided into two groups with or without iron supplementation within 90 days after starting ESA therapy. Patient follow-up took place until dialysis, death before initiation of dialysis or 31 December 2009. The primary outcomes were death before initiating dialysis, hospitalization before death or long-term dialysis. Results. After propensity score matching, the patients who received iron supplementation were associated with a lower risk of all-cause death [hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.80-0.90] compared with non-users. The survival benefit of iron use was consistent across the majority of dosage groups, except for those who were treated with monthly IV iron >200 mg. Moreover, compared with the non-users, the iron users were associated with a lower risk of hospitalizations (HR, 0.97; 95% CI, 0.94-0.99) but with a higher risk of faster progression to end-stage renal disease (HR, 1.05; 95% CI, 1.01-1.08). Conclusions. Iron supplementation is associated with 15% risk reduction in death among CKD 5NDpatients who received ESA treatment. Randomized studies are needed to validate this association. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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