210 results on '"Michael J. Germain"'
Search Results
102. The relative efficacy of telephone and email reminders to elicit blood donation
- Author
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Michael J. Germain and Gaston Godin
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Reminder Systems ,Blood Donors ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Sex Factors ,Phone ,Medicine ,Humans ,030212 general & internal medicine ,Registries ,Aged ,Demography ,Relative efficacy ,Electronic Mail ,business.industry ,Hematology ,General Medicine ,Middle Aged ,Phone call ,Telephone ,Blood donor ,Physical therapy ,Female ,business - Abstract
The aim of the study was to test the relative efficacy of telephone and email reminders to trigger blood donation. A sample of 3454 donors was randomized to one of three conditions: phone only (n = 1176), email only (n = 1091) and phone + email (n = 1187). There was a higher proportion of donors who registered to give blood in the phone + email condition (18·45%) compared to the other two conditions (phone: 15·73%, P < 0·05; email: 13·20%; P < 0·001); this effect was apparent only in men. The phone and email conditions did not differ significantly (P = 0·16), suggesting equivalent efficacy.
- Published
- 2015
103. List of Contributors
- Author
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Farsad Afshinnia, Anupam Agarwal, Gerald B. Appel, Susan P. Bagby, James L. Bailey, George L. Bakris, Brendan J. Barrett, Carolyn A. Bauer, Tomas Berl, Jeffrey S. Berns, Andrew Bomback, Anirban Bose, Frank C. Brosius, Lee K. Brown, David A. Bushinsky, Laurence W. Busse, Ruth C. Campbell, Helen Cathro, Lakhmir S. Chawla, Sheldon Chen, Glenn M. Chertow, Emily Chew, Michel Chonchol, David M. Clive, Debbie L. Cohen, Lewis M. Cohen, Scott D. Cohen, Ashte’ K. Collins, Sara Combs, Ricardo Correa-Rotter, Daniel Cukor, Monica Dalal, Tavis Dancik, Andrew Davenport, Sara Davison, Dick de Zeeuw, Pierre Delanaye, Sushma M. Dharia, Mirela A. Dobre, Paul Drawz, Albert W. Dreisbach, Michael Emmett, John H. Fanton, Arnold J. Felsenfeld, Hilda Fernandez, Michael F. Flessner, Barry I. Freedman, Yvette Fruchter, Susan L. Furth, Guillermo García-García, Michael J. Germain, Gregory G. Germino, Michael S. Goligorsky, Arthur Greenberg, Lisa M. Guay-Woodford, Katrina Hawkins, Charles A. Herzog, Jean L. Holley, Thomas H. Hostetter, Andrew A. House, Keith A. Hruska, Yonghong Huan, Hassan N. Ibrahim, Nashat Imran, Jonathan Chávez Iñiguez, Robert T. Isom, Kristen L. Jablonski, Kenar D. Jhaveri, Kirsten Johansen, Richard J. Johnson, Milind Y. Junghare, Duk-Hee Kang, Feras F. Karadsheh, Jameela Kari, Bertram L. Kasiske, Charbel C. Khoury, Paul L. Kimmel, Jeffrey B. Kopp, Andrew Kummer, Hiddo J.Lambers Heerspink, Lilach O. Lerman, Adeera Levin, Barton S. Levine, Susie Q. Lew, Sreedhar Mandayam, Tej K. Mattoo, Sharon E. Maynard, Timothy W. Meyer, William E. Mitch, Alvin H. Moss, Marva Moxey-Mims, Paul Muntner, Anne M. Murray, Karl A. Nath, Joel Neugarten, Gloria No, Madeleine V. Pahl, Mark S. Paller, Biff F. Palmer, Patrick S. Parfrey, Samir S. Patel, Roberto Pecoits-Filho, Steven J. Peitzman, Aldo J. Peixoto, Phuong-Chi T. Pham, Phuong-Thu T. Pham, Ton J. Rabelink, Jai Radhakrishnan, Anas Raed, Dominic S. Raj, Juan Carlos Ramirez-Sandoval, Jane F. Reckelhoff, Claudio Ronco, Mark E. Rosenberg, Mitchell H. Rosner, Brad Rovin, Prabir Roy-Chaudhury, Rebecca Ruebner, Andrew D. Rule, Jeff M. Sands, Steven J. Scheinman, Lynn E. Schlanger, Michael E. Seifert, Stephen Seliger, Ajay K. Singh, John C. Stendahl, Kameswaran Surendran, Stephen C. Textor, Ravi I. Thadhani, Raymond R. Townsend, Mark L. Unruh, Joseph A. Vassalotti, Nosratola D. Vaziri, Manuel T. Velasquez, Nisha Ver Halen, Connie J. Wang, Christoph Wanner, Marc Weber, Matthew R. Weir, Maria R. Wing, Michelle P. Winn, David C. Wymer, Jerry Yee, and Fuad N. Ziyadeh
- Published
- 2015
104. Treatment of Psychiatric Disorders in Chronic Kidney Disease Patients
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John H. Fanton, Lewis M. Cohen, and Michael J. Germain
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Nephrology ,medicine.medical_specialty ,business.industry ,Renal function ,Cognition ,urologic and male genital diseases ,medicine.disease ,Mental health ,female genital diseases and pregnancy complications ,Epidemiology of child psychiatric disorders ,Internal medicine ,medicine ,Psychopharmacology ,business ,Psychiatry ,Kidney disease - Abstract
This chapter examines the treatment and comprehensive management of patients with co-morbid psychiatric disorders, including eating and cognitive disorders, and CKD. Nephrologists need to coordinate care with community mental health resources. Practical and theoretical information, including pharmacologic considerations related to diminution in renal function, are necessary to assist the clinical nephrologist in the use of psychopharmacological treatments, including those for both pediatric and elderly patients with CKD.
- Published
- 2015
105. Withdrawal from dialysis: a palliative care perspective
- Author
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S Chater, Michael J. Germain, Sara N. Davison, and Lewis M. Cohen
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Adult ,Male ,Nephrology ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,MEDLINE ,Pilot Projects ,Disease ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Intensive care medicine ,Survival analysis ,Dialysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Palliative Care ,Retrospective cohort study ,General Medicine ,Middle Aged ,Euthanasia, Passive ,Survival Analysis ,Emergency medicine ,Etiology ,Kidney Failure, Chronic ,Female ,business - Abstract
A retrospective chart review was conducted in this pilot study of 35 patients who withdrew from dialysis and were followed by a palliative care team. Data included etiology of end-stage renal disease, comorbid illnesses, mode of dialysis and duration, survival time after withdrawal, reason for withdrawal, mental competency, symptom management, and the nature of death. Mean survival time was 10 days. The most frequent symptoms following withdrawal were confusion, agitation, pain and dyspnea. 1/3 of the sample were cognitively impaired at the time of the withdrawal decision. 17% experienced suffering during the withdrawal period, 24% had unrelieved symptoms, 19% psychological distress, while just over 1/3 of patients died alone. With the provision of palliative care, symptom prevalence in the last 24 hours dropped from 53 to 20% for pain, 68 to 33% for agitation and 46 to 26% for dyspnea. Opioids and benzodiazepines were used in the treatment of over 90% of patients. Palliative medicine has the potential to improve the care of patients who discontinue dialysis.
- Published
- 2006
106. Anemia in the Elderly: The Hidden Threat
- Author
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Michael J. Germain, Richard Eisenstaedt, and Maude Babington
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Pediatrics ,medicine.medical_specialty ,Anemia ,business.industry ,medicine ,Pharmacology (medical) ,medicine.disease ,business - Published
- 2005
107. Update on Psychotropic Medication Use in Renal Disease
- Author
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Michael J. Germain, Edward G. Tessier, Lewis M. Cohen, and Norman B. Levy
- Subjects
medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Population ,Comorbidity ,Disease ,Arts and Humanities (miscellaneous) ,medicine ,Humans ,Risk factor ,education ,Psychiatry ,Intensive care medicine ,Applied Psychology ,Psychotropic Drugs ,education.field_of_study ,Chemotherapy ,Mood Disorders ,business.industry ,Mental Disorders ,Mood stabilizer ,On psychotropic medication ,medicine.disease ,Antidepressive Agents ,Psychiatry and Mental health ,Treatment Outcome ,Anti-Anxiety Agents ,Kidney Diseases ,business ,Antipsychotic Agents ,Half-Life ,Kidney disease - Abstract
Renal failure is a common medical condition, and many patients have comorbid psychiatric disorders. In this review, which is intended as a resource for consultation psychiatrists, the authors discuss pharmacokinetic considerations and provide information about the use of individual psychotropic medications in patients with renal disease. Most psychotropic medications are fat soluble, easily pass the blood-brain barrier, are not dialyzable, are metabolized primarily by the liver, and are excreted mainly in bile. Consequently, the majority of these drugs can be safely used with the end-stage renal disease population.
- Published
- 2004
108. Acute renal failure and hyperkalaemia associated with cyclooxygenase-2 inhibitors
- Author
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Michael H. O'Shea, Gregory Braden, Jeffrey G. Mulhern, and Michael J. Germain
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Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,food.diet ,Urology ,Low sodium diet ,food ,Internal medicine ,medicine ,Humans ,Cyclooxygenase Inhibitors ,Diuretics ,Aged ,Aged, 80 and over ,Transplantation ,Kidney ,Cyclooxygenase 2 Inhibitors ,business.industry ,Membrane Proteins ,Furosemide ,Hyporeninemic hypoaldosteronism ,Acute Kidney Injury ,Middle Aged ,Loop diuretic ,medicine.disease ,Isoenzymes ,Endocrinology ,medicine.anatomical_structure ,Cyclooxygenase 2 ,Prostaglandin-Endoperoxide Synthases ,Nephrology ,Hyperkalemia ,Female ,Hemodialysis ,Diuretic ,business ,medicine.drug ,Kidney disease - Abstract
Background. The renal effects of cyclooxygenase-2 (COX-2) inhibitors have been incompletely elucidated, and acute renal failure (ARF) due to COX-2 inhibitors has been reported. Methods. In order to determine the causes of ARF and hyperkalaemia in five patients during COX-2 inhibitor therapy, we carefully analysed case studies of consecutive in-patients or out-patients referred to our Renal Division over a 6-month period for ARF and hyperkalaemia who had recently received COX-2 inhibitors. Results. ARF developed 2–3 weeks after COX-2 inhibitor therapy in five patients. The ARF was consistent with pre-renal azotaemia from renal hypoperfusion. Four patients were receiving the loop diuretic, furosemide. Four patients developed hyperkalaemia and decreased serum bicarbonate despite diuretic therapy, and one patient had changes in plasma renin activity and aldosterone levels consistent with reversible hyporeninaemic hypoaldosteronism. Renal failure was reversible after discontinuation of diuretics and COX-2 inhibitors. Conclusions. COX-2 inhibitors may cause reversible ARF and hyperkalaemia in patients with oedematous conditions treated with low sodium diets and loop diuretics.
- Published
- 2004
109. CASE REPORT: Pancreatitis and Duodenitis from Sarcoidosis: Successful Therapy with Mycophenolate Mofetil
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Michael J. Germain, Farhad Navab, Gregory Braden, Michael H. O'Shea, Jonathan K. Freeman, Robert L. Madden, Andrew S O'Connor, George S. Lipkowitz, and Jeffrey G. Mulhern
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medicine.medical_specialty ,Systemic disease ,Chemotherapy ,Pancreatic disease ,Physiology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Hepatology ,medicine.disease ,Mycophenolate ,Surgery ,Duodenitis ,Internal medicine ,medicine ,Pancreatitis ,Sarcoidosis ,business - Published
- 2003
110. The Renal Palliative Care Initiative
- Author
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Michael J. Germain, David M. Poppel, and Lewis M. Cohen
- Subjects
Nephrology ,Advance care planning ,medicine.medical_specialty ,Palliative care ,Psychological intervention ,MEDLINE ,Nursing ,New England ,Internal medicine ,Humans ,Medicine ,Program Development ,General Nursing ,Curative care ,Terminal Care ,Social work ,business.industry ,Mortality rate ,Palliative Care ,Hospices ,General Medicine ,Anesthesiology and Pain Medicine ,Family medicine ,Kidney Failure, Chronic ,Advance Directives ,business ,Bereavement - Abstract
Despite ongoing technological advances, patients with end-stage renal disease (ESRD) have a mortality rate of approximately 23% per year, and comorbid cardiovascular, cerebrovascular, and peripheral vascular disorders often make life on dialysis an ordeal. This patient population needs an improved approach to symptom assessment and control, as well as advance care planning and high-quality palliative care. Families need support during the lifetime and after the death of their loved ones. To address these needs, the Renal Palliative Care Initiative (RPCI) was instituted at Baystate Medical Center, a large tertiary care hospital, and at eight dialysis clinics in the Connecticut River Valley. With the cooperation of a large nephrology practice, the Western New England Renal and Transplant Associates, a core group of physicians, nurses, and social workers were trained in palliative medicine, and charged with the goals of developing and implementing innovative interventions. The RPCI's programs include symptom management protocols, advance care planning, and bereavement services for families and staff. The Initiative is increasing completion of formal advance directives by the patient population, while staff and families are particularly pleased with annual renal memorial services. The RPCI experience has much to offer the practice of nephrology, and it is relevant to ongoing efforts to extend palliative medicine beyond the traditional focus on cancer and AIDS.
- Published
- 2003
111. Palliative Care in CKD: The Earlier the Better
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Manjula Kurella Tamura, Michael J. Germain, and Sara N. Davison
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medicine.medical_specialty ,Palliative care ,Nursing ,Nephrology ,business.industry ,MEDLINE ,Medicine ,business ,Intensive care medicine - Published
- 2011
112. A palliative approach to dialysis care: a patient-centered transition to the end of life
- Author
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S. Vanita Jassal, Alvin H. Moss, Rajnish Mehrotra, Vanessa Grubbs, Jeffrey Perl, Michael J. Germain, Daniel E. Weiner, Michael J. Fischer, and Lewis M. Cohen
- Subjects
medicine.medical_specialty ,Palliative care ,Epidemiology ,Dialysis care ,Critical Care and Intensive Care Medicine ,Appropriate use ,Dialysis patients ,Patient Care Planning ,Quality of life (healthcare) ,Nursing ,Patient Education as Topic ,Renal Dialysis ,Patient-Centered Care ,medicine ,Humans ,Intensive care medicine ,Transplantation ,Terminal Care ,business.industry ,Communication ,Palliative Care ,Special Feature ,Patient Preference ,Prognosis ,Home Care Services ,Nephrology ,Life expectancy ,Quality of Life ,Kidney Failure, Chronic ,Dialysis (biochemistry) ,business ,Patient centered - Abstract
As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of
- Published
- 2014
113. Allowing blood donation from men who had sex with men more than 5 years ago: a model to evaluate the impact on transfusion safety in Canada
- Author
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Mindy Goldman, Pierre Robillard, Gilles Delage, and Michael J. Germain
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Adult ,Male ,Risk ,medicine.medical_specialty ,Canada ,Blood Safety ,Sexual Behavior ,Human immunodeficiency virus (HIV) ,Blood Donors ,HIV Infections ,Hiv risk ,medicine.disease_cause ,Unit (housing) ,medicine ,Humans ,Blood Transfusion ,Men having sex with men ,Homosexuality, Male ,Deferral ,business.industry ,Hematology ,General Medicine ,Surgery ,Blood donor ,business ,Sexual contact ,Demography - Abstract
Canada now allows donations from men who had sex with men (MSM) if their last sexual contact with a man was more than 5 years ago. We modelled the impact of this policy on supply and safety. Approximately 4500 new donors will be added and assuming compliance to the new policy remains unchanged, the worst-case scenario predicts the introduction of one HIV-contaminated unit in the inventory every 1072 years. This change will entail negligible additional HIV risk to recipients. A five-year deferral will also protect recipients against the theoretical concern that MSM may represent a group at higher risk of sexually transmitted, emerging blood borne pathogens.
- Published
- 2014
114. Iron dosing in kidney disease: inconsistency of evidence and clinical practice
- Author
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Eliezer A. Rachmilewitz, Michael J. Germain, Yossi Chait, Yelena Ginzburg, Adam E. Gaweda, and George R. Aronoff
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medicine.medical_specialty ,Iron Overload ,Individualized dosing ,Anemia ,Cutting-Edge Renal Science ,hemic and lymphatic diseases ,medicine ,Humans ,In patient ,Dosing ,Renal Insufficiency, Chronic ,Intensive care medicine ,Erythropoietin ,Transplantation ,Anemia, Iron-Deficiency ,business.industry ,Iron deficiency ,medicine.disease ,Surgery ,Clinical Practice ,Nephrology ,Hematinics ,business ,Iron Compounds ,Kidney disease ,medicine.drug - Abstract
The management of anemia in patients with chronic kidney disease (CKD) is difficult. The availability of erythropoiesis-stimulating agents (ESAs) has increased treatment options for previously transfusion-requiring patients, but the recent evidence of ESA side effects has prompted the search for complementary or alternative approaches. Next to ESA, parenteral iron supplementation is the second main form of anemia treatment. However, as of now, no systematic approach has been proposed to balance the concurrent administration of both agents according to individual patient's needs. Furthermore, the potential risks of excessive iron dosing remain a topic of controversy. How, when and whether to monitor CKD patients for potential iron overload remain to be elucidated. This review addresses the question of risk and benefit of iron administration in CKD, highlights the evidence supporting current practice, provides an overview of standard and potential new markers of iron status and outlines a new pharmacometric approach to physiologically compatible individualized dosing of ESA and iron in CKD patients.
- Published
- 2014
115. Bacterial contamination in platelet concentrates
- Author
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I. Symonds, A. Rapaille, Simon Panzer, Erhard Seifried, Carl McDonald, Véronique Deneys, R. Moule, J. P. Cazenave, Cornelius Knabbe, Kai M. Hourfar, A.-M. Svard-Nilsson, Jens Dreier, Jørgen Georgsen, Dirk de Korte, Ruby N.I. Pietersz, C. K. Lin, Jens Kjeldsen-Kragh, Daniele Prati, F. Bernier, Roslyn Yomtovian, S. Kuperman, Mindy Goldman, M. Spreafico, Pascal Morel, Susan R. Brailsford, Michael R. Jacobs, H. W. Reesink, L. Blanco, Tomislav Vuk, Micheline Lambermont, P. F. van der Meer, Sandra Ramirez-Arcos, Michael J. Germain, Gilles Delage, Tanja Vollmer, Masahiro Satake, J. L. Kerkhoffs, L. Bardiaux, C. Naegelen, S. Oknaian, D. Sondag, Alessandra Berzuini, L. Raffaele, and Christian Gabriel
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Blood Platelets ,Bacteria ,business.industry ,Blood preservation ,Plateletpheresis ,Hematology ,General Medicine ,Platelet Transfusion ,Bacterial RNA ,Microbiology ,Blood Preservation ,Immunology ,Medicine ,Humans ,business ,Alert system ,Cells, Cultured - Abstract
R. N. I. Pietersz, H. W. Reesink, S. Panzer, S. Oknaian, S. Kuperman, C. Gabriel, A. Rapaille, M. Lambermont, V. Deneys,D. Sondag, S. Ramirez-Arcos, M. Goldman, G. Delage, F. Bernier, M. Germain, T. Vuk, J. Georgsen, P. Morel, C. Naegelen,L. Bardiaux, J.-P. Cazenave, J. Dreier, T. Vollmer, C. Knabbe, E. Seifried, K. Hourfar, C. K. Lin, M. Spreafico, L. Raffaele,A. Berzuini, D. Prati, M. Satake, D. de Korte, P. F. van der Meer, J. L. Kerkhoffs, L. Blanco, J. Kjeldsen-Kragh,A.-M. Svard-Nilsson, C. P. McDonald, I. Symonds, R. Moule, S. Brailsford, R. Yomtovian & M. R. JacobsSeptic reactions after transfusion, particularly of plateletconcentrates, still occur and belong to the most serioustransfusion reactions. From a previous InternationalForum [1] on the subject, it could be concluded that inpart of the countries that participated in the forum, plate-let concentrates (PCs) were tested for bacterial contamina-tion and that culture-based methods, particularly theBacT/Alert system, were used.In recent years, several rapid bacterial detection meth-ods, such as surrogate measurements of the pH or glu-cose, the detection of bacteria with a scan system orPCR tests that detect bacterial RNA, have been devel-oped. These tests can either be performed immediatelyprior to transfusion of the PC or at a variety of testmoments at which culture and release tests are com-bined.Pathogen inactivation (PI) methods also affect bacterialcontamination of PCs. In 2007 [1], in some countries, theIntercept method of PI of PCs was implemented insteadof bacterial screening.It seemed of interest to evaluate the present state ofthe art of this subject. In order to obtain the desiredinformation, the following questions were sent to expertsin the field.Question 1: How long do you store PC and is there adifference between whole-blood-derived PC and apheresisPC? Which method of preparation do you use for whole-blood-derived PC? Are PCs leuco-reduced?Question 2: Do you use a culture method to detect bac-terial contamination of PC? If so
- Published
- 2014
116. Should DEHP be eliminated in blood bags?
- Author
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Michael J. Germain, Jørgen Georgsen, S. Biagini, S. Ismay, Patricia Scuracchio, D. Dernis, Veerle Compernolle, S. Bégué, Janet Yuen Ha Wong, Simon Panzer, Ralph R. Vassallo, S. Villa, D. de Korte, S. Wendel, Paolo Rebulla, H. Gulliksson, Joanne Pink, Joan Cid, Rebecca Cardigan, Anthony J. Keller, C. Buchta, Naomi L.C. Luban, Mark K. Fung, C. Tooke, Miquel Lozano, Louis Thibault, Richard J. Benjamin, P. F. van der Meer, H. W. Reesink, Minoko Takanashi, and E. Raspollini
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Adolescent ,Metabolite ,Population ,Urine ,Pharmacology ,chemistry.chemical_compound ,Plasticizers ,Internal medicine ,Diethylhexyl Phthalate ,medicine ,Humans ,education ,Whole blood ,education.field_of_study ,Blood Specimen Collection ,Anogenital distance ,Phthalate ,Hematology ,General Medicine ,Haemolysis ,Endocrinology ,chemistry ,Toxicity ,Female - Abstract
Whole blood for transfusion was initially collected in glass bottles, but these are fragile, heavy to transport and prone to bacterial contamination. After the Second World War, Carl Walter experimented with plastics for collection and storage of blood, and found that di-ethylhexyl phthalate (DEHP) as plasticizer for polyvinyl chloride (PVC) had the most favourable properties [1, 2]. The breakage rate of frozen plasma in DEHP PVC is low, and the better storage properties of red cell concentrates in DEHP PVC are explained by leaching of plasticizer into the lipid bilayer of these cells, thereby improving membrane stability resulting in lower haemolysis rates [3]. However, ever since the 1970s, scientific and public concern has been raised on the toxicity of DEHP for transfused patients [4, 5]. DEHP and its metabolite mono ethylhexyl phthalate (MEHP) are associated with impairment of reproduction in animal models, resulting in testicular dysgenesis syndrome in (male) rodents, as reviewed in depth elsewhere [6], and particularly, neonates are susceptible to the risks of high exposure to DEHP. Due to the omnipresence of phthalates (not only DEHP), and some important differences in DEHP metabolism between animal models and humans [6], it is difficult to estimate the effect of DEHP toxicity in humans. A study of 234 young men showed no effect of MEHP in urine on their reproductive function [7], but others showed that DNA damage in sperm was associated with the MEHP concentration (after adjustment for other DEHP oxidative metabolites) [8]. In vitro human testis explants incubated with DEHP or MEHP showed that both significantly inhibited testosterone production [9], and a study of 881 men showed a 9% lower free androgen index between the lowest and the highest quartile of the proportion DEHP excreted as MEHP (P = 0.02) [10]. Also, an association was found between urinary MEHP concentrations and lower free T4 and lower total T3 thyroid hormones in adult men [11]. In addition to these effects on hormonal level in adult males, DEHP and its metabolites can have an effect on fetal development, with a shorter anogenital distance associated with higher metabolite concentrations in urine samples collected during pregnancy [12]. Others found no difference in T4 and testosterone levels, as well as no effect on phallic length in 13 male adolescents 14– 16 years of age that had underwent ECMO treatment in their neonatal period, as compared to ageand sexmatched controls [13]. Also, DEHP/MEHP exposure (as detected in cord blood) was significantly associated with a shorter pregnancy duration [14]. Despite these associations, they should be interpreted with care. DEHP is not the only phthalate that may cause these effects; studies that showed no association may not have been published; DEHP administered through the intestinal tract is converted to MEHP in a higher degree as by intravenously [15]; and because phthalates are everywhere in our environment, comparisons are less versus more, rather than absent versus present. DEHP-plasticized PVC has long been used as standard material for a wide range of applications, like packing foil (including food), building material, toys and plastic devices. DEHP is considered to be a ubiquitous environmental contaminant and is present in air, dust, water, soil and food. The latter is considered to be the main source of DEHP intake for the general population. The current daily intake is estimated to be between 2 and 5 lg/kg for adults and between 4 to 8 lg/kg for children [16, 17]. Various measures to reduce the use of DEHP-plasticized PVC have indeed resulted in a 2-times lower exposure to DEHP in the general population over the last two decades [18]. DEHP is applied in many medical devices, and depending on the procedure, patients can be exposed to high (peak) concentrations of DEHP, in the order of 1 mg per kg of bodyweight. One of the sources of DEHP exposure is the leaching from the blood bags into the content of the container, particularly into lipophilic solutions such as plasma [19], but also red cells. Therefore some patient groups, including pregnant or nursing women and children, are considered to be most at risk of possible harmful effects attributable to DEHP exposure by medical treatments. DEHP is broken down into various metabolites. First, it is hydrolysed to MEHP and then further oxidized to mono-(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP)
- Published
- 2014
117. THE EFFECTS OF LIPID-LOWERING AGENTS ON ACUTE RENAL ALLOGRAFT REJECTION1, 2
- Author
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Karen L. Heim-Duthoy, Bruno Watschinger, Bahar Bastani, Gary G. Singer, Michael J. Germain, and Bertram L. Kasiske
- Subjects
Transplantation ,Kidney ,medicine.medical_specialty ,business.industry ,Urology ,Renal function ,Placebo ,Hydroxymethylglutaryl-CoA reductase ,medicine.anatomical_structure ,Endocrinology ,Simvastatin ,Internal medicine ,medicine ,Gemfibrozil ,lipids (amino acids, peptides, and proteins) ,business ,Adverse effect ,medicine.drug - Abstract
Background. Preliminary results from clinical trials suggest that 3-hydroxy-3-methylglutaryl co-enzyme A reductase inhibitors may help prevent acute renal allograft rejection. However, the mechanism for this putative effect of 3-hydroxy-3-methylglutaryl co-enzyme A reductase inhibitors, and whether it is independent of lipid-lowering per SE are unknown. Methods. Immediately after renal transplantation we randomly allocated (proportioned 2:1:2) patients to: 1) simvastatin (10 mg/day, n=53), 2) simvastatin placebo plus gemfibrozil (dose adjusted for renal function, n=36), and 3) simvastatin placebo (n=52). Results. Simvastatin, but not gemfibrozil, reduced total and low density lipoprotein cholesterol during the first 90 days posttransplant. There were no major adverse effects of therapy. However, there were no effects of treatment on acute rejection. Indeed, survival free of acute rejection at 90 days was 72% in the simvastatin group, 72% in the gemfibrozil group, and 77% in the placebo control group (P=0.771). A post hoc power analysis suggested that there was only a 7.5% chance that a true effect of simvastatin on acute rejection (versus placebo) was not detected, and a 2.5% chance that an effect of gemfibrozil on acute rejection (versus placebo) was not detected in this study. Conclusion. Lipid-lowering agents may not reduce the incidence of acute renal allograft rejection. However, additional studies are needed to confirm this observation. In the mean time, many if not most renal transplant recipients should be treated with HMG-CoA reductase inhibitors starting early posttransplant to prevent cardiovascular disease complications. The results of this study suggest that starting lipid-lowering therapy immediately after renal transplantation is both safe and effective in lowering total and low density lipoprotein cholesterol.
- Published
- 2001
118. Control-relevant erythropoiesis modeling in end-stage renal disease
- Author
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Michael J. Germain, Rajiv P. Shrestha, Joseph Horowitz, Christopher V. Hollot, Yossi Chait, and Brendan Nichols
- Subjects
medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,Feedback control ,Biomedical Engineering ,Disease ,Bioinformatics ,Models, Biological ,End stage renal disease ,medicine ,Humans ,Erythropoiesis ,Intensive care medicine ,Erythropoietin ,Dialysis ,Models, Statistical ,business.industry ,medicine.disease ,Recombinant Proteins ,Kidney Failure, Chronic ,Hemoglobin ,Drug Monitoring ,business ,Algorithms ,medicine.drug - Abstract
Anemia is prevalent in end-stage renal disease (ESRD). The discovery of recombinant human erythropoietin (rHuEPO) over 30 years ago has shifted the treatment of anemia for patients on dialysis from blood transfusions to rHuEPO therapy. Many anemia management protocols (AMPs) used by clinicians comprise a set of experience-based rules for weekly-to-monthly titration of rHuEPO doses based on hemoglobin (Hb) measurements. In order to facilitate the design of an AMP using model-based feedback control theory, we present a physiologically relevant erythropoiesis model and demonstrate its applicability using clinical data.
- Published
- 2013
119. Dialysis discontinuation and palliative care
- Author
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Lewis M. Cohen, Anne Woods, David M. Poppel, Michael J. Germain, and Carl M. Kjellstrand
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Adult ,Male ,Advance care planning ,medicine.medical_specialty ,Palliative care ,Adolescent ,medicine.medical_treatment ,Pain ,Peritoneal dialysis ,Quality of life (healthcare) ,Renal Dialysis ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Intensive care medicine ,Dialysis ,Aged ,Aged, 80 and over ,Terminal Care ,business.industry ,Palliative Care ,Middle Aged ,Euthanasia, Passive ,Discontinuation ,Nephrology ,Female ,business ,Peritoneal Dialysis ,Cohort study - Abstract
Little attention has been accorded to the terminal course and end-of-life care of patients after dialysis discontinuation. This prospective cohort observational study involves six dialysis clinics in the United States and two clinics in Canada. Data were collected on 131 patients who were undergoing maintenance dialysis and died after treatment discontinuation. Seventy-nine of the patients (60%) were prospectively studied until their deaths. Caregivers and families provided information about the symptoms and treatment provided in the final 24 hours of life, and structured interviews were conducted at the time of stopping dialysis with patients and families. The patient population was primarily white (73%), elderly (70 +/- 1.2 years), and diabetic (46%). Three quarters of the subjects had between three and seven comorbid conditions. Pain and agitation were the most common symptoms during the last day of life. Terminal treatment was generally considered to be satisfactory, and most people had good deaths. Although dialysis prolongs life, the integration of palliative medicine into dialysis programs offers opportunities to improve the quality of end-of-life care, especially for those patients who elect to stop treatment. Recommendations include making advance care planning an expectation at all clinics and using quality-of-dying measures to establish benchmarks for the provision of terminal care.
- Published
- 2000
120. Changing incidence of glomerular diseases in adults
- Author
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Shirin Nash, Jeffrey G. Mulhern, Michael H. O'Shea, Gregory Braden, Michael J. Germain, and Angelo A. Ucci
- Subjects
Male ,medicine.medical_specialty ,Pathology ,Kidney Glomerulus ,urologic and male genital diseases ,Gastroenterology ,White People ,Nephropathy ,Diabetic nephropathy ,Membranous nephropathy ,Internal medicine ,Membranoproliferative glomerulonephritis ,medicine ,Humans ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Glomerulonephritis ,Hispanic or Latino ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Black or African American ,Nephrology ,Mesangial proliferative glomerulonephritis ,Female ,Kidney Diseases ,business ,Kidney disease - Abstract
Studies performed at large metropolitan medical centers have reported an increasing incidence of idiopathic focal segmental glomerulosclerosis (FSGS) in adults. To determine whether a similar trend occurs in small urban and rural communities and to determine the role of race in these observations, we reviewed the patient records of all adults who underwent renal biopsies at our institution over the 20-year period from 1974 to 1994. The patients were grouped for analysis in 5-year intervals, 1975 to 1979, 1980 to 1984, 1985 to 1989, and 1990 to 1994, for the following diagnoses: FSGS, membranous nephropathy (MN), minimal change nephropathy (MCN), membranoproliferative glomerulonephritis (MPGN), immunoglobulin A (IgA) nephropathy, chronic glomerulonephritis, diabetic nephropathy, hypertensive nephrosclerosis, and chronic interstitial nephritis. Patients with secondary causes for these lesions were excluded. The relative frequency of FSGS increased from 13.7% during 1975 to 1979 to 25% during 1990 to 1994 (P < 0.05). The relative frequency of MN decreased from 38.3% during 1975 to 1979 to 14.5% during 1990 to 1994 (P < 0.01). There were no changes in the frequencies of MCN, MPGN, IgA nephropathy, chronic glomerulonephritis, diabetic nephropathy, hypertensive nephrosclerosis, or chronic interstitial nephritis over the 20-year period. However, there was a significant increase in the percentage of blacks with FSGS, from 0% in 1975 to 1979 to 22.6% in 1990 to 1994, and an increased percentage of Hispanics with FSGS, from 0% in 1975 to 1979 to 21.3% in 1990 to 1994 (P < 0.05). The modest increase in whites with FSGS did not reach statistical significance. The incidence of MN in blacks and whites decreased over the 20-year period. In the last 5 years, 15 patients per year had FSGS compared with 7 patients per year with MN (P < 0.05). No changes in age or sex between groups or over time accounted for these results. We conclude that FSGS is now diagnosed twice as often as MN and is the most common idiopathic glomerular disease at our hospital. Reasons for this increase include the emergence of FSGS in both Hispanics and blacks, with a modest increase of FSGS in whites. The increase in FSGS in the three most common races in our community suggests that factors other than genetic, perhaps environmental, have a role in the pathogenesis of FSGS.
- Published
- 2000
121. TRANSPLANTATION AND 2-YEAR FOLLOW-UP OF KIDNEYS PROCURED FROM A CADAVER DONOR WITH A HISTORY OF LUPUS NEPHRITIS
- Author
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Robert L. Madden, Gregory Braden, Michael H. O'Shea, Michael J. Germain, Jeffrey G. Mulhern, Jim Freeman, Aleksandr Kurbanov, and George S. Lipkowitz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tissue and Organ Procurement ,Urinalysis ,Biopsy ,Lupus nephritis ,Kidney ,Cadaver ,medicine ,Humans ,Postoperative Period ,Pathological ,Contraindication ,Transplantation ,Frozen section procedure ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Lupus Nephritis ,Iothalamic Acid ,Tissue Donors ,Surgery ,Creatinine ,Kidney Failure, Chronic ,Female ,Renal biopsy ,business - Abstract
Background. Two patients underwent cadaver transplantation with kidneys from a donor with a history of World Health Organization Class IV/V lupus nephritis, and we report their clinical and pathological outcome. Methods. The donor had a diagnosis of lupus nephritis made by renal biopsy 5 years before donation. At the time of donation, a biopsy was performed on the donor and on one of the recipients at 2 months and 1 year after the transplant. Results. Both recipients underwent uneventful renal transplantation. On the first postoperative day, the donor’s final pathological results became available. Although the frozen section seemed to be quite benign, the permanent sections revealed World Health Organization Class II/V lupus nephritis, with full house immunofluorescence and multiple electron dense deposits. Biopsies were performed on recipient #2 at 8 weeks and 1 year after the transplant. These revealed marked diminution followed by complete resolution of all tubular reticular structures and deposits as well as immunofluorescent activity. Both recipients remain with normal renal function and urinalysis at 3 years after the transplant. Conclusion. Although a history of clinically significant renal disease has been considered an absolute contraindication to kidney donation, with appropriate workup and caution, select patients may still be considered, which would increase the potential donor pool.
- Published
- 2000
122. Treadmill Time - A Sensitive Indicator of Improved Functional Capacity in CKD
- Author
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Jeff Gagnon, Beth Evans, Jyovani Joubert, Charles Milch, Richard D. Wood, Michael J. Germain, Allen E. Cornelius, and Laurel Ayvazian
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,business.industry ,medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Treadmill ,business - Published
- 2015
123. Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences
- Author
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David J. Watson, Michael J. Germain, Gregory Braden, Paul T. von Oeyen, and Burritt L. Haag
- Subjects
Adult ,Blood Glucose ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Potassium ,Terbutaline ,chemistry.chemical_element ,Hypokalemia ,Kidney ,chemistry.chemical_compound ,Obstetric Labor, Premature ,Heart Rate ,Pregnancy ,Internal medicine ,Renin ,medicine ,Humans ,Insulin ,Saline ,Aldosterone ,business.industry ,Pregnancy Complications ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Nephrology ,Renal potassium excretion ,Ritodrine ,Injections, Intravenous ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences. The effects of ritodrine and terbutaline on potassium homeostasis, renal function, and cardiac rhythm were assessed in women treated with these drugs for preterm labor. Timed blood and urine samples were obtained for two hours before and during six hours of intravenous ritodrine (N = 5) and terbutaline (N = 5) administered in pharmacologically equivalent doses. No differences were found in any parameters affecting potassium homeostasis or renal function between these drugs. A decrease in mean plasma potassium of 0.9 mEq/liter occurred after 30 minutes of drug infusion (4.2 ± 0.1 to 3.3 ± 0.1 mEq/liter, P < 0.005) before any significant changes in plasma glucose (75.0 ± 4.7 to 93.7 ± 6.1 mg/dl, P = NS) or plasma insulin (12.4 ± 6.0 to 28.4 ±5.1 mU/ml, P = NS). The mean plasma potassium after four hours of drug infusion was 2.5 ±0.1 mEq/liter. Plasma insulin rose to a level known to induce cellular potassium uptake (39.2 ±7.7 mU/ml) after 60 minutes of drug therapy and remained at this level for four hours. Hyperlactatemia occurred at four hours (4.7 ± 0.8 mmol/liter) and the plasma lactate/pyruvate ratio increased in a 10:1 ratio. Both drugs significantly reduced glomerular filtration rate, sodium, potassium, and chloride excretion and urinary flow rate. Changes in acid-base homeostasis, plasma aldosterone, or renal potassium excretion did not contribute to ritodrine- or terbutaline-induced hypokalemia. In 83 women with preterm labor randomly assigned to ritodrine (N = 42) or terbutaline (N = 41), the maximum decrease in plasma potassium occurred after six hours of drug infusion. During Holter monitoring, 3 of 14 women treated with ritodrine or terbutaline developed symptomatic cardiac arrhythmias at the lowest plasma potassium, while no women treated with saline and morphine (N = 12) developed cardiac arrhythmias (P = 0.14). We conclude that ritodrine and terbutaline induce profound hypokalemia by stimulating cellular potassium uptake and both drugs cause significant renal sodium and fluid retention and cardiac arrhythmias. Careful monitoring of electrolytes, fluid balance, and cardiac rhythm should occur during tocolytic therapy with ritodrine or terbutaline.
- Published
- 1997
- Full Text
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124. Denying the Dying Advance
- Author
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Michael J. Germain, Jack D. McCue, Anne Woods, and Lewis M. Cohen
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Public health ,media_common.quotation_subject ,Discontinuation ,Psychiatry and Mental health ,Denial ,Arts and Humanities (miscellaneous) ,Medical illness ,Structured interview ,medicine ,Terminal care ,Hemodialysis ,Intensive care medicine ,business ,Applied Psychology ,Dialysis ,media_common - Abstract
A structured interview was administered to a sample of patients on maintenance dialysis and their attending physicians to obtain information on the documentation of their end-of-life treatment preferences. The majonity of the patients reported never having considered stopping dialysis, or having discussed with their nephnologist on family the circumstances in which treatment should be discontinued. Only 7 patients (6%) had completed an advance directive; these patients were all men (P = 0.01) and tended to be better educated (P = 0.02). Only one of the nine physicians had completed an advance directive. In most cases, the dialysis patients and their treatment team staff were preoccupied with the struggles of daily life and had avoided on denied considerations of terminal illness and death. The literature on denial, medical illness, and dying is also reviewed as it relates to dialysis patients, end-of-life treatment, and terminal care.
- Published
- 1997
125. Short-term aerobic exercise and vascular function in CKD stage 3: a randomized controlled trial
- Author
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Beth A. Parker, Elizabeth Evans, Charles Milch, Jyovani Joubert, Samuel Headley, Michael J. Germain, Anthony Poindexter, Linda S. Pescatello, Allen E. Cornelius, Richard J. Wood, and Britton W. Brewer
- Subjects
Adult ,Male ,medicine.medical_specialty ,Randomization ,Time Factors ,Article ,law.invention ,Vascular Stiffness ,Randomized controlled trial ,law ,Medicine ,Aerobic exercise ,Humans ,Renal Insufficiency, Chronic ,Pulse wave velocity ,Exercise ,Aerobic capacity ,Aged ,business.industry ,VO2 max ,Middle Aged ,medicine.disease ,Nephrology ,Physical therapy ,Arterial stiffness ,Female ,Vascular Resistance ,business ,Kidney disease ,Follow-Up Studies - Abstract
Background The present study was designed to determine the effect of short-term moderate-intensity exercise training on arterial stiffness in patients with chronic kidney disease (CKD) stage 3. Study Design Randomized controlled trial with a parallel-group design. Setting & Participants Testing and training sessions were performed at Springfield College. 46 (treatment group, n=25; control group, n=21) patients with CKD with diabetes and/or hypertension completed the study. Intervention The aerobic training program consisted of 16 weeks of supervised exercise training at 50%-60% peak oxygen uptake (Vo 2peak ) 3 times per week, while the control group remained sedentary. Identical testing procedures were performed following the 16-week intervention. Outcomes The primary outcome was arterial stiffness. Secondary outcomes were aerobic capacity, various blood parameters (endothelin 1, nitrate/nitrite, and high-sensitivity C-reactive protein), and health-related quality of life. Measurements Arterial stiffness was assessed with aortic pulse wave velocity (PWV), aerobic capacity by Vo 2peak , blood parameters by enzyme-linked immunosorbent assays, and health-related quality of life by the 36-Item Short Form Health Survey (SF-36). Participants attended 4 sessions before being randomly assigned to either the treatment or control group. Participants gave consent during the first session, whereas a graded exercise test with measurement of Vo 2peak was completed during the second session. During sessions 3 and 4, aortic PWV was measured at rest prior to 40 minutes of either moderate-intensity exercise training or seated rest. A venous blood sample was obtained prior to exercise or rest and participants completed the SF-36 questionnaire. Results 16 weeks of training led to an 8.2% increase in Vo 2peak for the treatment group ( P =0.05), but no changes in aortic PWV . Limitations Randomization was not concealed and was violated on one occasion; also, use of an indirect measurement of endothelial function and the short duration of the intervention. Conclusions Short-term moderate-intensity exercise training does not alter arterial stiffness in patients with CKD, but seems to reduce endothelin 1 levels.
- Published
- 2013
126. What determines whether a patient initiates chronic renal replacement therapy?
- Author
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Michael J. Germain and Lewis M. Cohen
- Subjects
Male ,Transplantation ,medicine.medical_specialty ,Epidemiology ,business.industry ,medicine.medical_treatment ,Original Articles ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,female genital diseases and pregnancy complications ,Renal Replacement Therapy ,Nephrology ,Medicine ,Humans ,Kidney Failure, Chronic ,Female ,Renal replacement therapy ,business ,Intensive care medicine ,Dialysis - Abstract
Are there some people who should receive renal replacement therapy (RRT) and do not? Are there other people receiving RRT who should never have initiated dialysis or transplantation? These are stimulating questions facing today’s nephrologists, and in this issue of CJASN , Faruque and associates
- Published
- 2013
127. The elderly patient on dialysis: geriatric considerations
- Author
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Lewis M. Cohen, Michael J. Germain, Pooja Singh, and Mark Unruh
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Population ,Disease ,Quality of life (healthcare) ,Renal Dialysis ,Milestone (project management) ,medicine ,Humans ,Intensive care medicine ,education ,Geriatric Assessment ,Kidney transplantation ,Dialysis ,Aged ,Geriatrics ,Transplantation ,education.field_of_study ,Physician-Patient Relations ,business.industry ,Communication ,medicine.disease ,Prognosis ,Kidney Transplantation ,Nephrology ,Kidney Failure, Chronic ,Hemodialysis ,business - Abstract
The burgeoning population of older dialysis patients presents opportunities to provide personalized care. The older dialysis population has a high burden of chronic health conditions, decrements in quality of life and a high risk of death. In order to address these challenges, this review will recommend routinely establishing prognosis through the use of prediction instruments and communicating these findings to older patients. The challenges to prognosis in adults with end-stage renal disease (ESRD) include the subjective nature of clinical judgment, application of appropriate prognostic tools and communication of findings to patients and caregivers. There are three reasons why we believe these conversations occur infrequently with the dialysis population. First, there have previously been no clinically practical instruments to identify individuals undergoing maintenance hemodialysis (HD) who are at highest risk for death. Second, nephrologists have not been trained to have conversations about prognosis and end-of-life care. Third, other than hospitalizations and accrual of new diagnoses, there are no natural milestone guidelines in place for patients supported by dialysis. The prognosis can be used in shared decision-making to establish goals of care, limits on dialysis support or parameters for withdrawal from dialysis. As older adults with ESRD benefit from kidney transplantation, prognosis can also be used to determine who should be referred for evaluation by a kidney transplant team. The use of prognosis in older adults may determine approaches to optimize well-being and personalize care among older adults ranging from hospice to kidney transplantation.
- Published
- 2013
128. Recent insights into life expectancy with and without dialysis
- Author
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Michael J. Germain, Jane O. Schell, and Maria Da Silva-Gane
- Subjects
Nephrology ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Comorbidity ,Risk Assessment ,Decision Support Techniques ,Quality of life (healthcare) ,Life Expectancy ,Renal Dialysis ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,education ,Dialysis ,education.field_of_study ,business.industry ,Patient Selection ,Age Factors ,medicine.disease ,Treatment Outcome ,Life expectancy ,Disease Progression ,Quality of Life ,Kidney Failure, Chronic ,Observational study ,business ,Kidney disease - Abstract
Purpose of review Elderly patients comprise the fastest growing population initiating dialysis and also experience the worst outcomes, including increased mortality, loss of functional status, and impaired quality of life. Nephrologists are often challenged with how best to engage in dialysis decision-making discussions within this population. Prognostication tools can assist nephrologists in engaging in these discussions, especially in patients for whom survival benefits may be outweighed by the burdens of treatment. Recent findings This review includes the latest research in the survival of elderly patients with and without dialysis; prognostic factors associated with renal progression and survival; and integrative prognostic models to predict both short-term and long-term prognosis. The concept of kidney illness disease trajectory is defined with important outcomes including survival, health-related quality of life, and symptoms with and without dialysis. This prognostic information will then be integrated into an individualized approach to shared decision-making regarding treatment decision-making.(Figure is included in full-text article.) Summary Treatment decision-making for elderly patients with advanced kidney disease necessitates an active process between nephrologist and patient, incorporating medical information as well as patient preferences. Prognostic information and observational data can facilitate nephrologists' ability to foresee and foretell the illness trajectory both with and without dialysis, further guiding these conversations.
- Published
- 2013
129. Ambivalence and dialysis discontinuation
- Author
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Steven V. Fischel, Jack D. McCue, Michael J. Germain, Lewis M. Cohen, Anne Woods, and Gregory Braden
- Subjects
Adult ,medicine.medical_specialty ,media_common.quotation_subject ,medicine.medical_treatment ,Decision Making ,Ambivalence ,Peritoneal dialysis ,Conflict, Psychological ,Treatment Refusal ,Presentation ,Renal Dialysis ,medicine ,Humans ,Ethics, Medical ,Family ,Intensive care medicine ,Dialysis ,Aged ,media_common ,Aged, 80 and over ,business.industry ,Mental Disorders ,Flexibility (personality) ,Middle Aged ,Discontinuation ,Psychiatry and Mental health ,Female ,Hemodialysis ,business ,Social psychology - Abstract
Although dialysis discontinuation is the second leading "cause" of death among individuals who are maintained with chronic dialysis, little attention is accorded in the literature to patient ambivalence with this crucial decision. Three cases are presented of clinical situations involving termination of dialysis and ambivalence. The ambivalence of the patients is mirrored by the literature's vacillation between viewing cessation of life-support as pathological, and perceiving it as rational. There is considerable variability in the presentation of these cases, and they require exquisite sensitivity and flexibility on the part of medical personnel. As patient-physician communication is encouraged, and staff attempt to honor requests for initiation and/or discontinuation of treatment, we will see increasing numbers of ambivalent patients.
- Published
- 1996
130. Use of Computerized Tomography in the Evaluation of a Capd Patient with a Foramen of Morgagni Hernia: A Case Report
- Author
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Jeffrey G. Mulhern, Donna Polk, Michael J. Germain, Robert L. Madden, Michael H. O'Shea, Gregory Braden, and George S. Lipkowitz
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,medicine.disease ,Peritoneal dialysis ,Tomography x ray computed ,Nephrology ,Ambulatory ,medicine ,Foramen ,Hernia ,Tomography ,Radiology ,Dialisis peritoneal ,business - Published
- 1996
131. Crescentic glomerulonephritis and eosinophilic interstitial infiltrates in a patient with hypereosinophilic syndrome
- Author
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P. Richardson, G. Dickinson, Richard H. Steingart, Shirin Nash, Michael J. Germain, and Linda M. Hoffman
- Subjects
Pathology ,medicine.medical_specialty ,Interstitial nephritis ,Antigen-Antibody Complex ,Glomerulonephritis ,Prednisone ,Hypereosinophilic Syndrome ,Eosinophilic ,medicine ,Humans ,Eosinophilia ,Aged ,Crescentic glomerulonephritis ,business.industry ,Hypereosinophilic syndrome ,General Medicine ,medicine.disease ,Acute Disease ,Immunology ,Nephritis, Interstitial ,Female ,medicine.symptom ,business ,Nephritis ,Research Article ,medicine.drug - Abstract
Crescentic glomerulonephritis with immune complex deposition and acute eosinophilic interstitial nephritis developed in a patient with the hypereosinophilic syndrome. Acute renal failure ensued but was rapidly reversed by high-dose oral prednisone. Confounding factors and unusual findings are described with a review of recent literature. This mode of presentation has not previously been reported.
- Published
- 1995
132. Changes in LDL particle size after aerobic training in CKD patients
- Author
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Richard J. Wood, Greg McMahon, Samuel Headley, Sara M. Gregory, and Michael J. Germain
- Subjects
medicine.medical_specialty ,Endocrinology ,business.industry ,Internal medicine ,LDL Particle Size ,Genetics ,medicine ,Aerobic exercise ,business ,Molecular Biology ,Biochemistry ,Biotechnology - Published
- 2012
133. Lack of circulating bioactive and immunoreactive IGF-I changes despite improved fitness in chronic kidney disease patients following 48weeks of physical training
- Author
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Mary Ann Coughlin, Jan Frystyk, Samuel Headley, Bradley C. Nindl, Charles Milch, Michael J. Germain, Allan Flyvbjerg, Sara M. Gregory, and Sheila Sullivan
- Subjects
Adult ,Male ,Nephrology ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Fluoroimmunoassay ,Physical fitness ,Renal function ,Athletic Performance ,Kidney Function Tests ,Insulin-like growth factor-binding protein ,Endocrinology ,Dietary counseling ,Internal medicine ,medicine ,Humans ,Insulin-Like Growth Factor I ,Renal Insufficiency, Chronic ,Treadmill ,Cells, Cultured ,Aged ,biology ,business.industry ,Middle Aged ,Anthropometry ,medicine.disease ,Exercise Therapy ,Physical Fitness ,Body Composition ,biology.protein ,Female ,business ,Kidney disease - Abstract
Objective As known abnormalities exist in the insulin-like growth factor (IGF) system in chronic kidney disease (CKD) patients, the measurement of bioactive IGF-I may provide further insight into the therapeutic potential of long-term exercise training. Design Patients ( N =21) with stages 3 and 4 CKD were recruited from a local nephrology practice in Springfield, MA and randomized into matched treatment and control groups. The treatment group participated in 48weeks of supervised, progressive exercise training and dietary counseling, while the control group received only usual care. Treadmill testing, anthropometric measurements, and blood samples for analysis of immunoreactive IGF-I, IGF-II, IGFBP-1 and -2, and bioactive IGF-I were taken at baseline, 24weeks, and 48weeks. Results There were no significant differences in any of the components of the IGF system (all p -values>0.05). Immunoreactive IGF-I levels correlated significantly with bioactive IGF-I at baseline ( r =0.50, p =0.02) and at 48weeks ( r =0.64, p =0.01). There was a significant interaction between group and time for both VO 2peak ( p =0.03) and total treadmill time (TT) ( p Conclusions Despite improvements in physical performance, a 48-week training program did not affect any of the circulating IGF system measurements. Disparities between these findings and those of other researchers reporting a biphasic response to long-term training may be explained by differences in study groups and exercise programs.
- Published
- 2011
134. Simplification of an Erythropoiesis Model for Design of Anemia Management Protocols in End Stage Renal Disease
- Author
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Christopher V. Hollot, Adam E. Gaweda, Joseph Horowitz, Michael J. Germain, Brendan Nichols, Yossi Chait, and Rajiv P. Shrestha
- Subjects
medicine.medical_specialty ,Anemia ,Formal control ,medicine.medical_treatment ,Models, Biological ,Article ,End stage renal disease ,Hemoglobins ,hemic and lymphatic diseases ,medicine ,Humans ,Computer Simulation ,Erythropoiesis ,Intensive care medicine ,Erythropoietin ,Dialysis ,business.industry ,medicine.disease ,Anemia management ,Drug Therapy, Computer-Assisted ,Treatment Outcome ,Kidney Failure, Chronic ,Hemoglobin ,business ,medicine.drug - Abstract
Many end stage renal disease (ESRD) patients suffer from anemia due to insufficient endogenous production of erythropoietin (EPO). The discovery of recombinant human EPO (rHuEPO) over 30 years ago has shifted the treatment of anemia for patients on dialysis from blood transfusions to rHuEPO therapy. Many anemia management protocols (AMPs) used by clinicians comprise a set of experience-based rules for weekly-to-monthly titration of rHuEPO doses based on hemoglobin (Hgb) measurements. In order to facilitate the design of an AMP based on formal control design methods, we present a physiologically-relevant erythropoiesis model, and show that its nonlinear dynamics can be approximated using a static nonlinearity, a step that greatly simplifies AMP design. We demonstrate applicability of our results using clinical data.
- Published
- 2011
135. Patient Attitudes and Psychological Considerations in Dialysis Discontinuation
- Author
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E. Deborah Gilman, Michael J. Germain, Anne Woods, Jack D. McCue, and Lewis M. Cohen
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Patient Advocacy ,Treatment Refusal ,Arts and Humanities (miscellaneous) ,Renal Dialysis ,medicine ,Humans ,Dementia ,Risk factor ,Intensive care medicine ,Applied Psychology ,Dialysis ,Aged ,Blindness ,Adult patients ,Social perception ,business.industry ,Right to Die ,Middle Aged ,medicine.disease ,Discontinuation ,Psychiatry and Mental health ,Patient attitudes ,Withholding Treatment ,Educational Status ,Kidney Failure, Chronic ,Female ,business ,Attitude to Health ,Follow-Up Studies - Abstract
The authors surveyed 36 adult patients who were maintained with chronic renal dialysis concerning their attitudes about dialysis discontinuation. Few subjects reported having ever considered stopping the life-support treatment. When asked to consider 12 hypothetical scenarios in which they might consider stopping treatment (e.g., onset of dementia or blindness), most subjects would still not consider discontinuation. Consideration of dialysis discontinuation was directly correlated with the patient's educational level. Follow-up after 1 year underscored the substantial differences between the responses the subjects gave to the 12 hypothetical scenarios and their real-life responses when they were later faced with decisions to actually terminate treatment. Psychiatrists have an opportunity to participate in the complex clinical and ethical decisions associated with advance directives and patients' right to refuse life-support treatment.
- Published
- 1993
136. Supportive care for patients with renal disease: Time for action
- Author
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Michael J. Germain and Lewis M. Cohen
- Subjects
medicine.medical_specialty ,Action (philosophy) ,Nephrology ,business.industry ,medicine ,Disease ,Intensive care medicine ,business - Published
- 2001
137. Concomitant thrombotic thrombocytopenic purpura and ANCA-associated vasculitis in an adolescent
- Author
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Chirag K. Vaidya, Jiuming Ye, Christine McKiernan, Jim Freeman, Chester Andrzejewski, Peter R. Blier, Michael J. Germain, Varun Agrawal, and Gregory Braden
- Subjects
Nephrology ,medicine.medical_specialty ,Adolescent ,Thrombotic thrombocytopenic purpura ,Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ,Gastroenterology ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Glucocorticoids ,Anti-neutrophil cytoplasmic antibody ,Plasma Exchange ,business.industry ,Microangiopathic hemolytic anemia ,medicine.disease ,ADAMTS13 ,Purpura, Thrombocytopenic ,Pediatrics, Perinatology and Child Health ,Immunology ,Female ,business ,Microscopic polyangiitis ,Vasculitis ,Immunosuppressive Agents ,Systemic vasculitis - Abstract
Thrombotic thrombocytopenic purpura (TTP) rarely occurs with systemic vasculitis. A 17-year-old girl presented with non-bloody diarrhea, menorrhagia, and syncope. She had severe anemia (hemoglobin = 3.8 g/dl), thrombocytopenia (platelet = 7,000/mm(3)), and acute kidney injury (serum creatinine, Cr = 2.3 mg%). Peripheral smear examination confirmed the presence of microangiopathic hemolytic anemia. Additionally, she had a positive anti-nuclear antibody (1:1600) and normal complement levels. We considered the diagnosis of TTP, possibly associated with systemic lupus erythematosus, and promptly initiated pulse methylprednisolone and daily 3-4 l of plasma exchange therapy. Following resolution of her thrombocytopenia in 48 h, we performed a kidney biopsy that revealed diffuse proliferative, focal crescentic, and necrotizing glomerulonephritis with mild IgG immunofluorescence staining. Concomitantly, autoimmune work-up was significant for positive perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA = 1:640) and decreased von Willebrand factor cleaving protease activity (5%). A final diagnosis of TTP with microscopic polyangiitis (p-ANCA-mediated) was made and treatment with daily oral cyclophosphamide and prednisone resolved her renal injury over 2 months (follow-up Cr = 1.0 mg%). Our case highlights the importance of identifying systemic disorders such as ANCA-associated vasculitis with TTP.
- Published
- 2010
138. A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients
- Author
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Mark W. Smith, Mandeep Grewal, James A. Tumlin, Vandana Mathur, Dawn McGuire, Michael J. Germain, Geoffrey A. Block, and Jill S. Lindberg
- Subjects
Adult ,Male ,medicine.medical_specialty ,Longitudinal study ,Uremic pruritus ,Time Factors ,Epidemiology ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Quality of life ,Cost of Illness ,Predictive Value of Tests ,Renal Dialysis ,Internal medicine ,Surveys and Questionnaires ,Severity of illness ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Registries ,skin and connective tissue diseases ,Prospective cohort study ,Uremia ,Transplantation ,Chi-Square Distribution ,business.industry ,Pruritus ,Reproducibility of Results ,Original Articles ,Antipruritics ,Middle Aged ,medicine.disease ,United States ,Treatment Outcome ,Nephrology ,Physical therapy ,Linear Models ,Quality of Life ,Itching ,Kidney Failure, Chronic ,Female ,Hemodialysis ,medicine.symptom ,business ,Kidney disease - Abstract
Background and objectives: Although uremic pruritus (UP) is a highly prevalent complication of chronic kidney disease, it remains poorly characterized. There have been no longitudinal studies of natural history, and no health-related quality of life (HR-QOL) instruments have been developed for UP. The objectives of this study were to describe the natural history of UP, to compare rating scales of itching intensity, and to assess usefulness and validity of HR-QOL instruments for UP. Design, setting, participants, & measurements: The intensity, severity, and effects of pathologic itching on HR-QOL were assessed prospectively in 103 patients with UP on chronic hemodialysis. Outcome measures were obtained at scheduled intervals over 3.5 months. Results: Itching daily or nearly daily was reported by 84% of patients and had been ongoing for >1 year in 59%. In 83%, pruritus involved large, nondermatomal areas with striking bilateral symmetry. Two thirds of the patients were using medications such as antihistamines, steroids, and various emollients without satisfactory relief of itching. Statistically significant associations were found among itching intensity, severity, and HR-QOL measures in domains such as mood, social relations, and sleep. Among patients with moderate-to-severe UP, changes in itching intensity of 20% or greater were associated with significant reductions in HR-QOL measures. Conclusions: This first longitudinal study of UP describes key features of UP and its effect on HR-QOL. The assessment instruments we have developed are easily used, are responsive to changes in UP intensity, and should facilitate clinical evaluation and research to meet the needs of afflicted patients.
- Published
- 2010
139. Increasing Hospice Services for Elderly Patients Maintained with Hemodialysis
- Author
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Lewis M. Cohen, Michael J. Germain, and Robin Ruthazer
- Subjects
Male ,medicine.medical_specialty ,Referral ,medicine.medical_treatment ,Pilot Projects ,Risk Assessment ,Cohort Studies ,Advance Care Planning ,Renal Dialysis ,Intervention (counseling) ,Activities of Daily Living ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Karnofsky Performance Status ,Prospective cohort study ,General Nursing ,Hospice care ,Dialysis ,Aged ,Chi-Square Distribution ,business.industry ,General Medicine ,Original Articles ,medicine.disease ,Control subjects ,Prognosis ,Anesthesiology and Pain Medicine ,Hospice Care ,Massachusetts ,Family medicine ,Kidney Failure, Chronic ,Female ,Hemodialysis ,Medical emergency ,Quality-Adjusted Life Years ,business ,Educational outreach - Abstract
Few dying patients undergoing dialysis receive hospice care. An intervention to facilitate hospice referral was evaluated in a longitudinal prospective cohort study. Five hemodialysis units in Massachusetts were divided into intervention sites (N = 3 clinics) and control sites (N = 2 clinics). Five hundred twelve patients were screened to identify those with indicators of poor prognoses; 133 met the eligibility criteria and consented to participate. Eighty-two intervention subjects and 51 control subjects were followed for a median of 17 months. During that time, 45 died and 16 received hospice services. Directors from the community hospices were approached by the researchers and agreed to provide an educational outreach to the intervention clinics. Renal supportive care teams (RSCTs) consisting mainly of volunteer health-care providers recruited from the dialysis clinics and local hospices were notified about the high-mortality patients. Staff met periodically to discuss their contacts with subjects and/or family members from the intervention clinics, The subjects were encouraged to participate in advance care planning, and they were provided information about hospice resources. The control clinics did not have RSCTs, and their subjects received standard treatment. At the conclusion of the study, hospice services had increased at the intervention sites (p = 0.09), and the subgroup ofor = 65-year-old subjects had undergone a significant increase (p = 0.05) in obtaining hospice care. Greater familiarity between hospice and dialysis staff along with outreach to patients with poor prognoses holds the promise of expanding hospice use--especially for the elderly.
- Published
- 2010
140. Use of 12x/month haemoglobin monitoring with a computer algorithm reduces haemoglobin variability
- Author
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Jane Garb, Molly-Kate Mackie, Cherry Bartlett, Eric J. Will, Sue Picard, Warren Ho Md, and Michael J. Germain
- Subjects
Male ,medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,Hemoglobins ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Dosing ,Longitudinal Studies ,Dialysis facility ,Aged ,Monitoring, Physiologic ,Aged, 80 and over ,Transplantation ,Dose-Response Relationship, Drug ,business.industry ,Middle Aged ,medicine.disease ,Computer algorithm ,Surgery ,Nephrology ,Erythropoietin ,Case-Control Studies ,Therapy, Computer-Assisted ,Chronic Disease ,Hematinics ,Female ,Kidney Diseases ,Hemoglobin ,Hemodialysis ,business ,Algorithms ,Kidney disease ,medicine.drug - Abstract
Background. Haemoglobin variability may be associated with increased death. Frequent haemoglobin monitoring may allow earlier detection of trends in haemoglobin slopes, alerting staff to intercurrent events. The more frequent haemoglobin values may provide early evidence of response to erythropoietin (EPO) doses, and allow more appropriate anaemia management. Our objective is to assess whether frequent haemoglobin monitoring data (12x/month) using a computer algorithm (AMIE, Leeds, UK) will reduce haemoglobin variability compared with 1 ×/month monitoring. Methods. We performed an observational case-control study of 44 unselected patients, comprising one dialysis facility measuring Crit-Line haemoglobin, lab haemoglobin, standard deviation of residuals as surrogate of haemoglobin variability and EPO dosing. Results. Haemoglobin variability and 'percent in target haemoglobin range'significantly improved with 12×/month haemoglobin results using a computer algorithm. There was also a non-significant trend toward for lower EPO doses. Conclusion. Use of a computer algorithm to analyse 12×/month haemoglobin values provides early evidence of haemoglobin trends and allows more appropriate anaemia management, with decreased haemoglobin variability, lower EPO doses and more patients achieving target haemoglobin.
- Published
- 2010
141. An integrative approach to advanced kidney disease in the elderly
- Author
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James A. Tulsky, Michael J. Germain, Jane O. Schell, Lewis M. Cohen, and Fred Finkelstein
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,Population ,Disease ,Comorbidity ,Article ,Quality of life (healthcare) ,Renal Dialysis ,Internal medicine ,Medicine ,Humans ,Intensive care medicine ,education ,Dialysis ,Aged ,Geriatrics ,Aged, 80 and over ,education.field_of_study ,Integrative Medicine ,business.industry ,medicine.disease ,Chronic Disease ,Quality of Life ,Female ,Kidney Diseases ,business ,Kidney disease - Abstract
Chronic kidney disease (CKD) has increasingly become a "geriatric" disease, with a dramatic rise in incidence in the aging population. Patients aged >75 years have become the fastest growing population initiating dialysis. These patients have increased comorbid diseases and functional limitations which affect mortality and quality of life. This review describes the challenges of dialysis initiation and considerations for management of the elderly subpopulation. There is a need for an integrative approach to care, which addresses management issues, health-related quality of life, and timely discussion of goals of care and end-of-life issues. This comprehensive approach to patient care involves the integration of nephrology, geriatric, and palliative medicine practices.
- Published
- 2009
142. Evaluation of cinacalcet HCl treatment after kidney transplantation
- Author
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O. Wang, Stewart A. Turner, Stuart M. Sprague, J.B. Copley, Michael J. Germain, S. Katznelson, T. Shah, O. Pankewycz, and L. Stern
- Subjects
Adult ,medicine.medical_specialty ,Cinacalcet ,Calcimimetic ,Urology ,Parathyroid hormone ,Renal function ,Naphthalenes ,Bone and Bones ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Hyperparathyroidism ,Kidney ,business.industry ,Patient Selection ,medicine.disease ,Kidney Transplantation ,Endocrinology ,medicine.anatomical_structure ,Parathyroid Hormone ,Hypercalcemia ,Surgery ,Hyperparathyroidism, Secondary ,business ,Kidney disease ,medicine.drug ,Glomerular Filtration Rate - Abstract
Hyperparathyroidism often remains or develops after kidney transplantation. Vitamin D sterol used as treatment for an elevated parathyroid hormone (PTH) level and associated bone disease may be contraindicated due to hypercalcemia. The calcimimetic cinacalcet HCl (cinacalcet), which lowers PTH and calcium (Ca) in chronic kidney disease patients, may represent an alternate therapeutic modality.This multicenter, retrospective, observational study examined 41 kidney transplant patients receiving cinacalcet for ≥3 months starting ≥3 months posttransplantation. Levels of intact PTH, Ca, and phosphorus (P) were examined during the assessment phase (3-6 months after initiation).Median PTH decreased 21.8% during the assessment phase (P.001), with 32.5% of patients exhibiting a ≥30% decrease in PTH from baseline. Median Ca decreased 6.8% (P.0001). Median serum P rose 10.0% (P = .0124), but remained within normal limits. The estimated glomerular filtration rate was stable throughout the study.Cinacalcet may be useful for the treatment of hyperparathyroidism after kidney transplantation. Randomized, prospectively designed clinical trials are required to confirm these results.
- Published
- 2009
143. Strategies for successfully managing the anemia of chronic kidney disease in the long-term care setting
- Author
-
Michael J, Germain
- Subjects
Chronic Disease ,Hematinics ,Humans ,Anemia ,Blood Transfusion ,Drug Therapy, Combination ,Kidney Diseases ,Long-Term Care ,Risk Assessment ,Iron Compounds ,Aged - Abstract
To provide an overview of the challenges of and strategies for treating anemia associated with chronic kidney disease (CKD) in geriatric patients.Recent literature (1995-present)Papers that focused on geriatric patients and provided background on erythropoiesis and management of anemia that is associated with CKD disease were reviewed and included.Data included in the review are relevant to the risks and benefits of treatments for anemia that is associated with CKD.A review of the data allowed a relevant discussion of the current knowledge base of anemia that is associated with CKD in geriatric patients with a goal of enhancing the clinician's ability to effectively manage anemia in this population.The treatment of the anemia of CKD in the long-term care setting requires an understanding of the risks and limitations of the currently available therapies. Erythropoiesis-stimulating agents are often indicated in combination with iron supplementation. The activity and adverse effect profiles of the available agents are comparable. The decision to treat anemia in the long-term care setting should be based on a consideration of the risks and benefits of treatment.
- Published
- 2008
144. Maintaining quality of life at the end of life in the end-stage renal disease population
- Author
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Michael J. Germain and Lewis M. Cohen
- Subjects
medicine.medical_specialty ,education.field_of_study ,Palliative care ,business.industry ,medicine.medical_treatment ,Mortality rate ,Population ,Palliative Care ,Hospices ,medicine.disease ,End stage renal disease ,Quality of life (healthcare) ,Nephrology ,Renal Dialysis ,medicine ,Quality of Life ,Humans ,Kidney Failure, Chronic ,Intensive care medicine ,education ,business ,Medicaid ,Medical Futility ,Dialysis ,Kidney disease - Abstract
The rapidly advancing age of incident dialysis patient has coincided with a rising mortality rate during the first year of dialysis. This is occurring despite a steady decline in mortality of prevalent patients. These statistics suggest that there is a subset of sick, elderly dialysis patients who will not survive the first 6 months of dialysis. It may be that these patients would be better served with a conservative, palliative approach that does not include initiation of dialysis. Even though hospice care is universally available to the Center for Medicare and Medicaid Services population, dialysis patients encounter many barriers to obtaining this benefit and have a hospice utilization rate only one quarter that of cancer patients. This article discusses the barriers to and goals of palliative care in the chronic kidney disease/end-stage renal disease population.
- Published
- 2008
145. Contributors
- Author
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Enver Akalin, Alice Sue Appel, Gerald B. Appel, Shakil Aslam, Robert C. Atkins, Howard A. Austin, James E. Balow, Jonathan Barratt, Brendan J. Barrett, Bryan N. Becker, Tomas Berl, Catherine Blake, Peter G. Blake, Emily A. Blumberg, Joseph V. Bonventre, D. Craig Brater, William E. Braun, Emmanuel L. Bravo, Zachary Z. Brener, David M. Briscoe, Jonathan Bromberg, John Burkart, Giovambattista Capasso, Francesco P. Cappuccio, Culley C. Carson, Steven J. Chadban, Arlene B. Chapman, Joline L.T. Chen, Russell W. Chesney, Alfred K. Cheung, Monique E. Cho, Lewis M. Cohen, Paul R. Conlin, Dinna Cruz, Brett Cullis, Gary C. Curhan, John J. Curtis, Christopher J. Cutie, Giuseppe D-Amico, Simon J. Davies, Connie L. Davis, Sara N. Davison, Raffaele De Caterina, Laura M. Dember, Mark Denton, Thomas A. Depner, J. Eric Derksen, Vikas R. Dharnidharka, Bradley S. Dixon, Hamish Dobbie, Wilfred Druml, Thomas D. DuBose, Lance D. Dworkin, David H. Ellison, Stephen Z. Fadem, John Feehally, Donald A. Feinfeld, Steven Fishbane, John M. Fitzpatrick, Daniel J. Ford, Alessandro Fornasieri, Marc B. Garnick, Robert S. Gaston, Michael J. Germain, Pere Ginès, Joyce M. Gonin, Eddie L. Greene, Scott M. Grundy, Mounira Habli, Andrew Hall, Mitchell L. Halperin, Nikolas B. Harbord, Peter Hewins, Jonathan Himmelfarb, Norman K. Hollenberg, Enyu Imai, Yoshitaka Isaka, Hye Ryoun Jang, David Jayne, Jay R. Kaluvapalle, Kamel S. Kamel, Suraj Kapa, Norman M. Kaplan, Joana E. Kist-van Holthe, Mary E. Klotman, Paul E. Klotman, Jeffrey B. Kopp, Lawrence R. Krakoff, Aaron C. Lentz, Susan M. Lerner, Jerrold S. Levine, Jeremy B. Levy, Edmund J. Lewis, Julia B. Lewis, Shih-Hua Lin, Francisco Llach, Friedrich C. Luft, Samuel J. Mann, Kevin J. Martin, Tahsin Masud, Roy O. Mathew, W. Scott McDougal, Michael McKusick, Ravindra L. Mehta, Luigi Minetti, Adam M. Mirot, William E. Mitch, Alvin H. Moss, Barbara Murphy, Mitra K. Nadim, Eric G. Neilson, Elizabeth H. Nora, Marina Noris, Pouneh Nouri, Man S. Oh, Yvonne M. O-Meara, Biff F. Palmer, Vasilios Papademetriou, Patrick S. Parfrey, Manish P. Patel, Marie-Noëlle Pépin, William D. Plant, Charles D. Pusey, Rizwan A. Qazi, Hamid Rabb, Brian D. Radbill, Frederic F. Rahbari-Oskoui, Andrew J. Rees, Giuseppe Remuzzi, Zaccaria Ricci, Eberhard Ritz, Nancy M. Rodig, Claudio Ronco, Robert H. Rubin, Robert J. Rubin, Piero Ruggenenti, David J. Salant, Paul W. Sanders, Caroline O.S. Savage, Mohamed H. Sayegh, Arrigo Schieppati, Bernd Schröppel, Gerald Schulman, Douglas G. Shemin, Baha M. Sibai, Sandra Silva, Karen D. Sims, James P. Smith, Richard J.H. Smith, Michael J.G. Somers, Virend K. Somers, Maarten W. Taal, Yoshitsugu Takabatake, Eric N. Taylor, Edward G. Tessier, Stephen C. Textor, Joshua M. Thurman, Nina E. Tolkoff-Rubin, Robert D. Toto, A. Neil Turner, Robert Unwin, Joseph A. Vassalotti, Gloria Lena Vega, John P. Vella, Meryl Waldman, Ravinder K. Wali, Christoph Wanner, William L. Whittier, Christopher S. Wilcox, John D. Williams, James F. Winchester, Christina M. Wyatt, Jane Y. Yeun, Alan S.L. Yu, and Carmine Zoccali
- Published
- 2008
146. Neuropsychiatric Complications and Psychopharmacology of End-Stage Renal Disease
- Author
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Michael J. Germain, Adam Mirot, Ed Tessier, and Lewis M. Cohen
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Medicine ,Psychopharmacology ,business ,End stage renal disease - Published
- 2008
147. Palliative and Supportive Care
- Author
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Michael J. Germain, Lewis M. Cohen, and Sara N. Davison
- Subjects
business.industry ,Medicine ,business - Published
- 2008
148. A psychiatric perspective of dialysis discontinuation
- Author
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Jane Garb, Gregory Braden, Michael J. Germain, Lewis M. Cohen, Adam Mirot, and J. Michael Bostwick
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Perspective (graphical) ,General Medicine ,Disease ,Suicide rates ,United States ,Discontinuation ,Treatment Refusal ,Anesthesiology and Pain Medicine ,Renal Dialysis ,medicine ,Humans ,Intensive care medicine ,business ,Psychiatry ,General Nursing ,Dialysis - Abstract
In the 1970s, the suicide rate of patients with end-stage renal disease (ESRD) was calculated by conflating deaths from obvious clinical suicide attempts with deaths caused by lethal noncompliance and deaths preceded by dialysis discontinuation. Three decades later, although society's view about cessation of life-support treatment has markedly changed, relatively little is known about the psychiatric aspects of dialysis discontinuation. This paper reviews the literature and suggests a number of findings that warrant further research investigation.
- Published
- 2007
149. Withholding and withdrawal from dialysis: what we know about how our patients die
- Author
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Michael J, Germain, Lewis M, Cohen, and Sara N, Davison
- Subjects
Attitude to Death ,Withholding Treatment ,Renal Dialysis ,Culture ,Decision Making ,Palliative Care ,Humans ,Kidney Diseases ,Pain, Intractable - Abstract
Withholding and withdrawal of dialysis has been a reality since dialysis was invented. Only in the past 20 years has it been formally studied, and we still have a great deal to learn. The nephrology community has slowly come to accept that, for some of our patients, not having dialysis is a better option than continuing or initiating therapy. The principles of palliative care throughout the disease trajectory and hospice care at end of life are germane to this population due to its high symptom burden and mortality rate. We review what is currently known concerning patients who choose to withhold or withdraw from dialysis, and the current barriers (and solutions) to providing them with optimal palliative care.
- Published
- 2007
150. Effects Of An In-center Resistance Training Program On A Sample Of Hemodialysis Patients
- Author
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Tracey D. Matthews, Samuel Headley, Jennifer Mckinnon, Michael J. Germain, Shelby Van Huysen, Amanda LaCroix, Thomas Dodge, Paul Dalton, and Michael Bruneau
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Resistance training ,Physical therapy ,medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Center (algebra and category theory) ,Sample (statistics) ,Hemodialysis ,business - Published
- 2015
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