4 research outputs found
Effects of lowering dialysate calcium concentrations on arterial stiffness in patients undergoing hemodialysis
No full textBACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis.
METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A.
RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 ± 1.0 to 9.0 ± 0.7, p = 0.002 vs. 1.3 ± 0.1 to 1.1 ± 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 ± 45.8 pmol/mL at baseline to 124.9 ± 82.2 pmol/mL at 6 months, p = 0.043).
CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.ope
Severe cutaneous hypersensitivity to icodextrin in a continuous ambulatory peritoneal dialysis patient
No full textIcodextrin, a glucose polymer, is widely used as an alternative to glucose as the osmotic agent in peritoneal dialysis (PD). We describe a case of a continuous ambulatory peritoneal dialysis patient who developed severe cutaneous hypersensitivity after initiation of icodextrin PD solution. Erythematous skin lesions gradually disappeared after discontinuation of icodextrin PD solution. Although the safety and efficacy of icodextrin PD solution is well documented, clinicians should be mindful of the possibility of severe adverse cutaneous reactions to icodextrin PD solution.ope
Uremic Encephalopathy Associated with Bilateral Basal Ganglia and Cerebellar Lesion in a Non-diabetic Hemodialysis Patient
No full textInvolvement of central nervous system is a well-known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient.ope
The role of humanitarian NGO's: impact on South Korean food aid policy towards North Korea from 1995 to 2007
No full textThe existing literature has provided only a partial explanation of the political role of
South Korean humanitarian non-governmental organisations (NGOs) in government
food aid policy making towards North Korea between 1995 and 2007. Using a
constructivist approach which includes non-state actor and normative factors in the
analysis of state policy making, this thesis demonstrates that South Korean
humanitarian NGO advocacy was consequential in explaining changes in South Korea’s
food aid policy making in respect of state agenda setting, the formation of a discursive
position and institutional and policy development. Humanitarian NGO advocacy finally
contributed to government establishment of a legal framework that could provide for
more consistent and large scale food aid to North Korea, irrespective of the vagaries of
inter-Korean political relations.
Despite humanitarian NGO advocacy, however, changes at different stages of
state food aid policy making differed among the three administrations. This thesis
demonstrates that these differences were attributable to the differing abilities of NGO to
set agendas, network and graft new norms in respect of government policy on food aid
to North Korea. These differing abilities resulted from changes in organisational
mandates, funding capacities and the expertise of NGOs over time. Firstly, a strong
humanitarian mandate between 1995 and 2000 was a key factor that enabled NGOs to
overcome the organisational limits that stemmed from their poor funding capacity and
lack of expertise. Secondly, stable funding capacity contributed to improvements in
organisational expertise; however, increased reliance on government funding after 2000
resulted in the weakening of NGOs’ advocacy ability. Lastly, given the favourable
operational environment after the Inter-Korean Summit in 2000, the organisational
expertise of NGOs developed to a level where it was possible to exert direct influence
on government food aid policy making towards North Korea
