To
All Malaysian
Wishing You
A
Happy Merdeka Day!
God Blessed!
Best Wishes & Warmest Regards,
MalaysianKidneySPA
Saturday, August 27, 2011
Tuesday, August 23, 2011
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I found this conversation between the pencil and the eraser very inspirational. Parents are like the eraser whereas their children are the pencil. They're always there for their children, cleaning up their mistakes. Sometimes along the way... they get hurt, and become smaller (older, and eventually pass on). Though their children will eventually find someone new (spouse), but parents are still happy with what they do for their children, and will always hate seeing their precious ones worrying, or sad.
This is for all parents out there....
Friday, August 19, 2011
Patients' perspective of haemodialysis-associated symptoms
UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
http://ndt.oxfordjournals.org/content/26/8/2656.abstract?sid=f2a15578-dc86-4eb6-a467-2220f961f3e0
Introduction. Patients often report symptoms during haemodialysis (HD). To better understand patients' experience, we surveyed routine HD outpatients, to quantify the burden and duration of dialysis-associated symptoms.
Methods. Five hundred and eight symptom questionnaires were returned from 550 HD outpatients (92.4%). The symptoms in relation to the HD session were analysed using a visual analogue score. Multivariate logistical regression analysis was used to identify characteristics associated with total symptom burden and time to recover following a HD session.
Results. Fifty-four percent of the cohort were male, median age 64 years, 36% diabetic and median age unadjusted Charlson comorbidity score 3.0 (2–5). Fatigue (82%), intradialytic hypotension (76%), cramps (74%) and dizziness (63%) were the commonest symptoms reported, followed by headache (54%), pruritus (52%) and backache (51%), with fatigue occurring with a median frequency of 50% of dialysis sessions and intradialytic hypotension and cramps in 30%. Some 23% reported recovering from dialysis within minutes, 34% by the time they returned home, 16% by bed time, 24% the following morning and 3% just before the next dialysis session. Symptom burden was associated with female sex, younger age, longer duration of dialysis sessions, ethnicity and dialysis centre practice. The time taken to recover from dialysis varied from minutes to hours and was shorter for men and greater dialysis vintage but longer with increasing session time and those with increased intradialytic symptom burden.
Conclusions. Despite advances in HD, intradialytic symptoms were frequently reported by our patients. There was substantial unexplained variation in symptom burden across centres, suggesting that clinical practice or policies may play a role in preventing the adverse effects of dialysis. Symptom burden was worse in women, patients of South Asian as opposed to African origin and also in those receiving a longer duration of dialysis. These patients may therefore benefit from a different approach to dialysis prescription.
Sunday, August 14, 2011
Shakespeare said:
I always feel happy, You know why?
I always feel happy, You know why?
Because I don't expect anything from anyone,
Expectations always hurt..
Expectations always hurt..
Life is short.. So love your life.. Be happy..
And Keep smiling.. Just Live and
Before you speak Listen
Before you write Think
Before you spend Earn
Before you pray Forgive
Before you hurt Feel
Before you hate Love
Before you quit Try
Before you die Live
And Keep smiling.. Just Live and
Before you speak Listen
Before you write Think
Before you spend Earn
Before you pray Forgive
Before you hurt Feel
Before you hate Love
Before you quit Try
Before you die Live
That's Life...Feel it, Live it & Enjoy it.
Tuesday, August 9, 2011
Agreement between different parameters of dialysis dose in achieving treatment targets: results from the NECOSAD study
Nephrol. Dial. Transplant. (2011) - doi: 10.1093/ndt/gfr396 – First published online: August 4, 2011
By Karin E. Moret1, Diana C. Grootendorst2, Friedo W. Dekker2, Elizabeth W. Boeschoten3, Raymond T. Krediet4, Saskia Houterman1, Charles H. Beerenhout1, Jeroen P. Kooman5 and and the NECOSAD Study Group*
Author Affiliations: 1 Department of internal medicine, Máxima Medical Centre, Veldhoven, Leiden, The Netherlands2 Department of Clinical Epidemiology Leiden University Medical Centre3 Hans Mak Institute, Naarden, The Netherlands 4 Department of Nephrology, Amsterdam Medical Centre, Amsterdam, The Netherlands 5 Department of internal medicine, University Hospital Maastricht, The Netherlands
Submitted by Mr CS Soong
Abstract
Background.
The recommended parameter of dialysis dose differs between K-DOQI and the European Best Practice Guidelines. It is not well known to what extent an agreement exists between the different parameters, nor if target and delivered dialysis dose are prescribed according to the urea reduction rate (URR), single-pool Kt/V (spKt/V) or equilibrated double-pool Kt/V(eKt/V) and which parameter is most strongly related to mortality
Methods.
In 830 haemodialysis patients from the NECOSAD cohort URR, spKt/V and eKt/V were calculated and compared according to a classification regarding the recommended treatment targets (70%, 1.4 and 1.2, respectively) as well as minimum delivered dialysis dose (65%, 1.2 and 1.05, respectively). Moreover, the relation between treatment dose and survival was assessed using Cox regression analysis.
Results.
A spKt/V of ≥1.4 and URR ≥70% corresponded with eKt/V ≥1.20 (as reference method) in, respectively, 98.0 and 90.6% of patients. spKt/V of≥1.2 and URR ≥65% corresponded with eKt/V ≥1.05 in, respectively, 95 and 91.2% of patients. Deviations from the reference method were significantly related to differences in urea distribution volume (spKt/V), treatment time (URR) and ultrafiltration volume (URR). The adjusted HR (95% CI) was 0.98 (0.96, 0.99) for URR, 0.51 (0.31, 0.84) for spKt/V and 0.46 (0.30, 0.80) for the eKt/V
Conclusion.
The use of URR leads to larger disagreement with the reference method (eKt/V) treatment target as compared to spKt/V. Low urea distribution volume, short treatment time and low ultrafiltration volumes are predictive parameters for overestimation of dialysis dose when tilizing the alternative methods spKt/V and URR instead of eKt/V. Delivered eKt/V, spKt/V and URR were all positively related to survival.
http://ndt.oxfordjournals.org/content/early/2011/08/04/ndt.gfr396.abstract
Crabby Old Man...
What do you see nurses? . . ... . . What do you see?
What are you thinking . . . . . When you're looking at me?
A crabby old man . .. . . . Not very wise,
Uncertain of habit ... . . . . With faraway eyes?
Who dribbles his food . . . .. . And makes no reply.
When you say in a loud voice . . . . . 'I do wish you'd try!'
Who seems not to notice .. .. . ... . The things that you do.
And forever is losing . . . . . A sock or shoe?
Who, resisting or not . . . . . Lets you do as you will,
With bathing and feeding . .. . .. . The long day to fill?
Is that what you're thinking? . ... . . . Is that what you see?
Then open your eyes, nurse . . . . . You're not looking at me.
I'll tell you who I am. . . . ... . As I sit here so still,
As I do at your bidding, . . . . . As I eat at your will.
I'm a small child of Ten . .. . . .. With a father and mother,
Brothers and sisters . . . .. ... Who love one another.
A young boy of Sixteen . . . .. With wings on his feet.
Dreaming that soon now . . . . . A lover he'll meet.
A groom soon at Twenty . . . . .. My heart gives a leap.
Remembering, the vows . . . . . That I promised to keep.
At Twenty-Five, now . . . .. . I have young of my own.
Who need me to guide . . . . . And a secure happy home.
A man of Thirty . . . . . My young now grown fast,
Bound to each other .. . . . . With ties that should last.
At Forty, my young sons . . ... . . Have grown and are gone,
But my woman's beside me . . . . . To see I don't mourn.
At Fifty, once more, babies play 'round my knee,
Again, we know children . .. . . . My loved one and me.
Dark days are upon me . . . . . My wife is now dead.
I look at the future . . . . . Shudder with dread.
For my young are all rearing . ... . . . Young of their own.
And I think of the years .. . . .. . And the love that I've known.
I'm now an old man . . . . .... And nature is cruel.
Tis jest to make old age . . . . . Look like a fool.
The body, it crumbles . . . . . Grace and vigor, depart.
There is now a stone . . . . Where I once had a heart.
But inside this old carcass . . . . . A young guy still dwells,
And now and again . . . . . My battered heart swells.
I remember the joys . . . . . I remember the pain.
And I'm loving and living . . . ... . Life over again.
I think of the years, all too few . . . . . Gone too fast.
And accept the stark fact . . . . That nothing can last.
So open your eyes, people . . . ... . Open and see.
Not a crabby old man . ... . . Look closer . .. . See ME!!
What do you see nurses? . . ... . . What do you see?
What are you thinking . . . . . When you're looking at me?
A crabby old man . .. . . . Not very wise,
Uncertain of habit ... . . . . With faraway eyes?
Who dribbles his food . . . .. . And makes no reply.
When you say in a loud voice . . . . . 'I do wish you'd try!'
Who seems not to notice .. .. . ... . The things that you do.
And forever is losing . . . . . A sock or shoe?
Who, resisting or not . . . . . Lets you do as you will,
With bathing and feeding . .. . .. . The long day to fill?
Is that what you're thinking? . ... . . . Is that what you see?
Then open your eyes, nurse . . . . . You're not looking at me.
I'll tell you who I am. . . . ... . As I sit here so still,
As I do at your bidding, . . . . . As I eat at your will.
I'm a small child of Ten . .. . . .. With a father and mother,
Brothers and sisters . . . .. ... Who love one another.
A young boy of Sixteen . . . .. With wings on his feet.
Dreaming that soon now . . . . . A lover he'll meet.
A groom soon at Twenty . . . . .. My heart gives a leap.
Remembering, the vows . . . . . That I promised to keep.
At Twenty-Five, now . . . .. . I have young of my own.
Who need me to guide . . . . . And a secure happy home.
A man of Thirty . . . . . My young now grown fast,
Bound to each other .. . . . . With ties that should last.
At Forty, my young sons . . ... . . Have grown and are gone,
But my woman's beside me . . . . . To see I don't mourn.
At Fifty, once more, babies play 'round my knee,
Again, we know children . .. . . . My loved one and me.
Dark days are upon me . . . . . My wife is now dead.
I look at the future . . . . . Shudder with dread.
For my young are all rearing . ... . . . Young of their own.
And I think of the years .. . . .. . And the love that I've known.
I'm now an old man . . . . .... And nature is cruel.
Tis jest to make old age . . . . . Look like a fool.
The body, it crumbles . . . . . Grace and vigor, depart.
There is now a stone . . . . Where I once had a heart.
But inside this old carcass . . . . . A young guy still dwells,
And now and again . . . . . My battered heart swells.
I remember the joys . . . . . I remember the pain.
And I'm loving and living . . . ... . Life over again.
I think of the years, all too few . . . . . Gone too fast.
And accept the stark fact . . . . That nothing can last.
So open your eyes, people . . . ... . Open and see.
Not a crabby old man . ... . . Look closer . .. . See ME!!
Monday, August 8, 2011
'Bad' Cholesterol Not as Bad as People Think, Study Shows
ScienceDaily (May 8, 2011) — The so-called "bad cholesterol" -- low-density lipoprotein commonly called LDL -- may not be so bad after all, shows a Texas A&M University study that casts new light on the cholesterol debate, particularly among adults who exercise.
Steve Riechman, a researcher in the Department of Health and Kinesiology, says the study reveals that LDL is not the evil Darth Vader of health it has been made out to be in recent years and that new attitudes need to be adopted in regards to the substance. His work, with help from colleagues from the University of Pittsburgh, Kent State University, the Johns Hopkins Weight Management Center and the Northern Ontario School of Medicine, is published in theJournal of Gerontology.
Riechman and colleagues examined 52 adults from ages to 60 to 69 who were in generally good health but not physically active, and none of them were participating in a training program. The study showed that after fairly vigorous workouts, participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol, "a very unexpected result and one that surprised us.
Friday, August 5, 2011
Cutting Dietary Phosphate Doesn't Save Dialysis Patients' Lives, Studies Suggests
American Society of Nephrology. "Cutting dietary phosphate doesn't save dialysis patients' lives, study suggests." ScienceDaily, 10 Dec. 2010. Web. 5 Aug. 2011.
ScienceDaily (Dec. 10, 2010) — Doctors often ask kidney disease patients on dialysis to limit the amount of phosphate they consume in their diets, but this does not help prolong their lives, according to a study appearing in an upcoming issue of theClinical Journal of the American Society Nephrology (CJASN). The results even suggest that prescribing low phosphate diets may increase dialysis patients' risk of premature death
Blood phosphate levels are often high in patients with kidney disease, and dialysis treatments cannot effectively remove all of the dietary phosphate that a person normally consumes. Because elevated phosphate can lead to serious complications and premature death, dialysis patients are advised to restrict their phosphate intake and/or take phosphate binder medications. Kidney specialists and dietitians have long espoused dietary phosphate restriction; however, there have been few studies of its long-term effects on patient survival and health.
To investigate the issue, Steven Brunelli, MD, MSCE (Brigham and Women's Hospital and Harvard Medical School), Katherine Lynch, MD (Beth Israel Deaconess Medical Center), and their colleagues analyzed data from 1751 patients on dialysis who were followed for an average of 2.3 years. Prescribed daily dietary phosphate was restricted to levels < 870 mg, 871-999 mg, 1000 mg, 1001-2000 mg, and not restricted in 300, 314, 307, 297 and 533 participants, respectively.
Wednesday, August 3, 2011
Comparative Effectiveness of Calcium-Containing Phosphate Binders in Incident U.S. Dialysis Patients
Background and objectives Few studies have assessed the association between phosphate binder use and hard outcomes in dialysis patients. Furthermore, the comparative effectiveness of calcium carbonate and acetate is untested. We studied the association between use versus nonuse of calcium-containing phosphate binders (CCPBs) and mortality from any cause. We also tested whether mortality differed among users of individual CCPBs.
Design, setting, participants, & measurements A nationally representative prospective cohort of incident U.S. dialysis patients (1996 to 1997), assembled before the availability of sevelamer and lanthanum, was used. Use of each CCPB was ascertained from chart abstraction records. A large number of sociodemographic, clinical, and laboratory characteristics were available for confounding control in multivariate and propensity score-matched Cox regression models.
Results Among 3603 incident dialysis patients, 77.5% used a CCPB, whereas 22.5% did not. Baseline use of CCPB was associated with an adjusted 19% lower mortality rate among CCPB users compared with nonusers. With successful matching of 800 exposed and nonexposed individuals on their exposure propensity score, however, CCPB users and nonusers had similar mortality. No mortality differences were observed between calcium acetate and calcium carbonate users in crude, adjusted, or propensity-matched analyses.
Conclusions No association was found between CCPB use and 1-year mortality in incident dialysis patients; choice of calcium carbonate versus acetate was also not associated with this outcome. Randomized trials are necessary to understand whether the prevailing practice of phosphate-binding therapy actually reduces adverse clinical outcomes.
Copyright © 2011 by the American Society of Nephrology
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