Clinical Nephrology and Dialysis in the 1990s
| Autor: | Thomas J. Comstock |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Nephrology
medicine.medical_specialty business.industry Mortality rate medicine.medical_treatment Continuous ambulatory peritoneal dialysis Disease medicine.disease Transplantation Diabetes mellitus Internal medicine medicine Pharmacology (medical) Hemodialysis business Intensive care medicine Dialysis |
| Zdroj: | Journal of Pharmacy Practice. 6:106-112 |
| ISSN: | 1531-1937 0897-1900 |
| DOI: | 10.1177/089719009300600303 |
| Popis: | End-stage renal disease (ESRD) afflicts more than 200,000 patients in the United States today, and they undergo chronic dialysis or transplantation in order to sustain life. The primary causes of treated ESRD today are diabetes mellitus, hypertension, and glomerulonephritis. Hemodialysis remains the mainstay of therapy for patients, primarily due to the chronic shortage of organs available for transplantation. Technological advances have led to numerous improvements in hemodialysis therapy during the last 30 years. Dialysis is now provided in a variety of settings, including hospitals, outpatient dialysis units, and the home. Despite these advances, morbidity and mortality remain high for patients with ESRD. Patients with diabetes have the highest mortality rates primarily due to cardiac and infectious complications. Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are generally younger and healthier than their hemodialysis counterparts. Mortality is lower in the CAPD group for younger patients, whereas mortality is lower among older hemodialysis patients. Various methods have been described to assess adequacy of dialysis in order to develop the optimal dialysis prescription. Although these may ultimately prove beneficial, recent observations indicate an increased mortality in American hemodialysis patients compared with their European counterparts. These differences may be due in part to variances in reimbursement rates for dialysis therapy, and a reduction in dialysis time among U.S. centers. In light of the increasing number of patients and the complexity of their therapy, multiple opportunities exist for pharmacists to become actively involved in the comprehensive care of the ESRD patient. |
| Databáze: | OpenAIRE |
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