The effect of uraemia upon wound healing: An experimental study

Colin, J. F.; Elliot, P.; Ellis, Harold

doi:10.1002/bjs.1800661113

Cited by 66 publications

(29 citation statements)

References 22 publications

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“…The adverse effects of uremia on fibroblast proliferation, hydroxyproline level, and collagen production in wounds were identified as early as the 1960s and 1970s. [12][13][14] Further, the beneficial effect of hemodialysis in uremic dogs was reported in 1966. 15 It is important to note that hemodialysis in the United States become available to patients with ESRD via the Medicare Waver only in 1971, 4 which is when clinical observations of wound healing outcomes became possible in this population of patients.…”

Section: Uremiamentioning

confidence: 97%

Wound Healing in Patients With Impaired Kidney Function

Maroz

Simman

2013

Journal of the American College of Clinical Wound Specialists

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Renal impairment has long been known to affect wound healing. However, information on differences in the spectrum of wound healing depending on the type of renal insufficiency is limited. Acute kidney injury (AKI) may be observed with different wound types. On one hand, it follows acute traumatic conditions such as crush injury, burns, and post-surgical wounds, and on the other hand, it arises as simultaneous targeting of skin and kidneys by autoimmune-mediated vasculitis. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) often occur in older people, who have limited physical mobility and predisposition for developing pressure-related wounds. The common risk factors for poor wound healing, generally observed in patients with CKD and ESRD, include poorly controlled diabetes mellitus, neuropathy, peripheral vascular disease, chronic venous insufficiency, and aging. ESRD patients have a unique spectrum of wounds related to impaired calcium-phosphorus metabolism, including calciphylaxis, in addition to having the risk factors presented by CKD patients. Overall, there is a wide range of uremic toxins: they may affect local mechanisms of wound healing and also adversely affect the functioning of multiple systems. In the present literature review, we discuss the association between different types of renal impairments and their effects on wound healing and examine this association from different aspects related to the management of wounds in renal impairment patients.

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Section: Uremiamentioning

confidence: 97%

Wound Healing in Patients With Impaired Kidney Function

Maroz

Simman

2013

Journal of the American College of Clinical Wound Specialists

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“…Inguinal hernia, which accounts for 75 % of abdominal wall hernias [1], is common in dialysis patients as well as healthy individuals and is caused by abdominal wall fragility [2] and increased intra-abdominal pressure [3]. Aging, male sex, chronic cough [4], prolonged peritoneal dialysis (PD) vintage [5], and polycystic kidney disease [6] have been reported as risk factors of abdominal wall hernia formation.…”

Section: Introductionmentioning

confidence: 99%

Inguinal hernia in hemodialysis versus peritoneal dialysis patients: a case-control study

et al. 2016

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Background: Inguinal hernia is common in dialysis patients, especially peritoneal dialysis (PD) patients; however, no previous reports have assessed the incidence, type, treatments, and risk factors of inguinal hernia in hemodialysis (HD) patients. We retrospectively evaluated the differences in these factors between HD and PD patients. Methods: A total of 2287 HD and 410 PD patients treated between March 2006 and December 2013 were enrolled. The incidence, type (indirect, direct, or combined), and hernioplasty of inguinal hernia as well as demographic characteristics of HD and PD patients were compared. Results: The incidence of inguinal hernia was lower in HD (0.7 %) than in PD patients (5.9 %) (P < 0.001), and these incidences were higher among men (P = 0.007 and P < 0.001, respectively). Of the 16 HD and 24 PD patients with inguinal hernia, 14 and 21 (both 88 %) underwent hernioplasty. Among them, PD patients demonstrated a higher proportion of indirect hernia (91 %) than HD (47 %) patients (P = 0.003). No recurrence was observed in either group. In a multivariate logistic regression model, PD and male sex were risk factors for inguinal hernia (both P < 0.001). Conclusions: In this study, indirect inguinal hernia was more frequent in PD patients than in HD patients. Male sex and PD are risk factors for inguinal hernia in dialysis patients. Tension-free hernioplasty for inguinal hernia was effective in both HD and PD patients. Our findings can help inform clinicians when selecting the dialysis modality (HD or PD) prior to the initiation of dialysis therapy and guide clinical management practices for inguinal hernias in dialysis patients.

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“…Certain systemic conditions, such as hypotension, hypovolemia, intestinal ischemia, low oxygen tension, advanced malignant neoplasia, dehydration, uremia, age and malnutrition, can affect healing [8][9][10][11][12][13][14] . Some studies have shown a higher incidence of colonic anastomotic dehiscence in patients with intraoperative hypotension, anemia, and cirrhosis 1,6 .…”

Section: Introductionmentioning

confidence: 99%

Liver cirrhosis on the colonic anastomotic healing in rats

Bonifácio¹,

Parra²,

Almeida³

et al. 2011

Acta Cir. Bras.

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PURPOSE:To investigate the effects of cirrhosis on colonic anastomosis healing in rats. METHODS:Fifty five Wistar male rats were used (23 in the control group and 32 in the cirrhosis group). On the first day of the procedure, the rats in the cirrhosis group underwent double ligation and folding of the common bile duct to induce liver cirrhosis, and the control rats underwent a laparotomy and intestinal manipulation. On the fourteenth and thirty-fifth days, all of the animals were biochemically assessed for serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, bilirubin, total protein, and albumin and for liver histopathology. On the thirty-fifth day, cirrhosis was confirmed. On the twenty-eighth day, all of the animals were subjected to left colon transection and anastomosis. On the seventh day after the colonic anastomosis, the rats were sacrificed and macroscopically evaluated for dehiscence. The region of the colonic anastomosis was removed and subjected to hydroxyproline content measurement, conventional histology, and the immunohistochemical determination of vascular endothelial growth factor (VEGF) and matrix metalloproteinase type 1 (MMP 1). RESULTS:The biochemical and histopathological examinations confirmed cirrhosis in all of the animals in the cirrhosis group. More deaths occurred after anastomosis in the cirrhosis group (5/25) than in the control group (0/21), and anastomotic dehiscence was more frequent in the cirrhosis group (8/25) than in the control group (0/21). The average hydroxyproline concentration was lower in the cirrhosis group than in the control group. The immunohistochemical studies showed that the average VEGF expression in the cirrhosis group was lower than in the control group, and the average MMP1 expression was higher in the cirrhosis group. CONCLUSION:Hepatic cirrhosis leads to increased mortality and colonic anastomotic dehiscence, an increased distance between the mucosal edges of the anastomosis area, and a lower hydroxyproline concentration in the colonic anastomosis; therefore, these conditions are deleterious to healing. cirrose foi confirmada. No dia 28 todos os animais foram submetidos à colectomia esquerda e anastomose. 70 dias após anastomose os ratos foram submetidos à eutanásia e foram avaliados macroscopicamente a procura de deiscência. A região da anastomose colônica foi removida para dosagem de hidroxiprolina, histologia convencional e imunohistoquímica para determinação do fator de crescimento endotelial vascular (VEGF) e metaloproteinase tipo 1 (MMP 1). RESULTADOS:A análise bioquímica e histológica confirmou a cirrose em todos os animais do grupo cirrose. Óbito ocorreu em maior freqüência após a anastomose no grupo cirrose (5/25) se comparado com grupo controle (0/21), e a deiscência da anastomose foi mais freqüente no grupo cirrose (8/25) se comparado com controle (0/21). A concentração média de hidroxiprolina foi menor no grupo cirrose se comparado com grupo controle. A análise imonuhistoquímica mostrou que a exp...

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The effect of uraemia upon wound healing: An experimental study

Cited by 66 publications

References 22 publications

Wound Healing in Patients With Impaired Kidney Function

Wound Healing in Patients With Impaired Kidney Function

Inguinal hernia in hemodialysis versus peritoneal dialysis patients: a case-control study

Liver cirrhosis on the colonic anastomotic healing in rats

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