Abstract: This study aimed at evaluating the feasibility of an acetate-free hemodialysis (AFHD) technique, comparing it with acetate-free biofiltration (AFB) and bicarbonate dialysis (BD). The assessment of the parameters concerned: electrolyte kinetics (Na+, K+), acid-base balance (HCO3-, pH), dialysis efficiency (Kt/V), serum beta2-microglobulin reduction ratio, nutritional status (normalized protein catabolic rate, serum albumin and total proteins, body mass index), hemopoietic status (hemoglobin, hematocrit), and some clinical parameters (systolic and diastolic blood pressures, heart rate, percent blood volume reduction measured by Hemoscan). Nine patients participated in this study which was conducted using a Latin square randomized experimental design. The results of the last week of each month of the study (1 month for each technique) were analyzed by means of Anova for repeated measures. The different treatments were comparable with regard to the main dialysis parameters such as blood flow (320 ml/min) and weight loss rate (0.6 +/- 0.1 kg/h), while dialysis length and dialysate conductivities were different, depending on the dialysis technique. Electrolyte kinetics and acid-base balance were similar during the three periods. The dialysis efficiency for small molecules (Kt/V of urea) was similar (between 1.4 and 1.6); however, AFB seemed to show a higher beta2-microglobulin reduction rate (47.6 +/- 4 vs. 4.3 +/- 10% for AFHD and vs. 9.9 +/- 5% for BD; p < 0.001). The nutritional and hemopoietic status maintained stable, and the hemodynamic parameters were comparable during all periods. The percent blood volume reduction at the end of the treatments was not statistically different (-14.9 +/- 9.4% in AFB, -12.1 +/- 5.1% in AFHD, and -12.2 +/- 4.4% in BD), and these results could explain the similar hemodynamic behavior during the three periods. In conclusion, AFHD appears to be a safe technique which has all positive effects of AFB and the low costs of BD. In our opinion, it could be used in patients with few clinical impairments, usually treated with hemodialysis, in whom a biocompatible treatment is indicated.
Abstract: Eosinophilia and some acute dialysis side-effects, such as itching, flushing and bronchospasm, are often associated with the presence of ethylene oxide (ETO) as dialyzer sterilizing agent. This study evaluated the effects of two different polysulfone (PS) hollow-fiber dialysers sterilized with ETO and steam in 31 chronic dialysis patients with eosinophilia. Clinical symptoms, metabolic and biochemical parameters, complement (C3a and C5a) activation and production were evaluated in each patient dialysed for two months at a time with Cuprophan dialyser, ETO-PS dialyser and steam-PS dialyser. The steam-sterilizer agent does not alter the purifying capacity of the PS membrane which maintains its superiority over Cuprophan in terms of biocompatibility. Using steam-PS, intradialytic eosinophil kinetics seems to improve. In some patients with high serum levels of ETO-specific IgE these levels tend to diminish. Generic intradialytic symptoms do not differ between the two sterilization methods, although some hypersensitivity symptoms during the first dialysis hour are considerably lower in some patients when steam-sterilized PS is used.
Abstract: We retrospectively studied 370 chronic uremic patients, 234 males and 136 females with a mean age of 53 +/- 15 years, to determine the number of mortalities due to hypertension. With hypertension defined as blood pressure values > 150/90, a total of 168 patients were found to be normotensive and 202 as hypertensive. Blood pressure was also considered in association with some prognostic variables such as the patient's age, time of dialysis, renal diagnosis, and dialytic treatment (hemodialysis or peritoneal dialysis). No significant difference in survival was found between normotensive and hypertensive patients. Patients with diabetic nephopathy had a significantly poorer survival experience with respect to other nephropathies, independently of blood pressure values after beginning dialysis treatment. The Cox proportional hazard analysis showed an increased risk of death from aging and peritoneal dialysis, while the chi 2 test showed the role of hypertension as a mortality risk factor only in patients less than 50 years old (18% of deaths among normotensives vs. 31% of deaths among hypertensives, P < 0.05). We conclude that hypertension does not seem to represent the primary risk factor for overall survival in dialysis therapy.
Abstract: Twenty-six chronic uremic pts (8F and 18M, mean age 64 yrs) on CAPD for 15 months on the average, were studied as regards the levels of B2M measured by radioimmunoassay in fasting serum samples. Considering residual renal function, 2 pts groups were identified: 11 pts with a diuresis greater than or equal to 500 cc/day and 15 pts with a diuresis less than 500 cc/day. Serum B2M was significantly decreased in the first group (24.8 +/- 8.1 vs 34.7 +/- 7.1 mg/l; p less than 0.02). Considering the incidence of peritonitis episodes, 12 pts without and 14 pts with one or more peritonitis episodes were noted. The group with no peritonitis showed significantly decreased serum B2M values (25.1 +/- 7.6 vs 35.03 +/- 4.8 mg/l; p less than 0.005). No relationship was found as regards primary renal diseases, sex and age of pts. We conclude that residual renal function and peritonitis episodes modify serum B2M levels in CAPD. The long term follow up of pts could be of interest for better defining the role of these factors as regards the incidence of pathologic lesions associated with B2M deposition.
Abstract: In 30 calcium stone formers urinary citrate, magnesium, calcium, phosphorus, uric acid and oxalate excretion were compared with the activity product ratios and formation product ratios of oxalate, brushite and monosodium urate. A positive correlation was found between calcium and phosphorus excretions and APRox and APRbr; no correlation was found between oxalate, uric acid, citrate and magnesium excretion and APR or FPR. Thus calcium and phosphorus contribute significantly to the increments of urine saturation; citrate and magnesium do not modify the inhibitor urinary activity, and oxalate and uric acid do not influence inhibition and saturation activities of urine.
