Blood thiol status and erythrocyte glutathione-S-transferase in chronic kidney disease patients on treatment with frequent (daily) hemodialysis.

Background: Chronic kidney disease (CKD) is a condition of impaired homeostasis of blood thiols characterized by a severe hyperhomocysteinemia (HH) and abnormal expression of the red blood cell glutathione (GSH)-consuming enzyme GSH S-transferase (eGST) (Galli et al., Clin Chem 1999). The correlation between plasma Hcy and eGST recently identified by our group (Dessì et al.

Survival with short-daily hemodialysis: association of time, site, and dose of dialysis.

In thrice-weekly hemodialysis, survival correlates with the length of time (t) of each dialysis and the dose (Kt/V), and deaths occur most frequently on Mondays and Tuesdays. We studied the influence of t and Kt/V on survival in 262 patients on short-daily hemodialysis (SDHD) and also noted death rate by weekday. Contingency tables, Kaplan-Meier analysis, regression analysis, and stepwise Cox proportional hazard analysis were used to study the associations of clinical variables with survival.

Effect of hemodialysis schedules and membranes on hepatocyte growth factor and hepatitis C virus RNA levels.

Hemodialysis induces production of the hepatocyte growth factor (HGF) and decrease of serum hepatitis C virus (HCV) RNA in patients with HCV infection, but it is not known if the hemodialysis schedule or type of membrane affect both the HGF production and HCV viremia. The effects on both parameters of alternate-day intermittent hemodialysis and short-daily hemodialysis and high and low flux membranes were investigated in 41 patients treated by hemodialysis. Sixteen (39%) patients were anti-HCV positive and 11 (69%) had HCV RNA.

Awareness of hypertension and proteinuria in randomly selected patients in 11 Italian cities. A 2005 report of the National Kidney Foundation of Italy.

Arterial hypertension and proteinuria are risk factors for chronic kidney disease. A mobile clinic was parked in a central plaza of 11 Italian cities to check blood pressure (BP), prescribe antihypertensive drugs, assess for proteinuria, and provide awareness about hypertension. Among 3757 patients, 56% were hypertensive, 37% were not diabetic nor proteinuric with BP >or=140/90 mm Hg, 17% were diabetic or proteinuric with BP >or=130/80 mm Hg, and 11% were on treatment with BP at target.

Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years.

Background: Survival statistics for daily haemodialysis are lacking as most centres providing this have treated only a small number of patients for short observation times. We pooled our 23-year, 1006-patient-year, five-centre experience of 415 patients treated by short daily haemodialysis.

Methods: One hundred and fifty patients were treated in-centre, most because of medical complications and 265 by home or self-care haemodialysis.

Effect of two-hour daily hemodialysis and sham dialysis on breath isoprene exhalation.

Background: Isoprene, a volatile hydrocarbon produced by the human organism, is currently being extensively investigated because the mechanisms underlying its endogenous origin are unknown and because experiments suggest it is toxic and cancerogenous. Previous reports of increases in breath isoprene concentrations during 4-hour, thrice-weekly hemodialysis, but not during continuous ambulatorial peritoneal dialysis, prompted us to assess the behavior of isoprene in another dialytic modality, i.e.

Use of sodium hypochlorite in peritoneal dialysis: the genesis of the 'Y' set and beyond.

The 'Y' set introduced in the clinical practice in the early 80s with the aim of reducing the peritonitis rate in patients on continuous ambulatory peritoneal dialysis, successfully revolutioned the philosophy of the connection system catheter-container of dialysate, which was the main way of bacterial contamination of the peritoneal cavity. In fact, while the previous connection systems had focused the attention on the reduction of the possible contaminating acts, the 'Y' system, taking into account the fact that soon or later a failure could occur even with the most skilled and compliant patient, introduced the possibility to kill the bacteria with a disinfectant and to remove it and the killed bacteria together with the bacteria eventually still surviving, by flushing the contaminated area. This goal was achieved thanks to a 'Y' shaped connector, having a third way connected to the discharge bag/container, besides the two connected to the new bag and to the catheter.

Antisepsis.

All dialysis treatments include a certain risk of infection because of the decreased immune defenses of the patients and because of dialytic techniques that increase the potential of microbial contamination. Peritoneal dialysis, and in particular continuous ambulatory peritoneal dialysis (CAPD), has a higher risk of infections of the peritoneum, but even of the subcutaneous tunnel. These infections are caused by environmental microorganisms principally gram-positives (Staphylococcus epidermidis and Staphylococcus aureus).

Effects of short daily hemodialysis and extended standard hemodialysis on blood pressure and cardiac hypertrophy: a comparative study.

Background: Causes of hypertension and cardiac hypertrophy in hemodialysis (HD) patients are multiple, but the role of fluid overload appears to be crucial. Short daily HD (sDHD = 2 hr x 6/week) seems to allow reductions in left ventricular mass (LVM) through the reduction of extracellular water (ECW). Better cardiovascular stability during HD can be obtained with short, but more frequent HD sessions, but also by increasing the session length accompanied with a reduction in ultrafiltration (UF)/hr.

[Acute renal failure, hemolysis and thrombocytopenia].

A 41-year-old male was admitted because of severe systemic hypertension and acute renal failure (ARF) that required hemodialysis (HD). Also present were hemolytic anemia, thrombocytopenia and increased plasmatic levels of aldosterone and reninic activity. The diagnostic tests performed during the recovery led to the conclusion of malignant hypertension.

Prognostic value of 24-hour ambulatory blood pressure monitoring and of night/day ratio in nondiabetic, cardiovascular events-free hemodialysis patients.

Background: The use of 24-hour ambulatory blood pressure monitoring is increasing in end-stage renal disease (ESRD) patients but the prediction power for cardiovascular complications of time-averaged ambulatory blood pressure components has been little investigated in these patients.

Methods: We analyzed the prognostic power of 24-hour ambulatory blood pressure monitoring for all-cause and cardiovascular mortality in 168 nondiabetic, events-free hemodialysis patients selected from a total dialysis population of about 450 patients.

Results: During the follow-up period (38 +/- 22 months), 48 patients died, 29 of them of cardiovascular causes.

A randomized trial of steroid avoidance in renal transplant patients treated with everolimus and cyclosporine.

In this randomized trial renal transplant recipients were treated with basiliximab, everolimus 3 mg/day, low-dose CsA. At transplantation, patients were randomized to stop steroids at the seventh day (group A) or to continue oral steroids in low doses (group B). Of the 113 patients enrolled, 65 were randomized to group A and 68 to group B.

Vitamin E in uremia and dialysis patients.

Vitamin E therapy (based either on oral supplements or new dialysis methods such as vitamin E-coated hemodialysers) has been suggested to yield a better clinical outcome in hemodialysis (HD) patients than in other populations of patients. Among other factors, the presence of a modified vitamin E status might help to explain this apparently paradoxical response to vitamin E. In this study we investigated 104 regular HD patients.

Glycoxidation and inflammatory markers in patients on treatment with PMMA-based protein-leaking dialyzers.

Background: High-molecular-weight solutes such as glycation and oxidation protein products are putative proinflammatory mediators found in the uremic blood. The elimination of these and other large solutes by protein-leaking dialyzers (PLD) might help to correct the inflammatory status of maintenance hemodialysis (HD) patients.

Methods: Two matched groups of 13 standard 3 times/week HD patients were treated for 6 months with PMMA-based PLD and non-protein-leaking dialyzers (NPLD), respectively.

Haemodialysis with on-line monitoring equipment: tools or toys?

Background: On-line monitoring of chemical/physical signals during haemodialysis (HD) and bio-feedback represents the first step towards a 'physiological' HD system incorporating adaptive and logic controls in order to achieve pre-set treatment targets.

Methods: Discussions took place to achieve a consensus on key points relating to on-line monitoring and bio-feedback, focusing on the clinical applications.

Results: The relative blood volume (BV) reduction during HD can be monitored by optic devices detecting the variations in concentration of haemoglobin/haematocrit.

Effect of daily hemodialysis on monocytes apoptosis.

Uremia is associated with a state of immune dysfunction with increased susceptibility to infection and malignancy possibly related to dysregulation of immune system cell apoptosis. Peritoneal dialysis can restore plasma apoptosis activity on monocytes compared to intermittent hemodialysis. Whether the continuous modality or diverse clearance mechanisms involved are responsible is unknown.

Dialysis dose and frequency.

Background: From the beginning of the dialysis era, the issue of optimal dialysis dose and frequency has been a central topic in the delivery of dialysis treatment.

Methods: We undertook a discussion to achieve a consensus on key points relating to dialysis dose and frequency, focusing on the relationships with clinical and patient outcomes.

Results: Traditionally, dialysis adequacy has been quantified referring to the kinetics of urea, taken as a paradigm of all uraemic toxins, and applying the principles of pharmacokinetics using either single- or double-pool variable volume models.

The self-locating catheter: clinical experience and follow-up.

Background: The self-locating catheter invented by Nicola Di Paolo has been used increasingly in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted into the tip of the conventional Tenckhoff catheter during extrusion does not significantly change its form, but suffices to keep the tip firmly in the Douglas cavity.

Objective: The aim of the present study was to confirm our preliminary results in a large population of peritoneal dialysis patients.

Accumulation of vitamin E metabolites in the blood of renal failure patients.

Background & Aims: Carboxyethyl-hydroxychromans (CEHC) are hydrosoluble vitamin E metabolites excreted through the renal filter. In this study we investigated the effect of the kidney damage on the blood levels of CEHC.

Methods: Plasma levels of alpha-CEHC, gamma-CEHC and their precursors (namely, alpha-tocopherol and gamma-tocopherol) were measured by HPLC with electrochemical detection in chronic (CRF) and end-stage renal failure patients on regular hemodialysis (HD) before and after dialysis.

Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients.

Background: Hypertension and left ventricular hypertrophy (LVH) are present in the majority of patients undergoing haemodialysis (HD). These two pathologies persist after dialysis onset, and pharmacological therapy is often required for adequate control of blood pressure (BP). Although fluid overload is a determinant of hypertension, clinical assessment of this parameter remains difficult and unsatisfactory.

Mononuclear leukocyte apoptosis in haemodialysis patients: the role of cell thiols and vitamin E.

Background: An increased apoptotic rate of peripheral blood mononuclear leukocytes (PBMLs) in haemodialysis (HD) patients has been reported in several studies, but its underlying mechanisms remain poorly understood. Oxidant stress is a well known cause of cell damage, and several lines of evidence suggest that it might influence the induction and signalling steps of mononuclear cell apoptosis through different mechanisms so as to provoke disturbances of the intracellular pool of thiols (SHi). In this study, we investigated the in vitro apoptotic rate and SHi of PBMLs in end-stage renal disease (ESRD) patients on HD or peritoneal dialysis (PD).