Outcome of home haemodialysis patients: a case-cohort study.

Background: Randomized, controlled comparisons between home haemodialysis (HHD) and centre haemodialysis (CHD) have not been performed to date. Reported survival benefits of HHD as compared with CHD from uncontrolled studies have been attributed largely to patient selection.

Methods: In order to minimize a selection bias, we have compared the outcome of our HHD and CHD patients with a nested case-cohort study.

[Factors determining the choice of a modality of treatment by dialysis: a study of nine dialysis centers].

Background: The objective of this cross-sectional study in a population of 1472 dialysis patients was to identify the main factors involved in the choice of a specific option for dialysis therapy, taking into account three different types of criteria such as medical dependence (DM), nurse care requirement (SI) and independence for dialysis therapy (CA).

Methods: Each patient has been analysed, independently of present treatment modality, according to the above three criteria, namely DM, SI and CA. For each type of parameter, patients have been allocated to one of three levels, each level being established to evaluate whether dialytic treatment should be undertaken as hospital centre dialysis (HDC) or in a facility off the hospital.

Circulating ionized and total magnesium in end-stage kidney disease.

Background: Circulating magnesium exists in the ionized state and in the undissociated form, either bound to albumin, or complexed to various anions. Until recently, only the measurement of total plasma magnesium has been possible. Now circulating ionized magnesium can be assessed as well.

Prospective evaluation of pretransplant blood transfusions in cadaver kidney recipients.

Background: A beneficial effect of pretransplant transfusions on graft survival was demonstrated in the early 1970s. In the mid-1980s, however, retrospective studies showed that transfusions had lost their graft-protective effect in the cyclosporine era. During the last 10 years, deliberate transfusion pretreatment of transplant patients has been discontinued.

Six-month overnight administration of intraperitoneal amino acids does not improve lean mass.

Unlabelled: Intraperitoneal administration of 1% amino acid dialysis solution in patients on continuous peritoneal dialysis (CAPD) is associated with improvement in plasma amino acid concentrations and inconsistent results with respect to nitrogen balance. Whether alteration(s) in lean mass and body fat distribution also occur remains controversial. Therefore 18 patients (P), on CAPD for at least 6 months, were assigned in a prospective and controlled fashion to receive overnight either a 1% amino acid (AA-P) or a 1.

Evidence for preservation of cortical bone mineral density in patients on continuous ambulatory peritoneal dialysis.

It is still unclear whether dialysis modality, i.e., continuous ambulatory peritoneal dialysis (CAPD) versus hemodialysis (HD) specifically affects bone mineral density (BMD).

Effect of calcium-channel blockers on calcium-phosphate metabolism in patients with end-stage renal disease.

Background: After EDTA-induced hypocalcaemia, healthy volunteers treated with diltiazem display more severe hyperparathyroidism than subjects on felodipine studied under identical conditions. Therefore patients with end-stage renal disease (ESRD) and severe secondary hyperparathyroidism might be particularly sensitive to this side-effect.

Methods: To test this hypothesis, seven patients with ESRD on chronic haemodialysis (3 women and 4 men) with serum levels of intact PTH ranging from 204 to 675 pg/ml were studied both before and during the first 180 min of haemodialysis against a dialysate with low calcium concentration (0.

Impact of time-interval after transplantation and therapy with fibrates on serum cholesterol levels in renal transplant patients.

It is unclear to what extent different immunosuppressive regimens contribute to increased serum cholesterol levels observed in renal transplant patients after prolonged periods of immunosuppression (i.e. 3 and 5 years following kidney grafting).

Impact of dialysis modality on body composition in patients with end-stage renal disease.

Loss of muscle mass and altered body fat distribution (i.e. increased central fat stores in the presence of normal peripheral fat stores) have been reported in patients on hemodialysis (HD), when compared to normal volunteers.

[Toxicity of an organic Germanium compound: deleterious consequences of a "natural remedy"].

Reports mainly from Japan, recommend germanium (Ge)-containing compounds as "anti-cancer" and "immunostimulatory" remedies. We report on a 25-tear-old woman with stage II HIV disease who consumed a total of 47 g Ge as Ge-lactate-citrate 18%. She developed severe renal insufficiency (creatinine clearance 7 ml/min/1.

[Determination of fructosamine in chronic kidney diseases (dialysis-dependent patients)].

The serum fructosamine normal range was confirmed. Correction to protein or albumin did not significantly affect the results. Therefore, correction of fructosamine values from patients with normal protein and albumin values would not improve the clinical significance of fructosamine.

Serum immunoglobulin levels and natural antibodies to Haemophilus influenzae in hemodialysis patients: evidence for IgG subclass imbalances.

Humoral immune parameters were studied in 13 patients with end-stage renal failure on maintenance hemodialysis. Serum IgA, IgM and IgG concentrations were comparable to control values from 14 healthy blood donors. IgG subclass analysis revealed significantly increased IgG1 levels in the patients when compared to controls (p less than 0.

[Home dialysis].

Home haemodialysis is a good example of life-conserving medical technique performed outside the hospital. Since 1982, CPD has been displacing home haemodialysis as preferred independent dialysis. Nevertheless, for all those unable or unwilling to perform peritoneal dialysis, home haemodialysis continues to offer the advantages of self-treatment with good rehabilitation and excellent quality of life.

[Hemodialysis as kidney replacement therapy].

Haemodialysis is the most frequently used renal replacement therapy and in Europe keeps alive more than 80,000 patients with end-stage renal failure. Three times weekly the patient is connected to the artificial kidney and uraemic toxins are removed using a filter permeable for water and small solutes. This treatment lasts about 3-4 hours and can be performed in hospitals, dialysis centers or in the patient's own home.

[Selective elimination of atherogenic lipoproteins using dextran-sulfate cellulose. Experiences in 2 patients with heterozygote familial hypercholesterolemia].

Extracorporeal elimination of atherogenic lipoproteins with dextran-sulfate-cellulose for lowering of plasma cholesterol levels was tested in 2 patients with familial heterozygous hypercholesterolemia (untreated cholesterol values 12.9 +/- 1.5 and 12.

Pharmacokinetics of amoxycillin and clavulanic acid in haemodialysis patients following intravenous administration of Augmentin.

1. Serum concentrations of amoxycillin and clavulanic acid were measured in patients with end-stage renal disease (ESRD) following intravenous administration of 1.2 g Augmentin.

Lipoprotein changes in familial hypercholesterolemia after extracorporeal immunoadsorption of low density lipoproteins.

The effects of extracorporeal immunoadsorption of LDL on the lipoprotein metabolism in two patients with familial hypercholesterolemia are reported. The immunoadsorbent consisted of F(ab')2 fragments of sheep anti-LDL antibodies, which had been coupled to Sepharose CL 4B. Within a time period of 3 to 3.

Human recombinant erythropoietin in anaemic patients on maintenance haemodialysis. Secondary effects of the increase of haemoglobin.

Twelve anaemic patients on haemodialysis were treated with recombinant human erythropoietin, starting with 72 IU/kg/week. The dose was doubled after 2 weeks until an increase of 2 g/dl of haemoglobin was observed. The effects on various parameters were studied during a 3-month period.

Differential effect of impaired renal function on the kinetics of clavulanic acid and amoxicillin.

Amoxicillin and clavulanic acid are prescribed as a fixed drug combination. The purpose of the present study was to assess the influence of various degrees of renal insufficiency (glomerular filtration rate [GFR], less than 5 to greater than 75 ml/min per 1.73 m2) on the pharmacokinetics of amoxicillin and clavulanic acid following oral (500 and 125 mg of amoxicillin and clavulanic acid, respectively) and intravenous (1,000 and 200 mg, respectively) dosing.

Biocompatibility of different hemodialysis membranes: activation of complement and leukopenia.

The ability of three hollow-fiber dialyzers (Cuprophane [CU], polymethylmethacrylate [PMMA], and polyacrylonitrile [PAN]) to activate complement and to induce leukopenia was studied prospectively in six patients on long-term hemodialysis. CU membranes caused the most intense complement activation with C3a, C3d, and C5a levels peaking 15 min after beginning dialysis. Total white blood cell (WBC) counts dropped simultaneously by 76%, and the decrease in leukocytes was inversely correlated with the levels of C3a and C5a.

[Management of hypercholesteremia by extracorporeal immune adsorption].

Reduction of plasma cholesterol by extracorporeal immune elimination of low density lipoproteins (LDL) as an efficient approach to the treatment of familial hypercholesterolemia is described. LDL was removed from the plasma by immune adsorption on Sepharose-bound sheep antibodies against apo B, the protein fraction of LDL. To prevent the possibility of sensitization by the sheep antibodies, F(ab')2 fragments were used and the antibody containing Sepharose was underlaid by LDL containing Sepharose.

Pharmacokinetics of tenoxicam in patients with impaired renal function.

The pharmacokinetics of tenoxicam after a single oral dose of 20 mg has been studied in 12 patients with various degrees of decreased renal function. Unchanged tenoxicam and its 5'OH-metabolite in plasma and urine were determined by HPLC. The mean areas under the plasma concentration-time curve (138 +/- 53 micrograms/ml X h) and terminal half-lives in patients with impaired renal function did not differ from values previously reported in normal volunteers, nor did the peak concentration of tenoxicam.

Interferon as an adjuvant for hepatitis B vaccination in non- and low-responder populations.

To determine the effect of interferon on the production of antibodies against hepatitis B virus, recombinant alpha-interferon was added only to the fifth vaccine injection in a non-responder group and to all three initial vaccine injections in a low-responder group. In the non-responder group, 27% of the hemodialysis patients, 7% of the renal transplant patients, and both medical staff members tested developed low serum concentrations of anti-HBs (less than 25 mU/ml). Whereas in the low-responder group 60% of the hemodialysis patients developed the same amount of antibodies as a placebo group of comparable patients (greater than or equal to 25 mU/ml), 78% of the renal transplant patients showed a 25% higher antibody concentration than a placebo group (half less than 25 mU/ml;half less than 50 mU/ml).