Phosphate kinetics in dialysis patients.

During extrarenal therapy, plasma phosphate concentrations have specific kinetics: plasma values reach a steady-state nadir 90-120 min after the beginning of the session (from 0.6 to 1.1 mmol/l) with a subsequent high rebound in the 3-4 h following the session.

Technical and clinical data on high-performance hemofiltration: twelve patients during one year.

In 12 chronic hemodialysis patients, postdilutional hemofiltration (HF) was substituted for conventional acetate hemodialysis (HD) (4-5 h/session with high-area capillary dialyzers). In HF, the purposes were to obtain (a) no increase in pre-HF uremia compared with pre-HD uremia (high ultrafiltrate volume), (b) an HF duration shorter than that of HD (mean ultrafiltrate rate greater than 120 ml/min), (c) a disposable cost of an HF session identical to that of an HD session (reuse of hemofilters and extemporaneous preparation of substitution fluid). One-year results were (a) an ultrafiltrate volume of 26.

Arteriovenous shunt measured by bolus dye dilution: reproducibility and comparison between two injection sites.

Twenty-eight brachial arteriovenous fistulae (AVF) flows were assessed by the Stewart and Hamilton method by bolus dye injection. These measurements were divided in two groups: a first group with dye injection into the AVF artery and a second group with dye injection into the efferent vessel of the AVF in close proximity. The increase and the decrease of dye concentration were regular and the circulation occurred very late in both groups.

Plasma kinetics of small molecules during and after hemofiltration: decrease in hemofiltration efficiency related to increase in ultrafiltration rate.

The influence of delay in mass transfer on the real efficiency of hemofiltration sessions (HF) was studied in 7 patients during HF at a moderate ultrafiltration rate (UF rate = 100 ml/min) and at a high UF rate (UF rate = 200 ml/min). Real efficiency was expressed as "effective clearance" (KE) and compared to plasma clearance (KP); KE/KP was calculated from the kinetics of small molecules during HF and stabilized rebound post HF. Rebound in urea and uric acid plasma levels stabilized by 90 min post HF; increase in the UF rate from 100 to 200 ml/min was responsible for a decrease in KE/KP of 4% for urea and 11% for uric acid.

Peliosis hepatis in a chronic hemodialysis patient.

Peliosis has been described rarely in patients with chronic renal failure. The case reported shows the difficulty of diagnosis in a chronic hemodialysis patient with painful hepatomegaly, chronic ascites and cachexia. The rarity of this lesion under such circumstances, if the etiologies described in the literature are taken into account, is discussed.

[Arterial hypertension due to abuse of sympathomimetic drugs. One case (author's transl)].

A 36-year-old woman developed severe arterial hypertension after taking for five consecutive years increasing dose (up to 10 mg per day) of phenoxazoline HCl in nasal spray. A relationship between the abuse of this sympathomimetic drug and the hypertension was suggested by the unusual appearance of renal arteries on arteriography (stenosis and dilatations resembling aneurisms), the increase in renin activity and the disappearance of hypertension after the drug was discontinued. On control examination, two years later, blood pressure, renin activity and renal arteries were normal.

Hemodynamic effects of arteriovenous fistulae in chronic hemodialysis patients at rest and during exercise.

The effects of arteriovenous fistulae (AVF) on cardiac output (CO) and cardiac filling pressures were studied at rest and during exercise in 16 chronic hemodialysis patients. After the occlusion of the AVF, average CO fell but cardiac filling pressures remained unchanged, seven patients had a drop in CO greater than or equal to 1.0 l/min (group A) and nine patients had a drop in CO less than or equal to 0.

High efficiency haemofiltration (ultrafiltration of more than 250ml/min for two hours) in eight uraemic patients.

In eight uraemic patients a haemofiltration of very high efficiency was carried out from a double extracorporeal circuit set up via an arteriovenous fistula. The weight of the patients was kept constant throughout the session. The average ultrafiltration flow rate was 274ml/min; the total ultrafiltration volume was 32.

[Radiological, fibroscopical, histological and secretory gastric aspects in hemodialyzed patients (author's transl)].

Seventeen chronic hemodialyzed patients underwent a baryum meal, a fibroscopy with biopsic studies and an evaluation of gastric acid secretion. No duodenal ulcer was found. The gastric and duodenal folds are the most common anomaly.

[Left ventricular performance in chronic hemodialysis patients studied during intense exercise and during a dextran infusion test (author's transl)].

In 14 chronic hemodialysis patients with recent circulatory pulmonary congestion or pulmonary edema, left ventricular failure was suspected. Left ventricular function was studied by a sitting exercise test and a dextran infusion test. According to the left ventricular function curves the left ventricular function was not altered in chronic hemodialysis patients compared to normal subjects.

[Patients on chronic hemodialysis. Hemodynamic study at rest and during exercise before dialysis, in hypertensive and normotensive patients (author's transl)].

In twenty chronic hemodialyzed patients a hemodynamic study was carried out just before dialysis at bed rest and during sitting bicycle exercise. At bed rest, cardiac index (mean +/- standard deviation = 5.2 +/- 1.

[Relationship between gastric acid secretion and plasma calcium, parathormone and calcitonin levels in patients with chronic renal failure on haemodialysis (author's transl)].

In twelve patients on chronic haemodialysis, a relationship was established between gastric acid secretion on the one hand, and certain parameters of calcium metabolism on the other hand: in a multifactorial statistical analysis, plasma calcium before dialysis (p less than 0,05), plasma parathormone levels before dialysis (p less than 0,05) and plasma calcitonin before dialysis (p less than 0,05) were variable explicatives of basal gastric acid secretion according to a direct relationship, whilst plasma calcium (p less than 0,05) was the only explicative variable of maximal gastric acid secretion after pentagastrin, with an inverse relationship. These preliminary results suggest that gastric acid secretion in the haemodialysis patient must be interpreted in the light of the state of calcium metabolism. Thus hypocalcaemia may be accompanied by decreased basal acid secretion and by contrast by an increased maximal acid secretion.

[The infraclinical diagnosis of lead poisoning (author's transl)].

Laboratory study of 16 workers handling lead made it possible to define a state of infraclinical lead poisoning. Estimation of alpha-dehydrase and of free erythrocytic protoporphyrins is the most sensitive test for diagnostic purposes. The estimation of erythrocytic pyrimidine 5' Nucleotidase would seem to be of value in the diagnosis of mild lead poisoning.

[Myocardial function of the chronic hemodialysed patient. Evaluation by measurement of systolic time intervals].

Study of myocardial function in chronic haemodialysis patients by the measurement of systolic time intervals reveals an alteration in left ventricular performance. These results are in favour of the hypothesis of a multifactorial cardiomyopathy associated with chronic haemodialysis. In the absent of long standing or severe hypertension, blood pressure levels have no significant influence on systolic interval times, this also applying to the degree of anaemia.