The success of medicare's end-stage renal-disease program: the case for profits and the private marketplace.

The 92nd Congress extended Medicare benefits to patients with end-stage renal disease (ESRD), sparing patients the financial burden of treating this catastrophic illness. The costs of the ESRD program have been contained better than those of health care generally; payment was originally limited by a screen of $138 per dialysis but could be higher if higher cost was documented. About 48 per cent of patients receive dialysis in units outside hospitals.

Secondary hyperparathyroidism in human kidney transplant recipients.

76 kidney transplant recipients who were up to 4 years post transplant, were studied to assess the incidence of secondary hyperparathyroidism. All patients had good renal function with a mean serum creatinine of 1.4 mg/100 ml.

The influence of serum calcium and parathyroid hormone upon glucose metabolism in uremia.

The alterations in carbohydrate metabolism which attend the uremic syndrome have been recognized for some time. Recently, an interaction between hyperparathyroidism and these alterations in intermediary metabolism has been postulated. To further define any such interaction, 6 stable dialysis patients with significant secondary hyperparathyroidism were studied prior to and after subtotal parathyroidectomy.

Hemodialysis for acute anuric uric acid nephropathy.

A patient with acute oliguric uric acid nephropathy was treated with hemodialysis. Recovery in this disorder is based on treatment of both the uremic state and the intrarenal crystal obstruction. Hemodialysis with high uric acid clearance is much more efficient than other forms of therapy in this disorder.

Hemorrhagic pleural effusion in patients undergoing chronic hemodialysis.

Three patients maintained on chronic hemodialysis developed hemorrhagic pleural effusion. The effusions seemed to be solely related to the uremic state, other causes having been excluded. Pulmonary restriction requiring decortication occurred in one patient.

Testosterone therapy in hemodialysis patients.

30 patients undergoing regular, three times weekly hemodialysis were treated with large doses of intramuscular testosterone with evaluation of hematopoiesis before and after treatment. A control group of 30 patients not using the drug was evaluated in similar fashion. The presence or absence of native kidneys was the most important factor determining hematocrit level and transfusion requirements in these patients, whether treated with testosterone or not.

Cardiovascular disease in uremic patients on hemodialysis.

In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment.