In search of ideal hemodialysis: is prolonged frequent dialysis the answer?

Advances in technology have made it possible to deliver a high Kt/V in a shorter time. The realization that duration of dialysis may be an important predictor of survival independent of dialysis dose has resulted in the popularity of prolonged slow dialysis (PHD). The longer duration and increased frequency of dialysis achieve excellent small- and middle-molecular weight solute clearance and also attenuate the peak concentration of uremic toxins.

Is peritoneal dialysis a good option for black patients?

Blacks are less likely than whites to use peritoneal dialysis (PD) as the initial renal replacement therapy. The reason for the underusage of PD by blacks is unknown. In a cross-sectional multicenter trial, we studied peritoneal transport character, small-molecular-weight solute clearances, and nutritional status in 475 patients undergoing PD (168 whites, 192 blacks, and 115 Asians).

Mass balance index: an index for adequacy of dialysis and nutrition.

Determining adequacy of dialysis has remained a problem for the nephrologist despite the results of the National Cooperative Dialysis Study published more than 20 years ago. Urea Kinetics Modelling (UKM) which requires computer data entry is time-consuming for the dialysis staff but is the only method that has been rigorously studied. Furthermore, it is unclear today what value of Kt/V represents ideal dialysis; the technique is subject to a number of errors associated with estimation of dialyser clearance (K) and volume of distribution of urea (V) but it is useful for calculating protein catabolic rate (PCR).

Striated muscle calcium-stimulated cysteine protease (calpain-like) activity promotes myeloperoxidase activity with exercise.

An inflammatory response triggered by neutrophil accumulation into muscle tissue is thought to occur with exercise-induced muscle damage. To investigate the relationship between Ca2+-stimulated proteolysis (calpain-like activity) and neutrophil accumulation [myeloperoxidase (MPO) activity], cardiac and plantaris muscles from rats (n = 10) completing 1 h exercise (25 m/min) were investigated. Exercise promoted increases (P<0.

Exercise-induced muscle injury: a calpain hypothesis.

It is well established that periods of increased contractile activity result in significant changes in muscle structure and function. Such morphological changes as sarcomeric Z-line disruption and sarcoplasmic reticulum vacuolization are characteristic of exercise-induced muscle injury. While the precise mechanism(s) underlying the perturbations to muscle following exercise remains to be elucidated, it is clear that disturbances in Ca2+ homeostasis and changes in the rate of protein degradation occur.

Nocturnal hemodialysis: three-year experience.

There is evidence that high frequency, as well as long duration, hemodialysis provides better clinical outcomes. We developed nocturnal hemodialysis, a new innovative form of renal replacement therapy, which is performed six to seven nights per week for 8 to 10 h during sleep at home. Blood flow was set at 300 ml/min and dialysate flow at 100 ml/min.

Left ventricular morphology in chronic renal failure by echocardiography.

M-mode, two-dimensional, and Doppler echocardiography were performed in 38 chronic renal failure (CRD) patients on conservative management, 35 patients on hemodialysis, and 36 matched controls. The controls were matched for age, sex, and comorbidities. The incidence of hypertension, left ventricular (LV) end diastolic volume, LV end systolic volume, and LV mass index were significantly higher in patients on hemodialysis compared to the controls.

Blood urea levels 30 minutes before the end of dialysis are equivalent to equilibrated blood urea.

The steady decline in blood urea during high efficiency hemodialysis is followed by a rebound phase after dialysis in which the level of urea rises to an equilibrium value (Ct + 30) that may be up to 20% higher than the immediate post dialysis (Ct) concentration. The artificially low urea concentration immediately after dialysis leads to an overestimate of the efficiency of the dialysis calculated by Kt/V if the true equilibrium blood concentration of urea is not used in the calculation by the single-pool urea kinetic model. The measurement of equilibrium urea concentration requires a blood sample approximately 30 min after hemodialysis, which is an encumbrance on dialysis patients.

Ethnic variability in peritoneal equilibration test and urea kinetics.

The influence of ethnicity on peritoneal permeability and the adequacy of peritoneal dialysis was studied in 202 end-stage renal failure patients on peritoneal dialysis. Patients were classified into whites, Orientals, blacks, and a miscellaneous group consisting of East Indians, Persians, and others whose ethnicity was unknown. The patients were on peritoneal dialysis for a mean period of 29.

Quantitating dialysis using two dialysate samples: a simple, practical and accurate approach for evaluating urea kinetics.

Urea kinetics is now widely used to determine the adequacy of dialysis. Several simplified formulae are currently in use but only a few have been accepted into clinical practice because of their simplicity and ease of calculation. A recent analysis of these formulae showed that for the same set of blood urea values the calculated Kt/V can range from 1.

Quantitation of change in the medullary compartment in renal allograft by ultrasound.

Twenty-three renal allograft recipients with uncomplicated post-transplant courses were sonographically evaluated on the 3rd, 10th, 30th, and 90th post-operative day. The cortical thickness (CT), pyramidal length (PL), pyramidal width (PW), corticomedullary ratio (CMR), and medullary pyramidal index (MPI) were determined at each examination. The measurements obtained from the donor before implantation were used as the baseline.

Heart, liver, and skeletal muscle myeloperoxidase activity during exercise.

The purpose of this study was to determine whether contractile activity associated with running exercise was a prerequisite for neutrophil infiltration into rat tissues. H2O2-dependent myeloperoxidase (MPO) activity for rat (n = 8) liver, heart, and gastrocnemius muscles was assayed after 58 +/- 11 min of running to voluntary exhaustion (25 m/min; 0% grade). MPO activity values measured with 0.

Salt-induced changes in lipid composition and ethanol tolerance in Saccharomyces cerevisiae.

The effect of salt stress on lipid composition and its relationship with ethanol tolerance in Saccharomyces cerevisiae was studied. Amounts of phospholipids as well as that of sterols decreased, whereas that of protein and glycolipids increased with increasing salt concentration. Relative proportion of amino phospholipids (phosphatidylethanolamine and phosphatidylserine) decreased, whereas that of phosphatidylcholine showed a reverse trend.

Optimal cyclosporine therapy--an Indian experience.

Thirty consecutive adult patients who underwent renal transplantation were prospectively studied. The immunosuppression consisted of cyclosporine, azathioprine and prednisolone. Oral Cyclosporine CyA was initiated at a dose of 7 mg/kg/Day and reduced by 1 mg/kg/month.

Myoinositol and peroxidation--an in vitro study on human cataractous lens and human erythrocytes.

The effect of myoinositol on in vitro peroxidation induced by hydrogen peroxide in human erythrocytes and human cataractous lenses has been investigated. The lipid peroxidation was monitored as levels of thio barbituric reacting substances (TBARS). Addition of myoinositol decreased the peroxidation effect of hydrogen peroxide in a dose dependent manner.

Radiation dosimetry using junction field-effect transistor detectors.

The use of junction field effect transistors (JFET) has been studied by connecting them in a bridge circuit. With a suitable back-up circuit, it was possible to measure doses as well as dose-rates. It was possible to alter the sensitivity of the JFET bridge by varying the biasing components of the JFET.

Late-onset adrenal hyperplasia in north Indian hirsute women.

The occurrence of late-onset congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency was studied in 60 consecutive hirsute women by means of adrenocorticotrophin (ACTH)-stimulated serum 17-hydroxyprogesterone (17-OHP) levels. Five (8.3%) women had an exaggerated response (ACTH-stimulated 17-OHP 3,160 +/- 560 ng/dl).

Weight appreciation in the hand in normal subjects and in patients with leprous neuropathy.

The Weber fraction was used as an index of the sensitivity with which subjects appreciated weights ranging from 20 to 500 g suspended from the middle finger. Normal subjects were able to appreciate weight when it caused cutaneous compression alone. The sensitivity increased when subjects lifted weights by flexing the metacarpophalangeal joint.