Frequency of complications with prolonged femoral vein catheterization for hemodialysis access.

Analysis of 120 cases of femoral vein catheterization for > or = 2 days for hemodialysis in 89 hospitalized patients was performed to determine the frequency of catheter-related complications including infection and venous thrombosis. The rate of clinically significant complications was < 3.5% and compared favorably with published complication rates of central vein catheters.

Calcium acetate control of serum phosphorus in hemodialysis patients.

Calcium acetate has many characteristics of an ideal phosphorus binder. It is a readily soluble salt that avidly binds phosphorus in vitro at pH 5 and above. One-dose/one-meal balance studies show it to be more potent than calcium carbonate or calcium citrate.

Diabetic nephropathy: new directions in management.

Approximately 6 million people in the United States are known to be diabetic, with an estimated 4 million individuals having undiagnosed diabetes mellitus. The metabolic derangements of both insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) result in widespread end-organ damage, including progressive kidney failure. Since its initial description in 1936, the incidence of diabetic nephropathy has progressively increased, and it is now the most common cause of newly diagnosed end-stage renal disease (ESRD) requiring renal replacement therapy in the United States.

Renal disease in noninsulin-dependent diabetes mellitus.

Diabetic nephropathy now accounts for approximately one-third of all patients who develop end-stage renal disease. The estimated cost to supply renal replacement therapy for this population now exceeds $750 million. The relatively recent realization that half of these individuals suffer from noninsulin-dependent diabetes mellitus has sparked increased interest in attempts to understand the pathologic processes involved and how they may be similar or different from those alterations seen in insulin-dependent diabetes mellitus.

Acute renal failure. What to do until the nephrologist comes.

Careful medical management of acute renal failure is critically important to prevent serious complications. In some instances, it may obviate or delay the need for dialysis. History taking, physical examination, and laboratory assessment usually establish the cause from among the many possibilities--from prerenal (eg, hypotension) to postrenal (obstruction of the urinary tract).