[Extrarenal dialysis in end-stage renal disease].

Renal replacement therapy (RRT) has reached its plain maturity. RRT is an unavoidable and banal tool in the armamentorium in the treatment of end stage renal failure (ESRD). It relies on several practical modalities (hemodialysis, peritoneal dialysis and their variants) that permit to satisfy various patient's needs and to ensure the continuity of life support system.

Dialysis solutions buffered with lactate or bicarbonate: in vitro comparison of two dialysis solutions on human peritoneal cell growth from ESRD and non-ESRD patients.

In order to evaluate the injury to the mesothelial cell layer during long-term peritoneal dialysis (PD), a dialysis solution (solution A), buffered with bicarbonate, stabilized with 10 mmol/L glycylglycine, and sterilized by filtration (0.22 micron double filtration, pH = 7.4), was compared to traditional heat sterilized lactate solution (solution B) on human mesothelial cell cultures.

Daily subcutaneous administration of recombinant human erythropoietin (rhEPO) in peritoneal dialysis patients: a European dose-response study.

In a prospective randomized open multicenter study, 107 anemic (Hct < = 28%) peritoneal dialysis (PD) patients were treated with s.c. rhEPO daily.

Peritoneal catheters and exit-site practices: toward optimum peritoneal access.

The peritoneal catheter is the CAPD patient's lifeline. Advances in catheter knowledge have made it possible to access the peritoneal cavity safely and maintain access over an extended period of time. Infection at the exit site remains a major problem, a solution for which is being extensively researched.

Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis.

We studied 140 consecutive patients beginning continuous ambulatory peritoneal dialysis (CAPD) at one of seven hospitals to assess the relation of the nasal carriage of Staphylococcus aureus to subsequent catheter-exit-site infection or peritonitis. Shortly before the implantation of the catheters, the patients' anterior nares were cultured for the presence of S. aureus.

In vitro study of the flush effect in two reusable continuous ambulatory peritoneal dialysis (CAPD) disconnect systems.

Previously published in vitro results, confirmed by clinical studies, indicate that the use of a flush significantly reduces peritonitis in single-use and reusable continuous ambulatory peritoneal dialysis (CAPD) systems. Since reusable systems may use the flush plus inline disinfectant between exchanges, the question remains as to whether or not the flush could be used alone in all disconnect systems. Using an in vitro model, we evaluated the flush in two reusable disconnect systems that use both flush and disinfectant in vivo.

Beta-2 microglobulin serum levels in maintenance dialysis. What does it mean?

beta-2 Microglobulin levels (beta-2M) were analyzed at four month intervals in sera of 237 patients on various forms of dialysis over a 2 year period; twelve patients volunteered to participate in short-term kinetics studies. Duplicate beta-2M measurements in biologic fluids were performed using an RIA kit. The data presented confirm elevated serum beta-2M in dialyzed patients whatever the dialysis method used and give an overview on various factors affecting circulating serum beta-2M.

[What does circulating beta 2 microglobulin signify in uremic patients on maintenance dialysis?].

The authors report a 2 years prospective study on s beta 2M variations observed in a large uremic population (237 patients, 159 M, 78 F, age: 51.1 +/- 5.9 y.

Continuous peritoneal insulin infusion with portable pumps: factors affecting the operating life of the chronic catheter.

Fifty-nine chronic peritoneal catheters made of polyethylene covered with silastic were used to treat 43 IDDM patients peritoneally for 3-34 mo (mean 14 mo) with portable peristaltic pumps and U40 acidic insulin. The operative life of the catheters was determined by actuarial analysis. The mechanisms of catheter failure were determined by preremoval x-ray opacification, removal under laparoscopic examination, and electron microscopic analysis of the catheter.

Acquired multicystic transformation of kidneys.

Acquired multicystic renal transformation of diseased kidneys is a problem known since the early 19th century which has recently regained interest. Such cysts were known before dialysis was established, are seen prior to hemodialysis and in patients on peritoneal dialysis, and can therefore not be a consequence of hemodialysis. It is concluded that an increased incidence of renal cell carcinoma in such kidneys is not established, although, theoretically, several mechanisms might promote carcinogenesis in end-stage kidneys.

Experience with long-term peritoneal insulin infusion from external pumps.

The long-term acceptability and feasibility of continuous peritoneal insulin infusion (CPII) from external pumps was evaluated in 40 insulin-dependent diabetic patients continuously treated for 1-27 months (mean 12 months). Blood glucose control was satisfactory and did not deteriorate with time (glycosylated haemoglobin 8.1 +/- 1.

Optimal routes for chronic insulin infusion with portable and implantable devices.

The optimal route for chronic insulin infusion via portable or implantable pumps is still a subject of controversy. Through the literature reports and personal experience (representing 70 patient-years of continuous treatment), the authors have found that the subcutaneous route is the ideal route in terms of comfort, safety, and cost. However, owing to sluggish and unpredictable insulin resorption, it appears that subcutaneous infusion is often not more effective than intensive conventional insulin therapy.

Long-term ambulatory peritoneal insulin infusion of brittle diabetes with portable pumps: comparison with intravenous and subcutaneous routes.

This work compares different routes of insulin infusion via portable pumps with chronically implanted catheters and evaluates the long-term feasibility of the technique. Six severely unstable (i.e.

Permanent loss of ultrafiltration capacity of the peritoneum in long-term peritoneal dialysis: an epidemiological study.

Permanent loss of the ultrafiltration (UF) capacity of the peritoneum has been observed with an increasing frequency among our patients treated by long-term intermittent (IPD) and/or continuous ambulatory peritoneal dialysis (CAPD). The analysis of various characteristics of our PD population (patients age, dialysis techniques, peritoneal infection rate and treatment duration) indicates that the incidence of this complication increases exponentially with the duration of PD, the loss of UF capacity being observed after a shorter period in CAPD than in IPD. These observations suggest that long-term irrigation of the peritoneal cavity leads to a progressive deterioration of the peritoneum resulting in its altered permeability with loss of the ability to ultrafiltrate; the cause of this abnormality is as yet unknown.

Clinical experience in human diabetics with portable and implantable insulin minipumps.

We report our personal experience of chronic ambulatory insulin therapy via portable and implantable pumps in insulin-dependent diabetics. Fifteen patients, poorly controlled on conventional insulin injections, were equipped with portable Siemens pumps. These pumps offer compactness, safety means, portability, one-month insulin reservoir and variable insulin rates.