Decision to resuscitate or not in patients with chronic diseases.

Introduction: Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary resuscitation (CPR) in case of cardiac arrest.

Material And Methods: We carried out a questionnaire survey among 112 haemodialysis patients and 17 physicians at department of nephrology, Herlev Hospital.

Capnocytophaga cynodegmi peritonitis in a peritoneal dialysis patient.

The first reported case of peritonitis caused by Capnocytophaga cynodegmi is presented. The patient was treated with peritoneal dialysis and had contact with a cat. C.

Dietary habits and nutritional status of renal transplant patients.

Background: Although dialysis nutritional problems are well described, nutritional problems after renal transplantation (RT) have received little attention.

Methods: Body composition as assessed by dual-energy x-ray absorptiometry in 115 stable patients 6.6 +/- 5.

Hyperparathyroidism and long-term bone loss after renal transplantation.

Background: While early bone loss after renal transplantation (RT) is well described, factors affecting the long-term fate of bone have received less attention.

Methods: Whole body (WB), lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) was measured using dual energy X-ray absorptionometry in 126 stable RT patients and repeated in 114 survivors after 3 yr. Percentage change per year (%/yr) was correlated to clinical and biochemical markers of bone metabolism.

Bone loss after renal transplantation: role of hyperparathyroidism, acidosis, cyclosporine and systemic disease.

Unlabelled: In order to determine risk factors for bone loss after renal transplantation, dual energy X-ray absorptiometry was performed in 125 renal transplant patients. The bone mineral density (BMD) was expressed as a percentage of the normal population (BMD%) and Z-score (SD from normal). The whole body, lumbar spine and femoral neck BMD% (Z-score) values were 93.

Behçet's syndrome presenting with peripheral arterial aneurysms.

A case of Behçet's syndrome is described presenting with several peripheral arterial aneurysms. The diagnostic criteria are discussed and the need for increased vigilance of this disease is stressed due to an increasing number of immigrants.

Efficacy of recombinant human erythropoietin administered subcutaneously to CAPD patients once weekly.

Objective: The purpose of the present study was to compare the dosage requirements of recombinant human erythropoletin (rHuEPO) administered subcutaneously (SC) either one or three times weekly.

Design: A randomized, prospective study.

Setting: The patients were recruited from two university hospitals and five county hospitals.

Intermittent intravenous followed by intermittent oral 1 alpha(OH)D3 treatment of secondary hyperparathyroidism in uraemia.

Objectives: To examine whether intermittent oral 1 alpha(OH)D3 treatment of patients on haemodialysis with secondary hyperparathyroidism (HPT) was able to maintain the marked suppression of PTH, which previously had been induced by an intermittent intravenous administration of 1 alpha(OH)D3. Simultaneously, the effect of the different routes of administration of 1 alpha(OH)D3 on the circulating levels of N- and C-terminal PTH fragments was measured.

Design: An open study of patients on chronic haemodialysis.

Serum ionized calcium, parathyroid hormone and phosphate in uremic patients during and between hemodialysis.

The serum concentrations of actual ionized calcium (at actual pH), adjusted ionized calcium (at pH 7.4), pH, intact parathyroid hormone (PTH) and phosphate were studied in ten patients during and between two hemodialysis sessions using a dialysate containing 1.66 mmol/l of calcium.

Long-term suppression of secondary hyperparathyroidism by intravenous 1 alpha-hydroxyvitamin D3 in patients on chronic hemodialysis.

The effect of intravenous 1 alpha-hydroxyvitamin D3 [1 alpha(OH)D3] on circulating levels of intact parathyroid hormone (PTH 1-84) and COOH-terminal immunoreactive PTH(PTH 53-84) was examined in 13 patients on chronic hemodialysis. Thirteen patients were treated for 300 days (10 months), 9 patients for 520 days (14 months) and 6 patients for 720 days (2 years) with increasing doses of 1 alpha(OH)D3 intravenously under careful control of plasma Ca2+. Blood samples were obtained 1 week before start of treatment and then at every 2nd week.

Effect of intravenous 1-alpha-hydroxyvitamin D3 on secondary hyperparathyroidism in chronic uremic patients on maintenance hemodialysis.

The effect of intravenous 1 alpha(OH)D3 on circulating intact parathyroid hormone (PTH) and COOH-terminal immunoreactive PTH was examined in 21 patients on chronic hemodialysis. The patients were treated for 3 months with increasing doses of 1 alpha(OH)D3 under careful control of serum Ca2+. 1 alpha(OH)D3 was given intravenously at doses of up to 4 micrograms three times a week, and blood samples were obtained every week, including 1 week before treatment (basal control).

Alphacalcidol and renal function in normal subjects.

Sixteen young healthy adults were treated for 3 weeks with alphacalcidol (1 alpha OHD3), 1 microgram orally per day, and renal function tests were performed before, at the end and 3 weeks after termination of the drug. No significant changes occurred in the serum concentrations of calcium or phosphate, whereas the serum calcium-phosphorus product and the urinary excretion of calcium increased significantly. Serum creatinine and the urinary excretion of creatinine showed no significant changes.

Arterial disease in chronic renal failure--an experimental study in the rabbit.

Epidemiological studies have indicated an increased incidence of cardiovascular events among patients with chronic renal failure. An acceleration of the atherosclerotic disease process in uremia has been proposed and a few studies have even suggested the existence of a specific pathological entity, uremic arterial disease, characterized by medial degeneration and calcification rather than by accumulation of cholesterol. As an experimental model of arterial disease in uremia, rabbits with chronic renal failure (CRF rabbits) induced by renal cauterization and contralateral nephrectomy were studied.

An abnormal response of the adrenal cortex to insulin: glucose in essential hypertension.

This investigation demonstrates an abnormal response to the adrenal cortex to modulation of the potassium metabolism by an intravenous infusion of insulin-glucose in patients with essential hypertension. In response to insulin-glucose there was a transient decline of plasma aldosterone and plasma cortisol concentrations in control subjects with normal blood pressure, whereas a temporary increase of both hormones was found in patients with essential hypertension. Treatment with thiazide diuretics further magnified the different aldosterone response between the two groups.

Functional status of the liver during chronic renal failure: an experimental study in the rabbit.

Quantitative and qualitative measures of liver function were investigated in rabbits with chronic renal failure (CRF) induced 3 months earlier by surgical reduction of renal mass, and compared with a sham-operated control group. In the CRF group the galactose elimination capacity (GEC) was significantly decreased by 25%, but when related to liver weight the difference was not statistically significant. The clearance of antipyrine was unaffected.

Uremic arterial disease in rabbits with special reference to the coronary arteries.

In rabbits with chronic renal failure of 9 months' duration, the distribution and morphological characteristics of uremic arterial disease were investigated, with special reference to the coronary arteries. All major systemic arteries were affected, large vessels more severely than smaller ones, and within each artery the changes were most pronounced in the proximal part of the vessel. The intimal lesions consisted primarily of smooth muscle cells without calcification or lipid accumulation.

Aldosterone response to modulation of potassium in patients on dialysis or with essential hypertension.

This investigation demonstrates in patients with essential hypertension an abnormal response of the adrenal glands to modulation of potassium metabolism by infusion of insulin-glucose. Similar results have been reported in anephric patients, while the inverse response of non-nephrectomised patients on dialysis corresponded to that of normal subjects. It is suggested that the abnormal response of patients with essential hypertension may be of importance to the understanding of the pathogenesis of this important disease.

Liver function during chronic renal failure in rabbits.

In rabbits with chronic renal insufficiency the prothrombin index was increased by 25% and the alanine aminotransferase activity decreased by 20%; the results of other routine tests of hepatic function were not affected. The galactose elimination capacity was decreased by 12%, whereas the body clearance of antipyrine was unchanged. No change in hepatocytic structure was found.

Inhibition by methylprednisolone treatment of the aortic mineral accumulation in rabbits with chronic renal failure.

The effect of methylprednisolone treatment on the mineral accumulation in the rabbit aorta during chronic renal failure (CRF) was investigated. Groups of rabbits with surgically induced CRF and sham operated controls were treated for 14 weeks with 0.40 mg of methylprednisolone per day and compared to corresponding groups receiving placebo.

Effect of chronic renal failure and methylprednisolone treatment on the uptake of labelled plasma cholesterol into the aorta of normocholesterolemic rabbits.

The effects of chronic renal failure (CRF) and corticosteroid treatment on the aortic uptake of labelled free and esterified cholesterol (FC and EC) were investigated in normocholesterolemic rabbits. Methylprednisolone, 0.4 mg/day, or placebo was administered for 14 weeks to rabbits with normal renal function and with CRF.