Causes of impaired delivery of hemodialysis prescription.

Urea kinetic modeling (Kt/V) is used to assess adequacy of hemodialysis (HD). However, serial Kt/V measurements may vary with time in the same patient, making the interpretation of the results difficult. The aim of the present study was to find the frequency and the causes that account for these fluctuations of Kt/V.

Abdominal aortic aneurysm and renal artery stenosis: renal function and blood pressure before and after endovascular treatment.

We describe three patients with abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS). These patients were treated by placement of an aortic endograft and angioplasty or stenting of the renal artery. After the procedure renal function improved or remained stable in two patients and deteriorated slightly in one.

Relationship between interdialytic weight gain and acid-base status in hemodialysis by bicarbonate.

The aim of this study was to determine the relationship between interdialytic weight gain and acid-base balance pre- and posthemodialysis in uremic patients undergoing hemodialysis with a high bicarbonate dialysate (39 mmol/L). To this end we studied 8 stable uremic patients on regular hemodialysis thrice weekly who had stable hematocrit values for at least 3 months, similar clinical characteristics including dry weight but widely varying interdialytic weight gain. Arterial line blood samples were collected anaerobically in heparinized syringes pre- and posthemodialysis in 4 consecutive hemodialysis sessions for the determination of pH, Paco2, and HCO3.

Transplant renal artery stenosis: hypertension and graft function before and after angioplasty.

We present a case, who after 15 years of renal transplantation developed severe deterioration of her hypertension without alteration in renal function. Colour Doppler sonography revealed a 90% stenosis near the anastomosis of the graft artery to iliac artery, which was successfully and uneventfully corrected by percutaneous balloon angioplasty. Following the procedure the blood pressure control dramatically improved and her antihypertensive regimen returned and remained at baseline for the subsequent year of observation.

Changes in erythrocyte calcium and potassium in patients during HD and CAPD.

The purpose of this study was to determine the changes in calcium and potassium content in the red blood cells (RBC) of uremic patients during a hemodialysis (HD) session and a 6/hrs CAPD exchange. RBC calcium and potassium were determined in 20 patients on HD in three blood samples collected at 0'-HD (pre-HD), 45'-HD and 240'-HD (end-HD), in 20 patients on CAPD, in two blood samples, collected at 0' time (pre-inflow) and 120', (solution in peritoneal cavity) during a 6/hrs exchange (4 exchanges / 24 h) and in 20 normal subjects. The mean value (+/-SD) of RBC calcium in controls was 15.

Cytokine release and serum lipoprotein (a) alterations during hemodialysis.

It has been reported recently that a number of cytokines, mainly tumor necrosis factor alpha (TNFalpha), interleukin (IL)-1beta, and IL-6, can alter lipid metabolism and produce hyperlipidemia. Studies in hemodialysis (HD) patients have demonstrated increased production of these cytokines during HD. In order to investigate any possible relationship between changes of cytokines and lipid concentrations during HD in the serum of 25 uremic patients on chronic HD using modified cellulose membranes, TNFalpha, IL-1beta, IL-6, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein a (Lp[a]), and total proteins were measured immediately before (pre-HD) and after HD (post-HD), in one session.

Telemedicine technology and applications for home hemodialysis.

Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital.

Telematics Service for Home and Satellite Hemodialysis.

Home hemodialysis (HD) for the treatment of end-stage renal disease was first implemented about 30 years ago. In this paper the application of telematics monitoring services for supporting patients who need home HD or satellite HD is described. Two modified HD machines were located in two renal units, and a central control station (CCS, UNIX workstation with multimedia PC terminal) was located in another room of the hospital.

Ammonia concentration in the renal veins in unilateral renal artery stenosis with hypertension.

We measured blood ammonia in pre-angioplasty samples from the renal veins, aorta and inferior vena cava of 15 patients with hypertension due to unilateral renal artery stenosis confirmed by arteriography. Patients with renal insufficiency or small kidneys were excluded. Mean ammonia values were microgram/dl: vein of affected kidney, 106.

Management of claudication and hypertension by stent implantation in a renal transplant recipient.

Graft artery stenosis is one of the main causes of hypertension in renal transplant recipients. We present a rare case of severe common iliac artery stenosis, proximal to the graft artery, that was the cause of accelerated hypertension and claudication in a male renal transplant recipient. After percutaneous balloon angioplasty combined with a Palmaz stent implantation, a dramatic improvement of hypertension and claudication was observed during a 10-month follow-up period.

Arteriovenous difference of blood ammonia in uremic patients under hemodialysis.

In this study the ammonia concentration was determined in arterial and venous blood samples pre- and posthemodialysis (HD) in 18 uremic patients and in 18 health subjects (controls). The mean values (+/- SD) of ammonia in the arterial blood of uremic patients pre-HD were 98.32 +/- 26.

Alterations in echinocyte transformation and erythrocyte sedimentation rate during hemodialysis.

In 18 uremic patients under regular hemodialysis (HD) with bicarbonate dialysate, the echinocytes and erythrocyte sedimentation rates (ESR) were determined in 4 blood samples collected from the arterial line at 0, 45, 120, and 240 min (end-HD) in one HD session by a bioincompatible dialyzer and in another by a biocompatible one. In the HD session by a bioincompatible dialyzer, the mean values (+/- SEM) of echinocytes (%) at 0, 45, 120, and 240 min were 8.89 +/- 1.

Evaluation of the hypothalamic-pituitary axis in uremic males using dynamic tests. The possible role of testicular inhibin: a preliminary report.

Two dynamic tests (Gn-RH i.v. and clomiphene citrate-CC p.

A cross-over study of a new low molecular weight heparin (Logiparin) in hemodialysis.

The safety and effectiveness of a low molecular weight heparin (LMWH) of 4500 +/- 1500 Daltons were evaluated in eight hemodialysis (HD) patients, in comparison with unfractionated heparin (UFH). In phase A of the study 3000 +/- 500 anti-factor Xa (AFXa) IU of LMWH were administered in bolus for the three consecutive HD sessions of a week. In phase B, 10000 +/- 2500 IU of UFH were administered to the same patients for the same time.

Echinocytic transformation and aggregation of red cells in uremic patients.

Isolated rabbit lungs were perfused with washed and resuspended human red blood cells (RBCs) in the presence of drugs known to change the shape and deformability of RBCs. With sodium salicylate (0.5-2 g/l), which causes echinocytosis and increases RBC deformability, lung diffusing capacity for O2 (DLO2) increased by 21%.

Oral glucose tolerance test after high-dose i.v. biotin administration in normoglucemic hemodialysis patients.

Abnormal glucose metabolism in uremia may result from a complex interplay between decreased insulin secretion and insulin resistance. Recent studies report beneficial effect of biotin administration in glucose metabolism in diabetic animals and in a small number of patients with diabetes mellitus. The aim of the present study was to evaluate the response of oral glucose tolerance test (OGTT) to the i.

Serum transferrin and ceruloplasmin in patients with cancer of the gastrointestinal and other systems.

Serum transferrin and ceruloplasmin were determined in 20 healthy subjects, 23 patients with cancer of the gastro-intestinal system (G.I.S) and 22 patients with other types of cancer.

Lipid-lowering effect and safety of acipimox in hemodialysis patients and renal transplant recipients.

The efficacy and safety of acipimox, an antilipolytic agent, were studied in 10 uremic patients under hemodialysis (group A) and in 8 renal transplant recipients with adequate renal function (group B). The medication was given for 20 weeks at a dose of 250 mg daily in both groups. Total serum cholesterol decreased significantly from 218.

Changes of arterio-venous differences in pH and pCO2 by hemodialysis.

Normally the differences in arterial-venous pH (A-VpH) and veno-arterial pCO2 (V-ApCO2) are small and constant. This study deals with A-VpH and V-ApCO2 and their effect on arterial-venous saturation hemoglobin percentage (A-VSHb%) in uremic patients under hemodialysis (HD). In 17 uremic patients under HD with acetate, blood samples were collected anaerobically in heparinized syringes from artery (fistula) and vein (forearm without fistula) pre- and post-HD.

Contrast media nephrotoxicity: comparison of diatrizoate, ioxaglate, and iohexol after intravenous and renal arterial administration.

In several studies in humans and animals it has been suggested that high osmolality and ionicity of contrast media are responsible for higher nephrotoxicity. To examine this suggestion, we evaluated the renal effects of three different contrast media--an ionic high osmolar, an ionic low osmolar, and a nonionic--following intravenous and renal arterial administration, in a population of 84 unselected, nondiabetic patients with adequate renal function. The results showed that the nephrotoxicity is minimal and equal for all three contrast media and for both routes of their administration, and it is concluded that in this category of patients the far higher cost of the newer low osmolar ionics and nonionics should be considered seriously in regard to nephrotoxicity.

The effect of successful renal transplantation on hormonal status of female recipients.

The pituitary, thyroid, and ovarian hormone levels were measured by enzyme and fluorescence polarization immunoassays in 18 women with successful renal transplants (recipients): 10 menstruating, mean age 34.7 years, mean time after transplantation (Tx) 112.00 months, mean SCr 130.

Biotin for diabetic peripheral neuropathy.

Biotin in high doses was given for 1-2 years to three diabetic patients suffering from severe diabetic peripheral neuropathy. Within 4-8 weeks there was a marked improvement in clinical and laboratory findings. It is suggested that in diabetes may exist a deficiency, inactivity or unavailability of Biotin, resulting in disordered activity of biotin-dependent enzyme, pyruvate carboxylase, leading to accumulation of pyruvate and/or depletion of aspartate, both of which play a significant role in nervous system metabolism.