摘要:

The acute effect of amino acid based dialysis solution on peritoneal kinetics of amino acids and plasma proteins in comparison to conventional glucose-based dialysate was studied in 9 patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Instillation of 2.6% amino acid solution resulted in raised plasma concentrations of all essential amino acids included in the dialysis fluid (p < 0.005). The amino acid solution induced an augmented leakage of plasma proteins into the dialysate at all dwell times investigated (1-8 h). After a dwell time at 8 h, the dialysate total protein increased from 2.62 ± 0.45 g with glucose dialysate to 3.85 ± 0.42 g with amino acid solution (p < 0.05). Corresponding results were obtained for pV microglobulin, albumin, transferrin, IgG, and for the non-essential amino acids alanine, citrulline, and glutamine (p < 0.025) not included in the initial amino acid composition of the dialysis fluid. During the use of amino acid based dialysis fluid, the effluent prostaglandin E2 concentration increased by more than 80% in comparison to glucose dialysate (p < 0.025). The augmented loss of proteins induced by the amino acid solution was positively correlated with increased dialysate prostaglandin E2 (r = 0.8894; p < 0.001). Peritoneal ultrafiltration was not affected by the use of amino acid based dialysate fluid. The present results indicate that amino acid based dialysis fluid enhances the peritoneal permeability for plasma proteins and amino acids, probably mediated by locally generated prostanoid

ISSN:0250-8095    

DOI:10.1159/000168419

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Local pain due to subcutaneous erythropoietin (EPO) injection into the thigh was studied using a verbal score ranging from 0 to 4. Equivoluminous doses of epoetin-α (Cilag) and epoetin-β (Boehringer) were compared in 2 controlled single-blind experiments: 10 dialysis patients were treated at random for 4 weeks at consecutive sessions with both brands of EPO, and 40 patients were treated in 1 session only with the 2 brands simultaneously. Pain scores were 1.12 ± 0.28 versus 0.15 ± 0.06 (p < 0.05) and 1.75 ± 0.19 versus 0.08 ± 0.04 for epoetin-α and epoetin-β, respectively (p < 0.001). Treatment acceptance was 48% for epoetin-α versus 83% for epoetin-β (

ISSN:0250-8095    

DOI:10.1159/000168420

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

To determine whether thirst mechanisms are altered in nondiabetic patients with chronic renal failure on hemodialysis, 4 patients with an average weight gain between dialysis sessions of more than 5 % of dry body weight (group I), 5 patients with less than 3 % weight gain (group II), and a group of 6 healthy subjects (group III) were submitted to infusion of hypertonic saline. After infusion the subjects had free access to water. Thirst was evaluated by visual analogue rating scales. Despite similar increments of effective plasma osmolality during saline infusion, patients of group I were thirstier than groups II and III (p < 0.005 and p < 0.01, respectively). Changes in thirst ratings were similar in groups II and III. Osmotic thresholds for thirst onset were similar in groups II and III (288.9 ± 8.5 and 289.8 ± 3.4 mosm/kg, respectively), but lower in group I (277.6 ± 7.6 mosm/kg). Nevertheless, great variations were observed in the latter group. Thus, 2 patients showed thresholds for thirst within the normal range, whereas the others had low osmolar thresholds for thirst and baseline plasma osmolalities and high basal thirst scores. During the drinking period, the patients of group I drank more (14.2 ± 2.8 ml/kg) than those of groups II (5.3 ± 1.6 ml/kg; p < 0.02) and III (10.2 ± 1.6 ml/kg; n.s.) The plasma levels of angiotensin II in uremic patients were higher than in healthy subjects, although there were no differences between groups I and II and no correlation between basal angiotensin II levels and the interdialytic weight gain. Our results indicate that some patients with chronic renal failure on hemodialysis manifest excessive thirst and gain more weight between dialysis sessions. This disturbance could be mediated by a resetting of the thirst osmostat, although an apparent cause of hyperdipsia was not evident in all patients.

ISSN:0250-8095    

DOI:10.1159/000168421

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The current study focused on the effect of continuous ambulatory peritoneal dialysis (CAPD) dialysate obtained following different intraperitoneal dwell periods on the release of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFa) from mononuclear leukocytes (PBMC). Aliquots of 5 X 106/ml healthy peripheral PBMC were exposed to fresh or spent CAPD dialysate (10-240 min of intra-peritoneal dwell) and stimulated with Escherichia coli endotoxin (10 jxg/ml, 2 h). IL-6 and TNFa in cell supernatants were determined by specific enzyme immunoassays. Control PBMC in physiological buffer released 361 ± 70 pg/ml IL-6 and 717 ± 147 pg/ml TNFa (mean ± SEM, n = 8), whereas exposure to fresh dialysis fluids severely suppressed cytokine release from PBMC ( < 30 pg/ml IL-6 and < 15 pg/ml TNFa). A significant inhibition of IL-6 and TNFa release was also observed in PBMC exposed to spent dialysate. The inhibitory capacity of the spent fluids was pronounced with increasing intra-peritoneal dwell time (10 min: 183 ± 45 pg/ml IL-6 and 538 ± 109 pg/ml TNFa; 240 min: 26 ± 5 pg/ml IL-6 and 105 ± 30 pg/ml TNFa; mean ± SEM, n = 16). These data indicate that the impairment of cell responsiveness following exposure of PBMC to peritoneal dialysate is not restricted to the unused fluids, but is also observed following intra-peritoneal equilibration. Moreover, our findings suggest the presence of cytokine inhibitory factors in the peritoneal dialysate of CAPD patients which appear to accumulate in the peritoneal effluent during the CAPD cycle.

ISSN:0250-8095    

DOI:10.1159/000168422

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Since calcium plays a modulatory role in the activity of the sympathetic nervous system (SNS), in these studies, we have tested the hypothesis that hypercalcemia may alter renal SNS activity, and, consequently, renal function. Acute hypercalcemia was induced in Sprague-Dawley rats by infusion of calcium 30mg/kg/2h in 0.45% saline. A control group of rats received only 0.45 % saline. Two more groups of rats received either calcium or 0.45 % saline 7-10 days after total renal denervation. Calcium infusion increased serum calcium by 1.8 ± 0.23 mg/dl in rats with intact renal nerves and by 2.7 ± 0.48 mg/dl in renal denervated rats. Mean arterial pressure and inulin clearance did not change during calcium or 0.45% saline in rats with intact renal nerves. Renal sympathetic nerve activity (RSNA) decreased by 44% in rats infused with calcium, but it did not change in control animals. Calcium caused a significantly greater rise in urine volume, sodium excretion and fractional excretion of sodium than the infusion of 0.45% saline. Rats with renal denervation manifested greater baseline urine volume, sodium excretion and fractional excretion of sodium than rats with intact renal nerves. Infusion of calcium, however, caused no further rise in urine sodium excretion in these animals. α-Methyltyrosine, an inhibitor of norepinephrine (NE) synthesis, also increased natriuresis in rats. Calcium reduced by 27% the NE content in the kidney but not in the heart. Methyltyrosine, on the other hand, reduced NE content in both the heart and the kidney. These data demonstrate that acute hypercalcemia inhibits RSNA and increases diuresis and natriuresis in the absence of any change in blood pressure or in glomerular filtration ra

ISSN:0250-8095    

DOI:10.1159/000168423

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000168424

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Pseudohyperkalemia, defined as serum to plasma potassium difference of more than 0.4 mmol/l, occurs when platelets, leukocytes or erythrocytes release intracellular potassium in vitro, leading to falsely elevated serum values. Pseudohyperkalemia has been observed in myeloproliferative disorders [ 1 ], including leukemia [2] and infectious mononucleosis [3] as well as in rheumatoid arthritis [4]. We present 2 patients with renal disease and thrombocytosis in whom pseudohyperkalemia was recognized only after common therapeutic measures and/or dialysis failed to effect a decrease in serum potassium. In patients with renal disease and thrombocytosis, plasma as well as serum potassium should be routinely measured prior to instituting aggressive therapy or altering dialysis prescription in order to avoid potentially dangerous overtreatment with resulting hypokalemia.

ISSN:0250-8095    

DOI:10.1159/000168425

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A case of systemic lupus erythematosus (SLE) that developed 2 years after beginning hemodialysis is reported. The patient had not been given any drug implicated in the production of SLE. She had been treated with deferoxamine, an in vitro inhibitory of DNA synthesis. The difficulty of the diagnosis is emphasized. Clinical improvement after prednisone treatment was impressive. SLE may appear even in patients receiving hemodialysis, despite inmu-nological depression derived from chronic uremia.

ISSN:0250-8095    

DOI:10.1159/000168426

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We report case of extrinsic compression of the left brachiocephalic vein by the innominate resulting in massive edema of the arm in a patient with hemodialysis Gore-Tex graft. To our knowledge, such phenomenon has not been previously reported.

ISSN:0250-8095    

DOI:10.1159/000168427

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A 45-year-old woman with a pheochromocytoma who had been on regular hemodialysis for 4 years and underwent successful surgery is described. Careful preoperative management, including the use of prazosin and weight control, was carried out to prevent severe intraoperative and postoperative cardiovascular complications. Prazosin was given at an initial dose of 0.5 mg/day, and the dosage was increased to 20 mg/day prior to surgery. The increase in intravascular volume led to a gain of 3 kg in body weight. No deterioration of the cardiovascular or respiratory function was caused by these maneuvers, and surgery was performed without significant complications except for a rapid rise of blood pressure during tumor resection. To our knowledge, only one similar case report could be found in the English literature.

ISSN:0250-8095    

DOI:10.1159/000168428

出版商:S. Karger AG    

年代:1992

数据来源: Karger