Hemodialysis of Doxepin and Desmethyldoxepin in Uremic Patients

The disposition of doxepin and its active metabolite desmethyldoxepin was investigated in five uremic patients undergoing hemodialysis. The hemodialysis system yielded a mean extraction efficiency of 7.6% for doxepin and 13.9% for desmethyldoxepin. Mean dialysis clearances were 10.8 and 18.1 ml/min for doxepin and desmethyldoxepin, respectively. The drug and metabolite recovery constituted a very small fraction of the body store, i.e., less than 1%. Hemodialysis did not significantly alter the plasma half-life of doxepin, 14.6 +/- 4.3 h, or of desmethyldoxepin, 25.4 +/- 5.5 h. The nondialyzability of both compounds could be attributed to the compounds' protein binding and volume of distribution. The dialysis experiments show that modification of the usual dosage regimen is not necessary during hemodialysis or on dialysis days. The dialysis parameters confirm that hemodialysis is not likely to be of value in the management of acute doxepin poisoning.     

Arteriovenous Difference of Blood Ammonia in Uremic Patients Under Hemodialysis

It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
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 ± 26.55; post-HD, 63.18 ± 17.09; and in control group patients, 72.37 ± 10.09 μg/dl. In venous blood they were pre-HD, 71.70 ± 20.68; post-HD, 58.05 ± 16.73; and in control patients, 74.46 ± 12.0 μg/dl. Accord than that post-HD and that of control patients. The ammonia contents of venous blood pre- and post-HD ranges were within normal values, but the post-HD range was significantly lower than the pre-HD range (p < 0.05) and the control range (p < 0.01). Comparison between ammonia levels from arterial and venous blood showed significant and positive arteriovenous differences pre-HD (p < 0.001), which disappeared post-HD and were not observed in the control patients. In conclusion, uremic patients under HD present pre-HD high levels of ammonia in arterial blood with a significantly positive arteriovenous difference. In contrast, the post-HD ammonia levels in arterial and venous blood are decreased, and the arteriovenous difference is not significant.     

Relation Between Echinocytosis and Erythrocyte Calcium Content in Hemodialyzed Uremic Patients

A rise in intracellular calcium concentration in erythrocytes has multiple effects on these cells. The purpose of this study was to determine the changes of calcium content in red blood cells (RBCs) and of echinocyte percentages in uremic patients during hemodialysis sessions. In 30 uremic patients under hemodialysis, the calcium content of RBCs and echinocyte percentages were determined in 3 blood samples collected at 0 min hemodialysis (prehemodialysis), 45 min hemodialysis, and 240 min hemodialysis (end hemodialysis) for a 4 h hemodialysis session. Calcium content of RBCs and echinocytes were also determined in 22 normal subjects (controls). The findings of the present study were that the mean values (+/-SD) of calcium content of RBCs in patients at 0 min hemodialysis, 45 min hemodialysis, and 240 min hemodialysis were 2.00 +/- 1.0, 2.66 +/- 0.87, and 1.62 +/- 0.66 microg/ml respectively and 0.65 +/- 0.07 microg/ml in controls. These values show that the calcium content of RBCs in uremic patients at 0 min hemodialysis, 45 min hemodialysis, and 240 hemodialysis was significantly higher than in controls (p < 0.0001), and that RBC calcium content at 45 min hemodialysis was significantly higher in comparison to that at 0 min hemodialysis (p < 0.001) and to that at 240 min hemodialysis (p < 0.0001), while that at 240 min hemodialysis was significantly lower than at 0 min hemodialysis (p < 0.05). The mean values (+/-SD) of echinocyte percentages in patients at 0 min hemodialysis, 45 min hemodialysis, and 240 hemodialysis were 11.93 +/- 6.18, 17.23 +/- 4.1, and 7.96 +/- 5.67% respectively, and in controls ranged from 0 to 1%. The values in uremic patients show a transient increase of echinocyte percentages at 45 min hemodialysis, which is significant in comparison to that at 0 min hemodialysis (p < 0.001) and to that at 240 min hemodialysis (p < 0.0001). Echinocyte percentages at 240 min hemodialysis were significantly lower to those at 0 min hemodialysis (p < 0.001). Correlation between calcium content of erythrocytes and echinocyte percentages shows a significantly positive relationship at 45 min hemodialysis (r = 0.368, p < 0.05) but no significant relationship at 0 min hemodialysis and 240 min hemodialysis. In conclusion, uremic patients under hemodialysis present with high calcium content in erythrocytes and abnormal erythrocytes like echinocytes. A rapid and transient increase of erythrocyte calcium is also accompanied by transient elevation of echinocytes in the first hour of hemodialysis (45 min hemodialysis), which returns after hemodialysis to lower than prehemodialysis levels.     

Parathyroid Hormone and T-Cellular Immunity in Uremic Patients in Replacement Dialytic Therapy

Abstract: We studied 54 patients in replacement dialytic therapy divided into two groups: Group 1, 26 patients with normal parathyroid hormone (PTH) (10–80 pg/ml); and Group 2, 28 patients with elevated PTH (80–400 pg/ml). Total T lymphocytes, CD4, CD8, and CD4/CD8 ratio were evaluated. We found a reduction of total T lymphocytes in both groups compared with controls. A decrease of CD4 and CD4/CD8 ratio with a rise of CD8 occurred in Group 2 but not in Group 1. In Group 2, PTH presented a linear correlation with CD8 and a reverse correlation with total T cells, CD4, and CD4/CD8 ratio. PTH might act on T-cellular immunity with an immunosuppressive effect from the earlier phases of hyperparathyroidism.     

Oxygen Tension Monitoring in Uremic Patients During Hemodialysis Treatment

The aim of this study was to evaluate the influence on cerebral and cutaneous vascular regions of PaO2 reduction during acetate dialysis, by monitoring conjunctival oxygen tension (PcjO2) and transcutaneous oxygen tension (PtcO2) during hemodialysis (HD) treatment. The study was performed on 23 patients with end-stage renal disease in chronic HD. All patients underwent dialytic treatment with cuprophan membranes and acetate containing dialysate. PcjO2 and PtcO2 were recorded and PaO2 and arterial carbon dioxide tension (PaCO2) were also measured. Results of the study show that hypoxemia during acetate dialysis with cuprophan membranes is not accompanied by changes of PcjO2 and therefore by changes in cerebral oxygenation. Moreover, PtcO2 remains constant during dialysis treatment. Furthermore, maintenance of normal oxygen tension at the conjunctival level is not obtained at the expense of the peripheral region of the skin.     

Cardiovascular Pathology in Dialysis Patients with Spinal Cord Injury

Necropsy findings were examined in 20 male patients with end-stage renal disease associated with longstanding spinal cord injury and treated with maintenance hemodialysis. All patients exhibited cardiovascular abnormalities. Fibrinous pericarditis was found in 50% of the patients. Left and right ventricular hypertrophy was present in 45% and 20% of the cases, respectively. The respective incidences of left and right ventricular dilatation were 40% and 30%. Cardiac amyloidosis was noted in 25% of the cases, whereas myocardial fibrosis was found in 45% of the patients. Valvular abnormalities were limited to one case of aortic stenosis and two cases of mitral ring dilatation. No evidence of infective endocarditis was observed despite the high incidence of infections in this population. Whereas 45% of the patients exhibited some degree of coronary arteriosclerosis, none exhibited evidence of acute myocardial infarction and only one showed pathologic changes consistent with old myocardial infarction. Aortic atherosclerosis was noted in the majority of patients.     

维持性血液透析患者感染丙型病毒性肝炎150个月随访研究

目的:评价血液透析患者感染丙型肝炎病毒(HCV)的阳转率和危险因素。方法:随访1998年6月～2010年6月在本院透析的血透患者,共纳入2 465例血透患者,采用ELISA法每隔6月在同一实验室检测抗-HCV。结果:1998年6月的抗HCV阳性率为54.7%,每隔半年的阳性率分别为54.7%,53.8%,52.6%,53.0%,51.2%,45.9%,45.5%,48.2%,35.6%,33.7%,33.7%,31.7%,30.4%,28.4%,27.2%,24.5%,20.8%,19.4%,16.6%,14.4%,15.3%,15.2%,12.5%,11.9%和10.0%。在1～150个月随访期间,总计238例患者阳转,随访1～12月者阳转率为4.5%,13～24月者为6.9%,25～48月者为11.9%,49～60月者28.1%,61～72月者35.1%,73～84月者38.6%,85～96月者阳转率46.9%,97～108月者56.3%,109～126月者63.6%,随访至139～150月时,阳转率已高达75%。结论:提示透析环境对HCV传播有影响,可能一方面通过共用透析机,一方面是由于未隔离阳性患者;严格的消毒隔离措施对降低HCV感染和阳转有重要作用。     

血液透析结合血液灌流在尿毒症皮肤瘙痒患者中的应用效果

目的 分析血液透析结合血液灌流在尿毒症皮肤瘙痒患者中的应用效果。方法 选取我院2020年 4月-2022年6月收治的78例尿毒症且伴有皮肤瘙痒患者作为研究对象,采用随机数字表法分为对照组与观 察组,每组39例。对照组进行血液透析治疗,观察组在对照组基础上结合血液灌流治疗,比较两组血钙、 磷、甲状旁腺激素（PTH）水平、肾功能指标[血尿素氮（BUN）、血清肌酐（Scr）、血β2-微球蛋白 （β2-MG）]及皮肤瘙痒情况。结果 观察组治疗后1、3个月血钙水平高于对照组,血磷及PTH水平均低于 对照组（P＜0.05）;观察组治疗后1、3个月BUN、Scr、β2-MG水平均低于对照组（P＜0.05）;观察组治 疗后皮肤瘙痒评分低于对照组（P＜0.05）。结论 血液透析结合血液灌流在尿毒症皮肤瘙痒患者中的应用 效果确切,与单纯血液透析治疗相比,调节钙磷代谢、清除体内中分子物质的效果更好,还能有效改善患 者皮肤瘙痒症状,值得临床应用。     

不同置换液量血液透析滤过治疗尿毒症皮肤瘙痒疗效观察

目的：观察不同置换液量血液透析滤过(HDF)对尿毒症皮肤瘙痒的治疗作用。方法：将30例并发皮肤瘙痒的维持性血液透析尿毒症患随机分为三个组，分别接受高置换液量后稀释HDF(置换液20L)、低置换液量后稀释HDF(置换液10L)和高通量血液透析治疗。均使用F60透析器，隔日1次，连续3次，其余治疗条件相同。对皮肤瘙痒症状定量计分，比较三组病人治疗前后皮肤瘙痒症状积分的改变以及血磷和甲状旁腺激素(PTH)的变化。结果：高置换液量HDF组治疗后皮肤瘙痒积分明显下降，有统计学意义。其余两组无差异。以皮肤瘙痒积分下降50％为有效计算，高置换液量HDF组7例有效，有效率70％；低置换液量HDF组3例有效。有效率30％；透析组1例有效，有效率10％。三组间比较有统计学差异。三组透析后血磷均明显下降，有统计学意义；PTH亦有下降，HDF组有统计学差异，HD组无统计学差异。结论：增加置换液量可以提高HDF治疗尿毒症皮肤瘙痒的疗效；HDF治疗尿毒症皮肤瘙痒疗效优于高通量血液透析；HDF清除PTH的效果高于HD。     

Hemodialysis with Regenerated Cellulosic Membranes Does Not Reduce Plasma Selenium Levels in Chronic Uremic Patients

Abstract: Selenium (Se) is considered an essential and very important trace element for humans. Se blood levels are frequently low in end-stage renal disease (ESRD) patients, but very little has been established concerning the mechanisms that could modify Se status in uremia, including a supposed dialysis-mediated Se depletion. In order to verify whether hemodialysis (HD) can induce a loss of Se, thereby leading or contributing to a low plasma Se concentration, we investigated the effect of HD procedure with the most commonly used regenerated cellulosic membrane (Cuprophan) on plasma Se levels in 20 uremic patients on HD for 62.5 ± 49.4 months. Plasma Se levels were also determined in 15 chronic renal failure (CRF) nondialyzed patients and in 28 age-matched healthy controls. Se concentration was determined by atomic absorption spectrophotometry. Plasma Se levels of both HD patients (61.3 ± 8.5 μ/L) and CRF nondialyzed patients (56.4 ± 10.1 μg/L) were significantly lower than in normal subjects (78.3 ± 9.7 μg/L, p < 0.001). In CRF nondia-lyzed patients, a significant (p < 0.05) negative correlation was found between the plasma Se concentration versus serum creatinine values. Within the HD group, plasma Se levels significantly increased after the HD procedure (72.8 ± 17.2 μg/L, p < 0.02) together with hemat-ocrit and total plasma protein values (p < 0.05 and p < 0.001, respectively). In the hollow fiber dialyzer during an HD session, the Se concentration increased but not significantly from the blood inflow site (64.6 ± 12.5 μg/L) to the outflow site (72.6 ± 17 μg/L) and decreased, again not significantly, from the dialysate entrance (5 ± 1.9 μg/L) to the outlet (4.8 ± 2.5 μ?.). In HD with low-flux regenerated cellulosic dialyzer, very likely due to the high molecular weight of Se-binding proteins, the replacement treatment did not induce a Se loss in chronic uremic patients with a low plasma Se concentration.     

Isolated Amyloid Tumor in the Mediastinum: Report of a Case

Primary amyloidosis isolated in the mediastinum is rarely encountered in thoracic surgery and few such cases have been reported. We present a case of primary isolated hilar amyloidosis of the mediastinum to illustrate the difficulties in differentiating this disorder preoperatively from central bronchial carcinoma, carcinoid tumor, and mediastinal lymphoma. Usually, a definitive diagnosis can only be made by open biopsy during thoracoscopy or thoracotomy. In conclusion, amyloidosis should be considered in the differential diagnosis of patients when calcifications are found, bearing in mind that radiologic findings are inconclusive and transbronchial biopsy can be negative. Received: August 3, 2001 / Accepted: July 2, 2002 Reprint requests to: J. Ordemann     

不同频率血液透析滤过对维持性血液透析患者促红细胞生成素疗效的影响

目的:探讨不同频率血液透析滤过(hemodiafiltration,HDF)对维持性血液透析(maintenance hemodialysis,MHD)患者促红细胞生成素(erythropoietin,EPO)疗效的影响。方法:回顾性研究2017年06月~2019年06月杭州市中医院肾内科留治的MHD患者151例,按照在常规血液透析(hemodialysis,HD)基础上增加不同频率的HDF治疗分为HD组34例(常规HD治疗,不进行HDF治疗)、HDF1组25例(每月1次HDF)、HDF2组47例(每月2次HDF)、HDF4组45例(每月4次HDF)。所有入组患者每4周复查一次血红蛋白,根据血红蛋白水平调整EPO用量,分别于治疗前和治疗24周后测定血红蛋白、红细胞压积、超敏C反应蛋白、血清尿素氮、甲状旁腺素、干体重等指标。结果:治疗24周后,各组患者较入组时血红蛋白水平均明显上升(P均<0.05);HDF1组患者较入组时红细胞压积水平上升(P均<0.05);HDF1、HDF2、HDF4组患者较入组时ERI值、甲状旁腺素水平、超敏C反应蛋白水平下降(P均<0.05)。相关性分析显示,ERI值与铁蛋白、KT/V呈负相关关系,与甲状旁腺素、超敏C反应蛋白呈正相关关系。结论:不同频率的HDF治疗均能提高患者EPO的疗效,但提高HDF治疗的频率不能明显改善EPO疗效,就有效纠正MHD患者肾性贫血而言,可在常规HD基础上联合每月1次HDF治疗。     

Dialysis Treatment Using an Ethylene Vinyl Alcohol Membrane and No Anticoagulation for Chronic Uremic Patients

Abstract: Anticoagulation used in hemodialysis treatment brings with it the risk of hemorrhagic complications and the possible consequences associated with chronic heparin administration. These problems have not been satisfactorily addressed to date. This study examined a new dialysis method that does not require the administration of anticoagulants. Dialysis is performed for 3 h with a continuous infusion of 750 ml of physiological saline solution in predilution mode and using filters made of ethylene vinyl alcohol copolymer membranes. Eleven patients with chronic uremia underwent more than 2,000 dialysis treatments performed with 9 episodes of coagulation of the dialyzer or blood tubings (0.43%). An evaluation of individual treatments revealed a high degree of biocompatibility and only a scanty activation of coagulation. Blood depuration efficacy was very good as evaluated from pretreatment and posttreatment routine blood chemistries. The technique described here represents a simple and effective method for performing regular dialysis treatment and does not require anticoagulant therapy.     

Amyloid Tumor in the Anterior Mediastinum: Report of a Case

A 33-year-old woman being treated for rheumatoid arthritis was referred to our hospital for investigation of a mediastinal mass. A chest computed tomography scan showed an anterior mediastinal mass, 8.5 × 7.0cm in size, with a cystic lesion and calcification. These findings were suggestive of either a noninvasive thymoma or a mature teratoma. Therefore, we performed tumor resection and thymectomy. Histologically, the tumor consisted of diffuse deposits of massive eosinophilic amorphous material. The tumor was stained red-orange by Congo red, and the staining disappeared following potassium permanganate digestion. Based on these findings, a diagnosis of reactive amyloidosis of the amyloid A-protein-derived type was made. Amyloidosis in the mediastinum has rarely been described.     

Acetate Hemodialysis Does Not Increase the Frequency of Arrhythmia in Hemodialysis Patients

It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future. Arrhythmia is one of the most important causes of mortality in patients on hemodialysis and may develop due to cardiovascular diseases or fluid-electrolyte or acid-base abnormalities. Previous studies have shown that acetate hemodialysis (AHD) increased the frequency of arrythmia. To evaluate the frequency and the causes of arrhythmias during AHD, we studied 33 randomly selected patients (25 male and 8 female, mean age of 45 ± 18 years) who were under AHD (4 h, 3 times/week, mean duration of HD of 38 ± 29 months) with the same Cuprophan membranes. All patients underwent a detailed echocardiographic evaluation during the interdialytic period. Twenty-four hours of Holter monitoring was performed starting from the onset of HD. Twelve lead electrocardiography (ECG) was obtained, and venous and arterial blood samples were drawn for serum electrolytes, pH, and arterial blood gas measurements before and after HD. Serum magnesium and potassium levels dropped after AHD (from 2.3 ± 0.5 to 1.9 ± 0.3 mEq/L and from 5 ± 0.7 to 3.4 ± 0.4 mEq/L respectively, p < 0.001); on the other hand serum pH, bicarbonate, sodium, and calcium levels were normalized. Electrocardiographic evaluation revealed significant lengthening of the QTc interval (from 433 ± 42 to 464 ± 43 ms, p < 0.001), which was thought to be related to the decrease in serum magnesium and potassium levels. The frequencies of ventricular premature contractions (VPCs) were not different during AHD and the interdialytic period (8 ± 9.1 to 6.5 ± 11 contractions/h, p > 0.05). This was also true for supraventricular premature contractions (SVPCs) and supraventricular tachycardia (SVT). Nonsustained ventricular tachycardia was observed in 2 patients during HD and in 1 patient in the interdialytic period. No relation was established between the echocardiographic findings and the frequency of arrhythmia. In our ambulatory electrocardiographic study, the frequencies of VPCs and SVPCs observed during the interdialytic period were only positively correlated with age (r = 0.54, p = 0.013 and r = 0.50, p = 0.010, respectively). No relation was found between the frequency of arrhythmia and the gender of the patients; duration of HD; etiology of kidney disease; or serum Na, K, Ca, iCa, Mg, bicarbonate, or pH levels (p > 0.05). In conclusion, the application of AHD does not increase the frequency of arrhythmia in HD patients as had been shown in previous studies.     

The Acute Effect of Intravenously Administered Recombinant Human Erythropoietin on the Immune Response of Uremic Patients Maintained on Regular Hemodialysis

The uremic patient on regular hemodialysis (RHD) is subjected to a wide range of immune modulators including the uremic state per se, multiple transfusions and exposure to bioincompatible materials and endotoxins. Erythropoietin (EPO) therapy may raise concern about its potential influence on this complex scenario. To envisage this issue, 15 adequately selected patients, stable on RHD, were randomly assigned in a 2:1 ratio into EPO and placebo groups. After initial assessment and determination of baseline values, they received, in a double-blind manner, either EPO or normal saline as an intravenous bolus immediately after termination of dialysis for 30 successive sessions. Thirty minutes later, following sessions 1, 10, 20, and 30, samples were obtained for determination of blood counts, red cell indices, peripheral lymphocyte counts (PLC), CD4/CD8 ratios, blood EPO levels, and serum concentrations of interleukins (IL) IL-2r, IL-3, and IL-6, tumor necrosis factor (TNFs and TNFα), and neopterin (NPT). Blood EPO levels displayed the predicted rise in the EPO group, which correlated with partial improvement of red cell parameters. The mean total leukocyte count and PLCs was significantly increased in the EPO group (p < 0.05) but not in the placebo group. CD4/CD8 ratios were not significantly changed in either group. The serum concentrations of IL-2r, IL-3, and NPT remained fairly stable while that of IL-6 was widely variable in both study groups. The mean serum concentrations of TNF and particularly TNFα showed a steady and statistically significant increment in the EPO group from 6 to 41 pg/ml (p < 0.05) and 93 to 128 pg/ml (p < 0.03), respectively. No significant change was noticed in the control group. It is concluded that intravenous administration of EPO under the conditions of this study may have an immune stimulating effect. This is shown by the release of TNFs, which in turn may be responsible, through different potential mechanisms, for the increase in the mean peripheral neutrophil count and the blunting of erythroid responsiveness to EPO therapy.     

可调钠透析防治高危血液透析患者低血压研究

目的：观察可调钠透析（PHD）在高危人群（高龄、糖尿病肾病及心功能不稳定）血液透析中防治低血压的作用。方法：选择30例维持性血液透析中的高危患者透析，治疗分两阶段进行，第1月行普通透析（CHD）为A组，透析液钠浓度138mmol／L，第2月行可调钠透析（PHD）为B组，透析液钠离子浓度由148mmol／L，线性下降到135mmol／L，透析时间均4．5h，患者自身交叉对照，两者血流速相等，脱水量恒定，透析过程中监测透析前后血清钠浓度，监测透析过程中低血压发生率。结果：CHD组与PHI）组相比，透析前后血清钠浓度无明显差异（P〉0．05）。CHD组与PHD组相比，PHD组低血压发生率较CHD组明显降低（p〈0．01）。与CHD相比，PHD的作用以不增加患者的钠负荷为代价，不造成透析间期体重增长过多。结论：PHD组可明显减少维持血液透析中高危人群的低血压的发生率。     

维持性血液透析患者皮肤瘙痒情况的调查

目的 分析维持性血液透析患者皮肤瘙痒的部位、程度及治疗情况.方法 对我院血液净化中心63例维持性血液透析患者的皮肤瘙痒发生部位、以视觉模拟评分法评估瘙痒程度并调查其治疗情况.结果 63例维持性血液透析患者常见的瘙痒部位依次为背部、下肢、胸部、上肢、头颈部;轻度、中度、重度瘙痒分别为22例(34.9%)、25例(39.6%)、16例(25.4%);合并皮肤感染5例.63例患者中有40例患者接受血液灌流和(或)血液透析滤过治疗,经规律血液灌流和(或)血液透析滤过治疗后症状缓解.单纯行血液透析治疗的23例瘙痒患者中有14例去皮肤科就诊,经局部对症治疗效果不明显.结论 维持性血液透析患者皮肤瘙痒多为中、重度并可能发生皮肤感染.规律血液灌流和(或)血液透析滤过治疗能有效地缓解维持性血液透析患者皮肤瘙痒,而单纯局部对症治疗无效.     

Effect of Hemodialysis on T Lymphocyte Subsets, Con-A-Activated Suppressor Cell Activity, and Interleukin-2 Receptor Expression on Lymphocytes in Chronic Uremic Patients

Effect of hemodialysis (HD) on some indices of immune response was studied in nine chronic uremics. Total lymphocyte, OKT4+, and OKT8+ cell numbers significantly decreased during the first 20 min of HD, and they were decreased till the third hour of the procedure, whereas the OKT4+/OKT8+ cell number ratio did not change significantly. Before HD, Con-A--activated suppressor cells exerted a stimulatory action on autologous responder cells measured in two-step culture. During HD, Con-A-activated suppressor cell activity transiently appeared, with its peak at 60 min after the start of HD. It was accompanied by a transient rise in lymphocyte count with spontaneous interleukin-2 (IL-2) receptor expression, whereas the number of cells expressing IL-2 receptor following phytohemaglutinin (PHA) stimulation was progressively decreased during HD. A significant correlation was found between the increment of Con-A-activated suppressor cell activity and the increment of spontaneous IL-2 receptor expression on lymphocytes during one single blood flow through the dialyzer. The results supply further evidence that HD may impose additional disturbances on immune regulation in chronic uremics.     

Acid‐Base Balance and Oxygen Tension During Dialysis in Uremic Patients With Chronic Obstructive Pulmonary Disease

Recent reports on the effects of dialysis on acid‐base balance and metabolic acidosis correction in end‐stage renal disease (ESRD) patients with chronic obstructive pulmonary disease (COPD) are lacking. Here, we compared acid‐base balance and blood gasses among 14 patients with established COPD (group A) and eight patients with normal respiratory function (group B). The two groups were homogeneous for age, time on dialysis, and male/female ratio. At the beginning of dialysis, acid‐base balance and blood gasses were comparable between patients of groups A and B. A significant difference between groups was observed only in pCO₂ at 20 min, together with a delay in pH increase. Effective correction of acidosis was reported at the end of dialysis and is not significantly affected by COPD. Nevertheless, weight loss must be carefully monitored in these patients in order to prevent hyperhydration and worsening of respiratory function.