A comparison of alexithymia in American and Japanese dialysis patients.

A comparison of alexithymia in American and Japanese dialysis patients was performed using the Beth Israel Hospital Questionnaire (BIQ) and the MMPI Alexithymia Scale (MMPI-AS) including structured interviews. No significant differences between the USA and Japan were observed in all dialysis patients with both BIQ and MMPI-AS. However, the alexithymia score in US hemodialysis (HD) patients was significantly lower than that in Japanese HD patients, whereas the alexithymia score in American continuous ambulatory peritoneal dialysis (CAPD) patients was significantly higher than that in Japanese CAPD patients. These results may suggest the possibility that the differences in dialysis policy between USA and Japan have secondary effects on alexithymia, which is one of the psychosomatic factors reflecting self-control ability in dialysis patients.     

Psychosomatic aspects of patients on hemodialysis. 4. The relationship between quality of life and alexithymia

The relationship between quality of life (QOL) and alexithymia was examined in dialysis patients. Hemodialysis (HD) patients with diabetic nephropathy had poor QOL in medical dimension. Although they had good QOL in psychological and social dimensions, a high prevalence of alexithymia associated with self-control ability was observed. These results suggest that their inability to care for themselves was reflected in poor medical dimension, and that good psychological and social dimensions were merely an outward appearance. Therefore, identification of alexithymia in dialysis patients is important along with a three-dimensional evaluation of QOL. Multidisciplinary comprehensive assessment of QOL including alexithymia will lead to a real improvement of dialysis patients' QOL.     

Control of uremic neuropathy by equilibrium peritoneal dialysis

Motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNVC) and distal motor latencies times (DMLT) were evaluated both in upper and lower limbs in three groups of 15 patients of comparable age, treated respectively by extracorporeal dialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and combined peritoneal dialysis (CPD) for comparable sufficiently long periods. Moreover, MNCV was monitored longitudinally in two groups of patients shifted from CAPD to HD and vice versa. The results show a significant superiority of peritoneal dialysis and particularly of CAPD with respect to HD in controlling uremic neuropathy.     

Beta 2-microglobulin synthesis of mononuclear cells in chronic dialysis patients.

Beta 2 microglobulin (B2M) has been identified as a major component of amyloid deposits. This study was designed to determine whether changes occur in the synthesis of B2M in dialysis patients. Mononuclear cells (MNC) were isolated in peripheral blood from healthy volunteers, patients on hemodialysis (HD) and on continuous ambulatory peritoneal dialysis (CAPD). MNC were cultured in a medium of RPMI 1640 with or without interleukins IL-1, IL-2 or interferon INF-r. B2M in the cultured cells and supernatant was measured by enzyme immunoassay. IL-2 or INF-r stimulated B2M synthesis was significantly lower (25%) in patients on HD than in normal controls regardless of the type of dialysis membranes used, with no change in basal B2M synthesis. No differences were detected between healthy volunteers and CAPD patients. Preincubation of MNC with complement--activating or non-complement--activating membrane had no influence on B2M synthesis. The basal B2M synthesis of MNC significantly increased after a 4-hour HD regardless of the membranes used, and IL-2 and IFN-r stimulated synthesis were both essentially the same before and after HD. It was thus concluded that maximum capacity for B2M synthesis of MNC decreases in hemodialysis patients. This low responsiveness of MNC may be partially the cause for the reduction in cell-mediated immune response in HD patients.     

Significance of brain natriuretic peptides in patients on continuous ambulatory peritoneal dialysis

It is well known that plasma brain natriuretic peptide (BNP) concentration is elevated in cardiovascular diseases such as congestive heart failure. However, although it has been reported to increase in hemodialysis (HD) patients, little is known about plasma BNP in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Plasma BNP concentrations were measured and compared among CAPD patients (n=32), HD patients (n=63) and healthy volunteers (n=14) as well as those patients without cardiovascular disease. In addition, the correlation between plasma BNP concentration and parameters of echocardiography was examined. Plasma BNP concentration was significantly higher in CAPD patients without cardiovascular disease (n=23) than in healthy volunteers (n=14) (62.1+/-60.6 pg/ml versus 9.7+/-9.7 pg/ml, mean +/- SD, P<0.0001). Furthermore, it had a positive correlation with LVMI (CAPD: r=0.37, P=0.0354; HD: r=0.49, P<0.0001) but a negative correlation with LVEF (CAPD: r=-0.39, P=0.0277; HD: r=-0.40, P=0.0010) in both CAPD and HD patients. When all patients were compared, plasma BNP concentration was significantly lower in CAPD patients (n=32) than in HD patients (n=63) (114.8+/-142.7 pg/ml versus 296.8+/-430.4 pg/ml, P<0.0001). When those patients without cardiovascular disease was compared, it was also significantly lower in CAPD patients (n=23) than in HD patients (n=40) (62.1+/-60.6 pg/ml versus 151.8+/-102.2 pg/ml, P<0.0001). In conclusion, plasma BNP concentration was elevated in CAPD patients and correlated with LVMI and LVEF, suggesting that plasma BNP in CAPD patients may be associated with left ventricular hypertrophy (LVH) and left ventricular systolic dysfunction. In addition, plasma BNP concentration was significantly lower in CAPD patients than in HD patients, suggesting that cardiac load in CAPD patients may be lower than that of HD patients.     

Uremic polyneuropathy: different effects of hemodialysis and continuous ambulatory peritoneal dialysis

Registrations of clinical signs of neuropathy, quantified according to a fixed protocol, and determinations of vibratory perception thresholds and nerve conduction velocities (NCV) were performed in 22 patients treated with hemodialysis (HD) and in 21 patients treated with continuous ambulatory peritoneal dialysis (CAPD). Measurements were made at the start of dialysis and during a follow-up period of about 30 months. Motor NCV decreased in both groups; vibratory thresholds increased markedly in the CAPD patients, but not in the HD patients; and the clinical signs worsened in the HD patients, but not in the CAPD patients. The difference in outcome of the clinical signs during HD and CAPD was not of such a magnitude that one of these dialysis forms should be preferred before the other as regards neuropathy. We conclude that peripheral neuropathy may deteriorate during both HD and CAPD, but in significantly different ways, indicating that several pathogenetic mechanisms are probably involved in uremic neuropathy.     

Comparison of the quality of life in hemodialysed (HD) and peritoneally dialysed (CAPD) patients using the EORTC QLQ-C30 questionnaire

BACKGROUND: The aim of the paper was to assess reliability and validity of the QLQ-C30 questionnaire in studying the quality of life in dialysed patients, and then to compare the life quality in patients on hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and healthy controls. The present study included 65 HD patients, 22 CAPD patients and a group of 76 healthy volunteers. METHODS: Quality of Life Questionnaire (QLQ-C30), Hospital Anxiety and Depression Scale (HADS), Cantrill ladder. RESULTS: The EORTC QLQ-C30 questionnaire appeared to be a reliable and valid tool for assessing the quality of life in dialysis patients. HD patients had significantly poorer quality of life in the areas of physical, social, cognitive and emotional functioning in comparisons to the controls. CAPD patients were not significantly different life quality-wise from controls, except for their social and professional life.     

Comparison of magnesium and zinc levels in blood in end stage renal disease patients treated by hemodialysis or peritoneal dialysis.

The abnormal metabolism of macrominerals and trace metals, a frequently overlooked fact may be one of the factors influencing clinical disorders in chronic dialysis patients. The purpose of this study was to compare to what extent maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) therapy influences the magnesium (Mg) and zinc (Zn) levels in blood of patients treated by these two methods. Additionally, we examined the influence of rhEPO therapy on Hb concentration in erythrocytes, total protein and albumin levels in plasma, and possible impact of rhEPO on Zn and Mg content in blood. Seventy-five ESRD (25 treated and 15 non treated with rhEPO on HD), and (20 treated and 15 non treated with rhEPO on CAPD) patients participated in this study. Forty-five healthy volunteers (HV) served as a reference group. The mean plasma and erythrocytes Mg concentration (mmol/l) in HD and CAPD patients without and with rhEPO treatment was found to be significantly higher than in HV. In HD and CAPD patients treated by rhEPO the mean erythrocytes Mg levels were significantly lower than in non rhEPO treated groups. The inverse relationship between Hb and Mg concentration in erythrocytes in HD and CAPD patients with rhEPO treatment was observed (r = -0.63, P < 0.05 and r = -0.59, P < 0.01 respectively). The mean plasma Zn levels (micromol/l) in HD and CAPD patients with and without rhEPO have been significantly lower than in HV. In patients treated by rhEPO significant increase of Zn erythrocytes levels was found. We was found positive correlation between plasma and erythrocyte Zn levels and Hb concentration in HD and CAPD patients treated by rhEPO (r = 0.35, P < 0.05 and r = 0.4, P < 0.05 respectively). The Hb concentrations, total protein and albumin levels in HD and CAPD with rhEPO therapy were found significantly higher than in patients without rhEPO therapy, but still lower if compared to HV. Mean levels of iron and TIBC in plasma have been found significantly lower in both studied groups treated or non treated by rhEPO, in comparison to HV. In both studied groups of patients without rhEPO or treated by rhEPO plasma GC, GSA, Cr concentrations were significantly higher from those obtained in HV. No statistical correlations were found between Mg, Zn and total protein, albumin, iron levels and TIBC. During rhEPO therapy increased Hb concentration was connected with higher plasma and erythrocytes Zn levels and lower erythrocytes Mg levels. rhEPO may improve the Mg and Zn disturbed metabolism in uraemia.     

透析方式不影响慢性肾衰患者血浆内皮素、心钠素和甲状旁腺素水平的变化

对１２例持续非卧床腹膜透析（ＣＡＰＤ）维持一年以上和１６例维持一年以上血液透析的慢性肾衰透析患者（其中９例合并高血压），用放射免疫分析测定血浆内皮素（ＥＴ）、心钠素（ＡＮＰ）和甲状旁腺素（ＰＴＨ）的水平，以观察经ＨＤ和ＣＡＰＤ的慢性肾衰患者血浆ＥＴ、ＡＮＰ和ＰＴＨ的变化。慢性肾衰患者血浆ＥＴ、ＡＮＰ和ＰＴＨ浓度均较对照组显著升高，而透析８周前、后差异不显著，合并高血压的透析患者ＥＴ、ＡＮＰ和ＰＴＨ较对照组显著升高，但与无高血压的透析组比，差异也不显著。结果表明ＥＴ、ＡＮＰ和ＰＴＨ在慢性肾衰的发病机制中起重要作用，但ＣＡＰＤ与ＨＤ对ＥＴ、ＡＮＰ和ＰＴＨ水平的影响无明显差异。     

Development of peritoneal dialysis at Rijeka Clinical Hospital Center

The dialysis population is steadily rising as a consequence of the growing incidence of terminal renal failure patients and lack of organs for transplantation. Peritoneal dialysis (PD) has become an established form of renal replacement therapy. The development of new methods, techniques, PD fluids and catheters has significantly lowered the incidence of complications and increased the use of PD throughout the world. The development of PD at Rijeka University Hospital Center, the incidence of PD patients, their underlying renal disease leading to terminal renal failure, demographic characteristics of patients, complications of treatment, and causes of discontinuation of PD treatment are described. At Rijeka University Hospital Center, PD was introduced in 1963 in patients with acute renal failure (ARF), and in 1965 in patients with chronic renal failure (CRF). Until June 2002, 149 patients were treated, 71 with ARF and 78 with CRF. Continuous peritoneal dialysis was introduced at our hospital in 1978. An increasing number of patients on continuous ambulatory peritoneal dialysis (CAPD), altogether 35, was noticed in 1999. Automated peritoneal dialysis (APD) was introduced in January 2001. Five patients were treated with this method until June 2002. The most common underlying renal diseases in patients treated from January 1999 until June 2002 were diabetic nephropathy in 13 (37.1%) and glomerulonephritis in 11 (31.4%) patients, mean age 55.5 years, range 31-75 years, both sexes equally present. The leading cause of complications were infections and the main cause of death was cardiovascular disease. Five (14.3%) patients received kidney transplants which have been functioning well in all of them. Because of the high incidence of complications during the seventies, intermittent peritoneal dialysis (IPD) was used only occasionally. A significant increase in the number of patients on CAPD was observed in 1999. By the end of 2001 almost ten percent of patients receiving dialytic treatment were on CAPD. The most common complications were peritoneal catheter exit site infection and peritonitis, which caused referral to HD treatment in four (11.4%) and death in two (5.7%) patients with impossible vascular access. The knowledge and availability of different renal replacement therapies allow the choice and application of the most appropriate treatment option in individual patients with terminal renal failure. In comparison to HD, PD improves the quality of patient's life and decreases mortality in the first years of treatment. Patients with cardiovascular disease and diabetes, whose incidence is steadily rising, have a higher incidence of complications on hemodialysis treatment. In these patients PD is preferred, especially if used as the first dialytic treatment modality. PD has also provided a means of managing patients with no possibility for vascular access for HD treatment. Infective and mechanical complications are the main obstacles during PD treatment. Adequate facilities, equipment, educated and well-trained medical personnel and appropriate selection and thorough education of patients are necessary for a successful PD program.     

Bimodal dialysis: theoretical and computational investigations of adequacy indices for combined use of peritoneal dialysis and hemodialysis

A theoretically correct method for evaluating the adequacy of bimodal dialysis (BMD), a combination of peritoneal dialysis (PD) and hemodialysis (HD) in the same patient, is lacking. We therefore performed computer simulations using a variable-volume, two-compartment urea kinetic model for 1-week treatments with 1) HD with three sessions, HD3, 2) continuous ambulatory PD, CAPD, 3) 6 days of CAPD and 1 day with HD session, and 4) 5 days of CAPD and 2 days with HD. Four dialysis adequacy indices (KT/V, stdKT/V, fractional solute removal, FSR, and equivalent clearance, EKR) were analyzed using four different reference methods for normalization of urea amount and concentration: 1) peak value, 2) peak average value, 3) time average value, and 4) treatment time average value. The analyses show that a proposed simplified rule of adding one third of weekly FSR for HD3 for each dialysis session and one seventh of weekly FSR for CAPD for each PD day for prediction of weekly FSR for BMD provides a fair prediction, although some corrections may be necessary, depending on the chosen reference method. In particular, KT/V may be added using this rule. We conclude that theoretically correct adequacy indices for BMD may be defined and calculated by using numerical simulations.     

IL-6 mRNA synthesis by peripheral blood mononuclear cells (PBMC) in patients with chronic renal failure

We measured levels of IL-6 mRNA in PBMC obtained from patients with chronic renal failure, using polymerase chain reaction (PCR), PBMC were isolated from 45 patients on haemodialysis (HD) at the start of HD. PBMC were also isolated from 35 patients on HD at the end of HD, 23 patients on continuous ambulatory peritoneal dialysis (CAPD), 24 undialysed patients with chronic renal failure (CRF), and 19 healthy controls. Total RNA was extracted from PBMC with RNA zol and reverse transcribed into cDNA. To prepare samples containing identical amounts of β-actin cDNA, we performed competitive PCR by co-amplifying serial dilutions of mutant templates containing a single point mutation which generated a unique Eco RI site. Next, to measure IL-6 cDNA semiquantitatively in the samples containing identical amounts of β-actin (100 pg), we performed PCR amplification using 2 fg of the IL-6 mutant template containing a unique Eco RI site. Higher levels of IL-6 mRNA in the PBMC were observed in the HD patients than in the CAPD patients and healthy controls. The levels of IL-6 mRNA in the PBMC at the end of HD were not significantly higher than those at the start of HD. These results suggest that the dialysis session itself did not significantly affect IL-6 mRNA levels in the PBMC, but that chronic stimulation by maintenance HD may be associated with higher levels of IL-6 mRNA observed in HD patients.     

Effect of interleukin-2 and methylprednisolone on in vitro transformation of uremic lymphocytes

The functional relationship in vitro between mitogen-induced lymphocyte transformation, lymphocyte response to interleukin-2 (IL-2) and steroid, and production of IL-2 was examined in patients with chronic renal failure on hemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). The lymphocyte responses to optimal stimulation with phytohemagglutinin, concanavalin A, and pokeweed mitogen were depressed in lymphocyte cultures from HD patients, while CAPD lymphocyte cultures responded normally. However, at suboptimal phytohemagglutinin stimulation both CAPD lymphocyte and HD lymphocyte responses were subnormal. Uremic lymphocyte cultures were more sensitive to the immunosuppressive effect of methylprednisolone. Addition of IL-2 normalized the phytohemagglutinin responses of suboptimally stimulated CAPD lymphocyte cultures and clearly improved the mitogen responses of the HD lymphocyte cultures. Furthermore, the increased uremic lymphocyte sensitivity to methylprednisolone was normalized by addition of IL-2 to the cultures. The measured IL-2 production had clearly decreased in the HD cultures after 48 h as compared to that of the control cultures. A similar but not significant trend was also seen in the CAPD cultures. Thus, it is suggested that a deficient production of IL-2 may partly explain the reduced lymphocyte response of uremic lymphocytes in vitro.     

Lupus nephritis patients on maintenance dialysis in Hong Kong

Eleven patients with lupus nephritis required maintenance dialysis. Two were on haemodialysis (HD), 9 on continuous ambulatory peritoneal dialysis (CAPD). One was subsequently transplanted and recurrence of lupus nephritis occurred at 9 months posttransplant. One discontinued CAPD after 6 months; 4 died and the remaining 7 were fully rehabilitated. There was marked regression of extra-renal lupus activity post-dialysis.     

Total creatine kinase and isoenzyme fractions in chronic dialysis patients

We measured total serum creatine kinase (CK) and serum creatine kinase MB fraction (CK-MB) in 53 patients on continuous ambulatory peritoneal dialysis (CAPD) and 52 patients on maintenance hemodialysis (HD), using Scalva UV methodology for CK and electrophoresis for CK-MB. Seven of the 53 CAPD patients (13%) had an elevated total CK, and only one of these 7 patients had an elevated CK-MB greater than 5%. In contrast 22 HD patients (42%) had increased total CK values, and 6 of these 22 HD patients (27%) showed elevated CK-MB isoenzyme greater than 5%. For each sex, blacks had higher mean CK values than whites. Twenty-one out of the 43 HD patients who received intramuscular injections had elevated total CK values and 6 of these 21 patients had elevated CK-MB isoenzyme independent of the timing of injection. The increased frequency of higher total CK values in HD patients appears to be related to race and androgen administration. The modest elevations in CK-MB fraction (5 to 8%) in these patients require careful interpretation.     

Potential role of carnitine in patients with renal insufficiency

Summary Carnitine metabolism is altered in renal insufficiency and influenced by the treatment modalities. Chronically uremic patients with end-stage renal disease under conservative therapy, hemodialysis, or peritoneal dialysis show low, normal, or elevated serum levels of TC and a distorted pattern of FC, SCAC, and LCAC. HD induces a marked depletion of FC, while predialytic elevated SCAC and LCAC are in the normal range at the end of dialysis treatment. All carnitine fractions rapidly return to predialysis levels 6 h after HD due to a transport of carnitine from muscle stores to plasma pool. Muscle carnitine content is elevated in chronic uremic patients under conservative therapy. Normal or decreased levels are observed in patients on long-term HD treatment. In addition, weekly losses of carnitine in patients undergoing HD or peritoneal dialysis do not exceed urinary carnitine excretion of CO. Supplementation with currently recommended doses (1–2 gl-carnitine i.v. at the end of each HD) is followed by a marked rise in plasma carnitine levels, suggesting limited carnitine utilization in uremia. Therefore, lower carnitine doses and modified application regimens should be considered to avoid exaggerated plasma levels of carnitine and carnitine esters. Furthermore, carnitine application has been reported to show beneficial, worsening, or no effect on the deranged lipid metabolism of the uremic patients. In patients undergoing CAPD or IPD predominantly normal serum carnitine levels have been reported. On the other hand, SCAC and LCAC esters are markedly elevated in these patients.After kidney transplantation the pattern of carnitine fractions is fully normalized in patients with plasma creatinine 120 µmol/l. Increased levels for TC and its ester fractions are observed in case of an impaired kidney function. Acute renal failure due to massive rhabdomyolysis may occur in rare cases of CPT deficiency.Abbreviations AC Acylcarnitine - CAPD Continuous ambulatory peritoneal dialysis - CO healthy controls - CPT Carnitine palmityl transferase - FC Free carnitine - HD Hemodialysis - IPD Intermittent peritoneal dialysis - LCAC Long-chain acylcarnitine - RDT Regular dialysis treatment - SCAC Short-chain acylcarnitine - TC Total carnitine - TML 6-N-trimethyllysine     

The influence of defense mechanisms on secondary alexithymia in hemodialysis patients.

The influence of psychodynamic aspects such as the defense mechanisms for conflict on secondary alexithymia in hemodialysis (HD) patients was examined among 35 HD patients and their family members. Although HD patients had quite strong conflicts due to HD therapy, the manifestation of conflict and expressiveness toward the family were significantly lower in HD patients with alexithymia than in those without alexithymia. Significantly positive and negative correlations were observed between conflict and expressiveness, and between expressiveness and degree of alexithymia, respectively. These results suggest that this defense mechanism strongly suppresses the manifestation of conflict, and that secondary alexithymia in HD patients may be derived from defense mechanisms such as denial.     

Interpretation of serum aluminum values in dialysis patients

To determine the significance of serum aluminum levels in dialysis patients, the authors retrospectively analyzed a series of patients on maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). All patients had always been treated with a dialysate containing negligible amounts of aluminum. The serum aluminum levels of hemodialysis and CAPD patients were not significantly different, not related to age or sex, and not affected by the presence of diabetes or vitamin D intake. The most important determinant of serum aluminum level in the hemodialysis patients was the current dose of aluminum-containing phosphate-binding medication. This relationship was most striking in the compliant patients. In hemodialysis patients, after an increase during the first one to two years, the aluminum levels plateaued. Aluminum levels remained stable more than five years in CAPD patients. Red blood cell mean corpuscular volume was negatively correlated with serum aluminum level. In 28 dialysis patients who had bone biopsy, aluminum levels were positively correlated to histochemical aluminum staining and bone aluminum content. A level greater than 100 ng/mL was a reliable indicator of aluminum-associated osteomalacia, although a lower level did not exclude the presence of low turnover bone disease or mixed uremic osteodystrophy--two disorders possibly related to aluminum. In the presence of a high serum aluminum, elevated levels of immunoreactive parathyroid hormone (iPTH) were useful in detecting the presence of hyperparathyroidism; low levels of iPTH did not allow the authors to distinguish between other subtypes of uremic osteodystrophy.     

Dialysis in adults in year 2000 in the Republic of Macedonia

1,019 adult patients with terminal renal failure were treated with dialysis (D) in the first part of the year 2000 in the Republic of Macedonia. 1,010 patients (99%) were treated with chronic intermittent (maintenance) hemodialysis (HD) while nine patients (1%) were on continuous ambulatory peritoneal dialysis (CAPD). For the children, a special peritoneal dialysis program was developed; 509 patients per million of the population (PMP) were on dialysis. The Republic of Macedonia is, therefore, among those central and eastern European countries with a higher PMP number in the treatment of end-stage renal disease, following Croatia, the Czech Republic and Slovenia. The patients were treated at 18 Centers in a network of HD Centers at a distance of 30-50 km. from their place of residence in order to facilitate their access to treatment and to work. All patients who have had symptoms indicating need for treatment with D were accepted for treatment. The government payed all the expenses of the treatment and the salaries of the staff. 56% were male and 44% were female patients. The youngest patient was aged 9 and the oldest was 82 years old. There has been an increase in the age of the patients on D as well as an increase in their number. In 1993 we had 727 patients being treated with D, and now we have 1,019 with a constant increase in the number of patients with ESRD and a need for D and renal transplantation. Mortality per year at the different Centers ranged from 8-19% in 1999 and the average is 12%. Glomerulonephritis (GN)--both primary and secondary--is the main cause of renal failure (RF) in some Centers up to 45%. Tubulo-interstitial disease follows GN. ADPKD patients constitute 9.4% with a difference among the Centers of 3-29%, and diabetic nephropathy is found in 10%, 5-15% in different Centers. 11-61% of patients have an unknown etiology. 352 patients are on treatment with human recombinant erythropoietin (rhuEPO) - in some Centers up to 60%. The mode of application was subcutaneous and the initial dose is 20 U/kg body weight and the mean maintenance dose of EPO per patient weekly is 4,000 U. The Cimino-Brescia arteriovenous fistula is being applied as a standard vascular access. The survival rate of our patients treated with maintenance HD at 5 years was 58%. CAPD and particularly renal transplantation are to be further developed as alternative methods in treating terminal renal failure.     

Current concepts. Continuous ambulatory peritoneal dialysis

As a long-term dialysis therapy, CAPD has attractive features for use in children (in whom access to the circulation and immobility are often problems), adults in whom blood access is difficult, patients with diabetes, patients prone to hypotension, and patients seeking independence from a machine or medical facility. CAPD and related procedures are still evolving and improving. Efforts to reduce the rates of peritonitis are ongoing and should decrease the rates of treatment dropout and increase the use of this alternative method of dialysis. Continued research toward improvements in catheter configuration and connection devices and the tailoring of technique to meet the particular needs of patients have made peritoneal dialysis an acceptable replacement therapy in patients with end-stage renal disease. Neither peritoneal dialysis nor hemodialysis is the superior long-term dialysis therapy for all patients; the choice depends on numerous medical, social, geographic, and life-style considerations.