Endogenous digoxin-like immunoreactivity and erythrocyte sodium transport in uraemic patients undergoing dialysis

1. Erythrocyte Na+ transport (Na+ pump activity, co-transport, countertransport and passive Na+ efflux) and intracellular Na+ concentration were studied in 10 normal individuals and in 29 uraemic patients on chronic haemodialysis, before and after a haemodialysis session. Eight of them fulfilled the criteria of hypertension. 2. Normotensive patients before haemodialysis were classified in two groups: group 1 (pump-) with decreased erythrocyte Na+ pump activity, and group 2 (normal pump) with normal erythrocyte Na+ pump activity. Group 1 showed, compared with controls, a normal intracellular Na+ concentration and a decreased co-transport, but no difference in either countertransport or passive Na+ efflux. After haemodialysis this difference disappeared. Before haemodialysis, group 2 showed a high intracellular Na+ concentration, but activities of the Na+ transport systems studied were similar to those of controls. After haemodialysis, cell Na+ concentration decreased to a level not significantly different from that of controls. 3. Both before and after haemodialysis, hypertensive patients showed Na+ transport system activities and an intracellular Na+ concentration similar to those of controls. 4. Endogenous digoxin-like immunoreactivity (EDLI) and erythrocyte Na+ transport were studied in five normotensive and five hypertensive patients, before and after haemodialysis. EDLI in plasma was similar in both groups before and after haemodialysis. No correlation was found between EDLI and erythrocyte Na+ pump activity. 5. These results suggest the existence in some dialysed uraemic patients of alterations in erythrocyte Na+ fluxes, which may be corrected by haemodialysis. EDLI and erythrocyte Na+ fluxes do not seem to be markers of secondary hypertension in these patients.     

Parameter estimation in six numerical models of transperitoneal transport of potassium in patients undergoing peritoneal dialysis

Summary. The mechanisms of transperitoneal potassium transport during peritoneal dialysis were evaluated by validation of different mathematical models. The models were designed to elucidate the presence or absence of diffusive, non-lymphatic convective and lymphatic convective solute transport. Experimental results were obtained from 26 non-diabetic patients undergoing peritoneal dialysis. The validation procedure demonstrated that models including both diffusive and non-lymphatic convective solute transport were superior to the other models. Lymphatic convective solute transport was not identifiable. Furthermore, it was demonstrated experimentally that the equilibrium distribution of potassium between plasma water and dialysate did not differ from a Donnan equilibrium, although the precondition of the Donnan equilibrium was not fulfilled, i.e. the volumes on each side of the membrane were not constant and dialysate was not an ultrafiltrate of plasma.     

Volume control associated with better cardiac function in long-term peritoneal dialysis patients.

BACKGROUND: This study was undertaken to investigate the effect of long-term blood pressure (BP) reduction, achieved with salt restriction and strict volume control, on frequency and regression of left ventricular hypertrophy (LVH) in long-term peritoneal dialysis (PD) patients. METHODS: 56 patients who had been treated for more than 2 years under our care were enrolled. After echocardiographic (Echo) evaluation, 46 patients were included in the follow-up study. In our unit, we aim to keep patients' BP below 130/85 mmHg and cardiothoracic index below 0.50. To reach these targets, moderate salt restriction is advised, and if necessary, hypertonic PD solutions are used. Echo was performed at the beginning of the study (after a mean period of 36 months on PD) and at the end of the prospective follow-up period (24 months later). RESULTS: At the time of the first Echo, LVH was detected in only 8 (21%) patients. Residual urine volume was significantly decreased compared to data taken when they first started PD (658 +/- 795 vs 236 +/- 307 mL/day). Mean left ventricular mass index (LVMI) was 107 +/- 26.5 g/m2. LVMI was significantly decreased at the end of the follow-up in patients who had LVH at baseline. No LVH developed in patients who had normal LVMI at baseline. CONCLUSION: Our results indicate that control of hypertension is possible when extracellular fluid volume is kept under control using hypertonic PD solutions in case of recruitment in addition to salt restriction in long-term PD patients. Sustained normovolemia is associated with low incidence and regression of LVH.     

Enhanced rectal potassium secretion in chronic renal insufficiency: evidence for large intestinal potassium adaptation in man

The role of the large intestine in K+ excretion in chronic renal insufficiency was studied with a rectal dialysis technique in 14 normal subjects and eight normokalaemic, normotensive patients with chronic renal insufficiency. At initial intraluminal K+ concentrations of 10, 20, 30 and 45 mmol/l, net K+ secretion in patients with renal insufficiency was significantly greater than in normal subjects by approximately 1.8 mumol h-1 cm-2. The increase in net K+ secretion was more marked in those patients with creatinine clearances of less than 10 ml/min. In contrast, there were no significant differences in net Na+ and water transport, transmucosal potential difference and plasma aldosterone concentrations between the two groups. With an initial intraluminal K+ concentration of 30 mmol/l, the addition of amiloride (final concentration 1 mmol/l) to the rectal lumen decreased net Na+ absorption and transmucosal potential difference in normal subjects by 69% (P less than 0.005) and 31% (P less than 0.005) respectively, and in patients with renal insufficiency by 75% (P less than 0.05) and 36% (P less than 0.05) respectively, but there was no change in net K+ secretion in either group. These results indicate that the K+ secretory capacity of the rectal mucosa increases in chronic renal insufficiency, and the large intestine may therefore contribute to the maintenance of K+ homoeostasis as renal K+ excretion declines. Increased rectal K+ secretion in renal insufficiency occurs independently of changes in plasma K+ and aldosterone concentrations, net Na+ absorption and transmucosal potential difference, and may reflect stimulation of an active K+ secretory process.     

腹膜透析病人透析前教育模式及效果

目地探讨腹膜透析病人透析前教育模式在临床的实践与成效。方法对照组给予常规护理,干预组在常规护理基础上进行透析前教育模式的干预,根据病人疾病的不同阶段,实施不同内容、不同形式的教育。结果干预组病人的生活质量提高;焦虑、抑郁程度减轻;营养指标白蛋白、前白蛋白的改善优于对照组(P0.01或P0.05)。结论腹膜透析病人透析前教育模式在临床实践证明是有效、可行的。     

Pharmacokinetics of metronidazole in patients undergoing peritoneal dialysis.

After a single 500-mg intravenous dose of metronidazole, plasma and dialysate levels were measured over a 7.5-h period in five patients undergoing peritoneal dialysis for terminal renal failure. Approximately 10% of this dose was removed by dialysis during that period, and therapeutic levels were maintained in plasma. No routine adjustment in the dosage of metronidazole appears necessary in patients undergoing peritoneal dialysis.     

护理程序在腹膜透析病人健康教育中的应用

[目的]讨论应用护理程序对腹膜透析病人进行健康教育的效果.[方法] 将60例腹膜透析病人分为两组,实验组28例采用护理程序进行健康教育,32例对照组采用传统的健康教育.[结果] 实验组病人对腹膜透析治疗的依从性明显高于对照组,腹膜炎发生率显著低于对照组(P<0.01).[结论] 应用护理程序对腹膜透析病人进行健康教育可提高病人的生活质量,延长生命,提高透析质量,减少并发症,降低腹膜透析病人退出率和病死率.     

Osteoarthropathy of patients undergoing long-term hemodialysis

Maintenance hemodialysis, while capable of prolonging life, is an incomplete substitute for the patient's native functioning kidneys. Recently, it has become clear with time that long-term survivors of hemodialysis develop an osteoarthropathy differing from classic secondary hyperparathyroidism. The radiographic appearance includes erosive or destructive changes of articular surfaces, bone cysts, osteopenia, and periarticular calcific deposits. The most important clinical factor related to the development of the disease is increasing duration of hemodialysis. Although amyloid appears to be a causative factor, the exact etiology and treatment remain uncertain. It is important that the radiologist be aware of this entity and not mistake it for secondary hyperparathroidism, a variant of rheumatoid arthritis or infection.     

小儿截石位保暖及固定带的制作与应用

腹膜透析是治疗慢性肾衰竭、尿毒症既有效又简便的手段之一,是利用手术的方法在腹部置一根永久性的腹膜透析管,进行腹膜透析时把透析液通过这条腹透管灌进腹腔,日间每隔4h～5h、夜间每隔8h～10h灌注1次。我们把这些含有代谢废物和多余水分的腹膜透析液从腹腔放出来,再灌进去新的透析液,这样不断排出体内的毒素和多余水分,来代替肾脏一部分工作。为了减轻切口张力,促进手术切口的愈合,研制了腹膜透析病人专用腰带,临床试用效果满意,现介绍如下。1　材料　　以病人腰围2尺为例:取长2 0cm、宽16cm棉布2块,长16cm、宽8cm棉布1块。取长10cm、宽10…     

Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis.

Peritonitis is a well-known cause of mortality in peritoneal dialysis (PD) patients. We carried out a retrospective study to disclose the clinical spectrum and risk profile of peritonitis-related mortality. We analyzed 693 episodes of infectious peritonitis suffered by 565 patients (follow-up 1149 patient-years). Death was the final outcome in 41 cases (5.9% of episodes), peritonitis being directly implicated in 15.2% of the global mortality and 68.5% of the infectious mortality observed. In 41.5% of patients with peritonitis-related mortality, the immediate cause of death was a cardiovascular event. Highest mortality rates corresponded to fungal (27.5%), enteric (19.3%), and Staphylococcus aureus (15.2%) peritonitis. Multivariate analysis disclosed thatthe baseline risk of peritonitis-related mortality was significantly higher in female [relative risk (RR) 2.13, 95% confidence interval (CI) 1.24-4.09, p = 0.02], older (RR 1.10/year, CI 1.06-1.14, p < 0.0005), and malnourished patients (RR 2.51, CI 1.21-5.23, p = 0.01) with high serum C-reactive protein (s-CRP) levels (RR 4.04, CI 1.45-11.32, p = 0.008) and a low glomerular filtration rate (RR 0.75 per mL/minute, CI 0.64 -0.87, p < 0.0005). Analysis of risk after a single episode of peritonitis and/or subanalysis restricted to peritonitis caused by more aggressive micro-organisms disclosed that overall comorbidity [odds ratio (OR) 1.21, CI 1.05-1.71, p = 0.005], depression (OR 2.35, CI 1.14-4.84, p = 0.02), and time on PD at the time of the event (OR 1.02/month, CI 1.00-1.03, p = 0.02) were other predictors of mortality. In summary, the etiologic agent is a definite marker of peritonitis-related mortality but gender, age, residual renal function, inflammation (s-CRP), malnutrition, and depression are other significant correlates of this outcome. Most of these risk factors are common to cardiovascular and peritonitis-related mortality, which may explain the high incidence of cardiovascular event as the immediate cause of death in patients with peritonitis-related mortality.     

透析患者出血性疾病的诊断与治疗

出血性疾病是透析患者常见的严重并发症之一.各种因素导致的血小板功能异常是引起尿毒症患者出血的主要原因,多表现为出血时间延长.充分透析,积极纠正贫血可以预防及治疗尿毒症患者的出血.可以采用去氨加压素、雌激素和冷沉淀等药物治疗.临床上还需要重视与尿毒症治疗相关的出血性疾病,包括抗凝剂过量导致的出血性疾病及肝素诱导血小板减少.     

Pharmacokinetics of metronidazole in patients undergoing continuous ambulatory peritoneal dialysis

The pharmacokinetics of metronidazole, its biologically active alcohol metabolite, and its inactive acid metabolite were studied in five noninfected patients undergoing continuous ambulatory peritoneal dialysis and five patients undergoing hemodialysis. The latter were studied on off-dialysis days as a control group. Peritoneal dialysis caused insignificant changes in the apparent volume of distribution, elimination half-life, and total body clearance of metronidazole. Peritoneal dialysis clearance (4.49 +/- 0.88 ml/kg per h [mean +/- standard deviation]) accounted for only 8.9% of total body clearance (50.17 +/- 18.64 ml/kg per h). Analysis of the 24-h area under the serum concentration versus time curves and peritoneal dialysis clearance data for the two metabolites suggested a similar insignificant effect of peritoneal dialysis on their elimination. Metronidazole dialysate concentrations in the first 6-h exchange ranged from 7.6 to 11.7 micrograms/ml. This would suggest that cumulative penetration of metronidazole from the systemic circulation into the peritoneal cavity with dosing every 8 h should lead to adequate concentrations for the treatment of anaerobic peritonitis. For the treatment of systemic anaerobic infections, it would appear at present that metronidazole dosage adjustments are not necessary in patients undergoing continuous ambulatory peritoneal dialysis. The potential for metabolite accumulation was noted in this study. If further studies confirm that excessive serum metabolite concentrations are toxic, dosage reduction in this group of patients may be warranted.     

Relationship between dialysis adequacy and quality of life in long-term peritoneal dialysis patients.

OBJECTIVE: The purpose of this study was to compare quality of life (QOL) between peritoneal dialysis (PD) patients with adequate and inadequate total solute clearance (TSC). We also tried to determine the relationship between QOL and TSC. DESIGN: A cross-sectional study design was used in which QOL was evaluated and compared between PD patients with adequate and inadequate TSC. SETTING: The PD unit of a university teaching hospital. PATIENTS: Sixty-seven patients were recruited, 38 on continuous ambulatory PD and 29 on continuous cyclerassisted PD. METHODS: Patients were divided into adequate and inadequate groups, based on the results of either total urea clearance (Kt/Vurea) or total creatinine clearance (weekly CCr). The demographic data, dialysis variables, and clinical parameters of these patients were all collected. QOL was evaluated using the SF-36 questionnaire, which contains eight domains and is a comprehensive and validated instrument for QOL evaluation. QOL of patients in adequate and inadequate groups was compared. The relationship between QOL and TSC was also examined. RESULTS: Among patients grouped by Kt/Vurea, patients in the adequate group had significantly higher scores in two domains of the SF-36, that is, physical and emotional role functioning, than did those in the inadequate group. The total SF-36 scores were positively correlated with Kt/Vurea when all patients were pooled together. However, among patients grouped by weekly CCr, there was no significant difference in any of the eight domains of the SF-36 between patients in the adequate and inadequate groups. No correlation was found between the total SF-36 scores and weekly CCr. CONCLUSION: Our study had two important findings: First, PD patients with adequate total solute clearance, based on Kt/Vurea and not on weekly CCr, had a better QOL. Second, Kt/Vurea is better correlated with QOL than weekly CCr. These findings suggest that Kt/Vurea is a better parameter for the clinical evaluation of total solute clearance from the viewpoint of QOL.     

Quality of sleep and psychosocial factors for patients undergoing peritoneal dialysis.

OBJECTIVES: Sleep disorders are common in end-stage renal disease patients. This study examined the relationship between self-reported quality of sleep (QoS) and certain psychosocial domains for patients on peritoneal dialysis (PD). METHODS: The study subjects included 190 PD patients from 7 urban dialysis clinics in Northern Taiwan, from whom we obtained biochemical parameters and demographic data. QoS, quality of life (QoL), religious/spiritual activity, and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Medical Outcomes Study Short Form (SF-36) for QoL, the Royal Free Questionnaire, and the Beck Depression Inventory, respectively. RESULTS: The average PSQI score was 9.1 +/- 4.1 and, in total, 85.8% of all patients were poor sleepers (global PSQI > or =5). There was no difference in age, gender, and mode or duration of PD between good and poor sleepers. Biochemical data did not differ between the two groups. Widowed patients experienced significantly poorer QoS than patients with other marital status (PSQI scores: 12.3 +/- 4.9 vs 8.88 +/- 4.0, p = 0.006). The percentage of patients that held a bachelor's degree or above was significantly higher in good sleepers (55.6% vs 29.4%, p = 0.008). The PSQI value correlated negatively with the QoL scale in both physical (r = -0.295, p < 0.001) and mental domains (r = -0.410, p < 0.001), and correlated positively with the depression scale (r = 0.351, p < 0.001). There appeared to be no association between QoS and spiritual/religious activity (r = -0.097, p = 0.223). CONCLUSIONS: Psychosocial factors including depression, patients' perceptions regarding QoL, marital status, and educational background correlated significantly to the subjective QoS for PD patients. When dealing with sleep disorders in PD patients, physicians should pay considerable attention to their psychosocial backgrounds.     

自制腹膜透析托护腹带的应用

腹膜透析是慢性肾功能不全时一种有效的肾脏替代疗法,这种治疗方法以居家透析为主,而对于每次透析时必用的腹膜透析外导管,病人多自制简易装置加以固定,但效果不甚满意。为了妥善保护腹膜透析外导管,减少病人额外的痛苦和负担,我中心自行研制了一种腹膜透析托护腹带(已申请专利