Automatic adaptive system dialysis for hemodialysis-associated hypotension and intolerance: a noncontrolled multicenter trial.

BACKGROUND: Hemodialysis is complicated by a high incidence of intradialytic hypotension and disequilibrium symptoms caused by hypovolemia and a decrease in extracellular osmolarity. Automatic adaptive system dialysis (AASD) is a proprietary dialysis system that provides automated elaboration of dialysate and ultrafiltration profiles based on the prescribed decrease in body weight and sodium content. STUDY DESIGN: A noncontrolled (single arm), multicenter, prospective, clinical trial. SETTING & PARTICIPANTS: 55 patients with intradialytic hypotension or disequilibrium syndrome in 15 dialysis units were studied over a 1-month interval using standard treatment (642 sessions) followed by 6 months using AASD (2,376 sessions). INTERVENTION: AASD (bicarbonate dialysis with dialysate sodium concentration and ultrafiltration rate profiles determined by the automated procedure). OUTCOMES: Primary and major secondary outcomes were the frequency of intradialytic hypotension and symptoms (hypotensive events, headache, nausea, vomiting, and cramps), respectively. RESULTS: More stable intradialytic systolic and diastolic blood pressures with lower heart rate were found using AASD compared with standard treatment. Sessions complicated by hypotension decreased from 58.7% ± 7.3% to 0.9% ± 0.6% (P < 0.001). The incidence of other disequilibrium syndrome symptoms was lower in patients receiving AASD. There were no differences in end-session body weight, interdialytic weight gain, or presession natremia between the standard and AASD treatment periods. LIMITATIONS: A noncontrolled (single arm) study, no crossover from AASD to standard treatment. CONCLUSIONS: This study shows the long-term clinical efficacy of AASD for intradialytic hypotension and disequilibrium symptoms in a large number of patients and dialysis sessions.

High doses of intravenous calcitriol in the treatment of severe secondary hyperparathyroidism.

BACKGROUND: In hemodialysis (HD) patients, secondary hyperparathyroidism (HPTH) is a severe common disease. Calcitriol administration has been demonstrated as an effective therapy. In this prospective study, our aim was to determine the necessary calcitriol dose required to control severe HPTH preventing hypercalcemia or hyperphosphatemia and avoiding parathyroidectomy. METHODS: Eighteen dialysis patients suffering from severe HPTH during a 12-month period received intravenous (i.v.) calcitriol pulse doses (2-8 mcg/3x/week). Multislice helical computed tomography (CT) cardiac imaging was performed to measure coronary artery calcifications. RESULTS: Fourteen patients showed an improvement (parathyroid hormone (PTH) level < 400 pcg/mL), one patient an incomplete reduction, and three patients starting from PTH levels between 1100 and 2386 pcg/mL did not appear to benefit from the therapy. After a 6-month therapy in 15/18 patients PTH levels were significantly lower (p<0.05). In a large portion of the group, as well as in the control group, coronary calcification values were high when compared to the normal range. CONCLUSIONS: According to our data, we concluded that severe HPTH could be treated successfully by i.v. calcitriol pulse doses reaching high doses (up to 8 mcg/3x/week) and for a prolonged period of time (6 months). In such cases, close monitoring is necessary to prevent hyperphosphatemia and hypercalcemia episodes.