Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland.

Echinocandins represent the first-line therapy of candidemia. Echinocandin resistance among Candida spp. is mainly due to acquired FKS mutations. In this study, we report the emergence of FKS-mutant Candida albicans/glabrata in Switzerland and provide the microbiological and clinical characteristics of 9 candidemic episodes. All patients were previously exposed to echinocandins (median 26 days; range 15-77). Five patients received initial echinocandin therapy with persistent candidemia in 4 of them. Overall mortality was 33%.

Late acute humoral rejection in low-risk renal transplant recipients induced with an interleukin-2 receptor antagonist and maintained with standard therapy: preliminary communication.

Low-risk renal transplant recipients treated with standard immunosuppressive therapy including interleukin-2 receptor (IL-2R) antagonist show a low incidence of early rejection episodes but few reports have examined the incidence and severity of late rejection processes. This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors.

[Acute neck pain in an elderly patient]. / Akute Nackenschmerzen bei einem älteren Patienten.

Case report of an 85-year-old patient with acute neck pain and elevated parameters of inflammation in the blood. The symptoms and the MRI of the cervical spine were misleading and mimicked an infectious spondylitis with abscess formation in the prevertebral soft tissue and the dens. Lack of improvement following intravenous antibiotics led to an investigation of the spine by computed tomography showing typical calcifications of the transverse ligament around the odontoid process. Crowned dens syndrome, the cervical manifestation of calcium pyrophosphate dehydrate deposition disease, was diagnosed. After insufficient response to NSAIDs, oral glucocorticoids quickly resulted in complete relief of symptoms.

Evaluation of late immunologic parameters among renal transplant recipients induced with Campath-1H.

Organ transplantation success depends principally on avoiding rejection, a purpose almost accomplished with immunosuppressant therapy. Nevertheless, drug side effects have promoted the search for other mechanisms to restrain alloresponses. T-regulatory cells (Treg) might exert that function. Campath 1H (C1H) induces Treg proliferation in the period subsequent to T-cell depletion following C1H administration. In the present study, the status of Treg and de novo HLA antibody production was determined posttransplantation when T-cell repopulation had been completed. In 14 patients, the following parameters were analyzed: renal function, rejection, Treg, panel-reactive antibody (PRA), and HLA antibodies. Patient and graft survivals were 100%. At the moment of Treg determination (20 months following transplant) the mean tacrolimus level was 8.4 ng/mL. One patient experienced an antibody-mediated rejection at 15 months after transplantation while having 3.2% Treg, with excellent treatment responses. Mean leukocyte and lymphocyte counts were 5752 and 1183 cells/mm(3); the mean peripheral blood percentage of Treg of 7.1% +/- 5.9% was not different from that observed in subjects without induction (mean 5.5% +/- 2.5%). Three patients (21%) showed Treg greater than 8.0%. In seven patients, we compared Treg at 4 and 20 months posttransplant, observing a decline from a mean of 19.9% to 5.9% (P = .05). In seven recipients, posttransplant PRA was determined; five of them became "de novo" sensitized, three with a mean class I PRA of 16% and two with a mean class II PRA of 37%. In conclusion, patient and graft survivals were excellent, mean Treg percentage was not elevated with results lower than in the early posttransplant period. Rejection incidence was negligible. Late "de novo" sensitization occurred in 70% showing that B cell-mediated alloresponses were only partially controlled among recipients induced with C1H even when associated with sustained anticalcineurin treatment.

Using alfalfa leaf meal as a supplement in late-gestation beef heifer and nursing beef calf diets.

Two experiments were conducted to investigate using alfalfa leaf meal (ALM; 22% CP, DM basis) in beef cattle diets. In Exp. 1, a total of 24 late-gestation Angus heifers (initial BW 470 +/- 9 kg) were blocked by BW, calving date, and BCS to 1 of 4 dietary treatments in a randomized complete block design. All heifers were offered a basal hay diet (7.4% CP and 67.6% NDF, DM basis). Treatments were arranged as a 2 x 2 factorial consisting of CP supplied at 100 or 112.5% of the recommended daily intake using either soybean meal (SBM) or ALM as the supplemental protein source. Treatments were fed for an average of 100 d before calving. Total DMI was unaffected by supplemental protein source, although heifers consumed more (P < 0.001) ALM supplement than SBM supplement at the expense of hay and corn. Feeding 112.5% of recommended CP to heifers increased precalving rate of BW gain (P = 0.004) and DM digestibility (P = 0.003). Protein source did not affect DM digestibility (P = 0.17). Neither supplemental protein source nor protein amount affected changes in BCS or calving traits. In Exp. 2, replicates of treatments were conducted over 2 consecutive years at 2 locations in northern Minnesota to determine the effects of including ALM in creep-fed supplements on nursing calf performance, supplement BW gain efficiency (GF; BW gain over control/supplement intake), and cow performance. Treatments were control (no supplement), ALM supplement (58% ALM, as-fed basis), or a wheat middling- and soybean hull-based supplement (MIDD). Milk intake (estimated by the weigh-suckle-weigh technique) was similar among treatments. Creep-fed calves had greater (P < 0.001) ADG than control calves, whereas calves offered MIDD tended to have greater ADG (P = 0.05) than those offered ALM (1.38 vs. 1.30 kg/d, respectively). Calves offered MIDD had greater (P < 0.001) creep feed DMI than those offered ALM (2.6 vs. 1.3 kg/d, respectively). A year x treatment interaction was noted for GF (P = 0.02). In yr 1, GF for calves offered ALM was greater (P = 0.006) than GF for calves offered MIDD, but in yr 2, there were no differences. Alfalfa leaf meal may substitute for SBM in beef heifer wintering diets and conventional creep feed ingredients. When included in creep feed diets, ALM can result in slightly less ADG and less DMI, but supplement conversion efficiency may be increased.

Alemtuzumab induction in kidney transplantation: clinical results and impact on T-regulatory cells.

Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4+CD25+FoxP3+ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P < .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.

Conversion from a calcineurin inhibitor-based immunosuppressive regimen to everolimus in renal transplant recipients: effect on renal function and proteinuria.

New immunosuppressive agents are being actively researched to avoid complications of chronic allograft nephropathy (CAN), calcineurin inhibitor (CNI) nephrotoxicity, and posttransplantation cancer. The family of mTOR inhibitors offers a unique immunosuppressive opportunity to avoid CNI toxicity and reduce the incidence of malignancy. Nevertheless, increasing data have demonstrated that sirolimus (SRL), the first mTOR introduced in the treatment of solid organ transplant recipients, induces proteinuria, an adverse event that could produce deterioration of long-term renal function. In this short-term study of patients followed for 1 to 16 months, we examined changes in renal function and proteinuria among renal transplant recipients converted from a CNI-based regimen to an everolimus (EVL)-based one, a recently introduced mTOR inhibitor. Our data showed that renal function can be optimized after conversion to EVL by up to 42% in recipients showing CAN grade 1 or 2, or CNI nephrotoxicity. Importantly, patients who improved their creatinine clearance did not show increased proteinuria measured in a voided specimen as the ratio of urinary protein and creatinine concentration (P/C). These results, if confirmed with long-term follow-up and a larger number of patients, would allow us to consider EVL as a promising agent for maintenance immunosuppressive regimens in kidney transplantation.

Increasing blood flow increases kt/V(urea) and potassium removal but fails to improve phosphate removal.

BACKGROUND: Hyperphosphatemia and hyperkalemia are major determinants of morbidity and mortality in hemodialysis patients. Half of the dialysis population suffers from hyperphosphatemia which is now recognized as an important cardiovascular disease risk factor. It is, therefore, necessary to improve the removal of these molecules. In this study, we investigated the effect of enhancing blood flow on Kt/V for urea (Kt/Vu), potassium and phosphate removal. METHODS: Thirteen patients were investigated in a randomized, cross-over, prospective study using 3 blood flows (Qb) of 200,250 and 300 ml/min which gave 39 standardized high-flux hemodialysis treatments. Effective blood flows were measured by ultrasonic flow meter. Quantification of delivered dialysis dose was performed by partial dialysate and ultrafiltrate collection for the determination of potassium and phosphate removal and by blood urea concentrations for determination of Kt/Vu. RESULTS: Kt/Vu rose significantly from 1.10 +/- 0.14 to 1.22 +/- 0.14 and finally to 1.39 +/- 0.16 (p = 0.0001) with increasing Qb similar to the increase in potassium removal from 53.0 +/- 2.4 to 63.4 +/- 2.6 and to 74.2 +/- 3.8 mMol (p = 0.01). Phosphate removal only improved from 28.1 +/- 1.3 to 31.4 +/- 1.5 (p = 0.050) when Qb was increased from 200 to 250 ml/min but remained unchanged at 31.2 +/- 1.5 mMol (NS compared to phosphate removal at Qb = 250 ml/min) when Qb was increased to 300 ml/min. CONCLUSIONS: Increasing delivered Kt/Vu and potassium removal with higher Qb fails to produce the same desired effect with phosphate removal during high-flux hemodialysis.

Fixed-time insemination in peripuberal, lightweight replacement beef heifers after estrus synchronization with PGF2alpha and GnRH.

Estrus synchronization contributes to optimizing the use of time, labor, and financial resources by shortening the calving season, in addition to increasing the uniformity of the calf crop. We determined whether acceptable pregnancy rates could be achieved after synchronization of ovulation and fixed-time artificial insemination (AI) in peripuberal replacement beef heifers using gonadotropin-releasing hormone (GnRH) and PGF2alpha. Crossbred heifers from two herds (MH, n=239; SS, n=330) were wintered at a single location. After a prebreeding examination revealed that 55 heifers had a reproductive tract score (RTS) of 1 (infantile reproductive tracts), they were culled and the remaining heifers were assigned randomly to one of three treatment groups: administration of 25mg PGF2alpha i.m. on Days -12 and 0 followed by estrus detection and insemination between 10 and 14 h after an observed estrus (Control; n=173); administration of 100 microg GnRH i.m. on Day -6, followed by 25 mg PGF2alpha i.m. on Day 0, then fixed-time AI and administration of 100 microg GnRH i.m. on Day +2 (GPG; n=172); and, treatment as for group GPG in addition to administration of 100 microg GnRH i.m. on Day -12 (GGPG; n=169). Bulls were introduced 10 days after AI for 60 days to breed heifers which did not conceive after AI (clean-up bulls). On Days -12, -6, and 0 transrectal ultrasonography was used to monitor ovarian structures in a subset of heifers (30 per treatment). At 30-35 days after AI, ultrasound was used to determine the presence of a viable fetus. Presence of a fetus and stage of pregnancy were determined via palpation per rectum 61-63 days after the conclusion of the breeding season. Heifers in the MH herd (309+/-1.9 kg) were heavier (P<0.001) than those in the SS herd (283+/-1.7 kg) at initiation of the breeding season. Synchronized pregnancy rates were greater (P<0.05) in GGPG (25.4%) and GPG (22.1%) than Control (12.7%) heifers. Pregnancy rates were 9, 21, 32, or 31% for heifers with RTS of 2, 3, 4, or 5, respectively. The average diameter of 22 follicles induced to ovulate in heifers treated with GnRH (GPG and GGPG treatments) was 14.2+/-0.8 mm (range=10.0-23.6 mm). In conclusion, a fixed-time ovulation synchronization program using GnRH and PGF2alpha improved pregnancy rates in peripuberal, lightweight replacement beef heifers.

Metabolic costs incurred by crayfish (Procambarus acutus) in a trace element-polluted habitat: further evidence of similar responses among diverse taxonomic groups.

Recent studies of several vertebrates and an invertebrate have shown elevated standard metabolic rate (SMR) following chronic exposure to a mixture of trace elements in a contaminated habitat. In this study, we examined whether another invertebrate, a crayfish (Procambarus acutus), also experienced elevated SMR in response to the same contaminants. We compared SMR of individuals inhabiting the contaminated site with SMR of individuals from uncontaminated reference sites. We also examined SMR of individuals collected from the reference areas and exposed in the laboratory for 50 days to sediment and food derived from the contaminated site. Individuals collected from the contaminated site had elevated SMR compared to individuals collected from the unpolluted areas (25.1 vs. 19.2 J g(-1) day(-1)). Individuals exposed to contaminated sediment and food in the laboratory experienced elevations in SMR compared to controls after 27 days of exposure (35.2 vs. 29.4 J g(-1) day(-1)), but after 50 days of exposure, metabolic rate no longer differed between treatments. Growth of contaminant-exposed individuals was lower than growth of reference animals throughout the laboratory study. Elevated SMR associated with contaminant exposure may reflect energy-demanding mechanisms required to combat deleterious effects of contaminants. Our results support the prediction that increases in energy expenditure in the contaminated habitat would negatively influence production processes, such as growth. Results from this study in conjunction with observations from other species suggest that increased SMR is a common response among several taxa to the mixture of contaminants in the study site.

Low-potassium and glucose-free dialysis maintains urea but enhances potassium removal.

BACKGROUND: The influence of potassium (K) removal on dialysis efficiency as measured by urea elimination is not clear. In this prospective, randomized, cross-over study we investigated the magnitude of K removal and its effect on urea (u) elimination during high-flux haemodialysis (HD). METHODS: Twelve stable, non-diabetic HD patients were investigated during three one-week standardized HD periods (1.8 m(2) high-flux polysulphone dialyser, treatment time 240 min, Qb = 300 ml/min, Qd = 500 ml/min, dialysate without glucose, bicarbonate 40 mmol/l), using dialysates containing 0 (0K), 1 (1K), and 2 (2K) mmol/l of K. Mass removal of K (M(K)) and u (M(U)) were measured during the mid-week treatment by partial dialysate collection. Urea reduction rate (URR) and Kt/V were determined. RESULTS: 0K, 1K and 2K treatments were perfectly comparable. Plasma K (PK) continuously declined reaching stable concentrations after 180 min. While 0K dialysate removed 117.1 mmol, 80.2 and 63.3 mmol (P < 0.001) were removed by 1K and 2K baths respectively. M(U) was not influenced by M(K) (r = 0.22) and amounted to 491.1 (0K), 508.6 (1K), and 506.2 (2K) mmol (NS) respectively. Accordingly, urea clearance, URR and Kt/V were constant during 0K, 1K and 2K treatments. CONCLUSIONS: Potassium-free dialysate significantly enhances potassium elimination. Potassium removal has no influence on urea elimination. High potassium removal, when needed, does not impair dialysis efficiency as measured by urea kinetics in high-flux, glucose-free, 40 mmol/l bicarbonate HD.

Health and environmental implications of using composted household and yard waste bedding in a cattle feedlot.

A study was conducted to determine the safety and feasibility of using municipal solid waste compost (MSWC) as a bedding material for cattle feedlots. Two pens in an open-front pole barn were bedded with either corn stalks or MSWC in each of two feeding periods (blocks) with two pens (23 x 34 m) per block. Block 1 used 336 heifers (initial BW, 398 kg) during a 104-d period (summer), and Block 2 used 276 steers (initial BW, 412 kg) during a 92-d period (winter). Blood concentrations of regulated elements (Cd, Cu, Mo, Pb, Ni, and Zn), electrolytes, glucose, or liver and kidney enzymes were unaffected (P > .05) by use of either bedding material. Polychlorinated biphenyls in perirenal fat were not detectable (< .5 ppm) in cattle bedded with either material. At slaughter, kidney Cu and kidney and liver Pb concentrations were greater (P < .05) for cattle bedded with MSWC. Despite this, tissue concentrations of these elements were well within those considered normal for healthy cattle. Regulated element concentrations of feed did not differ (P > .05) between diets within period, and neither did DMI or DM digestibility; therefore, cattle bedded with MSWC were likely inhaling additional amounts of these elements and excreting them through feces. More MSWC than corn stalks was required to supply a dry bed per animal daily (P < .05). Soiled bedding (manure as-is) output was similar (P > .05) for both bedding materials. On a DM basis, more manure (P < .05) was removed from the pen bedded with MSWC in Block 2. Total manure N and P removed was similar for both bedding materials. Nitrogen and P concentrations in manure were lower (P < .05) during Block 2, but total manure N removed was greater (P < .05) during Block 2. Total manure P removed from the pens was not affected by season. Under the conditions of this study, MSWC seemed to be a safe and effective bedding material for cattle feedlots.

Hemodiafiltration--a new treatment option for hyperphosphatemia in hemodialysis patients.

BACKGROUND: Hemodiafiltration is used to increase the convective transport and thereby the elimination of small and middle molecules, mainly beta2-microglobulin (beta2-M) across the dialysis membranes. There is little information concerning urea, creatinine, beta2-M and principally phosphate kinetics during hemodiafiltration in vivo. In this prospective study, we evaluated the transmembrane solute mass removal (TSR) and clearance (Kd) of urea, creatinine and phosphate as well as serum beta2-M reduction rate (beta2-MRR) and collected beta2-M in dialysate plus ultrafiltrate during high-flux hemodialysis (HD) and post-dilutional hemodiafiltration (HDF). PATIENTS AND METHODS: 16 patients were studied using a polysulfone capillary filter (1.6 m2 surface area, 40 microm fiber internal diameter and 200 microm, wall thickness) during 2 one-week periods: first week HD 1.6 m2 and second week HDF 1.6 m2. Treatment time was 4 hours, blood flow rate 300 ml/min with constant dialysate and ultrafiltration rates for HD and HDF periods. TSR, Kd, beta2-MRR and beta2-M collection were assessed during the mid-week treatment. In a second part of the study, we repeated the same protocol using a second high-flux polysulfone capillary filter (2.4 m2 surface area, 30 microm fiber diameter and 150 microm wall thickness). RESULTS: TSR and Kd of urea and creatinine were not improved by HDF, however, HDF increased TSR and Kd of phosphate. Phosphate clearance rose from 120 (HD 1.6 m2) to 159 (HDF 1.6 m2) (p < 0.005) and from 146 (HD 2.4 m2) to 206 (HDF 2.4 m2) (p < 0.005) ml/min. Beta2-MRR increased from 64.1 +/- 8.6 to 77.7 +/- 8.2% (p < 0.005) and from 75.0 +/- 5.1 to 82.9 +/- 8.5% (p < 0.005) during HDF 1.6 m2 and HDF 2.4 m2, respectively. Collected beta2-M remained unchanged. This discrepancy seems to be due to an enhanced beta2-M adsorption to the polysulfone membrane during HDF. CONCLUSION: Our results provide a strong evidence that HDF has no advantage over HD with respect to urea and creatinine removal in vivo. However, HDF did improve the elimination of phosphate and should be considered as an additional treatment option for hyperphosphatemia in dialysis patients. HDF improves significantly the elimination of beta2-M.

Surgical treatment of "steal syndrome" induced by arteriovenous grafts for hemodialysis.

OBJECTIVE: A rare but serious complication of angioaccess surgery for hemodialysis is the so called steal syndrome presenting as ischemia distal to an arteriovenous fistula. The main problem of various surgical techniques to correct steal is subsequent thrombosis of the fistula or persistence of distal ischemia. INTERVENTIONS: This paper describes an unknown technique for correction of ischemic steal consisting of ligation of the artery just distal to the take-off of the fistula and arterial bypass from the artery proximal to the take-off of the fistula to the artery distal to ligation. PATIENTS: Six patients with chronic renal insufficiency (3 male, 3 female) with patent upper arm cephalic fistulas presented with severe hand ischemia. RESULTS: Symptoms improved in all 6 patients immediately after operation. Successful hemodialysis could be maintained using the original fistula. CONCLUSIONS: The described technique is maybe the procedure of choice for the correction of fistula induced ischemic steal.

Plasma potassium in patients with terminal renal failure during and after haemodialysis; relationship with dialytic potassium removal and total body potassium.

BACKGROUND: Chronic haemodialysis (HD) patients may present with severe predialysis hyperkalaemia which is improved by dialytic treatment. However, factors influencing the behaviour of postdialysis plasma potassium (plasma K) are not well known. METHODS: In this prospective study 14 patients (7 female, 7 male) on chronic HD were investigated during a standardized 4-h HD with a 2 m2 high-flux dialyser and up to 6 h postdialysis. Dialytic potassium removal was measured by dialysate collection. Total body potassium (TBK) was measured by whole-body counting of 40K. RESULTS: Plasma K declined from 5.65 to 3.62 mmol/l on HD. In spite of a total dialytic removal of 107 mmol of potassium plasma K rose to 5.01 mmol/16 h postdialysis. TBK, as adjusted for age, was 38.2 and 49.0 mmol/kg BW in female and male patients respectively, i.e. in the normal range. Of a total potassium removal of 107 mmol on HD only 42% originated from the extracellular space. Dialytic potassium removal was best correlated with removal of intracellular potassium but also with extracellular potassium content and with the product of plasma K x TBK. The 6-h postdialysis plasma K was correlated with the predialysis value but not with TBK or dialytic potassium removal. CONCLUSION: A rather high dialytic removal of potassium (which is correlated with plasma K x TBK) does not necessarily prevent a rapid postdialysis rebound of plasma K. Therefore patients with marked hyperkalaemia should be monitored closely postdialysis. TBK can be normal in haemodialysis patients who are well nourished.

Prevention of hepatitis C infection in haemodialysis units. A prospective study.

A prospective study was begun in our haemodialysis unit after four previously negative patients were found to be anti-HCV positive. A dedicated area and dedicated dialysis equipment (but not a separate room) were assigned to anti-HCV-positive patients and testing for HCV antibodies was performed every 3 months. A total of 131 patients were treated during the study period of 18 months. Of these, 50 patients were dialysed during the entire 18 months, and 21 were available to be tested six or more months after having left the centre. During the first 6 weeks after implementing the precautions two more anti-HCV-positive patients were detected. However, during the rest of the study period no further newly infected patients were found. It is concluded that the spread of HCV infection in a haemodialysis environment can be prevented by limited isolation procedures.

Influence of dialyser clearance measurement accuracy on haemodialysis prescription based on Kt/V.

Kt/V urea (u) has been used as a measure of adequacy of haemodialysis (HD). However, the accurate assessment of its components is difficult and subject to error in a clinical setting. This study was designed to evaluate different forms of dialyser clearance (K) measurements and their influence on Kt/V. Sixteen patients on high-flux HD were studied at blood flow (Qb) rates of 250 and 350 ml/min and at constant dialysate flow rates. K of urea was measured by the arteriovenous blood sampling technique (Kbu), corrected for access recirculation (Kbru) and compared with K as determined by dialysate collection (Kdu) using a new sampling device. At Qb 250 and 350 ml/min, Kbu as based on dialysate collection was significantly lower than Kbru and Kbu as based on arteriovenous blood sampling: at Qb 250, Kdu 169.0 +/- 13.3, Kbru 191.2 +/- 11.5, and Kbu 203.0 +/- 9.3 ml/min (P < 0.0005); at Qb 350, Kdu 196.5 +/- 17.3, Kbru 227.7 +/- 15.5, and Kbu 243.6 +/- 12.7 ml/min (P < 0.0005). At Qb 250 ml/min Kbu t/V (1.33 +/- 0.17) overestimated Kdu t/V (1.11 +/- 0.13) by 16:8%, at Qb 350 ml/min by 19.3% (1.58 +/- 0.19 versus 1.27 +/- 0.15). Dialyser clearances based on arteriovenous differences in blood overestimate true clearances (and therefore Kt/V) as measured by dialysate collection. This overestimation is more marked with higher blood flow rates.

Influence of long-term amelioration of anemia and blood pressure control on left ventricular hypertrophy in hemodialyzed patients.

The course of left ventricular hypertrophy was investigated in anemic hemodialysis patients treated with recombinant human erythropoietin (r-huEPO). 12 patients, aged 60.8 +/- 9.9 years (mean +/- SD) were treated for 18.8 +/- 2.7 months. Left ventricular size was estimated by echocardiography performed before treatment and at least 12 months after relieving anemia. Patients had signs of left ventricular and/or asymmetric septal hypertrophy when compared with a nonanemic and normotensive control group matched for sex and age. At baseline, hemoglobin (Hb) was 8.6 +/- 0.7 g/dl; interventricular septum thickness (IVST) was 1.75 +/- 0.34 cm, left ventricular posterior wall thickness (LVPWT) 1.32 +/- 0.19 cm, left ventricular muscle mass index (LVMI) 222.7 +/- 41 g/m2 and blood pressure (BP) 146.4 +/- 10/81.6 +/- 6 mm Hg. Hb rose to 11.4 +/- 1.2 g/dl (p less than 0.001); IVST and LVMI decreased to 1.42 +/- 0.35 cm (p less than 0.02) and 155.4 +/- 25.1 g/m2 (p less than 0.001); LVPWT and BP remained unchanged (1.30 +/- 0.26 cm and 146.8 +/- 16.9/81.2 +/- 7.8 mm Hg) at the end of the study. During the observation period, two groups of 5 and 7 patients differed from each other. The group of 5 patients had higher BP values (158.9 +/- 9.8/86.5 +/- 5.3 vs. 140.0 +/- 9.5/79.2 +/- 6.8 mm Hg, p less than 0.01), and the period with Hb values above 10 g/dl was shorter (14.5 +/- 2.4 vs. 17.8 +/- 2.4 months, p less than 0.05). These 5 patients failed to show a significant decrease in IVST and LVMI.(ABSTRACT TRUNCATED AT 250 WORDS)