Renal anemia and its hemodynamic response--findings invasively determined over a period of 20 years.

Among the uremia-associated risk factor, which can be influenced today, anemia is considered most relevant because it induces functional and organic alterations of cardiac/circulatory function. Research concerning influence of the anemia on the pulmonary hemodynamic and cardiac output (CO) in pre-uremic patients are not available up to now. Cardiac and circulatory function of 52 patients were examined before initiation of dialysis therapy using a Swan-Ganz thermodilution catheter. After excluding patients with impaired cardiac pump function the results of 31 of the 52 patients could be analyzed. They were divided into two groups (Hb > resp. < 7.0 g/dl): in patients with severe anemia (Hb 5.7 +/- 0.6 g/dl; n = 7) cardiac index was higher (4.8 +/- 0.4 1/min/m2 < 0.01) compared with the other group (Hb 9.8 +/- 1.7 g/dl; n = 24; CI 3.9 +/- 1.1 1min/m2). The increase of cardiac index caused by anemia correlated with increased stroke volume and heart rate and lowered pulmonary and peripheral resistance. Patients with severe anemia showed a tendency to an impaired cardiac index below Hb < 5-6 g/dl. The hypercirculation did not cause an increase of the pulmonary arterial and pulmonary wedge pressure. Particularly in the case of already existing myocardial damage and coronary arteriosclerosis the presence of anemia and renal insufficiency leads to a highly increased morbidity and mortality. This "cardio-renal anemia-syndrom" is responsible for frequent refractory heart failure. Disturbances of cardiac/circulatory function are observed in pre-uremic patients three times more frequently than in patients after myocardial infarction. Early correction of anemia seems to reduce the risk of fatal cardial complications and to improve the quality of life and the prognosis of pre-uremic patients.

[The effect of bemetizide-triamterene on the serum and whole body potassium in hypertensive patients (author's transl)]. / Der Einfluss von Bemetizid/Triamteren auf das Serum- und Gesamtkörperkalium bei Hochdruckkranken.

The hypotensive effect of Bemetizide (B)/Triamterene (T) and its action on the potassium balance was investigated in 10 patients with renovascular hypertension. Within 14 days treatment with 50 mg B and 100 mg T a significant fall in the mean blood pressure of 174/106 to 143/95 mm Hg occurred. Whereas the serum potassium concentration fell by an average of 4.2 +/- 0.5 to 3.9 +/- 0.6 mEq/1 the whole body potassium showed only a slight insignificant regression by 50 and 80 mEq after 2--4 weeks; however, the potassium content related to the body weight remained unchanged. In contrast to monotherapy with chlorthalidone or hydrochlorothiazide, treatment with a combination of B and T caused no significant alteration of the intracellular content of potassium.

Haemodynamic state in severe chronic renal failure. Pathophysiological aspects of cardiovascular function and the importance of bicarbonate dialysis.

Patients with chronic renal failure were investigated, immediately before dialysis and during haemodialysis for central and systemic haemodynamic parameters. The treatment used was changed from acetate to bicarbonate dialysis. Additionally, acid-base values were assessed and continuous long-time electroencephalographic monitoring was performed. As the severity of the cardiac dysfunction is a decided contributory determinant of the quality of dialysis, we have turned our attention to the changes in cardiac and circulatory function during the predialysis phase and the best method of treating them.

[Serum and total body potassium during treatment with chlortalidone and hydrochlorothiazide. Influence of triamterene (author's transl)]. / Serum- und Gesamtkörper-Kalium unter Chlortalidon und Hydrochlorothiazid: ihre Beeinflussung durch eine kombinierte Behandlung mit Triamteren.

The serum and total body potassium was investigated in 25 patients with non-congestive cardaic failure before and during saluretic treatment. Treatment with triamterene (100 mg/d; n = 10) over a period of 3 weeks led to an increase of serum potassium (from 4.1 +/- 0.65 to 4.7 +/- 0.51 mmol/l) and of total body potassium (by 110 mmol). After treatment with chlortalidon for 7 days (100 mg/d; n = 6) serum potassium concentration decreased from 4.38 "/- 0.37 to 3.30 +/- 0.46 mmol/l (approximately 25%). The total body potassium decreased by 240 mmol (approximately 10%). Continuation of the treatment with a combination of chlortalidon (50 mg/d) and triamterene (150 mg/d) led to correction of the extra- and intracellular potassium loss after 1 to 2 weeks. No significant change of serum and total body potassium was found during and after 6 months of treatment with hydrochlorothiazide (50 mg/d) and triamterene (100 mg/d; n = 9). The results demonstrate the potassium loss which occurs in the early stage of saluretic treatment and show the antikaluretic potency of triamterene.

[Surgical treatment of ventricular aneurysm: an analysis of post-resection haemodynamic changes (author's transl)]. / Die Resektion von Ventrikelwand-Aneurysmen. Vergleich prä- und postoperativer Untersuchungsbefunde

Of 500 patients with angiographically proven myocardial infarction 75 had a left ventricular aneurysm. 25 of them subsequently had resection of the aneurysm. Postoperative studies revealed marked improvement of symptoms. Pulmonary arterial pressure was significantly decreased at rest (from 28 to 20 mm Hg) and on exercise (from 58 to 35 mm Hg). There was a reduction in left ventricular end-diastolic volume (from 247 to 1.54 ml/1.73 m2) and a raised ejection fraction (from 36 to 59%). Good results were obtained especially in those patients who had congestive heart failure due to paradoxical systolic expansion of the ventricular wall and (or) secondary reversible damage in the remaining viable myocardium. Left ventricular aneurysms should be suspected after myocardial infarction when there is left ventricular failure and an increase in heart size.