[Hyperaluminemia in chronic hemodialysis patients. Evaluation of the respective roles of dialysate aluminum and oral aluminum hydroxide]. / Hyperaluminémie des hémodialysés chroniques. Evaluation du róle respectif de l'aluminium du dialysat et de celui de la prise orale d'hydroxyde d'alumine.

UNLABELLED: In order to evaluate the respective role of dialysate aluminium and of oral aluminium hydroxide in the occurrence of hyperaluminemia in patients on chronic hemodialysis, plasma aluminium was measured in 19 of them selected for their reliability, before and then 6 and 12 months after the use of a double step reverse osmosis system which allowed to have dialysate aluminium always below 20 micrograms/l, whereas before it was between 20 and 120 micrograms/l. No significant decrease of their plasma aluminium concentration was observed (81 +/- SEM 12, 81 +/- 12 and 75 +/- 12 micrograms/l respectively). But a significant correlation between plasma aluminium and the total or daily prescribed dose of Al (OH)3 was found before and after 12 months of reverse osmosis. A significant negative correlation was observed between plasma aluminium and the mean corpuscular volume, before and 12 months after reverse osmosis. No correlation was found between plasma aluminium and the plasma PTH levels or with the administration of active vitamin D metabolites. CONCLUSIONS: These data suggest that oral Al (OH)3 plays a predominant role in the hyperaluminemia of hemodialyzed patients and that hyperaluminemia may contribute to their microcytic anemia.

[Treatment of peritonitis in peritoneal dialysis. Comparison between continuous lavage with a machine and intermittent lavage with 4 CAPD bags/day]. / Traitement des péritonites en dialyse péritonéale. Comparaison entre lavage continu avec machine et lavage intermittent par quatre sacs/jour de DPCA.

Since 1978, 54 episodes of PT occurred in patients treated by PD, first 26 PT (group A) were treated by CLM (40 l/day) and in situ antibiotics (AB): in the absence of Candida, the association of sulfamethoxazol (SMZ: 80 mg/l) and trimethoprime (TMP: 16 mg/l) was used. Only when a Candida was present amphotericine B (AMB: 5 mg/l) was used. CLM was continued until PT was cured. The last 29 PT (group B) were treated by 4 bags/day of CAPD with in situ AB: SMZ: 200 mg/l and TMP 40 mg/l and a systematic oral prophylaxis of Candida was performed by AMB 1,5 g/day. In group A, 5 patients died and 2 others in group B. Complications were more frequent in group A (14) than in group B (6): p less than 0.02. In group A, the AB was changed in 7 cases because of initial resistance (1) or bacterial superinfection (2) or Candida superinfection (4). In group B, AB was changed in 9 cases because of initial resistance (7) or Candida superinfection (2). In conclusion the treatment of PT by 4 bags per day with in situ AB cure PT as rapidly as CLM in spite of lower doses of SMZ - TMP. However, this method is easier to perform and give less complication than CLM. It must be the treatment of choice of PT from peritoneal dialysis.

[Blood gas and acid-base changes and rhythmologic tolerance of acetate and bicarbonate hemodialysis using a standard dialyser with high sodium and control of ultrafiltration]. / Modifications gazométriques et acido-basiques et tolérance rythmologique durant les hémodialyses acétate et bicarbonate sur dialyseur standard avec sodium élevé et maîtrise de l'ultrafiltration.

In order to demonstrate a possible superiority of bicarbonate dialysis (HDB) over acetate dialysis (HDA) in conditions of standard dialysis (4 hours on a 1 m2 cuprophan dialyser) but with a bath rich in sodium (143 mEq/l) and control of ultrafiltration, we have compared 2 sequences of 3 runs of HDA and HDB with these conditions in 8 patients as regards their acido-basic and cardiologic parameters (continuous monitoring of ECG by Holter, regular measurement of blood pressure). Acid base balance study in AHD led to the distinction of 2 groups according to wether their plasma bicarbonate increased or decreased during the run. Rythmological tolerance was the same in BHD and AHD, wether all patients or both groups were considered. Heart rate was however slightly but significantly higher during AHD than during BHD, in the patients whose plasma bicarbonate decreased. In conclusion, the benefit of HDB is not remarkable when HDA is performed not only in standard conditions but also with a bath rich in sodium and with control of ultrafiltration.

Low molecular weight heparin in haemodialysis and haemofiltration--comparison with unfractioned heparin.

The low molecular weight heparin CY 222 (CHOAY) has been compared to unfractioned heparin (UFH) in patients on chronic haemodialysis and haemofiltration at various doses as regards it biological activity (measured by Activated Partial Thromboplastin Time and by anti-Xa activity) and its clinical effect on clot formation in the blood lines and bleeding at the puncture sites or recent wounds. Compared to UFH, CY 222 has a greater anti-Xa activity for a shorter APTT. This biological difference is of clinical advantage since clotting in lines is comparable or less than with UFH whereas compression time at puncture sites is shorter and recently bleeding wounds in 28 patients did not bleed again. The long half life of CY 222 allows its use as a single priming dose of 300 anti-Xa U/kg in haemodialysis and 450 anti-Xa U/kg in haemofiltration.