The role of percutaneous transluminal dilatation in the treatment of transplant renal artery stenosis.

The assessment of percutaneous transluminal dilatation (PTD) as a new therapeutic approach for transplant renal artery stenosis (TRAS) was prompted by allograft loss following surgical treatment. Seventeen (7.0%) of 243 allograft patients had TRAS greater than 80% diagnosed by angiography. The outcome of PTD in 4 TRAS patients was compared to antihypertensive drugs alone in 5 and attempted surgical repair in 8. Patients receiving antihypertensive drugs alone required 3.2 drugs at optimal doses to maintain diastolic BP less than or equal to 90 mm Hg. Malignant hypertension developed in 1 non-compliant patient. Three of the 8 surgical repairs resulted in loss of functioning grafts due to postoperative renal artery thrombosis; the remaining 5 had substantial reduction in diastolic BP (pre 112 +/- 8 mm Hg, post 93 +/- 8 mm Hg, P less than .05). Four patients with main renal artery stenosis had successful, uncomplicated PTD with no graft loss, a significant reduction in diastolic BP (pre 108 +/- 10 mm Hg, post 88 +/- 5 mm Hg, P less than .05) and less antihypertensive drug requirement (pre 3.0 +/- .8 drugs, post 1.0 +/- .8 drugs, P less than .05). Restenosis occurred in 1 patient during the 6 to 10 month follow-up period. PTD compared favourably with conventional management of TRAS as a new therapeutic approach.

Contrasting effect of hemodialysis and peritoneal dialysis on the inhibition of in vitro calcification by uremic serum.

Our findings support the earlier observation of Yendt, Connor and Howard that uremic serum inhibits the calcification of rachitic rat cartilage in vitro. We also confirmed their studies showing that this inhibition is not the consequence of increased levels of serum magnesium or blood urea. In addition, we have shown that aqueous solutions of creatinine and uric acid in concentrations up to 20 mg./100 ml. do not cause any inhibition.Hemodialysis of uremic patients does not change the inhibitory activity of their blood. In contrast, after 24 hours of peritoneal dialysis, the blood of most patients does not inhibit calcification.The inhibitory activity of uremic serum, observed in vitro, may be important in the pathogenesis of osteomalacia in patients with renal failure. Failure of hemodialysis to alter this activity may contribute to the progression of renal osteodystrophy in patients on maintenance hemodialysis.

Management of peritonitis and bowel perforation during chronic peritoneal dialysis.

Peritonitis and bowel perforation are the most serious conditions of peritoneal dialysis. This paper reports our experience with these two complications among 87 patients who were admitted to our porgram during a 3.5-year period and were treated with chronic peritoneal dialysis for periods up to 38 months (average 9 months). Approximately 6,000 dialyses were performed. Peritonitis occurred seven times in six patients (0.1%) and five patients had six episodes of bowel perforation (0.1%). All patients were successfully managed with conservative treatment, consisting of continuous peritoneal dialysis and intraperitoneal and systemic antibiotics. Careful aseptic technique seems to be the only necessary factor in prevention of peritonitis.

Three years' experience with home peritoneal dialysis.

Our results to date indicate that home peritoneal dialysis is a sucessful, safe, and simple dialysis treatment which is accessible to virtually all patients who require chronic dialysis treatment.

Comparison of intermittent with continuous peritoneal dialysis.

Our experience with 41 patients on CAPD is presented (127 patient months). Thirty-three patients were previously on intermittent peritoneal dialysis. We used 4 exchanges of 2 L each per 24 hours (8, 6, 6 and 4 hours dwell times). There was a dramatic fall in serum creatinine of 27%, BUN fell 22%, total CO2 rose 15%. Haemoglobin rose 10% and serum albumin fell by 5%. The incidence of peritonitis was one episode per 7.1 patient months. All patients noted an increase in well being. There were almost no dietary restrictions and patients gained real body weight. In most instances, their antihypertensive medication could be discontinued. This technique is superior to all the other forms of peritoneal dialysis.

Home peritoneal dialysis: 3 years' experience in Toronto.

From November 1972 to November 1975, 52 males and 39 females aged 11 to 71 years were trained for home peritoneal dialysis. Dialysis was performed through a permanent catheter 4 nights a week. The first 11 patients used the manual system, exchanging 2 / of dialysate solution every 50 to 60 minutes. Subsequently 73 patients used the automatic cycler and commercially available dialysate and 7 patients used Tenckhoff's reverse osmosis peritoneal dialysis machine. The average duration of training was 15, 11.6 and 15 dialysis days, respectively, for the three methods. For the 83 patients followed up, the average duration of home dialysis was 8.3 months (range, 0.5 to 33 months); the total number of dialyses at home was 10 571. Ten received a transplant, 20 were transferred to hospital peritoneal dialysis or hemodialysis, 8 died and 48 continued with home dialysis. Twenty-three patients had a total of 33 episodes of peritonitis, an incidence of 27.7% among the patients in the program for up to 3 years or 0.3% among all the dialyses. By November 1975, 46 patients had returned to their predialysis lifestyle, 18 were working part-time, 10 were able to work but were not doing so, and 9 were unable to work or care for themselves.