[Clinical evaluation of 12 months of biofiltration in an elderly group]. / Valutazione clinica su 12 mesi di biofiltrazione in un gruppo di anziani.

Biofiltration (BF) was performed on 8 elderly uraemic patients (mean age 73.75 +/- 8.72 years; dialytic age 75.00 +/- 38.42 months) to improve cardiovascular stability and to reduce the dialytic session time. Small molecules (nitrogen, creatinine, uric acid, phosphorus) depuration, heamogasanalysis and PA monitoring, were compared against previous datum obtained by the same group that had undergoing acetate dialysis (AC. HD) for a year. Small molecules showed no significant differences; in BF the incidence of symptomatic hypotensions and the dialytic session time were reduced (30% and 30 min. respectively), with a better metabolic acidosis correction versus AC.HD. Our results showed that BF is better than AC.HD in elderly uraemic patients.

[Hemo-rheologic changes following treatment with human recombinant erythropoietin in chronic hemodialysis patients]. / Alterazioni emoreologiche in seguito a trattamento con eritropoietina umana ricombinante in pazienti emodializzati cronici.

Human recombinant erythropoietin constitutes a remarkable improvement in the treatment of uraemic anemia. Nevertheless, it causes haemorheological changes, which in turn may affect smaller blood vessel circulation. Our study was conducted on a pool of chronic uraemic patients under hemodialytic treatment who were given erythropoietin therapy. Substantial increases in overall blood viscosity and red cell aggregation were recorded, with no change in erythrocyte deformation. An increase in cardiovascular morbidity might occur in these patients who are already liable to this condition. Several years will have to elapse and thorough studies will have to be conducted on a large number of patients, to have conclusive evidence on this point.

[Utility of electrophysiologic study using the blink reflex and brainstem evoked potentials for the evaluation of the course of uremic polyneuropathy]. / Utilità dello studio elettrofisiologico mediante blink reflex e potenziali evocati del tronco encefalico (BAEPS), per la valutazione dell'evoluzione della polineuropatia uremica.

On the present study the authors evaluate the utility of electrophysiologic examination in uraemic polyneuropathy. A group of 19 uraemic patients in chronic dialysis underwent the Blink reflex and BAEPSs study to evaluate the alterations of nervous pathways. The results obtained were compared with those of a group of 10 healthy patients comparable for age and sex. The electrophysiologic parameters have been statistically compared with the plasma levels of vit. B12. folic acid, PTH and beta-2-microglobulin. The results show a significant difference of uremic patients compared with the healthy ones for the Blink reflex (ipsilateral and contralateral R2 responses). Also BAEPSs show significant alterations in the uraemic group (latencies of the III, V components). A statistically significantly inverse correlation is present between folic acid values and blink reflex R1 and R2 responses. Therefore our study shows the existence of a combined degeneration of central and peripheral nervous pathways in chronic uraemic patients. We believe that the decrease in folic acid concentration found in our study may be one of the causes of the beginning and then of the worsening of neurologic damage.

Use of immunomodulators (thymopentine) in hepatitis B vaccine in elderly patients undergoing chronic hemodialysis.

Thymopentine is a synthetic immunomodulator that positively affects T-lymphocyte maturation, reproduction and differentiation. In elderly uremic patients nonresponders to hepatitis B vaccine, the administration of this drug has been shown to improve the response to the new vaccination.

Enalapril in the treatment of hypertension associated with renal failure: results from a multicenter study.

Forty-eight hypertensive patients affected by various levels of renal failure entered this open, non controlled study, lasting 12 weeks. Patients were divided into two groups according to baseline creatinine clearance: Group I (29 patients): creatinine clearance greater than or equal to 25 ml/min but less than 45 ml/min; Group II (19 patients): creatinine clearance greater than or equal to 10 ml/min but less than 25 ml/min. Patients in Group I started with enalapril 5 mg q.d. and patients in Group II with enalapril 2.5 mg q.d. Enalapril could be titrated up to 20 mg/day. At the end of the study in both groups of patients blood pressure normalization was reached in a high percentage of patients without any significant change in renal function parameters. Plasma potassium showed a significant increase during the study but no patient discontinued treatment due to hyperkaliemia. In conclusion this study shows antihypertensive therapy with enalapril during chronic renal insufficiency to be effective at low dosage (5-10 mg) in lowering blood pressure and to have a good safety profile.