Robust method to improve the quality of shearographic phase maps obtained in harsh environments.

This paper presents a new approach to improve the quality of shearographic phase maps acquired in a harsh environment. During in-field nondestructive inspections, the presence of higher disturbances, mainly vibrations, can introduce unknown phase deviations in the sequence of shearographic images. This paper presents a different approach that combines the N-dimensional Lissajous algorithm [Int. J. Optomechatron.8, 340 (2014)1559-961210.1080/15599612.2014.942933] and the concept of phase of differences [Proc. SPIE6345, 634510 (2006)PSISDG0277-786X10.1117/12.693149] to improve the quality of phase maps. The concept is compared with two other methods. Results, advantages, and difficulties of each method are also presented and discussed by using real fringe maps.

The Kidney Donor Profile Index (KDPI) of marginal donors allocated by standardized pretransplant donor biopsy assessment: distribution and association with graft outcomes.

Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the United States. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score<4 [median KDPI: 87; interquartile range (IQR): 78-94] and 62 with a score=4 [median KDPI: 87; IQR: 76-93]; 102 dual transplants [median KDPI: 93; IQR: 86-96]) and 248 single standard transplant controls (median KDPI: 36; IQR: 18-51). PTDB-based allocation of marginal grafts led to a limited discard rate of 15% for kidneys with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year estimated GFRs were significantly lower in recipients of marginal kidneys (-9.3, -17.9 and -18.8 mL/min, for dual transplants, single kidneys with PTDB score<4 and =4, respectively; p<0.001), graft survival (median follow-up 3.3 years) was similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95% confidence interval: 0.80-1.79; p=0.38]). In conclusion, PTDB-based allocation allows the safe transplantation of kidneys with KDPI in the highest range that may otherwise be discarded.

Pancreas transplantation inside Emilia-Romagna, Italy: referral pattern, demand forecasting, and organ availability.

In Italy, referral of diabetic patients for pancreas transplantation (PT) is an unstructured process, resulting in a low rate of activity and late referrals, often when the patient has already undergone dialysis. In addition, the continuous improvement in pancreas transplant alone, offering the opportunity to reduce cardiovascular risk due to proteinuria and reduced glomerular filtration rate (GFR), is rarely appreciated. We therefore analyzed (1) referral activity to PT during the time frame 2001-2005 in Emilia-Romagna, Italy (four million inhabitants), by collecting ICD 9 CM codes (55.69 + 52.80; 52.86 and 52.80 alone) by residence of the patient; (2) demand for PT among a sample population of 1670 diabetes patients, whose charts were reviewed for the type of diabetes and presence of overt diabetic nephropathy (DN: proteinuria >300 mg/24 h and/or GFR <60 mL/min); (3) potential pancreas availability as the ratio between pancreas and hearts utilized (UP/HR) in different areas of our country. As a results, (1) referral activity reached 8.4 PT per million people in 5 years in the whole region, ranging from 2.6 in the province where a PT program is active, to a maximum value of 20.7 in the province where a devoted outpatient clinic is operated by nephrologists. (2) Prevalence of overt DN was 6% in our cohort, corresponding to 510 D1 patients worthy of evaluation for PT inside Emilia-Romagna region. (3) During 2006, UP/HR was 0.58 in Associazione Inter-Regionale Trapianti agency, 1.16 in Tuscany, 0.30 in Piedmont, and 0.26 in our region. Taken together, our data showed that (1) the referral of D1 to PT has to be empowered, keeping in touch with all patients suffering from diabetic nephropathy; (2) the outpatient clinic devoted to evaluation and recruitment of D1 with nephropathy plays the key role in this program of timely and widespread referral; (3) the availability of pancreata can be increased by utilizing broader criteria for harvesting, increased consent rate to donation and increased the demand for PT (recipient pool). Pancreas grafts need to increase, since the current low demand produces underutilization of the pancreas resource, due to the frequent lack of a suitable recipient.

Multicenter study on double kidney transplantation.

BACKGROUND: Marginal organs not suitable for single kidney transplantation are considered for double kidney transplantation (DKT). Herein we have reviewed short and long-term outcomes of DKT over a 7-year experience. PATIENTS AND METHODS: Between 2001 and 2007, 80 DKT were performed in the transplant centers of Bologna, Parma, and Modena, Italy. Recipient mean age was 61+/-5 years. The main indications were glomerular nephropathy (n=33) and hypertensive nephroangiosclerosis (n=14). Mean HLA A, B, and DR mismatches were 3.1+/-1.2. Donor mean age was 69+/-8 years and mean creatinine clearance was 75+/-27 mL/min. Almost all kidneys were perfused with Celsior solution. Mean cold ischemia time was 17+/-4 hours and mean warm ischemia time was 41+/-17 minutes. Mean biopsy score was 4.4. Immunosuppression was based on tacrolimus (n=52) or cyclosporine (n=26). RESULTS: Fifty (62.5%) patients displayed good postoperative renal function. Thirty (37.5%) experienced acute tubular necrosis and required postoperative dialysis treatment; 8 acute rejections occurred. Urinary complications were 13.7% with 8/11 requiring surgical revision. There were 6 surgical reexplorations: intestinal perforation (n=2), bleeding (n=3), and lymphocele (n=1). Two patients lost both grafts due to vascular and infectious complications at 7 or 58 days after transplantation. Two patients underwent intraoperative transplantectomy due to massive vascular thrombosis. Four (5%) patients underwent transplantectomy of a single graft due to vascular complications (n=2), bleeding (n=1), or infectious complications (n=1). Graft and patient survivals were 95% and 100% versus 93% and 97% at 3 versus 36 months, respectively. CONCLUSIONS: DKT is a safe approach for organ shortage. The score used in this study is useful to determine whether a kidney should be refused or accepted.

[Autosomal dominant polycystic kidney disease: from genes to cilium]. / Rene policistico autosomico dominante: dai geni al cilio.

Autosomal dominant polycystic kidney disease (ADPKD) is a quite frequent monogenic hereditary disease. The incidence has been reported to range between 1:400 and 1:1000 life births. The disease is caused by a mutation of the PKD1 gene in 85% of the cases and by a mutation of the PKD2 gene in the remaining 15%. The main characteristic of this condition is the development of renal cysts. Observations regarding various cystic kidney diseases sustained by mutations of different genes are steadily converging to a common point. This unifying element is the primary cilium. The cilium, which has long been considered a mere biological oddity, has lately become the focus of intense scientific attention because it may turn out to be the key to the understanding of cystic degeneration. The cilia can be regarded as sensors projecting out of the cell. In particular in the kidney they are located in an ideal place to capture information from the tubular lumen. One of the roles the cilia may play is the reception of chemical signals. An alternative hypothesis attributes to the cilia the role of mechanosensors capable of detecting variations of the urine flux in the tubular lumen. The cilium projects itself into the lumen where it can readily capture variations in the external environment and transmit them to the cell by as yet undefined pathways. This is the still largely unexplored frontier that will provide the elements needed to understand and treat renal cystic diseases.

[Dyslipidemia and the risk of kidney disease]. / Dislipidemia e rischio nella patologia renale.

An abnormal lipid profile is very frequent in patients with kidney disease due to the well-known nephrotoxicity of lipids. During progression of chronic kidney disease, the excretion of triglycerides, LDL and proteins increases while the glomerular filtration rate declines. Blood lipoproteins and lipids are modulated depending on the type of treatment: hemodialysis, CAPD or renal transplant. We analyzed many studies on dyslipidemia in patients with kidney disease by comparing different therapies. The use of statins reduces protein excretion and hyperlipidemia as well as progression of chronic renal failure with a direct effect on mesangial cell proliferation. A decrease in total cholesterol and LDL occurs in hemodialysis patients, a decrease in LDL and an increase in HDL occur in CAPD patients, and a decrease in LDL and triglycerides is observed in renal transplant recipients; in the latter, graft survival increases without there being any relevant correlation with immunosuppressive treatment. In conclusion, we found that statins are useful to contrast the progression of chronic kidney disease and atherosclerosis in hemodialysis and CAPD patients and to reduce chronic allograft nephropathy in renal transplant recipients.

Accuracy of eight-polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in peritoneal dialysis patients.

OBJECTIVE: To establish the accuracy of bioelectrical impedance analysis (BIA) for the assessment of total and appendicular body composition in peritoneal dialysis (PD) patients. DESIGN: Cross-sectional study. SETTING: University Nephrology Clinic. SUBJECTS: In all, 20 PD patients and 77 healthy controls matched for gender, age and body mass index. METHODS: Whole-body fat-free mass (FFM) and appendicular lean tissue mass (LTM) were measured by dual-energy X-ray absorptiometry. Resistance (R) of arms, trunk and legs was measured by eight-polar BIA at frequencies of 5, 50, 250 and 500 kHz. Whole-body resistance was calculated as the sum of R of arms, trunk and legs. The resistance index (RI) was calculated as the ratio between squared height and whole-body or segmental R. RESULTS: RI at 500 kHz was the best predictor of FFM, LTM(arm) and LTM(leg) in both PD patients and controls. Equations developed on controls overestimated FFM and LTM(arm) and underestimated LTM(leg) when applied to PD patients. Specific equations were thus developed for PD patients. Using these equations, the percent root mean-squared errors of the estimate for PD patients vs controls were 5 vs 6% for FFM, 8 vs 8% for LTM(arm) and 7 vs 8% for LTM(leg). CONCLUSION: Eight-polar BIA offers accurate estimates of total and appendicular body composition in PD patients, provided that population-specific equations are used.

A randomized trial of steroid avoidance in renal transplant patients treated with everolimus and cyclosporine.

In this randomized trial renal transplant recipients were treated with basiliximab, everolimus 3 mg/day, low-dose CsA. At transplantation, patients were randomized to stop steroids at the seventh day (group A) or to continue oral steroids in low doses (group B). Of the 113 patients enrolled, 65 were randomized to group A and 68 to group B. All patients were followed for 2 years. During the study 28 (43%) group A patients required reintroduced corticosteroids. One patient died, in group B. The Graft survival rate was 97% in group A and 90% in group B. There were more biopsy-proven rejections in group A (32% vs 16%; P = .044). The mean creatinine clearance was 54 +/- 21 mL/min in group A vs 56 +/- 22 mL/min in group B. Mean levels of serum cholesterol tended to be lower in group A, but the difference was of borderline significance (191 +/- 91 vs 251 +/- 188 mg/dL; P = .07). Vascular thrombosis (0 vs 5) and pneumonia requiring hospitalization (2 vs 7) tended to be more frequent in group B. Only three cases of CMV infection (1 vs 2) occurred. An immunosuppressive therapy with everolimus and low-dose CsA allows one to obtain excellent renal graft survival and stable graft function at 2 years. Early interruption of steroids in patients treated with this regimen may increase the risk of acute rejection, but neither affects graft survival nor graft function, while possibly reducing the risk of hyperlipemia and vascular thrombosis. About 60% of patients given everolimus and low-dose CsA can definitively stop steroids after 1 week.

[Early kidney-pancreas transplantation in type 1 diabetics prevents hemodialysis]. / Il trapianto precoce di rene-pancreas previene l'ingresso in dialisi dei diabetici tipo 1.

BACKGROUND: The life-expectancy of type 1 diabetics (T1D) on dialysis is still shorter than that of non-diabetics. Pancreas transplantation (PT) in its different modalities should be considered as a life-saving procedure. METHODS: We analyzed our referral activity of T1D to PT from 1992. Since 2002, we have created a kidney and diabetes out-patient clinic devoted to the prevention of diabetic nephropathy and to the early referral of suitable T1D to combined kidney- pancreas transplantation (KPT) and isolated pancreas (PTA). RESULTS: In the last 14 yrs, 25 T1D underwent KP in our district (620000 inhabitants). At the beginning, KPT was performed abroad, but then the borders were closed. After stopping in the mid 1990s, KP activity restarted addressing preemptive KPT and PTA. Currently, only one patient is on dialysis while awaiting KPT. Four T1D were evaluated and excluded from the list on medical grounds; two patients are on the list and a further two patients are currently under evaluation. CONCLUSIONS: The implementation of a cooperative network among dialysis and transplant centers, supported by devoted out-patient clinics allowed the effective prevention of the dialysis requirement in T1D. Out-patient clinics devoted to diabetic nephropathy should play a pro-active role in preemptive KP, including the 'new' option of islet transplantation according to the Edmonton protocol.

Kidney preservation with university of Wisconsin and Celsior solution: a prospective multicenter randomized study.

BACKGROUND: Although the University of Wisconsin (U.W.) solution continues to be the most commonly used for intra-abdominal organs, a new solution, Celsior, already used for heart and lungs, has been proposed for kidney and liver preservation. The aim of this research was to assess the effect of Celsior as compared with U.W. on immediate graft function and a 2-year follow-up of kidney transplants. METHODS: A prospective multicenter randomized study was designed to evaluate the efficacy of the Celsior solution in the clinical preservation of the kidney. In this report, we present the data collected as of September 2000. One hundred donors were included in the trial resulting in 187 renal transplants. Ninety-nine kidneys were stored in Celsior solution and 88 in U.W. solution. The groups were comparable with regard to donor and recipient characteristics. RESULTS: Delayed graft function occurred in 31.3% of the Celsior group and in 33.9% of the U.W. group (P=n.s.). Mean serum creatinine levels and mean daily urinary output were also comparable. Two year graft survival in kidneys preserved with Celsior was 84% as compared with 75% for U.W.-preserved kidneys without any significant statistical difference. CONCLUSIONS: Our data show that the preservation of kidneys in Celsior solution in a clinical setting is equivalent to that of U.W. solution. When using Celsior during multiple-organ donor harvesting it would be possible to perform an in situ flush of all intra-abdominal and intrathoracic organs with a single cold storage solution.

Efficacy and tolerance of acetate free biofiltration: a central Italian multicenter trial.

One hundred and thirteen patients from 51 dialysis units have been treated for 12 months on AFB using a high flux AN69 dialyzer (Filtral 12 or 16-Hospal), a buffer free dialysate (Na+ 139, K+ 2, Ca++ 2 mmol/liter, glucose 1 g/liter) and a reinfusate solution containing 145 mmol/liter HCO3Na. All of them had previously been stabilized on acetate dialysis (30 patients) or bicarbonate dialysis (46 patients) or different dialysis procedures (37 patients). AFB sessions were performed for 3.71 +/- 0.28 hrs, three times a week, at an average blood flow of 308 +/- 8.5 ml/min so as to ensure a stable Kt/V value > 1 (1.16 +/- 0.08). Blood samples were drawn monthly pre- and post-dialysis, for blood electrolytes, calcium, phosphate, chloride, urea, creatinine and uric acid, proteins and lipid profiles, hemochrome. Body weights, blood pressures and adverse side effects were recorded at each session. Using a mean infusion volume of 7.96 +/- 0.61 liter/session, post-dialytic bicarbonate values consistently > 25 mmol/liter (26.33 +/- 2.71) were achieved. Intradialytic occurrence of symptoms was very low at an average rate < 1.5 episodes patient/month. After 12 months of Tx an adequate control of uremia, of electrolytes, of Ca-PO4 balance and of BP was obtained. AFB gets a very high intradialytic tolerance and an excellent depurative capacity which contributes to the well being of the patients.

N-3 polyunsaturated fatty acid supplementation in chronic progressive renal disease.

Chronic renal failure (CRF) may be accelerated by secondary lipid and immune abnormalities which could be antagonized by polyunsaturated fatty acid (PUFA). We examined 20 CRF patients on conservative treatment, randomized in two groups: G1 consisted of 10 control patients and G2 10 patients supplemented for 12 months with a 3.4 g daily dose of PUFA. In basal conditions and after 12 months the following parameters were checked: creatinine clearance (CCr), daily urinary protein excretion per unit of residual renal function (UProt/CCr), rate of progression of renal insufficiency (delta CCr); triglycerides (TG), total (TC), HDL (HDALC) and LDL (LDLC) cholesterol, apolipoproteins Apo Al, Apo B, lipoprotein(a) Lp(a); lymphocyte subpopulations; spontaneous (c) and stimulated (s) cytokines IL-1 beta, IL-2, tumor necrosis factors TNF-alpha secretion by peripheral mononuclear cells. The groups did not differ in their basal parameters, which did not change in G1 during follow-up. In G2 the following parameters, initially higher than normal significantly decreased after 12 months: TG (2.9 +/- 0.45 to 2.6 +/- 0.3 mmol/l p < 0.005), Apo B (1.40 +/- 0.37 to 1.22 +/- 0.36 g/l, p < 0.05), c TNF-alpha (1008.1 +/- 534.9 to 726.8 +/- 458.7 pg/ml, p < 0.05). Spontaneous (c) IL-1 beta (216.7 +/- 116.2 to 150.5 +/- 107.8 pg/ml, p < 0.05), c IL-2 (124.5 +/- 43.8 to 101.6 +/- 25.8 pg/ml, p < 0.05), and s TNF-alpha (2456.4 +/- 908.3 to 1632.2 +/- 497.1 pg/ml, p < 0.005) also decreased, although already within the normal range at baseline. G2 patients experienced a steady monthly reduction of CCr whereas it rose progressively in G1 (p < 0.05), with a simultaneous increase in UProt/CCr (p < 0.05). PUFA are beneficial on the lipid and immune abnormalities secondary to CRF and may also have a useful effect on the progression of chronic renal damage.

Electrophysiological aspects of nervous conduction in uremia.

Some neurophysiological techniques have been employed in clinical nephrology to record abnormalities of nervous conduction in central and peripheral pathways. The electrical monitoring on the peripheral and central nervous systems has allowed the detection of uremic neural injury, the diagnosis of specific electrophysiological abnormalities, the evaluation of various treatments employed and the identification of those abnormalities that uremia can induce. A group of 156 subjects subdivided into four groups were examined: 100 healthy subjects (64 M, 36 F); 56 patients (21 glomerulonephritis, 14 pyelonephritis, 5 nephrolithiasis, 5 polycystic kidney, 4 nephroangiosclerosis, 7 undetermined) with chronic renal failure treated with a conventional low nitrogen diet (CLND, 0.6 g/kg b.w./d. of proteins), 8 of whom passed from CLND to a very low nitrogen diet supplemented with alpha-keto-analogues; a group of 22 of these 56 underwent a regular dialysis treatment for 12 to 15 hours/weekly for 40.5 +/- 10.2 months. Three patients of the CLND group and 13 patients underwent renal transplantation after a variable period of RDT. In the uremic patients we found different populations of motor unit potentials; a decreased MNCV was found in 35% of the CLND patients, RDT patients had slowed MNCV in 42%. The SNCV was compromised more frequently than the MNCV. An increased duration of evoked potentials was sometimes observed in CLND and RDT patients inducing us to consider this a hallmark of uremic syndrome. The alpha-keto-analogues and HD/HP treated patients showed an improvement in several features.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of subcutaneous recombinant human erythropoietin in patients on continuous ambulatory peritoneal dialysis.

The use of recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of renal anemia, but the dose regimens, the optimal frequency, and the effects on other target organs like the central nervous systems (CNS) are still under discussion. We designed a prospective, ongoing study with 10 stable continuous ambulatory peritoneal dialysis (CAPD) patients (6 males, 4 females; mean age 64.4 +/- 7.8 years), with a pretreatment hemoglobin (Hb) < 7.0 g% and requiring regular blood transfusions. Seven patients were treated with 4000 U rHuEPO once weekly (Eritrogen, Boehringer Mannheim), 2 patients received 4000 U every 5 and 8 days, and the last one 4000 U every 10 days. The target hematocrit was 33% and Hb 10.0 g%. The CNS activity was recorded as visual (VEP), brainstem (BAER), and somatosensory (SEP)-evoked potentials. The mean Hb concentration increased from 6.9 +/- 1.2 g% to 10.3 +/- 1.6 g% (p < 0.001) over 8 weeks. There were no significant changes in urea, creatinine, and potassium levels, and urine output. rHuEPO induced a decrease in latency of P100 VEP, in the four main components of BAER, and in the P27-N35 intertime of SEP. Parallel to the improvement of red cell indices, patients experienced a dramatic improvement in well-being. The subcutaneous administration of a single vial of rHuEPO is safe, convenient, and inexpensive in CAPD. The role of rHuEPO treatment in improving the electrophysiological brain function in uremic and anemic patients remains to be studied and may not necessarily be based on improved cerebral oxygenation.

Effects of uremia and dialysis on brain electrophysiology after recombinant erythropoietin treatment.

Quantitative electrophysiologic assessments are sensitive and useful indices of clinical state, and they are valuable in evaluating brain electrical activity before and after recombinant human erythropoietin (r-HuEPO) treatment. To study the hypothesis that, theoretically, anemia might be a cause of brain dysfunction in uremia, the authors assessed 18 patients (10 men and 8 women) on hemodialysis (RDT, age range, 35-58 years) before treatment (T1), and after 12 weeks (T2) and 24 weeks (T3) of r-HuEPO treatment, utilizing the following electrophysiologic tests: visual evoked potentials (VEP), brainstem auditory evoked responses (BAER), and somatosensory evoked potentials (SEP). The r-HuEPO was injected subcutaneously two times a week after RDT to produce hematocrit (Hct) levels of 30-35%. This drug induced a decrement of latency in P100 VEP (134.2 +/- 7.9 msec in T1 versus 116.5 +/- 6.9 msec in T2, p < 0.001, and versus 107.6 +/- 5.7 msec in T3, p < 0.005) and in the four main components of BAER. The most significant SEP changes were P27-N35 from peroneal nerve (p < 0.01), as an augmentation of SEP amplitude. Correction of anemia with r-HuEPO leads to a significant improvement in brain function in patients on RDT. The increased Hct level leads to enhanced brain oxygen delivery, directly improving brain metabolism. When the Hct rises, cerebral blood flow falls from high levels to normal, decreasing delivery of uremic "toxins" to the brain. The decrease in cerebral blood flow may decrease intracranial pressure and, in this way, may exert its beneficial effects by a rheologic pathway.

Retention of limulus amoebocyte lysate reactive bacterial products by polysulfone dialyzers is affected by the type of disinfectant.

To reduce the level of contamination by bacterial products, ultrafiltration systems have been introduced and validated for their capacity to block the passage of bacterial components reactive to the limulus amoebocyte lysate (LAL) test. In this study, the absorptive capacity of polysulfone membranes undergoing disinfection cycles with free chlorine and peracetic acid were evaluated at various concentrations and contact times. The results of this study implicate a relevant physicochemical derangement of the polysulfone membranes treated with sodium hypochlorite but not with peracetic acid, diluted peracetic acid (Dialox) or Amuchina. The implications for the practical use of ultrafilters are discussed.

Platelet-neutrophil interactions during hemodialysis: a proposed biocompatibility approach.

Platelet interaction with neutrophils may occur to a significant degree during hemodialysis (HD). We have recently shown that the enhanced neutrophil reactive oxygen species (ROS) production during the early phase of HD with cuprophan (CUP) is sustained by neutrophils which have bound platelets through P-selectin (CD62P). The evaluation of platelet-neutrophil interactions during dialysis offers the novel aspect of cell-cell interactions as a new parameter for studying the biocompatibility of dialyzer membranes. By the use of flow cytometry techniques, the present study was set up to analyze intradialytic platelet-neutrophil coaggregate formation and neutrophil ROS (hydrogen peroxide) production from 6 HD patients each dialysed with CUP, cellulose diacetate (CDA), polymethylmethacrylate (PMMA), and polyacrylonitrile (PAN) in a cross-over clinical trial. Platelet-neutrophil coaggregate formation (percentage of neutrophil cells positive for CD62P) and ROS production by neutrophils (total population; CD62P+ cells; CD62P- cells) were determined before HD and after 10', 20'and 40'. CD62P+ neutrophils significantly increased during HD with CUP (10', 20', 40'), PMMA (20') and CDA (20), while no change was observed with PAN. The difference between CUP and the other membranes was significant at 10', 20' and 40'; at 20', PMMA vs PAN p<0.005. ROS production by total neutrophil population significantly increased with CUP (10', 20), PMMA (20) and CDA (20'). The increase with CUP was higher at 10' when compared to CDA (p<0.020) or PAN (p<0.005), and at 20' versus the other three membranes; at 20' PMMA vs PAN p<0.005. Only neutrophils gated in neutrophil-platelet coaggregate areas (CD26P+ neutrophils) produced hydrogen peroxide. ROS production by CD62P+ neutrophils significantly increased with CUP (10', 20), PMMA (20') and CDA (20'). The increase with CUP was significantly (p<0.0002) higher than the other three membranes at 10' and 20'; at 20', PMMA vs PAN p<0.02. With each membrane, ROS production by CD62P- neutrophils showed no significant change at any time point during HD. The results of the present study indicate that interactions between platelets and neutrophils can mediate some pathophysiological abnormalities associated with hemodialysis treatment. Our data show that cellulose diacetate, a modified cellulosic membrane, exhibits a biocompatibility profile in terms of platelet-neutrophil interactions improved as compared to the parent cellulose membrane and comparable to that of some synthetic membranes. Our data also show that there is considerable variability in the biocompatibility of synthetic membranes. Though cellulosic membranes are generally considered as being less biocompatible than synthetic membranes, our results indicate that classification of membranes by biocompatibility is more complex than a simple division into cellulosic and synthetic membranes, especially with the advent of modified cellulosic membranes.

Efficacy and tolerability of recombinant human erythropoietin treatment in pre-dialysis patients: results of a multicenter study.

Chronic renal failure is characterized by a normochromic normocytic anemia, the severity of which generally increases during progression toward uremia. The purpose of the study was to evaluate the efficacy and safety of recombinant human erythropoietin (rHu-EPO) given subcutaneously (s.c.), the dose required to reach and maintain Hb levels within 10 and 11 g% and its effects, if any, on the progression of chronic renal failure. Eighty-four pre-dialysis patients (46 F, 38M, age 61.7+/-13.9 years) with Hb levels between 6 and 9 g% and serum creatinine ranging from 3 to 9 mg/dl were treated with s.c. rHu-EPO (2000 U/twice weekly). After 6 weeks, if Hb increase was below 1 g%, 1000 U of s.c. rHu-EPO were added at each administration (3000 U twice weekly). Once the Hb target was reached (10-11 g%), the rHu-EPO weekly dose was halved and administration reduced to once weekly. The patients showed a significant rise in mean Hb values (p<0.001) after 3 months. Mean Hb values were as follows: 8.00+/-0.77 g% (pretreatment), 9.35+/-1.0 (3rd month), 10.06+/-1.04 (6th month), 10.25+/-0.62 g% (12th month). The mean rHu-EPO doses were 4000 U/w (start of the study), 3592+/-1685 U/w (6th month), 2840-/+1178 U/w (12th month). Renal function was evaluated by plotting the reciprocal of serum creatinine values vs time with a two period comparison: period A (retrospective-8 mo); period B (prospective-12 mo). The residual renal function was not impaired by rHu-EPO therapy. Meanwhile, no relevant modifications were observed in mean blood pressure values. Low doses of s.c. rHu-EPO were well tolerated, safe and effective; this therapeutic approach should therefore be considered for the improvement of anemia in pre-dialysis patients. A slow and gradual correction of anemia induces an improved sense of well being and a more active of life style.

A new polymethylmethacrylate membrane for hemodialysis.

High molecular weight (MW) solutes are not removed during conventional hemodialysis (HD), and their accumulation is thought to play a role in some long-term HD complications (anemia, bone and joint pain, neuropathy, itching). The present trial was conducted to evaluate the removal capacity during in vivo HD of a new polymethylmethacrylate (PMMA) membrane (Filtryzer BK-F, 1.3 m2) compared to conventional PMMA (BK-P, 1.6 m2) and to cellulose acetate (CA, 1.3 m2). BK-F dialyzers, with a pore size of 100 A degrees and 62% porosity, are designed to remove high MW substances. Ten stable anuric RDT patients (53 +/- 13 years) were treated for one week with each membrane in a randomized sequence. Plasma concentrations of creatinine, BUN and beta 2-microglobulin (beta 2-M) were measured before (b) and after (a) HD to determine the reduction rate for these substances (%). Beta 2-M concentration after HD was corrected for changes in distribution volume. Samples of spent dialysate were collected after 3 minutes, 120 minutes and at the end of HD sessions, and appropriately treated and concentrated for HPLC analysis. The reduction rate for BUN and creatinine was similar for the 3 membranes. BK-F showed a higher beta 2-M reduction rate than BK-P (p < 0.005) or CA (p < 0.0001). HPLC analysis of dialysate showed prevalent peaks < 4 kilodaltons (kDa) throughout HD for BK-P and CA. Solutes > 10 kDa were infrequently detected. Peak profile during HD with BK-F was quite different, showing a predominant peak > 50 kDa which also included albumin. However, albumin loss significantly decreased after 120 minutes and at the end of dialysis compared with the 3-minute values, and was lower than that reported in CAPD patients. With BK-F a peak of MW > 500 kDa was also detected which previous studies indicated as a range characterized by the presence of erythropoiesis inhibitors. Use of the BK-F membrane in HD could afford satisfactory removal of high MW substances, thereby preventing or controlling some long-term HD complications such as anemia or beta 2-M amyloid formation.

Polycentric 384-month study of biofiltration (BF) with AN69s.

Polycentric 384-month study of biofiltration (BF) with AN69s. Since January 1984, 39 uremic dialyzed patients have been included in a randomized prospective study, to evaluate the clinical utility of BF. The trial lasted 9.85 months/pt (384.15 months of total observations) and patients admitted had some not well controlled clinical signs: major acidosis, intradialytic cardiovascular instability, intolerance to acetate dialysis, hypercatabolism, neuropathy, etc. We obtained some positive effects: the incidence of intradialytic hypotension decreased 26.6%; interdialytic body weight gain fell from 3.1 to 2.7 kg (p less than 0.05) and the dialytic time per week was reduced from 12.3 to 10.0 hours (p less than 0.01). At the same time dry body weight increased from 62.4 to 64.6 kg with worthwhile improvement of the acid-base status (ABS) in all patients. This controlled trial showed that BF is particularly useful for patients suffering from severe acidosis and/or cardiovascular instability.