Quantitative ultrasound of phalanges and dual-energy X-ray absorptiometry of forearm and hand in patients with end-stage renal failure treated with dialysis.

The aim of the study was to evaluate the usefulness of quantitative ultrasound (QUS) measurement of the proximal phalanges of the hand in patients with end-stage renal failure (ESRF) treated with dialysis, and to compare results of this method with those from dual-energy X-ray absorptiometry (DXA) of hands and forearms (shaft and ultradistal site). Forty-one men aged 48.1 +/- 11.7 years and 31 women aged 43.1 +/- 12.3 years were examined. Mean QUS values of the hands in men and women with ESRF were significantly lower than the values of the healthy control group. There was a significant positive correlation between QUS and DXA of fingers, hands and also forearms, more pronounced in the shaft than in the ultradistal site. There was no significant difference in the measurements of extremities with or without a fistula. We conclude that QUS measurements are decreased in patients with ESRF treated with dialysis, and they correlate with DXA results. The simplicity of QUS makes it a valuable method in everyday practice. The clinical significance of the QUS results in these patients with ESRF treated with dialysis needs further investigation.

[Long-term treatment with large doses of alphacalicidol in secondary hyperparathyroidism of patients dialyzed for end stage renal failure]. / Dlugotrwale stosowanie duzych dawek alfakalcidolu w nadczynnosci przytarczyc u chorych dializowanych z powodu schylkowej niewydolnosci nerek.

The purpose of the study was to evaluate the effectiveness of the long-term oral pulse therapy with high doses of alphacalcidol (1 alpha (OH)D3) in severe uremic hyperparathyroidism. 43 hemodialysis patients with at least 5-fold 1-84 PTH serum elevation were given thrice a week oral (1 alpha (OH) D3) in doses up to 5 micrograms, according to serum calcium levels (monitored weekly). The drug was given in the evenings (Group A; 18 pts) or during hemodialysis sessions (Group B; 25 pts). The dialysate calcium was reduce to 1.40-1.45 mmol/l and CaCO3 was used as a main phosphate binder in doses up to 6 g/day; 13 pts received additionally small doses of Al (OH)3 (up to 3 g/day). After one month the PTH levels decreased by 67 +/- 7.7% (p < 0.001), while serum total calcium increased by 0.27 < or = 0.05 mmol/l. The parathyroid activity suppression progressed to 81 +/- 6.9% serum PTH reduction after 4 months and 74 +/- 6.1% fall after 8 months. Only 3 pts occurred to be non-responders; in 19 pts PTH levels normalized. A decrease of serum hydroxyproline and alkaline phosphatase with its bone isoenzyme activity was also observed with a direct correlation between those changes and parathyroid suppression. (1 alpha (OH) D3) dose at first month of therapy was 3.4 +/- 0.15 micrograms, but it was successively reduced because of hypercalcemia to a final dose of 2.2 +/- 0.22 micrograms. The frequency of hyperkalcemia was 7.6%; no difference between Group A and group B was noted. We conclude that oral (1 alpha (OH)D3) pulse therapy is very effective in the long-term parathyroid activity suppression in hemodialysis patients with severe hyperparathyroidism. To avoid dangerous hypercalcemia and relative hypoparathyroidism serum PTH and calcium levels should be carefully monitored.

[Antithrombotic activity of low molecular weight heparin (enoxaparin) during hemodialysis in patients with terminal kidney failure]. / Przeciwzakrzepowe dzialanie niskoczasteczkowej heparyny (enoksaparyny) w czasie hemodializy u pacjentów ze schylkowa niewydolnoscia nerek.

The aim of the study was to evaluate the efficacy of low molecular weight heparine (enoxaparin) in comparison to heparin during haemodialysis (HD) in prevention of blood clotting chestry extracorporeal circulation. Enoxaparin (Clexan, Rhone-Poulenc Rorer, in syringes, 20 mg) was evaluated in 42 patients with end stage renal failure treated with HD. In the first part of study heparine and in the second part enoxaparin given into arterial lines were evaluated during 6 following HD with the same type of dialysator. Clotting of extracorporeal circulation and bleeding time from the needle site after HD were evaluated. Activated partial thromboplastin time (APTT) before, after 1 hour of HD and after HD during heparine and enoxaparin were measured. There was advantage of enoxaparin in 23 patients when compared to heparine. It was depended on the reduction of number of injections of enoxaparin when compared to heparine (22 patients have received heparine in 2 or more doses when only 5 patients have received enoxaparin in 2 doses) on the reduction of clotting events in extracorporeal circulation (16 events during heparine treatment -6.3% of all HD and 5 events during enoxaparin treatment -2.0% of all HD), and on the shortening of the bleeding time from the needle site after HD (5.9 +/- 3.4 min. during heparin and 4.5 +/- 1.6 min. during enoxaparin treatment; p < 0.02). Increase of APTT after 1 hour of HD when compared to the value from before HD was significantly lower during enoxaparin than heparine therapy (1.73 +/- 0.4 and 2.55 +/- 0.91 respectively; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Test with calcitonin as an index of parathyroid function in chronic renal failure]. / Test z kalcytonina jako wskaznik czynnosci przytarczyc w przewleklej niewydolnosci nerek.

The aim of this study was to evaluate the clinical usefulness of the calcitonin test in predicting the hyperparathyroid bone disease severity in uremia. 200 IU of synthetic salmon calcitonin was given intranasally to 77 hemodialysed patients with end-stage renal failure. Before the test, serum calcium, PTH and serum alkaline phosphatase had been sampled; serum calcium was determined also in 2 to 4 hours after. The subjects were divided into 3 groups according to their serum PTH levels. Group I consisted of 24 patients with at least 10-fold serum PTH elevation, group II of 34 patients with intermediate values, and group III of 19 patients with serum PTH within normal range. In the group I the mean serum calcium fall was 0.32 +/- 0.16 mmol/l (1.28 +/- 0.64 mg/dl) (p < 0.001) and 0.27 +/- 0.15 mmol/l (1.08 +/- 0.60 mg/dl) (p < 0.001), after 2 to 4 hours respectively. In the group II serum calcium decreased by 0.16 +/- 0.12 mmol/l (0.64 +/- 0.48 mg/dl) after 2 hours and by 0.14 +/- 0.09 mmol/l (0.56 +/- 0.36 mg/dl) after 4 hours; the differences were statistically insignificant. In the group III no reduction in serum calcium was observed. In the whole 77 patients population significant linear correlations between the hypocalcemic response and iPTH as well as serum alkaline phosphatase were found. Our results confirm that the calcitonin-induced hypocalcemia a test can be, in addition to serum alkaline phosphatase and PTH evaluation, a simple and useful index of advanced hyperparathyroid bone disease in hemodialysed patients with chronic renal failure.

[Oral pulsatile therapy with active vitamin D3 metabolites--an efficient method of parathyroid hormone synthesis suppression in uremic patients with severe hyperparathyroidism. A pilot study]. / Leczenie pulsacyjne aktywnymi metabolitami witaminy D3 w postaci doustnej--skuteczna metoda hamowania syntezy parathormonu u chorych z zaawansowana nadczynnoscia przytarczyc w przebiegu schylkowej mocznicy. Doniesienie wstepne.

Standard therapy with orally administered active metabolites of vitamin D3 often does not satisfactorily control the biochemical manifestations of secondary hyperparathyroidism in uremic patients. This may be due to inadequate serum concentrations of 1,25 (OH)2D3 achieved during the treatment. Eighteen patients on chronic hemodialysis (HD) with severe hyperparathyroidism were given high doses of calcitriol (1,25 (OH)2D3) or alphacalcidol (1 alpha-OH-D3) orally, in ten evenings preceding each HD session. The effect of the treatment on circulating parathyroid hormone (PTH), serum hydroxyproline, serum alkaline phosphatase and bone isoenzyme was examined in a pilot study during 5 weeks. Irrespective the preparation given the treatment caused 71.7 +/- 22.2% reduction of intact serum PTH concentration with only moderate rise of serum calcium. A decrease of serum hydroxyproline and activity of alkaline phosphatase with its bone fraction, the direct indexes of bone turnover reduction, was also observed. With ongoing calcium carbonate therapy (3-6 g/day) 5 episodes of mild, asymptomatic hypercalcemia was observed for the 108 times of the total number of examinations; in those cases the dose of alphacalcidol was reduced. Our observations indicate that intermittent administration of 1,25 (OH)2D3 as well as 1 alpha-OH-D3 in high oral doses effectively suppress PTH synthesis in uremic hyperparathyroidism already in a couple of weeks. The effect is similar to that obtained with intravenous administration of the vitamin D3 active metabolites.

Intradialytic erythrocyte volume changes.

Haemodialysis (HD) should affect the erythrocytes, which constitute more than 99% of blood cells. The aim of this study was to reinvestigate the intradialytic changes in erythrocyte water content (MCV). MCV was measured during 81 HD (47 uncomplicated, 34 with hypotension), and 16 isolated ultrafiltrations (UF) performed in stable, haemodialysed adults (12 males and 8 females). The MCV following uncomplicated HD (n = 32) did not differ from the predialysis value. Significant MCV increase accompanied the HD initiation (4.9 +/- 9.0 fl, P less than 0.001), UF (2.99 +/- 1.49 fl, P less than 0.001) and hypotension (1.8 +/- 3.1 fl, P less than 0.01). This was independent of sodium and potassium within the cells and plasma. Erythrocyte oedema occurred in situations known to accompany both bioincompatibility reactions and blood volume decrease. Intradialytic MCV increase may reflect a response to these events, possibly hormonal, and needs further investigation.