[The history of home hemodialysis and its likely revival]. / Storia dell'emodialisi domiciliare e della sua probabile rinascita.

The home extracorporeal hemodialysis, which aroused a great interest in the past, has not kept its promises due to the complexity and expectations for family involvement in treatment management. In the United States NxStage One portable system was proposed and designed for home use. In this work we describe, starting from the history of home hemodialysis, the method with NxStage system by comparing it with the conventional HD in 5 patients. The dialysis efficiency was similar between the two treatments, even if home hemodialysis showed a reduction in serum urea, creatinine and phosphorus. At the same time phosphate binders use decreased with an increase in serum calcium while hemoglobin increased reducing doses of erythropoietin. The method was successful in the training of the patients and their partners during hospital training and at home. Patients have shown great enthusiasm at the beginning and during the therapy, which is developed around the users personal needs, being able to decide at its own times during 24 hours according to personal needs, in addition to faster recovery after the dialysis. This method certainly improved the patients' wellness and increased their autonomy.

[Is the Sodium Thiosulfate Therapy useful for vascular calcification in dialysis Pts?]. / È utile la terapia con Tiosolfato di sodio nel trattamento delle calcificazioni vascolari nei pazienti emodializzati?

Vascular calcifications in uremic patients are associated with a significant increase in cardiovascular morbidity and mortality. Sodium thiosulfate (STS) has been shown to reduce the progression of uremic calcifications in haemodialysis patients. In our study we evaluated the effects on evolution of aortic calcifications of the drug infused during the last 2 hours of dialysis sessions at a dose of 10 grams. 18 hemodialysis patients were evaluated as regards the calcifications index according to Kauppila, calcium-phosphorus metabolism, PTH, and oral chelation therapy. The side effects of STS and the symptomatic effects reported by the patient, were also evaluated using a questionnaire delivered to patients. After 6 months of therapy, a modest reduction of the Kauppila's index (from 16.4 5.5 to 15.1 4.6) was detected. No significant change was detected in blood tests. Even chelation therapy did not suffer variations. It was also showed a clear and statistically significant improvement in signs and symptoms of leg pain, a moderate improvement of' power reserve and a reduction of muscle fatigue. The results of our study, although preliminary and on a small number of patients, confirm a positive effect of STS on vasculopatic symptoms and progression of vascular calcifications.