Experience with erythropoietin in the treatment of anemia in predialysis patients is limited. A practical treatment regimen which minimized the number of outpatient visits was investigated. The Austrian multicenter study included 123 patients. At baseline, the treatment protocol mandated once weekly the administration of 10,000 U recombinant human erythropoietin (r-HuEPO) subcutaneously. The follow-up period was 3 months, and dose adjustments were made at monthly intervals. At baseline, the mean values for creatinine were 6.2 +/- 0.2 mg/dl, and for hemoglobin (Hb) 9.0 g/dl. During 3 months of therapy, mean Hb increased to 10.8 g/dl and creatinine to 6.6 mg/dl. The initial r-HuEPO weekly dose was 10,000 U. The mean dose after 3 months was 9,000 +/- 4,000 U. There was no significant alteration of the slope of the reciprocal creatinine curve or of blood pressure values. No side effects occurred during the 3-month treatment period. In conclusion, the results of this multicenter trial demonstrate that using a simple once-weekly subcutaneous treatment regime, r-HuEPO can be administered safely and effectively in predialysis patients.

In order to evaluate the potential role of parathyroid hormone on glucose metabolism in patients on chronic hemodialysis hyperglycemic clamp studies were performed in 7 parathyroidectomized and 11 nonparathyroidectomized patients on chronic hemodialysis and in healthy controls. There were no significant differences in the peripheral glucose uptake of the 3 groups. The beta cell response to hyperglycemia during the early phase as well as during the steady state was almost identical in controls and in nonparathyroidectomized uremics, whereas in the parathyroidectomized group a markedly enhanced insulin secretion was found. Calculated tissue sensitivity to insulin therefore was equal in controls and in nonparathyroidectomized uremics, whereas patients after parathyroidectomy had peripheral insulin resistance. Our results demonstrate that patients on chronic hemodialysis apparently have normal peripheral glucose uptake. The subgroup of patients who have undergone parathyroidectomy, however, show an enhanced insulin response to hyperglycemia suggesting peripheral insulin resistance. We conclude that longstanding and severe secondary hyperparathyroidism—the usual cause for parathyroidectomy in these patients—results in irreversible insulin resistance with a compensatory increase of insulin secretion.

A 13-year-old girl on chronic hemodialysis with renal failure thought to be due to polycystic renal disease, underwent bilateral nephrectomy as a pretransplant procedure. Microscopic examination of the grossly enlarged nodular kidneys revealed a bilateral diffuse tumor infiltration which was not Wilms tumor. Eventually the diagnosis of bilateral nephroblastomatosis was established. This is apparently unique at this age without coexistent Wilms tumor. Four months after nephrectomy metastases-exceedingly rare in nephroblastomatosis-developed. Local radiation and cytostatic therapy with Actinomycin D, Vincristine and Adriamycin were initiated. All drugs were administered 24 h before the beginning of hemodialysis; only Actinomycin D was reduced to 70% of the usual dosage. Therapeutic side effects remained within the usual limits. Renal transplantation was performed 34 months after metastases had developed, i.e. 10 months after cessation of cytostatic therapy.

1α-hydroxycholecalciferol was tried as a therapy for renal phosphate wasting in kidney allograft recipients with normal parathyroid gland activity. During a 3-week period of treatment we observed a significant rise in renal phosphate threshold concentrations and plasma phosphate levels paralleled by a significant decrease in serum immunoreactive parathyroid hormone levels and a significant increase in intestinal calcium absorption. It is suggested that 1α-hydroxycholecalciferol acts on renal phosphate handling in a dual fashion: one is by suppression of parathyroid hormone and the other by restoration of 1,25-dihydroxycholecalciferol levels to an appropriate level.

1 alpha-hydroxycholecalciferol was tried as a therapy for renal phosphate wasting in kidney allograft recipients with normal parathyroid gland activity. During a 3-week period of treatment we observed a significant rise in renal phosphate threshold concentrations and plasma phosphate levels paralleled by a significant decrease in serum immunoreactive parathyroid hormone levels and a significant increase in intestinal calcium absorption. It is suggested that 1 alpha-hydroxycholecalciferol acts on renal phosphate handling in a dual fashion: one is by suppression of parathyroid hormone and the other by restoration of 1,25-dihydroxycholecalciferol levels to an appropriate level.

The therapy of secondary hyperparathyroidism in chronic renal disease has been improved by the availability of active 1-alpha-hydroxylated vitamin D derivatives. However, in cases with progressive secondary hyperparathyroidism which have not been brought under control conservatively, surgical intervention is still required. Total parathyroidectomy with autologous transplantation of parathyroid tissue in the forearm has recently been recommended as the optimum surgical approach to secondary hyperparathyroidism. Recent literature is reviewed and personal clinical experience is reported in this paper, followed by a presentation and discussion of the pathophysiology of hyperparathyroidism in chronic renal failure, various means of conservative treatment, indications for parathyroidectomy, surgical aspects and technique of cryopreservation, as well as a standardized therapeutic regimen for pre- and postoperative treatment with calcium and 1-alpha-hydroxylated vitamin D analogues.

Employment and capacity of work were assessed in 69 kidney transplant recipients 6 to 144 months after transplantation. The results were correlated with patients age, transplant function and extrarenal complications, respectively. Fifty-one patients were fit for work. In this group 36 patients were fully employed, seven partially employed, one patient out of work and seven received unemployment benefit. Sixteen patients were partially or totally disabled. The age of the patients fit for work was 24 to 35 years and all patients receiving unemployment pay were older than 40 years. Employed transplant recipients formed the group with the best kidney function parameters, patients fit for work but unemployed showed only a slightly reduced transplant function. The results indicate that transplant function is the main precondition for capacity of work and employment. But the resumption of work also depends on the patients age and on the possibility to choose between employment and unemployment benefit.

Aluminum kinetics were studied in 24 patients on chronic hemodialysis. All patients had elevated predialytic serum concentrations of aluminum (mean, 3.44 mumoles/liter), which correlated significantly with the ingestion of aluminum hydroxide (P less than 0.01). Simultaneous measurements of aluminum in plasma and ultrafiltrate revealed an ultrafiltrability of about 20% of total plasma aluminum, thus suggesting that 80% of aluminum is protein bound. When a dialysate with a very low aluminum content (varying from 0.1 to 0.3 mumoles/liter) was used, mean values across the dialyzer were 3.20 and 2.67 mumoles/liter, respectively, showing a significant decrease of plasma aluminum during dialyzer passage (P less than 0.0001). It could be shown that dialysance of aluminum depends on the concentration gradient between the free diffusible plasma aluminum and the dialysate aluminum concentration. After 6 hours of dialysis, plasma aluminum concentrations were significantly lower than were predialysis values (P less than 0.0001). We conclude that a negative aluminum balance during hemodialysis can be assumed as long as the aluminum concentration of free diffusible plasma aluminum lies above the aluminum concentration of the dialysate.

Letters and Corrections1 January 1980Serum Aluminum and Continuous Ambulatory Peritoneal DialysisA. WOLF, M.D., H. GRAF, M.D., W. F. PINGGERA, M.D., H. K. STUMMVOLL, M.D., V. MEISINGER, M.D.A. WOLF, M.D.Search for more papers by this author, H. GRAF, M.D.Search for more papers by this author, W. F. PINGGERA, M.D.Search for more papers by this author, H. K. STUMMVOLL, M.D.Search for more papers by this author, V. MEISINGER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-92-1-130_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Accumulation of aluminum in the blood and tissues of patients maintained on chronic hemodialysis may cause "dialysis dementia," frequently leading to death (1). The aluminum content of the dialysis bath fluid or the aluminum-hydroxide (Al [OH]3) gels taken by dialysis patients are responsible for the hyperalbuminemia and the high aluminum body stores (2, 3). In the past 4 years continuous ambulatory peritoneal dialysis has been established in the treatment of patients with end-stage renal disease. To our knowledge no information exists on aluminum kinetics in patients thus treated.We have measured serum aluminum and aluminum clearances in...References1. ALFREYLE GENDREKAEHNY AGW. The dialysis encephalopathy syndrome. N Engl J Med. 1976;294:184-8. CrossrefMedlineGoogle Scholar2. KAEHNYHEGGALFREY WAA. Gastrointestinal absorption of aluminum-containing antacids. N Engl J Med. 1977;296:1389-90. CrossrefMedlineGoogle Scholar3. PARKINSONBECKETTWARD IAM. Aluminum removal from water supplies. Proc Eur Dial Transplant Assoc. 1978;15:586. MedlineGoogle Scholar4. BOENHAAGSMA-SCHOUTENBIRNIE SWR. Long-term peritoneal dialysis and a peritoneal dialysis index. Dial Transplantation. 1978;7:377. Google Scholar5. MONCRIEFNOLPHRUBINPOPOVICH JKJR. Additional experience with continuous ambulatory peritoneal dialysis. Trans Am Soc Artif Intern Organs. 1978;24:476. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: A. WOLF, M.D.; H. GRAF, M.D.; W. F. PINGGERA, M.D.; H. K. STUMMVOLL, M.D.; V. MEISINGER, M.D.Affiliations: University of Vienna Vienna, Austria PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAluminum: Its Measurement and MetabolismPlasma Aluminum Levels in Pediatric Dialysis Patients: Comparison of Hemodialysis and Continuous Ambulatory Peritoneal DialysisAluminum intoxicationSerum Concentration and Peritoneal Transfer of Aluminum during Treatment by CAPDBone Histomorphometry during Long-Term CAPDAluminum Kinetics During Renal Replacement TherapiesDeferoxamine and Aluminum RemovalSerum and dialysate aluminium concentration of dialysed patients with chronic renal failure determined by atomic absorption spectrometry with a graphite furnaceTrace Elements in Human Body Fluids and TissuesSerum concentration and peritoneal transfer of aluminum during treatment by continuous ambulatory peritoneal dialysisSerum Aluminum Levels and Peritoneal DialysisAluminum Hyoroxioe-Inouceo Osteomalacia, Encephalopathy ANO Hyperaluminemia in CAPO. Treatment with OesferrioxamineThe Health Effects of Aluminum Compounds in MammalsAluminium hydroxide versus sucralfate as a phosphate binder in uraemia.Dialysis, Hemofiltration, and HemoperfusionAluminumHistological renal osteodystrophy, and 25 hydroxycholecalciferol and aluminum levels in patients on continuous ambulatory peritoneal dialysisAluminum Associated Bone Disease: Clinico-Pathologic CorrelationThe aluminium content of human serum determined by atomic absorption spectroscopy with a graphite furnaceRenal Osteodystrophy in Continuous Ambulatory Peritoneal Dialysis 1 January 1980Volume 92, Issue 1Page: 130-131KeywordsBloodBody fluidsDementiaMedical dialysisPatientsPeritoneal dialysisRenal failure ePublished: 1 December 2008 Issue Published: 1 January 1980 PDF downloadLoading ...

Aluminium kinetics in patients with endstage renal failure and chronic intermittent haemodialysis have been studied. All patients revealed elevated predialytic serum aluminum levels. Because of a significant correlation between daily intake of aluminiumhydroxyd and serum aluminium levels it is concluded that the intestinal aluminium absorption plays an etiological role in the development of hyperaluminaemia. Plasma aluminium levels at the end of a regular dialysis procedure are significant lower compared to predialytic values. Similarly a significant decrease of aluminium concentration was observed in the plasma after passage through the dialyzer. This is due to the fact that the aluminium content of the dialysate used in our unit (0.1-0.3 mumol/l) is lower than the ultrafiltrable fraction of the plasma aluminium measured in vivo. Therefore a negative aluminium-balance during haemodialysis has to be assumed in our patients. Extreme aluminium-accummulation seems to be avoided and we therefore never experienced aluminium intoxication and dialysis dementia in our center. To assess a negative aluminium balance during haemodialysis, because of high protein binding of aluminium, a dialysate with an extreme low aluminium content has to be recommended.