Regular Dialysis Treatment Research Articles

Trace Elements in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients

Alterations in blood and tissue concentrations of trace elements in patients with chronic renal failure have been extensively investigated. Selenium, zinc and copper are elements which play an important role in biological systems as components of proteins, enzymes and antioxidants. The concentrations of selenium, zinc and copper were determined in the plasma, erythrocytes and whole blood of patients on regular hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) treatment using the method of inductively coupled plasma mass spectrometry (ICP-MS). Analysis of isotopes ⁷⁷Se, ⁶⁶Zn and ⁶⁵Cu was performed. Methodology presents the major limitation to valid studies on trace element levels in biological materials. One of the widely used contemporary techniques is ICP-MS. It is the most sensitive one and has a high dynamic range. The selenium concentration in the studied compartments (plasma 46.1 ± 3.0 vs. 78.0 ± 3.4 μg/l, p < 0.001; erythrocytes 90.4 ± 6.5 vs. 134.2 ± 7.6 μg/l, p < 0.01; whole blood 67.3 ± 3.1 vs. 106.4 ± 3.4 μg/l, p < 0.001) was significantly lower in HD patients compared to healthy controls. The same result was observed in plasma (63.2 ± 5.8 vs. 78.0 ± 3.4 μg/l, p < 0.05) and whole blood (82.7 ± 7.4 vs. 106.4 ± 3.4 μg/l, p < 0.01) from CAPD patients, but the selenium level of erythrocytes in CAPD patients was the same as in the control group (126.0 ± 8.8 vs. 134.2 ± 7.6 μg/l). The cooper content of erythrocytes was lower in HD patients than in controls (0.55 ± 0.02 vs. 0.66 ± 0.01 mg/l, p < 0.01) and CAPD groups (0.55 ± 0.02 vs. 0.68 ± 0.02 mg/l, p < 0.001). There were no differences in copper content in plasma (HD 1.02 ± 0.06; CAPD 1.11 ± 0.09; controls 1.02 ± 0.05 mg/l) and whole blood (HD 0.87 ± 0.04; CAPD 0.90 ± 0.05; controls 0.85 ± 0.02 mg/l) in HD and CAPD patients and healthy controls. The zinc concentration was increased in the whole blood of CAPD patients (6.68 ± 0.36 vs. 5.52 ± 0.11 mg/l, p < 0.001) and erythrocytes of HD (12.30 ± 0.23 vs. 10.11 ± 0.42 mg/l, p < 0.001), and CAPD groups (13.71 ± 0.56 vs. 10.11 ± 0.42 mg/l, p < 0.001) compared to controls. However, the plasma zinc concentration was lower in HD patients compared to blood donors (0.69 ± 0.03 vs. 0.92 ± 0.03 mg/l, p < 0.001) and CAPD patients (0.69 ± 0.03 vs. 0.95 ± 0.04 mg/l, p < 0.001). We did not find a significant increase in trace elements in whole blood after HD. These results suggest differences between plasma, erythrocytes and whole blood concentrations of the studied trace elements. The levels of trace elements are altered by HD and CAPD. A modern precise method with high accuracy, ICP-MS, which was used in our study, eliminated analytical errors and possible interferences.

Stimulation of Hepatocyte Growth Factor in Human Acute Renal Failure

Hepatocyte growth factor (HGF) is a potent mitogen for tubular cells. Experimental injury to the kidney is associated with HGF release both locally and by distant organs stimulated by circulating ‘injurins’. In this study, the serum HGF concentration was measured in patients with acute renal failure (ARF). Normal subjects and chronic renal failure patients either not on dialysis or on regular dialysis treatment served as controls. Human mesangial cells were incubated with sera from ARF patients and controls. The serum HGF concentration was strikingly increased in ARF patients (478 ± 68 ng/dl) and was normal in chronic renal failure patients not on dialysis (20 ± 3 ng/dl) and in those on regular dialysis treatment (25 ± 3 ng/dl). Serum of ARF patients strongly stimulated HGF release from mesangial cells (1,384 ± 55 ng/ml) in comparison with normal serum (67 ± 10 ng/ml). These results indicate that in ARF HGF participates in tubular repair both as an endocrine factor, released in the circulation, and as a paracrine substance, diffusing to the tubules from the mesangium.

Serum and urine fluoride concentration: Relationships to age, sex and renal function in a non-fluoridated population

Serum and urine fluoride levels were determined in 250 healthy subjects (15–90 years, 122 men and 128 women) residing in Catalonia, Spain, and in 150 patients (20–81 years, 84 men and 66 women) with chronic renal failure undergoing regular dialysis treatment, living in the same geographical area, to determine normal range and to investigate its relationships to age, sex and renal function. Serum and urine fluoride were determined by a fluoride ion specific electrode system. Mean (±S.D.) serum fluoride concentration was 17.5±9.5 μg/l, ranging from 1 to 47 μg/l, in the control group and 58±31 μg/l, ranging from 28 to 185 μg/l, in renal patients. Urine fluoride concentration in the healthy group was 671±373 μg/24 h, ranging from 156 to 1900 μg/24 h. Fluoride status in the patient group was significantly greater than the control group. There was significant correlation between serum fluoride and age. No sex related difference was found.

Hemodialysis stimulates hepatocyte growth factor release

Studies were performed in 26 patients on regular dialysis treatment with cuprophane (CU), polymethylmetacrilate (PMMA) or cuprammonium (CAM) dialyzers. Controls were six patients with chronic renal failure but not on regular dialysis treatment (CRF) and six healthy subjects (N). Blood was collected at the start (T0), and at 15 (T15) and 240 (T240) minutes of dialysis to measure the serum hepatocyte growth factor (HGF) concentration and to study HGF production by peripheral blood mononuclear cells (PBMC) in vitro. The form of HGF (that is, inactive/monomeric, active/dimeric) present in the serum was analyzed by immunoblotting. In addition, the ability of serum to stimulate proliferation of tubular cells (HK-2) and HGF release by PBMC and fibroblasts (MRC-5) was investigated. At T0, serum HGF levels were identical to that of the controls. In patients treated with CU, serum HGF rose from 0.24 ng/ml at T0 to 7.44 ng/ml at T15, and remained high at T240. PBMC collected at T15 and T240 released significantly more HGF in vitro than those collected at T0. Serum at T15 stimulated proliferation of HK-2 cells and the release of HGF by PBMC and MRC-5 cells. The PMMA and CAM dialyzers had similar effects as the CU. These results indicate that dialysis induces a striking rise in serum HGF and a prompt circulation of factor(s) stimulating HGF release. Dialysis-activated PBMC release HGF.

Is tear calcium an indicator of ocular calcification in patients with chronic renal failure?

In patients with chronic renal failure (CRF) on regular dialysis treatment, limboconjunctival degeneration and calcifications are common. The mechanisms of ectopic conjunctival and corneal calcification remain largely speculative. The aim of the present work was to study tear calcium levels in patients with chronic renal failure, which could alter calcium excretion patterns, and to examine whether the calcium level in tear fluid is of more diagnostic importance than static calcium levels in blood. Tear calcium levels were measured in 25 patients with chronic renal failure, compared with 14 normal subjects. Conjunctival and corneal calcium deposits were graded by the Porter and Crombie classification. While 11 of the 25 patients had no clinically apparent calcium deposits, six had Grade 1 or 2, and eight had Grade 3 and over limboconjunctival calcification. Mean tear calcium levels were 1.436 +/- 0.165 mg/dl in the patients and 1.307 +/- 0.155 mg/dl in the normal group. The difference was not significant (P = 0.572). No correlation was found between the grade of the calcium deposits and tear calcium levels. Tear calcium level has no diagnostic importance for the development of ocular calcification in chronic renal failure.

Impact of profile haemodialysis on intra-/extracellular fluid shifts and the release of vasoactive hormones in elderly patients on regular dialysis treatment.

In 15 patients with end-stage renal failure and proven coronary heart disease, profile haemodialysis with decreasing ultrafiltration rate and hyperionic, decreasing dialysate solute concentration was compared with conventional, extracorporeal bicarbonate haemodialysis (Na+D = 138 mmol/l). Body fluid distribution and the release of vasoactive hormones (plasma renin activity, aldosterone, norepinephrine, epinephrine, and atrial natriuretic peptide) were investigated. Haemodialysis with constant ultrafiltration rate and constant dialysate composition (A) was followed by two dialysis profiles: decreasing ultrafiltration rate (B) and additional hyperionic, decreasing dialysate sodium concentration (C). In all 15 patients, the dialysis procedures (A) - (C) were used for 2 weeks each with six sessions, the last being taken for investigation. Body fluid distribution was calculated. In patients with serum sodium above 136 mmol/l, the conventional dialysis (A) as well as the Uf profile (B) showed a net fluid shift from extracellular volume (ECV) to intracellular volume (ICV). Using the profile with hyperionic, decreasing Na+D (C), the reverse fluid shift with decreasing ICV was achieved not only in those with serum Na+ <136 mmol/l, but also in those with serum Na+ > or = 136 mmol/l. The release of vasoactive hormones decreased already at profile haemodialysis (B) compared with (A) and was further reduced in (C). These results would suggest, profile dialyses B and C to have less impact on the cardiovascular system in elderly patients assuming higher patient comfort compared with the standard dialysis procedure. A higher benefit was obtained in C compared with B, presumably due to the additional prevention of the ICV shift and plasma volume depletion in patients with initial serum sodium > or = 136 mmol/l using transiently hyperionic Na+D. These results show that in elderly patients, hyperionic profile haemodialysis (Na+D > Na+S) had less impact on cardiovascular regulation than conventional bicarbonate dialysis.

The Determination of Plasma Transferrin Receptor as Good Index of Erythropoietic Activity in Renal Anemia and after Renal Transplantation

Both the plasma determinations of erythropoietic (EPO) and transferrin receptor (TfR) would provide a good characterization of anemia especially when mixed erythron disorders underlie, such as in renal failure. Immunologic assays of EPO and TfR, as well as standard hematologic determinations (hematocrit, reticulocyte count, serum iron, transferrin, ferritin) were performed in patients with chronic renal failure (CRF), in regular dialysis treatment (RDT) and in transplanted (TX) patients. In nonanemic TX patients both EPO and TfR ranged normally, whereas in anemic TX ones (Hct < 40%) both values were increased suggesting the physiologic response both of the kidney and of the erythron to decreased red cell mass. In transitory posttransplant erythrocytosis the increased values of TfR, with normal EPO values, would hypothesize a defective feedback to EPO release. Both EPO and TfR values were found increased in TX patients with adult polycystic kidney disease with persistent erythrocytosis (Hct > 50%), thus confirming previous observations. In CRF and RDT patients, all anemic, both EPO and TfR were normal, even though significantly low with respect to the degree of anemia. In RDT seriously anemic patients, the administration of recombinant human EPO induced different patterns of bone marrow response. We conclude that the determination of TfR would provide further information on renal anemia since the receptor increase mostly preceded the rise of Hct, evidencing those patients who will not have an effective bone marrow response to the therapy.

わが国の慢性透析療法の現況（１９９４年１２月３１日現在）

1994年末の日本透析医学会の統計調査は2,759施設を対象に実施され, 2,752施設 (99.75%) から回答が回収された. 1994年末のわが国の慢性透析患者数は143,709人であり, 昨年末に比べて9,411人 (7.0%) の増加であった. 1993年末から1994年末までの1年間の粗死亡率は9.5%と前年に続いて高い値を示した. 透析導入症例の平均年齢は60.43±14.27歳と一層の高齢化が認められた. また, 透析導入症例の原疾患の割会は慢性糸球体腎炎が40.5%と昨年よりもさらに減少し, 糖尿病性腎症は30.7%とさらに増加した.生命予後解析では, 体重減少率6%未満, Kt/V 1.6以上, 1回透析時間は5時間以上, 非糖尿病症例ではprotein catabolic rate (PCR) 0.9g/kg/day以上, 糖尿病症傍ではPCR 0.7g/kg/day以上, %クレアチニン産生速度 (クレアチニン・インデックス) はできるだけ大きい値, 血清アルブミン濃度は4.0g/dl以上, および透析前血清リン濃度は4.0mg/dl以上5.0mg/dl未満が最も死亡のリスクが低い群であることが示された.

Are granulocyte inhibitory proteins contributing to enhanced susceptibility to infections in uraemia?

Infectious complications are still a major cause of morbidity and mortality in patients undergoing regular dialysis treatment. This increased morbidity and mortality of patients with uraemia has been attributed to the dysfunction of polymorphonuclear leukocytes (PMNLs). Uraemia contributes to impaired PMNL function by means of disarrangements in cellular biochemistry and biology. Reduced chemotaxis, adherence, oxidative activity, and glucose consumption in response to phagocytic challenge have been reported. Several compounds present in uraemic serum have been isolated and characterized to inhibit the biological activity of PMNLs. A first granulocyte inhibitory protein (GIP I) responsible for the PMNL dysfunction in uraemia has been isolated and characterized. The polypeptide, with a molecular weight of 28 000 Da, inhibits the uptake of deoxyglucose, chemotaxis, oxidative metabolism, and intracellular bacterial killing by PMNLs. A second granulocyte inhibitory protein (GIP II), with a molecular weight of 9500 Da, has been isolated from plasma ultrafiltrates obtained from haemodialysis patients. It interferes with similar functions of PMNLs. GIP I displays homology with light chain protein and GIP II with beta 2-microglobulin, respectively. Both proteins were also isolated from peritoneal dialysis effluents. Isolated kappa and lambda light chain monomers and dimers from haemodialysis and peritoneal dialysis patients also inhibit several PMNL functions. Recently, a PMNL degranulation inhibiting protein (DIP) was purified from plasma ultrafiltrates obtained from patients undergoing regular haemodialysis therapy. DIP shows homology with angiogenin and inhibits spontaneous as well as stimulated PMNL degranulation. These proteins may explain at least in part the enhanced susceptibility to infections in haemodialysis and peritoneal dialysis patients.

Hearing loss in short- and long-term haemodialysed patients

Hearing loss has been described in patients with chronic renal failure on regular dialysis treatment (RDT) with very different frequency, ranging from 20 to 75%; RDT does not seem to worsen hearing function for at least the first 5 years of treatment; no studies are available on patients on RDT for more than 10 years. We performed an audiometric evaluation in 91 patients on RDT for various periods: group I (34 patients), < 5 years; group II (32 patients), 5-10 years; group III (25 patients), > 10 years; patients with histories of chronic otitis, ototoxic drug treatment, and chronic auditory trauma were excluded; the possible correlations with some biochemical parameters (urea, creatinine, PTH) were also looked for. Hearing loss was present in 77% of patients and 69.2% of ears; the percentage of patients with hypoacusia was higher in group III (84%) than in group I (76.3%) and II (71.7%), but the differences were not statistically significant. Hypoacusia was cochlear neurosensory in 61.5%, conductive in 6.5%, and mixed in 9.0% of patients; the percentage of patients with cochlear neurosensory hypoacousia was similar in the three groups (I, 61.7%; II, 59.3%; III, 64%). Hearing loss was of slight to moderate degree and not different in the three groups (I, 22.7 +/- 15 dB; II, 26.9 +/- 6.0 dB; III, 29.1 +/- 8.9 dB). There were no correlations between hearing loss and plasma creatinine and PTH values; patients with plasma urea > 200 mg/dl had higher percentage of hypoacousia (86%) than patients with plasma urea < 200 mg/dl (69%) (P = 0.06). Hearing loss, mainly cochlear neurosensory in type, is present in a high percentage of patients on RDT even at the beginning of treatment, but no negative effects on hearing can be correlated with the duration of dialysis.

The Effect of Correction of Metabolic Acidosis on Calcium and Protein Metabolism in Patients on Hemodialysis

Acid-base balance can be improved in the patient on hemodialysis by increasing the dialysate bicarbonate. One hundred and forty-three adult patients undergoing hemodialysis at a university hospital dialysis center were studied for two consecutive months. After the regular dialysis treatment of 35 mEq/L of dialysate bicarbonate for one month, the experimental group (n = 110 patients) received an increase in their dialysate bicarbonate to 38 mEq/L. The control group (n = 33) was given their regular dialysis treatment of 35 mEq/L of dialysate bicarbonate for the entire two month study period. Monthly serum bicarbonate levels were compared in the experimental group and in the control group. Metabolic acidosis was corrected postdialysis in the experimental group as evidenced by improved levels of bicarbonate; midweek predialysis serum bicarbonate levels increased from 20.2 ± 0.3 (Mean ± SEM) to 21.2 ± 0.3 (p = 0.02), and midweek postdialysis serum bicarbonate levels increased from 27.1 ± 0.3 (Mean ± SEM) to 28.8 ± 0.3 (p = 0.000). In the experimental group the serum calcium levels increased from 8.3 ± 0.1 (Mean ± SEM) to 8.6 ± 0.1 (p = 0.04) despite a decrease in the dialysate calcium (30 to 2.8 mEq/L). No changes in the dialysate calcium or serum calcium occurred in the control group during the two month period. Improved serum calcium levels may reflect changes occurring in bone metabolism. No changes were detectable in protein metabolism after monthly analysis of the caloric and dietary protein intakes. KT/V. and protein catabolic rate during this short evaluation period.

Bony content of oxalate in patients with primary hyperoxaluria or oxalosis-unrelated renal failure

Oxalate retention occurs in end-stage renal failure. Regular dialysis treatment does not prevent progressive accumulation of oxalate in cases of ESRF due to primary hyperoxaluria (PH), whereas such accumulation seldom seems to occur in oxalosis-unrelated ESRF. To elucidate this issue we have measured the bony content of oxalate on biopsies of the iliac crest taken from 32 uremic patients, 7 of them with ESRF associated with PH1 (6 cases) or PH2 (1 case). Ten subjects with normal renal function and no evidence of metabolic bone disease were taken as controls. Only trace amounts levels of oxalate were detected in normal subjects and oxalate to phosphate ratio was below 3:10,000. Non-PH dialyzed patients exhibited fivefold increases in oxalate levels, which rose to 5.1 +/- 3.6 mumol/g bony tissue. Calcium oxalate was estimated to represent 0.18% of the hydroxyapatite content of bone. Oxalate amounts were neither related to pre-dialysis plasma levels of oxalate, nor with duration of dialysis treatment, suggesting that accumulation was not progressive disorder. Oxalate levels were slightly higher in patients with a low turnover osteodystrophy compared to those with a high turnover pattern. Dialyzed patients with PH had remarkable increases in oxalate levels, which ranged between 14.8 and 907 mumol/g bony tissue. Oxalate deposition appeared to be progressive in that oxalate levels were significantly related to time on dialysis. In three patients calcium oxalate was a significant fraction of the mineralized bone. The occurrence of calcium oxalate crystals affected the histomorphometric patterns, that were featured by an increase in resorptive areas and a decrease in bone formation rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Protein Layer on Hemodialysis Membranes: A New Immunohistochemistry Technique

In order to investigate the nature of the protein layer deposited on hemodialysis membranes we developed a direct immunohistochemical technique using fluoresceinated antibodies to plasma membranes. Fifteen patients on regular dialytic treatment were dialyzed with CU, HE, PAN, PS and PMMA and the dialyzers analyzed at the end of a standard dialytic session. Snap frozen sections of hollow fiber devices were treated with flourescein-isothiocyante conjugated antibodies for IgG, IgA, IgM C3c, fibrinogen, factor VIII, factor XIIIa-s, antithrombin III, fibrinogen degradation products (PDF) and plasminogen. Protein deposits were evaluated by a quantitative criteria, which evaluates the intensity of fluorescence and the area of the capillary wall occupied by this fluorescence by using an image analysis software. The coagulation cascade is activated by all membranes and similar deposits of these proteins were revealed, whereas important differences in C3c deposition were found.

Coronary angiography prior to renal transplantation

Summary: A retrospective analysis of coronary angiography in 89 patients (57 male, 32 female) on regular dialysis treatment, prior to their acceptance onto the cadaveric renal transplant waiting list, was performed. Patients studied included those older than 40 years and those symptomatic of coronary artery disease (CAD) or diabetics. Thirty patients (34%) had significant CAD: 18 one‐vessel, 8 two‐vessel, 3 three‐vessel and 1 four‐vessel disease. Significant predictors of CAD were a history of cardiac ischaemic symptoms, a diagnosis of diabetes mellitus, and a family history of CAD. There was no difference in survival between those with and those without CAD. Total mortality, and that due to myocardial infarction, was similar in patients with one‐ and two‐vessel disease and those without CAD, but increased in those with three‐ or four‐vessel disease (P&lt;0.001). Thirteen patients (11 with CAD) were excluded from the transplant waiting list, and their survival was significantly worse (P&lt;0.001). Restriction of coronary angiography to patients who were either symptomatic or diabetic would have resulted in 63% fewer angiograms without altering acceptance onto the transplantation waiting list for any patient.

Evaluation of oxidant stress in chronic hemodialysis patients: use of different parameters

Patients with chronic renal failure, particularly those undergoing regular dialysis treatment (RDT) are candidates for free radical damage. It is difficult to quantitate free radicals because of their short half-lives and reactive nature. Therefore, indirect methods measuring products of lipid peroxidation and protein oxidation are preferred. The present study displays a profile of lipid peroxidation and protein oxidation parameters, which are more sensitive and specific than the widely used method measuring thiobarbituric acid reactive substances (TBARS), adapted to the plasma and erythrocyte samples of RDT patients. We have observed increased levels of plasma and erythrocyte lipid peroxidation and also demonstrated increased protein oxidation in erythrocyte membranes of RDT patients.

Nutritional status in the elderly patient with uraemia

An increasing number of elderly patients with uraemia are treated by dialysis therapy. Virtually every published study on nutritional status of patients undergoing maintenance haemodialysis treatment or continuous ambulatory peritoneal dialysis (CAPD) has indicated that a substantial proportion of patients undergoing regular dialysis treatment have protein calorie malnutrition. Problems of undernutrition increase significantly with age; a combination of socioeconomic, psychological, and biochemical problems interfering with acquiring and assimilating a balanced diet are responsible for nutritional deficiencies in older people. We assessed the prevalence of protein calorie malnutrition in 183 regular dialysis patients aged 65 years or older treated with haemodialysis or CAPD. This group of patients was compared to two other groups aged 18-40 years (62 patients) and 41-64 years (239 patients). Presence of malnutrition was assessed by selected serum chemistries, anthropometry and Subjective Global Nutritional Assessment. Adequacy of dialysis, protein nitrogen appearance, as an index of protein intake, and residual renal function were measured. The results indicate that protein calorie malnutrition occurs commonly in regular dialysis patients, with a higher prevalence of malnutrition in the elderly; 51% of patients of the elderly group were classified as malnourished, and no difference was found with the two dialytic modalities.

Bronchial Responsiveness in Patients on Regular Hemodialysis Treatment of Very Long Duration

Several mechanisms (trapping of neutrophils, increased extravascular lung water, left ventricular hypertrophy, metastatic lung calcification, and iron deposition) may impair pulmonary function and alter bronchial responsiveness in patients on long-term regular dialysis treatment (RDT), but no studies have been published concerning patients on RDT for a very long time. To assess bronchial reactivity, a methacholine inhalation test was performed 2 to 24 hours after a dialysis session in 19 patients with RDT duration of almost 20 years (221 +/- 26 months) (group 1) and in 14 patients on RDT for a shorter time (24 +/- 22 months) (group 2); all patients had normal standard pulmonary function test results (group 1: forced vital capacity, 95% +/- 13% and forced expiratory volume in one second [FEV1]: 97% +/- 17%; group 2: forced vital capacity, 108% +/- 11% and FEV1, 108% +/- 9% of expected values). The methacholine provocation dose causing a 20% decrease in FEV1 was significantly lower than normal in seven (37%) group 1 patients and only in one (7%) group 2 patient; this difference was statistically significant (P = 0.049). There were no correlations between bronchial hyperresponsiveness and interdialysis weight gain, left ventricular hypertrophy, diastolic dysfunction expressed as the ratio between early diastolic filling and filling during atrial contraction, secondary hyperparathyroidism, and iron overload. Therefore, bronchial hyperresponsiveness is present in a substantial percentage of patients on RDT of very long duration, but the cause is unknown.

Sexual influence on bone metabolism in uremic patients on regular dialytic treatment.

In order to evaluate the influence of sex on bone metabolism in patients on regular dialytic treatment, 82 patients (51 males and 31 females) were studied. All the women were amenorrheic and none of them took estrogens. Women showed radiological features of hyperparathyroidism more frequently than men and, in addition, higher bone GLA protein and lower calcitonin serum levels. In both sexes a significant positive correlation was observed between PTH and BGP, but the slope was higher in females, even though not significant. These results suggest that the uremic females show an increased skeletal sensitivity to PTH, probably due to the lack of protective effect of estrogens.

High prevalence of silent gallstone disease in dialysis patients.

Gallstone disease was detected in 28% of 119 patients on regular dialysis treatment. The disease was silent in 82% of the patients. Stones were radiolucent in 88% of the cases, radioopaque in 8% and mixed in 4%. Among 49 variables considered, increasing age was the only variable that correlated significantly with increasing prevalence of gallstone disease. Since no relationships were found between gallstones and age or modes of dialysis, it is conceivable that some mechanism(s) linked with the preexisting chronic nephropathy might have been involved in the development of cholelithiasis. End-stage renal disease could be another so far unrecognized risk factor for cholelithiasis.

Atherogenic risk in patients undergoing regular dialysis treatment: improvement of lipid pattern and lipoproteins by polyunsatured omega-3 fatty acids

Atherogenic risk in patients undergoing regular dialysis treatment: improvement of lipid pattern and lipoproteins by polyunsatured omega-3 fatty acids