Trypsinogen and other pancreatic enzymes in patients with renal disease: a comparison of high-efficiency hemodialysis and continuous ambulatory peritoneal dialysis.

Although serum amylase and lipase levels have been studied extensively in patients with renal disease, there are fewer data regarding trypsinogen levels in patients with end-stage renal disease (ESRD) treated with different dialytic modalities. We therefore evaluated the blood concentrations of trypsinogen, amylase, and lipase in asymptomatic patients with chronic renal insufficiency (CRI) and ESRD, to determine whether treatment modality or renal handling of these enzymes is important in determining steady-state levels in asymptomatic patients with chronic renal disease. Mean trypsinogen concentration levels were higher in hemodialysis (HD) patients and patients with CRI compared with normal subjects when values in the different groups were compared. There was no difference in the mean trypsinogen levels between patients treated with HD and those with CRI, between patients treated with chronic ambulatory peritoneal dialysis (CAPD) and those treated with HD, or between CAPD patients and patients with CRI. The mean circulating trypsinogen concentration was elevated more frequently and to a higher level than amylase or lipase in patients with CRI and ESRD. HD treatment did not result in a lowering of mean circulating pancreatic enzyme levels. We propose that decreased peripheral clearance, pancreatic overproduction, increased release from the pancreas, or a combination of these mechanisms is responsible, at least in part, for the increased plasma concentration of trypsinogen in patients with CRI, rather than simply a decrease in renal clearance.

Baseline characteristics in the Modification of Diet in Renal Disease Study.

The Modification of Diet in Renal Disease Study is randomized, multicenter, clinical trial designed to determine the effects of three levels of dietary control of protein and phosphorus and two levels of blood pressure control on the rate of decline of kidney function among persons with chronic renal disease. Study participants were assigned to one of two studies, Study A or Study B, depending on their GFR just before randomization. Within each study, participants were randomly allocated to one of two levels of blood pressure control and to one of two dietary interventions according to separate 2 x 2 factorial designs. A total of 840 men and women aged 18 to 70 were randomized. This report summarizes the demographic, biochemical, and clinical characteristics of the randomized participants at the time of entry into the trail, overviews the protocol and purposes of the baseline period before randomization, and evaluates the balance among the treatment intervention groups within Studies A and B at the time of randomization. Major indicators of renal function were found to be well balanced among the treatment groups. Selected baseline characteristics of participants in the Modification of Diet in Renal Disease Study are compared with those of other renal clinical trials and with those of new cases of treated ESRD reported in the United States Renal Data System.

In vitro susceptibility studies with netilmicin: comparison of a 10-microgram netilmicin disk with a standardized 10-microgram gentamicin disk.

Netilmicin is a new, semisynthetic aminoglycoside antibiotic active against some gentamicin-resistant gram-negative bacteria. In this study we compared a 10-mug netilmicin disk with the standardized 10-mug gentamicin disk in terms of their abilities to predict probable clinical susceptibility to netilmicin. The agar dilution procedure of the International Collaborative Study of the World Health Organization and the U.S. Food and Drug Administration standardized disk test procedure were used. The gentamicin disk failed to predict the clinical susceptibility to netilmicin of 26 of 118 isolates previously shown by the agar dilution technique to to be netilmicin susceptible. The netilmicin disk correctly predicted probable susceptibility of all 26 isolates, including 20 shown by the agar dilution procedure to be resistant to gentamicin. These studies demonstrate the need for a separate netilmicin disk for use in agar diffusion disk susceptibility tests.