Subject(s)
Amyloidosis/immunology , Antibodies/blood , Aspergillosis/immunology , Lung Diseases, Fungal/immunology , Amphotericin B/therapeutic use , Anti-Glomerular Basement Membrane Disease/immunology , Antibodies, Antinuclear/blood , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Autoantibodies , Female , Humans , Lung Diseases, Fungal/drug therapy , Middle AgedABSTRACT
Hypertension in dialysis patients is considered a major factor in cardiovascular mortality. We investigated long-term efficacy of intermittent atenolol (AT) administration in 10 (7M/3F) hypertensive dialysis patients, age 60.5 (38-72), on dialysis for 56.5 months (8-156) thrice per week (10.5-13.5 h/w) (A). A similar group of 11 normotensive patients served as controls (B). Hypertension was defined as BP> 140/90 (day) and >120/80 mmHg (night) by a 44-h ambulatory BP monitoring (ABPM) after the mid-week session. Dialysis ultrafiltration, hematology, biochemistry were similar in A and B. Atenolol was started on an alternate day, 37.5 mg/w and increased as needed. After 34 days (6-80) and a dose of 68.75 (37.5-450) mg/w, BP dropped (ABPM: MAP 104+/-11.5 to 95.6+/-10.4 mmHg, P=0.0025) similar to controls and daytime HR dropped: 84.6+/-9.2 to 69.3+/-8.2, P=0.0008 and at night: 79.5+/-7.6 to 68.6+/-8.6 b/1' becoming lower than in B: 83+/-10.8/69.3+/-8.2, P=0.009 and 80.5+/-11.7/68.6+/-8.6 b/1' (P=0. 02). Six months later ABPM in A as well as echocardiography in A and B remained unchanged. Moderate, volume independent hypertension in stable dialysis patients is easily controlled during the interdialytic period by small intermittent atenolol doses.
Subject(s)
Adrenergic beta-Antagonists/administration & dosage , Antihypertensive Agents/administration & dosage , Atenolol/administration & dosage , Hypertension/drug therapy , Renal Dialysis , Adult , Aged , Blood Pressure/drug effects , Blood Pressure Monitoring, Ambulatory , Echocardiography , Female , Heart Rate , Humans , Hypertension/diagnosis , Kidney Failure, Chronic/metabolism , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Weight GainABSTRACT
Intramuscular (i.m.) and Intradermal (i.d.) vaccination against hepatitis B (HB) are efficient in hemodialysis patients. We retrospectively analysed the response of 32 patients during 48 consecutive months and compared the results of the two vaccination routes using the recombinant vaccine (Engerix, SKB). Thirteen patients were vaccinated with 5 mcg i.d. every 2 weeks (total 8 doses), plus an i.m. dose on month (M) 12 (group A). Nineteen patients (group B) were vaccinated with 4 i.m. doses of 20 mcg each, on months M0, 1, 2 and 12. HB antibodies were measured on M5, M11, M13, M24, M36 and M48. An additional 20 mcg i.m. dose was given with titers below 10 mIU/ml. Seroconversion, seroprotection and antibody levels were equivalent in both groups up to M13; with the exception of seroconversion rates, a significantly different response was observed afterwards (A/B, in mIU/ml): M5: 399 +/- 107 vs 342 +/- 69, M13: 536 +/- 118 vs 673 +/- 61, M24: 278 +/- 94 vs 595 +/- 81, P=0.02, and M48: 68 +/- 29 vs 565 +/- 92, P=0.003. Early HB(S)AB levels did not correlate with those found four years later in both groups. An additional booster dose was given 8 times in 4 group A patients (1-3 doses/patient) and 3 times in 1 group B patient. Immune response to HB vaccine in hemodialysis patients is initially equivalent by both immunization routes. Late antibody titers were found significantly lower in i.d. immunization with more frequent booster doses needed.
