Nonenzymatically glucosylated serum proteins in patients with end-stage renal disease.

We report here abnormally elevated levels of nonenzymatically glucosylated whole-serum proteins in nondiabetic, as well as diabetic patients with end-stage renal disease (ESRD). Increased glucosylation of serum proteins and structural proteins has been documented in patients with diabetes mellitus, but not previously in ESRD. Increased levels of hemoglobin A1 have been reported in patients with ESRD, but appear to be due to carbamylation of hemoglobin rather than glucosylation. Using an assay that does not detect carbamylation, the present study demonstrates abnormally elevated levels of nonenzymatically glucosylated whole-serum proteins in all the chronic hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients studied. Further, we found no change in levels of these abnormal proteins when patients were changed from hemodialysis with a dialysate that contained no glucose to one that did, or to CAPD in which large amounts of glucose are absorbed from the dialysate. The mode of dialysis does not appear to affect glucosylated protein levels in ESRD.

Diuretic regimens in essential hypertension. A comparison of hypokalemic effects, BP control, and cost.

Intolerable side effects and hypokalemia during thiazide treatment of hypertension frequently necessitate a change in diuretic regimen. The hypokalemic effects, effectiveness in controlling BP, and cost of several alternate diuretic regimens were evaluated. Prevalences of serum K+ values less than 3.5 mEq/L were as follows for the various regimens: hydrochlorothiazide, 50 mg daily, 11.0% (n = 500); chlorthalidone, 25 mg daily, 8.1% (n = 37); triamterene, 100 mg, plus hydrochlorothiazide, 50 mg daily, 5.3% (n = 357); hydrochlorothiazide, 25 mg daily, 2.2% (n = 183); and furosemide, 40 mg daily, 3.5% (n = 284). In paired studies comparing hydrochlorothiazide with alternate diuretic regimens, potassium conservation was comparable with furosemide, the triamterene/hydrochlorothiazide combination, the spironolactone/hydrochlorothiazide combination, and adding potassium, 37 mEq daily. All alternate diuretic regimens were as effective as hydrochlorothiazide in controlling BP. Furosemide reduced serum glucose and calcium levels compared with hydrochlorothiazide. When these factors and costs are considered, furosemide appears to be the most cost-effective alternative in patients with hypertension in whom intolerable side effects or hypokalemia develops while taking hydrochlorothiazide.