Long-term control of hypertension in dialysis patients by low dose atenolol.

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.

Long-term effects of small doses of calcitriol in hemodialysis patients with moderate secondary hyperparathyroidism.

Prevention of secondary hyperparathyroidism (SHPTH) and treatment of the moderate cases by small p.os doses of Vitamin D has not been thoroughly investigated on the long term, while large doses of Vitamin D have been successful in the short term treatment of this entity. We administered calcitriol p.os 0.5-1.0 microgram, according to iPTH levels, after each dialysis session, in 19 patients (group A) for 36 months. They were ten men and nine women, 63 years old (43-81), with iPTH levels > 4N (419 +/- 185 pg/mL). Seven adenomas were found in five of them (group A1). Serum Ca, phosphate (P) and alkaline phosphatase (AP) were measured every 15-30 days. Serum iPTH and aluminum as well as echogram or scanning of the parathyroid glands were checked every 6 months. Ten additional dialysis patients, seven men and three women, 54.5 years old (36-68), non-significantly different to group A in iPTH levels (290 +/- 225 pg/mL) with three adenomas in two of them (group B1) received no calcitriol and served as controls (group B). Calcitriol treatment significantly lowered serum iPTH levels in group A patients (from 419 +/- 185 to 173 +/- 142 pg/mL, p < 0.0001, delta iPTH: -246 +/- 161 pg/mL); iPTH remained stable in group B patients (delta iPTH: +7.9 +/- 116 pg/mL) with an intergroup significant difference at P < 0.0001. All other parameters measured did not show any significant change. No significant correlation of iPTH to Ca, P or AP was found in A. Initial iPTH levels were higher in A1 and B1 patients and decreased by calcitriol in A1 group. Adenomas in A1 patients did not change in number and size in contrast to B1 where new adenomas appeared (5 patients, 10 glands). Small doses of vitamin D lower high iPTH levels and prevent parathyroid gland hyperplasia. Existing hypertrophy is stabilized under calcitriol treatment both morphologically and biologically.

Long-term effect of low molecular weight heparin on serum lipids in hypertriglyceridemic chronic hemodialysis patients.

Although low-molecular-weight heparin (LMWH) has been reported to lower serum triglycerides and raise HDL in patients previously receiving classic heparin for hemodialysis by sparing lipoprotein lipase activation, this is not universally accepted. To evaluate this effect we studied 14 hypertriglyceridemic patients on hemodialysis for a median of 61 months (range 6-168 months); six were males and eight females, with a median age of 54 years (range 30-78). Eight patients were on bicarbonate and six on acetate HD. Eight were receiving EPO. All had been given conventional heparin, 102 +/- 5.8 IU/kg, at least for the last six months (control period) before switching to LMWH. Mean LMWH dose was 77 +/- 3.1 IU/kg. Fasting levels of total cholesterol (TC), triglycerides (TG) and HDL were measured monthly during the control period and every trimester for the next 36 months. Serum lipoproteins were measured at months 0 and 36 of the trial. TC, Lp alpha and beta showed no significant change. Serum TG and Lp pre-beta dropped significantly, to almost normal levels. EPO treatment, serum iPTH levels or dialysate buffer did not seem to influence this effect. HDL rose significantly higher in women than in men. It is concluded that LMWH substantially lowered the abnormally high serum TG and Lp pre-beta to almost normal and raised serum HDL in chronic hemodialysis patients.