Puglia cooperative study on biofiltration.

Biofiltration (BF) was performed on 60 patients from 12 dialytic centers in Puglia. The protocol was 9-10.5 hours a week with 1.2 m2 PAN dialyzers. A dialysate with 140 Na+, 2-2.5 K+, 3.5-4 Ca++, 38 mEq/l acetate was used in 49 patients; the acetate was replaced by bicarbonate (35-40 mEq/l) in 11 patients. The same patients were treated for 1 year with standard acetate dialysis (49 patients) and standard bicarbonate dialysis (11 patients). The two protocols were compared on the basis of the clinical state, BUN and serum creatinine, acid-base balance, PTH, anemia, and nerve conduction velocity (NCV). Favourable effects were achieved in 55 patients. Four patients left the program because of progressive hyperhydration. BUN and serum creatinine levels showed a moderate, but insignificant increase. PTH, anemia and NCV did not worsen. BF gave better correction of metabolic acidosis in the patients undergoing acetate dialysis.

Biofiltration with bicarbonate as dialysate buffer.

The biofiltration with bicarbonate as dialysate buffer (BiBF) was used in 10 patients on RDT: the patients were treated for 10 months on standard BF and for 10 months on BiBF. The amount of fluid infused varied between 3 and 5 liters and Na-bicarbonate (100 mEq/h) was infused during BF. The dialytic protocol was 3 hours every other day. Cardiovascular stability, waste molecules and acid-base balance were investigated. No differences in vascular stability and no significant changes in the waste-molecules concentrations were found. Both protocols correct the metabolic acidosis; however, in standard BF 50% of patients showed acute hypocapnia at the end of dialysis.

Favourable effects of bicarbonate dialysis on the body pool of phosphate.

An intravenous infusion of 3,430mg of PO4- has been given to 11 patients on acetate and to 11 patients on bicarbonate haemodialysis. The 'phosphate spaces' and dialytic removal were determined. The bicarbonate dialysis causes lower values of phosphate pool, total phosphate space, cellular space and phosphate cellular clearance. There is also a greater phosphate removal during bicarbonate dialysis. The better correction of metabolic acidosis and the absence of acetate metabolism are two factors which may be responsible for these phenomena.

Muzolimine in advanced chronic renal failure.

27 patients with creatinine clearances ranging from 20 to 2 ml/min were treated daily with 6.9 mg/kg of muzolimine, for 10 to 25 days. The hyperhydration state with oedema decreased gradually in all patients without hypotensive phenomena. Muzolimine benefited hypertension in patients with expansion of the extracellular space and it also strengthened the effect of clonidine or minoxidil. Important diuretic and natriuretic effects were obtained. Metabolic acidosis improved. No subjective adverse reactions to the drug or side effects were noted. High-dose muzolimine appears to be efficacious and safe for short-term treatment in patients with severe chronic renal failure.

Multicentric experience with combined hemodialysis/hemoperfusion in chronic uremia.

A multicentric study was carried out to investigate the safety and effectiveness of long-term treatment of chronic uremic patients by a regular combination of hemodialysis and charcoal hemoperfusion. 39 RDT patients from five dialysis centers were treated for up to 12 months. The combined treatment proved to be safe, well tolerated and effective in improving certain dialysis-resistant uremic signs, mainly severe peripheral neuropathy, asthenia, anorexia, nausea, lack of well-being and relapsing pericarditis. There was also a marked decrease, after several weeks of combined treatment, in plasma values of urea, uric acid and creatinine.

Bone densitometry with L125 in the study of uraemic osteropathy: semeiological signifiance and limitations.

Bone densitometry using I125 is a very easy method of investigation; it may be used repeatedly and simultaneously at different bone levels without distress to patients. The problems involved were those of the value, semeiological significance and possible limitations of this method in the investigation of uraemic osteopathy. These problems were solved successfully in tests carried out on 87 patients of both sexes suffering from various degrees of chronic nephropathy and on chronic haemodialysis patients. The method is reliable: reproducibility tests in normal and uraemic subjects were satisfactory; the indexes remain constant, usually in normal subjects. The parameters are "Bone Mineral Content" and "Bone Index". Trabecular bone is more sensitive than cortical bone, although comparisons between the two types of bone produce interesting data. There are difference dependent on sex. The method which is more sensitive than others enables: 1) Normal and nephropathic subjects, to be distinguished from one another. The latter generally show a lower mineral content and bone index (clinical picture of osteomalacia, osteoporosis, hyperparathyroidism) seldom a higher or a normal one. 2) The same bone sites to be examined over a given period. 3) Treatment of patients to be monitored.