ABSTRACT
The aims of the present prospective multicenter study were to assess the clinical tolerance and well being, the correlation between nPCr and Kt/V and the pretreatment beta 2-microglobulin level in patients sequentially treated with high-flux dialysis with ultrapure bicarbonate hemodialysis (HD; phase 1) and predilution hemofiltration (HF) with on-line prepared bicarbonate substitution fluid (phase II). The same monitor (Gambro AK 100 ULTRA) and membrane (polyamide) were used. Twenty-three patients, all in a stable clinical condition, entered the study. The treatment was targeted to an equilibrated Kt/V (eqKt/V) of 1.4 for HD and 1.0 for HF. No mortality or relevant morbidity were observed. The number of hypotensive episodes was 1.78 +/- 2.8 per patient and month during HD vs. 1.17 +/- 3.1 during HF (p = 0.003) and the number of the hypertensive episodes 1.28 +/- 2.8 during HD vs. 0.42 +/- 0.8 during HF (p = 0.04). Incidences of arrhythmia, muscular cramps and headache were significantly less frequent during HF. Interdialytic cramps, arthralgia and fatigue were also significantly less frequent during the HF period. The average beta 2-microglobulin level was 27.1 +/- 14.7 mg/dl at the start of the study, 22.9 +/- 4.9 mg/dl at the beginning of phase II and 22.4 +/- 4 mg/dl at the end of phase II (p = 0.01 compared to the start). A significant linear correlation between the normalized protein catabolic rate and eqKt/V was obtained faster during HD than during HF (45 vs. 120 days) indicating that HF affects the nutritional status with mechanisms different from HD. The present study is in agreement with the hypothesis that HF gives and adequate nutritional status with improved clinical stability and well being at a lower Kt/V compared to HD. Both therapies were efficient in controlling the pretreatment beta 2-microglobulin level.
Subject(s)
Hemofiltration/methods , Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Aged , Arrhythmias, Cardiac/etiology , Bicarbonates/administration & dosage , Bicarbonates/adverse effects , Body Weight , Electrolytes/blood , Fatigue/etiology , Female , Gastrointestinal Diseases/etiology , Hemodialysis Solutions/administration & dosage , Hemodialysis Solutions/adverse effects , Hemofiltration/adverse effects , Humans , Hypotension/etiology , Kidney Failure, Chronic/complications , Male , Middle Aged , Pain/etiology , Prospective Studies , Proteins/metabolism , Renal Dialysis/adverse effects , Urea/blood , beta 2-Microglobulin/analysisABSTRACT
A multicentre trial (11 nephrology centres) was carried out to test the effects of ibopamine, an orally active dopamine-like drug, on the progression of chronic renal failure. For a 2-year period 189 chronic renal failure patients (serum creatinine level 1.5-4.0 mg/dl) were observed. They were homogeneous for basic nephropathy, degree of residual renal function, blood pressure, and proteinuria. The patients were randomly divided into two groups: 96 took ibopamine at a dosage of 100 mg/day (group A) and 93 served as controls (group B). All were on a low-protein diet (mean 0.8 g/kg body weight). By the end of the observation period, the rate of decrease of the renal function indexes in time proved significantly slower (1.8 times) in group A than in group B. The survival curves for renal function (pre-established end points were creatinine level increases equal to or > 20% and equal to or > 40% of the basal values) proved significantly better (p < 0.02 and p < 0.002 respectively) in group A than in group B. The mean plasma creatinine values rose by 17% in group A and by 36% in group B. The creatinine clearance decreased by 5% in treated patients and by 14% in the controls. Statistical analysis ruled out any possible centre effect. The trial suggests that low-dosage ibopamine administration may be used as a valid and safe pharmacological adjunct for retarding the progression of renal failure in patients with mild or moderate chronic renal impairment.
Subject(s)
Deoxyepinephrine/analogs & derivatives , Dopamine Agonists/administration & dosage , Kidney Failure, Chronic/drug therapy , Adolescent , Aged , Creatinine/metabolism , Deoxyepinephrine/administration & dosage , Disease Progression , Female , Humans , Kidney/physiopathology , Kidney Failure, Chronic/physiopathology , Linear Models , Logistic Models , Male , Middle AgedABSTRACT
Serum prolactin, luteinising hormone and follicle-stimulating hormone, determined by radioimmunoassay were measured during the infusion of 10mg naloxone or saline in eight male patients with chronic renal failure on regular dialysis and in seven normal controls. Neither saline nor naloxone caused any significant change in luteinising hormone, follicle-stimulating hormone or prolactin in patients with chronic renal failure. On the contrary, luteinising hormone secretion was significantly stimulated by naloxone in normal controls. Since naloxone is a specific antagonist of opiate receptors, the results would suggest a reduced hypothalamic opiate tone in patients with chronic renal failure. The data does not support the concept that the high circulating met-encephalin reported in chronic renal failure represents the pathogenetic cause of hyperprolactinaemia in chronic renal failure.
