ABSTRACT
BACKGROUND: Icodextrin provides a different ultrafiltration mechanism than glucose-based dialysate. METHODS: To evaluate the difference in the peritoneal equilibrium test (PET) with regard to using icodextrin (Ico-PET) and glucose dialysate we designed a prospective study using Ico-PET and 2 cross-over conventional 2.5% glucose-based dialysate PETs (Gluco 1-PET and Gluco 2-PET) administered 3 months before and after the Ico-PET in 58 chronic peritoneal dialysis patients. RESULTS: More patients demonstrated higher transport types with the Ico-PET than the Gluco 1-PET and Gluco 2-PET (p<0.001). After a dwell time of 4 hours, the Ico-PET did not show an ultrafiltration benefit compared with the Gluco-PET (272.8 +/- 137.1 mL vs. 348.3 +/- 215.2 mL, p<0.001). The Ico-PET not only showed significantly higher values in the 0-hour, 2-hour and 4-hour dialysate to plasma creatinine concentration ratio (D/P Cr) than those of the Gluco 1-PET (p=0.029 and p<0.001, respectively), but also showed higher values in the 0-hour and 4-hour D/P Cr than those of the Gluco 2-PET (both p<0.001). The total ultrafiltration volume was positively correlated with the 4-hour D/P Cr with the Ico-PET (r=0.41, p=0.001), but the correlation was negative with the Gluco 1-PET (r=-0.33, p=0.012) and Gluco 2-PET (r=-0.51, p<0.001). The ratio of the glucose concentration in the outflow dialysate compared with baseline level (D/Do glucose), was also significantly higher with the Ico-PET than with the Gluco 1-PET and Gluco 2-PET after both 2 and 4 hours (both p<0.001). CONCLUSIONS: The Ico-PET showed a completely different result from the conventional Gluco-PET. The Ico-PET provi-des a superior solute transport and inferior ultrafiltration rates, and the prevalence of high transporters was also increased with the Ico-PET.
Subject(s)
Dialysis Solutions/pharmacology , Glucans/pharmacology , Glucose/pharmacology , Peritoneal Dialysis , Sweetening Agents/pharmacology , Adult , Biological Transport, Active/drug effects , Female , Humans , Icodextrin , Kidney Failure, Chronic , Male , Middle Aged , Osmolar ConcentrationABSTRACT
This investigation presents a case report of the successful treatment of severe calciphylaxis using zero- and low-calcium dialysate for hemodialysis, repeated wound debridement and skin grafting and medical parathyroidectomy with local injection of parathyroid glands with alcohol. To the authors' knowledge, this is the first case report of the use of medical parathyroidectomy and hemodialysis with low calcium dialysate to treat calciphylaxis in a dialysis patient. Finally, relevant English language articles on calciphylaxis from Medline are reviewed.
Subject(s)
Calciphylaxis/therapy , Calcium/administration & dosage , Hemodialysis Solutions/administration & dosage , Parathyroidectomy , Renal Dialysis/methods , Adult , Calciphylaxis/diagnosis , Calciphylaxis/etiology , Female , Hemodialysis Solutions/chemistry , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Severity of Illness IndexABSTRACT
Tuberculosis infection is common in patients on maintenance hemodialysis, and the extrapulmonary presentations, which is usually asymptomatic, and only mild clinical presentation, are not uncommon. These hemodialysis patients were always prescribed multiple antituberculosis agents, including isoniazid, rifampin, ethambutol, and pyrazinamide, alongside their usual medication. Conscious disturbance was also frequently observed in these patients, with different paramount etiologies in the pre- and post-hemodialysis phases. We report a case undergoing maintenance hemodialysis, showing disturbed consciousness ten days following antituberculosis treatment for his established extrapulmonary tuberculosis infection. Consciousness was regained seven days later, after discontinuation of isoniazid.
Subject(s)
Antitubercular Agents/adverse effects , Isoniazid/adverse effects , Kidney Failure, Chronic/drug therapy , Neurotoxicity Syndromes/etiology , Tuberculosis, Pulmonary/drug therapy , Humans , Kidney Failure, Chronic/complications , Male , Middle Aged , Renal Dialysis , Tuberculosis, Pulmonary/complicationsABSTRACT
Sheehan's syndrome is a rare complication of pregnancy with multiple hormone deficiency. The exact pathogenetic mechanism is not well understood, because such endocrine abnormalities are not obvious in most women with severe hemorrhage. Central diabetes insipidus with fluid and sodium disturbances occurred in about 5% of the patients. [1,2] There are very few existing literature discussing concomitant Sheehan's syndrome and acute renal failure. The following case reports a patient showing Sheehan's syndrome, irreversible acute renal failure and central diabetes insipidus concurrently.
