Development of a general ability index for the Wechsler Adult Intelligence Scale--Third Edition.

The Wechsler Adult Intelligence Scale--Third Edition (WAIS-III; D. Wechsler, 1997) permits the calculation of both traditional IQ and index scores. However, if only the subtests constituting the index scores are administered, especially those yielding the Verbal Comprehension and Perceptual Organization Indexes, there is no equivalent measure of Full Scale IQ. Following the procedure for calculating a General Ability Index (GAI; A. Prifitera, L. G. Weiss, & D. H. Saklofske, 1998) for the Wechsler Intelligence Scale for Children--Third Edition (D. Wechsler, 1991), GAI normative tables for the WAIS-III standardization sample are reported here.

The efficacy of once weekly compared with two or three times weekly subcutaneous epoetin beta: results from a randomized controlled multicentre trial. Swedish Study Group.

BACKGROUND: Anaemia in haemodialysis patients can be effectively treated with erythropoietin. We investigated whether subcutaneous (SC) epoetin ss administered once weekly was as effective as the same weekly dosage given in two to three divided doses. METHODS: One hundred and fifty-eight patients (delivered Kt/V >1.0, where K=dialyser-renal urea clearance, t=dialysis time and V=filtration volume, obtained by urea kinetic modelling) were randomized to treatment with SC epoetin beta either once weekly (n=118), or to their original dosage two or three times weekly (control group, n=40) for 24 weeks. All patients received intravenous iron supplementation when necessary. RESULTS: Eight-eight patients in the once weekly group and 30 patients in the control group were treated for at least 16 weeks and are included in the analysis. Stable haemoglobin levels were maintained without epoetin dose increases in 73% of patients in both groups. Mean haemoglobin levels at randomization and after 16 and 24 weeks were 11.4, 11.1 and 11.1 g/dl, respectively, in the once weekly group compared with 11.2, 11.3 and 11.2 g/dl, respectively, in the control group. The mean weekly epoetin beta dosages at randomization and after 16 and 24 weeks were 102, 103 and 106 IU/kg bodyweight, respectively, in the once weekly group compared with 109, 109 and 115 IU/kg bodyweight, respectively, in the control group. No statistically significant between-group differences were apparent for changes in haemoglobin levels or epoetin beta dosages at week 24. CONCLUSIONS: Once weekly SC administration of epoetin beta is as safe and effective in maintaining haemoglobin levels in stable haemodialysis patients as two or three times weekly administration of the same total dose. By using the once weekly regimen, patients can avoid up to 104 injections per year. This would reduce clinic time for patients who do not self administer, and may also encourage self-administration and improve overall compliance.

Apolipoprotein B-containing lipoproteins in renal failure: the relation to mode of dialysis.

BACKGROUND: The aim of this study was to establish whether there is a differential effect of mode of dialysis, hemodialysis (HD), or continuous ambulatory peritoneal dialysis (CAPD) on the dyslipidemia of renal failure. METHODS: The lipoprotein profile was determined in 61 non-diabetic patients on chronic HD (N = 30) and CAPD treatment (N = 31), and in a control group of 27 healthy subjects. The analysis included the measurement of individual apolipoprotein (apo) A- and apo B-containing lipoproteins (LPs) separated by sequential immunoaffinity chromatography. Apo A-containing lipoproteins include lipoprotein A-I with apo A-I and lipoprotein A-I:A-II with apo A-I and apo A-II as the main protein constituents, whereas apo B-containing lipoproteins comprise simple cholesterol-rich lipoprotein B (LP-B), with apo B as the only protein moiety and complex triglyceride (TG)-rich lipoprotein B complex (LP-Bc) particles with apo B, apo A-II, apo C, and/or apo E as the protein constituents. RESULTS: CAPD patients had significantly higher concentrations of total cholesterol (6.8 vs. 5.1 mmol/liter), low-density lipoprotein (LDL) cholesterol (4.6 vs. 3.2 mmol/liter), TG (2.3 vs. 1.5 mmol/liter), apo B (155.3 vs. 105.7 mg/dl), LP-B (136.0 vs. 91.9 mg/dl), and LP-Bc (19.3 vs. 13.8 mg/dl) than HD patients. Both HD and CAPD patients had significantly higher TG, VLDL cholesterol, apo C-III, and apo E and significantly lower high-density lipoprotein cholesterol, apo A-II, and lipoprotein A-I:A-II levels than control subjects. The distribution of apo C-III in high-density lipoprotein and VLDL-LDL was altered in CAPD patients in comparison with control subjects. This suggests that the removal of TG-rich lipoproteins is less efficient in patients on CAPD. Normotriglyceridemic (NTG; TG < or = 1.7 mmol/liter, 150 mg/dl) CAPD patients had significantly higher levels of TC, LDL cholesterol, apo B, and LP-B than NTG-HD patients. There was little difference in the LP-Bc levels between NTG-CAPD, NTG-HD, and controls. Similarly, hypertriglyceridemic (HTG) CAPD patients had significantly higher TC, LDL cholesterol, apo B, and LP-B levels than HTG-HD patients. The LP-Bc levels were significantly increased in HTG-HD and HTG-CAPD patients compared with controls, but the slightly higher levels in the CAPD patients did not differ significantly from the HD group. CONCLUSION: CAPD and HD patients have a lipoprotein profile characteristic of renal failure. Patients on long-term CAPD have higher levels of cholesterol-rich apo B-containing lipoproteins unrelated to TG levels. Many patients on CAPD also have a substantial elevation of the plasma concentrations of TG-rich LPs. The clinical significance of increased levels of potentially atherogenic LP-B during CAPD remains to be investigated.

Effects of ticlopidine in AV-fistula surgery in uremia. Fistula Study Group.

Two hundred and fifty-eight patients with uremia who were offered surgery for placement of an arteriovenous fistula for hemodialysis were recruited in nine regional dialysis centers. The patients were randomized to receive the platelet aggregation inhibitory compound ticlopidine, 250 mg b.d., or matching placebo. Study medication was targeted at 7, minimum 3, days before scheduled surgery and continued for 28 days after surgery. The overall rate of occlusion was 41/260 evaluable operations (16%), 25/131 (19%) in the placebo group and 16/129 (12%) in the ticlopidine group. The risk of early occlusion was a non-significant 35% lower in the ticlopidine group. Limited risk factor analysis did not clearly identify any subgroup other than females at greater risk of early thrombosis nor any subgroup deriving particular benefit from ticlopidine treatment.

Parathyroid hormone and osteocalcin levels in plasma and ultrafiltrate during hemofiltration.

The effects of hemofiltration (HF) on serum levels of intact parathyroid hormone (PTH), as well as its mid-C regional and C-terminal fragments and bone Gla-protein (bone gamma-carboxyglutamic acid, osteocalcin), were investigated in 17 patients during one session of HF. During HF there was a significant decrease in the serum concentrations of both intact PTH (p < 0.01), mid-C regional PTH (p < 0.01) and C-terminal PTH (p < 0.01) as well as in the osteocalcin concentrations (p < 0.01). There was a significant increase in serum calcium (p < 0.05) during the procedure and this increase correlated with the reduction in PTH (r = 0.56, p < 0.05). Mid-C regional PTH and osteocalcin were found in the ultrafiltrate of all patients, while intact PTH was found in the ultrafiltrate of 8 of 17 patients and C-terminal PTH was detected only in the ultrafiltrate of one patient. The data demonstrate that the permeability of HF membranes is high enough to cause filtration of both intact PTH, PTH fragments and osteocalcin. An inhibited secretion of PTH probably played a major part in reducing intact PTH in serum during HF.

Clinical aspects and applications of hemofiltration.

Thirty patients were referred for intermittent hemofiltration (HF) and were followed for long-term effects. Biochemical and uremic controls were comparable to those in the preceding hemodialysis (HD) period. All patients preferred to continue HF since they suffered fewer and less serious treatment-related complications. One hundred critically ill patients who developed acute renal failure were treated with continuous arteriovenous hemofiltration (CAVH). The survival rate was 45% and adequate uremic control was achieved with CAVH alone in 89 patients. The major improvement obtained with CAVH was the possibility of giving adequate nutritional support without the risk of overhydration, even to anuric hypotensive patients. The pharmacokinetics of intravenous cefuroxime was studied during HF and CAVH. During HF removal of cefuroxime was considerably higher than during HD. During CAVH, extrarenal clearance was two thirds of the total clearance. Dosage recommendations for HF and CAVH are given. Aluminum clearance and aluminum removal after a desferrioxamine infusion test was found to be 2.5-3 times higher during HF than during ordinary HD. A combination of HD and charcoal hemoperfusion was found to be more effective than HD, but less effective than HF. During HF there was a significant decrease in intact parathyroid hormone (PTH) in serum as well as in mid-C regional PTH and C-terminal PTH. Significant amounts of intact PTH were found in the ultrafiltrate of 8 of 17 patients. Another explanation of the fall in PTH was a down-regulation of the secretion of intact PTH, since there was an increase in serum calcium during hemofiltration. Osteocalcin--i.e., bone Gla-protein--was found in the ultrafiltrate during hemofiltration in all patients and the serum levels of osteocalcin decreased significantly during hemofiltration.

Aluminum removal with hemodialysis, hemofiltration and charcoal hemoperfusion in uremic patients after desferrioxamine infusion. A comparison of efficiency.

In order to compare the effectiveness of aluminum removal in uremic patients during extracorporeal treatment, 17 patients with endstage renal failure were given a desferrioxamine infusion of 40 mg/kg body weight after an ordinary dialysis treatment. Forty-eight hours later 7 patients were treated with hemodialysis, 6 with hemofiltration and 4 with a combination of hemodialysis and hemoperfusion. The clearance of aluminum was measured at different intervals. It was found that the aluminum clearance was 75 +/- 18 ml/min in hemofiltration compared to 30 +/- 10 ml/min in hemodialysis (p less than 0.001). A combination of hemodialysis and hemoperfusion with a charcoal column containing 100 g activated charcoal in series gave a total aluminum clearance of 56 +/- 11 ml/min. The total amount of aluminum in the ultrafiltrate after hemofiltration was found to be approximately 3 times as high (1,728 +/- 156 micrograms) as the total amount of aluminum in the hemodialysis water that had passed a single pass system during a 4-hour dialysis (576 +/- 104 micrograms). Our results indicate that hemofiltration or a combination of hemodialysis and hemoperfusion should be used to remove aluminum in patients with signs of severe aluminum accumulation such as encephalopathy or painful bone disease, because these methods are 2-3 times as effective as ordinary hemodialysis. In patients where aluminum has been accumulated but no severe symptoms occur hemodialysis gives a significant clearance of the aluminum desferrioxamine complex.

Four years' experience of long-term hemofiltration in a Swedish center.

Thirty patients with end-stage renal disease were switched from maintenance hemodialysis to postdilution hemofiltration and observed for long-term effects. The study comprised totally 496 months of hemofiltration. Uremic and biochemical control was similar in the hemofiltration and in the hemodialysis period. Of the small molecules, only serum creatinine showed slight increase after 3 months. No other significant changes in creatinine, serum urea or potassium levels were associated with long-term hemofiltration. During each hemofiltration session there was significant decrease of serum parathyroid hormone (PTH) and serum beta 2-microglobulin, but over the first 8 months of hemofiltration the beta 2-microglobulin values did not fall, and significant PTH reduction was found only after 12 months. Although uremic control was similar with both methods, there were fewer complications of hemofiltration, which was preferred by the patients. Because it is currently more expensive, however, hemofiltration should be reserved for patients with dialysis related problems, that are not helped by other changes in the dialysis technique, such as sequential ultrafiltration changes in the dialysis membranes and in the dialysis buffer from acetate to bicarbonate.

Pharmacokinetics of intravenous cefuroxime during intermittent and continuous arteriovenous hemofiltration.

The pharmacokinetics of cefuroxime were determined in ten patients during intermittent hemofiltration (IHF) and in three patients during continuous arteriovenous hemofiltration (CAVH). All patients received a bolus dose of 1.5 g of cefuroxime intravenously and the concentrations of cefuroxime in serum and ultrafiltrate were followed during the hemofiltration period and up to 16 hours after injection of cefuroxime. During IHF the mean terminal half-life of cefuroxime was 1.6 +/- 0.3 hours compared with a terminal half-life of 21.7 +/- 5 hours after treatment. The total cefuroxime clearance was 120 +/- 22 ml/min. The hemofiltration clearance represented 86% of the total clearance and the hemofiltration process removed in average 63% of the dose. During CAVH the terminal half-life of cefuroxime was 7.9 +/- 2.2 hours. The total plasma clearance for cefuroxime was 32 +/- 7.5 ml/min where the CAVH-treatment represented only 34% of the total clearance. From these data we suggest that a full loading dose (1.5 g of cefuroxime) should be given after each intermittent hemofiltration treatment when performed every second day. In CAVH, where nonrenal clearance will influence the dosage scheme significantly, we suggest an initial dose of 1.5 g of cefuroxime to be followed by a supplementary dose of 750 mg every 20-24 h.