Comparative crossover controlled study using polysulphone and vitamin E coated dialyzers.

OBJECTIVE: There is relatively little clinical experience reported on the use of the vitamin E coated dialyzer (CL-EE12, Terumo). This study compares its efficacy and intradialytic symptoms with a polysulphone dialyzer in 2 groups of patients in a controlled crossover trial design. METHODS: This study was carried out at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia, during the time period January to March 2002. In group A, 34 patients were dialyzed for 4 weeks with vitamin E dialyzer then switched over to Fresenius 60 (F60) for 4 weeks. In group B, 41 patients were dialyzed with F60 for 4 weeks then switched to vitamin E coated dilayzers for 4 weeks. The following parameters were measured weekly, hemoglobin level, urea reduction ratio (URR), urea clearance ratio (Kt/V), pre and post dialysis diastolic blood pressure (DBP) and systolic blood pressure (SBP), interdialytic weight gain. The patients were observed for interdialytic hypotension or symptoms. RESULTS: No significant findings were found in any of the parameters except more dialyzer clotting was observed with vitamin E dialyzer than in F60 dialyzers (1.6% of dialysis sessions versus 0.1% P<0.03). The interdialytic weight gain tended to be less in the vitamin E group but did not reach statistically significant difference. The Kt/V and URR were slightly higher when using the vitamin E dialyzer only in the second and third weeks. hypotensive episodes (P<.007) less leg cramp (P<.31) and less itching (P<.02) in the vitamin E coated treated group within group B. CONCLUSION: There were only minor differences noted between the 2 dialyzers in the parameters measured.

Long-term intravenous calcitriol in secondary hyperparathyroidism: the role of technetium-99m-MIBI scintigraphy in predicting the response to treatment.

BACKGROUND: Despite the effectiveness of intravenous calcitriol in suppressing parathyroid hormone secretion in patients with uremic hyperparathyroidism, 50% of the patients remain refractory to this treatment. There are conflicting reports regarding the factors that can predict the response to treatment. Technetium-99m-MIBI scintigraphy was found to be correlated with functional activity of the parathyroid gland. METHODS: We, retrospectively, evaluated 16 chronic hemodialysis patients, who were maintained on i.v. calcitriol for 36 months or longer, and who had MIBI scan either at the start of, or within the first 6 months of starting calcitriol. Nine patients had a positive uptake (+ve group), and 7 patients had a negative uptake (-ve group). All patients had an elevated iPTH (iPTH > 300 pg/ml) at the start of treatment. RESULTS: The percentage reduction of iPTH in the (-ve) and the (+ve) groups was 65% versus 45% at 12 months, and 65% versus 10% at 36 months respectively. In long-term follow-up of 36 months, all the patients in the (-ve) group responded to calcitriol; while 8 of the 9 patients (89%) in the (+ve) group didn't respond. The difference in response between the 2 groups was statistically significant (p<0.001). CONCLUSION: We conclude that MIBI scan is a reliable technique in predicting the response to treatment with i.v. calcitriol in patients with secondary hyperparathyroidism.