[Effectiveness of oral supplements of folates, vitamins B12 and B6 in hemodialysed patients. Preliminary results after 5 months of follow-up]. / Efficacia dei supplementi orali di folti, vitamine B12 e B6 in pazienti emodializzati. Risultati preliminari dopo 5 mesi di follow-up.

BACKGROUND: Elevated serum levels of homocysteine have increasingly been associated as a risk factor of cardiovascular disease. Recent reports demonstrated that supplements of folates, vitamin B12 (B12) and vitamin B6 (B6) are effective in correcting serum Hcy levels in hemodialysed patients. AIM: to assess the effectiveness of oral supplements of folates, B12 and B6, in order to reduce serum Hcy levels in our cohort of hemodialysed patients. METHODS: Sixty-one hemodialysed patients have been enrolled in the study (age 68+/-13 years; hemodialysis 62+/-42 months). Oral supplements of calcium folinate (30 mg 3 times a week), B12 (500 mg 3 times a week) and B6 (200 mg 3 times a week) were administered at the end of each hemodialysis session. Serum levels of Hcy, folic acid and B12 were tested at the beginning of the study and at 2 month intervals. RESULTS: After 5 months of follow-up, serum levels of Hcy were normalised in 19% of our patients and in total 70% of them showed a reduction >8% when compared with the basal Hcy levels. No side effects related to folates, B12 or B6 supplementation were observed. CONCLUSIONS: Oral supplements of folates, B12 and B6 are a safe and effective treatment of hyperhomocysteinemia in hemodialysed patients.

[Infections from extemporaneous catheters for hemodialysis. Experience in a center]. / Infezione dei cateteri estemporanei per emodialisi. Esperienza di un centro.

BACKGROUND AND AIMS: This study reports a retrospective evaluation of the predominance of infection in 67 dual lumen central venous catheters (CVC), 35 of which were positioned in the femoral vein by the nephrological team and 32 in the subclavian vein by anesthetists. METHODS: The microorganisms responsible for infection, the prevalence of clinically symptomatic infections, the relationship between CVC-correlated infection and the time the catheter remained inserted were evaluated, together with a comparison between the two different insertion sites. RESULTS: Culture tests, performed using Maki's semiquantitative technique, gave positive results in 16/67 (23.8%) cases. The main pathogenic agents found were Staphylococcus epidermidis (37.5%) and Staphylococcus aureus (31.2%). In 3/16 cases (18.78%) infections were clinically symptomatic. The mean permanence of CVC with positive cultures was not statistically different to the mean permanence of CVC with negative cultures (22.44 +/- 13.48 vs 18.38 +/- 17.76). The microorganisms isolated on femoral and subclavian catheters showed a comparable distribution and the prevalence of infection was not statistically different in the two insertion sites. CONCLUSIONS: In conclusion, in the absence of infection, the authors tend to keep working catheters in the site, thus avoiding repeated invasive manoeuvres for replacement and/or repositioning, whereas in the presence of suspected systemic infection they feel it is more prudent to remove the CVC without waiting for the results of the hemoculture, starting first empiric and then specific antibiotic treatment on the basis of the antibiogram.

[Levels of tumor necrosis factor and interleukin 1 in uremia and in hemodialysis]. / Livelli di tumor necrosis factor ed interleuchina-1 nell'uremia ed in emodialisi.

The present study aimed to assess the serum levels of tumor necrosis factor (TNFalpha) and Interleukin-1 (IL-1) in uremic patients and those patients undergoing extracorporeal replacement therapy in relation to the duration of dialysis and the type of membrane. Serum cytokine values were assayed using an immunoradiometric technique (monoclonal antibodies) in 28 uremic patients and 7 healthy controls. TNFalpha levels were normal in control subjects but increased in uremic patients. Patients undergoing hemodialytic treatment showed increases which were statistically significant in comparison to basal levels, with a trend which was directly correlated to the duration of dialysis. No significant variations were induced by the different types of dialysis membranes used. In virtually all patients IL-1 values could not be assayed using this method.