[C-reactive protein and homocysteinemia in patients undergoing on-line hemodiafiltration]. / Proteina C-reattiva e omocisteinemia in emodiafiltrazione on-line.

PURPOSE: In renal disease therapy (RDT) patients, high plasma homocysteine (tHcy) is common and high C-reactive protein(CRP) levels can be observed, attributed to the inflammatory process caused by the dialysis itself. Hyperhomocysteinemia and bioincompatibility are considered independent vascular risk factors. This study evaluated the behavior of these parameters in patients undergoing on-line hemodiafiltration (OL-HDF). METHODS: In 56 patients, HDF was performed using high permeability polyamide membranes, exchanging in the post-dilution mode 16-18 L/session of a reinfusate obtained by the on-line system (triple filtration AK200, Gambro). CRP was measured by an immunological method at the start and the end of the session in patients without comorbidities (group 1, n=30)and with inflammatory diseases (group 2, n=26). In 23 of the 56 patients, tHCY was measured (by high performance liquid chromatography (HPLC)) before and after the mid-week session on different schedule of folinic acid, vitamin B12 and vitamin B6. RESULTS: Pre-dialytic CRP was in the normal range in group 1 patients, whereas it was higher in group 2 patients; dialysis did not induce a significant change in either group. The intradialytic percentage tHcy decrease was approximately 50% regardless of the pre-dialytic value, which was significantly different according to the vitamin supplements administered. CONCLUSIONS: HDF, as performed in this study, demonstrated biocompatibility and efficient Hcy removal; therefore, it can prevent cardiovascular disease (CVD) in patients on regular extracorporeal dialysis.

[Plasma levels of homocysteine in patients on hemodiafiltration]. / Livelli plasmatici di omocisteina in pazienti in emodiafiltrazione.

BACKGROUND: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases, and is a common finding in patients on regular dialysis treatment. Hemodialysis lowers homocysteine plasma levels in variable amounts, and it was also suggested that folic acid and vitamin B12 supplements can reduce such levels. The purpose of the present study was to evaluate homocysteine plasma levels in patients on hemodiafiltration who received vit. B12 and folate supplements such as to keep their plasma levels in the normal range. METHODS: A retrospective study was carried out in a group of 36 patients on hemodiafiltration, who received routinely folate and vit. B12 supplements i.v. Pre-dialysis plasma levels of folate and vit. B12 and pre-postdialysis homocysteine concentration were evaluated. The latter was correlated with other parameters. RESULTS: The present study confirmed high homocysteine levels in patients on RDT and their reduction due to dialysis, demonstrated a weak negative correlation of pre-dialysis homocysteine with vit. B12 plasma level, but no correlation with folic acid. CONCLUSIONS: This study showed a good efficiency of hemodiafiltration using high permeability membranes on homocysteine removal, whereas the negative correlation between folate and homocysteine plasma level was not confirmed.

Prevalence and risk factors for micro- and macroalbuminuria in an Italian population-based cohort of NIDDM subjects.

OBJECTIVE: To determine the prevalence of micro- and macroalbuminuria in NIDDM and their relationship with some known and putative risk factors. RESEARCH DESIGN AND METHODS: Out of a population-based cohort of 1,967 NIDDM subjects, 1,574 were investigated (80%). Albumin excretion rate (AER) was evaluated on an overnight urine collection, and plasma and urine determinations were centralized. RESULTS: The prevalences of microalbuminuria (AER 20-200 micrograms/min), macroalbuminuria (AER > 200 micrograms/min), and hypertension were 32.1% (95% CI 29.8-34.4), 17.6% (15.7-19.5), and 67% (64.6-69.3), respectively. Apart from prevalence of hypertension, which after adjustment for age, BMI, and duration of diabetes was 2.3 times higher in women, rates were higher in men (odds ratio [OR] 1.31, 95% CI 1.04-1.66 for microalbuminuria and OR 1.63, 1.22-2.17 for macroalbuminuria). In comparison with normoalbuminuric subjects, both micro- and macroalbuminuric diabetic subjects had significantly longer duration of diabetes, higher levels of systolic blood pressure, fasting plasma glucose, HbA1c, triglycerides, and uric acid; in macroalbuminuric subjects only, levels of apolipoprotein B and HDL cholesterol were, respectively, higher and lower than in normo- and microalbuminuric subjects. In logistic regression, variables independently related to both micro- and macroalbuminuria were age, HbA1c, cigarette smoking habits, plasma uric acid, and diastolic blood pressure, after adjustment for plasma creatinine and diabetic treatment. In addition, duration of diabetes and HDL cholesterol levels were associated with macroalbuminuria. CONCLUSIONS: This population-based study showed high prevalence of micro- and macroalbuminuria in NIDDM subjects, who were characterized by a more adverse pattern of cardiovascular risk factors.

Calcitriol pulse therapy for severe hyperparathyroidism or calcium salts as phosphate binders in renal dialysis patients?

The concurrent use of calcitriol (CAL) pulse therapy to reduce parathyroid hormone (PTH) secretion and of calcium (Ca) salts as the most appropriate phosphate binders was evaluated for over 1 year in a group of 14 patients with good divalent ion control on CaCO3 therapy but with increasing levels of serum intact PTH. CAL pulse therapy was effective and safe in only 2 patients; in the remaining subjects it resulted in hypercalcemia and/or hyperphosphatemia, not reversed by adjusting the dialysate Ca concentration and or CaCO3 dose, and had to be stopped. Therefore, CAL pulse therapy does not seem to be compatible with Ca salts which, in our opinion, deserve priority in the therapy of renal dialysis patients.

[In vitro activity of netilmicin compared to the activity of other antibiotics against strains of urinary enterobacteria]. / Attività "in vitro" della Netilmicina a confronto con quella di altri antibiotici verso stipiti di enterobatteri urinari.

The in vitro susceptibility of 50 Gram-negative bacterial strains isolated from the urine was tested. Excluding Amikacin, Netilmicin was found to be the most effective antibiotic against the isolated bacterial complex.

[Variations in prolactinemia in 26 uremic subjects treated by periodic hemodialysis]. / Variazione della prolattinemia in 26 soggetti uremici in trattamento emodialitico periodico.

Prolactin level, creatinine, urea nitrogen and plasmatic natrium were evaluated in 26 uremic patients undergoing regular haemodialytic treatment. Prolactin level was found to be over normal range in 60% of the female patients and in 12.5% of the male patients. There was no correlation between prolactin, creatinine, urea nitrogen and natrium levels. No significant variations of the prolactin level were evident after a single haemodialytic treatment.

[Serologic methods in the diagnosis of toxoplasmosis]. / Considerazioni su alcuni metodi sierologici per la diagnosi della toxoplasmosi.

The data revealed on the same subject by the indirect agglutination test and the immunoenzyme test for IgG and IgM anti-toxoplasma antibodies were compared. The analysis shows that neither the indirect agglutination test nor the antibody count is sufficient for the diagnosis of the disease and that both are more appropriately employed in statistical epidemiological surveys.

[Comparative study of the drug resistance of strains of enterobacteria isolated from hospitalized and ambulatory patients]. / Studio comparativo della farmaco-resistenza di stipiti di enterobatteri isolati da pazienti ospedalizzati e ambulatoriali.

The Kirby-Bauer technique was employed in an assessment of the in vitro resistance to 8 antibiotics of 166 Enterobacteriaceae strains, isolated during routine diagnostic operations from various biological materials derived from wards, and from hospital out-patients. Their chemoresistance characteristics were also examined. It was found that Proteus strains from in-patients were more resistant to some antibiotics than those from out-patients. E. coli strains from in-patients were more frequently resistant to gentamycin.